Prevalence of pulmonary hypertension among children with Down syndrome:A systematic review and meta-analysis

BACKGROUND Pulmonary hypertension(PH)has serious short-and long-term consequences.PH is gaining increasing importance in high risk groups such as Down syndrome(DS)as it influences their overall survival and prognosis.Hence,there is a dire need to collate the prevalence rates of PH in order to undertake definitive measures for early diagnosis and management.AIM To determine the prevalence of PH in children with DS.METHODS The authors individually conducted a search of electronic databases manually(Cochrane library,PubMed,EMBASE,Scopus,Web of Science).Data extraction and quality control were independently performed by two reviewers and a third reviewer resolved any conflicts of opinion.The words used in the literature search were“pulmonary hypertension”and“pulmonary arterial hypertension”;“Down syndrome”and“trisomy 21”and“prevalence”.The data were analyzed by Comprehensive Meta-Analysis Software Version 2.Risk of bias assessment and STROBE checklist were used for quality assessment.RESULTS Of 1578 articles identified,17 were selected for final analysis.The pooled prevalence of PH in these studies was 25.5%.Subgroup analysis was carried out for age,gender,region,year of publication,risk of bias and etiology of PH.CONCLUSION This review highlights the increasing prevalence of PH in children with DS.It is crucial for pediatricians to be aware of this morbid disease and channel their efforts towards earlier diagnosis and successful management.Community-based studies with a larger sample size of children with DS should be carried out to better characterize the epidemiology and underlying etiology of PH in DS.

Novel drug designing rationale against Brugia malayi microfilariae using herbal extracts

Objective:To explore the effect of herbal polyphenolics on filariasis in vitro.Methods:Two herbal extracts,methanolic extracts of roots of Vitex negundo Linn.（Nirgundi） and leaves of Aegle marmelos Juss.（Beal） in different concentrations ranging from 40-80 ng/mL were tested for their antifilarial activity either alone or in combination with diethyl carbonate（DEC）（300μg/mL） and/or H2O2（0.5 mM）.Results:Combination of DEC and each extract had significant anti-filarial effect.And fractions of both extracts were not effective as crude herbal extract.Conclusions: Such unique pharmacodynamics reported in this study might provide new drug development stratagem against filariasis.

Strategies for Decreasing Infant Mortality Rate among the Arab Bedouins of Negev, Israel

The semi-nomadic Bedouins of Negev have undergone a transition to modernization. But due to political reasons many of them still live in unrecognized localities in the state of Israel. They suffer from number of diseases and have a high IMR （infant mortality rate） as compared to Jewish population. This review article aims at discussing different strategies that may be implemented for improving IMR among the Bedouins. Increasing literacy-rate among Bedouin women along with launching newer measures like trained female Bedouin health volunteers, community health-clinics and home-based newborn care may help in reducing IMR. Congenital anomaly among newborns is mostly due to consanguinity. Malnutrition, anemia and accidents were the other important reasons for child mortality. Unrecognized Bedouin habitats are not having the basic amenities for daily living. Poverty does not allow them to spend much on health. Dedicated inter-sectorial coordination and launching newer health programs for Bedouin children may help improve the IMR.

Novel pharmaceutical rationale against human lymphatic filarial parasite:An oxidative premise

Objective:Mandate from WHO has boosted up anti-filarial drug research.Diethylcarbamazine citrate(DEC) was not known for any direct effect on filarial parasites.However,recent report proposed its direct apoptotic effect.Oxidative stress has been implicated in apoptotic impact.A study was designed to explore the possibility of oxidative rationale to be operative in the direct anti-filarial effect of DEC.Methods:Various doses of DEC and potent oxidant H_2O_2 alone were used in vitro to check for the effects on B.malayi microfilariae,followed by the use of DEC in combination with H_2O_2.Reversal of the oxidative impact of the drug was tested using the antioxidant,vitamin C and also lipid peroxidation levels in the post incubation culture supematants were assayed.Result:As expected,DEC alone failed to record any anti-filarial effect.H_2O_2 alone also failed to show any significant effect until a very high dose was used.However,in combination significant anti-filarial effect was noticed,which allowed even 44%reduction in the dose of H_2O_2.Any significant lipid peroxidation was not found.Vitamin C demonstrated 30%inhibitory effect.Conclusion:DEC and H_2O_2 combination being able to educe synergistic anti-filarial effect and inhibition of the same by vitamin C hinted towards covert oxidative component in the mechanism of DEC.Further implication of non-significant lipid peroxidation was addressed in the perspective of subtle oxidative nexus that seems to be operative in observed anti-filarial effect. Exploration of such rationale might lead to novel drug development.

Unwanted pregnancies, unwanted births, consequences and unmet needs

Worldwide women have to cope up with heavy burden of unwanted pregnancies, mistimed, unplanned, with risk to their health. Their children and families also suf-fer. Such pregnancies are root cause of induced abortions （safe/unsafe） and grave consequences. Women, their partners can, for most part, prevent unwanted pregnancies by using contraceptives. However many women either do not use any contraceptive or use methods, with high failure rates. These women account for 82% of pregnancies that are not desired. Remaining unintended pregnancies occur among women who use modern contraceptive, either because they had diffculty using method consistently or because of failure. Helping women, their partner use modern contracep-tives effectively is essential in achieving Millennium Development Goals for improving women’s health, reducing poverty. If all women in developing countries use modern contraceptives, there would be 22 million less unplanned births, 25 million fewer induced, 15 million fewer unsafe abortions, 90000 less maternal deaths and 390000 less children losing their mothers. Also making abortion services broadly legal, by understand-ing size, type of unmet needs, most important by creating awareness in communities can surely help tackle this problem to a large extent.

Auricular seroma: a new concept in management

Aim:Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage.The successful treatment of auricular seromas remains a challenge because this disease has a high propensity for recurrence.Methods:A total of 20 patients with auricular seromas were treated by remodeling a corrugated rubber drain.Results:All patients tolerated the procedure well.No patient had any collection of fluid after the removal of the splint.No patient experienced pain,fever,or edema after treatment.The seroma disappeared without disfigurement.There were no recurrences on further follow-up.Conclusion:Aspiration and splint application by remodeling a corrugated rubber drain provides very simple,minimally invasive,and effective management of seromas.It is a cost-effective treatment that prevents patient distress from fluid recollection and social embarrassment.