Nutritional Status of Under-five Siblings of Severely Wasted Children in Bhopal

Objective: To study the prevalence and associated factors of undernutrition in siblings of children with severe acute malnutrition (SAM). Method: It was a community-based crosssectional study of under-five year siblings of children with SAM. Results: A total of 128 under-five years siblings were studied, 30% had SAM whereas 20% had moderate acute malnutrition (MAM). More than 7 members in a family (OR=4.23, CI 1.9-9.6, P<0.001), underweight mothers (OR=5.2, CI 2.08-13.0, P<0.001), children who received pre-lacteal feeds (OR=3.24, CI 1.33-7.87, P=0.007), and Muslim religion (OR=4.44, CI 1.78-11.1, P<0.001) were significantly associated with finding of another child with SAM in the family. Conclusion: There was high proportion of severe malnutrition in siblings of children with SAM. Consideration should be given to actively screen all under-5 children in the family of a newly diagnosed child with SAM for undernutrition.

Dietary practices in type 2 diabetes patients at Bhopal, Madhya Pradesh: a cross-sectional study

Background: Diabetes mellitus (DM) is a rapidly growing health problem in India. Diet and physical activity are important modifiable risk factors affecting the incidence, severity and management of DM. The aim of the study was to assess diet of diabetes mellitus patients. 87 adults from a cohort of diabetic patients attending the Medical Clinics at the Hamidia Hospital Bhopal were invited for the study.Methods: Information about their nutritional status & food consumption pattern was taken by 24-hour dietary recall and food frequency questionnaire. Data was analysed using Epi Info and MS Excel. Frequency counts and percentages were used to describe the demographic characteristics of the participants while the significance difference in between male and female participants. The significance level was set at P <0.05 and 0.01. Statistical analysis used: MS Excel and Epi Info.Results: The study sample was 87 out of which 56 were females and 31 were males; mean age of DM patients was 48.21±12.98.The mean energy intake was 1386.52 kcal and 1125.79 kcal among male and female. The mean protein intake was 68.71 g and 50.50 among male and female diabetics. There was significant difference between male and female age. There were no significant difference in body mass index and waist hip ratio between male and female. 30 (34.5%) & 16 (18.4%) were overweight and obese respectively.Conclusions: Based on these findings, the dietary practices of diabetic patients are inadequate and require improvement. Education and counselling about diet of a diabetes patient is needed.

Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India.

The Government of India initiated a cash incentive scheme—Janani Suraksha Yojana (JSY)—to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.

Neural mechanism of rapid eye movement sleep generation with reference to REM-OFF neurons in locus coeruleus.

The noradrenergic (NA-ergic) rapid eye movement (REM)-OFF neurons in locus coeruleus (LC) and cholinergic REM-ON neurons in laterodorsal/pedunculopontine tegmentum show a reciprocal firing pattern. The REM-ON neurons fire during REM sleep whereas REM-OFF neurons stop firing during REM sleep. The cessation of firing of REM-OFF neurons is a pre-requisite for the generation of REM sleep and non-cessation of those neurons result in REM sleep loss that is characterized by symptoms like loss of memory retention, irritation, hypersexuality, etc. There is an intricate interplay between the REM-OFF and REM-ON neurons for REM sleep regulation. Acetylcholine from REM-ON neurons excites the GABA-ergic interneurons in the LC that in turn inhibit the REM-OFF neurons. The cessation of firing of REM-OFF neurons withdraws the inhibition from the REM-ON neurons, and facilitates the excitation of these neurons resulting in the initiation of REM sleep. GABA modulates the generation of REM sleep in pedunculopontine tegmentum (PPT) by acting pre-synaptically on the NA-ergic terminals that synapse on the REM-ON neurons whereas in LC it modulates the maintenance of REM sleep by acting post-synaptically on REM-OFF neurons. The activity of REM sleep related neurons is modulated by wakefulness (midbrain reticular formation/ascending reticular activating system) and sleep inducing (caudal brainstem/medullary reticular formation) areas. Thus, during wakefulness the wake-active neurons keep on firing that excites the REM-OFF neurons, which in turn keeps the REMON neurons inhibited; therefore, during wakefulness REM sleep episodes are not expressed. Additionally, the wakefulness inducing area keeps the REM-ON neurons inhibited. In contrast, the sleep inducing area excites the REM-ON neurons. Thus, the wakefulness inducing area excites and inhibits the REM-OFF and REM-ON neurons, respectively, while the sleep inducing area excites the REM-ON neurons that facilitate the generation of REM sleep.

Role of norepinephrine in the regulation of rapid eye movement sleep.

Sleep and wakefulness are instinctive behaviours that are present across the animal species. Rapid eye movement (REM) sleep is a unique biological phenomenon expressed during sleep. It evolved about 300 million years ago and is noticed in the more evolved animal species. Although it has been objectively identified in its present characteristic form about half a century ago, the mechanics of how REM is generated, and what happens upon its loss are not known. Nevertheless, extensive research has shown that norepinephrine plays a crucial role in its regulation. The present knowledge that has been reviewed in this manuscript suggests that neurons in the brain stem are responsible for controlling this state and presence of excess norepinephrine in the brain does not allow its generation. Furthermore, REM sleep loss increases levels of norepinephrine in the brain that affects several factors including an increase in Na-K ATPase activity. It has been argued that such increased norepinephrine is ultimately responsible for REM sleep deprivation, associated disturbances in at least some of the physiological conditions leading to alteration in behavioural expression and settling into pathological conditions.