Determinants of Conception and Adverse Pregnancy Outcomes in Women with Endometriosis: A Longitudinal Study.

Endometriosis, affecting approximately 10% of reproductive-aged women globally, poses significant challenges, including chronic pelvic pain, dysmenorrhea, and infertility. In low- and middle-income countries like India, accessibility to affordable infertility care remains a concern. This multicenter prospective cohort study, conducted across six tertiary care hospitals in India from 2017 to 2022, aims to explore the natural progression of conception and pregnancy outcomes in women with endometriosis. Of the 257 participants, 19.1% conceived during the study, revealing significant geographic and income-based variations (p < 0.001, p = 0.01). Dysmenorrhea (p < 0.001) and dyspareunia (p=0.027) were correlated with conception, while no such associations were found with chronic pelvic pain or menstrual factors. Lesion type, number, and severity showed no conclusive link with conception. Natural conception occurred in 70% of cases, with an average post-surgery conception time of 282.1 days. Live birth rate was 85.7%, while complications included placenta previa (16.4%), preeclampsia (4.1%), and preterm births (4.1%). This study, one of the first in India on endometriosis-related fertility progression, emphasizes the need for comprehensive understanding and management of conception and pregnancy outcomes. Considering India's substantial endometriosis burden, the study recommends prioritizing larger multicenter investigations for a better understanding and effective strategies for infertility management.

Evaluating the Effect of Claytone-EM on the Performance of Oil-Based Drilling Fluids.

This study provides a detailed characterization and evaluation of Claytone-EM as a rheological additive to enhance the performance of oil-based drilling fluids (OBDFs) under high-pressure, high-temperature (HPHT) conditions. It also offers a comparative evaluation of the effectiveness of Claytone-EM with an existing organoclay, analyzing their mineral and chemical compositions, morphologies, and particle sizes. A series of experiments are performed to evaluate Claytone-EM's influence on crucial drilling mud properties, such as mud density, electrical stability, sagging tendency, rheology, viscoelastic properties, and filtration properties, to formulate a stable and high-performing OBDF. Results indicated that Claytone-EM had no significant impact on mud density but remarkably enhanced emulsion stability. Claytone-EM effectively mitigated sagging issues under both static and dynamic conditions, leading to improvements in the plastic viscosity (PV), yield point (YP), apparent viscosity (AV), and YP/PV ratio. The PV, YP, AV, and YP/PV ratios were improved by 11, 85, 28, and 66% increments, respectively, compared with those of the drilling fluid formulated with MC-TONE. The addition of Claytone-EM resulted in enhancing gel strength and improving the filtration properties of the drilling fluid. The filtration volume was reduced by 2% from 5.0 to 4.9 cm3, and the filter cake thickness had a 13% reduction from 2.60 to 2.26 mm. These findings highlight Claytone-EM as a valuable additive for enhancing OBDF performance, particularly under challenging HPHT conditions. Its ability to provide emulsion stability, reduce static and dynamic sag, and control filtration holds the potential to enhance drilling operations, minimize downtime, and bolster wellbore stability. This study acknowledges certain limitations, including its temperature range, which could benefit from exploration at extreme temperatures. Additionally, the absence of flow experiments limits a comprehensive understanding of sag effects, and further research and field-scale evaluations are recommended to validate and optimize the application of Claytone-EM in OBDFs.

Investigating the efficacy of novel organoclay as a rheological additive for enhancing the performance of oil-based drilling fluids.

Oil-based drilling fluids (OBDFs) are extensively used in the drilling industry due to their superior performance in challenging drilling conditions. These fluids control wellbore stability, lubricate the drill bit, and transport drill cuttings to the surface. One important component of oil-based drilling fluids is the viscosifier, which provides rheological properties to enhance drilling operations. This study evaluates the effectiveness of Claytone-IMG 400, a novel rheological agent, in enhancing the performance of OBDFs under high-pressure and high-temperature (HPHT) conditions. A comparative analysis was conducted with a pre-existing organoclay (OC) to assess the improvements achieved by Claytone-IMG 400. The OCs were analyzed using X-ray diffraction (XRD), X-ray fluorescence (XRF), scanning electron microscopy (SEM), and particle size distribution (PSD) to identify their mineral and chemical compositions, morphologies, and particle sizes. The drilling fluid density, electrical stability, sagging tendency, rheological properties, viscoelastic properties, and filtration properties were studied to formulate a stable and high-performance drilling fluid. The results confirmed that the novel OC does not affect the drilling fluid density but enhances the emulsion stability with a 9% increment compared with the drilling fluid formulated with MC-TONE. The sagging experiments showed that Claytone-IMG 400 prevented the sagging issues in both static and dynamic conditions. Also, Claytone-IMG 400 improved the plastic viscosity (PV), yield point (YP), and apparent viscosity (AV). The PV, YP, and AV were improved by 30%, 38%, and 33% increments respectively compared with the drilling fluid formulated with MC-TONE. The YP/PV ratio increased with a 6% increment from 1.12 to 1.19. Moreover, the gel strength (GS) was significantly increased, and the filtration properties were enhanced. The filtration volume was reduced by 10% from 5.0 to 4.5 cm3, and the filter cake thickness had a 37.5% reduction from 2.60 to 1.89 mm. The novelty of this study is highlighted by the introduction and evaluation of Claytone-IMG 400 as a new rheological additive for safe, efficient, and cost-effective drilling operations. The results indicate that Claytone-IMG 400 significantly improves the stability and performance of OBDFs, thereby reducing wellbore instability and drilling-related problems.

Optimizing jet pump efficiency via drag reducing polymers and enhanced efficiency definitions.

Liquid jet pumps are widely used in various industrial applications for fluid mixing, circulation, and transport. The efficiency and performance of liquid jet pumps play a crucial role in determining their overall effectiveness and economic viability. The performance of liquid jet pumps is primarily affected by parameters such as motive fluid pressure, nozzle design, and entrainment ratio. Liquid jet pumps exhibit a notable drawback in terms of comparatively lower efficiency when compared to alternative pump types. The reduced overall efficiency of liquid jet pumps stems primarily from energy dissipation incurred during the entrainment process. To address this obstacle, a water-water loop system was implemented in conjunction with a liquid jet pump, followed by the introduction of drag-reducing polymers (DRPs) into the suction flow of the liquid jet pump using a specific configuration. This configuration led to a significant reduction in drag within the liquid jet pump, raising its efficiency in some cases from 13.8% to 26.7% with a drag reduction of 46%, subsequently improving its overall performance. The resulting enhancement was evaluated using various efficiency models documented in the existing literature to comprehensively assess the overall performance of the liquid jet pump. A new interpretation of jet pump efficiency has been shared, along with a comparison of the various efficiencies.

A network pharmacology, molecular docking and in vitro investigation of Picrorhiza kurroa extract for the treatment of diabetic nephropathy.

Picrorhiza kurroa Royle ex Benth. (P. kurroa/PK/Kutki), a Himalayan herb belonging to the family Scrophulariaceae, is widely known for its hepatoprotective activity. Traditionally, it is found to be effective for upper respiratory tract disorders, kidney and liver problems, dyspepsia and chronic diarrhoea but the mechanism of action is unclear. In this study, the mode of action of P. kurroa for the treatment of diabetic nephropathy (DN) was investigated by network pharmacology, molecular docking and in vitro assays. Numerous databases have been screened and 33 P. kurroa bioactive compounds and 56 targets were identified. The compounds-targets network, targets-pathways network and compounds-targets-pathways network were constructed. The major bioactive compounds include picrorhizaoside D, scrophuloside A, vanillic acid, arvenin I, cinnamic acid, picein, 6-feruloyl catalpol, picroside V, pikuroside, apocynin, picroside I, picroside IV, androsin, cucurbitacin P, boschnaloside, kutkoside, cucurbitacin O, cucurbitacin K, picracin, etc. The potential protein targets identified in this study were MMP1, PRKCA, MMP7, IL18, IL1, TNF, ACE, ASC, CASP1, NLRP3, MAP, KURROA1, mitogen-activated protein kinase (MAPK)14 and MAPK8. In the Database for annotation visualization and integrated discovery (DAVID) pathways and Gene Ontology enrichment analysis, 14 major DN signalling pathways were identified, including MAPK, renin-angiotensin system (RAS), TNF, signal transducer and activator of transcription (JAK-STAT), TLR, vascular endothelial growth factor (VEGF), mTOR, Wnt, Ras, PPARs, NFB, NOD and phosphatidylinositol signalling pathways. A molecular docking study revealed that 32 bioactive compounds of P. kurroa interacted with 14 significant proteins/genes associated with DN. P. kurroa extract was proven to enhance the survival rate of HEK cells significantly. Protein expression analysis using Western blot demonstrated that P. kurroa extract significantly altered the expression of p47phox, p67phox, gp91phox, IL-1 and TGFß-1. As a result of network pharmacology and docking work, new concepts for discovering bioactive compounds and effective modes of action could be developed. The potential effect of P. kurroa extract on DN disease was evident in the in-vitro studies aided by network pharmacology and molecular docking.Communicated by Ramaswamy H. Sarma.

Prioritizing the Health and Well-Being of the Indigenous Communities in India.

The International Day of the World's Indigenous Peoples and the Tribal Pride Day hold significant importance in India, home to 106 million indigenous individuals. There are 705 recognized Scheduled Tribes (STs) in India that enrich the nation's cultural fabric but experience disproportionately high morbidity and mortality. Historical injustice, geographic isolation, and cultural diversity deeply influence ST health causing disparities between indigenous and non-indigenous health indicators. To meet Sustainable Development Goals, India established the Ministry of Tribal Affairs and implemented various health initiatives. However, climate change, deforestation, limited education and employment opportunities, poverty, and under-representation pose a challenge. Empowerment, inclusive policies, community-specific targets, resource allocation, technology utilization, and multi-sectoral collaboration are vital for indigenous health. Achieving health equity for indigenous communities is a global commitment and moral imperative. By addressing historical wrongs, and working holistically, we must ensure that indigenous communities in India and beyond enjoy improved health and well-being.

Novel Environmentally Friendly Nanomaterials for Drag Reduction of the Emulsified Acid System.

Matrix acidizing is a technique that is widely used in the petroleum industry to remove scales and create channels in the rock. Removal of scales and creation of channels (wormhole) enhance productivity. Conventional acidizing fluids, such as hydrochloric acid (HCl) for carbonate and a mixture of hydrofluoric acid (HF) and HCl acid, are used for the matrix acidizing process. However, these fluids have some drawbacks, including strong acid strength, corrosion at high temperatures, and quick reactions with scale and particles. Emulsified acid systems (EASs) are used to address these drawbacks. EASs can create deeper and narrower wormholes by reducing the reaction rate of the acid due to the external oil phase. However, EASs have a much higher viscosity compared to conventional acidizing fluids. The high viscosity of EASs leads to a high drag that restricts pumping rates and consumes energy. This study aims to utilize environmentally friendly and widely available nanomaterials as drag-reducing agents (DRAs) of the EAS. The nanomaterials used in this study are carbon nanodots (CNDs). CNDs have unique properties and are used in diverse applications in different industries. The size of these CNDs is usually smaller than 10 nm. CNDs are characterized by their biocompatibility and chemical stability. This study investigates the use of CNDs as DRAs for EAS. Several experiments have been conducted to investigate the CNDs as a DRA for the EAS. The developed EAS was initially tested for conductivity and drop-test analysis to ensure the formation of an inverted emulsion. Thereafter, the thermal stability for the range of temperatures and the rheological properties of the EAS were evaluated to meet the criteria of field operation. Then flow experiments with EASs were conducted before and after adding the CNDs to investigate the efficacy of drag reduction of EASs. The results revealed that CNDs can be used as viscosity reducers for the EAS, where adding the CNDs to the EAS reduces the viscosity at two different HCl concentrations (15 and 20%). It reduces the viscosity of the EAS in the presence of corrosion inhibitors as well as other additives to the EAS, showing its compatibility with the field formulation. The drag reduction was observed at the range of temperatures investigated in the study. The conductivity, stability, and rheology experiments for the sample taken after the flow experiment are consistent, ensuring CNDs work as a DRA. The developed EAS with CNDs is robust in terms of field mixing procedures and thermally stable. The CNDs can be used as a DRA with EAS, which will reduce drag in pipes, increasing pumping rates and saving energy.

Empowering Health care Systems and Communities for Snakebite Envenoming Control in India.

Snakebite envenoming (SBE) is a global health challenge, predominantly affecting economically disadvantaged regions. India contributes significantly to global snakebite mortality. Since 2013, the Indian Council of Medical Research (ICMR) has spearheaded efforts to combat SBE. A multi-sectoral engagement in the snakebite research projects and inputs from communities, traditional healers, and the health system have led to the creation of an Information Education and Communication (IEC) material suite, including management flowchart, information booklets, posters, and brochures, all available in local languages. These resources were broadly disseminated in high-burden regions in Maharashtra and Odisha, resulting in an approximately 10% increase in case reporting within a year. This holistic approach, engaging diverse stakeholders and addressing multiple facets of SBE, offers promise for alleviating the snakebite burden, not only in India but also in other low- and middle-income countries across South Asia, Africa, and South America, holding potential for broader positive global impact.

Application of Organoclays in Oil-Based Drilling Fluids: A Review.

Organoclays (OCs), formed by surface modification of clay minerals using organic compounds, are typical additives for providing rheology for oil-based drilling fluids (OBDFs). There are different studies on the effect of OCs on the rheological properties of oil-based systems under high-pressure, high-temperature (HPHT) conditions, but finding new OCs as rheology control agents is attractive for drilling fluid engineers. This work reviews different OCs used in OBDFs, namely, organo-montmorillonite (OMMT), organo-sepiolite (OSEP), and organo-palygorskite (OPAL). Furthermore, the structure of OCs in OBDFs, their rheological properties, and the thermal stability of OCs were investigated. Besides, the role of fibrous and layered OCs in enhancing the rheological properties of OBDFs is illustrated. Finally, the synergistic use of different OCs to enhance the thermal stability and rheological properties of the OBDFs is presented. The study highlights research gaps and recommendations for research approaches and potential areas that need further investigation. The application of OCs in OBDFs is a wide field and has huge potential to be developed. The use of OCs in OBDFs will promote development in the oil and gas industry.

Pregnancy outcomes among Indian women: increased prevalence of miscarriage and stillbirth during 2015-2021.

BACKGROUND: Pregnancy outcome is an important health indicator of the quality of maternal health. Adverse pregnancy outcomes is a major public health problem, which can lead to poor maternal and neonatal outcomes. This study investigates the trends in pregnancy outcomes prevalent during 2015-2021 in Indian women. METHODS: The study analysed the data presented in the fourth (2015-16) and fifth (2019-21) rounds of National Family Health Survey (NFHS). The absolute and relative changes in the birth outcomes of last pregnancy during the five years preceding the surveys were estimated using data collected from 195,470 women in NFHS-4 and from 255,549 women in NFHS-5. RESULTS: Livebirth decreased by 1.3 points (90.2% vs. 88.9%), and nearly half of the Indian states/UTs (n = 17/36) had lower than the national average of livebirth (88.9%) reported during 2019-21. A higher proportion of pregnancy loss was noted, particularly miscarriages increased in both urban (6.4% vs. 8.5%) and rural areas (5.3% vs. 6.9%), and stillbirth increased by 28.6% (0.7% vs. 0.9%). The number of abortions decreased (3.4% vs. 2.9%) among Indian women. Nearly half of the abortions were due to unplanned pregnancies (47.6%) and more than one-fourth (26.9%) of abortions were performed by self. Abortions among adolescent women in Telangana was eleven times higher during 2019-21 as compared to 2015-16 (8.0% vs. 0.7%). CONCLUSION: Our study presents evidence of a decrease in the livebirth and an increase in the frequency of miscarriage and stillbirth among Indian women during 2015-2021. This study emphasises that there is a need of regional-specific, comprehensive and quality maternal healthcare programs for improving livebirth among Indian women.

Increased risk of early-onset preeclampsia in pregnant women with COVID-19.

OBJECTIVE: To estimate incidence, risk of early and late-onset preeclampsia (PE) and understand their relationship with severity of COVID-19. METHODS: Pregnant women with COVID-19 (n = 1929) were enrolled from 1 April 2020 to 24 February 2022. Primary outcome measure was incidence and risk of early onset PE in women with COVID-19. RESULTS: The incidence of early and late-onset PE was 11.4% and 5.6%. Moderate to severe COVID-19 was associated with eight times higher risk of early onset PE [aOR = 8.13 (1.56-42.46), p = 0.0129] compared to asymptomatic group. CONCLUSIONS: Risk of early onset PE was higher in pregnant women with symptomatic COVID-19 as compared to asymptomatic women.

National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: A study protocol.

BACKGROUND: Snakebite envenoming (SBE) is an acute, life-threatening emergency in tropical and subtropical countries. It is an occupational hazard and a major socioeconomic determinant. Limited awareness, superstitions, lack of trained health providers, poor utilization of anti-venom results in high mortality and morbidity. India is the snakebite capital of the world. Yet, information on awareness, knowledge, and perceptions about snakebite is limited. Data on capacity building of health systems and its potential impact is lacking. Recommended by the National Task Force on snakebite research in India, this protocol describes the National Snakebite Project aiming for capacity building of health systems on prevention and management of snakebite envenomation in Maharashtra and Odisha states. METHODS: A cross-sectional, multi-centric study will be carried out in Shahapur, Aheri blocks of Maharashtra, and Khordha, Kasipur blocks of Odisha. The study has five phases: Phase I involves the collection of retrospective baseline data of snakebites, facility surveys, and community focus group discussions (FGDs). Phase II involves developing and implementing educational intervention programs for the community. Phase III will assess the knowledge and practices of the healthcare providers on snakebite management followed by their training in Phase IV. Phase V will evaluate the impact of the interventions on the community and healthcare system through FGDs and comparison of prospective and baseline data. DISCUSSION: The National Snakebite Project will use a multi-sectoral approach to reduce the burden of SBE. It intends to contribute to community empowerment and capacity building of the public healthcare system on the prevention and management of SBE. The results could be useful for upscaling to other Indian states, South Asia and other tropical countries. The findings of the study will provide critical regional inputs for the revision of the National Snakebite Treatment protocol. TRIAL REGISTRATION: Registered under the Clinical Trials Registry India no. CTRI/2021/11/038137.

Endometriosis and inflammatory immune responses: Indian experience.

Endometriosis is a public health disorder affecting ∼ 247 million women globally and ∼ 42 million women in India. Women with endometriosis suffer from dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, fatigue, depression, and infertility leading to significant socioeconomic impact and morbidity. The etiology of endometriosis is not understood well even after 100 years of research. Currently, there is no permanent cure for endometriosis. The inflammatory immune response is one of the important features of etiopathogenesis of endometriosis and therefore understanding the inflammatory immune response would lead to a better understanding of this enigmatic disorder and may also lead to biomarker discovery for diagnosis of endometriosis. We investigated the autoimmune etiology of endometriosis in the Indian population. Using the proteomics approach, anti-endometrial antibodies (AEAs) were detected in Indian women with endometriosis [anti-endometrial antibodies - tropomyosin 3 (TPM3), stomatin-like protein2 (SLP-2), and tropomodulin 3 (TMOD3)]. The studies on AEAs provided a better understanding of autoimmune mechanisms in endometriosis. All three subtypes of endometriosis; superficial peritoneal, ovarian endometrioma, and deep infiltrating endometriosis were reported in Indian women. In this review, we discuss our experiences of the inflammatory immune response, autoimmunity, comorbidities, and clinical phenotypes in women with endometriosis in India.

Dysregulated serum and seminal plasma levels of surfactant protein D and MCP-1 in men with genital tract infection/inflammation.

PROBLEM: Surfactant protein D (SP-D), a multimeric collectin expressed by testicular mucosal epithelia and is positively regulated by testosterone. It exerts antimicrobial effects, modulates inflammation and rescued spermatogenesis in a murine model. Various cytokines and chemokines, including MCP-1, play a key role in regulating the inflammation in rat and human testis. The study aimed to investigate the role of SP-D and involvement of chemokines and cytokines in the male infertility associated with urogenital infections or inflammation. METHOD OF STUDY: The cross-sectional study evaluated levels of SP-D, testosterone, estradiol and the cytokines/chemokines including MCP-1 in the serum and semen samples of fertile and infertile Indian men with and without urogenital infections/inflammation (n = 76). RESULTS: Both fertile and infertile males with urogenital infection/inflammation had significantly lower levels of SP-D and higher levels of the chemokine, Monocyte chemoattractant protein 1 (MCP-1) in the serum and seminal plasma. Seminal plasma of these males exhibited significantly higher proportion of proteolytically degraded forms of SP-D. The serum SP-D levels positively correlated with testosterone/estradiol (TE) ratio. There was no significant correlation between the SP-D levels in seminal plasma and sperm count/motility. With a significant area under the Receiver Operating Characteristic curves, the serum and seminal plasma SP-D levels exhibited significant potential to predict infertility with high sensitivity and specificity in men with genital infections/inflammation. CONCLUSIONS: The circulating and seminal plasma SP-D levels were decreased in men with urogenital infection and inflammation. This could be due to their engagement at the site of infection, dysregulated expression owing to the altered hormonal profile and increased proteolytic degradation.