Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India.

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.

Concurrent Undernutrition and Overnutrition within Indian Families between 2006 and 2021.

Background: The double burden of malnutrition (DBM), characterized by concurrent undernutrition and overnutrition, is a growing global concern. Families share resources and eating behaviors and programs often target households, yet evidence of the DBM at the family level is scarce. Objectives: This study examined trends and inequality in the intrahousehold DBM in India between 2006 and 2021. Methods: Data were from 3 waves of India's National Family Health Survey (NFHS 2006, 2016, and 2021). We examined 3 types of household member (with children aged <5 y) combinations: mother-child (N = 328,039 across 3 waves), father-child, and parent (mother and father)-child (N = 47,139 for each pair). The DBM was defined as one or more individuals with undernutrition (either wasting or stunting in children or underweight in adults) and one or more overweight individuals within the same household. DBM was examined over time, at national and subnational levels, and by residence and wealth. Results: Nearly all DBM was in the form of an overweight parent and an undernourished weight or stunted child. The prevalence of parent-child DBM increased from 15% in 2006 to 26% in 2021. Father-child pairs experienced the most rapid DBM increase, from 12% in 2006 to 22% in 2021, an 83% increase, driven by increasing overweight among men. In 2021, the DBM was highest in North-Eastern and Southern states, and among relatively rich households from urban areas. The increase in the DBM was faster in rural areas and among poor households compared with that in urban areas and rich households. Urban-rural and rich-poor inequalities in the DBM have decreased over time. Conclusions: The intrahousehold DBM has increased over time, affecting 1 in 4 households in India in 2021. Family-based interventions that can simultaneously address child underweight and parent overweight are required to address India's increasing intrahousehold DBM.

Cultural and Contextual Drivers of Triple Burden of Malnutrition among Children in India.

This study examines malnutrition's triple burden, including anaemia, overweight, and stunting, among children aged 6-59 months. Using data from the National Family Health Survey-5 (2019-2021), the study identifies risk factors and assesses their contribution at different levels to existing malnutrition burden. A random intercept multilevel logistic regression model and spatial analysis are employed to identify child, maternal, and household level risk factors for stunting, overweight, and anaemia. The study finds that 34% of children were stunted, 4% were overweight, and 66% were anaemic. Stunting and anaemia prevalence were higher in central and eastern regions, while overweight was more prevalent in the north-eastern and northern regions. At the macro-level, the coexistence of stunting, overweight, and anaemia circumstantiates the triple burden of childhood malnutrition with substantial spatial variation (Moran's I: stunting-0.53, overweight-0.41, and anaemia-0.53). Multilevel analysis reveals that child, maternal, and household variables play a substantial role in determining malnutrition burden in India. The nutritional health is significantly influenced by a wide range of determinants, necessitating multilevel treatments targeting households to address this diverse group of coexisting factors. Given the intra-country spatial heterogeneity, the treatment also needs to be tailor-made for various disaggregated levels.

Nontuberculous Mycobacterial Infection After Cholecystectomy: A Case Series and Literature Review.

Nontuberculous mycobacteria (NTM) are ubiquitous micro-organisms that can cause skin, soft tissue, and respiratory infections. Some of these bacteria are resistant to the commonly used disinfectants in hospitals and lead to wound infections after surgery. The diagnosis of NTM infections requires a high index of clinical suspicion as their clinical presentation often overlaps with other bacterial infections. Moreover, the isolation of NTM from clinical samples is difficult and time-consuming. Also, there is a lack of standardized treatment protocols for NTM infections. We report four cases of delayed wound infections after cholecystectomy probably due to NTM which were successfully treated by a combination of clarithromycin, ciprofloxacin, and amikacin.

Epidemiological risk factors of suicidal behavior and effects of the components of coping strategies on suicidal behavior in medical students: An institution-based cross-sectional study in India.

Background: Suicidal behavior in medical students can be triggered by mental stresses and adoption of poor coping strategies, and might have a negative impact on their quality of life. Aims: The aim of this study was to evaluate the prevalence and risk factors of suicidal behavior, and effects of the components of coping strategies on suicidal behavior among medical students. Methods: An institution-based cross-sectional study was conducted on 531 medical students for a period of two months from February to March 2021. Stratified random sampling technique was used to select the study participants. Data was collected using a self-administered questionnaire. Suicide Behaviors Questionnaire-Revised (SBQ-R) scale was used to measure suicidal behavior. Exploratory factor analysis was performed on the Brief-COPE Inventory to classify the coping components. Chi-squared test and multiple logistic regression were used to determine the risk factors and their association with suicidal behavior. Results: A total of 104 respondents (19.6%) had reported an SBQ-R cutoff score of ≥7 and had suicidal behavior. The rate of lifetime suicidal ideation, plan and attempt was 20.3%, 10.3% and 2.3%, respectively, among medical students with one-year prevalence of suicidal ideation at 33%. The mean age of the participants was 21.26 years (standard deviation (SD) = 1.99). The identified risk factors significantly associated with higher suicidal behavior were depression (OR = 9.6), dissatisfaction with academic performances (OR = 4.9) and coping with mental disengagement (OR = 4.6), while coping with supportive strategies (OR = 0.57) was investigated as a preventive factor for the suicidal behavior. Conclusions: The prevalence of suicidal behavior is found to be highly alarming, revealing that depression and poor coping strategies are risk factors among medical students. The analysis recommends that quantification of the problems, treatment at an early stage and proactive student counselling to help them embrace the appropriate coping strategies should be the first steps in prevention of suicidal behavior.

Epidemiological Risk Factors of Suicidal Behavior and Effects of the Components of Coping Strategies on Suicidal Behavior in Medical Students: A North-Indian Institution-Based Cross-Sectional Study.

Background Mental stresses and adoption of poor coping strategies can be a cause of suicidal behavior in medical students. Objective The aim of this study is to evaluate the prevalence and risk factors of suicidal behavior, and effects of the components of coping strategies on suicidal behavior among medical students Methodology An institution-based cross-sectional study was conducted among medical students of a college located in North India for a period of 2 months from February to March 2021. A total of 531 study participants (calculated sample size) were selected, and then allocated proportionally to each academic year, both through stratified random sampling technique. Then, the participants were asked to complete a self-administered questionnaire consisting of sociodemographic characteristics, Patient Health Questionnaire-9, Suicidal Behaviors Questionnaire-Revised (SBQ-R), and coping inventory. A pretest was done to modify the coping inventory and then exploratory factor analysis was performed on it to classify the components of coping strategies. Chi-square test and multiple logistic regression analysis were used to determine the risk factors and their association with suicidal behavior. Results A total of 104 (19.6%) respondents had reported SBQ-R cutoff score > 7 and had suicidal behavior. The rate of lifetime suicidal ideation, plan, and attempt was 20.3, 10.3, and 2.3%, respectively, among medical students, with 1-year prevalence of suicidal ideation at 33%. The mean age of the participants was 21.26 years (standard deviation = 1.99). The identified risk factors significantly associated with higher suicidal behavior were depression (odds ratio [OR] = 9.6), dissatisfaction with academic performances (OR = 4.9), and coping with mental disengagement (OR = 4.6), while coping with supportive strategies (OR = 0.57) was investigated as a preventive factor for the suicidal behavior. Conclusion The prevalence of suicidal behavior is found to be highly alarming, revealing that depression and poor coping strategies are risk factors among medical students. The analysis recommends that quantification of the problems, treatment at an early stage, and proactive student counseling to help them embrace the appropriate coping strategies, should be the first steps in prevention of suicidal behavior.

Identification of a Potent, Selective, and Brain-Penetrant Rho Kinase Inhibitor and its Activity in a Mouse Model of Huntington's Disease.

The Rho kinase (ROCK) pathway is implicated in the pathogenesis of several conditions, including neurological diseases. In Huntington's disease (HD), ROCK is implicated in mutant huntingtin (HTT) aggregation and neurotoxicity, and members of the ROCK pathway are increased in HD mouse models and patients. To validate this mode of action as a potential treatment for HD, we sought a potent, selective, central nervous system (CNS)-penetrant ROCK inhibitor. Identifying a compound that could be dosed orally in mice with selectivity against other AGC kinases, including protein kinase G (PKG), whose inhibition could potentially activate the ROCK pathway, was paramount for the program. We describe the optimization of published ligands to identify a novel series of ROCK inhibitors based on a piperazine core. Morphing of the early series developed in-house by scaffold hopping enabled the identification of a compound exhibiting high potency and desired selectivity and demonstrating a robust pharmacodynamic (PD) effect by the inhibition of ROCK-mediated substrate (MYPT1) phosphorylation after oral dosing.

Discovery of a Novel Class of d-Amino Acid Oxidase Inhibitors Using the Schrödinger Computational Platform.

d-Serine is a coagonist of the N-methyl d-aspartate (NMDA) receptor, a key excitatory neurotransmitter receptor. In the brain, d-serine is synthesized from its l-isomer by serine racemase and is metabolized by the D-amino acid oxidase (DAO, DAAO). Many studies have linked decreased d-serine concentration and/or increased DAO expression and enzyme activity to NMDA dysfunction and schizophrenia. Thus, it is feasible to employ DAO inhibitors for the treatment of schizophrenia and other indications. Powered by the Schrödinger computational modeling platform, we initiated a research program to identify novel DAO inhibitors with the best-in-class properties. The program execution leveraged an hDAO FEP+ model to prospectively predict compound potency. A new class of DAO inhibitors with desirable properties has been discovered from this endeavor. Our modeling technology on this program has not only enhanced the efficiency of structure-activity relationship development but also helped to identify a previously unexplored subpocket for further optimization.

Prevalence of psychological morbidities and their influential variables among nurses in a designated COVID-19 tertiary care hospital in India: A cross-sectional study.

BACKGROUND: Nurses are the main part of the health workforce, performing their duties as frontline warriors against the novel coronavirus pandemic. Nurses involved in the care of infected (COVID-19) patients, may feel more discomfort physically and experience greater psychological morbidities. AIMS AND OBJECTIVES: The main aim of the study is to evaluate the prevalence of anxiety and stress among nurses in a designated COVID-19 hospital and variables that influence these psychological problems. METHODOLOGY: Nurses working in the designated tertiary care hospital were invited to participate in an online cross-sectional survey (dated, September 5-15, 2020). A self-administered questionnaire regarding sociodemographic characteristics, COVID-19-related experiences, perceived threat regarding COVID-19, and two scales (Generalized Anxiety Disorder-7 and Perceived Stress Scale-10) for the assessment of anxiety and stress was applied to nurses. Chi-square test and multiple regression analysis were used to investigate the predictors (risk and protective) of psychological morbidities in nurses. RESULTS: On analysis of 209 participants, it was revealed that 65 (31.1%) participants have anxiety symptoms and 35.40% have moderate to the high level of stress. Being proud of working in this profession was the only protective factor from such psychological morbidities. The identified risk factors for greater anxiety symptoms and moderate-to-high-level stress were, working experience of >10 years (odds ratio [OR] = 3.36), direct involvement in the care of suspected/diagnosed patients (OR = 3.4), feeling worried about being quarantined/isolated (OR = 1.69,) and high risk of being infected at the job (OR = 2.3 for anxiety and OR = 2.1 for moderate-to-high stress). CONCLUSIONS: Deteriorating the psychic health of nurses is one of the major outcomes during the COVID-19 pandemic in India which warrants the necessity of providing psychological support to nurses and controlling the risk factors related to these problems. Greater focus should be on the frontline and experienced nurses.

Synthesis of cyanopyridine and pyrimidine analogues as new anti-inflammatory and antimicrobial agents.

A new series of substituted benzylidene acetophenone (Ia-Ih), 2-amino-4, 6- substituted diphenylpyridine-3-carbonitrile (IIa-IIh) and 4, 6-substituted diphenylpyrimidin-2-amine (IIId-IIIg) were synthesized and evaluated for anti-inflammatory and antimicrobial activities. Four compounds (Ie, If, IIh and IIId) have shown good anti-inflammatory activity when compared to standard drug indomethacin. Two compound (Ie and IIh) displayed significant activity against gram -ve bacteria (E. Coli) and three compounds (IId, IIf and IIIh) displayed good activity against gram +ve bacteria (S. aureus) on comparison with the standard drug ofloxacin.

Evaluating the antifertility potential of an aqueous extract from Cassia fistula seeds in male rats.

Cassia fistula suppresses fertility in male rats. Withdrawal of extract restored all the altered parameters, including organ weights, fertility, circulatory level of hormones and tissue biochemistry, to control levels after 120 days.

Assessment of the contraceptive efficacy of the aqueous extract of Aegle marmelos Corr. leaves in male albino rats.

The present study was conducted to evaluate the contraceptive effect of an aqueous extract from the leaves of Aegle marmelos (AMLAq) on the reproductive organs of male rats with an emphasis on reversibility. Adult male rats were treated daily with different doses of AMLAq, i.e., 150, 300 and 600 mg/kg bw/day for 60 days. The data presented in this study demonstrate that the weight of the reproductive organs was reduced significantly in all the treatment groups. AMLAq induced a significant decrease in the sperm motility and sperm density of the Cauda epididymis and testes. The reduction in fertility was 50%, 85% and 100%, respectively, in the treatment groups. The testosterone level also significantly declined. Biochemical analysis of the reproductive tissues for sialic acid, protein, glycogen, fructose, ascorbic acid, acid and alkaline phosphatase indicated a significant decrease whereas testicular cholesterol level significantly increased indicating alterations in the biochemical milieu of the genital organs. Fertility and other effects gradually returned to control levels 120 days after cessation of treatment. No clinical signs of side effects on general metabolism were detected throughout the treatment, and after withdrawal, body weight gain was similar in all groups together with no alterations in the weight of vital organs', hematological and serological parameters.

Reversible changes in the antifertility induced by Aegle marmelos in male albino rats.

To study the effects of Aegle marmelos on the testicular reproductive system, a 50% ethanolic extract of Aegle marmelos leaves (AMLEt) was fed orally to male albino rats at the dose levels of 200 and 300 mg/kg body wt./day for 60 days. Recovery was assessed for an additional 120 days. Oral administration of AMLEt did not cause body weight loss. The motility and sperm concentration were significantly reduced along with complete inhibition of fertility at a dose of 300 mg/kg. The level of serum testosterone also declined and spermatogenesis was impaired. The number of normal tubules and the height of epithelial cells of the caput and cauda were reduced significantly. The cross sectional surface area of Sertoli cells and mature Leydig cells was reduced along with a dose dependent reduction of preleptotene and pachytene spermatocytes. Thus the antifertility effects of Aegle marmelos seemed to be mediated by disturbances in structure and function in testicular somatic cells including Leydig and Sertoli cells resulting in an alteration in physio-morphological events of spermatogenesis. However, complete recovery was observed after a 120 day withdrawal.

Suppression of fertility in male albino rats following the administration of 50% ethanolic extract of Aegle marmelos.

BACKGROUND: Plants have served as a natural source of antifertility substances. The reactivated interest in the evaluation of some lead plants for fertility prompted us to undertake studies on the antifertility potential of Aegle marmelos leaves. STUDY DESIGN: Fifty percent ethanolic extract from the leaves of A. marmelos (AMLEt) was prepared. The effect of A. marmelos leaf extract on the reproductive system of male albino rats was investigated at three different doses, namely, 100, 200 and 300 mg(-1) kg (-1) day(-1) for each rat for 60 days. Recovery was also investigated after a withdrawal of 120 days. RESULTS: All the major accessory sex organs shed weight postadministration of the extract. There was a marked reduction in motility and density of the sperm derived from cauda epididymis of the treated animals. A. marmelos reduced fertility of male rats by 100% at the 300-mg dose level. Serum testosterone levels also decreased significantly in all the experimental groups. The protein, glycogen and lipid peroxidation content of the testes was significantly reduced at the highest dose level; a highly significant increase in testicular cholesterol was observed along with a highly significant reduction in the sialic acid contents of testes, epididymis and seminal vesicles. Blood tests did not point to distress in any of the vital organs. Withdrawal of the extract restored all the altered parameters including organ weights, fertility, testosterone levels and tissue biochemistry to control levels after 120 days. CONCLUSIONS: Taken together, it is inferred that the leaf extract of A. marmelos (AMLEt) suppresses fertility in male rats. Complete recovery of fertility was observed following the withdrawal of drug. Absence of any deleterious effect on the vital organs points to the safe use of the extract.