Micronutrient supplementation in pregnancy: a KAP survey with healthcare consultants in India

Background: Maternal nutrition during pregnancy is a serious public health issue as it negatively impacts women and their children. The most commonly used nutritional interventions during pregnancy are folic acid and omega-3 fatty acid (n-3 FA). This survey aimed to evaluate the knowledge, attitude and perception towards folic acid, n-3 FA and other supplementation amongst healthcare practitioners (HCPs). Methods: A close-ended questionnaire-based survey was distributed among obstetricians-gynaecologists and HCPs overlooking pregnant and lactating women between July and September 2022 in India. An excel based survey analysis was performed once the survey completed. Results: A total of 500 valid questionnaires were collected. Only 55% of them recommended n-3 FA, whereas 45% did not recommend as they believed that the typical Indian diet provides enough n-3 FA and supplements are not necessary. The majority (58.91%) of prescribers prescribed n-3 FA to all pregnant women, followed by older women with a history of abortion and high-risk pregnancy. Both eicosapentaenoic acid and docosahexaenoic acid were favoured in clinical practice. In addition, 56.8% of HCPs recommended folic acid at a dose of 5 mg/day for patients with a bad obstetric history, while 43.2% of HCPs recommended folic acid at a dose of 1 mg/day. Conclusions: Supplements and adequate nutrition can reduce the likelihood of poor maternal and foetal outcomes in high-risk pregnancies. Nutritional supplementation is a cost-effective and safe risk-reduction method, given the high prevalence of pregnancy complications. However, more knowledge dissemination on n-3 FA supplements, folic acid and micronutrients is essential

Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial

Importance: The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified. / Objective: To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age. / Design, Setting, and Participants: Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022. / Interventions: Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment. / Main Outcomes and Measures: The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years. / Results: Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]). / Conclusions and Relevance: In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life. / Trial Registration: anzctr.org.au Identifier: ACTRN12611000916943

Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies

Abstract Background Bronchopulmonary dysplasia (BPD) is the result of a complex process in which several prenatal and/or postnatal factors interfere with lower respiratory tract development, leading to a severe, lifelong disease. In this review, what is presently known regarding BPD pathogenesis, its impact on long-term pulmonary morbidity and mortality and the available preventive and therapeutic strategies are discussed. Main body Bronchopulmonary dysplasia is associated with persistent lung impairment later in life, significantly impacting health services because subjects with BPD have, in most cases, frequent respiratory diseases and reductions in quality of life and life expectancy. Prematurity per se is associated with an increased risk of long-term lung problems. However, in children with BPD, impairment of pulmonary structures and function is even greater, although the characterization of long-term outcomes of BPD is difficult because the adults presently available to study have received outdated treatment. Prenatal and postnatal preventive measures are extremely important to reduce the risk of BPD. Conclusion Bronchopulmonary dysplasia is a respiratory condition that presently occurs in preterm neonates and can lead to chronic respiratory problems. Although knowledge about BPD pathogenesis has significantly increased in recent years, not all of the mechanisms that lead to lung damage are completely understood, which explains why therapeutic approaches that are theoretically effective have been only partly satisfactory or useless and, in some cases, potentially negative. However, prevention of prematurity, systematic use of nonaggressive ventilator measures, avoiding supraphysiologic oxygen exposure and administration of surfactant, caffeine and vitamin A can significantly reduce the risk of BPD development. Cell therapy is the most fascinating new measure to address the lung damage due to BPD. It is desirable that ongoing studies yield positive results to definitively solve a major clinical, social and economic problem

Cost Estimates for Production of Flyash Based Zeolite -A

574-579National Environmental Engineering Research Institute (NEERI) has developed a process to manufacture zeolite-A using flyash as a substitute for conventional raw materials viz. sodium silicate and aluminate. This process has been patented nationally and internationally. The process developed consists of three majors steps viz. fusion of caustic soda and flyash for optimal extraction of silicates and aluminate, aging step which provides time for formation of nuclei and hydrothermal crystallization resulting in activation of nuclei into well defined crystals. Low temperature, operation simplicity of process and optimal recycling of unused reactants and process water are special features of NEERI Technology. Based on the laboratory-scale process, estimates have been worked out for cost benefit analyses. The process appears to be cost-effective wherein the cost of production is about 25-30 per cent less than the commercial zeolite-A. Further reduction in cost is envisaged due to reuse of mother liquor in the process itself

Chemical hydrides:Asolution to high capacity hydrogen storage and supply

Cycloalkanes are good candidate media for hydrogen storage (6.5 wt% and 60.62 kgH2/m3). A novel approach for the supply of hydrogen, through liquid organic hydrides (LOH) using catalytic reaction pair of dehydrogenation of cycloalkanes and hydrogenation of corresponding aromatics is a useful process for supply of hydrogen. Hydrogenation of aromatics is relatively well-established process. However, the efforts are needed to develop efficient catalyst for dehydrogenation of cycloalkanes. In this paper we review the dehydrogenation of cycloalkanes as useful reaction for storage of hydrogen in chemical hydride

A Non-Noble Metal Based Catalytic Converter for Two-Stroke, Two-Wheeler Applications

Two wheelers constitute almost three fourths of the vehicular population in developing countries like India, and consequently they are the major contributors to vehicular pollution. Catalytic converters based on nonnoble metal catalyst have been developed for 2-stroke, 2- wheelers application. In this study a modified and thermally stable alumina washcoat has been developed for application of non-noble metal catalyst. Alumina washcoat has been used on both ceramic and metallic honeycomb substrates and subsequently the perovskite type of catalyst has been synthesized in-situ on alumina washcoated substrates. Extensive characterization was carried out during development of alumina washcoat and synthesis of perovskite catalyst to establish the thermal stability of alumina washcoat and phase formation of catalysts. A number of prototypes based on alumina supported perovskite have been prepared and tested for mass conversion efficiency with respect to CO, HC and NOx. The results reveal the confirmation of performance of converter for EURO-I emission norms, which are presently applicable in India for 2-stroke, 2-wheelers. The optimized design of converter minimizes the pressure drop across the converter and the power loss of the engine is well within tolerable limits

Air Toxic Emission Inventory for Mobile Source and Fuel Quality Modeling

Fuel quality and vehicle technologies are linked very intimately and have a combined effect on emission levels. Fuel quality improvement alone can reduce total pollution load from vehicles to a certain extent. A spreadsheet-based model has been developed in this study. The emission factor based on variations in gasoline quality has been derived using “Complex” model of US EPA. The annual emission inventory for gasoline driven vehicles have been estimated with respect to volatile organic compounds (VOCs), toxic air pollutants (TAP) and nitrogen oxides (NOx) using vehicle population data, growth rate of vehicles and usage characteristics in cities from Indian subcontinent. Five pollutants were considered in TAP category: benzene, 1,3-butadiene, policyclic organic matter, formaldehyde, and acetaldehyde. The result of present and projected air toxic emission inventory using planned improvement in gasoline quality reveals that, the emission reduction less than 25% may be achieved. A significant reduction of about 69% in pollutant like benzene justifies the need of gasoline quality improvement in developing countries