Low cost calibrated mechanical noisemaker for hearing screening of neonates in resource constrained settings

BACKGROUND & OBJECTIVES

There is a need to develop an affordable and reliable tool for hearing screening of neonates in resource constrained, medically underserved areas of developing nations. This study valuates a strategy of health worker based screening of neonates using a low cost mechanical calibrated noisemaker followed up with parental monitoring of age appropriate auditory milestones for detecting severe-profound hearing impairment in infants by 6 months of age.

METHODS

A trained health worker under the supervision of a qualified audiologist screened 425 neonates of whom 20 had confirmed severe-profound hearing impairment. Mechanical calibrated noisemakers of 50, 60, 70 and 80 dB (A) were used to elicit the behavioural responses. The parents of screened neonates were instructed to monitor the normal language and auditory milestones till 6 months of age. This strategy was validated against the reference standard consisting of a battery of tests - namely, auditory brain stem response (ABR), otoacoustic emissions (OAE) and behavioural assessment at 2 years of age. Bayesian prevalence weighted measures of screening were calculated.

RESULTS

The sensitivity and specificity was high with least false positive referrals for 70 and 80 dB (A) noisemakers. All the noisemakers had 100 per cent negative predictive value. 70 and 80 dB (A) noisemakers had high positive likelihood ratios of 19 and 34, respectively. The probability differences for pre- and post- test positive was 43 and 58 for 70 and 80 dB (A) noisemakers, respectively.

INTERPRETATION & CONCLUSIONS

In a controlled setting, health workers with primary education can be trained to use a mechanical calibrated noisemaker made of locally available material to reliably screen for severe-profound hearing loss in neonates. The monitoring of auditory responses could be done by informed parents. Multi-centre field trials of this strategy need to be carried out to examine the feasibility of community health care workers using it in resource constrained settings of developing nations to implement an effective national neonatal hearing screening programme.

Genetic admixture studies on four in situ evolved, two migrant and twenty-one ethnic populations of Tamil Nadu, south India

We analysed the genetic structure of ≈ 1000 samples representing 27 ethnic groups settled in Tamil Nadu, south India, derived from two linguistic families (Dravidians and Indo-Europeans) representing four religious groups (Hinduism, Islam, Christianity and Jainism) using 11 mtDNA markers. Out of 27 ethnic groups, four are in situ populations (Anglo-Indian, Labbai Muslim, Nadar Christian and south Indian Jain) and two are migrants (Gypsy and north Indian Jain) from north India to Tamil Nadu, and 21 are native ethnic groups. Six of the markers we used were monomorphic (HaeIII663, HpaI3592, AluI5176, AluI7025, AluI13262, 9-bp deletion) and five markers were polymorphic (DdeI10394, AluI10397, HinfI12308, HincII13259 and HaeIII16517). Haplogroup frequencies, genetic affinities and admixture analysis are based on the genotype data of polymorphic markers observed in these populations. Haplogroup frequencies indicate that various ethnic groups entered Tamil Nadu during different time periods. Genetic affinities and admixture estimates revealed that the ethnic groups possessing advanced knowledge of farming cluster in a branch (C), and could be the late arrived settlers as agriculture, was introduced to this region at about 5 to 3 thousand years ago. In situ ethnic groups appear to have arisen at various times as a result of the prevailing dominant socio-cultural forces. Hierarchical Hindu caste system created many ethnic groups in the history of its existence; some of them became isolated for considerable period of time. Over all, among Tamil ethnic groups, in spite of caste systems' rigidity, built in flexibility in the system in the form of hypergamy and hypogamy had allowed maternal gene flow between them.

Phytase, phosphatase activity and p-nutrition of soybean as influenced by inoculation of bacillus

The efficiency of different Bacillus isolates on rhizosphere soil enzyme activities and P-nutrition of soybean was carried out under microcosm conditions. Significant increase in enzyme activities viz., fluorescein diacetate activity, phosphatase and phytase activity and consequent effects on P-nutrition were observed with the inoculation of Bacillus isolates over uninoculated control. Among the isolates, BD-3-1B, KHBD-6, BDKH-3, Bacillus amyloliquefacians, and Bacillus cereus were found to be promising. The phytic acid-P as a percentage of total P content in soybean seeds decreased with the inoculation of Bacillus isolates as compared to un-inoculated control. A decrease in phytic-P in soybean seeds not only results in better digestibility and increased feed efficiency. Pearson correlation studies revealed a significant positive association between acid, alkaline phosphatases, phytase activity on available P content in soil and P content in seeds with the inoculation of Bacillus isolates, indicating role of these enzymes in P mobilization and acquisition by soybean.

Phytase, phosphatase activity and p-nutrition of soybean as influenced by inoculation of bacillus

The efficiency of different Bacillus isolates on rhizosphere soil enzyme activities and P-nutrition of soybean was carried out under microcosm conditions. Significant increase in enzyme activities viz., fluorescein diacetate activity, phosphatase and phytase activity and consequent effects on P-nutrition were observed with the inoculation of Bacillus isolates over uninoculated control. Among the isolates, BD-3-1B, KHBD-6, BDKH-3, Bacillus amyloliquefacians, and Bacillus cereus were found to be promising. The phytic acid-P as a percentage of total P content in soybean seeds decreased with the inoculation of Bacillus isolates as compared to un-inoculated control. A decrease in phytic-P in soybean seeds not only results in better digestibility and increased feed efficiency. Pearson correlation studies revealed a significant positive association between acid, alkaline phosphatases, phytase activity on available P content in soil and P content in seeds with the inoculation of Bacillus isolates, indicating role of these enzymes in P mobilization and acquisition by soybean.

Genotoxic and antigenotoxic effects of Hemidesmus indicus R. Br. root extract in cultured lymphocytes

AIM OF THE STUDY

The genotoxic and antigenotoxic potential of the ethanolic extract of Hemidesmus indicus roots were evaluated in cultured human lymphocytes using cisplatin as the positive mutagen.

MATERIALS AND METHODS

Cytogenetic damage and cytotoxicity were determined in cells exposed to different doses of the extract, ranging from 2 to 32 microg/ml of culture medium, either alone or together with cisplatin.

RESULTS

There was a significant reduction in cisplatin-induced frequencies of sister chromatid exchanges, chromosome aberrations and micronucleated binucleate cells at the lower concentrations of 4 and 8 microg/ml (P<0.05). However, the extract by itself reduced the proliferative rate index, mitotic index and cytokinesis-block proliferative index (P<0.05). Further, a significant increase in the percentage of chromosome aberrations was noticed at the higher concentrations.

CONCLUSION

Hemidesmus indicus root extract possesses significant genoprotective effect at the lower concentrations although it is cytotoxic and probably genotoxic at higher doses.

Efficacy of a low cost protocol in reducing noise levels in the neonatal intensive care unit

OBJECTIVE

To examine the effectiveness and cost of implementing a noise reduction protocol in a level III neonatal intensive care unit (NICU).

METHODS

A prospective longitudinal study was done in a level III NICU, wherein a noise reduction protocol that included behavioral and environmental modification was implemented. The noise levels were measured sequentially every hour for 15 days before and after this intervention. The statistical significance of the reduction in noise levels after implementation of the protocol was tested by paired sample student's t-test. Cost was calculated using the generalized cost effectiveness model of the World Health Organisation. The present study has 80% power with 95% confidence to measure 2 dB differences between groups for the maximum recommended of 50 dB.

RESULTS

The protocol in the present study reduced noise levels in all the rooms of the NICU to within 60 dB with high statistical significance (p< 0.001). The extent of noise reduction in the rooms of the NICU was as follows: ventilator room by 9.58 dB (95% confidence interval: 6.73-12.42, p < 0.001), stable room by 6.54 dB (95% confidence interval: 2.92-4.16, p < 0.001), isolation room by 2.26 dB (95% confidence interval: 1.21-3.30, p < 0.001), pre-term room by 2.37 dB(95% confidence interval: 1.22-3.51, p < 0.001) and extreme preterm room by 2.09 dB (95% confidence interval: 1.14-3.02, p < 0.001). The intervention was most cost-effective in the ventilator room, requiring Rs. 81.09 to reduce 1 dB and least effective in the extreme pre-term room requiring Rs. 371.61 to reduce 1 dB.

CONCLUSION

The high efficacy and affordability of noise reduction protocols justify the need for implementation of these measures as a standard of care in neonatal intensive care units.

Myocardial wall thickening from gated Magnetic Resonance images using Laplace's equation

The aim of our work is to present a robust 3D automated method for measuring regional myocardial thickening using cardiac magnetic resonance imaging (MRI) based on Laplace's equation. Multiple slices of the myocardium in short-axis orientation at end-diastolic and end-systolic phases were considered for this analysis. Automatically assigned 3D epicardial and endocardial boundaries were fitted to short-axis and long axis slices corrected for breathold related misregistration, and final boundaries were edited by a cardiologist if required. Myocardial thickness was quantified at the two cardiac phases by computing the distances between the myocardial boundaries over the entire volume using Laplace's equation. The distance between the surfaces was found by computing normalized gradients that form a vector field. The vector fields represent tangent vectors along field lines connecting both boundaries. 3D thickening measurements were transformed into polar map representation and 17-segment model (American Heart Association) regional thickening values were derived. The thickening results were then compared with standard 17-segment 6-point visual scoring of wall motion/wall thickening (0=normal; 5=greatest abnormality) performed by a consensus of two experienced imaging cardiologists. Preliminary results on eight subjects indicated a strong negative correlation (r=-0.8, p<0.0001) between the average thickening obtained using Laplace and the summed segmental visual scores. Additionally, quantitative ejection fraction measurements also correlated well with average thickening scores (r=0.72, p<0.0001). For segmental analysis, we obtained an overall correlation of -0.55 (p<0.0001) with higher agreement along the mid and apical regions (r=-0.6). In conclusion 3D Laplace transform can be used to quantify myocardial thickening in 3D.

Probing Au nanoparticle uptake by enzyme following the digestion of a starch-Au-nanoparticle composite

In this letter, we report on the digestion of starch, when present as a composite with Au nanoparticles (NPs), by alpha-amylase. It has been observed that the rate of digestion of free starch and that in the composite were identical. Also, the well-established iodine test could be carried out to investigate the kinetics in the presence of Au NPs. The investigations revealed that following the digestion of starch in the composite the NPs were released and subsequently attached to the enzyme only and not to the degraded products of starch. Also, the enzyme attached to NPs, following digestion, retained its catalytic activity. The particle sizes of the NPs were not affected in the process because no agglomeration was observed. Experimental observations indicated the possibility of oriented attachment of alpha-amylase to the NPs in comparison to amyloglucosidase, another digestive enzyme. Finally, we observed a change in the surface plasmon resonance (SPR) of the NPs following the digestion of starch in the composite, and thus we could demonstrate that the SPR of the NPs could be used as a direct probe for monitoring the digestion of the composite by the enzyme.

Anti-inflammatory activity of four solvent fractions of ethanol extract of Mentha spicata L. investigated on acute and chronic inflammation induced rats

Anti-inflammatory effects of four solvent fractions of ethanol extract of Mentha spicata were evaluated in acute and chronic inflammation induced in Wistar albino rats. Lipid peroxidation (LPO) and some antioxidants produced during chronic inflammation were quantitated. Hexane (320mg/kg of body weight in 25% DMSO), chloroform (320mg/kg body weight in 25% DMSO), ethyl acetate (160mg/kg body weight in 25% DMSO), aqueous (320mg/kg of body weight in ddH(2)O) fractions, two negative control groups (25% DMSO and ddH(2)O) and two anti-inflammatory drugs (Diclofenac: 25mg/kg of body weight; Indomethacin: 10mg/kg of body weight both in ddH(2)O) were administered by oral intubations to the eight groups of rats consisting six animals, each. In acute study, 1% carrageenan was injected subcutaneously in the sub-plantar region of the right hind paw after 1h of administration of test doses. The increased paw edema was measured at 0.5, 1, 2, 4, 8, 16 and 24h intervals. In the chronic study, the oral administration was carried out for seven consecutive days. On eighth day, four sterile cotton pellets (50mg each) were implanted subcutaneously in the dorsal region of the rats. On the sixteenth day, the rats were sacrificed and the cotton pellets with granulomatous tissue were dissected out and weighed (fresh and dry). Both in chronic and acute inflammation, ethyl acetate (EAF) and aqueous fraction (AF) were effective. EAF is comparable with the positive standards in chronic inflammation. The results indicate that EAF's anti-inflammatory activity is largely due to its ability to modulate in vivo antioxidants.

Adsorption of gold(III), platinum(IV) and palladium(II) onto glycine modified crosslinked chitosan resin

The adsorption of Au(III), Pt(IV) and Pd(II) onto glycine modified crosslinked chitosan resin (GMCCR) has been investigated. The parameters studied include the effects of pH, contact time, ionic strength and the initial metal ion concentrations by batch method. The optimal pH for the adsorption of Au(III), Pt(IV) and Pd(II) was found to range from 1.0 to 4.0 and the maximum uptake was obtained at pH 2.0 for Au(III), Pt(IV) and Pd(II). The results obtained from equilibrium adsorption studies are fitted in various adsorption models such as Langmuir and Freundlich and the model parameters have been evaluated. The maximum adsorption capacity of GMCCR for Au(III), Pt(IV) and Pd(II) was found to be 169.98, 122.47 and 120.39mg/g, respectively. The kinetic data was tested using pseudo-first-order and pseudo-second-order kinetic models and an intraparticle diffusion model. The correlation results suggested that the pseudo-second-order model was the best choice among all the kinetic models to describe the adsorption behavior of Au(III), Pt(IV) and Pd(II) onto GMCCR. Various concentrations of HCl, thiourea and thiourea-HCl solutions were used to desorb the adsorbed precious metal ions from GMCCR. It was found that 0.7M thiourea-2M HCl solution provided effectiveness of the desorption of Au(III), Pt(IV) and Pd(II) from GMCCR. The modification of glycine on crosslinked chitosan resin (CCR) was studied by Fourier transform infrared spectrometry (FTIR) and scanning electron microscopy (SEM).

Universal hearing screening

OBJECTIVE

To determine the weighted incidence of hearing impairment in a standardized population of at risk and not at risk neonates seeking care at a tertiary level hospital in India.

METHODS

A prospective study of a nonrandomized cohort of 1769 neonates (1490: Not at risk; 279: At risk) from a total of 8192 neonates (6509: Not at risk; 1683: At risk) who sought care at St John's medical College hospital from 1st September 2002 to 31st March 2006 were screened for hearing impairment using transient evoked otoacoustic emissions. Weighting was performed using the expected value of 10 % at risk and 90 % not at risk infants in a typical tertiary care level center in India derived from the National Neonatology and Perinatology database 2002-2003. Z test and 95 % confidence interval was used to determine the external validity of the results. P less than 0.05 was considered as statistically significant. The power of the study is 90 %.

RESULTS

The incidence of hearing impairment in infants screened was 10 per 1769 infants screened (1490: Not at risk; 279: At risk) which is 5.65 per 1000 screened. 279 at risk infants were screened and 3 were detected to have hearing impairment which is an incidence of approximately 10.75 per 1000 screened. Of the 1490 not at risk infants screened 7 had hearing impairment that is 4.70 per 1000 screened. If this was extrapolated to a standardized population consisting of 10 % at risk and 90 % not at risk then the incidence would be 5.60 per 1000 screened with a 95 % confidence interval of 4.13-7.06. This narrow 95 % confidence interval with a p equal to 0.001 indicates that this value may be close to the caseload in a typical tertiary care center.

CONCLUSION

In this study the incidence of hearing impairment is 3 per 279 in at risk infants screened and 7 per 1490 in not at risk infants screened. The weighted incidence in a standardized population of neonates seeking care at tertiary level center in India is 5.60 per 1000 as per this study. This high incidence calls for all pediatricians to consider incorporating a basic hearing screen for all the neonates using cost effective and appropriate technology. Initial screening may be performed using behavioral observation techniques and confirmation by otoacoustic emissions.

Membrane biofouling by extracellular polymeric substances or soluble microbial products from membrane bioreactor sludge

This study extracted the soluble microbial products and loosely bound and tightly bound extracellular polymeric substances (EPS) from suspended sludge from a membrane bioreactor, original and aerobically/anaerobically digested, and compared their fouling potentials on a microfiltration membrane. The resistance of cake layer accounts for 95-98% of the total filtration resistances when filtering the whole sludges, with anaerobically digested sludge presenting the highest resistance among the three tested sludges. The tightly bound EPS has the highest potential to foul the membrane; however, the loosely bound EPS contribute most of the filtration resistances of the whole sludges. The foulants corresponding to the irreversible fouling have chemical fingerprints similar to those from loosely bound EPS, which have a greater predilection to proteins and humic substances than to polysaccharides.

Sorption of cadmium and zinc from aqueous solutions by zeolite 4A, zeolite 13X and bentonite

The sorption and desorption of cadmium and zinc on zeolite 4A, zeolite 13X and bentonite has been studied using batch sorption studies. Parameters such as equilibrium time, effect of pH and sorbent dose were studied. The sorbents exhibited good sorption potential for cadmium and zinc with a peak value at pH 6.0 and 6.5, respectively. The sorption followed the Freundlich sorption model. More than 70% sorption occurred within 20 min and equilibrium was attained at around 90 min for the three sorbents. The metals sorption by zeolite 4A was higher than that by zeolite 13X and bentonite. The desorption studies were carried out using NaCl solution and the effect of NaCl concentration on desorption was also studied. Maximum desorption of 76% for cadmium and 80% for zinc occurred with 10% NaCl.