Prevalence of various dermatoses in pregnancy at a tertiary care centre in Moradabad, Uttar Pradesh, India: an observational study

Background: This was a prospective study which was done to observe various skin lesions in pregnancy and to determine the most likely causes and their incidence in antenatal patients, it was noticed that many women in our institute were having pregnancy related cutaneous complaints thus this observational study was carried out so that better preventive measures and treatment options could be provided to these patients.Methods: Study was conducted in out-patient department of Obstetrics and Gynaecology, TMU, Moradabad. All ANC cases between October 2017 to September 2018 having any type of dermatoses were included in the study irrespective of gestational age. 6348 patients appeared in OPD in the given time period out of which 1256 were included. In case of pruritus, liver function tests were done with USG whole abdomen and patients were reviewed by physician if required. Screening with VDRL, HCV, HbSAg and ELISA for HIV was done in all. Results were tabulated and analyzed.Results: 50.8% primi gravidas ,49.2% multi gravidas. age range 18-38 years. 29.3% presented in third trimester ,25.6% presented in second trimester. Physiological changes seen in all cases, 8.68% specific dermatoses of pregnancy. 40.4 % no complaints, 5.65% melasma, 90.8% hyperpigmentation, 94.6% linea nigra. Secondary areola 89.3%,striae 80.3% out of which 38.9%- primi gravidas and 41.40% -multi gravidas. 92.9% no change in hair density. Montgomery’s tubercles 30-50% of cases. spiders nevi 67%. No cases of palmar erythema. Pruritus gravidarum 38.53%. PUPPP 28.4%. Pemphigoid Gestationis 9.17%. Prurigo of pregnancy 18.34%. Pruritic folliculitis 1.8%. Eczema in pregnancy : pre-existing in 3.7% , out of which exacerbation 1, 3 unaffected. 3 chicken pox.1 filariasis.24 herpetic lesions (herpes simplex).1 scleroderma.17.27% pre-existing taenia infection . Scabies 20.46%.11 0.87% dual infection (scabies-taenia).Conclusions: This study highlights high prevalence of community acquired infections in our region like taenia, scabies giving rise to skin lesions in Antenatal women. Moreover, it highlights a probable association between the prevalence of skin lesions with factors like poor personal hygiene, overcrowding, low socioeconomic status, anaemia and poor nutritional status

Current clinical trends in the management of gram positive infections in Indian critical care settings: a survey

Background: In India, gram-positive infections (GPIs) particularly, methicillin-resistant Staphylococcus aureus (MRSA) prevalence is reported to increase exponentially. The overall mortality rate among patients with multi drug resistant GPIs in ICU setting are as high as 16%, despite the availability of various therapeutic options. Aim of the study is to determine the burden of GPIs in critical care settings and to understand the practising behaviour among the specialists in the management of MRSA infections.Methods: The survey was conducted among 264 critical care specialists who attended the Annual National Conference of Indian Society of Critical Medicine held in February 2019 at Mumbai. The delegates were administered a validated 10 question survey.Results: In the survey, 72% of the respondents agreed to the rising prevalence of MRSA and associated increased mortality rate of >16%. Empirical gram positive cover is being given to 30-40% of ICU patients, with ABSSSI being listed as a major indication followed by CAP, VAP, CLABSI and DFI. 46% of the doctors listed vancomycin as their preferred anti-MRSA agents followed by teicolplanin and linezolid. However, more than 80% of the doctors feel that nephrotoxicity in vancomycin, thrombocytopenia in linezolid and poor biofilm penetration are major limitations of these anti-MRSA agents.Conclusions: The survey highlighted the increasing trend in the prevalence and associated mortality in GPIs in critical care settings in India. Further, the limitations of existing anti-MRSA agents have invoked the need for a newer agent with a broad spectrum anti-bacterial activity along with improved safety profile and effective biofilm penetration, which can be used as a suitable alternative empiric therapy to manage GPIs

Evaluation of the incidence, risk factors, severity, and outcome of hydrocephalic fetuses in a tertiary healthcare center located in Northern India: a prospective observational study

Background: Hydrocephalus is a heterogeneous disease marked by abnormal dilatation of the cerebral ventricles secondary to varying etiologies. This study was aimed to determine the incidence, risk factors, severity, and outcome of hydrocephalic fetuses presenting to a tertiary healthcare hospital located in northern India.Methods: In this prospective observational study, pregnant women visiting the obstetrics outpatient department of our hospital from 01 July 2017 to 31 June 2018 were screened for hydrocephalic fetuses via ultrasonography along with a detailed history, and a comprehensive battery of diagnostic investigations. They were followed up for a minimum period of two months after delivery/termination of pregnancy.Results: A total of 3627 pregnant women were screened, of which 10 had hydrocephalic fetuses in the observed time period. The incidence of hydrocephalus was determined to be 2.75 per 1000 live births. Low socio-economic status was identified as a major risk factor. 50% of the hydrocephalic fetuses were severely afflicted and were discontinued. The remaining 50% were successfully delivered and were managed via a ventriculo-peritoneal shunt or are under close observation in the postnatal period without any adverse outcome.Conclusions: The burden of hydrocephalus is considerably high in India, as compared to western countries. In rural settings, low socioeconomic status and lack of folic acid supplementation have a major influence in the etiopathogenesis of hydrocephalus. Management of hydrocephalus requires a multidisciplinary approach and is tailored according to the severity of the presentation. Severe cases of hydrocephalus and cases with associated anomalies have a poor prognosis

Cost-effectiveness of ticagrelor plus aspirin versus aspirin in acute ischaemic stroke or transient ischaemic attack: an economic evaluation of the THALES trial

Health economics; StrokeEconomía de la salud; IctusEconomia de la salut; IctusObjective THALES demonstrated that ticagrelor plus aspirin reduced the risk of stroke or death but increased bleeding versus aspirin during the 30 days following a mild-to-moderate acute non-cardioembolic ischaemic stroke (AIS) or high-risk transient ischaemic attack (TIA). There are no cost-effectiveness analyses supporting this combination in Europe. To address this, a cost-effectiveness analysis was performed. Methods Cost-effectiveness was evaluated using a decision tree and Markov model with a short-term and long-term (30-year) horizon. Stroke, mortality, bleeding and EuroQol-5 Dimension (EQ-5D) data from THALES were used to estimate short-term outcomes. Model transitions were based on stroke severity (disabling stroke was defined as modified Rankin Scale >2). Healthcare resource utilisation and EQ-5D data beyond 30 days were based on SOCRATES, another trial in AIS/TIA that compared ticagrelor with aspirin. Long-term costs, survival and disutilities were based on published literature. Unit costs were derived from national databases and discounted at 3% annually from a Swedish healthcare perspective. Results One-month treatment with ticagrelor plus aspirin resulted in 12 fewer strokes, 4 additional major bleeds and cost savings of €95 000 per 1000 patients versus aspirin from a Swedish healthcare perspective. This translated into increased quality-adjusted life-years (0.04) and reduced societal costs (−€1358) per patient over a lifetime horizon. Key drivers of cost-effectiveness were number of patients experiencing subsequent disabling stroke and degree of disability. Findings were robust over a range of input assumptions. Conclusion One month of treatment with ticagrelor plus aspirin is likely to improve outcomes and reduce costs versus aspirin in mild-to-moderate AIS or high-risk TIA.AstraZeneca funded the THALES trial and the cost-effectiveness analysis of this study

Pharmacological evaluation for anti-bacterial and anti-inflammatory potential of polymeric microparticles

The objective of the study was to evaluate anti-bacterial and anti-Inflammatory activities of polymeric microparticles. In vitro antibacterial activity was performed for prepared microparticles followed by in vivo anti-inflammatory activity on rats. From the present study, it was observed that the microparticles developed were appropriate in their shape and uniform size. The topography of SEM studies revealed that, the microparticles were smooth-surfaced. The result of antibacterial activity indicated that the formulation has not exhibited any zone of inhibition against the various strains of bacteria used for this study. The result of anti-inflammatory activity (Dextran induced paw edema) exhibits that, the formulations possess the inhibitory potential for various inflammatory mediators thereby reduces the inflammation in paws. From the results, it can be concluded that Acacia arabica microparticles is showing significant Anti-inflammatory activity after 6 h than conventional dosage form

Renal Stones: A Clinical Review

Renal stones are a common condition causing significant morbidity and economic burden. The prevalence of urinary tract stones in the developed nations ranges from 4–20%. Renal stones are of different types, the most common being the calcium oxalate stones. Various dietary, non-dietary, and urinary risk factors contribute to their formation. Their frequent association with systemic diseases (like hypertension, diabetes, and obesity) highlights the role of dietary and lifestyle changes in their occurrence, recurrence, and possible prevention. Non-contrast computed tomography (CT) identifies almost every stone and is the preferred investigation for identification. Ultrasound has its advantages, as it is low cost and requires no radiation, but is observer dependent. Metabolic profiles (including blood calcium, phosphate, magnesium, creatinine, uric acid, sodium, and potassium) should be measured and a detailed urinalysis should be done. This review further discusses the formation in depth, and covers risk factors and management of renal stones, and lays down the importance of preventive measures to avoid their recurrence

Challenges and Policy Implications for Low-Carbon Pathway for Kerala: An Integrated Assessment Modelling Approach

As India has embarked on the journey of fulfilling its net-zero emissions target by 2070, the states of India are steering up too to meet the target. The per capita emissions for Kerala are lower than the national average. The energy sector is the main contributor to GHG emissions in Kerala. A major share of 76 percent of electricity power is purchased from other states. When other states undergo an energy transition, the availability of imported electricity may be a challenge for Kerala. Hence, the State needs to harness its own potential for renewable energy sources and incorporate improved technologies leading to energy efficiencies in all sectors. Accordingly, this paper has undertaken integrated modelling (an approach with the primary objective of quantifying the gains and losses of low-carbon transitions and their financial implications). The integrated modelling approach involves soft linking of the macroeconomic top-down CGE model and bottom-up (Messageix) energy model. The integrated model is a recursive dynamic model with multiple periods of time. In this paper, we have undertaken a policy scenario in which (i) the imports of fossil-based electricity from other states of India are restricted to Kerala, (ii) 50 percent of the existing potential of renewable electricity by various modes is achieved in Kerala and the rest of India, and (iii) energy efficiency in all energy sectors is increased to the tune of 2.5 percent per annum along with 1 percent total productivity growth per annum in all sectors of the Kerala and India economies. Our results show that the reduced import of fossil fuel electricity without any policy intervention to strengthen the renewable energy sector would hamper growth. On the other hand, investment in renewable energy to facilitate a complete energy transition with self-reliance on energy for the state would expand the economy, increase the returns to the factors of production, and increase employment. The key message that comes out from our simulation is that the energy transition towards renewable energy will not take place without complementarity support polices towards this sector. Our observation is that energy transition may be a win‒win situation in the sense that growth and employment creation may be positive with suitable policy intervention. It must be mentioned that the paper focused only on the energy sector. The developed model may be used in the future to focus on the economic implications of other policies, such as carbon sequestration

Rapid assessment of facilitators and barriers related to the acceptance, challenges and community perception of daily regimen for treating tuberculosis in India

Introduction: The Revised National Tuberculosis Control Program (RNTCP) is the largest tuberculosis (TB) control program in the world based on Directly Observed Treatment Short-Course (DOTS) strategy. Globally, most countries have been using a daily regimen and in India a shift towards a daily regimen for TB treatment has already begun. The daily strategy is known to improve program coverage along with compliance. Such strategic shifts have both management and operational implications. We undertook a rapid assessment to understand the facilitators and barriers in adopting the daily regimen for TB treatment in three Indian states. Methods: In-depth interviews were planned across six districts of three purposively selected states of Maharashtra, Bihar and Sikkim, among health system personnel at various levels to identify their perspectives on adoption of a daily regimen for TB. These districts were sampled on the basis of TB notification rates. Thematic analysis of the qualitative data was undertaken. Results: 62 respondents were interviewed from these 6 districts. During the analysis, it was observed that an easily accessible, patient-centred and personalized outreach is an enabling factor for adherence to treatment. Lack of transportation facilities, out-of-pocket expenses and loss of wages for accessing DOTS at institutions are major identified barriers for treatment adherence at individual level. At program level, lack of trained service providers, poor administration of treatment protocols and inadequate supervision by health care providers and program managers are key factors that influence program outcomes. Conclusion: A major observation that emerged from the interviews is that the key to achieve a relapse-free cure is ensuring that a patient receives all doses of the prescribed treatment regimen. However, switching to a daily regimen makes adherence difficult and thus new strategies are needed for its implementation at patient and health provider levels. Most stakeholders appreciate the reasons for switching to a daily regimen. The stakeholders recognised the efforts of the Ministry of Health & Family Welfare (MoHFW) in spearheading the program. Strategies like the 99 DOTS call-centre approach may also further ensure treatment adherence

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

POLYMER/CERAMIC HYBRID SEPARATORS FOR HIGH-RATE LITHIUM-ION BATTERIES

107 pagesLithium-ion batteries are gaining popularity with increasing use of electronic devices especially laptops, cameras, and phones. With more and more electric vehicles hitting the market, next generation batteries with several advantages like, high energy density, long cycle life, low self-discharging are required. Separators act as an electrical insulator between battery’s positive and negative electrode. They serve as an electrolyte reservoir and their structure plays an important role in battery’s cycle life, safety, energy density and capacity.In this study, Polyimide (PI) / Polysilsesquioxane (PSSQ) hybrid separators were successfully fabricated via a single step electrospinning process. They are thermally stable, and non-flammable separators that enable high capacity and high-rate Li-ion batteries to be safer. The novelty of this project lies in its fundamental improvement of electrospun fibers. It involves controlling and tailoring morphology of nanoscale fiber made from a polymer and ceramic blend to reduce non-uniformity in the fiber morphology, leading to improved performance at high charging and discharging rates, as compared to Celgard, a commercially used separator. Fiber morphology was controlled by the addition of various surfactants. Sodium dodecyl sulfate (SDS) modified hybrid separators showed the best battery performance when paired with high-rate capable Silicon-graphene anodes. This combination of anode and separator performed better than the pristine hybrid separators and Celgard at high-rate cycling. These high-rate capable separators show huge potential to enable fast charging for electric vehicle