Complete coverage and covering completely: Breast feeding and complementary feeding: Knowledge, attitude, and practices of mothers.

BACKGROUND: Knowing current trends for timely comprehensive action for health promotion practices is an important prerequisite for medical practitioners and policy makers. METHODS: A survey of mothers at a Tertiary Care Hospital in central India. RESULTS: On the knowledge front >83.75% of the mothers studied showed good knowledge about breastfeeding and complementary feeding. Similar, but not as encouraging, were the results about attitude, with 76.25% of mothers having a positive attitude. The results of the practices part were varied. The WHO indicators assessed were 'early initiation of breastfeeding' (68.75%), 'exclusive breastfeeding under 6 months' (85%) (however exclusive breast feeding for first 6 months was carried out by only 36.25%), 'introduction of solid, semi-solid or soft foods' (48.75%), 'continued breastfeeding at 1 year' (63.75%) and 'continued breastfeeding at 2 years' (6.25%). CONCLUSIONS: There is a discrepancy between knowledge and practices. The exclusive breast feeding rates are far from the ideal and there is a decline of continued breast feeding beyond 15 months. This calls for sustained efforts with the aim - 'cover all and cover completely'. The ideal WHO indicator for exclusive breast feeding should be 'exclusive breastfeeding for first 6 months' which will provide information about the completeness of this ideal practice.

Self-care activities among patients with diabetes attending a tertiary care hospital in mangalore karnataka, India.

BACKGROUND: Increasing prevalence of diabetes in India is resulting in an epidemiological transition. The care of the people with diabetes is traditionally seen as doctor centered, but the concept of self-care of people with diabetes is a new domain and is proven beneficial. AIM: The aim was to determine the practice of self-care activities among people with diabetes attending a tertiary care hospital in Mangalore. SUBJECTS AND METHODS: A facility-based cross-sectional study was conducted in Government Wenlock Hospital, Mangalore during September-October 2012. A total of 290 patients with >1-year duration of diabetes mellitus (DM) were asked to respond to summary diabetes self-care activities questionnaire after obtaining the consent from them. The statistical analysis was performed in terms of descriptive statistics and association between the variables was tested using Mann-Whitney U-test. RESULTS: A healthy eating plan on a daily basis was followed by 45.9% (133/290) of the participants, daily exercises for 30 min were followed by 43.4% (126/290), and regular blood sugar monitoring was done by 76.6% (222/290). Regarding the adherence to oral hypoglycemic agents and insulin, daily adherence to medication was seen among 60.5% (155/256) and 66.9% (138/206) were found to be adherent to insulin injections on a daily basis. CONCLUSIONS: Self-care practices were found to be unsatisfactory in almost all aspects except for blood sugar monitoring and treatment adherence. As these practices are essential for prevention of complications and better quality-of -life, more efforts should be put to educate the people with diabetes.

Continuous positive airway pressure for spontaneously breathing premature infants with respiratory distress syndrome.

OBJECTIVE: To analyze the outcome of inborn preterm neonates with respiratory-distress-syndrome (RDS), using the approach of administering nasal-continuous-positive-airway-pressure (CPAP) alone and administering surfactant only if they require mechanical ventilation (MV). METHODS: All preterm neonates diagnosed as RDS from 01-May-2006 to 10-July-2010 were prospectively enrolled for the study at a referral centre in India. Nasal-CPAP alone was administered to all spontaneously breathing neonates. Surfactant was administered in babies <28 wk gestational age if the baby was intubated for resuscitation at birth. For the remaining babies, surfactant was administered if the baby required ventilation for RDS in first 72 h. The primary outcome assessed was survival to discharge. RESULTS: Of the 83 babies with RDS, 33(39.76%) neonates needed MV of which one baby was transferred due to non-availability of ventilator. Of the remaining 32 babies administered MV, 31 were administered surfactant. Fifty (61.24%) babies were managed with CPAP alone. Overall, 72/82(87.8%) babies managed at the authors' center survived the neonatal period, and 71/82(86.8%) babies were discharged to home. Among the neonates who were ventilated, 26/32(81.25%) survived the neonatal period, and 25/32(78.12%) were discharged home. Among the babies receiving CPAP, 46/50(92%) survived and were discharged to home. CONCLUSIONS: Institution of CPAP alone in all spontaneously breathing preterm babies with RDS and administration of surfactant to only those needing MV reduces the need for intubations and surfactant administration without affecting the outcome adversely. Extreme preterms with RDS, however, may be given surfactant if they happen to be intubated for resuscitation at birth.

Establishing the reliability of palatal rugae pattern in individual identification (following orthodontic treatment).

This study aims to determine the stability of palatal rugae before and after orthodontic treatment. 50 orthodontic cases were selected with pre- and posttreatment casts and 50 casts were randomly selected as variables. Landmarks on the palatal raphe and rugae were marked on the maxillary casts. Points were made on medial and lateral ends of first, second and third rugae. Each cast was photographed, measured and then trimmed leaving only the rugae area of the hard palate. In the pre and post-treatment group, changes in transverse measurements were significantly different for lateral points of first rugae and anteroposterior changes were significant for the distances between first and second rugae. All inter-point measurements of third rugae were stable in post-treatment casts. Thirty blinded examiners compared 50 trimmed preorthodontic casts to similarly prepared one hundred casts for possible matches based on pattern of rugae. The percentages of correct matches for examiners had a median of 90%. The matching of pre-operative and post-operative orthodontic casts demonstrated that although some changes do occur in the rugae during orthodontic treatment, the morphology of palatal rugae remains stable throughout life. Hence carefully assessed rugae pattern may have a definite role in forensic identification. Further, points associated with the third palatal ruage were the most immutable over a person's life and hence could be used as a reference to evaluate the changes in teeth positions during orthodontic treatment.

Biomedical waste management: incineration vs. environmental safety.

Public concerns about incinerator emissions, as well as the creation of federal regulations for medical waste incinerators, are causing many health care facilities to rethink their choices in medical waste treatment. As stated by Health Care Without Harm, non-incineration treatment technologies are a growing and developing field. Most medical waste is incinerated, a practice that is short-lived because of environmental considerations. The burning of solid and regulated medical waste generated by health care creates many problems. Medical waste incinerators emit toxic air pollutants and toxic ash residues that are the major source of dioxins in the environment. International Agency for Research on Cancer, an arm of WHO, acknowledged dioxins cancer causing potential and classified it as human carcinogen. Development of waste management policies, careful waste segregation and training programs, as well as attention to materials purchased, are essential in minimizing the environmental and health impacts of any technology.

Pyourachus: study of two cases.

The urachus, or median umbilical ligament, is a midline tubular structure that extends upward from the anterior dome of the bladder toward, the umbilicus and represents the vestigial remnant of at least two embryonic structures, the cloaca and the allantois. The tubular urachus normally involutes before birth, remaining as a fibrous band, however its persistence can give rise to various clinical problems, not only in infants and children but also in adults. We report two cases of pyourachus at our institute with a review of the clinical presentation, imaging findings and surgical management. Both our patients were young males, with haematuria being the presenting feature in one case which has not been previously described in literature.

Increased helix and protein stability through the introduction of a new tertiary hydrogen bond.

In an effort to quantify the importance of hydrogen bonding and alpha-helix formation to protein stability, a capping box motif was introduced into the small phosphocarrier protein HPr. Previous studies had confirmed that Ser46, at the N-cap position of the short helix-B in HPr, serves as an N-cap in solution. Thus, only a single-site mutation was required to produce a canonical S-X-X-E capping box: Lys49 at the N3 position was substituted with a glutamic acid residue. Thermal and chemical denaturation studies on the resulting K49E HPr show that the designed variant is approximately 2 kcal mol-1 more stable than the wild-type protein. However, NMR studies indicate that the side-chain of Glu49 does not participate in the expected capping H-bond interaction, but instead forms a new tertiary H-bond that links helix-B to the four-stranded beta-sheet of HPr. Here, we demonstrate that a strategy in which new non-native H-bonds are introduced can generate proteins with increased stability. We discuss why the original capping box design failed, and compare the energetic consequences of the new tertiary side-chain to main-chain H-bond with a local (helix-capping) side-chain to main-chain H-bond on the protein's global stability.

Influence of N-cap mutations on the structure and stability of Escherichia coli HPr.

This paper describes the effect of N-capping substitutions on the structure and stability of histidine-containing protein (HPr). We have used NMR spectroscopy and conformational stability studies to quantify changes in local and global free energy due to mutagenesis at Ser46, the N-cap for helix B in HPr. Previous NMR studies suggested that helix B of Escherichia coli HPr is dynamic as judged by the rate of exchange of amide protons with solvent. Ser46 was chosen because it is the site of regulatory phosphorylation in HPrs from Gram-positive bacteria, and mutation of this residue to an aspartic acid (S46D) in E. coli HPr (Gram-negative) also makes it a poor substrate in the bacterial phosphoenolpyruvate: sugar phosphotransferase system. Therefore, to understand the mechanism of inactivation of E. coli S46D HPr, as well as the effect of mutagenesis on protein stability, we have characterized three mutants of E. coli HPr: Ser46 has been mutated to an Asp, Asn, and Ala in S46D, S46N, and S46A HPrs, respectively. The results indicate that these N-cap replacements have a marked influence on helix B stability. The effect of mutagenesis on local stability is correlated to global unfolding of HPr. The ability of amino acids to stabilize helix B is Asp > Asn > Ser > Ala. In addition, since there are neither large-scale conformational changes nor detectable changes in the active site of S46D HPr, it is proposed that the loss of phosphotransfer activity of S46D HPr is due to unfavorable steric and/or electrostatic interactions of the Asp with enzyme I of the PTS.

The Escherichia coli adenylyl cyclase complex: requirement of PTS proteins for stimulation by nucleotides.

GTP, as well as other nucleoside triphosphates, stimulates the activity of Escherichia coli adenylyl cyclase in permeable cells; the stimulatory effect is lost when the cells are disrupted by passage through a French pressure cell. These data suggested that the allosteric regulation by GTP of adenylyl cyclase activity requires an interaction of the enzyme with other protein factors. Strains deleted for genes encoding proteins of the phosphoenolpyruvate:sugar phosphotransferase system (PTS) failed to show an activity stimulation by GTP. With a view to localizing the site of interaction of GTP with the adenylyl cyclase complex, a variety of studies using purified PTS proteins were performed using the photoaffinity labeling reagent, 8-azidoGTP. These studies showed that 8-azidoGTP bound specifically to HPr. A species specificity study showed that the photoaffinity reagent labeled E. coli HPr but not HPr proteins from Mycoplasma capricolum or Bacillus subtilis. A variety of site-directed mutations of E. coli HPr were evaluated for interaction with GTP by photoaffinity labeling as well as by nuclear magnetic resonance; the results of these studies indicate that the lysine residues at positions 24 and 27, serine-46, the threonine at position 36, and the aspartate at position 69 are important for the binding of GTP to HPr. Molecular modeling has been used to formulate a model for the binding of GTP to HPr involving electrostatic interaction of the phosphate groups of the nucleotide with the side chains of lysine residues 27 and 45 and serine-43, interaction of the sugar with serine-46, and interaction of the base with lysine-24. From these data, it is hypothesized that the binding of GTP to HPr is required for the GTP-dependent stimulation of the activity of the adenylyl cyclase complex.

The electronic structure of P840+. The primary donor of the Chlorobium limicola f. sp. thiosulphatophilum photosynthetic reaction centre.

The radical cation P840+. was studied in frozen suspensions of Chlorobium limicola f. sp. thiosulphatophilum membranes using ENDOR and Special TRIPLE spectroscopies. The spectra show that P840+. arises from a bacteriochlorophyll a 'special' pair with a highly symmetrical distribution of electron spin density between the constituent bacteriochlorophylls. Special TRIPLE spectroscopy has resolved the separate contributions of the two halves of the pair and revealed small deviations from a 1:1 electron spin density distribution. Nevertheless P840+. appears to come the closest yet to the symmetrical 'dimer' originally proposed for the structure of the primary donor radical cation (P870+.) in purple non-sulphur photosynthetic bacteria.

Somatic symptoms in depression and antidepressants.

Somatic side effects of antidepressant medications and of depression and anxiety were quantified in depressed patients before and after 4 weeks of treatment with amitriptyline (N = 11), or desipramine (N = 12). The entire group showed significant posttreatment decreases in depression. Side-effect symptoms were significantly reduced after treatment in the amitriptyline group; less reduction was seen in the desipramine group. Significant correlations were demonstrated between levels of anxiety and side effect symptoms both before and after treatment. The reduction in side effect symptoms in the amitriptyline group can be explained by the drug's anxiolytic property. Our findings suggest that symptoms resembling antidepressant side effects seen in medicated depressed patients are influenced by the patient's clinical condition more than by the anticholinergic activity of moderate dosages of the antidepressant.