Advancing our Understanding of Heat Wave Criteria and Associated Health Impacts to Improve Heat Wave Alerts in Developing Country Settings.

Health effects of heat waves with high baseline temperatures in areas such as India remain a critical research gap. In these regions, extreme temperatures may affect the underlying population's adaptive capacity; heat wave alerts should be optimized to avoid continuous high alert status and enhance constrained resources, especially under a changing climate. Data from registrars and meteorological departments were collected for four communities in Northwestern India. Propensity Score Matching (PSM) was used to obtain the relative risk of mortality and number of attributable deaths (i.e., absolute risk which incorporates the number of heat wave days) under a variety of heat wave definitions (n = 13) incorporating duration and intensity. Heat waves' timing in season was also assessed for potential effect modification. Relative risk of heat waves (risk of mortality comparing heat wave days to matched non-heat wave days) varied by heat wave definition and ranged from 1.28 [95% Confidence Interval: 1.11-1.46] in Churu (utilizing the 95th percentile of temperature for at least two consecutive days) to 1.03 [95% CI: 0.87-1.23] in Idar and Himmatnagar (utilizing the 95th percentile of temperature for at least four consecutive days). The data trended towards a higher risk for heat waves later in the season. Some heat wave definitions displayed similar attributable mortalities despite differences in the number of identified heat wave days. These findings provide opportunities to assess the "efficiency" (or number of days versus potential attributable health impacts) associated with alternative heat wave definitions. Findings on both effect modification and trade-offs between number of days identified as "heat wave" versus health effects provide tools for policy makers to determine the most important criteria for defining thresholds to trigger heat wave alerts

A randomized, comparative, open clinical trial for evaluating the efficacy of PP/JLN/107/09-10 Syrup in the management of Functional Constipation

Context: Functional constipation which has no underlying organic causes is difficult to be allopathic treatment for long term due to its side effects and undeniable effect, thus a natural balanced and compatible formulation needs to be validated. Objectives: Current study aimed to assess a poly-herbal formulation in management of functional constipation. Material and Methods: This study was 28 days, two armed, randomized, open labeled, prospective clinical study. 60 clinically confirmed cases of functional constipation patients randomized to receive orally either 2 teaspoonful of PP/JLN/107/09-10 Syrup or 1 teaspoonful of 5- 6 gm of Isabgol powder. Results were analyzed as per Rome II criteria and other associated symptoms like headache, acidity, belching, barborgysmy, flatulence and abdominal distension or bloating which are recorded on VAS score. Results: PP/JLN/107/09-10 scored over Isabgol on four out of six parameters of Rome II Criteria viz., frequency of bowel movement, straining at defecation, lumpy I hardstool formation, feeling of incomplete evacuation, feeling of ano-rectal blockage and manual maneuvers (p < 0.001). Trial drugs showed comparable effects (p > 0.05) in reducing the mean scores of associated symptoms like headache, acidity, belching, borgorgysmy, flatulence and abdominal distension. However, trial drug was found to perform statistically significant result in more number of parameters in comparison to Isabgol. Conclusion: PP/JLN/107/09-10 was found to be effective and safe in reliving functional constipation

Haemoglobinopathies- thalassaemias and abnormal haemoglobins in Eastern Uttar Pradesh and adjoining districts of neighbouring states

The haemoglobinopathies- thalassaemias and abnormal haemoglobins- constitute a major burden of genetic diseases in India. Our study, based on index cases from 120 families detected between May 1999 and May 2003, highlights the ethnic distribution of haemoglobinopathies in regions in and around Varanasi comprising 8-10 districts of eastern Uttar Pradesh and adjoining districts of Bihar, Jharkhand, Chhattisgarh and Madhya Pradesh. Homozygous and heterozygous β-thalassaemia was the most common (66.9%), with thalassaemic haemoglobinopathies HbE-β-thalassaemia (15.9%) and HbS-β-thalasseamia (7.8%) contributing to almost a quarter of the cases. Along with HbSS disease (4.3%), the results indicate a confluence of β-thalassaemia, HbS and HbE in this region. IVS1-5 nt was the most common mutation in the few carriers analysed for mutation detection. The significance of the study lies in the demonstration of wide prevalence of β-thalassaemia across all castes and communities of this region, with migrant population groups of Sindhis and Punjabis comprising only 5.8% of the index cases. Also, HbE seems to have a much higher presence in this region than so far believed and HbS has a significant presence in general castes as well

Personal Hygiene and Self-Reported Handwashing Practices among Food Handlers of a Medical College in Delhi

Introduction: Food handlers play a major role in ensuring food safety as mishandling and disregard for personal hygiene on their part may result in food borne- illness outbreaks.Methodology: Cross sectional observational study involving about 44 food handlers presently working were included. With structured proforma, details of socio- demographic data and self reported personal hygiene and handwashing practices were carried out. Results: Majority of the study subjects had satisfactory or good personal hygiene. Significantly greater number of study subjects working as servers or helpers had a better status of hygiene as compared to the cooks. Personal income was significantly associated with the status of personal hygiene of the study subjects. Although majority of them were using soap for handwashing after defecation and micturition but only few were using it at the workplace. Although all of them were brushing/ cleaning their teeth, 50% were doing it only once in a day. Majority of them were taking bath in summers while 9% were not taking bath in winters. Majority of them were trimming their nails on a regular basis while 2.3% didn’t cut their nails at all. Majority of them used to take medicine during diarrhea while only 2.3% used to take leave from work during illness. Most of them reported using towel to wipe the sweat. Most of them either covered their mouth or turned their face away from food while coughing/ sneezing. While 56.8% reported that they chased the stray animal, 20.4% said that animals never entered the premises, 2.3% had the habit of offering food to them.Conclusion: There is a lot of scope for improving the standards of personal hygiene practices of food handlers. Important personal hygiene habits that help in prevention of contamination of food should be included in the content of health education sessions

Sub chronic oral toxicity study of Janma Ghunti Honey in Wistar rats

The present study was conducted to evaluate the safety profile of Janma Ghunti Honey in Wistar rats on oral administration for 28 consecutive days. Animals were randomized on the basis of body weight into 6 groups. Three groups received test item (TI) at three different dose levels (3 mL/k g, 6 mL/kg and 12 mL/kg body weight). One group served as high dose satellite reversal group (12 mL/kg). One group each served as the control and satellite control group. Animals were observed for clinical signs of toxicity and mortality at least once daily. Animals from satellite groups were observed for further 14 days without treatment to evaluate delayed occurrence or reversibility of any signs/toxicity. At the end of the study, animals were studied through clinical pathology and necropsy examination. No treatment related mortality was observed in any group. Except in female low dose and female high dose satellite groups, all the treated groups exhibited weight gain and no statistically significant alterations were observed. No TI related toxicity was found on hematological investigation, blood biochemistry parameters and absolute and relative organ weights among treated groups. 'No Observed Adverse Effect Level' of TI in male and female Wistar rats was found to be above 12 mL/kg body weight

Caucasian and Asian Specific Rheumatoid Arthritis Risk Loci Reveal Limited Replication and Apparent Allelic Heterogeneity in North Indians

Genome-wide association studies and meta-analysis indicate that several genes/loci are consistently associated with rheumatoid arthritis (RA) in European and Asian populations. To evaluate the transferability status of these findings to an ethnically diverse north Indian population, we performed a replication analysis. We investigated the association of 47 single-nucleotide polymorphisms (SNPs) at 43 of these genes/loci with RA in a north Indian cohort comprising 983 RA cases and 1007 age and gender matched controls. Genotyping was done using Infinium human 660w-quad. Association analysis by chi-square test implemented in plink was carried out in two steps. Firstly, association of the index or surrogate SNP (r2>0.8, calculated from reference GIH Hap-Map population) was tested. In the second step, evidence for allelic/locus heterogeneity at aforementioned genes/loci was assessed for by testing additional flanking SNPs in linkage equilibrium with index/surrogate marker

Targeted gene sanger sequencing should remain the first-tier genetic test for children suspected to have the five common X-linked inborn errors of immunity

DATA AVAILABILITY STATEMENT : The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.The Hong Kong Society for Relief of Disabled Children and Jeffrey Modell Foundation.http://www.frontiersin.org/Immunologyam2023Paediatrics and Child Healt

Lithium overdose: Early hemodialysis is the key!

A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His medications included lithium for the treatment of bipolar disorder. The clinical examination and the laboratory investigations that followed revealed findings classical of lithium overdose. The patient was successfully managed and discharged from the hospital on Day 9 of admission. Clinicians should be aware of this rather unusual and relatively rare differential cause of acute on chronic renal failure with encephalopathy

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Delhi cohort of the A 1 chieve study

Background: The A 1 chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Delhi, India. Results: A total of 2242 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 1515), insulin detemir (n = 521), insulin aspart (n = 176), basal insulin plus insulin aspart (n = 11) and other insulin combinations (n = 19). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 10.0%) and insulin user (mean HbA 1 c: 11.0%) groups. After 24 weeks of treatment both the groups showed improvement in HbA 1 c (insulin naïve: −3.1%, insulin users: −3.6%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia