Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity

Cervical effacement, as an independent parameter versus modified bishop score, for predicting the favorability of vaginal delivery in a primigravida at 40 weeks gestation and beyond

Background: Dr. Edward Bishop developed the original bishop score. He concluded that elective induction in multiparous women was successful with a score > 8. Calder introduced the modified bishop score in which he replaced cervical effacement with cervical length in cms. Score of 6-12 is favourable. In this study, studied the cervical effacement/ length as an independent predictor of vaginal delivery in a primigravida.Methods: A retrospective observational study was conducted from May 2018 to January 2019. Total participants were divided into two groups on the basis of spontaneous labor and induced labor. Both the groups were assessed individually and collectively in terms of cervical effacement/length and modified bishop score. Study primary outcome was vaginal delivery. The results were reflected in terms of sensitivity, specificity, PPV and NPV. These values were compared for cervical effacement/ length as well as modified bishop score and p value calculated. Also, association between modified bishop score and cervical effacement/length was established.Results: Total number of participants included was n = 91. Those with modified bishop score > 6, 78.16% had vaginal delivery. This gave a sensitivity of 78.16%, specificity of 50%, PPV of 97.14%. Those with cervical effacement of >/=50% or cervical length of /= 50% had modified bishop score >/= 6, reflecting the association between them.Conclusions: Cervical effacement of >/= 50% or cervical length </= 2 cms yielded an equivalently high predictive ability similar to modified bishop score, for spontaneous as well as induced labor. Hence, cervical effacement can be taken as an independent parameter to assess the favorability of successful vaginal delivery in a primigravida

AUF1 p42 isoform selectively controls both steady-state and PGE2-induced FGF9 mRNA decay

Fibroblast growth factor 9 (FGF9) is an autocrine/paracrine growth factor that plays vital roles in many physiologic processes including embryonic development. Aberrant expression of FGF9 causes human diseases and thus it highlights the importance of controlling FGF9 expression; however, the mechanism responsible for regulation of FGF9 expression is largely unknown. Here, we show the crucial role of an AU-rich element (ARE) in FGF9 3′-untranslated region (UTR) on controlling FGF9 expression. Our data demonstrated that AUF1 binds to this ARE to regulate FGF9 mRNA stability. Overexpression of each isoform of AUF1 (p37, p40, p42 and p45) showed that only the p42 isoform reduced the steady-state FGF9 mRNA. Also, knockdown of p42AUF1 prolonged the half-life of FGF9 mRNA. The induction of FGF9 mRNA in prostaglandin (PG) E2-treated human endometrial stromal cells was accompanied with declined cytoplasmic AUF1. Nevertheless, ablation of AUF1 led to sustained elevation of FGF9 expression in these cells. Our study demonstrated that p42AUF1 regulates both steady-state and PGE2-induced FGF9 mRNA stability through ARE-mediated mRNA degradation. Since almost half of the FGF family members are ARE-containing genes, our findings also suggest that ARE-mediated mRNA decay is a common pathway to control FGFs expression, and it represents a novel RNA regulon to coordinate FGFs homeostasis in various physiological conditions

Selective cyclooxygenase-2 silencing mediated by engineered E. coli and RNA interference induces anti-tumour effects in human colon cancer cells

Colorectal cancer (CRC) has an elevated incidence worldwide and represents one of the most aggressive human tumours. Many experimental data provide the evidence of a strong association between cyclooxygenase-2 (COX-2) enzyme overexpression and colon tumorigenesis. Furthermore, it has been demonstrated that the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs, a class of COX-2 inhibitors), partially protects patients from CRC development and progression. Unfortunately, NSAIDs have been shown to induce severe side effects in chronically treated patients and, therefore, new strategies for selective COX-2 blockade are needed. In this paper we present an innovative COX-2 silencing approach mediated by RNA Interference (RNAi) which is a mechanism we have already described as a powerful tool to knockdown COX-2 protein in CRC cells. In particular, we developed an improved method to gain a highly selective COX-2 silencing in CRC cells by a tumour-dependent expression of anti-COX-2 short hairpin RNA (shCOX-2). Moreover, we efficiently delivered shCOX-2 expressing vectors in CRC cells, in vitro and ex vivo, by using engineered Escherichia coli strains, capable of infecting and invading human tumour cells (InvColi). Combining the highly selective shCOX-2 expression and the delivery of COX-2 silencers mediated by InvColi strains, we obtained a strong reduction of both proliferative and invasive behaviour of tumour cells and we also confirmed the pivotal role of COX-2 overexpression for the survival of CRC cells. Finally, ex vivo data showed a global anti-inflammatory and anti-tumour effect elicited by COX-2 silencing

The proliferative and migratory activities of breast cancer cells can be differentially regulated by heparan sulfates

To explore how heparan sulfate (HS) controls the responsiveness of the breast cancer cell lines MCF-7 and MDA-MB-231 to fibroblast growth factors (FGFs), we have exposed them to HS preparations known to have specificity for FGF-1 (HS glycosaminoglycan (HSGAG A)) or FGF-2 (HSGAGB). Proliferation assays confirmed that MCF-7 cells were highly responsive to FGF-2 complexed with GAGB, whereas migration assays indicated that FGF-1/HSGAGA combinations were stimulatory for the highly invasive MDA-MB-231 cells. Quantitative polymerase chain reaction for the levels of FGF receptor (PGFR) isoforms revealed that MCF-7 cells have greater levels of FGFR1 and that MDA-MB-231 cells have greater relative levels of FGFR2. Cross-linking demonstrated that FGF-2/HSGAGB primarily activated FGFR1, which in turn up regulated the activity of mitogen-activated protein kinase; in contrast, FGF-1/HSGAGA led to the phosphorylation of equal proportions of both FGFR1 and FGFR2, which in turn led to the up-regulation of Src and p125(FAK). MDA-MB-231 cells were particularly responsive to vitronectin substrates in the presence of FGF-1/HSGAGA, and blocking antibodies established that they used the alpha(v)beta(3) integrin to bind to it. These results suggest that the clustering of particular FGFR configurations on breast cancer cells induced by different HS chains leads to distinct phenotypic behaviors

Mobile Devices in the Public Healthcare Sector : Perceptions, Experiences and Expectations of Nursing Care Providers

There are high expectations regarding mobile technology and how it can be used to promote improvements in the quality and efficiency in healthcare. There appears to be a gap between the goals and strategy on the macro level and the micro level experiences of the usage of mobile devices among healthcare professionals.   The purpose of this study is to examine the perceptions, experiences and expectations of nursing care providers at two wards with regards to the recently implemented mobile platform COSMIC Nova Ward and other related IT artefacts. Special emphasis has been on COSMIC Nova Ward Tablet, a part of COSMIC Nova Ward, facilitated in iPad MINIs. It is designed to act as a tool to facilitate the provision of care and has been introduced at both the wards during a pilot project. Even though the two wards are similar in both practice and structure, the pilot project resulted in failure at one of the wards and a relative success at the other.   A comparative case study of the perceptions, experiences and expectations of the nursing personnel at the two wards was conducted in order to highlight the differences in the outcomes of the pilot project. By reflexively comparing these with theory, it was concluded that there are several factors other than adequacy of the IT system that determine the outcome of the implementation of a mobile platform in a clinical setting.   These findings were then compared with existing legislation and policies, in order to identify potential discrepancies between the nursing personnel’s usage of IT with the regional and national goals and strategy. It was then determined that there needs to be a clear connection between the usage of IT and the goals and strategy within healthcare

Mobile Devices in the Public Healthcare Sector : Perceptions, Experiences and Expectations of Nursing Care Providers

There are high expectations regarding mobile technology and how it can be used to promote improvements in the quality and efficiency in healthcare. There appears to be a gap between the goals and strategy on the macro level and the micro level experiences of the usage of mobile devices among healthcare professionals.   The purpose of this study is to examine the perceptions, experiences and expectations of nursing care providers at two wards with regards to the recently implemented mobile platform COSMIC Nova Ward and other related IT artefacts. Special emphasis has been on COSMIC Nova Ward Tablet, a part of COSMIC Nova Ward, facilitated in iPad MINIs. It is designed to act as a tool to facilitate the provision of care and has been introduced at both the wards during a pilot project. Even though the two wards are similar in both practice and structure, the pilot project resulted in failure at one of the wards and a relative success at the other.   A comparative case study of the perceptions, experiences and expectations of the nursing personnel at the two wards was conducted in order to highlight the differences in the outcomes of the pilot project. By reflexively comparing these with theory, it was concluded that there are several factors other than adequacy of the IT system that determine the outcome of the implementation of a mobile platform in a clinical setting.   These findings were then compared with existing legislation and policies, in order to identify potential discrepancies between the nursing personnel’s usage of IT with the regional and national goals and strategy. It was then determined that there needs to be a clear connection between the usage of IT and the goals and strategy within healthcare

Mobile Devices in the Public Healthcare Sector : Perceptions, Experiences and Expectations of Nursing Care Providers

There are high expectations regarding mobile technology and how it can be used to promote improvements in the quality and efficiency in healthcare. There appears to be a gap between the goals and strategy on the macro level and the micro level experiences of the usage of mobile devices among healthcare professionals.   The purpose of this study is to examine the perceptions, experiences and expectations of nursing care providers at two wards with regards to the recently implemented mobile platform COSMIC Nova Ward and other related IT artefacts. Special emphasis has been on COSMIC Nova Ward Tablet, a part of COSMIC Nova Ward, facilitated in iPad MINIs. It is designed to act as a tool to facilitate the provision of care and has been introduced at both the wards during a pilot project. Even though the two wards are similar in both practice and structure, the pilot project resulted in failure at one of the wards and a relative success at the other.   A comparative case study of the perceptions, experiences and expectations of the nursing personnel at the two wards was conducted in order to highlight the differences in the outcomes of the pilot project. By reflexively comparing these with theory, it was concluded that there are several factors other than adequacy of the IT system that determine the outcome of the implementation of a mobile platform in a clinical setting.   These findings were then compared with existing legislation and policies, in order to identify potential discrepancies between the nursing personnel’s usage of IT with the regional and national goals and strategy. It was then determined that there needs to be a clear connection between the usage of IT and the goals and strategy within healthcare