Rooftop water harvesting for managed aquifer recharge and flood mitigation in tropical cities: Towards a strategy of co-benefit evaluations in João Pessoa, northeast Brazil.

Intense urbanisation in many coastal areas has led to intensification of groundwater consumption, while reducing permeable areas and increasing the frequency and magnitude of flooding. Among the potential strategies to compensate for these adverse effects, which are expected to become worse as a result of climate change, rooftop rainwater harvesting (RWH) in combination with managed aquifer recharge (MAR), may be indicated. This work investigated the performance of different configurations of such a system, tested as a twofold sustainable stormwater and domestic water management tool in a tropical metropole (João Pessoa, Brazil). This area located over a sedimentary aquifer system illustrates the water security challenges of densely urbanised areas in southern cities. To that end, several configurations of rooftop catchments and storage volumes were evaluated, by simulating a MAR-RWH system connected to the regional unconfined aquifer (Barreiras Formation) through a 6″ diameter injection well. Rainfall-runoff-recharge processes and water balances were simulated using monitored high-temporal resolution rainfall data. The results showed that catchments ranging from 180 to 810 m2, connected to tanks from 0.5 to 30.0 m³, are the optimal solutions in terms of efficient rainwater retention and peak flow reduction. These solutions provided mean annual estimates of aquifer recharge between 57 and 255 m³/yr from 2004 to 2019. The results of this study highlight the opportunity for MAR schemes to reconcile stormwater management and water supply goals.

Reverted effect of mesenchymal stem cells in glioblastoma treated with agathisflavone and its selective antitumoral effect on cell viability, migration, and differentiation via STAT3.

Glioblastoma is the most lethal tumor of the central nervous system, presenting a very poor prognostic, with a survival around 16 months. The interaction of mesenchymal stem cells and tumor cells has been studied, showing a bias in their role favoring or going against aggressiveness. Natural products such as flavonoids have showed their anticancer properties and the synergic potential with the activation of microenvironment cells to inhibit tumor progression. Agathisflavone is a flavonoid studied in neurodegenerative diseases and cancer. The present study investigated the effect of flavonoid in the viability of heterogeneous glioblastoma (GBM) cells considering a coculture or conditioned medium of mesenchymal stem cells (MSCs) effect, as well as the dose-dependent effect of this flavonoid in tumor migration and differentiation via STAT3. Agathisflavone (3-10 µM) induced dose-dependent toxicity to GL-15 and U373 human GBM cells, since 24 h after treatments. It was not toxic to human MSC but modified the pattern of interaction with GBM cells. Agathisflavone also inhibited migration and increased differentiation of human GBM cells, associated with the reduction on the expression of STAT3. These results demonstrate that the flavonoid agathisflavone had a direct anti-glioma effect. However, could be observed its effect in MSCs response that may have an impact in controlling GBM growth and aggressiveness, an important factor to consider for new therapies.

Case-fatality From Orally-transmitted Acute Chagas Disease: A Systematic Review and Meta-analysis.

Orally-transmitted acute Chagas disease (CD) is emerging as an important public health problem. The prognosis of acute infection following oral transmission is unknown. The aim of this study was to analyze and summarize data on orally-transmitted acute CD. We searched for publications from 1968 to 31 January 2018. We included studies and unpublished data from government sources that reported patients with acute orally-transmitted CD. We identified 41 papers and we added 932 unpublished cases. In all, our study covered 2470 cases and occurrence of 97 deaths. Our meta-analysis estimated that the case-fatality rate was 1.0% (95% CI 0.0-4.0%). Lethality rates have declined over time (P = .02). In conclusion, orally-transmitted acute CD has considerable lethality in the first year after infection. The lethality in symptomatic cases is similar to that from other routes of infection. The lethality rate of orally-acquired disease has declined over the years.

Linear lesions in dermatology: a clinicoaetiopathological study.

BACKGROUND: Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis. AIMS: To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution. METHODS: We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis. RESULTS: Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus). CONCLUSION: Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

Blood group discrepancy in Ah para-Bombay phenotype: a rare blood group variant and its clinical significance.

Individuals with the rare para-Bombay phenotype have inherited defects in producing H associated with FUT1 and/or FUT2 genes. We report a case of blood group discrepancy in a para-Bombay patient from a tertiary care hospital of eastern India. A 31-year-old woman with rheumatic heart disease presented with fatigue and breathlessness and was then scheduled for valvuloplasty, for which a blood transfusion request was sent to the blood center. During pre-transfusion testing, red blood cell (RBC) testing showed group O, and serum testing showed strong reactivity with group B RBCs, weak reactivity with group O RBCs, and very weak reactivity with group A RBCs. Saliva inhibition testing and enzyme treatment of RBCs concluded the patient to be of "Ah para-Bombay" phenotype. The patient's Lewis phenotype was Le(a-b+). This patient's serum also had cold-reacting anti-IH along with anti-B. This case report highlights the importance of performing an advanced immunohematologic workup, including adsorption, elution, enzyme treatment, and saliva inhibition testing for identification of weak A or B subgroups as well as the rare para-Bombay blood group, when routine ABO typing, using forward and reverse grouping, is inconclusive. Accurate identification of blood group helps in preventing transfusion-related adverse events and encouraging safe transfusion practice.Individuals with the rare para-Bombay phenotype have inherited defects in producing H associated with FUT1 and/or FUT2 genes. We report a case of blood group discrepancy in a para-Bombay patient from a tertiary care hospital of eastern India. A 31-year-old woman with rheumatic heart disease presented with fatigue and breathlessness and was then scheduled for valvuloplasty, for which a blood transfusion request was sent to the blood center. During pre-transfusion testing, red blood cell (RBC) testing showed group O, and serum testing showed strong reactivity with group B RBCs, weak reactivity with group O RBCs, and very weak reactivity with group A RBCs. Saliva inhibition testing and enzyme treatment of RBCs concluded the patient to be of "Ah para-Bombay" phenotype. The patient's Lewis phenotype was Le(a­b+). This patient's serum also had cold-reacting anti-IH along with anti-B. This case report highlights the importance of performing an advanced immunohematologic workup, including adsorption, elution, enzyme treatment, and saliva inhibition testing for identification of weak A or B subgroups as well as the rare para-Bombay blood group, when routine ABO typing, using forward and reverse grouping, is inconclusive. Accurate identification of blood group helps in preventing transfusion-related adverse events and encouraging safe transfusion practice.

Spatial multicriteria approach to support water resources management with multiple sources in semi-arid areas in Brazil.

Semi-arid regions often face severe drought events that reduce agricultural and livestock production. In recent years, some international studies have used multicriteria decision analysis (MCDA) approaches combined with geographic information systems (GIS-MCDA) to support decision-makers in assessing the suitability of agricultural land for irrigation in semi-arid regions. Unlike previous studies, which have only considered a single source of water for crop irrigation, this study proposes a GIS-MCDA approach that considers all potentially available local water sources (e.g., groundwater, surface water, and wastewater) as possible alternatives for better multisource water resource management (MWRM) in regions facing water shortages. The geospatial multicriteria evaluation implemented in this study considers a series of technical, environmental, and agricultural productivity criteria using the analytical hierarchy process (AHP) method. Three independent baseline maps were generated, showing the spatial distribution of suitable areas for crop irrigation for each considered water source in the studied area. Surface water, groundwater, and wastewater offered suitable crop irrigation for 83%, 70%, and 26% of the study area, respectively. Overlapping these areas produced a final map showing all the feasible areas for each crop irrigation alternative at the same time. The MWRM approach considering all water sources increased the coverage of suitable areas to be irrigated in the study area by 2.2%, 20.4%, and more than 225% compared to considering surface water, groundwater, and wastewater, respectively, independently. The GIS-MCDA framework proposed in this study provides better support for decision-makers and stakeholders, favouring a reduction in possible conflicts over water scarcity, the diversification of irrigated crops, and an improvement in the quality-quantitative management of water resources in semi-arid regions.

Catheter-related blood stream infections: prevalence, risk factors and antimicrobial resistance pattern.

BACKGROUND: Intravascular devices have significant potential for producing iatrogenic diseases resulting in catheter-related blood stream infections (CRBSIs). A study was undertaken to find the prevalence of CRBSI among patients in acute wards and to analyze the associated risk factors, causative pathogens with their antibiotic susceptibility (ABST) patterns. METHODS: Randomly ten days per month were chosen, for a period of two years. All the acute wards patients who were on indwelling blood catheters were identified. Those fulfilling the CRBSI criteria were further worked up for confirmation of diagnosis by differential time to positivity. The catheter tip was cultured by Maki's semiquantitative method. ABST of the isolates obtained was performed by Kirby-Bauer disk diffusion method. RESULTS: The prevalence of CRBSI was found to be 39.25% with the most common organism isolate being Serratia marcescens (23.81%). The immunocompromised status of the patients and catheterisation time were significant risk factors. Methicillin resistance was found to be 33.33% in coagulase-negative staphylococci. The resistance to vancomycin among the Entercoccus faecium isolates was found to be 33.33%. Among the gram negatives, resistance to aminoglycosides, fluoroquinolones and third-generation cephalosporins was high. CONCLUSION: The study highlights the importance of regular surveillance programs, an efficient infection control program, strict adherence to antiseptic measures and use of a rational antibiotic policy for the early diagnosis and better management of CRBSI.

Waveguide design optimization for compact silicon photonic ferroelectric phase shifters.

In this paper, a new, to the best of our knowledge, design for a ferroelectric BaTiO3 cladded silicon photonic phase shifter with very small switching length for compact photonic integrated circuits (PICs) is proposed. The proposed design is based on the choice of a waveguide core with suitably slanted sidewalls in order to favor the desired polarization of ferroelectric cladding and to make guided modes spread toward the ferroelectric cladding with the consequence of further reduction in switching length compared to the conventional (rectangular core) structure. The proposed design also gives the additional benefit of having the identical switching length for both TE and TM modes with the same configuration. These results offer a viable strategy to realize compact non-volatile phase shifters for reconfigurable and programmable PICs.

Risk of Zika virus-associated birth defects in congenital confirmed cases in the Brazilian Amazon.

OBJECTIVE: To establish the risk of microcephaly in neonates born to women infected with ZIKV during pregnancy. METHODS: A cohort of laboratory-confirmed ZIKV cases of congenital infections (109 mothers infected during pregnancy and 101 newborns) among 308 suspect cases was followed in Belem, Pará, Brazil, from October 2015 to December 2017. RESULTS: A microcephaly risk of 1.98% (95% CI 0.54-6.93%) was found, or 2 cases among the 101 neonates infected with ZIKV during pregnancy. 72% of the pregnant women had ZIKV infection confirmed by RT-qPCR during gestation. CONCLUSIONS: Results showed a low incidence of ZIKV-associated birth defects, stillbirth, and miscarriage, which contrasts with previous studies in other Brazilian regions. Previous exposure to yellow fever vaccine and/or multiserotype DENV infection could be implicated in the protection from ZIKV congenital infection.

OBJETIVO: Establecer el riesgo de microcefalia en los recién nacidos de mujeres infectadas con ZIKV durante el embarazo. MÉTODOS: Se siguió a una cohorte de casos con infección congénita por ZIKV confirmada por laboratorio (109 madres infectadas durante el embarazo, 101 recién nacidos) conformada a partir de 308 casos sospechosos en Belem, Pará, Brasil, de octubre de 2015 a diciembre de 2017. RESULTADOS: Se encontró un riesgo de microcefalia de 1,98% (IC95% 0,54-6,93%), o 2 casos entre los 101 neonatos infectados con ZIKV durante el embarazo. En el 72% de las mujeres embarazadas se confirmó mediante RT-qPCR la infección por ZIKV durante la gestación. CONCLUSIONES: Los resultados mostraron una baja incidencia de malformaciones congénitas, mortinatos y abortos asociados al ZIKV, lo que contrasta con estudios anteriores de otras regiones de Brasil. La exposición previa a la vacuna contra la fiebre amarilla o la infección previa por varios serotipos de virus del dengue podrían estar implicados en la protección contra la infección congénita por ZIKV.

Evaluation of SMAP downscaled brightness temperature using SMAPEx-4/5 airborne observations.

The Soil Moisture Active and Passive (SMAP) mission, launched by the National Aeronautics and Space Administration (NASA) on 31st January 2015, was designed to provide global soil moisture every 2 to 3 days at 9 km resolution by downscaling SMAP passive microwave observations obtained at 36 km resolution using active microwave observations at 3 km resolution, and then retrieving soil moisture from the resulting 9 km brightness temperature product. This study evaluated the SMAP Active/Passive (AP) downscaling algorithm together with other resolution enhancement techniques. Airborne passive microwave observations acquired at 1 km resolution over the Murrumbidgee River catchment in south-eastern Australia during the fourth and fifth Soil Moisture Active Passive Experiments (SMAPEx-4/5) were used as reference data. The SMAPEx-4/5 data were collected in May and September 2015, respectively, and aggregated to 9 km for direct comparison with a number of available resolution-enhanced brightness temperature estimates. The results show that the SMAP AP downscaled brightness temperature had a correlation coefficient (R) of 0.84 and Root-Mean-Squared Error (RMSE) of ~10 K, while SMAP Enhanced, Nearest Neighbour, Weighted Average, and the Smoothing Filter-based Modulation (SFIM) brightness temperature estimates had somewhat better performance (RMSEs of ~7 K and an R exceeding 0.9). Although the SFIM had the lowest unbiased RMSE of ~6 K, the effect of cloud cover on Ka-band observations limits data availability.

Graphene-Anchored p-Type CuBO2 Nanocrystals for a Transparent Cold Cathode.

CuBO2 nanostructures were synthesized by employing a low-cost hydrothermal technique to combine into the CuBO2-RGO nanocomposite for the first time using chemically prepared graphene sheets. The nanohybrid samples were characterized for structural information using X-ray diffraction (XRD) that revealed the proper crystalline phase formation of CuBO2 unaltered by composite formation with graphene. Raman spectroscopic studies were employed to confirm the presence of graphene. A morphological study with field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM) suggested the proper wrapping of RGO sheets over CuBO2 nanocubes. Moreover, the close proximity of lattice planes of CuBO2 and RGO to each other was observed in high-resolution TEM studies that were correlated with the Raman spectroscopic studies. Finally, the samples were characterized to study the field emission (FE) properties of the same using a laboratory-made high-vacuum field-emission setup. Finite-element-based theoretical simulation studies were carried out to explain and compare the field emission properties with the experimental results. The FE properties of the composite samples were found to be tuned by the nature of wrapping the RGO sheets over the CuBO2 nanocubes, which was typically dependent upon the spiky morphology of the nanocubes.

Joint Sentinel-1 and SMAP data assimilation to improve soil moisture estimates.

SMAP (Soil Moisture Active and Passive) radiometer observations at ~40 km resolution are routinely assimilated into the NASA Catchment Land Surface Model to generate the 9-km SMAP Level-4 Soil Moisture product. This study demonstrates that adding high-resolution radar observations from Sentinel-1 to the SMAP assimilation can increase the spatio-temporal accuracy of soil moisture estimates. Radar observations were assimilated either separately from or simultaneously with radiometer observations. Assimilation impact was assessed by comparing 3-hourly, 9-km surface and root-zone soil moisture simulations with in situ measurements from 9-km SMAP core validation sites and sparse networks, from May 2015 to December 2016. The Sentinel-1 assimilation consistently improved surface soil moisture, whereas root-zone impacts were mostly neutral. Relatively larger improvements were obtained from SMAP assimilation. The joint assimilation of SMAP and Sentinel-1 observations performed best, demonstrating the complementary value of radar and radiometer observations.

Surgical morbidity and clinical outcomes in ovarian cancer - the role of obesity.

OBJECTIVE: To evaluate the effect of body mass index on the surgical outcomes in ovarian cancer patients. In addition, we performed a systematic review to compare our outcomes with the current literature. DESIGN: Retrospective cohort study and a systematic review of the literature. SETTING: Gynaecology department at the Royal Cornwall Hospital Trust. POPULATION: Surgically managed stage I-IV ovarian cancer patients between September 2006 and September 2014. METHODS: Primary and secondary outcome measures were evaluated across BMI categories; BMI <25 kg/m², BMI 25­29.9 kg/m², BMI ≥30 kg/m² and BMI ≥40 kg/m². A systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. MAIN OUTCOME MEASURES: The primary outcome measure was surgical complications. Secondary outcome measures were other intra- and postoperative outcomes. RESULTS: Two hundred twenty-eight women were included in the study, of which 84 had a BMI <25 kg/m², 84 women had a BMI 25­29.9 kg/m², and 60 women were obese (BMI ≥30 kg/m²), 13 of whom were morbidly obese. Morbid obesity was associated with increased rates of wound complications. However, BMI did not show an association with other outcomes. In the review, an increasing BMI was associated with increased rates of wound complications and prolonged hospital stay, but did not impact other surgical outcomes. CONCLUSION: Obesity is associated with increased rates of wound complications and a prolonged hospital stay, but does not appear to affect other operative outcomes including cytoreduction status and 30-day mortality. Therefore, operative management and postoperative care require a multifactorial approach to minimise adverse outcomes.

Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study.

OBJECTIVE: To explore the impact of risk-adjustment on surgical complication rates (CRs) for benchmarking gynaecological oncology centres. DESIGN: Prospective cohort study. SETTING: Ten UK accredited gynaecological oncology centres. POPULATION: Women undergoing major surgery on a gynaecological oncology operating list. METHODS: Patient co-morbidity, surgical procedures and intra-operative (IntraOp) complications were recorded contemporaneously by surgeons for 2948 major surgical procedures. Postoperative (PostOp) complications were collected from hospitals and patients. Risk-prediction models for IntraOp and PostOp complications were created using penalised (lasso) logistic regression using over 30 potential patient/surgical risk factors. MAIN OUTCOME MEASURES: Observed and risk-adjusted IntraOp and PostOp CRs for individual hospitals were calculated. Benchmarking using colour-coded funnel plots and observed-to-expected ratios was undertaken. RESULTS: Overall, IntraOp CR was 4.7% (95% CI 4.0-5.6) and PostOp CR was 25.7% (95% CI 23.7-28.2). The observed CRs for all hospitals were under the upper 95% control limit for both IntraOp and PostOp funnel plots. Risk-adjustment and use of observed-to-expected ratio resulted in one hospital moving to the >95-98% CI (red) band for IntraOp CRs. Use of only hospital-reported data for PostOp CRs would have resulted in one hospital being unfairly allocated to the red band. There was little concordance between IntraOp and PostOp CRs. CONCLUSION: The funnel plots and overall IntraOp (≈5%) and PostOp (≈26%) CRs could be used for benchmarking gynaecological oncology centres. Hospital benchmarking using risk-adjusted CRs allows fairer institutional comparison. IntraOp and PostOp CRs are best assessed separately. As hospital under-reporting is common for postoperative complications, use of patient-reported outcomes is important. TWEETABLE ABSTRACT: Risk-adjusted benchmarking of surgical complications for ten UK gynaecological oncology centres allows fairer comparison.

Netting the malaria menace: Distribution and utilization of long-lasting insecticidal net in a malaria endemic area in Bankura, West Bengal.

BACKGROUND & OBJECTIVES: Long-lasting insecticidal net (LLIN) is considered to be a highly effective intervention against malaria under National Vector Borne Disease Control Programme in India. A cross-sectional study was undertaken to assess the coverage and utilization of LLIN and the factors related thereto. METHODS: A survey of 1300 households was carried out in Ranibandh block of Bankura district in West Bengal, India, using lot quality assurance sampling (LQAS) method. Coverage/utilization of 80% was considered as minimum acceptable norm. The weighted sample size was calculated from each village of the block. The sociodemographic, economic information of the household along with the availability and use of LLIN was collected through interview and observation. RESULTS: In total, 7320 individuals including 840 children ≤ 5 yr were visited. Overall coverage of adequate LLIN was 65.4% (± 1.5%) and for children ≤ 5 yr, it was 60.5% (± 1.3%). Overall, 66.1% (± 1.4%) people of all ages and 63.7% (± 1.4%) children ≤ 5 yr slept under LLINs in the night before the survey. Out of 26 sub-centres, distribution of LLINs in 10 sub-centres was below the accepted norm, whereas utilization was sub-optimal in 19 sub-centres. In only 18.2% (± 0.5%) households, LLINs remained hanging during daytime. Poverty, caste, education, perception regarding malarial morbidity and preventive action of LLIN were associated significantly with the distribution of LLIN. Similarly, poverty (AOR = 2.14), threat perception regarding malarial morbidity (AOR = 1.51) and mortality (AOR = 2.52) were positively associated with the use of LLIN. Full utilization of bednets by under-fives of the households was higher in villages with sub-centres. INTERPRETATION & CONCLUSION: Around two-third population of the study area was effectively covered with LLIN. Higher proportion of socially marginalized people received LLIN. Threat perception regarding malaria was directly associated with both receipt and use of LLIN. Behaviour change communication on utilization along with adequate access to LLIN needs to be strengthened.

Drug sensitivity pattern of various Staphylococcus species isolated at a tertiary care hospital.

BACKGROUND: Staphylococcus aureus and other Staphylococcus species are important pathogenic organisms and are responsible for various hospital infections. These are the predominant organisms found in pus and blood culture isolates. Infections arising due to these bacterial isolates are difficult to treat because of developing multidrug resistance. METHODS: Over a 1-year period at a tertiary care hospital laboratory, 524 Staphylococci species were isolated from pus, blood and urine samples and species-level identification was done. RESULTS: S. aureus formed the predominant species (70.8%) followed by coagulase-negative Staphylococcus (CoNS) (29.20%). S. aureus (91%) was the main isolate from pus samples; however, CoNS was isolated in equally higher proportion in blood culture (63.58%). Among the CoNS, Staphylococcus hemolyticus was the main isolate (9.3%). ß-Lactamase production, alteration of PBP and MLSB resistance were seen in variable degrees in different species. CONCLUSION: CoNS group of Staphylococci is becoming an important cause of infection at tertiary care centres. The increased multidrug resistance among various Staphylococcus species is a cause of great concern and requires adequate measures to prevent the spread of these microorganisms in the hospital and the community.

Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications).

BACKGROUND: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. METHODS: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. RESULTS: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). CONCLUSIONS: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding.

BACKGROUND: Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. METHODS: 100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed. RESULTS: Menorrhagia was the commonest presenting symptom in the study population (n = 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898). CONCLUSION: TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.

Leucocyte complement receptor 1 (CR1/CD35) transcript and its correlation with the clinical disease activity in rheumatoid arthritis patients.

In view of the exaggerated complement activation in rheumatoid arthritis (RA) and significance of complement receptor 1 (CR1/CD35) as a complement regulatory protein (CRP), we aimed to determine the leucocyte-complement receptor 1 (L-CR1) transcript levels and the relationship of this protein with the clinical disease activity of RA patients. Sixty-six controls and 45 RA patients were enrolled. L-CR1 transcript levels were correlated with the levels of circulating immune complexes (CIC), C3, C4 and C3d in controls and patients and with disease activity score 28 (DAS28) in patients only. CIC levels were determined by polyethylene glycol (PEG) precipitation, C3 and C4 levels by nephlometry and C3d levels by enzyme-linked immunosorbent assay (ELISA). Eleven patients were recruited for follow-up of L-CR1 and DAS28 levels at weeks 0, 12 and 24. Appropriate statistical methods were used for the data analysis. L-CR1 (P < 0·01) transcript levels were decreased in patients compared to controls. L-CR1 levels correlated negatively with DAS28, CIC and C3d. DAS28 correlated positively with levels of CIC, C3 and C3d. Levels of CIC correlated positively with C3 and C3d. Levels of C3 correlated positively with C3d in patients and with C4 in both controls and patients. Levels of L-CR1 increased with decline in DAS28 scores in follow-up patients. Observations were statistically significant. Lower levels of L-CR1 transcript in patients compared to controls, their correlations with the levels of CIC, C3d and DAS28 at different time-points in RA patients suggest CR1 as a potential disease marker for RA.

Quantitative Mueller matrix fluorescence spectroscopy for precancer detection.

Quantitative fluorescence spectroscopic Mueller matrix measurements from the connective tissue regions of human cervical tissue reveal intriguing fluorescence diattenuation and polarizance effects. Interestingly, the estimated fluorescence linear diattenuation and polarizance parameters were considerably reduced in the precancerous tissues as compared to the normal ones. These polarimetry effects of the autofluorescence were found to originate from anisotropically organized collagen molecular structures present in the connective tissues. Consequently, the reduction of the magnitude of these polarimetric parameters at higher grades of precancer was attributed to the loss of anisotropic organization of collagen, which was also confirmed by control experiments. These results indicate that fluorescence spectral diattenuation and polarizance parameters may serve as potentially useful diagnostic metrics.