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1.  Malaria vaccine can prevent millions of deaths in the world 
Human Vaccines & Immunotherapeutics  2013;9(6):1268-1271.
Malaria is a major public health problem, afflicting ~36% of the world’s population. The World Health Organization (WHO) has estimated that there were 216 million cases of malaria in 2010, and ~655,000 people died from the disease (~2000 per day), many under age five. Yet the disease, a killer for centuries, remains endemic in many poor nations, particularly in Africa, where it is blamed for retarding economic growth. India contributes ~70% of the 2.5 million reported cases in Southeast Asia. Malaria is also an important threat to travelers to the tropics, causing thousands of cases of illness and occasional deaths. The 5 Plasmodium species known to cause malaria are P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. Most cases of malaria are uncomplicated, but some can quickly turn into severe, often fatal, episodes in vulnerable individuals if not promptly diagnosed and effectively treated. Malaria vaccines have been an area of intensive research, but there is no effective vaccine. Vaccines are among the most cost-effective tools for public health; they have historically contributed to a reduction in the spread and burden of infectious diseases. Many antigens present throughout the parasite life cycle that could be vaccine targets. More than 30 of these are being researched by teams worldwide in the hope of identifying a combination that can elicit protective immunity. Most vaccine research has focused on the P. falciparum strain due to its high mortality and the ease of conducting in vitro and in vivo studies. DNA-based vaccines are a new technology that may hold hope for an effective malaria vaccine.
PMCID: PMC3901816  PMID: 23403452
malaria; parasites; immunity; research; vaccines
2.  Pharmacognostical study and establishment of quality parameters of aerial parts of Costus speciosus-a well known tropical folklore medicine 
To evaluate the diagnostic pharmacognostical characters of Costus speciosus (aerial parts) along with their physico-chemical parameters and fluorosence analysis.
The pharmacognostical characters were determined in terms of macroscopy, microscopy, powder microscopy, leaf constant, fluorescence analysis and preliminary phytochemical investigation.
The findings of macroscopy revealed that leaves elliptic to oblong or oblong-lancoelate, thick, spirally arranged, with stem clasping sheaths up to 4 cm, flowers large, white, cone-like terminal spikes, with bright red bracts. Transverse section of leaflet showed the presence of cuticularised epidermis with polygonal cells on adaxial surface and bluntly angled cells on abaxial surface of lamina, mesophyll cells differentiated in to single layered palisade cells on each surface and 2-3 layered spongy parenchyma, unicellular and uniseriate multicellular covering trichomes, paracytic stomata and vascular bundles surrounded by sclerenchymatous multicellular sheath. Preliminary phytochemical screening exhibited the presence of various phytochemical groups like alkaloids, glycosides, steroids, phenolic constituents. Further, the leaf constants, powder microscopy and fluorescence characteristics indicated outstanding results from this investigation
Various pharmacognostical and physico-chemical parameters have pivotal roles in identification, authentication and establishment of quality parameters of the species.
PMCID: PMC3994359  PMID: 25182951
Costus speciosus; Quality control; Physico-chemical parameters; Microscopy; Fluorescence analysis
3.  Whole-cell inactivated Leptospirosis vaccine 
Leptospirosis is an infectious disease of worldwide distribution that is caused by pathogenic spirochete bacteria of the genus Leptospira. It is transmitted by the urine of an infected animal and contagious in a moist environment. Epidemiological studies indicate that infection is commonly associated with certain occupational workers such as farmers, sewage workers, veterinarians, and animal handlers. The annual incidence is estimated at 0.1–1 per 100,000 in temperate climates to 10–100 per 100,000 in the humid tropics. A disease incidence of more than 100 per 100,000 is encountered during outbreaks and in high-exposure risk groups. The 11 countries in South-East Asia (SEA) together have a population of more than 1.7 billion and a work force of about 770 million with more than 450 million people engaged in agriculture. Because of the large number of serovars and infection sources and the wide differences in conditions of transmission, the control of leptospirosis is complicated and will depend on local conditions. The available leptospirosis vaccines are mono- or polyvalent cellular suspensions. These cells are inactivated by chemical agents like formaldehyde and phenol, or by physical agents like heat. The vaccine confers protection for not longer than about one year, while there are cases that need revaccination six months later during epidemic periods.
PMCID: PMC3903893  PMID: 23295984
bacteria; incidence; outbreak; prevention; vaccine
4.  Economic Analysis of Delivering Primary Health Care Services through Community Health Workers in 3 North Indian States 
PLoS ONE  2014;9(3):e91781.
We assessed overall annual and unit cost of delivering package of services and specific services at sub-centre level by CHWs and cost effectiveness of Government of India’s policy of introducing a second auxiliary nurse midwife (ANM) at the sub-centre compared to scenario of single ANM sub-centre.
We undertook an economic costing of health services delivered by CHWs, from a health system perspective. Bottom-up costing method was used to collect data on resources spent in 50 randomly selected sub-centres selected from 4 districts. Mean unit cost along with its 95% confidence intervals were estimated using bootstrap method. Multiple linear regression model was used to standardize cost and assess its determinants.
Annually it costs INR 1.03 million (USD 19,381), or INR 187 (USD 3.5) per capita per year, to provide a package of preventive, curative and promotive services through community health workers. Unit costs for antenatal care, postnatal care, DOTS treatment and immunization were INR 525 (USD 10) per full ANC care, INR 767 (USD 14) per PNC case registered, INR 974 (USD 18) per DOTS treatment completed and INR 97 (USD 1.8) per child immunized in routine immunization respectively. A 10% increase in human resource costs results in 6% rise in per capita cost. Similarly, 10% increment in the ANC case registered per provider through-put results in a decline in unit cost ranging from 2% in the event of current capacity utilization to 3% reduction in case of full capacity utilization. Incremental cost of introducing 2nd ANM at sub-centre level per unit percent increase ANC coverage was INR 23,058 (USD 432).
Our estimates would be useful in undertaking full economic evaluations or equity analysis of CHW programs. Government of India’s policy of hiring 2nd ANM at sub-centre level is very cost effective from Indian health system perspective.
PMCID: PMC3953597  PMID: 24626285
5.  Development of Toxoplasma gondii vaccine 
Toxoplasmosis is caused by the protozoan parasite T. gondii. Humans and other warm-blooded animals are its hosts. The infection has a worldwide distribution; one-third of the world’s population has been exposed to this parasite. There are three primary ways of transmission: ingesting uncooked meat containing tissue cysts, ingesting food and water contaminated with oocysts from infected cat feces and congenitally. Those particularly at risk of developing clinical illness include pregnant women, given that the parasite can pose a serious threat to the unborn child if the mother becomes infected while pregnant, and immunosuppressed individuals such as tissue transplant subjects, AIDS subjects, those with certain types of cancer and those undergoing certain forms of cancer therapy. Maternal infections early in pregnancy are less likely to be transmitted to the fetus than infections later in pregnancy, but early fetal infections are more likely to be severe than later infections. In the absence of an effective human vaccine, prevention of zoonotic transmission might be the best way to approach the problem of toxoplasmosis and must be done by limiting exposure to oocysts or tissue cysts. Vaccine development to prevent feline oocyst shedding is ongoing, mostly with live vaccines. The S48 strain Toxovax is a live vaccine originally developed for use in sheep, but when used in cats inhibits sexual development of T. gondii. This vaccine is used in sheep to reduce tissue cyst development. The T-263 strain of T. gondii is a live mutant strain designed to reduce or prevent oocyst shedding by cats by developing only partial infection in the feline intestinal tract.
PMCID: PMC3859749  PMID: 23111123
parasite; oocyst; pregnancy; congenital anomalies; vaccine
6.  Hepatitis C, a silent threat to the community of Haryana, India: a community-based study 
Hepatitis C is a global public health problem. As many as 12 million people may be chronically infected in India and most are unaware of it.
To determine the incidence of hepatitis C in the Ratia block of the Fatehabad district, Haryana, India.
This cross-sectional study was carried out by house-tohouse visits over 2 weeks. After obtaining written consent, a blood sample was drawn from suspected cases by a laboratory technician maintaining all necessary safety precautions and sterilization.
Of the samples, 1,630 (22.3 per cent) were found to be positive for hepatitis C by ELISA, 253 (15.5 per cent) patients were previously hepatitis C positive, and adults (21–60 years) were affected maximally (70.0 per cent).
The study emphasises the need for public awareness campaigns at various levels and prevention of HCV infection. It also suggests the need to develop and strengthen evaluation methodology for the Integrated Disease Surveillance Project (IDSP).
PMCID: PMC3920471  PMID: 24567761
Hepatitis C; HCV; community
7.  Human papilloma virus vaccines 
Human papilloma viruses (HPVs) infect the skin and mucosal epithelium of both men and women. There are about 100 types of HPVs, which are differentiated by the genetic sequence of the outer capsid protein L1. More than 30 types of HPVs are sexually transmitted. Most cases of carcinoma of the cervix are caused by HPV. Cervical cancer is one of the most common forms of cancer in women is the second biggest cause of female cancer mortality worldwide. The worldwide incidence of cervical carcinoma is 529,000 per year, and mortality is 275,000, of which an estimated 88% of deaths occur in developing countries. At least 20 million people worldwide are already chronically infected. Over 80% of cases of cervical carcinoma occurs in developing countries, with 25% estimated to occur in India. At least 50% of sexually active men and women encounter genital HPV at some time in their lives. Cervical cancer is ranked as the most frequent cancer in women in India. India has a population of approximately 366 million women above 15 y of age, who are at risk of developing cervical cancer. The current estimates indicate approximately 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting for nearly one-third of the global cervical cancer deaths. HPV can be prevented by vaccination. Two types of HPV vaccines are available, as Gardasil and Cervarix, both of which are highly effective at preventing HPV infection. HPV vaccine is administered in a three-dose series administered by intramuscular injection, either in the deltoid muscle or in the antero-lateral thigh. The second and third doses should be administered 2 and 6 mo after the first dose respectively. The minimum interval between the first and second doses should be 4 weeks, between the second and third dose should be 12 weeks.
PMCID: PMC3667952  PMID: 23108360
HPV; cervical carcinoma; wart; death; vaccines
8.  Evaluating the Ameliorative Potential of Quercetin against the Bleomycin-Induced Pulmonary Fibrosis in Wistar Rats 
Pulmonary Medicine  2013;2013:921724.
The current study deals with the effect of a dietary flavanoid quercetin on fibrotic lung tissue in rats. Bleomycin was administered by single intratracheal instillation to Wistar rats to induce lung fibrosis. The pathologies associated with this included significantly reduced antioxidant capacity, ultimately leading to protracted inflammation of the lung tissue. The hallmark of this induced fibrosis condition was an excessive collagen deposition in peribronchial and perialveolar regions of the lung. Oral quercetin treatment over a period of twenty days resulted in significant reversal of the pathologies. The antioxidant defense in lung tissue was revived. Moreover, activity of the collagenase MMP-7, which was high in fibrotic tissue, was seen restored after quercetin administration. Trichome staining of lung tissue sections showed high collagen deposition in fibrotic rats, which may be a direct result of increased mobilization of collagen by MMP-7. This was appreciably reduced in quercetin treated animals. These results point towards an important protective role of quercetin against idiopathic lung fibrosis, which remains a widely prevalent yet incurable condition in the present times.
PMCID: PMC3875129  PMID: 24396596
9.  Meningococcal vaccine 
Human Vaccines & Immunotherapeutics  2012;8(12):1904-1906.
Meningococcal meningitis is caused by Neisseria meningitidis, a gram-negative, aerobic, encapsulated diplococcus. Meningococci are divided into numerous serogroups based on the composition of their capsular polysaccharide (Ps) antigens. At least 13 serogroups have been described: A, B, C, D, 29E, H, I, K, L, W-135, X, Y and Z. Out of these 13, six (A, B, C, W135, X and Y) can cause epidemics. The incubation period averages 3–4 d (range 1–10 d), which is the period of communicability. Bacteria can be found for 2–4 d in the nose and pharynx, and for up to 24 h after starting antibiotics. N. meningitidis is a leading cause of meningitis worldwide and a significant public health problem and dreaded disease in most countries. Morbidity and mortality rates from the disease remain high. Apart from epidemics, at least 1.2 million cases of bacterial meningitis are estimated to occur every year, 135,000 of which are fatal – of these, ~500,000 and ~50,000 respectively are caused by meningococci. Many outbreaks of meningococcal meningitis have been documented, with major outbreaks mainly seen in large cities of northern, western and eastern India like New Delhi, Mumbai, Kolkata and northeastern states. In 2011, 245 people died in India, the vast majority (179) in West Bengal, while 467 and 341 people in 2009 and 2010 respectively died of this disease. The meningococcal conjugate vaccines (MCV) are preferred for reasons of immunogenicity and persistence of immunity but are unavailable in India. Only the quadrivalent and bivalent meningococcal Ps vaccines (MPV) are available in India. The quadrivalent MPV is preferred for Haj pilgrims, international travelers and students in that it provides protection against emerging W-135 and Y disease in these areas. A single-dose 0.5mL injection is recommended.
PMCID: PMC3656083  PMID: 22906940
meningitis; disease; morbidity; mortality; vaccines
10.  Tetanus toxoid vaccine: Elimination of neonatal tetanus in selected states of India 
Human Vaccines & Immunotherapeutics  2012;8(10):1439-1442.
Tetanus is caused by a neurotoxin produced by Clostridium tetani (C. tetani), a spore-forming bacterium. Infection begins when tetanus spores are introduced into damaged tissue. Tetanus is characterized by muscle rigidity and painful muscle spasms caused by tetanus toxin’s blockade of inhibitory neurons that normally oppose and modulate the action of excitatory motor neurons. Maternal and neonatal tetanus (MNT) are caused by unhygienic methods of delivery, abortion, or umbilical-cord care. Maternal and neonatal tetanus are both forms of generalized tetanus and have similar clinical courses. About 90% of neonates with tetanus develop symptoms in the first 3–14 d of life, mostly on days 6–8, distinguishing neonatal tetanus from other causes of neonatal mortality which typically occur during the first two days of life. Overall case fatality rates for patients admitted to the hospital with neonatal tetanus in developing countries are 8–50%, while the fatality rate can be as high as 100% without hospital care. Tetanus toxoid (TT) vaccination of pregnant women to prevent neonatal tetanus was included in WHO’s Expanded Program on Immunization (EPI) a few years after its inception in 1974. In 2000, WHO, UNICEF, and UNFPA formed a partnership to relaunch efforts toward this goal, adding the elimination of maternal tetanus as a program objective, and setting a new target date of 2005. By February 2007, 40 countries had implemented tetanus vaccination campaigns in high-risk areas, targeting more than 94 million women, and protecting more than 70 million subjects with at least two doses of TT. In 2011, 653 NT cases were reported in India compared with 9313 in 1990. As of February 2012, 25 countries and 15 States and Union Territories of India, all of Ethiopia except Somaliland, and almost 29 of 34 provinces in Indonesia have been validated to have eliminated MNT.
PMCID: PMC3660763  PMID: 22894950
elimination; maternal; neonatal; tetanus; vaccine
12.  Pneumococcal conjugate vaccine: A newer vaccine available in India 
Human Vaccines & Immunotherapeutics  2012;8(9):1317-1320.
Streptococcus pneumoniae, or “pneumococcus,” causes pneumonia and infections of the brain and blood that are responsible for significant mortality in children under five years as well as in the elderly. Pneumococcal diseases are a major public health problem worldwide. S. pneumoniae is responsible for 15–50% of all episodes of community-acquired pneumonia, 30–50% of all cases of acute otitis media, and a significant proportion of bacterial meningitis and bacteremia. S. pneumoniae kills at least one million children under the age of five every year, which is more than malaria, AIDS and measles combined. More than 70% of the deaths are in developing countries. In 2007, pneumococcal pneumonia was the leading infectious killer of children worldwide. Perhaps more importantly, pneumonia remains the leading killer of children in India. A recent UNICEF publication estimated that 410,000 children under age 5 y die of pneumonia each year in India, and recent data shows that an estimated 25% of all child deaths in India are due to pneumonia. The fact that this high burden of pneumonia has remained undiminished in India in spite of economic growth and decline in child mortality due to other diseases is a reminder of the importance of tackling pneumonia head-on with dedicated resources. The burden of pneumococcal meningitis, which constitutes about half of all childhood meningitis cases in most settings and a greater proportion of meningitis deaths, makes it difficult to avoid the conclusion that the pneumococcus is responsible for 1 million child deaths each year. Global Alliance for Vaccine and Immunization (GAVI) has offered to supply PCV at a cost of 0.15–0.30 USD/dose to India for inclusion in the national immunization schedule and commits to extending this support until the year 2015. Pneumococcal vaccination in not recommended in children aged 5 and above.
PMCID: PMC3579915  PMID: 22894967
Streptococcus pneumonia; mortality; otitis media; pneumonia; vaccines
13.  Hepatitis A vaccine should receive priority in National Immunization Schedule in India 
Human Vaccines & Immunotherapeutics  2012;8(8):1132-1134.
Hepatitis A is an acute, usually self-limiting infection of the liver caused by a virus known as hepatitis A virus (HAV). Humans are the only reservoir of the virus; transmission occurs primarily through the fecal-oral route and is closely associated with poor sanitary conditions. The virus has a worldwide distribution and causes about 1.5 million cases of clinical hepatitis each year. The risk of developing symptomatic illness following HAV infection is directly correlated with age. As many 85% of children below 2 y and 50% of those between 2–5 y infected with HAV are anicteric, and among older children and adults, infection usually causes clinical disease, with jaundice occurring in more than 70% of cases. The infection is usually self-limiting with occasional fulminant hepatic failure and mortality. In most developing countries in Asia and Africa, hepatitis A is highly endemic such that a large proportion of the population acquires immunity through asymptomatic infection early in life. HAV is endemic in India; most of the population is infected asymptomatically in early childhood with life-long immunity. Several outbreaks of hepatitis A in various parts of India have been recorded in the past decade such that anti-HAV positivity varied from 26 to 85%. Almost 50% of children of ages 1–5 y were found to be susceptible to HAV. Any one of the licensed vaccines may be used since all have nearly similar efficacy and safety profiles (except for post-exposure prophylaxis / immunocompromised patients, where only inactivated vaccines may be used). Two doses 6 mo apart are recommended for all vaccines. All Hepatitis A vaccines are licensed for use in children aged 1 y or older. However in the Indian scenario, it is preferable to administer the vaccines at age 18 mo or more when maternal antibodies have completely declined. Vaccination at this age is preferable to later since it is easier to integrate with the existing schedule, protects those who have no antibodies, and protects children by the time they attend day care. In India the vaccine against hepatitis A is available for the people who can afford it, but the government of India should give this vaccine as a priority in the national immunization schedule.
PMCID: PMC3551887  PMID: 22854671
hepatitis A virus; immunity; jaundice; outbreak; vaccines
16.  Crimean-Congo haemorrhagic fever: An outbreak in India 
The Australasian Medical Journal  2011;4(11):589-591.
PMCID: PMC3562913  PMID: 23386871
18.  Why Say No to Tobacco: Indian Perspective 
The Australasian Medical Journal  2011;4(3):139-142.
PMCID: PMC3562961  PMID: 23390462
21.  Picture archiving and communication system—Asynchronous transfer mode network in a midsized hospital 
Journal of Digital Imaging  1997;10(Suppl 1):99-102.
This article describes the pathway to full implementation of a hospital information system-picture archiving and communication system-wide area network (HIS-PACS-WAN) in a 300-bed acute care hospital, and the linking of that system to two other off-site medical centers. The PACS included direct digital capture of computed tomography (CT), magnetic resonance (MR) imaging, nuclear medicine, and ultrasonography images into an Olicon archive. Plain radiographs and fluoroscopy images were digitized manually and archived into an Olicon system. The active archive included current images on each Olicon workstation and the juke box. Long-term archiving of the images on removable optical discs, which would be loaded manually by an operator every time a request for one of these studies appeared on the operator’s monitor, also was implemented. Ability to store, retrieve, and display simultaneously the physician’s report of each procedure along with the images was an ultimate goal. The WAN is to be used for teleradiology and teleconferencing among the three medical centers involved in this study as well as other off-site locations. Phase I included the design and installation of the local area network (LAN) in the Department of Radiology at Olive View-UCLA Medical Center. This included the clinics and the inpatient and hospitalwide fiber-optic network and its linkage to the local telephone company. Phase II involved linkage of the Olicon workstations to imaging equipment. This implementation has been delayed significantly because of inadequate needs assessment, absence of planning for forward-compatibility to imaging equipment, and incompatibilities in DICOM conformance among vendors. Every PACS project must include an in-depth needs analysis, which should be updated yearly because of rapid turnover of technology. Although this analysis should have a heavy emphasis on clinical needs, it must incorporate the hospital-wide needs for an integrated information systems network. Integration of PACS, HIS, RIS, and a dictation/transcription system is a complex task that requires a full-time, clinically oriented project officer for successful completion.
PMCID: PMC3452833  PMID: 9268851

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