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Abstract: Background: Patients with early rheumatoid arthritis may show a qualitative change in their short-term outcome if they are treated at presentation. We tried to evaluate these patients on disease modifying antirheumatic drugs (DMARDs) commenced at diagnosis. Methods: 110 consecutive patients enrolled in this study from our rheumatology clinic, fulfilling American College of Rheumatology (ACR) 1987 revised criteria for classification of RA with disease duration of less than 6 months who had not received any DMARD. Patients were randomized to two groups irrespective of clinical, serological and radiological findings and assigned to treatment with either MTX + HCQ or SSZ + HCQ and were followed for 6 months. Results: There were statistically significant differences in clinical and laboratory parameters after 6 months in comparison to baseline within each group but not between the two groups. There was good correlation between DAS28 and CRP when compared at baseline and after 6 months of treatment in both the treatment groups. Conclusions: Disease control is the real goal of treatment of early RA irrespective of the DMARD regimen employed. Radiological changes may be found even in early RA and may call for more aggressive management in some patients. Costly estimation of CRP should give way to simple estimation of DAS28. [Copyright &y& Elsevier]

Abstract: The land surface parameters are simulated with a Noah-LSM (NCEP, OSU, Air Force and Office of Hydrology Land Surface Model) version 2.7.1 for the tropical conditions using the surface and subsurface observations over a semi-arid region of Gujarat, India from the Land Surface Processes Experiment (LASPEX) data sets. The surface forcings are air temperature, air humidity, surface pressure, wind speed, and surface downward short wave and long wave radiations. The model simulations were carried out for two cases viz one in using soil moisture dependent soil thermal conductivity and the other by using a fixed site specific soil thermal conductivity. Simulated surface parameters are compared with observations obtained in the LASPEX to validate the Noah-LSM performance. Simulated skin temperature and net radiation are in agreement with observed results for dry surface conditions. However, simulated soil temperatures at different depths are deviating from observations particularly for wet period. Simulation of soil hydrology related parameters is very sensitive to the use of soil thermal conductivity. Based on the evaluations of model and observed results, we propose the improvement of Noah-LSM taking into consideration the site specific soil thermal conductivities and surface parameters for tropical conditions. [ABSTRACT FROM AUTHOR]

Introduction: The ongoing visceral leishmaniasis (VL) elimination programme in India is targeting the elimination of the disease VL but not the pathogen. The persistence of hidden parasite pool may initiate a resurgence in suitable conditions. This study dealt with a novel approach to unearth such pathogen pool and their proper management to prevent the resurgence of VL., Materials and Methods: We deployed a new approach for detection of pathogen pool by following up the VL and post kala-azar dermal leishmaniasis patients treated during the last 10 years along with mass sero-surveillance within a radius of 500 m of recently treated individuals., Results: We followed up 72.6% (3026/4168) previously treated VL and post kala-azar dermal leishmaniasis patients and diagnosed 42 (1.4%) new and 38 (1.3%) recurrent post kala-azar dermal leishmaniasis. We detected 93 asymptomatic leishmanial infection, 8 VL and 1 post kala-azar dermal leishmaniasis by mass sero-surveillance., Conclusion: Our three-step process including mapping and follow-up of previously treated cases, mass surveillance within 500 m of radius of known cases, and 6 monthly follow-on clinical and serological screening of asymptomatic cases, enabled detection of previously undetected cases of post kala-azar dermal leishmaniasis and VL. Recurrent post kala-azar dermal leishmaniasis deserves special attention regarding their treatment guideline. Early diagnosis and effective treatment of all leishmaniasis cases will hasten pathogen elimination and prevent resurgence of VL. This may help the policymakers to develop appropriate strategy for elimination of pathogen to prevent resurgence of VL., (© 2024. The Author(s).)

Influenza, COVID-19, tetanus, pertussis and hepatitis B pose increased risk for pregnant women and infants and could be mitigated by maternal immunization. In India Tetanus-diphtheria (Td) and COVID-19 vaccines are recommended during pregnancy, while influenza and tetanus-acellular pertussis-diphtheria (Tdap) vaccines are not. We conducted a multicenter study from November 2021 to June 2022 among pregnant women ( n  = 172) attending antenatal clinics in three public hospitals in West Bengal, to understand the factors that influence women's decisions to get vaccinated during pregnancy. Questions assessed vaccination coverage, knowledge, intention and willingness to pay for influenza vaccine, and factors influencing decisions to get Td, influenza, and COVID-19 vaccines. 152/172 (88.4%) women were vaccinated with Td, 159/172 (93%) with COVID-19, 1/172 (0.6%) with influenza, and none with Tdap. 10/168 (6%) had received hepatitis B vaccine (HBV). Community health workers advice was crucial for Td uptake and, the belief of protection from COVID for COVID-19 vaccines. Most women were unaware about Tdap (96%), influenza (75%), and influenza severity during pregnancy and infancy (85%). None were advised for influenza vaccination by healthcare providers (HCP), albeit, 93% expressed willingness to take, and pay INR 100-300 (95% CI: ≤100 to 300-500) [$ 1.3-4.0 (95% CI: ≤1.3, 4-6.7)] for it. Vaccination on flexible dates and time, HCP's recommendation, proximity to vaccination center, and husband's support were most important for their vaccination decisions. Women were generally vaccine acceptors and had high uptake of vaccines included in the Universal Immunization Program (UIP). Inclusion of influenza, Tdap, and HBV into UIP may improve maternal vaccine uptake.

Introduction: The coexistence of diabetes mellitus (DM) (both type 1 and type 2) and thyroid dysfunction, two common endocrine problems, is scientifically predictable. The prevalence of thyroid disorders among type 2 diabetics (more prevalent in India) was studied among patients visiting the outpatient department (OPD) of a district hospital in West Bengal to assess its relation with different characteristics of type 2 DM., Materials and Methods: A total of 120 patients suffering from type 2 DM (already diagnosed and on treatment) were randomly selected from the OPD (irrespective of their glycemic status). The thyroid status of all those patients was assessed. All diabetic patients were studied with a predesigned schedule and lab investigations for the prevalence of thyroid dysfunction and its association with pertinent variables from January to December 2019., Results: This study found a 28.3% prevalence of thyroid dysfunction among diabetics. It was significantly associated with poor glycemic control [rising hemoglobin A1c (HbA1c) level] (actual p -value for HbA1c vs abnormal thyroid status = 2.4 E -21 ) but not with other variables, including the duration of diabetes., Conclusion: Screening for thyroid dysfunction among diabetic persons should be routine, and strict glycemic control is essential., (© Journal of the Association of Physicians of India 2024.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health problems such as depression and anxiety. This study aims to investigate the prescribing pattern of psychotropic drugs in patients with common mental disorders which might be altered during the pandemic and also whether the pandemic could alter their quality of life (QOL) and medication adherence., Materials and Methods: After prior ethical approval, a descriptive cross-sectional drug utilization study (DUS) of 200 prescriptions was undertaken to evaluate the pattern of psychotropic drug usage as per WHO (World Health Organization)/International Network of Rational Use of Drugs (INRUD) guidelines. The correlation of the average number of drugs per prescription with QOL was observed. The correlation of adverse drug reactions (ADRs) with medication adherence was also analyzed., Results: The average number of drugs per prescription during the pre-COVID-19 and COVID-19 period was estimated to be 2.48 and 2.96. The percentage of drugs prescribed by generic name in the two different periods (pre-COVID-19 and COVID-19) was 97.40 and 95.77%. The percentage of drugs prescribed from the list of essential medicines was 89.40 and 85.12%, respectively. The percentage of prescriptions with injections was 0.45% and 0.53%, respectively for the two periods. The QOL during the COVID-19 pandemic was found to be negatively correlated to the average number of drugs per prescription (correlation coefficient = -0.61) and medication adherence was found to be poor in patients who developed ADRs with the drugs prescribed ( p -value of 0.001)., Conclusion: In the tertiary care hospital described, rational drug prescribing was followed. Increase in the number of drugs per prescription was found to be associated with poor QOL and the development of ADRs led to medication nonadherence in the patients. Further studies with larger sample sizes are needed to confirm these results. How to cite this article: Kumar A, Halder S, Srivastava S, et al. Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic. J Assoc Physicians India 2023;71(9):14-18., (© Journal of the Association of Physicians of India 2023.)

In the current study, subsurface characteristics within the complex formation of the Shilabati basin system of West Bengal, India, extending over an area of 3888 km 2 , have been estimated using a cost-effective piezometer and MIKE FEFLOW package based on a steady-state numerical model. Pore size and fine particle content of streambeds are affected by two opposing flow contraptions. Such opposite flow conditions are likely to affect the hydraulic conductivity of the streambed. However, analogies of the hydraulic conductivity (K h ) of streambeds for losing and gaining streams have not been well documented in the recent past. The K h value from the piezometer has been highest at the Dakshin Pairachali site (6.765 m/day), with the stream gaining water from the discharge of the local aquifer. Analysis of the stream-aquifer interaction using the FEFLOW model has allowed us to understand the groundwater water head of the basin ranging from 160.33 to 0.32 m.a.s.l (meters above sea level). The present study also constitutes the first attempt for the identification of suitable sites for the implementation of managed aquifer recharge (MAR) technology in West Bengal, India, to manage extreme drought events. The suitable sites have been identified by means of three fuzzy multi-criteria decision analysis based on nine criteria: river discharge, moisture content, porosity, drainage type, rainfall, land use type, geology, aquifer material, and hydraulic conductivity. To design a radial collector well and infiltration gallery for the selected site in an anisotropic, homogeneous, unconfined, and semi-infinite aquifer near a fully penetrating stream, a pumping test has been conducted to optimize a safe yield of 12.096 MLD (megaliters per day)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The current research is focused on detecting a river basin suitable for agriculture and priority for management using a new clustering tool of groundwater quality with fuzzy logic technique in R and Geographical Information System. A new fuzzy clustering-soft computing technique has been executed to determine the different hydrochemical zones considering 13 essential parameters such as electrical conductivity, hardness, chloride, sodium adsorption ratio, residual sodium carbonate, soluble sodium percent, magnesium hazard, permeability index, potential salinity, residual sodium bicarbonate, Kelly's ratio, synthetic harmful coefficient, and exchangeable sodium percentage. The derived fuzzy C-mean clustering (FCM) outperformed other available hard computing techniques like hierarchical clustering, K-means clustering, and agglomerative clustering. It divided the sampling sites into 2 clustering groups (FCM I and FCM II) which has been validated using fuzzy silhouette index (0.85), the partition coefficient (0.76), the partial entropy (0.68), and the modified partition coefficient (0.52). The hydrogeochemical analysis confirmed that the rock-water interaction, chemical weathering, and ion exchange process are predominant in the aquifer system of the study area. According to the correlation plots, the studied groundwater samples largely evolved from [Formula: see text], mixed [Formula: see text] types, and [Formula: see text] types. The spatial distribution map and the hydrochemical analysis also gives a clear depiction of the fluoride (> 1.0 mg/l) and high iron (> 0.3 mg/l) contamination in groundwater quality, making it unsuitable for both drinking and irrigation. A fuzzy EDAS priority map has been prepared based on all the irrigation suitability parameters which concludes that the groundwater at the upstream and downstream section of the basin requires the most attention. Based on the highest priority for management, five zones have been delineated: very high (5.98%), high (22.31%), medium (16.39%), low (32.30%), and very low (23.02). The findings of this study will be beneficial to planners and policymakers as they can develop schemes to solve similar problems across the country., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Top-down modeling estimates are among the most reliable information available on the CO 2 fluxes of the earth system. The inadequate coverage of CO 2 observing stations over the tropical regions adds a limitation to this estimate, especially when the satellite XCO 2 is strictly screened for cloud contamination, aerosol, dust, etc. In this study, we investigated the potential benefit of a global ground-based observing station network, 17 newly proposed stations over India, and global satellite XCO 2 in reducing the uncertainty of terrestrial biospheric fluxes of Tropical Asia-Eurasia in TransCom cyclo-stationary inversion. The data from selected 80 global ground-based CO 2 observation stations, together with two additional stations from India (i.e., Cape Rama and Sinhagad) and satellite XCO 2 , helps to reduce the temperate Eurasian terrestrial flux uncertainty by 23.8%, 26.4%, and 36.2%, respectively. This further improved to 54.7% by adding the newly proposed stations over India into the inversion. By separating the Indian sub-continent from temperate Eurasia (as inspired by the heterogeneity in the terrestrial ecosystems, prevailing meteorological conditions, and the orography of this vast region), the inversion evinces the capacity of existing CO 2 observations to reduce the Indian terrestrial flux uncertainty by 20.5%. The largest benefit (70% reduction of annual mean uncertainty) for estimating Indian terrestrial fluxes could be achieved by combining these global observations with data from the newly proposed stations over India. The existing two stations from India suggest Temperate Eurasia as a mild source of CO 2 (0.33 ± 0.57 Pg C yr -1 ), albeit with prominent anthropogenic influences visible in these two stations during the dry seasons. This implies that the proposed new stations should be cautiously placed to avoid such effects. The study also finds that the newly proposed stations over India also have an impact in constraining nearby oceanic CO 2 fluxes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Since its first identification in December 2019, in WUHAN (CHINA), SARS-COV-2, causative agent of Corona virus pandemic, has affected millions of people worldwide, causing thousands of death. There is much speculation about the interplay between ACEI/ARB and Corona virus infection, as for internalization into host cell SARS-COV-2 binds through S spike protein to ACE-2, aided TMPRSS2., Methods: A record based observational study has been conducted (data obtained from the clinics of fourteen physicians) in two worst affected districts of West Bengal, to find out the association of ACEI/ARB on patients, suffering from Corona virus infection. The study-protocol has already been approved by Clinical Research Ethics Committee of Calcutta School of Tropical Medicine. (IEC Ref. No: CREC-STM/2020-AS-37) Results: Increasing age, male sex and presence of co-morbidities (viz. Diabetes, COPD) are significantly associated with the occurrence of moderate and severe disease. Drugs (viz. ACEI/ARB), though are associated with less severe disease, have not achieved statistical significance, in the present study., Conclusion: Drugs, like ACEI/ARB, should be continued in patients suffering from COVID-19 infection, (if they are already on these drugs)., (© Journal of the Association of Physicians of India 2011.)

There is a shortage of research on the participation of children with intellectual disabilities from middle-income countries. Also, most child assessments measure either the child's or the caregiver's perceptions of participation. Participation, however, is an amalgamation of both perspectives, as caregivers play a significant role in both accessing and facilitating opportunities for children's participation. This paper reports on both perceptions-those of children with intellectual disabilities and those of their caregiver, in India and South Africa. A quantitative group comparison was conducted using the Children's Assessment of Participation and Enjoyment (CAPE) that was translated into Bengali and four South African languages. One hundred child-caregiver dyads from India and 123 pairs from South Africa participated in the study. The results revealed interesting similarities and differences in participation patterns, both between countries and between children and their caregivers. Differences between countries were mostly related to the intensity of participation, with whom, and where participation occurred. Caregiver and child reports differed significantly regarding participation and the enjoyment of activities. This study emphasises the need for consideration of cultural differences when examining participation and suggests that a combined caregiver-and-child-reported approach may provide the broadest perspective on children's participation.

Caregivers are an intrinsic component of the environment of children with intellectual disabilities. However, caregivers' capacity to support children's participation may be linked to the social support that they, as caregivers, receive. Social support may increase participation, educational, psychological, medical and financial opportunities. However, there is a lack of information on social support in middle-income countries. The current study described and compared the social support of caregivers of children with intellectual disabilities by using the Family Support Survey (FSS) in India and South Africa. The different types of social support were subsequently considered in relation to participation, using the Children's Assessment of Participation and Enjoyment (CAPE). One hundred caregiver-child dyads from India and 123 from South Africa participated in this study. The data were analysed using non-parametric measures. Indian caregivers reported greater availability of more helpful support than did the South African caregivers. Social support was associated with children's participation diversity (India) and intensity (South Africa). The child-/caregiver-reported participation data showed different associations with participation. Results from this study suggest that perceived social support of caregivers differs between countries and is associated with their child's participation. These factors need to be considered when generalising results from different countries.

Objective: Aloe vera (barbadensis Mill., Family Liliaceae) since ancient times has been used for the treatment of skin disorders, infection, and as a laxative. The present study was undertaken to explore the effect of A. vera (Family Liliaceae) in animal models of learning and memory, depression, and locomotion., Methods: To assess learning and memory, the passive avoidance task and elevated plus-maze were used. For evaluating depression, the forced swim test and tail suspension test were performed, and to assess locomotor activity, the rota rod test and photoactometer were used., Results: A. vera (200 and 400 mg/kg, p.o.) was found to significantly increase the acquisition and retention step-down latency as compared to control in the passive avoidance task. In the elevated plus-maze, the highest administered dose (400 mg/kg, p.o.) of A. vera significantly reduced the transfer latency as compared to control. The forced swim test as well as tail suspension test showed that A. vera at all administered doses (100, 200, and 400 mg/kg, p.o.) decreased the period of immobility significantly. However, the locomotor activity did not show any significant change in the rota rod test and photoactometer., Discussion: Thus from the above observations, it can be proposed that A. vera enhances learning and memory, and also alleviates depression in mice.

Prescription audit is a powerful tool for rational prescription. To evaluate pharmaco-epidemiology of drugs utilised for cataract surgery, a retrospective study was conducted in the department of pharmacology, RG Kar Medical College, Kolkata. Data from bed head tickets of one year, available in medical record section, were collected in case report forms and analysed. Utilisation pattern of drugs like dosage form, dose, route and frequency of administration and duration of therapy were audited. Drug prescription versus therapeutic indication was also evaluated. Price of the prescribed drugs was evaluated for rationality towards cost-effective prescription. For 848 cases of cataract surgery, drugs were prescribed pre-, per- and post-operatively. Different fluoroquinolone antibiotics, anti-inflammatory and mydriatic-cycloplegic agents were prescribed. High or low cost drugs were prescribed both in generic (52%) and brand (48%) names. Few Latin abbreviations were used in directions. Different parameters and study results were discussed from various aspects to explore their social impacts. Though prescription pattern was almost rational, some parts need improvement. Healthcare provider should be aware of cost-effectiveness of the prescribed drugs for the benefit of patients to provide a rational prescription.

A study was carried out based upon the data available from National Leprosy Eradication Program of Purulia district in West Bengal. The result showed that the disease was in a declining trend up to the year 1998 and was inclining during the year 1998-1999 due to more case detection through MLEC-I, then followed by declining trend during the year 2000 as it was observed by MLEC-II. Single skin lesion rate was higher, MB rate was same and reduced deformity rate indicates early detection of cases due to better awareness of the community about the disease.

Gangrenous syndrome/Degnala disease was recorded in a large number of buffaloes and cattle in Murshidabad district of West Bengal, India. Fusarium spp. had been isolated from the mouldy paddy straw which were fed to the animals. There was a reduction in the incidence of the disease following withdrawal of the mouldy paddy straw. Histopathological examination showed necrosis and loss of architectural details in the skin.