Relationship between Amniotic Fluid Index and Perinatal Outcome

Aims:  This study was done to evaluate the predictive value of low amniotic fluid index (AFI) of < 5 cm for adverse perinatal outcome in term of caesarean section for fetal distress, birth weight, meconium stained liquor and APGAR scores. Methods: This was a prospective study of 200 antenatal women booked at Nepal Medical College Teaching Hospital during the year 2013-2014 with gestational age between 34 and 41 weeks. Patients history and clinical examination were recorded and AFI was measured and the perinatal outcome was compared between two groups i.e AFI <5 cm and >5 cm. Results: The caesarean section (C/S) rate for fetal distress and low birth weight babies (<2.5 kg) was higher in patients with low AFI (p=0.048, 0.001 respectively). There was no significant difference in meconium staining, APGAR score at 5 minutes between the two groups (p=0.881, 0.884 respectively). Conclusions: Caesarean section for fetal distress and low birth weight babies was significantly associated with low amniotic fluid index. There was no significant difference in meconium staining liquor, APGAR score at 5 minutes between the two groups.  

Metal concentrations and histopathological changes in goats (Capra hircus) reared near an industrial area of West Bengal, India

The present investigation was performed to assess the concentrations of four heavy metals-lead (Pb), cadmium (Cd), copper (Cu), and cobalt (Co)-in goats reared in the vicinity of an industrial area of West Bengal, India, including soil, water, and feedstuffs; tissues of liver, kidney, lung, spleen, and muscle; and milk and faeces. In addition, histopathological changes in liver, lung, kidney, spleen, and muscle samples were examined. Mejia block as an industrial polluted site and Vatar block as a reference site (without any industrial activities and 120 km away from the polluted site) were selected for this study. The results showed that concentrations of these heavy metals in soil, water feedstuffs, all tissues, milk, and faeces were greater (P < 0.05) in the polluted site than the reference site. The largest concentrations of Cd and Pb were found in kidney followed by liver, lung, spleen, and muscle. However, Co and Cu accumulations in the tissues were in following order: liver > kidney > lung > spleen > muscle. Concentrations of heavy metals were greater in older animals than in young ones. Haemoglobin, total protein, packed cell volume, total erythrocyte counts, and total leucocytes counts were significantly (P < 0.01) decreased in blood of goats in the polluted site compared with the reference site. Serum glucose, creatinine, aspartate amino transferase, alanine amino transferase, and alkanline phosphatase were significantly (P < 0.05 to P < 0.01) increased. Histological examination showed several pathological alterations including degeneration, vacuolation, and tubulitis in kidney; congestion, degeneration, periportal necrosis, and focal haemorrhages in liver; and congestion and diffuse haemorrhage in lungs. It was concluded that natural exposure to these environmental heavy metals significantly increases toxic heavy-metal concentrations in several visceral organs resulting in pathological changes in these tissues. Thus, consumption of the meat of goats reared in the polluted site may pose human health hazards.

An atomic magnetometer with autonomous frequency stabilization and large dynamic range

The operation of a highly sensitive atomic magnetometer using elliptically polarized resonant light is demonstrated. It is based on measurement of zero magnetic field resonance in degenerate two level systems using polarimetric detection. The transmitted light through the polarimeter is used for laser frequency stabilization, whereas reflected light is used for magnetic field measurement. Thus, the experimental geometry allows autonomous frequency stabilization of the laser frequency leading to compact operation of the overall device and has a preliminary sensitivity of <10 pT/Hz(1/2) @ 1 Hz. Additionally, the dynamic range of the device is improved by feedback controlling the bias magnetic field without compromising on its sensitivity.

Oral Health Condition of School Children in Nawalparasi District, Nepal

BACKGROUND

Oral diseases and feeding habits are inextricably linked. Significance of assessing oral health conditions among the school children therefore exists. The current study investigated the oral health condition among 5-6 years and 12-13 years children in Nawalparasi district, Nepal.

METHODS

Recruiting 1,000 school children aged (5-6) and (12-13) years in Nawalparasi district, a cross-sectional study was carried out from November to December, 2014. Data assembled from standard instrument was entered in Epi-Data 3.1, cleaned in SPSS version 16.0, and analyzed in Epi Info 3.5.4.

RESULTS

Of 12-13 years children, three out of ten (32.0%, 95% CI: 27.8-36.4) suffered from occasional dental discomfort and pain, and 8.1% (95% CI: 5.9-11.0) often experienced dental discomfort and pain during the last 12 months. It was 73.6% (95% CI: 69.3-77.4) who brushed teeth at least once a day, while another 20.7% (95% CI: 17.2-24.7) brushed twice a day. Among all children, 86.1% (95% CI: 82.6-89.1) used toothpaste to brush the teeth. A three-fourth (73.8%, 95% CI: 69.5-77.7) drank tea with sugar daily. Dental caries was visible on 42.2% (95% CI: 37.7-46.8) (mean DMFT score 2.3 ± 1.5). Likewise, a quarter (24.1%, 95% CI: 20.3-28.3) had gingival bleeding, 10.9% (95% CI: 8.3-14.1) questionable enamel fluorosis, 4.5% (95% CI: 2.9-6.9) dental trauma, and 1.7% (95% CI: 0.8-3.5) oral mucosal lesion. Referral for preventive/routine treatment was observed in 40.5% (95% CI: 36.145.1). Among 5-6 years old children, a remarkable proportion of dental caries (64.4%, 95% CI: 59.2-69.4 and mean DMFT score 4.4 ± 3.0) was noted. Statistics of enamel fluorosis, dental trauma, and oral mucosal lesions in this age group were: 3.1% (95% CI: 1.6-5.6), 1.7% (95% CI: 0.7-3.8), and 1.1% (95% CI: 0.4-3.0) respectively. About 40.1% (95% CI: 35.0-45.4) were referred for preventive treatment, and the rest for prompt treatment.

CONCLUSIONS

Oral health of the children was poor, chiefly dental carries remained widespread. Dental hygiene awareness should be promoted in schools in active coordination and collaboration with education authorities.

Fetal Transcerebellar Diameter/ Abdominal Circumference Ratio as a Gestational Age Independent Parameter for Fetal Growth

Aims: The purpose of this study was to evaluate accuracy of trans-cerebellar diameter / abdominal circumference (TCD/AC) ratio to assess fetal growth. The ratio of TCD with head circumference (HC) and biparietal diameter (BPD) was also determined. Methods: This was a prospective cross-sectional study involving 442 women with uncomplicated singleton gestation between 15-40 weeks. Protocol included obtaining the BPD, HC, TCD and AC in conventional planes  and obtaining ratio of TCD with other biometric parameters.Results: We were able to visualize the cerebellum in about 93% of scans. The TCD/ AC ratio remained nearly constant throughout gestational age and was 0.138. The mean TCD/HC ratio was 0.124 and mean TCD/BPD ratio was 0.476.Conclusions: TCD/HC and TCD/BPD ratio showed a small increase towards the completion of gestation while TCD/AC ratio remained nearly constant throughout gestational age. TCD/AC ratio is reliable as a gestational age independent parameter of fetal growth.DOI: http://dx.doi.org/10.3126/njog.v9i2.11770   

Normal fetal nasal bone length at 14 to 28 weeks of gestation

The fetal nasal bone length (FNBL) is a recent sonographic marker included in second trimester genetic sonography which varies with race and ethnicity. The importance of measuring FNBL is in the prenatal diagnosis of Down's syndrome (DS), the most common chromosomal abnormality. Nasal bone hypoplasia or absence is one of the frequent features of DS. Different studies conducted in different parts of the world have established FNBL in different races. But, reference values for normal fetal nasal bone length are yet to be established for Nepalese population. So, the aim of this study was to determine normal FNBL in second trimester. Objective was to create normal reference values for fetal nasal bone in Nepalese population. A cross sectional study was carried out on 150 second trimester pregnancy cases referred for antenatal ultrasound to Department of Radiology at Nepal Medical College and Teaching Hospital between May 2014 and July 2014. Cases included all the clinically normal second trimester pregnancy in which fetal nasal bone could be visualized in midsagittal plane. Table demonstrating normal FNBL corresponding to weeks of gestation was generated using IBM SPSS Statistics Version 20. There was linear increase in mean FNBL with gestational age. Minimum mean FNBL was 2.93 mm at 14 weeks and maximum was 7.89 mm at 27 weeks. Age of patients ranged from 17 to 35 years. Normal FNBL values in Nepalese population corroborates with those published in Western literature but with variation. Hence, reference values for local population become more relevant for antenatal ultrasound practices in Nepal.

Inclusion of Three-Vessel View in Routine Fetal Cardiac Screening

Aims: The purpose of this study was to study the feasibility of inclusion of 3-vessel view (3-VV) of the fetal upper mediastinum in routine fetal anomaly screening; and to study the size relationship of these vessels namely, main pulmonary artery (MPA), ascending aorta (AA) and the superior venacava (SVC) in fetuses between 17 and 24 weeks of pregnancy by antenatal ultrasound. Methods: This was a prospective cross sectional study involving 106 pregnant ladies between 17 and 24 weeks of gestation. The time burden to the examination due to addition of 3-VV in routine anomaly screening was recorded. The relationships of the three great vessels of the fetal upper mediastinum were studied and their diameters were obtained. Regression equations were used to construct the reference ranges for all the parameters of statistical significance. Results: The 3-VV could be easily obtained in all but eight patients within five minutes (the difficulty in these eight patients was due to fetal position). The MPA, AA and SVC were aligned in a straight line from left to right respectively, the MPA being the largest vessel, the SVC being the smallest vessel and the AA having an intermediate diameter. All of these three vessels showed significant correlation of size with advancing gestational age. Conclusions: 3-VV is easily obtained in fetuses at the time of routine anomaly screening. This should be routinely included in the screening ultrasound of fetal heart along with the four-chamber view to detect the anomalies of the outflow tract. DOI: http://dx.doi.org/10.3126/njog.v9i1.11197 NJOG 2014 Jan-Jun; 2(1):82-86

USG assisted and USG guided percutaneous renal biopsy at Nepal Medical College Teaching Hospital: a three and half years study

A prospective study was carried out from 2009 to 2013 in the Department of Radiology and Imaging of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal, in which a total of 75 patients underwent percutaneous renal biopsy with a 16 or 18 gauge needles. This was done blindly by marking a site on the skin, or, whenever there was difficulty with the blind procedure, by direct real time USG guidance. In all cases, the marking in the skin was done by the radiologist and the biopsy was performed by the Nephrologist, with the aid of the radiologist in cases of real-time USG guided renal biopsy. This study was carried out to assess the safety and efficacy of the USG aided, and USG guided renal biopsy, to see for the types and severity of complications arising from renal biopsies to determine the optimal period of observation required after the procedure. All renal biopsies were performed after the patients were admitted to the hospital at least 1 day prior to the procedure. Coagulation profile was done in all patients prior to the procedure. All patients were kept under strict complete bed rest for 24 hours post procedure. The ages of the patients ranged between 14 years to 71 years, with 42 female and 33 male patients. A mean of 21.8 glomeruli was obtained in each specimen, with absent glomerular yield seen in only 3 patients. Minimal change disease was seen in 19 patients, being the most common histopathological diagnosis followed by a spectrum of others. The overall complication rate was 4% and all of these were self-limiting needing no other intervention, or management except for observation and bed rest. Late complications were not seen. Percutaneous renal biopsy with the help of USG is a safe and efficacious procedure with less chance of minor complications.

Nanostructuring of the conjugated polyelectrolyte poly[9,9-bis(4-sulfonylbutoxyphenyl)fluorene-2,7-diyl-2,2'-bithiophene] in liquid crystalline C12E4 in bulk water and aligned thin films

We report on the conjugated polyelectrolyte 12 mM poly[9,9-bis(4-sulfonylbutoxyphenyl) fluorene-2,7-diyl-2,2'-bithiophene] (PBS-PF2T) mixed in concentrated aqueous 680 mM tetraethylene glycol monododecyl ether (C12E4) in bulk and thin films. A blue-shift in the fluorescence spectrum demonstrates breakup of PBS-PF2T aggregates in bulk aqueous C12E4. Small-angle X-ray scattering data indicate that this mixture follows a very similar phase behaviour to binary mixtures of a pure surfactant with water, including a micellar phase below about 20 °C, a lamellar phase in between about 20 and 70 °C and a proposed coexistence of water and the liquid surfactant solution above 70 °C. Molecular dynamics simulations reproduce these transitions and suggest that PBS-PF2T is incorporated into the surfactant headgroup region, and is, on average, perpendicular to the alkyl chains. In wet thin films, grazing-incidence small-angle X-ray scattering shows that the phase window for the lamellar phase becomes much narrower, located at about 30-34 °C. Weakly ordered phases exist both below and above these temperatures. These phases are isotropic, but lamellae become aligned in a stacked manner on the surface whether approached from low or high temperatures. Dry films are disordered but can be reversibly ordered and disordered and aligned and misaligned by maintaining the temperature at 30-34 °C and switching relative outside humidity between 32% and 100%.