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Flooding is a regular danger in the Idukki district of Kerala causing serious damage to life and property. An attempt has been undertaken in this research to identify crucial zones in the Idukki district that are more susceptible to flooding. The AHP technique was used to give relative weights to 12 flood contributing parameters. The resultant flood susceptibility map shows that 1346.4 km2 of the total land in the Idukki district has a high to very high likelihood of flooding. Validation of the resultant map was achieved using the AUC-ROC approach, which showed good accuracy of 0.91. [ABSTRACT FROM AUTHOR]

Objective: Rare co-existance of disease or pathology. Background: Tuberculosis (TB) is a great mimic of central nervous system (CNS) tumors. This mimicry may pose a challenge, as the management of both diseases is quite different. Furthermore, the temporal association of initiating treatment affects prognosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly infects the pulmonary system. However, in a patient with concomitant pulmonary tuberculosis, it can be a diagnostic challenge. Case Report: A 28-year-old man of Indian origin presented with headache and vomiting. He had a brain mass on imaging suggestive of a glioma. He also had lung infiltrates and was diagnosed with a co-infection by SARS-CoV-2, by a reverse-transcription polymerase chain reaction (RT-PCR) using the GeneXpert system. The mass was excised and was found to be a tuberculoma, diagnosed by Xpert MTB. He received first-line anti-TB and treatment for COVID-19 pneumonia based on local guidelines. Conclusions: This report highlights that COVID-19 can co-exist with other infectious diseases, such as TB. A high degree of clinical suspicion is required to detect TB with atypical presentation. A co-infection of pulmonary and CNS TB with COVID-19 can present a diagnostic challenge, and appropriate patient management relies on an accurate and rapid diagnosis. Surgery may be necessary if there are compressive signs and symptoms secondary to CNS TB. A diagnosis of COVID-19 should not delay urgent surgeries. Further studies are needed to understand the effects of COVID-19 on the clinical course of TB. [ABSTRACT FROM AUTHOR]

To assess the impact of the COVID-19 pandemic on the use of brachytherapy in patients with gynecologic and prostate cancers including treatment delays, increased burden of mortality, and associated clinical outcomes. A comprehensive search of PubMed, Cochrane Library, CINAHL, Scopus, and Web of Science was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for studies published through September 2023 using MeSH terms and keywords related to "COVID and brachytherapy." Inclusion criteria included all studies reporting on the impact of COVID-19 on treatment delay, treatment omission, recurrence rates, and clinical outcomes in patients requiring brachytherapy for prostate or gynecologic cancers from December 2019 to September 2023. Data were extracted by two independent reviewers (LH, IV). Of the 292 screened records, 10 studies (9 retrospective, 1 prospective single-arm exploratory noninferiority) were included. Hypofractioned regimens were the preferred approach in radiation treatment (RT) centers, with 6 of 10 studies noting shift towards hypofractionation. For cervical cancer, intracavitary brachytherapy was limited to 3–4 fractions, reducing personnel and patient exposure. Treatment delays influenced by COVID-19 ranged between 19% and 53% and treatment omissions ranged between 2% and 28%. These disruptions arose from factors such as patient fear of contracting COVID-19, COVID-19 infection, barriers to accessing care, and operating room closures. Three studies reported on a single-application (SA) rather than a multiple application (MA) approach for cervical cancer. They reported excellent local control, shorter overall treatment time at the expense of higher grade ≥2 vaginal, genitourinary, and gastrointestinal events. For cervical cancer patients, overall treatment time (OTT) was significantly impacted by COVID-19 as reported by 2 studies from India. OTT > 60 days occurred in 40–53% of patients. This is the first systematic review to assess the impact of the COVID-19 pandemic on brachytherapy in patients with gynecologic and prostate cancers. Although many expert consensus recommendations have been published during the pandemic regarding radiation therapy, few studies evaluated its clinical impact on brachytherapy delivery and patient outcomes. The COVID-19 pandemic resulted in treatment delays, omissions in brachytherapy, and further adoption of hypofractionated regimens. Early results demonstrate that despite increased toxicities, local control rates with hypofractionated treatment are similar to standard fractionation. The impact of the pandemic on gynecologic and prostate cancers is yet to be determined as well as the long-term outcomes on patients treated during the lockdown period. [ABSTRACT FROM AUTHOR]

Isothermal techniques with lateral flow detection have emerged as a point of care (POC) technique for malaria, a major parasitic disease in tropical countries such as India. Plasmodium falciparum and Plasmodium vivax are the two most prevalent malaria species found in the country. An advanced multiplex loop-mediated isothermal amplification (mLAMP) combined with a lateral flow dipstick (LFD) technique was developed for the swift and accurate detection of P. falciparum and P. vivax, overcoming the challenges of the existing RDTs (rapid diagnostic tests). A single set of LAMP primers with a biotinylated backward inner primer (BIP primer) was used for DNA amplification of both malaria species in a single tube. The amplified DNA was hybridized with fluorescein isothiocyanate (FITC) and digoxigenin-labelled DNA probes, having a complemented sequence for the P. falciparum and P. vivax genomes, respectively. A colour band appeared on two separate LFDs for P. falciparum and P. vivax upon running the hybridized solution over them. In total, 39 clinical samples were collected from ICMR-NIMR, New Delhi. Melting curve analysis, with cross primers for both species, was used to ascertain specificity, and the sensitivity was equated with a polymerase chain reaction (PCR). The results were visualized on the LFD for both species within 60 min. We found 100% sensitivity and specificity, when compared with a traditional PCR. Melting curve analysis of mLAMP revealed the lowest detection limit of 0.15 pg/μL from sample genomic DNA. The mLAMP-LFD assays could be a potential point of care (POC) tool for early diagnosis in non-laboratory conditions, with the convenience of a reduced assay time and the simple interpretation of results. [ABSTRACT FROM AUTHOR]

Early diagnosis, risk stratification and evaluation of possible biomarkers are much in demand nowadays, as the routine laboratory markers do not always predict severity of disease. The prevention of malaria caused by Plasmodium falciparum which when in severe form may lead to life threatening complications like acute kidney failure, heart disease, and respiratory altered etc. may be facilitated by these biomarkers. The present study was designed to evaluate the potential diagnostic biomarkers of P. falciparum malaria in complications. Samples of P. falciparum (n = 74) and healthy control (n = 22) were collected from Dhalai district hospital, Dhalai, Tripura, India during September 2016 to October 2017 to study the potential biomarkers of the P. falciparum malaria severity and complications. 19 potential biomarkers of malaria complications and cellular signaling proteins were assessed using Enzyme Linked Immuno Sorbent assays (ELISA) and biochemical analyses for selected proteins. Mann -Whitney U test and chi square test were used to compare the malaria case versus healthy control group and uncomplicated malaria versus severe malaria group. The prognostic performance for all parameters was assessed using ROC (receiver operating characteristic) analysis. The demographic, clinical and laboratory parameters were significantly altered in case group compared to healthy controls, p -value <.05 except gender, cholesterol, triglycerides, Gamma-GT and Cytochrome c. The respiratory rate, CK-MB, uric acid, CKD-EPI eGFR, total bilirubin, Caveolin1 and pLDH were significantly altered in the severe malaria group as compared to the uncomplicated malaria group (p -value<.05). Interestingly, the known markers of heart ailment CK-MB and PGC1α, kidney dysfunction marker CKD-EPI eGFR and other cellular signaling markers, DAPK1, p53 and Beclin1 were significantly altered in uncomplicated malaria than healthy controls. These findings may pave path for unfolding of disease pathogenesis and complexity in malaria infection. • Lack of routine laboratory markers for predicting severity of malaria propelled to explore new biomarkers. • The present study was designed to evaluate the potential diagnostic biomarkers of P. falciparum malaria in complications. • Interestingly, the known markers of heart ailment CK-MB and PGC1α, kidney dysfunction marker CKD-EPI eGFR and other cellular signaling markers, DAPK1, p53 and beclin1 were significantly altered in uncomplicated malaria than healthy controls. • These findings may pave path for unfolding of disease pathogenesis and complexity in malaria infection. [ABSTRACT FROM AUTHOR]

Complications due to malaria are caused mostly by host immunological responses. Plasmodium falciparum subverts host immunity by various strategies, including modulation in the host immune responses by regulating cytokines. The transcriptional alterations of major cytokines and immunoregulators were analyzed in this study through gene expression profiling in clinically defined subgroups of P. falciparum patients. Malaria patients were included from Dhalai district hospital of Tripura with uncomplicated malaria (UC) and severe malaria (SM) and healthy controls from endemic and non-endemic areas of India. qPCR gene expression analysis was performed for all factors and they were grouped into three clusters based on their altered expressions. The first cluster was downregulated with an increased parasitic burden which included T-BET, GATA3, EOMES, TGF-β, STAT4, STAT6 and cytokines IFN-γ, IL-12, IL-4, IL-5, and IL-13. RANTES, IL-8, CCR8, and CXCR3 were decreased in the SM group. The second cluster was upregulated with severity and included TNF-α, IL-10, IL-1β and IL-7. PD-1 and BCL6 were increased in the SM group. The third cluster comprised of NF-κB and was not altered. The level of perforin was suppressed while GrB expression was elevated in SM. P. falciparum malaria burden is characterized by the modulation of host immunity via compromization of T cell-mediated responses and suppression of innate immune-regulators. [ABSTRACT FROM AUTHOR]

Recent studies have documented Pfhrp2/3 gene deletion globally as one of the biological threats in the fight against malaria. For malaria diagnosis, PfHRP2 based RDTs are most widely used in India, and performance of these RDTs are affected by deleted Pfhrp2/3 gene in Plasmodium falciparum. This study was planned to confirm Pfhrp2/3 gene deletion incidences and genetic variation in PfHRP2-based RDT positive with P.falciparum malaria cases from India. Confirmed positive samples by PfHRP2-based RDTs as P. falciparum (n = 240) from six different endemic regions of India were validated by PCR to assure the actual infection. Two hundred forty samples qualified for DNA intactness by single-copy genes were subjected to amplification for the Pfhrp2/3 gene and its neighbouring gene (downstream and upstream) by PCR genotyping. Genetic variation in samples was analysed post-sequencing using Mega X software. Statistical analysis was performed to validate the genetic variation using Mann-Whitney Test. RDT target region of Pfhrp2 gene (exon2) was found deleted in a single sample with presence of the Pfhrp3 exon2. Complete gene deletion of 4.2% was observed in the Pfhrp3 gene. Partial gene deletion was recorded for both pfhrp2 gene (exon2–0.4%, upstream 25.8% and downstream −9.1%) and Pfhrp3 gene (exon2–18.75%, upstream - 22.08% and downstream 13.3%). Eleven new unique types of amino acid repeat sequence and earlier reported amino acid repeat type was found in the Pfhrp2 gene, prompting high genetic variation. This study suggests that parasites lacking Pfhrp2/3 gene and its neighbouring gene (downstream and upstream) are present in malaria endemic areas of India, resulting in false positive results by RDT. Systematic countrywide monitoring for malaria control and elimination of malaria is warranted in this regard. [Display omitted] • WHO suggests measuring the prevalence of suspected false-negative HRP2 RDT of symptomatic patients with P.falciparum. • RDT target region of Pfhrp2 gene (exon2) was found deleted in single sample with presence of Pfhrp3 exon2. • Complete gene deletion of 4.1% was observed in Pfhrp3 gene. Partial gene deletion was recorded for both Pfhrp2 gene (- and Pfhrp3 gene (• Eleven new- types of amino acid repeat sequence along with earlier reported repeat type were found in Pfhrp2 gene prompting high genetic variation. [ABSTRACT FROM AUTHOR]