Obstetric and perinatal outcomes of expectant management and immediate induction of labour in term premature rupture of membranes: promising outcomes from expectant management cohort

Background: Premature rupture of membranes (PROM) is common obstetric entity, the management even at term is controversial and there is no consensus for definite protocol of management. Objective of the present study is to compare the effectiveness, safety of expectant management of 24 hours and immediate induction with PGE2 gel in terms of maternal and fetal outcome in term PROM.Methods: 200 women were randomized to group A expectant management and group B immediate induction, after strict Inclusion and exclusion criteria. In expectant group waiting period was 24 hours. Multiple end points were examined throughout management. Chi square test and independent t tests were performed for statistical analysis. P value<0.05 was considered significant.Results: Demographic parameters of patients, maternal and gestational age were similar in both groups. Primigravidae were more in both groups A and B. Vaginal delivery rate is more in expectant group and Caesarean Section rate is high in immediate induction group. CS rate was 37% and 23% in group A and B respectively; the difference is statistically significant (p value=0.031). ‘ROM to delivery interval’ was more in group A (16.31±8.67 hrs and 13.85±5.46 hrs) (p value=0.0256). Hospital stay was comparatively more in group A (5.40±0.81 days and 4.11±0.86 days) (p value=0.435). Infective morbidity of mother and baby was low in both groups and no difference was seen.Conclusions: An expectant management allows a good number of women to go into labour and deliver vaginally without an increase in CS rate and infectious morbidity for mother and fetus

Efficient Model Checking of Hardware Using Conditioned Slicing

AbstractIn this work, we present an abstraction based property verification technique for hardware using conditioned slicing. We handle safety property specifications of the form G(antecedent⇒consequent). We use the antecedent of the properties to create our abstractions, Antecedent Conditioned Slices. We extend conditioned slicing to Hardware Description Languages (HDLs). We provide a theoretical foundation for our conditioned slicing based verification technique. We also present experimental results on the Verilog RTL implementation of the USB 2.0. We demonstrate very high performance gains achieved by our technique when compared to static program slicing, using state-of-the-art model checkers

Applicability of Two Universally Accepted Mixed Dentition Analysis on a Sample from Southeastern Region of Andhra Pradesh, India

Background: Most of the universally accepted mixed dentition analyses are based on the data derived from northwestern European descent. However, the accuracy of these methods when applied to different ethnic population is questionable. Aim: The present study is aimed to evaluate the applicability of Tanaka and Johnston (TJ) and Moyers (50th and 75th percentile) mixed dentition analysis in a sample from south‑eastern region of Andhra Pradesh, India. Subjects and Methods: Study models were prepared from a sample of 100 patients (50 males and 50 females) in the age range of 13‑15 years. The mesio‑distal dimension of the teeth was measured using a Digital Vernier calipers. The actual values of permanent canine and premolars on the casts were compared with the predicted values from TJ and Moyers analysis. The values derived from this study were statistically analyzed using SPSS version 17.0 (IBM, Chicago, USA). Pearson’s coefficients were used to evaluate the correlations between the groups of teeth. Results: Overestimated values were noticed in males and females of both arches with TJ equation; Males showed no significant difference at Moyers 50th percentile (50/100), in both the arches where as females showed higher values in mandibular arch and underestimated values in maxillary arch. At Moyers 75th percentile, overestimated values were noticed in males for both the arches whereas in females lesser values were observed. Conclusion: As the values showed significant deviation from TJ and Moyers both at 50 and 75 percentile, its applicability to the present population is limited. So, new regression equations were derived.Keywords: Mixed dentition analysis, Tanaka Johnston analysis, Moyers analysi

AN IN VITRO STUDY OF CINNAMOMUM ZEYLANICUM AS NATURAL INHIBITOR OF ANGIOTENSIN-CONVERTING ENZYME (ACE) ON SHEEP (OVIS ARIES) TISSUES

Objective: The present study was aimed to find the angiotensin-converting enzyme (ACE) inhibitory activity using the methanolic extract ofCinnamomum zeylanicum (as a natural inhibitor) on sheep tissues as the enzyme source.Methods: Hippuryl-histidyl-leucine (HHL) as a substrate, tissue ACE activity was measured spectrophotometrically at 228 nm. For an incubationperiod of 30 minutes at 37°C, the linearity of ACE activity of kidney, lung, and testis enzyme was established. A known medicinal plant C. zeylanicumwas used as natural inhibitor of ACE. In this enzyme assay, inhibitory effect of methanolic extract of C. zeylanicum on kidney, lung and testicular ACEwas determined. ACE activity was confirmed by captopril, a standard inhibitor of ACE.Results: In the presence of a methanolic extract of C. zeylanicum (10:1), ACE activity was determined and this has inhibited ACE activity verysignificantly. C. zeylanicum leaves extract has reduced sheep kidney, lung, and testis ACE activity by 70.06%, 12.63%, and 20.23%, respectively.Conclusion: Significant inhibition was observed in the kidney ACE than in lung and testis ACE activity. This can propose that there may be a possiblerole in controlling blood pressure or reduction in cardiovascular diseases. Some plants with the great medicinal property may be considered aspromising sources of natural inhibitors of ACE for medicine and commercial uses. This comprehensive study may show numerous beneficial effects asa potential therapeutic agent for lowering blood pressure.Keywords: Angiotensin-converting enzyme, Natural angiotensin-converting enzyme inhibitor, Kinetic assay, Hippuryl-histidyl-leucine, Cinnamomumzeylanicum, Cardiovascular diseases

Role of soluble, cell wall bound phenolics, tannin and flavonoid contents in maize resistance to pink stem borer Sesamia inferens Walker

The pink stem borer Sesamia inferens Walker is an important pest of winter maize which causes significant yieldlosses. In an attempt to identify the biochemical basis of resistance against S. inferens, total soluble phenolics, boundphenolics, cell wall-bound hydroxycinnamic acids-p-coumaric acid (p-CA), ferulic acid (FA), total tannin contentand total flavonoid contents, were measured in leaf at 10, 20 days after germination (DAG); stem at 20, 40 DAG;pith and rind tissues at 60 DAG (stem differentiated). From the present study, it was found that bound phenolics,p-CA, ferulic acid and total tannin contents contribute to the maize defense mechanism against S. inferens. Totalbound phenolic content showed negative correlation with Leaf Injury Rating (LIR). Highly significant strong positivecorrelation (+0.9750) was observed between LIR and total soluble phenolics in leaf tissue at 20 DAG. Similarlyhighly significant strong positive correlation between LIR and total tannins (+0.9354**) and flavonoids (+0.9582**)in pith at 60 DAG was observed. Further, a strong significant positive correlation was also observed between LIRand p-CA (+0.9199*) in pith at 60 DAG and total ferulic acid (+0.9051*) in rind at 60 DAG. The significant strong negativecorrelation between LIR and p-CA (-0.8441*) in stem at 40 DAG was observed. The total bound phenolicsin rind at 60 DAG (0.756), in leaf at 20 DAG (0.681), and total soluble phenolics in the stem at 20 DAG (0.685) showedhigher loadings with PC1, PC2, and PC3, respectively. Genotype-by-biochemical factor biplot showed that thedata of biochemical parameters measured in different tissues and stages could be able to group the genotypesaccording to their reaction to S. inferens

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the expert panel

Background: The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence.Methods: An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review\u27s findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health).Results: The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence-based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached.Conclusions: Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence-based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs

Lost in Translation: No Effect of a High‐Profile Publication on the Concomitant Use of Interacting Drugs

Abstract We sought to assess whether a high‐profile publication that demonstrated serious clinical consequences of specific drug‐drug interactions (DDIs) reduced the concomitant use of those drugs. We conducted a quasi‐experimental study using 2000–2008 prescription claims from a commercial health insurer to examine trends in the dispensing of the interacting drug pairs (angiotensin‐converting enzyme inhibitors[ACEI] + potassium‐sparing diuretic, digoxin + clarithromycin, and glyburide + cotrimoxazole) and control drug pairs previously reported in a top‐tier general medicine journal. We examined prepublication and postpublication dispensing trends using Poisson regression. ACEI + potassium‐sparing diuretic use did not differ postpublication vs. prepublication (P = 0.11). Digoxin + clarithromycin use decreased minimally postpublication vs. prepublication (relative rate = 0.9996: 95% confidence interval [CI] = 0.9993–0.9998). Glyburide + cotrimoxazole use increased minimally postpublication vs. prepublication (relative rate = 1.0220; 95% CI = 1.0187–1.0254). Therefore, the high‐profile DDI publication had minimal to no measurable effect in reducing the concomitant use of the interacting drugs studied. We believe that better strategies are needed to translate knowledge about DDIs into clinical practice

Auto-validation of fluorescent primer extension genotyping assay using signal clustering and neural networks

BACKGROUND: SNP genotyping typically incorporates a review step to ensure that the genotype calls for a particular SNP are correct. For high-throughput genotyping, such as that provided by the GenomeLab SNPstream(® )instrument from Beckman Coulter, Inc., the manual review used for low-volume genotyping becomes a major bottleneck. The work reported here describes the application of a neural network to automate the review of results. RESULTS: We describe an approach to reviewing the quality of primer extension 2-color fluorescent reactions by clustering optical signals obtained from multiple samples and a single reaction set-up. The method evaluates the quality of the signal clusters from the genotyping results. We developed 64 scores to measure the geometry and position of the signal clusters. The expected signal distribution was represented by a distribution of a 64-component parametric vector obtained by training the two-layer neural network onto a set of 10,968 manually reviewed 2D plots containing the signal clusters. CONCLUSION: The neural network approach described in this paper may be used with results from the GenomeLab SNPstream instrument for high-throughput SNP genotyping. The overall correlation with manual revision was 0.844. The approach can be applied to a quality review of results from other high-throughput fluorescent-based biochemical assays in a high-throughput mode