Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons?

Introduction: In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis. Material and Methods: This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed. Results: A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ?27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82). Conclusion: The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.

Excess Screen Time and its Associated Factors among Young Men in a Rural Community of North India

Screen-based media usage among young people is blooming rapidly due to technological and digital revolution. We conducted community-based cross-sectional study to determine the prevalence of excess screen time and its association with sociodemographic and behavioral patterns in a rural block of Haryana, India. Asemi-structured interview schedule was administered by trained physicians to ascertain screen time in a typical day and various socioeconomic and behavioral factors among a random sample of 860 young men aged 18–24 years. The prevalence of excess screen time was 61.8% (95% confidence interval [CI] 58.4–65.1). It was significantly associated with education (adjusted odds ratio [AOR] 1.7, 95% CI 1.1–2.6) and occupation (AOR 2.2, 95% CI 1.2–3.9) of the father and their sleep duration of ?8 h (AOR 1.6, 95% CI 1.2–2.3). Limiting the screen time as per international standards and behavioral interventions are needed for this young population.

Sustainable control of malaria employing Gambusia fishes as biological control in Jalore and Barmer districts of Western Rajasthan

Sardar Sarovar Irrigation Canal system was constructed by Narmada Valley Development Authority (NVDA) to cater to drinking water as well as for irrigation purposes in Jalore and Barmer districts of Western Rajasthan. To cater to the needs of water for the villagers in the command areas, ‘Diggies’ (surface water tanks) with ‘Sumpwells’ (water supply surface tanks) were installed. In a health impact assessment study of the irrigation canals from December 2010 to February 2016, the breeding of two major malaria vectors. An. culicifacies and An. stephensi were observed in diggies and sumpwells. As a biological control, Gambusia affanis fishes were employed for larval control in such stagnated water sites during the intervention phase viz. February 2012 in 251 diggies and 251 sumpwells. A significant reduction of breeding in diggies (99.54%) and sumpwells (97.81%) was observed. The positivity and larval density (dip index) were monitored in the control from up to February 2016 for their sustainability.

Prevalence and determinants of depression among elderly persons in a rural community from northern India.

Background. Globally, more than 350 million people of all ages suffer from depression. Elderly persons are more vulnerable to depression. We conducted this study to estimate the prevalence of depression, and to study the association of depression with sociodemographic and clinical variables among elderly persons in a rural community. Methods. We conducted a community-based cross-sectional study among 395 randomly selected elderly persons aged 60 years and above in a rural area of Ballabgarh, Haryana, India. The participants were screened by using the Geriatric Depression Scale, and diagnosis was confirmed by the Mini International Neuropsychiatric Interview. Multivariate analysis was done for independent predictors of depression. Results. The prevalence of depression was 11.4% (95% CI 8.6%–14.9%). Living in a nuclear family (adjusted odds ratio [AOR] 8.98, 95% CI 3.40–23.71), lack of physical activity (AOR 4.95, 95% CI 2.00–12.27), whole-time involvement in household work (AOR 4.47, 95% CI 1.18–16.93), presence of two or more chronic diseases (AOR 4.45, 95% CI 1.60–12.35), having no role in family decision-making (AOR 2.77, 95% CI 1.19–6.42), sleep problems in past one year (AOR 2.97, 95% CI 1.32–6.69) and bilateral hearing impairment (AOR 4.00, 95% CI 1.80–8.88) were factors associated with depression in elderly persons. Conclusions. Depression is common among elderly persons in rural areas. Individuals providing healthcare to elderly persons need to be trained to identify depression and take appropriate action; elderly persons with chronic diseases and hearing impairment deserve special attention. Natl Med J India 2016;29:129–35

Impact of initial topical medical therapy on short‑term quality of life in newly diagnosed patients with primary glaucoma.

Purpose: To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33). Patients and Methods: The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months. Results: Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40–77 years) and controls (mean age: 54.9 ± 6.7 years, 42–73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01). Conclusions: Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.

Three port laparoscopic cholecystectomy in situs inversus totalis: A case report.

Situs inversus totalis (SIT) is a rare anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal anatomy. Location of symptoms and signs arising from a diseased organ may vary. The diagnosis as well as to operate any pathology in such patient is difficult. Laparoscopic cholecystectomy in patient with situs inversus totalis is a challenge but not a contraindication. We have reported here case of an adult woman who presented with on and off pain located at the epigastrium. Clinical examination and laboratory investigations were unremarkable. During radiological evaluation, the patient was found to have situs inversus totalis and features of chronic cholecystitis with cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion by right handed surgeon. In conclusion, Laparoscopic cholecystectomy in these patients is technically more demanding and needs reorientation of visual-motor skills.

Functional Disability Among Elderly Persons in a Rural Area of Haryana.

Background: The number and proportion of elderly persons is increasing, in India, as well as the world. Disability is an important indicator to measure disease burden in this group. While some chronic conditions may not be amenable to complete cure, their functional disabilities can be improved with timely and appropriate management. Objectives: The objective of the following study is to estimate the prevalence of functional disability and study its association with socio-demographic variables and self-reported chronic conditions among elderly persons in a rural area of Haryana. Materials and Methods: All persons aged 60 years and above in the randomly selected six clusters were included in this community-based cross-sectional study. Information was collected on socio-demographic variables and selfreported chronic conditions. Functional disability was defi ned as having disability in activities of daily living, or blindness or hearing impairment, or a combination of these. In multivariate analysis, backward stepwise logistic regression was carried out to study the association between the independent and dependent variables, after adjusting for confounding variables. Results: Among the 836 participants studied, the prevalence of functional disability was estimated to be 37.4% (95% confi dence interval: 34.2, 40.7). The prevalence was less among men (35.9%) than women (38.8%). The prevalence increased with age, was more common among persons who were not currently married, had diabetes and chronic obstructive pulmonary disease. Conclusion: Functional disability is common among elderly persons in the rural area. Community-based interventions are needed tto address them. Management of chronic conditions should include prevention and control of associated disability.

A spatial statistical approach to analyze malaria situation at micro level for priority control in Ranchi district, Jharkhand.

Background & objectives: The presence of efficient malaria vectors namely Anopeles culicifacies, An. fluviatilis and An. annularis (Diptera: Culicidae), rapid industrialization causing large influx of population and poor health infrastructure are some of the factors that make malaria an important public health problem in Ranchi, the capital of Jharkhand State, India. A geographical information system (GIS) based retrospective study using spatial statistical tools was initiated in 328 subcentres of 14 primary health centres (PHCs) of the district using malaria epidemiological data of three years (2007-2009) to identify spatial distribution pattern of Plasmodium vivax (Pv) and Plasmodium falciparum (Pf) occurrence, delineation of hot spots and to map directional distribution trend of Pf spread to help formulate evidence-based policy and to prioritize control during 2011. Methods: Spatial statistics tools like Global Moran's I index, Getis-Ord Gi* and Standard Deviational Ellipse were used in GIS domain for analysis. Results: Spatial distribution pattern of Pv occurrence was found random while Pf distribution was significantly clustered. During 2007-2009, the number of subcentres under Pf hot spot category exhibited downward trend while high Pf risk subcentres exhibited upward trend. One consistent Pf hot spot consisting of five subcentres was identified in Silli PHC. During 2009, one Pf hot spot consisting of 20 subcentres and 18 subcentres under high Pf risk category were identified in Angara, Silli, Burmu and Kanke PHCs. A shifting trend in Pf spread was noticed from north-west to western direction from 2008 onwards. Interpretation & conclusions: The study recommended priority control in 20 Pf hot spot and 18 high Pf risk reporting subcentres including five consistent Pf hot spot subcentres in Angara, Silli, Burmu and Kanke PHCs during 2011 to address grave malaria situation in the district in a cost-effective manner.

High burden of dental caries in geriatric population of India: A systematic review.

Oral health is an essential component of health throughout life. Poor oral health and untreated oral diseases can have a significant impact on the quality of life of the elderly. The objective of this study was to estimate the burden of dental caries among the elderly persons in India in the past two decades. A systematic review from available literature was carried out. Six community-based articles were included in this review. The selected studies were screened by using STROBE checklist for observational studies. All studies were found to contain the required essentials of observational studies. Weighted prevalence of dental caries experience was calculated. Trend was generated using Microsoft Excel program. The prevalence of dental caries experience ranged from 31.5 to 100%. Weighted prevalence of dental caries experience was 83.6% and 82.3% for 2000-2004 and 2005-2009, respectively. There is a high burden of dental caries in the elderly population. Treatment and restorative services need to be provided to alleviate this problem.

Spectrum of haemoglobinopathies diagnosed by cation exchange-HPLC & modulating effects of nutritional deficiency anaemias from north India.

Background & objectives: The usefulness of cation exchange high performance liquid chromatography (CE-HPLC) as a tool for detection of thalassaemia/haemoglobin variants was evaluated in a prospective study in a tertiary care centre in north India. We also tried to evaluate the effect of concurrent nutritional deficiency on the HPLC pattern in the local ethnic population. Methods: A total of 800 blood samples were analyzed on the Bio-Rad Variant HPLC system by β-thal short program. The retention times, proportion of the haemoglobin (%), and the peak characteristics for all haemoglobin fractions were recorded. Alkaline and acid haemoglobin electrophoresis was performed to document the identities of the haemoglobin variants, wherever necessary. Many cases were subjected to family studies for a definitive diagnosis. Results: Among 800 samples tested, 553 (69.1%) were found to have normal HPLC pattern. Apart from β- thalassaemia, nine additional variants were encountered; HbS (2.8%), HbE (2.5%) and HbD (1.1%) being the most common variants present. Other variants included Hb Q-India, Hb-Lepore, δβ-thalassemia/ HPFH, HbD-Iran, HbJ-Meerut and HbH disease. There was a significant decrease in the level of HbA2 associated with iron deficiency anaemia (IDA) (P=0.004) and increase in megaloblastic anaemia (P<0.001) among subjects with normal HPLC pattern. Interpretation & conclusions: HPLC was found to be a simple, rapid and reliable method for the detection of hemoglobin variants. An accurate diagnosis can be provided in majority of cases by use of retention time, proportion of total haemoglobin, and peak characteristics of HPLC. Haemoglobin electrophoresis and family studies play a valuable role in difficult cases. Concurrent nutritional deficiency also has an effect on HbA2 levels.