Falling between two stools: operational inconsistencies between ICDS and NRHM in the management of severe malnutrition

There has been a welcome interest in the issue of malnutrition by policy makers as well as technical experts in the recent years. The current public health systems for management of malnutrition, the ICDS and NRHM, have attempted to evolve approaches to the management of severe malnutrition. This paper makes a fresh analysis of data from well-accepted existing sources, indicating that 36-44% of all children with Severe Acute Malnutrition (SAM) are likely to be missed by current criteria of screening and referral; simultaneously, a large proportion of children selected for referral to Nutritional rehabilitation centres are likely not to have SAM. The paper also highlights other areas of inconsistencies between the ICDS and the NRHM in the continuum of care required for the prevention and proper management of severe malnutrition. Thus, the paper identifies areas that need further exploration to achieve a seamless and effective program for tackling severe malnutrition.

Mean-field dynamo action in renovating shearing flows

We study mean-field dynamo action in renovating flows with finite and nonzero correlation time (τ) in the presence of shear. Previous results obtained when shear was absent are generalized to the case with shear. The question of whether the mean magnetic field can grow in the presence of shear and nonhelical turbulence, as seen in numerical simulations, is examined. We show in a general manner that, if the motions are strictly nonhelical, then such mean-field dynamo action is not possible. This result is not limited to low (fluid or magnetic) Reynolds numbers nor does it use any closure approximation; it only assumes that the flow renovates itself after each time interval τ. Specifying to a particular form of the renovating flow with helicity, we recover the standard dispersion relation of the α(2)Ω dynamo, in the small τ or large wavelength limit. Thus mean fields grow even in the presence of rapidly growing fluctuations, surprisingly, in a manner predicted by the standard quasilinear closure, even though such a closure is not strictly justified. Our work also suggests the possibility of obtaining mean-field dynamo growth in the presence of helicity fluctuations, although having a coherent helicity will be more efficient.

Association of temporomandibular joint dysfunction, condylar position and dental malocclusions in Davangere population

AIMS

To study the association between dental malocclusions and temporomandibular joint dysfunction.To study the association between dental malocclusions and condylar position.To study the association between temporomandibular (TM) joint dysfunction and condylar position.

METHODS

The subjects were divided into four groups for dental malocclusions viz. class I malocclusion with or without TM dysfunction, class II division 1 malocclusion with or without TM dysfunction, class II division 2 malocclusion with or without TM dysfunction and class III malocclusion with or without TM dysfunction. Once the patient fulfilled the criteria, the presence or absence of signs of TM dysfunction were elicited from the patient.

RESULTS

It shows the association between TM dysfunction signs and left and right condylar positions. It shows the association between TM dysfunction symptom and left and right condylar positions. It shows the association between dental malocclusions and TM dysfunction signs and symptom. It shows the association between dental malocclusions and left and right condylar positions.

CONCLUSION

There was an association between TM dysfunction signs and left and right condylar positions. But, there was no association between TM dysfunction symptoms and left and right condylar positions. There was an association between dental malocclusions and TM dysfunction signs. But there was no association between dental malocclusions and TM dysfunction symptoms. There was an association between dental malocclusions and left condylar position, but there was no association between dental malocclusion and right condylar position.

CLINICAL SIGNIFICANCE

This study indicates that malocclusions and factors of condylar position should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of TM dysfunction. TM dysfunction factors that showed significant effects to various malocclusions through this study . This study shows clinical significance of association of various types of dental malocclusions to different conylar positions and TM dysfunction signs and symptoms. Before treating orthodontic patients, one should evaluate and treat the TM disorders for better prognosis.

Clinical profile of multiple myeloma and effect of thalidomide based treatment on its outcome

Multiple myeloma is a plasma cell malignancy that leads to bone pain, pathological fracture, anaemia, renal failure and recurrent bacterial infections. Recently, thalidomide has demonstrated significant activity in the treatment of multiple myeloma in various western studies. In India there are very minimal studies about multiple myeloma. To study the clinical profile of multiple myeloma and the effect of thalidomide based treatment on its outcome in the Indian scenario are the aims and objective of the study. A total of 25 multiple myeloma cases were enrolled in the study. The diagnosis of multiple myeloma was made based on the presence of greater than 10% plasma cells on bone marrow, an M band in serum electrophoresis and/or a skeletal survey revealing osteolytic lesions. All the above patients were treated with tablet thalidomide 200 mg once daily on all days and tablet dexamethasone 40 mg once daily on days 1-4, 9-12, 17-20 in a 28 days cycle for 4 cycles. At the end of four cycles, all patients were re-evaluated and the response rate was assessed. The most common clinical presentation (56%) was bone related like bony swelling, bone pain, low backache and pathological fractures. The overall response rate to thal-dexa regimen was 72% (n=18). Out of these, 10 patients (56%) had complete response and 8 patients (44%) had partial response. The mean bone marrow plasma cell percentage at the end of therapy was 2% compared to 56% before therapy which was significant (p < 0.0001). None of the patients developed neutropenia or thrombocytopenia during treatment. Although multiple myeloma has remained an incurable disease to date, presently available thalidomide based combination chemotherapy represents an active inductive regimen to improve the outcome and achieve eventual cure.

Escobar syndrome in three male patients of same family

We describe three male individuals from a consanguineous south Indian family affected with the multiple pterygium syndrome (Escobar syndrome). Common clinical features included short stature, multiple pterygium, skeletal anomalies, and normal intelligence. The first report of this condition was made in 1902 from this same place (Pondicherry) and the disease received its present popular name Escobar syndrome in 1982. The genetic defect for this condition was identified in 2006 as mutation in the fetal acetylcholine receptor.

Transport coefficients for the shear dynamo problem at small Reynolds numbers

We build on the formulation developed in S. Sridhar and N. K. Singh [J. Fluid Mech. 664, 265 (2010)] and present a theory of the shear dynamo problem for small magnetic and fluid Reynolds numbers, but for arbitrary values of the shear parameter. Specializing to the case of a mean magnetic field that is slowly varying in time, explicit expressions for the transport coefficients α(il) and η(il) are derived. We prove that when the velocity field is nonhelical, the transport coefficient α(il) vanishes. We then consider forced, stochastic dynamics for the incompressible velocity field at low Reynolds number. An exact, explicit solution for the velocity field is derived, and the velocity spectrum tensor is calculated in terms of the Galilean-invariant forcing statistics. We consider forcing statistics that are nonhelical, isotropic, and delta correlated in time, and specialize to the case when the mean field is a function only of the spatial coordinate X(3) and time τ; this reduction is necessary for comparison with the numerical experiments of A. Brandenburg, K. H. Rädler, M. Rheinhardt, and P. J. Käpylä [Astrophys. J. 676, 740 (2008)]. Explicit expressions are derived for all four components of the magnetic diffusivity tensor η(il)(τ). These are used to prove that the shear-current effect cannot be responsible for dynamo action at small Re and Rm, but for all values of the shear parameter.

A randomized clinical comparison of the Intersurgical i-gel and LMA Unique in non-obese adults during general surgery

BACKGROUND

The i-gel is a cuffless, single-use supralaryngeal airway device designed to provide a more effective seal than the laryngeal mask airway (LMA). Although the superiority of the i-gel compared to the LMA Classic was determined in a previous study, no studies have been performed that compare it to the disposable LMA Unique. The aim of this study was to compare the Intersurgical i-gelTM against the LMA UniqueTM (uLMA) in terms of ease of placement, time of insertion, and adequacy of placement through a randomized, controlled clinical trial.

METHODS

Following Institutional Review Board (IRB) approval and written informed consent, 50 adult patients were recruited for this study. All enrolled patients were ASA 1-2, Mallampati I-II, and scheduled to receive general anesthesia. Patients were randomized to have either the i-gel or the uLMA placed for airway management. After standardized induction techniques, the airway was secured with the assigned device. All patients were interviewed postoperatively for sore throat, hoarseness, and dysphagia. Standard vital signs, end-tidal CO2, tidal volumes, and peak pressures were recorded. Insertion time, leak pressures, and anatomic placement as assessed fiberoptically for the i-gel were recorded. Ease of placement and complications were also recorded.

RESULTS

The insertion time was significantly less with the i-gel (21.04±12.6 s vs. 30.04±14.1 s, P=0.02). An inadequate seal was noted in three patients with the i-gel, and it was exchanged for the uLMA in all three cases. There were no significant differences in the ease of insertion, leak pressures, or fiberoptic view. Most of the fiberoptic views, as assessed through the drain tube, demonstrated esophageal mucosa (22/25). Patients receiving the i-gel were significantly more likely to require a second attempt at insertion by the anesthesiologist (OR 8.11, CI 1.1-58.6, P=0.03). Finally, patients receiving the size 5 i-gel were significantly more likely to complain of immediate postoperative symptoms, such as sore throat and dysphagia (OR 29.32, CI 1.4-613.1, P=0.03).

CONCLUSION

Although the i-gel had a faster insertion time in comparison to the uLMA, there was a greater need for repeat insertions. The weight criteria established by the manufacturer may need to be readjusted to recommend a larger size device in some patients less than 90 kg because all of the repeat insertions were in patients weighing more than 80 kg. In all other aspects of its use, the i-gel performed similarly to the uLMA.

Anomalous drift of spiral waves in heterogeneous excitable media

We study the drift of spiral waves in a simple model of heterogeneous excitable medium, having gradients in the distribution of ion-channel expression or cellular coupling. We report the anomalous drift of spiral waves toward regions having shorter period or stronger coupling, in reaction-diffusion models of excitable media. Such anomalous drift can promote the onset of complex spatiotemporal patterns, e.g., those responsible for life-threatening arrhythmias in the heart.

Evidence-based National Vaccine Policy

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form.