UNDERSTANDING THE LONG-TERM INTERPLAY BETWEEN GLUCOCORTICOIDS, PARATHYROID HORMONE LEVELS, AND OSTEOPOROSIS IN PATIENTS.

Drugs called glucocorticoids (GC) are often prescribed for both inpatient and outpatient settings. They are often used to treat a number of disorders due to their anti-inflammatory activity. Long-term use of GCs, especially long-term high-dose administrations, may result in a variety of negative effects. In Hilla City, Babylon Governorate of Iraq, Merjan Teaching Hospital, Al-Hilla Teaching Hospital's Joint Enology Clinic, and Al-Imam Al-Sadiq Hospital, were the sites of this case-control research, which was carried out. There were 100 total participants in this trial, of whom 50 were patients with osteoporosis (OP). The ages of the patients and the control collection were. They were chosen since their gender and ages matched. The findings show extensively senior level of parathyroid hormone (PTH) in OP patients when compared to the control group, whereas calcium (Ca) level into the patient group significantly lowered during association toward the manage set. In summary, there is a positive correlation between PTH and the condition of bone mineralization. In those who use GCs for a long time, PTH may be used as a prognostic marker to predict when bone mineral abnormalities would develop.

Improved cellulase production by Botryosphaeria rhodina from OPEFB at low level moisture condition through statistical optimization.

The response surface method was applied in this study to improve cellulase production from oil palm empty fruit bunch (OPEFB) by Botryosphaeria rhodina. An experimental design based on a two-level factorial was employed to screen the significant environmental factors for cellulase production. The locally isolated fungus Botryosphaeria rhodina was cultivated on OPEFB under solid-state fermentation (SSF). From the analysis of variance (ANOVA), the initial moisture content, amount of substrate, and initial pH of nutrient supplied in the SSF system significantly influenced cellulase production. Then the optimization of the variables was done using the response surface method according to central composite design (CCD). Botryosphaeria rhodina exhibited its best performance with a high predicted value of FPase enzyme production (17.95 U/g) when the initial moisture content was at 24.32%, initial pH of nutrient was 5.96, and 3.98 g of substrate was present. The statistical optimization from actual experiment resulted in a significant increment of FPase production from 3.26 to 17.91 U/g (5.49-fold). High cellulase production at low moisture content is a very rare condition for fungi cultured in solid-state fermentation.

Size at birth is associated with blood pressure but not insulin resistance in 6-8 year old children in rural Nepal.

Earlier, we reported that antenatal micronutrient supplementation reduced the risk of metabolic syndrome and microalbuminuria among offspring at 6-8 years of age in rural Nepal. In the same birth cohort, we examined associations of size at birth (weight, length and ponderal index), and gestational age, with cardiometabolic risk factors in childhood across all antenatal micronutrient interventions. There was an inverse association between birth weight and systolic blood pressure (SBP, ß = -1.20 mm Hg/kg; 95% confidence interval (CI): -1.93, -0.46) and diastolic blood pressure (DBP, ß = -1.24 mm Hg/kg; 95% CI: -2.00, -0.49). Current child body mass index was positively associated with SBP but not with DBP. Birth weight was unassociated with insulin resistance, but each kilogram of increase was associated with a reduced risk of high triglycerides (odds ratio (OR) = 0.64/kg; 95% CI: 0.41, 0.97) and an increased risk of high waist circumference (OR = 3.16/kg; 95% CI: 2.47, 4.41). In this rural Nepalese population of children 6-8 years of age with a high prevalence of undernutrition, size at birth was inversely associated with blood pressure and triglycerides and positively associated with waist circumference.

Evaluation of the functional equivalence of crospovidone NF from different sources. II. Standard performance test.

Current NF monographs do not provide tests that reflect on the functionality of Crospovidone NF from multiple sources. Physical characterization studies such as particle size and distribution, surface area, porosity, and surface morphology revealed major differences among the crospovidones from different sources (Shah, U.; Augsburger, L.L. J. Pharm. Dev. Technol. 2001, 6 (1), 39-51). Differences in disintegration and dissolution were also observed for a model drug in an insoluble filler system (see Shah and Augsburger, 2001). The objective of this study was to determine the relationship between physical differences observed and disintegrant functionality and to develop standard performance test. Tests performed included settling volume studies, measurement of initial rate as well as extent of liquid uptake of the loose disintegrant powder, and simultaneous measurement of the axial and radial disintegrating forces along with the rate and extent of liquid uptake of the pure disintegrant compacts. Significant differences among the crospovidones were observed for all tests performed. Settling volume, liquid uptake, and disintegration force are recommended as standard performance tests to determine differences among crospovidones from different sources.

Maternity care in rural Nepal: a health service analysis.

This study assesses the performance of maternity care and its specific service components (preventive interventions in antenatal care, antenatal screening, referral, obstetric care) in Banke District, Nepal, using a set of structure, process, and output/outcome indicators. Data sources included health service documents in 14 first level health units and two hospitals, covering 1378 pregnancies and 1323 deliveries, structured observations, antenatal exit interviews (n = 136) and interviews with maternity users (n = 146). Coverage of antenatal care (28%) and skilled delivery care (16%) was low. In antenatal care, preventive interventions were only partially implemented (effective iron supplementation in 17% of users). On average one minute was spent on individual counselling per consultation. 41% of pregnancies were identified as high risk and 15% received referral advice, which was followed in only 32%. Hospital deliveries accounted for 9.8% of all deliveries. Hospital-based maternal mortality was 6.8/1000 births and the stillbirth rate 70/1000. High rates of stillbirth were observed in breech delivery (258/1000 births), caesarean section (143/1000) and twin delivery (133/1000). The risk of stillbirth was higher for rural women (RR 2.3; 95% CI 1.51-3.50) and appeared to be related to low socio-economic status. Emergency admissions were rare and accounted for 3.4% of hospital deliveries or only 0.4% of all expected deliveries. There was hardly any accumulation of high-risk pregnancies at hospital. The population-based rate of caesarean section was 1.1% (urban 2.3%, rural 0.2%). The estimated unmet obstetric need was high (82 cases or 61% of expected live-threatening maternal conditions did not receive appropriate intervention). The limited effectiveness of maternity care is the result of deficiencies of all service components. We propose a two-pronged approach by starting quality improvement of maternity care from both ends of maternity services: preventive interventions for all women and hospital-based obstetric care. Antenatal screening needs to be rationalized by reducing inflated risk catalogues that result in stereotypical and often rejected referral advice.

Improving neonatal care: women as health providers.

PIP: In a project in India, women play a major role in efforts to provide pregnant women with prenatal care, safe deliveries and reduce perinatal mortality. Undertaken in 1986 with the support of the Ford Foundation and the State government of Tamil Nadu in the Kanchipuam district, it demonstrates the feasibility of establishing a low-cost neonatal care unit at a rural district hospital to make services for neonates accessible to families living in the surrounding rural areas. Design of the project was based on changes implemented at a government hospital used for training medical staff, the Institute of Child Health in Madras, where mothers were admitted with their babies to provide dad-to-day care. While the new unit, which contained 10 cots, was prepared, training was given to a range of health providers including medical officers, pediatricians, obstetricians, nursing personnel and paramedical staff from the rural hospital by a neonatologist and a medical officer trained in neonatology. Anganwadi workers (local women who ran the preschool child care centers) who had completed high school were selected to be trained as a new category of workers called neonatal nursing aides. Month long initial training and refresher courses were given. Operations were begun in July 1987 and referral links established to the district hospital from the subcenter and primary health center levels. A project extension team undertook a neonatal morbidity and mortality survey covering a population of 10,000 in the 2 subcenter areas as well as information on traditional practices of neonatal care to identify harmful practices. TBAs in the population conduct 53.9% of deliveries, auxiliary nurse midwives/multipurpose workers 13.2% and doctors 20%. Home delivery was the major mode. Current training for TBAs was reviewed and shifted from the primary health center to the hospitals to give experience with complicated cases and the results of traditional practices These practices were modified and the TBAs helped put together a kit for their own use. Several were observed in the field following training and showed improved care and knowledge.^ieng

Risk-approach strategy in neonatal care.

PIP: This study applied a risk-approach strategy involving extra care to at-risk neonates by optimum utilization of existing resources to a cohort of newborns in rural India. Included in the analysis were all births in the study population of 47,000 people in 22 villages in 1981-82. 5 risk factors were identified (low birth weight and small size, preterm birth, feeding problem, illness, and history of prolonged and difficult labor). A management plan was developed for individual risks, and 40 community health workers were trained to implement these plans. During the 2-year study period, 851 newborns (28%) were designated as at-risk and adequate intervention was possible in 412 cases (48%). Neonatal mortality declined from 51.9 to 38.8/1000 live births between 1981 and 1982. The neonatal mortality rate was significantly higher among the infants designated as at-risk and increased with the number of risk factors present simultaneously. Neonatal mortality was highest among infants with feeding problems (439.2/1000) and illness (471.4/1000). 42% of neonatal deaths were related to low birth weight and associated complications; another 20% resulted from neonatal infections and 18% from asphyxia at birth. The neonatal mortality rate for the adequately intervened group (89.8/1000) was significantly lower than that for the group with inadequate intervention (200.5/1000). 92% of neonatal deaths occurred in 28% of the newborns who formed the at-risk groups. It is concluded that this strategy is effective and could be applied in rural areas with similar problems. Continued training of community health workers, greater cooperation with families through health education, and meetings with local leaders and traditional birth attendants are recommended to facilitate identification of at-risk neonates.^ieng

Pyrido[3',2':4,5]thieno[3,2-d]-N-triazines: a new series of orally active antiallergic agents.

A new series of orally active mediator release inhibitors, pyrido[3',2':4,5]thieno[3,2-d]-N-triazines, was synthesized and evaluated for antiallergic activity. Several products showed high activity as inhibitors or wheal information in the rat passive cutaneous anaphylaxis screen and as inhibitors of histamine release from passively sensitized rat mast cells. Many compounds were orally active in the PCA test. The most potent compound, 7-phenylpyrido-[3',2':4,5]thieno[3,2-d]-1,2,3-triazin-4(3H)- one (10) with an I50 value of 0.05 microM, was 60 times more potent than disodium cromoglycate (DSCG) in the RMC assay.

Perinatal mortality in rural India: a strategy for reduction through primary care. I Stillbirths.

In a prospective community based study of the distribution and determinants of stillbirths in a rural area of Maharashtra, India, that was carried out for two years, 3129 singleton and 22 twin births were recorded in a population of 47 000. Of the 3173 babies, 85 singletons and five of the twins were stillborn giving a stillbirth rate of 28.4/1000 births. The causes of stillbirths are analysed and the possibility of reducing the unacceptably high stillbirth rate by adequate training of grassroot level workers in screening pregnant women for detection of "at risk" mothers and their timely referral is discussed.

Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74% of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk" neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed.