Reversible cerebral vasoconstriction syndrome in a young primigravida woman with pre-eclampsia

Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe headache and is associated with reversible segmental vasoconstriction of cerebral arteries. Conditions associated with RCVS are commonly pregnancy with or without pre-eclampsia, neurological procedures, head trauma. Thunderclap headache is the chief clinical presentation. Visual disturbances and focal neurological deficits are also frequently encountered. Posterior reversible encephalopathy syndrome and RCVS are often overlapping and hence most cases of RCVS are diagnosed late. We reported a young primigravida who had no comorbidities presenting to the ER with elevated blood pressure and generalised tonic and clonic seizures. Post-delivery her headache persisted and clinically her neurological status started deteriorating. Later she was diagnosed as RCVS. Treatment is based on expert opinion. Nimodipine, nifedipine or verapamil have been used in most patients

PREVALENCE OF OBESITY AMONG NURSING STUDENTS IN SRM COLLEGE OF NURSING, SRM UNIVERSITY,KATTANKULATHUR, KANCHEEPURAM DISTRICT.

Objective: The objective of the study was to determine the prevalence of obesity among the nursing students.Methods: The research approach was quantitative and the research design adopted was cross-sectional research design. The researcher used non- probability purposive sampling technique, and 80 students were selected for the study. World Health Organization body mass index scale was used to assess the prevalence of obesity.Results: Among 80 samples taken for the study 24 (30%) students are in the stage of underweight; 43 (53.8%) students are in normal weight; and 13 (16.2%) are in the stage of pre-obesity.Conclusion: The study findings revealed that 16.2% of the students are in pre-obese stage; hence, awareness regarding complications of obesity may prevent obesity among the nursing students.Keywords: Obesity, Body mass index, Complications, Underweight, Students

Bone health after menopause: effect of surgical menopaus on bone mineral density and osteoporosis

Background: Natural menopause or surgical menopause is associated with endocrinological changes and alteration in bone and mineral metabolism. Hence this study was conducted to assess the bone mineral density changes in women with surgical menopause. Methods: This is a prospective observational study conducted in the department of obstetrics and gynaecology at Sri Ramachandra medical college, which is a tertiary care teaching hospital. 60 women with surgical menopause were included in the study. BMD was assessed by dual energy X-ray absorptiometry at the lumbar spine and hip joint. All the data was entered in Microsoft excel spread sheet and analysed by using SPSS software.Results: Among 60 study subjects, 41 individuals had a normal BMD, 16 had osteopenia, and 3 were diagnosed with osteoporosis. Osteopenia and osteoporosis is significantly higher in patients who had undergone hysterectomy with removal of ovaries. Observations of osteopenia and osteoporosis were significantly higher with increasing number of years post hysterectomy.Conclusions: Prevalence of osteoporosis is high in patients who undergo hysterectomy. Oophorectomy is associated with postoperative bone loss. Targeted management strategies should include routine BMD assessment and hormone therapy improves management of bone health in this population. Further more studies are needed in large populations to test alternative treatments for post oophorectomy osteoporosis

Anti Urolithiatic and anti hyperlipidemic activity of Coleus aromaticus An explanation of the underlying mechanisms

Leaves paste of Coleus aromaticus is used as a traditional remedy for urolithiasis in India. In the present study, the anti urolithiatic activity of Coleus aromaticus was investigated in ethylene glycol induced urolithiatic rats. There was a significant increase in the levels of calcium oxalate crystals in the kidneys as well as lipid levels in the blood serum. Treatment with hydro alcoholic extract of C.aromaticus leaves (CALHAE) significantly reduced cholesterol levels at 300 and 600 mg/kg, and triglyceride levels at 600 mg/kg in urolithiatic rats. Histopathalogical reports confirmed that chronic administration of CALHAE (300 and 600 mg/kg) diminished number of calcium oxalate crystals in kidneys. CALHAE has shown reduction in thiobarbituric acid reactive substances (TBARS) in urolithiatic rats. Moreover, CALHAE showed potent in vitro antioxidant activity in DMPD, ABTS radicals (MnO2 method). Results from these studies support the safe and effective use of C.aromaticus leaves for urolithiasis treatment.Keywords: Coleus aromaticus, Calcium oxalate crystals, Hypolipidemic activity, Antioxidant activit

Anti Urolithiatic and anti hyperlipidemic activity of Coleus aromaticus An explanation of the underlying mechanisms

Leaves paste of Coleus aromaticus is used as a traditional remedy for urolithiasis in India. In the present study, the anti urolithiatic activity of Coleus aromaticus was investigated in ethylene glycol induced urolithiatic rats. There was a significant increase in the levels of calcium oxalate crystals in the kidneys as well as lipid levels in the blood serum. Treatment with hydro alcoholic extract of C.aromaticus leaves (CALHAE) significantly reduced cholesterol levels at 300 and 600 mg/kg, and triglyceride levels at 600 mg/kg in urolithiatic rats. Histopathalogical reports confirmed that chronic administration of CALHAE (300 and 600 mg/kg) diminished number of calcium oxalate crystals in kidneys. CALHAE has shown reduction in thiobarbituric acid reactive substances (TBARS) in urolithiatic rats. Moreover, CALHAE showed potent in vitro antioxidant activity in DMPD, ABTS radicals (MnO2 method). Results from these studies support the safe and effective use of C.aromaticus leaves for urolithiasis treatment.Keywords: Coleus aromaticus, Calcium oxalate crystals, Hypolipidemic activity, Antioxidant activit

COLORIMETRIC METHODS FOR THE ESTIMATION OF TOPIRAMATE IN TABLETS

Two simple sensitive and precise colorimetric methods A and B were developed for the estimation of topiramate in bulk drug as well as in pharmaceutical dosage form. Methods A is based on the formation of yellow coloured chromogen by condensation reaction of topiramate with Ehrlich’s reagent ( p - dimethyl amino benzaldehyde ) which has absorption maximum at 547nm. Method B is based on the formation of an orange coloured complex by oxidation reaction of topiramate with 2,2’- bipyridyl in the presence of ferric chloride which has absorption maximum at 519nm. The proposed methods are statistically validated and found to be useful for the routine determination of topiramate in tablets. Keywords: Topiramate, Colorimetry, Tablets, Validatio

Impact of financial inclusion in low- and middle-income countries: a systematic review of reviews

Financial inclusion programmes seek to increase access to financial services such as credit, savings, insurance and money transfers and so allow poor and low-income households in low- and middle-income countries to enhance their welfare, grasp opportunities, mitigate shocks, and ultimately escape poverty. This systematic review of reviews assesses the evidence on economic, social, behavioural and gender-related outcomes from financial inclusion. It collects and appraises all of the existing meta-studies - that is systematic reviews and meta-analyses - of the impact of financial inclusion. The authors first analyse the strength of the methods used in those meta-studies, then synthesise the findings from those that are of a sufficient quality, and finally, report the implications for policy, programming, practice and further research arising from the evidence. Eleven studies are included in the analysis

Genetic diversity for grain nutrients contents in a core collection of finger millet (Eleusine coracana (L.) Gaertn.) germplasm

Finger millet is a promising source of micronutrients and protein contents besides energy and can contribute to alleviation of iron (Fe), zinc (Zn) and protein malnutrition, affecting women and preschool children in African and south-east Asian countries. The most cost effective approach for mitigating micronutrients and protein malnutrition is to introduce staple crop cultivars selected and/or bred for Fe, Zn and protein dense grain. Attempts to breed finger millet for enhanced grain nutrients are still in its infancy. Analysis, detection and exploitation of existing variability among the germplasm accessions are the initial steps in breeding micronutrient and protein-dense finger millet cultivars. Evaluation of finger millet core germplasm for grain nutrients and agronomic traits revealed a substantial genetic variability for grain Fe, Zn, calcium (Ca) and protein contents. The accessions rich in nutrient contents were identified and their agronomic diversity assessed. The accessions rich in Zn content have significantly higher grain yield potential than those rich in Fe and protein content. Grain nutrient-specific accessions and those contrasting for nutrient contents were identified for use in strategic research and cultivar development in finger millet

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic