Abnormal heart rate pattern in fetal anaemia secondary to transient abnormal myelopoeisis in a fetus without trisomy 21: A case report.

Decreased fetal movements (DFM) are a non-specific and common symptom in the third trimester of pregnancy that hold an association with fetal compromise. A 28-year-old woman at 31 weeks and 3 days of gestation presented with DFM and was found to have a pathological fetal heart rate trace. Following emergency Caesarean section the fetus was diagnosed with transient abnormal myelopoeisis (TAM). Timely treatment was initiated and the neonatal outcome was good. Transient myeloproliferative disorders are almost uniquely found in infants with trisomy 21 (T21). This is the first case report of TAM in the absence of T21 wherein the diagnostic process was commenced antenatally due to non-reassuring fetal status and highlights the importance of antenatal heart rate abnormalities.

Ruptured ectopic molar pregnancy and ruptured uterine fibroid: a challenging rare diagnosis.

Although rare and unusual occurrences, a ruptured ectopic molar pregnancy (MP) and a ruptured uterine fibroid can lead to significant maternal morbidity and mortality. We present a unique case of these complications developing concurrently-resulting in the haemodynamic compromise of an otherwise healthy young female patient. The patient underwent a diagnostic laparoscopy which converted into a laparotomy, salpingectomy and myomectomy. Comprehensive histopathology confirmed the diagnosis of a ruptured ectopic complete MP and ruptured uterine fibroid. The patient recovered quickly within days. Prompt definitive management, conclusive histopathology and adequate follow-up were the hallmarks of this singular case. These key factors lead to the rare diagnosis of ruptured ectopic MP and uterine fibroid, prevention of adverse outcomes and provision of comprehensive patient care.

An immunoinformatics and structural vaccinology study to design a multi-epitope vaccine against Staphylococcus aureus infection.

Staphylococcus aureus has been widely reported to be majorly responsible for causing nosocomial infections worldwide. Due to an increase in antibiotic-resistant strains, the development of an effective vaccine against the bacteria is the most viable alternative. Therefore, in the current work, an effort has been undertaken to develop a novel peptide-based vaccine construct against S aureus that can potentially evoke the B and T cell immune responses. The fibronectin-binding proteins are an attractive target as they play a prominent role in bacterial adherence and host cell invasion and are also well conserved among rapidly mutating pathogens. Therefore, highly immunogenic linear B lymphocytes (LBL), cytotoxic T lymphocytes (CTL), and helper T lymphocytes (HTL) epitopes were identified from the antigenic fibronectin-binding proteins A and B (FnBPA and FnBPB) of S aureus using immunoinformatics approaches. The selected peptides were confirmed to be non-allergenic, non-toxic, and with a high binding affinity to the majority of human leukocyte antigens (HLA) alleles. Consequently, the multi-peptide vaccine construct was developed by fusing the screened epitopes (three LBL, five CTL, and two HTL) together with the suitable adjuvant and linkers. In addition, the tertiary conformation of the peptide construct was modeled and later docked to the Toll-like receptor 2. Subsequently, a molecular dynamics simulation of 100 ns was employed to corroborate the stability of the designed vaccine-receptor complex. Besides exhibiting high immunogenicity and conformational stability, the developed vaccine was observed to possess wide population coverage of 99.51% worldwide. Additional in vivo and in vitro validation studies would certainly corroborate the designed vaccine construct to have improved prophylactic efficacy against S aureus.

Development of a Conserved Chimeric Vaccine for Induction of Strong Immune Response against Staphylococcus aureus Using Immunoinformatics Approaches.

Staphylococcus aureus is one of the most notorious Gram-positive bacteria with a very high mortality rate. The WHO has listed S. aureus as one of the ESKAPE pathogens requiring urgent research and development efforts to fight against it. Yet there is a major layback in the advancement of effective vaccines against this multidrug-resistant pathogen. SdrD and SdrE proteins are attractive immunogen candidates as they are conserved among all the strains and contribute specifically to bacterial adherence to the host cells. Furthermore, these proteins are predicted to be highly antigenic and essential for pathogen survival. Therefore, in this study, using the immunoinformatics approach, a novel vaccine candidate was constructed using highly immunogenic conserved T-cell and B-cell epitopes along with specific linkers, adjuvants, and consequently modeled for docking with human Toll-like receptor 2. Additionally, physicochemical properties, secondary structure, disulphide engineering, and population coverage analysis were also analyzed for the vaccine. The constructed vaccine showed good results of worldwide population coverage and a promising immune response. For evaluation of the stability of the vaccine-TLR-2 docked complex, a molecular dynamics simulation was performed. The constructed vaccine was subjected to in silico immune simulations by C-ImmSim and Immune simulation significantly provided high levels of immunoglobulins, T-helper cells, T-cytotoxic cells, and INF-γ. Lastly, upon cloning, the vaccine protein was reverse transcribed into a DNA sequence and cloned into a pET28a (+) vector to ensure translational potency and microbial expression. The overall results of the study showed that the designed novel chimeric vaccine can simultaneously elicit humoral and cell-mediated immune responses and is a reliable construct for subsequent in vivo and in vitro studies against the pathogen.

Next-Generation Bioinformatics Approaches and Resources for Coronavirus Vaccine Discovery and Development-A Perspective Review.

COVID-19 is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To fight this pandemic, which has caused a massive death toll around the globe, researchers are putting efforts into developing an effective vaccine against the pathogen. As genome sequencing projects for several coronavirus strains have been completed, a detailed investigation of the functions of the proteins and their 3D structures has gained increasing attention. These high throughput data are a valuable resource for accelerating the emerging field of immuno-informatics, which is primarily aimed toward the identification of potential antigenic epitopes in viral proteins that can be targeted for the development of a vaccine construct eliciting a high immune response. Bioinformatics platforms and various computational tools and databases are also essential for the identification of promising vaccine targets making the best use of genomic resources, for further experimental validation. The present review focuses on the various stages of the vaccine development process and the vaccines available for COVID-19. Additionally, recent advances in genomic platforms and publicly available bioinformatics resources in coronavirus vaccine discovery together with related immunoinformatics databases and advances in technology are discussed.

Prelacteal feeding practice and maintenance of exclusive breast feeding in Bihar, India - identifying key demographic sections for childhood nutrition interventions: a cross-sectional study.

Background:  Exclusive breastfeeding (EBF) during the first six months of life is considered a high impact, but low-cost, measure for improving nutritional status, and reducing morbidity and mortality among children. However, providing prelacteal feed to a newborn, a widely practiced custom in rural India, is a major barrier to the practice of EBF.  The present study evaluated the association between provision of prelacteal feeding and continuation of EBF among children up to 3 months age in Bihar, a resource-poor Indian state. Methods: Data from four rounds of a population-based multi-stage sampling survey, conducted in 8 districts of Bihar between 2012 and 2013, were used for the present analysis. Using simple and adjusted logistic regression modelling, we tested the association of providing prelacteal feeding with two outcome measures - 1) giving only breastmilk during the last 24 hours, and 2) exclusively breastfed (EBF) since birth (excluding the first 3 days of life). Results: Among 10,262 children for whom prelacteal feeding data was available, 26% received prelacteal feeding. About 55% mothers reported that their children were exclusively breastfed, whereas 82% mothers provided only breastmilk to their children during the previous 24 hours. Children who received prelacteal feeding had approximately 60% lesser odds of being breastfed exclusively during the previous 24 hours [AOR = 0.39(0.33-0.47)] and 80% lesser odds of receiving continued EBF since birth [AOR = 0.20(0.17-0.24)]. Conclusions: Frontline workers (FLW) provide nutritional counselling to mothers and children of rural India. In order to improve uptake of EBF, the families practicing prelacteal feeding should be identified early and educated on the harmful effects of prelacteal feeding for EBF and subsequently on infant health. Midwives/nurses at the public and private facilities as well as the home birth attendants should also be made aware about the negative effects of prelacteal feed.

The Influence of Seasonality and Community-Based Health Worker Provided Counselling on Exclusive Breastfeeding - Findings from a Cross-Sectional Survey in India.

BACKGROUND: Exclusive breastfeeding (EBF) during the first six months of life is considered a high impact but low-cost measure for reducing the morbidity and mortality among children. The current study investigated the association of seasonality and frontline worker(FLW) provided counselling with practice of EBF in Bihar, India. METHODS: We used the 'Lot Quality Assurance Sampling' technique to conduct a multi-stage sampling survey in 8 districts of Bihar. Regarding EBF, mothers of 0-5 (completed) months old children were asked if they had given only breastmilk to their children during the previous day, while mothers of 6-8 (completed) months old children were inquired about the total duration of EBF. We tested for association between EBF during the previous day with season of interview and EBF for full 6 months with nursing season. We also assessed if receiving counselling on EBF and complementary feeding had any association with relevant EBF indicators. RESULTS: Among the under-6 month old children, 76% received EBF during the previous day, whereas 92% of 6-8 (completed) months old children reportedly received EBF for the recommended duration. Proportion of 0-5 (completed) month old children receiving only breastmilk (during last 24 hours) decreased significantly with increasing age and with change of season from colder to warmer months. Odds of receiving only breastmilk during the previous day was significantly higher during the winter months (Adjusted odds ratio(AOR) = 1.50; 95% CI = 1.37, 1.63) compared to summer. Also, the children nursed primarily during the winter season had higher odds of receiving EBF for 6 months (AOR = 1.90, 95% CI = 1.43, 2.52) than those with non-winter nursing. Receiving FLW-counselling was positively associated with breastfeeding exclusively, even after adjusting for seasonality and other covariates (AOR = 1.82; 95% CI = 1.67, 1.98). CONCLUSIONS: Seasonality is a significant but non-modifiable risk factor for EBF. However, FLW-counselling was found to increase practice of EBF irrespective of season. Scale-up of FLW-counselling services, with emphasis on summer months and mothers of older infants, can potentially reduce the impact of seasonality on EBF.

Continuum of Care Services for Maternal and Child Health using mobile technology - a health system strengthening strategy in low and middle income countries.

BACKGROUND: Mobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector is becoming popular rapidly in these countries. To assess the effectiveness of the Continuum of Care Services (CCS) mHealth platform in terms of strengthening the delivery of maternal and child health (MCH) services in a district in Bihar, a resource-poor state in India. METHODS: The CommCare mHealth platform was customized to CCS as one of the innovations under a project funded by the Bill and Melinda Gates Foundation to improve the maternal and newborn health services in Bihar. The intervention was rolled out in one project district in Bihar, during July 2012. More than 550 frontline workers out of a total of 3000 including Accredited Social Health Activists, Anganwadi Workers, Auxilliary Nurse Midwives and Lady Health Supervisors were trained to use the mHealth platform. The service delivery components namely early registration of pregnant women, three antenatal visits, tetanus toxoid immunization of the mother, iron and folic acid tablet supply, institutional delivery, postnatal home visits and early initiation of breastfeeding were used as indicators for good quality services. The resultant coverage of these services in the implementation area was compared with rest of Bihar and previous year statistics of the same area. The time lag between delivery of a service and its record capture in the maternal and child tracking system (MCTS) database was computed in a random sample of 16,000 beneficiaries. The coverage of services among marginalized and non-marginalized castes was compared to indicate equity of service delivery. Health system strengthening was viewed from the angle of coverage, quality, equity and efficiency of services. RESULTS: The implementation blocks had higher coverage of all the eight indicator services compared to rest of Bihar and the previous year. There was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting. CONCLUSION: By virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.

Ecofriendly biosorption of dyes and metals by bacterial biomass of Aeromonas hydrophila RC1.

The ability of dried bacterial biomass in azo dye and heavy metal removal from aqueous solution was explored. Biosorption of three textile dyes, Eriochrome black T (EBT), Acid Red 26 (AR) and Trypan blue (TB) and heavy metals (Pb and Cr) by dried biomass of Aeromonas hydrophila RC1, was investigated in a batch system under various parameters such as dye concentration, contact time, concentration of biomass, pH, and temperature. The experimental results showed that the extent of biosorption for dyes increased with increase in initial concentration of dyes, biomass concentration, contact time, temperature and decreased with increase in pH. The experimental isotherms data were analyzed using Langmuir and Freundlich isotherm equations. The Langmuir model yielded good fit to the experimental data (R² approximately 0.794, 0.844 and 0.969 for the dyes, EBT, AR and TB, respectively) with maximum monolayer adsorption capacity of 58.8 mg g⁻¹ for AR. Similarly results were obtained for heavy metals and the data fit in Langmuir model (R² value of 0.849 and 0.787) with q(m) value of 40 mg g⁻¹ for Pb. The results fit in pseudo first order kinetics with removal upto 96.67 % for Pb. Involvement of the surface characteristics of the biomass in biosorption was studied using scanning electron micrographs, FTIR, EDX and XRD analysis. Thus, use ofA. hydrophila RC1 biomass can be extensively employed in water treatment plants in order to get desired water quality in the most economical way.

Dietary vitamin, mineral and herbal supplement use: a cross-sectional survey of before and during pregnancy use in Sydney, Australia.

AIM: To describe the use of dietary vitamin, mineral and herbal supplements before and during pregnancy. MATERIALS AND METHODS: Pregnant women attending for antenatal care at two tertiary Sydney hospitals between January and March 2014 completed an anonymous survey. Information on general maternal and pregnancy characteristics and the use of dietary and herbal supplements, including type, duration and sources of information, was collected. Frequency and contingency tabulations were performed. RESULTS: A total of 612 women agreed to participate (91% response rate). Of 589 women included in the analysis, mean gestational age at the time of survey was 28.5 weeks (SD 8.3), 55% had no children, and 67% were tertiary-educated. Overall, 62.9% of women reported taking a multivitamin (MV) and/or folic acid (FA) supplement in the 3 months prepregnancy, and 97.5% took a MV and/or FA in the first trimester. At the time of the survey, 93.8% of women were taking at least one supplement (median 2, range 1-13). During pregnancy, 79.1% of women were taking MVs, including 59.2% taking MV only and 19.9% taking MV and FA. The five most common supplements outside of a MV were FA (31%), iron (30%), vitamin D (23%), calcium (13%) and fish oil (12%). Reported herbal supplement rates were low. CONCLUSION: Folic acid, MVs and other supplements use during and prepregnancy is relatively high, although prepregnancy FA supplementation rates could still be improved. Further research on the actual dosages and dietary intakes consumed is needed to examine whether pregnant women have adequate intake of nutrients, regardless of supplement use.

Iron supplement use in pregnancy - Are the right women taking the right amount?

OBJECTIVES: To examine the prevalence and determinants of iron supplement use and the amount of iron consumed from iron-containing supplements. METHODS: A cross-sectional survey was performed in antenatal clinics in two tertiary hospitals in Sydney, Australia between January and March 2014. RESULTS: Of 612 (91% response rate) pregnant women, 589 with complete data were analysed. Overall iron-containing supplement use was 88.0%, of which 70.1% was multivitamin (MV) only, 7.2% was iron-only and 22.2% was both. Use of iron-containing supplements was associated with increased gestational age, a diagnosis of anaemia or iron deficiency (ID) in the current pregnancy and pre-pregnancy use of an iron-containing supplement. Several risk factors for ID or anaemia such as non-red meat eating and previous miscarriage were not associated with current iron supplement use. About 65% of women diagnosed with ID, and 62.3% of women diagnosed with anaemia were taking an iron-only supplement, with or without a MV. The proportion of women consuming low (<30), preventative (30-99) and treatment (≥100) mg/day doses were 36.8%, 45.4%, and 17.8%, respectively. Only 46.7% of women diagnosed with ID were taking ≥100 mg/day iron from supplements, while 23.3% were taking <30 mg/day. CONCLUSION: Women are consuming varying doses of iron and some high-risk women are taking inadequate doses of iron to prevent or treat ID or iron deficiency anaemia. Healthcare professionals are best positioned to advise women on iron supplement use in pregnancy and should educate women individually about the type and dose of supplement best suited to their needs.

Electrowetting of partially wetting thin nanofluid films.

It is observed that the presence of negatively charged, suspended nanoparticles significantly changes the electric-field-induced spreading and contact line dynamics of partially wetting liquid films. Image-analyzing interferometry is used to accurately measure the meniscus profile, including the spatial change in the meniscus curvature. The nanoparticle-containing meniscus exhibits enhanced spreading with an increase in the particle size and weight fraction. The instantaneous contact line velocities are measured using video microscopy and a frame-by-frame analysis of the extracted images. The effects of electric field polarity reversal on the flow toward the contact line are explored as well. The movement of the meniscus is analyzed taking into account the capillary forces and Maxwell-stress-induced flows. An analytical model based on the Young-Laplace equation is used to analyze the electric-field-induced contact line motion, and the model-predicted velocities are compared to the experiments.