The Impact of use of Modified WHO Partograph on Labour Progress and Delivery: Outcome among Spontaneous and Induced Labour in Nulliparous Women at Term

Labour is a normal physiological process considered by a progressive rise in frequency, intensity, and duration of uterine contractions resulting in effacement and dilatation of the cervix with descent of the fetus over the birth canal. Spontaneous or Induced labour has a significant role in the eventual mode of delivery and neonatal outcome. This study aims to compare mean duration of labour and maternofoetal outcome of spontaneous versus induced labour among nulliparous women. This was a prospective observational study conducted in the Department of Obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2016 to September 2017. The study was conducted in nulliparous women coming at term (38-41) weeks in active phase of labour (with cervical dilatation at least 4cm) either spontaneous or induced, both group of labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery, and the maternofoetal outcome. A total of 160 women were enrolled in this study into two groups. There was no difference in mean age group, but BMI and gestational age were noted significant (p=0.001) More women had spontaneous normal vaginal delivery among those with spontaneous labour (86.25% vs. 78.75%). The mean duration of the second stage of labour was significantly more in induced (17.65 minutes) than in spontaneous labour (14.78 minutes) with a significant P-value (p=0.001). The mean Apgar score between the groups showed almost same. No statistically significant difference was found (p>0.05). This study prevailed that, requirement of oxytocin for augmentation of labour and mean duration of labour was less in spontaneous group and most of the patient delivered vaginally but in induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. We observed that induced labour can be a safe procedure among nulliparous women if labour is monitored by modified WHO partograph.

Congenital muscular torticollis: experience of 14 cases

Congenital Muscular Torticollis (CMT) is a postural deformity of head and neck detected at birth or shortly after birth, primarily resulting from unilateral shortening of Sternocleidomastoid Muscle (SCM). In neonates and infants, patient may cure conservatively by physiotherapy but surgery is the treatment of choice for children and adolescents. There are various techniques of surgery. Here we show our experience regarding management of congenital muscular torticollis. In the present retrospective case series, fourteen patients of congenital muscular torticollis were treated. The cases were enrolled between Nov' 2005 to Oct' 2007 in Bangabandhu Sheikh Mujib Medical University, Gonosasthaya Somaj Vittik Medical College Hospital, Dhaka and different private clinics of Dhaka city of Bangladesh. Neonates and infants were treated conservatively with physiotherapy and others treated surgically by transection of both sternal and clavicular head of SCM under general anesthesia. Operated patients were released on following post operative day with advised to do physiotherapy. Patients age range from 7 days to 15 years of which ten were female and four male. SCM was shortened in all cases (8 on right side and 6 on left side). Eleven were female and three male. Of 14 patients, 2 neonates, 7 infants and 5 were more than 1 year age. There was no associated anomaly. Out of 9 neonates and infants 8 cured conservatively with physiotherapy and another one significantly improved. Six were treated surgically including one failed physiotherapy. Post operative period was uneventful and there was no complication. Results were evaluated clinically and comments of peers. Most of the patient of congenital muscular torticollis can be treated conservatively during infancy. Division of both sternal and clavicular head of SCM is easy and safe surgical technique for the treatment of CMT of older children and adolescents.

Transfer of radiocobalt from soil to selected plant species in tropical environments

Soil-to-plant transfer factors (TFs) of radiocobalt (60Co) were determined in pot experiments for leafy vegetation, root crops and rice grown in the tropical environment of Bangladesh. Soil properties were also measured to establish a relationship between these properties and TF values. Measured TF values of 60Co for leafy vegetation (average of 2.2 x 10(-2)) were slightly higher than the values obtained for root vegetation (average of 1.6 x 10(-2)). However, TF values obtained for rice (average of 1.17 x 10(-2)) were about a factor of 2 lower than the values obtained for leafy vegetation. TF values of 60Co for leafy vegetation and root crops were observed to decrease with increasing pH, exchangeable K+ and clay content in the soil, even though poor correlations were estimated statistically. No consistent relationship between the TF value for 60Co and organic matter content could be deduced. The results presented here provide a useful addition to existing databases on soil-plant transfer for 60Co, since this information is still rather sparse for tropical environments.

Body radioactivity and radiation dose from 40K in Bangladeshi subjects measured with a whole-body counter

A group of subjects of Bangladeshi adults from both sexes were studied for internal radioactivity and effective dose by measuring the whole-body activity of naturally occurring 40K using a whole-body counter. The mean activity concentration in the whole body and effective dose due to naturally occurring 40K for the average male were found to be 2.0 +/- 0.4 Bq x g(-1) and 100 +/- 26 microSv x y(-1), respectively and those for the average female were 1.7 +/- 0.3 Bq x g(-1) and 100 +/- 20 microSv x y(-1), respectively. The mean activity concentration in the whole body and effective dose for both sexes were 1.9 +/- 0.4 Bq x g(-1) and 100 +/- 25 microSv x y(-1), respectively. The effective dose from 40K for subjects is below the value reported by the UNSCEAR.

Measurements of radioactivity in books and calculations of resultant eye doses to readers

Natural and fallout radioactivity in some book samples were measured with an HPGe detector coupled with a 4096 channel analyzer in order to estimate the radiation doses to readers' eyes from books. The radiation doses to a population at large due to the presence of radioactivity in the book are not significant. Thus, no radiation hazard occurs from the radioactivity content in the book. The estimated radiation doses to eyes were found to be below the maximum permissible dose to eyes recommended by ICRP.

The role of Rho GTPases in the regulation of the rearrangement of actin cytoskeleton and cell movement

The rearrangement of the actin cytoskeleton has been shown to play a critical role in the development of transformation and malignant phenotype of cancer cells. Rho family GTPases regulate the arrangement of the actin cytoskeleton. By wound-healing assay, we have found that NIH 3T3 fibroblast cells move towards the wound- gaps by extending filopodial and lamellipdial structures at the leading edge of the moving cells. We have inactivated the function of Rho GTPases of v-Ras transformed NIH 3T3 cells by overexpressing Rho GTPase-activating (RhoGAP) domain of RhoGAP of p190. We have observed that inactivation of Rho, Rac and Cdc42 GTPases by overexpressing RHG causes inhibition of: (i) polymerization of actin to form filaments, (ii) formation of lamellipodia, filopodia and stress fibres, (iii) cell motility, (iv) cell spreading and (v) cell-to-cell adhesions. These results further strengthen the current knowledge on the role of Rho, Rac and Cdc42 GTPases in the regulation of the rearrangement of actin cytoskeleton. Our results, for the first time, demonstrate that RhoGAP domain of RhoGAP could be used to study the molecular mechanism of Ras-mediated signalling in growth, differentiation and carcinogenesis.

Serum-dependent perinuclear accumulation of Cdc42 in mammalian cells

Cdc42 is a member of the Rho family of GTPase. Cdc42 has been implicated to be involved in the movement, multiplication and transformation of mammalian cells by controlling the rearrangement of actin cytoskeleton and gene expression. But the mechanism of Cdc42 function has not yet been discovered. In this report we present data showing a perinuclear accumulation of Cdc42 in response to fetal bovine serum (FBS). There was no change in the amount of Cdc42 in response to FBS in the cell. It was found that protein component(s) of serum plays a major role in the perinuclear accumulation of Cdc42. Epidermal growth factor has also been found to stimulate the perinuclear accumulation of Cdc42 while NGF has no effect. Kinase inhibitors, quercetin and NDGA were found to block signals for the perinuclear accumulation of Cdc42. This suggests that phosphorylation of cellular proteins is essential for transducing signals generated from the serum component(s) to induce the perinuclear accumulation of Cdc42. These results indicate that redistribution of Cdc42 might be an important step in alteration of gene expression for controlling various functions of the cell including cell division.

Incidence of spontaneous echocontrast in left atrium in mitral stenosis detected by transoesophageal echo cardiography and related factors

The incidence of left atrial (LA) spontaneous echo contrast (SEC) and the clinical and echocardiographic variables related to it were prospectively evaluated in a series of 60 patients with mitral stenosis (MS) undergoing transoesophageal echocardiography (TEE) with a 5 MHz multiplane transducer. LA-SEC was found in 39 patients (65%) employing TEE. Statistical analysis showed a significant relationship between the presence of SEC and MS without mitral regurgitation (MR) (P < 0.05), MS with < or = MR grade II (P < 0.05), atrial fibrillation (P < 0.001) and increased left atrial dimension (P < 0.05). Age, sex, mitral valve area and ejection fraction did not show any positive association (P > 0.05). Thus, it is concluded that LA-SEC is a common finding observed in approximately 65% of MS patients undergoing TEE and associated with conditions favouring stasis of left atrial blood.

Common aerobic bacteria in post operative wound infection and their sensitivity pattern

Two hundred and four post-operative patients were examined and pus samples were collected with sterile cotton swabs from 64 patients with infected wounds. The samples were cultured aerobically and the isolates were identified as per standard methods. The prevalence rate of post-operative wound infection were 31.37% and the total number of bacterial isolates were 76 (37.25%). The isolates were identified up to their species level & they were E. coli, Staph. aureus, Kl. Pneumoniae, Ps. aeruginosa. Pr. vulgaris and S. pyogenes. Gram negative bacilli were the predominant organisms and among them E. coli was the most common. In antimicrobial susceptibility test Gentamycin and Cephalexin were found sensitive.

Antibiotic in general surgery: selection, timing and duration of administration

A continuous surveillance of hospital acquired infection (HAI) was done in the Department of Surgery, Dhaka Medical College Hospital during the period of 1st February '90 to 31st March '90. A new antibiogramme was prepared and applied in the same unit for chemotherapy and chemoprophylaxis of surgical cases in the subsequent six months from April '90 to September '90. The result of this selection, timing of administration and the duration of antimicrobial use have been described in this report. The antibiotic policy adopted in this study has been found to improve the problem of infection in our surgical practice substantially. The incidence of HAI has been reduced to 0.5% from 3.9% which was seen in our previous study. The median post operative hospital stay has been reduced to 15.5 days from 18.5 days in case with HAI and to 8.5 days from 9 days without HAI. We conclude that a continuous surveillance of hospital acquired infection is necessary to develop an appropriate antibiogramme. The appropriate antibiotic should be started at the induction of anaesthesia and may be a part of the induction procedure.

Plasmid Curing of Escherichia coli Cells with Ethidium Bromide, Sodium Dodecyl Sulfate and Acridine Orange

The plasmid eliminating abilities of acridine orange, ethidium bromide and sodium dodecyl sulfate were investigated on multi drug resistant Escherichia coli from urinary tract infection specimens. Three different concentrations of each curing agent (Et-Br, SDS and AO) were used. The frequencies of cured cells were 5.55 % (with 50 μg/ml) and 11.76 % (with 75 μg/ml) for acridine orange, 14.29 % (with 100 μg/ml), 21.05 % (with 100 μg/ ml), 17.65 % (with 125 μg/ml) for ethidium bromide and 7.4 % (with 10 % w/v) & 6.67 % (with 10 % w/v) for sodium dodecyl sulfate. However, no cured cells were obtained from 100 μg/ml acridine orange, 75 μg/ml ethidium bromide and 8 and 12 % SDS. Analysis of profiles of wild type and plasmid cured strains by electrophoresis yielded bands of varying sizes for wild type cells, but none were obtained for Et-Br cured cells. Acridine orange treated cells could eliminate only plasmids of 2.7 MDa and another smaller than 2 MDa. Key Words: Plasmid curing; Escherichia coli; Ethidium Bromide; Sodium Dodecyl Sulfate; Acridine Orange. DOI: http://dx.doi.org/10.3329/bjm.v27i1.9165 BJM 2010; 27(1): 28-31