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In the present study, we explored the potential diagnostic application of B cell linear peptides derived from the p72 protein of African Swine Fever Virus (ASFV) using a two-step bioinformatics approach for developing an indirect enzyme-linked immunosorbent assay (ELISA) for ASF detection. Through computational analysis, eight linear B cell epitopes with significant conservation across various ASFV genotypes were identified. These peptides were chemically synthesized and evaluated for their immunoreactivity using specific rabbit hyperimmune serum against the ASFV p72 protein. The synthesized peptides displayed notable reactivity in dot-ELISA and subsequently in indirect-ELISA. Validation of the indirect ELISA was conducted using samples collected during ASFV outbreaks in the northern states of India from 2022 to 2023, and further corroborated using a commercial kit. The P1 peptide-based indirect ELISA demonstrated a sensitivity of 100% and a specificity of 86%. Additionally, peptides P3, P4, P5, P7, and P8 exhibited a specificity of 100%, while peptides P2, P3, P4, P6, and P7 displayed a sensitivity greater than 70% in the indirect ELISA. These results underscore the diagnostic potential of p72 protein-specific B cell epitopes for the detection of ASFV infection in field settings. The developed assay holds promise for ASFV infection detection, as well as for seromonitoring and serosurveillance applications. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India; however, there are no programs for COPD in India at primary care level. Kerala became the first state in India to implement a program at primary care for COPD, called the Step Wise Approach to Airway Syndrome program. Objective: The objective of the study was to evaluate and document the implementation status of a program for obstructive airway disease (OAD) in Trivandrum district of Kerala state in India and compare the treatment characteristics of patients with OAD seeking care from the centers implementing and not implementing this program for OADs. Methods: A cross-sectional study was done as early evaluation of a program for OAD implemented in Kerala state, India, from October 2018 to February 2019. Results: A reflection of the health-seeking behavior due to better facilities at the FHCs. There was no difference in the hospital visits or emergency department visits between the two groups. However, there was a statistically significant difference in the average number of visits per patient to health center for taking injectable drugs and visits for nebulization. Forty-nine (94%) of the COPD and 36 (100%) of the asthma patients underwent spirometry from implementing center itself. A higher proportion of patients receiving care from implementing centers (30.9%) never had to buy inhalers from outside. Conclusion: This is the first time that a public health programme for chronic respiratory disease management at primary care level was evaluated in India. The study has provided valuable insights on the need for strengthening the training for health care providers as well as patient education in bringing about a change in patient attitudes. [ABSTRACT FROM AUTHOR]

Background: A robust disaggregated understanding of the determinants of tuberculosis (TB) in each local setting is essential for effective health system and policy action to control TB. Objectives: The objective of the study was to identify population attributable risk (PAR) for TB disease based on the locally available evidences for Kerala, India. Methods: Systematic review was done for risk factors of TB in the state. The second set of searches was done to understand the prevalence of the identified risk factors in general population in Kerala. With all available studies and reports, an expert group consensus was made to finalize state-specific prevalence of risk factors. Population attributable fractions were calculated for identified risk factors. Results: PAR for TB disease in Kerala obtained was 24% for undernutrition, 15% for diabetes, 15% for tobacco use, and 1% for HIV. Conclusion: Kerala state's PAR for TB was comparatively lower for HIV but higher for diabetes mellitus. Similar exercises for summarizing population risk factors need to happen at all states for making plans to effectively combat TB. [ABSTRACT FROM AUTHOR]

What is known and objective Chronic obstructive pulmonary disease ( COPD), a preventable and treatable disease, has been described as '10% medication and 90% education'. Extreme physician scarcity limits the implementation of quality healthcare delivery in India. We conducted this study to evaluate the effectiveness of clinical pharmacist intervention on health-related quality of life ( HRQoL) in patients with COPD in an Indian tertiary care hospital. Methods An open-labelled randomized controlled study was conducted over a 3-year period, at Kasturba Medical College Hospital, Manipal, India, after obtaining institutional ethics clearance ( IEC 88/2012). The study was registered with the Indian clinical trial registry ( CTRI/2014/08/004848). Patients were randomly assigned to two groups (intervention group [ IG] and control group [ CG]) by envelope method. St. George's Respiratory Questionnaire ( SGRQ) was used to assess the HRQoL. The pharmacist intervention laid emphasis on (i) importance of medication compliance, (ii) need for smoking cessation, (iii) simple exercise, (iv) proper use of inhaler devices and (v) need for timely follow-up by pulmonary medicine department. SGRQ assessment was repeated at 6, 12, 18 and 24 months. Results Of 328 patients with COPD screened during the study period (March 2012 to June 2013), 260 (79%) were recruited. Of these, 202 (78%) patients completed follow-up (98 in CG and 104 in IG). Both groups were matched for baseline, sociodemographics and clinical characteristics. SGRQ scores and its subscales (symptoms, activity and impact) improved significantly after the pharmacist intervention in IG at follow-up ( P < 0·001). What is new and conclusion Our randomized controlled study shows that pharmacist intervention improved the HRQoL of patients with COPD in India. The generalizability of our results requires exploration even within other settings in India. Nonetheless, our results provide support for a greater involvement of pharmacists in the care of patients with COPD. [ABSTRACT FROM AUTHOR]

Consequences of a catastrophic flood on the habitat quality and the concurrent responses of the bentho-pelagic community were studied in Cochin estuary, a eutrophic estuary along the southwest coast of India. The episodic flood in 2018 led to a marked decline in the dissolved nutrients and heavy metal concentrations in water and sediments of the estuary. The pre-flood phytoplankton abundance dominated by a bloom-forming species Cerataulina bicornis experienced a significant drop after the flood. Contrarily, zooplankton and macrobenthos responded favorably towards the flood-imposed habitat alterations. Higher susceptibility to heavy metal pollution and increased grazing pressure from gelatinous carnivores restricted the abundance of Copepoda, the dominant zooplankton taxon during pre-flood. The lower heavy metal concentration in the sediment after the flood favored higher macrobenthic abundance and diversity with a conspicuous change in the community structure from opportunistic polychaetes, indicators of pollution to molluscans and crustaceans, indicators of the healthy benthic zones. Unlabelled Image • Cochin estuary (CE) is a eutrophic wetland ecosystem in the west coast of India. • We studied the effect of flood on heavy metal pollution and bentho-pelagic community in CE. • Hydrological attributes and heavy metal concentration exhibited marked variability. • Phytoplankton abundance dropped significantly subsequent to flood. • Zooplankton and benthos responded favorably to flood-imposed habitat changes. [ABSTRACT FROM AUTHOR]

Background: Neurodevelopmental disability is a common long-term concern following surgery for congenital heart disease (CHD). Little information is available from low-resource environments where the majority of children with CHD are born. Several challenges in the CHD care continuum exist in such environments., Methods: We followed 1346 infants who were operated for CHD using cardiopulmonary bypass from five paediatric cardiac programmes across India. The neurodevelopmental assessment was done using the Developmental Assessment Scale for Indian Infants (DASII) at 6 months after surgery., Results: A total of 1145 (94.8%) infants were alive at 6 months and 127 (11.1%) were lost to follow-up. The mean age of participants at baseline was 5.2 (3.6) months. The mean motor developmental quotient (DMoQ) and mental developmental quotient (DMeQ) of the remaining 1018 infants were 81.8 (69.5, 93.0) and 87.7 (77.1, 95.7), respectively. A total of 262 (25.7%) infants had motor developmental delay and 157 (15.4%) had mental developmental delay. Syndromic association, younger age at surgery, duration of mechanical ventilation and head circumference were significantly associated with DMoQ. The DMeQ was associated with syndromes, duration of hospital and intensive care unit stay and socioeconomic status. The preoperative condition did not impact mental and motor development. Motor clusters with maximum delay included body control and locomotion. Mental clusters with maximum delay included reaching and manipulation, social interaction-imitative behaviour and vocabulary comprehension., Conclusions: Survivors of infant heart surgery experience significant motor and mental neurodevelopmental delay. This delay is associated with similar factors reported by earlier studies. As more high-risk infants undergo cardiac surgery in low-resource settings, a growing population will require significant societal resources for neurodevelopmental assessment as well as neurodevelopmental rehabilitation. These resources include trained personnel for comprehensive developmental assessment of survivors of CHD surgery, as well as infrastructural requirements for dedicated assessment rooms in centres providing surgical care for CHD patients., Competing Interests: Competing interests: None declared, (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Pregestational diabetes mellitus (PGDM) occurs when a woman becomes pregnant after having diabetes mellitus. The presence of diabetes during the entire pregnancy can have an adverse impact on fetal and neonatal outcomes. The objective of this study is to examine the association between PGDM and neonatal outcomes at birth., Methods and Analysis: This prospective hospital-based cohort study is ongoing at three tertiary-level hospitals in Kerala, India. The study targets to recruit 1260 pregnant women. All pregnant women above the age of eighteen who had confirmed pregnancy in an early pregnancy scan and in the first trimester of pregnancy visiting the three study sites for antenatal care will be included in the study. Those who will have a miscarriage, an abortion or twin pregnancies will be excluded from the study. All pregnant women will be evaluated for diabetic state via RBS, HbA1c and FBS based on the International Association of Diabetes and Pregnancy Study Groups criteria during their initial visit to the study sites. PGDM will be diagnosed by the following criteria-FBS ≥126 mg% OR HbA1c ≥6.5 mg% OR Random blood glucose ≥200 mg% on the initial visit or documented prior to the index pregnancy. Neonatal outcomes among the newborn babies will be assessed on the day of birth. We will report adjusted ORs with 95% CI for significant associations derived from multivariable logistic regression analysis., Ethics and Dissemination: The present study received ethical approval from the three study sites. Informed consent will be obtained from the study participants before data collection., Trial Registration Number: CTRI/2024/06/068978., Conclusion: Early identification and management of PGDM among mothers will probably help to prevent adverse neonatal outcomes at birth., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: We aim to characterize the clinical, pathological, laboratory and imaging features of various antibody defined IIM subgroups in Indian population., Methodology: 103 patients who satisfied 2017 ACR/ EULAR Classification criteria for IIM, and tested seropositive for myositis antibodies using Immunoblot technique were retrospectively identified. Patients were classified into following subgroups - Mi2B group, SRP group, Anti RNA Synthetase antibody group (Jo 1, PL 7, PL 12, OJ), multiple MSA, only MAA group (U1RNP, Ro 52, SS-A, SS-B, PM Scl 75, PM Scl 100). Clinical, laboratory, histopathology and imaging parameters were compared among different groups., Results: Ro52 (n = 31; 22.46%) was the most common autoantibody seen in our cohort followed by Mi2B (n = 26; 18.84%) and SRP (n = 20; 14.49%). Skin manifestations (p = 0.053) and joint involvement (p = 0.023) were seen more frequently among Mi2B and MAA sub groups. Three out of 4 patients with persisting antibody positivity on serial measurements developed clinical relapse between 2 and 3 years after the initial episode. Remaining 2 patients showed declining titres of antibodies and developed no clinical relapses during follow up period of 5 and 6 years. Among histopathology features, perifascicular atrophy was found to be more prevalent among Mi2B (55.6%) and MAA subgroups (31.3%) (p value = 0.037). In thigh muscle MRI, Mi2B group showed a pattern of diffuse involvement of affected muscles without regional preference, with sparing of hamstring group. SRP group showed characteristic pattern of edema involving peripheral regions of Quadriceps femoris and central regions of Adductor group along with severe atrophy involving hamstring and adductor compartment muscles. ILD was seen in 27.5% of patients who underwent CT Chest. 3 patients were found to have underlying malignancy at the time of diagnosis of myositis (Mi2B = 2 and PM Scl = 1)., Conclusion: Classification of IIM patients based on myositis antibodies yields subgroups with certain differences in clinical, laboratory, histopathological and imaging features., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: There is limited data on the prevalence and risk factors of colonic adenoma from the Indian sub-continent. We aimed at developing a machine-learning model to optimize colonic adenoma detection in a prospective cohort., Methods: All consecutive adult patients undergoing diagnostic colonoscopy were enrolled between October 2020 and November 2022. Patients with a high risk of colonic adenoma were excluded. The predictive model was developed using the gradient-boosting machine (GBM)-learning method. The GBM model was optimized further by adjusting the learning rate and the number of trees and 10-fold cross-validation., Results: Total 10,320 patients (mean age 45.18 ± 14.82 years; 69% men) were included in the study. In the overall population, 1152 (11.2%) patients had at least one adenoma. In patients with age > 50 years, hospital-based adenoma prevalence was 19.5% (808/4144). The area under the receiver operating curve (AUC) (SD) of the logistic regression model was 72.55% (4.91), while the AUCs for deep learning, decision tree, random forest and gradient-boosted tree model were 76.25% (4.22%), 65.95% (4.01%), 79.38% (4.91%) and 84.76% (2.86%), respectively. After model optimization and cross-validation, the AUC of the gradient-boosted tree model has increased to 92.2% (1.1%)., Conclusions: Machine-learning models may predict colorectal adenoma more accurately than logistic regression. A machine-learning model may help optimize the use of colonoscopy to prevent colorectal cancers., Trial Registration: ClinicalTrials.gov (ID: NCT04512729)., (© 2024. Indian Society of Gastroenterology.)

Background: Endoscopic sub-mucosal dissection (ESD) is an established endoscopic modality for the management of colorectal polyps. However, there are no studies regarding the outcomes of ESD from India. In this study, we aimed at evaluating the outcomes of ESD in patients with adenomatous polyps in the colon and rectum., Methods: Data of consecutive patients who underwent ESD for colorectal polyps from 2018 to 2021 were analyzed, retrospectively. The primary outcome of the study was the technical success of ESD. The secondary outcomes included the rate of histologically complete resection (R0), adverse events and recurrence., Results: Seventy patients (63.5 years, 60% males) underwent ESD for polyps in colon and rectum. A majority were located in rectum (80%) and sigmoid colon (15.7%). Narrow band classification of the polyps was Japanese Narrow Band Imaging Expert Team (JNET)-2a in 50 (71.4%) and JNET-2b in 13 (18.6%) patients. ESD was technically successful in 64 (91.4%) patients using conventional technique (72.8%) and pocket or tunnelling technique (18.6%). There were no major adverse events. Histologically RO was achieved in 58 (82.8%) patients and deep sub-mucosal invasion was noted in 12 patients. At a median follow-up of 19 (interquartile range [IQR] 15-27) months, recurrence was noticed in four (5.7%) patients all of which could be managed endoscopically., Conclusion: ESD, performed at a tertiary care centre in India, yields high rates of technical success and histologically R0, with a relatively low incidence of adverse events and recurrences., (© 2024. Indian Society of Gastroenterology.)

Background: Driven by habitat loss and fragmentation, large carnivores are increasingly navigating human-dominated landscapes, where their activity is restricted and their behaviour altered. This movement, however, raises significant concerns and costs for people living nearby. While intricately linked, studies often isolate human and carnivore impacts, hindering effective management efforts. Hence, in this study, we brought these two into a common framework, focusing on an interface area between the critical tiger habitat and the human-dominated multiple-use buffer area of a central Indian protected area., Methods: We employed a fine-scale camera trap survey complemented by GPS-collar movement data to understand spatio-temporal activity patterns and adjustments of tigers in response to anthropogenic pressures. We used an occupancy framework to evaluate space use, Bayesian circular GLMs to model temporal activity, and home range and step length analyses to assess the movement patterns of tigers. Further, we used predation-risk models to understand conflict patterns as a function of tiger presence and other habitat variables., Results: Despite disturbance, a high proportion of the sampled area was occupied by 17 unique tigers (ψ = 0.76; CI [0.73-0.92]). The distance to villages (β ± SE = 0.63 ± 0.21) and the relative abundance of large-bodied wild prey (β ± SE = 0.72 ± 0.37) emerged as key predictors of tiger space use probability, indicating a preference for wild prey by tigers, while human influences constrained their habitat utilisation. Distance to villages was also identified as the most significant predictor of the tigers' temporal activity (μ ± σ = 3.03 ± 0.06 rad) that exhibited higher nocturnality near villages. A total of 11% of tiger home ranges were within village boundaries, accompanied by faster movement in these areas (displacement 40-82% higher). Livestock depredation probability by tigers increased with proximity to villages ( P = 0.002) and highway ( P = 0.003). Although tiger space use probability ( P = 0.056) and wild prey abundance ( P = 0.134) were non-significant at the 0.05 threshold, their presence in the best-fit predation-risk model suggests their contextual relevance for understanding conflict risk. The results highlight the importance of appropriately managing livestock near human infrastructures to effectively mitigate conflict., Conclusions: Shared space of carnivores and humans requires dynamic site-specific actions grounded in evidence-based decision-making. This study emphasises the importance of concurrently addressing the intricate interactions between humans and large carnivores, particularly the latter's behavioural adaptations and role in conflict dynamics. Such an integrated approach is essential to unravel cause-effect relationships and promote effective interface management in human-dominated landscapes., Competing Interests: The authors declare that they have no competing interests., (© 2024 Mohan et al.)

Background: Most Parkinson's disease (PD) loci have shown low prevalence in the Indian population, highlighting the need for further research., Objective: The aim of this study was to characterize a novel phosphatase tensin homolog-induced serine/threonine kinase 1 (PINK1) mutation causing PD in an Indian family., Methods: Exome sequencing of a well-characterized Indian family with PD. A novel PINK1 mutation was studied by in silico modeling using AlphaFold2, expression of mutant PINK1 in human cells depleted of functional endogenous PINK1, followed by quantitative image analysis and biochemical assessment., Results: We identified a homozygous chr1:20648535-20648535 T>C on GRCh38 (p.F385S) mutation in exon 6 of PINK1, which was absent in 1029 genomes from India and in other known databases. PINK1 F385S lies within the highly conserved DFG motif, destabilizes its active state, and impairs phosphorylation of ubiquitin at serine 65 and proper engagement of parkin upon mitochondrial depolarization., Conclusions: We characterized a novel nonconservative mutation in the DFG motif of PINK1, which causes loss of its ubiquitin kinase activity and inhibition of mitophagy. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society., (© 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: Internet Addiction and phubbing are prevalent disruptive behaviours among students. The aim of this study was to assess the relationship between phubbing, smartphone addiction and some of the related psychological effects among dental undergraduates., Materials and Methods: A multi-centric cross-sectional pre-validated questionnaire-based study was conducted among undergraduate students of five different dental colleges across India. The questionnaire included the Phubbing Scale, Barratt Impulsiveness Scale (BIS), Smartphone Application-based Addiction Scale (SABAS), and Rosenberg Self-Esteem Scale (RSES). The data were analysed with IBM SPSS version 21, followed by a t-test, analysis of variance (ANOVA), and Spearmen's co-relation to find the association between different psychological variables among study subjects., Results: The total sample comprise of 1226 with mean age of 22.35. The SABAS showed a higher mean ± standard deviation (SD) score (3.17 ± 0.93). The Phubbing Scale showed a positive correlation with the SABAS (0.658), the results were found to be highly statistically significant (P = 0.01)., Conclusion: The present study found a higher prevalence of phubbing and smartphone addiction among dental students. Our results showed that impulsiveness leads to internet addiction and thus phubbing is becoming a way to find solace during communication to escape anxiety and distress., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Background: In advanced-stage epithelial ovarian cancer (EOC) standard of care is upfront debulking surgery (UDS) followed by adjuvant chemotherapy. Interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS) is a reasonable alternative., Methods: This study was a retrospective review of patients of Stage III/IV EOC treated either by UDS or NACT-IDS between January 2016 and December 2018 to report the comparison of progression-free survival (PFS) and overall survival (OS) of patients with advanced-stage EOC treated with either UDS or NACT-IDS., Results: Out of 50 patients, 19 (38%) underwent UDS, and 31 (62%) received NACT. The mean follow-up duration was 27.7 months. No gross residual disease was achieved in 52.6% of the UDS group and in 70.4% of the NACT-IDS group. The median PFS of 20 and 30 months was observed in the UDS and NACT-IDS groups, respectively (log-rank P = 0.054). The median OS was 36 months in the NACT-IDS group and could not be reached in the UDS group (log-rank P = 0.329). Only residual disease was significantly associated with survival (hazards ratio 3.03, 95% confidence interval: 1.19-7.74) on multivariate Cox regression analysis., Conclusions: In advanced-stage EOC, the survival outcomes of NACT-IDS are comparable with those of UDS. Apart from the patient-specific parameters, the decision for UDS or NACT-IDS should take in account the expertise of the surgeon and the institutional capacity as a whole., (Copyright © 2023 Copyright: © 2023 Indian Journal of Cancer.)

Dangi, Meenu, Arnab Sadhukhan, Poninder Kumar, S. Bandopadhayay, Vijay K. Sharma, V.K. Patra, Manu Chaudhary, and Vipin Rana. Retinal manifestations in high altitude. High Alt Med Biol . 24:296-301, 2023. Aim: To study the high altitude (HA)-related retinal manifestations among security personnel and thus to provide new insights into the characteristics and mechanisms of retinopathy. Materials and Methods: This was a multicentric, nonrandomized prospective observational and descriptive study. We studied 54 security personnel over 1 year, who were referred from HA areas of northern India and north-eastern India for ocular problems. Complete coagulation profile was performed among patients with vascular occlusion. Results: There were total of 54 patients with ages ranging from 22 to 55 years. HA retinopathy was noticed in 28 patients: central retinal vein occlusion (6 patients), branch retinal vein occlusion (4 patients), branch retinal artery occlusion (1 patient), central retinal artery occlusion (4 patients), ocular ischemic syndrome (1 patient), central serous chorioretinopathy (7 patients), acetazolamide-induced maculopathy (1 patient), and solar retinopathy (2 patients). Along with an increased hematocrit, serum homocysteine was raised in the majority of vascular occlusions. The mean age was 38.16 years, the mean altitude was 14,716 ft, and the mean duration of stay was 11.2 weeks. Conclusion: Hypobaric hypoxia due to HA is a potential risk for HA retinopathy and associated vascular occlusions. Aside from increased hematocrit, hyperhomocysteinemia is a potential cause of vascular occlusions.

It is estimated that Head and Neck Cancer (HNC) will cause over 500,000 deaths worldwide by 2030. This is coupled with a shortage of trained healthcare professionals to manage HNC. An alternative cadre of workers - community healthcare workers (CHWs) - could be deployed to address this shortage. A systematic scoping review was conducted. Seven major databases were searched from inception to 30 June 2021. Studies were included from across the globe and excluded if the focus was not on HNC or CHWs. We identified 13 studies for inclusion. Twelve were based in India. CHWs were deployed in education and awareness raising initiatives, community screening, and ensuring compliance with treatment and follow-up. CHWs were compared to specialists for effectiveness in four studies with one reporting sensitivity of 94·3% and specificity 99·3% for HNC screening. This review highlights ways in which CHWs can be deployed to meet the growing demand for HNC services. The existing evidence suggests that CHWs can have potential roles in screening for HNC, therefore facilitating an earlier diagnosis. It is important this screening is implemented where there is appropriate capacity to manage HNC. Further research needs to be carried out to explore barriers and facilitators to these programmes.

Objectives: The primary objective was to report the 1-year all-cause mortality among patients with stroke. The secondary objectives were (1) to report the mortality stratified by type of stroke and sex and (2) to report predictors of 1-year mortality among patients with stroke., Design: A prospective cohort study., Setting: Institutional-stroke care unit of a tertiary care hospital PARTICIPANTS: Patients who were treated in the study institution during 2016-2020 for acute stroke and were followed up for a period of 1 year after stroke in the same institution., Main Outcome Measures: The main outcome measures were the mortality proportion of any stroke and first ever stroke cohorts at select time points, including in-hospital stay, along with 2 weeks, 2 months, 6 months and 1 year after index stroke. The secondary outcomes were (1) mortality proportions stratified by sex and type of stroke and (2) predictors of 1-year mortality for any stroke and first ever stroke., Results: We recruited a total of 1336 patients. The mean age of participants was 61.6 years (13.5 years). The mortality figures for 2 weeks, 2 months, 6 months and 12 months after discharge were 79 (5.9%), 88 (6.7%), 101 (7.6%) and 114 (8.5%), respectively, in the full cohort. The in-hospital mortality was 45 (3.4%). The adjusted analysis revealed 3 predictors for 1-year mortality after first ever stroke-age, pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (mRS) score at baseline. The same for the full cohort had only two predictors-age and pre-treatment NIHSS score., Conclusion: Mortality of stroke at 1-year follow-up in the study population is low in comparison to several studies published earlier. The predictors of 1-year mortality after stroke included age, NIHSS score at baseline and mRS score at baseline., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The cleaning rock pool shrimp commonly inhabit the shallow waters of reef and crevices regions at 0.5-3.0 m depth. Recent exploration conducted off the Gulf of Mannar and Agatti Island yielded the species, Urocaridella antonbruunii (Bruce, 1967) from the bottom curve of the coral boulder at a depth of 0.5-1.0 m. This is the new record for the Gulf of Mannar and Lakshadweep waters. Major distinguishing morphological characters of the congener's were described and illustrated. The molecular analysis confirmed the species occurrence in Indian waters followed the intraspecific and interspecific genetic divergences (16S gene) were estimated between 0.3-2.1% for within species and 6.4-11.2% for between species respectively. Additionally, we updated and provided the illustrative key characters for all members of the genus Urocaridella.

Background: Previous data from South Asia and India had shown that patients with nonalcoholic fatty liver disease (NAFLD) have mild liver disease severity. There are no data regarding long-term clinical outcomes in patients with NAFLD from South Asia. The aim of the study was to evaluate the clinicopathological profile, severity of NAFLD, and clinical outcomes in a large cohort of patients with NAFLD from South Asia. Methods: In an ongoing real-life study [Indian Consortium on nonalcoholic fatty liver disease (ICON-D)], interim data captured across 23 centers in India over 18 months was analyzed for clinicopathological profile, severity of NAFLD, and hepatic/extrahepatic events on follow-up. Results: Of 4313 patients (mean age 45 ± 12.2 years, males 52%), data on metabolic risk factors in 3553 (82.3%) patients revealed that 378 (10.6%) were lean, 575 (16.2%) overweight, 2584 (72.7%) obese; metabolic syndrome in 1518 (42.7%) and at least one metabolic risk factor in 3292 (92.6%) patients. Evidence of significant or advanced fibrosis assessed with [aspartate transaminase to platelet ratio index (APRI), n  = 3196 (74%)], [fibrosis-4 (FIB-4), n  = 3554 (82.4%)], [NAFLD fibrosis score (NFS), n  = 1924 (44.6%)], [Fibroscan, n  = 2475, (57.3%)], and histology [ n  = 267 (6.2%)] was present in 682 (21.3%), 676 (19%), 397 (20.6%), 715 (29%), and 41 (15.4%) patients, respectively; 246 (10%) patients on Fibroscan and 22 (8.2%) on histology had evidence of cirrhosis. On a mean follow-up 43.5 months, hepatic and extrahepatic events recorded in 1353 (31.3%) patients showed that patients with compensated cirrhosis [71 (5.2%)] had more hepatic [26 (36.7%)] and extrahepatic events [8 (11.3%)] in comparison with those without cirrhosis ( P  < 0.0001). Conclusion: Around one fifth of patients with NAFLD in South Asia have significant liver disease. Both hepatic and extrahepatic events on follow-up are observed more commonly in patients with nonalcoholic steatohepatitis-related compensated cirrhosis.

Distribution and ecological risk assessment of trace metals were carried out in the core sediments of a highly urbanized tropical mangrove ecosystem along the Southwest coast of India. The metal distribution pattern was as follows: Co, Cu, Ni and Pb adsorbed onto Fe oxyhydroxides and fine grained sediments; Cd and Zn preferential adsorption by organic matter and Cr scavenging by Mn oxyhydroxides. Cd, Pb and Zn were significantly enriched in upper sediments, while Cd, Ni and Zn were present in metal exchangeable fractions. Geoaccumulation index (I geo ) suggested that the study area showed moderate to strong pollution of Cd and Zn, whereas unpolluted to moderately polluted with respect to Co, Cr, Cu, Mn, Ni and Pb. Cd enrichment caused high ecological risk, primarily attributed to anthropogenic activities. Mangrove ecosystems are efficient sequester of trace metals but anthropogenic addition can cause significant fraction of exchangeable metals and pose high ecological risk., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background and Aims: Pregnant women have significant morbidity and mortality due to COVID-19 infection. Pregnancy and diabetes are known risk factors for severe COVID 19 infection. Understanding the interactions between COVID-19 and diabetes in pregnancy is crucial in developing appropriate therapeutic approaches. India, like many other countries, has a very high prevalence of diabetes and COVID-19 infected cases. Such studies are minimal worldwide and none from India to the best of our knowledge., Materials and Methods: We did a retrospective cross-sectional study. 856 COVID-19 infected pregnant women were included in the study. We estimated the impact of diabetes on the severity of COVID-19 infected pregnant women and compared the outcomes with the non-diabetic group., Results: Prevalence of diabetes in pregnancy in the present study was 15.43%(n = 132/856). Prevalence of diabetes in non-severe infection was 14%(n = 115/818), severe infection was 44.73%(n = 17/38), and in maternal deaths was 75% (n = 6/8). The age-adjusted odds ratio for diabetes for severe infection was 4.492 (95% CI = 2.277-8.865, p < 0.001). COVID-19 infected pregnant women with diabetes were at higher risk for Cesarean section (78.3%) and ICU admission for newborns (14.81%) CONCLUSION: Diabetes in pregnant women is strongly associated with the severity of COVID-19 infection. The prevalence of diabetes in pregnancy increases as the severity of COVID-19 infection increases. Diabetes is associated with more adverse outcomes in mothers and newborns. It is necessary to identify pregnant women with diabetes and prioritize them in public health interventions like vaccination., (Copyright © 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Objectives: To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity., Design: Hospital-based prospective cohort study., Setting: Two tertiary care centres in Kerala, India., Participants: Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention., Statistical Analysis: Pearson χ 2 test or Fisher's exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni's correction was used for multiple comparisons., Results: We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes., Conclusions: Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The rapid consumption of advanced e-products has intensified problems for the linear economy; constantly diminishing natural resources employed in production processes have created a need of recycle and reuse. Although the transition to a circular economy proposes to end the loop of e-products, it needs the application of processes such as urban mining to recover resources as secondary raw material. The present study intends to examine the issues and challenges of electronic waste urban mining (EWUM) in India that need to be assessed for the development of a sustainable economy. To accomplish this, the current study employs integrated Multi-Criteria-Decision making methods (MCDM). Step-Wise Weight Assessment Ratio Analysis (SWARA) is used to prioritize issues and their possible solutions with Weighted Assessment Sum Product Assessment (WASPAS) methods introduced to explore these challenges and provide solutions for managing EWUM. There is an immediate need to acknowledge the issues confronted by stakeholders in urban mining processes for successful transition to a circular economy. A better understanding of the issues will help policy makers and decision makers to implement best practices to enhance the urban mining process in India. This study has shown that socio-economic (SE) issues are the most critical issues in EWUM in India. The possible solutions that would have most impact are to enhance awareness campaigns for people to educate themselves regarding e-waste, train staff to handle safe disposal of e-waste and produce eco-friendly electronic products., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Melioidosis is a tropical infectious disease with diverse clinical presentations. We aimed to investigate the characteristics and mortality risk factors of patients diagnosed with melioidosis in the past 10 years. This was a retrospective cohort study conducted at a quaternary care centre in South India. Clinical, demographic, and biochemical data in patients diagnosed with melioidosis with cultures were collected between January 2011 and December 2020 from medical records. Logistic regression analysis was performed to screen mortality risk factors of melioidosis in addition to descriptive statistics and chi-square analysis. Seventy-three melioidosis patients' records were analysed, and the most common comorbidity was type 2 diabetes mellitus ( n  = 53, 72.6%). The patients showed diverse presentations: pulmonary involvement, 30 (41.1%); splenomegaly, 29 (39.7%); abscesses and cutaneous involvement, 18 (24.7%); lymph node, 10 (13.7%); arthritis and osteomyelitis, 9 (12.3%); and genitourinary infection, 4 (5.4%). The mortality was noted to be 15 (20.5%). Logistic regression analysis indicated that chronic kidney disease (OR = 14.0), CRP >100 IU/L (OR = 6.964), and S. albumin <3 gm/dl (OR = 8.0) were risk factors associated with mortality and can guide in risk stratification. Hypoalbuminemia is a novel mortality risk factor, detected in this study, and requires further investigation to validate its utility as a prognostic marker and reveal possible therapeutic benefits in clinical correction., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Raviraj Menon et al.)

Swine influenza virus (SIV) belongs to family Orthomyxoviridae and can cause acute respiratory infection in pigs. Several pandemic H1N1 human fatal influenza cases were reported in India. Though pigs are predisposed to both avian and human influenza virus infections with the potential to generate novel reassortants, there are only a few reports of SIV in Indian pigs. We conducted a serological survey to assess the status of H1N1 infection in pigs of various states in India, between 2009 and 2016. Based on Haemagglutination inhibition (HI) assay, seroprevalence rate of H1N1 virus ranged between 5.2% (2009) and 36.3% (2011). Widespread prevalence of antibody was observed in eastern Uttar Pradesh from 6.2 to 37.5% during the study period. Co-circulation of seasonal H1N1 virus along with pandemic H1N1 virus was indicated by the presence of specific antibodies against seasonal H1N1 virus in eastern part of Uttar Pradesh. Seroprevalence rate in pigs and influenza infection trend in human shows the possible spill over transmission of influenza to pigs from human. Hence, besides serological surveillance, continuous and systematic molecular surveillance should be implemented in pig population to reduce/quantify the risk and emergence of pandemic influenza.

Purpose: The study aims to analyse patterns of recurrence following neoadjuvant treatment and surgery in carcinoma oesophagus with an intent to postulate optimal nodal radiation., Methodology: A retrospective review of patients who presented to our centre within a 5-year period (2014-2018), with recurrence following sequential neoadjuvant treatment and radical surgery, was conducted in this single-institution study. The patterns of recurrence and duration of disease-free survival were analysed., Results: Twenty-one patients (14 men, 7 women) presented with recurrence, of which 13, 7, and 1 patient(s) had received NACT, NACTRT, or both, respectively. Six patients who did not receive neoadjuvant radiotherapy received adjuvant RT. Among the 10 patients who had nodal recurrence after RT (either neoadjuvant or adjuvant), 6 and 4 patients had in-field and out-of-field nodal recurrences, respectively-the latter were equally distributed within 5 cm and outside 5 cm of the PTV margin., Conclusion: Among the patients who presented with recurrence, more than half had not received neoadjuvant RT (treated in the 'pre-CROSS era' or due to long-segment disease), reasserting the therapeutic superiority of NACTRT. Increased regularity of recurrences in the draining nodal region was not noted in this study, but large-scale, prospective, randomised head-to-head comparative trials to determine optimal nodal irradiation in carcinoma oesophagus are required.

Background: Malaria control system (MCS), an Information technology (IT)-driven surveillance and monitoring intervention is being adopted for elimination of malaria in Mangaluru city, Karnataka, India since October 2015. This has facilitated 'smart surveillance' followed by required field response within a timeline. The system facilitated data collection of individual case, data driven mapping and strategies for malaria elimination programme. This paper aims to present the analysis of post-digitization data of 5 years, discuss the current operational functionalities of MCS and its impact on the malaria incidence., Methods: IT system developed for robust malaria surveillance and field response is being continued in the sixth year. Protocol for surveillance control was followed as per the national programme guidelines mentioned in an earlier publication. Secondary data from the malaria control system was collated and analysed. Incidence of malaria, active surveillance, malariogenic conditions and its management, malariometric indices, shrinking malaria maps were also analysed., Results: Smart surveillance and subsequent response for control was sustained and performance improved in five years with participation of all stakeholders. Overall malaria incidence significantly reduced by 83% at the end of 5 years when compared with year of digitization (DY) (p < 0.001). Early reporting of new cases (within 48 h) was near total followed by complete treatment and vector control. Slide positivity rate (SPR) decreased from 10.36 (DY) to 6.5 (PDY 5). Annual parasite incidence (API) decreased from 16.17 (DY) to 2.64 (PDY 5). There was a negative correlation between contact smears and incidence of malaria. Five-year data analyses indicated declining trends in overall malaria incidence and correlation between closures by 14 days. The best impact on reduction in incidence of malaria was recorded in the pre-monsoon months (~ 85%) compared to lower impact in July-August months (~ 40%)., Conclusion: MCS helped to micromanage control activities, such as robust reporting, incidence-centric active surveillance, early and complete treatment, documentation of full treatment of each malaria patient, targeted mosquito control measures in houses surrounding reported cases. The learnings and analytical output from the data helped to modify strategies for control of both disease and the vector, heralding the city into the elimination stage.

Background: Health-related quality of life (HRQOL) is emerging as an important outcome among patients with documented coronary artery disease (CAD). The primary objective of this study was to report the HRQOL of CAD patients under secondary prevention-related treatment and follow-up using the 36-Item Short Form (SF-36) tool., Methods: This was an analytical cross-sectional survey done in a hospital/clinic setting. We recruited CAD patients 30 to 80 years old with 1 to 6 years of follow-up. Patients self-reported HRQOL using SF-36., Results: We recruited 1206 patients, among whom 879 (72.9%) were male. The mean age of patients was 61.3 (9.6) years. Mean (± standard deviation) scores for physical functioning, role limitations due to physical health, pain, and general health were 66.48 ± 29.41, 78.96 ± 28.01, 80.96 ± 21.15, and 51.49 ± 20.19, respectively. The scores for role limitations due to emotional problems, energy/fatigue, emotional well-being, and social functioning were 76.62 ± 28.0, 66.18 ± 23.92, 76.91 ± 20.47, and 74.49 ± 23.55. In subgroup analysis, age, sex, type of CAD, and treatment showed no significant association with any of the 8 domains of QOL. In addition, hypertension and diabetes showed no significant association with the individual domains of HRQOL., Conclusion: Patients with coronary artery disease under secondary prevention-related treatment have suboptimal HRQOL under both physical and mental domains. The role of demographic factors, comorbidities, disease subtypes, and treatment options in modifying HRQOL among patients with CAD appears to be minimal., (2021 Forum Multimedia Publishing, LLC)

Objective: To assess the effects of the COVID-19 pandemic on obstetric care and outcomes., Methods: A prospective observational single-center study was performed, including all antenatal and parturient women admitted from April to August, 2020. Data were collected regarding number of admissions, deliveries, antenatal visits, reason for inaccessibility of health care, and complications during pregnancy, and compared with data from the pre-COVID period of October 2019 to February 2020., Results: There was a reduction of 45.1% in institutional deliveries (P < 0.001), a percentage point increase of 7.2 in high-risk pregnancy, and 2.5-fold rise in admission to the intensive care unit of pregnant women during the pandemic. One-third of women had inadequate antenatal visits. The main reason for delayed health-seeking was lockdown and fear of contracting infection, resulting in 44.7% of pregnancies with complications. Thirty-two symptomatic women who tested positive for COVID-19 were managed at the center with good maternal and fetal outcomes., Conclusion: Although COVID-19 does not directly affect pregnancy outcomes, it has indirect adverse effects on maternal and child health. Emergency obstetric and antenatal care are essential services to be continued with awareness of people while maintaining social distancing and personal hygiene., (© 2020 International Federation of Gynecology and Obstetrics.)

Background: Variants in CDKN2B/CDKN2B-AS1 have been reported to modulate glaucoma risk in several GWAS across different populations. CDKN2B/CDKN2A encodes tumor suppressor proteins p16 INK4A /p15 INK4B which influences cell proliferation/senescence in RGCs, the degeneration of which is a risk factor for glaucoma. CDKN2B-AS1 codes a long non-coding RNA in antisense direction and is involved in influencing nearby CDKN2A/CDKN2B via regulatory mechanisms., Methods: Current study investigated four SNPs (rs2157719, rs3217992, rs4977756, rs1063192) of aforementioned genes in a case-control study in a North Indian cohort. Genotyping was done with Taqman chemistry. In addition, an updated meta-analysis was performed., Results: Two SNPs, rs3217992 and rs2157719 were found to be significantly associated with the disease. The frequency of 'T' allele of rs3217992 was significantly lower in cases (POAG/PACG) [p = 0.045; OR = 0.80(CI = 0.65-0.99) and p = 0.024; OR = 0.73(CI = 0.55-0.96)], respectively than in controls. Genetic model analysis revealed that TT + CT genotype confers 0.73-fold protection against POAG [p = 0.047; OR = 0.73(CI = 0.54-0.99)] and trend assumed additive model gives 0.53 times higher protection against PACG progression. However the association of rs3217992 with POAG and PACG did not remain significant after Bonferroni correction. For rs2157719, the 'C' allele was found to be less prevalent among cases (POAG/PACG) with respect to controls. Cochran Armitage trend test assuming additive model revealed 0.77 and 0.64-fold protection against POAG and PACG respectively. Bonferroni correction (p corr  = 0.003) was applied and the association of rs2157719 remained significant in PACG cases but not among POAG cases (p = 0.024). The 'CC' genotype also confers protection against primary glaucoma (POAG/PACG) among males and female subjects. The frequency rs1063192 and rs4977756 did not vary significantly among subjects, however the haplotype 'CATA' was found to be associated with increased glaucoma risk. An updated meta-analysis conducted on pooled studies on POAG cases and controls revealed significant association between rs1063192, rs2157719, rs4977756 and POAG except rs3217992., Conclusion: The study concludes significant association between INK4 variants and primary glaucoma in the targeted North Indian Punjabi cohort. We believe that deep-sequencing of INK4 locus may help in identifying novel variants modifying susceptibility to glaucoma. Functional studies can further delineate the role of CDKN2B and CDKN2B-AS1 in primary glaucoma for therapeutic intervention.

Objectives: To assess the effect of ambient temperature, humidity and wind speed on disease occurrence in Delhi, India., Data and Methods: Data regarding daily corona cases, temperature, humidity, wind speed, doubling time and basic reproduction number (R0) was retrieved from online sources. Pearson's coefficient was used to assess the correlation between daily as well as weekly corona cases and various environmental factors., Results: During the study period of 97 days, there was a steady rise in number of corona cases with median (interquartile range) cases per day being 224 (58 to 635). The doubling time demonstrated a strong positive correlation with temperature while R0 had strong negative correlation with temperature (correlation coefficients 0.814 and -0.78, respectively). No significant correlation with humidity or wind speed was observed., Conclusion: Increasing temperature decreases COVID-19 infectivity; however, actual role of environmental factors in expansion of pandemic needs further evaluation globally., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2020 American College of Occupational and Environmental Medicine.)

Background: Many professions tend to carry inherent risks for the practitioners. In such cases, it becomes mandatory for them to be aware of the risks and counselled about the preventive measures. The inevitable first step, however, is to ascertain the burden of risk. In the case of school teachers, it is known that they are prone to voice disorders of varying hues, at some point of their career. There should be an attempt to find the prevalence in the community. Presently, there is no such data documented from Kerala, a highly literate State in southern India., Aim and Objectives: The primary objective of this study was to document the prevalence of subjective dysphonia among the school teacher community. The secondary objective was to compare the prevalence and severity of dysphonia between primary and secondary school teachers., Materials and Methods: A cross-sectional study was conducted in 28 schools, using a screening questionnaire, based on similar ones used in other studies. All the schools were in the city of Kochi, the largest and most populous metropolitan area in Kerala. Teachers reporting a current voice complaint at the time of study were administered the validated vernacular version of the voice handicap index questionnaire (VHI 30). The completed questionnaires were collected and statistically analyzed., Results: The screening questionnaire was administered to 702 teachers; 165 were Primary school teachers (Class I-V), 242 Secondary (Class VI-XII), while 279 teachers had to take classes in both sections. The reported prevalence was 45.4% for present difficulty related to their voice, 52.8% for some voice problem in the last 1 year, and 70.1% for problems experienced during the duration of their teaching career. Possible risk factors like age, total years of teaching, hours of daily teaching and number of students taught did not show any significant association with voice problem., Conclusions: Nearly, half of all the screened school teachers reported a current voice problem, increasing to nearly three-fourths for symptoms during entire career. This is clearly a significant burden which must be addressed at various levels. The secondary school teachers seem to bear a bigger burden in this study., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Justification: With the unprecedented COVID-19 pandemic and the resultant school closure, children all over the country are undergoing a lot of educational, psychosocial, and physical problems. There is an urgent and deep felt need to offer scientific and concrete guidance for these concerns and support children in their educational development during these testing times., Objective: To review the guidelines and recommendations given by various international agencies and formulate guidelines in the Indian context on (a) how and when to reopen the schools; (b) ways and means of remote learning; and (c) to identify the contents of curriculum that need restructuring in context of the current situation., Process: Indian Academy of Pediatrics (IAP) formed a task force of pediatricians, educationists and technological experts who connected through various video and social platforms. They gathered and exchanged information and thoughts. The writing committee drafted the guidelines and got approval of all the members of the task force., Recommendations: Schools can be reopened only when the local epidemiological parameters are favorable, the administration is equipped with adequate infrastructure and health care facilities, and the stakeholders (teachers, students, parents, and support staff) are prepared for the new normal. In the meanwhile, remote learning (media-based and /or otherwise) should reach to the last student to maintain uninterrupted education. The curriculum needs to be revised, with focus on revision and core contents. Informal learning of psychosocial empowerment and daily living skills should be encouraged rather than stressful formal learning.

TB is a deadly infectious disease, in existence since time immemorial. This article traces the journey of TB developments in the last few decades and the path breaking moments that have accelerated the efforts towards Ending TB from National Tuberculosis Control Program (NTCP 1962-1992) to Revised National Tuberculosis Control Program (RNTCP - 1992-2019) and to National Tuberculosis Elimination Program (NTEP) as per the vision of Honorable Prime Minister of India. From increased funding for TB, the discovery of newer drugs and diagnostics, increased access to health facilities, greater investment in research and expanded reach of public health education, seasoned with TB activism and media's proactive role, private sector participation to political advocacy and community engagement, coupled with vaccine trials has renewed the hope of finding the elusive and miraculous breakthrough to END TB and it seems the goal is within the realms of the possibility. The recent paradigm shift in the policy and the drive of several states & UTs to move towards TB free status through rigorous population-based vulnerability mapping and screening coupled with active case finding is expected to act as the driving force to lead the country towards Ending TB by 2025. Continued investments in research, innovations and availability of more effective drugs and the vaccines will add to existing armamentarium towards Ending TB., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2020. Published by Elsevier B.V.)

Objectives: The primary objective of the study was to report the compliance to secondary prevention strategies for coronary artery disease (CAD), such as smoking cessation, weight management, low-density lipoprotein (LDL) cholesterol control, blood pressure control, glycaemic control, physical activity and cardiovascular drug therapy from a resource-limited setting., Design: Analytical cross-sectional survey with data collection using questionnaire administered by study personnel., Setting: Institutional-two tertiary care hospitals and two cardiology clinics., Participants: Patients in the age group of 30-80 years with documented CAD with a minimum of 1 year and a maximum of 6 years of follow-up after diagnosis., Main Outcome Measures: The main outcome measures were the prevalence of individual compliance to secondary prevention strategies for CAD such as smoking cessation, weight management, LDL cholesterol control, blood pressure control, glycaemic control, physical activity and cardiovascular drug therapy. The secondary outcomes were the association of secondary prevention strategies with age, sex, domicile, socioeconomic status, insurance and type of treatment., Results: We recruited a total of 1206 patients among whom 879 (72.9%) were males. The median age of patients was 62 (14) years. The compliance to smoking cessation was 93.86% (95% CI 91.66% to 96.06%), ideal body mass index was 63.76% (95% CI 61.05% to 66.47%), blood pressure control was 65.11% (95% CI 62.42% to 67.80%), LDL compliance was 36.50% (95% CI 33.18% to 39.82%), diabetes control was 51.23% (95% CI 46.10% to 56.36%) and adequate physical activity was 39.22% (95% CI 36.46% to 41.98%)respectively. Reported compliance for cardiovascular drugs therapy was 96% for antiplatelets, 89.4% for statins, 68.2% for beta blockers, 37.7% for renin angiotensin aldosterone system blockers, 81.28% for oral hypoglycaemic agents and 22% for insulin therapy., Conclusion: Compliance to secondary prevention strategies for CAD in resource limited settings are moderate. This needs further improvement for better outcomes related to CAD in future., 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.)

Background: Skin preparation with an antiseptic solution aims to reduce surgical site infection rates. Surgical site infections (SSIs) create a high burden on healthcare systems with impacts on morbidity, mortality, and cost. In 2016, The World Health Organization (WHO) conducted an extensive systematic review and meta-analysis of the existing evidence. From this, they recommended the use of "alcohol based antiseptic solutions based on CHG for surgical site skin preparation in patients undergoing surgical procedures." This study aimed to assess surgeon compliance with this guidance in the United Kingdom and India. Methods: A multiple-choice questionnaire was developed to assess surgeon preferences for antiseptic use in their surgical site preparation. The end point of data collection was defined after 50 responses in each region. Results: The majority of respondents in each center was general surgeons (n = 24, 48% United Kingdom; n = 21, 45% India), and registrars (n = 22, 44% United Kingdom; n = 23, 49% India). No surgeon preferred the use of any aqueous preparation. Chlorhexidine gluconate (CHG) was the preparation used most commonly in both centers (n = 30, 64% India; n = 24, 48% United Kingdom). In India, this represented a statistically significant difference (p = 0.0008), however, this was not observed in the United Kingdom (p = 0.22). There were no statistically significant differences between surgeon's reasons between the United Kingdom and India, other than "easier to see" (p = 0.016). Conclusions: This data show a reduced compliance of U.K. surgeons with WHO guidance for antiseptic use compared with Indian surgeons. Although the WHO has attempted to summarize the existing data to minimize the previous uncertainty surrounding antiseptic choices, the use of CHG continues to not be adopted widely. To draw robust conclusions to provide the foundations of further guidelines, future research should focus on prospective randomized controlled trials with large numbers across multiple surgical specialties.

Objectives: There is limited knowledge regarding epidemiology and risk of falls among the elderly living in low-income and middle-income countries. In this situation, the current study aims to report the incidence of falls and associated risk factors among free living elderly population from Kerala, India., Design: Prospective cohort study with stratified random cluster sampling., Setting: The study location was Ernakulam, Kerala, India, and we collected information via house visits using a questionnaire. During the research, the subjects were followed up prospectively for 1 year by phone at intervals of 3 months and missing subjects were contacted by house visits., Participants: Community-dwelling elderly above 65 years of age., Results: We recruited a total of 1000 participants out of which a total of 201 (20.1%) subjects reported a fall during the follow-up. The incidence rate of falls was 31 (95% CI 27.7 to 34.6) per 100 person-years. Female sex (OR 1.48, 95% CI 1.05 to 2.10, p=0.027), movement disorders including Parkinsonism (OR 2.26, 95% CI 1.00 to 5.05, p=0.048), arthritis (OR 1.48, 95% CI 1.05 to 2.09, p=0.026), dependence in basic activities of daily living (OR, 3.49, 95% CI 2.00 to 6.09, p<0.001), not using antihypertensive medications (OR, 1.53, 95% CI 1.10 to 2.13, p=0.012), living alone during daytime (OR 3.27, 95% CI 1.59 to 6.71, p=0.001) and a history of falls in the previous year (OR, 2.25, 95% CI 1.60 to 3.15, p<0.001) predicted a fall in the following year., Conclusions: One in five community-dwelling senior citizen fall annually and one in four who fall are prone to fall again in the following year. Interventions targeting falls among the elderly need to focus on modifiable risk factors such as living alone during daytime, movement disorders, arthritis and dependence on basic activities of daily living., 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.)

A new species of the genus Urocaridella Borradaile, 1915, Urocaridella arabianensis n. sp. is described and illustrated based on fifty-five specimens collected from the reef regions of Agatti Island, Lakshadweep, Arabian Sea. Urocaridella arabianensis n. sp. is morphologically close to U. pulchella Yokes Galil, 2006, reported from the Mediterranean Sea. However, the present specimen is clearly distinguished with its rostrum length, which is 1.7 to 2.1 times as long as carapace, 10 ventral rostral teeth, carpus of 1st pereopod is 2.5 times long as palm, carpus of 2nd pereopod is 1.8 times as long as palm, presence of a spine in latero-middle of the fourth and fifth abdomens and the sixth abdominal segment is 2.3 times long as the fifth segment. Partial segment of the mitochondrial COI, 16S rRNA and nuclear gene 18S rRNA and H3 indicates that the new species is sister to a clade comprising of U. pulchella, U. antonbruunii and U. degravei. The pair wise genetic distance of COI showed great distance with the closest congeneric species.

HbQ variants are rare alpha globin chain variants commonly found in Sindhi community. It results from a point mutation of α-1 globin gene at position 223 of the coding region of exon 64. It is inherited in an autosomal dominant fashion. HbQ-India is usually clinically silent in heterozygous state unless associated with other conditions like beta thalassemia, alpha thalassemia, HbE disease, or nutritional anemia. High performance liquid chromatography (HPLC) identifies HbQ-India with a prominent peak present just after the Sickle window. We present five cases of HbQ-India from a retrospective analysis of 6034 cases over a period of 3 years, a rarity in a referral setting of South India. Awareness of this entity is important for appropriate recognition to prevent clinically symptomatic hemoglobinopathies. This study also highlights the retention time (RT) and characteristic chromatographic HPLC pattern seen in HbQ-India.

Estuaries being the connecting link between terrestrial and marine environment, experience spatial variations in the hydrographic variables as well as concentrations of pollutants. The present study reports a contrasting difference in the metal tolerance and enzyme activity of particle-associated bacteria (PAB) isolated from the upstream and downstream reaches of a tropical estuary [Cochin Estuary (CE) in the southwest coast of India], exposed to different levels of heavy metal contamination. The upstream of the estuary has been overloaded with heavy metals in the last few decades, while the downstream is less polluted. There were only 25% of culturable PAB phylogenetically common in both upstream and downstream. The PAB isolated from the upstream were dominated by γ-proteobacteria (48.1%) followed by α-proteobacteria (25.0%), while it was in the reverse order of α-proteobacteria (45.9%) and γ-proteobacteria (36.1%) in the downstream. More number of PAB from the upstream showed tolerance to higher concentrations of Zn and Cd. The Acinetobacter sp. MMRF1051 isolated from the upstream showed tolerance up to 250 mM Zn, 100 mM Cd, and 250 mM Ni. The enzyme expression profile of PAB from downstream was in the order of lipase > phosphatase > β-glucosidase > aminopeptidase, while it was in the order of β-glucosidase > lipase > aminopeptidase > phosphatase in the upstream of the estuary. The present study shows the selective pressure exerted by heavy metal pollution on the diversity of culturable bacteria associated with particulate matter in a tropical estuary. Also, the variation in their enzyme activities may impinge the remineralization of particulate organic matter (POM) in the system and may impart adverse impacts on ecosystem functioning.

Introduction: Kerala, the southern Indian state piloted Lung Health Care Project (LHCP) which is a locally adopted version of WHO recommended Practical Approach to Lung health (PAL). The current study assessed the impact of the project on the prescribing practices of doctors and consumption of antibiotics and other drugs., Methods: This study compared performance of primary health care institutions with regard to drug prescriptions and consumptions before and after the implementation of the project. Chronic respiratory disease (CRD) patients in institutions implemented the project were interviewed in the OPD at exit and their prescriptions were documented at baseline and after six months. Focus group discussions were conducted with doctors to explore the reasons behind changes in drug consumption pattern., Results: In the project implementing institutions, mean number of drugs prescribed for CRDs was 3.88 (SD 1.50) and 2.73 (SD 1.18) at baseline and after six months respectively (p < 0.001). Adjusted odds ratio for prescribing an antibiotic and injection to a CRD patient during impact assessment at institutions implementing project was 0.34 (95% CI 0.15-0.75 p 0.008) and 0.39 (95% CI 0.20-0.74 p 0.004) respectively, as compared to baseline. The factors which helped in reducing antibiotic and injection use as felt by the doctors were presence of a protocol, good quality trainings, supportive supervision and monitoring, availability of alternate drugs and good participation of staff nurses especially in-patient education., Conclusion: Strict adherence to diagnostic and management algorithms of Lung health care project in a primary health care setting in India helped in reducing pill burden to patients and prescription of antibiotics and injections., (Copyright © 2020 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

With increasing population, excessive use of electrical and electronic products and extreme demand of resources have compelled the linear economy to transform into Circular Economy (CE). In the current scenario, e-waste management has become the top priority of all the developed and developing nations especially those in the transition phase. The generation of e-waste has increased proportionally across the world and created an intense pressure on the firms to implement sustainable practices to redesign and recycle the products. The current status of the developing countries like India confronts number of challenges to manage e-waste produced, and the only possible solution is to minimize the waste generation and practicing recycling processes. For transforming into CEs, there is a need to identify the most influencing key enablers through which an effective and robust e-waste management (e-WM) system can be developed. An extensive literature review and expert judgments are expended to identify the most influencing key enablers of e-WM in circular economies, and, being the highest producer of e-waste, Mumbai (Maharashtra) has been chosen as the case location. To explore the strength of causal and effect enablers, the DEMATEL method is applied. This study has shown that 'Environmental management system' (EMS) is the most significant and important driving enabler to influence all the other existing enablers. This study has also highlighted that e-WM can be efficient if it focuses on producing eco-friendly products, developing strict legislations, building green image and supporting the producers to implement CE practices. This study helps stakeholders and policy makers to reduce the burden from the environment and focus on developing an efficient e-WM system on the basis of identified key enablers like EMS and collaboration with environmental partners to contribute towards CE transition.

The present study reports the new records of two species of the hippolytid shrimp genus Lysmata Risso, 1816 in the water off Lakshadweep Islands, India from the Arabian Sea, viz. Lysmata hochi Baeza Anker, 2008 and Lysmata amboinensis (De Man, 1888) with more taxonomic information. Moreover, L. hochi is the first distributional report from the Indian Ocean. It is morphologically similar to L. kuekenthali and differences are discussed. Colour pattern and morphological trait of L. amboinensis are very close to L. grabhami which also differs in the presence of anti-penultimate segment of 3rd maxilliped more than 2.0 times as long as penultimate segment and stylocerite does not reaching the distal end of the cornea. These specimens were obtained at a depth of 0.5-2 m from the intertidal region of Agatti Island. Additionally, we estimated pairwise genetic distances for these two species and congeneric species using cytochrome oxidase subunit I gene sequences where interspecific distances ranged from 11-25.8 %.

Background: Under-reporting, delayed diagnosis, incomplete treatment and inadequate vector management are few among many factors responsible for uninterrupted transmission of malaria in India. Information technology (IT) and mobile apps can be utilized effectively to overcome these hurdles. Indigenously developed digital handheld geographic information system (GIS)-tagged Android-based tablets (TABs) has been designed especially for implementation of digitization protocol. This has changed the effectiveness of malaria surveillance and intervention strategies in a malaria endemic area of Mangaluru city, Karnataka, India., Methods: A software was developed and implemented for control measures to create a digital database of each malaria case. Secondary data analyses were carried out to determine and compare differences in malariometric indices between pre- and post-digitization years. With the introduction of this software active surveillance, information education and communication (IEC), and anti-vector measures were made 'incidence-centric'. This means that the entire control measures were carried out in the houses where the malaria cases (index cases) were reported and also in surrounding houses., Results: Annual blood examination rate (ABER) increased from 13.82 to 32.8%. Prompt reporting of new cases had improved (36% within 24 h and 80% within 72 h). Complete treatment and parasite clearance time were documented in 98% of cases. In the second post-digitization year untraceable cases reduced from 11.3 to 2.7%; contact blood smears collection also increased significantly (p < 0.001); Slide Positivity Rate (SPR) decreased from 15.5 to 10.48%; malaria cases reduced by 30%., Conclusions: IT is very useful in translation of digitized surveillance to core interventions thereby effectively reduce incidence of malaria. This technology can be used effectively to translate smart surveillance to core interventions following the '1-3-7-14' strategy.

The recent collection of Palaemonid shrimps from Agatti Island, Lakshadweep, Arabian Sea, have provided further additions to the Indian marine fauna. In the manuscript, a new species, Periclimenella agattii sp. nov. is described and illustrated. The new species is morphologically most similar to P. spinifera among other congeners, but it strongly differs from that species by having upper the antennular flagellum with 14-16 segments, short free ramus with 12-13 segments, lower antennal flagellum thin and bearing 35-37 segments; 4 minute lateral spines on basal segment of 3rd maxilliped; male palm:carpus ratio of second pereopod higher than in female, propodus of 3rd pereopod with 7-8 ventral spines and hepatic spine with groove. Genetic analysis using the mitochondrial COI and 16S rRNA genes sequences proved that, the new species is significantly distinct from the closed related species.