Qualitative assessment of family caregiver-centered neonatal education program in Karnataka, India

Globally 2.5 million newborns die every year before they reach the age of one month; the majority of these deaths occur in low- and middle-income countries. Among other factors, inadequate knowledge and skills to take care of newborns contribute to these deaths. To fill this gap, training patients and family members on the behaviors needed to improve essential newborn care practices at home is a promising opportunity. One program that aims to do this is the Care Companion Program (CCP) which provides in-hospital, skills-based training on care of mothers and newborns to families. This study uses semi-structured interviews to understand how and why knowledge and behaviors of maternal and newborn care behaviors change (or don't change) as a result of CCP sessions and participants' perception of the impact of CCP on change. Interviews focused on knowledge and behaviors around key neonatal and newborn topics and health seeking behaviors for health complications. Forty-two in-depth interviews were conducted among families with recently-delivered babies at their homes from four districts in Karnataka, India. Respondents have a positive perception about CCP, found training useful and appreciated other family members presence during the training. CCP increased knowledge and awareness and provided critical details to key behaviors like breastfeeding. Respondents were more likely to be receptive toward details on already known topics, like hand washing before touching the baby. Awareness increased on newly learned behaviors, like skin-to-skin care, which don't conflict with cultural norms. The CCP did not influence nonrestrictive maternal diet as much, which cultural norms heavily influence. In-hospital family caregiver education programs, like CCP, can positively influence key neonatal behaviors by imparting knowledge and key skills. However, the effect is not universal across health behaviors.

Influence of preoperative coronal and sagittal tibiofemoral subluxation in knee osteoarthritis on the outcome of primary total knee arthroplasty

BACKGROUND

The effect of osteoarthritis (OA) with tibiofemoral (TF) subluxation on patients undergoing total knee arthroplasty (TKA) has been less studied, and there have been no studies on sagittal knee subluxation which is a component of a three-dimensional problem. We aim to analyze the influence of preoperative coronal and sagittal knee subluxation with OA on other radiological parameters and the functional outcome in patients undergoing TKA.

METHODS

We retrospectively reviewed the 179-consecutive primary TKA in 151 patients from January 2017 to June 2017. The radiological parameters analyzed were the mechanical tibiofemoral angle (HKA), joint line congruence angle (JLCA) and coronal tibiofemoral (CTF) subluxation in long leg films. In the lateral view, posterior tibial slope, the settlement area of the femur over the tibia and the sagittal tibiofemoral (STF) subluxation were calculated. Preoperative and postoperative knee society and knee society functional scores were documented. Multivariate regression analysis was done to determine the association of preoperative radiological parameters with coronal and sagittal TF subluxation.

RESULTS

The average follow-up was 31 months (2.6 years). 102 knees (57%) had CTF subluxation (< 5 mm) within normal range, and 77 knees (43%) had CTF subluxation. There was a direct correlation between the magnitude of CTF subluxation and poor preoperative functional scores compared with the non-subluxation group (p < 0.05). CTF subluxation was not associated with the magnitude of varus deformity as it is correlated more with mild deformity (odds ratio [OR] 10.07, 95% confidence interval [CI] 3.47-29.25) than with moderate and severe varus deformity. The degree of the joint line convergence angle was positively correlated with the amount of CTF subluxation (p = 0.003). STF subluxation had a significant correlation with the posterior slope (p < 0.001), but not with the magnitude of varus deformity (p = 0.26).

CONCLUSION

Coronal and sagittal tibiofemoral subluxation had a significant association with poor preoperative clinical scores. The degree of CTF subluxation reduces with the increasing magnitude of varus deformity and JLCA. STF subluxation was associated with the posterior tibial slope. Patients who underwent posterior stabilized TKA had excellent clinical outcomes irrespective of preoperative knee subluxation.

Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programmes that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

Interdigitating Dendritic Cell Sarcoma of the Small Intestine Presenting as Spontaneous Hemoperitoneum - A Rare Case Report

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare neoplasm arising from the antigen-presenting cells of the immune system. It usually involves the lymph nodes, and extranodal sites are rarely affected. Here, we report a first known case of spontaneous hemoperitoneum caused by the rupture of IDCS of the small bowel. A 61-year-old male presented with complaints of abdominal pain and fever for 3 days and breathlessness for 1 day. Ultrasound abdomen revealed a 15 cm × 7 cm heterogeneous collection with thick septations in the periumbilical region. Diagnostic peritoneal lavage revealed hemoperitoneum and gangrenous bowel. Emergency laprotomy was done and it revealed a friable mass arising from the ileum. Resection of 2 ft of the ileum and double-barrel ileostomy was done. Immunohistochemical analysis revealed a positivity of S100 and leukocyte common antigen). A diagnosis of IDCS was made. The patient had an uneventful postoperative recovery and planned for postoperative chemotherapy.

A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial

Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.

Direct Observation of Thermal Equilibrium of Excited Triplet States of 9,10-Phenanthrenequinone. A Time-Resolved Resonance Raman Study

The photochemistry of aromatic ketones plays a key role in various physicochemical and biological processes, and solvent polarity can be used to tune their triplet state properties. Therefore, a comprehensive analysis of the conformational structure and the solvent polarity induced energy level reordering of the two lowest triplet states of 9,10-phenanthrenequinone (PQ) was carried out using nanosecond-time-resolved absorption (ns-TRA), time-resolved resonance Raman (TR(3)) spectroscopy, and time dependent-density functional theory (TD-DFT) studies. The ns-TRA of PQ in acetonitrile displays two bands in the visible range, and these two bands decay with similar lifetime at least at longer time scales (μs). Interestingly, TR(3) spectra of these two bands indicate that the kinetics are different at shorter time scales (ns), while at longer time scales they followed the kinetics of ns-TRA spectra. Therefore, we report a real-time observation of the thermal equilibrium between the two lowest triplet excited states of PQ, assigned to nπ* and ππ* of which the ππ* triplet state is formed first through intersystem crossing. Despite the fact that these two states are energetically close and have a similar conformational structure supported by TD-DFT studies, the slow internal conversion (∼2 ns) between the T(2)(1(3)nπ*) and T(1)(1(3)ππ*) triplet states indicates a barrier. Insights from the singlet excited states of PQ in protic solvents [ J. Chem. Phys. 2015 , 142 , 24305 ] suggest that the lowest nπ* and ππ* triplet states should undergo hydrogen bond weakening and strengthening, respectively, relative to the ground state, and these mechanisms are substantiated by TD-DFT calculations. We also hypothesize that the different hydrogen bonding mechanisms exhibited by the two lowest singlet and triplet excited states of PQ could influence its ISC mechanism.

99m-Tc-ubiquicidin scintigraphy in diagnosis of knee prosthesis infection and comparison with F-18 fluorodeoxy-glucose positron emission tomography/computed tomography

Total knee arthroplasty has witnessed a significant increase in recent years. Despite the advantages of this surgical procedure, it has some complications, the most serious of which is prosthetic infection. The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of periprosthetic infection (PPI). Ubiquicidin (UBI) is a synthetic antimicrobial peptide fragment reported to be highly infection-specific. Tc99m-UBI has recently been reported to be a promising radiotracer for infection imaging. We report a case of left knee PPI diagnosed using 99mTc-UBI scintigraphy and compared with F-18 fluorodeoxy-glucose positron emission tomography.

Spontaneous choledochoduodenal fistula with tuberculous duodenal ulceration

Spontaneous choledochoduodenal fistulas (CDFs) are rare. The most common aetiology is penetrating duodenal ulcers, observed in 80% of cases. Even in areas where acid peptic disease is common, tuberculosis should be considered as a cause, especially in developing countries like India, where tuberculosis is common. The management of CDF due to acid peptic disease is predominantly surgical while healing of tuberculous CDF has been reported with antitubercular treatment. A preoperative diagnosis of tuberculous CDF by endoscopic biopsy from the duodenal ulcer or image guided fine needle aspiration if abdominal lymph nodes are present can eliminate the need for surgery and achieve a cure with antitubercular treatment. The CDF in this case was due to caseation of periduodenal lymph nodes rupturing into the duodenum and the bile duct.

Sequence analysis of mitochondrial 12S rRNA gene can identify meat species

In this study, sequence analysis of mitochondrial 12S rRNA has been applied for meat species identification. The procedure involves polymerase chain reaction (PCR) amplification of a fragment of mitochondrial (mt) 12S rRNA gene and sequencing of amplicons. Amplified product of mt 12S rRNA gene was 456 bp in size. Species sequenced include cattle (Bos indicus), buffalo (Bubalus bubalis), sheep (Ovis aries), goat (Capra hircus) and mithun (Bos frontalis). Sequences were compared with the reported sequences of low land anoa (Bubalus depressicornis), yak (Bos grunniens) and pig (Sus scrofa). There was no effect of routinely used additives or cooking temperature (72, 90, 120 and 180 °C) on the efficacy of PCR amplification. The closely related species like cattle and buffalo, sheep and goat could also be differentiated decisively by sequence analysis. Sequencing and analysis of mt 12S rRNA gene was, hence, found to be an ideal, authentic and unambiguous qualitative method for meat species identification.

Jejuno-jejunal intussusception secondary to small-bowel lipomatosis: a case report

Intussusception is usually a disease of children aged between 6 months and 4 years, in which a part of a bowel telescopes into another part of the bowel. We report a case in a 60-year-old man who required resection and anastomosis. Although intussusception is unusual in adults, awareness of the differences in symptoms and causes should be borne in mind when adults present with intestinal obstruction.

A Comparative Study of Propofol and Isoflurane Anaesthesia using Butorphanol in Neurosurgery

SUMMARY

Propofol and isoflurane have well proven roles as intravenous and inhalational anaesthetics respectively in neurosurgery. We conducted this study to know the outcome using butorphanol as an intraoperative analgesic. Sixty craniotomy patients randomly divided into two groups of 30 each were included in this study. Group A patients were induced and maintained with propofol. Group B patients were induced with thiopentone and maintained with isoflurane. All patients were administered 30mug.kg(-1) butorphanol intravenously 10 minutes before induction of anaesthesia, followed by slow injection of 30mug.kg(-1) midazolam. All were assessed for sedation, respiratory insufficiency, postoperative nausea and vomiting (PONV) and other side effects in the recovery room. We found no difference in demographic parameters between the groups. The fall in HR was maintained in the post induction / intubation period and throughout the intraoperative period in Group A, unlike Group B patients in whom it rose significantly following intubation. Butorphanol was found to be a safe intraoperative analgesic in neurosurgical patients. In addition, it was associated with statistically better haemodynamics and earlier recovery when used with propofol as compared to thiopentone-isoflurane anaesthesia.

Characterization and expression of the mouse pregnant specific uterus protein gene and its rat homologue in the intestine and uterus

The pregnant specific uterus protein gene (Psup) is a novel mouse gene expressed in pregnant uterus. This paper describes the identification and expression of the rat homologue of Psup. The gene is highly expressed in the duodenum. Expression decreases in a proximal-distal gradient in the small intestine and was not detected in the cecum and colon. The pattern of expression in the mouse was similar. Expression of Psup in the mouse was localized to the epithelial cells in the intestine and pregnant uterus by in situ hybridization. The data show tissue-specific expression of Psup.

V-groove gratings for infrared beam splitting: reply

It is acknowledged that scalar diffraction theory may not be used to design accurately gratings with submicrometer features. This does not negate the concept of the v-groove beam-splitting grating.

V-groove gratings on silicon for infrared beam splitting

Infrared beam-splitting transmission gratings that utilize anisotropically etched v-grooves on silicon wafers are proposed. With scalar diffraction theory to find the amplitudes of the different diffraction orders, a numerical search is used to find optimum designs for 1:3, 1:5, and 1:7 splitters with efficiencies greater than 70% with a standard deviation in intensity of no more than 7%.

Fiber sensor for the simultaneous measurement of current and voltage in a high-voltage system

A sensor employing a single monomode low-birefringence fiber, excited with a 632.8-nm He-Ne laser, has been developed for the simultaneous measurement of current and voltage in an energy system. The piezoelectric effect for the voltage and the magnetic stress for the current are utilized. The current and voltage signals are separated at the detector end by suitable self-tracking tuned filters. Experimental results from a laboratory model demonstrate the feasibility of the sensor for field application in high-voltage systems.