The period from conception to two years of life denotes a critical window of opportunity for promoting optimal growth and development of children. Poor nutrition and health in women of reproductive ...age and during pregnancy can negatively impact birth outcomes and subsequent infant survival, health and growth. Studies to improve birth outcomes and to achieve optimal growth and development in young children have usually tested the effect of standalone interventions in pregnancy and/or the postnatal period. It is not clearly known whether evidence-based interventions in the different domains such as health, nutrition, water sanitation and hygiene (WASH) and psychosocial care, when delivered together have a synergistic effect. Further, the effect of delivery of an intervention package in the pre and peri-conception period is not fully understood. This study was conceived with an aim to understand the impact of an integrated intervention package, delivered across the pre and peri-conception period, through pregnancy and till 24 months of child age on birth outcomes, growth and development in children.
An individually randomized controlled trial with factorial design is being conducted in urban and peri-urban low- to mid-socioeconomic neighbourhoods in South Delhi, India. 13,500 married women aged 18 to 30 years will be enrolled and randomized to receive either the pre and peri-conception intervention package or routine care (first randomization). Interventions will be delivered until women are confirmed to be pregnant or complete 18 months of follow up. Once pregnancy is confirmed, women are randomized again (second randomization) to receive either the intervention package for pregnancy and postnatal period or to routine care. Newborns will be followed up till 24 months of age. The interventions are delivered through different study teams. Outcome data are collected by an independent outcome ascertainment team.
This study will demonstrate the improvement that can be achieved when key factors known to limit child growth and development are addressed together, throughout the continuum from pre and peri-conception until early childhood. The findings will increase our scientific understanding and provide guidance to nutrition programs in low- and middle-income settings.
Clinical Trial Registry - India #CTRI/2017/06/008908; Registered 23 June 2017, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies.
Abstract
Background
Ventriculoperitoneal shunt (VPS) is a common technique employed to treat the second most common congenital brain malformation, “hydrocephalus.” Postshunt insertion, the ...consequent complications and factors contributing to shunt malfunction are much fought occurrences. The current study was planned to assess the effectiveness of the procedure, analyze the complications of VP shunt, and recognize the factors influencing shunt malfunction.
Materials and Methods
The present study was a retrospective observational study, which was conducted at the Department of Neurosurgery, PGIMER RML Hospital, New Delhi, from August 2016 to July 2018. Patients with hydrocephalus requiring shunt intervention were included in the study. A Chhabra “slit n spring” hydrocephalus shunt system was inserted in all patients. All patients with VP shunts were followed to assess for any postshunt complications.
Results
Out of 541 patients for whom VP shunt was inserted over a period of 2 years, 126 (23.3%) patients developed complications. The most common cause of hydrocephalus for which VP shunt was done was tubercular meningitis (39.3%,
n
= 63), followed by ventriculitis (12.38%,
n
= 20), congenital hydrocephalus (8.87%,
n
= 14) and aqueductal stenosis (5.54%,
n
= 03). The most common complication in our study was obstruction of proximal end of the catheter by debris, which was noted in 50 patients (39.68%). The second most common complication was poor peritoneal absorption or obstruction of lower end (21.43%,
n
= 27 cases). Abscess along the shunt was seen in 21 patients (16.67%). Complications were mostly documented in cases with hydrocephalus due to tubercular meningitis (TBM) (39.3%, 63 patients) and ventriculitis (12.38%, 20 patients). Other complications were hyperemia with superficial ulceration or complete exposure of skin overlying the tube (11.9%,
n
= 15), overdrainage of the ventricles leading to chronic subdural hematoma (
n
= 14, 11.11%), and infection around the distal catheter (4.76%,
n
= 6).
Conclusion
VPS procedure led to a complication in several patients, with the most common being obstruction of proximal catheter and poor peritoneal absorption or obstruction of lower end followed by abscess and infection.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Herein, we demonstrated the synthesis of a hollow cylinder with a new architecture of up to several centimeters in diameter and several centimeters long and having similar to 100 mu m wall thickness. ...The hollow carbon cylinder was formed by radially aligned CNTs. These CNTs were grown on ferrocene derived Fe nanoparticles deposited throughout the inner wall of the quartz growth tube. This new ingenious carbon architecture was grown by a customized spray pyrolysis method. Furthermore, we also synthesized such carbon hollow cylinders using different precursor concentrations (ferrocene:benzene), different phases and microstructures to evaluate their EMI shielding effectiveness. The structural and microstructural characterizations of these hollow carbon cylinders comprising radially aligned CNTs were examined through various techniques, including XRD, Raman, FTIR, XPS, SEM, TEM, and HRTEM spectroscopy. Furthermore, the magnetic measurements (M-H) were performed for such structures to probe the magnetic properties of these carbon hollow cylinders for different concentrations. Furthermore, the EMI shielding through different concentrations of Fe bearing CNTs were explored in detail for tailoring the desired shielding effectiveness value for possible potential applications. Hence, our synthesis method provides a unique architecture for promising next generation building blocks in the form of carbon hollow cylinders made up of radially aligned CNTs over the conventional randomly oriented CNTs. This could be directly used to make it as a co-axial cover for electrical cables to protect them from EMI pollutants.
The everyday practice of dentistry relies heavily on achieving adequate local anesthesia. Even though the safety record of local anesthetic agents is high, complications do occur. Palate is a ...favorable site for soft-tissue lesions. Various factors such as direct effects of the drug, blanching of the tissues during injection, relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate. Among various complications, anesthetic necrotic ulcer is a rare and uncommon condition occurring mostly in the hard palate possibly after a local anesthetic infiltration. The ulceration is often deep and shows spontaneous but delayed healing. If proper treatment is not instituted on time, the necrosis can reach deep into the bone causing sequestrum formation and ultimately leading to palatal perforation. Here, we report a case of palatal perforation in a male patient followed by surgical interventions and follow-up.
Hormonal fluctuations during menopause lead to endocrine changes in women, especially in their sex steroid hormone production. Studies have documented the role of estrogen and progesterone (Pg) on ...autoimmune disorders such as multiple sclerosis, systemic lupus erythematosus, and rheumatoid arthritis. Lichen planus (LP), an autoimmune disorder, seen frequently in perimenopausal women, may also get affected by sex steroid hormones, but no direct relationship has been established yet.
The aim of this study is to find the incidence of oral LP (OLP) in perimenopausal women and evaluate the factors associated with it.
This cross-sectional study was conducted over a period of 1 year. All the perimenopausal women (44.69 ± 3.79 years) who came to the dental outpatient department were evaluated for the presence of LP and various factors associated with it. Depression Anxiety Stress Scale-21 questionnaire was used for psychometric evaluation of perimenopausal women.
According to our study, incidence of LP in postmenopausal women was 10.91%, which is higher than incidence of LP in general population, i.e., 0.5% to 2.0%. Incidence of LP increased with the severity of depression in perimenopausal women (
= 0.000).
The incidence of OLP is higher in perimenopausal women than in general population and increases significantly with increase in the severity of depression. LP in perimenopausal women can be mediated by declined level of estrogen and Pg directly or indirectly through causing depression that can trigger LP.
Mutations in the CYP1B1, MYOC, OPTN, and WDR36 genes result in glaucoma. Given its expression in the optic nerve, it is likely a mutation in the OPTC gene is also involved in initiating glaucoma. ...This study was designed to evaluate the involvement of the CYP1B1, MYOC, OPTN, and OPTC genes in the etiology of adult-onset primary open-angle glaucoma (POAG) found in 251 Indian patients.
Blood samples were obtained from individuals for DNA isolation. A combination of polymerase chain reaction-single strand conformation polymorphism, allele-specific PCR, and DNA sequencing techniques were used to detect mutations in four genes. Four microsatellite markers from the CYP1B1 candidate region and three intragenic CYP1B1 single nucleotide polymorphisms (SNPs) were used to determine the origin of the most common CYP1B1 mutations.
Three previously known mutations (Pro193Leu, Glu229Lys, and Arg368His) and one novel (Met292Lys) mutation were found in the CYP1B1 gene. Frequencies of the most common mutations, Glu229Lys and Arg368His, in patients were 5.12% and 3.98%, respectively. The Glu229Lys and Arg368His mutations were also found in normal controls at frequencies of 5% and 2%, respectively, suggesting that these mutations might be polymorphic variants in our population. The absence of allele sharing for D2S177, D2S1346, D2S2974, and D2S2331 markers and three intragenic CYP1B1 SNPs in patients suggested multiple origins for the Glu229Lys and Arg368His variants. Two of 251 (0.8%) patients had the Gln48His mutation in MYOC. There was no difference in the frequency of a MYOC -83G>A promoter polymorphism between patients and controls. A novel OPTN mutation, Thr202Arg, was detected in one of 251 (0.4%) patients. The OPTN variant Met98Lys was detected in similar frequencies in patients and controls. No mutation was detected in OPTC. Taken together, 3.59% (9/251) of our POAG patients had mutations in the CYP1B1, MYOC, and OPTN genes.
This is the first report to document the involvement of the CYP1B1, MYOC, and OPTN genes in the etiology of POAG in the same set of Indian patients. Our study shows that mutations in these genes are rare in Indian POAG patients.
Abstract Tuberculosis caused by Mycobacterium tuberculosis, requires multi drug therapy approach. Drug resistance in M. tuberculosis is caused by mutations in specific regions in drug target genes. ...The study aimed to identify mutations in katG and rpoB genes and investigate the drug–drug target interactions. A total of 27 MDR-TB isolates were sequenced for katG and rpoB genes and docking and MIC analysis were performed. Three types of mutations for katG gene (Arg463Leu in all isolates of Sahariya and non-tribes; Asp529Thr and Asp529His, each in two isolates only, in Sahariya) were observed. In rpoB gene, the Ser531Leu change was observed in 17/21 isolates in Sahariya and 3/6 isolates in non-tribes. The docking analysis revealed that the drugs isoniazid and rifampicin bind to different residues in mutant forms than their proposed active sites, making active binding sites rigid and causing resistance. The MIC for isoniazid was found to range from 0.2 to 5 μg/ml in Sahariya tribe, whereas, in non-tribes, it is 0.2 μg/ml and 1 μg/ml. The MIC for rifampicin was observed at 64 μg/ml in both the population groups. The study explored the possible functional variation in isoniazid and rifampicin resistance with respect to the identified mutations. The present results indicate that these mutations affect the drug binding affinity and are causing resistance.
Summary Background The incidence/prevalence of tuberculosis (TB) is reported to be high in the Sahariya tribe of North Central India. The outbreaks of different drug-resistant isolates of ...Mycobacterium tuberculosis emphasized the need for continuous monitoring of resistance to anti-tuberculosis drugs. This study aimed to assess the profile of multidrug resistant TB among the Sahariya tribe and their non-tribal neighbors for first line drugs through field-based investigations. Methodology A total of 274 sputum positive pulmonary TB individuals were enrolled and studied for their drug susceptibility profile by the proportion method. Results A total of 21 cases from Sahariya and 6 from non-tribes were identified with MDR-TB. Thus Sahariya tribe showed a 1.95-fold increased risk of developing drug resistance than non-tribes. Significant differences were observed for developing drug sensitivity between Sahariya males and females when analyzed for resistance developed to any drug and overall drug resistance vs. sensitive isolates, respectively. A 4.46-fold risk was found for MDR-TB among the smokers of Sahariya tribe, whereas, the non-tribes did not show any significant association. Conclusion The drug susceptibility profile developed in the present study indicates that drug-resistant tuberculosis is emerging as a serious public health concern in Sahariya tribe. Urgent and effective control measures and better management policies are needed for the prevention of MDR-TB in the tribe.
Background: Various techniques of central neuraxial blockade have been tried and successfully used for caesarean section surgeries. Nowadays it is must and essential to know the possible effective ...dose of clonidine to overcome its known side effect like bradycardia, hypotension and sedation for better outcome of mother as well as foetus in lower segment caesarean section. We have conducted such study to compare different doses of clonidine as an adjuvant to intrathecal isobaric levobupivacaine. The plain levobupivacaine has been shown to truly isobaric with respect to CSF of pregnant women and this property got advantage over hyperbaric bupivacaine in its predictable spread. Materials and Methods: There were about 90 cases of emergency caesarean section of more than 37 weeks gestation with ASA physical status class 2 under spinal anaesthesia were randomly divided into three groups of 30 patients each. In all groups we assessed onset, two segment regression and requirement of analgesic in post-operative period, level of motor block by modified bromage scale Table 1 and sedation by Campbell sedation score Table 2. Maternal and foetal hemodynamic was monitored as well. Group A (n = 30) 10 mg of 0.5% (2 ml) isobaric levobupivacaine + 15 mcg clonidine (0.5 ml). Group B (n = 30) 10 mg of 0.5% (2 ml) isobaric levobupivacaine + 30 mcg clonidine (0.5 ml). Group C (n = 30) 10 mg of 0.5% (2 ml) isobaric levobupivacaine + 45 mcg clonidine (0.5 ml). Normal saline was used to make volume of clonidine upto 0.5 ml. Result: Onset of sensory block was highest in group A with significant difference (P value <0.0001) in all three groups. Two segment regression time (in minutes) was highest in group C with significant difference (P value <0.0001) in all three groups. There was fall in systolic blood pressure (SBP) <80% of baseline was found in 0 (0.00%), 10 (33.33%) and 22 (73.33%) patients in group A, B and C respectively while fall in HR <80% of baseline was found in 0 (0.00%), 1 (3.33%) and 19 (63.33%) patients. Sedation score was 1 in 30 (100%) patients in group A, it was 1 in 10 (33.33%), 2 in 20 (66.67%) in group B while it was 1 in 5 (16.77%), 2 in 10 (33.33%) and 3 in 15 (50%) patients in group C. Conclusion: Spinal anaesthesia performed with isobaric 0.5% levobupivacaine with 30 mcg clonidine (Group B) provides better haemodynamic stability, early onset of sensory and motor blockade, decreased requirement of post-operative analgesia.
Lichen planus is a chronic, autoimmune, mucocutaneous disease that shows differences in clinical presentation at different times of the year. The present retrospective study was conducted to clarify ...the meteorological factors that influence the incidence of lichen planus, as well as the general features and clinical presentation of this condition during three consecutive years, 2008, 2009, and 2010, in Moradabad district (Western Uttar Pradesh, India). The study group comprised 1,355 patients extracted from the records of the outpatient department of Kothiwal Dental College Research Centre and Hospital, who were clinically diagnosed as having lichen planus during this three-year period. The highest number of patients (735) were recorded in summer, and the lowest (56) in winter. Females were affected more often, and psychosocial influences were also evident. There were significant differences in the incidence of lichen planus in different seasons, and the summer peak was attributable to the intensity of sun exposure (actinic lichen planus and summertime lichen planus). (J Oral Sci 55, 311-318, 2013)
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