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The aim of this study was to obtain normative nasalance scores for Indian Tamil-speaking children. Mean nasalance scores were obtained from 175 consecutive Tamil-speaking normal children (95 males, 80 females) aged 5–16 years during the repetition of six standardized sentences: two oral, two oronasal, and two nasal sentences. The nasal view was used to obtain nasalance scores for the standardized sentences Group mean and standard deviation (SD) nasalance scores of children for oral, oronasal, and nasal sentence were 35.65(SD 7.20), 44.42(SD 7.37), and 57.21(SD 8.15), respectively. The mean nasalance values of children aged 9–12 years were greater than children aged 5–8 years and 13–16 years for nasal sentences (p <.001). Males were found to have significantly higher nasalance scores for oral and oronasal sentences (p <.05) although these differences were within the range of normal variation. The present study provides normative nasalance scores for Tamil-speaking Indian children. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery presently is the best possible intervention for treatment of severe obesity and its related conditions. This study presents retrospective data on the pregnancy outcomes of Indian patients who underwent bariatric surgery before conception. Methodology: This is a single-centre retrospective, observational study. Data on demographics, pre-surgery weight, body mass index (BMI), types of bariatric surgery, weight at conception, weight gain during pregnancy, type of delivery and the health of the baby were collected and analysed to study the weight loss pattern and pregnancy outcomes in female patients of childbearing potential. Results: The study included 34 women of childbearing potential (BMI>30 kg/m2) who underwent bariatric surgery. The study population was followed up from the time of surgery until 1-year post-delivery of the baby. The mean weight gain during the pregnancy was 14.9±5.4 kg. Twenty-three underwent LSCS, and the rest had normal delivery with mean baby weight of 2.5±0.4 kg. Six babies required neonatal intensive care. In our series, only 4 of 35 cohorts that are only 11% had substantial weight retention (range 5–13 kg) at the end of 12 months which is significantly lower than the normal cohorts who did not undergo bariatric surgery. Conclusion: Bariatric surgery improves fertility with safe pregnancy and its outcomes in terms of preeclampsia, eclampsia, gestational diabetes, premature rupture of the membranes (PROM), postpartum haemorrhage (PPH) and puerperal sepsis in women with childbearing potential and safe for offspring in terms of shoulder dystocia, macrosomia, birth asphyxia and perinatal mortality. However, they should be well aware of the risks associated with bariatric surgery especially the mal-absorptive procedures. [ABSTRACT FROM AUTHOR]

Background In the absence of proper guidelines and algorithms, available rapid diagnostic tests (RDTs) for common acute undifferentiated febrile illnesses are often used inappropriately. Methods Using prevalence data of 5 common febrile illnesses from India and Cambodia, and performance characteristics (sensitivity and specificity) of relevant pathogen-specific RDTs, we used a mathematical model to predict the probability of correct identification of each disease when diagnostic testing occurs either simultaneously or sequentially in various algorithms. We developed a web-based application of the model so as to visualize and compare output diagnostic algorithms when different disease prevalence and test performance characteristics are introduced. Results Diagnostic algorithms with appropriate sequential testing predicted correct identification of etiology in 74% and 89% of patients in India and Cambodia, respectively, compared with 46% and 49% with simultaneous testing. The optimally performing sequential diagnostic algorithms differed in India and Cambodia due to varying disease prevalence. Conclusions Simultaneous testing is not appropriate for the diagnosis of acute undifferentiated febrile illnesses with presently available tests, which should deter the unsupervised use of multiplex diagnostic tests. The implementation of adaptive algorithms can predict better diagnosis and add value to the available RDTs. The web application of the model can serve as a tool to identify the optimal diagnostic algorithm in different epidemiological settings, while taking into account the local epidemiological variables and accuracy of available tests. [ABSTRACT FROM AUTHOR]

Aim: To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner's toolkit for insulin motivation in the management of diabetes mellitus (DM). Background: Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. Review Results: After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. Conclusions: In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals. [ABSTRACT FROM AUTHOR]

Information gaps on the distribution of data deficient and rare species such as four-horned antelope ( FHA) in Nepal may impair their conservation. We aimed to empirically predict the distribution of FHA in Nepal with the help of data from the Indian subcontinent. Additionally, we wanted to identify core areas and gaps within the reported range limits and to assess the degree of isolation of known Nepalese populations from the main distribution areas in India. The tropical part of the Indian subcontinent (65°-90° eastern longitude, 5°-30° northern latitude), that is, the areas south of the Himalayan Mountains. Using MaxEnt and accounting for sampling bias, we developed predictive distribution models from environmental and topographical variables, and known presence locations of the study species in India and Nepal. We address and discuss the use of target group vs. random background. The prediction map reveals a disjunct distribution of FHA with core areas in the tropical parts of central to southern-western India. At the scale of the Indian subcontinent, suitable FHA habitat area in Nepal was small. The Indo-Gangetic Plain isolates Nepalese from the Indian FHA populations, but the distribution area extends further south than proposed by the current IUCN map. A low to intermediate temperature seasonality as well as low precipitation during the dry and warm season contributed most to the prediction of FHA distribution. The predicted distribution maps confirm other FHA range maps but also indicate that suitable areas exist south of the known range. Results further highlight that small populations in the Nepalese Terai Arc are isolated from the Indian core distribution and therefore might be under high extinction risk. [ABSTRACT FROM AUTHOR]

Bronchial asthma is one of the most common illnesses in children. Factors influencing development of asthma have not been studied in rural population. 2000 school going children from five schools of Chhainsa and Dayalpur Primary Health Centre area in Ballabgarh Block of Haryana state were screened for presence of symptoms of asthma using a questionnaire suggested by International Study of Asthma and Allergy in Children (ISSAC). 40 children were identified as cases of bronchial asthma. For each child with asthma two age and sex matched non-asthmatic controls were selected from the study population. History, clinical examination and in-depth interview were carried out for all cases and controls. Factors associated with presence of symptoms of asthma on multivariate analysis were passive smoking (OR 3.33, 95% CI 1.85-7.65), pets at home (OR 5.5, 95% CI 1.04-29.15), and absence of windows in living rooms (OR 4.03, 95% CI 1.17-13.79). Factors such as family history of asthma, history of worm infestation, fuel used for cooking, location of kitchen and food allergy were not significant on statistical analysis. Thus, passive smoking, inadequate ventilation and pets (dogs and cats) at home are significant risk factors associated with presence of symptoms of asthma in rural children. [ABSTRACT FROM AUTHOR]

It has been revealed from the Modern-Era Retrospective analysis for Research and Applications MERRA analyses, Moderate Resolution Imaging Spectroradiometer MODIS/Terra satellite imageries, Naval Aerosol Analysis and Prediction System NAAPS model outputs, Cloud –Aerosol Lidar and Infrared Pathfinder Satellite Observations CALIPSO imageries, Hybrid Single Particle Lagrangian Integrated Trajectory HYSPLIT model trajectories, atmospheric soundings, and observational records of dust emission that there were multiple dust storms in the far western parts of India from 12 to 15 June 2018 due to thunderstorms. This led to the lifting of the dust from the surface. The entry of dust into the upper air was caused by the generation of a significant amount of turbulent kinetic energy as a function of strong wind shear generated by the negative buoyancy of the cooled air aloft and the convective buoyancy in the lower planetary boundary layer. Elevated dust reached a significant vertical height and was advected towards the northern/northwestern/northeastern parts of India. In the meantime, this dust was carried by northwesterly winds associated with the jets in the upper level, which advected dust towards the skies over Nepal where rainfall was occurring at that time. Consequently, this led to the muddy rain in Nepal. [ABSTRACT FROM AUTHOR]

Abstract Study objectives To review the key parameters related to the proposed modified pediatric tracheostomy technique with to determine the efficacy, safety and outcomes in a tertiary hospital in south India. Patients and Methods A retrospective chart review of all children aged below 16 years who underwent tracheostomy at a tertiary hospital in south India during the period of August 2014 to August 2016. Data on age, gender, indication for tracheostomy, primary disease condition, duration of intubation, complications and decannulation rate were recorded. Results Fifty children aged below 16 years underwent tracheostomy between August 2014 and August 2016. The average of the children was 5.35 years. (Range14 days to 14 years). The male female ratio was 1.6:1. In our study prolonged intubation was the most common indication (62%). None of the children had early post-operative complications such as bleeding, pneumothorax, surgical emphysema or accidental decannulation. Peristomal granulations (24%) was the most common complication although none was severe to warrant operative intervention. One child had a lifethreatening tube block requiring cardiopulmonary resuscitation. None of the children had accidental decannulation during the period of the study. Tracheocutaneous fistula was seen in 2 children (4%) and was the only long-term complication. These children required surgical decannulation. There was no clinical evidence of tracheal stenosis or tracheomalacia in any child. Conclusion Pediatric tracheostomy is challenging for both the surgeon and the care-giver specially in the early post-operative period. Our proposed modified technique addresses these concerns and without any significant complications. [ABSTRACT FROM AUTHOR]