Maternal determinants affecting perinatal mortality: a multivariate statistical approach

Background: India has made considerable progress over the last two decades in the area of maternal and child health, through innovative and comprehensive health packages that covers the spectrum of Reproductive Child Health (RCH). Awareness of the special vulnerability of the cohort of mothers with ‘high risk factor’ has led to the popular recognition of ‘risk approach’, involving the optimal use of existing MCH services, providing essential obstetrical care for all with early detection of complications and emergency services for those who need it, thus reducing the need for intensive care along with reduction in perinantal mortality. The objective was to assess the prevalence of various maternal risk factors in pregnant women in hospital admissions and their correlation with perinatal mortality.Methods: The present study was carried out on 2050 consecutive deliveries from 1st April 2015 to 31st March 2016 at Department of Obstetrics and Gynecology and Department of Pediatrics, Muzaffarnagar Medical College, Muzaffarnagar Uttar Pradesh, India. All the pregnant women were interviewed and examined in detail at the onset of labor regarding various biosocio-economic characteristics, history of past and present medical and obstetrical complications.Results: The PNMR (93.66/1000 birth) observed in present study was still at a higher level and comparable to that in other studies done by various authors in past in this region. A significantly higher PNMR was observed with increase in maternal age and parity (3 times higher PNMR at >35 years and 2 ½ times higher PNMR at parity >5). Similarly, medical illnesses (3 times higher PNMR) and obstetrical complications (1.5 times higher PNMR) during present pregnancy were showing significant effect on perinatal outcome. In a multivariate analysis, residence (rural /urban), place and number of antenatal visits, gestational age and type of delivery remained as most significant maternal risk factors (p35 years, parity >5, weight <40 kg, height < 140cm , poor dietary calories, medical and obstetrical complications. These can identified from history only by grass root workers like traditional birth attendants and even elderly female family members. These risk determinants, labeled as simple but ‘high’ high risk are associated with poor perinatal outcome. If these factors are timely identified at community level and appropriately referred by grass root workers, it will significantly reduce perinatal mortality and improve neonatal survival

Simulation Study of an Autonomous Ground Vehicle Model

The focus of the paper is to understand what an Autonomous Vehicle (AV) is, and realising a simulation model of intended vehicle for coarse testing of autonomous guidance navigation and control (AGNC) algorithm. MATLAB and SIMULINK are used as platform for development of this model. The model is developed to calculate the next position and direction of the vehicle based on the steering angle as commanded by the AGNC algorithm. This would lead towards the design of an scaled down model of AV using a modified radio control car chassis. The AV would then be equipped with a GPS and ultrasonic or infrared sensors to navigate it to a predetermined geographical location with obstacle avoidance. Keywords: Autonomous, Control, GPS, Model, Simulink, Vehicl

Identification, Functional Characterization, and Regulon Prediction of the Zinc Uptake Regulator (zur) of Bacillus anthracis – An Insight Into the Zinc Homeostasis of the Pathogen

Zinc has an abounding occurrence in the prokaryotes and plays paramount roles including catalytic, structural, and regulatory. Zinc uptake regulator (Zur), a Fur family transcriptional regulator, is connoted in maintaining zinc homeostasis in the pathogenic bacteria by binding to zinc and regulating the genes involved in zinc uptake and mobilization. Zinc homeostasis has been marginally scrutinized in Bacillus anthracis, the top-rated bio-terror agent, with no decipherment of the role of Zur. Of the three Fur family regulators in B. anthracis, BAS4181 is annotated as a zinc-specific transcriptional regulator. This annotation was further substantiated by our stringent computational and experimental analyses. The residues critical for zinc and DNA binding were delineated by homology modeling and sequence/structure analysis. ba zur existed as a part of a three-gene operon. Purified BaZur prodigiously existed in the dimeric form, indicated by size exclusion chromatography and blue native-polyacrylamide gel electrophoresis (PAGE). Computational and manual strategies were employed to decipher the putative regulon of ba zur, comprising of 11 genes, controlled by six promoters, each harboring at least one Zur box. The DNA binding capability of the purified BaZur to the upstream regions of the ba zur operon, yciC, rpmG, znuA, and genes encoding a GTPase cobalamine synthesis protein and a permease was ascertained by electrophoretic mobility shift assays. The regulon genes, implicated in zinc uptake and mobilization, were mostly negatively regulated by BaZur. The ba zur expression was downregulated upon exposure of cells to an excess of zinc. Conversely, it exhibited a marked upregulation under N, N, N′, N′-Tetrakis (2-pyridylmethyl) ethylenediamine (TPEN) mediated zinc-depleted environment, adding credence to its negative autoregulation. Moreover, an increase in the transcript levels of the regulon genes znuA, rpmG, and yciC upon exposure of cells to TPEN connoted their role in combating hypo-zincemic conditions by bringing about zinc uptake and mobilization. Thus, this study functionally characterizes Zur of B. anthracis and elucidates its role in maintaining zinc homeostasis

Dose optimization of ceftriaxone-vancomycin combination using fractional inhibitory concentration kinetics in resistant bacteria

The notorious Staphylococcus aureus resistant strains with ever changing resistance patterns have limited treatment options and have led to substantial number of deaths. Almost dried antibiotic pipeline has led us to look into combinations of already approved antibiotics for tackling rising incidence of antibacterial resistance. Recommended use of vancomycin and ceftriaxone together for treating severe infections involving resistant S. aureus is limited by dose adjustments and different dose frequencies. We have developed a pharmacodynamically synergistic fixed dose combination (FDC) of ceftriaxone and vancomycin (2:1), for eliminating individual component dose adjustments and frequencies. For identification of optimum exposure-response of FDC, one compartment in vitro system was used for dose escalation, fractionation and dose-response studies. The in-silico pharmacokinetic/pharmacodynamic (PK/PD) modeling, simulations and validations were done. The results suggested % T>MICcomb (percentage of time fractional inhibitory concentrations of the drugs combined remained above the MICcomb [minimum inhibitory concentration for FDC]) followed by AUCcomb/MICcomb (ratio of area under fractional inhibitory curves to MICcomb) can predict the exposure (dose of FDC)-response (reduction in bacterial load) relationships effectively (r2 >0.9). Total exposure of 6 g in two divided doses (3 g each) was identified to be optimum. Monte Carlo simulations were performed to evaluate the effect of increasing doses against different MICs. Clinical breakpoint of the FDC was identified to be 4 µg/mL, which was 2 fold higher than that of vancomycin suggesting better antibacterial coverage

WHO global research priorities for antimicrobial resistance in human health

The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR

Proceedings of tumor board meeting

The Tumour Board Meeting was held on August 16, 2011, in the Seminar Hall at B.J. Wadia Hospital for children. The panelists of the meeting were Dr. S. Ranganathan, Pediatric Pathologist from Children's Hospital of Pittsburgh; Dr. Archana Swami, Consultant Pediatric Oncologist at Wadia Children's Hospital; Dr. Sajid Qureshi Onco-surgeon (Pediatric) at Tata Memorial Hospital and Dr. Sushmita Bhatnagar

A single-dose PLGA encapsulated protective antigen domain 4 nanoformulation protects mice against Bacillus anthracis spore challenge.

Bacillus anthracis, the etiological agent of anthrax, is a major bioterror agent. Vaccination is the most effective prophylactic measure available against anthrax. Currently available anthrax vaccines have issues of the multiple booster dose requirement, adjuvant-associated side effects and stability. Use of biocompatible and biodegradable nanoparticles to deliver the antigens to immune cells could solve the issues associated with anthrax vaccines. We hypothesized that the delivery of a stable immunogenic domain 4 of protective antigen (PAD4) of Bacillus anthracis encapsulated in a poly (lactide-co-glycolide) (PLGA)--an FDA approved biocompatible and biodegradable material, may alleviate the problems of booster dose, adjuvant toxicity and stability associated with anthrax vaccines. We made a PLGA based protective antigen domain 4 nanoparticle (PAD4-NP) formulation using water/oil/water solvent evaporation method. Nanoparticles were characterized for antigen content, morphology, size, polydispersity and zeta potential. The immune correlates and protective efficacy of the nanoparticle formulation was evaluated in Swiss Webster outbred mice. Mice were immunized with single dose of PAD4-NP or recombinant PAD4. The PAD4-NP elicited a robust IgG response with mixed IgG1 and IgG2a subtypes, whereas the control PAD4 immunized mice elicited low IgG response with predominant IgG1 subtype. The PAD4-NP generated mixed Th1/Th2 response, whereas PAD4 elicited predominantly Th2 response. When we compared the efficacy of this single-dose vaccine nanoformulation PAD4-NP with that of the recombinant PAD4 in providing protective immunity against a lethal challenge with Bacillus anthracis spores, the median survival of PAD4-NP immunized mice was 6 days as compared to 1 day for PAD4 immunized mice (p<0.001). Thus, we demonstrate, for the first time, the possibility of the development of a single-dose and adjuvant-free protective antigen based anthrax vaccine in the form of PAD4-NP. Further work in this direction may produce a better and safer candidate anthrax vaccine

Glass forming ability of Te-Bi-Se based alloys

498-501In the present work, the relationships for the glass transition temperature Tg, the peak temperature Tp, and the difference of crystallization temperature and glass transition temperature, (Tc - Tg), for different heating rates have been studied with the increase in Bi content. With the increase in heating rates Tg, Tc  and Tp are found to increase. The glass transition temperature represents the strength or rigidity of the glass structure. This analysis helps in finding the suitability of an alloy to be used in phase transition optical memories/ switches