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1.
Horm Behav ; 141: 105129, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35168026

RESUMO

Maternal experience can promote a long-lasting increase in maternal motivation. This maintenance of caregiving behaviors, rather than avoidant or agnostic responses towards young, is advantageous for the survival of subsequent offspring. We have previously reported that maternal motivation is associated with differential immediate early gene expression in central motivation circuits and aversion circuits. Here we ask how these circuits come to differentially respond to infant cues. We used Targeted Recombination in Active Populations (TRAP) to identify cells that respond to pups in maternally hesitant TRAP2;Ai14 virgin female mice. Following an initial 60 min exposure to foster pups, virgin TRAP2;Ai14 mice were injected with 4-hydroxytamoxifen to induce recombination in c-Fos expressing cells and subsequent permanent expression of a red fluorescent reporter. We then examined whether the same cells that encode pup cues are reactivated during maternal memory retrieval two weeks later using c-Fos immunohistochemistry. Whereas initial pup exposure induced c-Fos activation exclusively in the medial preoptic area (MPOA), following repeated experience, c-Fos expression was significantly higher than baseline in multiple regions of maternal and central aversion circuits (e.g., ventral bed nucleus of the stria terminalis, nucleus accumbens, basolateral amygdala, prefrontal cortex, medial amygdala, and ventromedial nucleus of the hypothalamus). Further, cells in many of these sites were significantly reactivated during maternal memory retrieval. These data suggest that cells across both maternal motivation and central aversion circuits are stably responsive to pups and thus may form the cellular representation of maternal memory.


Assuntos
Comportamento Materno , Área Pré-Óptica , Animais , Feminino , Humanos , Hipotálamo/metabolismo , Comportamento Materno/fisiologia , Camundongos , Núcleo Accumbens/metabolismo , Área Pré-Óptica/metabolismo , Proteínas Proto-Oncogênicas c-fos/metabolismo
2.
Am J Clin Nutr ; 115(4): 1092-1104, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34982820

RESUMO

BACKGROUND: Newborn oil massage is a widespread practice. Vigorous massage with potentially harmful products and forced removal of vernix may disrupt skin barrier integrity. Hospitalized, very-preterm infants treated with sunflower seed oil (SSO) have demonstrated improved growth but community-based data on growth and health outcomes are lacking. OBJECTIVES: We aimed to test whether SSO therapy enhances neonatal growth and reduces morbidity at the population level. METHODS: We conducted an open-label, controlled trial in rural Uttar Pradesh, India, randomly allocating 276 village clusters equally to comparison (usual care) and intervention comprised of promotion of improved massage practices exclusively with SSO, using intention-to-treat and per-protocol mixed-effects regression analysis. RESULTS: We enrolled 13,478 and 13,109 newborn infants in demographically similar intervention and comparison arms, respectively. Adherence to exclusive SSO increased from 22.6% of intervention infants enrolled in the first study quartile to 37.2% in the last quartile. Intervention infants gained significantly more weight, by 0.94 g · kg-1 · d-1 (95% CI: 0.07, 1.82 g · kg-1 · d-1, P = 0.03), than comparison infants by intention-to-treat analysis. Restricted cubic spline regression revealed the largest benefits in weight gain (2-4 g · kg-1 · d-1) occurred in infants weighing <2000 g at birth. Weight gain in intervention infants was higher by 1.31 g · kg-1 · d-1 (95% CI: 0.17, 2.46 g · kg-1 · d-1; P = 0.02) by per-protocol analysis. Morbidities were similar by intention-to-treat analysis but in per-protocol analysis rates of hospitalization and of any illness were reduced by 36% (OR: 0.64; 95% CI: 0.44, 0.94; P = 0.02) and 44% (OR: 0.56; 95% CI: 0.40, 0.77; P < 0.001), respectively, in treated infants. CONCLUSIONS: SSO therapy improved neonatal growth, and reduced morbidities when applied exclusively, across the facility-community continuum of care at the population level. Further research is needed to improve demand for recommended therapy inside hospital as well as in community settings, and to confirm these results in other settings.This trial was registered at www.isrctn.com as ISRCTN38965585 and http://ctri.nic.in as CTRI/2014/12/005282.


Assuntos
Emolientes , Recém-Nascido Prematuro , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Morbidade , Óleo de Girassol
3.
Comput Intell Neurosci ; 2021: 6400045, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956352

RESUMO

This paper proposes a multivariate and online prediction of stock prices via the paradigm of kernel adaptive filtering (KAF). The prediction of stock prices in traditional classification and regression problems needs independent and batch-oriented nature of training. In this article, we challenge this existing notion of the literature and propose an online kernel adaptive filtering-based approach to predict stock prices. We experiment with ten different KAF algorithms to analyze stocks' performance and show the efficacy of the work presented here. In addition to this, and in contrast to the current literature, we look at granular level data. The experiments are performed with quotes gathered at the window of one minute, five minutes, ten minutes, fifteen minutes, twenty minutes, thirty minutes, one hour, and one day. These time windows represent some of the common windows frequently used by traders. The proposed framework is tested on 50 different stocks making up the Indian stock index: Nifty-50. The experimental results show that online learning and KAF is not only a good option, but practically speaking, they can be deployed in high-frequency trading as well.


Assuntos
Algoritmos , Investimentos em Saúde
4.
BMC Pediatr ; 21(1): 484, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34727913

RESUMO

BACKGROUND: Continuous invasive arterial monitoring is necessary in sick neonates needing hemodynamic and ventilatory support. The primary objective of our study was to describe clinical experience with percutaneous peripheral arterial cannulation (PAC) in sick neonates. METHODS: Neonates needing PAC were prospectively enrolled in the study. Inclusion criteria were: neonates needing respiratory support (invasive or non-invasive), neonates requiring vasoactive medications or neonate likely to need more than 5 sampling pricks in 24 h. RESULTS: One hundred eight neonates (93.1%) needed cannulation of one arterial site while 8 (6.9%) needed cannulation of 2 arterial sites, thus giving a total of 124 cannulations. Out of the 124 cannulations, 102 (82%) were performed in first attempt, while 22 (18%) cannulations needed 2 or more attempts. Serious complications like discolouration of digits, blanching of skin or bleeding were seen in 6 (4.9%) cannulations. These resolved after removal of arterial line and no long term consequences were noted. On comparing neonates having radial arterial cannulation(n = 108) with posterior tibial arterial cannulation (n = 16) there was no difference in duration of arterial line between radial artery group (mean, SD 53.30 ± 22.56) and posterior tibial artery group (mean, SD 48.25 ± 27.39). However, more attempts were needed to cannulate post tibial artery (mean, SD 2.25 ± 1.32) as compared to radial artery (mean 1.22 ± 0.789) and this difference was statistically significant (MD -1.02, 95% CI - 1.75 to - 0.30). There was no difference in incidence of serious complications between the radial artery group (3.7%, n = 4) as compared to posterior tibial group (5.5%, n = 1, OR 0.57, 95% CI 0.06-5.51, p = 0.63). CONCLUSIONS: Peripheral arterial cannulation is a safe method for hemodynamic monitoring and blood sampling in sick neonates. Complications can be minimized by diligent monitoring and proactive removal of line if there is damping of tracing.


Assuntos
Cateterismo Periférico , Países em Desenvolvimento , Cateterismo Periférico/efeitos adversos , Hemodinâmica , Humanos , Recém-Nascido , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Ultrassonografia de Intervenção
5.
PLoS Med ; 18(9): e1003680, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34582448

RESUMO

BACKGROUND: Hospitalized preterm infants with compromised skin barrier function treated topically with sunflower seed oil (SSO) have shown reductions in sepsis and neonatal mortality rate (NMR). Mustard oil and products commonly used in high-mortality settings may possibly harm skin barrier integrity and enhance risk of infection and mortality in newborn infants. We hypothesized that SSO therapy may reduce NMR in such settings. METHODS AND FINDINGS: This was a population-based, cluster randomized, controlled trial in 276 clusters in rural Uttar Pradesh, India. All newborn infants identified through population-based surveillance in the study clusters within 7 days of delivery were enrolled from November 2014 to October 2016. Exclusive, 3 times daily, gentle applications of 10 ml of SSO to newborn infants by families throughout the neonatal period were recommended in intervention clusters (n = 138 clusters); infants in comparison clusters (n = 138 clusters) received usual care, such as massage practice typically with mustard oil. Primary analysis was by intention-to-treat with NMR and post-24-hour NMR as the primary outcomes. Secondary analysis included per-protocol analysis and subgroup analyses for NMR. Regression analysis was adjusted for caste, first-visit weight, delivery attendant, gravidity, maternal age, maternal education, sex of the infant, and multiple births. We enrolled 13,478 (52.2% male, mean weight: 2,575.0 grams ± standard deviation [SD] 521.0) and 13,109 (52.0% male, mean weight: 2,607.0 grams ± SD 509.0) newborn infants in the intervention and comparison clusters, respectively. We found no overall difference in NMR in the intervention versus the comparison clusters [adjusted odds ratio (aOR) 0.96, 95% confidence interval (CI) 0.84 to 1.11, p = 0.61]. Acceptance of SSO in the intervention arm was high at 89.3%, but adherence to exclusive applications of SSO was 30.4%. Per-protocol analysis showed a significant 58% (95% CI 42% to 69%, p < 0.01) reduction in mortality among infants in the intervention group who were treated exclusively with SSO as intended versus infants in the comparison group who received exclusive applications of mustard oil. A significant 52% (95% CI 12% to 74%, p = 0.02) reduction in NMR was observed in the subgroup of infants weighing ≤1,500 g (n = 589); there were no statistically significant differences in other prespecified subgroup comparisons by low birth weight (LBW), birthplace, and wealth. No severe adverse events (SAEs) were attributable to the intervention. The study was limited by inability to mask allocation to study workers or participants and by measurement of emollient use based on caregiver responses and not actual observation. CONCLUSIONS: In this trial, we observed that promotion of SSO therapy universally for all newborn infants was not effective in reducing NMR. However, this result may not necessarily establish equivalence between SSO and mustard oil massage in light of our secondary findings. Mortality reduction in the subgroup of infants ≤1,500 g was consistent with previous hospital-based efficacy studies, potentially extending the applicability of emollient therapy in very low-birth-weight (VLBW) infants along the facility-community continuum. Further research is recommended to develop and evaluate therapeutic regimens and continuum of care delivery strategies for emollient therapy for newborn infants at highest risk of compromised skin barrier function. TRIAL REGISTRATION: ISRCTN Registry ISRCTN38965585 and Clinical Trials Registry-India (CTRI/2014/12/005282) with WHO UTN # U1111-1158-4665.


Assuntos
Emolientes/uso terapêutico , Mortalidade Infantil , Óleo de Girassol/uso terapêutico , Administração Tópica , Adulto , Análise por Conglomerados , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Massagem , Mostardeira , Óleos Vegetais/uso terapêutico , Creme para a Pele/uso terapêutico , Fatores Socioeconômicos , Óleo de Girassol/administração & dosagem
6.
PLoS Med ; 18(6): e1003644, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34181649

RESUMO

BACKGROUND: Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. METHODS AND FINDINGS: This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman's self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. CONCLUSIONS: Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. TRIAL REGISTRATION: The study is not a clinical trial.


Assuntos
Mortalidade Infantil , Mortalidade Materna , Complicações na Gravidez/mortalidade , Natimorto/epidemiologia , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Ásia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
7.
J Family Med Prim Care ; 10(4): 1656-1660, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34123908

RESUMO

BACKGROUND AND OBJECTIVES: Genital tuberculosis (TB) is an important cause of infertility in women that poses many challenges in diagnosis. The study is done to understand the utility of GeneXpert test in peritoneal fluid in the diagnosis of genital TB in infertile women. METHODS: All infertile women in postmenstrual phase who were planned for laparoscopy in study period were included. Women who were already on anti-TB therapy were excluded. Peritoneal fluid/washings were retrieved during laparoscopy to test for Mycobacterium tuberculosis by GeneXpert. A note was made of laparoscopy evidence of TB. Endometrial sample was sent for microbiological testing of mycobacterium on smear and liquid culture. Histopathological test of endometrium was also done to look for granulomas. RESULTS: In a total of 57 women, 8 (14.03%) women were diagnosed with TB on the basis of laparoscopy or microbiological or histopathological tests. Six women had caseating tubercles in pelvis, of them two women had presence of mycobacterium on smear, one woman also had positive liquid culture. In two women endometrial smear was positive. None of the women had a positive GeneXpert test in peritoneal fluid. CONCLUSION: Genital TB is a clinical problem in infertile women. Even in women with confirmed genital TB the peritoneal fluid/washings were negative for mycobacterium. GeneXpert did not pick Mycobacterium in peritoneal fluid in women with genital TB. Hence, it is not a sensitive and good tool for the diagnosis of female genital TB.

8.
J Oral Biol Craniofac Res ; 10(2): 220-226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32489825

RESUMO

This systematic review aims to comparatively evaluate the sealing ability gutta-percha and resilon as root canal filling materials. A Medline search was conducted to identify in-vitro studies published between October 01, 2004 and October 01, 2019, conducted on human extracted teeth, published in English and testing the sealing ability of gutta-percha and resilon as root canal filling materials using fluid filtration method. The search identified fifty-five published articles. After a thorough screening, five articles meeting the selection, and validity assessment criteria were critically appraised. The results indicated that during the initial time-period, resilon/epiphany sealer has better sealing ability than gutta-percha. However, over a period of time the resilon system demonstrated increased fluid flow. Gutta-percha with AH plus sealer showed the best long term sealing ability.

9.
Health Policy Plan ; 35(5): 600-608, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32163567

RESUMO

While it is mandated that reproductive and child health services be provided for free at public facilities in India, qualitative evidence suggests it is common for facilities to request bribes and other informal payments for medicines, medical tests or equipment. This article examines the prevalence of bribe requests, total out-of-pocket expenditures (OOPEs) and associations between bribe requests and total OOPEs on the experience of quality of care and maternal complications during childbirth. Women who delivered in public facilities in Uttar Pradesh, India were administered a survey on sociodemographic characteristics, bribe requests, total OOPEs, types of health checks received and experience of maternal complications. Data were analysed using descriptive, bivariate and multivariate statistics. Among the 2018 women who completed the survey, 43% were asked to pay a bribe and 73% incurred OOPEs. Bribe requests were associated with lower odds of receiving all health checks upon arrival to the facility (aOR = 0.49; 95% CI: 0.24-0.98) and during labour and delivery (aOR = 0.44; 95% CI: 0.25-0.76), lower odds of receiving most or all health checks after delivery (aOR = 0.44; 95% CI: 0.31-0.62) and higher odds of experiencing maternal complications (aOR = 1.45; 95% CI: 1.13-1.87). Although it is mandated that maternity care be provided for free in public facilities in India, these findings suggest that OOPEs are high, and bribes/tips contribute significantly. Interventions centred on improving person-centred care (particularly guidelines around bribes), health system conditions and women's expectations of care are needed.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/economia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Parto Obstétrico/economia , Parto Obstétrico/normas , Feminino , Humanos , Índia , Serviços de Saúde Materna/normas , Pessoa de Meia-Idade , Gravidez , Qualidade da Assistência à Saúde/economia , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Environ Mol Mutagen ; 61(5): 574-584, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32067264

RESUMO

The present case-control study aimed to investigate the role of interaction of glutathione-s-transferase (GST) genotypes with environmental risk factors in determining susceptibility to head and neck squamous cell carcinoma (HNSCC) involving 1,250 cases and equal number of healthy controls. An increase in the risk of HNSCC and its subsites (larynx, pharynx, and oral cavity) was observed among the cases with null genotypes of GSTM1 (odds ratio [OR] = 1.87) or GSTT1 (OR = 1.39) while reduced risk (OR = 0.81) was observed the cases with variant genotype of GSTP1. Tobacco use in the form of smoking or chewing interacted multiplicatively with GSTM1 or GSTT1 to increase the risk several folds (3-10 folds) in HNSCC and its subsites. Alcohol use also increased the risk (2-3 folds) to HNSCC and its subsites in cases with null or variant genotypes of GSTs, though this risk was of lesser magnitude when compared to the tobacco users. A synergistic effect of both, tobacco smoking and alcohol drinking, led to several folds (25-folds) increased risk to HNSCC among the cases with null genotype of GSTM1 and GSTT1 when compared to nonsmokers and nondrinkers with wild genotype of GSTM1 and GSTT1 in controls. Furthermore, cases with variant genotypes of GSTP1 (Val/Val) showed superior treatment response with improved survival rate and lower risk of death when compared to the patients with wild type genotype (Ile/Ile). The data suggest that though polymorphism in GSTs may be a modest risk factor for determining HNSCC risk, gene-environment interactions significantly modify the susceptibility to HNSCC by several folds.


Assuntos
Interação Gene-Ambiente , Predisposição Genética para Doença , Glutationa Transferase/genética , Neoplasias de Cabeça e Pescoço/enzimologia , Neoplasias de Cabeça e Pescoço/genética , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Fatores de Risco , Resultado do Tratamento
12.
Health Policy Plan ; 34(8): 574-581, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419287

RESUMO

In India, most women now delivery in hospitals or other facilities, however, maternal and neonatal mortality remains stubbornly high. Studies have shown that mistreatment causes delays in care-seeking, early discharge and poor adherence to post-delivery guidance. This study seeks to understand the variation of women's experiences in different levels of government facilities. This information can help to guide improvement planning. We surveyed 2018 women who gave birth in a representative set of 40 government facilities from across Uttar Pradesh (UP) state in northern India. Women were asked about their experiences of care, using an established scale for person-centred care. We asked questions specific to treatment and clinical care, including whether tests such as blood pressure, contraction timing, newborn heartbeat or vaginal exams were conducted, and whether medical assessments for mothers or newborns were done prior to discharge. Women delivering in hospitals reported less attentive care than women in lower-level facilities, and were less trusting of their providers. After controlling for a range of demographic attributes, we found that better access, higher clinical quality, and lower facility-level, were all significantly predictive of patient-centred care. In UP, lower-level facilities are more accessible, women have greater trust for the providers and women report being better treated than in hospitals. For the vast majority of women who will have a safe and uncomplicated delivery, our findings suggest that the best option would be to invest in improvements mid-level facilities, with access to effective and efficient emergency referral and transportation systems should they be needed.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Índia , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Assistência Centrada no Paciente/estatística & dados numéricos , Inquéritos e Questionários
13.
Glob Health Action ; 12(1): 1619155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159680

RESUMO

Background: Globally, opportunities to validate government reports through external audits are rare, notably in India. A cross-sectional maternal health study in Uttar Pradesh, India's most populous state, compares government administrative data and externally collected data on maternal health service indicators. Objectives: Our study aims to determine the level of concordance between government-reported health facility data compared to externally collected health facility data on the same maternal healthcare quality indicators. Second, our study aims to explore whether the level of agreement between government administrative data versus the externally collected data differs by level of facility or by type of maternal health service. Methods: Facility assessment surveys were administered to key health staff by government-hired enumerators from January 2017 to March 2017 at nearly 750 government health facilities across UP. The same survey was re-conducted by external data collectors from August 2017 to October 2017 at 40 of the same facilities. We conduct comparative analyses of the two datasets for agreement among the same measures of maternal healthcare quality. Results: The findings indicate concordance between most indicators across government administrative data and externally collected health facility data. However, when stratified by facility-level or service type, results suggest significant over-reporting in the government administrative data on indicators that are incentivized. This finding is consistent across all levels of facilities; however, the most significant disparities appear at higher-level facilities, namely District Hospitals. Conclusion: This study has a number of important programmatic and policy implications. Government administrative health data have the potential to be highly critical in informing large-scale quality improvements in maternal healthcare quality, but its credibility must be readily verifiable and accessible to politicians, researchers, funders, and most importantly, the public, to improve the overall health, patient experience, and well-being of women and newborns.


Assuntos
Confiabilidade dos Dados , Coleta de Dados/métodos , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
14.
Sudan J Paediatr ; 19(2): 110-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31969739

RESUMO

Carotid intima media thickness (cIMT) is considered as a surrogate marker for the various cardiovascular events that complicate nephrotic syndrome (NS). The present work was conducted to study cIMT in children with NS and to find out its correlation with dyslipidemia and other risk factors. This was a case control study conducted at a tertiary care hospital in children with NS who were more than 2 years with normal serum complement, being on therapy for NS for at least 1 year, glomerular filtration rate more than 90 ml/minute/1.73 m2 and absence of acute infection in previous 3 months. Sixty six children with NS constituted the case material and 128 age and sex matched children were taken as control. The mean age in case and control cohort was 6.71 ± 3.3 and 7.89 ± 3.95 years, respectively. The mean age of onset of illness was 4.32 ± 2.25 years. The mean duration of illness was 2.39 ± 1.44 years. Thickness of cIMT was higher in NS children as compared to control group in all the ages, but this difference was statistically significant only after 4 years of age. There was statistically significant, but weak positive correlation between cIMT and age of NS children, duration of disease and number of relapses. There was no correlation of cIMT with hypertension, body mass index, serum creatinine, and dyslipidemia. A negative, but statistically insignificant correlation of cIMT was found with serum albumin and serum cholesterol.

15.
J Oral Biol Craniofac Res ; 7(1): 13-18, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28316915

RESUMO

OBJECTIVES: This cross-sectional community based study was conducted to estimate the prevalence of consumption habits for non tobacco pan masala (ASU) and the risk of developing oral precancer in North India. METHODS: This study was conducted in the old town of Lucknow city in the state of Uttar Pradesh in India. Subjects residing for more than 6 months and aged 15 years or above, were enrolled in the study after their informed consent. A two page survey tool was used to collect the data. A three times more matched sample of non users was randomly obtained from this data to analyze and compare the final results. RESULTS: 0.45 million subjects were surveyed. Majority of tobacco users were in the age group of 20-35 years among males and 35-39 years among females. Consumption of non tobacco pan masala among males as well as females was most common in 15-19 years of age group. Prevalence of oral precancer (leukoplakia, submucous fibrosis, erythroplakia, lichen planus, smokers palate and verrucous hyperplasia) was 3.17% in non tobacco pan masala users and 12.22% in tobacco users. The odds of developing oral precancer in non tobacco pan masala users was 20.71 (18.79-22.82) and in tobacco users was 88.07 (84.02-92.31) at 95% confidence interval against non users of both. CONCLUSION: The odds of developing oral precancer even with consumption of pan masala is high, even when it is consumed without tobacco. It is hence recommended to discourage this habit.

16.
Indian J Endocrinol Metab ; 20(4): 437-42, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27366708

RESUMO

BACKGROUND: There are conflicting data regarding the prevalence of colorectal polyp in patients with acromegaly. SUBJECTS AND METHODS: Consecutive forty-seven acromegalic patients (21 men, 26 women), with a mean age of (40 ± 12 years) attending endocrinology outpatient department underwent full colonoscopy. All the patients underwent clinical and biochemical evaluation (glucose suppressed growth hormone (GH), Insulin-like growth factor-1 [IGF-1], fasting insulin, and glucose). The control group (n = 120) for colonoscopy was adult subjects undergoing evaluation for symptoms of irritable bowel syndrome. Clinical and biochemical parameters in acromegalic patients with colonic polyp were compared to those without a polyp. RESULTS: Patients with acromegaly had significantly higher prevalence of colonic polyp as compared to control subjects (10.6% vs. 0.8%). None of the patients with polyp had skin tags. There was no significant difference between subjects with and without colonic polyp in duration of illness, basal, and glucose-suppressed GH and most recent IGF-1. Fasting blood sugar was significantly higher (P < 0.05) in adenoma group after adjusting for age, body mass index (BMI), and insulin levels. Patients in adenoma group showed a trend toward male gender and younger age as compared to those without adenoma. CONCLUSIONS: Subjects with acromegaly as compared to control have a higher prevalence of colonic polyps. There was no association of polyps seen with age, BMI, skin tags, homeostasis model assessment of insulin resistance index, duration of disease, and basal and glucose-suppressed GH and IGF-1 levels. There were no specific predictive factors detected. Screening full colonoscopy is recommended in all cases with acromegaly.

17.
J Oral Biol Craniofac Res ; 5(3): 128-33, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26587377

RESUMO

BACKGROUND: Habit of consuming tobacco and areca-nut containing substances is in vogue in Lucknow as a part of the Nawabi culture. Hence, this study was planned with an aim to generate evidence for the prevalence of habits of substance abuse by the population of Lucknow and know their socio-demographic profile. METHODOLOGY: Population based cross-sectional study was conducted by organizing oral health check-up camps in randomly selected rural and urban parts of Lucknow, the capital city of Uttar Pradesh, which is the most populated state of India. Patients were enrolled after obtaining informed consent. A structured and validated questionnaire based tool was administered by a team of trained dental surgeons for collecting the desired information through interview and their oral cavity examination. RESULTS: A total of 3437 subjects were enrolled in the study, out of which 82.9% were male and 17.1% were female. Among them, 64.6% subjects belonged to rural domiciliary status, by religion, 80.6% and 18.5% of the subjects were Hindu and Muslims respectively. The most prevalent habit was consumption of smokeless tobacco substances, of which pan masala with tobacco (gutkha) was the most prevalent substance of abuse. CONCLUSION: Smokeless tobacco consumption was highly prevalent in the population surveyed. It is recommended to formulate and implement strong preventive strategies. Also, steps should be taken to increase the awareness of the harmful consequences of these habits.

18.
Biochemistry ; 50(44): 9532-44, 2011 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-21830810

RESUMO

MenB, the 1,4-dihydroxy-2-naphthoyl-CoA synthase from the bacterial menaquinone biosynthesis pathway, catalyzes an intramolecular Claisen condensation (Dieckmann reaction) in which the electrophile is an unactivated carboxylic acid. Mechanistic studies on this crotonase family member have been hindered by partial active site disorder in existing MenB X-ray structures. In the current work the 2.0 Å structure of O-succinylbenzoyl-aminoCoA (OSB-NCoA) bound to the MenB from Escherichia coli provides important insight into the catalytic mechanism by revealing the position of all active site residues. This has been accomplished by the use of a stable analogue of the O-succinylbenzoyl-CoA (OSB-CoA) substrate in which the CoA thiol has been replaced by an amine. The resulting OSB-NCoA is stable, and the X-ray structure of this molecule bound to MenB reveals the structure of the enzyme-substrate complex poised for carbon-carbon bond formation. The structural data support a mechanism in which two conserved active site Tyr residues, Y97 and Y258, participate directly in the intramolecular transfer of the substrate α-proton to the benzylic carboxylate of the substrate, leading to protonation of the electrophile and formation of the required carbanion. Y97 and Y258 are also ideally positioned to function as the second oxyanion hole required for stabilization of the tetrahedral intermediate formed during carbon-carbon bond formation. In contrast, D163, which is structurally homologous to the acid-base catalyst E144 in crotonase (enoyl-CoA hydratase), is not directly involved in carbanion formation and may instead play a structural role by stabilizing the loop that carries Y97. When similar studies were performed on the MenB from Mycobacterium tuberculosis, a twisted hexamer was unexpectedly observed, demonstrating the flexibility of the interfacial loops that are involved in the generation of the novel tertiary and quaternary structures found in the crotonase superfamily. This work reinforces the utility of using a stable substrate analogue as a mechanistic probe in which only one atom has been altered leading to a decrease in α-proton acidity.


Assuntos
Enoil-CoA Hidratase/química , Proteínas de Escherichia coli/química , Oxo-Ácido-Liases/química , Vitamina K 2/química , Sequência de Aminoácidos , Catálise , Domínio Catalítico , Cristalografia por Raios X , Enoil-CoA Hidratase/metabolismo , Proteínas de Escherichia coli/metabolismo , Dados de Sequência Molecular , Família Multigênica , Mycobacterium tuberculosis/enzimologia , Oxo-Ácido-Liases/metabolismo , Ligação Proteica , Especificidade por Substrato , Succinato-CoA Ligases/química , Succinato-CoA Ligases/metabolismo
19.
Proteins ; 59(2): 332-8, 2005 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-15726588

RESUMO

Ras superfamily GTP-binding proteins regulate important signaling events in the cell. Ras, which often serves as a prototype, efficiently hydrolyzes GTP in conjunction with its regulator GAP. A conserved glutamine plays a vital role in GTP hydrolysis in most GTP-binding proteins. Mutating this glutamine in Ras has oncogenic effects, since it disrupts GTP hydrolysis. The analysis presented here is of GTP-binding proteins that are a paradox to oncogenic Ras, since they have the catalytic glutamine (Glncat) substituted by a hydrophobic amino acid, yet can hydrolyze GTP efficiently. We term these proteins HAS-GTPases. Analysis of the amino acid sequences of HAS-GTPases reveals prominent presence of insertions around the GTP-binding pocket. Homology modeling studies suggest an interesting means to achieve catalysis despite the drastic hydrophobic substitution replacing the key Glncat of Ras-like GTPases. The substituted hydrophobic residue adopts a "retracted conformation," where it is positioned away from the GTP, as its role in catalysis would be unproductive. This conformation is further stabilized by interactions with hydrophobic residues in its vicinity. These interacting residues are strongly conserved and hydrophobic in all HAS-GTPases, and correspond to residues Asp92 and Tyr96 of Ras. An experimental support for the "retracted conformation" of Switch II arises from the crystal structures of Ylqf and hGBP1. This conformation allows us to hypothesize that, unlike in classical GTPases, catalytic residues could be supplied by regions other than the Switch II (i.e., either the insertions or a neighboring domain).


Assuntos
GTP Fosfo-Hidrolases/química , GTP Fosfo-Hidrolases/metabolismo , Glutamina , Guanosina Trifosfato/metabolismo , Substituição de Aminoácidos , Domínio Catalítico , GTP Fosfo-Hidrolases/genética , Proteínas de Ligação ao GTP/química , Proteínas de Ligação ao GTP/metabolismo , Guanosina Difosfato/metabolismo , Hidrólise , Ligantes , Modelos Moleculares , Conformação Proteica , Estrutura Secundária de Proteína
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