Seasonality and within-subject clustering of rotavirus infections in an eight-site birth cohort study.

Improving understanding of the pathogen-specific seasonality of enteric infections is critical to informing policy on the timing of preventive measures and to forecast trends in the burden of diarrhoeal disease. Data obtained from active surveillance of cohorts can capture the underlying infection status as transmission occurs in the community. The purpose of this study was to characterise rotavirus seasonality in eight different locations while adjusting for age, calendar time and within-subject clustering of episodes by applying an adapted Serfling model approach to data from a multi-site cohort study. In the Bangladesh and Peru sites, within-subject clustering was high, with more than half of infants who experienced one rotavirus infection going on to experience a second and more than 20% experiencing a third. In the five sites that are in countries that had not introduced the rotavirus vaccine, the model predicted a primary peak in prevalence during the dry season and, in three of these, a secondary peak during the rainy season. The patterns predicted by this approach are broadly congruent with several emerging hypotheses about rotavirus transmission and are consistent for both symptomatic and asymptomatic rotavirus episodes. These findings have practical implications for programme design, but caution should be exercised in deriving inferences about the underlying pathways driving these trends, particularly when extending the approach to other pathogens.

Low Dose Dexmedetomidine Attenuates Hemodynamic Response to Skull Pin Holder Application.

BACKGROUND: The application of skull pin holder elicits an adverse hemodynamic response that can be deleterious; there are many drugs that have been used to attenuate this response. We have conducted this study to evaluate the efficacy of intravenous (i.v.) dexmedetomidine on attenuation of hemodynamic responses to skull pin head holder application and to compare the effectiveness of two doses of i.v. dexmedetomidine (1 µg/kg and 0.5 µg/kg bolus). MATERIALS AND METHODS: Ninety American Society of Anesthesiologists physical Status I-III patients undergoing craniotomy were randomized into three groups of thirty each. After intubation, patients in Group A received 1 µg/kg of i.v. dexmedetomidine, Group B received 0.5 µg/kg of i.v. dexmedetomidine, whereas Group C received an equivalent quantity of normal saline. Hemodynamic parameters were monitored regularly after skull pin insertion. RESULTS: There was no significant difference in the monitored hemodynamic parameters among the three groups from baseline until intubation. Heart rate (HR) and mean arterial pressure (MAP) increased significantly at skull pin insertion and subsequent points in Group C, whereas the values decreased in Groups A and B (P < 0.05). Patients in Group A showed a higher and sustained attenuation of MAP. Patients in Group C had a higher incidence of tachycardia and hypertension requiring additional measures to attenuate the response. CONCLUSIONS: Dexmedetomidine in either dosage (1 µg/kg or 0.5 µg/kg) was effective in attenuating hemodynamic response to skull pin insertion. Dexmedetomidine in doses of 0.5 µg/kg was as effective in attenuating the HR and MAP response to skull pin insertion as compared to a dose of 1 µg/kg.

Epidural ropivacaine with dexmedetomidine reduces propofol requirement based on bispectral index in patients undergoing lower extremity and abdominal surgeries.

BACKGROUND AND AIM: To assess the amount of propofol required for induction based on bispectral index (BIS) after administering epidural anesthesia with ropivacaine alone and ropivacaine with dexmedetomidine in patients undergoing lower extremities and abdominal surgeries. SUBJECTS AND METHODS: A double-blinded randomized clinical trial was carried out in 60 patients over a period of 2 years in a tertiary care hospital. American Society of Anaesthesiologists I or II in age group 18-65 years were included in the study. Group R received epidural anesthesia with ropivacaine alone, and Group D received ropivacaine and dexmedetomidine. General anesthesia was induced with propofol under BIS monitoring after 15 min. Onset of sensory and motor block, time for loss of consciousness and total amount of propofol used during induction to achieve the BIS value < 55 were recorded. Student's t-test and Chi-square test were used to find the significance of study parameters. RESULTS: Time of onset of sensory block (Group R 11.30 ± 1.64/Group D 8.27 ± 0.83 min), motor block (Group R 14.16 ± 1.33/Group D 12.63 ± 1.22 min), time for loss of consciousness (Group R 90.57 ± 11.05/Group D 73.67 ± 16.34 s), and total amount of propofol (Group R 129.83 ± 22.38/Group D 92.13 ± 12.93 s) were reduced in Group D which was statistically significant with P < 0.001. CONCLUSION: Epidural ropivacaine with dexmedetomidine significantly reduces the total propofol dose required for induction of anesthesia. Also, it decreases the onset time of sensory and motor block and provides good hemodynamic stability.

Are hepatic and soleus lipid content, assessed by magnetic resonance spectroscopy, associated with low birth weight or insulin resistance in a rural Indian population of healthy young men?

AIMS: To assess young healthy men from rural India, who had normal or low birth weights, using magnetic resonance spectroscopy to determine the potential differences in ectopic fat storage between birth weight groups, and to determine if ectopic fat storage was associated with insulin resistance in this population. METHODS: A total of 54 lean men with normal birth weight and 49 lean men with low birth weight (age range 18-22 years) from rural India were recruited. All the men underwent anthropometry, magnetic resonance spectroscopy, a hyperinsulinaemic-euglycaemic clamp and a dual-energy X-ray absorptiometry. RESULTS: The median (interquartile range) values for hepatic cellular lipids, intramyocellular lipids and extramyocellular lipids, measured using magnetic resonance spectroscopy were 0.76 (0.1-1.8)%, 1.27 (1.0-2.3)% and 1.89 (1.3-3.2)%, respectively, for the normal birth weight group and 0.4 (0.1-1.3)%, 1.38 (0.9-2.2)% and 2.07 (1.2-2.8)%, respectively, for the low birth weight group (P > 0.05). No difference in ectopic fat storage was observed between the low and normal birth weight groups, with or without adjustment for age and total fat percentage. Homeostatic model assessment of insulin resistance values were not associated with hepatic cellular, intramyocellular or extramyocellular lipid content in any of the groups. Total fat percentage was the only independent predictor of intramyocellular and extramyocellular lipid content. CONCLUSION: Young and lean men from rural India with low birth weight were not observed to have ectopic fat storage in the liver or muscle, and the amount of liver and muscle fat was unrelated to insulin resistance. Older age and/or an urban affluent lifestyle may be required to show a potential role of ectopic fat storage on insulin resistance in Indian people with low or normal birth weight.

Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults.

Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with children (<5 years) residing in two semi-urban slums and three villages were visited weekly for 12-18 months to monitor gastrointestinal morbidity. Households were surveyed at baseline to obtain information on environmental and behavioural factors relevant to diarrhoea. There were 258 diarrhoeal episodes during the follow-up period, resulting in an overall incidence rate of 0·12 episodes/person-year. Incidence and longitudinal prevalence rates of diarrhoea were twofold higher in the slums compared to rural communities (P < 0·0002). Regardless of study site, diarrhoeal incidence was highest in infants (<1 year) at 1·07 episodes/person-year, and decreased gradually with increasing age. Increasing diarrhoeal rates were associated with presence of children (<5 years), domesticated animals and low socioeconomic status. In rural communities, open-field defecation was associated with diarrhoea in young children. This study demonstrates the contribution of site-specific environmental and behavioural factors in influencing endemic rates of urban and rural diarrhoea in a region with highly contaminated drinking water.

Quality of life among people with epilepsy: a cross-sectional study from rural southern India.

BACKGROUND: Epilepsy can be associated with profound physical, social and psychological consequences and it has an impact on a person's quality of life. We assessed the quality of life and factors associated with a poor quality of life, among adults with epilepsy in a rural block of Tamil Nadu. METHODS: We interviewed 91 epilepsy patients from 20 randomly selected villages using a structured questionnaire including World Health Organization Quality of Life BREF (WHOQOL-BREF), Patient Health Questionnaire 2 (PHQ-2) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires. RESULTS: The mean (SD) total score of the quality of life scale was 61.49 (12.56). Those who were single, separated or widowed (t statistic= -2.71, p<0.01), had not completed primary education (t statistic=-2.308, p<0.05), not currently going for work (t statistic=-2.748, p<0.01), had seizure in the past one year (t statistic=-4.068, p<0.01),had depressive symptoms (t statistic=-3.207, p<0.01),had higher anxiety scores (t statistic=-2.727, p<0.01), had low scores in the quality of life questionnaire. Multivariate analysis showed increasing age, education less than grade V, being unmarried, widowed or separated, lower per capita income, a high anxiety score and experiencing a seizure episode in the past one year to be significantly associated with a low score in the WHOQOL-BREF questionnaire (adjusted R²=0.378, SE 9.90). CONCLUSION: The presence of anxiety, lack of primary education, being single, separated or widowed, increasing age, low per capita income and having a seizure episode in the past year are associated with lower quality of life among people with epilepsy.

Changes in knowledge and practices related to taeniasis/cysticercosis after health education in a south Indian community.

A health education programme for taeniasis/cysticercosis was implemented and evaluated among schoolchildren and the general community in a rural block in southern India, an area that is endemic for cysticercosis. The baseline survey among 831 participants from three randomly selected villages showed poor knowledge regarding the spread of taeniasis and neurocysticercosis. There was also a lack of adequate hygiene and sanitation practices. Health education was given in these villages and in the schools located in these villages regarding the lifecycle of the pork tapeworm, spread of taeniasis and cysticercosis, and prevention of these conditions. The post-intervention test conducted 6 months later among 1060 participants revealed a 46% increase in the overall score of knowledge and practices. Awareness about the mode of spread of taeniasis and cysticercosis improved by almost 3 times and the reported practice of washing hands with soap and water before eating improved by 4.8 times and after using the toilet by 3.6 times. One person who reported the passage of tapeworm segments was confirmed to be a carrier of Taenia solium and was treated. The health education given on prevention of taeniasis and cysticercosis was useful in improving the knowledge and practices of the community and also in diagnosing taeniasis through self-reporting.

Antioxidant, antihyperlipidaemic and antidiabetic activity of eugenia floccosa bedd leaves in alloxan induced diabetic rats.

The ethanol extract of Eugenia floccosa Bedd (Family: Myrtaceae) leaf was investigated for its antioxidant, antihyperlipidaemic and antidiabetic effect in Wistar Albino rats. Diabetes was induced in Albino rats by administration of alloxan monohydrate (150mg/kg, i.p). The ethanol extracts of E. floccosa at a dose of 150 and 300mg/kg of body weight were administered at single dose per day to diabetes induced rats for a period of 14 days. The effect of ethanol extract of E. floccosa leaf extract on blood glucose, plasma insulin, creatinine, glycosylated haemoglobin, urea serum lipid profile [total cholesterol (TR), triglycerides (TG), low density lipoprotein - cholesterol (LDL-C), very low density lipoprotein - cholesterol (VLDL-C), high density lipoprotein - cholesterol (HDL-C) and phospholipid (PL)] serum protein, albumin, globulin, serum enzymes [serum glutamate pyruvate transaminases (SGPT) and serum glutamate oxaloacetate transaminases (SGOT), and alkaline phosphatase (ALP)], lipoprotein peroxidation (LPO) antioxidant enzymes (catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH) and glutathione peroxidase (GPx) were measured in the diabetic rats. The ethanol extract of Eugenia floccosa leaf elicited significant reductions of blood glucose (P<0.05), lipid parameters except HDL-C, serum enzymes and significantly increased HDL-C and antioxidant enzymes. The extracts also caused significant increase in plasma insulin (P<0.05) in the diabetic rats. From the above results, it is concluded that ethanol extract of Eugenia floccosa possesses significant antidiabetic, antihyperlipidaemic and antioxidant effects in alloxan induced diabetic rats.

Household food security in urban Tamil Nadu: a survey in Vellore.

BACKGROUND: Food security has been a matter of concern in recent years due to the global food crisis and rising food prices. We aimed to study the level of food security in a densely populated urban area in southern India. METHODS: A door-to-door survey of 130 households in an urban area in Vellore district, Tamil Nadu was done and information on food security status was collected using the United States Department of Agriculture Household Food Security Scale, on socioeconomic status using the modified Kuppuswamy scale and demographic details. RESULTS: Of the 130 households surveyed, food insecurity with hunger was present in 61.5% (95% CI 52.98%-70.02%), food insecurity without hunger in 13.1% (95% CI 7.2%-19%) and food security in 25.4% (95% CI 17.8%-33%) of the households. Prevalence of any form of food insecurity was present in three-fourths of the households (74.6%; 95% CI 67%-82.2%). Only 76 (58.5%) households used the public distribution system for buying rice-the staple food, and 63 (82.9%) households in the lower socioeconomic strata used the public distribution system for buying rice. CONCLUSIONS: Despite good penetration of the public distribution system in Tamil Nadu, the prevalence of food insecurity in urban areas is high. Nationwide and regional urban-rural food security data need to be studied to influence policy regarding the means to reduce food insecurity in India.

Chemical composition of certain tribal pulses in South India.

Raw seeds of tribal pulses Atylosia scarabaeoides, Canavalia gladiata, Lablab purpureus var. lignosus, Neonotonia wightii var. coimbatorensis, Rhynchosia filipes, Vigna trilobata and Vigna unguiculata subsp. unguiculata were investigated for their proximate composition, minerals, vitamins (niacin and ascorbic acid) and certain anti-nutritional substances. The seeds of L. purpureus var. lignosus and V. trilobata had a higher content of crude protein than the commonly consumed Indian pulses. The seeds were found to be a rich source of minerals like potassium when compared with recommended dietary allowance values. The total free phenolics, tannins, 3,4-dihydroxyphenylalanine and hydrogen cyanide were also analysed.

Chemical and nutritional evaluation of two germplasms of the tribal pulse, Bauhinia racemosa Lamk.

Two germplasms of the tribal pulse, Bauhinia racemosa Lamk. viz., Ayyanarkoil Forest and Mundanthurai Wildlife Sanctuary, were analysed for proximate composition, total (true) seed proteins, seed protein fractions, amino acid composition, fatty acids, minerals and antinutritional factors. Crude proteins, crude lipids, ash and nitrogen free extractives constituted 19.84%, 9.52%, 3.31% and 60.65%, respectively in Ayyanarkoil Forest germplasm; whereas, in Mundanthurai Wildlife Sanctuary germplasm they constituted 19.31%, 8.94%, 3.81% and 61.30%, respectively. The caloric values were found to be 407.64 KCal (Ayyanarkoil Forest) and 402.90 KCal (Mundanthurai Wildlife Sanctuary) germplasms. Essential amino acids like isoleucine, tyrosine, phenylalanine and lysine were found to be high in the seed proteins of both the germplasms. The fatty acids, palmitic, oleic and linoleic acids, were found to be relatively higher in the seed lipids of both the germplasms. Both the germplasms seemed to be a rich source of calcium, potassium, magnesium, zinc, manganese and iron. Antinutritional substances like total free phenols, tannins, L-DOPA and phytohaemagglutinating activity also were investigated.