A clinical study of effect of standard labour protocols on rates of primary caesarean section at a tertiary care centre, Madurai, India

Background: Caesarean section rates are on the rise all over the world. Primary caesarean section usually determines the future obstetric course of any woman and therefore should be avoided whenever possible. WHO recommended that caesarean rates should not be more than 15 %. In this view we started our study on how to reduce the rate of Primary caesarean section in Tertiary Care Centre, Madurai, India. The objective of the present study was to evaluate how the implementation of universally acceptable standards affects rates of primary caesarean section rates without compromising maternal and foetal safetyMethods: This a comparative study on the effect of standard labour protocols and guidelines devised after audit of cases from January 2017 to June 2017, on the rate of primary caesarean section rates, induction of labour, failed induction, maternal and fetal outcomes before and after the implementation of the guidelines.Results: Primary caesarean section rates from 52.85% to 45.02% noted in the induced cases. There were no significant adverse maternal and perinatal outcomes.Conclusions: Implementation of standard labour protocols can reduce primary caesarean section rate without compromising maternal or foetal safety

Comparison of one step glucose tolerance test (75 g GTT) and two step glucose tolerance test (100 g GTT) in screening and diagnosis of gestational diabetes mellitus

Background: Studies suggesting that increasing carbohydrate intolerance among patients not meeting the criteria for the diagnosis of GDM by two step OGTT leads to an increased rate of unfavourable maternal and perinatal outcomes. Patients with abnormal GCT results but a normal OGTT are at increased risk, as are those with one abnormal OGTT value rather than the two required for diagnosis by ADA criteria. Single value of one step GTT is enough to diagnose GDM and to improve the maternal and perinatal complications. The objective is to compare the efficacy of one step OGTT with two step OGTT in screening and diagnosis of gestational diabetes mellitus.Methods: Hospital based analytical cross-sectional study which was conducted for 1 year among all pregnant women booked at government medical college, Alappuzha. They were subjected to detect GDM by 2 methods at 24-28 weeks.Results: 2521 pregnant women were subjected for study, among them who were either 75 gm GTT or 50 gm GCT or both positive (332 pregnant women) were analyzed. 232 women (69.88%) were diagnosed as having gestational diabetes mellitus (GDM) by single step 75 gm GTT. Sensitivity of single step GTT was 92.4% and a false negative rate of the same was 7.6%.  False negative rate for 50 gm GCT was 35.2%.Conclusions: Present study concluded that this one step procedure is feasible in terms of better detection rates, saving time, limiting cost on repeated visits to health centre and reducing repeated invasive sampling. Single step GTT will be used both as a screening and a diagnostic procedure for detecting GDM

Anti-inflammatory and ulcerogenic activities of thiazolidine-4-ones in rats

Background: NSAIDS are associated with side effects and research should continue for developing safer drugs. This study aims to evaluate newer thiazolidine-4-ones for their anti-inflammatory and ulcerogenic activities in wister rats.Methods: Five groups of wister rats, 6 in each were used.  Anti-inflammatory and ulcerogenic activities of diclofenac (30mg/kg), nimesulide (50mg/kg), thia-1 (50mg/kg) and thia-2 (50mg/kg) are compared with control group (4% Gum Acacia). Carrageenin-induced paw edema, formaline induced acute peritonitis and cotton pellet-induced granulomatous tissue formation models were used for evaluating anti-inflammatory activity. After removing cotton pellets with granuloma on 8th day gastric ulcerogenicity was assessed by using macroscopic and microscopic scoring of ulcers.Results: Diclofenac, nimesulide and thia 2 reduced both paw edema and peritoneal exudate volume significantly (p 0.05). Nimesulide, thia-1 and thia-2 did not increase gastric ulcer score significantly (p >0.05). Diclofenac increased ulcer score significantly (p <0.01).Conclusions: Thia-2 demonstrated significant anti-inflammatory activity in acute and chronic models. In addition to inhibition of cyclooxygenase pathway, PPAR agonistic activity may be involved in its anti-inflammatory activity.  No significant ulcerogenicity was observed on comparing with nimesulide and control. Further in-vitro and in-vivo studies are recommended to confirm the results of this study

Analysis of cutaneous adverse drug reactions in a tertiary care teaching hospital

Background: Cutaneous Adverse Drug Reaction (CADR) is considered as one of the reasons for discontinuation of drug as well as medication non-adherence. This study analyses the common drugs causing CADR, clinical spectrum of different types of CADR, causality and drugs causing severe CADR.Methods: This was a retrospective cross-sectional observational study conducted by the Department of Pharmacology, Coimbatore Medical College, Coimbatore, Tamil Nadu, India. The study was conducted using data collected in CDSCO’s ADR reporting forms with CADR from June 2015 to July 2017. Patient’s information, details related to adverse drug reaction, suspected medication details, concomitant medication history, causality and seriousness were recorded.Results: A total of 102 CADR were evaluated in this study. The mean age of sample was 37.21±20.33 years. Maximum number of cases was in the age group of 40-49 years. Male to female ratio was 0.96:1. The commonly incriminated drugs causing CADR were antimicrobial agents. Ciprofloxacin (21.57%), phenytoin (9.8%), diclofenac sodium (6.86%), anti-snake venom (6.86%) and vancomycin (3.92%) were the common drugs implicated in CADR. Maculopapular rash and itching were the most common CADR. Anticonvulsants especially phenytoin was commonly associated with severe CADR.Conclusions: The present study has made an impact on all departments of this institution and awareness has been created about spontaneous reporting of all adverse drug reactions in CDSCO ADR reporting forms to the pharmacovigilance centres. Thus, sound knowledge about the adverse drug reactions may decrease the occurrence of drug induced morbidity and mortality.

Sustainable Management Practices: Trends, Issues and Challenges

Sustainability is the ability to endure and survive in an environment for a long time. In business parlance, sustainable management is incorporation of social, economic and environmental factors for business decisions. Incorporating these factors in decision making process of a business helps in identifying and avoiding future costs associated with unsustainable business practices, planning for changes in consumer expectations to capitalize on emerging markets and industries and practicing corporate social responsibility and business ethics. Sustainable Management practices in business prove to be more profitable as they tend to adapt and grow with the changing market, providing a competitive advantage over other firms. This also helps in gaining significance as socially responsible business by reducing the negative impact on society and increasing their positive influence. The focus on sustainable management has gained a new momentum since the market pressure from regulators and consumers holds organizations accountable for their actions. Failure on the part of business to adopt such practices can have a catastrophic impact on the viability of a business. In a global environment, it is increasingly difficult to succeed in any business without understanding the repercussions of business realities and developments. This book, "Sustainable Management Practices" provides an insight into recent trends, issues and challenges in business practices by focusing on Corporate Governance, Corporate Social Responsibility, Information Technology, E- tailing, Entrepreneurship, Total Quality Management, Employee Engagement and Organizational Performance is intended to help the readers in understanding the sustainable management practices of business

Near ω-continuous multifunctions on bitopological spaces

In this paper, we introduce and study basic characterizations, several properties of upper (lower) nearly (i; j)-!-continuous multifunctions on bitopological space

The prayer room :a novel, and, The salt of another earth : a critical study of food and culinary practice in Indian-American narratives of the immigrant experience

PhD ThesisThis dissertation examines, creatively and critically, the role of gastronomy in Indian- American literature. The creative element consists of a novel entitled The Prayer Room. The critical component is titled The Salt of Another Earth: The Role of Food and Culinary Practice in the Indian-American Narrative of the Immigrant Experience. The Prayer Room tells the story of a married couple, George and Viji Armitage, both immigrants to Sacramento, California, individually tracing each protagonist’s immigrant experience. George, a native of Nottingham, finds himself in an anti-climactic version of the America he once idolised, and grows increasingly lackadaisical in his professional and personal lives. Viji, a Tamil Hindu, struggles to gain control over her domestic realm, and makes a personal refuge of her prayer room. Here, she displays pictures and statues of Hindu deities, and portraits of deceased loved ones. She compartmentalises her past successfully enough to manage her present, until the arrival of her English father-in-law, Stan Armitage. Stan’s presence challenges the integrity both of George and Viji’s marriage, and of their decision to migrate. The critical portion of this thesis analyses, alongside The Prayer Room, two immigrant-centred novels by Indian authors: Bharati Mukherjee’s Jasmine and Anita Desai’s Fasting, Feasting. Each novel features an Indian immigrant protagonist who leaves a native collective for life in the United States and, in the process, experiences a rebirth of the individualism which their collectives have silenced. This reawakening is reflected by each author’s treatment of culinary preparation and consumption. The Prayer Room’s culinary practice provides distinct commentary on the immigrant experience, but has been influenced by its literary predecessors. The aim of this dissertation is to explore how the commonality and divergence of culinary incidence in the three chosen texts reflect upon the nature of the Indian immigrant experience

Prevalence of back-pain following caesarean section under spinal anesthesia

Back pain following a caesarean section is a typical complaint. It has been statistically proven that more than 70% of cases, or 7 out of 10 women who give birth, endure back pain. If it is not treated at the appropriate time and with adequate measurement, the back pain may worsen in the future. A systematic literature search was performed to determine the prevalence and factors associated with back pain among patients undergoing spinal anesthesia. Many studies have attempted to determine risk factors for back pain after birth in different populations, using different methods and outcome variables. Data were collected from PubMed, Google scholar and the medicine and nursing database. Back pain that persists after a caesarean delivery is brought on by a number of circumstances. Post-partum back pain is linked to a history involving pre- and post-pregnancy back pain, obesity, bad posture while nursing, sitting, walking, and standing are the contributing factors. The study results show that by maintaining posture correction, yoga, meditation, lumbar support, rest and massage helps to alleviate post anesthetic back pain. This study confirms that the overall incidence of back pain is high in comparison to the majority of studies. The severity of back pain caused by spinal anesthesia is highly connected to the size of the spinal needle, body mass index, and number of attempts, body posture and number of bone contacts

A cross sectional study of prevalence of depression among patients with cerebrovascular accident

Background: Depression is one of the most common neuropsychiatric condition in patients with stroke. Early identification of depression for stroke patients can improve the outcome leading to better quality of life. Prevalence and determinants of post stroke depression are highly variable and there is paucity of data in Indian literature.Methods: This cross-sectional study was conducted at neurology department of Saveetha Medical College, Chennai. All patients with history of stroke within past one month attending neurology department who fulfilled the inclusion criteria were taken up for the study after getting consent. Neurological examination and CT brain findings were noted with the site of lesion. All patients were evaluated for depression using ICD 10 criteria. MADRS score was used to assess the severity of depression. Chi square was used for statistical analysis.Results: The mean age of subjects in the study was 56.54±10.82 years. The prevalence of depression among patients with stroke in our study was 75.8%. Among classifying those with depression based on severity using MADRS score, 35% had mild depression and 65% had moderate depression. There was no severe depression in our sample. There was no statistically significant difference between prevalence of depression based on side of lesion.Conclusions: In this study the prevalence of depression among patients with cerebrovascular accident was found to be 75.8%. From this study we learn that the prevalence of depression in patients with stroke is high and this shows that regular screening of patients with stroke for depression might help in earlier detection and management of depression

The construction of cultural identity : Malaysian Indian youth reading the Indian Tamil Television Serial, Chitthia / N. V. Prasad and Shanthi Balraj

In this era of globalization, television artifacts from the cultural homeland have been studied in diverse diasporic settings for their socio cultural implications. In the Malaysian context, Tamil television programmes have not been the subject of intense scholarly debates on topics ranging from their ability to provide a source of cultural knowledge and identity to the Indians. The present study explores an area of diasporic communication in the context of Malaysian Tamil television audience's negotiations of cultural identity. The study will focus on the role of television in the lives of Indian youth in Malaysia by studying how they read the construction of family in the serial CHITTHIA, a popular Indian Tamil television serial that was broadcasted by Astro Vaanavil. Specifically, it examines youth readings of the constructions of thematic content and characterization pertaining to the following themes in CHITTHIA: marriage, remarriage, sibling rivalry and gender. The study finds that the youths could identify with the characters and narratives created in this serial and that they shared similar experiences in Malaysia and this has drawn them to the programme, even though it was produced in India