Intra-operative difficulties in repeat caesarean section-in a tertiary care hospital

Background: Caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction) and wound infections. The risk of the surgery may be increased due to a number of factors. The aim of the study was to study the effects of repeated caesarean sections and intra surgical difficulties.Methods: A cross sectional, observational, hospital-based study was done for all patients with repeat caesarean section for a period of 8 months. 190 women who have undergone one or more caesarean section of term gestation with a live foetus irrespective of amniotic fluid colour and amount with cephalic, breech, or transverse presentation elective and emergency caesarean sections and singleton or multiple pregnancies were selected for study.Results: In the present study the highest prevalence of previous C-section was seen in age group 20-29 years, which accounted for (88.5%). Complications are present in 42.1% patients in which adhesions was the most found complication. Adhesion between Parietal peritoneum and anterior surface of uterus is present in 26.3% patients, omentum and uterus is present in 25.8% patients, adhesiolysis was done in 28.9% patients. 80% complications were present in patients with one previous CS. The association was found to be statistically significant.Conclusions: Women undergoing repeated cesarean sections have a risk of increased morbidity due to increased intraoperative complications. To avoid this one should keep the cesarean section rate at reasonable limit with appropriate surgical techniques and to limit primary cesarean section rate

Molecular epidemiology of HIV-2 infection in KwaZulu-Natal Provnce, South Africa.

Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.Infection with HIV-2 has important implications for the diagnosis, treatment and management of the infection. The objective of this study was to describe the seroprevalence and molecular epidemiology of HIV-2 in KwaZulu-Natal – the province with the highest HIV prevalence in South Africa, which in turn is the country with the highest HIV prevalence in the world. HIV-1 positive samples were screened using a rapid test for HIV-2. Samples showing antibody positivity were subject to molecular confirmation by PCR and / or serological confirmation by Western blot. There was a large difference in results (10.6% by Western blotting versus 0% by PCR). This discrepancy between molecular and serological confirmation by Western blot. There was a large difference in results (10.6% by Western blotting versus 0% by PCR). This discrepancy between molecular and serological confirmation was attributed to cross-reacting antibodies. The use of rapid tests and Western blots for HIV-2 diagnosis in South Africa, should, therefore, be interpreted with caution. Based on the results of this study, HIV-2 is most probably not present in KwaZulu-Natal

COMBINATION OF MOMORDICA CHARANTIA AND PHYLLANTHUS AMARUS FOR HEPATOPROTECTIVE ACTIVITY IN ETHANOL AND ANTI-TUBERCULAR DRUGS INDUCED HEPATOTOXICITY IN RATS

Objective: To evaluate the synergistic protective effect of Momordica charantia and Phyllanthus amarus combination (MC+PA) of doses 200 and 400 mg/kg on the liver in different experimental models of hepatotoxicity. Methods: The hepatoprotective activity was evaluated in ethanol and anti-tubercular drugs (isoniazid-INH, rifampicin-RIF) induced hepatotoxicity models. Hepatotoxicity in both models was induced to all groups except the normal control. Intoxicated rats were treated with silymarin and various doses of MC+PA for 8 d in ethanol-induced and 21 d in INH+RIF induced hepatotoxicity models. At the completion of study, the biochemical markers and the anti-oxidant status (SOD and MDA) were measured and also the histopathological evaluation of the liver tissue was carried out. Results: Combination therapy remarkably reduced the elevated profile of the biochemical markers and thereby improved the anti-oxidant status, thus exhibiting the synergistic hepatoprotective effect when compared with the positive control group (p<0.001). Histopathological evaluation demonstrated that MC+PA decreased the liver damage significantly in comparison with the positive group. Conclusion: The current work suggests that the combined extract showed synergistic effects on ethanol and anti-tubercular drugs induced hepatotoxicity models by significantly decreasing the liver damage

van der Woude syndrome- a syndromic form of orofacial clefting

van der Woude Syndrome is the most common form of syndromic orofacial clefting, accounting for 2% of all cases, and has the phenotype that most closely resembles the more common non-syndromic forms. The syndrome has an autosomal dominant hereditary pattern with variable expressivity and a high degree of penetrance with cardinal clinical features of lip pits with a cleft lip, cleft palate, or both. This case report describes van der Woude syndrome in a 19 year old male patient with a specifi c reference to the various aspects of this condition, as clinical appearance, etiological factors (genetic aspects), differential diagnosis, investigative procedures and management

Southern African Treatment Resistance Network (SATuRN) RegaDB HIV drug resistance and clinical management database: supporting patient management, surveillance and research in southern Africa

Substantial amounts of data have been generated from patient management and academic exercises designed to better understand the human immunodeficiency virus (HIV) epidemic and design interventions to control it. A number of specialized databases have been designed to manage huge data sets from HIV cohort, vaccine, host genomic and drug resistance studies. Besides databases from cohort studies, most of the online databases contain limited curated data and are thus sequence repositories. HIV drug resistance has been shown to have a great potential to derail the progress made thus far through antiretroviral therapy. Thus, a lot of resources have been invested in generating drug resistance data for patient management and surveillance purposes. Unfortunately, most of the data currently available relate to subtype B even though >60% of the epidemic is caused by HIV-1 subtype C. A consortium of clinicians, scientists, public health experts and policy markers working in southern Africa came together and formed a network, the Southern African Treatment and Resistance Network (SATuRN), with the aim of increasing curated HIV-1 subtype C and tuberculosis drug resistance data. This article describes the HIV-1 data curation process using the SATuRN Rega database. The data curation is a manual and time-consuming process done by clinical, laboratory and data curation specialists. Access to the highly curated data sets is through applications that are reviewed by the SATuRN executive committee. Examples of research outputs from the analysis of the curated data include trends in the level of transmitted drug resistance in South Africa, analysis of the levels of acquired resistance among patients failing therapy and factors associated with the absence of genotypic evidence of drug resistance among patients failing therapy. All these studies have been important for informing first- and second-line therapy. This database is a free password-protected open source database available on www.bioafrica.net

Prevalence of GB virus type C in urban Americans infected with human immunodeficiency virus type 1

GBV-C virus infection has been linked to improved clinical outcome in HIV-1 co-infected individuals. The epidemiology of GBV-C has, thus far, been limited to the gay male, HIV(+ )population. Here we describe the prevalence of antibodies against GBV-C envelope glycoprotein E2 and GBV-C viremia in an HIV(+ )inner city population. This study group is predominantly African-American; 41% of the participants are women. The major risk factor for HIV infection is intravenous drug use. Overall, 56% of the study population had evidence of current or past infection with GBV-C. GBV-C exposure was not associated with hepatitis C virus infection. The group of participants, who had GBV-C viremia and anti-E2 antibodies, had high percentage of patients with an undetectable HIV-1 viral load. These data provide increased insight into the prevalence of GBV-C co-infection in the HIV epidemic in this understudied population

Data Analytics for Dynamic Urban Operations: A Test-Based Study on Data Analytics Efficiency

This paper explores the field of data analytics for dynamic urban operations and provides a systematic analysis of the importance and possible implications of this field. Our investigation indicates significant data volumes in an urban setting that is data-rich: 500 GB are generated by traffic sensors, 300 GB by environmental monitors, 150 GB by mobile apps, and 75 GB by emergency calls. A variety of analytics techniques, each with a different processing time, are built upon these data sources. These techniques include descriptive, predictive, prescriptive, and diagnostic analytics. The outcomes, which include 90% accuracy, an average processing time of 40 minutes, 80% resource utilization, and 4.2 user satisfaction ratings, highlight the benefits of data analytics. According to the comparison study, diagnostic analytics has a score of 7.8, indicating room for development, while prescriptive analytics leads with an efficiency score of 8.4. As urban stakeholders and academics work to improve urban systems and solve urban issues, the results give a thorough understanding of the effectiveness and application of data analytics in the context of dynamic urban operations

Agronomic biofortification of zinc in rice for diminishing malnutrition in South Asia

Zinc (Zn) is increasingly recognized as an essential trace element in the human diet that mediates a plethora of health conditions, including immune responses to infectious diseases. Interestingly, the geographical distribution of human dietary Zn deficiency overlaps with soil Zn deficiency. In South Asia, Zn malnutrition is high due to excessive consumption of rice with low Zn content. Interventions such as dietary diversification, food fortification, supplementation, and biofortification are followed to address Zn malnutrition. Among these, Zn biofortification of rice is the most encouraging, cost-effective, and sustainable for South Asia. Biofortification through conventional breeding and transgenic approaches has been achieved in cereals; however, if the soil is deficient in Zn, then these approaches are not advantageous. Therefore, in this article, we review strategies for enhancing the Zn concentration of rice through agronomic biofortification such as timing, dose, and method of Zn fertilizer application, and how nitrogen and phosphorus application as well as crop establishment methods influence Zn concentration in rice. We also propose data-driven Zn recommendations to anticipate crop responses to Zn fertilization and targeted policies that support agronomic biofortification in regions where crop responses to Zn fertilizer are high

Assessment of genetic variability in mutant lines of greengram (Vigna radiata) using ISSR markers

Out of 40 ISSR primers used in this study, 16 markers resulted in 163 amplifications with an average of 10.25 bands/ primer. Among 163 amplifications, 38 (42.89%) were found to be polymorphic. The genetic similarity coefficients among the mutant lines ranged from 0.88 to 0.99 with a mean value of 0.92. Cluster analysis based on ISSR profile grouped the genotypes into two major clusters which further divided into sub-clusters. The molecular diversity among the mutant lines was greater than that of the morphological diversity which also revealed that considerable amount of genetic variability has been generated through mutagenic treatment. The superiority of mutants AAIMM-10 and AAIMM-24 over the parental line in terms of yield and early maturity respectively proves the relevance of this study

HIV-1 drug resistance by ultra-deep sequencing following short course zidovudine, single-dose nevirapine, and single-dose tenofovir with emtricitabine for prevention of mother-to-child transmission

Antiretroviral drug resistance following pMTCT strategies remains a significant problem. With rapid advancements in next generation sequencing technologies, there is more focus on HIV drug-resistant variants of low frequency, or the so-called minority variants. In South Africa, AZT monotherapy for pMTCT, similar to World Health Organization option A, has been used since 2008. In 2010, a single dose of co-formulated TDF/FTC was included in the strategy for prevention of resistance conferred by single-dose nevirapine (sd NVP). The study was conducted in KwaZulu-Natal, South Africa, among pMTCT participants who received AZT monotherapy from 14 weeks of gestation, intrapartum AZT and sd NVP, and postpartum sd TDF/FTC. Twenty-six specimens collected at 6 weeks post-delivery were successfully sequenced using 454 ultra-deep sequencing. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was detected in 17 of 26 (65%) patients, 2 (7%) had Thymidine analogue mutations, and 3 (11%) had K65R. Of the 17 patients with NNRTI resistance, 11 (65%) had high-level NNRTI resistance, whereas 6 (35%) had intermediate NNRTI resistance. The levels of NNRTI resistance are much higher than would be expected, given the inclusion of antepartum AZT and postpartum TDF/FTC. This high level of NNRTI resistance could impact future NNRTI-containing treatment for a large proportion of pMTCT-exposed women. The detection of Thymidine analogue mutations highlights the need to understand the clinical impact of these on AZT-containing antiretroviral treatment in women exposed to AZT monotherapy