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Objective The aim of this study was to introduce a cost-effective and less invasive method for the evacuation of intraparenchymal hemorrhage (IPH).

BackgroundCoronavirus disease 2019 (COVID-19) convalescent plasma (CCP) reduces hospitalizations among outpatients treated early after symptom onset. It is unknown whether CCP reduces time to symptom resolution among outpatients.MethodsWe evaluated symptom resolution at day 14 by trial arm using an adjusted subdistribution hazard model, with hospitalization as a competing risk. We also assessed the prevalence of symptom clusters at day 14 between treatments. Clusters were defined based on biologic clustering, impact on ability to work, and an algorithm.ResultsAmong 1070 outpatients followed up after transfusion, 381 of 538 (70.8%) receiving CCP and 381 of 532 (71.6%) receiving control plasma were still symptomatic (P = .78) at day 14. Associations between CCP and symptom resolution by day 14 did not differ significantly from those in controls after adjustment for baseline characteristics (adjusted subdistribution hazard ratio, 0.99; P = .62). The most common cluster consisted of cough, fatigue, shortness of breath, and headache and was found in 308 (57.2%) and 325 (61.1%) of CCP and control plasma recipients, respectively (P = .16).ConclusionsIn this trial of outpatients with early COVID-19, CCP was not associated with faster resolution of symptoms compared with control. Overall, there were no differences by treatment in the prevalence of each symptom or symptom clusters at day 14.Clinical trials registrationNCT04373460.

Sea level rise (SLR) and heavy precipitation events are increasing the frequency and extent of coastal flooding, which can trigger releases of toxic chemicals from hazardous sites, many of which are in low-income communities of color. We used regression models to estimate the association between facility flood risk and social vulnerability indicators in low-lying block groups in California. We applied dasymetric mapping techniques to refine facility boundaries and population estimates and probabilistic SLR projections to estimate facilities' future flood risk. We estimate that 423 facilities are at risk of flooding in 2100 under a high emissions scenario (RCP 8.5). One unit standard deviation increases in nonvoters, poverty rate, renters, residents of color, and linguistically isolated households were associated with a 1.5-2.2 times higher odds of the presence of an at-risk site within 1 km (ORs [95% CIs]: 2.2 [1.8, 2.8], 1.9 [1.5, 2.3], 1.7 [1.4, 1.9], 1.5 [1.2, 1.9], and 1.5 [1.2, 1.9], respectively). Among block groups near at least one at-risk site, the number of sites increased with poverty, proportion of renters and residents of color, and lower voter turnout. These results underscore the need for further research and disaster planning that addresses the differential hazards and health risks of SLR.

Abstract Lumpy skin disease virus (LSDV) belongs to the genus Capripoxvirus and family Poxviridae. LSDV was endemic in most of Africa, the Middle East and Turkey, but since 2015, several outbreaks have been reported in other countries. In this study, we used whole genome sequencing approach to investigate the origin of the outbreak and understand the genomic landscape of the virus. Our study showed that the LSDV strain of 2022 outbreak exhibited many genetic variations compared to the Reference Neethling strain sequence and the previous field strains. A total of 1819 variations were found in 22 genome sequences, which includes 399 extragenic mutations, 153 insertion frameshift mutations, 234 deletion frameshift mutations, 271 Single nucleotide polymorphisms (SNPs) and 762 silent SNPs. Thirty-eight genes have more than 2 variations per gene, and these genes belong to viral-core proteins, viral binding proteins, replication, and RNA polymerase proteins. We highlight the importance of several SNPs in various genes, which may play an essential role in the pathogenesis of LSDV. Phylogenetic analysis performed on all whole genome sequences of LSDV showed two types of variants in India. One group of the variant with fewer mutations was found to lie closer to the LSDV 2019 strain from Ranchi while the other group clustered with previous Russian outbreaks from 2015. Our study highlights the importance of genomic characterization of viral outbreaks to not only monitor the frequency of mutations but also address its role in pathogenesis of LSDV as the outbreak continues.

Background:. There is limited consensus regarding the economic value of prosthetic devices with advancing age. We aimed to meet this knowledge gap by studying the cost-effectiveness of lower limb prostheses (LLPs) for older adults with dysvascular amputations. Methods Design:. We constructed a decision analytic model nested with Markov models with a lifetime horizon to compare LLP recipients (LLP) with non-recipients (no-LLP) from a health care sector perspective. A 3% annual rate was applied to obtain the present value of the main outcome measures. One-way sensitivity analyses that modeled clinically extreme scenarios were conducted on LLP cost, change, abandonment rate, fall rate, mortality, and utility. Data sources:. Model parameters were obtained from literature, with many source studies utilizing Medicare data and focusing on dysvascular amputations. Parameters included the “annual probability” of fall, LLP abandonment and mortality, costs associated with decreased physical inactivity or deconditioning, falls (rate and cost), abandonment (rate), mortality, and “utilities associated” with Markov model health states. All costs were adjusted to 2022 price levels. Intervention:. Lower limb prosthesis. Main Outcome Measures:. Lifetime cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER). Results:. The LLP group incurred a lifetime cost of $36,789 and yielded 4.54 QALYs. The no-LLP group incurred a lifetime cost of $23,909 and yielded 2.58 QALYs. The ICER was $6588/QALY, which is below the most conservative willingness-to-pay threshold of $50,000/QALY and indicated that LLP was cost-effective compared with no-LLP. Sensitivity analyses for increasing LLP replacement to annual (ICER = $33,477/QALY), abandonment rate to 22% (ICER=$6367), fall rate to 70% (ICER = $7140/QALY), and increasing No-LLP EuroQol–five-dimension to 0.71 (ICER = $10,819/QALY) were all below the willingness-to-pay as well. Conclusions:. LLP for older adults with dysvascular amputations was cost-effective for most clinically realistic scenarios.

Introduction Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing. Methods Nation Against Pneumococcal Infections – Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake. Outcome The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms. Conclusion These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.

Abstract Surface coal development activities include mining and ecological restoration, which significantly impact regional carbon sinks. Quantifying the dynamic impacts on carbon sequestration in vegetation (VCS) during coal development activities has been challenging. Here, we provided a novel approach to assess the dynamics of VCS affected by large-scale surface coal mining and subsequent restoration. This approach effectively overcomes the limitations imposed by the lack of finer scale and long-time series data through scale transformation. We found that mining activities directly decreased VCS by 384.63 Gg CO2, while restoration activities directly increased 192.51 Gg CO2 between 2001 and 2022. As of 2022, the deficit in VCS at the mining areas still had 1966.7 Gg CO2. The study highlights that complete restoration requires compensating not only for the loss in the year of destruction but also for the ongoing accumulation of losses throughout the mining lifecycle. The findings deepen insights into the intricate relationship between coal resource development and ecological environmental protection.

Abstract Background A thorough understanding of lameness prevalence is essential for evaluating the impact of this condition on the dairy industry and assessing the effectiveness of preventive strategies designed to minimize its occurrence. Therefore, this cross-sectional study aimed to ascertain the prevalence of lameness and identify potential risk factors associated with lameness in Holstein Friesian crossbred cows across both commercial and smallholder dairy production systems in Bengaluru Rural District of Karnataka, India. Methods The research encompassed six commercial dairy farms and 139 smallholder dairy farms, involving a total of 617 Holstein Friesian crossbred cattle. On-site surveys were conducted at the farms, employing a meticulously designed questionnaire. Lameness in dairy cattle was assessed subjectively using a locomotion scoring system. Both bivariate and binary logistic regression models were employed for risk assessment, while principal components analysis (PCA) was conducted to address the high dimensionality of the data and capture the underlying structure of the explanatory variables. Results The overall lameness prevalence of 21.9% in commercial dairy farms and 4.6% in smallholder dairy farms. Various factors such as age, body weight, parity, body condition score (BCS), floor type, hock and knee injuries, animal hygiene, provision of hoof trimming, and the presence of hoof lesions were found to be significantly associated with lameness. Binary logistic regression analysis indicated that the odds of lameness in crossbred cows increased with higher parity, decreased BCS, presence of hard flooring, poor animal hygiene, and the existence of hoof lesions. These factors were identified as potential risk factors for lameness in dairy cows. Principal component analysis unveiled five components explaining 71.32% of the total variance in commercial farms and 61.21% in smallholder dairy farms. The extracted components demonstrated higher loadings of housing and management factors (such as hoof trimming and provision of footbath) and animal-level factors (including parity, age, and BCS) in relation to lameness in dairy cows. Conclusions The findings suggest that principal component analysis effectively reduces the dimensionality of risk factors. Addressing these identified risk factors for lameness is crucial for the strategic management of lameness in dairy cows. Future research in India should investigate the effectiveness of management interventions targeted at the identified risk factors in preventing lameness in dairy cattle across diverse environments.

Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/ State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/ user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India.

Background: Due to high population density, more individuals with depressive symptoms reside in Low and Middle-Income Countries, though there exists limited published literature on factors that elevate risk in this population. Focusing on India, the most populous country in the world, the present study examined cross-sectional and longitudinal associations between poor relations with parents and other family members (e.g., siblings, grandparents) and depressive symptoms among urban, educated, young adults. Additionally, given the salience of familial interdependence, we examined the moderating effects of inclusion of others in one's definition of self in this association. Methods: A total of 548 young adults (Mage = 21.4 years, 67% women) completed online questionnaires at two time points separated by six months. Results: Poor relations with fathers and other family members were associated with greater depressive symptoms cross-sectionally, above and beyond the effects of other relations. Poor quality of interpersonal relations with parents and other family members was not associated with depressive symptoms longitudinally (after six months). There were significant main effects of poor relations (with mothers, fathers, others) cross-sectionally, over and above the effects of inclusion of others in one's sense of self though we did not find any moderating or main effects of inclusion of others in one's sense of self. Conclusion: Quality of interpersonal relations may be a correlate but not a predictor of depressive symptoms for urban, educated, young adults in India. Limitations: The findings may not hold true for groups other than urban, educated, young adults in India.

The present study evaluated the immuno-modulatory effect of intrauterine infusion of Neem oil (twice at 24 h interval) in repeat breeding cows (n=6) suffering with sub-clinical endometritis and compared with untreated control (n=6). There were no changes in the mean blood leucocyte count, lymphocytes (%), neutrophils (%) and monocyte (%) between and within groups. The phagocytic activity of blood neutrophils and monocyte was increased at next estrus compared to that at 0 h and 24 h of treatment in treated cows (NO), while, it did not differ in untreated control. The mean stimulation index (lymphocyte proliferation) was significantly higher at next estrus in NO treated cows compared to untreated control. The endometrial mRNA expression of IL-6 (0.18 fold), IL-1α (0.25 fold) and TNF- α (0.38 fold) were downregulated after the treatment in treated cows, while the mRNA transcript of IL-10 (3.28 fold) was upregulated after the treatment in group NO compared to control. All the cows showed negative endometrial cytology for PMNs after the treatment in NO group. The cervical mucus bacterial load reduced significantly at next estrus in treated cows compared to untreated control as well as after the treatment compared to before the treatment. The first service conception rate was 50% (3/6) in treated cows, while, the corresponding figure in untreated control was 16.67% (1/6). In conclusion, methanolic extract of neem oil may improve the recovery and conception rate in cows with sub-clinical endometritis through its bactericidal and immunomodulatory activity.

Aim: To evaluate the mandibular incisive nerve canal’s prevalence, location, and size. Objectives: To ascertain the frequency, relationship to surrounding critical structures, and variance in the size and position of the mandibular incisive nerve canal. Materials and Methods: Mandibular incisive canal (MIC) measurements, locations, and prevalence were noted in 80 patients’ cone-beam computed tomography (CBCT), ranging in age from 18 to 80. Result: The overall incidence of missing canals was found to be 30% on the right side, 33.75% on the left, and 23.75% on both sides. Conclusion: In summary, magnetic resonance imaging (MRI) (3 Tesla) and other higher-resolution imaging modalities should be compared with CBCT for accurate MIC measurement and location assessment.

Aim: The aim of the study was to assess the prevalence of quid-induced oral mucosal lesion (QIOML) among the population in Jodhpur, western Rajasthan, and to ascertain if they are associated with chewing tobacco, arecanut, or both tobacco and arecanut. Materials and Methods: The study design was cross-sectional. All the subjects reporting to the out patient department at Vyas Dental College were screened, and 1209 quid users (using processed, unprocessed, and both processed and unprocessed forms of tobacco and arecanut) were identified and included. Results: Among 1209 (18.8%) chewers, 949 (78.49%) chewers were reported to have QIOML and the majority of QIOML occurred in the subjects chewing both tobacco and arecanut in processed forms. Conclusion: Further studies should be done to find out the actual composition of the processed form of quid along with its concentration and its role in the occurrence of QIOML.

Background: Attempts should be made to identify the molecule-based biomarkers, which give indication about the progression of precancer and malignancy of the oral area. Aim: To evaluate the reliability of methylation of genes of saliva like P16, MGMT, and DAP-K as biomarkers for diagnosis of oral squamous cell carcinoma. Methods and Materials: This study included 30 cases of histopathologically proven cases of oral squamous cell carcinoma. This study was conducted to detect demethylation of genes P16, MGMT, and DAP-K in saliva in these patients. Approximately, 1 mL of saliva was collected from each individual. Bisulfite sequencing PCR (BSP) was done with bisulfite conversion-specific primers produced by MethPrimer. The BSP compounds will be quantified on a one percent agarose gel. A fraction of the products obtained in BSP were then analyzed with the help of qMSP. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of methylation of genes P16, MGMT, and DAP-K as biomarkers of oral carcinoma were statistically significant. In our research, there were some very important useful findings regarding the possibility of the use of deoxyribonucleic acid methylation as a potential biomarker for the progression of premalignancy and malignancy of oral cavity, which need to be further followed up. Conclusion: Salivary biomarkers like P16, MGMT, and DAP-K can be used in the diagnosis of oral squamous cell carcinoma.

Background: Current standard of care treatment for patients with ≥15 brain metastases (BM) is whole brain radiation therapy (WBRT), despite poor neurocognitive outcomes. We analyzed our institutional experience of treating these patients with stereotactic radiosurgery (SRS), with the aim of evaluating safety, cognitive outcomes, and survival metrics. Methods: Patients who received SRS for ≥15 BMs in 1 to 5 fractions from 2014 to 2022 were included. Cognitive outcomes were objectively evaluated using serial Patient-Reported Outcome Measurement Information System (PROMIS) scores. The Kaplan-Meier method was used for survival analysis and log-rank test for intergroup comparisons. Results: Overall, 118 patients underwent 124 courses of LINAC-based SRS. The median number of lesions treated per course was 20 (range, 15-94). Most patients received fractionated SRS to a dose of 24 Gy in 3 fractions (81.5%). At the time of SRS, 19.4% patients had received prior WBRT, and 24.2% had received prior SRS. The rate of any grade radiation necrosis (RN) and grade ≥3 RN were 15.3% and 3.2%, respectively. When evaluating longitudinal PROMIS score trends, 25 of 31 patients had a stable/improved PROMIS score. Patients who did not receive prior brain RT had a longer median survival (7.4 months vs 4.6 months, P = .034). The 12m local control was 97.6%, and the cumulative incidence of distant intracranial failure, with death as a competing event, was 46% (95% CI, 36%, 55%). One year freedom from neurologic death, leptomeningeal disease, and salvage WBRT were 89%, 94.6%, and 84%, respectively. Conclusion: We present here one of the largest studies evaluating SRS for patients with ≥15 BMs. SRS was safe, had favorable cognitive outcomes, and had comparable survival outcomes to contemporary studies evaluating WBRT in this population. Treatment-naïve patients had a median survival of >6 months, long enough to benefit from cognitive sparing with SRS. Our study supports randomized studies comparing SRS and hippocampal avoidance WBRT approaches for these patients.

Chitin deacetylase (CDA) modifies chitin into chitosan by removing acetyl groups, but its inherent instability poses a challenge for successful crystallisation. Despite limited successes in crystallizing CDAs, prior attempts with recombinant chitin deacetylase (BaCDA) failed due to poor stability. To address this, we propose an enzyme buffer formulation as a cost-effective strategy to enhance stability, prolong shelf life, and increase the likelihood of crystallisation. Utilizing the high-throughput screening technique FTSA, we developed a screening method correlating BaCDA stability with its activity. The optimised formulation comprises 50 mM Tris-HCl buffer pH 7, 1 M NaCl, 20 % glycerol, and 1 mM Mg2+ as excipients. This formulation significantly improves BaCDA's thermostability (140.47 % increase) and enzyme activity (2.9-fold enhancement). BaCDA remains stable in the formulated buffer at −20 °C and −80 °C for 30 days and at 4 °C for 15 days. The current study has designed a high-throughput screening method approach to assess the stability of CDA enzyme formulations. The results of this study could contribute to the exploration of formulation elements that enhance the structural stability of CDA, thereby facilitating investigations into the enzyme's structure-function relationships.