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Background: Tuberculosis (TB) is first opportunistic infection and leading cause of death among human immunodeficiency virus (HIV)/AIDS. Certainly, the prevalence of TB is expected to differ between general population and HIV-infected persons. This study was conducted to determine the prevalence of TB among newly diagnosed HIV-infected adults attending antiretroviral therapy (ART) center in the state of Gujarat, India. Materials and Methods: Cross-sectional study was carried out among newly diagnosed HIV-infected persons attending ART center from July 2012 to September 2012. Screening of TB symptoms and chest X-ray was done for those who consented. Sputum samples were collected for microscopy with Ziehl--Neelsen method for all presumptive TB cases and those diagnosed as pulmonary TB, culture, and drug susceptibility test was done. Blood samples were collected for CD4+ T-cells count and hemoglobin. Results: Out of 2021 eligible HIV-infected persons, 63.5% were males and 68.2% were in the age group of 26--45 years. The prevalence of TB was 17.8%. Among 360 patients with TB, 102 (28%) had smear positive TB, 86 (24%) had smear-negative TB, and 172 (48%) were diagnosed as extrapulmonary TB. Two hundred and thirty-eight (27%) TB patients with CD4+ T-Cell count below 200 compared to 122 (11%) patients above 200. Conclusion: A high prevalence of TB was found among newly diagnosed HIV-infected adults attending ART center for care and treatment. The prevalence of pulmonary and extrapulmonary TB was almost equal. Chances of TB disease were more with depletion of CD4 counts. The study highlights urgent need of intensive case finding as well as periodic screening of newly diagnosed HIV-infected individuals. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June–September 2012. Methods: We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child’s DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. Results: Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. Conclusion: DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. Trial Registration: Clinical Trials Registry–India, National Institute of Medical Statistics (Indian Council of Medical Research) [ABSTRACT FROM AUTHOR]

Background: Revised National TB Control Programme (RNTCP) in India recommends that all previously-treated TB (PT) patients are offered drug susceptibility testing (DST) at diagnosis, using rapid diagnostics and screened out for rifampicin resistance before being treated with standardized, eight-month, retreatment regimen. This is intended to improve the early diagnosis of rifampicin resistance and its appropriate management and improve the treatment outcomes among the rest of the patients. In this state-wide study from Gujarat, India, we assess proportion of PT patients underwent rapid DST at diagnosis and the impact of this intervention on their treatment outcomes. Methods: This is a retrospective cohort study involving review of electronic patient-records maintained routinely under RNTCP. All PT patients registered for treatment in Gujarat during January-June 2013 were included. Information on DST and treatment outcomes were extracted from 'presumptive DR-TB patient register' and TB treatment register respectively. We performed a multivariate analysis to assess if getting tested is independently associated with unfavourable outcomes (death, loss-to-follow-up, failure, transfer out). Results: Of 5,829 PT patients, 5306(91%) were tested for drug susceptibility with rapid diagnostics. Overall, 71% (4,113) TB patients were successfully treated - 72% among tested versus 60% among non-tested. Patients who did not get tested at diagnosis had a 34% higher risk of unsuccessful outcomes as compared to those who got tested (aRR - 1.34; 95% CI 1.20-1.50) after adjusting for age, sex, HIV status and type of TB. Unfavourable outcomes (particularly failure and switched to category IV) were higher among INH-resistant patients (39%) as compared to INH-sensitive (29%). Conclusion: Offering DST at diagnosis improved the treatment outcomes among PT patients. However, even among tested, treatment outcomes remained suboptimal and were related to INH resistance and high loss-to-follow-up. These need to be addressed urgently for further progress. [ABSTRACT FROM AUTHOR]

Abstract: X-band EPR spectroscopy has been employed to study the dynamic properties of magnetically aligned phospholipid bilayers (bicelles) utilizing a variety of phosphocholine spin labels (n-PCSL) as a function of cholesterol content. The utilization of both perpendicular and parallel aligned bicelles in EPR spectroscopy provides a more detailed structural and orientational picture of the phospholipid bilayers. The magnetically aligned EPR spectra of the bicelles and the hyperfine splitting values reveal that the addition of cholesterol increases the phase transition temperature and alignment temperature of the DMPC/DHPC bicelles. The corresponding molecular order parameter, Smol, of the DMPC/DHPC bicelles increased upon addition of cholesterol. Cholesterol also decreased the rotational motion and increased the degree of anisotropy in the interior region of the bicelles. This report reveals that the dynamic properties of DMPC/DHPC bicelles agree well with other model membrane systems and that the magnetically aligned bicelles are an excellent model membrane system. [Copyright &y& Elsevier]

Solid-state deuterium NMR spectroscopy was used to study the structural and dynamic properties of stearic acid-d35 in magnetically aligned phospholipid bilayers as a function of temperature. Magnetically aligned phospholipid bilayers or bicelles are model systems, which mimic biological membranes for magnetic resonance studies. Paramagnetic lanthanide ions (Yb3+) were added to align the bicelles such that the bilayer normal is colinear with the direction of the static magnetic field. The corresponding order parameters of the stearic acid-d35 probe were calculated and compared with values obtained from unoriented samples in the literature. The addition of cholesterol to the bicelle system decreases the fluidity of the phospholipid bilayers and increases the ordering of the acyl chains of stearic acid-d35. This study demonstrates the feasibility of utilizing magnetically aligned bicelles for calculating 2H order parameter profiles for non-biological systems such as polymer-grafted membranes and Schiff''s base complexes. [Copyright &y& Elsevier]

One- and two-dimensional electron-spin echo envelope modulation (ESEEM) spectra of Kramers’ multiplets in orientationally disordered systems are simulated using a simple mathematical model. A fairly general high-field spin Hamiltonian is considered with a general g-tensor and arbitrary relative orientations between all tensors involving the electron-spin S, the nuclear spin I, and their interaction. The zero field splitting (ZFS) and the nuclear quadrupole interactions are, however, approximated by their respective secular part in a way that retains all orientation dependencies and it is assumed that the nuclear quadrupole interaction is smaller than the hyperfine interaction. These approximations yield an effective sublevel nuclear Hamiltonian for each EPR transition and are sufficient to account for the most important characteristics of the ESEEM spectra of high electronic multiplets in orientationally disordered systems. Moreover, they allow to obtain some analytical expressions that for I=1/2 illuminate important aspects of 2D hyperfine sublevel correlation (HYSCORE) experiments in S=3/2, 5/2 systems. The pulses are considered as ideal and selective with respect to the different EPR transitions. The contributions of the latter to the echo intensity are weighed according to their different nutation angles and equilibrium Boltzmann populations. For simple axial cases with I=1/2, analytical expressions, analogous to the S=1/2 case, were derived for: (i) the modulation depth, (ii) the lineshapes of the HYSCORE cross-correlation ridges, and (iii) ENDOR powder pattern. Experimental results obtained from Mn(D2O)62+ and VO(D2O)52+ in frozen solutions are presented, compared, and analyzed in light of the theoretical part. [Copyright &y& Elsevier]

Purpose: The Major limitation in diagnosis of extra pulmonary tuberculosis (TB) is the lack of diagnostic tests that are accurate, simple to use and can be applied at the point of clinical care. This has been further enhanced by the widespread inability to test for drug resistance. Gene Xpert® MTB/RIF test is a novel test for the diagnosis of extrapulmonary TB and rifampicin resistance. Method: Total 388 EP samples were processed by GeneXpert. Liquid culture was performed from all Rifampicin resistant M. tuberculosis positive samples. Further liquid DST of Levofloxacin and Kanamycin were performed by MGIT 960 from culture positive isolates. Result: Out of 388 EP samples 151were detected positive by GeneXpert Among 151 samples rifampicin resistance was present in 19 & 2 were rifampicin indeterminate. 2 Rifampicin indeterminate samples were confirmed as resistant by liquid culture and DST. Out of 21, 15 samples turned to be culture positive. Among this 15 culture positive samples 93% were sensitive to Kanamycin and 80% were sensitive to Levofloxacin Conclusion: The GeneXpert is a sensitive and specific test for rapid diagnosis of EPTB and simultaneous rifampicin resistance in patients with strong clinical suspicion of TB with negative smear result. [ABSTRACT FROM AUTHOR]

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit. [ABSTRACT FROM AUTHOR]

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit. [ABSTRACT FROM AUTHOR]

Setting: Community based tuberculosis (TB) prevalence surveys in ten sites across India during 2006–2012 Objective: To re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a pooled national level estimate of prevalence of TB. Methods: Individuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB. Results: Of 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4–428.1, 147.9–429.8 and 170.8–528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7–377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas. Conclusion: TB burden continues to be high in India suggesting further strengthening of TB control activities. [ABSTRACT FROM AUTHOR]

Purpose: The Major limitation in diagnosis of extra pulmonary tuberculosis (TB) is the lack of diagnostic tests that are accurate, simple to use and can be applied at the point of clinical care. This has been further enhanced by the widespread inability to test for drug resistance. Gene Xpert® MTB/RIF test is a novel test for the diagnosis of extrapulmonary TB and rifampicin resistance. Method: Total 388 EP samples were processed by GeneXpert. Liquid culture was performed from all Rifampicin resistant M. tuberculosis positive samples. Further liquid DST of Levofloxacin and Kanamycin were performed by MGIT 960 from culture positive isolates. Result: Out of 388 EP samples 151were detected positive by GeneXpert Among 151 samples rifampicin resistance was present in 19 & 2 were rifampicin indeterminate. 2 Rifampicin indeterminate samples were confirmed as resistant by liquid culture and DST. Out of 21, 15 samples turned to be culture positive. Among this 15 culture positive samples 93% were sensitive to Kanamycin and 80% were sensitive to Levofloxacin Conclusion: The GeneXpert is a sensitive and specific test for rapid diagnosis of EPTB and simultaneous rifampicin resistance in patients with strong clinical suspicion of TB with negative smear result. [ABSTRACT FROM AUTHOR]

Context: Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making. Settings and Design: A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern. The reports had been analyzed on various critical variables. Results: In 2015-2016, Gujarat has operationalized forty SNCUs by saturating each district with at least one SNCU. The study found near proportions of (53%) inborn - (47%) outborn admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Similar pattern in mortality found as final diagnosis of deaths was RDS (23%) and infection (21%). The proportion of neonatal deaths in outborn was high compared to inborn. Conclusion: Strengthening of FBNC is essential to address neonatal mortality. NMR is of prime focus because the health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate. This accentuates the need for focused attention on facility- and community-based child health interventions along with quality maternal health services and robust referral mechanisms to all delivery points. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a major threat to world health. A major obstacle to control TB is the emergence of mycobacterial resistance to anti-tuberculous chemotherapy. Materials and Method: Total 145 MDR isolates were included in this study to determine the DST of 1st and 2nd line agents (levofloxacin 1.5, moxifloxacin 2.0, kanamycin 2.5 and capreomycin 2.5, ethambutol 5.0, ethionamide 5.0, PAS 4.0, clofazamine 1.0, linezolid 1.0 & pyrazinamaide 100) by MGIT 960. Results: 13.7% isolates were sensitive to all 10 drugs. Fluroquinolone (levofloxacin 1.5 & moxifloxacin 2.0) resistance was 11.7%, Aminoglycoside resistant (kanamycin 2.5 and capreomycin 2.5) resistance was 6.2%. 2.7% isolates were XDR. One MDR isolate was resistant to all studied drugs. Conclusion: Due to emergence of resistance to 2nd line drugs, there is a need of DST guided treatment in order to develop efficient regimens for appropriate treatment of individual cases. [ABSTRACT FROM AUTHOR]

²H and 15N solid-state NMR spectroscopic techniques were used to investigate the membrane composition, orientation, and side-chain dynamics of the transmembrane segment of phospholamban (TM- PLB), a sarcoplasmic Ca2+-regulator protein. ²H NMR spectra of ²H-labeled leucine (deuterated at one terminal methyl group) incorporated at different sites (CD3-Leu28, CD3-Leu39, and CD3-Leu51) along the TM-PLB peptide exhibited line shapes characteristic of either methyl group reorientation about the Cγ-Cδ bond axis or by additional librational motion about the Cα-Cβ and Cβ-Cγ bond axes. The ²H NMR line shapes of all CD3-labeled leucines are very similar below 0°C, indicating that all of the residues are located inside the lipid bilayer. At higher temperatures, all three labeled leucine residues undergo rapid reorientation about the Cα-Cβ, Cβ-Cγ and Cγ-Cδ bond axes as indicated by ²H line-shape simulations and reduced quadrupolar splittings. At all of the temperatures studied, the ²H NMR spectra indicated that the Leu51 side chain has less motion than Leu39 or Leu28, which is attributed to its incorporation in the pentameric PLB leucine zipper motif. The 15N powder spectra of Leu39 and Leu42 residues indicated no backbone motion, while Leu28 exhibited slight backbone motion. The chemical- shift anisotropy tensor values for 15N-labeled Leu TM-PLB were σ11 = 50.5 ppm, σ22 = 80.5 ppm, and σ33 = 229 ppm within ±3 ppm experimental error. The 15N chemical-shift value from the mechanically aligned spectrum of 15N-labeled Leu39 PLB in DOPCIDOPE phospholipid bilayers was 220 ppm and is characteristic of a TM peptide that is nearly parallel with the bilayer normal. [ABSTRACT FROM AUTHOR]

This is the first time 2H solid-state NMR spectroscopy and spin-labeled EPR spectroscopy have been utilized to probe the structural orientation and dynamics of a stearic acid incorporated into magnetically aligned phospholipid bilayers or bicelles. The data gleaned from the two different techniques provide a more complete description of the bilayer membrane system. Both methods provided similar qualitative information on the phospholipid bilayer, high order, and low motion for the hydrocarbon segment close to the carboxyl groups of the stearic acid and less order and more rapid motion at the end towards the terminal methyl groups. However, the segmental order parameters differed markedly due to the different orientations that the nitroxide and C–D bond axes transform with the various stearic acid acyl chain conformations, and because of the difference in dynamic sensitivity between NMR and EPR over the timescales examined. 5-, 7-, 12-, and 16-doxylstearic acids spin-labels were used in the EPR experiments and stearic acid-d35 was used in the solid-state NMR experiments. The influence of the addition of cholesterol and the variation of temperature on the fatty acid hydrocarbon chain ordering in the DMPC/DHPC phospholipid bilayers was also studied. Cholesterol increased the degree of ordering of the hydrocarbon chains. Conversely, as the temperature of the magnetically aligned phospholipid bilayers increased, the order parameters decreased due to the higher random motion of the acyl chain of the stearic acid. The results indicate that magnetically aligned phospholipid bilayers are an excellent model membrane system and can be used for both NMR and EPR studies. [Copyright &y& Elsevier]

Background: Private providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012–17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up. Methods and findings: We developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50%, 36% and 100% of the total private TB patients, respectively. For Patna and Mumbai pilots, the average cost per case at full scale, i.e. 100% coverage of private TB patients, was projected to be US$91 and US$101, respectively. In comparison, the national TB program’s budget for 2015 averages out to $150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million. Conclusions: As India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable. [ABSTRACT FROM AUTHOR]

Background: The 5As approach is a clinic-based approach and has been developed for primary health care providers who are uniquely positioned to interact with tobacco users. The 5As stands for: Ask about tobacco use at every visit, advise tobacco users to quit, assess readiness to quit, assist quit attempts through counseling and pharmacotherapy and arrange follow-up to prevent relapse. The present study explores whether auxiliary nurse midwives (ANMs) adhere to the 3As from the recommended 5As model for tobacco cessation. Materials and Methods: The study was a cross-sectional study conducted among 501 ANMs in the state of Gujarat and Andhra Pradesh. Descriptive analysis and chi-square test were employed to test the differences in knowledge levels and practices of ANMs. Bivariate logistic regression was used to examine the association between each predictor variable separately and the outcome variables after adjusting for age and location. Data was analyzed using SPSS version 17 software. Results: Majority of ANMs reported that they were aware of respiratory illnesses, tuberculosis, lung and oral cancer as conditions caused due to tobacco consumption. Awareness of adverse reproductive and child health effects associated with tobacco use was very low. Only about one third of respondents informed all patients about harmful effects. Only 16% of ANMs reported having ever received any on-job training related to tobacco control. ANMs who reported receiving training in tobacco control were about two times more likely to provide information on health effects of tobacco as compared to those who reported not being trained in tobacco control in the state of Gujarat. Conclusions: A majority of ANMs ask patients about tobacco use but provide advice only to patients suffering from specific diseases. A context-specific capacity building package needs to be designed to equip ANMs in recommended 5As approach in tobacco cessation. [ABSTRACT FROM AUTHOR]

Aim: To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008. Materials and Methods: Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration. Results: Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m3 Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m3 IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m3 at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160). Conclusion: Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban. [ABSTRACT FROM AUTHOR]

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease that causes a fatal hemorrhagic illness in humans. This disease is asymptomatic in animals. CCHF was first confirmed in a nosocomial outbreak in 2011 in Gujarat State. Another notifiable outbreak occurred in July, 2013, in Karyana Village, Amreli district, Gujarat State. Anti-CCHF virus (CCHFV) immunoglobulin G (IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals. The present serosurvey was carried out to determine the prevalence of CCHFV among bovine, sheep, and goat populations from 15 districts of Gujarat State, India. A total of 1226 serum samples from domestic animals were screened for IgG antibodies using a CCHF animal IgG enzyme-linked immunosorbent assay (ELISA) kit from the Centers for Disease Control and Prevention. Antibodies were detected in all the 15 districts surveyed; with positivity of 12.09%, 41.21%, and 33.62% in bovine, sheep, and goat respectively. This necessitates the surveillance of CCHFV IgG antibodies in animals and hemorrhagic fever cases in human. [ABSTRACT FROM AUTHOR]