Indian Academy of Pediatrics Consensus Guidelines on Preconception Care.

JUSTIFICATION: The preconception period is the earliest window of opportunity to ensure optimal human development.  Pregnancy and childbirth outcomes can be improved by interventions offered to support the health and well-being of women and couples prior to conception. Thus, preconception care is essential in preparing for the first thousand days of life. Adolescence, the stage of life that typically comes before the preconception stage, is characterized by various high-risk behaviors like substance abuse, sexual experimentation, injuries, obesity, and mental health issues which can adversely affect their health in adult life. Thus, a Consensus Guideline for pediatricians on providing preconception care to adolescents and young adults can go a long way in making the generations to come, healthier and more productive. OBJECTIVES: The purpose of these recommendations is to formulate an evidence-based Consensus Statement that can serve as a guidance for medical professionals to provide preconception care for young adults and adolescents. INTENDED USERS: All obstetric, pediatric, and adolescent health care providers. TARGET POPULATION: Adolescents and young adults. PROCESS: A large proportion of adolescents seek care from pediatricians and there is a lack of Consensus Guidelines on preconception care. Therefore, the Indian Academy of Pediatrics called an online National Consultative Meeting on April 03, 2023, under the chairmanship of Dr MKC Nair and the National Convenor Dr Himabindu Singh. A group of pediatricians with wide experience and expertise in adolescent health care were assigned the task of formulating evidence-based guidelines on preconception care. The group conducted a comprehensive review of existing evidence by searching resources including PubMed and Cochrane databases. Subsequently, a physical meeting was held at Amritsar on October 07, 2023 during which the consensus was reached through discussions and voting. The level of evidence (LoE) of each recommendation was graded as per the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011. RECOMMENDATIONS: Every woman planning a pregnancy needs to attain and maintain a eumetabolic state. Prospective couples need to be counselled on the importance of a healthy lifestyle including a nutritious diet, avoidance of substance abuse, and timely screening for genetic disorders. Screening for and management of sexually transmitted diseases in males and females, appropriate vaccination and addressing mental health concerns are also recommended.

Prevalence of Non-Alcoholic Fatty Liver Disease in Urban Adult Population in a Tertiary Care Center, Chennai.

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common liver diseases among the Indian population. The predisposing factors for NAFLD are diet, lifestyle modifications, and lack of exercise. There is a paucity of research on NAFLD in the South Indian population. Hence, the present study aimed to assess the prevalence of NAFLD among the urban adult population in Chennai. Material and Methods: This analytical cross-sectional study was conducted in General Medicine outpatient departments at a tertiary care center in Chennai. The study included 510 non-alcoholic adults (both male and female) aged between 21 and 40 years. Ultrasonography was performed to rule out fatty liver in all participants. All the results obtained were statistically analyzed using SPSS software version 22.0. The frequency was given in percentage. Results: The proportion of participants who screened positive for NAFLD was 61.5%. The participants with higher body mass index (BMI) were found to be significantly 23.09 times higher risk of developing NAFLD. An increase in age was also found to be a predictor of NAFLD. This study also supports that males are more prone to develop NAFLD and are at a 1.59% higher risk of developing the disease than females. Conclusion: Fatty liver has become one of the common non-communicable diseases in India, the high prevalence of NAFLD in the present study supports it. Therefore, people should have regular screening and diagnosis to rule out fatty liver disease. Proper diet patterns and exercise must be followed to prevent fatty liver.

Study to Determine a Prognostic Cutoff Values of the Coagulation Analyte D-dimer for ICU Admission among COVID-19 Patients.

Introduction: The measured D-dimer levels in coronavirus disease-2019 (COVID-19) patients have no specific cutoff to find the progression of coagulopathy and severity. Aim: This study aimed to determine prognostic cutoff values of D-dimer for intensive care unit (ICU) admission among COVID-19 patients. Materials and methods: This cross-sectional study was conducted in Sree Balaji Medical College and Hospital, Chennai, during a period of 6 months. This study included 460 COVID-19-positive individuals. Results: The mean age was 52.2 ± 12.53 years. Patients with mild illness have D-dimer value 461.8 ± 221, whereas moderate and severe COVID illness patients have D-dimer values of 1915.2 ± 699.9 and 7937.6 ± 2045.2, respectively. D-dimer cutoff value of 1036.9 is shown to be a prognostic cutoff value for COVID-19 patients admitted in the ICU with 99% sensitivity and 17% specificity. The area under curve (AUC) was considered excellent (AUC = 0.827, 95% Cl: 0.78-0.86, p-value < 0.0001) indicative of high sensitivity. Conclusion: The D-dimer value of 1036.9 ng/mL was found to be the optimum cutoff for the patients to predict the severity of the COVID-19-positive patients admitted in the ICU. How to cite this article: Anton MC, Shanthi B, Vasudevan E. Study to Determine a Prognostic Cutoff Values of the Coagulation Analyte D-dimer for ICU Admission among COVID-19 Patients. Indian J Crit Care Med 2023;27(2):135-138.

Comparison of Microalbuminuria Status in Type 2 Diabetes Mellitus Patients With Chronic Periodontitis: A Cross-Sectional Study.

Background Diabetes has increased the risk for various other ailments in various organs of the body. This can be contributing to periodontitis also as it is the sixth complication related to diabetes mellitus. There is a bidirectional relationship between both. Given the high global prevalence of type-2 diabetes mellitus (T2DM) with periodontitis, it is of great importance to determine the link between periodontitis and microalbuminuria in T2DM patients, which shows early renal disease. Methodology In the present study, a total of 500 patients having T2DM were assessed for periodontitis using Community Periodontal Index (CPI). Anthropometric and biochemical measurements were obtained. Blood samples were estimated for glycemic control tests such as fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and lipid profile. The subjects who participated in the study were categorized into three groups depending on the albuminuria level. The data were tabulated and analyzed using SPSS Statistics software (IBM Corp., Armonk, USA). Results Out of 500 T2DM subjects, 342 subjects had periodontitis. A statistically significant difference was found in FPG, HbA1c, total cholesterol (TC), triglycerides, and low-density lipoprotein (LDL) between subjects with periodontitis and without periodontitis using a t-test (p = <0.001). The prevalence of normoalbuminuria, micro-, and macroalbuminuria among periodontitis patients was 24.6%, 72.8%, and 2.6% respectively, and the Chi-square analysis revealed that was highly significant. In terms of albuminuria, one-way analysis of variance (ANOVA) revealed statistically significant differences among the periodontitis subjects for the following variables: inputs such as the number of teeth, diabetes mellitus (DM) duration, the level of LDL, and also the depth of the pocket. Intergroup comparison of variables among subjects with albuminuria using the statistical test of Tukey Post Hoc found that there is a significant difference between normoalbuminuria and microalbuminuria. CPI score, tooth mobility, smoking, education level, family income, tooth brushing duration, along with the use of other dental hygiene aids was also found to be statistically significant among subjects with periodontitis. Conclusion The study concluded that T2DM patients had a higher incidence of microalbuminuria among individuals with periodontitis. These subjects also had significantly higher HbA1c and FPG levels than subjects with normoalbuminuria. In addition, subjects with periodontitis exhibited a significant reduction in the total teeth numbers present in the case of albuminuria. The longitudinal correlation between DM, microalbuminuria, and periodontitis could be further investigated in detail to explore possible pathways.

Targeting Ovarian Solid Tumors by Elastin-Like Polypeptide Drug Conjugates: Current Trends and Future Prospectives.

BACKGROUND: Ovarian cancer is one of the leading causes of death worldwide. Polymers have low cytotoxicity and high functionalizability and are hence used for drug delivery systems, tissue engineering, and polymer therapeutics. In drug delivery systems, polymer-drug conjugates have shown considerable promise, especially in anticancer chemotherapy. OBJECTIVE: Anticancer Drug Delivery Systems (DDS) deliver drugs to the tumor site leading to reduced exposure of the drugs to healthy cells and hence reduced side effects. Efforts have been made in the past to develop effective DDS using stimuli-responsive polymers like thermosensitive and pH-sensitive polymers. CONCLUSION: Elastin-like Polypeptides (ELP), one of the thermoresponsive polymers, have been identified as drug carriers in anticancer therapy. ELP-drug conjugates have the potential and can be used effectively in combination with hyperthermia for targeting drugs to solid tumors. This review reports on the use of ELPs in cancer therapy, its biomedical applications, and recent developments to target drugs to ovarian solid tumors.

Potential Role of In Vitro-In Vivo Correlations (IVIVC) for the Development of Plant-Derived Anticancer Drugs.

BACKGROUND: Conventional medicines, along with herbal formulations of Chinese, serve as the primary source and hub of active new drugs where the initial research concentrates on the extraction and isolation of bioactive lead compound(s) to treat several diseases largely for cancer. Plant-derived natural products and their analogs reveal a significant source of several clinically useful anticancer agents. Herbs and herbal derived active compounds play an unavoidable role in the treatment, drug discovery and delivery for decades, as evidenced by numerous existing marked drugs and various cancer-related molecular targets in clinical development. OBJECTIVE: Solubility, resistance and metabolic limitations of the drug can be overcome by suitable molecular modifications. Due to enhancements in tumor targeting technology, some agents who failed in earlier clinical studies are also stimulating renewed interest. In this connection, In Vitro-In Vivo Correlation (IVIVC) plays an important role in the development of dosage forms in the field of pharmaceutical technology. CONCLUSION: IVIVC tool fastens and improves the drug development process and product quality, which is also utilized in internal control for scale-up to improve formulations and alternative production processes. Most importantly, this IVIVC tool lessens the number of human studies during new pharmaceuticals developments. In this review, we would like to grab the attention of readers to the importance and significance of IVIVC for natural products of anticancer drugs examples such as Docetaxel, Etoposide phosphate, 6-Gingerol, Capsaicin, etc.

Conversion of carbon dioxide to resorcylic acid under ultrasonication by Kolbe-Schmitt reaction.

The present work focuses on a new approach for the synthesis of ß-resorcylic acid based on Kolbe-Schmitt reaction using carbon dioxide under ultrasonic and mild condition. The Kolbe-Schmitt reaction is a process for the synthesis of ß-resorcylic acid (2,4-dihydroxybenzoic acid) from resorcinol in aqueous potassium hydroxide solution with gaseous CO2. The influences of carbonation time, flow rate of CO2 and the molar ratio of resorcinol/potassium hydroxide on the yield percentage of resorcylic acid were investigated. The study was assessed with the conventional thermal method (non ultrasonic method) for Kolbe-Schmitt reaction and it was observed that applying ultrasound to save more than 95% and 38.6% energy as shown by energy consumption calculations in bath type and horn type sonicator respectively. ß-Resorcylic acid formed was characterized by (1)H NMR, (13)C NMR, DEPT NMR and FTIR spectroscopy. The amount of CO2 utilized in the reaction was evaluated from the yield percentage of ß-resorcylic acid yield. The maximum yield of resorcylic acid of 30% and 65% was obtained at the resorcinol/potassium hydroxide ratio of 1:3, carbonation time of 150 min and the CO2 flow rate of 2L/min in bath type and horn type ultrasonicator, respectively. The applicability of the research work was examined in two different positional isomers of resorcinol under optimum conditions.

Properties of spray pyrolised ZnO:Sn thin films and their antibacterial activity.

Tin doped zinc oxide (ZnO:Sn) thin films were deposited onto glass substrates by the spray pyrolysis technique with the substrate temperature 400 °C. The structural, optical, photoluminescence (PL) properties and morphological studies were investigated for the films deposited with various doping concentration (0, 2, 4, 6 and 8 at.%) of tin. The XRD results had shown that the films were polycrystalline ZnO with hexagonal wurtzite type structure and the crystallites in the films were oriented along (002) direction. Surface morphology of the films obtained by scanning electron microscope (SEM) exhibited the change in morphology with doping concentration and porous nature for the film with 6 at.% of tin. Atomic force microscopy (AFM) revealed nanometer sized particles with decreased surface roughness for Sn doping. Optical analysis exhibited the band gap value of 2.8 eV for ZnO:Sn (6 at.%) which was lower than the band gap value for undoped ZnO film (3.2 eV). The resistivity of 6 at.% of Sn doped film was 1.28×10(2) Ω cm with increase in the hall mobility and carrier concentration. The ZnO and Sn doped ZnO thin films exhibited antibacterial activity against Staphylococcus aureus.

Utilization Article of CHC (Complete Health Checkup) Type Charts to Improve the Students' Understanding of Clinical Pathology.

BACKGROUND: Second year undergraduate medical students lack an integrated approach towards the basic laboratory data. So, they find it difficult when analytical exercises are asked for in pathology practical examinations. A Complete Health Checkup (CHC) is one exercise where an individual undergoes a clinical examination, followed by various basic laboratory tests, along with other tests like ECG, X-ray and USG of the abdomen. A critical analysis of such charts would help in developing higher cognitive skills in the form of integration of all the data which is available, in order to arrive at a final diagnosis. We hypothesized that facilitating the students to analyze a set of clinical pathology tests by using CHC charts as modules would enhance their integrated approach towards the laboratory data. AIM: To evaluate the use of pre designed complete health charts which were designed to enhance the students' ability to apply and integrate their knowledge on the clinical pathology data. MATERIALS AND METHODS: Two batches of 44 students each (Group 1 and Group 2), who attended the clinical pathology postings, were included in the study (totally 88 students). Informed consents were obtained from all of them. In addition to their routine posting schedules, the students in Group 2 were exposed to fifteen CHC charts, one at a time, with the subsequent analysis of each chart by using an objective test and a discussion. At the end of their clinical pathology postings, an OSPE was conducted for all the students and the test scores were analyzed. The statistical analysis was done using SPSS, version 15. RESULTS: Group 1 obtained a score which ranged from 48% to 78%, with a mean±SE (mean) of 62.0% ± 1.21 and Group 2 obtained a score which ranged from 65% to 94%, with a mean±SE (mean) of 86.2% ± 0.96. The Student's-t-test for the equality of means with a value of 15.59 (p=0.000), implied a statistical significance in the mean score, as was observed between the two groups. CONCLUSION: Facilitating the students' learning by using CHC charts helps in improving the students' capacity to analyze and interpret the clinical pathology data and so, it can be utilized on a routine basis.

IgE- and IgG mediated severe anaphylactic platelet transfusion reaction in a known case of cerebral malaria.

BACKGROUND: Allergic reactions occur commonly in transfusion practice. However, severe anaphylactic reactions are rare; anti-IgA (IgA: Immunoglobulin A) in IgA-deficient patients is one of the well-illustrated and reported causes for such reactions. However, IgE-mediated hypersensitivity reaction through blood component transfusion may be caused in parasitic hyperimmunization for IgG and IgE antibodies. CASE REPORT: We have evaluated here a severe anaphylactic transfusion reaction retrospectively in an 18year-old male, a known case of cerebral malaria, developed after platelet transfusions. The examination and investigations revealed classical signs and symptoms of anaphylaxis along with a significant rise in the serum IgE antibody level and IgG by hemagglutination method. Initial mild allergic reaction was followed by severe anaphylactic reaction after the second transfusion of platelets. CONCLUSION: Based on these results, screening of patients and donors with mild allergic reactions to IgE antibodies may help in understanding the pathogenesis as well as in planning for preventive desensitization and measures for safe transfusion.

Serum carbohydrate deficient transferrin as a sensitive marker in diagnosing alcohol abuse: a case - control study.

BACKGROUND: Alcoholism is a major problem in India thereby causing a heavy toll on the health related expenditure of the country. Detection of alcohol abuse rely mainly on clinical details which is sometimes inaccurate or unreliable and hence using a specific diagnostic parameter might be of immense use not only for early diagnosis but also during follow up of the cases. AIMS AND OBJECTIVES: This case control study aimed at evaluating the usefulness of Carbohydrate Deficient Transferrin (CDT) as a sensitive marker to diagnose alcohol abuse. MATERIALS AND METHODS: The study was approved by Institutional research and ethical committee. Twenty five known male alcoholics who attended to the OPD (Out Patient Department) of Alcohol de-addiction centre of a tertiary care hospital were selected as cases. All of them were diagnosed to have a strong likely hood of hazardous alcohol consumption based on 'Alcohol Use Disorders Identification Test" (AUDIT) questionnaire. Twenty five age matched, gender matched healthy individuals who were teetotalers were selected as controls. They scored zero in AUDIT questionnaire. Informed consent was obtained from all the cases and controls. The following tests were done: Liver function tests including Serum Bilirubin, Total Proteins, Aspartate Amino Transferase (AST), Alanine Amino Transferase (ALT), Alkaline Phosphatase (ALP), Gamma Glutamyl Transferase (GGT) and Blood glucose levels were estimated using a fully automated biochemistry analyser, XL - 300 (Trans Asia Biomedical systems) and Mean Corpuscular Volume (MCV) was done using an automated hematology analyser Sysmex KX-21. Percentage of Serum Carbohydrate Deficient Transferrin (%CDT) was assessed using immuno Turbidimetric assay, ELISA method (iMark, Bio-Rad Laboratories,). Statistical analysis of the data obtained was done using SPSS 16.0. RESULTS: There was a statistically significant difference in values of AST, ALT, ALP, MCV, GGT and % CDT in cases as compared to controls. ROC curves drawn to assess the sensitivity and specificity of each parameter showed that %CDT has the highest sensitivity and specificity (84% and 92% respectively) and MCV (48% and 52% respectively) had the least. GGT when compared to % CDT had a lower sensitivity and specificity (64% and 72% respectively). CONCLUSION: % CDT is a sensitive biomarker which can be used to diagnose alcohol abuse and is superior to GGT in terms of sensitivity as well as specificity.

The red cell distribution width as a sensitive biomarker for assessing the pulmonary function in automobile welders- a cross sectional study.

CONTEXT: Welding fumes are considered as a risk factor for pulmonary diseases and a periodic spirometry is essential to evaluate the lung function of the welders. The Red Cell Distribution Width (RDW) is a red cell measurement which is provided by automated haematology analyzers. It reflects the range of the red cell sizes which are measured within a sample. Few studies have shown a relationship between the RDW values and the changes in the spirometry. AIMS: This study was aimed at correlating the RDW% and the spirometry FEV1/FVC ratio (%) among automobile welders (cases). Further, we have analyzed the effect of smoking on the FEV1/FVC ratio% and the RDW% in the cases. SETTINGS AND DESIGN: A cross sectional study was done on 50 welders and 50 non-welding office workers (controls) who were working in an automobile industry on the outskirts of Chennai, india. All the cases were arc welders and the controls were from the same production unit, who had never worked as welders. This study was conducted during the period from March 2012 to May 2012. METHODS AND MATERIAL: The demographic data, smoking habits, work history and the respiratory symptoms were gathered by using a standard self -administered questionnaire. A complete haemogram study was done and pulmonary function tests were performed for both the cases and the controls. All the cases and the controls were examined in the hospital outpatients room and subsequently, their blood samples were collected. The pulmonary function tests were conducted in the spirometry room in the hospital. The statistical analysis was done using the SPSS, version 15.0. RESULTS: A statistically significant inverse correlation was found between the RDW% and the FEV1/FVC ratio% in the cases. CONCLUSIONS: RDW can be used as a biomarker to identify the pulmonary compromise in automobile welders.

Study of fluorescence quenching of Barley α-amylase.

The fluorescence quenching of Barley α-amylase by acrylamide and succinimide has been studied in water using steady-state and time-resolved fluorescence techniques. The steady-state fluorescence quenching technique has been performed in three different pHs (i.e., 6, 7 and 8) of water. Ground state and excited state binding constants (K(g) &K(e)) have been calculated. From the calculated binding constants (K(g) &K(e)) the free energy changes for the ground (ΔG(g)) and excited (ΔG(e)) states have been calculated and are presented in tables. UV and FTIR spectra have also been recorded to prove the binding of Barley α-amylase with acrylamide and succinimide.

The reference intervals for the haematological parameters in healthy adult population of chennai, southern India.

BACKGROUND: The haematological parameters are influenced by various factors like age, ethnicity, diet, genetic and gender differences and hence it is important to define the specific reference values with regards to the age, gender and the region. The indices like the Red Cell Distribution Width (RDW), the Mean Platelet Volume (MPV) and the Platelet Distribution Width (PDW) are newer haematological parameters which are calculated by automated haematology analyzers. There is an increasing evidence that these are clinically valuable bio markers. But not many studies have estimated the reference intervals for these parameters in our population. AIM AND OBJECTIVE: Our primary objective was to identify the gender specific reference intervals for RDW, MPV, PDW and other haematological parameters for the healthy adult population of our region. We also aimed at comparing the study reference intervals with the existing reference ranges. MATERIALS AND METHODS: A retrospective review of 2443 medical case sheets of the individuals who attended the preventive health check up program in a tertiary care hospital in the year 2011, was done. With 500 subjects who satisfied our study criteria, the haematological reference intervals were established. RESULTS: Gender specific reference intervals were established for the newer indices as well as for the other haematological parameters. We derived the reference intervals for the newer parameters in our population as: RDW: 12.23%-15.36% in males and 12.3%-15.85% in females. MPV: 7.9 fL-13.7 fL in males and 8 fL -13.28 fL in females PDW: 9 fL -16.56 fL in males and 8 fL -13.28 fL in females. CONCLUSION: Our values differed from the existing haematological reference values, thus showing the importance of developing region-specific reference intervals. Our data also showed the importance of establishing gender specific reference intervals.

Interaction of potassium mono and di phosphates with bovine serum albumin studied by fluorescence quenching method.

The interactions between potassium mono and di phosphates and bovine serum albumin (BSA) were studied using fluorescence spectroscopy (FS) and ultraviolet spectroscopy (UV). The experimental results showed that the potassium mono and di phosphates could insert into the BSA and quench the inner fluorescence of BSA by forming the potassium mono phosphate-BSA and pottassium di phosphate-BSA complexes. It was found that the static quenching was the main reason leading to the fluorescence quenching. It was conformed by XRD and SEM techniques.

Spectroscopic characterization studies of 1-methyl indole with benzene derivatives.

The NMR and fluorescence quenching of benzene, chlorobenzene and methoxybenzene in acetonitril and 2-propanol solvents have been carried out with a view to understand the quenching mechanisms. The quenching is found to be appreciable and shows positive derivation in the stern-volmer plots. UV absorbance is used to measure the excitation wavelength. Lifetime measurements are carried out and the quenching rate constant kq is also calculated. Molar extinction co-efficient, stoke's shift are also calculated. The NMR study is used to conform if there is any complex formation between 1-methylindole with the benzene derivatives.

Can community health workers screen under 5 yr children with computer program.

EKALAVYA computer program aims at high risk screening of under 5 children in Primary Health Centers by Community Health Workers (CHWs) simulating existing programs like CSSM, ICDS etc. This integrates many common symptoms like fever, respiratory, diarrhea, convulsions etc. along with health promotional aspects like growth, immunization etc. at Community Health Workers skills level. EKALAVYA program was user friendly for CHWs who were trained in 2-3 weeks. CHWs with computer guidance were compared with clinical evaluation of Research Team in 96 pediatric OPD cases in a teaching institution. Overall concordance was 91.66%. Symptom wise and severity wise analysis also showed good concordance. The study also indicated training and programme errors which could be easily corrected. EKALAVYA Program is now ready for field trial in PHCs for the guidance of CHWs in decision making.