Outcome of expectantly managed small-for-gestational-age pregnancies with normal Doppler parameters- a prospective cohort study

Background: SGA foetuses with normal Dopplers are not at risk of IUD. However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.Methods: We followed up women with clinically suspected growth restriction with foetal biometry, Doppler and biophysical profile. Pregnancies with foetal AC between 10th to 3rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labor till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks.Results: Spontaneous labor occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57±0.71 versus 37.0±0.0, p value <0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% versus 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 versus 1/36).The mean birth weight in the study group was higher (2426.5±154.1 gm versus 2297.9±101.4 gm, p value <0.001.Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birth weight and a significant reduction in caesarean section rate.

Under pressure: a psychophysiological analysis of the effect of temporal constraints on information processing and decision making

In recent times, decision making under time pressure has become more common than ever and hence, it has become a hot topic for behavioral researchers. This research studies the effects of temporal constraints on users\u27 decision quality and decision strategy. The paper primarily addresses two research questions: (i) Does time pressure affect decision quality? (ii) Does time pressure affect decision strategy? The decision accuracy and decision strategy of the participants were measured for three time-pressure conditions namely, No time pressure, Reasonable time pressure and Extreme time pressure. Research results from the past revealed that, Cognitive style is also observed to have an impact on decision quality under time pressure and thus, has also been introduced as a moderating variable to study the interaction effect. Physiological responses from users when subjected to time pressure have also been studied. The task instrument used to study the decision making behavior of users was a financial dashboard which consisted of financial information of three companies and the participants were asked to rank-order the companies in the order of their performance. Eye tracking was used to gauge the decision strategy. Electro-dermal activity, which is a measure of stress, was measured using a device called Q sensor. A pilot study was conducted with 20 participants to determine time pressure thresholds for the reasonable time pressure and extreme time pressure conditions. In the experiment phase, 20 users each were subject to reasonable and extreme time pressure conditions individually and were asked to provide their responses to a survey based on the task provided to them. Eye tracking and Q sensor results were also collected for all participants. Statistical analysis performed on the responses from the survey revealed that the decision quality increased as time pressure increased. Also, a majority of the users subject to time pressure adopted a non-compensatory decision strategy for making their decision. The fit between cognitive style and decision strategy was observed to have a significant effect on decision quality. It was also found that the analytical users performed better than the intuitive users under no time pressure. Statistical analysis performed on physiological responses revealed that stress experienced increased as time pressure induced on a participant increased --Abstract, page iii

Antibiotic prophylaxis in cesarean sections: a tertiary care hospital based survey

Background: The objective of the study was to study the pattern of prophylactic antibiotics usage in caesarean sections in Indian settings.Methods: A cross-sectional observational study was done on women undergoing elective and emergency caesarean sections in the Department of obstetrics and gynecology who were given antibiotics according to the existing trends in the hospital.Results: Almost 72% women received prophylactic antibiotics within 30-60 minutes of skin incision while rest 28% received it before 60 minutes. In post-operative period around 80% of the women received injectable antibiotics for 48 hours, 12% for 72 hours and rest 8% received antibiotics for more than 72 hours. 90% of the patients received injections ceftriaxone 1 gm IV BD, gentamycin 80 mg IV BD metronidazole 400 mg iv TDS while 10% received injection Ampicillin 500 mg QID along with Injection Metronidazole 400 mg iv TDS and injection gentamycin 80 mg IV BD. Two percent of the cases developed wound sepsis and required change to higher antibiotics.Conclusions: In spite of recommendations by International Guidelines for single dose of prophylactic antibiotics, multiple doses are being given. There are no Indian guidelines for antibiotic prophylaxis in cesarean sections and as a result, various combinations of antibiotics are being given for variable duration leading to antibiotic resistance and increased cost of treatment

Identifying a Ranking of Plant Preferences for a Pollinator

Pollinators are an integral part of agriculture and the ecosystem. However, due to changing land use, populations of wild pollinators are decreasing and plant distributions are changing all around the world. To understand how plant-pollinator networks will adapt over time, we would like to understand how pollinators choose flowers to visit. We will model a pollinator’s interaction with plant species in two ways: first using a probabilistic multinomial approach to fit a preference score to each plant and second to explain our findings from the multinomial model using the traits of the flowers themselves. Our findings show that a model with preferences performs better than a model which does not have preferences. While this model shows potential in finding plant preferences, it does not fully explain the distribution of plant-pollinator interactions. To try to explain the interactions more fully, we incorporated the traits of the plants into the score of the plant. We found that the traits do have some effect on the score of the plant, but again do not fully explain the interactions in this particular model

Correlation of maternal age and combined assessments on risk of chromosomal anomaly during prenatal screening

Background: Prenatal detection of genetic abnormalities is one of the biggest challenges of current fetal medicine. Prenatal screening for chromosomal abnormalities can be done using biochemical tests. The screening is a risk estimation test and not a diagnostic test. Methods: Statistical data treatment had been performed on a sample of 362 pregnant women for prenatal screening. This was a retrospective data analysis study undertaken at the National Reference Laboratory, Redcliffe Labs. Results: Nine (2.48%) women out of 362 were screen positive for chromosomopathy. The point biserial correlation between variables (Free β-hCG - Free Beta Human Chorionic Gonadotrophin, PAPP-A- pregnancy associated plasma protein-A and NT-(nuchal translucency) amongst patients with positive and negative screen test was statistically significant. There was a positive correlation between positive screen for chromosomopathy and hCG, MoM, NT MoM whereas a negative correlation between them and PAPP-A. This study indicates that higher values of hCG and lower values of PAPP-A MoM as seen in the positive screen patients is associated with a significant risk of chromosomopathy. A positive correlation between age and screen positive cases was seen. The McNemar’s test indicated a significant reduction in screen positive cases when biomarkers were added to screen for Trisomy 21 in women aged &gt;35 years (n=86). 81 women eventually screened negative. Conclusions: The analyses stresses on the importance of using state-of-the-art, prenatal noninvasive screening software to help provide a predictive outcome, individualized for that pregnant woman.

Case report on anti-tuberculosis drug-induced hepatitis and pancreatitis

Tuberculosis (TB) is a widespread infectious disease primarily impacting the lungs but with potential effects on various organs, such as bones, kidneys, and intestines. This case underscores a rare yet serious complication associated with anti-TB drug (ATD) treatment-the development of drug-induced acute pancreatitis. In this instance, a 65-year-old male undergoing ATD therapy exhibited symptoms including fever, vomiting, and fatigue. Despite receiving medical intervention, including intravenous antibiotics and hepatoprotective drugs, the patient's condition progressively worsened, ultimately resulting in a fatal outcome. This case emphasizes the crucial significance of early identification and effective management of such complications, highlighting the necessity for vigilant monitoring and regular assessment of liver function tests throughout ATD treatment

Comparison of CD3 and CD8 immunoscoring with histological grade of the tumor in urothelial carcinoma of bladder

Background: Inflammatory response within transitional cell carcinoma (TCC) bladder is known to be predictive of tumor prognosis. Lower scores are associated with worser outcome and vice versa. Simpler and cost-effective methods of immunoscoring using immunohistochemistry (IHC) have been described. This study uses two easily available T-cell markers CD3 and CD8 and compares their immunoscore with tumor grade and understands the association. Aims and Objectives: The aims of this study were as follows: (1) To perform immunoscoring for cytotoxic T lymphocytes -CD3+ and CD8+ lymphocytes in urothelial carcinoma and (2) to correlate the immunoscore with tumor grade and calculate its significance in predicting prognosis. Materials and Methods: A prospective cross-sectional study of 2 years duration from October 2018 to October 2020 was conducted at a tertiary level super specialty government institution. All the transurethral resection of bladder tissue biopsies reported as urothelial malignancies during the study period were included in the research. The tumors were graded histologically into high grade and low grade on histology based on the World Health Organization 2016 classification of Urothelial Carcinomas/International Society of Urological Pathology grading system. They were then subject to IHC with two T-cell markers CD3 and CD8 and immunoscoring was done using the method described by Galon. Results: A total of 42 cases of urothelial malignancies were diagnosed during the study period. Cases with higher tumor grade were 25 and lower tumor grade were 17. The association between the lower immunoscore and higher tumor grade was statistically significant. Conclusion: Immunoscoring is a useful adjunct to the routine histological evaluation of TCC. Easily available T-cell markers can be used as simple easy and cost-effective method for immunoscoring

Strategies to modulate charge variants of a Biosmilar monoclonal antibody through cell culture conditions

Monoclonal antibodies (mAb) are the most successful and rapidly growing class of biopharmaceuticals used in treating several diseases. Biosimilar mAb, an approved version of an original biological medicinal product (reference product) with demonstrated similarity to the reference in terms of critical quality attributes, safety and efficacy, is an increasingly accepted solution to provide greater access at affordable cost to the patients across the world. But, given the complex nature of mAbs, developing a biosimilar using a new cell line and a process is challenging, especially with regards to matching the glycosylation and charge profiles to the appropriate level. It is reported that culture environment during the production of monoclonal antibody affects its various quality attributes including charge variant profiles1. The charge variants are usually formed due to chemical modification of amino acids by deamidation, oxidation, glycation and methylglyoxal adducts2, and may lead to increase in acidic charge variants. These unintended changes in the protein are mainly due to it being exposed during the long duration of the cell culture to an environment, like elevated temperature, nutrients from media and feed, metabolites from live and lysed cells, culture pH, which favours certain chemical modifications. Understanding and controlling cell culture process parameters are vital in developing a protein biologic to ensure process consistency and product quality. In the present study, we discuss a case study of development of a cell culture process to produce a proposed biosimilar mAb using a CHO cell line, and ways to modulate its charge variants in the cell culture. The initial screening experiments were performed in an ambr® 15 cell culture micro bioreactor system, from which an optimal 12-day process was chosen and subsequently tested in 3L and 10L bioreactors. Significant time-dependent increase in acidic charge variants was observed from day 10 to 12 at both bioreactor scales, while all other quality parameters remained largely unchanged during the last days of the culture. Further various strategies such as use of different basal media, feed, and additives (amino acids/metal ions and insulin), and changes in culture temperature and pH, were applied during the cell culture process to control the charge variants, in particular the acidic charge variants. The impact of various additives, cell culture pH, temperature on the charge profiles, as well as on productivity and glycosylation, during the development of this biosimilar mAb using a CHO cell line is discussed in detail. References: Liu, H., Nowak, C., Shao, M., Ponniah, G. and Neill, A. (2016), Impact of cell culture on recombinant monoclonal antibody product heterogeneity. Biotechnol Progress, 32: 1103–1112. Chumsae, C., Gifford, K., Lian, W., Liu, H., Radziejewski, C. H., & Zhou, Z. S. (2013). Arginine modifications by methylglyoxal: discovery in a recombinant monoclonal antibody and contribution to acidic species. Analytical chemistry, 85(23), 11401-11409

Characterizing the normal proteome of human ciliary body

BACKGROUND: The ciliary body is the circumferential muscular tissue located just behind the iris in the anterior chamber of the eye. It plays a pivotal role in the production of aqueous humor, maintenance of the lens zonules and accommodation by changing the shape of the crystalline lens. The ciliary body is the major target of drugs against glaucoma as its inhibition leads to a drop in intraocular pressure. A molecular study of the ciliary body could provide a better understanding about the pathophysiological processes that occur in glaucoma. Thus far, no large-scale proteomic investigation has been reported for the human ciliary body. RESULTS: In this study, we have carried out an in-depth LC-MS/MS-based proteomic analysis of normal human ciliary body and have identified 2,815 proteins. We identified a number of proteins that were previously not described in the ciliary body including importin 5 (IPO5), atlastin-2 (ATL2), B-cell receptor associated protein 29 (BCAP29), basigin (BSG), calpain-1 (CAPN1), copine 6 (CPNE6), fibulin 1 (FBLN1) and galectin 1 (LGALS1). We compared the plasma proteome with the ciliary body proteome and found that the large majority of proteins in the ciliary body were also detectable in the plasma while 896 proteins were unique to the ciliary body. We also classified proteins using pathway enrichment analysis and found most of proteins associated with ubiquitin pathway, EIF2 signaling, glycolysis and gluconeogenesis. CONCLUSIONS: More than 95% of the identified proteins have not been previously described in the ciliary body proteome. This is the largest catalogue of proteins reported thus far in the ciliary body that should provide new insights into our understanding of the factors involved in maintaining the secretion of aqueous humor. The identification of these proteins will aid in understanding various eye diseases of the anterior segment such as glaucoma and presbyopia