Public Expenditure Accounatability in the Telecom Sector

The telecom sector has seen much change during the past two decades. At first, it was the opening up of the equipment manufacturing sector, followed by the corporatisation of the government owned entities, Videsh Sanchar Nigam Limited (VSNL) and Mahanagar Telephone Nigam Limited (MTNL). Subsequently, the sector was opened for private participation in basic, cellular and other value added services. The most recent liberalization moves have been the corporatization of the Department of Telecom into Bharat Sanchar Nigam Limited (BSNL) and the privatisation of VSNL.

Nutritional rickets - A hospital-based study from Southern Kerala

Objective: The aim of this study is to find the characteristics of nutritional rickets and the proportion of cases diagnosed prospectively. Methods: Details of 54 cases of nutritional rickets in the age group of 1 month-12 years diagnosed during 2013-2015 in a tertiary care teaching hospital in Kerala were collected. The criteria taken for diagnosis were clinical features, biochemical parameters such as calcium, phosphorous, alkaline phosphatase (ALP), radiological features, and response to vitamin D treatment. Vitamin D level and serum parathyroid hormone levels were collected whenever it is available. The data were then analyzed statistically. Results: Among the 54 cases analyzed, 61.11% were male. A maximum number of cases were identified in the age group of 1-2 years (44.44%). Nearly 88.89% of patients were born term. About 83.3% of patients were intermediate or dark skinned. The most common clinical feature identified was bowlegs. Radiological features were identified in 70.4% of cases. The most common biochemical abnormality noted was elevated serum ALP (83.33%). Hypocalcemic seizures were a predominant manifestation in <6 months’ age group. Rickets was detected prospectively in 26 patients (48.15%) during evaluation for other illnesses. The mean ALP level was found to be significantly lower in patients with clinical or radiological features of rickets compared to those without clinical or radiological evidence. Conclusions: Rickets is very common in the age group of 1-2 years and among exclusively breastfed term babies. The significant number of cases of nutritional rickets was detected prospectively during evaluation for other illnesses. ALP level may be routinely checked in the vulnerable high-risk age group for identification of early rickets as it is significantly elevated even before clinical and radiological changes appear

Rodenticide poisoning in children: A study of clinical profile and electrocardiographic changes

Objectives: To study the clinical profile and electrocardiographic (ECG) changes in rodenticide poisoning in children. Methods: Patients admitted with a history of ingestion of rat poison between October 2014 and October 2016 were included in the study. Clinical history was taken in detail, and stomach wash samples were sent for toxicological analysis. Continuous ECG monitoring was done in all cases. Investigations to assess organ functions and coagulation profile were done at admission and repeated as indicated. Results: There were 17 cases of rodenticide poisoning. Zinc phosphide was the rodenticide identified in 50% of cases, bromodiolone in 30%, and yellow phosphorous in 20% cases. Only 23% presented within 1 h of ingestion and only 12% received stomach wash from referring hospital. Out of the 17 cases, 12 cases (70%) were symptomatic, of which 42% hadminor symptoms such as vomiting and abdominal pain and 58% had major symptoms including dysrhythmias, shock, coagulation abnormality, hepatic failure, and seizures. ECG changes were observed in 7 cases (42%), and coagulopathy was seen in 2 (12%) cases of which one had hepatic failure. The mean time of onset of ECG changes was 19.7 h (range 9-36 h). The overall mortality rate was 17.6%. Cardiac arrhythmia was the most common cause of death (66%). Conclusion: Zinc phosphide has been detected as the most common chemical being used as domestic rodenticide. Transient rate abnormalities, metabolic acidosis, fever, and leukocytosis are early markers of toxicity and they should be looked for in all cases. General public, medical, and aramedicalpersonnel should be made aware of the toxic nature of rodenticides

Clinical profile and short-term outcome of perinatally asphyxiated term neonates in a tertiary hospital in Southern Kerala

Introduction: In India, in spite of improvement in perinatal-neonatal care, perinatal asphyxia accounts for 23% of the neonatal deaths. Objective: The objective of the study was to study the clinical profile and short-term outcome of perinatally asphyxiated term neonates. Materials and Methods: This prospective study conducted at a tertiary care teaching hospital in Southern Kerala from June 2011 to June 2015. 120 term asphyxiated neonates fulfilling the inclusion criteria admitted in the NICU were followed up till death or survival. Results: 49.2% babies were inborn and 50.8% babies were outborn. Of the total, 53 (44.2%) were delivered vaginally, 54 (45%) by cesarean section, and 13 (10.8%) by instrumental delivery. Antenatal complications were seen in 58 (48.3%) and intrapartum complications in 93 (77.5%). Hypoxic ischemic encephalopathy (HIE) was diagnosed in 78.3%, with HIE 1 in 19.3%, HIE 2 in 27.5%, and HIE 3 in 31.6%. The mortality was 31 (25.8%) and it was more in out born babies compared to inborn. Factors associated with development of severe HIE (HIE 3) were male gender (p=0.0057), need for endotracheal intubation (p=0.0114), instrumental delivery and pH <7.2 (p=0.0013). Factors associated with mortality were instrumental delivery (p=0.0032), place of birth (p=0.0012), pH ≤ 7 (p=0.0006), HIE 3 (p<0.0001), and 5 min Apgar ≤3 (p=0.0372). Conclusion: HIE was seen in 78.3% perinatally asphyxiated babies with HIE 3 contributing to 31.6%. The mortality rate in HIE 3 was 81.6% which was significantly associated with place of birth, instrumental delivery, pH <7, and 5 min Apgar ≤3

Iron status among under-five children with first febrile convulsion and subsequent febrile convulsion

Objective: The objective of this study is to estimate the iron status using hemoglobin (Hb), red cell indices, serum iron, plasma ferritin, total iron binding capacity (TIBC), and transferrin saturation (TSAT) in children with first febrile convulsion (FFC) and subsequent FC (SFC). Methods: The study was conducted in a tertiary care teaching hospital among children aged 6 months–5 years with first and subsequent episodes of the simple FC taking cases and controls in a ratio of 2:2:1. Consecutive cases and concurrent controls were selected for the study. Controls were children of the same age group with short febrile illness but without any seizures. After informed consent from parents, detailed history was taken; clinical examination and blood investigations were done to estimate iron status in both cases and controls. Laboratory tests included Hb, hematocrit( Hct), red cell indices, peripheral smear, red cell distribution width (RDW), serum iron concentration, plasma ferritin, TIBC, and TSAT. The data were then analyzed statistically using SPSS software. Results: 44 cases with FFC, 44 with SFC, and 22 controls were included in the study. The mean Hb, Hct, red cell indices, and RDW between the three groups did not show any significant difference. The mean serum ferritin was significantly lower in the SFC group compared to the control group (p=0.005). The mean serum TIBC was significantly higher in the SFC group compared to the control group (p=0.004) and also the SFC group compared to the FFC group (p=0.022). Conclusions: Poor iron status in subsequent febrile seizures indicates that iron deficiency is associated with subsequent seizures. Hence, screening for iron status rather than Hb level estimation should be considered for children presenting with or at high risk for febrile seizures

Deep-sea mud shrimp and shovel-nosed lobster from the Arabian Sea as prospective sources of long-chain polyunsaturated fatty acids

Fatty acid profile of deep-sea mud shrimp (Solenocera hextii) and shovel-nosed lobster (Thenus unimaculatus) harvested from south-west coast (Arabian Sea) of India were evaluated and compared. Palmitic and oleic acids were the principle saturated fatty acids and monounsaturated fatty acids, respectively in lobster and shrimp species. T. unimaculatus contained greater concentrations of C20-22 n-3 polyunsaturated fatty acids, such as docosahexaenoic acid and eicosapentaenoic acid. Higher n-3/n-6 polyunsaturated fatty acid ratio (greater than 4) in addition to considerably greater polyunsaturated/saturated fatty acid (>1.2) and hypocholesterolaemic/hypercholesterolaemic ratio (>2) were recorded in shovel-nosed lobster compared to the mud shrimp. Lesser thrombogenicity (≤0.5) and atherogenicity (<1.0) indices recognised T. unimaculatus as a desirable marine species for human nutrition

Seasonal variation of fatty acid profile in edible tissue of deep-sea whip lobster Puerulus sewelli (Decapoda, Palinuridae)

Seasonal variations of the fatty acid profile of deep-sea whip lobster Puerulus sewelli (Decapoda, Palinuridae), harvested from the south-west coast of India were compared. Fatty acid contents showed seasonal fluctuations, with eicosapentaenoic acid and docosahexaenoic acid being predominant during the post-monsoon and winter seasons (9-11% of cumulative fatty acids). P. sewelli was found to possess considerably higher C20-22 n-3 fatty acids during these seasons along with balanced n-3/n-6 (>2) and polyunsaturated/saturated fatty acid ratio (≥1) than those in pre-monsoon. Greater hypocholesterolemic/ hypercholesterolemic ratio (>2.4) and lesser atherogenicity (<1.8) and thrombogenicity (<0.3) indices qualify P. sewelli an ideal health food. This study comprises the first report on fatty acid profile from commercially important deep-sea whip lobster P. sewelli

Are tree seed systems for forest landscape restoration fit for purpose? An analysis of four Asian countries

High-quality, suitably adapted tree seed at volume is a key component for the implementation and long-term success of forest landscape restoration (FLR). We analysed the tree seed systems in four Asian countries—the Philippines, Indonesia, Malaysia and India—which have committed to restore in total over 47.5 million hectares of degraded lands by 2030. We assessed the national seed systems using an established indicator framework, literature review and expert surveys and interviews. Additionally, we surveyed 61 FLR practitioners about their challenges in acquiring seed to understand how the strengths and weaknesses identified at the national level were reflected in FLR projects on the ground. Identified key constraints common to the studied countries are (i) a mismatch between the growing demand for priority native species and the limited seed supply in terms of quantity and quality, (ii) lack of effective quality control for seed of native species and (iii) lack of information about the effects of climate change on native species to guide species selection and seed sourcing and to improve the resilience of restored ecosystems. We discuss options to strengthen seed systems for native tree species both in terms of quality and volume to enable them to effectively respond to the national FLR commitments and make recommendations on promising technical solutions

Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead.

Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy