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Purpose: The purpose of this study was to develop and validate a deep-learning model for noninvasive anemia detection, hemoglobin (Hb) level estimation, and identification of anemia-related retinal features using fundus images., Methods: The dataset included 2265 participants aged 40 years and above from a population-based study in South India. The dataset included ocular and systemic clinical parameters, dilated retinal fundus images, and hematological data such as complete blood counts and Hb concentration levels. Eighty percent of the dataset was used for algorithm development and 20% for validation. A deep-convolutional neural network, utilizing VGG16, ResNet50, and InceptionV3 architectures, was trained to predict anemia and estimate Hb levels. Sensitivity, specificity, and accuracy were calculated, and receiver operating characteristic (ROC) curves were generated for comparison with clinical anemia data. GradCAM saliency maps highlighted regions linked to anemia and image processing techniques to quantify anemia-related features., Results: For predicting anemia, the InceptionV3 model demonstrated the best performance, achieving 98% accuracy, 99% sensitivity, 97% specificity, and an area under the curve (AUC) of 0.98 (95% confidence interval [CI] = 0.97-0.99). For estimating Hb levels, the mean absolute error for the InceptionV3 model was 0.58 g/dL (95% CI = 0.57-0.59 g/dL). The model focused on the area around the optic disc and the neighboring retinal vessels, revealing that anemic subjects exhibited significantly increased vessel tortuosity and reduced vessel density (P < 0.001), with variable effects on vessel thickness., Conclusions: The InceptionV3 model accurately predicted anemia and Hb levels, highlighting the potential of deep learning and vessel analysis for noninvasive anemia detection., Translational Relevance: The proposed method offers the possibility to quantitatively predict hematological parameters in a noninvasive manner.

Cardiovascular diseases (CVDs) constitute an important cause of morbidity and mortality globally, and India is no exception to this trend. With the ongoing aging of the population in India, there is a notable surge in the prevalence and impact of CVDs among older adults. This review is aimed at providing a comprehensive overview of the current knowledge concerning the prevalence, risk factors, and management of CVDs in the context of Indian older adults. The incidence of CVDs in India is not only alarming but also exhibits an upward trajectory with advancing age. Primary risk factors contributing to the elevated incidence among older adults include hypertension (HT), diabetes, dyslipidemia, obesity, smoking, a sedentary lifestyle, and poor dietary habits. Additionally, stress and genetic predisposition emerge as noteworthy contributors to CVDs in this population. Effectively identifying and managing these risk factors among older adults in India is imperative to alleviate the burden of these diseases and enhance overall quality of life. Strategies aimed at mitigating the impact of CVDs in the country necessitate a comprehensive approach, integrating lifestyle interventions, public health initiatives, and a robust healthcare system. In summary, CVDs represent a significant health concern in both rural and urban areas of India. However, variations exist in the prevalence, risk factors, and accessibility to healthcare between these regions. Therefore, addressing the prevalence of CVDs in India necessitates a complex, multidimensional strategy that takes into account the unique opportunities and challenges that come with living in both rural and urban areas., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Bisma Jan et al.)

Serological assays used to estimate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often rely on manufacturers' cutoffs established on the basis of severe cases. We conducted a household-based serosurvey of 4,677 individuals in Chennai, India, from January to May 2021. Samples were tested for SARS-CoV-2 immunoglobulin G (IgG) antibodies to the spike (S) and nucleocapsid (N) proteins. We calculated seroprevalence, defining seropositivity using manufacturer cutoffs and using a mixture model based on measured IgG level. Using manufacturer cutoffs, there was a 5-fold difference in seroprevalence estimated by each assay. This difference was largely reconciled using the mixture model, with estimated anti-S and anti-N IgG seroprevalence of 64.9% (95% credible interval (CrI): 63.8, 66.0) and 51.5% (95% CrI: 50.2, 52.9), respectively. Age and socioeconomic factors showed inconsistent relationships with anti-S and anti-N IgG seropositivity using manufacturer cutoffs. In the mixture model, age was not associated with seropositivity, and improved household ventilation was associated with lower seropositivity odds. With global vaccine scale-up, the utility of the more stable anti-S IgG assay may be limited due to the inclusion of the S protein in several vaccines. Estimates of SARS-CoV-2 seroprevalence using alternative targets must consider heterogeneity in seroresponse to ensure that seroprevalence is not underestimated and correlates are not misinterpreted., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

River water pollution and water-related health problems are common issues across the world. The present study aims to examine the Jalangi River's water quality to assess its suitability for drinking purposes and associated human health risks. The 34 water samples were collected from the source to the mouth of Jalangi River in 2022 to depict the spatial dynamics while another 119 water samples (2012-2022) were collected from a secondary source to portray the seasonal dynamics. Results indicate better water quality in the lower reach of the river in the monsoon and post-monsoon seasons. Principal component analysis reveals that K + , NO 3 - , and total alkalinity (TA) play a dominant role in controlling the water quality of the study region, while, CaCO 3 , Ca 2+ , and EC in the pre-monsoon, EC, TDS, Na + , and TA in the monsoon, and EC, TDS and TA in the post-monsoon controlled the water quality. The results of ANOVA reveal that BOD, Ca 2+ , and CaCO 3 concentrations in water have significant spatial dynamics, whereas pH, BOD, DO, Cl - , SO 4 2- , Na + , Mg 2+ , Ca 2+ , CaCO 3 , TDS, TA, and EC have seasonal dynamics (p < 0.05). The water quality index depicts that the Jalangi River's water quality ranged from 6.23 to 140.83, i.e., excellent to unsuitable for drinking purposes. Human health risk analysis shows that 32.35% of water samples have non-carcinogenic health risks for all three groups of people, i.e., adults, children, and infants while only 5.88% of water samples have carcinogenic health risks for adults and children. The gradual decay of the Jalangi River coupled with the disposal of urban and agricultural effluents induces river pollution that calls for substantial attention from the various stakeholders to restore the water quality., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To determine the associations of predominant peripheral lesions (PPLs) with systemic comorbidities in individuals with diabetic retinopathy., Methods: This is a multicenter cross-sectional observational study conducted across three tertiary eye care centers in south India between January 2019 and July 2021. Ultra-widefield fundus images of consecutive patients with varying severity of diabetic retinopathy with data on systemic comorbidities were classified based on the presence or absence of PPL. Systemic comorbidities (hypertension, diabetic kidney disease, coronary artery disease, dyslipidemia, and anemia) were compared between the two groups., Results: A total of 879 participants (70.1% males) were included in the study, of which 443 (50.4%) patients had PPL. The mean age of the study participants was 56 ± 10 years, mean age of onset of diabetes was 41.24 ± 11.6 years, and mean duration of diabetes was 15.39 ± 7.6 years. The number of PPL increased with increasing severity of DR. Of all the systemic comorbidities analyzed, we found that coronary artery disease (CAD) had a significant association with PPL (Odds ratio [OR]-1.69; 95% confidence interval [CI], 1.12-2.55; P = 0.013) after adjusting for diabetic retinopathy severity, duration of diabetes, and age of onset of diabetes., Conclusion: The presence of PPL is a marker for coronary artery disease and early referral to cardiology is warranted., Competing Interests: None

Variation in levels of toxic heavy metals in river system during the COVID-19 pandemic lockdown might potentially assist in development of a public health risk mitigation system associated with the water consumption. The water quality of Punnakayal estuary in the Thamirabarani River system from the south India, a vital source of water for drinking and domestic purposes, industrial usage, and irrigation was assessed here. A comparitive assessment of physico-chemical variables (pH, EC, TDS, DO, BOD, turbidity and NO 3 ), microbiological parameters (total coliform bacteria, fecal coliform bacteria, fecal streptococci and escherichia coli) and toxic metals (As, Cr, Fe, Cu, Zn, Cd, and Pb) suggested a decrease of 20% in the contaminant ratio during the lockdown period in comparison to the pre-lockdown period. The Health risk assessment models (HQ, HI, and TCR) highlighted carcinogenic and non-carcinogenic hazards for both children and adults through the ingestion and dermal adsorption exposures. The HI values for both As and Cr exceeded the acceptable limit (>1) during the lockdown period, but the potential risk for children and adults remained low in compaisio with the pre-lockdown period. Our results suggested that the Thamirabarani River system remained hostile to human health even during the lockdown period, and it requires regular monitoring through a volunteer water quality committee with private and government participations., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic lockdown supposedly provided a 'window' of reinstatement to natural resources including the air quality, but the scenario after the phased unlocking is yet to be explored. Consequently, here we evaluated the status of air quality during the 8th phase of unlocking of COVID-19 lockdown (January 2021) at three locations of North India. The first site (S1) was located at Punjab Agricultural University, Ludhiana-PPCB; the second site (S2) at Yamunapuram, Bulandshahr-UPPCB; and the third site (S3) at Okhla Phase-2, Delhi-DPCC. The levels of PM2.5 showed a significant increase of 525.2%, 281.2%, and 185.0% at sites S1, S2 and S3, respectively in the unlock 8 (January 2021), in comparison to its concentration in the lockdown phase. Coherently, the levels of PM10 also showed a prominent increase of 284.5%, 189.1%, and 103.9% at sites S3, S1, and S2, respectively during the unlock 8 as compared to its concentration in the lockdown phase. This rise in the concentration of PM2.5 and PM10 could be primarily attributed to the use of biomass fuel, industrial and vehicular emissions, stubble burning considering the agricultural activities at sites S1 and S2. Site S3 is a major industrial hub and has the highest population density among all three sites. Consequently, the maximum increase (295.7%) in the NO 2 levels during the unlock 8 was witnessed at site S3. The strong correlation between PM2.5, PM10, and CO, along with the PM2.5/PM10 ratio confirmed the similar origin of these pollutants at all the three sites. The improvements in the levels of air quality during the COVID-19 lockdown were major overtaken during the various phases of unlocking consequent to the initiation of anthropogenic processes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: With the emergence of novel pathogens, there is a worldwide debate on the cancellation or conduction of mass gathering events., Methods: In the current coronavirus disease-2019 (COVID-19) pandemic situation, this study assesses the challenges in the conduction of the recently held Kumbh Mela mass gathering (MG), which took place from 14th January 2021 to 29th April 2021 at Haridwar, the capital city of the state of Uttarakhand, India. The correlation between increased cases of COVID-19 and the Kumbh Mela MG has been highlighted through statistical analysis and growth curves using the available data., Results: The Kumbh Mela-2021 emerged as a potential super spreader event with an increase of 37 cases per day to 144 cases per day (276%) in the COVID-19 cases in Haridwar. An increase from 138 to 480 cases per day (236%) and from 45 600 to 92 754 cases per day (92%) was noted in Uttarakhand and India respectively during this MG. A very strong correlation of 'more than 0.99' was seen between the number of cumulative cases of COVID-19 in Uttarakhand and Haridwar, and Haridwar and India during the Kumbh Mela in the third wave of the pandemic., Conclusions: The direct influence of Kumbh Mela on the increase in the overall number of COVID-19 cases is observed. Although, the socio-cultural, psychological and economical advantages of MGs are considerable in a developing nation like India, but organization of such events can be a huge health hazard. The lack of efficient implementation and observance of COVID-19 guidelines elevates the necessity of cancellation of such MGs to prevent the outbreak of diseases. Thus, a well-conducted risk assessment prior to the hosting of a MG event during a pandemic is required with strict application of precautionary measures towards prevention of super-spreader events., (© The Author(s) 2021. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: To compare the effectiveness of the Optos P200dTx and Zeiss Clarus 500 fundus cameras in detecting diabetic retinopathy (DR) lesions., Methods: A cross-sectional study was conducted among 243 patients with clinically diagnosed diabetes mellitus who were referred for an eye examination from two tertiary eye care centers in Chennai, India. Patients underwent DR screening based on mydriatic fundal images acquired by both fundal cameras. Fundal images from the two separate devices for each eye were compared based on accurately identified pathological retinal lesions with respect to type and location., Results: When studying lesions of the central retina, they were better identified by the Zeiss Clarus compared with the Optos P200dTx, with six out of eight being statistically significant (P < 0.05). However, lesions of the mid-peripheral retina and peripheral retina were better identified by the Optos P200dTx than the Zeiss Clarus, with three out of eight lesions and five out of eight lesions being statistically significant (P < 0.05), respectively. Based on the color and size of lesions, the Optos P200dTx had a higher chance (59.6%) of missing white lesions than did the Zeiss Clarus (17%) (P < 0.0001). Consequently, small- and medium-sized lesions were missed more by the Optos P200dTx (30.72% and 32.63%, respectively) than the Zeiss Clarus (22.3% and 19.30%, respectively)., Conclusions: The capability of detecting or missing a particular DR lesion among diabetics differed between the two cameras based on effective field of view, resolution, and the retinal zone being imaged., Translational Relevance: The choice of which ultra-widefield camera to be used for screening DR can be based on the greater prevalence of central versus peripheral retinal lesions noted in the patient population seen in a clinical practice.

The aim of the present study was to assess the status of heavy metal contamination and health risks associated with the use of water from River Gomti by millions of people. The value of the degree of contamination (C d ) was found to be '11.93', signifying 'high' risk levels due to heavy metal contamination in River Gomti across an approximate stretch of 61 km including upstream, midstream, and downstream locations of Lucknow city. The potential sources of heavy metal pollution in River Gomti include both sewage and industrial effluents, being transported by drains which overflow into the river. The heavy metals were found to have low mobility owing to the 'near neutral' pH of river water. The findings from the human health risk assessment revealed that the hazard index associated with non-carcinogenic risks exceeded the permissible limits at all sampling stations. The highest health risk was found at Bharwara sewage treatment plant discharge point, downstream of Lucknow city signifying the elevated levels of heavy metal in the river water post treatment from Bharwara STP. The results of carcinogenic risk assessment suggested that children were more susceptible to health risks, and immediate remedial measures are required to control the elevated levels of heavy metals at all the sampling stations., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Cultural collectivism, a core feature of honor cultures, is associated with the acceptance of aggression if it is used in the name of so-called "honor." Currently overlooked in the research literature, this study explored perceptions of antigay "honor" abuse in collectivist-orientated honor cultures, where homosexuality, in particular, is considered to be dishonorable. To conduct exploratory and comparative analysis, this study recruited 922 students in four Asian countries (India, Iran, Malaysia, and Pakistan), as well as Asian British and White British students in England. All participants read a brief vignette depicting a man whose relatives verbally abuse him and threaten him with life-threatening violence, after suspecting that he is gay and has joined an online dating website to meet men. Participants then completed a short questionnaire that assessed the extent to which they thought the man's actions had damaged his family's honor and their approval of the antigay "honor" abuse depicted in the scenario. Broadly in line with predictions, data analyses revealed attitudes more supportive of antigay "honor" abuse in all five collectivist-orientated populations than the sample of individualistic-orientated counterparts in England. Notably, however, a series of one-way analyses of variance (ANOVAs) demonstrated that these results varied depending on country of residence, gender, religious denomination, educational status, and age. The findings show that individual and demographic differences influence perceptions toward homophobic "honor" abuse in collectivist cultures. These differences are useful indices of the psychosocial factors that underpin hostile attitudes toward gay males in cultures where homosexuality is denounced.

Concerns regarding food safety and 'One Health' are increasing globally. Aflatoxin M 1 (AFM 1 ), a human carcinogenic toxin, is excreted by lactating animals in their milk after consumption of feed contaminated with aflatoxin B 1 . The present cross-sectional study aimed to determine the occurrence of AFM 1 in cattle and buffalo milk produced in rural and peri-urban areas under different agro-climatic conditions of Chhattisgarh, India, and assesses human health risks. Analyses of 545 milk samples by validated high-performance liquid chromatography revealed high level of AFM 1 contamination in 224 (41.1%) samples with mean concentration of 0.137 ± 0.029 μg/L. Statistically significant differences (p< 0.05) were observed in the levels and frequency of AFM 1 occurrence among different agro-climatic zones. AFM 1 was more frequently detected in milk samples from Northern hills (64%) followed by Bastar plateau (40.7%) and Chhattisgarh plain (27.3%), with mean concentration levels of 0.396 ± 0.099 μg/L, 0.081 ± 0.025 μg/L and 0.013 ± 0.002 μg/L, respectively. Species wise no significant difference was observed in the detection frequency and concentration of AFM 1 in milk from cattle and buffalo. AFM 1 contamination above maximum permissible limits established by European commission and Food Safety and Standard Authority of India was detected in 21.3% and 4.4% of samples, respectively. The estimated daily intakes for AFM 1 were found to be higher than tolerable daily intakes for both adults and children, especially of Northern hills implying a potentially high risk to consumer's health. This study provides valuable information on the contamination status of milk in one of the fastest developing state of India. It also highlights the importance and need for continuous farmers' awareness on good animal husbandry practices, routine surveillance of mycotoxins in animal feeds and food commodities to safeguard human health., (© 2021. Society for Mycotoxin (Research Gesellschaft für Mykotoxinforschung e.V.) and Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To study the association between gut microbial abundance and sight-threatening diabetic retinopathy among patients with a history of type 2 diabetes mellitus., Methods: An observational case-control study was performed using a sample population of diabetics referred to a tertiary eye institute. Sample subjects were identified as cases if they were diagnosed with sight-threatening diabetic retinopathy and controls if they were not but had at least a 10-year history of diabetes. Fecal swabs for all patients were collected for enumeration and identification of sequenced gut microbes. Statistical analyses were performed to associate the clinically relevant Bacteroidetes to Firmicutes relative abundance ratio (B/F ratio) with sight-threatening diabetic retinopathy and an optimal cutoff value for the ratio was identified using Youden's J statistics., Results: A sample size of 58 diabetic patients was selected (37 cases, 21 controls). No statistically significant difference in the relative abundance among the predominant phyla between the groups were found. In our univariate analysis, the B/F ratio was elevated in cases compared to controls (cases, 1.45; controls, 0.94; P = 0.049). However, this statistically significant difference was not seen in our multivariate regression model. Optimal cutoff value of 1.05 for the B/F ratio was identified, and significant clustering of cases above this value was noted in beta diversity plotting., Conclusions: No difference in gut microbial abundance for any particular phylum was noted between the control and diseased population. Increased gut microbial B/F ratio can be a potential biomarker for the development of sight-threatening diabetic retinopathy among type 2 diabetic patients.

To understand the spread of SARS-CoV2, in August and September 2020, the Council of Scientific and Industrial Research (India) conducted a serosurvey across its constituent laboratories and centers across India. Of 10,427 volunteers, 1058 (10.14%) tested positive for SARS-CoV2 anti-nucleocapsid (anti-NC) antibodies, 95% of which had surrogate neutralization activity. Three-fourth of these recalled no symptoms. Repeat serology tests at 3 (n = 607) and 6 (n = 175) months showed stable anti-NC antibodies but declining neutralization activity. Local seropositivity was higher in densely populated cities and was inversely correlated with a 30-day change in regional test positivity rates (TPRs). Regional seropositivity above 10% was associated with declining TPR. Personal factors associated with higher odds of seropositivity were high-exposure work (odds ratio, 95% confidence interval, p value: 2.23, 1.92-2.59, <0.0001), use of public transport (1.79, 1.43-2.24, <0.0001), not smoking (1.52, 1.16-1.99, 0.0257), non-vegetarian diet (1.67, 1.41-1.99, <0.0001), and B blood group (1.36, 1.15-1.61, 0.001)., Competing Interests: SN, VS, RU, NB, RK, AB, SP, SP, RK, BR, KT, MA, GC, AL, SK, SM, MM, MS, SK, AS, BT, MV, GV, SV, AA, DG, PH, MP, GS, RV, AP, VA, AM, RS, AR, SA, PK, SV, HS, AK, RJ, AT, DP, AS, JK, VK, AM, IG, GR, PS, RC, GC, PK, RY, SS, DS, SS, PB, SA, VS, SV, DS, SS, SV, ST, FF, AS, AS, BS, MS, YP, VH, VP, DS, NT, PC, SM, DG, JS, SR, BK, KK, SG, PJ, RC, VJ, NK, DG, GT, US, PS, SC, RK, PG, AT, DS, RR, AD, MK, DS, MD, SD, RJ, AP, SM, AK, VW, RY, AK, MB, AC, SK, KK, SP, JK, NS, TP, PM, WR, PB, DO, RS, EB, RS, AN, PV, AP, AV, KC, SD, YM, VA, SD, AA, DD, SS No competing interests declared, (© 2021, Naushin et al.)

Introduction: The global COVID-19 pandemic originated from the Chinese city of Wuhan and gradually reached every end of the world. It has adversely affected economies of developed as well as underdeveloped countries, the subcontinent has been hit badly by the negative consequences of deadliest coronavirus. People are getting affected by the virus in large numbers and cases in growing on daily bases., Methodology: The present study employs Automatic ARIMA through R package "forecast", to predict the growing number of cases for upcoming 14 days starting on 1st July 2020 and ending on 14 July 2020. Using 107 daily observations of the confirmed cases of COVID-19, it seems an important concern to predict the cases to help governments of the region plan accordingly., Results: The outcomes of the study indicate that ARIMA applied on the sample rationally predicts the confirmed cases of coronavirus for next 14 days in the subcontinent. An increased trend is observed for Pakistan and India with constant cases for Bangladesh in the coming 14 days., Conclusions: Pakistan is having the highest predicted growth rate in terms of cases followed by India. Therefore, the governments need to build adequate policies in order to contain the spread of the virus., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2021 Faheem Aslam, Tahir Mumtaz Awan, Ruqia Khan, Maira Aslam, Yasir Tariq Mohmand.)

Introduction: To report the 10-year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus., Methods: Ten centres in India with established vitreoretinal (VR) services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in 1 or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular oedema, use of anti-vascular endothelial growth factor (VEGF) therapy, vitrectomy with or without retinal surgeries over 10 years., Results: Over 10 years, 89% needed supplemental PRP after initial complete PRP. One-third required retinal surgery, 16% needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous (VR) surgery. Of the group with low-risk PDR, 56.8% did not require VR surgery, p < 0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5 and 28.2% needed subsequent vitreous (VR) surgery, p = 0.006 and <0.0001, respectively. Independent predictors of need for vitreoretinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline., Conclusion: Despite initial "complete" PRP, one-third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time., (© 2020 S. Karger AG, Basel.)

To provide the real-world outcomes of people with proliferative diabetic retinopathy (PDR) in India and highlight opportunities for improvement of their disease status and to evaluate their visual acuity (VA) status. A multicenter retrospective study in which ten centers in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. This study population were of Indian nationality. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to 10 years were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, diabetic retinopathy status in both eyes. Available follow-up data on VA were collected at 6 months post baseline, 5 years and 10 years within a ± 3 months window. Evaluating the presenting VA of people with PDR, short-term outcomes at 6 months and the incidence of visual impairment (VI) at 5 and 10 years are the main outcome of the study. Data was available for 516, 424 and 455 patients at baseline, 5 years and 10 years respectively. Gender and duration of diabetes did not have statistically significant effect on VI outcomes. Eyes receiving treatment early in the disease course (i.e. baseline VA ≥ 6/12) had significantly better VA outcomes at 10 years versus eyes treated at a later stage (i.e. baseline VA < 6/12) (p = <0.0001). On comparing eyes with stable treated PDR and persistent PDR at end of 10 year follow up, a significantly higher percentage of eyes in the stable treated group maintained VA of ≥ 6/12 (55.1% vs. 24.2%) (p = < 0.0001), indicating persistent disease activity due to inadequate treatment results in worse VA outcomes. We found no trend in VI or blindness with increasing levels of age at both 5- and 10-year time points (p > 0.05). The age standardized incidence for VI was 11.10% (95% CI 8.1, 14.2) and for blindness was found to be 7.7% (95% CI 5.2, 10.3). Our results suggest that despite robust recent clinical trial results showing that pan retinal photocoagulation is an excellent treatment for PDR, people with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

Background: Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India. India introduced the 13-valent pneumococcal conjugate vaccine (PCV) in several states in 2017, and is expected to expand to nationwide coverage in the near future. To establish a baseline for measuring the impact of PCV in India, we assessed overall and serotype-specific nasopharyngeal carriage in two pediatric populations., Methods: A cross-sectional study was conducted in Palwal District, Haryana, from December 2016 to July 2017, prior to vaccine introduction. Children 2-59 months of age with clinical pneumonia seeking healthcare and those in the community with no clear illness were targeted for enrollment. A nasopharyngeal swab was collected and tested for pneumococcus using conventional culture and sequential multiplex PCR. Isolates were tested for antimicrobial resistance using an E test. Children were considered colonized if pneumococcus was isolated by culture or PCR. The prevalence of pneumococcal and serotype-specific colonization was compared between groups of children using log-binomial regression., Results: Among 601 children enrolled, 91 had clinical pneumonia and 510 were community children. The proportion colonized with S. pneumoniae was 74.7 and 54.5% among children with clinical pneumonia and community children, respectively (adjusted prevalence ratio: 1.38; 95% confidence interval: 1.19, 1.60). The prevalence of PCV13 vaccine-type colonization was similar between children with clinical pneumonia (31.9%) and community children (28.0%; p = 0.46). The most common colonizing serotypes were 6A, 6B, 14, 19A, 19F, and 23F, all of which are included in the PCV13 vaccine product. Antimicrobial resistance to at least one drug was similar between isolates from children with clinical pneumonia (66.1%) and community children (61.5%; p = 0.49); while resistance to at least two drugs was more common among isolates from children with clinical pneumonia (25.8% vs. 16.4%; p = 0.08). Resistance for all drugs was consistently higher for PCV13 vaccine-type serotypes compared to non-vaccine serotypes in both groups., Conclusion: This study provides baseline information on the prevalence of serotype-specific pneumococcal colonization among children prior to the introduction of PCV in India. Our results suggest a role for pneumococcal vaccines in reducing pneumococcal colonization and antimicrobial resistant isolates circulating in India.

Aim: To compare the age of onset of diabetes with the prevalence and risk factors of diabetic retinopathy (DR) in a rural population of India., Methods: This is a population-based study for which 1,190 people with diabetes were recruited from rural areas of the districts of Kanchipuram and Thiruvallur, Tamil Nadu, India. The fundi of all patients were photographed using a 45°, four-field stereoscopic digital fundus camera. The diagnosis of DR was based on the Klein classification of the Early Treatment Diabetic Retinopathy Study scale., Results: The prevalence of DR was 11.5% in individuals with known onset of diabetes (aged ≤40 years) compared to 10.0% in those with late onset. The risk factors for any DR in both groups included longer known duration of diabetes, use of insulin, and the presence of high systolic blood pressure and hypertension. In the group with known onset of diabetes at ≤40 years, older age (p < 0.0001) and male gender (p = 0.018) were the significant factors for DR. In the group with age of onset of diabetes at > 40 years, high diastolic pressure (p = 0.001), higher HbA1c (p < 0.0001), high microalbuminuria (p < 0.0001), and high macroalbuminuria (p < 0.008) were the significant risk factors for DR., Conclusion: Control of risk factors in people with younger age of onset of diabetes may reduce both the prevalence and impact of retinopathy in rural populations., (© 2019 S. Karger AG, Basel.)

Informal caregivers are unpaid individuals who help friends or family members who cannot fully care for themselves. However fulfilling the act of helping debilitated individuals, exposure to another person's traumatic experiences often results in psychological distress. Caregiver's stigma towards HIV worsens this. Hence, this study aims to assess the effect of stigma on the mental health of caregivers so that their needs for support can be determined. A cross sectional hospital based study was carried out in Mangalore, India on 150 informal caregivers of PLHIV. The HIV Stigma Scale was used to assess stigma and DASS-21 was used to assess depression, anxiety and stress. Of the 150 caregivers, 20% marked one or more items on the stigma scale. Frequency of depression, anxiety and stress was 46%, 27% and 8% respectively. Most caregivers who had stigma and anxiety were of those patients diagnosed for a shorter duration of time (≤5 years) n = 20, p = 0.05 and n = 26, p = 0.03 respectively. Spouses of PLHIV (n = 31, p = 0.005), sero-positive caregivers (n = 25, p = 0.03) and those living with patients (n = 39, p = 0.01) suffered most from anxiety. Stress was significantly associated with depression (83%, p = 0.007) and anxiety (66.6%, p = 0.001) in caregivers. In conclusion, more of depression and anxiety was observed among the participants than stress. Stigma was seen in 20% of the participants. Stigma was not significantly associated with depression anxiety and stress.

Multiple myeloma (MM) is classically illustrated by a desynchronized cytokine system with rise in inflammatory cytokines. There are recent reports which emphasized the potential role of angiogenesis in the development of MM. Role of cyclooxygenase 2 (COX-2) is well documented in the pathogenesis of solid tumors, but little is known about its occurrence and function in hematologic neoplasms. Involvement of neoangiogenesis is reported in the progression of MM, and angiopoietins probably contribute to this progression by enhancing neovascularization. Circulatory and mRNA levels of angiogenic factors and cyclooxygenase were determined in 125 subjects (75 MM patients and 50 healthy controls) by using enzyme-linked immunosorbent assay and quantitative PCR. We observed significant increase for angiogenic factors (Ang-1, Ang-2, hepatocyte growth factor, and vascular endothelial growth factor) and cyclooxygenase at circulatory level, as well as at mRNA level, as compared to healthy controls except insignificant increase for Ang-1 at circulatory level. We have also observed the significant positive correlation of all angiogenic factors with cyclooxygenase. The strong association found between angiogenic factors and COX-2 in this study may lead to the development of combination therapeutic strategy to treat MM. Therefore, targeting COX-2 by using its effective inhibitors demonstrating antiangiogenic and antitumor effects could be used as a new therapeutic approach for treatment of MM.

Background: The oil content and fatty acid composition of the mature seeds of Acacia species collected from natural habitat of the northwest zone of the Indian subcontinent (Rajasthan) were analyzed in order to determine their potential for human or animal consumption., Results: Oil content varied between 40 and 102 g kg⁻¹. The highest oil content was obtained in Acacia bivenosa DC. (102 g kg⁻¹) among the nine Acacia species. The fatty acid composition showed higher levels of unsaturated fatty acids, especially linoleic acid (~757.7 g kg⁻¹ in A. bivenosa), oleic acid (~525.0 g kg⁻¹ in A. nubica) and dominant saturated fatty acids were found to be 192.5 g kg⁻¹ palmitic acid and 275.6 g kg⁻¹ stearic acid in A. leucophloea and A. nubica respectively. Seed oils of Acacia species can thus be classified in the linoleic-oleic acid group. Significant variations were observed in oil content and fatty acid composition of Acacia species., Conclusion: The present study revealed that the seed oil of Acacia species could be a new source of high linoleic-oleic acid-rich edible oil and its full potential should be exploited. The use of oil from Acacia seed is of potential economic benefit to the poor native population of the areas where it is cultivated. The fatty acid composition of Acacia seed oils is very similar to that reported for commercially available edible vegetable oils like soybean, mustard, sunflower, groundnut and olive. Hence the seed oil of Acacia species could be a new source of edible vegetable oil after toxicological studies., (Copyright © 2012 Society of Chemical Industry.)

Background: Recent studies have demonstrated an association between insulin growth factor (IGF) and insulin growth factor binding protein-3 (IGFBP-III) serum levels and increased risk for various cancers. However, little information is available on clinical implications of the IGF system in Indian patients with cervical cancer. This study explored associations by analyzing their expression profiles in cervical cancer cases., Materials and Methods: Totals of 50 patients with advanced cervical cancer and 40 healthy controls were enrolled. Human papillomavirus (HPV) and cervical biopsy sample were obtained from all participating women. Circulatory levels were estimated by ELISA and the tissue expression was assessed using RT-PCR and Western blotting., Results: Levels of IGF-I and II showed significant increase whereas IGFBP-III showed significant decline in all patients as compared to controls. Spearman correlation analysis between IGFs and HPV status showed significant correlations., Conclusions: We demonstrated elevated circulating levels and tissue expression of IGF-I and IGF-II in advancer cancer cervix patients, as compared with controls, with a converse trend being apparent for IGFBP-III. In future, associations of the IGF system and clinical outcome of cervical cancer patients in post treatment samples might point to significance in disease mapping as a prognostic marker after validation with a larger patient series.

Vitiligo is an acquired skin disease, characterized by white areas on the skin due to loss of functional melanocytes. The pathogenesis of the disease is still unclear. Published data show the involvement of oxidative stress in the pathophysiology of vitiligo. A total of 30 vitiligo patients and 30 healthy controls were included in this study. We estimated serum levels of malondialdehyde (MDA), vitamins E and C, total antioxidant activity and whole blood levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in vitiligo patients and controls. We found significantly higher levels of MDA and significantly lower levels of SOD, GPx, vitamins C and E and total antioxidant activity in vitiligo patients compared with controls. This study is a maiden attempt to report on antioxidant parameters of both generalized/localized-type Indian vitiligo patients. Our results confirmed that oxidative stress may play an important role in the pathogenesis of vitiligo and cause melanocyte damage in vitiligo.

One of the principles of primary health care is intersectoral co-ordination. A cross sectional study done at the primary health center revealed existence of unsatisfactory co-ordination between health and education department.

Fifty-nine Asian Indians were typed for HLA-A, B, D, and DR antigens. Peculiar to the population that we have tested was the absence of HLA-A25, B13, B14, DR1, DW1, LD13 (a DR1-associated HLA-D allele), and LD12 (a DR4-associated HLA-D allele). Certain haplotypes that exhibit high frequencies in Caucasians (such as A2-BW50, AW24-B18, B8-DR3, BW44-DR7, B18-DR5) or in Blacks (such as A29-B7) also show significant delta in Asian Indians. The HLA-D-DR associations previously described in European and North American Caucasians were also found in Asian Indians. Additionally, however, Asian Indians exhibited two new HLA-D antigens, one associated with DR5 and the other with DRw6. The genetic distance between Asian Indians and Caucasians, Blacks, or Mongoloids is of the same order of magnitude.