A Study on screening of antenatal women for Group B streptococci and the effect of streptococcal colonization on maternal and fetal outcome

INTRODUCTION: Bacterial infections can affect pregnant women prior to implantation of the fertilized ovum, during pregnancy and delivery. These infections can also affect the fetus and newborn. Many women with these infections are asymptomatic necessitating, both a high degree of clinical suspicion and adequate screening tests. Group B streptococcus (GBS) in recent times, has emerged as a leading cause of invasive bacterial infections in newborn globally. The recognition, that maternal colonization with the organism is a key factor, in the occurrence of group B streptococci associated neonatal morbidity and mortality has thus made the pathogen the primary focus of discussion about infection and pregnancy. While advances in prevention strategies have led to the decline in the incidence of neonatal disease in the recent times, Group B streptococcus still remains a major pathogen for neonate, pregnant women and immuno compromised non pregnant adults. AIM OF THE STUDY: 1. To study the prevalence of group B Streptococcal infection at 35-37 weeks of gestation, in normal asymptomatic primi gravida, attending antenatal clinic in a level three tertiary care institution. 2. To evaluate and compare the incidence of preterm labour, premature rupture of membranes and puerperal morbidity in group B streptococcal colonized and non-colonized women. 3. To study and compare, the effect of colonization on the mode of termination of the pregnancy, in group B streptococci positive and negative women. 4. To evaluate the fetal outcome and morbidity in colonized and non colonized mothers in the form of Neonatal Intensive care Unit(NICU) admissions, duration of stay and incidence of neonatal mortality. SUBJECTS AND METHODS: All primi gravid women of 35-37 weeks of gestation attending the antenatal clinic of Institute of Social Obstetrics and Government Kasturba Gandhi Hospital for Women and Children, Triplicane, Chennai were recruited for the study, based on the inclusion and exclusion criteria. The study was approved by the hospital ethical committee. Methodology: Study Design - Analytical Study. Place of study - Institute of Social Obstetrics and Government Kasturba Gandhi Hospital for Women and Children, Chennai – 600005 Duration of Study: January 2006 to July 2007. Inclusion Criteria: 1. Primi with singleton gestation at 35-37 weeks of gestation, 2. Cephalic presentation, 3. No history of sepsis or any other infection in the antenatal period, 4. No other medical or surgical complications, 5. Not on any long term therapy. Exclusion Criteria: 1. All multigravida, 2. Primi gravida with less than 35 weeks of gestation, 3. Non cephalic presentation, 4. Multiple pregnancy, 5. All high risk pregnancies, 6. Patients with uterine anomalies, 7. Associated medical and surgical illness complicating pregnancy, 8. Past history of sepsis in the antenatal period, 9. Patients on any long term therapy. Sample size: - 300 women based on the inclusion and exclusion criteria. CONCLUSION: a. The prevalence of Group B streptococcus infection at 35-37 weeks of gestation in normal, asymptomatic primi attending the routine antenatal clinic in a level three tertiary care institution is 15.66%. b. The incidence of preterm labour in GBS colonized women is 17.02%, and in non colonized women is 4.74%. There is statistically significant increased risk of preterm labour in GBS positive women. c. The incidence of premature rupture of membranes in colonized women is 10.63% and in non colonized women is 2.76%. The association of premature rupture of membranes and GBS positive status is statistically significant. d. The puerperal morbidity in GBS positive women is 44.68%, and in negative women is 9.48%. There is significant increased puerperal morbidity in GBS positive women. e. There is statistically increased incidence of operative deliveries (51.06%) in GBS positive women, when compared to negative women. (27.66%). f. There is statistically significant increase in neonatal morbidity in the form of increased neonatal admissions in GBS positive women (21.27%), when compared to GBS negative women. (5.53%).The number of days of NICU stay of the neonates was not significant in GBS positive women when compared to GBS negative women. g. The neonatal mortality rates were not significant (1/47 babies) in babies born to GBS positive patients when compared to GBS negative patients. (2/253 babies). All the above conclusions, point out the importance of GBS screening during the antenatal period and the need to include it in the screening protocol of our health systems in the present era of evidence based medicine

An Optimal HSI Image Compression using DWT and CP

The compression of hyperspectral images (HSIs) has recently become a very attractive issue for remote sensing applications because of their volumetric data. An efficient method for hyperspectral image compression is presented. The proposed algorithm, based on Discrete Wavelet Transform and CANDECOM/PARAFAC (DWT-CP), exploits both the spectral and the spatial information in the images. The core idea behind our proposed technique is to apply CP on the DWT coefficients of spectral bands of HSIs. We use DWT to effectively separate HSIs into different sub-images and CP to efficiently compact the energy of sub-images. We evaluate the effect of the proposed method on real HSIs and also compare the results with the well-known compression methods. The obtained results show a better performance when comparing with the existing method PCA with JPEG 2000 and 3D SPECK.DOI:http://dx.doi.org/10.11591/ijece.v4i3.6326

Klippel trenaunay syndrome-an obstetric challenge

Klippel Trenaunay Syndrome is a rare congenital disease characterized by triad of extensive cutaneous haemangiomas (most common), venous varicosities and hypertrophy affecting a leg and/or arm on one side. We report two cases of pregnant women with Klippel Trenaunay syndrome of which one patient presented with Kasabach Merritt Syndrome (refractory coagulopathy). 24-year-old primigravida of 29 weeks with KTS presented with bleeding gums for two days. Known case of diabetes, hypothyroid on treatment and treated TB lymphadenopathy. She had hypertrophy with varicosities and haemangiomas on left lower limb and vulvar region. She was treated for thrombocytopenia at 19 weeks gestation with steroids. Laboratory studies revealed thrombocytopenia. Steroids were given as per haematologist opinion for thrombocytopenia. She had emergency caesarean section with platelet transfusion at 35 weeks as per vascular surgeon opinion. Postoperatively she was given anticoagulants and steroids. 28-year-old primigravida of 39 weeks with KTS admitted for safe confinement. She had surgery for haemorrhoids at 14 years of age and had bleeding per rectum two years back. She had hypertrophy of left lower limb and cutaneous nevus in multiple dermatomes on left half of body. Doppler left lower limb shows superficial varicosities. Laboratory studies revealed normal. With multidisciplinary approach, she had elective caesarean in view of primigravida/breech-footling presentation. Post operatively she was given anticoagulants. The success in the management of these patients requires the participation of multidisciplinary approach. The use of prophylactic anticoagulant is generally advised during the pregnancy and postpartum period

Retinal Blood Vessels Extraction Based on Curvelet Transform and by Combining Bothat and Tophat Morphology

Retinal image contains vital information about the health of the sensory part of the visual system. Extracting these features is the first and most important step to analysis of retinal images for various applications of medical or human recognition. The proposed method consists of preprocessing, contrast enhancement and blood vessels extraction stages. In preprocessing, since the green channel from the coloured retinal images has the highest contrast between the subbands so the green component is selected. To uniform the brightness of image adaptive histogram equalization is used since it provides an image with a uniformed, darker background and brighter grey level of the blood vessels. Furthermore Curvelet transforms is used to enhance the contrast of an image by highlighting its edges in various scales and directions. Eventually the combination of Bothat and Tophat morpholological function followed by local thresholding is provided to classify the blood vessels. Hence the retinal blood vessels are separated from the background image.DOI:http://dx.doi.org/10.11591/ijece.v4i3.632

Automated sleep stage classification in sleep apnoea using convolutional neural networks

A sleep disorder is a condition that adversely impacts one\u27s ability to sleep well on a regular schedule. It also occurs as a consequence of numerous neurological sicknesses. These types of disorders can be investigated using laboratory-based polysomnography (PSG) signals. The detection of neurological disorders is exact and efficient thanks to the automated monitoring of sleep relegation stages. This automation method publicly presents a flexible deep learning model and machine learning approach utilizing raw electroencephalogram (EEG) signals. The deep learning model is a Deep Convolutional Neural Network (CNN) that analyses invariant time capacities and frequency actualities and collects assessment adaptations. It also captures the inviolate and long brief length setting conditions between the epochs and the degree of sleep stage relegation. This method uses an innovative function to calculate data loss and misclassified errors found while training the network for the sleep stage, considering the restrictions found in the publicly available sleep datasets. It is used in conjunction with machine learning techniques to forecast the best approach for the process. Its effectiveness is determined by using two open-source, public databases available from PhysioNet: two recordings with 5402 epoch counts. The technique used in this approach achieves an accuracy of 90.70%, precision of 90.50%, recall of 92.70%, and F-measure of 90.60%. The proposed method is more significant than existing models like AlexNet, ResNet, VGGNet, and LeNet. The comparative study of the models could be adopted for clinical use and modified based on the requirements

2-(2,4-Dichloro­phen­yl)-9-phenyl-2,3-di­hydro­thieno[3,2-b]quinoline

In the title compound, C23H15Cl2NS, the quinoline system is almost planar [r.m.s. deviation = 0.013 (2) Å]. The phenyl group is disordered over two positions with site occupancies of 0.55 and 0.45, and is oriented in a nearly perpendicular configuration to the quinoline ring [the dihedral angles between the quinoline ring and the major and minor disordered components of the phenyl ring are 81.8 (2) and 71.6 (2)°, respectively]. The dihydro­thiene ring adopts an envelope conformation. The dihedral angle between the chloro­phenyl ring and the quinoline system is 79.32 (1)°. In the crystal weak C—H⋯π inter­actions occur

Comparative Evaluation of Flexural and Impact Strength of Denture Base Acrylic Resin Using Different Processing Methods: An In Vitro study

STATEMENT OF THE PROBLEM: Chief Limitation of Polymethylmethacrylate denture base material was its inadequate mechanical property. Different processing methods of Polymethylmethacrylate have varying influences on the mechanical properties of denture base material. PURPOSE OF THE STUDY: The Aim of our In-vitro study was to comparatively evaluate the flexural and impact strength values between CAD-CAM, Compression-molded and Injection molded Polymethylmethacrylate specimens. MATERIALS AND METHODS: A total of 66 acrylic rectangular specimens of ISO Standardization (64 x10 x3.3 mm) were fabricated. Study was conducted between three groups: Group I (n=22)-CAD-CAM Milled specimens (Ruthinium, India), Group II (n=22)- Compression-molded specimens (Dental Products of India, Chennai), Group III (n=22)- Injection-molded specimens (SR- Ivocap High Impact, Ivoclar Vivadent). Flexural strength was evaluated using four-point bend test and Impact strength by IZOD Impact tester. Kruskal Wallis unpaired test was used to compare the mean values between groups and Mann Whitney U test was used to carry out pair wise comparison. RESULTS: Flexural strength of CAD-CAM samples were found to be statistically highest followed by injection molded specimens. Conversely, Impact strength of injection molded specimens were highest followed by CAD-CAM specimens. Both values were found to be least among compression-molded specimens. CONCLUSION: CAD-CAM specimens exhibited higher flexural strength whereas Injection molded specimens had the highest impact strength