Prevalence and risk factors for dysmenorrhoea among nursing student and its impact on their quality of life

Background: Dysmenorrhea is an important health problem of adolescent girls, that affects their quality of life and it is one of the leading causes of repeated school absenteeism. The purposes of this study was to determine the prevalence and risk factors for dysmenorrhea among nursing students and its impact on their quality of life.Methods: A prospective study was carried out in St Johns Nursing College, Bengaluru.200 nursing students aged between 18-20 years were included. Standardized questionnaires were used to obtain relevant data. Data was analysed using Chi-sq. test, correlation and regression analysis by SPSS version 23.Results: The prevalence of dysmenorrhea was 62.5%. The mean age, age at menarche and, the mean PABC of the students were 18.7±0.48, 13.3±1.20 and 74.96±16.14   respectively, which is not significant. The average length of menstrual cycle was between 28-30 days, duration of bleeding as 3-5 days. Duration of sleep, regular menstrual cycle and low BMI exhibited positive correlation (p<0.05) while Family history and exercising habits did not exhibit significant effect. Dysmenorrhea was significantly associated with repeated school absenteeism (16%).Conclusions: Dysmenorrhoea is found to be highly prevalent among nursing students and is one of the leading causes of absenteeism. Regular cycle, duration of sleep and low BMI were significant risk factors for dysmenorrhea. Findings of present study suggest the need for educating adolescent girls on appropriate and effective management of dysmenorrhea.

Pregnancy outcomes of mothers with immune thrombocytopenia

Background: It has been proposed that, thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Objectives were to determine the prevalence, pregnancy outcomes, treatment modalities of ITP mothers over five years in a tertiary health care hospital in South India.Methods: Our study was a retrospective record study, which looked into various aspects of obstetrical outcomes and complications in ITP mothers. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at St. Johns Medical Hospital, Bangalore were studied.Results: We identified 53 patients with ITP with a mean age of 25.6+4.6 years, age of diagnosis of ITP at 21.1+5.9 years and gestational age of 36.2+3 weeks. In our study 17 (32%) were acute and 36 (67.1%) were chronic ITP. In our study 39.6% had history of at least one prior pregnancy loss. Patients with ITP at 35-37 weeks were induced with PGE1 (35.7%) in comparison to those with PGE2 (p≤0.001). Post-partum haemorrage (PPH) was seen in 7.5% of the pregnancies and all four were mothers with chronic ITP. Severe preeclampsia in ITP mothers was seen in 2 (66.7%).Conclusions: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in the foetus.

A case of neurofibromatosis type 1 with clival chordoma

Neurofibromatosis type-1 is an autosomal dominant tumour syndrome with a high clinical susceptibility to malignancies, especially nervous system malignancies. Here, we reported a case of neurofibromatosis type-1 in a male in his 50s, who presented with generalised weakness, headache associated with ear pain, a feeling of heaviness of the head, and giddiness for a duration of 1 week. On examination, he had axillary freckling and multiple neurofibromas over his body. Nystagmus and dysdiadokokinesia were present. MRI brain revealed an enhancing lesion in the sphenoid and clivus, extending into the sellar and supra-sellar region. The possibility of pituitary adenoma and clival chordoma were considered. He was referred to Neurosurgery and underwent Trans-nasal Trans-sphenoidal near-total resection of the tumour. Biopsy of the lesion was indicative of conventional clival chordoma, which is rarely reported with NF-1. The post-operative period was uneventful and the patient is planned for regular follow-up to detect recurrence

BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization.

BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools. Bispectral index (BIS) monitors, which are based on the processing of electroencephalographic signals, may overcome the restraints of the sedation scales and provide a more reliable and consistent guidance for the titration of sedation depth.The benefits of BIS monitoring of patients under general anaesthesia for surgical procedures have already been confirmed by another Cochrane review. By undertaking a well-conducted systematic review our aim was to find out if BIS monitoring improves outcomes in mechanically ventilated adult intensive care unit (ICU) patients. OBJECTIVES: To assess the effects of BIS monitoring compared with clinical sedation assessment on ICU length of stay (LOS), duration of mechanical ventilation, any cause mortality, risk of ventilator-associated pneumonia (VAP), risk of adverse events (e.g. self-extubation, unplanned disconnection of indwelling catheters), hospital LOS, amount of sedative agents used, cost, longer-term functional outcomes and quality of life as reported by authors for mechanically ventilated adults in the ICU. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, ProQuest, OpenGrey and SciSearch up to May 2017 and checked references citation searching and contacted study authors to identify additional studies. We searched trial registries, which included clinicaltrials.gov and controlled-trials.com. SELECTION CRITERIA: We included all randomized controlled trials comparing BIS versus clinical assessment (CA) for the management of sedation in mechanically ventilated critically ill adults. DATA COLLECTION AND ANALYSIS: We used Cochrane's standard methodological procedures. We undertook analysis using Revman 5.3 software. MAIN RESULTS: We identified 4245 possible studies from the initial search. Of those studies, four studies (256 participants) met the inclusion criteria. One more study is awaiting classification. Studies were, conducted in single-centre surgical and mixed medical-surgical ICUs. BIS monitor was used to assess the level of sedation in the intervention arm in all the studies. In the control arm, the sedation assessment tools for CA included the Sedation-Agitation Scale (SAS), Ramsay Sedation Scale (RSS) or subjective CA utilizing traditional clinical signs (heart rate, blood pressure, conscious level and pupillary size). Only one study was classified as low risk of bias, the other three studies were classified as high risk.There was no evidence of a difference in one study (N = 50) that measured ICU LOS (Median (Interquartile Range IQR) 8 (4 to 14) in the CA group; 12 (6 to 18) in the BIS group; low-quality evidence).There was little or no effect on the duration of mechanical ventilation (MD -0.02 days (95% CI -0.13 to 0.09; 2 studies; N = 155; I2 = 0%; low-quality evidence)). Adverse events were reported in one study (N = 105) and the effects on restlessness after suction, endotracheal tube resistance, pain tolerance during sedation or delirium after extubation were uncertain due to very low-quality evidence. Clinically relevant adverse events such as self-extubation were not reported in any study. Three studies reported the amount of sedative agents used. We could not measure combined difference in the amount of sedative agents used because of different sedation protocols and sedative agents used in the studies. GRADE quality of evidence was very low. No study reported other secondary outcomes of interest for the review. AUTHORS' CONCLUSIONS: We found insufficient evidence about the effects of BIS monitoring for sedation in critically ill mechanically ventilated adults on clinical outcomes or resource utilization. The findings are uncertain due to the low- and very low-quality evidence derived from a limited number of studies

Responses of aerial insectivorous bats to local and landscape-level features of coffee agroforestry systems in Western Ghats, India

Shade coffee has shown great promise in providing crucial habitats for biodiversity outside formal protected areas. Insectivorous bats have been understudied in coffee, although they may provide pest control services. We investigated the influence of local and landscape-level features of coffee farms on aerial insectivorous bats in Chikmagalur district in the Western Ghats biodiversity hotspot, India. Bats were monitored in 20 farm sites using ultrasound detectors, and the response of bat species richness and activity to changes in tree density, proportion of built-up area in the neighborhood, and distance of farm from forest areas quantified. We examined if models built to explain the species richness and activity could also predict them in nine additional sites. We detected nine phonic types/species in the study area. The quantified predictors had no effect on assemblage-level species richness and activity of bats. Responses of edge-space and cluttered-space forager guilds mirrored those of the overall assemblage, but some species vulnerable to forest conversion like Rhinolophus beddomei were detected rarely. Best models explained up to 20% and 15% variation in assemblage-level species richness and activity respectively, and were poor predictors of both response variables. We conclude that coffee farms in our study area offer an important commuting space for insectivorous bats across a gradient of shade management. Further research should include species-specific responses to management decisions for at-risk species and quantification of ecosystem services like natural pest control to inform biodiversity conservation initiatives in the Western Ghats coffee landscapes

The Mechanism of Action of Cytokines to Control the Release of Hypothalamic and Pituitary Hormones in Infection

Abstract: During infection, bacterial and viral products, such as bacterial lipopolysaccharide (LPS), cause the release of cytokines from immune cells. These cytokines can reach the brain by several routes. Furthermore, cytokines, such as interleukin‐1 (IL‐1), are induced in neurons within the brain by systemic injection of LPS. These cytokines determine the pattern of hypothalamic‐pituitary secretion that characterizes infection. IL‐2, by stimulation of cholinergic neurons, activates neural nitric oxide synthase (nNOS). The nitric oxide (NO) released diffuses into corticotropin‐releasing hormone (CRH)‐secreting neurons and releases CRH. IL‐2 also acts in the pituitary to stimulate adrenocorticotropic hormone (ACTH) secretion. On the other hand, IL‐1α blocks the NO‐induced release of luteinizing hormone‐releasing hormone (LHRH) from LHRH neurons, thereby blocking pulsatile LH but not follicle‐stimulating hormone (FSH) release and also inhibiting sex behavior that is induced by LHRH. IL‐1α and granulocyte macrophage colony‐stimulating factor (GMCSF) block the response of the LHRH terminals to NO. The mechanism of action of GMCSF to inhibit LHRH release is as follows. It acts on its receptors on γ‐aminobutyric acid (GABA)ergic neurons to stimulate GABA release. GABA acts on GABAa receptors on the LHRH neuronal terminal to block NOergic stimulation of LHRH release. IL‐1α inhibits growth hormone (GH) release by inhibiting GH‐releasing hormone (GHRH) release, which is mediated by NO, and stimulating somatostatin release, also mediated by NO. IL‐1α‐induced stimulation of PRL release is also mediated by intra‐hypothlamic action of NO, which inhibits release of the PRL‐inhibiting hormone dopamine. The actions of NO are brought about by its combined activation of guanylate cyclase‐liberating cyclic guanosine monophosphate (cGMP) and activation of cyclooxygenase (COX) and lipoxygenase (LOX) with liberation of prostaglandin E2 and leukotrienes, respectively. Thus, NO plays a key role in inducing the changes in release of hypothalamic peptides induced in infection by cytokines. Cytokines, such as IL‐1β, also act in the anterior pituitary gland, at least in part via induction of inducible NOS. The NO produced inhibits release of ACTH. The adipocyte hormone leptin, a member of the cytokine family, has largely opposite actions to those of the proinflammatory cytokines, stimulating the release of FSHRF and LHRH from the hypothalamus and FSH and LH from the pituitary directly by NO.Fil: McCann, Samuel M.. Pennington Biomedical Research Center; Estados UnidosFil: Kimura, M.. Medical and Dental University; JapónFil: Karanth, S.. Pennington Biomedical Research Center; Estados UnidosFil: Yu, W. H.. Pennington Biomedical Research Center; Estados UnidosFil: Mastronardi, C. A.. Pennington Biomedical Research Center; Estados UnidosFil: Besuhli, Valeria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentin

Bilateral Upper Lobe Pneumonia with Acute Adrenal Insufficiency

Achromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection

Bringing the Tiger Back from the Brink—The Six Percent Solution

This article does not have an abstract

Absorption Spectroscopic Studies of Chip-scale Rubidium Atomic Vapour Cells in a Compact 3D Printed Magneto-Optic Package

This paper describes the design, development and spectroscopic studies of chip-scale Rb atomic vapour cell developed in the authors’ laboratory. A compact magneto-optic package for the chip-scale Rb cell comprising of TEC integrated VCSEL source, silicon p-i-n photo detector and a hemispherical lens for light collimation is reported. The package is manufactured using commercial 3D printing technology. A PC based data acquisition system has been developed to provide real time analysis of the captured spectral data of the Rb chip by laser interrogation of the D1 hyperfine transition. Doppler broadened absorption resonance lines of technological importance have been recorded for transitions 85Rb(2S1/2 F=2→2P1/2 F′ =2,3) having absorption amplitude 1.24 V and FWHM 850 MHz and 87Rb(2S1/2 F=2 →2P1/2 F′ =1,2) has absorption amplitude 0.47 V and FWHM 567 MHz at cell temperature of 70 oC . Further, the chip-scale Rb atomic cell in the magneto-optical package will be explored to develop atomic sensors for space applications

The Hanging/hanged Patient and Relevance to Pre-hospital Care

Death and injury from hanging is a complex situation, which requires careful and appropriate assessment and management in the pre-hospital environment. It is arguably an area of limited understanding and therefore may not be assessed and managed in the most effective manner. Most hanged/hanging patients will be found in their homes, rather than in institutions. It could be argued that due to prevalence as a suicide method, the majority of pre-hospital ambulance service staff will be responded to at least one hanged or hanging patient within their careers, thus a greater understanding will benefit both clinician and patient. Patients who attempt or achieve suicide will rarely achieve fracturing the spine and severing the spinal cord, bringing into question the requirement for the traditional cervical collar and spinal immobilisation techniques. Death from asphyxiation and carotid/vagal reflex require consideration and management as does raised ICP, which is likely to occur