Incidence of vaginal erosion with different synthetic materials for suburethral sling in the treatment of Stress Urinary Incontinence: A systematic review.

INTRODUCTION: The aim of this systematic review is to compare the vaginal erosion rates in different synthetic materials used in suburethral slings in Tension Free Vaginal Tape (TVT-O /TOT) procedures in management of female stress urinary incontinence. METHODS: PRISMA 2009 framework was adopted for study design. Scholarly literature search was done using MEDLINE, EMBASE, the Cochrane Library and Clinical Trials.gov using selected keywords. Five articles fulfilled the inclusion and exclusion criteria. Our main outcome of interest is to review the ideal properties of the suburethral sling, procedure of insertion and post-surgical complication following the sling insertion primarily vaginal erosion. Results were compared using one way-ANOVA test and independent T- test. RESULTS: Total of 1725 subjects were available for analysis in the five studies. Monofilament polypropylene constituted 92.5% of the total sample size from one study alone. Polyester (n= 16/51) causes higher incidence rate of vaginal erosion compared to monofilament polypropylene (31.4 vs., 4.7; p = 0.01). There was no difference in the vaginal erosion rate between monofilament polypropylene and multifilament polypropylene (4.7 vs, 14.1; p=0.055) as well as between multifilament polypropylene and polyester (14.1 vs, 31.4; p=0.068). Although there was a marginally lower rate of vaginal erosion in TVT-O over TVT, the difference was not significant. (5.6 vs., 6.4, p=0.468). Common presentations of vaginal erosion were vaginal discharge, perineal pain and dyspareunia. CONCLUSION: Given the limited sample size, polyester sling material appears to cause higher rates of vaginal erosion. No difference in erosion rate was seen between TVT and TVT-O.

Development of carbon/carbon composites with carbon nanotubes as reinforcement and chemical vapor infiltration carbon as matrix.

Carbon nanotubes based carbon/carbon composites were prepared by infiltration of purified ACNTs film with pyrolytic carbon. Densification was performed by filling the space between the CNTs through by deposition of the pyrocarbon on the nanotubes surface. It comprised of (i) Synthesis and purification of aligned carbon nanotubes films by CCVD process and (ii) Infiltration of CNTs film by pyrocarbon using CVI method at 950 degrees C. SEM studies showed that the film was well infiltrated using methane. The density of film increased to 1.4 gm/cm3 from 0.4 gm/cm3 of as purified ACNTs film. The I(D)/I(G) ratio for CNTs film is 0.67 and 0.80 for the CVI deposited pyrocarbon. The lower I(D)/I(G) ratio from Raman microscopy shows fine graphitic nature of carbon nanotubes and nanocomposites films.

Development of composites incorporating carbon nanofibers and nanotubes.

Nanocomposites provide significantly increased modulus, thermal, and electrical properties when compared to traditional reinforced composites. Present work was undertaken to study the microstructure, thermal, and electrical properties of carbon nanostructured reinforced polymer matrix composites. Composites were made with carbon nanofibers and nanotubes (produced by CVD method) as reinforcement with thermoplastic polymers as matrices. The amount of nanoreinforcements was varied between 1 to 5 wt% in different matrices. The problems associated with dispersion of reinforcing materials have been studied. Dispersion of nanofillers in thermoplastics, microstructures, and thermal stability of the reinforced thermoplastics have been studied using SEM, DSC, and TGA. Experimental results show that small amount of carbon nanofillers present in thermoplastic matrix systems enhance the thermal, mechanical, and electrical properties of the composites.

Aneurysm of sinus of Valsalva dissecting into interventricular septum with left ventricular communication.

Septal dissection with left ventricular communication is a rare complication of aneurysm of sinus of Valsalva. This report describes a case of aneurysm of sinus of Valsalva with septal dissection, almost in its entirety with left ventricular communication--which is a very rare occurrence.

Ortner syndrome and haemophilia.

Compression and paralysis of the left recurrent laryngeal nerve by a dilated pulmonary artery is a rare complication of pulmonary hypertension. We here report the case of a patient with severe haemophilia A and HIV infection who presented with a persistent hoarseness of voice and a left vocal cord palsy caused by HIV-associated pulmonary hypertension. This case suggests that HIV-associated pulmonary hypertension should be suspected in any HIV patient presenting with unexplained left vocal cord palsy.

Clinical evaluation of human placental extract (placentrex) in radiation-induced oral mucositis.

To evaluate human placental extract in the treatment of radiation mucositis involving the oral/oropharyngeal region, a prospective randomized study was carried out in 120 patients with squamous cell carcinoma of the head and neck from August 1997 to March 1999. The study was conducted in patients receiving radical external radiation therapy, planned for = > 60 Gy/30 F/6 weeks, who developed grade 2 radiation mucositis (patchy mucositis) during radiation treatment. The patients were randomized in two groups of 60 patients each to receive either placentrex treatment (placentrex group) or conventional treatment (control group). Placentrex treatment was given as Inj Placentrex 2 ml by deep intramuscular injection 5 days a week for 15 injections. Conventional treatment given in the control group was disprin gargles and betamethasone oral drops. A subjective decrease in pain was observed in 48/60 (80%) of patients in the placentrex group compared with 22/60 (36.7%) in the control group. The progression to grade 3 radiation mucositis was 24/60 (40%) in the placentrex group compared with 52/60 (86.7%) in the control group. The subjective improvement in difficulty in swallowing was seen in 56/60 (93%) of patients in the placentrex group compared with 9/60 (15%) of patients in the control group. Only one patient in the placentrex group compared with three in the control group required interruption of radiation therapy because of severe radiation reactions. Human placental extract appears to be effective in the management of radiation-induced oral/oropharyngeal mucositis and especially in controlling subjective symptoms.

Neuroleptic malignant syndrome: an experience of four cases.

We report four cases of neuroleptic malignant syndrome occurring after administration of a typical antipsychotic haloperidol and a newer atypical antipsychotic clozapine. The management of these patients is discussed.

Pattern of childhood trauma. Indian perspective.

Although infectious diseases are still the chief cause of death in children in a developing country like ours, but a definite increase in incident and related mortality due to trauma has been noted in the last decade. The problems relating to pediatric trauma are peculiar to our setup and differ considerably to the severe multiple organ trauma met with in the high velocity vehicular accidents, seen in developed Western countries. The present study identifies patterns of childhood trauma from our region. It comprises 2100 patients admitted over a 3 years period to Pediatric Surgical Unit. Cranial injuries were the most commonly encountered injuries followed by the abdominal and skeletal injuries. Fall from the house roofs is the commonest mode of injury, although road traffic accidents are also recognized to be on the increase. The overall mortality was 7.7%; its chief determinant being the presence of severe head injury. A few important epidemiological factors involved were identified.

Knowledge amongst adolescent girls about nutritive value of foods and diet during diseases, pregnancy and lactation.

Knowledge about nutritive value of food, diet during diseases and antenatal and postnatal period was assessed amongst 152 adolescent school girls. A total of 23.69 and 55.93% students had incorrect knowledge that pulses and non-vegetarian foods should be avoided during later half of the pregnancy. A total of 63.82, 66.45 and 71.72% of subjects had incorrect knowledge that almonds have more nutritive value than groundnuts, fruits are rich sources of calories and desi ghee has more nutritive value than vanaspathi, respectively. Majority (90.78%) had correct knowledge that obesity is caused due to excess intake of calories than required by an individual and low iron content and poor availability of iron from food is a major cause of anemia in mothers and children.

PIP: 152 upper-class, female teenagers attending the Delhi, India, Public School were interviewed to find knowledge gaps of these potential mothers so that an appropriate nutrition education training program could be designed. 96% lived in an urban area. 69% did not limit their diet to fruits, vegetables, and nuts. The remaining girls ate either a vegetarian or a similar diet with eggs. 90.8% knew that low iron content and poor availability of iron from food contributes greatly to anemia. The same percentage was aware that intake of too many calories causes people to be overweight. The mass media may have contributed to this high knowledge level. Just 35.52% knew that an ill child needs more food than a healthy child. In fact, 35.53% said that children with an acute respiratory infection should eat less food. 59.9% knew, however, that diarrhea fosters severe malnutrition in a moderately malnourished child. Only 45.39% were aware that vegetarian foods provide less strength than nonvegetarian foods. Apparently incorrect dietary beliefs still exist in India. 63.82% mistakenly believed that almonds were more nutritious than groundnuts, fruits provide many calories and protein, and apples are more nutritious than rice. Since these girls were from the elite class and society considered these foods to be prestigious, this finding is not surprising. 86.18% knew that a woman during the end of her pregnancy should eat more food. 76.3% were aware of the importance of eating pulses (a major source of protein) during the 3rd trimester, but only 44.1% knew the importance of eating nonvegetarian foods (major sources of protein) also during the 3rd trimester. The health education campaign must address and discourage incorrect dietary beliefs and reinforce correct beliefs.

Assessment of knowledge and skills about growth monitoring amongst child development project officers.

Knowledge and skills about growth monitoring (GM) amongst Child Development Project Officers (CDPOs) were assessed by interview technique. Majority (94%) of subjects had correct knowledge that GM helps in early detection of growth retardation while about 83% felt that a flattened growth curve indicates no weight gain. The percentages of CDPOs who were able to interpret and read correctly about what ascending descending and flattened growth curves indicate were 83, 71 and 50% respectively. There is thus a need of in-service training of CDPOs in GM activities.

PIP: Researchers interviewed 48 Child Development Project Officers (CDPOs) of the Integrated Child Development Services program (ICDS) in India before the CDPOs began an inservice refresher training course. All CDPOs had earlier graduated from preplacement training and worked for ICDS for 4 years. 85% of the CDPOs knew that Anganwadi workers should weight severely malnourished children every month. 83% understood that they should weight optimally nourished children regularly. 92% understood that a level growth curve demonstrates inadequate food intake over along period of time. 81% knew that adequate food intake results in an ascending growth curve. Despite the overall high understanding of the importance of growth monitoring activities, 17% of CDPOs did not know that Anganwadi workers should weigh 3 year old children every month and 33% did not know that they should weigh 3 year old children every 3 months. Moreover, even though 83% realized a flattened growth curve means a child is not gaining weight and 92% realized a falling growth curve means a deteriorating nutritional status, only 50% and 72% respectively could interpret the changes in the growth curve. The researchers concluded that these knowledge gaps among CDPOs could negatively affect subordinates. Thus inservice training of CDPOs should address these gaps to improve their knowledge of growth monitoring activities.

Assessment of knowledge and attitudes in human nutrition among nurses of Delhi.

The present study revealed that the majority of nurses had adequate knowledge about dietary practices during the antenatal and post-natal period. However, their knowledge about nutritive value of foods and nutrition advice during disease conditions was inadequate. It is recommended that to make the training more meaningful, the identification of the incorrect dietary beliefs of trainees should be done at the beginning of the training course. Each incorrect belief should be explained in detail for better comprehension of the correct knowledge in nutrition.

Knowledge and attitude amongst well-to-do adolescent school girls towards breast feeding.

A study was conducted to determine the knowledge and attitude about breastfeeding amongst adolescent school girls (n = 74) studying in an urban public school in Delhi. A pretested semi-structured questionnaire was administered. The majority of respondents had correct knowledge about the age of initiation of breast feeding (76%), introduction of semi-solid foods (61%), feeding of colostrum (58%) and superiority of breast milk over commercial preparations of milk (81%). Most believed wrongly that consumption of dry fruits (89%) and high intake of milk and pure ghee (78%) would increase breast milk secretion. The percentages of girls wrongly believing that breast feeding should be discontinued if mother was suffering from tuberculosis, malaria and diarrhea were 96, 85 and 81 respectively. There is need for including adolescent girls in continuing education activities about maternal and child health.

Knowledge and attitude towards breast feeding among adolescent girls.

Majority of the urban adolescent girl students (n = 76) from middle socioeconomic group correctly reported that breast milk is the best food for infants (95%), and it has protective antibodies (98%). However, most of them (92%) had incorrect knowledge about the role of diet in breast milk secretion and continuation of breastfeeding while mother is suffering from tuberculosis (92%), malaria (84%).

PIP: Researchers in New Delhi, India studied the knowledge and attitude of breast feeding of 76 year science college students (average age: 17 years) in 1987. None of the adolescent females were married and most of them were from middle class families. 95% recognized that breast feeding is best for the child and should be begun shortly after childbirth. In addition, almost 98% know that breast milk provides antibodies which protect the child against infections. 100% reported that breast feeding promotes more intense love, affection, and bondage between mother and child than does little bottle feeding. 92% knew that diarrhea is often caused by unhygienic bottle feedings and 89% knew that infants who are only breast fed have less diarrheal episodes than those who are bottle fed and/or breast fed and receive supplements. Almost 36% reported that bottle feeding should never be done. 82% reported correctly that infants should begin eating semi solid foods at 4-5 months old. 92% incorrectly believed that the more a mother eats dry fruits and ghee the more breast milk she will produce. In addition, 55% erroneously thought that the mother should dilute the top milk to ease digestion. Further, 68% thought the more milk a mother drinks the more breast milk she will produce. 60% believed that prolonged breast feeding causes breast deformity. 29% thought breast feeding to be embarrassing outside the home. Erroneous responses concerning nutrition may have been due to inadequate emphasis on nutrition education messages in the media. This study emphasizes the need to readdress these messages so as to increase knowledge of breast feeding among female adolescents.

Knowledge of nutritive values of foods and diet during diseases amongst nursing students.

Knowledge about nutritive value of foods and diet during diseases was assessed amongst forty nine nursing students at the beginning of their training course in Human Nutrition. Majority of the students had correct knowledge about dietary advice during antenatal and postnatal period. The knowledge of nutritive values of foods and diet during disease conditions was inadequate.

Knowledge and attitude among child development project officers towards breast feeding.

A study was conducted to determine the knowledge and attitude about breast feeding (BF) amongst child development project officers (CDPOs) working in Integrated Child Development Services Scheme. A semi structured pretested questionnaire was administered. It was found that majority of respondent had correct knowledge about feeding of colostrum, age of initiation of breast feeding and introduction of semi-solid foods. Majority of CDPOs had the knowledge that consumption of dry fruits, milk and desi ghee would increase that breast milk secretion. The percentage of subjects who were aware that BF should be discontinued if mother is suffering from illness like breast cancer (48%) tuberculosis (57%), malaria (67%) and Diarrhoea (84%). There is need of continuing education of CDPOs for updating their knowledge.

Knowledge attitude towards breast-feeding amongst auxiliary nurse midwives in rural Delhi.

A study was undertaken to determine the knowledge and attitude about breastfeeding amongst auxiliary nurse midwives (ANMs) working in rural Delhi. It was found that all respondents had correct knowledge about age of initiating breastfeeding, feeding of colostrum and superiority of breast milk over commercial milk preparations. About 76% responded that top milk given after 4 months of age should be diluted. A majority of workers mentioned that consumption of dry fruits, high quantity of milk and ghee increases the quantity of breast milk secretion. The percentage of ANMs who thought that breast-feeding should be discontinued if mother is suffering from an illness were: breast cancer (68%), tuberculosis (56%), malaria (50%) and diarrhea (36%). There is need for continuing education of peripheral health functionaries for updating their knowledge.

Lipids changes in alcoholic & non-alcoholic cirrhotics.

Fasting plasma samples from 29 patients of cirrhosis were analysed for cholesterol and triglycerides and their lipo-protein fractions. The patients included 11 alcoholic cirrhotics consuming over 130 g/day of absolute ethanol and 18 non-alcoholic cirrhotics. The difference in lipid values between the two patient groups was not significant except that VLDL cholesterol was raised in alcoholic cirrhotics (P less than 0.05). However, in comparison to normal healthy controls, the values were significantly altered. The dietary intake, in the two groups showed no difference, except that non-alcoholic cirrhotics consumed more animal proteins. Low intake of exogenous fat and reduced synthesis of endogenous cholesterol in cirrhotic patients seemed to influence the total lipid values.