Nutrition morbidity interactions in pre-school children

Background & objectives: Research studies in the 1970s reported that in pre-school children, undernutrition increased the risk of infections and infections aggravated undernutrition. Over decades, there has been a reduction in prevalence of undernutrition and improvement in access to healthcare for treatment of infections. A mixed longitudinal study was undertaken to assess whether over time there were any changes from the earlier reported effect of undernutrition prior to infection on the risk of morbidity and effect of morbidity on nutritional status in pre-school children. Methods: Pre-school (0-59 months of age) children from urban low- and middle-income families whose parents were willing to allow their participation in the study were enrolled. Information on sociodemographic profile of the families was collected at enrolment. Weight of all children and length in infants were recorded every month; length/height in children 12-59 months of age was recorded once in three months. Morbidity information was collected through fortnightly visits. Results: 3888 pre-school children were followed up in 74636 home visits. Among these children, underweight and wasting were associated with a small increase in risk of infections. The odds ratio for risk of infection for underweight children was 1.09 (95% CI: 1.02 to 1.16) and for wasting was 1.18 (95% CI: 1.08 to 1.29). The deterioration in Z scores for weight-for-age and body mass index-for-age in children during illness and convalescence was small but significant (P<0.001). Interpretation & conclusions: The increased risk of infections in undernourished children living in overcrowded tenements in areas with poor environmental hygiene was not significant, perhaps because the risk of infection in normally nourished children was also high. The deterioration in nutritional status following infection was small because of the ready access to and utilization of health and nutrition care.

INTRA-FAMILY DIFFERENCES IN NUTRITIONAL STATUS BETWEEN PRE-SCHOOL AND SCHOOL AGE CHILDREN

Currently under- and over-nutrition are public health problems in Indian children. A community-based study in 3249 children was undertaken to assess the magnitude of intra-family differences in nutritional status between pre-school and school age children from urban low middle income families. Length/height and weight were measured; nutritional status was computed using WHO Anthro and Anthro Plus software. One-fourth of children were stunted, 1/5th underweight, 1/10th wasted and less than 5% were overweight. Prevalence of stunting, underweight and wasting was higher in children whose elder siblings were stunted, underweight or wasted. However, majority of the younger siblings of under-nourished elder siblings were normally nourished; majority of the elder siblings of undernourished younger sibling were normally nourished. In view of this, it is essential to screen all children, identify those who are under- or overnourished using BMI-for-age and provide appropriate interventions.

Vernal keratoconjunctivitis in human immunodeficiency virus – The possible role of T-helper 1–T-helper 2 shift

Human immunodeficiency virus infection (HIV) is associated with a reduced T-helper (Th) 1 response, and vernal keratoconjunctivitis (VKC) occurs secondary to a heightened Th2 response. VKC has been reported to occur in patients with HIV. In all probability, a Th1–Th2 shift occurs in the immune response in progressive HIV patients with a decreasing CD4 count. This shift could be the probable cause for the initiation and gradual worsening of the VKC in our patient that corresponded to the dropping CD4 counts. VKC resolved only after a change in antiretroviral therapy for HIV that caused a demonstrable increase in the CD4 counts possibly by reversing the shift.

Time trends in prevalence of anaemia in pregnancy

Background & objectives: The prevalence of anaemia in pregnancy in India is among the highest in the world. In the last two decades, several national surveys have estimated haemoglobin levels in pregnant women. In this study, data from these surveys were analyzed to find out changes, if any, in prevalence of anaemia in pregnancy. Methods: National and State-level estimates on the prevalence of anaemia were tabulated from the reports of the National Family Health Survey (NFHS) 2, NFHS 3, Fact Sheets of NFHS 4 and District Level Household Survey (DLHS) 2. Unit level data from DLHS 4 and Annual Health Survey Clinical Anthropometric and Biochemical component (AHS CAB) were obtained and State level prevalence of different grades of anaemia was estimated. Time trends in the prevalence of anaemia and different grades of anaemia were assessed from these surveys. Results: NFHS 2, 3 and 4 reported relatively lower prevalence of anaemia as compared to DLHS and AHS CAB. There was not much change in the prevalence or severity of anaemia between NFHS 2, 3 and 4. There was substantial reduction in the prevalence and severity of anaemia in all States except Uttarakhand between DLHS 2 and 4 and DLHS 2 and AHS CAB. Interpretation & conclusions: There was a reduction in the prevalence and severity of anaemia in the last 15 years. The two-pronged strategy of increasing iron intake (dietary diversification and use of iron-fortified iodized salt) in all the population and testing, and detecting and treating pregnant women with anaemia will accelerate the pace of reduction in anaemia.

Time Trends in Prevalence of Anaemia in Adolescent Girls

Introduction: Anaemia in adolescent girls has been recognised as a major public health problem. The Mid-day meal programme guidelines envisage inclusion of 75 g/day of vegetables and use of iron fortified iodised salt for hot cooked meal. The National Iron Plus Initiative envisages weekly iron-folic acid (IFA) supplementation for adolescent girls; however, coverage and compliance have been reported to be low. Data from national surveys carried out in the last two decades were analysed to assess changes, if any, in Hb levels and prevalence of anaemia in adolescent girls. Material and Methods: Raw data from National Family Health Surveys (NFHS) -2, -3, and -4, District Level Household Surveys (DLHS) 2 and 4, and Annual Health Survey-related to Clinical, Anthropometric and Biochemical Components (AHS-CAB) were analysed to assess mean Hb, prevalence of anaemia and frequency distribution of Hb in adolescent girls. Comparison in these parameters was made between non-pregnant girls 10-14 years and 15-19 years of age in DLHS-2, -4 and AHS-CAB; in the 15-19 year age group comparisons were made between pregnant and nonpregnant girls in NFHS series and DLHS AHS series. Results: There were no clear and consistent changes in mean Hb, prevalence of anaemia and frequency distribution of Hb in pregnant and non-pregnant adolescent girls between NFHS-2, -3 and -4 either at national or at State level. However, there was a 0.7 and 1.3 g/dL increase in mean Hb levels in nonpregnant girls (10-19 yrs) between DLHS-2 and AHS-CAB and DLHS-4 States, respectively. The increase in mean Hb of pregnant girls (15-19 yrs) was 1.1 g/dLand 1.4g/dLin AHS-CAB and DLHS 4 States, respectively. There was significant reduction in prevalence of anaemia in both pregnant and non-pregnant girls between DLHS 2 and DLHS 4 and AHS-CAB at the aggregate level for each survey and in all States except Uttarakhand. Conclusion: There has been some improvement in Hb levels in adolescent girls in the last two decades. Improving dietary intake of vegetables and promoting use of iron fortified iodised salt in all households in the country have to be taken up so that iron intake across all age groups improves. This when combined with daily IFA supplementation for three months in a year in adolescent girls, might lead to sustained improvement in Hb.

Idiopathic intracranial hypertension associated with anaemia, secondary to antiretroviral drug in a human immunodeficiency virus positive patient

Papilledema in a patient with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome is an alarming finding. Any condition giving rise to raised intracranial tension (ICT) can cause papilledema, and in these patients, it could be secondary to opportunistic infections like meningitis to neoplasm. We report a case of a 28-year old female with HIV on antiretroviral therapy, who presented to us, with papilledema. Her fundus examination revealed superficial hemorrhages and Roth's spots along with papilledema. Patient was diagnosed with idiopathic intracranial hypertension (IIH), and all other possible systemic associations were ruled out. Her blood tests showed severe anemia. The papilledema and retinal changes resolved with treatment of anemia. This is a rare presentation of IIH in HIV positive patient due to anemia, secondary to zidovudine adverse effect.

An Efficient Watermarking Scheme for Medical Data Security With the Aid of Neural Network

ABSTRACT Digital watermarking has emerged as major technique for ensuring security for various types of data like medical data, digital copyright protection, transaction tracing and so on. With the advancement in digital data distribution over the network there has been increase in the need for protection of such data from unauthorized copying or usages. Watermarking helps in providing the security to some extent. Robustness against any sort of unauthenticated attack is the major requirement of watermarking. In this paper we proposed an efficient watermarking technique for medical data security with the aid of neural network. Usage of neural network is generally used to create and control watermarking strength automatically. This method provides better watermarked data which can be highly secured to unauthorized usage. It is observed that the proposed method provides better security for the multimedia data when compared with other data security methods.