Taken to Health Care Provider or Not,Under-Five Children Die of Preventable Causes: Findings from Cross-Sectional Survey and Social Autopsy in Rural India

Background:Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets.Findings:A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers.Conclusion:The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India.     

Plasma cell tumors in HIV-positive patients: report of a case and review of the literature

Plasma cell tumors show an increased incidence in HIV-positive patients. The cases reported in the literature suggest that plasma cell tumors occur in a younger age group than that encountered in the general population. Pathologically, many of these tumors show a plasmablastic morphology. Plasma cell tumors in HIV-positive patients may present at unusual sites and progress rapidly to involve multiple sites, including the soft tissues and viscera. The prognosis is generally poor. These features may be related to a combination of factors, including immunodeficiency, oncogenic viruses, and altered cytokine milieu in these patients. A case of plasma cell tumor in an HIV-positive patient is presented.     

Transesophageal echocardiography probe shutdown in a patient with hyperthermia

The use of transesophageal echocardiography (TEE) has been increasing over the past few years. It is considered a semi-invasive monitor and a safe diagnostic device. Though complications are rare, they must be known to operators who frequently perform TEE. TEE probes are known to cause tissue heating and damage on prolonged use. In this case report, we describe shutdown of the transesophageal probe in our patient with high-grade fever.     

Micronutrient supplementation and child survival in India

India contributes to a large number and proportion of child deaths, both due to higher under five mortality rate and large child population cohort in the country. The micronutrient malnutrition is an ignored area as it is not a direct cause of child mortality but a contributory factor in many deaths. The repeated surveys and studies have noted that iron deficiency anemia, vitamin A deficiency, iodine deficiency are highly prevalent amongst the children in the country and the preventive interventions are reaching only small proportion of 10–50% of the targeted populations. The contribution of these micronutrients (Iron, Vitamin A, Iodine and Zinc) towards child survival depends upon number of factors that are responsible for child mortality, and these situations vary from region to region, time to time and depend upon number of other socio demographic characteristics of the population. This paper discusses that although there may be debate on the role of some micronutrients in reducing childhood mortality, there is no doubt that these micronutrients are needed in small amount for overall child development. These micronutrients, both directly and indirectly, contribute to the child survival and should reach to each and every child in the country and the strategy is proven cost effective.     

Rapid and sensitive liquid chromatography/tandem mass spectrometry method for simultaneous determination of enalapril and its major metabolite enalaprilat, in human plasma: application to a bioequivalence study

A rapid and most sensitive method for simultaneous determination of enalapril (ENP) and its metabolite, enalaprilat (ENPT), in human plasma using ESI-LC-MS/MS (electrospray ionization liquid chromatography tandem mass spectrometry) positive ion multiple reactions monitoring (MRM) mode, was developed and validated. The procedure involves a simple solid-phase extraction (SPE) followed by evaporation of the sample. Chromatographic separation was carried out on a Hypurity C(18) column (50 mm × 4.6 mm, 5 μm) with an isocratic mobile phase and a total run time of 2.0 min only. The MRM of ENP and ENPT is 377.10 → 234.20 and 349.20 → 206.10 respectively. The standard calibration curves showed excellent linearity within the range of 0.064 to 431.806 ng/mL for ENA and 0.064 to 431.720 ng/mL for ENPT (r ≥ 0.990). This is the only method which can quantitate upto 0.064 ng/mL for both ENP and ENPT in a single run with the shortest analysis time. In matrix effect experiment, this method shows a % CV (% coefficients of variation) of less than 5, which means that the proposed method is free from any kind of irregular ionization process. This method was successfully applied to a pharmacokinetic study after oral administration of enalapril maleate 20 mg tablet in Indian healthy male volunteers.