Improving quality of intrapartum and immediate postpartum care in public facilities: experiences and lessons learned from Rajasthan state, India.

BACKGROUND: In spite of considerable improvement in maternal and neonatal outcomes over the past decade in India, the current maternal mortality ratio and neonatal mortality rate are far from the Sustainable Development Goal targets due to suboptimal quality of maternity care. A package of interventions for improving quality of intrapartum and immediate postpartum care was co-designed with the Ministry of Health as the Dakshata program and implemented in public sector health facilities in selected districts in the state of Rajasthan of India since June 2015. This article describes the key strategies, interventions, results and challenges from four years of Dakshata program implementation. METHODS: We have conducted secondary analysis of program data (government data) collected from 202 public facilities across 20 districts of Rajasthan state. The data collected between June-August 2015 (baseline) and the data collected between May-August 2019 (latest) were analyzed. The data sources included: facility assessments, service statistics, monthly progress reports. RESULTS: During the period of program implementation, there were 17,94,249 deliveries accounting for 70% of institutional deliveries in intervention districts. As a result of the intervention, there was a notable increase in competency of health care providers, availability of essential resources, achievement of labour room standards and adherence to evidence-based clinical standards. We also observed reductions in the proportion of referrals for pre-eclampsia/eclampsia, postpartum hemorrhage and neonatal asphyxia by 11, 8 and 3 percentage points respectively. Similarly, data revealed a reduction in stillbirth rates in Dakshata intervention facilities (19.3 vs 15.3) compared to non-Dakshata facilities (21.8 vs 18). CONCLUSIONS: Our experience and findings indicate that the quality of intrapartum and immediate postpartum care can be improved in low- and middle-income countries with the approach presented in this paper.

The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India.

BACKGROUND: Computerized clinical decision support (CDSS) -digital information systems designed to improve clinical decision making by providers - is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. METHODS: We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August -October 2017 (baseline) and the data collected between December 2019 - March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. RESULTS: The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. CONCLUSIONS: Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

Possible Novel Treatment Modality for Non Ossifying Fibroma Neck of Femur.

Nonossifying fibromas (NOFs) are benign bone tumors occurring in the second decade of life. Most of the NOFs are diagnosed incidentally on the basis of its presentation on plain radiographs where they typically appear as small, cortical osteolytic lesions with sclerotic margin. They are mostly asymptomatic but can result in pathologic fractures if the lesion involves more than 50% of bone diameter. They are mostly treated with curettage and bone grafting. But in challenging situations where the classical surgery has failed or there is impending fracture of the neck of femur, bone structural support is needed. We are discussing two cases diagnosed as NOFs of intracapsular femoral neck. Both cases underwent curettage of tumor followed by free vascularized fibular graft. Results in both the cases were very gratifying, with complete resolution of symptoms during 1 year of follow-up.

Ophthalmic considerations in pregnancy.

The eyes are our window to the world and offer us an island of vision in the sea of darkness. Equally, the eyes are also a window to peep into what is going on in the milieu interior. Pregnancy is a natural state of physiological stress for the body. Each organ system of the body in a pregnant lady behaves at variation than in a non-pregnant state. A complex interplay exists between how the pregnancy affects the eye and how ocular physiology and pathology may lead to the modification of the management of pregnancy. Added to this is the effect of systemic conditions on the eye which gets modified by pregnancy. An awareness of the interaction of Ophthalmology and Obstetrics for the benefit of the mother and the child requires a basic understanding of these complex interactions. This article aims at presenting to the reader in a simplified and organized manner the common ophthalmic issues encountered in a pregnant woman, their management and the effect of various ophthalmic medication on the fetus.

A bird's eye review of recent reports on 1,3,4-oxadiazoles' anti-inflammatory insights perspectives.

Anti-inflammatory agents suppress inflammatory mediators such as prostaglandins, prostacyclins, cytokines, thromboxane, histamine, bradykinins, COX-I and COX-II, 5-LOX, and other substances. These inflammatory chemicals create inflammatory responses when tissue is injured by trauma, bacteria, heat, toxins, or other factors. These inflammatory reactions may result in fluid flow from the blood vessels into the tissues, resulting in swelling. When the therapeutic importance of these clinically beneficial medications in treating inflammation was recognized, it spurred the invention of even more powerful and important molecules. Oxadiazole derivatives are exceptionally potent NSAIDs, and they are widely used. Comprehensive biochemical, structure-activity-relationship and pharmacological investigations have demonstrated that these 1,3,4-oxadiazole compounds exhibit anti-inflammatory properties. This review article outlines the synthesis scheme for 1,3,4-oxadiazole used in treating inflammation.

Recent Advancement in Synthesis and Bioactivities of 1,3,4-Oxadiazole.

Derivatives of 1,3,4-oxadiazole are effective in the treatment and cure of a wide range of diseases in medical chemistry, while industrial development has shown that they can be utilised as corrosion inhibitors and light-emitting diodes. The researchers discovered several promising synthetic strategies that created 1,3,4-oxadiazoles in extraordinarily high yields while using environmentally friendly methods. These compounds can potentially be used in a wide range of lifechanging applications. Stable isomeric oxadiazole forms of pleconaril, raltegravir, butalamine, fasiplon, oxolamine, and several other drugs are among the numerous potent and effective pharmaceuticals that are now on the market. Fasiplon, butalamine, raltegravir, and pleconaril treat HIV/AIDS patients. This article has attempted to bring attention to the chemistry and pharmacology of oxadiazole and its derivatives. Oxadiazole derivatives have been used extensively as prospective therapeutic agents in clinical research, and this has become standard practice. The use of biological and in-silico models has enabled scientists to identify more synthetic analogues of cancer prevention, antifungal, and anti-HIV medications. This article provides recent information regarding procedures for synthesizing 1,3,4-oxadiazoles and their biological actions on the body.

Anti-Inflammatory and Antimicrobial Potential of 1, 3, 4-Oxadiazoles and its Derivatives: A Review.

1, 3, 4-oxadiazole and its derivatives have significant anti-inflammatory and antimicrobial property. Their precise mechanism of action is not known but it is postulated that they act by inhibiting the biosynthesis of certain prostaglandins. 1, 3, 4-oxadiazoles are a class of heterocyclic compounds with wide variety of biological and pharmacological activities. They have been reported to possess analgesic, antimicrobial, antipyretic and anti-inflammatory properties. These compounds are also active against a number of other inflammatory conditions such as arthritis, gout etc. A wide variety of these compounds have been synthesized and some of them are under clinical trials. In this review article, anti-inflammatory and antimicrobial activity of the 1, 3, 4- oxadiazole shall be discussed.

A Review on Novel Synthesis Approaches and Biological Activities of 1,2,4- Oxadiazole and 1,3,4-Oxadiazole Tailored Compounds.

Rational design and synthesis of novel compounds with both effectivity and safety properties have always been a formidable task in the development of drugs. Oxadiazoles are heterocyclic bioscaffolds occurring as motifs in drug-like molecules. This review article highlights comprehensive and systematic information of compounds containing 1,2,4-oxadiazoles and 1,3,4-oxadiazole rings. The routes for the synthesis of the oxadiazoles have also been discussed, along with their biological significance. This review may help researchers in rational design for the development of effective and less toxic 1,3,4- oxadiazole based compounds. We present an informative review about the drugs derived from oxadiazole rings and their therapeutic application as well as a brief remark on the future development prospects.

A comparison of immediate postoperative complications in using left internal mammary artery + vein versus only vein as conduit in patients undergoing off-pump coronary artery bypass grafting.

Objective: The objective of the study is to compare the immediate postoperative cardiac complications in patients undergoing off-pump coronary artery bypass grafting (OPCABG) using mixed (arterial and venous grafts) versus only venous grafts and to compare the requirement of packed red cell units and intra-aortic balloon pump (IABP) in both the groups. Materials and Methods: This was an observational, analytical, prospective study. Sample Size: Fifty new patients were included in the study. Inclusion/Exclusion Criteria: Patients diagnosed with triple-vessel coronary artery disease (CAD) undergoing OPCABG with an ejection fraction (EF) of more than 30%. Patients who have undergone prior CABG, EF <30%, preexisting valvular heart disease, any evidence pulmonary hypertension, preoperative IABP, any history of neurological dysfunction, left atrium size more than 5.5 cm, and history of coagulation disorder was excluded from the study. Results: The most common immediate postoperative cardiac complication observed was atrial fibrillation followed by ventricular arrhythmias in both the groups. There was no statistically significant difference in complication rate between the two groups. Postoperative requirement of IABP and requirements of blood products were also similar in both the groups. Conclusion: Patients undergoing off-pump CABG have similar immediate postoperative complications irrespective of the type of conduit used.