Appraising LaQshya's potential in measuring quality of care for mothers and newborns: a comprehensive review of India's Labor Room Quality Improvement Initiative.

BACKGROUND: Poor intrapartum care in India contributes to high maternal and newborn mortality. India's Labor Room Quality Improvement Initiative (LaQshya) launched in 2017, aims to improve intrapartum care by minimizing complications, enforcing protocols, and promoting respectful maternity care (RMC). However, limited studies pose a challenge to fully examine its potential to assess quality of maternal and newborn care. This study aims to bridge this knowledge gap and reviews LaQshya's ability to assess maternal and newborn care quality. Findings will guide modifications for enhancing LaQshya's effectiveness. METHODS: We reviewed LaQshya's ability to assess the quality of care through a two-step approach: a comprehensive descriptive analysis using document reviews to highlight program attributes, enablers, and challenges affecting LaQshya's quality assessment capability, and a comparison of its measurement parameters with the 352 quality measures outlined in the WHO Standards for Maternal and Newborn Care. Comparing LaQshya with WHO standards offers insights into how its measurement criteria align with global standards for assessing maternity and newborn care quality. RESULTS: LaQshya utilizes several proven catalysts to enhance and measure quality- institutional structures, empirical measures, external validation, certification, and performance incentives for high-quality care. The program also embodies contemporary methods like quality circles, rapid improvement cycles, ongoing facility training, and plan-do-check, and act (PDCA) strategies for sustained quality enhancement. Key drivers of LaQshya's assessment are- leadership, staff mentoring, digital infrastructure and stakeholder engagement from certified facilities. However, governance issues, understaffing, unclear directives, competency gaps, staff reluctance towards new quality improvement approaches inhibit the program, and its capacity to enhance quality of care. LaQshya addresses 76% of WHO's 352 quality measures for maternal and newborn care but lacks comprehensive assessment of crucial elements: harmful labor practices, mistreatment of mothers or newborns, childbirth support, and effective clinical leadership and supervision. CONCLUSION: LaQshya is a powerful model for evaluating quality of care, surpassing other global assessment tools. To achieve its maximum potential, we suggest strengthening district governance structures and offering tailored training programs for RMC and other new quality processes. Furthermore, expanding its quality measurement metrics to effectively assess provider accountability, patient outcomes, rights, staff supervision, and health facility leadership will increase its ability to assess quality improvements.

Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year.

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15-20 mg/dl) -85(78.7%) cases, group 2: (20-25 mg/dl) -17(15.7%), and group 3: (>25 mg/dl) -6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

Disentangling source of moisture driving glacier dynamics and identification of 8.2 ka event: evidence from pore water isotopes, Western Himalaya.

Two atmospheric circulation patterns, the Indian Summer Monsoon (ISM) and mid-latitude Westerlies control precipitation and thus glacier variability in the Himalaya. However, the role of the ISM and westerlies in controlling climate and thus past glacier variability in the Himalaya is poorly understood because of the paucity of the ice core records. In this article, we present a new Holocene paleorecord disentangling the presence of the ISM and mid-latitude westerlies and their effect on glacier fluctuations during the Holocene. Our new record is based on high-resolution multi-proxy analyses (δ18Oporewater, deuterium-excess, grain size analysis, permeability, and environmental magnetism) of lake sediments retrieved from Chandratal Lake, Western Himalaya. Our study provides new evidence that improves the current understanding of the forcing factor behind glacier advances and retreat in the Western Himalaya and identifies the 8.2 ka cold event using the aforementioned proxies. The results indicate that the ISM dominated precipitation ~ 21% of the time, whereas the mid-latitude westerlies dominated precipitation ~ 79% of the time during the last 11 ka cal BP. This is the first study that portrays the moisture sources by using the above proxies from the Himalayan region as an alternative of ice core records.

Assessment of serum apolipoprotein B and apolipoprotein A-1 and their ratio in healthy full term small for gestational age newborns.

BACKGROUND: Programmed changes in growth restricted fetuses can increase the risk of adulthood diseases due to elevated serum cholesterol and apolipoprotein-B (Apo-B) concentrations. Increasing evidence demonstrated the role of apoB/apoA-I ratio as a strong risk factor for cardiovascular diseases. OBJECTIVE: To determine the concentration of cord blood lipoproteins and apolipoproteins as well as their correlation with birth weight. METHODS: This cross-sectional study was conducted in a teaching institution in central India. Healthy full-term newborns, born out of normal vaginal deliveries, were recruited. Cases include term small for gestational age (SGA) babies while term appropriate for gestational age (AGA) babies were taken as controls. Their umbilical venous blood was collected and sent for biochemical analysis. RESULTS: Out of 126 healthy newborns, 66 were cases and 60 were controls. Mean values of serum triglyceride (141.56±69.67 mg/dl vs. 113.67±33.38 mg/dl; p < 0.006; 95% CI = 8.31 to 47.46) and serum apo-B/apo-A-1 ratio (0.67±0.28 vs. 0.55±0.20; p < 0.007; 95% CI = 0.033 to 0.206) were significantly high and that of serum high density cholesterol (35.84±10.42 mg/dl vs. 40.73±11.70 mg/dl; p < 0.014; 95% CI = -8.79 to -0.98) and Apo-A1 [87.59±12.44 mg/dl vs. 101.87±35.07 mg/dl; p = 0.002; 95% CI = -23.39 to -5.16) were significantly low in SGA newborns. Serum cholesterol, very low-density cholesterol rlow-density cholesterol rand Apo-B did not show any significant difference. Among SGA newborns significant negative correlation was seen between birth weight and apo-B/apo-A1 and serum triglyceride, while birth weight and serum apo-A1 level showed significant positive correlation. There was no statistically significant correlation between birth weight and other parameters. CONCLUSION: These findings further support the association of prenatal factors with lipid profile rand can serve as starting point for studying lipid transport system changes during early life in Indian population.

Assessment of bioaerosol pollution over Indo-Gangetic plain.

Aerosol plays a very important role in climate change and public health. It affects cloud condensation nuclei and causes a number of epidemic diseases. The correlations of aerosol with epidemic diseases are due to the biotic components of aerosol. The present study deals with the measurements and characterization of bioaerosol over Indo-Gangetic plain. The levels of PM10 and PM2.5 are much higher than the recommended value set by NAAQS in India. Bacterial and fungal concentrations are in the reported range. Bacterial concentration is higher than fungal concentration. Gram-positive bacteria contribute 75% while gram-negative bacteria contribute 25% only. A total seven types of fungi are identified in aerosols. Aspergillus niger is dominant. Meteorological parameters play important roles in growth and presence of microorganism in the air. Bacterial concentrations are governed mainly by temperature while fungal concentration is influenced by relative humidity.

How effective is the integration of facility and community-based management of severe acute malnutrition in India?

SETTING: All children admitted to two nutritional rehabilitation centres (NRCs) during 2011-2012 in Madhya Pradesh, India. OBJECTIVE: To determine 1) adherence to in-patient care and follow-up visits, 2) attainment and maintenance of target weight gain, and 3) association with the children's demographic characteristics. DESIGN: A retrospective record review. The 74-day programme included 14 days of in-patient care, with subsequent home-based care and four follow-up visits to the NRC at 15-day intervals. The first three visits were part of the treatment, while the fourth was for assessment of sustained weight gain. RESULTS: Of the 1027 children admitted, 900 (88%) completed in-patient care. Of these, 685 (76%) attended the first three follow-up visits, 482 (70%) of whom gained >15% of their admission weight. Of these, 409 (85%) completed four visits, 314 (77%) of whom were able to sustain their weight gain. Those unable to gain >15% weight by the third visit had a significantly lower proportion of sustained weight gain at the fourth visit. Children aged ⩾6 months had significantly higher odds (OR 4.5, 95%CI 3.1-6.2, P < 0.05) of completing in-patient care. CONCLUSION: In-patient care combined with community-based follow-up was effective in adherence to follow-up visits; however, there is still room for improvement in attaining and sustaining the target weight.

Presence of Virus like Particles in Human Pathogenic Fungi: Chrysosporium sps and Candida albicans.

Out of eight isolates of different human pathogenic fungi, four were found to be infected with virus like particles (VLP): Chrysosporium pseudomerdarium, C. xerophillum, C. keratinophillum and Candida albicans through electron microscopy. Frozen mycelium without abrasive was seemingly better disruption method for VLP extraction in Chrysosporium extracts but in Candida albicans disruption with abrasive revealed the presence of considerable amount of VLP. The growth of five isolates of Chrysosporium species associated with VLP was significantly affected by different media tested. Absorption spectra revealed the nucleo protein nature of VLP in C. albicans. Virus like particles in Chrysosporium species reported for the first time and in C. albicans, it is reported for the first time in India.

Production of peptide antifungal antibiotic and biocontrol activity of Bacillus subtilis.

Among different bacterial cultures, a potent Bacillus subtilis MTCC-8114 was isolated from garden soil samples which showed 16 and 14 mm inhibition zones by spot inoculation method and 24 and 22 mm inhibition zones by well agar diffusion method against test fungi i.e. Microsporum fulvum and Trichophyton species. Among four media tested, the maximum growth and antibiotic production was found in trypticase soya broth (TSB) medium at 37 degrees C, pH-7 and 48 h of incubation. The Rf value (0.64) by Thin Layer Chromatography (TLC) technique and UV and FTIR spectral data of the active antifungal compound, indicated that the isolated compound belongs to peptide antifungal antibiotic group. MIC value of antifungal antibiotic was 135 and 145 microg/ml.

Incidence of keratinophilic fungi in waterlogged condition of paddy soil.

Prevalence of keratinophilic fungi was observed in paddy field soil during different stages of cultivation viz., transplanting, tillering, milking and maturation. Out of total 76 soil samples, 65 soil samples were found to be positive for the keratinophilic fungi. Fourteen species belonging to a single genus Chrysosporium were isolated through out the cropping season. C. keratinophilum (17.1%) followed by C. tropicum (13.15%) were found to be the most dominating geophilic species. The highest percent distribution of keratinophilic fungi appeared during the milking stage (100%) of paddy cultivation, followed by the maturation stage (89.47%).

Development and application of an ethically and epidemiologically advantageous assay for the multi-locus microsatellite analysis of Schistosoma mansoni.

Non-availability of adult worms from living hosts remains a key problem in population genetic studies of schistosomes. Indirect sampling involving passage through laboratory animals presents significant ethical and practical drawbacks, and may result in sampling biases such as bottlenecking processes and/or host-induced selection pressures. The novel techniques reported here for sampling, storage and multi-locus microsatellite analysis of larval Schistosoma mansoni, allowing genotyping of up to 7 microsatellite loci from a single larva, circumvent these problems. The utility of these assays and the potential problems of laboratory passage, were evaluated using 7 S. mansoni population isolates collected from school-children in the Hoima district of Uganda, by comparing the associated field-collected miracidia with adult worms and miracidia obtained from a single generation in laboratory mice. Analyses of laboratory-passaged material erroneously indicated the presence of geographical structuring in the population, emphasizing the dangers of indirect sampling for population genetic studies. Bottlenecking and/or other sampling effects were demonstrated by reduced variability of adult worms compared to their parent field-collected larval samples. Patterns of heterozygote deficiency were apparent in the field-collected samples, which were not evident in laboratory-derived samples, potentially indicative of heterozygote advantage in establishment within laboratory hosts. Genetic distance between life-cycle stages in the majority of isolates revealed that adult worms and laboratory-passaged miracidia clustered together whilst segregating from field miracidia, thereby further highlighting the utility of this assay.

Does multiple hosts mean multiple parasites? Population genetic structure of Schistosoma japonicum between definitive host species.

Multi-host parasites, those capable of infecting more than one species of host, are responsible for the majority of all zoonotic, emerging or persistent human and animal diseases and are considered one of the major challenges for the biomedical sciences in the 21st century. We characterized the population structure of the multi-host parasite Schistosoma japonicum in relation to its definitive host species by genotyping miracidia collected from humans and domestic animals across five villages around the Yangtze River in Anhui Province, mainland China, using microsatellite markers. High levels of polymorphisms were observed and two main genetic clusters were identified which separated water buffalo, cattle and humans from goats, pigs, dogs and cats. We thereby believe that we present the first evidence of definitive host-based genetic variation in Schistosoma japonicum which has important epidemiological, evolutionary, medical and veterinary implications.

Aspergillus niger as a new allergic agent associated with bindis and its efficacy against homeopathic drugs.

Aspergillus was found as a dominant fungi to associate with brands of bindis. Among three potencies of four homeopathic drugs, Lycopodium 1M, Sulphur 1M, and Sepia 30 showed maximum inhibition zone of Aspergillus niger in inhibition zone technique. In poison food technique, Sepia 30M, Tellurium 30M, Sulphur 1M and Lycopodium 200 showed maximum percentage inhibition against A. niger

Population genetics of multi-host parasites--the case for molecular epidemiological studies of Schistosoma japonicum using larval stages from naturally infected hosts.

Population genetics of multi-host pathogens offers great potential for the understanding of their complex epidemiology but care must be taken to ensure that the sampling procedure does not bias estimates of population indices. The transfer of material to laboratory passage, in particular, runs the risk of bottlenecking and imposing non-random host-induced selection pressures according to the hosts used in passage. We present a novel technique allowing single-locus microsatellite genotyping of the naturally sampled larval stages, enabling unbiased population genetic studies of the multi-host zoonotic parasite Schistosoma japonicum. The utility of these larval genotyping methods for molecular epidemiological studies are illustrated in results from 3 separate data sets. In the first data set, potential loss of alleles based on the definitive host species used for laboratory maintenance was identified by comparing adult worm populations derived from mice and rabbits infected with cercarial populations originating from the same set of snails. In the second data set, bottlenecking was demonstrated by the loss of alleles in adult worms derived within a single generation of laboratory maintenance compared to their parent field-collected cercarial samples. In the final data set, comparison of miracidia and adult worms recovered from naturally infected animals demonstrated that larval analyses can provide stage-specific epidemiological information and that population genetics of schistosomes can be well described by analysis of larval stages. Our results thus advocate the use of natural life-cycle stages to obtain an accurate and ethical representation of the population genetic structure of S. japonicum and other multi-host pathogens.

Biological control of dermatophytic fungus Trichophyton species by Bacillus subtilis.

A potent Bacillus subtilis-2 isolated from soil samples, showed 14 mm inhibition zone by spot inoculation method and 22 mm inhibition zone by well agar diffusion method against pathogenic test fungii. i.e. Trichophyton species. Among four media tested, the maximum growth and antibiotic production was found in trypticase soya broth (TSB) medium at 37 degrees C, pH 7 and 48 hrs of incubation. The MIC of antifungal substance was 35 microl/ml. The isolated Bacillus subtilis -2 has strong antifungal activity against dermatophytic fungi Trichophyton sp. and requires chemical characterization for its bioactive principle.

Diversity of keratinophilic mycoflora in the soil of Agra (India).

Diversity of keratinophilic mycoflora in the soil of Agra was under observation for 1 year (July 2001-June 2002) and isolation of keratinophilic fungi was followed by the hair-baiting method. The frequency of occurrence of keratinophilic fungi in 284 soil samples collected from various hospitals, cattle yards, poultry farms, crop fields and playgrounds was determined, 204 samples (72%) having been found to be positive. A total of 33 species classified into 11 genera (Acremonium, Aspergillus, Chrysosporium, Emmonsia, Geomyces, Keratinophyton, Microsporum, Myceliophthora, Penicillium, Sporotrichum, Trichophyton) were encountered from the soil samples. Sporotrichum spp. were found to be the most dominant species followed by Trichophyton simii. The parameter of keratinophilic fungi found in the samples studied ranged from 62 to 80% where playgrounds yielded the maximum number of species (80%) while the least dominating soil was hospital soil (62%). Among all the baits used maximum fungi occurred on human hairs (82%) followed by chicken feather (74%), wool (61%) and the least on horns (45%). The spectrum of keratinophilic fungi isolated from different sites differed considerably according to the frequency of use by humans.

Biodegradation of wool by Trichophyton simii and Aspergillus niger.

The amount of protein released into liquid culture medium and weight loss were taken as measures of wool degradation by Trichophyton simii and Aspergillus niger. Protein released into the culture medium was observed to be greater after T. simii treatment than after A. niger treatment. Sulphitolysis was shown by T. simii, whereas it was absent in the case of A. niger, pH was found to be alkaline with an increase in soluble protein in the culture medium in the case of both uniculture and dual culture. However, both the weight loss of wool and the amount of protein released were significantly reduced when both fungi were allowed to attack the substrate. The behaviour of these fungi in dual culture reflects their antagonistic activities.