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Vol.19 No.6
June, 1989
HIGHLIGHTS OF ICMR
RESEARCH ON NONCOMMUNICABLE DISEASES (1987-88)
Noncommunicable diseases which are the leading
causes of morbidity and mortality in the developed
world, have now emerged as important health problems
in the developing countries too. As many of the major
noncommunicable diseases have common risk factors
relating mainly to changing life styles, an integrated
approach to the control and prevention of these diseases
has been adopted by the Council. Appropriate research
on behavioural factors and lifestyles that have a direct
bearing on the prevalence of noncommunicable diseases
will also be undertaken. The next phase of research in
noncommunicable diseases is expected to involve the
Wransfer of technological know-how and skill from the
laboratory to pilot field projets and thence to outreach
programmes at the district and state level for interven
tional strategies.
INTEGRATED APPROACH TO CONTROL OF
NONCOMMUNICABLE DISEASES
There is increasing recognition of the emergence of
noncommunicable diseases such as cancer, mental
illness, cardiovascular and cerebro-vascular disorders
and diabetes as public health problems in developing
countries such as India as a result of (i) changes in the
health structure and demographic structure of the popu
lation (ii) changes in life styles: and (iii) changes in the
environment (including air, water, food, occupation etc)
as a consequence of industrialisation and urbanisation.
Some of these health problems have etiological
commonalities such as tobacco use and diet, which in
turn, could be related to “behaviour”. At present, health
services for noncommunicable diseases are limited to
larger towns and cities, and largely are only curative.
The ICMR has constituted an Advisory Group to
evolve an integrated approach for the control of major
noncommunicable diseases with major emphasis on
p ri maty- and secondary prevention. In phase 1 of the
study, intensive educational programme for bringing
changes in the community with regard to. life styles will.
be-undertaken. It is proposed to initiate a multicentric
study at 3 centres, viz Bangalore, Delhi and Pondi
cherry. The Bangalore centre will aim at utilizing the
primary health care approach and to integrate noncom
municable disease control as part of the total health care
at the Primary health centre (PHC) level, the Delhi cen
tre will use the primary and primordial health care
approach aimed at school children, while the Pondi
cherry centre will employ the rural health care infrastructure at the Medical College for an integrated
approach to the control of noncommunicable diseases.
ONCOLOGY
The emphasis on cancer research during 1987-88
has been in accordance with the national priorities. The
major areas of cancer research are cancer registration
(urban as well as rural) and site specific case control
studies, primary and secondary prevention of cervical
Division of Publication & Information, ICMR, New Delhi - 110 029
and oral cancers, clinical trials on buccal mucosal
cancers and study of viruses in cervical cancer.
National Cancer Registry Project
The National Cancer Registry Project (NCRP),
initiated in 1981-82 by the Council aims at generating
authentic data on the magnitude of the cancer problem;
understanding its epidemiological aspects and instituting
control measures; and human resource development in
cancer epidemiology. The network of NCRP consists of
six Population Based Cancer Registries (PBCRs),
including one rural PBCR and six Hospital Cancer Reg
istries (HCRs). To facilitate smooth taking over of the
Registry by the host Institute/State, it is proposed that
the new registries should be given 100 per cent assistance
by the Council for the first five years. The quantum of
ICMR financial support will be reduced by 25 per cent
every five years, with corresponding budgetary increase
by the host Institution/State. During this period, the
registries would undertake epidemiological and interven
tion studies, besides authentic data collection on cancer
occurrence. The Registry would thus be funded by the
host Institution/State after 20 years which would run it
according to the guidelines already established.
The data for 1985 for various registries have been
compiled. The quality of data collection has continued
to be high. A rural PBCR located at Barsi, Maharashtra,
would provide data regarding cancer incidence in rural
areas of India for the first time. Case control epidemio
logical studies have been initiated on cancers of uterine
cervix, pharynx, oesophagus and stomach. Such studies
are expected to throw further light on the causation of
these cancers.
Other activities during 1987-88 included the finalization of coding manuals, separately for use at the
PBCRs and HCRs; on-site review of technical data at
Bangalore and Madras; discussion on histopathological
slides with differences of opinion, pertaining to oral and
breast cancers, during the'meeting of the inter Registry
Panel of Pathologists; preparation of monographs on
oral cancers; and of a standardized tobacco-alcohol
questionnaire.
forma and codes for extent of disease; (v) expansion of
the Trivandrum HCR to a PBCR; and (vi) constitution
of a Task Force to update the WHO histological typing
of oral cancers.
Cervical Cancer
The feasibility project for involving the general
health infrastructure in prevention and early detection of
cervical cancer has completed the preparatory phase, the
main contributions of which have been the successful
training of paramedical personnel, KAP (knowledge,
attitude and practice) survey and preparation of health
education material. It was encouraging to note that the
paramedical workers could correctly identify the cervical
lesions in 81 per cent of cases. Second phase of this study
could not be initiated due to unwillingness of the Munic
ipal Corporation of Delhi to issue administrative orders
to the concerned personnel at PHC level to carry out the
work related to the project; frequent transfers of those
trained workers, whose cooperation had been obtained
on a non-official basis; non-implementation of ROME
(reorientation of medical education) scheme in the true
sense: and lack of physical facilities at three subcentres.
On the basis of experience gained from the feasibil
ity project on primary and secondary prevention of cer
vical cancer, a plan of action for district level screening
for cervical cancer among women above 35 years of age
is proposed to be initiated in state(s) in which cancer
control advisory boards have been constituted. The pro
ject will test the feasibility of extending such a pro
gramme to the national level; its acceptability by the
general population; cost-effectiveness of the approach;
determine the reliability of Pap test as a screening proce
dure; and identification of the risk groups in the (
community.
Through the study on the uterine cervical dysplasia,
carried out at the Cytology Research Centre—CRC (now
Institute of Cytology and Preventive Oncology—ICPO),
New Delhi, it has been possible to delineate ‘high risk'
dysplasias from those with ‘low risk' based on persist
ence of dysplasias and other clinco-epidemiological and
laboratory parameters during the first year of follow up.
Women who revealed evidence of dysplasia three or
more times in the first year of follow up had 19 times
more risk of progression to malignancy, as compared to
those who had no dysplasia during the first year of fol
low up. Progression to malignancy was significantly
influenced by the age of consummation of marriage and
the literacy status of women. Cervical erosion and blood
stained discharge have been identified as significant clin
ical risk indicators for dysplasia. Colposcopy has also
The data from NCRP clearly indicate the need for
initiating action on primary prevention of tobacco
related cancers and early detection of cervical cancer.
Other studies proposed to be undertaken include
(i) annual surveys of tobacco usage of PBCRs within
their area, to estimate the prevalence of tobacco habits;
(ii) analysis of death certificates in all PBCRs; (iii) study
trends of tobacco related cancers, cervical cancer and
breast cancers in the registries; (iv) revision of HCR pro62
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been found to be an important aid in the management of
early cervical lesions.
In another study, nuclear DNA contents of cervical
smears of seven dysplasia cases were retrospectively stu
died including six dysplasia cases which progressed to
malignancy and one case which regressed to inflamma
tion. All the dysplasia cases which progressed to malig
nancy revealed aneuploid DNA pattern which further
strengthens the previous observations that aneuploid
DNA pattern may be considered as a high risk factor in
the process of cervical carcinogenesis. In addition, the
nuclear DNA analysis was also performed on paraffin
sections of 15 cases of condyloma acuminata not asso
ciated with the dysplastic lesions. All these cases showed
aneuploid DNA pattern which also supports the histo
logical diagnosis.
Realising the importance of Human Papilloma
Virus (HPV) in cervical carcinogenesis, the CRC. New
Delhi has undertaken a multidisciplinary approach to
this problem. Cyto/histopathological diagnosis vs. colposcopic findings in 77 samples were found to have a
sensitivity for colposcopy in 73.1 per cent, specificity of
58.3 per cent, predictive value of 58.8 per cent and agree
ment in 58.4 per cent. Similarly comparison of
cyto/histopathological findings with immunoperoxidase
in 66 samples revealed sensitivity of 63.5 per cent, speci
ficity of 40.9 per cent, predictive value of 35 per cent and
agreement in 48.5 per cent. On the other hand when
colposcopic findings in 77 patients were compared with
the results of immunoperoxidase staining for HPV anti
gens, sensitivity was as high as 85.2 per cent, specificity
42 per cent, predictive value 44.2 percent and agreement
was 57.1 per cent. These results indicate that molecular
•hybridization is the most sensitive technique for the
detection of HPV infected lesions.
Recent observations have highlighted the role of
HPV during the process of cervical carcinogenesis. Dur
ing 1987-88. techniques such as dot blot. Southern blot
and in situ hybridization have been standardised at CRC,
New Delhi for the detection of HPV-DNA sequences
with 55 per cent positivity for HPV-16/18 in patients
with cervical cancer, in situ hybridisation technique has
been standardised using paraffin embedded sections with
70 per cent positivity for HPV. As HPV is sexually trans' milted, the CRC has initiated a study to elucidate the role
of male partners in its spread.
Sero-epidemiological study on Herpes Simplex
Virus (HSV) showed that the frequency of HSV-2 anti
body positivity among women with dysplasia and cont
rols increased with age and attains a plateau at 40 years
of age. The results have largely been inconclusive.
Other studies being continued at CRC. include stu
dies on uterine cervical dysplasia—Part II with the
objectives of (a) in depth study of preventable risk fac
tors (HPV infection, smoking and tobacco consumption,
and promiscuity of either partner) for cervical carcino
genesis through a multi-disciplinary approach and (b)
management of precancerous and early cancerous
lesions of the cervix by various treatment modalities:
host immune response in cervical cancer with reference
to cell mediated immunity and immunocompetent cells:
and pilot study on multidisciplinary approach with
emphasis on early diagnosis and prognostic parameters
for breast cancer.
Oral Cancer
A collaborative demonstration-cum-research pro
ject aimed mainly at assessing the effect of an anti
tobacco community education programme, utilizing the
existing health infrastructure has been initiated at Ban
galore, Goa, Agra and Trivandrum. The Goa centre
included school children and teachers among the catego
ries to be trained. PHC personnel have been trained to
inspect the oral cavity, identify lesions and classify them
into referrable and nonreferrable categories, at Banga
lore, Goa and Agra. Suitable health education material
for oral cancer prevention has been prepared at the Ban
galore and Goa centres. The health education material is
being prepared at other centres also. The baseline survey
to assess the knowledge, altitude and practices regarding
tobacco usage has been completed at the Bangalore centre.
whereas it has been completed in an experimental area at
the Goa centre.
A multicentred clinical trial to compare the efficacy
of radiation therapy alone on one arm and radiation plus
surgery on the other was initiated at Bombay. Delhi and
Trivandrum. The case registration had started with the
use of a standard proforma.
In the area of tobacco and health, it is proposed to
initiate work on tobacco economics and burden of
tobacco related diseases. The Council supported and
participated in various workshops conducted on primary
and secondary prevention of tobacco related diseases.
Nasopharyngeal Cancer
The Regional Medical Research Centre (RMRC) at
Dibrugarh has initiated epidemiological studies on
cancer of nasopharynx in Assam, Nagaland and
Manipur and case control studies in nasopharyngeal car
cinoma. Smoke dried meat, vegetables and soots were
collected from villages and processed for Ames test at
this Centre. Preliminary studies using Salmonella
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typhimurium - TA 100 strain suggest that the soots have
mutagenic activity.
CARDIOVASCULAR DISEASES
Research in cardiovascular diseases (CVDs) was
continued during 1987-88 with emphasis on the patho
genic mechanisms of various CVDs and launching of
preventive operations against them. A centre for preven
tive cardiology is proposed to be established to under
take planned epidemiological studies to determine the
prevalence and trends of CVDs, the profile of determi
nants in the community and formulating as well as eva
luating the efficacy of appropriate intervention strategies
and establishment of disease specific registries for follow
up care. The emphasis will be placed on organising spe
cial programmes for primordial and primary prevention
of CVDs in the form of dietary and behavioural modifi
cations including control of tobacco smoking and weight
reduction by physical exercise.
Rheumatic Fever and Rheumatic Heart Disease
The ICMR’s programmes in rheumatic fever
rheumatic heart diseases (RF-RHD) are aimed towards
both basic and applied research through its Centre for
Advanced Research, Task Force and ad-hoc research
projects. At the Centre for Advanced Research on RFRHD, in-depth studies on diagnostic criteria, clinical
and immunological profile, genetic marker and bacterio
logic studies on streptococci are being continued. Rea
gents have been developed for performing the Strep A
direct swab test which enables the rapid identification of
group A streptococci within a few minutes, at the field
level. Comprehensive humoral and cellular immunologi
cal, and immunohistopathological studies have sug
gested the pathogenetic mechanisms involved in acute
rheumatic fever. Evidence of immunodysregulation and
hightened cellular and humoral immune responses has
been demonstrated. Clinical, immunological and radion
uclide scintigraphic methods are being employed for
identification of rheumatic activity. Immunogenetic stu
dies are being carried out for identification of high risk
subjects for the purpose of primary prophylaxis. A Task
Force project on community control of RF/RHD with
the aim to test the feasibility of utilising the existing
health infrastructure at the PHC level for primary prev
ention, detection and management of RF-RHD has been
completed at the three centres,viz Delhi, Varanasi and
Vellore. This study is,one of the first in the South-East
Asian region to consider the integration of RF-RHD
control with primary health care services. The study has
confirmed the feasibility of such a programme. Impart
ing health education has been an integral component in
the intervention strategy. The KAP survey results have
64
been utilized in the preparation of two video films, var
ious posters, flip cards and stickers. The health educa
tion material is being utilized in the field to create greater
awareness and enhance the response towards seeking
treatment for sore throat, RF and RHD by the commun
ity. UNICEF has shown keen interest in providing finan
cial and technical help for the preparation of educational
material. A workshop for transfer of technology and
dissemination of the lessons learnt from the pilot studies
was conducted and two more centres were inducted into
the programme. An outreach programme for commun
ity control of RF/RHD at the existing centres is pro
posed to be mounted this year. The control of RF-RHD
utilizing the existing school health services has also been
continued during the year.
Coronary Heart Disease
A collaborative study is being initiated at Delhi and Y
Vellore for evaluation of the epidemiological character
istics of coronary artery disease (CAD) in rural and
urban populations. Studies on Indian immigrants in
United Kingdom (UK), Trinidad and South Africa have
shown a higher mortality due to CAD in this group as
compared to the native population. Research in collabo
ration with UK is proposed through extensive epidemio
logical data incorporating prevalence and associated risk
factor study so as to suggest remedial action in the form
of preventive strategies.
Cardiomyopathy
At the Centre for Advanced Research in Endomyo
cardial Fibrosis (EMF), Trivandrum, studies on myocar
dial cell cultures, cardiac basement membrane etc have
been undertaken to identify ultramorphologic and bio
chemical differences between the normal and diseased •
hearts. Experimental studies are being carried out for
evaluating thorium toxicity. Natural history of EMF is
also being assessed with special emphasis on early stages
of the disease.
Hypertension
India is one of the 39 participatory countries in the
WHO-ISFC international collaborative study on
INTERSALT. Population groups at New Delhi and
Ladakh have been studied to assess the role of salt intake
on blood pressure. The results are under analysis at the
central laboratory in Belgium.
MENTAL HEALTH
Earlier studies undertaken on mental health have
demonstrated that it is possible to provide basic mental
health care in rural areas by integrating mental health
with general health care. The feasibility of integrating
health care of the rural aged with the primary health care
infrastructure has also been demonstrated and results of
this feasibility project will have direct application in the
National Mental Health Programme. The results of
operational research in extension of mental health care
to rural areas are being utilised in the implementation of
the National Mental Health Programme. During 198788 studies were continued on the course and outcome of
schizophrenia, health modernity education, psychopa
thology of depression and suicidal behaviour, as well as
psychosocial stress and coping behaviour in .young
women, monitoring use of opiate drugs and on develop
ing indicators of mental health.
Schizophrenia
Results of the recently completed study on factors
associated with course and outcome of schizophrenia
have given important leads to help in the management of
schizophrenia patients and reduction of disability due to
this mental disorder.
The results indicate that the predictors of outcome
during the second, third and fourth year follow up
remain almost the same, viz shorter duration of index
episode, regular drug compliance, perception of patient
as being not dangerous, presence of agitation and
absence of symptoms such as worrying and social
unease. It has also been found that negative attitudes of
key relatives, viz critical comments, hostility and dissatisfaction had negative correlation with the outcome of
the disease. Longitudinal data show that the relapses
mainly contribute to worsening of outcome. The predictors of relapses are also being studied.
The results so far obtained indicate that outcome of
schizophrenia can be improved by reduction in duration
of index episode through early detection, better drug
compliance and positive attitudes of relatives. The
results of offshoot studies when available, can help in the
management of schizophrenics and in reduction of dis
ability due to this disease. It would also be possible to
include these aspects in the training of primary health
care staff for the management of psychiatric cases thus
directly helping in the National Mental Health
Programme.
Health Modernity Education
The health modernity education project being con
ducted in a tribal population of Ranchi district has main
focus on the personal habits, environmental sanitation
and attitudes towards health and disease. The health
modernity education material has been developed and is
being evaluated.
The dimensions included in personal habits are
alcohol and tobacco use, washing of hands after meals
and toilet, washing of mouth, regular bath and cleaning
of hair. The dimensions for environmental sanitation are
safe drinking water and covering of wells, spread of
infection through contact with animals, cattle manage
ment, garbage disposal, disposal of faeces and drainage
of water away from wells and other sources of drinking
water. Under attitude to health and disease, the attitude
and practices regarding the treatment of the mentally ill,
social stigma regarding physical diseases, such as lep
rosy, tuberculosis, immunisation of children and utilisa
tion of local health services have been included. It has
been proposed to use several methods for giving the mes
sages such as flip charts, posters, small group discus
sions, etc. The outcome of this project is expected to
have vast applications.
Monitoring Use of Opiate Drugs
During 1987-88, a project on monitoring use of
opiate drugs in the community was initiated at Delhi,
Jodhpur and Lucknow with the main objectives of estab
lishing a system of uniform and continuous data collec
tion on pattern and extent of opiate drug use by covering
all the treatment/counselling/rehabilitation facilities in
a city; and monitoring the trends of opiate drug use on a
long term basis.
As a first step, the three centres are in the process of
establishing rapport with all governmental and non
governmental treatment/counselling agencies in the
respective areas. The scope of this study has been
expanded to include all drugs, taking into consideration
the report of the Expert Committee of the Ministry of
Health & Family Welfare on Deaddiction Services in the
Country and the Narcotic and Psychotropic Substances
Act 1985.
It has also been proposed to initiate the treatment
evaluation study for the existing modalities of treatment
of drug dependence.
Non-Medical Use of Drugs in the Community
The intervention study on non-medical use of drugs,
being carried out at Bangalore, Delhi, Dibrugarh and
Ranchi has been completed. Health education material
on alcohol, arid tobacco has been developed and evalu
ated and has been found to be effective in reduction/pre
vention of their use.
Psychopathology of Depression and Suicidal Behaviour
Research, on psychopathology of depression and
suicidal behaviour as well as on psychosocial stress and
65
coping behaviour in young women is in progress at the
Centre for Advanced Research on Health & Behaviour,
at Madurai. The main objectives of the study are eva
luating the antecedent behavioural pattern in depressives
and suicidal persons, crisis intervention, and stress and
coping behaviour.
The study on suicidal behaviour included 250
suicide-attemptors. In suicide completors, a detailed psy
chological autopsy was carried out, which included col
lection of relevant information, from the surviving
members of the family of the deceased. Statements,
remarks, evidences of alterations in mood, behaviour,
habits and suicidal note, if any, were collected. The sur
vivors of suicidal attempts were submitted to detailed
clinical examination and assessed on various psychomet
ric instruments of lethality, depression, hopelessness,
personality factors, stressful life events and family and
social integration. A few broad diagnostic categories
have emerged: inter personal difficulties leading to acute
crisis (family, marital, academic, and occupational),
mental illness, immature personality characterised by
impulsiveness, traits of delinquency, and physical illness
like peptic ulcers, bronchial asthma, gynaecological
problems, premenstrual syndrome and dysfunctional
uterine bleeding.
In the study on psychopathology of depression, a
battery of psychometric tests were administered. Blood
and urine samples-(day and night) at the time of index
evaluation were collected for estimation of melatonin
and cortisol. From normal control subjects, matched for
age and sex, blood and urine were collected for estima
tion of melatonin and cortisol. The subjects have also
been investigated for the presence or absence of cogni
tive disturbances during the episode of depression. These
evidences are being correlated with social factor of
stressful life events and with the melatonin and cortisol
levels.‘Following remissions, the subjects were being stu
died for evidence of cognitive errors in information pro
cessing, such as arbitrary inference, selective obstruction,
personalisation, overgeneralisation, pseudological think
ing. Correlation of these disturbances and cognitive
symptoms in the depressive phase and in remission with
the hormonal profile is being done.
Indicators of Mental Health
During 1987-88, the Council initiated a Task Force
project in collaboration with WHO on indicators of
mental health at three centres, viz Bangalore, Delhi and
Lucknow with the main objectives to develop indicators
in areas of subjective well-being with focus on well-being
of young women and healthy child development; to
develop intervention strategy to improve the well-being
66
of young women; and to study the impact of intervention
on young women and child development.
In the first phase, development of instruments and
reliability exercises are being carried out for measures of
subjective well-being, home risk card and nutritional sta
tus and cognitive development of children.
The existing psychosocial intervention strategies
have been reviewed. The intervention strategies to
improve subjective well-being and self-image of young
women will be developed after examining the results of
phase-1.
It is planned to establish a Centre for Advanced
Research on Behavioural Psychopharmacology at the
Sanjay Gandhi Postgraduate Institute of Medical Scien
ces, Lucknow, to conduct research on psychotropic
drugs, biological basis of behaviour, biological markers •
in mental diseases and related areas.
A Centre for Advanced Research on Drug Abuse is
proposed for carrying out research on a long-term basis
on the epidemiology of drug abuse, culture specific treat
ment aspects, basic research on etiology of addiction and
other related aspects of drug dependence.
Some activities of the Centre for Advanced
Research in Community Mental Health at National
Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, have found application in the
National Mental Health Programme. These are (i) prep
aration of training packages in mental health for prim
ary health care workers, doctors and other para-medical
personnel; (ii) preparation of mental health education
material; and (iii) long-term epidemiological studies in
the field. The Centre has also undertaken the publication
of a community mental health newsletter.
•)
To continue research efforts in the field of commun
ity mental health, on a long-term basis, it is proposed to
convert the existing ICMR Advanced Centre at NIMHANS, Bangalore, into a ‘Centre for Research in Com
munity Mental Health’ during 1989-90. The main
objectives of this Centre will be (i) to undertake epidemi
ological, phenomenological and intervention research to
assist in the development of mental health services; (ii) to
develop and evaluate suitable models of care for the
rural mentally ill, including rehabilitation and disability
reduction, involving the primary health infrastructure
and the community; (iii) to serve as a central place for
training for mental health personnel in the above area;
and (iv) to act as a clearing house for dissemination of
information regarding innovations in mental health care
and related issues to professionals, planners, administra
tors and the general public.
OPHTHALMIC SCIENCES
During 1987-88, the thrust areas of research in oph
thalmic sciences continued to be cataract, operational
research on mobile eye camps and Eales’ disease. These
programmes are being organised in collaboration with
the National Programme for Control of Blindness, and
as part of the Indo-US Science and Technology Initia
tives (1983).
Cataract
Phase II study has been completed involving screen
ing of selected population and examination of target
cases of the collaborative study on cataract (epidemio
logical study) at 4 centres: two with high/medium preval
ence of cataract (Angamaly, Calcutta) and the other two
with the low prevalence of cataract (Raipur, Dharamsala). Phase III of the collaborative study on cataract ie
the intervention phase will be initiated during the next
year.
Another hospital-based case control study on senile
cataract was initiated to identify the risk factors and
assess their importance in the development of senile cata
ract. So far 4168 persons have been screened and 1210
patients and 512 controls included in the study. Data
collection is expected to be completed in September,
next year, after which the information will be decoded
and analysed.
Eales’ Disease
Laboratory and clinical studies on Eales’ disease
were continued during 1987-88 with the main objective
to characterise the immune status of patients with Eales’
disease, to evaluate the effectiveness of combined cryo
and photocoagglutination of specific retinal lesions.
Laboratory studies on 48 patients and 29 controls indi
cated no differences between patients and controls with
reference to general immune status, serum immunoglo
bulin levels, lymphocyte subsets and lymphoproliferative
response to mitogens. In clinical studies, of the 57
patients so far included, 22 belong to group I in which
one eye of the patients will be treated and the other eye
serves as control. In group II, patients are randomised as
cases and controls. So far, 40 eyes (22 in group I and 18
in group II) have been treated and patients are being
followed up.
Nutritional Blindness
Under the Indo-US Science & Technology Initia
tives (1983) Programme in blindness prevention, study
was continued during 1987-88 for detecting anterior seg
ment collagenase activity in keratomalacia, in 35 children
with corneal lesions and 30 controls matched for age
with protein energy malnutrition but without corneal
lesions and in 19 normal children. It was found that
children with corneal lesions and keratomalacia had sig
nificantly higher collagenolytic activity as compared to
normals. Serum alpha-2 macroglobulins and vitamin A
levels were found to be related to nutritional status and
not to corneal lesions.
Mobile Eye Camps
In the study on Operational Research on Mobile
Eye Camps, 8 camps have been visited for on the spot
assessment by a team consisting of a social scientist and
an ophthalmologist. Seven more camps were identified
to be visited during 1988 and the report was expected to
be ready by September, 1988.
ORAL HEALTH
During 1987-88. studies on the development of feas
ibility module for primary prevention of dental caries
and gingival diseases in children in the community
within the existing health infrastructure, development of
different biomaterials for oral health and development
of dental fillers for restorative dentistry were continued.
It is proposed to estimate the fluoride content in
drinking water from different samples and to do the fluo
ride mapping of the country using the village as a unit.
This will be initiated as a new Task Force project as
recommended by the expert group. It is proposed to
have at least 4 centres which will act as the receiving
points for the water samples from the respective regions.
The location of these centres will be decided based upon
the magnitude of the fluoride problem in that region,
availability of laboratory facilities for fluoride estima
tion and availability of field staff who will work in that
region. Four cities identified as strategic points are
Dibrugarh (Assam), Jodhpur (Rajasthan), Hyderabad
(A.P.) and Pondicherry.
In-depth, long-term studies on prevention of dental
caries and periodontal diseases through study of inhibi
tors of cariogenicity of dental plaque, and role of trace
elements are proposed to be initiated through a Centre
for Advanced. Research.
NEUROLOGICAL SCIENCES
During the past decade, multicentred clinical and
epidemiological studies were undertaken on epilepsy,
head injury, peripheral neuropathy, subarachnoid hae
morrhage, and Landry’s Guillain Barre (LGB) Syn
drome. These studies have attempted to describe the
clinical presentation and associated etiological factors of
the various disorders in the Indian population. It is pro
posed to initiate projects in the field of neuroepidemiolCOMMUNITY HEALTH CELL
326, V Main, 1 Block
Koromi !
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67
ogy, neurotraumatology and stroke. Neuroepidemiological data on the magnitude of occurrence of various
types of neurological disorders among the Indian popu
lation are.largely not available. A tentative plan for
undertaking a rural as well as urban based study in 3-4
centres in the country is under preparation.
An Advanced Centre for Research on Neurobiology
has been proposed with a multidisciplinary approach for
the study of various neurological conditions, ranging
from molecular biology to bio-behavioural aspects. This
centre will be provided with up-to-date facilities and
human resources from various disciplines to undertake
both basic and applied frontline research.
ACCIDENTS, DISABILITY AND REHABILITATION
In the past decade, there has been a concerted effort
to undertake research on the magnitude of different
types of accidents, rehabilitation and possible preventive
measures. Having completed the collaborative study on
the prevalence and etiology of hearing impairment, an
intervention study on hearing impairment has been
initiated in Delhi and Trivandrum with the objective to
test the feasibility of its primary and secondary preven
tion involving the Integrated Child Development Servi
ces scheme, PHC, and school health services. Baseline
survey and preparation of appropriate health educa
tional material has been completed, while the interven
tion phase has been initiated.
In order to develop health education material for
prevention of physical disability, a study has been com
pleted to gather and consolidate the existing information
on this subject. It is proposed to be followed up with an
appropriate intervention programme to develop health
education models aimed at reducing the prevalence of
physical disability.
HAEMATOLOGY
The Institute of Immunohaematology (HH) at
Bombay continued its research and service activities in
the field of immunohaematology.
Immunological Studies
Uptake of human anti-H specific antibodies Tor t
and t2 type H chain on red cells was studied on 50 nor
mal individuals. Similar uptake of t and t2 specific anti
bodies was observed on cord as well as adult ‘O’ group
cells, ti/t: ratio was 0.43 for adult ‘O'cells and 0.32 for
cord ‘O’ cells. While t2 antigenic sites were 2 tp 3 times
more on ‘O’ cells as compared to A, B or AB cells,
almost the same number of ti antigenic sites were
observed on all types of cells.
68
AIDS surveillance resulted in detecting 2 subjects
positive for anti-HTLV-111 antibodies. One was a patient
of SLE (a female of 16 yrs age) and another a drug
addict (a male French national aged 41 yrs). Positivity
was confirmed by Western blot in both subjects.
Systemic lupus erythematosus (SLE) patients were
investigated for anti-nucleoside antibodies. Antibodies
were detected against all the nucleosides though most of
the patients had antibodies to cytidine (79%) followed by
uracil (56.3%), guanosine (44.5%), adenosine (30.9%)
and thymidine (20%). There was a change in the specifici
ties of antibodies to nucleosides in some patients after
treatment with steroids or immunosuppresive drugs.
Peroxidase anti-peroxidase technique was used on
bone-marrow and peripheral blood smears to classify
leukaemia. Since leukaemia patients have a large s
number of leucocytes it was easy to judge the results. The™
peripheral blood smears from normal persons will now
be subjected to the same techniques.
Genetic studies are being continued in tribal popula
tions to get a comprehensive and comparative informa
tion on Bhils from Rajasthan, and Pardhan. Raj Gonds
and Naik Gonds from Maharashtra.
Thalassaemia
The thalassaemia screening programme was con
tinued in high school children at Bombay. Calcutta and
Delhi centres in order to assess the prevalence of thalas
saemia variants. The study also covers patients of homo
zygous thalassaemia and cord blood for screening of
alpha thalassaemia. So far. 8803 school children. 5986
samples of cord blood and 78 patients of thalassaemia
have been covered.
Leukaemia
"
A collaborative study on leukaemia initiated earlier
at Bombay and Calcutta was extended to Delhi and Tri
vandrum for assessing the efficacy of different treatment
regimens in acute myeloid (AML) as well as acute lym
phatic leukaemia (ALL) in both adults and children. In
all, 75 patients of AML and 97 of ALL were inducted
into this study, which was concluded during 1987-88.
The salient preliminary findings are that most of the
ALL patients fall into Li and L2 groups as per FAB
classification. Remission rates using ALL-2 regimen
(Vincristine 1.4 mg/M2/wk x 6 wks, L-asparginase 6000
units/m2 IM x alt. days x 10 days and prednisolone 40
mg/m2 daily x 6 wks) appear to be higher than with
ALL-1 regimen (Vincristine 1.4 mg/m2/wk x 6 wks,
Adriamycin 30 mg/m2/wk x 6 wks, and prednisolone 40
mg/m2 daily x 6 wks). Relapse rates were higher with
ALL-1 regimen.
In the case of AML patients, M2 group of FAB
system was most common, with Mi, M4, M3, Ms and Me
in descending order of frequency. Remission in one third
of the cases was achieved using either of two regimens
AML-1 (Adriamycin 30 mg/m2 x 2 wks, cytosine
arabinoside 100 mg/m2/day iv infusion over 12 hrs x 5
days, 6-mercaptopurine 100 mg/m2/day x 5 days) and
AML-2 (Cytosine arabinoside and 6-mercaptopurine as
in AML-1). Relapse rates were of the order of 60 per
cent. The data are being further analysed.
Haemophilia
A collaborative study on haemophilia to assess the
magnitude of the problem, quality control of various
tests and reagents, and production of blood components
was initiated at three centres viz Delhi, Bombay and
Vellore in 1985. It has been observed in All India Insti
tute of Medical Sciences (All MS), New Delhi that one
of every 10,000 new patients seen at the outpatient
department is a haemophiliac. The proportion of heamophilia A was 66.6 per cent at Vellore, 75.0 per cent at
Delhi and 81.2 per cent at Bombay, while that of haemo
philia B was 15.5, 10.0 and 6.2 per cent respectively.
Severe haemophiliacs constituted 52 and 18 per cent of
the patients at Delhi and Bombay respectively; the rea
sons for this difference are not clear at present. A com
prehensive laboratory manual for performing the
.various investigations in haemophilia patients has been
prepared. Production of cryoprecipitates increased two
to three fold in the different study centres since the initia
tion of this study.
Haematological Studies in Tribals
In Orissa, individuals with G-6-PD deficiency and
sickle cell disease have been reported. The RMRC. Bhu
baneswar, has organized a sub-centre for studying sickle
cell disease-trait in western districts of the State. Studies
on G-6-PD dificiency are being carried out in Keonjhar
district—a tribal area endemic for malaria.
Studies on sickle haemoglobin and G-6-PD defi
ciency in tribals carried out by RMRC for Tribal Health
at Jabalpur, have shown a higher incidence of sickle
haemoglobin (22.8 per cent) in the Baiga tribe than the
Gond tribe. Even the backward classes in the Baiga
Chak area have a high incidence (22.72%). Three homo
zygous cases have been detected. There was not much
difference in the mean Hb levels between sickle cell
group and normal group, indicating that sickle cell may
not be playing an important part in the incidence of
anaemia. Mating pattern and marital distances were also
studied in the same area. The high frequency of endo
gamy in the area with an average short marriage distance
of about 20 km will enhance the possibility of exposing
the deleterious recessive genes.
A cross-sectional study on the impact of sickle cell
disease on the growth of tribal children of Mandla dis
trict is in progress.
The RMRC, Dibrugarh, has studied the distribu
tion of haemoglobinopathy and G-6-PD deficiency
among the tea garden labour population of Bokel,
Dikom, Muttack and Nudwa Tea Estates of Dibrugarh
district. A total of 208 blood samples have been collected
at random from the labour population and analysed.
Thirty (14.4%) samples had the abnormal haemoglobin
pattern. Sickle cell trait was observed in 29 individuals
(13.9%), and one subject with sickle cell anaemia was
also detected. The frequency of abnormal sickle cell hae
moglobin observed was 44.4 per cent, 40.0 per cent, 28.8
per cent and 28.6 per cent among the Lohars, Karmakars, Tamis and Das communities respectively. A total of
55 samples screened for G-6-PD deficiency did not
reveal any abnormality. Further studies are in progress.
ICMR NEWS
Shri Ram Niwas Mirdha, Hon. Union Minister for
Health & Family Welfare and Textiles, presented various
ICMR Awards and Prizes for the year 1988 to outstand
ing Biomedical Scientists, at a function held at the ICMR
Headquarters, New Delhi, on June 10, 1989.
***
***
***
The 64th meeting of the Governing Body of the
ICMR was held on June 10, 1989, at the ICMR Head
quarters, New Delhi. Concurrently, a ‘brain storming
session’ of the Governing Body was also held on June
10-11, 1989 in which highlights of research activities of
three permanent Research Institutes of ICMR viz. the
Tuberculosis Research Centre, Madras: National Insti
tute of Nutrition, Hyderabad; and National Institute of
Virology, Pune were presented. The presentation was
made with the assistance of audio-visual programmes and
transparencies by the Directors and Senior scientists of
the concerned Institutes.
Project Review Committee (PRC)/Project Advisory
Committee (PAC) meetings of the Council, held during
the month:
PRC on Tuberculosis
June 13, 1989
(at New Delhi)
69
PRC on Leprosy
June 16, 1989
(at New Delhi)
PAC on Ophthalmology
June 19, 1989
(at Bhopal)
PRC on Malaria, Leishmaniasis
and Filariasis
June 19, 1989
(at New Delhi)
PRC on Diarrhoeal Diseases
June 21, 1989
(at New Delhi)
PRC on Microbiology
June 23, 1989
(at New Delhi')
Dr. S.P. Tripathy, Addl. Director-General, ICMR
and Dr. K. Banerjee, Director, Council’s National Insti
tute of Virology, Pune, participated in the V International
Conference on AIDS, at Montreal, Canada (June 4-9.
1989).
Dr. Usha K. Luthra, Addl. Director-General.
ICMR, participated in the meeting of the WHO Advisory
Committee on Health Research, at Yogyakarta, Indone
sia (June 4-12, 1989).
Dr. S.P. Tripathy has taken up an assignment as a
WHO short-term consultant on Tuberculosis, at Manila,
Philippines (June 19-July 18, 1989).
***
Participation of ICMR Scientists in Scientific Events:
Dr. A.S. Paintai, Director-General, ICMR, partici
pated in the meeting of the Executive Council of the
Society for Scientific Values, at New Delhi (June 2,1989).
A meeting of the Working Group of the Planning
Commission for formulation of 8th Plan proposals for g
Medical, Health Research & Development Sector, was "
held at the ICMR Hqs., New Delhi (June 27, 1989).
ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Sy mposium / Seminar/ Workshop/
Course/Conference
Date & Place
Contact Address
Workshop on Techniques in Human Cyto
genetics.
June 19 to July 22, 1989;
Bangalore
Dr. I.M. Thomas, Professor & Head, Depart
ment of Anatomy and Head, Division of
Human Genetics, St. John’s Medical College.
Bangalore.
International Symposium on Biology and
Chemistry of N-Nitroso Compounds.
June 23-25, 1989;
Bombay
Dr. S.V. Bhide. Organising Secretary*, Association
for Cancer Research and Head, Carcinogenesis
Division, Cancer Research Institute, Bombay.
International Workshop on Women and
Development: A Critical Appraisal of
Household Level Research Methodologies.
July 2-11, 1989;
Baroda
Dr. Amita Verma, Child Development Depart
ment, Faculty of Home Science, M.S. University
of Baroda, Baroda.
1 National Workshop on Enzyme Histo
chemistry and immunohistochemistry.
July 5-22, 1989;
Madras:
Dr. M. Madhavan, Professor & Head, Department
of Pathology, Dr. ALM Postgraduate Institute
of Basic Medical Sciences, Madras.
Continuing Medical Education on Nuclear
Medicine in Today’s Practice.
July 15-16, 1989;
Hyderabad
Dr. Kakarla Subbarao, Director. The Nizam’s
Institute of Medical Sciences, Hyderabad.
Continuing Medical Education Programme
on Rheumatology Update.
August 12-13, 1989;
Hyderabad
Dr. Kakarla Subbarao, Director. The Nizam’s
Institute of Medical Sciences, Hyderabad.
VII 1MA/CGP National Conference on
General Practice.
August 18-20, 1989;
Varanasi
Dr. S.P. Gupta, Organising Secretary 7th IMA/
CGP National Conference, IMA House, 7/31.
Chetganj, Varanasi.
National Seminar on Strategies for Optimal
Management of Cancer in Developing Count
ries.
August 24-27, 1989;
Srinagar
Dr. Shad S. Akhter, Department of Medical Onco
logy, Sher-I-Kashmir Institute of Medical Seciences, Srinagar.
70
Symposium/Seminar/Workshop/
Course/Conference
Date & Place
Contact Address
Seminar on New Trends in Methodology for
Social and Population Research.
October 1-3, 1989;
Tirupati
Prof. K. Mahadevan, Department of Population
Studies, S.V. University, Tirupati.
National Workshop on Burns Injuries and
their Sequele.
October 7-8, 1989;
Chandigarh
Dr. C.P. Sawhney, Professor & Head, Department
of Plastic Surgery, Postgraduate Institute of
Medical Education and Research, Chandigarh.
Brachytherapy Workshop for Cancer Cervix.
November, 1989;
Betul (M.P.)
Dr. Anand Vijay Kumar; Secretary, Paramedical
Section, Christian Medical Association of of India,
Smruti Theatre Compound Nagpur.
All India Symposium on Biophysics of Cell
Structure and Function.
"November 6-8, 1989;
Chandigarh
Dr. P.C. Mangai, Chairman, Department of Biophysics, Panjab University, Chandigarh.
Seminar on Zoonoses.
November 9-10. 1989;
Dibrugarh
Dr. L.P. Datta, Director, Regional Medical
Research Centre (ICMR), P.B. No. 105, Dibru
garh.
Workshop on Recent Advances in Intensive
Care.
November 26-30, 1989;
New Delhi
Dr. H.K. Kaul, Professor & Head, Department of
Anaesthesiology, All India Institute of Medical
Sciences, New Delhi.
COUNCIL’S TRAINING PROGRAMMES
Leprosy
Occupational Health
At the Central Jalma Institute for Leprosy, Agra:
At the Regional Occupational Health Centre (South-.
ern). Bangalore:
Training Course on Leprosy for Medical Officers
(August/September, 1989).
Virology
At the National Institute of Virology, Pune:
Short-term Course on Detection and Isolation of
Arboviruses Using Mosquito Inoculation and Mos
quito Cell Culture (October. 1989).
Endocrinology
At the National Institute of Nutrition, Hyderabad:
Annual Training Course on Endocrinological Tech
niques and their Application (August/September
1989).
Nutrition
At the National Institute of Nutrition, Hyderabad:
Annual Certificate Course in Nutrition (December
1. 1989 to February 28. 1990).
Refresher Course for Industrial/ESIS Medical
Officers (July 24-28, 1989).
At the National Institute of Occupational Health,
Ahmedabad:
Refresher Course for Industrial/ESIS Medical
Officers (October 9-14, 1989).
Training Course on Disaster Management of
Hazarduous Chemicals in Industry for Industrial
Physicians, Chemists. Safety Officers. Hygienists
(November 6-10. 1989).
Cytology
At the Institute of Cytology and Preventive Oncology
New Delhi:
Indo-US Workshop on Chemoprevention of the
Uterine Cervical Dysplasia with Nutrient Inter
vention (December, 1989).
71
Haematology
Laboratory Animal Technology
At the Institute of Immunohaematology, Bombay:
At the Laboratory Animal Information Service Centre.
National Institute of Nutrition, Hyderabad:
Training Course in Blood Banking Technology and
Immunohaematology for Technicians (August 131, 1989).
Training Course in Blood Banking Technology and
Immunohaematology for Medical Officers (August
1 to September 30, 1989).
Medical Entomology
,
At the Vector Control Research Centre, Pondicherry:
Two year M.Sc. Course (Trimester pattern) in Med
ical Entomology (from July 1989).
Training Course for Laboratory Animal Super
visors (September 1 to November 30, 1989).
Clinical Pharmacology
At the Seth G.S. Medical College. Bombay:
Training Course in Clinical Pharmacology (Novem
ber/December, 1989).
EDITORIAL BOARD
Chairman
Dr. A.S. Paintai
Director-General
Chief, Publications
Dr. G.V. Satyavati
Members
Dr. Usha K. Luthra
Dr. Badri N. Saxena
Dr. S.P. Tripathy
Editor
Dr. N. Medappa
Printed and Published by Shri G.P. Kulshreshth for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi
R.N. 21813/71
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