89 research outputs found
Genital and urinary tract infections in pregnancy in southern India : diagnosis, management and impact om perinatal outcome
No full textBackground: Prevalence of sexually transmitted infections varies in different parts of the world. These infections, occurring during pregnancy, can result in adverse outcome. There is paucity of information on the prevalence, effects and management of such infections in pregnancy in India. Similarly, urinary tract infection (UTI) is a common medical problem in pregnancy. But, very little is known about the patterns and mechanism of antimicrobial resistance among bacteria causing UTI and the prescription practices for this condition. Diagnostic methods, used for early onset sepsis (EOS) in the new-born also need evaluation.Methods: Endocervical samples from consecutive pregnant women at 26 to 36 weeks of gestation were tested to detect infection with Chlamydia trachomatis. Association of this infection with adverse pregnancy outcome was determined In another retrospective cohort study, information related to pregnancy and outcome was collected from pregnant women with reactive Venereal Disease Research Laboratory (VDRL) test, which was done as part of antenatal care. Data on susceptibility patterns of bacteria isolated in significant counts from urine of pregnant women suspected to have urinary infection were collected. To understand the mechanism of resistance, the prevalence of integrons among these E. coli were determined Prescribing patterns for these infections were ascertained using a questionnaire and based on antibiotics dispensed to pregnant women. To evaluate the use of CRP in diagnosing EOS, CRP levels in cord blood and neonatal blood at 24 hrs were estimated in two groups of neonates, one at risk of developing infection and the other at low risk of infection.Results: Prevalence of C trachomatis infection was 3.3% and this infection did not contribute significantly to adverse pregnancy outcome. Prevalence of syphilis was also low. However, fetal loss occurred in 32% of the infected women. The difference in outcome between those receiving antenatal care and those without was significant (P = 0.01; RR 7.53 95% Cl 1.1 - 51.9). In 2002, > 90% of E. coli causing UTI was susceptible to nitrofurantoin, a relatively inexpensive and safe drug. However, less than 25% of doctors used it for treatment of cystitis. The choice and duration of therapy varied greatly.Resistance to ampicillin (pDiscussion: The prevalence of STIs among antenatal women is low. However, syphilis is an unrecognised cause of pregnancy loss in the area. There are several lacunae in the diagnosis and treatment of infections in pregnancy - both UTI and STIs. A major reason probably is the lack of locally relevant uniform guidelines for the diagnosis and management of these conditions. There is also complacency because of low prevalence of STIs in pregnancy. We also observed that auditing the management of syphilis in pregnancy could be an effective and simple tool to assess the quality of antenatal care. High prevalence of resistance among E coli is associated with integrons. Since CRP levels rise in babies without infection, this test may be useful only in excluding infection.List of scientific papersI. Alexander R, Mathai E, Nayyar V, Mathew M, Jasper P (1993). "Low prevalence of chlamydial endocervical infection in antenatal south Indian women." Genitourin Med 69(3): 240-1 https://pubmed.ncbi.nlm.nih.gov/8335319II. Mathai E, Mathai M, Prakash JA, Bergstrom S (2001). "Audit of management of pregnant women with positive VDRL tests." Natl Med J India 14(4): 202-4 https://pubmed.ncbi.nlm.nih.gov/11547524III. Mathai E, Thomas RJ, Chandy S, Mathai M, Bergstrom S (2004). "Antimicrobials for the treatment of urinary tract infection in pregnancy: practices in southern India. " Pharmacoepidemiol Drug Saf 13(9): 645-52 https://pubmed.ncbi.nlm.nih.gov/15362088IV. Mathai E, Grape M, Kronvall G (2004). "Integrons and multidrug resistance among Escherichia coli causing community-acquired urinary tract infection in southern India. " APMIS 112(3): 159-64 https://pubmed.ncbi.nlm.nih.gov/15153157V. Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstrom S (2004). "Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection? " Indian Pediatr 41(9): 895-900 https://pubmed.ncbi.nlm.nih.gov/15475630</p
Evolution and future trends in battle injuries to the CNS
No full textDespite advances in personal protection, brain and spinal injuries amongst combatants pose significant management challenges. Battle field medical care has evolved over the year. In this article we discuss evolutions of military medicine, study current protocols and outcomes and discuss future perspectives. Mention is also made of some original work by the author
The neuroscience of management
No full textBehaviour is wired into and a product of our brain's circuitry. In this paper we discuss the neuroanatomical templates of education, training and decision making. This awareness is important and could influence the way we train young minds, to take over the mantle of tomorrow's leadership.
The bulk of our brain's volume is in two cerebral hemispheres, constituted by the frontal, parietal and occipital lobes. These hemispheres (the neocortex) act as centres of information processing and storage. Life sustenance and locomotion are controlled by the brainstem and cerebellum. The 60 billion neurons we are born with and their connections or synapses constitute the brain's ‘hardware'. While the software for life sustenance is loaded at birth, the information storage zones are blank pages.
The dominant mode of information input is initially visual. Speech acquisition facilitates verbal dominance. Verbal information is initially stored in the hippocampus. Hippocampi are ‘sea horse’ shaped structures located in the medial temporal lobes which act as the ‘desktop’ for easy storage and retrieval of information. Hippocampal relations with the lateral ventricle (regenerative potential), the Meyers loop of the visual pathway and the amygdala (rage centre) provide twists in the tale.
Information from the hippocampal desktop is projected in waves of bulk information transfer called ‘thalamocortical’ spindles to the neocortex. Fresh inputs modify this information by creating new synapses in a process called neosynaptogenesis. Retrieval and reinforcement of information circuits is by task performance and job training.
A silent quorum of neurons (Around 70%) is the repository of our personalities and character and the seat of our souls. Decision making involves the information template. Mature decisions invokes these personal qualities (which too a r e partially acquired and hence modifiable) modulating ethical and humane decisions. Decisions made in anger may bypass the information template altogether in a n ‘amygdala hijack'.
The capability of the human brain to process the varying levels of information, knowledge and wisdom anagrams bestows upon it a potential for ‘Fuzzy Logic’ and the ability to create ‘Blue Ocean’ strategies
Mathai-Quillen forms and Lefschetz theory
No full textMathai-Quillen forms are used to give an integral formula for the Lefschetz number of a smooth map of a closed manifold. Applied to the identity map, this formula reduces to the Chern-Gauss-Bonnet theorem. The formula is computed explicitly for constant curvature metrics. There is in fact a one-parameter family of integral expressions. As the parameter goes to infinity, a topological version of the heat equation proof of the Lefschetz fixed submanifold formula is obtained. As the parameter goes to zero and under a transversality assumption, a lower bound for the number of points mapped into their cut locus is obtained. For diffeomorphisms with Lefschetz number unequal to the Euler characteristic, this number is infinite for most metrics, in particular for metrics of non-positive curvature.First author draf
On a Generalized Entropy Measure Leading to the Pathway Model with a Preliminary Application to Solar Neutrino Data
No full textAn entropy for the scalar variable case, parallel to Havrda-Charvat entropy, was introduced by the first author, and the properties and its connection to Tsallis non-extensive statistical mechanics and the Mathai pathway model were examined by the authors in previous papers. In the current paper, we extend the entropy to cover the scalar case, multivariable case, and matrix variate case. Then, this measure is optimized under different types of restrictions, and a number of models in the multivariable case and matrix variable case are obtained. Connections of these models to problems in statistical and physical sciences are pointed out. An application of the simplest case of the pathway model to the interpretation of solar neutrino data by applying standard deviation analysis and diffusion entropy analysis is provided
Dynamics of finite-sized light spheres in turbulence
No full textWe report experimental results on the Lagrangian dynamics of finite-size light particles in turbulence. Using an orthogonal camera setup and 3D particle tracking, we study the velocity and acceleration statistics of rigid light spheres in a water tunnel with nearly homogeneous and isotropic turbulence. The Reynolds number (ReY) is varied from 180 to 300, and the study covers a range of size ratios (4 < D/η < 16) for marginally light spheres. We find that the normalised acceleration PDF decreases in intermittency with increasing size ratio - in qualitative agreement with the predictions of the Faxén corrected model. We also present preliminary results on the rotational dynamics of large light spheres in turbulence
Algebra cochains, the bivariant JLO cocycle and the Mathai-Quillen form
No full textThis is a first investigation by the author of the similarity between
Quillen's superconnection formalism, his constructions of (periodic) cyclic
cocycles via algebra cochains on a bar construction, and Kasparov bimodules for
KK-theory. In this article, we do so by deriving a slight extension of the
Mathai-Quillen Thom form via a bivariant JLO cocycle. The main idea (which is
in fact not really new) is that KK-cycles should be thought of as
superconnection forms; these methods will be applied to other contexts
elsewhere
Non-invasive ventilation in the postoperative period: Is there a role?
No full textNon-invasive positive pressure ventilation or non-invasive ventilation (NIV) has emerged as a simpler and safer alternative to invasive mechanical ventilation in patients developing acute postoperative respiratory failure. The benefits of NIV as compared to intubation and mechanical ventilation include lower complications, shorter duration of hospital stay, reduced morbidity, lesser cost of treatment and even reduced mortality rates. However, its use may not be uniformly applicable in all patient groups. This article reviews the indications, contraindications and evidence supporting the use of NIV in individual patient groups in the postoperative period. The anaesthesiologist needs to recognise the subset of patients most likely to benefit from NIV therapy so as to apply it most effectively. It is equally important to promptly identify signs of failure of NIV therapy and be prepared to initiate alternate ways of respiratory support. The author searched PubMed and Ovid MEDLINE, without date restrictions. Search terms included Non-invasive ventilation, postoperative and respiratory failure. Foreign literature was included, though only articles with English translation were used
Robotics & artificial intelligence : The future of surgeons & surgery
No full textRobotics and Artificial Intelligence complement surgical technical expertise and judgement. A robot’s accuracy in the programmed performance of predesignated tasks is exquisite. Historically, with the evolution of microsurgery, senior surgeons designated delicate suture placement to more steady handed, sharper eyed young fellows or even nurses. Tactile feedback and ultrasensitive pressure velocity controls make robotics a viable but expensive option to fine surgical assistance.
Autonomous surgical robots are however a distinct paradigm. Myriad unfathomed mysteries of human pathophysiology and anatomy confer upon surgical procedures complexities which defy stratification and simplification into sets of preordained tasks. In the current scenario where fuzzy logic, neural networks and intuitive computing are still in early evolution, robots replacing master surgeons seem as improbable as Google self driving cars in formula one racing.
Robots have evolved as dextrous, fatigue and tremor free surgical tools. The data crunching capability of computers is improving in speed and in capability for machine learning. Human surgical maturity on the other hand is attained and matures through phases of information assimilation, knowledge consolidation and attainment of surgical wisdom. Human surgeons at the helm will, in this decade harness robotic capabilities and information template paradigms to fine tune many procedures and to augment surgical reach. Quantum leaps and paradigm shifts towards robotic surgical autonomy may be neither desirable nor practical
Glioblastoma multiforme : A study of 22 patients and an analysis of the effect of gross total resection on quality of life and recurrence free survival
No full textWe present a series of 22 cases of Glioblastoma Multiforme (GBM) managed at our centre. Patients underwent surgical decompression followed by radio chemotherapy. Intraoperative ultrasound was used as an aid to surgery. Ultrasonic and later CT confirmation of extent of tumor resection was obtained. Outcomeswere evaluated with respect to tumor progression. In our study patients in whom a gross total resection was achieved had better outcomes
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