Foetal growth standards: Does one size fit all?

Antenatal ultrasonography to monitor foetal growth and well-being is an essential component of obstetric care. Measurement of foetal anthropometric parameters including head circumference, bi-parietal diameter, abdominal circumference and femur length, and the estimated foetal weight derived from these parameters is used for diagnosing restricted or excessive foetal growth and congenital anomalies, such as, small or large head size and skeletal dysplasias. These diagnoses have major therapeutic implications.Thus, it is quite imperative that the reference data should be accurate and representative of the population for which it is being used. There are two major categories of foetal growth charts—those based on serial foetal measurements by ultrasonography, and those based on measurements at birth plotted against gestational age based on last menstrual period. Many different charts of both categories are currently being used to serve as reference normative data. Recently, Intergrowth-21st Consortium has published international foetal growth standards, based on prospectively collected foetal biometric data. The study has been conducted with highly standardized methodology on healthy, affluent, low-risk pregnant women in 8 countries, including India. For the present paper, we have reviewed the merits and drawbacks of these standards, as well as, several other Indian and international charts. None of the currently available charts come up to our expectations from an ‘ideal’ foetal growth chart. We suggest that for a country of our magnitude and diversity, there is an urgent need to construct our national foetal growth standards based on carefully selected population and using robust techniques and methodology

Observations on the flesh-footed shearwater

A dead specimen of the flesh- footed shearwater Ardenna carneipes (Gould, 1844) was collected on 21.07.2017 from Paravoor beach, Alappuzha district, Kerala. The bird had a total length of 40 cm (bill tip to tail tip) and a wingspan of 86 cm. The specimen was deposited in the National Designated Repository, ICAR- CMFRI, Kochi under the Accession No. Misc.36. The bird is distinguished from other shearwaters in this area, namely, the Persian shearwater, Audubon’s shearwater, Sooty shearwater, Wedge-tailed shearwater, Short-tailed shearwater and Streaked shearwater by its pale bill with distinct black tips. It also has darker underwings and a shorter rounded tail as compared to other shearwaters of the region. Its flight is described as “a stiff-winged glide interspersed with slow lazy flaps” (Kazmierczak, 2015, A field guide to the birds of the Indian Subcontinent, p.34)

Factors Associated with Physician Agreement on Verbal Autopsy of over 27000 Childhood Deaths in India

Each year, more than 10 million children younger than five years of age die. The large majority of these deaths occur in the developing world. The verbal autopsy (VA) is a tool designed to ascertain cause of death in such settings. While VA has been validated against hospital diagnosed cause of death, there has been no research conducted to better understand the factors that may influence individual physicians in determining cause of death from VA.This study uses data from over 27,000 neonatal and childhood deaths from The Million Death Study in which 6.3 million people in India were monitored for vital status between 1998 and 2003. The main outcome variable was physician agreement or disagreement of category of death and the variables were assessed for association using the kappa statistic, univariate and multivariate logistic regression using a conceptual hierarchical model, and a sensitivity and specificity analysis using the final VA category of mortality as the gold standard. The main variables found to be significantly associated with increased physician agreement included older ages and male gender of the deceased. When taking into account confounding factors in the multivariate analysis, we did not find consistent significant differences in physician agreement based on the death being in a rural or urban area, at home or in a health care facility, registered or not, or the respondent's gender, religion, relationship to the deceased, or whether or not the respondent lived with the deceased.Factors influencing physician agreement/disagreement to the greatest degree are the gender and age of the deceased; specifically, physicians tend to be less likely to agree on a common category of death in female children and in younger ages, particularly neonates. Additional training of physician reviewers and continued adaptation of the VA itself, with a focus on gender and age of the deceased, may be useful in increasing rates of physician agreement in these groups

Structural Analyses of Stirling Power Convertor Heater Head for Long-Term Reliability, Durability, and Performance

Deep-space missions require onboard electric power systems with reliable design lifetimes of up to 10 yr and beyond. A high-efficiency Stirling radioisotope power system is a likely candidate for future deep-space missions and Mars rover applications. To ensure ample durability, the structurally critical heater head of the Stirling power convertor has undergone extensive computational analyses of operating temperatures (up to 650 C), stresses, and creep resistance of the thin-walled Inconel 718 bill of material. Durability predictions are presented in terms of the probability of survival. A benchmark structural testing program has commenced to support the analyses. This report presents the current status of durability assessments

APTAMER: A REVIEW ON IT’S IN VITRO SELECTION AND DRUG DELIVERY SYSTEM

In recent year, Aptamer has been one of the key tools in the field of advanced drug delivery systems. Aptamer are oligonucleotides or peptides that bind to a specific target molecule. In this review we summarize the major differences between the antibody and an Aptamer along with the different methodology of the In vitro selection of the Aptamer by using SELEX (Systematic evolution of ligands by exponential enrichment) technique. SELEX is a technique which has a based biosensor and some of the novel drug delivery system. The article referred in this review was referred from the above said source was in the range of 1990-2020 y. Primary contents is searched from science direct, springer nature, scopus indexed journals. The resources are downloaded from google scholar, peer-reviewed published literature from scientific journals and books

Evaluation of suitable sites for mud crab farming in Ratnagiri District of Maharashtra, India

The State of Maharashtra has vast stretches of estuaries, creeks and mangrove swamps, which offers great potential for aquaculture, particularly for mud crab farming. In view of the natural resources and market potential for mud crab, the Department of Forests, Government of Maharashtra plans to promote mud crab farming through a novel approach, which aims at providing livelihood support to the local communities utilizing the mangrove wetlands; thereby the local communities also shoulder the responsibility of conservation of mangroves. In this backdrop, a study was conducted to identify the suitable sites for sustainable mud crab culture, in GIS environment, based on various physical and environmental criteria including topography, soil types, landuse systems, vegetation, water quality, water availability, salinity, risks of flooding, infrastructure, seed resources and availability, market and support services. The brackishwater stretches of Anjarle, Kelshi, Aade, Velas and Ansure in the Ratnagiri district of Maharashtra were studied, and all study stations had patchy to thick mangrove vegetation. The major mangrove species encountered were: Avicennia marina, Avicennia officinalis, Sonneratia caseolaris, Rhizophora mucronata and Acanthus ilicifolius. The pH of water was near-neutral to alkaline, whereas dissolved oxygen levels were found to be within the ideal range. The salinity of the tidal creeks ranged from 7.24 ppt (Velas) to 35.9 ppt (Ansure) which generally varies with the tide. The ammonia levels which ranged from 0 (Aade and Ansure) to 0.5 ppm (Kelshi), falls within the safe levels for Available online at: www.mbai.org.in doi: 10.6024/jmbai.2017.59.2.2014-05 aquaculture. The sediment pH ranged from 6.2 to 8.32. The organic carbon levels in sediment ranged from 0.27 to 2.94% indicating medium to high productive nature of sediment. Samples of mud crab collected from the study areas were processed for screening for WSSV infection. All samples gave Negative results in primary as well as nested PCRs, indicating the absence of WSSV in the wild mud crab population. Integrating the analysis result along with supporting spatial data with the aid of GIS and Remote Sensing techniques, a total of 10.063 ha have been evaluated as suitable areas for mud crab farming along the brackishwater stretches of Anjarle (1.91 ha), Aade (2.069 ha), Kelshi (1.77 ha), Velas (0.538 ha) and Ansure (3.776 ha)

ജെല്ലി സേഫ് കിറ്റ് : കടൽച്ചൊറി ദംശനത്തിന് പ്രഥമ ശുശ്രൂഷ

ജെല്ലി സേഫ് കിറ്റ് : കടൽച്ചൊറി ദംശനത്തിന് പ്രഥമ ശുശ്രൂ

Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels.

BACKGROUND: Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden. METHODS: Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010. RESULTS: Twenty-four million (18% of 134 million live births ≥ 32 wk gestational age from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had either Rh disease (373,300; uncertainty range: 271,800-477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000-131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments. CONCLUSION: Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial

Background Evidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation. Methods In this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149. Findings Between March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: –1·6 (SD 1·2) in the 4 month group versus –1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI –0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group. Interpretation Although there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation

Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Survey)

BACKGROUND: SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated a 27% reduction in all-cause mortality with a systolic blood pressure (SBP) goal ofmellitus, stroke, or heart failure. To quantify the potential benefits and risks of SPRINT intensive goal implementation, we estimated the deaths prevented and excess serious adverse events incurred if the SPRINT intensive SBP treatment goal were implemented in all eligible US adults. METHODS: SPRINT eligibility criteria were applied to the 1999 to 2006 National Health and Nutrition Examination Survey and linked with the National Death Index through December 2011. SPRINT eligibility included age ≥50 years, SBP of 130 to 180 mm Hg (depending on the number of antihypertensive medications being taken), and high cardiovascular disease risk. Exclusion criteria were diabetes mellitus, history of stroke, \u3e1 g proteinuria, heart failure, estimated glomerular filtration ratemL·min RESULTS: The mean age was 68.6 years, and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.20% (95% confidence interval [CI], 1.91-2.48), and intensive SBP treatment was projected to prevent ≈107 500 deaths per year (95% CI, 93 300-121 200) and give rise to 56 100 (95% CI, 50 800-61 400) episodes of hypotension, 34 400 (95% CI, 31 200-37 600) episodes of syncope, 43 400 (95% CI, 39 400-47 500) serious electrolyte disorders, and 88 700 (95% CI, 80 400-97 000) cases of acute kidney injury per year. The analysis-of-extremes approach indicated that the range of estimated lower- and upper-bound number of deaths prevented per year with intensive SBP control was 34 600 to 179 600. Intensive SBP control was projected to prevent 46 100 (95% CI, 41 800-50 400) cases of heart failure annually. CONCLUSIONS: If fully implemented in eligible US adults, intensive SBP treatment could prevent ≈107 500 deaths per year. A consequence of this treatment strategy, however, could be an increase in serious adverse events