Maternal risk factors for low birth weight in neonates – A community-based prospective study in rural area of Puducherry

Background: The health of childbearing women and infants is a major area of concern, which needs special attention. The pregnancy outcome depends on the maternal characteristics which include the utilization of Reproductive and Child Health (RCH) services during pregnancy period. In view of the above, an attempt has been made to study the maternal characteristics and its impact on perinatal outcomes among rural women in India. Objectives: The objectives of this study were to find the incidence of delivering low birth weight (LBW) infants and to examine the association between delivering LBW infants and maternal characteristics. Materials and Methods: A community-based longitudinal study was conducted in Bahour Commune Panchayat of Puducherry, for 1 year and 3 months from January 1, 2012, to March 31, 2013. A total of 258 pregnant women registered in the Anganwadi centres serving Bahour Commune Panchayat from 1st January 2012 to 31st May 2012, and they were selected by universal sampling method, of those 244 pregnant women were responded. They interviewed with the help of questionnaire and followed until delivery. Results: The incidence of delivering LBW infants was 8.6%. Maternal characteristics including utilization of RCH services such as maternal body mass index (BMI), weight gain during pregnancy, maternal hemoglobin, and blood pressure level, history of previous abortion status, and intake of iron and folic acid tablets during pregnancy were significantly associated with the birth weight of the infants by univariate analysis. Some of the above factors such as religion, blood pressure level, and maternal BMI were found to be significantly associated with multivariate analysis also. Conclusions: Overall, integrated approach is needed to improve the health care and utilization of RCH services during pregnancy to reach the better outcomes.

Salmonella Paratyphi B bacteremia in Systemic Lupus Erythematosus with an unusual presentation- a case report.

Background- Systemic Lupus Erythematosus (SLE) is an inflammatory and multisystem autoimmune disorder. Patients of SLE are at increased risk of infections owing to underlying immunological derangements and to the use of therapeutic regimens like immunosuppressive agents. Among the bacterial infections presenting as bacteremia in these patients, non typhoidal and typhoidal salmonellosis are commonly encountered. We report a rare case of Salmonella Paratyphi B bacteremia in a patient with juvenile onset SLE on treatment with corticosteroids.

A finite element thermal analysis of various dowel and core materials.

Aim: Thermal analysis of the temperature and stress distribution of parallel sided, threaded and non-threaded dowels and core materials under thermal loading within a maxillary central incisor using a three dimensional finite element study. Materials and Methods: 3D models of endodontically treated maxillary central incisor with parallel sided, threaded and non- threaded post and core materials were simulated using the ANSYS software. Materials simulated were parallel sided cast gold post and core, parallel sided fibre reinforced composite (FRC) post and core, and parallel sided, threaded, prefabricated stainless steel post and amalgam core. Thermal loads simulating hot (60 degree C/ 333K) and cold (15 degree C/288K) liquid were applied for 15 seconds at the incisal edge. The temperature changes at the selected nodes were obtained on the various post and core materials, interface between post and dentin, interface between core and dentin, within the dentin and within the cement layer. Results: Temperature and stress distribution pattern were represented in numerical and color coding and results interpreted. Thermal stresses arises as a result of temperature changes. A decreased temperature gradient of the metallic dowels and core (T1 hot - 0.002K, T3 hot - 1.071K, T1 cold -0.99K, T3 cold - 0K) were obtained than that of the FRC dowel and core of 1.982K(hot) and1.55K(cold) respectively due to the higher thermal conductivity of the metals. Higher thermal stress values of 3.567 Mpa(hot) and 3.092 Mpa(cold) respectively were obtained for the FRC dowels and higher stress values of 39.679 Mpa(hot) and 57.855 Mpa(cold) respectively were also obtained for the FRC cores. These values indicated that thermal stresses of the FRC dowel and core were greater than that of cast gold dowel and core and prefabricated stainless steel dowel and amalgam core due to its high coefficient of thermal expansion. Maximum stress values of the FRC dowel and core of 1.87 Mpa(hot) and 2.57 Mpa(cold) respectively were also generated in the cement layer, core and metal ceramic crown. The junction of the metal ceramic crown and dentin demonstrated the maximum stress. Higher thermal stress values of 59.162 ± 10 Mpa were obtained in the restoration and the coronal portion of the dentin than the stress levels of .0039 ± 10Mpa in the supporting bone due to an increased thermal expansion. Conclusion: Non-metallic dowel and core materials such as fibre reinforced composite dowels (FRC) generate greater stress than metallic dowel and core materials. This emphasized the preferable use of the metallic dowel and core materials in the oral environment.

Evaluation and comparison of castability between an indigenous and imported Ni-Cr alloy.

Context: Since 1907 casting restorations have been in use in dentistry. Numerous companies have been manufacturing and marketing base metal alloys. Gold was a major component of casting alloys. But alloys with less than 65% gold tarnished easily and the increase in cost of gold post-1970s lead to the revival of base metal alloys such as nickel-chromium and cobalt-chromium alloys which were in use since 1930s. Aim: This study was conducted to evaluate and compare the castability between an indigenous alloy and an imported alloy, as imported base metal alloys are considered to be expensive for fabrication of crowns and bridges. Materials and Methods: This study was conducted to evaluate and compare the castability (for the accurate fabrication of crowns and bridges) between an indigenous base metal alloy-Non-ferrous Materials Technology Development Centre (NFTDC), Hyderabad (Alloy A) -and an imported base metal alloys (Alloy B). Castability measurement was obtained by counting the number of completely formed line segments surrounding the 81 squares in the pattern and later calculating the percentage values. The percentage obtained was taken as the castability value for a particular base metal alloy. The percentage of castability was determined by counting only the number of completely cast segments in a perfect casting (81 × 2 = 162), and then multiplying the resulting fraction by 100 to give the percentage completeness. Statistical Analysis Used: The Student t-test was used. Results: When the castability of alloys A and B was compared, the calculated value was less than the tabular value (1.171 < 2.048) leading to the conclusion that castability between alloys A and B is insignificant. Therefore we conclude that both the alloys have the same castability. Conclusions: Using the above-mentioned materials and following the method to test castability, we were able to derive favorable results. As the results were satisfactory, we can conclude that the castability of the indigenous alloy is on par with the imported alloy.

Induction of systemic resistance in different varieties of Solanum tuberosum by pure and crude elicitor treatment.

A 10 kD elicitor protein (infestin) produced by Phytopthora infestans was purified and its efficacy for induction of systemic resistance in resistant and susceptible varieties of Solanum tuberosum was studied. Culture filtrates from P. infestans with and without purified elicitor (infestin) were used as elicitors to understand the effect of purified elicitor (infestin) on development of systemic resistance. Culture filtrate and purified elicitor (infestin) were found to induce hypersensitive reaction on the leaves of resistant varieties, but not on susceptible varieties after 48 h. Culture filtrate devoid of purified elicitor (infestin) did not induce any necrotic spots even on resistant variety. Purified elicitor (infestin) was found to induce glucose oxidase, NADPH oxidase, superoxide dismutase, glutathione reductase, catalase and peroxidase enzymes in resistant S. tuberosum plants, however the induction of these enzymes was low in susceptible varieties. The oxidative enzymes were found to induce earlier than antioxidative enzymes and there was negative correlation between these two groups of enzymes. Levels of salicylic acid, phenylalanine ammonia lyase (PAL), -1, 3 glucanase and chitinase activities were also found higher in resistant than in susceptible varieties. It was observed that purified elicitor (infestin) was superior to crude culture filtrate, but was not capable of inducing systemic resistance in susceptible varieties.

Prognostic significance of bone marrow histology in multiple myeloma.

BACKGROUND: Bone marrow examination continues to be the cornerstone for establishing the diagnosis of multiple myeloma in association with other clinical and laboratory parameters. Plasma cell morphology has significant correlation with clinical stage and survival. AIMS: To note the bone marrow histology in detail in multiple myeloma and to correlate it with clinical stage and survival. METHODS AND MATERIAL: Fifty-five cases of multiple myeloma diagnosed between January 2001 and December 2006, who had a bone marrow aspiration and biopsy done at the time of diagnosis were included in the present study. STATISTICAL ANALYSIS: SPSS software version 13.0 was used. Clinical stage and plasma cell morphology were correlated using chi square test and Spearman's correlation coefficient. Survival analysis was done using the Kaplan-Meier method. RESULTS: Seventy-six percent patients were in clinical stage III, 17% and 7% were in stage II and I respectively. The clinical stage correlated significantly with plasma cell morphology, percentage of plasma cell infiltration and pattern of infiltration. Plasma cell morphology correlated significantly with bone marrow parameters like percentage infiltrate, pattern of infiltration, degree of fibrosis and mitotic activity. Patients in advanced clinical stage,> 50% plasma cells in the marrow, diffuse pattern of infiltration, high mitosis and increased fibrosis had a shorter median survival than patients with favorable features. CONCLUSIONS: It is recommended that the bone marrow histology be studied in detail in multiple myeloma at diagnosis since it correlates well with the clinical stage and offers useful prognostic information.

Caspofungin: a major breakthrough in treatment of systemic fungal infections.

Invasive fungal infections are difficult to eradicate especially in immuno-compromised host. Amphotericin B and voriconazole have been the mainstay of treatment but both have significant toxicity. Caspofungin belongs to a new class of antifungal agents, the echinocandins. It acts on the fungal cell wall by selective inhibition of beta-(1,3)-D-glucan syntheses, which is not present in mammalian cells. In vitro data and experimental studies have demonstrated that it has antifungal activity against yeasts of the genus Candida (including those resistant to amphotericin B and azoles), severe species of filamentous fungi, including aspergillosis and certain dimorphic fungi. As an empirical antifungal therapy in neutropenic patients, it has comparable clinical efficacy but superior tolerability compared with liposomal amphotericin B. In patients with invasive candidiasis, it is as effective as amphotericin B deoxycholate. In addition, it showed a significantly superior safety profile. Same has been shown in patients with oropharyngeal/oesophageal candidiasis. In patients with invasive aspergillosis refractory to or intolerant to other antifungal agents, 45% showed a partial or complete response to Caspofungin given as a salvage treatment. Caspofungin is cidal for all Candida species and is static against Aspergillus species. It also possesses activity against Pneumocystis jiroveci. In vitro and in animals, Caspofungin shows additive or synergic antifungal activity with amphotericin B and triazoles. Recently, it's use in paediatric patients, including after bone marrow transplantation, has also been shown to be safe. With compare to other antifungal agents known to be effective in systemic fungal infections, Caspofungin has the best safety profile, tolerability with very low potential for drug interactions. This makes Caspofungin an interesting and extremely valuable new antifungal agent that broadens the available therapeutic armamentarium for the treatment of systemic fungal infections.

Culture filtrate of Lasiodiplodia theobromae restricts the development of natural resistance in Brassica nigra plants.

Culture filtrate of Lasiodiplodia theobromae increased respiration rate, phenylalanine ammonia lyase activity, and levels of hydrogen peroxide, lipid peroxides and salicylic acid in B. nigra plants. Salicylic acid (SA) level increased for 1 hr of interaction and reduced later. Development of systemic acquired resistance (SAR) was found restricted in plants infected with L. theobromae due to deficiency of SA, which is a major signal for development of SAR. Exogenously supplied SA did develop resistance and plant death was delayed. It was hypothesized that deficiency of SA could be due to jasmonic acid produced by fungus that inhibits SA biosynthesis.

Primary pulmonary hypertension: natural history and prognostic factors.

A retrospective cohort study was carried out in 61 patients (30 males, 31 females, age 24.6 +/- 11.8 years) with primary pulmonary hypertension diagnosed by strict clinical and hemodynamic criteria, to obtain an understanding of the natural history and prognostic markers. While 15 patients were alive, 46 patients (76%) had expired during the follow up period. Two, five and ten years survivals were 48%, 32% and 12% respectively. Median survival duration from time of diagnosis was 22 months. The survivors had significantly higher age of onset, cardiac index and significantly lower right atrial mean pressure, right ventricular end diastolic pressure, cardiothoracic ratio from chest rontgenogram and calculated pulmonary vascular resistance as compared to non survivors. While pulmonary artery systolic pressure was not significantly different, pulmonary artery diastolic and pulmonary artery mean pressures were significantly lower in survivors than in non-survivors. Lower New York Heart Association class, right atrial mean pressure < or = 7 mm Hg, right ventricular end diastolic pressure < or = 10 mmHg, cardiac index > 2.5 L/min/m2, pulmonary arterial oxygen saturation > 60%, were associated with significantly longer survival. The degree of pulmonary arterial hypertension had an indirect prognostic effect through the above parameters. Vasodilator therapy did not significantly alter the outcome of patients with primary pulmonary hypertension.