Trends in Urban Immunization Coverage in India: A Meta-Analysis and Meta-Regression

Objectives To assess the gaps and trends in child immunization coverage among urban and rural areas in India, and compare the success of immunisation program in each. Methods PubMed, Scopus, and Crossref, and Google Scholar electronic databases were searched on October 9, 2019, and March 21, 2020, for studies that measured and reported immunization coverage indicators in India. Random-efects metaanalyses and meta-regressions were conducted. Results The authors' search identifed 545 studies, and 2 were obtained by expert suggestion. Among these 68 studies and 6 surveys were included. They found that full immunization coverage has grown yearly at 2.65% and 0.82% in rural and urban areas, respectively whereas partial immunization coverage declined by ?2.44% and ?0.69%, respectively. Percentage of nonimmunized children did not show a statistically signifcant trend in either. Conclusion While rural immunization coverage has seen a large increase over the past two decades, the progress in urban areas is weak and negligible. This was largely attributable to a focus on minimizing dropouts in rural areas. However, a lack of signifcant reduction in unimmunized children may indicate left-out children or pockets in both rural and urban areas. The poor performance of immunization programs in urban areas, coupled with a larger impact of COVID-19, warrants that India urgently adopts urban-sensitive and urban-focused policies and programs.

Laparoscopic Management Of Adnexal Mass

Background:Laparoscopy is a widely used procedure in gynecological cases both for diagnostic and operative procedures. It is recommended due to lesser hospital stay, less post operative pain and better panoramic vision. Aim of the study is to assess the effectiveness of laparoscopic intervention of adnexal masses with benign pathology in recent series of consecutive patient. The focus is on pathology findings, length of stay, operating time, complications and laparotomy conversion rate. Material And Methods: This was a prospective observational study conducted at tertiary care hospital in Department of Obstetrics & Gynaecology during period of 1stAugust 2018 to 31st July 2020.This study consists of 70 patients, who presented with symptoms like pain in abdomen, bleeding per vaginum, irregular menses, excessive white discharge, distension of abdomen, infertility visiting outdoor patient department either diagnosed clinically(sign and symptoms) or by ultrasonography of adnexal masses. Result:Maximumpatients in this study were in age group 21-30 years. Maximum patients(21.42%)were having simple cyst. Among laparoscopic procedure most common procedure was left ovarian cystectomy(38.57%). Mean operative duration was 40.78 min and average duration of hospital stay was 3 days. There were minimal peri-operative complications; commonest being postoperative fever. Conclusion:Ade quatesurgical skill, case selection, multi disciplinary team approach and expert laproscopic surgical team are imperative for good patient outcome. This study gives an overview of experience in favour of laproscopic management of benign adnexal mass

Retinopathy of prematurity: Maharashtra state model

This report describes the goal, activities, and outcomes of the Queen Elizabeth Diamond Jubilee Trust funded retinopathy of prematurity (ROP) program in the state of Maharashtra in collaboration with the Public Health Foundation of India, Hyderabad. The project was initiated in July 2016 with the goal of establishing a sustainable ROP program in the special newborn care units (SNCUs) in public health facilities of five districts. Between 2016 and 2018, ophthalmology and neonatology teams from five district hospitals (DHs) were trained by nongovernment partner hospitals in the state. Infrastructure was developed by procuring equipment for ROP screening/treatment, and awareness generation activities were conducted with a range of stakeholders. Eight ophthalmologists were trained to perform ROP screening (from five DHs and one medical college), and five neonatology teams (pediatricians and nurses) from the project hospitals were trained in best neonatal practices to prevent ROP. The Pune district's hospital was developed as an ROP treatment center. Toward the end of the project period, six new facilities had an established ROP program. The state health department is in the process of scaling up the ROP program to a larger geographic region to ensure universal ROP screening coverage in the state of Maharashtra.

Omics data-driven analysis identifies laminin-integrin-mediated signaling pathway as a determinant for cell differentiation in oral squamous cell carcinoma

Background: In recent years, high-throughput omics technologies have been widely used globally to identify potential biomarkers and therapeutic targets in various cancers. However, apart from large consortiums such as The Cancer Genome Atlas, limited attempts have been made to mine existing datasets pertaining to cancers. Methods and Results: In the current study, we used an omics data analysis approach wherein publicly available protein expression data were integrated to identify functionally important proteins that revealed consistent dysregulated expression in head and neck squamous cell carcinomas. Our analysis revealed members of the integrin family of proteins to be consistently altered in expression across disparate datasets. Additionally, through association evidence and network analysis, we also identified members of the laminin family to be significantly altered in head and neck cancers. Members of both integrin and laminin families are known to be involved in cell-extracellular matrix adhesion and have been implicated in tumor metastatic processes in several cancers. To this end, we carried out immunohistochemical analyses to validate the findings in a cohort (n = 50) of oral cancer cases. Laminin-111 expression (composed of LAMA1, LAMB1, and LAMC1) was found to correlate with cell differentiation in oral cancer, showing a gradual decrease from well differentiated to poorly differentiated cases. Conclusion: This study serves as a proof-of-principle for the mining of multiple omics datasets coupled with selection of functionally important group of molecules to provide novel insights into tumorigenesis and cancer progression.

Habilitation services for children blind from retinopathy of prematurity: Health care professionals' perspective in Maharashtra

Purpose: To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation. Methods: A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality. Results: Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum. Conclusion: Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.

Molecular genotyping of clinically important blood group antigens in patients with thalassaemia

Background & objectives: In multitransfused thalassaemic patients, haemagglutination fails to phenotype the patient's blood group antigens due to the presence of donor-derived erythrocytes. DNA-based methods can overcome the limitations of haemagglutination and can be used to determine the correct antigen profile of these patients. This will facilitate the procurement of antigen-matched blood for transfusion to multitransfused patients. Thus, the aim of this study was to compare the serological phenotyping of common and clinically important antigens of Rh, Duffy, Kell, Kidd and MNS blood group systems with molecular genotyping amongst multitransfused thalassaemic patients. Methods: Blood samples from 200 patients with thalassaemia and 100 'O' group regular blood donors were tested using standard serological techniques and polymerase chain reaction-based methods for common antigens/alleles (C, c, D, E, e, Fya, Fyb, Jka, Jkb, K, k, M, N, S, s). Results: Genotyping and phenotyping results were discordant in 77 per cent of thalassaemic patients for five pairs of antithetical antigens of Rh, Duffy, Kell and Kidd blood group systems. In the MNS blood group system, 59.1 per cent of patients showed discrepancy. The rate of alloimmunization among thalassaemics was 7.5 per cent. Interpretation & conclusions: Molecular genotyping enabled the determination of the actual antigen profile in multitransfused thalassaemia patients. This would help reduce the problem of alloimmunization in such patients and would also aid in the better management of transfusion therapy.

Effect of intensive lifestyle modification & metformin on cardiovascular risk in prediabetes: A pilot randomized control trial

Background & objectives: Prediabetes is associated with increased prevalence of cardiovascular disease (CVD). In participants with prediabetes, the effects of exercise and metformin were evaluated on high-sensitivity C-reactive protein (hsCRP) and carotid intima-media thickness (CIMT), surrogate markers of atherosclerosis and CVD compared with standard care. Methods: In a pilot randomized control trial, the participants were randomized in to three arms: standard care (STD), intensive lifestyle modification (ILSM) or ILSM and metformin (ILSM+Met) and followed up for six months. Monitoring of ILSM was done by a trained healthcare facilitator. hsCRP, CIMT and other relevant parameters were measured before and after intervention. Results: A total of 103 participants were randomized into three arms and followed up for six months. At six months, there was a reduction from baseline in weight and fasting blood sugar (FBS) (P <0.01) in all three arms and a reduction in haemoglobin A1c (P =0.03) only in the ILSM+Met arm. The differences in hsCRP over six months within the STD, ILSM and ILSM+Met arms were ?0.12 (95% confidence interval, ?1.81, 2.08), ?0.58 (?2.64, 0.43) and ?0.11 (?1.84, 1.56), respectively. There was no difference in hsCRP, CIMT (right) or CIMT (left) between the three arms at six months. Interpretation & conclusions: There was a reduction in weight and FBS from baseline in all three arms. There was, however, no difference seen in hsCRP and CIMT in the two intervention arms compared to standard care. Larger studies with long-term follow up need to be done to detect differences in risk markers for CVD in prediabetes.

Effective Position of Closed Suction Drain in Inguinal Hernia Surgery: A Retrospective Study.

Background: The aim of this study was to assess the efficacy of closed suction drains in inguinal hernia surgery inserted up to the base of the scrotum as compared to those in which the drain is limited to the inguinal region. Methods: Data of all lichtenstein hernioplasty from January 2012 to December 2014 in M. S. Ramaiah Medical Hospital were collected retrospectively. A total of 992 patients underwent hernia repair and only 133 patients were subjected to closed suction drain. In 133 patients data were collected regarding the type of presentation, age, gender, presence of coexisting diseases, type of hernia, type of anesthesia, postoperative general complications, data was collected regarding the presentation of the hernia, type of sac encountered, amount of dissection, location of the inserted drain, complications, and length of hospital stay. These patients were followed up for 6 months. Local wound complications, duration of operation, and length of hospitalization, recurrence and mortality were compared between the groups of patients with drains versus without drains. Results: Average amount of drain fluid was higher (58.5 ml) in the group where the drain was inserted to the bottom of the scrotum as compared to (22.4 ml) the group with the drain limited to the inguinal region. Furthermore, there was significant difference in the incidence of scrotal edema in the two groups (6 vs. 23). Hence, by positioning the drain to reach the bottom of the scrotum; it will lead to a better drainage of the collection and in turn lead to fewer associated complications such as scrotal hematomas, infections, and scrotal edema. Conclusion: In our study, placement of drain extending into the bottom of scrotum significantly reduced scrotal edemas a result alleviates immediate post-operative patient anxiety and morbidity in the reduction of scrotal size to normal. However, it requires a larger series to confirm our early observations.

A population‑based screening program for early detection of common cancers among women in India – methodology and interim results.

BACKGROUND: Cancers of the uterine cervix, breast, and oral cavity accounted for 134,420, 115,251, and 24,375 cases, respectively, and were responsible for 52.8% of the total cancers among women in India in 2008. AIM: The major objectives were to create awareness regarding common cancers among women, to detect pre‑cancers of the uterine cervix and oral cavity, and early cancers of the breast, uterine cervix, and oral cavity, by conducting screening with simple, low‑cost technology, within the community, and to facilitate confirmation of diagnosis among the screen positives and treatment and follow‑up among the diagnosed cases. SETTINGS AND METHODS: This is a community‑based screening program for early detection of breast, uterine cervix, and oral cancers, being implemented among the socioeconomically disadvantaged women in Mumbai, India. The process involves selection of clusters, household surveys, health education, and screening the eligible women for breast, uterine cervix, and oral cancers, by primary healthcare workers, at a temporarily set‑up clinic within the community. The program is planned to cover a 125,000 disadvantaged population in five years. RESULTS: Twenty‑one thousand and fifteen people, with 4009 eligible women, have been covered to date. The compliance for screening for breast, cervix, and oral cavity has been 85, 70, and 88% and the screen positivity rates are 3.9, 14.9, and 3.9%, respectively. Twenty‑seven oral pre‑cancers, 25 cervix pre‑cancers, one invasive cancer of the breast, two of the cervix, and one oral cavity cancer have been diagnosed among the screened women and all of them have complied with the treatment. CONCLUSIONS: The program is raising awareness about the common cancers and harms of tobacco among the disadvantaged women population in Mumbai. It is also helping in detecting pre‑cancers and cancers among asymptomatic women and is assisting them in receiving treatment.

Community-based tobacco cessation program among women in Mumbai, India.

BACKGROUND: Globally tobacco epidemic kills nearly six million people annually. Consumption of tobacco products is on the rise in low‑ and middle‑income countries. Tobacco is addictive; hence, tobacco users need support in quitting. AIMS: Providing tobacco cessation services to women in community enabling them to quit tobacco, identifying factors associated with quitting and documenting the processes involved to establish a replicable “model tobacco cessation program.” SETTINGS AND DESIGN: This is a community based tobacco cessation program of one year duration conducted among women in a low socioeconomic area of Mumbai, India. SUBJECTS AND METHODS: It involved three interventions conducted at three months interval, comprised of health education, games and counseling sessions and a post intervention follow‑up. STATISTICAL ANALYSIS: Uni and multivariate analysis was performed to find out association of various factors with quitting tobacco. RESULTS: The average compliance in three intervention rounds was 95.2%. The mean age at initiation of tobacco was 17.3 years. Tobacco use among family members and in the community was primary reasons for initiation and addiction to tobacco was an important factor for continuation, whereas health education and counseling seemed to be largely responsible for quitting. The quit rate at the end of the programme was 33.5%. Multivariate logistic regression analysis found that women in higher age groups and women consuming tobacco at multiple locations are less likely to quit tobacco. CONCLUSIONS: Changing cultural norms associated with smokeless tobacco, strict implementation of antitobacco laws in the community and work places and providing cessation support are important measures in preventing initiation and continuation of tobacco use among women in India.

Bacteriostatic activity of con a lectin from Canavalia ensiformis.

The aim of this work was to explore the therapeutic applications of Con A lectin from Canavalia ensiformis and to explore its antibacterial activity. Activity of lectin was quantified by their ability to agglutinate erythrocytes using Hemagglutination assay. Characterization and purity of Con A lectin was evaluated by using SDS-PAGE analysis. The reversal of hemagglutination activity of lectin was evaluated by using the sugars namely; mannose, galactose, lactose, fructose, glucose. The antibacterial activity of lectins was tested against Streptococcus mutans, Staphylococcus aureus, Bacillus subtilis, Escherichia coli using pour plate method. Amoxycillin was used as standard. At 250mg/ml concentration Con A lectin showed good bacteriostatic activity.

Influence of lactic acid on seed germination of finger millet (Eleusine Coracana Gaertn.).

Lactic acid is regarded as a harmful product of anaerobic respiration occurring under waterlogged conditions in plant tissues. Effect of exogenous application of lactic acid on seed germination and activities of some important enzyme systems in seed of finger millet cultivar GPU28 was investigated. High concentration (0.5%) of lactic acid caused a marked reduction in germination percentage during initial phase (first 24 h) of seed germination. Lactic acid treatment caused suppression of seedling growth; radical growth being more sensitive than the coleoptiles growth. The analysis of enzyme activities at 24h germination stage revealed that lactic acid treatment caused decrease in the activities of enzyme amylase, acid phosphatase, ATPase, peroxidase, and catalase while there was elevation of alkaline phosphatase activity.

Intestinal myiasis.

Purpose: Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces. This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man. They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe. The condition is not uncommon and is often misdiagnosed as pinworm infestation. Correct diagnosis by the clinical microbiologist is important to avoid unnecessary treatment. Materials and Methods: We had 7 cases of intestinal myiasis. In 2 cases the larvae were reared to adult fly in modified meat and sand medium (developed by Udgaonkar). This medium is simple and can be easily prepared in the laboratory. Results: Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans. Conclusions: S. haemorrhoidalis was the commonest maggot involved. A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics. The reason for long duration of illness and recurrence of infestation is baffling. The nearest to cure was colonic wash. We feel prevention is of utmost importance, which is to avoid eating food articles with easy access to flies.

Assessment of muscular fitness in school children using kraus-weber tests.

Objective of the study: The present study was carried out to assess muscular fitness in healthy Indian school children between 9 to 12 years of age (older pediatric age-group) using Kraus-Weber Tests. The aim was to compare the results of this study with similar studies that have been carried out in India, Europe and America previously. Methods: Kraus-Weber Tests don’t require sophisticated equipment and are much easier to administer than traditional tools for analyzing muscular fitness like Electromyogram (EMG). Earlier studies have proven these tests to be excellent screening devices not only for physical but also psychosocial incompetence. They can actually be used as indicators of overall health in this older pediatric age-group. Results: The present study found more number of fitness and flexibility failures as compared to the last such study in India. In stark contradistinction to previous studies, girls have fared poorly than boys on the fitness front.Conclusion: These findings could be attributed to increased stress in school children especially in female students. A sharp dip has been observed in muscular fitness just prior to puberty (most probably due to hormonal causes).

Academic performance of school children with their intelligence quotient.

Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.

Effect of preferential cyclooxygenase-2 (COX-2) inhibitor against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced striatal lesions in rats: Behavioral, biochemical and histological evidences.

Cyclooxygenase (COX) isoenzyme is known to play an important role in the pathophysiology of Parkinson’s disease. The present study evaluated the neuroprotective effect of nimesulide, a preferential COX-2-inhibitor against 1-methyl-4-phenyl-1,2,3,6-tertahydropyridine (MPTP)-model of Parkinson’s disease. Intrastriatal administration of MPTP (32 μmol in 2 μl) produced a significant decrease in the locomotor activity. Biochemical investigation of striatal region revealed a significant enhancement in the oxidative stress as evidenced by increased lipid peroxidation levels, nitrite levels and myeloperoxidase activity along with depleted antioxidant pool (reduced glutathione and superoxide dismutase levels) and reduced redox (GSH/GSSG) ratio. MPTP administration also showed significant mitochondrial complex-I inhibition and reduction in the mitochondrial viability. Histological examination of the MPTP-treated brain sections revealed alteration in the histo-architecture as well as undifferentiated bodies of varying contour and lesions. Chronic administration of nimesulide (5 or 10 mg/kg, po) for 12 days, significantly reversed the behavioral, biochemical, mitochondrial and histological alterations induced by MPTP. In conclusion, the findings of the present study implicate the possible neuroprotective potential of nimesulide in MPTP-treated rats and thus highlight the therapeutic potential of COX-inhibitors in treatment of Parkinson’s disease.

Effect of Convolvulus pluricaulis Choisy. and Asparagus racemosus Willd on learning and memory in young and old mice: A comparative evaluation.

A dose dependent enhancement of memory was observed with A. racemosus and C. pluricaulis treatment as compared to control group when tested on second day. A. racemosus and C. pluricaulis at the dose of 200 mg/kg, po showed significantly higher percent retentions, than piracetam. Multiple treatment with A. racemosus and C. pluricaulis for three days also demonstrated significant dose dependent increase in percent retentions as compared to control group. The effect was more prominent with C. pluricaulis as compared with piracetam and A. racemosus. A significantly lower percent retention in aged mice was observed as compared to young mice. Aged mice (18-20 months) showed higher transfer latency (TL) values on first and second day (after 24 h) as compared to young mice, indicating impairment in learning and memory. Pretreatment with A. racemosus and C. pluricaulis for 7 days enhanced memory in aged mice, as significant increase in percent retention was observed. Significantly higher retention was observed with C. pluricaulis (200 mg/kg; po) as compared with piracetam (10 mg/kg/; po). Post-trial administration of C.pluricaulis and A. racemosus extract demonstrated significant decrease in latency time during retention trials. Hippocampal regions associated with the learning and memory functions showed dose dependent increase in AChE activity in CA 1 with A. reacemosus and CA3 area with C. pluracaulis treatment. The underlying mechanism of these actions of A. racemosus and C. pluricaulis may be attributed to their antioxidant, neuroprotective and cholinergic properties.

Asymptomatic, isolated tubercular splenic abscess, in an immunocompetent person.

Tubercular splenic abscess in an immunocompetent person, especially when the patient is without any symptoms, is a rare clinical entity. We report a case of isolated tubercular splenic abscess in a 38-year-old asymptomatic healthy female and emphasize the importance of careful smear examination. The patient had come to the hospital for repair of vaginal vault prolapse. Her abdominal ultra sonography showed normal sized spleen with hypoechoic areas suggesting abscess. Fine needle aspiration of splenic lesion revealed tubercle bacilli on Ziehl Neelsen stain. The organisms also grew on culture. The splenic lesions cleared after six months of treatment with anti tubercular drugs at our Directly Observed Treatment centre under Revised National TB Control Programme. The patient was operated successfully for vault prolapse one year later.

Academic performance of school children with their intelligence quotient.

Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.

Assessment of autonomic functions in hypothyroidism.

Disturbances in autonomic functions have been observed in many diseases including hormonal disorder (Banisters 1983). Present study was undertaken to study the autonomic functions in thyroid hormones on in 60 untreated hypothyroid patients, using Valsalva and deep breath test, cold pressor test, hand grip test and orthostatic test to assess the sympathetic and parasympathetic reflexes. The results obtained in this study were compared with the age sex matched controls. It is concluded that the sympathetic response is not altered in the hypothyroid cases while reflex vagal activity is significantly reduced.