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Background and Objectives: Diabetes is a chronic metabolic disease, with current estimates by the IDF (International Diabetes Federation) suggesting nationwide prevalence rates of 9.2% among Indians aged 20–79 years. An appropriate dietary pattern is widely accepted as a cornerstone of treatment among diabetes patients. However, motivating patients to achieve dietary self-care behaviors is challenging and requires ongoing efforts between patients and multidisciplinary teams. Therefore, the objectives of this study were to assess the level of adherence to the diet, to find out the association between dietary practices and disease profile, and to explore the reasons behind not adhering to the recommended diet. Methodology: The present cross-sectional study was conducted among type 2 diabetic patients visiting the NCD clinic in a tertiary care hospital and three CHCs in Jamnagar district. The final sample size was 450. A structured interview schedule containing sociodemographic profiles, details regarding diabetes mellitus, and dietary details was developed. Dietary assessment was done using the UKDDQ. Result: In a study of 450 participants, 44.88% were aged 61–70 years. The majority were Hindu (88%), with 69.3% residing in urban areas and 30.7% in rural areas. Using the UKDDQ dietary score, 71.55% had a healthy diet. This score was negatively correlated with BMI, HbA1c, and RBS. Factors such as family type, area of residence, family history of diabetes mellitus, duration of diabetes, mode of treatment, HbA1c, and complications of diabetes were significantly associated with the dietary score. Conclusion: The study found that poor dietary scores were linked to worse disease outcomes in type 2 diabetes. Identifying and addressing barriers to dietary adherence is crucial for improving outcomes and modifying recommendations accordingly.

Background: The elderly are disproportionately affected by depression, a devastating mental health illness that is common and causes significant impairment and a poor quality of life. In a community setting in India, this study sought to evaluate the prevalence of depression, degrees of associated disability, healthcare use patterns, health-seeking behavior, and awareness of government initiatives of mental health and care for the elderly. Objectives: This study was aimed to determine the prevalence of depression and to assess the health-seeking behavior among the geriatric population aged ≥60 years in the study area during the study period. Methodology: A cross-sectional community study including 450 senior citizens aged ≥60 years living in urban slums was carried out. Data were collected through structured interviews, utilizing the Geriatric Depression Scale using 30 items for assessing depression, the Sheehan Disability Scale for evaluating disability levels, and questionnaires on healthcare utilization, health-seeking behavior, and knowledge of government programs. Results: The prevalence of depression was high, with 129 (28.67%) participants suffering from mild depression and 33 (7.33%) from severe depression. Moderate to marked disruptions in their work (17, 51.52%), social life/leisure pursuits (24, 72.73%), and social responsibilities (family life) (27, 51.52%) were reported in a significant proportion of those with severe depression. Additionally, a substantial percentage reported feeling impaired and unproductive for most days of the week (P < 0.001). While the majority (358, 79.56%) visited healthcare providers, with 333 (93.02%) visiting government providers and 330 (92.18%) visiting community-level providers, the utilization of mental health services (10, 2.79%) and treatment for depression with antidepressants (7, 4.32%) was minimal. In addition, just 26 people (5.78%) and 3 people (0.67%) knew about the National Programme for Health Care of the Elderly and the Mental Healthcare Act of 2017, respectively, indicating a lack of knowledge regarding government initiatives pertaining to mental health and geriatric care. Conclusion: The study highlights the significant burden of depression, associated disabilities, and inadequate health-seeking behavior among the elderly population in the study setting. Efforts should focus on strengthening community-based mental health services, improving awareness and access to existing health services and government programs and addressing the various risk factors responsible for the emergence and persistence of depression, and poor health-seeking behavior in the aforementioned vulnerable group.

Spray formulation can minimize pain and irritation experience during the application of conventional dosage forms. Econazole Nitrate is an active ingredient of the aerosol concentrate to be used for twice-daily application because of its long durability in the superficial layers of the fungal infected skin. The aim of this study is preliminary investigation of Econazole Nitrate spray by varying the concentrations of different constituents of the spray. The ratios of Propylene glycol (PG) and isopropyl myristate (IPM) were selected as independent variables in 2 2 full factorial designs, keeping the concentration of solvent, co-solvent and propellant LPG constant. Aerosol also contained Ethanol as solvent and Isopropyl alcohol as co-solvent. All ingredients of the aerosol were packaged in an aluminum container fitted with continuous-spray valves. Physical properties evaluated for the Econazole Nitrate spray included delivery rate, delivery amount, pressure, minimum fill, leakage, flammability, spray patterns, particle image and plume angle. Glass containers were used to study incompatibility between concentrate and propellant due to the ease of visible inspection. Isopropyl myristate at lower concentrate showed turbidity, while at high concentration it met the requirements for aerosol and produced Econazole Nitrate spray with expected characteristics.

Introduction: College students perusing health allied courses like Medical, Dental, Ayurveda and Physiotherapy are at a greater risk for overweight/obesity compared to their counterparts studying in other streams due to speciic risk factors. Objectives: 1) The present study was conducted to ind prevalence of obesity and overweight and their determinants in college-going students. 2) Internal comparison of obesity and overweight between students perusing selected health allied courses at Jamnagar City, Gujarat. Method: A cross-sectional study was conducted in 985 Medical, Dental, Ayurvedic and Physiotherapy college students using proportion of annual intake in each college. Data was collected using a pre-tested, structured questionnaire. Students were classiied using Asian BMI cut-off. Chi-square test, ANOVA and Univariate logistic analysis were used as statistical tools. Results: Out of the total sample size of 985, 18.37% students were obese and 13.80% students were overweight. Higher mean BMI was seen in medical college students as compared to students of other colleges (F ratio = 3.58, p-value

Abstract Vitiligo is a common chronic autoimmune disorder characterized by skin and hair depigmentation that affects 0.5%–2.0% of the global population. Vitiligo is associated with diminished quality of life (QoL) and psychosocial burden. The burden of vitiligo may vary based on skin tone and cultural differences as well as geographical variations in disease awareness, societal stigma, healthcare systems and treatment options. Data on the burden and management of vitiligo in Africa, the Middle East and Latin America are scarce. Literature searches using terms covering vitiligo in Africa, the Middle East and Latin America were conducted using PubMed to identify relevant publications that focused on disease prevalence and burden, QoL and psychosocial impact and disease management between 2011 and 2021. Most of the reviewed studies were conducted in the Middle East, and most Latin American studies were from Brazil. Most studies involved small patient numbers and may not be generalizable. Reported prevalence of vitiligo ranged from 0.18% to 5.3% in Africa and the Middle East, and from 0.04% to 0.57% in Latin America. In several studies, prevalence was higher among female participants. Generally, non‐segmental vitiligo was the dominant clinical variant identified and the age at onset varied widely across studies. Common comorbidities include autoimmune diseases such as Hashimoto's thyroiditis, alopecia areata and diabetes. Few treatment guidelines exist in these regions, with the exceptions of guidelines published by the Brazilian and Argentinian Societies of Dermatology. There is a clear unmet need for large epidemiological studies with uniform methodology to accurately ascertain the true prevalence of vitiligo in Africa, the Middle East and Latin America. Additional data on vitiligo burden and management in Africa and Latin America are also needed, along with local disease management guidelines that consider genetic variation, psychosocial burden and socioeconomic diversity in all 3 regions.

The present study was conducted in the Saurashtra region of Gujarat to demonstrate the development and validation of location and crop-specific composite drought index (CDI) using a linear combination of three parameters including meteorological drought index, vegetation drought index and inverse of maximum consecutive dry days%for major Kharif crops of the region i.e. cotton and groundnut. The performance of nine drought indices including six meteorological and three remote sensing-based vegetation indices wasevaluated in terms of correlation with district scale crop yields.The district-wise expressions of CDI were developed by assigning principal component analysis (PCA) based weights to parameters.Standardized Precipitation Evapotranspiration Index (SPEI)/ Reconnaissance Drought Index (RDI) among meteorological indices and NDVI Anomaly Index (NDVIA)/ Vegetation Condition Index (VCI) among vegetation indices were found suitable for generating district specific CDI expressions. The developed CDI showed higher correlation with Kharif cotton and Groundnut crop yields as compared to various meteorological as well as vegetation indices used in the study and effectively quantified major historic agricultural droughts.The average correlation coefficients of developed CDI with cotton and groundnut yields were 0.71 and 0.77 respectively. The correlations of CDI and crop yields for all CDI expression were highly significant with p

Introduction: Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO in recent years. During 2019, the National Vector Borne Disease Control Programme (NVBDCP) reported more than 100,000 in country and more than 14,000 laboratory confirmed cases of dengue in Gujarat. In hostels of Shree M. P. Shah Medical College, Jamnagar cases of dengue are reported in every season but during the rainy season number of cases gets increased. Objective: To assess the knowledge, attitude and practice regarding Dengue and its prevention and control measures among 1st year M.B.B.S students. Method: A cross sectional study was conducted among 192 1st year MBBS students of Shree M P Shah Government Medical College, Jamnagar in September 2019. A pre-designed, pre-tested, semi structured, self-administered questionnaire was used to collect information. Microsoft excel was used to analyze the data. Results: Among study participants 76% knew that dengue is spread by Aedes mosquito, 81.25% said that adult female mosquito bite responsible for dengue, 27.07% knew that clean storage water was the breeding place of dengue mosquito. Social media and newspaper were main source of information. 71.3% study participants were using mosquito coils/mats/ repellent/ liquid against mosquito. Only 25% were regularly checking for breeding site at hostel/house. Conclusion: Majority of 1st year medical graduates had a basic knowledge regarding dengue. But there is still gap in prevention knowledge and practices of personal protective measures and eliminating source of mosquitoes.

The experiment was conducted during 2020−21 and 2021−22 at Green house complex, AICRP on Plastic Engineering in Agriculture Structure and Environment Management, Departmental of Renewable Energy Engineering, College of Agricultural Engineering and Technology, Junagadh, Gujarat, India to study the economics of vegetable seedling nursery for high valued broccoli crop for profitable entrepreneurship. Timely sowing and optimizing plant population significantly increase vegetable production. The availability and required seedling in time play a major role in vegetable cultivation. The seedlings of broccoli are transplanted in the rabi season, therefore, farmers have to prepare seedlings in the late monsoon. The germination percentage and survival of seedlings are reduced due to extreme weather condition like frosting, freezing, heat wave, high temperature and excess soil moisture in the open field. Therefore, present work was carried out on the economic feasibility of seedling raising of broccoli in a natural ventilated net-cum-poly house. The seeds of broccoli of Namdhari seeds of F1 were sown in a plug tray in the month of September of the year 2020 and 2021. Plug trays were filled with the mixture of cocopeat and vermicompost in an equal proportion of 1:1 (V/V). The germination was recorded at 94% and each seedling of broccoli was sold for ` 1.60. The Gross Return (GR), Net Return (NR), and benefit-cost ratio of the seedling raising of broccoli were recorded as Rs. 556.80 m-2, Rs. 262.69 m-2 and 1.89, respectively.

Context: Unmet need is a valuable indicator of National Family Planning Programme. It shows how well the programme achieves the key mission of meeting the population’s felt need of family planning. It is added to the 5th MDG as an indicator concerned with maternal health. Aims: To find out 1.) Unmet need of family planning and 2.) Its determinants. Settings and Design: A community based cross sectional study was done among married women of age 15-45 years of urban slums in Jamnagar city. Methods and Material: total 200 study participants were selected by systemic random sampling and interviewed by using pretested semi-structured Performa. Statistical analysis used: Microsoft excel was used for data entry and analysis done by software Epi-info. Results: overall level of unmet need was 20.50%. It was found to be influenced by various socio-demographic factors (age of women, gender of last child and accessibility to the service providers) and these associations were found statistically significant. Number of living children, occupation, and period of active married life, religion and collective decision had no any effect on unmet need. (No statistically significant associations). Major reasons for not using any methods were inconvenience (51.22%), refusal by spouse/family members (21.95%) and lack of knowledge (19.51%) Conclusions: unmet need was higher in more fertile age-group therefore program should focus more on this agegroup. Female education contributes significantly in reduction of unmet need. By encouraging inter-spousal communication and male participation for family planning decision-making is important in bridging the gap between met and unmet need.

Introduction: Many of the health problems of Indian women are related to or exacerbated by high levels of fertility. The poor health of Indian women is a concern on both national and individual levels. It affects the children who will be India’s next generations of citizens and workers. The current study was aimed to see the impact of demographic characteristics on reproductive profile of pregnant women. Material and Methods: It was a community based cross-sectional study conducted among 300 pregnant women using pretested questionnaire. Sample size was calculated using the proportion of pregnant women having one or more living children. Results: Out of total 300 pregnant women studied, 6.00% of the total studied women were adolescents. Study revealed that 34.67% of the pregnant women were illiterate. More than three fourth i.e. 78.33% of the studied women got married by the age of 21 years and 16 % got married before legal age of marriage. Considering the age at first conception, 59 % women of the study group had their first pregnancy by 21 years of age and 5.00% of the study women conceived for the first time before 18 years of age. For 27.33% of the studied women, it was their third or more conception, while 17.33% of the studied pregnant women had two or more live children. Conclusion: Study revealed significant impact of area of residence, literacy of the women and socio-economic class of the family over reproductive profile of women including interpregnancy interval and high parity.

Introduction: In the last three decades, fungal infection has become important cause respiratory tract infection. The increase in frequency is mainly due to intensive cytotoxic therapy, greater use of broad spectrum antibiotics, corticosteroids and Immuno-suppresants. Material and Method: Sputum Samples were collected from june 2005 to june 2006.The samples were subjected to direct microscopy using Gram staining, KOH wet mounts, India ink preparations depending on the type of specimen and the suspected infection in the patient. Fungal culture was done on Sabouraud dextrose agar, with and without chloramphenicol, Czapek`s solution agar and malt extract agar. Result: This study was undertaken to determine isolation of Aspergillus species from sputum samples. 61% of sputum specimens were culture positive and 39% were negative among cases of chronic respiratory diseases. 29% of 100 samples are aspergillus spp. while 32% of positive culture are other than aspergillus spp. Highest number of male & female patients were from 31-40 years of age and then gradually decrease in number in 21-30 and 41-50 years of age group. Conclusion: An increase in rate of infection occurs during a period of building construction, particularly in zones surrounding hospitals.

Background: The vectors borne diseases poses an immense public health concern and are major impediments in the path of socio-economic development. Objective: To assess domestic environment as well as community level KAP on mosquito control measures in Jamnagar district. Methods & statistics: It was a cross-sectional survey of 450 household by a pre-tested proforma analyzed by Microsoft excel office 2007. It was carried out in urban, urban slum and rural areas of Jamnagar district. Results: Rural domestic environment was favorable for mosquito breeding. Most of the respondents were unaware about the places where mosquito bred. The knowledge regarding vector, routes and symptoms of malaria was good, while majority were unaware about types of malaria and other mosquito borne diseases. Active malaria surveillance activity was totally lacking in urban area (94%), while it was very poor in rural and slum area. The preferred treatment providers in the community neither screened malaria nor imparted health education about mosquito control. 56% of the respondents were practicing at least one personal protective and larvae control measure, but less efficient one. Conclusion: Community participation in term of KAP regarding vector control is deficient at places & needs to be addressed for effective mosquito control.

Background: Knowledge about performance of DOTS services in a given area shall provide vital information to find out discrepancies in DOT services and take necessary steps to strengthen the services in that area. The objective of the study is to evaluate functioning of DOT centres (both DOT providers and TB patients) by various indicators like record keeping, compliance of patients, proportion of supervised doses etc. Methods: It was a cross-sectional study. We identified and interviewed health personnel involved, reviewed the documents and records of all four Tuberculosis Units (TUs) of Jamnagar district. TB registers of all TUs of the district were reviewed and every 3rd TB patient registered from 1st January, 2009 to 30th June, 2009 (i.e. first two quarters of year 2009), was selected by systematic random sampling method. Results: About half of TB patients (52.16%) were representing the productive age group, with a male female ratio being 2.1:1. Every fifth patient was irregular in the treatment during Intensive Phase. Treatment was delayed by more than a week after diagnosis in 10% patients. Entry of Continuation Phase in treatment card was satisfactory in 61.29% patients. Compliance of patients was found satisfactory only in 74.19% patients. 85.68% patients found location and timing of DOT centre convenient. In only 81.37% of total defaulted TB patients, retrieval actions were taken by a TB worker. Conclusion: There is an urgent need to strengthen performance of the programme by training and motivating DOTS providers by effective supervision of DOTS, proper record-keeping and efficient supervision by district health officials.

Introduction: Chronic diseases of life-style particularly Hypertension, DM and CHD account for millions of deaths each year globally. These diseases share similar modifiable risk factors, including tobacco smoking, alcohol consumption, hyperlipidaemia, physical inactivity, obesity etc. so that identifying and modifying these risk factors have been recommended as a strategy for their prevention and control in various settings. Aim- To find out the prevalence of common life style diseases and their risk factors Method: A cross sectional study was done, which was containing 450 male respondents in the age group of 35-45 years from Patel colony in Jamnagar city. Predesigned and prestructured questionnaires covering socio-economic aspects, dietary pattern, smoking, alcohol intake, physical activity, personality and parental history of hypertension and diabetes were reviewed. In addition some anthropometric measurements (e.g., height, weight and BMI) and clinical measurements (e.g., blood pressure) were also done. Result: The overall prevalence rate for the common life-style diseases was observed to be 33.56% for hypertension, 10.44% for diabetes mellitus and 44.44% for overweight/obesity. The few major risk factors noted among participants were high fatty diet (99.11%), high salt intake (96.67%) and Type A personality (71.33%). About 2/5th (38 %) of them were current smokers and only 2% were consuming alcohol. 42.22% of the target population were physically inactive based on work and leisure time activities. While around 69.33% of the respondents were having a positive family history of hypertension and/or diabetes. Conclusion: The study demonstrated a high prevalence of life-style diseases and their risk factors. Serious consideration should be given to this escalating burden of lifestyle diseases in the study population. The development and implementation of relevant health promotion and intervention programmes that will improve the general health and reduce the risk for NCDs in this population are advised.

Abstract Background Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life. Aims and Findings AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.

Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light phototypes. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of “dark skin” spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 76 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, seven hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 14 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the “skin of color” spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed.

Dermoscopy has been showed to facilitate the non-invasive recognition of several infectious disorders (infectiouscopy) thanks to the detection of peculiar clues. Although most of the knowledge on this topic comes from studies involving light-skinned patients, there is growing evidence about its use also in dark phototypes. This systematic literature review summarizes published data on dermoscopy of parasitic, bacterial, viral and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 66 papers addressing 41 different dermatoses (14 bacterial, 5 viral, 11 fungal infections, and 11 parasitoses/bites and stings) and involving a total of 1096 instances were included in the analysis. The majority of them displayed a level of evidence of V (44 single case reports and 21 case series), with only 1 study showing a level of evidence of IV (case-control analysis). Moreover, our analysis also highlighted a high variability in the terminology used in the retrieved studies. Thus, although promising, further studies designed according to a systematic and standardized approach are needed for better characterization of dermoscopy of infectious skin infections.

Hair and scalp disorders are of significant interest for physicians dealing with dark phototypes due to their prevalence and potential aesthetic impact resulting from a higher tendency for scarring. In order to facilitate their non-invasive diagnosis, several dermoscopic studies have been published, yet data are sparse and no systematic analysis of the literature has been performed so far. This systematic literature review summarizes published data on trichoscopy of hair and scalp diseases (trichoscopic findings, used setting, pathological correlation, and level of evidence of studies). A total of 60 papers addressing 19 different disorders (eight non-cicatricial alopecias, nine cicatricial alopecias, and two hair shaft disorders) were assessed, for a total of 2636 instances. They included one cross-sectional analysis, 20 case-control studies, 25 case-series, and 14 single case-reports, so the level of evidence was V and IV in 65% and 33% of cases, respectively, with only one study showing a level of evidence of III. Notably, although there is a considerable body of literature on trichoscopy of hair/scalp diseases, our review underlined that potentially significant variables (e.g., disease stage or hair texture) are often not taken into account in published analyses, with possible biases on trichoscopic patterns, especially when it comes to hair shaft changes. Further analyses considering all such issues are therefore needed.

Introduction: India approved the “Covishield” vaccine for emergency use and began the first vaccination drive from January 16, 2021. As the new coronavirus disease-2019 (COVID-19) vaccine was developed within a short period, public acceptance for this new vaccine remains uncertain. Vaccine hesitancy remains an important challenge in the immunization against COVID-19. The aim of the current study was to assess different hesitancies, attitude, and beliefs about COVID-19 vaccine among health-care workers. Methods: A cross-sectional study was carried out among health-care professionals from 5th to January 15, just before the commencement of the first vaccination drive. All the participants were requested to fill out semi-structured pro forma containing following sections: (1) demographic details and (2) attitude and belief questionnaire. Following this, a lecture of around 45–60 min was conducted by trained professionals comprising of an education module. After the educational session, participants' willingness to take the vaccine was reassessed. Results: Totally, 598 participants participated in the study. Of these, 47% participants were not willing to take the vaccine. Participants with age

Abstract The majority of high-risk neuroblastomas can be divided into three distinct molecular subgroups defined by the presence of MYCN amplification, upstream TERT rearrangements or alternative lengthening of telomeres (ALT). The common defining feature of all three subgroups is altered telomere maintenance; MYCN amplification and upstream TERT rearrangements drive high levels of telomerase expression whereas ALT is a telomerase independent telomere maintenance mechanism. As all three telomere maintenance mechanisms are independently associated with poor outcomes, the development of strategies to selectively target either telomerase expressing or ALT cells holds great promise as a therapeutic approach that is applicable to the majority of children with aggressive disease. Here we summarise the biology of telomere maintenance and the molecular drivers of aggressive neuroblastoma before describing the most promising therapeutic strategies to target both telomerase expressing and ALT cancers. For telomerase-expressing neuroblastoma the most promising targeted agent to date is 6-thio-2′-deoxyguanosine, however clinical development of this agent is required. In osteosarcoma cell lines with ALT, selective sensitivity to ATR inhibition has been reported. However, we present data showing that in fact ALT neuroblastoma cells are more resistant to the clinical ATR inhibitor AZD6738 compared to other neuroblastoma subtypes. More recently a number of additional candidate compounds have been shown to show selectivity for ALT cancers, such as Tetra-Pt (bpy), a compound targeting the telomeric G-quadruplex and pifithrin-α, a putative p53 inhibitor. Further pre-clinical evaluation of these compounds in neuroblastoma models is warranted. In summary, telomere maintenance targeting strategies offer a significant opportunity to develop effective new therapies, applicable to a large proportion of children with high-risk neuroblastoma. In parallel to clinical development, more pre-clinical research specifically for neuroblastoma is urgently needed, if we are to improve survival for this common poor outcome tumour of childhood.