Genetic gains in forage sorghum for adaptive traits for non - conventional area through multi-trait-based stability selection methods.

Introduction: In the Asian tropics, unpredictable weather increases the risk of abiotic stresses in sorghum areas, making it harder to meet predicted demand. Genotype-by environment interaction (GEI) and the lack of an effective multi-trait-based selection approach make it challenging to breed climateresilient forage sorghum that adapts to nonconventional areas. Methods: The present investigation carried out to estimate genetic parameters, inter trait associations, genetic gain under selection (SGs) of 95 diverse forage sorghum genotypes. Fourteen forage yield and other secondary traits were evaluated at five different growing seasons at two locations. Negative and positive genetic gains under selection were estimated across different growing seasons including Kharif, Rabi and Summer in the year 2020 and 2021. Results and discussion: The GEI effects were significant (P < 0.001) for all the studied traits. The multi trait based stability indices have been said to assist breeders in ensuring sustained progress in primary traits likeforage yield without sacrificing genetic advancement in secondary traits. Fourteen genotypes were selected through each evaluation methods including genotype - ideotype distance index (MGIDI), multi-trait stability index (MTSI), multi-trait stability and mean performance (MTMPS) and multi-trait index based on factor analysis and genotype-ideotype distance (FAIBLUP Index), assuming 15% selection intensity. According to MGIDI, the selected genotypes exhibited desired positive genetic gains for dry forage yield per plant, inter-nodal length, green forage yield per plant, and plant height and negative genetic gains for days to 50% flowering. The strength and weakness plot is a potential graphical tool as portrayed by MGIDI, to identify and develop desirable genotype for particular environment. Two genotypes, G36 (302B) and G89 (348B) were found to be common across all four evaluation methods based on all the studied traits. Background: Multi-trait stability evaluation approaches are reliable and accessible for selecting multiple traits under varied testing environments with low multicollinearity issues. These tools proved effective in enhancing selection strategies and optimising breeding schemes for the development of climate-resilient forage sorghum genotypes. The aforementioned genotypes were found to be the most reliable, high-yielding, and earlymaturing and could be suggested for variety and hybrid development and ideotype breeding programmes to ensure the food and nutritional security.

'Testicular masquerade': a case report of testicular malignancy with persistent Müllerian duct syndrome and transverse testicular ectopia.

Persistent Müllerian duct syndrome (PMDS) is a rare sexual development disorder. It is even more rarely associated with transverse testicular ectopia (TTE), a rare form of testicular ectopia, in which both testes descend through a single inguinal canal and are present in the same hemiscrotum. PMDS with TTE is associated with 18%-33% malignant transformation. Here we report the case of a 48-year-old man who presented with a large right inguinoscrotal swelling and on evaluation was found to have a large right testicular mass with complete right inguinal hernia, undescended left testis and a central abdominal mass. On evaluation with contrast-enhanced computed tomography abdomen and pelvis and image-guided biopsy he was diagnosed with mixed germ cell tumour of the right testis (predominantly a seminoma) with a retroperitoneal nodal mass and absent left testis, for which he received chemotherapy. Post-chemotherapy he underwent surgery and was diagnosed intraoperatively with PMDS along with TTE and testicular malignancy arising from the ectopic left testis. Postoperative recovery and follow-up were uneventful. Most cases of PMDS are diagnosed early in life. They present clinically with unilateral or bilateral undescended testis with inguinal hernia. In adults, PMDS is usually associated with male infertility. However, TTE is associated with an increased risk of testicular tumours if undiagnosed until adulthood. In adults PMDS with TTE is usually an intraoperative finding and is commonly associated with malignancy in the ectopic/undescended testis.

Magnesium Sulfate as an Adjunct to Therapeutic Hypothermia in the Management of Term Infants with Hypoxic-Ischemic Encephalopathy: A Randomized, Parallel-Group, Controlled Trial.

OBJECTIVE: To evaluate whether magnesium sulfate and therapeutic hypothermia in combination decreases mortality and/or major neurodevelopmental disability at 1 y of age among term neonates with hypoxic-ischemic encephalopathy. METHODS: A total of 134 term neonates were randomized to receive intravenous magnesium sulfate at a dose of 250 mg/kg (at 8 mg/kg/min) once daily for 3 d starting within 6 h after birth along with therapeutic hypothermia in the intervention group and therapeutic hypothermia alone in the comparator group. The primary outcome was the composite outcome of mortality and/or major neurodevelopmental disability (Developmental Assessment Scale for Indian Infants score < 70) at 1 y of age. RESULTS: A total of 115 infants were included in the primary analysis. The composite primary outcome occurred in 14 (24%) infants in the intervention group and 19 (33%) infants in the comparator group, and the difference was not statistically significant (p = 0.30; relative risk 0.72; 95% confidence interval 0.40-1.30). The secondary outcomes including neonatal mortality, major neurodevelopmental disability at 1 y of age, neurological status at discharge, level of oxidative stress markers, and adverse effects including hypotension and respiratory depression requiring support were also comparable between the groups. CONCLUSIONS: The combination of magnesium sulfate and therapeutic hypothermia did not improve the composite outcome of neonatal mortality and/or major neurodevelopmental disability at 1 y of age. TRAIL REGISTRATION: Clinical Trials Registry of India (CTRI/2018/06/014594), prospectively registered.

Growth and Neurodevelopmental Outcomes of Very Low Birth Weight Infants From Southern India at Corrected Age of One Year.

OBJECTIVE: To assess the growth and neurodevelopmental outcome of very low birth weight (VLBW) infants at corrected age of one year. METHODS: This prospective cohort study enrolled VLBW infants delivered in a tertiary care hospital, and followed up till one-year corrected age. The WHO Anthropo version 3.2.2 software was used to calculate weight for age, length for age, and head circumference z-score during follow up. Neuro-developmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII) at the age of one year. RESULTS: The mean (SD) z-scores at one-year for weight for age, length for age and head circumference were -2.1 (1.1), -1.4 (1.03) and -2.2 (1.2), respectively. The mean (SD) DASII motor and mental scores were 90.8 (13.4) and 96.5 (13.2), respectively. Major and minor developmental abnormalities were noted in 9.4% and 18.2%, infants, respectively. Cerebral palsy was noted in 5.8% infants. CONCLUSION: VLBW infants showed impaired growth and significant developmental abnormalities at the corrected age of one year.

Therapeutic Hypothermia for Perinatal Asphyxia in India-Experience and Evidence.

Therapeutic hypothermia is an established therapy with proven benefit for term neonates with moderate and severe hypoxic-ischemic encephalopathy (HIE). Many centers in India have started therapeutic cooling of asphyxiated infants. There is enough evidence for the beneficial effect of cooling from the randomized trials conducted in India. However, the recently published hypothermia for encephalopathy in low- and middle-income countries (HELIX) trial has contrasting findings. In this context, this review is written summarizing the available experience and evidence for therapeutic hypothermia for perinatal asphyxia in India.

Subacute duodenal obstruction caused by Common Celiaco-Mesenteric Trunk anomaly-A case report.

INTRODUCTION AND IMPORTANCE: The origin of the mesenteric vasculature is highly variable. One such variation is the common celiaco-mesenteric trunk (CMT). To our knowledge, this is the first reported case of subacute duodenal obstruction caused by common CMT. The awareness of this anomaly helps keep a high index of suspicion for varied presentations, prompts appropriate investigations, timely intervention, and avoids iatrogenic injury. PATIENT PROFILE: A 15-year-old boy presented with a history of repeated attacks of colicky abdominal pain with bilious vomiting. Computed tomography of the abdomen with intravenous contrast revealed subacute duodenal obstruction caused by an acute angulation of common CMT with the abdominal aorta. To relieve the obstruction, the patient underwent a side-to-side duodenojejunostomy. DISCUSSION: A common CMT, where the coeliac artery (CA) and superior mesenteric artery (SMA) have a common origin from the aorta, accounts for less than 1% of all splanchnic artery anomalies. Most CMTs are incidental findings, but aneurysm or dissection of the common trunk commonly accompany this anatomical aberrancy. Intestinal obstruction due to CMT anomaly is a rare occurrence. CONCLUSION: There should be a high index of suspicion concerning vascular anomalies in patients, especially children presenting with repeated episodes of subacute intestinal obstruction. This knowledge of vascular aberrations prevents disastrous iatrogenic complications.

Short Term Outcome and Predictors of Mortality Among Very Low Birth Weight Infants - A Descriptive Study.

OBJECTIVE: To assess the short term outcome and predictors of mortality among very low birth weight (VLBW) neonates. METHODS: This descriptive study from a tertiary care teaching institute in south India included 239 VLBW neonates who were uniformly managed as per unit's protocol and followed up till discharge or death, whichever was earlier. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. Two logistic regression models were developed and to evaluate their discriminative performance, area under the receiver operating characteristic curves were calculated. RESULTS: Mean gestational age and mean birth weight of neonates were 31.4 ± 3 wk and 1191 ± 245 g respectively. Among the 239 infants, 49 (20.5%) expired and 190 (70.5%) survived. Mortality among extremely low birth weight (ELBW) and extreme preterm infants were 69.3% and 73.3% respectively. Univariate analysis showed multiple perinatal factors and neonatal morbidities were associated with mortality. On adjusted multivariate logistic regression, birth weight < 1000 g (OR 9.27), severe grade of intraventricular hemorrhage (IVH) (OR 29.2), hyperglycemia (OR 7.8) and respiratory distress syndrome (RDS) requiring surfactant therapy (OR 6.2) were the significant predictors of mortality. Both logistic regression models developed showed good prediction of mortality. CONCLUSIONS: VLBW mortality rate is 20% in the population studied. Birth weight < 1000 g, severe grade of IVH, hyperglycemia, and RDS requiring surfactant therapy were the significant predictors of mortality among VLBW neonates. Both prediction models developed showed good prediction of mortality.

Neurodevelopmental Outcome of Preterm Newborns with Abnormal Umbilical Artery Doppler - A Prospective Cohort Study.

OBJECTIVE: To assess the neurodevelopmental outcome of preterm neonates with absent/reversed end diastolic flow (A/REDF) in umbilical artery Doppler at 1 year of corrected age. METHODS: A cohort of 70 preterm newborns with fetal growth restriction (FGR), defined as estimated fetal weight (EFW) <10th centile, confirmed by birthweight <10th centile, along with A/REDF in the umbilical artery Doppler was followed up till 1 year of corrected age (CA). An equal number of gestation and gender matched preterm newborns with birthweight >10th centile [appropriate for gestational age (AGA)] and normal antenatal ultrasound were taken as controls. Primary outcome was a composite of death or major neurodevelopmental disability (NDD) at 1 year of corrected age. Matched analysis was performed. RESULTS: A total of 140 newborns were enrolled, of which, 20 expired and 8 were lost to follow-up. The primary outcome (death/major NDD) occurred in 26.8% of the FGR (A/REDF) newborns as compared to 9.3% of their AGA counterparts (RR-2.83, p = 0.02, 95% CI:1.11-7.18). Mean motor quotient in Development Assessment Scale for Indian Infants (DASII) at 1 year of corrected age was significantly lower in FGR (A/REDF) infants (91 ± 13.6 vs. 96.3 ± 7.1, p < 0.05). Multiple other co-morbidities were also significantly more among these newborns. CONCLUSIONS: Preterm newborns with FGR and A/REDF are at significantly increased risk of death/major NDD at 1 year of corrected age.

Utility of Low Dose Vasopressin for Persistent Pulmonary Hypertension of Newborn with Catecholamine Refractory Shock.

OBJECTIVE: To evaluate the effect of low dose vasopressin on the hemodynamics of neonates with persistent pulmonary hypertension and catecholamine refractory shock. METHODS: This retrospective study was conducted in a level III NICU of a tertiary care teaching hospital, south India. Eighteen neonates with hypoxemic respiratory failure due to persistent pulmonary hypertension of newborn with catecholamine refractory shock were studied. Neonates were managed for hypotension with conventional inotropic support with the additional use of low dose vasopressin (LDV). Effect of vasopressin on oxygenation index (OI), blood pressure, duration of inotropic usage and survival was evaluated. RESULTS: Mean OI was 38.2 ± 4.9, and mean blood pressure was 30.7 ± 5.3 mmHg before the start of vasopressin. Initiation of LDV (0.0003 ± 0.0001 IU/kg/min) for a median duration 36.4 ± 17.9 h was followed by a reduction in OI (p < 0.001), control of hypotension (p < 0.001), reduction in lactic acidosis (p < 0.001) and decline in inotropic support. CONCLUSIONS: In resource-restricted settings, LDV may be useful as a rescue therapy for persistent pulmonary hypertension of newborn with catecholamine refractory shock.

Neuronal Biomarkers in Predicting Neurodevelopmental Outcome in Term Babies with Perinatal Asphyxia.

OBJECTIVE: To assess whether serum levels of neuronal biomarkers (S100 calcium-binding protein B and Neuron specific enolase) correlate with the neurodevelopmental outcome of term neonates at 18 mo who had hypoxic ischemic encephalopathy and underwent therapeutic hypothermia. METHODS: This randomized controlled trial was conducted in a tertiary care teaching hospital, south India. There were 162 term infants with moderate to severe hypoxic ischemic encephalopathy who were randomized into 2 groups (Group A and B). Neonates in Group A and B received normothermia and therapeutic hypothermia respectively. Serum levels of neuronal biomarkers were estimated at 0, 24 (±1) and 72 (±1) h after birth using sandwich ELISA in both groups. All neonates were carefully monitored till discharge. Infants who survived the neonatal period were followed up in the high risk clinic for 18 mo and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Neurodevelopmental outcomes between the two groups were compared using Chi square test and neuronal biomarker levels between the groups were compared using Mann Whitney test. RESULTS: The baseline maternal and neonatal characteristics in both groups were comparable. There was statistically insignificant lesser mortality in therapeutic hypothermia group compared to normothermia group with Risk Ratio (RR): 0.82 (28.2% vs. 34.5%, 95% CI: 0.52-1.29, p = 0.38). Among the survivors, children in therapeutic hypothermia group had better motor and mental scores compared to those in normothermia group at 18 mo. There was no significant correlation between S100B and Neuron specific enolase levels and neurodevelopmental outcome. CONCLUSIONS: Serum levels of neuronal biomarkers (S100B and Neuron specific enolase) do not correlate with the long term neurodevelopmental outcome among these infants.

Identification of differentially expressed transcripts at critical developmental stages in sorghum [Sorghum bicolor (L.) Moench] in relation to grain yield heterosis.

Evaluation of a set of 10 F1 hybrids along with their female (27A and 7A) and male parents (C 43, RS 673, RS 627, CB 26, and CB 29) for grain yield and its component traits revealed that grain yield/plant followed by panicle weight, primary branches/panicle, and 100-seed weight exhibited high levels of heterosis. Eight hybrids exhibited 50% or more mid-parent heterosis for grain yield/plant, of which, one hybrid (27A × RS673) recorded heterobeltiosis above 50% (73.61%). Differential display analysis generated about 2995 reproducible transcripts, which were categorized as UPF1-expressed in any one of the parents and F1 (10.53-14.76%), BPnF1-expressed in both parents but not in F1 (4.56-11.44%), UPnF1-expressed in either of the parents and not in F1 (17.95-27.40%), F1nBP-expressed only in F1 but not in either of the parents (14.39-20.54%), and UET-expressed in both parents and F1 (34.52-42.43%). A comparison between high and low heterotic hybrids revealed that the proportions of UPF1 and F1nBP transcript patterns were much higher in the former (21.31% and 45.24%) as compared to the latter (16.67% and 32.14%) at the booting and flowering stage, respectively, indicating the role of over-dominance and dominance in the manifestation of grain yield heterosis. Significant positive correlations were observed for differential transcript patterns with mid-parent and better-parent heterosis for the components of grain yield such as primary branches (0.63 and 0.61 at p < 0.01) and 100-seed weight (0.64 and 0.52 at p < 0.01). Cloning and sequence analysis of 16 transcripts that were differentially expressed in hybrids and their parental lines revealed that they code for genes involved in basic cellular processes, cellulose biosynthesis, and assimilate partitioning between various organs and allocation between various pathways, pyrimidine, and polyamine biosynthesis, enhancing ATP production and regulation of plant growth and development.

Impact of human milk banking on neonatal mortality, necrotizing enterocolitis, and exclusive breastfeeding - experience from a tertiary care teaching hospital, south India.

OBJECTIVE: The objective of this study is to study the impact of a Human Milk Bank (HMB) on neonatal mortality, incidence of necrotizing enterocolitis (NEC) and rate of exclusive breastfeeding. METHODS: This pre-post intervention study was conducted in a tertiary care teaching institute in south India. Data regarding neonatal mortality, incidence of NEC, and exclusive breastfeeding rates were collected for a period of 6 months before and after establishing a modern HMB and compared. RESULTS: The number of deliveries, live births, and incidence of preterm and VLBW neonates during pre- and post-HMB periods were comparable. Neonatal mortality was 11.32/1000 live births pre-HMB compared with 10.77/1000 live births post HMB. The incidence of NEC was 1.26% of live births pre-HMB compared with 1.07% post-HMB. Exclusive breastfeeding rate pre-HMB was 34% compared with 74% post HMB (p < .001). CONCLUSION: There is a decreasing trend in neonatal mortality and incidence of NEC after establishing a HMB. Human milk banking significantly improved exclusive breastfeeding rate in the population studied.

Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk.

Objective: The objective of this study was to study the effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. Methods: This descriptive study was conducted in a Human Milk Bank of a tertiary care teaching institute in south India. Thirty random paired pooled donor human milk samples (before and after pasteurization) were analyzed for macronutrients (protein, fat, carbohydrates) using infrared spectroscopy. Similarly, immunoglobulin profile (IgA and IgG) before and after pasteurization was quantified using ELISA. Results: The mean values of protein, fat, and carbohydrates in pooled donor milk pre-pasteurization were 1.6, 3.6, and 6.1 g/dl compared with post-pasteurization values 1.4, 2.7, and 5.9 g/dl, respectively. Pasteurization reduced protein, fat, and energy content of pooled donor milk by 12.5%, 25%, and 16%, respectively. However, carbohydrates were not significantly reduced. Pasteurization decreased IgA by 30% and IgG by 60%. Conclusion: Holder pasteurization of pooled donor human milk decreases protein, fat, and energy content and also reduces the levels of IgA and IgG.

Hypothermia detection in low birth weight neonates using a novel bracelet device.

OBJECTIVE: The objective of this study is to assess the diagnostic accuracy of a novel hypothermia monitoring and alert bracelet device (BEMPU Bracelet) in low birth weight (LBW) neonates weighing less than 2000 g. DESIGN: This was a controlled prospective study. SETTING: This study was done in the step-down nursery of a tertiary level newborn unit of a major teaching hospital in India. METHODS: Eligible cases fulfilling inclusion criteria were given BEMPU Bracelets for a period of 24 h. A comparison was made between skin temperatures taken at the axilla by a mercury thermometer and skin temperatures taken at the wrist by the BEMPU Bracelet. Temperatures were taken every 6 h and every time the BEMPU Bracelet alarmed. Trained nurses obtained temperature measurements on newborns during their 24-h stay in the hospital step-down nursery. RESULTS: A total of 461 neonates were screened for hypothermia, giving 2428 temperature readings. Three hundred and eleven of 461 babies experienced hypothermia at some point. The 461 babies studied experienced 495 episodes of hypothermia in total. The sensitivity and the specificity of the bracelet in diagnosing hypothermia were 98.6% and 95% respectively. The positive and negative predictive values of the bracelet were 83.6% and 99.6%, respectively. The accuracy of the bracelet in diagnosing hypothermia was 95.8%. CONCLUSION: The BEMPU Bracelet is an accurate screening tool to detect and alert for neonatal hypothermia, thereby facilitating prompt management, which could prevent complications.

Two Randomized Trials of the Effect of the Russian Strain of Bacillus Calmette-Guérin Alone or With Oral Polio Vaccine on Neonatal Mortality in Infants Weighing <2000 g in India.

BACKGROUND: In randomized trials in Guinea-Bissau, the Danish strain of Bacillus Calmette-Guérin (BCG) reduces neonatal mortality, primarily by reducing deaths from pneumonia and sepsis. Because World Health Organization-prequalified BCG-Denmark was not available in India, we conducted 2 randomized trials to test whether BCG-Russia alone or with oral polio vaccine (OPV) has similar effects to BCG-Denmark. METHODS: We randomized neonates weighing <2000 g to a control group that was not vaccinated before 28 days of age or to receive either BCG-Russia alone (first trial) or BCG-Russia with OPV (second trial) soon after birth. We performed intention-to-treat analysis using Cox hazards models with age as the underlying time and adjusted for weight, sex and inborn versus outborn status. RESULTS: Administration of BCG-Russia alone had no effect on neonatal mortality (to 28 days of age): 15.6% of 1537 infants died in the BCG-Russia group and 16.1% of 1535 died in the control group; the adjusted hazard ratio was 0.95 [95% confidence interval (CI): 0.80-1.13]. Administration of BCG-Russia with OPV also had no effect on neonatal mortality: 18.0% of 1103 infants died in the BCG-OPV group and 17.6% of 1104 died in the control group; the adjusted hazard ratio was 1.01 (95% CI: 0.83-1.23). The adjusted hazard ratio for the 2 trials combined was 0.98 (95% CI: 0.85-1.11). CONCLUSIONS: BCG-Russia with or without OPV had no effect on neonatal mortality. It is important to determine which strains of BCG have the greatest specific effects (on tuberculosis) and nonspecific effects (on infections other than tuberculosis) in high-mortality regions.