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We report here the identification and validation of prefoldin 5-alpha (PFDN5-α) for the first time as prognostic biomarker for prediction of central nervous system (CNS) leukemia of B cell acute lymphoblastic leukemia (B-ALL) origin. Since cerebrospinal fluid (CSF) cytology being the gold standard of diagnosis for CNS leukemia with poor sensitivity, mandatory prophylactic intrathecal chemotherapy is administered irrespective of patients develop CNS leukemia. Thus, using interactome studies, we identified PFDN5-α as a prognostic biomarker for predicting CNS leukemia by interacting lymphoblastic proteins and CSF from B-ALL patients using far-western clinical proteomics approach. Validation by both western and ELISA methods confirmed our results. For further clinical translation, we performed Receiver Operating Characteristic (ROC) curve analysis generated from CNS +ve (n = 25) and −ve (n = 40) CSF samples from B-ALL patients and identified PFDN5-α-CSF reactivity cut-off value as 0.456. Values below 0.456 indicate the patient is at risk of developing CNS leukemia and suggestive of having intrathecal chemotherapy. Further flow cytometry validation for CNS leukemia positivity revealed that with increasing blast cells, a decrease in PFDN5-α-CSF reactivity confirming ELISA based PFDN5α-CSF reactivity assay. Predicting CNS leukemia development risk by ELISA based PFDN5-α-CSF reactivity assay could have potential in the clinical management of CNS leukemia.

Left ventricular hypertrophy (LVH), the most common structural cardiac complication, is the single most important cause for sudden cardiac death. There are no published data from India looking at the changes in left ventricular mass and cardiac dysfunction after kidney transplantation. We aimed to determine the changes in the left ventricular mass and other cardiovascular risk factors in kidney transplant recipients. This was a prospective observational study. All patients who underwent kidney transplantation at Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, during the study period were included in the study. Measurement of clinical and biochemical parameters and echocardiography were done before, six months, and one year after transplantation. There was significant reduction in LV mass index (124.8 ± 39 vs. 102.2 ± 24.4 g/m2, P

BACKGROUND Hand transplantation and advances in the field of prostheses have opened new frontiers in the restoration of hand function among bilateral hand amputees (BHA). There is only scarce literature evaluating the health utility (HU) and quality adjusted life years (QALY) gained by bilateral hand composite tissue allotransplantation (CTA) or prosthesis over amputation. The study was focused on BHA restored with prosthesis or CTA. METHODS The HU of three different health states (HS) namely, BHA, using prosthesis or with CTA and net QALYs gained by hand transplantation or prosthesis over amputation were computed by time trade-off (TTO) method among 236 study participants. RESULTS Among 236 study participants, medical professional (120), general public (89), BHA (23), and bilateral hand transplant recipients (4) were included. The mean HU by TTO method among the study participants (n = 232) as BHA, using prosthesis or CTA was 0.34 (±0.24), 0.50 (±0.26) and 0.69 (±0.26) respectively. Bilateral hand CTA imparted an expected gain of 12.57 (±11.43) mean QALYs over amputation among the study participants. The subgroup analysis displayed higher mean HU in hand CTA recipient HS along with maximum QALY gained by CTA over amputation. CONCLUSIONS Bilateral hand CTA HS stands above the other 2 HSs, namely BHA and prosthesis, in terms of the health utility. As demonstrated by QALY gain of 12.57, participants' valuation of health utility is notably higher for CTA with acceptance of lifelong immunosuppressant rather than for a state of uncompromised physical health with a bilateral hand amputation.

Objectives/hypothesis In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-a-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. Study design Prospective, observational. Methodology Sixty-five children, aged 0.4–36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used.Results: FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061–0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). Conclusion FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.

Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.

Background: There has been no previous study that has investigated the effect of a low glycemic index (LGI) diet with local recipes of South Indian cuisine on the body fat composition using dual-energy X-ray absorptiometry (DXA). Truncal obesity has been associated with the risk of metabolic disorders and cardiovascular diseases. Aim: The aim of this study was to examine the effect of a low GI diet on glycemic control and body composition in people with type 2 diabetes in South India. Method: This was a prospective and randomized controlled study that was conducted over a period of 24 weeks. A total of 40 participants were recruited from the Department of Endocrinology and Diabetes Outpatient in Kerala, South India. All the patients had type 2 diabetes and were randomly assigned and given advice and instructions to follow either a low GI diet plan (n = 18) or their usual diet, which served as control (n = 18). The advice was reinforced throughout the study period. Dietary compliance was evaluated based on a 24 h dietary recall at weeks 3, 11, 12, 18, 23, and 24. The age of the subjects ranged from 35 to 65 years. Anthropometric, body composition, and cardio-metabolic parameters were measured according to standard procedures. T-tests were conducted to compare differences between intervention and control groups and the Pearson correlation coefficient was used to evaluate associations between the variables. Results: There were significant reductions (p &lt, 0.05) in the low GI diet compared to the control group with respect to weight, body mass index (BMI), and triceps skinfold thickness. Similarly, significant reductions were observed in the low GI diet group with respect to region, total fat, android, and gynoid fat mass and the differences between the groups were significant at p &lt, 0.05. There was also a positive correlation between BMI and android fat mass (r = 0.745), total fat mass (r = 0.661), total truncal mass (r = 0.821), and truncal fat (r = 0.707). There was a significant reduction in glycated hemoglobin in the low GI diet group compared to the control group at p &lt, 0.05. Conclusion: This study has demonstrated that there was a significant reduction (p &lt, 0.05) of truncal obesity and glycated hemoglobin in patients with type 2 diabetes on a local diet of South Indian cuisine with low GI compared with the control.

BACKGROUND Microsatellite instability (MSI) accounts for 15-20% of colorectal cancer (CRC) and is considered to have favorable stage-adjusted prognosis compared to Microsatellite stable (MSS) CRCs. Determination of MSI in stage II CRC is important for management decisions regarding adjuvant chemotherapy administration. The aim of this study was to determine the prognostic and predictive significance of MSI in stage 2 CRC in the Indian scenario. MATERIALS AND METHODS A total of 195 patients who underwent curative surgery for stage II CRC from 2010 to 2017 were included. MSI testing by immunohistochemistry (DNA MisMatch Repair proteins) was performed in all. Various clinicopathological factors and disease-free survival and overall survival were assessed between MSI and MSS groups. The effect of treatment in terms of survival benefits with adjuvant therapy in the MSI group was also assessed. RESULTS 27.1% of the CRCs' showed MSI. Younger age (

To assess the efficacy of hyperbaric oxygen therapy (HBOT) in patients with hypoxic ischemic encephalopathy (HIE).Non-randomized case-control observational study.Tertiary level neurorehabilitation unit.Twenty-five patients with HIE seen between 1 to 12 months after the injury and having a coma recovery scale-revised (CRS-R) score less than 7 at entry were recruited.Out of the patients who received HBOT, 20 received 20 sessions of HBOT at two absolute atmosphere pressure (ATA), and two received 60 sessions at 2 ATA over three different treatment intervals. We compared the outcomes between cases (who received HBOT) and controls (who did not receive HBOT).Cases and controls were allocated to three groups based on the time interval after injury following which they were recruited to the study: 1-3 months (9 cases and 16 controls), 4-8 months (9 cases and 9 controls) and 9-12 months (8 cases and 3 controls).CRS-R, Karnofsky performance scale, and change in disorder of consciousness (DOC) at admission and discharge were assessed.We observed a significant difference in CRS-R favoring the HBOT group at time intervals of 1-3 and 4-8 months. More patients in the HBOT group improved in DOC than the control group.HBOT given in the first nine months post-HIE can result in a better recovery and functional outcome.

To determine the correlation between our questionnaire scores and two standard Parkinson's disease (PD) disability scores [Unified Parkinsons' Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y)], and to study the correlation between the various subgroups of our dysphagia screening questionnaire.This study was conducted at a movement disorder clinic in a tertiary care hospital in Kochi, Kerala. This was a cross-sectional observational study.A questionnaire was developed comprising 11 items, keeping in mind the most relevant swallowing issues in PD patients. The questions were subdivided into four groups representing the different stages of swallowing. Reliability and validity studies were conducted for the questionnaire. Corresponding UPDRS and H and Y scores were documented on the same day.Mean and standard deviation (SD) values of the scores in each group and the correlation between scores (Pearson correlation coefficient) were done.Responses were obtained from 106 PD patients (67 males, 39 females), with a mean age of 66.9 years (SD, 8.62). Our questionnaire score showed a high coefficient of variation (145%) compared to the UPDRS and H and Y scores. There was also moderate correlation between our questionnaire score and the two standard scores with a significant P value. Finally, the highest mean scores were for questions from group A and the least for questions from group D.The association between worsening motor symptoms and swallowing difficulties has been documented in this study. The oral stage of swallowing remains the most affected in PD, which can be recognized early using our questionnaire.

Background: The optimal dose of tranexamic acid in minimizing perioperative bleeding is uncertain. We compared efficacy of two different doses of tranexamic acid in reducing post-operative blood loss and its side effects in patients with congenital cyanotic heart disease undergoing cardiac surgery. Settings and Design: Prospective observational study at a pediatric cardiac center in South India. Methods: Consecutive cyanotic patients undergoing cardiac surgery were divided into groups I and II to receive either 10 mg/kg or 25 mg/kg of tranexamic acid administered as triple dose regime after induction, during cardiopulmonary bypass, and after protamine. Post-operative blood loss at 24 hours, blood component utilization, incidence of renal dysfunction and seizures were compared. Results: Totally, 124 patients were recruited, 62 in each group. The pre-operative variables and cardiopulmonary bypass time were comparable. Patients receiving 25 mg/kg had lower post-operative blood loss compared to patients in lower dose group (8.04 ± 8.89 vs 12.41 ± 19.23 ml/kg/24 hours, P = 0.03). There was no difference in the transfused volume of packed red cells (9.21 ± 7.13 ml/kg vs 12.41 ± 9.23 ml/kg, P = 0.712), fresh frozen plasma (13.91 ± 13.38 ml/kg vs 11.02 ± 8.04 ml/kg, P = 0.19), platelets (9.03 ± 6.76 ml/kg vs 10.90 ± 6.9 ml/kg, P = 0.14) or cryoprecipitate (0.66 ± 0.59 ml/kg vs 0.53 ± 0.54 ml/kg, P = 0.5) in group II and I, respectively. Two patients developed renal dysfunction secondary to low cardiac output in lower dose group. There were no seizures. Conclusions: Tranexamic acid administered at a dose of 25 mg/kg as triple dose regime is associated with lower post-operative blood loss compared to a lower dose of 10 mg/kg in cyanotic patients undergoing cardiac surgery without causing major adverse effects.

Background and rationale Coronary artery disease (CAD) and its pathological atherosclerotic process are closely related to lipids. Lipids levels are in turn influenced by dietary oils and fats. Saturated fatty acids increase the risk for atherosclerosis by increasing the cholesterol level. This study was conducted to investigate the impact of cooking oil media (coconut oil and sunflower oil) on lipid profile, antioxidant mechanism, and endothelial function in patients with established CAD. Design and methods In a single center randomized study in India, patients with stable CAD on standard medical care were assigned to receive coconut oil (Group I) or sunflower oil (Group II) as cooking media for 2 years. Anthropometric measurements, serum, lipids, Lipoprotein a, apo B/A-1 ratio, antioxidants, flow-mediated vasodilation, and cardiovascular events were assessed at 3 months, 6 months, 1 year, and 2 years. Results Hundred patients in each arm completed 2 years with 98% follow-up. There was no statistically significant difference in the anthropometric, biochemical, vascular function, and in cardiovascular events after 2 years. Conclusion Coconut oil even though rich in saturated fatty acids in comparison to sunflower oil when used as cooking oil media over a period of 2 years did not change the lipid-related cardiovascular risk factors and events in those receiving standard medical care.

Background: Inflammation is considered as a predictor of cardiovascular diseases in type 2 diabetes mellitus. No previous studies have investigated the effect of low glycemic index (LGI) recipes of South Indian cuisine on the risk factors of cardiovascular disease in patients with diabetes. Aim: The aim of this randomized controlled trial was to evaluate the improvement in cardiovascular risk factors and blood glucose control, in patients with type 2 diabetes, after intervention with recipes of Kerala cuisine, from locally available whole grain cereals, low in glycemic index. Method: This was a prospective and randomized controlled study that was conducted over a period of 24 weeks. A total of 80 participants were recruited from the Department of Endocrinology and Diabetes Outpatient in Kerala, South India. All 80 patients had type 2 diabetes, and were aged between 35 and 65 years. Participants were randomly assigned and advised to follow either a LGI diet plan (n = 40) or their usual diet, which served as a control group (n = 40). The advice was reinforced throughout the study period. Anthropometric, biochemical parameters which included glycemic and cardio-metabolic parameters were measured according to standard procedures. T-tests were conducted to compare the differences between intervention and control groups, and the Pearson correlation coefficient was used to evaluate associations between the variables. Results: There were significant differences (p &lt, 0.05) between the intervention and control groups with respect to weight, HbA1c, insulin, triglycerides, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), high sensitivity C-reactive protein (hs-CRP) and apolipoprotein B (ApoB). There was also a positive correlation between weight and blood glucose variables. ApoB was positively correlated with lipid profile and insulin levels. Conclusions: The long-term implementation of LGI diet of Kerala cuisine has been found to promote weight loss, enhance insulin sensitivity and reduce the cardiovascular risk.

Objectives. To study the impact of modular training and implementation of infection control practices on all health-careassociated infections (HAIs) in a cardiac surgery (CVTS) program of a tertiary care hospital. Design. Baseline data were compared with post-intervention (with modular training) data. Settings. This study was conducted in a cardiovascular surgical unit. Participants. In total, 2838 patients were admitted in cardiovascular surgical service. Interventions. Two training modules and online continuous education were delivered to all health-care workers in CVTS unit. Main Outcome Measures. All four HAIs, such as surgical site infections (SSI), central line-associated blood stream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CA-UTI), were studied. Additional outcome measures included average length of stay cost of avoidance mortality and readmission rates. Results. The SSI rate had decreased in the post-intervention phase from 46 to 3.27% per 100 surgeries (P , 0.0001), CLABSI had decreased from 44 to 3.10% per 1000 catheter days (P , 0.009), VAP was reduced from 65 to 4.8% per 1000 ventilator days (P , 0.0001) and CA-UTI had reduced from 37 to 3.48% per 1000 urinary catheter days (P , 1.0). For every $1 spent on training, the return on investment was $236 as cost of avoidance of healthcare associated infections (HAIs). Conclusions. Standardization of infection control training and practices is the most cost-effective way to reduce HCAIs and related adverse outcomes.

To study the profile of alcoholic liver disease in India, 144 consecutive, histologically diagnosed patients were prospectively studied. The patients were divided into those having alcoholic fatty liver (AFL) (Gr. I, n = 32), alcoholic hepatitis (AH) (Gr. II, n = 42) and alcoholic cirrhosis (AC) (Gr. III, n = 70) on the basis of their histological findings. All the patients were males, those with fatty liver being younger than those with cirrhosis. The amount of alcohol consumed by patients with AFL, AH and AC was not significantly different. Similarly, the duration of alcohol consumption was not significantly different between the three groups of patients. The clinical features of the patients were quite similar to those reported from the West, except that AH was relatively milder in our patients. Intake of poor quality country liquor was quite common (60%), but its use was not found to be associated with more severe liver injury as compared with the use of good quality foreign varieties of liquor.

This article aims to describe the National Family Health Survey (NFHS) being carried out in India with its first round during 1992-93 (NFHS-I) and second round during 1998-99 (NFHS-II), with special reference to information available in relation to children. The survey was on lines of the existing systems of Demographic Surveys (DHS) in various developed as well as developing countries. Another important objective of the survey was to provide quality data to the researchers to carry out analytical work on various aspects. Further, the survey has paved the way to carry out comparative studies not only between states in India but also between countries. An attempt has also been made here to present salient features of comparative results under NFHS-I and NFHS-II.

For the first time, models using multilevel analysis of Indian data and related simulation results are reported. They take hierarchical structure into account and incorporate variables from all levels to get correct analysis and proper interpretation of data on current contraceptive use (including sterilization and modern methods).The data from an Indian State, Uttar Pradesh (UP), collected by the National Family Health Survey (NFHS) conducted during 10 October 1992 to 22 February 1993 was used. For model I, 7851 currently married women who were neither pregnant nor had continuing post-partum amenorrhoea (PPA) were considered. For model II, these women with at least one child (n = 6748) were used. Two-level logistic regression analysis was carried out for which women's level (level 1) and PSU (Primary Sampling Unit) level (level 2) variables were considered. The results were considered significant at the 5% level of significance. Simulation analysis using each model was also carried out.Model I reveals that those more likely to adopt contraception were women exposed to a TV message (odds ratio [OR] = 1.3; 95% CI: 1.1-1.6); whose houses were pucca (bricks and mortar) (OR = 1.3; 95% CI: 1.1-1.5); who were educated to high school level and above (OR = 2.9; 95% CI: 2.2-3.7); whose husbands were literate with schooling ofor =11 years (OR = 1.7; 95% CI: 1.4-2.1); and who hador =2 living sons (OR = 2.2; 95% CI: 1.1-4.4). Muslim and other religious women were less likely than Hindu women to adopt contraception (OR = 0.5; 95% CI: 0.4-0.6). Also, the PSU level availability of all weather road was positively associated with contraceptive adoption (OR = 1.4; 95% CI: 1.1-1.7). The PSU level variance, which is the unexplained PSU level variation after controlling for the considered characteristics, was significantly higher. The simulation results revealed that public health education (a TV message) was found to be more effective among less educated women. The PSU level availability of all weather road was as effective as public health education. Similar results were evident from the analysis of second data set (model II) with the noticeable finding that those whose last child is surviving are most likely to adopt contraception (OR = 8.82; 95% CI: 1.01-77.38).These results reveal that the survival status of the last child has a marked effect on the adoption of contraception in UP. They further support the idea that public health education (a TV message) is more effective among less educated women. Also, the PSU level presence of all weather road is equally effective. Consideration of higher level variables provides not only more accurate results but also important public health clues to help the policy planners.This study examined models for contraceptive adoption in Uttar Pradesh (UP) using a multilevel analysis technique. Data were obtained from an Indian State, UP, collected by the National Family Health Survey conducted from October 1992 to February 1993. 7851 currently married women who were neither pregnant nor had continuing postpartum amenorrhea were considered for model I, while 6748 women with at least one child were used for model II. Two-level logistic regression analysis was carried out, for which women's level (level 1) and primary sampling unit (PSU) (level 2) level variables were taken into account. Findings revealed that, in model I, women who were exposed to a TV message (odds ratio [OR] = 1.3; 95% confidence interval [CI]: 1.1-1.6), whose houses were made of bricks and mortar (pucca) (OR = 1.3; 95% CI: 1.1-1.5), who had a secondary education or above (OR = 2.9; 95% CI: 2.2-3.7), who had literate husbands (OR = 1.7; 95% CI: 1.4-2.1), and who had 2 or more living sons were more likely to adopt contraception. In addition, the PSU level availability of all weather road was positively associated with contraceptive adoption (OR = 1.4; 95% CI: 1.1-1.7). The PSU level variance, which was the unexplained PSU level variation after controlling for the considered characteristics, was significantly higher. In conclusion, the survival status of the last child has a marked effect on the adoption of contraception in UP.

Assessment of the efficacy of iron therapy has usually been done in populations/patients by monitoring changes in hemoglobin concentration, serum iron, percent transferrin saturation, and serum ferritin. In this study the protoporphyrin heme (P/H) ratio (a measure of free erythrocyte protoporphyrin) was measured before and after iron therapy in three groups of pregnant women, who received 60 mg (group A), 120 mg (group B), and 240 mg (group C) of elemental iron with folic acid (0.5 mg) per day for a period of 12 weeks, to evaluate its efficacy to monitor iron therapy. The three groups were comparable regarding the initial mean Hb concentration and serum ferritin levels. The initial mean P/H ratios were markedly elevated in all three groups and were different in the three groups, being highest in group A (113.2+/-92.6), intermediate in group B (87.5+/-62.5), and lowest in group C (69.8+/-43.3). The initial P/H ratio was significantly higher in group A than in group C (p0.05). This probably affected the efficacy of iron therapy in the three groups. The P/H ratio decreased significantly in each of the three groups after iron therapy (A and B: p0.001; C p0.01). Mean Hb concentration and serum ferritin increased in all three groups post therapy; however, the magnitude of change in P/H ratio in all three groups was much greater. This indicated that the predominant contributory factor for anemia was iron deficiency in this group of pregnant women. Serum iron and percent transferrin saturation are difficult to interpret in our population, as iron is freely available over the counter and is prescribed as soon as anemia is detected in patients; therefore, the reduction in P/H ratio may be used to monitor response to iron therapy in population groups.

Cerebral palsy is a major cause of crippling in children, but it's etiology is poorly understood. This case control study was done to assess some of the identified risk factors for cerebral palsy, 125 cerebral palsy cases selected from hospital clinic and 125 age and sex matched neighbourhood controls, all aged less than 5 years and residing in Delhi (India) were studied. Information regarding antenatal, natal and postnatal period was collected by mother's interview, and wherever available, from hospital records with the study subjects. Most common type of cerebral palsy was spastic (88%). Quadriplegia was the commonest topographical subtype (86.4%). Birth asphyxia was found to be present in only 25.6% of cases. The commonest risk factor amongst cases was low birth weight (28.8%). The multivariate odds ratios (confidence limits) for the risk factors found to be significantly associated with cerebral palsy were 36.1 (7.76-160) for birth asphyxia, 13.8 (4.95-38.3) for low birth weight, 37.4 (4.47-313) for neonatal convulsion, 23 (4.7-112) for neonatal jaundice, 14.4 (3.69-56.4) for neonatal infection, 24.9 (2.78-223) for instrument assisted delivery and 15.4 (1.57-152) for antepartum hemorrhage. Precipitate labour, caesarean section, twins, toxemia, breech delivery and head injury were not found to be significantly associated with cerebral palsy. Thus birth asphyxia, low birth weight, neonatal convulsions, neonatal jaundice, neonatal infection, instrument assisted delivery and antepartum hemorrhage are significant risk factors for cerebral palsy.

Maximum likelihood method with probit transformation was applied to estimate median age at which chest circumference (CC) overtook head circumference (HC) in 1206 children from rural areas of Ballabhgarh in Haryana and in 1505 children from a slum population in Delhi. The results showed that, in case of rural area, this phenomenon occurred at an average age of 31.36 months and in children from urban slums, at an average age of 28 months. In both the areas, this phenomenon occurred at an average age of 20 to 21 months in normally nourished children. In children with grade I malnutrition, this was delayed by about 10 months as compared to those with normal nutrition and in children with grade II or worse malnutrition, this was further delayed by another 9 to 13 months on an average as compared to those with grade I malnutrition. These differences were found to be statistically significant (p < 0.001). These results indicate that the longer the delay in CC overtaking HC, the chance is higher for the children to be severely malnourished. Considering the relative ease of measuring head and chest circumferences, this parameter (age of CC crossing HC) could be useful in assessing the long term trend in the improvement of childhood nutrition in developing countries.

To test the hypothesis that fluconazole plus standard care is superior to the standard care for diabetic foot wounds infected with deep-seated fungal infections.We carried out a randomized, controlled, open-label, parallel-arm study in 75 patients with both fungal and bacterial infections in deep tissues of diabetic foot wounds. Thirty-seven patients (control group) were given standard care (surgical debridement + culture-specific antibiotics + offloading + glycaemic control) and 38 patients (treatment group) were given fluconazole 150 mg daily plus standard care. Wound surface area was measured every 2 weeks until the endpoints (complete epithelialization or skin grafting) were met.By week 4, the mean wound surface area reduced to 27.3 from 111.5 cm(2) in the treatment group, as opposed to 67.1 from 87.3 cm(2) in the control group. Subsequently, the mean wound surface areas were remarkably smaller in the treatment group compared with the control group, and statistically significant differences (P ≤ 0.05) in mean wound surface area were observed between the treatment group and the control group at week 6. However, no statistically significant (P ≤ 0.47) difference in complete healing was observed between the treatment group and the control group, 20 vs. 24. The mean wound healing time for the treatment group was 7.3 weeks, whereas for the control group it was 11.3 weeks (P ≤ 0.022). Similarly, the probability of wound healing in the treatment group was 50 vs. 20% in the control group at week 10.Fluconazole plus standard care was superior to standard care alone in accelerating wound reduction among patients with diabetes with deep-seated fungal infections in diabetic foot wounds. Those in the treatment group who did heal, healed more quickly (P ≤ 0.022), but overall healing was not different.

Naloxone-induced withdrawal was studied in seven patients currently dependent only on injecting buprenorphine, within 3 to 6 hours of their last dose. Withdrawal severity began to rise from 5 minutes and reached a peak at 60 minutes after 1.2 mg naloxone given intravenously. The mean withdrawal severity score was significantly higher at 30, 60 and 90 minutes compared to the baseline. The most frequent withdrawal signs and symptoms were mydriasis, systolic hypertension, tachypnoea, muscle pains, yawning, anxiety, restlessness and craving.

A cross-sectional survey of 507 in- and out-patients, with diagnosed Type 2 diabetes mellitus (T2DM) was undertaken to study the relationships between personal, disease and treatment-related factors and diabetes control in a tertiary care hospital. On multivariate logistic regression analysis, self-efficacy (odds ratio (OR) = 2.94; 95% confidence interval (CI) = 1.92–4.54); P < 0.001) was the single most important determinant of current diabetes control (HbA1c ≤ 7%), along with absence of hyperglycemic symptoms in the past year (OR = 1.83; 95% CI = 1.15–2.93, P < 0.01), current treatment with oral medication (OR = 1.77; 95% CI = 1.17–2.66; P < 0.007), and adherence to dietary restrictions (OR = 2.7; 95% CI = 1.28–5.88; P < 0.009). Self-efficacy was itself influenced by educational status, employment, availability of family support, and positive mental attitudes. Our findings suggest that health care delivery inputs, patients’ personal characteristics including education and attitude, and family support for care are complexly processed to determine patients’ ability to manage their disease, which ultimately influences disease outcomes.

To determine the frequency of chromosomal aberrations particularly 22q11 deletion in Indian children ≤2 years with different types of conotruncal malformations and their association with abnormal aortic arch. Additionally, extracardiac features were also studied.Conventional cytogenetic and fluorescence in situ hybridization analyses were performed in 254 patients with conotruncal defects. Multivariable logistic regression analysis was performed to ascertain extracardiac features helpful in identifying high-risk patients with deletion.Chromosomal abnormalities were identified in 52 (21%) children, of whom 49 (94%) showed 22q11 deletion and 3 (6%) had abnormalities of chromosome 6, 2 and X. None of the 11/254 children with tetralogy of Fallot with absent pulmonary valve showed deletion. The association of 22q11 deletion with right sidedness of the aortic arch varied with the type of conotruncal defect. The eight extracardiac features in combination showed 93.5% agreement with the presence of deletion.The extracardiac features along with specific type of conotruncal defect and associated cardiovascular anomaly should alert the clinician for 22q11 deletion testing. However, if deletion analysis is not possible, specific extracardiac features (six dysmorphic facial features, thin long fingers and hypocalcemia) can help to identify an increased risk of 22q11 deletion in patients with conotruncal defect.

Dental fluorosis is a major public health problem in 17 states of India. Earlier studies have reported that Jowar (a type of millet) consumption interacts with fluoride (F) in the body and enhances fluorosis. We conducted this study to determine the association between jowar consumption and severity of dental fluorosis.A community based case control study was carried out in villages having different F levels (low, medium, and high) in drinking water in North Karnataka, India. 352 school Children (12-15 years, male 58%) with severe dental fluorosis classified by ThylstrupFejerskov Index (1988) were selected as cases. 428 school children (12-15 years, male 48.8%) with no dental fluorosis were selected randomly from the same area as controls. Exposure ascertainment of jowar consumption was done by 24-h diet recall and food frequency questionnaire. Ion selective electrode method was used to estimate the F level in spot urine samples of subjects and in drinking water. Multiple logistic regression analysis was done using SPSS V. 11.01Children who consumed jowar had 2.67 times more chance of getting severe dental fluorosis compared to those who did not [Odds Ratio (OR) 2.67, CI 1.98-3.62]. Children from high F level villages (OR 1.91, CI 1.27-2.85) had higher odds of severe dental fluorosis compared to children from medium and low F level villages. Daily jowar consumers (OR 2.14, CI 1.64-3.09) and weekly consumers (OR 1.68, CI 1.31-3.45) had higher risk for dental fluorosis compared to non jowar consumers. Children who started consuming jowar before 8 years of age had significantly higher proportion of severe dental fluorosis compared to their counterparts. Urinary F excretion among jowar consumers was significantly lower than non-jowar consumers.Jowar consumption was positively associated with severity of dental fluorosis in this population.

The aim of the study was to examine the association of a trend in body mass index (BMI) status with current blood pressure in a cohort of school children from South India. A population of 25,228 children was selected using stratified random sampling method. Height and weight were measured in 2003-2004. Height, weight and blood pressure were measured in 2005-2006. A total of 12,129 children aged 5-16 years having paired data were analysed. Blood pressure and BMI values were converted to Z scores using International paediatric reference values. An increase in Z BMI meant that the child is moving to a higher BMI level with respect to his or her age and sex. In the cohort, 62.4% children had a higher Z BMI at follow-up than at baseline. Children with higher Z BMI at follow-up were labelled as positive BMI status group (PBSG) and the remaining as negative BMI status group (NBSG). The positive trend in BMI was more in rural areas, government schools and girls. In all subgroups, PBSG showed significantly higher systolic blood pressures (SBPs) than NBSG. PBSG showed significantly higher diastolic blood pressures (DBPs) in urban area, government schools and girls when compared with NBSG. Prevalence of first instance systolic hypertension was more in PBSG in all the subgroups except in rural children. Prevalence of diastolic hypertension was significantly higher in PBSG in urban subgroup only. BMI status trends are associated with blood pressure distribution in children.

Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III and IV carcinoma of the upper aero-digestive tract undergoing major resections in a randomized single-blind study. Ampicillin, gentamicin, cephalexin and metronidazole were used in different combinations for periods of 5 or 10 days. A cephalexin-metronidazole protocol for 10 days was associated with lowest post-operative infection rate. Oral-oropharyngeal resection and use of pectoralis major myocutaneous flap were the most important factors contributing to infection.

A prospective randomized study was conducted to compare the efficacy of long-term endoscopic sclerotherapy vs. propranolol in Child class B and C patients with variceal bleeds within the 30 days before the study. Forty-five and 46 patients were randomized to receive sclerotherapy and propranolol, respectively, after preentry stratification for Child scores. Sclerotherapy was administered with 1% polidocanol at 10-day intervals until obliteration of varices was achieved. Propranolol was administered to achieve a reduction in resting pulse rate of 25%. Rebleeding occurred in 19 patients undergoing sclerotherapy and in 31 receiving propranolol (p less than 0.05). The number of episodes of rebleeding was higher (p less than 0.05) in the propranolol group (n = 64) than in the sclerotherapy group (n = 35). The mean bleeding risk factor, number of hospitalizations for rebleeding and blood transfusion requirement were also significantly higher in the propranolol-treated patients. The median bleed-free period was more than 36 mo in the sclerotherapy group and 2.5 mo in the propranolol group (p less than 0.01). The median survival time was significantly longer in the sclerotherapy group (greater than 36 mo) than in the propranolol group (greater than 24 mo). We conclude that in decompensated cirrhotic patients, long-term endoscopic sclerotherapy is superior to propranolol in preventing rebleeding and improving survival.

To establish the normal limits for various pulsed Doppler echocardiographic indices of left ventricular diastolic function, 92 healthy volunteers aged from 5 to 75 years were prospectively studied. The influence of various variables including age, gender, body surface area, fractional shortening, and left ventricular mass on these parameters was also assessed. Mean (2SD) values for 15 direct and 11 derived parameters were analyzed from transmittal inflow velocity waveform. No statistically significant differences were observed between males and females for any of these parameters. On stepwise multivariate linear regression analysis, age was found to be an independent strong determinant (p < 0.001) of peak velocity of early diastolic filling wave, area of atrial filling period, deceleration slope, normalized peak filling rate, and early filling fraction. There was a significant correlation between heart rate and time to peak early diastolic velocity, total diastolic time period, early diastolic period, atrial filling period, and atrial filling fraction. It was further observed that a significant correlation (p < 0.001) persisted between both age and heart rate with area of early filling period, one-third filling area, one-half filling area, ratio of early to atrial peak velocity and area, atrial filling fraction, and one-third filling fraction. None of the parameters were found to correlate with fractional shortening or left ventricular mass. Thus an effort was made to establish normal limits for various Doppler-derived parameters in healthy volunteers for future comparison in diseased states. Age and heart rate were found to have a significant influence on pattern of diastolic filling and should be taken into account while studying transmittal flow pattern in diseased states.

India is in the transition phase from iodine deficiency to iodine sufficiency, and this is expected to change the thyroid status of the population. The thyroid status and auto-immune status of adult Indian population in the postiodisation phase is largelyunknown, and this study was conducted to answer this question. A cross-sectional population survey was conducted in two phases among the residents of urban coastal area of central Kerala. The initial phase included a house-to-house survey of 3069 adults (18 years of age), selected by cluster sampling method. From the surveyed population, 986 subjects underwent further physical examination and biochemical evaluation for thyroid function, thyroid autoimmunity status and iodine status. The total prevalence of goitre was 12.2% and median urine iodine excretion was 211.4 mcg/l (mean 220.3 +/- 99.5 mcg/l) indicating iodine sufficiency. Thyroid function abnormalities were present in 19.6% of subjects. Subclinical hypothyroidism was present in 9.4%. Among the population with normal thyroid function, 9.5% and 8.5% respectively had positive anti-TPO and anti-TG antibodies. Among those with thyroid dysfunction, 46.3% had positive anti-TPO and 26.8% were anti-TG positive. A significant proportion of this iodine-sufficient adult population had thyroid disorders. Further studies are required to characterise the reasons for this high prevalence. Iodine deficiency as well as thyroid dysfunction should both be the focus of public health strategies in susceptible populations.

Background There is paucity of information regarding time trends of weight status in children from rapidly developing economies like India. The aim of the study was to analyse the dynamics of growth and weight transitions in a cohort of school children from India. Methods A population of 25 228 children was selected using stratified random sampling method from schools in a contiguous area in Ernakulam District, Kerala, India. Weight and height were measured at two time points, one in 2003-04 and another in 2005-06. The paired data of 12 129 children aged 5-16 years were analysed for the study. Results The mean interval between the two surveys was 2.02 ± 0.32 years. The percentage of underweight, normal weight, overweight and obese children in the year 2003-04 were 38.4%, 56.6%, 3.7%, and 1.3% respectively. The corresponding figures in year 2005-06 were 29.9%, 63.6%, 4.8% and 1.7% respectively. Among the underweight children, 34.8% migrated to normal weight status and 0.1% migrated to overweight status. Conversion of underweight to normal weight predominated in urban area and girls. Among the normal weight children, 8.6% migrated to underweight, 4.1% migrated to overweight and 0.4% migrated to obesity. Conversion of normal weight to overweight status predominated in urban area, private schools and boys. Conversion of normal weight to underweight predominated in rural area, government schools and boys. Among the overweight children, 26.7% migrated to normal weight status, 16.4% became obese and 56.9% retained their overweight status. Of the obese children, 6.2% improved to normal weight status, 25.3% improved to overweight status and 68.5% remained as obese in 2005-06. There was significant difference in trends between socio demographic subgroups regarding conversion of underweight status to normal weight as well as normal weight status to overweight. Conclusion The study population is experiencing rapid growth and nutritional transitions characterised by a decline in the underweight population coupled with an escalation of the overweight population. The heterogeneous nature of this transition appears to be due to differences in socio demographic factors.

To determine blood pressure distribution in schoolchildren and to derive population specific reference values appropriate for age, gender and height status. Cross sectional observational study. Schools in Ernakulam district, Kerala, India, during 2005–06. Stratified random cluster sampling method was used to select the children. Blood pressure and anthropometric data were collected from 20,263 students of 5–16 years age. Three readings of blood pressures of each child were taken by mercury sphygmomanometer and mean was taken for analysis. Blood pressure percentiles in relation to gender, age and height were estimated from a non-overweight population of 18,931 children using polynomial regression models. Children from study population have higher diastolic pressures for both sexes than international standard across all age groups. For systolic blood pressure, girls showed higher values than the international standard while for boys, the difference appears to be minimal. Blood pressure distribution in children from our study population demonstrates a different pattern in comparison to existing international reference. Higher blood pressure values in the study population are of considerable public health significance.

In India 50% of patients with gastrointestinal bleeding bleed from esophageal varices. Causes of portal hypertension includes hepatic cirrhosis, non-cirrhotic portal fibrosis and extrahepatic portal obstruction. Endoscopic sclerotherapy is the treatment of choice to control continued active bleeding. Immediate hemostasis was not influenced by the etiology of portal hypertension. However, rebleeding episodes were lower, in extrahepatic portal vein obstruction than non-cirrhotic portal fibrosis and cirrhotic patients. Child's status significantly influenced recurrence of bleeding and mortality which was lower in child's A than B and lower in B than C irrespective of etiology. Results of long term sclerotherapy were also influenced by the etiology of portal hypertension and hepatic functional status. Sclerotherapy was most effective in patients of (EHO), than (NCPF) followed by cirrhosis of the liver.

We aimed to assess the glycaemic status and prevalence of comorbid conditions such as obesity, hypertension and dyslipidaemia in people with diabetes in a southern Indian community.A cross-sectional community survey of adults18 years of age was done in central Kerala. Among the 3069 subjects surveyed, 276 were known to have diabetes. Of these, 169 who had type 2 diabetes underwent a detailed physical examination and anthropometric measurements, and determination of levels of fasting blood glucose, glycosylated haemoglobin, fasting lipid, serum creatinine and urine protein. Data of 164 subjects who had glycosylated haemoglobin levels were included for final analysis.The mean (SD) duration of diabetes was 5.5 (5.04) years and the mean age was 56.9 (11.4) years. Among the patients, 28 (17.2%) were receiving no treatment for diabetes, 24 (14.7%) were on diet control and 111 (68%) on pharmacotherapy. Only 6 patients were on insulin. The mean fasting blood glucose was 153 (63) mg/dl and the mean glycosylated haemoglobin level was 8.1 (2.34)%. In 60% of patients, the glycosylated haemoglobin level was above the recommended target of 7%. Obesity (31%), hypertension (51%), low-density lipoprotein cholesterol100 mg/dl (90%) and serum triglyceride levels150 mg/ dl (38%) were present in the study population. Only 29% of patients were on antihypertensive treatment and 5% on lipid-lowering agents.In this population, only 40% of people with diabetes had adequate glycaemic control. The use of insulin was infrequent. Comorbid conditions were common and inadequately treated. This indicates a lack of proper diabetic care in this community, which could lead to an increase in the burden of cardiovascular disease in the future.

Background. Plate osteosynthesis is a widely used technique in head and neck reconstructive surgery. The objective of this study was to determine whether postoperative chemoradiotherapy, which was recently introduced for high-risk head and neck cancer, affects plate and osteosynthesis related complications. Methods. Fifty-two consecutive patients, who had undergone plate osteosynthesis for mandibular reconstruction between October 2003 and September 2006, were included in the study. The patients were divided into 3 groups: (1) surgery alone (n = 19), (2) surgery with postoperative radiotherapy (n = 14), and (3) surgery with concurrent chemoradiotherapy (n = 19). Outcome measures included any bone or plate related complications. Results. The plate and osteosynthesis related complications occurred in 10.5% of patients in surgery-alone group, 28.6% in surgery with postoperative radiation group, and 63.2% in surgery with postoperative concurrent chemoradiotherapy group. The differences in the complication rates among these 3 groups were statistically significant (p = .003). In univariate analysis, postoperative radiation (p = .007) and concurrent chemotherapy (p = .003) were found to be significantly associated with complications. In multivariate analysis, only concurrent chemotherapy was found to be statistically significant (p = .002) with odds ratio of 7.72. Conclusion. Postoperative concurrent chemoradiotherapy significantly increases plate and osteosynthesis related complications in oral cancer. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

ObjectiveSignificant technologic advances have improved outcomes in neonatal cardiac surgery over the past 3 decades. However, outcomes might be different in developing countries with resource limitations. We sought to identify the determinants of early outcome after neonatal cardiac surgery in a tertiary referral center in South India.MethodsHospital records of 330 consecutive neonates who underwent surgical intervention between January 1999 and April 2006 were reviewed, and perioperative variables were recorded. Main outcome measures were 30-day mortality, postoperative bloodstream infection, and hospital stay of longer than 10 days. Multivariate logistic regression analysis was performed.ResultsOverall mortality was 8.8%. Mortality significantly decreased from 21.4% before 2002 to 4.3% after 2002 (3.2% for corrective operations, P < .0001). The prevalence of postoperative bloodstream infection remained the same, whereas surgical site infection and hospital stay significantly increased after 2002. Predictors of outcomes on multivariate analysis were as follows: (1) mortality—operation before 2002 (odds ratio, 5.5), age less than 7 days (odds ratio, 3.8), preoperative antibiotic use (odds ratio, 5.6), and postoperative exchange transfusion (odds ratio, 14.9); (2) postoperative bloodstream infection (21.2%)—use of cardiopulmonary bypass (odds ratio, 2.0), reintubation (odds ratio, 7.7), and surgical site infection (odds ratio, 4.1); and (3) hospital stay of longer than 10 days (61.2%)—use of cardiopulmonary bypass (odds ratio, 2.8), delayed sternal closure (odds ratio, 3.6), reintubation (odds ratio, 12.1), surgical site infection (odds ratio, 13.8), and postoperative antibiotic use (odds ratio, 4.4).ConclusionsWith increasing experience, neonatal cardiac surgery can be performed with excellent outcomes in developing countries with resource limitations. Infectious complications contribute significantly to morbidity and mortality, and improvements in infection-control practices should be emphasized to improve outcomes further.

Periodontal disease is the most common cause of tooth loss. It is has insidious onset, chronic course, and commonly result due to cumulative effect of dietary habits, oral hygiene methods and oral habits practiced over the years. This study was planned to evaluate the periodontal health status of elderly population (above 60 years) in the community, using CPITN index, gingival recession, mobility of teeth and halitosis, using modified WHO Oral Health Survey Proforma. In addition, impact of several socio-demographic variables, oral hygiene practices, oral habits, chronic systemic diseases, dietary preferences and body mass index (BMI) on periodontal health status was also studied. It was found that prevalence of periodontal diseases in the elderly was high. Step-wise multivariate logistic regression analysis showed that periodontal diseases were directly correlated with age, oral hygiene practices and presence of cardiac diseases.

The present case-control study was undertaken with the objective to study the nutritional risk factors associated with esophageal cancer.One hundred and fifty diagnosed esophageal cancer patients and an equal number of healthy individuals constituted the patient and control groups, respectively. Dietary consumption pattern during the preceding 20 years prior to the diagnosis of esophageal cancer was assessed utilising the standard food frequency questionnaire method. Information on alcohol consumption, smoking habits, chewing of betel leaf with tobacco was also collected.Multivariate analysis revealed that the risk of esophageal cancer was 7.81 times (p0.01) higher with daily consumption of alcohol. The risk increased to 3.16 times (p0.01) with the daily habit of chewing of betel leaf with tobacco. Nearly a two fold risk was observed when the consumption of "other vegetables" was less than four times per week. A 1.95 times (p0.01) increase in risk was observed with the daily habit of bidi smoking.Cancers in general are multifactorial in origin, and several environmental interactions are possible. It is not easy to quantify the contribution of diet to cancer risk. However, the results of the present study suggested that nutritional factors do play a role.

A cross sectional study was conducted to determine the variables which have an individual predictive power on nonutilization of immunisation services using logistic regression model. Children between 12 and 23 months of age were assessed and enrolled using a pretested interview schedule. Statistical analysis was done using descriptive statistics, univariate analysis using Chi Square tests and multivariate logistic regression analysis. Of the 200 children studied 56% were fully immunised. Only illiterate mothers (p0.05) and poor access (3 km) to health facility (p0.001) were found to have an independent predictive power on the nonutilization of immunisation services. Sex of the child, parity levels, socioeconomic status did not independently influence the utilisation pattern. It is possible to identify these still existing small pockets of nonusers of immunisation services through the predictive variables and target them through special efforts.

ESR (Westergen) correlated significantly with the iron status (as measured by Hb concentration, haematocrit, red cell count, MCH, P/H ratio, serum iron, TIBC and percent saturation of transferrin) in a group of pregnant women (PW) at term. Serum ferritin correlated negatively with the ESR but the correlation was not statistically significant. Serum ferritin levels of50 micrograms/L were present in 9 (34.6%) PW with ESRor = 50 mm 1st hour and 5 (19.2%) PW with ESR50 mm 1st hour. The mean ESR in PW was 55.7 (+/- 22.9) and wasor = 50 mm 1st hour in 50% and75 mm 1st hour in 82.7%. The difference in the mean ESR in anaemic and nonanaemic PW was highly significant (p0.001), 87.5% anaemic PW with serum ferritin50 micrograms/L had ESRor = 50 mm 1st hour, suggesting the possible effect of chronic infection in raising ferritin levels in these PW.

AIM To find an optimal cluster size and number of clusters for a reasonable estimate of the prevalence of cataract blindness in people aged > or = 50 years in 19 rural districts of a state in India. MATERIALS Cluster sampling methodology was used in 19 rural districts of Karnataka State, India. In each district, 15 clusters were randomly selected and 90 people aged > or = 50 years were examined in each cluster. As a result the visual acuity and lens status of a total of 22,218 people were assessed. METHODS For each district, the design effect for cluster size ranging from 20 to 90 was calculated and the optimal cluster size and the required number of clusters to achieve an accuracy of 1% errors and 80% confidence was assessed. RESULTS The age and gender adjusted prevalence of cataract blindness varied from 1.58% to 7.24%, which justifies district level surveys. The design effect is nearly 1.5 for clusters of sizes 30 and 40. With an average prevalence of 4.93% with 1% error and 80% confidence level, the optimal number of clusters is 37 and 28 for a cluster size of 30 and 40 respectively and the average sample size for a district around 1100. CONCLUSIONS Rapid assessments for cataract blindness in those aged > or = 50 years can be conducted at district level in India with existing resources and at affordable costs. These provide reliable data, essential for effective monitoring and planning. Other parameters, for instance, surgical coverage can also be assessed. The availability of standardized software for data entry and analysis and strict adherence to survey procedures is essential.

Birth asphyxia is a major cause of neonatal mortality. An understanding of the determinants of mortality among asphyxiated neonates will help formulate effective management protocols.One hundred and fifty consecutive neonates with birth asphyxia (apnoea or gasping respiration at 1-minute of age) were prospectively studied. The association of the outcome variable, namely, mortality before discharge, was documented in relation to a number of clinically important risk factors.The neonatal mortality of 24.7% (37/150) among asphyxiated neonates was 34.5-times compared to that of the non-asphyxiated population (p0.001). The mortality rates in preterm-and term-asphyxiated neonates were 47.8% and 6%, respectively (p0.0001). The relative risk of mortality increased progressively with increased birth-weight. On univariate analysis, prematurity, low birth-weight, respiratory distress, severity of asphyxia, hypoxic-ischaemic encephalopathy, apnoea, acidosis and seizures were found to be significant risk factors of death. However, on step wise regression analysis, prematurity emerged as the most significant determinant of mortality. The highest positive predictive value (58.3%) for mortality was documented for hypoxic-ischaemic encephalopathy.A significant reduction in mortality among asphyxiated neonates will require aggressive management of prematurity-related neonatal complications and hypoxic-ischaemic encephalopathy.

A prospective case controlled study was conducted to evaluate the value of real time ultrasound in establishing the diagnosis and the etiology of portal hypertension. Patients attending the outpatient department of a tertiary care centre were included. There were 324 consecutive patients with portal hypertension due to cirrhosis (n = 229), non cirrhotic portal fibrosis (NCPF: n = 64) and extrahepatic portal venous obstruction (EHPVO: n = 31). During this period, 146 patients with dyspepsia, 35 with splenomegaly and 32 with ascites due to varied causes served as negative and positive controls. Real time ultrasonography using a 3.5 MHz linear array scanner was performed in a fasting state in all subjects. Portal and splenic vein diameter greater than 10 mm, splenomegaly, hepatic and splenic hilar collaterals were suggestive of portal hypertension. Non visualization of the portal vein which was replaced by a cavernoma had a diagnostic accuracy of 98% in EHPVO. Splenic infarcts and absence of ascites were features of non cirrhotic portal hypertension (NCPF and EHPVO). Sonography had an overall diagnostic accuracy of 80%. A stepwise logistic regression with multivariate analysis using discriminate function showed that collaterals at the hepatic and splenic hilum, hepatomegaly, ascites and splenic infarcts were independent markers to differentiate cirrhotic from noncirrhotic causes of portal hypertension. The discriminate equation generated had a mismatch of 9.8%. Correlations between the sonographic signs demonstrated that the variceal grade correlated positively with the presence of splenic hilar collaterals and the liver size inversely correlated with presence of ascites. It was concluded that real time ultrasonography is an accurate method to establish the presence and etiology of portal hypertension.

A non-linear equation of the type log w - 0.008 h = a - be-kl for weight (w) and height (h) of 1177 infants and pre-school children from the Rural Health Centre area in Ballabhgarh was fitted by modified Guass-Newton Method using BMDP 03R program. On applying the non-linear model to the data of the present study it was found that the curve was a good fit in both sexes and also in all nutritional groups. The value of 'a' (the nutritional index) was almost the same in boys and girls but it was higher in case of children with normal nutrition (0.37) and lower in children with malnutrition (0.34 in Grade I, 0.32 in Grade II and 0.28 in Grades IIIIV). The exponential term 'k' (index of maturation) was higher in boys compared to that of girls and higher in those with normal nutrition than with malnutrition. It was found that the rate of decay of the exponential term was slower in those with malnutrition compared to those with normal nutrition. While no difference was observed in the asymptotic value i.e., the rate at which infants reach the shape of older children, between boys and girls with normal nutrition (19 and 20 months respectively), it was delayed by 5 to 8 months in girls compared to boys with malnutrition. In the total sample, the Ehrenberg's index attained the asymptotic value at 20 months in boys and at 35 months in girls and at 27 months in the combined sample.

Ehrenberg’s Law-like relationship between height and weight [log $$(\bar w) = a\bar h + b$$ was applied to a group of public school and Govt. school children in New Delhi. It was found that the model log $$(\bar w) = 0.8 \bar h + 0.4$$ was comparatively a good fit for public school children and the model log $$(\bar w) 0.8 h + 0.35$$ for Govt. school children. On fitting the model to the sample data it was found that the value of ‘a’ was 0.8, with some minor variation in the second decimal point and the value of ‘b’ was 0.39 & 0.36 respectively for public school boys and girls and 0.32 & 0.29 respectively for Govt. school boys & girls. These results corroborates with the findings of the earlier studies that the intercept constant ‘b’ in the Law-like relationship equation is influenced by the nutrition of children. This model is recommended because of its simplicity and practical usefulness using only already available information.

Mutans streptococci are important aetiological agents in dental caries and their prolonged contact with oral tissues evokes a variety of immune responses through local secretory and systemic antibodies. Patterns of such humoral responses in Indian children have not been reported and we undertook the present study to examine these.One hundred and twenty-six children with dental caries and 55 matched controls were studied and saliva and sera collected from them. The tests on these specimens included total salivary and systemic immunoglobulins of different classes using radial immunodiffusion and Streptococcus mutans specific IgA, IgG and IgM using specifically standardized enzyme immunoassays.Children with caries had higher levels of IgG (1350 +/- 9.9 mg/dl; controls 1110 +/- 6.7 mg/dl) and IgA (260 +/- 1.8 mg/dl; controls 190 +/- 1 mg/dl) in the serum but their saliva had lower levels of total IgG (160 +/- 0.7 mg/dl; controls 340 +/- 2.9 mg/dl) and IgA (130 +/- 0.5 mg/dl; controls 410 +/- 3 mg/dl). IgM levels in caries children and controls were not significantly different. Higher levels of Streptococcus mutans specific IgA were detected in the saliva of 95 out of 126 (75%) children with caries compared to 13 out of 55 (22%) controls. Specific serum IgG and IgA levels were also increased in 105 and 114 children with caries, although the levels were not as high as those in saliva. Total and specific salivary and serum IgM antibodies were similar in children with caries and control subjects.The nature of the humoral immune response in Indian children with dental caries suggests that Streptococcus mutans specific salivary and serum antibodies may play a major role in pathogenesis. Our findings may have importance when devising methods for follow up and prognosis as well as for vaccination strategies.

Blood pressure and nutritional profiles in the 'Oraon' tribal community of India living in rural and urban areas were studied between 1981-85 after a house to house survey of 4523 rural tribal people (RT) and 935 of their urban tribal counterparts (UT). Prevalence of hypertension was found to be 4.8/1000 males and 4.3/1000 females in rural tribal group giving an overall rate of 4.6/1000. In contrast the same were 27.1/1000 males and 21.4/1000 females in UT group, overall rate being 25.6/1000. Average calorie consumption were 1750 and 2280 and mean 24 hour-urinary sodium excretions 58 and 118 milliequivalents in RT and UT groups respectively. Of the total of 21 subjects in RT and 24 in UT detected to be hypertensive, 7 had common family inheritance. Increased mean arterial pressure correlated with increased sodium consumption and body weight. Hypertensives from both the groups showed higher urinary sodium excretion (P0.05). This epidemiologic study proves the role of a genetic factor/defect complicated by higher salt consumption in causation of increased blood pressure.

The prevalence of malocclusion among 1608 children (777 boys and 831 girls) in the age group of 5-7 years, selected from different schools of varied locations of Delhi was observed as 18.4%. A number of factors that could influence the normal development of occlusion during early mixed dentition stage were recorded. These included spacing in anterior teeth, attrition of primary teeth and deleterious oral habits. The socio-demographic variables included occupation of parents, family size, location type and the school type. The age of the child and sex were also considered. In order to find out the contribution and importance of above mentioned occlusal characteristics and socio-demographic factors in the development of malocclusion, the data were subjected to univariate analysis. Further a stepwise logistic regression analysis was done to know whether any association exists between the occurrence of malocclusion and combination of these factors. Four factors were found to contribute significantly in the occurrence of malocclusion explaining 15.5% variation in case of boys and 22% in case of girls. More significant factors were absence of spacing, effect of habits and lack of attrition of primary teeth. About 80% of the total variation was independent of these factors and could not be explained by this analysis. It further testifies possible predominance of genetic influences in the development of occlusion.

The antibacterial activity of gentian violet (GV) impregnated silastic discs was studied by measuring the zone of inhibition (ZOI), (in mm) produced by the discs planted on Staphylococcus epidermidis seeded agar plates. The effect of varying concentration of GV, the duration of antibacterial activity and effect of autoclaving were studied. The mean ZOI for 1 per cent GV was 19.28 +/- 0.89 mm and for 2 per cent GV it was 22.55 +/- 0.71 mm (P0.001). There was no significant difference between GV concentrations of 2-5 per cent. Over a period of 1-5 wk, no significant difference was found in the antibacterial activity of GV for any of the concentrations. In each of the concentrations there was a significant reduction in the ZOI after multiple autoclavings. The study thus indicates that it is possible to impart antibacterial properties to silastic implants so that their colonization with Staph. epidermidis can be prevented and this finding has obvious clinical implications.