Morbidity and mortality profile of neonates admitted in special newborn care unit of a teaching hospital in Uttarakhand, India

Background: India accounts for 24% of global neonatal mortality. It is important to study the mortality and morbidity pattern as it helps to implement new treatment protocols, interventions, planning and policy making which helps in better survival and improvement in the quality of life among survivors. The aim of the project study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods: This study was conducted at Special Newborn Care Unit (SNCU) of Veer Chandra Singh Garhwali Government Institute of Medical Science and Research providing level II neonatal care. This is a retrospective hospital based observational study. Data from admission and discharge registers were extracted, compiled and analyzed from March 2016 to February 2018. Neonates taken against medical advice and those referred to tertiary care centers were excluded in calculation of survival outcome. Statistical analysis was done in form of percentage, proportions and chi square test was used to find statistical significance.Results: 1582 neonates were admitted during the study period. 60.80% were inborn and 39.20% were outborn. 59.54% were male and 40.46% were female. Major causes of admission were jaundice (24.72%), sepsis (20.48%), birth asphyxia (18.52%), meconium aspiration syndrome (10.11%). Birth asphyxia was the major cause of mortality, followed by sepsis and prematurity. Mortality was more in outborn babies 14.67% compared to inborn babies 9.80%.Conclusions: Neonatal jaundice, birth asphyxia and sepsis were the commonest causes of morbidity. Common causes of mortality were birth asphyxia and sepsis and prematurity. More deliveries at institutions with SNCU facility, early identification of danger signs and timely referral to tertiary care centers can prevent neonatal deaths

Prevalence of neurological malformation in newborns at a tertiary care center in Rajasthan, India

Introduction: Many newborns die every year due to various congenital anomalies and those who survive, suffer from long-term morbidity. To deal with birth defects, a large proportion of health resources and workforce is required. Among the various congenital anomalies, neurological birth defects are the leading type. Objective: The objective of the study was to document the epidemiological features and prevalence of congenital neurological anomalies in rural areas. Materials and Methods: This retrospective study was conducted in the department of pediatric of a medical college of Rajasthan. The study population included live births born in our institution between 1990 and 2018. A register was maintained after delivery to document the particulars of neonates with a congenital birth defect and their mothers. We had taken neonatal record from this register and analyzed the data of the past 28 years, retrospectively. Results: Of 241,848 live births, 6623 cases were identified with a primary diagnosis of one or more congenital anomalies giving a prevalence rate of 274/10,000 live births (95% confidence interval [CI]: 262.2–285.8). Anomalies of the nervous system were the second common defects, accounting for 19.95% of the birth defects just after the heart disease anomalies (21.65%). Neurological anomalies were diagnosed in 1321 neonates. The prevalence of neurological anomalies was 54.62/10,000 live births (95% CI: 49.75–59.49). The most common neurological anomaly was myelomeningocele/meningocele (spina bifida cystic) found in 64.87% of cases followed by Chiari malformation (7.72%), encephalocele (6.89%), microcephaly (6.88%), hydrocephalous (1.43%), and spina bifida occulta (1.43%). Conclusion: Neurological anomalies were among common congenital anomalies and considerable cause of mortality and morbidity. Myelomeningocele/meningocele (spina bifida cystic) was the most common neurological anomaly

Expression of Regulatory Platelet MicroRNAs in Patients with Sickle Cell Disease

Background: Increased platelet activation in sickle cell disease (SCD) contributes to a state of hypercoagulability and confers a risk of thromboembolic complications. The role for post-transcriptional regulation of the platelet transcriptome by microRNAs (miRNAs) in SCD has not been previously explored. This is the first study to determine whether platelets from SCD exhibit an altered miRNA expression profile. Methods and Findings: We analyzed the expression of miRNAs isolated from platelets from a primary cohort (SCD = 19, controls = 10) and a validation cohort (SCD = 7, controls = 7) by hybridizing to the Agilent miRNA microarrays. A dramatic difference in miRNA expression profiles between patients and controls was noted in both cohorts separately. A total of 40 differentially expressed platelet miRNAs were identified as common in both cohorts (p-value 0.05, fold change>2) with 24 miRNAs downregulated. Interestingly, 14 of the 24 downregulated miRNAs were members of three families - miR-329, miR-376 and miR-154 - which localized to the epigenetically regulated, maternally imprinted chromosome 14q32 region. We validated the downregulated miRNAs, miR-376a and miR-409-3p, and an upregulated miR-1225-3p using qRT-PCR. Over-expression of the miR-1225-3p in the Meg01 cells was followed by mRNA expression profiling to identify mRNA targets. This resulted in significant transcriptional repression of 1605 transcripts. A combinatorial approach using Meg01 mRNA expression profiles following miR-1225-3p overexpression, a computational prediction analysis of miRNA target sequences and a previously published set of differentially expressed platelet transcripts from SCD patients, identified three novel platelet mRNA targets: PBXIP1, PLAGL2 and PHF20L1. Conclusions: We have identified significant differences in functionally active platelet miRNAs in patients with SCD as compared to controls. These data provide an important inventory of differentially expressed miRNAs in SCD patients and an experimental framework for future studies of miRNAs as regulators of biological pathways in platelets. © 2013 Jain et al

An Approximation to the Greedy Algorithm for Differential Compression of Very Large Files

We present a new differential compression algorithm that combines the hash value techniques and suffix array techniques of previous work. Differential compression refers to encoding a file (a version file) as a set of changes with respect to another file (a reference file). Previous differential compression algorithms can be shown empirically to run in linear-time but they have certain drawbacks, namely they do not find the best matches for every offset of the version file. Our algorithm finds the best matches for every offset of the version file, with respect to a certain granularity (or block size) and above a certain length threshold. It has two variations depending on how we choose the block size. If we keep the block size fixed, we show that the compression performance of our algorithm is similar to that of the greedy algorithm, without the expensive space and time requirements. If we vary the block size linearly with the reference file size, we show that our algorithm can run in linear-time and constant-space to compress very large files. Our algorithm combines the techniques of hashing sections of the files to obtain footprints and the use of suffix arrays to find the longest match. We also show empirically that our algorithm performs better than xdelta [7], vcdiff [3], and the work of Ajtai et al. [1] in most cases in terms of compression and performs better than vcdiff and the work of Ajtai et al. in terms of speed.

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