Feasibility and outcomes of Desarda vs Lichtenstein hernioplasty by local anesthesia for inguinal hernia: a noninferiority randomized clinical trial.

INTRODUCTION: The Desarda autologous tissue repair is comparable to the Lichtenstein hernioplasty for inguinal hernia regarding recurrence, chronic groin pain, and return to work activities. This study was designed to establish the outcomes of Desarda's repair versus Lichtenstein's hernioplasty concerning post-operative recovery to normal gait and its feasibility under local anesthesia (LA). MATERIALS AND METHODS: This study was a single-center, prospective, double-blinded, non-inferiority, randomized trial. Patients undergoing open hernia repair for primary inguinal hernia were included. Patients were randomly assigned and followed up for 2 years. The primary endpoint was the time to return to normal gait post-surgery with comfort (non-inferiority margin fixed as 0.5 days). The secondary outcomes studied were post-operative pain score, the time required to return to work (all previously performed activities), and surgical-site occurrences (SSO). RESULTS: One hundred ten eligible patients were randomly assigned [56 patients (50.9%) in the Desarda group and 54 patients (49.1%) in the Lichtenstein group]. All the procedures were safely performed under LA. The median (interquartile range) time for resuming gait post-surgery with comfort was 5 days in the Desarda vs 4 days in Lichtenstein's arm (P = 0.16), thereby failing to demonstrate non-inferiority of Desarda against Lichtenstein hernioplasty. However, there were no significant differences in days to return to work, SSO, chronic groin pain, and recurrence within two years of surgery. CONCLUSIONS AND RELEVANCE: This study could not demonstrate the non-inferiority of the Desarda repair versus Lichtenstein hernioplasty regarding the time taken to return to normal gait. Comparing the days to return to work, pain score, SSO, and chronic groin pain, including recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility and efficacy under LA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03512366.

Lactate enhanced-quick Sequential Organ Failure Assessment 2 (LqSOFA2): A new score for bedside prognostication of patients with sepsis.

Background & objectives: Early diagnosis and prompt treatment remain a challenge in sepsis. To study the role of quick Sequential Organ Failure Assessment (qSOFA), blood lactate levels and a new score Lactate - Enhanced-qSOFA 2 (LqSOFA2) in predicting outcome in patients with sepsis and their association with established severity scores. Methods: This was a prospective, observational study in patients admitted to ICU of a tertiary care hospital in north India. qSOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), SOFA score and LqSOFA2 were calculated in 150 patients with sepsis. Measurements of lactate and SOFA score was done on days one, three and seven. Results: The mean arterial pressure (MAP) was significantly higher in survivors (70.14±19.54 vs. 48.53±26.86). The mean qSOFA significantly predicted mortality (1.81 vs. 2.63; P<0.0001). The mean lactate on days one, three and seven in survivors were 2.27±0.91, 1.72±0.77 and 1.14±0.48, respectively, while it was 4.32±2.35, 3.57±2.28 and 2.13±1.22, respectively, in the non-survivor group (P<0.001). The new score LqSOFA2 also significantly predicted mortality between non survivors and survivors (3.52±0.71 vs. 2.37±0.91). There was a significant correlation of qSOFA with SOFA and APACHE II on day one. Lactate levels and SOFA correlated on all three days. Interpretation & conclusions: qSOFA, a novel score and lactate can independently predict mortality in patients with sepsis. They correlate with APACHE II and SOFA but fail to equilibrate with either. The combination score LqSOFA2 showed marginal (statistically insignificant) increase in predictive accuracy and specificity when compared to lactate or qSOFA alone. Early diagnosis by LqSOFA2 makes it a good standalone bedside prognostic marker.

Effect of Rehydration With Normal Saline Versus Ringer Lactate on Serum Sodium Level of Children With Acute Diarrhea and Severe Dehydration: A Randomized Controlled Trial.

OBJECTIVE: To demonstrate the equivalence of Normal Saline (NS) and Ringer Lactate (RL) for change in serum sodium levels during correction of severe dehydration in children with acute diarrhea based on World Health Organization (WHO) plan C. DESIGN: Equivalence randomized control trial. SETTING: Pediatric diarrhea unit of a tertiary care hospital from May, 2016 to April, 2017. PARTICIPANTS: 72 children of 1-12 years with acute diarrhea and severe dehydration were enrolled. Children with dysentery, severe acute malnutrition, severe anemia, meningitis, and known surgical and systemic diseases were excluded. INTERVENTION: RL (n=36) or NS (n=36) were used as per WHO plan C. Blood samples were drawn before intravenous fluid correction and 3 h post-intervention. OUTCOME MEASURES: Mean change in serum sodium level from the baseline between the RL and NS groups. RESULTS: 70 children (35 in each group) completed the study. The difference in mean serum sodium levels from baseline in RL and NS groups were 1.4 (4.5) mEq/L and 2.1(4.9) mEq/L, respectively (P=0.58). CONCLUSION: Both RL and NS are equivalent in terms of change in serum sodium from baseline for intravenous rehydration in children with acute diarrhea and severe dehydration.

Evaluating NISCH and CDH1 Promoter Hypermethylation in Nonsmokers, Cancer Free Smokers and Lung Cancer Patients: A Case Control Study.

Lung cancer has very high mortality due to late stage diagnosis not amenable to curative resection. Cancer specific methylation patterns of tumor suppressor genes may precede precursor lesions of lung cancer. Our aim was to evaluate the promoter hypermethylation of tumor suppressor gene NISCH and CDH1 in cfDNA from plasma of lung cancer patients and its possible correlation with smoking status and various clinicopathological parameters. Forty histopathologically confirmed lung cancer cases, thirty smoker and thirty nonsmoker controls were enrolled. Plasma cfDNA was extracted and subjected to bisulfite treatment followed by MS-PCR. Serum nischarin levels were estimated by ELISA. The frequency of promoter hypermethylation of NISCH and CDH1 was significantly higher in lung cancer patients as compared to lifelong non-smoker controls (p < 0.05). It did not vary with smoking status among cancer cases. No significant association was found with staging or histological grading. NISCH methylation was found to be significantly higher among smoker controls. Pack years and packs per day were significantly higher in the methylated group. Serum nischarin levels showed no significant association with NISCH methylation or clinicopathological variables. NISCH is highly methylated in both high risk smoker controls as well as cancerousnon-smokers and may mark the convergence of varied etiologies of lung cancer. Hence NISCH and CDH1 are highly methylated in plasma cfDNA of lung cancer patients.

'Hiding their troubles': a qualitative exploration of suicide in Bhutanese refugees in the USA.

BACKGROUND: Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach. METHODS: Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted. RESULTS: Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness. CONCLUSIONS: This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees' social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.

Growth Patterns in Small for Gestational Age Babies and Correlation with Insulin-like Growth Factor-1 Levels.

OBJECTIVE: Correlation of catch-up growth and Insulin-like Growth Factor -1 levels (IGF-I) in SGA babies. METHODS: 50 Full-term Small for Gestational Age children aged 12-18 months were analyzed for Catch-up growth (gain in weight and/or length, Standard Deviation Score/SDS >0.67). IGF-1 was measured after post-glucose load using ELISA method and correlated with catch-up growth. RESULTS: Mean (SD) birthweight and length were 2.1 (0.3) Kg and 44.4 (3.1) cm, respectively. At enrollment, mean (SD) age, weight and length were 15.0 (2.1) months, 7.7 (1.3) Kg, and 72.9 (5.6) cm, respectively. Catch-up growth was noted in 60% children. IGF-1 levels were significantly higher in children showing catch-up growth (56.6 (63.2) ng/mL) compared to those not having catch up growth (8.7 (8.3) ng/mL). IGF-1 was positively correlated with both weight and length catch-up. CONCLUSION: Majority of Small for Gestational Age showed catch-up growth by 18 months, which had good correlation with IGF-1 levels.

Opioid-free anesthesia for breast cancer surgery: An observational study.

BACKGROUND AND AIMS: Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthesia with opioid-based general anesthesia for breast cancer surgery in a prospective cohort study. MATERIAL AND METHODS: Twenty four adult American Society of Anesthesiologists grade I-III patients posted for modified radical mastectomy (MRM) with axillary dissection were induced with propofol and maintained on isoflurane (0.8-1.0 minimum alveolar concentration) through i-gel on spontaneous ventilation and administered ultrasound-guided PECS 1 and 2 blocks (0.1% lignocaine + 0.25% bupivacaine + 1 mcg/kg dexmedetomidine, 30 ml). Postoperative nausea, pain scores, nonopioid analgesic requirement over 24 h, stay in the recovery room, and satisfaction of surgeon and patient were studied. Twenty-four patients who underwent MRM and axillary dissection without a nerve block under routine opioid anesthesia with controlled ventilation were the controls. RESULTS: MRM and axillary dissection under the nonopioid technique was adequate in all patients. Time in the recovery room, postoperative nausea, analgesic requirement, and visual analog scale scores were all significantly less in the nonopioid group. Surgeon and patient were satisfied with good patient quality of life on day 7. CONCLUSION: Nonopioid nerve block technique is adequate and safe for MRM with axillary clearance. Compared to conventional technique, it offers lesser morbidity and may allow for earlier discharge. Larger studies are needed to assess the long-term impact on chronic pain and tumor recurrence by nonopioid techniques.

Association of Levels of Serum Inhibin B and Follicle-stimulating Hormone with Testicular Vascularity, Volume, and Echotexture in Children with Undescended Testes.

AIMS: The aim of our study was to assess the association between reproductive hormones (inhibin B [inh B], follicle-stimulating hormone [FSH]) with testicular volume, echogenicity, and blood flow (resistive index [RI]) in children with undescended testis (UDT). SETTINGS AND DESIGN: This was a prospective study of 1-year study duration. MATERIALS AND METHODS: A total of 33 patients (16 unilateral and 17 bilateral) UDTs aged 5-12 years with palpable UDT were included in the study. Morning fasting blood samples were taken for estimation of serum inh B and FSH as well as inh B/FSH ratio. Testicular ultrasound was done to compute testicular volume, testicular echogenicity, and testicular vascularity in terms of RI. RESULTS: The mean age of patients enrolled in the study was 8.29 years for unilateral UDT and 7.97 years in bilateral UDT and it was comparable. The study groups were further subdivided into two age-wise subgroups school goers (5-8 years) and prepubertal (9-12 years). The values of inh B, FSH, and inh B/FSH ratios as well as mean testicular volume were comparable between both groups and subgroups. Overall mean testicular volume had a positive correlation with FSH, inh B, and inh B/FSH, but statistical significance was reached only for inh B (P < 0.001) in children with both unilateral and bilateral UDT. Apart from five patients with hypoechogenicity within the testis, all remaining testes were of homogenous echotexture with no instances of irregular echogenicity or tumor. Children with RI >0.6 were separately studied. The incidence of high RI (>0.6) was also comparable in unilateral or bilateral disease. These subjects had unfavorable biochemical parameters in terms of low inh B levels and high FSH levels. CONCLUSIONS: Our findings hint to the fact that palpable UDT forms a homogenous group, whether unilateral or bilateral, whereas impalpable testes may form a separate category and need further studies to substantiate this hypothesis.

Assessment of Adequacy of Supplementation of Vitamin D in Very Low Birth Weight Preterm Neonates: A Randomized Controlled Trial.

OBJECTIVES: To compare the effect of 400 IU and 1000 IU vitamin D for 6 weeks in very low birth weight preterm neonates. DESIGN: Randomized, double-blinded controlled trial in a teaching hospital. PARTICIPANTS: Fifty very low birth weight preterm neonates. INTERVENTION: Vitamin D 400 IU/day (Group 1) or 1000 IU/day (Group 2). OUTCOME MEASURES: Change in serum calcium, phosphate, alkaline phosphatase (ALP), 25-hydroxy vitamin D (25-OHD), parathormone, incidence of skeletal hypomineralization and growth. RESULTS: After 6 weeks of supplementation, the mean serum calcium and 25-OHD levels were significantly higher (p < 0.001 each), while ALP and parathormone levels significantly lower (p < 0.001 each) in group 2. Skeletal hypomineralization was lesser and growth better in group 2. CONCLUSION: Vitamin D supplementation in a dose of 1000 IU/day is more effective in maintaining serum calcium, phosphate, ALP, 25-OHD and parathormone levels with lower incidence of skeletal hypomineralization and better growth.

Validation of the EuroQol Five-dimensions - Three-Level Quality of Life Instrument in a Classical Indian Language (Odia) and Its Use to Assess Quality of Life and Health Status of Cancer Patients in Eastern India.

BACKGROUND AND OBJECTIVES: The EuroQol five-dimensions - 3-level (EQ5D) is a versatile quality of life (QOL) instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analog scale. It can be used to calculate quality-adjusted life years. We aimed to evaluate the validity, reliability, and responsiveness of an Odia version of EQ5D and to study the QOL of cancer patients in our part of the country as cancer treatment in India still focuses largely on longevity due to scarcity of resources. MATERIALS AND METHODS: The EQ5D tool was translated into Odia language in collaboration with the EQ group. This tool and the World Health Organization-5 (WHO-5) questionnaires were administered to 155 surgical outpatients and 150 cancer patients in two hospitals of Eastern India. The convergent and discriminant validities (construct validity), concurrent validity, reliability (test-retest method of administering the tool to a part of the population after 7-14 days), and the internal consistency (Cronbach's alpha) were measured using preestablished hypotheses. The data from the cancer patients were analyzed separately. RESULTS: The QOL worsened with age and was worse in cancer patients proved that the tool had good construct validity. The Anxiety Depression dimension had good correlation with all the dimensions WHO-5 (rho > 0.4) indicating a good concurrent validity. Internal consistency and reliability of the tool were good (Cronbach's alpha > 0.7). Cancer patients had a poor QOL (mean EQ5D index 0.37SD 0.4) with male patients, patients with Grade II cancer or referred for pain care services and those with living spouses reporting worse QOL. CONCLUSIONS: The Odia version of the EQ5D has good reliability and validity for the measurement of health status in cancer and outpatient department patients. Cancer patients in this part of the country have a poor QOL and may need a closer look at pain management and improved societal support systems.

Early onset mixed cryoglobulinemia in hepatitis C.

Cryoglobulinemia is one of the most common forms of extrahepatic manifestation of chronic hepatitis infection. The phenomenon is generally seen after several years of chronicity predominantly in the female population resulting in arthralgias, purpuras, and other symptoms, due to vasculitis. Here we present a case of incomplete mixed cryoglobulinemia Type III (as per Brouet's classification) in a young boy aged 13 years who presented with an unusual symptom of pruritus. Diagnosis was confirmed by cryoprecipitation test followed by immunofixation. We aim to highlight the difficulty in diagnosis of this rare case/presentation, important investigation pitfalls and how to avoid them.

Blood levels of isoniazid in Indian children with tuberculosis.

BACKGROUND: Under the Revised National Tuberculosis Control Program (RNTCP) in India children are receiving antituberculosis treatment (ATT) as per a weight band system. In this children may be receiving antituberculosis drugs in doses which may be more or less than that recommended in mg/kg body weight doses. The recommended dose of isoniazid (INH) for intermittent therapy under the RNTCP is 8-12 mg/kg body weight and by the World Health Organization (WHO) for daily therapy is 10-15 mg/kg body weight. AIMS: To evaluate the blood levels and pharmacokinetics of INH, in children suffering from tuberculosis, at doses administered under the weight band system of the Revised National Tuberculosis Control Program (RNTCP) 2009 of India. DESIGN: Prospective, open label, non-randomized single-dose study conducted in 20 children in the age group 5-12 years attending the outpatient, chest clinic of a tertiary care hospital. RESULTS: Group I (n = 8) included children who received INH in a dose of 10 mg/kg body weight or more and Group II (n = 12) included those who received INH in a dose less than 10 mg/kg body weight. The mean peak INH concentration (Cmax) was 6.03 ± 1.4 µg/mL and this was achieved in 2 hours (Tmax). The mean serum INH concentration was significantly higher in children who received INH in dose more than 10 mg/kg (Group I) as compared to those who received INH in doses lesser than 10 mg/kg body weight (Group II) at all-time points except at 2 hours (P < 0.05). The Cmax was also lower in Group II patients in comparison to Group I patients. Area under the concentration time curve (AUC) was significantly lower in Group II patients (P value 0.002). The elimination half-life of INH was 4.3 ± 0.4 h, elimination rate constant 0.16 ± 0.01/h, the volume of distribution 44.05 ± 5.3 L and clearance 7.1 ± 0.8 L/h. CONCLUSIONS: Lower blood levels and AUC of INH were achieved in children receiving doses of INH lesser than 10 mg/kg body weight. Long elimination half-life of INH is indicative of a slower rate of metabolism. Lower INH levels despite a slower rate of drug metabolism indicate caution with the INH doses being administered to children for intermittent therapy under the RNTCP.

Characterization and pollutant removal efficiency of biochar derived from baggase, bamboo and tyre.

Conversion of broad-spectrum organic waste into carbonaceous biochar has gained enormous interest in past few years. The present study aims to characterize feedstock (FS), i.e. bagasse (Bg), bamboo (Bm) and biochar (BC), i.e. baggase biochar (BBg), bamboo biochar (BBm) and tyre biochar (Ty). Significant changes in elemental composition, atomic ratio, proximate analyses, mineral content and heavy metal content were observed which was well supported by Fourier transform infrared (FTIR) spectroscopy and X-ray diffraction (XRD) analysis. Impregnation with ferric hydroxide was done, and resultant modified biochars (MBC), i.e. iron-impregnated baggase biochar (FeBBg), iron-impregnated bamboo biochar (FeBBm) and iron-impregnated tyre biochar (FeTy), along feedstock and biochar were used for PO4 (3-), Pb, Hg and Cu adsorption. In general, BBg, FeBBg, BBm, FeBBm, Ty and FeTy were found to adsorb PO4 (3-), Pb, Hg and Cu better than Bg and Bm, except in few cases. Results from adsorption experiments were fitted into Langmuir, Freundlich and Temkin models of isotherms and pseudo-first-order, pseudo-second-order and Elovich models of kinetics. Result of batch study adsorption revealed that maximum adsorption of PO4 (3-), Pb, Hg and Cu was done by FeBBg (adsorption mechanism explained by Freundlich model), FeTy (Temkin model), Ty (Langmuir model) and BBm (Langmuir model) respectively. According to R (2) values, pseudo-first-order reaction was well suited to PO4 (3-), Pb, Hg and Cu adsorption. The optimum pH for maximum adsorption was observed to be 7.4 for PO4 (3-), 5 for Cu and 6 for Pb and Hg respectively.

Percutaneous coronary intervention in a patient with single coronary artery.

Coronary artery anomalies are found in 1-5% of all coronary angiograms. Single coronary artery is a rare congenital anomaly. The prevalence of the anomaly is 0.024-0.066% of the general population and percutaneous coronary intervention in this anomaly is performed infrequently. The highest incidence of this condition is reported from India. We report a case of a 55 year old patient of anterior wall ST elevation myocardial infarction with L1 group of single coronary artery who underwent successful angioplasty and stenting to left anterior descending artery. The unique features and inherent risks of percutaneous coronary intervention to single coronary artery are discussed.

Heparin cofactor II thrombin complex as a biomarker for mucopolysaccharidosis: Indian experience.

BACKGROUND: Serum heparin cofactor II-thrombin complex (HCII-T) is an emerging biomarker for mucopolysaccharidosis disease (MPS I and MPS II). METHODS: Seventeen cases (6 MPS I and 11 MPS II) and sixty healthy controls were enrolled in study, conducted from September 2008 to December 2012. The mean ± SD age of MPS1 (n=6, 5 males) and MPS II was 7.02 ± 3.25 and 5.2 ± 2.15 years, respectively. Disease status was confirmed by clinical features and enzyme assay. Urinary glycosaminoglycans were measured in spot urine samples and expressed in relation to creatinine content. HCIIT measurement was done using sandwich ELISA at enrolment and after 12 and 24 months of recruitment. RESULTS: Urinary glycosaminoglycans and HCIIT were elevated in all patients compared to their healthy controls. Both markers could not discriminate between the type of mucopolysaccharidosis. CONCLUSIONS: Heparin Cofactor II Thrombin Complex is a good biomarker for mucopolysaccharidosis I and II.

Role of dexamethasone in neonatal meningitis: a randomized controlled trial.

OBJECTIVES: To evaluate the role of dexamethasone therapy in neonatal meningitis in a randomized placebo controlled trial. METHODS: The participants were eighty neonates with meningitis randomized to receive dexamethasone or saline placebo. Dexamethasone was started prior to the first dose of antibiotics in the dose of 0.15 mg/kg intravenous 6 hourly for 2 d. Primary outcome measure was mortality. Secondary outcome measures included progression of systemic inflammatory response syndrome (SIRS) up to 48 h, differences in cerebrospinal fluid (CSF) cytokines between baseline levels and 24 h after enrolment and brain stem auditory evoked response (BAER) after 4 to 6 wk of discharge. RESULTS: Baseline variables were comparable in both the groups. Mortality was significantly decreased in dexamethasone group (p = 0.005) and the absolute risk difference was 27.5 % (95 % CI 9.5-45.8 %). There was a significant reduction in cells per mm(3) (62.5 vs. 100) and proteins (162 vs. 217.5 mg/dl) after 24 h of treatment in the dexamethasone group. IL-1ß was significantly reduced after 24 h in dexamethasone group (290 vs 665 pg/ml). TNF- α was significantly lower (157.5 vs 427.5 pg/ml) and sugar significantly higher (50 vs 38 mg/dl) in the dexamethasone group after 24 h. Significant difference was noted between dexamethasone and saline groups in the progression of SIRS. CONCLUSIONS: Dexamethasone significantly reduced fatality, progression of SIRS and CSF inflammatory indices.

Effect of iron deficiency anemia on hemoglobin A1c levels.

BACKGROUND: Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. METHODS: Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. RESULTS: The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, P<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, P<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, P<0.01). CONCLUSIONS: In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted.

Stabilization of intrinsic defects at high temperatures in ZnO nanoparticles by Ag modification.

The stabilization of defects in ZnO at high temperatures has been investigated. The properties of unmodified and modified ZnO nanoparticles (NPs) with 2 at.% of Ag prepared by microwave assisted combustion method, have been systematically studied using X-ray diffraction (XRD), photoluminescence (PL), X-ray photoelectron spectroscopy (XPS) and photocatalytic activity measurements. Though the XRD data shows a marginal shift in the ZnO peak position upon Ag addition, the amount of shift does not change with annealing temperatures. The PL data reveals that the defect mediated visible emission intensity of unmodified ZnO NPs increases with increase in the annealing temperature, whereas it remains almost unchanged in Ag-ZnO. This study clearly establishes that silver is an efficient stabilizer of intrinsic defects in ZnO at high temperatures. This is further supported by the core and valence band XPS spectra.

Vitamin E supplementation in exclusively breastfed VLBW infants.

We conducted this study to evaluate the adequacy of breastmilk as a source of vitamin E in exclusively breastfed VLBW infants. Such infants (n=44) were randomly allotted to receive vitamin E supplementation (n = 23); the rest (n = 21) did not receive vitamin E. After 21 days, the vitamin E level in the supplemented group was 0.78 + 0.26 mg/dL as compared to 0.77+ 0.25 mg/dL in the unsupplemented group (P=0.69). The ratio of Vitamin E to lipids was also comparable in the two groups, (P=0.65). We concluded that vitamin E supplementation is not routinely needed in VLBW infants.