Prevalence of drug resistance in patients with pulmonary tuberculosis presenting for the first time with symptoms at chest clinics in India. Part 2. Findings in urban clinics among all patients with or without history of previous chemotherapy

A previous report (Indian Council of Medical Research First Drug Resistance Investigation, 1968) presented the results of a co-operative investigation on the prevalence of drug resistance in patients with pulmonary tuberculosis, presenting for the first time with symptoms at chest clinics in India and giving no history of previous antituberculosis chemotherapy. However, the information obtained from that investigation is of rather limited value because, in most clinics, fairly large proportions of patients reporting for the first time do so with a history of previous treatment. This is because antituberculosis chemotherapy is offered not only by chest clinics, but also by general hospitals and private practitioners. In these circumstances, information on the prevalence of drug resistance among all patients, irrespective of the history of previous antituberculosis chemotherapy, will be of great value, not only to the cliniciansin- charge of the chest clinics but also to those responsible for formulating general policies of treatment in the country. The second drug resistance investigation was undertake

Prevalence of drug resistance in patients with pulmonary tuberculosis presenting for the first time with symptoms at chest clinics in India. 1. Findings in urban clinics among patients giving no history of previous chemotherapy

IT is generally accepted that information on the prevalence of drug resistance is essential for countries which contemplate mass chemotherapy programme for tuberculosis (International Union against Tuberculosis, 1961). In India in 1964, information on this subject was confined to certain limited areas only (Tuberculosis Chemotherapy Centre, Madras, 1959, 1960, 1964 ; Frimodt-Moller, 1962 ; Menon, 1963 ; Balbir Singh, 1964). Therefore, the Indian Council of Medical Research (I.C.M.R.) launched a series of investigations to determine the prevalence of drug resistance in tuberculous patients reporting for the first time with symptoms at chest clinics ; chest clinics were chosen since they are an obvious starting point for any mass chemotherapy programme. A special sub-committee of the Indian Council of Medical Research (see footnote) was constituted to organise the execution of these investigations, and a Central Laboratory set up on the premises of the Tuberculosis Chemotherapy Centre, Madras, to undertake all the necessary bacteriological investigations

EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013. Scientific Opinion on the substantiation of a health claim related to increasing maternal folate status by supplemental folate intake and reduced risk of neural tube defects pursuant to Article 14 of Regulation (EC) No 1924/2006

Following an application from Rank Nutrition Ltd, submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of the United Kingdom, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to increasing maternal folate status by supplemental folate intake and reduced risk of neural tube defects. The Panel considers that the food constituent, supplemental folate, which is the subject of the claim, is sufficiently characterised. Increasing maternal folate status by supplemental folate intake is a beneficial physiological effect in the context of reducing the risk of neural tube defects. In weighing the evidence, the Panel took into account that the association between low maternal folate intakes and an increased risk of neural tube defects is well established, and that a recent systematic review showed an effect of maternal folic acid intakes on the risk of neural tube defects. The Panel concludes that a cause and effect relationship has been established between increasing maternal folate status by supplemental folate intake and a reduced risk of neural tube defects

Global regulatory developments for clinical stem cell research: diversification and challenges to collaborations

In this article, we explore regulatory developments in stem cell medicine in seven jurisdictions: Japan, China, India, Argentina, Brazil, the USA and the EU. We will show that the research methods, ethical standards and approval procedures for the market use of clinical stem cell interventions are undergoing an important process of global diversification. We will discuss the implications of this process for international harmonization and the conduct of multicountry clinical research collaborations. It will become clear that the increasing heterogeneity of research standards and regulations in the stem cell field presents a significant challenge to international clinical trial partnerships, especially with countries that diverge from the regulatory models that have been developed in the USA and the EU

High Reported Rates of Antimicrobial Resistance in Indian Neonatal and Pediatric Blood Stream Infections.

Background.: There is real shortage of national data on antimicrobial resistance rates in Indian neonates and children. A descriptive review was conducted to determine the patterns of antimicrobial resistance in isolates of blood stream infection among hospitalized children in India. Methods.: Published and gray literature on antibiotic resistance in children was searched using "Google Scholar", "Scopus", and "PubMed" databases between January 2000 and July 2015. Studies were included if they were original articles that reported a minimum of 10 pathogenic bacterial isolates from the bloodstream within a pediatric population in India, and studies were excluded if they reported studies done during an outbreak or epidemic. Results.: A total of 1179 studies were screened, and 82 papers were identified as eligible for inclusion. Most studies (78.7%) were reported from neonatal intensive care units. Among a total of 50545 reported blood cultures, 14704 (29.1%) were positive. Staphylococcus aureus (median, 14.7%; IQR, 7.4%-25.6%) and Klebsiella pneumoniae (median, 26%; IQR, 16.7%-35.4%) were the commonest reported Gram-positive and Gram-negative pathogens, respectively. Approximately half of all S aureus isolates were reported as methicillin-resistant S aureus (median, 50%; IQR, 31.4%-65.1%). After age stratification, the median rate of resistance of common Gram-negative pathogens to ampicillin and gentamicin/amikacin were extremely high (K pneumoniae/ampicillin 95.9%; K pneumoniae/gentamicin 75%; Escherichia coli/ampicillin 92.9%; E coli/gentamicin 55.6%). Likewise, the median resistance of common Gram-negative blood stream isolates to cephalosporins were also high (K pneumoniae/cefotaxime 62.6%; E coli/cefotaxime 47.5%). Conclusions.: High rates of resistance to World Health Organization-recommended first-line treatment options for neonates and children have been identified in blood stream infections across India. There is an urgent need to both enhance antibiotic stewardship and infection prevention and control measures and consider urgently how to repurpose older antibiotics back into routine care in India

Dietary and nutritional change in India: implications for strategies, policies, and interventions

Despite the global transition to overnutrition, stunting affected approximately 159 million children worldwide in 2014, while an estimated 50 million children were wasted. India is an important front in the fight against malnutrition and is grappling with the coexistence of undernutrition, overnutrition, and micronutrient deficiencies. This report summarizes discussions on trends in malnutrition in India, its evolution in the context of economic growth, intrahousehold aspects, infant and young child feeding practices, women's status, maternal nutrition, and nutrition policymaking. The discussion focuses on a review of trends in malnutrition and dietary intakes in India in the context of economic change over the past four decades, identification of household dynamics affecting food choices and their consequences for family nutritional status in India, and effective malnutrition prevention and treatment interventions and programs in India and associated policy challenges

A strategic assessment of cervical cancer prevention and treatment services in 3 districts of Uttar Pradesh, India

BACKGROUND: Despite being a preventable disease, cervical cancer claims the lives of almost half a million women worldwide each year. India bears one-fifth of the global burden of the disease, with approximately 130,000 new cases a year. In an effort to assess the need and potential for improving the quality of cervical cancer prevention and treatment services in Uttar Pradesh, a strategic assessment was conducted in three of the state's districts: Agra, Lucknow, and Saharanpur. METHODS: Using an adaptation of stage one of the World Health Organization's Strategic Approach to Improving Reproductive Health Policies and Programmes, an assessment of the quality of cervical cancer services was carried out by a multidisciplinary team of stakeholders. The assessment included a review of the available literature, observations of services, collection of hospital statistics and the conduct of qualitative research (in-depth interviews and focus group discussions) to assess the perspectives of women, providers, policy makers and community members. RESULTS: There were gaps in provider knowledge and practices, potentially attributable to limited provider training and professional development opportunities. In the absence of a state policy on cervical cancer, screening of asymptomatic women was practically absent, except in the military sector. Cytology-based cancer screening tests (i.e. pap smears) were often used to help diagnose women with symptoms of reproductive tract infections but not routinely screen asymptomatic women. Access to appropriate treatment of precancerous lesions was limited and often inappropriately managed by hysterectomy in many urban centers. Cancer treatment facilities were well equipped but mostly inaccessible for women in need. Finally, policy makers, community members and clients were mostly unaware about cervical cancer and its preventable nature, although with information, expressed a strong interest in having services available to women in their communities. CONCLUSION: To address gaps in services and unmet needs, state policies and integrated interventions have the potential to improve the quality of services for prevention of cervical cancer in Uttar Pradesh

Relationship between health-related quality of life and respiratory health status among coal-based sponge iron plant workers in Barjora, India

Background: Many coal-based sponge iron plant workers have poor health-related quality of life in general, and specifically a poor respiratory health status. However, the relationship between their health-related quality of life and respiratory health status is unknown. Aim: This study investigated the relationship between health related quality of life, measured using the EuroQol- 5D (EQ5D), and respiratory health status, measured using the St. George’s Respiratory Questionnaire (SGRQ), among coal-based sponge iron plant workers in Barjora, India. Method: A cross-sectional study was conducted among coalbased sponge iron plant workers in Barjora, and complete data were available on 252 participants. Spearman’s rank correlation coefficients were reported to show the strength of relationship between health-related quality of life and respiratory health status. Results and conclusion: Significant correlations were found between all EQ5D dimensions/visual analogue scale (VAS) and all SGRQ scores except between EQ5D-VAS and SGRQ-activity. A range of correlations was found. They were moderate between EQ5D-anxiety/depression and SGRQ-symptom, EQ5D-VAS and SGRQ-symptom, and EQ5D-anxiety/depression and SGRQ-total, but weak between all the other factors

Balanced amino acid and higher micronutrients in millets complements legumes for improved human dietary nutrition

Background and objectives: More than 2 billion people suffer with malnutrition arising from dietary protein and micronutrients deficiencies. To enhance the dietary nutrient quality, the current study used two largely grown varieties of finger millet, pearl millet, pigeonpea, and chickpea to evaluate the effect of millet–legume blends for their enhanced protein digestibility, amino acid profiles, and essential micronutrients. Findings: Our study revealed the presence of significant levels of proteins (6.3%– 22.3%), essential amino acids, and micronutrients (Fe: 2.6–8.5 mg; Zn: 2–5.5 mg; Ca: 22‐450 mg in 100 g) in these varieties. When specific millets combined with legumes in 3:1 proportion, significantly enhanced nutritional value of food by providing a balanced amino acid with good protein digestibility, and high levels of iron (7.58 mg) and zinc (4.96 mg) with 100 g of pearl millet and calcium (400.57 mg) with 100 g of finger millet. Conclusions: Pigeonpea and chickpea have a good level of proteins with essential amino acids except methionine and cysteine, whereas millet had balanced amino acid including methionine and cysteine (50% higher) and much higher levels of micronutrients (Fe, Zn and Ca). Therefore, specific millets and legumes combination complemented higher levels of micronutrients in addition to complete proteins to support comprehensive human nutrition. Significance and novelty: This study opens prospects for selecting complementary nutrient‐dense varieties for household consumption. Industries can explore these product developments significantly to reduce malnutrition if consumed adequately, which is not possible with polished rice, refined wheat flour or maize even if it is combined with legumes

Evaluation of Stepping Stones as a tool for changing knowledge, attitudes and behaviours associated with gender, relationships and HIV risk in Karnataka, India

<p>Abstract</p> <p>Background</p> <p>Stepping Stones training aims to help individuals explore sexual relationships and recognize gender inequalities, the structural drivers of the HIV epidemic, in order to understand risk behaviours and to seek solutions to factors that increase HIV vulnerability. Despite earlier studies suggesting the success of Stepping Stones, little data exist to show diffusion to trainees' social networks or the wider community.</p> <p>Methods</p> <p>A mixed-methods evaluation of this approach was undertaken using in-depth interviews of trainees and friends, and polling booth surveys in 20 villages where Stepping Stones training took place and in another 20 villages with no Stepping Stones intervention.</p> <p>Results</p> <p>The interview respondents and their friends reported significant changes in their relationships after training, and benefit from discussion of gender, sexuality, condom use and HIV vulnerability issues. However, though diffusion of this knowledge at the level of personal contacts was strong, the evaluation revealed that diffusion to the community level was limited.</p> <p>Conclusions</p> <p>The qualitative part of this study reflects other studies in different settings, in that SS participants gained immensely from the training. Wider behaviour change is a challenging goal that many programmes fail to attain, with most interventions too limited in scope and intensity to produce larger community effects. This may have contributed to the fact that we observed few differences between interventions and non-intervention villages in this study. However, it is also possible that we had excessive expectations of individual change at the community level, and that it might have been more appropriate to have had broader community level rather than individual behavioural change indicators. We suggest that SS could be enhanced by efforts to better engage existing community opinion leaders, to empower and train participants as community change agents, and to support the development of village-level action plans that combat sexual stereotyping and risky behaviours that lead to unhealthy sexual relationships.</p