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Prevention of postpartum haemorrhage has been a major issue for its life threatening impact on maternal morbidity and mortality worldwide. Conventional continuous infusion of oxytocin has been employed for this condition. Apparently, in place of conventional oxytocics, application of carbetocin with longer half-life shows the same clinical benefits. This requires doing this present study. To compare the effectiveness of I/V bolus cabetocin and oxytocin infusion used for prevention of primary PPH after caesarean section. This descriptive cross-sectional comparative study was carried out in Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2015 to April 2016. A total of 100 pregnant women undergoing elective or emergency caesarean section were enrolled and divided into two groups on the basis of exclusion and inclusion criteria. Group I (n=50) received bolus of 100μgm IV carbetocin after delivery of the babyGroup II (n=50) received 20 IU of oxytocin in 1000ml of Hartman solution I/V in 8 hours continuous infusion after delivery of the baby. Baseline demographic and obstetric profile, indications for C/S, estimated blood loss, hemoglobin level, additional uterotonic agents, blood pressure and the diuresis were compared immediate postoperatively and 24 hours after operation. The patients were followed up for 24 hours after operation regarding outcomes variables. Baseline profiles were similar between two groups. Regarding haemodynamic effects, both drugs have a hypotensive effect but a greater reduction in blood pressure is found in oxytocin group. There was no significant difference in respect of estimated blood loss, blood transfusion, additional oxytocics and diuresis between two groups. It can be concluded that a single injection of carbetocin is as effective as continuous oxytocin infusion to prevent postpartum haemorrhage, with similar haemodynamic profile. So, carbetocin as a uterotonic agent is an acceptable alternative for prevention of postpartum haemorhage after caesarean section.

Background Prevalence of both severe aortic stenosis (AS) and wild-type transthyretin cardiac amyloidosis (wtTTRCA) increases with age. Dual disease (AS+wtTTRCA) occurs in a significant proportion of patients undergoing aortic valve replacement. Prognostic significance of this dual disease is not established. Purpose TTRCA distribution has ethnic variability. This has not been studied in an Indian/Asian population before. India alone has >4.6 million estimated elderly individuals with severe AS. This pilot study was designed as part of a larger study to determine the prevalence of coexistence of severe AS and wtTTRCA in elderly Indian population and identify non-invasive predictors of its diagnosis. Methods Symptomatic severe AS patients aged ≥65 years undergoing surgical aortic valve replacement (SAVR) were enrolled. Detailed 2-D transthoracic echocardiogram including speckle tracking and longitudinal strain assessment was done preoperatively. TTRCA diagnosis was based on preoperative 99m-Technitium pyrophosphate scan (PYP), and intra-operatively obtained basal inter-ventricular septum (IVS) biopsy and excised native aortic valve subjected to histopathological examination (HPE). Congo red staining and immunohistochemistry using TTR monospecific antibodies were performed to identify and sub-type amyloid respectively. Serum/urine protein electrophoresis with serum immunofixation to rule out primary amyloidosis and genetic analysis to rule out mutant TTRCA were also done. Results SAVR was done in 46 severe AS patients (mean age 70±5 years, 70% men), 32 (70%) of whom also underwent PYP scan. Significant PYP uptake (Perrugini grade II or III) was seen in 3 (9%) patients (Figure 1E, F). On HPE, 33 (72%) native aortic valves had amyloid deposits, of which 19 (58%) had TTR deposition (Figure 1A, B, C, D). However, none of the IVS biopsies showed amyloid deposits. None of the patients had evidence of monoclonal protein elevation and mutation in the TTR gene. Non-invasive markers of this dual coexistence included elevated troponin-I (≥26.2 pg/mL, 35% vs 67%), combined elevated troponin-I & NT-ProBNP (≥26.2 pg/mL & ≥400 pg/mL, 24% vs 33%), and significantly low myocardial contraction fraction (≤30%, 72% vs 100%), deceleration time (207±80 msec vs 85±23 msec) and global longitudinal strain (−19.3±4.3% vs −13.6±3.7%). At median follow-up of 12.5 months, 1 patient each had died in TTR negative and TTR positive groups (3% vs 33%). The results are summarised in the central illustration (Figure 2). Conclusion In the Indian context, concomitant existence of severe AS and wtTTRCA is common. This pilot study suggests an absolute burden of >450,000 patients with dual disease of AS and wtTTRCA, in those otherwise believed to have lone severe AS. Further larger studies are thus indicated to establish the prevalence of this dual disease and to assess its prognostic implication. Funding Acknowledgement Type of funding sources: None. Figure 1. Histopathology and PYP scan resultsFigure 2. Central illustration

Epiphora due to Nasolacrimal duct obstruction (NLDO) is common in chidren. About 5% to 20% infants show evidence of congenital Nasolacrimal duct obstruction with symptoms 1,2. Most of them (95%) cured by conservative management. Majority of the remaining symptomatic patients are cured by probing, repeat probing, probing with incubation and Baloonplasty procedures. About 4% of the patients need surgical intervention. Conventional Dacryocystorhinostomy (DCR) is the main treatment of choice in these cases till to date. DCR means creation of an alternate pathway between lacrimal sac and nasal cavity to drain tear when nasolacrimal duct (NLD) is blocked. There are different surgical techniques available for DCR. These includes conventional or external DCR, endoscopic DCR, endoscopic Laser DCR, transcanalicular or endocanalicular Laser DCR. In adult DCR can be carried out comfortably by the conventional or newly developed endoscopic approach. Narrow space, inadequate development of anatomical landmark makes both the conventional & endoscopic DCR difficult in children. Long term success rate of External DCR in pediatric patients is less in comparison to adult due to vigorous growth of tissue in a child. Laser DCR has been tried but long term success rate is not up to the mark. Several observations like- primary osteum closure, cicatrix formation with middle turbinate and nasal septum, granulation tissue formation- all are more in children due to marked fibroblastic response. So Laser DCR is a challenge in pediatric patients.

The need for further studies on relationships between deaths and environmental variables has been reported in the literature. This case-control study was, therefore, carried out to find out the associations between several social and environmental variables and deaths of children due to infectious diseases such as those leading to diarrhoea, acute respiratory infection, measles and other diseases. Six hundred and twenty-five deaths (cases) and an equal number of matched living children (controls) aged 1–59 months, were studied in rural Matlab. An analysis of crude and adjusted odds ratio showed differential associations. Sources of drinking water, amount of stored water, conditions of latrines, number of persons sleeping with the child and the type of cooking site were statistically significantly associated with deaths due to infectious diseases after controlling for breast feeding, immunization, and the family size. Significant associations were also observed between: (i) the sources of drinking water and deaths due to ARI, and (ii) conditions of latrines and deaths due to diarrhoeal diseases, after controlling for the confounding variables. Several other environmental factors also showed associations with these various death groups, but they were not statistically significant. The size of the samples in death groups (small) and the prevalence of more or less homogeneous environmental health conditions probably diminished the magnitude of the effects. The results of the study reconfirm the importance of environmental health intervention in child survival, irrespective of breast-feeding, immunization, and selected social variables.

Biological parameters affecting microprojectile bombardment delivery of DNA into oil palm embryogenic calli were optimized by monitoring transient GUS gene expression. The parameters optimized were the following: explant type using gold and tungsten microcarrier, bombardment preculture, time between bombardment and GUS staining, genotype, immature embryo preculture, DNA concentration, osmoticum type and concentration, and osmoticum treatment duration before and after bombardment. An independent experiment was carried out to study the effect of each parameter and its variables on transient GUS expression. ANOVA was carried out for each experiment using completely randomized design and the treatment means were compared using Duncan's Multiple Range Test. The highest transient GUS expression was observed 2 days post-bombardment using embryogenic calli derived from immature embryos. Bombardment was carried out using 300 μ g of gold microcarriers coated with 1.5 μ g of DNA 24 h after transfer to fresh medium. GUS expression could be further enhanced when calli were transferred to medium containing osmoticum (0.4 M mannitol) 2 h prior to bombardment. Highly significant differences between the variables were observed for all the parameters studied except genotype.

Physical parameters for DNA delivery into oil palm embryogenic calli using the biolistic device have been successfully established. Helium pressures, distance from rupture disc to macrocarrier, distance from macrocarrier to stopping plate, distance from stopping plate to target tissue, vacuum pressures, number of bombardments, particle types and sizes and the effect of calcium chloride and spermidine on microcarrier-DNA binding have been optimizied. Embryogenic calli were bombarded with gold or tungsten particles coated with pEmuGN plasmid containing β-glucuronidase gene ( uidA ) driven by an Emu promoter. A completely randomized design was used to bombard a total of 200 plates (40 parameters × 5 replications) which were then incubated in a growth chamber at 28 °C. Two days after bombardment, the tissues were stained with GUS assay buffer for 16–20 h at 37 °C and the blue spots were counted under a binocular microscope. Analysis of variance (ANOVA) and Duncan's new multiple range test were used to analyze data from each experiment. All the variables used in this experiment were significantly different except for vacuum pressures and bombardment numbers.

The objective of this research was to use new molecular techniques to improve efficiency of traditional breeding programs of Pennisetum for biomass and forage production. Restriction fragment length polymorphic (RFLP) and random amplified polymorphic DNA (RAPD) genetic markers were developed to characterize the Pennisetum purpureum genome and those markers were used to facilitate genetic study and breeding improvement. Standard RFLP and RAPD methodologies were adapted and/or modified to work well with Pennisetum and the DNA marker system was developed. This marker system was used to “fingerprint” the P. purpureum plant introduction collection, to determine the genetic diversity in that collection, to measure heterozygosity of selected lines and to measure hybridization/self fertilization rates using different crossing methods. Linkage relationships were studied between the DNA markers and quantitative trait loci (QTL), especially those loci associated with biomass/forage productivity, conversion to methane and rumen digestibility. Linkage analyses revealed 64 markers were linked to QTL of 26 plant traits. Those QTL-linked markers form the basis for genetic study of important biomasstforage productivity and quality traits. While the research was conducted with biomass for energy objectives, it is equally applicable to forage production and quality.

Extracardiac total cavopulmonary connection has been proposed as a rational alternative to the lateral intra-atrial tunnel for complex congenital cyanotic heart diseases undergoing univentricular repair. In five patients, aged 4 1/2 years to 27 years, an extracardiac lateral conduit was used for total cavopulmonary connection at our Institute. Extracardiac lateral conduits were constructed in all the five patients using polytetrafluoroethylene tube grafts. One child required reoperation because of graft thrombosis and an aortic homograft was used in him on the second occasion. Aortic cross clamp was completely avoided in all including reoperation. The results showed no early or late mortality. One child developed persistent hypoxemia and progressive hepatomegaly. Reoperation on 5th post-operative day revealed graft thrombosis with technically unrestricted anastomosis which was replaced by an aortic homograft. He also required embolectomy for inferior vena cava and hepatic veins thrombosis. Post-operative follow-up (range 3 months to 14 months) revealed all patients in functional class I and in normal sinus rhythm. Doppler echocardiography, magnetic resonance imaging and angiocardiography revealed unrestricted anastomoses and unobstructed pulmonary blood flow across the conduit. The technical advantages and haemodynamic benefits of this operation are encouraging. However, the lone incidence of graft thrombosis raises concern about the routine usage of synthetic grafts in extracardiac total pulmonary connection. Other inherent weakness appears to be the lack of growth potential of the synthetic tube.

Out of the 600 patients undergoing univentricular repair during the last 11 years, 20 children had associated total anomalous pulmonary venous connection. The objective was to outline the clues to establish the diagnosis of this rare disease combination and the various surgical options available to manage the same. Bidirectional Glenn, bilateral bidirectional Glenn, total cavopulmonary connection and atriopulmonary connection were performed in combination with rechannelling of various types of total anomalous pulmonary venous connection in 20 children aged 6 months to 36 months (mean +/- SD 17.65 +/- 9.02 months). Diagnosis could be established pre-operatively in only 13 (65%) patients. Out of 6 early deaths (30%), 4 were directly attributable to missed diagnosis. No late deaths occurred over a follow-up period ranging from 1 month to 132 months. None of the surviving children required reoperation and all are in NYHA functional class I. Doppler echocardiography of the surviving children revealed unrestricted atrio/cavopulmonary anastomosis and pulmonary vein to atrium connection in all survivors. Our own experience, coupled with a review of the literature, indicates that a missed diagnosis increases the hospital mortality. Cross sectional 2D echocardiography is a superior method of detection of associated total anomalous pulmonary venous connection compared to angiocardiography. Exclusion of the diagnosis of anomalous pulmonary venous connection is imperative in all univentricular hearts pre-operatively and on operation table. Failure to recognise this disease combination results in formation of a closed systemic circuit after bidirectional Glenn or a modified Fontan of connection and is lethal as happened in our early experience. It is suggested that one-stage Fontan operation should be performed only if other criteria for Fontan procedure are satisfied.

The operative management of absent pulmonary valve syndrome remains controversial regarding palliative or one-stage correction, the need for pulmonary valve implantation and pulmonary arterioplasty. This retrospective report summarises the experience of a single centre with a view to provide some answers to this controversy. Forty-six consecutive patients including five infants, aged 2 months to 43 years, underwent primary surgical correction during the last 8.5 years. All the patients underwent two-dimensional echocardiography and cardiac catheterisation. Nine patients had mild and 10 moderate pulmonary artery hypertension. Repair consisted of patch closure of the ventricular septal defect and reconstruction of the right ventricular outflow tract. A valve was incorporated in the pulmonary position in 19 patients. Pulmonary arterioplasty was performed only in infants. Overall hospital mortality was 4 out of 46 patients (8.6%). Two out of five infants died accounting for 40 percent mortality. Forty-two survivors were followed up from 4 to 101 months; 40 patients are in functional class I and two in class II. Actuarial survival at 8.5 years was 91 percent. It is concluded that reconstruction of the right ventricular outflow tract with a transannular patch is sufficient in majority of patients. A selective approach to pulmonary valve insertion is recommended in patients with pulmonary hypertension or other anomalies. Pulmonary arterioplasty should be performed as the primary treatment in infants.

The need for further studies on relationships between deaths and environmental variables has been reported in the literature. This case-control study was, therefore, carried out to find out the associations between several social and environmental variables and deaths of children due to infectious diseases such as those leading to diarrhoea, acute respiratory infection, measles and other diseases. Six hundred and twenty-five deaths (cases) and an equal number of matched living children (controls) aged 1-59 months, were studied in rural Matlab. An analysis of crude and adjusted odds ratio showed differential associations. Sources of drinking water, amount of stored water, conditions of latrines, number of persons sleeping with the child and the type of cooking site were statistically significantly associated with deaths due to infectious diseases after controlling for breast feeding, immunization, and the family size. Significant associations were also observed between: (i) the sources of drinking water and deaths due to ARI, and (ii) conditions of latrines and deaths due to diarrhoeal diseases, after controlling for the confounding variables. Several other environmental factors also showed associations with these various death groups, but they were not statistically significant. The size of the samples in death groups (small) and the prevalence of more or less homogeneous environmental health conditions probably diminished the magnitude of the effects. The results of the study reconfirm the importance of environmental health intervention in child survival, irrespective of breast-feeding, immunization, and selected social variables.Findings are reported from a case-control study conducted to assess the associations between several social and environmental variables and deaths of children due to infectious diseases, such as those leading to diarrhea, acute respiratory infection (ARI), measles, and other diseases. 625 deaths (cases) and an equal number of matched living children (controls) aged 1-59 months were studied in rural Matlab. Sources of drinking water, the amount of stored water, latrine conditions, the number of persons sleeping with the child, and the type of cooking site were statistically significantly associated with deaths due to infectious diseases after controlling for breast-feeding, immunization, and family size. Significant associations were also observed between sources of drinking water and deaths due to ARI, and conditions of latrines and deaths due to diarrheal diseases, after controlling for confounding variables. No other statistically significant environmental factors were associated with these various death groups. Study results confirm the importance of environmental health interventions in child survival, irrespective of breast-feeding, immunization, and selected social variables.

The genetical control of F1 heterosis, observed in a cross of desirable Nicotiana tabacum varieties, was investigated by analysing the data of the basic generations, triple test cross-families and random samples of doubled haploids (DH) and single-seed descent (SSD) lines. Analyses of the first-degree statistics revealed a complex control underlying the genetic variation, including the presence of epistasis, linkage, maternal effects and their interactions, in addition to the additive and dominance effects of the genes segregating in the cross. These analyses identified gene dispersion, directional dominance, and duplicate epistasis, as the main causes of heterosis. The triple test-cross analysis also confirmed the presence of non-allelic interactions and indicated that the dominance ratio, although inflated by epistasis, is consistently partial for all the traits. The extent of transgression in the recombinant inbred lines finally established unequivocally that, as in numerous other crosses, gene dispersion and unidirectional, but partial, dominance are the true causes of heterosis in this cross too.

Stably transformed callus of a hybrid sugarcane cultivar (Saccharum species hybrid, CP72-1210) was achieved following high velocity microprojectile bombardment of suspension culture cells, and electroporation of protoplasts. A three-day old cell suspension culture (SC88) was bombarded with gold particles coated with pBARGUS plasmid DNA containing the s-glucuronidase (GUS) reporter gene and the bar selectable gene that confers resistance to the herbicide basta. The pBARGUS plasmid was also electroporated into the protoplasts of another cell line (SCPP). Colonies resistant to basta were recovered from both sources. Stable integration of the bar gene in the resistant cell lines was confirmed by Southern analysis. In addition, phosphinothricin acetyltransf erase (PAT) activity was also demonstrated in the transformed cell lines.

Detection of linkage and pleiotropy between characters of Nicotians tabacum using inbred lines produced by dihaploidy and single seed descent

Inbred lines extracted by single seed descent (129 SSD families) and by dihaploidy (60 DH families) from a cross of a flue cured (SCR) and an air cured burley (S3) variety of tobacco have been compared in a completely randomised experiment at two planting densities (normal and double) for 11 characters including yield. The basic generations (parental varieties, F1, F2 and first backcrosses, B1 and B2) were also included to provide contemporary genetical controls. Half the characters show no difference in mean between the SSD and DH samples of inbred lines and the majority (nine out of 11) show no difference in genetical variance. For most characters there is no suggestion that the DH sample is showing the widely reported reduction in vigour relative to the SSD sample and the original parental varieties. Indeed the DH mean is the larger, implying greater vigour in more than half the cases where the DH and SSD sample means differ significantly. It is quite clear, therefore, that the relationship between the properties of the SSD and DH samples of inbred lines differs widely between characters. Leaving aside non-genetical explanations, the means of the inbred lines and the mean of the original parental varieties (mp) are expected to differ only in the presence of non-allelic interaction whereas the means of the SSD and DH samples of lines are expected to differ only if there is a linkage disequilibrium involving these interacting genes. Within the limitations of the genetical analyses of the basic generations these expectations are borne out.