A review of health system infection control measures in developing countries: what can be learned to reduce maternal mortality

A functional health system is a necessary part of efforts to achieve maternal mortality reduction in developing countries. Puerperal sepsis is an infection contracted during childbirth and one of the commonest causes of maternal mortality in developing countries, despite the discovery of antibiotics over eighty years ago. Infections can be contracted during childbirth either in the community or in health facilities. Some developing countries have recently experienced increased use of health facilities for labour and delivery care and there is a possibility that this trend could lead to rising rates of puerperal sepsis. Drug and technological developments need to be combined with effective health system interventions to reduce infections, including puerperal sepsis. This article reviews health system infection control measures pertinent to labour and delivery units in developing country health facilities. Organisational improvements, training, surveillance and continuous quality improvement initiatives, used alone or in combination have been shown to decrease infection rates in some clinical settings. There is limited evidence available on effective infection control measures during labour and delivery and from low resource settings. A health systems approach is necessary to reduce maternal mortality and the occurrence of infections resulting from childbirth. Organisational and behavioural change underpins the success of infection control interventions. A global, targeted initiative could raise awareness of the need for improved infection control measures during childbirth

Calcifying fibrous tumour: a rare case report of an exceptional lesion localized in retroperitoneum, mesentery and pelvis

Calcifying fibrous tumours are rare benign lesions affecting mostly children and young adults. A 17-year-old female presented with abdominal pain and abdominal distention. Physical examination revealed intra-abdominal mass occupying retro peritoneum and right iliac fossa. Excisional biopsy from peritoneum and mesentery were performed. Histopathologically, it was composed of hypocellular hyalinised collagenized stroma, spindle cells, psammomatous and dystrophic calcification and mononuclear inflammatory cell infiltration. Authors are here in reporting a case of calcifying fibrous tumour and discussing its clinical and morphological features with regard to the literature

Early exposure of laparoscopic anatomy to first year medical undergraduate students: is it necessary?

The teaching of undergraduate anatomy is particularly based on cadaveric dissection. Currently, medical curriculum is continually evolving and focusing on clinical application, especially for first year medical undergraduate students. Recently, surgical educators defined a role for laparoscopy in teaching anatomy. This study was conducted to know the opinion by first year medical undergraduate students, of current teaching practices and which teaching modalities should be emphasized. In this study a total of 200 first-year medical undergraduate students were exposed to a Diagnostic Laparoscopy with appendectomy video, with explanation/commentary by a laparoscopic surgeon. A pre-test and a post-test questionnaire were given before and after exposure to the video. The objective of the study was to collect students’ opinion by answering the questions in the questionnaire. All pre-test and post-test questionnaire results were analysed. The results were quantified in terms of percentage. The knowledge of anatomy of abdominal wall and peritoneal cavity improved from 62% to 91% of students after exposure to surgical video. Similarly, knowledge regarding laparoscopy improved from 37% to 85% and awareness about surgical video as an additional method of learning improved from 46% to 89%. Almost 93% of students were able to appreciate the organs and structures within intraperitoneal cavity. Hence, the clinicians/surgeons need to try their best and put in their maximum efforts to make the training of future medical graduates more efficient and knowledgeable in anatomy subject, by creating interest in learning of the subject by using such additional method (surgical videos) learning tool

Biliary atresia with hyaline cartilage at the porta hepatis: a novel finding of undetermined significance: a case report

Biliary atresia is an important cause of liver disease and morbidity in infants with unknown etiology. To date, only five cases of biliary atresia with hyaline cartilage at the porta hepatis have been described. We present the case of a 65-day-old male child, with further insight and detailed discussion of this heterotopia of undetermined significance.Keywords: biliary atresia, hyaline cartilage, liver diseas

Study on drug profile used in common pregnancy influenced issues and its complications

Background: Pregnancy influenced issues are common among pregnant women treated by medications that causes complication in mother and fetus. The study aims to identify patients with pregnancy influenced issues like gestational diabetes mellitus, gestational hypertension, gastroesophageal reflux disease and anaemia. To assess the drug used pattern along with antibiotic therapy and to observe the above disease related complications.Methods: A hospital based prospective observational study was conducted at department of obstetrics and gynecology in Rajah Muthiah Medical College and Hospital. Totally 100 patients enrolled and data was collected using data collection form.Results: Out of 100 patients, high prevalence occurred in 26-30 years of age. Primarily gestational hypertension (39%), treated with Tab. Labetatol and complications were premature delivery, low birth weight. Anaemia (25%) cases treated with Tab. Ferrous sulphate, Iron sucrose and Folic Acid, Preterm delivery as complication. Gestational diabetes mellitus (18%) treated with Metformin and Human Insulin and complications were preterm delivery, maternal obesity, increased child weight. GERD (8%) treated with Pantoprazole, Ondansetron, Bifilac and complications were weight loss, dehydration, low birth weight. In pre-operative cases, 79% received antibiotics as monotherapy and 21% as dual therapy. In post-operative cases, 41% received antibiotics as monotherapy and 59% as dual therapy. Metronidazole (95%) given in both post and pre- operative conditions.Conclusions: The present study provides valuable insight about the overall drugs used in pregnancy related diseases and complications arise. We hope our data will make necessary recommendations to all health care professionals and pregnant women to ensure all pregnancy related safety measures were taken

Alveolar ridge preservation and biologic width management for perioaesthetics- A case report

Alveolar bone atrophy is a chronically progressive, irreversible process which results in bone loss in both the buccal, lingual and apico-coronal region. Without bone preservation measures, bone resorption is experienced and continues for life. Preservation of alveolar ridge is indicated when a tooth-supported fixed partial denture will rehabilitate the area. Authors report a case wherein alveolar ridge was preserved and simultaneously biologic width violation was corrected. An excellent aesthetic outcome was achieved and the patient was satisfied with the case resolution. Ridge preservation is an easy procedure to perform and almost always, results are predictable. It provides a good esthetic and functional benefit to the patient and the clinician

Pregnancy with super-obesity: an emerging pandemic

Pregnancy associated with obesity is an upcoming challenge in high risk obstetrics management. Ironically, in India though half the population is under the malnutrition zone, it is known as the diabetic capital. This is attributed to the changing lifestyles which have led to a steep rise in medical disorders like hypertension, diabetes and obesity, especially in metropolitan cities. A case of pregnancy in a super obese woman with a successful outcome is presented here

Cell cycle-dependent regulation of the bi-directional overlapping promoter of human BRCA2/ZAR2 genes in breast cancer cells

<p>Abstract</p> <p>Background</p> <p>BRCA2 gene expression is tightly regulated during the cell cycle in human breast cells. The expression of BRCA2 gene is silenced at the G0/G1 phase of cell growth and is de-silenced at the S/G2 phase. While studying the activity of BRCA2 gene promoter in breast cancer cells, we discovered that this promoter has bi-directional activity and the product of the reverse activity (a ZAR1-like protein, we named ZAR2) silences the forward promoter at the G0/G1 phase of the cell. Standard techniques like cell synchronization by serum starvation, flow cytometry, N-terminal or C-terminal FLAG epitope-tagged protein expression, immunofluorescence confocal microscopy, dual luciferase assay for promoter evaluation, and chromatin immunoprecipitation assay were employed during this study.</p> <p>Results</p> <p>Human <it>BRCA2 </it>gene promoter is active in both the forward and the reverse orientations. This promoter is 8-20 fold more active in the reverse orientation than in the forward orientation when the cells are in the non-dividing stage (G0/G1). When the cells are in the dividing state (S/G₂), the forward activity of the promoter is 5-8 folds higher than the reverse activity. The reverse activity transcribes the ZAR2 mRNA with 966 nt coding sequence which codes for a 321 amino acid protein. ZAR2 has two C4 type zinc fingers at the carboxyl terminus. In the G0/G1 growth phase ZAR2 is predominantly located inside the nucleus of the breast cells, binds to the BRCA2 promoter and inhibits the expression of BRCA2. In the dividing cells, ZAR2 is trapped in the cytoplasm.</p> <p>Conclusions</p> <p><it>BRCA2 </it>gene promoter has bi-directional activity, expressing BRCA2 and a novel C4-type zinc finger containing transcription factor ZAR2. Subcellular location of ZAR2 and its expression from the reverse promoter of the BRCA2 gene are stringently regulated in a cell cycle dependent manner. ZAR2 binds to BRCA2/ZAR2 bi-directional promoter <it>in vivo </it>and is responsible, at least in part, for the silencing of BRCA2 gene expression in the G0/G1 phase in human breast cells.</p

Agronomic and environmental determinants of direct seeded rice in South Asia

Rice (Oryza sativa L.) is the staple food of more than 50% of the world’s population. Manual puddled transplanted rice (PTR) system is still the predominant method of rice establishment. However, due to declining water tables, increasing water scarcity, water, labor- and energy-intensive nature of PTR, high labor wages, adverse efects of puddling on soil health and succeeding crops, and high methane emissions, this production system is becoming less proftable. These factors trigger the need for an alternative crop establishment method. The direct-seeded rice (DSR) technique is gaining popularity because of its low input demand compared to PTR. It is done by sowing pre-germinated seeds in puddled soil (wet-DSR), standing water (water seeding), or dry seeding on a prepared seedbed (dryDSR). DSR requires less water and labor (12–35%), reduces methane emissions (10–90%), improves soil physical properties, involves less drudgery and production cost (US$9–125 per hectare), and gives comparable yields. Upgraded short-duration and high-yielding varieties and efcient nutrient, weed, and resource management techniques encouraged the farmers to switch to DSR culture. However, several constraints are associated with this shift: more weeds, the emergence of weedy rice, herbicide resistance, nitrous oxide emissions, nutrient disorders, primarily N and micro-nutrients, and an increase in soil-borne pathogens lodging etc. These issues can be overcome if proper weed, water, and fertilizer management strategies are adopted. Techniques like stale bed technique, mulching, crop rotation, Sesbania co-culture, seed priming, pre-emergence and post-emergence spray, and a systematic weed monitoring program will help reduce weeds. Chemical to biotechnological methods like herbicide-resistant rice varieties and more competitive allelopathic varieties will be required for sustainable rice production. In addition, strategies like nitrifcation inhibitors and deep urea placement can be used to reduce N2O emissions. Developing site and soil-specifc integrated packages will help in the broader adoption of DSR and reduce the environmental footprint of PTR. The present paper aims to identify the gaps and develop the best-bet agronomic practices and develop an integrated package of technologies for DSR, keeping in mind the advantages and constraints associated with DSR, and suggest some prospects. Eco-friendly, cost-efective DSR package ofers sustainable rice production systems with fewer resources and low emissions

Effect of myo-inositol and di-chiro inositol plus vitamin D supplementation during pregnancy on prevention of gestational diabetes: a multi-centric, prospective, randomized, double-blind clinical trial

Background: Aim of study was to evaluate the impact of myoinositol and D-chiro inositol plus vitamin D supplementation on the prevention of gestational diabetes mellitus (GDM) in pregnant women. Methods: In the multi-centric, prospective, randomised, double-blind clinical trial, either vitamin D alone (group I) or myoinositol and D-chiro inositol plus Vitamin D (group II) were administered to pregnant women from 12 weeks of gestation. The administration was continued until delivery to primigravids who were normoglycemic at 12 weeks of gestation and consented. From October 2018 to December 2019. A total of 1250 women were enrolled, and randomly allocated to either of the groups: 630 women in Group I and 620 in Group II. The allocation was blinded. The primary outcome was the rate of GDM as assessed by oral glucose tolerance test (OGTT) recommended by diabetes in pregnancy Study Group India (DIPSI), International Federation of Gynecology and Obstetrics (FIGO) and the Government of India, at first antenatal visit followed by at weeks 24 to 28 in both the groups. Results: The rate of GDM was found more in group I as compared to group II treated with myoinositol and D-chiro Inositol plus vitamin D, but the difference was not statistically significant (5.08% in group I and 3.22% in group II). Conclusions: In conclusion, an improved trend has been noticed in the reduction of the rate of GDM with myoinositol and D-chiro inositol plus vitamin D as compared to vitamin D alone. Myoinositol and D-chiro inositol plus vitamin D supplementation may be a good option for pregnant women to prevent the GDM occurrence especially in women having positive risk factors for GDM.