Patients with Celiac Disease Have High Prevalence of Fatty Liver and Metabolic Syndrome.

OBJECTIVE: In recent years, patients with celiac disease (CeD) have been reported to have a high prevalence of fatty liver and metabolic syndrome. We conducted a systematic review and meta-analysis to assess the prevalence of fatty liver and metabolic syndrome in patients with CeD and effect of gluten-free diet in them. METHODS: The PubMed, Embase and the Cochrane Library databases were searched for original studies upto November 18, 2022. We included full-text articles published in the English language after 1990 that used well-defined criteria for CeD, fatty liver and metabolic syndrome. A random effects model was used to calculate pooled prevalence. RESULTS: Of 350 studies identified, 11 studies (n = 2578) were included in the analysis. On analysis of both cross-sectional and longitudinal studies, pooled prevalence of fatty liver and metabolic syndrome in treatment-naïve patients with CeD were 18.2% (95% CI 8.3-30.8%, n = 1237) and 4.3% (95% CI 2.4-6.7, n = 1239) and in those on GFD of varying duration was 28.2% (95% CI 20.7-36.4%, n = 1368) and 21.3% (95% CI 11.7-32.9%, n = 2193), respectively. There was no difference in the prevalence of fatty liver and metabolic syndrome between low- or high-income group countries. CONCLUSIONS: Patients with CeD have a high prevalence of fatty liver and metabolic syndrome which increases further with the initiation of GFD. Patients with CeD should thus be screened and monitored for development of fatty liver and metabolic syndrome. They should be counselled appropriately regarding their diet and inclusion of physical activity in their lifestyle.

Serum progesterone on the day of human chorionic gonadotropin (hCG) trigger as a predictor of in-vitro fertilization (IVF) outcome - a retrospective analysis of seven years.

OBJECTIVE: To investigate the relationship between progesterone (P4) levels on the day of hCG trigger and IVF outcomes. METHODS: This is a retrospective analysis of IVF cycles from January-2013 to December-2019 from a single center. Women (21-39 years) submitted to IVF treatment for various infertility factors were included, while donor oocyte cycles and cancelled cycles were excluded from the study. The primary outcome measure was live birth rate. RESULTS: A total of 2149 cycles were analyzed. Of these, 223 (10.38%) were in the low P4 group (<0.5 ng/ml), 1163 (54.12%) in the normal P4 group (0.5-1.5 ng/ml), and 763 (35.50%) in the high P4 group (>1.5ng/ml). The groups were comparable with respect to age, factor of infertility and baseline AMH. The antagonist protocol was significantly more prescribed to the high P4 group (p<0.001). Live birth rates were 14.4%, 21.6%, and 21% (p<0.001), respectively, in three groups. Univariate analysis found that total cetrotide dose, total number of retrieved and fertilized oocytes, total number of embryos formed, transferred, and vitrified, and P4 on the day of hCG (p<0.001) were statistically significant after adjusting for age and BMI. In multivariate logistic regression after adjusting for age and BMI, only high P4 (aOR:0.60; p<0.001), total cetrotide dose (aOR: 0.82; p<0.001), and total utilizable embryos (aOR:1.11; p=0.029) were statistically significant. CONCLUSIONS: Having an elevated serum progesterone level on the day of hCG trigger was associated with lower pregnancy rates, but this is still not a robust marker to predict live births. More good quality evidence is needed.

Establishing nomogram of blood pressure for late adolescents in India: Secondary analysis of NFHS-4 data.

Background: Hypertension among adolescents is a public health problem, which is going to become more severe given the current obesity epidemic. There is a scarcity of information on the reference range value for blood pressure (BP) cut-off for adolescents. Aim: We aimed to establish BP distribution in adolescents aged 15-19 years by using the nationally representative National Family Health Survey-4 (NFHS-4) data. Materials and Methods: We analyzed the data of 15,936 boys and 1,04,132 girls aged 15-19 years in the NFHS-4 survey. We took the mean of systolic and diastolic BPs. Height for age z scores for each individual was calculated using the WHO Anthro plus. The sampling weight was taken as provided by the demographic and health surveys (DHS) website. Nomograms of systolic and diastolic BPs were made by calculating their 50th, 90th, and 95th percentiles for each age (in months), gender, and height percentile for age categories. Results: Both systolic and diastolic BPs increased with age and height centiles. The BP was higher in boys than girls. The average annual increase in systolic and diastolic BPs was 2.52 and 1.20 mmHg in boys and 0.50 and 0.46 mmHg in girls, respectively, when adjusted for height centiles. Conclusion: This study provides a BP nomogram that can be generalized to all the Indian population. Research is required for the diagnostic performance of this nomogram for the diagnosis of adolescent hypertension.

Assessment of cardiovascular risk using WHO CVD risk prediction chart with respect to hypertension status among Indian population: A secondary analysis of National Family Health Survey (2015-16).

Background: Hypertension, is a crucial risk factor for the development of cardiovascular disease (CVD). Studies assessing the risk of developing CVD among high-risk groups like hypertensives is limited. Aim: The purpose of this study was to find the distribution of CVD risk with respect to hypertension status among Indian adults. Material and Methods: This was a secondary data analysis of NFHS-4 survey data. The distribution of CVD risk among hypertensive participants using 2019 WHO CVD risk prediction charts was compared with normotensive participants among women aged 40-49 years and men in the age group of 40-54 years. Results: The proportion of hypertension was higher among women who consumed alcohol (31.5%) than those who did not (24.3%). The proportion of hypertensives increased with increasing BMI, with maximum proportion among obese women (37.3%). Among women, majority (95.7%) had low CVD risk (<5%) while 4.2% had 5% to <10% CVD risk, and only 0.1% had >10% risk. Among men, those with low CVD risk (<5%) was 65%, those with 5% to <10% CVD risk was 32.3%, 10% to <20% was 2.7%, and a meagre 0.03% had 20 to <30% risk. Conclusion: In the current study, prevalence of hypertension was seen to be increasing with age and was higher in urban residents than rural among both men and women. Both high blood pressure reading during the survey and self-reported hypertension was found to be higher among richest wealth index category. Although risk was higher among hypertensives, self-reported hypertensives who had their blood pressure controlled, had risk similar to normotensives indicating the importance of management of hypertension.

Association of Serum Prolactin With Type 2 Diabetes Mellitus: A Comparative Cross-Sectional Study From South India.

BACKGROUND:  The association of serum prolactin (PRL) with diabetes is still uncertain, with a paucity of data in the south Indian population. This study aims to compare the serum PRL levels between type 2 diabetes mellitus (T2DM) patients and normoglycaemic volunteers and correlate the serum PRL level with fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated haemoglobin (HbA1c) levels, and the lipid profile in the study population. METHODS:  This was a comparative cross-sectional study among 112 T2DM participants and 112 healthy volunteers in a tertiary care centre in India. All participants were tested for FPG, PPG, HbA1c, fasting serum lipid profile, and serum PRL, which were compared between T2DM patients and healthy volunteers. RESULTS:  The serum PRL in T2DM patients was significantly lower compared to healthy volunteers (8.67 ± 4.37 vs. 13.76 ± 6.55 ng/ml, P < 0.001). FPG, PPG, and HbA1c correlated inversely with serum PRL in our study population. On multivariable logistic regression adjusted for age and sex, a higher serum PRL level within the physiological range was protective for T2DM (adjusted odds ratio: 0.83, 95% CI: 0.77-0.90, P < 0.001). Serum PRL levels were inversely correlated with serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides, but not with high-density lipoprotein cholesterol. CONCLUSIONS: A high serum PRL within the physiological range was inversely associated with the prevalence of T2DM in the south Indian population. Serum PRL also correlated inversely with glycaemic and blood lipid parameters. Larger longitudinal studies are required to further validate the association of serum PRL with various components of metabolic syndrome in the south Indian population.

Spectrum of height in patients with celiac disease.

BACKGROUND: Growth retardation is an important feature of celiac disease (CeD) that can lead to the failure of attainment of potential adult height. There is lack of data on the spectrum of height in treatment-naïve patients with CeD, with normal expected height at one end and short stature at the other. METHODS: We performed a retrospective analysis of a prospectively maintained database at our center, including a total of 583 treatment-naïve patients with CeD: 419 adults (183 [43.7%] males) and 164 adolescents (12-18 years) (72 [43.9%] males). The details extracted from the database included demographic details, height, weight, body mass index, clinical symptoms, biochemical parameters, anti-tissue transglutaminase antibody anti-tTG Ab) titer, and the severity of villous abnormalities (as per modified Marsh grade). The data from Indian National Family Health Survey-4 were used as comparators. RESULTS: Overall, 19.6% of adults and 57.9% of adolescents with CeD had short stature. While mean height of men with CeD was similar, women were taller than population controls. While a higher proportion of men with CeD had short stature as compared to the controls (32.2% vs. 20%, p<0.001), a lower proportion of women with CeD had short stature (9.7% vs. 18.9%, p<0.001). Higher proportion of adolescents with CeD had short stature compared to adults (57.9% vs. 19.6%, p<0.001). On multivariate analysis, adulthood was found to be associated with a lower prevalence of short stature. CONCLUSIONS: Overall, 19.6% of adults and 57.9% of adolescents with CeD had short stature. While the mean height of adult men with CeD was not significantly different from the population controls, women were taller. Adolescents with CeD were significantly shorter than their peers.

Single Dose of Intravenous Ferric Carboxymaltose Prevents Anemia for 6 Months among Moderately or Severely Anemic Postpartum Women: A Case Study from India.

The effectiveness of intravenous ferric carboxymaltose (FCM) in quickly increasing normal hemoglobin concentration and replenishing body iron reserves up to 6-12 wk is known; however, its long-term effectiveness is unknown. In this study conducted in northern India during August 2018 to February 2019, 100 postpartum women within 48 h of delivery with a hemoglobin concentration between 5.0 and 9.9 g/dL were included. A single dose of intravenous FCM was administered. The hemoglobin and serum ferritin concentrations were measured at baseline and at 6 mo. Out of 100 women recruited, 57 (57%) returned for the follow-up visit at 6 mo. The mean (± SD) hemoglobin and serum ferritin concentrations at baseline were 8.6 ± 1.1 g/dL and 15.8 ± 17.2 ng/mL, respectively, and at 6 months were 12.5 ± 1.2 g/dL and 72.0 ± 52.0 ng/mL, respectively. The mean increase in hemoglobin concentration was 3.9 (95% CI: 3.5, 4.3) g/dL (P < 0.001) and for serum ferritin was 53.8 (95% CI: 41.8, 65.8) ng/mL (P < 0.001). The study was registered prospectively in the Clinical Trials Registry-India (CTRI) as CTRI/2018/06/014332.

Prevalence of elevated alanine aminotransferase levels in adult participants from a community-based study from northern part of India.

Alanine aminotransferase (ALT) is a cytosolic enzyme specific to hepatocytes, and its elevated level in the peripheral blood denotes liver cell injury. Detection of persistently elevated ALT levels during routine health check-up in asymptomatic or symptomatic individuals provides a window of opportunity to explore the causes of liver cell damage and for the timely institution of appropriate treatment. This was a retrospective study using a subset of the data from a previous community-based prospective study done for the estimation of the prevalence of celiac disease (CD) in India,  during which estimation of ALT levels in the blood samples of participants was also carried out. Of the 11,053 individuals (4399 [39.8%] males; mean age 37.9 ± 13.3 years) screened, 6209 consented to provide blood samples for testing for CD. Of these, assessment of serum ALT levels was done in 6083 (2235 [36.7%] males) patients. ALT was elevated above the upper limit of normal (ULN) (> 40 IU/L) in 1246 (20.5%) of the participants and > 1.5 times (> 60 IU/L) in 329 (5.4%) participants. The ALT levels were elevated more frequently in men as compared to women (29.4% vs. 15.3%, p < 0.001). There was a significant positive correlation (Pearson correlation coefficient [r] = 0.25, p < 0.0001) between ALT levels and body mass index (BMI). With increasing age, there was a significant decrease in the proportion of subjects with ALT ≥ 1.5× ULN (p < 0.001). Our results suggest that a high proportion (20.5%) of individuals otherwise considered healthy have values of ALT level in the serum above the "normal" range/cut-off suggesting likely ongoing underlying liver damage. There is a need for measures to evaluate and, if found, treat the underlying cause for the same.

Diagnostic accuracy of non-contact infrared thermometers and thermal scanners: a systematic review and meta-analysis.

Infrared thermal screening, via the use of handheld non-contact infrared thermometers (NCITs) and thermal scanners, has been widely implemented all over the world. We performed a systematic review and meta-analysis to investigate its diagnostic accuracy for the detection of fever. We searched PubMed, Embase, the Cochrane Library, medRxiv, bioRxiv, ClinicalTrials.gov, COVID-19 Open Research Dataset, COVID-19 research database, Epistemonikos, EPPI-Centre, World Health Organization International Clinical Trials Registry Platform, Scopus and Web of Science databases for studies where a non-contact infrared device was used to detect fever against a reference standard of conventional thermometers. Forest plots and Hierarchical Summary Receiver Operating Characteristics curves were used to describe the pooled summary estimates of sensitivity, specificity and diagnostic odds ratio. From a total of 1063 results, 30 studies were included in the qualitative synthesis, of which 19 were included in the meta-analysis. The pooled sensitivity and specificity were 0.808 (95%CI 0.656-0.903) and 0.920 (95%CI 0.769-0.975), respectively, for the NCITs (using forehead as the site of measurement), and 0.818 (95%CI 0.758-0.866) and 0.923 (95%CI 0.823-0.969), respectively, for thermal scanners. The sensitivity of NCITs increased on use of rectal temperature as the reference. The sensitivity of thermal scanners decreased in a disease outbreak/pandemic setting. Changes approaching statistical significance were also observed on the exclusion of neonates from the analysis. Thermal screening had a low positive predictive value, especially at the initial stage of an outbreak, whereas the negative predictive value (NPV) continued to be high even at later stages. Thermal screening has reasonable diagnostic accuracy in the detection of fever, although it may vary with changes in subject characteristics, setting, index test and the reference standard used. Thermal screening has a good NPV even during a pandemic. The policymakers must take into consideration the factors surrounding the screening strategy while forming ad-hoc guidelines.

Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis.

BACKGROUND: There is paucity of evidence on the effectiveness of facemask use in COVID-19 in community settings. OBJECTIVES: We aimed to estimate the effectiveness of facemask use alone or along with hand hygiene in community settings in reducing the transmission of viral respiratory illness. METHODS: We searched PubMed and Embase for randomized controlled trials on facemask use in community settings to prevent viral respiratory illnesses published up to April 25, 2020. Two independent reviewers were involved in synthesis of data. Data extraction and risk-of-bias assessment were done in a standard format from the selected studies. Outcome data for clinically diagnosed or self-reported influenza-like illness (ILI) was recorded from individual studies. Pooled effect size was estimated by random-effects model for "facemask only versus control" and "facemask plus hand hygiene versus control." RESULTS: Of the 465 studies from PubMed and 437 studies from Embase identified from our search, 9 studies were included in qualitative synthesis and 8 studies in quantitative synthesis. Risk of bias was assessed as low (n = 4), medium (n = 3), or high (n = 1) risk. Interventions included using a triple-layered mask alone or in combination with hand hygiene. Publication bias was not significant. There was no significant reduction in ILI either with facemask alone (n = 5, pooled effect size: -0.17; 95% confidence interval [CI]: -0.43-0.10; P = 0.23; I2 = 10.9%) or facemask with handwash (n = 6, pooled effect size: (n=6, pooled effect size: -0.09; 95% CI: -0.58 to 0.40; P = 0.71, I2 = 69.4%). CONCLUSION: : Existing data pooled from randomized controlled trials do not reveal a reduction in occurrence of ILI with the use of facemask alone in community settings.

Correction: Health behaviors, outcomes and their relationships among young men aged 18-24 years in a rural area of north India: A cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0220285.].

Health behaviors, outcomes and their relationships among young men aged 18-24 years in a rural area of north India: A cross-sectional study.

BACKGROUND: There is limited information related to health behaviors and their related factors among young men in rural setting of India. This study was conducted to investigate multiple health risk behaviors and outcomes among young men aged 18-24 years in rural India. METHODS: This was a community-based cross-sectional survey conducted in the Ballabgarh block of Faridabad district, Haryana, India. Information regarding socio-demographic details, substance use, injury & violence, mental health and sexual behaviors were collected using a semi-structured interview schedule. Age adjusted prevalence estimates of behaviors and outcomes are computed along with 95% Confidence Intervals. Mediation analysis was carried out to examine relationships between socio-demographic variables, select behaviors and outcomes reported in the study. RESULTS: A total of 836 young men participated in the study, with mean (SD) age of 20.6 (1.9) years. The age-adjusted prevalence (with 95% Confidence Interval) for ever use of tobacco, alcohol, and other substances was 34.2% (33.9, 34.5), 23.4% (23.2, 23.6), and 4.5% (4.4, 4.5), respectively. Loneliness and suicidal thoughts were reported by 237 and 35 youth men with age adjusted prevalence as 28.6%, 95% CI: 28.4-28.8 and 4.3%, 95% CI: 4.23-4.31, respectively. A total of 330 young men met serious injury in past one year (prevalence 39.3%, 95%CI: 39.01-39.67). Almost one-third of men (prevalence 30.6%, 95%CI: 30.34-30.85) had engaged in pre-marital sexual intercourse. Current substance use was found to be significant mediator for associations with socio-demographic variables studied for dependent variables viz. pre-marital sexual intercourse and serious injury. CONCLUSION: High prevalence of various risk behaviors and outcomes was found in young men aged 18-24 years in our rural setting. It is imperative that multi-component health intervention package be rolled out to address these.

Challenges in the conduct of community-based research.

Community-based research is an excellent opportunity for medical students to learn outside the boundaries of a medical college, where health-related conditions and factors can be studied in a larger social context. It also brings a variety of other educational and social learning with it. The research question is usually a community-driven issue. There are multiple ways to arrive at a research question. Sampling poses a unique challenge, especially in terms of availability of a sampling frame. However, accessing electoral rolls, census data and approaching community leaders of voluntary agencies working in a particular area can be a suitable way. The interview schedule should be culturally and socially appropriate and locally validated if possible. Prior preparation of a timetable of activities is much needed, including slack time and contingency plans to fall back on as some social situations might make the area inaccessible. An important team member in these situations is a chaperone from the community who can facilitate these social interactions, including negotiations for the time of the participant. There may be sociocultural problems, which plague the research as much as they affect the community, which the researcher has to be sensitized to. Extra effort is needed to achieve a high response rate in community-based studies. Refusals by selected participants and their nonavailability despite 2-3 household visits need to be addressed with patience and perseverance. Several ethical issues arise during the research, and careful thought has to be given to avoid exploitation of the communities.