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Introduction: Anemia is an important public health disorder. There is a significant chunk of India’s population residing in poor housing quality with inadequate sanitation and hygiene, which might lead to higher anemia prevalence. The objective was to determine the association between anemia with poor housing quality among the older Indian adult population (≥45 years) as per residence. Methods: This study analyzed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). Bivariate analysis and logistic regression were conducted to show the association of anemia (outcome variable) with poor housing quality (explanatory variable). Multivariable logistic regression was conducted by adjusting for covariates as per their models. P value

Abstract Introduction The prevalence of important public health problems like road traffic accidents (RTA) and depression are surging. This study was aimed to estimate distribution and determine the association between RTA and depression among Indian population aged 45 years and above: overall and stratified into age group, gender and across states/union territories as aspirants, achievers, and front runners. Methods Using Longitudinal Aging Study in India (LASI) dataset (April 2017–December 2018), we have conducted this study among middle aged (45–59 years) and older adults and elderly (≥ 60 years) Indians. Bivariate analysis was conducted to estimate the prevalence of RTA and depression nationally and across aspirants, achievers, and front runner states. States and union territories were categorised as low, medium, and high as per RTA and depression prevalence, which were further cross tabulated. Spatial distribution maps were created using Microsoft Excel. We have documented the association of RTA with depression. To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was analysed using STATA version 17. Results Prevalence of RTA was 1.84% (1.74–1.94) nationally, highest among achiever states [2.04% (1.82–2.30)]. Prevalence of depression was 6.08% (5.90–6.26) nationally, highest among aspirant states [7.02% (6.74–7.30)]. The adjusted odds of having RTA was significantly among depressed [aOR (95% CI) 1.76 (1.45–2.15)] than non-depressed participants; which was much higher among females [aOR (95% CI) 1.93 (1.43–2.62)] than in males [aOR (95%CI) 1.67 (1.29–2.16)] and much higher among middle aged [aOR (95%CI) 2.08 (1.63–2.65)]. Odds of RTA was highest across front runners [aOR (95%CI) 1.86 (1.26–2.72)] followed by aspirant states [aOR (95%CI) 1.79 (1.37–2.33)]. Conclusion This study established the positive association between depression and road traffic accidents among middle aged, older adults and elderly. Therefore, efforts must be taken to address mental health issues in them with proper policy implication more focused on females and middle aged. Front runner’s states should get the limelight followed by aspirant states.

Abstract Introduction Anaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender. Methods Our study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09–1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18–1.43), and household indoor smoking (AOR 1.17 (1.07–1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15–1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15–1.61) than females (AOR 1.21; 1.08–1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure. Conclusion This study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states.

Alagille syndrome (ALGS) is a complex multisystem genetic disorder. Patients with ALGS usually require liver transplantation (LT). Congenital heart diseases are also common in ALGS patients. ALGS patients may become ineligible for LT procedure due to cardiac abnormalities whereas any corrective cardiac surgeries are precluded due to the Child C cirrhosis of the liver in these patients. We report a unique case of a 4-year- and 10-month-old girl who underwent open-heart surgery and living donor liver transplantation (LDLT). She had significant hepatic and cardiopulmonary involvement, and Child C cirrhosis with portal hypertension and complex cardiac defects, and was ineligible for up-front LT. An open-cardiac surgery was performed and after 12 h she received LDLT using a left lateral hepatic graft. This is the first report of a case of successful combined open-heart surgery and LDLT in a child with ALGS with cardiac defects and Child C liver cirrhosis.

A number of viruses transmitted by mosquitoes are well known to cause disease in both humans and horses, ranging from mild fevers to mortal neurological disease. A recently discovered connection between the alphavirus Sindbis virus (SINV) and neurological disease in horses in South Africa initiated this serological study in northern Europe, where the same genotype of SINV (SINV-I) is also highly endemic. We tested 171 serum samples, originally obtained from horses for other reasons from April to October 2019, for presence of SINV neutralising antibodies using a plaque reduction neutralisation test (PRNT). The serum from six horses reduced the plaque count more than 80%, and two out of these reduced the plaque count more than 90%. These horses were sampled in six different regions of Sweden, and included individuals sampled from April to August. This study shows that horses in Sweden have become infected with SINV and developed neutralising antibodies. Potential connections between infection and development of disease are important questions for future studies.

Purpose : To evaluate the treatment outcomes with high-dose-rate (HDR) interstitial brachytherapy (HDR-BRT) in head and neck cancers (HNC). Material and methods : Fifty-eight patients with HNC as per American Joint Committee on Cancer (AJCC) TNM staging criteria were analyzed retrospectively between 2008 and 2015. Forty-two patients received external beam radiotherapy (EBRT) with HDR-BRT and 16 patients received BRT alone. The survival was calculated with respect to median biological equivalent doses (BED) and median 2 Gy equivalent dose (EQD 2 ), keeping / = 10 for tumor. Loco-regional control and disease free survival was assessed. Results : The median follow-up period was 25 months (2-84 months). The disease-free survival (DFS) probability at year 1 was 82.7%, and 68% at year 7. The overall survival probability was 91.3% at year 1 and 85.8% at year 7. The local control rate was 70%. The rate of recurrence was 30%. Distant metastasis rate was 17.2%. The median BED and EQD 2 , respectively, were 86.78 Gy and 71.6 Gy. The DFS was 74.1% and 75.9% in patients receiving a dose more than median BED and EQD 2 , respectively, and was 64.8% and 61.5% for less than the median dose. Conclusions : The overall outcome was good with implementation of HDR-BRT used alone or as boost, and shows DFS as better when the dose received is more than the median BED and median EQD 2 . The role of HDR-BRT in HNC is a proven, effective, and safe treatment method with excellent long term outcome as seen in this study, which reflects the need for reviving the forgotten art and science of interstitial brachytherapy in HNC.

Background: Hepatitis B-X Protein (HBx) encoded in Hepatitis B virus (HBV) is known to play a critical role in development and progression of HBV induced hepatocellular carcinoma (HCC). HBx interacts with and activates various cells in HCC microenvironment to promote tumor initiation, progression and invasion. In this study, we investigated how surrounding stromal cells interact with HBx-infected hepatoma cells by a series of in vitro co-culture studies.Methods: Huh7 hepatoma cells were cultured and transfected with the mammalian expression vector pGFP-HBx. Co-culture assays were performed between HBx-transfected Huh7 cells and conditioned media (CM) from stromal cells [endothelial cell lines (HUVECs) and hepatic stellate cell lines (LX2 cells)]. The effect of these interactions was studied by a series of functional assays like chemotaxis, invasion, and wound healing scratch assays. Also, quantitative real time (RT)-PCRs of the mesenchymal genes was performed in the hepatoma cells with and without the co-cultures. Hep3B cells with an integrated HBV genome were taken as positive controls.Results: HBx-transfected Huh7 cells cultured in presence of CM from HUVECs illustrated enhanced migration and tube formation as compared to HBx-transfected cells cultured alone or co-cultured with LX2 cells. HBx-transfected hepatoma cells incubated with CM from HUVECs also expressed mesenchymal genes including Thy1, CDH2, TGFβR1, VIM, and CD133. ELISAs revealed increased levels of TGF-β in CM from HUVECs. In comparison to unstimulated HBx-transfected Huh7 cells, TGF-β stimulated cells displayed increased invasive properties and mesenchymal gene expression. RT-PCR and flow cytometry analysis further demonstrated that incubation with either CM from HUVECs or TGF-β significantly increased the expression of a stemness marker, CD133 in HBx-infected hepatoma cells. Gene inhibition experiments with CD133 siRNA showed a downregulation of mesenchymal gene expression and properties in TGF-β induced HBx-infected hepatoma cells as compared to that observed in control siRNA treated cells, indicating CD133 as one of the key molecules affecting epithelial to mesenchymal transition (EMT) in HBx-infected cells.Conclusion: The study indicates that secretory factors like TGF-β from neighboring endothelial cells may enhance expression of CD133 and impart an aggressive EMT phenotype to HBx-infected hepatoma cells in HBV induced HCC.

Introduction: In the era of Direct Acting Antiviral (DAA), elimination of HCV is possible but persistence in extra hepatic sites is hindrance. Detection of HCV has been reported in platelets, however its impact on DAA therapy not been studied. Aim: Detection and quantification of HCV RNA from the platelets and to compare with parallel plasma levels. Materials and Methods: Whole blood collected from 62 chronic HCV infected patients. HCV RNA quantitation was done from paired plasma and platelet pool at baseline using commercial real time PCR assay (Abbott). Correlation calculated by Bland-Altman analysis. Bivariate association and p-value calculated using chi-square tests. Results: A total of 45 patients were viremic while 17 were nonviremic. Median plasma viral load was log105.7 (IQR: log103.55- 6.7) IU/mL, median platelet viral load was log104.13 (IQR: log100- 5.5) IU/mL. Genotype (GT) 3 (66.6%) was commonest followed by GT 1 (33.3%). Sustained Virologic Response (SVR) was attained in 39/45 patients (92.8%) patients while 3/45 patients (6.67%) were non-responders. Viral load at baseline in platelet pool was higher in non-responders when compared to those achieved SVR (median log104.46 vs. log103.27, p=0.456). Conclusion: HCV-RNA was efficiently detected in platelets. Persistence in platelets could be one of the factors associated with treatment failure.

BACKGROUND: Dizziness/vertigo is one of the most common complaint and handicapping condition among patients aged 65 years and older (Geriatric patients). This study was conducted to assess the impact of dizziness/vertigo on the quality of life in the geriatric patients attending a geriatric outpatient clinic. SETTINGS AND DESIGN: A cross-sectional study was performed in a geriatric outpatient clinic of a rural teaching tertiary care hospital in central India. MATERIALS AND METHODS: In all consecutive geriatric patients with dizziness/vertigo attending geriatric outpatient clinic, DHI questionnaire was applied to assess the impact of dizziness/vertigo and dizziness associated handicap in the three areas of a patients' life: physical, functional and emotional domain. Later, each patient was evaluated and underwent Dix-Hallpike maneuver by the physician who was blind of the DHI scoring of the patient. STATISTICAL ANALYSIS USED: We compared means and proportions of variables across two categories of benign paroxysmal positional vertigo (BPPV) and non-BPPV. For these comparisons we used Student's t-test to test for continuous variables, chi-square test for categorical variables and Fisher's exact test in the case of small cell sizes (expected value

ABSTRACT: Introduction: Anemia is an important public health disorder. There is a significant chunk of India's population residing in poor housing quality with inadequate sanitation and hygiene, which might lead to higher anemia prevalence. The objective was to determine the association between anemia with poor housing quality among the older Indian adult population (≥45 years) as per residence. Methods: This study analyzed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). Bivariate analysis and logistic regression were conducted to show the association of anemia (outcome variable) with poor housing quality (explanatory variable). Multivariable logistic regression was conducted by adjusting for covariates as per their models. P value <0.05 was considered statistically significant. STATA version 17 was used for analysis. Results: Our study found that higher adjusted odds of having anemia among older Indian adults were observed among participants with overcrowding (AOR 1.30, 95%CI 1.19–1.42), having access to open/nonsanitary toilet facility (AOR 1.56, 95%CI 1.41–1.72), no electric supply (AOR 1.31, 95%CI 1.12–1.53), and overall poor housing quality (AOR 1.34, 95%CI 1.21–1.48). All of these associations were even higher in urban areas except for having access to open/nonsanitary toilet facilities, which was much higher in rural areas (AOR 1.61, 95%CI 1.45–1.79). Conclusion: Through a nationally representative large dataset, this study generated compelling evidence despite several obstacles indicating a positive association between anemia and poor housing quality among older Indian adults. It might raise awareness and assist individuals in steering clear of the negative effects of overcrowding, using open/nonsanitary toilet facilities, lack of electric supply, and overall housing quality on anemia status. It is advised to conduct additional research to determine temporality and causation. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of important public health problems like road traffic accidents (RTA) and depression are surging. This study was aimed to estimate distribution and determine the association between RTA and depression among Indian population aged 45 years and above: overall and stratified into age group, gender and across states/union territories as aspirants, achievers, and front runners. Methods: Using Longitudinal Aging Study in India (LASI) dataset (April 2017–December 2018), we have conducted this study among middle aged (45–59 years) and older adults and elderly (≥ 60 years) Indians. Bivariate analysis was conducted to estimate the prevalence of RTA and depression nationally and across aspirants, achievers, and front runner states. States and union territories were categorised as low, medium, and high as per RTA and depression prevalence, which were further cross tabulated. Spatial distribution maps were created using Microsoft Excel. We have documented the association of RTA with depression. To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was analysed using STATA version 17. Results: Prevalence of RTA was 1.84% (1.74–1.94) nationally, highest among achiever states [2.04% (1.82–2.30)]. Prevalence of depression was 6.08% (5.90–6.26) nationally, highest among aspirant states [7.02% (6.74–7.30)]. The adjusted odds of having RTA was significantly among depressed [aOR (95% CI) 1.76 (1.45–2.15)] than non-depressed participants; which was much higher among females [aOR (95% CI) 1.93 (1.43–2.62)] than in males [aOR (95%CI) 1.67 (1.29–2.16)] and much higher among middle aged [aOR (95%CI) 2.08 (1.63–2.65)]. Odds of RTA was highest across front runners [aOR (95%CI) 1.86 (1.26–2.72)] followed by aspirant states [aOR (95%CI) 1.79 (1.37–2.33)]. Conclusion: This study established the positive association between depression and road traffic accidents among middle aged, older adults and elderly. Therefore, efforts must be taken to address mental health issues in them with proper policy implication more focused on females and middle aged. Front runner's states should get the limelight followed by aspirant states. [ABSTRACT FROM AUTHOR]

Aim: Gestational diabetes mellitus (GDM) is a major public health problem. There is a scarcity of knowledge regarding the association of stress with GDM. Our objective was to determine the prevalence and association of stress with GDM among pregnant women in a rural area of Maharashtra. Methods: A community-based cross-sectional study was conducted among 965 pregnant women from the rural field practice area of the Department of Community Medicine, MGIMS, Sevagram. After taking written informed consent, a pretested semistructured questionnaire was administered. Diabetes in Pregnancy Study Group India recommendation was used (2-h plasma glucose > 140 mg/dL with 75 g oral glucose load to diagnose GDM irrespective of the duration of the last meal). Kessler Psychological Distress Scale (K10) was administered to assess the stress (anxiety and depression). Results: The K10 scale showed that 3.11% of participants were moderately affected, and 3.01% had mild symptoms of anxiety and depression. Only 1.14% of pregnant women had severe mental disorders. The participants with normal to mild depression (K10 score < 25) had 90% less chance (odds ratio: 0.10; 95% confidence interval: 0.05–0.23) of becoming GDM than participants with moderate to severe depression (K10 score > 25), which was statistically significant (P < 0.001). Conclusion: Our study highlighted that normal to mild stress had a lesser chance of getting GDM than moderate to severe stress during pregnancy, indicating that stress is a positive risk factor of GDM. Hence, it is advisable to screen for stress during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to determine the association of physical activity with gestational diabetes mellitus (GDM) among pregnant women in a rural area of Maharashtra. Methods: The current community-based cross-sectional study was conducted among 965 pregnant women from 3 primary health centers of the field practice area of the Department of Community Medicine, MGIMS, Sevagram, who were included in the ICMR-funded Central India Rural Pregnancy Cohort Project from October 2016 to May 2018. After assuring informed written consent, a pretested semi-structured questionnaire was administered. The Diabetes in Pregnancy Study Group India criteria were used for screening. The level of 2-h plasma glucose >140 mg/dL with 75 g oral glucose load was used to diagnose GDM irrespective of the duration of the last meal. The Pregnancy Physical Activity Questionnaire (PPAQ) was administered to assess the association of physical activity and GDM among the participants. Results: Among all participants, 5.39% were GDM positive; 24.45% of pregnant women had metabolic equivalent of task (MET) score <8.5 MET-h/day, and 75.54% had MET-h/day score >8.5 MET-h/day. The odds of having GDM in participants with physical activity < 8.5 MET-h/day was 22% more than that of participants with >8.5 MET-h/day. Two hundred and thirty-six participants (24.45%) reported to have sedentary levels of physical activity, 437 (45.28%) had light-level physical activity, 255 (26.42%) had moderate physical activity, and only 37 (3.83%) had heavy physical activity. With respect to participants with sedentary lifestyle, participants performing light (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.21–2.79), moderate (OR: 0.54; 95% CI: 0.15–1.92), and heavy physical activities (OR: 0.65; 95% CI: 0.17–2.41) had 24%, 46%, and 35% lesser odds of having GDM, respectively. Conclusions: The current study documented the inverse relationship of physical activity during pregnancy and the risk of developing GDM. With an increase in the intensity of exercise the risk of GDM became lesser respectively. It is advised to all the women to perform regular physical activity during family planning, as early as possible, and to continue during the span of pregnancy to avoid the risk of developing GDM. [ABSTRACT FROM AUTHOR]

Background: Health-care professionals routinely measure blood glucose of all critically ill patients in intensive care unit (ICU). The traditional reference standard, venous blood glucose requires venipuncture, and laboratories usually return the test results after 60 min. We wondered if a point of care (POC) capillary glucose measured by glucometer could be as accurate and reliable as blood venous glucose. Methods: We studied consecutive patients admitted to an ICU between May 1, 2009, and May 10, 2009. We compared the diagnostic accuracy of two-POC glucometers with laboratory venous glucose, the reference standard. We used Bland–Altman plots and the Clark error grid method to analyze the results. Results: This study included a total of 110 patients 38 (34%) women; mean age 52.1 years (standard deviation [SD] =17.3); range = 14–85 years. Fourteen patients (12%) were known to have diabetes. The mean glucose value (glucometer 1) was 152.9 mg/dL (SD = 83.1); range = 48–501 mg/dL; that by glucometer 2 was 152.2 mg/dL (SD = 76.2); range = 30–458 mg/dL and by the laboratory was 148.6 mg/dL (SD = 81.5); range = 52–480 mg/dL. Of the 110 subjects, 2 (2%) had blood glucose below 70 mg/dL; 85 (77%) between 70 and 180 mg/dL; and 23 (21%) had blood glucose exceeding 180 mg/dL. The Bland–Altman plot showed a bias of 4 mg% (95% confidence intervals = −9.8–+1.1); and the limits of agreement were −63 and +54 mg%. The area under the receiver operating characteristic curve for the two glucometers was 0.92 and 0.93, respectively. The error grid analysis showed that 80% (78/110) of samples lay within Zone A, 22 (110) in Zone B, and 1% (1/110) in Zone C. Conclusions: POC glucose, measured by glucometers was in agreement with the venous glucose estimation. Both glucometers were equally accurate and performed uniformly well across the wide range of blood glucose values. [ABSTRACT FROM AUTHOR]

Introduction: Anaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender. Methods: Our study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value < 0.05 was considered statistically significant. SATA version 17 was used for analysis. Results: More than half (52.52%) of the participants were exposed to IAP (male (53.55%) > female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09–1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18–1.43), and household indoor smoking (AOR 1.17 (1.07–1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15–1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15–1.61) than females (AOR 1.21; 1.08–1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure. Conclusion: This study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states. [ABSTRACT FROM AUTHOR]