Magnitude and Correlates of Elevated Blood Pressure among Adolescent School Students Aged 15-19 Years in a Block of Murshidabad, West Bengal, India

Background: The prevalence of adolescent hypertension is on the rise due to multiplicity of certain risk factors, like obesity, unhealthy dietary behaviour, physical inactivity, tobacco use, alcohol addiction, and academic stress. The present study aimed to estimate the prevalence of elevated blood pressure and hypertension among adolescent school children and identify the factors influencing it.Methods: The present observational, cross-sectional study was conducted in two higher secondary schools in a block of Murshidabad district, West Bengal, from February to April 2021. The subjects included 15 to 19-year-old school students. Multistage random sampling method was used for selecting a sample size of 183 adolescent school children. Data were obtained by interviewing the study participants, measurement of blood pressure and anthropometric measurements. Chi-squared test and binary logistic regression were used for bivariate and Multivariable data analysis, respectively, with P<0.05 as the level of significance.Results: The mean of Systolic Blood Pressure and Diastolic Blood Pressure were 115.02+10.853 and 71.52+8.484 mm of Hg, respectively. The overall prevalence of elevated blood pressure and adolescent hypertension was 21.3% (95% CI 15.4-27.2). The prevalence was significantly higher among those with paternal education of above middle school (AOR=1.803, P=0.011), high socioeconomic status (AOR=3.16, P=0.02), and high Body Mass Index for their age (AOR=11.474, P<0.0001). Smart phone use (P=0.03) and family history of hypertension (P=0.029) were also found to significantly influence elevated blood pressure among the subjects in bivariate analysis.Conclusions: Measurement of blood pressure, as a part of school health programme, should be given priority with emphasis on physical activity at school, health promotion to avoid unhealthy diet, and restricted smart phone use

Comparison of the Effect of Pretreatment with Cisatracurium and Rocuronium on Succinylcholine Induced Fasciculation for Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospital-based, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection was observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Postanesthesia Care Unit (PACU) on Postoperative Day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in group 2 (mean 0.2187±0.4200) than group 1 (mean 1.125±0.833, p-value <0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia

Breastfeeding practices based on the gestational age and weight at birth in the first six months of life in a population-based cohort of infants from North India

BackgroundShort and long term benefits of early Initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in the first six months of life are well established and recommended globally. However, reliable estimates of breastfeeding practices and impact of breastfeeding counselling interventions according to gestational age and weight at birth are not available in low and middle income countries.ObjectiveTo assess the impact of breastfeeding counselling on EIBF and EBF during the first 6 months of life according to gestational age and weight at birth.MethodsWe analysed the data collected from the Women and Infants Integrated Interventions for Growth Study (WINGS), an individually randomized factorial design trial. Mothers were counselled on EIBF during third trimester of pregnancy. They were supported throughout the first 6 months to continue EBF by early problem identification, frequent home visits and assistance in expressing breastmilk when direct breastfeeding was not possible. Breastfeeding practices were ascertained through 24 h recalls at infant ages 1, 3 and 5 months for both the intervention and control groups by an independent outcome ascertainment team. The World Health Organization (WHO) definitions were used for classification of infant breastfeeding practices. Generalized linear models of the Poisson family with a log-link function were used to estimate the effect of interventions on breastfeeding practices. The relative measures of effect on breastfeeding practices were estimated in term appropriate for gestational age (T-AGA), term small for gestational age (T-SGA), preterm AGA (PT-AGA), preterm SGA (PT-SGA) infants.ResultsAmongst all infants irrespective of gestational age and weight at birth, EIBF was (51.7%) higher amongst the intervention group (IRR 1.38, 95% CI 1.28–1.48) compared with the control group. The proportion of exclusively breastfed infants at ages 1 month (IRR 1.37, 95% CI 1.28–1.48), 3 months (IRR 2.13, 95% CI 1.30–1.44) and 5 months (IRR 2.78, 95% CI 2.58–3.00) were higher in intervention group than control group. We identified significant interaction (p value for interaction &lt;0.05) between intervention and infant size and gestation at birth on exclusive breastfeeding at 3 and 5 months of age. Subgroup analysis showed that the impact of the intervention was greater on exclusive breastfeeding in PT- SGA infants at 3 months (IRR 3.30, 95% CI 2.20–4.96) and 5 months of age (IRR 5.26, 95% CI 2.98–9.28).ConclusionThis is one of the first studies wherein impact of breastfeeding counselling interventions in the first 6 months of life was assessed according to infant size and gestation at birth wherein gestational age was reliably estimated. The impact of this intervention was higher in preterm and SGA babies compared to other infants. This finding is important as preterm and SGA infants have a higher burden of mortality and morbidity during early infancy. Intensive breastfeeding counselling to these vulnerable infants is likely to improve overall breastfeeding rates and reduce the adverse outcomes.Clinical Trial Registration: [http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies], identifier [#CTRI/2017/06/008908]

Long Term Two-Phase Flow Analysis of the Deep Low Permeability Rock at the Bruce DGR Site

Abnormal pressures have been measured in the deep boreholes at the Bruce site, southern Ontario, where a deep geologic repository for low and intermediate level radioactive waste disposal has been proposed. The pressure regime in the stratigraphic units exhibits either higher than hydrostatic pressure (over-pressured) or lower than hydrostatic pressure (under-pressured) are considered to be abnormal. At the Bruce site, the Ordovician sediments are under-pressured while the underlying Cambrian sandstone and the overlying Guelph carbonate are over-pressured. Hypotheses have been documented in literature to explain the phenomenon of abnormal pressures. These hypotheses include osmosis, glacial loading and deglaciation unloading, exhumation of overlying sediments, crustal flexure and the presence of an immiscible gas phase. Previous work on the Bruce site has shown that the under-pressures in the Ordovician limestone and shales could not be explained by glaciation and deglaciation or by saturated analyses. The presence of a gas phase in the Ordovician formations has been determined to be a reasonable cause of the under-pressure developed in the Ordovician shales and limestones at the Bruce site. Support for the presence of a gas phase includes solution concentrations of methane, concentrations of environmental isotopes related to methane and estimates of water and gas saturations from laboratory core analyses. The primary contribution of this thesis is the sensitivity analyses performed on the hydrogeologic parameters with respect to a one dimensional two-phase flow model. First, a one dimensional two-phase air and water flow model was adopted and reconstructed to simulate the long-term evolution of the groundwater regimes at the DGR site. Then the hydrogeologic parameters which impact the presence of under-pressure in the groundwater are investigated. Data required to quantify the properties of geologic media and groundwater are adopted directly from borehole testing and laboratory testing results. The permeable boundaries of the domain are assumed to be water saturated and pressure specified (using hydrostatic conditions in the Guelph Formation and hydrostatic with 120 m over-pressure condition in the Cambrian and Precambrian). Isothermal conditions were assumed, thus constant water density and viscosity values are estimated for the average total dissolved solids (TDS) concentration of the modelled stratigraphic column. A constant diffusion coefficient (a diffusivity of $0.25\times10^{-8}$ m$^2$/s) of air in water is assumed with a saturation-dependent tortuosity. The air generation rate is assumed to simulate the gas phase generated in the Ordovician formations. The numerical simulation of up to 4 million years provides a means to explore the behaviour of gas phase dissipation due to partitioning into the water phase and diffusive transport in the solute phase. Results confirmed that the presence of a gas phase would result in the under-pressure in water

Flow-cytometric monitoring of disease-associated expression of 9-O-acetylated sialoglycoproteins in combination with known CD antigens, as an index for MRD in children with acute lymphoblastic leukaemia: a two-year longitudinal follow-up study

<p>Abstract</p> <p>Background</p> <p>Over expression of 9-<it>O-</it>acetylated sialoglycoproteins (Neu5,9Ac₂-GPs, abbreviated as <it>O</it>AcSGP) has been demonstrated as a disease-associated antigen on the lymphoblasts of childhood acute lymphoblastic leukaemia (ALL). Achatinin-H, a lectin, has selective affinity towards terminal 9-<it>O-</it>acetylated sialic acids-α2-6-<it>N</it>acetylated galactosamine. Exploring this affinity, enhanced expression of <it>O</it>AcSGP was observed, at the onset of disease, followed by its decrease with chemotherapy and reappearance with relapse. In spite of treatment, patients retain the diseased cells referred to as minimal residual disease (MRD) responsible for relapse. Our aim was to select a suitable template by using the differential expression of <it>O</it>AcSGP along with other known CD antigens to monitor MRD in peripheral blood (PB) and bone marrow (BM) of Indian patients with B- or T-ALL during treatment and correlate it with the disease status.</p> <p>Methods</p> <p>A two-year longitudinal follow-up study was done with 109 patients from the onset of the disease till the end of chemotherapy, treated under MCP841protocol. Paired samples of PB (n = 1667) and BM (n = 999) were monitored by flow cytometry. Three templates selected for this investigation were <it>O</it>AcSGP⁺CD10⁺CD19⁺or <it>O</it>AcSGP⁺CD34⁺CD19⁺for B-ALL and <it>O</it>AcSGP⁺CD7⁺CD3⁺for T-ALL.</p> <p>Results</p> <p>Using each template the level of MRD detection reached 0.01% for a patient in clinical remission (CR). 81.65% of the patients were in CR during these two years while the remaining relapsed. Failure in early clearance of lymphoblasts, as indicated by higher MRD, implied an elevated risk of relapse. Soaring MRD during the chemotherapeutic regimen predicted clinical relapse, at least a month before medical manifestation. Irrespective of B- or T-lineage ALL, the MRD in PB and BM correlated well.</p> <p>Conclusion</p> <p>A range of MRD values can be predicted for the patients in CR, irrespective of their lineage, being 0.03 ± 0.01% (PB) and 0.05 ± 0.015% (BM). These patients may not be stated as normal with respect to the presence of MRD. Hence, MRD study beyond two-years follow-up is necessary to investigate further reduction in MRD, thereby ensuring their disease-free survival. Therefore, we suggest use of these templates for MRD detection, during and post-chemotherapy for proper patient management strategies, thereby helping in personalizing the treatment.</p

Population-based rates, timing and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

BackgroundModelled mortality estimates have been useful for health programmes in low-income and middle-income countries. However, these estimates are often based on sparse and low-quality data. We aimed to generate high quality data about the burden, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa.MethodsIn this prospective cohort study done in 11 community-based research sites in south Asia and sub-Saharan Africa, between July, 2012, and February, 2016, we conducted population-based surveillance of women of reproductive age (15–49 years) to identify pregnancies, which were followed up to birth and 42 days post partum. We used standard operating procedures, data collection instruments, training, and standardisation to harmonise study implementation across sites. Verbal autopsies were done for deaths of all women of reproductive age, neonatal deaths, and stillbirths. Physicians used standardised methods for cause of death assignment. Site-specific rates and proportions were pooled at the regional level using a meta-analysis approach.FindingsWe identified 278 186 pregnancies and 263 563 births across the study sites, with outcomes ascertained for 269 630 (96·9%) pregnancies, including 8761 (3·2%) that ended in miscarriage or abortion. Maternal mortality ratios in sub-Saharan Africa (351 per 100 000 livebirths, 95% CI 168–732) were similar to those in south Asia (336 per 100 000 livebirths, 247–458), with far greater variability within sites in sub-Saharan Africa. Stillbirth and neonatal mortality rates were approximately two times higher in sites in south Asia than in sub-Saharan Africa (stillbirths: 35·1 per 1000 births, 95% CI 28·5–43·1 vs 17·1 per 1000 births, 12·5–25·8; neonatal mortality: 43·0 per 1000 livebirths, 39·0–47·3 vs 20·1 per 1000 livebirths, 14·6–27·6). 40–45% of pregnancy-related deaths, stillbirths, and neonatal deaths occurred during labour, delivery, and the 24 h postpartum period in both regions. Obstetric haemorrhage, non-obstetric complications, hypertensive disorders of pregnancy, and pregnancy-related infections accounted for more than three-quarters of maternal deaths and stillbirths. The most common causes of neonatal deaths were perinatal asphyxia (40%, 95% CI 39–42, in south Asia; 34%, 32–36, in sub-Saharan Africa) and severe neonatal infections (35%, 34–36, in south Asia; 37%, 34–39 in sub-Saharan Africa), followed by complications of preterm birth (19%, 18–20, in south Asia; 24%, 22–26 in sub-Saharan Africa).InterpretationThese results will contribute to improved global estimates of rates, timing, and causes of maternal and newborn deaths and stillbirths. Our findings imply that programmes in sub-Saharan Africa and south Asia need to further intensify their efforts to reduce mortality rates, which continue to be high. The focus on improving the quality of maternal intrapartum care and immediate newborn care must be further enhanced. Efforts to address perinatal asphyxia and newborn infections, as well as preterm birth, are critical to achieving survival goals in the Sustainable Development Goals era

Comparison of caudal analgesia between ropivacaine and ropivacaine with clonidine in children: A randomized controlled trial

Background: Addition of clonidine to ropivacaine (0.2%) can potentially enhance analgesia without producing prolonged motor blockade. The aim of the present study was to compare the post-operative pain relieving quality of ropivacaine 0.2% and clonidine mixture to that of plain ropivacaine 0.2% following caudal administration in children. Methods: In a prospective, double-blinded, randomized controlled trial, 30 ASA 1 pediatric patients undergoing infraumbilical surgery were randomly allocated to receive a caudal injection of either plain ropivacaine 0.2% (1 ml/kg) (group A) or a mixture of ropivacaine 0.2% (1 ml/kg) with clonidine 2 μg/kg (group B). Objective pain score and need for supplemental analgesics were compared during the 1 st 24 hours postoperatively. Residual post-operative sedation and motor blockade were also assessed. Results: Significantly prolonged duration of post-operative analgesia was observed in group B (P<0.0001). Heart rate and blood pressure were not different in 2 groups. Neither motor blockade nor post-operative sedation varied significantly between the groups. Conclusion: The combination of clonidine (2 μg/kg) and ropivacaine 0.2% was associated with an improved quality of post-operative analgesia compared to plain 0.2% ropivacaine. The improved analgesic quality of the clonidine-ropivacaine mixture was achieved without causing any significant degree of post-operative sedation or prolongation of motor blockade

Assessment of infrastructure and status of biomedical waste management in primary health-care facilities in a district of West Bengal, India: A mixed method study

Background: The absence of proper waste management, lack of awareness about the health hazards from biomedical wastes, insufficient financial and human resources, and poor control of waste disposal are the most critical problems connected with biomedical waste management (BMWM). Objectives: The objectives of this study were to assess the infrastructure available for BMWM in primary health-care facilities in Murshidabad district of West Bengal and to find out the gaps in the management. Materials and Methods: This descriptive, observational, facility-based mixed method study with cross-sectional design was conducted in primary health-care facilities selected by multistage random sampling technique. In-depth interview was done with important stakeholders related to BMWM at block, subdivision, and district level. Results: The gaps were identified related to infrastructure, logistic supply, and workforce resources in the studied primary health-care facilities. Segregation at source and disposal of biomedical waste were improper. Training on BMWM and posttraining evaluation were also seen deficient. Information, education, and communication materials and proper record keeping were seen to be absent with lack of supervision. Conclusion: Logistics supply with emphasis on the supply chain with proper allocation of the fund at the primary health-care level should be ensured. Filling up of the vacancies of the Group D staff is essential. Training of health workers with supervision and monitoring by block and district officials needs to be strengthened for efficient BMWM

Oxytocin administration during cesarean delivery: Randomized controlled trial to compare intravenous bolus with intravenous infusion regimen

Background: Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients. Aims and Objectives: To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion. Study Design: Randomized, double-blind, active controlled trial. Materials and Methods: Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted. Results: There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group. Conclusion: Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events

Rapid sequence spinal anesthesia versus general anesthesia: A prospective randomized study of anesthesia to delivery time in category-1 caesarean section

Background and Aims: Spinal anesthesia is the preferred technique over general anesthesia in caesarean section. General anesthesia is still used for category-1 emergency caesarean section because of time constraints. We usually follow rapid sequence general anesthesia in obstetrics to avoid aspiration. However, this technique poses several problems. An approach of spinal anesthesia termed as rapid sequence spinal anesthesia has been described. The present study was designed to compare the time intervals (time for anesthesia, time to surgical readiness, incision to delivery time, emergence time) and Apgar score between rapid sequence spinal anesthesia and rapid sequence general anesthesia during category-1 caesarean section and to evaluate whether rapid sequence spinal anesthesia is a better option in category-1 caesarean section. Materials and Methods: In this prospective randomized study, 60 patients of American Society of Anesthesiologists physical status (ASA-PS) I posted for category-1 emergency caesarean section were randomly allocated into two equal groups and received either of the two techniques. Demographic data, respective time intervals, and Apgar scores were noted and compared. Results: The time for anesthesia, surgical readiness, and emergence were significantly longer (P < 0.001) in rapid sequence general anesthesia group as compared to rapid sequence spinal anesthesia group (144.80 ± 3.42 vs 131.20 ± 3.40 s, 178.76 ± 4.09 vs 169.93 ± 3.08 s, 512.13 ± 34.33 vs 222.10 ± 12.80 s). No significant difference was found in incision to delivery time and Apgar scores between the two groups. Conclusion: Because anesthesia to delivery time is shorter in rapid sequence spinal anesthesia, this technique may be equivalent to rapid sequence general anesthesia in category-1 emergency caesarean section