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Byline: Monika. Maan, Sukhwinder. Kaur, Geetanjli. Kalyan, Ram. Samujh, Nitin. Peters, Bhavneet. Bharti, Prahbhjot. Malhi Introduction: Among children, esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is one of [...]

Additional antenatal counselling of KMC and NNS improves breastmilk feeding in preterm infants however needs implementation.

Background: Preterm birth is an unexpected event, which is very stressful for the parents and family members as they are never prepared for this situation. The major stressors of parental stress such as the appearance of the neonate, neonatal intensive care unit (NICU) environment, condition of the neonate, behaviour of care professionals and financial implications are well documented.Objective: To assess the level of stress among the parents of preterm hospitalized neonates admitted in the NICU, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh.Methods: Data were collected by interviewing 17 parents on the fifth day of admission to the NICU, PGIMER, Chandigarh, after taking informed written consent from them. The Parental Stress Scale–NICU (PSS-NICU) and the fathers stress scale were used to assess the stress level of parents of hospitalized preterm neonates. Data were analysed by using SPSS (version 20).Results: The mean age of mothers was 28.24 ± 4.96 and that of the fathers was 30.29 ± 4.25. The total mean mothers’ stress score was 171.76 ± 33.44, and the total mean fathers’ stress score was 125.02 ± 36.16.Conclusion: The study showed that mothers and fathers were very stressful during the period of hospitalization of their preterm neonates.

Background Prematurity contributes to neonatal mortality and morbidity. There are many complications that can contribute to preterm morbidity and mortality. One of the complications is an alteration in temperature.Objective To assess the core temperature within the first seven days after birth, of hemodynamically stable preterm neonates born before 34 weeks of gestation.Methodology A total of 120 neonates were enrolled by using the total enumeration technique from the various neonatal units of PGIMER, Chandigarh. Permission from Institutes Ethic Committee was obtained, and consent was taken from parents of preterm neonates. The tools used for data collection were: (a) Interview schedule—it comprised of sociodemographic profile. (b) Temperature monitoring sheet. Protocol for recording core temperature was developed and validated by experts in nursing and pediatrics. Demographic profile of neonates was collected. Core temperature was recorded as per protocol in three shifts, i.e., morning, evening, and night time, by using a digital thermometer for the first seven days after birth. Temperature recording sheet was used to record the core temperature.Results Out of the total 120 hospitalized preterm neonates, 55.8% of the study participants were females, and the mean gestational age of the study participants was 31.5 ± 1.79 weeks. The mean values of core temperature of hemodynamically stable preterm neonates recorded in the morning, evening, and night of day 1 and day 2 were less than 36.5°C. From day 3 to day 7, the mean value of core temperature in morning, evening, and night was more than 36.5°C.Conclusion The study findings suggest that the core temperature, when monitored for first seven days after birth in hemodynamically stable preterm neonates, was low for the first two days, but normal for the next five days.

Exclusive human milk feeding improves outcome in preterm infants however implementation is inadequate.

Introduction: Anorectal malformations (ARM) are the birth defects, in which anus and rectum mature inappropriately, which include a wide spectrum of diseases ranging from simple imperforate anus to cloaca. Children with ARM and the caregivers have to undergo a lot of struggles/hassles to maintain a near-normal daily living. The impact of the disease is profound, as it affects the child’s entire life and the whole family dynamics.Objective: To explore the hassles of caregivers of children suffering from ARM and having a colostomy.Materials and Methods: A phenomenological research were conducted. A purposive sampling technique was used to conduct in-depth interview of caregivers of children suffering from ARM, who met the inclusion criteria. In-depth interviews were conducted telephonically using an interview guide. Fifteen caregivers were interviewed and all the interviews were recorded and verbatims were prepared. Analysis of data was done by Colaizzi’s analysis steps and formulated themes and subthemes.Result: The study results showed the difficulty of caregivers in caring for a child suffering from ARM and colostomy. The theme emerged was “Hassles in caring for the child with ARM and colostomy.” The subthemes were balancing home management and child care, lack of support system, lack of specialized training, fear in doing care, problems in feeding, readmissions because of health issues and troubles in hospital stay.Conclusion: The caregivers face a lot of hassles while caring for a child with ARM and colostomy. The study revealed the difficulties experienced by the caregivers in caring for the child suffering from ARM and having colostomy. The study will be helpful for students, nurses, doctors, and other health care providers to identify the various problems faced by caregivers and to take certain initiatives to lessen their strain of caregiving process.

Background:The WHO Multimodal Hand Hygiene Improvement Strategy (MHHIS) has been proposed to improve the Hand Hygiene (HH) compliance of the WHO recommendations on HH.Therefore, the current study was planned in our neonatal unit with the objective of evaluating the effectiveness of a Hand Hygiene Promotional Program (HHPP) based on the WHO MHHIS, in terms of compliance and decontamination efficacy among the health-care workers (HCWs) in the unit. Objective:The objective of the study was to evaluate the effectiveness of the WHO MHHIS on HH compliance and decontamination efficacy. Methods:The HHPP was carried out in our neonatal surgical intensive care unit from July to August 2013. A pre-intervention phase consisted of assessment of ward infrastructure, HH knowledge and perception, determination of HH compliance and collection of hand rinse samples from the HCWs before and after handwashing. Intervention phase consisted of changing traditional to elbow-operated taps, display of posters and reminders, placement of soaps in water draining trays, autoclaved single-use paper towels for hand drying, availability of hand rubs and training sessions for health-care providers. In the post-intervention phase, all the assessments and observations of pre-intervention phase were repeated. Results:HHPP resulted in a significant increase in overall HH compliance from 26.6% (95% confidence interval [CI] 23.9–29.3) to 65.3% (95% CI 62.4–68.2) (P< 0.001) and reduction in load of microorganisms (P= 0.013). There was a significant improvement in HH knowledge (P< 0.001), and perception surveys revealed high appreciation of each strategy component by the participants. Conclusion:To the best of our knowledge, this is the first study about the effect of implementation of the WHO MHHIS from an Indian hospital. HHPP was found to be effective in terms of HH compliance and decontamination efficacy. Its implementation is highly recommended to promote HH in a developing country like India.

Extreme ocean waves are part of the climate system but responsible for significant impacts on coastal and offshore environments, structures, and populations. In the Indian Ocean (IO), the wind and wave climate can be significantly influenced by natural climate variability, such as the El Niño–Southern Oscillation (ENSO), Indian Ocean Dipole (IOD), and Southern Annular Mode (SAM), yet our understanding on their regional influence is limited, particularly for seasonal extremes. Here, seasonal extreme significant wave heights (SWHs) and winds in the IO are examined over the period 1957–2010 utilizing ERA‐20C reanalysis data and the nonstationary generalized extreme value distribution to understand climatic extremes, by considering climate indices as covariates. ENSO influence on extreme SWHs include increases in the Bay of Bengal, southwest tropical IO (TIO), southern IO (SIO; a broad extension south of Australia), and South China and Philippine (SCP) Seas, and decreases in the Arabian Sea in boreal summer during El Niño. Extreme SWH responses to the IOD include increases in the eastern TIO, southwest TIO, and SIO in boreal autumn during its positive phase. Lastly, Southern Annular Mode not only significantly affects the SIO year round but has a weak influence in the northern and tropical IO. Composite analysis of ENSO and IOD events further highlight in phase combinations display less significant influence than out of phase combinations during summer, but not autumn. Mean and extreme wind responses are consistent with SWH responses to natural climate variability, and climate mode teleconnection patterns help explain the seasonal variations. Extreme ocean wave heights, produced mainly by large increases in surface wind speeds, can impact many vulnerable coastal populations and cause destruction to coastal or offshore structures. Therefore, better understanding of ocean wave height variability plays a vital role in potentially reducing such risk. This study focuses on the relationship between naturally occurring climate modes that drive wide spread atmospheric changes, namely the El Niño–Southern Oscillation, Indian Ocean Dipole, and Southern Annular Mode, and the wave climate of the Indian Ocean (IO). Climate mode influences on extreme wind and wave climates in the IO are analyzed using the nonstationary generalized extreme value distribution in combination with reanalysis data for 1957–2010. Composite analysis of different El Niño–Southern Oscillation and Indian Ocean Dipole phase combinations also highlights compounding impacts when they occur in (or out) of phase. Response patterns in the wind speeds, mean sea level pressure, and sea surface temperature also help to link the physical mechanisms responsible for driving the variations in the IO extreme wave heights. Patterns in the seasonal extreme wave and wind responses are found to be consistent with corresponding seasonal mean responses, suggesting similar teleconnection mechanisms are at work for both mean and extremes. The ENSO, IOD, and SAM regional influences on seasonal extreme significant wave heights (SWHs) and winds in the Indian Ocean are examinedMean and extreme response patterns are similar indicating that the same teleconnection mechanisms drive both mean and extreme SWHs and windsSignificant enhancement or reduction in the regional extreme SWH responses is observed during different phase combinations of ENSO and IOD

Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT. Sertraline (50–200 mg/day) was given as the SSRI for 52 weeks. A 16-h-manualized individual CBT was delivered over 8 weeks with four follow-up sessions. Assessors were ‘blinded’ to treatment allocation. A preliminary health economic evaluation was conducted. At week 16, combined treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest on the observed case analysis. The effect size (Cohen’s d) comparing the improvement in Yale Brown Obsessive Compulsive Scale on CBT versus combined treatment was −0.39 and versus sertraline was −0.27. Between 16 and 52 weeks, the greatest clinical improvement was seen with sertraline, but participant discontinuation prevented reliable analysis. Compared with sertraline, the mean costs were higher for CBT and for combined treatment. The mean Quality Adjusted Life Year scores for sertraline were 0.1823 (95% confidence interval: 0.0447–0.3199) greater than for CBT and 0.1135 (95% confidence interval: ‑0.0290–0.2560), greater than for combined treatment. Combined treatment appeared the most clinically effective option, especially over CBT, but the advantages over SSRI monotherapy were not sustained beyond 16 weeks. SSRI monotherapy was the most cost-effective. A definitive study can and should be conducted.

OBJECTIVES:Pancreatic cancer (PC) is a lethal malignancy that lacks specific diagnostic markers. The present study explores the diagnostic potential of the most differentially overexpressed secretory mucin MUC5AC alone and in combination with CA19-9 using multi-center training and validation sets.METHODS:The expression of MUC5AC in benign pancreatic pathologies, PC precursor lesions, primary PC tissues and metastatic lesions was evaluated by immunohistochemistry. Circulating MUC5AC levels were measured using sandwich ELISA assay developed in-house, and CA19-9 was measured using radioimmunoassay. A combined training set (n=346) was used to evaluate the diagnostic (n=241) and predictive (n=105, total samples 201 from pre- and post-surgical and chemotherapy set) significance of MUC5AC. Results were further validated with a pre-defined cut-off value using independent sets from the Mayo Clinic (n=94) and the University of Pittsburgh Medical Center (n=321).RESULTS:Tissue expression analyses indicated the de novo expression of MUC5AC in pancreatic intraepithelial precursor lesions 1A (PanIN1A); the expression was maintained through all stages of progression to invasive adenocarcinoma. The median circulating MUC5AC levels in patients with resectable early-stage PC (EPC) (stage 1/2; 67.2 ng/ml, IQR: 23.9–382.1) and unresectable late-stage PC (LPC) (stage 3/4; 389.7 ng/ml, IQR: 87.7–948.6) were significantly higher compared with (P-value ≤0.0001) benign controls (BC) (7.2 ng/ml, IQR: 0.4–26.5) and (P-value ≤0.0001) chronic pancreatitis (CP) controls (8.4 ng/ml, IQR: 1.5–19.2). In the diagnostic training set (n=241), MUC5AC efficiently differentiated EPC from healthy controls (HC) (83%/80% sensitive (SN)/specific (SP)), BC (67%/87% SN/SP), and CP (83%/77% SN/SP). Independent validation sets from the Mayo Clinic and UPMC confirmed the diagnostic potential of MUC5AC to differentiate EPC from BC (68%/73%; 65%/83%) and CP (68%/79%; 65%/72%). Furthermore, MUC5AC and CA19-9 combination significantly improved (p-value < 0.001) the diagnostic accuracy for differentiating resectable cases from controls.CONCLUSIONS:MUC5AC is a valuable diagnostic biomarker, either alone or in combination with CA19-9, to differentiate PC from CP and benign controls.

Pancreatic cancer remains a lethal malignancy with poor prognosis owing to therapeutic resistance, frequent recurrence and the absence of treatment strategies that specifically target the tumour and its supporting stroma. Deregulated cell-surface proteins drive neoplastic transformations and are envisioned to mediate crosstalk between the tumour and its microenvironment. Emerging studies have elaborated on the role of mucins in diverse biological functions, including enhanced tumorigenicity, invasiveness, metastasis and drug resistance through their characteristic O-linked and N-linked oligosaccharides (glycans), extended structures and unique domains. Multiple mucin domains differentially interact and regulate different components of the tumour microenvironment. This Review discusses: the expression pattern of various mucins in the pancreas under healthy, inflammatory, and cancerous conditions; the context-dependent attributes of mucins that differ under healthy and pathological conditions; the contribution of the tumour microenvironment in pancreatic cancer development and/or progression; diagnostic and/or prognostic efficacy of mucins; and mucin-based therapeutic strategies. Overall, this information should help to delineate the intricacies of pancreatic cancer by exploring the family of mucins, which, through various mechanisms in both tumour cells and the microenvironment, worsen disease outcome.

Pancreatic diseases pose significant diagnostic challenge as signs and symptoms often overlap. We investigated the potential of pancreatic juice neutrophil gelatinase-associated lipocalin, macrophage inhibitory cytokine 1 (MIC-1), and carbohydrate antigen 19-9 (CA19-9) to aid in the diagnosis of patients with symptoms suggestive of pancreatic diseases.

ABSTRACTAn imbalance in the crosstalk between the host and gut microbiota affects the intestinal barrier function, which results in inflammatory diseases and colorectal cancer. The colon epithelium protects itself from a harsh environment and various pathogenic organisms by forming a double mucus layer, primarily comprising mucins. Recent studies are focusing on how dietary patterns alter the gut microbiota composition, which in turn regulates mucin expression and maintains the intestinal layers. In addition, modulation of gut microbiota by microbiotic therapy (involving fecal microbiota transplantation) has emerged as a significant factor in the pathologies associated with dysbiosis. Therefore, proper communication between host and gut microbiota viadifferent dietary patterns (prebiotics and probiotics) is needed to maintain mucus composition, mucin synthesis, and regulation. Here, we review how the interactions between diet and gut microbiota and bacterial metabolites (postbiotics) regulate mucus layer functionalities and mucin expression in human health and disease.

ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract, please click on HTML or PDF.

ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract, please click on HTML or PDF.

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