Early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy: a multicentre double-blind pilot randomised controlled trial.

OBJECTIVE: To examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE). DESIGN: Double-blind pilot randomised controlled trial. SETTING: Eight neonatal units in South Asia. PATIENTS: Neonates (≥36 weeks) with moderate or severe HIE admitted between 31 December 2022 and 3 May 2023. INTERVENTIONS: Erythropoietin (500 U/kg daily) or to the placebo (sham injections using a screen) within 6 hours of birth and continued for 9 days. MRI at 2 weeks of age. MAIN OUTCOMES AND MEASURES: Feasibility of randomisation, drug administration and assessment of brain injury using MRI. RESULTS: Of the 154 neonates screened, 56 were eligible; 6 declined consent and 50 were recruited; 43 (86%) were inborn. Mean (SD) age at first dose was 4.4 (1.2) hours in erythropoietin and 4.1 (1.0) hours in placebo. Overall mortality at hospital discharge occurred in 5 (19%) vs 11 (46%) (p=0.06), and 3 (13%) vs 9 (40.9%) (p=0.04) among those with moderate encephalopathy in the erythropoietin and placebo groups. Moderate or severe injury to basal ganglia, white matter and cortex occurred in 5 (25%) vs 5 (38.5%); 14 (70%) vs 11 (85%); and 6 (30%) vs 2 (15.4%) in the erythropoietin and placebo group, respectively. Sinus venous thrombosis was seen in two (10%) neonates in the erythropoietin group and none in the control group. CONCLUSIONS: Brain injury and mortality after moderate or severe HIE are high in South Asia. Evaluation of erythropoietin monotherapy using MRI to examine treatment effects is feasible in these settings. TRIAL REGISTRATION NUMBER: NCT05395195.

Prevalence of non-communicable chronic diseases in rural India amongst peri- and post-menopausal women: Can artificial intelligence help in early identification?

AIMS: To identify peri- and post-menopausal women at risk of non-communicable diseases in rural India and to assess their prevalence amongst these groups via the use of artificial intelligence. SETTINGS AND DESIGN: An observational study conducted by the Indian Menopause Society in collaboration with the Government of Maharashtra. The study included rural women residents of three villages in the Latur district of Maharashtra, India. MATERIALS AND METHODS: Accredited social health activist workers identified 400 peri- and post-menopausal women aged 45-60 years. Specific symptoms able to predict the presence of a non-communicable disease were identified through the use of artificial intelligence. STATISTICAL ANALYSIS USED: Descriptive statistics and predictive network charts analysis. RESULTS: The mean age of 316 women included in the analysis was 50.4 years and the majority of them were illiterate (68 %). The prevalence of dyslipidaemia, osteopenia, diabetes mellitus, obesity and hypertension were 58 %, 50 %, 25 %, 25 %, and 20 % respectively. None of their symptoms or laboratory reports could be significantly correlated directly with any of these non-communicable diseases. Hence, we used a cluster of symptoms to suggest the presence of hypertension, diabetes mellitus, osteoporosis and hypothyroidism via predictive network analysis charts. CONCLUSIONS: Screening of at-risk women can be done using an artificial intelligence-based screening tool for early diagnosis, timely referral and treatment of non-communicable diseases with the support of community health workers.

Exposure to air pollution as a risk factor for anaemia: a global scoping review.

Anaemia is an important global health issue with various factors responsible for its occurrence. Though nutritional deficiency is one of the main causes of the disease, evidence suggests a potential link between long-term exposure to ambient air pollution and an increased risk of developing anaemia. Our scoping review evaluates studies conducted across the world to examine possible associations between anaemia and ambient air pollution. Six databases were searched, 153 sources were identified, and 21 articles were included in the review. Apart from one article which showed no significant effect, studies reported positive associations between anaemia and air pollution. This was true for both indoor and outdoor air pollution, various types of particulate matter exposure, and across demographic groups. The review highlights the importance of recognizing exposure to air pollution as a potential risk factor for anaemia and emphasizes the imperative for focused interventions and policy measures to mitigate air pollution.

Effect of in utero exposure to SARS-CoV-2 infection on pregnancy outcomes and growth and development of infants: protocol for a multicentre ambispective cohort study in India.

INTRODUCTION: Poor pregnancy and neonatal outcomes in infants born to COVID-19 positive mothers have been reported, but there is insufficient evidence regarding subsequent growth and development of these children. Our study aims to explore the effect of in-utero exposure to SARS-CoV-2 on pregnancy outcomes and growth and development of infants. METHODS AND ANALYSIS: A multicentric ambispective cohort study with comparison group (1:1) will be conducted at six sites. A total of 2400 participants (exposure cohort, n=1200; comparison cohort, n=1200), ie, 400 participants from each site (200 retrospectively; 200 prospectively) will be included. Exposure cohort will be infants born to women with documented COVID-19 infection anytime during pregnancy and comparison cohort will be infants born to women who did not test positive for SARS-CoV-2 anytime during pregnancy. All infants will be followed up till 1 year of age. Anthropometric measurement, age of attainment of developmental milestones and clinical examination findings will be recorded at each follow-up. Data regarding possible cofactors affecting the outcomes will be collected from both groups and adjusted for during analysis. The two groups will be compared for prevalence of every variable considered in the study. Relative risk, attributable and population attributable risks will be calculated. All risk factors with p<0.1 on bivariate analysis will be subjected to multiple logistic regression analysis. A final multivariable model will be developed by including the statistically significant risk factors. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Review Board of IIHMR Delhi (IRB/2021-2022/006) and will be required to be approved at all participating study sites. The study is scheduled from September 2021 to August 2023. Data from retrospective cohort will be reported by August 2022. All participants will provide written informed consent. We plan to publish our results in a peer-reviewed journal and present findings at academic conferences.

Effectiveness of Child-To-Child Approach in Preventing Unintentional Childhood Injuries and Their Consequences: A Non-Randomized Cluster-Controlled Trial.

BACKGROUND: Child-to-child approach is an innovative strategy for preventing and reducing the morbidity and mortality burden of unintentional childhood injuries. OBJECTIVES: To test effectiveness of Child-to-child Approach in preventing unintentional childhood injuries and their consequences. STUDY DESIGN: Community-based non-randomized cluster-controlled trial of parallel design. PARTICIPANTS: 397 children and adolescents. INTERVENTION: Eldest literate adolescent of selected families of intervention area were trained on prevention of injuries. They were to implement the knowledge gained to prevent injuries in themselves and their younger siblings and also disseminate this knowledge to other members of their families. OUTCOME: Data was collected from both intervention and control areas during pre- and post-intervention phases on the magnitude of injuries, time for recovery from injuries, place for seeking treatment, cost of treatment, knowledge and practice of participants and their families regarding injuries. RESULTS: During post-intervention phase, the intervention group experienced a significant reduction in incidence of injuries, increased preference for institutional treatment of injuries and increased knowledge and practice regarding injuries, in com-parison to its pre-intervention data and data of the control group in post-intervention phase. Total time for recovery and cost of treatment for injuries also decreased in intervention group in post-intervention phase, though differences were not statistically significant. CONCLUSIONS: Child-to-child approach is effective in reducing childhood injuries, improving choice of place for seeking treatment, increasing knowledge of participants, improving family practices regarding prevention of injuries and reducing expenditure on treatment of childhood injuries.

Safety and immunogenicity of rabies vaccine as 4 - dose Essen Intramuscular regimen for post exposure prophylaxis: A non - randomized, comparative controlled study.

Introduction: World Health Organization has recommended that in healthy persons with category III exposures, who receive wound care and rabies immunoglobulin infiltration, a vaccine regimen consisting of 4 doses administered intramuscularly on days 0, 3, 7, and 14 can be used as an alternative to the 5-dose intramuscular regimen.Objective: To assess the clinical safety and immunogenicity of rabies vaccine administered as 4-dose Essen intramuscular regimen for post-exposure prophylaxis.Methods: A non-randomized, comparative, controlled study was conducted at the anti-rabies clinic, KIMS Hospital and Research Center, Bangalore, India. The study subjects were divided into study group i.e., 4-dose intramuscular regimen, and control group i.e., 5-dose intramuscular regimen, and were given post-exposure prophylaxis. All subjects were followed for any adverse drug events. Rabies virus neutralizing antibodies was determined on day 14, 90 & 180 at the WHO collaborating center, NIMHANS, Bangalore, India to assess the immunogenicity.Results: The present study included 70 adult animal bite victims, 35 each in study group and control group. The incidence of ADEs was 7.8% in 4-dose Essen group and 7.0% in 5-dose Essen group;the difference between them was not significant (P > .05). Similarly, all the subjects in both the groups had protective antibody titers of ≥ 0.5 IU/mL (100% seroprotective) from day 14 till day 180; the difference between two groups was also not significant (P > .05).Conclusion: The 4-dose intramuscular Essen post-exposure prophylaxis regimen was found to be clinically safe and immunogenic.

Unintentional childhood injuries and their association with activity and location at the time of injury - A case-Crossover study in Delhi.

BACKGROUND: Childhood injury has been identified as a grave public health problem globally as well as in India. Most studies have reported injuries to have occurred while the child was at home, though injuries while on road, school, or playground also commonly occurred. OBJECTIVE: The objective of the study is to find the association between unintentional childhood injury and the activity and location of the child at the time of injury. METHODS: The present study is part of a larger study for preventing childhood injuries, conducted from August 2017 to January 2019 in Delhi, and reports the activity and location of the children at the time of injury. A total of 173 injuries that occurred during the total study duration were included in the analysis. Data regarding activity and location of the subjects were collected and analyzed by case-crossover study design, during "case/hazard period" and two "control/reference periods." RESULTS: Majority of the injuries occurred while the subjects were at home and engaged in activities other than normal activity. When various locations and activities were combined, unmatched odds ratios (ORs) were raised for activity other than normal activity (statistically significant) and for location other than at home. Similar results were obtained for matched Mantel-Haenszel OR, with activity other than normal being significantly more risk for injury (P = 0.000). CONCLUSION: Majority of unintentional injuries occurred in children and adolescents, while the subjects were away from home and engaged in any activity other than normal daily activities. This indicates the importance of teaching safety behavior to children so that they can prevent being injured wherever they go and whatever activity they perform.

Economic Benefit in Treatment of Unintentional Childhood Injuries by Implementation of Child-To-Child Approach.

BACKGROUND: Childhood injury has been recognized as a major threat to child survival and health, as well as economic burden, which includes the cost to government and out-of-pocket expenses (OOPE) to families. Child-To-Child Approach is an innovative technique to reduce childhood injuries and expenses on their treatment. OBJECTIVES: To assess economic benefit in the treatment of unintentional childhood injuries, including OOPE by families, by the implementation of the child-To-Child approach. MATERIALS AND METHODS: The present study is part of a quasi-experimental before-and-after intervention study conducted in the rural area of Delhi for the prevention of childhood injuries through intervention by the child-To-Child approach. Cost of injury treatment, including travel and accommodation expenses, and wage loss were noted. The projected gain in the total cost and out-of-pocket expenditure on injury treatment throughout 20 years of childhood and adolescence were calculated. RESULTS: Both incidences of injuries and total expenditure for treatment of injuries had decreased during the postintervention period in the intervention group, against a rise in the control group. The proportion of OOPE for availing private health care facilities for treatment of injuries, which was more than one-fourth of total expenses, also had decreased in the intervention group during the postintervention period. On economic analysis, it is projected that there will be enormous gain in cost by the implementation of child-To-Child approach in the study area in 20 years, along with saving of OOPE of the families. CONCLUSION: Child-To-Child approach is effective in preventing childhood injuries and reducing the cost of treatment of injuries.

Determinants of Drug Resistance in Previously-Treated Pulmonary Tuberculosis Patients Registered at a Chest Clinic in South Delhi, India.

Introduction  Drug-resistant tuberculosis (DR-TB) is a major concern to effective control of tuberculosis (TB) in India and the likelihood of drug resistance increases with repeated exposure to anti-TB drugs. India has emerged as one of the leading contributors of DR-TB in the world posing a major threat to TB control. In the current study, we aim to find the burden and factors associated with drug resistance in previously treated pulmonary TB patients. Methods  A cross-sectional study was conducted among 230 previously treated pulmonary TB patients registered with Directly Observed Treatment, Short-course (DOTS) centers under Nehru Nagar Chest clinic in Delhi, India. The participants were selected consecutively as they registered with the chest clinic. A predesigned, pretested, semi-structured questionnaire in the Hindi language used to collect socio-demographic data and factors associated with the development of drug resistance. Physical examination of all the participants was done (height, weight, pallor). Data were analyzed using SPSS version 21. Binary logistic regression analysis was used to identify independent risk factors of drug resistance. Results  Of 230 previously treated pulmonary TB patients, 80 (34.8% (95% CI:28.7-40.9%)) were drug-resistant. Age (p=0.021), ever consumption of alcohol (p= 0.001), pallor (p=0.06), BMI (p=0.028), fasting blood sugar (p=0.001), treatment failure (p=0.005) and the number of prior courses of anti-tuberculosis treatment (ATT) taken (p=0.004) were significantly associated with drug resistance. On applying binary logistic regression analysis, independently associated factors with drug resistance were ever consumption of alcohol, pallor, high fasting blood sugar level, previous treatment failure patients and the number of prior courses of ATT (p<0.05). Conclusion  The findings of this study revealed that patients who had pallor, high fasting blood sugar, treatment failure and who had two or more prior courses of ATT were more likely to have DR-TB. Identifying the risk factors for drug-resistant TB is essential in facilitating the government to draw public health interventions. Further research is warranted to explore the causal associations.