The reference values for muscle mass and strength in healthy Indian adults using whole-body potassium counter and isokinetic dynamometer.

The study aims to define the sex-based reference data for muscle mass and strength among healthy young Indians and to compare the data from the present study with available literature. Healthy Indian adults (n = 100) aged between 18 and 40 years were recruited. The assessment of muscle mass and strength was performed. The body cell mass (BCM), fat-free mass, and muscle strength parameters were significantly higher among males compared to females (P < 0.001). A comparison of the current study data with the available literature showed that though BCM was comparable, Indians demonstrated a significantly lower isometric peak torque (P < 0.001 for both sexes). These findings suggest that Indians tend to have a lower muscle strength compared to the Western population, despite having a comparable BCM content.

Awareness of the Use of Standard Precautions during Care of People Living with HIV by Ward Attendants in Indian Hospitals.

Context: Standard precautions (SP) are infection prevention practices universally used during patient care to lower infection transmission. Aims: The aim of the study was to (1) assess Indian ward attendants' (WAs) knowledge, perceived efficacy, and self-efficacy regarding SP and (2) examine correlates of SP self-efficacy and intent to use unnecessary precautions during care of people living with HIV. Subjects and Methods: Data are sourced from a face-to-face baseline survey of a stigma-reduction trial among 1859 WAs from Indian hospitals. Percentages were used to describe categorical variables means and standard deviations for continuous variables. Multiple regressions examined associations between measures. Results: WAs who had heard of SP had 44% higher odds of confidently using SP than those who had not heard of them. Those aware of universal SP use were 43% more likely to feel confident in using SP but also reported greater intent to use unnecessary precautions. Conclusions: Hospitals could implement SP training for WAs, as their knowledge of universal use was lacking.

Standard Precautions are for everyone: The role of HIV stigma and implications for nursing education in India.

Background and objective: Standard Precautions (SP) are infection control procedures universally applicable to every patient. Though SP reduces disease transmission, their implementation is dependent on the knowledge and skills of healthcare workers (HCWs). Poor knowledge regarding the appropriate use of SP can cause fear among HCWs, leading to stigma and discrimination while treating people living with HIV (PLWH). Stigma and discrimination are known barriers for PLWH to access HIV care services. The aim of the study was to assess nursing student knowledge of SP, SP self-efficacy and SP perceived efficacy of nursing students, and (2) to assess the association between SP knowledge, perceived efficacy, and intention to utilize unwarranted precautions, like using double gloves while treating PLWH. Methods: This paper analyzes baseline (non-randomized) data of a cluster randomized controlled trial amongst 1868 Indian nursing students. Data was collected using computer-administered structured questionnaire. The associations between the measures were done using multiple, logistic and poisson regression models. Results: Although 97% nursing students could identify SP, only 35.5% understood that they need to be used with all patients. Awareness of the importance of using SP with all patients was positively associated with self-efficacy. Students performing high-risk tasks frequently were significantly more likely to be confident in their ability to correctly use SP, but also had higher intention to use unwarranted precautions. Conclusions: Existing teaching and training programs for HCWs need to provide clear guidelines and emphasize on the correct use of SP with all patients. This will increase both skills and confidence in their abilities (self-efficacy).

The daily phenylalanine requirement of healthy Indian adults.

BACKGROUND: The daily requirement for phenylalanine is not known with certainty. Earlier 24-h tracer studies have suggested that the requirement is between 30 and 40 mg . kg(-1) . d(-1). OBJECTIVE: The objective was to assess the phenylalanine requirement in healthy well-nourished Indians with the use of 8 test phenylalanine intakes (19, 23, 27, 31, 35, 38, 43, and 47 mg . kg(-1) . d(-1)) and the 24-h indicator amino acid oxidation (24-h IAAO) and 24-h indicator amino acid balance (24-h IAAB) methods. DESIGN: Thirty-two healthy, well-nourished Indian men were studied during each of 2 randomly assigned 6-d diet periods in which phenylalanine intakes of 19, 23, 27, 31, 35, 38, 43, and 47 mg . kg(-1) . d(-1) were supplied; the diet was devoid of tyrosine. A 24-h [13C]leucine tracer infusion was used to measure 24-h IAAO and 24-h IAAB on day 7. The breakpoint in the relation between these values and the phenylalanine intake was determined. RESULTS: Two-phase linear regression of daily leucine oxidation and balance against phenylalanine intake estimated a breakpoint in the response curve at phenylalanine intakes of 37 and 38 mg . kg(-1) . d(-1) (95% CI for both: 31, >47 mg . kg(-1) . d(-1)), respectively. CONCLUSION: On the basis of the 24-h IAAO and 24-h IAAB methods, a mean phenylalanine requirement of 38 mg . kg(-1) . d(-1) is proposed for healthy well-nourished Indian adults in the absence of tyrosine intake. This finding is similar to that in Western adults.

The daily valine requirement of healthy adult Indians determined by the 24-h indicator amino acid balance approach.

BACKGROUND: The 1985 FAO/WHO/UNU requirement for valine was set at 10 mg x kg(-1) x d(-1) on the basis of nitrogen balance studies carried out in Western subjects. It is likely that the requirement is higher, however, because the requirement of another branched-chain amino acid, leucine, was found to be about 3 times as high (40 mg x kg(-1) x d(-1)) as the 1985 FAO/WHO/UNU value (14 mg x kg(-1) x d(-1)). OBJECTIVE: We assessed the valine requirement in healthy, well-nourished Indians by using 7 test valine intakes (5, 10, 15, 20, 25, 30, and 35 mg x kg(-1) x d(-1)) and the 24-h indicator amino acid oxidation (24-h IAAO) and balance (24-h IAAB) method, with phenylalanine as the indicator amino acid, while maintaining leucine intake at 40 mg x kg(-1) x d(-1). DESIGN: Eighteen healthy, well-nourished Indian men were studied during each of 3 randomly assigned 7-d diet periods supplying valine intakes that were equally placed on either side of a putative mean valine requirement of 20 mg x kg(-1) x d(-1). Twenty-four-hour IAAO and 24-h IAAB were measured on day 7 by use of a 24-h [13C]phenylalanine tracer infusion. The breakpoint in the relation between these values and the valine intake was determined. RESULTS: Two-phase linear regression of daily phenylalanine oxidation or balance against valine intake estimated a breakpoint in the response curve at a valine intake of 17 mg x kg(-1) x d(-1) (95% Fieller's CI: 11, > 35 and 11, 28 mg x kg(-1) x d(-1), respectively). CONCLUSION: From the 24-h IAAO/IAAB approach, a mean valine requirement of 17 mg x kg(-1) x d(-1) is proposed for healthy, well-nourished Indian adults.

Implementing an online reporting system in the anatomical pathology department of a tertiary care teaching hospital in India: a case study.

This article presents a case study in designing, developing, and implementing a web-enabled reporting application for the anatomical pathology (histopathology) department of a tertiary care teaching hospital in India. The article describes workflows, requirements assessment, and implementation methods that the investigators adopted for deploying the solution. The primary focus of the study was to demonstrate the requirements assessment performed, the strategies adopted, and the challenges encountered during the development and implementation. The study demonstrates a successful deployment as well as successful adoption of healthcare information technology by the end users. Factors that played a crucial role in adoption included the combination of people, processes, and technology. The lessons learned from this study would help application developers design efficient systems that suit the requirements of the end users while keeping in mind the ever-changing need for workflows and scalability in a developing country.

A randomized crossover study to determine bioequivalence of generic and brand name nevirapine, zidovudine, and lamivudine in HIV-negative women in India.

Low-cost generic antiretroviral drugs are available in resource-limited settings for treatment of HIV infections. However, few bioequivalence data in specific populations in which these generics are likely to be used are available. We conducted a randomized crossover bioequivalence study of generic and brand name formulations of nevirapine, zidovudine, and lamivudine in HIV-negative Indian women using US Food and Drug Administration (FDA) criteria. Subjects took single doses of all formulations separated by a 14-day washout period. Plasma concentrations were measured over 96 hours during each study period. Average bioequivalence was determined using natural log-transformed maximum concentration (C(max)) and area-under-the-concentration-time curve (AUC) mean ratio data. Fifteen Indian women were enrolled. The 90% confidence intervals for nevirapine (14 subjects) and lamivudine (15 subjects) C(max), AUC from 0 to the last measurable time point (AUC(0-t)), and AUC from 0 to infinity (AUC(0-infinity)) mean ratios and zidovudine (15 subjects) AUC(0-t) and AUC(0-infinity) mean ratios were all within 0.80 to 1.25. However, the 90% confidence interval for zidovudine C(max) mean ratio was 0.70 to 1.46. Generic and brand name nevirapine and lamivudine met FDA average bioequivalence criteria. Lack of average bioequivalence for zidovudine was found for C(max) but is not expected to be clinically significant, because the total AUC values were similar between formulations.