Optimizing Internet Use during Adolescence: eHealth Solutions

Internet offers an immense opportunity as a resource for education, training, and health promotion. This narrative review summarizes the opportunities for health promotion among adolescents through use of the Internet and technology (defined as eHealth). The details of technology and use of Internet for adolescent-health related topics such as nutrition, fitness, sexual health, adventure, and violence were searched through PubMed. The review reports few digital solutions to address key challenges during adolescence like promotion of nutrition and sexual reproductive health, prevention of noncommunicable diseases, substance abuse, and mental health issues. eHealth was concluded as a potential solution for preventive and promotional health practices during adolescence. However, concerns of Internet addiction, safety, privacy, mental health disorders, and misinformation need to be addressed and monitored during adolescence.

Prevalence Of Multidirectional Shoulder Instability In Shot Put Throwers

Objective: The objective of this study was to find out whether there was any shoulder instability prevailing in the shot put throwers due to the rotational activities achieved in the respective sport. Methods: A total of 76 shot put throwers were recruited for the study. The multidirectional instability of the shoulder joint was tested by performing special tests. Results: The study revealed that out of 76 shot put throwers, 49 individuals were found to be having shoulder instability, and 27 individuals were not having shoulder instability. This was confirmed by using a special test like the Sulcus sign and Rowe test followed by statistical analysis. The individuals diagnosed with multidirectional instability showed Sulcus sign and Rowe test positive, of which 30 individuals showed both the test positive and 19 individuals showed only Rowe test positive. Conclusion: About 64.47% of individuals were diagnosed with multidirectional instability in the shot put throwers while the rest 35.52% of individuals showed no signs of instability.

Management of Infants with Congenital Adrenal Hyperplasia

Treatment of congenital adrenal hyperplasia (CAH) requires lifelong replacement of glucocorticoids with regular follow up to manageassociated morbidities. The current review focuses on follow-up and management of infants diagnosed with classical CAH pertinent toIndian context. Early initiation of oral hydrocortisone in divided doses is recommended after diagnosis in newborn period, infancy andchildhood. Fludrocortisone is recommended for all infants with classical CAH. All infants should be monitored as per protocol fordisease and treatment related complications. The role of prenatal steroids to pregnant women with previous history of CAH affectedinfant for prevention of virilization of female fetus is controversial.

Newborn Screening and Diagnosis of Infants with Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder which can manifest after birth with ambiguousgenitalia and salt-wasting crisis. However, genital ambiguity is not seen in male babies and may be mild in female babies, leading to amissed diagnosis of classical CAH at birth. In this review, we provide a standard operating protocol for routine newborn screening forCAH in Indian settings. A standardization of first tier screening tests with a single consistent set of cut-off values stratified by gestationalage is also suggested. The protocol also recommends a two-tier protocol of initial immunoassay/time resolved fluoroimmunoassayfollowed by liquid chromatography tandem mass spectrometry for confirmation of screen positive babies, wherever feasible. Routinemolecular and genetic testing is not essential for establishing the diagnosis in all screen positive babies, but has significant utility inprenatal diagnosis and genetic counseling for future pregnancy.

An Optimal Capillary Screen Cut-off of Thyroid Stimulating Hormone for Diagnosing Congenital Hypothyroidism: Data from a Pilot Newborn Screening Program in Delhi

Objective: To determine an appropriate cut-off of capillaryThyroid stimulating hormone (TSH) for congenitalhypothyroidism.Study design: Cross-sectional.Participants: 174,000 neonates born in different hospitals ofDelhi, India, from November 2014 to October 2016.Main outcome measures: Correlation between initial andrepeat capillary TSH level and subsequent venous free thyroxine(fT4) level.Results: 102 newborns with initial/ repeat capillary TSH level of≥20 mIU/L (n=174) were confirmed to have congenitalhypothyroidism at mean (SD) age of 5 (4) days. A goodcorrelation between capillary TSH level and confirmatory venousfT4 level and postnatal age of sampling was obtained (r -0.6,-0.4). The area under the ROC curve (AUC) was 0.81 (95%CI0.75 to 0.88), indicating referral capillary TSH level of 20 mIU/L tobe a good predictor of subsequent high venous TSH level.Conclusion: A cut off of ≥20 mIU/L for capillary TSH screeningbeyond 24 hours of life is optimal in the Indian setting for decidingfurther recall and workup, keeping a balance between sensitivityand recall rate.

Growth Patterns in Small for Gestational Age Babies and Correlation with Insulin-like Growth Factor-1 Levels

Objective: Correlation of catch-up growth and Insulin-like Growth Factor -1 levels (IGF-I) inSGA babies. Methods: 50 Full-term Small for Gestational Age children aged 12-18 monthswere analyzed for Catch-up growth (gain in weight and/or length, Standard Deviation Score/SDS >0.67). IGF-1 was measured after post-glucose load using ELISA method andcorrelated with catch-up growth. Results: Mean (SD) birthweight and length were 2.1 (0.3)Kg and 44.4 (3.1) cm, respectively. At enrollment, mean (SD) age, weight and length were15.0 (2.1) months, 7.7 (1.3) Kg, and 72.9 (5.6) cm, respectively. Catch-up growth was notedin 60% children. IGF-1 levels were significantly higher in children showing catch-up growth(56.6 (63.2) ng/mL) compared to those not having catch up growth (8.7 (8.3) ng/mL). IGF-1was positively correlated with both weight and length catch-up. Conclusion: Majority ofSmall for Gestational Age showed catch-up growth by 18 months, which had good correlationwith IGF-1 levels

IAP Position Paper on Burden of Mumps in India and Vaccination Strategies.

Justification: Mumps, despite being a widely prevalent disease in the country, is considered as an insignificant public health problem mainly because of poor documentation of clinical cases and lack of published studies. In the absence of adequate published data on disease burden, Government of India has recently decided to introduce measles-rubella (MR) vaccine in its National Immunization Program and neglected mumps component. Process: Following an IAP ACVIP meeting on December 6 and 7, 2014, a detailed review of burden of mumps in India along with vaccination strategies to control the disease was prepared. The draft was circulated amongst the members of the committee for review and approval. Revised final draft was later approved by IAP executive board in January 2015. Objectives: To provide a review of community burden of mumps in India; and to discuss the vaccination strategies to impress upon policymakers to include mumps vaccination in National immunization program. Recommendations : A total of 14 studies and two media reports on mumps outbreak were retrieved. The outbreaks were reported from all the regions of the country. Mumps meningoencephalitis was responsible for 2.3% to 14.6% of all investigated hospitalized acute encephalitis syndrome or viral encephalitis cases in different studies. Data from Infectious Disease Surveillance (ID Surv) portal of IAP and Integrated Disease Surveillance Program (IDSP) of Government of India (GoI) were also reviewed. While a total of 1052 cases were reported by the IDSurv, IDSP had investigated 72 outbreaks with 1564 cases in 14 states during different time periods. Genotypes G (subtype G2) and C were found to be main genotypes of the mumps virus circulating in the country. Three studies studied serological status of young children and adolescents against mumps, and found susceptibility rates ranging from 32% to 80% in different age groups. Conclusions: Mumps poses a significant disease burden in India. This calls for inclusion of mumps vaccine in the National immunization program.

Revised IAP Growth Charts for Height, Weight and Body Mass Index for 5- to 18-year-old Indian Children.

Justification: The need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old. Process: The Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children’s growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole’s LMS method. Objectives: To construct revised IAP growth charts for 5-18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years. Recommendations: The IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5-18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.

Safety and Immunogenicity of a Quadrivalent Meningococcal Conjugate Vaccine (MenACYW-DT): A Multicenter, Open-label, Non-randomized, Phase III Clinical Trial.

Objective: To assess the safety and immunogenicity of a quadrivalent meningococcal (groups A,C,Y,W) polysaccharide diphtheria toxoid conjugate vaccine (MenACYW-DT) in India. Design: Open-label, descriptive, non-randomized study. Setting: Three medical college hospitals, one each in New Delhi, Bengaluru and Mumbai, India. Participants: 300 healthy, vaccine-naïve participants (100 children aged 2-11 years, 100 adolescents aged 12-17 years, and 100 adults aged 18-55 years). Intervention: One dose (0.5 mL) of MenACYW-DT administered intramuscularly. Main outcome measures: Serum bactericidal antibody titers against A, C, Y, and W were measured before and after MenACWY-DT vaccination. Safety data were also collected Results: Thirty days post-vaccination, geometric mean titers rose across all serogroups. Most participants had protective titers ≥8 (1/dil) across the four serogroups. The percentage (95% CI) achieving ≥8 (1/dil) in the Adolescent Group was typical – A: 96.9% (91.2%; 99.4%); C: 96.9% (91.2%; 99.4%); Y:100% (96.3%; 100%); W:100% (96.3%; 100%). In general, solicited reactions were mild and short-lived. Unsolicited events were uncommon and unrelated to vaccination. Conclusions: MenACYW-DT was well tolerated and elicited a robust and protective immune response 30 days post-vaccination against meningococcal serogroups A, C, Y, and W-135 in the Indian study participants aged 2-55 years.

Detection of persistent organic compounds from biomethanated distillery spent wash (BMDS) and their degradation by manganese peroxidase and laccase producing bacterial strains.

Biomethanated distillery spent wash (BMDS) retains dark black colour with complex persistent organic pollutants even after anaerobic treatment. The specific ratio (4:3:1:1) of Proteus mirabilis (FJ581028), Bacillus sp. (FJ581030), Raoultella planticola (GU329705) and Enterobacter sakazakii (FJ581031) decolourised BMDS up to 76% within 192 hr along with degradation of persistent organic compounds in presence of glucose (1%) and peptone (0.1%). The colour removal ability was noted due to ligninolytic enzyme activity. Where the maximum manganese peroxidase was 1.93 U ml-1 and laccase activity equalled 0.84 U ml-1. The gas chromatography–mass spectrophotometry (GC–MS) analysis confirmed the direct correlation between colourant and persistent organic pollutants due to simultaneous reduction of colour and pollutants present in BMDS. The seed germination test showed reduction of 75% toxicity after bacterial treatment process.

Causes of salinity and plant manifestations to salt stress: A review.

Salinity in agricultutal terms is the excess of salts above the level plant require. Most often it poses constrains in the growth hence productivity of the category of plants called glycophytes, wherein falls major crops, therefore is a serious concern. It is often recognized as excess of sodium ions (sodicity) that imparts life threatening consequences in plant due to mal-textured soil hindered porosity and aeration leads to physiological water deficit. Mingling with other edaphic/environmental factors viz. precipitation, temperature, flooding, soil profile, water table exaggerates the catastrophe synergistically. Improper irrigations system, leaching fraction added with land clearing and deforestation have been marked as the major cause. The present review underlines the different sources of salinity stress and their physiological manifestations, toxicity responses alongwith tolerance in plants and management strategies in affected landscapes.

Immune thrombocytopenic purpura as a presentation of childhood tuberculosis.

Immune thrombocytopenic purpura as a presentation of childhood tuberculosis is a rare event and occasional reports are described in the pediatric literature. We describe a 8-yr-old girl with mediastinal tubercular lymphadenitis-induced immune thrombocytopenia, who was successfully treated with anti-tubercular drugs. We also review the published reports. Tuberculosis should be considered a cause of immune thrombocytopenia in areas where tuberculosis is highly endemic.

Purification and properties of an extracellular pectin lyase produced by the strain of Penicillium oxalicum in solid-state fermentation.

A pectin lyase (PNL, EC 4.2.2.10) produced extracellularly by the strain of Penicillium oxalicum in solid-state fermentation medium containing deoiled mandarin orange peel meal was purified to apparent homogeneity by a protocol that included ammonium sulfate precipitation, DEAE-Sephadex A-50 and Sephadex G-100 chromatography. The enzyme had molecular mass of 50 kD, as determined by SDS- PAGE and showed optimum pH and temperature at 8.0 and 50 degrees C respectively. It had an isoelectric point (pI) of 5.0 and showed a K(m) of 1.1 mg/ml of citrus pectin. The enzyme was strongly inhibited by Mo4+, Ag+ and Pb2+ and also by polyphenolic compounds, in particular tannic acid.

Recharging of borewells and analysis of harvested rooftop rainwater in houses of Udaipur city.

Water is an inorganic component, which covers about 3/4th of the earth's surface, but only 3 percent of it is available to man for use. The remaining 97 percent of water found in oceans is full of soluble salts, being unfit for human use and consumption. Rainwater is free source of nearly pure water. The concept of rainwater harvesting lies in tapping the rainwater it falls. The present study was conducted in houses of Udaipur city. In order to find out the water management practices adopted by the families, a sample of 100 households was selected. Out of the total samples, 30 houses were selected purposively for commissioning the rainwater harvesting system and the rooftop rainwater harvesting potential was also calculated among these 30 households. Field experiment was conducted for quantitative analysis of harvested rooftop rainwater in houses which reveals that rooftop rainwater harvesting system is very effective measure in increasing the quantity of water in borewells as compared to those borewells without having the rainwater harvesting system attached to them. The availability of water per day was found to be higher i.e. 269 litres in those houses where the rainwater harvesting potential was also higher i.e. 98.32 m3, as the catchment area of these houses was found to be more (186 sq m.) as compared to other houses.

Nephrotic syndrome with X-linked ichthyosis, Kallmann Syndrome and unilateral renal agenesis.

We describe a 10-year-old boy with X-linked ichthyosis, Kallmann Syndrome and unilateral renal agenesis who presented with nephrotic syndrome. DNA analysis revealed deletion of the Steroid Sulfatase (STS) gene. STS deficiency in X-linked ichthyosis leads to cholesterol sulfate accumulation, which induces transglutaminase-1 dysfunction. Since the slit diaphragm of the glomerular epithelial cell is a modified adherens junction, the accumulation of cholesterol sulfate could interfere with the normal slit diaphragm function of the glomerular visceral epithelial cell, resulting in nephrotic range proteinuria. The child went into remission on oral prednisolone.

Symbiotic characterization of isoleucine+valine and leucine auxotrophs of Sinorhizobium meliloti.

Ten isoleucine+valine and three leucine auxotrophs of Sinorhizobium meliloti Rmd201 were obtained by random mutagenesis with transposon Tn5 followed by screening of Tn5 derivatives on minimal medium supplemented with modified Holliday pools. Based on intermediate feeding, intermediate accumulation and cross-feeding studies, isoleucine+valine and leucine auxotrophs were designated as ilvB/ilvG, ilvC and ilvD, and leuC/leuD and leuB mutants, respectively. Symbiotic properties of all ilvD mutants with alfalfa plants were similar to those of the parental strain. The ilvB/ilvG and ilvC mutants were Nod-. Inoculation of alfalfa plants with ilvB/ilvG mutant did not result in root hair curling and infection thread formation. The ilvC mutants were capable of curling root hairs but did not induce infection thread formation. All leucine auxotrophs were Nod+ Fix-. Supplementation of leucine to the plant nutrient medium did not restore symbiotic effectiveness to the auxotrophs. Histological studies revealed that the nodules induced by the leucine auxotrophs did not develop fully like those induced by the parental strain. The nodules induced by leuB mutants were structurally more advanced than the leuC/leuD mutant induced nodules. These results indicate that ilvB/ilvG, ilvC and one or two leu genes of S. meliloti may have a role in symbiosis. The position of ilv genes on the chromosomal map of S. meliloti was found to be near ade-15 marker.