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Acute myeloid leukemia (AML) is characterized by uncontrolled clonal expansion and differentiation block of immature myeloid cells. Some studies have shown that leukemia stem cells (LSC) are thought to be responsible for the initiation and development of leukemia. Moreover, abnormal O-glycosylation is a key modification in the process of cancer malignancy. In this study, GALNT1 expression was significantly upregulated in LSCs, while knockdown of GALNT1 inhibited cell viability and promoted apoptosis. Importantly, GALNT1 was the direct target of miR-582-5P, and MALAT1 directly interacted with miR-582-5P. In addition, Our investigation corroborated that MALAT1 functioned as an endogenous sponge of miR-582-5P to regulate mucin1 (MUC1) expression, catalyzed by GALNT1, which modulated the activity of JAK2/STAT3 pathway. MALAT1 and MUC1 were targets of transcription factor STAT3 and were regulated by STAT3. In general, these new findings indicated that MALAT1/miR-582-5P/GALNT1 axis is involved in the progression of LSCs, illuminating the possible mechanism mediated by O-glycosylated MUC1 via JAK2/STAT3 pathway. [ABSTRACT FROM AUTHOR]

Abstract Background Quiescent self-renewal of leukemia stem cells (LSCs) and resistance to conventional chemotherapy are the main factors leading to relapse of acute myeloid leukemia (AML). Alpha-enolase (ENO1), a key glycolytic enzyme, has been shown to regulate embryonic stem cell differentiation and promote self-renewal and malignant phenotypes in various cancer stem cells. Here, we sought to test whether and how ENO1 influences LSCs renewal and chemoresistance within the context of AML. Methods We analyzed single-cell RNA sequencing data from bone marrow samples of 8 relapsed/refractory AML patients and 4 healthy controls using bioinformatics and machine learning algorithms. In addition, we compared ENO1 expression levels in the AML cohort with those in 37 control subjects and conducted survival analyses to correlate ENO1 expression with clinical outcomes. Furthermore, we performed functional studies involving ENO1 knockdown and inhibition in AML cell line. Results We used machine learning to model and infer malignant cells in AML, finding more primitive malignant cells in the non-response (NR) group. The differentiation capacity of LSCs and progenitor malignant cells exhibited an inverse correlation with glycolysis levels. Trajectory analysis indicated delayed myeloid cell differentiation in NR group, with high ENO1-expressing LSCs at the initial stages of differentiation being preserved post-treatment. Simultaneously, ENO1 and stemness-related genes were upregulated and co-expressed in malignant cells during early differentiation. ENO1 level in our AML cohort was significantly higher than the controls, with higher levels in NR compared to those in complete remission. Knockdown of ENO1 in AML cell line resulted in the activation of LSCs, promoting cell differentiation and apoptosis, and inhibited proliferation. ENO1 inhibitor can impede the proliferation of AML cells. Furthermore, survival analyses associated higher ENO1 expression with poorer outcome in AML patients. Conclusions Our findings underscore the critical role of ENO1 as a plausible driver of LSC self-renewal, a potential target for AML target therapy and a biomarker for AML prognosis.

Background: Hypotension is most common complication of spinal anesthesia for patient undergoing LSCS. Hypotension can cause adverse outcome for both maternal and fetal. Early detection and treatment for hypotension to improve maternal and fetal outcome. Perfusion index (P.I) during spinal anesthesia for predicting hypotension in a patient undergoing LSCS. Methodology: In this study, 40 parturient belonging to ASA2 posted for elective LSCS. Under spinal anesthesia with adjusted dose of hyperbaric bupivacaine 0.5% at the L2-L3 or L3-L4 interspace. MAP, HR, Spo2 and P.I. were recorded at 1 minute interval after the SAB up to 10 minute and then 5 minute interval till end of surgery and compared with baseline hemodynamics parameter and perfusion index. Results: Mean age of the case is 26.925 with 4.95 sd. Mean SBP for 640 entries is 107.39 with 12.11 sd. Mean P.I. for 640 entries is 3.56 with 2.04 sd. There is a significant negative correlation (p<0.0001) between SBP and P.I. suggesting that P.I. increased in patient with hypotension. There is a statistically significant mean difference between before and after oxytocin bolus with hemodynamic variable of SBP, DBP, MAP SPO2 and P.I. Conclusion: The P.I. is useful tool for predicting hypotension in parturient undergoing LSCS under spinal anesthesia. [ABSTRACT FROM AUTHOR]

Background: Quiescent self-renewal of leukemia stem cells (LSCs) and resistance to conventional chemotherapy are the main factors leading to relapse of acute myeloid leukemia (AML). Alpha-enolase (ENO1), a key glycolytic enzyme, has been shown to regulate embryonic stem cell differentiation and promote self-renewal and malignant phenotypes in various cancer stem cells. Here, we sought to test whether and how ENO1 influences LSCs renewal and chemoresistance within the context of AML. Methods: We analyzed single-cell RNA sequencing data from bone marrow samples of 8 relapsed/refractory AML patients and 4 healthy controls using bioinformatics and machine learning algorithms. In addition, we compared ENO1 expression levels in the AML cohort with those in 37 control subjects and conducted survival analyses to correlate ENO1 expression with clinical outcomes. Furthermore, we performed functional studies involving ENO1 knockdown and inhibition in AML cell line. Results: We used machine learning to model and infer malignant cells in AML, finding more primitive malignant cells in the non-response (NR) group. The differentiation capacity of LSCs and progenitor malignant cells exhibited an inverse correlation with glycolysis levels. Trajectory analysis indicated delayed myeloid cell differentiation in NR group, with high ENO1-expressing LSCs at the initial stages of differentiation being preserved post-treatment. Simultaneously, ENO1 and stemness-related genes were upregulated and co-expressed in malignant cells during early differentiation. ENO1 level in our AML cohort was significantly higher than the controls, with higher levels in NR compared to those in complete remission. Knockdown of ENO1 in AML cell line resulted in the activation of LSCs, promoting cell differentiation and apoptosis, and inhibited proliferation. ENO1 inhibitor can impede the proliferation of AML cells. Furthermore, survival analyses associated higher ENO1 expression with poorer outcome in AML patients. Conclusions: Our findings underscore the critical role of ENO1 as a plausible driver of LSC self-renewal, a potential target for AML target therapy and a biomarker for AML prognosis. [ABSTRACT FROM AUTHOR]

Background: Uterine fibroids or leiomyomas are benign smooth muscle tumours of the uterus, found in approximately 20-50% of women of reproductive age and many are asymptomatic. The main objectives of this study were to assess the obstetric outcome in pregnancy with fibroid, its complications and management. Materials and Methods: This was a prospective observational study following confirmed diagnosis of uterine fibroids from ultrasonography with continuing pregnancy. The study conducted over two years pried from January 2022 to December 2023. All demographic information, baseline characteristics, Obstetric outcome-mode of delivery, complications and management and the foetal outcome-abortions, low birth weight, term or preterm, and associated complications and Neonatal intensive care (NICU)admissions. were noted. Results: Out of 6142 antenatal visits, 54 cases were identified with uterine fibroids during pregnancy, incidence being 0.8%. Majority belonged to age group between 25-30 years were about 31 (57%), 32 (59.2%) were primigravida, 18 (33.3%) had BMI more than 25 kg/m2, 8 (14.81%) had spontaneous miscarriages, 46 cases (85%) continued pregnancy, among them 28 (51.8%) underwent Lower segment caesarean section (LSCS), 18(33.27%) vaginal deliveries. 15 (32.6%) had pain abdomen, low birth weight (LBW) seen in 16 (34%) of deliveries. Conclusion: Pregnancy with uterine fibroids associated with various untoward obstetric outcomes. Pre-conceptional counselling, frequent antenatal visits and multidisciplinary team approach for planning delivery in tertiary care centres is essential for safe maternal and foetal outcome. [ABSTRACT FROM AUTHOR]

Liquid silicon‐based carbon dots (CDs) with a photoluminescence quantum yield (PLQY) of 50% were prepared using N‐[3‐(trimethoxysilyl)propyl]ethylenediamine (DAMO), citric acid, and n‐butylamine as raw materials. Firstly, the optimized characters have been determined, namely, the optimal DAMO, citric acid, and n‐butylamine addition amounts of 1 mL, 0.9 g, and 1 mL, a reaction time of 3 h, and a reaction temperature of 160°C. Further research has confirmed that the increase in fluorescence intensity of CDs is mainly due to the introduction of DAMO, in which the two amino groups in DAMO play a major role. In addition, the Si‐O‐Si group generated by the hydrolysis of siloxane groups is connected to the surface of the CDs and forms a core–shell structure, which modifies the defects on the surface and enhances the fluorescence intensity of the CDs. Finally, luminescent solar concentrators (LSCs) based on liquid silicon‐based CDs were assembled by spin coating. The obtained device has a transparency of up to 80% and an optical efficiency of 2.4%. [ABSTRACT FROM AUTHOR]

Engine technology urgently needs improvement to balance emigration and effectiveness situations, and using gas as energy is an implicit force, similar to Dual-Fuel (DF) engineering. The study uses a four-stroke diesel engine with one cylinder with CNG and diesel fuel. The measure and the quality of energy will affect combustion's effectiveness. Other processes with stoichiometry of combustion, air, gas, energy and air mixing, valve opening and closing time, injection time, etc, also cause it. If the engine figure is raised to accept further energy transfer, other combustion can be achieved, but this can affect the force on the substance, possibly causing damage. Increasing combustion capacity can lead to dangerous goods such as piston bowls, siding, injector needles, and gates. This value is one of the sins of the DF diesel engine, and the voluminous piston is its wimpish component. The bowl's structure should suit the heated cargo with respectable attention to jewels and biographies. This study covers non-identical configurations of the Colosseum piston shape with side-by-side system plans (LSCS). The optimal cargo control achieved during combustion is detected by utilizing gas dynamism in fresh fragments called anomalous conditions: Colosseum piston simulation and posterior testing using CFD software. Related previous work and research will be reviewed later in every project. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH. Material and Methods: Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH. Results: It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP

Intracranial bleed in the form of subdural hematoma (SDH) with intracranial hypotension after spinal anesthesia for cesarean section is a rare condition with an incidence of around 1 in 5,00,000 obstetric populations. As its presentation is similar to post-dural puncture headache (PDPH), it can be misdiagnosed sometimes. Persistent headache for more than 5 days, vomiting, blurring of vision, and convulsion can guide the diagnosis of intracranial bleed. Magnetic resonance imaging (MRI) helps to diagnose the location, size, and other abnormalities of bleed in such patients. The management ranges from conservative to surgical management in the form of craniotomy. Here, we present a case of a 19-year-old woman, who operated on for cesarean section under spinal anesthesia presented with SDH and intracranial hypotension on postoperative day (POD) 6. She was managed conservatively with plenty of intravenous (IV) fluids, bed rest, low head position, analgesics, and antiepileptics. A repeat computed tomography (CT) scan was performed after 14 days, which showed resolved SDH, and the patient was discharged.

Leukemic stem cells (LSCs) possess similar characteristics to normal hematopoietic stem cells, including self-renewal capacity, quiescence, ability to initiate leukemia, and drug resistance. These cells play a significant role in leukemia relapse, persisting even after apparent remission. LSCs were first described in 1994 by Lapidot et al. Although they have been extensively studied in acute leukemia, more LSC research is still needed in chronic lymphocytic leukemia (CLL) to understand if reduced apoptosis in mature cells should still be considered as the major cause of this disease. Here, we provide new evidence suggesting the existence of stem-like cell populations in CLL, which may help to understand the disease as well as to develop effective treatments. In this study, we identified a potential leukemic stem cell subpopulation using the tetraploid CLL cell line I83. This subpopulation is characterized by diploid cells that were capable of generating the I83 tetraploid population. Furthermore, we adapted a novel flow cytometry analysis protocol to detect CLL subpopulations with stem cell properties in peripheral blood samples and primary cultures from CLL patients. These cells were identified by their co-expression of CD19 and CD5, characteristic markers of CLL cells. As previously described, increased alkaline phosphatase (ALP) activity is indicative of stemness and pluripotency. Moreover, we used this method to investigate the potential synergistic effect of curcumin in combination with fludarabine and ibrutinib to deplete this subpopulation. Our results confirmed the effectiveness of this ALP-based analysis protocol in detecting and monitoring leukemic stem-like cells in CLL. This analysis also identified limitations in eradicating these populations using in vitro testing. Furthermore, our findings demonstrated that curcumin significantly enhanced the effects of fludarabine and ibrutinib on the leukemic fraction, exhibiting synergistic effects (combination drug index, CDI 0.97 and 0.37, respectively). Our results lend support to the existence of potential stem-like populations in CLL cell lines, and to the idea that curcumin could serve as an effective adjuvant in therapies aimed at eliminating these populations and improving treatment efficacy. [ABSTRACT FROM AUTHOR]

Leukemia stem cells (LSCs) exhibit self-renewal, resistance to standard treatments, and involvement in leukemia relapse. Higher Myeloid Ecotropic Integration Site-1 (MEIS1) expression in leukemic blast samples has been linked to resistance to conventional treatment. We studied the MEIS1 and associated factors in relapsed LSCs and assessed the effect of recently developed MEIS inhibitors (MEISi). Meis1 gene expression was found to be higher in patients with leukemia and relapsed samples. The majority of CD123+ and CD34+ LSCs demonstrated higher MEIS1/2/3 content. Depending on the patient chemotherapy regimen, Meis1 expression increased in relapsed samples. Although there are increased Meis2, Meis3, Hoxa9, Pbx1, or CD34 expressions in the relapsed patients, they are not correlated with Meis1 content in every patient or regimen. MEISi has reduced MEIS1 transcriptional activity and LSC cell survival by apoptosis. Pharmacological targeting with MEISi in LSCs could have a potential effect in limiting leukemia relapse and chemotherapeutic resistance. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH. Material and Methods: Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH. Results: It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP <65 mm Hg (P = 0.01). However, IVCCI was found to be statistically insignificant if PSH was considered a 20% reduction in baseline MBP. The correlation matrix between IVCCI and PI showed Pearson's r-value of 0.525, indicating a substantial relationship between the two (P = 0.003). Multivariate logistic regression analysis had shown that neither IVCCI nor PI was a good predictor of PSH in parturients for both definition groups for PSH. Conclusion: Although there is a modest correlation between PI and IVCCI, both cannot be used to predict postspinal hypotension in parturients undergoing elective lower-segment cesarean section (LSCS). [ABSTRACT FROM AUTHOR]

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS. Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery. Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p<0.05). Blood Transfusion and Premature rupture of membrane were not associated with any of the two groups. (p>0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p<0.01). Mean stay of hospitalization was significantly higher in LSCS group (p<0.01). Conclusion: Better Bisho's score has significantly more chances of successful VBAC. VBAC has better APGAR score at 1 min and at 5 min compared to LSCS group. Birth weight is not affected by the type of delivery after first caesarian delivery. [ABSTRACT FROM AUTHOR]

Exact primary cause for the development of preeclampsia is unknown. However abnormal trophoblastic invasion, inappropriate endothelial cell activation, exaggerated inflammatory response all this may play a key role in the development of preeclampsia. All the pregnancies with inclusion criteria were subjected to Doppler examination after recording the clinical history of the patients, clinical examination and ultrasound after taking informed consent gestational age is calculated by CRL measurement at the time of first trimester scan UA doppler recording were obtained prospectively twice, first at 11 to 14 weeks of Gestation and second at 20 to 24 weeks of gestation. In study group H/O FGR was present in 23 patients (46%), H/O HTN in 27 patients (54%) and previous LSCS in 8 patients (16%). In control group H/O previous LSCS was present in 12 cases (24%). In study group totally 13 HTN cases - 10 had severe preeclampsia, 2 had mild preeclampsia and 1 had gestational HTN. In control group totally 3 had HTN cases 1 had severe preeclampsia, 1 had mild preeclampsia and 1 had gestational HTN. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cholelithiasis is quite common in women of child bearing age. We planned a study to evaluate the safety of combined laparoscopic cholecystectomy and lower segment caesarean section (LSCS). AIMS AND OBJECTIVES: To study feasibility and safety of cholecystectomy at the time of caesarean section. MATERIALS AND METHODS: This was a prospective hospital based observational study and included 50 consecutive pregnant females who underwent a combined LSCS and were having symptomatic cholelithiasis. Patient demographics and a detailed history was taken. After completing LSCS, the rectus sheath was closed and a standard four port laparoscopic cholecystectomy was performed. Intraoperative parameters and postoperative morbidity were noted. RESULTS: Laparoscopic cholecystectomy was combined with LSCS under general anesthesia in all the patients. The mean age of patients was 32.28 + 4.67 years. Surgeries were completed in a mean operating time of 78.54 + 15.21minutes. There were no intraoperative or major postoperative complications. No extra antibiotics or analgesics doses were needed. Most of the patients were discharged on the third postoperative day. CONCLUSION: In addition to being safe and effective, a combination technique of laparoscopic cholecystectomy with LSCS provides the benefits of minimal access surgery for gallstone disease. Apart from minimising the separation of mother and newborn caused by reoperation, it also reduces the risk of developing acute cholecystitis while the patient is waiting for cholecystectomy. [ABSTRACT FROM AUTHOR]

Cardiac disease in pregnancy is a important fector responsible of maternal and fetal morbidity and mortality.(1) Pre-eclampsia is a serious complication seen in pregnancy that is characterized by high blood pressure. Problems arising due to this condition are fetal growth restriction, low birth weight, preterm birth, stillbirth. Eclampsia, increased risk of stroke, cardiovascular diseases, damage to kidneys, liver, eyes, lungs, and heart can be seen in the mother. A 24 year old female who was 1st gravida and 35 week pregnant came to hospital. Due to fetal distress emergency lscs was planned. The anaesthesia management used in a case of an emergency LSCS in a patient with moderate MR with preeclampsia is discussed at length in this article. [ABSTRACT FROM AUTHOR]

Despite remarkable differences in the severity of the fetal disease, early- and late-onset FGRs are both associated with poor long-term outcome from neurodevelopmental, cardiovascular and metabolic standpoints. This supports the notion that regardless of the severity, chronic exposure to adverse intrauterine environment is critical to determine adverse fetal programming. Women were categorized into high risk and low risk pregnancies and were followed up till delivery and fetal outcome were noted. Fetal arterial blood PH were noted and correlated with the fetal outcome. In the present study, out of 78 high risk cases, there were total 21 cases of late onset IUGR. There were 3 cases of IUGR associated with preeclampsia, mean POG at birth was 36 weeks, among them 2 had vaginal delivery and 1 underwent LSCS. Two babies had normal CPR and one baby had abnormal CPR. Two babies had abnormal ABG. Birth weights were less than 2.5kg. Mean duration of NICU stay was 6.6 days. No babies were ventilated. [ABSTRACT FROM AUTHOR]

Introduction: Women of reproductive age have also been impacted by the significant rise in the prevalence of obesity. A significant predictor of poor outcomes for the health of the mother and the newborn is excessive gestational weight increase. The study was conducted with an objective to study first trimester maternal Body Mass Index and gestational weight gain and their association with maternal and perinatal outcomes. Methodology: This was a prospective observational clinical study conducted in 196 primigravida patients presenting in a tertiary care hospital in central India. BMI of women were recorded during the first trimester and followed up to assesses gestational weight gain. Early pregnancy BMI and gestational weight gain were compared with various feto maternal outcome. Results: The mean of First trimester BMI was 21.3 kg/m2. In Overweight category, 65.2% had high weight gain (WG) while in obese, 26.1% had High WG. Type of delivery and NICU admission rate significantly differ in BMI categories (p <0.05). LSCS rate were higher in overweight and obese category. Preterm babies and post-partum hemorrhage were higher in higher WG categories; however, the difference was non-significant (p>0.05). Conclusion: This study conclude that First trimester underweights and overweight/obesity is associated with higher antenatal, intra-natal and postnatal complications as well as neonatal complications. Caesarian rate and instrumental deliver are also common in First trimester overweight and obese women. Preeclampsia is associated with extreme of First trimester BMI. [ABSTRACT FROM AUTHOR]

Background: Spinal anaesthesia (SA) using a bolus dose of Ropivacaine (0.75%) is known for its rapid onset but potential chances of hypotension. Administering Ropivacaine (0.75%) in fractions with intervals between the doses, has shown to establish a dense block, prolong analgesia and maintain better hemodynamic stability. This study aimed to compare the efficacy of fractionated and bolus doses of Ropivacaine (0.75%) in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: In a randomized, double-blinded trial, sixty patients scheduled for elective LSCS were enrolled and assigned to two groups. Group A received a single bolus spinal anaesthesia using Ropivacaine (0.75%) (2.5ml), while Group B received a fractionated dose approach: two-thirds of the total Ropivacaine (0.75%) dose (1.6ml) initially, followed by one-third dose (0.9ml) after 90 seconds. Results: The onset of sensory block (Group A: 3.59±1.31 min, Group B: 4.25±0.63 min) and motor block (Group A: 5.49±2.30 min, Group B: 7.34±11.28 min), as well as the duration of analgesia, were significantly longer in Group B (233.33±16.47 min) compared to Group A (185.17±20.61 min) (P < 0.05). Hemodynamic stability was superior in Group B, with all patients showing better stability than those in Group A. Conclusion: Utilizing a fractionated dose of Ropivacaine (0.75%) in spinal anaesthesia results in an extended duration of analgesia and improved hemodynamic stability compared to a bolus dose approach.

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS. Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery. Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p

Introduction: Women of reproductive age have also been impacted by the significant rise in the prevalence of obesity. A significant predictor of poor outcomes for the health of the mother and the newborn is excessive gestational weight increase. The study was conducted with an objective to study first trimester maternal Body Mass Index and gestational weight gain and their association with maternal and perinatal outcomes. Methodology: This was a prospective observational clinical study conducted in 196 primigravida patients presenting in a tertiary care hospital in central India. BMI of women were recorded during the first trimester and followed up to assesses gestational weight gain. Early pregnancy BMI and gestational weight gain were compared with various feto maternal outcome. Results: The mean of First trimester BMI was 21.3 kg/m2. In Overweight category, 65.2% had high weight gain (WG) while in obese, 26.1% had High WG. Type of delivery and NICU admission rate significantly differ in BMI categories (p 0.05). Conclusion: This study conclude that First trimester underweights and overweight/obesity is associated with higher antenatal, intra-natal and postnatal complications as well as neonatal complications. Caesarian rate and instrumental deliver are also common in First trimester overweight and obese women. Preeclampsia is associated with extreme of First trimester BMI.

Background: Women are gives birth usually on bed in recumbent positions. in healthcare facilities, Having choices and being involved in decision making contributes to women’s positive childbirth experiences. During a physiological birth, women’s preferences can play a leading role in the choice of birthing positions. Objectives: The present prospective clinical study was aimed to comparatively evaluate the differences in the upright and lying down position during childbirth. The study also aimed to study maternal outcome in upright and recumbent position, to study perinatal outcome with respect to APGAR score, need for mechanical ventilation, and to compare the upright positions with traditional position. Methods: A prospective comparative study was conducted. Participants were counseled about positions and companion. Women were assigned to their willing positions. Main outcome variables measured are the duration of second, third stages of labor and amount of blood loss, spontaneous or operative vaginal delivery, perineal trauma and need for episiotomy, maternal satisfaction, need of LSCS, and fetal outcome. Results: The analysis showed that non-supine position had lower rates of caesarean section. Duration of first and second stage of labor was shorter in non-supine position. Patient satisfaction in terms of reported discomfort is more in non-supine positions. Postpartum hemorrhage, perineal trauma and need of episiotomy were less in non-supine position. Conclusion: Based on this study, we recommend that women in low-risk labor should be informed of the benefits of upright positions, and encouraged and assisted to assume upright positions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the possibility of vertical transmission of COVID-19 from COVID-19 positive mothers to new-borns and the associated factors. Methods: This prospective observational study included a total of 128 antenatal COVID-19-positive women. The present study was conducted in a tertiary-care public hospital in south India. This study evaluated the SARS-CoV-2 positivity rate in neonates born to SARS-CoV-2-positive mothers who tested RT-PCR positive for this virus in their nasopharyngeal swab. During their hospital stay, these neonates' clinical outcomes were also evaluated. Result: Out of 128 pregnancies, 45 study subjects' placenta specimens were COVID-19 positive, 3 neonates and 2 stillborn were RTPCR positive, and 1 neonate's cord blood was also positive. As among 4 stillbirth babies, 2 stillbirth babies were COVID-19 positive therefore there is a statistically significant relationship between stillbirth and vertical transmission (p = 0.007). In the present study, all COVID-19-positive babies were preterm, therefore there is statistically significance between preterm and vertical transmission (p = 0.00). Conclusion: This study demonstrated that there is a possibility of vertical transmission of COVID-19 from COVID-19 positive mothers to new-borns. [ABSTRACT FROM AUTHOR]

Background and Aims: Hypotension following subarachnoid block (SAB) for lower segment cesarean section (LSCS) has adverse fetal and maternal implications. Perfusion index (PI) has been used for assessing peripheral perfusion dynamics. This study aimed to determine whether a baseline PI can predict hypotension after spinal anesthesia for LSCS. Materials and Methods: In this prospective, observational study, 152 term parturients were divided into two groups: Group I (PI of ≤ 3.5) and Group II (PI >3.5). SAB was performed using bupivacaine 0.5% (hyperbaric) 10 mg with dexmedetomidine 5 μg. PI, vital parameters, and correlation between baseline PI and hypotension were observed. Receiver operating characteristic (ROC) curve was plotted for PI and the occurrence of hypotension. Statistical analysis was performed using Chi-square test, independent sample t-test, Mann–Whitney U-test, and regression analysis with Spearman's rank correlation coefficient test. Results: The incidence of hypotension was higher in Group II (57.89%) compared to Group I (18.42%) (P < 0.0001). The correlation between baseline PI >3.5, the number of episodes of hypotension, and the total dose of mephentermine required were also significant. The sensitivity and specificity of baseline PI of 3.5 to predict hypotension were 72.37% and 81.58%, respectively. The area under the ROC curve for PI to predict hypotension was 0.830. Conclusion: Parturients with baseline PI >3.5 are at higher risk of developing hypotension following SAB compared to those with baseline PI ≤3.5; hence, PI is a safe and reliable device for predicting hypotension following SAB.

Rising in the rates of C-section deliveries worldwide is a major public health concern. According to WHO, C-section rate continues to rise globally, accounting for more than 1 in 5(21%) childbirths. There is lack of evidence supporting the maternal and neonatal benefits with the increasing C-section rates. Robson’s Ten Group Classification system (RTGCS) serves as an initial structure with which caesarean section rates can be analyzed and allow us to bring changes in clinical practice. The objective of the current study was to audit C-section rate using Robson’s Ten Group Classification System in our tertiary care hospital, and to identify the main contributors of each subgroup to overall C-section rate. This was a cross-sectional study conducted at out tertiary care center, Karpaga Vinayaga Institute of Medical Sciences and Research Centre (KIMS&RC), Madhuranthagam, Tamil Nadu, India during the period of January 2019 to December 2021. The study was conducted by reviewing the hospital record for analyzing the C-sections performed during the above-mentioned period. The study population include the pregnant women who underwent C-sections in our hospital during the specified period. The 401 women who underwent C-section were classified in Robson’s Ten group classification system, 45% women in Group 5 and it contributed to the maximum number of the total C-section rates. The second highest contributor was Group 1 and Group 2 contributing to 41% of the overall C-section rates. The Robson’s Ten group classification system provides a useful framework for auditing C-section rates. Regular audits and standardization of indication of C-section will help in reducing the C-section rate in future.

Acute myeloid leukemia (AML) is the most common and incurable leukemia subtype. Despite extensive research into the disease's intricate molecular mechanisms, effective treatments or expanded diagnostic or prognostic markers for AML have not yet been identified. The morphological, immunophenotypic, cytogenetic, biomolecular, and clinical characteristics of AML patients are extensive and complex. Leukemia stem cells (LSCs) consist of hematopoietic stem cells (HSCs) and cancer cells transformed by a complex, finely-tuned interaction that causes the complexity of AML. Microenvironmental regulation of LSCs dormancy and the diagnostic and therapeutic implications for identifying and targeting LSCs due to their significance in the pathogenesis of AML are discussed in this review. It is essential to perceive the relationship between the niche for LSCs and HSCs, which together cause the progression of AML. Notably, methylation is a well-known epigenetic change that is significant in AML, and our data also reveal that microRNAs are a unique factor for LSCs. Multiple-targeted approaches to reduce the risk of epigenetic factors, such as the administration of natural compounds for the elimination of local LSCs, may prevent potentially fatal relapses. Furthermore, the survival analysis of overlapping genes revealed that specific targets had significant effects on the survival and prognosis of patients. We predict that the multiple-targeted effects of herbal products on epigenetic modification are governed by different mechanisms in AML and could prevent potentially fatal relapses. Thus, these strategies can facilitate the incorporation of herbal medicine and natural compounds into the advanced drug discovery and development processes achievable with Network Pharmacology research. [ABSTRACT FROM AUTHOR]

Background and objectives: An investigational short course of antibiotics (two doses of Inj. Cefotaxime 1g IV) was compared to the conventional long course antibiotic for the prevention of postoperative infectious complications in patients undergoing elective caesarean sections at a government tertiary care hospital. To Determine which treatment most successfully stops infectious morbidity, like high body temperature, abnormal vaginal discharge, wound induration, wound discharge, and wound gaping. Methods: A prospective interventional study was undertaken by the Obstetrics and Gynaecology Department at Guntur Medical College in Guntur, Andhra Pradesh, India, from February 2022 to January 2023. For this study, 400 participants were randomly assigned to one of two groups. Two hundred individuals make up each group. Participants were chosen based on whether or not they met the inclusion/exclusion criteria. Result: Two groups of 200 patients each participated in the trial. 162 (81%) of the 200 participants were multi-para, while 38 (19%) were primi-para. 30 (15%) of the first group's 200 patients were primi, 9 (4.5%) were multi gravida, and 161 (80.5%) were multiparas who had previously had LSCS but chose to have another one. Its P value is 0.6. Thirty-six women experienced wound induration, 15 (7.4%) in Group 1 and 21 (10.6%) in Group 2. p=0.09 indicated no statistical significance. Serous wound leakage occurred in 12 (6%) group 1 patients and 15 (7.5%) group 2 patients. 41 (10.25%) of 400 patients had pus discharge, 22 (11%) from Group 1 and 19 (9.5%) from Group 2. Both groups' p values are insignificant. Conclusion: This study found that short-term antibiotics are as effective as long-term ones. Both groups had similar febrile morbidity, wound induration, serous and purulent wound discharge, wound gaping, and abnormal vaginal discharge. Lower-strength antibiotics are increasingly relevant due to antibiotic resistance. The short regimen is cheaper than the extended one since it uses less antibiotics. The short-course antibiotic is safe, effective, convenient, and manpower-saving. Thus, preventing irregular drug administration and replacing the three days of intravenous antibiotics followed by oral antibiotics used in tertiary government centres. [ABSTRACT FROM AUTHOR]

Background: Antepartum haemorrhage (APH) is an obstetrical emergency that accounts for 3-5% of pregnancies and is a leading cause of maternal and perinatal morbidity and mortality. Materials And Methods: This retrospective study was conducted in the department of obstetrics and gynaecology,SMGS Hospital, GMC Jammu over a period of 1 year from 1st January 2022 to 31st December 2022.Data was collected from records kept in the hospital .179 cases of APH were studied during the study period. The maternal baseline characteristics, mode of delivery, pregnancy outcome and obstetrical complications were studied. The study was approved by the Institutional Ethics Committee. The objective of this study was to determine the maternal and perinatal effects of APH. Results: Majority of the patients (67) were in the age group of 26-30 years (37.43 %).Majority of the patients (62) were primigravida (34.63 %), 47 patients were gravida 2 (26.25 %),41 patients were gravida 3 (22.90 %),18 patients were gravida 4(10.05 %) and 11 patients were gravida 5 and more (6.14 %). Majority of the patients (87) presented at 33-36.6 weeks of gestation (48.60%) followed by more than 37 weeks (39.10 %). Majority of the patients (72) had previous vaginal delivery (40.22 %) followed by primigravida (27.93 %),previous abortions (18.99 %),previous 1 LSCS (15.64 %) and previous 2 LSCS (7.26 %).130 patients had placenta praevia (72.62 %),abruption (20.67 %),accreta (3.35 %), Percreta (1.67 %) and increta (1.67 %). Majority of the patients underwent LSCS (75.55 %), LSCS WITH B/L UA Ligation (8.88 %),caesarean hysterectomy (10 %),vaginal delivery (4.44 %)and laparotomy with uterine repair (0.55 %). Majority of the babies had birth weight between 1.5 to 2.5 kg (69.27 %), more than 2.5 kg (24.02%)and <1.5 kg (8.37 %). Apgar score at birth >6 in 87.70%, < 6 in 10.05% and IUD in 3.88%. Conclusion: APH cannot reliably be predicted. APH is associated with high maternal and perinatal morbidity and mortality. All the cases diagnosed as APH during antenatal period must be considered high risk and proper antenatal management plan should be formulated. In suspected cases of morbidly adherent placenta, senior obstetrician, paediatrician and anaesthetist must be available during delivery. In such cases, a preoperative planning with multidisciplinary approach should be followed. Patient counselling and proper consent should be taken which include possibility of hysterectomy and interventional radiology. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVES: Lower segment caesarean section (LSCS) leads to moderate to severe pain in the patient. Pain severity is directly proportional to the functional limitations and depression in the postpartum period, making it essential to provide good pain relief after surgery. Maternal wellbeing and better nursing care of newborn requires good postoperative analgesia with minimal side effects. The main objective of the study was to evaluate the analgesic effect of intravenous low-dose ketamine, when administered pre-emptively, in patients undergoing caesarean delivery under spinal anesthesia. METHODOLOGY: Two groups were made, each with 50 full-term pregnant females with a plan of caesarean section under spinal anesthesia. Group-A received spinal anesthesia with bupivacaine 0.5% along with intravenous placebo of 2cc normal saline, whereas group-B received 0.5mg/kg ketamine intravenously after administration of spinal anesthesia but before the start of surgical incision. Pain intensity was monitored using a visual rating pain scale (VRS), till the need for the first analgesic dose postoperatively. RESULTS: Both groups were comparable in terms of age and weight. Analgesia was markedly prolonged, and postoperative pain scores were significantly less in Group-B (ketamine group) as compared to Group-A; with p-value< 0.001, demonstrating analgesic properties of ketamine when administered pre-emptively as an intravenous dose. CONCLUSION: Our study concluded that pre-emptive analgesic dose of ketamine (administered before surgical incision), leads to prolong analgesia in post-operative period in patients who underwent LSCS under spinal anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aims: Hypotension following subarachnoid block (SAB) for lower segment cesarean section (LSCS) has adverse fetal and maternal implications. Perfusion index (PI) has been used for assessing peripheral perfusion dynamics. This study aimed to determine whether a baseline PI can predict hypotension after spinal anesthesia for LSCS. Materials and Methods: In this prospective, observational study, 152 term parturients were divided into two groups: Group I (PI of ≤ 3.5) and Group II (PI >3.5). SAB was performed using bupivacaine 0.5% (hyperbaric) 10 mg with dexmedetomidine 5 μg. PI, vital parameters, and correlation between baseline PI and hypotension were observed. Receiver operating characteristic (ROC) curve was plotted for PI and the occurrence of hypotension. Statistical analysis was performed using Chi-square test, independent sample t-test, Mann-Whitney U-test, and regression analysis with Spearman's rank correlation coefficient test. Results: The incidence of hypotension was higher in Group II (57.89%) compared to Group I (18.42%) (P < 0.0001). The correlation between baseline PI >3.5, the number of episodes of hypotension, and the total dose of mephentermine required were also significant. The sensitivity and specificity of baseline PI of 3.5 to predict hypotension were 72.37% and 81.58%, respectively. The area under the ROC curve for PI to predict hypotension was 0.830. Conclusion: Parturients with baseline PI >3.5 are at higher risk of developing hypotension following SAB compared to those with baseline PI ≤3.5; hence, PI is a safe and reliable device for predicting hypotension following SAB. [ABSTRACT FROM AUTHOR]

Since only few reported studies propose anti-vascular endothelial growth factor (anti-VEGF) delivery through electrospun scaffolds, this study greatly contributes to the potential prevention of patient's vision loss, as it explores electrospun polycaprolactone (PCL) coated with anti-VEGF for the blockage of abnormal cornea vascularization. In terms of physicochemical properties, the biological component increased the PCL scaffold fiber diameter (by ~24%) and pore area (by ~82%), while ut slightly reduced its total porosity as the anti-VEGF solution filled the voids of the microfibrous structure. The addition of the anti-VEGF increased the scaffold stiffness almost three-fold at both strains of 5 and 10%, as well as its biodegradation rate (~36% after 60 days) with a sustained release profile after Day 4 of phosphate buffered saline incubation. In terms of scaffold application function, the PCL/Anti-VEGF scaffold proved to be more favorable for the adhesion of cultured limbal stem cells (LSCs); this was confirmed by the SEM images, where the cells showed flat and elongated conformations. Further support of the LSC growth and proliferation was confirmed by the identified p63 and CK3 markers after cell staining. These results demonstrate the advantageous effect of the surface-adsorbed anti-VEGF to stop vision loss and help damaged corneal tissue repair. [ABSTRACT FROM AUTHOR]

Intracranial bleed in the form of subdural hematoma (SDH) with intracranial hypotension after spinal anesthesia for cesarean section is a rare condition with an incidence of around 1 in 5,00,000 obstetric populations. As its presentation is similar to post-dural puncture headache (PDPH), it can be misdiagnosed sometimes. Persistent headache for more than 5 days, vomiting, blurring of vision, and convulsion can guide the diagnosis of intracranial bleed. Magnetic resonance imaging (MRI) helps to diagnose the location, size, and other abnormalities of bleed in such patients. The management ranges from conservative to surgical management in the form of craniotomy. Here, we present a case of a 19-year-old woman, who operated on for cesarean section under spinal anesthesia presented with SDH and intracranial hypotension on postoperative day (POD) 6. She was managed conservatively with plenty of intravenous (IV) fluids, bed rest, low head position, analgesics, and antiepileptics. A repeat computed tomography (CT) scan was performed after 14 days, which showed resolved SDH, and the patient was discharged. [ABSTRACT FROM AUTHOR]

Simple Summary: In hematological malignancies, specifically in acute myeloid leukemia, aberrant stem cells, also known as leukemic stem cells, may be responsible for the relapse of the disease. Since several authors have related the quiescence and chemoresistance of leukemic stem cells with the Wnt/β-catenin signaling pathway, new approaches to chemosensitize this population should be studied. Therefore, in this review, we summarize the current information about the Wnt/β-catenin signaling pathway in hematology. Wnt signaling is a highly conserved pathway in evolution which controls important processes such as cell proliferation, differentiation and migration, both in the embryo and in the adult. Dysregulation of this pathway can favor the development of different types of cancer, such as acute myeloid leukemia and other hematological malignancies. Overactivation of this pathway may promote the transformation of pre-leukemic stem cells into acute myeloid leukemia stem cells, as well as the maintenance of their quiescent state, which confers them with self-renewal and chemoresistance capacity, favoring relapse of the disease. Although this pathway participates in the regulation of normal hematopoiesis, its requirements seem to be greater in the leukemic stem cell population. In this review, we explore the possible therapeutic targeting of Wnt to eradicate the LSCs of AML. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine how the SARS-CoV-2 infection affects antenatal women and newborn babies in terms of symptoms, complications, and outcomes. Methods: A total of 128 antenatal women were included in this prospective single-center observational study. The present study was conducted in a tertiary-level public hospital in Kerala. The presence of SARS-CoV-2 was detected by running a real-time PCR using the extracted RNA using an appropriate PCR kit (SeegenAllplexTM 2019-nCoV Assay). Result: Out of 128 COVID-19-positive antenatal women, RT-PCR was positive for 57.8% of them, followed by antigen positive for 34.4% and TrueNat for 7.1%. The Mean ±SD duration of COVID positivity from delivery was 8.45±5.1 days and the Mean ±SD CRP was 3.15±6.2 mg/dl, Mean ±SD FERRITIN was 61.8±98.2 mg/l and the Mean ±SD D DIMER was 2.09±1.4 mg/l. Seven study subjects were transferred to the intensive care unit (ICU), 5 were given oxygen support, 3 were given NIV assistance with oxygen, and one was transferred on mechanical ventilation due to a severe complication. Out of 128 COVID-positive study subjects, the majority of them didn't have any post-partum complications. 19 study subjects experienced complications such as PPH (10 study subjects), sepsis, and maternal near-miss (4 study subjects), and one study subject died due to thromboembolism. Conclusion: The study demonstrated that LSCS was more in COVID pregnant women. However, the majority of the COVID-positive pregnant women didn't require ICU admission. Further, the study found that the majority of the neonates were COVID-negative and healthy. [ABSTRACT FROM AUTHOR]

Transparent polylactic acid (PLA) fibers with Lumogen Red 305 (LR305) were prepared by melt spinning. The crystallization and melting behavior, absorbance spectra, emission spectra, mechanical properties, and the concentrator effect for a real solar cell of the PLA/LR305 fibers were characterized by differential scanning calorimetry (DSC), UV–Vis–NIR spectrophotometer, FL spectrophotometer, yarn tensile tester, and a digital multimeter (Victor VC980+), respectively. The results showed that the hot drawing improves the mechanical properties of the fibers while maintaining the optical properties. When the concentration of LR305 was 0.05 wt%, the breaking strength of the stretched fiber 22@217 (22% crystallinity, 217 diameters) and the as-formed fiber 3@205 (3% crystallinity, 205 diameters) were 69.3 and 182.7 MPa, respectively. Meanwhile, the absorbance intensity and luminescence intensity of 22@217 decreased only 6 and 11% compared with 3@205. When triple-drafted PLA/LR305 fibers with a concentration of 0.25 wt% were combined with the solar cell, the solar cell output current changed from 0 to 2.8 μA. [ABSTRACT FROM AUTHOR]

Limbal stem cells (LSCs) are of paramount importance in corneal epithelial tissue repair. The cornea becomes opaque in case of limbal stem cell deficiency (LSCD), which may cause serious damage to the ocular visual function. There are many techniques to restore damaged epithelium, one of which is the transplantation of healthy cultured LSCs, usually onto a human amniotic membrane or onto bio-based engineered scaffolds in recent years. In this study, melt electrospun polylactic acid (PLA) was modified by silk fibroin or gelatin and further cultured with LSCs originating from three different donors. In terms of physicochemical properties, both modifications slightly increased PLA scaffold porosity (with a significantly larger pore area for the PLA/gelatin) and improved the scaffolds' swelling percentage, as well as their biodegradation rate. In terms of the scaffold application function, the aim was to detect/visualize whether LSCs adhered to the scaffolds and to further determine cell viability (total number), as well as to observe p63 and CK3 expressions in the LSCs. LSCs were attached to the surface of microfibers, showing flattened conformations or 3D spheres in the formation of colonies or agglomerations, respectively. All scaffolds showed the ability to bind the cells onto the surface of individual microfibers (PLA and PLA/gelatin), or in between the microfibers (PLA/silk fibroin), with the latter showing the most intense red fluorescence of the stained cells. All scaffolds proved to be biocompatible, while the PLA/silk fibroin scaffolds showed the highest 98% viability of 2.9 × 106 LSCs, with more than 98% of p63 and less than 20% of CK3 expressions in the LSCs, thus confirming the support of their growth, proliferation and corneal epithelial differentiation. The results show the potential of these bio-engineered scaffolds to be used as an alternative clinical approach. [ABSTRACT FROM AUTHOR]

Hypoplastic left heart syndrome is abnormal development of left sided cardiac structure, leading to obstruction to blood flow from the left ventricular outflow tract. We are presenting a case of primigravida with 35weeks period of gestation with gestational hypertension with left hypoplastic heart syndrome with single umbilical artery which was diagnosed at 24weeks anomaly scan but she continued the pregnancy. Emergency caesarean section was done and a live male baby was delivered but shifted to NICU in view of antenatally diagnosed hypoplastic left heart syndrome. Baby was discharged on day 8 of life, on day 21 of life baby presented with gasping breaths. Chest x-ray showed extensive infiltrates and baby died due to pneumonia and cardiac arrest.

Uterine rupture is a life threatening complication which may lead to significant mortality and morbidity. Posterior wall uterine rupture is a rare presentation especially in the first trimester. Abnormal placental attachment is, similarly, a rare phenomenon, diagnosed chiefly in 3rd trimester. The co-existence of uterine rupture with abnormal placentation in first trimester is extremely rare. Here in, we experienced a case of posterior uterine wall rupture in a 32-year-old gravida 4 para 2 pregnant woman with history of one spontaneous abortion. The patient presented at gestational age of 10 weeks with acute abdomen and severe anemia. She had history of two lower segment caesarean sections. Also, there was history of intake of mifepristone and misoprostol a month back. Ultrasonographic findings were suspicious towards heterotopic pregnancy. However, abdominal exploration revealed posterolateral uterine wall rupture away from the site of lower segment cesarean scar with adherent placenta at the site of scar. Subtotal hysterectomy was done. The patient was discharged 5 days later after transfusion of 4 units packed red blood cells.

Background: Transverse abdominis plane block is effective modality of post operative analgesia for anterior abdominal wall surgeries . Women undergoing LSCS need good pain relief for comfort and early recovery and mobilization. Ultrasound guided transverse abdominis plane block is safe and effective way for postoperative analgesia. Objectives: The primary objective is total duration of postoperative analgesia. The secondary objective is to compare any side effects. Methods: 80 primigravida ASA 1 status, undergoing LSCS were recruited in this prospective randomized study. They were divided into two groups,group R ropivacaine,who received 20 ml 0.2% ropivacaine, and group L patients who received 20ml 0.25% of levobupivacaine via TAP block under ultrasound guidance. Postoperative pain was assessed using the visual analog scale upon arriving at the recovery room,just prior to being discharge to ward and at 6hrs,12 hours,18hrs,and 24hrs postoperatively to compare the effectiveness of analgesia. Results: A total of 80 patients were analyzed . Duration of analgesia was significantly longer in L group 10.94+0.62hrs compared to group R 8.16+0.36hrs(p<000.1),mean consumption of diclofenac was 150.77+14.90mg and 75.88+28.77 mg in group R and and L respectively p<0.005). Conclusion : Postoperative analgesia is better with 0.25%levobupivacaine as compared to 0.2% ropivacaine. [ABSTRACT FROM AUTHOR]

Background and Aims: Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Material and Methods: A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally. Results: No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group). Conclusion: Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.

Background and Aims: Spinal anesthesia is the regional technique preferred for cesarean section and is usually administered using the traditional landmark technique. Ultrasonography of the spine appears to be helpful in locating the puncture site and increasing the success rate. The primary objective of this study was to assess the use of ultrasonogram in locating the lumbar interspinous space for spinal anesthesia in laboring parturients brought for elective cesarean section. Material and Methods: Sixty parturients scheduled to undergo elective cesarean section under spinal anesthesia were included in this prospective randomized controlled trial, after obtaining the institutional ethical clearance. In Group I, 30 patients received spinal anesthesia by landmark technique and in Group II, 30 patients underwent ultrasound-guided spinal anesthesia. The statistical analysis was done using SPSS software version 17 (SPSS Inc., Chicago, Illinois, USA) for Microsoft windows. Results: The time taken for spinal in Group I was longer than in Group II (62 ± 18s; 41 ± 11s; P = 0.0001). The number of attempts of needle insertion was significantly less in Group II (group I 1.86 ± 1.04: group II 1.06 ± 0.25). However, the total preparation time (28 8.30 ± 92 vs 804.73 ± 77; P = 0.0001) was more in the ultrasound-guided than in the landmark group. The patients had better satisfaction in group II. Conclusion: Preprocedural ultrasound is a useful tool for successful lumbar puncture in parturients as it minimizes the number of attempts of needle insertion and provides better patient satisfaction.

Abstract Background Human pluripotent stem cell-derived limbal stem cells (hPSC-derived LSCs) provide a promising cell source for corneal transplants and ocular surface reconstruction. Although recent efforts in the identification of LSC markers have increased our understanding of the biology of LSCs, much more remains to be characterized in the developmental origin, cell fate determination, and identity of human LSCs. The lack of knowledge hindered the establishment of efficient differentiation protocols for generating hPSC-derived LSCs and held back their clinical application. Results Here, we performed a time-course single-cell RNA-seq to investigate transcriptional heterogeneity and expression changes of LSCs derived from human embryonic stem cells (hESCs). Based on current protocol, expression heterogeneity of reported LSC markers were identified in subpopulations of differentiated cells. EMT has been shown to occur during differentiation process, which could possibly result in generation of untargeted cells. Pseudotime trajectory analysis revealed transcriptional changes and signatures of commitment of hESCs-derived LSCs and their progeny—the transit amplifying cells. Conclusion Single-cell RNA-seq revealed time-course expression changes and significant transcriptional heterogeneity during hESC-derived LSC differentiation in vitro. Our results demonstrated candidate developmental trajectory and several new candidate markers for LSCs, which could facilitate elucidating the identity and developmental origin of human LSCs in vivo.

Objectives: To assess the strength of lower uterine segment caesarean section scar after 36 completed weeks up to 40 weeks with the help of transabdominal ultrasonography (USG) and correlating with maternal and early neonatal outcome in patients with previous one LSCS. Methods: This prospective study was carried out in the Department of OBGY, GMCH, Aurangabad from 1st October 2017 to 1st October 2019. All these cases underwent transabdominal USG between 36 completed weeks to 40 weeks and scar finding noted. Based on scar thickness, cases were assigned into two groups of ≤ 3 mm and > 3 mm. TOLAC (Trial of labor after caesarean) was given to cases having scar thickness > 3 mm and elective LSCS was done in scar thickness ≤ 3 mm. Correlation of maternal and fetal outcome with caesarean section scar strength parameters were done. Results: Total 211 cases were included in present study. 83 cases had scar thickness ≤ 3mm (39.3%) and 128 cases had scar thickness >3mm (63.6%). Strong association was seen between scar thickness and scar shape, border, continuity and echogenicity.105(49.76%) cases were given TOLAC with successful VBAC (Vaginal birth after caesarean), in 83(39.33%) cases had repeat elective LSCS, and 23(10.90%) cases had failed TOLAC with repeat emergency LSCS. 20 neonates needed NICU (Neonatal intensive care unit) care but causes of it were not related to scar complications. No case of obstetric hysterectomy, maternal mortality or still birth in our study. Conclusion: Successful VBAC may be advocated considering clinical factors, counseling and vigilant intrapartum management along with scar thickness of > 3mm, in tertiary care centres.

Simple Summary: We review the state of the art of knowledge regarding the Notch signaling pathway to shed light on the role that this pathway has in hematopoiesis and hematological neoplasia, focusing on acute myeloid leukemia. The Notch signaling pathway is fundamental to early fetal development, but its role in acute myeloid leukemia is still unclear. It is important to elucidate the function that contains Notch, not only in acute myeloid leukemia, but in leukemic stem cells (LSCs). LSCs seem to be the principal cause of patient relapse. This population is in a quiescent state. Signaling pathways that govern this process must be understood to increase the chemosensitivity of this compartment. In this review, we focus on the conserved Notch signaling pathway, and its repercussions in hematopoiesis and hematological neoplasia. We found in the literature both visions regarding Notch activity in acute myeloid leukemia. On one hand, the activation of Notch leads to cell proliferation, on the other hand, the activation of Notch leads to cell cycle arrest. This dilemma requires further experiments to be answered, in order to understand the role of Notch not only in acute myeloid leukemia, but especially in LSCs. [ABSTRACT FROM AUTHOR]