HELLP syndrome and its implications on maternal and perinatal outcome

Background: The HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). This syndrome in general complicates 0.2-0.6% of all pregnancies but its incidence increases to 4-12% in severe preeclampsia. In about 15% cases, HELLP syndrome presents without definitive criteria for preeclampsia (atypical preeclampsia). This present study will throw light on incidence, clinical and biochemical profile of patients with HELLP syndrome and maternal and perinatal outcome.Methods: A prospective study was conducted in the department of Obstetrics and Gynecology, Bebe Nanki Mother and Child Care Centre, Amritsar, India from January 2016 to August 2017 after approval from institutional ethics committee.Results: In the present study, total 2949 antenatal admissions were there during the course of study. Out of these patients, 352 patients had preeclampsia-eclampsia (11.93%). Out of these 352 patients, 71 complicated with HELLP syndrome (20.17%). 17.9% had partial HELLP and 2.3% had complete HELLP syndrome. 30.16% had only EL, 31.75% had only LP, 87.3% had elevated LDH (depicted hemolysis). 4.76% had both EL and LP, 30.16% had both EL and elevated LDH, 20.63% had both LP and elevated LDH levels. Majority of the patients presented after 36 weeks of gestation. Only 5 patients had HELLP syndrome in the postpartum period. Among partial HELLP patients, 59.02% delivered vaginally and 40.98% delivered by LSCS and among complete HELLP patients 28.6% delivered vaginally and 71.4% delivered by LSCS. Perinatal mortality rate was 43.7%. Severe maternal complications such as PPH, DIC, abruptio placentae, pulmonary edema and renal failure were seen high among HELLP patients.Conclusions: As the incidence is very high, one must be aware of its clinical and laboratory findings so that early diagnosis and treatment can be initiated. Close surveillance of the mother should be continued even after delivery

How automated image analysis techniques help scientists in species identification and classification?

Identification of taxonomy at a specific level is time consuming and reliant upon expert ecologists. Hence the demand for automated species identification incre­ased over the last two decades. Automation of data classification is primarily focussed on images while incorporating and analysing image data has recently become easier due to developments in computational technology. Research ef­forts on identification of species include specimens’ image processing, extraction of identical features, followed by classifying them into correct categories. In this paper, we discuss recent automated species identification systems, mainly for categorising and evaluating their methods. We reviewed and compared different methods in step by step scheme of automated identification and classification systems of species images. The selection of methods is influenced by many variables such as level of classification, number of training data and complexity of images. The aim of writing this paper is to provide researchers and scientists an extensive background study on work related to automated species identification, focusing on pattern recognition techniques in building such systems for biodiversity studies. (Folia Morphol 2018; 77, 2: 179–193

Need to Adopt a Patient Centered Approach for Obtaining Favourable Results of Non- Pharmacological Interventions among Knee Osteoarthritis Patients in Out Patient Department Settings

Knee osteoarthritis (KOA) is one of the common causes of disability. Long-term effects of early to moderate KOA can be managed through non-surgical interventions. But due to overcrowding in Orthopaedic OPDs, doctors don’t have enough time for explaining non pharmacological interventions (NPIs) in detail to KOA patients. Hence, desired impact of NPIs is not evident among KOA patients. This study elaborates the degree of patient centered approach adopted during doctor patient interactions in the Orthopedics OPD of a tertiary care hospital of India. The study was conducted in 2012-2015. Eligible KOA patients (N=123) were divided into two groups for the RCT. The patients aged 40-65 years of either gender without significant deformity or co-morbidities needing surgery (e.g. meniscus tears etc) were enrolled. An intervention room was established in Physical and Rehabilitation Medicine (PRM) department of the hospital. Doctors of Orthopaedics and PRM departments were requested to send grade 1, 2, 3 KOA patients as per Kellgren Lawrence scale to intervention room after initial work up. A referral system was established for this. Interviews of the diagnosed patients (N=31) suffering from mild and moderate KOA were conducted. Textual analysis was done for qualitative data. Patients are unable to comprehend ‘capsule form’ of advice provided in OPDs. This results in non-adherence. For better outcomes physicians must talk to patients. They need to understand the patient’s underlying concerns, against their cultural background, and life history. Hence, patient centred approach is needed for obtaining the desired impact of NPIs in KOA patients reporting to Orthopaedics OPD in Indian hospitals

Study of prevalence of bacterial vaginosis in preterm and term labour patients

Background: Bacterial vaginosis (BV) is a clinical condition caused by replacement of the normal hydrogen peroxide producing Lactobacillus species with high concentrations of aerobic and anaerobic bacteria. Studies have shown that spontaneous abortion, preterm labour (PTL), premature birth, preterm premature rupture of membranes, amniotic fluid infection, and postpartum endometritis are increased because of infection with BV. In India, not many studies have been done to estimate the prevalence and association of BV with preterm labour, hence this study is being taken up to know the prevalence of BV in preterm and term labour patients and its relationship with preterm delivery, low birth weight of baby and puerperal sepsis.The objective of the present study was to observe the prevalence of bacterial vaginosis in women presenting with preterm and term labour, its impact on preterm and term delivery and to analyze the maternal and fetal complications associated with BV.Methods: An observational study involving 100 patients with preterm and term labour (50 patients in each group) was conducted at a BNMCCC, Government Medical College, Amritsar. Women fulfilling the Amsel’s criteria and/or a score of 7 or more on gram staining of vaginal smears (Nugent’s score) was considered to have bacterial vaginosis.Results: The proportion of patients, who fulfilled Amsel’s criteria and/or a Nugent’s score of 7 or more for the diagnosis of BV, was more in PTL group versus term labour group, and the difference was statistically significant. Prevalence of BV in preterm labour and term labour patients was 18(36%) versus 4(8%) respectively. In PTL group, 27.8% of low birth weight neonates were born to BV positive mothers versus 3.1% were born to BV negative mothers. Maternal postpartum complications observed were 33.3% with BV versus 6.25% without BV in PTL group.Conclusions: BV is major risk factor for PTL. Therefore, the testing and prompt treatment of BV may reduce the risk of PTL. This will also go a long way in the prevention of maternal morbidity and neonatal complications due to prematurity

Digital Financial Inclusion in a Cashless Society

Quarriers commissioned the Rix Inclusive Research team to carry out an evaluation study to explore how people with learning disabilities manage and use their money, what works and what is difficult. This report details the activities undertaken by the research team as part of this phase. It provides an account of the aims and objectives, methodology, points of discussion, conclusion, and recommendations for Phase 2 of the project, which will consider possible practical solutions to support people with learning disabilities to move from cash to cashless (digital) payments, and towards digital finance overall, in order to fully participate in the cashless society

Rearrangement of Parthenin and its derivatives using H2SO4-Ac2O

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Genotoxic Effects of Rice-Agrochemicals on Channa punctatus (Bloch) and Cyprinus carpio (Linnaeus) Using Micronucleus Assay and Alkaline Single Cell Gel Electrophoresis

Rice-cum-fish culture is a cost-effective practice for marginal farmers but the major constraint is the indiscriminate use of agrochemicals. Present work was designed to assess the genotoxic effects of rice agrochemicals in Channa punctatus (Experiment 1 CP1 to CP3) and Cyprinus carpio (Experiment 2 CC1 to CC3); using micronucleus, chromosome aberration, and single cell gel electrophoresis/Comet assay. Two experiments with three treatments (CP1/CC1: without pesticide; CP2/CC2: recommended doses; CP3/CC3: farmers’ dose) were maintained in triplicates. The presence of tail DNA and micronuclei depicted significant DNA damage (P<0.05) in all the treated fish. The mean percent frequency of MN showed significant (P<0.05) differences with respect to the initial. The chromosomal aberrations and mean frequencies of tail DNA (%) were significantly abundant in CP3 and CC3 indicating high a genotoxic effect. Keeping in view the low genotoxic effects, treatment of CP2 and CC2 with recommended doses of pesticides may be disseminated to farmers

Identification of selected monogeneans using image processing, artificial neural network and K-nearest neighbor

Over the last two decades, improvements in developing computational tools have made significant contributions to the classification of images of biological specimens to their corresponding species. These days, identification of biological species is much easier for taxonomists and even non-taxonomists due to the development of automated computer techniques and systems. In this study, we developed a fully automated identification model for monogenean images based on the shape characters of the haptoral organs of eight species: Sinodiplectanotrema malayanum, Diplectanum jaculator, Trianchoratus pahangensis, Trianchoratus lonianchoratus, Trianchoratus malayensis, Metahaliotrema ypsilocleithru, Metahaliotrema mizellei and Metahaliotrema similis. Linear Discriminant Analysis (LDA) method was used to reduce the dimension of extracted feature vectors which were then used in the classification with K-Nearest Neighbor (KNN) and Artificial Neural Network (ANN) classifiers for the identification of monogenean specimens of eight species. The need for the discovery of new characters for identification of species has been acknowledged for log by systematic parasitology. Using the overall form of anchors and bars for extraction of features led to acceptable results in automated classification of monogeneans. To date, this is the first fully automated identification model for monogeneans with an accuracy of 86.25% using KNN and 93.1% using ANN

General practitioners' perceptions on home medicines reviews: A qualitative analysis

Background: Home Medicines Review (HMR) is an Australian initiative introduced in 2001 to improve quality use of medicines. Medication management services such as HMRs have the potential to reduce medication related problems. In 2011, changes to the HMR program were introduced to allow for referrals directly to accredited pharmacists in addition to the community pharmacy referral model. These changes were introduced to improve efficiency of the process. This study explored the perceptions of Western Australian general practitioners (GPs) on benefits and barriers of the HMR service and process, including their insights into the direct referral model. Methods: Purposive sampling of GPs who had experience ensured that participants had a working knowledge of the HMR service. Semi structured interviews with 24 GPs from 14 metropolitan Western Australian medical centres between March and May 2013. Transcribing and thematic analysis of data were performed. Results: Most GPs had positive attitudes towards the HMR service. Main perceived benefits of the service were poly-pharmacy reduction and education for both the GP and patient. Strategies identified to improve the service were introduction of a standard HMR report template for pharmacists and better use of technology. Whilst reliability and GPs' familiarity were the main perceived benefits of the direct referral model, a number of GPs agreed that patient unfamiliarity with the HMR pharmacist was a barrier. Conclusions: Despite recognition of the value of the HMR service participating GPs were of the opinion that there are aspects of the HMR service that could be improved. As one of the success factors of HMRs is relying on GPs to utilise this service, this study provides valuable insight into issues that need to be addressed to improve HMR uptake