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The seasonal pattern of species diversity and abundance of waterbirds of the Chambal River in the extent of Mukundra Hills National Park, Rajasthan, India was evaluated. The pre-monsoon (March-April 2021) and post-monsoon surveys (August-September 2021) were carried out using the direct count method with the help of a motorboat to monitor the population status of waterbirds. A total of 44 species of waterbirds belonging to 15 families and nine orders were identified, including 11 winter migratory species. Forty species of birds were recorded during pre-monsoon and 27 species during post-monsoon seasons. The species richness and relative abundance varied significantly between observed seasons (x2 = 532.77, df = 43, p <0.05). Breeding activities of three species were recorded, namely, Grey Heron, Black-crowned Night Heron, and the 'Near Threatened' Woolly-necked Stork. The present study reveals the status of waterbirds in the protected area of Mukundra Hills National Park. [ABSTRACT FROM AUTHOR]

Dogs Canis lupus familiaris, among canids, have emerged as the most successful predators and facultative scavengers, and have prevented other carnivores from approaching human habitats through intraguild competition. Over time with increasing population and livestock predation, they have become a matter of concern for pastoralists. The present study was conducted to understand the patterns of free-ranging dogs’ predation on livestock and wildlife, from 2015 to 2017 in Changthang Wildlife Sanctuary (CWLS), Ladakh, India. Information was collected on (a) dog populations in 10 sites using polygon search in Spatially Explicit Capture-Recapture framework and block count, (b) their diet using scat analysis (n = 205) and (c) perceptions of pastoralists towards dogs through questionnaire-based interviews (n = 210). Dog densities varied between 10 and 310 individuals/ 100 km² and were high in and around human habitations. A major part of their diet constituted of livestock (74.29%) and wild species (13.06%). Among wild prey species, birds (4.49%), lagomorphs (3.67%), rodents (2.45%) and Tibetan wild ass (1.63%) had high occurrence in dog diet. The local people admitted that dogs pose a threat to livestock and wildlife. As unowned free-ranging dogs harm livestock and wildlife, about 40% of the respondents had negative perceptions towards them. The perception varied with occupation and pastoralists were more negative than non-pastoralists (P < 0.001). We suggest that effective mechanisms need to be identified or developed to manage dog populations in ecologically and economically sensitive areas to minimise the threats and safeguard the endangered wildlife and local livelihoods. [ABSTRACT FROM AUTHOR]

Red fox (Vulpes vulpes) is the most widespread wild carnivore globally, occupying diverse habitats. The species is known for its adaptability to survive in dynamic anthro-pogenic landscapes. Despite being one of the most extensively studied carnivores, there is a dearth of information on red fox from the Trans-Himalayan region. We studied the home range sizes of red fox using the different estimation methods: minimum convex polygon (MCP), kernel density estimator (KDE), local convex hull (LoCoH) and Brownian-bridge movement model (BBMM). We analysed the daily movement and assessed the habitat selection with respect to topographic factors (ruggedness, elevation and slope), environmental factor (distance to water) and anthropogenic factors (distance to road and human settlements). We captured and GPS-collared six red fox individuals (three males and three females) from Chiktan and one female from Hemis National Park, Ladakh, India. The collars were programmed to record GPS fixes every 15-min. The average BBMM home range estimate (95% contour) was 22.40 ± 12.12 SD km² (range 3.81-32.93 km²) and the average core area (50% contour) was 1.87 ± 0.86 SD km² (range 0.55-2.69 km²). The estimated average daily movement of red fox was 17.76 ± 8.45 SD km/d (range 10.91-34.22 km/d). Red fox significantly selected lower elevations with less rugged terrain and were positively associated with water. This is the first study in the Trans-Himalayan landscape which aims to understand the daily movement of red fox at a fine temporal scale. Studying the movement and home range sizes helps understand the daily energetics and nutritional requirements of red fox. Movement information of a species is important for the prioritisation of areas for conservation and can aid in understanding ecosystem functioning and landscape management. [ABSTRACT FROM AUTHOR]

Marginalized communities across the world are increasingly faced with a suit of social-ecological stressors, taking a huge toll on their biocultural resources and livelihoods. Collaborative learning is considered to be a feasible strategy for livelihood resilience among vulnerable communities experiencing such stressors. Taking insights from social-ecological resilience theory, this study discusses how Adi community, living in the ecologically fragile ecosystems of Arunachal Pradesh, India, has developed a location-specific biocultural resource-based adaptive strategy to enhance their livelihood resilience. A novel participatory approach—'recipe contest'—was used to mobilize Adi women from 11 villages of the state's East Siang district with overall aim of developing nutritious and culturally relevant food products based entirely on local resources and knowledge. A total of 43 women (winners of the recipe contests) and 33 other knowledgeable community members (total 76 participants), by participating in focus group discussions and personal interviews, shared their knowledge and experiences relating to local foods and sustainability. We found that a range of climatic, ecological, socioeconomic and political stressors were adversely impacting Adi women's subsistence livelihoods. Through community mobilization, these women formed Self-Help Groups (SHGs) and together they developed a marketable product, 'Adi Siang Nutri', with ingredients provided by 12 local species. This value-added product, integrated with local livelihood trajectories, helped diversify and increase the Adi women's income, allowing them to better safeguard themselves from aforementioned risks. The local species used as the ingredients are being conserved, and have several perceived socio-cultural, ecological and ethnomedicinal benefits. This participatory action research promises to make a significant change in the social-ecological resilience and associated biocultural resources of Adi women. Our findings provide valuable insights for several food, nutritional security and environmental policies to improve social-ecological resilience using biocultural resources. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health crisis. During huge surge in COVID-19 cases, most of the patient arrived at Rajiv Gandhi Government General Hospital, Chennai were severe due to late presentation and also available evidence demonstrating that the delay in treatment is directly associated with increased mortality or poor patient outcome. As an innovative concept of Zero Delay COVID-19 Ward were set up to provide the required critical care for all severe COVID-19 cases. The experience of setting up of such Zero Delay COVID-19 Ward and profile of admitted COVID-19 patients were described in this paper. Methods: A total of 4515 laboratory-confirmed COVID-19 patients admitted at Zero Delay COVID-19 Ward was analyzed retrospectively from 7th July to 31st December 2020. Results: At the time of admission the frequency of dyspnea were 85.6% among them 99.1% recovered from dyspnea after the oxygen therapy and other management at Zero Delay COVID-19 Ward. Of the 4515 COVID-19 individuals, about 1829 (40.5%) had comorbidity, 227 (5%) had died. Multivariable logistic regression analysis, COVID-19 death was more likely to be associated with comorbidity (OR: 18.687; 95% CI: 11.229-31.1) than other variables. Conclusions: Comorbidity is an independent high risk factor for mortality of COVID-19 patients. From our observation, it is strongly recommended that effective zero delay covid-19 ward model will help for the prevention of mortality in current/expected waves of COVID-19. [ABSTRACT FROM AUTHOR]

Diatoms occur in all natural conditions in lake and their distribution is mainly governed by the physicochemical composition of the water. Monitoring of water quality with physicochemical parameters is insufficient. Organic indicators of water quality monitoring used during the recent years have served as excellent tools in the areas of water pollution studies. Among all the fresh water organisms, diatoms are the most commonly used indicators of the water quality changes and paleoenvironments. In the present study, a total of 23 species distributed among 13 genera were recorded from the surface (grab) sediments of the Ooty Lake. Among these, the most abundant are Ulneria ulna, Cyclotella meneghiniana, Hantzschia amphioxys, Gomphonema affine, Aulacoseira granulata, Tabularia tabulata and Gomphonema gracile. Sediment samples were analysed for the organic matter, CaCO3, sand, silt and clay content, while water samples for pH, temperature and dissolved oxygen. The present finding mainly deals with the comparative study of diatom assemblages in relation to spatial-temporal changes in the environmental conditions of the Ooty Lake. The utility of the Principal Component Analysis (PCA) relative to diatoms to study the water quality of the Ooty Lake have also beendiscussed in the present work. [ABSTRACT FROM AUTHOR]

Palar basin is located between Pennar and Cauvery sedimentary basins of East coast of India in Bay of Bengal, northeast Indian Ocean. Sea floor drill (Wire-line Autonomous Coring System – WACS) with operational capability of up to 3000 m water depth was developed to collect long cores from deep sea floor for geotechnical and ocean resource assessment studies. During the drilling operation it encountered Nummulitic coralline limestone of Lower Eocene age at 18 meters below the seafloor (mbsf) at 850 m water depth indicating carbonated platform presence for the first time at the study region. Bathymetry contour from Naval Hydrography Chart and General Bathymetric Chart of the Oceans (GEBCO) has revealed the presence of shallow mounds from 50 to 200 m depth closure contour near the sampling site at 850 m water depth which might be a submerged carbonated structure. Since, Nummulites are shallow water dwelling fauna (<20 m depth) but its occurrence at 18 mbsf in 850 m water depth is recorded because of the advancement in technology tool for long core sampling by means of sea floor drill. [ABSTRACT FROM AUTHOR]

Anthracobunidae is an Eocene family of large mammals from south Asia that is commonly considered to be part of the radiation that gave rise to elephants (proboscideans) and sea cows (sirenians). We describe a new collection of anthracobunid fossils from Middle Eocene rocks of Indo-Pakistan that more than doubles the number of known anthracobunid fossils and challenges their putative relationships, instead implying that they are stem perissodactyls. Cranial, dental, and postcranial elements allow a revision of species and the recognition of a new anthracobunid genus. Analyses of stable isotopes and long bone geometry together suggest that most anthracobunids fed on land, but spent a considerable amount of time near water. This new evidence expands our understanding of stem perissodactyl diversity and sheds new light on perissodactyl origins. [ABSTRACT FROM AUTHOR]

The refraction of the 2004 Indian Ocean tsunami waves caused drastic devastation along East coast of India, mainly in the area of investigation. Here, we appraise and integrate the sedimentary characteristics and microfossil studies of the area. The gigantic tsunami waves caused the landward fining of sediments that were carried as suspended load. Tsunami sediments have distinctive characteristics, like fine-to-medium grained sand, moderately to poorly sorted sediments which indicating sudden winnowing followed by tranquil flood. Positively skewed grain size distribution indicating unidirectional transport, and mesokurtic to platykurtic character implying poorly sorted single source origin. The species of benthonic foraminifers and ostracods reside in marine environment indicating shallow water origin of sediments. The onshore deposits are vertically divided into three depositional units interpreted from Ground Penetrating Radar (GPR) signatures-Unit 1 is a relatively continuous parallel layer indicative of calm environment; Unit 2 has paleochannels and burial scarps, seen as oblique reflections that might be indicative of an intense erosional environment; Unit 3 is interpreted as 2004 tsunami layer, has three subunits. Each main units have been separated by Heavy Mineral Concentrated (HMC) layers, deposited by continuous wave action (~ 20 cm) and by the tsunami (> 30 cm) activity, evidenced by low magnetic susceptibility values at the bottom compared to the top of the HMC layers. GPR has been effectively utilized in this paper as subsurface imaging tool for the interpretation and reconstruction of stratigraphy, and also helped to unearth the erosional and depositional environments. [ABSTRACT FROM AUTHOR]

The present study focuses on sediment grain size, microfossil content and heavy minerals present in the sediments collected from a trench in the southeast coast of India in order to identify the frequent extreme wave events (e.g. storm surge, cyclone, tsunami, etc.). Two different depositional events were identified at different depths with distinct sedimentological, mineralogical and microfossil characteristics. These geological features further improve the understanding of depositional sequences in this region. [ABSTRACT FROM AUTHOR]

Palaeoclimate, palaeoecological and palaeoshoreline studies were carried out for a 2.5 m deep sediment core deposited since ∼3700 yrs BP in the central part of Pichavaram mangrove wetland, Cauvery river delta. Presently, the study area is dominated by Avicennia officinalis, A. marina and Suaeda sp. with fringes of Rhizophora sp. along the backwater channel. Based on sedimentology, palynological and thecamoebian analysis, it is inferred that since 2100 yrs BP the climate amelioration took place from warm and humid with strengthened monsoon to a dry and arid climate coupled with weakened monsoon condition inducing changes in ecology vulnerable for mangroves. Consequently, the vegetation too evolved from moist deciduous/evergreen forest to mixed deciduous forest and a reduction in mangrove diversity. The qualitative and quantitative study show a decline in the mangroves since the last millennium which may be attributed to the increased salinity along with enhanced anthropogenic activities in Pichavaram estuary. This is reflected by the dominance of salt tolerant mangrove associates since the last millennium. [ABSTRACT FROM AUTHOR]

Nitrogen in any form is in fact a depiction of the productive status of the natural ecological systems provided its concentration is within the prescribed limit. But unregulated anthropogenic intervention in the aquatic ecosystems enhances the nitrogen content and accelerates its senescence. Dal Lake in the present area of study is under incessant human interference which has in fact reduced it to a mere sink of the refuse generated by the stakeholders living around. As a consequence of the present investigation, nitrate, nitrite and ammonia values were found to record an increase. [ABSTRACT FROM AUTHOR]

Written history's limitation becomes apparent when attempting to document the predecessors of extreme coastal events in the Indian Ocean, from 550-700 years in Thailand and 1000 years in Indonesia. Detailed ground-penetrating radar (GPR) surveys in Mahabalipuram, southeast India, complemented with sedimentological analyses, magnetic susceptibility measurements, and optical dating provide strong evidence of extreme wave events during the past 3700 years. The diagnostic event signatures include the extent and elevation of the deposits, as well as morphologic similarity of buried erosional scarps to those reported in northern Sumatra region. Optical ages immediately overlying the imaged discontinuities that coincides with high concentration of heavy minerals date the erosional events to 340 ± 35, 350 ± 20, 490 ± 30, 880 ± 40, 1080 ± 60, 1175 ± 188, 2193 ± 266, 2235 ± 881, 2489 ± 293, 2450 ± 130, 2585 ± 609, 3710 ± 200 years ago. These evidences are crucial in reconstructing paleo extreme wave events and will pave the way for regional correlation of erosional horizons along the northern margin of Indian Ocean. [ABSTRACT FROM AUTHOR]

Urolithiasis in countries like India presents an important economic repercussion where cattle - based agriculture is strongly linked with the livelihood of an important segment of the population. Investigations on clinical studies on obstructive urolithiasis in cattle calves, were carried out from October 2006 - April 2008 with the objectives of studying the aetiopathogenesis of the disease. Thirty clinical cases of obstructive urolithiasis with 15 ruptured and 15 intact urinary bladders were brought to the clinics for the treatment during the study period. Diagnosis of the disease was made on the basis of history of anuria, clinical signs, radiographic, ultrasonographic, haematobiochemical, and peritoneal fluid examinations. Most of the calves suffering from obstructive urolithiasis had the history of feeding on diets containing wheat bran, commercial cattle feed, rice bran and rice straw. Wheat bran alone and in combination with other feed and fodder was given to maximum 76.66 per cent calves. Herbal litholytic agent (Tab. Cystone) was the most commonly used medication, which was used alone in 19 per cent and in combination with other drugs in 47.61 per cent cases. Under field conditions diuretics were the second most common drugs administered to the calves under study, before their presentation at the faculty clinics. In 90 per cent cases struvite was the only component of the calculi, while in rest of the cases other minor components like calcium phosphate, calcium carbonate, oxalate etc., were also found. High concentrate feeding with little provision of water during winter months seemed to be the most prominent predisposing factors for the development of the disease. [ABSTRACT FROM AUTHOR]

The conservation of biodiversity relies on the involvement of the community, both women and men, whose interests and perspectives regarding natural resources may differ. Often, an ostensibly gender-neutral initiative may in fact be biased against women. In this paper we present a case study of conservation initiative in two villages -- Ganeshpur and Gangabhogpur, adjoining Rajaji National Park. North India. The objectives of this paper are to explore the status of women in these villages. examine level of their participation in conservation programs and factors determining their participation, their awareness regarding participatory approaches and their perception on various management issues. In Ganeshpur, where educational status of women was low and gender stratification was traditional, women had less say in household and outside matters, Women's awareness regarding conservation and co-management initiatives was superficial. Their participation in conservation initiatives was negligible. In Gangabhogpur, women were educated and given more freedom of expression and movement they had more say in all matters concerning the family. They were aware about conservation and co-management initiatives. In both the villages, personal and household endowments and social norms were found to influence women's participation. Hence cultural and social constraints and factors which determine women's freedom of expression, need to be addressed in the policy guidelines to ensure effective participation of women in conservation programs. [ABSTRACT FROM AUTHOR]

In order to understand the type of microfauna (Foraminifera and Ostracoda), which might have been transported by tsunamigenic sediments that deposited on the beaches, estuaries/creeks and mangrove locations of Andaman Islands, a detailed fieldwork has been carried out from these islands. The main objective of this study is to record and document the calcareous microfaunal assemblage and its distribution pattern in the tsunamigenic sediment samples collected from Andaman group of Islands. The pre-tsunami foraminiferal fauna of Andaman Islands reported by earlier workers is also compared. A total of 46 surface and nine core samples have been collected from various coastal geomorphological features such as beaches, estuaries/creeks and mangrove areas of Andaman Islands. These samples are analysed for Foraminifera and Ostracoda, by applying standard micropalaeontological techniques. A total of 87 species belonging to 74 genera of Foraminifera and 29 species belonging to 22 genera of Ostracoda have been encountered. Among Foraminifera, Assilina ammonoides, Amphistegina radiata and Calcarina sp. are widely distributed. Most of the forms are highly to moderately abraded and appeared in milky white colour, may be due to churning action and transportation. However, the Ostracod population is scanty; of these only Macrocyprina sp. is comparatively a deep water form. Ostracod fauna is reported in this study based on the recent tsunamigenic sediments of Andaman Islands. All the forms recorded in the study area thrive in the shallow inner shelf (neritic) zone. From their distribution, it is inferred that the 26 December 2004 tsunamigenic sediments deposited on the coastal landforms in Andaman group of islands have been derived from shallow littoral to neritic depths and not from deeper bathyal territories. [ABSTRACT FROM AUTHOR]

Objective: This study investigates whether micronized purified flavonoid fraction (MPFF) is effective and acceptable without compression or surgical intervention for the management of chronic venous insufficiency of the leg (CVIL) in the primary care setting of a tropical country such as India. Methods: A prospective observational study on patients with early CVIL drawn from the clinical practice of randomly selected physicians distributed across India. Patients received MPFF 1000 mg/day for six months without compression stockings or surgery. The primary outcome was a change in their CEAP (clinical, aetiological, anatomical, pathophysiological) classification of CVIL severity. Secondary outcomes were changes in leg oedema, symptom intensity and quality of life. Results: Of the 308 patients recruited by 72 physicians, 166 (53.9%, 95% confidence interval (CI) 48.3-59.5) had regression in the CEAP severity stage. Mean leg circumference in those with oedema decreased by 2 cm (95% CI 1.7-2.3, P <0.05). Patient-assessed mean percentage decrease in symptom intensity was 32.3 for cramps (28.9-35.7, P <0.01); 32.4 for heaviness (29.8-35.7, P <0.01); 28.2 for pain (25.6-30.8, P <0.01); and 21.5 for swelling (18.7-24.3, P <0.01). Quality of life improved by 21.7% (16.9-26.5, P <0.01) in the physical domains, 25.9% (20.8-31.0, P <0.01) in the social domains, and 19.2% (14.7-23.7, P <0.01) in the psychological domains. Conclusions: When used alone, MPFF was effective and acceptable for the management of CVIL in primary care. This may be useful in tropical climates where compliance with compression stockings is poor and access to surgery limited. [ABSTRACT FROM AUTHOR]

Renewable energy has become very popular in recent years. The amount of renewable generation has increased in both grid-connected and stand-alone systems. This is because it can provide clean energy in a cost-effective and environmentally friendly fashion. Among all varieties, photovoltaic (PV) is the ultimate rising star. Integration of other technologies with solar is enhancing the efficiency and reliability of the system. In this paper a fuel cell–solar photovoltaic (FC-PV)-based hybrid energy system has been proposed to meet the electrical load demand of a small community center in India. The system is developed with PV panels, fuel cell, an electrolyzer and hydrogen storage tank. Detailed mathematical modeling of this system as well as its operation algorithm have been presented. Furthermore, cost optimization has been performed to determine ratings of PV and Hydrogen system components. The objective is to minimize the levelized cost of electricity (LCOE) of this standalone system. This optimization is performed in HOMER software as well as another tool using an artificial bee colony (ABC). The results obtained by both methods have been compared in terms of cost effectiveness. It is evident from the results that for a 68 MWh/yr of electricity demand is met by the 129 kW Solar PV, 15 kW Fuel cell along with a 34 kW electrolyzer and a 20 kg hydrogen tank with a LPSP of 0.053%. The LCOE is found to be in 0.228 $/kWh. Results also show that use of more sophisticated algorithms such as ABC yields more optimized solutions than package programs, such as HOMER. Finally, operational details for FC-PV hybrid system using IEC 61850 inter-operable communication is presented. IEC 61850 information models for FC, electrolyzer, hydrogen tank were developed and relevent IEC 61850 message exchanges for energy management in FC-PV hybrid system are demonstrated. [ABSTRACT FROM AUTHOR]

A 40 ky record of variations in the average diameter of Orbulina universa from a 5.4 m core (SK-322) in the Arabian Sea, off Goa, India has been analysed in this study. The chronology of the upper 1.00 m of the core was documented by AMS radiocarbon dates. Fifty specimens of O. universa were hand-picked from each of the 50 subsamples. In all, 2500 specimens were measured for their diameter. Downcore variations in the average diameter of O. universa were in excellent agreement with the curve representing the Iberian Margin temperature index, with the peak representing the Bølling-Allerød transition and the troughs reflecting Heinrich Event I and Younger Dryas. The lower part of the core examined in this study (between 58 and 100 cm), which is the equivalent of 30,000-40,000 years BP, is marked by closely spaced peaks and troughs that are interpreted as representing the Dansgaard-Oeschger cycles that were dominant in the Northern Hemisphere between 60,000 and 30,000 years BP. [ABSTRACT FROM AUTHOR]

This paper presents the long – term observational studies on aerosol optical properties measured at Sri Krishnadevaraya University (SKU) campus (14° 62′ N, 77° 65′ E, 331m asl), Anantapur, in southern India during 2007–2013 using a ground based Multi – Wavelength solar Radiometer (MWR). Seasonal mean values of Aerosol Optical Depth (AOD) for the whole study period were observed to be 0.34 ± 0.03, 0.45 ± 0.04, 0.24 ± 0.04, and 0.31 ± 0.03 during the winter, summer, monsoon and post – monsoon, respectively. Annual mean values of Ångström exponent (α) (turbidity coefficient (β)) varied from 0.68 ± 0.25 (0.18 ± 0.03) to 1.1 ± 0.12 (0.32 ± 0.12) during 2007–2013. However, high values of α in the range of 0.8–1.1 were observed during the winter, while low values in the range 0.3–0.7 were noticed during the monsoon. The frequency distribution of AODs during winter in the range of 0.2–0.4 is about 78%, while summer these were shifted from 0.3 to 0.6 around ∼70%, which indicated the dust strongly affects this region. The accumulated frequencies of Ångström exponent (α) less than 1.0 and greater than 1.0 were about 69% and 31%, respectively, occurred in the summer months indicates the dominance of coarse particles. Columnar size distributions, retrieved from the spectral optical depths, in general, show a bimodal log normal distribution in the optically active size range. The seasonal mean effective radius (R eff ) was found to be high in monsoon (∼0.61 μm) and low in winter (∼0.38 μm). The highest mean mass loading values are lies between 475 ± 36 to 769 ± 49 mg m −2 during the summer, whereas the lowest value in the range 204 ± 19 to 278 ± 23 mg m −2 during the monsoon. The difference between α and curvature effect have been studied as a function of AOD on seasonal basis. Finally, to understand the contribution of long range transported aerosols, we have investigated this analysis making use of back trajectories obtained from the HYSPLIT model for different seasons. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) has emerged as the most common malignancy among females. The genomic profile of BC is diverse in nature and complex due to heterogeneity among various geographically different ethnic groups. The primary objective of this study was to carry out a comprehensive mutational analysis of Indian BC cases by performing whole exome sequencing. The cohort included patients with a median age of 48 years. TTN, TP53, MUC16, SYNE1, and OBSCN were the frequently altered genes found in our cohort. The PIK3CA and KLC3 genes are driver genes implicated in various cellular functions and cargo transportation through microtubules, respectively. Except for CCDC168 and PIK3CA, several gene pairings were found to be significantly linked with co-occurrence. Irrespective of their hormonal receptor status, RTK/RAS was observed with frequently altered signaling pathways. Further analysis of the mutational signature revealed that SBS13, SBS6, and SBS29 were mainly observed in our cohort. This study supplements the discovery of diagnostic biomarkers and provides new therapeutic options for the improved management of BC., (© 2024. The Author(s).)

Urban forests face multiple human-mediated pressures leading to compromised ecosystem structure and functioning. Therefore, understanding ecosystem structure in response to ongoing pressures is crucial for sustaining ecological integrity and human well-being. We aim to assess the disturbance and its effects on the vegetation structure of urban forests in Chandigarh using a combination of remote sensing techniques and vegetation surveys. The disturbance was evaluated as a change in NDVI (Normalised Difference Vegetation Index) from 2001 to 2021 by applying the BFAST (Breaks For Additive Season and Trend) algorithm to the MODIS satellite imagery data. A vegetation survey was conducted to compare the species composition, taxonomic and phylogenetic diversity as measures of forest vegetational structure. While signals of disturbance were evident, the changes in vegetation structure were not well established from our study. Further, this analysis indicated no significant differences in vegetation composition due to disturbance (F 1,12  = 0.91, p = 0.575). However, the phylogenetic diversity was substantially lower for disturbed plots than undisturbed plots, though the taxonomic diversity was similar among the disturbed and undisturbed plots. Our results confirmed that disturbance effects are more prominent on the phylogenetic than taxonomic diversity. These findings can be considered early signals of disturbance and its impact on the vegetation structure of urban forests and contribute to the knowledge base on urban ecosystems. Our study has implications for facilitating evidence-based decision-making and the development of sustainable management strategies for urban forest ecosystems., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: The increasing ageing of the population with growth in NCD burden in India has put unprecedented pressure on India's health care systems. Shortage of skilled human resources in health, particularly of specialists equipped to treat NCDs, is one of the major challenges faced in India. Keeping in view the shortage of healthcare professionals and the guidelines in NEP 2020, there is an urgent need for more health professionals who have received training in the diagnosis, prevention, and treatment of NCDs. This paper conducts a scoping review and aims to collate the existing evidence on the use of digital education of health professionals within NCD topics., Methods: We searched four databases (Web of Science, PubMed, EBSCO Education Research Complete, and PsycINFO) using a three-element search string with terms related to digital education, health professions, and terms related to NCD. The inclusion criteria covered the studies to be empirical and NCD-related with the target population as health professionals rather than patients. Data was extracted from 28 included studies that reported on empirical research into digital education related to non-communicable diseases in health professionals in India. Data were analysed thematically., Results: The target groups were mostly in-service health professionals, but a considerable number of studies also included pre-service students of medicine (n = 6) and nursing (n = 6). The majority of the studies included imparted online learning as self-study, while some imparted blended learning and online learning with the instructor. While a majority of the studies included were experimental or observational, randomized control trials and evaluations were also part of our study., Discussion: Digital HPE related to NCDs has proven to be beneficial for learners, and simultaneously, offers an effective way to bypass geographical barriers. Despite these positive attributes, digital HPE faces many challenges for its successful implementation in the Indian context. Owing to the multi-lingual and diverse health professional ecosystem in India, there is a need for strong evidence and guidelines based on prior research in the Indian context., (© 2024. The Author(s).)

Our study focused on investigating the clinical significance of serum Sfrp5/Wnt-5a levels as a risk marker in metabolic syndrome (MetS). The study involved a total of 107 treatment-naive MetS cases and 100 controls with similar age and sex belonging to northern India. The profiling of clinical, biochemical, and anthropometric variables was done. ELISA methods were employed for serum cytokine estimation. Serum Sfrp5 was inversely correlated with BMI, WC, SBP, DBP, FPG, TG, fasting insulin level, and HOMA-IR in both males and females. The best cutoff value for Sfrp5 to predict MetS in males was ≤40.48 ng/ml (sensitivity 53.70% and specificity 90.48%), while in female, it was ≤66.67 ng/ml (sensitivity 98.11% and specificity 34.48%). MetS occurrence decreased with increasing concentration of Sfrp5 with an odds ratio (OR) of 0.95 (95% CI = 0.92-0.98, P < .001) in male and 0.93 (95% CI = 0.91-0.97, P < .001) in female. Quartile analysis revealed that odds of MetS significantly decreased in quartile 4 vs. 1, 0.06 (95% CI = 0.01-0.25), P = .001 and 0.13 (95% CI = 0.04-0.44), P = .001, respectively, in male and female. The inverse association of serum concentration of Sfrp5 with MetS might have a useful addition to the available risk marker as well as a therapeutic target for MetS.

The key objective of this research was to estimate out of pocket expenditure (OOPE) incurred by the Indian households for the treatment of childhood infections. We estimated OOPE estimates on outpatient care and hospitalization by disease conditions and type of health facilities. In addition, we also estimated OOPE as a share of households' total consumption expenditure (TCE) by MPCE quintile groups to assess the quantum of the financial burden on the households. We analyzed the Social Consumption: Health (SCH) data from National Sample Survey Organization (NSSO) 75th round (2017-18). Outcome indicators were prevalence of selected infectious diseases in children aged less than 5 years, per episode of OOPE on outpatient care in the preceding 15 days, hospitalization in the preceding year and OOPE as a share of households' total consumption expenditure. Our analysis suggests that the most common childhood infection was 'fever with rash' followed by 'acute upper respiratory infection' and 'acute meningitis'. However, the highest OOPE for outpatient care and hospitalization was reported for 'viral hepatitis' and 'tuberculosis' episodes. Among the households reporting childhood infections, OOPE was 4.8% and 6.7% of households' total consumption expenditure (TCE) for outpatient care and hospitalization, respectively. Furthermore, OOPE as a share of TCE was disproportionately higher for the poorest MPCE quintiles (outpatient, 7.9%; hospitalization, 8.2%) in comparison to the richest MPCE quintiles (outpatient, 4.8%; hospitalization, 6.7%). This treatment and care-related OOPE has equity implications for Indian households as the poorest households bear a disproportionately higher burden of OOPE as a share of TCE. Ensuring financial risk protection and universal access to care for childhood illnesses is critical to addressing inequity in care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Farooqui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure., Methods: We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households., Results: Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674-46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359-63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest., Conclusions: Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level., (© 2022. The Author(s).)

The present study aims to formulate the characterization and distribution of microplastic in the estuarine surface sediments of Kayamkulam estuary, southwest coast of India. The sediments were dominated by fibre and film shaped microplastic substances. The surface sediments were dominated by <1000 μm microplastics. The composition of microplastics in descending order was as follows: polyester > polypropylene > polyethylene. The distribution of microplastics was significantly higher than that observed in the other study regions, except for Pearl river estuary and Guanabara Bay. The distribution of microplastics was chiefly controlled by estuarine inundating water and the distance of the sampling site from the open sea., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The kinetic patterns of CpG methylation of the cis-regulatory region of heat stress-related genes on exposed to heat stress (at 42 °C) between the Sahiwal and Frieswal cattle was compared in the present study. Using an in vitro whole blood culture model, cells were continuously exposed to heat stress (at 42 °C) for 6 h. Methylation levels of five genes, viz., GPX1, HSP70, HSP90, c-FOS, and JUN were estimated by SyberGreen-based quantitative methylation-specific PCR (qMSP) assay. CpG methylation kinetics at different time points of heat stress (0.5, 1, 2, 4, 6 h) were analyzed using mixed ANOVA. The initial methylation level, estimated at 37 °C, of HSP70 was significantly high in the Sahiwal breed. A significant (p<0.001) time-dependent hypomethylation of an antioxidant gene (GPX1) CpG islands was detected at the acute phase of the stress. Heat shock protein gene (HSP70) showed a similar CpG methylation kinetics where the hypomethylation was prominent from 1 h and persisted up to 4 h. The heat stress responses of both Sahiwal and Frieswal cattle were identical as there was no distinctiveness in the methylation kinetics of CpG islands of studied genes. The acclimatization of Frieswal cattle-a breed developed in India over the years to the tropical climatic conditions, maybe one of the reasons for this similarity. Thus, the present study results could pave a path to understand the molecular mechanism of heat stress and adaptation of indigenous and crossbred cattle populations to the changing scenario in tropical climate conditions.

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities., Competing Interests: MW and JR work for HTA Consulting and MH works for Square Toiletries Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Godman, Haque, Leong, Allocati, Kumar, Islam, Charan, Akter, Kurdi, Vassalo, Bakar, Rahim, Sultana, Deeba, Khan, Alam, Jahan, Kamal, Hasin, Munzur-E-Murshid, Nahar, Haque, Dutta, Abhayanand, Kaur, Rwegerera, Nascimento, Dias Godói, Irfan, Amu, Matowa, Acolatse, Incoom, Sefah, Acharya, Opanga, Njeri, Kimonge, Kwon, Bae, Khuan, Abubakar, Sani, Khan, Hussain, Saleem, Malande, Piloya-Were, Gambogi, Hernandez Ortiz, Alutuli, Kalungia, Hoxha, Marković-Peković, Tubic, Petrova, Tachkov, Laius, Harsanyi, Inotai, Jakupi, Henkuzens, Garuoliene, Gulbinovič, Wladysiuk, Rutkowski, Mardare, Fürst, McTaggart, MacBride-Stewart, Pontes, Zara, Tagoe, Banzi, Wale and Jakovljevic.)

Background: Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India., Methods: We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017-2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels., Results: The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017-2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers' density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural-urban and public-private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets., Conclusion: India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.

Background: This study aimed to assess the effectiveness and safety of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of liver abscess., Methods: A prospective randomized study was conducted in the Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, UP, India, between February 2018 and August 2019, after getting approval from the institutional ethics committee. A total of 543 patients with liver abscess were randomized into two groups using computer-generated randomization method. Appropriate details regarding patients' clinico-demographic profile and investigations were also collected. The effectiveness of either treatment was measured in terms of duration of intravenous antibiotic, clinical improvement, reduction in the size of cavity, treatment success rate, duration of hospital stay including long-term outcomes such as sonographic resolution of cavity and recurrence rate at 6 months post-treatment., Results: The PCD group had statistically significant rate of duration of antibiotics need, days for clinical improvement and time for 50% reduction in abscess cavity and treatment success rate with comparable long-term outcomes., Conclusion: PCD is more efficient than PNA and can be used primarily in the treatment of both amoebic and pyogenic liver abscesses along with systemic antibiotics. However, PNA can serve as a safe alternative when PCD is not available., (© 2020 Royal Australasian College of Surgeons.)

The lichen species Parmotrema tinctorum (Nyl.) Hale was transplanted in two cities-Tezpur (small) and Guwahati (large)-of the Brahmaputra Valley to assess the impact of air pollution on the anatomy and physiology, and accumulation of pollutants. Significant damage to the anatomy was observed in samples, and the degree of damage was found to be higher in the transplants of the larger city. In the lichen transplants from locations having high traffic density, the total chlorophyll content was found to fall; on the contrary, electrical conductivity was found to be higher. The exposed-to-control ratio showed severe accumulation of Cd in all the transplants. Elements such as Cd, Pb, and Zn were found to be enriched in all the lichen samples from both Guwahati as well as Tezpur city. Besides, Cr, Cu, K, and Ni were also realized to be enhanced to a moderate extent. The correlations of indicator metal species pairs showed that anthropogenic influence was quite clear.

Objective: To evaluate the attitudes of undergraduate pharmacy students towards patient safety in six developing countries., Design: A cross-sectional study., Setting: Participants were enrolled from the participating universities in six countries., Participants: Undergraduate pharmacy students from the participating universities in six developing countries (Jordan, Saudi Arabia, Kuwait, Qatar, India and Indonesia) were invited to participate in the study between October 2018 and September 2019., Primary Outcome: Attitudes towards patient safety was measured using 14-item questionnaire that contained five subscales: being quality-improvement focused, internalising errors regardless of harm, value of contextual learning, acceptability of questioning more senior healthcare professionals' behaviour and attitude towards open disclosure. Multiple-linear regression analysis was used to identify predictors of positive attitudes towards patient safety., Results: A total of 2595 students participated in this study (1044 from Jordan, 514 from Saudi Arabia, 134 from Kuwait, 61 from Qatar, 416 from India and 429 from Indonesia). Overall, the pharmacy students reported a positive attitude towards patient safety with a mean score of 37.4 (SD=7.0) out of 56 (66.8%). The 'being quality-improvement focused' subscale had the highest score, 75.6%. The subscale with the lowest score was 'internalising errors regardless of harm', 49.2%. Female students had significantly better attitudes towards patient safety scores compared with male students (p=0.001). Being at a higher level of study and involvement in or witnessing harm to patients while practising were important predictors of negative attitudes towards patient safety (p<0.001)., Conclusion: Patient safety content should be covered comprehensively in pharmacy curricula and reinforced in each year of study. This should be more focused on students in their final year of study and who have started their training. This will ensure that the next generation of pharmacists are equipped with the requisite knowledge, core competencies and attitudes to ensure optimal patient safety when they practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Element concentration (Fe, Mn, Pb, Zn, Cu, Cr, Ni and Co) in the surface sediments of Ashtamudi estuary, Southwest coast of India, has been analyzed to understand the spatial variation and potential ecological risk status. The sediment pollution index and Potential Ecological Risk index suggest that the northeastern part of the estuary exhibits low to moderate polluted sediments with moderate ecological risk. The results of correlation analysis indicate that the natural weathering process and river input play an important role in the distribution of the elements in the surface sediments of the estuary. The extracted factor results indicate that the fine sediment fractions supporting for accumulation of the trace elements, whereas the enriched level of Fe and Mn is chiefly controlled by the riverine process, and other elements are contributed by anthropogenic influences., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Currently available human papillomavirus (HPV) detection devices are expensive, requiring a continuous power supply, high-priced reagents, skilled laboratory personnel, and infrastructure. These make it difficult to implement primary HPV screening in high-risk (HR) populations, particularly in low-income settings such as in India. The objective of our study was to evaluate the diagnostic performance of a point-of-care, portable, battery-operated device called Truenat, which detects 4 HR HPV genotypes (16, 18, 31, and 45), as a potentially cost-effective alternative to conventional HPV diagnostic tests., Patients and Methods: This was a single-site, blinded, cross-sectional study that evaluated the performance of the Trunat HPV-HR using cervical samples collected from nonpregnant women > 30 years old via consecutive sampling. The comparison was conducted against the Hybrid Capture 2 (HC2) method. All the positive samples were validated by 14 Real-TM Quant Kit., Results: Of 615 cervical samples, the HR-HPV DNA test was positive in 78 women (12.7%) by HC2 and in 49 (8%) by Truenat. With the consideration of limited genotype inclusivity, the sensitivity and specificity of Truenat HPV-HR were 97.7% and 98.9%, respectively., Conclusion: The performance of Truenat HPV-HR test was comparable to that of HC2 in the 4 HPV genotypes and would be appropriate to consider for use in primary HR cervical cancer screening and particularly in low-income settings.

Aim: The aim of the study was to determine the prevalence, predictors of anemia, and its impact on health-related quality of life among diabetic kidney disease (DKD) patients., Methods: Patients with a confirmed diagnosis of type 2 diabetes mellitus (T2DM), and had any stages of CKD (stages I to IV), based on their estimated glomerular filtration rate (eGFR) were enrolled in the study. Anemia was defined using the World Health Organization (WHO) criteria and quality of life was assessed using the EQ-5D scale. All the statistical analysis was performed using SAS v9.4., Results: A total of 323 patients completed the study. The mean ± SD age of patients was 56 ± 11.25 years, and 51.7% were female. Mean duration of diabetes was 9.6 ± 4.57 years. A total of 227 (70.27%) had anemia as per the WHO criteria. Linear association was observed between the eGFR and hemoglobin. After controlling for the possible confounders in multivariate logistic regression analysis, older age (odds ratio [OR]: 2.46 [95% CI: 1.16 to 5.28], P = .021), diabetes duration (OR: 1.53 [95% CI: 1.04 to 2.25], P = .022), and CKD stage III (OR: 3.63 [95% CI: 0.99 to 13.32], P = .004) were found to be significantly associated with the anemia. Consistently lower EQ-5D index values were observed for the anemic group., Conclusion: This study reported a high prevalence of anemia and impaired quality of life among DKD patients. Routine screening of anemia can be the most preventive measure to deal with this burdening co-morbid condition., (© 2019 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Background: Cyclin D1 (CCND1) polymorphisms, a regulator of the cell cycle progress from G1 to the S phase, may lead to uncontrolled cell proliferation and lack of apoptosis. G870A, a common single-nucleotide polymorphism in CCND1 influences breast cancer risk. However, the association between G870A polymorphism and breast cancer risk is ambiguous so far., Materials and Methods: In this case-control study, we analyzed the role of G870A polymorphism with breast cancer risk in Indian women. A meta-analysis of 18 studies was also performed to elucidate this association by increasing statistical power., Results: In our case-control study, significant risk association of the CCND1 G870A AA genotype with breast cancer in total cohort (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.64-5.42; P value, 4.96e-04) and premenopausal women (OR, 3.31; 95% CI, 1.54-7.08; P value, .003) was found. The results of the meta-analysis showed that AA genotype of the CCND1 G870A polymorphism significantly increases breast cancer risk in total pooled data (AA vs GG+GA: OR = 1.20; 95% CI = 1.03 to 1.39; P value, 0.016*) and Caucasian (AA vs GG+GA: OR = 1.22; 95% CI = 0.99 to 1.51; P value, .056*) but not in Asian population. Further, a significant protective association with breast cancer was also found in the GA vs AA comparison model in pooled data (OR = 0.73; 95% CI = 0.58 to 0.92; P value, .007*) as well as in Caucasian subgroup (OR = 0.62; 95% CI = 0.49 to 0.94; P value, .022*)., Conclusion: CCND1 G870A AA genotype was found associated with breast cancer risk. Future association studies considering the environmental impact on gene expression are required to validate/explore this association., (© 2019 Wiley Periodicals, Inc.)

Breast cancer is a highly aggressive disease contributing to high mortality rate among females across the globe owing to wide geographical variations, change in lifestyle along with rapid tumor growth, drug resistance, and high metastasis rate. To understand the molecular and genetic basis of breast cancer progression; we studied the role of E26 transformation-specific-1 (Ets-1) transcription factor which is implicated to have a role in carcinogenesis like invasion, metastasis, angiogenesis, etc. Our findings revealed an overexpression of Ets-1 gene in 75 breast cancer tumors as compared with their normal adjacent tissues. The findings significantly established a co-relation between Ets-1 expression in breast cancer tissue with hormonal receptor profiles and ductal-lobular histological subtypes in Indian population. In addition, a differential expression pattern of Ets-1 was observed between high, moderate, and low grades of breast cancer patients. The present study demonstrates a crucial role of Ets-1 transcription factor which may serve as a potential biomarker for breast carcinogenesis., (© 2019 Wiley Periodicals, Inc.)

Background: Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days., Methods: We performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013., Results: A total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2-7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2-11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus., Conclusions: Hepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed.

Diabetes and hypertension are the two major causes of chronic kidney disease (CKD). Epidemiological studies have found poor knowledge about the CKD among the general population. Hence, this study aimed to assess the awareness of CKD among type 2 diabetes mellitus (T2DM) patients in India. Patients with confirmed T2DM were included in the study. Patients receiving dialysis or with a history of a kidney transplant were excluded. A validated questionnaire was used to assess knowledge about CKD. Demographic characteristics were presented using descriptive statistics and trends in groups were calculated using the chi-square test. Statistical analysis was performed using SAS v9.4. A total of 323 patients completed the study. The mean age of the patients was 56 ± 11.25 years, and 51.7% were female. Only 33.43% of the patients correctly identified diabetes and hypertension as risk factors for CKD, while 44.27% were aware of the kidney's function. Statistically significant associations were observed between kidney disease knowledge and education status ( p = 0.004), socioeconomic status ( p = 0.000), and income status ( p = 0.003). No association was observed between the knowledge about CKD and age, gender, hypertension stages, CKD stages, duration of diabetes as well as hypertension and co-morbidities. Based on the results of this study, we found poor knowledge of CKD among Indian T2DM patients. The government should start a CKD awareness programme to deal with this rising co-morbid condition.

Depression as a co-morbid condition in type 2 diabetes mellitus (T2DM) patients is associated with significant morbidity, mortality, and rising health economic burden. Indian healthcare system is heavily burdened with T2DM, and it is important to understand the prevalence of depression associated with T2DM. This meta-analysis conducted as per the registered protocol (PROSPERO registration: CRD42016051552), searched for published studies in the databases including MEDLINE and Embase till 31st August 2018. The modified Newcastle-Ottawa Scale was used to assess the methodological quality. The pooled prevalence of depression among T2DM patients was estimated as primary outcomes, while prevalence based on demographic sub-group was estimated as the secondary outcome. In total, 43 studies including 10,270 patients fulfilled the eligibility criteria and were included in the analysis. The pooled prevalence of depression in T2DM patients was found to be 38% (95% CI: 31%-45%). Presence of depression in people with type 2 diabetes was more often associated with the presence of complications with an odds ratio of 2.33, 95% CI: 1.62-3.36, p < 0.00001. Overall, the study found a high prevalence of depression among T2DM patients in India. Diabetes management programs in India may consider early screening of depression in T2DM patients., (Copyright © 2018. Published by Elsevier B.V.)

Introduction: Survivin is an apoptosis inhibitor and plays a primary role in cancer development and progression. One of the most common polymorphism of the survivin promoter -31G/C (rs9904341) influences its expression and is associated with the risk of cancer development. This study was conducted to explore survivin promoter gene -31G/C (rs9904341) polymorphism and the risk of breast cancer., Patients and Methods: The study group included 190 pathologically confirmed breast cancer patients, in addition to 200 distinct cancer-free controls from Jammu and Kashmir region of India, where breast cancer is the most common cancer in women. Single nucleotide polymorphism genotyping for -31G/C polymorphism in the survivin promoter region was done using a polymerase chain reaction-restriction fragment length polymorphism method., Results: The variant genotype/allele was found in 54.1% of the cases compared with 46.5% of controls. The combined prevalence of genotype GC+CC was significantly higher in patients compared with the control group (P = .02). Analyses of odds ratios (ORs) in the patient and control groups indicated that the presence of homozygous CC genotype was associated with increased risk for development of breast cancer (OR, 2.04; 95% confidence interval [CI], 1.07-2.98). The gene frequencies for G and C alleles were statistically different between patient and control groups (OR, 1.37; 95% CI, 1.03-1.84)., Conclusion: The results suggest the association of -31G/C survivin polymorphism at a genotypic and allelic level in breast cancer., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background & Aims: Hyperbilirubinemia and hypoalbuminemia are features of hepatic dysfunction that associate with disease severity. This is because hepatic insufficiency causes hypoalbuminemia, which indirectly increases the circulating levels of free bilirubin. Circular dichroism (CD) spectroscopy can be used to quantify the molecular ellipticity (ME) of the albumin-bilirubin complex, and might associate with the severity or outcome of severe alcoholic hepatitis (SAH)., Methods: We performed a cross-sectional study of 265 patients with SAH admitted in the Department of Hepatology, Institute of Liver and Biliary Sciences in New Delhi, India from January 2014 through January 2016. Blood samples were collected and patients were followed for 12 months or death. The molar ratios of bilirubin: albumin and albumin-bilirubin complexes were determined for a discovery cohort (30 patients who survived the study period and 60 patients who did not survive) and compared with those of 60 patients with alcoholic cirrhosis and 30 healthy individuals (controls). Optical activities of albumin-bilirubin complexes in blood samples were determined by CD spectroscopy and compared among groups. Findings were validated in a separate cohort of 150 patients with SAH from the same institute. We studied the correlation between ME and albumin binding capacity (ABiC)., Results: The molar ratio of bilirubin: albumin was higher in patients with SAH than with alcoholic cirrhosis or controls (P < .05). Patients with SAH had different CD spectra and higher ME than the other groups (P < .01); ME correlated with model for end-stage liver disease score (with and without Na) and discriminant function (r 2 > .3; P < .01). ME values above a cut off of 1.84 mdeg predicted 3-month mortality in patients with SAH with an area under receiver operating characteristic curve of 0.87 (95% CI, 0.79-0.95), a 77% positive predictive value, and a 90% negative predictive value. The hazard ratio and concordance index of ME values for 3-month mortality in patients with SAH was 10% higher than the hazard ratio and concordance index of model for end-stage liver disease score. In patients with SAH, there was an inverse correlation between ME and ABiC (r 2 > 0.7; P < .01). We observed a significant reduction in ABiC with increasing levels of bilirubin in vitro prepared albumin-bilirubin complex., Conclusion: In a cross-sectional study of patients with SAH, we associated ME of the albumin-bilirubin complex, measured by CD spectroscopy, with outcomes of patients with SAH. Increased loading of bilirubin on albumin could explain reduced albumin function. Bilirubin removal by albumin dialysis might benefit patients with SAH., (Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.)

This cross-sectional study was carried out to assess drug prescribing pattern at a tertiary care teaching medical institute. One thousand prescriptions were randomly collected and analyzed using the world health organization prescribing indicators. The average number of drugs per prescription was 2.91. The percentage of drugs prescribed by generic name, from the essential drug list (National) and as fixed dose combinations (FDCs) was 10.05%, 22.57%, and 49.22%, respectively. The total percentage of encounters with antibiotics, injectables, and FDCs was 19.70%, 2.20%, and 73.60%, respectively. The most common group of drug prescribed was gastrointestinal tract drugs (26.38%) followed by Vitamins and Minerals (23.12%), cardiovascular system drugs (11.56%) and antimicrobials (9.63%). The prescribing practices were not appropriate as they consist of polypharmacy, lesser prescription by generic name, and overprescription of FDCs. There is a need for improvement in the standards of prescribing patterns in many aspects., Competing Interests: There are no conflicts of interest