Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations.

OBJECTIVE:  To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials. DESIGN:  Observational population based cohort study. SETTING:  PEGASUS-TIMI-54 trial population and CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records). PARTICIPANTS:  7238 patients who survived a year or more after acute myocardial infarction. INTERVENTIONS:  Prolonged dual antiplatelet therapy after acute myocardial infarction. MAIN OUTCOME MEASURES:  Recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease. Fatal, severe, or intracranial bleeding. RESULTS:  1676/7238 (23.1%) patients met trial inclusion and exclusion criteria ("target" population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER's target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER's target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year. CONCLUSIONS:  This novel use of primary-secondary care linked electronic health records allows characterisation of "healthy trial participant" effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction.

Less favorable body composition and adipokines in South Asians compared with other US ethnic groups: results from the MASALA and MESA studies.

BACKGROUND: Small studies have shown that South Asians (SAs) have more total body, subcutaneous, visceral and hepatic fat and abnormal adipokine levels compared with Whites. However, comprehensive studies of body composition and adipokines in SAs compared with other ethnic groups are lacking. METHODS: Using harmonized data, we performed a cross-sectional analysis of two community-based cohorts: Mediators of Atherosclerosis of South Asians Living in America (MASALA, n=906) and Multi-Ethnic Study of Atherosclerosis (MESA which included 2622 Whites, 803 Chinese Americans, 1893 African Americans and 1496 Latinos). General linear models were developed to assess the ethnic differences in ectopic fat (visceral, intermuscular and pericardial fat; and hepatic attenuation), lean muscle mass and adipokines (adiponectin and resistin). Models were adjusted for age, sex, site, alcohol use, smoking, exercise, education, household income and body mass index. Ectopic fat models were additionally adjusted for hypertension, diabetes, high-density lipoprotein and triglycerides. Adipokine models were adjusted for subcutaneous, visceral, intermuscular and pericardial fat; and hepatic attenuation. RESULTS: Compared with all ethnic groups in MESA (Whites, Chinese Americans, African Americans and Latinos), SAs had greater intermuscular fat (pairwise comparisons with each MESA group, P<0.01), lower hepatic attenuation (P<0.001) and less lean mass (P<0.001). SAs had greater visceral fat compared with Chinese Americans, African Americans and Latinos (P<0.05) and greater pericardial fat compared with African Americans (P<0.001). SAs had lower adiponectin levels compared with other ethnic groups (P<0.01; except Chinese Americans) and higher resistin levels than all groups (P<0.001), even after adjusting for differences in body composition. CONCLUSION: There are significant ethnic differences in ectopic fat, lean mass and adipokines. A less favorable body composition and adipokine profile in SAs may partially explain the increased predisposition to cardiometabolic disease. The mechanisms that underlie these differences warrant further investigation.

Pretreatment Dynamic Susceptibility Contrast MRI Perfusion in Glioblastoma: Prediction of EGFR Gene Amplification.

BACKGROUND AND PURPOSE: Molecular and genetic testing is becoming increasingly relevant in GBM. We sought to determine whether dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion imaging could predict EGFR-defined subtypes of GBM. MATERIALS AND METHODS: We retrospectively identified 106 consecutive glioblastoma (GBM) patients with known EGFR gene amplification, and a subset of 65 patients who also had known EGFRvIII gene mutation status. All patients underwent T2* DSC MRI perfusion. DSC perfusion maps and T2* signal intensity time curves were evaluated, and the following measures of tumor perfusion were recorded: (1) maximum relative cerebral blood volume (rCBV), (2) relative peak height (rPH), and (3) percent signal recovery (PSR). The imaging metrics were correlated to EGFR gene amplification and EGFRvIII mutation status using univariate analyses. RESULTS: EGFR amplification was present in 44 (41.5 %) subjects and absent in 62 (58.5 %). Among the 65 subjects who had undergone EGFRvIII mutation transcript analysis, 18 subjects (27.7 %) tested positive for the EGFRvIII mutation, whereas 47 (72.3 %) did not. Higher median rCBV (3.31 versus 2.62, p = 0.01) and lower PSR (0.70 versus 0.78, p = 0.03) were associated with high levels of EGFR amplification. Higher median rPH (3.68 versus 2.76, p = 0.03) was associated with EGFRvIII mutation. CONCLUSION: DSC MRI perfusion may have a role in identifying patients with EGFR gene amplification and EGFRvIII gene mutation status, potential targets for individualized treatment protocols. Our results raise the need for further investigation for imaging biomarkers of genetically unique GBM subtypes.

Potential role of preoperative conventional MRI including diffusion measurements in assessing epidermal growth factor receptor gene amplification status in patients with glioblastoma.

BACKGROUND AND PURPOSE: Epidermal growth factor receptor amplification is a common molecular event in glioblastomas. The purpose of this study was to examine the potential usefulness of morphologic and diffusion MR imaging signs in the prediction of epidermal growth factor receptor gene amplification status in patients with glioblastoma. MATERIALS AND METHODS: We analyzed pretreatment MR imaging scans from 147 consecutive patients with newly diagnosed glioblastoma and correlated MR imaging features with tumor epidermal growth factor receptor amplification status. The following morphologic tumor MR imaging features were qualitatively assessed: 1) border sharpness, 2) cystic/necrotic change, 3) hemorrhage, 4) T2-isointense signal, 5) restricted water diffusion, 6) nodular enhancement, 7) subependymal enhancement, and 8) multifocal discontinuous enhancement. A total of 142 patients had DWI available for quantitative analysis. ADC maps were calculated, and the ADCmean, ADCmin, ADCmax, ADCROI, and ADCratio were measured. RESULTS: Epidermal growth factor receptor amplification was present in 60 patients (40.8%) and absent in 87 patients (59.2%). Restricted water diffusion correlated with epidermal growth factor receptor amplification (P = .04), whereas the other 7 morphologic MR imaging signs did not (P > .12). Quantitative DWI analysis found that all ADC measurements correlated with epidermal growth factor receptor amplification, with the highest correlations found with ADCROI (P = .0003) and ADCmean (P = .0007). CONCLUSIONS: Our results suggest a role for diffusion MR imaging in the determination of epidermal growth factor receptor amplification status in glioblastoma. Additional work is necessary to confirm these results and isolate new imaging biomarkers capable of noninvasively characterizing the molecular status of these tumors.

Pulmonary tuberculosis: the day after.

BACKGROUND: Tuberculosis (TB) is a widespread disease, and in spite of timely diagnosis and treatment it can permanently compromise lung function. OBJECTIVE: To study the prevalence of pulmonary impairment in cured adult pulmonary TB (PTB) patients. MATERIALS AND METHODS: Adult cured PTB patients were included in the study; those with any other condition or disease affecting lung function were excluded. After detailed history taking and examination, all patients underwent chest X-ray (CXR) and spirometry; 76 patients were investigated for pulmonary hypertension using electrocardiogram and two-dimensional echocardiogram. RESULTS AND DISCUSSION: A total of 264 patients were enrolled in the study. The majority were male and aged between 40 and 50 years. The most common complaint was cough with expectoration. CXR showed varying degrees of lung destruction, with 38% of the patients having Wilcox Grade II involvement. Spirometry was normal in 34 cases, while in the remaining cases varying degrees of obstructive airway disease with restrictive pattern and reversibility were observed. Seventy-two patients had evidence of pulmonary hypertension. These findings are comparable to those reported in the literature. CONCLUSION: PTB patients need long-term follow-up to diagnose and treat functional impairment after cure.

Internet survey of home storage of paracetamol by individuals in the UK.

AIM: Paracetamol (acetaminophen) is a common cause of liver failure due to overdose. Legislation introduced in the UK in 1998 to limit pack sizes of paracetamol has had limited impact on the overall number and severity of paracetamol overdoses. This may be because people have large amounts of paracetamol stored at home, but no previous studies have explored this question. METHODS: Individuals who regularly take part in market research surveys were invited to take part in an Internet survey. They were asked to supply demographic details, the frequency with which they use paracetamol and ibuprofen, and details of the amount and location of these drugs that they possessed. RESULTS: The mean age of respondents was 43.3 years (standard deviation 14.5 years), and 49.9% were female. People with both ibuprofen and paracetamol tended to have more packs and tablets of paracetamol (P < 0.001) and over a third had 32 or more paracetamol tablets. The most common pack size was 16 tablet packs (44.8% of all packs), which accounted for 39.4% of tablets. The most common site of paracetamol storage in the home was the kitchen (63.8% of people, 95% confidence interval 60.7, 66.7). CONCLUSION: This study suggests that pack size legislation in the UK has had limited effect on the amount of paracetamol that individuals have access to in the home. This may explain, at least in part, the limited impact of the pack size legislation on paracetamol overdoses in the UK.

Giant solitary fibrous tumour of the pleura.

Solitary fibrous tumour of the pleura is a rare primary pleural neoplasm. These tumours are usually asymptomatic and are incidentally detected. Majority of these neoplasms are benign and surgical excision provides excellent results. With the widespread use of imaging and better diagnostic criteria, this tumour is likely to be detected more frequently. We encountered a patient with a giant solitary fibrous tumour of the pleura. In this report, we describe the case of a patient with a giant solitary fibrous tumour of the pleura, review the literature and present the details of management of this patient.

Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma.

OBJECTIVE: To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP). METHODS: This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ(2) or Fisher exact test. RESULTS: Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0). CONCLUSIONS: Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.

Survey of ICD-10 coding of hospital admissions in the UK due to recreational drug toxicity.

BACKGROUND: Hospital admissions for acute recreational drug toxicity are coded using the International Classification of Diseases (ICD-10) coding system. It is unclear how these admissions are coded, as often there are no specific ICD-10 codes for the drug(s) involved. This study was undertaken to determine how acute recreational drug toxicity admissions are routinely coded. DESIGN: Questionnaire survey. METHODS: Questionnaires were sent to clinical coding departments in all England and Wales acute National Health Service Trusts, comprising of 12 hypothetical discharge summaries (4 acute recreational drug toxicity for which there are no appropriate ICD-10 codes, 5 other toxicological presentations with appropriate ICD-10 codes available and 3 control medical admissions), and they were asked to code these discharge summaries. RESULTS: Seventy responses were received. Discharge summaries relating to acute recreational drug toxicity without appropriate ICD-10 codes, had a wider range of diagnostic codes used (7-19 primary codes per summary) compared to control/alcohol discharge summaries (1-4 per summary). Additionally, often the codes did not refer to recreational drugs in those summaries relating to acute recreational drug toxicity. CONCLUSIONS: Hospital admissions due to recreational drugs without specific ICD-10 codes are assigned a wide variety of primary codes and/or the use of recreational drugs may not be coded. Further work is needed to look at methods of capturing presentations to hospital with acute recreational drug toxicity, either by updating the ICD codes or using a more time-responsive data capture system in sentinel hospitals in the UK to monitor trends in acute recreational drug toxicity.

Correlation of radiographic and telemetric data from massive implant fixations.

One proximal femoral replacement (PFR) and two distal femoral replacements (DFR) used in tumoural limb salvage were instrumented to measure axial force in the femoral shaft and at the tip of the intramedullary stem in vivo. The prostheses were implanted in suitable subjects and regular recording sessions held over 2 years for each subject. The ratio of the tip force to the shaft force increased with time in all 3 subjects, albeit at different rates, indicating that a greater proportion of the load was being transmitted along the prosthesis stem. The aim of this study was to correlate these changes with bone remodelling observed radiographically over the same period. Radiographs were analysed using a computer-assisted method to quantify bone width, radiolucent line width and relative bone density. The analysis showed the development of radiolucent lines at the bone-cement interface and a decrease in the lateral to medial ratio of bone density near the transection site. For the PFR, the mean width of the radiolucent area alongside the proximal fifth of the stem on the lateral side increased from 0 to 0.67 mm over the 2 years. The tip to shaft ratio correlated significantly with radiolucency on the lateral side of the stem. Both the DFRs became loose within 2 years but the PFR has remained in situ for 13 years to date. The correlations found thus far suggest that it may be possible to establish relationships between load transfer (and therefore loosening in the fixation) and radiographic data, with possible application to advance warning of clinical loosening in stemmed implants.

Cytogenetics and fluorescence in-situ hybridization in detection of hematological malignancies.

BACKGROUND: The technique of Fluorescence In-Situ Hybridization (FISH), a hybrid of cytogenetics and molecular biology has increased the resolution and application of cytogenetics in various neoplastic processes. In various types of leukemias, primary investigation by conventional cytogenetic [CC] technique followed by FISH has increased our understanding of the abnormal clonal formation involving different gene region. AIMS: Present study is aimed to use different kinds of in-house FISH probes in various hematological malignancies and its correlation with conventional cytogenetic finding. MATERIAL AND METHODS: Cytogenetic study was carried out in 360 patients either from peripheral blood or from bone marrow cells suspected for various types of leukemias. Four of 360 cases were further selected for FISH study by using different types of in-house probes, such as BAC [Bacterial Artificial Chromosome], PAC [Phague Artificial Chromosome], alphoid, PCP [Partial Chromosome Paint] and WCP [Whole Chromosome paint]. RESULTS: The results confirmed breakpoints of inversion 16 and del 16 in case 2 and 3 respectively. Whereas, case 1 did not confirm the cytogenetic findings of t(15;17) by PML/RARa fusion signals as multiple cell lines were involved in the patients. PCP and WCP were helpful in the identification of the marker chromosome in case 1. Telomeric and centromeric probes confirmed the cytogenetic findings of t(5;7) in case 4. CONCLUSION: We observe from this study that, in addition to the conventional cytogenetic study, FISH study provide further confirmation of chromosomal rearrangements. This facilitates our understanding of the neoplastic process more precisely for the better prognostication of the patient.

Quantitative analysis of actin patch movement in yeast.

To investigate the mechanism of cortical actin patch movement in yeast, we implement a method for computer tracking the motion of the patches. Digital images from fluorescence microscope movies of living cells are fed into an image-processing program, which generates two-dimensional patch coordinates in the plane of focus for each movie frame via an algorithm based on detection of rapid intensity variations. The patch coordinates in neighboring frames are connected by a minimum-distance algorithm. The method is used to analyze control cells and cells treated with the actin-depolymerizing agent latrunculin. The motion of the patches in both cases, as analyzed by mean-square patch displacements, is found to be a random walk on average, with a much lower diffusion coefficient for the latrunculin-treated cells. The mean-squared patch travel distances for all of the latrunculin-treated cells are lower than those for all of the control cells. The patches move independently of one another. We develop a quantitative criterion for the presence of directed motion, and show that numerous patches in the control cells display directed motion to a very high degree of certainty. A small number of patches in the latrunculin-treated cells display directed motion.

Usefulness of cytogenetics in leukemias.

Present study consists of cytogenetic evaluation in 141 cases referred to our centre for various leukemias. This includes 110 cases of CML, 10 of ALL, 16 of AML (M3), 2 of AML(M2), 2 of MDS and 1 of CMML. The conventional cytogenetic study was carried out in all the cases using G Banding technique. Of the 141 patients studied, 17 patients showed secondary chromosomal alterations along with primary chromosomal alterations. In two patients of CML with secondary chromosomal alteration t(4:9:22), molecular cytogenetic technique (FISH) has been carried out which has confirmed the primary observations revealed by the conventional cytogenetic technique. Other secondary alterations were numerous and would have been missed if only FISH or PCR technique would have been used for diagnosis. We observed from our study that advanced molecular techniques like FISH and PCR cannot replace the conventional cytogenetic study but are useful as supportive and confirmative diagnostic tools.

A study of chromosome aneuploidy in hereditary breast cancer patients and their healthy blood relatives.

Chromosomal abnormalities that may predispose a group of individuals to develop certain neoplasms have been reported in lymphocytes. We evaluated cytogenetic abnormalities in 21 histopathologically confirmed primary breast cancer patients (BCPs), 52 healthy blood relatives (HBRs), belonging to 19 hereditary breast cancer families (HBFs) and 25 females as control. Phytohemagglutinin stimulated peripheral blood lymphocyte (PBL) cultures were used to study the chromosomal abnormalities in BCPs and their HBRs. Short term culture of the tumor tissue was also carried out in defined growth medium. Suitable metaphases (11 to 55) from tumors and a minimum of 100 metaphases from PBL were karyotyped for the cytogenetic analysis. Heterogeneous population of cells with random and nonrandom chromosomal abnormalities was noticed in tumors. In control groups 2-5% of metaphases showed numerical abnormalities, whereas this phenomenon was observed in 3-18% of metaphases in HBRs and 3-23% of metaphases in BCPs. In tumor tissue, 47.05% of BCPs showed numerical abnormalities in more than 16 metaphases. In lymphocytes, this event was observed in 33.33% of BCPs and 13.14% of HBRs. In controls 1.28%, in BCPs 52.04% (tumor) and 13.42% (lymphocytes), and in HBRs 9.03% of metaphases were found aneuploid. Statistically it was highly significant (Fisher's exact test, P<0.00001). In lymphocytes of BCPs, chromosomes 1, 6, 8, 9, 15, 17, 18, 20, and X and in HBRs, chromosomes 8, 15, 17, 18, and X were frequently involved. It can be inferred from the findings that the above mentioned chromosomes may have an important role in early stage of breast carcinogenesis in BCFs. Moreover, presence of similar abnormalities in HBR indicates inherited pattern of this genetic error among them.

Mechanical behavior of a vein pouch saccular aneurysm model.

The response of an intracranial saccular aneurysm to applied loads, whether blood pressure or endovascular intervention, depends on both the geometry and material properties of the lesion. Yet, in the development of animal models of these lesions little attention has been given to the evaluation of their mechanical behavior. Our goal was to compare the multiaxial mechanical behavior of a canine vein pouch model to published data on veins and human aneurysms. Nine vein pouches were created surgically in six mongrel dogs by anastomosing a 2 cm segment of the external jugular vein to the common carotid artery in an end-to-side fashion. The lesions were harvested one week post-surgery and subjected to cyclic inflation tests using a custom system. Pressure-regional strain data revealed that vein pouch aneurysms are very extensible for pressures up to 30 mmHg, especially in the axial direction, but stiff thereafter. None of the lesions ruptured in vivo or during inflation tests. Based on these data, we conclude that the overall behavior of canine vein pouch lesions, at one week post-surgery, did not mimic well that of human aneurysms. Thus, there is a need to pursue modifications or other models for the purposes of clinically relevant studies of lesion growth, rupture, and treatment.

Finite strain elastodynamics of intracranial saccular aneurysms.

Various investigators suggest that intracranial saccular aneurysms are dynamically unstable, that they resonate in response to pulsatile blood flow. This hypothesis is based on linearized analyses or experiments on rubber "models", however, and there is a need for a more critical examination. Toward this end, we (a) derive a new nonlinear equation of motion for a pulsating spherical aneurysm that is surrounded by cerebral spinal fluid and whose behavior is described by a Fung-type pseudostrain-energy function that fits data on human lesions, and (b) use methods of nonlinear dynamics to examine the stability of such lesions against perturbations to both in vivo and in vitro conditions. The numerical results suggest that this sub-class of lesions is dynamically stable. Moreover, with the exception of transients associated with initial perturbations, inertial effects appear to be insignificant for fundamental forcing frequencies less than 10 Hz and hence for typical physiologic and laboratory conditions. We submit, therefore, that further study of the mechanics of saccular aneurysms should be focused on quasi-static stress analyses that investigate the roles of lesion geometry and material properties, including growth and remodeling.

Further Roles of Geometry and Properties in the Mechanics of Saccular Aneurysms.

Rupture of intracranial saccular aneurysms continues to result in significant morbidity and mortality. Although it has long been thought that biomechanical factors play key roles in the genesis, growth, and rupture of these lesions, few analysis have employed realistic descriptions of the geometries and material properties. This paper presents parametric finite element studies for subclasses of elliptical and spherical lesions which complement those recently reported by Kyriacou and Humphrey. In particular, we show again that lesion shape, not size, is a primary determinant of aneurysmal wall stress. Moreover, material anisotropy and geometry can exhibit competing or synergistic effects on the stress fields - this suggests that these interactions may be important in the formulation of theories on lesion growth. Finally, we show that Laplace's equation (for spherical membranes) yields reasonable approximations for wall stress only for a very limited class of lesions. There is a need, therefore, for detailed analysis and thus more precise data on lesion geometry, material properties, and loading conditions.

Use of milk based commercial weaning foods amongst scheduled caste communities in Haryana.

PIP: Although breast milk is the best food for an infant until age 4-6 months, there has been a recent trend in urban areas to increasingly provide milk-based commercial weaning foods (CWF). This study was conducted to assess the use of CWF among the scheduled caste population in two districts of Haryana State. The data presented are part of a larger study on breast feeding and weaning practices in Haryana. 818 children aged 0-35 months from 44 villages were included in the study. 68 had received milk-based CWF at the time of survey or sometime previously. There was no significant difference between the socioeconomic characteristics of children who were given milk-based CWF and those who did not receive it. 36% of women who used CWF reported having done so because of insufficient lactation, while 37% cited the high price of animal milk. Family members were the most important source of advice for initiating the use of CWF, followed by medical functionaries. 65% of all children surveyed received home-based weaning foods. The percentages of children receiving such foods in the age groups 0-5, 6-11, 12-17, 18-23, 24-29, and 30-35 months were 1%, 56%, 77%, 97%, 95%, and 96%, respectively. Only 73.7% of children older than age 3 months were breastfed together with CWF.^ieng

Breast-feeding practices in Schedule Caste communities in Haryana state.

A study was conducted to assess exclusive breast-feeding, continued breast-feeding, bottle-feeding, predominant breast-feeding, timely complementary feeding and other breast-feeding practices in 818 children in the age group of 0-3 years belonging to the Schedule Caste communities of Haryana. The exclusive breast-feeding rate was 0.15 and the predominant breast-feeding rate 0.75 in children < 4 months. Timely complementary feeding rate was 0.42. The continued breast-feeding rate at 1 year and 2 years was 0.84 and 0.58, respectively. The bottle-feeding rate, ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding rate by mother were 0.09, 1.0, 0.0 and 0.15, respectively. The median duration of breast-feeding was 16 months.

PIP: Data on 818 children aged 0-3 years belonging to the schedule caste population from 44 villages in Faridabad and Hisar districts of Haryana State, India, were analyzed to determine the current status of breast feeding practices in this underprivileged population. All the children had been breast fed. The exclusive breast feeding rate during the first 4 months of life was only 15%. Even though water intake increases the risk of diarrhea, mothers supplemented breast feeding with water in 85% of children to improve hydration status. 98% of the children were given ghutti (an herbal decoction) to improve their digestive abilities. The median duration of breast feeding was 16 months. 2% of infants aged less than 1 year received infant formula. Overall, bottle feeding rate among this age group was 9%. 75% of infants aged less than 4 months were predominantly breast fed. 42% of infants aged 6-9 months received supplementary feedings. 84% of children aged 12-15 months were still breast feeding at 12 months. The timely first-suckling rate was zero. Other baseline surveys should be conducted in other areas of India so breast feeding promotional programs can be evaluated.