Addressing nutritional gaps and suggesting a practical framework to reduce the risk of malnutrition and improve nutrition security in santhal tribal communities in India

Background The double burden of malnutrition is a growing problem, which is disproportionately represented across the Indian population, with undernutrition dominating rural areas. This study aimed to identify nutritional gaps in traditional recipes of Santhal tribes, create a recipe book to address deficiencies and support diet diversity. Methods Food Frequency Questionnaires (FFQ) were conducted to analyse dietary patterns of Santhal communities. Recipes were collected from five villages and shortlisted into 37 dishes based on availability, acceptability and popularity. Commonly consumed templates were based on FFQ findings and individual dishes. Nutritics software was used to identify nutritional gaps. In total, 24 recommended templates, were created to satisfy adequate intake of nutrients. Mann-Whitney and unpaired t-test were performed and findings were presented as mean (standard deviation(SD)) and median (25th–75th percentile). Results Less than one-fifth of consumed templates met energy requirements, 27% met protein recommendations, and 4% met requirements for fibre, total fat, monounsaturated and polyunsaturated fat. Other nutrients of concern included vitamins B12, B9, iodine, calcium and iron. Recommended templates significantly increased energy (Consumed (C): 996.0kcal(930-1090); Recommended (R): 1183.0kcal(1094-1341); p<0.0001), protein (C: 25.0g(8.4); R: 40.5g(33.2-52.3); p<0.0001), total fat (C: 7.4g(6.1-8.8); R: 17.2g(14.1-22.9); p<0.0001) and fibre (C: 5.0g(4.0-6.5); R: 8.2g(5.8-11.7); p=0.0013) compared to consumed templates. Additionally, calcium (C: 108.5mg(36.0-302.5); R: 245.5mg(152.3-528.3); p=0.0121), iron (C: 5.3mg(2.1-8.2); R: 10.7mg(8.2-13.2); p=0.0002), vitamin B6 (C: 0.4mg(0.3-0.7); R: 1.1mg(0.6-1.6); p=0.0001), B9 (C: 54.5ug(36.3-172.8); R: 252ug(179.4); p=0.0026) and B12 (C: 0ug(0-0); R: 1.0ug(0-2.1); p=0.0001) were also significantly increased. Conclusion This study provides a novel insight on the nutritional adequacy of indigenous Santhal recipes and highlights the need to enhance the nutrition status of these communities. Concerted efforts should be made to increase communication for nutritional advocacy, both nationally and internationally. Future research should evaluate the acceptability, practicality, and uptake of this recipe book in addressing malnutrition in rural communities

A2ML1 and otitis media : novel variants, differential expression, and relevant pathways

A genetic basis for otitis media is established, however, the role of rare variants in disease etiology is largely unknown. Previously a duplication variant within A2ML1 was identified as a significant risk factor for otitis media in an indigenous Filipino population and in US children. In this report exome and Sanger sequencing was performed using DNA samples from the indigenous Filipino population, Filipino cochlear implantees, US probands, Finnish, and Pakistani families with otitis media. Sixteen novel, damaging A2ML1 variants identified in otitis media patients were rare or low-frequency in population-matched controls. In the indigenous population, both gingivitis and A2ML1 variants including the known duplication variant and the novel splice variant c.4061 + 1 G>C were independently associated with otitis media. Sequencing of salivary RNA samples from indigenous Filipinos demonstrated lower A2ML1 expression according to the carriage of A2ML1 variants. Sequencing of additional salivary RNA samples from US patients with otitis media revealed differentially expressed genes that are highly correlated with A2ML1 expression levels. In particular, RND3 is upregulated in both A2ML1 variant carriers and high-A2ML1 expressors. These findings support a role for A2ML1 in keratinocyte differentiation within the middle ear as part of otitis media pathology and the potential application of ROCK inhibition in otitis media.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Political masters and sentinels : commanding the allegiance of the soldier in India

textThis study is a serious effort to make a significant contribution to the underexamined field of Indian civil-military relations. The objective of the study is to set up a framework that helps explain changes in the division of labor between civilians and the military in India from 1947 to the present day. There are three basic themes in this dissertation that I seek to develop and explain in various chapters. The first theme examines key issues which directly address the divide between civilian and military functions. In discussing the division of labor between civilians and the military and changes affecting India’s structure of civil-military relations, I borrow Samuel Huntington’s general framework outlined in The Soldier and the State. Huntington’s framework provides the starting point for my argument by informing the reader about issues that emerge in the contestation of civilian space by the military. The second theme highlights the very different nature or experience of civil-military relations in India when compared to the United States. The third and final theme of this study seeks to illustrate differences in the nature of the Indian and American political systems. A major conclusion reached in this study is that the advent of nuclear technology in India has reduced the space between civilian and military functions, giving the military a greater role in shaping policy.Governmen

Diagnostic and Prognostic utility of Hormone receptors and KI67 in Proliferative Endometrial lesions

Background: The overall survival rate of patients with early-stage endometrial cancer is relatively high; how-ever, there are few treatment options for patients with advanced or recurrent endometrial cancer, and the prognosis of such patients remains poor. Recent progress in molecular-targeted therapies demonstrated that they have the potential to improve the long-term survival of cancer patients with appropriate biomarkers. In this study we evaluated 50 patients with endometrial proliferative lesions and their correlation with hormonal receptors and proliferative index, with emphasis on the utility of these markers in disease prognosis. Objective: To evaluate the association of expression of ER, PR and Ki67 in endometrial hyperplasia and carcinoma. Material and Methods: Small and large biopsy samples obtained from 50 female patients were evaluated by histopathology and immunohistochemistry by using specific markers. Statistical analysis was done to determine the P value. Results: Out of 50 cases studied 16 cases (32%) were endometrial hyperplasia and 34 cases (68%) were of endometrial carcinoma. Among the carcinoma cases 22 cases (65%) were grade 3, 8 (23%) were grade 2 and 4(12%) were grade 1 tumors. Assessment of myometrial invasion was possible in 23 cases out of which 20 cases showed &gt;50% invasion and 3 cases showed &lt;50% invasion. Cervical invasion was present in 17 cases and vascular invasion was seen in 10 cases. Negative expression of hormonal receptors was seen in grade 3 (high grade) endometrial carcinomas. P value was estimated at 0.0001. The proliferative index was high (&gt;35%) in grade 3 (high grade) endometrial carcinoma. P value was 0.006.Conclusion: There is significant association of expression of ER, PR and Ki67 in endometrial carcinomas with respect to histological variants, grade, tumor invasion and metastasis