BoneXpert-derived bone health index reference curves constructed on healthy Indian children and adolescents.

BACKGROUND: Artificial intelligence (AI)-based applications for the assessment of the paediatric musculoskeletal system like BoneXpert are not only useful to assess bone age (BA) but also to provide a bone health index (BHI) and a standard deviation score (SDS) for both. This allows comparison of the BHI with age- and sex-matched healthy Caucasian children. OBJECTIVE: We conducted this study with the objective of generating BHI curves using BoneXpert in healthy Indian children with BA between 2 and 17 years. METHOD: We retrospectively reviewed anthropometric parameters, BHI, and BHI SDS data of digitalized left-hand radiographs (joint photographic experts group [jpg] format) of a cohort of 788 paediatric patients from a previous study to which they were recruited to compare various methods of BA assessment. The recruited children represented all age groups for both sexes. The corrected BHI for jpg images was calculated using the formula corrected BHI=BHI*(stature/(avL*50))^0.33333 where stature is height of subject and avL is average length of metacarpal bones. The reference Indian BHI curves and centiles were generated using the Lambda-Mu-Sigma method. RESULT: The mean BHI and BHI SDS of the study group were 4.02±0.57 and -1.73±1.09, respectively. The average increase in median BHI from each age group was between 2.5% and 3% in both sexes up to age of 14 years after which it increased to 4.5% to 5%. The mean BHI of Indian children was lower than that of Caucasian children with maximum differences noted in boys at 16 years (21.7%) and girls at 14 years (16%). We report 8.4% SD of BHI for our study sample. Reference percentile curves for BHI according to BA were derived separately for boys and girls. CONCLUSION: Reference data has been provided for the screening of bone health status of Indian children and adolescents.

A comparison of bone age assessments using automated and manual methods in children of Indian ethnicity.

BACKGROUND: Bone age is useful for pediatric endocrinologists in evaluating various disorders related to growth and puberty. Traditional methods of bone age assessment, namely Greulich and Pyle (GP) and Tanner-Whitehouse (TW), have intra- and interobserver variations. Use of computer-automated methods like BoneXpert might overcome these subjective variations. OBJECTIVE: The aim of our study was to assess the validity of BoneXpert in comparison to manual GP and TW methods for assessing bone age in children of Asian Indian ethnicity. MATERIALS AND METHODS: We extracted from a previous study the deidentified left hand radiographs of 920 healthy children aged 2-19 years. We compared bone age as determined by four well-trained manual raters using GP and TW methods with the BoneXpert ratings. We computed accuracy using root mean square error (RMSE) to assess how close the bone age estimated by BoneXpert was to the reference rating. RESULTS: The standard deviations (SDs) of rating among the four manual raters were 0.52 years, 0.52 years and 0.47 years for GP, TW2 and TW3 methods, respectively. The RMSEs between the automated bone age estimates and the true ratings were 0.39 years, 0.41 years and 0.36 years, respectively, for the same methods. The RMSE values were significantly lower in girls than in boys (0.53, 0.5 and 0.47 vs. 0.39, 0.47 and 0.4) by all the methods; however, no such difference was noted in classification by body mass index. The best agreement between BoneXpert and manual rating was obtained by using 50% weight on carpals (GP50). The carpal bone age was retarded in Indian children, more so in boys. CONCLUSION: BoneXpert was accurate and performed well in estimating bone age by both GP and TW methods in healthy Asian Indian children; the error was larger in boys. The GP50 establishes "backward compatibility" with manual rating.

Prevalence of Sarcopenia and Relationships Between Muscle and Bone in Indian Men and Women.

Both ethnicity and age are important determinants of musculoskeletal health. We aimed to determine the prevalence of sarcopenia, assess the suitability of current diagnostic guidelines, and explore muscle-bone relationships in adults from India. A total of 1009 young (20-35 years) and 1755 older (> 40 years) men and women from existing studies were collated and pooled for the analysis. Dual-energy x-ray absorptiometry measured areal bone mineral density (aBMD) at the hip and spine, and fat and lean mass; hand dynamometer measured hand grip strength (HGS). Indian-specific cut-points for appendicular lean mass (ALM), ALM index (ALMI) and HGS were calculated from young Indian (-2SD mean) populations. Sarcopenia was defined using cut-points from The Foundations for the National Institutes of Health (FNIH), revised European Working Group on Sarcopenia in Older People (EWGSOP2), Asian Working Group for Sarcopenia (AWGS), and Indian-specific cut-points. Low lean mass cut-points were then compared for their predictive ability in identifying low HGS. The relationship between muscle variables (ALM, ALMI, HGS) and aBMD was explored, and sex differences were tested. Indian-specific cut-points (men-HGS:22.93 kg, ALM:15.41 kg, ALMI:6.03 kg/m2; women-HGS:10.76 kg, ALM:9.95 kg, ALMI:4.64 kg/m2) were lower than existing definitions. The Indian-specific definition had the lowest, while EWGSOP2 ALMI had the highest predictive ability in detecting low HGS (men:AUC = 0.686, women:AUC = 0.641). There were sex differences in associations between aBMD and all muscle variables, with greater positive associations in women than in men. The use of appropriate cut-points for diagnosing low lean mass and physical function is necessary in ethnic populations for accurate sarcopenia assessment. Muscle-bone relationships are more tightly coupled during ageing in Indian women than men.

Paradoxical Response of Parathyroid Hormone to Vitamin D-Calcium Supplementation in Indian Children.

OBJECTIVES: To investigate the effect of oral vitamin D-calcium supplementation on serum intact parathyroid hormone (PTH), calcium, phosphorous, and alkaline phosphatase (ALK-P) concentrations in children with habitually low calcium intakes. STUDY DESIGN: In this follow-up study to a randomized controlled trial that aimed to assess the effect of vitamin D-calcium supplementation on immunity, data related to dietary intake, anthropometry, and biochemistry [serum 25(OH)D and bone profile] were collected from 178 children-79 in the vitamin D group and 99 in the non-vitamin D group. RESULTS: Dietary calcium to phosphorus intake ratio was 0.4:1. Baseline serum 25(OH)D concentration was 58.2 ± 10.9 nmol/L; 66% children were vitamin D sufficient and none deficient. After supplementation, vitamin D group, compared with the non-vitamin D group, had significantly (P < .05) greater 25(OH)D (83.9 ± 30.1 nmol/L vs 58.3 ± 15.7 nmol/L), significantly greater PTH (6.7 ± 3.6 pmol/L vs 5.5 ± 3.2 pmol/L), and positive correlation (rs = 0.24) between serum 25(OH)D and PTH (vs negative correlation [rs = -0.1] in non-vitamin D group). Mean concentrations of serum bone measures in the vitamin D group were calcium (2.2 ± 0.1 mmol/L), phosphorus (1.7 ± 0.2 mmol/L), and ALK-P (178.7 ± 40.7 IU/L). At follow-up, 1-year post-supplementation, in the vitamin D group, PTH concentrations continued to remain high (but not significantly different from levels at 6 months), with low normal serum calcium, high normal phosphate, and ALK-P in reference range. CONCLUSIONS: In children who are vitamin D sufficient but with habitually low dietary calcium intake, vitamin D-calcium supplementation paradoxically and significantly increased serum PTH concentrations with no apparent effect on other bone biochemistry. Chronic low dietary calcium to phosphorus ratio is likely to have caused this paradoxical response.

Fast Acquisition of Proton-Detected HETCOR Solid-State NMR Spectra of Quadrupolar Nuclei and Rapid Measurement of NH Bond Lengths by Frequency Selective HMQC and RESPDOR Pulse Sequences.

Fast magic-angle spinning (MAS), frequency selective (FS) heteronuclear multiple quantum coherence (HMQC) experiments which function in an analogous manner to solution SOFAST HMQC NMR experiments, are demonstrated. Fast MAS enables efficient FS excitation of 1 H solid-state NMR signals. Selective excitation and observation preserves 1 H magnetization, leading to a significant shortening of the optimal inter-scan delay. Dipolar and scalar 1 H{14 N} FS HMQC solid-state NMR experiments routinely provide 4- to 9-fold reductions in experiment times as compared to conventional 1 H{14 N} HMQC solid-state NMR experiments. 1 H{14 N} FS resonance-echo saturation-pulse double-resonance (RESPDOR) allowed dipolar dephasing curves to be obtained in minutes, enabling the rapid determination of NH dipolar coupling constants and internuclear distances. 1 H{14 N} FS RESPDOR was used to assign multicomponent active pharmaceutical ingredients (APIs) as salts or cocrystals. FS HMQC also provided enhanced sensitivity for 1 H{17 O} and 1 H{35 Cl} HMQC experiments on 17 O-labeled Fmoc-alanine and histidine hydrochloride monohydrate, respectively. FS HMQC and FS RESPDOR experiments will provide access to valuable structural constraints from materials that are challenging to study due to unfavorable relaxation times or dilution of the nuclei of interest.

Unique, Cost-effective and Retentive Removable Prosthesis to Rehabilitate Long Span Kennedy's Class I Edentulism with Custom Attachment System: A Case Report.

AIM: This case report describes about a distinctive custom-made attachment on the abutment teeth to improve the retention and stability of the removable partial denture (RPD). It also throws light on the cost-effective method for altering the abutment teeth with the aid of the crowns and custom-made attachments. BACKGROUND: Achieving retention in Kennedy's class I bilateral edentulism usually affects the abutment teeth's periodontal health and eventually the retention is compromised. Distal extension edentulism also affects patient's masticatory efficiency. The rehabilitation of a patient with the long span Kennedy's class I condition complicates the problem because of the unavailability of enough abutments to support the prosthesis. Conventional removable prosthesis with clasps and cantilever fixed partial prosthesis are not advisable in this situation for the same reason. CASE DESCRIPTION: A case with Kennedy's class I modification 1 partially edentulous arch with 1st and 2nd molars missing along with central incisors was rehabilitated with an inexpensive custom attachment using die pin and sleeve for giving a fixed prosthesis on abutment teeth and removable prosthesis with missing teeth. CONCLUSION: This technique has advantages of retention better than conventional RPDs, protection of abutment health by restoring it with crown, easy to place and remove and very cost-effective. CLINICAL SIGNIFICANCE: The entire technique demands less skill compared to semi precision and precision attachments.

Rapid Characterization of Formulated Pharmaceuticals Using Fast MAS 1H Solid-State NMR Spectroscopy.

Active pharmaceutical ingredients (APIs) can be prepared in many different solid forms and phases that affect their physicochemical properties and suitability for oral dosage forms. The development and commercialization of dosage forms require analytical techniques that can determine and quantify the API phase in the final drug product. 13C solid-state NMR (SSNMR) spectroscopy is widely employed to characterize pure and formulated solid APIs; however, 13C SSNMR experiments on dosage forms with low API loading are often challenging due to low sensitivity and interference from excipients. Here, fast magic angle spinning 1H SSNMR experiments are shown to be applicable for the rapid characterization of low drug load formulations. Diagnostic 1H SSNMR spectra of APIs within tablets are obtained by using combinations of frequency-selective saturation and excitation pulses, two-dimensional experiments, and 1H spin diffusion periods. Selective saturation pulses efficiently suppress the broad 1H SSNMR signals from the most commonly encountered excipients such as lactose and cellulose, allowing observation of high-frequency API 1H NMR signals. 1H SSNMR provides a 1-3 orders of magnitude reduction in experiment time compared to standard 13C SSNMR experiments, enabling diagnostic SSNMR spectra of dilute APIs within tablets to be obtained within minutes. The 1H SSNMR spectra can be used for quantification, provided calibrations are performed on a standard sample with known API loading.

Association of body fat with stress levels and dietary intakes in Indian women.

A cross-sectional study of 605 women (aged 18-50 years) conducted from January 2013 to June 2014 in Gujarat, India assessed stress, dietary intakes and body fat percentage (PBF), and the inter-relationship of PBF with stress, dietary fat, and carbohydrates. The population was categorized according to PBF cutoffs for Asians. A generalized linear regression model adjusted for age was performed to assess the relationship of stress, fat, and carbohydrate intakes with PBF. PBF had a significant positive association with stress level (p = .02) and carbohydrate intake (p = .008); fat intake was not significantly associated (p = .8). Women with moderate PBF consumed significantly less carbohydrates (mean = 152.3 ± 13.3 gm/1000 kcal/day, p < .05) and had lower stress scores (mean = 9.7 ± 4.2, p < .05) than women with high PBF (mean carbohydrate intake = 156.2 ± 10.8 gm/1000 kcal/day; mean stress score = 10.9 ± 4.4) and very high PBF (mean carbohydrate intake = 156.8 ± 11.6 gm/1000 kcal/day; mean stress score = 11.2 ± 4.2). We conclude that PBF has a positive association with stress and dietary carbohydrate; women with higher stress and carbohydrate intake are more likely to accumulate higher body fat as compared to women with less stress and low carbohydrate intake.

Impact of dietary nutrient intake and physical activity on body composition and growth in Indian children.

BackgroundTo investigate interrelationships of dietary composition and physical activity (PA) with growth and body composition (BC) in urban Indian school children.MethodsA cross-sectional study was performed in 4,747 Indian school children (2,623 boys) aged 3-18 years. Weight, height, BC by body impedance analyzer, PA and dietary food intakes by questionnaire method were recorded.ResultsMean daily energy and protein intakes as recommended dietary allowance were significantly lower in both boys and girls (P<0.01) above 6 years, with 55% reduction in micronutrient intakes in older children. When compared with World Health Organization references, lower heights in pubertal boys and girls were related to dietary energy and protein intake. Multiple regression analysis showed positive association of height for age z-scores (HAZ) with midparental height z-scores (ß=0.45, P=0.0001) and protein density (ß=0.103, P=0.014). HAZ was negatively associated with inactivity (ß=-0.0001, P=0.049) in boys and girls (R2=0.104, P<0.01). Further, body fat percentage was negatively correlated with moderate or light activity and antioxidant intakes (P<0.01) but not with dietary fat intake. Percentage muscle mass was positively correlated with moderate activity and negatively with inactivity (P<0.05).ConclusionAdequacy of protein and antioxidant intakes, reducing inactivity and increasing moderate activity are essential for optimal growth and body composition in Indian children.

Indian girls have higher bone mineral content per unit of lean body than boys through puberty.

Our aim is to describe changes in the muscle-bone unit assessed as a ratio of bone mineral content (BMC) to lean body mass (LBM) through puberty at total body and various skeletal sites in Indian boys and girls. A cross-sectional study was conducted (888 children, 480 boys, aged 5-17 years) in Pune, India. Pubertal staging was assessed. BMC, LBM and fat percentage at the arms, legs, android, gynoid and total body (less the head) were assessed by dual energy X-ray absorptiometry. The amount of BMC per unit LBM (BMC/LBM) was computed. Changes in mean BMC/LBM at 5 Tanner (pubertal) stages after adjustment for age and fat percentage were calculated. In boys, adjusted BMC/LBM was significantly higher with successive Tanner stages [legs (TS-II vs TS-I), android (TS-III vs TS-II, TS-IV vs TS-III) and gynoid region (TS-III vs TS-II and TS-II vs TS-I) (p < 0.05)]. In girls, adjusted BMC/LBM was significantly higher with successive Tanner stages at total body, legs and gynoid (TS-III vs TS-II; TS-II vs TS-I; TS-V vs TS-IV), arms (TS-I to TS-V) and android regions (TS-V vs TS-IV) (p < 0.05). Boys had significantly higher adjusted BMC/LBM than girls at earlier Tanner stages (TS-I to TS-III), whereas girls had significantly higher adjusted BMC/LBM than boys at later Tanner stages (TS-IV, TS-V) (p < 0.05). Indian boys and girls showed higher total and regional body, and age- and fat percentage-adjusted BMC/LBM with successive pubertal stages. Girls had higher BMC/LBM than boys which may possibly act as a reservoir for later demands of pregnancy and lactation.

INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANE: Long-Term Visual and Anatomical Outcomes After Intravitreal Anti-vascular Endothelial Growth Factor Therapy.

PURPOSE: To assess the long-term visual and anatomical outcomes after intravitreal anti-vascular endothelial growth factor therapy for inflammatory choroidal neovascular membrane (CNVM). METHODS: Retrospective case series of 15 consecutive cases of newly diagnosed inflammatory CNVM who were treated with intravitreal bevacizumab or ranibizumab injections. RESULTS: The study included 8 women and 7 men with mean age at presentation with CNVM of 40.53 ± 17.46 years (range, 11-70 years), and mean follow-up duration after anti-vascular endothelial growth factor therapy was 20.53 ± 14.53 months (range, 6-48 months). All eyes had classic CNVM confirmed by fluorescein angiography, most commonly located in the peripapillary area (8 eyes, 53.3%), followed by juxtafoveal (4 eyes, 26.7%), and subfoveal location (3 eyes, 20%). All CNVMs showed complete resolution with mean 2.6 ± 1.2 injections per eye. Preinjection mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.79 ± 0.76 (approximate Snellen equivalent 20/123) and mean central macular thickness of 435.9 ± 190.2 µm improved significantly to mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.46 ± 0.43 (approximate Snellen equivalent 20/58) and mean central macular thickness of 262.13 ± 108.70 µm (P value 0.02 and <0.0001, respectively) at the final visit. Recurrence was seen in 26.7% eyes (4/15), all of which regressed with single injection. Only complication noted was subretinal fibrosis in one eye (6.7%). CONCLUSION: For inflammatory CNVM, in addition to immunosuppression in cases with active inflammation, anti-vascular endothelial growth factor therapy seems as a very effective treatment modality resulting in significant visual improvement and foveal flattening. Incidence of major complications is rare, and the recurrence rate seems low.

Nonlinear convection of binary liquids in a porous medium.

Thermal convection of binary mixtures in a porous medium is studied with stress-free boundary conditions. The linear stability analysis is studied by using the normal mode method. The effects of the material parameters have been studied at the onset of convection. Using a multiple scale analysis near the onset of the stationary convection, a cubic-quintic amplitude equation is derived. The influence of the Lewis number and the separation ratio on the supercritical-subcritical transition is discussed. Stationary front solutions and localized states are analyzed at the Maxwell point. Near the threshold of the oscillatory convection, a set of two coupled complex cubic-quintic Ginzburg-Landau type amplitude equations is derived, and implicit analytical expressions for the coefficients are given.

Impact of occupation on stress and anxiety among Indian women.

The objectives of this study were to: (1) assess the prevalence of anxiety and stress in Indian women; and (2) evaluate the relationship of occupation to the prevalence of anxiety and stress. A cross-sectional study was performed from January 2013 to June 2014, on women (aged 18-50 years) randomly selected from different occupations in Gujarat, India. Anxiety was evaluated using Spielberg's State and Trait Anxiety Inventory scale and stress was assessed using the International Stress Management Association questionnaire. Serum cortisol concentration was measured in a sub-sample. The association of occupation with stress and anxiety was analyzed by a generalized linear model adjusted for age. Among all participants, 26% were the most prone and 66% were somewhat more prone to stress; 35% of women showed high anxiety levels. Homemakers had 1.2 times higher anxiety and 1.3 times higher stress than working women (p < .05). Prevalence of stress (37%, p < .001) and anxiety (40%, p = .068) were also higher in homemakers compared to working women and students. Serum cortisol levels did not differ significantly (p > .05) by occupation. This study revealed high prevalence rates of stress and anxiety in Indian women. Involvement in activities outside the home may help women to reduce stress.

Dietary patterns with special reference to calcium intake in 2-16-year-old Urban Western Indian children.

BACKGROUND: It is important to establish good dietary practices in childhood that promote adequate calcium intake throughout life and reduce the risk of osteoporotic fractures in later life. OBJECTIVES: To assess dietary patterns of 2-16-year-old children with special reference to calcium and suggest strategies and develop recipes suitable to identified patterns to increase dietary calcium intake. METHODS: We studied 220 schoolchildren (2-16 years) around Pune city, India. The study duration was June 2013-July 2014. Height and weight were measured using standard protocols. Dietary intake was assessed by 24-h diet recall on 3 nonconsecutive days. Dietary patterns were derived by cluster analysis in two age groups; children (2-9 years) and adolescents (10-16 years). As per the dietary patterns, calcium-rich recipes were developed. RESULTS: Among children, "rice-pulse" (RP) and "wheat, milk, and milk products" (WM) patterns were observed. Among adolescents, RP, "wheat, milk, and bakery" (WMB), and "mixed food" patterns were observed. Children who consumed "WM" and "WMB" patterns had greater intake of calcium (P < 0.05) than children consuming other dietary patterns. The daily calcium intake of whole group was 53% of the recommended dietary allowance. From this, 30% calcium came from milk. Each serve of the developed recipe provided an average of 254 mg of calcium. CONCLUSION: Majority of children had cereal-pulse-based dietary patterns. By replacing foods from existing dietary patterns with calcium-rich foods, the dietary calcium content may be increased in a sustainable manner.

Prevalence of the ß(S) gene among scheduled castes, scheduled tribes and other backward class groups in Central India.

Sickle cell disease is an inherited disorder of the blood, and characterized by vasoocclusive crises (VOC), risks for pneumococcal infections and organ toxicities, is associated with morbidity and premature mortality. India, with a population of 1.2 billion individuals, is estimated to be home to over 50.0% of the world's patients with sickle cell disease. The ß(S) gene [ß6(A3)Glu→Val; HBB: c.20A>T] has the highest prevalence in three socio-economically disadvantaged ethnic categories: the Scheduled Castes (SC), the Scheduled Tribes (ST), and Other Backward Class (OBC) groups in India. The tradition of endogamy practiced by the ethnic groups in India provides the rationale for the screening of individual populations to better understand the distribution of the ß(S) gene, guide counseling and awareness programs and aid development of public policy. We undertook a study to describe the prevalence of the ß(S) gene in these ethnic groups in the district of Nagpur, Maharashtra in Central India. Through community screening and subsequent targeted screening of high risk individuals, 35,636 individuals were screened, of whom 5466 were found to have sickle cell trait and 1010 were identified with sickle cell disease. Community screening revealed a sickle cell trait prevalence of 13.0% in the SC, 12.0% in the ST and 3.4% in the OBC population. This study describes the prevalence of the ß(S) gene within these groups in Central India determined by large scale community screening. This program has uncovered previously undiagnosed cases, provided detailed information to guide population-based disease counseling, prevention and comprehensive care programs.

Insecticidal compounds from Rhizophoraceae mangrove plants for the management of dengue vector Aedes aegypti.

BACKGROUND & OBJECTIVES: Mosquito control is facing a threat due to the emergence of resistance to synthetic insecticides. Insecticides of botanical origin could serve as potential alternatives in future. Larvicidal efficacies of different parts of mangrove plants belonging to Rhizophoraceae family were tested against the late IV instar larvae of dengue vector, Aedes aegypti. METHODS: Different plant parts (leaf, bark, root, stilt root, hypocotyl and flower) of Rhizophoraceae family mangrove plants (Bruguiera cylindrica, Ceriops decandra, Rhizophora mucronata and R. apiculata) were collected from Karangadu southeast coast of India. The larval mortality was observed after 24 h exposure. Repellency bioassays were carried out in a 10 Χ 10 Χ 3 m room at 27- 35°C and 60- 80% RH. The bark (A3 and E1) and stilt root (A3 and E4) fractions of R. mucronata with different concentrations (0.25, 0.50, 0.75, 1, 2 and 4 mg/cm) were applied on one arm. RESULTS: The stilt root crude extract of R. mucronata showed maximum larvicidal activity (LC50 value 0.0275 ± 0.0066 µg/ml and LC90 = 0.0695 ± 0.156 µg/ml) followed by the bark extract (LC50 value of 0.03 ± 0.0076 µg/ml and LC90 = 0.0915 ± 0.156 µg/ml). Column chromatographic fractions of R. mucronata bark extracts (E1) showed maximum larvicidal activity (LC50 = 0.0496 ± 0.0085 µg/ml and LC90 = 0.1264 ± 0.052 µg/ml) followed by the acetone extract (LC50 = 0.0564 ± 0.0069 µg/ml and LC90 = 0.1187 ± 0.05 µg/ml). Ethanolic fraction (E4) of R. mucronata stilt root extracts showed maximum larvicidal activity (LC50 = 0.0484 ± 0.0078 µg/ml and LC90 = 0.1191 ± 0.025 µg/ml) followed by acetone fraction (A3) (LC50 = 0.0419 ± 0.0059 µg/ml and LC90 = 0.0955 ± 0.069 µg/ml). Repellent activity of R. mucronata stilt root and bark extracts (A3) showed maximum percentage of protection (97.5%) with 9.1 h protection time at 4 mg concentration of the stilt root extract. Moreover, ethanolic fraction of the stilt root (E4) extract showed maximum percentage of protection (100%) with 10 h protection time at 4 mg concentration. GC-MS analysis revealed that R. mucronata possesses variety of biopesticidal compounds. INTERPRETATION & CONCLUSION: The results as well as the significance of this preliminary investigation highlight the importance of R. mucronata as a novel source for natural insecticidal products.

Micronutrient deficiency, dietary diversity, and sociodemographic and lifestyle determinants of dietary diversity among pregnant slum-dwelling women in Pune, India.

BACKGROUND: Increasing dietary diversity is a sustainable solution to combat micronutrient deficiencies. Given the large slum population in urban India, double burden of malnutrition, nutritional transition among slum-dwellers, and limited studies focusing on dietary intake and diversity among pregnant slum-dwellers, this study aimed to 1) describe macro- and micronutrient intakes and compare them with guidelines, 2) describe dietary diversity and intake of unhealthy foods and, 3) investigate the sociodemographic and lifestyle determinants of adequate dietary diversity among pregnant slum-dwellers in Pune, Maharashtra, India. METHODS: This study presents cross-sectional data of 454 pregnant slum-dwelling women completing mid-pregnancy visit collected from a larger cohort study. Sociodemographic and lifestyle data were collected at baseline (< 12 weeks gestation). Dietary data (24-h dietary recall) were collected in mid-pregnancy (23 ± 2 weeks). Nutrient intakes were compared with the Estimated Average Requirements (EAR) for pregnant Indian women. Dietary diversity score (DDS, range 0-10) and unhealthy food (sweet snacks, sweet beverages, fried and salty food) group score (range 0-3) were calculated as per FAO guidelines. Multivariate logistic regression was conducted to examine determinants of adequate dietary diversity (DDS ≥ 5). RESULTS: The average age of women was 25 (4.5) years. The median (Q1, Q3) total energy and protein intakes were 1771 (1456, 2185) kcal/d and 44.7 (34.7, 55.0) g/d, respectively. Total energy and protein were consumed as per EAR by 37% and 54% of women, respectively. Forty percent of women exceeded the recommended energy intake from carbohydrates. Diets of slum-dwelling women were lacking in multiple micronutrients (especially iron, zinc, riboflavin, thiamine, folate). The mean DDS was 4.2 ± 1.2 and 36.5% of the women had DDS ≥ 5. All women consumed mainly cereal-based starchy staples; 80% consumed pulses and legumes, and 60% consumed other vegetables. Fifty-nine percent of women consumed ≥ 2 unhealthy food groups. Higher educational and occupational status of the primary earning members of the family and lower parity were determinants of adequate dietary diversity. CONCLUSION: The diets of pregnant slum-dwelling women were lacking in numerous micronutrients. Dietary counselling programs need to be tailored to the socioeconomic backgrounds of pregnant slum-dwelling women and involve their family members to improve reach and effectiveness.

Role of Dietary Macronutrient Composition and Fibre Intake in Development of Double Diabetes in Indian Youth.

Introduction: Insulin resistance (IR) and obesity are common presentations of double diabetes (DD) in subjects with type-1 diabetes (T1D). There is evidence that dietary composition has an impact on developing IR. Objectives were to assess the impact of macronutrient and fibre intake on glycaemic control and the role of macronutrient composition of diet in the development of DD in subjects with T1D. Methods: This cross-sectional study included 77 young adults (10-25 years) with T1D. Data related to demography, anthropometry, biochemistry and body composition were collected. Dietary data was collected by fourteen-day food diary. IR was calculated using eGDR, SEARCH and CACTI equations, and metabolic syndrome (MS) was diagnosed using the International Diabetes Federation Consensus Definition. Results: Subjects at risk of DD had higher age, leptin levels, percentage carbohydrate consumption in diet and IR. A positive association of insulin sensitivity with fibre intake and %protein intake was noted. Poor glycaemic control, adiponectin/leptin ratio, fibre intake and insulin/carbohydrate ratio were significant negative predictors of IR. Addition of dietary factors to the regression model improved the R square and percentage of subjects identified correctly. Inclusion of dietary parameters significantly improves the prediction of the risk of development of DD in subjects with T1D. Conclusion: Good glycaemic control and increased intake of dietary fibre may prevent the development of IR in subjects with T1D and reduce the burden of DD.

Dynamic Muscle Function Parameters in Indian Children and Adolescents with Type 1 Diabetes Mellitus: A Case-Control Study.

Introduction: Recent evidence reveals that type 1 diabetes mellitus (T1DM) impairs muscle function (MF) in adolescents. However, despite its importance in physical well-being, data on dynamic MF in Indian children and adolescents (C and Y) with T1DM are scarce. We assessed MF using Jumping Mechanography (JM, a measurement method for motion analysis and assessment of muscle power and force). (1) To assess dynamic MF by JM in C and Y with T1DM as compared to healthy controls (2) To determine predictors of MF in children with T1DM. Methods: A cross-sectional observational study on 266 children (133 - T1DM duration >1 year with no known comorbidities + 133 age and gender-matched healthy controls) aged 6-19 years. Anthropometry, body composition, and MF (maximum relative power Pmax/mass, maximum relative force Fmax/BW by JM) were recorded. The lean mass index (LMI) was calculated as lean mass (kg)/height (m2). HbA1c was assessed in T1DM. Independent sample t-test and linear regression were performed. Results: MF parameters (Pmax/mass 33.5 ± 7.2 vs 38.0 ± 8.6 W/kg and Fmax/BW 10.5 ± 2.9 vs 11.4 ± 4.1 N/kg, P < 0.05) were significantly lower in T1DM group vs controls. Positive association of body mass index and LMI with both MF parameters and negative association of insulin requirement and HbA1c with Fmax was observed in T1DM. Predictors of MF identified were MMI (Pmax/mass:b = 1.6,95%CI = 0.6-2.6; Fmax/BW:b =2.0,95%CI = 1.6-2.4) and HbA1c (Pmax/mass:b = -2.1,95%CI = -4.5--0.5; Fmax/BW:b = -1.1,95%CI = -2.0--0.2) (P < 0.05). Conclusion: C and Y with T1DM exhibits compromised muscle function. Poor glycaemic control increases the risk of having decreased MF, irrespective of diabetes duration and may contribute to sarcopenia in adulthood.

Comparison of WHO 2006 Growth Standards and Synthetic Indian References in Assessing Growth in Normal Children and Children with Growth-Related Disorders.

Introduction: A good screening tool, such as a growth chart, should distinguish between children with normal growth and those with perturbed growth. Suitability of synthetic Indian growth references for diagnosing growth-related disorders for under-five children has not been evaluated. To assess the validity of World Health Organization (WHO) 2006 standards vs synthetic Indian references (2019) (by comparing weight, height, body mass index (BMI), standard deviation scores (SDS) and the composite index of anthropometric failure (CIAF)) in differentiating normal children and children with growth-related disorders. Methods: Records of 2188 children (0-60 months) attending a tertiary centre paediatric outpatient department (OPD) were retrospectively studied; 1854 children were healthy and 334 were diagnosed with growth-related disorders as per the European Society for Paediatric Endocrinology (ESPE) classification. The anthropometric parameters converted to Z-scores for weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ) and a CIAF were computed using WHO and synthetic charts; Student's t-test was used for assessing differences and Youden's index for validity. Results: Disease status of children and anthropometric failure on WAZ, HAZ, BAZ and CIAF on both WHO and synthetic charts had a significant association (P-value <0.05). WAZ, HAZ on both charts and CIAF on synthetic chart had a fair to moderate agreement (Kappa statistics) with disease status as per diagnosis (P-value <0.05). The sensitivity and negative predictive value for all anthropometric parameters were higher for synthetic charts. Conclusion: Indian charts were more sensitive for diagnosing growth-related disorders from birth to 60 months of age when compared to WHO growth standards.