Hypertext Narrative and Globalisation: Studying the Cultural Intersection of Carnivalesque and Altermodernism in Michael Joyce’s Twelve Blue

Globalisation has brought the world together and technology has helped it do so efficiently. It has eliminated the idea of distance by proposing virtual proximity so much that everything seems almost the same. Although this cultural homogenisation leads the path towards wider accessibility, it has also resulted in a lack of originality and uniqueness. This article aims to explore the structure of Michael Joyce’s work Twelve Blue to understand the contemporary cultural significance of hypertext narrative construction in this globalised context. By drawing from the notion of carnivalesque by Mikhail Bakhtin and altermodernism by Nicolas Bourriaud, it seeks to present the function of hypertext as that of creating singularities within a totalization of heterogeneous values. The nodal standpoint of this kind of narrative, where the chaos of the carnival and altermodernist individuality converge, represents the inherent complication of our cultural ethos faced by all individuals. The article argues that hypertexts like Twelve Blue address this complexity and writers like Joyce make sure that their work structurally replicates the dilemma of this age. Moreover, it is posited that instead of mourning the loss of a traditional reading process which had stability, Twelve Blue celebrates the newfound authority of choice with readers of a literary work. The article is thus an attempt to reconcile the hypertext narratology of Twelve Blue with our present cultural sensibility in terms of its disconnection within connection, singularity within standardisation, and chaos within stability.&nbsp

How useful is HPV-DNA test for screening of cervical cancer: a prospective study

Background: The aim of present study was to evaluate the utility of HPV-DNA testing in cervical cancer screening.Methods: The study included 110 women presenting to the Gynaecological OPD of SMI Hospital who were subjected to HPV DNA test and one or more of other tests like cytology, colposcopy and histopathological examination. The results were evaluated by standard statistical methods.Results: Out of 110 patients in whom HPV-DNA testing was done, 24 had positive result, 83 had negative result and 3 had borderline test result. Sensitivity & Specificity of HPV-DNA testing was calculated to be 90% and 84.61% respectively. Its positive predictive value and negative predictive value were 69.23% and 95.66%. The percentage of false negative was calculated to be 10% and that of false positive was 15.38%.Conclusions: In our study, the sensitivity and negative predictive value of HPV-DNA testing was found to be more as compared to its specificity and positive predictive value. Widespread HPV testing for primary cervical cancer screening is not recommended as it will increase the volume of HPV testing and will not be cost- effective. It may be used for secondary screening in patients with abnormal or (ASC) cytology results as this will help in their subsequent management

A prospective study of immediate postpartum intra uterine device insertion in a tertiary level hospital

Background:In India there is an unmet need for contraception. Intrauterine device is a long acting reversible method. This study was done to determine the efficacy and safety of immediate Post-Partum Intrauterine Device (PPIUD) and to compare the outcome of PPIUD insertion after vaginal delivery and caesarean section.  Methods:A total of 113 women who underwent PPIUD insertion were followed up at 6 weeks and 6 months post-partum. Outcome in term of side effects, removal and expulsion was compared in vaginal delivery and caesarean section insertions.Results:In 61.45% women there was no complaint. Menstrual disturbances were found in 16.66% women and pelvic pain in 13.54% women. The expulsion rate was 5.20% and IUD removal was done in 13.54% women. Incidence of removal was more in vaginal insertions than in caesarean insertions and this difference was statistically significant. Continuation rate at 6 months was 81.25%.  Conclusion:Immediate postpartum IUD insertion is a safe, convenient and effective method

Obstetrics outcome in pregnant women with cardiac disease in tertiary care center, Dehradun, India

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement

Overview of liver disorders during pregnancy at a tertiary care centre: Uttarakhand scenario

Background: Liver disorders in pregnancy encompass a spectrum of diseases encountered during antenatal and postnatal period resulting in abnormal liver function tests and hepatobiliary dysfunction or both. This study is aimed at determining the causes of liver disorders during pregnancy and associated maternal and fetal outcomes over a period of 3 years at a tertiary care centre of Dehradun.Methods: All case records of patients with liver disorders during pregnancy from May 2013 to May 2016 were retrieved from medical record department of SGRRIMHS, Dehradun and analyzed for various causes of liver disorders and associated maternal and fetal outcomes.Results: During the three-year study period, 146 pregnant patients were found to have liver disorders. The study found that viral hepatitis was the most common cause of liver disorders followed by Intrahepatic cholestasis of pregnancy IHCP. There were 6 mortalities among the study group out of which hepatitis E was the culprit for maternal mortality in two patients. The serum bilirubin levels were directly proportional to the maternal deaths.Conclusions: Liver disorders during pregnancy are rare but an important cause of maternal and fetal morbidity and mortality. Early recognition, timely referral and aggressive management may lead to better maternal and fetal outcome

A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state

Background: Instrumental vaginal delivery is an age-long obstetric practice used to expedite vaginal delivery or avert recourse to caesarean delivery. Objective of the study is to compare maternal and neonatal outcomes of vacuum and forceps application in instrumental vaginal delivery.Methods: This is a retrospective observational study. Retrospective study of 70 consecutive ventouse and 70 consecutive forceps deliveries was done. Maternal and neonatal morbidity were compared in terms of perineal laceration, episiotomy extension, postpartum hemorrhage, apgar score, neonatal injuries and NICU admissions.Results: Maternal morbidity in terms of periurethral tear, second and third degree perineal tear were significantly more in forceps group (p=0.0332 and p=0.0173 respectively). However neonatal outcomes were found to be similar in both types of instrumental deliveries.Conclusions: Ventouse should be preferred over forceps whenever there is an indication for instrumental delivery (except in fetal distress) as it is associated with less maternal trauma and most of the neonatal morbidities were insignificant in comparison with both instruments

Analysis of maternal deaths over a period of three years at a tertiary care centre of Uttarakhand, India

Background: Globally, about 800 women die every day of preventable causes related to pregnancy and childbirth; 20 per cent of these women are from India. The study is aimed at evaluating maternal deaths over a period of three years at a tertiary care centre of Dehradun, India.Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology at SGRRIMHS, Dehradun. The case record files of all maternal deaths from January 2015 to December 2017 was obtained from medical record section of the hospital. Maternal age, parity, educational status, antenatal registration, mode of delivery, admission death interval and causes of each maternal death was noted and analysed statistically.Results: There were 48 maternal deaths from January 2015 to December 2017.Maximum deaths were in the age group of 21-25 years. The maternal mortality ratio over a period of three years was 671 per one lac live births. Most of the maternal deaths were due to direct causes like hemorrhage , eclampsia followed by sepsis.Conclusions: Most of the maternal deaths are preventable. High risk cases should be identified at root level and early referral should be the moto. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. To avoid maternal deaths, unwanted and too-early pregnancies should be avoided. All women, including adolescents, should have access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for both the mother and the baby

MHC class I-restricted presentation of maleylated protein binding to scavenger receptors

Pathways for loading exogenous protein-derived peptides on MHC class I are thought to be present mainly in monocyte-lineage cells and to involve phagocytosis- or macropinocytosis-mediated antigenic leakage into either cytosol or extracellular milieu to give peptide access to MHC class I. We show that maleylation of OVA enhanced its presentation to an OVA-specific MHC class I-restricted T cell line by both macrophages and B cells. This enhanced presentation involved uptake through receptors of scavenger receptor (SR)-like ligand specificity, was TAP-1-independent, and was inhibited by low levels (2 mM) of ammonium chloride. No peptide loading of bystander APCs by maleylated (maleyl) OVA-pulsed macrophages was detected. Demaleylated maleyl-OVA showed enhanced MHC class I-restricted presentation through receptor-mediated uptake and remained highly sensitive to 2 mM ammonium chloride. However, if receptor binding of maleyl-OVA was inhibited by maleylated BSA, the residual presentation was relatively resistant to 2 mM ammonium chloride. Maleyl-OVA directly introduced into the cytosol via osmotic lysis of pinosomes was poorly presented, confirming that receptor-mediated presentation of exogenous maleyl-OVA was unlikely to involve a cytosolic pathway. Demaleylated maleyl-OVA was well presented as a cytosolic Ag, consistent with the dependence of cytosolic processing on protein ubiquitination. Thus, receptor-specific delivery of exogenous protein Ags to APCs can result in enhanced MHC class I-restricted presentation, suggesting that the exogenous pathway of peptide loading for MHC class I may be a constitutive property dependent mainly on the quantity of Ag taken up by APCs

Different Patterns of Inappropriate Antimicrobial Use in Surgical and Medical Units at a Tertiary Care Hospital in Switzerland: A Prevalence Survey

Audits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial prescriptions without indication, and divergence from institutional guidelines were frequent errors. Based on these results, we will tailor education, amend institutional guidelines and further develop the infectious diseases consultation service