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Introduction: Chronic kidney disease patients on hemodialysis (CKD-5D) are among the worst hit by the coronavirus disease 2019 (COVID-19) pandemic. Need to travel for dialysis, comorbidities, and immunosuppressive state put them at risk of severe disease and poor outcomes. We report our experience of COVID-19 in a cohort of CKD-5D from a public sector tertiary-care center from western India. Material and Methods: We retrospectively analyzed the records of 58 CKD-5D patients with confirmed COVID-19 admitted to our COVID-19 hospital. Suspected COVID-19, acute kidney injury (AKI), or AKI on CKD were excluded. We studied the clinical, demographic, radiological, and laboratory profiles; treatment; and outcomes of the patients. We assessed the potential clinical and laboratory parameters to predict mortality. Results: The mean age of the patients was 48.7 ± 16.9 years, with 55% males. Comorbidities included hypertension (65%), diabetes (19%), and cardiovascular disease (15.5%). The presenting features included fever (69%), respiratory distress (50%), upper respiratory symptoms (36%), and diarrhea (13%). Five (8.6%) were asymptomatic. Bilateral infiltrates on chest imaging were the commonest radiological pattern. The patients were managed with oxygenation, hydroxychloroquine, steroids, anticoagulation, remdesivir, and favipiravir. Twenty-two (37.9%) patients died, predominantly due to respiratory failure. Disease severity and C-reactive protein (CRP) above 175 mg/L at admission were the only parameters predictive of mortality. Conclusion: CKD-5D patients with COVID-19 were less likely to present with the classical syndrome of fever and respiratory distress compared with reports from the general population and had higher mortality. Only disease severity and high CRP (>175 mg/L) were predictive of mortality in our cohort. [ABSTRACT FROM AUTHOR]

Background: Physical performance refers to the functional demonstration of task. Little is known about physical performance among Indian kidney-transplant recipients(KTRs). The objective of the present study was to evaluate the physical performance among Indian KTRs and to find its determinants from transplant, demographic, or behavior components. Methodology: In this single-center, prospective observational study, 149 KTRs with estimated glomerular filtration rate (eGFR) ≥45 ml/min/1.72 m2 and posttransplant duration (PTD) >6 months were enrolled. Physical performance was evaluated by 6 minute walk distance (6MWD), dominant hand grip strength (DHGS), numbers of 1 minute sit to stand (1MSTS), and time taken to perform 5 times sit to stand (5xSTS). Multivariate analysis was performed between transplant-related components(PTD, dialysis vintage, eGFR, and comorbidity); health behavioral components(total physical activity [TPA], sedentary time, fear of activity participation, body mass index, abdominal circumference); demographic components (age and gender); and each of the physical performance measures. Results: The average 6MWD was 392 ± 96.2 meters, the DHGS was 33.1 ± 6.8 kg, the number of 1MSTS repetitions was 24.0 ± 3.7/min, and the time taken to do 5xSTS was 10.6 ± 1.9 s among participants. When adjusted for cofounders with multivariable analyses, the health behavior of habitual physical activity was statistically significantly (P < 0.001) associated with all aspects of physical performance. Conclusion: Relatively low physical performance was seen among KTRs. Behavior of participation in physical activity contributed to the positive change in all aspects of physical performance against transplant and demographic variables, and it is the major determinant of physical performance. [ABSTRACT FROM AUTHOR]

In this article, we explore real-time translation work undertaken by frontline healthcare professionals as they interact with marginal tribal communities in Western India. Our 1-year ethnographic study of a healthcare organization delivering obstetric and gynaecological care to tribal communities helps us understand how obstetric counsellors translate allopathic medical expertise across epistemological boundaries to the tribal community they serve, in localized comprehensible forms. We identify four distinct mechanisms of translation work—Interpreting, Annotating, Norming, and Justifying—which differentially deploy and integrate elements of tribal vocabulary, symbols, knowledge, and imaginations of health and body with specific aspects of clinical diagnosis and prescription, making the latter meaningful and actionable in the process. Furthermore, we use configurational approach—Qualitative Comparative Analysis—to investigate how the type of space where the interaction between the counsellors and tribal women patients happens influences the translation work undertaken. We find that counsellors engage in spatially differentiated translation work. They predominantly use justifying and norming in clinical space (hospital); interpreting and annotating in community space (village or school); and interpreting and norming in the overlapping in-between space (outdoor patient department). Our study contributes to translation literature by showing how real-time translation is undertaken in practice, especially in a setting representing high-stakes institutional translation, and how translation work is influenced by the type of space in which interactions happen. [ABSTRACT FROM AUTHOR]

Introduction: Tunneled cuffed catheters (TCC) provides a short and intermediate-term access solution for dialysis patients who fail to get an arteriovenous fistula (AVF). They are associated with high morbidity and mortality along with high rates of infectious complications. Methods: We present a single-center prospective cohort of 159 TCCs inserted over one year. Patients were dialyzed in-hospital and in various peripheral dialysis units attached to the institute. The primary endpoint was catheter drop-out. Results: The mean age of patients was 41.8 ± 16.9 years. The right internal jugular vein was the commonest site of TCC insertion (66%). The absence of suitable veins was the predominant reason for TCC insertion. The mean time to catheter drop-out was 134.4 ± 83.3 days (5-399 days). Death with a working catheter was the most common cause of catheter drop-out (22.6%). About 25% of catheters were lost to catheter-related bloodstream infections (CRBSI), either alone or as overlap with poor flow. CRBSI rates were 3.74 episodes per 1000 catheter-days. No difference in survival between the staggered tip and split-tip catheters was found. Conclusions: With the advent of the "hub and spoke" model for dialysis in the public sector healthcare, TCCs are suboptimal with regards to patient and catheter survival, with high infection rates. It must be regarded as a temporary solution and AVF creation should be prioritized. [ABSTRACT FROM AUTHOR]

Background: Systematic data on physical activity level in Indian kidney transplanted patients are limited. Physical activity is considered an essential part of healthy life style for all population including kidney transplant recipients. The International Physical Activity Questionnaires (IPAQ) is internationally accepted self-reported screening tool for assessment of physical activity. However, till date Gujarati and Hindi version of IPAQ is not validated for Indian kidney transplant recipients. Aim: To validate the Gujarati and Hindi translated version of IPAQ long form in Indian kidney transplant recipients. Method: Original English version of IPAQ-long form was translated in Gujarati and Hindi language and evaluated for face, construct, concurrent validity and test retest reliability among Gujarati and Hindi transplant recipients. Result: 4 questions out of 27 were modified with 80% consensus of panelist to achieve face validity of both version of questionnaire. Total physical activity score of Gujarati (r=0.83) and Hindi (r=0.72) version were positively correlated with 6MWD in male transplant patients suggesting accepted construct validity. There was high positive correlation noted between all component of English, Gujarati and Hindi version (r>0.8, p<0.05) having good concurrent validity and acceptable test retest reliability. Conclusion: The modified Gujarati and Hindi version of IPAQ long form showed acceptable validity and reliability for the assessment of physical activity among kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Context: There is a paucity of research investigating the association between antenatal care (ANC) attendance and child undernutrition in Madhya Pradesh, India. Aim: To determine whether body weight status in children under the age of 5 years is associated with ANC attendance in Madhya Pradesh. Methods: A cross-sectional study was carried out using data from India's National Family Health Survey (2005–2006). Bodyweight status (an indicator of undernutrition) was determined using weight-for-age. Descriptive statistics and logistic regression were used to estimate prevalence and obtain adjusted odds ratios (AOR) to investigate associations between ANC indicators and weight-for-age. Results: Majority of children were underweight (55.1%). ANC attendance was inadequate, with only 36.8% of women having four or more visits. None of the ANC indicators were associated with body weight status. Increased child age especially an age of 2 years (AOR 2.29; 1.66–3.15), belonging to a scheduled tribe [ST] (AOR 2.36; CI 1.64–3.39), scheduled caste [SC] (AOR 1.75; CI 1.25–2.45) or other backward caste [OBC] (AOR 1.43; CI 1.08–1.89) were associated with being underweight; a birth weight of ≥2.5 kg was associated with lower relative odds of being underweight (AOR 0.43; CI 0.29–0.64). Mothers who had a normal BMI (AOR 0.66; CI 0.53–0.82) or were overweight (AOR 0.42; CI 0.25–0.69) were less likely to have underweight children. Conclusions: ANC attendance was not associated with body weight status. Increased child age, low birth weight, poor maternal nutrition status and belonging to SCs, STs or OBCs increased the odds of child undernutrition. [ABSTRACT FROM AUTHOR]

Present study was conducted to assess the magnitude of variability and character association for grain yield and contributing traits in black gram genotypes at the experimental farm of School of Agricultural Sciences and Rural Development, Nagaland University Medziphema campus representing foot hill condition of Nagaland. Pulses being the major source of protein of vegetarian population of India are high in demand. So this study aimed to identify genotypes of black gram which have a broad spectrum of variability and traits having positive association with seed yield for indirect selection. Studies were done in twenty-six genotypes of black gram for twelve traits. The results indicated that PCV was higher than the GCV for almost of all the traits. High heritability was observed for seed yield per plant, number of pods per cluster and number of clusters per plant suggesting that these traits are primarily under genetic control. Correlation studies revealed a significant and positive association of seed yield per plant with number of pods per cluster and number of clusters per plant at phenotypic level. In general, the magnitude of genotypic correlation was higher than the phenotypic correlation. This suggested a strong genetic association between the traits and the phenotypic expression was suppressed due to environmental influence. Based on variability and association studies, number of seeds per pod and number of pods per cluster were found to be the major contributing traits for yield. Therefore, these traits can be considered as selection criteria for selection and for discrimination of outstanding black gram genotypes. [ABSTRACT FROM AUTHOR]

Covid-19-associated neurological manifestations are being reported with increased frequency throughout the world. In a study from China, symptoms referable to peripheral nervous system (PNS) were described in approximately 9% of hospitalized Covid-19 patients. Common PNS symptoms reported in the study were loss of taste/smell and muscle pains. With this communication, we expand the spectrum of PNS manifestations of Covid-19 infection by reporting an association of steroid responsive diffuse anterior horn cell disease with Covid-19 infection from a tertiary care centre in India. Neurological manifestations of Covid-19 are diverse, and our case which to best of my knowledge is the first case in literature to report an occurrence of steroid responsive diffuse anterior horn cell disease associated with Covid-19 infection, adds to the ever-increasing spectrum of neurological manifestations associated with this pandemic causing virus. Good response to steroid in our case serves to provide an insight into the possible pathogenesis of this manifestation and also paves the way for future therapeutic decisions related to this association. [ABSTRACT FROM AUTHOR]

Introduction: India is a developing economy and IT industry is a major contributor for India’s industrial and economic growth. The prevalence of computer users are exponentially increasing with years, and as a result of the duration and intensity of exposure to computers, the health problems related to prolonged computer use are also on the rise. This study was done to evaluate the musculoskeletal problems among women IT professionals. Methodology: This cross sectional study was carried out among 609 women with over one year of experience working in one of the large projects in a software company in Chennai. Data collection comprised of work related history, questions related to self reported symptoms of musculoskeletal problems and symptoms of carpal tunnel syndrome. Wong-Baker faces scale was used to assess the severity of pain. Clinical examination was carried out by the investigator to look for the signs of carpal tunnel syndrome namely phalen’s sign and tinel’s sign. Results: The mean age of the participants was 24.9 years. Over 57.2% had a work experience <3 years. Musculoskeletal problems were present in 73.1% of the participants. Carpal tunnel syndrome was present among 6.1% of the participants. Software developers were significantly at risk of musculoskeletal problems (p<0.05) Conclusion: The high prevalence of musculoskeletal problems emphasizes the need for continuous, motivational, on site health education and rehabilitative measures to prevent the impact of these problems on the quality of life [ABSTRACT FROM AUTHOR]

Background Adolescence is a period of physiological, psychological and social transition between childhood and adulthood and is characterized by the onset of menstruation in girls. A adolescent girls are naïve about menstruation and they take time to adapt to these changes both socially and psychologically. This study was carried out to assess the psychosocial impact of menstrual problems among schoolgoing adolescent girls. Methods This study is a cross-sectional study carried out in 350 schoolgoing adolescent girls in the year 2012 in the Thiruvallur district of Tamil Nadu. Girls who attained menarche 1 year prior to the data collection were included in the study. Data regarding background characteristics and psychosocial impact of menstrual problems were collected. Data was analyzed using SPSS ver. 15 software. The χ2-test was carried out to assess the statistical significance at the 95% level of significance. Results The mean age of the participants was 14.7 years. In this study, 87.7% of the girls had at least one menstrual problem. Among these, 78.5% could not attend school during menstruation, 51.1% were unable to perform household/sports activities (p < 0.001). It was observed that dysmenorrhea and menorrhagia were at increased risk of absenting the girls from school (p < 0.05). Conclusion The key to a sound adolescent health programme is a holistic approach which also focuses on the psychological and social domain of health. This could be achieved by involving all the stakeholders like parents, teachers, etc. to work as a team. It is also essential to develop adolescent friendly health services at the grass root level. [ABSTRACT FROM AUTHOR]

Background. To ascertain the validity of kidney paired donations (KPDs) as an alternative strategy for increasing living donor kidney transplantations (LDKTs) in an LDKT-dominated transplant programme since directed kidney transplantation, ABO-incompatible or crossmatch-positive pairs are not feasible due to costs and infectious complications. Methods. This was a prospective single-centre study of 77 KPD transplantations (25 two-way, 7 three-way and 1 six-way exchange) from 1 January 2015 to 1 January 2016 of 158 registered donor recipient pairs. During this period, a total of 380 kidney transplantations [71 deceased donor kidney transplantations (DDKTs), 309 LDKTs] were performed. The reasons for opting for KPD were ABO incompatibility (n=45), sensitization (n=26) and better matching (n=6). Results. KPD matching was facilitated in 62% (n=98) of transplants. In all, 48.7% (n=77) of the transplants were completed in 2015, whereas 13.3% (n=21) of the matched patients were to undergo transplant surgery in early 2016 after getting legal permission. The waiting time for KPD was shorter compared with DDKT. The death-censored graft survival and patient survival were 98.7% (n=76) and 93.5% (n=72), respectively. In all, 14.2% (n=11) of patients had acute rejection. Match rates among sensitized (n=60) and O group patients (n=62) were 58.3% (n=35) and 41.9% (n=26), respectively. Of these, 43.3% (n=26) and 29% (n=18) of transplants were completed and 15% (n=9) and 12.9% (n=8), respectively, are waiting for legal permission. Conclusions. LDKT increased by 25% in 1 year in our single-centre KPD programme. Our key to success was the formation of a KPD registry, awareness and active counselling programs and developing a dedicated team. [ABSTRACT FROM AUTHOR]

In a living donor kidney transplantation ( LDKT) dominated transplant programme, kidney paired donation ( KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation ( DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility ( n = 222), positive cross-match ( n = 59) and better matching ( n = 19). A total of 124 two-way ( n = 248), 14 three-way ( n = 42), one four-way ( n = 4) and one six-way exchange ( n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% ( n = 288) and 83.3% ( n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist. [ABSTRACT FROM AUTHOR]

Background: Anemia during adolescence affects growth and development of girls and boys increasing their vulnerability to dropping out-of-school. Hence investing in preventing anemia during adolescence is critical for their survival, growth and development. Objective: To find out the burden of anemia on adolescent age group in the tribal area of Jhagadia block and to assess the change in the hemoglobin level through the weekly Iron and Folic Acid IFA (DOTS) directly observed treatment supplementation under Supervision by Peer Educators at Community level among adolescents. Methods: Community based intervention study conducted with adolescents (117 girls and 127 boys) aged 10-19 years, through supplementation of IFA (DOTS) by trained Peer Educators for 52 weeks in 5 tribal villages of Jhagadia. Hemoglobin level was determined by HemoCue method before and after intervention and sickle cell anemia by Electrophoresis method. Primary data on hemoglobin and number of tablets consumed was collected and statistically analyzed in SPSS 16.0 software by applying paired t-test. Results: The overall findings suggest that the prevalence of anemia reduced from 79.5% to 58% among adolescent girls and from 64% to 39% among boys. Mean rise of hemoglobin seen was 1.5 g/dl among adolescent boys and 1.3 g/dl among girls. A significant association was found in change in hemoglobin before and after intervention (P = 0.000) Conclusion: Prevalence of anemia among girls and boys can be reduced in their adolescent phase of life, through weekly supplementation of iron folic acid tablets under direct supervision and Nutrition Education by Peer Educator at community level. [ABSTRACT FROM AUTHOR]

Background: To determine the knowledge, attitudes and practices regarding organ donation in western India. Methods: Convenience sampling was used to generate a sample of 250; 200 interviews were successfully completed and used for analysis. Data collection was carried out via face to face interviews based on a pre-tested questionnaire in selected public areas of Ahmedabad, Gujarat state of India. Data entry was made in excel software in codes and analysis was done by SPSS software. Results: About 86% of participants were aware of the term organ donation but knowledge about its various aspects was low. About 48% aware people heard about organ donation through medical fraternity, whereas only about 21% became aware through mass media. About 59% of aware people believed there is a potential danger of donated organs being misused, abused or misappropriated. About 47% of aware people said they would consider donating organs, while only 16% said they would definitely donate irrespective of circumstances. Around 97.67% participants said they would prefer to donate to nonsmokers. About 74.41% participants were unaware about any legislation regarding organ donation. About 77% participants showed their will to donate to mentally sound persons, and 42.04% participants showed their will to donate even physically challenged people. Around 78 participants felt that they would donate organs to persons irrespective of their religion. About 81% of aware people were of the opinion that consent for organ donation after death should be given by family members. None of the interviewed participants had a donor card. Conclusion: Better knowledge and awareness will help in promoting organ donation. Effective campaign needs to be driven to educate people with relevant information with the involvement of media, doctors and religious scholars. [ABSTRACT FROM AUTHOR]

Because access to transplantation with HLA-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end-stage renal disease (ESRD) patient in India. We present a government and institutional ethical review board approved study of 56 ESRD patients [25 two-way and 2 three-way pairs] who consented to participate in KPD transplantation at our center in 2013, performed to avoid blood group incompatibility (n = 52) or positive cross-match (n = 4). All patients had anatomic, functional, and immunologically comparable donors. The waiting time in KPD was short as compared to deceased donor transplantation. Laparoscopic donor nephrectomy was performed in 54 donors. Donor relationships were spousal (n = 40), parental (n = 13), others (n = 3), with median HLA match of 1. Graft survival was 97.5%. Three patients died with functioning graft. 16% had biopsy-proven acute rejection. Mean serum creatinine was 1.2 mg/dl at 0.73 0.32 months follow-up. KPD is a viable, legal, and rapidly growing modality for facilitating LDRT for patients who are incompatible with their healthy, willing living donor. To our knowledge, this is the largest singlecenter report from India. [ABSTRACT FROM AUTHOR]

Objective To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. Methods This study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios ( IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. Results Thirty-two thousand eight hundred and ninety-three pregnancies, 29 817 live births and 80 maternal deaths were recorded. Maternal mortality ratio improved from 607 (19 deaths) in 2002-2003 to 161 (five deaths) in 2010-2011. The institutional delivery rate increased from 23% to 65%. The trend of falling maternal deaths was significant over time, with an annual reduction of 17% (adjusted IRR 0.83 CI 0.75-0.91, P-value <0.001). There were significant reductions in adjusted incidence rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes. Conclusion Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritise management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5. [ABSTRACT FROM AUTHOR]

Background and Methods: We examined data from a cohort of births that occurred in the period 2004–08 in the SEWA-Rural project area, covering a population of ∼175000, in Gujarat, India, to assess the trends and risk factors for neonatal mortality.Results: In this population living in 168 villages, there has been a significant declining trend in infant and neonatal mortality, more marked in the tribal population, in whom this paralleled a rise in the proportion of women delivering in hospitals. The more important risk factors for neonatal mortality risk to emerge from multivariate analysis are low birth weight, prematurity, young age of mother, older mother and high birth order.Conclusion: Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health. [ABSTRACT FROM PUBLISHER]

Plasmodium vivax is causing increasingly more cases of severe malaria worldwide. Among 25 cases in India during 2010-2011, associated conditions were renal failure, thrombocytopenia, jaundice, severe anemia, acute respiratory distress syndrome, shock, cerebral malaria, hypoglycemia, and death. Further studies are needed to determine why P. vivax malaria is becoming more severe. [ABSTRACT FROM AUTHOR]

SEWA-Rural (Society for Education Welfare and Action - Rural) is a voluntary development organisation functioning in the tribal area of Jhagadia block in Bharuch district of Gujarat since 1980. The founder members of the organisation, inspired by the life and teachings of Swami Vivekananda and Mahatma Gandhi, were committed to work for the poorest of the poor. SEWA-Rural initiated its programme of community development with health services and gradually expanded the scope of activities to other services. The major activities of SEWARural in the field of health include (i) hospital service, (ii) managing primary health centre under a unique government-nongovernment partnership, (iii) community health project for reducing maternal and neonatal mortality, (iv) comprehensive eye care project and (v) training and resource centre for community health care. The main activities of SEWA-Rural beyond the health field include (i) community based rehabilitation programme for the visually challenged persons, (ii) vocational training of youth and (iii) activities for empowerment of women. In recognition of its admirable service for the rural poor and tribal community, SEWA-Rural has received several awards from different sectors in India and abroad. [ABSTRACT FROM AUTHOR]

Introduction: Paired-kidney exchange (PKE) is used in western countries to increase donor pool. In India, there are not many centers involved in PKE program. We present 10 years of this experience and outcome of the recipients. Materials and Methods: Between year 2000 and 2009, 34 transplants with PKE were performed. All donors were live related, and permission from Authorization committee(s) from one or more states was obtained prior to transplantation. Both donor and recipient surgeries were carried out simultaneously in all cases at a single institution. Last 10 donors were offered laparoscopic donor nephrectomy and all other previous donors were operated by open surgery. Results: Five donor-recipient pairs were from the state of Rajasthan, one from Madhya Pradesh, and all others from Gujarat. ABO incompatibility between donor and recipient was present in 12 pairs and positive lymphocyte cross-match in 5 pairs. Conclusion: Paired-kidney-exchange transplantation expands donor pool and total number of transplantation. [ABSTRACT FROM AUTHOR]

The article presents a research on the differences in the prevalence of metabolic syndrome in urban and rural India. These differences are analyzed using the data obtained from a cross-sectional survey in Delhi and Ballabgarh using National Cholesterol Education Programme (NCEP) ATP III criteria. The relationship of risk determinants, such as age, gender, and body weight, to metabolic syndrome is also examined.

We report a case of lead nephropathy due to Sindoor treated successfully with steroid, hemodialysis and chelating agent. Diagnosis of lead nephropathy was confirmed by identification of potential sources of lead exposure (Sindoor, 5-10 gm per year for 11 years) indicated by high blood lead level, 95 µg/dL and presence of extrarenal features of lead poisoning (hypertension, anemia, lead line, hyperuricemia). A search for the underlying systemic causes of renal failure yielded no results. A kidney biopsy showed acute or chronic tubule-interstitial nephritis with mesangioproliferative glomerulonephritis with no immune deposit on immunofluorescence consistent with lead nephropathy. He was discharged in good health after psychiatric consultation and continued with oral D-Penicillamine with normal renal function tests and urine output. This case identifies Sindoor as a potential lead exposure among Indians and clinicians should be aware of this risk factor and enquire about it when searching a source of lead exposure in high-risk population. [ABSTRACT FROM AUTHOR]

The article presents a case study conducted to examine the effectiveness of the maternity schemes in Gujarat to increase institutional deliveries. It mentions that the study is based on a secondary analysis of community based data collected by village level frontline workers of SEWA‑Rural (SR), a NGO located in Jhagadia block of Gujarat since 1980. It concludes that most of the women who delivered at hospital after initiation of maternity schemes chose hospital for subsequent delivery.

Background: Oral submucous fibrosis (OSMF) is a premalignant condition. Incidence of OSMF in India is 0.5%, mainly found in southern states and also in Saurashtra region. The pathological changes can involve mucosa, submucosa and the underlying muscles. The changes of tubal and paratubal muscles can affect the eustachian tube function. So, this study was carried out with an aim to determine the effect of OSMF on the eustachian tube function. Materials and Methods: 54 ears of 27 patients with OSMF and 50 ears of 25 normal persons were screened by eustachian tube function test (ETFT) after thorough history taking and clinical examination. Results: Out of the 54 ears in the OSMF group, type A curve was obtained in 42 (77.8%) ears, type B curve in none and type C curve was found in 12 (22.2%) ears, as compared to the normal group in which type A curve was obtained in 46 (92%) ears, type B curve in 2 (4%) ears, type C curve was found in 2 (4%) ears. On testing compliance of the middle ear, no change was observed at -200 daPa in 15 (27.8%) ears in the OSMF group and 5 (10%) ears in the normal group. Conclusion: The data observed were statistically analyzed by chi-square test, which suggested significant association between OSMF and eustachian tube function. Therefore, it can be concluded that eustachian tube function may be affected in OSMF and vice versa. So, while treating OSMF, hearing disability due to eustachian dysfunction has to be kept in mind and vice versa because treatment of hearing disability without taking care of OSMF will not be successful. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to the kidney donation programs in India, that was published in previous issue.

A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff. The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) is a hereditary blood disorder prevalent in tribal regions of India. SCD can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. This study reports the analysis of tribal maternal admissions in the community-based hospital of SEWA Rural (Kasturba Maternity Hospital) in Jhagadia block, Gujarat. The objective of the study is to compare the pregnancy outcomes among SCD, sickle cell trait and non-SCD admissions. This study also estimated the risk of adverse pregnancy outcomes for SCD admissions.Methods: The data pertains to four and half years from March 2011 to September 2015. The total tribal maternal admissions were 14640, out of which 10519 admissions were deliveries. The admissions were classified as sickle cell disease, sickle cell trait and non-sickle cell disease. The selected pregnancy outcomes and maternal complications were abortion, stillbirth, Caesarean section, haemoglobin levels, blood transfusion, preterm pregnancy, newborn birth weight and other diagnosed morbidities (IUGR, PIH, eclampsia, preterm labour pain). The odds ratios for each risk factor were estimated for sickle cell patients. The odds ratios were adjusted for the respective years.Results: Overall, 1.2% (131 out of 10519) of tribal delivery admissions was sickle cell admissions. Another 15.6% (1645 out of 10519) of tribal delivery admissions have sickle cell trait. The percentage of stillbirth was 9.9% among sickle cell delivery admission compared to 4.2% among non-sickle cell deliveries admissions. Among sickle cell deliveries, 70.2% were low birth weight compared to 43.8% of non-sickle cell patient. Similarly, almost half of the sickle cell deliveries needed the blood transfusion. The 45.0% of sickle cell delivery admissions were pre-term births, compared to 17.3% in non-SCD deliveries. The odds ratio of severe anaemia, stillbirth, blood transfusion, Caesarean section, and low birth weight was significantly higher for sickle cell admissions compared to non-sickle cell admissions.Conclusions: The study exhibited that there is a high risk of adverse pregnancy outcomes for women with SCD. It may also be associated with the poor maternal and neonatal health in these tribal regions. Thus, the study advocates the need for better management of SCD in tribal Gujarat. [ABSTRACT FROM AUTHOR]

The Government of India has started a new scheme aimed at offering sanitary pads at a subsidized rate to adolescent girls in rural areas. This paper addresses menstrual health and hygiene practices among adolescent girls in a rural, tribal region of South Gujarat, India, and their experiences using old cloths, a new soft cloth (falalin) and sanitary pads. Qualitative and quantitative data were collected in a community-based study over six months, with a pre-and post- design, among 164 adolescent girls from eight villages. Questions covered knowledge of menstruation, menstrual practices, quality of life, experience and satisfaction with the different cloths/pads and symptoms of reproductive tract infections. Knowledge regarding changes of puberty, source of menstrual blood and route of urine and menstrual flow was low. At baseline 90% of girls were using old cloths. At the end of the study, 68% of adolescent girls said their first choice was falalin cloths, while 32% said it was sanitary pads. None of them preferred old cloths. The introduction of falalin cloths improved quality of life significantly (p<0.000) and to a lesser extent also sanitary pads. No significant reduction was observed in self-reported symptoms of reproductive tract infections. Falalin cloths were culturally more acceptable as they were readily available, easy to use and cheaper than sanitary pads. Le Gouvernement indien a lancé un plan qui propose des serviettes hygiéniques à prix subventionné aux adolescentes vivant dans les zones rurales. Cet article aborde la santé menstruelle et l'hygiène des adolescentes dans une région tribale rurale du Gujarat méridional, et leur expérience de l'utilisation de vieux chiffons, d'un nouveau tissu doux (falalin) et de serviettes hygiéniques. Les données qualitatives et quantitatives ont été recueillies par une étude communautaire sur six mois, avec évaluation préalable et postérieure, auprès de 164 adolescentes originaires de huit villages. Elles ont été interrogées sur leurs connaissances de la menstruation, leurs pratiques menstruelles, leur qualité de vie, l'utilisation et la satisfaction avec les différents linges/serviettes et les symptômes d'infections de l'appareil reproducteur. Elles connaissaient mal les changements de la puberté, la source des règles et la voie de l'urine et du flux menstruel. Au début de l'étude, 90% des adolescentes utilisaient de vieux chiffons. À la fin de l'étude, 68% des filles ont déclaré que leur premier choix était le linge en falalin, contre 32% pour les serviettes hygiéniques. Aucune n'a préféré les vieux chiffons. L'introduction des linges en falalin a sensiblement amélioré la qualité de vie (p<0,000) comme, dans une moindre mesure, les serviettes hygiéniques. Aucune réduction notable des symptômes auto-signalés d'infections de l'appareil reproducteur n'a été observée. Les linges en falalin étaient culturellement plus acceptables car les adolescentes pouvaient se les procurer et les utiliser aisément, et ils étaient moins onéreux que les serviettes hygiéniques. El Gobierno de India ha puesto en marcha un nuevo plan para ofrecer toallas sanitarias a una tarifa subsidiada a las adolescentes de zonas rurales. En este artículo se trata la salud menstrual y las prácticas de higiene entre las adolescentes de una región tribal rural de Gujarat meridional, en India, y sus experiencias usando paños viejos, un paño suave nuevo (falalin) y toallas sanitarias. Durante un plazo de seis meses, se recolectaron datos cualitativos y cuantitativos en un estudio comunitario, con un diseño preliminar y posterior, entre 164 adolescentes de ocho poblados. Las preguntas abarcaron sus conocimientos de la menstruación, prácticas menstruales, calidad de vida, experiencia y satisfacción con los diferentes paños y toallas sanitarias, y síntomas de las infecciones del tracto reproductivo. Pocas tenían conocimientos de los cambios relacionados con la pubertad, la fuente de la sangre menstrual y la vía del flujo urinario y menstrual. En la línea base, el 90% de las adolescentes estaban usando paños viejos. Al final del estudio, el 68% dijo que su primera elección era el paño falalin, mientras que el 32% dijo que prefería las toallas sanitarias. Ninguna prefirió los paños viejos. La introducción del paño falalin mejoró la calidad de vida considerablemente (p<0.000) y a menor grado también las toallas sanitarias. No se observó ninguna reducción significativa en los síntomas autoreportados de infecciones del tracto reproductivo. Los paños falalin fueron más aceptados culturalmente, ya que eran fáciles de adquirir y usar y más baratos que las toallas sanitarias. [ABSTRACT FROM AUTHOR]

The majority of adolescent girls in rural India lack awareness regarding menstrual hygiene management (MHM), access to sanitary absorbents and necessary facilities in schools, homes, and workplaces. This study evaluated an intervention to strengthen a public health programme aimed to increase the use of safe, sanitary absorbents and knowledge of MHM among tribal adolescent girls. This project was implemented in 202 villages of two sub-districts of Narmada district in Gujarat, India, for one year (2018–2019). The intervention consisted of capacity building of 892 government frontline health workers and teachers, followed by supportive supervision. Convergence with concerned departments was achieved through meetings with stakeholders. "MHM-corners" and "MHM-Committees" were created at schools and Anganwadi-centres to improve access to menstrual absorbents and information. Household surveys of adolescent girls were conducted at baseline (n = 507) and end-line (n = 550) in 27 randomly selected villages to evaluate outcomes. Of 550 girls at the end-line, mean age 16.3 years, 487 (88.5%) were tribal, and 243 (44%) were out-of-school. The primary outcome of interest, the proportion of adolescent girls using safe, sanitary absorbents, increased from 69% to 90.5% (OR: 5.19, CI: 3.61–7.47). Their knowledge of the uterus as the origin of menstrual blood and hormonal changes as the cause for menstruation improved from 6.3% to 66% (p-value < 0.001) and 7.5% to 73% (p-value < 0.001), respectively. School absenteeism during menstruation reduced from 24% to 14% (p-value < 0.001). It is possible to improve MHM knowledge and practices among adolescent girls from tribal communities by utilising existing government systems. Awareness and access to safe absorbents can lead to safe and hygienic MHM practices. [ABSTRACT FROM AUTHOR]

Background: To evaluate prognostic effect of submicroscopic deletions involving breakage and fusion points of the derivative chromosome 9 and 22 in chronic myeloid leukemia in untreated patients and their follow up samples to correlate with disease outcome. Methods: The study included 78 pretreatment (PT) samples from CML patients and 90 follow-up samples, classified as complete responders (CR, n=33), nonresponders (NR, n =54), and partial responder (PR, n=3) depending on the treatment status of the follow-up samples. Karyotype analysis was performed on metaphases obtained through short term cultures of bone marrow and blood. Detection of BCR-ABL fusion gene was performed using dual color dual fusion (D-FISH) translocation probes. Results: BCR-ABL fusion gene detection by D-FISH showed ABL-BCR deletion on derivative 9 in 47.8% of nonresponders which was higher as compared to pretreatment (11%). Mix D-FISH signal pattern was found in around 20% of pretreatment and non-responder samples. Average interval from chronic phase to blast crisis and accelerated phase was respectively 3.5 and 18 months and accelerated to blast crisis was 16.5 months from the time of diagnosis. The follow-up duration of 31 patients responded to therapy was significantly higher (p=0.0001) as compared to 45 patients who did not respond to therapy. Variant D-FISH signal pattern was seen at the time of diagnosis in patient who responded to therapy as well as those patients who did not respond to therapy. Conclusion: This is the first study from India reporting deletion in ABL, BCR, or ABL-BCR on derivative 9 did not correlate with response to therapy. [ABSTRACT FROM AUTHOR]

Background: Tobacco chewing is attributed to oral cancer. Prediction of cancer development by genotoxicity analysis is a major challenge to identify tobacco users at greater risk. Therefore, present study aimed to analyze tobacco related genotoxic effects in chewers monitoring micronuclei (MN) and chromosome aberrations (CA). The biomarkers were compared with non chewer to (i) predict risk for genotoxicity, (ii) estimate synergistic effect of tobacco exposure with level of biomarkers, and (iii) identify best cellular site of measurements for genotoxicity assessment. Methods: Healthy tobacco chewers (n=47); and controls (n=48) were enrolled in the study. The peripheral blood lymphocyte and exfoliated buccal mucosa cells were studied for CA and micro nucleated cell count (MNC) respectively. An arbitrary unit was obtained for Lifetime Tobacco Exposure (LTE) using frequency/day multiplied by duration of years of tobacco use. Data were analyzed using SPSS statistical software. Results: MNC was significantly higher (p=0.001) in chewers than controls. CA was higher in chewers than controls. MNC can differentiate higher tobacco exposure in chewers than CA. Controls having MNC above cutoff level have greater risk of genotoxic exposition (95% C.I.; 1.462-23.26, p=0.012). Conclusion: The present study concludes that MNC is a better surrogate biomarker to predict genotoxicity than CA for tobacco exposure and DNA damage index in tobacco chewers. [ABSTRACT FROM AUTHOR]