Prevalence and determinants of anemia among school going children in the state of Tamil Nadu, India: applications of two-level logistic regression model

Background: Anemia still remains as one of the major public health problems in India despite implementing preventive measures. The objective was to find the prevalence and determinants of anemia among school going children in Tamil Nadu. Methods: We used the data from the fourth round of district level household survey (DLHS-4) for Tamil Nadu pertaining to the year 2012-13. Our analysis included 23997 children. Descriptive statistics, Random intercept and empty models of two-level logistic regression analysis were used. Results: The overall prevalence of anemia was found to be 41.4% (95% CI: 40.77%-42.02%). We observed a district level variation on anemia (District level variance=0.1, p<0.001) and the intra class correlation coefficient was 0.0295. The prevalence of anemia was more in coastal districts as compared to non-coastal districts (43.85% vs. 40.18%, p<0.001). Variables that are found to have significant association with anemia on multilevel analysis were younger age (Adjusted odds ratio (AOR)=1.343, 95% CI: 1.270-1.420), female children (AOR=1.462, 95% CI: 1.387-1.541), more than eight family members in the household (AOR=1.120, 95% CI: 1.008-1.245), rural residence (AOR=1.103, 95% CI: 1.038-1.172) and lower standard of living (AOR=1.203, 95% CI: 1.084-1.334). Conclusions: Half of school going children were anemic in the state. Geospatial distribution of anemia varied significantly. Governments and regional health centres should take adequate measures to avert the consequences of anemia in school going children considering these factors.

Clerodendrum infortunatum Attenuates Pancreatic Oxidative Stress and Dysregulated Carbohydrate Metabolism in Streptozotocin-Induced Experimental Diabetes

The prevalence of diabetes mellitus is increasing at an alarming rate and is gravely troubling human health and quality of life. Side effects of synthetic hypoglycemic agents have led to investigations on alternative sources such as herbal drugs in treating diabetes. Anti-diabetic properties of Clerodendrum infortunatum in streptozotocin-induced experimental diabetes were evaluated and compared with the standard anti-diabetic drug glibenclamide. Aqueous extract of C. infortunatum on carbohydrate metabolism revealed its hypoglycemic effect in diabetic conditions. Furthermore, it could significantly modulate insulin secretion, glycolysis, gluconeogenesis and glycogen metabolism for effective glucose homeostasis. Notably, the drug could accelerate the activities of major antioxidant enzymes and reduce the content of lipid peroxidation products in the pancreas. The study proves the efficacy of C. infortunatum as a potent source of phytochemicals in ameliorating diabetic complications and suggests the medicinal plant as a nutraceutical agent.

Prevalence and Correlates of Vitamin D Deficiency Among Children and Adolescents From a Nationally Representative Survey in India

Objective: To evaluate the prevalence of vitamin D deficiency (VDD) and its correlates among apparently healthy children and adolescents. Methods: We carried out a secondary analysis of data of Comprehensive National Nutrition Survey 2016-18 to analyze the pre-valence and predictors of VDD among Indian children and adolescents. Results: The over-all prevalence of VDD in preschool children (1-4 years), school age (5-9 years) children, and adolescents (10-19 years) was 13.7%, 18.2%, and 23.9%, respectively. Age, living in urban area, and winter season were significantly associated with VDD. Vegetarian diet and high-income households were the main risk factors observed in 5-19 years age category. Female sex and less than three hour of physical activity/week were independent risk factors among adolescents. Conclusion: The prevalence and determinants of VDD across different age-groups are reported, and these should be interpreted and addressed to decrease the burden of VDD in India.

A Prospective Study on Outcome of Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

Background: Cerebrospinal fluid (CSF) rhinorrhea is the result of an osseous defect in the skull base coupled with a disruption of duramater and arachnoid mater with a resultant pressure gradient, leading to CSF leak. CSF leak can be categorized into spontaneous(idiopathic), traumatic, and non-traumatic. Endoscopic transnasal approach is an extracranial approach which has the advantage ofbeing less invasive, no external scar, excellent site localization with preservation of the surrounding anatomy, and shorter hospital stay.Aim of the Study: The aim of the study was to assess the outcome of repair, cause, site of leak, and efficacy of materials usedfor the repair, elucidate the advantages of endoscopic approach.Materials and Methods: A total of 25 patients with CSF rhinorrhea arising from anterior and middle cranial fossa not subsidingwith medical management were included in this prospective study. Patients of all ages and gender were included in the study.Patients with recent history of meningitis were excluded from the study. All the patients were evaluated for CSF rhinorrhea usingbattery of tests including clinical examination for reservoir sign, biochemical and microbiological analysis of fluid, radiologicalinvestigations, and diagnostic nasal endoscopy to assess the site of leak. The demographic data, CSF leak site and size, etiology,complications, surgical closure techniques, complications of surgery, and recurrences and its management were observed andrecorded. All the data were analyzed using standard statistical methods.Observation and Results: Among the 25 patients, 14/25 (56%) patients were aged below 30 years followed by 11/25 (44%)patients who were aged between 30 and 60 years. The mean age was 34.20 ± 2.35 years. 16/25 (64%) patients were (64%)female and 9/25 (36%) patients were male. 22/25 patients (88%) had spontaneous leaks and 3 patients (12%) had traumaticleaks. In 18/25 (72%) of the patients, the site of leak was in the cribriform plate, 4/25 (16%) from fovea ethmoidalis, 2/25(8%)from the sphenoid, and 1/25 (4%) from the frontal sinus. Immediate post-operative results were observed in 23/25 (92%) of thepatients and there was no CSF leak. 2/25 (8%) patients had CSF leak for 10 days which later subsided.Conclusions: The most common etiology of CSF rhinorrhea was spontaneous, most common site being the cribriform plate.Autologous fat graft was used as the first layer of underlay technique in most of the cases which act as a good sealant. The efficacyof transnasal endoscopic CSF leak repair in our study was found to be 100%, and it is a highly successful and safe procedure.

Potential increase in photosynthetic response of taro (Colocasia esculenta L.) to photon flux density and elevated CO2

Aim: The present study was undertaken to study the net photosynthetic rate (Pn), stomatal conductance (gs) and intercellular CO2 (Ci) in five eddoe and four dasheen type taro genotypes under ambient and elevated CO2 , and subjected to different photon flux densities. Methodology: The critical evaluation of Pn was assessed at different photosynthetic photon flux densities (PPFDs) viz., 200, 400, 600, 800, 1000, 1200 and 1500 µmol m-2 hr-1 under ambient CO2 (400 ppm) and at saturation PPFD (1500 µmol m-2 hr-1) at short-term (ten min) exposure of leaves to elevated CO2 (eCO2; 600, 800 and 1000 ppm) at 30oC using portable photosynthesis system LI-6400, LICOR, USA in a controlled-climate cuvette system. Results: The Pn in the leaves of nine taro genotypes persistently augmented upon short-term (10 min) exposure to eCO2 concentrations which ranged between 400 ppm and 1000 ppm. Taro genotypes exhibited 61.80 – 113.3% hike in Pn at eCO2 (1000 ppm) as compared to ambient CO2 (400 ppm). However, the per cent increase in Pn at eCO2 for every 200 ppm between 400 to1000 ppm significantly declined (4.4-18.4%) at 1000 ppm CO2. The differences in gs were statistically significant across taro genotypes (P>0.001) and CO2 concentrations (P>0.001). Further, the Ci was also found to increase constantly at eCO2 concentrations (400 ppm to 1000 ppm). However, there was significant reduction (16.2 - 31.3%) in Ci for every 200 ppm between 400-1000 ppm. Interpretation: Results of the study revealed that the genotypes Muktakeshi, Sree Pallavi and Telia are promising in the context of climate change as they significantly responded to eCO2 concentrations. Response mechanism to eCO2 need to be elucidated.

Monitoring and decontamination of pesticide residues in okra (Abelmoschus esculentus Moench).

A monitoring study was carried out in okra for a period of six months to assess the level of pesticide residues of three different chemical groups ie organochlorines, organophosphates and synthetic pyrethroids. Okra samples showed residues of malathion and profenophos. To evaluate the effect of different decontaminating solutions in the removal of pesticide residues, okra var. Varsha Upahar was sprayed with a mixture of pesticides which were frequently detected in okra. Estimation of residues was done using Gas Chromatograph equipped with Electron Capture Detector. The results indicated that dipping in tamarind (2 %) solution for 15 minutes followed by washing in tap water was found to be more effective in reducing all pesticides tested when compared with other treatment solutions. This study helped to standardize simple cost effective strategies to eliminate harmful pesticides from okra which could be practiced by home makers.

Prevention of vertical transmission of HIV in India through service integration: lessons from Mysore District, Karnataka.

Meeting the needs of HIV‑positive pregnant women and their offspring is critical to India’s political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent‑to‑child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT‑RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels − policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.

Perceived stress, life events & coping among higher secondary students of Hyderabad, India: A pilot study.

Background & objectives: Psychosocial stressors leading to allostatic load need to be explored further as these have great scope for early intervention. Stress studies done in India are mostly based on sources of stress and objective measures of stress. Therefore, the objective of the present study was to assess stress appraisal among students (16-17 yr) and to identify institution-specific differences (Private vs. Government) in stress appraisal and coping. Methods: The study was carried out among 16-17 yr old apparently normal students. Eighty students were recruited from six schools ensuring equal representation from gender/category of schools (Government/ Private). Validated and culturally adaptable behavioural scales for perceived stress (PSS), stressful life events (LES) and coping were administered. Psychological morbidity was assessed using GHQ-12. Data on 75 students were available for statistical analysis. Results: The students of both Government and Private schools showed similar stress perception, though the former tend to have a higher mean score. The scores were significantly higher on avoidance coping (P<0.05). The stepwise regression model showed coping as the independent predictor of perceived stress (R2= 10%). Interpretation & conclusions: Students from Government schools had significantly higher scores on avoidance coping and therefore, suitable for a systematic study on chronic stress for early intervention.

Prevalence of Clinical and Sub-Clinical Vitamin A Deficiency Among Rural Preschool Children of West Bengal, India.

A community based cross-sectional study was carried out in rural areas of West Bengal with the aim to assess the prevalence of vitamin A deficiency (VAD) among rural preschool children. Clinical examination was carried out on 9,228 children for the signs and symptoms of VAD and a sub-sample of 590 children were covered for the estimation of blood vitamin A levels using dried blood spot (DBS) method. The prevalence of Bitot’s spots was 0.6% (95% CI=0.44, 0.76), which is more than the public health significance, and it increased with increase in age. The prevalence was significantly higher (P<0.001) among boys (0.8%) as compared to girls (0.4%). The proportion of children with subclinical vitamin A deficiency (blood vitamin A < 20μg/dL) was 61% (95% CI: 52.3-65.1), and it was significantly (P<0.01) higher among the children of lower socioeconomic communities.

Iron-zinc interaction during uptake in human intestinal Caco-2 cell line: Kinetic analyses and possible mechanism.

Iron and zinc interact at the enterocyte during absorption, but the mechanism(s) remain elusive. The aim was, therefore, to understand the mechanism of interaction using kinetic analyses of iron and zinc uptake, individually and in combination under normal and altered cellular mineral concentrations in human intestinal Caco-2 cell line. Striking differences in kinetic parameters were observed between iron and zinc uptake. Iron uptake followed a two-component model, while zinc uptake followed a three-component model. Iron uptake had a Km of 3.6 µM and Vmax of 452 pmol/mg protein/min, while zinc uptake had a Km of 42 µM and Vmax of 3.09 pmol/mg protein/min. Zinc dose-dependently inhibited iron uptake through mixed-inhibition but iron marginally increased zinc uptake. Cellular zinc repletion doubled iron uptake and eliminated inhibition, but zinc depletion decreased iron uptake. Iron pre-treatment had no effect on zinc uptake. Based on these results, a two-transporter model of iron uptake, comprising the apical iron uptake transporter divalent metal ion transporter-1 (DMT-1) and an unknown putative transporter was derived. This model for DMT-1 was verified by immunoblotting. These results implied that cellular zinc status profoundly influenced iron uptake and its interactions with zinc during uptake. DMT-1 might not simultaneously transport iron and zinc, providing a mechanistic basis for observed interactions.

Skeletal muscle mitochondrial dysfunction & diabetes.

Skeletal muscle insulin resistance is a key contributor to the pathophysiology of type 2 diabetes. Recent studies have shown that insulin resistance in a variety of conditions including type 2 diabetes, ageing and in offspring of type 2 diabetes is associated with muscle mitochondrial dysfunction. The important question is whether insulin resistance results from muscle mitochondrial dysfunction or vise versa. Gene array studies from muscle biopsy samples showed that transcript levels of several genes, especially OXPHOS genes are altered in type 2 diabetic patients during poor glycaemic control but many of these alterations are normalized by insulin treatment suggesting that reduced insulin action is a factor involved in muscle mitochondrial dysfunction. Moreover, insulin infusion while maintaining glucose and amino acid levels results in increase in muscle mitochondrial gene transcript levels and ATP production indicating that insulin is a key regulator of muscle mitochondrial biogenesis. At a similar post-absorptive insulin levels both type 2 diabetic patients and non diabetic controls have similar muscle mitochondrial ATP production but increasing insulin from low to high levels stimulate ATP production only in non diabetic people but not in the diabetic people. The lack of muscle mitochondrial response to insulin in type 2 diabetic patients is likely to be related to insulin resistance and reduced substrate utilization.

Regional differences in constituents of gall stones.

The pathogenesis of pigment and mixed gall stone formation remains elusive. The elemental constituents of gall stones from southern states of Tamil Nadu, Kerala and Karnataka have been characterized. Our aim was to determine the elemental concentration of representative samples of pigment, mixed and cholesterol gall stones from Andhra Pradesh using proton-induced X-ray emission (PIXE) using a 3 MV horizontal pelletron accelerator. Pigment gall stones had significantly high concentrations of copper, iron and lead; chromium was absent. Except for iron all these elements were significantly low in cholesterol gall stones and intermediate levels were seen in mixed gall stones. Highest concentrations of chromium was seen in cholesterol and titanium in mixed gall stones respectively; latter similar to other southern states. Arsenic was distinctly absent in cholesterol and mixed gall stones. The study has identified differences in elemental components of the gall stones from Andhra Pradesh.

Role of clinical neurophysiological tests in evaluation of erectile dysfunction in people with spinal cord disorders.

BACKGROUND: While erectile dysfunction is frequent among people with disorders of the spinal cord, the role of various clinical neurophysiological tests in assessment is not clear. AIMS: To study the role of clinical neurophysiological investigations in assessing erectile dysfunction among men with spinal cord disorders. SETTING: National Institute of Mental Health and Neurosciences, India. DESIGN: Survey. MATERIALS AND METHODS: Subjects with a score of 21 or less on the International Index of Erectile Function-5 were classified as with erectile dysfunction and with a score of more than 21 as without erectile dysfunction. Clinical neurophysiological studies done were Sympathetic Skin Response from limbs, posterior tibial sensory evoked potential, pudendal sensory potential and bulbocavernous reflex. STATISTICAL ANALYSES: Chi-square test. RESULTS: Among 40 subjects 26 had erectile dysfunction. The frequency of abnormalities in clinical neurophysiological studies were: pudendal sensory evoked potentials--16, posterior tibial sensory evoked potentials--26, bulbocavernous reflex--5, sympathetic skin response from sole--24 and, sympathetic skin response from palm--18. Significant associations were noted between erectile dysfunction and abnormal pudendal sensory evoked potentials (P=0.0479), and absent sympathetic skin response from palm (P=0.0279) and sole (P< 0.001). There was no correlation between erectile dysfunction and posterior tibial sensory evoked potentials (P=0.133) or bulbocavernous reflex (P=0.418). Sympathetic skin response from sole was most sensitive (80.8%) and had best positive (87.5%) and negative predictive (68.8%) values. The specificity of these three tests was 78.6%. CONCLUSIONS: Sympathetic skin response from the sole of the foot was the most sensitive and specific clinical neurophysiological test for erectile dysfunction in spinal cord disorders.

Vitamin E prevents deleterious effects of di (2-ethyl hexyl) phthalate, a plasticizer used in PVC blood storage bags.

Vitamin E administration prevented DEHP induced deleterious effects like (i) degenerative changes in the brain and thyroid, (ii) decrease in the activity of neuronal membrane Na+ - K+ ATPase, (iii) decrease in the concentration of insulin, cortisol and TSH, and (iv) the increase in T3 and T4 in female Albino rats. The results suggest use of vitamin E to prevent harmful effects of repeated transfusion of DEHP containing blood as in thalassemia patient. The possibility of using vitamin E to prevent the harmful effects of repeated transfusion of DEHP containing blood, as in thalassemia patients, is discussed.

Effects of eyestalk ablation on moulting and growth of penaeid prawn Metapenaeus dobsoni (de Man).

Penaeid prawns M. dobsoni of two different size ranges were ablated both unilaterally (UEA) and bilaterally (BEA) and subjected to individual study. The UEA prawns consumed almost the same amount of food as the control prawns in the size group, 35-40mm, but consumed about 57.8% more food than the control prawns in the larger size group, 48-53mm. Growth was estimated as length and weight changes and significant variation was observed. The moult rate and dry moult weight showed marked differences. Average intermoult period increases with second ablation. Dry weight of moult in every succeeding moult was found to decrease irrespective of the level of ablation. Unilateral eyestalk ablation resulted in increase in dry weight whereas bilateral eyestalk ablation reduced the dry weight of moult and this decrease in the rate increased after each subsequent moult. In the larger size group, values of protein efficiency ratio (PER) were almost same as that of the lower size group. The UEA prawns exhibited highest conversion efficiency. The production rate of UEA prawns was 84% more than that of the control whereas BEA prawns indicated negative production. The same trend followed for net growth efficiency also. The results suggest that unilateral eyestalk ablation can be resorted to accelerate growth and conversion efficiency. Eyestalk ablation has been frequently resorted in matured forms for inducing maturation of gonads. For the first time attempts have been made to compare between the effects of removing one eyestalk versus two and changes taking place in juvenile forms especially in their physiology related to growth.

Diabetes in old age: an emerging epidemic.

Diabetes in the elderly is emerging as one of the most important public health problems of the 21st century. In developing countries, the majority of people with diabetes are in the age range of 45-64 years. A better understanding on the pathogenesis of diabetes in the aging population is required to successfully treat and prevent its devastating complications. Changes in body composition with accumulation of fat in the abdomen is a key factor in the causation of diabetes in the aging population. The size and strength of skeletal muscle, a major tissue involved in glucose metabolism, also declines leading to muscle weakness and a reduction in physical activity. These changes lead to marked reduction in energy expenditure and abdominal fat accumulation causing insulin resistance. Recent evidence suggests that four months of aerobic exercise can improve muscle oxidative capacity similarly in younger and older people, but that insulin sensitivity is less likely to improve in older people. It appears that older people need to exercise more frequently to improve their insulin sensitivity. Diagnosis and management of diabetes in the elderly requires special attention since age, genetics, body composition and lifestyle factors all interact. Increasing evidence suggests that postprandial hyperglycemia is more sensitive to diagnose diabetes in elderly people than in the young. Age related changes in body function and cognition demand special caution in the selection of hypoglycemic drugs in the elderly. Targets of diabetes therapy in the elderly have to be individualized, considering the age of the patient, remaining life-expectancy and severity of co-morbid conditions. Short acting insulin secretogogues are preferred to avoid prolonged and frequent hypoglycemia. Judicious choice of insulin sensitizers, timely introduction of insulin, meticulous control of hypertension and hyperlipidemia are critical to prevent complications.