Maternal Diets in India: Gaps,Barriers, and Opportunities

Suboptimal dietary intake is a critical cause of poor maternal nutrition, with several adverse consequences both for mothers and for their children. This study aimed to (1) assess maternal dietary patterns in India; (2) examine enablers and barriers in adopting recommended diets; (3) review current policy and program strategies to improve dietary intakes. We used mixed methods, including empirical analysis, compiling data from available national and subnational surveys, and reviewing literature, policy, and program strategies. Diets among pregnant women are characterized by low energy, macronutrient imbalance, and inadequate micronutrient intake. Supply- and demand-side constraints to healthy diets include food unavailability, poor economic situation, low exposure to nutrition counselling, food restrictions and taboos, adverse family influence and gender norms, and gaps in knowledge. Intervention strategies with potential to improve maternal diets include food-based programs, behavior change communication, and nutrition-sensitive agriculture interventions. However, strategies face implementation bottlenecks and limited effectiveness in real-world at-scale impact evaluations. In conclusion, investments in systems approaches spanning health, nutrition, and agriculture sectors, with evaluation frameworks at subnational levels, are needed to promote healthy diets for women.     

Iatrogenic coronary artery stenosis following aortic valve replacement.

Until recnetly, coronary arterial perfusion was one of the best methods to protect myocardium during aortic valve replacement. However, the insertion of perfusion cannulas may produce immediate traumatic lesions and late stenosis of the coronary arteries, with grave consequences. Two patients with normal coronary arteries prior to operation developed obstruction of the maximal left main coronary artery following aortic replacement. One of these patients represents the first case of iatrogenic coronary arterial stenosis in which the aortic valve was replaced with a porcine bioprosthesis. Accelerating angina pectoris and ventricular arrhythmias were the presenting clinical manifestations. Aorta-coronary bypass grafting to the left anterior descending and circumflex coronary arteries was successfully performed in one patient, while the other patient died before investigative procedures could be undertaken. Any patient whose aortic valve has been replaced and who develops angina pectoris a few months after operation should be suspected of having developed stenosis of the proximal coronary artery. Coronary angiography should be perfomed promptly. Once the lesion is recognized, the operaiton should be performed posthaste because these lesions are life threatening owing to their proximal location and rapid evolution.     

A randomized trial comparing a polyherbal pessary (a complementary and alternative medicine) with Ginlac-V pessary (containing clotrimazole,tinidazole and lactobacilli) for treatment of women with symptomatic vaginal discharge

BACKGROUND: Most women with abnormal vaginal discharge have infection due to candida species, bacterial vaginosis or trichomoniasis and often seek treatment without laboratory confirmation. In this context, a single agent effective against these infections would be useful. AIM: To compare the efficacy of two such agents: Praneem polyherbal pessary; a complementary and alternative medicine (CAM) with Ginlac-V pessary (containing clotrimazole, tinidazole and lactobacilli) for treatment of abnormal vaginal discharge. SETTINGS AND DESIGN: A randomized study in a tertiary care hospital in North India. Methods: One hundred women were randomized for treatment with either of the two pessaries. Clinical examination and laboratory evaluation was done before and after treatment. STATISTICAL ANALYSIS: Mc-Nemar test and Chi-square test. RESULTS: Overall, 82% (82/100) reported symptomatic relief; 78% (39/50) with Praneem and 86% (43/50) with Ginlac-V. Only 36% (18/50 in each group) had laboratory-confirmed infection; 18% (18/100) candidosis, 17% (17/100) bacterial vaginosis, 1% (1/100) both; none had trichomoniasis. Among these, symptomatic improvement was seen in 72% (13/18) and laboratory cure in 78% (14/18) with Praneem; symptomatic improvement in 78% (14/18) and laboratory cure in 78% (14/18) with Ginlac-V. Clinical or laboratory criteria could assess treatment efficacy equally. Neither drug was efficacious in candidosis. Ginlac-V was efficacious in bacterial vaginosis (100%) and though Praneem showed a similar trend, it was not statistically significant. Vaginal irritation was more frequent with Praneem (16% vs 4% with Ginlac-V). CONCLUSION: Both Praneem and Ginlac-V provided symptomatic relief in most of the women. Either clinical or laboratory criteria could assess treatment efficacy of both drugs. Ginlac-V was efficacious for treating bacterial vaginosis.     

Emodin inhibits growth and induces apoptosis in an orthotopic hepatocellular carcinoma model by blocking activation of STAT3

BACKGROUND AND PURPOSE

Aberrant activation of STAT3 is frequently encountered and promotes proliferation, survival, metastasis and angiogenesis in hepatocellular carcinoma (HCC). Here, we have investigated whether emodin mediates its effect through interference with the STAT3 activation pathway in HCC.

EXPERIMENTAL APPROACH

The effect of emodin on STAT3 activation, associated protein kinases and apoptosis was investigated using various HCC cell lines. Additionally, we also used a predictive tumour technology to analyse the effects of emodin. The in vivo effects of emodin were assessed in an orthotopic mouse model of HCC.

KEY RESULTS

Emodin suppressed STAT3 activation in a dose- and time-dependent manner in HCC cells, mediated by the modulation of activation of upstream kinases c-Src, JAK1 and JAK2. Vanadate treatment reversed emodin-induced down-regulation of STAT3, suggesting the involvement of a tyrosine phosphatase and emodin induced the expression of the tyrosine phosphatase SHP-1 that correlated with the down-regulation of constitutive STAT3 activation. Interestingly, silencing of the SHP-1 gene by siRNA abolished the ability of emodin to inhibit STAT3 activation. Finally, when administered i.p., emodin inhibited the growth of human HCC orthotopic tumours in male athymic nu/nu mice and STAT3 activation in tumour tissues.

CONCLUSIONS AND IMPLICATIONS

Emodin mediated its effects predominantly through inhibition of the STAT3 signalling cascade and thus has a particular potential for the treatment of cancers expressing constitutively activated STAT3.     

Antiulcer potential of the ethanolic extract of Aerva persica Merrill root in rats

The ethanol extract of the roots of Aerva persica (Burm f) Merrill (Amaranthaceae) was investigated to determine its antiulcer and in vivo antioxidant activities in albino Wistar rats. Ulcers were induced by ethanol and pylorus ligation. The extract was administered at the dose of 200 mg/kg orally, p.o. for 15 consecutive days. The ulcer index of the ethanol extract was found to be significantly reduced compared with control animals. The effect was also assessed by determining the free acidity, pepsin activity, total carbohydrate (TC), and protein content (PK) in control, standard, and test group animals. The in vivo antioxidant activity was evaluated by determining the reduced glutathione level (GSH) and malondialdehyde (MDA) level in the tissue homogenates. The results reveal the significant reduction in the level of malondialdehyde and the increase in the level of reduced glutathione in the rats that received the ethanolic extract. Furthermore, histopathological studies have shown that pretreatment with the ethanolic extract of the roots of A persica reduces (100%) ethanol- and pylorus ligation-induced hemorrhagic necrosis in rats.