Single dose oral zinc as adjuvant therapy in children admitted with severe pneumonia: A randomized, placebo-controlled study

Background: Childhood pneumonia is one of the major causes of under-five mortality in developing countries. Any interventions whichcan reduce the mortality and morbidity of pneumonia are of great importance. Adjuvant zinc therapy is one such intervention studiedin various parts of the world with inconclusive results. Objective: We aim to study the impact of a single dose of zinc therapy on theoutcome of childhood severe pneumonia. Material and Methods: Randomized, placebo-controlled study of young children between2 and 24 months was conducted to study the impact of single dose zinc administration on time to resolution of severe pneumonia. Thesubjects were assigned two groups, zinc group and non-zinc group, by stratified randomization. The zinc group received unlabeled oralzinc syrup 20 mg of elemental zinc as single dose for children >6 months of age and 10 mg of elemental zinc as single dose for children<6 months. The non-zinc group children were administered unlabeled non-zinc containing placebo as single dose. Results: From April2011 to December 2011, 1284 children screened for pneumonia as per Integrated Management of Neonatal and Childhood Illnessesguidelines and 126 children were included in the study. Of these 126 children, 63 were randomized to receive zinc and 63 to receiveplacebo. The mean duration of respiratory distress before hospitalization was 1.4±0.5 days in zinc group as compared to 1.1±0.5 days innon-zinc group (p=0.001). The mean duration of resolution of distress was 52.47±33.99 h in zinc group as compared to 74.17±37.76 h inthe non-zinc group (p=0.05). Similarly, the mean duration for resolution of symptoms was 65.52±36.03 h in zinc group as compared to88.00±37.97 in non-zinc group (p=0.05). The 23% of the children in non-zinc group had treatment failure (p=0.03). Conclusion: Singledose of adjuvant oral zinc therapy in severe pneumonia, reduces the duration of respiratory distress, resolves the symptoms early anddecreases the incidence of treatment failure. However, the total duration of hospitalization was not affected by zinc therapy

A study of abuse including physical, substance, and sexual abuse among urban adolescent children

Background: Adolescents are the future citizens of a country, and it is imperative to systematically address their needs. The prevalenceof abuse including physical and sexual, by these adolescents as well as against them, have been increased. Objective: The study wasundertaken to estimate the prevalence of abuse including physical, substance, and sexual abuse in adolescents of Bengaluru urban.Materials and Methods: This was a cross-sectional survey conducted among the adolescents aged 10-19 years in Bengaluru. A pretestedself-designed semi-structured questionnaire which included demographic profile and details of the substance abuse (physical and sexualabuse), juvenile delinquency was used. Data were analyzed using SPSS software. Results: A total of 303 adolescents were enrolledduring the study period, out of which 167 adolescents were from school and 136 adolescents from the slum. Most children (54.1%)belonged to the age group of 14-16 years. Smoking (48.5%) was the most common form of abuse among the parents. The most commonsubstance abuse seen among children was smoking (30%). Majority were involved in violence with other adolescents (71%). Sexualabuse was seen more in slum children as compared to school children. Substance abuse among children was mostly influenced byfriends in 70 (40.7%) cases. Conclusion: Substance abuse was common in male slum adolescents for which peer pressure and curiositywere the main influences. More than one-quarter of slum adolescents reported physical abuse while sexual abuse was more commonlyreported in female slum adolescents

BOBMEX: the Bay of Bengal monsoon experiment

The first observational experiment under the Indian Climate Research Programme, called the Bay of Bengal Monsoon Experiment (BOBMEX), was carried out during July-August 1999. BOBMEX was aimed at measurements of important variables of the atmosphere, ocean, and their interface to gain deeper insight into some of the processes that govern the variability of organized convection over the bay. Simultaneous time series observations were carried out in the northern and southern Bay of Bengal from ships and moored buoys. About 80 scientists from 15 different institutions in India collaborated during BOBMEX to make observations in most-hostile conditions of the raging monsoon. In this paper, the objectives and the design of BOBMEX are described and some initial results presented. During the BOBMEX field phase there were several active spells of convection over the bay, separated by weak spells. Observation with high-resolution radiosondes, launched for the first time over the northern bay, showed that the magnitudes of the convective available potential energy (CAPE) and the convective inhibition energy were comparable to those for the atmosphere over the west Pacific warm pool. CAPE decreased by 2-3 kJ kg-1 following convection, and recovered in a time period of 1-2 days. The surface wind speed was generally higher than 8 m s-1. The thermohaline structure as well as its time evolution during the BOBMEX field phase were found to be different in the northern bay than in the southern bay. Over both the regions, the SST decreased during rain events and increased in cloud-free conditions. Over the season as a whole, the upper-layer salinity decreased for the north bay and increased for the south bay. The variation in SST during 1999 was found to be of smaller amplitude than in 1998. Further analysis of the surface fluxes and currents is expected to give insight into the nature of coupling

Pharmacokinetics of First-Line Antituberculosis Drugs in HIV-Infected Children with Tuberculosis Treated with Intermittent Regimens in India

The objective of this report was to study the pharmacokinetics of rifampin (RMP), isoniazid (INH), and pyrazinamide (PZA) in HIV-infected children with tuberculosis (TB) treated with a thrice-weekly anti-TB regimen in the government program in India. Seventy-seven HIV-infected children with TB aged 1 to 15 years from six hospitals in India were recruited. During the intensive phase of TB treatment with directly observed administration of the drugs, a complete pharmacokinetic study was performed. Drug concentrations were measured by high-performance liquid chromatography. A multivariable regression analysis was done to explore the factors impacting drug levels and treatment outcomes. The proportions of children with subnormal peak concentrations (C(max)) of RMP, INH, and PZA were 97%, 28%, and 33%, respectively. Children less than 5 years old had a lower median C(max) and lower exposure (area under the time-concentration curve from 0 to 8 h [AUC(0–8)]) of INH (C(max), 2.5 versus 5.1 μg/ml, respectively [P = 0.016]; AUC(0–8), 11.1 versus 22.0 μg/ml · h, respectively [P = 0.047[) and PZA (C(max), 34.1 versus 42.3 μg/ml, respectively [P = 0.055]; AUC(0–8), 177.9 versus 221.7 μg/ml · h, respectively [P = 0.05]) than those more than 5 years old. In children with unfavorable versus favorable outcomes, the median C(max) of RMP (1.0 versus 2.8 μg/ml, respectively; P = 0.002) and PZA (31.9 versus 44.4 μg/ml, respectively; P = 0.045) were significantly lower. Among all factors studied, the PZA C(max) influenced TB treatment outcome (P = 0.011; adjusted odds ratio, 1.094; 95% confidence interval, 1.021 to 1.173). A high proportion of children with HIV and TB had a subnormal RMP C(max). The PZA C(max) significantly influenced treatment outcome. These findings have important clinical implications and emphasize that drug doses in HIV-infected children with TB have to be optimized

Molecular Characterization of the Gene of Vertically Transmitted HIV-1 Strains in Children with Virological Failure.

HIV-1 gene sequences were analyzed from 77 HIV-1 positive children infected perinatally and exhibiting virological failure (VF). Viral subtyping, phylogenetic analysis, and genotypic drug resistance analysis were carried out on samples collected before start of anti retroviral treatment (ART) (baseline, BL), and at 12 months post-ART initiation (M12). Subtype C was found to be most predominant, seen in 75 of the 77 (97.4%) children. The level of pretreatment drug resistance (PDR) was 14% among these children. At BL, K103N (5), E138A/G (4), and M184V (3) were the most common mutations. At M12 the prevalence of any resistance-associated mutation (RAM) (acquired drug resistance/ADR) was 81.8% (63/77). Dual class resistance mutations were seen in 64% (49/77) of children. M184V/I, K103N/S, and Y181C were the most commonly occurring mutations, seen in 76%, 51%, and 36% children. RAMs to the second-generation non-nucleoside reverse transcriptase inhibitors (NNRTI), etravirine (ETR) and rilpivirine (RPV), were seen in 40.2% (31/77) and 48.05% (37/77) of the children, respectively. Our findings reveal similar prevalence rates of PDR and ADR in children with VF as reported in other studies. Occurrence of ETR and RPV resistance associated mutations (RAMs) is of concern and highlights the need for timely switch of regimens guided by genotypic resistance testing in perinatally infected children from India

Effectiveness of symptom screening and incidence of tuberculosis among adults and children living with HIV infection in India.

BACKGROUND WHO recommends the use of a simplified symptom-based algorithm for screening for tuberculosis (TB) among people living with HIV (PLHIV). We assessed the feasibility and effectiveness of this algorithm and determined the prevalence and incidence of TB among PLHIV attending antiretroviral treatment (ART) centres in India. METHODS We did a prospective multicentric implementation research study in four states of India. To rule out TB, we administered the WHO symptom-screen algorithm to all PLHIV every month for 6 months. If they were found to be symptomatic any time during this period, they were referred for investigations for TB. A case of TB diagnosed during the first month of screening was taken as a prevalent case while those detected TB in the subsequent 5 months were considered cases of incident TB. We calculated the incidence rate using the person-years method. Results . Between May 2012 and October 2013, a total of 6099 adults and 1662 children living with HIV were screened for TB at the ART centres of four states. Of the 6099 adult PLHIV, 1815 (30%) had at least one symptom suggestive of TB, of whom only 634 (35%) were referred for investigations of TB. Of those referred, 97 (15%) PLHIV were diagnosed with TB. Overall, the prevalence of undiagnosed TB was 0.84 person-years and in the subsequent period, the incidence of TB was 2.4/100 person-years (95% CI 1.90-3.10). Among 1662 children, 434 (26%) had at least one symptom suggestive of TB. But only 57 (13%) children were referred for investigations of TB and 13 (23%) of them were diagnosed with TB. The prevalence of TB among children was 0.5% and its incidence among them was 2.7/100 person-years (95% CI 1.60-4.30). CONCLUSION Prevalence and incidence of TB is high among PLHIV attending ART centres. This emphasizes the need to strengthen regular screening for symptoms of TB and further referral of those symptomatic for diagnosis of TB

Aggregation and settling in aqueous polydisperse alumina nanoparticle suspensions

Nanoparticle suspensions (also called nanofluids) are often polydisperse and tend to settle with time. Settling kinetics in these systems are known to be complex and hence challenging to understand. In this work, polydisperse spherical alumina (Al2O3) nanoparticles in the size range of ~10-100nm were dispersed in water and examined for aggregation and settling behaviour near its isoelectric point (IEP). A series of settling experiments were conducted and the results were analysed by photography and by Small Angle X-ray Scattering (SAXS). The settling curve obtained from standard bed height measurement experiments indicated two different types of behaviour, both of which were also seen in the SAXS data. But the SAXS data were remarkably able to pick out the rapid settling regime as a result of the high temporal resolution (10s) used. By monitoring the SAXS intensity, it was further possible to record the particle aggregation process for the first time. Optical microscopy images were produced on drying and dried droplets extracted from the suspension at various times. Dried deposits showed the rapid decrease in the number of very large particles with time which qualitatively validates the SAXS prediction, and therefore its suitability as a tool to study unstable polydisperse colloids. Keywords: Nanoparticles, nanofluids, polydisperse, aggregation, settling, alumina, microscopy, SAX

Suppression of uPA and uPAR Attenuates Angiogenin Mediated Angiogenesis in Endothelial and Glioblastoma Cell Lines

In our earlier reports, we showed that downregulation of uPA and uPAR inhibited glioma tumor angiogenesis in SNB19 cells, and intraperitoneal injection of a hairpin shRNA expressing plasmid targeting uPA and uPAR inhibited angiogenesis in nude mice. The exact mechanism by which inhibition of angiogenesis takes place is not clearly understood.In the present study, we have attempted to investigate the mechanism by which uPA/uPAR downregulation by shRNA inhibits angiogenesis in endothelial and glioblastoma cell lines. uPA/uPAR downregulation by shRNA in U87 MG and U87 SPARC co-cultures with endothelial cells inhibited angiogenesis as assessed by in vitro angiogenesis assay and in vivo dorsal skin-fold chamber model in nude mice. Protein antibody array analysis of co-cultures of U87 and U87 SPARC cells with endothelial cells treated with pU2 (shRNA against uPA and uPAR) showed decreased angiogenin secretion and angiopoietin-1 as well as several other pro-angiogenic molecules. Therefore, we investigated the role of angiogenin and found that nuclear translocation, ribonucleolytic and 45S rRNA synthesis, which are all critical for angiogenic function of angiogenin, were significantly inhibited in endothelial cells transfected with uPA, uPAR and uPA/uPAR when compared with controls. Moreover, uPA and uPAR downregulation significantly inhibited the phosphorylation of Tie-2 receptor and also down regulated FKHR activation in the nucleus of endothelial cells via the GRB2/AKT/BAD pathway. Treatment of endothelial cells with ruPA increased angiogenin secretion and angiogenin expression as determined by ELISA and western blotting in a dose-dependent manner. The amino terminal fragment of uPA down regulated ruPA-induced angiogenin in endothelial cells, thereby suggesting that uPA plays a critical role in positively regulating angiogenin in glioblastoma cells.Taken together, our results suggest that uPA/uPAR downregulation suppresses angiogenesis in endothelial cells induced by glioblastoma cell lines partially by downregulation of angiogenin and by inhibition of the angiopoietin-1/AKT/FKHR pathway

Observations of trace gases and aerosols over the Indian Ocean during the monsoon transition period

Characteristics of trace gases (O3, CO, CO2, CH4 and N2O) and aerosols (particle size of 2.5 micron) were studied over the Arabian Sea, equatorial Indian Ocean and southwest part of the Bay of Bengal during the monsoon transition period (October-November, 2004). Flow of pollutants is expected from south and southeast Asia during the monsoonal transition period due to the patterns of wind flow which are different from the monsoon period. This is the first detailed report on aerosols and trace gases during the sampled period as the earlier Bay of Bengal Experiment (BOBMEX), Arabian Sea Monsoon Experiment (ARMEX) and Indian Ocean Experiments (INDOEX) were during monsoon seasons. The significant observations during the transition period include: (i) low ozone concentration of the order of 5 ppbv around the equator, (ii) high concentrations of CO2, CH4 and N2O and (iii) variations in PM2.5 of 5-20μg/m3