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A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects kidneys
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Borthakur, Dibakar

; Ansari, Mohammed Ahmed

; Rani, Neerja

; Kumar, Rajesh

; Baxla, Monica

Jornal Vascular Brasileiro

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2024, Volume 23 elocation e20230120

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O conhecimento das variações anatômicas dos ramos viscerais da aorta abdominal é uma informação importante para o planejamento de qualquer cirurgia nessa região. Neste relato, apresentamos um raro conjunto de variações de vasos viscerais ao redor dos rins, bem como uma breve revisão da literatura recente. No lado direito, foi observada uma artéria renal acessória originando-se distal à artéria renal principal. Não havia artéria suprarrenal média no lado direito, e havia duas artérias suprarrenais inferiores originando-se de um ramo da artéria renal direita. No lado esquerdo, a artéria testicular apresentava um curso arqueado anterior à veia renal esquerda, simulando uma variedade incomum do fenômeno do quebra-nozes. O rim direito era drenado por duas veias renais para a veia cava inferior. O conhecimento da coexistência de tais variações anatômicas complexas pode ser útil para os clínicos durante os procedimentos diagnósticos e terapêuticos. região relato rins recente originandose originando se principal direita esquerdo esquerda quebranozes. quebranozes quebra nozes. nozes quebra-nozes inferior terapêuticos

Abstract Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures. region literature phenomenon cava procedures

https://doi.org/10.1590/1677-5449.202301202

Exploration of allelic diversity reveals a novel FAD2 (Oleate desaturase) gene in Brassica juncea FAD Oleate desaturase
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Kumar, Rajesh

; Radhamani, J

; Rajkumar, S

Crop Breeding and Applied Biotechnology

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2024, Volume 24 N. 2 elocation e47702424

Abstract: En | Text: En | PDF: En

Abstract Indian mustard (Brassica juncea) is an important contributor towards edible oil supply in India. Traditional Indian mustard varieties contain high proportion of 18C polyunsaturated fatty acids (linoleic and linolenic acids) and large amounts of long-chain monounsaturated FAs, mainly erucic acid, in seeds. Oleate desaturase (FAD2) regulates the composition of 18C PUFAs in cellular membranes and TAG in seed oil. The present study was conducted to gain insight into the allelic diversity of the FAD2 gene in Indian mustard. Analyses of cloned FAD2 genes of three Indian mustard varieties revealed a novel FAD2 gene that has a longer ORF (1167 bp) owing to insertions and several SNPs across its length that distinguish it from the more prevalent native FAD2 gene. Overall, the Indian mustard varieties possess three FAD2 alleles, but there is limited nucleotide diversity among members of each FAD2 type across varieties, suggesting narrow genetic diversity among the varieties examined. Brassica juncea India C linoleic longchain long chain FAs acid seeds FAD (FAD2 1167 (116 bp Overall alleles examined (FAD 116 (11 11 (1 1 (

https://doi.org/10.1590/1984-70332024v24n2a17

Efficacy of Motivational Interviewing and Brief Interventions on tobacco use among healthy adults: A systematic review of randomized controlled trials
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Kumar, Rajesh

; Sahu, Maya

; Rodney, Tamar

Investigación y Educación en Enfermería

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dec 2022, Volume 40 N. 3 elocation e03

Abstract: Es En Pt | Text: Es En Pt | PDF: Es | PDF: En | PDF: Pt

Resumen Objetivo. Evaluar la eficacia de una intervención breve y de la entrevista motivacional para reducir el consumo de diferentes productos relacionados con el tabaco en adultos. Métodos. Para esta revisión sistemática, se buscaron en las bases de datos PubMed, Web of Science y PsychINFO ensayos controlados aleatorizados sobre el efecto de una intervención breve y/o una entrevista motivacional en la reducción del consumo de tabaco entre adultos sanos, que hubieran sido publicados entre el 1 de enero de 2011 y el 1 de enero de 2021. Los títulos y los resúmenes de los artículos incluidos fueron evaluados por dos revisores independientes para determinar los criterios de elegibilidad, se analizó la calidad de los estudios con la guía CONSORT y se utilizaron los criterios de Cochrane para evaluar el riesgo de sesgo. Resultados. Se incluyeron un total de 12 de los 1406 estudios que arrojó la búsqueda. La intervención breve y la entrevista motivacional mostraron efectos variados en la reducción del consumo de tabaco entre los adultos en diferentes seguimientos. Siete de los 12 estudios (58.3%) informaron de un impacto beneficioso en la reducción del consumo de tabaco. La utilización de indicadores bioquímicos de la reducción del consumo de tabaco fueron limitados en comparación con los autoinformes. Los resultados sobre el abandono y la cesación del tabaco fueron variados con diferentes seguimientos. Conclusión. La evidencia apoyó la efectividad de una intervención breve y de la entrevista motivacional para la cesación del consumo de tabaco. Sin embargo, se sugiere realizar más estudios con marcadores bioquímicos como medidas de resultado para llegar a una decisión específica de la intervención. Se recomienda formar a los enfermeros en la realización de intervenciones de enfermería no farmacológicas, incluidas las intervenciones breves, para ayudar a las personas a dejar de fumar.

Abstract Objective. To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults Methods. For this systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trials on the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies. Results. A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups. Conclusion. The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.

Resumo Objetivo. Avaliar a eficácia de uma intervenção breve e entrevista motivacional na redução do uso de diferentes produtos relacionados ao tabaco em adultos. Métodos. Para esta revisão sistemática, se buscou nas bases de PubMed, Web of Science e PsychINFO ensaios controlados aleatórios sobre o efeito de uma breve intervenção e/ou entrevista motivacional na redução do uso de tabaco entre adultos saudáveis, publicados entre 1º de janeiro de 2011 e 1º de janeiro de 2021. Os títulos e resumos dos artigos incluídos foram avaliados por dois revisores independentes para critérios de elegibilidade, a qualidade do estudo foi avaliada usando a diretriz CONSORT e os critérios Cochrane foram usados para avaliar o risco de viés. Resultados. Um total de 12 dos 1.406 estudos retornados pela busca foram incluídos. Intervenção breve e entrevista motivacional mostraram efeitos mistos na redução do uso de tabaco entre adultos em diferentes acompanhamentos. Sete dos 12 estudos (58.3%) relataram um impacto benéfico na redução do uso de tabaco. O uso de indicadores bioquímicos de redução do uso de tabaco foi limitado em relação ao autorrelato. Os resultados sobre parar de fumar e parar de fumar foram variados com diferentes seguimentos. Conclusão. As evidências apoiaram a eficácia de uma intervenção breve e entrevista motivacional para a cessação do uso do tabaco. No entanto, mais estudos com marcadores bioquímicos como medidas de resultados são sugeridos para chegar a uma decisão de intervenção específica. Recomenda-se que os enfermeiros sejam treinados na execução de intervenções de enfermagem não farmacológicas, incluindo intervenções breves, para ajudar as pessoas a parar de fumar.

https://doi.org/10.17533/udea.iee.v40n3e03

Primary peripheral T-cell lymphoma of the cervix with mononeuritis multiplex: an unusual case presentation
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Seal, Ratul

; Parkhi, Mayur

; Kumar, Rajesh

; Mitra, Suvradeep

Autopsy and Case Reports

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2022, Volume 12 elocation e2021354

Abstract: En | Text: En | PDF: En

ABSTRACT Peripheral neuropathy (PN) is characterized by the injury to the peripheral nervous system of varied etiology. Lymphoma is one of the etiologies of PN, presenting various neurological manifestations. Neuropathy associated with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is unusual and fewer cases are documented in the literature. In addition, PTCL, NOS is extremely rare as primary in the female genital tract, especially uterine cervix, and exhibits aggressive clinical course with poor therapy response. We hereby describe a 47-year-old female who presented with fever and chills for 15 days. Clinical examination revealed left-sided lower motor neuron type of facial nerve palsy with Bell’s phenomenon. Nerve conduction study of all four limbs illustrated asymmetrical axonal neuropathy (motor > sensory), suggesting mononeuritis multiplex. She developed vaginal bleeding during her hospital stay. Pelvic examination and imaging revealed a 4x3cm polypoidal mass on the posterior lip of the cervix, which was excised and diagnosed as extranodal primary PTCL, NOS based on morphology, immunohistochemistry, and in-situ hybridization findings. Besides, the cerebrospinal fluid (CSF) was infiltrated by the lymphoma cells, detected on cell block preparation. The patient succumbed to her illness within one week despite best efforts and the commencement of chemotherapy. No consent was obtainable for nerve biopsy and autopsy. Thus, we report an extremely rare case of primary extranodal PTCL, NOS of the uterine cervix with unusual presentation of mononeuritis multiplex. Further, we discussed the differentials of PTCL, NOS at this extranodal site.

https://doi.org/10.4322/acr.2021.354

Establishment of Tissue Biodistribution and Blood Clearance Rates of Intravenously Administered Radioactive 51Cr3+ in New Zealand White Rabbits
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Baby, Prathap Moothamadathil

; Kumar, Pramod

; Kumar, Rajesh

; Jacob, Sanu Susan

; Rawat, Dinesh

; Nair, Binu V Sreekumaran

; Karun, Kalesh M

Brazilian Archives of Biology and Technology

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2022, Volume 65 elocation e22210627

Abstract: En | Text: En | PDF: En

Abstract Radioactive trivalent chromium (51Cr3+) is a known radiopharmaceutical used to tag plasma proteins, platelets and also for estimation of blood volume. Nevertheless, there exist insufficient reports with limited sample sizes concerning its clearance from blood and its biodistribution after intravenous administration. This study focused to understand clearance rate of 51Cr3+ from blood and analyze its biodistribution. For biodistribution, six adult New Zealand white albino rabbits were injected with 51Cr3+ through their marginal vein. Percentage clearance of 51Cr3+ from blood was calculated by recording radioactive counts obtained at 1, 58, 61, 120, 180 and 240 minutes post-administration in thirty-three adult New Zealand white albino rabbits. For evaluating 51Cr3+ biodistribution, organs were surgically removed from the rabbits and weighed. Radioactivity of the organs and urine were counted in a nucleonix gamma-ray spectrometer with a NaI scintillation detector. Data were expressed as cps/g. Average clearance of 51Cr3+ was 34% from the first to the 58 minute. Subsequent measurements for hourly clearance at 120, 180 and 240 minutes showed percentage reduction of radioactivity of 33, 14 and 8, respectively. Minimal specific activities were found in the muscle and brain. Spleen, lungs, liver and kidneys exhibited moderate radioactivity. Urine tracer-concentrations were found to be ten times more than that of plasma. From this study, it has been observed that clearance of 51Cr3+ from blood was faster initially which slowed down progressively and there displayed moderate uptake of 51Cr3+ by certain organs. Understanding pharmacokinetics of 51Cr3+ is relevant for its potential use as a diagnostic tool.

https://doi.org/10.1590/1678-4324-2022210627

The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries
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Savell, Emily

; Gilmore, Anna B

; Sims, Michelle

; Mony, Prem K

; Koon, Teo

; Yusoff, Khalid

; Lear, Scott A

; Seron, Pamela

; Ismail, Noorhassim

; Calik, K Burcu Tumerdem

; Rosengren, Annika

; Bahonar, Ahmad

; Kumar, Rajesh

; Vijayakumar, Krishnapillai

; Kruger, Annamarie

; Swidan, Hany

; Gupta, Rajeev

; Igumbor, Ehimario

; Afridi, Asad

; Rahman, Omar

; Chifamba, Jephat

; Zatonska, Katarzyna

; Mohan, V

; Mohan, Deepa

; Lopez-Jaramillo, Patricio

; Avezum, Alvaro

; Poirier, Paul

; Orlandini, Andres

; Li, Wei

; McKee, Martin

; Rangarajan, Sumathy

; Yusuf, Salim

; Chow, Clara K

Bulletin of the World Health Organization

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dec 2015, Volume 93 N. 12 Pages 851 - 861

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Abstract Objective To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. Methods Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. Findings Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11 842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. Conclusion Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

resumen está disponible en el texto completo

https://doi.org/10.2471/BLT.15.155846 2140 downloads

Rotavirus mortality in India: estimates based on a nationally representative survey of diarrhoeal deaths
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Morris, Shaun K

; Awasthi, Shally

; Khera, Ajay

; Bassani, Diego G

; Kang, Gagandeep

; Parashar, Umesh D

; Kumar, Rajesh

; Shet, Anita

; Glass, Roger I

; Jha, Prabhat

Bulletin of the World Health Organization

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oct 2012, Volume 90 N. 10 Pages 720 - 727

Abstract: En Es Fr | Text: En Es Fr | PDF: En | PDF: Es | PDF: Fr

OBJECTIVE: To estimate the number of rotavirus-associated deaths among Indian children younger than five years. METHODS: We surveyed more than 23 000 child deaths from a nationally representative survey of 1.1 million Indian households during 2001-2003. Diarrhoeal deaths were characterized by region, age and sex and were combined with the proportion of deaths attributable to rotavirus, as determined by hospital microbiologic data collected by the Indian Rotavirus Strain Surveillance Network from December 2005 to November 2007. Rotavirus vaccine efficacy data from clinical trials in developing countries were used to estimate the number of deaths preventable by a national vaccination programme. Data were analysed using Stata SE version 10. FINDINGS: Rotavirus caused an estimated 113 000 deaths (99% confidence interval, CI: 86 000-155 000); 50% (54 700) and 75% (85 400) occurred before one and two years of age, respectively. One child in 242 died from rotavirus infection before five years of age. Rotavirus-associated mortality rates overall, among girls and among boys were 4.14 (99% CI: 3.14-5.68), 4.89 (99% CI: 3.75-6.79) and 3.45 (99% CI: 2.58-4.66) deaths per 1000 live births, respectively. Rates were highest in Bihar, Uttar Pradesh and Madhya Pradesh, which together accounted for > 50% of deaths (64 400) nationally. Rotavirus vaccine could prevent 41 000-48 000 deaths among children aged 3-59 months. CONCLUSION: The burden of rotavirus-associated mortality is high among Indian children, highlighting the potential benefits of rotavirus vaccination.

OBJETIVO: Calcular el número de muertes asociadas al rotavirus entre niños indios menores de cinco años. MÉTODOS: Estudiamos más de 23 000 muertes de niños procedentes de una encuesta representativa a nivel nacional sobre 1,1 millón de hogares indios durante 2001-2003. Las muertes por diarrea se caracterizaron por región, edad y sexo y se combinaron con la proporción de muertes atribuibles al rotavirus, como determinaron los datos microbiológicos hospitalarios recogidos por la Red india de vigilancia de la cepa del rotavirus (Indian Rotavirus Strain Surveillance Network) desde diciembre de 2005 hasta noviembre de 2007. Los datos acerca de la eficacia de la vacuna contra el rotavirus de ensayos clínicos en países en vías de desarrollo se emplearon para calcular el número de muertes prevenibles por medio de un programa de vacunación nacional. Los datos se analizaron mediante Stata SE versión 10. RESULTADOS: El rotavirus causó aproximadamente 113 000 muertes (99% intervalo de confianza, IC: 86 000-155 000); el 50% (54 700) y el 75% (85 400) sucedió antes del primer y segundo año de edad, respectivamente. Un niño de cada 242 falleció debido a una infección por rotavirus antes de llegar a los cinco años de edad. Las tasas generales de mortalidad asociadas con el rotavirus entre niños y entre niñas fueron de 4,14 (99% IC: 3,14-5,68), 4,89 (99% IC: 3,75-6,79) y 3,45 (99% IC: 2,58-4,66) muertes por 1 000 nacidos vivos, respectivamente. Las tasas más altas se dieron en Bihar, Uttar Pradesh y Madhya Pradesh, que en conjunto integraron más del 50% de las muertes (64 400) a nivel nacional. La vacuna contra el rotavirus podría prevenir 41 000-48 000 muertes entre niños de entre 3 y 59 meses. CONCLUSIÓN: La carga de la mortalidad asociada con el rotavirus es mayor entre los niños indios, y resalta los beneficios potenciales de la vacuna contra el rotavirus.

OBJECTIF: Estimer le nombre de décès associés au rotavirus chez les enfants indiens de moins de cinq ans. MÉTHODES: Nous avons examiné plus de 23 000 décès d'enfants sur la base d'une enquête représentative au niveau national de 1,1 million de foyers indiens durant la période 2001-2003. Les décès par diarrhée étaient classés par région, âge et sexe, ainsi que corrélés à la proportion de décès attribuables au rotavirus, tels que déterminés par les données microbiologiques hospitalières collectées par le réseau de surveillance indien de la souche du rotavirus de décembre 2005 à novembre 2007. Les données d'efficacité du vaccin contre le rotavirus provenant d'essais cliniques réalisés dans les pays en développement ont été utilisées pour estimer le nombre de décès évitables par un programme national de vaccination. Les données ont été analysées à l'aide de Stata SE version 10. RÉSULTATS: Le rotavirus a causé environ 113 000 décès (intervalle de confiance, IC de 99%: 86 000 à 155 000), 50% (54 700) et 75% (85 400) d'entre eux survenaient respectivement avant l'âge d'un an et de deux ans. Un enfant sur 242 est mort d'une infection par le rotavirus avant l'âge de cinq ans. Les taux de mortalité associés au rotavirus étaient, dans l'ensemble, parmi les filles et les garçons, de 4,14 décès (IC de 99%: 3,14-5,68), 4,89 (IC de 99%: 3,75-6,79) et 3,45 (IC de 99%: 2,58-4,66) pour 1 000 naissances vivantes, respectivement. Les taux étaient les plus élevés dans le Bihar, l'Uttar Pradesh et le Madhya Pradesh, représentant au total, à l'échelle nationale, plus de 50% des décès (64 400). Le vaccin contre le rotavirus pourrait éviter 41 000 à 48 000 décès chez les enfants âgés de 3 à 59 mois. CONCLUSION: L'impact de la mortalité associée au rotavirus est élevé chez les enfants indiens, soulignant les avantages potentiels d'une vaccination contre le rotavirus.

https://doi.org/10.2471/BLT.12.101873 2190 downloads

In Vitro antifungal potency of plant extracts against five phytopathogens
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Tapwal, Ashwani

; Nisha,

; Garg, Shipra

; Gautam, Nandini

; Kumar, Rajesh

Brazilian Archives of Biology and Technology

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dec 2011, Volume 54 N. 6 Pages 1093 - 1098

Abstract: En | Text: En | PDF: En

The antifungal activity of aqueous extract of Cannabis sativa, Parthenium hysterophorus, Urtica dioeca, Polystichum squarrosum and Adiantum venustum was investigated against Alternaria solani, Alternaria zinniae, Curvularia lunata, Rhizoctonia solani and Fusarium oxysporum at different concentrations (5, 10, 15 and 20%). At 20%, maximum antifungal potential was observed with the extracts of C. sativa, which recorded excellent inhibitory activity against C. lunata (100%), A. zinniae (59.68%), followed by leaf extract of P. hysterophorus (50%) against A. solani. The application of botanical extracts for disease management could be less expensive, easily available, non-polluting and eco-friendly.

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Validity of verbal autopsy for ascertaining the causes of stillbirth
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Aggarwal, Arun K

; Jain, Vanita

; Kumar, Rajesh

Bulletin of the World Health Organization

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jan 2011, Volume 89 N. 1 Pages 31 - 40

Abstract: En Es Fr | Text: En Es Fr | PDF: En | PDF: Es | PDF: Fr

OBJECTIVE: To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment versus verbal autopsy. METHODS: In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. All mothers had to be at least 24 weeks pregnant and live within 100 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency. FINDINGS: Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval, CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% CI: 0.65-0.84); pregnancy-induced hypertension, 0.76 (95% CI: 0.69-0.81); antepartum haemorrhage, 0.76 (95% CI: 0.67-0.84) and obstetric complication, 0.82 (95% CI: 0.71-0.93). CONCLUSION: The WHO verbal autopsy tool for stillbirth can provide reasonably good estimates of common underlying causes of stillbirth in resource-limited settings where a medically certified cause of stillbirth may not be available.

OBJETIVO: Validar las entrevistas verbales a parientes y allegados para determinar las causas de la mortinatalidad que utiliza la Organización Mundial de la Salud (OMS), empleando el diagnóstico hospitalario de las causas subyacentes a la mortinatalidad («criterio de referencia») y comparar la proporción de mortinatos atribuidos a determinadas causas específicas, a través de la valoración del hospital, en comparación con los resultados de las investigaciones verbales. MÉTODOS: Realizamos un estudio prospectivo de todos los mortinatos que nacieron en un hospital de Chandigarh (India) entre el 15 de abril de 2006 y el 31 de marzo de 2008 y cuya causa de defunción se diagnosticó dentro de un plazo de 2 días. Todas las madres debían encontrarse como mínimo en la semana 24 de gestación y vivir dentro de un radio de 100 km del hospital. Para las entrevistas verbales, los trabajadores en el terreno visitaron a las madres entre las 4 y las 6 semanas posteriores a la mortinatalidad. Dos obstetras independientes revisaron los resultados de las autopsias y, en caso de desacuerdo, se solicitó la participación de un tercer experto. Se comparó la frecuencia de las causas de la mortinatalidad, según lo establecido por la valoración hospitalaria y por las investigaciones verbales. RESULTADOS: Tanto la valoración hospitalaria como la entrevista verbal coincidieron en cuáles eran las cinco causas de mortinatalidad más frecuentes: preeclampsia (30%), hemorragia prenatal (16%), enfermedad subyacente de la madre (12%), malformaciones congénitas (12%) y complicaciones obstétricas (10%). La precisión general del diagnóstico mediante investigación verbal, en comparación con el diagnóstico basado en la información hospitalaria para las cinco causas más frecuentes de mortinatalidad, fue del 64%. Las áreas bajo la curva de eficacia diagnóstica (ROC) fueron: para las malformaciones congénitas, 0,91 (intervalo de confianza del 95%, IC: 0,83-0,97); enfermedad pre-gestacional de la madre, 0,75 (95%, IC: 0,65-0,84); preeclampsia, 0,76 (95%, IC: 0,69-0,81); hemorragia prenatal, 0,76 (95%, IC: 0,67-0,84) y complicaciones obstétricas, 0,82 (95%, CI: 0,71-0,93). CONCLUSION: La herramienta de investigación verbal de la mortinatalidad que emplea la OMS puede ofrecer unas estimaciones razonablemente aceptables de las causas subyacentes más frecuentes a la mortinatalidad en los ámbitos con recursos limitados, en los que la causa de mortinatalidad pueda no estar certificada por un médico.

OBJECTIF: Valider l'outil de l'autopsie verbale de l'Organisation mondiale de la Santé dans le cadre des mortinaissances en recourant au diagnostic hospitalier de la cause sous-jacente de la mortinaissance (modèle idéal) et comparer la part des mortinaissances attribuée à différentes causes spécifiques selon l'évaluation de l'hôpital d'une part, et l'autopsie verbale, d'autre part. MÉTHODES: Dans un hôpital de Chandigarh, nous avons étudié de manière prospective toutes les mortinaissances survenues du 15 avril 2006 au 31 mars 2008 et dont les causes avaient été diagnostiquées dans les 2 jours suivant l'évènement. Toutes les mères devaient avoir eu une grossesse d'une durée minimale de 24 semaines et résider dans un périmètre maximum de 100 km autour de l'hôpital. Pour réaliser l'autopsie verbale, les agents de terrain ont rendu visite aux mères 4 à 6 semaines après la mortinaissance. Les résultats de l'autopsie ont ensuite été examinés par deux obstétriciens indépendants et leurs divergences ont été résolues par l'engagement d'un troisième expert. Les causes des mortinaissances, telles que déterminées par l'évaluation hospitalière et par l'autopsie verbale, ont été comparées en fonction de leur fréquence. Résultats: L'évaluation hospitalière et l'autopsie verbale ont rapporté cinq causes sous-jacentes principales identiques de la mortinaissance: hypertension liée à la grossesse (30%), hémorragie ante partum (16%), pathologie maternelle sous-jacente (12%), malformations congénitales (12%) et complications obstétriques (10%). L'exactitude générale de l'autopsie verbale au regard du diagnostic hospitalier, pour les cinq causes principales de mortinaissance, était de 64%. Les aires sous la courbe de caractéristique de fonctionnement du récepteur étaient, pour les malformations congénitales, 0,91 (95% intervalle de confiance, IC: 0,83-0,97); les pathologies maternelles prégestationnelles, 0,75 (95% IC: 0,65-0,84); l'hypertension due à la grossesse, 0,76 (95% IC: 0,69-0,81); l'hémorragie ante partum, 0,76 (95% IC: 0,67-0,84) et les complications obstétriques, 0,82 (95% IC: 0,71-0,93). CONCLUSION: L'outil d'autopsie verbale de l'OMS en matière de mortinaissance peut fournir des estimations relativement bonnes des causes communes sous-jacentes de la mortinaissance chez les familles aux ressources limitées, pour lesquelles une cause de mortinaissance médicalement certifiée peut ne pas être disponible.

https://doi.org/10.2471/BLT.10.076828 1638 downloads

10.

Problems associated with clinical trials of Ayurvedic medicines
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Sharma, Ashish K

; Kumar, Rajesh

; Mishra, Anurag

; Gupta, Rajiv

Revista Brasileira de Farmacognosia

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may 2010, Volume 20 N. 2 Pages 276 - 281

Abstract: En | Text: En | PDF: En

Herbal drugs have been used since ancient times as medicines for the treatment of various diseases. Especially in countries like India many of herbal drugs and formulations are used in different practices of treatment like Ayurveda, Siddha and Unani. It is estimated that about 25% of all modern medicines are directly or indirectly derived from plants sources. The contribution of developing countries in global herbal business is very poor due to lack of quality control and standardization measures. There is lack of common standards and appropriate methods for evaluating Traditional Medicine to ensure the safety, efficacy and quality control. This indicates the importance and necessity to develop a standard operational procedure for the standardization of herbal drugs and formulations. Benchmarking the evaluation protocols including both quality control and quality assurance of herbal drugs would play a major role in providing highly reliable and effective herbals drugs and to attract international trade, thus generating revenue. The article highlights various problems being faced by developing countries and suggests a unique approach for the preparation of SOP/guidelines for the standardization of all herbal based formulations, also there is a need for systematic clinical trials of traditional plant based medicines to enhance global acceptance

26773 downloads

11.

Effectiveness of planning and management interventions for improving age-appropriate immunization in rural India
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Prinja, Shankar

; Gupta, Madhu

; Singh, Amarjeet

; Kumar, Rajesh

Bulletin of the World Health Organization

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feb 2010, Volume 88 N. 2 Pages 97 - 103

Abstract: En Es Fr | Text: En Es Fr | PDF: En | PDF: Es | PDF: Fr

OBJECTIVE: To study the effectiveness of planning and management interventions for ensuring children in India are immunized at the appropriate age. METHODS: The study involved children aged less than 18 months recruited from Haryana, India, in 2005-2006: 4336 in a pre-intervention cohort and 5213 in a post-intervention cohort. In addition, immunization of 814 hospitalized children from outside the study area was also assessed. Operational barriers to age-appropriate immunization with diphtheria, pertussis and tetanus (DPT) vaccine were investigated by monitoring vaccination coverage, observing immunization sessions and interviewing parents and health-care providers. An intervention package was developed, with community volunteers playing a pivotal role. Its effectiveness was assessed by monitoring the ages at which the three DPT doses were administered. FINDINGS: The main reasons for delayed immunization were staff shortages, non-adherence to plans and vaccine being out of stock. In the post-intervention cohort, 70% received a third DPT dose before the age of 6 months, significantly more than in the pre-intervention cohort (62%; P = 0.002). In addition, the mean age at which the first, second and third DPT doses were administered decreased by 17, 21 and 34 days, respectively, in the study area over a period of 18 months (P for trend < 0.0001). No change was observed in hospitalized children from outside the study area. CONCLUSION: An intervention package involving community volunteers significantly improved age-appropriate DPT immunization in India. The Indian Government's intention to recruit village-based volunteers as part of a health sector reform aimed at decentralizing administration could help increase timely immunization.

OBJETIVO: Estudiar la eficacia de intervenciones de planificación y gestión para garantizar que los niños de la India se vacunan a la edad apropiada. MÉTODOS: El estudio se realizó en 2005-2006 en menores de 18 meses de Haryana (India): 4336 en una cohorte preintervención y 5213 en una cohorte posintervención. Además también se investigó la vacunación de 814 niños hospitalizados que no pertenecían a la zona en estudio. Los obstáculos a la vacunación DTP (difteria, tétanos y tos ferina) a la edad apropiada se investigaron monitorizando la cobertura vacunal, observando las sesiones de vacunación y entrevistando a los padres y a los dispensadores de atención sanitaria. Se elaboró un conjunto de intervenciones en las que desempeñaron un papel destacado los voluntarios de la comunidad. La eficacia se evaluó en función de las edades a las que se administraron las tres dosis de la DTP. RESULTADOS: Las principales causas de retraso de la vacunación fueron la escasez de personal, el incumplimiento de los planes y el agotamiento de las existencias de la vacuna. En la cohorte posintervención, el 70% de los casos recibieron la tercera dosis de DTP antes de los 6 meses, porcentaje que fue significativamente mayor que en la cohorte preintervención (62%; P = 0,002). Además, en la zona estudiada el promedio de edad en el momento de la administración de la primera, segunda y tercera dosis de DTP disminuyó a lo largo de un periodo de 18 meses en 17, 21 y 34 días, respectivamente (P de la tendencia < 0,0001). En los niños hospitalizados que no pertenecían a la zona en estudio no se observaron cambios. CONCLUSIÓN: En la India, un conjunto de intervenciones en las que participaron voluntarios de la comunidad mejoró significativamente la vacunación con la DTP a edades apropiadas. La intención del Gobierno de la India de reclutar a voluntarios de los pueblos en el marco de la reforma del sector de la salud destinada a descentralizar la administración podría ayudar a incrementar la vacunación en el momento oportuno.

OBJECTIF: Étudier l'efficacité des interventions de planification et de gestion visant à garantir la vaccination des enfants à un âge approprié en Inde. MÉTHODES: L'étude a porté sur des enfants de moins de 18 mois, recrutés dans l'Haryana en Inde, sur la période 2005-2006 : 4336 composant une cohorte pré-intervention et 5213 constituant une cohorte post-intervention. En outre, on a évalué la vaccination de 814 enfants hospitalisés, mais n'habitant pas la zone étudiée. On a étudié les obstacles opérationnels à l'administration à un âge approprié du vaccin antidiphtérique-anticoquelucheuxantitétanique (DTP) par une surveillance de la couverture vaccinale, une observation des sessions de vaccination et un entretien avec les parents et les prestataires de soins. On a mis au point un module d'intervention dans lequel des volontaires appartenant à la communauté jouaient un rôle central. L'efficacité de ce module a été évaluée en suivant les âges auxquels les doses de DPT étaient administrées. RÉSULTATS: Les retards dans la vaccination étaient principalement imputables à des pénuries de personnel, au non-respect des plans et à des ruptures de stocks de vaccins. Parmi la cohorte postintervention, 70 % des enfants avaient reÃ§u une troisième dose de DTP avant l'âge de 6 mois, soit significativement plus que dans la cohorte pré-intervention (62 %, p = 0,002). De plus, l'âge moyen d'administration de la première, de la deuxième et de la troisième doses de DTP avait diminué respectivement de 17, 21 et 34 jours dans la zone étudiée, sur une période de 18 mois (probabilité de la tendance < 0,0001). Aucun changement n'a été observé chez les enfants hospitalisés ne provenant pas de la zone étudiée. CONCLUSION: Un module d'intervention faisant appel à des volontaires communautaires a permis en Inde de rapprocher significativement l'âge d'administration du vaccin DPT de l'âge approprié. L'intention du Gouvernement indien de recruter des volontaires dans les villages dans le cadre de la réforme de décentralisation de l'administration pourrait favoriser la vaccination à un âge approprié.

1788 downloads

12.

Reducing health inequities in a generation: a dream or reality?
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Prinja, Shankar

; Kumar, Rajesh

Bulletin of the World Health Organization

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feb 2009, Volume 87 N. 2 Pages 84 - 84

Abstract: En | Text: En | PDF: En

676 downloads

13.

Group A streptococcal sore throat in a periurban population of northern India: a one-year prospective study
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Nandi, Sobhan

; Kumar, Rajesh

; Ray, Pallab

; Vohra, Harpreet

; Ganguly, Nirmal K.

Bulletin of the World Health Organization

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2001, Volume 79 N. 6 Pages 528 - 533

Abstract: En Es Fr | Text: En Es Fr | PDF: En | PDF: Es | PDF: Fr

OBJECTIVE: To estimate the incidence and risk factors of group A streptococcus (GAS) sore throat among school-aged children living in a periurban slum area of Chandigarh, North India. METHODS: A total of 536 children aged 5-15 years from 261 families identified by a systematic random selection method were enrolled in the study. Episodes of sore throat were recorded through fortnightly home visits over a one-year period. The local vernacular (Hindi) terms gala kharab (bad throat) and khansi jukam (cough and cold) were used to identify symptoms of sore throat, and throat swab specimens were collected from children who had these symptoms on the day of the home visit. Bacterial culture was carried out and the isolation of GAS was confirmed using group-A-specific antiserum. FINDINGS: The incidences of sore throat and GAS sore throat were, respectively, 7.05 and 0.95 episodes per child-year. The incidence was higher in the following situations: among 11-year-olds, during the winter (November to January) and rainy (August) months (a bimodal peak), among children living in houses where there was no separate room for the kitchen, and in homes that included a tobacco smoker. CONCLUSION: The results show that the incidence of GAS sore throat was related to age, season, and indoor air pollution.

OBJETIVO: Estimar la incidencia y los factores de riesgo de faringoamigdalitis por estreptococos del grupo A (EGA) entre escolares de un barrio pobre periurbano de Chandigarh, en el norte de la India. MÉTODOS: En total participaron en el estudio 536 niños de 5 a 15 años de edad de 261 familias identificadas mediante un método sistemático de selección aleatoria. A lo largo de un periodo de un año se realizaron visitas domiciliarias cada dos semanas para registrar los episodios de faringoamigdalitis. Los síntomas de la enfermedad se identificaron empleando los términos vernáculos locales del hindi gala kharab (dolor de garganta) y khansi jukam (tos y síntomas de resfriado), y se practicaron hisopados faríngeos en los niños que presentaban esos síntomas el día de la visita a domicilio. Se hicieron cultivos bacterianos, y se utilizó antisuero específico contra el grupo A para confirmar el aislamiento de EGA. RESULTADOS: La incidencia de faringoamigdalitis y de faringoamigdalitis por EGA fue, respectivamente, de 7,05 y 0,95 episodios por niño y año. La incidencia fue mayor en las siguientes situaciones: entre los niños de 11 años, durante los meses de invierno (de noviembre a enero) o lluviosos (agosto) (pico bimodal), entre los niños de viviendas donde la cocina no estaba separada del resto del espacio doméstico, y en los hogares en que había una persona fumadora. CONCLUSIÓN: Los resultados muestran que la incidencia de faringoamigdalitis por EGA guarda relación con la edad, con la estación y con la contaminación del aire en locales cerrados.

OBJECTIF: Estimer l’incidence et les facteurs de risque de l’angine à streptocoque du groupe A chez des écoliers d’un quartier pauvre de la périphérie de Chandigarh, dans le nord de l’Inde. MÉTHODES: L’étude a porté sur 536 enfants de 5 à 15 ans appartenant à 261 familles sélectionnées par tirage au sort selon une méthode systématique. Les épisodes d’angine ont été consignés lors de visites à domicile effectuées toutes les deux semaines pendant un an. Les termes de la langue vernaculaire locale (hindi) gala kharab (mal de gorge) et khansi jukam (toux et rhume) ont été utilisés pour identifier les symptômes d’angine, et des écouvillonnages de gorge ont été prélevés le jour de la visite à domicile chez les enfants qui présentaient ces symptômes. Une culture bactériologique a été effectuée et l’isolement des streptocoques du groupe A a été confirmé au moyen d’un immunsérum spécifique du groupe A. RÉSULTATS: L’incidence de l’angine était de 7,05 épisodes par enfant-année et celle de l’angine streptococcique (groupe A) de 0,95 épisode par enfant-année. Elle était plus élevée: chez les enfants de 11 ans; pendant les mois d’hiver (novembre à janvier) et la saison des pluies (août), avec une répartition bimodale; chez les enfants vivant dans une habitation sans cuisine séparée; et dans les familles comptant au moins un fumeur. CONCLUSION: Les résultats montrent que l’incidence de l’angine à streptocoque du groupe A est liée à l’âge, à la saison et à la pollution de l’air à l’intérieur des habitations.

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