Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group

Micropropagation And Antimicrobial Activity Of Callicarpa Macrophylla (Priyangu) Against Medically Important Pathogens

Callicarpa macrophylla (Priyangu) a medicinally important plant, represents a class of herbal drug with very strong conceptual and traditional base. In present study extract of leaf, stem showed less antimicrobial activity than seed. They showed antimicrobial activity against three bacterial strains Staphylococcus aureus, Bacillus subtilis, Escherichia coli and Pseudomonas and three fungal Strains Aspergillus fumigatous, Rhizopus oryzae and Aspergillus awamori. Maximum activity was observed in ethanol extract of leaf and stem, Methanol extracts of seed. Phytochemical analysis of the plant extract revealed the presence of phenol, reducing sugar, coumarin and saponins.  Micropropogation of C.macrophylla was done using stem as a explant material on MS and Woody media. Which revealed that woody media containing BAP (6-amino benzyl purine) NAA(α-napthaleneacetic acid) gave maximum proliferation  response in comparison to MS media. Plant extract (leave, stem and seed) have provide protection against RBC haemolysis and protein denaturation may act as anti-arthritic agent. We propose antiarthritic and antimicrobial activity of C.macrophylla

Downregulation of peripheral PTGS2/COX-2 in response to valproate treatment in patients with epilepsy

Antiepileptic drug therapy has significant inter-patient variability in response towards it. The current study aims to understand this variability at the molecular level using microarray-based analysis of peripheral blood gene expression profiles of patients receiving valproate (VA) monotherapy. Only 10 unique genes were found to be differentially expressed in VA responders (n = 15) and 6 genes in the non-responders (n = 8) (fold-change >2, p < 0.05). PTGS2 which encodes cyclooxygenase-2, COX-2, showed downregulation in the responders compared to the non-responders. PTGS2/COX-2 mRNA profiles in the two groups corresponded to their plasma profiles of the COX-2 product, prostaglandin E(2) (PGE(2)). Since COX-2 is believed to regulate P-glycoprotein (P-gp), a multidrug efflux transporter over-expressed at the blood-brain barrier (BBB) in drug-resistant epilepsy, the pathway connecting COX-2 and P-gp was further explored in vitro. Investigation of the effect of VA upon the brain endothelial cells (hCMEC/D3) in hyperexcitatory conditions confirmed suppression of COX-2-dependent P-gp upregulation by VA. Our findings suggest that COX-2 downregulation by VA may suppress seizure-mediated P-gp upregulation at the BBB leading to enhanced drug delivery to the brain in the responders. Our work provides insight into the association of peripheral PTGS2/COX-2 expression with VA efficacy and the role of COX-2 as a potential therapeutic target for developing efficacious antiepileptic treatment

Phylogeography of mtDNA haplogroup R7 in the Indian peninsula.

BACKGROUND: Human genetic diversity observed in Indian subcontinent is second only to that of Africa. This implies an early settlement and demographic growth soon after the first 'Out-of-Africa' dispersal of anatomically modern humans in Late Pleistocene. In contrast to this perspective, linguistic diversity in India has been thought to derive from more recent population movements and episodes of contact. With the exception of Dravidian, which origin and relatedness to other language phyla is obscure, all the language families in India can be linked to language families spoken in different regions of Eurasia. Mitochondrial DNA and Y chromosome evidence has supported largely local evolution of the genetic lineages of the majority of Dravidian and Indo-European speaking populations, but there is no consensus yet on the question of whether the Munda (Austro-Asiatic) speaking populations originated in India or derive from a relatively recent migration from further East. RESULTS: Here, we report the analysis of 35 novel complete mtDNA sequences from India which refine the structure of Indian-specific varieties of haplogroup R. Detailed analysis of haplogroup R7, coupled with a survey of approximately 12,000 mtDNAs from caste and tribal groups over the entire Indian subcontinent, reveals that one of its more recently derived branches (R7a1), is particularly frequent among Munda-speaking tribal groups. This branch is nested within diverse R7 lineages found among Dravidian and Indo-European speakers of India. We have inferred from this that a subset of Munda-speaking groups have acquired R7 relatively recently. Furthermore, we find that the distribution of R7a1 within the Munda-speakers is largely restricted to one of the sub-branches (Kherwari) of northern Munda languages. This evidence does not support the hypothesis that the Austro-Asiatic speakers are the primary source of the R7 variation. Statistical analyses suggest a significant correlation between genetic variation and geography, rather than between genes and languages. CONCLUSION: Our high-resolution phylogeographic study, involving diverse linguistic groups in India, suggests that the high frequency of mtDNA haplogroup R7 among Munda speaking populations of India can be explained best by gene flow from linguistically different populations of Indian subcontinent. The conclusion is based on the observation that among Indo-Europeans, and particularly in Dravidians, the haplogroup is, despite its lower frequency, phylogenetically more divergent, while among the Munda speakers only one sub-clade of R7, i.e. R7a1, can be observed. It is noteworthy that though R7 is autochthonous to India, and arises from the root of hg R, its distribution and phylogeography in India is not uniform. This suggests the more ancient establishment of an autochthonous matrilineal genetic structure, and that isolation in the Pleistocene, lineage loss through drift, and endogamy of prehistoric and historic groups have greatly inhibited genetic homogenization and geographical uniformity.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Impact of targeted interventions on heterosexual transmission of HIV in India

<p>Abstract</p> <p>Background</p> <p>Targeted interventions (TIs) have been a major strategy for HIV prevention in India. We evaluated the impact of TIs on HIV prevalence in high HIV prevalence southern states (Tamil Nadu, Karnataka, Andhra Pradesh and Maharashtra).</p> <p>Methods</p> <p>A quasi-experimental approach was used to retrospectively compare changes in HIV prevalence according to the intensity of targeted intervention implementation. Condom gap (number of condoms required minus condoms supplied by TIs) was used as an indicator of TI intensity. Annual average number of commercial sex acts per female sex worker (FSW) reported in Behavioral Surveillance Survey was multiplied by the estimated number of FSWs in each district to calculate annual requirement of condoms in the district. Data of condoms supplied by TIs from 1995 to 2008 was obtained from program records. Districts in each state were ranked into quartiles based on the TI intensity. Primary data of HIV Sentinel Surveillance was analyzed to calculate HIV prevalence reductions in each successive year taking 2001 as reference year according to the quartiles of TI intensity districts using generalized linear model with logit link and binomial distribution after adjusting for age, education, and place of residence (urban or rural).</p> <p>Results</p> <p>In the high HIV prevalence southern states, the number of TI projects for FSWs increased from 5 to 310 between 1995 and 2008. In high TI intensity quartile districts (n = 30), 186 condoms per FSW/year were distributed through TIs as compared to 45 condoms/FSW/year in the low TI intensity districts (n = 29). Behavioral surveillance indicated significant rise in condom use from 2001 to 2009. Among FSWs consistent condom use with last paying clients increased from 58.6% to 83.7% (p < 0.001), and among men of reproductive age, the condom use during sex with non-regular partner increased from 51.7% to 68.6% (p < 0.001). A significant decline in HIV and syphilis prevalence has occurred in high prevalence southern states among FSWs and young antenatal women. Among young (15-24 years) antenatal clinic attendees significant decline was observed in HIV prevalence from 2001 to 2008 (OR = 0.42, 95% CI 0.28-0.62) in high TI intensity districts whereas in low TI intensity districts the change was not significant (OR = 1.01, 95% CI 0.67-1.5).</p> <p>Conclusion</p> <p>Targeted interventions are associated with HIV prevalence decline.</p

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions

Awareness of Cardiovascular Health among Adults Residing in a Municipality in Kathmandu District, Nepal

Background: Cardiovascular diseases are the leading cause of high disability adjusted life years and premature death, accounting disability among 43% of cases. If there is public awareness, most of the cardiovascular diseases can be prevented with modification of behavioral risk factors.  Therefore, this study was conducted to find out the peoples’ awareness on cardiovascular health.  Methods: A cross-sectional design was used. Data was collected using an in-person interview technique among randomly selected 236 adults residing in Budhanilkantha Municipality of Kathmandu District. Semi-structured interview schedule based on WHO Stepwise approach and literature review was used to collect data. Data analyzed using descriptive statistics (frequency, percentage, median, Inter Quartile Range) and inferences were drawn with an application of the chi-square test, and Fisher’s exact test. Results: Among 236 participants, most (85.6%) of the adults had an adequate level of awareness regarding cardiovascular health. However, around 80% of them were unaware of radiating pain as a symptom of heart attack and around 40% of adults did not recognize high blood sugar and dyslipidemia as risk factors of cardiovascular disease. Awareness of cardiovascular health was significantly associated with educational level (p<0.001), ethnicity (p=0.021), self-reported morbidities (p=0.044) and family history of morbidities (p<0.001).  Conclusion: Although adults were aware of cardiovascular health, most of them did not know that control of blood sugar and blood cholesterol are necessary to maintain cardiovascular health. Hence, awareness programs targeting these aspects would be beneficial

Renal profile of asphyxiated neonates in relation to the severity of asphyxia

Background and Objectives:Perinatal asphyxia (PA) is a major problem that contributes significantly to neonatal mortality as well as long term morbidity.Due to their unique characteristics, neonatalKidneys are one of the most common organs involved in multiple organ dysfunction caused by asphyxia. Whereas renal complications in perinatal asphyxia have been well studied, literature regarding degree of renal dysfunction in relation to severity of asphyxia is sparse. This study was conducted to determine the incidence of renal failure in asphyxiated neonates and to correlate severity and type of renal failure with APGAR score and hypoxic ischemic encephalopathy (HIE) grading of neonates.Methodology: This prospective case control study was conducted over 1 year from July 2019 to June 2020 at NICU of our tertiary care hospital. Consecutively admitted neonates of gestational age &gt;34 weeks with PA formed the study group who were carefully matched with equal number of non-asphyxiated neonates of comparable gestational age, weight &amp; gender. Renal function was assessed by urine output, urine microscopy, biochemical parameters &amp; sonographic findings. Observation and Results: 102 asphyxiated neonates were enrolled as cases (group A) in the present study. Of these asphyxiated neonates, 58 (56.9%) had hypoxic ischemic encephalopathy (HIE). Urine output in group A was 1.23 mL ± 0.41 mL/kg/hour which was comparable to 1.31 mL ± 0.39 mL/kg/hour in the control group (P = 0.15). Blood urea and serum creatinine were significantly higher in asphyxiated babies as compared to the control group (P&lt;0.05). Concentration of urea and creatinine increased with progression of the HIE stage. This trend was statistically significant between babies with no HIE and those with HIE stage III (P &lt;0.05). Neonates with asphyxia also had significantly higher incidence of hyponatremia (30.4% vs 10.8%). 44.1% neonates had acute renal failure. Non-oliguric renal failure (29/45, 64.4%) was more common than oliguric renal failure (16/45, 35.6%). Neonates with oliguric renal failure had higher mortality rate. Renal parameters normalized in all survivors by 1 months of age.Conclusion: Renal failure is a significant problem in asphyxiated neonates with majority of neonates having non-oliguric renal failure. Severity of renal function abnormality correlates well with degree of asphyxia

First reported case of Alcaligenes faecalis isolated from bronchoalveolar lavage in a patient with dengue hemorrhagic fever

Bacterial co-infections have been reported in association with dengue fever (DF) and can exacerbate dengue infections. However, DF with acute respiratory distress syndrome and co-infection with Alcaligenes faecalis (A. faecalis) has not been reported earlier. Most infections caused by A. faecalis are opportunistic. Urinary tract infection, bacterial keratitis, postoperative endophthalmitis, skin and soft tissue infections, bacteremia, meningitis, wound infections, and peritonitis in patients undergoing peritoneal dialysis have been described in association with A. faecalis. A. faecalis, a Gram-negative environmental organism rarely cause significant infections. Treatment can be difficult in some cases due to the high level of resistance to commonly used antibiotics. We report a case of fatal bronchopneumonia caused by extensively drug resistance A. faecalis in a patient of dengue hemorrhagic fever

A pilot study for the evaluation of pcr as a diagnostic tool in patients with suspected dermatophytoses

Context: The conventional diagnostic tools for dermatophytoses suffer from several limitations including low sensitivity, specificity, and long turn-around-time. Aims: The present study was, therefore, performed to evaluate the performance of a polymerase chain reaction (PCR)-based method for the diagnosis of this condition. Settings and Design: The study was conducted in the Dermatology outpatient department of a tertiary care teaching hospital in central India over a period of 3 months from July to September 2015. Materials and Methods: Forty participants, including 25 cases and 15 controls, were recruited in this observational study. Direct microscopy and fungal culture were performed from skin scrapings and nail clippings collected from the participants. PCR was also performed to amplify the chitin synthase 1 and internal transcribed spacer 2 genes from DNA samples extracted from the same clinical materials, using the method reported by Brillowska-Dabrowska et al. The diagnostic performance of fungal culture and PCR was compared using OpenEpi software. Results: We observed a significant male predominance among patients with dermatophytoses. The sensitivity of fungal culture and dermatophyte PCR to diagnose dermatophytoses was 24% and 48%, respectively, whereas the specificity of the two assays was 100% and 93.3%, respectively. The likelihood ratio of a positive PCR assay was 7.2 and the negative likelihood ratio was 0.5. PCR assay also delivered a significant shortening of the time-to-diagnosis, with the mean turn-around-time being 8 hours and 14 days for PCR and culture, respectively. Conclusion: This study, thus, highlights the potential merits of the dermatophyte PCR assay in achieving a rapid diagnosis of dermatophytoses and underscores its utility as a complementary test to improve the sensitivity of the conventional diagnostic tools for this condition, as well as to reliably differentiate this condition from other similar skin conditions