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Fresh fruits are highly needed for the health benefits of human beings because of the presence of high content of natural nutrition in the form of vitamins, minerals, antioxidants, and other phenolic compounds. However, some nutritional fruits such as guava are climacteric in nature with very less post-harvest shelf-life because of the ripening in a very short period and possibility of microbial infections. Thus security of natural nutrients is a serious concern in order to properly utilize guava without generating a huge amount of waste. Among reported various methods for the enhancement of fruits shelf-life, the application of edible coatings with antimicrobial activities on the outer surface of fruits have attracted significant attention because of their eco-friendly nature, easy applicability, high efficacy, and good durability. In recent years, researchers are paying more and more attention in the development of antimicrobial edible coatings to enhance the post-harvest shelf-life of guava using polysaccharides, protein and lipids. In this review, basic approaches and recent advancements in development of antimicrobial and edible coatings on guava fruit by the application of polysaccharides and protein and lipids along with the combination of nanomaterials are summarized. In addition, improvements in basic properties of edible coatings to significantly control the permeation of gases (O2/CO2) by the optimization of coating components as well as delay in ripening process are reviewed and discussed.
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Anti-Infecciosos , Filmes Comestíveis , Psidium , Humanos , Frutas , Conservação de Alimentos/métodos , Polissacarídeos/farmacologia , Anti-Infecciosos/farmacologia , Proteínas/farmacologia , Lipídeos/farmacologiaRESUMO
In recent years, extensive research endeavors are being undertaken for synthesis of an efficient, economic and eco-friendly cerium oxide nanoparticles (CeO2 NPs) using plant extract mediated greener approach. A number of medicinal plants and their specific parts (flowers, bark, seeds, fruits, seeds and leaves) have been found to be capable of synthesizing CeO2 NPs. The specific key phytochemical constituents of plants such as alkaloids, terpenoids, phenolic acids, flavones and tannins can play significant role as a reducing, stabilizing and capping agents in the synthesis of CeO2 NPs from their respective precursor solution of metal ions. The CeO2 NPs are frequently using in diverse fields of science and technology including photocatalytic degradation of dyes, antibiotics as well as antimicrobial applications. In this review, the mechanism behind the green synthesis CeO2 NPs using plant entities are summarized along with discussion of analytical results from characterization techniques. An overview of CeO2 NPs for water remediation application via photocatalytic degradation of dyes and antibiotics are discussed. In addition, the mechanisms of antimicrobial efficacy of CeO2 NPs and current challenges for their sustainable application at large scale in real environmental conditions are discussed.
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Anti-Infecciosos , Cério , Nanopartículas Metálicas , Nanopartículas , Antibacterianos/química , Corantes , Nanopartículas/química , Cério/química , Plantas , Nanopartículas Metálicas/químicaRESUMO
Background: UP has the 2nd highest MMR which is 197 compared with national average of 113 (RGI-SRS-2016-2018).Although institutional deliveries in India has been increased from 78.9% (NFHS-4) to 89% (NFHS-5) [ UP from 67.8% to 83.4%] but still we are far away from SDG -3 target. It reflects that there may be increase in crude coverage but not in effective coverage. Materials and Methods: It is a cross sectional study conducted in May - June 2017. Out of 8 blocks of rural Varanasi, 4 blocks were selected randomly. Best functioning facility for EmOC services in each selected block were assessed using Facility Gap Assessment Schedule of IPHS. Result: None of the facility met the recommended standard for BEmOC .Tracking of drop out of ANC and PNC services, use of Partograph, treatment of abortion-related complications, were not found at all the 4 facility. Blood grouping and RH typing was also not functional at 2 of the 4 centers. Caesarean section and availability of blood bank were also lacking in CHC (FRU). Conclusion: If condition of best functioning facility in a block is not according to the recommendation then how can we expect to provide a good maternal health service to public.
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BACKGROUND: Splenic injuries are common solid organ injuries resulting from blunt abdominal trauma in road traffic accidents. Very often, splenic injuries can be life-threatening. Earlier, splenic injuries were often dealt with surgical intervention, such as splenectomy. With the recognition of the immunological function of the spleen and possible complications of splenectomy surgery, such as overwhelming post-splenectomy infections (OPSI), there has been a recent trend for non-operative management (NOM). OBJECTIVE: To study the variables predicting failure of NOM in blunt abdominal trauma patients with splenic injury. METHODS: This is a retrospective study that includes 235 patients who presented to the Safdarjung Hospital emergency room (New Delhi, India) with blunt trauma abdomen and splenic injuries with or without associated injuries between January 2019 and December 2021. The data was entered in a Microsoft Excel spreadsheet (Microsoft Corp., Redmond, WA, USA). Categorical variables were expressed as frequencies and percentages. Pearson's chi-square test of association was used to determine if there is a relationship between two variables. A p-value of <0.05 was considered statistically significant. RESULTS: Out of 235 patients with blunt abdominal trauma and splenic injuries, 82 were hemodynamically unstable despite resuscitation and were taken up for emergency laparotomy. The remaining 153 patients, who were either hemodynamically stable or stabilized after adequate resuscitation, were managed on the lines of NOM. The number of patients with splenic injury in AAST grades 1, 2, 3, 4, and 5 was 36, 50, 40, 24, and three, respectively. Out of 153 patients, 130 (85%) were successfully managed by NOM, while eight (5%) had to discontinue NOM as they required surgical intervention. The failure of NOM (fNOM) is seen mostly with grade 5 injuries (2/2, 100%, p<0.01), followed by grade 4 (4/20, 20%) and grade 3 (2/37, 5.7%). The mean age in fNOM was 58.3 years, as compared to 42.2 years in the success of NOM (sNOM). All eight patients had multiple concomitant injuries, with femur fracture being the most common association in up to six patients (p<0.01), followed by liver injury in four patients. There were 15 mortalities, irrespective of AAST severity grade. All of these patients had associated concomitant injuries, with intracranial bleeding (n = 10, 32%, p<0.01) being the most common association, followed by femur fracture (n = 6, 20%) and liver injury (n = 5, 16%). Also, the cause of death was unrelated to splenic trauma (p = 0.67), with pulmonary embolism (n = 6, 40%, p<0.01) being the most common cause, followed by brain stem herniation (n = 5, 34%). CONCLUSION: Non-operative management is a safe and efficient method for treating patients with splenic injuries who are hemodynamically stable or stabilized. The factors associated with fNOM include elderly age, a higher American Association for the Surgery of Trauma (AAST) grade of splenic injury, and associated concomitant injuries. Femur fracture was the most common concomitant injury present in cases where NOM failed, followed by liver injury. The presence of intracranial bleeds in these patients was a common association with mortality, irrespective of the grade of splenic injury.
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Over the past several years, the Muzaffarpur district of Bihar (India) has witnessed recurrent outbreaks of acute encephalitis illness of unknown etiology, called acute encephalitis syndrome (AES) among young children, especially during the peak-summer season. Pesticide exposure, viral encephalitis, and litchi toxin intake have all been postulated as potential sources of the ailment. However, no conclusive etiology for AES has been identified in the affected children. During recent rounds of the outbreak, metabolic abnormalities have been documented in these children, and a direct correlation was observed between higher environmental temperature during the peak-summer month and AES caseload. The clinical and metabolic profiles of these children suggested the possible involvement of mitochondrial dysfunction during heat stress as one of the several contributory factors leading to multisystem metabolic derangement. The present study observed that mitochondrial function parameters such as cell death, mitochondrial membrane potential, oxidative stress, and mitochondrial pathway-related gene expression in peripheral blood mononuclear cells (PBMCs) isolated from children were affected in peak-summer when compared to post-summer months. Similar observations of mitochondrial function parameters along with impaired bioenergetic parameters were demonstrated in the heat-exposed model of PBMCs isolated from healthy adult individuals. In conclusion, the results suggested that there is an association of transient mitochondrial dysfunction when exposed to sustained heat during the summer months. One may consider mitochondrial dysfunction as one of the important factors leading to an outbreak of AES among the children from affected regions though this needs to be substantiated with further studies.
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Encefalopatia Aguda Febril , Leucócitos Mononucleares , Adulto , Humanos , Criança , Pré-Escolar , Índia/epidemiologia , Surtos de Doenças , Metabolismo Energético , Encefalopatia Aguda Febril/epidemiologia , Encefalopatia Aguda Febril/etiologia , MitocôndriasRESUMO
Natural bio-material surface with hydrophobic behavior (aqueous droplet to roll off from its surface) has inspired researchers to design sustainable artificial coatings with hydrophobic or superhydrophobic behavior. The developed hydrophobic or superhydrophobic artificial coatings are highly useful in various applications such as water remediation, oil/water separation, self-cleaning, anti-fouling, anti-corrosion and also in medical fields including anti-viral, anti-bacterial efficacy. In recent years, among various coating materials, bio-based materials derived from plants and animals (cellulose, lignin, sugarcane bagasse, peanut shell, rice husk, egg cell etc.) are applied on various surfaces in order to develop fluorine free hydrophobic coatings with longer durability by lowering the surface energy and increasing the surface roughness. This review summarized recent developments in hydrophobic/superhydrophobic coating fabrication methods, properties and applications with the use of different bio-based materials and their combinations. In addition, basic mechanisms behind the coating fabrication process and their durability under different environmental conditions are also discussed. Moreover, prospects and limitations of bio-based coatings in practical applications have been highlighted.
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Quitosana , Saccharum , Animais , Lignina , Propriedades de Superfície , CeluloseRESUMO
Rare diseases (RD) are severe and debilitating conditions. They are one of the leading causes of childhood mortality globally. In India, RDs have not been considered in most healthcare programs which usually cater to more common diseases. We believe, that for efficient utilization of resources in a resource-constrained healthcare system, existing programs must integrate RD management strategies. In this study, we explore the utility, expandability, and limitation of one of the important national child healthcare programs, Rashtriya Bal Swasthya Karyakram (RBSK) which translates to National Child Healthcare Program. We found that RBSK has immense potential to cater to RDs through some of its unique features, such as comprehensive screening, wide target age group, and efficient utilization of resources. We provide recommendations that can help to strengthen the present program. This study will inspire other low-resource countries to identify and expand existing public healthcare programs for RD management. Moreover, RBSK can serve as a model program to integrate RD management globally.
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Política de Saúde , Doenças Raras , Humanos , Criança , Índia , Gerenciamento ClínicoRESUMO
BACKGROUND: Periodic outbreaks of acute encephalopathy in children have been reported from Muzaffarpur, Bihar, India. No infectious cause has been identified for this. This study presents the clinical and metabolic profile of children hospitalized with acute encephalopathy and the potential role of ambient heat stress. METHODS: This cross-sectional study included children (<15 years) with acute encephalopathy admitted from April 4, 2019, to July 4, 2019. The clinical and laboratory investigations included infections, metabolic abnormalities, and muscle tissue analysis. The children who had metabolic derangements but no infectious cause were labeled as acute metabolic encephalopathy. The descriptive analysis summarized the clinical, laboratory, and histopathology findings, and their association with the ambient heat parameters was explored. RESULTS: Out of the 450 children hospitalized (median age, four years), 94 (20.9%) died. Children had early morning onset (89%), seizures (99%), fever (82%), hypoglycemia at admission (64%), raised aminotransferases (60%), and high blood urea (66%). Blood lactate (50%), lactate dehydrogenase (84%), pyruvate (100%), ammonia (32%), and creatinine phosphokinase (69%) were raised. Viral marker tests were negative. The patients had abnormal metabolic markers like decreased blood-free carnitine, elevated blood acylcarnitines, and elevated urinary lactate, oxalate, maleate, adipate, and fatty acid metabolites. Blood carnitine and acylcarnitine levels normalized in 75% of the patients treated with carnitine and coenzyme-Q. Muscle tissues showed megamitochondria on electron microscopy and reduced respiratory enzyme complex-I activity. A significant correlation between the number of admissions and ambient heat indices was observed. CONCLUSIONS: The findings suggest secondary mitochondrial dysfunction as a possible mechanism for acute encephalopathy in children from Muzaffarpur, Bihar, and ambient heat stress as a possible risk factor.
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Right ventricular wall dissection is extremely rare and can result in dismal clinical outcomes. We report a 68-year-old patient who presented with acute myocardial infarction and was found to have right ventricular wall dissection by ventriculography. At surgery, the infarcted myocardium was excised, and a two-patch technique was used to repair the ventricular septal defect.
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Comunicação Interventricular , Infarto do Miocárdio , Ruptura do Septo Ventricular , Humanos , Idoso , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Comunicação Interventricular/cirurgia , EcocardiografiaRESUMO
Background and Introduction: In the modern era of spine surgery for subaxial cervical spine, transfacetal screw fixation has evolved enormously. Transfacetal screw fixation for subaxial cervical spine is a biomechanically effective technique. In this fixation, four cortical surfaces of the facets are purchased by the transfacetal screws. Objectives: In this video, we demonstrated the surgical technique of posterior transfacetal screw fixation. Surgical Technique: Transfacetal screw fixation of subaxial cervical spine was done along with posterior decompression. The entry point of transfacetal screw was defined as 1 mm caudal to mid-point of lateral mass, and screws were directed perpendicular to facet joint in the sagittal plane and straight in the coronal plane. Bone chips were placed over decorticated lateral mass after decompression. Result: Patient had uneventful recovery and maintained good status at follow up. Conclusion: In subaxial cervical spine, transfacetal screw fixation is a biomechanically effective, rigid, and an inexpensive technique to obtain immediate rigid fixation.
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Fusão Vertebral , Articulação Zigapofisária , Parafusos Ósseos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Fusão Vertebral/métodosRESUMO
OBJECTIVES: Despite periodic outbreaks, the causes and risk factors of acute encephalitis syndrome (AES) in children of Muzaffarpur, Bihar, India, remain unknown. We explored the correlation between AES caseload and the climate parameters. METHODS: Data for 1318 hospitalized children with AES during 2012-20 were used. The correlation between AES cases and daily climate parameters (temperature, sunshine, rainfall, humidity and wind speed) for the previous 24, 48 and 72 h were examined using Pearson's and Spearman's rank-order correlation and Poisson regression or negative binomial regression analyses. RESULTS: Most (91.8%) of the AES cases occurred during the summer season (May-July months), especially June month. Pearson's and Spearman's rank-order correlation analyses revealed that AES caseload had positive correlations with maximum (r = 0.275, ρ = 0.293) and minimum (r = 0.306, ρ = 0.306) temperatures during past 24 h and heat index (r = 0.325, ρ = 0.325) and negative correlation with humidity (r = -0.222, ρ = -0.222) and rainfall (r = -0.183, ρ = -0.183) (all p < 0.05). The correlation was consistent for the climate parameters for the past 24, 48 and 72 h. Regression analysis also documented a significant association of AES cases with daily maximum (ß: 0.32-0.36) and minimum (ß: 0.53-0.62) temperatures and heat index (ß: 0.92-1.03) over past 24, 48 and 72 h (all p < 0.01). The number of AES cases exponentially increased when the daily maximum and minimum temperatures crossed 40°C and 31°C, respectively. CONCLUSIONS: The climate parameters, especially temperature appears to be a risk factor for AES in children. The definite aetiological role of heat for AES in children needs further exploration.
Repeated seasonal outbreaks of acute encephalitis syndrome (AES) in children have been observed in Muzaffarpur, Bihar (India), since 1995. These children mostly present during the summer months (MayJune) of the year with sudden early morning onset of seizures, altered sensorium, hypoglycaemia, with or without fever. A high fatality (2763%) or sequels among those who survive have been observed. Large outbreaks were observed in 2005, 2009, 2011, 2012, 2014 and 2019. The despite periodic outbreaks, the causes and risk factors of AES in these children remain mostly unknown. We explored the correlation between the AES caseload (data for 1318 hospitalized children with AES during 20122020) and the daily climate parameters (temperature, heat index, sunshine, rainfall, humidity and wind speed) for the previous 24, 48 and 72 h using various statistical tests. Most (91.8%) of the AES cases occurred during the summer season (MayJuly months), especially June month. The AES caseload had significant positive correlation with maximum and minimum temperatures and heat index and negative correlation with humidity and rainfall. The number of AES cases exponentially increased when the daily maximum and minimum temperatures crossed 40°C and 31°C, respectively.
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Encefalopatias , Surtos de Doenças , Criança , Humanos , Umidade , Índia/epidemiologia , Fatores de Risco , Estações do Ano , TemperaturaRESUMO
We have developed a monoclonal antibody (mAb) cocktail (ZRC-3308) comprising of ZRC3308-A7 and ZRC3308-B10 in the ratio 1:1 for COVID-19 treatment. The mAbs were designed to have reduced immune effector functions and increased circulation half-life. mAbs showed good binding affinities to non-competing epitopes on RBD of SARS-CoV-2 spike protein and were found neutralizing SARS-CoV-2 variants B.1, B.1.1.7, B.1.351, B.1.617.2, and B.1.617.2 AY.1 in vitro. The mAb cocktail demonstrated effective prophylactic and therapeutic activity against SARS-CoV-2 infection in Syrian hamsters. The antibody cocktail appears to be a promising candidate for prophylactic use and for therapy in early COVID-19 cases that have not progressed to severe disease.
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Anticorpos Monoclonais Humanizados/imunologia , COVID-19/terapia , SARS-CoV-2/imunologia , Animais , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Neutralizantes/imunologia , Anticorpos Neutralizantes/uso terapêutico , Afinidade de Anticorpos , Sítios de Ligação , COVID-19/prevenção & controle , Cricetinae , Modelos Animais de Doenças , Epitopos , Humanos , Imunização Passiva , Mesocricetus , Mutação , SARS-CoV-2/genética , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/imunologia , Soroterapia para COVID-19RESUMO
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), initially originated in China in year 2019 and spread rapidly across the globe within 5 months, causing over 96 million cases of infection and over 2 million deaths. Huge efforts were undertaken to bring the COVID-19 vaccines in clinical development, so that it can be made available at the earliest, if found to be efficacious in the trials. We developed a candidate vaccine ZyCoV-D comprising of a DNA plasmid vector carrying the gene encoding the spike protein (S) of the SARS-CoV-2 virus. The S protein of the virus includes the receptor binding domain (RBD), responsible for binding to the human angiotensin converting enzyme (ACE-2) receptor. The DNA plasmid construct was transformed into E. coli cells for large scale production. The immunogenicity potential of the plasmid DNA has been evaluated in mice, guinea pig, and rabbit models by intradermal route at 25, 100 and 500 µg dose. Based on the animal studies proof-of-concept has been established and preclinical toxicology (PCT) studies were conducted in rat and rabbit model. Preliminary animal study demonstrates that the candidate DNA vaccine induces antibody response including neutralizing antibodies against SARS-CoV-2 and also elicited Th-1 response as evidenced by elevated IFN-γ levels.
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COVID-19 , Vacinas de DNA , Animais , Anticorpos Neutralizantes , Anticorpos Antivirais , Formação de Anticorpos , Vacinas contra COVID-19 , China , Escherichia coli , Cobaias , Humanos , Camundongos , Modelos Animais , Coelhos , Ratos , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus/genéticaRESUMO
Introduction Reconstruction forms the primary tenet in plastic surgery. Venous flaps are a known option but the survival is limited. Arterialization of venous flap can enhance its survival. While various techniques of arterialization of venous flaps are described, there are very few studies comparing them. Material and methods The current study was conducted among 34 rats weighing 160 to 200 grams. The rats were divided into four groups. Group I-islanded epigastric flap was raised with superficial caudal epigastric vessels as pedicle. Group II-arterialized flow through venous flap was raised with superficial caudal epigastric vein (SCEV) as afferent and lateral thoracic vein as drainage vein. Side-to-side anastomosis was done between femoral artery and vein, lateral to the origin of superficial caudal epigastric artery. Group III-after raising the flap, as in group II, femoral vein was ligated proximal to superficial caudal epigastric vessels. Group IV-an arterialized flow through venous flap was raised with superficial caudal epigastric vein as afferent and lateral thoracic vein as drainage vein. End-to-side anastomosis was done between femoral artery and superficial caudal epigastric vein. Animals that died before completion of the study were excluded. The color changes of flaps were noted. Flap survival was expressed as a percentage of the total flap surface area. The patency of anastomosis was seen on postoperative day 5. Results There was no total flap failure. On statical analysis, the flap survival area on day 5 between Group I and Group IV was not significant ( p value 0.431). The survival area in Group I (78.85 ± 10.54%) was comparable to Group IV (65.71 ± 20.70%). Group II and III had poor results as compared with Group I. In four rats, thrombosis of arteriovenous anastomosis was noted with flap survival area of 30 to 33%. Conclusion It was noted that epigastric venous flaps with end-to-side anastomosis between femoral artery and superficial caudal epigastric vein (group IV) have survival area comparable to islanded flaps.
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The next generation sequencing (NGS) approach has facilitated the investigations of gut microbiota with high throughput and resolution. The present study was focused on the taxonomic and functional characterization of bacterial community associated with different developmental stages of melon fly, Zeugodacus cucurbitae using 16S ribosomal RNA (rRNA) gene amplicons metagenomics. Z. cucurbitae is considered an invasive and most staid polyphagous pest of cucurbitaceous and other related crops. The taxonomic analysis of highly variable V3-V4 region of bacterial 16S rRNA gene sequencing indicated that the bacterial community associated with Z. cucurbitae consists of a total of 23 bacterial phyla (including unclassified and unassigned bacteria), comprising 32 classes, 69 orders, 99 families and 130 genera. Proteobacteria, Firmicutes, Actinobacteria and Tenericutes were dominant phyla of which family, Enterobacteriaceae was the most abundant in the larval and adult female stages, whereas Mycoplasmataceae was the dominant in the pupal stage. In larval stages of Z. cucurbitae, genus Providencia and Comamonas were the most abundant. However, genus Candidatus-Bacilloplasma and Klebsiella were the most dominant in pupae and adult females of Z. cucurbitae, respectively. PICRUSt analysis conducted for prediction of metabolic activities revealed that associated microbiota were involved in membrane transport, carbohydrate metabolism, amino acid metabolism, energy metabolism, replication and repair processes as well as cellular processes and signalling. The higher number of OTUs was annotated for phosphoglycerate mutase and transketolase in adult females followed by larval stages, which may support the digestive function of the microbiota in larvae and adult females. Our findings provide insights about the high variation in microbiota across developmental stages and basis for microbiota-based management strategies of fruit flies.
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Cucurbitaceae , Tephritidae , Animais , Bactérias/genética , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , RNA Ribossômico 16S/genéticaRESUMO
This paper presents three self-powered photodetectors namely, p+-bilayer graphene (BLG)/n+-ZnO nanowires (NWs), p+-BLG/n+-Si NWs/p--Si and p+-BLG/n+-ZnO NWs/p--Si. The Silvaco Atlas TCAD software is utilized to characterize the optoelectronic properties of all the devices and is validated by analytical modeling. The proposed dual-junction photodetectors cover broadband spectral response varying from ultraviolet to near-infrared wavelengths. The dual-heterojunction broadband photodetector exhibits photocurrent switching with the rise and fall time of 1.48 and 1.27 ns, respectively. At -0.5 V bias, the highest external quantum efficiency, photocurrent responsivity, specific detectivity, and the lowest noise equivalent power of 71%, 0.28 A W-1, 4.2 × 1012 cmHz1/2 W-1, and 2.59 × 10-17 W, respectively, are found for the dual-heterojunction device with a wavelength of 480 nm at 300 K. The proposed nanowires based photodetectors offer great potential to be utilized as next-generation optoelectronic devices.
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AIMS: This project tests a novel, targeted home visitation programme for child development targeted behaviour change during the first 1,000 days for families in Delhi urban slums. BACKGROUND: The first 1,000 days have highest brain development potential and is dependent on the available nutrition, health, social and cognitive stimulus. Over 1.3 million children are born annually in the slums of India and are at risk of limited development potential. The children in urban slums at multiplicity of adversities at family, society and environmental levels. No tools are available for the community health functionaries to support the families to promote child development. DESIGN: This cohort study targets provision of behaviour change interventions targeted at three groups (pregnant women, infants and children in year 2) to document the impact on child development. METHODS: This implementation project delivers nutrition, health and child stimulation integrated services for the families through existing government community health workers and nurses. These workers shall train the families using audio-visual messages in tablets and demonstration kits for practice through quarterly home visits. Data on health, nutrition and child development shall be collected at baseline, midterm and after one year. The data from these participants shall be compared with data from recently delivered women, children aged 13 months and 25 months without intervention to document the impact. DISCUSSION: The successful implementation of the project has potential for future integration of the child development components into the existing programme at scale. The learning from this project shall be useful for India and other developing countries. IMPACT: The first 1,000 days are critical period in human brain development and cognitive function acquisition potential, which is dependent on the available nutrition, health, social and cognitive stimulus. The development potential in children born and living in the slums, who are exposed to various adversities, can be mitigated through appropriate family-level practices with support from the community health workers and Nurses. This study is documenting the feasibility and impact of home visit linked coaching of families for improving child development status during the first 1,000 days in three sums of Delhi, India.
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Desenvolvimento Infantil , Áreas de Pobreza , Criança , Estudos de Coortes , Agentes Comunitários de Saúde , Feminino , Humanos , Índia , Lactente , GravidezRESUMO
Background: Trapezius transfer has shown promise to restore shoulder movements and has stood through the passage of time. We here in describe a modification of trapezius transfer technique and review the current literature available. Methods: The modified trapezius transfer in which the trapezius muscle is extended with folded tensor fascia lata graft and attached as distally possible to the deltoid insertion was done in twelve patients at tertiary health care centre in India. Post-operative splinting and staged physiotherapy were given. Results: Results were described in the form of improvement in degree of shoulder abduction and Disabilities of the Arm, Shoulder and Hand (DASH) score. Six months post-surgery there were improvement in shoulder abduction and DASH score with mean 116 degrees (10-180 degree) and 38 (23-58) respectively. One patient showed poor results due to poor compliance in post-operative period. There were no major complications observed. Conclusions: The modified technique of trapezius transfer described here is a feasible option with good biomechanical outcomes. The technique is simple and can be adopted easily by emerging brachial plexus surgeon as a technique for secondary reconstruction of shoulder joint.