Opinion and Beliefs of Physicians about Integrating Families into the Care System of Preterm Hospitalized Neonates- A Qualitative Experience

OBJECTIVES

To explore the opinions and beliefs of physicians about integrating families into the care system of hospitalized preterm neonates.

METHODS

The setting was Neonatal Intensive Care Unit (NICU) of a tertiary care center in North India. Focus group discussions (FGDs) were conducted with the physicians using a pre-validated FGD topic guide. The FGDs were audio-recorded and transcribed. The meanings were drawn, and dependability was ensured. Themes and sub-themes were generated and finalized with a common consensus.

RESULTS

Five FGDs were conducted involving 28 physicians. The physicians opined that making families a part of the care system has several benefits, though they brought out some concerns. They opined that involving parents gives them confidence and satisfaction as they get empowered about neonatal care at the hospital and home after discharge. They reported difficulties in communication due to perceived inadequacy in counseling skills, language barriers and literacy levels of families, and lack of adequate time due to clinical overload. They identified nurses and public health nurses as an important bridge between physicians and families, and peer support as a useful facilitator. They suggested that role assignments to team members, training in counseling and communication, improving the comfort of parents and organizing information in easy-to-understand audio- visual content can help improve the family integration.

CONCLUSIONS

The physicians highlighted practical barriers, facilitators, and remedial measures to effectively integrate the families into the care system of preterm hospitalized neonates. There is a need to address the concerns of all stakeholders including the physicians for successful implementation of family integration.

Phytochemical rich Himalayan Rhododendron arboreum petals inhibit SARS-CoV-2 infection in vitro

Phytochemicals with potential to competitively bind to the host receptors or inhibit SARS-CoV-2 replication, may prove to be useful as adjunct therapeutics for COVID-19. We profiled and investigated the phytochemicals of Rhododendron arboreum petals sourced from Himalayan flora, undertook in vitro studies and found it as a promising candidate against SARS-CoV-2. The phytochemicals were reported in various scientific investigations to act against a range of virus in vitro and in vivo, which prompted us to test against SARS-CoV-2. In vitro assays of R. arboreum petals hot aqueous extract confirmed dose dependent reduction in SARS-CoV-2 viral load in infected Vero E6 cells (80% inhibition at 1 mg/ml; IC50 = 173 µg/ml) and phytochemicals profiled were subjected to molecular docking studies against SARS CoV-2 target proteins. The molecules 5-O-Feruloyl-quinic acid, 3-Caffeoyl-quinic acid, 5-O-Coumaroyl-D-quinic acid, Epicatechin and Catechin showed promising binding affinity with SARS-CoV-2 Main protease (M^Pro; PDB ID: 6LU7; responsible for viral replication) and Human Angiotensin Converting Enzyme-2 (ACE2; PDB ID: 1R4L; mediate viral entry in the host). Molecular dynamics (MD) simulation of 5-O-Feruloyl-quinic acid, an abundant molecule in the extract complexed with the target proteins showed stable interactions. Taken together, the phytochemical profiling, in silico analysis and in vitro anti-viral assay revealed that the petals extract act upon M^Pro and may be inhibiting SARS-CoV-2 replication. This is the first report highlighting R. arboreum petals as a reservoir of antiviral phytochemicals with potential anti-SARS-CoV-2 activity using an in vitro system.

Effectiveness of Kanna photoscreener in detecting amblyopia risk factors

Purpose:

Amblyopia is a significant public health problem. Photoscreeners have been shown to have significant potential for screening; however, most are limited by cost and display low accuracy. The purpose of this study was validate a novel artificial intelligence (AI) and machine learning–based facial photoscreener “Kanna,” and to determine its effectiveness in detecting amblyopia risk factors.

Methods:

A prospective study that included 654 patients aged below 18 years was conducted in our outpatient clinic. Using an android smartphone, three images of each the participants’ face were captured by trained optometrists in dark and ambient light conditions and uploaded onto Kanna. Deep learning was used to create an amblyopia risk score based on our previous study. The algorithm generates a risk dashboard consisting of six values: five normalized risk scores for ptosis, strabismus, hyperopia, myopia and media opacities; and one binary value denoting if a child is “at-risk” or “not at-risk.” The presence of amblyopia risk factors (ARF) as determined on the ophthalmic examination was compared with the Kanna photoscreener.

Results:

Correlated patient data for 654 participants were analyzed. The mean age of the study population was 7.87 years. The algorithm had an F-score, 85.9%; accuracy, 90.8%; sensitivity, 83.6%; specificity, 94.5%; positive predictive value, 88.4%; and negative predictive value, 91.9% in identifying amblyopia risk factors. The P value for the amblyopia risk calculation was 8.5 × 10⁻¹⁴² implying strong statistical significance.

Conclusion:

The Kanna photo-based screener that uses deep learning to analyze photographs is an effective alternative for screening children for amblyopia risk factors.

Application of deep learning and image processing analysis of photographs for amblyopia screening

Purpose

Photo screeners and autorefractors have been used to screen children for amblyopia risk factors (ARF) but are limited by cost and efficacy. We looked for a deep learning and image processing analysis-based system to screen for ARF.

Methods

An android smartphone was used to capture images using a specially coded application that modified the camera setting. An algorithm was developed to process images taken in different light conditions in an automated manner to predict the presence of ARF. Deep learning and image processing models were used to segment images of the face. Light settings and distances were tested to obtain the necessary features. Deep learning was thereafter used to formulate normalized risks using sigmoidal models for each ARF creating a risk dashboard. The model was tested on 54 young adults and results statistically analyzed.

Results

A combination of low-light and ambient-light images was needed for screening for exclusive ARF. The algorithm had an F-Score of 73.2% with an accuracy of 79.6%, a sensitivity of 88.2%, and a specificity of 75.6% in detecting the ARF.

Conclusion

Deep-learning and image-processing analysis of photographs acquired from a smartphone are useful in screening for ARF in children and young adults for a referral to doctors for further diagnosis and treatment.

Exploring the opinion of stakeholders about self-care, home care and hospital management of heart failure patients: A qualitative study

Introduction

Heart failure is a widespread chronic cardiac illness with varying etiologies. If the HF patients manage themselves at home by following the appropriate advice by healthcare professionals, they tend to have better quality of life and less readmissions. This study was aimed to identify and explore practices of self-management by heart failure patients, home management of heart failure by their family caregivers and hospital management by healthcare providers.

Methods

A qualitative study was conducted in a tertiary care center in Northern India on participants (patients, their family caregivers, doctors and nurses) who were recruited purposively and interviewed individually by principle investigator using semi-structured questionnaires. Interviews were audio recorded and transcribed after taking informed consent. Iterative process including coding, reviewing and analyzing was done by four researchers and themes were finalized.

Results

Total 41 participants (15 patients, 12 family caregivers, 4 doctors and 10 nurses) completed the interviews. It was observed that patients and family caregivers were not able to manage heart failure efficiently. Nurses and doctors reported many barriers to provide specialized care to these patients.

Discussion

There were definite barriers and challenges in the management of heart failure symptoms by the stakeholders. For the patients and family members who suffer this debilitating illness, managing heroically is a challenge. It is important to develop self-care management protocol for the heart failure patients. Healthcare professionals must overcome the barriers to train patients and family caregivers. Multidisciplinary integration can fulfill the gap in providing care to such patients.

Adipokine Visfatin's Role in Pathogenesis of Diabesity and Related Metabolic Derangements

Visfatin is one of the prominent adipokines secreted by adipose tissue. The level of visfatin increases significantly in persons with obesity owing to increased body mass index (BMI). During obesity, the adipocytes, which populate adipose tissue, undergo hypertrophy and hyperplasia and secrete a number of adipocytokines including visfatin. Visfatin, which also acts as an enzyme nicotinamide phosphoribosyl transferase, is one of the prominent adipokines that influence metabolic homeostasis in the body. Visfatin exists in two forms, extracellular and intracellular, and enacts a multitude of actions. The direct and indirect evidence gathered from in-vitro, in-vivo and clinical studies indicate that visfatin modulates obesity and metabolic syndrome-related pathophysiological activities including enhanced inflammation, angiogenesis, synthesis of NAD mononucleotide, and upregulation of antiapoptotic proteins in a number of cell types. It has been implicated in a number of obesity-related alterations and metabolic derangement such as diabetes, cardiovascular complications and some forms of cancers. In this review, the novel hypothesis about the role of visfatin in diabesity has been proposed which implies recent advances in studies about the pathophysiological roles of visfatin during obesity and chronic high glucose in the circulation. Visfatin at high concentration attracts immune cells and produces chronic inflammation in adipocytes. Additionally, it induces insulin resistance in many tissues and causes pancreatic beta cells dysfunction at later stages. Further, its potential as an important target to develop molecular medicine in diabesity and related metabolic syndrome has been highlighted.

Biodegradation of pyrene and phenanthrene by bacterial consortium and evaluation of role of surfactant

High molecular weight poly aromatic hydrocarbons (HMW PAHs) are well known for their hydrophobicity and they get strongly adsorbed onto the soil particles. Generally, surfactants facilitate the biodegradation of PAH by enhancing their solubility and desorption of hydrophobic compounds from soil particles. To investigate the role of synthetic surfactant in biodegradation of PAHs, two bacterial strains BP10 and P2 were incubated in soil spiked with pyrene and phenantherene (100 μg g-1of soil each) in isolation and in combination with/without Tween 80. After 14 days of incubation, pyrene and phenantherene were degraded by a combination of BP10 and P2 to the extent of 98% and 99%, respectively. Addition of tween 80 reduced the degradation of pyrene and phenantherene by 35 and 10%, respectively. Biosurfactant produced by selected strains i.e. BP10 and P2 could enhance desorption of pyrene (100 μg g-1of soil) by about 27% and 12%, respectively. However, desorption activity was relatively higher (32 and 29%, respectively) in case of phenanthrene (100 μg g-1of soil) from the spiked soil. Present study showed that in spite of additional chemical surfactant, bioaugmentation of highly petroleum hydrocarbon degrading bacterial combination was very effective in boosting the bioremediation of PAHs- contaminated sites.

Simultaneous spectrophotometric estimation of norfloxacin and ornidazole in tablet dosage form

Three simple, accurate and economical methods have been developed for the estimation of norfloxacin and ornidazole in tablet dosage form. First method is based on the simultaneous equations, wavelengths selected for analysis were 273.0 nm (λ_max of norfloxacin) and 318.5 nm (λ_max of ornidazole), respectively, in 0.1N NaOH. Second method is Q-analysis method, based on absorbance ratio at two selected wavelengths 297.0 nm (iso-absorptive point) and 318.5 nm (λ_max of ornidazole). Third method is first order derivative spectroscopy using 297.5 nm (zero cross for norfloxacin) and 264.0 nm (zero cross for ornidazole). The linearity was obtained in the concentration range of 4-20 μg/ml and 5-25 μg/ml for norfloxacin and ornidazole, respectively. The results of the analysis have been validated statistically and by recovery studies.

Biodiversity, bioaccumulation and physiological changes in lichens growing in the vicinity of coal-based thermal power plant of Raebareli district, north India

The lichen diversity assessment carried out around a coal-based thermal power plant indicated the increase in lichen abundance with the increase in distance from power plant in general. The photosynthetic pigments, protein and heavy metals were estimated in Pyxine cocoes (Sw.) Nyl., a common lichen growing around thermal power plant for further inference. Distributions of heavy metals from power plant showed positive correlation with distance for all directions, however western direction has received better dispersion as indicated by the concentration coefficient-R(2). Least significant difference analysis showed that speed of wind and its direction plays a major role in dispersion of heavy metals. Accumulation of Al, Cr, Fe, Pb and Zn in the thallus suppressed the concentrations of pigments like chlorophyll a, chlorophyll b and total chlorophyll, however, enhanced the level of protein. Further, the concentrations of chlorophyll contents in P. cocoes increased with the decreasing the distance from the power plant, while protein, carotenoid and phaeophytisation exhibited significant decrease.

Isolation and structure elucidation of a new antifungal and antibacterial antibiotic produced by Streptomyces sp. 201

An antibacterial and antifungal antibiotic was isolated from the culture filtrate of Streptomyces sp. 201, and its structure was determined as 2-methyl-heptyl isonicotinate by extensive use of NMR spectroscopy. The compound exhibited marked antimicrobial activity against Bacillus subtilis, Shigella sp., Klebsiella sp., E. coli, Proteus mirabilis, and the pathogenic fungi, Fusarium moniliforme, F. semitectum, F. oxysporum, F. solani and Rhizoctonia solani.

Experimental biofilm and its application in malathion degradation

Mixed bacterial culture consisting of three different strains of Micrococcus sp. (AG 36, AG 94 and AG 98) and two strains of Pseudomonas sp. (AG 7 and AG 52) and its individual components was passed through a sand column and 25.5-92% of cell dry mass was found to be retained (adsorbed) on it. Incubation of sand soaked in mineral medium containing glucose as a sole carbon source resulted in formation of a biofilm with 1.2-2.5-fold increase in biomass. A 61% degradation of malathion by the mixed culture biofilm could be achieved in 4 d.

Degradation of fenitrothion by Bacillus stearothermophilus adhering to silica

B. stearothermophilus strain AG-49, when cultivated in mineral medium in the presence of silica (SA), adhered to SA. Adhesion depended on age of culture, contact time and glucose concentration of the culture medium. Mid-exponential phase culture (5 h) required minimum contact time (30 min) for maximum adhesion. 0.6% glucose concentration was optimum. Quantitative variation in protein and saccharide extractable in sodium chloride and sodium dodecyl sulfate (SDS) was observed. Five % degradation of fenitrothion by adherent B. stearothermophilus could be achieved in 4 d.

Possible involvement of plasmids in degradation of malathion and chlorpyriphos by Micrococcus sp

Two plasmid-harboring strains of Micrococcus sp. (M-36 and AG-43) degrade malathion and chlorpyriphos. Derivatives of the strains (SDS-36 and AO-43) treated with acridine orange and sodium dodecyl sulfate could not utilize malathion and chlorpyriphos for growth as the sole carbon source. Agarose gel electrophoresis of cell extracts of M-36 and AG-43 revealed the presence of a plasmid which was absent in SDS-36 and AO-43--suggesting probable involvement of plasmids in the degradation of malathion and chlorpyriphos by M-36 and AG-43. Nalidixic acid resistance in M-36 was also lost upon elimination of plasmids.