Prognostic values of SYNTAX score II in patients with coronary artery disease undergoing percutaneous coronary intervention - Cohort study.

BACKGROUND: The data on prognostic values of SYNTAX score II in patients undergoing percutaneous coronary intervention is limited. We report predictive utility of SYNTAX score II in relation to in hospital and 1 year mortality of the patients undergoing percutaneous coronary intervention. METHODS: This was a cohort study of patients who underwent percutaneous coronary intervention (PCI) at a single centre from January 2018 to December 2019. In hospital and 12-month events and mortality was analysed among 1000 patients. The patients were divided into 3 groups based on tertiles of Syntax II score (<22, 22-27.7 and >27.7). RESULT: The total mortality at 12 months was 60 (6%). Major adverse cardiac events (MACE) occurred in 87 (9%). The patients who died had higher SYNTAX score II score compared to those alive at 12 months 34 (38, 24) vs 24 (28.1, 20.9) P < 0.01. The same trend was seen in patients who had major adverse cardiac events (MACE) 28 (34, 24) vs 24 (28.6, 21) P < 0.01 Among the 3 groups of SYNTAX score II, in hospital mortality, all-cause mortality, cardiovascular death, myocardial infarction, unstable angina, revascularization and major adverse cardiac events (MACE) were higher in the third tertile (>27.7) compared the lower tertiles. CONCLUSION: The patients who had higher SYNTAX score II had more in hospital and 12 month mortality and major adverse cardiac events (MACE). SYNTAX II score is a better predictor of in-hospital, and 12 month cardiovascular and all cause mortality.

Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review.

BACKGROUND: Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. OBJECTIVE: This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? METHODS: This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. RESULTS: As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. CONCLUSIONS: The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51792.

Normative data for aquagenic wrinkling of palms in children 1-15 years of age: A cross-sectional study.

BACKGROUND: Aquagenic wrinkling of palms (AWP) is emerging as a screening test for cystic fibrosis (CF). There is lack of normative data for the same in our population. OBJECTIVES: To generate normative data for AWP in children 1-15 years of age and to describe the factors associated with it. METHODS: Children aged 1-15 years were enrolled after obtaining informed consent and assent of the parent and child based on age. Information regarding age, gender, anthropometry, indications for visiting hospital and drug intake were noted down. Wrinkling test was done using distilled water maintained in room temperature. Sweat chloride analysis was done using Nano duct sweat analysis system for children having AWP within 3 min. The mean/median time to wrinkle was noted and presented as centile curves after smoothing. RESULTS: The mean (SD) and median (interquartile range [IQR]) aquagenic wrinkling time in children 1-15 years of age was 4.88 (1.066) and 5 (4-5.75) minutes respectively. The mean (SD) and median (IQR) time for AWP was 4.78 (1.076) and 5 (4-5) minutes respectively for boys and 4.98 (1.048) and 5 (4-6) minutes, respectively for girls. The time taken to wrinkle was observed to increase with age. Males have earlier AWP than females. There was no association between AWP and anthropometry or sweat chloride levels. CONCLUSION: We have estimated the normative data for AWP in children 1-15 years of age which can be used for CF screening in children with typical clinical features from resource limited settings.

Predictive models for fentanyl dose requirement and postoperative pain using clinical and genetic factors in patients undergoing major breast surgery.

ABSTRACT: Fentanyl exhibits interindividual variability in its dose requirement due to various nongenetic and genetic factors such as single nucleotide polymorphisms (SNPs). This study aims to develop and cross-validate robust predictive models for postoperative fentanyl analgesic requirement and other related outcomes in patients undergoing major breast surgery. Data regarding genotypes of 10 candidate SNPs, cold pain test (CPT) scores, pupillary response to fentanyl (PRF), and other common clinical characteristics were recorded from 257 patients undergoing major breast surgery. Predictive models for 24-hour fentanyl requirement, 24-hour pain scores, and time for first analgesic (TFA) in the postoperative period were developed using 4 different algorithms: generalised linear regression model, linear support vector machine learning (SVM-Linear), random forest (RF), and Bayesian regularised neural network. The variant genotype of OPRM1 (rs1799971) and higher CPT scores were associated with higher 24-hour postoperative fentanyl consumption, whereas higher PRF and history of hypertension were associated with lower fentanyl requirement. The variant allele of COMT (rs4680) and higher CPT scores were associated with 24-hour postoperative pain scores. The variant genotype of CTSG (rs2070697), higher intraoperative fentanyl use, and higher CPT scores were associated with significantly lower TFA. The predictive models for 24-hour postoperative fentanyl requirement, pain scores, and TFA had R-squared values of 0.313 (SVM-Linear), 0.434 (SVM-Linear), and 0.532 (RF), respectively. We have developed and cross-validated predictive models for 24-hour postoperative fentanyl requirement, 24-hour postoperative pain scores, and TFA with satisfactory performance characteristics and incorporated them in a novel web application.

Impact of Genetic Variants on Postoperative Pain and Fentanyl Dose Requirement in Patients Undergoing Major Breast Surgery: A Candidate Gene Association Study.

BACKGROUND: Postoperative analgesia is crucial for the early and effective recovery of patients undergoing surgery. Although postoperative multimodal analgesia is widely practiced, opioids such as fentanyl are still one of the best analgesics. The analgesic response of fentanyl varies widely among individuals, probably due to genetic and nongenetic factors. Among genetic factors, single nucleotide polymorphisms (SNPs) may influence its analgesic response by altering the structure or function of genes involved in nociceptive, fentanyl pharmacodynamic, and pharmacokinetic pathways. Thus, it is necessary to comprehensively ascertain if the SNPs present in the aforementioned pathways are associated with interindividual differences in fentanyl requirement. In this study, we evaluated the association between 10 candidate SNPs in 9 genes and 24-hour postoperative fentanyl dose (primary outcome) and also with postoperative pain scores and time for first analgesia (secondary outcomes). METHODS: A total of 257 South Indian women, aged 18-70 years, with American Society of Anesthesiologists (ASA) physical status I-III, undergoing major breast surgery under general anesthesia, were included in the study. Patients were genotyped for candidate SNPs using real-time polymerase chain reaction. All patients received a standardized intravenous fentanyl infusion through a patient-controlled analgesic (PCA) pump, and the 24-hour postoperative fentanyl dose requirement was measured using PCA. RESULTS: The median 24-hour postoperative fentanyl requirement was higher in rs1799971 carriers (G/G versus A/A + A/G-620 µg [500-700] vs 460 µg [400-580]) with a geometric mean (GM) ratio of 1.91 (95% confidence interval [CI], 1.071-1.327). The median 24-hour pain scores were higher in rs4680 carriers (A/G + A/A versus G/G-34 [30-38] vs 31 [30-38]) with a GM ratio of 1.059 (95% CI, 1.018-1.101) and were lower in rs1045642 carriers (A/A + A/G versus G/G-34 [30-38] vs 30 [30-34]) with a GM ratio of 0.936 (95% CI, 0.889-0.987). The median time for first analgesic was lower in rs734784 carriers [C/C versus T/T + C/T-240 minutes (180-270) vs 240 minutes (210-270)] with a GM ratio of 0.902 (95% CI, 0.837-0.972). Five of 9 clinical factors, namely, history of diabetes, hypertension, hypothyroidism, anesthesia duration, and intraoperative fentanyl requirement were associated with different outcomes individually ( P < .05) and were used to adjust the respective associations. CONCLUSIONS: The SNP opioid receptor mu-1 ( OPRM1 ) (rs1799971) was associated with higher postoperative fentanyl requirement in South Indian patients undergoing major breast surgery. Twenty-four hour postoperative pain scores were higher in catechol-O-methyl transferase ( COMT ) (rs4680) carriers and lower in ATP binding cassette subfamily B member 1 ( ABCB1 ) (rs1045642) carriers, whereas time for first analgesic was lower in potassium channel subunit 1 ( KCNS1 ) (rs734784) carriers. However, these exploratory findings must be confirmed in a larger study.

Can serum autoantibodies be a potential early detection biomarker for breast cancer in women? A diagnostic test accuracy review and meta-analysis.

BACKGROUND: The increasing incidence of breast cancer necessitates the need to explore alternate screening strategies that circumvent the setbacks of conventional techniques especially among population that report earlier age at diagnosis. Serum autoantibodies is one such potential area of interest. However, their ubiquitous presence across cancer types limits its applicability to any one specific type of cancer. This review was therefore carried out to explore and consolidate available evidence on autoantibodies for early detection of breast cancer and to identify those that demonstrated a higher sensitivity. METHODS: A diagnostic test accuracy (DTA) review was carried out to ascertain serum autoantibodies that could be used for early detection of breast cancer among women. All relevant articles that investigated the role of autoantibodies in early detection of breast cancer were included for the review. MEDLINE, Scopus, ProQuest, Ovid SP, and Cochrane Library were searched extensively for eligible studies. Quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. RevMan 5.3 was used for exploratory and MetaDTA 2019 for hierarchical analyses. The review helped identify the most frequently investigated autoantibodies and a meta-analysis further consolidated the findings. RESULTS: A total of 53 articles were included for the final analysis that reported over a 100 autoantibodies that were studied for early detection of breast cancer in women. P53, MUC1, HER2, HSP60, P16, Cyclin B1, and c-Myc were the most frequently investigated autoantibodies. Of these P53, MUC1, HER2, and HSP60 exhibited higher summary sensitivity measures. While the individual pooled sensitivity estimates ranged between 10 and 56%, the panel sensitivity values reported across studies were higher with an estimated range of 60-87%. CONCLUSION: Findings from the review indicate a higher sensitivity for an autoantibody panel in comparison to individual assays. A panel comprising of P53, MUC1, HER2, and HSP60 autoantibodies has the potential to be investigated as an early detection biomarker for breast cancer.

Effectiveness of an Evidence-Based Practice Training Program for Nurse Educators: A Cluster-Randomized Controlled Trial.

BACKGROUND: Evidence-based practice (EBP) endeavors to integrate the best available evidence with clinical expertise and patient preference to enhance clinical outcomes. For nurses to effectively demonstrate EBP, the concepts of EBP should be systematically incorporated into the nursing curriculum, with nurse educators playing a pivotal role in execution. However, the effect of EBP training programs on nurse educators remains largely unexplored. AIM: To evaluate the effectiveness of an EBP training program on the knowledge, attitude, practice, and competency of nurse educators. METHODS: A pragmatic randomized controlled trial was conducted at a nursing education institution. Fifty-one nurse educators were cluster randomized into intervention and control groups. A 30-hour EBP training intervention was provided for nurse educators in the intervention group. The outcome variables were knowledge, attitude, practice, and competency regarding EBP. These outcomes were evaluated using the EBP knowledge and practice questionnaire, EBP attitude scale, and Fresno test. Data were collected at baseline, the end of 5 months, and the end of 10 months. RESULTS: Fifty-one eligible participants were enrolled in the study. The intervention and control group had three clusters each with 27 and 24 participants, respectively. Participants in both groups were comparable for variables such as age, years of experience, and educational background (p > .05). Between groups, outcome variables were compared using mixed linear multi-level modeling. Nurse educators who received the EBP training program demonstrated significant differences in knowledge (p < .05), attitude (p < .05), practice (p < .05), and competency scores (p < .05), than that of the control group, indicating the intervention effectiveness. LINKING EVIDENCE TO ACTION: EBP training programs are effective in improving the knowledge, attitude, practice, and competency of nurse educators.

Sudden death and its predictors in myocardial infarction survivors in an Indian population.

OBJECTIVE: This study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD. METHODS: Left ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD. RESULTS: Fifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association. CONCLUSIONS: Among patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.

Factors associated with neonatal pneumonia in India: protocol for a systematic review and planned meta-analysis.

INTRODUCTION: India accounts for more neonatal deaths than any other country. There is a lack of consolidated evidence from India regarding the determining factors of pneumonia in neonates. This systematic review is aimed to consolidate and appraise the evidence on risk factors and determinants of pneumonia among neonates in India. METHODS AND ANALYSIS: This protocol is part of a project consisting of three reviews (two systematic reviews and one scoping review) and a qualitative study on neonatal pneumonia in India. English language observational studies which report risk factors and determinants of neonatal pneumonia in India will be eligible for inclusion. Electronic searching of nine databases, and hand searching will be done. Two authors will independently conduct screening (title, abstract and full-text stages), extract data and assess risk of bias. A meta-analysis is planned to be performed with random-effects model. A narrative synthesis will be used to summarise the characteristics and findings of the review, if a meta-analysis cannot be performed. If there are more than 10 studies, publication bias will be assessed. Sensitivity and subgroup analysis will performed based on data availability. The quality of our review will be assessed by using 'Assessing the Methodological quality of Systematic Reviews' and 'Grades of Recommendation, Assessment, Development and Evaluation'. ETHICS AND DISSEMINATION: The protocol of the entire project has been approved by the host institution's ethics body (Institutional Ethics Committee, Manipal University, Manipal, India), and the 'Health Ministry Screening Committee' under the Ministry of Health and Family Welfare, Government of India. The study findings will be disseminated among relevant stakeholders using knowledge dissemination workshops, policy briefs, publications, etc. PROSPERO REGISTRATION NUMBER: CRD42016044019.

Mapping Neonatal Mortality in India: A Closer Look.

INTRODUCTION: Fifty-three percent of Indian under-5 deaths occur during the neonatal age group. Recognizing that there is a lack of illustrated district-level data on neonatal mortality in India, we mapped this to visually highlight districts where neonatal health issues require the most attention. METHODS: District-level estimates of 596 Indian districts were used to generate maps and to illustrate neonatal mortality rates (NMRs), absolute numbers of neonatal deaths; the best and worst performing districts (positive and negative deviants) in each Indian state; the neonatal female/male death ratio; and district lag in NMR reductions. RESULTS: The NMR ranged from 4.3 (Kannur, Kerala) to 65.1 (Datia, Madhya Pradesh), with the mean NMR being 29.8. Almost two-thirds of the districts (n = 380, 63.7%) had NMRs between 20 and 40. The top third of neonatal deaths could be accounted for by just 71 districts of a total of 596. CONCLUSION: There is an urgent need for up-to-date data on district-level neonatal mortality in India.

Community-Based Prevalence of Genital Human Papilloma Virus (HPV) Infection: a Systematic Review and Meta-Analysis

Introduction: Cervical cancer probably represents the best-studied human cancer caused by a viral infection and the causal association of this preventable cancer with human papilloma virus (HPV) is well established. Worldwide there is a scarcity of data regarding HPV prevalence with vast differences existing among populations. Objective: The aim of this meta-analysis was to determine the community-based HPV prevalence estimates among asymptomatic women from urban and rural set ups and in participants of cancer screening clinics. Study design: Systematic review and meta-analysis. Methods: PubMed-Medline, CINAHL, Scopus, and Google scholar were systematically searched for studies providing prevalence data for HPV infection among asymptomatic women between 1986 and 2016. Results: The final analysis included 32 studies comprising a population of 224,320 asymptomatic women. The overall pooled HPV prevalence was 11% (95% confidence interval (CI), 9%-12%). The pooled HPV prevalence of 11% (95% CI, 9%-11%) was observed among women attending cervical cancer screening clinics. The pooled HPV prevalences were 10% (95% CI 8%-12%) and 11% (95% CI 4%-18%) from urban and rural areas respectively, indicating higher infection rates among the rural women with the least access to cancer screening and cancer care. Conclusion: The prevalence rates in this systematic quantitative review provide a reliable estimate of the burden of HPV infection among asymptomatic women from developed as well as developing nations. Rural women and women attending cervical cancer screening programmes feature higher genital HPV prevalences compared to their urban counterparts.

A longitudinal study of whole body, tissue, and cellular physiology in a mouse model of fibrosing NASH with high fidelity to the human condition.

The sequence of events that lead to inflammation and fibrosing nonalcoholic steatohepatitis (NASH) is incompletely understood. Hence, we investigated the chronology of whole body, tissue, and cellular events that occur during the evolution of diet-induced NASH. Male C57Bl/6 mice were assigned to a fast-food (FF; high calorie, high cholesterol, high fructose) or standard-chow (SC) diet over a period of 36 wk. Liver histology, body composition, mitochondrial respiration, metabolic rate, gene expression, and hepatic lipid content were analyzed. Insulin resistance [homeostasis model assessment-insulin resistance (HOMA-IR)] increased 10-fold after 4 wk. Fibrosing NASH was fully established by 16 wk. Total hepatic lipids increased by 4 wk and remained two- to threefold increased throughout. Hepatic triglycerides declined from sixfold increase at 8 wk to threefold increase by 36 wk. In contrast, hepatic cholesterol levels steadily increased from baseline at 8 wk to twofold by 36 wk. The hepatic immune cell population altered over time with macrophages persisting beyond 16 wk. Mitochondrial oxygen flux rates of FF mice diet were uniformly lower with all the tested substrates (13-276 pmol·s-1·ml-1 per unit citrate synthase) than SC mice (17-394 pmol·s-1·ml-1 per unit citrate synthase) and was accompanied by decreased mitochondrial:nuclear gene copy number ratios after 4 wk. Metabolic rate was lower in FF mice. Mitochondrial glutathione was significantly decreased at 24 wk in FF mice. Expression of dismutases and catalase was also decreased in FF mice. The evolution of NASH in the FF diet-induced model is multiphasic, particularly in terms of hepatic lipid composition. Insulin resistance precedes hepatic inflammation and fibrosis. Mitochondrial dysfunction and depletion occur after the histological features of NASH are apparent. Collectively, these observations provide a unique overview of the sequence of changes that coevolve with the histological evolution of NASH.NEW & NOTEWORTHY This study demonstrates in a first of kind longitudinal analysis, the evolution of nonalcoholic steatohepatitis (NASH) on a fast-food diet-induced model. Key findings include 1) hepatic lipid composition changes in a multiphasic fashion as NASH evolves; 2) insulin resistance precedes hepatic inflammation and fibrosis, answering a longstanding chicken-and-egg question regarding the relationship of insulin resistance to liver histology in NASH; and 3) mitochondrial dysfunction and depletion occur after the histological features of NASH are apparent.

A systematic review of community-based health insurance programs in South Asia.

BACKGROUND: Community-based health insurance (CBHI) has been evolving as an effective means of healthcare financing in many countries of South Asia. A systematic review in this context would give a comprehensive report of the performance of these schemes in terms of improving the health-seeking behaviour of the beneficiaries enrolled for the schemes. METHODS: Important databases like PubMed, Elsevier, SocINDEX (EBSCO), Cochrane Reviews, Medline and Scopus were reviewed along with relevant portals-Google Scholar, www.who.int/, www.worldbank.org and www.cochrane.org-and specific journals and discussion series with published literature in the areas of community health insurance and health microfinance. RESULTS: The review finally chronicles 20 CBHI schemes from published and unpublished literature from the countries comprising South Asia. These schemes have been reviewed in terms of their enrolment process, entry point and the extent to which they have contributed to the healthcare-seeking behaviour. CONCLUSION: The CBHI schemes can also serve as an alternative healthcare financing mechanism where fee-for-service and user fees have not made any impact. There have been very few studies that have tried to carry out an impact evaluation of the CBHI schemes on the target population, and more and more such studies can be a scope for further research. Copyright © 2016 John Wiley & Sons, Ltd.

Mental Health Literacy Among Late Adolescents in South India: What They Know and What Attitudes Drive Them.

BACKGROUND: Early recognition of mental health problems gives an individual the opportunity for better long-term outcomes if intervention is initiated early. Mental health literacy is a related concept which is increasingly seen as an important measure of the awareness and knowledge of mental health disorders. AIM AND OBJECTIVES: This study aimed at assessing the mental health literacy, help-seeking behavior and beliefs and attitudes related to mental illnesses among adolescents attending preuniversity colleges. MATERIALS AND METHODS: A cross-sectional study was conducted among randomly selected preuniversity college students (n = 916). Data were collected through self-administered questionnaires. Data were computed using STATA. Analysis and interpretation were carried out using descriptives and Chi-square test. RESULTS: Of the 916 respondents, 54.15% were male while 45.85% were female. The majority (78.60%) of the respondents ascribed to the Hindu religion, hailed largely from rural areas (57.21%) and were mostly studying in the 11(th) standard (72.49%). The percentage of mental health literacy among the respondents was very low, i.e., depression was identified by 29.04% and schizophrenia/psychosis was recognized by 1.31%. The study findings indicate that adolescents preferred reaching out more to informal sources including family members such as mothers than formal sources for self than for others indicating deeply prevalent stigmatizing attitudes toward mental health conditions. CONCLUSIONS: There is a need for immediate improvement in the knowledge of adolescents on mental health literacy which suggests that programs need to be developed such that adolescents can seek help from valid resources if the need were to arise and have appropriate knowledge on whom to approach for help.

Effect of Exclusive Breastfeeding on Rotavirus Infection among Children.

OBJECTIVES: To assess, whether exclusive breastfeeding plays a protective role in Rotavirus infection among children under age of five and to estimate whether breastfeeding has an impact on reducing the severity and symptoms among children infected with Rotavirus. METHODS: A systematic search was performed in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMEd (from 1980 to present), ScienceDirect (from 1980 to present), OVID (from 1980 to present) and regional database IndMED. All the studies along with the research publications with descriptive, case series, cross sectional, case control and cohort studies (prospective and retrospective) that provided effectiveness of exclusive breastfeeding were considered for this review. Two review authors independently scrutinized the studies and extracted the data. In case of disagreement, the senior reviewer was consulted. RESULTS: Total seven studies qualified for the systematic review in which 6 studies qualified for meta-analysis. Exclusive breastfeeding was found to be effective in prevention of Rotavirus infection and in reducing the risk of Rotavirus infection among children (OR = 0.62, 95 % CI = 0.48-0.81). CONCLUSIONS: This systematic review suggests that there is significant benefit in prevention of Rotavirus diarrhea among children by practicing exclusive breastfeeding throughout first 6 mo of life. Thereby, this study provides next reason to promote exclusive breastfeeding practice among mothers.

Genome-wide analysis correlates Ayurveda Prakriti.

The practice of Ayurveda, the traditional medicine of India, is based on the concept of three major constitutional types (Vata, Pitta and Kapha) defined as "Prakriti". To the best of our knowledge, no study has convincingly correlated genomic variations with the classification of Prakriti. In the present study, we performed genome-wide SNP (single nucleotide polymorphism) analysis (Affymetrix, 6.0) of 262 well-classified male individuals (after screening 3416 subjects) belonging to three Prakritis. We found 52 SNPs (p ≤ 1 × 10(-5)) were significantly different between Prakritis, without any confounding effect of stratification, after 10(6) permutations. Principal component analysis (PCA) of these SNPs classified 262 individuals into their respective groups (Vata, Pitta and Kapha) irrespective of their ancestry, which represent its power in categorization. We further validated our finding with 297 Indian population samples with known ancestry. Subsequently, we found that PGM1 correlates with phenotype of Pitta as described in the ancient text of Caraka Samhita, suggesting that the phenotypic classification of India's traditional medicine has a genetic basis; and its Prakriti-based practice in vogue for many centuries resonates with personalized medicine.

DNA methylation analysis of phenotype specific stratified Indian population.

BACKGROUND: DNA methylation and its perturbations are an established attribute to a wide spectrum of phenotypic variations and disease conditions. Indian traditional system practices personalized medicine through indigenous concept of distinctly descriptive physiological, psychological and anatomical features known as prakriti. Here we attempted to establish DNA methylation differences in these three prakriti phenotypes. METHODS: Following structured and objective measurement of 3416 subjects, whole blood DNA of 147 healthy male individuals belonging to defined prakriti (Vata, Pitta and Kapha) between the age group of 20-30years were subjected to methylated DNA immunoprecipitation (MeDIP) and microarray analysis. After data analysis, prakriti specific signatures were validated through bisulfite DNA sequencing. RESULTS: Differentially methylated regions in CpG islands and shores were significantly enriched in promoters/UTRs and gene body regions. Phenotypes characterized by higher metabolism (Pitta prakriti) in individuals showed distinct promoter (34) and gene body methylation (204), followed by Vata prakriti which correlates to motion showed DNA methylation in 52 promoters and 139 CpG islands and finally individuals with structural attributes (Kapha prakriti) with 23 and 19 promoters and CpG islands respectively. Bisulfite DNA sequencing of prakriti specific multiple CpG sites in promoters and 5'-UTR such as; LHX1 (Vata prakriti), SOX11 (Pitta prakriti) and CDH22 (Kapha prakriti) were validated. Kapha prakriti specific CDH22 5'-UTR CpG methylation was also found to be associated with higher body mass index (BMI). CONCLUSION: Differential DNA methylation signatures in three distinct prakriti phenotypes demonstrate the epigenetic basis of Indian traditional human classification which may have relevance to personalized medicine.