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Evaluating drought parameters at the basin level is one of the fundamental processes for planning sustainable crop production. This study aimed to evaluate both short-term and long-term meteorological drought parameters within the Vaippar Basin, located in southern India, by employing the standardized precipitation index (SPI). Gridded rainfall values developed from 13 rain gauge stations were employed to calculate the SPI values. Drought parameters, encompassing occurrence, intensity, duration, frequency, and trends, were assessed for both short-term and long-term droughts. The study findings indicated that the occurrence of short-term drought was 51.7%, while that of long-term drought was 49.82%. Notably, the basin experienced extreme short-term droughts in 1980, 1998 and 2016 and long-term droughts in 1981, 2013, and 2017. Utilizing an innovative trend identification method for SPI values, a significant monotonic upwards trend was identified in October and December for short-term drought and in December for long-term drought. This study defined the minimum threshold rainfall, which represents the critical amount required to prevent short-term drought (set at 390 mm) and long-term drought (set at 635 mm). The drought severity recurrence curves developed in this study indicate that when the SPI values fall below − 1.0, short-term drought affects 25% of the basin area, while long-term drought impacts 50% of the basin area at a 20-year recurrence interval. Additionally, the drought hazard index (DHI), which combines drought intensity and severity, demonstrated higher values in the northwestern regions for short-term drought and in the southern areas for long-term drought. The study's findings, highlighting areas of drought vulnerability, severity, and recurrence patterns in the basin, direct the attention for timely intervention when drought initiates. [ABSTRACT FROM AUTHOR]

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Diabetes mellitus (DM) has become a significant health concern with an increasing rate of morbidity and mortality worldwide. India ranks second in the number of diabetes cases in the world. The increasing burden of DM can be explained by genetic predisposition of Indians to type 2 diabetes mellitus (T2DM) coupled with rapid urbanization and socio-economic development in the last 3 decades leading to drastic changes in lifestyle. Environment and lifestyle changes contribute to T2DM development by altering epigenetic processes such as DNA methylation, histone post-translational modifications, and long non-coding RNAs, all of which regulate chromatin structure and gene expression. Although the genetic predisposition of Indians to T2DM is well established, how environmental and genetic factors interact and lead to T2DM is not well understood. In this review, we discuss the prevalence of diabetes and its complications across different states in India and how various risk factors contribute to its pathogenesis. The review also highlights the role of genetic predisposition among the Indian population and epigenetic factors involved in the etiology of diabetes. Lastly, we review current treatments and emphasize the knowledge gap with respect to genetic and epigenetic factors in the Indian context. Further understanding of the genetic and epigenetic determinants will help in risk prediction and prevention as well as therapeutic interventions, which will improve the clinical management of diabetes and associated macro- and micro-vascular complications. [ABSTRACT FROM AUTHOR]

Angiotensin receptor/neprilysin inhibitors (ARNI) have become a pillar of heart failure (HF) management. Clinicians gain practical insight into the use of sacubitril/valsartan in patients with HF with reduced ejection fraction (EF) from a comprehensive overview based on clinical experience with ARNI therapy. The objective was to develop a consensus document addressing common concerns regarding the use of ARNI in patients with HF in clinical settings in India. Subject matter experts (SMEs) from India with decision-making expertise in the management of HF were identified to address experiences of ARNI use in Indian patients, its function in reversing myocardial remodeling, improvement in health status, and its safety. In regional meetings, five SMEs from India who consented to participate discussed data from practical experiences and current evidence. ARNI has been shown to substantially enhance EF 5%–10% in a majority of HF patients, although the range of improvement could vary widely in a few patients. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blocker antagonists have been eclipsed by ARNI. Patients who have diminished or declining estimated glomerular filtration rates are more likely than those with normal renal function to experience hyperkalemia. It is prudent to consistently monitor potassium levels in patients with borderline chronic kidney disease. In India, potassium binders may be used to temporarily control hyperkalemia caused by ARNI. Patients with a systolic blood pressure of <100 mmHg may initiate taking ARNI while being tracked for clinical symptoms. In clinical practice, symptomatic improvement with ARNI is observed soon after initiating, even before alterations noted in echocardiography. [ABSTRACT FROM AUTHOR]

Background: Dental professionals could play a significant role in identifying, documenting and reporting child maltreatment to appropriate authorities as children are exposed to various maltreatments that can present in the head and neck region. Aim: The aim of this paper is to assess the level of knowledge, awareness and attitude among dental professionals regarding child maltreatment and to identify the barriers that prevent reporting suspected maltreatment. Methodology: The present cross-sectional questionnaire-based study was conducted on dental professionals practising in India by emailing a self-structured questionnaire to assess knowledge, awareness and attitude regarding child maltreatment. Results: 422 dental professionals participated in the survey of which 270 were females. A significant difference was observed in mean knowledge (p=.015), awareness (p=.014) score of the participants with regard to place of work and mean knowledge score (p=.024) of the participants with regard to educational qualification. 300 participants reported that lack of adequate knowledge and awareness about the role of dental professionals regarding child maltreatment is one of the major barriers that prevent reporting child maltreatment. Conclusion: Findings of the study showed that 43.8% of participants had good knowledge and 44.8% were fairly aware regarding child maltreatment. 86.7% of participants showed a very good attitude towards learning more about the role of dental professionals in the management of child maltreatment. [ABSTRACT FROM AUTHOR]

Objectives: Primary objective -- Phase I: The primary objective of this study was as follows: (1) To identify common protective resilient factors that enabled the adult female cancer survivors to cope with the cancer experience. (2) To identify potential barriers to the resilience of adult female cancer survivors. Secondary objective -- Phase II: The secondary objective of this study was to develop and validate a resilience tool for cancer survivorship. Material and Methods: A mixed approach using sequential exploratory design was used in the study. A qualitative approach using phenomenology design was used in the first phase followed by a quantitative approach in the second phase. In the first phase, in-depth interviews were conducted until data saturation with 14 female breast cancer survivors chosen by purposive and maximum variation sampling methods based on inclusion criteria. The researcher used Colaizzi's data analysis framework to analyse the transcripts. Findings were configured as protective resilience factors and barriers to resilience. Based on the analysis of the qualitative phase, the researcher developed a 35-item resilience tool for cancer survivorship. Content validity, criterion validity and reliability of the newly developed instrument were assessed. Results: In the qualitative phase, the mean age of the participants was 57.07 years and the mean age at diagnosis was 55.5 years. The majority 11 (78.57%) of them were homemakers. All 14 (100%) of them had undergone surgery. The majority 11 (78.57%) of them had all three modes of therapy, that is, surgery, chemotherapy and radiation therapy. The categories of themes identified are presented under two main headings, that is, protective resilience factors and barriers to resilience. The theme categories identified under protective resilience factors were personal, social, spiritual, physical, economic and psychological factors. The barriers to resilience identified were lack of awareness, medical/biological barriers, social, financial and psychological barriers. The developed resilience tool had a content validity index of 0.98, a criterion validity of 0.67, internal consistency of 0.88 and stability of 0.99 at a 95% confidence interval. Principle component analysis (PCA) was used to validate the domains. PCA of protective resilience factors (Q1-Q23) and barriers to resilience (Q24-Q35) had Eigenvalues of 7.65 and 4.49, respectively. The resilience tool for cancer survivorship was found to have good construct validity. Conclusion: The present study has identified the protective resilience factors and barriers to resilience among adult female cancer survivors. The developed resilience tool for cancer survivorship was found to have good validity and reliability. It will be useful for nurses and all other healthcare professionals to assess the resilience needs of cancer survivors and to provide need-based quality cancer care [ABSTRACT FROM AUTHOR]

Background: Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH) are often the ignored forms of hypertension and are determinants of future cardiac and neurological events and contribute to mortality. However, the nationally representative estimates of both these forms of hypertension remain unknown from India. Aim: To estimate the ISH and IDH from a nationally representative survey of India. Material and Methods: The present study used data from 7,23,181 people (15–54 years), recorded during the fourth round (2015–2016) of the National Family Health Survey (NFHS), India. The prevalence of ISH and IDH was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of both types of hypertension. Results: The prevalence of ISH and IDH was found to be 1.2% (95% CI 1.0–1.4) and 5.7% (95% CI 5.2–6.2), respectively. The prevalence of both ISH and IDH increased with age, with a more significant increase in systolic pressure towards the higher age. Northeastern states of India (Assam, Meghalaya, and Arunachal Pradesh) had the highest prevalence of both forms of hypertension. On multilevel logistic regression, male gender, increasing age groups (highest odds ratio (OR) being in 45–49 year age group), alcohol, and diabetes positively predicted both ISH and IDH. Urban residence, literacy, and tobacco were positive predictors of IDH, whereas urban residence, smoking, and literacy negatively predicted ISH. Conclusion: ISH and IDH have a significant presence among the population of India. This data provides insights to formulate strategies at the primary and primordial prevention levels. [ABSTRACT FROM AUTHOR]

Background: COVID-19 poses a severe threat to global human health, especially the USA, Brazil, and India cases continue to increase dynamically, which has a far-reaching impact on people's health, social activities, and the local economic situation.Methods: The study proposed the ARIMA, SARIMA and Prophet models to predict daily new cases and cumulative confirmed cases in the USA, Brazil and India over the next 30 days based on the COVID-19 new confirmed cases and cumulative confirmed cases data set(May 1, 2020, and November 30, 2021) published by the official WHO, Three models were implemented in the R 4.1.1 software with forecast and prophet package. The performance of different models was evaluated by using root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE).Results: Through the fitting and prediction of daily new case data, we reveal that the Prophet model has more advantages in the prediction of the COVID-19 of the USA, which could compose data components and capture periodic characteristics when the data changes significantly, while SARIMA is more likely to appear over-fitting in the USA. And the SARIMA model captured a seven-day period hidden in daily COVID-19 new cases from 3 countries. While in the prediction of new cumulative cases, the ARIMA model has a better ability to fit and predict the data with a positive growth trend in different countries(Brazil and India).Conclusions: This study can shed light on understanding the outbreak trends and give an insight into the epidemiological control of these regions. Further, the prediction of the Prophet model showed sufficient accuracy in the daily COVID-19 new cases of the USA. The ARIMA model is suitable for predicting Brazil and India, which can help take precautions and policy formulation for this epidemic in other countries. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is principal cause of potentially inappropriate medications (PIMs) in elderly patients, which include over prescribing, under prescribing, and misprescribing. Methods: Elderly subjects (≥60 years), of either sex, receiving two or more medications for one or more chronic ailments, attending Geriatrics Outpatient Department (OPD), at All India Institute of Medical Sciences (AIIMS) New Delhi, were included. Their prescriptions were assessed for PIMs by using Beers criteria 2015 and were further followed up at least once in 6 months for adverse events, telephonically. The results were analyzed by using suitable regression models and correlation analysis. Results: Three hundred eighty patients average age of 65.4 ± 4.7 years were enrolled. Eighty‐eight percent of the people were having greater than or equal to two ailments. Each patient was prescribed 6.7 ± 2.1 medications with 65% of prescriptions having one or more PIMs. Out of the total prescribed drugs, 15% were satisfying Beers criteria for PIMs. There were 63 adverse drug reactions (ADRs) reported. A statistically significant correlation was observed among comorbidities, number of prescribed medications, PIMs, and ADRs. Quality of life (QOL) of the elderly patients was negatively corelated with polypharmacy and female sex. Conclusion: A risk‐benefit analysis of prescribed medications is part and parcel of prescribing, especially in elderly patients. In order to decrease further risks associated with inappropriate prescribing, there is need for indigenous guidelines and intensive training. [ABSTRACT FROM AUTHOR]

The global growth of electronic media usage among children has caused concerns regarding screen time (ST) impact on child development. No previous population-based studies have evaluated ST and child development in India. This study aimed to determine the burden of ST, associated sociodemographic factors, and its impact on domains of child development. A population-based cross-sectional study was conducted in the field practice area of rural and urban health centers in Tamil Nadu, India. A total of 718 children (396 rural and 322 urban) were selected, using a cluster random sampling method. ST estimates were obtained from parents/guardian after a 7-day observation period. The Communication DEALL Developmental Checklist was used to assess child development. The mean ST was 2.39 hours/day (95% confidence interval [CI]: 2.23–2.54), and the prevalence of excessive ST was 73% (95% CI: 69.2–76.8). Excessive ST was significantly associated with the mothers' ST, screen usage at bedtime, birth order (in children < 2 years), and attending school (in children ≥ 2 years). Increased ST was significantly associated with developmental delay, in particular, in the domains of language acquisition and communication. In children aged ≥ 2 years, a delay in ≥ 3 domains was associated with ST (adjusted odds ratio [AOR] = 17.75, 95% CI: 5.04–62.49, p < 0.001), as was language delay (AOR = 52.92, 95% CI: 12.33–227.21, p < 0.001). In children aged < 2 years, a delay in ≥ 2 domains was associated with ST (AOR = 16.79, 95% CI: 2.26–124.4, p < 0.001), as was language delay (AOR = 20.93, 95% CI: 2.68–163.32, p < 0.01). A very high prevalence of excessive ST was identified, with a significant association with developmental delay in children. There is an urgent need to include education on ST limits at the primary healthcare level. [ABSTRACT FROM AUTHOR]

Background: India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women's mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae.Methods: We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants.Results: Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention.Conclusions: Understanding factors contributing to women's suffering related to reproductive challenges in this pronatalist context is critically important for women's wellbeing. [ABSTRACT FROM AUTHOR]

Background: Majority of the population relies on traditional medicines for many of their health related problems. Particularly individuals with chronic illness like diabetes mellitus (DM) are more likely to simultaneously use herbal medicines. Many of such users believe that traditional medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines may be associated with adverse effects, which include interactions with prescribed drugs. Information on such concomitant use of anti-diabetic drugs along with Ayurveda medicines is limited in Indian scenario. Aims and objectives: To survey the patterns of concomitant use of Ayurveda and conventional anti-diabetic drugs by diabetic patients attending an out-patient department of a tertiary care teaching hospital in New Delhi, India through a validated questionnaire. Materials and methods: This is a questionnaire-based survey, carried out after the approval of the Institutional Ethics Committee, subsequently registered at CTRI. A questionnaire to assess the pattern of concomitant use was developed; content was validated and pre-tested by a pilot study in 40 patients, further refined and used in the survey. The data was analyzed to evaluate the patterns of concomitant use of Ayurvedic and conventional anti-diabetic drugs. Results: About 95.9% of diabetic patients were taking herbo-mineral formulations concomitantly with conventional anti-diabetic drugs. Although 45.3% of diabetics were using Ayurveda interventions under the supervision of qualified AYUSH physicians, remaining involved in procuring the drugs over the counter (OTC) or from the local vendors. In majority of these instances, the use of Ayurveda formulations was not communicated with their physicians. Conclusion: The observations reveal that a majority of the diabetics (95.9%) were taking one or the other form of herbal preparations along with their conventional anti-diabetic drugs and about 44% among them were using these concomitantly. Thus, generating awareness on good practices of drug use seems to be essential. [ABSTRACT FROM AUTHOR]

Context: Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality. Aims: The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO. Materials and Methods: This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited. Results: A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, P = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, P = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge (P = 0.001). Conclusions: Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival. [ABSTRACT FROM AUTHOR]

Background: The etiopathogenesis of Pityriasis rosea (PR), a papulo-squamous skin disease, remains elusive and hypothesized to be caused primarily by human herpesvirus (HHV) 6 or 7 or immune dysfunction. Aims: The recent increasing incidences of hepatitis B virus (HBV) infections, including asymptomatic occult HBV infections (OBIs), in a densely populated city in India, prompted us to investigate whether PR patients (from varied socioeconomic and immune status) harbor the underlying HBV infections. These cases were also investigated for HHV 6 and 7 infections. Materials and Methods: DNA from ethylenediaminetetraacetic acid blood samples from PR-diagnosed individuals (n = 13; mostly young adults) and healthy controls (n = 11) were subjected to virus gene-specific polymerase chain reactions (PCRs) for HBV and HHV 6 and 7. PCR products of expected length, when observed, were sequenced (bidirectional) using overlapping primers. Sequences were identified by NCBI BLAST and analyzed by multiple sequence alignment and phylogenetic studies. The blood samples were tested for HBsAg by EIA. Results: In 5/13 PR samples, only HBV DNA (4/5 being HBsAg negative) was detected, providing first-time evidence that PR may be manifested in asymptomatic HBV carriers. 6/13 cases were HHV 7 (not HHV 6) DNA positive, providing confirmatory molecular genetic evidence for the first time of PR association with HHV 7 from India. Surprisingly, 5/6 HHV 7-positive PR cases were also HBV positive. Overall, 10/13 PR samples showed evidence of HBV infection. 8/13 were OBI, harboring at least one OBI-signature S protein mutation. All healthy controls were HBsAg EIA and PCR negative. Conclusions: 77% of PR patients presented the evidence of underlying HBV infection (genotype D2), suggestive of horizontal HBV transmission. This warrants for mass HBV vaccination. PR patients should be tested for underlying virus infections for appropriate therapy and management. [ABSTRACT FROM AUTHOR]

Background: Construction industry is the second largest employment giving industry in India with many semi-skilled or unskilled workers taking up the occupation for livelihood without any training and proper guidance. Aim: To evaluate the pathogenic association of cement exposure to occupational contact dermatoses as evidenced by immune markers and to correlate their pulmonary functions with years of exposure to cement. Setting and Design: This was a cross-sectional study conducted among randomly selected cement workers. Methods and material: Evaluation of socioeconomic status (SES) and years of exposure of cement workers was done using a questionnaire. Clinical examination of skin lesions and strip patch test with application of potassium dichromate on unexposed skin was performed. Results were interpreted after 48 hours. Absolute eosinophil count (AEC) and IgE levels measured, and spirometric evaluation was performed. Statistical Analysis: Analysis of variance and Pearson's correlation test were used for data analysis. P< 0.05 was considered to be statistically significant. Results: Clinically, skin lesions were noticed in 51%, elevated AEC in 47%, and raised Anti IgE in 73%. Two participants developed positive reactions to the skin strip patch test. Duration of exposure to cement and SES were compared with clinical skin lesions. Spirometry result was normal in 81%, obstruction in 8%, restriction in 10%, and mixed pattern in 1%. Forced expiratory volume at 1.0 second, forced expiratory flow (25-75%), and (PEFR) Peak Expiratory Flow Rate were markedly reduced with years of exposure. Workers who had greater skin lesions and with increase in exposure had increased AEC and IgE levels, although statistically not significant. Conclusions: Exposure to cement and poor SES is strongly correlated to increased prevalence of skin lesions and reduced pulmonary functions. [ABSTRACT FROM AUTHOR]

Trematodes are recognized as a group of emerging parasites in tropical countries. We identified a trematode as a cause of ocular granulomas that developed in children who bathed in ponds or rivers in South India. DNA was isolated from patients' surgically excised granulomas and from the trematode cercariae (larvae) released by the snail Melanoides tuberculata in water in which the children bathed. Real-time and conventional PCRs were performed that targeted ribosomal DNA regions spanning the internal transcribed spacer 2 and 28S sequences of this trematode. The PCR-amplified products were subjected to bidirectional sequencing. Analysis of sequences for the granuloma samples and the trematode cercariae showed maximum sequence similarity with Procerovum varium (family Heterophyidae). Our results confirmed the etiology of the ocular infection, implicating snail vectors as environmental risk factors for ocular parasitosis. [ABSTRACT FROM AUTHOR]

Background: India being a developing country has tremendous demand of physical infrastructure and construction work as a result there is a raising demand of construction workers. Workers in construction industry are mainly migratory and employed on contract or subcontract basis. These workers face temporary relationship between employer and employee, uncertainty in working hours, contracting and subcontracting system, lack of basic continuous employment, lack basic amenities, and inadequacy in welfare schemes. Objective: To estimate the prevalence of respiratory and dermatological symptoms among migratory construction workers. Materials and Methods: This cross-sectional study was conducted in Manipal, Karnataka, among 340 male migratory construction workers. A standard modified questionnaire was used as a tool by the interviewer and the physical examination of the workers was done by a physician. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 15.0. Result: Eighty percent of the workers belong to the age group of 18-30 years. The mean age of the workers was 26 ± 8.2 years. Most (43.8%) of the workers are from West Bengal followed by those from Bihar and Jharkhand. The rates of prevalence of respiratory and dermatological symptoms were 33.2% and 36.2%, respectively. Conclusion: The migrant construction workers suffer from a high proportion of respiratory and dermatological problems. [ABSTRACT FROM AUTHOR]

Background: Global prevalence of thyroid cancer has been on the rise in recent decades. Objectives: To study the clinical presentations to reach an agreement for diagnosis and optimal management of incidentally revealed thyroid swellings for early diagnosis. Materials and Methods: A prospective study was carried out on 178 cases of incidentally detected thyroid swelling attending a tertiary care teaching institute of Kishanganj Bihar. All the cases were subjected to a thorough clinical examination followed by evidence-based interventions. Fine needle aspiration cytology was done in all the cases preoperatively as out-patients basis and histopathologically confirmed postoperatively. Results: The highest incidence of thyroid swelling (75.84%) was found in the age group of 20-40 years; a female preponderance was noted in the ratio 4:1. The duration of swelling ranged from six months to three years. Difficulty in swallowing and breathing was complained by 23 (12.9%) and 18 (10.1%) of the patients respectively. Typically the swellings were located in the right lobe. Commonly the subjects in our study were in euthyroid state (90%) and were with firm swellings (66.7%). Follicular and anaplastic carcinoma was important postoperative cytological findings. Majority of surgical intervention was hemithyroidectomy (55.06%). Conclusion: Incidentally revealed thyroid swelling was quite high in eastern India for which we need a consensus line of intervention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Arterial blood gas (ABG) analysis is routinely performed for sick patients but is fraught with complications, is painful, and is technically demanding. OBJECTIVE: To ascertain agreement between the arterial and peripheral venous measurement of pH, pCO2, pO2, and bicarbonate levels in sick patients with cardiopulmonary disorders in the valley of Kashmir in the Indian subcontinent, so as to use venous gas analysis instead of arterial for assessment of patients. SETTING: Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, a 650-bedded tertiary care hospital in North India located at an altitude of 1584 m. METHODS: One hundred patients who required ABG analysis were admitted. Peripheral venous blood was drawn within 5 min of an ABG measurement, and the samples analyzed immediately on a point of care automated ABG analyzer. Finger pulse oximetry was used to obtain oxygen (SpO2) saturation. Data were analyzed using Pearson correlation and bias (Bland Altman) methods. RESULTS: The venous measurements of pH, pCO2, pO2 and bicarbonate, and the digital oxygen saturation were highly correlated with their corresponding arterial measurements. Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements with clinically acceptable differences. The difference in pO2 measurements was, however, higher (-22.34 ± 15.23) although the arterial saturation and finger oximetry revealed a good degree of agreement with clinically acceptable bias. CONCLUSION: Peripheral venous blood gas assessment in conjunction with finger pulse oximetry can obviate the routine use of arterial puncture in patients requiring ABG analysis. [ABSTRACT FROM AUTHOR]

Background: Hypervirulent K. pneumoniae (hvKp) causes severe community acquired infections, predominantly in Asia. Though initially isolated from liver abscesses, they are now prevalent among invasive infections such as bacteraemia. There have been no studies reported till date on the prevalence and characterisation of hvKp in India. The objective of this study is to characterise the hypervirulent strains isolated from bacteraemic patients for determination of various virulence genes and resistance genes and also to investigate the difference between healthcare associated and community acquired hvKp with respect to clinical profile, antibiogram, clinical outcome and molecular epidemiology. Results: Seven isolates that were susceptible to all of the first and second line antimicrobials and phenotypically identified by positive string test were included in the study. They were then confirmed genotypically by presence of rmpA and rmpA2 by PCR. Among the study isolates, four were from patients with healthcare associated infections; none were fatal. All patients with community acquired infection possessed chronic liver disease with fatal outcome. Genes encoding for siderophores such as aerobactin, enterobactin, yersiniabactin, allantoin metabolism and iron uptake were identified by whole genome sequencing. Five isolates belonged to K1 capsular type including one K. quasipneumoniae. None belonged to K2 capsular type. Four isolates belonged to the international clone ST23 among which three were health-care associated and possessed increased virulence genes. Two novel sequence types were identified in the study; K. pneumoniae belonging to ST2319 and K. quasipneumoniae belonging to ST2320. Seventh isolate belonged to ST420. Conclusion: This is the first report on whole genome analysis of hypervirulent K. pneumoniae from India. The novel sequence types described in this study indicate that these strains are evolving and hvKp is now spread across various clonal types. Studies to monitor the prevalence of hvKp is needed since there is a potential for the community acquired isolates to develop multidrug resistance in hospital environment and may pose a major challenge for clinical management. [ABSTRACT FROM AUTHOR]