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Anemia among older adults aged ≥ 60 years is a well-described risk factor that increases the risk of falls, cardiovascular diseases, and mortality. In India, objectively measured national estimates of anemia prevalence and the causes of anemia among older adults are lacking. The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) collected venous blood samples from a nationally representative sample of 3,252 individuals in wave 2 of the study. Out of these, 3,009 samples were used to estimate national prevalence and regional differences in anemia prevalence and its underlying causes. Anemia was defined as hemoglobin < 13 mg/dl in males and < 12 mg/dl in females and further categorized into nutritional and non-nutritional anemia based on several nutritional (ferritin, Vitamin B12, and folate), inflammatory (ferritin, C-reactive protein), and renal (serum creatinine) biomarkers. The overall national anemia prevalence was 49.92%. Anemia prevalence was significantly higher among women (53.9%) than men (45.8%). Among those with anemia, nutritional anemia was found in 63.5% of the respondents, with isolated iron deficiency anemia being the most common cause (51.8%). Among the non-nutritional category, anemia of chronic disease was the most common type (31.4%). About 10% of all anemia cases could not be classified into either category using the available data. Regional differences were seen with the highest prevalence of anemia in Assam, West Bengal, Jharkhand, and Odisha, and the lowest prevalence (< 30%) in Jammu & Kashmir and Haryana. Multivariate adjustment showed that age, sex, and region of residence are independently associated with anemia status. The study provides valuable insights into the overall anemia prevalence among older adults in India, its underlying causes, and regional differences to lay a strong foundation for making informed decisions toward anemia control in India.
One hundred and twenty-five cases of biopsy proven sarcoidosis have been found during a prospective study since 1972 in Calcutta, Eastern India. The presentation, clinical course and radiological features are considerably different from those seen in the West. Elderly males over 40 years are more prone. Low grade fever, cough, dyspnoea, arthralgia are common symptoms while hepatosplenomegaly, hypercalcaemia, hypercalciuria and hyperglobulinaemia are frequent signs. Nearly 60% are MT negative (up to 100 TU). Serum angiotensin converting enzyme and high lymphocyte count in bronchoalveolar lavage fluid are usual findings in active disease. Chest X-ray usually shows mottled opacities or fibrosis in 60% cases. Clinico-radiological dissociation (i.e. remarkable dissociation between the alarming-looking chest X-ray and scanty physical signs and symptoms in chest) was a very remarkable feature in this series. Treatment with oral steroid or steroid aerosol with oxyphenbutazone and chloroquine give equally good results initially. However, most cases tend to relapse inspite of adequate initial treatment. The pattern of the disease is similar almost all over India with minor regional differences like more erythema nodosum and eye involvement in Chandigarh in the extreme north (which could also have been due to case selection). The pattern from Northern India (Delhi) and Western India is nearly similar to our figures.
In India are approximately 4 million blind people by advanced or mature cataract. For only 10 US$ one patient can be operated in eye camps in the villages by an intracapsular cataract cryoextraction an + 12.00 dptr. aphakia glasses. Also estimated four million people are blind by xerophthalmia. The project is to examine all the babies and little children in the villages and to give them for 2 years each month vitamin-A-medication. On the other side the parents of children suffering from xerophthalmia are instructed to plant vegetables rich in vitamin A. The goal of both projects is to make a cataract and xerophthalmia free zone in Uttar Pradesh, which should spread over the entire country. Both projects are sponsored by Combat Blindness Foundation, P.O. Box 5, 332 Madison Wisconsin 53705 USA, Professor Suresh Chandra, chairman.
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In a hospital-based case-control study of 1441 patients with age-related cataracts and 549 controls, we studied associations between types of cataract--nuclear, cortical, posterior subcapsular, and mixed--and a number of physiologic, behavioral, environmental, and biochemical variables. Using polychotomous logistic regression analysis, we found an increased risk of cataract with lower educational achievement (all types of cataract), decreased cloud cover at place of residence (all types), use of aspirin less than once a month (posterior subcapsular and mixed), diets low in selected nutrients (posterior subcapsular, nuclear, and mixed), higher blood pressure (nuclear and mixed), lower body mass index (nuclear and mixed), use of cheaper cooking fuels (cortical, nuclear, and mixed), and lower levels of an antioxidant index based on red blood cell levels of glutathione peroxidase and glucose-6-phosphate dehydrogenase and plasma levels of ascorbic acid and vitamin E (posterior subcapsular and mixed). All risks cited were significantly different from those for the other cataract types, a finding that emphasizes the need to investigate the epidemiology of specific types of cataract.
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To determine the origin of sickle cell anemia (SS) in India, we analyzed haplotypes of the beta gene cluster in beta S-carrying individuals belonging to tribal populations living in the Nilgiris region of southern India and complemented the available data on tribes of east-central India. We found that in the Nilgiris tribes chromosomes bearing the beta S gene are linked in 91% of the cases to the "Asian" (Arab-Indian) haplotype (although 25% of the haplotypes had the epsilon polymorphic site negative, making the 5' portion of the haplotype identical with the African Senegal haplotype). These XmnI (+) chromosomes were associated with high G gamma expression (67.2 +/- 5.9%) and a high percentage of Hb F (15.5 +/- 7.9%; range, 6-25.3%). We have similar findings for tribal groups from west-central India (Gujarat). In east-central India we have confirmed the data of others, finding the same haplotype linked to beta S in tribes living in the east (Orissa, Andhra Pradesh). We conclude that the beta S gene in presently isolated and disperse tribal populations in India is associated with one predominant typical haplotype, suggesting a unicentric origin of the mutation in India. In addition, this finding implies a unicentric origin of the tribal populations themselves: The gene must have arisen and spread before tribal dispersion. Furthermore, we find extremely high frequencies of the (-alpha) haplotype in the Nilgiris (0.89) and in Gujarat (0.95). The beta S gene linkage to a high Hb F-expressing haplotype and the high incidence of alpha-thalassemia predict a mild phenotypical expression of sickle cell anemia in India.
Venom samples of Russell's viper (Vipera russelli) from three localities in India were analysed for their composition and toxicity. Column chromatographic fractionation on CM-Sephadex C-25 showed the absence of three fractions in the venom samples of southern India compared with the samples from northern and western India. The SDS-PAGE pattern of southern Indian venom samples also showed lack of three protein bands corresponding to molecular weights of 66,000, 39,000 and 9000. Venom samples from northern and western India possessed high acidic phospholipase activity while acidic phospholipase activity was absent in the samples from southern India, which in contrast showed large basic fractions with phospholipase activity. Proteolytic activity was present in all the venom samples; however, this activity, as well as trypsin inhibitor activity, was very low in the southern Indian samples. The ratio of proteolytic activity to inhibitor activity remained constant in most of the venom samples studied. LD50 values for most of the venom samples from northern and western India were twice as high as that of the samples from southern India. High phospholipase activity correlated with high lethal potency in the venom samples studied.
India is a vast subcontinent with 845 million peoples occupying 2.5% of land mass of the earth, but carrying 15% of the world population. It is a multiracial society with widely varying cultures, habits, languages and many different ethnic groups. The pattern of cancer, therefore, mainly depends on their habits and life styles apart from other variations. Head, Neck & Esophagus cancers in the male and cervix and breast cancers in the females are the main cancers. All together they form nearly 60% of all cancers. The incidence rates are around 90/100,000 though this is an underestimate as cancer is not a notifiable disease in India. It is estimated that by the year 2,000 there will be six million cancer patients in India at any given time with nearly 2 million new patients annually. The over-all facilities for cancer treatment vary widely from metropolitan cities to rural areas where 70% of the Indian population lives. In major cities, good to excellent treatment facilities exist in comprehensive cancer centres--yet in the rural setting the facilities are sketchy at best or non-existent at worst. The Government of India in its national cancer policy has recognized regional cancer centres and consolidated other existing centres. There are 10 regional cancer centres thus identified, each one at a different level of development. For optimal requirements at least 600 teletherapy units, (existing 150--not always functional) 100 departments of surgical oncology and an equal number of medical oncology divisions are needed (existing 20). The demand for cancer treatment facilities are, therefore, very high with poor available facility. Nearly 50% of patients present late for treatment and therefore appropriate education in prevention and early diagnosis are important factors. The Government of India through Ministry of Health has identified cancer as a major health problem by the year 2,000 and hence planning by the National Cancer Plan is operative in many States. Major cancer institutions (like the Tata Memorial Centre) have taken a lead to intensify the public and professional educational activities and have developed rural modules for primary and secondary prevention. The author exemplifies this by actual on the spot activities of the rural centre and stresses that in a country like India, the need is to develop small community cancer centres with the rural cancer effort as the base so as to reach out to the community for early diagnosis of treatment.
Kerala is a small, densely crowded state in South India. It is a poor state, even by Indian standards. Its per capita income of US$80 lies well below the all-India average of US$120, and it suffers from the lowest per capita caloric intake in India. Nevertheless, Kerala has managed to achieve the demographic transition from high (premodern) to low (modern) birth and death rates-something no other Indian state has been able to attain. Indeed, the magnitude of Kerala's fertility decline-the birth rate fell from 39 in 1961 to 26.5 in 1974-has never before been observed in a nation with comparable levels of income and undernutrition. Other indices of Kerala's soical development are equally surprising: levels of literacy, life expectancy, female education, and age at marriage are the highest in India, while mortality rates, including infant and child mortality, are the lowest among Indian states. But Kerala's anomalous and unexpected demographic trends and levels are not the result of the direct interventions designed to influence health and fertility levels elsewhere in India-conventional strategies of population control and health services delivery that thus far are notable for their failure to generate such positive results. Instead, Kerala's demographic levels evidently reflect a broad social response to structural reforms in its political economy.
The problems of alcoholism and drug addiction are major concerns in India. Alcohol and drugs were used in the past to obtain relief from pain and misery and to attain a state of forgetfulness. India is presently facing the problem of increased trafficking in drugs; heroin and hashish are supplied to the west through the subcontinent. Addiction has become a major problem in metropolitan centers. The Ministry of Welfare is responsible for drug abuse prevention programs and the rehabilitation of addicts. The Ministry of Health and Family Welfare is concerned with drug treatment. A deaddiction center, established at the All India Institute of Medical Sciences, became operational in 1988; it is responsible for health manpower training, research, and documentation. India has witnessed an exponential growth in the literature on drug abuse; it is no longer possible for a single library to acquire all of the international literature. There is a clear need to establish a drug abuse information center in India. This paper describes the aims, objectives, and planning for such a center and recommends the establishment of a national center in New Delhi with regional centers in other geographic areas.