Analysis of caesarean sections according to Robson’s criteria at a tertiary care teaching hospital in central India

Background: The rate of caesarean section (CS) has been skyrocketed globally over the past three decades which makes it utmost essential to be reanalyzed. Hence, the Robson’s classification of international standards has become a need of an hour. This study aimed to analyze the trend of caesarean sections at a tertiary care teaching hospital, by using Robson’s criteria.Methods: This cross-sectional observational study was conducted at Government Medical College in Akola. The data was collected for the women delivered by CS during November 2017 to April 2019 and proportions in various groups as per Robson’s criteria were calculated.Results: The overall CS rate for the study period at our hospital was 63.89%. Robson Group 1 (24.5%) had the greatest representation in the study population followed by Group 5 (21.27%) and 3 (14.18%). While Groups 6 (10.13%) and 9 (0.63%) had the least representation. Group 5 was found to be the highest absolute contributor (20.5%) to overall CS rates followed by Group 1 (16.08%). Group 9 had a least possible share in the study population, but it had 100% CS rate.Conclusions: Robson’s classification must be implemented in all delivery units to avoid unnecessary caesarean sections. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate and Robson’s criteria is a step forward in the same direction

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure.

INTRODUCTION: The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery. MATERIALS AND METHODS: Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted. RESULTS: LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs. CONCLUSIONS: This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures

Effect of Irrigation Level and Sowing Date on Yield of Field Bean in Saline Soils of Konkan Region of Maharashtra

A field experiment was conducted during consecutive Rabi seasons of 2019-2020 and 2020-2021 in coastal saline soils at Khar Land Research Station, Panvel, Maharashtra, India to study the effect of different sowing dates and irrigation levels on the production potential of field bean. The experiment was laid out in factorial randomized block design (FRBD) with four replications, comprising three dates of sowing viz., immediately after harvest of paddy (D1), 10 days after harvest of paddy (D2), and 20 days after harvest of paddy (D3); and three irrigation levels viz., no irrigation (I0), one irrigation at flowering (I1), and one irrigation each at flowering and at pod formation (I2). The results showed that the treatment D1 recorded significantly higher seed yield of field bean (915 kg.ha-1) over D2 (713 kg.ha-1) and D3 (605 kg.ha-1). Among the irrigation levels, treatment I1 resulted in significantly higher seed yield of field bean (856 kg.ha-1) over I2 (726 kg.ha-1) and I0 (650 kg.ha-1). The treatment combination I1D1 produced significantly higher seed yield of field bean (1065 kg.ha-1) with higher net realization (1,06,500 ₹.ha-1), net income (55,222 ₹.ha-1) and benefit cost ratio (2.08). Both sowing date and irrigation level played important role in management of root zone soil moisture and soil salinity which influenced the seed yield. Sowing of field bean immediately after the harvest of paddy and providing one irrigation at the time of flowering is recommended to obtain better yield and returns from the field beans cultivated in Konkan region of Maharashtra

Reaction of ependymal cells to spinal cord injury: a potential role for oncostatin pathway and microglial cells

Abstract Ependymal cells with stem cell properties reside in the adult spinal cord around the central canal. They rapidly activate and proliferate after spinal cord injury, constituting a source of new cells. They produce neurons and glial cells in lower vertebrates but they mainly generate glial cells in mammals. The mechanisms underlying their activation and their glial-biased differentiation in mammals remain ill-defined. This represents an obstacle to control these cells. We addressed this issue using RNA profiling of ependymal cells before and after injury. We found that these cells activate STAT3 and ERK/MAPK signaling during injury and downregulate cilia-associated genes and FOXJ1, a central transcription factor in ciliogenesis. Conversely, they upregulate 510 genes, six of them more than 20 fold, namely Crym, Ecm1, Ifi202b, Nupr1, Rbp1, Thbs2 and Osmr . OSMR is the receptor for the inflammatory cytokine oncostatin (OSM) and we studied its regulation and role using neurospheres derived from ependymal cells. We found that OSM induces strong OSMR and p-STAT3 expression together with proliferation reduction and astrocytic differentiation. Conversely, production of oligodendrocyte-lineage OLIG1 + cells was reduced. OSM is specifically expressed by microglial cells and was strongly upregulated after injury. We observed microglial cells apposed to ependymal cells in vivo and co-cultures experiments showed that these cells upregulate OSMR in neurosphere cells. Collectively, these results support the notion that microglial cells and OSMR/OSM pathway regulate ependymal cells in injury. In addition, the generated high throughput data provides a unique molecular resource to study how ependymal cell react to spinal cord lesion

Temperature-responsive biometamaterials for gastrointestinal applications

We hypothesized that ingested warm fluids could act as triggers for biomedical devices. We investigated heat dissipation throughout the upper gastrointestinal (GI) tract by administering warm (55°C) water to pigs and identified two zones in which thermal actuation could be applied: esophageal (actuation through warm water ingestion) and extra-esophageal (protected from ingestion of warm liquids and actuatable by endoscopically administered warm fluids). Inspired by a blooming flower, we developed a capsule-sized esophageal system that deploys using elastomeric elements and then recovers its original shape in response to thermal triggering of shape-memory nitinol springs by ingestion of warm water. Degradable millineedles incorporated into the system could deliver model molecules to the esophagus. For the extra-esophageal compartment, we developed a highly flexible macrostructure (mechanical metamaterial) that deforms into a cylindrical shape to safely pass through the esophagus and deploys into a fenestrated spherical shape in the stomach, capable of residing safely in the gastric cavity for weeks. The macrostructure uses thermoresponsive elements that dissociate when triggered with the endoscopic application of warm (55°C) water, allowing safe passage of the components through the GI tract. Our gastric-resident platform acts as a gram-level long-lasting drug delivery dosage form, releasing small-molecule drugs for 2 weeks. We anticipate that temperature-triggered systems could usher the development of the next generation of stents, drug delivery, and sensing systems housed in the GI tract.Bill and Melinda Gates Foundation (Grants OPP1139921 and OPP1139937)NIH (Grant EB000244

Scalable Gastric Resident Systems for Veterinary Application

Gastric resident dosage forms have been used successfully in farm animals for the delivery of a variety of drugs helping address the challenge of extended dosing. Despite these advances, there remains a significant challenge across the range of species with large variation in body size. To address this, we investigate a scalable gastric resident platform capable of prolonged retention. We investigate prototypes in dimensions consistent with administration and retention in the stomachs of two species (rabbit and pig). We investigate sustained gastric retention of our scalable dosage form platform, and in pigs show the capacity to modulate drug release kinetics of a model drug in veterinary practice, meloxicam, with our dosage form. The ability to achieve gastric residence and thereby enable sustained drug levels across different species may have a significant impact in the welfare of animals in both research, agricultural, zoological, and clinical practice settings.Bill & Melinda Gates Foundation (Grant No. OPP1096734)Bill & Melinda Gates Foundation (Grant No. OPP1148627)National Institutes of Health (U.S.) (Grant# EB-000244)Max Planck Society (Research Award, Award Ltr Dtd. 2/11/08)Alexander von Humboldt FoundationBrigham and Women's Hospital. Division of GastroenterologyMassachusetts Institute of Technology. Division of Comparative Medicin

SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

ObjectiveTo determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group.DesignMulticentric case-control study.Data sourcesAmbispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020.Study populationAll pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls.Data qualityDedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy.Statistical analysisData converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression.ResultsA total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%).ConclusionCovid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls