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Background & aims Previous studies have reported the beneficial roles of the activation of calmodulin-dependent protein kinase (CaMK)II to many cellular functions associated with human health. This review aims at discussing its activation by exercise as well as its roles in the regulation of unsaturated, saturated, omega 3 fatty acids, and lipid metabolism. Methods A wide literature search was conducted using online database such as ‘PubMed’, ‘Google Scholar’, ‘Researcher’, ‘Scopus’ and the website of World Health Organization (WHO) as well as Control Disease and Prevention (CDC). The criteria for the search were mainly lipid and fatty acid metabolism, diabetes, and metabolic syndrome (MetS). A total of ninety-seven articles were included in the review. Results Calmodulin-dependent protein kinase activation by exercise is helpful in controlling membrane lipids related with type 2 diabetes and obesity. CaMKII regulates many health beneficial cellular functions in individuals who exercise compared with those who do not exercise. Regulation of lipid metabolism and fatty acids are crucial in the improvement of metabolic syndrome. Conclusions Approaches that involve CaMKII could be a new avenue for designing novel and effective therapeutic modalities in the treatment or better management of metabolic diseases such as type 2 diabetes and obesity.

Prostate cancer (PC) is one of the major impediments affecting men, which leads approximately 31,620 deaths in both developing and developed countries. Although some chemotherapy drugs have been re...

Polycystic ovarian syndrome (PCOS) is the primary cause of female infertility affecting several women worldwide. Changes in hormonal functions such as hyperandrogenism are considered a significant factor in developing PCOS in women. In addition, many molecular pathways are involved in the pathogenesis of PCOS in women. To have better insights about PCOS, it is data from clinical studies carried on women suffering from PCOS should be collected. However, this approach has several implications, including ethical considerations, cost involved and availability of subject. Moreover, during the early drug development process, it is always advisable to use non-human models mimicking human physiology as they are less expensive, readily available, have a shorter gestation period and less risk involved. Many animal models have been reported that resemble the PCOS pathways in human subjects. However, the models developed on rats and mice are more preferred over other rodent/non-rodent models due to their closer resemblance with human PCOS development mechanism. The most extensively reported PCOS models for rats and mice include those induced by using testosterone, letrozole and estradiol valerate. As the pathophysiology of PCOS is complex, none of the explored models completely surrogates the PCOS related conditions occurring in women. Hence, there is a need to develop an animal model that can resemble the pathophysiology of PCOS in women. The review focuses on various animal models explored to understand the pathophysiology of PCOS. The article also highlights some environmental and food-related models that have been used to induce PCOS.

Coronavirus disease (COVID-19) has emerged as a fast-paced epidemic in late 2019 which is disrupting life-saving immunization services. SARS-CoV-2 is a highly transmissible virus and an infectious disease that has caused fear among people across the world. The worldwide emergence and rapid expansion of SARS-CoV-2 emphasizes the need for exploring innovative therapeutic approaches to combat SARS-CoV-2. The efficacy of some antiviral drugs such as remdesivir, favipiravir, umifenovir, etc., are still tested against SARS-CoV-2. Additionally, there is a large global effort to develop vaccines for the protection against COVID-19. Because vaccines seem the best solution to control the pandemic but time is required for its development, pre-clinical/clinical trials, approval from FDA and scale-up. The nano-based approach is another promising approach to combat COVID-19 owing to unique physicochemical properties of nanomaterials. Peptide based vaccines emerged as promising vaccine candidates for SARS-CoV-2. The study emphasizes the current therapeutic approaches against SARS-CoV-2 and some of the potential candidates for SARS-CoV-2 treatment which are still under clinical studies for their effectiveness against SARS-CoV-2. Overall, it is of high importance to mention that clinical trials are necessary for confirming promising drug candidates and effective vaccines and the safety profile of the new components must be evaluated before translation of in vitro studies for implementation in clinical use.

Respiratory syncytial virus–associated acute respiratory infection (RSV-ARI) constitutes a substantial disease burden in older adults aged ≥65 years. We aimed to identify all studies worldwide investigating the disease burden of RSV-ARI in this population. We estimated the community incidence, hospitalization rate, and in-hospital case-fatality ratio (hCFR) of RSV-ARI in older adults, stratified by industrialized and developing regions, using data from a systematic review of studies published between January 1996 and April 2018 and 8 unpublished population-based studies. We applied these rate estimates to population estimates for 2015 to calculate the global and regional burdens in older adults with RSV-ARI in the community and in hospitals for that year. We estimated the number of in-hospital deaths due to RSV-ARI by combining hCFR data with hospital admission estimates from hospital-based studies. In 2015, there were about 1.5 million episodes (95% confidence interval [CI], .3 million–6.9 million) of RSV-ARI in older adults in industrialized countries (data for developing countries were missing), and of these, approximately 14.5% (214 000 episodes; 95% CI, 100 000–459 000) were admitted to hospitals. The global number of hospital admissions for RSV-ARI in older adults was estimated at 336 000 hospitalizations (uncertainty range [UR], 186 000–614 000). We further estimated about 14 000 in-hospital deaths (UR, 5000–50 000) related to RSV-ARI globally. The hospital admission rate and hCFR were higher for those aged ≥65 years than for those aged 50–64 years. The disease burden of RSV-ARI among older adults is substantial, with limited data from developing countries. Appropriate prevention and management strategies are needed to reduce this burden.

Theranostic nanoparticles, which consolidate both helpful and symptomatic capacities in a single portion, are guaranteed to impel the biomedical field toward customized prescriptions. The outline of various theranostic methodologies created for the analysis and treatment of infection, with an accentuation on disease, decide the nearness of a molecular target for which a particular medication is planned. The features of diverse imaging tests, for example, MRI, fluorescent markers (organic dyes and inorganic quantum dots), and nuclear medicine lately propels this field and furthermore investigates nanometer-sized structures, called nanomedicines. The first utilization of radioiodine was ostensibly by early imaging-based nuclear theranostic specialists. Imaging with 123I (a γ-producer) and consolidated with treatment imaging with 131I (β and γ producer) has been the foundation of subordinate treatment for separated thyroid malignant growths, and 131I ablative treatment may even be used to treat metastatic sickness. Be that as it may, notably, that dedifferentiated or anaplastic thyroid malignant growth subtypes with poor iodine energy react inadequately with 131I; at present, rehearsed nuclear imaging as PET with the 18F-marked glucose simple, FDG, has altered medication, the job of FDG PET. The idea of cationic 68Ga is the start of a renaissance of 68Ga-generators and 68Ga-radiopharmaceuticals. The patient administration for disease organizing, restaging, and observing treatment reaction for various reimbursable signs, piercingly epitomize the requirement for dynamic focusing on a key component, a significant repeating topic in this chapter, which presents a great theranostic stage appropriate to both medication revelation and clinical use.

In this chapter, we have discussed briefly about the pancreatic cancer, its etiology, and pathogenesis of this deadly disease. In the second section of this chapter, the discussion has been made on the significant issues related to the treatment of cancer, their limitations, and drug resistance. The last section of the chapter covers different types of technologies and mechanisms used for targeting the anticancer drugs in case of pancreatic cancer followed by the available treatments or approaches of treatment and concluding remarks encompassing the treatment and techniques that can be explored in the coming future.

The mortality and morbidity rates for prostate cancer have recently increased to alarming levels, rising higher than lung cancer. Due to a lack of drug targets and molecular probes, existing theranostic techniques are limited. Human LIN28A and its paralog LIN28B overexpression are associated with a number of tumors resulting in a remarkable increase in cancer aggression and poor prognoses. The current review aims to highlight recent work identifying the key roles of LIN28A and LIN28B in prostate cancer, and to instigate further preclinical and clinical research in this important area.

MoS2 is a transition metal dichalcogenide (TMD), currently finding application as a theranostic agent in the category of two-dimensional (2D) substances used in biomedical-based applications. This chapter seeks to expand the knowledge base of MoS2-based nanostructures as related to recent innovations in the biomedical field, highlighting the various functions of these nanomaterials in a diverse set of applications, including bioimaging, photothermal therapy, biosensors, and drug delivery. The remarkable MoS2-based nanomaterial 2D texture provides a nearly perfect interface for use in the burgeoning technology of nanomedicine. The chapter concludes with a brief look at the ongoing serious global health issue of tuberculosis, examining how carbon-based nanomaterials are beginning to be used in treatment.

Introduction: Diabetic neuropathy (DN) is one of the major complications arising from hyperglycaemia in diabetic patients. In recent years polyphenols present in plants have gained attention to treat DN. The main advantages associated with them are their action via different molecular pathways to manage DN and their safety. However, they failed to gain clinical attention due to challenges associated with their formulation development such as lipophilicity,poor bioavailability, rapid systemic elimination, and enzymatic degradation. Area covered: This article includes different polyphenols that have shown their potential against DN in preclinical studies and the research carried out towards development of their nanoformulations in order to overcome aforementioned issues. Expert opinion: In this review various polyphenol based nanoformulations such as nanospheres, self-nanoemulsifying drug delivery systems, niosomes, electrospun nanofibers, metallic nanoparticles explored exclusively to treat DN are discussed. However, the literature available related to polyphenol based nanoformulations to treat DN is limited. Moreover, these experiments are limited to preclinical studies. Hence, more focus is required towards development of nanoformulations using simple and single step process as well as inexpensive and non-toxic excipients so that a stable, scalable, reproducible and non-toxic formulation could be achieved and clinical trials could be initiated.

The highly contagious coronavirus, which had already affected more than 2 million people in 210 countries, triggered a colossal economic crisis consequently resulting from measures adopted by various goverments to limit transmission. This has placed the lives of many people infected worldwide at great risk. Currently there are no established or validated treatments for COVID-19, that is approved worldwide. Nanocarriers may offer a wide range of applications that could be developed into risk-free approaches for successful therapeutic strategies that may lead to immunisation against the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) which is the primary causative organism that had led to the current COVID-19 pandemic. We address existing as well as emerging therapeutic and prophylactic approaches that may enable us to effectively combat this pandemic, and also may help to identify the key areas where nano-scientists can step in.

Skin diseases are the fourth leading non-fatal skin conditions that act as a burden and affect the world economy globally. This condition affects the quality of a patient's life and has a pronounced impact on both their physical and mental state. Treatment of these skin conditions with conventional approaches shows a lack of efficacy, long treatment duration, recurrence of conditions, systemic side effects, etc., due to improper drug delivery. However, these pitfalls can be overcome with the applications of nanomedicine-based approaches that provide efficient site-specific drug delivery at the target site. These nanomedicine-based strategies are evolved as potential treatment opportunities in the form of nanocarriers such as polymeric and lipidic nanocarriers, nanoemulsions along with emerging others viz. carbon nanotubes for dermatological treatment. The current review focuses on challenges faced by the existing conventional treatments along with the topical therapeutic perspective of nanocarriers in treating various skin diseases. A total of 213 articles have been reviewed and the application of different nanocarriers in treating various skin diseases has been explained in detail through case studies of previously published research works. The toxicity related aspects of nanocarriers are also discussed.

Cancer continues to be one of the most challenging diseases to be treated and is one of the leading causes of deaths around the globe. Cancers account for 13% of all deaths each year, with cancer-related mortality expected to rise to 13.1 million by the year 2030. Although, we now have a large library of chemotherapeutic agents, the problem of non-selectivity remains the biggest drawback, as these substances are toxic not only to cancerous cells, but also to other healthy cells in the body. The limitations with chemotherapy and radiation have led to the discovery and development of novel strategies for safe and effective treatment strategies to manage the menace of cancer. Researchers have long justified and have shed light on the emergence of nanotechnology as a potential area for cancer therapy and diagnostics, whereby, nanomaterials are used primarily as nanocarriers or as delivery agents for anticancer drugs due to their tumor targeting properties. Furthermore, nanocarriers loaded with chemotherapeutic agents also overcome biological barriers such as renal and hepatic clearances, thus improving therapeutic efficacy with lowered morbidity. Theranostics, which is the combination of rationally designed nanomaterials with cancer-targeting moieties, along with protective polymers and imaging agents has become one of the core keywords in cancer research. In this review, we have highlighted the potential of various nanomaterials for their application in cancer therapy and imaging, including their current state and clinical prospects. Theranostics has successfully paved a path to a new era of drug design and development, in which nanomaterials and imaging contribute to a large variety of cancer therapies and provide a promising future in the effective management of various cancers. However, in order to meet the therapeutic needs, theranostic nanomaterials must be designed in such a way, that take into account the pharmacokinetic and pharmacodynamics properties of the drug for the development of effective carcinogenic therapy.

The world has a rich diversity of indigenous medicinal plants. The World Health Organization (WHO) gives high priority to eco-friendly, non-hazardous and cost effective healthcare such as the use of medicinal plants to treat various illnesses, including Human immunodeficiency virus (HIV) infection and Acquired immune deficiency syndrome (AIDS), tuberculosis (TB), diabetes mellitus (DM), malaria, and cancer. In developing countries, a high proportion of the population tends to use complementary and alternative medicines (CAM) together with conventional prescription drugs. Globally, CAM has been used in both developed and developing countries. In China, 30-50% of medicinal use is based on traditional alternative medicine. In Africa, it is estimated that 80% of primary health care is CAM, whilst in the USA, about 158 million people us CAM. This increase is due to three main influences: improve their eminence of life, relieve symptoms and preclude long-term complications. Despite the advances and advantages of conventional pharmaceutical medication, these are associated with long-term side effects and pose risks of inefficacy for treatment of chronic diseases such as cancer and DM. The biosynthesis of metal nanoparticles (NPs) using medicinal plants has received considerable attention as a proper alternative to using hazardous chemical and physical synthetic techniques. Plants are being exploited for their unique metal tolerance and effective production of gold metal NPs. A single medicinal plant contains an orchestra of chemical elements (e.g. proteins, vitamins, enzymes, amino acids, polysaccharides and organic compounds) that are "environmentally benign, yet chemically complex" and therefore serve as ideal tools for enhanced medicinal applications. It is reported that phytocompounds such as terpenoids, polysaccharides, polyols and flavones take part in the bio-reduction, stabilization and bio-capping mechanisms to form stable gold and silver NPs. Also the inhibitory potential of plant compounds against diabetic targets followed by a study of enzyme inhibitor kinetics, ligand binding dynamics supported by in silico docking studies that reveal the mode of bioactive compounds and their inhibitory activities. The present review focuses on the potential anticancer, antidiabetic and antimicrobial activity of phyto-synthesized gold and silver NPs. In phytonanotherapy, synergistic features of plant and metal NPs are unique as they offer healing properties that may be the clinical bioequivalent to many synthetic drugs, with minimal side effects. This could provide alternative treatment for chronic diseases that is efficient to overcome the disadvantages of synthetic monotherapy and allows medicinal plant therapy to co-exist with current synthetic treatments. This creates a much needed paradigm shift for further clinical studies in non-communicable and communicable diseases.

Sound stream segregation is an important challenge faced by simultaneously vocalizing animals. In duetting passerine birds, coordinating vocal timing helps minimize overlap. Alternatively, in birds that do not coordinate their vocalizations, sound stream segregation may involve other mechanisms. For example, birds are known to use frequency differences to segregate sound streams, and vocalizing at different frequencies may enable them to remain distinct from each other. Here, I present data showing that conspecific individuals of four species of Asian barbets vocalize at distinctly different peak frequencies from each other. Additionally, they also differ in repetition rate such that each species exhibits two peaks in frequency-repetition rate space. However, conspecific individuals across species do not temporally coordinate with each other during vocal interactions, maintaining independent and highly stereotyped individual rhythms together with different peak frequencies. Frequency differences between individuals may facilitate sound stream segregation when calls overlap in time. I hypothesize that simple, uncoordinated temporal rhythms with different frequencies may have given rise to the more complex coordination seen in duetting birds.

Sodium, an element needed for the normal human physiology is known to be associated with high blood pressure and other consequences if consumed in excess. The assessment of knowledge and behavior related to sodium that is consumed in the form of salt plays an important role in the control of cardiovascular diseases. To control the intake of sodium, dietary sources of sodium need to be identified. To address this, a community-based cross-sectional study was conducted among women aged 20 to 59 years in north India, where knowledge, attitude, and behavior questionnaire given by the World Health Organization and 24-h dietary recall were used. The mean age of the participants was 34.5 years, and the majority of them were homemakers. Approximately, 80% of the participants believed that high salt diet causes serious health problems, and only 5% of the participants were aware of the existence of a recommendation for daily salt intake. Less than 20% of the participants took measures to control their salt intake. Vegetable-based dishes were found to be the major contributors to the daily salt intake followed by pulse-based and cereal-based dishes. This is because of the high quantity in which they are consumed. Food cooked at home contributed to 90% of the daily salt intake. To control the salt intake, we should cut- down the discretionary salt use. Dietary advice should be customized to the individual, and the family physician plays an important role in this. Behavioral change is the need of the hour to control the epidemic of non-communicable diseases.

Eosinophils are bi-lobed, multi-functional innate immune cells with diverse cell surface receptors that regulate local immune and inflammatory responses. Several inflammatory and infectious diseases are triggered with their build up in the blood and tissues. The mobilization of eosinophils into the lungs is regulated by a cascade of processes guided by Th2 cytokine generating T-cells. Recruitment of eosinophils essentially leads to a characteristic immune response followed by airway hyperresponsiveness and remodeling, which are hallmarks of chronic respiratory diseases. By analysing the dynamic interactions of eosinophils with their extracellular environment, which also involve signaling molecules and tissues, various therapies have been invented and developed to target respiratory diseases. Having entered clinical testing, several eosinophil targeting therapeutic agents have shown much promise and have further bridged the gap between theory and practice. Moreover, researchers now have a clearer understanding of the roles and mechanisms of eosinophils. These factors have successfully assisted molecular biologists to block specific pathways in the growth, migration and activation of eosinophils. The primary purpose of this review is to provide an overview of the eosinophil biology with a special emphasis on potential pharmacotherapeutic targets. The review also summarizes promising eosinophil-targeting agents, along with their mechanisms and rationale for use, including those in developmental pipeline, in clinical trials, or approved for other respiratory disorders.

Background & objectives: Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight and obesity. Hence an attempt was made to review the data on trends in childhood overweight and obesity reported from India during 1981 to 2013. Methods: Literature search was done in various scientific public domains from the last three decades using key words such as childhood and adolescent obesity, overweight, prevalence, trends, etc. Additional studies were also identified through cross-references and websites of official agencies. Results: Prevalence data from 52 studies conducted in 16 of the 28 States in India were included in analysis. The median value for the combined prevalence of childhood and adolescent obesity showed that it was higher in north, compared to south India. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was a significant increase from the earlier prevalence of 16.3 per cent reported in 2001-2005. Interpretation & conclusions: Our review shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern.

Cancer is classified as one of the leading causes of global mortality. It has affected millions of people, often with poor prognosis. Having severe side-effects with conventional chemotherapy, alternate drugs and therapies are actively being investigated. There is a need for innovative drug discovery and design as existing cancer therapies are costly and not readily available. Ayurveda and traditional medicine have utilised natural resources such as plants and trees as part of their regime to treat various illness and diseases with positive outcomes. One such tree is Moringa oleifera (MO). Almost all parts have shown to be effective against several ailments including cancer which was attributed to the bioactive constituents. Targeted therapies had led to the development of nanoparticles which are extremely effective in various biomedical applications due to their small size. Green synthesis of gold nanoparticles have great potential as naturally occurring plants and trees such as MO can be used in the synthesis process. The resultant gold phytonanoparticles are useful in cancer therapies with improved survival rates and quality of life. The review highlights the importance of MO in natural medicine, synthesis of phytonanoparticles and the fundamental role as a potential antiproliferative agent against cancer.

Aim: The study aimed to document home-based neonatal care practices and their association with type of birth attendance. Methods: This study was conducted in rural Haryana on mothers who had delivered a live baby one to 2 months prior to interview. The study instrument, administered through home visits, had questions related to cord care, breastfeeding, thermal care, baby handling and healthcare seeking. Logistic regression was performed to test for association [OR; 95% CI] of key newborn care practices with skilled birth attendance. Results: Of the 415 mothers interviewed, 26.7% applied nothing on umbilicus; 15% were kept in skin-to-skin contact with mother; 20.2% were exclusively breastfed in first month. Seeking care in private sector and cost incurred in the treatment for a neonatal illness was significantly higher for male babies. Delivery by skilled birth attendant (68.5%) was associated with applying nothing on the cord [1.8; 1.01–3.25], in skin-to-skin contact with mother for ≥6 h a day [2.21; 1.18–4.13], bathing the baby after third day [14.63; 6.85–31.21] and exclusive breastfeeding [8.84; 3.42–22.8]. Conclusion: The results of this study call for not only upscaling skilled birth attendance but also improving the quality of care currently provided.

Background and Aim: While celiac disease is estimated to affect about 1% of the world's population, it is thought to be uncommon not only in India but in Asia also. There is a lack of studies on the prevalence of celiac disease from Asian nations. The aim of the present study was to estimate the prevalence of celiac disease in the community. Methods: In a cross sectional study, we estimated the prevalence of celiac disease in urban and rural populations in the National Capital Region, Delhi, India. A structured question- naire was administered, by door-to-door visits, to all participants to collect socio- demographic data and to screen for features of celiac disease, namely chronic or recurrent diarrhea and, anemia. In children, additional features, namely short stature (linear height below 5th percentile for age) and failure to thrive/gain weight were also used. All respon- dents who were screen positive (any one of above) and 10% of screen negative individuals were called for serological testing, which is anti-tissue transglutaminase antibody. All serologically positive respondents were invited to undergo further evaluation including endoscopic biopsy. Celiac disease was diagnosed on the basis of a positive serology, the presence of villous atrophy and/or response to gluten free diet. Result: Among 12 573 contacted, 10 488 (83.4%) (50.6% male) agreed to participate. Based on screening, 5622 (53.6%) participants were screen positive. Of all those screen positive, 2167 (38.5%) agreed for serological testing; additionally 712 (14%) negatives were also tested. The overall sero-prevalence of celiac disease was 1.44% (95% confidence interval (CI) 1.22 1.69) and the overall prevalence of celiac disease was 1.04% (95% CI 0.85 1.25). Conclusion: The prevalence of celiac disease in this north Indian community is 1 in 96. Celiac disease is more common than is recognized in India.

Objective To assess the accuracy of cervical screening with visual inspection and cytology testing, and the cure rate of cervical intraepithelial neoplasia (CIN) after treatment, in a rural population in North India. Methods A cross-sectional study evaluated the detection rates of CIN 2 and CIN 3 lesions by cytology testing and by visual inspection of the cervix following the application of 5% acetic acid (VIA) or Lugol's iodine (VILI). It also evaluated the cure rates following treatment of CIN. Results Of 5050 women approached in 17 villages, 3000 (59.4%) participated (range, 41%–91%). Of these, 14.2% were positive by VIA, 15.6% by VILI, and 5.4% by cytology testing at ASCUS threshold, and 37 women were diagnosed as having CIN 1 and 20 as having CIN 2 or CIN 3. Detection rates of CIN 2 or 3 using VIA, VILI, and cytologic findings of ASCUS and LSIL were 3.7, 3.3, 4.5, and 4.2 per 1000 women, respectively, and 91.4% of the treated women were cured. Conclusion Both VIA and VILI were found to be accurate screening tests and the cure rates for CIN were satisfactory.

STUDY OBJECTIVE: To determine the most appropriate surrogate indicator and its cut off point for identifying low birthweight babies in northern India. STUDY SETTING: A secondary level hospital at Ballabgarh. The patients were from nearby rural and urban areas and mostly belonged to lower and middle socioeconomic strata. PARTICIPANTS: These comprised 733 singleton newborns delivered in the hospital between April and December 1991. DESIGN: Birth weight, arm circumference, and chest circumference were measured in all the newborns. Different cut off points for each index were identified and their validity was tested. Based on the regression equations, a simple chart was drawn up and was used to predict weights for different arm and chest circumferences in the hospital and community settings. MAIN RESULTS: Cut off points for arm and chest circumferences of 8.5 cm and 29.5 cm respectively gave a sensitivity and specificity of around 80%. When the chart based on the regression equations was tested in both the hospital and the community, chest circumference was found to be the better of the two indicators. CONCLUSION: Chest circumference seems to be the most appropriate surrogate measure for birth weight. Cut off points of 29.5 cm and 27.5 cm seem to be satisfactory for predicting birth weight below 2500 g and 1800 g respectively. The birthweight prediction card using chest circumference was effective in predicting birth weight.

Iodine deficiency disorders (IDD) are an important public health problem in India with an estimated 270 million people at risk of IDD. India has adopted the strategy of salt iodization for control of IDD and has the goal of "Universal iodization of salt by 1995 and elimination of IDD by 2000". There is a high degree of political commitment which need to continue if the goal is to be achieved. Currently the ban on ale of un-iodized salt is only applicable to salt on human consumption. There is a need for extending the ban to include salt for animal consumption as IDD affects livestock as well. India has the installed capacity to produce its requirement of 5 million tonnes iodised salt. Communication strategies have to be strengthened especially to educate people who have concerns about of iodine toxicity. The success to a large extent depends on the quality control and monitoring of iodine content of salt at all stages from production to consumption. NGO's and the community have to be encouraged to participate in this process. To sustain the elimination of IDD, a partnership of various stakeholders IDD elimination is essential.

Background: 18 500 laboratory-confirmed deaths caused by the 2009 pandemic influenza A H1N1 were reported worldwide for the period April, 2009, to August, 2010. This number is likely to be only a fraction of the true number of the deaths associated with 2009 pandemic influenza A H1N1. We aimed to estimate the global number of deaths during the first 12 months of virus circulation in each country. Methods: We calculated crude respiratory mortality rates associated with the 2009 pandemic influenza A H1N1 strain by age (0-17 years, 18-64 years, and >64 years) using the cumulative (12 months) virus-associated symptomatic attack rates from 12 countries and symptomatic case fatality ratios (sCFR) from five high-income countries. To adjust crude mortality rates for differences between countries in risk of death from influenza, we developed a respiratory mortality multiplier equal to the ratio of the median lower respiratory tract infection mortality rate in each WHO region mortality stratum to the median in countries with very low mortality. We calculated cardiovascular disease mortality rates associated with 2009 pandemic influenza A H1N1 infection with the ratio of excess deaths from cardiovascular and respiratory diseases during the pandemic in five countries and multiplied these values by the crude respiratory disease mortality rate associated with the virus. Respiratory and cardiovascular mortality rates associated with 2009 pandemic influenza A H1N1 were multiplied by age to calculate the number of associated deaths. Findings: We estimate that globally there were 201 200 respiratory deaths (range 105 700-395 600) with an additional 83 300 cardiovascular deaths (46 000-179 900) associated with 2009 pandemic influenza A H1N1. 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 51% occurred in southeast Asia and Africa. Interpretation: Our estimate of respiratory and cardiovascular mortality associated with the 2009 pandemic influenza A H1N1 was 15 times higher than reported laboratory-confirmed deaths. Although no estimates of sCFRs were available from Africa and southeast Asia, a disproportionate number of estimated pandemic deaths might have occurred in these regions. Therefore, efforts to prevent influenza need to effectively target these regions in future pandemics. Funding: None. © 2012 Elsevier Ltd.

BACKGROUND: The role of prevalent culturally driven beliefs and practices in influencing home-based newborn care has not been adequately studied especially in North India. METHODS: The study was conducted in 28 villages under Comprehensive Rural Health Services Project (CRHSP) All India Institute of Medical Sciences (AIIMS). A total of 415 mothers who had a baby in the second month of life at the time of the visit for data collection were interviewed using pre-tested questionnaire. RESULTS: Nearly 77% of mothers reported some beliefs/practices with regard to care of the cord. Similarly 81.0% mothers had beliefs regarding taking the baby out of the house for the first time after birth. Out of all the mothers that were interviewed around 11% did not prefer their baby to be weighed at frequent intervals because according to them doing so could lead to slowing of the growth of the baby. CONCLUSION: Traditional knowledge and practices must be considered before developing neonatal health care intervention strategies.

This study was conducted at a secondary level hospital at Ballabgarth, run by Centre for Community Medicine, All India Institute of Medical Sciences. The still birth rate during the study period 1987-1992 was 19.5 per 1,000 births. It showed a sudden decline during these six years probably reflecting the change in the admission policy of the hospital. A case control study of 72 still births and 144 controls was carried out to identify risk factors for still births. Maternal age, gravidity, previous history of still births or abortion were not found to be significantly associated with still births. Poor socio-economic status measured by parental literacy and occupation were significantly associated with still births. Lack of antenatal care [(OR 9.2 (2.5-37.9)], low birth weight (2500 gms) [OR-18.1 (4.4-74.5)], non-vertex presentation [(OR 41.2 (66-257.3)], maternal illiteracy [OR 2.75 (1.01-11.3)] were found to be the important predictors of still birth as identified by logistic regression analysis. The provision of good antenatal care and improvement of the socio-economic status, especially female literacy, will help in decreasing the still birth rate in the country.

Background Dried blood may be a convenient method of sample collection in epidemiological studies; however, the method needs evaluation in a field settings. In the present study, feasibility of using dried blood for measurement of cholesterol and triglycerides was evaluated in multicenter surveillance study for noncommunicable disease (NCD). Methods Samples were collected in a cross-sectional study for NCD risk factor surveillance conducted in six centers in India. For every tenth subject recruited, a blood sample was also collected on filter paper. These 10% serum samples and dried blood spots were analyzed for cholesterol and triglycerides. Results The mean coefficient of variation (CV) for cholesterol was less than 10% between dried blood and serum in five of the six participating centers. Only one center showed a high CV of 14%. Similarly, the mean bias was less than 10% in five centers. The intraclass correlation between cholesterol values in dried blood and serum were greater than 0.638 in all centers, which suggests a good homogeneity of results. The mean CV for triglycerides ranged from 0.36% to 17.97%. The intraclass correlation between triglyceride values in dried blood and serum ranged from 0.756 to 0.880 in the six centers. Conclusion In conclusion, dried blood would be a good method for collection of blood for measurement of cholesterol and triglycerides for population health surveys. However, the benefits of blood spot analysis should be weighed against potential sources of errors attributable to sampling and other factors, such as temperature and humidity, in a country like India.

Background: Studies in developed nations have reported an association of blindness and hearing impairment with mortality in elderly persons. Objectives: To study the association of blindness and hearing impairment with mortality in a cohort of elderly persons in rural north India. Materials and Methods: This community-based prospective study was conducted in eleven randomly selected villages, in Ballabgarh block, Haryana. A cohort of 1422 participants, of age 60 years and above, was examined at baseline, for their visual and hearing status. Data on the sociodemographic factors, various comorbidities, activities of daily living, and self-rated health were recorded. Baseline data was collected for the period May 2008 to August 2008. Follow-up data collection for mortality was completed in December 2009. The median follow-up period was 518 days. Results: One hundred out of 1422 elderly (7.0%) participants died during the follow-up period. Significant hazard ratios were found after adjustment for various comorbid conditions. On adjustment for sociodemographic factors (age, sex, and literacy), neither blindness nor hearing impairment was found to be significantly associated with mortality. After adjustment for all covariates in the study, hearing impairment (Hazard Ratio = 2.13; 95% CI, 1.29 - 3.54) was found to be significantly associated with mortality in the age group ΃70 years. Conclusions: This study demonstrated that hearing impairment was an independent risk factor for mortality in people aged ΃70 years. Similar studies with a longer period of follow-up are required in India, to guide public health interventions.

Objective To describe the extent of problem of diabetes in rural India based on review of available literature and examine the secular trends over a period of 15 years i.e. from 1994 to 2009. Methods A systematic search was performed using electronic as well as manual methods. Studies providing details of sample size, age group of participants, criteria used for diagnosis, along with the prevalence of any of the three outcomes of interest i.e. diabetes mellitus, impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), were included. Results Analysis of secular trends reveals an increase in diabetes prevalence among rural population at a rate of 2.02 per 1000 population per year. The rate of increase was high in males (3.33 per 1000 per year) as compared to females (0.88 per 1000 per year). High prevalence of IFG and IGT has been observed in southern and northern parts of the country. Conclusion The prevalence of diabetes is rising in rural India. There is a large pool of subjects with IFG and IGT at high risk of conversion to overt diabetes. Population-level and individual-level measures are needed to combat this increasing burden of diabetes.

Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p

Summary: Purpose: To develop and test a clinical case definition for identification of generalized tonic–clonic seizures (GTCSs) by community-based health care providers. Methods: To identify symptoms that can help identify GTCSs, patients with history of a jerky movements or rigidity in any part of the body ever in life were recruited from three sites: the community, secondary care hospital, and tertiary care hospital. These patients were administered a 14-item structured interview schedule focusing on the circumstances surrounding the seizure. Subsequently, a neurologist examined each patient and, based on available investigations, classified them as GTCS or non-GTCS cases. A logistic regression analysis was performed to select symptoms that were to be used for case definition of GTCSs. Validity parameters for the case definition at different cutoff points were calculated in another set of subjects. Results: In total, 339 patients were enrolled in the first phase of the study. The tertiary care hospital contributed the maximal number of GTCS cases, whereas cases of non-GTCS were mainly from the community. At the end of phase I, the questionnaire was shortened from 14 to eight questions based on statistical association and clinical judgment. After phase II, which was conducted among 170 subjects, three variables were found to be significantly related to the presence of GTCSs by logistic regression: absence of stress (13.1; 4.1–41.3), presence of frothing (13.7; 4.0–47.3), and occurrence in sleep (8.3; 2.0–34.9). As a case definition using only three variables did not provide sufficient specificity, three more variables were added based on univariate analysis of the data (incontinence during the episode and unconsciousness) and review of literature (injury during episode). A case definition consisting of giving one point to an affirmative answer for each of the six questions was tested. At a cutoff point of four, sensitivity was 56.9 (47.4–66.0) and specificity, 96.3 (86.2–99.4). Among the 197 GTCS and 26 new non-GTCS patients recruited from hospitals from select SEAR Member Countries, in phase III, the sensitivity of this clinical case definition was 72% and specificity, 100%. A stratified analysis by gender in all the three phases did not show any differences between the sexes. Conclusions: Based on these criteria, we recommend that all patients with a history of two or more episodes of jerking or rigidity of limbs, having a score of ≥4 in the case definition, be identified as having GTCSs and started on antiepileptic medications. This clinical case definition can be very useful for community-based health care providers to identify and manage cases of GTCSs in the community. This should play a major role in the reduction of treatment gap for epilepsy in developing countries.

An estimated 35 million persons with epilepsy today live in developing countries. The diagnosis of some types of epilepsy is complex and requires a high level of sophistication on the part of physicians specializing in neurosciences, supported by high-technology laboratory tests. Conversely, identification of major seizures (grand mal seizures, estimated to account for∼60–70% of all epilepsy cases) is possible by simple observation of a seizure without the help of EEGs, computed tomography (CT), and magnetic resonance imaging (MRI) scans. The major seizures have the highest morbidity and a good outcome if treated early with easily available and effective antiepileptic drugs (AEDs).

The prevalence of obesity in adolescents and children has risen to alarming levels globally, and this has serious public health consequences. Sedentary lifestyle and consumption of calorie-dense foods of low nutritional value are speculated to be two of the most important etiological factors responsible for escalating rate of childhood overweight in developing nations. To tackle the childhood obesity epidemic we require comprehensive multidisciplinary evidence-based interventions. Some suggested strategies for childhood obesity prevention and management include increasing physical activity, reducing sedentary time including television viewing, personalized nutrition plans for very obese kids, co-curriculum health education which should be implemented in schools and counseling for children and their parents. In developing countries like India we will need practical and cost-effective community-based strategies with appropriate policy changes in order to curb the escalating epidemic of childhood obesity.

India has adopted the World Health Organisation’s recommended strategy of National Immunization Days (that is, Pulse Polio Immunization) from the year 1995. Oral polio vaccine (OPV) was introduced at national level in 1985. 1 However, no community based surveillance has been instituted. The data from the sentinel centres based in cities suggest a decline in the incidence of poliomyelitis. 34 As the surveillance is passive and the extent of under reporting is not known, sentinel surveillance may not reflect the true situation in the community. We report our experience with oral polio immunisation and its impact on prevalence of poliomyelitis in Ballabgarh Block of Haryana state in Northern India. The information on poliomyelitis occurrence in this community is available for past 30 years.

Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women′s health.

Introduction Lot Quality Assurance Sampling (LQAS) was developed as technique for quality assurance in industrial production. The use of LQAS in health sciences is limited to coverage evaluations of different health activities such as immunisation coverage, antenatal care coverage, elimination of neonatal tetanus and coverage iodised salt and others. LQAS has been accepted as rapid epidemiological survey method. The present study was carried out to explore the feasibility of using LQAS in Census Verification. Methods Comprehensive Rural Health Services Project (CRHSP) located in northern India, caters to a population of 70 000 spread in 28 villages. All the individuals in the project area have been assigned a 10 digit unique identification number. Every year a health census is carried out to update the computerised health management information system by multi-purpose health workers. Quality control measure of such activity amounts cross verification of records of 25% population by the medical officer. The whole process takes 2 months time. LQAS was applied as a quality control measure for census operation. Village was considered as a Lot. 25% individual IDs were selected randomly from each village for quality check of demographic and health records. Allowable error was fixed at 5%. If the error exceeded the limit of 5% the Lot was considered to be rejected and the whole census process was repeated. Results Four villages were rejected upon using LQAS. The total duration of census operation was similar to previous method. Conclusion LQAS can be used a scientific and robust method of quality control of census verification.

Low birth weight (LBW) is the most important determinant of infant mortality rate (IMR).1 In India, the current IMR is around 72 per 1000 live births and prematurity and LBW account for 49.6% of infant mortality as reported by the government of India in 1990.2 3 To reduce the IMR, early identification, prompt referral and management of low birthweight babies is essential. In India, 80% to 90% of the roughly 20 million births in rural areas, occur at home and are conducted by illiterate and often untrained traditional birth attendants (TBAs). Provision of valid weighing scales at domiciliary level poses logistic (carrying a heavy scale), as well as, operational problems (inability of TBAs to read ). Also, because of sociocultural reasons, parents are reluctant to get their children weighed immediately after birth. To overcome these problems. various surrogate measures like mid-arm circumference (MAC), chest circumference (CC), etc, have been assessed for appropriateness of use to detect LBW newborns.4 In an earlier paper, we had identified cut off points for CC and MAC in hospital births to detect low birthweight newborns.5 Here, we describe the feasibility and validity of the two indicators in identifying low birthweight babies under field situations using health workers. …

Background: Tobacco is the leading cause of mortality globally and in India. The magnitude and the pattern of tobacco consumption are likely to be influenced by the geographical setting and with rapid urbanization in India there is a need to study this differential pattern. Aim: The aim was to study the rural, urban, and urban-slum differences in patterns of tobacco use. Settings: The study was conducted in Ballabgarh block, Faridabad district, Haryana, and was a community-based cross-sectional study. Materials and Methods: The study was conducted in years 2003-2004 using the WHO STEPS approach with 7891 participants, approximately equal number of males and females, selected using multistage sampling from urban, urban-slum, and rural strata. Statistical Analysis: The analysis was done using the SPSS 12.0 statistical package (SPSS Inc., Chicago, IL, USA). Direct standardization to the WHO world standard population was done to and chi-square and ANOVA tests were used for comparison across three study settings. Results: Self-reported tobacco use among males was as follows: urban 35.2%; urban-slums 48.3%; and rural 52.6% (P value P value Conclusion: The antitobacco policies of India need to focus on bidis in antitobacco campaigns. The program activities must find ways to reach the rural and urban-slum populations.

The aim of this study was to determine the impact of training of health workers in the management of pediatric morbidity in terms of reduction in infant mortality rate (IMR) a 2-year period in rural Ballabgarh with a present IMR of 37 per 1000 live births. The study was designed as a pre- and post-intervention trial. The intervention was started in November 1999 and the outcome measured for the years 2000 and 2001. A sample size of 4000 was estimated for a power of 80 per cent at 5 per cent significance level. The training of the workers was for 4 days and included didactics, video-films, patient demonstrations, etc. Data on under-fives' deaths and their causes using a verbal autopsy tool was done as a part of the routine data collection system. The workers management of pediatric morbidity was assessed based on the post-training knowledge gain, forms filled by them, and referrals seen at the secondary level. The knowledge of the workers on disease and their management improved after the initial training but reached a plateau at a 50 per cent score. A review of 948 forms showed that the workers' disease classification and management was not satisfactory, especially for pneumonia and sick neonates. It was better for fever, measles, dysentery, and diarrhoea. A review of 11 cases referred by workers confirmed this. There was no impact on IMR. A look at the cause of death revealed that malnutrition, diarrhoea, and pneumonia to be the main causes among post-neonatal deaths and birth-asphyxia and prematurity as the main cause of deaths in the neonates. While implementing Integrated Management of Childhood Illnesses (IMCI) in India through the health workers, increased emphasis needs to be placed on training and supervision. Community level issues, such as healthcare seeking, female neglect, etc., may limit the scope of reduction in IMR due to implementation of IMCI.

Introduction: In developing countries like India, in addition to the infectious diseases, noncommunicable diseases are emerging as signifi cant causes of morbidity and mortality. Workplaces present a setting which is appropriate for intervention for adults in a community. The aim of this study is to assess the knowledge, attitude and prevalence of selected risk factors for non-communicable diseases. Methods: A cross sectional study was conducted among the regular employees of the factories. Smoking, alcohol consumption, dietary intake and physical activity were measured through interview schedules and height, weight and blood pressure were also measured by standard instrument. An awareness generation program was pre-tested. Results: A total of 545 employees were interviewed. Among them 307 (56.3%) and 238 (43.7%) were manual and non-manual workers respectively. Most of the employees knew [smoking as a risk factor for hypertension (55.2%), heart attack (61.1%) and cancer (78.7%); Alcohol as a risk factor for hypertension (72.1%), heart attack (73.9%), cancer ( 54.9%); Physical inactivity as a risk factor for hypertension (82.6%), heart attack (78.5%), diabetes (60.4%) and high fat diet as a risk factor for hypertension (67.2%), heart attack (64.8%)] that these risk factors lead to different noncommunicable diseases. The prevalence (95% CI) of the risk factors is as follows: male current smoker [40.7% (36.4-45.3)], current alcohol consumption [31.0 % (27.2 – 35.1)], sedentary activity [41.2% (37.0 – 45.5)], high fat intake [93.7% (90.2 - 95.5)], over weight [26.9% (23.2 – 30.9)] ; and hypertension [21.0% (17.62 - 24.6)] Conclusions: This study showed that the risk factors for non-communicable diseases are prevalent in factory employees. Implementation of the risk factors control programme is desirable and there is an interest among employees and management. Key Words: alcohol consumption, diet, over weight, physical activity, risk factor, smoking

Methods The study was carried out in two DOTS centres of Ballabgarh Tehsil of district Faridabad, Haryana. It was a health facility based cross sectional survey. Study subjects were all TB patients (Pulmonary and Extra Pulmonary) who were registered for DOTS. Data was collected from January 2007 to June 2008. We enrolled 413 patients. Eligible subjects were informed about the study objectives and written consent was obtained. Interview schedule was used for data collection. All patients were offered free Liver Function Test. Unlinked anonymous testing on aliquot of LFT blood samples was performed after removing all identifiers. HIV testing was done using three E/R/S