Maternal and perinatal outcome in multifetal gestation

Background: Multifetal gestation is a high-risk pregnancy associated with increased maternal and fetal complications. The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). The present study aims to investigate maternal and perinatal outcome in multifetal gestation.Methods: The prospective study was carried in the department of obstetrics and gynaecology, B. J. medical college, civil hospital, Ahmedabad from August 2019 to July 2020. All cases of multifetal pregnancy either admitted from antenatal clinics or from labor room as emergency cases were included in the study.Results: Out of total 7786 births during this period, 103 were twin pregnancies and 3 were triplets. The incidence was 1 in 73.5 births. Maternal complications observed were anaemia in 27.3% patients, preterm deliveries in 58% patients, PROM in 20.7% patients, hypertensive disorders of pregnancy in 13.2% patients, APH in 1.8% patients and PPH in 4.7% patients. No maternal mortality occurred. Fetal complications like gross congenital anomalies in 6.13% cases, single fetal demise in 8.49%, growth discordance in 7.53%, fetal growth restriction in 5.18% cases and 82% babies were low birth weight. Still birth rate was 8.01% and perinatal mortality rate was 12.3%.Conclusions: Early detection of high-risk cases, timely referral, frequent antenatal visits and early hospitalization with optimum obstetrics care and intensive neonatal care set up are necessary to improve maternal and perinatal outcomes

Taking stock of 10 years of published research on the ASHA programme: Examining India’s national community health worker programme from a health systems perspective

Background: As India’s accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW–health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight

VITAMIN C AS AN ADD ON SUPPLEMENTATION TO STANDARD ANTITUBERCULAR TREATMENT IMPROVES SPUTUM SMEAR CONVERSION IN NEWLY DIAGNOSED DRUG SENSITIVE PULMONARY TUBERCULOSIS PATIENTS

Objective: This study was aimed to evaluate the effect of oral supplementation of Vitamin C along with standard anti-tubercular (anti TB) drugs on the sputum smear conversion in the newly diagnosed pulmonary tuberculosis (TB) patients. Methods: This was a prospective, observational study in which 49 newly diagnosed pulmonary TB patients were given oral vitamin C supplementation along with standard anti TB treatment during intensive phase (2 months)  of the treatment. Examination of sputum smear at the end of intensive phase of anti-tubercular treatment was done. At the end of intensive phase, comparison was done between results of sputum smear examination of study population with the TB patients of general population from the same locality who were receiving only standard anti TB treatment and not add on Vitamin C supplementation. Results: The comparison between the results of study population (Sputum conversion – 100%) with that of general population (Sputum conversion – 92.47%) shows significant difference between both the population with p value < 0.05 (p-value = 0.041). Conclusion: This study showed that Vitamin C supplementation as add on therapy to the existing standard anti TB treatment improves the sputum smear conversion and decreases the disease activity to a greater extent than routine standard anti TB treatment alone

Transarterial radioembolization with Iodine-131-Lipiodol for hepatic metastases from gastrointestinal malignancies – Experience in tertiary care oncology center in India

Context: Unresectable colorectal hepatic metastases can be treated with radioembolization. Aims: The aim of this study is to analyze the response and survival benefits of transarterial radioembolization (TARE) with Iodine-131 (131I) Lipiodol for hepatic metastases from gastrointestinal malignancies. Settings and Design: Retrospective study of 20 patients with pathologically proven hepatic metastases from primary gastrointestinal malignancies referred for palliative therapy with TARE. Subjects and Methods: At baseline, standard laboratory and imaging data were recorded. All patients fulfilling the inclusion/exclusion criteria underwent TARE with 131I Lipiodol. Post procedure, the patients were reviewed after 1 month with follow-up positron emission tomography–computed tomography and tumor marker levels to evaluate treatment response with continued follow-up till December 2016 and overall survival calculated. Statistical Analysis Used: Data were analyzed using a statistical analysis package (Social sciences, version 15.0 for Windows; SSPS Inc.). Survival data were plotted using Kaplan–Meier survival curves. Results: At the end of follow-up period, 15 of 20 patients were alive. The mean and median survival was 38.88 ± 5.0 months (95% confidence interval [CI], 29.03–48.74 months, P = 0.17) and 49.3 ± 12.4 months (95% CI, 25.0–73.7 months, P = 0.17), respectively. 66 months survival was 75%. Response evaluation in 10 patients showed partial response in 3 (30%), stable disease in 2 (20%) and progressive disease in 5 (50%) patients. All patients with partial response showed a reduction in serum tumor marker levels. Conclusions: TARE with 131I-Lipiodol is highly effective with a significant survival benefit in refractory cases of hepatic metastases from gastrointestinal malignancies

Multivariate Correlation and Path Coefficient Analysis of Various Agro-Physiological Traits in CIMMYT Accessions of Bread Wheat [Triticum aestivum (L.) em. Thell]

Bread wheat (Triticum aestivum L. em. Thell) is one of the most vital staple crops globally, providing sustenance for billions of people. The continued increase in the global population, coupled with the ever-changing climate patterns and growing concerns about food security, has intensified the need for enhancing the productivity and adaptability of wheat varieties. In this context, in the 2019-20 Rabi season, a research study was conducted at Banaras Hindu University's Agriculture Research Farm, Varanasi, in a randomized complete block design with two replications. This research examines the association and interrelationships between thirteen different agro-physiological traits among fifty accessions of CIMMYT bread wheat. The results demonstrate significant positive correlations between grain yield and yield-related traits, including plant height, spike length, biological yield per plot, test weight, and harvest index at both genotypic and phenotypic levels. Further analysis using path coefficients shed light on the direct and indirect effects of these traits on grain yield. Among the studied traits, harvest index and biological yield per plot were found to have higher direct effects than others. Days to 50 % flowering, days to maturity, plant height, canopy temperature showed negligible positive direct effect on grain yield. These findings hold significant promise for informing and optimizing selection and breeding programs aimed at enhancing wheat varieties

Comparative yield of molecular diagnostic algorithms for autism spectrum disorder diagnosis in India: evidence supporting whole exome sequencing as first tier test

Abstract Background Autism spectrum disorder (ASD) affects 1 in 100 children globally with a rapidly increasing prevalence. To the best of our knowledge, no data exists on the genetic architecture of ASD in India. This study aimed to identify the genetic architecture of ASD in India and to assess the use of whole exome sequencing (WES) as a first-tier test instead of chromosomal microarray (CMA) for genetic diagnosis. Methods Between 2020 and 2022, 101 patient-parent trios of Indian origin diagnosed with ASD according to the Diagnostic and Statistical Manual, 5th edition, were recruited. All probands underwent a sequential genetic testing pathway consisting of karyotyping, Fragile-X testing (in male probands only), CMA and WES. Candidate variant validation and parental segregation analysis was performed using orthogonal methods. Results Of 101 trios, no probands were identified with a gross chromosomal anomaly or Fragile-X. Three (2.9%) and 30 (29.7%) trios received a confirmed genetic diagnosis from CMA and WES, respectively. Amongst diagnosis from WES, SNVs were detected in 27 cases (90%) and CNVs in 3 cases (10%), including the 3 CNVs detected from CMA. Segregation analysis showed 66.6% (n = 3 for CNVs and n = 17 for SNVs) and 16.6% (n = 5) of the cases had de novo and recessive variants respectively, which is in concordance with the distribution of variant types and mode of inheritance observed in ASD patients of non-Hispanic white/ European ethnicity. MECP2 gene was the most recurrently mutated gene (n = 6; 20%) in the present cohort. Majority of the affected genes identified in the study cohort are involved in synaptic formation, transcription and its regulation, ubiquitination and chromatin remodeling. Conclusions Our study suggests de novo variants as a major cause of ASD in the Indian population, with Rett syndrome as the most commonly detected disorder. Furthermore, we provide evidence of a significant difference in the diagnostic yield between CMA (3%) and WES (30%) which supports the implementation of WES as a first-tier test for genetic diagnosis of ASD in India