Biomedical subjects

A Bhide

Publications and source records attributed to A Bhide.

At least 19 recordsLinked to original sources

PubMed2007

First-trimester uterine artery Doppler and spontaneous preterm delivery.

OBJECTIVES: To assess the relationship between first-trimester uterine artery Doppler measurements and spontaneous preterm delivery. METHODS: This was a retrospective analysis of uterine artery Doppler findings at 11-14 weeks in 73 singleton pregnancies with spontaneous preterm labor and 2417 pregnancies delivered at term. RESULTS: The uterine artery mean resistance index (RI) was 0.68 (coefficient of variation 19%) and 0.69 (17%) in the preterm and term delivery groups, respectively (P = 0.35). The mean pulsatility index (PI) was 1.42 (39%) and 1.42 (46%) in the term and preterm delivery groups, respectively (P = 0.95). Bilateral diastolic notches were present in 34% of preterm deliveries and 33% of controls (P = 0.84). Restricting the analysis to the 19 pregnancies with preterm delivery before 34 weeks of gestation, no significant difference from controls was observed for RI (mean 0.71, coefficient of variation 11%, P = 0.41), PI (mean 1.56, coefficient of variation 29%, P = 0.27) or the number of bilateral notches (42%, P = 0.41). CONCLUSIONS: Despite pathological evidence suggesting that defective placentation is associated with spontaneous preterm delivery, first trimester uterine artery resistance, as assessed by Doppler ultrasound investigation, is not different in pregnancies subsequently complicated by preterm labor compared to pregnancies delivered at term. This finding may be explained by a late failure of trophoblast development in cases destined to deliver preterm.

Adult↗

PubMed2006

Doppler and biophysical assessment in growth restricted fetuses: distribution of test results.

OBJECTIVE: Multi-vessel Doppler ultrasonography and biophysical profile scoring (BPS) are used in the surveillance of growth restricted fetuses (IUGR). The interpretation of both tests performed concurrently may be complex. This study examines the relationship between Doppler ultrasonography and biophysical test results in IUGR fetuses. METHODS: Three hundred and twenty-eight IUGR fetuses (abdominal circumference < 5th percentile, elevated umbilical artery (UA) pulsatility index (PI)) had concurrent surveillance with UA, middle cerebral artery (MCA) and ductus venosus (DV) Doppler ultrasonography and BPS (fetal tone, movement, breathing, maximal amniotic fluid pocket and fetal heart rate). Patients were stratified into three groups according to their Doppler examination: (1) abnormal UA alone; (2) brain sparing (MCA-PI > 2 SD below mean for gestational age); and (3) abnormal DV (PI > 2 SD above the mean for gestational age) and BPS groups: (1) normal (> 6/10); (2) equivocal (6/10); and (3) abnormal (< 6/10). Predictions of short-term perinatal outcomes by both modalities were compared for stratification. The distribution and concordance of Doppler and BPS test results were examined for the whole patient group and based on delivery prior to 32 weeks' gestation. RESULTS: Abnormal UA Doppler results alone were observed in 109 fetuses (33.2%), brain sparing in 87 (26.5%) and an abnormal DV in 132 (40.2%). The BPS was normal in 158 (48.2%), equivocal in 68 (20.7%) and abnormal in 102 (31.1%). Both testing modalities stratified patients into groups with comparable acid-base disturbance and perinatal outcome. Of the nine possible test combinations the largest subgroups were: abnormal UA alone/normal BPS (n = 69; 21%) and abnormal DV Doppler/abnormal BPS (n = 62; 18.9%). Assessment of compromise by both testing modalities was concordant in 146 (44.5%) cases. In 182 fetuses with discordant results the BPS grade was better in 115 (63.2%, P < 0.0001). Marked disagreement of test abnormality was present in 57 (17.4%) fetuses. Of these, abnormal venous Doppler in the presence of a normal BPS constituted the largest group (Chi-square P < 0.002). Stratification was not significantly different in patients delivered prior to 32 weeks' gestation. CONCLUSION: Doppler ultrasonography and BPS effectively stratify IUGR fetuses into risk categories, but Doppler and BPS results do not show a consistent relationship with each other. Since fetal deterioration appears to be independently reflected in these two testing modalities further research is warranted to investigate how they are best combined.

Adolescent↗

PubMed2006

Effect of inter-twin delivery interval on neonatal haemoglobin concentration.

The aim of this study was to examine the effect of the inter-twin delivery interval on neonatal haemoglobin concentration. We retrospectively analysed 108 twin deliveries over a 5-year period. Chorionicity was determined by first trimester ultrasound or placental histopathology. The mode of delivery, time of delivery and cord/neonatal blood counts were recorded. A total of 88 sets of dichorionic and 20 sets of monochorionic twins were studied. There was no correlation between inter-twin delivery interval and haemoglobin difference (rho = 0.020, p = 0.857). In monochorionic twin pregnancies, there was a trend towards increasing inter-twin hemoglobin differences with prolonged delivery intervals. However, this trend did not reach statistical significance (rho = -0.303, p = 0.193). In monochorionic twins, there is a trend towards a lower haemoglobin concentration in the twin delivered second. This haemoglobin deficit appears to be related to the inter-twin delivery interval.

Delivery, Obstetric↗

PubMed2005

Fetal congenital cardiac diverticulum with pericardial effusion: two cases with different presentations in the first trimester of pregnancy.

Two cases of fetal congenital cardiac diverticula diagnosed at 14 and 12 weeks of gestation are reported. Both presented with a large pericardial effusion. One fetus presented with increased NT which evolved into fetal hydrops. Pericardiocentesis at 16 weeks led to progressive resolution of hydrops. The other showed no hemodynamic compromise, normal nuchal translucency (NT) and spontaneous regression of the effusion. Both children were well at 22 and 17 months of age at the time of writing.

Adult↗

PubMed2005

The sensitivity of antenatal ultrasound for predicting renal tract surgery in early childhood.

OBJECTIVE: To establish the sensitivity of antenatal ultrasound for identifying the need for renal tract surgery in infancy and early childhood. METHODS: A retrospective analysis of the surgical records in children under 5 years of age undergoing renal tract surgery in a regional pediatric urological surgery referral unit was carried out. All records between May 1997 and July 2002 were examined to assess the relationship between prenatal ultrasound findings and postnatal surgical pathology. RESULTS: A total of 106 operations had been performed. The detection rate of multicystic renal dysplasia was 100% (17/17). The equivalent detection rates for pelviureteral junction obstruction, duplex renal system and vesicoureteral reflux were 82.8, 67 and 26.1%, respectively. None of the babies with renal tumors had abnormal antenatal ultrasound findings. The diagnosis of postnatal renal surgical pathology was made on the basis of prenatal scan findings in 59.6% of cases, while recurrent urinary tract infection led to the diagnosis in 26.0%. CONCLUSIONS: Approximately 40% of children requiring surgery for renal tract pathology will have a normal antenatal ultrasound examination. The prevalence of abnormal antenatal ultrasound findings varies depending on the type of renal tract pathology. Despite these findings, the commonest indicator for surgery remains abnormal prenatal scan findings, followed by recurrent urinary tract infections.

Child, Preschool↗

PubMed2005

Neonatal outcome of antenatally diagnosed congenital cystic adenomatoid malformations.

OBJECTIVE: To investigate the natural history and outcome of antenatally diagnosed congenital cystic adenomatoid malformation (CCAM) of the lung. METHODS: This was a retrospective study of all cases of fetal CCAM of the lung diagnosed antenatally. All cases were referred to a tertiary center for further management. A computer search identified all referred cases, and the records of these patients were examined to determine the pregnancy outcome. RESULTS: In a 4-year period, 34 cases of fetal CCAM were referred for further management. At presentation, all the cases were noted to be unilateral CCAMs and the majority (79%) were microcystic in nature. The CCAMs were complicated by varying degrees of mediastinal shift (79%) and hydrops fetalis (18%). During the course of the pregnancy, the lung lesion was seen to reduce in size or resolve spontaneously in 76% of cases without any prenatal intervention (including resolution of hydrops in three cases). The overall survival rate into infancy was 88%. One pregnancy was terminated for persisting hydrops fetalis and another resulted in infant death from complications of neonatal cardiac surgery for an associated aortic coarctation. CONCLUSION: The outcome of antenatally detected CCAM is much better than previously reported even when complicated by hydrops fetalis at presentation. The latter seems to be related to the high spontaneous regression rate of this tumor. Despite the antenatal resolution of CCAMs on ultrasound, postnatal follow-up is recommended in view of the long-term complications of this malformation.

Cystic Adenomatoid Malformation of Lung, Congenita↗

PubMed2004

Second-trimester uterine artery Doppler and spontaneous preterm delivery.

OBJECTIVE: To assess the relationship between second-trimester uterine artery (UtA) Doppler measurements and spontaneous preterm delivery. METHODS: This was a retrospective analysis of UtA Doppler findings at 18-23 weeks' gestation in 234 singleton pregnancies with spontaneous preterm labor and 5472 pregnancies delivered at term. Cases with fetal chromosomal or structural abnormalities, pre-eclampsia, small-for-gestational-age (SGA) fetuses, concurrent maternal disease, cervical cerclage or history of cone biopsy were excluded. RESULTS: UtA mean resistance index (RI) and number of protodiastolic notches were not significantly different in the spontaneous preterm labor group compared to the normal group. The 62 preterm deliveries not preceded by spontaneous preterm premature rupture of membranes (PPROM) showed a significantly higher RI and prevalence of bilateral notches than cases of preterm deliveries preceded by PPROM (n = 172). However, this difference was not confirmed in a logistic regression model. CONCLUSION: Despite pathological evidence suggesting that defective placentation is associated with spontaneous preterm delivery, second-trimester UtA resistance, as assessed by Doppler ultrasound investigation, is not different in pregnancies subsequently complicated by preterm labor compared to pregnancies delivered at term.

Adult↗

PubMed2004

Effect of parity on second-trimester uterine artery Doppler flow velocity and waveforms.

OBJECTIVES: To investigate the relationship between second-trimester uterine artery Doppler findings and parity in a large pregnant population. METHODS: Uterine artery Doppler studies were performed in all singleton pregnancies at 18-23 weeks of gestation. The mean uterine artery resistance index and the presence or absence of protodiastolic notches were recorded. Two groups were identified: pregnancies not complicated by pre-eclampsia, and pregnancies with pre-eclampsia severe enough to require delivery at or before 32 weeks of gestation. RESULTS: In the 4132 pregnancies uncomplicated by pre-eclampsia, parity was shown to be an independent predictor for both mean uterine artery resistance index (beta = 0.073, P < 0.001) and the presence of bilateral protodiastolic notches (odds ratio = 0.67; 95% CI, 0.45-0.98). In the 17 pregnancies complicated with severe pre-eclampsia, uterine artery Doppler indices showed a trend towards being better predictors of disease in nulliparous compared with parous women. CONCLUSION: Parity has a significant effect on the resistance index and the prevalence of protodiastolic notching in the uterine artery flow waveforms. This difference is clinically noticeable in its effect on notching. These findings suggest that some permanent modification may persist in the maternal vessels after a successful pregnancy, altering their impedance in subsequent pregnancies.

Adult↗

PubMed2003

Nuchal translucency thickness measurement: repeatability using a virtual ultrasound scanner.

AIM: To use a PC-based virtual ultrasound scanner (VirUS) in the investigation of inter- and intraoperator nuchal translucency (NT) thickness measurement repeatability of experienced ultrasound operators. METHODS: Realistic fetal ultrasound images of defined NT thickness were simulated with VirUS with emulation of scanner gain and time-gain compensation and gain-dependent echo size changes. A set of 50 images was generated with uniformly distributed NT thickness (range, 1-5 mm at 1-mm intervals) and translucency angle (mean +/- standard deviation of +/- 2.52 degrees +/- 1.85 degrees about the horizontal). Operators (n = 13) measured NT thickness in the image set on three occasions separated by at least 1 day, giving 150 measurements per operator (total measurements, 1950). RESULTS: Inter- and intraoperator repeatabilities were +/- 0.41 mm and +/- 0.22 mm, respectively (at the 95% confidence level). There were significant correlations between repeatability and mean measured NT thickness (r = - 0.72, P = 0.005 at 4-mm interval), between gain and mean measured NT thickness (P </= 0.002, n = 8/13) and between gain and repeatability coefficient (P < 0.01, n = 6/13). DISCUSSION: VirUS provides a consistent NT audit environment and demonstrates the need to both optimize repeatability vs. mean measured thickness and to set gain consistently. The technique has potential in operator training.

Computer Simulation↗

PubMed2003

First-trimester uterine artery blood flow and birth weight.

OBJECTIVES: To determine reference values for first-trimester uterine artery resistance index (RI) in healthy pregnant women with uncomplicated pregnancies and to investigate the relationship between uterine artery Doppler indices and birth weight. METHODS: This was a cross-sectional study of 265 consecutive pregnant women attending routine ultrasound examination at 11-14 weeks' gestation. Both uterine arteries were identified using color Doppler ultrasound and the RI was measured. The presence or absence of an early diastolic notch was also noted. Pregnancy outcomes were obtained from the delivery suite database and birth weight was expressed as Z-scores. RESULTS: The 5(th), 50(th) and 95(th) centiles for uterine artery RI between 11 and 14 weeks' gestation were 0.53, 0.71 and 0.85, respectively. Complete pregnancy outcome data were available for 246 fetuses. There was a significant negative correlation between birth-weight Z-scores and first-trimester uterine artery mean RI (r = - 0.219, P = 0.001). The difference in birth weight between fetuses with absent and those with bilateral diastolic notches was also significant (P < 0.001). Multiple regression analysis demonstrated that both mean RI (standardized regression coefficient = - 0.14, P = 0.039) and uterine artery notching (standardized regression coefficient = - 0.17, P = 0.017) contributed independently towards the prediction of birth-weight Z-score. CONCLUSIONS: A significant negative correlation exists between birth weight and first-trimester uterine artery Doppler parameters, a reliable and non-invasive method of examining uteroplacental perfusion. The value of first-trimester uterine artery Doppler as a prognostic screening tool, either in isolation or in conjunction with maternal biochemistry, remains to be determined.

Adolescent↗

PubMed2002

Comparison of feticide carried out by cordocentesis versus cardiac puncture.

OBJECTIVE: Feticide may be achieved by the injection of strong potassium chloride (KCl) into the fetal circulation via the cardiac route, or less frequently, into the umbilical cord. Despite the relative frequency of this procedure, little published information is available on the subject. SUBJECTS AND METHODS: This was a retrospective analysis of all feticide procedures carried out prior to legal pregnancy termination in mid trimester of pregnancy from January 1996 to July 2001, in a tertiary fetal medicine referral center. The effect of gestational age and the route of access to fetal the circulation on the dose of strong KCl required to achieve cardiac asystole was evaluated. RESULTS: A total of 106 women underwent the procedure of feticide during the study period. Gestational age had no effect on the dose of strong KCl. The median dose of KCl administered by cordocentesis (5 mL) was significantly less (P < 0.001) than the dose required when fetal cardiocentesis was performed for administration of the drug (10 mL). CONCLUSION: This is the first comparative study of feticide by the administration of strong KCl by fetal cardiocentesis and cordocentesis. The study demonstrates that both cardiac and umbilical routes can be used to achieve feticide effectively, without compromising maternal safety. A finding of this study is that significantly smaller doses of KCl were required to achieve fetal cardiac asystole when using the umbilical compared to the cardiac route, although this may be explained by differences in technique. Strong 15% KCl can safely be used to achieve feticide in volumes up to 20 mL for cardiocentesis and 8 mL for cordocentesis.

Abortion, Induced↗

PubMed1995

Measures of acuity in primary-school children and their ability to detect minor errors of vision.

492 five to nine year old children participated in a study of the ability of three tests of linear acuity --the Sonksen-Silver Acuity System (SSAS), the Sheridan Gardiner 7-letter chart and the Keelers MK2 chart to identify children requiring specialist visual examination. The ability of the three tests to detect children with visual defects at 6m and of the SSAS in several test test conditions (3m and 6m, monocular and binocular) was investigated at two acuity levels for referral (3/4.5 or 6/9 and 3/6 or 6/12). Although specificity was very high for all tests and test conditions using a 3/6 or 6/12 cut-off for referral, the sensitivity and yield were disappointingly low; higher levels of the latter were achieved at the expense of a degree of specificity using a 3/4.5 or 6/9 cut off. Similarly, sensitivity and yield were greater for the monocular than binocular condition and for the 6m than 3m condition. A test of near vision (SSAS) did not detect any children not already identified by a distance measure. The optometric and developmental rationale behind the differences is discussed.

Animals↗

PubMed1994

Structure determination of the intact major sialylated oligosaccharide chains of recombinant human erythropoietin expressed in Chinese hamster ovary cells.

Recombinant human erythropoietin (rHuEPO) is used abundantly in the clinic to stimulate red blood cell growth in anaemic patients. The efficacy of the drug depends strongly on the extent of sialylation of its carbohydrate moiety. Prompted by conflicting literature reports on the issue, we reinvestigated the structures of the intact sialylated carbohydrate chains of rHuEPO expressed in Chinese hamster ovary (CHO) cells. The asparagine-linked oligosaccharides were released from rHuEPO with N-glycanase and fractionated by anion-exchange chromatography. The O-linked oligosaccharides were released under alkaline borohydride conditions. The primary structures of the major sialylated N- and O-type oligosaccharides were identified by 500-MHz 1H-NMR spectroscopy, supported by data from composition analysis, methylation analysis, low- and high-pH anion-exchange chromatography, and fast atom bombardment-mass spectrometry. The most abundant N-linked oligosaccharides in CHO cell-derived rHuEPO were found to be di-antennary, 2,4-branched tri-antennary, 2,6-branched tri-antennary and tetra-antennary chains (in the ratio of 7:6:5:82), with the latter containing between zero and three repeating N-acetyllactosamine units, in well-defined branches. The major (> 95%) di-, tri- and tetra-antennary structures are fully sialylated, i.e. they have two, three and four sialic acid residues, respectively, linked exclusively alpha(2-->3) to galactose residues. The majority (> 95%) of N-linked structures contain alpha(1-->6)-linked fucose at the proximal GlcNAc residue. The O-type mono- and disialyl oligosaccharides were characterized as a linear tri- and a branched tetra-saccharide, respectively.

Amidohydrolases↗

PubMed1992

High-performance anion-exchange chromatography of asparagine-linked oligosaccharides.

Oligosaccharides released enzymatically by N-glycanase from fetuin, alpha-acid glycoprotein, human chorionic gonadotropin, platelet-derived growth factor, and kallikrein were chromatographed on a polymeric pellicular anion-exchange column at pH values of 5 and 13. Separations occurred into groups of peaks containing the same number of sialic acids with an additional separation dependent upon the nature of the antennary structure present. High pH conditions were required for the optimum separation of fetuin oligosaccharides, while low pH conditions significantly improved resolution of oligosaccharides obtained from the other glycoproteins. The analytical separation of oligosaccharides under conditions of low pH has important implications in the development of chromatographic mapping and identification techniques for N-linked oligosaccharides present on recombinant proteins.

Animals↗

PubMed1992

Computer simulation of human tympanic membrane.

Because of the difficulties in studying the mechanical properties of the human tympanic membrane in situ, structural data from the cadaveric tympanic membrane samples is used for simulation of the surface structure of the tympanic membrane with the help of a computer. The hitherto poorly understood contour of the tympanic membrane is available for the development of a tympanic membrane and middle ear model.

Computer Simulation↗

PubMed1990

Predictive value of the nonreactive nonstress test in evaluating neonatal outcome.

High-risk pregnancies were followed up with antepartum foetal heart testing, in terms of perinatal mortality, Apgar score and incidence of caesarian section for foetal distress to look for the significance of a nonreactive nonstress test in 143 cases. The mean sensitivity was 65.64%, mean positive predictive value was 23.12%, and mean false positive rate was 76.87% for the nonreactive test results.

Apgar Score↗

PubMed1977

Etiology of the retraction pocket in the posterosuperior quadrant of the eardrum.

The tympanic membrane meets the posterosuperior bony canal wall at a wide angle and thus makes the posterosuperior quadrant of the eardrum the most vulnerable part against the thrust effect of the air column in the external auditory canal compared with the rest of the pars tensa. The air column thrust effect becomes active when there is a decrease in the middle ear pressure because of Eustachian tube obstruction. The medial displacement of the eardrum exposes the posterosuperior quadrant of the eardrum to the venturi effect in the isthmus tympanicus posticus and the region below. The retraction pocket is the end result.

Ear Diseases↗

PubMedDate not supplied

Bootstrap finance: the art of start-ups.

Entrepreneurship is more popular than ever: courses are full, policymakers emphasize new ventures, managers yearn to go off on their own. Would-be founders often misplace their energies, however. Believing in a "big money" model of entrepreneurship, they spend a lot of time trying to attract investors instead of using wits and hustle to get their ideas off the ground. A study of 100 of the 1989 Inc. "500" list of fastest growing U.S. start-ups attests to the value of bootstrapping. In fact, what it takes to start a business often conflicts with what venture capitalists require. Investors prefer solid plans, well-defined markets, and track records. Entrepreneurs are heavy on energy and enthusiasm but may be short on credentials. They thrive in rapidly changing environments where uncertain prospects may scare off established companies. Rolling with the punches is often more important than formal plans. Striving to adhere to investors' criteria can diminish the flexibility--the try-it, fix-it approach--an entrepreneur needs to make a new venture work. Seven principles are basic for successful start-ups: get operational fast; look for quick break-even, cash-generating projects; offer high-value products or services that can sustain direct personal selling; don't try to hire the crack team; keep growth in check; focus on cash; and cultivate banks early. Growth and change are the start-up's natural environment. But change is also the reward for success: just as ventures grow, their founders usually have to take a fresh look at everything again: roles, organization, even the very policies that got the business up and running.

Capital Financing↗