Use of Misoprostol for Induction of Labour

Background: To find out safety and efficacy of Misoprostol in induction of labour at term in women with live fetus through vaginal versus sublingual route Methods: In this cross sectional study, total of 200 pregnant women at term (37-42 week) with live fetus were selected randomly for induction of labour with tab misoprostol. These women were divided in two groups with 100 women in each group. Misoprostol was administered in a dose of 50 microgram (1/4th tab),in group I through vaginal route and in group II through sublingual route. Maximum of three doses were given in 24 hours and resumed on next day if there was no improvement. Results: Number of doses of misoprostol used for induction of labour was less than two in 68% cases in group I and 78% cases in group II, while more than two doses were used in 32%cases in vaginal group and 22% in sublingual group. Administration to induction interval was less than 12 hours in 60% cases in vaginal group and 80% cases in sublingual group. Total duration of labour was less than 8 hours, seen in more cases of sublingual group than vaginal group i.e56% versus 40%. Vaginal delivery was achieved in 60% cases in vaginal group and 70%cases in sublingual group with rate of caesarean section 40% versus 30% respectively. Regarding fetal outcome, fetal distress and meconium stained liquor was seen in 26% and 24% cases in vaginal and sublingual groups respectively, showing no significant difference between two groups. However neonatal intensive care unit(NICU) admissions were more in vaginal group than sublingual group i.e. 30% versus 20%.There were 100% live births in both groups with ENND (early neonatal death)02% in each group. Maternal out come was good in both groups. Uterine hyperstimulation was seen in 02%cases in each group while only two cases of fever were seen in sublingual group. There was no case of post partum haemorrhage (PPH) and no maternal death in both groups.. Conclusion: Misoprostol is effective for induction of labour at term with live fetus, more through sublingual than vaginal route. Its safety and efficacy can be further ensured by using lower dosage regimes.

Metabolic syndrome in type 2 diabetes: comparison of WHO, modified ATPIII & IDF criteria

OBJECTIVES: To determine the frequency of metabolic syndrome in type 2 diabetes according to three commonly used operational definitions {World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) and International Diabetes Federation( IDF)}. To evaluate the agreement between these classifications in the Pakistani cohort. METHODS: Data was collected retrospectively of 210 patients with type 2 diabetes visiting outpatient clinics of one of the large tertiary care hospitals at Karachi, Pakistan between June 2008 to November 2008. RESULTS: The prevalence of metabolic syndrome was found to be 81.4% (WHO), 86.7 % (IDF) and 91.9 % (NCEP ATPIII). The degree of agreement (kappa statistic) was found to be highest among IDF & NCEP ATPIII (0.728) as compared to (0.436 & 0.417) between WHO & ATP and WHO & IDF respectively. The most significant predictors for metabolic syndrome were found out to be female gender OR= 8.74 95% CI 1.51-50.53, low HDL cholesterol levels OR = 0.89 95% CI 0.84-0.94 and high systolic blood pressure OR= 1.06 95% CI 1.009-1.11. CONCLUSION: Our study results suggested that NCEP ATPIII and IDF are the most reliable criteria for diagnosing metabolic syndrome in type 2 diabetic patients, with NECP capturing more patients in comparison to IDF definition. The alarmingly high frequency of metabolic syndrome in type 2 diabetes found in this study suggests that primary prevention strategies should be initiated earlier and early in this ethnic group and our health care system should be geared up to cope with this deadly quartet

Development and characterization of efficient k-solubilizing rhizobacteria and mesorhizobial inoculants for chickpea

The use of mineral fertilizers has long been associated with the improved growth of crop plants as well as increased yield potential per unit area. However, the incessant practice of imbalanced fertilizers application has increased the economic and environmental costs for the agricultural sector. The deficiency of potassium (K) has been identified as a primary crop production challenge in certain semi-arid regions where soil-K reserves are increasingly being depleted. This study aimed to isolate and characterize K-solubilizing bacterial strains from the rhizosphere and root nodules of chickpea. Initially, 50 rhizobacterial strains and 50 rhizobial strains were isolated using Aleksandrov’s medium. Each of these collections was narrowed down to 25 strains, following a rigorous qualitative screening based on different physiological, morphological and biochemical tests. From these, five strains each of rhizosphere and nodule origins were selected based on qualitative as well quantitative determination of various growth promoting traits. In addition to efficient potassium and phosphate solubilization, the selected strains displayed better growth conditions, as evident by glucose substrate use at 25◦C and pH 7. In this study, we found that strains SKB3 (rhizosphere) and JKR7 (rhizobia) were the most efficient K-solubilizers. Additionally, they possessed diverse plant growth promoting traits such as root colonization, the synthesis of siderophores, exopolysaccharides, chitinase activity, indole-acetic acid production and 1-aminocyclopropane-1-carboxylic acid deaminase activity. Overall, our results suggest that the application of bacterial K-solubilizers could be employed as a useful K-supplement in K-limited agroecosystems. Moreover, the use of these K-solubilizers may help lead in alleviating the negative environmental impacts associated with chemical fertilizer.I am very grateful to all of those with whom I have had the pleasure to work during this project, especially the Department of Soil and Environmental Sciences, College of Agriculture, University of Sargodha, Sargodha, Pakistan, the Soil & Water Sciences Department (SWD), Institute of Food and Agricultural Sciences (IFAS), University of Florida, USA, and the Higher Education Commission (HEC), Islamabad, Pakistan. Each of the members of the SWD, IFAS, University of Florida, USA, specifically L.Q. Ma, Letuzia Maria De Oliveira and Evandro Da Silva have provided me with extensive personal and professional guidance and have taught me a great deal about both scientific research and life in general during my six months stay there under International Research Support Initiative Program (IRSIP), HEC, Pakistan. The authors would also like to extend their sincere appreciation to the acknowledgment of the research supporting project (RSP-2021/95, King Saud University, Riyadh, Saudi Arabia)

Role of fertilization regime on soil carbon sequestration and crop yield in a maize-cowpea intercropping system on low fertility soils

Achieving food security through intensive agricultural practices on low fertility soils is challenging as crop productivity is increasingly curtailed by the loss of soil structural stability and rapid depletion of soil organic carbon (SOC). As such, the conversion from traditional mono-cropping to legume-cereal intercropping, especially with integrated fertilization, may increase crop yields with the least ecological footprint. We set up a 2-year field experiment in a split-plot design with cowpea-maize monoculture and intercropping under different organic-inorganic fertilization regimes, including no fertilization (control), organic input only (compost), chemical input only (NPK), and multi-nutrient enriched compost (NPKEC). We observed that intercropped maize had a significantly higher biomass yield compared to the corresponding monoculture when fertilized with NPKEC fertilizer. However, cowpea biomass yield differences between monoculture and intercropped plots were comparable under all fertilization regimes. In contrast, the grain yield advantage of both maize and cowpea was significantly enhanced under the intercropping system compared to monoculture, with NPKEC showing the most significant effect among all fertilization regimes. When comparing the relative contribution of the fertilization regime to SOC, the NPKEC fertilizer provided the highest SOC-sequestration (0.30 Mg C/ha yr−1). At the same time, the effect of the cropping system on C-sequestration showed that intercropping provided the highest C-sequestration (0.17 Mg C/ha yr−1) compared to monocultures of both crops. Although compost application significantly increased mineral associated (MAOC) and particulate associated organic carbon (PAOC) concentrations compared to unfertilized control plots, NPKEC fertilization with intercropping system was the most effective combination causing the greatest increase of both soil C pools over time. Based on redundancy analysis (RDA), the positive association of MAOC and PAOC with C-sequestration suggests the importance of both organic fractions as primary C reservoirs conducting SOC storage. Importantly, although compost alone in association with intercropping had a lower C-sequestration, it was associated to a better soil structure as confirmed by its positive relationship with macro-and micro-aggregation, water stable aggregates (WSA), and mean weight diameter (MDA). Overall, our results indicate the importance of restoring soil structure in degraded soils through appropriate land management solutions, such as stoichiometrically balanced fertilization practices (NPKEC) and crop diversification (intercropping), in order to achieve significant gains in SOC storage and, ultimately, improve crop productivity

Water-pipe smoking promotes epithelial-mesenchymal transition and invasion of human breast cancer cells via ERK1/ERK2 pathways.

With the increasing popularity of water-pipe smoking (WPS), it is critical to comprehend how WPS may affect women's health. The main goal of this study is to identify the potential outcome of WPS on human breast cancer progression. Two breast cancer cell lines, MCF7 and BT20, were used in this investigation. We explored the outcome of WPS on cell morphology and cell invasion using inverted microscope and Biocoat Matrigel invasion chambers. On the other hand, Western blot was employed to study the expression patterns of key control genes of cell adhesion and invasion. Our data reveal that WPS induces epithelial-mesenchymal transition (EMT) of MCF7 and BT20 breast cancer cell lines; thus, WPS enhances cell invasion ability of both cell lines in comparison with their matched controls. More significantly, WPS provokes a down- and up-regulation of E-cadherin and focal adhesion kinase (FAK), respectively, which are important key regulators of cancer progression genes. Finally, our data point out that WPS incites the activation of Erk1/Erk2, which could be behind the stimulation of EMT and invasion as well as the deregulation of E-cadherin and FAK expression. Our data show, for the first time, that WPS initiates EMT and stimulates cell invasion of breast cancer cells, which could incite metastatic development in breast cancer patients. Thus, we believe that further studies, both in vitro and in vivo, are required to elucidate the pathogenic outcome of WPS on cancer progression of several human carcinomas including breast

S‐Fertilizer (Elemental Sulfur) Improves the Phytoextraction of Cadmium through Solanum nigrum L.

Soil contamination with toxic heavy metals [such as cadmium (Cd)] is becoming a serious global problem due to the rapid development of the social economy. This study was carried out to assess the beneficial role of two different kinds of (S)‐fertilizer in the phytoremediation of Cd contaminated soil through Solanum nigrum L. Gypsum (Gyp) and Elemental sulfur (ES) was applied alone and in combination with different ratios (0, 100:0, 0:100, 50:50 mg kg−1) accompanied by different Cd levels (0, 25, 50 mg kg−1). After seventy days of sowing, plants were harvested for determination of growth, physiological characteristics, oxidants and antioxidants, along with Cd uptake from different parts of the plant. Cd toxicity significantly inhibited growth, physiology and plant defence systems, and also increased Cd uptake in the roots and shoots of Solanum nigrum L. The application of Gyp 100 mg kg−1 boosted plant growth and physiology along with oxidants and antioxidants activity as compared to ES 100 mg kg−1 alone, and combine application of GYP+ES 50 + 50 mg kg−1. The application of ES 100 mg kg−1 showed an effective approach to decreasing Cd uptake as compared to Gyp 100 mg kg−1. Overall results showed that the combined application of GYP+ES 50 + 50 mg kg−1 significantly enhanced the phytoremediation potential of S. nigrum in Cd contaminated soil. Thus, it is highly recommended to apply the combined application of GYP+ES for phytoremediation of Cd contaminated soil

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Effectiveness of Pipelle as Endometrial Sampling Procedure in Comparison with Dilatation and Curettage

Background: To determine safety and effectiveness ofpipelle for taking endometrial biopsy as out patientprocedure in comparison with dilatation and curettage(D&C).Methods: In this comparative study, detailed clinicalevaluation of 80 patients was done to establish indicationfor endometrial sampling. Subjects were divided into 2groups.In 1st group pipelle (n=40)procedure wasperformed as outpatient procedure without analgesiaunder aseptic conditions.Biopsies were taken and sent forhistopathology and for acid fast bacilli in cases ofinfertility .Subjects were retained for 30 min to observe forany complication. In 2nd group (n=40) patients wereadmitted from out patient department and D&C done onvery next day in operation theatre as formal procedureunder anaesthesia .Patients were retained in ward afterprocedure to observe any post operative complications forone day. Samples were sent for histopathology . ChiSquare test was used for statistical analysis.Results: There was no case of perforation in bothgroups.In first group of Pipelle 36 cases had nopain.When compared to second group statisticalsignificance was .000. Mild bleeding was observed in 2cases of pipelle as compared to 4 cases of 2nd group.Sample was adequate in 37 cases of pipelle while in 39cases of D&C .Histopathology report when compared in 2groups showed statistical significant difference was 0. 05.Conclusion: Endometrial Biopsy with Pipelle is safe,efficient and cost effective means of evaluating uterineendometrium It is associated with minimal discomfort,adequate sampling without need of anaesthesia