Correlation between obstetric outcome and amniotic fluid index (AFI) in preterm prelabour rupture of membranes (PPROM)

Background: The purpose was to determine whether AFI 5 after PPROM between 24- and 37-weeks’ gestation

A study to find out the association between duration of preterm premature rupture of the membrane’s delivery interval and maternofetal complications

Background: The main maternal complications of preterm premature rupture of the membranes (PPROM) are chorioamnionitis, puerperal pyrexia, abruption and the neonatal complications are neonatal sepsis, congenital pneumonia, neonatal ICU stay and neonatal death. The aim of the study is to find out the association between duration of latent period in PPROM i.e. the time period between rupture of membrane to delivery and maternofetal complications.Methods: The present study was a Prospective observational study conducted on 240 preterm antenatal women with PPROM in the Department Obstetrics and Gynecology, SATH, GMC, Thiruvananthapuram. The gestational age at rupture of membranes, latent period from time rupture of membranes to delivery, gestational age at time of delivery and the maternal and neonatal outcome were compared and subjected to statistical analysis.Results: Maternal chorioamnionitis in the group with PPROM delivery interval between 2-7 days (79.3%) whereas there were (13.8%) in which PPROM delivery interval was less than 24 hrs. Puerperal pyrexia in 2-7 days delivery interval was 11.3% and in <24 hrs were 2.6%. Neonatal sepsis in 2-7 days was 28.3% and 12.5% in<24 hrs. Congenital pneumonia in 2-7 days was 16.9% and in<24 hrs was 11.6%.Conclusions: In the present study membrane rupture between 28-34 weeks gest age and latency period. 2-7 days were associated with high incidence of maternal chorioamnionitis, puerperal pyrexia congenital pneumonia, early onset neonatal sepsis and neonatal death. Undue prolongation of pregnancy may increase the risk of chorioamnionitis, neonatal sepsis and neonatal deaths

A study on the obstetric outcome in preterm pre-labour rupture of membranes

Background: The major risks to the baby following preterm pre-labour rupture of membranes (PPROM) are related to the complications of prematurity. Since the goal of management in PPROM is prolongation of pregnancy, the most commonly accepted management scheme for the patient less than 34 weeks is expectant management in the hospital which consists of careful observation for signs of infection, labour or fetal distress in an effort to gain time for fetal growth and maturation.Methods: Patients admitted in Obstetrics and Gynaecology Department SAT Hospital, Medical College Trivandrum, Kerala with PPROM meeting the inclusion and exclusion criteria were recruited for the study. They were followed in the antenatal, intrapartum and postnatal period and the babies were also followed in the postnatal ward. The maternal and neonatal outcome were analysed and studied.Results: Maternal chorioamnionitis developed in 12.1% of cases, abruption 1.7%, puerperal pyrexia 8.8%, early onset neonatal sepsis in 22.9% of cases, congenital pneumonia in 17% cases and neonatal deaths in 6.3% of cases. The mean gestational age at delivery in this study was 33.42 weeks with majority of cases delivering between 32-34 weeks.Conclusions: The study suggests that maternal chorioamnionitis, puerperal pyrexia, congenital pneumonia, early onset neonatal sepsis, neonatal death, and requirement for ICU care occur with increased frequency in cohorts with PPROM. The present study concluded that most common maternal morbidity associated with PPROM was chorioamnionitis, that of neonatal morbidity was prematurity and its complications. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure healthy and fruitful life for the mother and her baby

Studies on the Corrosion Performance for Steel Embedded in Fly Ash Blended Concrete

The present investigation it to study the corrosion performance of fly ash blended cement concrete in chloride-contaminated environments by various electrochemical and non-electrochemical techniques. The chloride binding ability at the optimum replacement level of fly ash was also studied

Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh

Background: Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. Methods: We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18–22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. Findings: We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87–1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. Interpretation: Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. Funding: National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. Translations: For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section

Leveraging technology-driven strategies to untangle omics big data: circumventing roadblocks in clinical facets of oral cancer

Oral cancer is one of the 19most rapidly progressing cancers associated with significant mortality, owing to its extreme degree of invasiveness and aggressive inclination. The early occurrences of this cancer can be clinically deceiving leading to a poor overall survival rate. The primary concerns from a clinical perspective include delayed diagnosis, rapid disease progression, resistance to various chemotherapeutic regimens, and aggressive metastasis, which collectively pose a substantial threat to prognosis. Conventional clinical practices observed since antiquity no longer offer the best possible options to circumvent these roadblocks. The world of current cancer research has been revolutionized with the advent of state-of-the-art technology-driven strategies that offer a ray of hope in confronting said challenges by highlighting the crucial underlying molecular mechanisms and drivers. In recent years, bioinformatics and Machine Learning (ML) techniques have enhanced the possibility of early detection, evaluation of prognosis, and individualization of therapy. This review elaborates on the application of the aforesaid techniques in unraveling potential hints from omics big data to address the complexities existing in various clinical facets of oral cancer. The first section demonstrates the utilization of omics data and ML to disentangle the impediments related to diagnosis. This includes the application of technology-based strategies to optimize early detection, classification, and staging via uncovering biomarkers and molecular signatures. Furthermore, breakthrough concepts such as salivaomics-driven non-invasive biomarker discovery and omics-complemented surgical interventions are articulated in detail. In the following part, the identification of novel disease-specific targets alongside potential therapeutic agents to confront oral cancer via omics-based methodologies is presented. Additionally, a special emphasis is placed on drug resistance, precision medicine, and drug repurposing. In the final section, we discuss the research approaches oriented toward unveiling the prognostic biomarkers and constructing prediction models to capture the metastatic potential of the tumors. Overall, we intend to provide a bird’s eye view of the various omics, bioinformatics, and ML approaches currently being used in oral cancer research through relevant case studies

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Abstract: Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis

BACKGROUND Patisiran, an investigational RNA interference therapeutic agent, specifically inhibits hepatic synthesis of transthyretin. METHODS In this phase 3 trial, we randomly assigned patients with hereditary transthyretin amyloidosis with polyneuropathy, in a 2:1 ratio, to receive intravenous patisiran (0.3 mg per kilogram of body weight) or placebo once every 3 weeks. The primary end point was the change from baseline in the modified Neuropathy Impairment Score+7 (mNIS+7; range, 0 to 304, with higher scores indicating more impairment) at 18 months. Other assessments included the Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) questionnaire (range, −4 to 136, with higher scores indicating worse quality of life), 10-m walk test (with gait speed measured in meters per second), and modified body-mass index (modified BMI, defined as [weight in kilograms divided by square of height in meters]×albumin level in grams per liter; lower values indicated worse nutritional status). RESULTS A total of 225 patients underwent randomization (148 to the patisiran group and 77 to the placebo group). The mean (±SD) mNIS+7 at baseline was 80.9±41.5 in the patisiran group and 74.6±37.0 in the placebo group; the least-squares mean (±SE) change from baseline was −6.0±1.7 versus 28.0±2.6 (difference, −34.0 points; P<0.001) at 18 months. The mean (±SD) baseline Norfolk QOL-DN score was 59.6±28.2 in the patisiran group and 55.5±24.3 in the placebo group; the least-squares mean (±SE) change from baseline was −6.7±1.8 versus 14.4±2.7 (difference, −21.1 points; P<0.001) at 18 months. Patisiran also showed an effect on gait speed and modified BMI. At 18 months, the least-squares mean change from baseline in gait speed was 0.08±0.02 m per second with patisiran versus −0.24±0.04 m per second with placebo (difference, 0.31 m per second; P<0.001), and the least-squares mean change from baseline in the modified BMI was −3.7±9.6 versus −119.4±14.5 (difference, 115.7; P<0.001). Approximately 20% of the patients who received patisiran and 10% of those who received placebo had mild or moderate infusion-related reactions; the overall incidence and types of adverse events were similar in the two groups. CONCLUSIONS In this trial, patisiran improved multiple clinical manifestations of hereditary transthyretin amyloidosis