Emerging Two-Dimensional Materials for Electromagnetic Interference Shielding Application.

Graphene is the first two-dimensional material that becomes the center material in various research areas of material science, chemistry, condensed matter, and engineering due to its advantageous properties, including larger specific area, lower density, outstanding electrical conductivity, and ease of processability. These properties attracted the attention of material researchers that resulted in a large number of publications on EMI shielding in a short time and play a central role in addressing the problems and challenges faced in this modern era of electronics by electromagnetic interference. After the popularity of graphene, the community of material researchers investigated other two-dimensional materials like MXenes, hexagonal boron nitride, black phosphorous, transition metal dichalcogenides, and layered double hydroxides, to additionally enhance the EMI shielding response of materials. The present article conscientiously reviews the current progress in EMI shielding materials in reference to two-dimensional materials and addresses the future challenges and research directions to achieve the goals.

Endoscopic Disease Activity and Biologic Therapy Are Independent Predictors of Suboptimal Bowel Preparation in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy.

BACKGROUND AND AIMS: Optimal bowel preparation (BP) is critical for endoscopic assessment of inflammation and dysplasia in patients with inflammatory bowel disease (IBD). Comorbidities and patient-related factors have been associated with suboptimal BP (SOBP) in the general population. We sought to identify disease-specific characteristics that may impact the quality of BP in patients with IBD. METHODS: We conducted a retrospective analysis of adult IBD patients who underwent outpatient colonoscopies between January 2014 and September 2020 at a large academic medical center. Quality of BP was documented using the Boston Bowel Preparation Scale (BBPS) or the Aronchick scale and dichotomized into "suboptimal" (BBPS 0-5 or Aronchick "fair," "poor," unsatisfactory") and "optimal" (BBPS 6-9 or Aronchick "excellent," "good"). IBD-specific and other factors associated with SOBP were evaluated using logistic regression analyses. RESULTS: Among a total of 395 IBD patients [54% males, mean age 40 years, 63% with Crohn's disease (CD), 35% with ulcerative colitis (UC)], 24.8% had SOBP. On multivariable analysis, moderate-to-severe endoscopic disease vs mild or inactive disease was associated with a higher odds of SOBP [adjusted OR 2.7(95% CI 1.52-4.94)], whereas baseline biologic use was associated with a lower odds of SOBP [aOR 0.24(0.09-0.65)] among the overall IBD cohort. Additionally, age > 65 years [aOR 2.99(1.19-7.54)] and single-dose vs split-dose BP [aOR 2.37(1.43-3.95)] were predictors of SOBP. In the subgroup analysis by IBD type, moderate-to-severe endoscopic disease predicted SOBP among both CD and UC cohorts. CONCLUSION: Endoscopic disease activity was predictive of SOBP, and biologic therapy was protective against SOBP among IBD patients.

The Age of Next-Generation Therapeutic-Microbe Discovery: Exploiting Microbe-Microbe and Host-Microbe Interactions for Disease Prevention.

Humans are considered "superorganisms," harboring a diverse microbial collective that outnumbers human cells 10 to 1. Complex and gravely understudied host- and microbe-microbe interactions-the product of millions of years of host-microbe coevolution-govern the superorganism in almost every aspect of life functions and overall well-being. Abruptly disrupting these interactions via extrinsic factors has undesirable consequences for the host. On the other hand, supplementing commensal or beneficial microbes may mitigate perturbed interactions or enhance the interactive relationships that ultimately benefit all parties. Hence, immense efforts have focused on dissecting the innumerable host- and microbe-microbe relationships to characterize if a "positive" or "negative" interaction is at play and to exploit such behavior for broader implications. For example, microbiome research has worked to identify and isolate naturally antipathogenic microbes that may offer therapeutic potential either in a direct, one-on-one application or by leveraging its unique metabolic properties. However, the discovery and isolation of such desired therapeutic microbes from complex microbiota have proven challenging. Currently, there is no conventional technique to universally and functionally screen for these microbes. With this said, we first describe in this review the historical (probiotics) and current (fecal microbiota or defined consortia) perspectives on therapeutic microbes, present the discoveries of therapeutic microbes through exploiting microbe-microbe and host-microbe interactions, and detail our team's efforts in discovering therapeutic microbes via our novel microbiome screening platform. We conclude this minireview by briefly discussing challenges and possible solutions with therapeutic microbes' applications and paths ahead for discovery.

Antibacterial efficacy of Carica papaya leaf extract, probiotics, kidodent, and placebo mouthwashes in reduction of salivary Streptococcus mutans: A double-blinded parallel designed randomized controlled trial.

AIM: To compare the antibacterial efficacy of Kidodent, Probiotics, and Carica papaya Leaf extract mouthwashes in reducing Streptococcus mutans count in 8-12 years' old school children. METHODOLOGY: Sixty children of age group of 8-12 years were nominated and grouped as Group A (Kidodent mouthwash), Group B (probiotics mouthwash) Group C (C. papaya leaf extract mouthwash), and Group D (distilled water placebo). Probiotics sachets (Prebact) of about 1 g were diluted in 10 ml of water and given as mouthwash. C. papaya leaf extract was obtained by Soxhlet extraction using ethanol as a solvent. Participants were asked to rinse with mouthwashes for 30 s once daily for up to 15 days. Saliva samples were collected and inoculated using Salivarius Mitis and Agar Agar Type I at 38°C for 24 h and incubated, later colony-forming units per milliliter were determined by serial dilution and calculated using colony counter manually. Statistical Analysis: Data were statistically analyzed using the one-way ANOVA and t-test using the SPSS V.20 software. RESULTS: Probiotics and C. papaya leaf extract mouthwashes were equally effective as Kidodent in reducing S. mutans count in saliva. CONCLUSION: Probiotics and C. papaya leaf extract mouthwashes manifested potential efficacy in reduction of S. mutans.

Safety and Efficacy of Biological Therapy in Chronic Antibiotic Refractory Pouchitis: A Systematic Review With Meta-analysis.

BACKGROUND: Pouchitis is the most common long-term complication after ileal pouch-anal anastomosis in patients with ulcerative colitis. Those with ≥3 episodes of pouchitis/year and symptoms despite antibiotics are considered to have chronic antibiotic refractory pouchitis (CARP). While several agents including probiotics, steroids and immunomodulators have been used, treatment of CARP remains challenging. We conducted a systematic review and meta-analysis evaluating the safety and efficacy of various biological agents in treatment of CARP. METHODS: Multiple databases were searched through June 2020 for studies that reported the efficacy and safety of biological therapy including antitumor necrosis factor-alpha agents [infliximab (IFX) and adalimumab (ADA)], vedolizumab (VDZ), and ustekinumab in CARP. We excluded studies on Crohn's like and/or other inflammatory complications of the pouch. Meta-analysis was performed to calculate pooled rates of clinical as well as endoscopic improvement and remission. RESULTS: We included 15 studies with 311 patients in our final analysis. Ninety-two patients were treated with IFX, 42 with ADA, 144 with VDZ and 33 with ustekinumab. Pooled rate of clinical improvement was 71.4%, 58.2%, 47.9% and clinical remission was 65.7%, 31%, 47.4% with IFX, ADA, and VDZ, respectively. Pooled rate of endoscopic improvement was achieved in 61.2% patients treated with VDZ while endoscopic remission was achieved in 70.3% patients treated with IFX. Adverse events were reported in 3.9% patients. CONCLUSION: Biologic therapy is safe and effective in the treatment of CARP.

Effect of yoga as add-on therapy in migraine (CONTAIN): A randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of yoga as an adjuvant to conventional medical management on clinical outcomes in patients with migraine. METHODS: CONTAIN was a prospective, randomized, open-label superiority trial with blinded endpoint assessment carried out at a single tertiary care academic hospital in New Delhi, India. Patients enrolled were aged 18-50 years with a diagnosis of episodic migraine and were randomized into medical and yoga groups (1:1). Randomization was computer-generated with a variable block size and concealed. A predesigned yoga intervention was given for 3 months. Outcomes were recorded by a blinded assessor. The primary endpoint was a decrease in headache frequency, headache intensity, and Headache Impact Test (HIT)-6 score. Secondary outcomes included change in Migraine Disability Assessment (MIDAS) score, pill count, and proportion of headache free patients. RESULTS: Between April 2017 and August 2018, 160 patients with episodic migraine were randomly assigned to medical and yoga groups. A total of 114 patients completed the trial. Baseline measures were comparable except for a higher mean headache frequency in the yoga group. Compared to medical therapy, the yoga group showed a significant mean delta value reduction in headache frequency (delta difference 3.53 [95% confidence interval 2.52-4.54]; p < 0.0001), headache intensity (1.31 [0.60-2.01]; p = 0.0004), HIT score (8.0 [4.78-11.22]; p < 0.0001), MIDAS score (7.85 [4.98-10.97]; p < 0.0001), and pill count (2.28 [1.06-3.51]; p < 0.0003). CONCLUSION: Yoga as an add-on therapy in migraine is superior to medical therapy alone. It may be useful to integrate a cost-effective and safe intervention like yoga into the management of migraine. CLINICALTRIALSGOV IDENTIFIER: CTRI/2017/03/008041. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with episodic migraine, yoga as adjuvant to medical therapy improves headache frequency, intensity, impact, and disability.

Application of mindfulness on stress, anxiety, and well-being in an adolescent student: A case study.

BACKGROUND: Stress and anxiety are the major problems students face in their lives and specifically in their academic life, which, in turn, has a significant negative impact on their academic performance. There are different approaches to deal with stress and anxiety, for example, cognitive behavioral therapy and relaxation techniques. OBJECTIVE: The present study was conducted to evaluate the applicability of mindfulness on stress, anxiety, and psychological well-being in an adolescent student. METHODS: In this study, single-case study design was used. The Pediatric Symptoms Checklist, Youth Self-Report, Institute of Personality and Ability Testing Anxiety Scale, and Checklist of Psychological Well-Being were administered on ten adolescent students. After the initial assessment, one participant was selected who was having significant level of stress, anxiety, and poor psychological well-being. Further detailed assessment was done using the Raven Standard Progressive Matrices, Parents' Observation Checklist, Teachers' Observation Checklist, and Students' Self-Observation Checklist. The student underwent 24 sessions of mindfulness training with a frequency of three sessions in a week. After completion of sessions, post assessment was done. He was re-assessed after 3 months. RESULTS: After completion of mindfulness training, improvement was observed in stress, anxiety, well-being, and other variables, and the improvement was maintained till follow-up. CONCLUSION: Mindfulness training has the potential in effectively reducing stress and anxiety and increasing a sense of well-being, but the major barrier is getting fixated with an idea of what's the right way to do mindfulness and feel it.

A prospective study on the effects of Ayurvedic massage in post-stroke patients.

BACKGROUND: Few stroke patients have reported improvements after Ayurvedic massage. Unfortunately, there is a dearth of indexed literature to support the use of this in rehabilitation. OBJECTIVES: To objectively measure the differences between patients with stroke who received Ayurvedic massage in addition to standard Physiotherapy (PT) versus those who received only standard PT. MATERIALS AND METHODS: The study was a prospective case control study, retrospectively analysed. The setting was a tertiary level hospital with neuro-rehabilitation unit. Fifty-two patients undergoing acute inpatient rehabilitation were prospectively followed post stroke. They were self-selected one month from the event for Ayurvedic massage with regular PT or PT alone. Twenty five received Ayurvedic massage with PT and twenty seven received only PT. All participants completed treatment. Information related to age, gender, National Institute of Health Stroke Scale result, number of co-morbidities, and whether cases were deemed simple or complex were taken at baseline. All patients received 6 hours of physical therapy averaged over a week. Massage was delivered daily for a total of 10 sessions followed by steam application. RESULTS: Patients were categorized as simple or complicated stroke based on events prior to rehabilitation. Both simple and complicated patients who received Ayurvedic massage had lower MAS and need for antispastic drugs, achieved standing with minimal assistance sooner, and had better locomotion at discharge. All these differences were significant. CONCLUSION: Utilizing Ayurvedic massage in post stroke patients with flaccidity can promote faster standing with minimal assistance and lead to less need for antispastic drugs at discharge.

Microbacterium aureliae sp. nov., a novel actinobacterium isolated from Aurelia aurita, the moon jellyfish.

The taxonomic position of a lemon-yellow-pigmented actinobacterium, strain JF-6T, isolated from Aurelia aurita, the moon jellyfish, collected from the Bay of Bengal coast, Kanyakumari, India, was determined using a polyphasic approach. The strain had phenotypic and chemotaxonomic properties that were consistent with its classification in the genus Microbacterium. Alignment of the 16S rRNA gene sequence of strain JF-6T with sequences from Microbacterium arthrosphaerae CC-VM-YT, Microbacterium yannicii G72T, Microbacterium trichothecenolyticum IFO 15077T, Microbacterium flavescens DSM 20643T, Microbacterium insulae DS-66T, Microbacterium resistens DMMZ 1710T and Microbacterium thalassium IFO 16060T revealed similarities of 98.95, 98.76, 98.43, 98.41, 98.41, 98.26 and 98.22 %, respectively. However, the levels of DNA-DNA relatedness with its closest phylogenetic neighbours confirmed that it represents a novel species within the genus. The major polar lipids were phosphatidylglycerol, diphosphatidylglycerol and an unknown glycolipid. The major menaquinones detected for strain JF-6T were MK-13 and MK-12. The diamino acid in the cell-wall peptidoglycan was ornithine and the peptidoglycan was type B2ß (Glu/Hyg-Gly-d-Orn). The DNA G+C content was 69.4 mol%. Based on these differences, strain JF-6T (=MTCC 11843T=JCM 30060T=KCTC 39828T) should be classified as the type strain of a novel species of Microbacterium, for which the name Microbacterium aureliae sp. nov. is proposed.

Neonatal septic arthritis in a tertiary care hospital: a descriptive study.

PURPOSE: The study was conducted to evaluate clinical and microbiological profile of neonates with septic arthritis and also to assess changing epidemiology in the microbial etiology. METHODS: Twenty-nine neonates (1-28 days of life) presenting to the Department of Orthopaedics with acute septic arthritis were included in the study. This was a descriptive study, and the data were collected during the time of hospital admission. History and clinical examination of the neonates were taken, and diagnosis was made based on clinical and laboratory parameters. Emergency arthrotomy was performed to prevent catastrophic sequelae in all the cases given antibiotics as per the culture results. RESULTS: Female children predominated in our study. The children were brought to the OPD with an average of 2.7 days of fever. Thirty-four joints were involved in 29 neonates, out of whom five had more than one joint involvement. Joint effusion or subperiosteal abscess was found in 22 patients by USG. All children had leukocytosis with neutrophilic predominance. Twenty-one of twenty-nine patients had hip-joint involvement followed by knee in seven patients. Gram-negative organisms had grown more commonly, among which Klebsiella pneumonia was grown in nine patients. CONCLUSION: Prematurity and anemia still appear to be important risk factors for neonatal septic arthritis. As there is changing trend toward gram-negative infections, attention has to be given toward preventing nosocomial and community-acquired infections. This is very important in premature infants who are susceptible for infection when they are kept in resuscitative units in hospitals.

Impaired macromolecular protein pools in fronto-striato-thalamic circuits in type 2 diabetes revealed by magnetization transfer imaging.

Previous research has shown that type 2 diabetes mellitus (T2DM) is associated with white matter microstructural changes, cognitive impairment, and decreased resting-state functional connectivity and spontaneous brain activity. This study used magnetization transfer imaging to examine, for the first time, the integrity of macromolecular protein pools in fronto-striato-thalamic circuits and its clinical and cognitive correlates in patients with T2DM. T2DM patients without mood disorders (n = 20, aged 65.05 ± 11.95 years) and healthy control subjects (HCs; n = 26, aged 62.92 ± 12.71 years) were recruited. Nodes of fronto-striato-thalamic circuits-head of the caudate nucleus (hCaud), putamen, globus pallidus, thalamus-and four cortical regions-rostral and dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and lateral orbitofrontal cortex-were examined. Compared with HCs, patients with T2DM had significantly lower magnetization transfer ratio (MTR) in bilateral anterior cingulate and hCaud. Reduced MTRs in the above regions showed correlations with T2DM-related clinical measures, including hemoglobin A1c level and vascular risk factors, and neuropsychological task performance in the domains of learning and memory, executive function, and attention and information processing. The impaired biophysical integrity of brain macromolecular protein pools and their local microenvironments in T2DM patients may provide insights into the neurological pathophysiology underlying diabetes-associated clinical and cognitive deficits.

Clinical, cognitive, and functional connectivity correlations of resting-state intrinsic brain activity alterations in unmedicated depression.

The pervasive and persistent nature of depressive symptoms has made resting-state functional magnetic resonance imaging (rs-fMRI) an appropriate approach for understanding the underlying mechanisms of major depressive disorder. The majority of rs-fMRI research has focused on depression-related alterations in the interregional coordination of brain baseline low frequency oscillations (LFOs). However, alteration of the regional amplitude of LFOs in depression, particularly its clinical, cognitive and network implications, has not been examined comprehensively yet. rs-fMRI amplitudes of low-frequency fluctuation (ALFF/fALFF) mediated by two LFO bands of 0.01-0.08 Hz (LF-ALFF/fALFF) and 0.1-0.25 Hz (HF-ALFF/fALFF) were measured in unmedicated subjects with major depressive disorder (n=20) and a healthy control group (n=25). A novel method of "ALFF-based functional connectivity" analysis was developed to test regional/network interaction abnormalities in depression. Our results revealed abnormal alterations in ALFF for both lower and higher frequency bands of LFOs in regions that participate in affective networks, corticostriatal circuits and motor/somatosensory networks. A strong positive correlation was detected between depressive symptom severity and fALFF in the anterior cingulate cortex. Functional connectivity of the thalamus and postcentral area with altered ALFF were found to be decreased with other interacting regions of their involved networks. Major depressive disorder relates to the alterations of regional properties of intrinsic neural activity with meaningful clinical and cognitive correlations. This study also proposes an integrating regional/network dysfunction in MDD.

Role of oxygen in the regulation of Leydig tumor derived MA-10 cell steroid production: the effect of cobalt chloride.

We have earlier shown that cobalt chloride (CoCl2)-induced hypoxia and second messenger 8-bromoadenosine 3', 5'-cyclic adenosine monophosphate (8-Br-cAMP) stimulates vascular endothelial growth factor (VEGF) production in Leydig tumor cell derived MA-10 cells. Both stimuli follow common signal transduction pathways including protein kinase A (PK-A), extracellular regulated kinase 1/2 (ERK1/2), and phosphatidyl inositol-3 kinase/akt (PI3-K/Akt) pathways in the stimulation of VEGF by MA-10 cells. In the present study we investigated the role of CoCl2 and 8-Br-cAMP on steroid production in MA-10 cells. The MA-10 cells were cultured in Waymouth MB 752/1 medium, supplemented with 15% heat inactivated horse serum. Progesterone was estimated by radioimmunoassay (RIA).We report that 8-Br-cAMP stimulated progesterone production by the MA-10 cells whereas CoCl2 inhibited the same. Also, 8-Br-cAMP stimulated steroidogenic acute regulatory protein (StAR) and cytochrome P450 side-chain cleavage enzyme (P450scc) mRNAs expression. However, CoCl2 had no effect on StAR mRNA. Cobalt chloride directly inhibited the expression of P450scc mRNA. The decrease in progesterone production could be attributed to three different mechanisms, (1) an increase in production of reactive oxygen species (ROS), (2) an increase in HIF-1α activity, and (3) ultimately a decrease in the level of cytochrome P450 side chain cleavage (CYT P450scc). Hypoxia has an action and mechanism of action similar to that of gonadotropins on VEGF production, whereas they have a contrasting effect on steroidogenesis. This study suggests that hypoxia could be as important as gonadotropins in regulating Leydig cell steroidogenesis.

Development of a new international classification of health interventions based on an ontology framework.

: The WHO International Classification of Diseases is used in many national applications to plan, manage and fund through case mix health care systems and allows international comparisons of the performance of these systems. There is no such measuring tool for health interventions or procedures. To fulfil this requirement the WHO-FIC Network recommended in 2006 to develop an International Classification of Health Interventions (ICHI). This initiative is aimed to harmonise the existing national classifications and to provide a basic system for the countries which have not developed their own classification systems. It is based on the CEN/ISO ontology framework standard named Categorial Structure defined from a non formal bottom up ontology approach. The process of populating the framework is ongoing to start from a common model structure encompassing the ICD 9CM Volume 3 granularity.

Optimizing antimicrobial therapy in sepsis and septic shock.

This article reviews principles in the rational use of antibiotics in sepsis and septic shock and presents evidence-based recommendations for optimal antibiotic therapy. Every patient with sepsis and septic shock must be evaluated at presentation before the initiation of antibiotic therapy. However, in most situations, an abridged initial assessment focusing on critical diagnostic and management planning elements is sufficient. Intravenous antibiotics should be administered as early as possible, and always within the first hour of recognizing severe sepsis and septic shock. Broad-spectrum antibiotics must be selected with one or more agents active against likely bacterial or fungal pathogens and with good penetration into the presumed source. Antimicrobial therapy should be reevaluated daily to optimize efficacy, prevent resistance, avoid toxicity, and minimize costs. Consider combination therapy in Pseudomonas infections, and combination empiric therapy in neutropenic patients. Combination therapy should be continued for no more than 3 to 5 days and deescalation should occur following availability of susceptibilities. The duration of antibiotic therapy typically is limited to 7 to 10 days; longer duration is considered if response is slow, if there is inadequate surgical source control, or in the case of immunologic deficiencies. Antimicrobial therapy should be stopped if infection is not considered the etiologic factor for a shock state.

The history and evolution of circulatory shock.

This article reviews the development of early ideas regarding the origins and pathogenesis of shock. The early history of shock is related primarily to traumatic shock. More recent history centers on differentiation of clinical syndromes and individual characteristics. Definitions, classification systems, pathogenic theories, and treatments have evolved. Progress has been aided by constant development of improved assessment technologies. Today, shock is not a single syndrome and the definition of shock no longer is descriptive in nature. The most accepted current definition involves an oxygen supply/demand imbalance that can have various causes-hypovolemia, cardiac dysfunction, vascular failure, or obstructive processes.

Case of the month: Honey I glued the kids: tissue adhesives are not the same as "superglue".

A case of a father who treated his child's facial laceration with the home supply of "superglue" having been previously misinformed that superglue is used to treat lacerations is presented. The differences between tissue adhesive and superglue are described and suggest that emergency staff should be careful to avoid using the term "superglue" when using tissue adhesives.

Doppler study of splanchnic hemodynamics in Hirschsprung's disease.

BACKGROUND: Doppler studies of splanchnic vessels have demonstrated alteration in blood flow in bowel obstruction and strangulation. The aim of this study was to evaluate hemodynamic changes in celiac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) using pulsed Doppler sonography (PDS) in Hirschsprung's disease. MATERIAL AND METHODS: Fasting splanchnic flowmetry of CA, SMA, and IMA arteries was performed using PDS preoperatively in 13 patients with Hirschsprung's disease and 13 healthy age- and sex-matched controls. Diagnostic workup for Hirschsprung's disease included a barium enema and a rectal biopsy. A primary transanal pull through was performed if the transition zone was at rectosigmoid or midsigmoid. Doppler studies were repeated on the 1st and 7th postoperative day under similar conditions. Mean flow velocity (V(mean)) and the pulsatility index (PI) of the three major vessels was measured. RESULTS: Patients with Hirschsprung's disease showed increased blood flow velocities in CA, SMA, and IMA (p < 0.001), an increased resistance to blood flow in IMA (p < 0.001) and a decreased resistance to blood flow in CA and SMA (p < 0.005 and p < 0.001, respectively). The blood flow velocity for IMA normalized after resection of the aganglionic segment (r = 0.41, p < 0.005, 95% CI: 45.4-52.7). CONCLUSIONS: Hirschsprung's diseaseis associated with alterations in splanchnic vessel hemodynamics which are reversible after corrective surgery. Doppler studies may play an important role in the assessment of bowel function after surgery.

Application of a plain abdominal radiograph transition zone (PARTZ) in Hirschsprung's disease.

BACKGROUND: A standard contrast enema for Hirschsprung's disease can sometimes be inconclusive in delineating a transition zone especially in neonates and infants. The aim of this study was to determine the utility and diagnostic accuracy of a plain abdominal radiograph transition zone (PARTZ) in predicting the level of aganglionosis. METHODS: A prospective observational study of neonates and infants with biopsy proven Hirschsprung's disease was carried out from March 2004 through March 2006. All patients underwent a plain abdominal radiograph and a contrast enema followed by a rectal biopsy. The transition zone on a plain radiograph (PARTZ) and contrast enema (CETZ) were compared with operative and pathology reports. Results were analyzed by chi square test and expressed as their p values and 95% confidence intervals. RESULTS: PARTZ and CETZ suggestive of Hirschsprung's disease was seen in 24(89%) and 18(67%) patients respectively. The PARTZ and CETZ matched with the pathologic level of transition zone in 22(92%) and 13(72%) patients, p = 0.001, 95% CI (-1.87 to -0.79). In the 9 (33%) patients in whom contrast enema failed to reveal a transition zone, PARTZ was seen in 6/9(66%) patients and correlated with the pathological level of aganglionosis in 4/6(67%) patients, p = 0.001 95% CI (-1.87 to -0.79). The overall accuracy of PARTZ and CETZ was 96% and 84% respectively, p = 0.008, 95% CI (-6.09 to -3.6). CONCLUSION: A plain abdominal radiographic transition zone is reliable in predicting the level of transition zone in cases of inconclusive contrast enema. It may be particularly helpful developing countries where laparoscopic techniques are not available to accurately identify the transition zone.

Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana.

UNLABELLED: Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW. OBJECTIVE: The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area. METHODS: A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-Immuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 microg/dl, 80.0 microg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology. RESULTS: Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies. CONCLUSION: There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.