Assessment of Operational Efficiency and Service Utilization of Adolescent Reproductive and Sexual Health Clinic in an Urban Health Center of Surat City

Background and Objectives: “Adolescent Reproductive and Sexual Health (ARSH)” has been included in the existing public health system in Gujarat from 2006 for addressing issues of adolescents. This study was done to identify the operational gaps and service utilization of ARSH clinic in one of the urban health centers (UHC) in Surat city.Methodology: Mixed approach having in-depth interviews and observation and record-based analysis was done to assess operational efficiency of ARSH clinic. In-depth interviews were carried out among four service providers and secondary data of 157 adolescents were analyzed from the UHC records. The ARSH assessment check list was developed using national guidelines. Quantitative data analysis was done by MS excel 2007. Interviews were transcribed, translated and content analysis was done. The problem analysis was done using Fish-bone diagram and SWOC analysis. Action plan was prepared by developing the critical pathway method.Results: Only 1.9% beneficiaries were boys. Service utilization was done mainly for STI/ RTI counseling (96.83%), IFA tablets (59.23%) and Immunization (81.53%). Inadequacy of infrastructure, materials, human resources, referral linkages, monitoring and supervision was observed. SWOC analysis revealed that the staff was empathetic towards the needs of adolescents but lack of IEC was identified as a major challenge to prepare an action plan. Demand generation was identified as the critical pathway.Conclusion: Service utilization was comparatively very low among boys and only for few services even among girls. Demand generation in schools and community and strengthening of weaknesses in operational aspects of ARSH may improve service utilization

Sildenafil citrate therapy in absent end diastolic flow in umbilical artery in an early onset fetal growth restriction (FGR) fetus

Fetal growth restriction (FGR), a pregnancy complication still poses as a challenge for obstetricians worldwide. This is because of its association with severe morbidity and mortality outcomes. Obstetrical management becomes a dilemma in determining the optimal time of delivery and weighing the risks of prematurity against the risks of a potentially hostile intrauterine environment. There may be placental insufficiency characterized by insufficient blood flow in the umbilical artery. This is termed as abnormal umbilical artery flow with absent or reversed end diastolic flow on Doppler USG. Worsening of this condition demands an earlier delivery of the fetus. Authors report a case of structurally normal foetus showing severe early onset FGR with absent end diastolic flow in umbilical artery on Doppler, which was managed using vaginal Sildenafil citrate. Sildenafil citrate led to improvement in uterine artery and umbilical artery Doppler parameters; thereby improving the utero-placental blood flow with a favorable fetal outcome at delivery. The gestation was prolonged by 51 days. Thus, Sildenafil citrate can be used as promising agent in early onset FGR in selected cases

Mathematical Model and Solution for Fingering Phenomenon in Double Phase Flow through Homogeneous Porous Media

The present paper analytically discusses the phenomenon of fingering in double phase flow through homogenous porous media by using variational iteration method. Fingering phenomenon is a physical phenomenon which occurs when a fluid contained in a porous medium is displaced by another of lesser viscosity which frequently occurred in problems of petroleum technology. In the current investigation a mathematical model is presented for the fingering phenomenon under certain simplified assumptions. An approximate analytical solution of the governing nonlinear partial differential equation is obtained using variational iteration method with the use of Mathematica software

Mathematical Model and Solution for Fingering Phenomenon in Double Phase Flow through Homogeneous Porous Media

The present paper analytically discusses the phenomenon of fingering in double phase flow through homogenous porous media by using variational iteration method. Fingering phenomenon is a physical phenomenon which occurs when a fluid contained in a porous medium is displaced by another of lesser viscosity which frequently occurred in problems of petroleum technology. In the current investigation a mathematical model is presented for the fingering phenomenon under certain simplified assumptions. An approximate analytical solution of the governing nonlinear partial differential equation is obtained using variational iteration method with the use of Mathematica software

Influence of the Choice of Disease Mapping Method on Population Characteristics in Areas of High Disease Burdens

Disease maps are powerful tools for depicting spatial variations in disease risk and its underlying drivers.  However, producing effective disease maps requires careful consideration of the statistical and spatial properties of the disease data. In fact, the choice of mapping method influences the resulting spatial pattern of the disease, as well as the understanding of its underlying population characteristics. New developments in mapping methods and software in addition to continuing improvements in data quality and quantity are requiring map-makers to make a multitude of decisions before a map of disease burdens can be created. The impact of such decisions on a map, including the choice of appropriate mapping method, not been addressed adequately in the literature. This research demonstrates how choice of mapping method and associated parameters influence the spatial pattern of disease. We use four different disease-mapping methods – unsmoothed choropleth maps, smoothed choropleth maps produced using the headbanging method, smoothed kernel density maps, and smoothed choropleth maps produced using spatial empirical Bayes methods and 5-years of zip code level HIV incidence (2007- 2011) data from Dallas and Tarrant Counties, Texas. For each map, the leading population characteristics and their relative importance with regards to HIV incidence is identified using a regression analysis of a CDC recommended list of socioeconomic determinants of HIV. Our results show that the choice of mapping method leads to different conclusions regarding the associations between HIV disease burden and the underlying demographic and socioeconomic characteristics. Thus, the choice of mapping method influences the patterns of disease we see or fail to see. Accurate depiction of areas of high disease burden is important for developing and targeting appropriate public health interventions

Inhibition of GRK2 Augments Cardiac Beta2-Adrenergic Receptor-Dependent Contractility andSurvival

Objective. Investigation of the effect of inhibition of cardiac GRK2 on ß2AR pro-contractile and prosurvival signaling in vivo. Background. ß1- and ß2-adrenergic receptors (ßARs) are G-protein coupled receptors (GPCRs) that play clearly distinct roles in cardiac physiology/pathology. This might be explained by differences in assembly of macromolecular signaling complexes: ß1AR forms a signaling complex with phosphodiesterase (PDE) type 4D8 directly, and agonist binding dissociates this complex. Conversely, GPCR kinase (GRK)2-induced ß2AR phosphorylation leads to recruitment of a complex consisting of ßarrestin (ßarr), a universal GPCR adapter/scaffolding molecule, and another PDE4D variant, PDE4D5. This PDE4D recruitment is postulated to constrain ß2AR pro-contractile signaling by limiting compartmentalization of 3\u27-5\u27-adenosine monophosphate signaling. Methods. We crossed ß1AR knockout (B1KO) mice, which do not express ß1AR, with M27 mice, which overexpress, specifically in cardiac myocytes, the GRK2 inhibitor GRK2ct. By blocking GRK2-mediated phosphorylation, ßarrdependent PDE4D recruitment to ß2AR is prevented. We studied the offspring both under normal conditions and after surgically induced myocardial infarction (MI). Results. Contractility was significantly augmented in M27/B1KO mice compared to B1KO\u27s, both in healthy mice and at 4 weeks after MI, and M27/B1KO hearts displayed significantly less membrane recruitment of PDE4D compared to B1KO hearts, indicating less ß2AR-PDE4D interaction. Additionally, survival of M27/B1KO mice overexpressing the GRK2 inhibitor was increased after MI. Conclusion. Cardiac GRK2 inhibition by GRK2ct increases ß2AR-dependent contractility and survival both normally and in post-MI heart failure. Grants. This study 33 was funded in part by a Scientist Development Grant from the American Heart Association (AHA) and an HPD Research Grant, both to A.L

Development of Epinephrine Nanoparticles Using Chitosan for the Treatment of Anaphylaxis

Purpose. Epinephrine was previously formulated into fast-disintegrating sublingual tablets (AAPS PharmSciTech. 2006;7(2): Article 41) and the sublingual bioavailability was established in vivo (J Allergy Clin Immunol 2006;117(2):398-403) for the potential first-aid treatment of anaphylaxis. The purpose of this study was to develop and characterize epinephrine nanoparticles to enhance the sublingual bioavailability of epinephrine. Methods. Epinephrine bitartrate equivalent to epinephrine 10%, 20%, 30% and 40% were loaded into chitosan nanoparticles using ionic gelation method. Chitosan to tripolyphosphate (TPP) weight ratio was studied at 2:1, 3:1, 4:1, 5:1 and 6:1. Particle size and zeta potential were measured after nanoparticles fabrication using Zetasizer. Samples were centrifuged and supernatant was analyzed using HPLC to determine the encapsulation efficiency. Results. Nanoparticles in the size range of 100-400 nm were obtained using 2:1 and 3:1 weight ratios of chitosan to TPP. Zeta potential was increased with the increase chitosan weight ratio, and decreased with the increase in epinephrine load %. Encapsulation efficiency was increased by increasing weight ratio of chitosan; but resulted in lower encapsulation efficiency at epinephrine 40%. Conclusion. By adjusting the chitosan 31 weight ratio, optimum size of epinephrine nanoparticles can be obtained. Encapsulation efficiency of epinephrine into chitosan nanoparticles depends on weight ratio of chitosan and epinephrine load

A comparative analysis of upper airway space with lateral cephalogram and cone beam computed tomography in north Gujarat population

Objective : The Aim and objective of this study is to evaluate the accuracy of upper airway measurement using with lateral cephalogram , CBCT lateral reconstruction and CBCT axial planes as well as to correlates these finding with area measurements acquired with the latter imaging methods. Methods : In this study , 44 subject (22 males & 22 females) included from north Gujarat adults . Landmark were defined for measurement of naso and Oropharynx , for different planes , using linear antero-posterior measurement and the corresponding area. Result : Analysis of variance shows linear measurement in nasopharynx and oropharynx area wise distribution and Inter Group Wise Distribution in Nasopharynx , all three group have significant different value. In inter Group Wise Distribution in Oropharynx, there is statistically no significant difference between Lateral Reconstruction Group and Lateral Cephalogram Manual Tracing Group. Statistically, no significant difference between Lateral Reconstruction Group and Axial Slice Group & also Statistically, no significant difference between Lateral Cephalogram Manual Tracing Group and Axial Slice Group. Conclusion : The linear measurements of the airway space obtained using the different techniques correlated positively with the respective area measurements, which demonstrate the reliability of the investigated techniques