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India represents the third largest country in the world of individuals living with HIV. Current surveillance data indicate a prevalence rate of 0.2% in the general population, with 2.1 million individuals living with HIV, including 61,000 children under the age of fifteen. HIV may result in a variety of academic, motor, language, psychosocial, and mental health problems, including neuropsychological deficits in attention, memory, and planning. India is making a concerted attempt to manage the HIV crisis through laws and advocacy efforts that include raising public awareness, education, reduction of parent-to-child-transmission, prevention, and the increased use of antiretroviral therapy. These efforts have resulted in a 57% decline in HIV infections over the past decade and it is now estimated that 56% of those infected are on antiretroviral therapy. Schools and school psychologists in India can play an important role in combating HIV/AIDS, while providing a full range of psychological services that are responsive to India's unique cultural context, including its collectivism, poverty, diversity of ethnicity, religion, and language, gender disparities, low rate of literacy, and inequalities in educational access. Continued management of HIV and the eradication of the HIV/AIDS epidemic in India will require a collaborative, sustained, and multi-dimensional approach to this complex condition.

Introduction: Children and young people in India have a high prevalence of dental decay. As part of a broader epidemiological study, we interviewed 10 head teachers to understand the status of, and challenges to, inclusion of oral health education in the curricula of public and private schools in Tamil Nadu, India. Objectives: The two main objectives of this study were (1) to describe the views of head teachers about the implementation of oral health education in school curricula and (2) to identify challenges to achieving oral health education in public and private schools in Tamil Nadu. Method: Qualitative descriptive design, with a purposive sample of 10 head teachers who participated in semi-structured interviews. Thematic coding was used to analyse and report on the data. Results: There is a lack of oral health education in public and private schools in Tamil Nadu, India. Four main types of barriers to the initiation and implementation of oral health education were lack of recognition, academic burden, prioritisation of other health needs and policy inequities. Head teachers acknowledged the lack of oral health education in their schools, yet also acknowledged the importance of oral health education in promoting students' health. Conclusion: Health curricula in Tamil Nadu schools lack integration of oral health education. Limited access to the services, cultural factors, policy deficiencies, insufficient awareness among policy-makers, the nature of the education system and lack of research contribute to the current situation. Policy-makers should address these barriers to enable and promote oral health education strategies in both private and public schools of Tamil Nadu.

Autism spectrum disorder (ASD) is being identified in an ever-increasing number of countries, including many that are low or middle income (LMIC). Research conducted in these countries requires awareness of unique ethical issues. Drawing on the experience of two organizations that have been involved in conducting and collaborating in ASD research in India, we describe specific considerations in conducting epidemiological, genetic and treatment studies as well as general principles from the field of multinational clinical research as they apply to the conduct of ASD research. We argue that greater attention to ethical concerns will result in quality studies conducted in LMICs that are also of greatest relevance for families and children with ASD.

Although it is well known that vaccines against many infectious diseases confer positive economic externalities via indirect protection, analysts have typically ignored possible herd protection effects in policy analyses of vaccination programs. Despite a growing literature on the economic theory of vaccine externalities and several innovative mathematical modeling approaches, there have been almost no empirical applications. The first objective of the paper is to develop a transparent, accessible economic framework for assessing the private and social economic benefits of vaccination. We also describe how stated preference studies (for example, contingent valuation and choice modeling) can be useful sources of economic data for this analytic framework. We demonstrate socially optimal policies using a graphical approach, starting with a standard textbook depiction of Pigouvian subsidies applied to herd protection from vaccination programs. We also describe nonstandard depictions that highlight some counterintuitive implications of herd protection that we feel are not commonly understood in the applied policy literature. We illustrate the approach using economic and epidemiological data from two neighborhoods in Kolkata, India. We use recently published epidemiological data on the indirect effects of cholera vaccination in Matlab, Bangladesh (Ali et al., 2005) for fitting a simple mathematical model of how protection changes with vaccine coverage. We use new data on costs and private demand for cholera vaccines in Kolkata, India, and approximate the optimal Pigouvian subsidy. We find that if the optimal subsidy is unknown, selling vaccines at full marginal cost may, under some circumstances, be a preferable second-best option to providing them for free. (Contains 14 footnotes, 2 tables, and 8 figures.)

This article illustrates the complex relationship between culture and illness in the context of changes in autism awareness and prevalence. The first half of the article argues that increased awareness is the result of global flows of information and that increased prevalence is the result of significant achievements in mental health and educational services. The author describes how culture influences both disease classification and epidemiology. The second half of the article illustrates the role of culture in the lives of three mothers of autistic children in India.

Lymphatic filariasis (LF) is an endemic parasitic disease and a major cause of acute and chronic morbidity and incapacitation with devastating public health and socio-economic consequences. It exacerbates poor conditions of afflicted persons and endemic communities through reduced or lost labour supply and productivity. Stigmatisation and discrimination are byproducts of LF that lead to reduced prospects of both marriage and a normal sexual life. LF causes absenteeism from school and poor academic performance. Socioeconomic factors and the cost of treatment for LF are presented. Additionally, our discussion includes the description of a two-drug combination introduced in endemic communities to suppress circulating microfilariae and interrupt spread of the disease. An argument is also made for collective support of the current Global Programme for the elimination of lymphatic filariasis as a public health problem and obstacle to socioeconomic development.

Indian teachers rating the prevalence of psychiatric problems in 79 school children with visual handicaps, 91 with hearing handicaps, and 105 nonhandicapped identified a higher prevalence than did psychiatrists. Although similar percentages of children in the 3 groups were diagnosed as having psychiatric problems, the types of problems experienced by each group varied. (JDD)

In this prospective cohort of 2006 individuals with drug-susceptible tuberculosis in India, 18% had unfavorable treatment outcomes (4.7% treatment failure, 2.5% recurrent infection, 4.1% death, 6.8% loss to follow-up) over a median 12-month follow-up period. Age, male sex, low education, nutritional status, and alcohol use were predictors of unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Road Traffic Accidents (RTAs) can develop Post-Traumatic Stress Disorder (PTSD) due to emotional trauma, which significantly affects the quality of life. Despite satisfactory psychological recovery for many RTA victims, a notable percentage of survivors continue to live with PTSD without diagnosis or treatment. In India, the rising number of RTAs necessitates research into their psychological impacts to inform healthcare strategies and interventions. Aim: To assess the prevalence of PTSD symptoms among RTA survivors and explore the association between PTSD and sociodemographic and clinical variables. Materials and Methods: A cross-sectional descriptive study was conducted and data was collected from selected trauma centres in Gujarat state, India, from April to May 2024. The study involved 380 participants who had experienced RTAs within 30-40 days prior to data collection. Data collection employed an interviewer-administered questionnaire with two sections: a demographic and clinical questionnaire and the PTSD Checklist (PCL-5) for PTSD symptom assessment. The PCL-5 is a 20-item tool, with scores ranging from 0 to 80, where a score of =33 indicates PTSD symptoms. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0, employing descriptive statistics, Chi-square tests, and Confidence Intervals (CI) to determine the significance of associations at a p-value<0.05 level. Results: The prevalence of PTSD symptoms among RTA survivors was 46.3%, with a mean±SD PTSD score of 29.41±10.68. The highest rates of PTSD were observed among younger individuals {18-25 years, 55 (52.4%)} and females 43 (47.3%). Education (p-value=0.027) and monthly income (p-value=0.011) were significantly associated with higher PTSD prevalence. Among clinical variables, the type of vehicle involved in the accident was associated with PTSD prevalence (p-value=0.012). Conclusion: The prevalence of PTSD symptoms among RTA survivors was 46.3%. Lower education levels, lower income, and involvement in two or three-wheeler accidents were significantly associated with a higher prevalence of PTSD. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is a significant public health problem in India, with an estimated 74 million Indian adults suffering from the condition as of 2021, and the prevalence is continuing to grow. Aim: To investigate the prevalence and forecasted trends of Diabetes Mellitus (DM) in India through time series analysis and forecasting models. Materials and Methods: A cross-sectional study was conducted in the Department of Statistics at Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India, from January 2024 to March 2024. The prevalence of diabetes in India was forecasted from 2023 to 2035 using existing diabetes prevalence data from 2009 to 2021, with the help of Gretl software and the Autoregressive Intregated Moving Average (ARIMA) model. Results: Authors observed a consistent upward trajectory in DM prevalence, with rates steadily increasing from 7.1% in 2009 to 9.6% in 2021. Time series analysis reveals non stationarity in the data, necessitating the use of ARIMA models for forecasting. Among the models considered, ARIMA (2,1,2) emerges as the best fit, demonstrating strong explanatory power with an R-squared value of 0.80. Forecasting projections indicate a continued rise in DM prevalence, with rates projected to increase from 10.35% in 2023 to 13.46% by 2035, which translates to an increase from 97.5 million in 2023 to 139 million in 2035. Conclusion: These findings underscore the urgent need for comprehensive public health interventions to address the escalating burden of diabetes in India, emphasising the importance of prevention, early detection, and effective management strategies. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) persists as a global health challenge, with pulmonary tuberculosis (PTB) constituting over 85% of all cases. India, with its distinctive demographic challenges, bears a significant burden, especially impacting the economically vital age group of 15 to 60 years. Methods: Our prospective study, conducted at the National Institute of Medical Science & Research, Jaipur, Rajasthan, encompassed a comprehensive reassessment of PTB subjects. Clinical evaluations, laboratory investigations, and radiological assessments, including chest X-rays (CXR) and high-resolution computed tomography (HRCT), were employed. A sample size of 320 cases underwent meticulous statistical analysis, adhering to ethical considerations. Results: Analysis revealed no significant association between gender and PTB cases (χ² = 0.186, df = 1, p = 0.666) or between age, gender, and PTB diagnosis (χ² = 4.651, df = 3, p = 0.266). Radiological findings demonstrated noteworthy correlations, emphasizing their diagnostic significance. Chest X-ray findings associated significantly with patchy infiltrate, mediastinal lymphadenopathy, fibrosis, and pleural effusion (p < 0.05). Conclusion: Our study unravels the complex tapestry of PTB, highlighting its historical significance and contemporary challenges. The pivotal role of radiological precision in diagnosis is underscored, especially in India's high-burden context. The findings emphasize the need for nuanced approaches and ongoing research to enhance our understanding and management of TB. As we confront the radiological intricacies of PTB, this study contributes to the discourse aimed at fostering transformative change in TB care and control. [ABSTRACT FROM AUTHOR]

Aim: The human adenovirus (HAdV) is beginning to spread rapidly in children through human, surface and animal vectors. Around 12,000 cases were recognised in 2022 in West Bengal and a shocking number of cases arose throughout India and in other under‐developed areas. This is going to be a big threat to public health since no vaccine, awareness or protocol policies were introduced. Early detection, immediate isolation and proper policy developments are the key factors in overcoming the situation. Therefore, we performed this rapid review and discussed probable mitigation strategies, updated research on vaccine development, and treatment strategies to control the outbreaks of mutated HAdV. Design: This is a narrative review of publicly available information. Methods: Here, we extracted updated information and data using the terms HAdV outbreaks, mutations, species, risks and prevention from Google Scholar and PubMed. We considered relevant articles that have discussed prevention strategies, ongoing research, and antiviral drugs for managing HAdV outbreaks. Results: Early detection from throat swabs, isolation and symptomatic treatments are required to minimise viral infections. A massive test needs to be performed to find the affected people. The cases should be immediately isolated. It is recommended to treat high‐touch surfaces with heat‐ or bleach‐containing cleaners to prevent the spread of infection. Oxygen support and many broad‐spectrum antivirals have been used to treat HAdV. Several studies showed antibody neutralisation and interactions between the natural killer cell receptor KIR3DS1 and HLA‐F in infected cells, indicating possible therapeutic options in the future. HAdV‐4 and HAdV‐7 vaccines have been limitedly approved for administration to military personnel. Conclusion: Isolation, certain safety measures, broad‐spectrum antiviral drugs and further research on new vaccines could be useful to prevent this virus from producing a worldwide pandemic. Also, the authorities should ensure the proper therapeutic interventions and nursing care facilities for the infected children. Patient or Public Contribution: Patient or public contribution was not relevant to our work. [ABSTRACT FROM AUTHOR]

Background and Objectives: The study aimed to assess the control of asthma and the severity of chronic obstructive pulmonary disease (COPD) and evaluate the adequacy of treatment in patients presenting to the outpatient department (OPD) across India. The secondary aim was to assess the risk factors associated with poorly controlled asthma and severe COPD. Materials and Methods: This is the analysis of Phase IV of the multicenter questionnaire-based point prevalence SWORD survey, conducted in May 2018, and designed to capture details on disease control and treatment as per the global initiative for asthma and the global initiative for chronic obstructive lung disease guidelines. Results: Of the 5,311 respiratory disease patients presenting to the OPD, there were 1,419 and 412 patients with asthma and COPD, respectively, across 290 sites in India. There were 1,022 (72%) patients having well-controlled asthma, 293 (20.6%) patients with partly controlled asthma, and 104 (7.4%) patients with poorly controlled asthma. Of the 412 patients with COPD, there were 307 (74.5%) in A, 54 (13.1%) in B, and 51 (12.4%) in the E category. In spite of poor control or severe disease, 34.8% of asthmatic and 25.7% of patients in the B and E categories of COPD were not using any medicine. Risk factors for partly and poorly controlled asthma included rain wetting (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.02--2.47) and gastroesophageal reflux disease (AOR: 1.50, 95%CI: 1.08--2.10). Conclusion: This study identifies a gap in the treatment of both poorly controlled asthma and severe COPD. A substantial number of patients had poorly controlled asthma and severe COPD, and many were either not taking treatment or taking it inappropriately. [ABSTRACT FROM AUTHOR]

Background: India is a vast and diverse country with existing variations in the frequency and distribution of cancers across its various parts. In regions lacking population-based cancer registries (PBCRs) in a vast country like India, hospital-based cancer registry (HBCR) data become an important source of information on the trends and patterns of a region. To determine the numerical trends of cases of the top ten cancer sites reporting to HBCR of a tertiary care cancer center in Bihar from 2014 to 2021. Materials and Methods: The details of all histopathologically confirmed cancer cases registered in the HBCR department of radiation oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India between January 2014 and December 2021 were included in this retrospective observational study. All these cases were grouped site-wise and listed in descending order of the total number of cases reported in each group. Cross-tabulation with age and sex distribution was done. The frequency distribution of the top ten leading cancers for every consecutive calendar year was plotted in line diagrams for time trend analysis. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). was used for analysis. Annual percent change (APC) was determined for the number of cases of all ten cancer sites using joinpoint regression analysis (Joinpoint Regression Software, Version 4.0.4--May 2013; Statistical Methodology and Applications Branch, Surveillance Research Program of the US National Cancer Institute; Bethesda, MD, USA). Results: Out of 32,057 total cancer cases registered between Jan 2014 and Dec 2021, 21,848 patients (68.2%) cases constituted the top ten cancers. The top ten cancers among both sexes were cancer gallbladder (n = 4204, 13.1%), head and neck (n = 3395, 10.6%), breast (n = 3392, 10.6%), lung (n = 2069, 6.5%), cervix (n = 2039, 6.4%), hematolymphoid (n = 1930, 6.0%), liver (n = 1572, 4.9%), stomach (n = 1116, 3.5%), ovary (n = 1103, 3.4%), and colon-rectum (n = 1028, 3.2%). Except for cervical and hematolymphoid cancers, the rest all showed a rising trend over consecutive years. Conclusion: Cancer of the gallbladder continues to be among the most common cancers in the region. Focused research in all aspects of this deadly disease is needed. Strengthening of prevention and screening programs for common cancers and upliftment of the existing infrastructure for diagnosis and treatment of cancer in the region are necessitated. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus is a major causative agent of lower respiratory tract infection in children, especially infants with substantial morbidity and mortality implications. The virus undergoes continuous evolution documented by accumulation of mutations in the glycoprotein gene necessitating vigilant surveillance to provide essential data to epidemiologists and researchers involved in development of vaccines. This study was aimed to perform molecular characterization of respiratory syncytial virus (RSV) among children ≤ 5 years admitted in hospital. In the current study we observed RSV‐A (2019 (n = 95) and 2021 (n = 61) seasons) and RSV‐B (2022 season (n = 68)). Phylogenetic analysis revealed all RSV‐A strains (n = 47) to be GA.2.3.5 and RSV‐B (n = 22) were classified as GB.5.0.5a. Selection pressure analysis identified one positive (P274L/V) and one negative site (P230T) in RSV–A, while in RSV‐B there was only one negatively selected site (S295). This study spanning over three seasons contributes to RSV evolutionary dynamics in India emphasizing the importance of on‐going surveillance to inform effective public health strategies and vaccine development efforts. [ABSTRACT FROM AUTHOR]

In this paper, the existing Susceptible-Infected-Recovered-Deceased (SIRD) compartmental epidemiologic process model is modified for forecasting the coronavirus effect in India. The data from India was studied for weekly fatalities, weekly infected, weekly recovered, new cases, infected and recovered individuals, Reproductive Number R0, recovery rate, death rate, and coefficient of transmission from 30 January 2020 to 31 July 2021. SARS Coronavirus 2 (SARS-CoV-2) is the Covid strain that causes Covid sickness (COVID-19), a respiratory ailment that triggered the outbreak of COVID-19 at the beginning of December 2019. We aim to provide a hybrid SIRD model for predicting the COVID-19 outbreak. In the proposed method, to improve the exploration ability of the Grey Wolf Optimizer (GWO) or to avoid stagnation in the swarm, a modified Grey Wolf Optimization Algorithm is used to optimize the initial value of Infected individuals. The modified SIRD model is further applied to get the predicted values. The data is examined on weekly basis to prevent noise. Depending on the fact, that the precise mode of transmission is highly dependent on how and when different precautions such as isolation, confinement, and other preventative measures were implemented, we put together our projections concerning satisfactory speculations based on genuine realities. The experimental results show the various trends observed in the pandemic in terms of number of peaks, increasing trend, decreasing trend, and continuous trend for infected individuals, weekly change in number of cases, weekly deaths, weekly infected, and weekly recoeverd cases of Covid-19. The proposed modified SIRD model could be a valuable tool for assessing the impact of government measures on COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Background: A novel coronavirus was identified in Wuhan, China in December 2019. The pandemic brought all people closer to internet to access information about the disease and its prevention. However, this intention of gaining knowledge is a spinal reaction to an adverse situation and once that has passed, the same knowledge and practices decline. Aims and Objectives: The aim of the study was to assess the apprehension regarding COVID-19 along with its demographic correlates in the post-pandemic era. Methodology: A cross-sectional study was conducted in district Ghaziabad using a predesigned, pre-tested and semi-structured questionnaire regarding the awareness and knowledge levels of COVID-19. Regression analysis was performed to determine the factors significantly associated with the knowledge of the study participants. Results: In this study, 277 (69.25%) were males and 123(30.75%) were females. The mean knowledge score was 25.09 ± 6.85 (range 4-41). Knowledge regarding various aspects of COVID-19 was better among the study participants with higher education levels. Conclusion: Even after the pandemic had passed, good knowledge levels were retained. Participants had a huge disparity in the individual levels of information. Overall higher levels of education, younger age group and nuclear family were associated with better knowledge regarding the disease. [ABSTRACT FROM AUTHOR]

Objectives: Respiratory syncytial virus (RSV) is undoubtedly the single most important cause of severe lower respiratory tract infection (LRTI) globally. While new prevention measures in young infants have become available, their use in developing countries is likely many years away. While risk factors for severe or very severe RSV LRTI in impoverished rural areas likely differ to urban areas, there are very few studies, especially those conducted in India, the major country contributing to the global burden of disease. Methods: Active surveillance for acute LRTI in enrolled infants and children <2 years of age, was conducted through weekly home visits in 93 villages of Melghat, India, from August 2016 to December 2020. Local hospitals and primary health centres were surveyed for admissions of enrolled subjects. Nasopharyngeal swabs were collected from children with severe, or very severe LRTIs and all who died, with RSV testing using nucleic acid tests at ICMR, National Institute of Virology Pune. Risk factors for both RSV associated and non‐RSV associated, severe and very severe LRTI were identified through univariate and multivariate logistic regression. Results: There were 483 severe or very severe RSV LRTI cases and 2807 non‐RSV severe or very severe LRTI infections in a cohort of 13,318 children. Weight for age z‐score ≤−2, the use of kerosene or wood for cooking, obtaining drinking water from a public tap and low gestational age significantly increased the risk of RSV LRTI. A higher wealth score index and water purification were protective. Comparison with non‐RSV LRTI showed male sex as an additional risk factor. The analysis highlighted the risk of kerosene use [OR = 17.8 (3.0–104.4) (p ≤ 0.001)] and [OR = 3.4 (0.8–14.4) (p ≤ 0.05)] for RSV and non‐RSV LRTIs, respectively. Conclusions: Nutritional status and environmental air quality are predisposing factors for developing an RSV LRI in young children, factors which are amenable to environmental and behavioural interventions. [ABSTRACT FROM AUTHOR]

Homicide is a brutal crime where one person kills another, robs them of their life. Forensic pathologists must distinguish between suicide, murder and accidents using autopsy. Homicides can involve various methods, including assault, strangulation, drowning, burns and poisoning. The rising incidence of homicides prompts a study to identify vulnerable age groups, sex incidence, motives, injury patterns, crime locations and survival periods. The study was conducted from January to December 2023 on 103 cases from 4172 autopsies in the Department of Forensic Medicine & Toxicology at B. J. Medical College, Ahmedabad. In this study we included the cases with alleged homicide history and those later converted to homicide. Most of the cases were in the age group of 21 years to 30 years and least in the age group of 0 to 10 years. Injuries were most common (36.89%) between 6 pm and 12 midnight and least common (17.48%) between 12 noon and 6 pm. The majority of homicidal deaths involved hard and blunt weapons (39.80%), followed by sharp and penetrating weapons (31.06%). Argument was the most common reason for homicidal death in 42.72% of instances. Homicides occurred most common on the street in 38.83% of cases. The majority of victims died within 30 minutes to 24 hours (45.63%) of infliction of injuries. 42.72% of incidents involved an acquaintance as the assailant. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the commonest malignancy among women globally. The aims of our study were to evaluate the diversity and epidemiology of breast cancer on patients admitted in Burdwan Medical College and Hospital for elective mastectomy for carcinoma breast. Materials and methods: All the patients suspected of breast malignancy were clinically evaluated with age>25 years (as breast cancer is common beyond this age) and were included in the study. All the mastectomy specimens sent to Department of Pathology, Burdwan Medical College & Hospital, for histopathological examination were considered in the study. Results: The range of patients presenting with breast cancer was between 30-65 years, while 29 patients were below the age of 50 years and 17 above it. Maximum nos of case were between 40-49 years. Among the histopathological types of the tumours, IDC NOS constituted 40 cases (86.9%), invasive lobular carcinoma constituted 2 cases (4.3%), medullary carcinoma 2 cases (4.3%), invasive papillary carcinoma and mucinous carcinoma 1 case each (2.2%). T1 (size < 2 cm) was observed in 2 cases (4.3%), T2 (size 2-5 cm) was observed in 10 cases (21.7%). T3 (size > 5cm) was seen in 5 cases (10.9%), T4 (tumour of any size with fixity to the chest wall or skin) was observed in 29 cases (63%). Grading of 42 cases was done and only 1 case (2.4%) of Grade I was seen, whereas 25 cases (59.5%) belonged to Grade II, and 16 cases (38.1%) to Grade III. Out of the 46 cases, Stage IIA constituted 8 cases (17.4%), Stage IIB 3 cases (6.5%), Stage IIIA 6 cases (13%), and Stage IIIB 29 cases (63%). Conclusion: The government needs to urgently strengthen and augment the existing facilities including screening, which is inadequate at present to handle the current breast cancer load in India, especially Eastern India. [ABSTRACT FROM AUTHOR]

Background: India is a large and populous country where reliable data on headache disorders are relatively scarce. This study in northern India (Delhi and National Capital Territory Region [NCR], including surrounding districts in the States of Haryana, Uttar Pradesh and Rajasthan) continues the series of population-based studies within the Global Campaign against Headache and follows an earlier study, using the same protocol and questionnaire, in the southern State of Karnataka. Methods: This cross-sectional study used the Global Campaign's established methodology. Biologically unrelated Indian nationals aged 18–65 years were included through multistage random sampling in both urban and rural areas of NCR. Interviews at unannounced household visits followed the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire in its original English version or in the validated Hindi version. Demographic enquiry was followed by a neutral headache screening question and diagnostic questions based on the International Classification of Headache Disorders edition 3 (ICHD-3), which focused on each respondent's most bothersome headache. Questions about headache yesterday (HY) enabled estimation of 1-day prevalence. A diagnostic algorithm first identified participants reporting headache on ≥ 15 days/month (H15+), diagnosing probable medication-overuse headache (pMOH) in those also reporting acute medication use on ≥ 15 days/month, and "other H15+" in those not. To all others, the algorithm applied ICHD-3 criteria in the order definite migraine, definite tension-type headache (TTH), probable migraine, probable TTH. Definite and probable diagnoses were combined. Results: Adjusted for age, gender and habitation, 1-year prevalences were 26.3% for migraine, 34.1% for TTH, 3.0% for pMOH and 4.5% for other H15+. Female preponderance was seen in all headache types except TTH: migraine 35.7% vs. 15.1% (aOR = 3.3; p < 0.001); pMOH 4.3% vs. 0.7% (aOR = 5.1; p < 0.001); other H15 + 5.9% vs. 2.3% (aOR = 2.5; p = 0.08). One-day prevalence of (any) headache was 12.0%, based on reported HY. One-day prevalence predicted from 1-year prevalence and mean recalled headache frequency over 3 months was slightly lower (10.5%). Conclusions: The prevalences of migraine and TTH in Delhi and NCR substantially exceed global means. They closely match those in the Karnataka study: migraine 25.2%, TTH 35.1%. We argue that these estimates can reasonably be extrapolated to all India. [ABSTRACT FROM AUTHOR]

Leptospirosis is one of the most neglected zoonotic infections of public health concern worldwide and a remerging infection in tropical countries such as India. The infection least explored disease and the epidemiological and other critical data are scarce for the disease rate reported and to control the infection. Leptospirosis as sapronosis is as underrated as the infection itself, and this article aims to explore the significance of this aspect of the disease. The research review aimed at the epidemiological understanding of the infection to control the negative impact of the disease. A mixed review and analysis were carried out to understand the knowledge published on the critical and understudied areas like epidemiology, transmission, diagnosis, treatment, and control of infection. A systematic analysis was carried out to extract information about the reported circulating strains, and research lacunae in India with the published data available in PubMed. The article elaborately discusses crucial inference areas of infection transmission and addresses lacunae in critically unacclaimed areas of infection to control the spread of infection using one health approach (OHA), and strategies to control leptospiral infection are proposed. The article also reviewed how and why Leptospirosis can be best studied and controlled by "One health approach" in India. Highlights: Leptospiral strains reported from one health domain source, human, animal, and environmental samples in India are listed to display the epidemiology of infection in India. This article discusses the lacunae in Leptospirosis research in crucial domains and one of the core areas of transmission and how it is the major target for the control of infection in animals and humans. The study has a list of recommendations for the establishment of a One Health working group and possible control strategies for transmission. [ABSTRACT FROM AUTHOR]

Background: The limited representation from developing countries in the original COME TOGETHER survey gave us an impetus to conduct this survey in the Indian subcontinent. Methods: This cross-sectional online survey was conducted from August through September 2022. Participants were health care physicians caring for patients with coma and disorders of consciousness. Fischer's exact test or the Mann–Whitney U-test was used to compare respondents who agreed or disagreed with the preestablished coma definition. Fleiss κ values were calculated to assess agreement among respondents. A p value less than 0.05 was considered statistically significant. Results: The survey was completed by 130 physicians. We found substantial interrater agreement on absence of wakefulness (71.54%; κ = 0.71), Glasgow Coma Score ≤ 8 (78.46%; κ = 0.78), and failure to respond purposefully to visual, verbal, or tactile stimuli (66.15%; κ = 0.66). Reported common etiologies of coma included traumatic brain injury (50.76%), ischemic stroke (30%), and intracerebral hemorrhage (29.23%). The most common clinical assessment tools used for coma included the Glasgow Coma Score (92.3%) and neurological examination (60.8%). Neurological examination was the most common diagnostic tool used (100%), followed by magnetic resonance imaging (89.2%), basic laboratory studies (88.5%), and head computed tomography/angiography (86.9%). Pharmacological interventions used to stimulate arousal in patients with coma were sedation vacation (91.5%), electrolyte/endocrine correction (65.4%), osmotic therapy with mannitol (60%), hypertonic saline (54.6%), modafinil (46.9%), and antidote for drugs (45.4%). Among the nonpharmacological interventions, sensory stimulation (57.7%) was the most commonly used modality. The most common discharge disposition for comatose patients who survived hospitalization were home with or without services (70.0%). Conclusions: Differences from the global survey were noted regarding the following: traumatic brain injury being the most common etiology of coma in India, more frequent practice of sedation interruption, less frequent use of electroencephalography in India, rare use of pharmacological neurostimulants, and home being the most common discharge disposition in India. [ABSTRACT FROM AUTHOR]

Aims: Japanese encephalitis (JE) is endemic in India. Although pigs are considered important hosts and sentinels for JE outbreaks in people, limited information is available on JE virus (JEV) surveillance in pigs. Methods and Results: We investigated the spatio‐temporal distribution of JEV seroprevalence and its association with climate variables in 4451 samples from pigs in 10 districts of eastern Uttar Pradesh, India, over 10 years from 2013 to 2022. The mean seroprevalence of IgG (2013–2022) and IgM (2017–2022) was 14% (95% CI 12.8–15.2) and 10.98% (95% CI 9.8–12.2), respectively. Throughout the region, higher seroprevalence from 2013 to 2017 was observed and was highly variable with no predictable spatio‐temporal pattern between districts. Seroprevalence of up to 60.8% in Sant Kabir Nagar in 2016 and 69.5% in Gorakhpur district in 2017 for IgG and IgM was observed, respectively. IgG seroprevalence did not increase with age. Monthly time‐series decomposition of IgG and IgM seroprevalence demonstrated annual cyclicity (3–4 peaks) with seasonality (higher, broader peaks in the summer and monsoon periods). However, most variance was due to the overall trend and the random components of the time series. Autoregressive time‐series modelling of pigs sampled from Gorakhpur was insufficiently predictive for forecasting; however, an inverse association between humidity (but not rainfall or temperature) was observed. Conclusions: Detection patterns confirm seasonal epidemic periods within year‐round endemicity in pigs in eastern Uttar Pradesh. Lack of increasing age‐associated seroprevalence indicates that JEV might not be immunizing in pigs which needs further investigation because models that inform public health interventions for JEV could be inaccurate if assuming long‐term immunity in pigs. Although pigs are considered sentinels for human outbreaks, sufficient timeliness using sero‐surveillance in pigs to inform public health interventions to prevent JEV in people will require more nuanced modelling than seroprevalence and broad climate variables alone. [ABSTRACT FROM AUTHOR]

Background: Adult soft tissue sarcomas (STS) are rare and diverse. Current management is based on limited literature from the West. Therefore, data from different geographical regions is required, including the low‐middle‐income countries. This is our experience managing adult sarcomas in the tertiary cancer center of North India. Materials and methods: This is a retrospective analysis of the structured sarcoma database of patients treated in the surgical oncology department between 1992 and 2020. The descriptive analysis includes demography, site distribution, diagnosis, histopathology variations, prior surgical interventions, and stage. Results: A total of 1106 soft tissue sarcoma patients were treated in three decades. Age distribution was 13%, 43%, 31%, and 11% in <20, 21–40, and 41–60 and >60 years, respectively. The male‐to‐female ratio was 1.73. The anatomical distribution was 17%, 42%, 23%, 7%, 7%, and 3% in upper extremity, lower extremity, trunk, retroperitoneum, head and neck, and viscera, respectively. Overall, 49% of patients had undergone prior suboptimal surgeries at community hospitals. Common histology subtypes were synovial sarcoma (18%), undifferentiated pleomorphic sarcoma (UPS) (13%), dermatofibrosarcoma protuberans (12%), and liposarcoma (9%). A pathological discordance of 13% was identified between the initial and the final histologies. Overall, 61% of tumors were high‐grade. Memorial Sloan Kettering Stages II and III were present in 33% and 35% of patients, respectively. Conclusions: This is one of the largest single institutional experiences of STS from the Asian population. Mostly young adults were affected with male preponderance. The lower extremity and trunk were common subsites. Frequent histologies were synovial sarcoma and UPS. A high rate of suboptimal surgical intervention at the community level and pathological discordance was noted. This study highlights the need to establish prospective structured databases for capturing quality information related to rare malignancies and providing insights for future research. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common sustained supraventricular arrhythmia encountered in clinical practice. Due to the higher prevalence of rheumatic fever in several regions of India, rheumatic heart disease (RHD) is the most common etiological factor of AF. Aims and Objectives: The objective of the study was to study clinical features, electrocardiographic (ECG) and echocardiographic (ECHO) findings, complications, and incidence of AF in rheumatic mitral valve disease (R-MVD). Methods: It is an observational cross-sectional study of 40 indoor patients in a Tertiary Care Hospital in Vadodara, Gujarat, carried over a period of a year. Clinical data including symptoms, signs, systemic examination, and relevant investigations were studied. Results: 67.5% (n = 27) of patients having AF were below the age of 50 years with higher incidence among females (72.50%) as compared to males (27.5%). Fifteen (37.5%) had mitral stenosis (MS) and 13 (32.5%) had MS with regurgitation. Most of the patients 35 (87.5%) presented with breathlessness, followed by palpitation 28 (70%). The most commonly heard murmur was mid-diastolic (65%, n = 26), followed by pansystolic murmur (40%, n = 16) at the apex. Out of 40 patients, 15 (37.5%) had evidence of left ventricular hypertrophy on ECG, whereas only 5 (12.5%) had right ventricular hypertrophy. Four out of five patients with the evidence of cardioembolic stroke had left atrium (LA) size >45 mm which suggests an increased risk of embolic stroke with increased LA size. Only 3 (7.5%) patients had a visible LA clot in LA on two-dimensional ECHO, whereas only one patient had vegetation on valves. Twenty-seven out of 30 patients treated with diltiazem show good response. Heart failure was the most common complication affecting 85% (n = 34) of the patients with AF with R-MVD. Four (10%) patients out of 40 expired including 1 (25%) of the four pregnant patients, suggesting higher mortality among pregnant females due to superimposed physiological changes occurring during pregnancy. Conclusion: In developing countries like India, RHD is a major cause of AF affecting the younger population and more commonly females. Most of the patients in our study presented with breathlessness and palpitation. LA size was directly proportional to the risk of cardioembolic stroke and most of the patients developed heart failure as a complication. [ABSTRACT FROM AUTHOR]

Background Neglected tropical diseases are responsible for considerable morbidity and mortality in low-income populations. International efforts have reduced their global burden, but transmission is persistent and case-finding-based interventions rarely target asymptomatic individuals. Methods We develop a generic mathematical modeling framework for analyzing the dynamics of visceral leishmaniasis in the Indian sub-continent (VL), gambiense sleeping sickness (gHAT), and Chagas disease and use it to assess the possible contribution of asymptomatics who later develop disease (pre-symptomatics) and those who do not (non-symptomatics) to the maintenance of infection. Plausible interventions, including active screening, vector control, and reduced time to detection, are simulated for the three diseases. Results We found that the high asymptomatic contribution to transmission for Chagas and gHAT and the apparently high basic reproductive number of VL may undermine long-term control. However, the ability to treat some asymptomatics for Chagas and gHAT should make them more controllable, albeit over relatively long time periods due to the slow dynamics of these diseases. For VL, the toxicity of available therapeutics means the asymptomatic population cannot currently be treated, but combining treatment of symptomatics and vector control could yield a quick reduction in transmission. Conclusions Despite the uncertainty in natural history, it appears there is already a relatively good toolbox of interventions to eliminate gHAT, and it is likely that Chagas will need improvements to diagnostics and their use to better target pre-symptomatics. The situation for VL is less clear, and model predictions could be improved by additional empirical data. However, interventions may have to improve to successfully eliminate this disease. [ABSTRACT FROM AUTHOR]

A growing number of studies have linked the incidence of leptospirosis with the occurrence of flood events. Nevertheless, the interaction between flood and leptospirosis has not been extensively studied to understand the influence of flood attributes in inducing new cases. This study reviews leptospirosis cases in relation to multiple flood occurrences in Kerala, India. Leptospirosis data were obtained for three years: 2017 (non-flood year) and two years with flooding—2018 (heavy flooding) and 2019 (moderate flooding). We considered the severity of flood events using the discharge, duration and extent of each flooding event and compared them with the leptospirosis cases. The distribution of cases regarding flood discharge and duration was assessed through descriptive and spatiotemporal analyses, respectively. Furthermore, cluster analyses and spatial regression were completed to ascertain the relationship between flood extent and the postflood cases. This study found that postflood cases of leptospirosis can be associated with flood events in space and time. The total cases in both 2018 and 2019 increased in the post-flood phase, with the increase in 2018 being more evident. Unlike the 2019 flood, the flood of 2018 is a significant spatial indicator for postflood cases. Our study shows that flooding leads to an increase in leptospirosis cases, and there is stronger evidence for increased leptospirosis cases after a heavy flood event than after a moderate flooding event. Flood duration may be the most important factor in determining the increase in leptospirosis infections. [ABSTRACT FROM AUTHOR]

Background: In an individual, the development and severity of Non-Communicable Diseases (NCDs) are determined by the presence or absence of clustering of NCD risk factors in them. We aimed to determine the prevalence and the factors associated with clustering of risk factors of NCDs in the district of Puducherry in India. Methodology: We conducted a community-based cross-sectional survey among the adult population (18–69 years) of Puducherry district (N = 1114) between February 2019 and February 2020. Ten risk factors of NCDs (behavioral, physical measurements and biochemical) were assessed. Individuals having ≥ 3 risk factors were regarded as having clustering of risk factors. Categorical variables are summarized using proportions (95% CI). Adjusted prevalence ratio was estimated using weighted forward stepwise generalized linear modelling. Results: Clustering of NCD risk factors was present in majority (95.2%, 95% CI: 93.8–96.3) of the population. The presence of clustering was significantly higher among women (97.1%, 95% CI: 95.9–98.3) and the urban population (97.2%, 95% CI: 96.1–98.3). The risk factors that primarily drove the high prevalence of clustering were raised salt intake and inadequate intake for fruits and vegetables in nine out of 10 people in the district. Nearly 1 in 10 (13.3%, 95% CI: 11.3–15.3), 1 in 5 (21.5%, 95% CI: 19.1–23.8) and 1 in 4 (26.8%, 95% CI: 24.1–29.4) participants had three, four and five risk factors, respectively. Conclusion: We highlight the urgent need for population-based health promotion interventions in the district of Puducherry targeting the highly prevalent NCD risk factors, especially among the women and urban populations. [ABSTRACT FROM AUTHOR]

Objective: We prospectively determined incident cardiovascular events and their association with risk factors in rural India. Methods: We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package). Results: Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow‐up (median of 4.9 years, 23,180 person‐years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21–2.49], adjusted PAF 18%), diabetes (1.96 [1.15–3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non‐traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF. Conclusions: Both traditional and non‐traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events. [ABSTRACT FROM AUTHOR]

Introduction: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. Methods: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. Results: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. Conclusion: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies. [ABSTRACT FROM AUTHOR]

Objective We report the epidemiology of Japanese encephalitis (JE) disease after the implementation of routine immunization in medium-endemic districts in the states of Maharashtra and Telangana in Central India. Methods We investigated acute encephalitis syndrome (AES) patients hospitalized from October 2018 to September 2020. Field visits were also made to the residences of 262 AES cases, including 54 JE cases. Results The overall case fatality ratio was 31%. Maharashtra state contributed 72% of JE and 67% of AES cases. The rural localities had a significantly higher number of JE cases than the urban areas. The occurrence of JE was reported year round, with most JE cases reported during the rainy season. Both AES and JE cases were reported mostly among children, with JE in 66% and non-JE AES in 70% of children. Conclusion The JE disease continues to affect the population after routine immunization. Surveillance, prevention, and control need to be enhanced to achieve accelerated control. [ABSTRACT FROM AUTHOR]

Dengue is one of the most important vector-borne disease in India. It has been linked to monsoons when Aedes aegypti mosquitoes breed profusely in containers. No study exists in Armed Forces wherein a community-based sero-survey has described the epidemiology of dengue. The present study tries to fill this knowledge gap. A total of 422 participants were studied for one transmission season of July–December. Blood samples were collected for testing dengue IgG and IgM at the beginning and at end of the study period. The study participants were interviewed at least twice within this period of 6 months to assess clinical condition and follow-up. Point prevalence and incidence were measured. Distribution of presence or absence of symptoms was noted for positive as well as negative cases. All participants were males. Average age was 31.75 years. Point prevalence at the beginning of transmission season was 11.6% (95% CI: 8.4%–14.6%) and 15.6% (95% CI: 12.1%–19.1%) towards the end. Incidence was found to be 147.4 per 1000 for 6 months. Forty percent of incident cases were asymptomatic. Healthcare planners and hospital commanders in stations across Armed Forces can use the prevalence and incidence figures obtained in this study as a general guide while planning for prevention and control of dengue. Also, this study points to the fact that dengue transmission in Delhi may have shifted earlier to months of April/May than the conventionally accepted season of July–December. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although many studies have investigated the physical and ergonomic risks of spine pain in specific occupation groups, the literature is lacking on occupation-based clinical and psychological presentation in patients with spine pain. OBJECTIVE: To analyze occupation-based variation in demographic, clinical, and psychological presentation in patients with spine pain. METHODS: This retrospective study analyzed the clinical data of 71727 patients with spine pain visiting a chain of spine rehabilitation clinics. Demographic and clinical variables such as gender, age, affected site, symptom duration, clinical symptoms and presentation, pain intensity, disability, and STarT Back Screening Tool (SBT) risk were compared between 9 occupational groups. RESULTS: The service and sales workers (44%) and students (43.5%) groups had the highest percentage of patients who presented with central spine pain; military personnel had the highest percentage of patients who presented with unilateral radicular pain (51.5%); and the retired or unemployed group had the highest percentage of patients who presented with severe myotomal loss (grade≤3) (6%). Homemakers had significantly higher pain intensity and disability (p < 0.001) and had the highest percentage of patients who presented with severe pain (47%), severe and crippled disability (59.5%), and medium to high risk (59%) with SBT when compared to other occupational groups. CONCLUSION: Patients with spine pain showed variation in demographic, clinical, and psychological presentation based on their occupation. The findings of this study can be the basis for identifying risk factors for spine pain and helping plan preventive and treatment measures based on their occupation. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is a disease of the older population in developed countries where the incidence among the young is rising despite the decline in the overall incidence. Contrary to this, in India, which is a low-incidence country for CRCs, the incidence among all age groups including the young is rising. This study aimed at describing the clinico-demographic profile of young CRC cases and the epidemiological trend of the proportion of young cases from 2014 to 2021 in a tertiary cancer center in Eastern India. Methods: This retrospective observational study was conducted at Department of Radiation Oncology, State Cancer Institute, IGIMS Patna, India a prominent tertiary cancer care center of Bihar. All histopathologically confirmed CRC cases in the 0-39 years age group were considered young and evaluated for the clinical, demographic profile as well as yearly trends in proportion out of total CRC cases. Microsoft Excel (2021) was used for statistical analysis. A P value of 0.05 was considered significant. Results: Young colorectal (less than 40 years) patients constituted a third (n = 344, 33.4%) of total colorectal (n = 1028) cases. The median age among the young CRC cases was 30 years (range: 12 to 39 years). Rectum was the most common subsite noted (n = 255,74.1%) among this group of young patients. The most commonly encountered stage of the disease was III (n = 107, 31.1%) and chemotherapy was the most common treatment offered (n = 153, 44.5%). The proportion of young (0-39 years) CRC cases ranged between 29.4 and 37.4 (mean 33.5 ± 2.77, P value = 0.725) over the calendar years of the study period. Conclusion: The proportion of young (<40 years of age) cases out of total CRC cases in our study is higher than that in developed countries. However, the trends of this proportion have been consistent over the study period, i.e., from 2014 to 2021 without any significant change in our hospital-based cancer registry. Rectal cancer affected nearly three out of every four CRC patients in this age group. More advanced disease at presentation emphasizes the need for measures of screening, early diagnosis, and adequate infrastructure for treatment. [ABSTRACT FROM AUTHOR]

Leaf blight disease (LBD) of mungbean caused by Macrophomina phaseolina is one of the major yields reducing factor in mungbean (Vigna radiata (L.) Wilczek). Temperature and relative humidity play a significant role in development of this disease. In the present studies which was carried out at Agricultural Research Station, Badnapur during kharif 2017. The factors were found to have a temperature showing non-significant and humidity showing significant role in disease development on leaf blight under field conditions. Maximum temperature (31.4°C), minimum temperature (25.61°C) and relative humidity (84.04%) favored high disease development. Positive and non-significant correlation was observed between disease and temperature while significant, positive correlation was noticed between disease development and relative humidity. This is the first-time study on the impact of weather parameter on leaf blight of mungbean in Maharashtra State. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease is a neurological condition that progresses over time and causes terrible socioeconomic consequences for affected people, their families, and society as a whole. It is linked to both motor and non-motor symptoms, which has a substantial negative impact on older people's quality of life. Methods: This one-year hospital-based observational cross-sectional study was carried out in the K.R. Hospital's neurology and medicine departments from November 2022 to October 2023. The study covered all Parkinson's disease patients who visited the K.R. Hospital's medicine and neurology outpatient and inpatient departments. Both the clinical signs and symptoms and the demographic information were noted. Results: Males outnumbered girls by a significant margin. The average age of the research participants was 63.87±6.52 years. A total of 100%, 70%, and 26.67% of the participants reported having cardinal, motor, and non-motor symptoms, respectively. Subjects with both motor and nonmotor symptoms had higher mean ages than their counterparts, indicating a statistically significant difference. Conclusion: The features of the PD patients included in this study closely resemble those of other populations in India and other developing countries. However, the paucity of research and data on Parkinson's disease highlights the need for additional study of this neurodegenerative illness to gain a deeper understanding of its clinical and epidemiological features in our area. [ABSTRACT FROM AUTHOR]

Background: Accidental injuries sustained during helocasting remain unexamined. Methods: Conditions prevalent during a helocasting exercise performed at a still water body and the resulting casualties were analyzed. Results: Despatch from greater-than-ideal height (>7 m) and speed (>5 knots) causes a high-velocity impact of the body with water in a non-aerodynamic configuration, exposing maximal body area at penetration. The brunt is borne by the torso/back, specifically, the lungs, ribs, and posterior aspect of the spine. The injuries result from direct trauma, sudden deceleration, barotrauma, and hyperflexion. Computerized tomography (CT) is the imaging of choice in the assessment of these injuries. Prompt evacuation to an equipped center, whilst stabilizing the spine in the suspected, proves pivotal to the outcome. Conclusions: Adverse slamming dynamics cause accidental injuries in helocasting. Thorax and spine are predominantly traumatized, both directly and indirectly, and are assessed best using CT. Timely spine stabilization and evacuation prove vital. Accurate assessment of height/ speed and adherence to their ideal limits, at despatch, may avert such injuries. [ABSTRACT FROM AUTHOR]

This study collected data related to agricultural injuries, analyzed their causes, and suggested possible remedial actions. Few studies from developing countries have investigated this important topic. Such investigations are extremely important and are required to frame national policies. A well-designed structured form was developed to collect and evaluate data on agricultural incidents, their causes, the severity of injuries, and possible prevention methods. The authors followed a door-to-door survey methodology to collect data with the help of local village leaders. Less educated and older adults in the age group 31 to 45 years were more prone to agricultural incidents (p <.05). The mean age of the victims was 35.02 years (95% CI 32.7 to 37.3); 124 (91.18%) of the victims were men; and 21 (15.4%) of the cases were fatal. Tractor rollovers caused most of the deaths. Chaff cutters were responsible for most of the incidents that required amputation. Eighteen (45%) of the chaff-cutter incidents occurred in the evening between 3:00 PM and 6:00 PM, and 12 (30%) of these incidents occurred due to fatigue. The authors strongly recommend that rollover protective structures (ROPS) for tractors and seat belts should be made mandatory in India. Public guidelines emphasizing mandatory higher education for farmers and a model curriculum for both schools and colleges that focuses on the safety of rural populations should be developed. Special training should be provided on the safe operation of machinery and a definitive work – rest schedule should be followed to prevent fatigue and protect agricultural workers from incidents. [ABSTRACT FROM AUTHOR]

Blast disease causes significant damage to millets (pearl millet, finger millet and foxtail millet) and rice in India. This study investigates strains of Pyricularia, the causal agent of blast disease, in rice and millets in India in terms of their diversity, host preferences and phylogeny. One hundred and thirty‐six Pyricularia isolates causing rice and millet blast were collected from 46 locations in India. They displayed morphological diversity irrespective of host or location. All Pyricularia isolates were separated into two major clusters by a multilocus sequence‐based phylogenetic tree, which also demonstrated that most isolates are grouped according to their host associations. In contrast, a few finger millet isolates were found to be grouped with foxtail millet isolates. We explored how Pyricularia isolates behaved when exposed to rice and millets. Finger millet isolates were shown to be pathogenic on a wide variety of millets, whereas rice isolates were only found to infect rice and wheat. The majority of the blast isolates of millets were shown to be pathogenic on common weed species of the millet ecosystem, such as Echinochloa crusgalli, Eleusina indica and Erogrotis gagantica. Our findings emphasize the importance of pathogen surveillance in both cultivated crops and weed hosts, as well as the possible risk of blast fungus infection in Indian millets due to host expansion. Blast disease control programmes in India will be greatly enhanced by the knowledge gained in this study on the diversity and host association of Pyricularia strains. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the prevalence and attributable burden of headache disorders in India is sparse, with only two recent population-based studies from South and East India. These produced conflicting results. A study in North India is needed. We report the methodology of such a study using, and validating, a Hindi translation of the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire developed by Lifting The Burden (LTB). Almost half of the Indian population speak Hindi or one of its dialects. Methods: The study adopted LTB's standardized protocol for population-based studies in a cross-sectional survey using multistage random sampling conducted in urban Delhi and a surrounding rural area. Trained interviewers visited households unannounced, randomly selected one adult member from each and applied the Hindi version of HARDSHIP in face-to-face interviews. The most bothersome headache reported by participants was classified algorithmically into headache on ≥ 15 days/month (H15 +), migraine (including definite and probable) or tension-type headache (including definite and probable). These diagnoses were mutually exclusive. All participants diagnosed with H15 + and a 10% subsample of all others were additionally assessed by headache specialists and classified as above. We estimated the sensitivity and specificity of HARDSHIP diagnoses by comparison with the specialists' diagnoses. Results: From 3,040 eligible households, 2,066 participants were interviewed. The participating proportions were 98.3% in rural areas but 52.9% in urban Delhi. In the validation subsample of 291 participants (149 rural, 142 urban), 61 did not report any headache (seven of those assessed by HARDSHIP, eight by headache specialists and 46 by both) [kappa = 0.83; 95% CI: 0.74-0.91]. In the remaining 230 participants who reported headache in the preceding year, sensitivity, specificity and kappa with (95% CI) were 0.73 (0.65-0.79), 0.80 (0.67-0.90) and 0.43 (0.34-0.58) for migraine; 0.71 (0.56-0.83), 0.80 (0.730.85) and 0.43 (0.37-0.62) for TTH and 0.75 (0.47-0.94), 0.93 (0.89-0.96) and 0.46 (0.34-0.58) for H15 + respectively. Conclusion: This study validates the Hindi version of HARDSHIP, finding its performance similar to those of other versions. It can be used to conduct population surveys in other Hindi-speaking regions of India. [ABSTRACT FROM AUTHOR]

Background: Agrawal and Shah modified CAST (Caries Assessment Spectrum and Treatment) is the novel index prepared specifically for the Indian population for the complete evaluation of the spectrum/range of dental caries described hierarchically. Objective: To assess the prevalence of dental caries and treatment needs in an adult Indian population using Agrawal and Shah modified CAST index. Materials and Methods: A cross-sectional transverse study was performed on 2000 adult patients in the age range of 19--70 years. All the adult patients were scored for caries presence by Agrawal and Shah modified CAST codes on a structured proforma. SPSS version 20 was used to analyze the data. Results: The prevalence of dental caries calculated using Agrawal and Shah modified CAST index was 85.6%. 5.2% (104) adults had sound dentition, 4.1% (82) adults had restorations, 2.1% (42) adults had non-cavitated lesions, 13.7% (274) adults had the presence of caries in the enamel, 19% (380) adults had the presence of caries in dentine, and pulpal involvement was observed in 27.7% (554) adults. 10.3% (206) adults had presented with a root surface and cervical caries. 13.6% (272) adults had lost at least one tooth due to caries, and 3% (60) adults had lost teeth due to any other reason except dental caries. 1.3% (26) adult patients do not show any caries-related diagnosis but were having predisposing conditions. Conclusion: Agrawal and Shah modified CAST index proved to be simple, useful, and appropriate in assessing dental caries prevalence in the Indian population along with the treatment needs of the Indian population. [ABSTRACT FROM AUTHOR]

Non-parkinsonian tremors represent a heterogeneous spectrum of movement disorders where knowledge gaps persist regarding epidemiology, pathophysiology, and clinical burden. This scoping review aimed to systematically consolidate literature on these disorders in India across the domains of prevalence, biological mechanisms, psychiatric comorbidity, disability impact, and quality of life. A systematic search was undertaken across databases to identify studies on non-parkinsonian tremors in India. Extracted data were synthesized descriptively under themes spanning reported prevalence estimates and variability, proposed biological processes, psychiatric symptom rates, stigma perceptions, and quality-of-life deficits. Methodological appraisal was undertaken. Twenty-nine studies reported prevalence estimates displaying wide variability from 0.09% to 22% for essential tremor, partly attributable to definitional inconsistencies. Proposed pathologic processes centered on cerebellar dysfunction, neurotransmitter disturbances, and genetic risks. Nine studies revealed variable anxiety (6.8%--90%) and depression (3.4%--60%) rates among essential tremor patients, while two indicated perceived stigma. Five studies unanimously concurred significant quality of life impairment in essential tremors. Evidence of dystonic tremor, functional tremor, and other tremors was limited. This review exposed critical knowledge gaps and methodological limitations, while systematically evaluating the Indian literature on non-parkinsonian tremors concerning epidemiology, mechanisms, and clinical burden. Large-scale collaborative research applying standardized diagnostic criteria is imperative to determine contemporary prevalence statistics and comprehensively characterize the multifaceted disability footprint to inform patient-centric models optimizing diagnosis and holistic care. [ABSTRACT FROM AUTHOR]

Background: Congenital ichthyoses are a rare Mendelian group of disorders affecting the integument with a heterogeneous clinical presentation amongst which scaling is a constant feature. There is scanty epidemiologic data regarding the clinical profile and histologic patterns of inherited ichthyosis from resource-poor countries. Aims and Objectives: The study was aimed at assessing the clinic-epidemiologic characteristics associated with the different forms of non-syndromic congenital ichthyosis. Materials and Methods: This was a retrospective chart review of ichthyosis patients that presented between July 2016 and Jun 2020. Details including demographic profile, clinical characteristics along with any relevant investigations done were included. Results: During the study period of 4 years, 107 patients with congenital non-syndromic ichthyosis were seen. The most frequent diagnosis was of common ichthyoses, followed by autosomal recessive congenital ichthyosis, epidermolytic ichthyosis and erythrokeratoderma, in decreasing order. Conclusion: Important clinical findings like erythema and the type of scales as well as histological differences including an absent or reduced granular layer in ichthyosis vulgaris can help differentiate among the clinical phenotypes of inherited non-syndromic ichthyosis especially in resource-poor settings. Also, there is a high prevalence of vitamin D deficiency and hence a need for screening for the same in all patients of congenital ichthyosis including the milder phenotypes. [ABSTRACT FROM AUTHOR]

Background: Lichenoid drug eruption (LDE) is an uncommon cutaneous adverse drug reaction, where a variety of drugs used in day-to-day clinical practice have been implicated. Objective: To describe the clinico-demographic characteristics of patients with LDE and to identify the most likely drugs involved. Methods: In this prospective, observational study, consecutive patients with LDE presenting to the dermatology department of a tertiary teaching hospital were included. The clinico-demographic profile of patients with LDE and implicated drugs was noted. Treatment of drug reaction along with outcome was also documented. Naranjo adverse drug reaction probability scale was used for causality assessment of the drug reactions. A thorough literature review on LDE was also undertaken due to the paucity of existing literature. Results: A total of 15 patients (11 males and 4 females) with LDE were evaluated. Their age ranged from 37 to 61 years, with a mean of 51.53 ± 7.59 years. Anti-hypertensive medications (40%) were the most common culprit agent, followed by antitubercular drugs (33.4%), anti-diabetic agents (13.3%), and others (13.3%). The latent period (time from drug initiation to the appearance of a cutaneous eruption) varied from 15 days to 6 months (mean 2.2 months). Cutaneous involvement was generalized in 73.4% and photo-distributed lesions in 26.6%. Drug provocation test was done to identify the culprit drug. According to the Naranjo adverse drug reaction probability scale, one-third of LDEs were "definite,' whereas two-thirds were designated as "probable." Conclusion: LDE is more common in the elderly population. The latent period is comparatively longer in LDE than in other common drug reactions. Prompt recognition and withdrawal of suspected drug are essential to minimize disease morbidity. KEy wordS: Cutaneous adverse drug reaction, lichenoid drug eruption, Naranjo causality assessmen Rahul Mahajan, Shirin Bakshi, Debajyoti Chatterjee1, Dipankar De, Uma N. Saikia1, Sanjeev Handa From the Departments of Dermatology, Venereology, and Leprology, 1Histopathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India Abstract Background: Congenital ichthyoses are a rare Mendelian group of disorders affecting the integument with a heterogeneous clinical presentation amongst which scaling is a constant feature. There is scanty epidemiologic data regarding the clinical profile and histologic patterns of inherited ichthyosis from resource-poor countries. Aims and Objectives: The study was aimed at assessing the clinic-epidemiologic characteristics associated with the different forms of non-syndromic congenital ichthyosis. Materials and Methods: This was a retrospective chart review of ichthyosis patients that presented between July 2016 and Jun 2020. Details including demographic profile, clinical characteristics along with any relevant investigations done were included. Results: During the study period of 4 years, 107 patients with congenital non-syndromic ichthyosis were seen. The most frequent diagnosis was of common ichthyoses, followed by autosomal recessive congenital ichthyosis, epidermolytic ichthyosis and erythrokeratoderma, in decreasing order. Conclusion: Important clinical findings like erythema and the type of scales as well as histological differences including an absent or reduced granular layer in ichthyosis vulgaris can help differentiate among the clinical phenotypes of inherited non-syndromic ichthyosis especially in resource-poor settings. Also, there is a high prevalence of vitamin D deficiency and hence a need for screening for the same in all patients of congenital ichthyosis including the milder phenotypes. [ABSTRACT FROM AUTHOR]

Background: Based on the lipid nephrotoxicity hypothesis, a great deal of research is being done worldwide to evaluate the function of hyperlipidemia in people with chronic renal disease, particularly in India. Aim: The purpose of this retrospective clinical investigation was to evaluate the relationship between dyslipidemia and the prevalence of chronic renal disease in Indian participants. Methods: Clinical data from patients' medical records that did not have overt renal illness were gathered and evaluated for this retrospective clinical investigation. Based on their levels of total cholesterol and low-density lipoprotein, the research participants were split into four groups. A statistical analysis was performed on the gathered data to see if chronic renal disease and blood lipid profile were correlated. Results: The group with the greatest cholesterol had the lowest HDL-C value and the highest HDL-C value, with a value of >5.40 mmol/l (p<0.001). With p<0.001, BUN and FPG levels were highest for cholesterol ranges >5.40 mmol/l and lowest for cholesterol values ≤ 4.20 mmol/l. When comparing high cholesterol to low cholesterol levels, SUA and hypertension values were considerably higher (p<0.001) for high cholesterol values. The age group of >60 years old had the greatest incidence of new chronic kidney disease (CKD) at 8.08% (n=24) individuals, followed by >40-≤60 years old at 3.93% (n=21) subjects, and ≤40 years old at 1.93% (n=9) subjects. 8.07% (n=26) of the high cholesterol group's participants had new chronic kidney disease episodes, compared to 1.82% (n=6) of the low cholesterol group's individuals. Conclusion: The elevated levels of total cholesterol, low-density lipoprotein (LDL), and triglycerides are independently associated with a higher risk of declining eGFR (estimated glomerular filtration rate) and developing chronic kidney disease. [ABSTRACT FROM AUTHOR]

Background: Leprosy remains a significant public health concern in many regions, including India, with multibacillary forms posing unique challenges in diagnosis and management. This study aimed to comprehensively assess the spectrum of disease in multibacillary leprosy patients at a tertiary care center in Chennai. Methods: A prospective study was conducted over one and a half years, involving 38 newly diagnosed and untreated multibacillary leprosy patients. Clinical, bacteriological, and treatment response parameters were evaluated using standardized methods. Statistical analysis was performed using SPSS version 26. Results: The study analyzed 38 multibacillary leprosy patients. The study cohort exhibited a mean age of 40.2 years, with a notable male predominance (79%) aged 30-39. Coolies (28.9%) were the most affected occupation group. Borderline lepromatous leprosy (66%) was prevalent. Clinical assessments showed trophic ulcers (13%) and grade 2 deformities like claw hand (5.3%) and lagophthalmos (2.6%). Bacteriological evaluation post-MDT revealed significant BI reduction at 6 months (p < 0.001). While most patients attained negative smears, some remained positive at 12 months, warranting continued surveillance for sustained clearance. Conclusion: This study provides comprehensive insights into the epidemiological, clinical, and bacteriological characteristics of multibacillary leprosy, highlighting the efficacy of multidrug therapy in achieving favorable treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: The lack of focus on the health status of shrimp cultivators by previous studies while the production of shrimp has been rising over the years after the introduction of the blue revolution in India. The present study estimated the burden of diseases among shrimp cultivators in India. Methods: Primary data were collected by using simple random sampling. The sample size was 357. The classification of diseases were made by using the international classification of diseases, tenth revision (ICD-10), version 2019. Disability-adjusted life years (DALY) were used to measure the health status of shrimp cultivators. DALY is the summation of the burden of disease from mortality and morbidity. Sensitive and uncertainty analysis was used by changing the value of the parameter and method, respectively. Results: The burden of disease among shrimp cultivators in 2020 ranges from 101.03 DALY based on equal age weightage, without discount rate, and potential life expectancy (DALY0,0,PLE) to 84.02 DALY based on unequal age weightage, discount rate, and standardized life expectancy (DALY1,0.03,SLE). The burden of disease per 100,000 shrimp cultivators was 28,477.74 DALY and 23,600.84 DALY when calculated by using DALY0,0,PLE and DALY1,0.03,SLE method, respectively. The higher burden of diseases from non-communicable diseases was followed by injury and communicable diseases for both methods. The disease burden from mortality was more than two-thirds of the total burden of disease and the rest from morbidity. The burden of disease among shrimp cultivators was sensitive to parameter changes because it changes between 92.10 DALY and 63.03 DALY with the change in the parameter. Uncertainty in the burden of disease among them was due to method variation, which ranges from 120.03 DALY to 74.06 DALY. Conclusion: The higher burden of non-communicable diseases, and the lower burden of communicable, and injuries per 100,000 shrimp cultivators compared to the national level in India. [ABSTRACT FROM AUTHOR]

Scrub typhus is one of the most neglected tropical diseases, a leading cause of acute undifferentiated febrile illness in areas of the 'tsutsugamushi triangle', diagnosed frequently in South Asian countries. The bacteria Orientia tsutsugamushi is the causative agent of the disease, which enters the human body through the bite of trombiculid mites (also known as chiggers) of the genus Leptotrombidium deliense. Diagnosis of the disease is challenging, as its early symptoms mimic other febrile illnesses like dengue, influenza and corona viruses. Lack of rapid, reliable and cost-effective diagnostic methods further complicates the identification process. Northeast India, a mountainous region with a predominantly rural tribal population, has witnessed a resurgence of scrub typhus cases in recent years. Various ecological factors, including rodent populations, habitat characteristics and climatic conditions, influence its prevalence. Entomological investigations have confirmed the abundance of vector mites, highlighting the importance of understanding their distribution and the probability of transmission of scrub typhus in the region. Proper diagnosis, awareness campaigns and behavioural interventions are essential for controlling scrub typhus outbreaks and reducing its impact on public health in Northeast India. Further research and community-based studies are necessary to accurately assess the disease burden and implement effective prevention strategies. [ABSTRACT FROM AUTHOR]

Injuries from animal attacks usually occur when animals feel provoked, surprised or threatened. They may range from minor bruises and contusions to deep extensive injuries caused by biting, kicking or trampling, etc. The scenario differs from animal to animal and between species; by comparing the pattern of injuries it may be possible to work out the animal involved. We present a case where a story of an animal attack was conceived for monetary benefits. Determining the circumstances surrounding death may not be possible in all post-mortem cases but a medical examiner should strive to elicit as much information as possible from the dead body. [ABSTRACT FROM AUTHOR]