Congenital anomalies in a tertiary care hospital in North East region, India

Background: Congenital anomalies are important cause of morbidity and mortality in newborns and are defined as structural and functional abnormalities including metabolic disorders present at birth. These defects are of prenatal origin resulting from defective embryogenesis or intrinsic abnormalities in the process of development and are associated with various risk factors.Methods: Our study is a cross sectional study done at Regional Institute of Medical Sciences, Imphal over period of 3 years from January 2015 to December 2017. Aim of study was to find out incidence of congenital anomalies and proportions of different types of congenital anomalies. Outcome was studied in relation to maternal age, religion, parity, and gestational age, sex of the baby, outcome and sex of the baby.Results: Total numbers of congenital anomalies were 257 babies out of 29879 births giving the incidence of 0.86%. Most common congenital anomalies in this study are musculoskeletal followed by craniospinal, genitourinary, cardiovascular and gastrointestinal. It was more common in preterm babies and parity 1-3, more common in 21-30 years of maternal age. Consanguinity was seen in 7 out of 257 patients.Conclusions: Congenital malformations are a major cause of still births and infant mortality. Targeted scan should be done at 18-20 week to find out anomalies and reduce the prevalence. There should be widespread education in the community regarding the common congenital malformations, their outcomes and possible available mode of treatmen

A woman presenting with postabortal pyomyoma and treated with exploratory laparotomy with myomectomy and fistulectomy: a case report

Pyomyoma (suppurative leiomyoma of the uterus) is a rare condition resulting from infarction and infection of a leiomyoma. It is more usual in pregnant women or postmenopausal women who have vascular disease. The condition is usually fatal unless treated with appropriate antibiotics and surgical intervention. We report a case of a 42-year-old woman who presented with abdominal pain and lump abdomen for 6 months with fever over a period of one month with anaemia for which she was readmitted. She had a history of incomplete abortion with fibroid with red degeneration for which check evacuation was done one and half months before readmission. During the course of treatment in hospital she developed an umbilical fistula with continuous drainage of pus. Her clinical presentation proved to be a diagnostic dilemma mimicking other clinical entities including Tuberculosis and ovarian cancer. Her blood culture and urine culture were sterile. She was widal (dilution) positive and Mantoux negative. Her pus culture from umbilical wound and vaginal swab culture revealed growth of E- coli sensitive to gentamicin and amoxicillin clavulanic acid. An ultrasound scan suggested uterine fibroid with mixed echogenic collection in pelvic cavity with fistulous communication to the umbilicus, but a Magnetic resonance imaging scan suggested a big mass that appeared heterogeneous with fluid filled areas in posterior wall. She was treated with several courses of antibiotics and finally had to undergo laparotomy. During laparotomy, it was found that a large pyomyoma came into view which was successfully removed followed by fistulectomy by surgeon. The patient had uneventful recovery till discharge from hospital. The diagnosis of pyomyoma should be considered in perimenopausal women with large fibroids and pyrexia of unknown origin

Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality

Fetomaternal outcome in eclampsia

Background: Eclampsia is the third most common cause of maternal mortality, after haemorrhage and infection in the developing countries. Majority of cases of eclampsia are young primigravidas. The reduction in both maternal and perinatal morbidity and mortality remains the yard stick of success in the management of eclampsia.Methods: A hospital based analytical cross-sectional study was conducted among the pregnant women with eclampsia admitted in the department of Obstetrics and Gynecology in Regional Institute of Medical Sciences, Imphal. The study was conducted for a period of one and half years from September 2018 to March 2020.Results: Fifty-five (55) patients in the age group between 21 and 25 years constitute the maximum percentage of eclampsia (67.3%). Forty-five (81.8%) cases were antepartum eclampsia, 2 (3.6%) were intrapartum eclampsia and 8 (14.5%) cases were postpartum eclampsia. Majority (78.2%) of the cases were primigravidae, which is comparable to other studies. As much as 23 (41.8%) of the cases presented at 32-37 weeks period of gestation. There were two maternal deaths (3.6%) due to eclampsia related complications. There were 13 (21.7%) perinatal deaths in this study, out of which 10 (16.7%) were still births and 3(5%) were early neonatal deaths.Conclusions: Eclampsia is still an important obstetric emergency in the community contributing to significant maternal and perinatal morbidity and mortality. Eclampsia may not develop de novo and as such, it is not always a preventable condition. Early detection and prompt intervention of complications is vital to ensure a healthy outcome for both mother and baby

An Analysis of the Impact of Boko Haram insurgents on Business Entrepreneurship Environment in Nigeria

This paper will examine the impact of boko haram on business entrepreneurship environment in Nigeria. Since the emergence of the group in 2002, the business environment has not been conducive for business related activities due to bombings and attacks on the people. An exploratory method of data collection was carried out using secondary data such as news papers, journals and online information. the findings revealed that businesses no longer takes place in the affected areas such as the northeast part of Nigeria because markets were closed, banking services not rendered or hours of services reduced. The paper then recommends that the source of income; training; and supply of weapons to Boko Haram be blocked by the Nigerian government and also engage in human security such as job creation; and provision of infrastructural facilities so as to combat the activities of the sect and thereby creating enabling environment for business and entrepreneurship to flourish. DOI: 10.5901/ajis.2015.v4n3p3

Bluetooth Remote Home Automation System Using Android Application

This paper presents the overall design of Home Automation System (HAS) with low cost and wireless remote control. This system is designed to assist and provide support in order to fulfill the needs of elderly and disabled in home. Also, the smart home concept in the system improves the standard living at home. The main control system implements wireless Bluetooth technology to provide remote access from PC/laptop or smart phone. The design remains the existing electrical switches and provides more safety control on the switches with low voltage activating method. The switches status is synchronized in all the control system whereby every user interface indicates the real time existing switches status. The system intended to control electrical appliances and devices in house with relatively low cost design, user-friendly interface and ease of installation

Molecular Landscape of the Ribosome Pre-initiation Complex during mRNA Scanning: Structural Role for eIF3c and Its Control by eIF5

Citation: Obayashi, E., Luna, R. E., Nagata, T., Martin-Marcos, P., Hiraishi, H., Singh, C. R., . . . Asano, K. (2017). Molecular Landscape of the Ribosome Pre-initiation Complex during mRNA Scanning: Structural Role for eIF3c and Its Control by eIF5. Cell Reports, 18(11), 2651-2663. doi:10.1016/j.celrep.2017.02.052During eukaryotic translation initiation, eIF3 binds the solvent-accessible side of the 40S ribosome and recruits the gate-keeper protein eIF1 and eIF5 to the decoding center. This is largely mediated by the N-terminal domain (NTD) of eIF3c, which can be divided into three parts: 3c0, 3c1, and 3c2. The N-terminal part, 3c0, binds eIF5 strongly but only weakly to the ribosome-binding surface of eIF1, whereas 3c1 and 3c2 form a stoichiometric complex with eIF1. 3c1 contacts eIF1 through Arg-53 and Leu-96, while 3c2 faces 40S protein uS15/S13, to anchor eIF1 to the scanning pre-initiation complex (PIC). We propose that the 3c0:eIF1 interaction diminishes eIF1 binding to the 40S, whereas 3c0:eIF5 interaction stabilizes the scanning PIC by precluding this inhibitory interaction. Upon start codon recognition, interactions involving eIF5, and ultimately 3c0:eIF1 association, facilitate eIF1 release. Our results reveal intricate molecular interactions within the PIC, programmed for rapid scanning-arrest at the start codon

Implementation of Multigene Germline and Parallel Somatic Genetic Testing in Epithelial Ovarian Cancer: SIGNPOST Study

We present findings of a cancer multidisciplinary-team (MDT) coordinated mainstreaming pathway of unselected 5-panel germline BRCA1/BRCA2/RAD51C/RAD51D/BRIP1 and parallel somatic BRCA1/BRCA2 testing in all women with epithelial-OC and highlight the discordance between germline and somatic testing strategies across two cancer centres. Patients were counselled and consented by a cancer MDT member. The uptake of parallel multi-gene germline and somatic testing was 97.7%. Counselling by clinical-nurse-specialist more frequently needed >1 consultation (53.6% (30/56)) compared to a medical (15.0% (21/137)) or surgical oncologist (15.3% (17/110)) (p 0.001). The median age was 54 (IQR = 51–62) years in germline pathogenic-variant (PV) versus 61 (IQR = 51–71) in BRCA wild-type (p = 0.001). There was no significant difference in distribution of PVs by ethnicity, stage, surgery timing or resection status. A total of 15.5% germline and 7.8% somatic BRCA1/BRCA2 PVs were identified. A total of 2.3% patients had RAD51C/RAD51D/BRIP1 PVs. A total of 11% germline PVs were large-genomic-rearrangements and missed by somatic testing. A total of 20% germline PVs are missed by somatic first BRCA-testing approach and 55.6% germline PVs missed by family history ascertainment. The somatic testing failure rate is higher (23%) for patients undergoing diagnostic biopsies. Our findings favour a prospective parallel somatic and germline panel testing approach as a clinically efficient strategy to maximise variant identification. UK Genomics test-directory criteria should be expanded to include a panel of OC genes.Peer reviewe