Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UKbased ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053.

Introduction:Asphyxia is a condition caused by interference with respiration due to lack of oxygen in inspired air due to which the tissues are deprived of oxygen (together failure to eliminate CO 2 ) causing unconsciousness or death. \ Study aimed to know the total incidence of Mechanical asphyxial deaths and to know the incidence of types of Mechanical asphyxial deaths with age and sex wise distribution. Material and Methods:The autopsies conducted at mortuary of Government General Hospital, Guntur during the period of one year. The material consists of -Inquest reports, Perusal of police papers, Postmortem reports, Information collected from the police officers, relatives and friends of the deceased accompanying the dead bodies. Results:During the period of one year 1035 deaths were autopsied in the morgue out of which 54 were of mechanical asphyxial deaths. The incidence of Mechanical Asphyxial deaths was 5.23% out of the total number of cases autopsied. The most common form of mechanical asphyxial death was hanging 35 (64.8%) drowning 11 (20.1%) out of 54 cases of mechanical asphyxial deaths. The sex wise distributions of mechanical asphyxial deaths were little more in females 28 cases (51.8%) than males 26 cases (48.2%). Conclusion:Out of 1035 cases of unnatural deaths in which autopsy was conducted over the period of one year 54 (5.21%) cases were mechanical asphyxial deaths in which 35(64.8%) cases were dead by using the mode of suicidal hanging irrespective of age and sex. Hence the numbers of suicidal hanging cases are increasing day by day.

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Background: Hypothermia is a well-known contributor to neonatal morbidity and mortality, especially for preterm and low-birth weight neonates. Identifying the predictors for admission hypothermia which are specific to the settings is important to initiate quality improvement projects and improve clinical outcomes. Methods: Study was conducted over a period of 6 months from 1 April to 31 September 2018. All inborn infants needing neonatal intensive care unit (NICU) admission were eligible for the study. The study involved measuring temperatures at exit from delivery room (DR) and at admission to NICU. Hypothermia was defined as core admission temperature <36.5°C. The data collected included all modifiable and nonmodifiable risk factors for hypothermia in newborns. Data was analyzed using logistic regression to determine associations, if any, between admission hypothermia and maternal, neonatal, and environmental characteristics. Results: One hundred and ninety-three infants were enrolled in the study. The incidence of admission hypothermia (<36.5°C) was 83.9%. Forty-four (22.8%) infants had mild hypothermia, 61.1% infants had moderate hypothermia, and none of the neonates had severe hypothermia. Nonmodifiable factors affecting admission temperature were birth weight/gestational age and mother’s temperature before shifting to DR. DR temperature strongly predicted the admission temperature and every 1°C increase in DR temperature improved the rate of admission hypothermia by 34%. Conclusion: Significant proportion of neonates is hypothermic at the time of admission to NICU. DR temperature significantly predicts hypothermia at admission in neonates needing NICU admission.

Antibiotic residues in shrimp meat pose food safety threats and trade implications. Shrimp farmers employ prophylactic health products, commonly known as probiotics (gut, water and soil probiotics), to prevent disease occurrence thereby negating the need for the use of antibiotics in shrimp health management. Information on the use of probiotics, decision on probiotic selection and farming practices was elicited from 182 Penaeus vannamei shrimp farmers of Andhra Pradesh from four districts representing the north coastal (Srikakulam District), central coastal (East Godavari and West Godavari districts) and south coastal (Nellore District) districts, by questionnaire based survey. Majority of the farmers (50%) used only one probiotic during the rearing of P. vannamei but 15% farmers used up to three probiotics. P. vannamei farmers used 45 different probiotics brands and the probiotic brand was mostly co-selected with the feed brand. Feed technician (employee of the feed manufacturer involved in marketing and promotion of feed) alone was responsible for the selection of the probiotic brand to be used by 52% of shrimp farmers in Srikakulam, 50% of shrimp farmers in East Godavari, 40% of shrimp farmers in West Godavari and 32% of shrimp farmers in Nellore districts. More than 30% of the shrimp famers of West Godavari, Nellore and East Godavari took a neutral stance on the performance of the probiotic but were still using probiotics as a safety measure. The baseline data on prophylactic health products usage is the first step in understanding the dynamics of probiotic use and underlines the need for concerted research to assess the quality of these products (in terms of label claims) that are used by shrimp famers in significant quantities that profoundly influence the production cost.