Ethnopharmacological uses of fauna among the people of central Punjab, Pakistan.

Introduction: The utilization of fauna and fauna-based byproducts in ethnomedicinal usages has been a longstanding human activity, practiced across various cultures worldwide. This study focuses on investigating the utilization of animal-based traditional medicine by the people of Pakistan, specifically in the Gujranwala area. Methods: Data collection took place from January to September 2019 through interviews with local communities. Ethnomedicinal applications of animal products were analyzed using several indices, including Relative Frequency of Citation (RFC), Relative Popularity Level (RPL), Folk Use Value (FL), and Relative Occurrence Percentage (ROP). Results: The study identified the use of different body parts of 54 species of animals in treating various diseases and health issues. These include but are not limited to skin infections, sexual problems, pain management (e.g., in the backbone and joints), eyesight issues, immunity enhancement, cold, weakness, burns, smallpox, wounds, poisoning, muscular pain, arthritis, diabetes, fever, epilepsy, allergies, asthma, herpes, ear pain, paralysis, cough, swelling, cancer, bronchitis, girls' maturity, and stomach-related problems. Certain species of fauna were noted by informers with high "frequency of citation" (FC), ranging from 1 to 77. For instance, the black cobra was the most frequently cited animal for eyesight issues (FC = 77), followed by the domestic rabbit for burn treatment (FC = 67), and the Indus Valley spiny-tailed ground lizard for sexual problems (FC = 66). Passer domesticus and Gallus gallus were noted to have the highest ROP value of 99. Discussion: The findings of this study provide valuable preliminary insights for the conservation of fauna in the Gujranwala region of Punjab, Pakistan. Additionally, screening these animals for medicinally active compounds could potentially lead to the development of novel animal-based medications, contributing to both traditional medicine preservation and modern pharmaceutical advancements.

Dengue hemorrhagic fever: a growing global menace.

Dengue virus is an arthropod-borne virus, transmitted by Aedes aegypti among humans. In this review, we discussed the epidemiology of dengue hemorrhagic fever (DHF) as well as the disease's natural history, cycles of transmission, clinical diagnosis, aetiology, prevention, therapy, and management. A systematic literature search was done by databases such as PubMed and Google Scholar using search terms, 'dengue fever', 'symptoms and causes of dengue fever', 'dengue virus transmission', and 'strategies to control dengue'. We reviewed relevant literature to identify hazards related to DHF and the most recent recommendations for its management and prevention. Clinical signs and symptoms of dengue infection range from mild dengue fever (DF) to potentially lethal conditions like DHF or dengue shock syndrome (DSS). Acute-onset high fever, muscle and joint pain, myalgia, a rash on the skin, hemorrhagic episodes, and circulatory shock are among the most common symptoms. An early diagnosis is vital to lower mortality. As dengue virus infections are self-limiting, but in tropical and subtropical areas, dengue infection has become a public health concern. Hence, developing and executing long-term control policies that can reduce the global burden of DHF is a major issue for public health specialists everywhere.

Comparative efficacy of different salt tolerant rhizobial inoculants in improving growth and productivity of Vigna radiata L. under salt stress.

Worldwide, salinity severely affects agricultural production of crops such as mung bean in arid and semi-arid regions. In saline conditions, various species of Rhizobium can be used to enhance nodulation and induce salinity tolerance in maize. The present study conducted a pot experiment to determine the efficiency of three rhizobial isolates under different salinity conditions, such as 1.41, 4 and 6 dS m-1, on mung bean growth parameters, antioxidant status and yield. Results revealed that salt stress imparted adverse effects on the growth, antioxidants, yield and nodulation of mung bean. Under high salt stress conditions, fresh weights were reduced for roots (78.24%), shoots (64.52%), pods (58.26%) and height (32.33%) as compared to un-inoculated control plants. However, an increase in proline content (46.14%) was observed in high salt stressed plants. Three Rhizobium isolates (Mg1, Mg2, and Mg3), on the other hand, mitigated the negative effects of salt stress after inoculation. However, effects of Mg3 inoculation were prominent at 6 dS m-1 and it enhanced the plant height (45.10%), fresh weight of shoot (58.68%), root (63.64%), pods fresh weight (34.10%), pods number per plant (92.04%), and grain nitrogen concentration (21%) than un-inoculated control. Rhizobium strains Mg1, and Mg2 expressed splendid results at 1.41 and 4 dS m-1 salinity stress. The growth promotion effects might be due to improvement in mineral uptake and ionic balance that minimized the inhibitory effects caused by salinity stress. Thus, inoculating with these strains may boost mung bean growth and yield under salinity stress.

Synergistic Effects of Rhizobacteria and Salicylic Acid on Maize Salt-Stress Tolerance.

Maize (Zea mays L.) is a salt-sensitive plant that experiences stunted growth and development during early seedling stages under salt stress. Salicylic acid (SA) is a major growth hormone that has been observed to induce resistance in plants against different abiotic stresses. Furthermore, plant growth-promoting rhizobacteria (PGPR) have shown considerable potential in conferring salinity tolerance to crops via facilitating growth promotion, yield improvement, and regulation of various physiological processes. In this regard, combined application of PGPR and SA can have wide applicability in supporting plant growth under salt stress. We investigated the impact of salinity on the growth and yield attributes of maize and explored the combined role of PGPR and SA in mitigating the effect of salt stress. Three different levels of salinity were developed (original, 4 and 8 dS m-1) in pots using NaCl. Maize seeds were inoculated with salt-tolerant Pseudomonas aeruginosa strain, whereas foliar application of SA was given at the three-leaf stage. We observed that salinity stress adversely affected maize growth, yield, and physiological attributes compared to the control. However, both individual and combined applications of PGPR and SA alleviated the negative effects of salinity and improved all the measured plant attributes. The response of PGPR + SA was significant in enhancing the shoot and root dry weights (41 and 56%), relative water contents (32%), chlorophyll a and b contents (25 and 27%), and grain yield (41%) of maize under higher salinity level (i.e., 8 dS m-1) as compared to untreated unstressed control. Moreover, significant alterations in ascorbate peroxidase (53%), catalase (47%), superoxide dismutase (21%), MDA contents (40%), Na+ (25%), and K+ (30%) concentration of leaves were pragmatic under combined application of PGPR and SA. We concluded that integration of PGPR and SA can efficiently induce salinity tolerance and improve plant growth under stressed conditions.

Vernacular Taxonomy, Cultural and Ethnopharmacological Applications of Avian and Mammalian Species in the Vicinity of Ayubia National Park, Himalayan Region.

Numerous investigations on plant ethnomedicinal applications have been conducted; however, knowledge about the medicinal use of wild animals is still limited. This present study is the second on the medicinal and cultural meaning of avian and mammalian species used by the population in the surrounding area of the Ayubia National Park, KPK, Pakistan. Interviews and meetings were compiled from the participants (N = 182) of the study area. The relative frequency of citation, fidelity level, relative popularity level, and rank order priority indices were applied to analyze the information. Overall, 137 species of wild avian and mammalian species were documented. Of these, 18 avian and 14 mammalian species were utilized to treat different diseases. The present research showed noteworthy ethno-ornithological and ethno-mammalogical knowledge of local people and their connection with fauna, which might be useful in the sustainable utilization of the biological diversity of the Ayubia National Park, Khyber Pakhtunkhwa. Furthermore, in vivo and/or in vitro examination of the pharmacological activities of species with the highest fidelity level (FL%) as well as frequency of mention (FM) might be important for investigations on faunal-based new drugs.

Molecular Characterization and Phylogenetic Analysis of Casein Gene Family in Camelus ferus.

Camel milk is known for its exceptional medical uses. It has been used since ancient times to treat infant diarrhea, hepatitis, insulin-dependent diabetes (IDDM), lactose intolerance, alcohol-induced liver damage, allergies, and autism. It has the power to treat several diseases, with cancer being the most significant. This study investigated the evolutionary relationship, physiochemical characteristics, and comparative genomic analysis of the casein gene family (CSN1S1, CSN2, CSN1S2, and CSN3) in Camelus ferus. Molecular phylogenetics showing the camelid species clustered casein nucleotide sequences into four groups: CSN1S1, CSN2, CSN1S2, and CSN3. The casein proteins from camels were evaluated and found to be unstable, thermostable, and hydrophilic. CSN1S2, CSN2, and CSN3 were acidic, but CSN1S1 was basic. CSN1S1 showed positive selection for one amino acid (Q), CSN1S2 and CSN2 for three (T, K, Q), and CSN3 showed no positive selection. We also compared high-milk-output species such as cattle (Bos Tarus) and low-milk-yield species such as sheep (Ovies Aries) with camels (Camel ferus) and discovered that YY1 sites are more frequent in sheep than in camels and very low in cattle. We concluded that the ratio of YY1 sites in these species may affect milk production.

Cross-cultural diversity analysis: traditional knowledge and uses of freshwater fish species by indigenous peoples of southern Punjab, Pakistan.

BACKGROUND: Fisheries have tremendous cultural and educational importance in human societies. The world is undergoing fast environmental and cultural changes, and local knowledge is being lost. Understanding how people interpret environmental change and develop practices in response to such change is essential to comprehend human resource use. This study was planned with the intent to document and conserve the knowledge about the uses of the freshwater fish fauna among the residents in South Punjab, Pakistan. METHODS: Semi-structured interviews and questionnaires were conducted to collect data from informers (N = 88). Principal component analysis, relative frequency citation, fidelity level, relative popularity level, rank-order priority, and similarity index were used to analyze the fish data. RESULTS: Overall, a total of 43 species of fishes were utilized in the study region, but only 26 species were utilized ethnomedicinally to treat a variety of illnesses such as asthma, body weakness, burn, chicken pox, cold, cough, eyesight, hepatitis, impotence, joint pain, night blindness, skin burn, spleen treatment, stomach infection, and weakness. The uses of fishes were analyzed employing various indices. The highest use value (UV) of 0.86 was calculated for spotted snakehead (Channa punctata), whereas the lowest UV of 0.05 was attained by karail fish (Securicula gora). Moreover, Channa punctata, Cyprinus carpio, Labeo rohita, Oreochromis niloticus, Wallago attu, Hypophthalmichthys molitrix, Rita rita, Sperata seenghala, Notopterus notopterus, Labeo dyocheilus, Systomus sarana, Puntius punjabensis, Securicula gora, Ompok bimaculatus, and Ompok pabda were the most popular species with RPL = 1.0. Out of the total, 20 species had a "zero" similarity index, while the ethnomedicinal use of 12 species (i.e., Labeo dyocheilus, Labeo boggut, Systomus sarana, Puntius punjabensis, Aspidoparia morar, Securicula gora, Crossocheilus diplochilus, Mastacembelus armatus, Ompok bimaculatus, Ompok pabda, Labeo gonius, and Sperata seenghala) was documented for the first time for a variety of diseases (i.e., body weakness, stomach infection, skin burn, joint pain, impotence, asthma, spleen treatment, and chicken pox). CONCLUSION: Our findings showed that the local people of the study area hold noteworthy traditional knowledge about the medicinal and cultural uses of fish species. Furthermore, a comprehensive analysis of active chemicals and in vivo and/or in vitro activities of chemicals derived from ichthyofauna with the highest FC as well as UVs could be interesting for research on new drugs.

An assessment of the efficacy of biochar and zero-valent iron nanoparticles in reducing lead toxicity in wheat (Triticum aestivum L.).

Soil heavy metal contamination is increasing rapidly due to increased anthropogenic activities. Lead (Pb) is a well-known human carcinogen causing toxic effects on humans and the environment. Its accumulation in food crops is a serious hazard to food security. Developing environment-friendly and cost-efficient techniques is necessary for Pb immobilization in the soil. A pot experiment was executed to determine the role of biochar (BC), zero-valent iron nanoparticles (n-ZVI), and zero-valent iron nanoparticles biochar composite (n-ZVI-BC) in controlling the Pb mobility and bioaccumulation in wheat (Triticum aestivum L.). The results showed that BC and n-ZVI significantly enhanced the wheat growth by increasing their photosynthetic and enzymatic activities. Among all the applied treatments, the maximum significant (p ≤ 0.05) improvement in wheat biomass was with the n-ZVI-BC application (T3). Compared to the control, the biomass of wheat roots, shoots & grains increased by 92.5, 58.8, and 49.1%, respectively. Moreover, the soil addition of T3 amendment minimized the Pb distribution in wheat roots, shoots, and grains by 33.8, 26.8, and 16.2%, respectively. The outcomes of this experiment showed that in comparison to control treatment plants, soil amendment with n-ZVI-BC (T3) increased the catalase (CAT), superoxide dismutase (SOD) activity by 49.8 and 31.1%, respectively, ultimately declining electrolyte leakage (EL), malondialdehyde (MDA) and hydrogen peroxide (H2O2) content in wheat by 38.7, 33.3, and 38%respectively. In addition, applied amendments declined the Pb mobility in the soil by increasing the residual Pb fractions. Soil amendment with n-ZVI-BC also increased the soil catalase (CAT), urease (UR), and acid phosphatase (ACP) activities by 68, 59, and 74%, respectively. Our research results provided valuable insight for the remediation of Pb toxicity in wheat. Hence, we can infer from our findings that n-ZVI-BC can be considered a propitious, environment friendly and affordable technique for mitigating Pb toxicity in wheat crop and reclamation of Pb polluted soils.

A Case of Successful Management of Adult-Onset Linear IgA Bullous Disease With Sulfasalazine During the COVID-19 Pandemic.

Linear IgA bullous disease (LABD) is a rare, acquired, autoimmune, pruritic, and blistering skin condition. Dapsone is a first line treatment option, however, there are limited options if this fails, or if contraindicated. We present a case of successful management of LABD with sulfasalazine. A 46-year-old Caucasian female with LABD was commenced on high dose corticosteroids. She failed to wean, and dapsone was contraindicated due to a history of primary sclerosing cholangitis and risk of hepatitis. Following the failure of mycophenolate mofetil, sulfasalazine was trialed and successfully controlled both this patient’s LABD and ulcerative colitis. There is little literature on the use of sulfasalazine in dermatological conditions. We present sulfasalazine as an option for patients who are unable to use classically used treatments for LABD, or in those who have a dual diagnosis, as in this case, allowing for one agent to manage both conditions. Furthermore, The National Institute for Health and Care Excellence guidance mentions sulfasalazine as one of the few drugs that can be continued during the COVID-19 pandemic, and its use spared this patient from the significant immunosuppression associated with other treatment modalities.J Drugs Dermatol. 2022;21(12): doi:10.36849/JDD.6717.

Prevalence of metabolic syndrome among adolescents in India: a population-based study.

BACKGROUND: In India, the prevalence of overweight among adolescents is on the rise, setting the stage for an increase in metabolic syndrome (MS). This paper presents the national prevalence of MS in adolescents in India. METHODS: A nationally representative data of adolescents (10-19 years) from the Comprehensive National Nutrition Survey was used. MS was defined based on the NCEP-ATP III criteria for adolescents. Bivariate analysis was used to report socio-demographic differentials in prevalence and to assess interstate variability. Multivariate logistic regression model was constructed to measure the association between socio-demographic characteristics and prevalence of MS. Census data from 2011 was projected to 2017 to calculate burden. RESULTS: The prevalence of MS was 5.2% among adolescents. 11.9%, 15.4%, 26.0%, 31.9% and 3.7% had central obesity, high blood pressure, hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, respectively. The prevalence was higher among males (5.7% vs. 4.7%, adjusted odds ratio (AOR): 1.3, 95% confidence interval [CI]: 1.0, 1.6), those residing in urban areas (7.9% vs 4.2%, AOR: 1.4, 95% CI: 1.1, 1.8), and from wealthier households as compared to their counterparts (8.3% vs. 2.4%, AOR: 3.4, 95% CI: 2.1, 5.5). There was wide interstate variability in the prevalence of MS (0.5% - 16.5%). In 2017, 14.2 million adolescents had MS in India. CONCLUSIONS: The prevalence of MS among adolescents in India is low and clustered in urban areas and richer households. Early prevention interventions promoting a healthy lifestyle, especially in high prevalence areas, are needed to keep MS from becoming a public health issue.

Medicinal waterbirds in the traditional healthcare system: an assessment of biodiversity-cultural linkages in Eastern Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: Eastern Khyber Pakhtunkhwa is home to a vast range of medicinal and edible waterbird species due to its diverse geographical environment. Waterbird species have been used for various ailments and cultural practices since ancient times, while ethno-pharmacological applications and cultural uses of waterbird species in this area have seldom been documented. This study is the first ethnomedicinal and cultural assessment of waterbird species, and the first compilation and listing of all known data on these species in Eastern Khyber Pakhtunkhwa, Pakistan. METHODS: Interviews and questionnaires were used to collect data from native respondents (N = 100). To analyze the data, principal component analysis (PCA), relative frequency of citation (RFC), fidelity level (FL%), relative popularity level (RPL), rank order priority, and similarity index were used. RESULTS: In total, 64 waterbird species were utilized in cultural practices, of which 40 species are used to cure different infectious and chronic diseases such as cold, cough, flu, fever, respiratory disorders, asthma, TB, gastric ulcers, kidney stones, male impotency, obesity, paralysis, piles, cancer, arthritis, body pain, and weakness. PCA showed significant differences in the use of waterbird species among the local inhabitants of the study area, separated along the axis-2 (p < 0.05). The FL% of waterbird species varied from 12 to 100%. 100% FL was analyzed for four waterbird species, i.e., Charadrius mongolus (cold), Gallicrex cinerea (asthma), Anas platyrhynchos (cancer), and Esacus recurvirostris (body weakness). In this study, Mallard (Anas platyrhynchos) was the most popular species used in the healthcare system of Eastern Khyber Pakhtunkhwa, with high RFC (4.06), FL% (100), and RPL (1.0) values. CONCLUSION: We concluded that waterbird species are more used for medicine and food purposes in the study area. However, in vitro/in vivo assessment of biochemical activities of waterbird species with a maximum FL% might be significant to produce novel drugs. Recent research shows important ethno-ornithological information about native people and their links with waterbird species, which might be helpful for the sustainable use of waterbird diversity in the research area.

Cultural and Medicinal Use of Amphibians and Reptiles by Indigenous People in Punjab, Pakistan with Comments on Conservation Implications for Herpetofauna.

Amphibians and reptiles have interacted with humans for millennia. However, humans interact with amphibian and reptile species in different manners, which depend on their culture and traditions. This study was designed to better understand the interactions between amphibian and reptile species and their usage among the native peoples in the vicinity of the Jhelum and Chenab rivers, Pakistan. Information was collected through semi-structured interviews and questionnaires, and was analyzed by using different indices, including the frequency of citation, corrected fidelity level, fidelity level, relative importance level, and informant major ailment. Two amphibians and twenty-six reptile species were used in therapeutic medicine in the study area. Based on the cultural analysis, we found that Naja naja (black cobra) was highly cited across all cultural groups. A 100% Fidelity Level was calculated for the following species: Naja naja (eye infection), Varanus bengalensis (joint pain), Eurylepis taeniolatus (cataract), and Acanthodactylus cantoris (cancer). We found five endangered species in the study area, i.e., Aspideretes gangeticus, A. hurum, Chitra indica, Varanus flavescens, and Geoclemys hamiltonii, that were used to cure joint pain, muscle stretching and pain, backbone pain, paralysis, and psoriasis, respectively. Likewise, Lissemys punctata andersoni, a vulnerable species as labelled by the International Union for Conservation of Nature, was extensively used for the treatment of joint pain, body pain, paralysis, and arthritis in the study area. In terms of conservation, it is critical to protect the highly vulnerable and endangered species that are being used in therapeutic medicines. Our findings may be helpful for the conservation of amphibian and reptile species by helping to make an effective plan to prevent their extinction. The main threats to the diversity of amphibian and reptile species in the area are hunting, trading, and cultural use. These threats could potentially lead to the extinction of these species. Therefore, with the involvement of concerned authorities, e.g., local stakeholders, the Ministry of Climate Change, provincial wildlife departments, academia, and conservation managers, immediate conservation measures should be taken for the protection and sustainable utilization of medicinal species.

Effects of emollient therapy with sunflower seed oil on neonatal growth and morbidity in Uttar Pradesh, India: a cluster-randomized, open-label, controlled trial.

BACKGROUND: Newborn oil massage is a widespread practice. Vigorous massage with potentially harmful products and forced removal of vernix may disrupt skin barrier integrity. Hospitalized, very-preterm infants treated with sunflower seed oil (SSO) have demonstrated improved growth but community-based data on growth and health outcomes are lacking. OBJECTIVES: We aimed to test whether SSO therapy enhances neonatal growth and reduces morbidity at the population level. METHODS: We conducted an open-label, controlled trial in rural Uttar Pradesh, India, randomly allocating 276 village clusters equally to comparison (usual care) and intervention comprised of promotion of improved massage practices exclusively with SSO, using intention-to-treat and per-protocol mixed-effects regression analysis. RESULTS: We enrolled 13,478 and 13,109 newborn infants in demographically similar intervention and comparison arms, respectively. Adherence to exclusive SSO increased from 22.6% of intervention infants enrolled in the first study quartile to 37.2% in the last quartile. Intervention infants gained significantly more weight, by 0.94 g · kg-1 · d-1 (95% CI: 0.07, 1.82 g · kg-1 · d-1, P = 0.03), than comparison infants by intention-to-treat analysis. Restricted cubic spline regression revealed the largest benefits in weight gain (2-4 g · kg-1 · d-1) occurred in infants weighing <2000 g at birth. Weight gain in intervention infants was higher by 1.31 g · kg-1 · d-1 (95% CI: 0.17, 2.46 g · kg-1 · d-1; P = 0.02) by per-protocol analysis. Morbidities were similar by intention-to-treat analysis but in per-protocol analysis rates of hospitalization and of any illness were reduced by 36% (OR: 0.64; 95% CI: 0.44, 0.94; P = 0.02) and 44% (OR: 0.56; 95% CI: 0.40, 0.77; P < 0.001), respectively, in treated infants. CONCLUSIONS: SSO therapy improved neonatal growth, and reduced morbidities when applied exclusively, across the facility-community continuum of care at the population level. Further research is needed to improve demand for recommended therapy inside hospital as well as in community settings, and to confirm these results in other settings.This trial was registered at www.isrctn.com as ISRCTN38965585 and http://ctri.nic.in as CTRI/2014/12/005282.

Association of maternal height and body mass index with nutrition of children under 5 years of age in India: Evidence from Comprehensive National Nutrition Survey 2016-18.

BACKGROUND AND OBJECTIVES: Child undernutrition remains an area of public health concern across the globe, particularly in developing countries like India. Previous studies have focused on the association of maternal nutrition with premature pregnancy and birthweight of child, with few establishing the intergenerational effect but limited to select populations and geography. METHODS AND STUDY DESIGN: This study used data from 35,452 children aged under 5 years and their biological mother from nationally representative Comprehensive National Nutrition Survey (CNNS) in India. The outcome variables were anthropometric indices: height-for-age, weightfor- height, and weight-for-age. The exposure variables were maternal height and body mass index (BMI). Multivariate regression analysis was used to examine the association between maternal height and BMI with child undernutrition. RESULTS: Out of total number of mothers, 11.1% were short in stature and 28% were underweight. Of total number of children, 33.9%, 17.3% and 32.7% were stunted, wasted, and underweight respectively. Children born to mother with short stature were more likely to be stunted (OR=1.73, 95% CI 1.59-1.89), wasted (OR=1.26, 95% CI 1.12-1.41) and underweight (OR=1.64, 95% CI 1.50-1.79). Similarly, children with underweight mother were more likely to be stunted (OR=1.63, 95% CI 1.53-1.73), wasted (OR=1.64, 95% CI 1.52-1.77) and underweight (OR=2.14, 95% CI 2.01-2.27). CONCLUSIONS: The study shows a strong association between maternal and child undernutrition demonstrating intergenerational linkage between the two. The national programme needs to focus on holistic and comprehensive nutrition strategy with targeted interventions to improve both maternal and child health.

Effect of sunflower seed oil emollient therapy on newborn infant survival in Uttar Pradesh, India: A community-based, cluster randomized, open-label controlled trial.

BACKGROUND: Hospitalized preterm infants with compromised skin barrier function treated topically with sunflower seed oil (SSO) have shown reductions in sepsis and neonatal mortality rate (NMR). Mustard oil and products commonly used in high-mortality settings may possibly harm skin barrier integrity and enhance risk of infection and mortality in newborn infants. We hypothesized that SSO therapy may reduce NMR in such settings. METHODS AND FINDINGS: This was a population-based, cluster randomized, controlled trial in 276 clusters in rural Uttar Pradesh, India. All newborn infants identified through population-based surveillance in the study clusters within 7 days of delivery were enrolled from November 2014 to October 2016. Exclusive, 3 times daily, gentle applications of 10 ml of SSO to newborn infants by families throughout the neonatal period were recommended in intervention clusters (n = 138 clusters); infants in comparison clusters (n = 138 clusters) received usual care, such as massage practice typically with mustard oil. Primary analysis was by intention-to-treat with NMR and post-24-hour NMR as the primary outcomes. Secondary analysis included per-protocol analysis and subgroup analyses for NMR. Regression analysis was adjusted for caste, first-visit weight, delivery attendant, gravidity, maternal age, maternal education, sex of the infant, and multiple births. We enrolled 13,478 (52.2% male, mean weight: 2,575.0 grams ± standard deviation [SD] 521.0) and 13,109 (52.0% male, mean weight: 2,607.0 grams ± SD 509.0) newborn infants in the intervention and comparison clusters, respectively. We found no overall difference in NMR in the intervention versus the comparison clusters [adjusted odds ratio (aOR) 0.96, 95% confidence interval (CI) 0.84 to 1.11, p = 0.61]. Acceptance of SSO in the intervention arm was high at 89.3%, but adherence to exclusive applications of SSO was 30.4%. Per-protocol analysis showed a significant 58% (95% CI 42% to 69%, p < 0.01) reduction in mortality among infants in the intervention group who were treated exclusively with SSO as intended versus infants in the comparison group who received exclusive applications of mustard oil. A significant 52% (95% CI 12% to 74%, p = 0.02) reduction in NMR was observed in the subgroup of infants weighing ≤1,500 g (n = 589); there were no statistically significant differences in other prespecified subgroup comparisons by low birth weight (LBW), birthplace, and wealth. No severe adverse events (SAEs) were attributable to the intervention. The study was limited by inability to mask allocation to study workers or participants and by measurement of emollient use based on caregiver responses and not actual observation. CONCLUSIONS: In this trial, we observed that promotion of SSO therapy universally for all newborn infants was not effective in reducing NMR. However, this result may not necessarily establish equivalence between SSO and mustard oil massage in light of our secondary findings. Mortality reduction in the subgroup of infants ≤1,500 g was consistent with previous hospital-based efficacy studies, potentially extending the applicability of emollient therapy in very low-birth-weight (VLBW) infants along the facility-community continuum. Further research is recommended to develop and evaluate therapeutic regimens and continuum of care delivery strategies for emollient therapy for newborn infants at highest risk of compromised skin barrier function. TRIAL REGISTRATION: ISRCTN Registry ISRCTN38965585 and Clinical Trials Registry-India (CTRI/2014/12/005282) with WHO UTN # U1111-1158-4665.

Waist circumference, waist-to-height ratio and BMI percentiles in children aged 5 to 19 years in India: A population-based study.

OBJECTIVE: Nationally representative percentiles for waist circumference (WC), waist-to-height-ratio (WHtR), and body mass index (BMI) are not available for children and adolescents in India. METHODS: Using LMS method, age- and gender-specific reference growth charts were constructed for WC (n = 68,261), WHtR (n = 68,261), and BMI (n = 67,741) from children/adolescents aged 5-19 years who participated in a nationally representative survey. General obesity, indicating overall obesity, was defined as age-sex-specific BMI z-scores ≥ 95th percentile. Central obesity was defined in three ways: WC ≥ 90th percentile, WHtR ≥ 0.5, and both WC ≥ 90th percentile and WHtR ≥ 0.5. FINDINGS: WC and BMI percentiles for boys and girls are lower than those previously reported from India and several other countries. The BMI percentiles are lower than the WHO 2007 reference population. The prevalence of general obesity using India specific BMI centiles was 2.9% (95% CI: 2.6-3.2). The prevalence of central obesity was 6.1% (95% CI: 5.7-6.6) using WC ≥ 90th percentile, 5.3% (95% CI: 5.0-5.7) using WHtR ≥ 0.5, and 3.6% using both criteria. Three-fourth of children with general obesity also had central obesity based on WC ≥ 90th. CONCLUSIONS: Indian children are thinner than Caucasian and other Asian children, and the global WHO reference population. Using India specific reference, the prevalence of central obesity is higher than general obesity with a significant overlap between the two.

Kawasaki Shock Syndrome and Covid-19.

Kawasaki disease (KD) is a systemic vasculitis of unknown cause affecting children under 5 years of age. It is thought to be triggered by several viruses. Recently, Kawasaki-like disease has been reported worldwide in patients with COVID-19, giving rise to a new term of multi-system inflammatory syndrome in children (MIS-C). We report a case of a previously healthy 7-year boy, referred to our hospital with provisional diagnosis of measles due to generalised erythematous, maculopapular rash and conjunctivitis. On detailed evaluation, the patient fulfilled the clinical and laboratory criteria of MIS-C, and COVID-19 antibodies were positive. He was treated successfully with high dose of intravenous immunoglobulins (IVIG) and methylprednisolone. Patient was followed one week later with repeat echocardiography, which showed improvement. In conclusion, early recognition and timely treatment can prevent adverse outcomes in MIS-C. Key Words: COVID-19, Kawasaki disease, MIS-C.

Socio-economic inequality in anthropometric failure among children aged under 5 years in India: evidence from the Comprehensive National Nutrition Survey 2016-18.

BACKGROUND: Conventional indicators used to access the nutritional status of children tend to underestimate the overall undernutrition in the presence of multiple anthropometric failures. Further, factors contributing to the rich-poor gap in the composite index of anthropometric failure (CIAF) have not been explored. This study aims to estimate the prevalence of CIAF and quantify the contribution of factors that explain the rich-poor gap in CIAF. METHODS: The present study used data of 38,060 children under the age of five years and their biological mothers, drawn from the nationally representative Comprehensive National Nutrition Survey of children and adolescents aged 0-19 years in India. The CIAF outcome variable in this study provide an overall prevalence of undernutrition, with six mutually exclusive anthropometric measurements of height-for-age, height-for-weight, and weight-for-age, calculated using the World Health Organization (WHO) Multicenter Growth Reference Study. Multivariate regression and decomposition analysis were used to examine the association between covariates with CIAF and to estimate the contribution of different covariates in the existing rich-poor gap. RESULTS: An overall CIAF prevalence of 48.2% among children aged aged under 5 years of age was found in this study. 6.0% children had all three forms of anthropometric failures. The odds of CIAF were more likely among children belonging to poorest households (AOR: 2.41, 95% CI: 2.12-2.75) and those residing in urban area (AOR: 1.06, 95% CI 1.00-1.11). Children of underweight mothers and those with high parity were at higher risk of CIAF (AOR: 1.51, 95% CI: 1.42-1.61) and (AOR: 1.15, 95% CI: 1.08-1.22), respectively. Children of mother exposed to mass media were at lower risk of CIAF (AOR: 0.87, 95% CI: 0.81-0.93). CONCLUSION: This study estimated a composite index to assess the overall anthropometric failure, which also provides a broader understanding of the extent and pattern of undernutrition among children. Findings show that maternal covariates contribute the most to the rich-poor gap. As well, the findings suggest that intervention programs with a targeted approach are crucial to reach the most vulnerable groups and to reduce the overall burden of undernutrition.

Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1-19 years in India: a population-based study.

BACKGROUND: WHO's haemoglobin cutoffs to define anemia were based on five studies of predominantly White adult populations, done over 50 years ago. Therefore, a general re-examination of the existing haemoglobin cutoffs is warranted for global application, in representative healthy populations of children and adults. Such data are scarce in low-income and middle-income countries; however, a 2019, large-scale, nationally representative survey of children and adolescents aged 0-19 years in India (Comprehensive National Nutrition Survey [CNNS]) offered an opportunity for this re-examination. Using this survey, we aimed to assess the age-specific and sex-specific percentiles of haemoglobin and cutoffs to define anaemia in the CNNS population. METHODS: For this population-based study, we constructed age-specific and sex-specific haemoglobin percentiles from values reported for a defined healthy population in the CNNS, which used rigorous quality control measures during sample collection and in the laboratory analyses. To obtain a healthy population, we excluded participants with iron, folate, vitamin B12, and retinol deficiencies; inflammation; variant haemoglobins (haemoglobin A2 and haemoglobin S); and history of smoking. We considered age-specific and sex-specific 5th percentiles of haemoglobin derived for this healthy population as the study cutoff to define anaemia. We compared these with existing WHO cutoffs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anaemia in the entire CNNS sample. FINDINGS: Between Feb 24, 2016, and Oct 26, 2018, the CNNS survey collected blood samples from 49 486 individuals. 41 210 participants had a haemoglobin value, 8087 of whom were included in our study and comprised the primary analytical sample. Compared with existing WHO cutoffs, the study cutoffs for haemoglobin were lower at all ages, usually by 1-2 g/dL, but more so in children of both sexes aged 1-2 years and in girls aged 10 years or older. Aanemia prevalence with the study cutoffs was 19·2 percentage points lower than with WHO cutoffs in the entire CNNS sample with valid haemoglobin values across all ages and sexes (10·8% with study cutoffs vs 30·0% with WHO cutoffs). INTERPRETATION: These findings support the re-examination of WHO haemoglobin cutoffs to define anaemia. Our haemoglobin reference percentiles, derived from healthy participants in a large representative Indian survey, are suitable for national use in India. Substantial variations in the 5th percentile of haemoglobin values across the 1-19 years age range and between sexes argue against constructing common cutoffs in stratified age groups for convenience. FUNDING: None. TRANSLATIONS: For the Hindi, Punjabi, Tamil and Kannada translations of the abstract see Supplementary Materials section.

Phytoremediation: Environmentally sustainable way for reclamation of heavy metal polluted soils.

Soil contamination with toxic metals is a widespread environmental issue resulting from global industrialization within the past few years. Therefore, decontamination of heavy metal contaminated soils is very important to reduce the associated risks and for maintenance of environmental health and ecological restoration. Conventional techniques for reclamation of such soils are expensive and environmental non-friendly. Phytoremediation is an emerging technology implementing green plants to clean up the environment from contaminants and has been considered as a cost-effective and non-invasive alternative to the conventional remediation approaches. There are different types of phytoremediation including, phytostabilization, phytostimulation, phytotransformation, phytofiltration and phytoextraction, the latter being most extensively acknowledged for remediation of soils contaminated with toxic heavy metals. Recent literature is gathered to critically review the sources, hazardous effects of toxic heavy metals and environmentally sustainable phytoremediation technique for heavy metal polluted soils to offer widespread applicability of this green technology. Different strategies to enhance the bioavailability of heavy metals in the soil are also discussed shortly. It can be concluded that phytoremediation of heavy metal contaminated soils is a reliable tool and necessary for making the land resource accessible for crop production.