Genomic blueprint of population of Rajasthan based on autosomal STR markers.

Aim: Genetic diversity and forensic efficacy of 20 autosomal STR genetic markers were investigated in a highly diverse population of Rajasthan, a state in north-western India.Subjects and methods: In this study, 317 blood samples from unrelated healthy individuals were directly amplified using the PowerPlex® 21 multiplex system (Promega). Amplified products were separated by capillary electrophoresis using a Genetic Analyser -3500 XL (Thermo Fisher Scientific). The data thus obtained was statistically analysed using population genetic software.Results: The studied population showed genetic affinity with the geographically close populations. The locus Penta-E was found to be the most polymorphic with a value of 0.90 in the studied population. The combined discrimination power (CPD) and combined power of exclusion (CPE) were observed as >0.999999999 and 0.999999997, respectively, for all the studied 20 autosomal STR loci. The combined probability of match (CPm) was 1.39 × 10-25 and combined paternity index (CPI) was 3.66 × 108 for all the studied loci.Conclusion: The results conclusively support the hypothesis that the studied autosomal STR loci are polymorphic in nature and, besides being useful in forensic applications they can also be applied in anthropological and other population genetic studies. This study supports the 'isolation-by-distance' model. Genetic data obtained from this study will enrich the population data bank.

HIV Presenting as Cerebellar Ataxia.

Presenting features of HIV has always been a Pandora's box largely due to multisystem affection by the virus and a large array of opportunistic infections. We hereby report an extremely rare case of 40 yr old patient presenting as symmetric, progressive cerebellar ataxia later found to be HIV positive. Thorough knowledge of rare presentations of HIV and a high index of suspicion are necessary for early diagnosis and efficient treatment of HIV.

Transgene-mediated suppression of dengue viruses in the salivary glands of the yellow fever mosquito, Aedes aegypti.

Controlled sex-, stage- and tissue-specific expression of antipathogen effector molecules is important for genetic engineering strategies to control mosquito-borne diseases. Adult female salivary glands are involved in pathogen transmission to human hosts and are target sites for expression of antipathogen effector molecules. The Aedes aegypti 30K a and 30K b genes are expressed exclusively in adult female salivary glands and are transcribed divergently from start sites separated by 263 nucleotides. The intergenic, 5'- and 3'-end untranslated regions of both genes are sufficient to express simultaneously two different transgene products in the distal-lateral lobes of the female salivary glands. An antidengue effector gene, membranes no protein (Mnp), driven by the 30K b promoter, expresses an inverted-repeat RNA with sequences derived from the premembrane protein-encoding region of the dengue virus serotype 2 genome and reduces significantly the prevalence and mean intensities of viral infection in mosquito salivary glands and saliva.

Role of angiotensin receptor blockers in the prevention and management of ischaemic stroke.

Angiotensin receptor blockers (ARB's) are an important class of antihypertensive agents and appear to have a role in the prevention and management of ischaemic stroke. We present a discussion of the data on ARB's in this important condition.

Stronger relationship of serum apolipoprotein A-1 and B with diabetic retinopathy than traditional lipids.

AIM: Diabetic retinopathy (DR) is the most common preventable cause of blindness where early detection and treatment can be sight-saving. Search for biomarkers of the disease has been relentless. We aimed to determine whether lipoproteins apolipoproteins A1 and B1 (Apo-A1 and Apo-B1) have stronger associations with DR in contrast to conventionally measured low-density lipoprotein (LDL) and high-density lipoprotein cholesterol levels. MATERIALS AND METHODS: We performed a cross-sectional study and studied 117 patients. Serum lipid profile was assessed by autoanalyzer. Serum Apo-A1 and Apo-B were measured using immunoturbidimetric kit on an autoanalyzer. Apo-B/A1 ratio was calculated. Retinopathy was graded from the digital retinal photographs, taken with nonmydriatic auto fundus camera and classified according to International Clinical DR Disease Severity Scale. RESULTS: Mean Apo-A1 for mild, moderate, severe retinopathy, and proliferative DR (PDR) shows a significant negative correlation (P = 0.001) with severity of retinopathy. Mean Apo-B for mild, moderate, severe, PDR displayed a significant positive correlation with severity of retinopathy (P = 0.001). Mean Apo-B/A1 for mild, moderate, severe, PDR showed highly significant positive correlation with severity of retinopathy (P < 0.001). In contrast, mean LDL for mild, moderate, severe, PDR showed insignificant association with severity of DR (P = 0.081). CONCLUSION: Apo-A1 and Apo-B have a stronger association with the development of DR than traditional lipids and can thus facilitate early detection and treatment of the disease.

Free volume study on calcification process in an intraocular lens after cataract surgery.

An opacified intraocular lens explanted from a patient in the postoperative period after phacoemulsification was investigated to find the cause of opacification. From the UV-visible and energy dispersive X-ray spectroscopy (EDS) measurements, the opacification in the present case seems to be due to calcification of the intraocular lens and not due to modification in the UV absorber material of the lens. The average free volume size of the intraocular lens both in unimplanted and explanted state were obtained from positron lifetime spectroscopy (PLS). Further, the combined FTIR and PLS results indicate that calcium gets into the free volume cavities of the intraocular lens matrix as a cationic moiety, may be in the form of Ca(++). The small decrease in glass transition temperature of the calcified lens seems to indicate the plasticizing action of calcium ions. The present results could be of some use in the design of the intraocular lens material in which calcification would be minimum.

Determining the optimal pacing intervention rate for vasovagal syncope.

INTRODUCTION: In this study, patients with rate hysteresis pacemakers implanted for vasovagal syncope were re-studied using serial tilt testing to determine whether, once triggered, pacing was more effective if the intervention rate was higher than the standard rate. METHODS AND RESULTS: Twenty patients (mean age 55.4 years, range 23-81, 14 male) were studied, with randomisation to either initial standard rate (80-90 beats/min) intervention, or to initial high rate (120 beats/min) intervention. Although 18 of the 20 reported complete abolition of syncope since pacing, only 8 patients could be objectively assessed. The respective mean time to tilt down after symptom onset with standard and high rate intervention was 193+/-234s and 185+/-143s, (P>0.05). CONCLUSION: Repeat tilt testing was only of limited value in assessing the benefit of pacing. There was no advantage with high rate intervention in delaying the loss of consciousness (or intolerable symptoms) after the initial onset of symptoms.

In vitro plantlet regeneration from mature zygotic embryos of Pinus wallichiana A.B. Jacks.

Plantlet regeneration was achieved in blue pine (Pinus wallichiana A.B. Jacks) by organogenesis of mature zygotic embryos. The effect of various basal media and five cytokinins on adventitious bud induction, development and elongation was investigated. Half-strength Douglas fir cotyledon revised medium (DCR) supplemented with 2.5 µm N6-benzyladinine (BA) and 0.025 µM thidiazuron was found to be most effective in inducing adventitious buds. The effect of a BA pulse treatment was also tested, and the bud-forming capacity of each treatment was quantified. The elongation of adventitious buds was achieved on hormone-free half-strength DCR medium containing 2% sucrose and 0.05% activated charcoal. Rooting was induced in the elongated shoots with a 6-h treatment of indoleacetic acid and indolebutyric acid solutions (1 mM each). Rooted shoots were transplanted in the greenhouse for hardening and their survival percentage was 64.4 after 5 weeks and 45.7 after 6 months.

Prevalence of HBsAg & anti-HBs in children & strategy suggested for immunisation in India.

The prevalence of HBsAg and anti-HBs was studied in sera from 982 children of different age groups below 5 yr. HBsAg was detected in 0.9, 2.3, 4.1, 2.3 and 1.6 per cent children of 0-1, 2-6, 7-12, 13-36 and 37-60 months age groups respectively. Anti-HBs in these five groups was noted in 17.0, 12.9, 18.4, 14.2 and 13.7 per cent children, respectively. The findings suggest that the carrier pool is built up in the preschool age group, particularly, below the age of 6 months. Perinatal transmission and the relative role of transplacental need re-evaluation. Cost analysis does not permit inclusion of HBV in the Expanded Programme of Immunisation.

Value of serum prolactin in differentiating epilepsy from pseudoseizure.

We studied the serum prolactin levels in 35 cases with various types of seizures viz. generalized tonicolonic seizures (GTC), complex partial seizures (CPS), and simple partial seizures (SPS). We also studied 20 cases with pseudoseizure (hysteria) presenting in an epileptiform manner. Twenty two normal healthy subjects were also studied. All the cases were studied both in the postictal and interictal periods. Serum prolactin rose significantly in the postictal periods in patients with GTC and CPS, but patients with SPS or pseudoseizure did not demonstrate this rise. Thus serum prolactin estimation can be of help in differentiating true generalized seizures from pseudoseizure presenting in an epileptiform manner.

Infant feeding practices of peri-urban areas of Gorakhpur.

PIP: A study of infant feeding practices in the peri-urban areas of Gorakhpur interviewed 155 lactating mothers. prelacteal feeds were administered mainly by cotton swab (665%). However, the Indian Academy of Pediatrics survey observed a greater (50%) use of the bottle followed by cotton swab (24%). For most of the cases, animal's milk was used for prelacteal feed. In the present study, animal milk was used in 73.9% of the cases as supplemental feeding to breast milk. A 2-3 day period of prelacteal feed is still a common practice in the surveyed area. No health or nutritional education was available for any of the mothers. Low weight infants were prevalent, and all of these were bottled fed. Bottles were repeatedly used without hygiene and sterilization. The most popular reason for the initiation of bottle feeding was insufficient breast milk. Despite the current effects and knowledge of bottle feeding, many doctors prescribe commercial baby milk. It is, therefore, incumbent upon the Indian Academy of Pediatrics to dispense information on the benefits of breast feeding to every practicing medical practitioner.^ieng

Non-nutritive suckling and use of pacifiers.

One hundred and sixteen infants and children with normal development were studied for their non-nutritive suckling habit with special reference to pacifier suckling. The use of pacifier was more common among the lower socio-economic group (83.6%) and those residing in slums (58.6%). In 88.7% of cases it was the mother, family member, friend or relative who was responsible for introduction of pacifier to the baby with the aim to soothe the child. The other indications for use of pacifier were to facilitate dentition (60.0%) and nutritive function (18.1%). The use of pacifier in most of the cases was associated with chronic diarrhea (86.2%), respiratory illnesses (52.5%) and pica (10.2%). Defective dentition was noted only in 5.1% of children. The medical/paramedical staff were against the use of pacifiers.

Neonatal morbidity and mortality in ICDS urban slums.

PIP: A communitywide prospective survey was conducted in the urban slums of Gorakhpur, to elicit information on factors contributing to India's high rate of neonatal mortality. Neonatal mortality accounts for more than 50% of total infant mortality in India. To successfully reduce infant mortality to 60/1000 live births, more information is needed on the contribution of prematurity, low birth weight, infections, respiratory distress, birth asphyxia, hyperbilirubinemia, birth injury, congenital malformation, and other determinant factors of neonatal morbidity and mortality, especially in urban slums. Compared with the standards of more developed countries, high levels of neonatal morbidity and mortality were found with the main causes being infections and respiratory distress. Neonatal mortality was found to bear an inverse relationship with birth weight and gestational age. Higher mortality rates were observed in institutional deliveries, despite the fact that the overall majority of mortality occurred in the home. Neonatal mortality was found to be significantly higher (p.001) in home deliveries conducted by untrained dais. Proper training of traditional dais and paramedical workers would minimize the extent of these deaths.^ieng

Prescription audit of under six children living in periurban areas.

One hundred and seventy two children were prescribed, in 212 episodes of illness, antimicrobial agents (28.4%), followed by antidiarrheals (10.9%), nutritional products (9.4%), analgesics (7.5%) and steroids (6.8%). Ampicillin (22.7%) and cotrimoxazole (12.7%) were the most commonly prescribed antimicrobials. Tetracyclines, which are not indicated in children below 8 years, were used in 7.1% of total exposures of chemotherapeutic agents. Penicillin, a comparatively safe and useful drug, was used only in 4.5% exposures. Analgin and hydroxyquinolines were used frequently. Corticosteroids were used for simple ailments like diarrhea, fever and jaundice. ORS was used in only 13.9% episodes of diarrhea. Adverse drug reactions were noted in 30 (17.4%) cases and death in 6 (3.5%) cases. The average cost per prescription for neonates was Rs 32.43 and for a child was Rs 30.65. Weight of the children was not taken prior to prescribing drugs. There is need for prescription audit as there is high consumption rate of drugs, with overuse of antimicrobial and nutritional products, and misuse of steroids.

Mortality patterns in under six children in I.C.D.S. urban slum.

PIP: The present study was conducted in 40 Anganwadi centers covering a population of 42,684 in the urban slums of Gorakhpur City under the ICDS scheme. The infant mortality rate was 98.9/1000 livebirths. The higher mortality in children between 1-3 years (45/1000) in comparison to those ages 3-6 (22.8/1000) reflects the higher vulnerability of children under age 3. Diarrhea (36.3%) was the major cause of infant mortality followed by respiratory infections (24.2%), and tetanus (15.4%). Diarrhea (50.2%), respiratory infections (32.4%), and malnutrition (2.0%) were the major killers in children between 1-6 years. Mortality in various age groups was found to be significantly higher in poor social classes, in children in grades III and IV malnutrition categories, in those not breastfed, and in those who had not yet been weaned. Risk factors associated with a high infant mortality included birthweight or= 2500 g, maternal age 20 or 35 years, primipara or multipara, mothers receiving no antenatal care, interval between 2 births of 12 months, gestational age of 32 weeks, mothers with a poor obstetric history, and those mothers who had been delivered by untrained personnel.^ieng

Delivery of better maternal and child health (MCH) services through continuous monitoring of grades III and IV malnourished children in ICDS scheme.

PIP: A multidirectional approach was adopted to break down the ecosystem of PEM in a population of 13,286. A continuous monitoring of children suffering from grades 3 and 4 malnutrition was done for 1 year in the ICDS Urban Project, Gorakhpur. 68.05% of the children with grades 3 and 4 malnutrition improved their grades. 4.63% suffering from severe malnutrition died in 1 year. Due to this monitoring system, morbidity of children due to diarrhea and respiratory infections has fallen from 3.4 and 2.7 to 3.1 and 2.3 episodes/child/year. 64 of 84 malnourished mothers gained weight during 1 year. Maternal mortality rates have been reduced from 3.23 to 2.94/1000 livebirths and the infant mortality rate has dropped from 153.7/1000 livebirths to 147.1/1000 livebirths. 13.15% of the eligible couples were effectively protected by family planning services.^ieng

Lactation failure.

Seventy five mothers with lactation failure were studied, whose less than 4-month-old babies were admitted to the hospital. Partial lactational failure (94.7%) was noted more often than complete lactational failure (5.3%). Initiation of breastfeeding was delayed for 2 to 5 days usually for traditional reasons (77.3%) and because the mothers felt that the milk output was inadequate (92%). The various causes of lactation failure were determined and the relationship to various factors was analyzed. The commonest cause of lactation failure was insufficient milk or no milk (80%). The age, parity, education, socio-economic status, religion, family structure and urban vs rural status of mother--all had a bearing on the occurrence of lactation failure. An attempt was made to relactate all these mothers. The outcome was successful in 69.3 cases and failed in only 4% cases. In 26.7% cases, we cannot predict the outcome as the mothers hospital stay was very brief with no follow up.

PIP: A total of 75 mothers whose babies under 4 months old were hospitalized with lactation failure were studied. The age of the mothers varied from 16 years to 40 years with a mean of 23.7 years. 50 (66.7%) of the mothers were from the urban areas. 43 (57.3%) of them were primipara and 61 (81.3%) were Hindus. All the mothers given prelacteal feeds comprising water, water with sugar or glucose, milk (goat, cow, or milk powder) to their babies. The commonest cause of lactation failure with insufficient milk or no milk (80%). The age, parity, education, socioeconomic status, religion, family structure, and urban vs. rural residence of mother had a bearing on the occurrence of lactation failure. The initiation of breast feeding was delayed for 2-5 days usually for traditional reasons (77.3%) and because the mothers felt that the milk output was inadequate (92%). Only 4 (5.3%) mothers had complete lactation failure and practiced exclusive top feeding. Of the 71 (94.7%) mothers with partial lactation failure, 41 (54.7%) were giving frequent breast feeds while 30 (40%) were breast feeding occasionally. Relactation was attempted in all cases. Mothers have been motivated to breast feed and were provided adequate rest, nutrition, and psychological support. If lactation was still not established, then metoclopramide was given orally in the 8-hourly dosage of 10 mg for 10 days. If this also failed, nursing supplementer was tried. The relactation attempt was successful in 49 (69.3%) partial and 3 (7.5%) complete lactation failure cases. Relactation failed in 22 (30.7%) mothers with partial lactation failure and 1 (2.5%) mother with complete lactation failure. (26.7%) mothers with partial lactation failure were lost to follow up. Out of 4 cases of complete lactation failure, 1 had severe anemia with hypoproteinemia, the 2nd developed intense dislike of her baby at birth, the 3rd had tuberculosis and was advised not to breast feed, and in the 4th case the mother stopped breast feeding completely because she felt that her milk was unsuitable.

Prothrombin time in first week of life with special reference to vitamin K administration.

Prothrombin time was estimated in 100 neonates (80 full term and 20 preterm). Among the full term infants 50 were healthy and 30 sick. Prothrombin time was altered in neonates with birth hypoxia and prematurity (p less than 0.001). Vitamin K administration to anoxic babies resulted in improvement in prothrombin time after 48-72 hours (p less than 0.001). Four newborns has bleeding, 2 had anoxia and 2 were only in preterms who did not receive vitamin K after birth. It is concluded that vitamin K should be given to all preterms and those with difficult deliveries; term, healthy newborns do not need it.

Anterior fontanel size.

Anterior fontanel size was determined in a cross-sectional study of 445 infants ranging in age from newborn period to 2 years. The mean anterior fontanel size in neonates was 3.37 +/- 0.61 cm which decreased to 0.37 +/- 0.06 cm in 24 months age group. The age of closure of anterior fontanel was 12, 18 and 24 months in 40%, 70.4% and 91.3%, respectively.