Geochemical contamination of heavy metals and health risk assessment of coastal sediments along the North Chennai to Pondicherry, India using total reflection X-ray fluorescence spectroscopy (TXRF).

The present work aimed to assess the contamination and human health risk assessment of heavy metals (HMs) in 21 sediment samples collected from the North Chennai to Pondicherry coastal area of Tamil Nadu using total reflection X-ray fluorescence spectroscopy (TXRF). Enrichment factor (EF), contamination factor (CF), and geo-accumulation index (Igeo) were calculated to estimate sediment contamination. The average concentrations of HMs (mg kg-1 dry weight) were: Al (4305.12), V (25.77), Cr (15.08), Mn (83.39), Fe (4539.77), Ni (2.89), Cu (2.67), Zn (9.46), As (2.81), Hg (0.05), and Pb (0.92). Results of EF indicated no enrichment with Al, Ni, and Pb, moderate enrichment with V, and severe enrichment with As and Hg. Based on Igeo, all sediment samples showed unpolluted with HMs (except As and Hg). Based on total lifetime cancer risk (LCR), there are no significant health risks for people in the study area from carcinogenic Cr, As, and Pb.

Effect of minerals and heavy metals in sand samples of Ponnai river, Tamil Nadu, India.

River sand samples have been collected from Ponnai river, Tamil Nadu, India for characterization of minerals and heavy metals by different spectroscopic techniques. Initially, the samples were subjected by Fourier Transform-Infra Red (FT-IR) spectroscopic technique and infra-red absorption bands values are observed in the range of 515-520, 695-700, 775-780 cm-1 which shows the presence of quartz in all the samples. Similarly, infra-red peaks were absorbed for feldspar, kaolinite, calcite, gibbsite and organic carbon and confirmed by X-Ray diffraction (XRD) technique. Additionally, zircon, aragonite, magnetite and kyanite minerals were identified in the samples using only the XRD method. The concentration of heavy metals such as Pb, Cr, Zn, Ni, Hg, As, Mn, Cu has been determined by flame atomic absorption spectrometry (FAAS). An average metal concentration measured in mg kg-1 were: Pb 0.12, As 0.15, Hg 0.13, Cu 2.80, Zn 10.15 Cr 12.70, Ni 2.86 and Mn 104.94 and hence found in the order of Mn > Cr > Zn > Ni > Cu > As > Hg > Pb. These average values do not exceed the world average value and hence potentially do not affect the quality of sand in the river. In addition to that, presences of heavy metals are confirmed by scanning electron microscope equipped with energy dispersive X-ray spectrometry (SEM/EDS) analysis. In order to understand the possible natural and anthropogenic sources of heavy metals, multivariate statistical techniques such as Pearson correlation, principal component and cluster analysis were performed. Results obtained from the statistical techniques were good agreement with each other.

Data on minerals and crystallinity index of quartz in rock samples collected from Paleolithic archaeological site of Attirampakkam, Tamil Nadu.

In the present work, rock samples were collected from Paleolithic archaeological site of Attirampakkam, Tamil Nadu, India to assess the mineralogical composition using Fourier transform infrared-spectroscopic (FT-IR) technique and X-Ray Diffraction Spectrometry (XRD). The quartz, kaolinite, montmorillonite, calcite, orthoclase, microcline and illite minerals are identified in rock samples and crystallinity index of quartz (SiO2) is estimated for all the samples by comparing the ratio of intensity of the characteristic peak at 778 and 695 cm-1 using FT-IR spectrum. In rock samples, calculated crystallinity index of quartz is greater than the 1 from FT-IR spectrum and it shows that the distribution is disordered in nature. Additionally, some more minerals such as hematite and rutile are identified in rock samples by X-ray diffraction technique. This extensive study shows that archeological rock samples are wide variation in mineral composition.

Volumetric and dosimetric impact of MRI in delineation of gross tumor volume of non-spinal vertebral metastases treated with stereotactic ablative radiation therapy.

PURPOSE: To investigate the Gross Tumor Volumes (GTV) and its dosimetric impact of magnetic resonance imaging (MRI) assisted contouring for non-spinal metastasis treated with stereotactic ablative body radiotherapy (SABR). MATERIAL AND METHODS: Five observer contours on CT (GTVCT) and CT+MR (GTVCT+MR) were evaluated against expert team contours (GTVEC) for 14 selected cases. Dice Similarity Index (DSC) and Geographical Miss Index (GMI) quantify observer variation. We also analyze the maximum dose (Dmax) and dose received by 0.35cc (D0.35cc) of the spinal cord (SC) for GTVCT and GTVCT+MR, where optimization parameters and priorities were unchanged. Percent rank function is also evaluated for SC doses. RESULTS: The mean DSC and GMI scores for the CT-only dataset are 0.6974 and 0.2851 and for CT+MR dataset is 0.7764 and 0.1907 respectively. Statistically, significant results were found for mean GTV volumes between GTVEC versus GTVCT and GTVCT versus GTVCT+MR (P<0.001). Dosimetric analysis of Dmax and D0.35cc exceeded 84.2% and 88.5% of times its respective threshold doses for CT-only dataset, whereas for the CT+MR dataset, it exceeded only by 18% and 15.7% times. 'Percent rank' function analysis for SC doses also indicates the same. CONCLUSION: This study supports MRI fusion for GTV and OAR delineation for non-spinal metastasis. Our study showed that the dosimetric analysis is vital for observer variation studies and the addition of the MR data set is significant to improve the confidence of Stereotactic treatments.

Physician Health in the Times of COVID-19.

BACKGROUND AND OBJECTIVES: A virtual registry study evaluating real world evidence on physicians' use of prophylactic regimens for protection against SARS-CoV-2. This paper summarizes the interim results. METHODS: Asymptomatic physicians at risk of acquiring SARS-CoV-2 responded to online questions at baseline and 7 weeks post-baseline. Baseline data included demographics, prophylaxis regimen (including "no prophylaxis") and start date. Participants who provided complete week-7 data (information on type of health facility [COVID/Non-COVID], number of presumed/confirmed cases exposed to, PPE use, SARS-CoV-2 testing and symptoms, regimen adherence and intercurrent illness) comprised the Completer population. Limited data (regimen adherence, SARS-CoV-2 testing) was collected for participants who failed to provide complete week7 data. Those providing limited/complete information comprised the Evaluable population. RESULTS: Of 369 enrolled participants, 182 (mean age 42±11.05 years) comprised the Evaluable population. They showed a male preponderance (67.6%). Practitioners from Maharashtra (59.9%) and specialties of Pediatrics, Internal Medicine, Anesthesiology and Critical Care (63.2%) accounted for the majority. ICMR's HCQ prophylaxis regimen was initiated by 125 (68.7%) participants with 31 (17%) initiating 'No prophylaxis'. The highest adherence was for the ICMRregimen (87.2%). In the Completer population comprising 150 participants, 87 were exposed to presumed (81) and/or confirmed cases (60). Most exposures to confirmed cases (49, 81.7%) were high-risk. PPE use was generally high (75-100%). Most participants (94.7%) did not report an AE. The proportions with an AE was similar with ICMR regimen (5.9%) and no prophylaxis (6.5%). INTERPRETATION AND CONCLUSIONS: Physicians in India preferred ICMR's HCQ regimen. The regimen appears to be safe and associated with a high level of adherence.

Potential ecological risk assessment in soils of Yelagiri hill, Tamil Nadu using energy dispersive X-ray fluorescence (EDXRF) technique.

Soil contamination by heavy metals is a serious concern due to their toxicity and ability to accumulate in the environment. The present work explains the assessment of heavy metal contamination in soils of Yelagiri hill, Tamilnadu using energy dispersive X-ray flurascence (EDXRF) technique. Among the determined concentration of heavy metals, the concentration of chromium (Cr-181.9 mg kg-1) for sample YS-6 is more than twice the average crustal value since possibility of anthropogenic activities. The determined metal concentrations were found in the order of Fe > K > Ca > Ti > Mn > V > Zn > Cr > Ni > Co. In order to assess the pollution status of soil, a potential contamination index (Cp), contamination factor (CF), Contamination degree (Cd), modified contamination degree (mCd), single pollution index (Pi) and nemerow pollution index (NPI) and potential ecological risk factor (Eri) were estimated to prevent the biological effects on the soil. The calculated values of potential contamination index (Cp), contamination factor (CF), Contamination degree (Cd), modified contamination degree (mCd) suggested that, soil samples are moderately contaminated by metals Ti, V, Cr, Mn, Co due to anthropogenic activities. The calculated values of potential ecological risk factor (Eri) for Cr, Ni, and Zn is less than 40. This indicates that soil samples are low in ecological risk. Similarly the calculated potential contamination index (RI) value is 26.70 for Cr; 59.96 for Ni; 18.73 for Zn which is less than 95 indicating the soil samples show low potential ecological risk index. The potential ecological risk assessment indicates that living organisms are at no risk of heavy metals.

Angular and Spectral Bandwidth of Extreme UV Multilayers Near Spacer Material Absorption Edges.

High resolution imaging systems for EUV range are based on multilayer optics. Current generation of EUV lithography uses broadband Sn LPP sources, which requires broadband mirrors to fully utilize the source power. On the other hand, there always remains a possibility to use FEL or synchrotron as EUV source. FEL can produce very bright narrowband EUV light of a tunable wavelength, and the spectral bandwidth of the mirror is no longer a restriction. In this paper we look at the consequences of switching to different wavelengths if FEL source is used. For instance, it is known that the reflectance of Mo/Si multilayers increases when approaching Si L-edge, and the spectral bandwidth drops. But the behavior of an angular bandwidth (and its relation with the spectral bandwidth) is usually left out. It is also sometimes assumed that these bandwidths are correlated. For a large aperture EUV optical system with diffraction-limited resolution angular acceptance of a mirror is also a very important parameter. We show that the angular bandwidth of several multilayer systems (Mo/Si, Mo/Be, Ru/Si, Ru/B, La/B) actually increases close to spacer absorption edges, opposite to what occurs with the spectral bandwidth. We study this effect and show that it is caused by an interplay of changing optical constants of respective materials used in these multilayer combinations. We also provide an experimental check of the angular bandwidth of Mo/Si multilayers at 13.5 and 12.6 nm, which confirms our calculations.

Assessment of gamma radiation and associated radiation hazards in coastal sediments of south east coast of Tamilnadu, India with statistical approach.

Gamma spectroscopy was performed to determine the concentrations of 226Ra, 232Th and 40K in sediment samples collected from Periyakalapet to Parangaipettai, East coast of Tamilnadu. The activity concentrations were determined by direct counting using a hyper pure germanium (HPGe) detector inter phased with a multi channel analyzer (MCA). The average activity concentrations of the corresponding nuclides were 30.81 Bq kg-1 for 226Ra, 85.67 Bq kg-1 for 232Th and 425.72 Bq kg-1 for 40K. The average activity concentration of 232Th and 40K are slightly higher and 226Ra is lower than world average values. The radiation hazard indices namely Radium Equivalent Activity (Raeq) Absorbed Gamma Dose Rate (DR), Annual Effective Dose Rate (HR), Representative Level Index (RLI), Annual Gonadal Dose Equivalent (AGDE), Internal Hazard Index (Hin) and External Hazard index (Hex) are calculated and compared with the previously reported data. The extracted values are comparable to the recommended values and they all fall within the safety limits. Hence harmful radiation effects are not posed to the public and tourists going to the beaches for recreation or to the fishermen involved in their activities in the area as a result of the natural radioactivity of sediments. Multivariate Statistical analyses were carried out between the parameters obtained from the radioactivity to know the existing relations and to study the spatial distribution of radionuclides.

Assessing heavy metal toxicity in sediments of Chennai Coast of Tamil Nadu using Energy Dispersive X-Ray Fluorescence Spectroscopy (EDXRF) with statistical approach.

The concentration of some heavy metals: Al, Ca, K, Fe, Ti, Mg, Mn, V, Cr, Zn, Ni and Co in sediments from Pulicat Lake to Vadanemmeli along Chennai Coast, Tamil Nadu has been determined using EDXRF technique. The mean concentrations of Mg, Al, K, Ca, Ti, Fe, V, Cr, Mn, Co, Ni, and Zn were found to be 1918, 25436, 9832, 9859, 2109, 8209, 41.58, 34.14, 160.80, 2.85. 18.79 and 29.12 mg kg-1 respectively. These mean concentrations do not exceed the world crustal average. The level of pollution attributed to heavy metals was evaluated using several pollution indicators in order to determine anthropogenically derived contaminations. Enrichment Factor (EF), Geoaccumulation Index (Igeo), Contamination Factor (CF) and Pollution Load Index (PLI) were used in evaluating the contamination status of sediments. Enrichment Factors (EF) reveal the anthropogenic sources of V, Cr, Ni and Zn Geoaccumulation Index (Igeo) results reveal that the study area is not contaminated by the heavy metals. Similar results were also obtained by using pollution load index (PLI). The results of pollution indices indicates that most of the locations were not polluted by heavy metals. Multivariate statistical analysis performed using principal components and clustering techniques were used to identify the source of the heavy metals. The result of statistical procedures indicate that heavy metals in sediments are mainly of natural origin. This study provides a relatively novel technique for identifying and mapping the distribution of metal pollutants and their sources in sediment.

Statistical assessment to magnetic susceptibility and heavy metal data for characterizing the coastal sediment of East coast of Tamilnadu, India.

A rapid urbanization and industrialization enhances the significant heavy metal pollution in the sediments of coastal area and introduced a serious threat to the human health. In the present study, concentration of heavy metals such as Al, Ti, Fe, V, Cr, Mn, Co, Zn, La, Pb, Mg, Ca, Ni, Cd and Ba are determined in sediments along Periyakalapet to Parangaipettai coastal area, Tamilnadu using energy dispersive X-ray fluorescence spectrometer (EDXRF).These metals have more affinity to establish metallic bond with ferrous material leading to enhancement of sediment magnetic susceptibility. Hence, a magnetic susceptibility (χLF, χHF, χFD) measurement was carried for sediments by using MS2B dual frequency susceptibility meter. Multivariate statistical analysis (Pearson correlation, factor and cluster analysis) was carried out between heavy metals and magnetic susceptibility to assess the anthropogenic impact in the sediments. The study revealed that a magnetic susceptibility measurement is an inexpensive, fast, non-destructive and suitable method to identify the heavy metal pollution sources.

Data on heavy metal and magnetic relationships in coastal sediments from South East Coast of Tamilnadu, India.

In this data, the heavy metal concentration and magnetic susceptibility in coastal sediment samples collected from Periyakalapet to Parangaipettai of East Coast of Tamilnadu using Energy Dispersive X-ray Fluorescence (EDXRF) technique and dual frequency susceptibility meter. We aimed to (i) determine the heavy metal concentration in the sediments from Periyakalapet to Parangaipettai of East Coast of Tamilnadu (ii) assess the magnetic mineral property of sediments (iii) study the correlation between heavy metal and magnetic susceptibility. The determined heavy metal concentration found in the order of Mn> Ba > V > Cr > Zn > La > Ni >Pb> Co > As > Cd > Cu > Al > Fe >Ca> Ti > K > Mg. The magnetic susceptibility (χlf) measurements show that they vary from 5.92×10-8 m3 kg-1to 29.06×10-8 m3 kg-1 with an average of 20.39×10-8 m3 kg-1. Analysed data confirmed that magnetic susceptibility has the potential tool to indicate the heavy metal pollution sources.

Rechallenge temozolomide in glioma: A case series from India.

INTRODUCTION: Temozolomide (TMZ) is an integral part of upfront treatment of high-grade gliomas. It is administered postsurgery as concurrent therapy with radiation and subsequently as adjuvant chemotherapy for 6-12 cycles. It is unknown whether rechallenge of salvage TMZ in previously treated high-grade glioma has any efficacy. MATERIAL AND METHODS: Patients treated with salvage rechallenged TMZ between January 2015 and August 2016 were included for this retrospective analysis. SPSS version 20 was used for this analysis. Time to event analysis was performed using the Kaplan-Meier method. Progression-free survival (PFS) and overall survival (OS) were estimated. The maximum grade of toxicity was noted in accordance with CTCAE version 4.02. RESULTS: A total of 23 patients were selected for analysis with the median age being 43 years (range: 26-69 years). The tumor histopathology at baseline was astrocytoma Grade 2 in 1 patient, oligodendroglioma Grade 2 in 3 patients, anaplastic astrocytoma in 7 patients, anaplastic oligodendroglioma in 2 patients, and glioblastoma in 10 patients. All of them had previously received TMZ. The median numbers of previous TMZ cycles received were 6 (4-18). The median time to failure postlast treatment was 24 months (5-72 months). The median number of cycles of rechallenged salvage TMZ administered was 6 cycles (range: 1-18). Grade 3-4 myelosuppression was seen in 3 patients (13.4%). The median PFS was 459 days (95% confidence interval: 212.1-705.9). The median OS was 25 months. Six-month OS and 1-year OS were 81.4% and 75.1%, respectively. CONCLUSION: Rechallenge with TMZ in recurrent glioma that had previously responded to TMZ is associated with improvement in PFS and OS and has a sufficiently long disease-free interval.

Altered neurite morphology and cholinergic function of induced pluripotent stem cell-derived neurons from a patient with Kleefstra syndrome and autism.

The aim of the present study was to establish an in vitro Kleefstra syndrome (KS) disease model using the human induced pluripotent stem cell (hiPSC) technology. Previously, an autism spectrum disorder (ASD) patient with Kleefstra syndrome (KS-ASD) carrying a deleterious premature termination codon mutation in the EHMT1 gene was identified. Patient specific hiPSCs generated from peripheral blood mononuclear cells of the KS-ASD patient were differentiated into post-mitotic cortical neurons. Lower levels of EHMT1 mRNA as well as protein expression were confirmed in these cells. Morphological analysis on neuronal cells differentiated from the KS-ASD patient-derived hiPSC clones showed significantly shorter neurites and reduced arborization compared to cells generated from healthy controls. Moreover, density of dendritic protrusions of neuronal cells derived from KS-ASD hiPSCs was lower than that of control cells. Synaptic connections and spontaneous neuronal activity measured by live cell calcium imaging could be detected after 5 weeks of differentiation, when KS-ASD cells exhibited higher sensitivity of calcium responses to acetylcholine stimulation indicating a lower nicotinic cholinergic tone at baseline condition in KS-ASD cells. In addition, gene expression profiling of differentiated neuronal cells from the KS-ASD patient revealed higher expression of proliferation-related genes and lower mRNA levels of genes involved in neuronal maturation and migration. Our data demonstrate anomalous neuronal morphology, functional activity and gene expression in KS-ASD patient-specific hiPSC-derived neuronal cultures, which offers an in vitro system that contributes to a better understanding of KS and potentially other neurodevelopmental disorders including ASD.

Assessment of Heavy Metal Contamination in Marine Sediments of East Coast of Tamil Nadu Affected by Different Pollution Sources.

The aim of this study was to determine the concentration of heavy metals in the sediments of Periyakalapet to Parangipettai coast, east coast of Tamil Nadu, by using energy-dispersive X-ray fluorescence (EDXRF) technique. The average heavy metal concentrations in the sediment samples were found in the order Al>Fe>Ca>Ti>K>Mg>Mn>Ba>V>Cr>Zn>La>Ni>Pb>Co>Cd>Cu. The average heavy metal concentrations were below the world crustal average. The degree of contamination by heavy metals was evaluated using pollution indices. The results of pollution indices revealed that titanium (Ti) and cadmium (Cd) were significantly enriched in sediments. Pearson correlation analysis was performed among heavy metal concentrations to know the existing relationship between them. Multivariate statistical technique was employed to identify the heavy metal pollution sources.

The effects of 100% wild blueberry (Vaccinium angustifolium) juice consumption on cardiometablic biomarkers: a randomized, placebo-controlled, crossover trial in adults with increased risk for type 2 diabetes.

BACKGROUND: Wild blueberries have a high content of polyphenols, but there is limited data evaluating their health benefits in adults at risk for type 2 diabetes. The objective of the study was to investigate whether consumption of 100% wild blueberry juice improves cardiometabolic biomarkers associated with type 2 diabetes risk. METHODS: A single-blind, randomized, placebo-controlled, crossover design trial was conducted in which adults (women, n = 19, ages 39-64 y) at risk for type 2 diabetes consumed 240 mL of wild blueberry juice or a placebo beverage as part of their free-living diet for 7 days. Blood was collected to determine various biomarkers such as fasting plasma glucose, fasting serum insulin, surrogate markers of insulin sensitivity, triglycerides, inflammation (interleukin-6, interleukin-10, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, serum amyloid A), adhesion molecules (soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1), oxidative stress (LDL-oxidation, total 8-isoprostanes), and nitric oxide. Endothelial function and blood pressure were also assessed. RESULTS: Wild blueberry juice consumption for 7 days produced no significant changes in glucose, insulin, insulin sensitivity, triglycerides, inflammatory markers, adhesion molecules, oxidative stress, endothelial function or blood pressure. However, wild blueberry juice consumption showed a trend for lowering systolic blood pressure: 120.8 ± 2.2 mmHg in the placebo group vs 116.0 ± 2.2 mmHg in the blueberry juice group (P = 0.088). Serum concentrations of nitrates and nitrites, an index of nitric oxide production, increased from 2.9 ± 0.4 µM after placebo drink to 4.1 ± 0.4 µM after drinking wild blueberry juice (P = 0.039). CONCLUSIONS: Short-term consumption of wild blueberry juice may promote cardioprotective effects, by improving systolic blood pressure, possibly through nitric oxide production, in adults at risk for type 2 diabetes. This outcome warrants longer-term human studies of blueberries, including defined amounts of either the whole fruit or juice, to clarify whether polyphenol-rich foods can be efficacious for improving cardiometabolic biomarkers in adults at risk for type 2 diabetes. TRIAL REGISTRATION: NCT02139878, clinicaltrials.gov; date of registration: May 4, 2014.

Dataset on elemental concentration and group identification of ancient potteries from Tamil Nadu, India.

The dataset contains concentration of major and trace elements of ancient potteries from Tamilnadu and grouping different potteries from the statistical techniques of factor and cluster analysis (Figs. 2, 3 and 4). The major and trace elemental concentration data generated using energy dispersive X-ray fluorescence technique (EDXRF) and factor and cluster analysis data obtained using STATISTICA (10.0 version) software. The concentration of major and trace elements determines the type of clay minerals (Calcareous/Non-Calcareous and either low or high refractory) and firing atmosphere adopted by the artisans at the time of manufacture. The statistical tool examined graphically the grouping pattern of the samples in terms of chemical composition and extract information about their provenance. The compilation of this data provides a resource for the wider research community in archeology.

Assessment of Natural Radioactivity and Radiological Hazards in Brick Samples Used in Tiruvannamalali District, Tamilnadu, India, With a Statistical Approach.

The activity concentration of Ra, Th and K in brick samples used in Tiruvannamalai District of Tamilnadu has been determined using gamma ray spectrometry. The activity concentration ranges from BDL to 16.02 Bq kg, 17.86 to 120.19 Bq kg, 240.09 to 481.35 Bq kg for Ra, Th, and K, respectively. The concentration of these radionuclides is compared with reported data from other countries. The radium equivalent activity (Raeq), absorbed gamma dose rate (DR), annual effective dose rate (HR), annual gonadal dose equivalent (AGDE), criteria formula (CF), representative level index (RLI), activity utilization index (AUI), gamma index (Iγ), alpha index (Iα), the external hazard (Hex), and internal hazard (Hin) indices are calculated for the measured samples to assess the radiation hazards due to the use of these materials in the construction of dwellings. Multivariate statistical techniques (Pearson correlation, principal component analysis and cluster analysis) are used to study the relation between radionuclides and radiation hazards. The treatment of 14 radioactive variables sampled at 32 bricks by the factor and cluster analyses provided a possible interpretation of the collective data. The spatial distribution pattern of radionuclides has been depicted through the Kriging method using MapInfo software.

When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries.

About 99% of neonatal deaths occur in low- and middle-income countries. There is a paucity of information on the exact timing of neonatal deaths in these settings. The objective of this review was to determine the timing of overall and cause-specific neonatal deaths in developing country settings. We searched MEDLINE via PubMed, Cochrane CENTRAL, WHOLIS and CABI using sensitive search strategies. Searches were limited to studies involving humans published in the last 10 years. A total of 22 studies were included in the review. Pooled results indicate that about 62% of the total neonatal deaths occurred during the first 3 days of life; the first day alone accounted for two-thirds. Almost all asphyxia-related and the majority of prematurity- and malformation-related deaths occurred in the first week of life (98%, 83% and 78%, respectively). Only one-half of sepsis-related deaths occurred in the first week while one-quarter occurred in each of the second and third to fourth weeks of life. The distribution of both overall and cause-specific mortality did not differ greatly between Asia and Africa. The first 3 days after birth account for about 30% of under-five child deaths. The first week of life accounts for most of asphyxia-, prematurity- and malformation-related mortality and one-half of sepsis-related deaths.

Umbilical cord cleansing with chlorhexidine in neonates: a systematic review.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of chlorhexidine application to the umbilical cord in neonates. We searched MEDLINE and other electronic databases, and included all RCTs that evaluated the effect of single or multiple chlorhexidine cord applications on the neonatal mortality rate (NMR) and/or the incidence of systemic sepsis and omphalitis. A total of six RCTs-four community-based cluster RCTs and two hospital-based trials-were included in the review. Of the four cluster RCTs, three were conducted in South Asia in settings with high rates of home births (>92%) while the fourth, available only as an abstract, was conducted in Africa. Pooled analysis by the 'intention-to-treat' principle showed a significant reduction in NMR after chlorhexidine application (four studies; relative risk (RR) 0.85; 95% confidence interval (CI) 0.76 to 0.95; fixed effects (FE) model). On subgroup analysis, only multiple applications showed a significant effect (four studies; RR 0.88; 95% CI 0.78 to 0.99) whereas a single application did not (one study; RR 0.86; 0.73 to 1.02). Similarly, only the community-based trials showed a significant reduction in NMR (three studies; RR 0.86; 95% CI 0.77 to 0.95), while the hospital-based study did not find any effect (RR 0.11; 0.01 to 2.03). Since all the studies were conducted in high-NMR settings (⩾30 per 1000 live births), we could not determine the effect in settings with low NMRs. Only one study-a hospital-based trial from India-reported the incidence of neonatal sepsis; it did not find a significant reduction in any sepsis (RR 0.67; 95% CI 0.35 to 1.28). Pooled analysis of community-based studies revealed significant reduction in the risk of omphalitis in infants who received the intervention (four studies; RR 0.71; 95% CI 0.62 to 0.81). The hospital-based trial had no instances of omphalitis in either of the two groups. Chlorhexidine application delayed the time to cord separation (four studies; mean difference 2.11 days; 95% CI 2.07 to 2.15; FE model). Chlorhexidine application to the cord reduces the risk of neonatal mortality and omphalitis in infants born at home in high-NMR settings. Routine chlorhexidine application, preferably daily for 7 to 10 days after birth, should therefore be recommended in these infants. Given the paucity of evidence, there is presently no justification for recommending this intervention in infants born in health facilities and/or low-NMR settings.