To compare the perinatal outcome of IUGR infants with abnormal and normal antenatal umbilical artery Doppler flow in the immediate neonatal period

Background: Intrauterine growth restriction (IUGR) is one of the cause of perinatal mortality and morbidity and affects approximately 7-15% of worldwide pregnancies. IUGR is the failure of the fetus to achieve intrinsic growth potential, due to disorders and diseases in the feto–placental–maternal unit. Doppler indices from the fetal circulation can reliably predict adverse perinatal outcome. Aim of the study was to determine perinatal outcome of IUGR infants with abnormal antenatal umbilical artery Doppler flow versus IUGR infants with normal Doppler flow.Methods: All Preterm and term IUGR infants with abnormal and normal antenatal umbilical artery Doppler scan admitted in NICU of St Martha’s Hospital were included in the study. 30 in each group with total sample size of 60. Study was conducted from March 2015 to February 2016. Primary outcome measure will be neonatal mortality and secondary outcome measure will be neonatal morbidities like perinatal asphyxia, hypoglycemia, NEC, polycythemia, sepsis, hyperbilirubinemia etc.Results: IUGR infants with abnormal antenatal umbilical artery Doppler scan were included as cases and those with normal antenatal umbilical artery Doppler scan as control. At birth resuscitation rate and therefore perinatal asphyxia was observed more in case group, 11 out of 30 (36.6%), compared to 1 out of 30 (3.3%) in control group, statistically significant (P <0.05). Hypoglycemia was noticed in 19 infants in case group (63.3%) compared to 2 infants (6.6%) in control group, statistically significant. NEC, polycythemia, sepsis was noticed more in case group, but statistically not significant.Conclusions: Infants with abnormal antenatal Doppler flow are at increased risk of perinatal complications than infants with normal antenatal umbilical artery Doppler and needs extra care during this period

The incidence of pregnancy hypertension in India, Pakistan, Mozambique, and Nigeria: A prospective population-level analysis.

Background: Most pregnancy hypertension estimates in less-developed countries are from cross-sectional hospital surveys and are considered overestimates. We estimated population-based rates by standardised methods in 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials. Methods and findings: CLIP-eligible pregnant women identified in their homes or local primary health centres (2013–2017). Included here are women who had delivered by trial end and received a visit from a community health worker trained to provide supplementary hypertension-oriented care, including standardised blood pressure (BP) measurement. Hypertension (BP ≥ 140/90 mm Hg) was defined as chronic (first detected at \u3c20 weeks gestation) or gestational (≥20 weeks); pre-eclampsia was gestational hypertension plus proteinuria or a pre-eclampsia-defining complication. A multi-level regression model compared hypertension rates and types between countries (p \u3c 0.05 considered significant). In 28,420 pregnancies studied, women were usually young (median age 23–28 years), parous (53.7%–77.3%), with singletons (≥97.5%), and enrolled at a median gestational age of 10.4 (India) to 25.9 weeks (Mozambique). Basic education varied (22.8% in Pakistan to 57.9% in India). Pregnancy hypertension incidence was lower in Pakistan (9.3%) than India (10.3%), Mozambique (10.9%), or Nigeria (10.2%) (p = 0.001). Most hypertension was diastolic only (46.4% in India, 72.7% in Pakistan, 61.3% in Mozambique, and 63.3% in Nigeria). At first presentation with elevated BP, gestational hypertension was most common diagnosis (particularly in Mozambique [8.4%] versus India [6.9%], Pakistan [6.5%], and Nigeria [7.1%]; p \u3c 0.001), followed by pre-eclampsia (India [3.8%], Nigeria [3.0%], Pakistan [2.4%], and Mozambique [2.3%]; p \u3c 0.001) and chronic hypertension (especially in Mozambique [2.5%] and Nigeria [2.8%], compared with India [1.2%] and Pakistan [1.5%]; p \u3c 0.001). Inclusion of additional diagnoses of hypertension and related complications, from household surveys or facility record review (unavailable in Nigeria), revealed higher hypertension incidence: 14.0% in India, 11.6% in Pakistan, and 16.8% in Mozambique; eclampsia was rare (\u3c0.5%). Conclusions: Pregnancy hypertension is common in less-developed settings. Most women in this study presented with gestational hypertension amenable to surveillance and timed delivery to improve outcome

The community-level interventions for pre-eclampsia (CLIP) cluster randomised trials in Mozambique, Pakistan, and India: An individual participant-level meta-analysis

Background: To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries.Methods: In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014-17. Consenting pregnant women, aged 12-49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of care. The intervention comprised community engagement and existing community health worker-led mobile health-supported early detection, initial treatment, and hospital referral of women with hypertension. For this meta-analysis, as for the original studies, the primary outcome was a composite of maternal or perinatal outcome (either maternal, fetal, or neonatal death, or severe morbidity for the mother or baby), assessed by unmasked trial surveillance personnel. For this analysis, we included all consenting participants who were followed up with completed pregnancies at trial end. We analysed the outcome data with multilevel modelling and present data with the summary statistic of adjusted odds ratios (ORs) with 95% CIs (fixed effects for maternal age, parity, maternal education, and random effects for country and cluster). This meta-analysis is registered with PROSPERO, CRD42018102564.Findings: Overall, 44 clusters (69 330 pregnant women) were randomly assigned to intervention (22 clusters [36 008 pregnancies]) or control (22 clusters [33 322 pregnancies]) groups. 32 290 (89·7%) pregnancies in the intervention group and 29 698 (89·1%) in the control group were followed up successfully. Median maternal age of included women was 26 years (IQR 22-30). In the intervention clusters, 6990 group and 16 691 home-based community engagement sessions and 138 347 community health worker-led visits to 20 819 (57·8%) of 36 008 women (of whom 11 095 [53·3%] had a visit every 4 weeks) occurred. Blood pressure and dipstick proteinuria were assessed per protocol. Few women were eligible for methyldopa for severe hypertension (181 [1%] of 20 819) or intramuscular magnesium sulfate for pre-eclampsia (198 [1%]), of whom most accepted treatment (162 [89·5%] of 181 for severe hypertension and 133 [67·2%] of 198 for pre-eclampsia). 1255 (6%) were referred to a comprehensive emergency obstetric care facility, of whom 864 (82%) accepted the referral. The primary outcome was similar in the intervention (7871 [24%] of 32 290 pregnancies) and control clusters (6516 [22%] of 29 698; adjusted OR 1·17, 95% CI 0·90-1·51; p=0·24). No intervention-related serious adverse events occurred, and few adverse effects occurred after in-community treatment with methyldopa (one [2%] of 51; India only) and none occurred after in-community treatment with magnesium sulfate or during transport to facility.Interpretation: The CLIP intervention did not reduce adverse pregnancy outcomes. Future community-level interventions should expand the community health worker workforce, assess general (rather than condition-specific) messaging, and include health system strengthening.Funding: University of British Columbia, a grantee of the Bill & Melinda Gates Foundation

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial's Baseline Study Results.

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013-2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women's and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013-2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013-14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas

Avian Colibacillosis and Salmonellosis: A Closer Look at Epidemiology, Pathogenesis, Diagnosis, Control and Public Health Concerns

Avian colibacillosis and salmonellosis are considered to be the major bacterial diseases in the poultry industry world-wide. Colibacillosis and salmonellosis are the most common avian diseases that are communicable to humans. This article provides the vital information on the epidemiology, pathogenesis, diagnosis, control and public health concerns of avian colibacillosis and salmonellosis. A better understanding of the information addressed in this review article will assist the poultry researchers and the poultry industry in continuing to make progress in reducing and eliminating avian colibacillosis and salmonellosis from the poultry flocks, thereby reducing potential hazards to the public health posed by these bacterial diseases

Comparison of the properties of composition-tunable CdSe–ZnSe and ZnxCd1−xSe nanocrystallites: Single- and double-pot synthesis approach

In this work, a simple, effective and reproducible synthetic route (single-pot (SP) approach) for the preparation of high quality core–shell CdSe–ZnSe quantum dots without the use of any pyrophoric organometallic precursors is presented and their properties are compared with those prepared by the conventional double-pot (DP) approach. Effective surface passivation of stoichiometric, monodispersed, small-sized (∼5 nm) CdSe nanocrystallites is achieved by coating them with a ZnSe shell by single-pot approach. The resulting core–shell nanocrystallites exhibit high quantum yield values ∼11.33%, narrow line-width of the PL band, stable surface-bonds configuration and superior structural properties at lower Zn content (∼10 at.%). With increasing Zn content (≥20 at.%), a composition-tunable emission across the visible spectrum has been demonstrated by a systematic blue-shift in emission wavelength due to the formation of ternary ZnxCd1−xSe quantum dots with acceptable luminescence properties. Here, contribution to emission process from surface states of nanocrystallites increases with zinc content. The core–shell and ternary QD's formed by different routes are modeled, based on the observations of several complimentary techniques (XPS depth-profiling, PL, UV–VIS absorbance, TEM/SAED). The improved properties of core–shell CdSe–ZnSe quantum dots with similar zinc content using single-pot synthesis approach as compared to the corresponding samples obtained by double-pot synthesis, is due to better-passivation effect rendered by thin ZnSe-shell in the SP approach. Their strong luminescence, narrow emission bands and wide colour-tunability makes such quantum dot structures attractive for various scientific and commercial applications

Effect of ratios of Cd : Se in CdSe nanoparticles on optical edge shifts and photoluminescence properties

This paper addresses the issue related to morphology of CdSe nanoparticles capped with organic molecules. Semiconducting CdSe nanoparticles of 5-16 nm are synthesized using CdO precursor, capped with trioctyl phosphine (TOP)/trioctyl phosphine oxide (TOPO) using different starting precursor ratios of Cd:Se. At an optimum ratio of Cd/Se-2:1, highly luminescent and small sized (similar to 5 nm) nanoparticles are obtained. At other Cd/Se precursor ratios (0.5:1, 1:1, 3: 1) larger particles are formed with varying photoluminescence (PL) intensity and optical absorption (UV-VIS). X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) are used to determine the crystallinity and stoichiometry of the system, respectively. It is shown that the blue shifts of the optical absorption edge concurrent with the CdSe nanocrystal size reduction, for sizes measured by XRD with respect to the bulk semiconductor, agree perfectly with the strong quantum confinement model. The optical edge shifts are significantly higher for CdSe nanocrystallite as measured by transmission electron microscopy (TEM) than the theoretical prediction based on the strong quantum confinernent model. This is understood on the basis of agglomeration effects as observed by TEM for CdSe nanocrystallites. The nano-sized CdSe growth island thus formed comprises of several TOP/TOPO passivated nanocrystals

Low energy ion induced effects on TOPO capped CdSe nanocrystals probed by XPS depth profiling and optical measurements

Low energy ions have been used as a probe to determine the chemical composition and structure of CdSe nanocrystals along the depth. Semiconducting CdSe nanoparticles of 5-7 nm in size are synthesized using CdO precursor and capped with TOP/TOPO using different starting precursor ratios of Cd:Se. At an optimum ratio of Cd/Se similar to 2:1, highly luminescent and monodispersed 5 nm nanoparticles are obtained. At other Cd/Se precursor ratios (1: 1 and 3: 1), signatures of polydispersity are visible. The PL peak positions of CdSe nanocrystals are significantly blue-shifted compared to the bulk band gap of CdSe. The damage caused by the bombardment of low energy 4 keV argon ions erodes the CdSe nanoparticles layer by layer. In conjunction with this sputtering, XPS studies were performed to chemical composition of the nanoparticles as the function of the depth. The results are supported by absorbance, PL and XRD studies as well. The nanoparticles formed by the different routes are modeled, based on the observations of several complementary techniques

Studies of interaction of amines with TOPO/TOP capped CdSe quantum dots: Role of crystallite size and oxidation potential

This work reports the interaction of aliphatic (triethyl amine, butyl amine) and aromatic amines (PPD, aniline) with CdSe quantum dots of varied sizes. The emission properties and lifetime values of CdSe quantum dots were found to be dependent on the oxidation potential of amines and crystallite sizes. Smaller CdSe quantum dots (size similar to 5 nm) ensure better surface coverage of amines and hence higher quenching efficiency of amines could be realized as compared to larger CdSe quantum dots (size similar to 14 nm). Heterogeneous quenching of amines due to the presence of accessible and inaccessible set of CdSe fluorophores is indicated. PPD owing to its lowest oxidation potential (similar to 0.26 V) has been found to have higher quenching efficiency as compared to other amines TEA and aniline having oxidation potentials similar to 0.66 and >1.0 V, respectively. Butyl amine on the other hand, plays a dual role: its post-addition acts as a quencher for smaller and enhances emission for larger CdSe quantum dots, respectively. The beneficial effect of butyl amine in enhancing emission intensity could be attributed to enhance capping effect and better passivation of surface-traps

Identification of a novel mutation in an Indian patient with CAII deficiency syndrome

Carbonic anhydrase II (CAII) deficiency syndrome characterized by osteopetrosis (OP), renal tubular acidosis (RTA), and cerebral calcifications is caused by mutations in the carbonic anhydrase 2 (CA2) gene. Severity of this disorder varies depending on the nature of the mutation and its effect on the protein. We present here, the clinical and radiographic details along with, results of mutational analysis of the CA2 gene in an individual clinically diagnosed with renal tubular acidosis, osteopetrosis and mental retardation and his family members to establish genotype-phenotype correlation. A novel homozygous deletion mutation c.251delT was seen in the patient resulting in a frameshift and a premature stop codon at amino acid position 90 generating a truncated protein leading to a complete loss of function and a consequential deficiency of the enzyme making this a pathogenic mutation. Confirmation of clinical diagnosis by molecular methods is essential as the clinical features of the CAII deficiency syndrome are similar to other forms of OP but the treatment modalities are different. Genetic confirmation of the diagnosis at an early age leads to the timely institution of therapy improving the growth potential, reduces other complications like fractures, and aids in providing prenatal testing and genetic counseling to the parents planning a pregnancy