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Rizwan SA

All India Institute of Medical Sciences, New Delhi, Centre for Community Medicine, Alumnus

Madurai Medical College, Madurai, MBBS, Undergraduate

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Dr. Rizwan is a medical doctor who graduated from Madurai Medical College in 2010. He also holds an M.D., in Community Medicine (Public Health) from the All India Institute of Medical Sciences, New Delhi.
His interest areas are Epidemiology, Data science, Health systems, Reproductive and Child Health and Non-communicable diseases.
His ambition is to contribute to the public health revolution in India through research and implement evidence based approaches to achieve equitable access to health.

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Papers by Rizwan SA

Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region

Objectives We used findings from the Global Burden of Disease 2015 study to update our previous p... more Objectives We used findings from the Global Burden of Disease 2015 study to update our previous publication on the burden of diabetes and chronic kidney disease due to diabetes (CKD-DM) during 1990–2015. Methods We extracted GBD 2015 estimates for prevalence , mortality, and disability-adjusted life years (DALYs) of diabetes (including burden of low vision due to diabetes, neuropathy, and amputations and CKD-DM for 22 countries of the EMR from the GBD visualization tools. Results In 2015, 135,230 (95% UI 123,034–148,184) individuals died from diabetes and 16,470 (95% UI 13,977–18,961) from CKD-DM, 216 and 179% increases, respectively, compared to 1990. The total number of people with diabetes was 42.3 million (95% UI 38.6–46.4 million) in 2015. DALY rates of diabetes in 2015 were significantly higher than the expected rates based on Socio-demographic Index (SDI). Conclusions Our study showed a large and increasing burden of diabetes in the region. There is an urgency in dealing with diabetes and its consequences, and these efforts should be at the forefront of health prevention and promotion.

Burden of cardiovascular diseases in the Eastern Mediterranean Region 1990 2015

Objectives To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Reg... more Objectives To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990–2015. Methods We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. Results A total of 1.4 million CVD deaths (95% UI: 1.3–1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest ages -tandardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. Conclusions The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.

Danger ahead the burden of diseases injuries and risk factors in the Eastern Mediterranean Region 1990 2015

Objectives The Eastern Mediterranean Region faces several health challenges at a difficult time w... more Objectives The Eastern Mediterranean Region faces several health challenges at a difficult time with wars, unrest, and economic change. Methods We used the Global Burden of Disease 2015 study to present the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region from 1990 to 2015. Results Ischemic heart disease was the leading cause of death in the region in 2015, followed by cerebrovascular disease. Changes in total deaths ranged from a reduction of 25% for diarrheal diseases to an increase of about 42% for diabetes and tracheal, bronchus, and lung cancer. Collective violence and legal intervention increased by 850% during the time period. Diet was the leading risk factor for disability-adjusted life years (DALYs) for men compared to maternal malnutrition for females. Childhood undernu-trition was the leading risk factor for DALYs in 1990 and 2005, but the second in 2015 after high blood pressure. Conclusions Our study shows that the region is facing several health challenges and calls for global efforts to stabilise the region and to address the current and future burden of disease.

Burden of vision loss in the Eastern Mediterranean region 1990 2015

Objectives To report the estimated trend in prevalence and years lived with disability (YLDs) due... more Objectives To report the estimated trend in prevalence and years lived with disability (YLDs) due to vision loss (VL) in the Eastern Mediterranean region (EMR) from 1990 to 2015. Methods The estimated trends in age-standardized prevalence and the YLDs rate due to VL in 22 EMR countries were extracted from the Global Burden of Disease (GBD) 2015 study. The association of Socio-demographic Index (SDI) with changes in prevalence and YLDs of VL was evaluated using a multilevel mixed model. Results The age-standardized prevalence of VL in the EMR was 18.2% in 1990 and 15.5% in 2015. The total age-standardized YLDs rate attributed to all-cause VL in EMR was 536.9 per 100,000 population in 1990 and 482.3 per 100,000 population in 2015. For each 0.1 unit increase in SDI, the age-standardized prevalence and YLDs rate of VL showed a reduction of 1.5% (p \ 0.001) and 23.9 per 100,000 population (p \ 0.001), respectively. Conclusions The burden of VL is high in the EMR; however, it shows a descending trend over the past 25 years. EMR countries need to establish comprehensive eye care programs in their health care systems.

Adolescent health in the Eastern Mediterranean Region

Objectives The 22 countries of the East Mediterranean Region (EMR) have large populations of adol... more Objectives The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10–24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Methods Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Results Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communi-cable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally , many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Conclusions Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.

The burden of mental disorders in the Eastern Mediterranean region 1990 2015

by Rizwan SA, Maheswar Satpathy, and Farshad Pourmalek

Objectives Mental disorders are among the leading causes of nonfatal burden of disease globally. ... more Objectives Mental disorders are among the leading causes of nonfatal burden of disease globally. Methods We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Results Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7–5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of non-fatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. Conclusions The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

Maternal mortality and morbidity burden in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study GBD 2015 Eastern Mediterranean Region Maternal Mortality Collaborators @BULLET

Objectives Assessing the burden of maternal mortality is important for tracking progress and iden... more Objectives Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. Methods We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. Results The maternal mortality ratio in the EMR decreased 16.3% from 283 (241–328) maternal deaths per 100,000 live births in 1990 to 237 (188–293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Conclusion Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life.

Burden of cancer in the Eastern Mediterranean Region 2005 2015

Objectives To estimate incidence, mortality, and disability adjusted life years (DALYs) caused by... more Objectives To estimate incidence, mortality, and disability adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.

Neonatal infant and under 5 mortality and morbidity burden in the Eastern Mediterranean region

Objectives Although substantial reductions in under-5 mortality have been observed during the pas... more Objectives Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. Methods We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. Results In 2015, 755,844 (95% uncertainty interval (UI) 712,064–801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812–181,463) in 1990 to 80,985 (76,308–85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. Conclusions Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths.

Level of Perceived Stress and Coping Strategies Prevailing Among 1 st year Medical Undergraduate Students: A Cross-sec- tional Study from South India

by Rizwan SA and Farhad Ahamed

To maintain high level of proficiency and better patient outcomes, medical personnel suffer from ... more To maintain high level of proficiency and better patient outcomes, medical personnel suffer from high degree of stress. The aim of this study was to determine the prevalence of stress and associated coping strategies among medical undergraduate students in a south Indian medical college. Settings and Design: Cross-sectional study was done among 1st year students in a private medical college in Tamil Nadu, India. A self-administered pretested questionnaire was used to collect socio-demographic information and information on perceived mental stress (PSS-10) and coping strategies (Brief COPE). Results: About 80% of the boys and 75% of the girls reported a moderate or higher stress level according to the PSS. Most commonly employed coping mechanism among students under stress was religion (25%). Among boys, the most common mechanism was humor (26%) and that of girls was religious methods (30%). Conclusions: Stress was common among first year medical students. There is a requirement for stress management training among MBBS students.

A prospective study on adverse drug reactions reported in a tertiary referral hospital

To determine the incidence of Adverse drug reactions in our hospital, to study the age wise distr... more To determine the incidence of Adverse drug reactions in our hospital, to study the age wise distribution, the role of concurrent medication and the common drugs that are prone to cause adverse drug reactions and its seriousness. Methods: After getting prior approval from Institutional ethical committee a prospective study was done where in cases attending OPD, ward, ICU were studied over a year. A complete history was taken regarding drug exposure (dosage, date started, duration and interruptions in use), initiation of drug use and onset of reaction ,previous adverse drug reactions, improvement after decrease in dosage, disease states predisposing to eruptions, previous family and personal history of skin disease, environmental and occupational exposure to chemicals. Relevant laboratory test such as blood investigations, liver and renal function tests are carried out and results were analysed statistically by SPSS version 21 and interpretations done based on the results. Results: Incidence of ADR among OPD =0.18, IPD=1.98, OPD+IPD=0.39 /1000cases.The highest incidence of Adverse drug reactions were found among the age group of 30-39 years (27.45%), 40-49 years (23.53%), with the highest among antibiotic group of drugs (35.29%) involving a maximum duration of 2-7 days. Drug reactions mostly occurred with the oral route 66.67) and most of it requiring hospitalization (47.06%), 60.78% of reactions were manifested in skin, 58.82% of patients with ADR had concomitant medications and 19.61% had Diabetes mellitus, 90% of reactions abated after drug withdrawal with regard to its outcome 94.12% of reactions recovered. Conclusions: The study suggest the adverse drug reactions commonly occur in middle age, mostly manifesting in skin with oral route of administration ,associated with concomitant medications and it requires hospitalisation with a good recovery rate with diabetes being the common comorbid disorder.

Pre-treatment factor structures of the Montgomery and Åsberg Depression Rating scale as predictors of response to escitalopram in Indian patients with non-psychotic major depressive disorder

A B S T R A C T Background: Major Depressive Disorder (MDD) is a broad heterogeneous construct re... more A B S T R A C T Background: Major Depressive Disorder (MDD) is a broad heterogeneous construct resolving into several symptom-clusters by factor analysis. The aim was to find the factor structures of MDD as per Montgomery and Asberg Depression Rating Scale (MADRS) and whether they predict escitalopram response. Methods: In a longitudinal study at a tertiary institute in north India, 116 adult outpatients with non-psychotic unipolar MDD were assessed with MADRS before and after treatment with escitalopram (10–20 mg) over 6–8 weeks for drug response. Results: For total 116 patients pre-treatment four factor structures of MADRS extracted by principal component analysis with varimax rotation altogether explained a variance of 57%: first factor 'detachment' (concentration difficulty, lassitude, inability to feel); second factor 'psychic anxiety' (suicidal thoughts and inner tension); third 'mood-pessimism' (apparent sadness, reported sadness, pessimistic thoughts) and fourth 'vegetative' (decreased sleep, appetite). Eighty patients (68.9%) who completed the study had mean age 35.37 ± 10.9 yrs, majority were male (57.5%), with mean pre-treatment MADRS score 28.77 ± 5.18 and majority (65%) having moderate severity (MADRS < 30). Among them 56 (70%) responded to escitalopram. At the end of the treatment there were significant changes in all the 4 factor structures (p < 0.01). Vegetative function was an important predictor of response (p < 0.01, odd's ratio: 1.3 [1.1–1.6] 95% CI). Melancholia significantly predicted non-response (p = 0.04). Conclusions: Non-psychotic unipolar major depression having moderate severity in north Indian patients as per MADRS resolved into four factor-structures all significantly improved with adequate escitalopram treatment. Understanding the factor structure is important as they can be important predictor of escitalopram response.

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by meas... more Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

Characteristics of the Ozone pollution and its health effects in India

Surface level ozone is one of the important air pollutants. It is formed by the reaction of atmos... more Surface level ozone is one of the important air pollutants. It is formed by the reaction of atmospheric pollutants in the presence of sunlight. The surface ozone shows temporal and spatial variations in the country. The levels are maximum during summer and minimum in monsoon seasons. The levels are maximum during daytime and minimum during night or early morning. In India, surface ozone levels are above the recommended threshold of 8 hour average of 100 µg/m 3 for air quality monitoring at various stations. Exposure to high levels of surface ozone causes number of health problems. Short term exposure causes drop in lung function measures and it also affects the lung's mucociliary function thereby increasing the susceptibility to bacterial infections. With increase in surface ozone levels, there is likelihood of an increase in risk of hospital admissions for Chronic Obstructive Pulmonary Diseases (COPD) and the number of cardiovascular and respiratory deaths. In children, increase in ozone concentration is associated with increase in hospital admissions and unscheduled asthma medications. The high levels of surface ozone are becoming a threat to people's health and so surface ozone levels have to be monitored and steps taken to reduce their levels.

Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis

Objectives To systematically review and meta-analyse the studies investigating the association be... more Objectives To systematically review and meta-analyse the studies investigating the association between smokeless tobacco (SLT) use and all-cause mortality and cause-specific mortality outcomes among adult users of SLT and estimate the number of attributable deaths worldwide. Methods Random-effects meta-analysis was used to estimate the pooled risk of death due to SLT use.

Evaluation of state-run STI/RTI clinics in the state of Haryana, India through a supportive supervision approach

by Rama Shankar Rath, AYUSH LOHIYA, and Rizwan SA

Indian dermatology online journal, 2014

Sexually transmitted infections (STIs) are an important public health problem because of their ad... more Sexually transmitted infections (STIs) are an important public health problem because of their adverse effects on reproductive health of men and women. About 5% of adult population in India suffers from STIs. To tackle this issue the government has set up reproductive tract infection (RTI) clinics across the country. To assess the effect of supportive supervision on the quality of services provided in STI/RTI clinics in the state of Haryana, India. Selected state-run STI/RTI clinics, facility-based pre- and post evaluation study. Sixteen STI/RTI clinics were selected for the study, including six from government facilities and 10 from targeted intervention sites across five districts of Haryana. From each of the selected sites one physician in-charge was interviewed twice with an interval of 2-3 months using pretested formats. Scores were given in selected domains of STI/RTI management for each visit and the improvement was assessed. Wilcoxon signed rank test. A total of 16 physician...

A study on the utility of preventive health check-up in early detection of disease states

Miraculous Aloe Vera: Its healing potential on experimental dermal wound in mice

BACKGROUND Healing is a survival mechanism and represents an attempt to maintain normal anatomica... more BACKGROUND Healing is a survival mechanism and represents an attempt to maintain normal anatomical structure and function. Aloe vera is a very important plant for its large number of medicinal properties. The objective of the study is to evaluate the wound healing activity of Indian Aloe (Aloe Vera) leaves pulp in experimental model.

Sensitivity and Specificity of Pulse Oximetry and Ankle-Brachial Index for Screening Asymptomatic Peripheral Vascular Diseases in Type 2 Diabetes Mellitus

Objectives: To compare pulse oximetry and Ankle-Brachial Index (ABI) with duplex ultrasonography ... more

Fixed-dose combination drugs for the treatment of tuberculosis under India's RNTCP

by Rizwan SA and karthik balajee

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2015

Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region

Objectives We used findings from the Global Burden of Disease 2015 study to update our previous p... more Objectives We used findings from the Global Burden of Disease 2015 study to update our previous publication on the burden of diabetes and chronic kidney disease due to diabetes (CKD-DM) during 1990–2015. Methods We extracted GBD 2015 estimates for prevalence , mortality, and disability-adjusted life years (DALYs) of diabetes (including burden of low vision due to diabetes, neuropathy, and amputations and CKD-DM for 22 countries of the EMR from the GBD visualization tools. Results In 2015, 135,230 (95% UI 123,034–148,184) individuals died from diabetes and 16,470 (95% UI 13,977–18,961) from CKD-DM, 216 and 179% increases, respectively, compared to 1990. The total number of people with diabetes was 42.3 million (95% UI 38.6–46.4 million) in 2015. DALY rates of diabetes in 2015 were significantly higher than the expected rates based on Socio-demographic Index (SDI). Conclusions Our study showed a large and increasing burden of diabetes in the region. There is an urgency in dealing with diabetes and its consequences, and these efforts should be at the forefront of health prevention and promotion.

Burden of cardiovascular diseases in the Eastern Mediterranean Region 1990 2015

Objectives To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Reg... more Objectives To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990–2015. Methods We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. Results A total of 1.4 million CVD deaths (95% UI: 1.3–1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest ages -tandardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. Conclusions The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.

Danger ahead the burden of diseases injuries and risk factors in the Eastern Mediterranean Region 1990 2015

Objectives The Eastern Mediterranean Region faces several health challenges at a difficult time w... more Objectives The Eastern Mediterranean Region faces several health challenges at a difficult time with wars, unrest, and economic change. Methods We used the Global Burden of Disease 2015 study to present the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region from 1990 to 2015. Results Ischemic heart disease was the leading cause of death in the region in 2015, followed by cerebrovascular disease. Changes in total deaths ranged from a reduction of 25% for diarrheal diseases to an increase of about 42% for diabetes and tracheal, bronchus, and lung cancer. Collective violence and legal intervention increased by 850% during the time period. Diet was the leading risk factor for disability-adjusted life years (DALYs) for men compared to maternal malnutrition for females. Childhood undernu-trition was the leading risk factor for DALYs in 1990 and 2005, but the second in 2015 after high blood pressure. Conclusions Our study shows that the region is facing several health challenges and calls for global efforts to stabilise the region and to address the current and future burden of disease.

Burden of vision loss in the Eastern Mediterranean region 1990 2015

Objectives To report the estimated trend in prevalence and years lived with disability (YLDs) due... more Objectives To report the estimated trend in prevalence and years lived with disability (YLDs) due to vision loss (VL) in the Eastern Mediterranean region (EMR) from 1990 to 2015. Methods The estimated trends in age-standardized prevalence and the YLDs rate due to VL in 22 EMR countries were extracted from the Global Burden of Disease (GBD) 2015 study. The association of Socio-demographic Index (SDI) with changes in prevalence and YLDs of VL was evaluated using a multilevel mixed model. Results The age-standardized prevalence of VL in the EMR was 18.2% in 1990 and 15.5% in 2015. The total age-standardized YLDs rate attributed to all-cause VL in EMR was 536.9 per 100,000 population in 1990 and 482.3 per 100,000 population in 2015. For each 0.1 unit increase in SDI, the age-standardized prevalence and YLDs rate of VL showed a reduction of 1.5% (p \ 0.001) and 23.9 per 100,000 population (p \ 0.001), respectively. Conclusions The burden of VL is high in the EMR; however, it shows a descending trend over the past 25 years. EMR countries need to establish comprehensive eye care programs in their health care systems.

Adolescent health in the Eastern Mediterranean Region

Objectives The 22 countries of the East Mediterranean Region (EMR) have large populations of adol... more Objectives The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10–24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Methods Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Results Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communi-cable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally , many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Conclusions Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.

The burden of mental disorders in the Eastern Mediterranean region 1990 2015

by Rizwan SA, Maheswar Satpathy, and Farshad Pourmalek

Objectives Mental disorders are among the leading causes of nonfatal burden of disease globally. ... more Objectives Mental disorders are among the leading causes of nonfatal burden of disease globally. Methods We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. Results Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7–5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of non-fatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. Conclusions The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

Maternal mortality and morbidity burden in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study GBD 2015 Eastern Mediterranean Region Maternal Mortality Collaborators @BULLET

Objectives Assessing the burden of maternal mortality is important for tracking progress and iden... more Objectives Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. Methods We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. Results The maternal mortality ratio in the EMR decreased 16.3% from 283 (241–328) maternal deaths per 100,000 live births in 1990 to 237 (188–293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Conclusion Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life.

Burden of cancer in the Eastern Mediterranean Region 2005 2015

Objectives To estimate incidence, mortality, and disability adjusted life years (DALYs) caused by... more Objectives To estimate incidence, mortality, and disability adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. Methods Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. Results In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. Conclusions Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.

Neonatal infant and under 5 mortality and morbidity burden in the Eastern Mediterranean region

Objectives Although substantial reductions in under-5 mortality have been observed during the pas... more Objectives Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. Methods We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. Results In 2015, 755,844 (95% uncertainty interval (UI) 712,064–801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812–181,463) in 1990 to 80,985 (76,308–85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. Conclusions Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths.

Level of Perceived Stress and Coping Strategies Prevailing Among 1 st year Medical Undergraduate Students: A Cross-sec- tional Study from South India

by Rizwan SA and Farhad Ahamed

To maintain high level of proficiency and better patient outcomes, medical personnel suffer from ... more To maintain high level of proficiency and better patient outcomes, medical personnel suffer from high degree of stress. The aim of this study was to determine the prevalence of stress and associated coping strategies among medical undergraduate students in a south Indian medical college. Settings and Design: Cross-sectional study was done among 1st year students in a private medical college in Tamil Nadu, India. A self-administered pretested questionnaire was used to collect socio-demographic information and information on perceived mental stress (PSS-10) and coping strategies (Brief COPE). Results: About 80% of the boys and 75% of the girls reported a moderate or higher stress level according to the PSS. Most commonly employed coping mechanism among students under stress was religion (25%). Among boys, the most common mechanism was humor (26%) and that of girls was religious methods (30%). Conclusions: Stress was common among first year medical students. There is a requirement for stress management training among MBBS students.

A prospective study on adverse drug reactions reported in a tertiary referral hospital

To determine the incidence of Adverse drug reactions in our hospital, to study the age wise distr... more To determine the incidence of Adverse drug reactions in our hospital, to study the age wise distribution, the role of concurrent medication and the common drugs that are prone to cause adverse drug reactions and its seriousness. Methods: After getting prior approval from Institutional ethical committee a prospective study was done where in cases attending OPD, ward, ICU were studied over a year. A complete history was taken regarding drug exposure (dosage, date started, duration and interruptions in use), initiation of drug use and onset of reaction ,previous adverse drug reactions, improvement after decrease in dosage, disease states predisposing to eruptions, previous family and personal history of skin disease, environmental and occupational exposure to chemicals. Relevant laboratory test such as blood investigations, liver and renal function tests are carried out and results were analysed statistically by SPSS version 21 and interpretations done based on the results. Results: Incidence of ADR among OPD =0.18, IPD=1.98, OPD+IPD=0.39 /1000cases.The highest incidence of Adverse drug reactions were found among the age group of 30-39 years (27.45%), 40-49 years (23.53%), with the highest among antibiotic group of drugs (35.29%) involving a maximum duration of 2-7 days. Drug reactions mostly occurred with the oral route 66.67) and most of it requiring hospitalization (47.06%), 60.78% of reactions were manifested in skin, 58.82% of patients with ADR had concomitant medications and 19.61% had Diabetes mellitus, 90% of reactions abated after drug withdrawal with regard to its outcome 94.12% of reactions recovered. Conclusions: The study suggest the adverse drug reactions commonly occur in middle age, mostly manifesting in skin with oral route of administration ,associated with concomitant medications and it requires hospitalisation with a good recovery rate with diabetes being the common comorbid disorder.

Pre-treatment factor structures of the Montgomery and Åsberg Depression Rating scale as predictors of response to escitalopram in Indian patients with non-psychotic major depressive disorder

A B S T R A C T Background: Major Depressive Disorder (MDD) is a broad heterogeneous construct re... more A B S T R A C T Background: Major Depressive Disorder (MDD) is a broad heterogeneous construct resolving into several symptom-clusters by factor analysis. The aim was to find the factor structures of MDD as per Montgomery and Asberg Depression Rating Scale (MADRS) and whether they predict escitalopram response. Methods: In a longitudinal study at a tertiary institute in north India, 116 adult outpatients with non-psychotic unipolar MDD were assessed with MADRS before and after treatment with escitalopram (10–20 mg) over 6–8 weeks for drug response. Results: For total 116 patients pre-treatment four factor structures of MADRS extracted by principal component analysis with varimax rotation altogether explained a variance of 57%: first factor 'detachment' (concentration difficulty, lassitude, inability to feel); second factor 'psychic anxiety' (suicidal thoughts and inner tension); third 'mood-pessimism' (apparent sadness, reported sadness, pessimistic thoughts) and fourth 'vegetative' (decreased sleep, appetite). Eighty patients (68.9%) who completed the study had mean age 35.37 ± 10.9 yrs, majority were male (57.5%), with mean pre-treatment MADRS score 28.77 ± 5.18 and majority (65%) having moderate severity (MADRS < 30). Among them 56 (70%) responded to escitalopram. At the end of the treatment there were significant changes in all the 4 factor structures (p < 0.01). Vegetative function was an important predictor of response (p < 0.01, odd's ratio: 1.3 [1.1–1.6] 95% CI). Melancholia significantly predicted non-response (p = 0.04). Conclusions: Non-psychotic unipolar major depression having moderate severity in north Indian patients as per MADRS resolved into four factor-structures all significantly improved with adequate escitalopram treatment. Understanding the factor structure is important as they can be important predictor of escitalopram response.

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by meas... more Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

Characteristics of the Ozone pollution and its health effects in India

Surface level ozone is one of the important air pollutants. It is formed by the reaction of atmos... more Surface level ozone is one of the important air pollutants. It is formed by the reaction of atmospheric pollutants in the presence of sunlight. The surface ozone shows temporal and spatial variations in the country. The levels are maximum during summer and minimum in monsoon seasons. The levels are maximum during daytime and minimum during night or early morning. In India, surface ozone levels are above the recommended threshold of 8 hour average of 100 µg/m 3 for air quality monitoring at various stations. Exposure to high levels of surface ozone causes number of health problems. Short term exposure causes drop in lung function measures and it also affects the lung's mucociliary function thereby increasing the susceptibility to bacterial infections. With increase in surface ozone levels, there is likelihood of an increase in risk of hospital admissions for Chronic Obstructive Pulmonary Diseases (COPD) and the number of cardiovascular and respiratory deaths. In children, increase in ozone concentration is associated with increase in hospital admissions and unscheduled asthma medications. The high levels of surface ozone are becoming a threat to people's health and so surface ozone levels have to be monitored and steps taken to reduce their levels.

Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis

Objectives To systematically review and meta-analyse the studies investigating the association be... more Objectives To systematically review and meta-analyse the studies investigating the association between smokeless tobacco (SLT) use and all-cause mortality and cause-specific mortality outcomes among adult users of SLT and estimate the number of attributable deaths worldwide. Methods Random-effects meta-analysis was used to estimate the pooled risk of death due to SLT use.

Evaluation of state-run STI/RTI clinics in the state of Haryana, India through a supportive supervision approach

by Rama Shankar Rath, AYUSH LOHIYA, and Rizwan SA

Indian dermatology online journal, 2014

Sexually transmitted infections (STIs) are an important public health problem because of their ad... more Sexually transmitted infections (STIs) are an important public health problem because of their adverse effects on reproductive health of men and women. About 5% of adult population in India suffers from STIs. To tackle this issue the government has set up reproductive tract infection (RTI) clinics across the country. To assess the effect of supportive supervision on the quality of services provided in STI/RTI clinics in the state of Haryana, India. Selected state-run STI/RTI clinics, facility-based pre- and post evaluation study. Sixteen STI/RTI clinics were selected for the study, including six from government facilities and 10 from targeted intervention sites across five districts of Haryana. From each of the selected sites one physician in-charge was interviewed twice with an interval of 2-3 months using pretested formats. Scores were given in selected domains of STI/RTI management for each visit and the improvement was assessed. Wilcoxon signed rank test. A total of 16 physician...

A study on the utility of preventive health check-up in early detection of disease states

Miraculous Aloe Vera: Its healing potential on experimental dermal wound in mice

BACKGROUND Healing is a survival mechanism and represents an attempt to maintain normal anatomica... more BACKGROUND Healing is a survival mechanism and represents an attempt to maintain normal anatomical structure and function. Aloe vera is a very important plant for its large number of medicinal properties. The objective of the study is to evaluate the wound healing activity of Indian Aloe (Aloe Vera) leaves pulp in experimental model.

Sensitivity and Specificity of Pulse Oximetry and Ankle-Brachial Index for Screening Asymptomatic Peripheral Vascular Diseases in Type 2 Diabetes Mellitus

Objectives: To compare pulse oximetry and Ankle-Brachial Index (ABI) with duplex ultrasonography ... more

Fixed-dose combination drugs for the treatment of tuberculosis under India's RNTCP

by Rizwan SA and karthik balajee

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2015