040858   BASU S, ARORA E, SINGH M M, GARG S, BUDH N (Community Medicine Dep, Maulana Azad Medical Coll, New Delhi - 110 002, Email: aroraekta09@gmail.com) : Adherence to iron with folic acid supplementation in women attending an antenatal clinic at a low‑income urban area in Delhi, India. Indian J Community Fam Med 2020, 6(2), 120-4.

Adherence to Iron-Folic Acid Supplementation (IFAS) in pregnant women can safeguard them against nutritional anemia and the related adverse pregnancy outcomes. The objective of this study was to assess the adherence to oral IFAS in women attending an antenatal clinic in an urban resettlement colony of Delhi, India. We conducted a cross-sectional study and enrolled 211 antenatal women through consecutive sampling during a 4-month period from December 2018 to April 2019. IFAS adherent status was defined as women taking ≥80 % of their prescribed IFAS in the previous 7 days, equivalent to IFAS intake for at least 6 days in the previous week. We also estimated adequacy of IFAS drug stocks with the patient during the past 30 days. The data were analyzed using IBM SPSS Version 25. A P < 0.05 was considered statistically significant. The mean (± standard deviation) age of the women was 24.6 (±3.4) years, ranging from 19 to 35 years. Median years of education was 11, and all the women were currently married. A total of 54 (25.6) women reported being non-adherent to their prescribed IFA medication. Only 175 (82.9 %) women had adequate IFAS stocks during the past 30 days. On adjusted analysis, running out of IFAS stocks was a significant predictor of IFAS non-adherence (P = 0.004). The present study indicates that adherence to IFAS among pregnant women is suboptimal. Non-adherence was usually because of running out of drug-stocks but rarely due to drug side-effects.

1 table, 18 ref

040857   BHATIA V, PARIDA S P, MAHAJAN P B, PALEPU S, PAUL S (CM and FM Dep, All India Institute of Medical Sciences, Bhubaneswar, Odisha, Email: swayamaiims@gmail.com) : A discrepancy in logistics and supply chain management: Findings from national iron plus initiative process documentation in Odisha. Indian J Community Fam Med 2020, 6(2), 114-9.

Anemia is highly prevalent in India affecting all age groups. In 2016, process documentation program was done in Odisha by Department of Health and family Welfare, Government of Odisha with the aid of UNICEF and All India Institute of Medical Sciences, Bhubaneswar to assess National Iron Plus Initiative program. The objectives were to assess facilitating factors and hindrances in implementation of program. In the present study, hurdles in logistics and supply chain management are discussed. A mixed-methods study was done among four districts (3 poor performing and one good performing) based on Iron folic acid tablets consumption. Two blocks from Keonjhar and Jagatsinghpur and one block from Bhadrak and Kalahandi were selected. In depth interviews and Focus group discussion were done among 170 respondents (officials and beneficiaries). By probability proportion to size, 50 sub-centres were chosen and front line workers interviewed. Data was collected by survey team and analysis was done using Nvivo qualitative research software program for qualitative surveys and Microsoft Excel for quantitative surveys. It was seen that there were discrepancies in the method (bypassing officials), frequency of indenting (quarterly, bi-annual and annual), supply chain, stock out management (informal methods) and flow of supply (prolonged quarantine period). It was also seen that only 41% of sub-centres had IFA tablets at the time of survey. Logistics and supply chain management play a crucial role in the success of any program. Timely and orderly management, centralised method and formal approach need to be incorporated.

1 illus, 11 ref

040856   KUMAR D, BARWAL V K, SACHDEVA A, GUPTA A (Community Medicine Dep, IGMC, Shimla, Himachal Pradesh, Email: barwalvk@gmail.com) : External rapid convenience monitoring of measles–rubella campaign 2017 and lessons learned: Study from a hilly district of North India. Indian J Community Fam Med 2020, 6(2), 108-13.

The most recent vaccine incorporated in the Universal Immunization Program of India is measles-rubella vaccine, introduced as a catch-up campaign to eliminate measles and control rubella by the year 2020. The success of any immunization campaign lies on its meticulous planning for areas such as trainings, cold chain management, advocacy, and social mobilizations. Rapid convenience monitoring (RCM) was done in nine health blocks of a hilly district of Himachal Pradesh, pertaining to various campaign activities, for determining vaccine coverage and side effects. Standardized formats developed by the World Health Organization for RCM of the quality of activity at session sites which included information regarding vaccinating teams, immunization sites, logistics used, cold chain and aseptic condition management, waste disposal, and record maintenance were used. School and house-to-house visits were conducted randomly to check the indelible ink mark/vaccination cards to find out any missed child. A total of 107 immunization sessions were observed for compliance. We assessed 1182 children between the age group of 9 months and 15 years for determining vaccine coverage during the measles–rubella campaign in September–October 2017. Compliance to various aspects of the campaign was found very good, exceeding 90 % in almost all the domains. The total vaccination coverage was 98.1 %. Schools and health-care providers were the major source of information for this campaign. No severe adverse events following immunization were reported during the survey. Activity compliance and vaccination coverage were found high. Adequate supply of indelible ink pens and functional hub cutters needs to be ensured. There should be revision of incentives to team members with increased involvement of accredited social health activist workers in such campaigns.

3 illus, 4 tables, 14 ref

040855   DORA S, SINGH A K, PANDA P S, SAHOO J K (CMFM Dep, AIIMS, Bhubaneswar, Odisha, Email: cmfm_arvind@aiimsbhubaneswar.edu.in) : Inventory management of drugs at a secondary level health‑care center in Odisha. Indian J Community Fam Med 2020, 6(2), 104-7.

Planning the recurring purchases in the pharmacy results in efficient functioning of a health-care facility. Limited studies have explored the inventory management at secondary-care settings. The objective of this study was to analyze the annual drug expenditure of Community Health Centre (CHC), Tangi during the year 2017-2018. The annual procurement of, and expenditure incurred on drugs for financial year 2017-2018 drugs was analyzed at the secondary level CHC always, better, control (ABC) analysis, vital, essential, desirable (VED) analysis and combination matrix of ABC-VED which are inventory management techniques based on expenditure, criticality, and combination of both. Total expenditure for the year 2017–2018 on 232 drugs was 4,606,487 rupees. According to ABC analysis, Category A, B and C constituted 8.6 %, 19.4 %, and 72 % accounting for 70 %, 20 %, and 10 % of the total expenditure. VED analysis showed 21 %, 66 %, 13 % items as Vital, Essential, and Desirable, accounting for 14 %, 67 %, and 19 % of annual expenditure. On ABC-VED matrix analysis, 24.1 %, 66.8 %, and 9.1 % drugs were found to be Category A, B and C, accounting for 74.7 %, 24.6 %, and 0.7 % of annual expenditure. ABC-VED matrix analysis can be used for effective management of inventory at a secondary level healthcare centre.

3 illus, 4 tables, 9 ref

040854   AGARWAL I, YADAV K, RAMASWAMI G, RAI T (All India Institute of Medical Sciences, New Delhi - 110 029, Email: dr_kapilyadav@yahoo.co.in) : Role of ayurvedic intervention in the management of anemia. Indian J Community Fam Med 2020, 6(2), 93-103.

Anemia is an important public health problem in India. Complementary and alternative systems/traditional medicines can also be explored for the control of anemia apart from the existing platforms. Interventions with various herbal and iron formulations have been reported in Ayurveda. Hence, this review was aimed to explore the effect of various ayurvedic drugs on anemia from the existing literature. Literature was searched in PubMed, Google Scholar, Cochrane Library, Medline (Ovid), IndMed and by cross-referencing the articles. Key words used included “Pandu Roga,” “Anemia” and “Ayurveda.” The search was restricted to original research articles published in the English language from January 2005 to June 2018 among human subjects. Randomized and nonrandomized control trials were included in this review, which assessed the effectiveness of ayurvedic drugs on improvement in hemoglobin as well as subjective parameters such as weakness, anorexia, and pallor. Effectiveness of 17 different Ayurvedic preparations was assessed in the studies. The maximum increase in hemoglobin was observed by the drug Sarva-juara-hara-lauha in a dose of 500 mg (145.55 mg elemental iron), when administered daily for 30 days using honey as a vehicle. Increase in hemoglobin from 7.3 ± 1.9 to 12.1 ± 1.6 g/dL was observed. All studies that assessed the effect of the drugs on the basis of subjective parameters reported a decreased percentage of complaints by the patients. No adverse reactions were reported. In conclusion, administration of ayurvedic drugs is an effective and safe approach for prevention and management of anemia in various population groups. However, larger multicentric studies are required to assess the exact potential of these drugs in the control of anemia.

1 illus, 1 table, 34 ref

040853   SAYA G K, CHINNAKALI P, PREMARAJAN K C (Preventive and Social Medicine Dep, Jawaharlal Institute of Postgraduate Medicine and Research, Puducherry - 605 006, Email: sssgan@yahoo.com) : Determinants of COVID‑19 transmission in India: Issues and challenges. Indian J Community Fam Med 2020, 6(2), 88-92.

The recent increase in trend of COVID-19 cases in India is an important public health issue. Cases reported vary in calendar time in different states and regions. Case presentations, its determinants and mediators such as behavioral and social factors may be different across and within countries. Although agent, host and environmental factors play a major role, there are other influencing factors for transmission of infection. Appropriate cost-effective prevention strategies such as social distancing, use of face mask and its implementation in the Indian context is a big challenge. Recent data available on the public domain was reviewed on various issues and challenges related to determinants of COVID-19 and its transmission in the Indian context. This review emphasizes to further strengthen prevention of infection transmission strategies at regional and state level by a combination of multiple strategies and robust surveillance system.

29 ref

040852   SHRIVASTAVA S R, SHRIVASTAVA P S (Community Medicine Dep, Shri Sathya Sai Medical Coll and Research Institute, Tamil Nadu - 603 108, Email: drshrishri2008@gmail.com) : Understanding the trends of public spending on health sector: World Health Organization. Indian J Community Fam Med 2020, 6(1), 66-7.

Since the global leaders have adopted the Sustainable Development Goals, major steps have been taken by different nations to attain the goal of universal health coverage. Apart from the various measures which have been tried upon, due emphasis has been given to augment the financial allocation to the health sector and thus expand the reach of health care services. The findings of a recently released report have indicated a hike in the total health spending both in low- & middle-income nations and high-income nations. In the nutshell, it was reported that in excess of 50 % and 35 % expenditure on health has been through government sector and through out of pocket expenditure respectively. In conclusion, there is an immense need for an augmentation in the government spending on the health sector to minimize the health inequalities and the strengthening of the primary health care.

4 ref

040851   SHRIVASTAVA S R, SOWBHA C, SHRIVASTAVA P S (Community Medicine Dep, Shri Sathya Sai Medical Coll and Research Institute, Tamil Nadu - 603 108, Email: prateekbobhate@gmail.com) : A cross‑sectional descriptive study to assess the awareness of breast cancer and practice of breast self‑examination among rural women in Kancheepuram district. Indian J Community Fam Med 2020, 6(1), 61-5.

Breast cancer has been ranked as leading cancer across the world among women. The current study was done to assess the awareness about breast cancer and the practice of breast self-examination (BSE) among rural women in Kancheepuram district. A cross-sectional community-based descriptive study in the rural field practice area of a medical college was conducted for 2months. The sample size for the study was estimated to be 120 and systematic random sampling was employed. All women aged between 30 and 70 years of age were included in the study, and they were interviewed using a pretested semi-structured schedule. The knowledge responses were arbitrarily categorized as poor, fair, and good knowledge. Utmost care was taken to maintain privacy and confidentiality. Data entry was done in Microsoft Excel, and statistical analysis was performed using SPSS version 23.0. The mean age of the study participants were 47.2 ± 7.8 years, with the majority of women from 50 to 60 years age-group. Most of the study participants 102 (85 %) have heard about breast cancer, and positive family history and inadequate breastfeeding were identified as the most common risk factors. Only 4 (3.3 %) women were practicing BSE and even among them none of them were doing it regularly. Factors like women being not aware of what to look for or how to perform it were the main barriers preventing them from doing BSE. In conclusion, 51 (42.5 %) women had good to fair knowledge about breast cancer, whereas only 20 % of the study participants were aware about BSE and its role in early detection of breast cancer. These findings clearly indicate that intensive efforts have to be taken for the advocacy, communication, and social mobilization to enable early detection of breast cancer among these underprivileged women.

3 tables, 20 ref

040850   MADHUSUDAN M, PUTTASWAMY S B, KRISHNA K M A, FARSANA P K, ANGELA A S, MUNEER I, THOMAS T (Community Medicine Dep, DM Wayanad Institute of Medical Sciences, Wayanad - 673 577, Kerala, Email: drsudhibp@gmail.com) : Stress, its determinants and its association with academic performance among the students of a medical college in Kerala. Indian J Community Fam Med 2020, 6(1), 56-60.

Medical education is one of the most stressful academic curricula worldwide, negatively affecting the health of medical students. Stress in medical students if not tackled in time, can have professional ramifications, as well as personal consequences. Hence, in this background, this study was undertaken to find out the prevalence of stress among medical students, its determinants and its association with academic performance. This was a cross-sectional study done at a medical college, Wayanad district, between January and June 2019. All the undergraduate medical students of the college were the study subjects. Data were collected using a predesigned and pretested self-administered questionnaire, the first part of which had questions pertaining to basic sociodemographic details, factors affecting stress, and their academic performance, and the second part was the Medical Student Stress Questionnaire. Completed responses were obtained from a total of 605 students. About 29.8 %, 53.6 %, 16.7 % and 0 % were found to have no/mild stress, moderate stress, high stress and severe stress respectively. The prevalence of moderate/high stress was more among 25–26 years, males, married, Phase I MBBS, government quota, Muslim, urban origin, and day scholar students. However, only religion and place of origin were found to have a significant association (P = <0.01 and 0.048 respectively). The median stress score was highest for the academic domain 1.5 and least for drive and desire related and group activities related domain (1 for both). There was a very weak positive correlation (r = 0.007) between the percentage of marks obtained and total stress scores, and the correlation was found to be statistically insignificant (P = 0.868). The prevalence of stress among the participants was low. Muslim religion and urban origin were found to have a significant association with the prevalence of moderate/high stress. There was a very weak positive correlation between the percentage of marks obtained and total stress scores.

4 tables, 14 ref

040849   NAYAK M S D P, NARAYAN K A (Community Medicine Dep, Dr. NTR Univ of Health Sciences, Prakasam - 523 001, Andhra Pradesh, Email: sivadurgaprasadnayak@gmail.com) : Selection of urban health equity assessment and response tool indicators using item response theory analysis to assess a city health profile in India. Indian J Community Fam Med 2020, 6(1), 47-55.

City health profile is a useful tool for understanding the health gap and to plan to close the health gap. Of the different tools available to draft a city health profile, the Urban Health Equity Assessment and Response Tool (HEART) developed by the WHO Kobe Centre is one of the best among them. A list of core indicators of the Urban HEART varies from country to country. In this scenario, an attempt was made with an aim to choose feasible indicators in the Urban HEART to assess a city health profile in Indian setting. The current study is a cross-sectional observational study conducted among different public health experts in India using an online survey technique. An online survey form was created to collect the public health expert’s opinion and sent to public health experts. A total of 105 responses were collected. The average opinion score for each indicator was measured. Item response theory analysis technique was used to calculate the feasibility score to categorize the indicators. The average score of the 60 indicators ranged from 4.54 to 2.77. The feasibility score ranged from 4.13 to − 0.49. Of 60 indicators, 16 indicators were strongly recommended, 41 were recommended, and 3 indicators were optional indicators. Nineteen were highly feasible, 28 feasible, and 13 were less feasible indicators. The Urban HEART can be applied in Indian setting. Data collection can be started with feasible indicators and later can be extended to other indicators.

1 illus, 3 tables, 26 ref

040848   ANNADANI R R, BHAT S K, UNDI M (Community Medicine Dep, Karwar Institute of Medical Sciences, Karwar - 581 301, Karnataka, Email: malatesh.u@gmail.com) : A study to assess the magnitude of exposure to secondhand smoke among antenatal mothers in an urban slum of central Karnataka. Indian J Community Fam Med 2020, 6(1), 41-6.

Secondhand smoke (SHS) exposure in reproductive-age women can cause adverse reproductive health outcomes similar to active tobacco smoking such as pregnancy complications, fetal growth restriction, preterm delivery, stillbirths, and infant death. Nearly 56 % of the reproductive-age women in the World Health Organization South-East Asian region are exposed to SHS. However, no data is available on exposure to SHS among pregnant mothers, especially in urban slums. The objective was to assess the magnitude of exposure to SHS among antenatal mothers in an urban slum and their knowledge regarding hazards of exposure to SHS on them and fetus. After obtaining ethical clearance, 418 antenatal mothers who visited the antenatal clinic in an urban slum were included. Data regarding exposure to SHS were collected. Their knowledge on hazards of exposure to SHS on both mother and fetus was also collected. Majority were in the age group of 21–25 years (55.5 %), studied up to high school (40.7 %), and were homemakers(72.1 %). Among the 418 antenatal mothers, 277 (66.27 %) were exposed to secondhand smoke; 199 (47.61 %) at public places, 53 (12.68 %) at their homes, and 25 (5.98 %) at their workplaces. Only half of the study participants were aware that SHS is injurious to health of the individual, and only 24.4 % of the study participants were aware that SHS is also injurious to fetal health. Exposure to SHS among the study participants was high (66.27 %), and the awareness regarding the harmful effects of SHS on the health of the mother and fetus among the participants was poor.

6 tables, 15 ref

040847   NINAMA K S, HATHILA P M, BALA D V (Community Medicine Dep, Smt. NHL Municipal Medical Coll, Ahmedabad - 380 006, Gujarat, Email: drpar_2006@yahoo.com) : A study on epidemiological determinants of malnutrition and health status of under‑5 children in the field practice area of rural health training center. Indian J Community Fam Med 2020, 6(1), 34-40.

Malnutrition is the condition that results from eating a diet in which certain nutrients are lacking, in excess, or in the wrong proportions. Child is the victim of interplay of nutrition, socioeconomic (SE), and health factors that cause malnutrition. The aim is to study the epidemiological determinants of malnutrition and health status of under-5 children. The present cross-sectional study was carried out in 600 under-5 (0–59 months) children from March 1, 2012 to July 31, 2013, in Rural Health Training Center field practice area by house-to-house survey till the desired sample was achieved. Sociodemographic information, mother’s obstetric history, clinical examination, and anthropometry measurement of under-5 children and immunization status (either by history or by available medical records) was obtained. Majority (534 [89 %]) of children were Hindus, from lower SE Class III and IV, 337 (56.2 %) and 193 (32.2 %), respectively. Sex ratio was 980 females/1000 males. Quarter (122) of the children belonged to age group 0–11 months followed by 138 (23 %) and 123 (20.5 %) from 12 to 23 months and 48–59 months, respectively. The prevalence of wasting, stunting, and underweight was 151 (25.2 %), 237 (39.5 %), and 223 (37.2 %), respectively. Acute morbidity rate was observed to be 47 (7.8 %). Full immunization appropriate for age was 537 (89.5 %). Under-5 mortality rate was 30/1000 under-5 years children per year (n = 18). Prevalence of malnutrition was high in males and lower SE Class (III and IV). Acute morbidity was higher in males than females.

6 tables, 28 ref

040846   PEDAPUDI A D, DAVIS R A, ROSENBERG P, KOILPILLAI P, BALASUBRAMANYA B, JOHNSON A R, KUMAR A, MENEZES L (Community Health Dep, St. John’s Medical Coll, Bengaluru - 560 034, Karnataka, Email: avita@johnson.in) : Overweight and obesity among school‑going adolescents in Bengaluru, South India. Indian J Community Fam Med 2020, 6(1), 28-33.

Adolescent obesity is an emerging public health problem in urban India. This study assessed the prevalence of overweight and obesity and its associated factors among school-going adolescents in Bengaluru, India. Cross-sectional study of 734 male and female students aged 10 years and older from two private schools in Bengaluru city, India. Students were administered a questionnaire that recorded socioeconomic, and family-related factors and lifestyle behaviors. Anthropometric measurements done to determine overweight and obesity using the WHO body mass index for age charts. Nominal variables were described in terms of frequency and proportion, and odd’s ratio (OR) (with 95 % confidence interval) as test of association. The prevalence of overweight and obesity among adolescents was 21.7 % and 6.1 % respectively. Age, gender, religion, education level of parents, mother working outside the home, participation in vigorous physical activities, vegetarian diet, and consumption of junk foods as snacks were not found to be significantly associated with overweight/obesity. The prevalence of overweight/obesity among school-going adolescents in Bengaluru, India was 27.8 %. Adolescents from the higher income families, OR = 2.35 (1.43–3.85) as well as students who indicated a family history of obesity, OR = 2.4 (1.72–3.33) were more likely to be overweight or obese. Since young adolescents spend a significant portion of their day in school, a comprehensive school health service including growth monitoring, nutrition education, and exercise programs remains one of the most cost-effective public health measures.

1 illus, 2 tables, 36 ref

040845   YADAV S, KHOKHAR A (Community Medicine Dep, Vardhman Mahavir Medical Coll and Safdarjung Hospital, Gautam Nagar, New Delhi, Email: dr.srishti@yahoo.in) : Effect of information, education, and communication activity on health literacy of obesity and physical activity among school‑going adolescents in Delhi. Indian J Community Fam Med 2020, 6(1), 22-7.

Awareness about risk factors of lifestyle diseases such as obesity and lack of physical activity is present among adolescents but to some extent only. Furthermore, younger ones tend to maintain the unhealthy habits as they age. Thus, intervention should start at an early age. This study was conducted to assess the health literacy of school-going adolescents regarding obesity and lack of physical activity as risk factors for lifestyle diseases and assess the improvement in their knowledge after different information, education and communication (IEC) activities in two schools. It was a school-based interventional study conducted in two schools. Pretested questionnaire for baseline and post-IEC activity assessment of health literacy of risk factors like obesity and physical inactivity in lifestyle diseases was administered among students of Class 6, 7, and 8. Postintervention data were collected at 2 weeks after the first intervention and 3 months after the last intervention. Responses were scored and categorized as satisfactory and unsatisfactory. Chi square test was applied to compare the proportion of scores (satisfactory and unsatisfactory) at baseline, 2 weeks and 3 months. About 64 % students in school 1 and 69 % students in school 2 knew what obesity was. Moreover, about 79 % of students in school 1 and 69 % students in school 2 knew the minimum duration of physical activity required to prevent lifestyle diseases. There were a higher proportion of students with a satisfactory level of knowledge in both the schools after 2 weeks and 3 months of IEC activity, and the differences were statistically significant (P < 0.05). The proportion of students having satisfactory knowledge satisfactory knowledge of obesity and physical activity increased after educational interventions among school-going adolescents of both the schools.

6 tables, 16 ref

040844   KUMAR P, BHAR D, SINGH G, AHMAD S (Community and Family Medicine Dep, All India Institute of Medical Sciences, Patna, Bihar, Email: bharditipriyaa@gmail.com) : Assessment of mental health status using patient health questionnaire‑9 in patients attending outpatient department at a block primary health center in Patna, Bihar. Indian J Community Fam Med 2020, 6(1), 17-21.

Identification of untreated depression could be a chance of opportunity in outdoor settings. Earlier findings show a high proportion of depression among patients visiting outdoor at the tertiary level of care. We want to estimate its burden in an outdoor setting at the primary level of care. he current study was a facility-based cross-sectional study which was conducted for 3 months at a primary health center (PHC) in a rural area of Patna (Naubatpur), Bihar. Patient health questionnaire (PHQ)-9, along with sociodemographic variables, was included in the development of a semi-structured questionnaire. A trained data collector took one-to-one interview using this questionnaire. The proportion of male and female were almost equal (49 % vs. 51 %). The mean age of the study subjects was 38.80 ± 13 years. Most study subjects were suffering from depression (59.60 %). One-third of them had mild, one-fourth had moderate, and rest had a moderately severe and severe category of depression. The mean score was 6.67 ± 5.08. In mild to the moderate category of depression, higher age group of the study subjects was more affected. In the severe category of depression, younger age group was affected worse. The prevalence of depression was almost doubled in females as compared to males in all category of depression, and this was statistically significant. The prevalence of moderately severe depression was highest in the study subjects who were illiterate. PHQ-9 can be used at PHC to screen the patients with depression.

1 illus, 3 tables, 10 ref

040843   PURI S (Community Medicine Dep, Government Medical Coll and Hospital, Sector 32, Chandigarh, Email: soniagpuri@gmail.com) : SARS COVID‑19 crisis – developing nations to emulate what?. Indian J Community Fam Med 2020, 6(1), 13-6.

A new public health crisis, SARS COVID 19/2019 novel coronavirus has engulfed the world in no time causing enormous affliction and mortality, collapsing health care, social devastation, and economic Wreck down. Developing nations are affected disproportionately more in contrast to developed nations. The purpose of this article is primarily to highlight the time tested strategies which must be emulated by developing nations in view of resource and time constraints.

25 ref

044679   SUDHEER A, RANI K, KUMARI A, SINGH A K, KUMAR A, SINGH K (Oral Medicine and Radiology Dep, Buddha Institute of Dental Science, Patna, Bihar, Email: yadavkhusbu40@gmail.com) : Morphological variation of the nasopalatine canal: A cone beam computed tomography study. J Indian Acad Oral Med Radiol 2020, 32(1), 27-30.

To assess the morphological variation of the nasopalatine canal (NPC) concerning age and gender. To assess the correlation between the gender and morphology of the canal. To assess the correlation between age and length of the canal. This is a retrospective, randomized observational study. The study comprised of 50 CBCT scans of maxilla showing NPC completely. The scans were obtained in the department during the period ranging from December 2018 to June 2019. The patients were in the age range of 15–75 years. Scan of 22 females and 28 males were included in the study. Patient below 15 years of age and NPC pathology or impacted teeth in same region were excluded in the study. The scans were obtained using ICAT17‑19 machine and analyzed Vision software. Cone‑Beam 3D Imaging machine operating at 120 kvp, 37.07 mAs with 0.25 mm voxel size, and a field of view of 16 × 6 cm maxilla. Nasopalatine canal has 4 different morphological shapes. The most common shape was the cylindrical shape amongst both males and females. The least common shape was found to be hourglass shape with increasing age the length of NPC was found to decrease. The length of the canal was found to be longer in males when compared to females. This study highlights the importance of NPC morphology before or during surgical procedures involving the maxilla.

1 illus, 5 tables, 12 ref

044678   RAMASWAMY P, SAIKIRAN C, RAJU B M, SWATHI M, TEJA D D (Oral Medicine and Radiology Dep, St.Joseph Dental Coll, Eluru, Andhra Pradesh, Email: tejadouluri@gmail.com) : Evaluation of the depth of submandibular gland fossa and its correlation with mandibular canal in vertical and horizontal locations using CBCT. J Indian Acad Oral Med Radiol 2020, 32(1), 22-6.

Dental implant is the most preferable option for the replacement of missing teeth because of its advantage of maintaining the structural and functional integrity of bone, like that of a natural tooth. Aim of this study is to evaluate the depth of submandibular gland fossa and its relationship with the mandibular canal, based on gender and side of the mandible. 100 CBCT scans of both males and females were acquired. The deepest region of submandibular gland fossa and the superior, parallel, and the inferior relationship of the mandibular canal to submandibular gland fossae were obtained. The mean ± SD of the depth of the submandibular gland fossa on the right side in males and females were 1.69 ± 0.73 mm and 1.62 ± 0.58mm, respectively, and those on the left were 1.69 ± 0.61 mm and 1.56 ± 0.42 mm, respectively. The deepest region in both the genders was above the infra‑alveolar canal. Males showed greater depths when compared to females, Right side of the mandible showed greater depth when compared to the left side in both genders. Therefore, careful evaluation of alveolar bone thickness during implant placements is of great importance in males.

6 illus, 2 tables, 14 ref

044677   SHROFF N B, MOTGHARE P C, KUMBHARE S P, KALASKAR A R (Oral Medicine & Radiology Dep, Government Dental Coll & Hospital, Nagpur, Maharashtra, Email: nikhila15.shroff@gmail.com) : Correlation of mandibular gonial angle and mandibular angle fracture: A radiographic study. J Indian Acad Oral Med Radiol 2020, 32(1), 17-21.

The purpose of the study was to evaluate the correlation between mandibular gonial angle and mandibular third molar with the risk of mandibular angle fracture. Materials and Methods: The study sample consisted of 294 orthopantomograms (OPG) of mandibular fracture. The sample was broadly divided into two groups, i.e. angle fracture group and non‑angle fracture group. Gonial angle was measured digitally using software IWCR ROCKEY version 3.2 and status of third molar was assessed in the angle fracture group.  The mean age of the patients is 30.29 ± 8 years. Out of 294 OPGs, 226 were non‑angle fracture and 68 were angle fracture. The mean gonial angle of patients in angle fracture group was 117.91 ± 7.74 °, which was 0.9 ° larger than the non‑angle fracture group (mean 117.03 ± 8.43; P = 0.4427). The third molar was present in 88 % of angle fractures and 57 % were impacted molars.  There was no correlation between high gonial angle and mandibular angle fracture. Impacted third molar can be one of the risk factors for mandibular angle fracture.

7 illus, 2 tables, 29 ref

044676   KATARIA A P S, KONIDENA A, PURI G, PATIL D J, GUPTA R ( Oral Medicine and Radiology Dep, Swami Devi Dyal Hospital and Dental Coll, Barwala, Haryana, Email: karavinda1@gmail.com) : Reliability of digitized cheiloscopy, dactyloscopy and combination approach for gender identification – A comparative study. J Indian Acad Oral Med Radiol 2020, 32(1), 9-16.

The oral cavity allows for a numerous prospects for personal identification of subjects. Dental profiling, palatoscopy, cheiloscopy had enabled in nailing the suspects in addition to traditional methods like anthropometry, finger prints, blood groups, DNA analysis. The aim of this study is to assess the reliability of digitized lip prints, finger prints and combination approach in gender determination in Panchkula population. A total of 500 healthy subjects, (250 females and 250 males) aged 20 to 30 years of both genders were recruited and evaluated. Lip prints were obtained by painting lip stick and using cellotape to take the impression, while finger prints were obtained by fingerprint rolling technique. Scanned images of the obtained lip and finger prints were analyzed according to Suzuki K and Tsuchihashi Y and classification by Cummins and Midlo, respectively, using applications of ‘Adobe Photoshop 7’ software. Finger print analysis correctly classified gender in 52.6 %, but was not statistically significant (Canonical correlation = 0.117, P = 0.230) Lip print analysis correctly identified gender in 64.8 % and was statistically significant (Canonical correlation = 0.350, P < 0.001). When a combination approach was used, the gender was correctly identified in 65.8 % and was statistically significant (Canonical correlation = 0.369, P < 0.001). Although not a 100 % accurate method, the combination method was found to be more accurate and thus can be used as a supplementary tool in sex determination.

4 illus, 7 tables, 20 ref

044675   KHATOR A M, MOTWANI M, SHARMA A, SINGH J, SAYYED F, SOLANKI M (Oral Medicine and Radiology Dep, Vspm’s Dental Coll, Nagpur, Maharashtra, Email: apurvakhator@gmail.com) : A study to evaluate the knowledge and belief regarding tobacco consumption among the non teaching staff members working in four heath institutes in Hingna. J Indian Acad Oral Med Radiol 2020, 32(1), 4-8.

In a developing country like India, where illiteracy is high, tobacco is the leading cause of mortality estimated to have killed hundreds of people. The emergence of tobacco‑related diseases is a growing public health problem. The increased risks for diseases like cardiac diseases, lung cancer, oral and pharyngeal cancers, and tuberculosis are shared by both men and women who consume tobacco. One in two males and one in ten females in India use tobacco in some or the other form. A large number of awareness programs are conducted especially in the health institutes regarding ill effects of tobacco, despite which it is observed that the non‑teaching staff members working in the same institutes are regularly consuming tobacco. Therefore, this study is being carried out to assess the level of knowledge regarding the same in these people (non‑teaching staff members) who mainly belong to the lower socioeconomic group. To evaluate the level of awareness regarding tobacco consumption among the non‑teaching staff members of four health institutes in Hingna. The study was interview based using a validated questionnaire consisting of closed‑ended questions to evaluate the knowledge regarding tobacco consumption among the non‑teaching staff members of four health institutes (medical, dental, physiotherapy, and nursing colleges in Hingna). A trained interviewer interviewed one subject at a time in person and the questions were asked in Marathi or Hindi depending on subjects’ choice. The study population included 600 non‑teaching staff members (300 males and 300 females) irrespective of their age. Out of the total 600 subjects, the number of people who consumed tobacco was 387 of which 175 were females and 212 were males. It was evident from the results of the questionnaire study that even though moderate amount of awareness was present among the non‑teaching staff members, they still did not refrain from the use of tobacco.  Awareness programs must be undertaken to educate the non‑teaching population about the ill effects of tobacco consumption and further studies should be undertaken to evaluate a larger number of people.

5 illus, 7 ref

044674   DAS A, CHAKRABORTY A, SUKUL B ( Forensic & State Medicine Dep, Medical Coll, West Bengal, Email: dranamikachakraborty@gmail.com) : Learning styles of undergraduate medical students – A cross sectional study using VARK questionnaire. J Indian Acad Forensic Med 2020, 42(1), 49-53.

Learning is an individual's way of perceiving, processing and retaining new information. VARK (Visual, Aural, Reading/writing and Kinesthetic) is a tool for assessing learning style. VARK study helps in assessing learning preference of students and guide teachers to modify their teaching approach to enrich the domains of learning namely knowledge, skill, attitude and communication according to AETCOM, thus aiding implementation. To find out preferred learning style in the study population and to ascertain genderwise variation of preference. A cross-sectional prospective study in Department of Forensic & State Medicine, Medical College Kolkata was performed on 4th semester students over two months. All the students present in demonstration classes during data collection and gave their consent to take part in study were included. A pretested and validated VARK questionnaire (version 3) containing 13 questions were distributed among undergraduates. Data collected were evaluated according to proposed evaluation guideline dividing into 4 predominant groups namely 'V', 'A', 'R', 'K'. Total 192 students, (Male=116, Female=76), response rate 73 %, aged between 19-25 years participated, among which females were 'R” and males 'K' predominant. Batch wise preference analysis showed on Monday and Friday batch was 'A' and other batches were 'K'. Kinesthetic was the most one all over, reading/writing being the second, auditory third and visual the fourth. Bimodal and trimodal responses were also found in few and 'RK' was most common. This study for implementation of competency based medical education (AETCOM) is first of its kind which is helpful to start new MBBS curriculum in a more effective approach.

6 tables, 11 ref

044673   BHANARKAR U, KOLEY B (Anatomy Dep, ICARE Institute of Medical Science and Research, Haldia, West Bengal, Email: kbaishakhi@gmail.com) : Study of Cephalic Index in medical students of West Bengal. J Indian Acad Forensic Med 2020, 42(1), 44-5.

Human beings are always very much interested in making comparison over other creatures to prove their superiority. Different types of measurements are important tool for comparative study, related to various characteristic features. Craniofacial measurement especially cephalic index is an important tool among those comparative studies, useful in determining different head and face shapes. Present study is going to be carried out with an objective to find out Cephalic Index of Medical Students of West Bengal. Total 325 young and healthy medical students were taken as subjects, whose head length, head breadth were measured. Cephalic indices of the subjects were calculated by Hrdlicka's method. Most of the subjects were found mesocephalic, 59 % male & 51.7 % female. Mean cephalic index in male 78.45 % ± 2.44 and for female 77.65 % ± 3.58. Mean cephalic index irrespective of gender was found 80.5 % ± 3.67. This study showed the head type of students in West Bengal was mesocephalic predominant. This statistically significant data can be utilized by anthropologist or forensic expert.

2 tables, 17 ref

044672   HASHAM S A , KOTIAN R P, MADHAVAN T S (Radiology Dep, Agah Khan Hospital, Tanzania, Email: madhavan.ts@manipal.edu) : Comparison of morphological measures of nasal bone between genders using computed tomography. J Indian Acad Forensic Med 2020, 42(1), 40-3.

Facial anthropometry plays an important role in forensic investigations especially in identification of decomposed bodies from skeletal remains. Dimensions of nasal bone is one such parameter that can be used to determine sex. The main aim of the study is to compare the morphological measures of nasal bone between genders using computed tomography. This is a retrospective study on the patients visiting the Dept. of Radiodiagnosis and Imaging, Kasturba Hospital, Manipal. Based on the inclusion and exclusion criteria, 240 subjects (120 males and 120 females) who were referred for routine CT OMC were included in the study. The axial sections were converted into coronal and sagittal slices using the multiplanar reconstruction tool. Three anthropometric parameters were measured. A total of 240 (120 males and 120 females) data was obtained with age group ranging from 20-50 years. Mean and Standard deviation was calculated. The data was normally distributed hence independent sample T test was performed to find the difference between males and females. Null hypothesis stated that there was no significant difference based on the anthropometric measurements between the males and females since the (p>0.05). Alternate hypothesis stated that there is significant difference noted between the males and females(p<0.001). In present study, three measurements of the nasal bone were taken such as the nasofrontal angle, pyramidal angle and the linear distance out of which two variables i.e. the pyramidal angle and the linear distance were good discriminators which contributed high accuracy in comparison to the other parameter.

4illus, 1 table, 9 ref

044671   SHARMA N, ROHATGI S, PURI P (Amity Univ, Noida, Uttar Pradesh, Email: shiprarohatgi8@gmail.com) : Potential use of cranial morphology in identification of monozygotic twins: A preliminary study. J Indian Acad Forensic Med 2020, 42(1), 36-9.

Twins occur in about 1 in 85 human birth. Monozygotic twins are thought to be genetically indistinguishable yet can show high variability in their phenotypes. This difference and variability may be attributed to the various parameters like external factors and the role of epigenetic polymorphism. This paper aims at studying the various cephalometric measurements on the lateral cephalogramsto aid the investigators in identification of identical twins. A study on ten pairs of twins lateral cephalogram was performed in order to examine the cephalometric landmarks of cranium under controlled condition. After a thorough metric analysis, it can be stated that there are considerable variations in cephalometric dimensions of monozygotic twins.

1 illus, 1 table, 18 ref

044670   GUPTA S, PAREKH U, BHATT C (Forensic Medicine Dep, Pramukhswami Medical Coll, Karamsad, Gujarat, Email: drsanjaymdfm@gmail.com) : Routine preservation of viscera: Is it really required? A Study from Gujarat, India. J Indian Acad Forensic Med 2020, 42(1), 33-5.

At most centers, viscera are routinely preserved in four jars, which involve multiple resources in terms of money, manpower and time. The present study was intended to examine & evaluate the reports of chemical analysis with a hypothesis that if blood tests alone are equivalent to chemical analyses, then the need of viscera preservation may be abandoned. The study was conducted at S. K. Hospital and P. S. Medical College, Karamsad, Gujarat, India. Data were collected from poisoning cases in which autopsy examination was conducted during 2011-15 and routine viscera were preserved in four jars for chemical analyses. Details about their demographic profile, autopsy observations and chemical analysis report findings were incorporated in the validated proforma. Out of 121 alleged cases of poisoning where routine viscera were collected for chemical analyses, 116 cases reported positive findings. Of those 116 cases, blood testing was positive in 101 cases. The remaining 15 poisoning cases were not routine ones. The present study suggests and recommends that sending only blood samples for chemical analyses in place of routine preservation in autopsy poisoning cases will not only satisfy the purpose, but will also be less resource intensive. In some specific cases as per the discretion of the Forensic Expert, viscera can also be sent along with blood

2 tables, 9 ref

044669   BANSAL A, GUPTA R, SINGH P, SUNITA, KAUR G, KAUR K, KAUR S, KAUR D (Chemical Examiner Laboratory, Mohali, Punjab, Email: abheybiochem@gmail.com) : Pattern of substance or drug abuse in cases reported by chemical examiner laboratory, Punjab, India. J Indian Acad Forensic Med 2020, 42(1), 29-32.

Punjab in the northern part of India has been facing a drug or substance abuse (mainly of heroin, commonly known as chitta in Punjab) in recent years, resulting in considerable harm both to the individual and to the society. Drug abuse refers to the inappropriate (e.g., using chemicals that are never intended to be put into the body like glue sniffing), usually excessive and self-administration of a drug, any other chemical or illegal substance to affect the mind and body for a non-medical purpose. The geographical location of Punjab also contributes to the increasing problem of drug abuse. Drug abuse is also associated with crime. The analysis of available data was conducted from January to September 2018. During this period, 82 viscera cases were received by Chemical Examiner Laboratory (CEL) with a history of suspected drug abuse/drug overdose. After analysis by seven analysts, morphine, a metabolite of diacetylmorphine (the active ingredient of heroin), was found to be the most common drug. These statistics can be helpful for the government and various public health agencies to identify emerging trends of drug abuse in the state so that they can better target prevention measures.

4 tables, 15 ref

044668   YADAV P K, KUMARI S, VERMA A K, SINGH R, RUPANI R, SHIULI, CHAUDHARY R, SINGH M (Forensic Medicine Dep, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, Email: mousamisingh@kgmcindia.edu) : Epidemiological profile of fatal burn cases in tertiary care centre of Lucknow: An observational study. J Indian Acad Forensic Med 2020, 42(1), 24-8.

Burn is one of the most common injuries which has been recognized as public health problem. It affects nearly every population and every geographical zone in the world and have always been considered as one of the most destructive injuries, causing not only morbidity and mortality but also major economic and psychological impacts. This study intends to explore the medicolegal aspects and recent epidemiological trends of burn cases. This is an autopsy based cross sectional observational study from a period of August 2015- July 2016 and was carried out in the department of Forensic Medicine and Toxicology, King George’s Medical University, Lucknow, Uttar Pradesh. Cases were thoroughly studied using specially designed proforma that include demographic profile of deceased, history from relatives, police and hospital records and autopsy findings. A total of 550 burn cases were studied for which significant information regarding epidemiological and medicolegal aspects have been obtained. Out of 550 cases, majority were females 70.18 %. Male: Female ratio was 1:2.35. The age of the victims ranged from age 7 months to 84 years and mean age was 28.98+11.65 years. Most common affected age group was 21-30 years (47.45 %). Majority of cases were married. A statistically significant (p=0.019) higher proportion of married cases were found among female. Majority of the cases were housewives (60.97 %), followed by students (15.80 %), farmers (11.52 %), businessmen (4.83 %) and laborers (4.46 %). Majority of the cases, 82.55 % occurred at home and only 2.91 % at workplaces, rest 14.55% cases occurred elsewhere. The majority of the cases occurred in Summer and Winters seasons (38.91 %and37.91 %), while least number of cases were seen during Monsoon season (6.36 %). Majority of burn injuries were found to occur between 2:00 pm -10:00 pm. Flame was the most common type of causative agent in males as well as in females, however difference in causative agent of burn injuries of female and male cases was found to be statistically significant (p80% (36.73%), while in 2.18% cases %TBSA was 1-20 %. Commonest manner of death among burn injury cases was found to be accidental. And also, among accidental cases, proportion of males was higher than females, while proportion of females was higher in homicidal and suicidal cases. This study highlights the parameters that should make the clinician reassess the course of treatment, warning that the patient might be critically near death. For example, the probability of sepsis increases with prolonged ICU stay. Patient's age and % TBSA affect the mortality of post trauma victim.

6 tables, 34 ref

044667   KULKARNI P R, NARAYANA K S, KOTABAGI R B, MALED V (Forensic Medicine Dep, SDM Coll of Medical Sciences and Hospital, Dharwad, Karnataka, Email: pratibha_ak@rediffmail.com) : Pattern and distribution of skeletal injuries in victims of fatal road traffic accidents. J Indian Acad Forensic Med 2020, 42(1), 20-3.

Globally, road traffic accidents are increasing at an alarming rate, with victims usually sustaining multiple injuries, with skeletal injuries being one of the commonest injuries with increased mortality rates secondary to vital organ injuries and massive haemorrhage. The present study assesses the pattern and distribution of skeletal injuries in victims of fatal road traffic accidents and its relationship with cause of death. We found that majority (51 %) of the victims were aged between 21-40 years with male preponderance (83 %). Motorcyclists were the most common victims (53 %), followed by pedestrians (18 %). Most common sites of fractures were of the skull (74 %), ribs (43 %) and lower limb bones (18 %). Forty percent of cases succumbed to injuries within 24 hours of accident. Most common cause of death was head injury (71 %), followed by haemorrhagic shock (18 %). Skull fracture was present in 95.78 % of victims who died of head injury.

4 tables, 12 ref

044666   CHAWLA H, TYAGI A, KUMAR R ( Forensic Medicine & Toxicology Dep, SHKM Govt. Medical Coll, Nuh, Haryana, Email: drhiteshchawla@gmail.com) : Reliability of Glasgow Coma Scale in Traumatic Brain Injury: A retrospective analysis. J Indian Acad Forensic Med 2020, 42(1), 17-9.

Glasgow Coma Scale is a valuable tool in the monitoring and management of traumatic brain injury. Still the reliability of GCS is suspected. A retrospective analysis was undertaken to assess the reliability of GCS recorded in head trauma cases by comparing the initial GCS score recorded following hospitalization and last GCS documented prior to death. Hospital record of sixty cases that had been hospitalized and died of traumatic head injury during treatment was analyzed, over a period of two years. The initial GCS score at the time of admission and last GCS score recorded preceding the death of patient was studied. McNemar-Bowker test was applied for symmetry around the diagonal of the table and Wilcoxon signed-rank test was used to analyze the statistical significance between the initial and last recorded GCS scores. The change in GCS score from initial to last record examined by applying the McNemar-Bowker statistical test and found to be significant (p 0.016). The distribution of median from initial to last GCS record assessed by non- parametric Wilcoxon Signed Ranks test and was found statistically significant (p 0.001). To endure the reliability of GCS and to make it more efficacious, teaching and training in evaluating GCS to its users across relevant disciplines has to be imparted on regular basis. It will improve inter-rater reliability. Standard operating procedures to be formulated for applying standardized stimuli for assessing pain response.

2 tables, 22 ref

044665   CHAPHALKAR K N, KHANDEKAR I, TIRPUDE B H (Forensic Medicine and Toxicology Dep, MGIMS, Sevagram, Maharashtra, Email: khandekar@mgims.ac.in) : A retrospective analysis of project undertaken to curtail the number of post-mortem examinations based on Section 174 CrPC with respect to burn injuries. J Indian Acad Forensic Med 2020, 42(1), 13-8.

A project was implemented at MGIMS, Sevagram from 2016 onwards based on Section 174 CrPC to curtail the avoidable cases of post-mortem examination without violating the law. Under this project, police were directed to use modified formats for inquiry or investigation into the cause of deaths i.e., commonly known as inquest. Modified inquest format mandates to mention the cause of death if it is certified by the treating doctor and also the reason/s for forwarding the case for post-mortem examination as per subclauses under Section 174(3) CrPC. The aim of current study was to analyse outcome of this project with respect to number of post-mortem examinations in cases of burn injuries. Data of all cases of burn admitted and died while under treatment at the hospital during period from 2013 to Sep' 2018 was gathered from 'Hospital Information System' and Computerized Autopsy reports and retrospectively analysed using Microsoft Office 2007 excel worksheet. There were 287 deaths due to burn injuries during the study period. Out of these 287 deaths, 178 cases were during the period 2013-2015. Out of these 178 cases, 176 (98.88%, n= 178) cases were forwarded by police for post-mortem examination. Out of 287 deaths, 109 cases were during the period 2016-2018 with number of cases forwarded by police for postmortem examination was 56 (51.38 %, n=109). This indicates that there is decrease in number of cases for post-mortem examination after implementation of the project without violating the provisions of Section 174 CrPC.

2 tables, 6 ref

044664   VORA D H, PATEL A P (Forensic Medicine & Toxicology Dep, B.J Medical Coll, Ahmedabad, Gujarat, Email: draks83fm@gmai.com) : An evaluation of medical negligence cases: Role and contribution of medico-legal autopsy. J Indian Acad Forensic Med 2020, 42(1), 7-12.

Autopsy based forensic evaluations are critical to the final outcome of medical negligence cases. It is imperative that autopsy surgeon is aware of clinical issues and should plan autopsy dissection with respect to those issues. This study is aimed to determine the role of medico-legal autopsy in the ascertainment, assessment and evaluation of the medical negligence cases. In this retrospective study, total 61 medico-legal autopsy cases involving medical negligence claims were studied. Cases were classified according to type of health care facility, type of medical or surgical specialty as well as discrepancies between clinical and autopsy diagnosis and type of medical error involved. Surgical branches (82%) are more involved in alleged medical negligence cases than medical branches (18 %). 33 % cases are of Obstetrics & Gynecology followed by Anesthesia (29 %), and Surgery (20 %). In majority of cases (65 %), small private hospitals with less than 100 beds (type C) are involved. Act of commission was found in 26 % cases. Act of omission was claimed in 7 %. In 18 % cases there was a failure to diagnose major disease in pre-anesthetic and pre-operative check up. In 8 % cases wrong diagnosis was claimed. In one case, nursing staff has given wrong drug to the child led to the sudden death. In 13 % cases death occurred due to known complications. Present work indicates that early post-mortem examination in alleged medical negligence cases provides new and unrecognized information of great assistance in determining the cause of death.

6 tables, 8 ref

044663   DAS R, DEBNATH B J, CHAKRABORTY P (Forensic Medicine & Toxicology Dep, R.G. Kar Medical Coll, West Bengal, Email: bhaskarjyotidebnath@gmail.com) : Analysis of postmortem serum sodium concentration: A way out for determination of time since death?. J Indian Acad Forensic Med 2020, 42(1), 3-6.

Despite a large amount of research undertaken, the post mortem interval remains one of the most challenging variables to be + quantified and established. Our project aimed to study the pattern of serum sodium(Na ) concentration change after death and to correlate it with the post mortem interval. Post mortem blood samples collected from the external jugular vein of a total of 150 subjects with a documented time of death were analyzed in a period of one and half years from January 2017 to June 2018 to assess + + the changing pattern of Na concentration to their time since death. Serum Na concentration was found to be decreased almost + linearly with the progression of time within 6-33 hours after death. Coefficient co-relation of mean post mortem Na concentration + and time since death was (-0.96). The average decrease rate of serum Na concentration was found to be 1.14 meq/L per hour. The present study also showed that a 95 % confidence limit of over ± 17.24 hours limits the usefulness of this method in estimating time since death.

1 illus, 4 tables, 11 ref

042638   MUNSHI R (King Abdulaziz Univ Hospital, Jeddah, Saudi Arabia, Email: raafat.munshi@ gmail.com ) : Characterization of outer membrane vesicles from Fusobacterium nucleatum. Indian J Sci Technol 2020, 13(2), 161 – 92.

Fusobacterium nucleatum is an oral pathogen and is associated with the development of colorectal cancer (CRC). This study is to evaluate the ability of outer membrane vesicles (OMV) from F. nucleatum to modulate cellular responses in colonic cells. Here we show that infection of colonic epithelial cells with F. nucleatum and its OMV induce pro-inflammatory chemokine and cytokine production and promote an EMT-like pheno- and genotypes in vitro as demonstrated by suppression of E-cadherin and up-regulation of several mesenchymal markers. F. nucleatum and its OMV modulate the barrier function of intestinal monolayers, a process likely related to their demonstrated ability to degrade E-cadherin and suppress its expression. Analysis of the OMV proteome by mass spectrometry demonstrates that they harbor the known virulence factors that appear to be enriched with proteolytic activity. Taken together, these data indicate that F. nucleatum OMV have the potential to contribute to disease progression in the context of CRC.

6 illus, 7 tables, 91 ref

040842   KUMAR R, KUMAR A, MASAND R, BISHT A, SINGLA A, ASRANI R K (Veterinary Pathology Dep, Dr. G.C. Negi Coll of Veterinary and Animal Sciences, Palampur, Himachal Pradesh, Email: rkvetpath@gmail.com) : Clinico-pathological characterization of chronic renal diseases in geriatric dogs. Indian J Vet Pathol 2020, 44(2), 123-8.

The prevalence of chronic kidney diseases (CKD) is higher in geriatric population than in the general population. CKD in dogs is influenced by a complex relationship among various factors including environmental stress, imbalanced diet, genotypic ground, hyperparathyroidism and affections related to cardio-renal axis. The necropsy investigation of CKD suspected dogs in this study has explored the evidences of progressive bone lesions (Osteodystrophy fibrosa), palatine erosions, stomach ulcers, renal tissue affections (chronic nephritis, hydronephrosis, atrophy), urolithiasis and prostate enlargement. Apart from oral, stomach, intestinal, bone, lungs and prostate lesions, the renal lesions were pronounced especially in aged dogs. Grossly, kidneys of the aff ected dogs exhibited indented, contracted and pale appearance. Histological lesions documented in the renal tissues of geriatric dogs included degenerative changes in the renal tubules, mineralization of tubular and glomerular basement membranes, glomerulosclerosis and fi brosis of interstitial tissue along with mononuclear cells (MNCs) infiltration particularly macrophages, lymphocytes and plasma cells. Microscopic examination of the tissue collected from mandibular area depicted the presence of increased osteoclastic activity and resorption of osseous tissue with collagen. This study suggests that CKDs in geriatric dogs is associated with age and complicated by various related factors. The adverse effects of renal dysfunction in dogs with advancing age can be reversed via early diagnosis and mitigation of factors associated with CKDs. Further eff orts are needed to derive a correlation between multifactorial etiologies associated with CKD in dogs.

6 illus, 1 table, 20 ref

042624   PATEL J H, DUGGAL L , CHATURVEDI V , JAIN N , BHANDARI G , GUPTA M (Arthritis Rheumatology Clinic, Vadodara - 390 007, Gujarat, Email: jeet5patel5@gmail.com) : Intravenous immunoglobulin in the management of idiopathic inflammatory myositis: A single centre retrospective review. Indian J Rheumatol 2020, 15(6), S200-4.

Intravenous immunoglobulin (IVIG) has been used in the treatment of severe idiopathic inflammatory myositis (IIM) in the past. We conducted a retrospective analysis of IIM cases and compared patients who received IVIG with those who did not. Electronic records from the year 2015–2019 were searched for myositis cases using the terms “myositis, inflammatory myositis, autoimmune myositis.” Cases with dermatomyositis, polymyositis, necrotizing autoimmune myositis, and connective tissue disease myositis/overlap myositis were included (n = 28) and those with infectious or granulomatous myositis were excluded (n = 7). Relevant data were noted. Participants were classified into cases and controls based on IVIG use for treatment. Results were expressed as median and interquartile range. Nonparametric testes were used for comparisons. Word search revealed 35 cases of myositis. Of them, 28 patients were included in the study. From these patients, ten patients had treatment with IVIG and 18 had not. The median age was 49.5 (39.5, 57) years, and disease duration 5.5 (2.5, 12) months. IVIG‑treated patients had a more extended hospital stay and less arthritis (P < 0.05). A common indication of IVIG use was esophageal ± respiratory muscle weakness (n = 5/10). In the IVIG group, there was a higher rate of pulse glucocorticoids use (P = −0.02); however, the use of other drugs was similar. Sepsis, gastrointestinal complications, and pneumonia were higher in IVIG‑treated patients (P < 0.05). IVIG‑treated patients had a higher mortality rate and lower response compared to controls (P < 0.05). IVIG is often the drug of choice for patients with infections in IIM in the Indian setting. Although the IVIG group suffered high mortality, confounding factors, and small sample size, limit conclusions on the usefulness of IVIG in IIM. However, this study showed that IVIG might not alleviate infections complicating IIM cases. Further studies are required.

1 illus, 3 tables, 18 ref

042623   NAVEEN R, ANUJA A K, RAI M K, AGARWAL V, GUPTA L (Clinical Immunology and Rheumatology Dep, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: drlatikagupta@gmail.com) : Development of the myocite biobank: cost-efficient model of public sector investigator-driven biobank for idiopathic inflammatory myositis. Indian J Rheumatol 2020, 15(6), S194-9.

Biobanking refers to the cryopreservation of the various biologic samples for future research. In the era of omics, biobanking has emerged as a vital process to aid research, more so for rare diseases. We describe herein the development of a biobank for idiopathic inflammatory myopathies (IIMs), a rheumatic illness with low prevalence. This study addresses the sample collection, transport, storage, maintenance, retrieval, and disposal of samples with a focus on cost-effectiveness, limitations, ethics, and legal aspects involved. Financial constraints are juxtaposed next to a wealth of clinical data in the developing countries with a large population size and consequently high burden of rare diseases. Fine-tuning efforts toward the development of bio-archival facilities can maximize outcomes from research units in these countries. A time and cost-efficient model can be the first step toward such initiatives in the appropriate setting. Unique ethical, executive, and scientific challenges were encountered by the authors while establishing the MyoCite biobank in a resource-poor setting. The various efforts to foreclose these obstacles are discussed. This brief summarizes the unmet need, unique challenges, and potential solutions based on the authors’ experiences gathered while setting up the MyoCite biobank for research in IIM. It also outlines the means and directions for national and global collaborations in the times ahead.

2 illus, 2 tables, 34 ref

040838   PRASATH N B, SELVARAJ J (Veterinary Pathology Dep, TANUVAS, Thanjavur, Tamil Nadu, Email: vetdrprasad@gmail.com) : Cavernous haemangioma of thymus : A rare vascular tumour in a cross bred cow. Indian J Vet Pathol 2020, 44(2), 104-6.

A six-year-old cross bred Jersey cow was presented for necropsy. On examination of thoracic cavity, pericardium over the base of the heart revealed dark reddish, fi rm, tortuous mass embedded in thoracic part of thymus surrounded by adipose tissue. Histopathological of the tissue revealed thymus with involution changes. Lobes were shrunken. Capsule was thin and was surrounded and infi ltrated by adipocytes. Thymic lobules were shrunken, follicles were atrophied. Cortex and medulla were non-delineated containing condensed area composed of epithelial cells, Hassall’s corpuscles and thymocytes. Cystic degenerations were noticed in Hassel’s Corpuscles, epithelial cells and stromal tissue. Thymocytes were arranged to form acinar pattern. Atrophic thymus showed variable sized vascular channels fi lled with blood. The vascular channels were lined by endothelial cells. The stroma composed of fat and fi brous tissues admixed with remnant of thymic tissue and follicles. Based on the location, gross and histopathological features of the tissue, the case was diagnosed as cavernous haemangioma of thymus in a cross bred Jersey cow.

7 illus, 19 ref

042622   MEHTA P, GUPTA L (Clinical Immunology and Rheumatology Dep, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: drlatikagupta@gmail.com) : Combined case record forms for collaborative datasets of patients and controls of idiopathic inflammatory myopathies. Indian J Rheumatol 2020, 15(6), S191-3.

Idiopathic inflammatory myopathies are heterogeneous, and the clinico‑serologic phenotypes differ significantly in various populations. Collaborative work with a structured case record form (CRF) is vital to successful data collection and collation. We describe herein various CRFs to the same effort.

18 ref

042621   GUPTA L, MAJUMDER S, AGGARWAL A, MISRA R , LAWRENCE A (Clinical Immunology Dep, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: drlatikagupta@gmail.com) : Serum fatty acid binding protein 3 levels differentiate active from inactive myositis and correlate with response to therapy. Indian J Rheumatol 2020, 15(6), S187-90.

Delay in the diagnosis of idiopathic inflammatory myopathies (IIMs) and resultant muscle wasting leads to a setting, wherein conventional biomarkers fail to identify inflammation amid damage. Fatty acid‑binding protein 3 (FABP3) has a selective location and function lending unique potential as a specific biomarker in IIM. Patients with IIM (ACR/EULAR criteria) prospectively evaluated for clinical features and laboratory data were screened to identify cases without ongoing infection, pregnancy, and renal disease. Clinical data and sera of patients and healthy controls were retrieved, and case details supplanted with standard outcome measures. For the inception cohort, 6‑month follow‑up sera were used for comparison of FABP3 using ELISA. Nonparametric tests were used for analysis and results expressed as median and interquartile range. One hundred and thirty two IIM patients (M:F 1:3.1) of age 38 (24.5–46.0) years and 0.9 (2.3–5.1) year long disease were compared with ten healthy controls. FABP3 levels were higher in active (5.73 vs. 2.91 ng/ml, P = 0.0351) disease, more so in early IIM (n = 16, 21, 3.84 vs. 0.00 ng/ml, P = 0.002). Levels fell with treatment in responders (n = 7, 14.5–7.5 ng/dl, P = 0.03) but not in nonresponders. A serum FABP3 ≥ 4.066 had a high specificity (80.6 %) to distinguish active from inactive myositis, albeit lower than conventional biomarkers. Serum FABP3 is elevated in active IIM, especially early disease, and decreases with treatment among responders. FABP3 has a favorable specificity but insufficient sensitivity, limiting role as a stand‑alone biomarker. It might be useful in early IIM, without renal or cardiac involvement, pending further validation.

1 illus, 14 ref

042620   PALLO P A O, SILVA M S R, SOUZA F H C, SHINJO S K (Rheumatology Div, De Sao Paulo Univ, CEP 01246?903, Cerqueira Cesar, SP, Brazil, Email: samuel.shinjo@usp.br) : Is polymyositis a rare or over diagnosed entity? A descriptive follow up study of patients initially admitted in a tertiary center with the diagnosis of polymyositis. Indian J Rheumatol 2020, 15(6), S180-6.

This study aimed to describe a significant sample of patients with an initial diagnosis early‑stage polymyositis (PM) in who were reclassified to different diagnoses after new evaluations during follow‑ups. In a single‑center descriptive study conducted from 2000 to 2019, 108 patients with an initial presumptive diagnosis of PM were admitted to our tertiary center and were reevaluated during follow‑up. Patients with promptly suspected or definite initial diagnoses of other autoimmune or hereditary myopathies were excluded. The mean age of the 108 patients when admitted initially into our center was 45.3 ± 15.4 years; they were predominantly female (70.4 %) and Caucasian (81.5 %). During a median follow‑up period of 4.0 years and constant diagnostic reinvestigation, only 30 (27.7 %) out of the 108 participants maintained the PM diagnosis, whereas the other patients were re‑diagnosed with immune‑mediated necrotizing myopathy (20.4 %), inclusion body myositis (18.5 %), muscular dystrophy 13.0 % as (13.0 %), antisynthetase syndrome (8.3 %), metabolic myopathies (5.6 %), and other muscle diseases (7.3 %). The initial clinical and laboratory parameters were not distinguishable between the PM and reclassified patients. Twenty‑two of 30 patients with PM continued follow‑up in our service, all with clinical remission or complete clinical response, full recovery of muscle strength, and normalization of the serum levels for muscle enzymes. Patients with PM should be reevaluated constantly, as PM can mimic other muscle diseases. Notably, only one‑third of our large patient samples maintained diagnoses of PM until the end of the present study’s data collection. 

1 illus, 2 tables, 37 ref

042619   DAVALBHAKTA S , OSWAL A , PHATAK S (King Edward Memorial Hospital and Research Centre, Pune ? 411 011, Maharashtra, Email: sanatphatak@gmail.com) : Assistive devices: Regaining mobility in myositis. Indian J Rheumatol 2020, 15(6), S175-9.

Assistive devices (ADs) refer to external devices adapted to improve tasks and function. The common types of ADs include those improving mobility such as wheelchairs and walkers, positioning devices such as standing frames, custom‑made devices (orthotics) such as fitted shoes and braces, and daily living devices. In inflammatory myositis, ADs are of utility in combating weakness, improving mobility, preventing and treating contractures, preventing falls, and assisting in daily chores. This narrative review looks at the evidence for the use of ADs in myositis and disorders with a similar pattern of muscle weakness (e.g., muscular dystrophy) subsequent to a literature search. A range of devices, from ankle orthoses to robotic exoskeletons, has been used in children with these diseases, and is part of the rehabilitation process. Evidence for their use in inflammatory myositis comes mainly from inclusion body myositis where progression is usual, and distal movement loss additionally affects functionality. In these patients, gait ADs and lower limb orthoses have been shown to be useful. Patient acceptability of these interventions is paramount in choosing the correct device and fit. An interaction of the treating rheumatologist with the physiatrist, the physical therapist, the occupational therapist, and the patient is paramount in ensuring compliance and benefit.

2 illus, 35 ref

042618   GONO T (Nippon Medical School Graduate School of Medicine, Tokyo 113?8603, Japan, Email: t?gono@nms.ac.jp) : The evolving spectrum of interstitial lung disease in myositis—management pearls. Indian J Rheumatol 2020, 15(6), S163-74.

Idiopathic inflammatory myopathies (IIMs) are characterized by muscle inflammation caused by exacerbated autoimmunity reactions. Patients with IIMs also have extramuscular lesions, such as skin rash, arthritis, interstitial lung disease (ILD), and cardiomyopathy. ILD is one of the leading causes of mortality in patients with IIMs. Thus, physicians need to manage patients with IIM‑associated ILD (myositis‑ILD) appropriately to prevent the development and progression of ILD. Predictive factors for morality should be considered at the time of making decisions on therapeutic strategies for myositis‑ILD. There have been numerous prognostic factors associated with mortality or pulmonary dysfunction. According to the latest research, which contains the large database analysis enrolling 499 incident cases of myositis‑ILD with the comprehensive measurement of myositis‑specific autoantibodies (MSAs), the presence of anti‑melanoma differentiation‑associated gene 5 antibody, age ≥60 years, C‑reactive protein ≥1 mg/dL, and pulse saturation oxygen <95 % have been identified as independent risk factors for mortality. We should also consider the severity of ILD, such as lower values of vital capacity and extensive ILD, and disease behavior to. The clinical characteristics of myositis‑ILD are highly diverse. Thus, the categorization of homogenous groups by MSAs and prognostic factors is required to offer appropriate therapeutic regimens to individual patients with myositis‑ILD. This effort will contribute to improve the daily quality of life as well as the survival rate in patients with myositis‑ILD.

1 illus, 3 tables, 118 ref

042617   SATO S (Internal Medicine Dep, Tokai Univ School of Medicine, Kanagawa 259?1193, Japan, Email: shinsjam@tokai-u.jp) : Emerging therapeutics in idiopathic inflammatory myopathy. Indian J Rheumatol 2020, 15(6), S153-62.

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases characterized mainly by inflammation of muscle tissue. Although IIM traditionally encompasses polymyositis, dermatomyositis (DM), and inclusion body myositis, the disease concept has been changing in association with progress in diagnostic techniques. Thus, the new disease entities of amyopathic DM (ADM) or clinically ADM and immune‑mediated necrotizing myopathy have been recognized recently. Because of the variety of symptoms or low prevalence or difficulty in correct evaluation of muscle strength and function in IIM patients, no standard treatment strategies have been established yet. Currently, glucocorticoids remain the first line of treatment of IIMs, but in addition to these, several other immunosuppressive agents or intravenous immunoglobulin have been used in a variety of different combinations. However, due to clinical heterogeneity of these conditions as well as the number of therapeutic target organs, IIM therapy remains challenging, and refractory cases are especially difficult to treat. In recent years, new therapeutic approaches using biologics or Janus kinase inhibitors, plasma exchange therapy, and other agents have been evaluated for IIMs. However, validation of the efficacy of these new treatment options remains an issue to be resolved. In this article, the author reviews current treatment strategies and new emerging therapies for IIM patients.

1 illus, 2 tables, 16 ref

042616   SOUZA F H C D, PINTO G L B, SOUZA J M D, PALLO P A O, HOFF L S, SHINJO S K (Rheumatology Div, De Sao Paulo Univ, SP, Brazil (BR), Email: samuel.shinjo@usp.br) : Sporadic inclusion body myositis in the rheumatology clinic. Indian J Rheumatol 2020, 15(6), S145-52.

Sporadic inclusion body myositis (sIBM) is a progressive and insidious skeletal muscle disorder characterized classically by the quadriceps, wrist, and finger flexor weakness. The main irreversible complications of sIBM are dysphagia and walking difficulties. The disease affects more men than women, and the symptom onset mainly occurs between 50 and 70 years of age. Due to its slow progression, sIBM diagnosis is frequently delayed and therefore misdiagnosed as other muscle diseases. sIBM remains refractory to treatment (e.g., glucocorticoid, and immunosuppressive/immunomodulatory/immunobiological drugs). Although there have been no robust clinical trials, training exercise/physiotherapy should be prescribed regularly in sIBM patients.

4 illus, 3 tables, 57 ref

042615   XU A, LIMAYE V (Rheumatology Dep, Adelaide Univ, North Tce, 5000, Adelaide, SA, Australia, Email: vidya.limaye@sa.gov.au) : Statin‑associated muscle disorders. Indian J Rheumatol 2020, 15(6), S137-44.

Statins are one of the most widely used and reputable medications worldwide, with strong evidence of mitigating cardiovascular complications and with a generally favorable safety profile. Nevertheless, statins have commonly come under scrutiny, owing to their associations with muscle disorders. Statins are known to cause a range of effects on muscles, varying from mild self‑limiting symptoms to detrimental muscular necrosis. In particular, there has been emerging evidence of statin‑associated necrotizing autoimmune myositis related to the presence of anti‑3‑hydroxy‑3‑methylglutaryl coenzyme A reductase (HMGCR) autoantibodies. Patients often demonstrate proximal muscle weakness and hyperCKemia, and treatment guidelines are not robust owing to the rarity of the disease. Nevertheless, literature provides evidence for use of corticosteroids, and there are emerging data supporting the incorporation of immunomodulatory agents such as methotrexate, intravenous immunoglobulin, and rituximab. In performing this review, we searched databases in PubMed and EMBASE written in English and limited to the last two decades. Keywords used included “statin,” “myositis,” ”autoimmune myopathy,” “anti‑HMGCR,” and “necrotising.” Articles were selected by relevance to the topic, and articles pertaining to antisignal recognition particle myopathy and other forms of myositis were excluded.

2 illus, 1 table, 63 ref

042614   SELVA-O'CALLAGHAN A, TERRONES-PEINADO M MARQUES-SOARES J R, GIL-VILA A (Medicine Dep, Autonoma de Barcelona Dep, C/Siracusa nº 12 BIS “A”, Barcelona 08012, Spain, Email: aselva@vhebron.net) : Cancer in myositis. Indian J Rheumatol 2020, 15(6), S131-6.

There is an intriguing relationship between cancer and myositis. The immunosuppressive agents commonly used to treat myositis patients are known to favor the development of cancer, but this factor does not seem to be the main cause of the association. Most myositis patients who develop cancer are considered to have cancer‑associated myositis, which suggests that there are some types of etiopathogenic relationship between these two conditions. The malignancy usually appears within 3 years of the myositis diagnosis, and the risk of cancer depends on the myositis phenotype, with classic or amyopathic dermatomyositis (DM) and immune‑mediated necrotizing myopathy being the main associated phenotypes. Several considerations regarding the pathogenesis of this association and strategies to detect occult malignancy in these patients are discussed here, with special emphasis on the role of autoantibodies as markers of this condition. Anti‑ TIF1g (Transcription Intermediary Factor 1 gamma) antibodies have been extensively studied in patients with cancer‑associated DM. In addition, we discuss the peculiarities of treating patients with cancer‑associated myositis and suggest some good treatment options, and finally, we examine the cancer–myositis relationship with regard to the recently described concept of myositis as an immune‑related adverse event derived from the use of checkpoint immune inhibitors to treat cancer.

5 illus, 28 ref

042613   VERMA R, PALIWAL V K ( Pathology Dep, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: dr_rituverma@rediffmail.com) : Idiopathic inflammatory myopathy: From muscle biopsy to serology. Indian J Rheumatol 2020, 15(6), Autoantibody, Classification, Diagnostic criteria, Inflammatory myopathy, Muscle biopsy.

Idiopathic inflammatory myopathies (IIMs) are heterogeneous group of muscle disorders characterized by variable degree of muscle weakness and muscle inflammation. Various classification systems have been proposed for myositis. However, there remains a diagnostic uncertainty due to the presence of overlapping clinical and pathological features. Similar treatment outcomes to immunosuppressant drugs further add to diagnostic confusion. Introduction of myositis‑specific and myositis‑associated autoantibodies has widened the disease spectrum of IIMs. Despite being very crucial for the diagnosis and classification of myositis, these autoantibodies are not always present. Therefore, histopathological features and immunohistochemical markers are considered gold standard for the diagnosis of myositis. A correct diagnosis has important clinical and therapeutic implications. In this review, we have focused on salient clinicopathological features and newly developed serological markers in major subtypes of IIMs.

1 illus, 3 tables, 42 ref

042612   CHAUDHARY H, LOGANATHA S K, SINGH S (Pediatrics and Chief Dep, Postgraduate Institute of Medical Education and Research, Chandigarh ? 160 012, Email: surjitsinghpgi@rediffmail. com) : Juvenile dermatomyositis: Controversies and recent developments in management. Indian J Rheumatol 2020, 15(6), S112-22.

Juvenile dermatomyositis (JDM) is an autoimmune disorder of childhood that mainly affects the skin and muscles. As compared to adults, children are more likely to suffer from disease relapses and long‑term complications such as lipodystrophy, insulin resistance, calcinosis, and systemic vasculopathy. There have been significant advancements in our understanding of the pathophysiology, disease course and complications of JDM in the last two decades. Due to scarcity of clinical trials in JDM, therapeutic decisions in every patient with JDM remain a challenge. This review aims to provide a comprehensive overview of the controversies, challenges in clinical management and latest advances in treatment regimens of JDM.

1 illus, 6 tables, 52 ref

040835   SINGH B, SINGH N D, LEISHANGTHEM G D, BANGA H S (Veterinary Pathology Dep, Guru Angad Dev Veterinary and Animal Sciences Univ (GADVASU), Ludhiana - 141 004, Punjab) : Critical developmental eff ects on rat fetuses of low-level arsenic exposure in water. Indian J Vet Pathol 2020, 44(2), 81-90.

Arsenic has been incriminated to cross the placental barrier both in humans as well as animals, which might be the putative cause of alteration(s) in developmental defects reported in fetuses. The present study was conducted to determine the teratogenic eff ect of arsenic induced toxicity, when given at the same level (0.0191 to 0.2080 mg/l) at which it is found in drinking water in different parts of India. Young male and female Wistar rats were randomly divided in four groups viz. I, II, III, and IV and were given sodium arsenite at a dose rate of 0.01 mg/l, 2.5 mg/l, 5 mg/l and distilled water respectively. The animals were kept for a period of 10 weeks prior to mating and fed sodium arsenite at the doses described, and pregnant females were sacrifi ced on 20^th day of gestation and fetuses were collected. Gross anomalies of the foetus were examined. Half of each litt er was processed for skeletal examination using Alizarin Red S staining while the remaining foetus was fi xed in Bouin’s solution for visceral tissue evaluation. There were increased foetal resorption(s) in all treated groups. The foetal body weights and crown to rump lengths were signifi cantly decreased and the percent gross, visceral and skeletal anomalies were signifi cantly increased in fetuses of dams of arsenic treated groups in a dose dependent manner. The wrist drop, subcutaneous hematoma, internal hydrocephalus, cerebellar hypoplasia, microphthalmia, dilated renal pelvis, roundening of heart, incomplete ossifi cation of skull bones, vertebrae, ribs, and agenesis of phalanges and caudal vertebrae were the most important foetal malformations. The occurrence of foetal gross, skeletal and visceral malformations were more severe in the group III followed by group II, suggesting the teratogenic nature of arsenic (sodium arsenite). It was concluded in the present study that albeit when arsenic was fed at lower dose mimicking the levels in the fi eld conditions, it signifi cantly caused developmental anomalies in the present study discernible as gross, visceral and skeletal anomalies.

14 illus, 7 tables, 44 ref