Effectiveness of nanosilver fluoride in arresting dental caries in children with one- year follow-up - a systematic review.

OBJECTIVE: This systematic review assesses the effectiveness of nanosilver fluoride in arresting dental caries in children, with one-year follow-up. METHODOLOGY: Multiple databases were searched for RCTs (randomized controlled trials) according to specified inclusion-exclusion criteria. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) reporting guidelines were followed to conduct the systematic review. Nanosilver fluoride was compared against silver diamine fluoride varnish or topical fluoride varnish or placebo. The primary outcome was effectiveness in arresting dental caries. The Cochrane risk of bias tool was used to assess the risk of bias. DATA SOURCES: Articles were searched in the following databases: PubMed, Ovid, Web of Science, Wiley Online, Proquest and Cinahl. DATA SELECTION: The initial search yielded a total of 3660 hits. After deduplication, a total of 2507 articles were obtained. After screening the title and abstract, 11 studies were included. After the full-text screening, a total of three articles that fulfilled the eligibility criteria were included in the analyses. DATA EXTRACTION AND DATA SYNTHESIS: All the three studies were RCTs carried out in school children, and involved application of the material in primary teeth with a follow-up of one year. RESULTS: In two studies, nanosilver fluoride varnish group showed significantly higher arrest of dental caries compared to placebo group. In the study comparing nanosilver fluoride and silver diamine, both the groups showed arrest of dental caries and there was no significant difference between the groups. One study showed high risk of bias for allocation concealment. CONCLUSION: The included studies in the final review effectively demonstrated the benefit of using nanosilver fluoride in the arrest of dental caries.

Fortification of condiments and seasonings with iron for preventing anaemia and improving health.

BACKGROUND: Anaemia affects approximately 1.8 billion people worldwide; over 60% of anaemia cases globally are due to iron deficiency (ID). Iron deficiency and anaemia contribute to the global burden of disease and affect physical and cognitive development in children, and work productivity and economic well-being in adults. Fortification of food with iron, alone or in combination with other nutrients, is an effective intervention to control ID. Condiments and seasonings are ideal food vehicles for iron fortification in countries where they are commonly used. OBJECTIVES: To determine the effects and safety of condiment and seasoning fortification with iron alone or iron plus other micronutrients on iron deficiency, anaemia, and health-related outcomes in the general population. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and other databases up to 24 January 2023. We also searched the International clinical trials registry platform (ICTRP) for any ongoing trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (randomisation at individual or cluster level), non-randomised controlled trials, interrupted time series with at least three measure points both before and after intervention, and controlled before-after studies. Participants were populations of any age (including pregnant women), from any country, excluding those with critical illness or severe co-morbidities. We included interventions in which condiments or seasonings have been fortified with any combination of iron and other vitamins and minerals, irrespective of the fortification technology used. DATA COLLECTION AND ANALYSIS: Two review authors independently screened and assessed the eligibility of studies. Disagreements were resolved through discussion or input from a third review author. Two review authors extracted the data and assessed the risk of bias in all the included studies. We followed the methods laid out by Cochrane and used GRADE criteria for assessing certainty of the evidence. MAIN RESULTS: Our search identified 15,902 records after removal of duplicates. We included 16 studies with 20,512 participants (18,410 participants after adjusting for clustering effects). They were all carried out in upper-middle- and lower-middle-income countries. Three studies were controlled before-after studies, one was non-randomised trial, and 12 were RCTs (including three cluster RCTs). Six studies took place in schools; seven in communities; and one each in a nursery/kindergarten, tea estate, and factory. Three studies involved only women, one study involved both women and their children, and all other studies focused on children and/or adolescents. Nine studies used salt as a vehicle for iron fortification, three used fish sauce, two used soy sauce, one used curry powder, and one a "seasoning powder". The dose of iron received by participants ranged from 4.4 mg to 55 mg/day. The sample sizes in the trials ranged from 123 to 14,398, and study durations ranged from three months to two years. Twelve RCTs contributed data for meta-analysis. Six trials compared iron-fortified condiments versus the unfortified condiment, and six trials provided data comparing iron fortification in combination with other micronutrients versus the same condiment with other micronutrients, but no added iron. In one trial, the fortificant contained micronutrients that may have affected the absorption of iron. Overall no studies were assessed as having a low risk of bias. All included studies were assessed to have a high overall risk of bias, with the most concerns being around allocation concealment, blinding, and random sequence generation. There was very high heterogeneity amongst studies in almost all examined outcomes. Condiments/seasonings fortified with iron versus unfortified condiments/seasonings We are uncertain about whether consuming condiments/seasonings fortified with iron in comparison to the same unfortified condiment reduces anaemia at the end of intervention (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.18 to 0.65; 2328 participants; 4 studies; very low-certainty of evidence). We are uncertain about whether consuming iron-fortified condiments increases haemoglobin concentrations (mean difference (MD) 6.40 (g/L), 95% CI -0.62 to 13.41; 2808 participants; 5 studies; very low-certainty evidence). Fortification of condiments/seasonings with iron probably slightly reduces ID (RR 0.33, 95% CI 0.11 to 1.01; 391 participants; 2 studies; moderate-certainty evidence). We are uncertain about whether fortification with iron increases ferritin concentration (MD 14.81 (µg/L), 95% CI 5.14 to 24.48; 4459 participants; 6 studies; very low-certainty evidence). Condiments/seasonings fortified with iron plus other micronutrients versus condiments/seasonings fortified with other micronutrients except iron Consuming condiments/seasonings fortified with iron plus other micronutrients may reduce anaemia (RR 0.59, 95% CI 0.40 to 0.89; 1007 participants; 4 studies; low-certainty evidence). We are uncertain about whether fortification of condiments/seasonings with iron plus other micronutrients will improve haemoglobin concentration (MD 6.22 g/dL, 95% CI 1.60 to 10.83; 1270 participants; 5 studies; very low-certainty evidence). It may reduce ID (RR 0.36, 95% CI 0.19 to 0.69; 1154 participants; 4 studies; low-certainty evidence). We are uncertain about whether fortification with iron plus other micronutrients improves ferritin concentration (MD 10.63 µg/L, 95% CI 2.40 to 18.85; 1251 participants; 5 studies; very low -certainty evidence). Condiments/seasonings fortified with iron versus no intervention No trial reported data on this comparison. No studies reported adverse effects. Funding sources do not appear to have distorted the results in any of the assessed trials. AUTHORS' CONCLUSIONS: We are uncertain whether consuming iron-fortified condiments/seasonings reduces anaemia, improves haemoglobin concentration, or improves ferritin concentration. It may reduce ID. Findings about ferritin should be interpreted with caution since its concentrations increase during inflammation. Consuming condiments/seasonings fortified with iron plus other micronutrients may reduce anaemia, and we are uncertain whether this will improve haemoglobin concentration or ferritin concentration. More studies are needed to determine the true effect of iron-fortified condiments/seasonings on preventing anaemia and improving health. The effects of this intervention on other health outcomes like malaria incidence, growth and development are unclear.

ANTECEDENTES: La anemia afecta aproximadamente a 1800 millones de personas en todo el mundo; más del 60% de los casos de anemia en el mundo se deben a la deficiencia de hierro (DH). La deficiencia de hierro y la anemia contribuyen a la carga mundial de morbilidad y afectan al desarrollo físico y cognitivo de los niños, así como a la productividad laboral y el bienestar económico de los adultos. El enriquecimiento de los alimentos con hierro, solo o en combinación con otros nutrientes, es una intervención eficaz para controlar la DH. Los condimentos y sazonadores son vehículos alimentarios ideales para el enriquecimiento con hierro en los países donde se utilizan habitualmente. OBJETIVOS: Determinar los efectos y la seguridad del enriquecimiento de condimentos y aderezos con hierro solo o hierro más otros micronutrientes sobre la deficiencia de hierro, la anemia y los desenlaces relacionados con la salud en la población general. MÉTODOS DE BÚSQUEDA: Se realizaron búsquedas en CENTRAL, MEDLINE, Embase, CINAHL y otras bases de datos hasta el 24 de enero de 2023. También se realizaron búsquedas de ensayos en curso en la Plataforma de registros internacionales de ensayos clínicos (ICTRP). CRITERIOS DE SELECCIÓN: Se incluyeron ensayos controlados aleatorizados (ECA) (asignación aleatoria a nivel individual o grupal), ensayos controlados no aleatorizados, series temporales interrumpidas con al menos tres puntos de medición tanto antes como después de la intervención, y estudios controlados del tipo antes­después. Los participantes fueron poblaciones de cualquier edad (incluidas mujeres embarazadas), de cualquier país, excluidos aquellos con enfermedades críticas o comorbilidades graves. Se incluyeron las intervenciones en las que los condimentos o sazonadores se han enriquecido con cualquier combinación de hierro y otras vitaminas y minerales, independientemente de la tecnología de enriquecimiento utilizada. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión seleccionaron y evaluaron de forma independiente la elegibilidad de los estudios. Los desacuerdos se resolvieron mediante debate o aporte de material de un tercer autor de la revisión. Dos autores de la revisión extrajeron los datos y evaluaron el riesgo de sesgo en todos los estudios incluidos. Se siguieron los métodos establecidos por Cochrane y se utilizó el método GRADE para evaluar la certeza de la evidencia. RESULTADOS PRINCIPALES: La búsqueda identificó 15 902 registros tras eliminar los duplicados. Se incluyeron 16 estudios con 20 512 participantes (18 410 participantes después de ajustar los efectos del conglomerado). Todos ellos se llevaron a cabo en países de ingresos medios­bajos y medios­altos. Tres estudios fueron controlados del tipo antes­después, uno fue un ensayo no aleatorio y 12 fueron ECA (incluidos tres ECA grupales). Seis estudios tuvieron lugar en escuelas, siete en comunidades y uno en una guardería, uno en una plantación de té y uno en una fábrica. En tres estudios participaron solo mujeres, en un estudio participaron tanto mujeres como sus hijos, y todos los demás estudios se centraron en niños y/o adolescentes. Nueve estudios utilizaron la sal como vehículo para el enriquecimiento con hierro, tres la salsa de pescado, dos la salsa de soja, uno el curry en polvo y otro un "sazonador en polvo". La dosis de hierro recibida por los participantes osciló entre 4,4 mg y 55 mg/día. El tamaño muestral de los ensayos osciló entre 123 y 14 398, y la duración de los estudios, entre tres meses y dos años. Doce ECA aportaron datos para el metanálisis. Seis ensayos compararon condimentos enriquecidos con hierro versus el condimento no enriquecido, y seis ensayos proporcionaron datos que comparaban el enriquecimiento con hierro en combinación con otros micronutrientes versus el mismo condimento con otros micronutrientes, pero sin hierro agregado. En un ensayo, el fortificante contenía micronutrientes que podrían haber afectado la absorción del hierro. En general, no se evaluó ningún estudio como de riesgo de sesgo bajo. Se evaluó que todos los estudios incluidos tenían un riesgo de sesgo general alto, y las mayores preocupaciones se centraron en la ocultación de la asignación, el cegamiento y la generación de secuencias al azar. Hubo una heterogeneidad muy alta entre los estudios en casi todos los desenlaces examinados. Condimentos/sazonadores enriquecidos con hierro versus condimentos/sazonadores no enriquecidos Es incierto si el consumo de condimentos/sazonadores enriquecidos con hierro en comparación con el mismo condimento no enriquecido reduce la anemia al finalizar la intervención (razón de riesgos [RR] 0,34; intervalo de confianza [IC] del 95%: 0,18 a 0,65; 2328 participantes; cuatro estudios; evidencia de certeza muy baja). Es incierto si el consumo de condimentos enriquecidos con hierro aumenta las concentraciones de hemoglobina (diferencia de medias [DM] 6,40 g/l; IC del 95%: ­0,62 a 13,41; 2808 participantes; cinco estudios; evidencia de certeza muy baja). El enriquecimiento de condimentos/sazonadores con hierro probablemente reduce ligeramente la DH (RR 0,33; IC del 95%: 0,11 a 1,01; 391 participantes; dos estudios; evidencia de certeza moderada). Es incierto si el enriquecimiento con hierro aumenta la concentración de ferritina (DM 14,81 µg/L; IC del 95%: 5,14 a 24,48; 4459 participantes; seis estudios; evidencia de certeza muy baja). Condimentos/sazonadores enriquecidos con hierro y otros micronutrientes versus condimentos/sazonadores enriquecidos con otros micronutrientes excepto hierro El consumo de condimentos/sazonadores enriquecidos con hierro más otros micronutrientes podría reducir la anemia (RR 0,59; IC del 95%: 0,40 a 0,89; 1007 participantes; cuatro estudios; evidencia de certeza baja). Es incierto si el enriquecimiento de condimentos/sazonadores con hierro más otros micronutrientes mejorará la concentración de hemoglobina (DM 6,22 g/dL; IC del 95%: 1,60 a 10,83; 1270 participantes; cinco estudios; evidencia de certeza muy baja). Podría reducir la DH (RR 0,36; IC del 95%: 0,19 a 0,69; 1154 participantes; cuatro estudios; evidencia de certeza baja). Es incierto si el enriquecimiento con hierro más otros micronutrientes mejora la concentración de ferritina (DM 10,63 µg/L; IC del 95%: 2,40 a 18,85; 1251 participantes; cinco estudios; evidencia de certeza muy baja). Condimentos/sazonadores enriquecidos con hierro versus ninguna intervención Ningún ensayo informó datos sobre esta comparación. Ningún estudio informó efectos adversos. Las fuentes de financiación no parecen haber distorsionado los resultados en ninguno de los ensayos evaluados. CONCLUSIONES DE LOS AUTORES: Es incierto si el consumo de condimentos/sazonadores enriquecidos con hierro reduce la anemia, mejora la concentración de hemoglobina o mejora la concentración de ferritina. Podría reducir la DH. Los resultados sobre la ferritina deben interpretarse con cautela, ya que sus concentraciones aumentan durante la inflamación. El consumo de condimentos/sazonadores enriquecidos con hierro más otros micronutrientes podría reducir la anemia, y no se sabe con certeza si mejorará la concentración de hemoglobina o de ferritina. Se necesitan más estudios para determinar el verdadero efecto de los condimentos/sazonadores enriquecidos con hierro en la prevención de la anemia y la mejora de la salud. Los efectos de esta intervención en otros desenlaces sanitarios como la incidencia del paludismo, el crecimiento y el desarrollo son inciertos.

Paternal perspectives towards infant and young child feeding (IYCF): a qualitative analysis from Coastal South India.

BACKGROUND: The infant and young child feeding practices (IYCF) decide child growth and well-being. Paternal perspectives and involvement in IYCF are of paramount importance and are grossly under-studied. AIMS: To study the experiences and opinions of fathers of infants and young children towards feeding practices. SETTINGS AND DESIGN: Two focus group discussions (FGD) were carried out in the community settings in Dakshina Kannada District, Karnataka State. METHODS AND MATERIAL: FGDs were carried out in the areas of two selected primary health centres. FGD guide was used and the discussions were audio recorded. Themes were derived from the transcript. RESULTS: Four main themes were generated from the transcripts of two FGDs. Lack of time to involve in child feeding, lack of felt need for increased involvement, sense of being complete in providing paternal care and readiness to learn were the generated themes. All participating fathers had favourable attitudes towards learning more about IYCF. CONCLUSIONS: Lack of time felt need for higher paternal involvement in IYCF and sense of being complete in providing paternal care were the themes extracted, along with favourable attitude towards increasing their involvement in IYCF.

Improving Underweight Mothers' Essential Newborn Care During Early Infancy: A Single-Blinded, Parallel-Randomized, Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of using a standardized Essential Newborn Care (ENC) module taught by pediatric residents on ENC skills and growth of offspring born to underweight primigravida mothers. STUDY DESIGN: This facility-based, single-blinded, parallel, randomized controlled trial was conducted between May 2018 and March 2019. Eighty-eight underweight primigravida mothers and their vaginally delivered offspring were blindly allocated into the intervention group (IG) or control group (CG). The IG mothers received education on ENC through pictorial aids, demonstrations, and practice sessions. All mothers received information from ongoing public health programs. A trained hospital nurse, blinded to the study, assessed the mothers' neonatal care skills on the second postnatal day. The infants were followed until 6 months. Weight, length, and head circumference were measured at birth and age 6 weeks, 10 weeks, 14 weeks, and 6 months (±1 week). RESULTS: Mothers in the IG had significantly better ENC skills in all domains (P < .001). Their infants had a statistically significant increase in weight (at 10 and 14 weeks and 6 months), length (at 14 weeks and 6 months), and head circumference (at 6 months). Infants' z-scores indicated significant improvements in anthropometry in the IG compared with the CG. At age 6 months, the number of infants with weight <3rd percentile decreased in the IG (from 20 of 44 to 5 of 41) and increased in the CG (from 17 of 44 to 22 of 42) compared with birth percentiles. CONCLUSIONS: An educational intervention to strengthen maternal ENC knowledge and skills soon after delivery improved physical growth in infants born to underweight primigravida mothers. TRIAL REGISTRATION: Clinical Trials Registry-India: CTRI/2018/04/013096.

Perceptions of teachers towards COVID appropriate behaviors for school children in coastal South India.

COVID appropriate behavioral measures need to be followed once school reopens. School teachers being in the forefront could substantiate the feasibility of suggested safety measures. This study aimed to assess teachers' perceptions towards COVID appropriate behaviors for children with school reopening and compare their mean scores between public versus private schools and across school boards. We conducted an observational school-based study of teachers over two months. Perceptions were scored using a five-point Likert symmetric agree to disagree scale. Results were expressed as proportions and analyzed using an independent sample t-test. Of the 547 teachers surveyed, most (> 90%) agreed to the suggested social distancing and hygiene measures. There was a significant difference in perception scores between private versus public schools and across boards regarding i) reducing the academic syllabus, ii) adopting a cloud-based system to integrate online-offline learning, and iii) conducting meetings online. In addition, measures such as i) teaching classes on alternate days with a limited number of children, ii) arranging benches/desks to maintain six feet distance between students, iii) dealing with psychological stress by counselors, and iv) arrangement with local hospitals for medical services were significant statistically across school boards. To conclude, most schoolteachers agreed with the need for social distancing and hygiene measures for children. There was a significant difference in perceptions between public versus private schools and across boards regarding academic syllabus, integration of online-offline student learning, number of children per class, the timing of classes, student seating arrangement, and medical/psychological guidance availability.

Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations.

BACKGROUND: Anaemia is a condition where the number of red blood cells (and consequently their oxygen-carrying capacity) is insufficient to meet the body's physiological needs. Fortification of wheat flour is deemed a useful strategy to reduce anaemia in populations. OBJECTIVES: To determine the benefits and harms of wheat flour fortification with iron alone or with other vitamins and minerals on anaemia, iron status and health-related outcomes in populations over two years of age. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, 21 other databases and two trials registers up to 21 July 2020, together with contacting key organisations to identify additional studies. SELECTION CRITERIA: We included cluster- or individually-randomised controlled trials (RCTs) carried out among the general population from any country, aged two years and above. The interventions were fortification of wheat flour with iron alone or in combination with other micronutrients. We included trials comparing any type of food item prepared from flour fortified with iron of any variety of wheat DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results and assessed the eligibility of studies for inclusion, extracted data from included studies and assessed risks of bias. We followed Cochrane methods in this review. MAIN RESULTS: Our search identified 3538 records, after removing duplicates. We included 10 trials, involving 3319 participants, carried out in Bangladesh, Brazil, India, Kuwait, Philippines, South Africa and Sri Lanka. We identified two ongoing studies and one study is awaiting classification. The duration of interventions varied from 3 to 24 months. One study was carried out among adult women and one trial among both children and nonpregnant women. Most of the included trials were assessed as low or unclear risk of bias for key elements of selection, performance or reporting bias. Three trials used 41 mg to 60 mg iron/kg flour, three trials used less than 40 mg iron/kg and three trials used more than 60 mg iron/kg flour. One trial used various iron levels based on type of iron used: 80 mg/kg for electrolytic and reduced iron and 40 mg/kg for ferrous fumarate. All included studies contributed data for the meta-analyses. Iron-fortified wheat flour with or without other micronutrients added versus wheat flour (no added iron) with the same other micronutrients added Iron-fortified wheat flour with or without other micronutrients added versus wheat flour (no added iron) with the same other micronutrients added may reduce by 27% the risk of anaemia in populations (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.55 to 0.97; 5 studies, 2315 participants; low-certainty evidence). It is uncertain whether iron-fortified wheat flour with or without other micronutrients reduces iron deficiency (RR 0.46, 95% CI 0.20 to 1.04; 3 studies, 748 participants; very low-certainty evidence) or increases haemoglobin concentrations (in g/L) (mean difference MD 2.75, 95% CI 0.71 to 4.80; 8 studies, 2831 participants; very low-certainty evidence). No trials reported data on adverse effects in children (including constipation, nausea, vomiting, heartburn or diarrhoea), except for risk of infection or inflammation at the individual level. The intervention probably makes little or no difference to the risk of Infection or inflammation at individual level as measured by C-reactive protein (CRP) (mean difference (MD) 0.04, 95% CI -0.02 to 0.11; 2 studies, 558 participants; moderate-certainty evidence). Iron-fortified wheat flour with other micronutrients added versus unfortified wheat flour (nil micronutrients added) It is unclear whether wheat flour fortified with iron, in combination with other micronutrients decreases anaemia (RR 0.77, 95% CI 0.41 to 1.46; 2 studies, 317 participants; very low-certainty evidence). The intervention probably reduces the risk of iron deficiency (RR 0.73, 95% CI 0.54 to 0.99; 3 studies, 382 participants; moderate-certainty evidence) and it is unclear whether it increases average haemoglobin concentrations (MD 2.53, 95% CI -0.39 to 5.45; 4 studies, 532 participants; very low-certainty evidence). No trials reported data on adverse effects in children. Nine out of 10 trials reported sources of funding, with most having multiple sources. Funding source does not appear to have distorted the results in any of the assessed trials. AUTHORS' CONCLUSIONS: Fortification of wheat flour with iron (in comparison to unfortified flour, or where both groups received the same other micronutrients) may reduce anaemia in the general population above two years of age, but its effects on other outcomes are uncertain. Iron-fortified wheat flour in combination with other micronutrients, in comparison with unfortified flour, probably reduces iron deficiency, but its effects on other outcomes are uncertain. None of the included trials reported data on adverse side effects except for risk of infection or inflammation at the individual level. The effects of this intervention on other health outcomes are unclear. Future studies at low risk of bias should aim to measure all important outcomes, and to further investigate which variants of fortification, including the role of other micronutrients as well as types of iron fortification, are more effective, and for whom.

Discriminant value of automated leucocyte VCS parameters in the detection of tropical infections.

INTRODUCTION: In India, infectious diseases are a leading treatable cause of morbidity and mortality. Mangalore being endemic to many vector-borne diseases, their incidence is known to show seasonal variations with sharp increase during monsoon. Leucocytes have substantial role in the immunological pathogenesis of infections. METHODS: The present series was a hospital-based cross-sectional study performed in a tertiary care hospital for a period of three months from June-August wherein the cell population data of cases of malaria, dengue, leptospirosis, typhoid and rickettsial infections along with equal number of healthy controls were collected and analysed. Effectiveness of leucocyte-related volume (V), conductivity (C) and scatter (S) parameters by Coulter®DXH800 haematology analyser in predicting these infections was appraised. RESULTS: A total of 324 cases comprising of malaria (50%), dengue (30.9%), leptospirosis (13.9%), typhoid (4.0%) and rickettsial infections (1.2%) were included. There was statistically significant differences (P < 0.05) in the mean values of complete blood count parameters-haemoglobin, total leucocyte count, red blood cell count, haematocrit, red cell distribution width, differential leucocyte count, platelet count and plateletcrit between cases and controls and also between specific infections. The mean volumes of neutrophil, monocyte and lymphocyte were considerably increased in malaria and dengue fever compared to leptospirosis, typhoid and rickettsial infections. VCS parameters were the least altered in typhoid fever, except for a strikingly high conductivity and scatter of eosinophils. CONCLUSIONS: Haematological analysis is a part of routine evaluation of any case of febrile illness. This study showed that there are specific alterations in VCS parameters in different types of infections such as malaria, dengue, leptospira, typhoid and rickettsia, the information and analysis of which comes without any additional cost.

Wheat flour fortification with iron for reducing anaemia and improving iron status in populations.

BACKGROUND: Anaemia is a condition where the number of red blood cells (and consequently their oxygen-carrying capacity) is insufficient to meet the body's physiologic needs. Fortification of wheat flour is deemed a useful strategy to reduce anaemia in populations. OBJECTIVES: To determine the benefits and harms of wheat flour fortification with iron alone or with other vitamins and minerals on anaemia, iron status and health-related outcomes in populations over two years of age. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and other databases up to 4 September 2019. SELECTION CRITERIA: We included cluster- or individually randomised controlled trials (RCT) carried out among the general population from any country aged two years and above. The interventions were fortification of wheat flour with iron alone or in combination with other micronutrients. Trials comparing any type of food item prepared from flour fortified with iron of any variety of wheat were included. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results and assessed the eligibility of studies for inclusion, extracted data from included studies and assessed risk of bias. We followed Cochrane methods in this review. MAIN RESULTS: Our search identified 3048 records, after removing duplicates. We included nine trials, involving 3166 participants, carried out in Bangladesh, Brazil, India, Kuwait, Phillipines, Sri Lanka and South Africa. The duration of interventions varied from 3 to 24 months. One study was carried out among adult women and one trial among both children and nonpregnant women. Most of the included trials were assessed as low or unclear risk of bias for key elements of selection, performance or reporting bias. Three trials used 41 mg to 60 mg iron/kg flour, two trials used less than 40 mg iron/kg and three trials used more than 60 mg iron/kg flour. One trial employed various iron levels based on type of iron used: 80 mg/kg for electrolytic and reduced iron and 40 mg/kg for ferrous fumarate. All included studies contributed data for the meta-analyses. Seven studies compared wheat flour fortified with iron alone versus unfortified wheat flour, three studies compared wheat flour fortified with iron in combination with other micronutrients versus unfortified wheat flour and two studies compared wheat flour fortified with iron in combination with other micronutrients versus fortified wheat flour with the same micronutrients (but not iron). No studies included a 'no intervention' comparison arm. None of the included trials reported any other adverse side effects (including constipation, nausea, vomiting, heartburn or diarrhoea). Wheat flour fortified with iron alone versus unfortified wheat flour (no micronutrients added) Wheat flour fortification with iron alone may have little or no effect on anaemia (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.61 to 1.07; 5 studies; 2200 participants; low-certainty evidence). It probably makes little or no difference on iron deficiency (RR 0.43, 95% CI 0.17 to 1.07; 3 studies; 633 participants; moderate-certainty evidence) and we are uncertain about whether wheat flour fortified with iron increases haemoglobin concentrations by an average 3.30 (g/L) (95% CI 0.86 to 5.74; 7 studies; 2355 participants; very low-certainty evidence). No trials reported data on adverse effects in children, except for risk of infection or inflammation at the individual level. The intervention probably makes little or no difference to risk of Infection or inflammation at individual level as measured by C-reactive protein (CRP) (moderate-certainty evidence). Wheat flour fortified with iron in combination with other micronutrients versus unfortified wheat flour (no micronutrients added) Wheat flour fortified with iron, in combination with other micronutrients, may or may not decrease anaemia (RR 0.95, 95% CI 0.69 to 1.31; 2 studies; 322 participants; low-certainty evidence). It makes little or no difference to average risk of iron deficiency (RR 0.74, 95% CI 0.54 to 1.00; 3 studies; 387 participants; moderate-certainty evidence) and may or may not increase average haemoglobin concentrations (mean difference (MD) 3.29, 95% CI -0.78 to 7.36; 3 studies; 384 participants; low-certainty evidence). No trials reported data on adverse effects in children. Wheat flour fortified with iron in combination with other micronutrients versus fortified wheat flour with same micronutrients (but not iron) Given the very low certainty of the evidence, the review authors are uncertain about the effects of wheat flour fortified with iron in combination with other micronutrients versus fortified wheat flour with same micronutrients (but not iron) in reducing anaemia (RR 0.24, 95% CI 0.08 to 0.71; 1 study; 127 participants; very low-certainty evidence) and in reducing iron deficiency (RR 0.42, 95% CI 0.18 to 0.97; 1 study; 127 participants; very low-certainty evidence). The intervention may make little or no difference to the average haemoglobin concentration (MD 0.81, 95% CI -1.28 to 2.89; 2 studies; 488 participants; low-certainty evidence). No trials reported data on the adverse effects in children. Eight out of nine trials reported source of funding with most having multiple sources. Funding source does not appear to have distorted the results in any of the assessed trials. AUTHORS' CONCLUSIONS: Eating food items containing wheat flour fortified with iron alone may have little or no effect on anaemia and probably makes little or no difference in iron deficiency. We are uncertain on whether the intervention with wheat flour fortified with iron increases haemoglobin concentrations improve blood haemoglobin concentrations. Consuming food items prepared from wheat flour fortified with iron, in combination with other micronutrients, has little or no effect on anaemia, makes little or no difference to iron deficiency and may or may not improve haemoglobin concentrations. In comparison to fortified flour with micronutrients but no iron, wheat flour fortified with iron with other micronutrients, the effects on anaemia and iron deficiency are uncertain as certainty of the evidence has been assessed as very low. The intervention may make little or no difference to the average haemoglobin concentrations in the population. None of the included trials reported any other adverse side effects. The effects of this intervention on other health outcomes are unclear.

Fortification of rice with vitamins and minerals for addressing micronutrient malnutrition.

BACKGROUND: Rice fortification with vitamins and minerals has the potential to increase the nutrition in rice-consuming countries where micronutrient deficiencies exist. Globally, 490 million metric tonnes of rice are consumed annually. It is the dominant staple food crop of around three billion people. OBJECTIVES: To determine the benefits and harms of rice fortification with vitamins and minerals (iron, vitamin A, zinc or folic acid) on micronutrient status and health-related outcomes in the general population. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and 16 other databases all up to 10 December 2018. We searched ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (ICTRP) on 10 December 2018. SELECTION CRITERIA: We included randomised and quasi-randomised trials (with either individual or cluster randomisation) and controlled before-and-after studies. Participants were populations older than two years of age (including pregnant women) from any country. The intervention was rice fortified with at least one micronutrient or a combination of several micronutrients (iron, folic acid, zinc, vitamin A or other vitamins and minerals) compared with unfortified rice or no intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently screened studies and extracted data. MAIN RESULTS: We included 17 studies (10,483 participants) and identified two ongoing studies. Twelve included studies were randomised-controlled trials (RCTs), with 2238 participants after adjusting for clustering in two cluster-RCTs, and five were non-randomised studies (NRS) with four controlled before-and-after studies and one cross-sectional study with a control (8245 participants). Four studies were conducted in India, three in Thailand, two in the Philippines, two in Brazil, one each in Bangladesh, Burundi, Cambodia, Indonesia, Mexico and the USA. Two studies involved non-pregnant, non-lactating women and 10 involved pre-school or school-age children. All 17 studies reported fortification with iron. Of these, six studies fortified rice with iron only; 11 studies had other micronutrients added (iron, zinc and vitamin A, and folic acid). One study had one arm each with vitamin A alone and carotenoid alone. Elemental iron content ranged from 0.2 to 112.8 mg/100 g uncooked rice given for a period varying from two weeks to 48 months. Thirteen studies did not clearly describe either sequence generation or allocation concealment. Eleven studies had a low attrition rate. There was no indication of selective reporting in the studies. We considered two RCTs at low overall risk of bias and 10 at high overall risk of bias. One RCT was at high or unclear risk of bias for most of the domains. All controlled before-and-after studies had a high risk or unclear risk of bias in most domains. The included studies were funded by Government, private and non-governmental organisations, along with other academic institutions. The source of funding does not appear to have altered the results. We used the NRS in the qualitative synthesis but we excluded them from the quantitative analysis and review conclusions since they provided mostly contextual information and limited quantitative information. Rice fortified with iron alone or in combination with other micronutrients versus unfortified rice (no micronutrients added) Fortification of rice with iron (alone or in combination with other micronutrients) may make little or no difference in the risk of having anaemia (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.54 to 0.97; I2 = 74%; 7 studies, 1634 participants; low-certainty evidence) and may reduce the risk of iron deficiency (RR 0.66, 95% CI 0.51 to 0.84; 8 studies, 1733 participants; low-certainty evidence). Rice fortification may increase mean haemoglobin (mean difference (MD) 1.83, 95% CI 0.66 to 3.00; I2 = 54%; 11 studies, 2163 participants; low-certainty evidence) and it may make little or no difference to vitamin A deficiency (with vitamin A as one of the micronutrients in the fortification arm) (RR 0.68, 95% CI 0.36 to 1.29; I2 = 37%; 4 studies, 927 participants; low-certainty evidence). One study reported that fortification of rice (with folic acid as one of the micronutrients) may improve serum or plasma folate (nmol/L) (MD 4.30, 95% CI 2.00 to 6.60; 215 participants; low-certainty evidence). One study reported that fortification of rice with iron alone or with other micronutrients may slightly increase hookworm infection (RR 1.78, 95% CI 1.18 to 2.70; 785 participants; low-certainty evidence). We are uncertain about the effect of fortified rice on diarrhoea (RR 3.52, 95% CI 0.18 to 67.39; 1 study, 258 participants; very low-certainty evidence). Rice fortified with vitamin A alone or in combination with other micronutrients versus unfortified rice (no micronutrients added) One study had one arm providing fortified rice with vitamin A only versus unfortified rice. Fortification of rice with vitamin A (in combination with other micronutrients) may increase mean haemoglobin (MD 10.00, 95% CI 8.79 to 11.21; 1 study, 74 participants; low-certainty evidence). Rice fortified with vitamin A may slightly improve serum retinol concentration (MD 0.17, 95% CI 0.13 to 0.21; 1 study, 74 participants; low-certainty evidence). No studies contributed data to the comparisons of rice fortification versus no intervention. The studies involving folic acid and zinc also involved iron in the fortification arms and hence we reported them as part of the first comparison. AUTHORS' CONCLUSIONS: Fortification of rice with iron alone or in combination with other micronutrients may make little or no difference in the risk of having anaemia or presenting iron deficiency and we are uncertain about an increase in mean haemoglobin concentrations in the general population older than 2 years of age. Fortification of rice with iron and other micronutrients such as vitamin A or folic acid may make little or no difference in the risk of having vitamin A deficiency or on the serum folate concentration. There is limited evidence on any adverse effects of rice fortification.

Patients' Awareness About Their Rights: A Study from Coastal South India.

Respecting patients' rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients' rights was independent of gender, socio-economic and educational status. Doctors were found to be the most common source of information for patient's about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services.

Clinico-Epidemiological Profile of Snakebite Cases Admitted in a Tertiary Care Centre in South India: A 5 Years Study.

OBJECTIVES: This study was conducted to assess the clinic-epidemiological profile of snakebite cases admitted at a Tertiary Care Centre in South India. MATERIALS AND METHODS: A record based retrospective study was carried out at Kasturbha Medical College affiliated hospitals in Mangalore. All the snakebite cases admitted to the hospitals from January 2007 to December 2011 were included in the study. Data were collected using a pretested semi-structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS version 11.5). The results are expressed as percentages. RESULTS: The study included 198 cases of snakebite victims. The majority of the cases were males (68.2%). The mean age of the study population was 34.8 years. Maximum numbers of snakebite cases were reported during the month of September to December (47.9%). The peak time of snakebite was between 18.01 and 24.00 h which was reported in 40.5% of the cases. Lower extremities were the most common site of bite in more than three-fourth of the cases (80.9%). The most common symptoms were a pain (45.9%) and swelling (44.9%). The case fatality rate was observed to be 3.0%. CONCLUSION: Snakebite still remains a major public health problem in this part of the world. Knowledge must be imparted regarding the prevention of snakebites through community health programs. Messages regarding prompt reporting of such cases and importance of effective treatment must be disseminated among people through mass media and role plays.

A comparative evaluation of the effect of addition of 8†mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study.

Background: Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially. Aim: To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars. Methodology: A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures. Results: Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7. Conclusion: The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.

Effectiveness of multi-component modular intervention on screen-based and non-screen-based sedentary time among adolescents in an urban area of Mangalore: a school-based cluster randomised controlled trial-protocol.

Background: Behavioural risk factors may often present during adolescence and account for 70% of premature deaths during adulthood. Excessive sedentary behaviour and screen time have become significant concerns, especially among adolescents, due to their potential negative impact on physical and mental health. Adolescents with a high screen-based sedentary time are more likely to be physically inactive, have unhealthy body structure and poor academic performance. The objective of our study is to assess the effect of multi-component modular educational intervention on screen-based sedentary time (SST) and non-screen-based Sedentary time (NSST) among adolescents. Methods: Ethical approval for the study has been obtained from the institutional Ethics Committee of Kasturba Medical College in Mangalore, India. This cluster randomized control trial will be carried out in schools located in the urban area of Mangalore. Using simple randomization, the eligible schools will be randomized into intervention and control arms, each consisting of 10 clusters. A multi-component modular educational intervention will be administered to participants in the intervention group at baseline, second and fourth month. The control group will receive the standard curriculum. Both the groups will be assessed at baseline and at second month, fourth month and sixth month of follow up for SST, NSST and level of physical activity. Anthropometric measurements like height, weight, waist circumference and hip circumference will be taken at baseline and sixth month of follow up. Results: A comprehensive school-based modular educational intervention can have cumulative advantages by reducing screen- and non-screen-based sedentary time, and encouraging physical activity. Similar modular teaching can be incorporated into the curriculum, which will promote healthy life-style among the adolescents.

Effectiveness of novel facial stretching with structured exercise versus conventional exercise for Bell's palsy: a single-blinded randomized clinical trial.

The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell's palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell's palsy when compared to conventional exercise regimen.

Perceptions and attitudes towards organ donation among people seeking healthcare in tertiary care centers of coastal South India.

BACKGROUND: Organ transplantation is the most preferred treatment modality for end-stage organ diseases. The need for the transplants is higher than the availability. Prerequisites for the success of transplantation program include awareness and positive attitudes. AIM: To assess the perceptions and attitudes of the people seeking health care in tertiary care centers towards organ donation in Mangalore, India. SETTINGS AND DESIGN: This cross-sectional study included 863 people seeking general healthcare as outpatients. MATERIALS AND METHODS: Face to face interviews were carried out using pretested tools which included the socio demographic data. Data was analyzed using Statistical Package for Social Sciences version 11.5. RESULTS: Overall, 59.6% participants showed the willingness to donate organs. Females (64.1%) and participants from upper socio economic status (62.7%) had higher willingness rates for organ donations. Hindus (63.6%) and Christians (63.3%) had higher willingness rates for organ donations than Muslims (38.2%). Also, 23.7% participants showed willingness to donate eyes and 33.6% wished to donate any organ after death. Most of the participants (67%) were aware that money should not be accepted for donating organs, and 58.1% were aware that it is an offence to accept any benefit for organ donations. Forty percent participants had perceived risks associated with organ donation. Regarding donor cards, 42.3% of the participants knew about it and 3.7% already possessed it. CONCLUSION: It is apparent from the study that though there was high level of awareness about organ donation, a high proportion of the participants did not have positive attitudes towards organ donation.

Impact of COVID-19 on Academic and Psychological Aspects in Students of Medicine: A Cross-Sectional Study.

Background The COVID-19 pandemic has caused a devastating disruption in medical education worldwide. The influence on training, mainly for undergraduate MBBS pupils, has been noteworthy, especially the significant and unexpected shift to online learning. Materials and methods We performed a two-month, cross-sectional study from June to August 2022 at Kasturba Medical College in Mangalore, India. The study participants were second- and third-year MBBS students at Kasturba Medical College. The sample size was 319. We collected data using a pre-structured, validated, printed questionnaire, then coded and entered the data into SPSS Statistics for Windows, version 25.0, for interpretation. Results A total of 319 people took part in the study. Of these, 60.2% were females, 39.4% were males, 71.8% were from the batch of 2019-2020, and the remaining 28.2% were from the batch of 2018-2019. Among the participants, 90 students suffered from COVID-19, including 72.7% (n = 65) from the second year. Twenty-four percent of the population did not contract COVID-19, including 88 from the second year. A total of 153 participants were unsure whether they were infected with COVID-19, including 57.5% from the second year and 42.5% from the third year. The study group's p-value of <0.0001 is statistically significant. On multivariate analysis, 54.5% of the study participants said the pandemic caused a significant disruption to their medical education. A majority of students (51.7%) agreed that the pandemic hampered practical/clinical work; 42.9% of participants somewhat disagreed that the pandemic hampered their interest in pursuing medical education in the future; and 21.9% of students said the pandemic hindered their interest in further studying medicine. Regardless of gender, a majority of the participants (78.1%) felt that online education negatively affected their time management skills and ability to cover the syllabus. Nearly half (46.4%) reported proficiency in using electronic devices. The medical students encountered multiple challenges: approximately 88% indicated that anxiety over the possibility of contracting the disease led to changes in personal behavior and interactions with family and friends. The study also revealed that 71% exhibited anxiety traits, and 11% displayed depressive symptoms, which may have been pre-existing. Furthermore, 77.1% of the participants experienced poor sleep quality, which, according to another study, is a significant predictor of depression and anxiety during COVID-19. Our findings show a significant correlation between undergoing COVID-19 testing and increased anxiety and stress levels among students, most of whom were infected during the pandemic's second wave in India. Conclusion The study has shed light on the effect of the COVID-19 pandemic on MBBS scholars and the students' reactions to this unparalleled situation. This aligns with Sustainable Development Goal 3, which focuses on "good health and well-being." The medical community has been significantly impacted by the pandemic due to its frontline position, and medical students' struggles to thrive academically. The knowledge gained from this study will assist facilitators and students of the medical fraternity in carrying out effective teaching modalities during this pandemic and any future outbreaks.

Serum calprotectin as a marker of neonatal sepsis: a hospital-based cross-sectional diagnostic study.

Background: Despite significant advances in neonatal care, neonatal sepsis remains a major contributor to mortality, morbidity, and protracted hospitalization. The development of early possible diagnostic indicators for newborn sepsis is critical. Since calprotectin participates in major biological processes, it could be a diagnostic marker for infection/inflammation. This study aimed to estimate serum calprotectin in neonates with clinical sepsis. In addition, we compared serum calprotectin with standard sepsis markers and serum procalcitonin to evaluate its diagnostic accuracy. Methods: A hospital-based cross-sectional diagnostic study of neonates identified with clinical sepsis using standard criteria was carried out. We compared estimated serum calprotectin levels to serum procalcitonin levels and conventional sepsis markers (leucocyte count, blood culture, immature to total neutrophil ratio, and C- reactive protein). We used SPSS version 25 to analyze the data. To examine diagnostic accuracy and determine a cut-off value for serum calprotectin, we used the receiver operating characteristics (ROC) curve. Results: Of the 83 subjects included, 36.5% (30/83) had blood culture positive status, the median value of serum calprotectin being 0.93 ng/ml (0.67 to 1.3). Respiratory, cardiovascular, and gastrointestinal instabilities were present in 67.5% (56/83), 59% (49/83), and 50.1% (42/83) cases, respectively. The median values of serum calprotectin, procalcitonin, TLC, and I/T ratio between neonates withpositive blood culturesand negative culturesdid not differ significantly.. On ROC, calprotectin was not predictive for blood culture positivity (sensitivity: 50%; specificity: 44% at 0.83 ng/ml of serum calprotectin) and C-reactive protein (CRP) levels (sensitivity: 57%; specificity: 67% at serum calprotectin levels of 0.89 ng/ml). However, compared with serum procalcitonin, serum calprotectin at 1.2 ng/ml had sensitivity and specificity of 60% and 73%, respectively. Conclusions: Serum calprotectin did not show a distinct advantage over the existing sepsis markers. Serum calprotectin level at 1.2 ng/ml had a sensitivity and specificity of 60% and 73%, respectively, compared to serum procalcitonin in detecting neonatal sepsis.

Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study - protocol.

INTRODUCTION: The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120-139 mmHg and a (diastolic blood pressure) DBP of 80-89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life. METHODS: This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol. ETHICS AND DISSEMINATION: Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India. The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals.

Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India.

(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.

Mediation effect of cord blood cortisol levels between maternal prepregnancy body mass index and birth weight: a hospital-based cross-sectional study.

BACKGROUND: Changes in maternal weight affect the maternal and fetal hypothalamic-pituitary-adrenal axis, influencing birth weight and contributing to the fetal origin of adult diseases (Barker's hypothesis). This study primarily focused on cord blood cortisol levels and identified the association between maternal prepregnancy body mass index (pre-BMI) and birth weight. It also assessed cord blood lipid profile changes related to maternal pre-BMI, birth weight, and cord blood cortisol levels. PURPOSE: To study the mediation effect of cord blood cortisol level between maternal pre-BMI and birth weight and its correlation with cord blood lipid profile. METHODS: A total of 169 maternal-neonatal pairs were included at 2 tertiary care centers. Mediation analysis was used to estimate the extent of the association between maternal weight changes and birth weight. RESULTS: For each unit increase in maternal pre-BMI, birth weight increased by 90.5 g; for every kilogram increase in gestational weight, birth weight increased by 128.44 g. No considerable mediation effect of cortisol was found between pre-BMI and gestational weight gain or between rate of weight gain and birth weight. Pre-BMI and birth weight had a significant negative correlation with high-density lipoprotein cholesterol (HDL-C) levels, i.e., HDL-C was decreased by 1.1 mg/dL for every unit increase in BMI (P=0.017) and for every 100-g increase in birth weight, HDL-C decreased by 0.6 mg/dL (P=0.046). A significant positive correlation was found between cord blood lipid profile and cortisol levels, especially HDL-C (P=0.041). CONCLUSION: Cord blood cortisol levels did not mediate the association between maternal weight change and birth weight. A positive correlation was noted between cord blood cortisol levels and HDL-C level. Cord blood HDL-C level was negatively correlated with maternal pre-BMI and birth weight.