Surgical conditions - A neglected aspect of public health: Call to action

The burden of surgical conditions is large, though unrecognized. Surgical interventions are cost – effective, but thought to be otherwise. Investments aimed at including surgery at primary care level are affordable. Globally, a momentum is being created to strengthen surgery infrastructure especially for the poor in the low and middle income countries – who bear the burden most. In India, the Association of Rural Surgeons of India, and a body for implementing Lancet Commission of Global Surgery, India are taking lead. A blue print of activities needed to bring surgery on the centre stage of public health in India has been developed. The IPHA can play a catalytic role and use its convening power in getting various associations of public health professionals in India to partner surgeons in this effort. Integration of surgery in public health has the potential to improve equity, access, and universal health coverage.

A real-time PCR genotyping assay to detect FAD2A SNPs in peanuts (Arachis hypogaea L)

The high oleic (C18:1) phenotype in peanuts has been previously demonstrated to result from a homozygous recessive genotype (ol1ol1ol2ol2) in two homeologous fatty acid desaturase genes (FAD2A and FAD2B) with two key SNPs. These mutant SNPs, specifically G448A in FAD2A and 442insA in FAD2B, significantly limit the normal function of the desaturase enzyme activity which converts oleic acid into linoleic acid by the addition of a second double bond in the hydrocarbon chain. Previously, a genotyping assay was developed to detect wild type and mutant alleles in FAD2B. A real-time PCR assay has now been developed to detect wild type and mutant alleles (G448A) in FAD2A using either seed or leaf tissue. This assay was demonstrated to be applicable for the detection of homozygous and heterozygous samples. The FAD2A genotyping assay was validated by employing gas chromatography (GC) to determine total fatty acid composition and by genotyping peanut lines that have been well characterized. Overall, development of rapid assays such as real-time PCR which can identify key genotypes associated with important agronomic traits such as oleic acid, will improve breeding efficiency by targeting desirable genotypes at early stages of development.

Socioeconomic and health implications of adult deaths in families of rural Bangladesh.

Effects of adult deaths on subsequent health and socioeconomic well-being of rural families of Bangladesh were examined. Data for this study were drawn from the longitudinal Sample Registration System (SRS) operational in two rural areas of the then MCH-FP Extension Project (Rural) of ICDDR,B. In total, deaths of 327 married adults aged 15-59 years, during January 1983-December 1987, were reviewed. The families of the deceased were followed up for five years after death. Factors, such as survival status of children, educational status of children aged 6-12 years, and out-migration status among adolescents aged 12-20 years in those families, was observed and recorded. A control group of 3,350 families experiencing no adult deaths was also followed up for five years. The health and socioeconomic impacts on children in both the groups five years after death of the adult were compared. The findings of the study showed that negative impact was more pronounced among the children of poor families, and the female children were most severely affected. Death of a father or a mother was associated with a higher rate of out-migration (especially marriage) of adolescent daughters. An adult death was associated with a significantly higher mortality risk of children during the five years following death of the adult. These child-mortality risks were significantly higher when an adult female died, and when the index child was a female and/or aged less than five years at the time of death of an adult. The children, aged 6-12 years, in families where a parent had died were significantly more likely to be uneducated and out-of-school after the death of a father or a mother compared to the children in families where neither of the parents had died. This finding remained valid even after controlling for the educational status of the parents who died and of those who did not die. Since the study used a limited number of independent variables and since there is a need to understand the specific reasons why such significant differences occurred, it is recommended to conduct a more in-depth qualitative study to know more clearly the nature and mechanisms of the socioeconomic and health impacts of death of an adult on the family and the society.

Use of mid-upper arm circumference for evaluation of nutritional status of children and for identification of high-risk groups for malnutrition in rural Bangladesh.

Measurements of mid-upper arm circumference (MUAC) of 8,881 children were considered cross-sectionally to determine the effects of diarrhoea, breast-feeding, and birth-spacing on the nutritional status of children in rural Matlab, Bangladesh. It was observed that age was one of the most significant determinants of child nutrition. The younger children (< 2 years) had significantly higher levels of severe malnutrition than the children aged 2 years or older. Children who had diarrhoea during the last 12 months prior to the study had significantly (p < 0.001) higher severe malnutrition than the children who did not suffer from diarrhoea. Children born with a longer interval after birth of an elder sibling (24+ months) and who were breastfed for a longer duration (2-3 years) were less likely to be severely malnourished than those who were born with a shorter birth interval or who terminated breast-feeding prior to 2 years of age. Education of mothers, housing space, family size, religion, and sex of children had significant effects on the nutritional status of children. Results of the study suggest that MUAC is a potential anthropometric indicator of child nutrition.

Hypochromic anaemia in chronic renal failure--role of aluminium.

BACKGROUND: Anaemia is a cardinal feature of chronic renal failure and classically it is normochromic normocytic. Hypochromic anaemia in these patients is often attributed to iron deficiency. AIM: This study was aimed to find the contribution of aluminium in causation of anaemia in CRF patients. METHODS: Dialysis dependent patients of chronic renal failure with adequate dietary intake (> 1500 Cals/day) and no apparent source of blood loss were evaluated for type of anaemia. (During period of this study centre didn't have reverse osmosis plant for water treatment). Evaluation included upper GI endoscopy, complete hemogram, serum proteins, serum iron, total iron binding capacity, and bone marrow iron status. For aluminium evaluation serum aluminium levels were done. RESULTS: Sixty-four patients were evaluated for type of anaemia. Mean age of patients was 41.19 years (15-76 years) with male:female ratio 2.3:1. Classical normochromic picture was seen in 28.5% while rest had hypochromic picture. On bone marrow aspiration study two patients had zero iron stores while all others had normal/excessive iron stores. In 10 patients with hypochromic picture, mean serum aluminium levels were 170 micrograms/L (30-310 micrograms/L). CONCLUSIONS: This study highlights the high prevalence of hypochromic anaemia in patients with adequate dietary intake and aluminium overload in Indian CRF patients.