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PubMed2003

Epidemiology and treatment of Parkinson's disease in India.

Parkinson's disease (PD) has a low prevalence in India except in the small Parsi community where Bharucha et al. found a high prevalence. Although early onset PD and familial cases have been described from India, no genetic mutations have as yet been identified. PD has been known in India since ancient days and the powder of Mucuna Pruriens seeds was used for its treatment. The present day management of PD in India is similar to that in the other countries. Unfortunately, lack of awareness, limitation of human resources and cost factors deny the benefits of therapy to many patients.

Antiparkinson Agents↗

PubMed2001

Current status and history of teleradiology in India.

Teleradiology is yet to take off in India. This is unfortunate since this technology is ideal for a country like India, where expertise in remote areas for advanced investigations such as CT and MR, is lacking. We were the first center in India to use teleradiology on a regular basis. Our initial methodology in 1996 was using video-capture cards and Windows 95 dial-up protocols. Now we use DICOM transfers and remote-access software. Even today, 4 years later, we are the only center in India using teleradiology on a regular basis.

Humans↗

PubMed2002

Changing perspectives of apheresis in India in the twentieth century.

Globally, the last century (20th) has seen many changes in terms of amazing advancements and applications of modern science, medicine, biotechnology and computers. One of the dramatic outcomes of such great inventions and discoveries was that the medical profession got the wonderful tool of immunomodulation and haemapheresis which has changed the outlook of the entire spectrum of immune complex disorders both in terms of the great success in treatment and the rehabilitation from so-called incurable diseases. Additionally this has resulted in a better quality of life and lower morbidity and mortality. Organ transplants have become a reality and immunomodulation plays a pivotal role in their success. India also has tasted this sweet recipe of modern medicine and has imbibed it in its medical culture. India is not only famous for the Taj Mahal and Hawa Mahal (Agra and Jaipur) but also for its brain (of brain drain/otherwise) and betz cells which have brought glories and laurels in the field of medicine, mathematics, engineering, literature, physics and computers, etc. to the native countries and India equally. Apheresis has now invaded the Indian scenario also and there is a growing interest, demand and application for it in the clinical field. But, being a unique country, the problems encountered are also unique. This paper deals with an overview of the changing perspectives of apheresis in India in the 20th century.

Blood Component Removal↗

PubMed2006

Containing HIV/AIDS in India: the unfinished agenda.

India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Female autonomy as a contributing factor to women's HIV-related knowledge and behaviour in three culturally contrasting States in India.

Factors contributing to India's vulnerability to the AIDS epidemic include pervasive poverty, low levels of education and high gender stratification. This study uses data collected in the 1998-99 National Family Health Survey-2 (NFHS-2) to investigate the relationship between aspects of women's autonomy and four measures of HIV-related knowledge and behaviour--awareness and knowledge of HIV/AIDS, condom awareness and condom use--in three culturally contrasting states in India: Kerala (n=2884), Karnataka (n=4357) and Uttar Pradesh (n=8981). The NFHS-2 is a nationally representative survey of India, with a sampling scheme that was designed such that each state sample can be generalized back to represent ever-married women aged 15-49 living in the state. Kerala scores highest in the four health outcome measures, followed by Karnataka and then Uttar Pradesh, but condom use is lowest in Karnataka. Kerala also leads in the four dimensions of autonomy examined and in socio-demographic status, followed again by Karnataka and Uttar Pradesh. Despite these observed differences, in all three states, women with greater autonomy as measured by this study were more likely to be knowledgeable about AIDS and condoms and to use condoms, after controlling for socio-demographic factors. These results concur with other studies focusing on women's autonomy and health outcomes around the world, and point to the importance of incorporating a gender-based approach to AIDS prevention programmes in India.

Adolescent↗

PubMed2002

Partial VP1/2A gene sequence based molecular epidemiology of wild type 1 poliovirus isolates from some parts of India.

Genomic variability within the sequences of VP1/2A junction among polioviruses from across the globe has revealed the existence of several endemic genotypes and their epidemiological inter-relationships; but such data on Indian isolates are scanty. The present work was intended to ascertain the persistence and transmission pattern of different genotypes of wild type 1 polioviruses circulating in India. Forty-eight wild type 1 poliovirus isolates obtained from different parts of India during 1996-8 were subjected to RT-PCR and nucleotide sequencing using M13 tailed primers. A 293 base pair region was amplified and sequenced for genetic variation study. Considering the 15% divergence of the sequences from Sabin 1, the isolates from six different states of India confirmed a single dominant genotype 4. Phylogenetic analysis revealed the circulation and active inter-state transmission of many genetically distinct strains of wild poliovirus type 1 belonging to genotype 4. This warrants the need for insisting on more efficient surveillance mechanisms so as to assess the impact of an extensive pulse polio immunization programme in India.

Amino Acid Sequence↗

PubMed1998

Rapid spread of the new clone of Vibrio cholerae O1 biotype El Tor in cholera endemic areas in India.

Using molecular techniques, we investigated whether the clone of Vibrio cholerae O1 biotype El Tor which appeared in Calcutta, India, in 1994 has spread to other cholera endemic areas in the country. The ribotype of 31 of the 33 strains isolated from different parts of India during 1996 and 1997 was identical to the ribotype displayed by the new clone of V. cholerae O1 which emerged in Calcutta in 1994. Likewise, 12 of the 15 strains examined by pulsed-field gel electrophoresis (PFGE) showed identical profile to that exhibited by the new clone of O1. The restriction fragment length polymorphism (RFLP) of CTX genetic element of these strains also matched with the new clone of O1 which emerged after the outbreak of V. cholerae 0139 in Calcutta. However, two strains (AH042 and AH046) isolated from an outbreak in Ahmedabad (western India) showed different CTX RFLP but had the same ribotype and PFGE profile as the new clone, whereas one strain from Goa (G2) showed distinct ribotype and PFGE profile and the CTX RFLP was identical to the O1 strains which prevailed before the genesis of 0139 in Calcutta. The drug resistance pattern of most of the O1 strains examined in this study, except strain G2, was similar to that of the new clone of V. cholerae O1. None of the strains in this study carried plasmids. Molecular studies clearly show that the new expanded drug resistant clone of V. cholerae O1 has spread to all cholera endemic areas in India and also provide evidence for the evolution of new clones of the O1 serogroup.

Cholera↗

PubMed2006

Neurocognitive consequences of HIV in southern India: a preliminary study of clade C virus.

The neurocognitive impact of the clade C viral strain of human immunodeficiency virus (HIV) has not been determined. The purpose of this study was to examine neurocognitive function in southern India among individuals with the clade C virus with advanced HIV. A battery of cognitive tasks sensitive to the effects of HIV on brain function was translated and administered in Tamil and Telegu, two widely spoken languages in southern India. A sample of 30 treatment-naïve HIV-positive individuals with a median CD4 cell count of 97, and 30 age and education matched healthy controls obtained from the same region of India, were included in the study. Results revealed significant differences on most cognitive tests, with lower performances obtained by the HIV-positive individuals. These results suggest that cognitive difficulties are present among individuals with the clade C virus in India, with as many as 56% of the patients with advanced HIV meeting the criterion for impairment in two cognitive domains. Additional study is needed to determine if clade C HIV infection is more or less prone to cause neurocognitive deficit than the clade B virus. Furthermore, the impact of antiretroviral therapy on neurocognitive dysfunction in clade C virual infection needs to be determined.

Adult↗

PubMed1997

Antigenic variation in Foot and Mouth Disease Virus type Asia 1 isolates circulated during 1993-95 in India.

The antigenic variation in Foot and Mouth Disease Virus (FMDV) is very high. The effective strategy to control the Foot and Mouth Disease (FMD) in India which is a habitat of four serotypes O, A, C and Asia 1, is by regular vaccination, using the vaccine strain most suitable for the local situation. India is an endemic country with the disease being widely distributed. Selection of vaccine strain should therefore need the information on the circulating viruses. Asia 1 causes the second largest number of disease outbreaks in India. As there is no information available with respect to the extent of antigenic variation in FMDV type Asia 1, we have studied FMDV isolates from vaccinated and unvaccinated animals from different parts of the country and compared their relationship with Asia 1 vaccine virus. The immunogenic, hypervariable region of viral protein 1 (VP1) gene was amplified by RT-PCR and sequenced. Analysis of sequence data showed that the viruses from two field outbreaks of Southern India were closely related to each other when compared to the isolate from the North and all the three isolates are away from the vaccine virus.

Animals↗

PubMed2004

Morphological and molecular variation of Morus laevigata in India.

Morus spp., commonly known as mulberry, is significantly associated with human civilization and spread of silk-culture from Asia to Europe, Africa and Latin America. One of its species, Morus laevigata, traditionally well known for its timber value, forage use and silkworm's feed, is widely distributed in India extending from Himalayan foothill to Andaman islands. The variability occurring for 12 morpho-biochemical parameters and RAPD profiles, generated with 13 selected RAPD primers, for M. laevigata accessions from six different zones were investigated. Analyses revealed high degree of genotypic similarity of collection from Himalayan foothill (West Bengal) with those from Andaman Islands. Specific accessions from central India and south India also revealed genotypic similarities with specific accessions from north-east India. These observations are discussed in the context of clonal propagation of mulberry and evolutionary perspective of dispersal of this species, through human activities

Biological Evolution↗

PubMed2000

Clinical and immunologic evaluation of Cedrus deodara pollen: a new allergen from India.

BACKGROUND: Allergy to pollen from gymnosperms is well documented in the West. However, many allergenic species are native to the Himalayan region of India, and Cedrus deodara (Pinaceae) was selected for allergologic investigation. The objective was to define the allergologic and immunochemical aspects of C. deodara pollen. METHODS: Pollen antigen from C. deodara (CD) was prepared and characterized by biochemical and biologic assays. Specific IgE binding was determined by means of ELISA and immunoblotting. RESULTS: CD pollen antigen caused marked skin sensitivity in 7.5% of an atopic population. A significantly elevated level of CD-specific IgE antibodies was observed in 65.8% of the skin-positive patients. Immunoblotting showed protein fractions of 37, 44, 58, and 78 kDa with 100% binding with the patients' sera suspected to be due to carbohydrate moieties. CONCLUSIONS: Patients from the Himalayan region, where CD occurs naturally, were sensitized more than patients from distant places. The immunochemical characterization revealed multiple protein fractions from low to very high molecular mass (14-126 kDa) mostly in the acidic pI range. CD pollen has been recognized as a new allergen from India for the first time. The role of pollen as a causative agent of respiratory allergic disorders is very well established, as is evident from the recent increase of reports from across the world (1-4). India is blessed with the richest flora on the earth, from alpine tundra to Rajasthan desert. Consequently, it provides considerable variation in the quality and quantity of airborne pollen in different ecogeographic regions of the country (5-8). Although studies on the allergenic properties of airborne pollen from various species have been carried out by several workers in India (9-12), information on allergy to aerial pollen from Himalayan tree species has been completely

Allergens↗

PubMed1995

Childhood blindness in India: causes in 1318 blind school students in nine states.

It is estimated that at least 200,000 children in India have severe visual impairment or blindness and approximately 15,000 are in schools for the blind. Although this represents a small percentage of the estimated 5 million blind in India, it is significant in terms of 'blind-years'. Strategies to combat childhood blindness require accurate data on the causes to allocate resources to appropriate preventive and curative services. Since socio-economic factors vary in different areas of this industrializing country data should be representative of the country as a whole. This is the first multi-state study to be undertaken in India using the Record for Children with Blindness and Low Vision from the World Health Organization/PBL Programme. A total of 1411 children in 22 schools from nine states in different geographical zones were examined by an ophthalmologist and optometrist. Of these, 1318 children were severely visually impaired or blind (SVI/BL). The major causes of SVI/BL in this study were: (1) corneal staphyloma, scar and phthisis bulbi (mainly attributable to vitamin A deficiency) in 26.4%; (2) microphthalmos, anophthalmos and coloboma in 20.7%; (3) retinal dystrophies and albinism in 19.3%; and (4) cataract, uncorrected aphakia and amblyopia in 12.3%. This mixed pattern of causes lies in an intermediate position between the patterns seen in developing countries and those seen in industrialised countries. The causes identified indicate the importance both of preventive public health strategies and of specialist paediatric ophthalmic and optical services in the management of childhood blindness in India.

Adolescent↗

PubMed2000

Sources of variability in dietary intake in two distinct regions of rural India: implications for nutrition study design and interpretation.

OBJECTIVE: Limited inter-person variability in nutrient intake hampers epidemiologic studies of diet-disease relationships. Despite conjecture about non-traditional study bases providing large inter-person differences, virtually nothing is known about variations in nutrient intake outside of Europe and North America. The current study was conducted in India to determine sources of variability in the intakes of nutrients thought to be of public health importance. DESIGN: Adult subjects in Gujarat (North India; n=60) and in Kerala (South India, n=60) were administered 24 h diet recall interviews six and eight times, respectively, over a 1 y period. To assess subject (inter-person) and residual (intra-person) contributions to variance, regression models were fit to the data. From this, the variance ratio (VR, total within or intra-person: total between or inter-person) was computed. SETTING: Rural communities in North and South India. RESULTS: In both regions, inter-person variability was larger than that observed in the West. This was most pronounced in Gujarat, for which the VR was <1.0 for seven of the 12 energy-adjusted nutrient intakes in both men and women. In analyses of the combined data, region accounted for >20% of variance for fat, iron, copper, zinc, beta-carotene and riboflavin in both men and women. With the region term removed from this model, virtually all of the variability ascribed to region contributed to inter-person variability. CONCLUSIONS: The relatively large inter-person variability observed here could contribute to improved 'resolution' of diet-outcome relationships in epidemiologic studies. While this applies to data from each region, it was especially evident in analyses of the combined data.

Adult↗

PubMed2005

Population differentiation within and among Asian elephant (Elephas maximus) populations in southern India.

Southern India, one of the last strongholds of the endangered Asian elephant (Elephas maximus), harbours about one-fifth of the global population. We present here the first population genetic study of free-ranging Asian elephants, examining within- and among-population differentiation by analysing mitochondrial DNA (mtDNA) and nuclear microsatellite DNA differentiation across the Nilgiris-Eastern Ghats, Anamalai, and Periyar elephant reserves of southern India. Low mtDNA diversity and 'normal' microsatellite diversity were observed. Surprisingly, the Nilgiri population, which is the world's single largest Asian elephant population, had only one mtDNA haplotype and lower microsatellite diversity than the two other smaller populations examined. There was almost no mtDNA or microsatellite differentiation among localities within the Nilgiris, an area of about 15,000 km2. This suggests extensive gene flow in the past, which is compatible with the home ranges of several hundred square kilometres of elephants in southern India. Conversely, the Nilgiri population is genetically distinct at both mitochondrial and microsatellite markers from the two more southerly populations, Anamalai and Periyar, which in turn are not genetically differentiated from each other. The more southerly populations are separated from the Nilgiris by only a 40-km-wide stretch across a gap in the Western Ghats mountain range. These results variably indicate the importance of population bottlenecks, social organization, and biogeographic barriers in shaping the distribution of genetic variation among Asian elephant populations in southern India.

Animals↗

PubMed2002

Carrier detection and prenatal diagnosis in haemophilia in India: realities and challenges.

Organizing services for haemophilia in developing countries with few resources is a formidable task. There is wide variation in haemophilia care and management between developing and developed countries. The management of a genetic disorder such as haemophilia becomes difficult in developing countries where scanty resources are allocated mainly to nutrition and infectious diseases as a first priority. In a country such as India, with one billion people and with a wide diversity in cultural, educational and financial conditions, educating people about such diseases is difficult and will take a long time to have an effect on attitudes. Meanwhile, attempts are being made at several centres in India to develop carrier detection and prenatal diagnosis for this disease. Counselling a carrier for detection of her carrier status remains problematic in India because marriages are still largely arranged by the parents of prospective brides and bridegrooms. Hence, the very idea of communicating the carrier status to the bridegrooms' families may lead to cancellation of the marriages, and concealing the carrier status is associated with guilt both for the bride's parents as well as the bride. Prenatal diagnosis and carrier detection in India therefore must be discussed in this context.

Clinical Competence↗

PubMed2000

Ocular trauma in an urban population in southern India: the Andhra Pradesh Eye Disease Study.

PURPOSE: To assess the cumulative prevalence of ocular trauma and presence of vision loss due to ocular trauma in an urban population in southern India. METHODS: As part of the population-based Andhra Pradesh Eye Disease Study, 2522 people of all ages from 24 clusters representative of the population of Hyderabad city in southern India, underwent a detailed interview and standardized dilated ocular evaluation. An eye was considered to be blind due to trauma if best corrected distance visual acuity was worse than 6/60 due to trauma. RESULTS: One hundred and thirteen subjects gave a history of ocular trauma and another two had evidence of ocular trauma by examination, a combined age sex-adjusted rate of 3.97% (95% CI 2.52-5.42%). Blindness in one eye due to trauma was present in 17 subjects, and in both eyes in one subject, a combined age-sex-adjusted prevalence of 0.60% (95% CI 0.23-1.04%). Visual acuity in all the blind eyes except one was worse than 3/60. With multiple logistic regression, the odds of blindness in at least one eye due to trauma were highest for current age range of 30-39 years (odds ratio 6.33, 95% CI 1.69-23.77 compared with a current age of less than 30 years), were significantly higher for lower socioeconomic status (3.74, 95% CI 1.18 -11.84), and were higher for males (2.48, 95% CI 0.91-6.82) though this did not reach statistical significance. Trauma resulting in blindness had occurred by the age of 15 years in 55% of subjects, and before the age of 40 years in 92.1% of subjects; this had occurred most commonly while playing (53.6% of the cases). With multiple logistic regression, the odds ratios for any ocular trauma were significantly higher for males (2.10, 95% CI 1.40-3.15), and for labourers than for other occupations (2.50, 95% CI 1.62-3.86). CONCLUSIONS: Ocular trauma affects one in 25 people in this urban population in India, and one in 167 people in this population are estimated to be blind in at least one eye due to trauma. The majority of the trauma resulting in blindness occurs during childhood and young adulthood, and slightly more than half occurs while playing. Targeting mothers and children of lower socioeconomic strata in eye health awareness strategies to reduce blindness due to trauma needs to be considered in urban India.

Adolescent↗

PubMed2003

Isolation and characterization of Shiga toxin-producing Escherichia coli (STEC) and enteropathogenic Escherichia coli (EPEC) from calves and lambs with diarrhoea in India.

AIMS: To determine the prevalence and molecular characteristics of Shiga toxin-producing Escherichia coli (STEC) and enteropathogenic E. coli (EPEC) in calves and lambs with diarrhoea in India. METHODS AND RESULTS: Faecal samples originating from 391 calves and 101 lambs which had diarrhoea were screened for presence of E. coli. A total number of 309 (249 bovine and 60 ovine) E. coli strains were isolated. A total of 113 bovine and 15 ovine strains were subjected to multiplex polymerase chain reaction (m-PCR) for detection of stx1, stx2, eaeA and EHEC hlyA genes. STEC and EPEC belonging to different serogpoups were detected in 9.73% of calves studied. Six per cent and 26.66% of lambs studied were carrying STEC and EPEC, respectively. Majority of the STEC serogroups isolated in this study did not belong to those which have been identified earlier to be associated mainly with diarrhoea and enteritis in cattle and sheep outside India. The most frequent serogroup among bovine and ovine EPEC was O26 (40%). One of the most important STEC serogroup O157, known for certain life-threatening infections in humans, was isolated from both bovine and ovine faecal samples. CONCLUSIONS: A high percentage of STEC and EPEC belonging to different serogroups are prevalent in calves and lambs with diarrhoea in India and could be the cause of disease in them. SIGNIFICANCE AND IMPACT OF THE STUDY: The study reports, for the first time, the isolation and characterization of STEC and EPEC serogroups associated with diarrhoea in calves and lambs in India. Many STEC and EPEC strains belonged to serogoups known for certain life-threatening diseases in humans.

Animals↗

PubMed2003

End-stage renal disease in India and Pakistan: burden of disease and management issues.

In the absence of national registries, no reliable data are available on the incidence and prevalence of end-stage renal disease (ESRD) in India and Pakistan. The incidence of ESRD is likely to be higher than that reported from the developed world, with chronic glomerulonephritis being the most common cause, accounting for more than one third of patients, while diabetic nephropathy accounts for about one fourth of all patients in India. Patients are generally younger (mean age 42 years) at the time of detection of ESRD and two-thirds first see a nephrologist after they have reached end stage. Treatment of ESRD is a low priority for the cash-strapped public hospitals and in the absence of health insurance plans, less than 10% of all patients receive any kind of renal replacement therapy. The vast majority of patients starting hemodialysis die or stop treatment because of cost constraints within the first three months, and less than 2% patients are started on ambulatory peritoneal dialysis. Although renal transplantation is the cheapest option, only about 5% of all patients with ESRD end up having a transplant. Living related donor transplants constitute 30 to 40% of all transplants in India, but there is a conspicuous gender bias with female donors donating kidneys for their male relatives. Cadaveric transplantation has yet to pick up and accounts for less than 2% of all transplants. The enactment of legislation to regulate renal transplantation in India has not been able to prevent unrelated (paid) donor transplants, which constitute 60 to 70% of all renal transplants. Cyclosporine, azathioprine and prednisolone continue to be the backbone of post-transplant immunosuppression, with cyclosporine being stopped in a significant proportion at one year post-transplant to cut down costs. Increasing awareness of renal disease amongst the population and general practitioners could result in early diagnosis of chronic renal failure and give opportunity for preventive strategies to delay the onset of ESRD. Preemptive transplantation and use of generic cyclosporine can help bring down the costs of treatment. Innovative and affordable health insurance policies can also increase the number of patients who receive effective treatment for ESRD in these two countries.

Health Care Costs↗