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Background & objectives: Research studies in the 1970s reported that in pre-school children, undernutrition increased the risk of infections and infections aggravated undernutrition. Over decades, there has been a reduction in prevalence of undernutrition and improvement in access to healthcare for treatment of infections. A mixed longitudinal study was undertaken to assess whether over time there were any changes from the earlier reported effect of undernutrition prior to infection on the risk of morbidity and effect of morbidity on nutritional status in pre-school children. Methods: Pre-school (0-59 months of age) children from urban low- and middle-income families whose parents were willing to allow their participation in the study were enrolled. Information on sociodemographic profile of the families was collected at enrolment. Weight of all children and length in infants were recorded every month; length/height in children 12-59 months of age was recorded once in three months. Morbidity information was collected through fortnightly visits. Results: 3888 pre-school children were followed up in 74636 home visits. Among these children, underweight and wasting were associated with a small increase in risk of infections. The odds ratio for risk of infection for underweight children was 1.09 (95% CI: 1.02 to 1.16) and for wasting was 1.18 (95% CI: 1.08 to 1.29). The deterioration in Z scores for weight-for-age and body mass index-for-age in children during illness and convalescence was small but significant (P<0.001). Interpretation & conclusions: The increased risk of infections in undernourished children living in overcrowded tenements in areas with poor environmental hygiene was not significant, perhaps because the risk of infection in normally nourished children was also high. The deterioration in nutritional status following infection was small because of the ready access to and utilization of health and nutrition care.
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Background: H. pylori-associated gastritis in patients from the high-altitude area of Ladakh showed severe gastritis, mucosal nodularity, atrophy, and cancer in comparison to those from North India. This study served to analyze if differences in the H. pylori virulence genotypes decide the extent of gastric mucosal inflammation. Methods: Fifty gastric biopsies each from patients with H. pylori-associated gastritis from Ladakh and a tertiary care center in North India were included. The presence of H. pylori strain was confirmed with Warthin starry stain and polymerase chain amplification of the H. pylori-specific 16S rRNA. The cagA, vacA s1, s2, and m1, m2 alleles, and dupA virulence genotypes were studied in all archival samples, followed by their histological correlations. Results: cagA (P 0.009) and vacAs1 m1 (P 0.009) genes were distinctly more in H. pylori strains colonizing the biopsies of North Indian patients. In contrast, the cagA -ve vacAs2 m2 strains were significantly more in H. pylori strain colonizing the biopsies from Ladakhi patients. dupA genotype was almost similarly present in strains from both regions. Among these, only cagA and dupA virulence genes were associated with severe mucosal neutrophilic activity and deep infiltration of H. pylori strains in North Indian patients. Conclusions: Differences in virulence genotypes of H. pylori in gastric biopsies from North Indian and Ladakhi patients were found not significant in deciding the severity of H. pylori-associated gastritis.
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The aim of this study is to develop and validate a method that is simple, precise, sensitive, and rapid compared tousing the liquid chromatography–tandem mass spectrometry method for the quantitative determination of Ribavirin(antiviral drug) in its tablet formulation. The development and validation of the method were achieved using a column(Zorbax 50 mm × 4.6 mm × 5 µm) with mobile phase ammonium formate (pH: 7.50): acetonitrile in the ratio (30:70,v/v) with the flow rate of 0.5 ml/min. The retention time for Ribavirin was 1.1 minutes with the total run time of2.5 minutes. The linearity range for Ribavirin was from 2 to 100 ng/ml with a correlation coefficient of 0.9956. Thedetection and quantitation limits of Ribavirin are 0.7 and 2 ng/ml, respectively. The percentage recovery of Ribavirinranged from 94.00% to 98.33%. The percentage relative standard deviation for intraday and interday precision resultswas found to be 0.67%–2.11% and 1.92%–3.11%, respectively. The new method developed for Ribavirin drug wasfound to be rapid, sensitive, selective, and economical. The established method was the evaluation of Ribavirin in itsmarketed formulation (tablet). The values obtained from the analysis were found out to be within the acceptable limitsas per the International Council for Harmonisation (ICH) guidelines.
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Purpose: Very few studies have been conducted in India and other parts of the world on visual impairment among individuals aged 15–49 years. This study was conducted to determine the prevalence, causes, and associated factors of visual impairment among adults aged 15–49 years in a rural population of Jhajjar district, Haryana, north India. Methods: A population-based cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 15–49 years were selected using compact segment cluster sampling approach. As part of the house-to-house survey, presenting visual acuity using screening chart corresponding to five “E” 6/12 optotypes was measured along with collection of other demographic details. The optometrists performed detailed eye assessment including repeat measurement of visual acuity using retro-illuminated conventional logMAR tumbling “E” charts, torch light examination, and non-cycloplegic refraction at a clinic site within the village to ascertain visual impairment and its cause. Results: Of 5,470 enumerated adults, 5,117 (94%) completed all study procedures. The age- and sex-adjusted prevalence of visual impairment was found to be 1.85% [95% confidence interval (CI): 1.48, 2.23] and blindness was 0.09% (95% CI: 0.01, 0.18). The age- and sex-adjusted prevalence of unilateral visual impairment was 1.11% (95% CI: 0.81, 1.41). Uncorrected refractive errors (84%) contributed maximum to visual impairment in this age group. The visual impairment in study participants was found to be associated with age and educational status. Conclusion: At the community level, uncorrected refractive errors contribute largely to visual impairment in the age group of 15–49 years.
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Anthropometric changes take place with increasing age. Progressive loss of height makes it difficult to use height for calculation of body mass index in nutritional screening of elderly persons. There is a need to find other alternative methods which could be used as proxy measurements of height in them. To assess the relationship of height and arm span and among elderly persons. A community-based cross-sectional study was conducted among elderly persons in urban colony of Delhi. Height and arm span of persons aged 60 years and above (n = 711) were measured according to standard methods. Correlation between arm span and height was calculated. The mean arm span was seen to be more than the mean height in all age-groups and both sexes. There was a linear relationship between height and arm-span in all age-groups. There was a strong correlation between arm span and height in all age groups. Arm span could be used instead of height as an alternative in the conventional body mass index in elderly persons.
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Background and Objectives: Palmo-plantar psoriasis and dermatitis show several overlapping clinical features. We undertook this retrospective study to elucidate and compare the histological findings in these two dermatoses. Materials and Methods: Biopsies of 31 clinically diagnosed cases of palmo-plantar psoriasis and 24 cases of hyperkeratotic palmo-plantar dermatitis, with concomitant presence of representative lesions at other body sites, were retrieved and analysed. Results: Histologically, confluent parakeratosis, suprapapillary thinning and dermal edema were observed in significantly greater number of palmo-plantar psoriasis biopsies while an inflammatory infiltrate confined to the papillary dermis only, was a significant feature in palmo-plantar dermatitis. The two conditions could not be differentiated on the basis of features like focal parakeratosis, presence of neutrophils and fibrin globules in the stratum corneum, hypogranulosis, acanthosis, spongiosis, rete ridge pattern, or vascularity. Conclusion: Histopathology of palmo-plantar psoriasis and dermatitis can have several overlapping features. In our study, we found only few features as strong pointers towards psoriasis.
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Background & objectives: Though Unani medications have been used for centuries to treat psoriasis, there is paucity of published studies which have systematically evaluated their efficacy and safety. This study was conducted to establish non-inferiority of Unani medications (oral UNIM-401 and topical UNIM-403) vs psoralen plus ultraviolet A (PUVA) sol in treatment of moderate-severe chronic plaque psoriasis (CPP) in achieving psoriasis area severity index (PASI) 75 at 12 wk and to estimate proportion of patients who relapsed in follow up period of 12 weeks, after having achieved PASI 50. Methods: In this randomized, controlled trial patients with CPP were block randomized to receive either Unani treatment (147 patients) or PUVA sol (140 patients) for 12 weeks. Percentage reduction in PASI was determined in each patient at 12 wk to calculate number of patients who achieved PASI 75 as also to estimate median of percentage reduction in PASI in each group. All patients who achieved PASI 50 at 12 weeks were followed up for another 12 wk to determine proportion of patients who relapsed. Results: Of the 287 patients randomized, 84 of 147 in Unani group and 67 of 140 in PUVA sol group completed 12 weeks of treatment. On intention-to-treat (ITT) analysis, the response in patients on Unani medication was not inferior to those receiving PUVA sol, in attaining PASI 75 (16.3% in Unani group vs 15.7% in the PUVA sol group). Median of percentage reduction of PASI at 12 wk from baseline in Unani group (68.2%; ?60, 100) and PUVA sol group (63%; ?15.7, 100) was comparable. Proportion of patients who relapsed at 24 wk was comparable in both groups. However, frequency of clinical side effects was significantly higher (P =0.001) in PUVA sol group (16.4%) compared to Unani group (2%). Interpretation & conclusions: The findings of the present study indicated that oral UNIM-401 and topical UNIM-403 were effective and well tolerated therapeutic options in patients with moderate-severe CPP.
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Objective: This study was devised to translate Cystic Fibrosis Questionnaire-Revised to Hindi and administer it to Indian children and adolescents diagnosed with cystic fibrosis. Design: Cross-sectional study. Setting: This study was carried out in cystic fibrosis patients attending Pediatric Chest Clinic of a tertiary-care hospital in Northern India from July 2012 to December 2012. Participants: 45 children (6-13 years) and their parents, and 14 adolescents. Patients with unstable health in the past two weeks were excluded. Intervention: Cystic Fibrosis Questionnaire- Revised translated in Hindi was administered. Clinical evaluation and scoring, throat swab cultures and spirometry were also done during the same visit. Main Outcome Measures: Health Related Quality of Life scores were the primary measures, and clinical scores, swab cultures and spirometry were secondary measures. Results: Cronbach’s alpha ranged from 0.020-0.863.The Factor analysis indicated that most test-items correlated more with competing scales than the intended scales. Convergence between self and proxy-rating was found to be dependent on the domain. The Cystic Fibrosis Questionnaire- Revised scores correlated well with clinical scores (r=0.65,P=0.011), Pseudomonas spp culture data and pulmonary function tests. There was an inverse relation between Health Related Quality of Life scores and age at diagnosis (r=-0.339, P=0.02). Conclusions: Hindi versions of Cystic Fibrosis Questionnaire- Revised: Child, Adolescent and Parents’ instruments will act as an important step towards data on Health Related Quality of Life of Indian patients with cystic fibrosis.
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Serous ovarian cancer is the most common malignant ovarian tumour. Traditional management consists of surgical resection with postoperative chemotherapy. Currently neoadjuvant chemotherapy is offered to patients with advanced stage disease. The present study aims to analyse the histomorphological alterations in serous ovarian cancer following neoadjuvant chemotherapy. Correlation of these morphological alterations with survival is also presented here. Serous ovarian cancers from 100 advanced stage cases were included; 50 were treated with pre-surgery chemotherapy. Semi-quantitative scoring was used to grade the alterations in tumour morphology. Survival data was correlated with the final morphological score. Tumour morphology was significantly different in cases treated with neoadjuvant chemotherapy (CT group) as compared to cases with upfront surgery. The CT group cases showed more fibrosis, calcification, and infiltration by lymphocytes, plasma cells, foamy and hemosiderin-laden macrophages. The residual tumour cells had degenerative cytoplasmic changes with nuclear atypia. Patients with significant morphological response had a longer median survival, although it did not attain statistical significance in the current study. With the increasing use of neoadjuvant chemotherapy in management, the pathologist needs to be aware of the altered morphological appearance of tumour. Further studies are required to establish a grading system to assess the tissue response which can be helpful in predicting the overall therapeutic outcome and the prognosis of patients.
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Objective: To identify the determinants of neonatal mortality. Study design: Nested case-control study. Study setting: 28 villages under the intensive field practice area of Comprehensive Rural Health Services Project, Ballabgarh, Haryana serving a population of 87,016, as on 31st December 2009. The study period was from 2005 to 2009. Methods: The data were obtained from Health Management Information System and analyzed using multivariate logistic regression analysis. A hierarchical approach was used to analyze the factors associated with neonatal deaths, using community level factors, socio-economic status and biological determinants. The population attributable fractions were estimated for significant variables. Results: The total live births during the study period were 10392 and neonatal deaths were 248. The infant and neonatal mortality rates during the study period were 45.6 and 23.8 per 1000 live births, respectively. Socio-economic determinants (Low educational status of parents [OR 2.1, 95% CI; 1.4, 3.3]; father’s occupation [OR 1.8, 95% CI; 1.0, 3.0]; Rajput caste [OR 2.0, 95% CI; 1.2, 3.4] appeared to explain a major fraction (45.7%) of neonatal deaths. Community level factors (villages with no health facility [OR 1.5, 95% CI; 1.0, 2.1]; villages with population >6000 [OR 1.7, 95% CI; 1.2, 2.5]) were associated with 27.3% of all neonatal deaths. Proximate determinants (early childbearing age of mother (<20 years) [OR 2.0, 95% CI; 1.2, 3.2]) were least important. All the three level of variables seemed to act independently with little mediation among them. Conclusion: Neonatal mortality is affected by socioeconomic, community level and proximate biological determinants.
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The present study examines the growth actions of area, production and yield of selected cereal crops in the Tamil Nadu state. Using the data from 1993-94 to 2007-08, the Compound Growth Rate (CGR) of area, production and yield for the selected cereal crops in the Tamil Nadu state were estimated for each period to study the growth performance of area of cultivation, production and yield of these crops. In Tamil Nadu state, the paddy holds good performances in absolute terms, among the other cereal crops are concerned. But the compound growth rate reveals that the maize was found to be positive and records a highest growth rate among other cereal corps in terms of area of cultivation, production and yield in Tamil Nadu over the study period. Despite the fact that maize was found to acquire highest in terms of growth actions of area of cultivation, production and yield among other cereal crops, it cannot serve the purpose of livelihood for majority of the population in Tamil Nadu state. Hence, the importance had given to the paddy cultivations. Besides, the study suggests that the farmers can also cultivate maize for the money-making purpose in the Tamil Nadu state that suits for the climatic conditions of the state as well.
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BACKGROUND AND AIM: Malnutrition is a common feature in patients with Crohn's disease (CD), which leads to frequent infections and poor prognosis. In view of the rising incidence of CD in India we planned this study to assess the nutritional status of patients with CD. METHODS: Nutritional status of 112 patients (mean age 35.9 [SD 11.7] years; 61 men) with CD was assessed by anthropometric, dietary and biochemical parameters. Patients were considered malnourished if 3 or more anthropometric parameters (% ideal body weight [IBW], % tricep skin fold [TSF], %mid upper arm circumference [MUAC], and % mid arm muscle circumference [MAMC], body mass index [BMI]) were abnormal. Dietary intake was assessed by a 24-hour dietary recall along with a semi-quantitative food frequency method. Eighty volunteers were taken as healthy controls (HC). RESULTS: At the time of assessment, 77 patients were in remission and 35 had active disease. The values of BMI, MUAC, TSF and mid arm fat area (MAFA) in patients were significantly lower than those in healthy controls. MAMC and mid arm muscle area (MAMA) of patients and controls were comparable. TSF (Rem vs HC = 10.4 [2.8-71] vs 16 [3-41]) and MAFA (Rem vs HC = 1236 [240-7757] vs 1858 [322-5650]) of the patients in the remission phase were significantly lower than those of healthy controls; the remaining parameters were comparable. There was no difference in the dietary intake of patients in the remission and active phases, and healthy controls. The percentage energy fulfillment of the patients was lower than that of healthy controls. Twenty-nine of 35 (82.8%) patients in the active and 30 of 77 (38.9%) patients in the remission phase were malnourished (OR 7.5, 95% CI 2.8-20.4). The overall prevalence of malnutrition was 52.6% among patients. CONCLUSION: The percentage of malnourished patients in the active and remission phases of the disease was 82.8% and 38.9%, respectively, possibly due to low percentage energy fulfillment.