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Background Stunting is determined by using the World Health Organization (WHO) child growth standard which was developed using precise measurements. However, it is unlikely that large scale surveys maintain the same level of rigour and precision when measuring the height of children. The population measure of stunting in children is sensitive to over-dispersion, and the high prevalence of stunting observed in surveys in low and middle-income countries (LMIC) could partly be due to lower measurement precison. Objectives To quantify the incongruence in the dispersion of height-for-age in national surveys of Methods An uncertainty factor was proposed and measured from the observed incongruence in dispersion of the height-for-age of Results The uncertainty factor was estimated for 17 LMICs. This ranged from 0.9 to 2.1 for Peru and Egypt respectively (reference value 1). As an explicit country example, the dispersion of height-for-age in the Indian National Family Health Survey-4 test dataset was 39% higher than the MGRS study, with an uncertainty factor of 1.39. From this, the uncertainty-adjusted Indian national stunting prevalence estimate reduced to 18.7% from the unadjusted estimate of 36.2%. Conclusions This study proposes a robust statistical method to estimate uncertainty in stunting prevalence estimates due to incongruent dispersions of height measured in national surveys for children

A century ago, when Student’s t-statistic was introduced, no one ever imagined its increasing applicability in the modern era. It finds applications in highly multiple hypothesis testing, feature selection and ranking, high dimensional signal detection, etc. Student’s t-statistic is constructed based on the empirical distribution function (EDF). An alternative choice to the EDF is the kernel density estimate (KDE), which is a smoothed version of the EDF. The novelty of the work consists of an alternative to Student’s t-test that uses the KDE technique and exploration of the usefulness of KDE based t-test in the context of its application to large-scale simultaneous hypothesis testing. An optimal bandwidth parameter for the KDE approach is derived by minimizing the asymptotic error between the true p-value and its asymptotic estimate based on normal approximation. If the KDE-based approach is used for large-scale simultaneous testing, then it is interesting to consider, when does the method fail to manage the error rate? We show that the suggested KDE-based method can control false discovery rate (FDR) if total number tests diverge at a smaller order of magnitude than N3/2, where N is the total sample size. We compare our method to several possible alternatives with respect to FDR. We show in simulations that our method produces a lower proportion of false discoveries than its competitors. That is, our method better controls the false discovery rate than its competitors. Through these empirical studies, it is shown that the proposed method can be successfully applied in practice. The usefulness of the proposed methods is further illustrated through a gene expression data example.

Central vascular thrombosis (CVT) in critically ill neonates carries significant clinical implications. Neonates with congenital heart disease (CHD) awaiting cardiac intervention might be associated with increased risk of thrombosis. Outcome analysis was undertaken. An analysis of 77 neonates with CHD who were admitted to the NICU prior to cardiac intervention between January 2015 and December 2016 was undertaken. Patients requiring extracorporeal life support prior to any cardiac intervention, or receiving prophylactic anticoagulation not related to central vascular catheter (CVC) were excluded. Diagnosis of CVT was provided based on clinical indication and verified with imaging that warranted anticoagulation therapy. Location of CVC and extent of CVT along with treatments, outcomes, and vascular access types and durations were assessed. Logistic regression multivariate analysis was used to assess predictors of outcome. Neonates with CHD were complicated with CVT in 10.4%. Longer duration of CVC was also associated with thrombosis in neonates with CHD (72.7 days vs. 29.3 days, p

Direct cell translocation of nanomaterials is preferred over the endocytotic uptake for various subcellular targeting applications that can bypass the lysosomal trafficking/degradation. Although arginine-rich cell-penetrating peptides are routinely used for cell transfection of wider range materials from molecule to nanoparticle, the direct cell translocation of nanoparticle is not a routine approach, particularly because of the predominate endocytotic uptake. Here we report arginine-terminated, designed nanoparticle of 15-30 nm hydrodynamic size that enters into cell via direct translocation. We found that direct cell translocation of nanoparticle is very efficient without localization at any specific subcellular compartment for 12-24 h. This study shows that nanomaterial can be chemically designed for direct cell translocation and for cytosolic delivery without any biomembrane-coated endosome that can be employed for subcellular targeting applications.

BackgroundHigh body iron stores have been associated with risk for non-communicable diseases (NCD) like diabetes (high fasting blood sugar, FBS), hypertension (HTN) or dyslipidaemia (high total cholesterol, TC) in adults, but not in adolescent children. This is relevant to iron supplementation and food iron fortification programs that are directed at Indian children. MethodsThe association of NCD with serum ferritin (SF) was examined using logistic additive models, adjusted for confounders such as age, Body Mass Index, C-Reactive Protein, haemoglobin and sex, in adolescent (10-19 years old) participants of the Indian Comprehensive National Nutrition Survey. The interaction of these associations with wealth and co-existing prediabetes was also examined. A scenario analysis was also done to understand the impact of iron fortification of cereals on the prevalence NCD among adolescents.ResultsThe odds ratio (OR) of high FBS, HTN and TC were 1.05 (95% CI 1.01-1.08), 1.02 (95% CI: 1.001-1.03) and 1.04 (95% CI: 1.01-1.06) respectively for every 10µg/L increase in SF. The odds for high TC increased with co-existing prediabetes. The scenario analysis showed that providing 10 mg of iron/day by fortification could increase the prevalence of high FBS by 2%-14% across states of India. Similar increments in HTN and TC can also be expected.ConclusionsHigh SF is associated with a significant risk for NCD in adolescents, and this is dependent on the wealth class, and on co-existing prediabetes. This should be considered when evaluating the benefits and harms of enhancing iron intake in anaemia prevention programs.

There is a paucity of literature on the prevalence, predictors, prognostic markers, and outcomes of sepsis-induced myocardial dysfunction (SMD) in pediatric septic shock. The objectives of our study were to estimate the prevalence of SMD in pediatric septic shock by point-of-care functional echocardiography (POCFE) and to study the association of SMD with severity of illness, organ dysfunctions, and outcomes. This prospective, observational study was conducted over a period of 1 year (from July 2018 to July 2019) in a 12-bed, tertiary pediatric intensive care unit (PICU) of an academic and referral hospital in South India. Children presenting with septic shock were enrolled in the study. POCFE was done within 6 hours of PICU admission and patients were categorized as having SMD based on POCFE findings. The prevalence of SMD (left ventricle ± right ventricle) was 32% (32/100). More than half of the children (54.5%) died in SMD group, whereas only 7.5% died in non-SMD group (p

Population zinc (Zn) status assessment is based on serum zinc concentration (SZC) cut-offs defined by the International Zinc Nutrition Consultative Group (IZiNCG). The objective of this study is to derive reference SZC cut-offs in apparently healthy 1-19 year Indian children and adolescents using comprehensive national nutrition survey (CNNS) data, and to measure the prevalence of Zn deficiency.Apparently healthy children (n = 12,473) were selected from the CNNS, by including the highest 2 wealth quintiles, and excluding stunted, thin and obese children, and those with CRP 5 mg/L, anaemia, hypo-albuminemia, diabetes, recent diarrhoea and history of smoking. The 2.5th centile of age-based distributions defined the SZC cut-offs, used to measure the prevalence of Zn deficiency in India, as against the IZiNCG cut-offs.The present study SZC cut-offs were significantly lower, by 10-18 µg/dL, than the IZiNCG cut-offs; more in adolescents. Prevalence of Zn deficiency in the entire CNNS, with these cut-offs, was 2.7 (10 years) to 5.5 (10-19 years) times lower than with the IZiNCG cut-offs. No geographical state, nor any age group, had Zn deficiency as a serious public health problem (≥20%). In contrast, with IZiNCG cut-offs, 9-27 states (depending on age group) had a public health problem.The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and their rigorous selection from a national sample makes them more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs in other LMICs appears appropriate.

Although wide variety of molecular precursors have been used for carbonization-based synthesis of fluorescent carbon nanoparticle, biomolecule-derived carbon nanoparticle with tunable fluorescence is difficult to synthesize. Here, we report a generalized approach for the preparation of fluorescent carbon nanoparticle from various biomolecules, such as lactose, ascorbic acid, tyrosine and sucrose. The method involves controlled carbonization of molecular precursor in ethylene glycol at 190°C in the presence of Na3PO4. The presented synthetic method can produce 20–30 mg of nanoparticles in one batch with fluorescence quantum yield in the range of 1–10% and nanoparticles can be conjugated with primary amine-terminated chemical/biochemical by simple incubation. These fluorescent carbon nanoparticles can be transformed into different nanobioconjugates for various biomedical applications.

BACKGROUND Differential expression of chemokines/chemokine receptors in colorectal cancer (CRC) may enable molecular characterization of patients' tumors for predicting clinical outcome. OBJECTIVE To evaluate the prognostic ability of these molecules in a CRC cohort and the CRC TCGA-dataset. METHODS Chemokine (CXCL-12α, CXCL-12β, IL-17A, CXCL-8, GM-CSF) and chemokine receptor (CXCR-4, CXCR-7) transcripts were analyzed by RT-qPCR in 76 CRC specimens (normal: 27, tumor: 49; clinical cohort). RNA-Seq data was analyzed from the TCGA-dataset (n= 375). Transcript levels were correlated with outcome; analyses: univariate, multivariable, Kaplan-Meier. RESULTS In the clinical cohort, chemokine/chemokine receptor levels were elevated 3-10-fold in CRC specimens (P⩽ 0.004) and were higher in patients who developed metastasis (P= 0.03 - < 0.0001). CXCR-4, CXCR-7, CXCL-12α, CXCL-8, IL-17 and GM-CSF levels predicted metastasis (P⩽ 0.0421) and/or overall survival (OS; P⩽ 0.0373). The CXCR-4+CXCR-7+CXCL-12 marker (CXCR-4/7+CXCL-12 (α/b) signature) stratified patients into risk for metastasis (P= 0.0014; OR, 2.72) and OS (P= 0.0442; OR, 2.7); sensitivity: 86.67%, specificity: 97.06%. In the TCGA-dataset, the CXCR-4/7+CXCL-12 signature predicted metastasis (P= 0.011; OR, 2.72) and OS (P= 0.0006; OR: 4.04). In both datasets, the signature was an independent predictor of clinical outcome. CONCLUSIONS Results of 451 specimens from both cohorts reveal that the CXCR-4/7+CXCL-12 signature potentially predicts outcome in CRC patients and may allow earlier intervention.

This study aimed to define the estimated average requirement and the recommended dietary allowance of iron for Indian children and adolescents.The Estimated average requirement was derived for children aged 1-17y, from the mean bioavailability-adjusted daily physiological iron requirement, which in turn was estimated using a factorial method. This consisted of mean daily iron losses from the body and additional iron required for tissue growth and storage, while also defining the variance of each factor to derive the Recommended dietary allowance.Results: The estimated average requirement of iron for children ranged from 5.6 to 11.0 mg/d in children aged 1-9y. For adolescents aged 10-17y, these ranged from 10.8 to 18.4 mg/d and 15.4 to 18.5 mg/d for adolescent boys and girls, respectively.New estimates of estimated average requirement for iron in Indian children are presented, and same may be used to inform iron supplementation and food fortification policies.

BACKGROUND Anemia prevalence in India remains high despite preventive iron supplementation programs. Consequently, concurrent national policies of iron fortification of staple foods have been initiated. OBJECTIVES This study evaluated the relation between dietary iron intake and anemia (hemoglobin

Introduction: Diabetes mellitus is one of the metabolic disorders that have multi-factorial pathogenesis. Diabetes is a chief public health issue being suffered by 415 million adults (aged 20-79 years) worldwide as evidenced in 2015. Evidence from the studies recommends that environmental contaminants including insecticides might play a significant role in diabetic pathogenesis. The present study aims to evaluate the relation between OP applicators and incidence of type 2 diabetes mellitus (T2DM). Methods: The study was conducted in 19 rural health centers of Theni District, Tamil Nadu in India. A total of 102 pesticide applicators were recruited for the study. History of occupational pesticide applicators was collected by using questionnaires and HbA1c levels (>6.5%) in pesticide applicators were confirmed as diabetic. Result: Among the pesticide applicators, the prevalence of diabetes was found to be 39(38.24%) among pesticide applicators and only 9 (10.47%) were found to have the family history of diabetes. Risk factors including blood pressure, smoking habit and alcohol drinking were found to be noticeably high with 34 (33.33%), 59 (57.84%), 45 (44.12%), respectively. Conclusion: Our study revealed that the prevalence of diabetes among OP pesticide applicators was higher. The findings of the present study may attract the policymakers to develop a control mechanism against the pesticide-exposed rural population. The variance is deliberated to be explainable by the subject discrepancy regarding safety practices, health background, and nutritional status. Keywords: Diabetes Mellitus, Occupation, Organophosphate, Pesticide Applicators

Anemia in Indian women continues to be highly prevalent, and is thought to be due to low dietary iron content. The high risk of dietary iron deficiency is based on the Indian Council of Medical Research recommendation of 21 mg/d, but there is a need for a secure and transparent determination of the Estimated Average Requirement (EAR) of iron in this population. In nonpregnant, nonlactating women of reproductive age (WRA), the EAR of iron was determined to be 15 mg/d. Applying this value to daily iron intakes among WRA in nationally representative Indian state–based data showed that the median risk of dietary iron deficiency was lower than previously thought (65%; IQR: 48–78%), with considerable heterogeneity between states (range: 25–93%). However, in a validation, this risk matched the risk of iron deficiency as defined by blood biomarkers in a recently completed survey. When the risk of dietary iron deficiency was modelled for an increase in iron intake through food fortification of a single dietary staple, that provided 10 mg/d, the median risk reduced substantially (from 65% to 20%), and it virtually disappeared when supplementary iron intakes through the national iron supplementation program were considered. The risk of exceeding the tolerable upper level (TUL) of intake of iron remains low in the population when receiving fortification of 10 mg/d, but is much higher if they consume greater amounts of iron through supplements (range: 0–54%). This newly and transparently defined Indian EAR of iron should be used to evaluate, with precision, the benefits and risks of iron fortification and supplementation policies.

Objective: The Augusta Heart Study is a NIH-funded multiracial longitudinal project, started in 1985, that examines cardiovascular health of children and adolescents in the Metro Augusta area. The objective was to develop a longitudinal cohort starting in childhood that would identify precursors and underlying pathophysiologic mechanisms that contribute to preclinical manifestations of cardiovascular disease (CVD). The focus was initially on sociodemographic factors, ethnicity, physical activity and obesity. In 2002, an additional focus on stress-related mechanisms of hypertension risk was initiated. The main objective of this paper is to introduce the rich database of this longitudinal multiracial cohort to researchers interested in assessing risk factors of lifetime development of CVD. Methods: Overall, 585 youth were recruited during 1985-2002. This cohort was maintained, and new age-matching participants were added so that, by 2007, the participant pool included 300 African Americans and 307 European Americans. Results: Valuable data, including childhood and young adulthood cardiovascular phenotypes and genotypes, were collected over a thirty-year span. Data were carefully curated and a comprehensive database was created to store data in digital format. As an illustration of the valuable research potential of the database, we performed a longitudinal analysis of the left ventricular mass using a mixed effect growth curve model. Conclusions: The database allows longitudinal analysis of precursors of cardiovascular disease and their underlying mechanisms, allowing to explore beyond simple epidemiology and orienting toward translational research. This cohort may also be used to evaluate the development of other disease processes. Our analysis of the left ventricular mass points out to the early onset and rapid elevation of blood pressure and cardiac mass in African Americans compared to European Americans, and males compared to females.

Background Chronic pulmonary aspergillosis (CPA) is a severe form of post tuberculosis lung disease (PTBLD). Considering the high burden of TB in India, it can be concluded that the prevalence of CPA is also high. Chest x-ray though most feasible, interpretation is subjective. Therefore, decision on evaluation for CPA cannot be based on x-ray alone. Objective Present study evaluated an x-ray score as a marker for extent of lung damage in patients with PTBLD presenting with hemoptysis and its utility to predict Aspergillus serum IgG levels. Methods We used a modified scoring system developed by Anna Ralph et al. X-ray score cut-offs of >71 and 40, with or without history of massive hemoptysis, were compared with serum IgG levels. Results With a chest x-ray score cut-off of 71, specificity was 88%. With an x-ray score of >71 combined with history of massive hemoptysis; 86% cases were found to be IgG positive. The specificity of this combination was 96%. Conclusion This study concluded that a simple chest x-ray scoring system in addition to the symptom of massive hemoptysis helped in the decision on further evaluation of the subject for CPA, especially in resource constrained settings.

Background In spring 2020, the novel coronavirus prompted a sudden shift in nursing education. This study evaluated students' perceptions of their ability to adjust to these challenges. Methods A cross-sectional survey of students (n = 286) in BSN programs throughout the United States was conducted via email to examine 3 areas of student confidence (academic success, NCLEX-RN success, and patient care delivery) and to determine how these were affected by the abrupt transition to remote learning. Results Variables, including alignment of remote instruction styles with learning styles, ease of transition to distance learning, and educating children at home, were significantly associated with students' confidence in their ability to be successful academically, on NCLEX-RN, and in patient care. Conclusions With potential for ongoing challenges due to the coronavirus, faculty need to identify and support students at greater risk of experiencing difficulties and threats to success, thereby preventing attrition and ensuring preparation of a diverse workforce.

Background The overall goal of this longitudinal study was to determine if the Black population has decreased myocardial function, which has the potential to lead to the early development of congestive heart failure, compared with the White population. Methods and Results A total of 673 subjects were evaluated over a period of 30 years including similar percentages of Black and White participants. Left ventricular systolic function was probed using the midwall fractional shortening (MFS). A longitudinal analysis of the MFS using a mixed effect growth curve model was performed. Black participants had greater body mass index, higher blood pressure readings, and greater left ventricular mass compared with White participants (all P Conclusions Changes in myocardial function mirror the race‐dependent variations in blood pressure, afterload, and cardiac mass, suggesting that myocardial function depression occurs early in childhood in populations at high cardiovascular risk such as Black participants.

Supplemental Digital Content is available in the text., Background: Anemia is highly prevalent in India, especially in children. Exposure to ambient fine particulate matter (PM2.5) is a potential risk factor for anemia via. systemic inflammation. Using health data from the National Family and Health Survey 2015–2016, we examined the association between ambient PM2.5 exposure and anemia in children under five across India through district-level ecological and individual-level analyses. Methods: The ecological analysis assessed average hemoglobin levels and anemia prevalence (hemoglobin

Background: The quantification of population zinc (Zn) deficiency is based on serum zinc concentration (SZC) cut-offs, defined by International Zinc Nutrition Consultative Group (IZiNCG), derived from the 2·5th centile of age- and sex-specific SZC distributions from a high-income country. However, the SZC distributions, and its 2·5tthcentile cut-offs, can left-shift for a variety of reasons in lower middle-income countries (LMICs). The recent quality-controlled Indian Comprehensive National Nutrition Survey (CNNS) offered an opportunity to re-examine the SZC cut-offs in healthy 1–19-year-old children and adolescents and evaluate whether Zn deficiency was truly a public health problem in India. Methods: A healthy population (n=12473) of children was selected by including the highest 2 wealth quintiles, and excluding stunted, thin and obese children, and those with CRP >5mg/L, anemia, hypo-albuminemia, diabetes, recent diarrhea and a history of smoking. The 2·5th centile of the SZC distribution from this sample yielded the present cut-off to re-evaluate the prevalence of Zn deficiency against the IZiNCG cut-offs. Findings: The present study SZC cut-offs were significantly lower, by 10–18 µg/dL, than the IZiNCG cut-offs; more in adolescents. Thus, the prevalence of Zn deficiency in the entire CNNS sample, with the present cut-offs, was 2·7 to 5·5 times lower than with the IZiNCG cut-offs. No geographical state, nor any age group, showed Zn deficiency as a serious public health problem (≥20%). In contrast, with the IZiNCG cut-offs, between 9 to 27 states (depending on age group) had a serious public health problem with Zn deficiency. Interpretation: The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and since they were selected rigorously from a national sample, are more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs to quantify Zn deficiency in other LMICs is required. Funding Source: CNNS is funded by The Mittal Foundation. However, there is no specific funding for this secondary analysis. Declaration of Interests: HSS designed the draft protocol of the CNNS with consultancy support from UNICEF, India. HSS, UK, and AVK were members of the Technical Advisory Committee of the CNNS, constituted by the Ministry of Health and Family Welfare of the Government of India, to oversee its conduct and analysis. HSS is a member of the WHO Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Guideline Development Group on the use and interpretation of haemoglobin concentrations for assessing anaemia status in individuals and populations, member of the World Health Organization Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Expert group on nutrient requirements: setting calcium, vitamin D and Zn nutrient intake values for children aged 0-4 years. He is also member of Expert Groups of the Ministry of Health and Family Welfare on Nutrition and Child Health. SD was involved in the CNNS study implementation. There were no other conflicts to declare. Ethics Approval Statement: The Population Council’s International Review Board (New York, USA) and the Ethics Committee of the Post Graduate Institute of Medical Education and Research (Chandigarh, India) gave ethical approval. Written consent from parent/caregiver for children under 10 years, consent of parent/caregiver as well as assent from adolescents (11-17 years) and written consent of adolescents above 17 years were obtained after due description of study details in local languages.

BACKGROUND Anemia control programs in India focus mainly on the measurement of hemoglobin in response to iron-folic acid supplementation. However, representative national estimates of iron deficiency (ID) are not available. OBJECTIVES The objective of the present study was to evaluate ID prevalence among children and adolescents (1-19 y) using nationally representative data and to examine the sociodemographic patterning of ID. METHODS Cross-sectional data from the Comprehensive National Nutrition Survey in children (1-4 y: n = 9635; 5-9 y: n = 11,938) and adolescents (10-19 y; n = 11,507) on serum ferritin (SF) and other biomarkers were analyzed to determine inflammation-adjusted ID prevalence [SF (μg/L)

Background: Air pollution in the household and ambient environment ranks among the leading risk factors contributing to the national burden of disease in India. We describe results from the Tamil N...

BACKGROUND: Biomarkers of micronutrient status vary with inflammation, and can be corrected by a regression-based approach [Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA)] using measured concentrations of inflammation biomarkers, e.g., C-reactive protein (CRP) and/or α1-acid-glycoprotein (AGP). However, this is confounded when inflammation is measured with multiple assays with variable limits of detection (LOD) and lower limits of quantification (LLOQ). OBJECTIVES: We aimed to develop a probability approach for the estimation of prevalence of micronutrient deficiency using the distribution of true serum/plasma micronutrient concentrations in the population. METHODS: Left-censoring of an inflammation biomarker due to varying values of LOD or LLOQ was addressed by estimating the distribution of the inflammation biomarker at concentrations lower than the LOD and using this for the probability estimation of prevalence of nutrient deficiency. This method was evaluated using 2 publicly available data sets for children

Background Lysine rich foods such as milk and legumes serve as important food additions to the lysine deficient cereal-based diets of vegetarian populations in low- and middle-income countries (LMICs) to alleviate the risk of quality corrected dietary protein inadequacy. Dietary protein quality can be determined by estimating the metabolic availability (MA) of lysine. Objectives The study aimed to estimate the MA of lysine in spray-dried cow milk powder (SMP), heat-treated spray-dried cow milk powder (HSMP), and a habitually consumed cereal-legume based vegetarian meal (VM), using the indicator amino acid oxidation (IAAO) slope-ratio method. Methods The MA of lysine in SMP, HSMP, and VM was estimated in 7 healthy young men aged 19-24 y with BMI of 21.5 ± 0.5 kg/m2 in a repeated measures design. The IAAO response slopes with 2 graded lysine intakes (10.5 and 15.0 mg·kg-1·d-1) from the SMP and VM were compared with the response slope generated with 3 graded crystalline lysine intakes (6.0, 10.5, and 15.0 mg·kg-1·d-1) at the subrequirement level. To produce HSMP, pasteurized cow milk was heat treated and spray dried. The MA of lysine in HSMP was tested at a single level of lysine intake (15 mg·kg-1·d-1). A total of 8 IAAO experiments were conducted on each participant in randomized order. The IAAO slopes were estimated using a linear mixed-effect regression model. Results The MA of lysine in SMP, HSMP, and VM was 91.9%, 69.9%, and 86.6% respectively. Conclusions Heat treatment reduced the MA of lysine by 22% in HSMP compared with SMP in healthy Indian adults. The lysine MA estimates can be used to optimize lysine limited cereal-based diets, with the addition of appropriately processed legumes and milk powder, to meet the protein requirement. This trial was registered at Clinical Trials Registry of India (http://ctri.nic.in) as CTRI/2019/08/020568.

Central vascular thrombosis (CVT) in critically ill neonates carries significant clinical implications. Neonates with congenital heart disease (CHD) awaiting cardiac intervention might be associated with increased risk of thrombosis. Outcome analysis was undertaken. An analysis of 77 neonates with CHD who were admitted to the NICU prior to cardiac intervention between January 2015 and December 2016 was undertaken. Patients requiring extracorporeal life support prior to any cardiac intervention, or receiving prophylactic anticoagulation not related to central vascular catheter (CVC) were excluded. Diagnosis of CVT was provided based on clinical indication and verified with imaging that warranted anticoagulation therapy. Location of CVC and extent of CVT along with treatments, outcomes, and vascular access types and durations were assessed. Logistic regression multivariate analysis was used to assess predictors of outcome. Neonates with CHD were complicated with CVT in 10.4%. Longer duration of CVC was also associated with thrombosis in neonates with CHD (72.7 days vs. 29.3 days, p 0.001). Independent predictors of outcome included lower gestational age and CHD with single-ventricle (SV) anatomy (p 0.05). In neonates with CHD awaiting cardiac intervention risk of CVT is substantial. Duration CVC, lower gestational age and SV anatomy are risk determinants of outcome. Standardized development of customized surveillance protocols tailored to this unique subsets of neonates and adherence to quality guidelines can influence outcome.

Sequential organ failure assessment (SOFA) score is used as a predictor of outcome of sepsis in the pediatric intensive care unit. The aim of the study is to determine the application of SOFA scores as a predictor of outcome in children admitted to the pediatric intensive care unit with a diagnosis of sepsis. The design involved is prospective observational study. The study took place at the multidisciplinary pediatric intensive care unit (PICU), tertiary care hospital, South India. The patients included are children, aged 1 month to 18 years admitted with a diagnosis of sepsis (suspected/proven) to a single center PICU in India from November 2017 to November 2019. Data collected included the demographic, clinical, laboratory, and outcome-related variables. Severity of illness scores was calculated to include SOFA score day 1 (SF1) and day 3 (SF3) using a pediatric version (pediatric SOFA score or pSOFA) with age-adjusted cutoff variables for organ dysfunction, pediatric risk of mortality III (PRISM III; within 24 hours of admission), and pediatric logistic organ dysfunction-2 or PELOD-2 (days 1, 3, and 5). A total of 240 patients were admitted to the PICU with septic shock during the study period. The overall mortality rate was 42 of 240 patients (17.5%). The majority (59%) required mechanical ventilation, while only 19% required renal replacement therapy. The PRISM III, PELOD-2, and pSOFA scores correlated well with mortality. All three severity of illness scores were higher among nonsurvivors as compared with survivors (p 8, the relative risk of prolonged duration of mechanical ventilation, requirement for vasoactive infusions (vasoactive infusion score), and PICU length of stay were all significantly increased (p 2 adds additional prognostic accuracy in determining not only mortality risk but also duration of inotropic support as well.

Fluorescent carbon dot has emerged as promising alternative of conventionally known quantum dot or molecular probe as potential intracellular imaging probe. In particular,10 nm size, tunable and bright fluorescence of carbon dot deserve the application potential as intracellular imaging probe. However, synthesis of carbon dot with narrow particle size distribution, preparation of high-quality red/near-infrared emitting carbon dot and appropriate design of functional carbon dot for subcellular targeting are most critical issues. This advanced review focus on the application potential of fluorescent carbon dot as intracellular imaging probe. At first, we briefly discuss different types of fluorescent carbon dots and origin of their fluorescence. Next, we focus on surface chemistry and functionalization which are relevant to intracellular probe development. Finally we have summarized various types of intracellular nanoprobes that are developed from fluorescence carbon dot. This article is categorized under: Diagnostic Toolsin vitro Nanoparticle-Based Sensing.

Additional file 1. National Family Health Survey-4 (NFHS-4) methodology; This file provides details of the NFH 4 survey methodology

Additional file 3: Additional Figure 1. Flow diagram of country selection from DHS data to calculate the prevalence of relative stunting; DHS: Demographic Health Survey

Additional file 5: Additional Figure 3. Distribution of height-for-age in NFHS-4 test data set and MGRS

Estimation and hypothesis tests for the covariance matrix in high dimensions is a challenging problem as the traditional multivariate asymptotic theory is no longer valid. When the dimension is larger than or increasing with the sample size, standard likelihood based tests for the covariance matrix have poor performance. Existing high dimensional tests are either computationally expensive or have very weak control of type I error. In this paper, we propose a test procedure, CRAMP (covariance testing using random matrix projections), for testing hypotheses involving one or more covariance matrices using random projections. Projecting the high dimensional data randomly into lower dimensional subspaces alleviates of the curse of dimensionality, allowing for the use of traditional multivariate tests. An extensive simulation study is performed to compare CRAMP against asymptotics-based high dimensional test procedures. An application of the proposed method to two gene expression data sets is presented.

Additional file 2. Derivation of test statistic based on Z-score; Describes the derivation of test statistic over or under dispersion

Ensuring clean air quality for the population is a priority consideration in many metro cities of the world particularly in middle- and low-income group South Asian cities. Urban population are exposed to various pollutants from vehicular and industrial sources. In a typical urban area, its population are exposed to more than 100 different chemical species. An extensive literature review has established the link between exposure to the classical pollutants and ill-health endpoints ranging from increases in asthma attacks, increases in acute bronchitis and decreased lung function to hospital admissions for respiratory-cardiovascular diseases and congestive heart failure. Communicating air quality through air quality index (AQI) system has become one of the major tools of air pollution information systems and is widely used for local and regional air quality management in many metro cities of the world. The metropolitan city of Delhi is the capital of India and is considered among one of the most polluted cities of the world. The study analyse the air quality for the City of Delhi, India with the help of AQI system proposed by EPA. A significant correlation was observed between air quality data with health data.

Additional file 4: Additional Figure 2. Distribution of height-for-age in NFHS-3 and MGRS

Lamellidens marginalis is an easily available food with high nutritive value. The present study is based on the East Kolkata Wetlands (EKW), India that produces mussels, consumed by human. ...

A published pilot study showed the feasibility of integrating ethics into physiology in a single medical college. However, questions were raised about feasibility of scale-up and acceptance across different colleges. To assess feasibility of integrating ethics into Physiology, first year MBBS students of three medical colleges (n=449, College A=149; 59M, 90F; College B=150; 78M, 72F; College C=150; 48M, 102F) were exposed to the integrated ethics programme. Triggers related to theory or practicals were included. Faculty volunteers conducted the sessions with feedback from observers and students. Students across three colleges felt that the programme was relevant (92%-98%), effectively integrated (86%-98%) [significantly greater number of College A students: (p=0.003)], seldom interfered with physiology teaching (59%-66%). Greater number of students from College C followed by College B and A opined to continue the integrated programme for future years (p=0.004). A scale-up study of integration of ethics programme across different colleges was perceived to be feasible by students and observers.

In this present study, we eliminate the strong interference effect of Fe3+ ions commonly observed in silver nanoparticles (AgNPs) based selective detection of toxic metal ions by localized surface plasmon resonances (LSPRs) of AgNPs. The photoinduced green crystalline silver nanoparticles (NPs) are synthesized using Allium sativum (garlic) extract. The bio ligands act as reducing as well as stabilizing agents and presence of ambient light source enhances the process of nanoparticles formations. The nanoparticles are well characterized by different measurement techniques (UV–vis, DLS-zeta sizer, XRD, TEM). The average particle size as calculated from TEM histogram study was found to be around 10 nm. The as synthesized nanoparticles are employed for selective and sensitive detection of Hg2+ showing excellent sensitivity with a lower detection limit of 2 μM. Fe3+ ions are also capable of oxidizing metallic Ag nanoparticles into ionic Ag+ in water medium and we are able to sense Fe3+ ions are by this green synthesized AgNPs. But the etching of Ag+ ions from AgNPs by Fe3+ ions are extremely quenched by the components of phosphate buffer medium. So the phosphate buffer medium provides good environment around AgNPs for selective and sensitive sensing of Hg2+ ions by lowering the localized surface plasmon resonances.

ObjectivesSevere pulmonary hypertension (PH) causing right heart failure can occur due to thiamine deficiency in exclusively breastfeeding infants. This study describes the clinical profile and management of thiamine-responsive acute pulmonary hypertension.MethodsA prospective observational study of infants presenting with severe PH without any other significant heart or lung disease. History of symptoms, clinical examination, echocardiography and basic investigations were performed. Dietary patterns of mothers were recorded. Thiamine was administered and serial echocardiography was performed.ResultsA total of 250 infants had severe PH and 231 infants responded to thiamine. The mean age was 3.2±1.2 months. Fast breathing, poor feeding, vomiting and aphonia were the main symptoms. Tachypnoea, tachycardia and hepatomegaly were found on examination. Echocardiogram revealed grossly dilated right heart with severe PH. Intravenous thiamine was administered to all the babies based on clinical suspicion. Clinical improvement with complete resolution of PH was noticed within 24–48 hours. Babies were followed up to a maximum of 60 months with no recurrence of PH. All the mothers consumed polished rice and followed postpartum food restriction.ConclusionThiamine deficiency is still prevalent in selected parts of India. It can cause life-threatening PH in exclusively breastfeeding infants of mothers who are on a restricted diet predominantly consisting of polished rice. It can contribute to infant mortality. Thiamine administration based on clinical suspicion leads to remarkable recovery. High degree of awareness and thiamine supplementation in relevant geographical areas is required to tackle this fatal disease.

Fluid management has a major impact on the duration, severity, and outcome of critically ill children. The aim of this study was to examine the relationship between cumulative fluid overload (CFO) with mortality and morbidity in critically ill children. This was a prospective observational study wherein children (1 month–16 years) who were critically ill (with shock requiring inotropes and/or mechanically ventilated) were enrolled. CFO was defined as the sum of daily fluid balances. Daily fluid balance was calculated as a difference between fluid intake (oral and intravenous) and output (urine output, discharge from nasogastric tube) in 24 hours. Percentage of fluid overload (FO) (PFO) was calculated as the ratio of CFO with weight at admission in kilogram. The CFO and PFO at 24, 48, 72 hours and at 7 days or end of PICU stay were calculated. A total of 291 children (244 survivors and 47 non-survivors; 47% males) were included in the final analysis. A higher mortality was observed in children with higher PFO (>20% FO: 45.8% mortality vs. 14.5% 0.05) increase were found for every 1% increase in fluid overload, respectively. Oxygenation index is also associated with fluid overload with the adjusted model estimated 0.27 units (95% confidence interval: 0.18–0.36) increase per 1% increase in fluid overload. FO was associated with increased mortality and morbidity in critically ill children.

The present study reports short-term impact of poor air quality on cardiovascular and respiratory morbidity rate in Delhi. The data on monthly count of patients visiting Out Patient Department (OPD) and hospital admission due to respiratory and cardiovascular illnesses from hospitals along with daily air quality data from air quality monitoring stations of Central Pollution Control Board (CPCB), Government of India, across Delhi were collected for the period 2008 to 2012. A semi-parametric Quasi-Poisson regression model was used to examine the association of high pollution episodes with relative risk of hospital OPD visit and hospital admission due to respiratory and cardiovascular diseases. This study has confirmed the substantial adverse health effects due to air pollution across criterion air pollutants. The study reports the short-term effects of air pollution on morbidity from a time-series study first time in India. The study findings illustrate the evidence of adverse health impact of air pollution from India to the global pool and can influence the policy makers to implement better air quality management system for Indian cities.OPD: Out Patient Department; IPD: Inpatient Department; RD: Respiratory Disease; CVD: Cardiovascular Disease; COPD: Chronic Obstructive Pulmonary Disease; CPCB: Central Pollution Control Board; NAAQMP: National Ambient Air Quality Monitoring Programme; NAAQS: National Ambient Air Quality Standards; RR; Relative Risk; IMD: Indian Meteorological Department; PM