Feasibility of kangaroo mother care in Mumbai

Objective: The purpose of this study was to determine the feasibility and acceptability of kangaroo care in a tertiary care hospital in India.Methods: A randomized controlled trial was performed over one year period in which 89 neonates were randomized into two groups kangaroo mother care (KMC) and conventional method of care (CMC).Results: Forty-four babies were randomized into KMC group and 45 to CMC. There was significant reduction in KMCvs CMC group of hypothermia (10/44vs 21/45, p-value<0.01). There were no statistically significant differences in the incidence of hyperthernia, sepsis, apnea, onset of breastfeeding and hospital stay in two groups. 79% of mothers felt comfortable during the KMC and 73% felt they would be able to give KMC at home. KMC is feasible, as mothers are already admitted in hospitals and are involved in the care of newborn.Conclusion: KMC is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of KMC demonstrated in the study. The present study has important implications in the care of LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all place.     

Effects of erythropoietin on hyperoxic lung injury in neonatal rats

Pulmonary oxygen toxicity is believed to play a prominent role in the lung injury that leads to the development of bronchopulmonary dysplasia (BPD). To determine whether human recombinant erythropoietin (rhEPO) treatment reduces the risk of developing BPD, we investigated the effect of rhEPO treatment on the histopathologic changes seen in hyperoxia-induced lung injury of BPD. Twenty-five rat pups were divided into four groups: air-exposed control group (n = 5), hyperoxia-exposed placebo group (n = 7), hyperoxia-exposed rhEPO-treated group (n = 6), and air-exposed rhEPO-treated group (n = 7). Measurement of alveolar surface area, quantification of secondary crest formation, microvessel count, evaluation of alveolar septal fibrosis, and smooth muscle actin immunostaining were performed to assess hyperoxia-induced changes in lung morphology. Treatment of hyperoxia-exposed animals with rhEPO resulted in a significant increase in the mean alveolar area, number of secondary crests formed, and the microvessel count in comparison with hyperoxia-exposed placebo-treated animals. There was significantly less fibrosis in rhEPO-treated animals. However, treatment of hyperoxia-exposed animals with rhEPO did not result in a significant change in smooth muscle content compared with hyperoxia-exposed placebo treated animals. Our results suggest treatment with rhEPO during hyperoxia exposure is associated with improved alveolar structure, enhanced vascularity, and decreased fibrosis. Therefore, we conclude that treatment of preterm infants with EPO might reduce the risk of developing BPD.     

Do sexual maturation stages affect flexibility in adolescent boys aged 14 years?

AIM: Pubertal changes constitute a background for development of motor abilities and flexibility as an important component of physical fitness. The aim of the present study was to investigate whether the flexibility is actually related to sexual maturation stages in adolescent boys. METHODS: This cross-sectional study was conducted on 69 healthy boys aged 14 years. Before testing, all participants performed a 3 min warm up and static stretch routine, emphasizing the lower body. The flexibility tests were performed in a counterbalanced design. Sit-and-reach test and goniometric measurement of hamstring flexibility was administered. The results of flexibility tests and body measures were analysed for cross-sectional comparison. Groups were formed according to Tanner's classification and consisted of boys in Stage II, III, IV, V, respectively. RESULTS: The results of sit and reach test scores and goniometric measurements did not correlate with age in months, height, weight and BMI; and furthermore they did not correlate with the sexual maturation stages (p>0.05). The sit and reach test scores were significantly correlated with goniometric measurements (right: r=0.653, p=0.00; left: r=0.638, p=0.00). CONCLUSIONS: The results suggest that sexual maturation stages in pubertal period would not be effective in determining the flexibility. Besides, sexual maturation is not a cause of decreased flexibility in adolescent boys aged 14 years.     

The effect of tamoxifen on sex hormone binding globulin in adolescents with pubertal gynecomastia

We investigated the relationship between sex hormone binding globulin (SHBG) and pubertal gynecomastia in 21 adolescents evaluated longitudinally. Thirteen patients were given tamoxifen treatment after grading according to the Nydick classification (group 1). Group 2 consisted of eight patients followed without treatment. Gynecomastia existed bilaterally in 15 patients. There was a statistically significant breast size reduction in both groups. There was a significant decrease in serum SHBG only in group 2. These findings suggest that serum SHBG is increased by tamoxifen treatment in male adolescents. There was a decrease in SHBG levels through the duration of follow up in patients who recovered with or without treatment. However, this decrease was statistically significant in the untreated group, but not in the tamoxifen treated group. In conclusion, we suggest that the pubertal fall in SHBG levels is attenuated by tamoxifen treatment given for pubertal gynecomastia since tamoxifen increases SHBG levels in male adolescents.     

Courses for medical residents and trainers in Turkey for promotion of quality of reproductive health services: a pilot study

In order to provide high quality services in reproductive health, training of health professionals is essential. In Turkey, a project for in-service training of medical residents was conducted in 2003 under the aegis of the Human Resources Development Foundation, the Turkish Ministry of Health and UNFPA. The project included a needs assessment, training programme development and evaluation activities. A seven-day course was developed to train institutional trainers in both training skills and reproductive health information. Fourteen experienced master trainers conducted four courses for 67 institutional trainers from 37 hospital departments in four cities, who in turn conducted a three-day programme on reproductive health topics in their respective institutions, using interactive teaching methods. 163 residents from departments of obstetrics and gynaecology, family medicine, urology, public health and paediatrics participated. Over three-quarters of trainers and residents who participated in the programme approved of the content of the courses. A limited number of topics, e.g. sexual health and adolescent reproductive health, were thought to need more attention. Trainers cited improvements in doctor-patient communication and quality of outpatient and in-patient care, and initiation of counselling in their institutions. We conclude that this training programme, attended by trainers and participants from different disciplines and using interactive teaching methods, has been successful as an effective training model for medical residents. The establishment of an ongoing collaboration between the Ministry of Health and other institutions involved in resident training in Turkey is needed to ensure the expansion of this programme to all residents in training.     

Localization of T cells and subtypes in the paranasal sinus and turbinate mucosa in patients with chronic sinusitis

The aim of this study was to quantitate total T lymphocytes (total CD3+ cells) and T-lymphocyte subtypes (CD4+ [T helper] and CD8+ [T suppressor] cells) in patients with chronic sinusitis who were treated with functional endoscopic sinus surgery (FESS) and to investigate the pathophysiology of persistent inflammation in chronic sinusitis. This prospective study was conducted in study and control groups. The study group consisted of 32 patients (20 male, 12 female) with chronic sinusitis who underwent FESS. The control group consisted of 8 nonsinusitis patients (5 male, 3 female) who underwent septoplasty. Specimens from the study group were excised from five regions: the uncinate process, maxillary and ethmoid sinuses, and middle and inferior turbinates. The specimens were examined with x10 magnification by light microscopy, and the slides with a severe inflammatory process were included. Punch biopsy of the control group was taken from the inferior turbinate with patients' written approval. The surgical specimens from the study and control groups were examined with an immunohistochemical staining technique with monoclonal antibodies against CD3, CD4, and CD8 surface antigens of T lymphocytes. In every specimen, the numbers of CD3+, CD4+, and CD8+ cells were calculated in 3 to 4 high magnification field on light microscopy, and the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and deep paraglandular layer of the mucosa was determined. Statistical analysis by Kruskal-Wallis analysis of variance and the Mann-Whitney U test with Bonferroni correction revealed that the CD3 epithelial layer value of the inferior turbinate (p = .030) and the CD4 deep layer value of the middle turbinate (p = .048) were significantly higher than the corresponding values of the control group. In the epithelial (p = .018) and subepithelial (p = .012) layers of the uncinate process group, in the epithelial (p = .050) and subepithelial (p = .012) layers of the ethmoid sinus group, and in the subepithelial (p = .018) and deep paraglandular (p = .012) layers of the middle turbinate group, the difference between the CD4+ and CD8+ cell counts was found to be statistically significant by the Wilcoxon signed rank test. The number of CD4+ cells was higher than the number of CD8+ cells. In conclusion, T cells play a role in the pathophysiology of chronic sinusitis. CD4+ T helper cells, in particular, are predominant at the initiation and regulation of inflammation. The uncinate process, ethmoid sinus, and middle and inferior turbinates have the main roles by T cells and subtypes in the defense system in chronic sinusitis.     

Domoic acid enhances Bcl-2-calcineurin-inositol-1,4,5-trisphosphate receptor interactions and delayed neuronal death in rat brain slices

Mechanisms of neuronal death following neuronal damage due to domoic acid are not completely defined. Bcl-2, a survival protein, protects neurons from ischemia and excitotoxin-induced damage. We previously demonstrated that Bcl-2 shuttles calcineurin to its substrates and may regulate calcium release from internal stores during neuronal ischemia. We now confirm that during excitotoxicity induced by domoic acid, calcineurin-Bcl-2 and calcineurin-1,4,5-inositol-trisphosphate receptor (IP3-R) interactions increase. Furthermore, we now show that calcineurin-IP3-R interactions are mediated by Bcl-2 in brain slices following short-term treatment with domoic acid (10 microM). Domoic acid induced late neuronal death and caspase-3-like activity in organotypic cortical and hippocampal cultures. These experiments further define the mechanisms by which neurons respond to excitotoxic insults, and suggest that interactions between calcineurin and its target proteins may influence cellular responses to injury.     

Effects of electrohydraulic extracorporeal shock wave lithotripsy on submandibular gland in the rat: electron microscopic evaluation

OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) has been applied in sialolithiasis as a new treatment modality. The aim of this experimental study is to investigate the local effects of electrohydraulic ESWL applied to the right submandibular gland of the rats. METHODS: This prospective study was conveyed in four groups; groups I, II, III and IV; each group consisting of 20, 20, 18 and 9 rats, respectively, with a randomized distribution. Groups I, II, III and IV received 250, 500, 1000 and 2000 shock waves at 14-16 kV (average 15.1 kV), respectively, to the right submandibular glands on the 0th day. In groups I, II, III, right submandibular glands of the rats were removed on the 0th, 1st, 7th and 15th days; in group IV, this procedure could be managed only on the 0th and 7th days. Light and electron microscopic evaluation were assessed. Using the light microscopic changes, severity of damage score of the glands (SDS) was found. Statistical analysis was done using SDSs. RESULTS: Light and electron microscopic observations have shown that the damage produced by the shock waves were confined to focal areas in the acinar cells (AC), granulated convoluted tubule (GCT) cells and blood vessels at all doses applied. Vacuolization in the cytoplasms of the AC and GCT cells, disintegration of membranes, alteration in the cytoplasmic organization, swelling of the mitochondria and loss of the features were observed on electron microscopy. Increase in the secretion rate; stasis and dilatation in the blood vessels; blebbing and loss of features in the cytoplasm of the endothelial cells were observed. According to the result of the statistical analysis using SDSs; at 250 shock wave dose, a statistically significant difference between the SDSs of the days (0th, 1st, 7th and 15th) was found (P<0.05). The SDS on the 0th day was found to have the lowest value among the other days. And also a statistically significant difference was found on the 0th day between the SDSs at doses of 250, 500, 1000 and 2000 shock waves (P<0.05). The SDS at 250 and 500 shock waves was found to have the lower value than the SDS at the 2000 shock wave. It was observed that produced damage was less prominent by small doses (250, 500 doses) initially (0th day). Electrohydraulic ESWL caused a "patchy type" generalized pathology on submandibular glands of the rats and damaged focal areas were widespread all through the gland from the 1st day on. CONCLUSION: Formation of the damage was concluded to be related to the direct effect of the shock waves rather than the dose used. Electrohydraulic lithotripters are not suitable for sialolithiasis because of the focus problems, local tissue damage and the risk of the damage to the adjacent structures.     

Volume of nerve fibers in the stress-induced bladder of adult rats following capsaicin treatment

INTRODUCTION: We have investigated the volume of nerve fibers in the rat urinary bladder following systematic exposure to cold-restraint stress and capsaicin treatment. MATERIALS AND METHODS: Adult Wistar albino rats were either exposed to cold-restraint stress (vehicle group) or treated with capsaicin before exposure to cold-restraint stress (capsaicin group). In the control group, animals were neither exposed to cold-restraint stress nor given capsaicin. From each group, samples of bladder were prepared for morphological investigation and stereological evaluation of the volume of nerve fibers. RESULTS: Stress exposure was associated with urothelial degeneration, a higher incidence and degranulation of mast cell profiles in the mucosa, and an increased volume of nerve fibers in the muscular layer of the bladder wall. Capsaicin treatment prevented the stress-induced degenerative changes. In the capsaicin group, the volume of nerve fibers in the muscular layer was also significantly smaller than that in the stress group. CONCLUSIONS: Exposure of adult rats to capsaicin prevented the stress-induced degeneration of the bladder and changed the volume of capsaicin-sensitive fibers in muscular layer. We conclude that capsaicin and related compounds may be useful in treating stress-induced bladder problems.