Ravindra Kumar

Background: Saharia tribe has a very high prevalence of TB, primarily attributed to lack of access to diagnosis and treatment, stigma, associated risk factors etc. To demonstrate reduction in burden of TB, novel approached were adopted in one of the Saharia dominated district of Madhya Pradesh, India. Methods: Active case-finding using door-to-door survey with Hand-held X-rays and high throughput molecular testing to detect TB in Saharias and Non-Saharias was done in three blocks of Sheopur district, Karahal, Sheopur and Vijaypur, during January 2022 to April 2023 in four rounds. Anti-tubercular treatment (ATT) for TB cases and TB preventive therapy (TPT) for their house hold contacts (HHCs) was administered. Results: A total of 405290 population [125,362 (30.93%) from Saharias tribe and 279,928 (69.06%) non-Saharia] residing in Sheopur district were screened in multiple rounds of house to house survey of which 14602 (3.60%) residents were found to be symptomatic which included 8790 (7.01%) from Saharia tribe and 5812 (2.07%) from non-tribals/non-saharias. All symptomatics were screened for suspected TB using hand-held X-rays and those suspected of TB, sputum was tested using molecular tests for confirmation. A total of 860 (5.9%) TB cases were identified of all symptomatics tested which were significantly more in from Saharia Tribe (528 (0.42%) ) compared to non-Saharias (332 (0.12%)) from Non-Saharia/Tribes). ATT was initiated for TB cases. A total of 35 TB patients (27 from Saharia, 8 from non-Saharia) died due to delayed diagnosis and treatment, or no treatment. TPT was given to HHCs. Reduction of 78.6% and 83.33% in number of TB cases was observed in the fourth round compared to the first round in Saharias and non-Saharias respectively. Conclusions: Multiple rounds of successive door-to-door survey using hand-held X-rays for screening and high through put molecular testing to diagnose TB, treatment with ATT and TPT for HHCs and strict follow-up for compliance resulted in reduction of TB prevalence.

Objectives: This systematic review and meta-analysis aimed to compile and analyze available evidence to estimate the pooled prevalence of undernutrition (underweight, stunting, and wasting) among tribal children in India. Methods: A comprehensive literature search was done using PubMed and Google Scholar and other web-based searches to find studies reporting the prevalence of undernutrition (underweight, stunting, and wasting) among tribal children of India. Out of 1606 identified studies, 58 met the eligibility criteria. Meta-analysis was performed using the inverse variance method, and the random effect model was used to estimate the pooled prevalence. The heterogeneity across studies was assessed using the I2 statistic. Results: The meta-analysis revealed that the overall pooled prevalence of underweight among tribal children was 43.78% (95% CI: 38.80%–48.83%). The pooled prevalence of stunting and wasting was 43.16% (95% CI: 39.10%–47.26%) and 29.58% (95% CI: 25.59%–33.73%). The significant heterogeneity observed across studies was likely due to variations in study design, geographic location, and measurement methods. Conclusion: This systematic review and meta-analysis highlight the alarmingly high burden of undernutrition among tribal children of India, with nearly half of the population being underweight and stunted and a substantial proportion suffering from wasting. These findings highlight the pressing need for tailored public health interventions that tackle the specific challenges encountered by tribal communities, including improving healthcare access, addressing poverty, and overcoming geographical barriers. Targeted interventions focusing on nutrition supplementation, health service accessibility, and socio-economic support are urgently recommended to reduce undernutrition in tribal children.

Mycobacterium tuberculosis (M.tuberculosis) continues to cause one of the most pressing health burdens in the world, especially in developing nations, in the form of tuberculosis (TB). In addition to socio-environmental factors, it is widely believed that host genetic factors, particularly polymorphisms within the human leukocyte antigen (HLA) system, may play an extensive role in the likelihood of a host’s TB infection. Studies on the influence of HLA class I alleles (HLA-A, -B, -C) in human susceptibility to TB reported contradictory results. Therefore, this systematic review and meta-analysis aim to see the association of HLA class I alleles with susceptibility to TB in humans. In this meta-analysis, the literature was searched using PubMed, ScienceDirect, and Google Scholar, until 23rd May 2025. A total of 13 eligible case–control studies were included, comprising 1951 TB cases and 2109 matched healthy controls. Together with a 95% Confidence interval, pooled odds ratio was calculated for each allele. To evaluate heterogeneity I² statistic was used. Sensitivity and subgroup analyses were also performed. Publication bias was investigated using Egger’s and Begg’s tests. The analysis results demonstrated 40 HLA class I alleles (12-A, 22-B, 6-C). HLA-A32 (OR = 1.67, 95% CI= 1.09–2.56, p = 0.0191) and B58 (OR = 1.45, 95% CI= 1.02–2.07, p = 0.0404) found to be associated with increased TB risk, while HLA-A1 (OR = 0.70, 95% CI= 0.57–0.85; p = 0.0007) showed a protective trend after analysis. Sensitivity analysis strengthened the significance of all different alleles. Regional variations emerged: B58 was a risk allele in Africa, and A32 was a risk allele in Asia. HLA-B15 and B35 were reported to have a statistically significantly increased risk in North America. Post-sensitivity analysis revealed possible publication bias, as HLA-B17 shifted from susceptibility to a protective effect. This is the first meta-analysis that systematically evaluates the associations between HLA class I alleles and TB susceptibility. Our findings determine selective associations at both the allele and regional levels. The findings of this study can inform future studies in immunogenetics and aid in formulating solutions for the prevention and treatment of TB that are tailored to individual alleles.

Background & objectives: Sickle cell disease (SCD) is a monogenic disorder characterised by aberrant haemoglobin production, leading to haemolytic anaemia and vaso-occlusive crises. Genetic variations and altered expression of cell adhesion molecules (CAMs) are implicated in disease pathogenesis. This cross-sectional study investigated the association between single nucleotide polymorphisms (SNPs) in the SELP , SELE , ICAM-1 , and VCAM-1 genes and their protein levels in individuals with SCD. Methods: A total of 140 individuals with SCD were recruited. Plasma levels of P-selectin, E-selectin, ICAM-1 and VCAM-1 were measured by ELISA method alongside a control group (n=10). The selected SNPs of SELP , SELE , ICAM-1 , and VCAM-1 genes were identified through Sanger sequencing method. Results: The expression of adhesion molecules were found to be significantly higher in SCD group as compared to control. Furthermore, the results showed significant associations between SNPs, SELE: c.109+138A>C ( P C ( P C ( P= P =0.0025). Interpretation & conclusions: Significant correlation observed between SELP, SELE, and VCAM-1 levels suggests complex interactions of these markers that may influence disease progression and identify potential therapeutic targets for managing SCD complications. Further studies are warranted to validate these findings in larger cohorts and explore the functional implications of the observed genetic and molecular associations in SCD.

ObjectiveThe aim of this study is to see the association of P-selectin, E-selectin, Vascular Cell Adhesion Molecule-1 (VCAM-1) and Intercellular Adhesion Molecule-1 (ICAM-1) with Vaso-occlusive crisis (VOC) in sickle cell disease patients.MethodsIn this longitudinal study, a total of 140 SCD patients admitted into a Government Medical College, Jabalpur, were recruited . Plasma levels of soluble P-selectin, E-Selectin, ICAM-1, and VCAM-1 were measured at three different time points, that is, (i) at the time of admission (n = 140), (ii) at discharge (n = 139), and (iii) during steady state (n = 118).ResultsThe most common presenting symptoms at the time of VOC were severe joint pain (65.7%) and back pain (49.3%). All the cell adhesion molecule levels were similar in males and females except sVCAM-1. The plasma P-selectin, E-Selectin, ICAM-1 and VCAM-1 levels were significantly higher during crisis than at the discharge and steady state . No statistically significant association of any of the CAM levels with the severity of pain was observed. High plasma VCAM-1 levels (≥1676 ng/mL) were associated with longer duration of hospital stay.ConclusionsSignificant association of soluble CAMs with VOC in SCD suggests that soluble CAMs play a crucial role in the pathophysiology of the VOC.

Background: Sickle cell disease (SCD) with vaso-occlusive pain crisis (VOC) has a major impact on healthcare resource utilisation and poses a significant financial burden for the patients. This study examines the economic implications of managing VOC in individuals with SCD in India, from the perspectives of patients, healthcare system and society. Methods: This cross-sectional, observational study included 1000 patients with SCD across 14 centres enrolled from November 2021 to June 2022. Data were collected systematically using a structured electronic case record form. Employing a cost-of-illness approach, the study assessed the economic impact of SCD and VOC management, including assessing patient/caregiver costs, healthcare provider costs and societal burdens extrapolated to the larger SCD population in India. Findings: Patients incurred substantial out-of-pocket expenses, with a median (IQR) annual expenditure of INR 22 080/US$267 (IQR: INR 36 990/US$447.7), representing 14.65% (26.53) of their annual household income. Overall, catastrophic healthcare expenditure (CHE) for total annual average SCD care with VOC management was experienced by 624 patients (62.40%). Moreover, 334 patients (33.4%) experienced CHE of >25% of the annual household income. Patients with SCD with VOC had significantly higher median annual healthcare expenditures and used a higher median percentage of their yearly household income on healthcare compared with those without VOC (19.82% vs 6.08%; p<0.001). Cost incurred by healthcare providers for VOC management in different healthcare facilities (outpatient department/emergency department/intensive care unit) was similar across different reimbursed facilities (government tertiary care hospitals, non-governmental organisation-operated healthcare centres and government-subsidised healthcare setups). The estimated societal burden for VOC management in 1 year for 1000 patients visiting different healthcare facilities was around INR 35 119 074 (~US$0.42 million). Interpretation: These findings highlight the considerable economic strain on both patients and healthcare providers in SCD and VOC management, which is similar to the other non-communicable diseases emphasising the urgent need for targeted interventions to improve financial hardships among patients. Funding: The study was funded by Novartis Healthcare Private Limited.

Objective: The current study is a cross-sectional survey that aims to assess an association COVID-19 on mental health in rural areas of Central India.Methods: Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), and Impact of Events Scale-Revised (IES-R) were used to evaluate the anxiety, depression, and post-traumatic stress disorder (PTSD) among families with at least one member having been affected by COVID-19 during November 2022 to December 2022 in Durg District of Chhattisgarh State.Results: A total of 431 participants were interviewed from 18 villages of Durg district of Chhattisgarh state. Symptoms of distress, anxiety and depression were observed in 26.2, 14.8 and 11.8% of participants. The death of family members due to COVID-19 and out of pocket expenditure was considerably associated with a higher risk of mental distress. A reduction in income was significantly associated with depression (p-value = 0.025, OR = 2.066, 95% CI = 1.115–3.817). Decline in income was also linked to depression among study participants (p value = 0.025, OR = 2.066, 95% CI = 1.115–3.817). Education, smoking and out of pocket expenditure was found be independently associated with occurrence of symptoms concerned with PTSD.Conclusion: The study points to the significance of socioeconomic factors like food security, and income stability during COVID-19 in mental health outcomes even after 1 year of pandemic. Increasing access to mental health resources and support for those affected by financial and food insecurities can help individuals cope with stress and maintain mental well-being.