A pre-B acute lymphoblastic leukemia cell line model reveals the mechanism of thalidomide therapy-related B-cell leukemogenesis.

Lenalidomide, a thalidomide derivative, is prescribed as maintenance therapy for multiple myeloma (MM). Patients with MM receiving lenalidomide were found to develop a distinct therapy-related B cell acute lymphoblastic leukemia (B-ALL). However, the molecular mechanism by which lenalidomide drives B-ALL is unknown. We show that thalidomide treatment of B cell lines increased CD34 expression and fibronectin adhesion. This resembled the effects of Ikzf1 loss of function mutations in B-ALL. IKZF1 is a transcription factor that can act as both a transcriptional activator and a repressor depending upon the target loci. In our experiments, thalidomide-induced degradation of IKZF1 increased the expression of its transcriptional repression targets Itga5 and CD34 explaining the increased adhesion and stemness. Strikingly, withdrawal of thalidomide lead to the mis-localization of IKZF1 to the cytoplasm. Moreover, chromatin immunoprecipitation data showed a long-term effect of thalidomide treatment on IKZF1 target loci. This included decreased chromatin occupancy at early B cell factor 1 (EBF1) and Spi1 (PU.1). Consequently, B-cell lineage specifying transcription factors including Pax5, Spi1 and EBF1 were downregulated even after 7 days of thalidomide withdrawal. Our study thus provides a molecular mechanism of thalidomide-induced B-ALL whereby thalidomide alters the chromatin occupancy of IKZF1 at key B-cell lineage transcription factors leading to a persistent block in B-cell differentiation.

Cinnamaldehyde attenuates TNF-α induced skeletal muscle loss in C2C12 myotubes via regulation of protein synthesis, proteolysis, oxidative stress and inflammation.

Inflammation is the primary driver of skeletal muscle wasting, with oxidative stress serving as both a major consequence and a contributor to its deleterious effects. In this regard, regulation of both can efficiently prevent atrophy and thus will increase the rate of survival [1]. With this idea, we hypothesize that preincubation of Cinnamaldehyde (CNA), a known compound with anti-oxidative and anti-inflammatory properties, may be able to prevent skeletal muscle loss. To examine the same, C2C12 post-differentiated myotubes were treated with 25 ng/ml Tumor necrosis factor-alpha (TNF-α) in the presence or absence of 50 µM CNA. The data showed that TNF-α mediated myotube thinning and a lower fusion index were prevented by CNA supplementation 4 h before TNF-α treatment. Moreover, a lower level of ROS and thus maintained antioxidant defense system further underlines the antioxidative function of CNA in atrophic conditions. CNA preincubation also inhibited an increase in the level of inflammatory cytokines and thus led to a lower level of inflammation even in the presence of TNF-α. With decreased oxidative stress and inflammation by CNA, it was able to maintain the intracellular level of injury markers (CK, LDH) and SDH activity of mitochondria. In addition, CNA modulates all five proteolytic systems [cathepsin-L, UPS (atrogin-1), calpain, LC3, beclin] simultaneously with an upregulation of Akt/mTOR pathway, in turn, preserves the muscle-specific proteins (MHCf) from degradation by TNF-α. Altogether, our study exhibits attenuation of muscle loss and provides insight into the possible mechanism of action of CNA in curbing TNF-α induced muscle loss, specifically its effect on proteolysis and protein synthesis.

Mapping malaria vectors and insecticide resistance in a high-endemic district of Haryana, India: implications for vector control strategies.

BACKGROUND: Achieving effective control and elimination of malaria in endemic regions necessitates a comprehensive understanding of local mosquito species responsible for malaria transmission and their susceptibility to insecticides. METHODS: The study was conducted in the highly malaria prone Ujina Primary Health Center of Nuh (Mewat) district of Haryana state of India. Monthly entomological surveys were carried out for adult mosquito collections via indoor resting collections, light trap collections, and pyrethrum spray collections. Larvae were also collected from different breeding sites prevalent in the region. Insecticide resistance bioassay, vector incrimination, blood meal analysis was done with the collected vector mosquitoes. RESULTS: A total of 34,974 adult Anopheles mosquitoes were caught during the survey period, out of which Anopheles subpictus was predominant (54.7%). Among vectors, Anopheles stephensi was predominant (15.5%) followed by Anopheles culicifacies (10.1%). The Human Blood Index (HBI) in the case of An. culicifacies and An. stephensi was 6.66 and 9.09, respectively. Vector incrimination results revealed Plasmodium vivax positivity rate of 1.6% for An. culicifacies. Both the vector species were found resistant to DDT, malathion and deltamethrin. CONCLUSION: The emergence of insecticide resistance in both vector species, compromises the effectiveness of commonly used public health insecticides. Consequently, the implementation of robust insecticide resistance management strategies becomes imperative. To effectively tackle the malaria transmission, a significant shift in vector control strategies is warranted, with careful consideration and adaptation to address specific challenges encountered in malaria elimination efforts.

Multi-location evaluation of field pea in Indian climates: eco-phenological dynamics, crop-environment relationships, and identification of mega-environments.

Characterization of crop-growing environments in relation to crop's genotypic performance is crucial to harness positive genotype-by-environment interactions (GEI) in systematic breeding programs. Given that, the study aimed to delineate the impact of diverse environments on crop phenology and yield traits of dwarf-statured field pea, pinpointing location(s) favoring higher yield and distinctiveness within breeding lines. We tested twelve field pea breeding lines across twenty locations in India, covering Central Zone (CZ), North Western Plain Zone (NWPZ), North Eastern Plain Zone (NEPZ), and Northern Hill Zone (NHZ). Across these locations, maximum and minimum temperatures during flowering (TMAXF, TMINF) and reproductive period (TMAXRP, TMINRP) ranged 18.9-28.3, 3.3-18.0, 15.0-30.8, and 7.9-22.1oC, respectively. Meanwhile, notable variations in phenological and agronomic traits (coefficient of variation) were observed: flowering (31%), days to maturity (21%), reproductive period (18%), grain yield (48%), and 100-seed weight (18%). Combined ANOVA demonstrated an oversized impact of environment (81%) on yield, while genotype and GEI effects were 2% and 14%, respectively. The variables TMINF, TMINRP, and cumulative growing degree-day showed positive correlations with yield, while extended vegetative and maturity durations negatively influenced yield (p < 0.05). Additionally, linear mixed-models and PCA results explained that instability in crop phenology had significant influence on field pea yield. Seed weight was markedly varied within the locations (9.9-20.8 g) and both higher and lower seed weights were associated with lower yields (Optimal = 17.1 g). HA-GGE biplot-based on environment focus-scaling demonstrated three mega-environments and specific locations viz. Kota (CZ), SK Nagar (CZ), Raipur (CZ), Sehore (CZ), and Pantnagar (NWPZ) as the ideal testing-environments with high efficiency in selecting new genotypes with wider adaptability. The study findings highlight distinct impact of environments on crop phenology and agronomic traits of field pea (dwarf-type), hold substantial value in designing efficient field pea (dwarf-type) breeding program at mega-environment scale.

Impact of urbanization on the abundance and distribution of Anophelines population in Ghaziabad district, Uttar Pradesh, India.

BACKGROUND OBJECTIVES: In urban areas, upsurge in population has resulted in more breeding sites for malaria vectors, and hence this scenario potentially undermine malaria elimination and control programs. The change in land use due to urbanization may result in the presence and distribution of malaria vectors. Understanding potential malaria vectors is essential for current and future malaria transmission control strategies. This study investigated the effects of rapid urbanization on malaria vectors An. culicifacies s.l. and An. stephensi L. in Ghaziabad district. METHODS: Ghaziabad district which presents several levels of urbanization was selected for this study. Entomological investigations were conducted seasonally from 2014-2016 in the rural, urban, and peri-urban regions. Vector incrimination study was done using ELISA (confirmation by PCR) on suspected Anopheles vectors viz. An. culicifacies, An. stephensi, An. annularis and An. subpictus. RESULTS: An. culicifacies showed alteration in distribution influenced by rural and agricultural land whereas An. stephensi was found to be influenced by artificial habitats and population growth. INTERPRETATION CONCLUSION: The study also confirms the association between the abundance of malaria vectors and land use change.

Influence of climatic factors on the life stages of Aedes mosquitoes and vectorial transmission: A review.

BACKGROUND OBJECTIVES: Aedes aegypti and Aedes albopictus are two sympatric mosquito species that compete with each other for resources when their breeding habitats overlap. This study examines what happens when sympatric Aedes aegypti and Aedes albopictus mosquitoes' mate with each other and other species by looking at insemination rates, fecundity, and hatchability rate. METHODS: We performed controlled mating experiments in laboratory setting, assessing both conspecific and interspecific crosses. We measured insemination rates, egg numbers, and hatching success to examine the reproductive interference dynamics between these two distinct mosquito species. RESULTS: In the context of conspecific mating, it was observed that both female Ae. aegypti and Ae. albopictus exhibited high insemination rates, with percentages of 98% and 94%, respectively. However, interspecific mating exhibited interesting asymmetries: Ae. albopictus males achieved a notable insemination success rate of 28% when mating with Ae. aegypti females, while Ae. aegypti males achieved only 8% insemination success with Ae. albopictus females. Additionally, females that mated with interspecific males had reduced production of viable eggs compared to conspecific mating. Most notably, interspecific mating resulted in the production of infertile eggs, while conspecific mating led to successful hatching. INTERPRETATION CONCLUSION: The study reveals that, Ae. aegypti and Ae. albopictus can asymmetrically interfere with each other's reproduction, causing a 'satyr' effect. This understanding of interspecific competition and reproductive interference in these mosquito species could impact their coexistence in shared breeding habitats.

miRNA-378 Is Downregulated by XBP1 and Inhibits Growth and Migration of Luminal Breast Cancer Cells.

X-box binding protein 1 (XBP1) is a transcription factor that plays a crucial role in the unfolded protein response (UPR), a cellular stress response pathway involved in maintaining protein homeostasis in the endoplasmic reticulum (EnR). While the role of XBP1 in UPR is well-characterised, emerging evidence suggests its involvement in endocrine resistance in breast cancer. The transcriptional activity of spliced XBP1 (XBP1s) is a major component of its biological effects, but the targets of XBP1s in estrogen receptor (ER)-positive breast cancer are not well understood. Here, we show that the expression of miR-378 and PPARGC1B (host gene of miR-378) is downregulated during UPR. Using chemical and genetic methods, we show that XBP1s is necessary and sufficient for the downregulation of miR-378 and PPARGC1B. Our results show that overexpression of miR-378 significantly suppressed cell growth, colony formation, and migration of ER-positive breast cancer cells. Further, we found that expression of miR-378 sensitised the cells to UPR-induced cell death and anti-estrogens. The expression of miR-378 and PPARGC1B was downregulated in breast cancer, and higher expression of miR-378 is associated with better outcomes in ER-positive breast cancer. We found that miR-378 upregulates the expression of several genes that regulate type I interferon signalling. Analysis of separate cohorts of breast cancer patients showed that a gene signature derived from miR-378 upregulated genes showed a strong association with improved overall and recurrence-free survival in breast cancer. Our results suggest a growth-suppressive role for miR-378 in ER-positive breast cancer where downregulation of miR-378 by XBP1 contributes to endocrine resistance in ER-positive breast cancer.

Dermoscopic Correlation of an Eccentric Case of Kindler Syndrome.

Kindler syndrome (KS) is a rare autosomal recessive skin condition. The FERMT1 gene mutates and causes symptoms such as blistering and epidermal atrophy, as well as an increased risk of cancer and poor wound healing. A male in his 20s sought treatment for his hyper-hypopigmentation over the body with poikiloderma of the face with thin wrinkled cigarette paper skin in association with photosensitivity. He gave a history of developing blisters all over the body during his childhood, which formed raw areas and eventually healed forming atrophic scars. The objective is to assess the correlation of clinical findings with dermoscopy in a case of KS. KS is a rare disorder with poikiloderma, photosensitivity, and acral bullae in infancy as predominant features. Dermoscopy proves to be a useful tool in the diagnosis of this rare disorder as it helps in the identification of poikiloderma, adermatoglyphia, and cigarette paper scarring.

Comparative study of antioxidant activities of Allium sativum (a novel variety, HG17) and Allium ampeloprasum (SMG): Revealing the higher potential of HG17 and analyzing its phytochemicals.

Garlic, belonging to the genus Allium, is renowned for its rich antioxidant potential. Snow Mountain garlic (SMG) (Allium ampeloprasum) has been traditionally used for medicinal purposes because of its higher antioxidant potential. Considering its potential in medical therapies, we compared the antioxidant activity of SMG with a novel variety of Allium sativum, Hisar garlic 17 (HG17). Comparative antioxidant activity data (2,2-diphenyl-1-picrylhydrazyl and 2,2-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) revealed the higher antioxidant activity of HG17 than SMG, which prompted us to conduct a comprehensive phytochemical investigation to elucidate the factors contributing to antioxidant potential of HG17. To get a detailed antioxidant and phytoconstituents profiling, we differentially extracted HG17 by processing it in different forms (fresh, dry, heated, and aged) with two solvents (50% methanol and n-butanol). Our data (antioxidant activities, total phenolics, and flavonoids) showed that dry garlic methanolic extract (DgM) had maximum potential than other HG17 forms/solvents, which concludes that different extraction techniques had direct impact on the phenolics/flavonoids and antioxidant potential of the extracts. Further, phytochemical analysis of HG17 extracts by high resolution liquid chromatograph mass spectrometer quadrupole time of flight validated the maximum potential of DgM. LCMS revealed the presence of garcimangosone C, osmanthuside A, and protoaphin aglucone polyphenols exclusively in DgM compared to other HG17 extracts, which possibly contributing in its high antioxidant potential. The overall differential extraction and LCMS data of HG17 strongly depict that it may be used as an alternative of SMG under diverse medical applications. HG17 higher antioxidant potential and rich array of unique phytochemicals make it valuable for food and pharmaceutical industries to integrate into functional foods/therapeutics. PRACTICAL APPLICATION: Garlic unique phytochemical composition and its remarkable ability to scavenge different radicals make it valuable therapeutic asset to mitigate diseases associated with oxidative stress. SMG is well known for its anti-arthritic and anti-inflammatory properties. HG17 showed higher antioxidant potential than SMG and can be used as an alternative of SMG for anti-arthritic properties.

Difficult venesections: An easy solution.

Venesection is common procedure performed in day to day life of every doctor. Conventional vein finders available are costly and not easily available. The present paper highlights the use of makeshift vein finder.

"I Would Rather Die Drinking than take the Medicine": Role of Alcohol Use Disorder in Loss-to-follow-up of Tuberculosis Treatment in a Rural Area of Ballabgarh, Haryana.

Introduction: Alcohol use disorder (AUD) is a significant risk factor for tuberculosis (TB) treatment loss-to-follow-up (LTFU). This field-based study was undertaken to understand the role of AUD and TB treatment LTFU and the reasons behind this association in a rural area of Ballabgarh, Haryana. Material and Methods: TB patients who had completed their treatment and who had been LTFU were included in the study, along with the National TB Elimination Program (NTEP) staff, healthcare providers, family, and community members from Ballabgarh block of the north Indian state of Haryana. In-depth interviews (IDIs) and focused group discussions (FGDs) were conducted to gauge the perceptions of stakeholders regarding reasons for LTFU, especially in the context of alcohol use. Inductive analysis of the transcripts was done in keeping with the grounded theory, and themes with their sub-themes were identified. A conceptual framework of TB-AUD was constructed, and potential areas for intervention were determined. Results: Fifty-eight IDIs and four FGDs were conducted in mid-2018. Almost all key informants and many patient participants believed that alcohol use makes TB patients highly susceptible to treatment LTFU. Key themes identified were shared personality traits and attitudes, combined side effects of anti-tubercular drugs and alcohol use, lack of family support, and an adverse financial situation. Conclusion: These findings call for a change in NTEP's approach to AUD-TB. Interventions may include collecting alcohol use information at patient enrolment and closure, integrating brief interventions for alcohol cessation in NTEP, and linking patients to deaddiction centers with the provision of appropriate dietary and financial support.

Prevalence and Correlates of Malnutrition in Nuh District, Haryana State, India.

India has a substantial burden of undernutrition coupled with overweight and obesity at the other end of the spectrum of malnutrition. Nuh district, in the Haryana State in northern India, is an impoverished district in India. With an aim to investigate the problem of malnutrition in the community, a cross-sectional study was conducted in four villages of the Nuh district. Height/length, weight, and age data of children under 5 years were used to calculate three indices: weight-for-age, height-for-age, and weight-for-height. The body mass index was calculated for individuals older than 6 years. Associations between malnutrition and other factors were assessed using simple and multiple logistic regression to get adjusted coefficients. The total surveyed population comprised 11,496 individuals. Over 51% were female, and 13.2% of the surveyed population were children under 5 years. Almost half of the population was illiterate and unemployed. The prevalences of underweight, stunting, and wasting in children under 5 years were 37%, 53%, and 21%, respectively. The prevalences of underweight and stunting in the 6- to 19-year-old age group were 29% and 38%, respectively. The prevalence of overweight was 36% in the 20- to 40-year-old and > 60-year-old age groups, and 44% in the 41- to 60-year-old age group. Our findings reveal a considerable burden of undernutrition among children under 5 years and a dual burden of undernutrition and overnutrition in adults, highlighting the need to map these areas and sharpen our responses to mitigate the overwhelming and long-term consequences of malnutrition in the Nuh district.

Disease spectrum and its molecular characterisation in the lentil production system of lower-Indo Gangetic plains.

Lentil is a food legume grown in the Indo-Gangetic plains including lower Gangetic Bengal (LGB). Lentil productivity in this zone is severely impeded because of the prevalence of several biotic cues. Plausible reports regarding the status of disease scenario and the associated risk factors are missing. Therefore, judicious crop management strategies are lacking. An intensive survey of 267 farmers' fields was conducted over 3 years in major lentil-growing districts of LGB to evaluate the disease incidence and prevalence. Additional insights were generated, apprehending isolation and characterisation of associated pathogens through spore morphology and molecular markers as well as elucidating the role of biophysical factors in influencing disease development. Climate change has shifted the disease dimension of lentil and precipitated new disease complexes of great risk, which was reflected through geospatial mapping results in the present study. The prevalence of three major diseases, namely collar rot (Sclerotium rolfsii), lentil blight complex (LBC) incited by both Alternaria and Stemphylium, and lentil rust (Uromyces viciae-fabae), was ascertained through cultural and molecular studies and contextualised through pathogenicity appraisal. This study is the first to investigate the complex mixed infection of Alternaria alternata and Stemphylium botryosum, successfully isolating S. botyrosum in India, and confirming the pathogens through sequencing by using internal transcribed spacer (ITS) primers and Stemphylium-specific Glycerol-3-phosphate dehydrogenase 1 (gpd1) and gpd2 primers. Unlike late planting, early planting promoted collar rot infestation. LBC and rust incidence were magnified in late planting. Soil texture resulted in the spatial distribution of collar rot disease. The surveyed data also highlighted the potential role of resistant cultivars and cropping pattern intervention to ensure associational resistance towards addressing the disease bottleneck in lentil.

Evaluating the cost of robotic-assisted total and unicompartmental knee arthroplasty.

As uptake of robotic-assisted arthroplasty increases there is a need for economic evaluation of the implementation and ongoing costs associated with robotic surgery. The aims of this study were to describe the in-hospital cost of robotic-assisted total knee arthroplasty (RA-TKA) and robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and determine the influence of patient characteristics and surgical outcomes on cost. This prospective cohort study included adult patients (≥ 18 years) undergoing primary unilateral RA-TKA and RA-UKA, at a tertiary hospital in Sydney between April 2017 and June 2021. Patient characteristics, surgical outcomes, and in-hospital cost variables were extracted from hospital medical records. Differences between outcomes for RA-TKA and RA-UKA were compared using independent sample t-tests. Logistic regression was performed to determine drivers of cost. Of the 308 robotic-assisted procedures, 247 were RA-TKA and 61 were RA-UKA. Surgical time, time in the operating room, and length of stay were significantly shorter in RA-UKA (p < 0.001); whereas RA-TKA patients were older (p = 0.002) and more likely to be discharged to in-patient rehabilitation (p = 0.009). Total in-hospital cost was significantly higher for RA-TKA cases (AU$18580.02 vs $13275.38; p < 0.001). Robotic system and maintenance cost per case was AU$3867.00 for TKA and AU$5008.77 for UKA. Patients born overseas and lower volume robotic surgeons were significantly associated with higher total cost of RA-UKA. Increasing age and male gender were significantly associated with higher total cost of RA-TKA. Total cost was significantly higher for RA-TKA than RA-UKA. Robotic system costs for RA-UKA are inflated by the software cost relative to the volume of cases compared with RA-TKA. Cost is an important consideration when evaluating long term benefits of robotic-assisted knee arthroplasty in future studies to provide evidence for the economic sustainability of this practice.

Malaria Vector Bionomics: Countrywide Surveillance Study on Implications for Malaria Elimination in India.

BACKGROUND: The biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. OBJECTIVE: This study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. METHODS: Mosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)-specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. RESULTS: Anopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with <39% mortality). Moreover, it showed resistance to malathion (with mortality rates ranging from 49% to 78%) in all districts except Angul in Odisha and Palwal in Haryana. In addition, resistance to deltamethrin was observed in districts of Maharashtra, Gujarat, Haryana, and Karnataka. CONCLUSIONS: Our study offers vital insights into the prevalence, resting behavior, and sibling species composition of malaria vectors in India. It is evident from our findings that resistance development in An. culicifacies, the primary vector, to synthetic pyrethroids is on the rise in the country. Furthermore, the results of our study suggest a potential change in the resting behavior of An. culicifacies in Madhya Pradesh, although further studies are required to confirm this shift definitively. These findings are essential for the development of effective vector control strategies in India, aligning with the goal of malaria elimination by 2030.

Community perspective and healthcare assessment in malaria endemic states of India: a cross-sectional study protocol.

INTRODUCTION: India's contribution to the malaria burden was highest in South-East Asia Region in 2021, accounting for 79% of the estimated malaria cases and 83% of malaria-related deaths. Intensified Malaria Control Programme supported by Global Funds to Fight against AIDS, Tuberculosis and Malaria has deployed crucial interventions to reduce the overall burden of malaria in India. Evaluation of utilisation of malaria elimination interventions by the community and assessment of the healthcare system is underway in eleven high malaria endemic states in India. Health system preparedness for malaria elimination, logistics, and supply chain management of diagnostic kits and anti-malarial drugs in addition to the knowledge, attitude and practice of the healthcare workers is also being assessed. METHODS AND ANALYSIS: The study is being undertaken in 11 malaria endemic states with a variable annual parasite incidence of malaria. In total, 47 districts (administrative unit of malaria control operations) covering 37 976 households are to be interviewed and assessed. We present here the protocol following which the study is being undertaken at the behest and approval of Ministry of Health and Family Welfare in India. ETHICS AND DISSEMINATION: No patients were involved in the study. Study findings will be shared with Institutional ethics board of National Institute for Malaria Research New Delhi (NIMR) in a timely, comprehensive, accurate, unbiased, unambiguous and transparent manner and to the National Vector-borne Disease (Malaria) Control Programme officers and the Community public who participated. Important findings will be communicated through community outreach meetings which are existing in the Health system. Results will be informed to study participants via local fieldwork supervised by District Malaria Officers. Also findings will be published in reputed journals based on Indian Council of Medical Research (ICMR) publication policy.The ICMR-NIMR ethics committee approved the study via letter No. NIMR/ECM/2023/Feb/14 dated 24 April 2023 for version 5. All standard ethical practices will be followed.

Prevalence of anaemia among adolescent girls (10-19 years) in India: A systematic review and meta-analysis.

Background Anaemia is a serious public health problem. It is the second-commonest contributing factor to years lost by adolescents to disability and death. Targeting adolescent girls will allow a window of opportunity to correct their nutritional health and improve their obstetric outcomes. Studies in India have reported varying prevalence rates of anaemia among adolescent girls. Hence, we did a systematic review and meta-analysis of community-based studies to obtain a comprehensive pooled estimate of the prevalence of anaemia among adolescent girls in India. Methods We did a systematic electronic search in PubMed, Embase, Cochrane Library and Google scholar to retrieve community-based studies that reported the prevalence of anaemia among adolescent girls (10-19 years) in India, without any date or language restriction. To estimate the pooled prevalence and heterogeneity, the random-effects model and I2 statistical methods were used. We did subgroup analyses based on geographical region, study setting, method used to measure haemoglobin concentration, and year of publication. Results We included 35 studies in this meta-analysis comprising 152 640 participants. The pooled prevalence of anaemia among adolescent girls was 65.7% (95% CI 59.3%- 71.9%). There was significant heterogeneity between the studies (I2 99.6%; p<0.001). Conclusion There is a high prevalence of anaemia among adolescent girls in India. While all regions of the country have a high prevalence, tribal areas need special attention. Targeted actions need to focus on the identification of determinants of anaemia apart from iron supplementation.

Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana - A record-based comparative study.

Background: The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. Materials and Methods: This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019). Results: There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002). Conclusion: COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.