Correlation of visceral body fat with waist-hip ratio, waist circumference and body mass index in healthy adults: A cross sectional study.

BACKGROUND: Visceral Fat (VF) is the underlying culprit for cardiovascular diseases, type 2 diabetes, breast cancer, etc. VF can be estimated at present only by using expensive instruments as Bio Impedance Analyzer (BIA), DEXA scanner, etc. Measurement of Waist-Hip Ratio (WHR) can be used as a proxy for VF. Hence, the present study was done to assess the role of WHR as appropriate technology for assessment of VF. The aim of this study was to find correlation of Visceral Fat Area (VFA) with (WHR), Waist Circumference (WC) and Body Mass Index (BMI) in young healthy adults. METHODS: It was a descriptive cross-sectional study conducted on 215 healthy adults over one year in Western Maharashtra. Biospace 720 was used to assess VF. Data was analyzed by using software SPSS version 20.0. In body 720 was used to assess VF of subjects. RESULTS: Majority 155 (73%) were males and 57 (27%) were females. Nearly half (42% of males, 49% of females) had VFA above cut off value (i.e. 100 cm2) and 42% of males had WHR >0.9 and 56% of females had WHR >0.8. We found a very strong correlation between VFA and WHR (r = 0.936, p < 0.05) among males and females (r = 0.920, p < 0.05) and correlation between WC and BMI with VFA (r = 0.739, r = 0.758) for males, (r = 0.774, r = 0.605) for females was modest. CONCLUSION: There is a strong correlation between VF and WHR. Measurement of WHR is simple, handy, and inexpensive tool which can be used as a surrogate to measure VF.

A systematic review and cost-effectiveness analyses of the new World Health Organization guidelines for the treatment of HIV-positive adults in India.

BACKGROUND: The World Health Organization (WHO) in 2013 has revised its guidelines on antiretroviral therapy (ART) treatment for human immunodeficiency virus (HIV)-positive adults and further updated it in 2016. Based on the WHO recommendations, in May 2017, National AIDS Control Organisation, India recommended initiation of ART treatment for all people living with HIV, regardless of CD4 count, clinical stage, age, or population. This systematic review aims to assess the clinical effectiveness and cost implication of the new guidelines for India. METHODS: A systematic and comprehensive literature search on PubMed, OvidSP, Cochrane Library, and Google Scholar was carried out. Studies reporting either acquired immunodeficiency syndrome (AIDS) or mortality or both as outcome variables were selected. A meta-analysis of the available studies was carried out. The risk ratio was calculated to assess the reduction in AIDS or mortality or both. Cost-effectiveness analysis using health technology principles evaluating the lives saved in terms of incremental cost-effectiveness ratio and cost per quality-adjusted life years gained was carried out. RESULTS: Nine eligible studies were included for the meta-analysis. For India, the pooled relative risk of AIDS or mortality or both being 0.84 (95% confidence interval [CI], 0.76-0.92) and 0.78 (95% CI, 0.68-0.89) for ART initiation at CD4 count of ≤350 vs CD4 count of ≤500 and at CD4 count of ≤500 vs CD4 count > 500 cells/mm3, respectively. The incremental cost for per additional life saved is US$ 2592 and US$ 2357 for ART initiation at ≤500 and > 500 CD4 count, respectively. CONCLUSION: The adoption of the new WHO guidelines is beneficial with substantial reduction in AIDS or mortality or both. This study suggests that adopting new WHO guidelines is cost-effective for India.

'Jago Grahak Jago': A cross-sectional study to assess awareness about food adulteration in an urban slum.

BACKGROUND: Food adulteration includes various forms of practices, including mixing, substituting, concealing the quality of food, etc. One of the main causes for rampant adulteration is ignorance of consumer regarding their right and responsibilities resulting in faulty buying practices. Hence, the present study was done to assess the knowledge about adulteration among consumers in an urban slum. METHODS: A community-based cross-sectional study was done among residents of an urban slum over a period of 2 months. Adults responsible for purchasing groceries for the household were included. A sample size of 100 was taken and pilot-tested questionnaire was administered. All of them were made aware about adulteration. RESULTS: The mean age of the study subjects was 40.2 ± 11.7 years. Only 7% of the study subjects were illiterate. Good practices like checking of Food Safety and Standards Authority of India (FSSAI) logo (90%), Agmark logo (76%) and nutrition label (65%) are lacking among the majority. The most prominent source of knowledge about adulteration is mass media especially television (65%). Almost 40% of the study subjects are unaware about the consumer empowering initiative 'Jago Grahak Jago'. Factors which had a strong positive relationship with good practices like checking of nutrition label, FSSAI logo, Agmark logo, seal and expiry date are age, education status and socio-economic status (p value ≤ 0.05). CONCLUSION: Majority of study subjects are unaware about adulteration. 'Jago Grahak Jago' initiative which empowers the consumers has to be instilled in the minds of consumers. Awareness and motivation will lead to empowerment and end the menace of food adulteration.

Sense of coherence and self reported health amongst medical students: A cross sectional study.

BACKGROUND: In late 70s, Antonovsky proposed a salutogenic theory. This theory was based on the assumption that the human environment causes stress, and sense of coherence could serve as a stress-resisting resource. This study examined association between sense of coherence and self rated health of medical students. The aim of this study was to determine the association between sense of coherence and self reported health among medical students. METHODS: This was a cross-sectional analytical study conducted among medical students. The study tool used was a pre-designed, pre-tested, structured and self administered questionnaire (SOC scale and the SF 12 version 2 self-rated health measure). 172 medical students participated in the study. The data collected was entered into Microsoft Excel and analyzed using SPSS 20. All students were educated about sense of coherence after the study. RESULTS: Among the respondents, there were 99 (57.6%) female students, and 73 (42.4%) were male. The mean age of the students was 20.8 + 1.20 years. The mean (±SD) SOC scale score was 56.15 (±7.83). The mean self rated health score was 53.52 (±7.11). Pearson's χ2 test was used to determine the association and there was significant association between students SOC and self reported health (p < 0.000). CONCLUSION: There is a significant association between score of sense of coherence scale and self rated health among medical students.

Performance of Indian Diabetes Risk Score (IDRS) as screening tool for diabetes in an urban slum.

BACKGROUND: India is diabetic capital of world, with maximum number of diabetic patients. There is large burden of undetected diabetic cases in community. There is increasing risk of diabetes in urban slum, because of illiteracy, lack of awareness, low socioeconomic status and unhealthy life style. Madras Diabetes Research Foundation (MDRF) has developed Indian Diabetes Risk Score (IDRS) to detect undiagnosed Type 2 diabetes. The aim of this article is to study the performance of IDRS as screening tool for undiagnosed cases of Type 2 diabetes and to find the prevalence of undiagnosed Type 2 diabetes in an urban slum. METHODS: Screening for diabetes was carried out in an urban slum. The sample size was 155 (assumed prevalence of undiagnosed diabetes 9%). IDRS tool comprising of two modifiable (waist circumference, physical activity) and two non-modifiable risk factors (age, family history) for diabetes was used to assess the risk of diabetes anthropometry data was obtained. Conformation of diabetes was done using blood sugar levels on fasting venous sample. RESULTS: Mean and SD for age of study subjects were 49.68 ± 14.80 years, BMI 26.60 ± 8.51 kg/m2, waist hip ratio (females) 0.87 ± 0.06 cm, waist hip ratio (males) 0.95 ± 0.06 cm, waist circumference (females) 89.99 ± 10.95 cm, waist circumference (males) 89.44 ± 10.9 cm. IDRS predicted the risk of diabetes mellitus with sensitivity of 95.12% and specificity of 28.95% in individuals with score >60. CONCLUSION: IDRS can be used as an effective tool for screening undiagnosed diabetes in the community.

Predictors of first line antiretroviral therapy failure and burden of second line antiretroviral therapy.

BACKGROUND: As HIV steps into the third decade, there are more number of patients living on lifelong (antiretroviral therapy) ART and facing the threat of drug resistance with subsequent treatment failure. The aim of this study was to determine predictors of first-line ART failure with the objectives to estimate the burden of 2nd line ART. METHODS: A retrospective 5-year cohort of HIV patients who were initiated on first line ART in 2008-09 was studied. Patients were followed from the time of ART initiation. Kaplan-Meier methods and Cox proportional hazards regression models were used to estimate probabilities and predictors of first line ART failure. RESULTS: Of the total of 195 patients initiated on first line ART, 15 patients were switched to second line ART yielding 7.69% failure rate. During the 7178 person-years of follow-up, the incidence of first line ART failure was 2.09 per 1000 person-years. The Kaplan-Meier survival analysis gave a mean survival time of 55.6 months. BMI, CD4 count at ART initiation and presence of opportunistic infections were significant predictors of first line ART failure. The burden of second line ART patients by the end of 5 years of first line ART is expected to be 151 patients. CONCLUSION: Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.

Dengue, chikungunya and the missing entity - Zika fever: A new emerging threat.

Zika virus (ZIKV), a relative newcomer from the flavivirus group that includes dengue, Japanese encepahalitis and yellow fever, is one of the emerging pathogens that is fast transcending geographical boundaries. It is a vector-borne disease transmitted by the same Aedes aegypti and Aedes albopictus, which cause dengue and chikungunya. In addition to the vector-mediated transmission of Zika fever, probable human-to-human transmission through exchange of body fluids, including sexual and perinatal transmission and through blood transfusion, makes containment of this new entity more challenging. Moreover, a high index of suspicion by an astute physician is necessary for diagnosis of Zika fever in view of the similarity of symptoms with dengue and chikungunya, especially in areas, where these two diseases are already endemic. Zika, till recently, has had minimal impact, but its true potential is unfolding with increasing detection of congenital malformities, Guillain-Barré syndrome and other neurological and autoimmune syndromes in patients with recent history of ZIKV infection, or when mothers get infected with Zika during first or second trimester of pregnancy. The association, however, needs to be established, nonetheless it is important that we keep a close vigil on this emerging vector borne disease - the 'ZIKA' fever.

Impact of health education intervention on food safety and hygiene of street vendors: A pilot study.

BACKGROUND: Street foods are major source of food to millions of people. However, these are frequently associated with food-borne illnesses. It is imperative that street food vendors are educated to maintain hygiene and hence safety of food. With this background, a pilot study was undertaken to assess the impact of health education intervention on food safety and hygiene of street vendors. The aim of this study was to assess impact of health education intervention on food safety of street vendors. METHODS: It was a before and after study conducted in twenty street vendors of an urban area. Tool based on Bureau of Indian Standards (BIS) 2012 was prepared with scoring system to rate hygiene and sanitation of street vendors (score 0-156). Health education was given to all and scores of these vendors on same tool were reassessed after four weeks. RESULTS: Mean age of the study subjects was 35 ± 13.2 years. Highest score attained in BIS tool for food safety was 104 out of 156 (66.6%). No vendor was found to have achieved excellent score. Reasons for poor score were poor condition of vending cart, location, lack personal hygiene and incorrect and unsafe food handling practices. After intervention, it was observed that there was no significant improvement in overall score of vendors. However, scores in domains of personal habits, hygiene and food handling practices improved significantly after intervention (p < 0.05). CONCLUSION: The street vendors do not meet required standards given by BIS for food safety. Health education alone can only partly improve food safety practices of street vendors.