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Objective: ESPRITE (Study 508; NCT03836924) evaluated the real‐world safety, tolerability, and efficacy of adjunctive perampanel in patients aged ≥12 years with focal‐onset seizures (FOS), with or without focal to bilateral tonic–clonic seizures (FBTCS), in India. Methods: ESPRITE was a prospective, multicenter, single‐arm, observational, Phase IV study with a 6‐month Treatment Period. Patients were aged ≥12 years and had been prescribed perampanel for adjunctive treatment of FOS, with or without FBTCS. Assessments included incidence of treatment‐emergent adverse events (TEAEs; primary endpoint), median percent reduction in seizure frequency per 28 days from baseline, 50% responder rates, and seizure‐freedom rates. Results: Overall, 200 patients were enrolled (199 patients in the Safety Analysis Set and 174 patients who completed all visits in the main efficacy analyses). TEAEs (all mild or moderate in severity) were reported in 18.1% (n = 36/199) of patients (the most common were dizziness [3.0%] and irritability [2.0%]). TEAEs leading to discontinuation of perampanel were reported in 2.0% of patients; no deaths or serious TEAEs occurred. At 6 months, median percent reduction in seizure frequency was 100.0%, 50% responder rate was 83.3%, and seizure‐freedom rate was 49.4%. Significance: Adjunctive perampanel (at a mean daily dose of 4 mg/day) was shown to be well tolerated and effective in patients aged ≥12 years with FOS, with or without FBTCS, from India. Plain Language Summary: Many patients do not receive adequate treatment for epilepsy and need effective seizure control medications. In this 6‐month clinical study, 199 patients from India, aged 12 years or older, added perampanel to the anti‐seizure medications they were already taking. At 6 months, 49% of patients experienced no seizures since starting perampanel and seizure frequency was reduced by half in 83% of patients. Side effects occurred in 18% of patients (most commonly dizziness and irritability) and caused 2% to stop perampanel; no deaths were reported. Perampanel was an effective and generally safe added medication for patients with epilepsy from India. [ABSTRACT FROM AUTHOR]

The study investigates the impact of digital banking usage on women's economic empowerment (WEE) from a developing country stance by considering working women in formal sectors. WEE simply means providing opportunities to women to facilitate their economic decision-making. This study employed a descriptive, exploratory, and causal research design. A total of 286 responses from women working in the formal sector of Delhi-NCR were collected through self-administered questionnaires on a 5-point Likert scale using non-probability quota sampling technique. The sample was controlled for the employment sector, that is, healthcare, education, and Information Technology (IT). Partial least square structural equation modelling methodology (PLS SEM) was employed to examine the relationship between the constructs. The results show that among the different determinants of WEE, digital banking usage was the strongest influencer followed by financial literacy and workplace human resource policies. Research findings indicate that, if WEE initiatives are to reach their full potential, they must individually address the context-specific influencing factors. This study offers a new framework for understanding and enhancing WEE for urban working women in India. [ABSTRACT FROM AUTHOR]

Filariasis, an affliction caused by thread-like filarial worms, poses a formidable health challenge in India, with diverse regional endemicities. It manifests in two distinct forms: lymphatic and extralymphatic. The former induces agonising limb swelling, while the latter, often overlooked due to its atypical presentation, can affect various organs. Here we, present a noteworthy case involving a 25-year-old woman who succumbed to septic shock, displaying Multiple Organ Dysfunction Syndrome (MODS). The patient exhibited bicytopaenia, leukocytosis, and progressively deteriorating liver and kidney functions, culminating in Acute Respiratory Distress Syndrome (ARDS). Postmortem examinations, conducted with proper consent, revealed sheathed microfilaria in liver and bone marrow tissues. This rare multisystem involvement in filariasis, leading to a fulminant course, raises questions about potential immunosuppression triggered by disseminated filarial dissemination. The hypothesis centres on the notion that the systemic spread of filaria might underlie the severe and rapid deterioration observed in this unique case, shedding light on the intricate dynamics of this parasitic disease and its implications for immune function. [ABSTRACT FROM AUTHOR]

Background: Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case-control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM.Methods: Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls.Results: CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls.Conclusions: Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Sudden surge of mucormycosis cases in India needs an urgent attention as multiple factors have been implicated. However, diabetes mellitus remains to be one of the most important and modifiable factors. Methodology: We prospectively followed 11 patients with mucormycosis in May 2021 and June 2021, admitted to our hospital to study the possible etiologies. Results: Out of the 11 patients, six were males and five were females, with an average age of 52.45 years. Type 2 diabetes mellitus was the ubiquitous comorbidity, and every patient presented with uncontrolled hyperglycemia (six out of them were in diabetic ketoacidosis). Glycated hemoglobin levels ranged from 10.2% to 15.1%. Out of 11 patients, four patients were non-COVID, whereas five patients had a history of COVID-19 infection. All these five post COVID-19 patients presented approximately 20 days after recovery, out of which one patient had severe infection who was hospitalized. The remaining two patients were COVID-19-positive. Out of 11 patients, 10 patients had rhino-orbital mucormycosis at presentation, among which four patients had cerebral involvement, and one out of them later developed invasive disease. However, one patient had only pulmonary mucormycosis at presentation. Serum ferritin was raised in all the patients, and six had serum zinc levels below the reference range. Serum flow cytometry showed leukopenia with normal CD4:CD8 ratio in seven patients. In the clinical outcome, six patients expired, whereas five patients responded to the treatment and were discharged on oral posaconazole therapy. Conclusion: From our study, it is quite evident that uncontrolled diabetes and its complications such as diabetic ketoacidosis were an important risk factor for the occurrence of mucormycosis in COVID-19 patients as well as non-COVID-19 patients, even without exposure to steroids or oxygen. Thus, blood glucose levels should be kept at optimum level during the management of COVID-19 patients. [ABSTRACT FROM AUTHOR]

This article gives an overview of consensus statements reached for twelve difficult clinical scenarios discussed at Indian perspective of St. Gallen consensus for customizing local and systemic therapies for breast cancer patients. Pathological states in which breast cancer patients should/should not undergo chemotherapy were analysed. It was agreed upon that post-operative radiation is associated with decreased recurrence rates across all subgroups of DCIS and was found to have a survival benefit too. Surgeons recommended re-sentinel procedures instead of complete axillary dissection in women with ipsilateral breast recurrence and negative nodes on imaging after previous treatment with breast conserving surgery and sentinel node mapping. Radiation oncologists established that hypofractionation is a safe and effective radiation technique for breast cancer. Indian experts advised against the addition of carboplatin to standard "dose-dense AC and paclitaxel" or other cyclophosphamide-/anthracycline-/taxane-type regimen and recommended the usage of anthracyclines in a case of HER2-positive node-negative breast cancer receiving taxane-based chemotherapy and anti-HER2 antibodies. They supported adjuvant chemotherapy after neoadjuvant endocrine therapy if there was any evidence of any residual lymph nodal involvement or residual breast lump > 5 cm. Indian oncologists favoured that de novo oligometastatic disease with single bone-only metastases should be treated with curative intent. In patients with more sites of metastatic cancer, such as three or more bone lesions, experts were split between curative and palliative intents. [ABSTRACT FROM AUTHOR]

Background & objectives: Early diagnosis and prompt treatment remain a challenge in sepsis. To study the role of quick Sequential Organ Failure Assessment (qSOFA), blood lactate levels and a new score Lactate - Enhanced-qSOFA 2 (LqSOFA2) in predicting outcome in patients with sepsis and their association with established severity scores. Methods: This was a prospective, observational study in patients admitted to ICU of a tertiary care hospital in north India. qSOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), SOFA score and LqSOFA2 were calculated in 150 patients with sepsis. Measurements of lactate and SOFA score was done on days one, three and seven. Results: The mean arterial pressure (MAP) was significantly higher in survivors (70.14±19.54 vs. 48.53±26.86). The mean qSOFA significantly predicted mortality (1.81 vs. 2.63; P<0.0001). The mean lactate on days one, three and seven in survivors were 2.27±0.91, 1.72±0.77 and 1.14±0.48, respectively, while it was 4.32±2.35, 3.57±2.28 and 2.13±1.22, respectively, in the non-survivor group (P<0.001). The new score LqSOFA2 also significantly predicted mortality between non survivors and survivors (3.52±0.71 vs. 2.37±0.91). There was a significant correlation of qSOFA with SOFA and APACHE II on day one. Lactate levels and SOFA correlated on all three days. Interpretation & conclusions: qSOFA, a novel score and lactate can independently predict mortality in patients with sepsis. They correlate with APACHE II and SOFA but fail to equilibrate with either. The combination score LqSOFA2 showed marginal (statistically insignificant) increase in predictive accuracy and specificity when compared to lactate or qSOFA alone. Early diagnosis by LqSOFA2 makes it a good standalone bedside prognostic marker. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) not only increases risk of mortality, but it also increases the risk of impaired motor, cognitive, and psychosocial development. Across the globe, 43% of all children younger than five years of age are at risk of not achieving their developmental potential. The World Health Organization management guidelines for SAM has included the integration of early childhood development (ECD) directed sensory and psychosocial stimulation and structured play therapy in the medico-nutritional care process. Despite this, management still largely focuses on nutrition rehabilitation, while these interventions take a backseat. Most countries are moving towards home-based management of uncomplicated SAM children. Hence, it is equally important to have a strong ECD component in the community-based management programs. Strengthening the support of sensory and psychosocial stimulation and structured play support in both facility and community-based care of SAM children will not only help them to survive, but also thrive and transform. With this background, we briefly describe the experiences of a pilot study aiming at strengthening of these interventions support in 10 nutritional rehabilitation centers across India. [ABSTRACT FROM AUTHOR]

BACKGROUND: Self-reported food allergy is very common in asthmatics and hence these food items are frequently avoided by the patients. Food allergy is defined as an adverse immunological response to a dietary protein. Skin prick test (SPT) is a sensitive tool for identifying the presence of specific immunoglobulin E antibodies that can be associated with acute allergic reactions. However, sensitization often exists without clinical consequences, and at the same time, self-reported food allergens are frequently negative on SPT. The purpose of our study was to assess the clinical relevance of self-reported food allergy and the role of SPT in identifying food allergies in patients with bronchial asthma. METHODOLOGY: One hundred bronchial asthma patients were screened for this study, and skin prick testing for 22 food allergens frequently consumed in India, particularly Northern India was performed. RESULTS: A total of 36 subjects reported perceiving precipitation or an increase in severity of the asthmatic symptoms by one or more food items, and the most common food items mentioned in history were curd in 24%, rice in 19%, citrus fruits such as lemon in 14%, orange in 14%, banana in 8%, cold drinks in 16%, and ice creams in 16%. There were 68 patients negative for food allergens by SPT (food allergen negative [FAN] group) and 32 patients were positive (Food allergen Positive [FAP] group). Out of 36 asthmatics with self-reported food allergy, none was found to be SPT positive to the reported food allergens. However, 50% of patients with self-reported and only 21.9% with no history of food allergy were positive to one or more food allergens. Further, FAP group patients were tolerating these foods without any trouble or exacerbation of symptoms. Among the FAP group, 96.9% of patients had positive SPT for one or more other allergens also such as insects, pollens, fungi, or other aeroallergens. Only one patient had isolated food allergy by SPT. It implies that isolated food allergy is very rare in asthmatic patients. Common food allergens found positive by SPT were black gram in 12%, followed by red gram 9% and bengal gram, rice, and Baker's yeast 7% each. CONCLUSION: We concluded that the prevalence of food allergy in India among asthmatic adults though high, has a very poor correlation between patient's history of food allergens that is perceived as a precipitating or exaggerating factor for symptoms and actual sensitization as elicited by SPT. At the same time, there is high nonspecific food sensitization in self-reported patients as compared to those with no history of any perceived food allergy. [ABSTRACT FROM AUTHOR]

Familial amyloid polyneuropathy (PN), also known as amyloid transthyretin (TTR)-PN is an autosomal dominant adult-onset fatal disease, if not treated. It occurs due to mutations in (TTR) gene which leads to a faulty TTR protein which folds up to form amyloid and gets deposited mainly on nerves and causes length-dependent PN and autonomic dysfunction. We report a case of a 45-year-old female who presented with symptoms of painful peripheral neuropathy for 5 months, a history of deafness for 5 years, and cardiac pacemaker implantation 2 years ago for complete heart block. She denied any symptoms of autonomic dysfunction. Her brother with similar symptoms died of cardiac arrest at the age of 50 years. Clinical examination was suggestive of symmetrical sensorimotor PN. The nerve conduction study was suggestive of axonal sensorimotor PN. Abdominal fat biopsy was negative for amyloid. Sural nerve biopsy was suggestive of amyloid neuropathy. Genetic analysis showed c. 165G > T mutation encoding amino acid p. Lys55Asn on exon-4 of TTR gene. This mutation has not been reported from India. [ABSTRACT FROM AUTHOR]

Chikungunya is a common tropical viral infection in India. The majority of patients have limited systemic manifestations. Neurological manifestations of chikungunya may be due to direct viral infection or immune mediated. We present a case of a 45-year-old male who presented with acute onset paraplegia with diminution of vision in the right eye. A detailed evaluation revealed a diagnosis of chikungunya myeloradiculitis with viral keratitis. The patient was treated with steroids followed by intravenous immunoglobulin and had a good recovery. [ABSTRACT FROM AUTHOR]

Objectives: Prevalence of under-nutrition is very high in India. Under-nutrition is a result of interplay between different immediate, underlying, and basic causes. The study was conducted with the objective to identify significant predictors of stunting, wasting, and underweight. Methods: Cross-sectional studies with 2299 children from five high-burden pockets of four Indian states were conducted. Primary data on their anthropometric measurements along with their households' demographic and socioeconomic characteristics were collected. Binary logistic regression analyses were performed to examine the predictors of stunting, wasting, and underweight. Results: Results show very high prevalence of stunting, wasting, and underweight in all five regions covered in the study. Multivariate analyses show that food security, use of toilets, and low body mass index status of mothers were the major predictors of stunting and underweight among children. Acute respiratory infection disease was the major predictor of underweight and diarrhea was the major predictor of stunting. Younger children (<24 months) had lower odds of underweight and stunting compared to older children (24-59 months). The analyses showed higher odds of wasting among male children. Regional variations were also seen in the study with higher odds of underweight and wasting in Khuntpani block and higher odds of stunting in Naraini block. Conclusion: The above findings indicate that for comprehensively addressing child under-nutrition, it is very important to address maternal nutrition, improve food security, and reduce poverty status, provide better water and sanitation facility to the community, control infections, and address regional disparity. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a chronic neurological disease which often leads to disability. The complex etiology and progressive nature pose challenges in the management of patients with MS, particularly in developing countries like India. Lack of data on prevalence further complicates estimation of the magnitude of MS in India. There are various other challenges associated with management of patients with MS due to which the therapy is utilized by only a small segment of population in India. This article encapsulates the gaps and challenges in the management of patients with MS and presents suggestions and recommendations of the members of advisory boards held to discuss these challenges. The advisory board members suggested that an early diagnosis of MS and an early initiation of treatment are essential to achieve better results for tackling MS-related challenges. In addition, awareness and education about MS among people, regular training to physicians, emphasis on the use of revised 2010 McDonald criteria, and utilization of advanced diagnostic modalities in magnetic resonance imaging would help to achieve desirable as well as effective therapeutic outcomes. Further, access to an easy-to-use therapy delivery system could also be beneficial in attaining an adequate treatment adherence and related health benefits. [ABSTRACT FROM AUTHOR]

Limited access to tertiary-level health care, limited trained pediatric nephrologists and transplant physicians, lack of facilities for dialysis, lack of an effective deceased donor program, non-affordability, and non-adherence to immunosuppressant drugs poses a major challenge to universal availability of pediatric transplantation in developing countries. We present the results of a survey which, to the best of our knowledge, is the first such published attempt at understanding the current state of pediatric renal transplantation in India. A designed questionnaire formulated by a group of pediatric nephrologists with the aim of understanding the current practice of pediatric renal transplantation was circulated to all adult and pediatric nephrologists of the country. Of 26 adult nephrologists who responded, 16 (61.5%) were involved in pediatric transplantation, and 10 of 15 (66.6%) pediatric nephrologists were involved in pediatric transplantation. Most of the centers doing transplants were private/trust institution with only three government institutions undertaking it. Induction therapy was varied among pediatric and adult nephrologists. There were only a few centers (n=5) in the country routinely doing >5 transplants per year. Preemptive transplants and protocol biopsies were a rarity. The results demonstrate lower incidence of undertaking pediatric transplants in children below 6 years, paucity of active cadaveric programs and lack of availability of trained pediatric nephrologists and staff. In contrast to these dissimilarities, the immunosuppressant use seems to be quite similar to Western registry data with majority favoring induction agent and triple immunosuppressant (steroid, mycophenolate mofetil and tacrolimus) for maintenance. The survey also identifies major concerns in availability of this service to all regions of India as well as to all economic segments. [ABSTRACT FROM AUTHOR]

Background. Colour vision of candidates is tested in many medical colleges in India at the time of admission to undergraduate courses; however, there are no guidelines, and therefore no counselling, on how students with congenital colour vision deficiency (CCVD) should negotiate the medical course, and how best they can practise safely after graduation. Problems in interpreting coloured signs may lead to misdiagnosis. This study aimed to explore difficulties during clinical work that requires colour discrimination, and to offer suggestions on safe practice based on the findings and a review of the literature. Methods. We did a cross-sectional study after obtaining institutional ethical clearance and written informed consent. Thirty volunteer medical students with CCVD (>3 errors on Ishihara chart) were matched with 30 volunteers from their own batch who made no errors. All participants interpreted colour-dependent clinical and laboratory photographs. Results. Students with CCVD made more errors (range 5-26; mean [SD] 13.17 [5.873] out of 75 items in 35 colour-dependent photographs) than colour-normal students (range 2-13; mean [SD] 5.53 [3.037], p<0.001). The nature of the errors suggested that medical students with CCVD could have problems in learning histology, pathology, haematology, microbiology, dermatology, paediatrics, medicine, biochemistry and during ophthalmoscopy. Conclusions. Screening at the time of admission will make students aware of their CCVD status and, through conscious practice thereafter, they may understand their limitations. Faculty could guide and prepare such students for safe practice. [ABSTRACT FROM AUTHOR]

The article discusses the findings of study which investigated the clinical profile of functional gastrointestinal disorders in a tertiary care center in Delhi, India.

Objective: Globally more than 1/3rd of the child deaths are attributed to under nutrition and it continues to be a major public health problem in developing countries. This research paper is an attempt towards intervention and management of severely malnourished children with the use of locally prepared therapeutic diets to bring down the case fatality rate.Methods: A cross-sectional longitudinal study was undertaken at a tertiary care hospital in North India. Children under 5 y of age fulfilling the WHO case definition of severe acute malnutrition and suffering from medical complications were enrolled and managed on standard WHO protocols using locally prepared therapeutic diet (Starter F-75 diet and Catch-up F-100 diet).Results: During the period of 11 mo, a total of 315 children (192 boys and 123 girls) under 5 y with severe acute malnutrition requiring in-patient care were enrolled and evaluated. The overall case fatality rate was 3.5% while average weight gain seen was 9.33 ± 8.28 g/kg body weight/day and average length of stay was 11.71 ± 7.59. The Nutrition Rehabilitation Centre (NRC) observed a cure rate of 47% and secondary failure rate of 19%.Conclusions: The present study highlights the integral role of locally prepared therapeutic diet (starter F-75 and F-100) besides standardized care provided at Nutrition Rehabilitation Centre (NRC) to combat malnutrition which is a major scourge in the developing world. To sustain the benefits and prevent relapse, there is a need to integrate the services at NRC with the community-based therapeutic care to deliver continuum of care from facility to door step and vice versa. [ABSTRACT FROM AUTHOR]

Background: Behcet's disease (BD) is a chronic, recurrent, multi-system inflammatory disorder involving mucocutaneous (MC), ocular, intestinal, articular, vascular, urogenital and neurologic systems. BD occurs with a high prevalence in the Mediterranean population. There is scarcity of clinical data on BD from India with only three case series in the last two decades. Aims: To study demographic profile, clinical manifestations and treatment outcome of patients with BD presenting to the dermatologic clinic in a tertiary hospital in north India. Methods: Prospective analysis of all patients diagnosed to have BD between 1997 to 2011. Result: Twenty nine patients were diagnosed to have BD. The disease had a female preponderance (M:F = 1:3.8) with a mean age of disease onset of 27.4 (range 16-61) years. The prevalence of various MC and systemic manifestations are as follows: oral aphthae (100%), genital aphthae (93.1%), erythema nodosum (62%), papulopustular and acneiform lesions (31%), articular involvement (68.9%), ocular involvement (31%) and gastrointestinal (GI) involvement (3.4%) . Pathergy test positivity was observed in 31%. The treatment comprised of colchicine (16/29 patients), dapsone (7/29), dapsone with pentoxiphylline (3/29), systemic steroid (2/29), systemic steroid with methotrexate (1/29). Colchicine was effective and well tolerated in all patients. Conclusion: The disease occurs in a much milder form in India and is primarily mucocutaneous and arthritic. A high index of suspicion in patients with MC lesions may result in early diagnosis, management and prevention of complications of BD. We suggest colchicine as an effective and safe therapeutic option for MC and joint involvement. [ABSTRACT FROM AUTHOR]

The prevailing position of law in India that has long clouded the securities law landscape in the country has finally been resolved through the recent Securities Appellate Tribunal (SAT) order in the matter of Mr Raghu Hari Dalmia and Ors v Securities and Exchange Board of India, which has cleared the ambiguities clouding the issue of trigger of the Securities and Exchange Board of India (Substantial Acquisition of Shares and Takeovers) Regulations, 1997 (the "Code"), pursuant to a buy-back of shares by a listed company resulting in "passive increase" in shareholding or voting rights in the company. The SAT has, through this order, settled the position of law on this issue by holding that passive acquisition does not attract the provisions of regulations 10 and 11 of the Code. Prior to this decision, SEBI had always maintained that such a passive increase in voting rights would trigger the open offer requirements under the Code. The authors argue that although SAT, through this ruling, has finally settled a moot point of law, this decision may have broader implications. It could embolden other promoters and cause a rash of such offers as it allows promoters to raise stakes by using company money and also to sidestep takeover regulations. It could act as an easy passage for them to raise stakes in companies without complying with the open offer requirements. The authors further contend that this decision of SAT might not prove to be conclusive, given that the new Takeover Code, 2011 provides for specific exemption provisions for buy-back offers. [ABSTRACT FROM AUTHOR]

Merely two decades ago marketers in India realised that to sell a product the customers needs to recognise their product and hence focus was on making the product visible (branding), then a decade ago too many players entered the market and confused the customer and hence the concept of differentiation of the brand became the sole important factor so as to give visibility to the brand. Today, almost every product comes with a differentiated offering and customer still remains confused. Marketers needed something to penetrate into the clutter of all brands surrounding the customer and hence came the concept of experiential marketing. Experiential marketing is to stimulate in active manner, to engage consumer in a personal life experience, to allow them to be receptive with the brand in a personalised environment. It is to create and add the value of life, which are to be involved in the product development process. Experiential marketing focuses on customer experiences. It aims at gauging sensory, motional, cognitive behavioural relationship wants of the customer. This paper will focus on consumer behaviour, the impact of experiential marketing on the consumers, why a concept like this will place an effect on consumer and how will it do. Customer-centricity is the buzzword. Positioning companies, services or products is a technique which helps in easy brand recall due to its approach of occupying separate place in customer's mind and how are marketers creating this space is through experiential marketing. Another aspect which this paper will explore is employee involvement without which the whole concept of providing a customer with a positive experience cannot be executed. [ABSTRACT FROM AUTHOR]

Objectives. This study was planned to determine the prevalence of ocular abnormalities in multi-transfused children with β-thalassaemia receiving desferrioxamine and to determine the association of abnormalities with the patients' age, serum ferritin level, haemoglobin concentration, and dosage and duration of treatment with desferrioxamine. Methods. Twenty-five thalassaemic children receiving desferrioxamine and attending the day-care centre of a tertiary care hospital in Delhi, India, and 25 healthy age-matched controls were examined to determine the prevalence and pattern of ocular abnormalities. A refraction test, the visual evoked response and fluorescein angiography were done where applicable. Ocular changes were correlated with serum ferritin levels, the dosage and duration of chelation with desferrioxamine, and pre-transfusion haemoglobin levels. Results. None of the children reported any visual symptoms. The prevalence of ocular abnormalities in the thalassaemic group was 36% (9/25). Ocular changes seen included cataract (5/25),blurred optic disc margins (6/25) and dilatation and tortuosity of retinal vessels (2/25). The thalassaemic children had a significantly higher prevalence of cataract than the controls (p<0.0S). Prevalence of cataract was associated with serum ferritin values above 4500 ng/ml (p<0.0S), and blurring of disc margins was significantly associated with increased duration ((5 years) and frequency ((5 times/week) of desferrioxamine administration. A positive correlation was seen between the incidence of cataract and blurred disc margins. Conclusions. Children with thalassaemia should be screened periodically for ocular abnormalities. Rational usage of desferrioxamine and use of newer chelating agents will reduce the prevalence of these abnormalities. [ABSTRACT FROM AUTHOR]

Context: Visual disability in India is categorized based on severity. Sometimes the disabled person does not fit unambiguously into any of the categories. Aims: To identify and quantify disability that does not fit in the current classification, and propose a new classification that includes all levels of vision. Settings and Design: Retrospective chart review of visual disability awarded in a teaching hospital. Materials and Methods: The last hundred records of patients who had been classified as visually disabled were screened for vision in both eyes and percentage disability awarded. Data were handled in accordance with the Helsinki Declaration. Results: Twenty-one patients had been classified as having 30% disability, seven each had 40% and 75%, and 65 had 100% disability. Eleven of them did not fall into any of the current categories, forcing the disability board to use its own judgment. There was a tendency to over-grade the disability (seven of 11; 63.6%). The classification proposed by us is based on the national program for control of blindness. definition of normal vision (20/20 to 20/60), low vision (<20/60 to 20/200), economic blindness (<20/200 to 20/400) and social blindness (<20/400). It ranges from the mildest disability (normal vision in one eye, low vision in the other) up to the most severe grade (social blindness in both eyes). Conclusions: The current classification of visual disabilities does not include all combinations of vision; some disabled patients cannot be categorized. The classification proposed by us is comprehensive, progresses logically, and follows the definitions of the national program. [ABSTRACT FROM AUTHOR]

Breastfeeding is an essential key factor for reducing child mortality and the risk of disease. Therefore, to ensure health and wellbeing for all (Sustainable Development Goal 03), and to reduce inequalities in child health status (SDG 10), understanding the determinants of breastfeeding is essential. Our research aims to investigate determinants of different breastfeeding practices from 2005–06 (NFHS-3) to 2015–16 (NFHS-4), and changes in different breastfeeding practices among various demographic, social, religious, and economic groups during this decade. We have used a multivariate binary logistic regression model to estimate significant determinants of different breastfeeding practices. The results show an 8.4% hike in Exclusive Breastfeeding (EBF), along with a 3.3% and 1% drop in the Continuation of Breastfeeding (CBF) up to one and two years respectively during this decade in India. Significant variation has been found in EBF, CBF1 and CBF2 among various categories of child's birth interval, place of residence, social groups, economic communities, and geographic regions. Maternal nutritional status and anemia levels had significant influence on CBF1 and CBF2, and gender of the children on EBF and CBF2 from 2005–06 to 2015–16. There was no significant variation in CBF1 and CBF2 among children born in different birth orders, whereas EBF was significantly less among higher birth orders children. A dramatic improvement in EBF was found among first birth ordered children, teenage and/or highly educated mother, rich families, and in north India, and CBF2 was significantly raised only among higher educated mothers. The estimation of determinants throughout the decade is essential for improving government policies related to supporting and encouraging breastfeeding. The study suggests more initiatives and investment for the promotion, support and improvement of CBF for one and two years, and reduction of inequality among various demographic and socio-economic groups and geographic regions. • From 2005–06 to 2015–2016 India exhibited an 8.4% increase in exclusive breastfeeding. • Continued breastfeeding up to one and two years declined 2.9% and 1% respectively. • Different types of breastfeeding practices vary significantly by geographic regions, social, economic groups in India. • Maternal physical health (BMI, Anemia level) influences continuation of breastfeeding. • Boys are more privileged in exclusive and continuation of breastfeeding up to two years than girls in India. [ABSTRACT FROM AUTHOR]

Background: The duodenal ulcer (DU)-promoting gene ( dupA) of Helicobacter pylori has been identified as a novel virulent marker associated with an increased risk for DU. The presence or absence of dupA gene of H. pylori present in patients with DU and functional dyspepsia in North Indian population was studied by polymerase chain reaction (PCR) and hybridization analysis. Materials and Methods: One hundred and sixty-six patients (96 DU and 70 functional dyspepsia) were included in this study. In addition, sequence diversity of dupA gene of H. pylori found in these patients was analyzed by sequencing the PCR products jhp0917 and jhp0918 on both strands with appropriate primers. Results: PCR and hybridization analyses indicated that dupA gene was present in 37.5% (36/96) of H. pylori strains isolated from DU patients and 22.86% (16/70) of functional dyspepsia patients ( p  .05). Of these, 35 patients with DU (97.2%) and 14 patients with functional dyspepsia (81.25%) were infected by H. pylori positive for cagA genotype. Furthermore, the presence of dupA was significantly associated with the cagA-positive genotype ( p  .02). Conclusion: Results of our study have shown that significant association of dupA gene with DU in this population. The dupA gene can be considered as a novel virulent marker for DU in this population. [ABSTRACT FROM AUTHOR]

Objective: Improved survival of low birth weight, premature babies have increased the incidence of retinopathy of prematurity. This hospital-based, prospective, study was undertaken to determine its incidence and risk factors in our neonatal unit.Methods: Neonates with gestational age < or = 35 weeks and/or birth weight < or = 1500 gm born over a one-year period were examined by indirect ophthalmoscopy between 2 to 4 weeks after birth, and followed up till retinal vascularisation was complete. Maternal and neonatal risk factors were noted and data analyzed by statistical package SPSS-10.0.Results: Sixty babies were thus examined. The incidence of retinopathy was 21.7% in the cohort, 33.3% in babies < or = 32 weeks gestation and 36.4% in babies weighing < or = 1250 gm. Oxygen (p=0.01), sepsis (p=0.04) and apnoea (p=0.02) were independent risk factors. Retinopathy was significantly more severe in babies with hyaline membrane disease (p=0.02) and lower birth weight (p=0.02). Severe disease was never seen before 6.5 weeks of age.Conclusion: Indirect ophthalmoscopy should be performed at 4 weeks of post natal age in all preterm babies with birth weight < or = 1500 gm, and intensified in the presence of risk factors like oxygen administration, apnoea and septicemia. [ABSTRACT FROM AUTHOR]

Introduction: Megalencephalic leucodystrophy with subcortical cysts(MLC) is a rare form of leucodystrophy described in particular ethnic group(Agarwals)in India. It is an autosomal recessive disease due to mutation in MLC -1 gene (22q13.33) characterized by megalencephaly, early onset ataxia followed by slowly progressive spasticity, occasional seizures and mild to moderate cognitive decline. MRI brain shows early and severe cerebral white matter involvement with subcortical cysts in the temporal lobes and fronto-parietal areas. It is non-progressive variety and the prognosis is good. Management is based on physical and psychomotor therapy and treatment of seizures. Identification of MLC-1 mutation is the only way of prenatal diagnosis. Case Summary: We present here a genetically confirmed case of 7yrs old, Agarwal boy, born of non -consanguinous marriage, delivered through caeserian section due to large head size. The child had normal motor and mental milestones till three years of age when he developed slowly progressive gait and limb ataxia and generalized seizures. There is no family history. MRI brain revealed diffuse white matter changes with bilateral temporal and frontal cortical cysts. Genetic testing revealed MLC-1 gene mutation. [ABSTRACT FROM AUTHOR]