Prospective study of large uterine fibroids encountered during laparotomy and hysterectomy and their management

Background: Study of large fibroids is necessary to throw light on complications associated with them. This helps the surgeon to safeguard patients from anticipated complications during surgery. The objective is to study the clinical features, complications and outcome of large uterine fibroids.Methods: A hospital based prospective study was carried out among 32 eligible patients undergoing laparotomy hysterectomy at Department of Obstetrics and Gynecology from October 2015 to June 2018. Age groups, clinical features, complications and outcome of surgery were recorded. Data was analyzed using proportions.Results: Majority of the study subjects were in the age group of 25-35 years. The most common presenting symptom of large size fibroid uterus was abnormal uterine bleeding followed by pain abdomen in 18.8% of the cases. Majority of the women had fibroid size of 16-20 weeks in 62.5% of the cases followed by size of the 20-26 weeks in 31.3% of the cases. Only two women had very large size of 26-28 weeks in 6.3% of the cases. Only three patients had intra operative complications (9.4%). Among them two (6.3%) had injury to the urinary bladder and only one had injury to the ureters. 90.6% of the cases had no intra operative complications. All cases had complete symptomatic relief. Thus the successful outcome was seen in 100% of the cases.Conclusions: Large uterine fibroids can end up with urological complications more than smaller fibroids. Among these bladder and ureteric complications are important. Malignant degeneration is rare. Other complications include infection and wound dehiscence

A study to assess factors contributing for the occurrence of incisional hernia among patients operated with pfannenstiel incision and management with mesh repair

Background: Incisional hernia is due to failure of lines of closure of abdominal wall following laparotomy. Bowel or a part of bowel or omentum can bulge through the gap. The early occurrence (within 5 years) is mainly due to early sepsis and obesity. Objective of present study was to assess the factors contributing for the occurrence of incisional hernia.Methods: All the women who were operated between March 2014-December 2016 using a low transverse Pfannenstiel incision and who did not have any other lower (vertical) incisions and laparoscopic surgeries were followed up in the outpatient department. 1,252 cases were followed up during the above-mentioned period and the detail history was elicited and meticulous physical examination was conducted. USG Abdomen was done in all the cases. Out of 1,252 cases 25 were having incisional hernia and mesh repair was done for incisional hernia.Results: Nearly 2% of these cases had incisional hernia. Obesity was the main risk factor in 36% of the study participants followed by wound infection in 32%.Conclusions: Obesity, redo surgeries, size of the incision and type of suture materials used contribute to the formation of incisional hernia. Although the incidence is low still incisional hernia can occur following Pfannenstiel low transverse abdominal incision

A prospective study of abdominal wall endometriomas: a review of 16 cases

Background: Endometriosis is a disorder in which an ectopic endometrial tissue grows outside the uterine cavity. The ectopic endometrium in abdominal wall is called as abdominal wall endometriosis (AWE). AWE is a very rare condition and exact incidence is not known. This is usually known to develop along with previous surgical scars especially following Caesarean section and Hysterectomy.Methods: Retrospective analysis of the patients operated for AWE was done. Data relating to age, symptomology, and previous caesarean section, relation to symptoms with the menstrual cycle, physical examination, surgical treatment and post-operative course was analyzed.Results: 16 patients were operated during the study period of 3 years between September 2013-september 2016.The ages ranged between 20-35 years. Presences of local mass and cyclical pain during menstruation were the main symptoms. Ultrasonography was done in all the cases and CT abdomen was done in few cases (2) to know the exact depth of the mass and to differentiate from other diseases. Wide surgical excision was carried out in all cases.Conclusions: There is definite relationship with AWE and caesarean sections in women

DEVELOPMENT AND VALIDATION OF STABILITY INDICATING RP-HPLC METHOD FOR THE SIMULTANEOUS ESTIMATION OF ACLIDINIUM BROMIDE AND FORMOTEROL FUMARATE IN BULK AND INHALER FORMULATION

Objective: To develop a simple, accurate, precise, rapid and sensitive method for the simultaneous estimation of Formoterol fumarate and Aclidinium bromide in pharmaceutical dosage form. Methods: The chromatogram was run through Ascentis C18 150 x 4.6 mm, 5µ. Mobile phase containing Water: Acetonitrile taken in the ratio 60:40 was pumped through the column at a flow rate of 1.0 ml/min. The temperature was maintained at 30 °C. The optimized wavelength selected was 220 nm. Results: The retention times of Formoterol fumarate and Aclidinium bromide were found to be 2.953 min and 2.364 min. %RSD of the Aclidinium bromide and Formoterol fumarate was found to be 0.6 and 0.9, respectively. %Recovery was obtained as 99.81 % and 100.20% for Aclidinium bromide and Formoterol fumarate, respectively. LOD, LOQ values obtained from the Signal-to-noise ratio of Aclidinium bromide and Formoterol fumarate were 0.84 µg/ml, 2.56 µg/ml and 0.01 µg/ml, 0.03µg/ml respectively. Regression equation of Formoterol fumarate is y =9023x+268.67, and y = 4661.2x+1941.9 of Aclidinium bromide. Retention times were decreased and that run time was decreased, so the method developed was simple, rapid, sensitive and economical that can be adopted in regular quality control tests in Industries. Conclusion: Developed and Validated Formoterol fumarate and Aclidinium bromide in pharmaceutical dosage form by using RP-HPLC method

Autonomous Probabilistic Coprocessing with Petaflips per Second

In this paper we present a concrete design for a probabilistic (p-) computer based on a network of p-bits, robust classical entities fluctuating between -1 and +1, with probabilities that are controlled through an input constructed from the outputs of other p-bits. The architecture of this probabilistic computer is similar to a stochastic neural network with the p-bit playing the role of a binary stochastic neuron, but with one key difference: there is no sequencer used to enforce an ordering of p-bit updates, as is typically required. Instead, we explore \textit{sequencerless} designs where all p-bits are allowed to flip autonomously and demonstrate that such designs can allow ultrafast operation unconstrained by available clock speeds without compromising the solution's fidelity. Based on experimental results from a hardware benchmark of the autonomous design and benchmarked device models, we project that a nanomagnetic implementation can scale to achieve petaflips per second with millions of neurons. A key contribution of this paper is the focus on a hardware metric $-$ flips per second $-$ as a problem and substrate-independent figure-of-merit for an emerging class of hardware annealers known as Ising Machines. Much like the shrinking feature sizes of transistors that have continually driven Moore's Law, we believe that flips per second can be continually improved in later technology generations of a wide class of probabilistic, domain specific hardware.Comment: 13 pages, 8 figures, 1 tabl

Role of adipokines, oxidative stress, and endotoxins in the pathogenesis of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is associated with chronic inflammation and oxidative stress, implicated in the pathophysiology of non-alcoholic fatty liver disease (NAFLD). Present study aimed to assess the role of adipokines, oxidative stress, and endotoxins in the pathogenesis of NAFLD in T2DM.Methods: Present cross-sectional observational study included healthy controls (n=50; group 1); T2DM patients without NAFLD (n=50; group 2), T2DM patients with NAFLD (n=50; group 3). Study subjects were age and gender matched.Results: Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high sensitive C-reactive protein (hs-CRP), endotoxin, malondialdehyde (MDA) were significantly elevated and adiponectin, ferric reducing ability of plasma (FRAP), and glutathione (GSH) were significantly lower (p<0.001) in T2DM patients with NAFLD when compared to T2DM patients without NAFLD and controls. Endotoxin showed significant positive correlation with TNF-α (r=0.304; p<0.001), hs-CRP (r=0.193; p=0.018), and MDA (r=0.420; p<0.001), and significant negative correlation with adiponectin (r=-0.406; p<0.001). TNF-α and IL-6 showed significant positive correlation with MDA (r=0.526; p<0.001, r=0.229; p=0.005) and significant negative correlation with adiponectin (r=-0.396; p<0.001, r=-0.318; p<0.001), FRAP (r=-0.418; p<00.001, r=-0.170; p=0.038), and GSH (r=-0.353; p<0.001, r=-0.301; p<0.001).Conclusions: Authors observed elevated endotoxin, oxidative stress, inflammation and lower adiponectin levels in T2DM subjects compared to controls. These changes were more pronounced in T2DM with NAFLD when compared to T2DM without NAFLD.  Lower adiponectin levels were found to be a better predictor of NALFD in T2DM and is associated with oxidative stress and systemic inflammation

Text Line Segmentation of Historical Documents: a Survey

There is a huge amount of historical documents in libraries and in various National Archives that have not been exploited electronically. Although automatic reading of complete pages remains, in most cases, a long-term objective, tasks such as word spotting, text/image alignment, authentication and extraction of specific fields are in use today. For all these tasks, a major step is document segmentation into text lines. Because of the low quality and the complexity of these documents (background noise, artifacts due to aging, interfering lines),automatic text line segmentation remains an open research field. The objective of this paper is to present a survey of existing methods, developed during the last decade, and dedicated to documents of historical interest.Comment: 25 pages, submitted version, To appear in International Journal on Document Analysis and Recognition, On line version available at http://www.springerlink.com/content/k2813176280456k3

Predictors of Academic Procrastination in Asian International College Students

This study examined the relationships among acculturative stress, coping styles, self-efficacy, English language proficiency, and various demographic characteristics as predictors of procrastination behavior in Asian International students (N = 255) studying in the United States. Results of multiple logistic regression indicated that a collective coping style, avoidant coping style, academic self-efficacy, and English language proficiency were the significant predictors of academic procrastination in non-Indian Asian international students. Implications for college student affairs professionals and researchers are addressed

Impact and Perception of Virtual Team-based Learning in Comparison to Online Lectures in Pharmacology- A Randomised Crossover Interventional Study

Introduction: Competency-based Medical Education (CBME) emphasizes small group teaching; henceforth, more innovative educational strategies are needed to stimulate student learning. Team-based Learning (TBL) is structured small-group teaching featuring student preparation out of class to acquire critical concepts. In the current study, TBL was carried out on a virtual platform using commonly available web applications. Aim: To evaluate the impact and perception of virtual TBL compared to online lectures in Pharmacology. Materials and Methods: The randomised crossover study was conducted from September 2021 to January 2022, in the Pharmacology department of Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. The students were assigned into two groups in the ratio of 1:1 by simple random sampling. Students in group A attended TBL sessions, whereas group B attended lectures on the same topic via Google classroom for the first session. A crossover of groups was done for the second session. At the end of both sessions, a questionnaire with Multiple Choice Questions (MCQs) to assess knowledge recall and Short Answer Questions (SAQs) to assess critical analysis was sent to both groups in Google forms, and responses were collected and evaluated. A validated 33 item TBL Student Assessment Instrument (TBL-SAI) was used to determine the student perceptions. An unpaired t-test was used to compare the scores of both groups to assess performance. Mann-Whitney U test was used to compare the student accountability, preference, and satisfaction scales of TBL-SAI. Results: Out of 130 students, 125 were taken up for analysis as five failed to attend the sessions or complete the questionnaire. TBL group scored significantly better than the lecture group in MCQs {(15.8±2.2 vs 12±2.6) and (12.7±3.5 vs 6.4±2.2)} and SAQs {(5.4±2.1 vs 2.3±1.4) and (6.1±2.0 vs 3.3±1.9)} in sessions 1 and 2, respectively. TBL-SAI subscale and total scores were higher than neutral scores in both groups, indicating a positive attitude toward virtual TBL. Conclusion: Implementation of virtual TBL in synchronous setting in Pharmacology course established proof of high student accountability and satisfaction. Students preferred online TBL to online lectures. Virtual TBL sessions were more effective than online lectures