Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal- retrospective cross sectional study.

BACKGROUND: The maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and identify the various risk factors and causes of maternal mortality. METHODS: This is a retrospective study conducted in a tertiary care center in Eastern Nepal from 16th July 2015 to 15th July 2020. The maternal mortality ratio was calculated per 100,000 live-births over five year's study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics. RESULTS: There was a total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in the year 2015 to 2020. The mean age and gestational age of women with maternal deaths were 24.69 ± 5.99 years and 36.15 ± 4.38 weeks of gestation. Obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis were the leading causes of maternal death. The prime contributory factors were delay in seeking health care and reaching health care facility (type I delay:40.9%). CONCLUSIONS: Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors of maternal mortality are delay in seeking care and delayed referral from other health facilities. The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium.

GQD@NiFe-LDH Nanosheets for Photocatalytic Activity towards Textile Dye Degradation via Lattice Contraction.

The functionalized NiFe-LDH with photosensitized GQDs were synthesized through the hydrothermal route by differing the amount of GQDs solution and studied its efficacy towards the mineralization of textile dyes under visible light. The synthesized samples were characterized by XRD, FESEM, HRTEM, DRUV-Vis, RAMAN, XPS, and BET. The combined effect of the hexagonal carbon lattice in GQD and open layered porous structure of NiFe-LDH nanosheets results in the contraction of the lattice. Different reactive and conventional dyes were taken as representative dyes to evaluate the activity of the as-synthesized photocatalysts. The enhanced electron absorption/donor effect between GQDs and NiFe-LDH, and the growth of oxygen-bridged Ni/Fe-C moieties enable the composite to exhibit better photocatalytic activity. Both photocatalytic activity and characterization results confirmed that the GQD@NiFe-LDH nanocomposite heterostructure synthesized at 160 °C by taking 10 mL of GQDs aqueous solution named GNFLDH10 has a higher degree of crystallinity and has the best photocatalytic efficiency compared to other reported visible light catalysts. Specifically, the above optimized GQD@NiFe-LDH photocatalyst is capable of photo-mineralizing 50 ppm of Reactive Green in 20 min, Reactive Red in 20 min, and Congo Red in 25 min respectively following a direct Z-scheme mechanism with substantial reusability.

Birth Defects among Newborns in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The incidence of birth defects is 2-3% in the general population but it is increasing. An estimated 303,000 newborns die within 4 weeks of birth every year, worldwide, due to congenital anomalies. The objective of this study was to find out the prevalence of birth defects among newborns in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Obstetrics and Gynaecology and the Department of Paediatrics from 15 June 2016 and 14 June 2019. Ethical approval was obtained from the Institutional Review Committee (Reference number: 142/077/078-IRC). Data of newborns were collected from the hospital records. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Results: Among 32,695 newborns, birth defects were seen in 169 (0.51%) (0.41-0.61, 99% Confidence Interval). The most common birth defect was musculoskeletal defects seen in 60 (35.50%) newborns followed by central nervous system defect seen in 30 (17.75%) newborns. Conclusions: The prevalence of birth defects among newborns was lower than in other studies done in a similar setting. Keywords: birth defect; congenital malformation; prevalence.

Overt Hyperthyroidism in Third Trimester of Pregnancy: A Case Report.

Hyperthyroidism is a state of excessive thyroid function. The most common cause of hyperthyroidism is Graves' disease. Overt hyperthyroidism if not treated can have serious outcome on the mother and the fetus. We present a pregnant women at 31 weeks of gestation presented with shortness of breath and palpitation with previous history of caesarean section and was treated with propyl thiouracil, beta blockers, antihypertensive drug, and during her course of treatment had Preterm Prelabor Rupture of Membrane with subsequent onset of labor and had normal vaginal delivery of 1.7 kg healthy baby. This report emphasize on the timely management of overt symptoms before the onset of labor.

Amniotic fluid embolism: A rare cause of maternal collapse-A case report.

High index of suspicion of amniotic fluid embolism should be considered in any intrapartum or postpartum collapse where the obvious cause of collapse is not identified.

Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis.

BACKGROUND: Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. METHODS: A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. RESULTS: Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P=0.043). CONCLUSION: The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

Molecular interactions of MnO2@RGO (manganese dioxide-reduced graphene oxide) nanocomposites with bovine serum albumin.

Graphene based materials have attracted global attention due to their excellent properties. GO-metal oxide nanocomposites have been conjugated with biomolecules for the development of novel materials and potentially used as biomarkers. Herein, a detailed study on the interaction of Bovine serum albumin (BSA) with MnO2@RGO (manganese dioxide-reduced graphene oxide) nanocomposites (NC) has been carried out. MnO2@RGO nanocomposites were prepared through a template/surfactant free hydrothermal route at 180 °C for 12 h by varying the graphene oxide (GO) concentration. Different biophysical experiments have been carried out to evaluate molecular interactions between BSA and NCs. Intrinsic fluorescence has been used to quantify the quenching efficiency of NCs and the binding association of BSA-NC complexes. NCs effectively quenched the intrinsic fluorescence of BSA via static and dynamic mechanism. Further, the results indicate that the molecular interactions of NC with BSA are dependent on the GO percentage in NC. Circular dichroism results demonstrate nominal changes in the secondary structure of BSA in presence of NCs. Also, the esterase-like activity of BSA was marginally affected after adsorption upon NCs. In addition, the FESEM micrographs reveal that the protein-NC complexes consist of nanorod and sheet-like morphologies are forming aggregates of different sizes. We hope that this study will provide a basis for the design of novel graphene based and other related nanomaterials for several biological applications.Communicated by Ramaswamy H. Sarma.

Two-dimensional fetal biometry versus three-dimensional fractional thigh volume for ultrasonographic prediction of birthweight.

OBJECTIVE: To develop and validate birthweight prediction models using fetal fractional thigh volume (TVol) in an Indian population, comparing them with existing prediction models developed for other ethnicities. METHODS: A prospective observational study was conducted among 131 pregnant women (>36 weeks) attending a tertiary hospital in New Delhi, India, for prenatal care between December 1, 2014, and November 1, 2016. Participants were randomly divided into formulating (n=100) and validation (n=31) groups. Multiple regression analysis was performed to generate four models to predict birthweight using various combinations of two-dimensional (2D) ultrasonographic parameters and a three-dimensional (3D) ultrasonographic parameter (TVol). The best fit model was compared with previously published 2D and 3D models. RESULTS: The best fit model comprised biparietal diameter, head circumference, abdominal circumference, and TVol. This model had the lowest mean percentage error (0.624 ± 8.075) and the highest coefficient of determination (R2 =0.660). It correctly predicted 70.2% and 91.6% of birthweights within 5% and 10% of actual weight, respectively. Compared with previous models, attributability for the 2D and 3D models was 0.65 and 0.55, respectively. Accuracy was -0.05 ± 1.007 and -2.54 ± 1.11, respectively. CONCLUSION: Models that included TVol provided good prediction of birthweight in the target population.

Repercussion of Solid state vs. Liquid state synthesized p-n heterojunction RGO-copper phosphate on proton reduction potential in water.

The same copper phosphate catalysts were synthesized by obtaining the methods involving solid state as well as liquid state reactions in this work. And then the optimised p-n hybrid junction photocatalysts have been synthesized following the same solid/liquid reaction pathways. The synthesized copper phosphate photocatalyst has unique rod, flower, caramel-treat-like morphology. The Mott-Schottky behavior is in accordance with the expected behavior of n-type semiconductor and the carrier concentration was calculated using the M-S analysis for the photocatalyst. And for the p-n hybrid junction of 8RGO-Cu3(PO4)2-PA (PA abbreviated for photoassisted synthesis method), 8RGO-Cu3(PO4)2-EG(EG abbreviated for Ethylene Glycol based synthesis method), 8RGO-Cu3(PO4)2-PEG (PEG abbreviated for Poly(ethylene glycol)-block-poly(propylene glycol)-block-poly(ethylene glycol based synthesis method)the amount of H2 synthesized was 7500, 6500 and 4500 µmol/h/g, respectively. The excited electrons resulting after the irradiation of visible light on the CB of p-type reduced graphene oxide (RGO) migrate easily to n-type Cu3(PO4)2 via. the p-n junction interfaces and hence great charge carrier separation was achieved.

Lupus erythematosus-lichen planus overlap syndrome in an HIV-infected individual.

Lupus erythematosus-lichen planus (LE-LP) overlap syndrome is an uncommon disorder with clinical, histological and/or immunopathological features of both diseases. We report a case of LE-LP overlap syndrome in a patient with HIV infection. To the best of our knowledge, LE-LP overlap syndrome with HIV infection has never been reported in literature.

3 D Co3 (PO4 )2 -Reduced Graphene Oxide Flowers for Photocatalytic Water Splitting: A Type†II Staggered Heterojunction System.

The design, synthesis, and photoelectrochemical characterization of Co3 (PO4 )2 , a hydrogen evolving catalyst modified with reduced graphene oxide (RGO), is reported. The 3 D flowerlike Co3 (PO4 )2 heterojunction system, consisting of 3 D flowerlike Co3 (PO4 )2 and RGO sheets, was synthesized by a one-pot in situ photoassisted method under visible-light irradiation, which was achieved without the addition of surfactant or a structure-directing reagent. For the first time, Co3 (PO4 )2 is demonstrated to act as a hydrogen evolving catalyst rather than being used as an oxygen evolving photoanode. In particular, 3 D flowerlike Co3 (PO4 )2 anchored to RGO nanosheets is shown to possess dramatically improved photocatalytic activity. This enhanced photoactivity is mainly due to the staggered type II heterojunction system, in which photoinduced electrons from 3 D flowerlike Co3 (PO4 )2 transfer to the RGO sheets and result in decreased charge recombination, as evidenced by photoluminescence spectroscopy. The band gap of Co3 (PO4 )2 was calculated to be 2.35 eV by the Kubelka-Munk method. Again, the Co3 (PO4 )2 semiconductor displays n-type behavior, as observed from Mott-Schottky measurements. These RGO-Co3 (PO4 )2 conjugates are active in the visible range of solar light for water splitting and textile dye degradation, and can be used towards the development of greener and cheaper photocatalysts by exploiting solar light.

Huge Nevus Lipomatosus Cutaneous Superficialis on Back: An Unusual Presentation.

Nevus lipomatosus cutaneous superficialis (NLCS) is a benign dermatosis, histologically characterized by the presence of mature ectopic adipocytes in the dermis. We hereby report a case of a 10-year-old boy who presented with multiple huge swellings on the scapular regions and lower back. The lesions were surmounted by small papules, along with peau-d orange appearance at places. Histology showed features consistent with NLCS. The case is being reported for the unusual clinical presentation.

Porokeratotic eccrine ostial and dermal duct nevus.

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare nevoid condition characterized by asymptomatic grouped keratotic papules and plaques with a linear pattern on the extremities, having distinct porokeratotic histopathological features. The lesions usually present at birth or in childhood. We present here a case of late-onset PEODDN in a 23-year-old man who had lesions on the palm, forearm, arm and the chest along the lines of Blaschko, strictly localized to the left side of the body.

Granular Cell Tumor: An Uncommon Benign Neoplasm.

Granular cell tumor is a distinctly rare neoplasm of neural sheath origin. It mainly presents as a solitary asymptomatic swelling in the oral cavity, skin, and rarely internal organs in the middle age. Histopathology is characteristic, showing polyhedral cells containing numerous fine eosinophilic granules with indistinct cell margins. We present a case of granular cell tumor on the back of a 48-year-old woman which was painful, mimicking an adnexal tumor.

Physicochemical characterization and adsorption behavior of calcined Zn/Al hydrotalcite-like compound (HTlc) towards removal of fluoride from aqueous solution.

A Zn/Al hydrotalcite-like compound (HTlc) was prepared by co-precipitation (at constant pH) method and was characterized by XRD, TG/DTA, FTIR, and BET surface area. The ability of Zn/Al oxide to remove F- from aqueous solution was investigated. All the adsorption experiments were carried out as a function of time, pH, concentration of adsorbate, adsorbent dose, temperature etc. It was found that the maximum adsorption takes place within 4 h at pH 6.0. The percentage of adsorption increases with increase in the adsorbent dose, but decreases with increase in the adsorbate concentration. From the temperature variation it was found that the percentage of adsorption decreases with increase in temperature, which shows that the adsorption process is exothermic in nature. The adsorption data fitted well into the linearly transformed Langmuir equation. Sulfate and phosphate were found to have profound effects on fluoride removal. Thermodynamic parameters such as DeltaG0, DeltaH0, and DeltaS0 were calculated. The negative value of DeltaH0 indicates that the adsorption process is exothermic. The apparent equilibrium constants (Ka) are also calculated and found to decrease with increase in temperature. With 0.01 M NaOH the adsorbed F- could be completely desorbed from Zn/Al oxide in 6 h.

Juvenile pemphigoid nodularis: Report of a rare case.

Bullous pemphigoid is an autoimmune blistering disease that is rare in childhood. Pemphigoid nodularis is a variant of BP that is exceedingly rare in children. Pemphigoid nodularis is characterized by overlapping clinical features of both prurigo nodularis and BP. We report here a case of pemphigoid nodularis in an 11-year-old boy.

Generalized benign acanthosis nigricans in an infant.

The generalized form of acanthosis nigricans, especially in infants, is extremely rare. Herein we report a 1-year-old female child who developed generalized acanthosis nigricans without any evidence of internal malignancy or endocrine disorder. This case is being reported for its rarity.

One-Pot Fabrication of RGO-Ag3 VO4 Nanocomposites by in situ Photoreduction using Different Sacrificial Agents: High Selectivity Toward Catechol Synthesis and Photodegradation Ability.

Weak photon absorption and fast carrier kinetics in graphene restrict its applications in photosensitive reactions. Such restrictions/limitations can be overcome by covalent coupling of another photosensitive nanostructure to graphene, forming graphene-semiconductor nanocomposites. Herein, we report one-pot synthesis of RGO-Ag3 VO4 nanocomposites using various sacrificial agents like ethanol, methanol, propanol and ethylene glycol (EG) under visible light illumination. The Raman spectral analysis and (13) C MAS NMR suggest ethanol to be the best sacrificial agent among those studied. Thermal analysis studies, further, confirm the stability of the synthesized nanocomposite with ethanol as sacrificial agent. In view of this, the activity toward dye degradation was focused over the composites prepared via ethanol as sacrificial agent. It was observed and proved that cationic dyes could be degraded quantitatively and swiftly compared to anionic dyes (37.79%) in 1.5 h. This suggests that the surface of the nanocomposites is anionic as partial reduction takes place during synthesis process. In case of mixed dye degradation process, it was noticed that the presence of cationic dye doubles the degradation of anionic dye. The activity of these synthesized nanocomposites is more than five-fold toward the phototransformation of phenol and photodegradation of textile dyes under visible light illumination.

One pot synthesis of water-dispersible dehydroascorbic acid coated Fe3O4 nanoparticles under atmospheric air: blood cell compatibility and enhanced magnetic resonance imaging.

Water dispersible and biologically important molecule dehydroascorbic acid (DHA, capable to cross the blood brain barrier) coated Fe3O4 superparamagnetic nanoparticles having an average size of ∼6 nm were synthesized through one pot aqueous coprecipitation method under atmospheric air. An antioxidant ascorbic acid (AA) used in the synthesis oxidized itself to dehydroascorbic acid (DHA) to consume dissolved or available oxygen in reaction mixture which died away the oxidative impact of atmospheric air and formed DHA encapsulated the Fe3O4 nanoparticles which stabilized the Fe3O4 nanoparticles and significantly enhanced their colloidal solubility in water. Fe3O4 phase, superparamagnetic property, DHA coating and stable colloidal solubility in water were confirmed by means of XPS, VSM, IR and zeta potential analysis respectively. T1, T2 and T2(∗) weighted magnetic resonance imaging (MRI) and corresponding relaxivity (r1=0.416, r2=50.28 and r2(∗)=123.65 mM(-1) and r2/r1=120.86, r2(∗)r1=297.23) of colloidally dispersed DHA-coated nanoparticle water phantom revealed a strong contrast enhancement in T2 and T2(∗) weighted images. The compatibility of DHA-coated Fe3O4 nanoparticles toward human blood cells was examined by means of cell counting and cell morphological analysis with the use of optical microscope and scanning electron microscope imaging.

Assessment of the customized birth weight formula in a low risk Indian population

Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas.