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Background: We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care. Methods: Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared. Results: 29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % p

Background: The data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment.

Background: The data on incidence of recovered Left Ventricular Ejection Fraction (LVEF) and outcome in patients with non ischemic systolic heart failure is limited. We report the incidence, determinants and mortality in patients with recovered LVEF. Methods: The 369 patients with HFrEF with LVEF of less than 40% of non ischemic etiology with available follow up echocardiography study at one year were enrolled. The baseline data of clinical characteristics and treatment was recorded prospectively and were followed up annually for mean of 3.6 years (range 2 to 5 years) to record all cause death and LVEF measured echocardiographically. The recovered, partially recovered and no recovery of LVEF was defined based on increase in LVEF to 50% and more, 41% to 49% and to persistently depressed LVEF to 40% or lower respectively. Results: The LVEF recovered in 36.5%% of the cohort at 5 years. The rate of recovery of LVEF was slower in patients with no recovery of LVEF at one year compared to cohort with partially recovered LVEF (18% vs.53%) at five year. The Baseline LVEF was significantly associated with recovered LVEF, odd ratio (95% C.I.) 1.09(1.04, 1.14). The cumulative mortality at five years was significantly lower in cohort with recovered LVEF (18.1% vs. 57.1%). Conclusions: One third of the patients had recovered LVEF and was significantly associated with baseline LVEF and lower mortality rate.

Hydrogen mitigation using Passive Autocatalytic Recombiners (PARs) has been widely accepted methodology inside reactor containment of accident struck Nuclear Power Plants. They reduce hydrogen concentration inside reactor containment by recombining it with oxygen from containment air on catalyst surfaces at ambient temperatures. Exothermic heat of reaction drives the product steam upwards, establishing natural convection around PAR, thus invoking homogenisation inside containment. CFD models resolving individual catalyst plate channels of PAR provide good insight about temperature and hydrogen recombination. But very thin catalyst plates compared to large dimensions of the enclosures involved result in intensive calculations. Hence, empirical correlations specific to PARs being modelled are often used in integral containment studies. In this work, an experimentally validated CFD model of PAR has been employed for developing an empirical correlation for Indian PAR. For this purpose, detailed parametric study involving different gas mixture variables at PAR inlet has been performed. For each case, respective values of gas mixture variables at recombiner outlet have been tabulated. The obtained data matrix has then been processed using regression analysis to obtain a set of correlations between inlet and outlet variables. The empirical correlation thus developed, can be easily plugged into commercially available CFD software.

Summary: Background: It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India. Methods: Children aged 0–19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, ‘unclassified’) or non-severe disease. The mortality rates were estimated in different phenotypes. Findings: Among 2468 eligible children enrolled, 2148 were hospitalised. Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18.6%), severe acute COVID-19 (13.3%) and the unclassified severe COVID-19 disease (12.3%). Mortality remained high (17.5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14.1% mortality when associated with comorbidity. Interpretation: Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs. Funding: Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva, Switzerland.

Outbreak of COVID-19 pandemic in December 2019 affected millions of people globally. After substantial research, several biomarkers for COVID-19 have been validated however no specific and reliable biomarker for the prognosis of patients with COVID-19 infection exists. Present study was designed to identify specific biomarkers to predict COVID-19 severity and tool for formulating treatment. A small cohort of subjects (n = 43) were enrolled and categorized in four study groups; Dead (n = 16), Severe (n = 10) and Moderate (n = 7) patients and healthy controls (n = 10). Small RNA sequencing was done on Illumina platform after isolation of microRNA from peripheral blood. Differential expression (DE) of miRNA (patients groups compared to control) revealed 118 down-regulated and 103 up-regulated known miRNAs with fold change (FC) expression ≥2 folds and p ≤ 0.05. DE miRNAs were then subjected to functional enrichment and network analysis. Bioinformatic analysis resulted in 31 miRNAs (24 Down-regulated; 7 up-regulated) significantly associated with COVID-19 having AUC>0.8 obtained from ROC curve. Seventeen out of 31 DE miRNAs have been linked to COVID-19 in previous studies. Three miRNAs, hsa-miR-147b-5p and hsa-miR-107 (down-regulated) and hsa-miR-1299 (up-regulated) showed significant unique DE in Dead patients. Another set of 4 miRNAs, hsa-miR-224-5p (down-regulated) and hsa-miR-4659b-3p, hsa-miR-495-3p and hsa-miR-335-3p were differentially up-regulated uniquely in Severe patients. Members of three miRNA families, hsa-miR-20, hsa-miR-32 and hsa-miR-548 were significantly down-regulated in all patients group in comparison to healthy controls. Thus a distinct miRNA expression profile was observed in Dead, Severe and Moderate COVID-19 patients. Present study suggests a panel of miRNAs which identified in COVID-19 patients and could be utilized as potential diagnostic biomarkers for predicting COVID-19 severity.

Background: Present study aimed to identify DNA polymorphisms (variants) which can modulate the risk of COVID-19 infection progression to severe condition. TaqMan based SNP genotyping assay was performed for 11 single nucleotide polymorphisms (SNPs) in pro-coagulant and anti-coagulant genes. Methodology: A total of 33 COVID-19 patients, including dead, severe and moderately infected individuals were compared to 35 healthy controls. Both alleles in the SNP were labelled with two different fluorescent dyes (FAM and VIC) during assay formulation. DNA of study subjects were mixed with SNP assay and TaqMan master mix on 96 well PCR plate according to manufacturer’s protocol and RT-PCR was performed. Allelic discrimination assay gave clear results for presence of specific allele in each sample. Three SNPs were located in the pro-coagulant genes, another three involved in blood clot dissolution while rest five were in the genes encoding natural anti-coagulants. COVID-19 infected patients were further sub-divided into three groups, deceased (n = 16), severe (n = 10) and moderately infected (n = 7). Results: SNP genotyping showed significant differences between COVID-19 patients and controls in two SNPs, rs6133 in Selectin-P (SELP) and rs5361 in Selectin-E (SELE) gene. Also, rs2020921 and rs8176592, in clot dissolution genes, tissue Plasminogen activator (tPA) and tissue factor pathway inhibitor (TFPI) respectively showed significant genotypic and allelic difference in patients of COVID-19 compared to healthy controls. Further three SNPs rs2227589, rs757583846, and rs121918476 in natural anti-coagulant genes anti-thrombin III (ATIII), protein C (PROC), and protein S (PROS) respectively showed statistically significant difference between the study groups. Conclusion: Our findings indicate that gene variants, those involved in coagulation and anti-coagulation may play a major role in determining individual susceptibility to COVID-19.

Background: In the absence of a specific drug for COVID 19, treatment with plant extracts could be an option worthy of further investigation and has motivated to evaluate the safety and anti-SARS-CoV-2 activity of plant extracts. Purpose: To screen the phytochemicals for anti-SARS-CoV-2 in silico and evaluate their safety and efficacy in vitro and in vivo. Method: The phytochemicals for anti-SARS-CoV-2 were screened in silico using molecular docking. The hits generated from in silico screening were subjected for extraction, isolation and purification. The anti-SARS-CoV-2 activity of Zanthoxylum piperitum (E1), Withania somnifera (E2), Calophyllum inophyllum (E3), Andrographis paniculata (E4), Centella asiatica (E5) ethanol extracts. The aerial parts were used for E1, E3, E4, E5 and root was used for E2. The in vitro safety and anti-SARS-CoV-2 activity of plant methanol extracts were performed in VeroE6 cells using Remdesivir as positive control. The acute and sub-acute toxicity study was performed in Wistar male and female rats. Results: The percentage of cell viability for E4, E5 and E2 treated VeroE6 cells were remarkably good on the 24th and 48th hour of treatment. The in vitro anti-SARS-CoV-2 activity of E4, E5 and E2 were significant for both E gene and N gene. The percentage of SARS-CoV-2 inhibition for E4 was better than Remdesivir. For E gene and N gene, Remdesivir showed IC50 of 0.15 µM and 0.11 µM respectively, For E gene and N gene, E4 showed IC50 of 1.18 µg and 1.16 µg respectively. Taking the clue from in vitro findings, the E4, E5 and E2 were combined (E 4.5.2) and evaluated for acute and sub-acute toxicity in Wistar male and female rats. No statistically significant difference in haematological, biochemical and histopathological parameters were noticed. Conclusion: The study demonstrated the anti-SARS-CoV-2 activity in vitro and safety of plant extracts in both in vitro and in vivo experimental conditions.

Objectives: We report the gender-based differences in the prevalence, severity, pattern of valvular involvement, and complications in patients with Rheumatic Fever/Rheumatic heart disease (RF/RHD). Methods: The 2475 consecutive patients with RF/RHD diagnosed using clinical and echocardiographic criteria were registered prospectively from January 2011 till December 2019. The association of gender with the pattern of valvular involvement, nature, and severity of valvular dysfunction and cardiovascular complications was analyzed using a logistic regression model, and odds ratios with 95% CI were estimated. Results: The mitral and tricuspid valve involvement was significantly lower in the male gender, odds ratio with 95% CI of 0.55 (0.44–0.61), and 0.69 (0.58–0.83) respectively, while the aortic valve was affected more frequently than females, odds ratio 1.36 (1.14–1.62). The severity of valvular disease had no significant association with gender, 0.99 (0.82–1.20). The association between gender and cardiovascular complications, heart failure, stroke, and atrial fibrillations were not statistically significant. The prevalence of RF/RHD was more than two-fold higher in female gender than male (71.4% vs. 29.6%, p

Background: Extreme environments are inherently stressful and are characterized by a variety of physical and psychosocial stressors, including, but not limited to, isolation, confinement, social tensions, minimal possibility of medical evacuation, boredom, monotony, and danger. Previous research studies recommend adaptation to the environment to maintain optimal function and remain healthy. Different interventions have been tried in the past for effective management of stress. Yoga practices have been shown to be beneficial for coping with stress and enhance quality of life, sleep and immune status. Objective: The current article describes preparation of a Yoga module for better management of stressors in extreme environmental condition of Antarctica. Materials and methods: A Yoga module was designed based on the traditional and contemporary yoga literature as well as published studies. The Yoga module was sent for validation to forty experts of which thirty responded. Results: Experts (n = 30) gave their opinion on the usefulness of the yoga module. In total 29 out of 30 practices were retained. The average content validity ratio and intra class correlation of the entire module was 0.89 & 0.78 respectively. Conclusion: A specific yoga module for coping and facilitating adaptation in Antarctica was designed and validated. This module was used in the 35th Indian Scientific expedition to Antarctica, and experiments are underway to understand the efficacy and utility of Yoga on psychological stress, sleep, serum biomarkers and gene expression. Further outcomes shall provide the efficacy and utility of this module in Antarctic environments.

The southernmost region of earth, Antarctica, has world's most challenging environments. Those who live for long time and work in Antarctic stations are subjected to environmental stresses such as cold weather, photoperiod variations leading to disrupted sleep cycles, constrained living spaces, dry air, non-availability of fresh food items, and high electromagnetic radiations, psychological factors, such as geographical and social isolation, etc. All these factors have a significant impact on the human body. The present study investigated the impact of Antarctica harsh environment on human physiology and its metabolic processes by evaluating urine metabolome, using 1H NMR spectroscopy and analyzing certain physiological and clinical parameters for correlation with physiological expression data and metabolite results. Two study groups - before Antarctic exposure (B) and after Antarctic exposure (E), consisting of 11 subjects, exposed to one-month summer expedition, were compared. 35 metabolites in urine samples were identified from the 700 MHz 1H NMR spectra from where integral intensity of 22 important metabolites was determined. Univariate analysis indicated significant decrease in the levels of citrate and creatinine in samples collected post-expedition. Multivariate analysis was also performed using 1H NMR spectroscopy, because independent metabolite abundances may complement each other in predicting the dependent variables. 10 metabolites were identified among the groups; the OPLS-DA and VIP score indicated variation in appearance of metabolites over different time periods with insignificant change in the intensities. Metabolite results illustrate the impact of environmental stress or altered life style including the diet with absence of fresh fruits and vegetables, on the pathophysiology of the human health. Metabolic adaptation to Antarctic environmental stressors may help to highlight the effect of short-term physiological status and provide important information during Antarctic expeditions to formulate management programmes.

Pacemaker malfunctions are due to multiple reasons like lead dislodgement, lead perforation, lead maturation process, lead conductor or insulation failure, battery depletion, loose set screw and inadequate seating of terminal connector pin within connector block. We report a case of the 57-year-old female, who underwent dual chamber pacemaker implantation few years back for complete heart block and this time she presented to us with symptomatic bradycardia. After pacemaker interrogation, electrocardiogram and chest X-ray, the final diagnosis of pacemaker malfunction due to loss of ventricular capture as a result of the poor connection between the lead pin and connector header was made.

This article contains data on the effects of seagrass decline on wave energy along the shoreline of Barnegat Bay (USA) previously evaluated in Donatelli et al., 2019. This study was carried out applying the Coupled-Ocean-Atmosphere-Wave-Sediment Transport (COAWST) numerical modelling framework to six historical maps of seagrass distribution. A new routine recently implemented in COAWST was used, which explicitly computes the wave thrust acting on salt marsh boundaries. The numerical modelling results are reported in terms of wind-wave heights for different seagrass coverages, wind speeds and directions. From a comparison with a numerical experiment without submerged aquatic vegetation, we show how the computed wave thrust on marsh boundaries can be reduced by seagrass beds. Keywords: Vegetation, COAWST, Wave thrust

Objective: To report the prevalence, risk factors and consequences of atrial fibrillation (AF) in patients of rheumatic heart disease (RHD). Methods: The Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry database of 1918 patients was analyzed. AF was diagnosed with 12-lead ECG recording at entry in to the registry. The association of AF with nature and severity of valvular dysfunction was analyzed, adjusted for age, left atrial (LA) dimension and pulmonary arterial hypertension using multivariable logistic regression model and strength of association was reported as odds ratio (OR) with 95% confidence intervals (C. I.). Results: The study population consisted of young (40.2 ± 14.3 years), predominantly females (72.3%) from rural area (94.1%). Prevalence of AF was 23.9% (95% C. I. 22.1%–25.8%). The independent determinants AF were age (OR 1.04, 95% C.I. 1.03–1.06), LA size (OR 1.10, 95% C.I. 1.08–1.11). The association of AF with age, New York Heart Association functional class, mitral stenosis severity and tricuspid regurgitation was statistically significant and graded. Mitral regurgitation and aortic valve disease had no significant independent association with AF. The prevalence of heart failure, stroke, peripheral embolism and mortality was significantly higher among patients with AF (p

Background: The study aimed to estimate the prevalence, risk determinants, and its clinical significance of iron deficiency and anemia in patients of nonischemic heart failure with reduced ejection fraction (HFrEF). Methods: Serum ferritin, transferrin saturation, and the hemoglobin (Hb) levels were measured in 226 consecutive patients with HFrEF diagnosed based on the left ventricular ejection fraction ≤ 45% and absence of coronary artery luminal narrowing of more than 50%, in a prospective tertiary care hospital-based heart failure registry. Patients with the New York Heart Association functional class III/IV were classified as patients with advanced heart failure. Multivariable logistic regression modeling was performed to assess the risk determinants of iron deficiency and anemia and their clinical significance as the risk factors for advanced heart failure. Odds ratio with 95% confidence interval (CI) was reported as the estimates of the strength of association between exposure and outcome variables. Results: Iron deficiency and anemia were prevalent in 58.8% (52.2%–65.1%) and 35.8% (29.8%–42.3%) of patients, respectively. Female gender [OR 3.5 (95% CI 1.9–6.5)], history of bleeding [OR 11.7 (95% CI 1.4–101.2)], and vegetarian diet [OR 2.5 (95% CI 1.4–4.6)] were significantly associated with iron deficiency, while diabetes [OR 3.0 (95% CI 1.40–6.5)], estimated glomerular filtration rate [OR 0.98 (95% CI 0.97–0.99)], history of bleeding [OR 13.0 (95% CI 2.3–70.9)], and female gender [OR 2.9 (95% CI 1.5–5.7)] had significant association with anemia. The Hb level (OR 0.82 (95% CI 0.70–0.96) and transferrin saturation (OR 0.98 (95% CI 0.96–0.99)] had a significant inverse association with symptoms of advanced heart failure. Conclusion: Iron deficiency and anemia are common comorbidities associated with HFrEF. Low Hb and transferrin saturation are significantly associated with advanced heart failure. The findings have important implications in the management of heart failure. Keywords: Nonischemic systolic heart failure, Heart failure with reduced ejection fraction, Iron deficiency, Anemia, Risk factor, Advanced heart failure

The aim of this study was to develop a highly specific and sensitive (RT-)PCR capable of potentially amplifying the rearranged/expressed VH and VL gene belonging to any mouse immunoglobulin V gene family from a single or a small number of B cells. A database of germline immunoglobulin sequences was used to design 112 primers for a nested (RT-)PCR based strategy to cover all VH, VL, JH, JL, CH and CL gene families/genes from C57BL/6 and BALB/c mice. 93.7% of the primers had 4-fold or less, while 71.4% had no degeneracy. The proportions of germline V genes to which the primers bind with no, up to 1 and up to 2 mismatches are 59.7%, 84.1% and 94.9%, respectively. Most but not all V gene family specific primers designed allow amplification of full-length V genes. The nested primers permit PCR amplification of rearranged V genes belonging to all VH and VL gene families from splenocyte genomic DNA. The V gene family-specific nature of the primers was experimentally confirmed for randomly selected 6 VH and 6 Vkappa families, and all Vlambda genes. The broad V gene family coverage of our primer set was experimentally validated by amplifying the rearranged/expressed VH and VL genes from splenocytes and a panel of 38 hybridomas under conditions where primer mixes and genomic DNA or total RNA was used as starting template. We observed no or low-level cross-family priming. Pooled constant region specific primers allowed efficient RT-PCR amplification of H and L chain isotypes. The expressed VH and VL genes belonging to different V gene families RT-PCR amplified from a mixture of hybridomas in a representative manner. We successfully amplified the expressed VH and Vkappa gene from a single hybridoma cell by RT-PCR and from 10-15 microdissected B cells by genomic PCR. This, first of its kind, comprehensive set of highly sensitive and specific nested primers that provide broad V gene family coverage will open up new avenues and opportunities to study various aspects of mouse B cell biology.