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PubMed1997

Impact of roles of women on health in India.

India's population has more than doubled since 1961. Although India has been a leader in developing health and population policies, there have been major implementation problems due to poverty, gender discrimination, and illiteracy. Yet, three-quarters of the food produced annually in India is because of women. In 1991, only 39.3% of Indian women were literate. The literacy level of women can affect reproductive behavior, use of contraceptives, health and upbringing of children, proper hygienic practises, access to jobs and the overall status of women in the society. Early marriage and childbirth was a major determinant of women's health and was also responsible for the prevailing socioeconomic underdevelopment in India. The overall maternal mortality for India is 572.3 per 100,000 births, ranging from 14.9% in Bihar to 1.3% in Kerala. Anemia is an indirect factor in 64.4% of the maternal deaths. Trained birth attendants currently assist in about 60-80% of all births in women at the time of delivery. Socioeconomic factors are responsible for maternal deaths to a large extent - money in 18.3%, transport in 13.7%. When the mother dies it doubles the chances of death of her surviving sons and quadruples that of her daughters. Among the avoidable factors in maternal deaths, lack of antenatal care is the most important. Women, if educated and aware, can improve the health of their children by simple measures like good hygiene, exercise and dietary habits. Because of poverty, many of the young children, especially girls living on streets are easy prey for criminal prostitution rings, drug trafficking and consequences of HIV infection, and severe emotional and mental disturbances. Women are responsible for 70-80% of all the healthcare provided in India. Female healthcare providers can play an important role in educating society to recognize their health and nutrition needs. Women professionals and empowerment of women at all levels are required for improvement of the health and nutrition structure in India.

Family Health↗
PubMed1998

Is current eye-care-policy focus almost exclusively on cataract adequate to deal with blindness in India?

BACKGROUND: India's National Programme for Control of Blindness focuses almost exclusively on cataract, based on a national survey done in the 1980s which reported that cataract caused 80% of the blindness in India. No current population-based data on the causes of blindness in India are available. We assessed the rate and causes of blindness in an urban population in southern India. METHODS: We selected 2954 participants by stratified, random, cluster, systematic sampling from Hyderabad city. Eligible participants were interviewed and given a detailed ocular assessment, including visual acuity, refraction, slitlamp biomicroscopy, applanation intraocular pressure, gonioscopy, dilatation, grading of cataract, stereoscopic fundus assessment, and automated-threshold visual fields. FINDINGS: 2522 participants, including 1399 aged 30 years or more, were assessed. 49 participants (all aged > or =30 years) were blind (presenting distance visual acuity <6/60 or central visual field <200 in the better eye). The rate of blindness among those aged 30 years or more, adjusted for age and sex, was 3.08% ([95% CI 1.95-4.21]). Causes included cataract (29.7%), retinal disease (17.1%), corneal disease (15.4%), refractive error (12.5%), glaucoma (12.1%), and optic atrophy (11.0%). 15.7% of the blindness caused by visual-field constriction would have been missed without visual-field examination. Also without visual-field and detailed dilated-fundus assessments, blindness attributed to cataract would have been overestimated by up to 75.8%. If the use of cataract surgery in this urban population was half that found in this study, which simulates the situation in rural India, cataract would have caused 51.8% (39.4-64.2) of blindness, significantly less than the 80% accepted by current policy. INTERPRETATION: Much of the blindness in this Indian population was due to non-cataract causes. The previous national survey did not include detailed dilated-fundus assessment and visual-field examination which could have led to overestimation of cataract as a cause of blindness in India. Policy-makers in India should encourage well-designed population-based epidemiological studies from which to develop a comprehensive long-term policy on blindness in addition to dealing with cataract.

Adult↗
PubMed2002

Regional variation in the distribution of subtypes of lymphoid neoplasms in India.

Lymphoid malignancies (LM) are a heterogeneous group of tumours. The relative frequencies of the various types of LMs vary across geographic regions. The pattern in India shows significant differences from the rest of the world. As India is a vast country, we set out to investigate whether there are regional differences in the relative frequencies of the various LMs. A total of 562 LMs from three different regions in India--Barshi (western India, 102 cases), Pondicherry (southern India, 156 cases) and Jaipur (northern India, 304 cases) were analysed according to the WHO classification. The non-Hodgkin lymphoma (NHL) to Hodgkin disease (HD) ratio was 6.28 in Barshi, 1.26 in Pondicherry and 2.27 in Jaipur. The frequency of HD's various subtypes did not significantly differ among the three regions. While T-cell NHLs constituted only 12.5% of NHLs at Barshi, they accounted for 31 and 27.5% of all NHLs at Pondicherry and Jaipur, respectively. There were also notable differences in the specific subtypes of NHL between the three different geographic regions in India.

Demography↗
PubMed2005

Subtype B and subtype C HIV type 1 recombinants in the northeastern state of Manipur, India.

The predominant HIV-1 strain circulating in India is subtype C. However, subtype A and B strains of HIV-1 have also been reported in India. In 1999, the first A/C recombinant strain was reported from Pune in India. Intravenous drug users (IVDUs) from the northeastern region of India have a high HIV-1 seroprevalence. Studies carried out in intravenous drug users in the northeastern region of India have shown that HIV-1 subtype C is the predominant strain infecting IVDUs. Fourteen blood samples were collected from HIV-1-infected individuals from the northeastern region of India and screened by env and gag heteroduplex mobility assays (HMA). Where the env and gag HMA results from a sample yielded different subtypes, sequencing of env and gag PCR products was carried out to confirm the presence of HIV-1 recombinants. Of the 14 samples subtyped, nine samples belonged HIV-1 subtype C (gag C/env C), one to HIV-1 subtype B (gag B/env B), and the remaining were B/C recombinants (gag C/env B). This is the first report of HIV-1 B/C recombinants from India.

Amino Acid Sequence↗
PubMed2005

Origin and development of forensic medicine in India.

CONTEXT: : The medical profession is one of great antiquity in India. However, the history of medicine and, in particular, the role of medicine in the administration of justice in India has not been discussed very much. The present paper attempts to fill in this lacuna and traces the medicolegal practice from ancient times to British India. SOURCE: : This paper is based on archival materials collected from the Tamilnadu State Archives, Chennai, and Madras Medical College Library, Chennai, and University of Madras Library, Chennai. MAIN OBSERVATIONS: : The medical men in ancient India were considered as men of wisdom, and one of the ancient Tamil hymns equates the doctor-patient relationship to that of the dedicated love of a devotee to God. Kautilya's Arthashastra gives a list forensic evidence for establishing the cause of death and describes the necessity of autopsy in establishing the cause of death. In British India, the early incidence of custodial death and its certification by medical practitioners, issuance of medical certificate and wound certificate, and medicolegal autopsy are documented. The most outstanding contribution of India to legal medicine during this period is modern dactylography. It is recorded that there was a high ratio of homicidal poisonings in India.

Forensic Medicine↗
PubMed1995

Tomato leaf curl geminivirus from India has a bipartite genome and coat protein is not essential for infectivity.

Genomes of two isolates of tomato leaf curl geminivirus from India (ToLCV-India) have been sequenced. ToLCV-India contains A and B components, both of which are required for systemic movement and symptom development. The two isolates have 94% sequence identify but one isolate gave mild symptoms in Nicotiana benthamiana and tomato. The genome organization of ToLCV-India is similar to other whitefly-transmitted geminiviruses (WTGs) with bipartite genomes. However, it contains an additional ORF, AV3, that has not been reported for other WTGs. Its coat protein (CP) sequence is highly homologous to that of Indian cassava mosaic virus (90%). Two mutations that truncated the CP after amino acids 65 or 172 did not affect systemic movement and symptom development in either N. benthamiana or tomato. However, the symptoms caused by mutant viruses were different from those in plants infected with unmodified viruses, and plants infected with the mutants had markedly reduced amounts of single-stranded viral DNA. Comparison of sequences and other biological features of ToLCV-India with other geminiviruses showed that ToLCV-India is a distinct virus and is related to the WTGs from the Old World. It is similar to African cassava mosaic virus in its requirement for B component and dispensability of coat protein for symptom development, unlike other geminiviruses that infect tomato in the Old World. It is proposed that ToLCV-India evolved more recently as compared to other geminiviruses that infect tomato in the Old World.

Base Sequence↗
PubMed2004

A review of the HIV epidemic in India.

India has a population of more than 1 billion people. Although only about 0.7% of its population is infected with HIV, it has more cases than any other country in the world, with more than 4.5 million HIV-seropositive patients. The epidemic of HIV/AIDS in India is distributed between the urban and rural populations mainly in the southern and western states of the country (APAC-VHS, Community Prevalence of Sexually Transmitted Diseases in Tamil Nadu-A Report, 1998; Solomon, Kumarasamy, Ganesh, & Amalraj, 1998, International Journal of Medical Research, 85; 335-338). India has several different epidemics in various parts of the country. The epidemic in the western and southern states is primarily heterosexual. The northeastern states of India, being in geographical proximity to the Golden Triangle of Asia, initially experienced HIV in the injection drug user population and their sexual partners, but spread to the heterosexual population has been increasing. At present, the northern states, which are the most densely populated, appear to remain largely unaffected by the HIV epidemic. India has mounted a broad intervention program, including the government, and international, nongovernmental, and community-based organizations. The main barriers to effective control are insufficient resources, illiteracy, and stigma. Antiretroviral drugs are manufactured in the country and exported elsewhere, but their affordability (despite a drastic reduction in costs) and the feasibility of monitoring patients on drugs are in question. Starting April 1, 2004, the government of India has announced free provision of ART drugs to all who need it in the six most prevalent states of India.

Female↗
PubMedDate not supplied

Epidemiology of digestive tract cancers in India IV. Gall bladder and pancreas.

Pancreatic cancer is a leading cause of cancer-related deaths in developed countries. Gall bladder cancer is very common in South American countries, around the Mediterranean and in Japan. A majority of patients with these cancers receive only palliative therapy in spite of recent advances in investigation and surgery. Their poor prognosis and increasing incidence in India necessitate a better epidemiologic approach towards their control. This review is based on epidemiological data, publications and abstracts from India. Population-based data reveal that the incidence of gall bladder cancer is very high in northern Indian cities (5-7 per 100,000 women) and low (0-0.7 per 100,000 women) in southern India. The distribution suggests a high-incidence region comprising Uttar Pradesh, Bihar, Orissa, West Bengal and Assam. The cancer is twice more common in women and is the leading cancer among digestive cancers in women in the northern Indian cities of Delhi and Bhopal. There are few analytical data to hypothesize why this geographical predisposition. The high incidence is also observed in north Indian immigrants to the United Kingdom. The incidence of pancreatic cancer is low (0.5-2.4 per 100,000 men and 0.2-1.8 per 100,000 women) in most parts of India. Somewhat higher rates are seen in the male urban populations of western and northern India. Studies from Kerala support an association between tropical pancreatitis and pancreatic cancer. Time trends reveal an increase in the incidence of gall bladder and pancreas cancers; the increase in the former is alarming. We estimate that the approximate annual cancer burden of India in 2001 would include 17,730 cases of gallbladder cancer and 14,230 of pancreatic cancer. Multi-center studies are needed to identify potentially preventable risk factors associated with gall bladder and pancreatic cancer in India.

Age Factors↗
PubMed1999

Mesostigmatid mite infestations of rodents in diverse biotopes of central and southern India.

Examination of 165 rodents trapped in domestic, peridomestic, and feral biotopes of central and southern India revealed the presence of 1,359 mesostigmatid mites. Rodents in central India were infested with 1 species of mite, Laelaps nuttalli; 98% of these mites were recovered from the peridomestic rodent Bandicota bengalensis. Material from the burrow nest of a peridomestic rodent examined in central India revealed the mite, Hypoaspis miles. Rodents from the diverse biotopes of southern India were infested by 8 species of mites: L. nuttalli, Laelaps buxtoni, Laelaps myonyssognathus, Androlaelaps aduncus, Androlaelaps marshalli, Androlaelaps sp. A, Hypoaspis sp. 1, and Hypoaspis sp. 2. Sheep from nearby villages regularly graze in feral biotopes. From the hair of these sheep, 2 species of mesostigmatid mites were recovered, A. aduncus and A. marshalli. The sheep appeared to aid the dispersal of rodent-infesting mites passively. Laelaps nuttalli was the predominant mite species found on the peridomestic rodent B. bengalensis. In both central and southern India, the prevalence, mean intensity, and relative density of this mite were much higher on peridomestic rodents than on domestic and feral rodents. A significant negative correlation was found between the numbers of mites and fleas infesting rodents in central India. A highly significant positive association between A. marshalli and A. aduncus on the feral rodent Tatera indica was recorded. In southern India, the overall prevalence of the 8 species of mites was highest on Mus platythrix. However, the combined prevalence of these mites on 2 feral rodents T. indica and M. platythrix was lower than their prevalence on B. bengalensis. Similarly, the combined values for mean intensity and relative density of these mites on the 2 feral rodents were lower than on the peridomestic rodent B. bengalensis.

Animals↗
PubMed2002

The drug lag: new drug introductions in India in comparison to United States.

CONTEXT: Important drugs become available late in India, some much later, than in the United States. The prevailing trends in new drug introduction in India as compared to USA have been looked into this study. OBJECTIVES: To determine the trends in new drug introduction, both qualitative and quantitative, during the period, 1988 to 1999, in India. DESIGN: Data search, compilation and analysis. SOURCE: Various issues (1982-1997) of "Journal of the American Pharmaceutical Association" and "Indian Drug Manufacturers Association" Bulletin (1988-2000). MAIN OUTCOME MEASURES: Average drug lag, trends in drug lag over years (1988-1999), drug lag by therapeutic categories, drug lag by FDA classification of drugs. RESULTS: Average drug lag in India during the years 1988 to 1999 was 4.02 +/- 2.77 years. It has shown a decreasing trend over the years. Gastrointestinal drugs have the least drug lag (1.2 +/- 2 years). Cardiovascular drugs suffer the highest drug lag among therapeutic categories (5.21 +/- 2.2 years). 1AA drugs and 1P drugs (FDA classification) are priority drugs in India also. 1A drugs, which are important new therapeutics agents have been unfortunately neglected by drug developers and regulatory authorities in India. CONCLUSION: Important new drugs become available in India with a drug lag. This 'drug lag' has declined over the years. Qualitative analysis show that 1A class drugs, supposedly the most important category, has been the worst affected.

Drug Approval↗
PubMedDate not supplied

A cross-national study of the effect of intercaste marriage on fertility in India and the United States.

The purpose of this study was 1) to determine the effects of intercaste marriages on fertility in India (high-low caste marriage) and the United States (white-black marriage); and 2) to compare the demographic characteristics of intercaste married couples in India and the United States. The sample consisted of 366 intercaste and intracaste married couples in India and the U.S. The data revealed that in both countries intercaste married couples had a significantly lower number of children than intracaste married couples at .001 level of significance (as between Brahmin or Chamar subcaste in India and as between whites and whites and between blacks and blacks in the U.S.). In both countries, high caste husband-low caste wife had more children (India 1.8, U.S. 1.5) than high caste wife-low caste husband (India 1.5, U.S. 1.1). The main conclusion was that intercaste marriages produced fewer children than intracaste marriages in India and the U.S. Additional demographic and socio-psychological factors which contributed to a lower number of children in both countries were: age difference at the time of marriage, educational achievement level of husband and wife, rural or urban place of origin, fear of caste or racial discrimination, and acceptance of the children by the family and the community.

Age Factors↗
PubMedDate not supplied

Publications by radiation oncologists from India: a brief survey.

BACKGROUND: In India, the past three decades have seen a rapid growth of radiotherapy as a specialty. Has this led to an improvement in the quality and quantity of publications related to radiotherapy? To study this we evaluated publications by radiation oncologists of India from 1992 to 1998. METHODS: Twelve journals (5 Indian and 7 international) indexed in PubMed which publish radiation oncology-related papers were surveyed between January 1992 and June 1998 in terms of the content of the papers and institutional affiliation of the radiation oncologists from India. Of a total of 14 436 papers published during this period, 2562 were in Indian and 11 874 in international journals. We also evaluated the contents of the publications. RESULTS: The contribution of radiation oncologists from India accounted for 109 papers (0.75%)-64 (2.5%) and 45 (0.4%) in Indian and international journals, respectively. Three institutions from India contributed 52 of the 109 published papers (47.7%). Articles on radiation oncology from India constituted less than 1% of the surveyed publications. Also, publications with a 'good' scientific content formed a small part of the Indian radiotherapy publications. CONCLUSIONS: Collaborative studies, inter-institutional trials and randomized clinical trials relating to key oncological problems in India need to be carried out to establish consensus and guidelines at a national level.

Bibliometrics↗
PubMed1994

A review of human immunodeficiency virus infection in India.

By the turn of the century 20-50 million adults are projected to be HIV positive in Asia, and India will have the largest burden of newly infected patients in a single country. To determine the present status of the epidemic, a systematic review of available data in India has been carried out. Regional differences in reported HIV seroprevalence were found, with high levels in western, northeastern, and southern India and lower levels in northern, central, and eastern India. While differences in the temporal introduction of HIV may be partly responsible, the more likely explanation is incomplete data and reporting. In the past 4 years HIV has rapidly increased among commercial sex workers and patients coming to sexually transmitted diseases clinics in western (Bombay) and southern (Madras and Vellore) India. Assessing HIV seroprevalence in the general population is difficult because of limited data, especially from rural areas, where 60% of Indians reside. Heterosexual contact with commercial sex workers is the major reported risk factor, except in eastern India, where intravenous drug use is common. The impact of transfusions or contaminated needles is uncertain, but between 25 and 75% of blood donations are not screened for HIV, and 15% of infected patients had received transfusions. By October 1993, 494 cases of AIDS had been reported, but this number grossly underestimates the real situation since HIV is often unrecognized. Tuberculosis is the major HIV-associated infection. In its efforts to control HIV, India needs to institute a standardized surveillance system to provide data needed to design and implement appropriate interventions.

Blood Transfusion↗
PubMedDate not supplied

Epidemiology of digestive tract cancers in India. III. Liver.

Liver cancer or hepatocellular carcinoma (HCC) is the fourth commonest cause of cancer deaths in the world. The condition is extremely common in Southeast Asia and Africa. In this report the available data on the epidemiology of HCC from India are summarized. We estimate that 12,750 new patients will be diagnosed to have HCC in India in the year 2001; this will comprise 1.6% of all incident cancers. Published studies from India and those involving Indian immigrants to other countries suggest that the prevalence of HCC is relatively lower in Indians than in most parts of the world. This contrasts with the widespread contamination of foods with aflatoxin and the moderately high prevalence of hepatitis B (HBV) and hepatitis C (HCV) virus-related chronic liver disease in India. There are no studies available to explain this observation. There are several articles on HBV and HCC in India but there is a paucity of analytical epidemiological data on HCV and HCC from India. Published studies indicate HBV to be the single most important etiologic association, with HCV playing a lesser but important role. About 80% of Indian patients with HCC have hepatitis virus-associated liver disease. Multicenter epidemiological studies are needed to solve some of the enigmas and observations peculiar to India.

Aflatoxins↗
PubMed2004

"Harnessing genomics to improve health in India" - an executive course to support genomics policy.

BACKGROUND: The benefits of scientific medicine have eluded millions in developing countries and the genomics revolution threatens to increase health inequities between North and South. India, as a developing yet also industrialized country, is uniquely positioned to pioneer science policy innovations to narrow the genomics divide. Recognizing this, the Indian Council of Medical Research and the University of Toronto Joint Centre for Bioethics conducted a Genomics Policy Executive Course in January 2003 in Kerala, India. The course provided a forum for stakeholders to discuss the relevance of genomics for health in India. This article presents the course findings and recommendations formulated by the participants for genomics policy in India. METHODS: The course goals were to familiarize participants with the implications of genomics for health in India; analyze and debate policy and ethical issues; and develop a multi-sectoral opinion leaders' network to share perspectives. To achieve these goals, the course brought together representatives of academic research centres, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems. RESULTS: Seven main recommendations emerged: increase funding for healthcare research with appropriate emphasis on genomics; leverage India's assets such as traditional knowledge and genomic diversity in consultation with knowledge-holders; prioritize strategic entry points for India; improve industry-academic interface with appropriate incentives to improve public health and the nation's wealth; develop independent, accountable, transparent regulatory systems to ensure that ethical, legal and social issues are addressed for a single entry, smart and effective system; engage the public and ensure broad-based input into policy setting; ensure equitable access of poor to genomics products and services; deliver knowledge, products and services for public health. A key outcome of the course was the internet-based opinion leaders' network - the Indian Genome Policy Forum - a multi-stakeholder forum to foster further discussion on policy. CONCLUSION: We expect that the process that has led to this network will serve as a model to establish similar Science and Technology policy networks on regional levels and eventually on a global level.

Journal Article↗
PubMed1997

Effect of particle sizes in India ink on its use in evaluation of apical seal.

We investigated the use of India ink as an indicator of root canal sealing ability. Sealing ability is one of the most important factors required of root canal cements. Various dyes have been used for this purpose. Methylene blue, radioisotopes and India ink have all been tried. However, there is no evidence that India ink is suitable as an indicator. We measured the particle size distribution of India ink to determine how this factor affects test results. In addition, we observed the surface texture of an experimentally developed calcium phosphate sealer and a commercially available root canal sealer using SEM. We found that a portion of the India ink particles were smaller than cracks on the two sealer surfaces, indicating, that India ink could pass through these cracks. We concluded that India ink is suitable as an indicator of root canal seal.

Calcium Phosphates↗
PubMed2003

Swine HEV infection in south India and phylogenetic analysis (1985-1999).

Hepatitis E is endemic in India. It was recently noted that although all the Indian human hepatitis E virus (HEV) isolates (1976-2001) were placed in genotype I, the swine HEV recovered from western India (2000) belonged to genotype IV. This was in contrast to reports from the United States and Taiwan wherein both human and swine HEV belonged to the same genotype, i.e., genotypes III and IV, respectively. In order to validate these findings further, we retrospectively examined serum samples collected from pigs from southern India. Sequential serum samples from 45 (1985-1987) and 12 (1999) pigs from Karnataka state, south India, were screened for the presence of HEV RNA (nested PCR) and IgG-anti-HEV (ELISA). PCR products (Open Reading Frame-2 region) were sequenced and subjected to phylogenetic analysis. In this study, 42/45 (1985-1987) and 12/12 (1999) pigs showed seroconversion to IgG anti-HEV antibodies, with a mean age at seroconversion of 4.8 +/- 1.6 months. Four samples collected in 1999 and two samples collected during 1985 were HEV RNA positive. All swine HEV sequences clustered with genotype IV, demonstrating that swine HEV was prevalent among south Indian pigs for at least for 16 years and, similar to western India, belonged to genotype IV. Thus, genotype I and IV HEV continue to circulate in humans and pigs, respectively, from India. Whether swine HEV infects humans remains to be determined.

Animals↗
PubMed2005

Primary central nervous system lymphoma--a hospital based study of incidence and clinicopathological features from India (1980-2003).

Over the last two decades, an increase in the incidence of PCNSL cases has been reported in the West, both among immunosuppressed and immunocompetent patients. The present study was undertaken to assess the trend of incidence of PCNSL cases in India. To the best of our knowledge, only a single such report is available from India. All biopsy proven PCNSL cases obtained from the Neurosurgical databases of two large referral hospitals, one in Northern India (AIIMS, New Delhi) and another in Southern India (NIMHANS, Bangalore) from the period 1980 to 2003, were reviewed. Immunophenotyping was done and relevant clinical details collected. Appropriate statistical analysis was done to assess any change in trend of incidence or age at presentation. PCNSL cases constituted 0.95% and 0.92% of the total intracranial neoplasms at AIIMS and at NIMHANS, respectively. The mean age for cases diagnosed at AIIMS was 44.35 years, while that for NIMHANS was 39.51 years. Statistical analysis to evaluate any change in trend either of incidence or of age at presentation, over the study period, did not reveal any significant change. All the cases occurred in immunocompetent patients, except one case of HIV positive at NIMHANS, and one case of renal transplant at AIIMS. Frontal lobe was the most common site of involvement. Majority of the cases were diffuse, high grade, large cell lymphoma, B-cell immunophenotype. Thus, this multicentric hospital based study did not reveal any increase in incidence of PCNSL cases in India over the past 24 years. Further, in contrast to the West, majority of the cases in this Indian study were immunocompetent and a decade younger than in the West. The association of PCNSL with HIV/AIDS has been low in India, possibly due to early death in AIDS on account of opportunistic infections.

Adolescent↗