Neonatal mortality in India's rural poor: Findings of a household survey and verbal autopsy study in Rajasthan, Bihar and Odisha.

In 2011, Save the Children India launched a project for the disadvantaged population of Rajasthan, Bihar and Odisha. As a baseline activity, neonatal deaths during January-December 2012 were investigated using modified verbal autopsy tool in six sub-district-level administrative units (blocks) adopting 30-cluster sample survey approach. Our study reported a total of 189 neonatal deaths of which 50% occurred at home and 39% happened on Day 1. About half of the deaths occurred in blocks from Bihar. High number of neonatal deaths belonged to households that were below poverty line (64%) and other disadvantaged classes (46%); among mothers who were illiterate (65%), <20 years of age (54%) and during their first-order births (36%). Birth asphyxia was a major cause of neonatal deaths across all blocks. These findings indicate need for easy and early access to transport services, specialized neonatal care and advocacy targeted towards increasing community awareness.

Adenosine deaminase activity in normal pregnancy and pregnancy associated disorders.

Adenosine deaminase (ADA) is an enzyme of purine salvage pathway and has two important isoenzymes ADA1 and ADA2. The activity of ADA has been changed in diseases characterized by altered cell-mediated immunity. It was observed that total serum ADA activity was decreased during normal pregnancy compared with non-pregnant women. However, total serum ADA activity and serum ADA2 activity was increased in hyperemesis gravidarum and pre-eclampsia in pregnant women. Less information is available regarding role of ADA in abortions (recurrent and missed) and anembryonic pregnancies. Here, we review the activity of ADA and its isoenzymes. Despite these findings, it will be interesting to know whether activity of ADA will be same if ADA is estimated throughout the pregnancy and in pregnancy related complications from early first trimester to third trimester, as all studies until now were carried out at a particular stage of pregnancy.

Relation of oxidative stress, zinc and alkaline phosphatase in protein energy malnutrition.

OBJECTIVE: To determine serum zinc (Zn), total anti-oxidant capacity (TAC), malondialdehyde (MDA), alkaline phosphatase (ALP) and albumin in protein energy malnutrition (PEM) and to analyse the appropriateness of using low weight-for-age for detecting childhood under-nutrition. METHODS: This study comprised 455 children (355 malnourished and 100 normal). They were classified according to the Nutrition Subcommittee of Indian Academy of Pediatrics, Z-Score Classification and Composite Index of Anthropometric Failure. Serum Zn, TAC, MDA, ALP and albumin levels were determined. RESULTS: The serum Zn, TAC, ALP and albumin levels were found to be significantly decreased and MDA levels were significantly increased in malnourished children as compared with control (P < 0.001). CONCLUSION: The significant increase in serum MDA concentration associated with the decrease in serum TAC, Zn and ALP in malnourished children suggest that these children were potentially susceptible to high oxidative stress. Current study also suggest that conventional measures of detecting under-nutrition (low weight-for-age) may be missing out a considerable proportion of undernourished children present in the population.

Sputum adenosine deaminase and alkaline phosphatase activity in pulmonary tuberculosis.

OBJECTIVE: The aim was to determine adenosine deaminase (ADA) and alkaline phosphatase (ALP) activity in sputum for the diagnosis of pulmonary tuberculosis. METHODS: This study comprised of 64 subjects (33 pulmonary tuberculosis and 31 lung cancer). The ADA and ALP activity was measured in sputum and serum. RESULTS: The mean ADA activity in sputum, serum and mean sputum/serum ADA ratio was 205.20 IU/L, 42.32 IU/L and 4.90 in pulmonary tuberculosis and 127.74 IU/L, 29.90 IU/L and 4.27 in lung cancer subjects respectively. The mean ALP activity in sputum, serum and mean sputum/serum ALP ratio was 461.34 IU/L, 159.24 IU/L and 2.90 in pulmonary tuberculosis and 226.64 IU/L, 119.87 IU/L and 1.99 in lung cancer subjects respectively. CONCLUSION: The mean ADA and ALP activity was significantly increased in pulmonary tuberculosis as compared to lung cancer subjects and hence may be a useful tool for the diagnosis of pulmonary tuberculosis.

Elevated adenosine deaminase activity in overweight and obese Indian subjects.

OBJECTIVE: To determine adenosine deaminase activity in overweight and obese Indian subjects. METHODS: This study comprised of 100 subjects. The body mass index (BMI) of subjects was calculated and adenosine deaminase activity was determined in their fasting blood sample. The study was divided into three groups depending upon BMI: Control (n = 40, BMI < 25 kg/m(2)), Overweight (n = 30, BMI 25-29.9 kg/m(2)) and Obese (n = 30, BMI ≥ 30 kg/m(2)). RESULTS: The serum adenosine deaminase activity was significantly increased in overweight and obese subjects and as well as in combined overweight and obese group as compared to control (P < 0.0001). CONCLUSION: Adenosine, an endogenous anti-inflammatory metabolite, is increased in response to inflammation produced by adipose tissue in obesity. However, adenosine deaminase acts on adenosine to convert it into inosine, thereby increasing adenosine deaminase activity in overweight and obese Indian subjects.

Sodium selenate effect on Synechococcus elongatus PCC 7942: appearance of novel enzymatic reaction, ATP:selenate adenylyltransferase, and variation in antioxidant enzyme activities.

Synechococcus elongatus PCC 7942 was grown with SO(4) (2-) or S(2)O(3) (2-) sulfur source with varying concentration of SeO(4) (2-). Up to 150 muM, SeO(4) (2-) was growth supportive and above this it was inhibitory. Selenate is believed to induce ROS production, and to counter, the cells produce increasing amounts of ROS quenching enzymes. To investigate the differential growth response of SeO(4) (2-) at the level of ROS production, the activities of antioxidant enzymes viz. glutathione peroxidase, catalase, pyrogallol-peroxidase, superoxide dismutase and glutathione reductase were determined. Regardless of SeO(4) (2-) concentration in the medium, except catalase, the activity of other enzymes increased over SeO(4) (2-)-free controls. To understand the fate of SeO(4) (2-) added at lower concentrations, the activities of key inorganic sulfur metabolizing enzymes, ATP sulfurylase in SO(4) (2-) medium and thiosulfate reductase in S(2)O(3) (2-) medium were measured. This was done with an assumption that these enzymes would consume the SO(4) (2-) analog SeO(4) (2-) as sulfur source. We found enzymatic SeO(4) (2-)/ATP dependent formation of inorganic pyrophosphate in a reaction, analogous to ATP sulfurylase (SO(4) (2-) + ATP --> pyrophosphate) carried out by an enzyme different from ATP sulfurylase, tentatively called ATP:selenate adenylyltransferase. We hypothesize that selenium could act as trace element for S. elongatus PCC 7942.

Evidence-based National Vaccine Policy.

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form.

Alkaline phosphatase: Distinguishing between tuberculous and nontuberculous pleural effusion.

OBJECTIVES: To evaluate the value of pleural fluid alkaline phosphatase and pleural fluid/serum alkaline phosphatase ratio for the purpose of differentiating tuberculous from nontuberculous pleural effusion. MATERIALS AND METHODS: A total of 60 indoor patients, admitted to our hospital, having pleural effusion and suffering from varying etiologies, were included in this study. According to the final diagnosis, these 60 patients were divided into two groups: Tuberculous (30) and nontuberculous (30) pleural effusion. RESULTS: The mean pleural alkaline phosphatase and pleural fluid/serum alkaline phosphatase ratio was significantly higher in tuberculous compared to nontuberculous pleural effusion. (P < 0.0001). In receiver operating characteristic curve analysis, sensitivity and specificity values were 90% and 80% for a cut-off value of 71 IU/L for pleural alkaline phosphatase activity; and were 90% and 86.66% for a cut-off value of 0.51 for pleural fluid/serum alkaline phosphatase ratio. CONCLUSION: From this study it is concluded that alkaline phosphatase activity remains a useful test in differentiation of tuberculous from nontuberculous pleural effusion.

Serum zinc and malondialdehyde concentrations and their relation to total antioxidant capacity in protein energy malnutrition.

The aim of present study was to assess the association between serum zinc and oxidant/antioxidant status in children with protein energy malnutrition. Serum zinc, total antioxidant capacity and malondialdehyde were measured spectrophotometrically in 100 children (6 mo to 5 y); out of these, 50 children were malnourished and 50 children served as controls. Serum zinc levels were found to be significantly low in the malnourished (p<0.001). Serum zinc levels in Grade I and Grade II malnourished were 82.7 and 67.7 microg/dL respectively and in Grade III and IV combined was 53.2 microg/dL as compared to 109.5 microg/dL in the control group. These levels were significantly lower in children who had skin lesions than in those without such lesions (p<0.001). Total antioxidant capacity was found to be significantly lowered in malnourished children (Grade I=1.3 mmol/L, Grade II=1.1 mmol/L, Grade III and IV=0.5 mmol/L) as compared to 2.0 mmol/L in the control group (p<0.001). The malondialdehyde concentration in malnourished children was significantly higher (p<0.001) (Grade I=1.6 nmol/mL, Grade II=1.9 nmol/mL, Grade III and IV=2.9 nmol/mL) as compared to 1.3 nmol/mL in controls. Total antioxidant capacity and hypoalbuminaemia were also correlated positively with low serum zinc level. Serum trace element deficiency leading to depleted antioxidant protection may be a contributing factor to the pathophysiology of protein energy malnutrition and replacement of these elements in the management of this condition might be important.

Catalytic and regulatory properties of sulphur metabolizing enzymes in cyanobacterium Synechococcus elongatus PCC 7942.

Synechococcus elongatus PCC 7942 was able to grow with several S sources. The sulphur metabolizing enzymes viz. ATP sulphurylase, cysteine synthase, thiosulphate reductase and L- and D-cysteine desulphydrases were regulated by sulphur sources, particularly by sulphur amino acids and organic sulphate esters. Sulphur starvation reduced ATP sulphurylase and cysteine synthase whereas reduced glutathione appreciated Cys degradation activity. With partially purified enzymes apparent Km values for sulphate, ATP, D- and L-Cys, thiosulphate, sulphide and O-acetyl serine were in a range of 12-50 microM. p-Nitrophenyl sulphate inhibited ATP sulphurylase competitively. Met was a feedback inhibitor of several key enzymes.