Effect of low cost public health staff training on exclusive breastfeeding

Objective  To assess the effectiveness and feasibility of on the job staff training and supportive supervision to improve six months Exclusive Breastfeeding (EBF). Methods  A longitudinal study was conducted in a public health field practice area-Sri Lanka in 2006–2007. Three breastfeeding counseling sessions were conducted for public health midwives. Supportive supervision and on the job training were done by two public health physicians. Pre and post intervention independent cross sectional studies were conducted to assess the effectiveness of the programme. The study sample consisted of mother-infant pairs where infants were aging 6 to 12 months, attending child welfare clinics. Primary outcome measure was the proportion of infants who received EBF up to 6 months. Logistic regressing model was used for analysis of predictors of EBF. Results  Study sample consisted of 336 mother-infant pairs (pre 139, post 197). Proportion of mothers who breastfed their infants exclusively for six months improved from 19% to 70% after the intervention. The median duration of EBF increased from 4 months to 6 months (inter-quartile range 2–6 and 5–6 months respectively). Unconfounded effect of intervention on 6 months EBF in logistic regression model was highly significant (OR=13.67. p<0.001). Intervention significantly reduced the bottle feeding rate (OR=0.212, p<0.001) but not formula feeding (OR=1.146. p=0.642). Of potential predictors assessed. Sinhalese mothers than Muslim mothers (OR=3.37, p<0.001) and employed mothers compared to housewives (OR=4.45. p=0.014) were more likely to breastfeed their infants upto six months. Parity, maternal education and maternal age were not significantly associated with six months EBF. Conclusions  The existing public health infrastructure can be used effectively to improve six months EBF in places where the care is given primarily by public health system.     

Mediastinal impalement with a fibreglass sheet

Mediastinal impalement injuries are uncommon and often fatal. There have been very few reported cases of survival following mediastinal impalement. Patients who present with these injuries always undergo operative intervention regardless of their underlying haemodynamic status or associated injuries. We herein present a case of mediastinal impalement injury, where a sheet of fibreglass had fractured the manubrium and entered thffige anterior mediastinum with no associated great vessel injury. The fibreglass sheet was removed via a partial sternotomy and the patient made an uneventful postoperative recovery.     

Graphite-type activated carbon from coconut shell: a natural source for eco-friendly non-volatile storage devices

Carbon from biomass as an active material for supercapacitor electrodes has attracted much interest due to its environmental soundness, abundance, and porous nature. In this context, activated carbon prepared from coconut shells via a simple activation process (water or steam as activation agents) was used as an active material in electrodes for eco-friendly supercapacitors. X-ray diffraction (XRD), Raman spectroscopy, conductivity, scanning electron microscopy (SEM), N₂ sorption and thermogravimetry coupled to mass spectrometry (TGA-MS) studies revealed that activated carbon produced by this approach exhibit a graphitic phase, a high surface area, and large pore volume. The energy storage properties of activated carbon electrodes correlate with the morphological and structural properties of the precursor material. In particular, electrodes made of activated carbon exhibiting the largest Brunauer–Emmett–Teller (BET) surface area, i.e. 1998 m² g⁻¹, showed specific capacitance of 132.3 F g⁻¹ in aqueous electrolyte (1.5 M H₂SO₄), using expanded graphite sheets as current collector substrates. Remarkably, this sample in a configuration with ionic liquid (1-methyl-1-propy-pyrrolizinium bis(fluorosulfonyl)mide) (MPPyFSI) as electrolyte and a polyethylene separator displayed an outstanding storage capability and energy-power handling capability of 219.4 F g⁻¹ with a specific energy of 92.1 W h kg⁻¹ and power density of 2046.9 W kg⁻¹ at 1 A g⁻¹ and maintains ultra-high values at 30 A g⁻¹ indicating the ability for a broad potential of energy and power related applications. To the best of our knowledge, these values are the highest ever reported for ionic liquid-based supercapacitors with activated carbon obtained from the biomass of coconut shells.

Simple ecofriendly activation process of carbon obtained from coconut shell-based waste was used for the fabrication of non-volatile high performance supercapacitors.     

Generalized ligament laxity associated with isolated proximal tibiofibular joint dislocation

Proximal tibiofibular dislocations are a rare orthopaedic injury. It is one that is easily missed if one does not have high clinical suspicion for such an injury. This report discusses two cases of proximal tibiofibular dislocations that presented to the emergency department. In both cases, the patients fulfilled the criteria for having generalized ligamentous laxity—including passive apposition of thumb to extensor aspect of forearm, passive hyperextension of the fingers so that they lie parallel to the forearm, hyperextension of the elbow and knee, and excessive range of passive dorsiflexion of the ankle and eversion of the foot. Both cases also highlighted the difficulty in diagnosing the injury with single X-ray films, requiring additional comparison films to confirm the diagnosis.     

Anti-acetylcholinesterase activity and antioxidant properties of extracts and fractions of Carpolobia lutea

Context: There is an unmet need to discover new treatments for Alzheimer’s disease. This study determined the anti-acetylcholinesterase (AChE) activity, DPPH free radical scavenging and antioxidant properties of Carpolobia lutea G. Don (Polygalaceae).

Objective: The objective of this study is to quantify C. lutea anti-AChE, DPPH free radical scavenging, and antioxidant activities and cell cytotoxicity.

Materials and methods: Plant stem, leaves and roots were subjected to sequential solvent extractions, and screened for anti-AChE activity across a concentration range of 0.02–200?μg/mL. Plant DPPH radical scavenging activity, reducing power, and total phenolic and flavonoid contents were determined, and cytotoxicity evaluated using human hepatocytes.

Results: Carpolobia lutea exhibited concentration-dependent anti-AChE activity. The most potent inhibitory activity for the stem was the crude ethanol extract and hexane stem fraction oil (IC₅₀?=?140?μg/mL); for the leaves, the chloroform leaf fraction (IC₅₀?=?60?μg/mL); and for roots, the methanol, ethyl acetate and aqueous root fractions (IC₅₀?=?0.3–3?μg/mL). Dose-dependent free radical scavenging activity and reducing power were observed with increasing stem, leaf or root concentration. Total phenolic contents were the highest in the stem: ～632?mg gallic acid equivalents/g for a hexane stem fraction oil. Total flavonoid content was the highest in the leaves: ～297?mg quercetin equivalents/g for a chloroform leaf fraction. At 1?μg/mL, only the crude ethanol extract oil was significantly cytotoxic to hepatocytes.

Discussion and conclusions: Carpolobia lutea possesses anti-AChE activity and beneficial antioxidant capacity indicative of its potential development as a treatment of Alzheimer’s and other diseases characterized by a cholinergic deficit.     

N-acetylcystein in dengue associated severe hepatitis

Although, N-acetylcystein (NAC) has shown benefit in non-acetaminophen related liver failure, it was not well studies in dengue associated severe hepatitis. We report a case of dengue hemorrhagic fever associated severe hepatitis (encephalopathy grade 2-drowsy and intermittent disorientation) treated with NAC resulted in good outcome without hepatic transplantation.