Setting priorities in global child health research investments: assessment of principles and practice

This article reviews theoretical and practical approaches for setting priorities in global child health research investments. It also provides an overview of previous attempts to develop appropriate tools and methodologies to define priorities in health research investments. A brief review of the most important theoretical concepts that should govern priority setting processes is undertaken, showing how different perspectives, such as medical, economical, legal, ethical, social, political, rational, philosophical, stakeholder driven, and others will necessarily conflict each other in determining priorities. We specially address present research agenda in global child health today and how it relates to United Nation's (UN) Millennium Development Goal 4, which is to reduce child mortality by two-thirds between 1990 and 2015. The outcomes of these former approaches are evaluated and their benefits and shortcomings presented. The case for a new methodology for setting priorities in health research investments is presented, as proposed by Child Health and Nutrition Research Initiative, and a need for its implementation in global child health is outlined. A transdisciplinary approach is needed to address all the perspectives from which investments into health research can be seen as priorities. This prioritization requires a process that is transparent, systematic, and that would take into account many perspectives and build on advantages of previous approaches.     

Polyhydramnios with bidirectional fetal ductus arteriosus flow in a fetus with congenital diaphragmatic hernia: case report

The etiology of polyhydramnios may be attributed to either increased production of amniotic fluid (fetal polyuria or high-output cardiac failure) or decreased fetal swallowing (obstruction or neurological impairment). Although idiopathic polyhydramnios occurs in nearly half of all cases, it is often associated with fetal abnormalities. Fetal ductus arteriosus flow is normally from right to left. We report a case of antenatally detected bidirectional fetal ductus arteriosus flow diagnosed concomitantly with polyhydramnios. Amnioreduction was performed due to severe maternal symptoms, which resulted in correction of the fetal ductus arteriosus flow. Postnatal diagnosis of a Morgagni diaphragmatic hernia indicates that our sonographic findings collectively may have been a diagnostic clue.     

Anihypercholesterolemic effect of Semecarpus anacardium Linn nut milk extract in high-cholesterol-fed rats

The present study was carried to bring about the hypolipidemic effect of the drug Semecarpus anacardium Linn nut milk extract (SA) in hypercholesterolemia-induced rat model. Adult male Wistar rats were divided into four groups which included control rats, hypercholesterolemia-induced rats (high-cholesterol diet (4 %) for 30 days), hypercholesterolemic rats treated with the drug SA (200 mg/kg/b. wt oil), and the control rats treated with the drug SA (200 mg/kg/b. wt). Increased level of ROS and lipid peroxides were observed in hypercholesterolemic rats, whereas the levels of activities of antioxidant enzymes were found to be decreased in animals fed with a high-fat diet. Simultaneous administration of SA to these rats reverted back the changes to near-normal levels. Similarly, an increase in the expression of iNOS and LOX-1 were observed in high-fat-fed rats when compared to normal rats. Upon treatment with the drug SA, their expressions were brought back to near-normal levels. No adverse effects were observed in SA-alone treated group of rats, indicating its protective nature. The present study suggests that SA could play a protective role against hypercholesterolemia, thereby preventing coronary heart disease.     

Immunomodulatory effect of Kalpaamruthaa on 7,12-dimethyl benz(a)anthracene-induced mammary carcinoma studied in rats

Kapaamruthaa is a modified Siddha preparation prepared in our laboratory. It has been proven to have therapeutic effect against arthritis and liver cancer. The present study was carried out to bring about the protective effect of Kalpaamruthaa on experimental mammary carcinoma in rats with special reference to cytokines, carcinoembryonic antigen (CEA), carbohydrate antigen 15–3 (CA 15–3), immunoglobulin levels, and glycoprotein components. Breast cancer was induced in rats by administering 7,12-dimethylbenz(a)anthracene (DMBA) orally (25 mg/rat) as a single dose. After 90 days of induction, Semecarpus anacardium Linn. (200 mg/kg body weight) and Kalpaamruthaa (KA) (300 mg/kg body weight) were administered for 14 days, by gastric intubation. In mammary carcinoma-bearing rats, the levels of interleukin-6, interleukin-8, and tumor necrosis factor-α were significantly increased (p?<?0.001) in serum when compared to control rats. The levels of CEA and CA 15–3 were found to be significantly increased (p?<?0.001) in mammary carcinoma-bearing rats. The levels of IgG and IgM were significantly decreased (p?<?0.001) whereas IgA levels were significantly increased (p?<?0.001) in mammary carcinoma-bearing rats. The levels of glycoprotein components namely hexose, hexosamine, and sialic acid were significantly (p?<?0.001) increased in the spleen and thymus of the mammary carcinoma-bearing (group II) rats when compared to control rats. Treatment with KA significantly altered the levels of cytokines, CEA, CA 15–3, immunoglobulins, and glycoprotein components to near normal levels when compared to breast cancer-induced rats. The present study suggests the therapeutic effect of KA in DMBA-induced mammary carcinoma in rats.     

Microstructure,mechanical and corrosion properties of Mg–Dy–Gd–Zr alloys for medical applications

In previous investigations, a Mg–10Dy (wt.%) alloy with a good combination of corrosion resistance and cytocompatibility showed great potential for use as a biodegradable implant material. However, the mechanical properties of Mg–10Dy alloy are not satisfactory. In order to allow the tailoring of mechanical properties required for various medical applications, four Mg–10(Dy + Gd)–0.2Zr (wt.%) alloys were investigated with respect to microstructure, mechanical and corrosion properties. With the increase in Gd content, the number of second-phase particles increased in the as-cast alloys, and the age-hardening response increased at 200 °C. The yield strength increased, while the ductility reduced, especially for peak-aged alloys with the addition of Gd. Additionally, with increasing Gd content, the corrosion rate increased in the as-cast condition owing to the galvanic effect, but all the alloys had a similar corrosion rate (～0.5 mm year^?1) in solution-treated and aged condition.     

Hip muscle atrophy in patients with acetabular labral joint pathology

Intra-articular hip joint pathology is a source of hip and groin pain in active individuals and is thought to be a precursor to hip osteoarthritis. Limited evidence exists to guide appropriate physiotherapy management for these patients. Identification of which hip muscles are affected may help clinicians to develop effective exercise programs. A cross-sectional observational study in a hospital setting was conducted to investigate the size of individual hip abductor, hip extensor, and hip external rotator muscles in patients with acetabular labral joint pathology compared with age and sex matched healthy subjects. Twelve participants (eight females, four males), aged 20–53 years, with a medical diagnosis of unilateral acetabular labral tear and 12 healthy participants were recruited. Magnetic resonance imaging was used to assess cross-sectional areas of the gluteus minimus, gluteus medius, upper gluteus maximus, lower gluteus maximus, piriformis, and quadratus femoris muscles bilaterally. Gluteus medius muscle cross-sectional area was significantly different between groups (P < 0.01, effect size = 0.92) with muscle size found to be smaller in the pathology group. No differences were found for the other hip muscles (P > 0.05). These findings suggest that hip muscles are not all affected equally by the presence of intra-articular hip joint pathology. Atrophy of specific hip muscles, which are important in hip joint and pelvic stability, may alter hip joint function during gait and functional tasks. Clinicians treating patients with intra-articular hip joint pathology may need to prescribe exercises targeting the specific muscles with demonstrated dysfunction. Clin. Anat. 33:538–544, 2020. © 2019 Wiley Periodicals, Inc.     

Bone mineral density and prevalent vertebral fractures in men and women

To test the hypothesis that the association between bone mineral density (BMD) and estimated volumetric BMD and prevalent vertebral fractures differs in men and women, we studied 317 Caucasian men and 2,067 Caucasian women (average age 73 years). A total of 43 (14%) men and 386 (19%) women had a vertebral fracture identified on lateral spine radiographs using vertebral morphometry. Hip and spine areal BMD was about 1/3 standard deviation lower among men and women with a vertebral fracture. A 0.10 g/cm² decrease in areal BMD was associated with 30–40% increased odds of having a fracture in men and 60–70% increased likelihood in women. Low bone mineral apparent density (BMAD) was also associated with 40–50% increased odds of a vertebral fracture in both genders. The probability of a man having a fracture was observed at higher absolute areal BMD values than observed for women (P=values for interaction of BMD × gender: trochanter, P=0.05; femoral neck, P=0.10; total hip, P=0.09). In contrast, the probability of fracture was similar in men and women across the range of estimated volumetric BMD (BMAD). In conclusion, low BMD and low BMAD are associated with increased odds of vertebral fracture in both men and women. Measures of bone mass that partially correct for gender differences in bone size may yield universal estimates of fracture risk. Prospective studies are needed to confirm this observation.     

Belief models in first episode schizophrenia in South India

Background Existing evidence indicates that dissonance between patients’ and professionals’ explanatory models affects engagement of patients with psychiatric services in Western and non-Western countries. Aims To assess qualitatively the explanatory models (EMs) of psychosis and their association with clinical variables in a representative sample of first episode patients with schizophrenia in South India. Method One hundred and thirty one patients with schizophrenia presenting consecutively were assessed. Measures included the patient’s explanatory models, and clinician ratings of insight, symptoms of psychosis, and functioning on standard scales. Results The majority of patients (70%) considered spiritual and mystical factors as the cause of their predicament; 22% held multiple models of illness. Patients who held a biomedical concept of disease had significantly higher scores on the insight scale compared to those who held non-medical beliefs. Multivariate analyses identified three factors associated with holding of spiritual/mystical models (female sex, low education and visits to traditional healers); and a single factor (high level of insight) for the endorsement of biological model. Conclusions Patients with schizophrenia in this region of India hold a variety of non-medical belief models, which influence patterns of health seeking. Those holding non-medical explanatory models are likey to be rated as having less insight.