Search

Introduction India has unique tobacco-free film and TV rules designed to prevent tobacco uptake. In this study, we examined the potential influence of exposure to smoking imagery in regionally famous films, on susceptibility to smoke in teenagers enrolled in schools in a district in Southern India. Methods A longitudinal survey of students, in grades 6 to 8 at baseline in 2017 and grades 7 to 9 one year later in 2018, ascertained prospective incident susceptibility to smoking during the study period in relation to baseline exposure to 27 locally popular films with actual or implied smoking imagery. Results We analyzed linked data from 33676 participants, and 3973 (11.8%) of the adolescents reported incident susceptibility. There was a significant increase in susceptibility to smoking with increasing exposure at baseline to smoking imagery in films on univariable analysis, highest tertile of exposure relative to no exposure (OR=1.4; 95% CI: 1.0 –2.1, ptrend

Introduction Patients with chronic kidney disease (CKD) are at increased risk of developing tuberculosis (TB). These patients may also be at higher risk of developing antitubercular treatment (ATT)-associated adverse drug reactions (ADRs). Although dose modification has been recommended, data regarding the impact of impaired kidney function on ATT-associated ADRs is sparse. We studied the incidence and profile of ATT-associated ADRs in patients with CKD and compared them with those with normal kidney function.Methodology This retrospective study analyzed all patients initiated on ATT from January 2016 to August 2019. Patients were grouped into CKD and normal kidney function based on their eGFR. Data on ATT-associated ADRs were collected from medical records. Predictors of ADRs were assessed using univariable and multivariable logistic regression. Additionally, Propensity score matching and analysis were done for CKD and normal kidney function in 1:3 ratio.Results Of 1815 patients on ATT, 75 (4.1%) had CKD. ADRs were more frequent [36/75 (48.0%) vs. 239/1740 (13.7%), p ≤ 0.0001] and more severe [15/46 (32.6%) vs. 43/283 (15.1%), p = 0.010] in CKD than those with normal kidney function. The most common ADRs were hepatobiliary [23/75 (30.6%) vs. 156/1740 (8.9%), p ≤ 0.0001], neuropsychiatric [8/75(10.6%) vs. 21/1740(1.2%), p ≤ 0.0001], renal [4/75(5.3%) vs. 8/1740(0.4%), p = 0.001], and gastrointestinal [5/75(6.6%) vs. 34/1740 (1.9%), p = 0.020]. CKD was an independent predictor for ADRs (OR −4.96, 95% CI: 2.79–8.82; p ≤ 0.0001). The matched cohort showed similar results.Conclusion ATT-associated ADRs were more common and severe in patients with CKD, despite drug dose modifications. Optimal dosing of ATT in CKD needs to be further evaluated.

Background: Smear microscopy for acid-fast bacilli visualization is important to assess the infectivity rate in patients with pulmonary tuberculosis (PTB), but it has limited sensitivity; hence, it is important to find an alternative strategy. The aim of our study was to compare the fluorescence microscopy grading by Auramine O phenol staining technique of respiratory samples with the cyclic threshold (Ct) values of GeneXpert Ultra (Mycobacterium tuberculosis/rifampicin [MTB/RIF]) and assess the diagnostic efficacy of GeneXpert Ultra (MTB/RIF) compared to microscopy in suspected cases of PTB. Methods: The study was conducted in the Mycobacteriology Laboratory, Department of Microbiology, in Kasturba Hospital, Manipal. The study was a prospective, single-centered, cross-sectional study. Four hundred and fifty-two respiratory samples were included in the study. An optimal Ct cutoff value for ruling smear-positivity and smear-negativity and the mean Ct cutoff value were calculated. Clinical and radiological data from the requisition forms were assessed. IBM SPSS statistics software version 22 was used. The correlation between GeneXpert Ultra (MTB/RIF) Ct values and smear status was calculated by polychoric correlation. The extended McNemar's test was used to find the association between the variables. Results: GeneXpert Ultra (MTB/RIF) yielded a higher positivity rate of 22.2% compared to smear microscopy 17.2%. Ct value and smear grading yielded a positive correlation (P = 0.8681; P < 0.05). GeneXpert Ultra (MTB/RIF) yielded nontuberculous mycobacteria in five undetected cases and speciated as Mycobacterium abscessus complex. Conclusions: Our study confirms the GeneXpert Ultra (MTB/RIF) Ct value levels as a predictor of smear positivity.

Background: Depression and cognitive impairment are two psychosocial health problems significantly affecting the quality of life of older adults across the globe. This study aimed to estimate the prevalence of psychosocial morbidities among older adults in a rural community of coastal Karnataka, India, and to determine the socio-demographic correlates of these morbidities.Methods: This cross-sectional study was conducted in rural and semi-urban Udupi taluka, in southern India. A total of 1,832 men and women aged ≥60 years were surveyed from 2015 to 2017 using a simple random method. Data was collected from the participants through an interviewer-administered pre-designed semi-structured questionnaire, Geriatric depression scale-Short version, and Everyday Abilities Scale India, and data were analyzed using SPSS version 26.0. Prevalence of depression and cognitive impairment among the study participants were reported, and significant sociodemographic predictors of these morbidities were determined using multivariate analysis.Results: Prevalence of depression and cognitive impairment were 38.7% and 49.1%, respectively, among older adults. Low literacy, low socioeconomic status, and unemployment were significant predictors of depression, while only low literacy was found to be the predictor of cognitive impairment. Further, being employed in old age showed a protective effect on their cognitive health.Conclusion: Psychosocial problems were highly prevalent among community-dwelling older adults. Improving their general health conditions, getting them involved in social activities tailored to their abilities and preferences, and ensuring economic independence through social security measures would pave the way in enhancing the mental health of older adults in southern India.

Background Early life growth trajectories of Indian small for gestational age (SGA) infants are sparse. This study aimed to compare longitudinal growth in appropriate for gestational age (AGA) and SGA infants during their first year of life.Methods Apparently healthy term infants (52 SGA, 154 AGA) were recruited at birth and followed up till 1 year. Parental, sociodemographic characteristics and feeding patterns were recorded. Anthropometric measurements were assessed at birth, 3, 6, 9 and 12 months of age; Z scores and growth velocity at 3-month intervals were computed. Longitudinal measurements were compared between the two groups, using the two-way Friedmans test. Median regression with mixed effects was used to adjust covariates; p value

Introduction In India there is insufficient knowledge of the risks associated with tobacco use. Increasing awareness of these risks is critical, with pictorial warnings on tobacco packs a cost-effective way to communicate this information. We explored perceptions of the current warning, ‘Tobacco causes cancer’, displayed on packs in India and four novel warnings about other potential impacts of tobacco use including social, financial, and environmental, but also complications with diabetes. As loose cigarette sales are common in India, we also explored perceptions of warnings on cigarette sticks. Methods A cross-sectional survey of college students aged ≥18 years in Karnataka, India, was conducted between January 2019 and February 2020. Participants were asked about salience, believability, and cognitive processing of warnings currently on packs. They were then shown an image of one current and four novel warnings and asked about their perceived effectiveness in preventing uptake and reducing and stopping tobacco use. They were then asked about warnings on cigarette sticks. Results Most participants (70.2%) recalled warnings on packs and considered them believable (55.7%), but only 12.0% read and 12.4% thought about them often. Warnings about the health impacts of tobacco use were viewed as most effective in preventing uptake, and reducing and stopping tobacco use. Nevertheless, at least a third of participants rated warnings pertaining to financial, social, and environmental impacts effective in preventing uptake, and reducing and stopping tobacco use. Approximately one-fifth (22.0%) thought that warnings on cigarette sticks would deter initiation. Conclusions Our results suggest that health warnings are perceived as most effective in discouraging tobacco use among college students in Karnataka. While viewed as less effective than health warnings, novel non-health related messages were viewed as effective in preventing uptake, and reducing and stopping tobacco use by at least one in three participants. Warnings on cigarette sticks may help complement warnings on cigarette packs.

Background: Antimicrobial resistance acts as a global problem in many regions of the world. The prevention and treatment of modern medicine are becoming ineffective. Governments all over the world are working effortlessly to overcome this problem and there is a requirement for extra care by the government and healthcare delivery systems to strengthen antimicrobial policy and standardize treatment guidelines. Objective: This study aims to forecast the antimicrobial resistance rate for the future and simultaneously to bring awareness of new time-series proportion models available to model the rate/proportion data in the field of clinical and public health by taking an example of antimicrobial resistance rate data. Methods: Data on Escherichia coli isolated from blood cultures showing variable susceptibility to different antimicrobial agents has received from a clinical microbiology laboratory of tertiary care hospital, Manipal, Karnataka, between the years June 2015 and December 2019. Beta auto-regressive moving average model is used to forecast the antimicrobial resistance rate data. To help non-statisticians an R shiny app named BARMA. app has been developed for the same. Results: A resistance rate of a total of 55-time points was used to forecast the resistance rate of E.coli to the antimicrobial Amoxicillin-clavulanic acid. On average, the forecasted resistance rate is 57% (50%–65%). Conclusion: Forecasting of antimicrobial resistance rate can help to alert healthcare policymakers to have appropriate precautionary measures and to attain the sustainable development goals (SDGs).

Background: Infancy is a very crucial phase of comprehensive development. Optimum nutrition has the potential to boost immunity and decrease disease susceptibility. Our hypothesis is that exclusive breastfeeding and homebased complementary feeding improves gastrointestinal health and reduces antibiotic exposure in infants, in comparison to partial breast feeding and mixed complementary feeding. Very few studies have explored this topic in a rural Indian setting. Methods: A prospective cohort study was conducted with a sample size of 200 mothers of 6–12 months old healthy infants in rural areas of Karnataka, India. Data collection was done by in-depth interview exclusivity of Breast Feeding (Exclusive-EBF, Formula-FF and Partial -PBF), type of Complementary Feeding (Homebased-HCF, Commercial-CCF, Mixed-MCF) followed, episodes of vomiting, diarrhoea and antibiotic exposure. Pearson's chi-square tests were performed using SPSS version 16 for statistical analysis. Results: EBF was observed in 50.5% (101) of infants, PBF in 49% (98) and FF in 0.5% (1). On EBF for 6 months, 3% (3) of infants had vomiting and 1% (1) had diarrhoea, whereas on PBF, 5.2% (5) and 3% (3) (p > 0.05) of infants had vomiting and diarrhoea, respectively. None of the infants on HCF suffered from diarrhoea or vomiting. While 5.4% (9) and 2.4% (4) of infants on MCF had vomiting and diarrhoea respectively (p > 0.05). Antibiotic exposure was reported in 30.3% (10) of HCF and 54.8% (90) of MCF infants (p > 0.05) respectively. Conclusion: A population-level awareness regarding EBF and HCF could lead to decreased incidences of gastrointestinal infections.

Introduction In India, the retail prices of bidis and cigarettes varied between the two Global Adult Tobacco Surveys (GATS) conducted in 2009–2010 and 2016–2017. The relationship between the retail price of smoked tobacco products and their use is unclear for India. Our study thus aimed to use available datasets to investigate the association between the retail price and current smoking status of bidis and cigarettes in India. Methods Current smoking status data for bidis and cigarettes were obtained from the two GATS rounds. The average state-level retail prices of bidis and cigarettes were obtained from India’s Consumer Price Index- Industrial Workers database. Descriptive statistics were used to describe current smoking status patterns. Generalized Linear Mixed Models were used to investigate the association between the retail prices and current smoking status of bidis and cigarettes. Results For cigarettes, an increase in the average retail price by one Indian Rupee was associated with a reduction in the odds of being a current smoker of 7% (OR=0.925; 95% CI: 0.918–0.932, p

Introduction: The relationship between occurrence of sepsis and Body Mass Index (BMI) has been studied by treating BMI as a categorical variable based on the standard categories developed by the World Health Organisation (WHO). This technique masks the actual form of the relationship that exist between BMI and sepsis. Aim: To determine the shape of the association between BMI and probability of sepsis after adjusting the effect of gender, age, ethnicity and co-morbidities among critically-ill patients and to identify an appropriate technique to elucidate this association. Materials and Methods: The study was based on the data extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database, a real-world dataset. A robust Poisson regression model and a Restricted Cubic Spline (RCS) regression model were applied to model the data. Results: The study revealed a non linear relationship between BMI and occurrence of sepsis. From the RCS plot, an increased risk of sepsis was observed among underweight and obese males and a similar pattern was observed among those with hypertension. BMI, age, and hypertension were found to be significant in the robust Poisson model (RR 1.01, 95% CI 1.00-1.02, RR 1.01, 95% CI 1.00-1.02, and RR 0.76, 95% CI 0.69-0.84, p

Background: Article 5.3 of the World Health Organization's Framework Convention on Tobacco Control necessitates the governments to take measures to protect health policy from the commercial and other vested interests of the tobacco industry (TI). Considering the vast geographical area and diversity between states within India, it is necessary to evaluate the level of implementation of Article 5.3 at the sub-national level. Hence, this study was conducted to assess the implementation of Article 5.3 in the Karnataka state of southern India. Materials and Method: Southeast Asia Tobacco Control Alliance Tobacco Industry Interference index was adopted and used for the study. A desk review was conducted for 2018. Publicly available evidence of tobacco industry interference was scored based on its frequency, severity, and the government's response to it. Lower the score, effective the level of governance against the TI interference, which predicts well for the state. Results: The study demonstrates a score of 46 out of 95 in the implementation of Article 5.3 in Karnataka, which is lower when compared to the national score of 69 out of 100 for 2018. Corporate social responsibility, conflict of interest, and unnecessary interactions with TI are the major areas that need focus to comply with the provisions of Article 5.3. Conclusion: Overall, Karnataka needs to strengthen the implementation of Article 5.3 and develop a strategy in line with the global best practices. This assessment can help in identifying areas requiring enhanced vigilance to avoid industry interference.

Introduction: The study aimed to propose a framework for identifying patient clusters in medical intensive care units (MICUs) based on the Medical Information Mart for Intensive Care II (MIMIC-II) database. The suggested framework makes use of the survival outcomes and physiological information available in the dataset and is hence called a semi-supervised approach. Five neural networks were trained on the clusters identified using the proposed approach to determine whether the proposed framework could improve the predictive accuracy of the deep learning models. Methods: This study utilized data from the MIMIC-II database, which is a publicly available database that contains information on patients admitted to intensive care units. The clusters underlying the MICU patient population were identified using unsupervised and semi-supervised K-means clustering. Mortality in the resulting clusters was predicted using five deep learning-based survival models and the performance of these models was compared using two metrics. Results: Three clusters (cluster 1, n = 1304; cluster 2, n = 474; cluster 3, n = 1079) were identified using unsupervised K-means, and another three clusters (cluster 1, n = 479; cluster 2, n = 1492; cluster 3, n = 886) were identified using semi-supervised K-means clustering. Experimental results demonstrate that, in general, the performance of deep learning models was better on semi-supervised clusters obtained by combining Cox proportional hazards (Cox-PH) model-based feature selection and K-means compared to unsupervised clusters. Conclusions: In the present study, it was observed that deep learning-based survival models tend to perform better on clusters that are identified in a semi-supervised fashion. This approach helps to extract more meaningful patterns and associations between different clinical features and patient outcomes.

BackgroundAntimicrobial resistance has emerged as one of the foremost public health troubles of the 21st century. This has ended in a public health disaster of the global situation, which threatens the exercise of present-day remedy. There is an urgent requirement for a cost-effective strategy to reduce antimicrobial resistance. Infectious disease control researchers most often analyze and predict antimicrobial resistance rate data that includes zeros or ones. Commonly used time-series analysis such as autoregressive moving average model is inappropriate for such data and may arrive at biased results.ObjectiveThis study aims to propose a time-series model for continuous rates or proportions when the interval of series includes zeros or ones and compares the model with existing models.DataThe Escherichia coli, isolated from blood cultures showing variable susceptibility results to different antimicrobial agents, has been obtained from a clinical microbiology laboratory of a tertiary care hospital, Udupi district, Karnataka, during the years between 2011 and 2019.MethodologyWe proposed a Degenerate Beta Autoregressive model which is a mixture of continuous and discrete distributions with probability mass at zero or one. The proposed model includes autoregressive terms along with explanatory variables. The estimation is done using maximum likelihood with a non-linear optimization algorithm. An R shiny app has been provided for the same.ResultsThe proposed Degenerate Beta Autoregressive model performed well compared to the existing autoregressive moving average models. The forecasted antimicrobial resistance rate has been obtained for the next 6 months.ConclusionThe findings of this article could be beneficial to the infectious disease researchers to use an appropriate time-series model to forecast the resistance rate for the future and to have better or advance public health policies to control the rise in resistance rate.

Malaria, dengue and leptospirosis are three tropical infectious diseases that present with severe hematological derangement causing significant morbidity and mortality, especially during the seasonal monsoons. During the course of these infectious diseases, circulating red blood cells are imperiled to the direct ill-effects of the infectious pathogen in the body as well as to the pro-inflammatory cytokines generated as a consequence of the infection. RBCs when exposed to such inflammatory and/or pathogenic milieu are susceptible to injuries such as RBC programmed eryptosis or RBC programmed necrosis. This research aimed to explore the Raman spectra of live red cells that were extracted from patients infected with malaria, dengue, and leptospirosis. Red cells were optically trapped and micro-Raman probed using a 785 nm Diode laser. RBCs from samples of all three diseases displayed Raman signatures that were significantly altered from the normal/healthy. Distinct spectral markers that were common across all the four groups were obtained from various standardized multivariate analytical methods. Following comprehensive examination of multiple studies, we propose these spectral wavenumbers as “Raman markers of RBC injury.” Findings in our study display that anemia-triggering infections can inflict variations in the healthy status of red cells, easily identifiable by selectively analyzing specific Raman markers. Additionally, this study also highlights relevant statistical tools that can be utilized to study Raman spectral data from biological samples which could help identify the very significant Raman peaks from the spectral band. This approach of RBC analysis can foster a better understanding of red cell behavior and their alterations exhibited in health and disease.

Abstract Background India is currently facing a rising epidemic of Non-Communicable Diseases (NCDs). Identification of modifiable risk factors is of paramount importance to curb this menace. Fishermen are one of the most vulnerable occupational groups with unique characteristics that make them prone to acquire NCDs, as a significant share of their life is spent at sea. Hence, this study was planned to ascertain the burden of NCDs, determine various risk factors of NCDs, and measure the association between risk factors and NCDs among fishermen of Coastal Karnataka in South India. Methods A cross-sectional study was conducted among 681 fishermen aged 18 years and above as per the semi-structured interview schedule for two years (2017–2019). A convenience sampling strategy was adopted. The data was entered and analyzed using SPSS v.15.0. The results were described in terms of proportions and their 95% confidence intervals. Continuous data were summarized using the mean and standard deviation or median and interquartile range depending on the skewness of data. Chi-square test was used to study the association between NCDs and modifiable risk factors. Multiple logistic regression was used to identify risk factors of NCDs. Results The mean (SD) age of the population was 42.5 (SD 12.5) years. The mean years involved in fishing was 19.8 years (SD 10.9). More than half (59.5%) of the study participants had severe stress and most (80.3%) were ever substance users. Advancing age, not being able to contact family while at sea, poor dietary practice, ever substance use, increasing waist circumference were significant correlates of NCDs. Conclusions The commonly prevalent risk factors of NCDs among fishermen included poor dietary practice, higher stress levels, substance use, increasing waist circumference, and inability to contact with family while at sea. Hypertension and Diabetes were the two common NCDs in the study population. There is a need for immediate attention in managing NCDs’ risk factors by promoting a healthy lifestyle by primary health care providers through a sustainable community awareness program targeting fishermen at a convenient time and location, either at the sea-port or meeting places. Harmful effects of substance use, healthy dietary practices, and the importance of physical activity outside their job need emphasis. In addition, screening programs should be organized with the help of boat owners and fishing associations at-least once a year to pick up NCDs at an early stage.

BACKGROUND: The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique. AIM: To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3–6 years children and agreement to detect refractive amblyogenic risk factors. SUBJECTS AND METHODS: A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis. STATISTICAL ANALYSIS: Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed. RESULTS: In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors. CONCLUSION: Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.

Background: Beedi rolling is one of the principal occupations of women residing in coastal Karnataka. The beedi worker's welfare fund consists of a combination of schemes to improve the living conditions of beedi workers and their families. On the other hand, the government is introducing several anti-tobacco policies, which could lead to insecurity among beedi rollers about their future. As a result, majority of the trade unions believe that alternate livelihood must be provided to the workers. In the midst of economic benefits and stringent tobacco control policies, this study explores the perception of beedi rollers to quit tobacco rolling and engage with an alternative livelihood. Objectives: The objectives of this study were as follows: (1) to explore the opinion of beedi workers toward alternate means of livelihood and (2) to identify the benefits availed by the beedi workers. Methodology: The study was conducted with a semi-structured questionnaire by interview method in all the seven blocks of the Udupi district of Karnataka with a total of 381 respondents through convenience sampling. The interviewer administered the survey with the help of a predesigned user application which was developed through Kobo Toolbox, and the analysis was carried out using IBM SPSS version 26. Results: Although 69% of the respondents believed that beedi rolling is not a secured job, three-fourth of the respondents were not ready to quit the beedi rolling job due to low education, higher age, and lack of financial support to invest in other occupations. Conclusion: Our study showed that most of the participants were full-time beedi rollers and most of them were not ready to shift to other jobs due to old age, lack of experience with other vocations, and benefits availed. There is a need to focus on strengthening skill development programs and introduce sustainable economic alternatives to the beedi rollers.

Background and Purpose: This work aims at optimizing and studying the feasibility of imaging the brachial plexus at 1.5T using 3D nerve-SHeath signal increased with INKed rest-tissue RARE imaging (3D SHINKEI) neurography sequence by comparing with routine sequences. Materials and Methods: The study was performed on a 1.5T Achieva scanner. It was designed in two parts: (a) Optimization of SHINKEI sequence at 1.5T; and (b) Feasibility study of the optimized SHINKEI sequence for generating clinical quality magnetic resonance neurography images at 1.5T. Simulations and volunteer experiments were conducted to optimize the T2 preparation duration for optimum nerve-muscle contrast at 1.5T. Images from the sequence under study and other routine sequences from 24 patients clinically referred for brachial plexus imaging were scored by a panel of radiologists for diagnostic quality. Injury detection efficacy of these sequences were evaluated against the surgical information available from seven patients. Results: T2 preparation duration of 50 ms gives the best contrast to noise between nerve and muscle. The images of 3D SHINKEI and short-term inversion recovery turbo spin-echo sequences are of similar diagnostic quality but significantly better than diffusion weighted imaging with background signal suppression. In comparison with the surgical findings, 3D SHINKEI has the lowest specificity; however, it had the highest sensitivity and predictive efficacy compared to other routine sequences. Conclusion: 3D SHINKEI sequence provides a good nerve–muscle contrast and has high predictive efficacy of nerve injury, indicating that it is a potential screening sequence candidate for brachial plexus scans at 1.5T also.

Context: Fractional exhaled nitric oxide (FeNO) is a noninvasive test for airway inflammation in asthma. The usefulness of FeNO in predicting exacerbations is uncertain. Aims: The study aims to assess and compare the ability of FeNO, spirometry, and asthma control test (ACT) in predicting future exacerbations of asthma and their correlation with each other. Settings and Design: This prospective, cohort study was conducted at the Department of Respiratory Medicine, Kasturba Medical College, Manipal. Materials and Methods: Adult asthma patients of age 18–65 years were included. Patients with a smoking history of >10 pack-years and those in whom spirometry was contraindicated were excluded. Patients who consented underwent FeNO and spirometry. The control of asthma was assessed using the ACT questionnaire. We captured the number of exacerbations in the follow-up period of 4 months. Statistical Analysis Used: Mann–Whitney test was used to compare the utility of FeNO, spirometry, ACT in predicting exacerbations and Spearman's correlation coefficient was used to ascertain the correlation among them. Results: Of 154 study patients, 28% had exacerbations. We found that there was no significant difference in FeNO in patients with and without exacerbations. The median (interquartile range [IQR]) FEV1% in the patients with and without exacerbations were 68 (55–79) and 75 (65–88), respectively (P = 0.013). The median (IQR) ACT score in patients with exacerbations was 12 (10–16) which was significantly lower than in those without exacerbation in whom it was 16 (14–18) (P = 0.003). There was a negative correlation of ACT with FeNO (Correlation coefficient: −0.167, P = 0.038). The median (IQR) FeNO level (ppb) was lower in patients who were on inhaled corticosteroid (ICS) than in the other group values being 22 (14–38) and 30 (17–58), respectively (P = 0.05). Conclusions: In our study, FEV1% and ACT score could predict exacerbations of asthma whereas FeNO could not. FeNO level correlated inversely with ACT score. FeNO level decreased with inhaled corticosteroid usage.

Background: The current recommendation in India to commence first dose of measles immunization is at 9 months of age. The effectiveness of measles vaccination is greatly impacted by the level of maternal measles antibody (MMA) during infancy.Objectives: To find the prevalence of MMA and to study the maternal and infant factors associated with persistence of MMA among the infants in a Indian rural community.Methodology: Dried blood spot sample was collected before vaccination among infants aged 9 months and above when they came for first dose of measles vaccine to assess measles-specific maternal IgG antibody titers by enzyme immunoassay. Maternal and child factors influencing persistence of MMA were collected by interviewing the mothers. Association between various factors affecting seropositivity was tested using univariate logistic regression analysis and strength of association is reported as risk ratio with 95% confidence interval.Results: Based on the qualitative estimation among all the recruited children (250) in the study, 4 (1.6%) infants showed the presence of MMA whereas 25 (10%) of children had MMA on quantitative estimation. The effect of maternal factors, child nutrition, and sociodemographic factors on the presence of MMA was not found to be statistically significant.Conclusion: The prevalence of persistent MMA (IgG titer ≥200 mIU/ml) among the infants aged 9–12 months was 10%. The choice of vaccinating infants at the end of 9 months for the first dose of measles vaccine is justified as the remaining (90%) of infants were susceptible for measles infection at this age.

Background: Understanding the progression of kidney disease is of great interest among clinicians. The multi-state model is an adequate tool to model the effects of covariates that influence the onset, progression, and regression of kidney function. Objective: The goal of the present study is to propose a stochastic model for kidney disease progression and to demonstrate the application of the same. Methodology: We proposed a semi-parametric continuous time homogeneous multi-state Markov model for the kidney disease progression data obtained from a retrospective study of 225 patients prescribed with colistin (a re-emerging antibiotic) in a tertiary care hospital in coastal Karnataka. Different stages of kidney disease were defined based on the Kidney Disease Improving Global Outcome (KDIGO) score. The model consists of three transient states, and an absorbing state death. Covariate effects on the bidirectional transition rates were estimated using the multi-state model. Results: We used the data of 225 patients to see their kidney disease progression. All the patients were under colistin therapy. The median length of hospital stay was 21 days. A total of 83 (36.89%) patients died in the hospital. The prognostic factors such as gender, hypertension, sepsis, and surgery are significant factors affecting kidney disease in different stages. Conclusion: The findings of the study will be useful for public health policymakers to implement the policies and treatment plans to improve the survival of the patients. Moreover, modelling the disease progression helps in understanding the expected burden of the disease.

BackgroundCholera, an acute diarrheal disease is a major public health problem in many developing countries. Several rapid diagnostic tests (RDT) are available for the detection of cholera, but their efficacies are not compared in an endemic setting. In this study, we have compared the specificity and sensitivity of three RDT kits for the detection of Vibrio cholerae O1 and compared their efficiency with culture and polymerase chain reaction (PCR) methods.MethodsFive hundred six diarrheal stool samples collected from patients from two different hospitals in Kolkata, India were tested using SD Bioline Cholera, SMART-II Cholera O1 and Crystal-VC RDT kits. All the stool samples were screened for the presence of V. cholerae by direct and enrichment culture methods. Stool DNA-based PCR assay was made to target the cholera toxin (ctxAB) and O1 somatic antigen (rfb) encoding genes. Statistical evaluation of the RDTs has been made using STATA software with stool culture and PCR results as the gold standards. The Bayesian latent class model (LCM) was used to evaluate the diagnostic tests in the absence of the gold standard.ResultsInvolving culture technique as gold standard, the sensitivity and specificity of the cholera RDT kits in the direct testing of stools was highest with SAMRT-II (86.1%) and SD-Cholera (94.4%), respectively. The DNA based PCR assays gave very high sensitivity (98.4%) but the specificity was comparatively low (75.3%). After enrichment, the high sensitivity and specificity was detected with SAMRT-II (78.8%) and SD-Cholera (99.1%), respectively. Considering PCR as the gold standard, the sensitivity and specificity of the RDTs remained between 52.3-58.2% and 92.3-96.8%, respectively. In the LCM, the sensitivity of direct and enrichment testing was high in SAMRT-II (88% and 92%, respectively), but the specificity was high in SD cholera for both the methods (97% and 100%, respectively). The sensitivity/specificity of RDTs and direct culture have also been analyzed considering the age, gender and diarrheal disease severity of the patients.ConclusionOverall, the performance of the RDT kits remained almost similar in terms of specificity and sensitivity. Performance of PCR was superior to the antibody-based RDTs. The RTDs are very useful in identifying cholera cases during outbreak/epidemic situations and for making them as a point-of-care (POC) testing tool needs more improvement.

Background: Iodine deficiency is one of the most prevalent micronutrient deficiencies globally. Women in reproductive age group are vulnerable to develop iodine deficiency as there is an increase in demand for iodine, especially during pregnancy. Objectives: The objective is to assess the prevalence of goiter and its association with iodine status and salt usage practices among the women of reproductive age group. Methods: A community-based cross-sectional study was conducted from August 2015 to July 2017 among 1500 women of reproductive age group in five villages of Udupi Taluk. Stratified sampling design and proportion to population size of the reproductive age women in the study area was used to select the study participants. A pretested semi-structured questionnaire was used for data collection. Goiter was assessed clinically and graded as per the recommended criteria of the WHO. Salt samples from every household were collected for iodine estimation. Blood and urine samples were collected from subsample to estimate thyroid-stimulating hormone levels and urinary iodine excretion levels, respectively. Results: The overall prevalence of goiter was 13% with 11.5% being Grade 1 and 1.5% being Grade 2. No significant association of goiter with urinary iodine, salt iodine levels, and salt usage practices was found. Conclusions: Median urinary iodine among the women with goiter indicates iodine sufficiency and no significant difference observed in urinary iodine levels between women with and without goiter.

Abstract Background Spatial analysis has been vital in mapping the spread of diseases and assisting in policy making. Targeting diarrhea transmission hotspots is one of the potential strategies for reducing diarrhea cases. This study aimed to examine the spatial-temporal variations and to identify the modifiable determinants of diarrhea while controlling for the spatial dependence in the data. Methods An ecological study on diarrhea data from DLHS-3 and NFHS- 4 in India. Moran’s I and LISA were used to detect the spatial clustering of diarrhea cases and to test for clustering in the data. Spatial regression was used to identify the modifiable factors associated with the prevalence of diarrhea. The study comprised of the prevalence of diarrhea among the children below the age of five years (U-5 s) across different states in India. The determinants of diarrhea were obtained using spatial lag models. The software used were GeoDa 1.6.6 and QGIS 2.0. Results The presence of spatial autocorrelation in DLHS-3 and NFHS-4 (Moron’s I = 0.577 and 0.369 respectively) enforces the usage of geographical properties while modeling the diarrhea data. The geographic clustering of high-prevalence districts was observed in the state of UP consistently. The spatial pattern of the percentage of children with diarrhea was persistently associated with the household with a sanitation facility (%) (p = 0.023 and p = 0.011). Compared to the diarrhea cases in the period 2007–2008, no much reduction was observed in the period 2015–2016. The prevalence of diarrhea and percentage of household with sanitation were ranging between 0.1–33.8% and 1.3–96.1% in the period 2007–2008 and 0.6–29.1% and 10.4–92.0% in the period 2015–2016 respectively. The least and highest prevalence of diarrhea being consistently from Assam and UP respectively. Conclusion Despite improvements in controlling spread of diarrheal disease, the burden remains high. Focus on widespread diarrheal disease control strategy by addressing the social determinants of health like basic sanitation is crucial to reduce the burden of diarrhea among U-5 s in India. The identification of hotspots will aid in the planning of control strategies for goal setting in the targeted regions.

Background: Chronic obstructive pulmonary disease (COPD) is one of the major public health problems worldwide and a leading cause of morbidity and mortality in India. This study was undertaken to assess the Health Related Quality of Life (HRQoL), and the factors affecting it among patients diagnosed with COPD and to study their healthcare seeking behavior towards COPD. Methods: A hospital based cross-sectional study was conducted among 93 patients aged 25–80 years, diagnosed with COPD based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria at a tertiary care hospital in southern India. St. George's Respiratory Questionnaire-COPD (SGRQ-C) was used to assess their HRQoL. Data was analyzed using SPSS version 15.0 and the results are expressed in frequencies and proportions. Results: Most of the participants presented initially with cough (67.7%) and breathlessness (62.4%). About half of them (54.8%) suffered from COPD for less than five years and 76.3% of them had less than five recurrent visits, with an average interval of

Background Exposure to tobacco imagery in films causes young people to start smoking. Popular Indian films contain high levels of tobacco imagery, but those that do are required by law to display onscreen health warnings when smoking imagery occurs and to include other health promotion messaging before and during the film. We report a prospective cohort study of incident smoking in relation to exposure to film tobacco imagery and anti-tobacco messaging in a cohort of children in southern India. Methods We carried out a one-year longitudinal follow up questionnaire survey in 2018 of a cohort of 39,282 students in grades 6, 7 and 8 (aged between 10 and 15 years) in schools in the Udupi district of Karnataka State in India who participated in a 2017 cross-sectional study of exposure to smoking in films and ever smoking status. Results We obtained usable linked data in 2018 from 33,725 of the 39,282 (86%) participants with data from 2017. Incident smoking was reported by 382 (1.1%) participants. After adjusting for age, sex and common confounders significantly associated with incident smoking there was no significant independent effect of exposure to film smoking, either as a binary (Odds Ratio 1.6, 95% Confidence Interval (CI) 0.5 to 4.9) or as a graded variable, on smoking uptake. An exploratory analysis indicated that the presence of on-screen health warnings that complied fully with Indian law was associated with a significantly lower odds of smoking uptake (Odds Ratio 0.8 (0.6 to 1.0, p = 0.031) relative to the same exposure sustained in absence of compliant warnings. Conclusion Exposure to tobacco imagery in Indian films was not associated with a significantly increased risk of incident smoking in South Indian children. While it is possible that this finding is a false negative, it is also possible that the effect of film exposure has been attenuated by the presence of on-screen health warnings or other Indian tobacco-free film rules. Our findings therefore support the wider implementation of similar tobacco-free film measures in other countries.

BackgroundExploring the cultural context of intergenerational continuity of warm and harsh parenting informs parents motivations to adopt specific parenting behaviours.ObjectiveParents' perceptions of being parented in the past and their current parenting as well as adolescents' perceptions of current parenting were explored applying a multi-method approach.MethodsFollowing written informed consent, a total of 24 interviews with 10 families (dyads of 14 parents and ten adolescents) from Udupi taluk in southern India was conducted. In the first stage, in-depth interviews were conducted with parent participants (Generation 1 (G1)) and in the second stage, adolescents (Generation 2 (G2)) participated in the photovoice component. Multiple forms of data including photographs, journals and interviews facilitated using the SHOWeD model were collected and were analysed thematically using ATLAS.ti(v.8).ResultsSubtle changes in reinforcing culture-specific gender norms between generations were elicited. Differences in communication, granting autonomy to female adolescents, and in disciplining methods between G1 and G2 were observed. Warm parenting was transmitted between generations while harsh parenting in G1 in the presence of external social support was discarded in favor of warm parenting in G2.ConclusionWe provide evidence for perceptions of parenting and adolescent behaviors across two generations. Transmission of warm parenting and interruption in the cycle of harsh parenting in the presence of external social support were significant findings. Related theoretical and methodological applications are discussed.

Derangements in bilirubin metabolism and/or dysfunctions in the hepato-biliary system lead to the unhealthy buildup of bilirubin in blood, resulting in jaundice. During the course of this disorder, circulating red cells are invariably subjected to toxic effects of serum bilirubin and an array of inflammatory compounds. This study aimed to investigate the vibrational spectroscopy of live red cells in jaundice using micro-Raman spectroscopy combined with optical-trap. Red cells from blood samples of healthy volunteers and patients with jaundice were optically immobilized and micro-Raman probed using a 785 nm diode laser. Raman signatures from red cells in jaundice exhibited significant variations from the normal and the spectral-markers were obtained from multivariate analytical methods. This research gives insightful views on how different pathologies can act as “stress-milieus” for red cells in circulation, possibly impeding their normal functions and also exasperating anemia. Raman spectroscopy, an emerging bio-analytical technique, is sensitive in detecting molecular-conformations in situ, at cellular-levels and in real-time. This study could pave way in understanding fundamental red cell behavior in different diseases by analyzing Raman markers.

The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79-8.29), respiratory (OR = 5.04; 95% CI: 2.52-10.07), cardiovascular (OR = 6.07; 95% CI: 1.88-19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07-12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08-5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region.

Longer survival due to use of antiretroviral therapy (ART) has made human immunodeficiency virus- (HIV-) infected individuals prone to chronic diseases such as diabetes, hypertension, and cardiovascular diseases (CVD). Metabolic syndrome (MS), a constellation of risk factors which increase chances of the cardiovascular disease and diabetes, can increase the morbidity and mortality among this population. Hence, the present study was conducted with the objectives of estimating the prevalence and determinants of MS among ART naïve and ART-treated patients and assess their 5-year CVD risk using the reduced version of Data Collection on Adverse Effects of Anti-HIV Drugs (D : A : D) risk prediction model (D : A : D(R)). This hospital-based cross-sectional study included 182 adults aged ≥ 18 years. MS was defined using the National Cholesterol Education Program-Adult Treatment Panel-3 (NCEP ATP-3) criteria. Univariate and multivariate logistic regressions were done to identify the factors associated with MS. Prevalence of MS was 40.1% (95% confidence interval (CI) = 33.0%–47.2%). About 24.7% of the participants had at least a single criterion for MS. Age >45 years (adjusted odds ratio (AOR) = 2.3; 95% CI = 1.1–4.9, p 23 kg/m2 (AOR = 6.4; 95% CI = 3.1–13.1, p

BACKGROUND: Obesity has been identified as a serious global health concern whose prevalence doubles almost every 10 years. Health education regarding physical activity and healthy diet imparted to adolescents could prove to be fruitful in reducing obesity-risk. Objectives of this study were to evaluate the effect of health education intervention on knowledge, attitude, and practices (KAP) regarding obesity-risk reduction and to estimate the postinterventional change in body mass index (BMI) and total body fat (%) among adolescent school children in South India. MATERIALS AND METHODS: Stratified cluster randomized controlled trial was carried out among 398 students recruited at baseline including 206 and 192 participants in intervention and control group respectively selected through simple random sampling from eligible government aided and private schools to assess KAP regarding physical activity and diet using pretested and validated questionnaire by making three school visits 6 months apart. Anthropometric measurements were recorded in first and third visit only, while health education intervention was given in first visit to intervention and third visit to control group after taking their responses on the questionnaire. Data were entered and analyzed using SPSS version 15. RESULTS: Overall dropout rate was 13.5% with dropout in intervention and control group being 12.6% and 14.5% respectively, making 180 participants in intervention and 164 in control group available for analysis. Mean physical activity KAP score improved significantly from 16.19 ± 4.61 to 19.46 ± 10.07 in intervention group. Mean dietary KAP score also improved significantly from 21.38 ± 4.07 to 23.43 ± 4.53 in intervention group (p < 0.001). Mean BMI decreased significantly within intervention group (p < 0.001) as compared to control group (p = 0.908). Based on cut-off level for total body fat (%) to categorize obesity-risk among participants, statistically significant decline in proportions from 26.1% to 13.3% was observed in intervention group (p < 0.001). CONCLUSION: Results depicted better KAP in intervention group than control group in all the three visits while it improved significantly within both groups. Hence, the health education was found to be effective in improving the overall KAP regarding modifiable risk factors of obesity among the study participants. Further studies to screen the adolescents for obesity-risk and successive health education sessions must be carried within schools in order to bring about change in knowledge, attitude, and practices regarding obesity-risk.

INTRODUCTION: Educators, academicians, and teachers are responsible for the development of the nation's human capital. Teacher coping methods are becoming more widely recognized as a key factor in determining teacher effectiveness. The aim of this study was to identify the various coping strategies adopted by high school teachers in Southern India. MATERIALS AND METHODS: A cross-sectional study was conducted in government, aided, and unaided schools of Udupi, a coastal district in Southern India. A self-administered questionnaire was used to collect the data from 460 high school teachers chosen based on convenience sampling. The coping strategies were identified using a modified version of Brief COPE(Coping Orientation to Problems Experienced) Inventory (Carver, 1997). Data were entered using SPSS version 15 and descriptive statistics was performed. RESULTS: The study found that teachers had moderate level of coping skills in all domains. The most popular coping techniques used by secondary school teachers were positive reframing, active coping, and planning; nevertheless, substance use was recognized as the least popular coping strategy. CONCLUSION: Positive reframing, active coping, and preparation were the most commonly used coping strategies by the teachers in the survey. Teachers are a vital resource who have received less attention than they deserve for their psychological well-being. A customized intervention program based on their perceived needs could be a good place to start.

Study Design Cross-sectional study. Purpose To evaluate the association between zygapophyseal joint angle (ZJA), facet tropism (FT), and lumbar intervertebral disc prolapse (IVDP). Overview of Literature Several studies have shown that FT increases the risk of IVDP and have postulated that a more sagittally oriented zygapophyseal joint provides less mechanical resistance to axial torque, thereby exerting excessive rotational strain on the intervertebral disc, resulting in an annular tear. In contrast, other studies have found no definitive association between FT and IVDP. Therefore, conclusive evidence regarding the role of FT in the pathogenesis of disc prolapse is currently lacking. Methods Magnetic resonance imaging scans of 426 patients with single-level lumbar IVDP were analyzed. Right and left ZJAs of the lumbar segments were measured on axial sections. The frequency and severity of FT were determined by calculating the absolute difference between the right and left ZJAs. Patients without IVDP at L4–L5 and L5–S1 served as controls for those with IVDP at L4–L5 and L5–S1, respectively. Chi-square test and t-test were used to compare the severity and frequency of FT between patients with and without IVDP. The receiver operating characteristic analysis was performed to determine the critical FT values that were predictive of IVDP. Results Patients with IVDP exhibited a higher frequency (L4–L5: 47% vs. 15.08%; L5–S1: 39.62% vs. 22.69%; p=0.001) and severity (L4–L5: 7.85°±3.5° vs. 4.05°±2.62°; L5–S1: 7.30°±3.07° vs. 4.82°±3.29°; p

Background: Urinary tract infections are not only one of the most common infections, but also one of the most common sources of bacteremia in both the general population and hospitalized patients. Aims and Objectives: The objective of this study was to identify risk factors for bacteremia caused by urinary tract infections. Materials and Methods: This was a prospective case control study conducted from October 2012 to July 2014in a tertiary care teaching hospital in southern India. Urinary tract infections were diagnosed based on the CDC criteria.Patients witha set of blood cultures and urine culture isolating same organism were grouped as cases while patients with urine culture alone isolating organism with sterile blood cultures were identified as controls. Results: Out of the 198 patientsin the study, 66 were cases while 132 were controls. E coli was the most organism isolated (81% of cases and 66% of controls). Risk factors for bacteremia based on univariate and multivariate analysis were diabetes mellitus with uncontrolled sugars (univariate: p=0.001; OR=5.250 [2.044-13.582]; and multivariate: p=0.01; OR= 6.023 [1.52-23.51]) and pyelonephritis (univariate: p=0.001; OR=6.56 [2.87-1.48]; and multivariate: p=0.047; OR=4.95 [1.02-24.12]). Conclusion: Upper UTI and complicated UTI patients should be evaluated for bacteremia since prompt and targeted treatment may be required.

Abstract Background Diabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus. Methods A community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system. Results The overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS. Conclusion The overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level.

Objective: To estimate the prevalence of obesity and high blood pressure among undergraduate students of a university medical college. Methods: A cross-sectional study was conducted at a medical college among 434 medical students. A questionnaire was used to collect basic demographic details, followed by anthropometric measurements. Body mass index (BMI) was classified according to the World Health Organization classification. Blood pressure was measured with a standard mercury sphygmomanometer and classified according to the seventh report of the Joint National Committee (JNC VII) on prevention, detection, evaluation, and treatment of high blood pressure. Data were entered into and analyzed with SPSS version 15.0. Results: Nearly 65.0% of students had normal BMI, 9.9% were underweight, 17.9% were overweight, and 7.6% were obese. Obesity was more prevalent among males than among females on the basis of anthropometric variables such as BMI, waist-hip ratio, and waist-stature ratio, and this difference was found to be statistically significant. Blood pressure was in the normal range among 55.0% of the students, 36.6% had blood pressure in the prehypertensive range, 7.6% had blood pressure in the stage 1 category of the JNC VII criteria, and 0.5% had blood pressure in the stage 2 category of the JNC VII criteria. Among the students who had blood pressure greater than 140/90 mm Hg, 63.0% were males and 37.0% were females, and this difference was statistically significant. Conclusion: The prevalence of obesity was 7.6% and that of high blood pressure was 8.1% among the medical students, which were higher than those reported in the literature for the same age group and warrant further evaluation.

Aims: To dissect the clinical-microbiological profile of Infective endocarditis (IE) population and to determine the risk factors for IE related mortality. Methods: A cohort study was conducted using relevant data from clinical records of patients (≥12 years) with definite/possible IE from December 2007 to December 2013 and was analyzed using appropriate statistical tests. Results: In the cohort of 139 IE patients, mean age was 47.9 ± 15.8 years, with male preponderance (68.3%). Rheumatic heart disease was the commonest (30.9%) underlying cardiac lesion followed by mitral valve prolapse with mitral regurgitation (23.7%), degenerative valvular disease (23%), congenital heart disease (15.8%) and prosthetic valves (3.6%). Vegetations were detected in 94.2% cases. Blood cultures were positive in 69.8% cases, commonest organism isolated was α – hemolytic streptococci (30.9%) followed by Enterococcus (12.9%) and methicillin sensitive Staphylococcus aureus (10.8%). Complications observed were congestive cardiac failure (31.2%), acute kidney injury (25.9%), stroke (21.6%), septic shock (16.5%), embolic phenomenon non-stroke (8.6%), atrial fibrillation (5%) and ring abscess (2.9%). Mortality rate was 17.3%. Congestive cardiac failure, increase in the peak leucocyte count and stroke were the independent predictors of mortality. Conclusions: This study reiterates the persistent dominance of rheumatic heart disease in the population studied and α – hemolytic Streptococci as the commonest responsible microorganism. Keywords: Infective endocarditis, α – Hemolytic streptococci, Rheumatic heart disease, Mitral regurgitation

Background: Preterm neonates are at a high risk of respiratory depression at birth. Incidence of respiratory distress is reported in 60-80% of the neonates born with the gestational age of less than 28 weeks and 15-30% of the neonates with the gestational age of less than 32-34 weeks. The present study aimed to compare the incidence and risk of failed extubation in using caffeine and aminophylline in the preterm neonates with the gestational age of ≤30 weeks in the periextubation period.Methods: This single-centered, parallel, open-label, randomized controlled trial was conducted in a tertiary care referral hospital in India during June 2014-2016. Neonates with the gestational age of ≤30 weeks who were intubated for a minimum of 24 hours were enrolled in the study. Neonates with major anomalies, heart disease, and sepsis were excluded from the study. After the random allocation of the infants to treatment with the standard dose of caffeine citrate and aminophylline methylxanthine, intubation continued for seven consecutive days with or without non-invasive ventilatory support. As the primary objective, the incidence and risk of failed extubation were assessed. Secondary objective of the research was to compare the relative incidence of acute adverse effects, persistent apnea, and the associated morbidities.Results: Neonates treated by caffeine were at a higher risk of extubation failure (1.09 times) adjusted with birth weight (31.5% versus 21.4%; RR=1.09; 95% CI: 0.81-1.46; P=0.55), which was not statistically significant. In addition, risk of apnea within seven days and after seven days of methylxanthine therapy was 1.57 (95% CI: 0.95-2.61) and 1.10 (95% CI: 0.95-2.61) times higher in the neonates with caffeine treatment. Also, rate of tachycardia was high in the neonates treated by aminophylline, which was statistically significant (RR=0.27; 95% CI: 0.13-0.56; P