sCTX II is a better biomarker than sMMP-3 to identify early knee osteoarthritis.

The aim of this study is to assess the ability of serum MMP-3 and serum CTX-II levels to differentiate between normal and early knee osteoarthritis case (eKOA). Subjects with clinical features of primary knee osteoarthritis of K-L Grade I and K-L Grade II with ages more than 45 years were included in the case group (98), and healthy adults with ages less than 40 years were included in the control group (80). Those having knee pain for the last 3 months but having no radiological features were labeled as K-L grade I and those having minimal osteophytes on radiographs were labeled as K-L Grade II. Antero-posterior views of knee and serum levels of MMP-3 and CTX II were estimated. Cases show significantly higher values of both biomarkers than in controls (p < 0.0001). Both biomarkers show significantly higher values with an increase in K-L Grades, that is, K-L Grade 0 versus I (MMP-3: p = 0.003; CTX-II: p = 0.002), K-L Grade I versus II (MMP-3: p < 0.000; CTX-II: p < 0.000). Multivariate analysis shows the dependence of both biomarkers only on K-L Grades. ROC analysis suggests cutoff value between KL Grade 0 and Grade I (MMP-3: 12.25 ng/mL; CTX II: 407.50 pg/mL) and between K L Grade I and Grade II (MMP-3: 18.37 ng/mL; CTX II: 528.00 pg/mL). The discriminating ability of CTX II is superior between normal population and eKOA (CTX II: Accuracy: 66.83%, p = 0.0002; MMP-3: Accuracy: 50.39%, p = 0.138), but MMP-3 is superior than CTX II between eKOA and mild KOA (CTX II:67.52%, p < 0.000; MMP-3: 70.69%, p < 0.000).

Can serum MMP-3 diagnose early knee osteoarthritis?

Aims: This study aims to assess the ability of serum MMP-3 levels to differentiate between normal knee with primary knee osteoarthritis (KOA) and its ability to differentiate between various severity grades. Material & methods: The study included 80 cases of primary knee osteoarthritis (KOA) and 80 young individuals with no features of KOA. Results: The subjects in Case group were younger (52.80 ± 10.31 years) than in Control group (28.55 ± 5.98 years) (p = 0.001). The BMI of Case group (27.5 ± 4.81 kg/m2) was significantly higher than in Control group (25.40 ± 5.71 kg/m2) (p = 0.012). Mean sMMP-3 level in Cases (59.85 ± 39.92 ng/ml) was significantly higher than in Controls (14.52 ± 6.09 ng/ml) (p = 0.0001). There was no gender difference in biomarker values in Cases (p = 0.1) and in Controls (p = 0.88). The level of sMMP-3 rises with increasing age in cases only (p = 0.0001). MMP-3 values were significantly elevated in cases in the sub-categories of BMI within case group and control group (>0.05) but higher in cases in normal, overweight and obese subcategories (p < 0.05). Serum MMP-3 level differs significantly between K-L grade 0-I (p = 0.004), K-L grade I-II (p = 0.000), K-L grade II-III (p = 0.007) and also between K-L grade III-IV (p = 0.02). Biomarker showed moderate positive correlation with KL grade (r = 0.68, p = 0.000) and age (r = 0.38, p = 0.000) and weak positive correlation with WOMAC score (r = 0.289, p = 0.009). The receiver operative curve (ROC) analysis suggested a cut off value of sMMP-3 as 20.03 ng/ml between Control group and Case group, as 12.25 ng/ml between K-L grade 0-I; as 18.37 ng/ml between K-L grade I-II; as 55.60 ng/ml between K-L grade II-III; as 102.0 ng/ml between K-L grade III-IV. Conclusions: sMMP-3 estimation as a tool has a good discriminatory power to differentiate between healthy and a diseased knee (KOA) and between severity grades. It can be used as a test to identify individuals with KL grade I and II of KOA.

Assessment of Home-Based Care for Young Child (HBYC) Program in Aspirational Districts of Madhya Pradesh, India: A Cross-Sectional Study.

Context: In 2018, Government of India initiated Home-Based Care for Young Child (HBYC) program having five quarterly structured home visits for children age 3 to 15 months to promote early childhood development. Assess knowledge and practices of Accredited Social Health Activist (ASHAs), other health functionaries, and mothers related to HBYC. Cross-sectional evaluation design with ASHAs, AWWs, ANMs, ASHA, and mothers of 3 to 15 month's children as participants. Material and Methods: Knowledge and practices of 801 ASHAs, 200 other health functionaries, and 787 mothers were assessed on exclusive breastfeeding, complementary feeding, hand washing, iron folic acid (IFA) and oral rehydration solution (ORS) supplementation, danger referral signs in eight aspirational districts of Madhya Pradesh. Results: 88% ASHAs had correct knowledge on ORS, 85% on complementary feeding, 85% on adequacy of IFA, and 47% on danger signs which required child referral. Similarly, 85% of mothers had knowledge on exclusive breastfeeding, 40% mothers knew about complementary feeding, and only 18% knew correct ORS preparation. Statistically significant association was observed between ASHAs home visits and availability of ORS with mothers and their knowledge on correct Initiation of IFA (p < 0.001). Conclusion: Findings of study confirmed majority of health functionaries were aware about roles, responsibilities, and key tasks under HBYC. However, there observed a gap in knowledge transfer by health functionaries and thus inadequate translation of knowledge into practices among mothers on HBYC. This necessitates the need of appropriate actions from health system strengthening to capacity building to accelerate uptake of HBYC program.

Clinical and Biochemical Correlation of Intra-articular Platelet-Rich Plasma and Corticosteroid Using Serum Matrix Metalloproteinase 3 (MMP-3) Levels in Osteoarthritis of Knee.

Introduction Osteoarthritis (OA) in humans is an inevitable consequence of ageing and can now be effectively managed with advancements in knowledge and understanding of the disease. The major concern in a patient suffering from this disease is the functional impairment caused by the pain. The goals in the management of OA knee include symptom relief with preservation of joint function. Despite there being a number of studies on the effectiveness of PRP and CS for knee OA, most of them have focused on patient-reported functional outcomes only. Hence, we conducted this study to assess the potential and effectiveness of a single intra-articular injection of PRP and CS in the functional improvement of knee OA patients using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) and to establish the bio-modulatory effects of intra-articular PRP and CS in knee OA patients by estimating the serum matrix metalloproteinase-3 (MMP-3) levels. Methodology Patients attending the outpatient department with complaints of knee pain were screened. Standing anteroposterior and lateral radiographs of the knees were obtained. Patients with Kellgren and Lawrence (K-L) grades II and III were enrolled in our study. A total of 96 patients were included in the study after fulfilling the inclusion and exclusion criteria. Patients were divided into two groups (PRP and CS) by randomisation. There were 48 each in the PRP and CS groups, out of which nine were lost to follow-up, two from the PRP group and seven from the CS group. A total of 87 patients fulfilling the inclusion criteria were finally enrolled in the study and followed up for nine months after a single intra-articular injection. The biochemical assessment of serum levels of MMP-3 was done at baseline and in the ninth month. Accordingly, patients in the PRP group were injected with freshly prepared PRP (3 ml) within two hours of preparation, whereas those in the CS received 80 mg of methylprednisolone acetate. VAS and WOMAC were measured at baseline, and then in the first, third, sixth, and ninth month post-injection follow-ups. MMP-3 level was estimated before the injection and at the ninth-month post-injection follow-up. Data collected for both groups were analysed and compared with each other. Conclusion PRP is unquestionably a better option than CS in OA of the knee based on boosting functional activity, lowering stiffness, and reducing pain, all three of which are denoted by the WOMAC and VAS scores as the effect of PRP lasts longer than CS injections for the aforesaid issues. We could not find any significant change in levels of MMP3 post PRP and CS injections, which signifies that these two modalities do not have any effect in either preventing cartilage degeneration or promoting cartilage regeneration. Our findings have shown that PRP injections are safe, minimally invasive, and effective treatment modalities for OA knee.

An Assessment of Implementation of Family Participatory Care in Special Newborn Care Units in Three States of India.

OBJECTIVE: To study special newborn care units (SNCUs) in terms of family participatory care (FPC) quality initiative as per Government of India guidelines in select public health facilities, and to document the perspectives of the doctors and mothers. DESIGN: Cross-sectional. SETTINGS: SNCUs with functional FPC units in the states of Odisha, Madhya Pradesh and Rajasthan. PARTICIPANTS: 38 SNCUs; doctors and nurses in-charge of the unit; and two eligible mothers per unit, one inside the step-down unit and second outside the step-down unit whose newborns were admitted to special new-born care unit, having a stable baby weighing above 1500 g. INTERVENTION: The states implemented FPC as per Government of India guidelines using National Health Mission funds across special newborn care units. This assessment involved onsite observation and interviews of key providers. OUTCOME: Proportion of facilities providing regular counselling sessions, enabling support to mothers, recording FPC information; perspectives of health providers on improvement of breastfeeding and kangaroo mother care; proportion of eligible mothers practicing FPC, exclusively breastfeeding, and providing kangaroo mother care services. RESULTS: Out of 38 SNCUs, we found that FPC sessions for mothers were happening in 36 (95%) facilities. SNCUs provided enabling support to mothers on FPC (74.2%), held regular sessions for the families (70.6%), nurses assisted mothers and family members for breastfeeding and kangaroo mother care (76.4%) and FPC information were recorded (70.6%). CONCLUSIONS: The assessment of facilities where FPC was implemented showed that SNCUs were equipped to implement FPC in public health settings.

Tracking Weight-for-Age of Infants Using Home Based Newborn Care Plus by ASHA Workers.

BACKGROUND: Malnutrition in all its forms remains a serious global concern, particularly affecting children, a highly vulnerable population group. Home visits during the first year of life using the community worker platform is an unexplored opportunity for making improvements in nutritional status. OBJECTIVE: To analyze the nutritional status (weight for age) of a cohort of infants between 3 and 12 months of age. DESIGN: Tracking weight for age of infants by ASHA workers. SETTINGS: 13 districts in the states of Bihar, Madhya Pradesh, Odisha and Rajasthan. INTERVENTION: Home visits under a home-based newborn care program, home-based newborn care plus (HBNC+). METHODS: Norway India Partnership Initiative (NIPI) project supported implementation of HBNC+, in 13 districts across four states in India. A descriptive analysis of infants based on retrospective record based program data was done. The nutritional status (weight-for-age) of the cohort was analyzed. Categories were defined based on the z-scores of weight for age (≤-3 SD; ≤-2 SD and > -3 SD; and > -2 SD). Trend of malnutrition and proportions of children in each category at 3, 6, 9 and 12 months were assessed. RESULTS: At 3 months of age, out of 3,50,986 infants provided home visits, 1,82,049 (51.97%) were underweight as per WHO definition with weight for age z-score ≤- 2 SD; this reduced to 11.1% at 12 months of age. Difference of means at 3 months and 12 months significantly different for weight for age z-score (P<0.001). There was a decline in the proportion of children in severe and moderate malnutrition categories by 15% and 26%, respectively. CONCLUSIONS: Catch-up growth in terms of weight-for-age among malnourished children is possible within one year of age. Frequent contacts with the health care functionaries may result in this improvement, though it is difficult to conclude in the absence of an appropriate control.

Special Newborn Care Plus Project in India: Preliminary Findings from Community-Based Follow-up of Newborns Discharged from Facilities.

OBJECTIVE: An innovation of structured community based followup of SNCU discharged babies by ANM and ASHA was piloted under Norway India Partnership initiative. The current study describes the survival status and other outcomes among newborns discharged from SNCUs and followed at community level in first 42 days of life. METHODS: It is a retrospective cohort study on newborns discharged from SNCUs from 13 districts across four states of India. Routine health systems data have been utilized to record key parameters like birth weight, sex, weights during follow-ups, any illnesses reported, status of feeding and survival status. These were compared between normal and low birth weight babies. Newborns discharged from special newborn care units (SNCUs) and followed up at community level at 24 hours, 7 days after first visit, and at 6 weeks of life. RESULTS: Follow up of 6319 newborns were conducted by the ANM (25.4%), ASHAs (4.7%) or both (69.8%); 97% of the babies were followed-up at all the visits. The median duration of follow- ups were 1 day post-discharge, 13th day and 45th days of life. Majority (97%) of them were breastfed, and were warm to touch at the time of the visit. More than 11% of the babies needed referral at every visit. Mortality rate in the cohort of babies discharged from SNCUs till 6 weeks of follow up was 1.5%. Among normal birth weight newborns, it was 0.4% while it was 2.02% among LBW babies. The proportion of girls among those who died increased from 20% in the first follow up to 38.1% at second follow up and 41% at 6 weeks. CONCLUSIONS: Babies with LBW were at higher risk of death as compared to babies with normal birth weight. Follow-up at critical timepoints can improve survival of small and sick newborns after discharge from SNCUs.

Situational Analysis of Management of Childhood Diarrhea and Pneumonia in 13 District Hospitals in India.

OBJECTIVE: To generate evidence on the current situation of hospital care (emergency, inpatient and outpatient), for managing children presenting with diarrhea and pneumonia at 13 district hospitals in India. DESIGN: Facility-based assessment of district hospitals. SETTINGS: 13 district hospitals in four states of Bihar, Madhya Pradesh, Odisha and Rajasthan. PARTICIPANTS: Staff nurses and doctors. INTERVENTION: None. METHODS: An assessment was done across 13 district hospitals in four states by a group or trained assessors using an adapted quality assurance tool developed by Government of India where each aspect of care was scored (maximum score 5). Emergency services and triage, case management practices, laboratory support, and record maintenance for diarrhea and pneumonia were assessed. RESULTS: Separate diarrhea treatment unit was not earmarked in any of the DHs surveyed. Overall score obtained for adequate management of diarrhea and pneumonia was 2 and 2.2 which were poor. Pediatric beds were 6.8% of the total bed strength against the recommended 8-10%. There was a 65 percent short-fall in the numbers of medical officers in position and 48 percent shortfall of nurses. There were issues with availability and utilization of drugs and equipment at appropriate places with cumulative score of 2.8. Triage for sick children was absent in all the facilities. CONCLUSIONS: The standards of pediatric care for management of diarrhea and pneumonia were far from satisfactory. This calls for improvement of pediatric care units and implementation of operational guidelines for improving management of diarrhea and pneumonia.

Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI).

OBJECTIVE: To develop a composite index that serves as a proxy marker of quality of clinical service and pilot test its use in 11 special neonatal care units (SNCUs) across two states in India. DESIGN: Secondary data from SNCU webportal. SETTING: Special new-born care units in Rajasthan and Orissa. INTERVENTION: We developed a composite SNCU Quality of care Index (SQCI) based on seven indices from SNCU online database. These included rational admission index, index for rational use of antibiotics, inborn birth asphyxia index, index for mortality in normal weight babies, low birth weight admission index, low birth weight survival index, and optimal bed utilization index. OUTCOME: Based on the SQCI score, the performance of SNCUs was labelled as good (SQCI 0.71- 1.0), satisfactory (SQCI 0.4- 0.7) or unsatisfactory (SQCI <0.4). RESULTS: The mean difference in SQCI between Jan-Mar 2016 and 2017 was 0.20 (95% CI 0.13- 0.28; P<0.001). Similar results were obtained for rational admission index, rational use of antibiotics, mortality in normal weight babies, low birth weight survival and optimal bed utilization. A significant improvement in the overall composite score was noted in Odisha (Mean difference 0.22, 95% CI 0.11-0.33, P=0.003) and Rajasthan (Mean difference 0.17, 95% CI 0.05- 0.3, P=0.002). CONCLUSIONS: QI approach using SQCI tool is a useful and replicable intervention. Preliminary results show that it does lead to strengthening of implementation of the programs at SNCUs based on the comprehensive scores generated as part of routine system.

Delivery of molecules to cancer cells using liposomes from bacterial cultures.

Liposomes have a variety of applications as model systems to study enclosed biological membranes, as delivery vehicles for a variety of drugs and as micro- and nano-reactors, amongst others. However, preparation of liposomes requires use of expensive raw material (synthetic lipids) from specialized commercial suppliers, and ability to make reproducible preparations remains a specialized art till date. In this work, we prepared liposomes using natural lipids extracted from the bacteria Escherichia coli (E. coli), which are extremely economical compared to the synthetic lipids. We demonstrate robust procedures for convenient and reproducible preparations of 200-300 nm diameter liposomes from bacterial cells. We also show a potential application of these bacterial liposomes in delivery of aqueous molecules to cancer cells. We show not only intracellular uptake, but also biodegradation of the liposomes inside cancer cells. Our economical liposomes promise to serve as excellent model systems for studies on encapsulation of molecules inside soft materials with desired efficiencies. Additionally, they certainly show a strong potential to be tools for research in diverse areas ranging from drug delivery applications to sub-micron reaction engineering for carrying out and understanding the mechanisms of chemical reactions in small enclosed volumes.