Setting up a Quality Assurance model for newborn care to strengthen health system in Bihar,India

Background

A Quality Assurance model was rolled out in Bihar, India. It had two components: external and internal monitoring and giving feedback for action. The parameters included infrastructure and policy, equipment maintenance, stock supply and aseptic measures.

Methods

The performance and gradation into good/average/poor was measured based on the scores translated from the data collected after giving appropriate weights.

Result

12%, 63%, and 25% units were categorized as good, average and poor based on infrastructure. For equipment, 68% of units performed poorly; for stock maintenance 64% and 35% of NBCCs fell under good and average categories respectively; most (54%) NBCCs had average scores for aseptic measures; 30% fell in the poor category.

Conclusions

Involvement of government in monitoring and feedback mechanism, establishing a system of data collection at the grass root level and analysis at the state level were the positive outcomes.     

ZnO thin film-nanowire array homo-structures with tunable photoluminescence and optical band gap

The growth and optical behavior of ZnO thin film-nanowire array homo-structures is reported. The ZnO films are deposited on glass substrates by thermal evaporation and subjected to heat treatment at 400 °C for 2 h to achieve crystallinity and stoichiometry. The surface comprises spherical grains or elongated flakes depending on thickness of films. These films are introduced in to a hydrothermal reactor in a medium of zinc acetate and HMTA to realize the nanostructures. The process results in the formation of ZnO nanowires with dimensions that are strongly dependent on the surface microstructure of the ZnO films. The role of temperature (90–180 °C) and duration (10 min to 10 h) of hydrothermal processing is investigated in detail. It is demonstrated that low temperature and short duration are ideal for producing nanowires with diameter < 100 nm, while longer durations and higher temperatures lead to large diameter and long length nanowires. Interestingly, all wires converge to a hexagonal shape with increase in duration or temperature. The lowest diameter of the vertically aligned nanowires is 50 nm and length upto 10 μm is achieved. Optical band gap of the homo-structures is of the order of 3.4–3.5 eV. Raman and photoluminescence spectra indicate the presence of defects in the films. The thin films exhibit a strong defect related photoluminescence peak centred around 550 nm. The nanowires grown on the films display both the UV-near band edge peak as well as the defect related peak. However, the intensity of the defect peak decreases with increase in length of the nanowires indicating that the photoluminescence of the homo-structures can be tuned by changing the surface microstructure of the films and also the aspect ratio of the nanowires.

ZnO homo-structures with tunable photoluminescence and band gap.     

Inhibition of mixed lineage kinase 3 attenuates MPP+-induced neurotoxicity in SH-SY5Y cells

5-HT(1B) autoreceptors regulate serotonin release from terminals of dorsal raphe nucleus (DRN) projections. Due to postsynaptic 5-HT(1B) receptors in DRN terminal fields, it has not previously been possible to manipulate 5-HT(1B) autoreceptor activity without also changing 5-HT(1B) heteroreceptor activity. We have developed a viral gene transfer strategy to express epitope-tagged 5-HT(1B) and green fluorescent protein in vivo, allowing us to increase 5-HT(1B) expression in DRN neurons. We have shown that increased 5-HT(1B) autoreceptor expression reduced anxiety in unstressed animals but increased anxiety following inescapable stress. These findings suggest that effects of increased 5-HT(1B) autoreceptor expression are dependent on stress context. To better understand the mechanisms underlying these observations, we have used fear-potentiated startle (FPS). FPS is especially sensitive to the activity of the amygdala, which shares reciprocal connections with DRN. In the absence of an inescapable stressor, increased 5-HT(1B) autoreceptor expression attenuated FPS response compared with animals injected with a virus expressing only green fluorescent protein. Administration of the 5-HT(1B) antagonist SB224289 (5 mg/kg i.p.) before startle testing blocked the effects of increased 5-HT(1B) autoreceptor expression. Since SB224289 had no effect on FPS in the absence of viral gene transfer, these results suggest that the antagonist reversed the behavioral effects of increased 5-HT(1B) autoreceptor expression through blockade of transgenic receptors. When tested 24 h following water-restraint stress, animals with increased 5-HT(1B) autoreceptors demonstrated restoration of robust FPS response. These results extend our previous studies and suggest explanations for the complex relationship between 5-HT(1B) autoreceptor expression, stress, and anxiety behavior.     

Preferential recognition of a microbial metabolite by human Vgamma2Vdelta2 T cells

Human Vgamma2Vdelta2 T cells are stimulated by prenyl pyrophosphates, such as isopentenyl pyrophosphate (IPP), and play important roles in mediating immunity against microbial pathogens and have potent anti-tumor activity. (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP) has been identified as a metabolite in the 2-C-methyl-D-erythritol-4 phosphate (MEP) pathway for isoprenoid biosynthesis that is used by many bacteria and protozoan parasites. We find that HMBPP is the major Vgamma2Vdelta2 T-cell antigen for many bacteria, including Mycobacterium tuberculosis, Yersinia enterocolitica and Escherichia coli. HMBPP was a 30 000-fold more potent antigen than IPP. Using mutant bacteria, we show that bacterial antigen levels for Vgamma2Vdelta2 T cells are controlled by MEP pathway enzymes and find no evidence for the production of 3-formyl-1-butyl pyrophosphate. Moreover, HMBPP reactivity required only germ line-encoded Vgamma2Vdelta2 TCR elements and is present at birth. Importantly, we show that bacterial HMBPP levels correlated with their ability to expand Vgamma2Vdelta2 T cells in vivo upon engraftment into severe combined immunodeficiency-beige mice. Thus, the production of HMBPP by a microbial-specific isoprenoid pathway plays a major role in determining whether bacteria will stimulate Vgamma2Vdelta2 T cells in vivo. This preferential stimulation by a common microbial isoprenoid metabolite allows Vgamma2Vdelta2 T cells to respond to a broad array of pathogens using this pathway.     

Innovative nerve approximator from external fixator: a quick fix solution

The outcome of primary and secondary neurorrhaphy depends on the technical precision followed during the procedure. The aim of the surgery is to establish near-anatomic coaptation and to maintain it without tension at the anastomotic site. A nerve approximator can aid in peripheral neurorrhaphy with optimal tension at the anastomotic site and better maintenance of coaptation of fascicles, but their use is limited because of the high price of the commercially available ones. We describe a simple and inexpensive nerve approximator that can be prepared any time, and according to the need using the universal mini external fixator system. This fixator system is almost always available in an orthopedic and hand operation theater. It is an extremely handy, inexpensive, atraumatic, and user-friendly nerve approximator that can be used clinically to aid and augment the final results of peripheral neurorrhaphy. Its use can also be extrapolated for simulated tendon and nerve repair during microvascular laboratory training.     

Nonpeptide antigens, presentation mechanisms, and immunological memory of human Vγ2Vδ2 T cells: discriminating friend from foe through the recognition of prenyl pyrophosphate antigens

Summary:  Human Vγ2Vδ2 T cells play important roles in mediating immunity against microbial pathogens and have potent anti-tumor activity. Vγ2Vδ2 T cells recognize the pyrophosphorylated isoprenoid intermediates ( E )-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP), an intermediate in the foreign 2- C -methyl- d -erythritol 4-phosphate (MEP) pathway, and isopentenyl pyrophosphate (IPP), an intermediate in the self-mevalonate pathway. Infection with bacteria and protozoa using the MEP pathway leads to the rapid expansion of Vγ2Vδ2 T cells to very high numbers through preferential recognition of HMBPP. Activated Vγ2Vδ2 T cells produce proinflammatory cytokines and chemokines, kill infected cells, secrete growth factors for epithelial cells, and present antigens to αβ T cells. Vγ2Vδ2 T cells can also recognize high levels of IPP in certain tumors and in cells treated with pharmacological agents, such as bisphosphonates and alkylamines, that block farnesyl pyrophosphate synthase. Activated Vγ2Vδ2 T cells are able to kill most tumor cells because of recognition by T-cell receptor and natural killer receptors. The ubiquitous nature of the antigens converts essentially all Vγ2Vδ2 T cells to memory cells at an early age. Thus, primary infections with HMBPP-producing bacteria are perceived by Vγ2Vδ2 T cells as a repeat infection. Extensive efforts are underway to harness these cells to treat a variety of cancers and to provide microbial immunity.