Impact of sleep disturbance on maternal and foetal outcomes

Sleep is a vital factor that regulates the physiology of the body in various aspects. During pregnancy, sleep problems are common. Sleep deprivation has been suggested by previous research to be associated with more adverse birth outcomes that impact both maternal and foetal outcomes. The purpose of this review is to analyse the current evidence regarding the effects of sleep deprivation during pregnancy. Quantitative studies were included and for this review, Google Scholar, PubMed and CINAHL were used to perform a literature search. A total of 38 articles were chosen for this review. Sleep deprivation may increase the risk of adverse birth outcomes in female residents due to long work hours. The initial approach to treating sleep disturbances during pregnancy is non-pharmacological. Sleep position is a major component that influences sleep quality and pregnancy outcome. Poor sleep hygiene during pregnancy can lead to a worsening of the mother, especially in the third trimester, which can have an impact on the outcome of the pregnancy. Maintaining good sleep hygiene is crucial. It has been proven by research that several non-pharmacological measures can enhance the circadian cycle. Further research with longitudinal study designs is required to examine the effect of sleep deprivation on adverse effects on the mother and foetus. Furthermore, additional research is needed to confirm the impact of sleep deprivation on the postpartum period.

Impact of sleep disturbance on maternal and foetal outcomes

Sleep is a vital factor that regulates the physiology of the body in various aspects. During pregnancy, sleep problems are common. Sleep deprivation has been suggested by previous research to be associated with more adverse birth outcomes that impact both maternal and foetal outcomes. The purpose of this review is to analyse the current evidence regarding the effects of sleep deprivation during pregnancy. Quantitative studies were included and for this review, Google Scholar, PubMed and CINAHL were used to perform a literature search. A total of 38 articles were chosen for this review. Sleep deprivation may increase the risk of adverse birth outcomes in female residents due to long work hours. The initial approach to treating sleep disturbances during pregnancy is non-pharmacological. Sleep position is a major component that influences sleep quality and pregnancy outcome. Poor sleep hygiene during pregnancy can lead to a worsening of the mother, especially in the third trimester, which can have an impact on the outcome of the pregnancy. Maintaining good sleep hygiene is crucial. It has been proven by research that several non-pharmacological measures can enhance the circadian cycle. Further research with longitudinal study designs is required to examine the effect of sleep deprivation on adverse effects on the mother and foetus. Furthermore, additional research is needed to confirm the impact of sleep deprivation on the postpartum period.

Knowledge and attitudes towards evidence-based practice among clinical physical therapists in Metro Manila / The Health Sciences Journal

Introduction @#The study aimed to determine the demographic profile of clinical physical therapists in Metro Manila, their knowledge and attitudes towards evidence-based practice and the relationship of their educational background to knowledge and attitudes towards evidence-based practice.@*Methods @#A quantitative correlational research design was utilized to describe the profile, knowledge and attitudes of clinical physical therapists, selected by purposive sampling, towards evidence-based practice. An adapted Likert-type questionnaire was utilized to gather data necessary to the study.@*Results @#Majority of 33 respondents had their basics of evidence-based practice as part of their academic preparation and had positive attitudes towards evidence-based practice. There was a weak non-significant correlation of educational background with knowledge of evidence-based practice and no correlation with attitudes towards evidence-based practice@*Conclusion @#Educational background may be factor in terms of knowledge of evidence- based practice. However, educational background is not correlated with the personal attitudes towards evidence-based practice.

Chemokine profile among human immunodeficiency virus-1 (HIV-1) infected individuals from southern India.

BACKGROUND & OBJECTIVE: Individuals infected with HIV-1 have higher levels of chemokine producing cells compared to uninfected individuals. It is important to know the changes in chemokine levels associated with rate of progression of disease. There is a paucity of information on the plasma chemokines in HIV-1 infected individuals from India. We therefore carried out this study to estimate the levels of three chemokines namely macrophage inflammatory protein alpha (MIP1alpha), MIP1beta and RANTES, in relation to disease status in HIV-1 infected individuals and compared with uninfected individuals. METHODS: RANTES and MIP1alpha were estimated using ELISA in 114 HIV-1 infected and 30 controls, whereas MIP1beta was estimated in 101 HIV infected individuals only and 30 controls. The values were compared to the T cell subsets, HIV-1 viral loads and plasma cytokines (interferon gamma and interleukin-10). RESULTS: Compared to controls the mean MIP1alpha and RANTES level among the HIV-1 infected individuals was higher while MIP1beta level was lower in HIV infected individuals except CDC C groups. There was a significant positive correlation for MIP1á with HIV-1 viral load and IFNgamma, for MIP1alpha with viral load and IL10. There was a significant negative correlation between MIP1alpha with CD4 count and CD4: CD8 ratio and MIP1beta with CD4 count and CD8 count. There was a negativecorrelation between RANTES values and CD8 per cent. INTERPRETATION & CONCLUSION: In conclusion, our study showed a significantly higher level of beta chemokines in south Indian HIV-1 infected individuals compared to controls. These beta chemokines may have the inhibitory effect on HIV-1 only during the initial period and with the progression of disease this inhibitory effect wanes as shown by the positive correlation of beta chemokines with HIV-1 viral load.

Predictors of obstructive sleep apnea in snorers.

Snoring is a commong problem that poses a high risk for obstructive sleep apnea [OSA]. We studied the contribution of risk factors for OSA in snorers for full-night polysomnography [PSG]. A questionnaire was administered to subjects referred for PSG in the period from April 2002 to March 2005. There were 191 [84%] snorers identified by 227 PSG studies. They had a mean age of 48.1 +/- 9.8 years, [age range, 23-73 years] and 78.5% were males. OSA as indicated by a respiratory disturbance index [RDI] of>5 events/hour was seen in 126 [66%] subjects. In males, 72.7% had OSA, with a mean RDI of 43.0 +/- 26 events/hour, versus 41.5% [corrected] with OSA in females with a mean RDI of 27.8 +/- 26.5 events/hour [P<0.001]. The OSA group had a higher mean Epworth Sleepiness Scale [ESS] [P<0.001], a larger mean neck circumference [P<0.01], an increased mean age [P<0.050], and more witnessed apneas [P<0.001] but not choking [P=0.096]. The mean increase in body mass index was linked to OSA only in females [P<0.05] but not in the overall study [P=0.507]. Multivariate analysis showed that ESS, male gender, and a history of witnessed apneas were associated with OSA, while controlling for obesity, large neck circumference, age, and history of choking. In screening snorers for PSG, male gender, ESS and a history of witnessed apneas were the most important predictors of OSA, but other factors should be considered in referring snorers for PSG. In males, obesity did not contribute to the risk of OSA in our study population

Toxigenicity testing of clinical isolates of non-typhoidal salmonellae in Vero cell culture & Caenorhabditis elegans model.

The non-typhoidal salmonellae (NTS) are recognized agents of gastroenteritis worldwide. Some of the NTS do not produces cytotoxic changes in tissue culture and not much is known about the endotoxicity of the clinical isolates of NTS (mostly Salmonella enterica serotype Typhimurium and Salmonella enterica serotype Enteritidis). We examined the exotoxic (cytotoxin) and endotoxic activity of clinical isolates of NTS in two assay models namely Vero cell culture and the nematode, Caenorhabditis elegans. Bacteria-free culture supernatants of 40 isolates NTS were tested in 96 well microtitre plate containing confluent monolayers of Vero cells. For the effects on C. elegans, the worms were exposed to bacteria free culture supernatants in 24 well microtitre plate for 24 h and then transferred to OP50 Escherichia coli lawn culture. The endotoxic activity of the live bacterium was studied by feeding the worms in the lawn culture of NTS separately. No cytopathic effect was observed with NTS tested in Vero cell culture assay. Likewise, the worms exposed to the bacteria-free culture supernatants were found active up to 7 days. In the co-culture killing assay, worms were found dead with characteristic stiff and straight appearance by 16(th) day. The worms were alive up to 21 days in OP50 E. coli. Bacteria-free culture supernatants did not have any deleterious effect on worms or in Vero cell culture, suggesting that there is no soluble toxic factor (diffusible toxin) in the culture supernatants. However, live NTS were found to be lethal to the worms; indicating that direct interaction between viable NTS and C. elegans is necessary for killing.

Prospective evaluation of a rapid diagnostic test Typhidot for typhoid fever.

BACKGROUND & OBJECTIVE: Typhoid fever still continues to be a major public health problem around the world. A simple, reliable and affordable rapid diagnostic test has been a long felt need of the clinicians. We therefore prospectively evaluated the sensitivity and specificity of Typhidot test. METHODS: The study was carried out between January 2002 and December 2003, on a total of 563 samples from patients clinically suspected to have typhoid fever; blood culture as well as serum for Typhidot test were received. RESULTS: Of the 563 samples, Typhidot test and blood culture were positive in 36 patients, both the tests were negative for 503 patients. Typhidot test was positive for 9 patients with S. Paratyphi A infection. The sensitivity and specificity of the test using blood culture as gold standard were 92.3 and 98.8 per cent respectively for the typhoid fever. INTERPRETATION & CONCLUSION: Typhidot test is rapid, easy to perform and reliable test for diagnosing typhoid fever, useful for small less equipped laboratories as well as for those with better facilities.

Primary oral tuberculosis: report of two cases.

Oral lesions of tuberculosis though uncommon, are seen in both the primary and secondary stages of the disease. In secondary tuberculosis, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes, or in any other part of the body and can be detected by a systemic examination. Primary oral tuberculosis may present as a diagnostic challenge for the clinician. Here we report two patients with primary tuberculosis in the oral cavity who presented to the dental department, were diagnosed and referred for medical management.

Comparison of two methods to detect carbapenemase & metallo-beta- lactamase production in clinical isolates.

BACKGROUND & OBJECTIVE: Bacterial resistance has greatly hampered effective treatment of patients in clinical settings. Non-fermenting Gram-negative bacilli (NFGNB) are common nosocomial pathogens. In this study we attempted to develop a convenient test for early detection of carbapenemase and metallo-beta-lactamase (MbetaL) production in NFGNB. Lack of sufficient reports from India in this area indicated the need for this study. METHODS: A total of 50 imipenem resistant NFGNB were speciated, and their resistance reconfirmed by disk diffusion and minimum inhibitory concentration (MIC) determination by agar dilution. Two different methods namely modified Hodge and EDTA disk synergy tests were evaluated for carbapenemase and metallo-beta-lactamase (MbetaL) production. RESULTS: Of the 50 imipenem resistant NFGNB, 48 and two respectively fell in the resistant and intermediate range in MIC using agar dilution. Majority of these were Pseudomonas aeruginosa (n=28), followed by Burkholderia cepacia (n=9). The modified Hodge test could detect 28 strains as carbapenemase and MbetaL producers, while the EDTA disk synergy test was able to detect an additional 8 strains producing MbetaL and carbapenemase. INTERPRETATION & CONCLUSION: Pseudomonas aeruginosa was found to be the predominant NFGNB in our hospital setting and EDTA disk synergy could detect more carbapenemase and metallo-beta- lactamase producers compared to modified Hodge test.

Cytotoxin testing of environmental Aeromonas spp. in Vero cell culture.

BACKGROUND & OBJECTIVES: Aeromonas spp. are known to cause a variety of infections in humans and this organism has been isolated from a variety of sources including environmental sources. The pathogenicity of the environmental isolates in and around Vellore has not been studied. This study was conducted to determine the cytotoxicity of the Aeromonas spp. isolated from water bodies, soil sediments, plankton and sewers in and around Vellore. METHODS: Aeromonas spp. isolated from environmental sources were identified by standard procedures. Representative isolates of Aeromonas spp. were tested for cell free cytotoxic factor in tissue culture system. Undiluted and diluted cell free filtrates of isolates and known toxigenic and non-toxigenic bacteria were added to Vero cell monolayer in microtitre plates. After appropriate incubation in 5 per cent CO2 atmosphere, the microtitre plate was examined for cytopathic effect. Cell detachment and shrinkage of Vero cells were recorded as toxic changes. RESULTS: All 36 environmental isolates demonstrated cytopathic effect of which 41.7, 50 and 8.3 per cent belonged to A. hydrophila, A. veronii biotype sobria and A. caviae respectively. INTERPRETATION & CONCLUSION: The results demonstrated the presence of potentially pathogenic environmental aeromonads in and around Vellore and they produced cytotoxin.

Detection of virulence attributes of Burkholderia pseudomallei.

BACKGROUND & OBJECTIVES: Melioidosis caused by Burkholderia pseudomallei is an emerging disease in India. This study examined the toxin activity of bacteria-free culture filtrate in three different cell lines (cytotoxic assay) and its effect on Caenorhabditis elegans (nematode toxicity assay). Endotoxic activity of the viable bacteria was also studied in C. elegans (co-culture killing assay). METHODS: For toxin studies, serial doubling dilutions of unheated, heated crude and ultra filtrate of bacteria-free culture supernatants of B. pseudomallei were tested in 96-well microtitre plate containing confluent mono layers of McCoy, Hep-2 and HeLa cell lines. For the effects on C. elegans, the worms were exposed to heated and unheated bacteria-free culture supernatants in 24-well microtitre plate for 24h and then transferred to OP50 Escherichia coli lawn culture. The endotoxic activity of the live bacterium was studied by feeding the worms in the lawn culture of B. pseudomallei. RESULTS: All the clinical isolates (n=38) produced cytotoxic changes in all the cell lines. No difference was observed in the cytotoxicity of unheated, heated and ultra-filtered culture supernatant. The septicaemic isolates were observed to produce cytotoxic changes in high dilutions (1:160) of culture filtrate. None of the unheated and heated crude filtrate had deleterious effect on C. elegans, while all the live bacteria were found to be lethal to the nematode. INTERPRETATION & CONCLUSION: The culture supernatants, though produced cytopathic effect in various tissue cultures, failed to have any deleterious effect on the worms. However, live bacteria were lethal to the worms B. pseudomallei. Use of C. elegans model to detect virulence attributes of B. pseudomallei is recommended as an alternative to tissue culture methods as this can be carried out in laboratories where a tissue culture set up is not available.

Association of vitamin A and zinc status with altered intestinal permeability: analyses of cohort data from northeastern Brazil.

To examine the association of intestinal barrier function with vitamin A deficiency and whether supplementation of micronutrients improves intestinal function and/or linear growth, height-for-age z-score (HAZ), concentrations of serum retinol and zinc, and intestinal permeability were determined in a cross-sectional sample of 75 children in northeastern Brazil. Effects of vitamin A and supplementation of zinc on intestinal permeability and growth were also determined comparing results before and after treatment in 20 children and age-matched controls. Lactulose:mannitol (L/M) permeability ratios inversely correlated with serum retinol concentrations (r = -0.55, p < 0.0005). Increased L/M permeability ratios with reduced concentrations of serum retinol were predominantly attributable to lower absorption of mannitol (r = 0.28, p = 0.02). L/M permeability ratios (p = 0.001) and HAZ scores (p = 0.007) improved with supplementation. It is concluded that impaired intestinal barrier function and linear growth shortfalls improve following supplementation of vitamin A and zinc in this setting.

Indirect immunofluorescent antibody test for the rapid diagnosis of melioidosis.

Culture is the only reliable method available at present for the diagnosis of melioidosis. Though serological tests have been described, their value in routine diagnosis is controversial. All indirect immunofluorescent assay (IFA) was therefore evaluated to determine its use in the diagnosis of melioidosis. Whole cell antigen prepared from a laboratory isolate of Burkholderia pseudomallei was used to assay IgG and IgM antibodies. Fourteen of the 22 (63.6%) culture proven cases had IgM antibodies while only 10 (45.5%) had IgG antibodies. Negative predictive value of IgM assay was 92 per cent. Positive predictive value was 100 per cent if both IgM and IgG were considered together. The present study done on a limited number of samples suggests that IFA may be useful in routine diagnosis of melioidosis.

Septicaemic melioidosis in a tertiary care hospital in south India.

BACKGROUND & OBJECTIVES: Melioidosis and the causative organism Burkholderia pseudomallei are being recognized gradually in various centres in India. In the septicaemic form, melioidosis is a serious and life threatening condition which requires early detection and specific treatment to avoid case fatality. A review of patients with septicaemic melioidosis at a tertiary care hospital in south India was carried out with a view to define the clinical features, predisposing conditions, if any, and the outcome. METHODS: A total of 28 patients with culture proven septicaemic melioidosis during December 1993 to December 2002 were included. Information on clinical details and outcome was obtained and antibiotic susceptibility of the isolates studied. RESULTS: Of the 28 patients of blood culture proven septicaemic melioidosis, the organism was also isolated from pus in two patients. The presenting clinical features were varied, most presenting as pyrexia of unknown origin or visceral abscesses, or septic arthiritis. Associated/predisposing conditions were present in 50 per cent of the patients, and diabetes mellitus was the commonest one. mortality was 58 per cent in our series. INTERPRETATION & CONCLUSION: Melioidosis is an emerging infection in India. The magnitude of the problem can only be assessed by increasing awareness, both of its existence in the clinical setting and its identification in the laboratory.

Non-01 Vibrio cholerae septicemia and meningitis in a neonate.

Non-O1 Vibrio cholerae is known to cause diarrhoea as well as extra-intestinal infections in adults and children. However meningitis in children is a rare occurrence. We report a neonate who developed septicemia and meningitis due to Non-O1 Vibrio cholerae.

Increased number of CCR5+ CD4 T cells among south Indian adults probably associated with the low frequency of X4 phenotype of HIV-1 in India.

BACKGROUND & OBJECTIVE: The shift of the human immunodeficiency virus (HIV) from nonsyncytium inducing strains (NSI/R5) to syncytium inducing strains (SI/X4) seen in subtype B infections during progression to acquired immunodeficiency syndrome (AIDS) is less frequently reported in subtype C. NSI and SI strains differ in the co-receptor they utilize to infect a T-cell. We postulated that a larger pool of CD4 T cells expressing CCR5 would be present among individuals in the Indian population. To validate this hypothesis, we estimated the percentage of CD4 cells expressing CCR5 or CXCR4 molecules among healthy south Indian adults and HIV infected individuals. METHODS: HIV-1 infected and uninfected adult volunteers, belonging to the four southern states of India with Tamil/Malayalam/Kannada or Telugu as their spoken language were prospectively recruited. A two colour flowcytometry examination of the blood sample was done using the following monoclonals; anti-CD45 (FITC)/CD14 (PE), anti IgG1 (FITC)/IgG2a (PE), anti-CD3 (FITC)/CD4 (PE), anti-CD3 (FITC)/CD8 (PE), anti-CD4 (FITC) and anti CCR5 (PE) or anti CXCR4 (PE). RESULTS: In the healthy population (n = 30) studied, 24.6 per cent of CD4 T cells expressed CCR5 and the percentage of CD4 T cells expressing CXCR4 was 80.4. Among the HIV infected individuals (n = 51) the percentage of CD4 T cells expressing CCR5 and CXCR4 was 26.8 and 78.7 per cent respectively. INTERPRETATION & CONCLUSION: The percentage of CD4 cells expressing CCR5 and CXCR4 in both the HIV uninfected and infected adults was significantly higher in the south Indian population than in the West. The larger pool of CCR5 positive CD4 cells probably allows for the R5 HIV strain to have a replication advantage over X4 HIV strains. This may explain the lack of shift in the viral phenotype during disease progression and also the perceived rapid progression of the disease in India compared to the West.

Quinolone susceptibility of Vibrio cholerae O1 & O139 isolates from Vellore.

BACKGROUND & OBJECTIVES: Vellore is an endemic area for cholera. The relative prevalence of clinical cases of Vibrio cholerae O1 and O139 has been fluctuating. Few studies have examined the susceptibility of local isolates to quinolones. The objective of the present study was to look at quinolone susceptibility and determine MIC of ciprofloxacin to representative clinical isolates of V. cholerae O1 and O139 in Vellore, obtained between 1997 and 1999. METHODS: Antimicrobial susceptibility testing of V. cholerae strains was performed by disc diffusion technique and MIC determination by E test. RESULTS: Five of 30 O1 and all the O139 serogroup isolates were susceptible to nalidixic acid. All isolates of both serogroups were sensitive to norfloxacin. All isolates of both serogroups gave MIC results in the susceptible range to ciprofloxacin; the MICs being lower for V. cholerae O139 (MIC50 = 0.004 microgram/ml and MIC90 = 0.047 microgram/ml) than for O1 serogroup (MIC50 = 0.38 microgram/ml and MIC90 = 0.5 microgram/ml). INTERPRETATION & CONCLUSION: V. cholerae O1 and O139 show differences in quinolone susceptibility, the reason for this is not clear. This could be because of longer exposure of the O1 serogroup to quinolone antimicrobials as compared to the O139 serogroup.

Shigella isolation in Vellore, south India (1997-2001).

Shigellosis has been a major cause of dysentery for many years at Vellore, south India. In the last two years the number of Shigella being isolated from samples of faeces from patients with diarrhoea has decreased (5% isolation rate in 1997 to 3.9% in 2001), although the microbiological methods and media used have not changed. Also, the nalidixic acid (NA) resistance has increased for S. sonnei (now 94%). This is noteworthy, since NA has been recommended for the empirical treatment of patients suspected to have shigellosis and this concept needs to be reconsidered based on available data.

Sexual History and Contraception among Women with Indused and Spontaneous Abortion in Dar es Salaam

The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of; attitude to; and practice of contraception. The study was carried out in two settings; Temeke District Hospital (TDH) and Muhimbili Medical Centre (MMC) in Dar es Salaam. At TDH 362/603 (60 per cent) were identified as IA and 241/603 (40 per cent) as SA. At MMC the figures were 68/220 (31 per cent) IA and 152/220 (69 per cent) SA. Both groups were well informed about modern contraception. As a contrast the rate of ever users of contraception was low in both groups; although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion; sexual intercourse before marriage is common in the setting studied and contraceptive use in comparatively uncommon