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Background: Out of the 1.324 billion people in India (2016), around 12.4% of the population is below the poverty line. In India, out-of-pocket health expenditure (OOP) expenses account for about 62.6% of total health expenditure – one of the highest in the world. High OOP health expenditures push many households into poverty. This study aims to identify the impoverishing effects of OOP health expenditures in India. Methods: Data from the recent national survey by the National Sample Survey Organization – Social Consumption in Health 2014 are used to investigate the effect of OOP health expenditure on household poverty. Poverty headcounts and poverty gaps were estimated at the household level before and after making OOP healthcare payments. A logistic regression model is for predicting the effect of various factors on the incidence of impoverishment due to OOP health expenditures. Results: There were 65,932 households in the sample. The total poverty headcount in the population before making OOP payments was 16.44% and it increased to 19.05% after making OOP payments. This 2.61% increase in the poverty headcount corresponds to 6.47 million households. Logistic regression results showed that medium and large households, household members with increased duration of stay in the hospital, utilization of private health facility and the presence of chronic illness increased odds of impoverishment due to OOP health expenditures. Conclusions: Health insurance programmes must be expanded to cover outpatient and preventive health services, include people above the poverty line, cover the whole household irrespective of the number of members living in the household and the coverage threshold limits must be increased. Urban poor must be enrolled in health insurance programmes without any delay. [ABSTRACT FROM AUTHOR]

Background and Introduction: Intramuscular injections are usually given in the arm or the gluteal region. Needle insertions done through the intramuscular route in the arm are almost always administered at a point 1 - 2 cm above the insertion of the deltoid. However, this site is not such an ideal one as found by certain other workers. Hence, this study was done to establish a series of safe determinant points in and around the arm in the South Indian population of the state of Telangana. Materials and Methods: The five proven safe injection points were tested through needle insertions by observing sterile aseptic precautions in the arms of 370 subjects at the outpatient department of a national level medical research institute after obtaining their consent following the universal safety protocol. Results: The points I [1 to 2 cm above deltoid insertion], II [a point midway between the midpoint of arm and insertion of deltoid] and III [midpoint between anterior acromion and deltoid insertion] were found to be safe for administering intramuscular arm injections in this subset of the population. Conclusion: This explains the erratic course of the anterior branches of the axillary nerve in different geographical populations. Hence, needle insertion points for arm intramuscular injections need to be determined according to the region. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical and virological status in urban and rural populations. Methods: A cross-sectional study was conducted in a tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak for a period of six months. Upper respiratory tract (URT) specimens including nasopharyngeal and oropharyngeal swabs were collected from the patients and their contacts and processed by RT-PCR technique for COVID-19 detection. Further, clinical and virological response in both the population were assessed and compared. Results: A total of 37,724 URT samples were tested, out of which 20,144 (53%) samples were from the rural population and 17,580 (47%) from the urban population. Out of the total samples from urban and rural population, COVID-19 positivity was 13.9% in urban population and 6.2% in rural population. Around 86% patients or contacts were asymptomatic in both the rural and urban population and rests were symptomatic 14%. Among the symptomatic patients, sore throat was seen as the most common presenting symptom (95-100%) followed by fever (80-83%), dry cough (55-61%), nasal discharge (18-23%), and breathlessness (3-5%) in both the rural and urban population. Conclusion: Our outcomes provide novel facts that the COVID-19 epidemic severely affected both rural and urban populations but with few differences. In our study, positivity rate in case of urban population was 13.9% as compared to 6.2% in rural population. There are two foremost facets that contributed variation in positivity in both the population. First, better immune response in rural population as compared to urban population which can be due to the fact that rural people in India are more exposed to various pathogens during their early lifetime thus, improving their immune status. Second, factor could be elevated population densities in urban areas which can contribute to increased infectiousness thus higher positivity rate. In addition, people living in urban population have to commute more for their work and are exposed to more people throughout the day thus, having more possibility to get infection of COVID-19 as compared to the rural population. To the best of our knowledge, there are no studies conducted on COVID-19, among rural population of Haryana. Hence, this study will allow us to fill the gap in knowledge about the variation in contagion spread and immune response in both rural and urban populations. [ABSTRACT FROM AUTHOR]

Background: Hand-eye coordination is essential for our daily activities. It involves the accuracy and concentration with which an individual performs tasks. Memory tasks like abacus involve the increased use of the superior and middle frontal gyrus, the motor region of the cerebral cortex, which improves the blood supply to this region, and nourishment to the neurons. This enhances neural plasticity in the developing age, which, in turn, improves the rapidity and precision of physical responses to various stimuli. Objectives: To assess and compare the reaction times of children who have undergone abacus training and those who have not undergone abacus training in the age group of 8–13 years. Methods: It is a cross-sectional study, selected by Indian Council of Medical Research- Short Term Studentship 2018, approved by the undergraduate research monitoring committee, and institutional ethics committee. The research study was conducted in a central school in Puducherry among age-matched and body mass index (BMI)-matched healthy children aged between 8 and 13 years who were undergoing abacus training and who did not receive abacus training. Anthropometric parameters such as weight, height, and BMI were measured. Following that, the auditory (ART) and visual reaction time (VRT) of the participants were measured using a recognition reaction time apparatus. Results: The auditory and visual reaction time in the study group was significantly less than that of the control group (P = 0.04 for ART and P = 0.001 for VRT). Interpretation and Conclusion: This study concludes that students trained in memory tasks like abacus have better hand-eye coordination as recorded by their enhanced processing speed, thereby decreased response to auditory and visual stimuli when compared with untrained students. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic gave an opportunity to adopt many appropriate changes in the behavior of the people in India. The major gears of those behavior changes were the enforcement by the government, fear, motivation (self and induced), and self-experiences or realizations with time. If those changes are fitted in the Trans-Theoretical Model, Indian people have passed through the "Pre-Contemplation" to "Action" stage of behavior changes during different phases of this pandemic. Frequent hand hygiene, maintaining physical distancing, use of face mask, cough etiquettes, avoid greetings through physical contacts, fear in spitting and urination at public places, refrain from gatherings and avoiding outside food are some of the examples of those appropriate behaviors which were enforced or learnt during the COVID pandemic. The continuous lockdown made people understand the difference between "want" and "need," the importance of local production, and the significance of social media and technology in routine life. The work-from-home strategy gave a chance to appreciate the work--life balance in a more applied way. The first-ever lifetime experience of unbelievable rejuvenating nature because of lack of human play taught people to appreciate nature. Although the current focus is on responding to the pandemic and on coping with its immediate effects, yet this is the time when there is an urgent need to create an enabling environment to support and sustain these COVID-19 appropriate behaviors (maintenance stage) to reap the maximum benefits out of them. Sustaining these appropriate behaviors is also important considering the bimodal distribution of the COVID-19 and possibility of advent of the second wave of COVID-19 in near future. [ABSTRACT FROM AUTHOR]

Background: Non‑alcoholic fatty liver disease (NAFLD) is an important etiology for the development of chronic liver disease worldwide. Its pathophysiology includes chronic low‑grade inflammation. There are limited studies on the association of inflammatory markers with NAFLD. Hence, in the present research, we aimed to study the association of one such inflammatory marker hs‑CRP with NAFLD in north Indian population. Materials and Methods: For this cross‑sectional study, 100 subjects of either sex above 18 years of age, being diagnosed as a case of NAFLD on the basis of ultrasonography and age, sex and BMI matched subjects fulfilling the inclusion and exclusion criteria were included. Anthropometric profile, high‑sensitivity C‑reactive protein (hs‑CRP), HbA1c, and hepatic function tests were recorded. Results: The baseline variables were matched for age, weight, BMI, waist‑hip circumference ratio, and blood pressure. The HbA1c (P < 0.001), alanine aminotransferase (P = 0.002), alkaline phosphatase (0.002), and hs‑CRP (P < 0.001) were elevated in subjects with NAFLD. The mean level of hs‑CRP was significantly higher in subjects with NAFLD as compared to the control group (3.12 ± 1.42 mg/L vs 1.05 ± 0.44 mg/L, P < 0.001). The mean hs‑CRP level was 1.42 ± 0.55 mg/L in grade 1, 0.98 ± 0.72 mg/L in grade 2 with P < 0.001, and 4.5 ± 1.11 mg/L in grade 3 with P < 0.001 when compared to grade 1.The comparative value of hs‑CRP in the control group was found to be 1.05 ± 0.44 mg/L. On univariate analysis waist‑hip circumference ratio (P = 0.035), HbA1c (P < 0.001), and hs‑CRP (P < 0.001), showed a significant association with NAFLD. On logistic regression hs‑CRP was found to have significant association with NAFLD even after adjusting waist‑hip circumference ratio and HbA1C (odds ratio 1.311, 95% confidence interval 1.146–1.488, P < 0.001). Conclusion: In this cohort of north Indian population, hs‑CRP showed independent relationships with NAFLD. Thus, hs‑CRP may be used as a surrogate marker for the disease severity in NAFLD. [ABSTRACT FROM AUTHOR]

Background: International Obesity Task Force proposed lower body mass index (BMI) cut-off values for defining overweight and obesity in Asian population. However, there is an absence of unanimity regarding the definition of overweight and obesity that is confusing while estimating disease burden, resource allocation, and priority setting. Therefore, the primary aim of the study was to assess the prevalence of overweight and obesity and its predictors as per different criteria (WHO criteria, Modified Asian criteria of BMI classification and BF% estimation by bioelectric impedance analysis technique). The secondary aim was to assess the concordance of overweight and obesity as diagnosed using these three methods. Methodology: A community-based cross-sectional study was conducted in a rural area of Rohtak, north India over a period of 1 year with a sample size of 1080. Anthropometric measurements including height, weight, blood pressure, body fat % analysis were recorded using standard protocols. Results: The prevalence of overweight and obesity were observed to be 49.62% (N = 536) as per the modified criteria for the Asian Indians (BMI ≥23 kg/m2) and 34.62% (N = 374) according to WHO criteria (BMI ≥25 kg/m2). A total of 18.3% of the study population were hypertensive. Modified criteria of BMI classification for Asian Indians had high sensitivity (67%) as compared to WHO criteria (55%) in predicting, diagnosing hypertension, and resembled sensitivity estimate obtained through direct body fat percentage estimation (69%). Conclusion: Modified criteria of overweight and obesity classification are better in terms of reducing comorbid dysmetabolic conditions, as exemplified by hypertension. [ABSTRACT FROM AUTHOR]

Background: The rising incidence of obesity is one of the most serious public health issues in the developed as well as in developing countries like India. Obesity and overweight are most important risk factors for many chronic diseases, including cardiovascular diseases, diabetes and cancer. In this study the body mass index (BMI) cut off was taken as 18.5-22.9 kg/m2 for normal, 23.0-24.9 kg/m2 for Overweight and >25 kg/m2 for obese as per WHO recommendation for Asian Indians, which is different for developed and developing countries. Role of gut microbiota mediated immune response in the development of obesity has been studied but the literature on Indian population are lacking. Therefore, a study was conducted to determine Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals using viable colonocytes in a Non invasive technique and Flowcytometry. Methods: A total of 20 healthy volunteer (10 obese and 10 lean) were enrolled in the study as per inclusion and exclusion criteria. Viable colonocytes were isolated from fecal samples using a Non invasive technique (SCSR Method). Toll like receptors (TLRs) and immunoglobulin (IgA &IgG) receptor concentration were measured by standard Flowcytometry methods using specific fluorochrome conjugated antibodies. Results: Average TLR2 receptor concentration was significantly higher in obese (6.35 %) as compared to lean (2.9 %) (P = 0.01). TLR4 receptor concentration was 1.4 % in obese and 1.65 % in lean although the difference was not statistically significant (P = 0.59). IgA & IgG receptor concentration was 49.6 % & 11.2 % in the obese and 67.15 % & 8.05 % in the lean respectively but the differences among both the group were not statistically significant. Conclusion: The results of the present study will be helpful for physicians and researchers to find some biomarkers which can determine predisposition of the obesity in Indian population and helps to use alternative therapeutics such as probiotics to maintain gut homeostasis and immune modulation to prevent obesity. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic myonecrosis or muscle infarction is an unusual complication of Type 2 Diabetes, usually associated with longstanding disease. It commonly presents as an acute non-traumatic palpable swelling of the affected muscle with predilection for the quadriceps and thigh muscles, often accompanied by retinopathy and nephropathy. Methodology: A retrospective review of the medical records of patients admitted with diabetic myonecrosis under the Department of Endocrinology, Christian Medical College Vellore over a period of ten years(2006-2015) was done. Data pertaining to clinical, biochemical and radiological characteristics were obtained and treatment modalities and outcomes were recorded. Results and Analysis: A total of n = 4 patients with diabetic myonecrosis and completed clinical data were included in the study. In our present series, the mean age at presentation was 45.5 years (±7.3 years), the mean duration of the diabetes was 9.0 years (±2.5 years)with an equal distribution of male and female subjects. The mean HbA1c (9.5 ± 0.6%) was suggestive of poor glycemic control at presentation with all (100%) the patients in our series having concomitant one or more microvascular complications. While laboratory parameters of elevated CPK or LDH were mostly normal, the findings of T1 hyperintense and T2 hypointense heterogenous lower limb lesions were present in all the subjects (n = 4). Conservative management with bed rest, analgesics and good glycemic control were effective in good clinical improvement over a period of 1-2 months. Conclusions: Our series of diabetic myonecrosis in Indian patients with Type 2 diabetes mellitus, elucidates the varied clinical presentations, with MRI findings rather than laboratory markers being the mainstay of diagnosis. [ABSTRACT FROM AUTHOR]