Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India

Introduction

Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors.

Materials and methods

An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done.

Results

367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics.

Conclusion

Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

Epidemiology and pattern of injury of pediatric trauma patients in level l trauma centre of Northern India

Introduction

Uttar Pradesh ranks first in India as far as trauma deaths are concerned with 40% of victims under 18 years of age. In spite of such high mortality and morbidity no national portal for trauma registry data exists. This study was conducted to evaluate the profile of injured pediatric patients, to provide baseline knowledge for further research, management and development of pediatric injury prevention programmes.

Methods

A retrospective observational study was conducted in the only Level 1Trauma Centre of the most populous state of India. Children aged less than 18 years of age admitted to the trauma centre were analysed for mechanism, type and severity of injury, the mode of management and outcome.

Result

In a 2 year period 916 children were admitted and their data analysed. Most were boys (73%) and the most common age group was 12–18 years. Half of injuries were caused by road traffic accidents, and blunt injuries were commonest. Blunt abdominal trauma then head injury were the commonest areas injured; 20% of children had life-threatening injuries. Nearly half (47%) had moderate to severe trauma according to the Pediatric Trauma Score. 507 patients (55.4%) were managed conservatively and 409 children (44.6%) required surgery; 657 (71%) were successfully discharged and 39 children (4.25%) unfortunately died.

Conclusion

This study identifies the need for dedicated trauma registries, training of trauma team according to standard operating procedures, the development of paramedical teams for in-the-field management of patients and development of injury prevention programmes according to both age and gender.

Modulation of intrinsic defects in vertically grown ZnO nanorods by ion implantation

Intrinsic defects created by chemically inert gas (Xe) ion implantation in vertically grown ZnO nanorods are studied by optical and X-ray absorption spectroscopy (XAS). The surface defects produced due to dynamic sputtering by ion beams control the fraction of O and Zn with ion fluence, which helps in tuning the optoelectronic properties. The forbidden Raman modes related to Zn interstitials and oxygen vacancies are observed because of the weak Fröhlich interaction, which arises due to disruption of the long-range lattice order. The evolution of the lattice disorder is identified by O K-edge and Zn K-edge scans of XAS. The hybridization strength between the O 2p and Zn 4p states increases with ion fluence and modulates the impact of intrinsic defects. The ion irradiation induced defects also construct intermediate defects bands which reduce the optical bandgap. Density functional theory (DFT) calculations are used to correlate the experimentally observed trend of bandgap narrowing with the origin of electronic states related to Zn interstitial and O vacancy defects within the forbidden energy gap in ZnO. Our finding can be beneficial to achieve enhanced conductivity in ZnO by accurately varying the intrinsic defects through ion irradiation, which may work as a tuning knob to control the optoelectronic properties of the system.

Long-term variability of trace gases over the Indian Western Himalayan Region

The four-year continuous measurements of CO, NOx, NH₃, SO_2, and O₃ were carried at a high altitude site (32.12°N, 76.56°E at 1347 m AMSL) of the Indian Western Himalayan area to study the mixing ratios of these gases for understanding the changing trends of these trace gases over the region. Each of these trace gases showed significant daily and monthly variabilities. The highest variability was recorded in the monthly mean values of O₃ as it varied from 10 to 63 ppb during the study period. All the trace gases except CO showed maximum variability in the pre-monsoon seasons due to the strong advection and vertical circulation of air masses at the site. The seasonal mean maxima of CO were recorded during the monsoon season, while the mean maxima of NH₃ were recorded during the post-monsoon seasons. The meteorological parameters have been found to influence the mixing ratios of trace gases. The least variability in the mean seasonal mixing ratios of SO₂ during the study period indicated the constant point source of SO₂ near the site. The trajectories analysis revealed that the area receives maximum air masses from the southeast to the west directions where a number of the coal-based thermal power plants, industries, cement plants, and agricultural fields are also located. The influence of valley-to-mountain circulations was also observed at the site, resulting in the transport of pollutant-rich air masses from local and distant sources to the site. A comparison of the mixing ratios of different trace gases obtained in the present study is also made with the values reported for other high altitude stations in the world.

Cross-sectional study on prevalence and consequences of screen time on physical and mental health in children in the era of COVID-19

Background: With the ongoing growth and expansion of digital media and COVID-19 pandemic, children are inclining more and more toward spending time on digital media as compared to outdoor sports, leading to poor physical and mental growth. Developed nations have already set up a screen time guideline which is yet to be established in developing nations. This study was conducted with the objectives of identifying the needs of screen time guidelines and to study the impact of screen time on mental and physical health in children. Aims and Objectives: This study aims to check the screen time in children aged 2–18 and find the health consequences both physical and psychological in those children. Materials and Methods: A cross-sectional study on children aged 2–18 years was conducted between 2019 and 2020. Parents were asked to fill a pre-structured questionnaire. Impact on health physical and mental were assessed by pediatrician and psychologist. Results: A total of 155 children were enrolled in the study. Mean child hours in children aged 2–5 years, 5–10 years, and 10–18 years were 4 h, 5.83 h, and 6.29 h on week days and 5.64 h, 5.76 h, and 7.69 h on weekends, respectively. More than one-third of children had age of onset of screen time below 2 years of age. About 70% of children had malnutrition. Only 18% of parents were aware of concept of screen free days. Screen time had negative impact on health (P=0.0001) and on behavior of child (P=0.001). Average increase in screen time during COVID-19 was nearly 3 times the pre-COVID era. Conclusion: This study has paved the way for the need of larger study and development of guidelines on impact of screen time on children in developing nations where screen time guidelines is yet to be set more so in era of COVID 19 pandemic.

The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019

BACKGROUND

A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India.

METHODS

Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates.

FINDINGS

The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2-5·0) in 1990 to 8·2% (6·6-10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2-0·3) to 0·6% (0·5-0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5-4·8) to 1·1% (0·9-1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9-46·1]), headache disorders (17·5% [3·6-32·5]), epilepsy (11·3% [9·0-14·3]), cerebral palsy (5·7% [4·2-7·7]), and encephalitis (5·3% [3·7-8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution.

INTERPRETATION

The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India

Background & objectives:

The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels.

Methods:

Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015.

Results:

The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed.

Interpretation & conclusions:

With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019

BACKGROUND

The association of air pollution with multiple adverse health outcomes is becoming well established, but its negative economic impact is less well appreciated. It is important to elucidate this impact for the states of India.

METHODS

We estimated exposure to ambient particulate matter pollution, household air pollution, and ambient ozone pollution, and their attributable deaths and disability-adjusted life-years in every state of India as part of the Global Burden of Disease Study (GBD) 2019. We estimated the economic impact of air pollution as the cost of lost output due to premature deaths and morbidity attributable to air pollution for every state of India, using the cost-of-illness method.

FINDINGS

1·67 million (95% uncertainty interval 1·42-1·92) deaths were attributable to air pollution in India in 2019, accounting for 17·8% (15·8-19·5) of the total deaths in the country. The majority of these deaths were from ambient particulate matter pollution (0·98 million [0·77-1·19]) and household air pollution (0·61 million [0·39-0·86]). The death rate due to household air pollution decreased by 64·2% (52·2-74·2) from 1990 to 2019, while that due to ambient particulate matter pollution increased by 115·3% (28·3-344·4) and that due to ambient ozone pollution increased by 139·2% (96·5-195·8). Lost output from premature deaths and morbidity attributable to air pollution accounted for economic losses of US$28·8 billion (21·4-37·4) and $8·0 billion (5·9-10·3), respectively, in India in 2019. This total loss of $36·8 billion (27·4-47·7) was 1·36% of India's gross domestic product (GDP). The economic loss as a proportion of the state GDP varied 3·2 times between the states, ranging from 0·67% (0·47-0·91) to 2·15% (1·60-2·77), and was highest in the low per-capita GDP states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, and Chhattisgarh. Delhi had the highest per-capita economic loss due to air pollution, followed by Haryana in 2019, with 5·4 times variation across all states.

INTERPRETATION

The high burden of death and disease due to air pollution and its associated substantial adverse economic impact from loss of output could impede India's aspiration to be a $5 trillion economy by 2024. Successful reduction of air pollution in India through state-specific strategies would lead to substantial benefits for both the health of the population and the economy.

FUNDING

UN Environment Programme; Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Subnational mapping of under-5 and neonatal mortality trends in India: the Global Burden of Disease Study 2000-17

BACKGROUND

India has made substantial progress in improving child survival over the past few decades, but a comprehensive understanding of child mortality trends at disaggregated geographical levels is not available. We present a detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality.

METHODS

We assessed the under-5 mortality rate (U5MR) and neonatal mortality rate (NMR) from 2000 to 2017 in 5 × 5 km grids across India, and for the districts and states of India, using all accessible data from various sources including surveys with subnational geographical information. The 31 states and groups of union territories were categorised into three groups using their Socio-demographic Index (SDI) level, calculated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study on the basis of per-capita income, mean education, and total fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using the coefficient of variation. We projected U5MR and NMR for the states and districts up to 2025 and 2030 on the basis of the trends from 2000 to 2017 and compared these projections with the NHP 2025 and SDG 2030 targets for U5MR (23 deaths and 25 deaths per 1000 livebirths, respectively) and NMR (16 deaths and 12 deaths per 1000 livebirths, respectively). We assessed the causes of child death and the contribution of risk factors to child deaths at the state level.

FINDINGS

U5MR in India decreased from 83·1 (95% uncertainty interval [UI] 76·7-90·1) in 2000 to 42·4 (36·5-50·0) per 1000 livebirths in 2017, and NMR from 38·0 (34·2-41·6) to 23·5 (20·1-27·8) per 1000 livebirths. U5MR varied 5·7 times between the states of India and 10·5 times between the 723 districts of India in 2017, whereas NMR varied 4·5 times and 8·0 times, respectively. In the low SDI states, 275 (88%) districts had a U5MR of 40 or more per 1000 livebirths and 291 (93%) districts had an NMR of 20 or more per 1000 livebirths in 2017. The annual rate of change from 2010 to 2017 varied among the districts from a 9·02% (95% UI 6·30-11·63) reduction to no significant change for U5MR and from an 8·05% (95% UI 5·34-10·74) reduction to no significant change for NMR. Inequality between districts within the states increased from 2000 to 2017 in 23 of the 31 states for U5MR and in 24 states for NMR, with the largest increases in Odisha and Assam among the low SDI states. If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target or either of the NHP 2025 targets. To reach the SDG 2030 targets individually, 246 (34%) districts for U5MR and 430 (59%) districts for NMR would need a higher rate of improvement than they had up to 2017. For all major causes of under-5 death in India, the death rate decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects, although the magnitude of decline varied widely between the states. Child and maternal malnutrition was the predominant risk factor, to which 68·2% (65·8-70·7) of under-5 deaths and 83·0% (80·6-85·0) of neonatal deaths in India could be attributed in 2017; 10·8% (9·1-12·4) of under-5 deaths could be attributed to unsafe water and sanitation and 8·8% (7·0-10·3) to air pollution.

INTERPRETATION

India has made gains in child survival, but there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Inequality between districts within states has increased for the majority of the states. The district-level trends presented here can provide crucial guidance for targeted efforts needed in India to reduce child mortality to meet the Indian and global child survival targets. District-level mortality trends along with state-level trends in causes of under-5 and neonatal death and the risk factors in this Article provide a comprehensive reference for further planning of child mortality reduction in India.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

A setup for Seebeck coefficient measurement through controlled heat pulses

A setup is designed for measuring the Seebeck coefficient (S) of materials in the form of thin films, bars, and wires. The main feature of this setup is its control in heating and cooling cycles. In this setup, a heat pulse is used to generate the temperature gradient. To demonstrate the capabilities of this setup, S versus T of standard wire samples such as Au-Fe (0.07%), chromel, Pt, and thin films of Pt and F doped SnO₂ are presented. The standard uncertainty of the repeatability in the S measurement is found to be ∼±0.056 μV/K while the temperature stability is ∼±10 mK (at 320 K), estimated for a chromel wire sample. We have tested the setup in the temperature range 100 K-320 K, while it does not have any intrinsic limitations in going down to liquid He temperatures. For temperatures above 320 K, the limitation is due to gluing materials such as varnish.

The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017

BACKGROUND

Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017.

METHODS

We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure-response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss.

FINDINGS

The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0-112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8-56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09-1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55-0·79) from ambient particulate matter pollution and 0·48 million (0·39-0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6-1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana.

INTERPRETATION

India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990-2016

BACKGROUND

The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016.

METHODS

We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates.

FINDINGS

The number of people with diabetes in India increased from 26·0 million (95% UI 23·4-28·6) in 1990 to 65·0 million (58·7-71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9-6·1) in 1990 to 7·7% (6·9-8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1-46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6-49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7-9·3) in 1990 to 20·4% (19·9-20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34-42) with diabetes, compared with the global average of 19 adults (17-21) in 2016.

INTERPRETATION

The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Efficient multicolor tunability of ultrasmall ternary-doped LaF3 nanoparticles: energy conversion and magnetic behavior

Luminescence-tunable multicolored LaF₃:xCe³⁺,xGd³⁺,yEu³⁺ (x = 5; y = 1, 5, 10, and 15 mol%) nanoparticles have been synthesized via a low cost polyol method. Powder X-ray diffraction and high-resolution transmission electron microscopy studies confirm the hexagonal phase of the LaF₃:xCe³⁺,xGd³⁺,yEu³⁺ nanophosphors with average sizes (oval shape) ranging from 5 to 7 nm. Energy-dispersive X-ray spectroscopy analyses show the uniform distribution of Ce³⁺, Gd³⁺, and Eu³⁺ dopants in the LaF₃ host matrix. The photoluminescence spectra and electron paramagnetic resonance measurements guarantee the presence of Eu²⁺, corroborated through DC susceptibility measurements of the samples displaying paramagnetic behavior at 300 K, whereas weak ferromagnetic ordering is shown at 2 K. The non-radiative energy transfer processes from the 4f(²F_5/2) → 5d state (Ce³⁺) to the intraconfigurational 4f excited levels of rare earth ions and simultaneous emissions in the visible region from the 4f⁶5d¹ (Eu²⁺) and ⁵D₀ (Eu³⁺) emitting levels, leading to overlapped broad and narrow emission bands, have been proclaimed. The energy transfer mechanism proposes involvement of the Gd³⁺ ion sub-lattice as the bridge and finally trapping by Eu^2+/3+, upon excitation of the Ce³⁺ ion. The calculation of experimental intensity parameters (Ω_2,4) has been discussed and the highest emission quantum efficiency (η = 85%) of the Eu³⁺ ion for the y = 10 mol% sample is reported. The advantageous existence of the Eu²⁺/Eu³⁺ ratio along with variously doped nanomaterials described in this work, results in tunable emission color in the blue-white-red regions, highlighting the potential application of the samples in solid-state lighting devices, scintillation devices, and multiplex detection.

The influence of carbon concentration on the electronic structure and magnetic properties of carbon implanted ZnO thin films

The influence of carbon concentration on the electronic and magnetic properties of C-implanted ZnO thin films has been studied using synchrotron radiation based X-ray absorption spectroscopic techniques and vibrating sample magnetometer measurements. 20 keV carbon ions were implanted in ZnO films with different fluences (2 × 10¹⁶, 4 × 10¹⁶ and 6 × 10¹⁶ ions per cm²). The pristine ZnO film shows diamagnetic behaviour while the C-implanted films exhibit room temperature ferromagnetism. Our first-principles calculations based on density functional theory show an appreciable magnetic moment only when the implanted C atom sits either in the O-site (2 μ_B) or in the interstitial position (1.88 μ_B), whereas the C atom in the Zn substitutional position does not possess any magnetic moment. X-ray absorption near edge structure analysis at the O K-edge reveals that the charge transfer from O-2p to the C-defect site causes the ferromagnetism in the C-implanted ZnO film at low fluence. However at high fluence, the implanted C replaces the lattice and produces more Zn vacancies, as evidenced by extended X-ray absorption fine structure studies at the Zn K-edge, which favors the ferromagnetism. The persistence of the implanted carbon and ferromagnetism of the C-implanted ZnO film has also been studied by isothermal annealing at 500 °C and discussed in detail.

Potassium channel gene associations with joint processing speed and white matter impairments in schizophrenia

Patients with schizophrenia show decreased processing speed on neuropsychological testing and decreased white matter integrity as measured by diffusion tensor imaging, two traits shown to be both heritable and genetically associated indicating that there may be genes that influence both traits as well as schizophrenia disease risk. The potassium channel gene family is a reasonable candidate to harbor such a gene given the prominent role potassium channels play in the central nervous system in signal transduction, particularly in myelinated axons. We genotyped members of the large potassium channel gene family focusing on putatively functional single nucleotide polymorphisms (SNPs) in a population of 363 controls, 194 patients with schizophrenia spectrum disorder (SSD) and 28 patients with affective disorders with psychotic features who completed imaging and neuropsychological testing. We then performed three association analyses using three phenotypes - processing speed, whole-brain white matter fractional anisotropy (FA) and schizophrenia spectrum diagnosis. We extracted SNPs showing an association at a nominal P value of <0.05 with all three phenotypes in the expected direction: decreased processing speed, decreased FA and increased risk of SSD. A single SNP, rs8234, in the 3' untranslated region of voltage-gated potassium channel subfamily Q member 1 (KCNQ1) was identified. Rs8234 has been shown to affect KCNQ1 expression levels, and KCNQ1 levels have been shown to affect neuronal action potentials. This exploratory analysis provides preliminary data suggesting that KCNQ1 may contribute to the shared risk for diminished processing speed, diminished white mater integrity and increased risk of schizophrenia.

Correlations of charge neutrality level with electronic structure and p-d hybridization

The formation of charge neutrality level (CNL) in highly conducting Cadmium oxide (CdO) thin films is demonstarted by the observed variation in the band gap upon annealing and doping. It may be explained by the observation that Tin (Sn) doping breaks the perfect periodicity of CdO cubic crystal structure and creates virtual gap states (ViGS). The level of local CNL resides at the branch point of ViGS, making the energy at which native defect’s character changes from predominantly donor-like below CNL to predominantly acceptor-like above the CNL and a schematic band diagram is developed to substantiate the same. Further investigations using soft x-ray absorption spectroscopy (SXAS) at Oxygen and Cadmium edges show the reduction of Sn⁴⁺ to Sn²⁺. The analysis of the spectral features has revealed an evidence of p-d interaction between O 2p and Cd 4d orbitals that pushes the valence band minima at higher energies which is symmetry forbidden at г point and causing a positive valance band dispersion away from the zone centre in the г ~ L, K direction. Thus, origin of the CNL is attributed to the high density of the Oxygen vacancies as confirmed by the change in the local electronic structure and p-d hybridization of orbitals.

Indian Council of Medical Research consensus document for the management of tongue cancer

The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.

Early diagnosis is imperative in improving outcomes and preserving quality of life. High index of suspicion is to be maintained for leukoplakia (high risk site).

Evaluation of a patient with newly diagnosed tongue cancer should include essential tests: Magnetic resonance imaging (MRI) is investigative modality of choice when indicated. Computed tomography (CT) scan is an option when MRI is unavailable. In early lesions when imaging is not warranted ultrasound may help guide management of the neck.

Early stage cancers (stage I & II) require single modality treatment – either surgery or radiotherapy. Surgery is preferred. Adjuvant radiotherapy is indicated for T3/T4 cancers, presence of high risk features [lymphovascular emboli (LVE), perineural invasion (PNI), poorly differentiated, node +, close margins). Adjuvant chemoradiation (CTRT) is indicated for positive margins and extranodal disease.

Locally advanced operable cancers (stage III & IVA) require combined multimodality treatment - surgery + adjuvant treatment. Adjuvant treatment is indicated in all and in the presence of high risk features as described above.

Locally advanced inoperable cancers (stage IVB) are treated with palliative chemo-radiotherapy, chemotherapy, radiotherapy, or symptomatic treatment depending upon the performance status. Select cases may be considered for neoadjuvant chemotherapy followed by surgical salvage.

Metastatic disease (stage IVC) should be treated with a goal for palliation. Chemotherapy may be offered to patients with good performance status. Local treatment in the form of radiotherapy may be added for palliation of symptoms.

Intense follow-up every 3 months is required for initial 2 years as most recurrences occur in the first 24 months. After 2^nd year follow up is done at 4-6 months interval. At each follow up screening for local/regional recurrence and second primary is done. Imaging is done only when indicated.

Establishing integrated rural-urban cohorts to assess air pollution-related health effects in pregnant women, children and adults in Southern India: an overview of objectives, design and methods in the Tamil Nadu Air Pollution and Health Effects (TAPHE) study

INTRODUCTION

In rapidly developing countries such as India, the ubiquity of air pollution sources in urban and rural communities often results in ambient and household exposures significantly in excess of health-based air quality guidelines. Few efforts, however, have been directed at establishing quantitative exposure-response relationships in such settings. We describe study protocols for The Tamil Nadu Air Pollution and Health Effects (TAPHE) study, which aims to examine the association between fine particulate matter (PM2.5) exposures and select maternal, child and adult health outcomes in integrated rural-urban cohorts.

METHODS AND ANALYSES

The TAPHE study is organised into five component studies with participants drawn from a pregnant mother-child cohort and an adult cohort (n=1200 participants in each cohort). Exposures are assessed through serial measurements of 24-48 h PM2.5 area concentrations in household microenvironments together with ambient measurements and time-activity recalls, allowing exposure reconstructions. Generalised additive models will be developed to examine the association between PM2.5 exposures, maternal (birth weight), child (acute respiratory infections) and adult (chronic respiratory symptoms and lung function) health outcomes while adjusting for multiple covariates. In addition, exposure models are being developed to predict PM2.5 exposures in relation to household and community level variables as well as to explore inter-relationships between household concentrations of PM2.5 and air toxics. Finally, a bio-repository of peripheral and cord blood samples is being created to explore the role of gene-environment interactions in follow-up studies.

ETHICS AND DISSEMINATION

The study protocols have been approved by the Institutional Ethics Committee of Sri Ramachandra University, the host institution for the investigators in this study. Study results will be widely disseminated through peer-reviewed publications and scientific presentations. In addition, policy-relevant recommendations are also being planned to inform ongoing national air quality action plans concerning ambient and household air pollution.

Reference equation for the 6-minute walk test in healthy North Indian adult males

SETTING

Lala Ram Swarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.

BACKGROUND

The 6-min walk distance (6MWD) correlates well with functional capacity. However, previous reference equations for the 6MWD have failed to accurately predict the 6MWD due to variations in population ethnicity and geography.

OBJECTIVE

The aims of this study were 1) to measure 6MWD in healthy North Indian adult males, 2) to determine the applicability of Enright and Sherrill's reference equation to healthy North Indian adult males, and 3) to develop a regression equation for Indian males.

DESIGN

After physical examination and investigations, the 6-minute walk test was conducted in male subjects aged 40-60 years.

RESULTS

The mean (±SD) 6MWD was 536.1 ± 46.9 m. Enright and Sherrill's reference equation did not correctly predict distance in an Indian population: walk distance was overestimated by a mean (±SD) of 46.8 ± 32.9 m. The regression equation developed for males was 6MWD (m) = 3.654 × height (cm) - 4.139 × age (years) + 127.121, and accounted for 63.9% of total variance.

CONCLUSIONS

Enright and Sherrill's equation cannot be used to predict the 6MWD in healthy North Indian adult males. The new regression equation is expected to prove useful for various purposes in healthy North Indian adult males.

Resonant scattering and diffraction beamline P09 at PETRA III

The resonant scattering and diffraction beamline P09 at PETRA III is designed for X-ray experiments requiring small beams, energy tunability, variable polarization and high photon flux. It is highly flexible in terms of beam size and offers full higher harmonic suppression. A state-of-the-art double phase-retarder set-up provides variable linear or circular polarization. A high-precision Psi-diffractometer and a heavy-load diffractometer in horizontal Psi-geometry allow the accommodation of a wide variety of sample environments. A 14 T cryo-magnet is available for scattering experiments in magnetic fields.

Electric-field-induced polar order and localization of the confined electrons in LaAlO3/SrTiO3 heterostructures

With ellipsometry, x-ray diffraction, and resistance measurements we investigated the electric-field effect on the confined electrons at the LaAlO3/SrTiO3 interface. We obtained evidence that the localization of the electrons at negative gate voltage is induced, or at least enhanced, by a polar phase transition in SrTiO3 which strongly reduces the lattice polarizability and the subsequent screening. In particular, we show that the charge localization and the polar order of SrTiO3 both develop below ∼50  K and exhibit similar, unipolar hysteresis loops as a function of the gate voltage.

Effect of camel milk on glucose metabolism in adults with normal glucose tolerance and type 2 diabetes in Raica community: a crossover study

BACKGROUND

To investigate effects of camel milk consumption on insulin sensitivity and glycemic control in normal and type-2 diabetics of Raika and Non-Raika community.

METHODS

28 raika and non-raika male were enrolled in study, categorized in 2 groups, non-diabetic and diabetic after one month stabilization. Non-diabetics were supplemented with cow milk and diabetics with camel milk; followed by one-month washout period. Afterwards regimen was interchanged for 3 months. Biochemical and anthropometric data was recorded at baseline, after stabilization, before and after washout and at end of study.

RESULTS

An improving trend was observed in both the groups for camel milk effect (FBS 203.86 +/- 24.09 to 161.43 +/- 11.39 mg/dl; p<0.05, OGTT 320.86 +/- 25.34 to 213.79 +/- 15.96 mg/dl; p<0.05 in diabetics and FBS 101.79 +/- 3.06 to 96.79 +/- 2.56 mg/dl, OGTT 114.36 +/- 7.99 to 100.36 +/- 6.74 mg/dl in control). HbAlc improved due to camel milk consumption (8.39 +/- 0.64 to 7.27 +/- 0.67%) whereas deteriorated in the case of cow milk (7.36 +/- 0.66 to 8.26 +/- 0.60%) in diabetic group. The HOMA-IR reduced from 13.21 +/- 4.88 to 4.38 +/- 0.75, AUC-glucose from 37253.57 +/- 2859.08 to 30724.29 +/- 3677.33 and AUC-insulin from 5871.86 +/- 1210.73 to 3301.86 +/- 629.98 in the camel milk group.

CONCLUSIONS

In type-2 diabetics camel milk reduces FBS, post-prandial glucose and HbA1c. AUC-insulin and AUC-glucose also decreased significantly along with HOMA-IR. It shows hypoglycemic effect of camel milk reducing insulin resistance. (www.actabiomedica.it).

Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study

AIMS/HYPOTHESIS

This study reports the results of the first phase of a national study to determine the prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in India.

METHODS

A total of 363 primary sampling units (188 urban, 175 rural), in three states (Tamilnadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India were sampled using a stratified multistage sampling design to survey individuals aged ≥ 20 years. The prevalence rates of diabetes and prediabetes were assessed by measurement of fasting and 2 h post glucose load capillary blood glucose.

RESULTS

Of the 16,607 individuals selected for the study, 14,277 (86%) participated, of whom 13,055 gave blood samples. The weighted prevalence of diabetes (both known and newly diagnosed) was 10.4% in Tamilnadu, 8.4% in Maharashtra, 5.3% in Jharkhand, and 13.6% in Chandigarh. The prevalences of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) were 8.3%, 12.8%, 8.1% and 14.6% respectively. Multiple logistic regression analysis showed that age, male sex, family history of diabetes, urban residence, abdominal obesity, generalised obesity, hypertension and income status were significantly associated with diabetes. Significant risk factors for prediabetes were age, family history of diabetes, abdominal obesity, hypertension and income status.

CONCLUSIONS/INTERPRETATIONS

We estimate that, in 2011, Maharashtra will have 6 million individuals with diabetes and 9.2 million with prediabetes, Tamilnadu will have 4.8 million with diabetes and 3.9 million with prediabetes, Jharkhand will have 0.96 million with diabetes and 1.5 million with prediabetes, and Chandigarh will have 0.12 million with diabetes and 0.13 million with prediabetes. Projections for the whole of India would be 62.4 million people with diabetes and 77.2 million people with prediabetes.

Inspection of multiferroicity in BiMn(2-x)Ti(x)O(5) ceramics through specific heat and Raman spectroscopic studies

Inspection of multiferroicity in BiMn(2 - x)Ti(x)O(5) (0 ≤ x ≤ 0.30) (BMTO) ceramics is performed through specific heat and Raman spectroscopic studies. Thermal variation of specific heat (C) (in the absence and presence of fixed magnetic fields up to 14 T) and Raman spectra of BMTO are presented. In the temperature variation of C, a remarkable anomaly at the antiferromagnetic (AFM) ordering temperature (T(N) ∼ 39 K) is observed in all samples. Pure BiMn(2)O(5) (for x = 0.0) exhibits a larger specific heat anomaly at T(N) compared to that of Ti substituted samples, both in the presence and absence of external magnetic fields. The excess specific heat (ΔC) versus T clearly illustrates appreciable anomalies at ∼ 86 and ∼ 120 K in Ti doped samples related to the magnetic and dielectric transitions, respectively. The low temperature specific heat (LTSH) data indicate a considerably improved ferromagnetic contribution in samples with higher Ti concentration (x > 0.15). The Raman spectra of the doped samples at different fixed temperatures validate the strong electron-phonon coupling corresponding to the observed magnetism and increased harmonicity at dielectric transitions.

Bi-substitution-induced magnetic moment distribution in spinel Bi(x)Co(2-x)MnO(4) multiferroic

We report the near-edge x-ray absorption spectroscopy (NEXAFS) at the Co/Mn L(3,2) edge and oxygen K edge of the well-characterized Bi-substituted Co(2)MnO(4) multiferroic samples. The evolution of peak features in NEXAFS spectra of the Co/Mn L(3,2) edge and O K edge show the Bi-induced redistribution of magnetic cations (Co/Mn). The variation in valence states of Co and Mn in all the substituted compositions is consistent with the observed ferrimagnetic behaviour of the samples. Magnetization data show the decrease in molecular field complementing the ferrimagnetism. The role of Bi in the enhancement of magnetic interactions as well as the appearance of ferroelectricity in Bi(x)Co(2-x)MnO(4) (0≤x≤0.3) is discussed.

Prevalence of risk factors for non-communicable disease in a rural area of Faridabad district of Haryana

BACKGROUND & OBJECTIVES

To estimate the prevalence and levels of common risk factors for noncommunicable disease in a rural population of Haryana.

METHODS

The study involved a survey of 1359 male and 1469 female respondents, aged 15-64 years. Multistage sampling was used for recruitment (PHCs/sub-centres/villages). All households in the selected villages were covered, with one male and one female interviewed in alternate household. WHO STEP-wise tool was used as the study instrument which included behavioural risk factor questionnaire and physical measurements of height, weight, waist circumference and blood pressure. The age adjusting was done using rural Faridabad data from Census 2001.

RESULTS

The age adjusted prevalence of daily smoked tobacco was 41% for men and 13% for women. Daily smokeless tobacco use was 7.1% and 1.2% for men and women respectively. The prevalence of current alcohol consumption was 24.6% among men and none of the women reported consuming alcohol. The mean number of servings of fruits and vegetables per day was 3.7 for men and 2.7 for women. The percentage of people undertaking at least 150 minutes of physical activity in a week was 77.8% for men and 54.5% for women. Among men 9.0% had BMI > or = 25.0 compared to 15.2% among women. The prevalence of measured hypertension, i.e. > or = 140 SBP and/or > or = 90 DBP or on antihypertensive drugs was 10.7% among men and 7.9% among women.

CONCLUSION

The study showed a high burden of tobacco use and alcohol use among men, inactivity and overweight among women and low fruit and vegetable consumption among both sexes in rural areas.

Urban rural differences in prevalence of self-reported diabetes in India--the WHO-ICMR Indian NCD risk factor surveillance

Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p<0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nation-wide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study.

Iron deficiency anaemia in sickle cell disorders in India

BACKGROUND & OBJECTIVE

Iron deficiency anaemia (IDA) is uncommon in individuals with sickle cell disease (SCD) because of availability of an adequate iron source potentially from increased red cell turnover and from blood transfusions. Also, iron deficiency anaemia can often go unnoticed because the sickle cell disease patients are already anaemic. Iron deficiency in sickle cell patients may result in lowering the intracellular haemoglobin concentration and this may ameliorate sickling. The present study was undertaken to determine the prevalence of iron deficiency anaemia and the response of iron supplementation in sickle cell disorders in tribal population of the four States viz. Maharashtra, Gujarat, Orissa and Tamil Nadu.

METHODS

A total of 8434 individuals (7105 AA, 1267 AS and 62 SS) were tested for zinc protoporphyrin/haem (ZPP/H) ratio and haemoglobin levels. Twenty two sickle cell anaemia (SS), 47 sickle cell trait (AS) and 150 normal control (AA) individuals who were iron deficient, were given iron therapy for a period of 12 wk and the laboratory investigations were repeated at the 13th wk.

RESULTS

Sixty seven per cent of subjects with sickle cell anaemia and 26 per cent with sickle cell trait had elevated ZPP/H ratios (>80 micromol/mol) as against 22.8 per cent of normal individuals. The elevated ZPP/H ratios is an indicator of microcytic anaemia of iron deficiency. Following iron therapy, an improvement in the Hb levels and ZPP/H ratios was observed in both sickle cell disorders and normal individual cases.

INTERPRETATION & CONCLUSION

This study suggests that iron deficiency anaemia is an important problem in Indian sickle cell anaemia patients and iron supplementation should be given only in proven cases of iron deficiency anaemia.

NICU in a community level hospital

OBJECTIVE

To study the clinical profile and outcome of neonates in NICU of a community hospital and highlight the importance and problems in neonatal care at a community level hospital.

METHODS

Retrospective analysis of case records during the period Jan. 2001- Dec. 2003. Data regarding antenatal care, maternal morbidity, place of birth, age at admission, birth weight, gestational age, diagnosis, relevant investigations, duration of stay and outcome were recorded on a preset proforma. A cost analysis for average expenses per newborn per day for different morbidities was also done. Neonatal data was analyzed among survivors and expired using appropriate statistical tests. Probability of less than 5% was taken significant. Factors found significant on univariate analysis were subjected to logistic regression model to study independent predictor of fatality.

RESULTS

A total of 168 neonates were admitted during the study period. The overall survival rate was 65%. 42(25%) neonates expired and 5.4% were referred to higher centers. The commonest morbidity in survivors was hyperbilirubinemia. Prematurity with HMD and neonatal sepsis were the commonest cause of mortality. 36(24.3%) expired within 48 hr of admission (Mean 33.2 hr). 31(17.8%) could not be referred and none survived. The difference of birth weight, gestational age and duration of stay was statistically different in survivors & expired. These variables retained their significance on multivariate analysis and thus were independent predictors of fatality. An average expense of Rs 400-500/day/newborn was charged in the NICU.

CONCLUSION

In a country of limited resources, 65 % neonates requiring NICU can be managed at community level hospitals.

Oral habits in school going children of Delhi: a prevalence study

This study was conducted on 5554 children aged 5-13 years old with the objectives of recording the prevalence of oral habits among North Indian children according to sex. These children were selected from the schools of Delhi. The sample represented the entire school-going population of Delhi in the age group of 5-13 years. Statistical analysis was carried out using BMDP software and sex differences were calculated by using Fisher's exact test. The results showed that the prevalence of oral habits in Delhi school going children was 25.5%. Tongue thrust was the commonest habit (18.1%) followed by mouth breathing (6.6%). Thumb sucking was relatively less common habit and seen in only 0.7% of children. There were no significant differences between boys and girls for the prevalence of oral habits. However, for the specific habit types there was a sex difference. Thumb sucking was more common in girls (1.0%) when compared with boys (0.4%) and this difference was statistically significant (P < 0.001). There was a reverse trend for the mouth breathing, which was more common (P < 0.001) in boys (7.8%) than girls (5.3%). There were no differences for tongue thrust habit between boys (17.5%) and girls (18.6%).

Epidemiological study of congenital heart disease

A community based survey of congenital heart disease was carried out on a random sample of 11,833 children below 15 years in Delhi, India. Congenital heart disease was diagnosed on clinical history and/or clinical examination. Out of the examined sample, 50 were found suffering from congenital heart disease, giving an overall prevalence of 4.2/1000 (4.6/1000 in boys and 3.7/1000 in girls). The prevalence rate was slightly higher than other studies carried out in the country. The reason is obvious. The present study is community based while other studies were hospital or school based. The type of lesions were similar to those reported from other studies. The lesions in order of frequency were ventricular septal defect (46%), atrial septal defect (18%), patent ductus arteriosus (14%), Fallot's tetrology (10%), aortic stenosis (4%), and pulmonary stenosis (4%). Like other studies ventricular septal defect was the commonest lesion. The prevalence rate was higher in the age group 0-4 years and 5-9 years in boys whereas it was higher in adolescent age group (10-14 years) in girls.

Autologous bone marrow/stem cell transplantation: initial experience at a north Indian referral centre

BACKGROUND

High-dose chemotherapy and/or radiation therapy rescued by autologous bone marrow or peripheral blood stem cells is being increasingly used for the treatment of haematological and solid malignancies. While few centres in India use this modality of therapy, the worldwide experience is encouraging. We, therefore, analysed the results of our initial experience with this therapeutic modality.

METHODS

Forty-two patients [multiple myeloma (17), Hodgkin's disease (4), non-Hodgkin's lymphoma (3), chronic myeloid leukaemia (2), acute myeloid leukaemia (2), acute lymphoblastic leukaemia (2), epithelial ovarian cancer (6), breast cancer (4), primitive neuroectodermal tumour and testicular germ cell tumour (1 each)] underwent high-dose chemotherapy followed by either autologous bone marrow transplant (n = 9), peripheral blood stem cell transplant (n = 30) or both (n = 3). The indications for transplant included either advanced stage at diagnosis, other adverse prognostic indicators during the course of their disease, or relapse. The data were analysed retrospectively in December 1998 using hospital records. Follow up data of all the patients were available.

RESULTS

Thirty-four of the 42 patients (81%) showed stable engraftment. Eight patients (19%) died in the early post-transplant period (day 5 to day 52 post-transplant). Seven patients died due to neutropenic infections and one due to acute renal failure. Of the 34 surviving patients, 20 were alive at the time of analysis and 14 had died. All but one death in this group were due to progressive primary malignancy. The median overall survival for all patients was 17 months and for the 34 engrafted patients it was 27 months. An analysis of factors affecting survival revealed that patients with chemosensitive disease had a longer overall survival (20.9 v. 6.1 months, p = 0.04) compared to those with chemoresistant disease.

CONCLUSION

Autologous bone marrow or peripheral stem cell transplantation is a feasible procedure in India with an acceptable morbidity and mortality. It should be offered more frequently to properly selected patients.

A study of dental caries in school children from rural Haryana

The prevalence of dental caries among rural school children (688 boys and 331 girls) in the age group of 12-16 years in Haryana was found to be 39.4%. It was 37.9% in boys and 42.6% in girls. The difference between males and females was statistically not significant. A significant increase in prevalence of dental caries with age was observed (i.e. 33.1% in 12-year-old children to 45.8% in 14-year-old children). The mean DMFT per child was found to be 1.03 and DMFT per affected child was 2.6. The mean of D, M and F was found to be 1.0, 0.03 and 0.0 respectively.

Prognostic markers in amebic liver abscess: a prospective study

OBJECTIVES

Amebic liver abscess (ALA) is being increasingly recognized with the progressive spread of AIDS. The prognosis of ALA needs to be determined to decide whether aggressive intervention therapy should be used. A prospective study was conducted to determine the factors that predicted mortality in patients with ALA.

METHODS

The study population consisted of 135 consecutive patients with ALA who were treated with 80 mg/kg/day of metronidazole for 10 days if they survived. Needle aspiration or open surgical drainage was performed in patients who deteriorated despite drug therapy or had an abscess that clinically appeared to be at risk of impending rupture. Survivors and nonsurvivors were compared by univariate and multivariate analysis to identify predictors of outcome. These predictors were then prospectively evaluated in a subsequent cohort of patients with ALA.

RESULTS

Twenty-four patients died during the acute phase. Significant differences between survivors and nonsurvivors were observed. A stepwise logistic regression suggested that a bilirubin level >3.5 mg/dl, encephalopathy, volume of abscess cavity, hypoalbuminemia (serum albumin level <2.0 g/dl), and the number of abscesses were independent risk factors for mortality. The duration of symptoms and type of treatment did not influence mortality. The regression equation derived was then applied prospectively to 64 subsequent patients with ALA, and the validity of the prediction rule was confirmed. The qualities of simplicity, availability, low cost of derivation, and good discriminating power suggest that this index would be useful in assessing prognosis in patients with ALA.

Age at which chest circumference overtakes head circumference in children

Maximum likelihood method with probit transformation was applied to estimate median age at which chest circumference (CC) overtook head circumference (HC) in 1206 children from rural areas of Ballabhgarh in Haryana and in 1505 children from a slum population in Delhi. The results showed that, in case of rural area, this phenomenon occurred at an average age of 31.36 months and in children from urban slums, at an average age of 28 months. In both the areas, this phenomenon occurred at an average age of 20 to 21 months in normally nourished children. In children with grade I malnutrition, this was delayed by about 10 months as compared to those with normal nutrition and in children with grade II or worse malnutrition, this was further delayed by another 9 to 13 months on an average as compared to those with grade I malnutrition. These differences were found to be statistically significant (p < 0.001). These results indicate that the longer the delay in CC overtaking HC, the chance is higher for the children to be severely malnourished. Considering the relative ease of measuring head and chest circumferences, this parameter (age of CC crossing HC) could be useful in assessing the long term trend in the improvement of childhood nutrition in developing countries.

A study of the etiological factors associated with the development of malocclusion

The prevalence of malocclusion among 1608 children (777 boys and 831 girls) in the age group of 5-7 years, selected from different schools of varied locations of Delhi was observed as 18.4%. A number of factors that could influence the normal development of occlusion during early mixed dentition stage were recorded. These included spacing in anterior teeth, attrition of primary teeth and deleterious oral habits. The socio-demographic variables included occupation of parents, family size, location type and the school type. The age of the child and sex were also considered. In order to find out the contribution and importance of above mentioned occlusal characteristics and socio-demographic factors in the development of malocclusion, the data were subjected to univariate analysis. Further a stepwise logistic regression analysis was done to know whether any association exists between the occurrence of malocclusion and combination of these factors. Four factors were found to contribute significantly in the occurrence of malocclusion explaining 15.5% variation in case of boys and 22% in case of girls. More significant factors were absence of spacing, effect of habits and lack of attrition of primary teeth. About 80% of the total variation was independent of these factors and could not be explained by this analysis. It further testifies possible predominance of genetic influences in the development of occlusion.