Study on HELLP syndrome - maternal and perinatal outcome

Background: HELLP Syndrome is a serious obstetric complication in pregnancy characterised by haemolysis, elevated liver enzymes and low platelet count. Incidence is 0.5-0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia and eclampsia. The aim of the study was to study the incidence, different clinical presentations and diagnosis of HELLP syndrome in Pre eclampsia and Eclampsia and to analyze the severity, complications, maternal and perinatal outcome.Methods: It is a 16 months period retrospective study of 102 cases of preeclampsia and eclampsia admitted in NRIMC and GH in OBGY Department with more than 28 weeks gestation. Of these, 91 cases had preeclampsia and 11 cases had eclampsia. Out of these, 15 cases developed HELLP Syndrome. The available history, clinical data, detailed laboratory investigations were studied and categorized by Mississippi classification for better analysis of complications and outcome in HELLP syndrome.Results: Of 91 cases of Preeclampsia, 12 cases (13.18%) developed HELLP syndrome and out of 11 cases of Eclampsia, 3 cases (27.27%) had HELLP Syndrome. Majority of the cases belonged to 21-25years age group and were mostly from lower Socio economic status. The present study showed 60% maternal morbidity and 6.6% maternal mortality and the perinatal morbidity and mortality was 46.6% each.Conclusions: HELLP Syndrome is a severe variant and a dreadful complication of Preeclampsia and Eclampsia, it needs early diagnosis and timely intervention in the form of termination of pregnancy to arrest further progress of pathophysiology leading to complications

DISCOSOMES: A FUTURISTIC UPHEAVAL IN VESICULAR DRUG DELIVERY

The formulation system employed to convey pharmaceutical drugs compound in the body to attain the desired therapeutic effect at a predetermined rate depending on pharmacological aspects, drug profile, and physiological conditions can be referred to as a novel drug delivery system (NDDS). Due to the intricately sensitive anatomy and physiology of the eye pharmacologist find the ocular delivery system to be more involuted than other routes. Pre-corneal, static and dynamic is the 3 types of ophthalmic barriers, which along with the inflow and outflow of lacrimal fluids, nasolacrimal drainage, are some of the germane factors that affect bioavailability. Unlike conventional dosage forms, where the distribution of drugs in non-targeted body fluids and tissues transcends the quantity of required drug in targeted tissues and causes repercussions, these modified drug delivery systems surpass the ocular barriers and adverse reactions, emphasizing on less invasive, prolonged action. It also promotes sustained release formulation that subjugates the drug loss or degradation to treat many ocular diseases effectively. The current review recapitulates the fundamentals of discosomes, a type of vesicular drug delivery system that acts as a vehicle for the drug delivery of both hydrophilic and lipophilic drugs. Discosomes are giant, disc-shaped structures modified from niosomes by arresting the vesicles at the discosome phase. Due to their idiosyncratic size, it provides all due benefits compared to other ocular drug delivery systems. From the review, it can be culminated that discosomes are a potential subject of opposition and opportunities in the arena of safe and effective ocular drug delivery

A SENSIBLE FARM WATERING STRATEGY USING MUD HUMIDITY AND HEAT

The aim of coordinator node would be to collect the parameters like soil moisture and soil temperature wirelessly. Each sensor node includes soil moisture and soil temperature sensor and something ZigBee RF antenna device for communication using the coordinator node. The Apache server crated on Raspberry Pi easily displaying the items in sensor data. Raspberry Pi stores collected data within the database and analyzes the stored data. The machine works based on the formula produced for watering the crop. The module includes, recognition probe, and sensor board. It's getting triple output mode, digital, analog, and serial with exact readings. Within this paper, Raspberry Pi can be used being an embedded Linux board that is designed in line with the arm 11 microcontroller architecture. Embedded Linux board helps make the communication with all of distributed sensor nodes put into the farm through ZigBee protocol and itself behave as a coordinated node within the wireless sensor network. The ZigBee protocol can be used for wireless communication it'll create network easily and mixture of Arduino, Xbee and sensor produce a low power affordable sensor node. More water contained in the soil helps make the soil conduct electrical current easier indicate less resistance, while dry soil getting less water conducts electricity poorly indicate more resistance. The board comes with an Ethernet interface and runs the straightforward data server

Reliability and validity of an enhanced paper grip test; a simple clinical test for assessing lower limb strength

Background The paper-grip-test (PGT) involves pulling a small card from underneath the participant’s foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force). Research question Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength? Methods Reliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured. Results Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83%±4% of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88% in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more. Significance EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment

Apoptosis Inducing Effect of Plumbagin on Colonic Cancer Cells Depends on Expression of COX-2

Plumbagin, a quinonoid found in the plants of the Plumbaginaceae, possesses medicinal properties. In this study we investigated the anti-proliferative and apoptotic activity of plumbagin by using two human colonic cancer cell lines, HT29 and HCT15. IC50 of Plumbagin for HCT15 and HT29 cells (22.5 µM and 62.5 µM, respectively) were significantly different. To study the response of cancer cells during treatment strategies, cells were treated with two different concentrations, 15 µM, 30 µM for HCT15 and 50 µM, 75 µM for HT29 cells. Though activation of NFκB, Caspases-3, elevated levels of TNF-α, cytosolic Cytochrome C were seen in both HCT15 cells HT29 treated with plumbagin, aberrant apoptosis with decreased level of pEGFR, pAkt, pGsk-3β, PCNA and Cyclin D1was observed only in 15 µM and 30 µM plumbagin treated HCT15 and 75 µM plumbagin treated HT29 cells. This suggests that plumbagin induces apoptosis in both HCT15 cells and HT29 treated, whereas, proliferation was inhibited only in 15 µM and 30 µM plumbagin treated HCT15 and 75 µM plumbagin treated HT29 cells, but not in 50 µM plumbagin treated HT29 cells. Expression of COX-2 was decreased in 75 µM plumbagin treated HT29 cells when compared to 50 µM plumbagin treated HT29 cells, whereas HCT15 cells lack COX. Hence the observed resistance to induction of apoptosis in 50 µM plumbagin treated HT29 cells are attributed to the expression of COX-2. In conclusion, plumbagin induces apoptosis in colonic cancer cells through TNF-α mediated pathway depending on expression of COX-2 expression

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Efficacy of the q-switched neodymium: Yttrium aluminum garnet laser in the treatment of blue-black amateur and professional tattoos

Background: Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same. Aim: The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions. Materials and Methods: This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4-6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm 2 . The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs. Results: After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos. Conclusion: Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals

Detection Of Leakage In Boilers Using Helium Leakage Detector

It is important to develop a system in which leakage in a boiler can be detected to minimize the accidents­ in nuclear power plant. Leakage in a boiler can be ensured using a system employing vacuum pump system which is automated by PLC. The present work aims to monitor the leakage in a nuclear boiler by deriving the pressure solution as functions of pressure and the opening or closing of valves in the nuclear boiler. The proposed system is expected to optimize the overall vacuum system design of a boiler during shutdown period

Preoperative maltodextrin in minimally invasive colorectal surgery: Is it safe for diabetics? A randomised controlled trial

Background and Aims: Preoperative fasting can result in thirst and fatigue. We evaluated the blood glucose levels during and after surgery following the administration of maltodextrin among patients including diabetics, undergoing minimally invasive colorectal surgery. Methods: One hundred and fifty patients undergoing colorectal surgery were randomised into group CL (received 50 g of 12.5% maltodextrin dissolved in 400 ml of water 2 h before surgery) and group W (received 400 ml of plain water 2 h before surgery). Blood glucose was checked at T0 (induction of anaesthesia), T2 (2 h), T4 (4 h), T6 (6 h) of surgery and eight hourly postoperatively in the intensive care unit (ICU) for 24 h. Thirst or discomfort before induction, gastric aspirate after intubation, incidence of hyperglycaemia and need for insulin intervention intra- and postoperatively were also assessed. Results: Mean (standard deviation [SD]) blood glucose levels were lower at T2 in group CL (136.2 [28.4] mg/dl) than in group W (157.8 [37.8] mg/dl) (P < 0.001). It remained lower in group CL at T4 (P = 0.008), T6 (P = 0.009), T8 ICU (P = 0.012), T16 ICU (P = 0.001) and T24 ICU (P = 0.001). The thirst scores were superior in group CL (P < 0.001). Among diabetic patients, blood glucose levels remained significantly lower at T2 (P < 0.001), T4 (P = 0.002), T6 (P = 0.002), T8 ICU, T16 ICU and T24 ICU (P = 0.016, 0.025 and 0.003, respectively). Lesser number of insulin interventions at T4 (P = 0.006), T6 (P = 0.002), T8 ICU (P = 0.025) and T16 ICU (P = 0.012) was needed in group CL in the diabetic subgroup. Conclusion: Preoperative administration of oral maltodextrin lowers the blood glucose levels from 2 h into surgery until 24 h postoperatively, even among controlled diabetic patients, and improves preoperative thirst scores in patients undergoing minimally invasive colorectal surgery