Strategies for primary HPV test-based cervical cancer screening programme in resource-limited settings in India: Results from a quasi-experimental pragmatic implementation trial.

BACKGROUND: In order for low and middle income countries (LMIC) to transition to Human Papilloma Virus (HPV) test based cervical cancer screening, a greater understanding of how to implement these evidence based interventions (EBI) among vulnerable populations is needed. This paper documents outcomes of an implementation research on HPV screening among women from tribal, rural, urban slum settings in India. METHODS: A mixed-method, pragmatic, quasi-experimental trial design was used. HPV screening on self-collected cervical samples was offered to women aged 30-60 years. Implementation strategies were 1) Assessment of contextual factors using both qualitative and quantitative methods like key informant interviews (KII), focus group discussions (FGDs), pre-post population sample surveys, capacity assessment of participating departments 2) enhancing provider capacity through training workshops, access to HPV testing facility, colposcopy, thermal ablation/cryotherapy at the primary health care centers 3) community engagement, counselling for self-sampling and triage process by frontline health care workers (HCWs). Outcomes were assessed using the RE-AIM (Reach, Effectiveness, adoption, implementation, maintenance) framework. RESULTS: Screening rate in 8 months' of study was 31.0%, 26.7%, 32.9%, prevalence of oncogenic HPV was 12.1%, 3.1%, 5.5%, compliance to triage was 53.6%, 45.5%, 84.6% in tribal, urban slum, rural sites respectively. Pre-cancer among triage compliant HPV positive women was 13.6% in tribal, 4% in rural and 0% among urban slum women. Unique challenges faced in the tribal setting led to programme adaptations like increasing honoraria of community health workers for late-evening work and recalling HPV positive women for colposcopy by nurses, thermal ablation by gynaecologist at the outreach camp site. CONCLUSIONS: Self-collection of samples combined with HCW led community engagement activities, flexible triage processes and strengthening of health system showed an acceptable screening rate and better compliance to triage, highlighting the importance of identifying the barriers and developing strategies suitable for the setting. TRIAL REGISTRATION: CTRI/2021/09/036130.

Plant Stomata: An Unrealized Possibility in Plant Defense against Invading Pathogens and Stress Tolerance.

Stomata are crucial structures in plants that play a primary role in the infection process during a pathogen's attack, as they act as points of access for invading pathogens to enter host tissues. Recent evidence has revealed that stomata are integral to the plant defense system and can actively impede invading pathogens by triggering plant defense responses. Stomata interact with diverse pathogen virulence factors, granting them the capacity to influence plant susceptibility and resistance. Moreover, recent studies focusing on the environmental and microbial regulation of stomatal closure and opening have shed light on the epidemiology of bacterial diseases in plants. Bacteria and fungi can induce stomatal closure using pathogen-associated molecular patterns (PAMPs), effectively preventing entry through these openings and positioning stomata as a critical component of the plant's innate immune system; however, despite this defense mechanism, some microorganisms have evolved strategies to overcome stomatal protection. Interestingly, recent research supports the hypothesis that stomatal closure caused by PAMPs may function as a more robust barrier against pathogen infection than previously believed. On the other hand, plant stomatal closure is also regulated by factors such as abscisic acid and Ca2+-permeable channels, which will also be discussed in this review. Therefore, this review aims to discuss various roles of stomata during biotic and abiotic stress, such as insects and water stress, and with specific context to pathogens and their strategies for evading stomatal defense, subverting plant resistance, and overcoming challenges faced by infectious propagules. These pathogens must navigate specific plant tissues and counteract various constitutive and inducible resistance mechanisms, making the role of stomata in plant defense an essential area of study.

Soil organic carbon and labile and recalcitrant carbon fractions attributed by contrasting tillage and cropping systems in old and recent alluvial soils of subtropical eastern India.

Conservation agriculture-based sustainable intensification (CASI) technologies comprising zero-tillage with crop residue retention (>30%) on the soil surface, diversified cropping systems, and balanced nutrient management are recognized as operative and efficacious strategies to ensure food security in the parts of South Asia. The present investigation was a component of CASI technologies undertaken in the farmers' field of Malda (old alluvial Inceptisol) Coochbehar (recent alluvial Entisol) district, West Bengal (subtropical eastern India). This study was conducted to evaluate the short-term impact of contrasting tillage (zero and conventional) and cropping systems (rice-wheat and rice-maize) on total organic carbon (TOC) and its fractions, viz., labile pool-1 (LP1), labile pool-2 (LP2) and recalcitrant carbon (RC) fractions after 4-year trial of conservation agriculture (CA) in the old and recent alluvial soils. Soil samples were collected from three depths (0-5, 5-10, and 10-20 cm), and thus, our study was focused on two factors, viz., cropping system and tillage. Results pointed that TOC along with LP1, LP2, and RC fractions under rice-maize (RM) cropping system were significantly (p<0.05) greater (15-35%) over rice-wheat (RW) system as a result of higher residue biomass addition. Zero-tillage (ZT) improved the C fractions by 10-20% over conventional tillage (CT) in all aspects. TOC and its fractions were observed to be greater under the ZT system in the topmost soil depths (0-5 and 5-10 cm), but the same system failed to improve these at 10-20 cm. Interestingly, the CT increased all the fractions at 10-20 cm depth due to the incorporation of crop residues. The concentration of TOC along with its fractions decreased with increasing soil depth was evident. Comparatively, all the C fractions, including TOC were maximum in soils from Malda sites as compared to Coochbehar sites because of a higher amount of residue biomass application, higher clay content, and greater background content of C in these soils. All the studied C fractions showed a significant correlation (r = >0.635; p<0.01) with TOC among all the soil depths in both the districts but the relationship with soil texture showed some interesting results. TOC fractions were significantly correlated (p<0.01) with clay particles indicating that its higher stabilization with clay in old alluvial Inceptisol (Malda); while in recent alluvial Entisol (Coochbehar), sand particle showed its strong relation with TOC fractions. Higher stratification ratio (SR) in the ZT system suggested that the concentration of TOC and its fractions are confined to the upper soil layers whereas in the case of CT, by and large, the distribution of these was comparatively high in subsequent soil depths due to residue incorporation effect. The concentration of C fractions in soils followed the order: TOC > RC > LP2 > LP1. The present investigation concluded that ZT under the RM system increases the turnover rates of C in both soil types but the amount of clay influences the stabilization/storage of C.

Anaemia among schoolchildren from southern Kerala, India: A cross-sectional study.

BACKGROUND: Iron deficiency anaemia remains a major nutritional problem among adolescents in India. The weekly iron and folic acid supplementation programme was launched in Kerala in 2013-14. We aimed to estimate the prevalence of anaemia among schoolchildren in Kollam district, Kerala and determine the associated factors. METHODS: The haemoglobin level of 1600 boys and 1600 girls belonging to class V to IX in 32 randomly selected schools in Kollam district was measured using HemoCue 301 photometers by trained nurses. They also recorded details about the intake of food as well as iron tablets by the students. The anaemia status was evaluated as per the WHO guidelines. Univariate analysis for factors associated with anaemia was done and selected variables were entered into a logistic regression model. RESULTS: The prevalence of anaemia among the students was estimated to be 31.4% (95% CI 29.76-33.04). About 1% had severe, 11.9% had moderate and 18.5% had mild anaemia. Among them 35.3%, 22.3% and 45.3% reported that they were not in the habit of consuming meat, green leafy vegetables and citrus fruits, respectively, at least once a week. Anaemia among schoolgoing children was associated with irregular consumption of weekly iron folic acid supplementation tablets (adjusted OR 1.39, 95% CI 1.08-1.82) and regular intake of tea/coffee along with major meals (adjusted OR 1.41, 95% CI 1.21-1.66). CONCLUSION: Anaemia among schoolgoing adolescents in Kollam district is a public health problem and is more among those who consumed less quantities of weekly iron and folic acid supplementation tablets and those who regularly consumed tea/coffee along with major meals. It may be helpful to introduce a comprehensive school health anaemia prevention package with effective behaviour change communication for dietary modification as well as strategies to improve the coverage of the iron and folic acid supplementation programme along with its monitoring and evaluation.

Single Stage Transanal Pull-Through for Hirschsprung's Disease in Neonates: Our Early Experience.

OBJECTIVE: Hirschsprung's disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung's disease. In this study, we present our early experience with single stage transanal pull through in neonates. DESIGN: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung's disease in our institute from January 2011 to January 2013. MATERIAL AND METHOD: Five newborn boys who presented with Hirschsprung's disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years. RESULTS: Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range - 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range - 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series. CONCLUSION: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.

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.