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Over the last few decades, the proportion of students receiving arts education has shrunk drastically. When students were asked to share information about their culture and history, it was discovered that a majority of students lacked knowledge of their own history and culture. It is also important for students to have exposure to other cultures and perspectives. To create this learning environment, teachers need to skillfully draw on student experiences and enrich the curriculum by including art, culture, and history. This article describes how these experiences and knowledge gave birth to a new program of cultural education called Virsa.

Background: Globally ovarian tumor is one of the leading causes of cancer death among women. It can present in childhood to postmenopausal age group and accounts for the most prevalent cause of hospital admissions. Ovarian tumor has varied histogenesis, clinical behavior and malignant potential. Aim and Objectives: This study was done to analyse the frequency of ovarian lesions, their clinicohistological features in a tertiary care center. Materials and Methods: Prospective hospital based study conducted in the department of pathology in tertiary care hospital in central India over a period of 1 year. All the relevant clinical data of patients who were treated surgically for suspected benign lesions of ovary were analysed. Results: Out of the total of 120 cases, 92 cases were classified as benign, accounting for 76.6% of the cases. There were 4 cases classified as borderline, representing 3.28% of the cases. The remaining 24 cases were classified as malignant, making up 20.12% of the cases. Serous cystadenoma is a frequently observed benign tumour. Serous cystadenocarcinoma is a frequently observed malignant tumour. The younger age group predominantly exhibited benign tumours, while malignant tumours were more prevalent among the senior age group. Malignant ovarian tumours are most frequently observed in women who have never given birth. Conclusion: Ovarian tumours of the surface epithelium were the most prevalent. Typically observed in individuals aged 40 to 59 years. The highest incidence of malignant ovarian tumours occurred in individuals over the age of 50. [ABSTRACT FROM AUTHOR]

Primary cutaneous blastomycosis is very rare in non-endemic regions like India. Only few cases have been reported from India. Herein, we are reporting a rare case of chronic cutaneous blastomycosis in a young immunocompetent male presenting as mycetoma with multiple discharging sinuses in the anterior abdominal wall with no significant travel history. [ABSTRACT FROM AUTHOR]

Sustainable development goals (SDGs) were meant to put each and everywhere ‘at par’. The tobacco epidemic globally is one major deterrent to their achievement. While it gets addressed under SDG 3 through the Framework Convention on Tobacco Control (FCTC) - the World Health Organization (WHO) global treaty (the target 3.a of SDG 3), the progress made globally and by India is slow. As a result, many countries may fall short of achieving the target of reducing tobacco usage (taking 2016 as base year) by 30 per cent by the year 2030. India with its high burden of tobacco use and abysmally low quitting along with soaring economic costs of tobacco related diseases and deaths can do better with the engagement of multisectoral stakeholders to strengthen tobacco control under SDGs. Moreover, there is a need to emphasize that the goal of O - Offer to Quit of WHO MPOWER can be achieved through increasing ‘onus’ on policy makers, and strategists, and opportunities for masses, tobacco users, healthcare professionals (HCPs) and enforcers to have tobacco cessation delivered optimally. By doing so, the United Nations can significantly facilitate a reduction in tobacco use and the resultant economic costs. Furthermore, it will assist the WHO to fulfil the targets set for 2030 under SDG 3.a by the FCTC member countries. In addition, it will fulfil the vision and mission defined in the Chandigarh declaration of the 5th National Conference on Tobacco or Health for India to be tobacco free by 2030. [ABSTRACT FROM AUTHOR]

Human capital is a broad and multifaceted concept encompassing many different types of investment in people. However, the key aspect of human capital has to do with the knowledge and skills embodied in people. Human capital has always been an extremely important determinant of individual and social progress. In the present scenario, it is the central instrument for developing economies in an increasingly competitive, services-led, knowledge-driven global economy. The degree of responsiveness of the skilled human resources on the overall development and specifically the economic growth has been well established. Notwithstanding the known linkages between economic growth and human capital, it is pertinent to understand the significance of the skilled workforce in knowledge economy and hence in economic development. This study highlights the emerging trends in the global economy, which shows an increasing reliance on the knowledge-driven sectors for growth. It focuses on the emerging issues and challenges in the face of an ageing population in developed countries and the increasing trend of relocating services jobs through offshoring and their likely impact. It argues that the changing demographic profile of high-income nations and offshoring provide countries like India with an opportunity to increase their pace of economic development. It examines the higher education infrastructure in India and the quality and depth of skilled human resources coming out of this system so as to capitalize on this opportunity. It deliberates whether India can leverage its talent pool to build/sustain the competitive advantage or not, and whether it can maximize returns from the pace of the globalization process. (Contains 4 figures and 6 tables.)

In view of the vast variability of the compliance of Sections 4-7 of COTPA in India, a need for a collective evaluation appeared appropriate and timely. The aim of this review was to specifically analyze the country wide compliance of Section 4,5,6a and 6b,7 of COTPA along with the displays of signage on No Smoking (NoSmok) and Tobacco Free Institution (TFI). Studies published between 2003-December 2020 reporting compliance/non compliance (C/NC) were reviewed. Eligible study designs were observational studies and brief reports. To obtain the effect measure, Med Calc version 20 was used. 60 full text articles were assessed for eligibility and included in the qualitative and quantitative synthesis. The compliance for the Sections 4,5, 6b and 7 was 71.97% (95%CI:61.87-81.05, I2 =99.70%), 58.95% (95%CI:44.90-72.28, I2=99.53%), 51.08% (95% CI:39.30-62.81, I2=99.46%), 57.60% (95%CI:37.58-76.40, I2=99.48%) respectively whereas for the NoSmok and TFI board display it was 42.30% (95%CI:32.53-52.39, I2=99.75%) and 26.81% (95%CI:9.94-48.25, I2=99.51) respectively. Compliance of the Section 6a, sale of tobacco products to and by the minors was 66.39% (CI:49.50-81.36, I2=99.69%) and 94.11% (95%CI:78.54-99.99, I2=99.76%) respectively. This study observed a significant variability in compliance of Sections 4-7 of COTPA. It points to a critical need for a robust, self – sustained and effective enforcement mechanism countrywide to eliminate potential for any NC. Amendments to the COTPA appear critical for a policy reform and an optimal implementation. [ABSTRACT FROM AUTHOR]

Background. The medical curriculum for undergraduates was revised by the Medical Council of India in 2019, after 21 years. We did this study to determine teachers' pedagogical and technical readiness to implement the competency-based curriculum in medical colleges and determine factors that affect readiness, from their perspective. Methods. We conducted a cross-sectional survey in the form of an online questionnaire. The qualitative data were coded numerically and were analysed using frequencies and proportions. Pearson Chi-square test was used to study the association among variables. Results. The majority (85%) of respondents had attended a curriculum implementation training programme; 62.2% with experience <5 years, 56.1% with experience 5-10 years and a minority of 13.3% with >10 years' experience were ready to a 'great extent' to implement the new curriculum; 54.1% agreed to re-frame lectures and 64.9% possessed technological skills to suit the needs of a competency-based curriculum. About 77% agreed that it will provide a rich learning environment, inspire self-directed learning while 52% believed it will promote scientific thinking and provide better learning outcomes in the long run. Conclusion. Medical teachers had a positive attitude towards implementation of the new curriculum. However, numerous factors such as low teacher-student ratio, textbooks designed according to the traditional curriculum, limited teachers' training and cumbersome paperwork may hinder its successful implementation. Updation of teachers' knowledge and skills through seminars/workshops is recommended to facilitate delivery of the new curriculum. Like any other ongoing reforms in medical education, competency-based curriculum is a work in process. [ABSTRACT FROM AUTHOR]

Introduction: PE is a pregnancy-related syndrome with Gestational hypertension and proteinuria. It is caused by improper maternal spiral artery remodelling leading to reduced perfusion to the placenta, promoting exaggerated inflammatory markers CRP, IL 6, TNF alpha, and oxidative stress (OS) tags (MDA) into circulation. Therefore, this study was planned to explore any association between telomere length, inflammatory markers, and oxidative stress markers with change in BP (increase every ten mmHg). To the best of our knowledge, it is the first study exploring this association in preeclamptic patients. Methods: A case-control study included PE cases (n=90) and controls (n=70). RT-PCR measured relative telomere length (RTL) as a T/S ratio. Serum levels of Malondialdehyde (MDA) and C-reactive protein (CRP) by using competitive ELISA and uric acid (UA) levels by autoanalyzer. Results: RTL is significantly(p=.000) reduced in PE compared to control. MDA, CRP, and Uric acid levels significantly(p=.000) increased in cases than in control. Telomere length decreased with the rise in BP, and CRP, MDA, and UA levels increased significantly with an increase in BP. Therefore, we planned to explore the association between telomere length, inflammation, and oxidative stress with every ten mmHg increase in BP. Conclusion: Increasing BP by ten mmHg led to shorter Telomere Length and increased MDA, CRP, and UA levels. Therefore, increasing BP is associated with shorter telomere length, oxidative stress, and inflammation in PE. [ABSTRACT FROM AUTHOR]

Newly isolated Bacillus cereus strain NK91 was characterized for extracellular chitinase production. Partially purified chitinase showed a molecular weight of 43.7 kDa in SDS–PAGE analysis. The optimum pH and temperature for the partially purified enzyme were 7.0 and 40°C, respectively. The addition of Mn2+ resulted in a 21% increase in enzyme activity as compared to the control. The Vmax and Km of the enzyme were determined as 76.9 μmol/min and 0.07 mg/mL, respectively. This enzyme exhibited stronger antifungal activity towards Fusarium oxysporum (66.7%), Rhizoctonia solani (64.6%), and Colletotrichum gloeosporioides (63%), and transmission electron microscopy and scanning transmission electron microscopy analysis showed considerable changes in cell wall structure with the treatment of purified chitinase as compared to control. Therefore, this enzyme reveals its biocontrol potential against potent phytopathogens in agriculture that can be helpful in swapping harmful as well as expensive fungicides. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia is a pregnancy disorder with gestational hypertension and proteinuria, it affects maternalfoetal vasculature. The risk of preeclampsia increases upon exposure to different genetic mutations, environmental changes, obesity, gestational diabetes mellitus, multifoetal gestations, and hydatidiform mole. Preeclampsia affects the mother and foetus. Its pathogenesis is complex involving inflammation, stress, and molecular factors. Aim: To measure the circulatory levels of endothelin-1 (ET-1), Glutathione (GSH), Interleukin 6 (IL-6), and Tumor Necrosis Factor-α (TNF-α) by Enzyme Linked Immunosorbent Assay (ELISA) kit (sandwich) in preeclamptic women and healthy controls. Materials and Methods: The present study was a case-control study carried out at the Department of Biochemistry of the Government Institute of Medical Science (GIMS), Greater Noida, and Santosh Medical College, Ghaziabad, Uttar Pradesh, India, from November 2018 till November 2020. The demographic data were recorded, and blood samples were studied. Preeclamptic women (cases, n=90) were grouped as group A: 140/90-149/99 mmHg, group B: 150/100-159/109 mmHg, and group C: =160/110 mmHg along with controls (n=70). The normotensive pregnant women without family history of preeclampsia were included as controls. The competitive ELISA principles were used to quantify ET-1, GSH, IL-6, and TNF-α levels. One-way analysis of variance tests (ANOVA) and Tukey Post-Hoc Test was carried out to compare the clinical characteristics, ET-1, GSH, IL-6, and TNF-α between the cases and controls. Results: The demographic data of age, gestational age, and Body Mass Index (BMI) were not significantly different between cases and control. The ET-1 levels were significantly (p=0.042) higher in cases (A: 116±79.4, B: 99.2±72, C: 159±96) than controls (54±49). In contrast, GSH levels were low in preeclampsia. In addition, cases had elevated IL-6 and TNF-α levels (IL-6; cases A: 112.3±49.3, B: 127±17.5, C: 324±52.9, and control 40.3±13, TNF-α; cases A: 241±179, B: 200.9±196, C: 391±299 and controls: 167±104). GSH levels decreased with the rise in Blood Pressure (BP), while IL-6 increased significantly with an increase in BP. Conclusion: Every 10-mmHg increase in BP led to increase in IL-6 levels, and ET-1 and TNF-α levels were increased and the GSH levels were decreased in all three groups in comparison to controls. Thus, the present study provided evidence that links oxidative stress, inflammation, and a potent vasoconstrictor ET-1 with altered antioxidants (GSH) that led to the pathophysiology of preeclampsia. [ABSTRACT FROM AUTHOR]

Background: India, the second leading producer of tobacco, puts the population at a higher chance of tobacco consumption contributing to a significant disease burden. Though tobacco smoking is a modifiable risk factor for hypertension and has been on the rise among the population, studies on the relationship of tobacco with hypertension are limited in India. Aim: This study aimed to assess the population-level risk of tobacco (smoke) use and elevated blood pressure (BP) among Indians and also assess the association of risk of tobacco smoking with hypertension based on the place of residence. Materials and Methods: Data from the National Family Health Survey (NFHS)-4 conducted between January 2015 and December 2016 was utilized. The prevalence of hypertension and its magnitude of association with smoking factors was found using univariable logistic regression. Multivariable logistic regression was performed to predict the association of smoking products with elevated BP by adjusting the model for sociodemographic factors, illness, physical characteristics, and state-wise data. Results: The weighted prevalence of hypertension was 16.56% (confidence interval [CI]: 16.34–16.78) in males and 11.20% (CI: 11.12–11.27) in females. Among those who smoked tobacco, 15.3% women and 22.4% men were hypertensive. This study highlights the significant association of smoking of various tobacco products with hypertension in both men and women on univariate analysis. But the adjusted mean elevated BP among the tobacco-using males and females was not significantly associated with smoking cigarettes, pipe, cigars, and hookah. Conclusion: Cigarette smoking is a modifiable factor for the development and progression of hypertension. Adequate preventive and promotive health measures targeting the young, rural inhabitants and the poorer sections of society may help in reducing tobacco consumption. [ABSTRACT FROM AUTHOR]

Background and Objectives: Amidst multiple waves of the coronavirus disease 2019 (COVID-19) pandemic, numerous vaccines are being used worldwide to provide immunity against the coronavirus. Knowledge, attitudes, and perceptions of the community toward COVID-19 vaccination could influence vaccine acceptance. This study aimed to evaluate the knowledge, attitudes, and perceptions toward COVID-19 vaccination and assess its determinants. Material and Methods: A web-based cross-sectional study was conducted as a structured 27-item questionnaire through Google Forms. Qualitative data were processed by categorizing responses for an item according to intended objectives, and data were coded numerically. The associations between variables were explored by using a modified Poisson regression to determine adjusted prevalence ratios and their 95% confidence intervals. Results: The vaccine acceptance rate among the respondents was 72% and was more among those involved in the health care sector. The participants feared vaccine-related side effects and were less willing to accept the vaccination. The participants who believed adults also require vaccination against diseases accepted the COVID-19 vaccine. We found that the subjects with comorbid conditions, urban areas, and those who had contacted COVID-19 infection or family members were more willing to get vaccinated (P < 0.001). Conclusions: We concluded that a considerable majority (72%) of residents exhibit good vaccine acceptability. Health care providers, social media, and community influencers can design awareness campaigns to address perceived safety concerns and achieve a 100% acceptance rate in the community. [ABSTRACT FROM AUTHOR]

Background: Globally, India is recognized for providing comprehensive coverage of tobacco cessation through the infrastructure and resources over the last two decades. Nevertheless, its current tobacco burden is worrying due to an increase in ~2 million initiators and 5.87% tobacco related deaths annually. Objective: It was to identify and describe challenges and barriers in tobacco cessation delivery that exist at various levels of health care as well as at the level of tobacco users, their care givers and communities in which they live. Method: Besides authors' first-hand collective experience in the tobacco control for over 80 years and ~35 years in tobacco cessation and reviewed references, the stakeholders communications during various events along with telephonic or in-person with some of them were assimilated to comprehend an overall understanding of the issue. Results: The challenges and barriers are primarily due to low priority assigned by the relevant functionaries, the inadequacy of resources, poor engagement of health-and insurance-sectors and healthcare workers, a low intent to quit by its users, suboptimal and discontinuous enforcement of the Cigarette and Other Tobacco Products Act of 2003 (COTPA), and indifference of the non-users. Conclusion: The countrywide strategic initiatives required "as a package" should include political and bureaucratic commitment, mass communication on benefits of quitting, licensed current users quitting through a timeline, use of systems approach in tobacco cessation delivery, implementation, and enforcement of vendor licensing and the proposed amendments in COTPA. Their perceived benefits will become a win-win situation for all stakeholders engaged in tobacco cessation delivery. [ABSTRACT FROM AUTHOR]

Zygogramma bicolorata Pallister is an effective biocontrol agent of Parthenium hysterophorus L. We evaluated the variability in reproductive attributes and diapause behaviour among populations of Z. bicolorata from six geographical locations of India, viz. Jammu, Poonch, Rajouri, Almora, Jabalpur and Coimbatore. This was done to optimize its augmentative rearing. We collected the adult insects from these locations and reared them in the laboratory. The eggs obtained from these adults were reared from egg-hatch to adult emergence to determine the development, reproduction, diapause and the influence of extremes of temperature on survival. The percentage of pupation (84.30 ± 1.41%), adult emergence (86.75 ± 1.11%), egg viability (77.30 ± 2.02%) fecundity (2159.5 ± 8.45 eggs), and longevities of males and females (86.5 ± 4.8 and 146.9 ± 6.1 days) were greater in the Coimbatore population of South India experiencing tropical climatic conditions than the other populations. In addition, this population had the lowest incidence of diapause in adult males (26.1 ± 1.0%) and females (26.1 ± 1.0%), and shortest mean diapause durations. The Coimbatore population had the highest survival when adult females were exposed to three suboptimal temperatures with the highest survival at 35 °C, followed by 45 °C and – 5 °C, while the Jabalpur and the Almora populations survival was the lowest. The adult survival percentage of this tropical population declined with an increase in the duration of exposure to the temperature extremes. We conclude that tropical climatic conditions favour development and reproduction, and minimize the prevalence of diapause in Z. bicolorata than the colder habitats of northern India. The findings may help mass rearing of parthenium beetle under controlled conditions and to manage parthenium across various geographical habitats. [ABSTRACT FROM AUTHOR]

Introduction: The present study was undertaken to describe and quantify the spectrum of radiographic findings on coronavirus disease 2019 (COVID-19) patients. The study also aimed to analyse the changes in chest X-ray (CXR) with disease progression. Methods: COVID-19 patients admitted between the period of 15 March 2020 and 1 July 2020 were retrospectively enrolled. CXR images were assessed and reported as 'Normal' or 'Abnormal'. A severity score was calculated using Warren et al.'s Radiographic Assessment of Lung Edema scoring. Correlations of the severity score thus calculated were sought with age, sex, clinical manifestations and presence of comorbidities. Results: Five hundred patients (342 males, 158 females) were enrolled, median age being 35 years. Fever and cough were the most common symptoms but significant correlation of an abnormal CXR was found with dyspnoea. CXRs were normal in 67% and abnormal in 33% patients. The commonest comorbidities were diabetes mellitus and cardiovascular disease including hypertension, coronary artery disease and congestive heart failure. Predominant pattern was ground glass opacities, reticular alteration and consolidation peaking in the second week from symptom onset. The most frequent distribution was bilateral, peripheral with middle/lower predominance. Increasing age, male sex, presence of dyspnoea and comorbidities correlated with abnormal findings on CXR. Critical illness and mortality correlated strongly with increasing age, male sex and presence of dyspnoea, less so with presence of comorbidities. Conclusion: In the current scenario with clinicians and radiologists working in tandem, CXR seems to be a promising tool in providing relevant information in a simplified way. [ABSTRACT FROM AUTHOR]

The Government of India initiated the Beti Bachao Beti Padhao (B3P) programme in 2015 as a flagship initiative to reduce gender imbalance in sex ratio at birth (SRB) and to ensure social protection of girls. The present study was conducted to evaluate the medium-term impact of B3P implementation in Haryana state, from 2015 to 2019, on SRB. Monthly data on SRB were collected for the entire state of Haryana through a civil registration system. Segmented time series regression analysis was used to estimate the variations in SRB after the B3P programme with the help of Winter's additive interrupted time series model. The SRB in Haryana increased from 876 girls per 1000 boys in 2015 to 923 in 2019. The results of the model demonstrated that before the inception of intervention (pre-slope), there was a significant monthly change in SRB of 0.217 (95% confidence interval: 0.144-0.290). Following the B3P programme, SRB was found to increase by 0.835 per month, which implied that an increase of 0.618 (confidence interval: 0.338, 0.898) every month in SRB can be attributed to the B3P programme. This indicated that SRB for the state of Haryana increased at the rate of 7.42 units per year as a result of the B3P programme. B3P has led to a significant improvement in SRB in Haryana state. The continuity of efforts in the same direction with a sustained focus on behaviour change will further help achieve the goal of gender parity in births and child survival. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis is a major cause of death in India, which needs hospital management but many families cannot access hospitals. The World Health Organization and the Government of India developed a guideline to manage possible serious bacterial infection (PSBI) when a referral is not feasible. We implemented this guideline to achieve high coverage of treatment of PSBI with low mortality. Methodology: The implementation research study was conducted in over 50 villages of Palwal district, Haryana during August 2017-March 2019 and covered a population of 199143. Policy dialogue with central, state and district health authorities was held before initiation of the study. A baseline assessment of the barriers in the implementation of the PSBI intervention was conducted. The intervention was implemented in the program setting. The research team collected data throughout and also co-participated in the implementation of the intervention for the first six months to identify bottlenecks in the health system and at the community level. RE-AIM framework was utilized to document implementation strategies of PSBI management guideline. Implementation strategies by the district technical support unit (TSU) included: (i) empower mothers and families through social mobilization to improve care-seeking of sick young infants 0–59 days of age, (ii) build capacity through training and build confidence through technical support of health staff at primary health centers (PHC), community health centers (CHC) and sub-centers to manage young infants with PSBI signs and (iii) improve performance of accredited social health activists (ASHAs). Findings: A total of 370 young infants with signs of PSBI were identified and managed in 5270 live births. Treatment coverage was 70% assuming that 10% of live births would have PSBI within the first two months of life. Mothers identified 87.6% (324/370) of PSBI cases. PHCs and CHCs became functional and managed 150 (40%) sick young infants with PSBI. Twenty four young infants (7-59days) who had only fast breathing were treated with oral amoxicillin without a referral. Referral to a hospital was refused by 126 (84%); 119 had clinical severe infection (CSI), one 0–6 days old had fast breathing and six had critical illness (CI). Of 119 CSI cases managed on outpatient injection gentamicin and oral amoxicillin, 116 (96.7%) recovered, 55 (45.8%) received all seven gentamicin injections and only one died. All 7–59 day old infants with fast breathing recovered, 23 on outpatient oral amoxicillin treatment; and 19 (79%) received all doses. Of 65 infants managed at either district or tertiary hospital, two (3.1%) died, rest recovered. Private providers managed 155 (41.9%) PSBI cases, all except one recovered, but sub-classification and treatment were unknown. Sub-centers could not be activated to manage PSBI. Conclusion: The study demonstrated resolution of implementation bottlenecks with existing resources, activated PHCs and CHCs to manage CSI and fast breathers (7–59 day old) on an outpatient basis with low mortality when a referral was not feasible. TSU was instrumental in these achievements. We established the effectiveness of oral amoxicillin alone in 7–59 days old fast breathers and recommend a review of the current national policy. [ABSTRACT FROM AUTHOR]

Microcredit is a path toward financial inclusion through the lending of small loans, without collateral, to the poor. Microcredit is part of the broader spectrum of microfinance institutions (MFIs) that provide additional financial services like micro-insurance and financial literacy. Globally, 55 per cent of women live in poverty and 42 per cent do not have access to financial institutions. The majority are subject to subordination by patriarchal societies and reliant on their male counterparts because they do not have access to financial independence. This prevents women from better providing for themselves and their families. However, with the arrival of microcredit and microfinance institutions in the last couple of decades, millions of women around the world are uplifting generations out of poverty. Research has established that women spend 90 per cent of their income on family needs compared to only 35 per cent of men. This also means educational attainment for their children increases, which can double or triple a young girl's future income. Research also shows that when women control family money, their children are more likely to survive by 20 per cent. Microcredit allows for the kinds of investments and benefits for gender equality to occur through avenues of financial independence. Nobel Laureate Muhammad Yunus has said that "if illiterate and poor women can transform themselves into entrepreneurs, imagine what millions of high school and university graduates around the world, empowered by enormously powerful technology, can do". Historical evidence suggests that in India, representation of women entrepreneurs was abysmally low during both the colonial and postindependence era, much of it due to the social set-up and the role entrusted upon women. To support women entrepreneurial initiatives, many banks, such as Small Industries Development Bank of India (SIDBI), National Agricultural Development Bank of India (NABARD), and commercial banks started to offer credit assistance to women. Several schemes were also launched to provide necessary momentum to women entrepreneurship in the country. The Government of India and the RBI has taken a number of initiatives from time to time to promote financial inclusion and to bring these bottom of pyramid, in banking fold in order to effectively deal with poverty issues. Facilitating banks' outreach, leveraging digital technology such as mobile phones and micro ATMs, Business Correspondents (BC) model are able to help reach banking services to remote unbanked areas. Microfinance evolutionary growth has given a great opportunity to the rural poor to attain reasonable economic, social and cultural empowerment, leading to better living standard and quality of life for participating households. Micro credit to women entrepreneur has been a panacea for poverty reduction in India. [ABSTRACT FROM AUTHOR]

Improper complementary feeding practices are common in India, thus leading to malnutrition. The objective was to compare complementary feeding practices of mothers with children aged between 6 months and 2 years before and after individualized nutritional counseling. This before-and-after interventional study was carried out in a tertiary care teaching hospital between June 2018 and August 2018 on 30 mothers attending an immunization clinic. Feeding practices were assessed using interview techniques with the Breastfeeding Promotion Network of India Maharashtra checklist for Complementary Food Counseling (Diet Audit), and scoring was carried out. Baseline data included history of inclusion of items from food groups such as cereals; pulses; vitamins A, C, and D; vegetables/fruits; milk/dairy products; non-vegetarian items; and iron-rich foods; and consumption of baby feeds and junk foods. Individualized counseling was given to all study subjects, which lasted for 30–40 min. Models of various food items were shown to mothers. Feeding practices were reassessed after 4 weeks of one-to-one counseling. Feeding by mothers improved significantly in the form of items from the total number of groups from 4.3 (1.4) to 5.6 (1.3) after nutritional counseling (p: 0.001). Consumption of junk foods decreased significantly from 4.3 (2.8) to 2.6 (1.8; p: 0.001) and baby foods decreased from 0.8 (0.7) to 0.2 (0.4; p: 0.001). Individualized nutritional counseling of mothers can improve complementary feeding practices and ensure food diversification. [ABSTRACT FROM AUTHOR]

The article explores prospective study of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) household transmission in the United States (US) by Lewis and colleagues. Household transmission of SARS-CoV-2 is an important contributor to R0 and cannot be realistically addressed by continuous masking and social distancing. Use of data from contact tracing likely leads to an underestimate of household transmission.

Brief Background Despite specific national effort for over a decade, in published reports on tobacco cessation from India, the quit rate has ranged from 2.6% to 28.6%. One of their challenges has been an inability to follow-up all those treated comprehensively. Objective It was to determine an optimum number of follow-up telephonic calls to be made proactively post the cessation treatment. Materials and Methods This study was conducted for a period of one year w.e.f. 5th September 2017 at a Tobacco Cessation Clinic (TCC) of a private health sector tertiary care hospital to 296 patients currently using tobacco treated by counselling with/without pharmacotherapy; and integration of the quitline methodology with follow ups at 3rd and 7th days, and thereafter at the end of 1st, 3rd, 6th and 12th months respectively, i.e., until 4th September 2019. Results As per study protocol, the TTC could follow up 91.2% patients telephonically to achieve a quit rate of 42.9% while those who failed to quit and relapsed were 37.7% and 19.9% respectively. Staying on with the quit date set at the outset and adequacy of three follow-up calls have emerged as the statistically significant outcomes for p values of 0.000 and 0.001 respectively. Summary and Conclusions Achieving a quit rate of 42.9% through the proactive follow-up calls reinforces its perceived utility in tobacco cessation. Making at least 3 follow-up calls after primary intervention (on 3rd, 7th and at 1 month) is recommended to achieve a satisfying outcome. For an optimal outcome, the study recommends follow-ups until 6 months. [ABSTRACT FROM AUTHOR]

Background and Aims: Chhattisgarh is an endemic region for rhinosporidiosis infection in Central India. This high prevalence can be explained by suitable hot tropical environment as well as social practice of common bathing of public with animals outdoor, mainly in ponds and river. There are more than 200 ponds in and around Bilaspur district, mainly in Ratanpur region. However, due to limited literature describing rhinosporidiosis from this part of India, it remains neglected and still not recognized as a serious health-care issue and any definite government or private measures/initiatives are not taken to counter this problem. Materials and Methods: It is a retrospective demographic study analyzing 113 consecutive biopsies received from different clinical departments in a tertiary care center with a histological diagnosis of rhinosporidiosis over a period of 7 years from January 2011 to December 2017. Results: Most of the patients presented in the otorhinolaryngology (86.7%) department, followed by ophthalmology (10.6%). The mean age of the patients was 23.4 years, with a range of 3–70 years. A male-to-female ratio of about 3:2 was noted. Nasal cavity was the most common site of involvement (90/113), followed by conjunctiva (7/113), nasal cavity with oropharynx (6/113), and eyelid (3/113). Patients' complaints showed a varying range from nasal block, nasal mass, bleeding, bleed on touch, difficulty in breathing, and conjunctival mass. Two of the cases presented as recurrent rhinosporidiosis. Conclusion: Rhinosporidiosis is endemic and possesses a great health-care burden in Chhattisgarh. The socioeconomic status, outdoor bathing, and cultural practice in rural areas are the major factors contributing to newer cases. An urgent government initiative to decontaminate public water bodies and public health education through health-care workers and nongovernment organizations is the need of the hour to curtail the incidence of rhinosporidiosis. [ABSTRACT FROM AUTHOR]

Breast milk is the most ideal form of nutrition for neonates, but the rate of early initiation of breast feeding is as low as 41.6% in India. We aimed to improve the proportion of new-borns on exclusive breast feeds in first 24 h after birth in our hospital from a baseline rate of 33% to more than 90% by 6 weeks using concepts of quality improvement (QI) initiative. We implemented this QI initiative using Plan-Do-Study-Act (PDSA) cycles and the project was conducted from 07 May 2017 to 17 Jun 2017. All singleton term neonates with birth weight above 2.5 kg were included. Neonates requiring any form of resuscitation at birth, respiratory distress requiring any form of respiratory support, and neonates requiring observation in NICU for any other reason were excluded. We ran PDSA cycles (including educating residents and nurses on breast feeding, initiating skin to skin contact and breast feeding in first hour of birth, demonstrating all mothers face to face about attachment and positioning and restriction on issue of formula milk) to improve breast feeding exclusivity. A total of 199 neonates were enrolled, over a span of 6 weeks. We could achieve sustained exclusive breast feeding in first 24 h of life in more than 90% of the enrolled neonates by adhering to the QI initiative. This QI project using PDSA methodology has significantly improved the rates of exclusive breast feeding in first 24 h of life in normal neonates roomed in with their mothers. [ABSTRACT FROM AUTHOR]

Background: In a randomized controlled trial (RCT) with 8402 stable low birthweight (LBW) infants, majority being late preterm or term small for gestational age, community-initiated KMC (ciKMC) showed a significant improvement in survival. However, the effect of ciKMC on neurodevelopment is unclear. This is important to elucidate as children born with low birth weight are at high risk of neurodevelopmental deficits. In the first 552 stable LBW infants enrolled in the above trial, we evaluated the effect of ciKMC on neurodevelopmental outcomes during infancy.Method: This RCT was conducted among 552 stable LBW infants, majorly late preterm or term small for gestational age infants without any problems at birth and weighing 1500-2250 g at birth. The intervention comprised of promotion of skin-to-skin contact and exclusive breastfeeding by trained intervention delivery team through home visits. The intervention group mother-infant-dyads were supported to practice ciKMC till day 28 after birth or until the baby wriggled-out. All infants in the intervention and control groups received Home Based Post Natal Care (HBPNC) visits by government health workers. Cognitive, language, motor and socio-emotional outcomes were assessed at infant-ages 6- and 12-months using Bayley Scale of Infant Development (BSID-III). Other outcomes measured were infant temperament, maternal depression, maternal sense of competence, mother-infant bonding and home-environment. We performed post-hoc equivalence testing using two one-sided tests of equivalence (TOST) to provide evidence that ciKMC does not do harm in terms of neurodevelopment.Results: In the intervention arm, the median (IQR) time to initiate ciKMC was 48 (48 to 72) hours after birth. The mean (SD) duration of skin-to-skin-contact was 27.9 (3.9) days with a mean (SD) of 8.7 (3.5) hours per day. We did not find significant effect of ciKMC on any of the child developmental outcomes during infancy. The TOST analysis demonstrated that composite scores for cognitive, language and motor domains at 12 months among the study arms were statistically equivalent.Conclusion: Our study was unable to capture any effect of ciKMC on neurodevelopment during infancy in this sample of stable late preterm or term small for gestational age infants. Long term follow-up may provide meaningful insights.Trial Registration: The trial is registered at clinicaltrials.gov NCT02631343 dated February 17, 2016; Retrospectively registered. [ABSTRACT FROM AUTHOR]

India has the highest burden of Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) worldwide. Innovative technology is the need of the hour to identify these cases that remain either undiagnosed or inadequately diagnosed due to the unavailability of appropriate tools at primary healthcare settings. We developed and evaluated 3 kits, namely ‘TB Detect’ (containing BioFM-Filter device), ‘TB Concentration and Transport’ (containing Trans-Filter device) and ‘TB DNA Extraction’ kits. These kits enable bio-safe equipment-free concentration of sputum on filters and improved fluorescence microscopy at primary healthcare centres, ambient temperature transport of dried inactivated sputum filters to central laboratories and molecular detection of drug resistance by PCR and DNA sequencing (Mol-DST). In a 2-site evaluation (n = 1190 sputum specimens) on presumptive TB patients, BioFM-Filter smear exhibited a significant increase in positivity of 7% and 4% over ZN smear and LED-FM smear (p<0.05), respectively and an increment in smear grade status (1+ or 2+ to 3+) of 16% over ZN smear and 20% over LED-FM smear. The sensitivity of Mol-DST in presumptive MDR-TB and XDR-TB cases (n = 148) was 90% for Rifampicin (95% confidence interval [CI], 78–96%), 84% for Isoniazid (95% CI, 72–92%), 83% for Fluoroquinolones (95% CI, 66–93%) and 75% for Aminoglycosides (95% CI, 35–97%), using phenotypic DST as the reference standard. Test specificity was 88–93% and concordance was ~89–92% (κ value 0.8–0.9). The patient-friendly kits described here address several of the existing challenges and are designed to provide ‘Universal Access’ to rapid TB diagnosis, including drug-resistant disease. Their utility was demonstrated by application to sputum at 2 sites in India. Our findings pave the way for larger studies in different point-of-care settings, including high-density urban areas and remote geographical locations. [ABSTRACT FROM AUTHOR]

Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12–23 months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators − 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals. [ABSTRACT FROM AUTHOR]

Hepatitis A virus (HAV) causes an enterically transmitted viral disease mainly affecting children and endemic in many developing countries, including India. There is an epidemiological shift with an increased incidence of symptomatic cases among children. This study was conducted to assess the seroprevalence of HAV among young children aged below 5 years and the need for universal immunization. This cross-sectional study was conducted at two tertiary care hospitals in Northern India, from Apr 2014 to Jul 2015, among healthy children aged between 1 and 5 years. The sample size was calculated based on the prevalence of HAV seropositivity of 40% among children aged <10 years [16–60%] and alpha error of 5%. Analysis of serum IgG against HAV was performed by enzyme-linked immunosorbent assay method, and results were analyzed. A total of 1084 children aged between 12 and 60 months were enrolled, with male-to-female ratio of 1.86:1. A total of 471 children (43.5%) were found to be positive for IgG against HAV. The seroprevalence of HAV was lower among younger children aged 12–23 months (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.52–0.87, p = 0.03), which was statistically significant. Seropositivity of HAV was lower among boys and families consuming safe drinking water and having improved sanitation facilities. The study observed lower seropositivity against HAV among younger children, making them susceptible of contracting the disease. Possible underlying risk factors were younger age, unsafe drinking water, poor sanitation, and low education status of parents. Therefore, vaccination may be recommended as optional vaccine at one year of age, along with improved public health efforts for safe drinking water, hygiene practices, and food safety. [ABSTRACT FROM AUTHOR]

Entrepreneurial orientation (EO) is the entrepreneurial behavior displayed by firms that contributes towards their success of firms, but the view that firms who possess higher EO perform well has limited empirical support. A large majority of studies on EO define it as a uni-dimension, consisting of three dimensions - namely, innovativeness, risk taking, and pro-activeness - that co-vary and collapse to make this overarching construct. This masks the influence of individual EO dimensions that possibly explains the reason behind the indifferent results about the EO-firm performance relationship. Some studies have focused on the EO construct as a multidimensional one, comprising five dimensions that act independently as proposed by Lumpkin and Dess (1996). Small firms have limited resources, and so for them knowing which dimensions of EO are significant is an important issue. This study thus focuses on the EO construct as a multidimensional one consisting of five dimensions that act independently and examines the relationship between each EO dimension and growth of small firms and how resources moderate this relationship. It highlights that small firms should make judicious use of their limited resources by allocating them to only those dimensions of EO that contribute to firm growth rather than focusing on the entire EO construct. We analyze the data in this study using structural equation modeling (SEM) and the ordinary least square regression method. The findings of this study empirically establish that individual EO dimensions have a unique and independent influence on small firm growth, varying in strength as well as direction. Further resources moderate the relationship between individual EO dimensions and firm growth differently. [ABSTRACT FROM AUTHOR]

This case deals with the challenges and dilemma faced by WudStay, a start-up engaged in the aggregation of different accommodation options in India. The company wants to evaluate the attractiveness and the challenges facing the houseboat sector and decide whether to enter this sector. The case illustrates the present state of the houseboat sector and captures the direction it is heading. Since its inception, the sector has remained unorganized, resulting in unsatisfactory customer service standards. The short-sighted approach of houseboat owners to maximize profits and refusal to adopt technological solutions has put doubts on the long-term health of this sector with many tourists looking for better alternatives. The sector is concentrated in two states in India: Jammu and Kashmir (J&K) and Kerala. The differences in the external-macro environment has taken the sector in these two states to completely different directions. In Kashmir, the deteriorating security situation has a negative impact on tourist inflows, thus reducing the demand for houseboats. In Kerala, the sector is on an upswing, with the government playing a catalytic role in promoting tourism and incentivizing houseboats through subsidies. In this background, WudStay wants to evaluate its long-term attractiveness and the opportunity of creating a sustainable value proposition in this sector. [ABSTRACT FROM AUTHOR]

This study on systems approach in tobacco dependence treatment was done to (a) Assess the feasibility of tobacco treatment protocol (TTP), (b) Assess quit rate among those treated with TTP vs. no treatment and (c) Compare treatment outcome in Brief Intervention (BI) and Intensive Intervention (II) with or without pharmacotherapy. This one year study (2013), undertaken at a hospital at Jaipur, India identified currently tobacco-using patients. Those willing were assisted to quit through brief intervention (BI) or intensive treatment (II). All were followed-up telephonically for one year. The responders were categorized as successful quit, failed to quit and relapsed. This study enrolled 1264 patients out of 19657 (6.43%). In 43.4 per cent patients (549/1264) who consented for the treatment, the overall quit rate was 26.1 per cent (CI: 23.8 -28.6) whereas in those treated with BI and II were 54.2 per cent (CI: 49.7 -59.0) and 84.9 per cent (CI: 78.4 -92.0) respectively vs. zero quit rate in untreated. The use of pharmacotherapy improved overall quit rate by 14.6 per cent. The quit rates did not differ for the type of tobacco used. Since, this study could achieve its objective of implementing the systems approach in tobacco treatment protocol in a hospital-setting, it merits a replication. [ABSTRACT FROM AUTHOR]

The Government of India launched a nationwide programme to save and educate the girl child, Beti Bachao Beti Padhao (B3P), by stringent prohibition of sex-selective abortion, enforcement of Preconception and Prenatal Diagnostic Technique (PC-PNDT) and Medical Termination of Pregnancy (MTP) Acts, and social mobilization. We undertook this study to assess the effectiveness of intervention in Haryana state to improve sex ratio at birth (SRB). The monthly data on SRB (represented as girls per 1000 boys) were collected from civil registration system for the entire state of Haryana to evaluate the impact of B3P programme. The segmented time-series regression analysis was used to estimate the change in SRB after B3P programme. In this process, the seasonal auto regressive integrated moving average model was used to control the seasonality, autocorrelation and secular trend imbibed in the data before calculating the estimate of change in slope using regression equation. Overall, the sex ratio at birth in Haryana increased from 827 girls per 1000 boys in January 2005 to 900 girls per 1000 boys in September 2016. The estimates from segmented time-series regression analysis show that there was an insignificant change in SRB of -0.012 units before the intervention. Post slope was estimated to be 1.684, which suggested an increase in SRB of 1.696 [(confidence interval: 0.23, 3.15), P = 0.025] in terms of the difference between pre- and post-slope. This indicates a statistically significant increase of SRB by 1.696 per month attributable to B3P programme. B3P programme has resulted in an improvement of SRB in Haryana. [ABSTRACT FROM AUTHOR]

Background: The immunization coverage in India is far away from satisfactory with full immunization coverage being only 62% at national level. Targeting the intensive efforts to poor performing areas and addressing the determinants of nonimmunization and dropouts offers a quick solution. In this paper, we assess the inter-district variations in Haryana state, and the association of social determinants with partial and no immunization. Methodology: This analysis is based on data collected as part of a large household survey undertaken in the state of Haryana to measure the extent of Universal Health Coverage. A multistage stratified random sampling design was used to select primary sampling units (i.e., subcenters), villages, and households. A total of 11,594 mothers with a child between 12 and 23 months were interviewed on receipt of immunization services. Determinants of nonimmunization and partial immunization were assessed using multiple logistic regression. Results: About 21% of children aged 12-23 months were partially immunized, while 4.3% children aged 12-23 months had received "no immunization." While the coverage of full immunization was 74.7% at the state level, it varied from 95% in best performing district to 38% in poorest performing district. Odds of a partially immunized child were significantly higher in urban area (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.1-1.38), among Muslim household (OR = 3.52; 95% CI = 3.03-4.11), children of illiterate parents (OR = 1.58; 95% CI = 1.22-2.05), and poorest quintile (OR = 1.61; 95% CI = 1.36-1.89). Conclusions: Wide interdistrict variations call for a need to consider changes in resource allocation and strengthening of the government initiatives to improve routine immunization in these districts. [ABSTRACT FROM AUTHOR]

Context: "Integrated Management of Neonatal and Childhood Illnesses" (IMNCI) needs regular supportive supervision (SS). Aims: The aim of this study was to find suitable SS model for implementing IMNCI. Settings and Design: This was a prospective interventional study in 10 high-focus districts of Haryana. Subjects and Methods: Two methods of SS were used: (a) visit to subcenters and home visits (model 1) and (b) organization of IMNCI clinics/camps at primary health center (PHC) and community health center (CHC) (model 2). Skill scores were measured at different time points. Routine IMNCI data from study block and randomly selected control block of each district were retrieved for 4 months before and after the training and supervision. Statistical Analysis Used: Change in percentage mean skill score difference and percentage difference in median number of children were assessed in two areas. Results: Mean skill scores increased significantly from 2.1 (pretest) to 7.0 (posttest 1). Supportive supervisory visits sustained and improved skill scores. While model 2 of SS could positively involve health system officials, model 1 was not well received. Outcome indicator in terms of number of children assessed showed a significant improvement in intervention areas. Conclusions: SS in IMNCI clinics/camps at PHC/CHC level and innovative skill scoring method is a promising approach. [ABSTRACT FROM AUTHOR]

Background & objective: Good examples of evidence generation using Health Policy and Systems Research (HPSR) in low and middle-income countries (LMIC); and its application in policy making are scarce. In this paper, we describe the experience of establishing a system of HPSR from the Haryana state in India, outline how the HPSR is being utilized for policy making and programmatic decision making, and analyse the key factors which have been critical to the implementation and uptake of HPSR. Material & Methods: Multiple methods are employed in this case study, ranging from unstructured in-depth interviews, review of the program and policy documents, and participatory notes from the meetings. The steps towards creation of a knowledge partnership between stakeholders are outlined. Four case studies i.e. development of a plan for universal health care (UHC), nutrition policy, centralized drug procurement system and use of RAPID appraisal method highlight the use of research evidence in agenda setting, policy formulation and policy implementation respectively. Results: Our analysis shows that the most important factor which contributed to Haryana model of HPSR was the presence of a dedicated and motivated team in National Rural Health Mission (NRHM) at state level, many of whom were researchers by previous training. Overall, we conclude by highlighting the need for establishing an institutional mechanism at Central and State level where health service administrators and managers, academicians and researchers working in the field of health system from medical colleges, public health schools, management and technology institutions and social science universities can identify health system research priorities. Increased budgetary allocation for HPSR is required. [ABSTRACT FROM AUTHOR]

Background: Around 70% neonatal deaths occur in low birth weight (LBW) babies. Globally, 15% of babies are born with LBW. Kangaroo Mother Care (KMC) appears to be an effective way to reduce mortality and morbidity among LBW babies. KMC comprises of early and continuous skin-to-skin contact between mother and baby as well as exclusive breastfeeding. Evidence derived from hospital-based studies shows that KMC results in a 40% relative reduction in mortality, a 58% relative reduction in the risk of nosocomial infections or sepsis, shorter hospital stay, and a lower risk of lower respiratory tract infections in babies with birth weight <2000 g. There has been considerable interest in KMC initiated outside health facilities for LBW babies born at home or discharged early. Currently, there is insufficient evidence to support initiation of KMC in the community (cKMC). Formative research in our study setting, where 24% of babies are born with LBW, demonstrated that KMC is feasible and acceptable when initiated at home for LBW babies. The aim of this trial is to determine the impact of cKMC on the survival of these babies.Methods/design: This randomized controlled trial is being undertaken in the Palwal and Faridabad districts in the State of Haryana, India. Neonates weighing 1500-2250 g identified within 3 days of birth and their mothers are being enrolled. Other inclusion criteria are that the family is likely to be available in the study area over the next 6 months, that KMC was not initiated in the delivery facility, and that the infant does not have an illness requiring hospitalization. Eligible neonates are randomized into intervention and control groups. The intervention is delivered through home visits during the first month of life by study workers with a background and education similar to that of workers in the government health system. An independent study team collects mortality and morbidity data as well as anthropometric measurements during periodic home visits. The primary outcomes of the study are postenrollment neonatal mortality and mortality between enrollment and 6 months of age. The secondary outcomes are breastfeeding practices; prevalence of illnesses and care-seeking practices for the same; hospitalizations; weight and length gain; and, in a subsample, neurodevelopment.Discussion: This efficacy trial will answer the question whether the benefits of KMC observed in hospital settings can also be observed when KMC is started in the community. The formative research used for intervention development suggests that the necessary high level of KMC adoption can be reached in the community, addressing a problem that seriously constrained conclusions in the only other trial in which researchers examined the benefits of cKMC.Trial Registration: ClinicalTrials.gov identifier: NCT02653534 . Registered on 26 December 2015 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: Studies have shown that cellularity of glial tumors are inversely correlated to minimum apparent diffusion coefficient (ADC) values derived on diffusion-weighted imaging (DWI). The purpose of this prospective exploratory study was to evaluate whether temporal change in "minimum ADC" values during follow-up predict progressive disease in glial tumors post radiotherapy and surgery. Materials and Methods: Adult patients of glial tumors, subjected to surgery followed by Radiotherapy (RT), were included in the study. Serial conventional magnetic resonance imaging with DWI at the following time points - presurgery, pre-RT, post-RT imaging at 3, 7, and 15 months were done. For "minimum ADC" values, multiple regions of interest (ROI) were identified on ADC maps derived from DWI. A mean of 5 minimum ADC values was chosen as "minimum ADC" value. The correlation was drawn between histology and minimum ADC values and time trends were studied. Results: Fourteen patients were included in this study. Histologies were low-grade glioma (LGG) - 5, anaplastic oligodendroglioma (ODG) -5, and glioblastoma multiforme (GBM) - 4. Minimum ADC values were significantly higher in LGG and GBM than ODG. Presurgery, the values were 0.812, 0.633, and 0.787 × 10-3 mm2/s for LGG, ODG, and GBM, respectively. DWI done at the time of RT planning showed values of 0.786, 0.636, 0.869 × 10-3 mm-3/s, respectively. During follow-up, the increasing trend of minimum ADC was observed in LGG (P = 0.02). All these patients were clinically and radiologically stable. Anaplastic ODGs, however, showed an initial increase followed by the fall of minimum ADC in all the 5 cases (P = 0.00). Four of the five cases developed progressive disease subsequently. In all the 4 GBM cases, a consistent fall of minimum ADC values was observed (P = 0.00), and they all progressed in spite of RT. Conclusions: The DWI-derived minimum ADC values are an important yet simple quantitative tool to assess the treatment response and disease progression before they are evident on conventional imaging during the follow-up of glial tumors. [ABSTRACT FROM AUTHOR]

Rationale: Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India.Objectives: To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses.Methods: Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement.Measurements and Main Results: A total of 1,084 patients were recruited. Final diagnosis: hypersensitivity pneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD.Conclusions: Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide. [ABSTRACT FROM AUTHOR]

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The agriculture sector, which sustains more than half the country, is no longer the first preference of rural households in India. It is heading towards a huge never-ending debt crisis. The plight of India's farmers has only become grimmer in the past decade. The lot of the embattled Indian farmer only keeps getting worse with the passage of time. Even as India celebrates the golden jubilee of the Green Revolution, NSSO Survey (Jan-Dec, 2013, 70th Round) has come out with data indicating that nearly 70 per cent of farmers subsist on economically unviable farm holdings of less than a hectare in size. Farmers' distress is particularly acute at present since 18 of the 29 states are facing drought in one part or the other for the second year in a row. Through analysis of the data on agricultural households and farmers' debts trend, an attempt has been made to point out urgent needs of the agriculture sector and possible solutions that may be relooked by the country's policy-makers with a holistic approach. [ABSTRACT FROM AUTHOR]

Background: Stillbirth is a prevalent adverse outcome of pregnancy in India despite efforts to improve care of women during pregnancy. Risk factors for stillbirths include sociodemographic factors, medical complications during pregnancy, intake of harmful drugs, and complications during delivery. The objective of the study was to examine the risk factors for stillbirth with a focus on sex selection drugs (SSDs).Methods: A population-based case-control study was undertaken in Haryana. Cases of stillbirths were identified from the Maternal Infant Death Review System portal of Haryana state for the months of August-September 2014. A consecutive birth from the same geographical area as the case was selected as the control. The sample size was 325 per group. Mothers were interviewed using a validated tool. Bivariate analyses and logistic regression were conducted to examine the association between risk factors and stillbirth. Attributable risk proportions (ARP) and population attributable risk proportions (PARP) were estimated.Results: The sociodemographic profiles of the cases and controls were similar. History of intake of SSDs [adjusted odds ratio (OR) 2.6, 95% confidence interval (CI) 1.5, 4.5] emerged as a risk factor. Other significant factors were preterm <37 weeks (OR 3.5, 95% CI 2.1, 6.0), history of previous stillbirths (OR 4.0, 95% CI 2.1, 7.8), and complications during labour (OR 3.3, 95% CI 2.1, 5.3). Estimates of the ARP and PARP for intake of SSDs were 0.60 (95% CI 0.32, 0.77) and 0.1 (95% CI -0.13, 0.28), respectively.Conclusions: SSDs could be attributed as a risk factor in a fifth of the cases of stillbirths. The number needed to harm for the use of SSDs in causing adverse effect of stillbirths was 5, suggesting thereby that for every five mothers exposed to SSDs, one would have stillbirth. Greater efforts are required to inform people about the harmful effects of SSD consumption during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Oral, breast, and cervical cancers are amenable to early detection and account for a third of India's cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts.Methods: Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages.Results: Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences.Conclusions: Symposium participants proposed implementation-focused research, advocacy, and policy/program priorities to strengthen primary and secondary prevention efforts in India to address the burden of oral, breast, and cervical cancers and improve survival. [ABSTRACT FROM AUTHOR]

Introduction: Congenital malformations (CMFs) are a major public health problem in India. Consanguineous marriages, infections during pregnancy, folic acid deficiency during the periconceptional period, exposure to pesticides and a history of intake of drugs during pregnancy have been hypothesized as risk factors. Drugs include oral contraceptive pills, progesterone analogues, medications for ailments and indigenous drugs to bear male offspring. It is important to analyze the risk factors in order to implement preventive measures. The prime objective of this study was to study the risk factors of visible structural CMFs, with a focus on indigenous medicines for sex selection.Methods: A population-based, case-control study was undertaken in Haryana state. Cases included children (0-18 months) with any apparent structural deformity as reported by various Government sources. A consecutive birth from the same area as the case was labelled and included as the control. The sample size calculated was 175 in each group. Mothers of every case and control were interviewed at their respective homes using a structured tool. Descriptive analysis, bivariate analysis, followed by logistic regression was conducted to establish the association between risk factors and CMFs.Results: The sociodemographic profiles of the cases and controls were similar. Among the various risk factors studied, more than two living children (unadjusted odds ratio [OR] 1.6, 95 % CI 1.04-2.4) and intake of sex-selection drugs (unadjusted OR 2.8, 95 % CI 1.6-5.1) were significant risk factors on bivariate and regression analyses. The risk of having a child with CMFs was threefold more among mothers with a history of intake of indigenous medicines for sex selection (adjusted OR 3; 95 % CI 1.7-5.6).Conclusions: The intake of indigenous drugs during pregnancy increased the risk of CMFs almost threefold. This has social as well as economic implications, and hence needs further investigation. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the present study was to identify the true prevalence of hemorrhage in the abscess using T2*-weighted angiography (SWAN) imaging and to study its influence on diffusion tensor imaging (DTI) metrics. Methods: Fifteen patients of brain abscess underwent conventional, SWAN, and DT imaging on a 3-T MRI followed by its confirmation with histology. DTI metrics were quantified by region-of-interest analysis on hemorrhagic and non-hemorrhagic regions of the abscess wall. Prussian blue staining was performed on excised abscess walls to confirm hemorrhage on histology. Results: Eleven of 15 patients showed evidence of hemorrhage on both Prussian blue staining as well as SWAN imaging. Fractional anisotropy (FA) and linear anisotropy (CL) values were significantly higher, while spherical anisotropy was significantly lower in hemorrhagic compared to non-hemorrhagic regions of the abscess wall. Conclusion: Hemorrhage in the abscess wall is a common feature and may not always indicate neoplasm. The presence of intracellular iron in addition to concentrically laid collagen fibers may have synergistic effect on FA and CL values in the abscess wall. Inclusion of SWAN to MRI protocol will define the true prevalence of hemorrhage in brain abscess. [ABSTRACT FROM AUTHOR]

Summary: Epilepsy is a major health problem worldwide, and neurocysticercosis (NCC) is one of the important causes of epilepsy in the tropics. The present study was carried out in a rural pig farming community of north India to estimate the prevalence of NCC in patients with active epilepsy (AE) and to determine the associated risk factors. Based on 30-cluster sampling recommended by WHO, a total of 1640 individuals belonging to 294 families from 30 villages were enrolled in the study. Demographic and socio-economic details of all individuals and families were recorded. Individuals with AE were identified by door-to-door survey. NCC was diagnosed by clinical, immunological, neuroimaging (brain magnetic resonance imaging) and epidemiological criteria. During the survey, 95 (5.8%) patients with AE were identified and clinically confirmed; 91 agreed to further evaluation for NCC and 44 (48.3%) of them fulfilled either definitive or probable diagnostic criteria for NCC. These 44 patients belonged to 37 households. Epilepsy in the family and no separate place for keeping pigs were identified as risk factors for NCC clustering in a family. The study shows a very high prevalence of AE in the pig farming community and NCC as its major cause. Since NCC is a preventable and potentially eradicable disease, appropriate intervention strategies may help to reduce the disease burden. [Copyright &y& Elsevier]

Abstract: We performed in vivo diffusion tensor imaging (DTI) in a total of 33 patients with brain tuberculomas (BT). Thirteen of them had surgical excision of the lesion as it was clinically indicated, and in these samples matrix metalloproteinase-9 (MMP-9) expression was quantified. We correlated the results of DTI indices like fractional anisotropy (FA), mean diffusivity (MD), linear anisotropy (CL), planar anisotropy (CP) and spherical anisotropy (CS) with MMP-9 expression. In addition, the remaining 20 patients had serial DTI studies while on specific anti-tuberculous drug therapy and DTI indices in these patients were quantified. The FA, CL and CP significantly decreased while MD and CS significantly increased in BT compared to normal white matter. The FA, CL and CP showed negative correlation with MMP-9 while CS correlated positively. In serial follow-up studies in 20 patients FA, CL and CP showed significant increase while CS decreased significantly over time. We conclude that DTI indices show strong correlation with MMP-9 and these may be used as a surrogate marker of MMP-9 expression in BT. In addition, these indices may be of value in assessing the therapeutic response in patients with BT who are treated only with specific anti-tuberculous drugs. [Copyright &y& Elsevier]

Abstract: Colloidal and calcified cysts are considered responsible for seizure in neurocysticercosis (NCC); however, calcified cysts have also been reported in asymptomatic individuals. We carried out a MRI-based study in a rural pig farming community of North India to detect the various stages, locations and numbers of the cyst in asymptomatic individuals and compared them with symptomatic NCC cases to see its association with occurrence of seizures. A total of 107 asymptomatic family members of 29 symptomatic NCC confirmed cases were evaluated clinically, immunologically and by neuroimaging for NCC. MRI-based staging of the parasite was done in both groups, and compared to look for the differences, if any. Thirty-one (29.0%) asymptomatic family members of symptomatic cases were diagnosed to have NCC. There was no difference in proportion of colloidal/degenerating and calcified stages of the parasite between symptomatic and asymptomatic groups; however, significantly higher proportion of the asymptomatic populations had vesicular stage of the parasite (P =0.029). Our findings show that a large number of individuals harboring different stages of cysticerci in their brain remain symptoms free and question the belief that the degenerating/calcified stages of the parasite are primarily responsible for seizure occurrence in NCC. [Copyright &y& Elsevier]

Summary: There is a lack of information on the disease burden due to Taenia solium taeniasis and its associated risk factors in pig farming communities throughout the world. The present study was conducted in a rural pig farming community of north India to estimate the prevalence of T. solium taeniasis and associated factors. Demographic, clinical and epidemiological data were collected from 1181 subjects in 210 households in 30 villages. Stool specimens from 924 subjects were examined for eggs of Taenia and other parasites. Identification of T. solium was confirmed by morphological features of segments and species-specific DNA detection from segments and stool. The prevalence of T. solium taeniasis was 18.6% (172/924); factors associated with taeniasis on multivariate analysis were age above 15 years, history of passage of Taenia segments in stool, undercooked pork consumption and poor hand hygiene (hand-washing with clay/water after defecation). Seventy-eight subjects (6.6%) with epilepsy were identified. The study showed alarmingly high rates of epilepsy and T. solium taeniasis in the study community; it highlights the need for large-scale imaging-based surveys to identify the factors associated with epilepsy including neurocysticercosis. Health education, mass anthelminthic therapy and other preventive measures are required to control the menace of the disease. [Copyright &y& Elsevier]

BACKGROUND: A very little information about tobacco use among school personnel is available. This is a step to have cross country and within country data using standardized methodology. AIMS: To obtain baseline information about tobacco use prevalence, knowledge and attitude among school personnel. STUDY DESIGN: Two stage cluster sample. SETTING: A state of Rajasthan. MATERIALS AND METHODS: A cross-sectional study, using anonymous self-administered questionnaire. A sample of schools with probability proportional to the enrolment in grades 8-10. All school personnel in sampled schools were eligible to participate. STATISTICAL ANALYSIS: Percentage, 95% confidence interval. RESULTS: School response rate was 97.4% (75/77) and school personnel response rate was 67.2% (909/1352). Majority of school personnel (men 69%, women 31%) were school teachers (78.3%). The prevalence of ever any tobacco use was reported by 35.9%, more among men than women (46.2% vs. 13.0%). The prevalence of current daily smoking was reported by 14.4% (men 20.6%, women 0.8%) and occasional by 7.3%, where as current daily smokeless tobacco use was 11 .7% (men 16.4%, women 1 .1%) and occasional 13.6%. Current daily tobacco use was significantly more among men than women. Four out of nine reported their schools have a tobacco prohibiting policy for both students (48.4%) as well as for school personnel (44.4%) and about same (47.2%) reported their schools enforce its tobacco policy or rule. Over 85% of all school personnel strongly support the tobacco control policies and wanted training in tobacco cessation and prevention. CONCLUSION: First study from Rajasthan to report tobacco use among school personnel. School personnel not only strongly support the tobacco control policies but also ready to work for its successful implementation with proper training. [ABSTRACT FROM AUTHOR]