Search

Objectives: Pre-procedure liver impairment has been revealed as a poor prognostic factor post-percutaneous coronary intervention (PCI). Recent investigations discovered that the aspartate aminotransferase-to-alanine aminotransferase ratio (De-Ritis ratio) indicates the severity of liver impairment and was related to adverse outcomes. We aimed to evaluate the predictive value of the De-Ritis ratio for contrast-associated acute kidney injury (CA-AKI). Materials and Methods: We prospectively enrolled 150 patients undergoing elective PCI between June 2022 and August 2022. Contrast-induced AKI: It is defined as an acute decline in renal function, defined as an increase in creatinine of =0.5 mg/dL or =25% compared to baseline. It usually develops 24-72 h post administration of an IV contrast agent in the absence of other identifiable causes. Results: The incidence of CA-AKI was 8% (n = 12). The De-Ritis ratio >1.30 was identified as the best cutoff value for CA-AKI prediction. Conclusion: The De-Ritis ratio was an independent risk factor for CA-AKI in patients undergoing elective PCI. [ABSTRACT FROM AUTHOR]

Generic medicine is a pharmaceutical drug which contains the same active ingredients as a branded drug in terms of strength, dosage, route of administration, quality, safety, performance characteristics, and therapeutic use. Generic medicine plays a major role in providing affordable medicines to patients. This systematic review was done to identify the knowledge regarding generic medicine prescription among dental and medical professionals worldwide. The search was performed in four databases PubMed, Turning Research Into Practice database (Trip database), Cochrane Library, and Google Scholar to identify the relevant articles with specific keywords and the time filter was February 2012 to February 2022. Finally we included 11 cross-sectional studies. However, generic prescribing is not very much adopted in India due to a lack of awareness about regulatory standards used in generic drug manufacturing. Based on this, the systematic review found that limited knowledge and negative perception among medical and dental professionals about generic medicine are clearly a major barrier to the implementation of generic medicine. [ABSTRACT FROM AUTHOR]

The current research was taken up at Institute of Biotechnology (IBT), PJTSAU, Hyderabad Telangana, India in kharif from August to November, 2021 to access the parental polymorphism between 10-3 and Telangana Sona. 10-3, an Assam landrace, is a bold grain rice variety with high BPH resistance to biotype-4. Whereas, Telangana Sona (RNR 15048) is a short and slender grain variety of rice that is popular among farmers and consumers across Telangana and other Indian states due to its high yield and low glycemic index. Despite being blast resistant, Telangana Sona is susceptible to the insect pest Brown Plant hopper (BPH) Nilaparvata lugens (Stål). The present study aimed to characterize the parental polymorphism between 10–3 and Telangana sona to facilitate mapping of genetic loci linked with BPH resistance in the 10–3 and to optimize the retention of favourable alleles from Telangana sona during marker assisted backcross breeding. Eight hundred and sixteen highly variable Simple Sequence Repeats (SSRs) including thirty-five BPH linked markers covering 12 chromosomes were used to assess DNA polymorphism between 10-3 and Telangana Sona. Out of 816 markers screened, 97 (11.89%) were found to be polymorphic between 10–3 and Telangana Sona of which, 82 were genomic SSRs and 15 were BPH linked markers. Chromosome 6 exhibited highest polymorphism percentage with a value of 30%, indicating that this chromosome is useful in studying parental variation and lowest polymorphism percentage found on chromosome 5 (3.49%). These 97 polymorphic markers will help in construction of linkage map for identifying QTLs linked with BPH resistance and for marker assisted backcrossing breeding in Telangana Sona. [ABSTRACT FROM AUTHOR]

The Air (Prevention and Control of Pollution) Act, 1981, is a crucial legislative cornerstone in India's ongoing efforts to combat air pollution and safeguard public health and the environment. This abstract delves into the motivation, objectives, approach, outcomes, and conclusion of this landmark legislation, shedding light on its pivotal role in addressing the pressing issue of air pollution in the country. Motivation: The rapid industrialization and urbanization in India, coupled with increasing vehicular emissions and other anthropogenic activities, have led to a significant deterioration in air quality. Recognizing the alarming consequences of air pollution on human health and the environment, the Indian government was motivated to enact a comprehensive legal framework that could effectively prevent and control air pollution. Objectives: The primary objectives of the Air (Prevention and Control of Pollution) Act, 1981, are to establish a legal framework for the prevention, control, and abatement of air pollution and to empower regulatory authorities to enforce strict measures against polluters. It aims to create a sustainable balance between economic development and environmental protection while prioritizing public health. Approach: The Act adopts a multifaceted approach to tackle air pollution. It establishes Central and State Pollution Control Boards to regulate and monitor pollution levels. These boards are granted the authority to issue permits, set emission standards, conduct inspections, and take necessary legal actions against violators. The Act also empowers the government to declare specific areas as "air pollution control areas" to impose stringent regulations and improve air quality. Outcomes: Since its implementation, the Air (Prevention and Control of Pollution) Act has yielded significant outcomes in India's battle against air pollution. The establishment of pollution control boards and the implementation of emission standards have led to increased accountability among industries and other pollution sources. Air quality monitoring and data collection have improved, aiding policymakers in formulating evidence-based measures. As a result, there has been a noticeable reduction in air pollutants, contributing to enhanced public health and environmental preservation. Conclusion: The Air (Prevention and Control of Pollution) Act, 1981, serves as a pivotal legal blueprint for tackling air pollution in India. By adopting a proactive approach and promoting compliance with emission standards, the Act has played a crucial role in improving air quality and safeguarding the wellbeing of citizens and the environment. However, ongoing efforts, public awareness, and continuous updates to the legal framework are essential to sustain these positive outcomes and pave the way for cleaner air and a healthier future. [ABSTRACT FROM AUTHOR]

Objective: Our study aimed to determine the association between high sensitivity-c reactive protein to albumin ratio (CAR) and in-hospital major adverse cardiovascular event (MACE) in patients with acute coronary syndrome and also to assess whether hs-CAR is a better marker than hsCRP or albumin alone in predicting MACE. Materials and Methods: We enrolled 110 cases who were hospitalized and major adverse cardiovascular event was defined as cardiogenic shock, acute heart failure, reinfarction and death. Blood sample for Serum albumin and hs-crp was taken at the time when patients were admitted. Results: The incidence of MACE was more in patients with high CAR (=1.8 group) as compared to those with low CAR (<1.8 group). Conclusion: The CAR is an independent predictor of MACE in patients who present with ACS. [ABSTRACT FROM AUTHOR]

Insecticide resistance development was monitored in the rice brown planthopper, BPH Nilaparvata lugens (Stål) fieldpopulation collected from West Godavari district, Andhra Pradesh state, India during 2015 and 2016. The results indicated that, Brown Planthopper has developed high level of resistance to imidacloprid and thiamethoxam and no resistance to dinotefuron. It has developed about 108.5 to 258.4 fold resistance during 2015 and 164.0 - 517.9 fold resistance during 2016 to imidacloprid. Similarly, 41.3 to 91.8 fold resistance during 2015 and 39.7 - 103.5 fold resistance during 2016 was observed to thiamethoxam. BPH population has not acquired resistance to dinotefuron (RR = 1.24 - 3.9). It has not developed resistance to organophosphorous compounds such as monocrotophos, acephate and dichlorvos with Resistance Ratios of 1.12 to 2.82. Moderate to high level of resistance to ethiprole (RR = 51.74-96.35) during 2016 and combination product ethiprole 40% + imidacloprid 40% (Glamore 80 WG) (RR = 40.51- 101.84) during 2015 and (RR= 50.82-100.41) during 2016 was observed. Very high level of resistance to chitin synthesis inhibitor, buprofezin was acquired during 2015 i.e. 1318 fold and 1662.4 fold during 2016. The resistance increased during 2016 compared to that of 2015. Different strategies to manage insecticide resistance are explained in brief. [ABSTRACT FROM AUTHOR]

In India, the banks have a formidable edge in maintaining their customer retention ratio for past few decades. Downfall makes the private banks to reduce their operations and the nationalised banks merge with other banks. The researchers have used the traditional and ensemble algorithms with relevant feature engineering techniques to better classify the customers. The proposed algorithm uses a Meta classifier instead of an ensemble algorithm with an adaptive genetic algorithm for feature selection. Churn prediction is the number of customers who wants to terminate their services in the banking sector. The model considers twelve attributes like credit score, geography, gender, age, etc, to predict customer churn. The project consists of five modules as follows. First is the pre-processing module that identifies the missing data and fills the value with mean and mode. Second is the data transformation module where, the categorical data is converted into numerical data using label encoding to fasten the computations. The converted numerical data is normalized using the standard scalar technique. The feature selection module identifies the essential attributes using DragonFly and Firefly (Hybrid Fly) algorithms. The classification module designs an intelligent Meta learner, which combines the Ensemble Algorithm Extreme Gradient Boosting (XGBOOST) with base classifiers as "Extra Tree Classifier" and "Logistic Regression" to predict the churn customers. [ABSTRACT FROM AUTHOR]

A SIR model is formulated for COVID-19 with initial and secondary states. Existence and uniqueness of solutions, stability of the model and basic reproduction number were derived. In this article, the vulnerability of COVID-19 in Tirupathur district, Tamilnadu, India is discussed to exhibit the flow of variables of the model using numerical simulations. Also, analysis of recovered is explored for Siddha and allopathy treatments. [ABSTRACT FROM AUTHOR]

Microfinance programs have received considerable worldwide attention for their income-generating and employment-generating ability to alleviate poverty. Microfinance has a high degree of outreach to women. Microfinance is supported by self-help groups. The SHG-Bank linkage program funded in India's National Bank for Agriculture and Rural Development (NABARD) is the world's massively growing micro-finance system covering 97 million poor households as of 31 March 2011.Microfinance has a high degree of outreach to women. Microfinance is supported by self-help groups. In India, the SHG-Bank linkage program funded by the National Bank for Agriculture and Rural Development (NABARD) is a vastly expanding microfinance system covering 97 million poor households worldwide as of 31 March 2011 Microfinance has a high degree of outreach to women. Microfinance is supported by self-help groups. Self-help groups are the groups micro-finance has evolved as a need-based programme for empowerment and alleviation of poverty to the so far neglected groups This is a study focused on the awareness of SHG, Having membership in these types of groups, obtaining finance in the range, maximum range of availability of finance, interest rate payments their range, sufficiency of obtaining funds to their need and fund utilisation fields, Process to obtain fund from SHG compared with other institutes and Financial position of individual as a member in self-helped groups compared prior to without having member ship. [ABSTRACT FROM AUTHOR]

The brown planthopper (BPH) Nilaparvata lugens (Stål) (Homoptera: Delphacidae) is considered a threat to rice (Oryza sativa ssp.) crop in many parts of the world including India. Among the BPH-resistance (R) genes so far reported in rice, most of them are ineffective against BPH biotype 4 predominant in the Indian sub-continent. In this study, we show the introgression line RPBio4918-230S was identified as BPH resistant after five years of rigorous screening at seedling stage and two years at tillering and reproductive stages. The inheritance of resistance indicated that two recessive genes are involved at seedling and reproductive stages. The allelic relation with known genes using linked reported markers suggested that the genes present in RPBio4918-230S are different. We report here the genetics of the two newly introgressed BPH resistance genes from O. nivara in the background of Swarna which are effective at all the important growth stages. The genes have been tentatively named as bph39(t) and bph40(t). The honeydew area (feeding rate) and days to wilt parameters observed at 30 days after sowing in BC1F3 indicated that newly introgressed genes have both antibiosis and tolerance mechanisms for resistance. The BPH resistance genes identified in this study would facilitate the breeding of broad spectrum and durable resistance in rice against BPH biotype 4. [ABSTRACT FROM AUTHOR]

Renal transplantation is an effective and commonly performed procedure for end-stage renal disease. Urinary tract infections are a major cause of morbidity and mortality in renal transplant patients. As data on postrenal transplant urinary tract infections from the Indian subcontinent are limited, the present study was conducted to estimate the burden of urinary tract infections in this vulnerable group of patients. This was a prospective study on patients undergoing renal transplantation in 2014 at our tertiary hospital in South India with a follow-up of 2 years to evaluate the risk factors for urinary tract infections. The prevalence of urinary tract infections was 41.9% with a male preponderance of 76.9%. Mean age of the 31 patients was 32.4 ± 10.2 years (range: 16-55 years). Gram-negative bacilli were the most common isolates with Escherichia coli being the predominant pathogen (53.3%). All the infections occurred within 1 year of transplantation with delayed graft function (P < 0.001; confidence interval [CI]: 29.0-96.3) and prolonged hospital stay (P = 0.0281; CI: 42.1-99.6) being the significant risk factors for acquiring urinary tract infections. Carbapenemase production was noted in 33.3% of isolates and all the Gram-negative organisms isolated in the 1st month of transplantation were carbapenem-resistant (CR) E. coli. The high rate of carbapenem-resistant organisms in the early posttransplant period is a point of concern, especially with cadaver transplants. Infection control practices and catheter care need to be strictly monitored to minimize the risk for UTI in the immediate posttransplant period. [ABSTRACT FROM AUTHOR]

The study aims at examining the efficiency of futures market with a sample of 11 commodities traded on National Commodity and Derivatives Exchange Limited (NCDEX). Augmented Dickey-Fuller (ADF) and Phillips-Perron (PP) tests are applied for testing stationarity and order of integration of both spot and futures market. Zivot-Andrews test of unit root is also applied to ensure reliable results in the event of structural break. Stationarity in spot and futures series at level is observed in case of three commodities, viz., barely, jeera and soybean, and non-stationary at level and stationarity in return series is observed in the case of the remaining eight commodities. To test the cointegrating relationship between both the markets, Johansen test of cointegration is used and finally to observe the direction of causality, Granger causality test is applied. There is evidence of cointegrating relationship indicating the presence of long-run relationship between spot and futures market in eight agricultural commodities. There is also evidence of futures Granger causing spot in the case of six commodities, i.e., barley, castor seed, cotton seed oilcake, gur, mustard seed and refined soya oil. However, there is evidence of bidirectional relationship in the case of remaining five commodities; coriander, jeera, soybean, sugar M grade and wheat. As a whole, it is observed that agricultural commodity futures market is efficient in India. [ABSTRACT FROM AUTHOR]

Deposit is an important element determining the development of the bank. Deposits are the reserves of the people with the bank. Mobilisation of deposits promotes social wellbeing of the depositors as also the public at large by instilling in them the habit of savings. The present study is an empirical analysis on deposit mobilisation of Andhra Pragathi Grameena Bank. The study is mainly based on secondary data which is collected from the annual reports of APGB. Data were processed by using simple statistics like mean, standard deviation, coefficient of variation compound growth rate and t tests. The study concludes that there is a rapid progress in the mobilisation of deposits by APGB. [ABSTRACT FROM AUTHOR]

Early and rapid detection of dengue virus (DENV) infection during the acute phase of illness is crucial for proper patient management and prevention of the spread of the infection. In the present study, the standardization and validation of a one step, four tube reverse transcription loop-mediated isothermal amplification assay (RT-LAMP) for rapid detection and serotyping of the DENV targeting NS1 gene using the Genie® II flourometer was carried out. The performance of the RT-LAMP was compared to RT-PCR, CDC 1-4 Real time PCR and the NS1 antigen ELISA, IgM and IgG anti DENV antibodies. Acute DENV infection was confirmed in 250/300 patients suspected clinically of DENV infection. RT- LAMP and CDC 1-4 Real time PCR assay was positive in 148/250 patients, while 92/250 patients were positive for anti- Dengue IgM and IgG antibodies. The RT-LAMP assay and the CDC real-time RT-PCR assay showed high concordance ( k = 1.0). The detection rate of acute DENV infection improved to 96% (240/250) when the results of RT-LAMP were combined with NS1 Ag, IgM and IgG ELISA. The RT-LAMP had a detection limit of 100 copies for DEN-1 and DEN-2, 10 copies for DEN-3 and DEN-4 compared to 1000 copies for DEN-1 and DEN-2, 100 copies for DEN-3 and DEN-4 by the conventional RT-PCR. The assay showed 100% specificity. The RT-LAMP assay developed in this study has potential use for early clinical diagnosis, serotyping and surveillance of DENV infection in endemic countries such as India. [ABSTRACT FROM AUTHOR]

The present study attempts to examine the random movements in stock indices in the Indian equity market. It tests the random walk hypotheses in daily, weekly and monthly returns of six Indian stock market indices from January 2000 to October 2009. The indices considered for the purpose of the study include Nifty, CNX Nifty Junior, NSE 500, SENSEX, BSE 100 and BSE 500. The study uses Jarque-Bera (JB) Test for testing normality in return series. It also applies Box Pierce Q-Statistics and Ljung-Box (LB) statistics, and Augmented Dickey-Fuller (ADF) test to test whether return series follow random walk or not. The results indicate that there are no random movements in share indices. However, when we apply Lo and MacKinlay (1988) variance ratio test under the assumptions of both homoskedasticity and heteroskedasticity, we observe contradictory results. It is also found that sometimes heteroskedasticity is the source of non-random behavior in share indices. [ABSTRACT FROM AUTHOR]

Background: Although the overall sensitivity and specificity of the western blot (WB) test for detection of antibodies to various viral proteins is high, there has been a substantial difference in the timing of the appearance of antibody bands and their intensities during different stages of HIV infection.Aims: Mapping different band patterns of Western blot results and correlating them with stages of HIV infection.Methods: We performed a retrospective study with 1,467 HIV-1 infected cases confirmed by WB test between January 2002 to July 2005, with the objective of mapping different band patterns of western blot results and determining whether the presence or absence of certain bands was associated with any specific stage of HIV infection. For the interpretation of the WB results in this study, the guidelines recommended by NACO, India were followed.Results: Reactivity with all the bands was the most commonly observed WB pattern, occurring in 92.91% (1363/1467) of cases, whereas the other 7.09% showed uncommon band patterns. Of all individual bands, p31 band was the most frequently missing one, absent in 7.09% cases. On classifying the WB reactive cases by the WHO clinical staging system, 38.45% (564/1467) were in Stage 1, 47.99% (704/1467) in stages 2 and 3 and 13.56% in stage 4. Correlation of CD4 cell counts with the various uncommon band patterns showed that only 5.56% (4/72) had counts in the 200-500 cells/microl range, whereas 45.83% and 48.61% had counts of < 200 and> 500 cells/microl respectively.Conclusion: Interpretation of the WB band pattern in combination with clinical features may be occasionally useful in predicting the stage of HIV infection. [ABSTRACT FROM AUTHOR]

The article discusses a study on represent the structure and tectonic frame work of the Chintalapudi sub-basin in Chintalapudi, Andhra Pradesh, India using using Remote Sensing Data (RSD). It informs that the lithological boundaries of the Chintalapudi sub-basin between the Archean and the Gondwana rocks and the the north and south boundaries withinthe basin by E - W trending lineaments near Mulkalapalli, Andhra Pradesh, India and Epigunta, Andhra Pradesh, India.

In this article, the author focuses on the importance of training undergraduates in the field of psychiatry for the development of mental health services in India. It mentions the initiatives taken by Medical Council of India such as making department of psychiatry in all medical colleges as a part of teaching hospitals and providing mental health services. It also mentions the University Grants Commission for teaching psychiatry in universities.

Background: Chronic osteomyelitis (COM) is a major medical problem in most countries, mainly associated with violent trauma, modern surgery and inadequate treatment of acute osteomyelitis. Although the incidence of osteomyelitis has reduced to a certain extent with the advent of antibiotics and chemotherapeutic agents, yet it continues to be a major problem in India. Methods & Materials: A retrospective analysis of data of purulent (Pus/pus swabs, tissue) specimen received from patients with chronic osteomyelitis by the microbiology department between January 2013-0ctober 2015 was carried out. The samples were processed using standard microbiological techniques. Identification and antimicrobial susceptibility pattern of the bacterial isolates were done using the Vitek 2 (bioMerieux, Marcy l'Etoile- France) system. Results: In all, 184 patients with chronic osteomyelitis were documented during the study period. There was a male preponderance (163 / 184, 88.5%) with majority, in the age group of 10-20 years. Trauma was the major risk factor for osteomyelitis (95/ 184, 51.6%). The lower limb bones were more commonly affected of which femur (166/184, 90.2%) was the predominant bone involved. Culture was positive in 104/184 (56.6%), with the Gram positive organisms most predominant. MRSA was the predominant organism isolated in 28/104 (27%) cases. Among Gram negative bacilli, Escherichia coli was most common organism isolated in 11/104 (10.4%). Other organisms isolated included Pseudomonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumanii, Proteus mirabilis, Enterobacter cloacae, Morganella morgagnii and showed a high level of antibiotic resistance. In this study no anaerobic organisms were isolated. One patient had a mixed infection with Mycobacterium tuberculosis and A.baumannii. Majority of the patients (85/184, 46%) were managed conservatively with wound care and antibiotics. No mortality was recorded. Conclusion: Prognosis of chronic osteomyelitis depends on proper microbiological techniques that help in isolation, identification and treatment of the bone-infecting, often multidrug resistant organism. Complications can be further reduced with surgical debridement and removal of the dead tissues. [ABSTRACT FROM AUTHOR]

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form. [ABSTRACT FROM AUTHOR]

Geographic Information Systems have been widely accepted to manage and manipulate spatial data associated with the hydrologic response of a watershed. Due to climate change and drought impacts, there is a need to conserve freshwater resources, which can be accomplished by introducing the concept of stormwater harvesting. Apart from hotspot identification and site screening, several economic, social, cultural, environmental aspects need to be considered before finalizing the suitable site for stormwater harvesting. The shortlisted sites are commonly ranked by considering various parameters, i.e. water demand, availability of stormwater and distance to end-use locations, which relate to economic aspects. In the present study, socio-environmental considerations are also constituted by adopting a web-GIS based approach. The geospatial datasets and metadata associated with the study area are organized as a repository in the open source database server (PostgreSQL/PostGIS), which is further assessed and analyzed by using GeoServer. This technique publishes the geospatial datasets to the public domain websites that can be accessed and visualized around the clock and across the world. This will help stakeholders gather and store responses from water planners and inhabitants, while minimizing the time and cost associated with field visits for collecting individual responses. In this respect, a questionnaire is prepared that includes queries associated with site selection and the responses are gathered from various institutions, water professionals, stakeholders and residents. Once the responses are collected, the Analytic Hierarchy Process has been implemented to compute the relative weights of each criterion with respect to the responses collected. The weights thus obtained assisted the planners in deciding the suitable stormwater harvesting site for Dehradun city in India. In context to responses gathered the sites 'B' and 'D' are given the maximum weightage to be the suitable sites in the study region. Also, the socio-environmental criteria such as 'community acceptance', 'recreational activities' and 'need for water reuse' have gathered the maximum weightage from the responses for the specific sites. Hence, the proposed methodology demonstrated how water professionals, civilians, planners, stakeholders and public can be included as participants in water-related decision making processes., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

An indigenous fungal strain was isolated from Indian Kolar Gold Field mine soil. The isolate was heterothallic, branched septate, deeply floccose, fast-growing, dull green with white background conidial columnar mycelium from Aspergillus section Fumigati. Diverse metabolic patterns of the isolate exhibit high metal, thermal resistance which grews well from 28 ± 1 degrees C to 37 degrees C and pH concentration was significant on the growth of isolate. Phylogenetic analysis of 16srRNA β-Tubulin gene sequence established relationship among isolate and other taxa. Molecular identification and morphological features of fungal isolate were consistent with those of Neosartorya udagawae. Heterothallic N. udagawae FJ830683 strain was closely related to homothallic N. aureola EF661890. Fungal isolate extract synthesized narrow sized stable Gold nanoparticles (AuNPs).

Objectives: Herpes simplex virus-2 (HSV-2) and syphilis are associated with increased risk of HIV, highlighting the importance of understanding their transmission dynamics. In India, most studies of HSV-2 and syphilis incidence are in high-risk populations and may not accurately reflect infectious activity. In this study, we aim to define HSV-2/syphilis incidence and risk factors in a population sample., Methods: We conducted a longitudinal population-based survey in Andhra Pradesh, India, in two rounds: 2004-2005 and 2010-2011. Sociodemographic and behavioural data were collected, and dried blood spots tested for HSV-2 and Treponema pallidum IgG. After calculating sexually transmitted infection (STI) incidence, associated factors were assessed using modified Poisson regression and within-couple transmission rates modelled using seroconcordance/discordance data., Results: 12,617 adults participated at baseline with 8494 at follow-up. Incidence of HSV-2 and syphilis per 1000 person-years was 25.6 (95% CI 24.1 to 27.2) and 3.00 (95% CI 2.52 to 3.54). Incidence of HSV-2 was higher in women vs. men (31.1 vs. 20.2) and in rural vs urban residents (31.1 vs 19.0) (p<0.05 for both). STI seroincidence increased in a step-wise fashion with age and was associated with spousal seropositivity for both sexes (incidence rate ratio (IRR) 2.59 to 6.78). Within couples the rate of transmission per 1000 couple-years from men to women vs. women to men was higher for HSV-2 (193.3 vs. 119.0) compared with syphilis (27.6 vs. 198.8), p<0.05 for both., Conclusions: HSV-2 has higher incidence among subpopulations such as women, rural residents and older-aged individuals, suggesting a need for more generalised STI prevention approaches among populations traditionally considered low risk., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Awareness of mental illness as a cause of morbidity is increasing the world over. Of the top ten causes of disability, five are psychiatric illnesses. Availability and accessibility of psychiatrists as well as treatment facilities is meagre, making pathways to psychiatric care tortuous hence delayed, affecting outcomes negatively. With an attempt to study the pathways to psychiatric care, a cross sectional study was undertaken, on 63 consecutive first contact patients in tertiary care centre in Bangalore, India. Socio demographic details, time taken to reach professional help, and reasons for delay were noted. Pathways to care were recorded using 'WHO pathways to care' proforma. One third of the study population were aged between 31 and 45 years, mostly Hindus. Two thirds of them had received about 10 years of formal education, hailed from urban areas and lived in nuclear families. Majority sought help from trained medical professionals, with almost 40% seeking psychiatric help initially itself. While the choice of consultation was influenced by people in the immediate environment, that of first contact was based on the physician or treating facility. Almost 57% had more than two referrals before reaching the tertiary care centre. Though the urban educated population are well aware of the nature of psychiatric illnesses, need for medical intervention and its availability, there was a delay in seeking help from a tertiary psychiatric centre. There is thus a need to educate medical professionals about timely referral to these centres, as early and appropriate interventions result in a favourable outcome., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Toll-like receptor 2 (TLR2) and interferon-gamma (IFN-γ) coordinate with a diverse array of cellular programs through the transcriptional regulation of immunologically relevant genes and play an important role in immune system, reproductive physiology and basic pathology. Alterations in the functions of TLR2 2258G (guanine)/ A, IFN-γ (+874T/A) and signalling molecules that result from polymorphisms are often associated with susceptibility or resistance, which may, in turn, establish the innate host response to various infectious diseases. Presently, we proposed to investigate the risk of common single nucleotide polymorphism (SNP) of TLR2 and IFN-γ genes, for their effect on infertility in women with female genital tuberculosis (FGTB) and healthy women as controls., Methodology/principal Findings: Genotyping of TLR2 and IFN-γ gene polymorphisms was performed by amplification refractory mutation system multi-gene/multi-primer polymerase chain reaction followed by restriction fragment length polymorphism in 175 FGTB patients and 100 healthy control women (HCW). The TLR2 polymorphism [adenine (A) allele] was observed in 57.7 and 58.0% of FGTB patients and HCW, respectively. The IFN-γ (+874T/A) polymorphism (A allele) was significant in 74.3 and 71.0% of FGTB patients and HCW, respectively, while the odds ratios for the AA and TA genotypes for predisposition of FGTB were found to be 0.304 and 1.650 in HCW, respectively. The SNP of TLR2 was not associated with FGTB but the SNP of IFN-γ was found to be associated with mycobacteria infections and to induce infertility., Conclusions/significance: At present, we hypothesize that infertile women with FGTB and HCW without tuberculosis (TB) have identical frequency of TLR variants, which may be adequate in the production of IFN-γ in response to Mycobacterium tuberculosis infections. Thus, the study appears to be the first of its kind reporting a mutation in the IFN-γ gene [+874 T (thymine) to A] responsible for susceptibility to TB infections and further inducing infertility.

Introduction: The present study is a retrospective analysis of a total of 36 cases of bacteriologically proven extra-intestinal salmonellosis, managed at Nizam's Institute of Medical Sciences, between 1987 and 2012 (25 years). The extra-intestinal sites involved were the skin, cerebrum, spleen, ovary, synovium, and the skeletal muscle., Methodology: The extra-intestinal specimens were first processed using standard methods. Colonies suspected as Salmonella were identified by standard laboratory methods, initially by manual biochemical reactions and later by the API system (bioMerieux, Marcy l'Etoile- France) and the Vitek-2 system (bioMerieux). All the Salmonella isolates were sent to Central Research Institute, Kasauli, for serotyping., Results: The predominant serotype isolated was Salmonella Typhi (S. Typhi) in 27 (75%) patients, followed by Salmonella Senftenberg (S. Senftenberg) in 5 (14%), Salmonella Paratyphi A (S. Paratyphi A) in 3 (8%), and Salmonella Typhimurium (S. Typhimurium) in 1 (3%). There was an increasing resistance to ampicillin, chloramphenicol, cephalosporins (third generation), and quinolones over the 25 years., Conclusions: The diagnosis of extra-intestinal salmonellosis requires a high degree of clinical suspicion and should be included in the differential diagnosis in patients with deep-seated abscesses.

Background: The aim of this multi-centric prospective study in India was to assess the accuracy of a serological test as an additional tool for diagnosing active tuberculosis (ATB). In particular, an assay based on ELISA using a phenolic glycolipid (PGL-Tb1) or a fusion protein (ESAT-6/CFP10) was compared to the tuberculin skin test (TST) and the microbiological results according to HIV status., Methods: Individuals with and without ATB and HIV infection were enrolled. Serology and TST results were analyzed per se and in combination with the microbiological data., Results: Among the 778 ATB patients, 102 were HIV-infected, 316 HIV-uninfected and 360 had an HIV-unknown status. Of the 945 non-ATB subjects, 559 were at low risk (community adults) and 386 at high risk of M. tuberculosis exposure. Among those with ATB, the sensitivity of ELISA-PGL-Tb1 for ATB was higher than that of ELISA-ESAT-6/CFP10, both in HIV-infected (72.3% versus 63.7%, p = 0.29) and HIV-uninfected/HIV-unknown groups (40.5% versus 28.6%; p<0.0001), whereas the specificity was around 91% for both tests. Sensitivity for ATB increased when the results of the two ELISA were combined, reaching 75.5% in the HIV-infected and 50.9% in the group of HIV-uninfected/HIV-unknown ATB, with a significant decrease of the global specificity (83.9%). Analyzing the ELISA results with the microbiological results, we observed that the sensitivity of both serology tests was independent of the ATB patients' smear microscopy (SM) status and grade. Combining the results of SM with both ELISA, the detection of ATB patients significantly increased (p<0.0001), particularly in those with extrapulmonary TB (up to 45.1%) or HIV infection (up to 83.3%). No significant association was observed between TST and serology results., Conclusions: In this prospective multi-centric study, the combination of two rapid tests, such as SM and serology, might be useful in detecting ATB, especially in HIV-infected patients.

Background: Primary caregivers of HIV-infected patients face enormous burden, which if inappropriately coped, leads to psychiatric morbidity. Little is known of what role caregiver's age and gender play in this., Purpose: To assess the socio-demographic profile and the influence of age and gender on coping strategies and psychiatric morbidity., Procedure: Sixty caregivers were assessed on a semistructured sociodemographic proforma, a coping checklist, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; [SCID-I])., Main Findings: Majority of the carers were young, equally from both genders, and used the same number of coping strategies which increased with age. "Avoidance" was preferred by males and older carers. Youngsters had maximum psychiatric morbidity, majority of the depressed were females, while 90% of nicotine dependants were males., Conclusion: Gender, but not age, decided the style of coping and extent of psychiatric morbidity hence gender-specific interventions will improve the quality of life of the carers and their wards.

Introduction: In the complex setting of a medical school it becomes essential to utilize an approach to teaching and learning that is best suited to the needs of the students. In developing countries like India, where there is an exponential increase of institutions catering to medical students, it becomes a challenge to teach to large number of students per class. Hence, research is needed to identify the needs of students in relation to their day to day learning activities., Objectives: To understand the preferences and perception of medical students about the current methods of teaching, aids used for teaching and also identify barriers in learning as perceived by the students., Method: A Cross-sectional study was carried out at Kasturba Medical College, Mangalore during May 2012. Study participants included 2(nd) and 3(rd) year medical students. A semi-structured questionnaire was used to collect the information in relation to preferences and perceptions regarding teaching methods utilized for theory and clinical teaching. SPSS version 11.5 was used for analysis of data. The association between variables of interest was tested using Chi-square test., Results: A total of 286 students (56.6 % females and 43.4% males) participated with a dropout rate of 10.6%. The study revealed that 71.3% of the students had an attendance above 75%. The most preferred teaching method was Problem Based Learning (PBL) (71.4%) as students felt that it enhanced lateral thinking while Didactic Lectures was the least preferred (32.8%). The most preferred modality of teaching aid was found to be Black board preferred by 46.9% students. In learning rare signs and cases, students preferred video lectures (41%) and mannequins (75.9%) in learning clinical skills. The main barrier in theory learning identified was inappropriate teaching methods (15%) and being new to clinical posting (38.5%) in case of learning clinical skills., Conclusion: The findings of the study suggest that a combination of traditional methods with other methods such as PBL, video lectures and mannequins could be an effective way of teaching theory and clinical skills.

We attempt to evaluate the nature of association of TCF7L2 gene variants with T2DM, for the first time in the population of Hyderabad, which is considered to be diabetic capital of India. It is a case-control study of the three SNPs of TCF7L2, rs7903146, rs12255372 and rs11196205, genotyped on Sequenom Massarray platform, in a sample of 758 patients and 621 controls. The risk allele frequency of the three SNPs was found to be significantly higher in the T2DM cases than controls, implicating susceptibility for diabetes (p<0.01). The greatest risk of developing the disease was conferred by rs7903146. Further, the logistic regression of genotypes of each SNP under log additive model, and the haplotypes constituted by at least one of the three risk alleles also show significantly greater risk of developing T2DM when compared to the wild type haplotype. Further, BMI and WHR emerge as significant covariates with confounding effects. The strong association of the TCF7L2 SNPs with T2DM is consistent with the findings among other Indian and Non-Indian populations, suggesting universal phenomena of its association across ethnic groups globally, both within and outside the Indian subcontinent, albeit the functional relevance of these SNPs needs yet to be established.

Indian truck drivers and their younger apprentice drivers are at increased risk of HIV infection. We determine network and risk practices associated with willingness to adopt HIV prevention interventions currently not being used in India: rapid HIV testing, circumcision, and preexposure prophylaxis (PrEP) in order to inform the National AIDS Control Program (NACP). Truck drivers and truck cleaners were systematically recruited to participate in a social network and risk survey in Hyderabad, Southern India. Three separate composite measures of acceptability of rapid HIV testing, circumcision, and PrEP acceptability were utilized to independently assess the relationship of these prevention interventions with risk-practices and social network characteristics. An 89% participation rate yielded 1602 truck drivers and truck cleaners with 54.2% younger than 30 years of age and 2.8% HIV infected. Twenty-five percent of respondents reported sex with female sex workers (FSW) and 5% with men (MSM). Rapid testing, circumcision, and PrEP acceptability were 97.4%, 9.1%, and 85.9%, respectively. Participants reporting prosocial network characteristics were more accepting of rapid testing (adjusted odds ratio [AORs] 3.07-6.71; p<0.05) and demonstrated variable PrEP acceptability (AORs 0.08-2.22; p<0.001). Sex with FSWs was associated with PrEP acceptability (AOR 4.27; p<0.001); sex with MSM was associated with circumcision acceptability only (AOR 2.66; p<0.01). Social network factors and risk-practices were associated with novel prevention acceptability, but not consistently across intervention type and with variable directionality. The NACP will need to consider that intervention uptake may likely be most successful when efforts are targeted to individuals with specific behavior and social network characteristics.

In India, men who have sex with men (MSM) and truck drivers are high-risk groups that often do not access HIV testing due to stigma and high mobility. This study evaluated a field testing package (FTP) that identified HIV positive participants through video pre-test counseling, OraQuick oral fluid HIV testing, and telephonic post-test counseling and then connected them to government facilities. A total of 598 MSM and truck drivers participated in the FTP and completed surveys covering sociodemographics, HIV testing history, risk behaviors, and opinions on the FTP. MSM and truck drivers equally preferred video counseling, although MSM who had been previously tested preferred traditional methods. Nearly all participants preferred oral testing. Rates of counseling completion and linkage to government centers were low, with one-third of newly identified positives completing follow-up. With increased public-private coordination, this FTP could identify many hard-to-reach preliminary positive individuals and connect them to government testing and care.

Aim: The aim of this study was to evaluate the maturity levels of the individual by comparing the correlation between dental, skeletal and the chronological ages., Materials and Methods: Intraoral periapical radiographs of the complete right side of the dentition and posteroanterior radiographs of the hand and wrist were obtained from 260 subjects, ranged from 3 to 15 years of age. Evaluation of handwrist roentgenograms for skeletal age and intraoral roentgenograms for dental age was done., Results: The findings of present study indicated that participated children were skeletally and dentally, retarded in maturation as compared with the standards except at 3 and 6 years of age. The girls were found to be skeletally more advanced than boys at all ages except 7 and 10 years of age. The dental maturity is more for girls than that of boys., Conclusion: No significant correlation was found among skeletal age, dental age and chronological age. Dental age and skeletal age was found to be correlated at 6, 10 and 11 years in boys and 6 and 9 years of age in girls., Clinical Significance: The results of this study could enhance the diagnosis and treatment planning in orthodontics and other dental disciplines.

Using population-based and family structural data from a high HIV-prevalence district of Southern India, this paper considers four suggested social scenarios used to explain the positive correlation between HIV prevalence and previously married status among Indian women: (1) infection from and then bereavement of an infected husband; (2) abandonment after husbands learn of their wives' HIV status; (3) economic instability after becoming previously married, leading women to seek financial support through male partners; and (4) the social status of being previously married exposing women to sexual harassment and predation. By also considering seroprevalence of two other common sexually transmitted infections (STIs), herpes and syphilis, in a combined variable with HIV, we limit the likelihood of the first two scenarios accounting for the greater part of this correlation. Through a nuanced analysis of household residences patterns (family structure), standard of living, and education, we also limit the probability that scenario three explains a greater portion of the correlation. Scenario four emerges as the most likely explanation for this correlation, recognizing that other scenarios are also possible. Further, the interdisciplinary literature on the social position of previously married women in India strongly supports the suggestion that, as a population, previously married women are sexually vulnerable in India. Previously married status as an STI risk factor requires further biosocial research and warrants concentrated public health attention.

Background: The aim of this multicentric prospective study in India was to assess the value of several microbiological tools that contribute to the diagnosis of tuberculosis (TB) according to HIV status., Methods: Standard microbiological tools on individual specimens were analyzed., Results: Among the 807 patients with active TB, 131 were HIV-infected, 316 HIV-uninfected and 360 had HIV-unknown status. Among the 980 non-active TB subjects, 559 were at low risk and 421 were at high risk of M. tuberculosis (Mtb) exposure. Sensitivity of smear microscopy (SM) was significantly lower in HIV-infected (42.2%) than HIV-uninfected (75.9%) (p = 0.0001) and HIV-unknown pulmonary TB patients (61.4%) (p = 0.004). Specificity was 94.5% in non-TB patients and 100% in health care workers (HCW) and healthy family contacts. Automated liquid culture has significantly higher diagnostic performances than solid culture, measured by sensitivity (74.7% vs. 55.9%) (p = 0.0001) and shorter median time to detection (TTD) (12.0 vs. 34.0 days) (p = 0.0001). Specificity was 100% in HCW and cured-TB patients, but was lower in non-TB patients (89%) due to isolation of Mycobacteria other than tuberculosis (MOTT). TTD by both methods was related to AFB score. Contamination rate was low (1.4%). AccuProbe hybridization technique detected Mtb in almost all culture-positive specimens, but MOTT were found in 4.7% with a significantly higher frequency in HIV-infected (15%) than HIV-uninfected TB patients (0.5%) (p = 0.0007). Pre-test classification significantly increased the diagnostic value of all microbiological tests in pulmonary TB patients (p<0.0001) but to a lesser degree in extrapulmonary TB patients., Conclusions: Conventional microbiological tools led to results similar to those already described in India special features for HIV-infected TB patients included lower detection by SM and culture. New microbiological assays, such as the automated liquid culture system, showed increased accuracy and speed of detection.

A divide exists between categories of men who have sex with men (MSM) in India based on their sex position, which has consequences for the design of novel HIV prevention interventions. We examine the interaction between sex position and other attributes on existing HIV risk including previous HIV testing, unprotected anal intercourse (UAI), and HIV serostatus among MSM recruited from drop-in centers and public cruising areas in the twin cities of Hyderabad and Secunderabad, India. A survey was administered by trained research assistants and minimally invasive HIV testing was performed by finger-stick or oral testing. HIV seropositive MSM underwent CD4+ lymphocyte count measurement. In our sample (n = 676), 32.6% of men were married to women, 22.2% of receptive only participants were married, and 21.9% of men were HIV seropositive. In bivariate analysis, sex position was associated with previous HIV testing, UAI, HIV serostatus, and CD4+ lymphocyte count at diagnosis. In multivariate analysis with interaction terms, dual unmarried men were more likely to have undergone an HIV test than insertive unmarried men (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.2-6.5), a relationship that did not hold among married men. Conversely, dual married men were less likely than insertive married men to engage in UAI (OR 0.3; 95% CI 0.1-0.6), a relationship that did not hold among unmarried men. Further implementation research is warranted in order to best direct novel biologic and behavioral prevention interventions towards specific risk behaviors in this and other similar contexts.

Dengue is an emerging arboviral disease and currently poses the greatest arboviral threat to human health. In recent decades, there has been a substantial increase in dengue outbreaks in many parts of the world including India. We performed an in-depth investigation of a major dengue outbreak in Andhra Pradesh, southern India in 2007 by serology, virus isolation, RT-PCR and genotyping. The results revealed an unusual emergence of dengue virus type 4 (DENV-4) along with the prevailing DENV-3. Phylogenetic analysis based on complete envelope gene of 182 globally diverse DENV-4 isolates demonstrated the involvement of a unique clade of genotype I of DENV-4 in the outbreak. This study also demonstrated a clear shift in the dominant serotype from DENV-3 to DENV-4 in India. This is the first report regarding the molecular characterization of Indian isolates of DENV-4, which has the potential to be involved in future outbreaks.

Studies of HIV prevention interventions such as pre-exposure prophylaxis (PREP) and circumcision in India are limited. The present study sought to investigate Indian truck-drivers initial commitment to PREP and circumcision utilizing the AIDS Risk Reduction Model. Ninety truck-drivers completed an in-depth qualitative interview and provided a blood sample for HIV and HSV-2 testing. Truck-drivers exhibited low levels of initial commitment towards PREP and even lower for circumcision. However, potential leverage points for increasing commitment were realized in fear of infecting family rather than self, self-perceptions of risk, and for PREP focusing on cultural beliefs towards medication and physicians. Cost was a major barrier to both HIV prevention interventions. Despite these barriers, our findings suggest that the ARRM may be useful in identifying several leverage points that may be used by peers, health care providers and public health field workers to enhance initial commitment to novel HIV prevention interventions in India.

Background: Understanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India., Methods: Persons 15-49 years old from 32 rural and 34 urban clusters were sampled using a stratified random method to represent adults in the high HIV prevalence Guntur district in Andhra Pradesh state. Interviews were conducted and dry blood spots were collected on 12,617 study participants. Testing for HSV-2 and syphilis was performed., Results: Adjusted HSV-2 and syphilis seroprevalence rates were 4.70% and 2.08% for men and 7.07% and 1.42% for women. For men, tattooing, >3 lifetime sex partners, tobacco use, and sex with men in the past 6 months were associated with HSV-2 or syphilis (ORs, 1.66-2.95, p < 0.05). Male circumcision was positively associated with HSV-2 infection (OR, 1.37, p = 0.028) though this could be due to residual confounding. In women, greater than one lifetime partner remained significantly associated with HSV-2 in multivariate analysis (OR, 2.61; 95% CI, 1.39-4.87). Among all behavioral risk factors and other covariates in women and men, HIV infection exhibited the strongest association with HSV-2 and syphilis (ORs, 8.2-14.2, p < 0.001). The proportion of individuals with HSV-2 who were HIV infected was less than the proportion with syphilis who were HIV infected (11.8% vs. 22.7%; p = 0.001)., Conclusions: Nearly one in four persons surveyed in this population-based study that were seroprevalent for syphilis, were also HIV infected. Common population risk factors for syphilis, HSV-2 and HIV and high rates of co-seroprevalence suggest that HIV testing, STI testing and service strategies for these would benefit from direct linkage in India.

Background: HIV testing is a key component of HIV control efforts. We examined the distribution of HIV testing in a population-based sample from Guntur district in Andhra Pradesh, which is estimated to have one of the highest prevalence rates of HIV in India., Methods: A total of 12,994 persons (15-49 years of age) were interviewed in Guntur district. We assessed associations with the uptake of HIV test, place and reasons for undergoing HIV testing and awareness of voluntary counselling and testing centres (VCTC) among sexually active adults., Results: The age-, sex-, urban- and rural-adjusted prevalence of HIV testing was 21.1% (95% CI: 19.1-23.2). The uptake of HIV testwas higher in women (27.2%) than in men (18.8%). Increasing education level, urban area residence and being in an occupation requiring mobility were significantly associated with uptake of the HIV test. A previous test for HIV was reported by 37.8% of men and 30.3% of women. The adjusted prevalence of VCTC awareness was 5.4% (95% CI: 4.3-6.4), being higher in men (9.2%) than in women (3.5%). Among those who had undergone HIV testing, 83.9% of men and 76.2% of women did so at a private sector health facility. Women were significantly more likely to under-go testing at VCTC/public sector facility (23.5%) than men (15%). More men (47.6%) than women (3.3%) reported undergoing testing voluntarily (p < 0.001). Women reported pregnancy (57.4%) as the most common reason for undergoing the test., Conclusion: These population-based data highlight the patterns of HIV testing and their associations. The high proportion of HIV testing in the private sector suggests the need to strengthen counselling in this sector to enhance HIV prevention activities.

The aim of the present study was to evaluate the impact of hypothyroidism on the autonomic regulation of the cardiovascular system by analyzing sympathetic and parasympathetic influences on the heart and the effect of thyroxine replacement. Thirty newly diagnosed female hypothyroid patients with mean age 32.73 +/- 9.98 years were recruited from the Thyroid Clinic, GTB Hospital, Delhi. Various Autonomic function tests to assess Basal heart rate variability, parasympathetic activity (E:I Ratio, 30:15 Ratio, Valsalva Ratio) and sympathetic activity (Postural Challenge test, Sustained handgrip test) were done before and after attainment of euthyroidism. There was significant increase in parasympathetic activity on achieving euthyroid state. The sympathetic activity too significantly improved after L-thyroxine supplementation. Lipid profile parameters significantly decreased after achieving euthyroid state. Our findings are consistent with previous reports that thyroxine therapy appears to restore the efferent vagal activity and alters the relative contribution of systems that maintain resting blood pressure and heart rate.

Dried blood spots (DBSs) on filter paper are being used increasingly in population-based human immunodeficiency virus (HIV) studies. This study evaluated the application of a BED enzyme immunoassay (EIA) on DBSs to estimate HIV incidence in a population-based study in India. The Calypte HIV-1 BED Incidence EIA was performed on 224 HIV-1-positive DBS samples, after screening 12 617 individuals from a population-based sample in Guntur district in the southern Indian state of Andhra Pradesh. The number of recently infected HIV cases was identified using this BED assay and was used to estimate the annual HIV incidence rate based on calculations and adjustment formulae suggested by the Centers for Disease Control and Prevention (CDC). The updated BED data management software provided by the CDC was used for analyses. Of the 224 HIV-1 antibody-positive DBS samples, 29 (12.95 %) were estimated by the BED HIV-1 assay to have been infected within the past 155 days. After adjusting for age, gender and rural/urban distribution of the population, the annual incidence rate of HIV-1 infection was estimated to be 0.32 % (95 % confidence interval 0.20-0.44 %). This annual incidence was 18.6 % of the HIV prevalence of 1.72 % in this study. Thus, the BED assay revealed a higher incidence of HIV in this study than was expected from the prevalence. Correlation of the BED assay with panel testing and longitudinal incidence data in the Indian population is needed to calibrate it for use in India.

Dengue (DEN) and chikungunya (CHIK) have emerged as the 2 most important arboviral infections of global significance. The similarities in clinical presentations, their circulation in the same geographic area, and the transmission through the same vector necessitate an urgent need for the differential diagnosis of these 2 infections. So far, no single assay is reported for differential diagnosis of these 2 infections. In this study, we report the development and evaluation of a 1-step single-tube duplex reverse transcription polymerase chain reaction (D-RT-PCR) assay by targeting E1 gene of CHIK and C-prM gene junction of DEN virus (DENV), respectively. The sensitivity of this assay was found to be better than conventional virus isolation and could detect as low as 100 copies of genomic RNA, which is equivalent to respective virus-specific RT-PCR. The evaluation was carried out with 360 clinical samples from recent CHIK and DEN outbreaks in India. This assay could also be able to detect dual infection of CHIK and DEN in 3 patients. The phylogenetic analysis based on the nucleotide sequencing of D-RT-PCR amplicon could precisely identify the genotypes of all the serotypes of DENV and CHIK viruses (CHIKV). These findings demonstrate the potential clinical and epidemiologic application of D-RT-PCR for rapid sensitive detection, differentiation, and genotyping of DENV and CHIKV in clinical samples.

An epidemic of Chikungunya fever of unprecedented magnitude occurred in many parts of India in early 2006 after an interval of 33 years, and there has been a resurgence in some parts of South India since June 2007. The article highlights clinical manifestations of infection and various molecular tests that were used for diagnoses of Chikungunya virus infection. Of particular interest is the real-time loop-mediated isothermal amplification (RT LAMP) assay, which is rapid and cost-effective and can be adopted at ill-equipped laboratories. Clinical symptoms were characterized by a triad of fever, rash, and severe rheumatic manifestations. RT LAMP identified 20 additional Chikungunya virus-positive cases, compared with reverse-transcriptase polymerase chain reaction. Chikungunya virus was isolated from 20 randomly selected samples. Genotyping of the virus isolates revealed that the East Central South African genotype of Chikungunya virus was the etiologic agent of this epidemic. Molecular diagnosis is an important tool to identify such new vectorborne viral illnesses.

Chikungunya fever is an important arboviral infection prevalent throughout Africa and Southeast Asia. Recently, in 2006, it has reemerged in many parts of India, affecting more than a million persons. A detail serological, virological, and molecular investigation of this unprecedented outbreak was carried out by collecting and studying 540 samples from all the affected regions of India during this epidemic. An in-depth investigation revealed the presence of anti-Chikungunya antibodies in 68% of the samples and genomic RNA in 49% of them. In addition 32 Chikungunya viruses were isolated from 45 representative polymerase chain reaction-positive samples. The nucleotide sequences of partial E1 gene of 25 representative Chikungunya viruses were deciphered. The sequence analysis indicated that all the isolates of this epidemic belonged to the new Indian Ocean island clade of East Central South (ECS) African genotype. This study conclusively proved the genotype shift from Asian to ECS African as the major factor in the reemergence of Chikungunya in an unprecedented outbreak in India after a gap of 32 years.

Background: The introduction of highly active antiRetroviral therapy (HAART) in several centers in India has raised the expectation that many human immunodeficiency virus (HIV)-infected individuals will live longer. However, as most infected individuals remain undiagnosed till the late stage of infection; several continue to succumb to this infection even in the era of HAART., Materials and Methods: A retrospective study was conducted over a 14 year period on 2,050 HIV-infected, hospitalized patients to evaluate the pattern of mortality and to determine proportion, risk factors and causes of death., Results: A total of 145 deaths among HIV-infected patients were documented during hospitalization, with an overall mortality rate of 8.15%: 2.94% in the pre HAART era (1992-1996), 7.29% in the early HAART era (1997-2000) and 9.73% in the present HAART era (2001-2005). 11.7% (17/145) of deceased patients were aware of their HIV-infected status before getting admitted. Only five patients were on any antiretroviral treatment prior to admission. Ninety (62.07%) deaths were HIV-related (AIDS-defining conditions) and 55 (37.93%) were non HIV-related., Discussion: Our study stresses the importance of early diagnosis of HIV infection to curb adult mortality, which will continue to rise unless effective treatment interventions are introduced.

Central nervous system cryptococcosis is an important cause of mortality among human immunodeficiency virus (HIV) reactive patients. A retrospective study was conducted on a total of 1,863 HIV reactive hospitalized patients suspected of cryptococcal meningitis. Three hundred and fifty-nine cerebrospinal fluid specimens of these cases were screened for various cryptococcal investigations. Thirty-nine out of 359 (10.86%) showed a definite diagnosis of cryptococcosis with a mortality rate of 25.64%. Prevalence of cryptococcal meningitis in the total HIV reactive cohort was 2.09%. Concurrent cryptococcal meningitis and tuberculosis was seen in 33.3% cases. A high index of clinical suspicion and routine mycological surveillance is required to help an early diagnosis and appropriate therapy, as majority of patients respond well to therapy if treated early.