Maternal Nutrition, Body Composition and Gestational Weight Gain on Low Birth Weight and Small for Gestational Age-A Cohort Study in an Indian Urban Slum

Maternal nutritional status and care during pregnancy are essential for adequate birth weight. In this prospective cohort study (N = 1061) in an urban slum, we investigated the association of maternal anthropometry, body composition, gestational weight gain and dietary intakes with low birthweight (LBW, <2.5 kg). About one-third of the women were short (<150 cm), 35% were underweight (<45 kg), 23% suffered from chronic energy deficiency (CED, BMI < 18.5 kg/m2) and another 30% were overweight/obese. The mean age and BMI were 23 years and 21.7 kg/m2, respectively, and haemoglobin was 10.73 g/dL. The mean birthweight (N = 605) was 2.81 ± 0.5 kg, and the average gestational age was 38 ± 2 weeks. About 15% of infants had LBW, and 48% were small for gestational age (SGA). Maternal body composition was assessed by skinfold thickness (SFT) in all trimesters. In the first trimester (N = 762), we found that mean fat-free mass (FFM), fat mass (FM) and body fat percentage (% BF) were 38.86 kg, 11.43 kg and 21.55%, respectively. Low birthweight was significantly associated with preterm deliveries (p < 0.001) and less fat free mass (p = 0.02) in the third trimester. Among other factors were age (p = 0.017), maternal anthropometry (height: p = 0.031; weight: p = 0.059) and fewer antenatal check-ups (p = 0.037). Small size (SGA) was consistently associated with maternal bodyweight at all trimesters (term I, p = 0.013, term II, p = 0.003 and term III, p < 0.001), fat mass in the third trimester (p < 0.001) and maternal height (p = 0.003).

Knowledge, attitude, and practice of autotransplantation among the practicing pediatric dentists in Chennai - A questionnaire study

Background

Autotransplantation is a minor surgical procedure which involves transplantation of teeth within the same oral cavity. For children, autotransplantation may be considered as a provisional measure with good survival probability. It offers a viable biological approach for replacing the missing teeth and also for orthodontic treatments in children.

Aim

The aim of this study is to assess the knowledge, attitude, and practice of autotransplantation among pediatric dentists in Chennai, India.

Methods

An 18-item questionnaire was developed, piloted, and distributed among 100 practicing pediatric dentists in Chennai, India. Descriptive statistical analysis was done using Chi-square test.

Results

Seventy valid responses from the practicing pediatric dentists were obtained. Among them, 39.7% had an experience of 5-10 years, 47.1% practiced less than 5 years, and 13.2% had experience more than 10 years. Analysis of the responses showed that 76.5% of the pediatric dentists were aware of the procedure but have not observed autotransplantation being done. Among the respondents, 95.6% have not performed this technique and 40.6% of them were not sure of the prognosis. Atraumatic extraction of donor tooth was considered to be a major limitation in autotransplantation by 41.8% of the pediatric dentists. From the responses received, 95.6% were interested in gaining more information with majority opting for more hands on workshops on the technique of autotransplantation.

Conclusion

Though most of the respondents were aware of autotransplantation procedure, they have not practiced it due to inadequate training.

Antibacterial efficacy of Lawsonia inermis (Henna) against the predominant endodontic pathogen (Enterococcus faecalis)-An in vitro antimicrobial assay

Introduction and Aim: The prospect of a successful root canal therapy relies on three main factors which includes proper instrumentation, disinfection and obturation of root canal. The goal of the present study is to analyse the anti-microbial efficacy of henna (Lawsonia inermis) against the major endodontic pathogen, Enterococcus faecalis.   Materials and Methods: In this study, the antibacterial efficacy of Lawsonia inermis is investigated against Enterococcs feacalis using the method of agar disc diffusion. Extracts of L. inermis were prepared by using methanol as an extraction solvent, whereas DMSO (Dimethyl sulfoxide) and water were used as dissolution solvents. The diluted henna sample was used as the test sample, while positive control used was chlorhexidine gluconate solution and the negative control used was saline. The bacteria were cultured, and the samples were placed to measure the zone of inhibition.   Results: Extracts of L. inermis displayed noteworthy antimicrobial activity against E. fecalis. The zone of inhibition of henna against E. fecalis was found to be 11mm whereas the positive control had 14mm.   Conclusion: In conclusion, the henna extracts had shown acceptable antimicrobial efficacy and thus this study provides the scientific reason for the use of L. inermis in dentistry.

Effectiveness of biofeedback relaxation and audio-visual distraction on dental anxiety among 7- to 12-year-old children while administering local anaesthesia: A randomized clinical trial

BACKGROUND

Local anaesthesia (LA) administration provokes dental anxiety in children. BrightHearts is a biofeedback relaxation application designed to reduce anxiety in children during painful procedural interventions.

AIM

To compare the effectiveness of biofeedback relaxation (BR) and audio-visual (AV) distraction on dental anxiety among 7- to 12-year-old children while administering LA.

DESIGN

A total of 70 children requiring dental treatment under LA for three visits were recruited for this single-blinded randomized control trial. They were randomly divided into two equal groups. Group A received BR and Group B received AV distraction during LA delivery in the first two visits, and both groups did not receive any intervention during LA in third visit. Outcomes were measured using heart rate and a cartoon-based anxiety measuring scale (Chotta Bheem-Chutki (CBC) scale).

RESULTS

AV group had statistically significant higher mean heart rates than BR group (P < .001) during needle penetration and post-intervention, respectively. CBC scale showed no statistical differences between the groups.

CONCLUSION

Both the interventions are effective in reducing dental anxiety during LA administration. Based on objective measures, BR is found to be better than AV distraction. Subjective scores, however, show no differences between the two.

Corrigendum to "Cholesterol-Lowering Probiotics as Potential Biotherapeutics for Metabolic Diseases"

[This corrects the article DOI: 10.1155/2012/902917.].

Molecular Mechanisms and Biochemical Pathways for Micronutrient Acquisition and Storage in Legumes to Support Biofortification for Nutritional Security

The world faces a grave situation of nutrient deficiency as a consequence of increased uptake of calorie-rich food that threaten nutritional security. More than half the world's population is affected by different forms of malnutrition. Unhealthy diets associated with poor nutrition carry a significant risk of developing non-communicable diseases, leading to a high mortality rate. Although considerable efforts have been made in agriculture to increase nutrient content in cereals, the successes are insufficient. The number of people affected by different forms of malnutrition has not decreased much in the recent past. While legumes are an integral part of the food system and widely grown in sub-Saharan Africa and South Asia, only limited efforts have been made to increase their nutrient content in these regions. Genetic variation for a majority of nutritional traits that ensure nutritional security in adverse conditions exists in the germplasm pool of legume crops. This diversity can be utilized by selective breeding for increased nutrients in seeds. The targeted identification of precise factors related to nutritional traits and their utilization in a breeding program can help mitigate malnutrition. The principal objective of this review is to present the molecular mechanisms of nutrient acquisition, transport and metabolism to support a biofortification strategy in legume crops to contribute to addressing malnutrition.

Nonclinical safety evaluation of oral recombinant anti-human papilloma virus vaccine (RHPV 16 & 18): Regulatory toxicology studies in mice, rats and rabbits - An innovative approach

AIM

The human papilloma virus (HPV) type 16 and 18 causes nearly 70% of uterine cervical cancers. Oral administration of live Salmonella typhi Ty21a, expressing major capsid proteins (L1) of HPV 16 and 18 is a potential choice for immunization in adolescent girls under low resource settings. Present study aimed to assess the nonclinical safety of recombinant S. typhi expressing HPV 16 and 18 (rStHPV) proteins.

METHODOLOGY

The acute toxicity of rStHPV was tested by intranasal single dose administration, of 10 and 50 folds higher than clinical prophylactic dose, in mice and rat followed by monitoring their survival for 14 days. Sub-chronic toxicity was evaluated in rats and rabbits with prophylactic and 5 times (average) to clinical prophylactic dosages on scheduled days (1st, 3rd & 5th day) through oral and intranasal routes. The immune/allergic response of rStHPV was assessed in mice through intranasal and intra-peritoneal routes. Experimental animals were daily monitored for live phase, and clinical chemistry, haematology, immunotoxicology, immunogenic response and histopathological examination of vital organs on 15th, 29th and 93rd days.

RESULTS

No abnormal changes were noticed in live phase activity, clinical chemistry and haematology profile. The gross necropsy, organ weights and histopathology were found to be normal. No immunotoxicity was recorded as evaluated by tier I tests. Allergic immune response, as evaluated with IgE levels was also negative irrespective of test routes. On the other hand, a significant (P < 0.01) increase of anti-HPV IgG levels was noted in mice exposed through intranasal route. Though the pre-terminal mortality was noted in mice (6-15%), rats (10%) and rabbits (15%), the autopsy revealed no signs of toxicity related to rStHPV, as the changes neither significant nor dose dependent; and even noted in vehicle control also.

CONCLUSION

The study results suggested 'no observable adverse effects' of rStHPV even at higher dosages (5, 10 & 50 folds) than intended clinical dose. A significant increase of anti-HPV specific IgG suggests the immunogenicity of vaccine. The innovative approach of current study is nonclinical toxicology evaluation of vaccine through intra-nasal route, an alternate route apart from stipulated regulatory guidelines.

Topical anesthesia for stainless steel crown tooth preparation in primary molars: a pilot study

Background

Placement of full-coverage restorations such as stainless steel crowns (SSCs) for pulpectomy treated primary molars is essential for successful outcomes. The tooth preparation process for SSCs can cause discomfort to gingival tissues since the crown should be seated 1 mm subgingivally. The purpose of this prospective trial was to compare the effectiveness of subgingival and transmucosal application of topical anesthetics on dental pain during SSC tooth preparation among 6- to 8-year-old children.

Methods

A consecutive sample of 27 children, aged 6-8 years, who required an SSC after pulp therapy in primary molars were randomly divided into three groups. Group A received infiltration anesthesia before tooth preparation for SSC placement, whereas in Group B and C, only topical anesthesia was applied subgingivally and transmucosally. Wong-Bakers Faces pain rating scale (WBFPS) scores were recorded after tooth preparation. Faces, Legs, Activity, Cry and Consolability (FLACC) scores were evaluated by two blinded and calibrated investigators through video recordings of the patient during tooth preparation. Data were tabulated, and inter-group comparisons were performed using the Kruskal-Wallis and analysis of variance tests.

Results

Out of the 27 participants, 48% were boys and 52% were girls, with an overall mean age of 6.83 years. Group A showed the least pain scores according to both the scales, followed by Group B and Group C. The pain intensity was statistically significant on both the pain scales with P = 0.003 for FLACC and P < 0.001 for WBFPS.

Conclusion

Subgingival application of topical anesthesia reduced pain to a certain extent but not as effectively as infiltration anesthesia during SSC tooth preparation in primary molars. Transmucosal application of topical anesthesia did not reduce discomfort when compared to the other two interventions.

Undernutrition in children & critical windows of opportunity in Indian context

It is intriguing to note that majority of the wasting among the under 5 yr in India is present at birth. The National Family Health Survey 4 (NFHS-4) data analysis shows 31.9 per cent wasting at birth, which is decreasing to 17.7 per cent in the under five children; clearly suggesting that any reduction in wasting should come from improvement in foetal growth. In addition, children with both severe wasting and severe stunting, in whom the risk of mortality increases many folds, are <1 per cent in almost all the States; and these are the children in whom special care is required under the community-based management of severe acute malnutrition. This article presents an overview of nutrition status in children, their antecedents, and the critical phases; especially, nutrition status before pregnancy that plays a crucial role in all the nutrition status indicators of children. More attention on the critical phases is crucial to maximize the benefits from national programmes.

National Institute of Nutrition: 100 years of empowering the nation through nutrition

The National Institute of Nutrition (NIN) has reached a remarkable milestone of completing 100 years of exemplary service to the nation. The long journey that started in a humble one-room laboratory at Coonoor (now in Tamil Nadu) in 1918 to a colossus of the nutrition research in the country today is dotted with several interesting vignettes. The NIN has always been at the forefront of need-based, pragmatic research. Its large-scale community-based interventions have been of great practical value in the nation's fight against malnutrition. The evolution of nutrition as a modern science almost coincides with the growth of the Institute. Being the oldest in the fraternity of institutes under the Indian Council of Medical Research (ICMR), the NIN has grown from strength to strength due to the sheer relevance of its contributions in furthering nutrition science and promoting public health in the country. This article provides a historical overview of the evolution and contributions of ICMR-NIN in the areas of nutrition, food safety, public health and policy.

Effect of probiotic supplementation on total lactobacilli, bifidobacteria and short chain fatty acids in 2-5-year-old children

​Background: Consumption of Lactobacillus paracasei Lpc-37 or Bifidobacterium lactis HN019 by 2-5-year-old children was found to reduce risk for diarrhoea and fever during the rainy season. Objective: Can changes in faecal short chain fatty acids (SCFAs) or branched chain fatty acids (BCFAs) explain the observed positive influence of probiotics and their role on nutritional status and diarrhoea risk? Design: Faecal samples were analysed for SCFAs and BCFAs and correlated to Bifidobacterium and Lactobacillus levels; both at the start and after nine months' consumption of either of the two probiotic strains, or placebo. Results: No differences in SCFAs, BCFAs, Lactobacillus or Bifidobacterium levels were found between boys and girls. Severely underweight children were observed to have the highest Lactobacillus levels. Probiotic intervention was found to be associated with higher levels of selected SCFAs and BCFAs in subjects who had experienced diarrhoea. Treatment with either of the probiotics led to changes in SCFAs and BCFAs. SCFAs, acetate, propionate and butyrate, were found to correlate with each other. Likewise, BCFAs isobutyrate, 2-methylbutyrate and isovalerate correlated with each other. After the intervention, L. paracasei Lpc-37 correlated positively with total Bifidobacterium counts and isovalerate levels. B. lactis HN019 counts were found to correlate positively with total bacterial counts and negatively with propionate levels. Conclusions: ​Nutritional status was associated with higher levels of faecal lactobacilli; the meaning of this requires further investigation. The intervention with the two probiotics was observed to influence the levels of faecal SCFAs and BCFAs and there is a differential response in those who developed diarrhoea and those who did not. It is, however, not clear to what extent this is a mechanism that explains the earlier observed effect the strains had on diarrhoea risk.

Comparison of compressive strength among three different intracanal post materials in primary anterior teeth: An in vitro study

Objective:

The objective of our study was to compare the fracture resistance and the mode of failure among three different post materials in primary anterior teeth.

Materials and Methods:

A total of sixty extracted primary anterior teeth were selected for the study. The samples were divided into three groups of twenty teeth each: Group I (Ribbond), Group II (Omega loop), and Group III (Glass fiber post). Pulp therapy was followed by intracanal post and crown buildup. The samples were mounted in self-cure acrylic and subjected to compressive strength test using universal testing machine (Instron). The maximum force at which the tooth fractured was recorded.

Results:

The values were subjected to one-way analysis of variance. The mean compressive strength values of Ribbond, omega loop, and glass fiber post were found to be 83.25 N, 61.60 N, and 75.55 N, respectively. The P value was found to be 0.220.

Conclusion:

Group I (Ribbond) showed the highest fracture resistance values followed by Group III (Glass fiber post) and Group II (Omega loop). Although there is difference in mean values, they were nonsignificant.

Rehabilitation of complicated crown-root fracture by invisible approach

Dental trauma is one of the most common and significant problems met in all dental offices almost every day. In particular, injury to the anterior teeth is more vulnerable as it may affect the psychosocial behavior, severe emotional complications can occur leading to disturbances in their mental attitude. Cosmetic (lingual) orthodontics is the recent development in the field of dentistry in the last few decades. Patients are more concerned about their appearance during the treatment and are affected by psychosocial issues because of labially placed brackets, thus leading to the evolution of lingual orthodontic appliances. In this article, we are sharing our clinical experience treating a complicated crown-root fracture using the lingual orthodontic technique.

Oral Lesions in HIV Infection in Developing Countries: an Overview

HIV infection is a major global health problem affecting developing and developed countries alike. Oral lesions that are associated with this disease are important, since they affect the quality of life of the patient and are useful markers of disease progression and immunosuppression. Oral lesions in HIV infection have been well-documented in developed countries, but there are fewer reports on oral lesions from developing countries. Oral candidiasis is the most common opportunistic infection seen in all continents. Kaposi’s sarcoma has been reported only from Africa and Latin America, while histoplasmosis and penicilliosis were reported in patients with advanced disease from Thailand. HIV-associated salivary gland disease has a high prevalence in Africa and Latin America, especially in the pediatric group. It is clear that there are considerable regional variations in the oral manifestations of HIV infection, depending both on the populations studied and on the clinical expertise available, among other factors. Well-designed and -documented studies are necessary for the correct assessment of the nature and magnitude of the problem in developing countries, if oral health measures are to be effectively formulated for the HIV-infected.

Effect of inclusion of hepatitis B vaccine in childhood immunization program in India: a retrospective cohort study

OBJECTIVE

To assess the effectiveness of hepatitis B immunization program in a field setting in India.

DESIGN

Serological survey of retrospective cohorts of children, vaccinated or not vaccinated with hepatitis B vaccine.

SETTING

Rural field areas of five districts in Andhra Pradesh state, where childhood hepatitis B immunization began in 2003.

PARTICIPANTS

Children aged 5-11 years who had received HB immunization (n=2674; 1357 boys) or not received such immunization (n=2350; 1236 boys).

MAIN OUTCOME MEASURES

Serum HBsAg, anti-HBc and anti-HBs (quantitative) using automated enzyme-immunoassays in the year 2010.

RESULTS

Anti-HBs positivity was higher among immunized than in unimmunized children (53% vs.18%; P<0.001), and anti-HBc positivity was lower (1.1% vs 10.8%: P<0.01). HBsAg positivity was low in both the groups (0.15% and 0.17%; P=0.855). Anti-HBs positivity rate declined with increasing age.

CONCLUSIONS

Administration of hepatitis B vaccine as part of Universal immunization program led to anti-HBs in a large proportion of children and a reduction in anti-HBc positivity, a marker of hepatitis B virus infection. These data provide evidence supporting efficacy of hepatitis B immunization program in an Indian field setting, justifying the decision to include it in the universal immunization program.

Lactobacillus rhamnosus GG supplementation during critical windows of gestation influences immune phenotype in Swiss albino mice offspring

Probiotic supplementation during critical windows of gestation might have a significant influence on the infant’s immune phenotype. Swiss albino mice (F0 generation) aged 31 days were supplemented orally with probiotic Lactobacillus rhamnosus GG (LGG); and the supplementation was continued throughout mating, gestation and lactation. The pups (F1 generation) born to them were separated post weaning and received either the same probiotic supplementation as their mothers or were denied supplementation postnatally. Neutrophil phagocytic ability, splenocyte proliferation, immunoglobulins and cytokines were determined in both F0 and F1 pups. In addition, antibody response against hepatitis-B surface antigen (HBsAg) was determined in F1 pups. Probiotic supplementation had no effect on the neutrophil phagocytic ability and splenocyte proliferation index. The serum immunoglobulin G (IgG) and secretory IgA (s-IgA) among the probiotic supplemented group of F0 generation were significantly (P<0.05) higher compared to the controls. Similarly, the mean concentration of interleukin (IL)-10, IL-17 and interferon gamma (IFN-γ) among F0 probiotic group were significantly higher (P<0.05) compared to the control. Prenatal and postnatal probiotic supplementation in F1 pups led to similar results as F0 dams. Prenatal probiotic supplementation in F1 pups led to significantly (P<0.05) higher serum IgG (55.15±1.35 ng/ml) and intestinal s-IgA (77.9 ± 2.86 ng/mg protein) concentration when compared to the control. Similarly, IFN-γ concentration increased (P<0.05) with prenatal probiotic supplementation compared to the control. However, IL-10 and IL-17 concentrations of prenatal probiotic supplemented F1 pups were comparable to the control. As for the antibody response to HBsAg, prenatal probiotic supplementation led to enhanced HBsAg antibody response (471.4±3.97 U/ml) compared to the control. LGG affected the immune regulation and immune responses favourably in mothers and offspring. In addition, some of the beneficial effects of prenatal LGG supplementation extended into postnatal life of the offspring, thus suggesting possible immunoprogramming effect of LGG.

Health & nutritional status of HIV infected children in Hyderabad, India

BACKGROUND & OBJECTIVES

Information on nutritional status of HIV infected children from India is lacking and is required before taking up nutritional supplementation trials. Thus, the aim of the present study was to assess the growth and morbidity status of HIV infected children over a period of one year in a city in southern India.

METHODS

This was an observational study carried out between July 2009 and February 2011, at two orphanages in Hyderabad, India. Seventy seven HIV-positive children aged between 1 and half and 15 years, both on and not on antiretroviral therapy (ART) were included. Nutritional status was assessed longitudinally for one year by weight gain, linear growth and body composition. Serum samples were analyzed for haemoglobin, micronutrients, CD4 and CD8 counts. Dietary intakes were assessed by institutional diet survey and morbidity data were recorded every day for 12 months.

RESULTS

Mean energy intakes were less than recommended dietary allowance (RDA) in all age groups. Iron and folate intakes were less than 50 per cent of RDA; 46 (59.7%) children were stunted, 36 (46.8%) were underweight and 15 (19.5%) had low BMI for age. Anaemia was observed in 35 (45.5%) children. Micronutrient deficiencies such as vitamin D (40/77; 51.9%), vitamin A (11/77; 14.3%), folate (37/77; 48.1%), iron (38/77; 49.3%) were widely prevalent. HIV viral load was higher in children not on ART and those with morbidity. Respiratory (36.6%) and dermatological illnesses (18.8%) were the commonest presentations.

INTERPRETATION & CONCLUSIONS

Acute, chronic malnutrition and micronutrient deficiencies were common in HIV infected children, especially in those not on ART and having morbidity. With severe malnutrition being an alarming consequence of HIV, prophylactic nutritive care should be considered for integration into HIV care strategies besides initiation of ART to improve the nutritional status and quality of life of these children.

Gut microbiota in health and disease: an overview focused on metabolic inflammation

In concern to the continuously rising global prevalence of obesity, diabetes and associated diseases, novel preventive and therapeutic approaches are urgently required. However, to explore and develop such innovative strategies, a meticulous comprehension of the biological basis of these diseases is extremely important. Past decade has witnessed an enormous amount of research investigation and advancement in the field of obesity, diabetes and metabolic syndrome, with the gut microbiota receiving a special focus in the triangle of nutrition, health and diseases. In particular, the role of gut microbiota in health and diseases has been one of the most vigorous and intriguing field of recent research; however, much still remains to be elucidated about its precise role in host metabolism and immune functions and its implication in the onset, progression as well as in the amelioration of metabolic ailments. Recent investigations have suggested a significant contribution of the gut microbiota in the regulation and impairment of energy homeostasis, thereby causing metabolic disorders, such as metabolic endotoxemia, insulin resistance and type 2 diabetes. Numerous inflammatory biomarkers have been found to be associated with obesity, diabetes and risk of other associated adverse outcomes, thereby suggesting that a persistent low-grade inflammatory response is a potential risk factor. In this milieu, this review intends to discuss potential evidences supporting the disturbance of the gut microbiota balance and the intestinal barrier permeability as a potential triggering factor for systemic inflammation in the onset and progression of obesity, type 2 diabetes and metabolic syndrome.

Phytochemical composition, GC-MS analysis, in vitro antioxidant and antibacterial potential of clove flower bud (Eugenia caryophyllus) methanolic extract

Plant derived pharmacologically active compounds have gained importance in food and pharmaceutical industries. The aim of the present study is to identify and study the antioxidant, antimicrobial properties of the phytochemicals present in the crude extract of Eugenia caryophyllus flower buds. The antioxidant activity of the methanol, acetone and chloroform extract was evaluated by 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. The methanol extract showed better radical scavenging activity than other selected solvents. Preliminary screening of phytochemicals was carried out in methanol extract and total phenol content was found high. Antibacterial activity was determined by well diffusion assay and methanol extract was found effective against Klebsiella pneumonia. FTIR and GC-MS results indicate the presence of aromatic compounds and major constituents were found to be eugenol and eugenyl acetate. Results of this study implied that Eugenia caryophyllus flower bud extract could be considered as health nutriments in food and pharmaceutical industries.

Electronic solutions for combating counterfeit drugs

Introduction:

The problem of counterfeiting of drugs is assuming alarming proportions and is getting difficult to combat due to its trans-national character. It is undermining the faith of people on health care system. Therefore, there is a need to adopt zero tolerance approach to combat the problem.

The Way Forward:

There are many solutions available which are being adopted in piece meal manner by individual manufacturers. However, for wholesalers and resellers it is getting difficult to maintain multiple solutions. Therefore, there is a need to adopt a unified solution preferably with the help of the government.

Conclusions:

This paper discusses the available solutions, their shortcomings and proposes a comprehensive solution where at each level in the supply chain the authenticity is verified preferable linking it with Unique identification.

Reprint of "Vitamin D deficiency in pregnant women impairs regulatory T cell function"

Regulatory T cells and IgE receptors (CD23 and CD21) on B cells were assessed in vitamin D deficient pregnant women. For this, 153 pregnant women were recruited from a government hospital and were categorized into three groups based on 25-hydroxyvitamin D3 (25(OH)D3) status. Regulatory T cell population (Treg cells) and CD23/CD21 expression on B cells were quantified by FACS ARIA II in maternal blood at third trimester; and the same parameters were evaluated in cord blood soon after delivery. In addition, TGF β and IL-10 were quantified in maternal and cord blood by using Milliplex kits. In a representative sample of eight women from each group (vitamin D sufficient, insufficient and deficient), placental tissues were processed for mRNA expressions of vitamin D receptor (VDR), retinoic acid receptor (RXR), vitamin D binding protein (VDBP) and vitamin D regulating enzymes. Of the 153 pregnant women, 18 were sufficient (≥30ng/mL), 55 were insufficient (20-29ng/mL) and 80 were deficient (≤19ng/mL) for 25(OH)D3 status. The maternal blood Treg cell population (mean (%)±SE) was lower (p<0.05) in 25(OH)D3 deficient (0.2±0.01) pregnant women compared to insufficient (0.34±0.01) and sufficient (0.45±0.02) pregnant women. Similarly, cord blood Treg cell population (mean (%)±SE) was also lower (p<0.05) in 25(OH)D3 deficient (0.63±0.03) pregnant women when compared to insufficient (1.05±0.04) and sufficient (1.75±0.02) pregnant women. Mean (%)±SE of B cells with CD23 and CD21 in maternal blood was higher (p<0.05) in 25(OH)D3 deficient pregnant women (0.35±0.02; 1.65±0.04) when compared to insufficient (0.22±0.02; 0.55±0.05) and sufficient (0.15±0.02; 0.21±0.01) pregnant women. Similarly, mean (%)±SE of B cell population with CD23 and CD21 in cord blood was also higher (p<0.05) in 25(OH)D3 deficient (0.41±0.02; 1.2±0.03) when compared to insufficient (0.32±0.01; 0.6±0.05) and sufficient (0.2±0.01; 0.4±0.02) pregnant women. Regulatory cytokines, TGF β and IL-10 were lower (p<0.05) in 25(OH)D3 insufficient and deficient subjects. In the placenta tissue of women with 25(OH)D3 deficiency, the regulatory T cell transcription factor FOXP3, vitamin D receptor (VDR) and retinoic acid receptor (RXR) expressions were downregulated. In contrast, CD23, CD21 and VDBP expressions were upregulated in 25(OH)D3 deficient and insufficient women. Vitamin D regulating enzymes (CYP24A1, CYP2R1 and CYP27B1) expression were also altered in women with 25(OH)D3 deficiency. The current study shows that impaired maternal 25(OH)D3 during pregnancy influences the spectrum of immune cells such as regulatory T cells and B cells with IgE receptors and this in turn may be linked to allergy and asthma in neonates.

Vitamin D deficiency in pregnant women impairs regulatory T cell function

Regulatory T cells and IgE receptors (CD23 and CD21) on B cells were assessed in vitamin D deficient pregnant women. For this, 153 pregnant women were recruited from a government hospital and were categorized into three groups based on 25-hydroxyvitamin D3 (25(OH)D3) status. Regulatory T cell population (Treg cells) and CD23/CD21 expression on B cells were quantified by FACS ARIA II in maternal blood at third trimester; and the same parameters were evaluated in cord blood soon after delivery. In addition, TGF β and IL-10 were quantified in maternal and cord blood by using Milliplex kits. In a representative sample of eight women from each group (vitamin D sufficient, insufficient and deficient), placental tissues were processed for mRNA expressions of vitamin D receptor (VDR), retinoic acid receptor (RXR), vitamin D binding protein (VDBP) and vitamin D regulating enzymes. Of the 153 pregnant women, 18 were sufficient (≥30 ng/mL), 55 were insufficient (20-29 ng/mL) and 80 were deficient (≤19 ng/mL) for 25(OH)D3 status. The maternal blood Treg cell population (mean (%)± SE) was lower (p<0.05) in 25(OH)D3 deficient (0.2 ± 0.01) pregnant women compared to insufficient (0.34 ± 0.01) and sufficient (0.45 ± 0.02) pregnant women. Similarly, cord blood Treg cell population (mean (%)± SE) was also lower (p<0.05) in 25(OH)D3 deficient (0.63 ± 0.03) pregnant women when compared to insufficient (1.05 ± 0.04) and sufficient (1.75 ± 0.02) pregnant women. Mean (%) ± SE of B cells with CD23 and CD21 in maternal blood was higher (p<0.05) in 25(OH)D3 deficient pregnant women (0.35 ± 0.02; 1.65 ± 0.04) when compared to insufficient (0.22 ± 0.02; 0.55 ± 0.05) and sufficient (0.15 ± 0.02; 0.21 ± 0.01) pregnant women. Similarly, mean (%)± SE of B cell population with CD23 and CD21 in cord blood was also higher (p<0.05) in 25(OH)D3 deficient (0.41 ± 0.02; 1.2 ± 0.03) when compared to insufficient (0.32 ± 0.01; 0.6 ± 0.05) and sufficient (0.2 ± 0.01; 0.4 ± 0.02) pregnant women. Regulatory cytokines, TGF β and IL-10 were lower (p<0.05) in 25(OH)D3 insufficient and deficient subjects. In the placenta tissue of women with 25(OH)D3 deficiency, the regulatory T cell transcription factor FOXP3, vitamin D receptor (VDR) and retinoic acid receptor (RXR) expressions were downregulated. In contrast, CD23, CD21 and VDBP expressions were upregulated in 25(OH)D3 deficient and insufficient women. Vitamin D regulating enzymes (CYP24A1, CYP2R1 and CYP27B1) expression were also altered in women with 25(OH)D3 deficiency. The current study shows that impaired maternal 25(OH)D3 during pregnancy influences the spectrum of immune cells such as regulatory T cells and B cells with IgE receptors and this in turn may be linked to allergy and asthma in neonates.

Effect of social and environmental determinants on overweight and obesity prevalence among adolescent school children

BACKGROUND

Overweight and obesity among children and adolescents is a public health concern.

OBJECTIVE

To assess the prevalence of overweight and obesity and its association with social and environmental determinants among the adolescent school children of Tirupati town of Andhra Pradesh, India.

MATERIALS AND METHODS

Data was collected by interviewer-administered method from school children aged between 12 to 16 years. The sample consisted of 2258 subjects (1097 boys and 1161 girls). Overweight and obesity were defined by body mass index (BMI) based on the current method recommended by the Centre for Disease Control and Prevention 2000. Data on social and environmental determinants were collected by using a pre-tested and validated questionnaire.

RESULTS

In the present sample, 11.2 percent and 4.8 percent of boys and 10.3 percent and 4.8 percent of girls were overweight and obese. The literacy level of parents, family income and child sleep duration significantly associated with overweight. Parental level of education was a risk factor for overweight (Mother: 1.570; 95% CI: 1.048-2.354). Similarly increase in family income (OR = 1.529; 95% CI: 1.089-2.148) and child sleep duration <7 hrs per day (OR = 2.006; 95% CI: 1.194-3.371) raised children's association in gaining weight.

CONCLUSION

Our study reinforces the burgeoning prevalence of overweight and obesity among the adolescents. Interventional measures taken should consider family, school and physical environment to check the problem of overweight/obesity.

Biological control of vaginosis to improve reproductive health

The human vaginal microbiota plays an important role in the maintenance of a woman's health, as well as of her partner's and newborns'. When this predominantly Lactobacillus community is disrupted, decreased in abundance and replaced by different anaerobes, bacterial vaginosis (BV) may occur. BV is associated with ascending infections and obstetrical complications, such as chorioamnionitis and preterm delivery, as well as with urinary tract infections and sexually transmitted infections. In BV the overgrowth of anaerobes produces noxious substances like polyamines and other compounds that trigger the release of pro-inflammatory cytokines interleukin (IL)-1 β and IL-8. BV can profoundly affect, with different mechanisms, all the phases of a woman's life in relation to reproduction, before pregnancy, during fertilization, through and at the end of pregnancy. BV can directly affect fertility, since an ascending dissemination of the involved species may lead to tubal factor infertility. Moreover, the increased risk of acquiring sexually transmitted diseases contributes to damage to reproductive health. Exogenous strains of lactobacilli have been suggested as a means of re-establishing a normal healthy vaginal flora. Carefully selected probiotic strains can eliminate BV and also exert an antiviral effect, thus reducing viral load and preventing foetal and neonatal infection. The administration of beneficial microorganisms (probiotics) can aid recovery from infection and restore and maintain a healthy vaginal ecosystem, thus improving female health also in relation to reproductive health.

Anti-inflammatory treatments for chronic diseases: a review

Inflammation is viewed as one of the major causes for the development of different diseases like cancer, cardiovascular disease, diabetes, obesity, osteoporosis, rheumatoid arthritis, inflammatory bowel disease, asthma, and CNS related diseases such as depression and parkinson's disease; and this fervent phenomenon provides space for understanding different inflammatory markers. Increasing evidences have elucidated the outcome of inflammatory pathways dysregulation resulting in many symptoms of chronic diseases. The detection of transcription factors such as nuclear factor kappa-B (NF-κB), STAT and their gene products such as COX-2, cytokines, chemokines and chemokine receptors has laid molecular foundation for the important role of inflammation in chronic diseases in which the NF-κB is reported as a major mediator which makes a possible way for the development of new therapeutic approaches using synthetic and natural compounds that might eventually decrease the prevalence of these diseases. Even if many inflammatory markers like TNF-α, IL-1, IL-6, IL-8 and C-reactive protein (CRP) are reported to be the major key factors with proved role in several inflammatory diseases, IL-1 and TNF-α are the important cytokines that can induce the expression of NF-κB which is the potential target in these inflammatory diseases. This review aims to explore and summarize that how some drugs and natural compounds show their modulatory activity in inflammatory pathways and chronic inflammatory markers in these inflammatory diseases.

Evaluation of vaginal pH for detection of bacterial vaginosis

BACKGROUND & OBJECTIVES

Bacterial vaginosis (BV) is highly prevalent among women in reproductive age group. Little information exists on routine vaginal p H measurement in women with BV. We undertook this study to assess the utility of vaginal p H determination for initial evaluation of bacterial vaginosis.

METHODS

In this cross-sectional study vaginal swabs were collected from women with complaints of white discharge, back ache and pain abdomen attending a government hospital and a community health clinic, and subjected to vaginal p H determination, Gram stain, wet mount and whiff test. Nugent score and Amsel criteria were used for BV confirmation.

RESULTS

Of the 270 women included in the analysis, 154 had BV based on Nugents' score. The mean vaginal p H in women with BV measured by p H strips and p H glove was 5 and 4.9, respectively. The vaginal p H was significantly higher in women with BV. Vaginal discharge was prevalent in 84.8 per cent women, however, only 56.8 per cent of these actually had BV by Nugent score (NS). Presence of clue cells and positive whiff test were significant for BV. Vaginal p H >4.5 by p H strips and p H Glove had a sensitivity of 72 and 79 per cent and specificity of 60 and 53 per cent, respectively to detect BV. Among the combination criteria, clue cells and glove p H >4.5 had highest sensitivity and specificity to detect BV.

INTERPRETATION & CONCLUSIONS

Vaginal p H determination is relatively sensitive, but less specific in detecting women with BV. Inclusion of whiff test along with p H test reduced the sensitivity, but improved specificity. Both, the p H strip and p H glove are equally suitable for screening women with BV on outpatient basis.

Effectiveness of zinc supplementation to full term normal infants: a community based double blind, randomized, controlled, clinical trial

The study was aimed to test whether zinc supplementation, if initiated early, can prevent stunting and promote optimum body composition in full term infants. For this, full term pregnant women from low income urban community were enrolled and were followed-up for 24 months postpartum. Body mass index (BMI) was calculated from maternal weight and height that were collected one month after delivery. Infants' weight, and length, head, chest and mid upper arm circumferences and skin fold thicknesses at triceps, biceps and subscapular area were collected at baseline (before randomization) and once in three months up till 24 months. Three hundred and twenty four infants were randomized and allocated to zinc (163) or placebo (161) groups respectively. Supplementation of zinc was initiated from 4 months of age and continued till children attained 18 months. The control (placebo) group of children received riboflavin 0.5 mg/day, whereas the intervention (zinc) group received 5 mg zinc plus riboflavin 0.5 mg/day. When infants were 18 months old, dietary intakes (in 78 children) were calculated by 24 hour diet recall method and hemoglobin, zinc, copper and vitamin A were quantified in blood samples collected from 70 children. The results showed prevalence of undernutrition (body mass index <18.5) in 37% of the mothers. Mean±SD calorie consumption and zinc intakes from diets in infants were 590±282.8 Kcal/day and 0.97±0.608 mg/day respectively. Multiple linear regression models demonstrated maternal weight as a strong predictor of infants' weight and length at 18 months of age. As expected, diarrhea duration impacted infants' linear growth and weight gain adversely. Zinc supplementation for a mean period of 190 days, starting from 4 months up to 18 months of age, in full term normal infants, consuming an average energy of 590 Kcal/day, had significant effect on the skin fold thicknesses, but not on their linear growth.

TRIAL REGISTRATION

Clinical Trail Registration India (CTRI) CTRI/2012/08/002884.

Probiotic Lactobacillus rhamnosus GG and Aloe vera gel improve lipid profiles in hypercholesterolemic rats

OBJECTIVE

The effects of Lactobacillus rhamnosus GG (LGG) and Aloe vera (AV) gel on lipid profiles in rats with induced hypercholesterolemia were studied.

METHODS

Five treatment groups of rats (n = 7) were the fed experimental diets: a normal control diet, a hypercholesterolemic diet (HD), HD + LGG, HD + AV gel, and HD + LGG + AV gel.

RESULTS

Supplementation with LGG decreased serum total cholesterol by 32%; however, in combination with AV, the decrease was 43%. The decreases in triacylglycerol levels in the HD + LGG, HD + AV, and HD + LGG + AV groups were 41%, 23% and 45%, respectively. High-density lipoprotein increased by 12% in the HD + LGG + AV group, whereas very low-density and low-density lipoprotein values decreased by 45% and 30%, respectively. The atherogenic index in the HD + LGG + AV group decreased to 2.45 from 4.77 in the HD + LGG group. Furthermore, fecal Lactobacillus species counts increased significantly when LGG was fed in combination with the AV gel. The oral administration of LGG fermented milk alone or in combination with the AV gel increased cholesterol synthesis (3-hydroxy-3-methylglutaryl coenzyme A reductase expression) and absorption (low-density lipoprotein receptor expression), whereas cholesterol 7α-hydroxylase mRNA expression levels were lower in the HD + LGG and HD + LGG + AV groups compared with the control HD group.

CONCLUSION

The combination of LGG and AV gel may have a therapeutic potential to decrease cholesterol levels and the risk of cardiovascular diseases.

Targeted cancer therapies: the future of cancer treatment

For decades, the hallmark of medical treatment for cancer has been intravenous cytotoxic chemotherapy, where these drugs target rapidly dividing cells, including cancer cells and certain normal tissues. As a result, many patients experience the classic toxicities of alopecia, gastrointestinal symptoms, and myelosuppression. In the past decade, however, a dramatic shift has been witnesses in the cancer therapy. Although traditional cytotoxic chemotherapy still remains the treatment of choice for many malignancies, targeted therapies are now a component of treatment for many types of cancer, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma.

Cholesterol-lowering probiotics as potential biotherapeutics for metabolic diseases

Cardiovascular diseases are one of the major causes of deaths in adults in the western world. Elevated levels of certain blood lipids have been reported to be the principal cause of cardiovascular disease and other disabilities in developed countries. Several animal and clinical trials have shown a positive association between cholesterol levels and the risks of coronary heart disease. Current dietary strategies for the prevention of cardiovascular disease advocate adherence to low-fat/low-saturated-fat diets. Although there is no doubt that, in experimental conditions, low-fat diets offer an effective means of reducing blood cholesterol concentrations on a population basis, these appear to be less effective, largely due to poor compliance, attributed to low palatability and acceptability of these diets to the consumers. Due to the low consumer compliance, attempts have been made to identify other dietary components that can reduce blood cholesterol levels. Supplementation of diet with fermented dairy products or lactic acid bacteria containing dairy products has shown the potential to reduce serum cholesterol levels. Various approaches have been used to alleviate this issue, including the use of probiotics, especially Bifidobacterium spp. and Lactobacillus spp.. Probiotics, the living microorganisms that confer health benefits on the host when administered in adequate amounts, have received much attention on their proclaimed health benefits which include improvement in lactose intolerance, increase in natural resistance to infectious disease in gastrointestinal tract, suppression of cancer, antidiabetic, reduction in serum cholesterol level, and improved digestion. In addition, there are numerous reports on cholesterol removal ability of probiotics and their hypocholesterolemic effects. Several possible mechanisms for cholesterol removal by probiotics are assimilation of cholesterol by growing cells, binding of cholesterol to cellular surface, incorporation of cholesterol into the cellular membrane, deconjugation of bile via bile salt hydrolase, coprecipitation of cholesterol with deconjugated bile, binding action of bile by fibre, and production of short-chain fatty acids by oligosaccharides. The present paper reviews the mechanisms of action of anti-cholesterolemic potential of probiotic microorganisms and probiotic food products, with the aim of lowering the risks of cardiovascular and coronary heart diseases.

Prevalence of & knowledge, attitude & practices towards HIV & sexually transmitted infections (STIs) among female sex workers (FSWs) in Andhra Pradesh

BACKGROUND & OBJECTIVES

As part of the baseline survey carried out during 2005-06, biological and behavioural data were generated on about 3200 female sex workers (FSWs), from eight districts of Andhra Pradesh (AP), India. This study describes the relationship between socio-demographic and behavioural factors with consistent condom use (CCU) and HIV among FSWs in AP.

METHODS

A cross-sectional community-based study was conducted among female sex workers (FSW) in eight districts of Andhra Pradesh, India, using conventional cluster sampling and time-location cluster sampling. Key risk behaviours and STIs related to the spread of HIV were assessed. Blood samples were collected to detect syphilis, Herpes simplex virus type 2 (HSV-2) Chlamydia trachomatis (CT), Neiserria gonorrhoeae (NG) and HIV serology.

RESULTS

About 70 per cent of the FSWs were illiterates, nearly 50 per cent were currently married and 41 per cent of the FSWs had sex work as the sole source of income. More than 95 per cent of the FSWs heard of HIV, but about 99 per cent believed that HIV/AIDS cannot be prevented. Logistic regression analysis showed significantly lesser CCU with high client volume, not carrying condom and could not use condom in past 1 month due to various reasons such as non co-operation by the clients. Similarly, CCU was significantly (P<0.001) lesser (only 8.9%) with regular non-commercial partners. Overall there was 16.3 per cent prevalence of HIV amongst FSWs. C. trachomatis and N. gonorrheae were prevalent in 3.4 and 2 per cent of the FSWs, respectively and about 70 per cent of the FSWs were positive for HSV2 serology. HIV was significantly associated with STIs.

INTERPRETATION & CONCLUSIONS

Misconception that HIV/AIDS cannot be prevented is very high. Most of the subjects in the present study had first sexual debut at a very young age. HIV was associated with STIs, emphasizing aggressive STI diagnosis and treatment. CCU must be emphasized right from first sexual debut with all clients and non-commercial partners as well.

ICMR-DBT guidelines for evaluation of probiotics in food

There has been an increased influx of probiotic products in the Indian market during the last decade. However, there has been no systematic approach for evaluation of probiotics in food to ensure their safety and efficacy. An initiative was, therefore, taken by the Indian Council of Medical Research (ICMR) along with the Department of Biotechnology (DBT) to formulate guidelines for regulation of probiotic products in the country. These guidelines define a set of parameters required for a product/strain to be termed as 'probiotic'. These include identification of the strain, in vitro screening for probiotic characteristics, animal studies to establish safety and in vivo animal and human studies to establish efficacy. The guidelines also include requirements for labeling of the probiotic products with strain specification, viable numbers at the end of shelf life, storage conditions, etc., which would be helpful to the consumers to safeguard their own interest.

E-cadherin and CD1a expression in gingival epithelium in periodontal health, disease and post-treatment

BACKGROUND

Epithelial integrity is important for maintenance of periodontal health. It is not fully known if non-surgical periodontal therapy is capable of recreating the epithelial barrier in its functional state.

PATIENTS AND METHODS

Sixty-five patients (31 males and 34 females) were included in the study. They were divided into group A (healthy gingiva 16 patients), group B (gingivitis 17 patients), group C (periodontitis 17 patients), and group D (post-treatment 15 patients). Gingival samples were collected and immunohistochemical study was done using E-cadherin and CD1a antibody. Statistical analysis was done using analysis of variance (ANOVA), followed by Tukey-Kramer multiple comparison test for CD1a and Tukey's highly significant difference (HSD) test for E-cadherin.

RESULT

There was a statistically significant difference (P < 0.001) in the expression of E-cadherin between healthy (1.846±0.555), gingivitis (1.100±0.994), and periodontitis group (0.700±0.483). Similarly, there was a statistically significant difference (P < 0.001) in the expression of CD1a between healthy (75.70±3.09), gingivitis (42.53±3.09), and periodontitis group (29.07±3.08). However, the expression of E-cadherin (1.242±0.653) and CD1a in post-treatment samples (52.18±2.90) was lower with no statistically significant difference when compared to health.

DISCUSSION

The significant reduction in E-cadherin and CD1a levels in periodontal disease when compared to health could possibly be a result of invasion by the periodontopathogens and its subsequent sequel. Although, the post-treatment samples showed significant improvement when compared to disease, the reduction in E-cadherin and CD1a levels when compared to gingival health suggests that the epithelial barrier was not yet fully established in its functional state.