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Abstract Introduction Noncommunicable diseases (NCDs) are associated with high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of National policy, Nigeria has committed to implement the World Health Organization (WHO) Package of Essential Non-communicable Disease interventions for primary care. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems (HMIS), equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the DM component of the WHO package, and the readiness of the health workers in these PHCs to implement a DM screening, evaluation, and management program to inform future adoption and implementation. Methods This cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August and October 2021. The SARA tool was adapted to focus on DM services and the availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain. Results All 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] = 5 [4–9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1–4]. At least one staff member was recently trained in DM care in 11 PHCs (36%). The study also reported high availability of paper-based HMIS (100%), and DM screening services using a glucometer (87%), but low availability of DM job aids (27%), treatment (23%), and national guidelines/protocols (0%). Conclusion This formative assessment of PHCs’ readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs regarding equipment, paper-based HMIS, and nonphysician health workers' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and supply essential DM medications.

INTRODUCTION: To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure (CHF). METHODS: This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity, derived from the Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24 hours of hospitalization and evaluated for free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), N-terminal pro-brain natriuretic peptide (NT pro-BNP) and reverse T3. RESULTS: A total of 80 (64 acyanotic CHD) children of median (interquartile range) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%) of whom 27 had low fT3 levels. The proportion of NTI was highest in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41) (p=0.018). Ten (27%) patients with NTI died compared to 2 (4.7%) without NTI with unadjusted odds ratio (OR) [95% confidence interval (CI)] 7.593 (1.54, 37.38); p=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR: 1.41, 95% CI: 1.03, 1.92; p=0.032). Linear regression for fT3 identified a significant relationship with log NT-BNP [beta -3.541, (95% CI: -1.387, -0.388)] and with TSH [beta 2.652 (95% CI: 0.054, 0.383)]. The cutoff (area under the curve, 95% CI) that predicted mortality were fT4 3725 pg/mL (0.702; 0.53, 0.88). DISCUSSION AND CONCLUSION: NTI was present in a significant proportion of children with CHD and CHF. fT3 level was significantly associated with NTBNP levels and thus severity of CHF.

Introduction: To assess the performance of growth hormone stimulation tests (GHSTs) in the evaluation of short stature. Methods: It was a single-centre retrospective study carried out in children evaluated for short stature between January 2005 to March 2020. The clonidine stimulation test (CST) and glucagon stimulation test (GST) were used to assess growth hormone (GH) reserve (GST was performed only when peak GH levels were between 5 to ≤10 ng/mL on CST). A GH level of

The need for strengthening national capacities for disease prevention, preparedness, and response is increasingly becoming urgent. Central to this is strengthening existing systems and workforce capacity for disease surveillance and disease outbreak response. This study aimed to evaluate the national capacity and needs of veterinary services in Vietnam in animal disease surveillance and outbreak investigation skills. A cross-sectional, convergent, mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government field veterinarians, followed by descriptive and multivariable analyses to understand field capacity, specifically levels of experience in outbreak investigation and animal health surveillance. Semi-structured interviews were conducted with various stakeholders in veterinary services and interview transcripts were coded and thematically analyzed. Qualitative results were used to contextualize quantitative findings from the survey. Overall, 178 field veterinary staff completed the online survey, and 25 stakeholders were interviewed. Eighty percent of respondents reported a high priority for further training in both animal disease surveillance and outbreak investigation. Training and competence were more limited at the district and commune levels, highlighting a gap in capacity at the subnational level. Reasons included a lack of in-depth training opportunities, limited access to resources and high staff turnover. Respondents who completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs were more likely to have higher levels of experience in animal health surveillance and outbreak investigation. This study identified gaps in knowledge and adoption of practices most often related to local-level or less experienced veterinary staff with limited training opportunities in epidemiology. Findings inform the prioritization of training and planning activities to further enhance the national capacity of veterinary services in Vietnam. Underlying explanations for existing gaps in capacity include inequities in skill development and training opportunities across levels of veterinary staff, gaps in the chain of command and unequal funding across provinces.

Background: The establishment of the Ayushman Arogya Mandir marks a fundamental change in India's approach to healthcare. The present study aimed to examine the effectiveness and shortcomings of health packages extended through the Ayushman Arogya Mandir in Block Marh, Jammu, Jammu and Kashmir identifying areas for improvement, and addressing barriers to optimal utilization. Methods: This cross-sectional study was done among 10 centres in the Marh block of Jammu, Jammu and Kashmir to achieve the desired objectives using structured and self-administered questionnaires. A convenience sampling of 105 participants, including 55 healthcare professionals and 50 community members, was adopted using time-bound enumeration. Checklists were also included to assess healthcare services, ensuring a thorough understanding of how healthcare packages are administered and implemented. Confidentiality was prioritized and ethical considerations guided the data collection process, allowing for a comprehensive examination of healthcare utilization patterns in the target region. Results: The results revealed that reproductive and family planning services, as well as neonatal/infant healthcare, have high utilization rates (95 % and 78 %, respectively), highlighting their significance, whereas lower rates in elderly/palliative care, psychiatric/neurological/substance use disorder care, and eye/ENT treatments indicate potential areas for improvement in healthcare awareness, access, and service provision barriers. Conclusion: The Ayushman Arogya Mandir in Block Marh, Jammu, Jammu and Kashmir are heavily leaning towards maternal and child health initiatives while other services are underutilised, highlighting the need for targeted awareness of the availability and accessibility to these services.

Background: The attitudes of dental students to study a particular specialty of dentistry in post-graduation are of great importance as these facilitate workforce planning in the dental sector. Aim and Objective: To assess the attitude of dental students towards choosing periodontology as their future career and to explore demographic variables that affect their choice. Materials and Methods: A cross-sectional survey based on a questionnaire was conducted, including students of the third and fourth years and interns of the dental college. Twenty-seven questions, graded on a Likert scale (5-point) were included in the questionnaire, and the responses were categorised via three attitudes: negative (score 0–21), neutral (score 22–44) and positive (score 45–64). The Chi-square test for proportions was used to examine the differences between groups. Results: Among 114 participants, 53 (46.5%) were males and 61 (53.5%) were females. One-third of the respondents had a positive attitude towards selecting periodontology as their future career, and the majority had a neutral perspective, with a few students having a negative attitude (20.2%). Out of the total, 34.2% of respondents had a positive attitude, and 45.6% showed a neutral attitude or perspective. Conclusion: Efforts should be intensified, and undergraduate (UG) students should be motivated by broadening the scope of the field in the UG curriculum by the dental council so that the students show considerable interest in pursuing the field as their future career.

The ubiquity of public-space sexual harassment (PSH) of women in the global South, particularly in South Asia, is both a public health and gender equity issue. This study examined men’s experiences with and perspectives on PSH of women in three countries with shared cultural norms and considerable gender inequalities – Bangladesh, India, and Pakistan. The three-country survey in 2021–2022 was completed by 237 men who were generally young, urban, single, well-educated, and middle-/high-income. Among the 53.3% who witnessed PSH, 80% reported intervening to stop it or help the victim. A substantial share of men worried about PSH, and bore emotional, time, and financial costs as they took precautionary or restorative measures to help women in their families avoid PSH or deal with its consequences. Most respondents articulated potential gains for men, women, and society if PSH no longer existed. However, a non-negligible share of participants held patriarchal gender attitudes that are often used to justify harassment, and a small share did not favour legal and community sanctions. Many called for stricter legal sanctions and enforcement, culture change, and education. Men’s perspectives offer insights for prevention of harassment and mitigation of its consequences.

Funding and financing for One Health initiatives at country level remain challenging as investments commonly require demonstrated evidence of economic value or returns. The objectives of this review were to i) identify, critically analyse and summarise quantitative evidence of the net economic value of One Health initiatives; ii) document methodologies commonly used in the scientific literature; and iii) describe common challenges and any evidence gaps. Scientific databases were searched for published literature following the PRISMA guidelines and an online survey and workshop with subject matter experts were used to identify relevant grey literature. Studies were included if they reported on quantitative costs and benefits (monetary and non-monetary) and were measured across at least two sectors. Relevant publications were analysed and plotted against the six action tracks of the Quadripartite One Health Joint Plan of Action to help classify the initiatives. Ninety-seven studies were included. Eighty studies involved only two sectors and 78 reported a positive economic value or return. Of those studies that reported a positive return, 49 did not compare with a sectoral counterfactual, 28 studies demonstrated an added value of using a cross-sectoral approach, and 6 studies demonstrated an added value of One Health communication, collaboration, coordination, and capacity building. Included studies most frequently related to endemic zoonotic, neglected tropical and vector-borne diseases, followed by health of the environment and food safety. However, diversity in economic analysis methodology between studies included resulted in difficulty to compare or combine findings. While there is a growing body of evidence of the value of One Health initiatives, a substantial part of the evidence still focuses on “traditional” One Health topics, particularly zoonoses. Developing a standardised and practical approach for One Health economic evaluation will facilitate assessment of the added value and gather evidence for One Health to be invested in and endorsed by multiple sectors.

The rapid emergence of resistance to existing frontline antimalarial drugs emphasizes a need for the development of target-oriented molecules with novel modes of action. Given the importance of a plant-like Calcium-Dependent Protein Kinase 1 (PfCDPK1) as a stand-alone multistage signalling regulator of P. falciparum, we designed and synthesized 7-chloroquinoline-indole-chalcones tethered with a triazole (CQTrICh-analogs 7 (a–s) and 9) directed towards PfCDPK1. This was accomplished by reacting substituted 1-phenyl-3-(1-(prop-2-yn-1-yl)-1H-indol-3-yl) prop-2-en-1-one and 1-(prop-2-yn-1-yl)-1H-indole-3-carbaldehyde with 4-azido-7-chloroquinoline, respectively via a ‘click’ reaction. The selected CQTrICh-analogs: 7l and 7r inhibited the growth of chloroquine-sensitive 3D7 strain and -resistant RKL-9 isolate of Plasmodium falciparum, with IC50 values of 2.4 μM & 1.8 μM (7l), and 3.5 μM & 2.7 μM (7r), respectively, and showed no apparent hemolytic activity and cytotoxicity in mammalian cells. Intra-erythrocytic progression studies revealed that the active hybrids: 7l and 7r are effective against the mature stages of the parasite. 7l and 7r were found to stably interact with the catalytically active ATP-binding pocket of PfCDPK1 via energetically favourable H-bonds. The interaction was confirmed in vitro by microscale thermophoresis and kinase assays, which demonstrated that the active hybrids interact with PfCDPK1 and inhibit its kinase activity which is presumably responsible for the parasite growth inhibition. Interestingly, 7l and 7r showed no inhibitory effect on the human kinases, indicating their selectivity for the parasite kinase. We report the antiplasmodial potential of novel kinase-targeting bio-conjugates, a step towards developing pan-kinase inhibitors which is a prerequisite for multistage anti-malarial protection.

Abstract Complementary feeding practices are greatly influenced by local contexts. Therefore, national home‐grown evidence, policies and guidelines are critical to improving infant and young children's diets. This Special Issue has provided a comprehensive, evidence‐based analysis of the situation, gaps and context‐specific opportunities for improving young children's diets in Kenya. The primary research findings of the Special Issue supported the identification of a set of recommendations articulated across the four systems (food, health, water, sanitation and hygiene [WASH] and social protection) to improve food availability and accessibility in Kenya at the national and subnational levels. It is anticipated that the decentralised government functions seen in Kenya provide a strong opportunity to develop and mainstream context‐specific recommendations into action. This Special Issue recommends adopting a multi‐sectoral systems approach, including a shared vision, joint planning, implementation and monitoring, towards improving young children's diets with a focus on service delivery as well as scaled‐up community social behaviour change interventions. In particular, the approach should entail advocacy for policy revisions for service delivery that support complementary feeding and development of costed implementation strategies in support of the same, across four critical systems—food, health, WASH and social protection, along with, the strengthening of national coordination, monitoring and accountability structures as per the Kenya Nutrition Action Plan. Finally, the development of a legal framework for enhanced accountability from all relevant sectors towards sustainable, nutritious, safe and affordable children's diets. These recommendations provide a clear direction in addressing the complementary feeding challenges, which the primary research of this Special Issue has presented.

Abstract Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal‐source foods could be improved. Ethnographic data were analyzed to identify socio‐cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user‐friendly and low‐cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal‐source foods. Furthermore, it emphasizes the need for a multi‐sectoral approach in enacting policies and programmes that address these barriers.

Abstract Background Osteomas are benign slow-growing tumors, which typically arise on the surface of the bone. They rarely arise from the temporal bone, accounting for 0.1–1% of all benign tumors of the skull. The external auditory canal (EAC) is the most common site for osteomas in the temporal bone. Other extra-canalicular osteomas of the temporal bone are uncommon and infrequently reported. In this case report, we discuss the clinical presentation and surgical management of osteoma of the squamous part of the temporal bone. A limited review of literature is also presented. Case presentation A 20-year-old male presented to the outpatient department (OPD) with a chief complaint of a hard swelling above his left ear, for 4 years. He had no other complaints other than cosmetic concern. On examination, there was a solitary, smooth, bony hard swelling just antero-superior to the left pinna, and the overlying skin was unremarkable. The left EAC and tympanic membrane were normal. A non-contrast computed tomography (CT) scan of the head and face with 3-D reconstruction showed a16 × 18 mm exophytic, pedunculated bony lesion arising from the squamous part of the temporal bone suggestive of an osteoma. The patient was taken up for surgical excision under general anesthesia. The bony lesion was removed from its attachment to the skull using a gouge and a mallet. The base of the tumor was drilled using a polishing burr to ensure complete removal and prevent recurrence. The histopathology was confirmatory of compact osteoma. Postoperative period was uneventful, and follow-up at 18-month post-surgery did not reveal any recurrence clinically. Conclusion Osteoma of the temporal squama is rarely reported, and surgical excision is the definitive treatment if symptomatic. This case report highlights the surgical management of this rare tumor. A limited review of literature suggests that squamous part of the temporal bone is an unusual site for extra-canalicular osteomas, and the prognosis is good after surgery.

Cathelicidins are human peptides involved in innate immunity, and are believed to be mediators of vitamin D-related immune benefits. We aimed to evaluate the correlation between serum levels of 25 hydroxy vitamin D (25(OH)D) and serum cathelicidin antimicrobial peptide (CAMP) in children hospitalized with severe pneumonia. This was a secondary analysis from a larger randomized double-blind placebo-controlled trial on vitamin D supplementation in severe pneumonia. Children aged 6 months to 5 years with the World Health Organization (WHO) defined severe pneumonia were included. Any child with rickets, immunodeficiency, or chronic illness was excluded. Baseline serum CAMP, serum 25(OH)D, and immunoglobulins were measured and analyzed. A total of 163 under-five children were recruited with mean (standard deviation) age 16.4 (13.0) months. The median (interquartile range [IQR]) serum CAMP was 12.5(8.0–20.0) ng/mL and serum 25(OH)D was 14.4 (8.4–24.2) ng/mL. There was no significant correlation between serum cathelicidin and serum 25(OH)D (r = −0.064, p = 0.415). Serum 25(OH)D was low (

Objective: To compare and evaluate the clinical efficacy of diode laser and cryosurgery for treating melanin pigmentation of gingiva. Material and Methods: A total of twenty-five subjects with physiological gingival pigmentation on the facial aspect of both maxillary and mandibular anterior arches (50 sites), both male and female, with an average age ranging from 18-35 years, participated in the study. The sites were randomly divided into Group I: depigmentation by Laser and Group II: depigmentation by Cryosurgery. The following parameters were assessed for the evaluation of treatment results: Melanin Oral Pigmentation Index (PI), Visual Analogue Scale (VAS) for pain evaluation and Healing index (HI). The data collected was statistically evaluated. Results: On intergroup comparison, there was no statistical difference in the score from baseline (p>0.05); however, a statistically significant difference was seen at the end of 1 year (p

A definite worldwide shift towards healthier and more nutrient-dense meals has emerged in the past couple of decades. There exists an emerging need for efficient preservation solutions that can effectively mitigate the perishable nature due to the increasing interest in healthy and fresh food products. An efficient method for lengthening the post-harvest lifespan of whole as well as chopped vegetables and fruits is packaging, which includes plastic films and coatings, however plastic packaging has the shortcoming of being a significant environmental threat in nearly every nation. Therefore, sustainable alternatives to traditional food packaging comprise films and/or coatings composed of bio polymers. However, compared to conventional plastic packaging, these biopolymers, which come from nature, have shortcomings such as essential physio-chemical and mechanical qualities. These flaws are fixed by strengthening biopolymers with nanomaterials, which also gives the resulting nanocomposites useful features including antioxidant and/or antibacterial activity. These advances in biopolymer-based nanocomposite can be made with the application of both inorganic (eg., zinc oxide, montmorillonite) and organic (such as nanocellulose fibrils) nanomaterials. This review article discusses the worth of biopolymer coating and films reinforced with nanocomposites to package whole and sliced fruits and vegetables to enhance their lifespan.

Abstract Fixed‐dose combination (FDC) therapy is recommended for hypertension management in Nigeria based on randomized trials at the individual level. This cluster‐randomized trial evaluates effectiveness and safety of a treatment protocol that used two‐drug FDC therapy as the second and third steps for hypertension control compared with a protocol that used free pill combinations. From January 2021 to June 2021, 60 primary healthcare centers in the Federal Capital Territory of Nigeria were randomized to a protocol using FDC therapy as second and third steps compared with a protocol that used the same medications in free pill combination therapy for these steps. Eligible patients were adults (≥18 years) with hypertension. The primary outcome was the odds of a patient being controlled at their last visit between baseline to 6‐month follow‐up in the FDC group compared to the free pill group. 4427 patients (mean [SD] age: 49.0 [12.4] years, 70.5% female) were registered with mean (SD) baseline systolic/diastolic blood pressure 155 (20.6)/96 (13.1) mm Hg. Baseline characteristics of groups were similar. After 6‐months, hypertension control rate improved in the two treatment protocols, but there were no differences between the groups after adjustment (FDC = 53.9% versus free pill combination = 47.9%, cluster‐adjusted p = .29). Adverse events were similarly low (

Background: Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim: A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods: The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist – Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results: The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion: There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.

Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small‐for‐gestational‐age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy‐related conditions is lacking. Methods and Results A 6‐month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small‐for‐gestational age baby in Melbourne, Australia. The co‐primary end points were (1) blood pressure

Summary: Background: The hormonal profile varies considerably with age, gender, ethnicity, diet or physiological state of an individual. Limited population-specific studies have studied the variations in hormonal parameters among apparently healthy women. We aimed to analyse the biological reference interval for various hormonal parameters in the reproductive-aged healthy Indian women. Methods: Out of 3877 participants that were clinically evaluated, 1441 subjects were subjected to laboratory investigations. All participants underwent a detailed clinical, biochemical and hormonal profiling. The hormone analysis was carried out at a single centre using a uniform methodology. Among the participants evaluated for biochemical and hormonal parameters, subjects that presented any abnormal profile or had incomplete investigations (n = 593) were excluded for further analysis. Findings: The mean age (±SD) of the subjects retained in the final analysis (n = 848) was 29.9 (±6.3) years. In the present study, the biological reference interval (2.5th–97.5th centile) observed were: serum T4: μg/dL (5.23–12.31), TSH: μg/mL (0.52–4.16) and serum prolactin: ng/mL (5.13–37.35), LH: mIU/mL (2.75–20.68), FSH: mIU/mL 2.59–15.12), serum total testosterone: ng/mL (0.06–0.68), fasting insulin: mIU/mL (1.92–39.72), morning cortisol: μg/dL (4.71–19.64), DHEAS:μg/dL (50.61–342.6) and SHBG: nmol/L (21.37–117.54). Unlike T4, TSH, LH, and E2, the biological reference interval for prolactin, FSH, testosterone, C-peptide insulin and DHEAS varied when the subjects were stratified by age (p

Abstract This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6–23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6–11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin‐A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.

Internet offers an immense opportunity as a resource for education, training, and health promotion. This narrative review summarizes the opportunities for health promotion among adolescents through use of the Internet and technology (defined as eHealth). The details of technology and use of Internet for adolescent-health related topics such as nutrition, fitness, sexual health, adventure, and violence were searched through PubMed. The review reports few digital solutions to address key challenges during adolescence like promotion of nutrition and sexual reproductive health, prevention of noncommunicable diseases, substance abuse, and mental health issues. eHealth was concluded as a potential solution for preventive and promotional health practices during adolescence. However, concerns of Internet addiction, safety, privacy, mental health disorders, and misinformation need to be addressed and monitored during adolescence.

Abstract Background Hypertension is the most common cardiovascular disease in Nigeria and contributes to a large non-communicable disease burden. Our aim was to implement and evaluate a large-scale hypertension treatment and control program, adapted from the Kaiser Permanent Northern California and World Health Organization HEARTS models, within public primary healthcare centers in the Federal Capital Territory, Nigeria. Methods A type 2 hybrid, interrupted time series design was used to generate novel information on large-scale implementation and effectiveness of a multi-level hypertension control program within 60 primary healthcare centers in the Federal Capital Territory, Nigeria. During the formative phase, baseline qualitative assessments were held with patients, health workers, and administrators to inform implementation package adaptation. The package includes a hypertension patient registry with empanelment, performance and quality reporting, simplified treatment guideline emphasizing fixed-dose combination therapy, reliable access to quality essential medicines and technology, team-based care, and health coaching and home blood pressure monitoring. Strategies to implement and adapt the package were identified based on barriers and facilitators mapped in the formative phase, previous implementation experience, mid-term qualitative evaluation, and ongoing stakeholder and site feedback. The control phase included 11 months of sequential registration of hypertensive patients at participating primary healthcare centers, followed by implementation of the remainder of the package components and evaluation over 37 subsequent, consecutive months of the intervention phase. The formative phase was completed between April 2019 and August 2019, followed by initiation of the control phase in January 2020. The control phase included 11 months (January 2020 to November 2020) of sequential registration and empanelment of hypertensive patients at participating primary healthcare centers. After completion of the control phase in November 2020, the intervention phase commenced in December 2020 and will be completed in December 2023. Discussion This trial will provide robust evidence for implementation and effectiveness of a multi-level implementation package more broadly throughout the Federal Capital Territory, which may inform hypertension systems of care throughout Nigeria and in other low- and middle-income countries. Implementation outcome results will be important to understand what system-, site-, personnel-, and patient-level factors are necessary for successful implementation of this intervention. Trial registration ClinicalTrials.gov NCT04158154 . The trial was prospectively registered on November 8, 2019.

Abstract Plant food bioactives (PFBs) offer immense health benefits with a greater scope for treating various life‐threatening diseases and lifestyle disorders. Knowing their therapeutic potentials, a lot of research works are being carried out on formulating PFBs‐loaded nano delivery systems (NDSs) to enhance their bioefficacy. However, limited information are available on the interactions occurring at the nano‐bio interface. Therefore, studies on nano‐bio interactions are of immense importance towards designing/formulating effective NDSs for PFBs. Understanding the significance of nano‐bio interface of food bioactive‐loaded NDSs would help us to predict the formation of biocorona as well as the correlation between the nanoparticles and their surrounding environments that are influenced by the NDS's physicochemical properties. The physicochemical characteristics of NDSs like size, shape, and surface charge will decide their fate in the biological fluids and have been discussed in detail. As the bioactives‐loaded NDS enters the gastrointestinal tract, formation of biocorona including protein and enzyme corona at the nano‐bio interface will takes place. Subsequently, the fate of PFBs‐loaded NDSs influences the absorption, distribution, metabolism, and excretion (ADME) processes and thereby its bioavailability, bioefficacy, and biosafety. The current review focuses on understanding the journey of PBFs‐loaded NDSs, the nature of interactions happening at nano‐bio interface, and its pharmacokinetics properties. In addition, a specific case study approach on curcumin‐loaded NDSs, and its reported interactions at nano‐bio interface, including ADME mechanism are comprehensively presented.

Artificial Intelligence has evolved as an alternative to human intelligence. It affects the lives of billions of people. It mimics humans by solving problems and understanding the task. These Artificial Intelligence technologies must have some moral values and ethics incorporated within itself. The usage of AI is growing worldwide, posing more ethical issues to consider. In recent years, many companies have used various Artificial Intelligence tools such as chatbots and face recognition software for fulfilling their hiring needs. This research work will focus on such devices that help manage one of the important functions of human resources: recruitment. It will identify various challenges and ethical issues that a firm faces while assimilating Artificial Intelligence tools in the process of Recruitment. The hiring companies need to make the job seekers realize that AI-powered tools would be free from discrimination and safeguard privacy. The purpose of the study is to identify the ethical issues while incorporating Artificial Intelligence into hiring needs. The study will be based on reviews and features of applications. The study mentions various applications whose features might be unethical for job seekers. Findings reveal that the significant unethical issues faced by the hiring companies are Data privacy and unconscious biasness. The biasness is due to the algorithm that works according to the inputs fed to build it, and the programmer might have subconscious biasness in his mind. AI has restored concerns regarding privacy and data protection. According to a report by UNESCO, Women make up only 22% of all AI professionals. Gender prejudices and stereotyping are perpetuated in AI technologies due to their underrepresentation in the sector. Virtual personal assistants like Siri, Alexa, and Cortana are ;female; by default, which is no accident. The submissiveness they display is an illustration of how Artificial Intelligence (AI) might continue to support and extend gender bias in our society.

Healthcare workers, both globally and in Nigeria, have an increased risk for SARS-CoV-2 infection compared with the general population due to higher risk contacts, including occupational exposures. In addition, primary healthcare workers represent an important group for estimating prior infection to SARS-CoV-2 because they work at the first point-of-contact for most patients yet have not been included in prior COVID-19 seroepidemiology research in Nigeria. We sought to evaluate baseline seroprevalence, rates of seroconversion (IgG- to IgG+) and seroreversion (IgG+ to IgG-), change in IgG concentration at 3- and 6-month follow-up, and factors associated with seropositivity. From June 2020 to December 2020, we conducted a longitudinal seroepidemiology study among frontline health care workers in Nigeria using a validated dried blood spot assay. Among 525 participants, mean (SD) age was 39.1 (9.7) years, 61.0% were female, and 45.1% were community health workers. The six-month follow-up rate was 93.5%. Seropositivity rates increased from 31% (95% CI: 27%, 35%) at baseline to 45% (95% CI: 40%, 49%) at 3-month follow-up, and 70% (95% CI: 66%, 74%) at 6-month follow-up. There was a corresponding increase in IgG levels from baseline (median = 0.18 ug/mL) to 3-month (median = 0.35 ug/mL) and 6-month follow-up (median = 0.59 ug/mL, Ptrend < .0001). A minority of participants reported symptoms from February 2020 until baseline (12.2%) or during 3-month (6.6%) or 6-month (7.5%) follow-up. only 1 participant was hospitalized. This study demonstrated high baseline, 3-month and 6-month follow-up prevalence of IgG antibodies to SARS-CoV-2 during the first two waves of the COVID-19 pandemic in Nigeria among a cohort of unvaccinated frontline healthcare workers, including primary healthcare workers despite low symptomatology. These results may have implications in state- and national-level disease pandemic modeling. Trial registration: NCT04158154.

Abstract Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6–23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994–2011) and Multiple Indicator Cluster Surveys (MICS, 2000–2016), the trends and predictors of World Health Organization‐United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6–8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011–2016, the proportion of children aged 6–23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi‐level strategies to improve young children's diet in Côte d'Ivoire.

Background: Coronavirus disease 2019 (COVID-19) and the nationwide lockdown have resulted in profound disruptions in health care. Thus, the study was done to assess the barriers faced by caregivers of children with chronic diseases in accessing healthcare services due to the lockdown. Methods: A questionnaire-based telephonic survey was performed after 2 months of nationwide lockdown in children with chronic diseases at a tertiary hospital in India. Barriers faced were recorded and compared with the place of residence and socioeconomic status (SES). Results: A total of 101 children with mean ± standard deviation age of 9.7 ± 3.6 years and median (interquartile range) disease duration of 48 (12, 84) months were included. The majority (84.6%) was on daily therapy and 65.3% reported disrupted treatment. Patients residing away from the capital had greater difficulty in investigations and in transport to the hospital (P < 0.05) compared to those in the capital. Patients from lower SES had more difficulty in procuring medications (64.1% and 35.4%; P = 0.006), transport (62.3% and 29.1%; P = 0.003), and perceived significant effect of COVID-19 on their child (47.2% and 16.7%; P = 0.002) compared to middle SES. Conclusions: Disrupted health-care access during COVID-19 suggests the need for health-care systems to be better equipped to manage patients with chronic illnesses during such pandemics.

Objective: To detect effect of removing cervical mucus before performing intrauterine insemination (IUI) on pregnancy rate in patients with unexplained infertility. Methods: The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital. Totally 80 patients of unexplained infertility were recruited. By computer generated block randomization in block size of 4 and 6, patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI, 40 in each group. Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7. Follicular monitoring was done and further doses given as per response; trigger was planned when 1-3 follicle reach a diameter of >18 mm. IUI was planned after trigger. IUI was done as per the group allocated. Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI. The primary outcome was clinical pregnancy rate. Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted. Results: IUI was not done in 4 patients due to hyperstimulation. Pregnancies per IUI cycle occurred in 7.9% (3/38) in the cervical mucus removal group and 21.1% (8/38) in the non-removal of cervical mucus group. There was no statistically significant difference in clinical pregnancy rate between two groups (P=0.19). Conclusions: There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant. Further studies with large sample size need to be done on this intervention. Trial registration: The trial registration was done with Clinical Trial Registry-India (Registration number: CTRI/2019/03/018326).

Background: Severe acute respiratory syndrome coronavirus 2 is a severe respiratory infection that spreads through infected droplets. Facemasks have been mandated by the World Health Organization and Centers for Disease Control as the cornerstone for preventing the spread of infection among healthcare workers. However, despite the ubiquitous use of masks, many healthcare professionals are unaware of their properties and proper use. Therefore, the study aims to assess the awareness, practices followed, and problems faced in the use of facemasks among medical professionals in a coronavirus disease (COVID)-dedicated hospital. Methodology: An e-questionnaire-based survey was conducted among medical professionals working in a tertiary care (COVID-dedicated) hospital in North India. The questionnaire tested for the knowledge and awareness on properties of facemasks, problems faced on regular or prolonged use, and removal, storage, and disposal practices among professionals. Results: The survey was sent to 368 medical professionals with a response rate of 45.65%. About 43.3% of the participants were aware of the properties of the N95 facemask, and 26% of the health professionals checked for the proper fit of the mask after putting it on. Discomfort and sweat issues were the most common problems reported by 84% and 69.33% of participants, respectively. About 86% of the participants had the knowledge of appropriate removal of the mask, but only one-third were aware of the proper mask disposal practices. Conclusion: Knowledge about the properties of facemasks, their use, and disposal practices among the North Indian healthcare professionals was found to be significantly lower than in western countries; however, the awareness increased with experience in the participants studied (P < 0.001). As it is the young medical force at the forefront to tackle the menace, regular training and accurate information on facemask usage must be disseminated via institutional training programs to prevent the risk of infection and equip the frontline workers to share this knowledge with the community further.

Background: Coronavirus disease 2019 (COVID-19) pandemic-related refocusing of healthcare along with needs for social distancing, complete or partial lockdowns, and burgeoning economic crisis has created immense barriers to the access of healthcare services by the non-COVID patients. Aim: We aimed to assess the perspectives of Indian healthcare workers taking care of pediatric patients on the barriers to healthcare delivery to pediatric non-COVID illnesses. Methods: Indian healthcare workers, working in both public and private sectors, taking care of pediatric patients were surveyed using a predesigned pretested online questionnaire over a period of 1 month (May 2020). The impact on healthcare delivery was graded using a Likert scale. Results: Of the total of 356 responses obtained, 75.3% reported a significant negative impact of the COVID-19 pandemic on delivery of healthcare to non-COVID pediatric patients. Respondents of government and COVID hospitals reported a significantly worse impact than private (P = 0.0002) and non-COVID hospitals (P = 0.01), respectively. Significant decline in number of non-COVID patients attending outpatient department (86.2%), admitted in wards (71.6%), number of routine (81.7%) and emergency surgeries (60.5%), number of diagnostic procedures (61.2%), and scheduled therapies (50.2%) was reported by the surveyed healthcare workers. Most important factors for disrupted healthcare delivery were restricted travel (78.3%) and fear of contracting COVID-19 (68.8%). Telemedicine (67.4%) was the commonest alternate strategy deployed for continuing care of patients. Conclusion: Several challenges exist to maintain the continuity of healthcare services to pediatric non-COVID patients especially in those with chronic diseases, poor financial background, and follow-up in COVID government hospitals. Use of telemedicine, strategic preplanning, strengthening peripheral healthcare, and optimal resource reallocation may help reduce the broader health impact of the COVID-19 pandemic.

While biosecurity is of increasing importance globally, there is still limited evidence of the factors or elements that support the progressive and sustainable scaling up of biosecurity along the value chains from the local to the global level. To gain insight into the current body of literature on biosecurity, a mixed-methods approach was used based on a scoping literature review and an online survey with subject matter experts. Six databases were searched for published literature, and textual information from titles and abstracts of all included records (n = 266) were analysed through inductive content analysis to build biosecurity-relevant categories and identify strengths, weaknesses, opportunities, and threats (SWOT) of existing biosecurity systems or initiatives (such as projects or programs). Most records focused on initiatives in high-income countries, traditional livestock species (pigs, poultry, and large ruminants), and the production stage and had a disease-specific focus. No records described a comprehensive or global framework to progressively scale up biosecurity. Overall, the findings highlight the need for initiatives such as the FAO Progressive Management Pathway for Terrestrial Animal Biosecurity (FAO-PMP-TAB), which is a stepwise approach for strengthening biosecurity management along value chains to enhance the health, resilience, and sustainability of animal sectors. The findings highlight important elements and provide recommendations useful for developing approaches or a global framework to progressively improve biosecurity management.

Electrochemical water splitting is one of the most important method for energy conversion and storage. For this, the design and development of a low-cost robust electrocatalyst are highly desirable. In this study, Cobalt-based electrocatalyst for Oxygen Evolution Reaction was synthesized by thermal treatment of Cobalt-dehydroacetic acid (Co-DHA). The as-synthesized Co nanostructures and Co-DHA crystals were characterized with powder X-ray diffraction, X-ray photoelectron spectroscopy thermo-gravimetric analysis, and field emission scanning electron microscopy. The electrochemical O2 evolution study shows the overpotential (at 10 mV/cm−2) correspond to 294 mV vs reference hydrogen electrode (RHE) for K-300 (Co3O4@300), whereas K-500 (Co3O4@500) shows 170 mV vs RHE values in 1 M KOH solution, respectively. Similar trends have been observed for electrochemical O2 evolution studies in 0.5 M H2SO4, where K-300 and K-500 shows the overpotential (at 10mV/cm−2) of 234 mV vs RHE, and 199 mV vs RHE, respectively. The outcomes show better catalytic efficiency of K-500 as compared to K-300.

Coronaviruses did not invite attention at a global level and responsiveness until the series of 2003-SARS contagion followed by year-2012 MERS plus, most recently, 2019-nCoV eruptions. SARS-CoV & MERS-CoV are painstaking, extremely pathogenic. Also, very evidently, both have been communicated from bats to palm-civets & dromedary camels and further transferred ultimately to humans. No country has been deprived of this viral genomic contamination wherever populaces reside and are interconnected. This study aimed to develop a mathematical model for calculating the transmissibility of this viral genome. The analysis aids the study of the outbreak of this Virus towards the other parts of the continent and the world. The parameters such as population mobility, natural history, epidemiological characteristics, and the transmission mechanism towards viral spread when considered into crowd dynamism result in improved estimation. This article studies the impact of time on the amount of susceptible, exposed, the infected person taking into account asymptomatic and symptomatic ones; recovered i.e., removed from this model and the virus particles existing in the open surfaces. The transition from stable phase to attractor phase happens after 13 days i.e.; it takes nearly a fortnight for the spread to randomize among people.Further, the pandemic transmission remains in the attractor phase for a very long time if no control measures are taken up. The attractor-source phase continues up to 385 days i.e., more than a year, and perhaps stabilizes on 386th day as per the Lyapunov exponent's analysis. The time series helps to know the period of the Virus's survival in the open sources i.e. markets, open spaces and various other carriers of the Virus if not quarantined or sanitized. The Virus cease to exist in around 60 days if it does not find any carrier or infect more places, people etc. The changes in LCEs of all variables as time progresses for around 400 days have been forecasted. It can be observed that phase trajectories indicate how the two variables interact with each other and affect the overall system's dynamics. It has been observed that for exposed and asymptomatically infected (y–z), as exposed ones (y) change from 0 to 100 the value of asymptomatically infected (z) increased upto around 58, at exposed ones (y) = 100, asymptomatically infected (z) has two values as 58 and 10 i.e. follows bifurcation and as exposed ones (y) changes values upto 180, the value of asymptomatically infected (z) decreases to 25 so for exposed ones (y) from 100 to 180, asymptomatically infected (z) varies from 58 to 25 to 10 follows bifurcation. Also, phase structures of exposed-symptomatically infected (y–u), exposed-removed (y–v), exposed-virus in the reservoir (y–w), asymptomatically infected-removed (z–v), symptomatically infected-removed (u–v) specifically depict bifurcations in various forms at different points. In case of asymptomatically infected-virus in the reservoir (z–w), at asymptomatically infected (z) = 10, the value of viruses in the reservoir (w) = 50, then as asymptomatically infected (z) increases to upto around 60. At this point, removed ones (v) increase from 50 to 70 and asymptomatically infected (z) decrease to 20 i.e., crosses the same value twice, which shows its limiting is known as limit cycle behavior and both the values tend to decrease towards zero. It shows a closed-loop limit cycle. Today, there has been no scientific revolution in the development of vaccination, nor has any antiviral treatment been successful, resulting in lack of its medication. Based on the phases, time series, and complexity analysis of the model's various parameters, it is studied to understand the variation in this pandemic's scenario.

Introduction: Covid 19 pandemic has taken the world by storm. As far as maternal health is concerned, it has been affected both directly and indirectly. Not only are the women getting affected by COVID disease but also the health services are suffering in terms of availability, approachability and access. The study aimed to analyze the change in the trends of maternal near and maternal mortality comprising severe maternal outcome (SMO) between 2019 and 2020 in the department of obstetrics and gynaecology of our hospital due to COVID pandemic. Methods: This retrospective study was conducted in the Obstetrics and Gynaecology department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. The maternal death review data and maternal near miss statistics were analysed. This included assessing the change in the number of maternal deaths and obstetric near miss, their respective causes, and case fatality rate specific to COVID during pregnancy. Results: The total births decreased from 6056 in 2019–4140 in 2020 whereas women with severe maternal outcomes increased from 4.6% in 2019 to 6.5% in 2020(p value

Amyloidosis constitutes a group of diseases characterized by extracellular deposition of fibrils composed of low molecular weight subunits of a variety of proteins. Secondary amyloidosis may result from chronic inflammatory conditions such as familial Mediterranean fever, juvenile idiopathic arthritis, tuberculosis, and bronchiectasis. Myelomeningocele is reported rarely in literature as a cause of amyloidosis. We report here a case of 6-year-old boy with operated congenital lumbar myelomeningocele with paraparesis and neurogenic bladder, who was diagnosed with nephrotic syndrome with hypertension. He underwent a renal biopsy which showed amyloidosis. During the course of treatment, he acquired a perigenital infection and later succumbed to it. A closer follow-up of patients with neurogenic bladder can help identify and manage renal complications early.

Abstract The transformation of mature (urbanized) phase of the ancient Indus civilisation between ∼4200 and 3800 years Before Present (yr BP) overlaps with the beginning of the Meghalayan Age (∼4200 ± 100 yr BP). Though exact cause(s) for decline of urbanized Indus phase are not yet clear, researchers continue to debate whether monsoonal dryness was the sole cause or several other regional factors manifested in a compounding manner. Here, we show a regional relative sea level fall in the downstream area of Indus habitation (south‐western Gujarat region) which initiated at 4150 ± 230 and continued up to 3625 ± 200 yr BP. We provide a multi‐proxy (chronological, sedimentological, mineralogical, isotopic and elemental abundance) data set from a well‐dated vertical sediment trench from Lothal (ancient dockyard area of Indus era) to support this inference. Chief proxies used for inferring the relative sea level fall were bulk sediment carbon and sulfur contents along with their stable isotopes (δ13C and δ34S) and foraminiferal assemblage. The conspicuous shifts in majority of proxies hint at a lowering of sea stand at the regional level that likely dried this ancient Harappan dockyard (used for sea trade). Findings of our study possess implications for Holocene climate changes and their plausible impact(s) on Harappan trade and culture. Additionally, it invites evidences for large scale geological changes at ∼4200 yr BP distinct to the Meghalayan era.

ObjectiveCancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries.MethodsThe estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles.ResultsIn Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 – 1.3 million] and 711,429 [611,604 – 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa.ConclusionHigh cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.

Primary hypothyroidism is observed in adult patients with chronic kidney disease (CKD) though described scantily in the pediatric population. The primary objective of this study was to detect the prevalence of hypothyroidism in children (1-18 years) with CKD as assessed by thyroid profile. This cross-sectional study was conducted in the department of pediatrics of a tertiary care teaching hospital between January 2016 and January 2017. Clinical examination and biochemical investigations were performed for children with CKD aged 1 -18 years. Sixty-five children (51 boys, 43 CKD Stages 1-3) with a mean [standard deviation (SD)] age of 7.9 (3.2) years were enrolled. Overall, 17 (26.2%) had thyroid dysfunction; nine (13.8%) had subclinical hypothyroidism, three (4.6%) overt hypothyroidism, and five (7.7%) had isolated low T3 levels. The prevalence of hypothyroidism increased from 20.9% in CKD Stages 1-3 to 40.9% in Stages 4-5 of CKD; P = 0.09. The mean (SD) height SD scores were lower in those with hypothyroidism than with normal thyroid function [−1.02 (1.69) and −1.89 (1.12), P = 0.003, respectively], lowest at -2.79 (0.65) in overt hypothyroidism. A significant proportion of children with CKD manifest with hypothyroidism who have more profound growth failure. It may be prudent to screen CKD patients for thyroid dysfunction.

Objective: The present study was undertaken to assess the perceived stress levels in medical students and doctors in India during coronavirus disease (COVID-19) pandemic. Various studies have been done to assess the perceived stress levels among medical professionals and other associated health care workers, but no significant study has been done among medical students. This study is done with a special emphasis on the latter. Methods: A semi-validated online questionnaire was used to collect stress scores among medical students and doctors using Perceived Stress Scale. The aggravating and relieving factors of stress were also recorded and analyzed. Results: A total of 346 responses were analyzed from across various medical schools of country. The mean cumulative stress score among participants was 18.2 ± 6.8 indicating moderate stress with 34 (9.8%) respondents reporting high stress scores. Female gender was identified as a risk factor (OR 2.76, 95% CI: 1.58, 4.78; P < 0.001). Stress scores were higher among those not directly involved in COVID-19 care (OR 1.08, 95% CI: 0.57, 2.05; P = 0.47). Education and health of the family were major concerns recorded in 39% and 38% participants, respectively. The main stress aggravating factors were found to be news/media (39%) and unsafe work environment (16%). Among the stress relieving factors, hobbies (31%), family support (25%), and meditation (23%) were common. Conclusions: A moderate to high stress was reported in medical students and doctors. Educational concerns should be equally addressed as health care delivery and personal safety.

Objectives: High prevalence of vitamin D deficiency mandates prescribing an appropriate form of vitamin D that allows attainment of sufficiency in a cost-effective manner. We aimed to compare vitamin D products in Indian market in terms of composition and cost in 2020 with 2013 to understand price dispersion over 7 years. Methods: Constituents, formulations, and prices of 'branded' and generic vitamin D products were sourced from various drug information compendia and online sources. Price per defined daily dose (DDD), percentage cost variation, and change in prices over 7 years (2020 vs. 2013) was determined. Results: There has been a disproportionate increase in the number of brands and cost variation of cholecalciferol and calcitriol in the last 7 years. The percentage cost variation increased almost 10 times for calcitriol and 4.4 times for alfacalcidiol tablets and cholecalciferol granules. An analysis of >1,100 products in 2020 showed that the predominant form was calcitriol which was combined with calcium in >90% of the products with huge cost variation (>3000%). Ergocalciferol and cholecalciferol were available in 22 and 15 different strengths respectively. Median price/unit of cholecalciferol (60,000IU) was lower for tablets/capsules compared to other formulations; but with >1000% cost variation. Conclusion: A wide cost variation exists with the use of different vitamin D brands and preparations with conventional cholecalciferol tablets and capsules being a low-priced alternative. Quality control measures and strict enforcements of existing regulations are essential to ensure that competitive prices of branded generics are translated into availability and affordability for the population.

Background: Effective communication between health-care providers (HCP) and women during labor is a key component for providing dignified and consented maternity care. The quality improvement (QI) study was planned to improve the communication skills of HCP to provide dignified and consented care in the labor ward. Methodology: This study was conducted at the labor ward of a tertiary care hospital. To assess the magnitude of nondignified and nonconsented care, baseline data were collected from the women who had normal vaginal delivery through interviews using a prestructured questionnaire. The HCPs were also interviewed about the reasons for nondignified and nonconsented care. Various change ideas were tested through the plan-do-study-act cycle to sensitize the HCP with World Health Organization recommendations on intrapartum communication. Results: There was a marked improvement in communication between HCP and women in labor, i.e., addressing the woman by her name (100%), consent before each clinical examination (93%), and providing information about the progress of labor after each examination (50%). Conclusion: A QI approach is feasible and effective as a behavior change intervention to provide dignified and consented care in the existing settings.

Objective: The aim of this study was to evaluate thyroid dysfunction in COVID-19 and study its association with disease severity in COVID-19. Methods: Patients with confirmed COVID-19 infection who were admitted to dedicated COVID hospital were recruited over 3 months period. Those with pre-existing thyroid disease were excluded. The thyroid function tests were performed and correlated with interleukin-6 levels. Results: A total of 164 patients (14 children) with mean(SD) age 53.85 (19.54) years were recruited. The proportion of patients with mild, moderate and severe disease were 22 (13.4%), 78 (47.6%) and 64 (39.0%), respectively, among which 12 (54.5%), 56 (71.8%) and 43 (67.2%) patients had thyroid dysfunction, respectively; P = 0.309. Eighty eight (53.7%) had sick euthyroid (84 had low fT3 only), 14 had overt hypothyroidism and 9 had thyroiditis. Median (IQR) levels of serum fT3 showed significant decline from mild category [4.54 (3.81, 5.27)], to moderate [3.95 (3.67, 4.24)] and severe category [3.56 (3.22, 3.89)]; P = 0.011. Low fT3 had significant risk [odds ratio (95% CI)] of death [2.634 (1.01, 6.87); P = 0.031] and elevated IL-6 [2.575 (1.084, 6.118); P = 0.021]. Conclusion: Sick euthyroid was seen in the majority of patients hospitalized with COVID. Low fT3 was associated with death and increased inflammation, suggesting poor prognosis.

Wolfram syndrome (WFS) is a rare autosomal recessive disorder which manifests with diabetes mellitus, diabetes insipidus (DI), optic atrophy, and deafness. Central DI is a late presentation of the disease which may rarely present with renal tract anomalies and recurrent urinary infections instead of classical symptoms. We report a family of three siblings with WFS with early onset of central DI and renal tract abnormalities indicating need to suspect and manage these conditions early.

Coronavirus disease-2019 (COVID-19) emerged as a pandemic with varied clinical presentations. Patients with an underlying comorbidity such as diabetes and chronic kidney diseases (CKDs) had an increased risk of developing secondary bacterial and fungal coinfections which was further accentuated by the use of steroids during the management and with prolonged intensive care unit stay. This case series describes the clinical course of two patients with CKD who developed acute respiratory syndrome coronavirus-2 infection and mucormycosis.

Abstract DWARF14 (D14) is an ɑ/β‐hydrolase and receptor for the plant hormone strigolactone (SL) in angiosperms. Upon SL perception, D14 works with MORE AXILLARY GROWTH2 (MAX2) to trigger polyubiquitination and degradation of DWARF53(D53)‐type proteins in the SUPPRESSOR OF MAX2 1‐LIKE (SMXL) family. We used CRISPR‐Cas9 to generate knockout alleles of the two homoeologous D14 genes in the Nicotiana benthamiana genome. The Nbd14a,b double mutant had several phenotypes that are consistent with the loss of SL perception in other plants, including increased axillary bud outgrowth, reduced height, shortened petioles, and smaller leaves. A ratiometric fluorescent reporter system was used to monitor degradation of SMXL7 from Arabidopsis thaliana (AtSMXL7) after transient expression in N. benthamiana and treatment with the strigolactone analog GR24. AtSMXL7 was degraded after treatment with GR245DS, which has the stereochemical configuration of natural SLs, as well as its enantiomer GR24ent‐5DS. In Nbd14a,b leaves, AtSMXL7 abundance was unaffected by rac‐GR24 or either GR24 stereoisomer. Transient coexpression of AtD14 with the AtSMXL7 reporter in Nbd14a,b restored the degradation response to rac‐GR24, but required an active catalytic triad. We used this platform to evaluate the ability of several AtD14 mutants that had not been characterized in plants to target AtSMXL7 for degradation.

The Latin America and Caribbean region exhibit some of the lowest undernutrition rates globally. Yet, disparities exist between and within countries and countries in the region increasingly face other pressing nutritional concerns, including overweight, micronutrient deficiencies and inadequate child feeding practices. This paper reports findings from a regional analysis to identify the determinants and drivers of children's diets, with a focus on the complementary feeding window between the age of 6-23 months. The analysis consists of a narrative review and descriptive data analysis, complemented with qualitative interviews with key informants in four countries: Guatemala, Paraguay, Peru and Uruguay. Findings indicate that poverty and inequality (disparities within countries by wealth and residence), unequal access to services, inadequate coverage of social programmes and lack of awareness on appropriate feeding practices are important drivers for inadequate diets. We conclude that countries in the region need to invest in policies to tackle overweight and micronutrient deficiencies in young children, considering inequalities between and within countries, enhance coverage of social protection programmes, improve coordination between sectors to improve children's diets and expand the coverage and intensity of awareness campaigns on feeding practices, using iterative programme designs.