The rise and fall of training and visit extension : an Asian mini-drama with an African epilogue

The paper reviews the origins and evolution of the Training and Visit (T&V) extension system, which was promoted by the World Bank in 1975-98 in over 50 developing countries. The discussion seeks to clarify the context within which the approach was implemented, and to analyze the causes for its lack of sustainability and its ultimate abandonment. The paper identifies some of the challenges faced by the T&V approach as being typical of a large public extension system, where issues of scale, interaction with the agricultural research systems, inability to attribute benefits, weak accountability, and lack of political support tend to lead to incentive problems among staff and managers of extension, and limited budgetary resources. The different incentives and outlook of domestic stakeholders and external donor agencies are also reviewed. The main cause of the T&V system's disappearance is attributed to the incompatibility of its high recurrent costs with the limited budgets available domestically, leading to fiscal unsustainability. The paper concludes with some lessons that apply to donor-driven public extension initiatives, and more generally to rural development fads. The role of timely, independent, and rigorous evaluative studiesis specifically highlighted.Agricultural Knowledge&Information Systems,Rural Development Knowledge&Information Systems,Rural Poverty Reduction,ICT Policy and Strategies,Banks&Banking Reform

Cervical ectopic pregnancy: 10 year experience at tertiary care hospital and current literature review

Background: Objective of the study was to critically analyze the clinical experience and literature on cervical pregnancy.Methods: This is a retrospective analysis of cervical ectopic pregnancies (CEP) diagnosed in our tertiary care institute from 2005 to 2015 and literature search.Results: In this study period the total numbers of births in our institute were 1, 32, 752, ectopic pregnancies were 307 and three cases of cervical ectopic pregnancies were diagnosed. Incidence of CEP at our institute is 0.9% of all ectopic pregnancies and 0.002% or 1 in 44,250 of livebirths which matches the available literature. The first two cases developed torrential haemorrhage which ended in hysterectomy and the third case was managed conservatively with methotrexate (MTX) and mefiprestone.Conclusions: The early detection of cervical pregnancy in asymptomatic or minimally symptomatic patients increases use of more conservative approaches which aim to preserve the uterus and the patient's reproductive potential. We suggest that systemic administration of low dose MTX is ideal for patients who are stable and if live embryo is detected, to reduce MTX failure rate concomitant feticide must be done, for which mefiprestone seems to be easy safe alternative to local chemotherapy

Robson ten groups classification system for caesarean section audit: are our operation theatre registers RTGC enabled?

Background: Rising caesarean section rate is a global problem. Robson ten groups classification (RTGC) system of audit has been recommended as the first step towards planning strategies to reduce caesarean section rate. Getting data for this audit is often difficult. If operation theatre (OT) registers are maintained properly this would become easy. The study proposes to know if enough information is available in the operation theatre registers to get caesarean section data for ten groups of Robson classification system. To suggest changes in OT register format for future convenience.Methods: We studied data from 100 consecutive caesarean section entries in OT registers from two medical college institutions to know if the information recorded is adequate to classify these 100 caesarean sections into ten groups given by Robson. Last 100 caesarean section entries into the OT register during the period 1st April 2018 till 31st March 2019 were studied.Results: Presentation of the foetus was the only factor which could be clearly known for all 100 cases. Labour onset whether spontaneous or induced was the least recorded observation in traditional operation theatre registers. The next information which was commonly not recorded was the labour status (woman in labour or not in labour) at the time of caesarean section.Conclusions: For Robson’s classification of caesarean sections to become useful tool to guide strategies in reducing caesarean sections we need to modify format of our OT registers. Traditional OT registers do not provide enough information to categorize caesarean section cases into Robson ten groups. Missing information makes caesarean section audit imperfect or impossible. We suggest a format for it to be incorporated into the operation theatre registers of centres providing maternity services

To evaluate the anticonvulsant activity of ethanolic extract of Moringa oleifera (drumstick leaves) in albino mice

Background: To evaluate the anti-convulsant activity of ethanolic extract of Moringa oleifera (Drum stick leaves) in seizure induced albino mice and to compare it with standard drug Sodium valproate.Methods: Swiss albino mice of either sex weighing around 25-30g were randomly selected and divided into four groups of six mice each. Group 1: control- treated with gum acacia. Group 2: Standard - Valproic acid 40mg/kg body weight. Group 3: T1- ethanolic extract of Moringa oleifera (150mg/kg). Group 4: T2 - ethanolic extract of Moringa oleifera (300mg/kg). All drugs were administered orally one hour prior to induction of seizure. The anticonvulsant activity was screened using maximal electroshock seizure (MES) model and pentylenetetrazole (PTZ) model.Results: Results were analysed by ANOVA followed by Bonferroni’s post hoc test. Abolition of Tonic hind limb extension was taken as the protective end point against MES induced seizures and prolongation of seizure latency in PTZ model.At both the doses the ethanolic extract of Moringa oleifera significantly (p value <0.05) reduced the duration of hind limb extension in MES test and also significantly (p value <0.05) delayed the onset of clonic seizures in PTZ induced convulsion when compared with control group.Conclusions: On comparing the percentage protection offered by Moringa oleifera leaves against both MES and PTZ model, it possesses significant anticonvulsant activity at both doses, with more efficacy at 300mg/kg BW indicating that the test drug can prove a very promising drug for treatment of epilepsy. Further studies are required for isolation and identification of the active constituent

Pulse Wave Velocity and Electroneurophysiological Evaluation in patients of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic systemic inflammatory disease of undetermined etiology involving the synovial membranes and articular structures of multiple joints and is also associated with carditis, pleuritis, hepatitis, peripheral neuropathy and vasculitis. The present study was undertaken to investigate arterial stiffness using carotid-radial and femoral-dorsalis pedis pulse wave velocity measurements and electrophysiological tests for peripheral nervous system involvement. 25 patients (aged between 20-60 years) with rheumatoid arthritis according to the criteria of the American College of Rheumatology and 25 control subjects of the same age and sex were recruited. In the motor conduction studies, out of 25 patients of Rheumatoid arthritis, 6 had clinical evidence of peripheral neuropathy. 11 patients showed pure sensory neuropathy (44%), 10 showed mixed sensory motor neuropathy (40%) while 4 showed normal motor and sensory conduction velocity. Two patients (8%) showed features of entrapment neuropathy of median nerve i.e. feature of Carpal tunnel syndrome. In the pulse wave velocity evaluation statistically significant increase in pulse wave velocity between femoral-dorsalis pedis and carotid-radial artery segments was observed in Rheumatoid arthritis patients as compared to the control group. Measurement of carotid-radial and femoral-dorsalis pedis PWV may provide a simple and non-invasive technique for identifying patients at increased risk of vascular disease in Rheumatoid arthritis

Profile of serious adverse drug events in a tertiary care hospital of South India - a five years experience

Background: Adverse drug event (ADE) is said to be serious, when it is life-threatening, leads to hospitalization, disability, congenital anomaly, death or requires intervention to prevent permanent impairment or damage. The present study aimed to determine the pattern, causality, preventability of serious ADEs.Methods: This retrospective study was carried out to profile serious ADEs reported from Bangalore Medical College and Research Institute to Adverse Drug Reaction (ADR) Monitoring Centre, under Pharmacovigilance Programme of India from 2012 to 2016. Patient demographics, clinical and drug data, details of the ADE, onset time, causal drug details, outcome and severity were collected as per CDSCO form. Causality was assessed by WHO-ADR probability scale, preventability by modified Schumock and Thornton scale.Results: A total of 809 ADEs were reported, of which 50 (6.18%) were serious in nature. Male preponderance (74%) was observed, with 42% among patients aged 20-40 years. 56% of serious ADEs were reported from department of Dermatology. Steven Johnson Syndrome (SJS) (20%) contributed for most of the ADEs. Antiepileptics caused maximum number of serious ADEs (32%). 76% of the ADEs were found to be ‘probable’ and 4% were definitely preventable. 56% of them was life threatening and 86% required intensive interventions. 16% patients experienced serious ADEs during hospital stay.Conclusions: Serious ADEs constituted 6.18% of all ADEs reported. SJS was commonly seen with antimicrobials and hepatotoxicity with ATT. Antiepileptics and ATT contributed for majority of them. This study highlights the importance of monitoring and timely management of serious ADEs to commonly prescribed medications

Antimicrobial property of bioactive factor isolated from Parmelia perlata

Parmelia is previously mentioned in India Materia Medica as a treatment for a number of ailments and hence they are being used in large quantities as a food supplement in India. The crude hot extracts of Parmelia perlata and the isolated compounds were evaluated for their antimicrobial activity. The antibacterial activity of Parmelia perlata crude hot extracts revealed that the extracts showed significant effect against Clavibacter michiganensis (33 ± 0.06), moderate against Pseudomonas solanacearum (33 ± 0.32) and less potent against Escherichia coli (28 ± 0.10) when compared to the standard drug Streptomycin. The Fusarium oxysporum (26 ± 0.38) and Rhizopus nigricans (20 ± 0.06) were more susceptibility to wards the treatment of hot extracts, whereas Aspergillus niger (18 ± 0.15)  demonstrated less susceptibility to crude hot extracts, but stardard antifungal drug bavistin was potent against all the fungal pathogens used in the study. Compound-I and compound-II isolated from the crude extract of Parmelia perlata showed efficient antibacterial activity. The antibacterial activity of compound-II was significant against to Clavibacter michiganensis (22 ± 0.17) and Pseudomonas solanacearum (44 ± 0.21), but less against to Escherichia coli (11 ± 0.17). Compound-I were more active against Pseudomonas solanacearum (31 ± 0.06) and moderately active against Clavibacter michiganensis (28 ± 0.05) and less active against to Escherichia coli (21 ± 0.23) when compared to Streptomycin. The antifungal activity of compound-II was better than compound-I. Compound-II was significant against Fusarium oxysporum (40 ± 0.05), Rhizopus nigricans (27 ± 0.02) and less active against to Aspergillus niger (18 ± 0.02) than compared to compound-I. The compound-I did not impotent against Aspergillus niger. The present investigation indicated that the crude hot extracts and the isolated compounds of Parmelia perlata have potential antimicrobial property.Â

A comparative study of probiotic, prokinetic based triple therapy with USFDA regimen in the eradication of Helicobacter pylori in a tertiary care hospital

Background: Helicobacter pylori infection has been associated with peptic ulcer disease, gastric carcinoma and gastric mucosa associated lymphoid tissue (MALT) lymphoma. Its eradication is important and current regimens are associated with antibiotic resistance, side effects and poor patient compliance. Probiotics supplementation can overcome the above problem and additions of prokinetics improve dyspepsia symptoms and thereby improve patient compliance. So the aim of the study was to compare efficacy and safety of standard United States Food and Drug Administration (USFDA) regimen with probiotic, prokinetic based novel regimen.Methods: 100 patients diagnosed with H. pylori infection were randomly assigned into two eradication regimen groups viz., group A and group B. Group A received standard USFDA regimen, amoxicillin 1 gm, lansoprazole 30 mg and clarithromycin 500 mg twice a day for 2 weeks and group B received a probiotic and prokinetic itopride 50 mg thrice daily, pantoprazole 40 mg, amoxicillin 1 gm and clarithromycin 500 mg twice daily for 2 weeks. Patients with Rapid Urease Test (RUT) and histopathology reports negative for H. pylori were considered as eradicated and then the percentage of eradication rate in both groups was compared.Results: H. pylori eradication rates were more in group B compared to group A (84% vs 70%, p =0.096 at 95% CI). The occurrence of side effects was less in group B compared to group A (30% vs 46%, p= 0.099). Diarrhoea was statistically less in group B compared to group A (p< 0.05).Conclusions: Probiotics supplementation increases eradication rates of anti H. pylori therapy and improves tolerability by reducing side effects especially diarrhoea. Prokinetics and probiotic based novel regimen improved dyspepsia symptoms and patient compliance

Effect of Integrated Nutrient Management on Onion Yield and Soil Properties under Chromic haplusterts of Karnataka

A field experiment was conducted during the Kharif season of 2002 and 2003 under Chromic Haplusterts (medium black soils) at Zonal Agricultural Research Station, Hiriyur to study the effect of Coir Pith Based Compost (CPBC) along with organic manures and inorganic fertilizers on yield of Onion. The study revealed that combined application of CPBC @ 15 t/ha along with press mud (PM) and half the recommended dose of fertilizer (RDF) gave significant higher bulb yield of onion (14.70 t/ha) as compared to RDF along with FYM (9.55 t/ha). The bulb yields were on par with the combined application of CPBC along with FYM and 50% RDF or combined application of CPBC and Green manure (GM) along with 100% RDF, indicating the utility of CPBC in onion cultivation. Higher net and gross returns were recorded with application of CPBC and PM @ 15 t/ha each along with 50% RDF with better benefit cost ratio. The yield and quality parameters also differed significantly among the various combinations of CPBC with PM or FYM in conjunction with inorganic fertilizers. Analysis of the soil after the harvest of onion crop did not show any significant difference in pH and EC among the treatments. However, organic carbon, available phosphorus and available potash were significantly higher due to application of CPBC, PM, FYM and GM along with 50% or 100% RDF