Search

Mitochondrial DNA sequence of the sub-unit 1 of cytochrome c oxidase (Cox1) and ribosomal DNA sequence of the first internal transcribed spacer (ITS-1) of Fasciola collected from mithun and cattle from Arunachal Pradesh, India were characterized at molecular level in order to identify the species of parasite. Based on sequence and phylogenetic analysis, the identity of the parasite was confirmed as Fasciola gigantica in mithun as well as from cattle. In order to know histopathological alteration in Fasciola infection, a histopathological study was performed on eight liver specimens, out of 110 animals studied during the period from 2010-2016. Histopathological examination of F.gigantica infected liver showed extensive fibrous connective tissue proliferation with necrosis of hepatocytes and infiltration of polymorphonuclear cell. There was evidence of migratory tracts of parasites with losing of normal lobular hepatic architecture. Bile duct proliferation was followed by congestion of portal vein with perivascular cuffing with surrounding degeneration of hepatocytes. The hepatocytes showed pyknosis with hyperplasia of bile duct. [ABSTRACT FROM AUTHOR]

This article is based on the community college experiences emerging from India which has the largest number of a non-literate population in the world, and possibly the largest number of out-of-school children. India is undergoing rapid changes due to globalisation, competitiveness and a knowledge-based economy. Linkages with the local community and industry are an essential prerequisite for the community college movement in India. The social work processes are associated with poverty, unemployment, poor health, disablement and other sources of disadvantage. The community college movement in India is one solution to India's persistent problems of under employment, unemployment, illiteracy and unemployability and a powerful means for social workers to utilise to empower people through community involvement. The objective of this article is to trace the community college movement as an empowering process, to fine-tune the linkages between the movement and the social work profession, and provide guidelines to social work professionals to develop and implement the system far and wide as an educational alternative and empowerment of the poor, through developing suitable and relevant curriculum for the dropouts and slow learners coming out from the economically and educationally undeveloped communities in India. [ABSTRACT FROM AUTHOR]

The article considers HIV transmission and prevention information and the amount of knowledge rural Indian women in the Namakkal district of Tamilnadu have on the subject. A questionnaire was given before and after a voluntary health education course on HIV. The article explains the growth of AIDS in India, the population dynamics of Tamilnadu and the results of the questionnaire. The role of husbands in HIV testing, efforts to prevent mother to child HIV transmission and the relationship between prior education and HIV knowledge are covered.

The vulnerability of the young women to HIV/AIDS in the tribal dominated Udaipur district in Rajasthan of India is mainly due to low literacy, less control over decision making, alcoholism, cultural practices, RTI/STDs and sexual net-working. CHARCA (Co-ordinated HIV/AIDS and STD Response through Capacity Building and Awareness) a Joint UN project to reduce the vulnerabilities of young women to HIV/AIDS was implemented in the district to address the vulnerabilities of young women to HIV/AIDS. The strategies included awareness generation, provision of services and capacity building. The VCTCs were estabished as part of the provision of services in all the 11 blocks in a phased manner. It was for the first time in the state that VCTCs were established at the Community Health center (100000 population) much lower than the District Hospital. From 2004 end to 2007 June, about 25499 clients were counseled, 1438 were tested and 100 were positive. The lessons learned are 1) The client load in t VCTCs have increased over time period due to the Peer educator approach and awareness campaigns 2) Linkages between the SRH services in the health institution and the VCTC have increased 3) Presence of VCTC at the block level have helped the PLWHA to access the SRH services at the institution and for PLWHAs to access the ART therapy. Apart from this the paper will also look at the lessons learned and challenges on operationalising the VCTC services in a SRH setting like Community health center. [Copyright &y& Elsevier]

Supralittoral zones of 13 sandy beaches of remote Rutland Island were divided into three zones to identify the litter contamination, its source, pathway of plastic transport to determine the level of macro-litter contamination, and its impact on coastal biota. Owing to the floral and faunal diversity, apart of the study area is protected under Mahatma Gandhi Marine National Park (MGMNP). The supralittoral zones of each sandy beach (between low-tide and high-tide line) were individually calculated from 2021 Landsat-8 satellite imagery before conducting the field survey. The total area of the surveyed beaches was 0.52 km 2 (5,20,020.79 m 2 ), and 317,565 litters representing 27 distinct litter types were enumerated. Two beaches in Zone-II and six in Zone-III were clean; however, all five in Zone-I were very dirty. The highest litter density (1.03 items/m 2 ) was observed in Photo Nallah 1 and Photo Nallah 2, whereas the lowest (0.09 items/m 2 ) was observed in Jahaji Beach. According to the Clean Coast Index (CCI), Jahaji Beach (Zone-III) is the very cleanest beach (1.74) while other beaches of Zone-II and Zone-III are clean. The findings of the Plastic Abundance Index (PAI) indicate that Zone-II and Zone-III beaches have a low abundance of plastics (< 1), while two beaches of Zone-I, viz., Katla Dera and Dhani Nallah, exhibited a moderate abundance of plastics (< 4) while a high abundance of plastics (< 8) was observed in the rest of three beaches of the same zone. The primary contributor of litter on Rutland's beaches was plastic polymers (60-99%), which were presumed to originate from the Indian Ocean Rim Countries (IORC). A collective litter management initiative by the IORC is essential in preventing littering on remote islands., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The coronavirus disease (COVID) pandemic caused disruption globally and was particularly distressing in low- and middle-income countries such as India. This study aimed to provide population representative estimates of COVID-related outcomes in India over time and characterize how COVID-related changes and impacts differ by key socioeconomic groups across the life course., Methods: The sample was leveraged from an existing nationally representative study on cognition and dementia in India: Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). The wave-1 of LASI-DAD enrolled 4096 older adults aged 60 years and older in 3316 households from 18 states and union territories of India. Out of the 3316 LASI-DAD households, 2704 with valid phone numbers were contacted and invited to participate in the Real-Time Insights COVID-19 in India (RTI COVID-India) study. RTI COVID-India was a bi-monthly phone survey that provided insight into the individual's knowledge, attitudes, and behaviour towards COVID-19 and changes in the household's economic and health conditions throughout the pandemic. The survey was started in May 2020 and 9 rounds of data have been collected., Findings Till Date: Out of the 2704 LASI-DAD households with valid phone numbers, 1766 households participated in the RTI COVID-India survey at least once. Participants were in the age range of 18-102 years, 49% were female, 66% resided in rural area. Across all rounds, there was a higher report of infection among respondents aged 60-69 years. There was a greater prevalence of COVID-19 diagnosis reported in urban (23.0%) compared to rural areas (9.8%). Respondents with higher education had a greater prevalence of COVID-19 diagnosis compared to those with lower or no formal education. Highest prevalence of COVID-19 diagnosis was reported from high economic status compared to middle and low economic status households. Comparing education gradients in experiencing COVID-19 symptoms and being diagnosed, we observe an opposite pattern: respondents with no formal schooling reported the highest level of experiencing COVID-19 symptoms, whereas the greatest proportion of the respondents with secondary school or higher education reported being diagnosed with COVID-19., Future Plans: The study group will analyse the data collected showing the real-time changes throughout the pandemic and will make the data widely available for researchers to conduct further studies., (© 2023. The Author(s).)

Background: Every society has persons with illness who do not have any family support. Taking care of such uncared-for patients requires a well-structured system providing medical, psychological, emotional, and rehabilitory support. The first ever rehabilitation ward among government hospitals in Tamil Nadu was created at Rajiv Gandhi Government General Hospital (RGGGH), Chennai with the motto of "Caring for the uncared for." This paper highlights the organizational structure, functionality, profile of patients admitted, challenges faced, and the outcome of patients admitted in the rehabilitation ward., Methods: A retrospective study was done on the "untended" patients, who were admitted in the rehabilitation ward at Rajiv Gandhi Government General Hospital (RGGGH), Chennai, Tamil Nadu, India from December 2020 to June 2022. Sociodemographic and clinical characteristics and outcome of the patients were analyzed., Results: A total of 201 adults with physical disabilities or mixed physical and psychiatric disabilities were admitted for intensive rehabilitation. Common medical illnesses included orthopedic disorders in 80 (39.8%), followed by neurological illness in 43 (21.4%) patients. The median length of stay was 50 (24.5-103.5) days with longest stay of 447 days. Of those patients who recovered, 54 patients (26.9%) reunited with family and returned home and 125 (62.2%) patients were sent to old age homes/asylums., Conclusion: A dedicated ward for untended patients is the first of its kind in the state of Tamil Nadu, India. Such a venture has proved to be of benefit, considering the positive outcome in a significant proportion of the beneficiaries.

Background: We report pediatric PAKT patient and graft outcomes at a large tropical tertiary center spanning two transplant eras., Methods: In this retrospective cohort study, all children ≤18 years who underwent kidney transplantation at our center between 1991 and 2016 were included. Data pertaining to their baseline characteristics, post-transplant events, and outcome were retrieved from transplant records and compared between transplant eras (1991-2005 and 2006-2016)., Results: A total of 139 children (mean age 15.2 ± 2.9 years) underwent PAKT during this period. The incidence of UTIs, CMV disease, BKVN, invasive fungal infections, new-onset diabetes after transplant, leucopenia, and recurrent NKD was higher in the 2006-2016 era (P < .001 for all), while 1-year cumulative BPAR was comparable (P = .100). Five-year graft and patient survival in the two eras were 89.9% and 94.2% (P = .365) and 92.1% and 95.3% (P = .739), respectively. Incidence of CMV disease, BKVN, graft loss, and death was lower in the calcineurin withdrawal group. Non-adherence accounted for 36% of graft loss; infections caused 43.7% of deaths. On multivariate Cox proportional hazards analysis, independent predictors for graft loss were UTIs and blood transfusion naïve status and for death were serious infections and glomerular NKD., Conclusions: PAKT in India has excellent long-term graft outcomes, though patient outcomes remain suboptimal owing to a high burden of infections. Current immunosuppression protocols need to be re-examined to balance infection risk, graft, and patient survival., (© 2021 Wiley Periodicals LLC.)

Juvenile crime or delinquency has been increasing at an alarming rate in recent times. In many countries, including India, the minimum age for criminal responsibility is 16 years. The present study aimed to estimate the probability of a south Indian adolescent either being or being older than the legally relevant age of 16 years using Demirjian's tooth formation stages. Orthopantomograms (OPG) of 640 south Indian adolescents (320 boys and 320 girls) aged between 12 and 20 years were retrospectively analyzed. In each OPG, Demirjian's formation stage of the mandibular left third molar was recorded and the data was subjected to statistical analysis. Descriptive and Pearsons correlation statistics were performed. The empirical probabilities were provided relative to the medico-legal question of predicting 16 years of age. The distribution of age throughout the 10th, 25th, 50th, 75th and 90th percentile follows a logical distribution pattern horizontally and vertically. Pearson's correlation statistics showed a strong positive correlation between the Demirjian's stages and age for both sexes. Therefore, it can be concluded that stage "F" can be used to predict the attainment of age equal to or older than 16 years with a probability of 93.9% for boys and 96.6% for girls.

Objective: Non-small cell lung carcinomas often present at an advanced stage with a grim prognosis. Immune checkpoint (ICP) inhibitors have drastically changed the scenario, and the response to ICP inhibitors is determined by analyzing the expression of PD-L1 by immunohistochemistry. PD-L1 immunohistochemistry helps in optimizing the treatment, and avoiding unnecessary exposure of patients to the toxic effects of the drugs that are ineffective and expensive in non-expressing tumors. This study was conducted to assess the prevalence of the expression of PD-L1 in non-small cell carcinomas of the lung diagnosed at our institution, which is a tertiary care center in South India., Material and Method: The PD-L1 immunohistochemistry of 77 cases of non-small cell carcinomas of the lung diagnosed over a period of two years were reviewed and analyzed (2018-2020). All tissues were fixed in 10% neutral buffered formalin and processed by standard methods, and the Ventana SP263 clone was used., Results: Seventy-seven cases of non-small cell lung carcinomas were reviewed and studied for (PD-L1) expression. 35/77 (45%) of the cases had PD-L1 expression (≥ 1%) and 14 (18 %) had high (PD-L1) expression. Also there was a male preponderance of 2.3:1. High PD-L1 expression was seen mostly in patients above 60 years of age and was usually associated with high tumor grade., Conclusion: It is important to assess PD-L1 expression in non-small cell carcinomas of patients especially with higher tumor grade and older age groups that they may benefit from immune checkpoint inhibitor therapy.

Traditionally, sensitizing events such as previous pregnancies, previous transfusions and prior transplants result in the production of anti-Human Leukocyte Antigen (HLA) antibodies. However, it has been observed that, anti-HLA antibodies have been detected in many patients with no prior history of sensitizing events. This retrospective study analysed the most recent 100 consecutive Single Antigen Bead (SAB) assay results performed on 100 patients. The SAB assay is used routinely to detect anti-HLA antibodies in transplant recipients. Results of the SAB assay were analyzed and subsequently studied to see if a correlation existed between sensitizing events, the type of events and presence of antibody. Analysis showed that 77% (77/100) had anti-HLA antibodies. 61 out of 100 patients had prior sensitizing events while the remaining 39 had none. Both these groups showed an almost equal percent of patients with anti-HLA antibodies 77% (47/61) and 76.9% (30/39) respectively. A single sensitizing event was seen in 54.1% (33/61) patients including previous transfusions in 29.5% (18/61), pregnancies in 11.4% (7/61) and prior transplant in 13.1% (8/61). Our study suggests that irrespective of whether patients have prior sensitizing events or not, patients run the risks of alloimmunization, and therefore appropriate screening tests should be included in the pre-transplant compatibility algorithm., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

In the present study, the prevalence of Anaplasma species in diary animals from India and World was estimated using meta-analysis. Based on systematic review of studies on Anaplasma species from India [35] and World [66] from 1988 to 2017 and 1978-2017, respectively, using online databases and offline literatures, meta-analysis using meta package in R-Software was done. Prevalence of Anaplasma species in India and World were 11% [95% level, Confidence Interval[CI] 7-16%, Prediction Interval[PI] 1-69%] and 39% [95% level, CI 30-49%, PI 2-95%], and these were obtained using 31,117 and 46,365 samples, respectively. Period-wise analysis revealed high Anaplasma species prevalence before 2011 for India and the World than from 2011 through 2017. Zone-wise prevalence indicated high prevalence in Central zone [61%] and low in West and South zones [6%] in India, and continent-wise, it was high in South America [82%]. The studies used methods including blood smear examination, serology and nucleic acid-based techniques and revealed high prevalence in serology for India [34%] and World [46%], low prevalence by blood smear for India [7%] and World [21%], but higher sensitivity using nucleic acid-based techniques. Species-wise indicated higher prevalence in cattle [12%] than buffaloes [2%] in India. Prevalence was lower in India compared to the World and higher in South America. Overall, anaplasmosis causes low productivity in dairy animals and economic loss to dairy farmers. Hence, there is a need to control Anaplasma infections in high risk areas by adopting effective therapeutic and preventive measures so as to improve the economic benefits in dairy farming., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To estimate the incidence of fetal inflammatory response syndrome (FIRS) in preterm neonates and correlate it with immediate and one-year neurodevelopmental outcome., Materials and Methods: This prospective observational analytical study, in preterm neonates with gestational age between 26 and 34 weeks was conducted from May 2014 to December 2015 in a tertiary care hospital in South India. FIRS was defined as the presence of either elevated levels of interleukin-6 (IL-6) in cord blood ≥11 pg/ml and/or the placental histopathology showing evidence of fetal inflammatory response. One hundred and twenty neonates were recruited. During delivery 2 ml cord blood for interleukin-6 and placenta were collected and stored appropriately. Based on presence/absence of FIRS (IL-6 in cord blood ≥11 pg/ml and or features of placental fetal inflammation), neonates were grouped into two groups. The neonatal and maternal characteristics between two groups were compared. The short-term outcome parameters during NICU stay and neurodevelopmental outcome at one year of corrected age was compared between groups., Results: Among the 120 infants studied, 19 expired. Out of 101 babies discharged, 87 were followed up till corrected 1 year of age. On examination of placenta and cord blood, 50 neonates had evidence of FIRS (41.6%). So there were 50 neonates in FIRS and 70 in NO-FIRS group. The mean gestational age, birth weight, and gender distribution were comparable between the two groups. Mortality [OR: 2.44 (CI: 1.14-5.26)] and early hypotension [OR: 2.13 (CI: 1.1-4.2)] were significantly higher in the FIRS group. The neurodevelopmental assessment at corrected age of 1 year showed that infants with FIRS had lower mean motor developmental quotient by developmental assessment scale for Indian infants (DASII) [87.6 ± 9.15 versus 93.07 ± 9.3, p < .04]., Conclusions: FIRS has a significant role on survival and neurodevelopmental outcome of preterm infants.

Purpose: Leptospirosis is a re-emerging infectious disease that has been reported from all over the world, including South India. Several studies have documented the prevalence of Leptospira in the general population. However, the data on leptospirosis in children were limited. We evaluated the prevalence of antileptospiral antibodies and the distribution of Leptospira serovars in children and adolescents., Methodology: In this retrospective study, details for a total of 5407 children who presented with fever and whose test results for antileptospiral antibodies available were recorded. A microscopic agglutination test (MAT) was performed to detect the presence of anti-leptospiral antibodies and a titre of more than 1 : 80 was considered positive. The antigen panel included the following six serovars: Icterohaemorrhagiae, Canicola, Autumnalis, Australis, Grippotyphosa and Patoc. Demographics such as age and gender were recorded., Results: An overall seropositivity rate of 30.8 % (95 % CI: 21.54-25.81) was observed. More male children (59 %) were infected than female children (41 %). Leptospirosis occurs throughout the year among children. Cases peak in the summer time and during the months of November and December. The most prevalent serovar in this study was L. Canicola followed by L. Australis and L. Autumnalis., Conclusion: This seroprevalence study suggested that leptospirosis occurs among children throughout the year in Chennai, India. This makes it almost mandatory to include it in the differential diagnosis for febrile illnesses in children. Early detection and treatment, together with control measures, may significantly reduce the spread of this endemic pathogen in this city.

Pregnancy offers a precious window of opportunity to diagnose previously undetected or new onset kidney diseases in emerging countries like India, where access to medical, educational and health care facilities are not equitably distributed across varied sections of society. We report a case of a 33 year-old primi gravida who had a successful pregnancy following what was initially considered to represent preeclampsia at 38 weeks of gestation, in whom a subsequent kidney biopsy for persistence of pregnancy-related acute kidney injury (Pr-AKI) revealed light chain deposition disease (LCDD). The etiological evaluation of LCDD led to the detection of an underlying plasma cell dyscrasia which was treated effectively with chemotherapy and autologous stem cell transplant. In this report, we explore the hitherto uncharted pathophysiological relationship between LCDD and pregnancy-related kidney injury by transmission electron microscopic (TEM) studies of endothelial injury in this setting, and underscore the benefits of medical care in a multidisciplinary environment which yielded gratifying results in preservation of maternal kidney health and fetal outcome.

Hepatitis C virus (HCV) infection in kidney transplantation is an important issue with effects on patient and graft survival. The current standard of care involves using oral Direct Acting Antiviral drugs. Till recently, pre-transplant treatment with interferon was the only option for treatment. We studied 677 consecutive kidney transplant recipients with HCV infection. 5.2% patients had evidence of HCV infection. 2.0% were newly detected to have HCV infection after transplant (de novo HCV group). Nearly 28.6% had negative antibody tests but positive Nucleic Acid Test at the time of diagnosis. Eighty-five percent of pre-transplant HCV-positive patients were treated with interferon-based regimens. Early virologic response was seen in 66.6%. End of treatment response was achieved by 94.1%. Sustained virologic response was seen in 81.2%. Overall, patient and graft survival were not different between HCV and control groups (log-rank P = 0.154). Comparing HCV and control groups, there was a tendency toward increased fungal (11.4% vs. 5.6%, P = 0.144) and CMV infections (25.7% vs. 17.1%, P = 0.191) in the HCV group, though it did not reach statistical significance. Eighty-percent of the interferon-treated patients suffered side effects. On comparing, the pre-transplant HCV-positive group (85% treated) with the de novo HCV group (none treated), the de novo group had significantly reduced patient survival (P = 0.020) and NODAT (35.7 vs 4.8%, P = 0.028), and a tendency toward higher CMV infections (35.7% vs 19%, P = 0.432). In addition, death and hepatic complications (decompensated liver disease, fibrosing cholestatic hepatitis) occurred only in de novo HCV group. These results highlight the need for continued post-transplant treatment of HCV positive patients. The newer anti-HCV drugs are expected to fulfill this felt-need in kidney transplantation but long-term results are awaited. This study can serve as a benchmark for future studies to compare the long-term effect of Direct Acting Antiviral drugs., Competing Interests: None declared.

The majority of maternal health interventions in India focus on increasing institutional deliveries to reduce maternal mortality, typically by incentivising village health workers to register births and making conditional cash transfers to mothers for hospital births. Based on over 15 months of ethnographically informed fieldwork conducted between 2015 and 2017 in rural Assam, the Indian state with the highest recorded rate of maternal deaths, we find that while there has been an expansion in institutional deliveries, the experience of childbirth in government facilities is characterised by obstetric violence. Poor and indigenous women who disproportionately use state facilities report both tangible and symbolic violence including iatrogenic procedures such as episiotomies, in some instances done without anaesthesia, improper pelvic examinations, beating and verbal abuse during labour, with sometimes the shouting directed at accompanying relatives. While the expansion of institutional deliveries and access to emergency obstetric care is likely to reduce maternal mortality, in the absence of humane care during labour, institutional deliveries will continue to be characterised by the paradox of "safe" births (defined as simply reducing maternal deaths) and the deployment of violent practices during labour, underscoring the unequal and complex relationship between the bodies of the poor and reproductive governance.

Background: Healthcare-associated infection rates are higher in low- and middle-income countries compared with high-income countries, resulting in relatively larger incidence of patient mortality and disability and additional healthcare costs., Objective: To use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries., Methods: Six international sites located in Argentina, Greece, Hungary, India, Nepal, and South Africa provided information on the health facility and the surgical modules relating to IC programs, surgical antibiotic use and surgical equipment procedures, surgical area practices, sterilization and disinfection of equipment and intravenous fluid, and hand hygiene. Modules were scored for each country., Results: The 6 international sites completed 5 modules. Of 121 completed sections, scores of less than 50% of the recommended IC practices were received in 23 (19%) and scores from 50% to 75% were received in 43 (36%). IC programs had various limitations in many sites and surveillance of healthcare-associated infections was not consistently performed. Lack of administration of perioperative antibiotics, inadequate sterilization and disinfection of equipment, and paucity of hand hygiene were found even in a high-income country. There was also a lack of clearly written defined policies and procedures across many facilities., Conclusions: Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.

Objective: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in malnutrition treatment centres (MTC)., Design: Early detection and treatment of SAM using locally adapted protocols; assessment of programme outcomes, including survival, default, discharge and recovery rates., Setting: All forty-eight MTC in Jharkhand, India., Subjects: Children (n 3595) with SAM admitted to MTC (1 July 2009-30 June 2011)., Results: Of children admitted, 55·0% were girls, 77·7% were 6-23 months old and 68·6% belonged to scheduled tribes or castes; 34·4% had oedema or medical complications. Of the 3418 programme exits, the proportion of children who died was 0·6% (n 20), the proportion of children who defaulted was 18·4% (n 628) and the proportion of children discharged was 81·0% (n 2770). Children's average weight gain was 9·6 (sd 8·4) g/kg body weight per d and their average length of stay was 16·0 (sd 5·7) d. Among the 2770 children who were discharged from the programme, 39·4% (n 1090) gained 15 % or more of their initial weight while 60·6% (n 1680) gained less than 15 % of their initial weight., Conclusions: MTC provide live-saving care for children with SAM as demonstrated by high survival rates. However, the protocols and therapeutic foods currently used need to improve to ensure the recovery of all discharged children. MTC should be reserved for children with complicated SAM; children with uncomplicated SAM should be admitted to a community-based programme for the management of SAM, at a lesser risk to children and a lesser cost to families and the health system.

Introduction: Bone marrow involvement by a non-haematological malignancy gives an opportunity to identify the lodgement, invasion of metastatic cells and the response of the host to the tumor cells. The study was undertaken to assess the involvement of bone marrow with non-haematopoietic malignancies and its significance in establishing primary diagnosis in clinically unsuspected cases., Materials and Methods: This was a descriptive study which included record review of the departmental archives for the last five years (January 2007 to December 2011). Eighty four cases were studied; which included clinically diagnosed non-haematological malignancy for staging or symptomatic cytopenias/bony lesions (group 1, n = 63), clinically suspected bone marrow metastasis of unknown primary malignancy due to symptomatic cytopenias/bony lesions (group 2, n = 07) and clinically unsuspected malignancy with incidentally detected bone marrow metastasis (group 3, n = 14)., Results: Bone marrow metastases of solid tumors were identified in 23 cases (27.3%) which included 9 cases from group 1, 14 cases from group 3 and nil in group 2. Of the 14 cases in group 3, in 12 cases a definitive diagnosis could be made by correlating clinicoradiological findings with morphology and immunohistochemistry. The most common tumor in pediatric cases were neuroblastoma and Ewing's sarcoma (40%) and in adult's adenocarcinoma of gastrointestinal tract (30.7%) was the commonest., Conclusion: Bone marrow metastasis can masquerade as a primary haematopoietic disorder; however its detection has both therapeutic and prognostic significance. Immunohistochemistry is a useful adjunct to morphology in reaching a definitive diagnosis.

Aims: There are limited contemporary data on the presentation, management, and outcomes of acute coronary syndrome (ACS) admissions in India. We aimed to develop a prospective registry to address treatment and health systems gaps in the management of ACSs in Kerala, India., Methods and Results: We prospectively collected data on 25 748 consecutive ACS admissions from 2007 to 2009 in 125 hospitals in Kerala. We evaluated data on presentation, management, and in-hospital mortality and major adverse cardiovascular events (MACE). We created random-effects multivariate regression models to evaluate predictors of outcomes while accounting for confounders. Mean (SD) age at presentation was 60 (12) years and did not differ among ACS types [ST-segment myocardial infarction (STEMI) = 37%; non-STEMI = 31%; unstable angina = 32%]. In-hospital anti-platelet use was high (>90%). Thrombolytics were used in 41% of STEMI, 19% of non-STEMI, and 11% of unstable angina admissions. Percutaneous coronary intervention rates were marginally higher in STEMI admissions. Discharge medication rates were variable and generally suboptimal (<80%). In-hospital mortality and MACE rates were highest for STEMI (8.2 and 10.3%, respectively). After adjustment, STEMI diagnosis (vs. unstable angina) [odds ratio (OR) (95% confidence interval = 4.06 (2.36, 7.00)], symptom-to-door time >6 h [OR = 2.29 (1.73, 3.02)], and inappropriate use of thrombolysis [OR = 1.33 (0.92, 1.91)] were associated with higher risk of in-hospital mortality and door-to-needle time <30 min [OR = 0.44 (0.27, 0.72)] was associated with lower mortality. Similar trends were seen for risk of MACE., Conclusion: These data represent the largest ACS registry in India and demonstrate opportunities for improving ACS care.

Objective: To evaluate the serological profile of leptospirosis by microscopic agglutination test (MAT) and dark field microscopy (DFM) and to determine the serovar prevalence rate among patients with pyrexia of unknown origin., Materials and Methods: A total of 3830 blood samples were received from different hospitals and laboratories in and around Chennai. They were screened for leptospirosis by MAT and direct observation of live Leptospira by DFM., Results: A total of 748 (19.5%) Leptospira positive cases were identified; among these, 36.76% were Leptospira australis, 30% were Leptospira canicola, 14.57% were Leptospira autumnalis, 12% were Leptospira icterohaemorrhagiae, 4.68% were Leptospira patoc and 1.87% were Leptospira grippotyposa. Patients were in the age group of 1-86 years, with a median age of 43.5 years. 50% positive cases were in the age group of 10-35 years. Majority of the Leptospira infected cases were males (62.98%) than females (37.02%)., Conclusion: Leptospirosis occurs in Chennai throughout the year although the number and positivity of cases increased during the monsoon season.

Purpose: To report a case of Avellino corneal dystrophy (ACD) in a patient of Indian origin treated with femtosecond-assisted lamellar keratoplasty (FALK)., Methods: A 6-year-old male patient presented with severe photophobia with decreased vision for 2 months. A clinical diagnosis of Avellino dystrophy was made after complete examination under anesthesia and FALK was performed., Results: The postoperative period was uneventful with good symptomatic improvement and graft clarity. Histopathological study with special staining, namely Masson trichrome and Congo red stain, of the patient's corneal button showed features of both granular and lattice lesions suggestive of ACD. Genetic analysis showed absence of R124H mutation in BIGH3 gene. No recurrence or exacerbation was noted at 19-month follow-up., Conclusions: To our knowledge, this is the first case report of clinical, histopathological, microscopic features of ACD in young patient of Indian origin with absence of BIGH3 gene treated with FALK with IntraLase Femtosecond Laser for donor and recipient cuts.

Background: The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition., Objectives and Method: An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status., Results: Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages., Conclusions: Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.

Eighty-five women with epilepsy were followed up for reproductive functions under the registry of epilepsy and pregnancy. 32 of them had completed the pregnancy. Their mean age was 26 years and mean seizure frequency was 0.7 during current pregnancy. Nineteen of them (59.4%) had generalized epilepsy. Nine of them were not on any anti epileptic drugs (AED), 23 women were on various AEDs, 19 being on monotherapy. Only 40% of the women were taking folic acid during pregnancy. Pregnancy ended as spontaneous abortion in one patient. Nearly one third required cesarean section. Majority (87.5%) had term babies. Three (10.7%) babies had birth asphyxia. Six babies (21.4%) had low birth weight. Congenital malformations were detected in four cases (12.5%). Malformations included neural tube defects, talipes equinovarus and other minor anomalies. These babies were exposed to sodium valproate, carbamazepine or phenobarbitone. The risk of malformation was significantly greater (p<0.05) when the mother had generalized epilepsy. The odds ratio for risk of malformation was much higher with sodium valproate (6) than that with carbamazepine (1.2) or phenobarbitone (0.8). Majority of women with epilepsy had safe pregnancy and childbirth without any aggravation of epilepsy.

Malnutrition is a common problem in maintenance hemodialysis (MHD) patients, and compromised intake is an important cause. There is no information available about the nutrient intakes of MHD patients in India. The nutrient intakes of 106 MHD patients were studied cross-sectionally and on follow-up. A 24-hour recall was used on 4 consecutive days. After 2 months on dialysis, the mean energy intake was 29 +/- 6.6 kcal/kg ideal body weight (IBW) and the mean protein intake was.93 +/-.39 g/kg IBW (high biological value [HBV] protein 49% +/- 8.5%). Dietary deficiency of both protein and calories was present in 64.9%. Intake was better on nondialysis days compared with dialysis days, and in women and older patients. On follow-up there was no significant increase in food intake up to 6 months. After that, the total calorie intake increased significantly with a disproportionate drop in high biological value protein consumed and appeared to be derived predominantly from carbohydrate food (mean kcal/kg, 37 +/- 6.9; mean protein g/kg, 0.96 +/- 0.19; ratio of HBV protein to total protein consumed,.42 +/-.09). In summary this study showed suboptimal energy and protein intake in an MHD population. Intakes were further compromised on dialysis days, and with increasing time spent on dialysis, the quality of nutrient intake became poorer.

A rare case of a mediastinal enterogenic cyst with an intraspinal extension through a anterior vertebral defect presenting with paraplegia in a 10 year boy is presented. Laminectomy and the trans-thoracic excision of the cyst resulted in the complete recovery of the neural deficit.

Objective: To obtain birthweight standards for south Indian babies., Design: Prospective cohort study., Setting: A tertiary care hospital in south India., Patients and Methods: Data from 11, 641 singleton live births between 1991 and 1994 were used to calculate smoothed gestation specific birthweight centiles for four categories based on sex of the infant and birth order. Smoothed gestation specific birthweight centiles were also calculated for all births between 37-41 weeks without adjustments for sex of infant or birth order. Data for births between 37 and 41 weeks were reanalysed using non-adjusted birthweight centiles and birthweight centiles adjusted for sex and birth order to determine misclassification of data. Multiple regression analysis was used to determine the influence of various variables on birthweight., Results: Factors influencing birthweight were gestation at birth, sex of infant, birth order and maternal height. A quadratic equation including these variables and the square of the gestational age explained 18% of variation in birthweight. Female infants were on the average 113 g (95% CI 26-200 g) lighter than male infants. Later born babies were on the average 130 g (95% CI 40-220 g) heavier than first born babies. Therefore significant misclassification of infants occurred when non-adjusted birthweight centiles were used. Babies born to women whose heights were outside the interquartile range (150-158 cm) were 81 g lighter or heavier than those born to women within this range., Conclusions: Birthweight centiles for gestation when used should be adjusted for birth order, sex of infant and maternal height.

Primary malignant tumours of the body of the uterus are less common in India compared to carcinoma of the cervix. This study analyzed 86 primary malignant tumours of the body of the uterus over a 5 year period with regard to incidence of the various tumours, age group, gravidity, any predisposing factor, and the incidence of carcinoma of the cervix in the same period. Adeno-carcinomas were found to be the most common type of tumour. Tropho-blastic malignancies and mixed mullerian tumours also formed a significant number of cases. Compared to Western studies our patients with adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma and mixed mullerian tumour, were younger. Patients with adeno-carcinomas had a higher parity and patients with choriocarcinoma had a lower parity. Diabetes, hypertension and obesity were not as common as in the West. Carcinoma of the cervix was found to be commoner than primary malignant tumours of the body of the uterus.