Role of hysteroscopy and histopathology in evaluating patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the leading causes for seeking gynaecological advice. The aim and objectives of the study was to determine the pattern of hysteroscopic abnormalities and histopathological features of Abnormal Uterine Bleeding and to correlate hysteroscopic findings with histopathological findings.Methods: The present study “Role of Hysteroscopy and Histopathology in Evaluating patients with Abnormal Uterine Bleeding” was an observational study carried out in the Postgraduate Department of Obstetrics and Gynaecology and Postgraduate Department of Pathology of Government Medical college, Srinagar after obtaining clearance from the institutional ethical committee. The period of the study was One and a Half Years from April 2014 to September 2015.Results: The most common abnormality detected by hysteroscopy was Endometrial Hyperplasia (27 cases, 27%) followed by endometrial polyps (21 cases, 21%). Endometrial Hyperplasia was the most common abnormality found in Menorrhagia followed by polyps while polyps were the most common finding in polymenorrhea and endometrial hyperplasia was the most common pathology in postmenopausal bleeding. Hysteroscopy had a sensitivity of 93.2%, specificity of 83.9%, positive predictive value of 82%, Negative Predictive Value of 94% in diagnosing etiology of abnormal uterine bleeding.Conclusions: This study confirms that hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding and hysteroscopy and histopathology complement each other in the evaluation of a patient with Abnormal uterine bleeding

Comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor

Background: Elective induction of labor is defined as an initiation of labor, either by mechanical or pharmacological means at a time earlier than nature regardless of a medical or obstetric indication. Objectives were to estimate the proportion of caesarean sections and vaginal deliveries and magnitude of maternal complications following elective induction and spontaneous labor.Methods: The study entitled “comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor in LD Hospital, Kashmir” was a hospital based observational study, conducted in the Postgraduate Department of Obstetrics and Gynaecology, LallaDed Hospital of Government Medical College, Srinagar over a period of one and a half years.Results: Women in induced labor group had slightly increased risk of caesarean section than those in spontaneous group. Fetal distress was the most common indication for caesarean section in both the groups. There was no difference in both groups regarding maternal complications such as perineal lacerations; postpartum hemorrhage (PPH); need for blood transfusions and post partum hospital stay.Conclusions: Though induction of labor is associated with a slight increased risk of caesarean delivery, it is not related to other maternal complications. Therefore inductions are safe in hands of safe obstetricians

Demographic Assessment of Low Vision in Niger State, Nigeria

Purpose: The study was conducted to assess the demographic distribution of low vision in Niger State, Nigeria. Methods: The retrospective cross-sectional study design was adopted. The study sample consisted of 306 low vision patients selected from a total of 12,960 clinical records of patients seen over a 5-year period (2012-2016) in three selected public hospitals in Niger State. Diagnostic criterion for low vision was based on World Health Organization (WHO) definition. Data were analyzed using the Statistical Package for the Social Sciences (SPPS) version 21.0. Results: The prevalence rate of low vision was 2.36%. There were more males (184; 60.1%) than females (122; 33.9%). The males had a higher  proportion of the middle-aged (36-55 years; 33.7%) while the females had more of older adults/elderly (≥ 56 years; 33.6%). Low vision was most prevalent among students (39.2%). Glaucoma (118; 38.6%) was the leading cause of low vision. Albinism accounted for more than half (16/31) of low vision cases amongst children while glaucoma (37/91) and cataract (38/91) accounted for 82.5% of low vision cases among older adults/elderly. The majority (115; 37.6%) of patients had severe low vision (VA < 6/60 to 3/60). The uptake of low vision devices was high (217; 70.9%) and the spectacle magnifier (70; 22.9%) was mostly dispensed. Conclusion: The study has provided baseline information on the demographics of low vision in NigerState, Nigeria which could be the basis for the planning of low vision services in the State. Keywords: Demographic, assessment, low vision, Niger State, Nigeria

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Diversity of Bacillus-like bacterial community in the rhizospheric and non-rhizospheric soil of halophytes (Salsola stocksii and Atriplex amnicola) and characterization of osmoregulatory genes in halophilic Bacilli

Salinity is one of the major abiotic stresses, with a total of 3% of the worldâ s land mass being affected by salinity. Approximately 6.3 million hectares of land in Pakistan is affected by salinity to varying degree and most of the areas are arid to semiarid with low annual precipitation. The aim of present study is to identify and characterize Bacillus and Bacillus-derived bacterial genera from the rhizospheric and non-rhizospheric soil samples from Khewra Salt Mine, Pakistan by using culture-independent as well as culture-dependent methods. Seven Bacillus-like bacterial genera Bacillus, Halobacillus, Virgibacillus, Brevibacillus, Paenibacillus, Tumebacillus and Lysinibacillus were detected by using pyrosequencing analysis whereas only four genera Bacillus, Halobacillus, Oceanobacillus and Virgibacillus were identified by culture-dependent methods. Most of Bacillus-like isolates identified in this study were moderately halophilic, alkaliphilic and mesophilic bacteria and were considered as a good source of hydrolytic enzymes because of their ability to degrade proteins, carbohydrates and lipids. Eight Bacillus-like strains from the genera Bacillus, Halobacillus, Oceanobacillus and Virgibacillus showed positive results for the presence of ectABC gene cluster (ectoine), six strains could synthesize betaine from choline and six strains tested positive for the synthesis of proline from either glutamate or ornithine by using proline dehydrogenase enzyme.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Comparison of Microbial Communities Associated with Halophyte (Salsola stocksii) and Non-Halophyte (Triticum aestivum) Using Culture-Independent Approache

Halophyte microbiome contributes significantly to plant performance and can provide information regarding complex ecological processes involved in osmoregulation of these plants. The objective of this study is to investigate the microbiomes associated with belowground (rhizo­sphere), internal (endosphere) and aboveground (phyllosphere) tissues of halophyte (Salsola stocksii) through metagenomics approach. Plant samples were collected from Khewra Salt Mines. The metagenomic DNA from soil, root and shoot samples was isolated with the help of FastDNA spin kit. Through PCR, the 16S rRNA gene from four different Salsola plants and wheat plants was amplified and cloned in InsTAclone PCR cloning kit. Metagenomic analyses from rhizosphere, endosphere and phyllosphere of Salsola showed that approximately 29% bacteria were uncultured and unclassified. Proteobacteria and Actinobacteria were the most abundant phyla in Salsola and wheat. How­ever, Firmicutes, Acidobacteria, Bacteriodetes, Planctomycetes, Cyanobacteria, Thermotogae, Verrucomicrobia, Choroflexi and Euryarchaeota were predominant groups from halophyte whereas Actinobacteria, Proteobacteria, Firmicutes, Cyanobacteria, Acidobacteria, Bacteriodetes, Planctomycetes and Verrucomicrobia were predominant phyla of wheat samples. Diversity and differences of microbial flora of Salsola and wheat suggested that functional interactions between plants and microorganisms contribute to salt stress tolerance

Tropism of SARS-CoV-2 for Developing Human Cortical Astrocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) readily infects a variety of cell types impacting the function of vital organ systems, with particularly severe impact on respiratory function. It proves fatal for one percent of those infected. Neurological symptoms, which range in severity, accompany a significant proportion of COVID-19 cases, indicating a potential vulnerability of neural cell types. To assess whether human cortical cells can be directly infected by SARS-CoV-2, we utilized primary human cortical tissue and stem cell-derived cortical organoids. We find significant and predominant infection in cortical astrocytes in both primary and organoid cultures, with minimal infection of other cortical populations. Infected astrocytes had a corresponding increase in reactivity characteristics, growth factor signaling, and cellular stress. Although human cortical cells, including astrocytes, have minimal ACE2 expression, we find high levels of alternative coronavirus receptors in infected astrocytes, including DPP4 and CD147. Inhibition of DPP4 reduced infection and decreased expression of the cell stress marker, ARCN1. We find tropism of SARS-CoV-2 for human astrocytes mediated by DPP4, resulting in reactive gliosis-type injury