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BACKGROUND AND AIMS India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The "HEAD-Start Project Delhi" aimed to enhance HCV diagnosis and treatment pathways among the general population. METHODS A prospective study was conducted at 5 district hospitals (Arm 1: one-stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn-around time were measured. RESULTS Between January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26-48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P

Leptospirosis is a worldwide zoonotic infection with a much greater incidence in tropical regions and has now been identified as one of the emerging infectious diseases. The epidemiology of leptospirosis has been modified by changes in animal husbandry, climate and human behavior. Resurgent interest in leptospirosis has resulted from large outbreaks that have received significant publicity. The transmission cycle of leptospirosis involves maintenance hosts, carrier hosts, environment and human beings. The carrier animals in India include rats, pigs, cattle, bandicoots and dogs. Intervention strategies include vaccination, rodent control and improved environmental hygiene to eliminate possibility of water, soil and food contamination. Mass awareness or public education is of utmost importance. The development of simpler, rapid assays for diagnosis has been based largely on the recognition that early initiation of antibiotic therapy is important in acute disease but also on the need for assays which can be used more widely. The gold standard is microscopic agglutination test though serological studies are widely conducted for the diagnostic purpose. The antibiotics use for the treatment of leptospirosis includes oral doxycycline, azithromycin and penicillins. Among the parenteral therapy Intravenous penicillin G and third generation cephalosporins are used. We reviewed the clinical presentation, diagnosis, treatment and prevention of leptospirosis in this study.

Background Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). Objectives This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. Methods The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life–5 Dimensions–5 Level visual analogue scale at 12 weeks. Results MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). Conclusions Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408)., Central Illustration

Background: Multiple forms of malnutrition (MOM) are a public health concern that requires strong and collaborative policy action. One common thread across MOM is inadequate consumption of fruits a...

Diseases spread by pathogens are a major cause of both illness and death of human beings. The danger of getting infectious diseases in every hospital throughout the world is always there and is a universal fact. This paper proposes an Ultra Violet Disinfection and Sterilizing (UVDS) robot, which helps to sterilize an area in hospitals and resolve the problem of acquiring infectious diseases through hospitals and other potential places. The aim to innovate this equipment is to estimate the disinfection capacity of a UVDS robot. This robot can be used in hospitals, public transport, airlines and any enclosed areas. This technique will help to increase the sanitation process of contaminated areas and dramatically reduce the need for workforce. The UVDS robot is designed with ultraviolet lights and sanitizer spray along with the controllers to program I according to the need of disinfecting areas, which is contaminated by bacteria, viruses and other harmful microorganisms. To disinfect a wide range of surfaces, the sanitizer sprays are used, which rotates at an angle of 180°. Our UVDS robot has six 20 watts of UV lights. The concept of Internet of Things (IoT) is utilized to control the robot as well as measure the parameters. The operator will operate the system through the mobile application from outside the room. Ultraviolet Disinfection and Sterilizing Robot will remotely disinfect hospital wards and the patient’s private room. The objective of this UVDS robot is to reduce Healthcare-Associated Infections (HAI) in hospitals. This robot moderates the number of viruses, infectious diseases and deaths caused by them in healthcare services provided during hospitalization. The proposed UVDS robot is used for hospitals, institutions, industries, airports and other infected areas.

Objective Prescription opioid misuse has led to a new cohort of opioid use disorder (OUD) patients who were introduced to opioids through a legitimate prescription. This change has caused a shift in the demographic profile of OUD patients from predominantly young men to middle age and older people. The management of OUD includes medication-assisted treatment (MAT), which produces varying rates of treatment response. In this study, we will examine whether the source of first opioid use has an effect on treatment outcomes in OUD. Using a systematic review of the literature, we will investigate the association between source of first opioid introduction and treatment outcomes defined as continuing illicit opioid use and poly-substance use while in MAT. Methods Medline, EMBASE, CINHAL, and PsycInfo were searched from inception to December 31st, 2019 inclusive using a comprehensive search strategy. Five pairs of reviewers conducted screening and data extraction independently in duplicate. The review is conducted and reported according to the PRISMA guidelines. A random-effects model was used for meta analyses assuming heterogeneity among the included studies. Results The initial search results in 27,345 articles that were screened, and five observational studies were included in the qualitative and quantitative analyses. Our results found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while on MAT. They were also less likely to use cannabis (0.54, 95% CI 0.32, 0.89), alcohol (0.75, 95% CI 0.59, 0.95), cocaine (0.50, 95% CI 0.29, 0.85), and injection drug use (0.25, 95% CI 0.14, 0.43) than those introduced to opioids through recreational means. Conclusion This study shows that the first exposure to opioids, whether through a prescription or recreationally, influences prognosis and treatment outcomes of opioid use disorder. Although the increased pattern of prescribing opioids may have led to increased OUD in a new cohort of patients, these patients are less likely to continue to use illicit drugs and have a different prognostic and clinical profile that requires a tailored approach to treatment. Systematic review registration PROSPERO CRD42017058143.

The benefits of fruit and vegetables are well established, particularly their role in preventing general micronutrient-deficiencies and chronic diseases. However, global food systems are not delivering diverse and high quality diets: healthy food is unavailable and too expensive for many. Creating food environments that foster consumer access to fruit and vegetables will require coordinated policy action across sectors, mostly outside of the health sector. The aim of this paper is to identify opportunities to strengthen food system policy for nutrition, through an analysis of the policies relevant to the external food environment for fruit and vegetables in India. We conducted interviews based on policy theory with 55 stakeholders from national and state level, from within government, research, private sector and non-government agencies, and from health, agriculture and economic sectors. Specific strategies identified in this study to improve consumers’ external food environment for fruit and vegetables in India were: development of strategic Public-Private Partnerships to increase access to diverse expertise across the supply chain; linking health and economic/agricultural policy agendas; and strengthening surveillance of policy impacts on consumer access to fruit and vegetables. We also found that public health actors can play an important role in advocating for ‘consumer oriented’ fruit and vegetable supply policy. This study demonstrates the usefulness of ‘policy learning’-oriented qualitative policy analysis in identifying ‘points of entry’ for food policy change, and extends understanding of political dynamics in engendering agricultural policy change for nutrition. Improving access to affordable fruit and vegetables is a global priority, and given common global food supply challenges, the findings from this study are also likely to be relevant for other low and middle income countries.

Background Cardiac rehabilitation (CR) is a standard treatment for secondary prevention of acute myocardial infarction (AMI) in high income countries (HICs), but it is inaccessible to most patients in India due to high costs and skills required for multidisciplinary CR teams. We developed a low-cost and scalable CR program based on culturally-acceptable practice of yoga (Yoga-CaRe). In this paper, we report the rationale and design for evaluation of its effectiveness and cost-effectiveness. Methods This is a multi-center, single-blind, two-arm parallel-group randomized controlled trial across 22 cardiac care hospitals in India. Four thousand patients aged 18–80 years with AMI will be recruited and randomized 1:1 to receive Yoga-CaRe program (13 sessions supervised by an instructor and encouragement to self-practice daily) or enhanced standard care (3 sessions of health education) delivered over a period of three months. Participants will be followed 3-monthly till the end of the trial. The co-primary outcomes are a) time to occurrence of first cardiovascular event (composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and emergency cardiovascular hospitalization), and b) quality of life (Euro-QoL-5L) at 12 weeks. Secondary outcomes include need for revascularization procedures, return to pre-infarct activities, tobacco cessation, medication adherence, and cost-effectiveness of the intervention. Conclusion This trial will alone contribute >20% participants to existing meta-analyses of randomized trials of CR worldwide. If Yoga-CaRe is found to be effective, it has the potential to save millions of lives and transform care of AMI patients in India and other low and middle income country settings.

Diabetes mellitus (DM) is a known independent predictor of mortality following acute myocardial infarction (AMI). In addition, patients with DM may have other risk factors for AMI such as hypertension (HTN), tobacco use, physical inactivity. This study aimed to explore the distribution of cardiovascular (CV) risk factors among patients of AMI with and without DM. Yoga-CaRe, a multicenter randomized controlled trial, included patients of AMI (first or consequent AMI) with DM (n=856) and without DM (n=2330), aged 18-80 years from 24 cardiac centers across India. The baseline socio-demographics, clinical and behavioral characteristics of those with and without DM were analyzed using multivariable logistic/linear regression models, sequentially adjusted for age, gender, education and physical inactivity. Patients of AMI with DM were older as compared to those without DM (mean age 56.4± 9.4 vs. 51.9 ± 11.2). Patients with DM had higher odds of having hypertension, being physically inactive and had lower odds of self-reported ever tobacco use. Patients with DM had higher mean waist circumference, systolic and diastolic blood pressure (Table). No differences were found in body mass index between diabetes and nondiabetes groups.The observed differential distribution of CV risk factors in AMI patients with DM calls for a tailored rehabilitation plan. Cardiovascular risk factors among AMI patients with diabetes vs. without diabetesVariableDiabetes (n=856)Without diabetes (n=2330)Adjusted OR/Regression coefficient* [95% CI]Ever tobacco use (%)34.2%49.2%0.73 [0.60-0.88]Physical inactivity (%)57.8%49.2%1.38 [1.18-1.62]Body Mass Index ≥25Kg/m2 (%)57.6%50.8%1.13 [0.95-1.34]Waist circumference (cm) (mean)99.3±20.792.3±17.94.7 [3.1-6.3]*Systolic blood pressure (mmHg) (mean)123.4±17.2118.8±16.13.6 [2.3-4.9]*Diastolic blood pressure (mmHg) (mean)76.7±10.774.9±10.31.9 [1.02-2.7] *Hypertension (%)53.1%18.6%3.8 [2.9-5.1] Disclosure D. Soni: None. C.M. Ambalam: None. V.S. Ajay: None. K. Singh: None. K. Singh: None. P.A. Praveen: None. A. Roy: None. S.C. Manchanda: None. B. Mohan: None. P.C. Negi: None. P. Bhat: None. K.S. Sadananda: None. P.M. R.: None. P. Sarma: None. S. Natarajan: None. C. Narasimhan: None. N. Desai: None. S. Patil: None. D.S. Chadha: None. S. Chandra: None. S. Kinra: None. D. Prabhakaran: None.

Objectives:The association between clinical profile such as electrocardiographic changes and angiographic changes without and with comorbid hypertension among acute myocardial infarction (AMI) patients is not explored in Indian population. To examine the clinical profile among AMI patients with and

Objectives:Patients with acute myocardial infarction (AMI) demonstrates poor health-related quality of life (HRQoL) scores in comparison to the general population. Although hypertension is associated with quality of life, little is known about the synergistic effect of blood pressure on HRQoL follow

Music is one of the beautiful and greatest creations of human kind in the course of history. As we know it, music plays a vital role not only in the film industry but also in our daily life. The creation of a popular song is a tedious task in today's world because of the availability of many popular and known songs worldwide. While on the one hand musicians or song writers try to give their level best, on the other side there are people who try to remix the old songs with new music and sometimes they do prove beneficial. From the classification of various genres like Pop, Jazz, Bhangra(an Indian genre) our proposal is to use the technological development in data and pattern mining, keeping the sense of creativity to a minimum and providing more chances to technology in the Hindi Jazz songs. This paper deals with the recognition of similar pattern in the Jazz music which makes them popular from the rest of the songs.

The taxation of cross-border transactions involving the transfer of shares of an Indian company to a Mauritius-based shareholder and the applicability of the India-Mauritius treaty has been a controversial and divisive issue for many years. This ruling highlights the determination of the Indian tax authorities to block attempts at treaty shopping, albeit in an indirect manner. Although India did not have a general anti-avoidance rule (GAAR) when the transaction took place, the tax authorities had argued that the transaction was an attempt at tax avoidance and should be termed “colorable.” The AAR's re-characterization of capital gains as dividends is the first of its kind and seeks to ignore the very form of the transaction.