Management of post-partum haemorhage at tertiary care center

Background: In developing countries like India post-partum haemorrhage (PPH) contributes to 35% of all maternal deaths and 239 per 1,00,000 deaths. So, PPH is a high-risk condition which increases maternal morbidities and mortalities. Hence it mandates a multidisciplinary approach. Audit of misses and near misses helps to determine causes of maternal morbidity and mortality and identify gaps in care. Aim of the study was to study conservative and definitive management of PPH. Methods: A retrospective analysis of all patients who has undergone PPH and also cases who referred from outside with PPH in department of obstetrics and gynaecology at civil hospital Ahmedabad from January 2021 to January 2022. Results: Out of 6029 deliveries there were 171 cases of PPH (2.8%). Which of 150 cases (87.7%) managed by conservative management (uterine conserving) and 21 (12.3%) cases were required definitive management (hysterectomy) due to failure of conservative management. Out of all cases 78.8% cases of PPH were due to atonicity of uterus and 19.1% cases were due to traumatic cause. Early recourse to hysterectomy was recommended especially where bleeding is associated with morbidly adherent placenta. Conclusions: PPH is an important cause of morbidity and mortality. We now have more options for conservative management which can greatly reduce its sequelae and more importantly in patients with wider issues of reproductive health. But in case of intractable bleeding and non-responsive by conservative management definitive management (Hysterectomy) is life saving and last resource

Developing an app to provide physical and mental health benefits for menopausal women

Background: Menopause is the end of a women’s menstrual cycle and reproductive years. For some women the transition is without major problems; others struggle with various psychological and physical symptoms. Regular walking exercise can be an easy way to maintain physical and mental health. Previous focus groups revealed that women enjoy and want the social aspect of walking groups.    Objectives: The goal of this study is to test use and effectiveness of a walking app platform specific for menopausal women that allows them to connect with each other to schedule walks in Edmonton, and track the effect of walking on their symptom changes.   Methods: Women will be recruited from the Edmonton Menopause clinics and by word of mouth. Interested and consented women receive login information to use the app to schedule and sign-up for walks. Women will complete menopause-specific QOL and symptom questionnaires at their first login and will be prompted to complete them monthly thereafter. Women will also be asked to record their walking durations and intensities. Participating women will be invited to focus groups to discuss their experience using the app. Descriptive statistics will be applied to analyze data collected at the backend from questionnaires and surveys, and qualitative content analysis will be applied to analyze the audio-recorded focus groups.    Results: A prototypic online application has been created including a user manual. Access is restricted and all potential participants will be screened after their first login by the research team prior to gaining full access. Women will then be able to use the app features for schedules and surveys. Data collected at the back end by the researchers will determine the use and effectiveness of the app and explore the impact of social walking on menopause symptom changes.   Conclusion: This is the first social platform of this kind created specifically for menopausal women. Ultimately we hope that this platform will empower women to seek lifestyle changes such as walking exercises and connect with each other on the communality of menopause. Testing the use and effectiveness of the app will help us to improve and further develop the app

Evolutionary sequence analysis of complete eukaryote genomes

BACKGROUND: Gene duplication and gene loss during the evolution of eukaryotes have hindered attempts to estimate phylogenies and divergence times of species. Although current methods that identify clusters of orthologous genes in complete genomes have helped to investigate gene function and gene content, they have not been optimized for evolutionary sequence analyses requiring strict orthology and complete gene matrices. Here we adopt a relatively simple and fast genome comparison approach designed to assemble orthologs for evolutionary analysis. Our approach identifies single-copy genes representing only species divergences (panorthologs) in order to minimize potential errors caused by gene duplication. We apply this approach to complete sets of proteins from published eukaryote genomes specifically for phylogeny and time estimation. RESULTS: Despite the conservative criterion used, 753 panorthologs (proteins) were identified for evolutionary analysis with four genomes, resulting in a single alignment of 287,000 amino acids. With this data set, we estimate that the divergence between deuterostomes and arthropods took place in the Precambrian, approximately 400 million years before the first appearance of animals in the fossil record. Additional analyses were performed with seven, 12, and 15 eukaryote genomes resulting in similar divergence time estimates and phylogenies. CONCLUSION: Our results with available eukaryote genomes agree with previous results using conventional methods of sequence data assembly from genomes. They show that large sequence data sets can be generated relatively quickly and efficiently for evolutionary analyses of complete genomes

Antibacterial and Antifungal Activity of Ashwagandha (Withania somnifera L.): A review

Approaches for studying antimicrobial susceptibility and discovering new antimicrobial agents from the plants and other natural sources have been extensively utilized. Withania somnifera (L.) Dunal, commonly known as Ashwagandha or Indian ginseng or winter cherry, is a popular medicinal plant in Ayurvedic medicine. The principal active compounds include several withanolide-type compounds. Various plant parts, like roots and less often leaves and fruits of Ashwagandha, have been used as plant-derived medicines. The plant possesses various pharmacological activities including antimicrobial activity. Many bacterial and fungal species have been used as a test microorganism for the assessment of the antimicrobial activity of extracts and purified compounds of various plant parts of Ashwagandha. In this article, we tried to compile and to discuss the information about the antimicrobial activity of W. somnifera. This will provide the platform for the researchers to select plants, plant parts, solvent system, test microorganisms, method of evaluation and other related factors affecting the analysis

Impact of oral contraceptives on periodontal health

Background: Oral contraceptives pills (OCPs) are common and a convenient form of contraception. The use of hormonal contraceptives by women has been considered to influence gingival and periodontal disease progression.Aim: This study was conducted to assess the effect of oral contraceptive pills on the periodontal health.Materials and method: A cross-sectional comparative study was conducted among 200 females aged 18 years and above of Jaipur city. The study subjects were divided into two groups i.e. contraceptive users and non-contraceptive users, each group consisted 100 females. Data was collected using Modified WHO Performa (1997). Periodontal status was examined using Com- munity Periodontal Index (CPI) and Loss of Attachment (LOA). Chi-square test and one sample t-test was used for statistical analysis and P value was set (p< 0.05) as significant.Results: Mean CPI score in subjects and non-contraceptive users was 2.34+ 0.81 and 1.16+ 0.89 respectively. Mean LOA score in each group was 0.28+ 0.45 and 0.19+ 0.50 respectively.Conclusion: Oral Contraceptive pills had adverse effects on periodontal health.Keywords: Oral contraceptive, community periodontal index, loss of attachment, periodontal healt

Fetomaternal outcome in pregnancy with HELLP syndrome

Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available

Study of various treatment modalities of caesarean scar pregnancy

Background: Caesarean scar pregnancy (CSP) can be defined as the implantation of the gestational sac within the scar of a previous caesarean surgery. Incidence of CSP is 1 in 1800 pregnancies.Methods: It is a retrospective study based on clinical diagnosis and management of CSP of women who presented to the obstetrics and gynaecology department SVP hospital from January 2008 to August 2021. Total number of cases of CSP were 28. Incidence, gestational age, ultrasound findings, serum β-human chorionic gonadotropin (β-hCG) levels, flow profiles of color Doppler, and different methods of treatment were recorded. Diagnosis was confirmed by ultrasound.Results: In this study, all 28 cases of CSP considered were offered definitive management. In present study 5 cases (17.88%) showed torrential haemorrhage during dilatation and evacuation (D and E) which was treated by various methods like 1 (3.57%) Foley’s tamponade, 1 (3.57%) uterine artery embolization (UAE) and 3 (10.71%) hysterectomy. Hysterotomy was performed in 13 cases (46.42%) and (7.69%) of heterotrophic CSP (HCSP). One case (3.84%) of CSP presented at 26 weeks of gestation with haemorrhagic shock, underwent obstetric hysterectomy.Conclusions: There is a rise in the incidence of CSP because of increase in the global rate of caesarean sections and early transvaginal USG in pregnancy. Transvaginal sonography is the best diagnostic tool. Medical management can be offered when diagnosis is made at gestational age of 7 weeks of gestational age. Surgical management has an advantage of shorter follow up.

Mullerian ductal anomalies and its outcome

Background: The aim is to study various investigative modalities to diagnose Mullerian anomalies and to evaluate the reproductive outcome that occurs as a result of malformation of genital tract.Methods: A prospective study of reproductive anomalies and its outcome was performed by using data from women with congenital anomalies attended in OPD either with complains or for operative treatment or incidental diagnosis during caesarean section, manual removal of placenta, during laparoscopy or laparotomy at tertiary care center. Total 70 women with different types of congenital anomalies were included in study. Out of them gynecological cases (27) were diagnosed on basis of clinical examination and other diagnostic aids while Mullerian anomalies in obstetric cases (43) were observed and their outcomes were studied.Results: Most common utero-vaginal anomaly seen in present study was septate uterus with 18 (25.7%) cases, followed by bicornuate uterus with 13 (18.6%) cases. Most common presenting symptom is primary amenorrhea 21 (30%) followed by cyclical abdominal pain 11 (15.7). HSG, USG are the primary tools to detect genital tract anomalies. Surgical correction was required in 47.1% patients.Conclusions: Present study shows prevalence of congenital malformation of female reproductive tract is 0.17% at our tertiary care center. Utero-vaginal anomalies are a morphologically diverse group of developmental disorders. Establishing an accurate diagnosis is essential for planning treatment and management strategies. The surgical approach for correction of utero-vaginal anomalies is specific to the type of malformation and may vary in a specific group

Neonatal central diabetes insipidus in a case of hydranencephaly

Neonatal diabetes insipidus (DI) poses both diagnostic and therapeutic challenge to the neonatologists. Neonatal central DI (CDI) is an uncommon disorder which is characterized by polyuria, hypernatremia, high plasma osmolality, and low urine osmolality. Our full-term neonate with an antenatal magnetic resonance imaging showing hydranencephaly presented to us on day 4, with persistent hypernatremic dehydration along with the polyuria which was not getting corrected by the routine management of hypernatremic dehydration. Further investigations revealed urine hypo-osmolality and high serum osmolality and a good response to oral desmopressin (DDAVP). This helped to diagnose CDI secondary to hydranencephaly. The baby was discharged on oral DDAVP, but unfortunately, the baby succumbed at 3 months of age

Improvements to GALA and dbERGE II: databases featuring genomic sequence alignment, annotation and experimental results

We describe improvements to two databases that give access to information on genomic sequence similarities, functional elements in DNA and experimental results that demonstrate those functions. GALA, the database of Genome ALignments and Annotations, is now a set of interlinked relational databases for five vertebrate species, human, chimpanzee, mouse, rat and chicken. For each species, GALA records pairwise and multiple sequence alignments, scores derived from those alignments that reflect the likelihood of being under purifying selection or being a regulatory element, and extensive annotations such as genes, gene expression patterns and transcription factor binding sites. The user interface supports simple and complex queries, including operations such as subtraction and intersections as well as clustering and finding elements in proximity to features. dbERGE II, the database of Experimental Results on Gene Expression, contains experimental data from a variety of functional assays. Both databases are now run on the DB2 database management system. Improved hardware and tuning has reduced response times and increased querying capacity, while simplified query interfaces will help direct new users through the querying process. Links are available at http://www.bx.psu.edu/