Active Physical Practice Followed by Mental Practice Using BCI-Driven Hand Exoskeleton: A Pilot Trial for Clinical Effectiveness and Usability

Appropriately combining mental practice (MP) and physical practice (PP) in a post-stroke rehabilitation is critical for ensuring a substantially positive rehabilitation outcome. Here we present a rehabilitation protocol incorporating a separate active PP stage followed by MP stage, using a hand exoskeleton and brain-computer interface (BCI). The PP stage was mediated by a force sensor feedback based assist-as-needed control strategy, whereas the MP stage provided BCI based multimodal neurofeedback combining anthropomorphic visual feedback and proprioceptive feedback of the impaired hand extension attempt. A 6 week long clinical trial was conducted on 4 hemiparetic stroke patients (screened out of 16) with left hand disability. The primary outcome, motor functional recovery, was measured in terms of changes in Grip-Strength (GS) and Action Research Arm Test (ARAT) scores; whereas the secondary outcome, usability of the system, was measured in terms of changes in mood, fatigue and motivation on a visual-analog-scale (VAS). A positive rehabilitative outcome was found as the group mean changes from the baseline in the GS and ARAT were +6.38 kg and +5.66 accordingly. The VAS scale measurements also showed betterment in mood (-1.38), increased motivation (+2.10) and reduced fatigue (-0.98) as compared to the baseline. Thus the proposed neurorehabilitation protocol is found to be promising both in terms of clinical effectiveness and usability

Eff ect of participatory women’s groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial

Background A quarter of the world’s neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country’s government-approved Accredited Social Health Activists (ASHAs). We aimed to test the eff ect of participatory women’s groups facilitated by ASHAs on birth outcomes, including neonatal mortality. Methods In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women’s groups) or control (no women’s groups). Study participants were women of reproductive age (15–49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women’s groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identifi ed strategies to address them, implemented the strategies, and assessed their progress. We identifi ed births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106. Findings Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identifi ed 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53–0·89). Interpretation ASHAs can successfully reduce neonatal mortality through participatory meetings with women’s groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India

Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: A cluster-randomised controlled trial

Background: A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality. Methods: In this cluster-randomised controlled trial of a community interve

Community mobilisation with women's groups facilitated by Accredited Social Health Activists (ASHAs) to improve maternal and newborn health in underserved areas of Jharkhand and Orissa: study protocol for a cluster-randomised controlled trial

Background: Around a quarter of the world's neonatal and maternal deaths occur in India. Morbidity and mortality are highest in rural areas and among the poorest wealth quintiles. Few interventions to improve maternal and newborn health outcomes with government-mandated community health workers have been rigorously evaluated at scale in this setting.The study aims to assess the impact of a community mobilisation intervention with women's groups facilitated by ASHAs to improve maternal and newborn health outcomes among rural tribal communities of Jharkhand and Orissa.Methods/design: The study is a cluster-randomised controlled trial and will be implemented in five districts, three in Jharkhand and two in Orissa. The unit of randomisation is a rural cluster of approximately 5000 population. We identified villages within rural, tribal areas of five districts, approached them for participation in the study and enrolled them into 30 clusters, with approximately 10 ASHAs per cluster. Within each district, 6 clusters were randomly allocated to receive the community intervention or to the control group, resulting in 15 intervention and 15 control clusters. Randomisation was carried out in the presence of local stakeholders who selected the cluster numbers and allocated them to intervention or control using a pre-generated random number sequence. The intervention is a participatory learning and action cycle where ASHAs support community women's groups through a four-phase process in which they identify and prioritise local maternal and newborn health problems, implement strategies to address these and evaluate the result. The cycle is designed to fit with the ASHAs' mandate to mobilise communities for health and to complement their other tasks, including increasing institutional delivery rates and providing home visits to mothers and newborns. The trial's primary endpoint is neonatal mortality during 24 months of intervention. Additional endpoints include home care practices and health care-seeking in the antenatal, delivery and postnatal period. The impact of the intervention will be measured through a prospective surveillance system implemented by the project team, through which mothers will be interviewed around six weeks after delivery. Cost data and qualitative data are collected for cost-effectiveness and process evaluations

Bilateral adenomyoepithelioma of breast

Adenomyoepithelioma is a rare tumor characterized by proliferation of two different cell populations. These tumors have a variable biological behavior. Majority of them are benign but have a tendency to recur locally. Malignant transformation is rare in this disease and distant metastasis is rarer still. We report here an unusual case of bilateral adenomyoepithelioma at an unusual age and showing a remarkable response to an unconventional drug, tyrosine kinase inhibitor "imatinib"

A case report of osteogenic sarcoma with leprosy

This is a rare case report of osteosarcoma with lepromatous leprosy. A 15 year old male patient presented with swelling around the right knee joint. Imaging and biopsy were consistent with osteosarcoma. After his first cycle of adjuvant chemotherapy (ACT), the patient developed fever, erythematous nodules, perichondritis of ear lobe, and thickened nerves. His slit-skin smear examination showed acid-fast bacilli in clumps, and a diagnosis of multibacillary leprosy was made. He was treated with anti-leprosy medications with steroids, and once his condition stabilized, his ACT was continued. On follow-up, his skin lesions completely recovered

Role of RAAS pathway gene polymorphisms in congenital uropathies

Aims: To study the prevalence of gene polymorphisms of RAS pathway genes in children with Congenital Anomalies of kidney and urinary tract (CAKUT) and evaluate their role in the outcome. Material and Methods: A cross sectional study was done in 250 children (<14 yr) with CAKUT and 150 controls over a period of 3 years (2019–2021). Three diseases namely Posterior Urethral Valve (PUV), Vesicoureteric reflux (VUR) and Pelvic ureteric junction obstruction (PUJO) were selected. Polymorphism of 4 genes of RAAS pathway-AGT, AT2R, AT1R and ACE was assessed in blood samples of subjects. Polymorphism frequency was analysed with respect to clinical and radiological outcomes. Patients were followed over a period of 1 year to evaluate the role of gene polymorphisms in disease progression. Results: While comparing the polymorphism frequencies in cases and controls, we found that disease alleles of all 4 genes were over represented in the case group and significant association was seen with 2 genes-AT2R (p = 0.03) and AT1R (p = 0.02). Multivariate analysis showed that odds of getting CAKUT were higher with following genotypes namely ACE DD (+0.5 times), AT2R (+0.4 times), AT1R AC (+1.6 times) and AGT CC (=0.6 times). Progressive deteriorators formed 22% of the cases, more seen in PUV patients. Sub group analysis of progressive deteriorators showed that AT2R G allele and ACE DD allele increased the odds of progressive deterioration by 7 and 14 times respectively. Cumulative effect of pathogenic alleles of different RAS genes showed that co existence of DD alleles with other alleles had the most serious outcomes, thus raising the possibility of synergism like a ‘second hit’. Conclusion: Almost 1/4th of children with CAKUT deteriorated despite getting the adequate treatment. Our studies found significant association of ACE and AT2R gene polymorphisms with incidence and progression of congenital uropathies