Maternal Health Situation in India: A Case Study

Maternal Health Services are one of the basic health services to be provided by nay government health system as pregnant women are one of the most vulnerable victims of dysfunctional health system, India, in spite of rapid economic progress is still farm away from the goal of lowering maternal mortality to less than 100 per 100,000 live births. It still accounts for 25.7% maternal deaths. The maternal mortality in India varies across the states. Geographical vastness and socio-cultural diversity make implementation of health sector reforms a difficult task. The chapter analyses the trends in maternal mortality and various maternal health programs implemented over the years including the maternal health care delivery system at various levels including the recent innovative strategies. It also identifies the reasons for limited success in maternal health and suggests measures to improve the current maternal health situation. It recommends improvement in maternal death reporting, evidence based, focused, long term strategy along with effective monitoring of implementation for improving Maternal Health situation. It also stress the need for regulation of private sector and proper Public Private Partnership (PPP) policy together with a strong political will for improving Maternal Health.

Anti-ulcer activity of arachidonic acid (PUFA) oils in different induced ulcer animal models

Background: Ulcers of the lower part of the oesophagus, the stomach and the first part of the duodenum are also known as peptic ulcers. Peptic ulcers can affect people of any age, but they are more common as you get older. There is a focus on research for better tolerated and efficacious anti-ulcer agents.Methods: Effect of anti-ulcer activity of fish oil and Arasco oil was evaluated in different animal models of ulcers i.e. ethanol induced, water immersion and pyloric ligation techniques. The Superoxide dismutase activity in gastric tissue was also ascertained in two groups of animals. The animals received either fish oil (40 µl, PO), Arasco oil (40 µl, PO), omeprazole (20 mg/kg PO) or ranitidine (30 mg/kg PO). The gastro-protection was calculated based on ulcer index, pH and gastric juice volume.Results: The results of this study suggest that poly unsaturated fatty acid (PUFA) contained in fish oil and Arasco oil have moderate anti-ulcer activity although probably lesser in potency than the available anti-ulcer drugs like omeprazole and ranitidine.Conclusion: These  results  have  shown  that  PUFA containing oils  provided  moderate  gastrointestinal  protection  in  all  the induced ulcer models employed. Thus it can be concluded that PUFA containing oils like the Fish oil and Arasco oil have anti-ulcer properties and the mechanisms involved in these actions need to be investigated.

Cancer risks of anti-hyperglycemic drugs for type 2 diabetes treatment - a clinical appraisal

AIM: A clinical appraisal of existing scientific literature sought to assess the need for long-term prospective epidemiological studies to investigate an increased cancer risk of anti-hyperglycemic medication in type 2 diabetes. METHOD: A focus statement was formulated as: "With a higher risk of cancers in patients with type 2 diabetes, all anti-hyperglycemic drugs should undergo long-term, prospective epidemiological studies for cancer risks." Field surveys were sent to practicing physicians and endocrinologists to identify the currently prevalent level of acceptance of this statement. Subsequently, a meeting with a six-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This publication reviews the publications and discussion points brought forth in this meeting and their effect on statement acceptance by the panel. RESULTS: Whereas the majority of field survey responders primarily agreed with the statement, panel members were divided in their statement support. This division remained intact after review of the literature. CONCLUSIONS: While there was evidence that type 2 diabetes is associated with an increased risk of cancer, existing studies seemed insufficient to definitively demonstrate a link between cancer risk and use of specific anti-hyperglycemic therapies

An immunohistochemical study of altered immunomodulatory molecule expression in head and neck squamous cell carcinoma.

For the presentation of peptide antigens to cytotoxic CD8+ T lymphocytes of the immune system, the expression of human leukocyte antigen (HLA) class I molecules on the cell surface is necessary. There is increasing evidence that surface HLA class I antigen expression is altered in a variety of human tumours by either loss or down-regulation of these molecules, which may be a strategy for evasion of immunosurveillance by malignant cells. This study has examined the expression of HLA class I molecules in head and neck squamous cell carcinoma (HNSCC) specimens by immunohistochemistry, using a wide panel of antibodies directed against allele-specific as well as monomorphic determinants of these molecules. The expression of TAP proteins, HLA-DR and the co-stimulatory molecule ICAM-1 were also studied. In addition, the expression of the tumour-associated antigens (TAA) p53 and MAGE genes was determined. Aberrant allelic expression of HLA class I antigens was detected in 17 out of 34 (50%) of the specimens stained, whereas HLA class I expression determined by W6/32 staining was found to be heterogeneous in only 2 out of 34 (6%) cases. Decreased expression of ICAM-1 was observed in 12 out of 34 (35%) tumour specimens and de novo expression of HLA-DR (HLA class II) by carcinoma cells in 13 out of 34 (38%) cases. Aberrant expression of HLA class I antigens was frequently observed in cases in which MAGE genes and p53 overexpression were detected. The altered expression of these immunomodulatory molecules in HNSCC may affect prognosis and has important implications for peptide-based immunotherapy strategies for these patients

Clinical Utility of Radiologic Disease Reassessment in the Management of Pediatric B-Cell Non-Hodgkin Lymphoma

Although outcomes for children with B-cell non-Hodgkin lymphoma are excellent, between 20% and 40% demonstrate residual radiologic abnormalities at disease assessment during consolidation therapy, the significance of which remains uncertain. The authors report the outcomes for all children treated for B-cell non-Hodgkin lymphoma at our center over an 11-year period. Twenty-four of 64 (38%) children had residual radiologic abnormalities at disease remission assessment. Seven (29%) underwent histologic biopsies that were normal. No children with residual radiologic abnormalities experienced disease relapse or death, suggesting that imaging at this time point creates clinical uncertainty without indicating residual disease or predicting relapse

A high pressure XRD setup at ADXRD beamline (BL-12) on Indus-2

A high pressure XRD measurement setup in the angle dispersive geometry has been setup in the Angle Dispersive X-ray diffraction beamline (BL-12) in Indus-2 synchrotron facility. The X-ray beam is collimated inside the Diamond Anvil Cell (DAC) using a pair of cross-slit collimators and 100 micron orifice in a 400 micron thick Ta sheet. With the use of an adaptive optics to ensure a converging beam at the sample position, the need of an X-ray beam collimator is eliminated making the alignment of the DAC quite easy. The alignment of the DAC with respect to the incident X-ray beam is made by placing it on a computer controlled sample mounting and alignment stage developed specifically for this setup. Interactive software has been developed to make the alignment of the X-ray through the DAC very easy and accurate. NIST standard LaB6 powder was used for test runs, and a few fine pieces of gold served as pressure calibrator. The data was recorded on a MAR345 Image plate detector

Barriers to adherence in juvenile idiopathic arthritis: A multicenter collaborative experience and preliminary results

© 2018. All rights reserved. Objective. Nonadherence is currently an underrecognized and potentially modifiable obstacle to care in juvenile idiopathic arthritis (JIA). The purpose of our study was to design and implement a standardized approach to identifying adherence barriers for youth with JIA across 7 pediatric rheumatology clinics through the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) and to assess the frequency of adherence barriers in patients and their caregivers across treatment modalities. Methods. An iterative process using coproduction among parents and providers of patients with JIA was used to design the Barriers Assessment Tool to screen for adherence barriers across 4 treatment modalities (i.e., oral medications, injectable medications, infusions, and physical/occupational therapy). This tool was implemented in 7 rheumatology clinics across the United States and patient responses were collected for analysis. Results. Data were collected from 578 parents and 99 patients (n = 44 parent-child dyads). Seventy-seven percent (n = 444) of caregivers and 70% (n = 69) of patients reported at least 1 adherence barrier across all treatment components. The most commonly reported adherence barriers included worry about future consequences of therapy, pain, forgetting, side effects, and embarrassment related to the therapy. There was no significant difference between endorsement of barriers between parents and adolescents. Conclusion. Implementing a standardized tool assessing adherence barriers in the JIA population across multiple clinical settings is feasible. Systematic screening sheds light on the factors that make adherence difficult in JIA and identifies targets for future adherence interventions in clinical practice

Multi-Response Optimization of WEDM Process Parameters for Machining of Superelastic Nitinol Shape-Memory Alloy Using a Heat-Transfer Search Algorithm

Nitinol, a shape-memory alloy (SMA), is gaining popularity for use in various applications. Machining of these SMAs poses a challenge during conventional machining. Henceforth, in the current study, the wire-electric discharge process has been attempted to machine nickel-titanium (Ni55.8Ti) super-elastic SMA. Furthermore, to render the process viable for industry, a systematic approach comprising response surface methodology (RSM) and a heat-transfer search (HTS) algorithm has been strategized for optimization of process parameters. Pulse-on time, pulse-off time and current were considered as input process parameters, whereas material removal rate (MRR), surface roughness, and micro-hardness were considered as output responses. Residual plots were generated to check the robustness of analysis of variance (ANOVA) results and generated mathematical models. A multi-objective HTS algorithm was executed for generating 2-D and 3-D Pareto optimal points indicating the non-dominant feasible solutions. The proposed combined approach proved to be highly effective in predicting and optimizing the wire electrical discharge machining (WEDM) process parameters. Validation trials were carried out and the error between measured and predicted values was negligible. To ensure the existence of a shape-memory effect even after machining, a differential scanning calorimetry (DSC) test was carried out. The optimized parameters were found to machine the alloy appropriately with the intact shape memory effect

A Pediatric Infectious Disease Perspective of SARS-CoV-2 and COVID-19 in Children.

Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for novel coronavirus (COVID-19) infections is emerging. While the severe manifestations and acute clinical burden of COVID-19 has largely spared children compared to adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities as well as the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Herein we summarize the current knowledge, identify useful resources, and outline research opportunities. Pediatric infectious disease clinicians have a unique opportunity to advocate for the inclusion of children in epidemiological, clinical, treatment and prevention studies to optimize their care, as well as to represent children in the development of guidance and policy during pandemic response