Quantitative Assessment and Predicting the Effects of Soil Pollutants on Herbaceous Biomass Production in Reserved Forests

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Heavy metal concentrations in surface soils of Reserved Forests (RFs) have a significant impact on...     

The feasibility of task-sharing the identification,emergency treatment,and referral for women with pre-eclampsia by community health workers in India

Background

Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.

Methods

This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.

Results

There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.

Conclusion

Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.

     

Detection and care of women with gestational diabetes mellitus from early weeks of pregnancy results in birth weight of newborn babies appropriate for gestational age

The policy of screening for gestational diabetes mellitus (GDM) between 24 and 28 weeks of gestation and care has resulted in a few women delivering big babies despite good glycemic control. Hence we undertook a study to assess the merits of care given to women in whom GDM was diagnosed in different weeks of gestation and to find out the ideal period of screening in women with history of high-risk pregnancies. A total of 207 consecutive pregnant women irrespective of trimester referred to our referral clinic for diabetes in pregnancy, underwent a 75g oral glucose tolerance test (OGTT) and GDM was diagnosed if 2h plasma glucose (PG) >/=140mg/dl. A1c was estimated in all of them. Women who failed to respond to medical nutrition therapy were advised insulin and the dose titrated to maintain fasting PG (FPG) <90mg/dl and 2h PG <120mg/dl. The mean age of the population screened was 28.38+/-4.31 years and the mean gestational age of screening was 20.05+/-10.71 weeks. Among them, 87 were diagnosed as GDM. The gestational week at diagnosis was 相似文献   

Availability and use of magnesium sulphate at health care facilities in two selected districts of North Karnataka,India

Background

Pre-eclampsia and eclampsia are major causes of maternal morbidity and mortality. Magnesium sulphate is accepted as the anticonvulsant of choice in these conditions and is present on the WHO essential medicines list and the Indian National List of Essential Medicines, 2015. Despite this, magnesium sulphate is not widely used in India for pre-eclampsia and eclampsia. In addition to other factors, lack of availability may be a reason for sub-optimal usage. This study was undertaken to assess the availability and use of magnesium sulphate at public and private health care facilities in two districts of North Karnataka, India.

Methods

A facility assessment survey was undertaken as part of the Community Level Interventions for Pre-eclampsia (CLIP) Feasibility Study which was undertaken prior to the CLIP Trials (NCT01911494). This study was undertaken in 12 areas of Belagavi and Bagalkote districts of North Karnataka, India and included a survey of 88 facilities. Data were collected in all facilities by interviewing the health care providers and analysed using Excel.

Results

Of the 88 facilities, 28 were public, and 60 were private. In the public facilities, magnesium sulphate was available in six out of 10 Primary Health Centres (60%), in all eight taluka (sub-district) hospitals (100%), five of eight community health centres (63%) and both district hospitals (100%). Fifty-five of 60 private facilities (92%) reported availability of magnesium sulphate.Stock outs were reported in six facilities in the preceding six months – five public and one private. Twenty-five percent weight/volume and 50% weight/volume concentration formulations were available variably across the public and private facilities. Sixty-eight facilities (77%) used the drug for severe pre-eclampsia and 12 facilities (13.6%) did not use the drug even for eclampsia. Varied dosing schedules were reported from facility to facility.

Conclusions

Poor availability of magnesium sulphate was identified in many facilities, and stock outs in some. Individual differences in usage were identified. Ensuring a reliable supply of magnesium sulphate, standard formulations and recommendations of dosage schedules and training may help improve use; and decrease morbidity and mortality due to pre-eclampsia/ eclampsia.

Trial registration

The CLIP trial was registered with ClinicalTrials.gov (NCT01911494).

     

Real-time functional MR imaging (fMRI) for presurgical evaluation of paediatric epilepsy

Background The role of fMRI in the presurgical evaluation of children with intractable epilepsy is being increasingly recognized. Real-time fMRI allows the clinician to visualize functional brain activation in real time. Since there is no off-line data analysis as in conventional fMRI, the overall time for the procedure is reduced, making it clinically feasible in a busy clinical sitting. Objective (1) To study the accuracy of real-time fMRI in comparison to conventional fMRI with off-line processing; (2) to determine its effectiveness in mapping the eloquent cortex and language lateralization in comparison to invasive procedures such as intraoperative cortical stimulation and Wada testing; and (3) to evaluate the role of fMRI in presurgical decision making in children with epilepsy. Materials and methods A total of 23 patients (age range 6–18 years) underwent fMRI with sensorimotor, visual and language paradigms. Data processing was done in real time using in-line BOLD. Results The results of real-time fMRI matched those of off-line processing done using the well-accepted standard technique of statistical parametric mapping (SPM) in all the initial ten patients in whom the two techniques were compared. Coregistration of the fMRI data on a 3-D FLAIR sequence rather than a T1-weighted image gave better information regarding the relationship of the lesion to the area of activation. The results of intraoperative cortical stimulation and fMRI matched in six out of six patients, while the Wada test and fMRI had similar results in four out of five patients in whom these techniques were performed. In the majority of patients in this series the technique influenced patient management. Conclusion Real-time fMRI is an easily performed and reliable technique in the presurgical workup of children with epilepsy.     

A single test procedure to diagnose gestational diabetes mellitus

Universal screening for gestational diabetes mellitus (GDM), detects more cases and improves maternal and offspring prognosis. Of all the screening tests, World Health Organization (WHO) procedure is simple and cost effective; the only disadvantage is that the pregnant woman has to come in the fasting state to undergo oral glucose tolerance test (OGTT). Hence, we undertook a study to elucidate a test that is casual and reliable to diagnose GDM. A total of 800 pregnant women underwent 75-g glucose challenge test (GCT) irrespective of the time of the last meal and their 2-h plasma glucose (PG) was estimated. They also underwent a 2-h 75-g OGTT recommended by WHO after 72 h. There was no statistically significant difference in the glycemic profile between GCT and WHO OGTT in the diagnosis of GDM. In conclusion, GCT performed irrespective of the last meal timing is a patient-friendly approach and causes least disturbance in the pregnant woman's routine activities.     

Position of the axillary nerve in the deltoid muscle

The relationship of the anterior branch of the axillary nerve to the deltoid muscle was studied on both sides in 66 adult cadavers. The nerve runs a course on the deep surface of the deltoid muscle about 2.2 cm above the midpoint on the vertical plane of the muscle.     

Does a SCN1A gene mutation confer earlier age of onset of febrile seizures in GEFS+?

SCN1A is the most clinically relevant epilepsy gene and is associated with generalized epilepsy and febrile seizure plus (GEFS+) and Dravet syndrome. We postulated that earlier onset of febrile seizures in the febrile seizure (FS) and febrile seizure plus (FS+) phenotypes may occur in the presence of a SCN1A mutation. This was because of the age-related onset of Dravet syndrome, which typically begins in the first year of life. We found that patients with FS and FS+ with SCN1A mutations had earlier median onset of febrile seizures compared to the population median. Patients with GABRG2 mutations had a similar early onset in contrast to patients with SCN1B mutations where onset was later. This study is the first to demonstrate that a specific genetic abnormality directly influences the FS and FS+ phenotype in terms of age of onset.     

Danazol has potential to cause PKC translocation,cell cycle dysregulation,and apoptosis in breast cancer cells

Danazol, the established clinical drug, has given promising therapeutic results in a series of clinical trials with breast cancer patients. Danazol shares structural similarities with several known PKC agonists and fits well into the C1 domain. Danazol binds to the C1b domain of PKC with K_d of 5.64 ± 1.27 μm . MD simulation studies further support that the PKC–danazol molecular model is stable and showing minimum distortion to the structure during the simulation period. Immunofluorescence and Western blotting studies indicate that MDAMB‐231 cells stimulated with danazol exhibit translocation of PKCα to the plasma membrane. Cells stimulated with danazol causes appearance of several phosphorylated proteins in lysate and plasma membrane. In addition, danazol affects carcinogenic molecule (PMA)‐induced intracellular signaling in cancer cells. It halted the cancer cells in the G1 phase of the cell cycle and reduced the viability of ER^+ve and triple‐negative breast cancer cells with an IC₅₀ of 31 ± 2.63 and 65 ± 4.27 μg/ml, respectively. DNA fragmentation and flow cytometry experiments revealed that the cell death follows the apoptotic pathway. It affects mitochondrial membrane potentials and releases cytochrome‐C from mitochondria to induce downstream apoptosis in breast cancer cells. Hence, the current study may help clinicians to re‐design their treatment strategy to optimize therapeutic potentials of the molecule.