Healthcare professionals' perspectives of the provision of, and challenges for, eating, drinking and psychological support post stroke: findings from semistructured interviews across India

AIM

This qualitative study explores with health professionals the provision of, and challenges for, postdischarge stroke care, focussing on eating, drinking and psychological support across India.

DESIGN

Qualitative semistructured interviews.

SETTING

Seven geographically diverse hospitals taking part in a Global Health Research Programme on Improving Stroke Care in India.

PARTICIPANTS

A purposive sample of healthcare professionals with current experience of working with patients who had a stroke.

RESULTS

Interviews with 66 healthcare professionals (23 nurses (14 staff nurses; 7 senior nurse officers; 1 intensive care unit nurse; 1 palliative care nurse)); 16 doctors (10 neurologists; 6 physicians); 10 physiotherapists; 5 speech and language therapists; 4 occupational therapists; 4 dieticians; 2 psychiatrists; and 2 social workers resulted in three main themes: integrated inpatient discharge care planning processes; postdischarge patient and caregiver role and challenges; patient and caregiver engagement post discharge.

CONCLUSIONS

Discharge planning was integrated and customised, although resources were limited in some sites. Task shifting compensated for a lack of specialists but was limited by staff education and training. Caregivers faced challenges in accessing and providing postdischarge care. Postdischarge care was mainly hospital based, supported by teleservices, especially for rural populations. Further research is needed to understand postdischarge care provision and the needs of stroke survivors and their caregivers.

Community Perspective of Male Involvement in Maternal Health Care in Uttarakhand, India: A Qualitative Study

Background

Due to the significant role of male in decision making in India, they may decide if, when and where a woman may access antenatal, delivery and postnatal care; and whether or not to provide financial resources to travel to these services. Men's involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating the reduction of maternal mortality. This study explores key components and challenges to male involvement in maternal health care (MHC).

Methods

Focus group discussions (FGDs) were conducted with a purposive sample of the community key stakeholders from the field practice area of All India Institute of Medical Sciences, (AIIMS) Rishikesh from October 2020 to January 2021. Manual thematic analysis with a semantic approach was used for the data analysis. Themes were prioritized using Participatory rural appraisal (PRA) technique.

Results

Twenty-three participants represented the heterogeneous group of key stakeholders. Stakeholders identified the need for improved awareness regarding MHC services among men. Husband involvement is affected by availability (work stations at different places), literacy, gender-based work domain and social cultures, finances and health facility environment.Four major themes were identified: Male involvement in antenatal, intranatal; postnatal care; and barriers to male involvement in MHC. Sub-themes under male involvement in antenatal care; intranatal care; and postnatal care were further prioritized via PRA as 'very important'; 'important' and 'not so important' and scores were given as 3, 2 and 1 respectively.

Conclusions

Male involvement is a key strategy to improve pregnancy outcome; however, different challenges exist in their involvement in the maternal health care. Current study helped to contextualize the perception regarding importance of male involvement in MHC; and the situation of study area in order to understand social and cultural factors that shape the behavior and practices of men in relation to their involvement.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Alien genome mobilization and fixation utilizing an apomixis mediated genome addition (AMGA) strategy in Pennisetum to improve domestication traits of P. squamulatum

An approach to release 'frozen' variability in apomictic species using sexuality of another species, eventually its utilization in crop improvement and de-novo domestication of crop wild relatives is presented. Pennisetum squamulatum, a secondary gene pool species of pearl millet (P. glaucum), harbours many desirable traits. However, it was neither utilized to improve pearl millet fodder traits nor improvement of its own domestication traits was attempted, due to the complexities of genomes and apomictic reproduction. To overcome this, we followed an Apomixis Mediated Genome Addition (AMGA) strategy and utilized the contrasting reproductive capacities (sexuality and apomixis) of both the species to access the otherwise un-available variability embedded in P. squamulatum. Segregating population of interspecific hybrids exhibited significant variability and heterosis for desired morphological, agronomical, and nutritional traits. Elite apomictic and perennial hybrids were evaluated in breeding trials, and eventually a novel grass cultivar was released for commercial cultivation in India. The performance of newly developed cultivar was superior to other adapted perennial grasses of arid and semi-arid rangelands. Through AMGA, the sexuality of one species was successfully utilized to 'release' the 'frozen' variability embedded in another species. Subsequently, the hybrids representing desirable trait combinations were again 'fixed' utilizing the apomixis alleles from the male parent in a back-and-forth apomixis-sexual-apomixis selection cycle. This study also demonstrated the potential of AMGA to improve crop relatives through genomes introgression as well as de novo domestication of new crops from wild species.

Polycystic ovary syndrome among Indian adolescent girls - A systematic review and metanalysis

Background

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in the progenitive age group and the leading cause of infertility. The worldwide prevalence of PCOS in women varies between 2.2% to 26%. Due to limited literature on burden of PCOS among adolescent girls, its significance is still unfathomed as a research is few and far between in the present time. We conducted Systematic review and metanalysis to estimate the pooled prevalence of PCOS among Indian adolescent girls (14-19 years).

Methods

With the help of a search strategy, two authors searched Scopus, Embase and Pubmed independently. We screened studies considering eligibility criteria and extracted data. Selected studies were assessed for quality and risk biases using the NIH tool. R software was used for analysis.

Results

Twelve studies were included in the meta-analysis. The total number of participants in the study was 4473. All studies scored average and above as per the NIH quality assessment tool. The prevalence of PCOS among adolescents based on the Rotterdam criteria was 17.74 per 100 (CI = 11.77-23.71) with I² =97 %. Hospital-based studies had a comparatively higher prevalence of PCOS as compared to community-based.

Conclusion

Pooled prevalence of PCOS among Indian adolescents’ girls was high, approximately one in five.

Effectiveness of Integrated Google Classroom, Reciprocal Peer Teaching and Flipped Classroom on Learning Outcomes of Research Methodology: A Natural Experiment

Background

To maintain physical distancing for reducing the spread of COVID-19, online learning appears to be a viable option to carry on teaching and learning.

Aim

The aim of study was to assess the effectiveness of integrated flipped classroom and reciprocal peer teaching (RPT) using Google Classroom as a learning management system (LMS) for teaching and learning, a module of Research Methodology. We also aimed to assess learner’s satisfaction.

Methods

An educational interventional study was conducted with 17 students enrolled in the Master of Public Health course, All India Institute of Medical Sciences, Rishikesh, for one month. As per protocol development and integration were conducted and validated pre- and post-tests were held for assessment of knowledge and skill component. Class normalized learning gain was used as objective measure for improvement in knowledge and skill. Students' feedback was collected using a structured questionnaire at the end of module.

Results

Mean test scores of knowledge and skill, improved significantly from 26.4 (11.95) to 33.64 (6.63) and 17.88 (5.7) to 62.76 (18.18) respectively. Class average normalized gain for knowledge and skill was 30.28% and 55.67, respectively. Students agreed that online learning imparted good understanding, at comfortable pace, opportunity for interaction. Students felt poor network affected their learning.

Conclusion

The study concluded that flipped classroom and RPT integrated with Google Classroom is an effective intervention.

Complementary gene interaction and xenia effect controls the seed coat colour in interspecific cross between Trifolium alexandrinum and T. apertum

Trifolium alexandrinum (Egyptian clover) is a widely cultivated winter annual fodder. Present work deals with inheritance of the seed coat colour in segregating progenies of the interspecific cross between T. alexandrinum and T. apertum. Although, both the parent species possessed yellow seed coat, the F₁ seeds were black coloured in the reciprocal cross (T. apertum × T. alexandrinum). Seeds borne on individual F₂ plants and the advancing generations segregated in yellow and black seed coat colour, which confirmed xenia effect. F₂ seeds collected from individual F₁ plants exhibited nine black and seven yellow segregation ratio. The segregation of the seed coat colour recorded from F₃ to F₅ generations revealed that yellow seed coat was true breeding (i.e. non-segregating) in this interspecific cross (including the reciprocal crosses). However, the black seeded progenies were either true breeding or segregated in nine black: seven yellow ratio or three black: one yellow ratio suggesting a complementary gene interaction or duplicate recessive epistasis. It indicated that the seed coat colour is controlled by complementary gene interaction along with xenia effect in interspecific crosses between T. alexandrinum and T. apertum. Occurrence of the complementary genes across the species could suggest T. apertum to be the progenitor of T. alexandrinum. Inheritance of seed coat colour in reference to its importance in Egyptian clover breeding is also discussed.

Transcriptomic data of pre-meiotic stage of floret development in apomictic and sexual types of guinea grass (Panicum maximum Jacq.)

Guinea grass (Panicum maximum Jacq), an important fodder crop of humid and sub-humid tropical regions, reproduces through apomixis, a method of clonal propagation through seeds. Lack of knowledge of the genetic and molecular control of this phenomena has hindered the genetic improvement of this crop. The dataset provided here represents the first RNA-Seq based assembly and analysis of florets at pre-meiotic stage from the apomictic and sexual genotypes of guinea grass. The raw sequence files in FASTQ format were deposited in the NCBI SRA database with accession number SRP115883. A total of 24.8 Gb raw sequence data, corresponding to 17,96,65,827 raw reads was obtained by paired end sequencing. We used Trinity for de-novo assembly and identified 57,647 transcripts in sexual and 49,093 transcripts in apomictic type. This transcriptome data will be useful for identification and comparative analysis of genes regulating the mode of reproduction in grasses.

Late onset of rhegmatogenous retinal detachments after successful posterior segment intraocular foreign body removal

BACKGROUND/AIM

A lack of data exists concerning the development of late postoperative, non-proliferative vitreoretinopathy (PVR), rhegmatogenous retinal detachments (RRDs) after successful posterior segment intraocular foreign body (PSIOFB) removal. The authors present a series of PSIOFB cases over several years with posterior hyaloid separation resulting in RRD in two patients, 4 and 8 months after initial injury and vitrectomy. This report aims to increase awareness concerning the possibility of late RRDs complicating PSIOFB injuries and to emphasise careful long term observation.

METHODS

Medical records of consecutive cases referred for presumed PSIOFB injury during a 4 year period were retrospectively reviewed. All eyes referred for presumed PSIOFB injuries were included.

RESULTS

11 patients were included in the series. Two patients had eyes so badly injured by large PSIOFBs that primary globe closure was followed within days by enucleation. Nine patients underwent pars plana vitrectomy for PSIOFB removal. Two patients experienced late RRDs that were managed with excellent long term visual outcomes.

CONCLUSIONS

Late RRD may occur following successful removal of PSIOFBs, even several months after initial management. These RRDs may be successfully managed with a variety of methods, depending upon the extent and location of the detachment and causative break as well as surgeon comfort and preference.

Interspecific hybridization of Trifolium alexandrinum with T. constantinopolitanum using embryo rescue

The embryo rescue technique was successfully used to raise hybrids between Trifolium alexandrinum and T. constantinopolitanum. As a result of its narrow genetic base, genetic improvement in Egyptian clover (syn. Berseem; T. alexandrinum), an important fodder crop in tropical and subtropical countries, is hampered, thereby making it imperative to introduce alien genes from related species. In a conventional interspecific hybridization program, hybrids could not be raised due to post-fertilization barriers. Of the several combinations tried, pollination 2 days after emasculation was found to be the best. Globular embryos were observed 5-7 days after pollination (DAP), followed by heart-shaped embryos 10-12 DAP. Embryos excised at the heart-shaped stage responded well to EC3 culture medium. Of 612 crosses, 33 healthy embryos could be excised and cultured on EC3 medium. The plumule emerged 8-12 days following inoculation. The embryo-rescued plants were hardened, inoculated with Rhizobium and transferred to the field. The hybrids showed intermediate morphological features with reduced pollen fertility (55-65%) and a chromosomal complement of 2n = 16. Biochemical characterization using isozymes confirmed hybridity.

Peptide mapping and disulfide bond analysis of myeloid progenitor inhibitory chemokine and keratinocyte growth factor by matrix-assisted laser desorption ionization mass spectrometry

Peptide mapping and matrix-assisted laser desorption ionization mass spectrometry (MALDI-MS) were conducted to characterize the human genome-based recombinant proteins. Accurate mass values for the deleted forms of the myeloid progenitor inhibitory factor chemokine (MPIF-1d23), and the keratinocyte growth factor (KGF-2d33) were measured as 8848.55 +/- 0.25 and 16,175.87 +/- 0.89 Da, respectively. The mass accuracy of delayed ion extraction MALDI-MS measurements was within 20 ppm of the cDNA predicted value. Reduction and alkylation of the chemokine showed the presence of six cysteine residues and three disulfide bonds. Additional confirmation of disulfide bonding among the cysteine residues of the chemokine was demonstrated by identifying the RP-HPLC separated tryptic and endoprotease Glu-C peptides. Three methionine residues of the chemokine were identified by MALDI-MS of its cyanogen bromide (CNBr) cleavage products. The KGF-2d33 growth factor, however, lacked the disulfide bonding between the two-cysteine residues and contained two free sulfhydryl groups. Direct analysis of the growth factor CNBr digest showed 7542.99, 4993.4, and 3107.7 Da peptides, which identified the methionine residues. Peptide mapping mass spectrometry indicated that host-specific posttranslational modifications had not influenced the gene expression work.

Studies on the effect of fenbendazole and mebendazole on some enzymes of swine kidney worm Stephanurus dentatus

The effect of fenbendazole and mebendazole on the activity of some enzymes of the homogenates of swine kidney worm Stephanurus dentatus was investigated. Fenbendazole at 10(-5) M inhibited malate oxidation by 49% and 51% and oxaloacetate reduction by 33% and 40% whereas, mebendazole at 10(-5) M diminished malate oxidation by 25% and 35% and oxaloacetate reduction by 12% and 14% in male and female S. dentatus, respectively. Lactate dehydrogenase activity was inhibited by 45% and 50% in male and female worm respectively by 10(-5) M fenbendazole. Aldolase activity in both male and female S. dentatus was inhibited by 10(-5) M fenbendazole and mebendazole. Fenbendazole at 10(-5) M caused moderate inhibition of acid and alkaline phosphomonoesterases but mebendazole did not show a significant effect on these enzymes. Cholinesterase activity was not affected significantly with either compound. The possible mode of action of the two compounds is compared.

Planting stress, water status and non-structural carbohydrate concentrations in Corsican pine seedlings

Two-year-old Corsican pine (Pinus nigra ssp. laricio var. Corsicana) seedlings were either well watered or subjected to a moderate drought for one month before being lifted from the nursery bed on October 9 and transplanted. Well-watered, non-transplanted seedlings served as controls. Needle predawn water potential (Psi(wp)), non-structural carbohydrate concentrations and plant development (survival, bud break, shoot elongation) were assessed before and during the first growing season after transplanting. On April 16, just before bud break, Psi(wp) was lower for the well-watered + transplanted and drought-conditioned + transplanted seedlings (Psi(wp) = -1.45 and -1.83 MPa, respectively) than for the controls (Psi(wp) = -0.56). There was a close relationship between the Psi(wp) measured on April 16 and bud break, shoot elongation and plant survival during the following growing period. Above a Psi(wp) of -1.1 MPa, all plants developed normally. Between -1.1 MPa and -1.6 MPa, bud break, and thus shoot elongation, did not occur in all plants. Between -1.6 MPa and -2.1 MPa, the plants were characterized by the absence of shoot growth, but mortality was zero. Below -2.1 MPa, there was a large increase in plant mortality. On April 16, starch concentrations were markedly lower in the roots of transplanted seedlings than in the controls. There was a positive correlation between Psi(wp) and root starch concentration. The Psi(wp) (-2.3 MPa) at which complete starch depletion was observed in the roots corresponded to the Psi(wp) below which plants did not survive. These results suggest that mechanisms specifically linked to altered water status and metabolic processes associated with altered carbohydrate status are involved in transplanting stress; however, it was not possible to disentangle the two effects. Drought conditioning did not lead to a marked increase in soluble carbohydrate concentrations, as reported for other species, and did not increase plant tolerance to transplanting stress.