Role of echocardiography for assessment of cardiovascular haemodynamics during pregnancy

Background: Pregnancy is associated with volume overload producing significant vascular and hemodynamic adaptations in cardiovascular physiology. Present study was designed to follow up gradual adaptations in cardiovascular hemodynamics during the course of pregnancy using Doppler echocardiography which is reproducible and noninvasive technique.Methods: In present prospective study of 50 women, were divided into 2 groups of 25 each: control group & study group (pregnant patient in I trimester, II trimester & III trimester). They were non-invasively analysed for cardiovascular function and systemic hemodynamics using echocardiography and compared with control group. The data was analysed using ANOVA for comparison within the group and student’s t- test for comparison between the groups. p value <0.05 was considered to be significant.Results: Mean age and height in control and study groups were comparable. Weight gain was within the expected range with advancement of pregnancy. Heart rate was increased in I and II trimesters with peak rise in III trimester. The difference between control group and study groups was statistically significant (p < 0.05).Systolic blood pressure was slightly decreased in all the trimesters as compared to control group which was statistically not significant. There was gradual increase in SBP from I to III trimesters. Diastolic blood pressure progressively decreased in I and II trimesters and then increased in III trimester. The difference in DBP between control group and I, II trimesters of pregnancy was significant (p<0.05).Systemic vascular resistance progressively decreased with advancement of pregnancy and difference was statistically significant (p <0.05) . Cardiac output is steadily increased in all trimesters of pregnancy with peak at 36 weeks and was statistically significant (p<0.05). It was due to increase in both heart rate and Stroke volume. Ejection fraction also increased in all trimesters.Conclusions: Present study shows significant functional changes in the cardiovascular dynamics during pregnancy. Doppler echocardiography provides an excellent noninvasive method for the evaluation and serial analysis of hemodynamic changes. These results will help in distinguishing abnormal echocardiographic changes from the normal physiologic changes of pregnancy. Therefore maternal echocardiography should be introduced into the antenatal management protocol, which will help to identify women at high risk to developing cardiovascular complications and there by early intervention.

A study of intra-operative maternal morbidity after repeating caesarean section

Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible

Evaluation of series of 177 cases of acute gynaecological emergencies in tertiary care hospital

Background: Gynecologic emergencies are relatively common and acute pain of pelvic origin is a common symptom necessitating emergency medical evaluation, because late diagnosis, potentially leading to progression to severe morbidity or death, is a matter of concern. The objective of present study is to have an overview of emergency gynecological conditions and their management.Methods: In present retrospective observational study total 177 cases were analyzed. They were divided into three groups depending on age, adolescent group patients aged 19 year and below (group A), reproductive group between 20 to 44 year (group B) and perimenopausal/postmenopausal group aged 45year and above (group C). The data collected were expressed as mean±S.D.Results: The distribution of cases was as follows: 29 cases (16.38%) in group A with a mean age of 15.5±2.21 years, 97 cases (54.80 %) in group B with a mean age of 24.20±4.38 years and 51 cases (28.81%) in group C with a mean age of 46.75±9.11 years. Pain was in right lower quadrant (36.70%), in left lower quadrant (27.95%), suprapubic (19.35%) and diffuse (16%). The most common etiology of APP were as follows: simple ovarian cysts in 16.9% patients followed by ectopic pregnancy (15.2%), complication of uterine fibroid (10.7%), rupture ovarian of cysts (9.7%) and haemorragic ovarian cysts (6.8%). Modality of management in all of the groups was as follows: observation in 21.5%, medical in 25.4% and surgical in 53.1%.Conclusions: Accurate clinical and laboratory evaluation are essential in gynecological emergencies. There should be a high index of suspicion for early detection and early intervention to reduce morbidity and mortality

Squeezing out the last 1 nanometer of water: A detailed nanomechanical study

In this study, we present a detailed analysis of the squeeze-out dynamics of nanoconfined water confined between two hydrophilic surfaces measured by small-amplitude dynamic atomic force microscopy (AFM). Explicitly considering the instantaneous tip-surface separation during squeezeout, we confirm the existence of an adsorbed molecular water layer on mica and at least two hydration layers. We also confirm the previous observation of a sharp transition in the viscoelastic response of the nanoconfined water as the compression rate is increased beyond a critical value (previously determined to be about 0.8 nm/s). We find that below the critical value, the tip passes smoothly through the molecular layers of the film, while above the critical speed, the tip encounters "pinning" at separations where the film is able to temporarily order. Pre-ordering of the film is accompanied by increased force fluctuations, which lead to increased damping preceding a peak in the film stiffness once ordering is completed. We analyze the data using both Kelvin-Voigt and Maxwell viscoelastic models. This provides a complementary picture of the viscoelastic response of the confined water film

Scale Inside-Out: Rapid Mitigation of Cloud DDoS Attacks

The distributed denial of service (DDoS) attacks in cloud computing requires quick absorption of attack data. DDoS attack mitigation is usually achieved by dynamically scaling the cloud resources so as to quickly identify the onslaught features to combat the attack. The resource scaling comes with an additional cost which may prove to be a huge disruptive cost in the cases of longer, sophisticated, and repetitive attacks. In this work, we address an important problem, whether the resource scaling during attack, always result in rapid DDoS mitigation? For this purpose, we conduct real-time DDoS attack experiments to study the attack absorption and attack mitigation for various target services in the presence of dynamic cloud resource scaling. We found that the activities such as attack absorption which provide timely attack data input to attack analytics, are adversely compromised by the heavy resource usage generated by the attack. We show that the operating system level local resource contention, if reduced during attacks, can expedite the overall attack mitigation. The attack mitigation would otherwise not be completed by the dynamic scaling of resources alone. We conceived a novel relation which terms “Resource Utilization Factor” for each incoming request as the major component in forming the resource contention. To overcome these issues, we propose a new “Scale Inside-out” approach which during attacks, reduces the “Resource Utilization Factor” to a minimal value for quick absorption of the attack. The proposed approach sacrifices victim service resources and provides those resources to mitigation service in addition to other co-located services to ensure resource availability during the attack. Experimental evaluation shows up to 95 percent reduction in total attack downtime of the victim service in addition to considerable improvement in attack detection time, service reporting time, and downtime of co-located services

DDoS victim service containment to minimize the internal collateral damages in cloud computing

Recent Distributed Denial of Service (DDoS) attacks on cloud services demonstrate new attack effects, including collateral and economic losses. In this work, we show that DDoS mitigation methods may not provide the expected timely mitigation due to the heavy resource outage created by the attacks. We observe an important Operating System (OS) level internal collateral damage, in which the other critical services are also affected. We formulate the DDoS mitigation problem as an OS level resource management problem. We argue that providing extra resources to the victim's server is only helpful if we can ensure the availability of other services. To achieve these goals, we propose a novel resource containment approach to enforce the victim's resource limits. Our real-time experimental evaluations show that the proposed approach results in reduction in the attack reporting time and victim service downtime by providing isolated and timely resources to ensure availability of other critical services

Physiological and transcriptomic response of Saccharomyces pastorianus to cold storage

Removal of yeast biomass at the end of fermentation, followed by a period of storage before re-inoculation into a subsequent fermentation, is common in the brewing industry. Storage is typically conducted at cold temperatures to preserve yeast quality, a practice which has unfavourable cost and environmental implications. To determine the potential for alleviating these effects, the transcriptomic and physiological response of Saccharomyces pastorianus strain W34/70 to standard (4°C) and elevated (10°C) storage temperatures was explored. Higher temperatures resulted in increased expression of genes associated with the production and mobilisation of intracellular glycogen, trehalose, glycerol and fatty acids, although these observations were limited to early stages of storage. Intracellular trehalose and glycerol concentrations were higher at 4°C than at 10°C, as a consequence of the cellular response to cold stress. However, significant changes in glycogen degradation or cellular fatty acid composition did not occur between the two sets of populations, ensuring that cell viability remained consistent. It is anticipated that this data may lead to changes in standard practice for handling yeast cultures, without compromising yeast quality. This work has significance not only for the brewing industry, but also for food and biofuel sectors requiring short term storage of liquid yeast

Comparing the findings of clinical examination versus magnetic resonance imaging for the diagnosis of ligamentous injuries of knee in rural area

Background: The knee is a complex synovial joint allowing flexion, extension, anteroposterior gliding and internal-external rotation. The major articular surfaces are the medial and lateral condyles of the femur and patellar surface. The aim of the study was to compare the findings of clinical examination versus magnetic resonance imaging (MRI) for the diagnosis of ligamentous injuries of knee in rural area.Methods: Present study was an observational study carried out at rural medical college under orthopaedic department. All patients coming with ligamentous injury to orthopaedic department were studied. Thus such 50 cases were studied. All cases were referred to radiology department for MRI of knee. MRI reports and clinical reports were compared and analysis was done. Cases contraindicated for MRI examination were excluded from study. General demoghraphic history, clinical presentation and MRI reports were recorded. All data was compiled in Microsoft excel and analysed using OpenEPi 2.3.1.Results: Mean age was 46.4±11.2 years. Majority were males 70% and 30% were females. Swelling 62% was most commonly seen followed by knee pain. Majority 58% cases had grade 3 tear on MRI, followed by 36% had grade II and only 6% had grade I.  Conclusions: MRI is an excellent, non-invasive, radiation free imaging modality with multilane capabilities and excellent soft tissue delineation. It can accurately detect, localize and characterize various internal derangements of the knee joint and help in arriving at a correct anatomical diagnosis thereby guiding further management of the patient