Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Heavy metal concentrations in surface soils of Reserved Forests (RFs) have a significant impact on... 相似文献
The policy of screening for gestational diabetes mellitus (GDM) between 24 and 28 weeks of gestation and care has resulted in a few women delivering big babies despite good glycemic control. Hence we undertook a study to assess the merits of care given to women in whom GDM was diagnosed in different weeks of gestation and to find out the ideal period of screening in women with history of high-risk pregnancies. A total of 207 consecutive pregnant women irrespective of trimester referred to our referral clinic for diabetes in pregnancy, underwent a 75g oral glucose tolerance test (OGTT) and GDM was diagnosed if 2h plasma glucose (PG) >/=140mg/dl. A1c was estimated in all of them. Women who failed to respond to medical nutrition therapy were advised insulin and the dose titrated to maintain fasting PG (FPG) <90mg/dl and 2h PG <120mg/dl. The mean age of the population screened was 28.38+/-4.31 years and the mean gestational age of screening was 20.05+/-10.71 weeks. Among them, 87 were diagnosed as GDM. The gestational week at diagnosis was =12 in 36 (41.4%) women (group 1), between 13 and 23 in 18 (20.7%) (group 2), between 24 and 30 in 15 (17.2%) (group 3) and beyond 30 weeks of gestation in 18 (20.7%) (group 4). The A1c was 5.34+/-0.43% in normal glucose tolerance (NGT) women, while it was 6.93+/-1.62% in group 1, 6.03 +/-0.79% in group 2, 6.14+/-0.93% in group 3 and 6.20+/-0.31% in group 4, respectively. The birth weight of babies born to women with NGT was 3.28+/-0.50kg. The birth weight of babies born to GDM women in group 1, group 2, group 3 and group 4 was 3.15+/-0.48, 3.09+/-0.68, 3.32+/-0.51 and 3.51+/-0.63kg, respectively. Group 1 women in spite of the history of high-risk pregnancies, delivered babies appropriate for gestational age like NGT women. Screening in the first trimester of pregnancy and institution of therapy is advisable in women with high-risk pregnancies. 相似文献
Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.
Methods
This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.
Results
There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.
Conclusion
Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
Universal screening for gestational diabetes mellitus (GDM), detects more cases and improves maternal and offspring prognosis. Of all the screening tests, World Health Organization (WHO) procedure is simple and cost effective; the only disadvantage is that the pregnant woman has to come in the fasting state to undergo oral glucose tolerance test (OGTT). Hence, we undertook a study to elucidate a test that is casual and reliable to diagnose GDM. A total of 800 pregnant women underwent 75-g glucose challenge test (GCT) irrespective of the time of the last meal and their 2-h plasma glucose (PG) was estimated. They also underwent a 2-h 75-g OGTT recommended by WHO after 72 h. There was no statistically significant difference in the glycemic profile between GCT and WHO OGTT in the diagnosis of GDM. In conclusion, GCT performed irrespective of the last meal timing is a patient-friendly approach and causes least disturbance in the pregnant woman's routine activities. 相似文献
Background The role of fMRI in the presurgical evaluation of children with intractable epilepsy is being increasingly recognized. Real-time
fMRI allows the clinician to visualize functional brain activation in real time. Since there is no off-line data analysis
as in conventional fMRI, the overall time for the procedure is reduced, making it clinically feasible in a busy clinical sitting.
Objective (1) To study the accuracy of real-time fMRI in comparison to conventional fMRI with off-line processing; (2) to determine
its effectiveness in mapping the eloquent cortex and language lateralization in comparison to invasive procedures such as
intraoperative cortical stimulation and Wada testing; and (3) to evaluate the role of fMRI in presurgical decision making
in children with epilepsy.
Materials and methods A total of 23 patients (age range 6–18 years) underwent fMRI with sensorimotor, visual and language paradigms. Data processing
was done in real time using in-line BOLD.
Results The results of real-time fMRI matched those of off-line processing done using the well-accepted standard technique of statistical
parametric mapping (SPM) in all the initial ten patients in whom the two techniques were compared. Coregistration of the fMRI
data on a 3-D FLAIR sequence rather than a T1-weighted image gave better information regarding the relationship of the lesion
to the area of activation. The results of intraoperative cortical stimulation and fMRI matched in six out of six patients,
while the Wada test and fMRI had similar results in four out of five patients in whom these techniques were performed. In
the majority of patients in this series the technique influenced patient management.
Conclusion Real-time fMRI is an easily performed and reliable technique in the presurgical workup of children with epilepsy. 相似文献
Pre-eclampsia and eclampsia are major causes of maternal morbidity and mortality. Magnesium sulphate is accepted as the anticonvulsant of choice in these conditions and is present on the WHO essential medicines list and the Indian National List of Essential Medicines, 2015. Despite this, magnesium sulphate is not widely used in India for pre-eclampsia and eclampsia. In addition to other factors, lack of availability may be a reason for sub-optimal usage. This study was undertaken to assess the availability and use of magnesium sulphate at public and private health care facilities in two districts of North Karnataka, India.
Methods
A facility assessment survey was undertaken as part of the Community Level Interventions for Pre-eclampsia (CLIP) Feasibility Study which was undertaken prior to the CLIP Trials (NCT01911494). This study was undertaken in 12 areas of Belagavi and Bagalkote districts of North Karnataka, India and included a survey of 88 facilities. Data were collected in all facilities by interviewing the health care providers and analysed using Excel.
Results
Of the 88 facilities, 28 were public, and 60 were private. In the public facilities, magnesium sulphate was available in six out of 10 Primary Health Centres (60%), in all eight taluka (sub-district) hospitals (100%), five of eight community health centres (63%) and both district hospitals (100%). Fifty-five of 60 private facilities (92%) reported availability of magnesium sulphate.Stock outs were reported in six facilities in the preceding six months – five public and one private. Twenty-five percent weight/volume and 50% weight/volume concentration formulations were available variably across the public and private facilities. Sixty-eight facilities (77%) used the drug for severe pre-eclampsia and 12 facilities (13.6%) did not use the drug even for eclampsia. Varied dosing schedules were reported from facility to facility.
Conclusions
Poor availability of magnesium sulphate was identified in many facilities, and stock outs in some. Individual differences in usage were identified. Ensuring a reliable supply of magnesium sulphate, standard formulations and recommendations of dosage schedules and training may help improve use; and decrease morbidity and mortality due to pre-eclampsia/ eclampsia.
Trial registration
The CLIP trial was registered with ClinicalTrials.gov (NCT01911494).
SCN1A is the most clinically relevant epilepsy gene and is associated with generalized epilepsy and febrile seizure plus (GEFS+) and Dravet syndrome. We postulated that earlier onset of febrile seizures in the febrile seizure (FS) and febrile seizure plus (FS+) phenotypes may occur in the presence of a SCN1A mutation. This was because of the age-related onset of Dravet syndrome, which typically begins in the first year of life. We found that patients with FS and FS+ with SCN1A mutations had earlier median onset of febrile seizures compared to the population median. Patients with GABRG2 mutations had a similar early onset in contrast to patients with SCN1B mutations where onset was later. This study is the first to demonstrate that a specific genetic abnormality directly influences the FS and FS+ phenotype in terms of age of onset. 相似文献
The relationship of the anterior branch of the axillary nerve to the deltoid muscle was studied on both sides in 66 adult cadavers. The nerve runs a course on the deep surface of the deltoid muscle about 2.2 cm above the midpoint on the vertical plane of the muscle. 相似文献