Costs and benefits of climate services for heat-health adaptation in Europe

Background

Climate services for health aim to support informed decision-making and enable early action and preparedness. More knowledge is still needed regarding the costs and benefits of climate services, as well as effectiveness, and technical, structural, and societal barriers and facilitators to implementation and use.

Aim

To map the evidence on the economic assessment and use of climate services for health in reducing heat-associated mortality and morbidity and explore the societal impact of climate services, particularly in Europe.

Methods

We focus on two methods in this study: 1) a scoping review of literature on the economic assessment and health benefit of climate services 2) a set of interviews with climate service developers and providers in Europe to understand further technical and societal aspects as well as evaluation of such services.

Findings

From the scoping review, a total of 27 peer-reviewed articles all presenting heat early warning systems (HEWS) that work on a weather timescale were identified. The results from economic assessment studies suggested HEWS can produce health benefits greater than the operational cost, even during future climate change scenarios. While most of the studies assessing health outcomes have suggested that HEWS can help in reducing heat-related mortality and morbidity, some concluded no significant impact and some suggested increased healthcare services utilization after implementation of HEWS. The findings from the six interviews conducted across Europe identifies barriers for climate service development and implementation such as insufficient financing and cultural differences between climate and health professionals.

Conclusions

Our results find limited evidence on the economic assessment of climate services, gap in knowledge regarding health benefits from climate services using seasonal/sub-seasonal and long-term climate information and several barriers to making these services useful for end-users.

High-dose femtosecond-scale gamma-ray beams for radiobiological applications

Objective. In the irradiation of living tissue, the fundamental physical processes involved in radical production typically occur on a timescale of a few femtoseconds. A detailed understanding of these phenomena has thus far been limited by the relatively long duration of the radiation sources employed, extending well beyond the timescales for radical generation and evolution. Approach. Here, we propose a femtosecond-scale photon source, based on inverse Compton scattering of laser-plasma accelerated electron beams in the field of a second scattering laser pulse. Main results. Detailed numerical modelling indicates that existing laser facilities can provide ultra-short and high-flux MeV-scale photon beams, able to deposit doses tuneable from a fraction of Gy up to a few Gy per pulse, resulting in dose rates exceeding 1013 Gy/s. Significance. We envisage that such a source will represent a unique tool for time-resolved radiobiological experiments, with the prospect of further advancing radio-therapeutic techniques.

Thyroid hormone and thyromimetics inhibit myelin and axonal degeneration and oligodendrocyte loss in EAE

We have previously demonstrated that thyromimetics stimulate oligodendrocyte precursor cell differentiation and promote remyelination in murine demyelination models. We investigated whether a thyroid receptor-beta selective thyromimetic, sobetirome (Sob), and its CNS-targeted prodrug, Sob-AM2, could prevent myelin and axonal degeneration in experimental autoimmune encephalomyelitis (EAE). Compared to controls, EAE mice receiving triiodothyronine (T3, 0.4 mg/kg), Sob (5 mg/kg) or Sob-AM2 (5 mg/kg) had reduced clinical disease and, within the spinal cord, less tissue damage, more normally myelinated axons, fewer degenerating axons and more oligodendrocytes. T3 and Sob also protected cultured oligodendrocytes against cell death. Thyromimetics thus might protect against oligodendrocyte death, demyelination and axonal degeneration as well as stimulate remyelination in multiple sclerosis.

Low-Voltage Domain-Wall LiNbO3 Memristors

Application of conducting ferroelectric domain walls (DWs) as functional elements may facilitate development of conceptually new resistive switching devices. In a conventional approach, several orders of magnitude change in resistance can be achieved by controlling the DW density using supercoercive voltage. However, a deleterious characteristic of this approach is high-energy cost of polarization reversal due to high leakage current. Here, we demonstrate a new approach based on tuning the conductivity of DWs themselves rather than on domain rearrangement. Using LiNbO₃ capacitors with graphene, we show that resistance of a device set to a polydomain state can be continuously tuned by application of subcoercive voltage. The tuning mechanism is based on the reversible transition between the conducting and insulating states of DWs. The developed approach allows an energy-efficient control of resistance without the need for domain structure modification. The developed memristive devices are promising for multilevel memories and neuromorphic computing applications.

Cadaverless anatomy: Darkness in the times of pandemic Covid-19

The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected.

Prevalence of Extended Spectrum Beta-Lactamase Producing Klebsiella Pneumoniae Isolated From Urinary Tract Infected Patients

BACKGROUND

Klebsiella pneumoniae, one of the bacterial agents associated with urinary tract infection has been often implicated as a major extended spectrum beta-lactamase (ESBL) producer in last few decades. This study was designed to assess the prevalence of ESBL producing Klebsiella pneumoniae in urinary isolates at a tertiary care hospital in Kathmandu, Nepal, from July to December 2014.

METHODS

One thousand nine hundred eighty six mid-stream urine specimens were collected aseptically from the clinically suspected patients of urinary tract infections attending Capital Hospital and Research Center, Kathmandu. The samples were processed following standard guidelines as recommended by American Society for Microbiology (ASM) and the isolates including Klebsiella spp. were identified using the specific biochemical and sugar fermentation tests recommended by ASM. Antibiotic sensitivity testing was done by modified Kirby-Bauer disk diffusion method and interpreted following Clinical and Laboratory Standards Institute (CLSI) guidelines. Klebsiella pneumoniae isolates showing resistance upon initial screening with ceftriaxone (30 μg) disc were then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 µg) and ceftazidime + clavulanic acid (30 µg + 10µg) and cefotaxime (30 µg) and cefotaxime + clavulanic acid (30 µg +10µg) disc as per CLSI guidelines.

RESULTS

Out of a total 1986 specimens investigated, Escherichia coli was isolated in 309 (83.9%) and Klebsiella pneumoniae in 38 (10.3%) cases. Initial screening with ceftriaxone disc revealed 18 isolates of Klebsiella pneumoniae to be resistant. Further testing by PCDDT method confirmed 7 (18.4%) Klebsiella pneumoniae isolates to be ESBL producers.

CONCLUSIONS

Compared to some earlier studies done in Nepal, higher prevalence of ESBL-producing Klebsiella pneumoniae was observed warranting a national surveillance for routine monitoring of ESBL producing Klebsiella pneumoniae isolates.

Primary hepatic angiosarcoma

Primary hepatic angiosarcoma is a rare, aggressive tumor; composed of spindle or pleomorphic cells that line, or grow into, the lumina of pre-existing vascular spaces like sinusoids and terminal hepatic venules; with only about 200 cases diagnosed annually worldwide but it is the most common primary malignant mesenchymal tumor of the liver in adults and accounts for 2% of all primary hepatic malignancies. HAS occurs in association with known chemical carcinogens, but 75% of the tumors have no known etiology. Patients present with vague symptoms like abdominal pain, weight loss, fatigue or an abdominal mass. Hepatic angiosarcoma is usually multicentric and involves both lobes, entire liver may also found to be involved. CD31 is the most reliable marker. These tumors lack specific features on imaging, so, pathological diagnosis is necessary. There are no established treatment guidelines because of low frequency and aggressive nature of tumor, chemotherapy is only palliative, liver resection is indicated for solitary mass and liver transplant is contraindicated. The aim of this article is to comprehensively review all the available literature and to present detailed information and an update on primary hepatic angiosarcoma.

Protective effect of proteins derived from Calotropis procera latex against acute inflammation in rat

The non-dialysable proteins present in the latex of plant Calotropis procera possess anti-inflammatory and analgesic properties. The aim of this study was to evaluate the effect of latex proteins (LP) on the level of inflammatory mediators, oxidative stress markers and tissue histology in the rat model of carrageenan-induced acute inflammation. This study also aimed at evaluating the anti-inflammatory efficacy of LP against different mediators and comparing it with their respective antagonists. Paw inflammation was induced by subplantar injection of carrageenan, and the effect of LP was evaluated on oedema volume, level of TNF-α, PGE(2), myeloperoxidase, nitric oxide, reduced glutathione, thiobarbituric acid-reactive substances and tissue histology at the time of peak inflammation. Paw inflammation was also induced by histamine, serotonin, bradykinin and PGE(2), and the inhibitory effect of LP against these mediators was compared with their respective antagonists at the time of peak effect. Treatment with LP produced a dose-dependent inhibition of oedema formation, and its anti-inflammatory effect against carrageenan-induced paw inflammation was accompanied by reduction in the levels of inflammatory mediators, oxidative stress markers and normalization of tissue architecture. LP also produced a dose-dependent inhibition of oedema formation induced by different inflammatory mediators, and its efficacy was comparable to their respective antagonists and more pronounced than that of diclofenac. Thus, our study shows that LP has a potential to be used for the treatment of various inflammatory conditions where the role of these mediators is well established.

Ecosystem Services and Stakeholder Analysis in Bishajari Lake and Associated Wetland Areas, Chitwan, Nepal

Wetlands as other ecosystems deliver goods and services of enormous value to the human society and are regarded as one of the most productive ecosystems. We assessed the ecosystem services delivered by Bishajari Lake and its associated wetland areas of Chitwan district during June to August, 2012. A household survey consisting 110 households, interviews with key informants, group discussions and stakeholder analysis were carried out for this purpose to document the overall status of ecosystem services, evaluate the provisional services generated by the lakes, understand potentials for payment to ecosystem services, and identify stakeholders involved and their roles and responsibilities. A total of 12 fish species, 17 wild and domestic fruits, 12 timber species, 15 fodder species, 20 wild vegetables species and 31 medicinal plant species were recorded. Moreover 65.5% of respondents were found receiving some sort of income from the wetland area. The majority of respondents felt that the ecosystem is being changed mostly on provisional services. So far with little support from government, the local people have practiced some adaptive responses like biogas plant, afforestation, electric fencing, contract fisheries, ecotourism and other climate-smart measures. It suggest that raising awareness and sharing information among the locals should be done more frequently and effectively to continuously cope with ecosystem change. DOI: http://dx.doi.org/10.3126/ijasbt.v2i4.11552  Int J Appl Sci Biotechnol, Vol. 2(4): 563-569 

Profile of Obstetric Morbidity Among Maternal Intensive Care Unit Patients

Aims: The objective of the study was to determine the outcome of the obstetric admissions to Maternal Intensive Care Unit in the setting of a tertiary care hospital. Methods: This was a cross-sectional study undertaken at Paropakar Maternity and Women’s Hospital from April 1, 2012 to March 31, 2013. Patient characteristics, gestational age, booking status, indication for intensive care unit admission, intervention, length of stay and outcome were analyzed. Results: During the study period, 19,247 deliveries occurred and 247 women were admitted to maternal intensive care unit. This accounts for 1.28% of all deliveries. The most common indication of admission to intensive care unit was hypertensive disorders in pregnancy (45.3%) followed by obstetric hemorrhage (39.27%). Sepsis was the cause in ten (4.04%) cases. Ten cases (4.04%) of postpartum hemorrhage were managed by balloon tamponade, seven (2.83%) by B-Lynch compression sutures and three (1.21%) necessitated cesarean hysterectomy. Among 18 cases of ruptured uterus, 13 (5.26%) were repaired while five (2.02%) required hysterectomy. Maternal mortality occurred in four (1.61%) of the cases. One was a case of severe preeclampsia who died on 4th post-operative day due to pulmonary embolism, another due to anesthetic complication and the other two died of septic shock and multiorgan failure. Conclusions: Hypertensive disorders of pregnancy and obstetric hemorrhage appeared as the major risk factors for admission to an intensive care unit thereby influencing maternal outcomes in obstetric patients. DOI: http://dx.doi.org/10.3126/njog.v9i2.11762 

Intra-amniotic Digoxin for Fetal Anomaly in Second and Early Third Trimester

Aims: Carrying a baby with major anomaly is emotional trauma for mother and her family. If born alive, these babies would either not survive or would have significant disability. The objective of this study was to induce fetal demise by instillation of digoxin intra-amniotically for fetal anomaly before termination of pregnancy. Methods: This was a cross-sectional study undertaken at Paropakar Maternity and Women’s Hospital from April 13, 2012 to October 13, 2013. Patient characteristics, gestational age, types of fetal anomaly and its time of detection were recorded in 32 cases with fetal anomaly in second and early third trimester. One milligram digoxin was instilled intra-amniotically under ultrasound guidance and after 24 hours, ultrasonography was done to check fetal cardiac activity. Induction of labour using misoprostol as per FIGO guideline and augmentation with oxytocin was done if already in labour. Induction to delivery interval, effectiveness and side effects of digoxin were recorded. Results: Among 32 cases of fetal anomaly, majority occurred in primigravida (n=17, 53.12%). The mean age was 25 years and mean gestational age was 26.5 weeks’. Majority of them were anencephaly (n=16, 50%) followed by multiple anomaly (n=6, 18.75%). Thirty one (96.87%) cases visited out-patient department, 25% of them had presented late at 30-34 weeks’. Following 24 hours of intra-amniotic digoxin, cardiac activity was absent in all cases and there was no side effect of digoxin. Spontaneous expulsion occurred in 9.37%, oxytocin augmentation (n=6, 18.75%) and misoprostol induction (n=23, 71.87%). The mean induction to delivery interval was 47.3 hours. Conclusions: Intra-amniotic digoxin instillation appeared safe and effective in inducing fetal demise for fetal anomaly in second and early third trimester. DOI: http://dx.doi.org/10.3126/njog.v9i1.11188 NJOG 2014 Jan-Jun; 2(1):48-51

Prevention of Mother to Child Transmission (PMTCT) Program at Paropakar Maternity and Women’s Hospital: A Review

Aims: Vertical transmission from mother to fetus is the main route of HIVinfection among children. This study is an effort to review utilization of prevention of mother to child transmission (PMTCT) services by pregnant women seeking care in Paropakar Maternity and Women’s Hospital (PMWH). Methods: Case records of 165 pregnant women with HIV positive status who delivered at Paropakar Maternity and Women’s Hospital, Kathmandu from April 2005 to Dec 2011 were reviewed. Demographic profile of these women and interventions to prevent mother to child transmission (MTCT) including antiretroviral prophylaxis (ARV), mode of delivery, infant feeding practice as well as HIV status of their children were recorded. Results: Hospital records showed 109262 antenatal attendees and 120823 deliveries including 165 HIV infected women who delivered in this facility. Prevalence of HIV infection among antenatal attendees was 0.11 % and 0.13% in hospital deliveries. Migrant worker spouse (44.2%) was the main source of infection in their wives. Eighty eight (55.7%) out of 150 eligible women received ARV drugs and 97% babies received antiretroviral prophylaxis . Spontaneous vaginal delivery occurred in 60% women and caesarean section performed in the rest. While 60.8% women opted for exclusive breast feeding, remaining 39.2% chose formula feeding. For prophylaxis of opportunistic infection, Cotrimoxazole was given to 70.3% children. The incidence of HIV infection in babies born to HIV infected mother was 5.1%. Conclusions: Integrating PMTCT services into existing maternal and child health system can significantly reduce perinatal transmission of HIV infection to children. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11138 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 25-28

Severe Acute Maternal Morbidity and Intensive Care in Paropakar Maternity and Women’s Hospital

Aims: Maternal morbidity occurs due to complications arising in pregnancy or within 42 days of delivery. Women with acute severe morbidity require admission in the intensive care unit (ICU). This study was done to explore the profile of those women requiring intensive care. Methods: A study was conducted at Paropakar Maternity and Women’s Hospital in which records of patients admitted in Maternal Intensive Care Unit (MICU) were evaluated for demographics, disease responsible for critical illness, complications that prompted MICU admissions, interventions required, length of MICU stay and resulting maternal morbidity and mortality.  Results: Over the study period, 159 obstetric patients were transferred to MICU, representing 2.23% of 7109 deliveries. Hypertensive disorders of pregnancy (50%) and postpartum haemorrhage (14.46 %) were the two major obstetrical conditions responsible admission into MICU. Conclusions: Auditing of severe maternal morbidity will improve the quality of obstetric care and decrease the incidence of maternal morbidity and maternal mortality.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 38-41 DOI: http://dx.doi.org/10.3126/njog.v8i2.9768  

Acute Uterine Inversion: Case Series from Paropakar Maternity and Women’s Hospital

Acute puerperial uterine inversion is a rare life threatening obstetric emergency, in which the uterine fundus collapses into and out of the uterine cavity. Although precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labour. The duration of time elapsed from moment of diagnosis to that of correction, along with rapid resuscitation measures are of utmost importance in its prognosis. Principle of treatment includes resuscitation followed by manual reduction of inversion uterus. Surgical procedure may be needed if reinversion is impossible. Reporting here are series of cases with acute inversion of uterus at third stage of labour followed by a short review of the literature. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 46-49 DOI: http://dx.doi.org/10.3126/njog.v8i1.8865

Rothia prosthetic knee joint infection: report and mini-review

Rothia spp. are gram-positive pleomorphic bacteria that are part of the normal oral microflora. They are associated with dental and periodontal disease, although systemic infections have also been reported. We describe the case of a 75-year-old lady with rheumatoid arthritis who presented with prosthetic knee joint infection due to Rothia aeria. We discuss its identification and the evidence regarding association of dental disease with Rothia spp. joint infections based on available literature.

Major non-ABO incompatibility caused by anti-Jk(a) in a patient before allogeneic hematopoietic stem cell transplantation

A 49-year-old white man with blood group AB, D+ was found to have alloanti-Jk(a) and -K when he developed a delayed hemolytic transfusion reaction before allogeneic hematopoietic stem cell transplant (HSCT). Given that his stem cell donor was blood group O, D+, Jk(a+), K-, rituximab was added to his conditioning regimen of fludarabine and melphalan to prevent hemolysis of engrafting Jk(a+) donor red blood cells. The patient proceeded to receive a peripheral blood stem cell transplant from a matched unrelated donor with no adverse events. To our knowledge, this is the first case of successful management of major non-ABO incompatibility caused by anti-Jk(a) in a patient receiving an allogeneic HSCT reported in the literature.

Interplay between protein-modified surface and functional response of osteoblasts

The objective of the study is to elucidate the interplay between fibronectin-metal hybrid surfaces and osteoblast function. The practical relevance is that a significant initial step in the process of prosthetic integration within a physiological system is the rapid adsorption of proteins, including fibronectin, on the surface of biomedical device. Here, we compare and contrast the cell-substrate interactions on bare and protein-modified surfaces. The protein adsorption on the surface was beneficial in favorably modulating biological functions including cell attachment, proliferation, and viability. Additionally, immunofluorescence studies demonstrated stronger vinculin signals associated with actin stress fibers in the outer regions of the cells and cellular extensions on protein-adsorbed surfaces. These results support the hypothesis that protein adsorption on artificial biomedical devices can promote bioactivity and regulate biological functions.

Achieving Millennium Development Goals 4 and 5 in Nepal

The under 5 child mortality rate in Nepal is on track to achieve the target of 54 per 1000 live births by 2015 compared with 158 per 1000 live births in 1991. The maternal mortality rate also looks set to drop to its target of 134 per 100,000 live births by 2015 from 539 per 100,000 live births in 1991. A 3-year interim plan (2008-11) was established to provide free basic health care for all citizens and the safe delivery incentive programme has proved to help progression towards achieving Millennium Development Goals 4 and 5. The development of a policy targeting women, children and vulnerable populations in hard to reach places is a key feature. The principle of a primary healthcare approach is applied in the development and implementation of strategy plans and programmes. The focus is on ensuring that there are functioning facilities for essential obstetric care at health facilities and provision of trained personnel at delivery.

Atypical sarcoidosis masquerading as neutropenia

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Gastrointestinal involvement in sarcoidosis is rare and so are its hematological manifestations. We report an unusual case of sarcoidosis with isolated gastric involvement and concomitant B12 and iron deficiency, leucopenia and severe neutropenia. The diagnosis of GI tract sarcoidosis is difficult and other causes of GI tract granulomas should be excluded. Patients can have unusual manifestations like B12 deficiency and one should be aware of this possibility. Careful follow-up and frequent reevaluation of the patient may be a sound strategy in equivocal cases with unusual presentation.

Whole body protection against lethal ionizing radiation in mice by REC-2001: a semi-purified fraction of Podophyllum hexandrum

The current study has concentrated on assessment of the radioprotective potential of REC-2001, a semi-purified fraction of rhizomes of Podophyllum hexandrum, in Swiss albino Strain 'A' mice exposed to 10 Gy whole-body gamma radiation. Animals were treated with 10 and 15 mg/kg b wt (i.p.) of REC-2001 1h prior to exposure to a lethal dose of gamma-radiation (10 Gy) and observed upto 30 days. For analysis of maximum tolerable dose (MTD), LD(50) and acute toxic dose, different concentrations of the extract were administered to animals and their mortality and morbidity status was observed upto 72 h and one week, respectively. Dose reduction factor (DRF) was determined by exposing REC-2001 pre-treated mice to supra-lethal doses of gamma-radiation. Endogenous spleen colony forming units (CFU), DNA strand breaks in thymocytes (alkaline halo assay) and lipid degradation was studied to understand the mechanism of radioprotection. A single dose of REC-2001 (10 and 15 mg/kg b wt i.p.) exhibited >90% survival in the pre-treated irradiated group versus no survival in radiation control group. Single doses of upto 75 mg/kg b wt (i.p.) did not cause any mortality (MTD) in mice. REC-2001, a dose of 90 mg/kg b wt, resulted in 50% mortality (LD(50)), while the LD(100) was 115 mg/kg b wt REC-2001 exhibited a DRF of 1.62. CFU counts in the REC-2001 treated group were found significantly high (5.33/spleen) as compared to controls. Exposure of thymocytes to 10 Gy radiation resulted in increased halo diameter (45+/-3 microm) in comparison to untreated controls (8+/-1 microm). REC-2001 administration (500 microg/ml) decreased the halo diameter to 15+/-2 microm. Radiation-induced lipid degradation was also inhibited by REC-2001. The present study has revealed that REC-2001 is a promising radioprotective fraction that can be effectively used against lethal doses of gamma-radiation after further investigations in higher animal models.

Eclampsia : before and after magnesium sulphate

This study was done to see the incidence and impact of changes in the intervention strategy for the management of eclampsia in a maternity hospital on maternal and perinatal outcome. Analysis of case records of all eclampsia cases over two different study periods designated as study period A (April, 1994 to Oct, 1996) and study period B (April, 2000 to April, 2001) were done. Total number of eclampsia cases who received intervention over two different study period (46 in study period A and 47 in study period B) were comparable despite the difference in the duration of study period. During study period A, diazepam was used as anticonvulsant, whereas magnesium sulphate was used to control fits during study period B. Incidence of eclampsia has markedly increased in this hospital (0.12% vs 0.29%). Epidemiology and clinical profile of eclamptic patients do not show remarkable change. There was no maternal death in study period B (April, 2000 to April, 2001) whereas there was one maternal death in the study period A (April, 1994 to October, 1996). Marked improvement was noticed in terms of recurrence of fit (19.13% vs 73.91%) with change in the intervention strategy. Perinatal deaths were fewer in study period B (20% vs 33%). Overall, it seems that care of eclamptic patients and use of magnesium sulphate as anticonvulsant has resulted in positive impact on maternal outcome.

Accidental out-of-hospital deliveries: factors influencing delay in arrival to maternity hospital

OBJECTIVE

To find out various factors influencing delay in arrival to Shree Panch Ratna Rajya Laxmi Maternity Hospital leading to accidental - out - of hospital delivery.

METHODOLOGY

This was a hospital based cross sectional descriptive study conducted at maternity hospital, Kathmandu. Women who delivered on the way to the maternity hospital during the time period- 060/9/1 to 060/12/ 31 (4 months) were interviewed using a structured questionnaire.

RESULTS

The prevalence of such deliveries was 45 out of 5703 deliveries i.e. 0.78%. Majority of women (n= 37) who had accidental - out - of hospital delivery were of parity 1-2 group (82.22%), whereas 2 of them were primigravida (4.44%) and 6 of them were of group parity 3-4 (13.33%). Economic factor was not responsible for delay for majority of women as they could arrange money immediately in emergency situation (88.88%) and majority of women had personal money saved for use in emergency (71.11%). Accessibility to the hospital was difficult for few women (21.00%) only as many women lived within the ring road of Kathmandu valley (48.88%) or outside the ring road but within municipality area of Kathmandu valley (31.11%). Only 60% of women could get transport easily during daytime only. Eight of them were late due to delay in getting transport (17.77%), whereas five patients were late due to disturbed / diverted traffic (11.11%). In three cases, transport was not available due to Nepal Bundh and delay was due to time taken to arrange ambulance (6.66%). Majority of women came for antenatal visits (84.44%) and most of them came to maternity hospital for antenatal visits (73.33%). Lack of birth preparedness and inadequate counselling during antenatal visits probably contributed towards many A-O-H (65.78%). More than half of patients were not satisfied with health staff during ANC (63.15%). Many women did not have any discussion about place of birth during ANC (73.68%) and many of them had no discussion even in the family (36.84%). Seven patients had probably precipitate labour (15.55%). 4 patients were returned back home with diagnosis of false labour pain (8.88%) and later on they delivered on the way to the hospital.

SUMMARY AND CONCLUSION

Lack of birth preparedness that involves adequate counselling during ANC about symptoms and signs of onset of labour pain and prior decision about place of birth together with delay in getting transport or delay due to diverted traffic were important factors leading to A-O-H. In addition, unusually short duration of labour or dismissing the diagnosis of true onset of labour may have accounted for few cases of A-O-H.

B-Lynch brace suture: an effective method of conservative surgical management for placenta increta

Placenta accreta is defined as an abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall. Placenta increta occurs when the placenta invades deeply into the myometrium. Placenta increta is a life threatening condition. We report a case of placenta increta managed by unilateral uterine artery and ovarian artery ligation followed by B-Lynch Brace suturing of the uterus to control bleeding from the placental bed.

The glucanases of Cellulomonas

Cellulomonas is a unique bacterium possessing not only the capacity to degrade various carbohydrates, such as starch, xylan and cellulose, but crystalline cellulose as well. It has developed a complex battery of glucanases to deal with substrates possessing such extensive microheterogeneities. Some of these enzymes are multifunctional, as well as cross inducible, possessing a multi-domain structure; these enzymes are thought to have arisen by the shuffling of these domains. Intergeneric hybrids have been constructed between Cellulomonas and Zymomonas so as to enhance the industrial potential of this organism. This review examines the unique features of this microorganism and evaluates its key role in the conversion of complex wastes to useful products, by virtue of its unusual attributes.

Neuroprotective effect of alpha(2) agonist (brimonidine) on adult rat retinal ganglion cells after increased intraocular pressure

Brimonidine, a selective alpha(2)-adrenoceptor agonist, has recently been shown to be neuroprotective as it significantly improves survival of retinal ganglion cells (RGCs) after calibrated optic nerve injury in rats. In the present study, we examined the effect of brimonidine (alpha(2)-adrenoceptor agonist) on RGC survival after increased intraocular pressure (IOP) in adult rats. RGCs were prelabeled by bilateral tectal injection of 5% Fluoro-Gold (FG). Two days later, unilaterally IOP was increased 2.2-2.5 times (28-30.5 mmHg) that of the normal pressure (12.5-14.5 mmHg) by cauterization of three episcleral veins. The elevated IOP was maintained throughout the duration of the experiment. Rats were treated intraperitoneally with brimonidine (1 mg/kg) or phosphate-buffered saline (PBS) once per week beginning either before (group A) or after (group B) increasing the IOP. Another group of rats was left as the control with elevated IOP but without any brimonidine/PBS treatment. Rats were euthanized at 3, 4 and 5 weeks after IOP elevation. Identifiable RGCs were counted and compared between control and experimental groups. Brimonidine significantly protected RGCs from elevated IOP-induced cell death. In control rats with three-vein cauterization, there was 5-6% cell death per week. Almost all RGCs were protected following brimonidine treatment for 3 weeks both in groups A and B. At 4 weeks, there was 4.5% cell death in group A and 6.5% in group B. At 5 weeks, cell death was 5.9% in group A and 6.2% in group B. The difference in cell death in groups A and B was insignificant. No significant differences were observed between PBS-treated and control groups. No significant changes in elevated IOP was found after brimonidine or PBS treatment when compared with the nontreated control group. Although pressure remained elevated throughout the length of the experiment, 3 weeks later the amount of cell death gradually increased in brimonidine-treated animals.

Vanilloid receptor expression and capsaicin excitation of rat dental primary afferent neurons

Little is known about the molecular mechanisms that cause excitation of neurons which innervate the teeth. We investigated whether rat dental sensory neurons express the vanilloid (capsaicin) receptor (VR1). Dental sensory neurons were identified by retrograde transport of the fluorescent dye DiIC18 placed in maxillary molars. Patch-clamp recordings in culture showed that 65% of DiIC18-labeled rat trigeminal ganglion neurons are excited by capsaicin. Responders covered the entire range of cell sizes examined (soma diameter, 24 to 48 microm). All non-responders had a soma diameter > 33 microm. Capsazepine (1 microM) reduced the capsaicin-evoked membrane current (6/6) and depolarization (7/7 responders). RT-PCR amplified a 375-bp product from DiIC18-labeled neurons which was identical to that expected for VR1. Thus, many rat dental primary afferent neurons are excited by capsaicin, and the response appears to be mediated by VR1. These results suggest that pharmacological blockers of VR1 may provide significant relief of dental pain.

Effects of increased intraocular pressure on rat retinal ganglion cells

The effects of elevated intraocular pressure (IOP) on the morphology of rat retinal ganglion cells (RGCs) was analyzed in this study. After cauterizing two limbal derived episcleral veins, IOP in experimental eyes was elevated 1.5--1.8 times that of control. RGCs of experimental and control eyes were analyzed after: bilateral tectal injections of Fluoro-Gold, and application of fluorescent dye crystals, 4-Di-10-ASP to the proximal stump of the cut optic nerve, at different time intervals after IOP elevation. The RGCs in control and experimental eyes were evaluated at 4, 6, 8, and 10 weeks by counting, as well as by determining the soma diameter. The dendritic field of three types (I, II, III) of RGCs between control and experimental eyes were also studied at 4,6,10 weeks after IOP elevation. At every time point, the number of cells in experimental eyes were significantly less than those of the control eyes. The average retinal ganglion cell death was 3--4% per week in the eyes with elevated IOP. The soma and dendritic field diameter of the RGCs in the experimental eyes were significantly larger in all cell types. However, types I and III cells expanded their dendritic fields more rapidly than type II cells. Furthermore, dendritic fields of surviving RGCs in experimental eyes occupied about the same extent of the retina as the controls. The increase in soma diameter and expansion of dendritic fields in the remaining RGCs in eyes with elevated IOP suggests the existence of plasticity in adult retina.

Caspase inhibitors block the retinal ganglion cell death following optic nerve transection

Retinal ganglion cells die by apoptosis following axotomy. The molecular mechanisms of the retinal ganglion cell death are not well understood. In the present study using RT-PCR and in situ hybridization techniques we demonstrated that levels of mRNA for Bcl-2 and Bcl-x decreased after axotomy. Bax levels remained high until 4 days after axotomy, decreased by day 7 and remained low up to day 10. CPP32 levels increased at day 7 and remained high after optic nerve cut. We studied whether inhibitors of CPP32/caspase would save the axotomy induced ganglion cell death. DEVD-CHO (Ac-Asp-Glu-Val-aspartic acid aldehyde) and DEVD-FMK (Z-Asp-Glu-Val-Asp-FMK), caspase inhibitors, when administered intraocularly at the time of optic nerve cut, at days 3 and 7 protect about 30-35% the ganglion cells from death. We further demonstrated that the number of reactive microglia decrease in the retina when the inhibitors were given as compared with retina where no inhibitors were given. The present data offers new avenues for studying the complex interactions between the retinal ganglion cell death and the activation of resident microglia/macrophages.

MK801-a neuroprotectant in rat hypertensive eyes

Excitatory synaptic transmission in the mammalian CNS and retina is mainly mediated through l-glutamate. The effect of MK-801, a non-competitive antagonist of the NMDA subtype of glutamate receptor was studied on rat retinal ganglion cells in hypertensive eyes. MK-801 was administered intraperitoneally to the first group, 1 day before the increase, and in the second group, 2 days after the intraocular pressure (IOP) elevation. Phosphate-buffered saline was administered to the control group. Animals were sacrificed 2 and 4 weeks post-IOP increase. The retinal ganglion cells were counted and compared between control (right) and experimental (left) eyes. The data presented here suggests that MK-801 has neuroprotective properties.

The patterns of retinal ganglion cell death in hypertensive eyes

We have recently described a rat model of hypertensive eye in which cauterizing limbal derived episcleral veins leads to increase in the intraocular pressure [S.R. Shareef, E. Garcia-Valenzuela, A. Salierno, J. Walsh, S.C. Sharma, Chronic ocular hypertension following episcleral venous occlusion in rats, Exp. Eye Res. 61 (1995) 379-382.]. We have further documented that retinal ganglion cell death is apoptotic [E. Garcia-Valenzuela, S. Shareef, J. Walsh, S.C. Sharma, Programmed cell death of retinal ganglion cells during experimental glaucoma, Exp. Eye Res. 61 (1995) 33-44.]. Here, we describe the total loss of retinal ganglion cells at various time intervals following increased IOP. At early time points death of ganglion cells in the central, peripheral retina occurred with similar frequencies. Between 4-6 weeks after intraocular elevation, ganglion cells in the peripheral retina were more susceptible than the central retina. Percentage of total ganglion cell death over the 10 week period was presumably linear and was about 4% per week.