Unusual changes in colostrum composition in lactating Indian women having medical complications during pregnancy—A pilot study

Colostrum, the mammary secretion during first 2–4 days of lactation, provides all the essential components of nutrition and passive immunity required by the newborn. Pregnancy induced hypertension (PIH), glucose intolerance and anaemia are common medical complications observed during pregnancy in Indian women and their effects were studied on the composition of colostrum collected within 24 hours of delivery from lactating women included in the study. PIH during pregnancy significantly decreased colostrum IgA and total proteins, but showed a significant increase in K⁺ levels, where as women with glucose intolerance showed a significant decrease in total lipids and lactose and an increase in Na⁺ levels in colostrum compared to normal controls. The group with anaemia also showed a significant decrease in colostrum IgA and total protein levels when compared with the control group. Awareness about the changes that occur in the composition of colostrum during complicated pregnancies can be an important and useful tool for preventive and protective paediatrics.     

Dyslipidemia in pregnancy may contribute to increased risk of neural tube defects -a pilot study in north Indian population

Neural tube defects are congenital structural abnormalities of the brain and vertebral column resulting from improper or non-timely closure of the neural tube. Prevalence of neural tube defects is reported to be higher among women with diabetes mellitus and obesity. This study was designed to investigate the relation between the presence of dyslipidemia in antenatal patients and the risk of fetal neural tube defects. The present study was an observational, cross-sectional study involving 129 pregnant women in 16 to 18 weeks gestation period. Of these, 80 women had normal pregnancies and 49 were clinically high-risk cases for neural tube defects. Fasting blood samples were analyzed for blood sugar and lipid profile by enzymatic assay and alpha-fetoprotein levels using Enzyme Immunoassay. Alpha-fetoprotein (AFP) values were converted to Multiples of Median (MoM) appropriate for the gestational age. Based on AFP values, women were labeled as screen negative (AFP <2 MoM, n= 102) and screen positive (AFP > 2 MoM, n =27). Screen positive women were further evaluated by ultrasound and 21 women were found to carry a neural tube defects positive pregnancy. Statistical analysis was done on SPSS software. Body weight of the women showed a significant positive correlation with serum triglycerides, plasma sugar and AFP MoM values. A significant difference was observed in serum cholesterol levels (p= 0.038), triglycerides (p=0.001) and plasma sugar levels (p=0.002) between normal women and those with neural tube defects positive pregnancy. The Odds ratio for neural tube defects risk in dyslipidemic cases was 24.23 (CI 4.73 − 148.60) with a relative risk of 12.12. Dyslipidemia especially hypertriglyceridemia was found to be significantly associated with fetal neural tube defects.     

Stress and women

Stress-tension-pain occur more often in health disorders of women than anywhere in the entire spectrum of human illness. No where is the effect of rapid change more apparent than in the changing role of today's women who are subjected to pressures from all sides. Now a days women virtually take part occupy positions, in day to day activities similar to their male counterparts. An outline of conceptual consideration, biochemical overview of stress and intricacies of coping mechanisms are delineated from the point of view of stress situations in female (during reproductive life span) peculiar to them only viz menarche, menstrual cycle, pregnancy-eventualities of pregnancy-labour-delivery, purperium, postpartum psychosis, abortions-induced, spontaneous, menopause. Lipid profile and oxidative stress status as biochemical responses in these stresses were investigated. As expected observed maximal/minimal biochemical responses well correlated with peak time and at termination of stress. Present day emphasis is on menstrual regulation by intake of oral contraceptive to improve health if women prefer not to bleed every month and hormone replacement therapy for elderly women to improve post menopausal quality of life and avoiding menstrual problems at the same time.     

Bardet–Biedl Syndrome: A Rare Cause of Chronic Kidney Disease

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive condition characterized by retinitis pigmentosa, postaxial polydactyly, central obesity, and renal involvement. Renal failure is the commonest cause of death. We report a case of BBS with chronic kidney disease (CKD) at younger age (17 year) from India. This diagnosis should be considered in patients with renal disease and the characteristic phenotype of retinitis pigmentosa, postaxial polydactyly and central obesity. These patients should undergo regular monitoring of renal function test to early diagnosis and treatment of CKD to prevent morbidity and mortality. Renal transplantation is a viable option of renal replacement therapy in these patients. These findings are valuable for comparing phenotype of BBS patients with CKD from various national and international centers.     

Down Syndrome with End-Stage Renal Disease

Down syndrome is one of the most common genetic causes of learning disabilities in children. Although the incidence of renal and urological involvement in Down syndrome is not very common, monitoring of patients with Down syndrome for renal diseases should be done regularly as patient’s age into the second and third decades. With increased survival, it appears that a growing number of these patients present with chronic renal failure. Down syndrome patients are apparently not suited for peritoneal dialysis because of lacking cooperation. This procedure can be prone to failure, mainly because of an increased risk of peritonitis. Handling such patients especially those on peritoneal dialysis is challenging. Here we report a case of Down syndrome with end-stage renal disease treated with hemodialysis for 6 months. To the best of our knowledge and current literature review this is the first case report of a patient with Down syndrome undergoing hemodialysis.     

Primary Myoglobinuria: Differentiate Myoglobinuria from Hemoglobinuria

Myoglobin is dark red colour heme containing protein, stored in muscle. Change in permeability of myolemma causes myoglobin leak in plasma, which is cleared by kidney swiftly. Differentiating myoglobinuria from hemoglobinuria is important. Clinicians concern over myoglobinuria is to protect the patient from acute renal disease. We present a case of primary myoglobinuria, its clinical symptoms, diagnosis and treatment.     

Tier 3 specialized writing instruction for students with dyslexia

Two instructional experiments used randomized, controlled designs to evaluate the effectiveness of writing instruction for students with carefully diagnosed dyslexia, which is both an oral reading and writing disorder, characterized by impaired word decoding, reading, and spelling. In Study 1 (4th to 6th grade sample and 7th to 9th grade sample), students were randomly assigned to orthographic or morphological spelling treatment but all students were taught strategies for planning, writing, and reviewing/revising narrative and expository texts. Both treatments resulted in improvement on three measures of spelling and one measure of composition. Morphological treatment resulted in better improvement in spelling pseudowords, whereas orthographic treatment resulted in better improvement in rate of reading pseudowords. In Study 2 (4th to 6th grade sample), students were randomly assigned to explicit language treatment (phonological working memory + phonological-orthographic spelling + science report writing training) or nonverbal problem solving treatment (virtual reality-based computer simulation, drawing maps, and building clay models). Both treatments used science content material and resulted in significant improvement in spelling and reading pseudowords (accuracy and rate). The surprising finding was that hands-on, engaging science problem solving led to more improvement in phonological working memory than did specialized phonological instruction. Only when spelling instruction emphasized orthography or morphology (Study 1) did real word spelling improve. Preparation of this chapter was supported by Grant Nos. HD25858 and P50 33812 from the National Institute of Child Health and Human Development (NICHD). In Study 1 teaching assistants included Sylvia Abbott, Marci Anderson-Youngstrom, Belle Chennault, Kate Eschen, Noelia Garcia, Sandra Hiramatsu, Lynn Junell, Julia Kim, Stephanie King, Shin-Ju (Cindy) Lin, Rebecca Metzger, Heather Murphy, Jennifer Norton, Sue Palewicz, Rebecca Pirie, and Suzanna West. Also on the assessment team were Sylvia Abbott, Belle Chenault, Kate Eschen, and Rebecca Pirie. Certified teachers Diana Hoffer and Christina Johnson implemented the composition lessons written by the first author. In Study 2, teaching assistants included Nicole Alston-Abel, Leah Altemeier, Wade Altom, Marci Anderson-Youngstrom, Annie Boyd, Nicole Garcia, Laura Gould, Marta Holsinger, Yen-Ling Lee, Shin-Ju (Cindy) Lin, Laurie McCarthy, Heather Murphy, Hema O’Shea, Michelle Proux, Kristine Tardiff, and Kari Terjeson. Janine Jones supervised the assessment team. Margaret McShane and Doug Stock served as administrative assistants.     

Comparison of Mass Versus Activity of Creatine Kinase MB and Its Utility in the Early Diagnosis of Re-infarction

Currently employed markers for the detection of acute coronary syndrome are Troponin T, CK (Creatine Kinase) and CKMB activity. CKMB activity measured by immunoinhibition method can give falsely elevated results due to the presence of atypical CK and CKBB and at times lead to the mis-diagnosis of acute coronary syndrome. Hence, CKMB mass (CKMB) measured by electrochemiluminence sandwich principle was employed. In this cross-sectional study 183 samples of 61 patients were analyzed within 6 h of diagnosis of acute coronary syndrome and followed up to 72 h. The correlation coefficient between CKMB activity and CKMBM at 4–6 h was 0.744, while at 12–24 h it was 0.909 and at 48–72 h it was 0.337. Thus there was good association between the two methods at 12–24 h but, statistically for method comparison studies and for replacing one method by another, the two methods need to be in agreement with one another. In this study the two methods are not in agreement with one another and thus analytically not replaceable. Another finding was obtained that CKMBM reached cut off levels prior to CKMB enzyme activity and hence, CKMBM is clinically better than CKMB activity to detect reinfarction.     

Extracellular Methemoglobin Mediated Early ROS Spike Triggers Osmotic Fragility and RBC Destruction: An Insight into the Enhanced Hemolysis During Malaria

Malaria infection is known to cause severe hemolysis due to production of abnormal RBCs and enhanced RBC destruction through apoptosis. Infected RBC lysis exposes uninfected RBC to the large amount of pro-oxidant molecules such as methemoglobin. Methemoglobin (MetHb) exposure dose dependently makes RBCs susceptible to osmotic stress and causes hemolysis. MetHb mediated oxidative stress in RBC correlated well with osmotic fragility and hemolysis. Interestingly, a reactive oxygen species (ROS) spike at 15 min was responsible for the observed effects on RBC cells. Two natural antioxidants N-acetyl cysteine and mannitol protected the RBC from MetHb-mediated defects, which clearly indicated involvement of oxidative stress in the process. MetHb due to its pseudo-peroxidase activity produces ROS in the external microenvironment. Therefore, classical peroxidase inhibitors were tested to probe peroxidase activity mediated ROS production with defects in RBCs. Clotrimazole (CLT), which irreversibly inactivates the MetHb (CLT-MetHb) and abolishes peroxidase activity, did not produce significant ROS outside RBC and was inefficient to cause osmotic fragility and hemolysis. Hence, initiating a chain reaction, MetHb released from ruptured RBC produces significant ROS in the external microenvironment to make RBC membrane leaky and enhanced hemolysis. Together data presented in the current work explored the role of MetHb in accelerated humorless during malaria which could be responsible for severe outcomes of pathological disorders.     

Burnout in indian teachers

Burnout is a concept which was born in the mid 1970’s in the USA and with astonishing rapidity has become a catch-word to convey an almost unlimited variety of social and personal problems afflicting workers. It describes a specific dysfunction among helping professionals, believed to be the result of excessive demands made upon their energy, strength and resources. Although a clearly agreed upon definition does not exist, burnout is characterized by the inability to be sufficiently concerned about and involved with service recipients. A burnt out worker tends to withdraw emotionally from the demands of the job. Burnout is reflected in emotional exhaustion and apathy, physical fatigue, lack of energy, psychosomatic illness, increased alcohol and drug consumption, cynicism, inappropriate anger, depression and lack of personal achievements. Now, it is observed that teachers are also showing symptoms of burnout, which directly or indirectly affect their teaching performance. Motivated by these reasons the investigators decided to investigate the status of burnout among secondary school teachers and assess its extent in Indian teachers.