Ashoo Grover

Identification of genetic contribution to ischemic stroke by screening of single nucleotide polymorphisms in stroke patients by using a case control study design

BackgroundStroke is the second most common cause of death and disability worldwide. It is a multi-factorial disease influenced by both environmental and genetic factors. Studies from the different ethnic regions of world have reported variable results on association of Apolioprotein E (APOE), Methylenetetrahydrofolate reductase (MTHFR), Endothelial Nitric Oxide Synthase (ENOS), Factor V Leiden (F5), Cytochrome P450 4F2 (CYP4F2), beta-fibrinogen and Phosphodiesterase 4D (PDE4D) gene in stroke. There has been substantial evidence from the European descent genetic studies showing that genetic risk of stroke varies as per specific subtypes of ischemic stroke.This study aims to test the hypothesis that above mentioned encoding gene polymorphisms are associated with stroke and to determine whether risk varies as per specific subtypes of stroke.Methods/DesignThe study design would be case–control study. Six hundred cases with diagnosis of stroke and 600 age and sex matched controls will be recruited. Controls will be matched in 1:1 ratio. Baseline and demographic data will be collected in standardized data collection form. Four ml of blood will be collected in EDTA coated vial and will be used for DNA isolation. Genotyping will be done by using PCR-RFLP method. For the reconfirmation of RFLP results, PCR product of each genotype in triplet for all the selected polymorphism will be sent for DNA sequencing. Data will be analyzed using conditional logistic regression to determine odds ratio associated with the above genes.DiscussionThis protocol will assess the association of above mentioned gene polymorphisms with ischemic stroke in North Indian Population. This study will also helpful to determine genetic component of stroke and whether variation in genetic risk as per different subtypes of stroke.

Role of mobile phone technology in health education in Asian and African countries: a systematic review

The objective of this systematic review was to explore the role of mobile phone technologies in delivering health education programs in Asian and African countries. The search engine used was Pubmed during 2008-2011. Randomised controlled trials or controlled studies that improved health outcomes through delivery of health educational interventions using cell phone or text messaging were included in the review. Results showed studies from six Asian and African countries including Philippines, China, Kenya, South Korea, Taiwan and India. Mobile phone technology has shown to improve health outcomes for chronic disease conditions such as diabetes, heart disease and hypertension. Additional conditions include obesity and cardiopulmonary resuscitation guidance. Other studies have shown improvement in self management of breast cancer and post-hospitalisation HIV and pharmaceutical care. Overall results of the present review showed that mobile phone technologies can be a possible solution to improve healthcare outcome.

Is Dementia Differentially Distributed? A Study on the Prevalence of Dementia in Migrant, Urban, Rural, and Tribal Elderly Population of Himalayan Region in Northern India

Background: Throughout the world, a large number of surveys have been carried out to find the prevalence of dementia with variable results. Aims: This study was to generate data on the prevalence of dementia and to generate a hypothesis on the differential distribution across populations. Materials and Methods: Four settings identified for the purpose of this study included a migrant, urban, rural, and tribal. The study was conducted in two phases: 1) A screening phase and 2) a clinical phase, on 2,000 individuals above 60 years of age. To complete the required sample of 2,000 elderly individuals, 500 individuals were approached from each site. Nobody refused to participate. Results: A total of 32/2,000 (1.6%) elderly individuals were classified as demented. No case of dementia was reported from tribal population. A look at sex differential reveals that majority (21/32; 66%) of individuals identified as demented were females. As age advanced scores on cognitive screen decreased with elders above 80 years of age showing lowest scores. Out of 32, 18 (56%) of patients classified as demented were more than 80 years of age. Conclusion: The findings of this study are in agreement with previous studies which point towards differential distribution of dementia across populations.

Institutionalising health technology assessment: establishing the Medical Technology Assessment Board in India

India is at crossroads with a commitment by the government to universal health coverage (UHC), driving efficiency and tackling waste across the public healthcare sector. Health technology assessment (HTA) is an important policy reform that can assist policy-makers to tackle inequities and inefficiencies by improving the way in which health resources are allocated towards cost-effective, appropriate and feasible interventions. The equitable and efficient distribution of health budget resources, as well as timely uptake of good value technologies, are critical to strengthen the Indian healthcare system. The government of India is set to establish a Medical Technology Assessment Board to evaluate existing and new health technologies in India, assist choices between comparable technologies for adoption by the healthcare system and improve the way in which priorities for health are set. This initiative aims to introduce a more transparent, inclusive, fair and evidence-based process by which decisions regarding the allocation of health resources are made in India towards the ultimate goal of UHC. In this analysis article, we report on plans and progress of the government of India for the institutionalisation of HTA in the country. Where India is home to one-sixth of the global population, improving the health services that the population receives will have a resounding impact not only for India but also for global health.

Investigation of mitochondrial DNA variations among Indian Friedreich's ataxia (FRDA) patients.

OBJECTIVE The loss of function mutations (biallelic) in frataxin (FXN) has primarily been implicated in Friedreichs ataxia (FRDA), an autosomal recessive cerebellar ataxia. The protein product of FXN is a nuclear-encoded mitochondrial protein required for the biogenesis of iron- clusters (Fe-S). FRDA is characterized by neurological and non-neurological features which show variable expression in affected individuals. An inverse relationship has been demonstrated between GAA repeat size and age at onset and explains 50% variability of the age at onset. MtDNA variations and haplogroups could be one of the contributory factors to explain the remaining heterogeneity in FRDA, since mitochondrial oxidative stress is thought to be involved in the pathogenesis of FRDA. METHODS In our study, targeted resequencing of the D-loop and coding region of mitochondrial genes (ND1-6 and ATP) was conducted in 30 genetically confirmed FRDA patients and 62 ethnicity-matched unrelated healthy controls to identify the functionally important mtDNA variations and to trace the mitochondrial lineage of Indian FRDA patients. Cumulative mitochondrial SNP scores were computed for the identified variations in the functional region and haplogroups were determined by Haplogrep. RESULTS A significantly higher load of overall mitochondrial variations (with a trend toward the coding region) per individual was noted among FRDA cases rather than controls (p-value<0.03). A non-synonymous variation (p. L237M) in ND2 was over-represented among FRDA cases (p-value 0.04). This variation has a reported association with longevity and myocardial infarction. We also observed over-representation of H haplogroup (Caucasian mitochondrial haplogroup) among FRDA patients. We have not observed the influence of mitochondrial variations and haplogroup upon age at onset of FRDA. CONCLUSIONS Overall, our study identifies the functionally important variations and mitochondrial lineage of Indian FRDA cases and, that underscores the importance of studying the role of mitochondrial genome variations in FRDA.

Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India

Introduction: Cognitive impairment, characteristic of dementia, is measured objectively by standard neuropsychological (cognitive) tests. Given the diversity of culture and language in India, it is difficult to use a single modified version of MMSE uniformly to Indian population. In this article, we report methods on the development of a cognitive screening instrument suitable for the tribal (Bharmour) elderly (60 years and above) population of Himachal Pradesh, India. Materials and Methods: We used a systematic, item-by-item, process for development of a modified version of MMSE suitable for elderly tribal population. Results: The modifications made in the English version of MMSE and the pretesting and pilot testing thereof resulted in the development of Bharmouri version of cognitive scale. Discussion: The study shows that effective modifications can be made to existing tests that require reading and writing; and that culturally sensitive modifications can be made to render the test meaningful and relevant, while still tapping the appropriate cognitive domains.

Role of medical education in preventing and control of noncommunicable diseases in India

India has approximately 335 medical colleges, which produce around 40,000 medical graduates annually. Even though medical professional have a critical role in prevention and control of noncommunicable diseases (NCDs) including injuries, it has been observed that the present medical and nursing curriculum in India does not adequately cover prevention and control of NCDs. The topics for specific approach to prevent NCDs and various strategies can be incorporated into public health and clinical courses in undergraduate medical education, with brief optional courses in residency and continuing medical education for established practitioners. High-level expert group instituted by Planning Commission of India on Universal Health Coverage recommended that medical education requires greater orientation of providers to the social determinants of health as well as to gender and equity issues. Curricula in medical schools should keep pace with the changing dynamics of public health, health policy, and health demographics. Medical education and training should be reoriented by introducing competency-based, health system connected curricula, and continuous education. There is a need to review of medical curriculum, introducing innovative integrated teaching methods, and capacity building of teachers for meeting the challenge of rising burden of NCDs in India.

Is focus on prevention missing in national health programs? A situation analysis of IEC/BCC/Health promotion activities in a district setting of Punjab and Haryana

Context: Health promotion (HP) has been an integral part of all national programs although it has been a low priority in India, which has resulted in a failure to achieve the desired results. Settings and Design: Situation analysis of information education communication (IEC)/behavior change communication (BCC)/HP activities within the existing national health programs was undertaken in the district of Hoshiarpur in Punjab and the district of Ambala in Haryana during 2013-14. Materials and Methods: Facility-based assessments were done by conducting in-depth interviews with stakeholders, program officers, medical officers, health workers, and counselors. Household survey (332 individuals) and exit interview (102 interviews) were conducted to assess the knowledge of the community regarding key risk factors. Results: There was a high vacancy in the mass media division with 40% (2 out of 5) and 89% (8 out of 9) of the sanctioned positions vacant in Hoshiarpur and Ambala, respectively, with low capacity of staff and budget. There was no annual calendar, logbook of activities with poor recording of IEC material received and disseminated. The knowledge of community members regarding key risk factors such as tobacco use, salt intake, blood pressure level, anemia, and tuberculosis was 77.3%, 26.4%, 16.4%, 32.7%, and 91.8%, respectively, in the district of Ambala as compared to 77.5%, 37.5%, 33.3%, 25.8%, and 88.3%, respectively, in the district of Hoshiarpur. The village health and sanitation committee (VHSC) in the district of Hoshiarpur and village level core committee (VLCC) in the district of Ambala were found to be nonfunctional with no Iec/Bcc activities in the covered villages in the last month. Monitoring and supervision of Iec/Bcc activities were poor in both the districts. Conclusions: Iec/Bcc/HP is a neglected area in national health programs in the selected districts with inadequate budget, human resources with poor implementation, and requires strengthening for better implementation of the national health programs.

Oral health status and treatment needs among primary school going children in Nagrota Bagwan block of Kangra, Himachal Pradesh

Background: Oral diseases such as gingival diseases and dental caries affect about 80% of the school students worldwide. The study was taken up with the aim to evaluate the oral health status and treatment need in the School going children of Nagrota Bagwan Block of Kangra District, Himachal Pradesh. Materials and Methods: A total number of 3069 school children in the age group of 5-12 years studying in 96 government primary schools of study area were surveyed to find out the Oral Hygiene Index simplified (OHI-S) scores, community periodontal index (CPI) scores, dental caries and treatment need using dentition status and treatment need index (WHO diagnostic criteria, 1997). Results: The mean OHI-S was 2.7 ± 2.81and 2.8 ± 2.99 in 5-8 and 9-12 years age group, respectively. The gingival bleeding was observed in 76.8% and 75.9%, calculus in 10.2% and 18.3% in 5-8 and 9-12 years age group, respectively. The overall caries prevalence of subjects was 58.4% with high caries prevalence in females as compared to males and in 9-12 years age group as compared to 5-8 years age group. The mean dmft/DMFT was 2.05 ± 4.13 and 2.56 ± 4.20 in 5-8 years and 9-12 years age group, respectively. Treatment need observed was 62.3% and 75.3% in 5-8 and 9-12 years age group, respectively. Conclusion: The study demonstrated that school children in Nagrota Bagwan, Kangra district suffer from high prevalence of dental caries and have high treatment need as well as poor oral hygiene and gingival health status.

Protocol for an experimental study design to evaluate computer-enabled intervention to prevent and manage metabolic syndrome

Introduction The rising prevalence of overweight and obesity has a direct correlation with increasing prevalence of hypertension, dyslipidaemia, type 2 diabetes, metabolic syndrome (MetS) and cardiovascular diseases. Most of the previous studies have been cross-sectional in nature and have looked at the prevalence of metabolic syndrome. Despite the clinical and public health importance of this phenomenon, not enough work has been carried out so far to study and remedy this situation. The objectives of the proposed study is to develop an innovative user-centred informatics platform that will facilitate delivery of a multifactorial intervention after taking into account user sociodemographics, health behaviour, prior disease state and knowledge attitudes and practices. Objective The objective of the proposed study is to develop an innovative user-centred informatics platform that will facilitate delivery of a multifactorial intervention after taking into account users’ sociodemographics, health behaviour, prior disease state and knowledge, attitudes and behaviour. Methods and analysis A randomised two-group repeated-measures clinical trial design will be used, on 750 subjects from urban, rural and slum areas, in an Indian setting. The study participants will be randomly assigned to either the intervention (computer-based MetS Program, CBMP) or control (printed educational material, PEM) group. Both the groups will undergo screening, learning and evaluation assessments at the time of the visit and at follow-up visits 30, 60 and 90 days after the first visit. Outcomes The outcomes expected in the intervention group include improvement in Mets-related knowledge, adherence to self-care practices, better quality of life and increased satisfaction with medical care. Ethics and dissemination The study has been approved by the Institutional Review Board of Asian Institute of Public Health (IRB#621). The proposed study will also help us assess the usefulness and challenges of technology to disseminate health education among diverse users. Findings will be disseminated through peer-reviewed publications and national and international conference presentations to various stakeholders and local community health leaders. The ClinicalTrials.gov Identifier is NCT01713465.