Farm-level plans and husbandry measures for aquatic animal disease emergencies.

Disease is one of the gravest threats to the sustainability of the aquaculture industry. A good understanding of biosecurity and disease causation is essential for developing and implementing farm-level plans and husbandry measures to respond to disease emergencies. Using epidemiological approaches, it is possible to identify pond- and farm-level risk factors for disease outbreaks and develop intervention strategies. Better management practices (BMPs) should be simple, science-based, cost-effective and appropriate to their context if farmers are to adopt and implement them. As part of a regional initiative by the Network of Aquaculture Centres in Asia-Pacific (NACA) to control aquatic animal diseases, effective extension approaches to promote the widespread adoption of BMPs have been developed in India, Indonesia, Vietnam and Thailand, and have proved their worth. A highly successful programme, which addresses rising concerns about the effect of disease on the sustainability of shrimp farming in India, is now in its seventh year. In this paper, the authors present a brief insight into the details of the programme, its outcomes and impact, the lessons learned and the way forward.

Poliomyelitis trends in Pondicherry, south India, 1989-91.

STUDY OBJECTIVES: To assess the poliomyelitis trend, including study of the epidemiological features, and to correlate this with the immunisation coverage of infants. DESIGN: Three annual lameness surveys in children aged 0-60 months employing cluster sampling methods and a series of five cross sectional surveys of immunisation coverage in children aged 12-23 months of age were undertaken. SETTING: Pondicherry, India, 1988-92. SUBJECTS: More than 10,000 children in the age group of 0-60 months took part in the three annual lameness surveys and samples of 210 children aged 12-23 months were covered each year in immunisation coverage surveys. MEASUREMENTS AND MAIN RESULTS: Altogether 50 of 11,461, 24 of 10,093, and 17 of 11,218 children surveyed during 1989, 1990, and 1991 respectively had become lame as a result of poliomyelitis, giving prevalences of 4.4, 2.4, and 1.5 per 1000 children for the three surveys. The corrected prevalences of poliomyelitis were 5.9, 3.2, and 2.0 per 1000 children during 1989, 1990, and 1991 respectively. The proportion of cases aged up to 36 months fell from 48% in 1989 to 12.5% in 1990 and 6% in 1991. The age at onset was less than 1 year in most. The median age at onset was 10.7 months. About 54% of the affected children had received three doses of oral poliomyelitis vaccine (OPV) before the onset of paralysis. In 1988 immunisation coverage for the third dose of OPV was 91% and in 1992 it was 97.6%. The drop out rate for the first versus the third dose of OPV fell from 6.3 in 1988 to 1.9% in 1992. CONCLUSION: Three successive annual lameness surveys showed that poliomyelitis was declining between 1989 and 1991. Five immunisation coverage surveys conducted from 1988 to 1992 showed high initial coverage followed by an improvement in the form of almost universal coverage for OPV.

Particle-inflow-gun-mediated genetic transformation of buffel grass (Cenchrus ciliaris L.): optimizing biological and physical parameters.

The present study was conducted to optimize various biological and physical parameters for developing an efficient and reproducible gene transfer method for genetic transformation of buffel grass. Transformation was carried out using a helium-driven particle inflow gun (PIG). Embryogenic calli produced from mature seeds of buffel grass cv. CC-119 were separately bombarded with four plasmids, containing Actin (pAct1DX), Ubiquitin (pAHC-25; pAHC-27) and CaMV-35S (pCaMVGUS) promoters, coated on tungsten and gold particles. The efficiency of transformation was monitored through transient GUS expression. Different parameters, viz., the type of promoter, type and size of microcarrier, helium gas pressure, distance and time of bombardment, were standardized for delivering DNA into embryogenic calli. Bombardment with plasmid DNA carrying the actin promoter coated on 1.6 micro gold particles, at a helium pressure of 4 bars, a distance of 10 cm for 10 micro sec and 28 mm Hg vacuum in the chamber, produced the best result in transient GUS expression. The Actin promoter was found to be more efficient in driving expression of the GUS gene in buffel grass, followed by Ubiquitin and CaMV-35S promoters. Lower helium pressure was found to be sub-optimal, while higher pressure produced a smaller number of blue spots, probably due to excessive damage to the cells. Maximum of 385 blue spots was observed with gold particles of 1.6 micro size, whereas only 213 blue spots were recorded for tungsten particles of 1.0 micro size. The optimized parameters can be employed for genetic transformation of buffel grass with genes of agronomic importance.

Intrauterine perineal tear: a rare birth injury.

A rare case of birth injury having intrauterine complete perineal tear is presented. Defunctioning sigmoid colostomy was undertaken because of bad perineal condition. The baby died of Pseudomonas septicemia on the 15th day before definitive surgical procedure could be undertaken.

Epidemiology of respiratory distress of newborns.

The present prospective study was conducted to find out the incidence, etiology and outcome of respiratory distress (RD) in newborns. All newborns (n = 4505), delivered at this hospital over a period of 13 months, were observed for respiratory problems. Relevant antenatal, intranatal and neonatal information was noted. Cases were investigated for the cause of respiratory distress and followed up for the outcome. The overall incidence of RD was 6.7%. Preterm babies had the highest incidence (30.0%) followed by post-term (20.9%) and term babies (4.2%). Transient tachypnea of newborn (TTN) was found to be the commonest (42.7%) cause of RD followed by infection (17.0%), meconium aspiration syndrome (10.7%), hyaline membrane disease (9.3%) and birth asphyxia (3.3%). TTN was found to be common among both term and preterm babies. While Hyaline membrane disease (HMD) was seen mostly among preterms, and Meconium aspiration syndrome (MAS) among term and post-term babies. Overall case fatality ration for RD was found to be 19%, being highest for HMD (57.1%), followed by MAS (21.8%) and infection (15.6%). Our results indicate that RD is a common neonatal problem. TTN accounts for a large proportion of these cases. MAS and infection also contribute significantly and are largely preventable. Without adequate ventilatory support HMD and MAS carry high mortality.

Early neonatal mortality in an intramural birth cohort at a tertiary care hospital.

Early neonatal mortality (ENM) occurring among 12,283 consecutive live births over a period of 3 years were analysed. The early neonatal mortality rate (ENMR) was 26.6/1000 live births. Birth weight less than 2,000 gm, lack of antenatal care, male sex, operative vaginal delivery, prematurity and multiple pregnancy were significantly associated with early neonatal deaths. Birth asphyxia was found to be the most important cause of death, followed by hyaline membrane disease and congenital malformations. Majority of the asphyxia related deaths were due to late intrapartum referral of the mothers. Forty-two per cent of early neonatal deaths occurred in babies weighing less than 1,500 gm. Early identification and referral of high risk mothers and health education would significantly reduce the early neonatal deaths.

Congenital malformations at birth--a prospective study from south India.

Congenital malformations were studied prospectively from September 1989 to December 1992 covering 12,797 consecutive deliveries. The overall incidence of malformations was 3.7% and it was 3.2% among live births and 15.7% among still births. Three hundred and ninety seven birth defects were observed among 308 live births and 72 among 45 still births. The incidence of malformation was significantly higher among male babies (p < 0.001), still births (p < 0.001), low birth weights (p < 0.001) and preterm babies (p < 0.001). Consanguinity among parents of malformed babies was more common (p < 0.001). Musculo-skeletal malformations were the commonest (9.69 per 1000) followed by cutaneous (6.33 per 1000), genitourinary (5.47 per 1000), gastrointestinal (5.47 per 1000), central nervous system (3.99 per 1000) and cardiac anomalies (2.03 per 1000). Musculoskeletal, cutaneous and genitourinary malformations were common among live born babies while central nervous system and gastrointestinal defects were common among still born babies. Antenatal infections and ingestion of drugs were not found to be significant factors in the causation of birth defects.

Bone injuries during delivery.

Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.

Growth pattern of low birth weight babies in the first year of life.

OBJECTIVE: The growth pattern of low birth weight (LBW) babies was studied prospectively in our hospital from September 1995 to august 1996. METHOD: Every baby <1.5 kg birth weight (B.Wt), every 2nd baby between 1.5 to 2 kg, every 6th baby between 2 to 2.5 kg and 120 term appropriate for gestation (AGA) babies ( as controls) were included in the study. Severe birth asphyxia, multiple gestation, major malformations or severe birth trauma formed exclusion criteria. Weight, length and head circumference were measured in all babies at birth and at 2 monthly intervals till 1 year of age. All babies completing 1 year follow-up were included for final analysis. Growth distance curves were constructed separately for each parameter for the six categories based on birth weight (Groups I-VI) and on gestational age (Divisions A-F). Comparison was made between the LBW babies and the controls for growth pattern among the babies who completed 1 year follow up (total of 220 babies). RESULT: The growth pattern for weight and length showed good catch up growth in babies >1.25 kg B.Wt. and >30 weeks gestation, reaching almost the same level as controls by 1 year of age. Babies with B.Wt <1.25 kg and <30 weeks gestation showed late and poor catch up growth, with considerable lag persisting at 1 year of age. Head circumference increased rapidly in all babies, with maximal growth rate initially followed by a steady decline. All babies showed catch up growth, although those <1.25 kg and <30 weeks gestation still lagged behind even at 1 year. CONCLUSION: It was seen that the smallest and least mature babies had late and poor catch up growth. Recognition of the factors influencing catch up growth and adequate measures to improve growth (like attention to feeding practices) may improve the overall outcome of these babies.

Perinatal mortality trends in a referral hospital.

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992-93 (Group B). The perinatal mortality rate (PMR) in Groups A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.

Neonatal septicaemia among inborn and outborn babies in a referral hospital.

Neonatal sepsis was studied among one hundred neonates (50 hospital born and 50 outborn babies) over one year period. The incidence of neonatal septicaemia was 15.5 per 1000 live births in the hospital. Among outborn babies it accounted for 6.1% of total pediatric admissions and 43.7% of sick neonates referred from outside. Low birth weight and prematurity were important predisposing factors in both the groups. Blood culture was positive among 32% of outborn and 34% of inborn babies. Coagulase-negative Staphylococcus, Klebsiella and Acinetobacter were the common causative organisms. All isolated organisms were sensitive to Gentamicin whereas 75% of them were resistant to Ampicillin. Mortality among outborn neonates (32%) was much higher in comparison to (10%) hospital born babies. Early identification of high risk antenatal cases and neonates and appropriate referral can bring down mortality and morbidity from neonatal sepsis.

Perinatal risk factors in neonatal infections.

Perinatal risk factors were studied among 50 cases of neonatal septicemia and 200 matched normal neonates during one year period. The consanguinity among parents, birth order and sex of the baby did not increase the risk for developing septicemia. There was significant increase in the risk for septicemia when the duration of labour was more than 24 hours (P less than 0.01), time interval between rupture of membrane and delivery of baby was more than 12 hours (P less than 0.001), liquor was meconium stained or foul smelling (P less than 0.001) and delivery was operative (P less than 0.01). The neonatal factors identified with risk for septicemia were preterm delivery (P less than 0.01), low birth weight (P less than 0.01), birth asphyxia (P less than 0.001) assisted ventilation (P less than 0.001) and intravenous alimentation (P less than 0.02). Identification of high risk pregnancies and appropriate management can minimize many of the above risk factors which in turn will reduce the occurrence of neonatal sepsis.

Perinatal autopsy--a seven-year study.

A retrospective analysis of autopsies conducted on perinatal deaths during 7 years period (Oct 1983 to Sept 1990) was done. There were 650 neonatal deaths and 944 still births during the study period. Autopsy rates among neonates and still births were 33% and 4.9% respectively. There ware significant findings in 97.2% of neonatal deaths and in all still births. Pulmonary lesions followed by congenital malformations were the major pathological findings. Infection was observed among smaller number of babies compared to other Indian studies. Autopsy revealed many internal congenital malformations which were not diagnosed clinically. Autopsy changed or added to clinical diagnosis in 59.5% of cases. Perinatal autopsy is highly productive in our set up.

Growth hormone levels in relation to birth weight and gestational age.

Growth hormone levels were measured in 33 umbilical cord blood samples collected from babies born at JIPMER Hospital during April and May-1998. The study was done to evaluate the growth hormone profile in relation to birth weight and gestational age. There was statistically significant difference in the cord blood growth hormone levels between babies weighing > 2500 gms (28.1 +/- 12.83 ng/dl) and low birth weight babies (76.8 +/- 55.7 ng/dl). The difference in growth hormone levels between term babies weighing > 2500 gms and preterm babies (72.5 +/- 29.4 ng/dl) was also statistically significant. However, there was no significant difference in the cord blood growth hormone levels between term low birth weight and preterm babies. Growth hormone levels were higher in preterm babies and low birth weight babies as compared to term babies weighing > 2500 gms indicating that growth hormone has an important role to play in intrauterine growth along with other growth promoting factors.

Genital standards for south Indian male newborns.

One hundred and thirty-five male newborns in JIPMER hospital were studied. The penile length (stretched and unstretched), width as well as testicular length and breadth were measured. The influence of the gestational age and intrauterine growth on these measurements were studied. The mean stretched penile length for term babies was 3.57 cms (+/- 0.46), the unstretched length 3.26 cms (+/- 0.41), and the width was 1.04 cms (+/- 0.15). There was a linear increase in the above measurements with increasing gestational age. The right testicular length was 1.39 cms (+/- 0.28) and breadth was 0.98 cm (+/- 0.15) while the length and breadth for left testis were 1.32 cms (+/- 0.24) and 0.95 cm (+/- 0.14) respectively for term babies. The prepucial type was tubular in 103 (76.3%) babies and of ring type in 32 (23.7%). In 72 (53.3%) babies the prepuce could be retracted enough to visualise external urinary meatus.

Twin fetus in fetu.

Fetus in fetu is a rare cause of intra-abdominal mass. The presence of vertebral and skeletal axis differentiates it from a teratoma. We report an unusual case of two well developed fetuses in the retroperitoneal area of a neonate delivered at term.

Clinico-bacteriological study of neonatal conjunctivitis.

Perinatal risk factors and bacteriological profile of conjunctivitis were studied among 245 newborns delivered at JIPMER Hospital between July 1986 and June 1988. Maternal and neonatal factors like lack of antenatal care, presence of adverse intrapartum factors, operative deliveries, birth asphyxia, pre-maturity and prolonged hospital stay significantly increased the chances of developing conjunctivitis (P less than 0.001). Bacteria were recovered from 163 (66.5%) cases. Staphylococcus was the commonest pathogenic bacteria isolated, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae. Neisseria gonorrhoeae was isolated in only one case. Most of the organisms showed in vitro sensitivity to chloramphenicol, gentamycin and tetracycline. All the cases responded to topical chloramphenicol except three which required systemic antibiotics. No complications were observed. The identification and appropriate management of high risk pregnancies with minimal hospital stay can reduce the incidence of neonatal conjunctivitis.

Perinatal mortality: a hospital based study.

Three thousand seven hundred and two deliveries between January and December, 1990 were the study subjects. The perinatal mortality rate (PNMR), stillbirth rate (SBR) and early neonatal death rates (ENDR) were found to be 57/1000, 35.1/1000 and 22.7/1000, respectively. The preterms had much higher PNMR, SBR and ENDR as compared to term babies. Term babies weighing > or = 2500 g had a PNMR of 18/1000. In preterm and term babies the mortality was reduced considerably with increase in birth weight (BW). The unbooked deliveries had significantly higher PNMR, SBR and ENDR compared to booked deliveries. The fall in PNMR compared to observations of a decade ago was due to a fall primarily in ENDR, with SBR remaining unchanged signifying failure of existing MCH set up. Nearly, 92% of ENDR were in first 72 hours which signifies the need for developing and strengthening the intensive care facilities along with timely referral of high risk mothers.

Loose stools in the early neonatal period.

During a two-year period, the various factors associated with loose stools in the early neonatal period were studied among hospital born babies. Low birth weight babies had a lower incidence of non-infective loose stools when compared to neonates with a birth weight of more than 2500 g (p < 0.001). Newborns delivered by Cesarean section (p < 0.001) and those born to women with more than two children (p < 0.02) had a greater frequency of loose stools. Initiation of supplementary feeding and administration of antibiotics were important factors in causing loose stools. Bacterial etiology could be found only in 9.3% of newborns having loose stools. A later onset of loose stools was noted in those, whose stool culture grew bacterial organisms. Only nine newborns with loose stools required antibiotic therapy. Although loose stools were less common among low birth weight babies, they often required treatment with antimicrobials. None of them developed any complications. Since majority of them are non-bacterial and non-infective, great caution must be exercised before administering antibiotics to newborns with loose stools.

Training of final year MBBS students in neonatal resuscitation.

Sixty final year MBBS students were trained in the art of neonatal resuscitation based on the 'NALS' course material. The students scored 11.6 +/- 3.02 in the pretest and 17.85 +/- 4.42 (out of 20) in the post-test. The trainees felt that the programme was extremely useful. Majority of them said that the course content was optimum with appropriate use of teaching-learning media. It is recommended that this training may be imparted to all the undergraduate students at the entry of final year MBBS course before their labor room posting so that they can have effective reinforcement of the training.