Regional with urban-rural variation in low birth weight and its determinants of Indian children: findings from National Family Health Survey 5 data.

BACKGROUND: Low birth weight is a key indicator for child health, especially a concern in low-middle-income countries. However, health and medically-related reforms are being actively implemented in some middle-income countries like India. Identifying low birth weight (LBW) babies with their determinants across the whole country is essential to formulate regional and area-specific interventions. The objective of this study was to find out the burden and determinants of LBW on the regional and residential (rural-urban) divisions of India. METHODS: The present study was based on the NFHS-5 dataset (2019-21), a nationally representative survey in India. A total of 209,223 births were included in this study. A newborn weighing less than 2500 g was considered as LBW. According to the objectives, we used frequency distribution, chi-square test and binary logistic regression analysis for analysing the data. RESULTS: About 18.24% of the babies were LBW in India, significantly higher in rural areas than in urban areas (18.58% vs 17.36%). Regionally prevalence was more frequent in western (20.63%) and central (20.16%) rural areas. Regarding maternal concerns, in the eastern and southern regions of India, mothers aged 25-34 were less likely to have LBW children than mothers aged 35-49 years. It was found that the risk of LBW was more likely among the children born out of unintended pregnancies in almost all regions except for eastern part. In rural India, women who delivered children at home were more likely to have LBW children in India (AOR = 1.19, CI: 1.12-1.28, p < 0.001) and its central, northern, and southern regions than those who gave birth in institutions. The study indicates that LBW coexists with lower maternal education levels and poor household wealth index across all regions. About 58% and 57% of cumulative effects of independent variables on LBW can be distinguished in urban and rural India, respectively. CONCLUSIONS: Targeted-specific strategies need to be undertaken as per region and geographical variations. Then only India should be able to decline LBW as proposed by National Health Policy.

Self-care practices and quality of life of filariasis patients in a gram panchayat of Paschim Burdwan district, West Bengal, India.

Background & objectives: Self-care management is one of the important components in the goal of elimination of lymphatic filariasis (LF) and Quality of Life (QoL) has become an important deliverable in the present day health care system. The objective was to assess the self-care management of the affected limb and to find out the quality of life who were suffering from lymphoedema. Methods: This was a community-based cross-sectional epidemiological study conducted during 2019-2020 in a Gourbazar gram panchayat area of Paschim Burdwan district of West Bengal, India. QoL was assessed by Lymphatic Filariasis Specific Quality of life Questionnaire (LFSQQ). Results: Total 115 LF patients were identified with a mean age of 53.9 years. About 26.1% correctly knew the management of the affected area. Out of the 33 patients having cracked skin, around 39.4% used to take care of the affected skin. Overall, median quality of life score was found to be 77.84 (65.90-89.20). Age-wise, median score gradually decreased with increase in age except in the age group of 50-60 years. Males had higher score compared to females (79.54 vs. 76.13). Activity domain score was found to be lowest followed by mobility score, while social and psychological domain score was found to be good. Interpretation & conclusion: Self-care practice is not known to the affected patients. Time has also come to integrate measures like rehabilitation, psychological intervention, social assistance in addition to self-care management to put up a holistic approach of the existing program.

Research rating: Some technicalities.

From time immemorial, the body of scientific knowledge has grown with incremental additions of research. Metrics-based research evaluation provides crucial information regarding research credibility that would be difficult to understand by means of individual expertise. h-index and its modifications give an approximate quantitative measure of research output. Furthermore, g-index, e-index, h-index and i10-index address various intricacies involving authorship. Altmetrics and Plum X metrics are newer usage metrics that put an additional weightage on the impact on social media, usage, capture and scholarly networking. Indirect evaluation of research can also be obtained from the Journal Impact Factor in which the research is published but with certain limitations. While the scientific community is still waiting for a unique one-stop solution based on a high-quality robust process to exert judgement on research, the Leiden Manifesto comprising ten principles for research assessment can act as a guiding tool for development of a comprehensive evaluation system.

Impact of long-term doxycycline on lung function & exacerbations: A real-world open, prospective pilot observation on chronic obstructive pulmonary disease.

BACKGROUND & OBJECTIVES: Upregulation of matrix metalloproteinases (MMPs) is related to the pathogenesis of chronic obstructive pulmonary disease (COPD). We aimed at assessing the tolerability and impact of long-term use of MMP inhibitor doxycycline in COPD. METHODS: A cohort of COPD patients was randomized to continue a uniform COPD treatment with or without add-on long-term oral doxycycline. The lung exacerbations (spirometry), adverse events and health status (COPD Assessment Test score) were noted at 3, 6, 9 and 12 months of therapy. Measurement of the serum MMP-2, and 9 and high-sensitive C-reactive protein (hs-CRP) levels was done at the start of the study and at three months, whenever possible. RESULTS: There were 27, 19, 13 and 10 patients with add-on doxycycline group and 22, 19, 11 and 7 patients with COPD treatment alone at 3, 6, 9 and 12 months of treatment respectively. The improvement was obvious and mostly (at 6 and 12 months) significant (P >0.05) for lung function parameters [forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) and forced expiratory flow at 25-75% of FVC (FEF25-75)] and universal for health status at all measurements, with an overall 26.69 per cent reduction in exacerbations. The analysis with the lung function changes in the available population with protocol violation also supported the same trend. The concomitant reduction in serum MMP-9 (P =0.01), MMP-2 (P =0.01) and hs-CRP (P =0.0001) levels (n=21) at three months was also significant. The adverse reactions with add-on doxycycline appeared acceptable. INTERPRETATION & CONCLUSIONS: Long-term doxycycline appears well tolerated and seems to improve lung function, health status and exacerbations in COPD. The claim needs further scientific validations.

Novel variations in spermatogenic transcription regulators RFX2 and TAF7 increase risk of azoospermia.

PURPOSE: Genetic etiology of idiopathic male infertility is enigmatic owing to involvement of multiple gene regulatory networks in spermatogenesis process. Any change in optimal function of the transcription factors involved in this process owing to polymorphisms/mutations may increase the risk of infertility. We investigated polymorphisms/mutations of spermatogenic transcription regulators TAF7 and RFX2 and analysed their association with incidence of azoospermia among the men from West Bengal, India. METHODS: Genotyping was carried by Sanger's dideoxy sequencing of 130 azoospermic men who were detected negative in Y chromosome microdeletion screening and 140 healthy controls. Association study was done by suitable statistical methods. In silico analysis was performed to infer the intuitive damaging effects of detected variants at transcripts and protein level. RESULTS: We found significant association of TAF7 C16T (MW827584 G > A), RFX2 562delT (MZ560629delA), rs11547633 A > C, rs17606721 A > G, MW827583 C > T, and MZ379836 C > T variants with the incidence of azoospermia. In silico analysis predicted that the variants either alter the natural splice junctions of the transcript or cause probable damage in the structure of proteins of respective genes. CONCLUSION: Polymorphisms/mutations of TAF7 and RFX2 genes increase risk of male infertility in Bengali population. The novel variants may be used as markers for male infertility screening in ART practise.

Does presence of adenomyosis affect reproductive outcome in IVF cycles? A retrospective analysis of 973 patients.

RESEARCH QUESTION: Reports on the effect of adenomyosis on assisted reproductive technology (ART) outcomes are conflicting. Does presence of adenomyosis affect reproductive outcome in IVF cycles in women pretreated with gonadotrophin releasing hormone (GnRH) agonist? DESIGN: In this retrospective cohort study, 973 women were divided into four groups: only endometriosis (n = 355); endometriosis and adenomyosis (n = 88); adenomyosis alone (n = 64); and tubal factor infertility as controls (n = 466). The pregnancy outcome parameters (clinical pregnancy, miscarriage rate, live birth rate) were compared between these groups. RESULTS: The clinical pregnancy rate was 36.62% in women with endometriosis alone, 22.72% in women with endometriosis and adenomyosis, 23.44% in women who only had adenomyosis and 34.55% in controls. Miscarriage rates were as follows: 14.62%, 35%, 40% and 13.04%, respectively. Live birth rates were 27.47% in controls; 26.48% in women with only endometriosis; 11.36% in women with endometriosis and adenomyosis; and 12.5% in women with only adenomyosis. Live birth was observed to be less in adenomyosis groups compared with controls and women with only endometriosis. No significant difference was observed in clinical pregnancy, miscarriage or live birth rate between controls and women with only endometriosis. Live birth rate was significantly different between controls and women with adenomyosis only (P = 0.01) and women with endometriosis and adenomyosis (P = 0.002). CONCLUSION: Presence of adenomyosis seems to have adverse effects on IVF outcomes in clinical pregnancy rate, live birth rate and miscarriage rate. Screening for adenomyosis might be considered before ART so that the couple has better awareness of the prognosis.

Private sector involvement envisaged in the National Strategic Plan for Tuberculosis Elimination 2017-2025: Can Tuberculosis Health Action Learning Initiative model act as a road map?

Tuberculosis (TB), one of the oldest diseases known to mankind has become a notifiable disease. Public private mixes guidelines for TB programme managers had already been published by Central TB Division in the Ministry of Health and Family Welfare. One of the tremendous challenges that impede private sector involvement in TB care is delayed diagnosis, treatment of variable quality, surveillance, adherence monitoring, contact investigation, and outcome recording. The present article has addressed the involvement of the private sector with special emphasis on Tuberculosis Health Action Learning Initiative (THALI) model. The key elements of THALI being: (1) Identifying and scaling up of innovative approaches to improve the quality of private sector diagnosis, referral, and treatment of TB, (2) Strengthening the utilization of TB resources of the respective municipalities, (3) Testing of upcoming technological innovations, and (4) Improving data for evidence-based decision making. Nevertheless, sustainable parallel implementation framework adopting the strategies of THALI Model, along with prior Geographic Information System mapping of private health facilities e.g. hospitals/nursing homes, private providers, diagnostic centres, pharmacies etc. should be in place so as to correctly implement the slogan - "Unite to end TB: Leave no one behind".

Efficacy of GnRH agonist trigger in women having history of follicular-endometrial asynchrony with clomiphene/IUI cycles in unexplained infertility.

PURPOSE: An alternative option to human chorionic gonadotropin (hCG) is GnRH agonist (GnRH-a) for ovulation trigger in intrauterine insemination (IUI) cycles. This study aims to compare the efficacy of GnRH-a with hCG in women with history of follicular-endometrial asynchrony after clomiphene in IUI cycles. METHODS: This prospective observational study recruited 631 women with unexplained infertility and follicular-endometrial asynchrony (follicle ≥ 18 mm, endometrial thickness (ET) < 7 mm) in previous two failed clomiphene/IUI cycles. Overall 27 patients with synchronized follicular-endometrial relationship and 49 women with persistent ET < 7 mm and/or follicle > 26 mm were excluded. Remaining women (n = 555) were divided into two groups: Group A (n = 285) received GnRH-a and Group B (n = 270) received hCG ovulation trigger. Finally, 513 patients, who underwent IUI, were analysed. RESULTS: Cancellation due to luteinized unruptured follicle was more in hCG group (P = 0.01). Higher clinical pregnancies (10.33 vs. 4.96%, P = 0.03) and live birth rates (8.86 vs. 4.13%, P = 0.03) were noted with GnRH-a trigger. Miscarriage rate was comparable in both the groups (10.71 and 16.67% in Group A and Group B, respectively). CONCLUSION: In unexplained infertility, GnRH agonist is an useful alternative for triggering ovulation in women with follicular-endometrial asynchrony following clomiphene induction.

War against tobacco: Where do we stand?

India has launched war against tobacco epidemic for the past few decades but with partial success; hence, challenges are still there which need to be identified and addressed for winning the battle. Targeted approach directed at motivating smoking cessation of female smokers, frequent changing of pictorial warnings depicting variety of health consequences in cigarette packets and devoid of logos and colors in conjunction with plain packaging, and display of toll-free number for quitting are expected to dissuade tobacco consumers to quit and save themselves from the devastating health, social, environmental, and economic consequences of tobacco consumption. Online reporting system for violating legal enforcements can also be implemented easily. Moreover, guidance from success stories of countries/states who have achieved smoke-free status along with concerted efforts such as innovative anti-tobacco campaigns, involvement of religious leaders in anti-tobacco propaganda, strict legislations, and overall strong political commitment would further aid in winning the war.

Research submission: Some technicalities and vital links.

Publishing allows the author to share with the world his original findings, reasoning, important breakthroughs and it also creates the avenue for mandates of promotion and career upliftment. In an endeavour to publish an article, the first vital technicality that the authors face is selection of an appropriate journal. There has been steady increase in the number of predatory publishers and journals. Knowledge of the different publication models, websites to check valid open access journals and reliance on certain reputable publishing houses may actually guide the authors in selecting legitimate journals. Open Researcher and Contributor ID (ORCID ID) or Researcher ID is required during submission of articles. ResearchGate, Mendeley or Scholar Universe are useful sites to collaborate and disseminate research publication in an effective manner. Search Engine Optimization (SEO) is another vital technicality that needs to be adopted by the authors before submission of the research work for publication to ensure higher visibility of the published research article in the academic community and increase citations. Thorough understanding of the publication process, following simple technicalities of manuscript submission and establishing vital links in the post publication phase is some of the useful guidelines for shaping up the success story of the research.

Rapidly Fatal Silicosis Among Jewellery Workers Attending a District Medical College of West Bengal, India.

BACKGROUND: Silicosis is a slowly progressive chronic occupational lung disease, developed after a prolong period of exposure to high concentration of silica dust. METHODS: In this longitudinal study, we enrolled old and new silicosis patients (n=19; 8 jewellery polishers, 11 from other occupations) seen at our Pulmonary Medicine Department from June 2009 to December 2012 to document the course of illness as per their occupational exposure. RESULTS: Six of the eight jewellery polishing workers had developed silicosis within five years of exposure, while six of the 11 other workers with other occupational exposure had developed silicosis after exposure of 10 years or more. Mean duration of exposure was significantly less among jewellery polishing workers compared to other workers (3.4 +/- 1.7 versus 9.3 +/- 4.1; p=0.001). Mean duration of illness (months) (14.9 +/- 5.8 versus 28.5 +/- 16.5; p=0.040) were significantly less among the jewellery polishing workers compared to other workers. At the end of the study period, all eight jewellery polishing workers with silicosis had died while four of the 11 patients with other occupational exposure had died. CONCLUSION: Silicosis among jewellery polishing workers was found to be more severe and progressive compared to silicosis due to other occupational exposures, in our study.

Mobile phones: time to rethink and limit usage.

Radiofrequency waves generated from mobile phones cause potential public health problems. Short-term effects like changes in sleep, heart rate, and blood pressure, and long-term effects like carcinoma are well documented. The Government of India's efforts in laying down regulations regarding the safety limits, manufacture, marketing, and mobile use are still in nascent stage. The need for stringent enforcement of laws for prevention of phone usage while driving and guidelines of medical regulatory bodies regarding rules and regulations of phone usage while at class or attending patients is of utmost importance. This should be supplemented by mass media to raise awareness among people regarding the possible health effects of radiofrequency emissions from mobile phones and the guidelines to minimize its exposure. It is the need of the hour to teach young people to be structured, to know when to have the cell phone on, and to avoid becoming the slave of technology instead of its mastery.

Predictors of quitting behaviour with special reference to nicotine dependence among adult tobacco-users in a slum of Burdwan district, West Bengal, India.

BACKGROUND & OBJECTIVES: Information on predictors of quitting behaviour in adult tobacco users is scarce in Indian context. Hence, this study was undertaken to assess the intention of tobacco-users towards quitting and its predictors with reference to nicotine dependence. METHODS: A community-based observational, cross-sectional study was conducted on 128 adult tobacco-users (89.8% male) with mean age of 41.1 ± 15.7 yr selected by complete enumeration method. Data were collected by interview using pre-designed, pre-tested schedule. Nicotine dependence was assessed by Fagerstrφm Test for Nicotine Dependence (FTND) questionnaire. RESULT: Of the 128 users, 63.3 per cent had intention to quit. Majority of the tobacco users who did not intend to quit belonged to the age group of > 40 yr (66.0%), were illiterate (55.3%), started tobacco use at 11 - 15 yr of age (57.4%), had been using tobacco for 20 yr or more (70.2%), were daily tobacco users (91.5%), and highly dependent on nicotine (80.9%). Tobacco users having high FTND score and who started tobacco use early in life were 1.83 and 3.30 times more unintended to quit, respectively. INTERPRETATION & CONCLUSIONS: Suitable plan for quitting should be developed depending on the FTND score of an individual, the most important determinant of quitting that would be beneficial for categorization of the treatment leading to successful quitting.

Risk of tuberculosis among HAART receiving HIV patients attending an ART centre of West Bengal, India: a prospective cohort study.

This prospective study was conducted to find out the incidence density rate and to identify the attributed risk factors of Tuberculosis development among ART receivers. All patients who were registered in a nodal ART centre of India within 1st January 2008-31st December 2008 and had been initiated ART in the year of 2008 were considered as a cohort and were followed up till 31st December 2012. This study was started with 169 ART receivers and ended with 129 patients. During total 631.1 person-years observation, 39 TB cases (31 pulmonary and 8 extra pulmonary) were diagnosed. TB incidence density rate reduced from 12.08/100 to 1.12/100 person-years during the follow up periods. Cox regression model revealed that patients having past history of Tuberculosis were at 5 times higher risk (Hazard ratio = 5.205; 95 % CI 2.439-11.106; p = 0.000). Patients with WHO clinical stage 3 or 4 at the time of enrolment had 2 times more risk of development of TB (Hazard ratio = 2.081; 95 % CI 1.502-2.884; p = 0.000). This study highlighted that special attention should be paid on earliest identification of TB among the HIV patients who had past history of TB or suffering from WHO clinical stage 3 or 4 to prevent the silent transmission and multidrug resistance development of Tuberculosis in the community.

Depression among nursing students in an Indian government college.

BACKGROUND: Depression is a major public health threat that can affect anyone including health professionals and nursing students. OBJECTIVES AND METHODS: This analytical, cross-sectional study was conducted among 180 students of a nursing college to find out the burden of depression on them and possible contributing factors using the Beck Depression Inventory. RESULTS: 63.9% of the students were found to be depressed, the majority being mild in grade. First-year students were found to be significantly more affected (P=0.008). Binary logistic regression showed that familial disharmony, disinterest in the course and insecurity about future placement were statistically significant factors behind the development of depression. CONCLUSION: It is imperative that the psychological condition of nursing students be viewed as an important aspect to be considered, particularly within the Indian population and others in which there is a paucity of data.

A reactive neural network framework for water-loaded acidic zeolites.

Under operating conditions, the dynamics of water and ions confined within protonic aluminosilicate zeolite micropores are responsible for many of their properties, including hydrothermal stability, acidity and catalytic activity. However, due to high computational cost, operando studies of acidic zeolites are currently rare and limited to specific cases and simplified models. In this work, we have developed a reactive neural network potential (NNP) attempting to cover the entire class of acidic zeolites, including the full range of experimentally relevant water concentrations and Si/Al ratios. This NNP has the potential to dramatically improve sampling, retaining the (meta)GGA DFT level accuracy, with the capacity for discovery of new chemistry, such as collective defect formation mechanisms at the zeolite surface. Furthermore, we exemplify how the NNP can be used as a basis for further extensions/improvements which include data-efficient adoption of higher-level (hybrid) references via Δ-learning and the acceleration of rare event sampling via automatic construction of collective variables. These developments represent a significant step towards accurate simulations of realistic catalysts under operando conditions.

Pharmacogenomics-assisted schizophrenia management: A hybrid type 2 effectiveness-implementation study protocol to compare the clinical utility, cost-effectiveness, and barriers.

OBJECTIVES: The response to antipsychotic therapy is highly variable. Pharmacogenomic (PGx) factors play a major role in deciding the effectiveness and safety of antipsychotic drugs. A hybrid type 2 effectiveness-implementation research will be conducted to evaluate the clinical utility (safety and efficacy), cost-effectiveness, and facilitators and barriers in implementing PGx-assisted management compared to standard of care in patients with schizophrenia attending a tertiary care hospital in eastern India. METHODS: In part 1, a randomized controlled trial will be conducted. Adult patients with schizophrenia will be randomized (2: 1) to receive PGx-assisted treatment (drug and regimen selection depending on the results of single-nucleotide polymorphisms in genes DRD2, HTR1A, HTR2C, ABCB1, CYP2D6, CYP3A5, and CYP1A2) or the standard of care. Serum drug levels will be measured. The patients will be followed up for 12 weeks. The primary endpoint is the difference in the Udvalg for Kliniske Undersøgelser Side-Effect Rating Scale score between the two arms. In part 2, the cost-effectiveness of PGx-assisted treatment will be evaluated. In part 3, the facilitators and barriers to implementing PGx-assisted treatment for schizophrenia will be explored using a qualitative design. EXPECTED OUTCOME: The study findings will help in understanding whether PGx-assisted management has a clinical utility, whether it is cost-effective, and what are the facilitators and barriers to implementing it in the management of schizophrenia. TRIAL REGISTRATION: The study has been registered with the Clinical Trials Registry-India (CTRI/2023/08/056210).

Investigating proline puckering states in diproline segments in proteins.

In the current study, the puckering states of the Proline ring occurring in diproline segments ((L) Pro-(L) Pro) in proteins has been investigated with a segregation made on the basis of cis and trans states for the Pro-Pro peptide bond and the conformational states for the diproline segment to investigate the effects of conformation of the diproline segment on the corresponding puckering state of the Proline ring in the segment if any. The value of the endocyclic ring torsional angles of the pyrrolidine ring has been used for calculating and visualizing various puckering states using a proposed new sign convention (+/-) nomenclature. The results have been compared to that obtained in a previous study on peptides from this group. In this study, quite interestingly, the Planar (G) conformation that was present in 14.3% of the cases in peptides, appears to be nearly a rare conformation in the case of proteins (1.9%). The present study indicates that the (C(γ)-exo/C(γ)-exo), (C(γ)-exo/Twisted C(γ)-exo-C(ß)-endo) and (Twisted C(γ)-endo-C(ß)-exo/Twisted C(γ)-endo-C(ß)-exo) categories are the most preferred combinations. For Proline rings in proteins, the states C(γ)-exo, Twisted C(γ)-exo-C(ß)-endo and Twisted C(γ)-endo-C(ß)-exo are the most preferred states. Within diproline segments, the pyrrolidine ring conformations do not show a strong co-relation to the backbone conformation in which they are observed. It is likely that five-membered rings have a considerable plasticity of structure and are readily deformed to accommodate a variety of energetically preferred backbone conformations.