Evaluation of the Rashtriya Bal Swasthya Karyakram (RBSK): A National Children Healthcare Program in a health district of West Bengal, India

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) was launched in 2013 to screen and manage birth defects, deficiencies, diseases, and developmental delays including disabilities in Indian children, with the help of designated mobile health teams and grassroot workers across the country. Objectives: Performance of the RBSK program in three selected blocks of a health district of a large Indian state (West Bengal) was assessed. Methods: The performance assessment was based on input, process, and output performances, using checklists based on RBSK operational guidelines. Results: While some essential evaluation tools were available in required numbers at the block level, many were unavailable. There were deficiencies in the number of health staff appointed. Although most screening camps were conducted as per microplan, some were not. Anthropometric measurements were not done in some camps; Information, Education, and Communication (IEC) materials were not used adequately. Issues with fund management were also noted. The intervention rate at higher centers (District Early Intervention Centre) was low with regard to the children referred for management. Involvement of grassroot workers such as ASHA was also found to be lacking. Conclusion: Frequent orientation training of medical officers and staff is needed along with the efforts to strengthen the referral system and the patient tracking system. Sensitizing the children and their guardians regarding the importance of the relevant health issues is also needed with the help of the proper implementation of IEC services.

A Retrospective Cohort study on Utilization of Rashtriya Bal Swasthya Karyakra (RBSK) Services among Children Screened at an Urban Health Centre (UHC) ofAhmedabad Municipal Corporation (AMC)

Introduction : Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. (1) Document utilization of RBSK services within a year of referral, (2) Assess reasonsObjectives : for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) takingMethod: two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; majorResults: reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. After referral by RBSK team, only half utilized the services. Among users,Conclusion: OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.

Efecto de Lactobacillus casei microencapsulado sobre la salud intestinal y parámetros bioquímicos y productivos en pollo de engorde / Effect of microencapsulated Lactobacillus casei on intestinal health and on biochemical and productive parameters in broiler

RESUMEN El sector avícola ha disminuido los antibióticos por problemas de resistencia, lo que ha generado interés investigativo en alternativas para el manejo sanitario. Por ello, se evaluó el efecto del suministro de Lactobacillus casei microencapsulado en los parámetros productivos y salud intestinal del pollo de engorde. La investigación incluyó 240 pollos, en 4 tratamientos: alimento sin antibióticos ni anticoccidiales (T0), alimento con probiótico comercial (T1) y T2 y T3 con inclusión de L. casei microencapsulado y sin microencapsular, respectivamente. Se evaluó la eficiencia y la viabilidad de la conservación de la bacteria por parte del microencapsulado, además de sus características físicas. Se valoró in vivo el suministro de la bacteria láctica, mediante los parámetros productivos, bioquímicos en sangre, la morfología intestinal y la respuesta inmunológica. Se observó viabilidad y eficiencia de 75,9 y 89,4%, para el microencapsulado. El grupo de tratamiento con probiótico microencapsulado tuvo incremento significativo en la ganancia de peso y de consumo de alimento (p<0,05). En la bioquímica sanguínea solo se encontró un incremento del colesterol con el microencapsulado (p<0,05). Se mejoró la respuesta inmunológica con el suministro de L. casei microencapsulado (p<0,05). Se concluye que el uso de L. casei microencapsulado puede mejorar los parámetros productivos e inmunológicos del pollo de engorde.

ABSTRACT The poultry production has reduced antibiotics due to resistance problems, which has generated research interest in alternatives for sanitary management. Therefore, the effect of supplying microencapsulated Lactobacillus casei on the production parameters and intestinal health of broilers was evaluated. The research included 240 chickens in 4 treatments: food without antibiotics or anticoccidials (T0), food with commercial probiotic (T1), and T2 and T3 with inclusion of microencapsulated and non-microencapsulated L. casei, respectively. The efficiency and viability of the conservation of the bacterium by the microencapsulate was evaluated, in addition to its physical characteristics. The supply of lactic acid bacteria was evaluated in vivo by means of the productive, biochemical parameters in blood, intestinal morphology and the immune response. Viability and efficiency of 75.9 and 89.4% were observed for the microencapsulation. The microencapsulated probiotic treatment group had a significant increase in weight gain and food consumption (p<0.05). In blood biochemistry, an increase in cholesterol was only found with microencapsulation (p<0.05). The immune response was improved with the supply of microencapsulated L. casei (p<0.05). It is concluded that the use of microencapsulated L. casei can improve the productive and immunological parameters of broilers.

Burden of malnutrition and anemia among children with congenital heart disease

Background: Congenital heart disease (CHD) is the most common birth defect and in India, the prevalence is 2.5 to 5/1000 live births. Malnutrition and anemia are common co-morbidities, that determine the outcome in CHD. This study was undertaken to assess the extent of malnutrition and anemia among 1-12-year-old children with CHD.Methods: A total 80 children with CHD, admitted for intervention under the Rashtriya Bal Swasthya Karyakram (RBSK) scheme were enrolled.  Nutritional status was assessed using standardized anthropometric measurements. Anemia was estimated using hemoglobin, red cell indices, red cell distribution width and peripheral smear. IEC approval, informed consent and assent from participants were obtained prior to the study. Statistical analysis was performed using SPSS version 19.Results: 2/3rd children were >5-years-old. Acyanotic CHD was more common (81.3%) and 35% had ventricular septal defect. Among cyanotic CHD (18.7%), 13.7% had tetralogy of fallot. In CCHD, there was only one child with normal weight and height. In ACHD, 71% were underweight, 49%, had stunting and 82% had wasting. Anemia was diagnosed in nearly 1/3rd, and iron deficiency was the most common. Even though polycythemia was noted in those with CCHD, increased RDW and reduced red cell indices unmasked iron deficiency.Conclusions: Majority were >5-years-old, due to late referral for intervention. The burden of malnutrition and iron deficiency anemia, that modify the outcome, was very high, Hence, early identification, prompt referral and correction of co-morbidities are of utmost importance, as majority are likely to get surgical/non-surgical interventions under government sponsored schemes like RBSK in India.

Knowledge assessment of accredited social health activist and anganwadi workers about the Rashtriya Bal Swasthya Karyakram in rural area of District Kathua

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) program is technically known as Child Health Screening and Early Intervention Services. The main purpose of the program is to detect and manage 4Ds which are prevalent in children. Objective: The objective of the study was to assess the knowledge of ASHA workers as well as anganwadi workers about the RBSK in rural area of District Kathua using semi-structured questionnaire. Materials and Methods: The present study was a cross-sectional descriptive study conducted in the zone Budhi which is a field practice area of the Department of Community Medicine, GMC Kathua. The zone consists of 24 villages with 18 ASHA workers and 35 anganwadi workers and one mobile RBSK team available at Community Health Center, Parole. After obtaining ethical clearance, all the ASHA workers and anganwadi workers were included in the study as they were willing to participate. Results: The present study revealed that majority of the workers were between the age group of 20–40 years. About 71.42% of the anganwadi workers were 12th pass and majority of the ASHA workers were 8th and 10th pass. Majority of the anganwadi workers received training related to RBSK program and knew about the benefits of the RBSK program. About 82.85% of the workers knew about the equipment used by RBSK team members for screening. Conclusion: Anganwadi workers and ASHAs need to be made aware of their perceptions and role in the program so that their efficiency is increased and the percentage of child morbidity and mortality can further be lowered.

Bronchoscopic Analysis in Sputum Smear Negative Pulmonary Tuberculosis Patients A Hospital based Study

Introduction: India has the highest burden of TB cases inthe world, majority of them are pulmonary tuberculosis.The method of choice for diagnosis of PTB is microscopicexamination of AFB by sputum smear. However, 30 to 50%of patients with pulmonary tuberculosis can have negativesputum report or may not produce sputum. Flexible fibreopticbronchoscopy can provide excellent material for diagnosis forpatients with suspected sputum smear negative pulmonarytuberculosis. Study aimed to evaluate the role of fiberoptic bronchoscopy in sputum smear negative pulmonorytuberculosis.Material and methods: Forty suspected cases of pulmonaryTB with clinical and radiological evidence of tb and sputumsmear negative on 2 occasions were selected for thisprospective nonrandomised observational study. Detailedexamination of the bronchial tree was done and specimensincluding bronchial aspirate and lavage was collected andsend for investigations. Post bronchoscopy sputum (PBS) wasalso collected and sent for smear microscopy.Results: In our study of 40 patients, tuberculosis wasconfirmed in 13 (32.50%) by smear examination of AFB inBroncho alveolar fluid and by post bronchoscopy sputumsmear examination in 3/40 (7.5%) cases. A definitive diagnosisof tuberculosis was possible in 23 (57.5%) of the 40 patientsby AFB culture by BACTEC MGIT960.Conclusion: Fibreoptic bronchoscopy with post bronchoscopysputum,BAL and BAL AFB culture is a useful tool fordiagnosis and can thereby prompt treatment of sputum smearnegative pulmonary tuberculosis patients.

Magnitude and pattern of birth defect babies at Bhopal district early intervention center under RBSK’s 4Ds approach: an observational study

Background: As per World Health Organization (WHO) congenital anomalies are also known as birth defects, congenital disorders or congenital malformations. Most common and severe congenital anomalies are congenital heart diseases, neural tube defect and Down’s syndrome. No data on the magnitude of congenital anomalies is available in India. Thus, the study aims to determine the magnitude and pattern of babies with birth defect reporting at District Early Intervention Center, Bhopal in children aged 0 to 6 years.Methods: This was an observational study conducted at DEIC, Bhopal under Rashtriya Bal Swasthya Karyakram services, over a period of one year. Children between 0 to 6 years visiting the center and belonging to Bhopal district were included in the study. Data entry was by Microsoft Excel and analysis was by Epi info.Results: 2891 children were registered for the study out of affected children 18.7% of them were diagnosed with Developmental delays while birth defect was observed in 4.3% cases. Of the birth defect cases majority i.e. 37.7% had congenital heart disease and 16.7% had congenital hearing loss. No case of retinopathy of prematurity was registered.Conclusions: The study also helps to know the magnitude and pattern of congenital anomalies. Any effective health intervention will reduce both direct costs and out-of-pocket expenditure.

Study to determine gender variation in severe acute malnutrition at nutrition rehabilitation centre

Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.

Saline for adverse effects caused by septic shock fluid resuscitation and the exploration of new resuscita￣tion fluid / 中国小儿急救医学

Sepsis is a life￣threatening organ dysfunction caused by deleterious host response due to infection. Septic shock is a type of sepsis that has a high mortality rate worldwide each year. At present, 0. 9% saline is still the first choice for resuscitation fluid in septic shock in the world,but hyperchloremia and acute kidney injury caused by 0. 9% saline resuscitation are receiving more and more attention. This review elaborates on the mechanism of hyperchloremia and acute kidney injury caused by saline,and explores a new type of liquid (balanced crystalloids) instead of 0. 9% saline for fluid resuscitation,thereby reducing compli￣cations caused by fluid resuscitation.

Crecimiento de Ocotea cernua (Lauraceae) en bosques aluviales inundables de la Amazonía peruana / Growth of Ocotea cernua (Lauraceae) in Peruvian Amazon floodplain forests

Ocotea cernua (Nees) Mez, "moena negra", es una especie comercial que se desarrolla en los bosques del llano aluvial inundable de la Amazonía peruana. Este estudio, proporciona información sobre su crecimiento, y que puede utilizarse en el manejo de la especie. Se analizó la abundancia y estructura de O. cernua en nueve parcelas permanentes (100 m x 100 m) y 24 transectos (40 m x 100 m). El análisis de los registros sobre crecimiento en diámetro, mostró que el incremento anual medio y el incremento anual máximo, alcanzan un valor máximo de 9.5 y 17.4 mm/año, ambos en la clase diamétrica de 25 a 30 cm. Tomando como base ambos incrementos, el tiempo necesario para que un árbol alcance diámetros >30 cm DAP, sería de 60 y 34 años, respectivamente. Basado en factores de competencia entre árboles, el modelo de crecimiento ajustado estima que la tasa máxima de crecimiento en diámetro anual es 2.10, 1.28 y 0.50 cm para árboles con baja, media y alta competencia. Esta tasa máxima de crecimiento ocurre cuando los árboles cuentan con DAP que oscilan entre 21.10, 20.28 y 20.50 cm, para baja, media y alta competencia, respectivamente; sin embargo, el tiempo que requiere un árbol para obtener dichos diámetros varía enormemente, con valores de 12.31 cm para baja competencia, 20.35 para media competencia y 54.51 años para alta competencia.

Ocotea cernua (Nees) Mez "moena negra" is a commercial species that thrives in alluvial floodplain forests in the Peruvian Amazon. This study presents information about diameter growth of O. cernua and provides useful information for its forest management. The stand density and structure was analysed in nine permanent sample plots (100 m x 100 m) and 24 transects (40 m x 100 m). Analysis of tree diameters at different time indicates maximum values of 9.5 and 17.4 mm/year for the average annual diameter increment and the maximum annual diameter increment respectively; both into 25 ‒ 30 cm diameter classes. Considering this increments, a tree will reach a diameter higher than 30 cm DAP, in 60 to 34 years respectively. Estimations of the adjusted model showed the maximum annual growth increment estimated in 2.10, 1.28 and 0.50 cm for trees with low, medium and high competition, corresponding to trees with DBHs of 21.10, 20.28 and 20.50 cm for trees with low, medium and high competition, respectively. However, the time required to reach such diameters is highly variable with values of 12.31, 20.35 and 54.51 years, respectively.

The protection effects of Liuweiwuling Tablets against concanavalin A-induced acute immunological liver injury in mice / 中国药理学通报

Aim To explore the protective effects and underlying mechanisms of Liu weiwuling Tablets (LW-WL)in concanavalin A (ConA)induced acute immu-nological liver injury in mice.Methods Mice were randomly divided into control,model,Bicyclol,LW-WL low dose (8 g·kg-1 )and LWWL high dose (16 g ·kg-1 )group.The medicattion was performed once daily for seven consecutive days,then the model of im-munological liver injury was prepared by intravenous injection of ConA (15mg·kg-1)in the tail of mice in each group except for the control group one hour after the last treatment.The pathological changes of liver tissues of mice were evaluated by HE staining with, and the levels of alanine amino transferase (ALT),as-partate aminotransferase (AST),and total bilirubin (TBIL)in serum were analyzed by colorimetric meth-od;the level of interleukin 12 (IL-12 ),interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleu-kin 4 (IL-4)and interleukin 10 (IL-10)in liver was measured by real-time quantitative polymerase chain reaction (RT-qPCR);the changes of Th1 (IFN-γ) and Th2 (IL-4)cells were observed by flow cytometric (FCM)analysis;the expression of Th1/Th2 transcrip-tion factor T-bet/GATA-3 in liver tissue was detected by Western blot.Results Compared with normal con-trol group,the serum ALT,AST and TBIL were signif-icantly increased in model group, the pathological damage of the liver tissue was severe,and the necrosis and apoptosis of hepatic cells were large, which showed that the model was successful .Compared with model group,both low and high dose of LWWL could significantly reduce ALT,AST,TBIL levels in serum induced by ConA;Th1 cells in the spleen decreased, while Th2 cells increased;the expressions of IL-12, IFN-γand TNF-αmRNA were significantly inhibited with IL-4 and IL-10 mRNA expression elevated in mouse liver tissue;the expression of GATA-3 protein was up-regulated,T-bet protein expression showing no significant changes.Conclusion LWWL could regu-late Th1/Th2 balance,thus inhibiting the acute immu-nity hepatic injury induced by ConA.

EL USO DE Enterococcus faecium MEJORA PARÁMETROS PRODUCTIVOS EN POLLOS DE ENGORDE / USAGE OF Enterococcus faecium TO IMPROVE PRODUCTIVE PARAMETERS IN BROILERS

El consumo de probióticos se ha asociado con mejoras en algunos parámetros productivos como la conversión alimenticia y la ganancia de peso vivo, lo que se ve reflejado en el desarrollo y salud de las aves. el objetivo de este trabajo fue evaluar la influencia de la inclusión de cepas probióticas en la alimentación de pollos de engorde sobre parámetros productivos de importancia económica. se utilizaron 180 pollos machos (Cobb) de un día de edad, alimentados con cinco dietas: dieta comercial con y sin la adición de antibióticos, y a esta última se le adicionó una de tres diferentes cepas probióticas (Lactobacillus casei, Lactobacillus acidophilus o Enterococcus faecium) en el agua de bebida (10(8) UFC/ml) durante 42 días. se evaluaron parámetros zootécnicos: consumo de alimento, peso corporal, conversón alimenticia (CA) y ganancia de peso (GDP); e indicadores productivos: supervivencia, factor de eficiencia americana (Fea), índice productivo (IP), eficiencia europea (EE) y eficiencia alimenticia (EA). El diseño estadístico utilizado fue de bloques al azar. La inclusión de probióticos, específicamente E. faecium, mejoró parámetros productivos (P < 0,05) como peso (2.730 g), conversión (1,55), GDP (53,59 g/día), FEA (172), iP (393), EE (400) y EA (63,11%). Por todo lo anterior, la utilización de probióticos, especialmente E. faecium, puede ser considerada como factor promotor de crecimiento durante todo el ciclo de producción del ave debido a que demostró tener efectos positivos, tanto en el desempeño productivo, como en el rendimiento económico del lote.

The intake of probiotics has been associated with improvements in production parameters such as feed conversion and body weight gain, which is reflected in the development and health of broilers. The objective of this study was to evaluate the inclusion of probiotic strains in broiler feed on growth performance of economic importance. 180 one-day-old male chicks (Cobb) were used and fed with five diets: Commercial diet with and without the addition of antibiotic, to which was added one of three different probiotic strains (Lactobacillus casei, Lactobacillus acidophilus or Enterococcus faecium) in the drinking water (108 CFU/ml) of animals over 42 days. Were evaluated zootechnical parameters: Feed intake, body weight, feed conversion (FC), weight gain (WG); and productive indicators: mortality, american efficiency factor (AFE), production index (PI), european efficiency (EE) y feed efficiency (FE). The statistical design used was a randomized blok. The inclusion of probiotics, specifically E. faecium, improved production parameters (P < 0.05) like: weight (2730 g), conversion (1.55), WG (53.59 g/day), AFE (172), PI (393), EE (400) and AE (63.11%). Therefore, the use of probiotics, especially E. faecium, can be considered as growth promoters throughout the production cycle because the bird proved to have positive effects on productive performance and economic performance of the batch.

Optimization of Processing Technology of Nine Steaming Nine Drying of Rehmannia glutinosa by Multiple Indexes Comprehensive Balance Method-Orthogonal Test / 中国药房

OBJECTIVE:To optimize the processing technology of nine steaming nine drying of Rehmannia glutinosa. METH-ODS:L9(34) orthogonal experimental design was adopted to investigate the effects of the amount of added wine,steaming time and drying way on processing technology using the content and property of 5-hydroxymethyl furfural,acteoside,reducing sugar wa-ter extract,and character score as indexes. Comprehensive balance method was used for result evaluation,and optimized technolo-gy was validated. RESULTS:The optimized processing condition was as follows as the amount of added yellow wine 40%,steam-ing for 9 times,lasting for 6 h each time,blast drying at 70 ℃. Average value of each factor in validation test was 4.030 mg/g, 0.117 mg/g,0.376 7 g/g,0.733 g/g and 9.0 points,respectively. Their RSDs were 1.78%,2.9%,1.54%,2.13% and 0.1%(n=3). CONCLUSIONS:Optimized technology is reasonable and controllable in product quality,and can provide reference for quality control study of nine steaming nine drying of R. glutinosa.

Evaluate the effect of mucosal healing after low-dose azathioprine in patients with small bowel Crohn's disease by double-balloon enteroscopy / 中华消化内镜杂志

Objective To evaluate the clinical value of double-balloon enteroscopy( DBE)in as-sessing the effect of mucosal healing in patients with moderate small bowel Crohn's disease( CD)treated with low-dose azathioprine. Methods CD patients who were naive to any immunomodulators or biological a-gents with lesions mainly located in ileu were screened by multislice CT enterography and anal-route DBE at baseline. Lesions at 150 cm proximal to ileocecal valve were assessed by DBE with Simple Endoscopic Score for CD( SES-CD)after 12 and 24 months of low-dose azathioprine treatment,respectively. Results A total of 36 patients were enrolled and the average tolerated dose of azathioprine was(61. 8 ± 17. 2)mg/day. The total rates of complete,near-complete,partial and no mucosal healing in 36 patients were 19. 4%(7/36), 5. 6%(2/36),27. 8%(10/36),and 47. 2%(17/36)at month 12 and 30. 6%(11/36),25. 0%(9/36), 33. 3%(12/36),and 11. 1%(4/36)at month 24,respectively. The baseline SES-CD score(OR=2. 71, 95%CI:1. 11-6. 63,P=0. 029)and duration of disease(OR=1. 27,95%CI:1. 10-1. 47,P =0. 001) were two relevant factors associated with mucosal healing of small bowel CD. Conclusion DBE has a signif-icant advantage in assessing post-therapy mucosal healing for patients with small bowel CD. The optimal time point for the first follow-up by DBE is at least 12 months after low-dose azathioprine treatment.

Nasal and Pulmonary Toxicity of Titanium Dioxide Nanoparticles in Rats

In recent decades, titanium dioxide (TiO2) nanoparticles have been used in various applications, including paints, coatings, and food. However, data are lacking on the toxicological aspects associated with their use. The aim of this study was to assess the inhalation toxicity of TiO2 nanoparticles in rats by using inhalation exposure. Male Wistar rats were exposed to TiO2 nanoparticles for 2 weeks (6 hr/day, 5 days/week) at a mean mass concentration of 11.39 +/- 0.31 mg/m3. We performed time-course necropsies at 1, 7, and 15 days after exposure. Lung inflammation and injury were assessed on the basis of the total and individual cell counts in bronchoalveolar lavage fluid (BALF), and by biochemical assays, including an assay for lactate dehydrogenase (LDH). Furthermore, histopathological examination was performed to investigate the lungs and nasal cavity of rats. There were no statistically significant changes in the number of BALF cells, results of biochemical assays of BALF and serum, and results of cytokine analysis. However, we did observe histopathological changes in the nasal cavity tissue. Lesions were observed at post-exposure days 1 and 7, which resolved at post-exposure day 15. We also calculated the actual amounts of TiO2 nanoparticles inhaled by the rats. The results showed that the degree of toxicity induced by TiO2 nanoparticles correlated with the delivered quantities. In particular, exposure to small particles with a size of approximately 20 nm resulted in toxicity, even if the total particle number was relatively low.

Comparison of ventilatory effects between three-way laryngeal mask airway and tracheal catheter on patients during bronchoalveolar lavage / 中华急诊医学杂志

Objective To compare the ventilatory effects between three-way laryngeal mask airway (TLMA)and tracheal catheter (TC) on hemodynamics, respiratory function and stress responses on patients during bronchoalveolar lavage (BAL). Method Forty patients scheduled for BAL under general anesthesia were divided (stratified sampling) into either TLMA group (group T,n = 20) or TC group (group C, n = 20) according to the stratified sampling principle. SpO2, SBP, DBP and HR were measured in 5 min after entering the operating theater (To), just before inserting TLMA or TC(T1), immediately after inserting TLMA or TC(T2) ,3 min(T3), 5 min(T4), 10 min(T5)after mechanical ventilation, 10 min(T6),20 min(T7), 30 min(T8)during the course of BAL,immediately after extubating TLMA or TC (T9)and 3 min after extubating TLMA or TC (T10). The tidal volume (VT), peak inspiratory airway pressure (Ppeak) and end expiratory CO2 pressure(PETCO2)were recorded at T2,T4,T6,T7, T8, T10. The venous blood samples were taken at T0, T2, T3, T4, T6, T9, T10 for the measurements of epinephrine(AE), norepinephrine(NE)and dopamine (DA) levels with high performance liquid chromatography.Data were dealt with SPSS version 10.0 statistic software. The variables of hemodynamics and stress responses were analyzed with ANOVA of repeating test data. P ＜ 0.05 means the difference in statistical significance. Results In group C, SBP, DBP and HR were significantly higher than those in group T at T2 ,T3 ,T9 (P ＜ 0.05). In group C, the levels of Ppeak were significantly higher than those in group T at T6 ,T7 ,T8 (P ＜ 0.05), and the concentrations of AE, NE and DA were also significantly higher in group C than those in group T at T2, T3 and T9 (P ＜0.05). Conclusions Ventilation with TLMA in patients during BAL is better than TC in respects of keeping stable ventilation, stable hemodynamics and producing less stress responses.

Caracterização da bacteriocina produzida por Lactococcus lactis subsp. lactis MK02R isolado de rúcula (Euruca sativa Mill.) e avaliação do seu potencial probiótico utilizando o modelo dinâmico TIM-1 / Characterization of the bacteriocin produced by Lactococcus lactis subsp. lactis isolated MK02R rocket salad (Euruca sativa Mill.) and evaluation of its potential probiotic using the dynamic model TIM-1

Após a constatação da escassez de estudos realizados com vegetais crus na busca por novas estirpes de bactérias láticas (BAL) produtoras de bacteriocinas e diante do potencial tecnológico da aplicação destas cepas tanto como agentes de conservação em alimento, bem como cultura probiótica em alimentos funcionais, este estudo objetivou isolar e identificar cepas de bactérias láticas potencialmente bacteriocinogênicas de amostras de rúcula obtidas no comércio local de São Paulo, SP - Brasil, identificar e caracterizar as bacteriocinas produzidas pelos isolados e avaliar o potencial probiótico dos isolados testando sua sobrevivência no modelo dinâmico do trato gastrointestinal TNO gastro-Intestinal Model - TIM-1 disponível no TNO (The Netherlands Organization for Applied Scientific Research) divisão Quality of Life (Zeist, Holanda). A produção de bacteriocinas neste modelo também foi avaliada, comparando-se com L. sakei 2a, também produtora de bacteriocinas e ainda avaliou-se a interferência na viabilidade de E. faecium LMA1. A cepa Lactococcus lactis subsp. lactis MK02R de rúcula produziu uma bacteriocina sensível à enzimas proteolíticas, termoestável e não influenciada pelo pH, sendo capaz de inibir Enterococcus faecium, Lactobacillus sakei, Listeria innocua, Lactobacillus delbrueckii e Listeria Monocytogenes de diferentes grupos sorológicos. Os ensaios genéticos utilizando primers Nisf e Nisr confirmaram que a bacteriocina MK02R é uma nisina, apresentando uma alteração dos aminoácidos no peptídeo líder em relação às nisinas A, Z, Q, F e U, porém com a estrutura do peptídeo maduro idêntica ao da nisina F. Estes resultados foram confirmados por espectrometria de massas de amostras purificadas por HPLC. L. lactis MK02R resistiu à passagem no modelo dinâmico TIM-1, apresentando uma alta capacidade de sobreviver nas condições simuladas do trato gastrointestinal humano. Entretanto, não foi capaz de causar a redução no número de E. faecium LMA1. Em contrapartida, L. sakei 2a, mesmo apresentando uma sobrevivência menor, foi capaz de causar uma redução de 70% na população de E. faecium LMA1 no ambiente simulado do TGI. Não foi detectada atividade residual da ação antimicrobiana das bacteriocinas produzidas por L. lactis MK02R ou L. sakei 2a após a passagem pelo modelo dinâmico TIM-1. Estes resultados evidenciam a possível aplicação de L. lactis MK02R como um agente de controle biológico na conservação de alimentos e também como uma cultura potencialmente probiótica

Given the scarcity of studies performed with raw vegetables addressing the search for new bacteriocinogenic strains of lactic acid bacteria (LAB) and considering the technological application of these strains as food preservatives and probiotic cultures in functional foods, this study was aimed at isolation and identification of bacteriocinogenic LAB strains from samples of rocket salad obtained in the local market of São Paulo, SP - Brazil, subsequent characterization of the bacteriocins produced by these LABs and evaluation of their probiotic potential by testing their survival in the dynamic gastrointestinal model TNO gastro- Intestinal-Model - TIM-1, available at the TNO (Netherlands Organization for Applied Scientific Research) Quality of Life division (Zeist, Netherlands). The studies in the TIM-1 model were also done with another bacteriocinogenic strain L. sakei 2a for comparison, evaluating their interference on the viability of E. faecium LMA1. The bacteriocin produced by strain Lactococcus lactis subsp. lactis MK02R isolated from rocket salad was sensitive to proteolytic enzymes, heat-stable and not influenced by the pH. The bacteriocin inhibited the growth of Enterococcus faecium, Lactobacillus sakei, Listeria innocua, Lactobacillus delbrueckii the primers Nisf and Nisr indicated that the bacteriocin produced by the strain MK02R is a nisin, with a change in the amino acid sequence of the leader peptide when compared to nisin A, Z, Q, U and F, but with the structure of the mature peptide homologous to that of nisin F. These results were confirmed by mass spectrometry of purified samples obtained by HPLC. L. lactis MK02R withstood the test in the dynamic model TIM-1, presenting capability to survive in the simulated conditions of the human gastrointestinal tract. However, the strain was not able to cause a reduction in the number of E. faecium LMA1. On the other hand, L. sakei 2a, even presenting lower survival, was able to cause 70% reduction in the population of E. faecium LMA1 in the gut simulated environment. No residual antimicrobial activity of bacteriocin produced by L. lactis MK02R or L. sakei 2a was detected after the transit through the dynamic model TIM-1. These results demonstrate the possible application of L. lactis MK02R both as a biocontrol agent in food preservation and as a potentially probiotic culture

A case report of chronic granulomatous disease presenting with aspergillus pneumonia in a 2-month old girl / 소아과

Chronic granulomatous disease (CGD) is an uncommon inherited disorder caused by mutations in any of the genes encoding subunits of the superoxide-generating phagocyte NADPH oxidase system, which is essential for killing catalase producing bacteria and fungi, such as Aspergillus species, Staphylococcus aureus, Serratia marcescens, Nocardia species and Burkholderia cepacia. In case of a history of recurrent or persistent infections, immune deficiency should be investigated. Particularly, in the case of uncommon infections such as aspergillosis in early life, CGD should be considered. We describe here a case of CGD that presented with invasive pulmonary aspergillosis in a 2-month-old girl. We confirmed pulmonary aspergillosis noninvasively through a positive result from the culture of bronchial alveolar lavage fluid, positive serological test for Aspergillus antigen and radiology results. She was successfully treated with Amphotericin B and recombinant IFN-gamma initially. Six weeks later after discharge, she was readmitted for pneumonia. Since there were infiltrates on the right lower lung, which were considered as residual lesions, voriconazole therapy was initiated. She showed a favorable response to the treatment and follow-up CT showed regression of the pulmonary infiltrates.

t(9;22) with 5'ABL1 Deletion and t(6;19) in Biphenotypic Acute Leukemia / 대한혈액학회지

Biphenotypic acute leukemia (BAL) is a rare type of leukemia, comprises 4% of all acute leukemias. It is more common in adults and the clinical features, as related to marrow dysfunction, are similar to those found in other patients with acute leukemia. BAL commonly shows a dimorphic blast population with, one resembling lymphoblasts and the other resembling myeloblasts. The majority of BAL patients express B-lymphoid and myeloid markers. BAL can be diagnosed by morphologic studies and by a comprehensive panel of immunological markers, as well as cytogenetic/molecular studies, such as fluorescence in situ hybridization (FISH) and reverse transcriptase-polymerase chain reaction (RT-PCR). In addition, its prognosis is relatively poor. We present here a 27 year-old female patient who showed lymphoblasts and myeloblasts on her marrow studies and these cells were positive for myeloid and B-lymphoid markers on the immunophenotypic studies. Chromosome analysis revealed 46,XX,t(6;19)(p23;p13.1),t(9;22)(q34;q11.2). A major (b3a2) type of BCR-ABL1 mRNA transcript was detected by RT-PCR, and a 5'ABL1 deletion was identified by FISH.

Susceptibilidad antimicrobiana de microorganismos aislados en el tracto traqueobronquial de caballos pura sangre de carrera alojados en el hipódromo nacional de santa rita, municipio santa rita. Estado zulia, venezuela / Antimicrobial susceptibility of microorganisms isolated from the trachea of thoroughbred horses housed in the nacional race track of santa rita, zulia state, venezuela

Con el fin de conocer el patrón de susceptibilidad antimicrobial en la población equina activa, se extrajeron treinta y ocho muestras de lavados traqueo-bronquiales trans-endoscópico de equinos alojados en el hipódromo Nacional de Santa Rita ubicado en municipio Santa Rita del estado Zulia, Venezuela; de ambos sexos, adultos, sin lesiones y sin evidencia clínica de ninguna enfermedad respiratoria, seleccionados al azar; dichas secreciones obtenidas fueron remitidas al laboratorio bacteriológico para su cultivo y antibiograma, donde se probaron 25 antimicrobianos diferentes, para pruebas de susceptibilidad antimicrobiana. En todos los ejemplares muestreados se aisló al menos una bacteria aeróbica. Hubo aislamientos mixtos de dos o tres bacterias, lo más común fueron los aislamientos dobles (68,42%); de las especies bacterianas aisladas con mayor frecuencia la Pseudomona aeruginosa 28 veces (73,68%), Escherichia coli 13 veces (32,21%) y Klebsiella pneumoniae 10 veces (26,32%). Se realizaron tablas de frecuencias para la proporción de susceptibilidad de las bacterias respiratorias a los agentes antimicrobiales, con el procedimiento FREQ para el cálculo de frecuencias del SAS. Se determinó que la P. aeruginosa y la E. coli fueron sensibles a 11 y resistentes a 14 antimicrobianos de los 25 antimicrobianos probados in vitro; la K. pneumoniae fue sensible a 19 antimicrobianos y solo resistente a 6 de los 25 antimicrobianos probados in vitro. La P. aeruginosa y la E. coli fueron sensibles a dos de los tres aminoglicósidos probados, en cambio la K. pneumoniae fue sensible a los tres aminoglicósidos. La mayoría de las cepas de estas bacterias aeróbicas conseguidas en este hipódromo, fueron resistentes a los b-lactámicos, combinaciones de ellos o cefalosporinas (de primera y segunda generación).

With the purpose of knowing the antimicrobial susceptibility pattern in the active equine population, thirty eight samples of traqueo-bronchial trans-endoscopic washings were extracted of horses housed in the Santa Rita National Race Track located in Santa Rita Municipality of the Zulia State, Venezuela; of both sexes, adults, without injuries and clinical evidence of any pulmonary disease, selected at random; these obtained secretions were sent to the bacteriological laboratory for their culture and antibiotic test, where 25 different antibiotics were proven, for tests of antimicrobial susceptibility. In all the units samples at least one aerobic bacterium was isolated. There were mixed isolations of two or three bacteria, commonest were the double isolations (68; 42%); of the isolated bacterial species most frequently were the Pseudomona aeruginosa 28 times (73; 68%), Escherichia coli 13 times (32; 21%) and Klebsiella pneumoniae 10 times (26; 32%).Tables of frequencies for the proportion of susceptibility of the respiratory bacteria to the antimicrobiales agents were made with procedure FREQ for the calculation of frequencies of the SAS. Was determined that the P. aeruginosa and the E. coli were sensible to 11 and resistant to 14 antibiotics of 25 antibiotics proven in vitro; the K. pneumoniae was sensible to 19 antibiotics and single resistant to 6 of 25 antibiotics proven in vitro. The P. aeruginosa and the E. coli sensible to two of the three were aminoglicosids proven ones; however the K. pneumoniae was sensible to the three aminoglicósidos ones. Most of the stocks of these obtained aerobics bacteria in this race course, were resistant to the b-lactámics, combinations of them or cefalosporinas (of first and second generation).