Cell and molecular targeted therapies for diabetic retinopathy.

Diabetic retinopathy (DR) stands as a prevalent complication in the eye resulting from diabetes mellitus, predominantly associated with high blood sugar levels and hypertension as individuals age. DR is a severe microvascular complication of both type I and type II diabetes mellitus and the leading cause of vision impairment. The critical approach to combatting and halting the advancement of DR lies in effectively managing blood glucose and blood pressure levels in diabetic patients; however, this is seldom achieved. Both human and animal studies have revealed the intricate nature of this condition involving various cell types and molecules. Aside from photocoagulation, the sole therapy targeting VEGF molecules in the retina to prevent abnormal blood vessel growth is intravitreal anti-VEGF therapy. However, a substantial portion of cases, approximately 30-40%, do not respond to this treatment. This review explores distinctive pathophysiological phenomena of DR and identifiable cell types and molecules that could be targeted to mitigate the chronic changes occurring in the retina due to diabetes mellitus. Addressing the significant research gap in this domain is imperative to broaden the treatment options available for managing DR effectively.

Small extracellular vesicle-loaded bevacizumab reduces the frequency of intravitreal injection required for diabetic retinopathy.

Diabetic retinopathy (DR) is associated with retinal neovascularization, hard exudates, inflammation, oxidative stress and cell death, leading to vision loss. Anti-vascular endothelial growth factor (Anti-VEGF) therapy through repeated intravitreal injections is an established treatment for reducing VEGF levels in the retina for inhibiting neovascularization and leakage of hard exudates to prevent vision loss. Although anti-VEGF therapy has several clinical benefits, its monthly injection potentially causes devastating ocular complications, including trauma, intraocular hemorrhage, retinal detachment, endophthalmitis, etc. Methods: As mesenchymal stem cells (MSCs) and MSC-derived extracellular vesicles (MSC-EVs) demonstrated safety in clinical studies, we have tested the efficacy of MSC-derived small EVs (MSC-sEVs) loaded anti-VEGF drug bevacizumab in a rat model of DR. Results: The study identified a clinically significant finding that sEV loaded with bevacizumab reduces the frequency of intravitreal injection required for treating diabetic retinopathy. The sustained effect is observed from the reduced levels of VEGF, exudates and leukostasis for more than two months following intravitreal injection of sEV loaded with bevacizumab, while bevacizumab alone could maintain reduced levels for about one month. Furthermore, retinal cell death was consistently lower in this period than only bevacizumab. Conclusion: This study provided significant evidence for the prolonged benefits of sEVs as a drug delivery system. Also, EV-mediated drug delivery systems could be considered for clinical application of retinal diseases as they maintain vitreous clarity in the light path due to their composition being similar to cells.

Effect of Light Emitting Diodes (LED) Exposure on Vitreous Metabolites-Rodent Study.

The exposure to blue and white Light emitting diodes (LED) light leads to damage in the visual system with short-term LED light exposure. Chronic exposure, adaptive responses to light, and self-protective mechanisms against LED light exposures need to be explored, and it would be essential to understand the repercussions of LED radiation on vitreous metabolites. A total of 24 male Wistar rats were used in this study, divided into four groups (n = 6 in each group). Three experimental groups of rats were exposed to either blue, white, or yellow LED light for 90 days (12:12 light-dark cycle routine) with uniform illumination (450−500 lux). Standard lab settings were used to maintain control rats. Vitreous fluids were subjected to untargeted metabolomics analysis using liquid chromatography-mass spectrometry (LC/MS). PLS-DA analysis indicated significant the separation of m metabolites among groups, suggesting that LED exposure induces metabolic reprogramming in the vitreous. Amino acids and their modifications showed significant alterations among groups which included D-alanine, D-serine (p < 0.05), lysine (p < 0.001), aspartate (p = 0.0068), glutathione (p = 0.0263), taurine (p = 0.007), and hypotaurine. In chronic light exposure, the self-protective or reworking system could be depleted, which may decrease the ability to compensate for the defending mechanism. This might fail to maintain the metabolomic structural integrity of the vitreous metabolites.

An exploration of pulmonary fitness of construction workers in Delhi NCR in light of the building and other construction workers act, 1996.

Workers in the construction sector are exposed to high concentrations of particulate matter at their workplace. This increases their susceptibility to various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The study reports comparative pulmonary fitness and hematological parameters of the migrant workers in the construction sector versus other sectors in Delhi. Parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the ratio of FEV1 to FVC, and peak expiratory flow were measured in both groups using a spirometer. We observed significant differences (P < 0.05) in FEV1 and FVC between both groups. The study thus confirms that workers exposed to poor air quality at the construction site are susceptible to respiratory diseases, particularly ARDS. All of this reflects the poor enforcement of the adequate safety measures well enlisted in social legislations such as the Building and Other Construction Workers Act.

Association of periodontal therapy, with inflammatory biomarkers and complications in COVID-19 patients: a case control study.

BACKGROUND: In previous studies, COVID-19 complications were reported to be associated with periodontitis. Accordingly, this study was designed to test the hypothesis that a history of periodontal therapy could be associated with lower risk of COVID-19 complications. METHODS: A case-control study was performed using the medical health records of COVID-19 patients in the State of Qatar between March 2020 and February 2021 and dental records between January 2017 and December 2021. Cases were defined as COVID-19 patients who suffered complications (death, ICU admissions and/or mechanical ventilation); controls were COVID-19 patients who recovered without major complications. Associations between a history of periodontal therapy and COVID-19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood parameters were compared using Kruskal-Wallis test. RESULTS: In total, 1,325 patients were included. Adjusted odds ratio (AOR) analysis revealed that non-treated periodontitis was associated with significant risk of need for mechanical ventilation (AOR = 3.91, 95% CI 1.21-12.57, p = 0.022) compared to periodontally healthy patients, while treated periodontitis was not (AOR = 1.28, 95% CI 0.25-6.58, p = 0.768). Blood analyses revealed that periodontitis patients with a history of periodontal therapy had significantly lower levels of D-dimer and Ferritin than non-treated periodontitis patients. CONCLUSION: Among COVID-19 patients with periodontal bone loss, only those that have not received periodontal therapy had higher risk of need for assisted ventilation. COVID-19 patients with a history of periodontal therapy were associated with significantly lower D-dimer levels than those without recent records of periodontal therapy. CLINICAL RELEVANCE: The fact that patients with treated periodontitis were less likely to suffer COVID-19 complications than non-treated ones further strengthen the hypothesis linking periodontitis to COVID-19 complications and suggests that managing periodontitis could help reduce the risk for COVID-19 complications, although future research is needed to verify this.

Non-communicable disease risk factors among people living with HIV/AIDS (PLHA) - A relook during the covid-19 pandemic.

Background: The Covid-19 pandemic has resulted in syndemic due to factors like overcrowding, loneliness, poor nutrition, and lack of access to health care services. With the ongoing pandemic, people with NCDs, including PLHA, are at high risk for developing severe and even fatal Covid-19 infections. Our study, which was carried out prior to the pandemic gives us an insight into the NCD risk factors profile of PLHAs so that effective interventions could be initiated to protect them from Covid-19 severity and NCDs. Materials And Methods: A prospective study was carried out among PLHA in western Maharashtra, where PLHA were selected from five ART centers by means of a systematic random sampling method. Data were collected by means of a pretested questionnaire to assess NCD risk factors and anthropometric measurements were done. Data were collected at the baseline during the time of ART initiation and then after one year. Analysis was done by means of SPSS software (version 20.0). Results: The mean age of the study participants was 41.73 years. 59% belonged to rural areas, 21% were illiterate, and 12% belonged to the lower class as per the Modified BG Prasad scale. 33% were laborers by occupation, 66% were married, and 22% were widowed. At baseline, during the start of ART, 26% of the subjects were found to be overweight or obese, 36% had tobacco or smoking habits, and 15% had alcohol consumption habits. Even after one year, despite repeated counseling, about 32% of the subjects were found to be overweight or obese, 28% had tobacco and 8% had alcohol consumption habits, pointing to the need to integrate NCD prevention measures, such as screening routinely as per the national program, even in the PLHAs. 34% had normal BMI, while 35% were underweight, 14% overweight, and 17% obese after one year. 24% of PLHA had abnormal waist circumference at the end of one year. Conclusion: These findings indicate the incorporation of early screening for NCD risk factors among PLHA and effective behavior change communication (BCC) strategies to prevent and manage the same at the earliest before it can aggravate the already compromised immune status in these subjects, particularly during this Covid 19 pandemic. It will also act as a guiding article for family physicians or primary care physicians to help them look at specific basic parameters while screening of NCDs among PLHAs.

Blue Light-Induced Retinal Neuronal Injury and Amelioration by Commercially Available Blue Light-Blocking Lenses.

Blue light exposure-induced retinal damage has been extensively studied. Although many in vitro studies have shown the benefits of blue light-blocking lenses (BBL) there have been few comprehensive in vivo studies to assess the effects of BBL. We investigated the influence of blue light exposure using light-emitting diodes on retinal histology and visual cortex neurons in rodents. We also considered whether retinal and cortical changes induced by blue light could be ameliorated with blue light-blocking lenses. A total of n = 24 (n = 6 in each group; control, light exposure without lenses, two different BBLs)) male Wistar rats were subjected to blue light exposure (LEDs, 450-500 lux) without or with BBLs (400-490 nm) for 28 days on a 12:12 h light-dark cycle. Histological analysis of retinae revealed apoptosis and necrosis of the retinal pigment epithelium (RPE), photoreceptors, and inner retina in the light exposure (LE) group, along with increase caspase-3 immunostaining in the ganglion cell layer (p < 0.001). BBL groups showed less caspase-3 immunostaining compared with the LE group (p < 0.001). V1-L5PNs (primary visual cortex layer 5 pyramidal neurons) demonstrated reduced branching and intersections points for apical (p < 0.001) and basal (p < 0.05) dendrites following blue light exposure. Blue light-blocking lenses significantly improved the number of basal branching points compared with the LE group. Our study shows that prolonged exposure to high levels of blue light pose a significant hazard to the visual system resulting in damage to the retina with the associated remodeling of visual cortex neurons. BBL may offer moderate protection against exposure to high levels of blue light.

Epigenetic alterations-The silent indicator for early aging and age-associated health-risks.

Aging is the process of gradual physiological deterioration till death and this process perpetually reduce the functionality of an individual. To address the rationale and provide geriatric care, the constant target of geroscience is to identify reliable biomarkers for aging. Over the past decades, diversified advancements in epigenetic studies crescively support the fact that the accumulation of epigenetic changes accompanies the process of aging. A growing number of studies have suggested that alterations occur through three fundamental mechanisms like methylation of DNA, histone protein modification, and production of non-coding microRNAs. Each of these changes occurs silently and provokes alterations in the circumstantial expression of genetic material without altering the underlying gene sequences. The changes in gene expression due to epigenetic alterations are suggested to be the cause of early aging and the onset of age-related health risks. This review would attempt to give an integrated overview of epigenetic changes related to aging and age-associated health risks. This review also discussed epigenomes influencing early aging and factors modulating it. Since epigenetic changes are reversible, early identification of epigenetic markers can be a hope for future geriatric medicine. Finally, this review emphasizes the identification of blood-based epigenetic biomarkers in order to enlighten the future scope for therapeutic intervention to slow down the aging process.

Whole genome global insight of antibiotic resistance gene repertoire and virulome of high - risk multidrug-resistant Uropathogenic Escherichiacoli.

Elucidation of genetic determinants via whole genome sequence (WGS) analyses can help understand the high risk multidrug-resistant (MDR) Uropathogenic Escherichia coli (UPEC) associated with urinary tract infections (UTI) and its evasion strategies from treatment. We investigated the WGS of 30 UPEC strains from UTI samples across the world (2016-2019) and found 25 UPEC strains carrying 2-23 antibiotic resistance genes (ARGs) scattered across 1-3 plasmids per strain. Different ARGs (blaTEM, blaCTXM, blaNDM, blaOXA, blaCMY) encoding extended-spectrum beta-lactamases (TEM, CTXM, CMY) and carbapenemases (NDM, OXA) were found in 24/30, ARGs encoding aminoglycoside modifying enzymes (AAC, APH, AAD) variants in 23/30, trimethoprim ARGs (dfrA17, dfrA12, dfrA5, dfrB4 variants) encoding dihydrofolate reductase in 19/30 and sulfonamide ARGs (sul1, sul2, sul3) encoding dihydropteroate synthase and macrolide ARGs (mph1) encoding macrolide 2' phosphotransferase in 15/30 UPEC strains. Collectively the ARGs were distributed in different combinations in 40 plasmids across UPEC strains with 20 plasmids displaying co-occurrence of multiple ARGs conferring resistance to beta lactam, aminoglycoside, sulfonamide, trimethoprim and macrolide antibiotics. These resistance plasmids belonged to seven incompatibility groups (IncF, IncI, IncC, IncH, IncN, IncB and Col), with IncFI and IncFII being the predominant resistance plasmids. Additionally, we observed co-occurrence of specific mutation pattern in quinolone resistance determining region (QRDR) viz., DNA gyrase (gyrA: S83L, D87N), and topoisomerase IV (parC: S80I, E84V; parE: I529L) in 18/30 strains. The strains also harbored diverse virulence genes, such as fimH, gad, iss, iha, ireA, iroN, cnf1 and san. Multilocus sequence typing (MLST) reconfirmed ST131(n = 10) as the predominant global high-risk clonal strain causing UTI. In summary, our findings contribute to better understand the plasmid mediated ARGs and its encoded enzymes that may contribute in antibiotic inactivation/modification or alteration in the antibiotic target site in high risk MDR hypervirulent UPEC strains causing UTI. The study reinforces the need to characterize and design appropriate inhibitors to counterattack different enzymes and devise strategies to curtail resistance plasmid.

Pediatric Asthma: Prevalence and Socio-Cultural Factors Affecting Asthma Management in a Rural Area of Northern Karnataka.

CONTEXT: Asthma prevalence and severity is increasing among Indian children. There is the paucity of data on pediatric asthma in rural India and treatment received by asthmatics is not up-to-standard treatment guidelines. AIM: The aim is to estimate asthma prevalence and factors influencing access to standard asthmatic care among 5-15 years aged children. SETTINGS AND DESIGN: Cross-sectional study conducted in rural north-Karnataka for 1 year. SUBJECTS AND METHODS: The International Study of Asthma and Allergies in Childhood questionnaire was administered to participants followed by clinical examination. A child was considered as asthmatic if there was affirmative response to: (a) History of wheeze in the past 12 months, (b) Physician diagnosed/ever asthma, (c) history of taking inhaled/oral bronchodilators. STATISTICAL ANALYSIS: All characteristics were summarized descriptively. RESULTS: Prevalence of Current-wheeze, Ever-asthma, and wheeze on exertion were 4%, 2%, and 3.7%, respectively. About 63.9% of asthmatics had severe-asthma and 44.4% reported severe attack of wheezing limiting speech. About 89% of current-wheezers used only oral medications for wheeze/asthma, 50% did not take medicines as per doctors' advice. None availed regular follow-up. Financial constraints and ignorance were major reasons cited. CONCLUSIONS: Illiteracy, poverty, lack of proper guidelines, and non-availability of inhalational medications have affected treatment adherence resulting in severe asthma.

Household Chores or Play Outdoors? The Intersecting Influence of Gender and School Type on Physical Activity Among Indian Adolescents.

Most Indian adolescents, particularly girls and private school students, do not engage in sufficient physical activity (PA). Current understanding of these sociodemographic differences is limited by a focus on exercise, which may not fully capture PA in developing countries. We examined how gender and school type are associated with multiple PA domains and whether associations with gender differ by school type. We randomly selected an equal number of girls and boys (ages 13-16 years) from public and private schools in Southern India (n = 395). Cross-sectional 24-hour time-use surveys measured PA, which was categorized into three domains: chores, errands, and work; play; and transportation. Negative binomial and logistic regression modeled relative differences in domain-specific PA minutes and the probability of engaging in ≥60 minutes of moderate-to-vigorous PA (MVPA), respectively, in the prior 24 hours. Girls and boys were equally likely to meet MVPA recommendations. However, girls spent twice as much active time completing chores, errands, and work (rate ratio = 1.98, 95% confidence interval = [1.32, 2.98]), while boys spent twice as much active time playing (rate ratio = 2.11, 95% confidence interval = [1.23, 3.62]). Public and private school girls spent more active time in chores, errands, and work than boys; however, gender differences were greater among public school students (p value for interaction <.05). Although comparable MVPA levels for girls and boys are beneficial for physical health, girls may gain fewer cognitive, social, and emotional benefits associated with play. Additional research may clarify why the gendered burden of household responsibilities was greater among public school students. School-based programs to engage girls in active play may help reduce inequities.

Evaluation of sympathetic sudomotor responses to auditory stimuli in children with autism spectrum disorders.

AIM AND OBJECTIVE: Autism spectrum disorder (ASD) being a complex neurological and developmental disorder is also associated with autonomic nervous system dysfunction. Sudomotor nerve function is one highly sensitive index of sympathetic cholinergic activity and can be evaluated by measuring sympathetic skin response (SSR) to various stimuli. Studies reporting SSR to auditory stimulus among ASDs are limited and to the extent of our knowledge not assessed in the Indian scenario. The objective of the study was to assess and compare sympathetic sudomotor activity by evaluating SSR to auditory stimuli in children with and without ASDs. MATERIALS AND METHODS: A total of eighty individuals were enrolled in the study, including forty children with ASD and forty typically developing (TD) children. SSR to auditory stimulus was assessed using a digitized data acquisition unit in a soundproof room, maintained at 23°C. SSR indices such as latent period (s), amplitude (mv), and habituation were analyzed and compared using appropriate statistical tests between the groups. P < 0.05 was considered statistically significant. RESULTS: Habituation for SSR was statistically significantly lower (P < 0.001) in children with ASD (0.43 [0.21, 0.61]) compared to TD children (0.78 [0.65, 0.95]). Latent period was also statistically significantly higher in children with ASD (1.67 [1.37, 2.02]) compared to TD children (1.41 [1.2, 1.72]). However, there was no significant difference in amplitude values between the groups. CONCLUSIONS: Children with ASDs exhibited slower habituation of SSR to auditory stimuli compared to healthy controls. This slower habituation process might be due to the persistent predominant state of sympathetic nerves, which, in turn, contributes to the atypical emotional and behavioral traits prevailing in ASDs.

Evaluation of resident satisfaction and change in knowledge following use of high-fidelity simulation teaching for anaesthesia residents.

BACKGROUND AND AIMS: Anaesthesia practice demands medical knowledge and skills as essential components for patient management in peri-operative emergencies. Since all residents are not exposed to such situations during their residency, training them using simulation technology could bridge this knowledge and skill gap. The aim of this study was to train and evaluate residents to manage anaesthesia emergencies on high fidelity simulators. METHODS: Kirkpatrick model of program evaluation was carried out. Resident reaction was captured using a satisfaction questionnaire and the change in knowledge was assessed using pre-test and post-test Multiple Choice Questions (MCQs). Six scenarios were created and executed on a human patient simulator (HPS). All 22 residents participated in this teaching learning method. The steps of simulation teaching included pre-test, pre-briefing, orientation to manikins, performing/scribe, debriefing, feedback questionnaire, and post-test. The satisfaction questionnaire was administered following the second and fourth scenario. RESULTS: 95% residents agreed on overall satisfaction, that it helps in building team dynamics and clinical reasoning. All students agreed that this teaching had positive professional impact. 14% residents felt they were anxious during the class. The items in the questionnaire had a Cronbach's α value of 0.9. The mean score for pre-test was 24.22 ± 7 (Mean ± SD) and the post-test was 47.18 ± 5.6, the difference between the scores were statistically significant (P = 0.007). CONCLUSION: The use of high-fidelity simulation to train anaesthesia residents resulted in greater satisfaction scores and improved the residents' reasoning skills.

Has Spectral-Domain Optical Coherence Tomography Retinal Nerve Fiber Layer Assessment Become the Method of Choice for Glaucoma Evaluation in Clinical Practice?

AIM: The aim of the study was to assess the role of spectral-domain optical coherence tomography (SD-OCT) as a method of choice for early glaucoma diagnosis in glaucoma suspects. DESIGN: This was a retrospective cross-sectional study. MATERIALS AND METHODS: After a comprehensive ophthalmic examination and visual field analysis, 20 patients were included in each of the three groups: Normal group, possible glaucoma, definitive glaucoma, respectively. The optic nerve head (ONH) and peripapillary retinal nerve fiber layer parameters of participants were analyzed using SD-OCT optic disc cube protocol scans. Data was analyzed using one.way analysis of variance test. RESULTS: ONH RNFL defects in possible glaucoma patients were frequently found in superior, inferior, and temporal quadrants. CONCLUSION: Diagnostic capability of SD-OCT parameters for detection of structural changes in the ONH and retinal nerve fiber layer differed in three groups significantly. Hence, using SD-OCT has become an imperative and quick way of timely diagnosis of glaucoma in private practice.

Comparison of Physiological and Biochemical Autonomic Indices in Children with and without Autism Spectrum Disorders.

Background and objectives: Autism Spectrum Disorder (ASD) is a complex neuro-developmental disorder and it has been suggested that symptoms of ASD are associated with neural networks that regulate the Autonomic Nervous System (ANS). However, the nature of autonomic atypicalities in ASDs remain largely unknown. Measures like Heart Rate Variability (HRV) and urinary Vanillylmandelic Acid (VMA) estimation are sensitive and non-invasive physiological and biochemical indicators of autonomic nervous activity. This study aimed to compare the physiological and biochemical autonomic indices in children with and without ASD. Materials and Methods: In this case-control study, 40 children with autism and 40 Typically Developing (TD) children were recruited. Measures of physiological autonomic index were assessed by the analysis of short term HRV, and the urinary levels of VMA estimation was used as a biochemical autonomic index. Results: Cardiac sympathetic activity assessed by Low Frequency (nu) of HRV was significantly higher in the ASD group in comparison with the TD group (p = 0.006). On the contrary, both the High Frequency (abs) and (nu) of HRV were found to be significantly lower in autistic children (p = 0.034 and p = 0.000) than controls. Autistic children also exhibited a significantly higher level (p = 0.049) of VMA concentration compared to TD children. Conclusion: The study concludes that children with ASD exhibit lower cardio-vagal activity as measured by HRV and increased sympathetic activity as assessed by urinary VMA compared to that of TD children. The core autistic symptoms exhibited by children with ASD could be due to the differences in baseline arousal or stress which might be associated with autonomic dysfunction. Further studies are needed to examine the association of this autonomic dysregulation with ASD symptoms and comorbidities.

Is LEA symbol better compared to Snellen chart for visual acuity assessment in preschool children?

Aim: To compare visual acuity using the LEA symbol chart with Snellen E test chart in preschool children of age 3-5 years. Patients and methods: Inclusion criteria: 50 emmetropic children aged 3 to 5 years. Exclusion criteria: Strabismus, amblyopia, ametropia, and any organic eye disease. A pseudo randomized protocol was used to test visual acuity (VA) in each subject monocularly on both eyes using Snellen E chart and LEA symbol chart. Visual acuity for both charts was scored as smallest optotype size which the child correctly identified 3 of maximum 4 optotypes. The strength of agreement on VA between two charts was tested using Interclass correlation coefficient (ICC). A Mann-Whitney U test was applied to compare both the groups. Results: Boys: Girls = 26:24 with a mean age and standard deviation of 4.12 + 0.79 years. ICC between Snellen's and LEA symbol chart was 0.256 and 0.213 for right and left eye respectively. Analysis of the two samples using Mann-Whitney test showed a significant difference between the two charts (p value <0.000). Conclusion: LEA symbol test showed only a fair agreement with Snellen E charts for visual acuity measurements. Visual acuity measurement with LEA symbol chart showed significantly higher scores as compared to Snellen's chart.

Incidence of Deep Vein Thrombosis in Neurointensive Care Unit Patients-Does Prophylaxis Modality Make Any Difference?

BACKGROUND AND AIMS: To determine the incidence of upper and lower limb deep vein thrombosis (DVT) using ultrasonography (USG) in adult patients admitted to neuro-medical and neurosurgical intensive care unit (ICU). MATERIALS AND METHODS: In this prospective observational study, patients admitted to the medical and surgical neuro-ICU and remained in the ICU for more than 48 hours were recruited. All patients were clinically examined for DVT. Basilic and axillary veins in the upper limbs and popliteal and femoral veins in the lower limbs were screened for DVT using USG. USG examination was performed on the day of admission to ICU and thereafter every 3rd day till discharge from ICU or death. Intermittent pneumatic compression (IPC) stockings were applied to the lower limbs to all the patients in both ICUs. Unfractionated heparin (UFH) was given subcutaneously to neuromedical ICU patients, while in surgical ICU, it was left to the discretion of the neurosurgeons. RESULTS: A total of 130 adult patients were admitted to the ICU during the 8 month study period. Thirty patients were excluded and the remaining 98 patients' (38 in medical and 60 in surgical ICU) data were analyzed. None of the 38 medical ICU patients developed DVT, while in neurosurgical ICU, 4 out of 60 patients developed DVT. CONCLUSION: A combination of UFH and IPC stockings were effective in minimizing the DVT in neuromedical ICU patients. In surgical patients, through IPC stockings were effective, UFH can be considered for patients with intracranial malignancy. HOW TO CITE THIS ARTICLE: Behera SS, Krishnakumar M, Muthuchellappan R, Philip M. Incidence of Deep Vein Thrombosis in Neurointensive Care Unit Patients-Does Prophylaxis Modality Make Any Difference? Indian Journal of Critical Care Medicine, January 2019;23(1):43-46.

UNHEALTHY WEIGHT IN INDIAN FAMILIES: THE ROLE OF THE FAMILY ENVIRONMENT IN THE CONTEXT OF THE NUTRITION TRANSITION.

India faces a dual burden of increasing obesity and persistent underweight as it experiences the nutrition transition-the dietary and lifestyle changes that accompany globalization, economic development, and technological change. Yet, the nutrition transition is not solely a top-down process; rather, global forces converge with local practices at multiple levels of the social ecology. The family environment, a key site for the transmission of local customs and norms, remains largely unexplored in India. We examined the extent to which opposite-gender siblings and mother-child pairs were concordant or discordant in body weight, and whether domains of the family environment, specifically, food practices, food-related gender norms, and household resources, were associated with patterns of unhealthy weight within and between families. Multilevel dyadic analysis and logistic regression were conducted using survey data from a representative sample of 400 families in a Southern Indian city. We identified substantial clustering of weight among opposite-gender sibling pairs (ICC=0.43) and mother-child pairs, as well as important patterns of discordance, including 11% of families experiencing a dual burden of underweight and overweight. Household resources, including mother's education and income, were salient in explaining the distribution of body weight within and between families. Importantly, less examined domains of the family environment were also relevant, including food practices (e.g. grocery shopping frequency), and food-related gender norms (e.g. mother's control of food served at home). Continued exploration of how global and local practices converge in households will be necessary to develop programming that effectively addresses India's dual burden of unhealthy weight.

Curse of Fluorosis.

Fluoride was identified to have caries preventive properties and was widely used for fluoridation of water since 1940, especially in developed countries. After this there was sudden increase in the use of fluorides in food items and in oral medicinal products like toothpastes and mouth washes. Inadvertent use of above has lead to increase in fluorosis as a public health problem. In many places high fluorides are naturally present in earth crust leading to high water fluoride content increasing the risk of fluorosis. Maintaining a fine balance of fluorides in the body is mandatory for exploiting its advantages. World Health Organization (WHO) has fixed permissible limit of fluorides in water to 1.5 mg/L as a preventive step to contain fluorosis. Fluorosis has three clinical components: Dental, Skeletal and Non-Skeletal Fluorosis. It occurs with increasing level of fluorides in the body. Acute toxicity due to fluorides is also known and occurs as a result of sudden exposure to high levels of fluorides, usually by ingestion. Once fluorosis occurs it is irreversible without any cure. Only symptomatic and supportive management is possible. Hence prevention is the mainstay of management. Prevention is by using alternative sources of water or its de-fluoridation. National Program for Prevention and Control of Fluorosis (NPPCF) was launched in 2008-9 to identify areas with high fluoride content of water, manage the water bodies, screen schools and community for fluorosis and comprehensive management of cases. Improving quality of drinking water as per standards and improving nutritional status of children are also important components of prevention of fluorosis.