Assessment of clinical methods and ultrasound in predicting fetal birth weight in term pregnant women

Background: Birth weight is the greatest single factor in the survival of fetus and important factor of neonatal problems. Thus estimating fetal weight antenatally is important to the obstetricians to prevent respiratory morbidity and anticipate problems of shoulder dystocia. The objectives of this study were to assess the fetal weight in term pregnancies by various clinical methods and Ultrasound and to correlate these methods of estimation of fetal weight with the actual birth weight of the baby after delivery.Methods: Between January 2013 to June 2014 a prospective cross-sectional hospital based study was conducted at the Department of Obstetrics and Gynaecology of Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences Gangtok. All subjects with singleton pregnancy with reliable date/dating scan, with no fetal anomalies, undergoing obstetric scan at term one week prior to delivery were included. Estimated fetal weight (EFW) was calculated by clinical method AG×SFH (Abdominal girth x Symphysiofundal height) and Johnson’s formula. Hadlock formula using Ultrasound was used. EFW were compared with the actual birth weight.Results: Two hundred women were recruited during the study period. Mean age of the women were 25.24 ±3.32 years and mean gestational age was 38.83 ± 1.10 weeks. For all the cases scan delivery interval was less than seven days. Sixty nine percent of birth weights were distributed between 2000-3500 grams. Mean birth weight of Hadlock’s formula (3240 grams) was closest to the mean of actual birth weight (3100 grams). Hadlock Formula was more accurate for birth range between 2500-3500 grams followed by AG×SFH. For Large for Gestational age babies Johnson’s Formula was found to be better. Average error in estimating fetal weight was 190.34 grams by Hadlock’s formula, 208.78 grams by AG x SFH and 290.29 grams by Johnson’s method. The difference between Hadlock’s and AG×SFH was not statistically significant (p>0.01); but for Johnson’s it was statistically significant (p<0.01). Prediction of birth weight within 10% of actual birth weight was in 81% of Cases by AG x SFH formula, 79% by Hadlock’s formula, and 47% by Johnson’s formula.Conclusions: Clinical estimation of birth weight clearly has a role in management of labour and delivery in a term pregnancy. Clinical estimation especially by SFH×AG method is as accurate as routine USG estimated in average birth weight. SFH × AG clinical formula can be of great value in developing countries like ours, where ultrasound is not available at many health care centers especially in a rural area

Assessment of Doppler velocimetry versus nonstress test in antepartum surveillance of high risk pregnancy

Background: High risk pregnancies increase the maternal and fetal morbidity and mortality; and there is a need for appropriate investigation which can diagnose it early and predicts the morbidity and mortality. The objectives of this study were to compare the efficacy of Doppler velocimetry studies and NST in predicting fetal compromise in utero and compare their ability in predicting the perinatal outcome in cases of high risk pregnancies.Methods: It was a prospective cross-sectional hospital based study conducted at Central Referral Hospital (CRH) which is a teaching hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS). The study was conducted over a period of eighteen months between November 2012 and April 2014. One hundred consecutive cases of high risk pregnancies were enrolled into the study and investigated with NST (non-stress test) and Doppler velocimetry and results were correlated with perinatal outcome. In all cases, accurate gestational age was established from detailed menstrual history and ultrasonographic evidence of gestational age. Detailed examination, history and investigation were undertaken in each patient. Inclusion criteria were patients with singleton pregnancy beyond 34 weeks having one or more high risk factors. In these patients antenatal surveillance was done by Doppler and NST and results of these tests were correlated with perinatal outcome. Based on the Doppler velocimetry and NST results, the study population was divided in to four groups. Pregnant women below 34 weeks, multiple pregnancy and women with no risk factors were excluded from the study.Results: Maximum (63%) patients belonged to pregnancy induced hypertension (PIH) group, followed by oligohydramnios (11%), and gestational diabetes mellitus (GDM). The study showed that patients with both NST and Doppler waveform abnormal (group D) had the highest percentage of neonatal complication, NICU admissions and perinatal deaths. Even those patients with NST normal but Doppler velocimetry abnormal (group B) had comparatively higher neonatal complications. However, in group with NST abnormal and Doppler velocimetry normal (group C) had no fetal compromise. It was observed that normal NST and normal Doppler velocimetry were not statistically different in predicting fetal compromise and prediction value was low. But abnormal Doppler had statistically significant (p value = 0.021) predictive value in detecting fetal compromise. In cases with abnormal Doppler and fetal compromise, NST was still normal showing that abnormal Doppler waveform was better in predicting the bad perinatal outcome. Three out of 100 cases had absent end diastolic flow (AEDF) and all 3 were associated with perinatal morbidity with 2 perinatal deaths. Cerebroplacental ratio was < 1.08 in seven cases and all seven had neonatal complications including 3 neonatal deaths which also had AEDF. Thus, cerebroplacental ratio was better in detecting fetal compromise as compared to NST.Conclusions: Doppler velocimetry was better in predicting fetal compromise in comparison to NST in high risk pregnancies. Normal NST and normal Doppler velocimetry were not significantly different in prediction of fetal outcome. Abnormal Doppler value was better in predicting fetal compromise in comparison to abnormal NST

Profile of gynecological malignancies after the start of gynecology oncology surgeries in Sikkim-experience from a tertiary hospital in North East India

Background: North East is the “cancer capital” of India where there is acute lack of oncologists and oncology facilities. Objectives of the study were to evaluate the trends of gynecological malignancies and to evaluate the need for oncology facility in Sikkim.Methods: This is a retrospective desk review conducted in department of obstetrics and gynecology at Sikkim Manipal institute of medical sciences, India, for a period of three years after the start of oncology surgeries. Women operated for any gynecological malignancy were taken into the study while women referred outside for alternative treatment were excluded from the study.Results: A total 29 women with gynecological malignancies were operated during the 3-year period. Of the total, 17 (58%) were women operated for carcinoma ovary, 6 (21%) for cancer cervix and 6 (21%) for carcinoma uterus. Epithelial ovarian cancer was the most common ovarian cancer. 105 women with large complex ovarian masses were operated during the three-year period, however, only 17 women were diagnosed with cancer of which 8 women had stage I disease while 9 women had advanced disease (stage III-IV). 12 women underwent primary debulking surgery while 5 women underwent interval debulking surgery. Average age for cervical cancer was 48 years, average age for ovarian cancer was 46 years while 52 years was the average age for cancer uterus. Conclusions: High number of gynecological malignancies operated in the only center offering minimum oncological surgical facility points towards the need for a specialized center providing all the needs for treating oncology cases in Sikki

Epidemiology, impact and control of rabies in Nepal : a systematic review

Background: Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal. Methods: We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal. Findings: So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle. Interpretation: Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal

One Health research and training and government support for One Health in South Asia

Introduction: Considerable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps. Materials and methods: A landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors’ professional networks. Results: Only a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes. Discussion: Overall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies

Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study

Introduction: Ketamine and dexmedetomidine decrease anesthetic requirement and provide analgesia to patients. We designed this study to compare the effect of dexmedetomidine and ketamine when added to lignocaine in intravenous regional anesthesia (IVRA). Materials and Methods: Seventy two patients undergoing hand surgery were randomly assigned to three groups to receive IVRA. They received 20 ml of 1% lignocaine and either 1 ml of isotonic saline (Group L, n = 24); or 0.5 mg/kg body weight ketamine (Group LK, n = 24) or 1 mcg/kg body weight dexmedetomidine (Group LD, n = 24). Sensory and motor block onset and recovery time were noted. After the tourniquet deflation, pain and sedation values, time to first analgesic requirement and any side effects were noted. Results: Shortened sensory and motor block onset times (69.17 min and 7.83 min respectively, P < 0.0001) and improved quality of anesthesia (satisfaction score = 3, P < 0.05) were found in ketamine group. Visual analog scale scores (3.21 ± 0.41) were comparable while time to first analgesic requirement (166.25 ± 25.89 min, P < 0.0001) was significantly longer in dexmedetomidine group after tourniquet release. Conclusion: We conclude that the addition of 1 mcg/kg of body weight dexmedetomidine or 0.5 mg/kg of body weight ketamine to lignocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects. We considered ketamine reduced the time for onset of block, delayed the onset of tourniquet pain, and reduced postoperative analgesic requirement and had a better patient satisfaction than placebo or dexmedetomidine

Serological evidence of type 2 (North American genotype) porcine reproductive and respiratory syndrome virus in Nepal

Porcine reproductive and respiratory syndrome virus (PRRSV) has spread throughout Asia, causing significant losses to commercial farmers and smallholders. However, little is known about PRRS in Nepal, a South Asian country with a gradually increasing pig industry. In 2011, a pilot project was initiated to identify the status of PRRSV in pigs of the Kathmandu Valley of Nepal. Out of 98 serum samples, 31 (32 %; 95 % CI 23–42 %) were found positive by ELISA. All positive samples belonged to the type 2 (North American) genotype. Molecular evaluation by real-time PCR however did not yield positive results. At the herd level, seropositivity was associated with a history of abortion and premature birth. Veterinarians, farmers and government should be aware of this threat to the Nepalese pig industry and initiate an appropriate response

Unveiling thereinforcement potentiality of MWCNTs architecture towards the improvement of microstructural vis-a-vis mechanical and thermo-mechanical properties of pressureless sintered MgAl2O4 spinel ceramic composite

The study presented in this work focuses on the preparation of composites made of multi-walled carbon nanotubes (MWCNTs) and magnesium aluminate spinel through a pressureless sintering technique. The effects of sintering temperature and MWCNTs content on the densification behavior and mechanical properties of the composite were investigated in detail. The results revealed that the composite exhibited improved densification behavior, enhanced mechanical performance and decent control at the micro -structural refinement with increasing MWCNTs content up to 0.75 wt%. The superior mechanical properties obtained in case of sintered composite were attributed to the synergetic toughening mechanisms involving the fiber pull out, cracks bridging and cracks deflection effects of reinforcing phases, observed as a resultant effect of strong interfaces with the matrix phase. The crystalline structural arrangement obtained from the XRD and Raman spectral analysis of the composites structure also satisfies the attainment of the promising reinforcement potential of the nanotubular structure. Most importantly, the study also exemplified the subsidiary interference of a surface decorative coating on the MWCNTs structure with the MgAl-binary oxide network. The strategic grafting of the oxide protective shell and the consequent development of a robust interfacial bridging network between the matrix and reinforcement phase regulated the energy dissipation characteristic for fiber debonding. This, in turn, restricted the crack growth phenomenon during mechanical loading, and thereby ultimately contributing to the enhanced fracture toughness, reduced thermal expansion co-efficient and augmented thermo-mechanical performance of the evolved spinel-based composite structure & COPY; 2023 Elsevier B.V. All rights reserved

Fabrication, characterization and optimization of industrial alpha alumina powders based ceramic membrane supports and its applicative potential for CO2/N-2 separation

In this investigation, an economically feasible strategy has been proposed for the fabrication of good quality membrane support by utilizing low-cost industrial-grade alumina powders, coded as A-16SG and CT-1200SG with an average particle size of 0.44 and 1.41 mu m, respectively. Herein, the meticulous alteration of the processing parameters and the targeted utilization of industrial grade powders with distinctive particle morphologies have shown promising aspect towards governing the overall sintering and densification behavior, pore morphology and the microstructural facets of the sintered alumina compacts. More precisely, while connecting the structure-property relationship aspect, the broader particle size distribution and the higher quartile ratio of CT-1200SG powders lends to originate relatively higher average pore size and wider pore size distribution in the as-optimized sintered membrane support system in comparison to the narrow particle sized and low quartile ratio comprising A-16SG powder. Additionally, the near surface morphology of the intermediate layers deposited over the two distinctive membrane support systems via implementing differential colloidal chemistry of the respective sols have also been demonstrated for the precise understanding of the role of particle morphology on the progressive perseverance of pore characteristics of the overall asymmetric graded membrane substrate. Finally, the performance evaluation of the alumino-silicate membrane layer assembled on the tailor-made multilayered graded cost-competent alumina support system has been executed which revealed comparable CO2/N2 gas permeance of 46.44GPU and 534.25GPU along with the selectivity of 12.5 and 1.9 for the respective A-16SG and CT-1200SG powders based individual support systems under nearly identical flue gas separation conditions