Mainstreaming Disaster-Relief Service-Learning in Communication Departments: Integrating Communication Pedagogy, Praxis, and Engagement

Communication is the primary mode through which students inculcate critical thinking skills for (re)construction of social reality and engagement with communities in need (Craig, 1989). Thus it is well-suited to disaster-relief service-learning approaches that provide a pathway for democratic engagement with the material consequences of inequality evidenced in disaster-struck communities. Communication administrators can advocate for disaster-relief service-learning programs by aligning theoretically-informed student input in faculty–administration partnerships to construct transformative learning experiences sustaining trusting relationships. This study is the first to employ the theory of planned behavior (Ajzen, 1986) to identify themes comprising student composite disaster-relief volunteering belief-structure and disaster-relief volunteering intentions elicited by surveys (N=352) and theme analyses of qualitative data. The findings center the role of communication administrators in integrating disaster-relief pedagogies and advocating for institutional initiatives that bridge “thought to action, theory to practice” (Boyer, 1994, p. A48) around the vital social issues evoked by disaster-relief contexts

Evaluation of causes of still birth in a tertiary care teaching hospital

Background: Whenever pregnancy occurs there is an expectation that every pregnancy will end with the birth of a healthy baby, yet in a developing country like India 22 in every 1000 births are stillborn. The objective of this study was to evaluate the rate and causes of still birth in a tertiary care teaching hospital, Queen Mary, King George Medical college and university, Lucknow, Uttar Pradesh, India.Methods: Present study was an observational study in a tertiary care hospital. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. After informed consent, details of history about epidemiological factors, obstetric history and medical history were obtained. Antenatal investigations including imaging, delivery details and stillborn morphological characteristics were analyzed to identify the cause of stillbirthResults: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, mal-presentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth.Conclusions: The rate of stillbirth is higher as compared to the Indian data (22/1000 total births). Antepartum obstetric complications (APH, hypertensive disorder of pregnancy, IUGR) were the most common. 15.45% cases showed intrapartum causes of stillbirth (obstructed labour and rupture uterus) which was significantly higher than developed countries where such cases are negligible. The higher number of intrapartum deaths indicate that better healthcare services can drastically reduce stillbirth rates in developing countries

High rate of caesarean section in cases of intrauterine fetal demise in a low resource setting: Why?

Background: Stillbirth as an obstetric complication is emotionally devastating for the women as well as the clinician and having a caesarean section for stillbirth is even more catastrophic. The aim of the present research was to study the indications of caesarean section in women with intrauterine fetal demise in a low resource setting.Methods: This was an observational study for assessing the indication of caesarean section among 222/ 550 stillbirths from June 2013 to May 2014 in a tertiary care teaching hospital of North India. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. Details of women with intrauterine fetal demise in which caesarian section was done were noted and analyzed.Results: Out of 550 stillbirths, 222 women underwent caesarean section. Rate of caesarean section among women with stillbirth was 40.36%.  Placenta previa (23.87%), Rupture uterus (22.1%), obstructed labour (10.8%), transverse lie (9.45%), failed induction (7.20%), massive abruption (5.86%), non-progress of labour (5.40%), eclampsia/pre-eclampsia related causes (4.95%), acute fetal distress (4.95%), were leading indications of caesarean sections. Out of 222 women, 162 (73%) women had anaemia (Hb <11g%). Severe anaemia (haemoglobin less then 7gm/dl) was present in 51 cases (23%).Conclusions: Caesarean section done for intrauterine death in present study were mostly inevitable. Reducing intrapartum stillbirths by improving essential obstetric services will ultimately result in reducing caesarean section rates in stillbirths in developing countries. Further studies are needed both in developing and developed countries to strategize the management of intrauterine dead fetus to prevent such high rate of caesarean section

Acute pancreatitis in pregnancy: a case report

Acute pancreatitis is a rare event, can be associated with a high maternal mortality and fetal loss with an incidence of 3 in 10,000 pregnancies. A 24 years old primigravida with 28 weeks of gestation, presented with pain in upper abdomen since 4 days and nausea, vomiting and fever sine two days, abdomen distended and tenderness present in epigastric region. Serum amylase and lipase were raised. Sonography abdomen showed pancreas bulky with peripancreatic free fluid and inflammatory changes suggestive of pancreatitis. Patient was managed condervatively and was discharged to home after 7 days. Regular follow up was done till 36 weeks and emergency cesarean delivery was done in view of non-reassuring fetal heart rate at 36 weeks 3 days of gestation. Early diagnosis of acute pancreatitis in pregnancy and supportive treatment with maternal and fetal monitoring results in good perinatal outcome. The treatment of pancreatitis in pregnancy should be conservative as far as possible with delaying the definitive treatment until delivery of the baby

Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Background: To assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio>2standard deviation (SD) or UA-Pulsatility Index (PI) and UA-Resistive Index (RI) >2SD were taken as abnormal. The middle cerebral artery (MCA) was visualized and cerebroumblical PI ratio calculated. MCA-RI2SD (RR 4.46, 95% CI 1.40-14.17) and RI>2SD (RR 3.36, 95% CI 1.03-10.61) and MCA RI2SD predicted acute fetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Decoding the effect of time interval between hCG and IUI and sperm preparation and IUI

Background: The study was aimed to assess the difference in IUI outcome depending on the interval between hCG trigger and IUI and sperm preparation and IUI.Methods: The study was conducted in the Department of Obstetrics and Gynecology in Infertility unit at King George’s Medical University, Lucknow from January-December 2016. All the women eligible for IUI were included in the study. Once the follicle attained size of 17-18 mm, IUI was planned 36-48 hours after Inj. hCG 10,000 IU im. Semen processing was done in laboratory and time noted between sperm preparation and IUI. Outcome was confirmation of pregnancy by urine test. Cases were women in whom IUI was done 36-40 hours after hCG as against controls (>40 hours). Interval between sperm preparation and IUI was <30 minutes in cases and ≥30 minutes in controls.Results: A total of 624 cycles were included in the study. Clomiphene was used in 582/624 cycles (93.3%) gonadotropins used in 42/624 cycles (2.7%). There was a total of 23 conceptions in study (3.7%). Of these 8/98 (8.2%) were seen when the interval between ovulation trigger and IUI was 36-40 hours and 15/526 in cycles (2.9%) when the interval was more than 40 hours (p=0.023; OR-3.028 95% CI -1.247-7.352). Of a total of 23 conceptions in the study, 18/324 conceptions were seen when IUI was done within 30 minutes of sperm preparation as compared to 5/300 when interval was more than 30 minutes (p=0.01).Conclusions: IUI with ovarian stimulation is a simple and effective procedure and its outcome can be maximized keeping in consideration the availability of gametes. IUI performed within 36-40 hours of hCG trigger and within 30 minutes of sperm preparation can increase conception rates

Prediction of pre-eclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A

Background: The possibility of prediction of preeclampsia (PE) at 11-14 weeks of pregnancy is a fairly new concept and in recent years, studies combining various parameters at 11-14 weeks of pregnancy have been undertaken, but an algorithm with a high predictive value is yet to be developed. The objective of this study was to develop such a protocol using mean arterial pressure (MAP), uterine artery Doppler and PAPP-A (pregnancy associated plasma protein-A) at 11-14 weeks of pregnancy (individually or in combination) for prediction of preeclampsia in a developing country like India.Methods: A prospective cohort study was done at the Department of Obstetrics and Gynecology, King George Medical University, Lucknow, Uttar Pradesh with pregnant women attending the antenatal OPD at 11- 14 weeks of gestation. A preformed questionnaire was filled for the enrolled women, MAP, blood pressure was recorded, uterine artery Doppler was done, serum sample for PAPP-A was drawn. Uterine artery Doppler pulsatility index (PI) at 11-14 weeks of pregnancy was found to be a good screening method (sensitivity-75.9%, specificity-79.6% at cut-off of 1.7) for prediction of preeclampsia and IUGR. The data was analyzed using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software.Results: Out of the 78 women enrolled, 29 women (37.18%) developed complications. Uterine artery Doppler pulsatility index (PI) at 11-14 weeks of pregnancy was found to be a good screening method (sensitivity-75.9%, specificity-79.6%) for prediction of preeclampsia and IUGR. Presence of early diastolic notch on uterine artery Doppler was found predictive for IUGR. MAP and PAPP-A were not found to have a significant correlation with development of these complications.Conclusions: This study concluded that uterine artery Doppler alone was a good screening method at 11-14 weeks of gestation for women at high risk of developing preeclampsia and related complications

Increasing rates of cesarean section, an upcoming public health problem: an audit of cesarean section in a tertiary care center of North India based on Robson classification

Background: Increasing rates of cesarean section during last three decades has become a cause of alarm since and a need for ongoing studies. Objective of present study was to investigate cesarean section rates as per modified Robsons Criteria and to determine area of concern which requires maximum focus to decrease overall caesarean rateMethods: This cross sectional study was conducted over a period of one year (From January 2016 to December 2016) in the Department of Obstetrics and Gynecology at King George’s Medical University, Lucknow.Results: Total number of deliveries for one year was 8526. Out of them, 4275 (50.1%) were vaginal and 4251 (49.9%) were abdominal. Overall maximum caesarean section rate was contributed by group 5 of modified Robsons criteria i.e. previous section, singleton, cephalic, ≥37 weeks (17.7%).Conclusions: Robson 10 group classification provides easy way in collecting information about Cesarean section rate which obtains good insight into certain birth groups. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate (group 1 and 2) and on increasing vaginal birth after CS (group 5). The caesarean rate is commonest in group 5 that is previous section (17.7%)

Surgical outcome of single site phacotrabeculectomy in management of concurrent glaucoma and cataract

Background:The aim of our study is to evaluate the efficacy and safety of combined procedure of single site phacoemulsification and trabeculectomy in terms of improvement of visual acuity and intraocular pressure control.Methods: Prospective, noncomparative, consecutive, interventional study of 74 eyes (64 patients) of single site phacotrabeculectomy in cases of primary open angle glaucoma with significant operable cataract from April 2014 to March 2015. Out of 64 patients 30 were male and 34 were female with age ranged 48 to 80 (mean 64.5) years. Ten patient required bilateral surgery. The controlled mean preoperative IOP was 20 mmHg ranged (12- 36 mmHg).Postoperative best corrected visual acuity, intraocular pressure and fundus examination were  done one day, one week, one month, three months and one year following surgery. Perimetery was done at third and twelve months.Results: Mean postoperative intraocular pressure after 12 months of follow up was 12 mmHg (range 08 to 20 mmHg) and overall improvement in visual acuity achieved in 90.54% (67) of eyes. Visual acuity of 6/12 and better was achieved in 62.16% (46) eyes. IOP was controlled without any treatment in 83.78% (62) eyes, and rest 16.22% (12) eyes needed antiglaucoma drugs to control IOP. Hyphema and uveitis were common complications noted.Conclusions: Combined phacotrabeculectomy is safe and effective method in restoring vision and lowering intraocular pressure. It helps in early visual rehabilitation and convenient, economical method to manage concurrent glaucoma and cataract.

Complementary and Alternative Medicine Provider Knowledge Discourse on Holistic Health

Complementary and alternative medicine (CAM) promises a wide array of therapies employed increasingly by consumers for disease prevention and health promotion. Despite this increasing use, however, CAM and biomedical paradigms are often not combined effectively in the US. The lack of coordination negatively impacts several aspects of patient care including CAM and biomedical provider-patient relationships and the practice of integrative medicine (IM). The goal of this study is to understand how CAM providers position their knowledge and practice of holistic health within the healthcare landscape in the US. In-depth interviews with CAM providers (N = 17) sampled from practices in the mid-Atlantic region of the US were analyzed for provider descriptions of holistic health. Discourse analysis of CAM provider interviews identifies the three themes employed by CAM providers to describe holistic health as comprising the: (a) epistemologies of legitimization and identity, (b) epistemologies of sense and intuition, and (c) epistemologies of environment and community. The three epistemologies define holistic health by organizing diverse knowledge foundations through reconciling and integrating differences, including diverse modes of evidence such as non-empirical forms of whole body experiences, and privileging the relational praxis through integrating the individual's biological and sociocultural environment. The epistemologies illuminate how CAM knowledge and practice is positioned as alternative within the sociocultural context of the participants and reflect CAM providers' challenges in carving out a distinct knowledge space reflecting their professional identity. CAM providers' discourse encompasses the ontological and experiential-relational praxis to foreground health as a mutually constitutive, ongoing process of granting legitimacy to diverse sense-making ontologies of medicine within a continuum of provider-patient meaning-making. Theoretically, CAM knowledge of holistic health integrates the experiential praxis of the patient's spiritual and physiological self and the relational praxis of the patient's biological-sociocultural-epigenetic relationships in the conceptualization and delivery of health outcomes. The study findings recommend including CAM knowledge discourses to inform the epistemological foundations of basic medicine. Pragmatically, the study recommends support for efforts to include credentialing of CAM practitioner teaching within allopathic healthcare institutions, faculty development within existing allopathic health professional schools, and incorporation of CAM content in allopathic medical education and practice