A clinico-epidemiological study of cognitive function status of community-dwelling elderly.

BACKGROUND: Cognitive decline and dementia are an important problem affecting quality-of-life in elderly and their caregivers. There is regional variation in prevalence of cognitive decline as well as risk factors from region to region. AIM: The aim was to determine the prevalence of dementia and cognitive decline and its various risk factors in the elderly population of more than 60 years in Eastern Uttar Pradesh (India). MATERIALS AND METHODS: A camp-based study was conducted on rural population of Chiraigaon block of Varanasi district from February 2007 to May 2007. Block has 80 villages, of which 11 villages were randomly selected. Eleven camps were organized for elderly people in 11 randomly selected villages on predetermined dates. A total of 728 elderly persons of age >60 years were examined, interviewed and data thus collected was analyzed. Elderly who got Hindi-mini-mental state examination (HMSE) score developed by Ganguli based on the Indo-US Cross-National Dementia Epidemiology Study) score ≤23 were evaluated further and in those with confirmed cognitive and functional impairment, diagnosis of dementia was assigned according to Diagnostic and Statistical Manual for Mental Disorder fourth edition criteria after ruling out any psychiatric illness or delirium. Based on International Classification of Diseases-10 diagnostic criteria sub-categorization of dementia was done. RESULTS: Mean, median and 10(th) percentile of HMSE of the study population were 23.4, 24 and 17, respectively. About 14.6% elderly had scored <17. 42.9% of rural elderly population had HMSE score <23, 70.6% <27 and 27.7% between 23 and 27. Literate people had statistically significant higher mean HMSE score (26.1 ± 3.9) than illiterate people (22.9 ± 4.9). Other risk factors were female gender, malnutrition, and obesity. Prevalence of dementia was 2.74%; in male 2.70% and in female 2.80%. Most common type of dementia was Alzheimer (male 1.5%, female 1.5%) followed by vascular (male 1.2%, female 0.6%) and others 0.6% (male 0%, female 0.6%). CONCLUSIONS: Study showed that a very high percentage of rural elderly attending health camps had poor cognitive function score; though the prevalence of dementia was relatively low. Alzheimer dementia was most common, followed by vascular dementia, which was predominant in males. Illiteracy, age, and under-nutrition were the most important risk factors for poor cognitive function. Our study suggest that cut-off of HMSE score should be 17 (10(th) percentile) for illiterate population.

Correlation of nutritional parameters of gallbladder cancer patients.

BACKGROUND AND OBJECTIVE: Gallbladder cancer (GBC) is a highly fatal disease with poor prognosis and 5-year survival <5%. Weight loss and nutritional deterioration are associated with adverse outcomes in terms of cancer prognosis. Protein-calorie malnutrition is the single most common secondary diagnosis in a patient with cancer, and is a direct consequence of the anorexia of malignancy and altered host metabolism induced by the tumor. The present study of nutritional assessment is of particular interest for it helps in better understanding the extent of malnutrition in patients of GBC. PATIENTS AND METHODS: A case-control study was designed comprising of 153 cases of GBC and 153 controls of gallstone disease (GSD). To assess the nutritional status of the GBC patients, anthropometric measurements such as height, weight, mid arm circumference, and skinfold thickness were recorded together with the biochemical parameters and their nutrient intake. RESULTS AND CONCLUSIONS: The present study showed that GBC influences the nutritional status of the patients. Forty-three percent of GBC patients were malnourished with low body mass index (BMI). A significant reduction in all the anthropometric measures was observed for GBC patients compared to those with GSD. GBC patients had significantly low hemoglobin and serum albumin levels compared to the control group. The hemoglobin levels in case and control groups were 10.87 g/dl (+/-1.81 SD) and 11.62 g/dl (+/-1.89 SD), respectively (P < 0.001). Intake of almost all the nutrients was far below the recommendations of Indian Council of Medical Research. GBC patients had anorexia and weight loss.

A review of association of dietary factors in gallbladder cancer.

Gallbladder cancer (GBC) is the prominent malignancy of hepato-biliary tract, being the fifth most common carcinoma for gastrointestinal tract in United States. Epidemiological studies world wide have implicated dietary factors in the development of gallbladder cancer. The ecological evidences indicate considerable geographic variation in the incidence of gallbladder cancer. However the variations in GBC incidence of different populations might be partly determined by their dietary variations. Higher intake of energy and carbohydrate possibly increase the risk of gallbladder cancer. Obesity plays an important role in the causation of GBC. Adequate intake of fruits and vegetables probably reduce the risk of GBC. This nutritional preventive effect against GBC could be attributed to high content of vitamins, carotenes and fibers. They can not be too emphatically stated as the sole determinants of GBC. It is apparently clear that a variety of essential nutrients can significantly modify the carcinogenic process. Furthermore, an attempt has been made to establish an association between dietary factors and the occurrence of gallbladder cancer.

Prevalence of HIV among low and high risk population of eastern part of northern India.

A total of 7,904 persons visiting University Hospital of Banaras Hindu University (BHU), Varanasi, were screened for HIV antibody by ELISA and/or rapid test. The overall seroprevalence of HIV (3.17%) in this area was higher than that of Uttar Pradesh and India as a whole. The seroprevalence of HIV/AIDS among the high risk group (HRG) (6.42%) being significantly higher than low risk group (LRG) (0.37%). In the LRG, the prevalence among medical and surgical patients; and ANC (antenatal cases) was 1.17% and 0.14%, respectively. However, HIV infection was not detected in HCWs (healthcare workers), BHU students and foreigners. Among HRG, CSWs (commercial sex workers) had the highest prevalence (14.0%) and STD (sexually transmitted diseases) patients, the lowest prevalence (1.99%). The STD patients had significantly lower prevalence rate as compared to others in HRG. Majority of the HIV positive were found to be within the age group 15-44 years, with heterosexual mode as the main route of transmission. Seven HIV positive children were of 2-5 yr old age group. Majority of seropositive women (62.52%) were working in a low income jobs and were mainly infected by their spouses who was mostly migrating labourers of lower socioeconomic group and with less than primary level of education. Married females, being mainly the spouses of HIV positive males had the highest seropositivity (60.25%). These population people were directly transmitting the infection from the metropolitan cities to the rural areas of this region. Prevalence of HIV-2 was negligible as compared to HIV-1, the actual reason is yet to be explored.

Prevalence of human immunodeficiency virus infection in and around Varanasi, Uttar Pradesh, India.

Human Immunodeficiency Virus (HIV) infection is rising rapidly in the eastern Uttar Pradesh; however no data is available regarding its positivity rate. We have screened 1239 cases of various groups. HIV seropositivity rate of 0.28% was noted. These results suggest that HIV infection is spreading rapidly in this part of the country. M. tuberculosis was the commonest co-infection amongst them (29.5%). We recommend routine HIV screening of all patients of tuberculosis, especially if the persons frequent the cities, visit foreign countries where sex tourism is encouraged or stay away from their spouses for long periods as true history of sexual contact with commercial sex workers was difficult to obtain from them.

Antibody response to sheep erythrocytes in Indian native vis-à-vis imported breeds of chickens.

1. A total of 433 birds (7 weeks old) of both sexes belonging to Indian native breeds, including, Aseel, Kadakanath, Naked Neck and Frizzle fowl along with the imported breeds Dahlem Red, White Leghorn, Synthetic dam line broiler (SDL) and Naked Neck broiler were utilised to test the primary antibody response to sheep erythrocytes by haemagglutination test. The effect of genotype (breed), sex and their interactions on antibody response were also studied. 2. The results revealed the presence of natural antibodies in all groups under study. 3. All groups except broilers showed the highest HA titre on day 5 post immunisation, which gradually declined until the end of the experiment (19th day post immunisation). In broilers, the peak HA titre was observed on day 12. 4. Dahlem Red showed the highest response throughout. The lowest antibody response was recorded for broilers except on day 19 post immunisation when it exceeded the White Leghorn value. 5. Amongst the native Indian breeds, the Naked neck had the highest titre on day 5 post immunisation but the Aseel titre was highest on days 12 and 19. 6. Males tended to have higher titres than females in Aseel, Kadakanath, Naked Neck, White Leghorn and Naked Neck broilers whereas Frizzle, Dahlem Red and SDL broilers showed the converse. 7. Statistical analysis revealed significant variation in HA response among the various genetic groups on different days post immunisation. The apparent differences between sexes were not significant. However, interactions between breed and sex were significant on day 5 and 19 post immunisation.

Optimizing lipase activity, enantioselectivity, and stability with medium engineering and immobilization for beta-blocker synthesis.

Lipase from Pseudomonas cepacia showed poor activity and moderate enantioselectivity (E) in pure aqueous systems for hydrolysis of a racemic mixture (+/-)-1-chloro-2-acetoxy-3-(1-naphthyloxy)-propane, which is a potential intermediate for beta-blocker synthesis. However, addition of polar organic solvents to the reaction can change both the activity and the enantioselectivity for this chiral reaction significantly. It was observed, in general, that the activity increases and the enantioselectivity decreases with the increase in the polarity of the organic solvent added to the medium. Among the six solvents chosen (i.e., dimethylsulfoxide [DMSO], 1, 4-dioxane, dimethylformamide [DMF], acetone, 1-propanol, and tetrahydrofuran [THF]), maximum activity and minimum enantioselectivity was obtained with DMSO, whereas minimum activity and maximum enantioselectivity was obtained with THF as the cosolvents. In the subsequent studies, native or polyethylene glycol (PEG)-modified lipase was immobilized by entrapping in Caalginate gel beads. In a fixed-bed continuous reactor containing these catalyst beads, the enzyme was found to be at least three times more enantioselective than the native form in a batch reactor. This fixed-bed reactor with the beads could be operated with high concentration of acetone (33% v/v) for about 1 month without a significant loss of enzyme activity and enantioselectivity.

Factors affecting direct and correlated responses in a White Leghorn population under long-term selection for egg number.

1. Data on 13,773 pullets, the progeny of 30 to 50 sires and about 135 to 220 dams per generation of a strain of White Leghorn under long-term selection for part period egg production over 16 generations, were examined. 2. Realised genetic gain per generation was highly significant for egg production (2.55 eggs), egg weight (-0.51 g), age at sexual maturity (-2.30 d) and 40 week body weight (-11.73 g). 3. The significant genetic response of 4.46 to 4.72 eggs per generation was realised in the first 8 generations only, which was accompanied by a marked decline in egg weight (-1.67 and -0.79 g per generation) and in age at sexual maturity (-4.63 and -6.39 d per generation). The 20 and 40 week body weights showed significant improvement in the last 4 generations. 4. Realised heritabilities were much lower in the last 8 than in the first 8 generation. 5. The additive genetic variance for most traits, except 20 week body weight and genetic covariances of egg production with egg weight and age at sexual maturity, declined significantly. 6. Natural selection did not seem to play any major role. No appreciable change in fitness traits was observed in the selected line. 7. The time trends were non-significant for all the traits in the control line, indicating its stability over generations.

Lipase kinetics in organic-water solvent with amphipathic substrate for chiral reaction.

Lipase from Pseudomonas cepacia was used for asymmetric hydrolysis of the substrate (+/-)1-chloro-2-acetoxy-3-(1-naphthyloxy)-propane, which is a precursor for (S)-(-)-beta-blocker synthesis. Because this substrate is insoluble in water and partially soluble in hydrophobic solvents such as hexane and octane, a mixture of hydrophilic organic solvents and aqueous buffer was used to study the initial reaction rates. Because of the amphipathic nature of the substrate, it can remain in three different forms: (1) monomeric (solution); (2) micellar; and (3) emulsion, depending on the acetone and substrate concentrations in the medium. This behavior is presented in a phase diagram. The enzyme was found to be active with micelle as well as emulsion form of the substrate, whereas it showed negligible activity with the monomeric form. Michaelis-Menten constants were determined experimentally for the emulsion and micellar part of the substrate. The initial rate of hydrolysis (v(0)) goes through a maximum with respect to the acetone content of the mixture. It is due to the combined effect of various factors occurring simultaneously with the increase in acetone content in the solvent. These phenomena are discussed based on the interfacial activation of lipase, deactivation of the enzyme at very high acetone concentration, and increase in critical micelle concentration (CMC) and critical emulsion concentration (CEC) with the increase in acetone content in the solvent. (c) 1997 John Wiley & Sons, Inc. Biotechnol Bioeng 55: 399-407, 1997.

Total DNA content: a marker for early diagnosis of breast cancer.

PIP: The incidence of breast cancer is high in the US, it accounts for 7.4% of all cancers in India, and it is one of the most common cancers among middle-aged women in many developing countries. Findings are presented from an evaluation of the total DNA content of breast tissue as a marker for the early diagnosis of breast cancer in women. Results are based upon the measurement of mean total DNA content in mg per g of wet breast tissue in 85 breast cancer patients and 170 controls. The control group comprised 85 patients with benign breast disease (BBD) and 85 healthy, normal women. The mean DNA content in the groups was determined to be 0.84 +or- 0.43 mg/g among normal controls, 4.76 +or- 2.37 mg/g among women with BBD, and 27.28 +or- 20.86 mg/g among cancer cases. The ranges for the respective groups were 0.2-1.75 mg/g, 0.7-10 mg/g, and 4.63-92.5 mg/g, indicating an absolute increase in the DNA content in gradient from normal to cancerous stage of breast tissue.^ieng

Keeping chewing tobacco in the cheek pouch overnight (night quid) increases risk of cheek carcinoma.

Chewing Chewable Indian Tobacco (CIT) is a popular addiction in India. Some of the addicts keep the bolus of chewed tobacco tucked in the gingivo-labial sulcus (cheek pouch) overnight. This is known as the habit of the night quid. To assess the influence of night quid on the development of oral cancer we carried out this case control observational study in the Out Patient Department of Surgery, Sir Sunder Lai Hospital, Varanasi, India. A total of 105 consecutive oral cancer patients (epidermoid carcinoma) and 71 sex- and age-matched CIT addicts of the same duration of addiction were investigated for the habit of the night quid. The habit increased the risk of development of cheek carcinoma significantly at Odd's Ratio of 12.5. Simply giving up the habit of night quid could help in the reduction of oral cancer in CIT addicts.

Reproductive health: faces old and new.

PIP: India's program of Maternal and Child Health (MCH) underwent nomenclature changes first to the program of MCH and Family Planning, then to MCH and Family Welfare (FW). Short-term policy and management changes produced positive results. However, once the MCH and FW program was launched, it became clear that the survival of mother and child is of high priority. Therefore, under the direction of UNICEF/World Health Organization and the government of India, the MCH and FW program was renamed as the Child Survival and Safe Motherhood (CSSM) program. CSSM included all components and issues of MCH, FW, and survival. However, not included are the early detection of cervical carcinoma, the prevention of infertility, the prevention of AIDS, sex education, the prevention of unwanted pregnancies, breast feeding, referral services, and women development. The name of the program should therefore again be changed to "Reproductive Health."^ieng

CHILD - to - child: the programme in survival and development of children.

PIP: This study examined the effectiveness of training programs during October 1986 and September 1987 for elder children who reared younger siblings in rural villages in India. The study population came from Bariasanpur, Rustampur, and Khanpur for the experimental group and from Narayanpur, Kodopur, and Ledhupur for the matched control group. Baseline information and interviews were collected for 280 families and 1745 persons: 136 experimental group families and 144 control group families. 46 children in the experimental group and 30 children in the control group were selected for the training sessions. Training was conducted over a four-day period for groups of 15 children. Pictures were used for illiterates to depict illness and treatment. Topics included injury, fever, diarrhea, and food hygiene. Assessment was made after seven days using an instrument and scales developed by Guilbert and methods suggested by Siegel. 48.57% of families used a child-to-child system of care at some point. 70.54% or 86 families in areas where training was available agreed to have their elder children trained. Child care by elder children involved about 26 days per month. Only 3-6% of the families had toys for children. Younger children were fed about three times a day in either group. There were significant differences in knowledge between the control and experimental groups. Skills were also improved in the experimental group. 53.6% of families were lower caste, and 44.3% were middle caste. The mean per capital income was Rs. 77.90 +or- 31.33. 97 of 144 families involved maternal caretakers. Good quality of care was provided by 75% of mothers on food hygiene, 82.1% on diarrhea, 50% on fever, and 64.3% on accidents. 10.7% of grandparents provided good quality care.^ieng

Study of infant and childhood mortality in an ICDS block of eastern U.P.

Information on births and deaths was collected in 11 randomly selected AWW areas of Barhaj Mahen ICDS project area in Eastern U.P. by an independent survey team in 1988-89. The findings revealed that the births and deaths were under-reported to the tune of 36.6 and 13.9 percent respectively, by AWWs. The different demographic indicators generated from the data were as follows, CBR and CDR were 30.3 and 7.1 per 1000 population. Neonatal mortality rate, IMR, and MMR were 58.3, 74.7 and 6.5 per 1000 live births. 0-6 yr mortality was 16.3 per 1000 children and constituted 37.5% of the total deaths. ARI, diarrhoea and fever were the major causes of mortality in 0-6 yr old children accounting for 25.9, 22.3 and 14.8% respectively. The findings indicated that there was underreporting in adult mortalities despite the independent investigation, and a reduction in infant and childhood mortality possibly due to the beneficial effect of ICDS services.

PIP: This analysis aims to determine the extent of underreporting of births and deaths by anganwadi workers (AWW) in Barhaj Mahen project area in Eastern Uttar Pradesh state, India, in 1988, and to identify the birth rate and childhood mortality rate. Causes of mortality are identified. The project area is known to have a high infant mortality rate. Data were obtained from 11 AWW areas serving a population of 10,206. Sampling followed the random cluster technique. Initial household data collection missed 309 births (36.6%) but only 10/72 deaths (13.9%). 35.5% of male and 37.8% of female births were unreported. 14.6% of male and 12.9% of female deaths were unreported. 18 neonatal and 5 postneonatal infants died. Early neonatal mortality was 45.3/1000 live births, and neonatal mortality was 58.3. Infant mortality was 74.7, and maternal mortality was 6.5/1000 live births. Respiratory infections accounted for the highest mortality (25.9%). Other cause of death were diarrhea (22.3%), fever (14.8%), prematurity (8.1%), tetanus (7.4%), and accident (3.7%). The total death rate (7.2/1000) was lower than the national average. The birth rate in project areas of Uttar Pradesh was almost the same as the national average. Postneonatal mortality showed the lowest rates compared to Uttar Pradesh and the nation. Since this study area had been included in the Integrated Child Development Services (ICDS) since 1981, it is likely that the lower child mortality reflects the emphasis on ICDS services. Underreporting of deaths is considered to be marginal.