Effect of utilization of antenatal services on pregnancy outcome in Aligarh - A Community based study

Background: Low birthweight has long been used as an important public health indicator. Low birthweight is not a proxy for any one dimension of either maternal or perinatal health outcomes rather this indicator is a good summary measure of a multifaceted public health problem that includes long-term maternal malnutrition, ill health, hard work and poor pregnancy health care. Methods: The present Community based prospective study was conducted in the field practice areas of the Urban and Rural Health Training Centers, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh. Registered pregnant women who were in their first trimester and whose Expected Date of Delivery lie within our study period of one year were considered for study. Three home visits were made (two in antenatal period, one in post-natal period). Data was analyzed using SPSS version 20. Percentages, and Chi Square Test used.  Results: Prevalence of LBW was found to be 40%. Statistically significant association was found between antenatal visits, iron folic acid supplementation and birth weight of baby. Conclusion: More number of antenatal visits equate to better antenatal care of females.  It may result in better compliance with irofol supplementation and dietary intake and also early detection of any complications thus resulting in lower rates of LBW

Nutritional status among pregnant women of Aligarh district and its association with birth weight

Background: Low birth weight is a prospective marker of future growth and development and a retrospective marker of mothers nutritional and health status.Methods: A community based prospective study conducted in field practice areas of Urban and Rural Health Training Center Department of Community Medicine, JNMCH, AMU, Aligarh. Participants were registered pregnant women who were in their first trimester and whose expected date of delivery lies within our study period. Study period was of one year. Data was analyzed using SPSS version 20. Percentages and chi square test used.Results: Prevalence of LBW was found to be 40%. Occurrence of LBW babies decreased as the nutritional intake of mothers in the form of kilocalories consumed per day increased. The association between dietary calorie intake and birth weight was found to be statistically highly significant.Conclusions: Nutritional status of mother has to be improved not only during pregnancy, but also in her early childhood by undertaking food supplementation programs implemented through National Health Programs that improve the weight gain during delivery and result in improved fetal outcome

Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

Background: Simulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts.Methods: Sixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations.Results: The majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p \u3c 0.001. There was an average reduction of 1.3 s (β = - 1.3; 95% CI: - 1.66 to - 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above.Conclusion: We found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings

INTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES Dendrimers-a novel drug delivery system

Abstract Dendrimers are the polymeric materials for targeted delivery of drug molecule. These are the highly branched nanoscopic structure for the potential delivery of bioactive. The structure of these materials has a great impact on their physical and chemical properties. As a result of their unique behaviour dendrimers are suitable for a wide range of biomedical and industrial applications. The bioactive agents can be easily encapsulated into the interior of the dendrimers or chemically attached i.e. conjugated or physically adsorbed onto the dendrimer surface, serving the desired properties of the carrier to the specific needs of the active material and its therapeutic applications. In addition to supplying a multivalent backbone for drug attachment, dendrimers also provide access to various new polymer architectures that are potentially relevant to drug delivery applications. Through this review we are mainly focusing on the various properties and applications of dendrimer in pharmaceutical sciences

Diagnostic accuracy of point-of-care ultrasound compared to standard-of-care methods for endotracheal tube placement in neonates

Introduction: Point-of-care ultrasound (POCUS) is a valuable tool to determine endotracheal tube (ETT) placement; however, few studies have compared it with standard confirmation methods. We evaluated the diagnostic accuracy of POCUS and time-to-interpretation for correct identification of tracheal versus esophageal intubations compared to a composite of standard-of-care methods in neonates.Methods: A cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Aga Khan University Hospital Karachi, Pakistan. All required intubations were performed as per NICU guidelines. The clinical team simultaneously determined the ETT placement using standard-of-care methods (auscultation, colorimetric capnography, and chest X-ray) by POCUS. In addition, the clinical team was blinded to the POCUS images. Timings were recorded for each method by independent study staff.Results: A total of 348 neonates were enrolled in the study. More than half (58%) of intubations were in an emergency scenario. POCUS user interpretation showed 100% sensitivity and 94% specificity using an expert as the reference standard. We found a 99.4% agreement (Kappa: 0.96; p \u3c 0.001). Diagnostic accuracy of POCUS compared with at least two standard-of-care methods demonstrated 99.7% sensitivity, 91% specificity, and 98.9% agreement (Kappa:0.93; p \u3c 0.001). The median time required for POCUS interpretation was 3.0 (interquartile range [IQR] 3.0-4.0) seconds for tracheal intubation. The time recorded for auscultation and capnography was 6.0 (IQR 5.0-7.0) and 3.0 (IQR 3.0-4.0), respectively.Conclusion: POCUS is a rapid and reliable method of identifying ETT placement in neonates. Early and correct identification of airway management is critical to save lives and prevent mortality and morbidity

Exploring the long-term seroprevalence of SARS-CoV-2 antibodies in infants born to women with clinical or laboratory-confirmed COVID-19

Introduction: Infants are at a higher risk of severe illness with COVID-19 infection compared to older children. While COVID-19 vaccination is not recommended for young infants, they can acquire maternally-derived anti-SARS-CoV-2 antibodies passively through the placenta and breastmilk. We described the persistence of infection-induced maternal antibodies in infant circulation at 9-12 months of age.Methodology: This was a cross-sectional study nested within the INTERCOVID multinational cohort study. For each COVID positive pregnant woman, two unmatched consecutive COVID negative pregnant women were enrolled between April and September 2020. Women with a positive PCR test, radiographic signs consistent with COVID-19, or at least 2 predefined symptoms of COVID-19 were considered as COVID positive. For this nested cross-sectional study, all COVID positive and either one of the COVID negative participants recruited from the Aga Khan University, Pakistan were approached 9-12 months after delivery, and maternal and infant sera were collected for antibody detectionResults: Altogether, 83 mothers provided consent, of whom 32 (38.6 %) were COVID positive and 51 (61.4 %) were COVID negative during pregnancy. Anti-SARS-CoV-2 antibodies were present in 13 (41 %) infants born to COVID positive and 19 (39 %) infants born to COVID negative mothers (p = 0.87). The presence of reactive antibodies in infants at follow-up was associated with maternal antibodies at follow-up (OR:9.50, 95 % CI:2.03-44.42; p = 0.004). COVID infection occurred in 3 (6 %) infants born to COVID negative mothers while no infant born to a COVID positive mother had a history of infection (p = 0.27)Conclusion: The presence of reactive anti-SARS-CoV-2 antibodies in infants at 9-12 months of age is associated with maternal seropositivity 9-12 months after delivery rather than maternal infection during pregnancy. Further studies are required to validate these findings and assess whether passive immunity in infants is protective against COVID-19 infection