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This study introduces a detailed compartmental model developed to understand the complex dynamics of COVID-19 transmission, focusing on the Delta and Omicron variants in India. The model tracks disease progression through different population compartments, considering factors like vaccination, time-dependent transmission, economic burden and COVID-19 death rates, loss of vaccine-induced immunity, and the transition of asymptomatic cases to recovery. The model is validated against established epidemiological knowledge and real-world data, emphasizing dynamic parameterization and accurate representation of immunity dynamics. The basic reproduction number for both variants is calculated, and sensitivity analysis for various parameters is conducted. Time-dependent parameters are estimated using the discrete inverse method. The study also explores the economic burden, impact of different types of masks, vaccine efficacy, and vaccine-induced immunity through numerical analysis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: India aims to eliminate rubella and congenital rubella syndrome (CRS) by 2023. We conducted serosurveys among pregnant women to monitor the trend of rubella immunity and estimate the CRS burden in India following a nationwide measles and rubella vaccination campaign., Methods: We surveyed pregnant women at 13 sentinel sites across India from Aug to Oct 2022 to estimate seroprevalence of rubella IgG antibodies. Using age-specific seroprevalence data from serosurveys conducted during 2017/2019 (prior to and during the vaccination campaign) and 2022 surveys (after the vaccination campaign), we developed force of infection (FOI) models and estimated incidence and burden of CRS., Results: In 2022, rubella seroprevalence was 85.2% (95% CI: 84.0, 86.2). Among 10 sites which participated in both rounds of serosurveys, the seroprevalence was not different between the two periods (pooled prevalence during 2017/2019: 83.5%, 95% CI: 82.1, 84.8; prevalence during 2022: 85.1%, 95% CI: 83.8, 86.3). The estimated annual incidence of CRS during 2017/2019 in India was 218.3 (95% CI: 209.7, 226.5) per 100, 000 livebirths, resulting in 47,120 (95% CI: 45,260, 48,875) cases of CRS every year. After measles-rubella (MR) vaccination campaign, the estimated incidence of CRS declined to 5.3 (95% CI: 0, 21.2) per 100,000 livebirths, resulting in 1141 (95% CI: 0, 4,569) cases of CRS during the post MR-vaccination campaign period., Conclusion: The incidence of CRS in India has substantially decreased following the nationwide MR vaccination campaign. About 15% of women in childbearing age in India lack immunity to rubella and hence susceptible to rubella infection. Since there are no routine rubella vaccination opportunities for this age group under the national immunization program, it is imperative to maintain high rates of rubella vaccination among children to prevent rubella virus exposure among women of childbearing age susceptible for rubella., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Hypertension, a major non-communicable disease, is responsible for a significant number of global deaths, including approximately 17.9 million yearly. The Global Burden of Disease 2019 (GBD 2019) estimates that 19% of global deaths are attributed to elevated blood pressure. India, with a population of over 1.4 billion, is facing a serious challenge in combating this silent killer. This study aims to analyze the gender-based prevalence of hypertension in India and explore its associated risk factors using data from the fifth National Family Health Survey (NFHS-5)., Methods: NFHS-5 collected data from 636,699 households across all states and union territories. The study includes standardized blood pressure measurements for 17,08,241 individuals aged 15 and above. The data were analyzed using Stata, employing descriptive statistics for the assessment of the prevalence and binary logistic regression to identify predictors of hypertension., Results: The study found the overall prevalence of hypertension in India to be 22.6%, with men (24.1%) having a higher prevalence than women (21.2%). Prevalence increased with age, reaching 48.4% in individuals aged 60 and above. Urban residents had a slightly higher prevalence (25%) than rural residents (21.4%), indicating the rapid spread of hypertension across all populations. Regional variations were observed, with the highest prevalence in Sikkim (37.9%) and the lowest in Rajasthan (16.5%). Increasing age, urban residence, belonging to certain religions (Muslim and other than Hindu or Muslim), and being classified as Scheduled Tribes (ST) were associated with a higher likelihood of hypertension. Conversely, belonging to Scheduled Castes (SC) or Other Backward Classes (OBC), being currently unmarried, and having higher education were associated with a lower likelihood of hypertension. Wealth index analysis revealed that those in the richest quintile were more likely to have hypertension. Behavioural risk factors, such as alcohol consumption, overweight, obesity, increased waist circumference, and high blood glucose levels, are positively associated with hypertension., Conclusion: Hypertension is a significant health burden in India, affecting both men and women. Age is the strongest non-modifiable predictor for both men and women. However, ageing women have higher odds of hypertension than ageing men, and this distinction becomes much more evident in their older ages. Obese women, based on BMI, have higher odds of hypertension than men. However, hypertension prevalence is slightly higher among men who are overweight or obese compared to women. BMI, waist circumference, random glucose level, alcohol use, and education level emerged as major predictors. Health education and awareness campaigns are critical to control the growing burden of hypertension in India. Policymakers must focus on preventive measures, targeting lifestyle changes and improved healthcare access for both men and women. By addressing these risk factors, India can make significant progress in controlling hypertension and reducing its impact on public health., (© 2024. The Author(s).)

This study aimed to investigate the levels of vitamins A, C, and E in patients with Non-Alcoholic Fatty Liver Disease (NAFLD) compared to healthy controls and to explore the correlation between these vitamin levels and various other parameters, including bone mineral density (BMD), adiposity (fat storage), insulin resistance and subclinical inflammation. The study involved 50 participants diagnosed with NAFLD and 50 healthy controls. Blood samples were collected to measure vitamin A, C and E levels, along with other parameters like insulin, inflammatory markers, and liver function tests. Additionally, participants underwent DEXA scans to assess BMD and body composition. Vitamin levels: The study found no significant deficiencies in vitamin A or C levels in either group. However, vitamin E levels were significantly higher in the NAFLD group compared to controls, although only one case of vitamin E deficiency was observed in the NAFLD group. No significant correlations were found between vitamin levels and BMD, adiposity parameters, insulin resistance, or subclinical inflammation markers in either group. The study acknowledges the limited data available on the association between NAFLD, vitamin levels and BMD in the Asian Indian population. The findings regarding vitamin A and C levels are consistent with some previous studies, whereas the higher vitamin E levels in the NAFLD group contradict other research. This discrepancy might be due to factors like sample size, dietary habits, or vitamin fortification programs. The lack of significant correlations between vitamin levels and other parameters suggests that further research is needed to understand the complex interplay between these factors in NAFLD development and progression.

This paper employs Topological Data Analysis (TDA) to detect extreme events (EEs) in the stock market at a continental level. Previous approaches, which analyzed stock indices separately, could not detect EEs for multiple time series in one go. TDA provides a robust framework for such analysis and identifies the EEs during the crashes for different indices. The TDA analysis shows that L1, L2 norms and Wasserstein distance (WD) of the world leading indices rise abruptly during the crashes, surpassing a threshold of μ+4∗σ, where μ and σ are the mean and the standard deviation of norm or WD, respectively. Our study identified the stock index crashes of the 2008 financial crisis and the COVID-19 pandemic across continents as EEs. Given that different sectors in an index behave differently, a sector-wise analysis was conducted during the COVID-19 pandemic for the Indian stock market. The sector-wise results show that after the occurrence of EE, we have observed strong crashes surpassing μ+2∗σ for an extended period for the banking, automobile, IT, realty, energy, and metal sectors. While for the pharmaceutical and FMCG sectors, no significant spikes were noted. Hence, TDA also proves successful in identifying the duration of shocks after the occurrence of EEs. This also indicates that the banking sector continued to face stress and remained volatile even after the crash. This study gives us the applicability of TDA as a powerful analytical tool to study EEs in various fields., (© 2024 Author(s). Published under an exclusive license by AIP Publishing.)

Purpose: With the increased survival of retinoblastoma (RB) patients, it is important to evaluate the quality of life (QoL) of RB survivors as well as caregivers to provide comprehensive care to the children and caregivers. This study aims to assess the QoL of survivors of RB, as perceived by parents and the self-report by patients, through a pediatric QoL (PEDs-QoL) questionnaire., Methods: The study cohort included 86 RB survivors, 86 age-matched controls, and their primary carers. PedsQL 4.0 generic core scale and structured interview were administered. QoL in physical, social, emotional, and school health was evaluated and correlated with clinical and sociodemographic parameters., Results: The mean age of the RB survivors was 5.7 years with an M:F ratio of 1.1:1. Disease was bilateral in 79% of cases. About 45% (39/86) underwent enucleation, while others received combination therapy (16; 18%), chemotherapy (30; 34%), and radiation (1; 1%). As reported by parents, the QoL of physical health domain of RB survivors was 70.2 SD ± 27.8 and 96.15 ± 13 SD, emotional health was 72.1 ± 27.4 SD and 94.4 ± 12.5 SD, social health was 80.4 ± 24.9 SD and 98.6 ± 6.2 SD; and school health was 71.9 ± 2 6.5 SD and 96.1 ± 12.2 SD. As per the self-report perception, the QoL of physical health was 68.2 ± 27.8 SD and 96.2 ± 13 SD, emotional health was 66.2 ± 28.4 SD and 95.3 ± 12.5 SD, social health was 69.5 ± 24.9 SD and 98.7 ± 6.2 SD, and school health was 63.5 ± 26.5 SD and 95.1 ± 12.2 SD. There was a significant relationship between enucleation and QoL domains, where χ2 = 67.75, degrees of freedom (df) = 36, and P < 0.01. There was a significant association between vision in the better eye (6/18 or better = 8, 6/18-6/60 = 8, 3/60 or worse = 42) and QoL scores (χ2 = 95.36, df = 62, P < 0.01). There was a substantial association between socioeconomic status and QoL domains, where χ2= 88.5, df = 56, P < 0.01., Conclusion: The results of the study showed that the QoL of parents of RB survivors and self-proxy reports were negatively affected in many ways, including physical, social, emotional, and school-related dimensions. Despite the small differences, self-proxy reports indicated a lower QoL than the parents' group. The study findings indicate that there are notable correlations between enucleation and visual acuity less than 6/18, as well as socioeconomic status, with various aspects of QoL domains among individuals who have survived RB., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

This study examined Haemonchus contortus prevalence and benzimidazole resistance in eight districts of Marathwada, Maharashtra, India. A comprehensive investigation of 264 abomasa of goats collected from abattoirs and goats necropsied at the College of Veterinary Sciences and Animal Husbandry, Parbhani, revealed 21.21 % a prevalence of H. contortus. The incidence of H. contortus did not vary much across seasons and it was highest in summer (23.42 %), followed by monsoon (22.89 %), and lowest in winter (15.71 %). Statistically non-significant (p < 0.05) prevalence was observed in male and female animals. A detailed examination of 168 adult H. contortus worms from eight districts revealed the presence of all conceivable genotypes including homozygous resistant (rr), susceptible (SS), and heterozygous (Sr) BZ susceptible genotypes. The rr was the most frequent at 50 %, followed by SS at 27 % and Sr at 22 %. The presence of the SNP was observed in in all eight randomly selected and sequenced samples., Competing Interests: Declaration of competing interest The authors affirm that they do not possess any identifiable conflicting financial or personal interests that could have potentially influenced the findings presented in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: This study aims to present a case series detailing sight-threatening ocular and adnexal manifestations following dengue fever., Methods: A retrospective observational study was conducted, analyzing records of patients presenting with ocular manifestations post dengue fever at a tertiary eye care institute in Uttar Pradesh from October 2023 to November 2023. Demographic details, systemic comorbidities, and detailed ophthalmic examinations were recorded., Results: Fifteen eyes of 13 patients with dengue fever were studied. The mean age of presentation was 39.07 years, with a male predominance (84.61%). Systemic comorbidities were noted in 30.76% (diabetes mellitus) and 23.07% (hypertension) of patients. Thrombocytopenia was observed in 53.84% of patients, while 23.07% required blood transfusions, and 15.38% experienced systemic bleeding episodes. The majority of cases were unilateral (84.61%), with the best-corrected visual acuity of perception of light in 84.61% of cases. Diminution of vision was the most common presenting symptom (84.61%), followed by pain (53.84%), redness (38.46%), and watering (23.07%). Major ocular manifestations included panophthalmitis (26.07%), total ophthalmoplegia (26.07%), endogenous endophthalmitis (20%), central retinal artery occlusion (20%), retinal hemorrhage (20%), ischemic optic neuropathy (20%), orbital cellulitis (13.3%), proptosis (13.3%), retrobulbar hemorrhage (13.3%), retinal detachment (13.3%), and foveolitis (6.7%)., Conclusion: The diverse array of ocular and adnexal manifestations in dengue hemorrhagic fever may result in permanent visual loss, emphasizing the need for adequate treatment and timely intervention. The risk of sight-threatening complications underscores the importance of early screening by ophthalmologists and increased public awareness., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era., Methods: This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation., Results: In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities., Conclusion: During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: Rhino-orbital-cerebral mucormycosis (ROCM) is the most common presentation of mucormycosis. Sinonasal-orbital debridement with exenteration is a life-saving procedure in ROCM patients in view of severe involvement of sinuses and the eyeball. Following the second wave of coronavirus disease 2019 (COVID-19), there was a massive surge in mucormycosis cases in India in post-COVID-19 patients. Of over 300 cases of mucormycosis admitted in our hospital, many underwent exenteration and these specimens were evaluated histopathologically, where fat necrosis was found to be a prominent finding. The spectrum of fat necrosis in ROCM in orbital fat has not been described in literature. Hence, we sought to evaluate the significance and spectrum of orbital fat necrosis in ROCM., Methods: This 3-month retrospective study included 15 cases of ROCM which underwent exenteration. Clinical data, radiologic details, and histopathologic findings were tabulated. Sections were also subjected to Periodic acid Schiff (PAS) and Gomori's methenamine silver (GMS) stains for confirming the fungus., Results: All 15 cases showed fat stranding on computed tomography (CT) scan. On histopathologic examination, various tissue reaction patterns observed included acute/chronic inflammatory infiltrate, suppurative granulomas with giant cells, coagulative and fat necrosis, broad aseptate fungal hyphae with or without angioinvasion, and neural invasion. Fungal hyphae were confirmed with PAS and GMS stains. The spectrum of fat necrosis observed in all the cases included 1) acute necrotizing fat necrosis, 2) ghost adipocytes with or without saponification, and 3) crystalline/gouty fat necrosis., Conclusion: Fat necrosis is a significant finding in ROCM, both on CT scan and histopathology. All three patterns of fat necrosis may be observed simultaneously in a case of ROCM., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Coccidiosis is an intestinal infection caused by Eimeria spp. that results in economic losses owing to morbidity and mortality in young buffalo calves. This study aimed for molecular diagnosis and phylogenetic analysis of Eimeria spp. in buffaloes of Meghalaya's sub-tropical mountainous terrain. Fresh buffaloes' fecal samples were collected from buffalo farms of Umling, Umsning and Bhoirymbong blocks, Ri Bhoi, Meghalaya and screened for Eimeria oocysts using flotation and modified McMaster methods. Fecal sample examination revealed 27.44 % (87/317) infection in buffaloes. Age wise, 64.44 % (29/45), 25.35 % (36/142) and 16.92 % (22/130) infections were recorded in <6 months, 6 months to 1 year and 1-2 year old buffaloes, respectively. Morphological characterization of Eimeria spp. revealed E. bovis (21.83 %), E. bareillyi (18.39 %), E. zuernii (11.49 %), E. ellipsoidalis (3.44 %) and mixed infection (44.82 %). Amplification of ITS-1 gene confirmed Eimeria spp. (410 bp), E. bovis (238 bp) and E. zuernii (344 bp). Phylogenetic analysis of E. bovis Umiam isolate revealed that these were closely related to the E. bovis isolate from South Korea (MH245198.1), and Turkey (KU351711.1) and distantly related to the isolates from Jammu and Kashmir (OQ103422.1) and Uttar Pradesh, Mathura (OK486542.1). E. zuernii isolate from Umiam, Meghalaya was observed to be phylogenetically close to the isolates from South Korea (MH245202.1), Japan (LC171339.1) and Turkey (KU351715.1), whereas phylogenetic divergence was observed between, E. zuernii isolate from Umiam, Meghalaya with isolates of Andhra Pradesh, Tirupati (MN601278.1) and Jammu and Kashmir (OQ103424.1). Therefore, treatment and effective control strategies should be implemented immediately to prevent spread of infection in the buffaloes., Competing Interests: Declaration of competing interest Meena Das reports financial support was provided by Department of Biotechnology (DBT), Ministry of Science and Technology, Government of India, New Delhi., (Copyright © 2024. Published by Elsevier B.V.)

Background: The objectives of this study were to bring out the results of application of pleural wrap in primary repair of tracheo - esophageal fistula (TEF) with long-gap oesophageal atresia (LGEA) and also define the role of neonatologists and paediatric intensivists in post-operative management in these patients by laying down standard neonatal management protocol., Materials and Methods: This was a retrospective descriptive observational study conducted between March 2011 and April 2019 on 23 cases of LGEA with TEF. The study was conducted at two tertiary care paediatric surgery centres in Northern part of India wherein these newborn babies were operated by two paediatric surgeons with variable experience of 8-12 years. It also describes the neonatal management protocol used in post-operative period., Results: Out of 23 patients, 15 were boys and 8 were girls, with a mean age of 32.25 weeks and a mean birth weight of 2.02 kg. The mean hospital stay was 23.5 ± 8 days. Eleven cases had gap between 3 and 3.5 cm, 8 cases between 3.5 and 4 cm and 4 cases had gap more than 4 cm. The incidence of associated anomalies was 52%. Anastomotic leak rate was 8.69%, and 3 (13.04%) patients died in the post-operative period. All the operated patients were managed postoperatively as per strict neonatal management protocol exclusively by the team of neonatologists and neonatal intensivists., Conclusion: Application of pleural wrap over anastomosis following primary repair of LGEA with TEF significantly reduced the incidence of anastomotic leak in our study. Apart from the pleural wrap, the key to successful outcome also is contributed by the little prolonged, controlled ventilation and patience and perseverance in post-operative feeds. This post-operative management protocol that has been followed by us in our study is easily reproducible and can be adopted by paediatric surgeons working alongside neonatologists as a team., (Copyright © 2024 Copyright: © 2024 African Journal of Paediatric Surgery.)

Introduction: Extrapulmonary tuberculosis (EPTB) accounts for 16 % of tuberculosis cases globally, with knee joint tuberculosis more prevalent in underdeveloped nations. Total knee arthroplasty (TKA) is commonly used to treat tubercular arthritis of knee, however, there is a marked paucity of research on the outcomes after an incidental diagnosis. The aim of the study is to investigate the outcomes of total knee arthroplasty after an incidental diagnosis of tuberculosis and its management., Methods: A prospective-observational study was conducted in NCR-Delhi from May 2019 to June 2023, wherein 533 patients had synovial tissue abnormalities and 11 patients reported with positive histopathological examination (HPE) for knee tuberculosis. All the patients whose informed consent was obtained were put on a twelve-month standard treatment (2HRZE or S/10HR) according to World Health Organization (WHO) guidelines for extrapulmonary TB after TKA and were monitored for the outcome of treatment, any postoperative complication, or implant failure., Result: The mean age of the patients was 63 ± 13 years and 72.7 % of patients were female. The mean hemoglobin, Body Mass Index (BMI), and Erythrocyte Sedimentation Rate (ESR) values were 10.29 ± 1.36 mg/dl, 29.78 ± 6.1 kg/m 2 , and 37.37 mm/h respectively and the median of the C-reactive protein (CRP) value was 11 mg/dl at the time of operative procedure. All patients presented with knee-joint pain and swelling and were operated for knee-joint replacement surgery. After one year of standard treatment (2HRZE or S/10HR), no relapses, pain, or progressive radiolucency around the component, or postoperative neurologic or vascular complications were observed. The median range of motion (ROM) was improved from 10 - to 100 to 0-115, the average knee score improved from 44.9 ± 8.9 to 84.9 ± 7.73 points and the average function score improved from 28.82 ± 15.56 to 94.0 ± 7.68 points which were statistically significant at 95 % CI (p < 0.0001)., Conclusion: We concluded from this study that any abnormalities in ESR, CRP level prior to, and bone tissue or synovial tissue during operative procedure should be considered for articular tuberculosis and managed according to guidelines. This will make replacement procedures more sustainable and effective by lowering the risk of post-operative infection or implant-related complications and improving patients' quality of life., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Introduction: In India, the prevalence of diabetes mellitus neuropathy was reported to be as high as 30%. Eight percentage of the diabetic population suffer from foot ulceration and 1.8% have amputations. Popliteal nerve block can be potentially used for foot and ankle surgery with several advantages., Aim: To compare analgesic duration of an ultrasound (US)-guided popliteal sciatic nerve block between diabetics with neuropathy and nondiabetics without neuropathy., Patients and Methods: Participants were allocated into two groups for popliteal sciatic nerve blocks under US guidance. The primary outcome was the duration to onset of sensory and motor blockade. The secondary outcome was the duration to rescue analgesic and the visual analog scale scoring within 24 h. Hemodynamic outcomes were also monitored along with the above variables., Results: It was observed that the onset of sensory blockade was faster in participants with diabetes mellitus with peripheral neuropathy as compared to the nondiabetic participants and the duration for onset of motor blockade in dorsiflexion was faster in diabetic patients as compared to the nondiabetic patients (17.48 ± 3.21 min). However, there was no significant changes when comparing the onset of duration to loss of plantar flexion, in diabetics (17.86 ± 2.29 min) versus in nondiabetics (18.51 ± 3.32 min). The duration for rescue analgesics was found to be longer in diabetic participants (13.19 ± 2.14 h) as compared to the nondiabetic participants (11.44 ± 1.86 h). No differences were observed in the hemodynamic changes and the complications associated with local anesthetics in either group., Conclusion: Diabetic patients with neuropathy have faster onset of blockade when compared to nondiabetic patients without neuropathy which may be due to the degenerative condition of the peripheral nerves in them. The hemodynamic parameters do not play a role in defining the outcome of the block., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Key learnings from some landmark studies that the author has been associated with and their implications on program strategies are highlighted. Learnings from prevalence surveys provide justification for active TB Case finding (ACF), role of Chest X-ray screening, justification of the elderly as a key vulnerable population and suggest re-think of the methods of sub-national certification for progress towards tuberculosis free status. Risk of infection studies suggest 14 million people acquiring new tuberculous infection each year in India suggesting a re-think on the targets for TB elimination. Justification is given for 'TB deaths averted' as a parameter for monitoring program impact, reviving risk of infection surveys using CyTB and higher emphasis on careful analysis of routine surveillance data for monitoring epidemiological trends rather than oft-repeated surveys. The modelling outputs suggest higher focus on reducing transmission of infection in urban and reducing treatment delay in rural areas and the need to scale up active case finding and TB preventive treatment in order to achieve End TB targets. Case finding studies justify upfront molecular diagnostics, need to confirm a single sputum result by another specimen or radiology during ACF and futility of X-ray based diagnosis during ACF. High rates of recurrence with intermittent treatment regimen providing evidence in favor of daily regimen, role of family centric approach to nutritional supplementation to prevent TB mortality and reduce TB incidence among household contacts are highlighted besides the need to address high proportion of families suffering catastrophic expenses during pre-treatment period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Introduction: Metabolic syndrome (MetS) and hypothyroidism are well-established forerunners of atherogenic cardiovascular disease (CVD). It is possible that patients suffering from both these disease entities may have a compounded risk. This study aimed at determining the prevalence of hypothyroidism in MetS., Materials and Methods: This cross-sectional study was conducted from September 2017 to August 2018 in the department of medicine at a tertiary care hospital in Northern India. Ethical approval was obtained from the institutional ethical committee. The study subjects consisted of 157 patients with MetS, the diagnosis of which was based on the International Diabetes Federation criteria. After a detailed history and physical examination, relevant investigations including complete thyroid profile were done. The data were analyzed using appropriate statistical tests (P < 0.05)., Results: In our study, the age of subjects ranged between 14 and 92 years, with a mean ± standard deviation of 48.1 ± 17.01 years. There were more females than males with a male-to-female ratio of 1:1.3. The prevalence of hypothyroidism was 46.5%. Hypothyroidism was more common in females (58.9%) as compared to males (41.1%). Patients with hypothyroidism had significantly higher body weight and body mass index (BMI) in comparison to euthyroid patients. The rest of the anthropometric parameters were comparable. Waist circumference and BMI of overt hypothyroid patients were found to be higher as compared to subclinical hypothyroid patients. Total cholesterol and triglyceride were significantly higher (P = 0.001 and P < 0.001, respectively), while high-density lipoprotein levels were significantly lower in patients with hypothyroidism than the euthyroid group (P < 0.001)., Conclusion: Hypothyroidism, especially subclinical hypothyroidism, is a common endocrine disorder in patients with MetS. As MetS and hypothyroidism are independent risk factors for CVD, hence there is a need for screening for hypothyroidism and the treatment of the same can be beneficial in reducing the cardiovascular morbidity and mortality in patients with MetS., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Background: Pleural effusion indicates an imbalance between pleural fluid formation and removal. Classified into exudative and transudative, with common symptoms of dry cough, dyspnea and pleuritic chest pain. Confirmed etiology has to be established for effective treatment., Objective: Correlate clinical and biochemical profile of various etiologies of pleural effusion., Materials & Methods: Retrospective observational study of 2 years in the department of respiratory medicine, GMC Bhopal on 280 cases of pleural effusion., Results: Most common etiology was tubercular 202 (72.4%) followed by malignant in 36 (12.8%). With respect to tubercular, malignant pleural effusion has relative risk (RR) of 0.138 (p value < 0.05) in the age group of 51-60 years, which is statistically significant. Patients of tuberculosis complained of fever 158 (78.2%) whereas with malignancy complained of chest pain 16 (44.4%) followed by hemoptysis 12 (33.3%). For hemoptysis, with respect to tubercular, malignant effusion has RR of 5.68 (p value < 0.05) which is significant. History of smoking was significant in malignant effusion with RR of 2.57 (p value < 0.05) as compared to tubercular. Pleural fluid ADA was >70 in 83.7% in tubercular effusion, glucose was <60 mg/dl in 79% tubercular, malignant and bacteriological cause, LDH was >1000 in 88.4% in bacteriological and 72.3% in malignant effusion., Conclusion: Lack of tools for confirming diagnosis leads to diagnostic dilemma and delay in treatment initiation, leading to deterioration and untoward fatality in some cases. Our goal is early diagnosis by correlating clinical symptoms with biochemical profile and help initiate rapid treatment., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background and Aim: Cutaneous Tuberculosis constitutes 1-1.5 % of extrapulmonary tuberculosis with a wide clinical spectrum which relies upon the portal of entry of mycobacteria and patient's immunity. Complications of cutaneous tuberculosis if treatment is delayed includes hazardous sequel like dissemination and disfigurement. Early diagnosis and cure is the ultimate way to prevent such complications. This has motivated us to study clinicoepidemiological, histopathological profile and outcome post treatment of cutaneous tuberculosis patients of our region in detail., Methods: Total 78 patients were studied during the period of August 2018-2022, who were suspicious to have cutaneous tuberculosis clinically of which 54 were confirmed with histopathology. Patient related clinicoepidemiological data such as age, gender, past history of tuberculosis or contact history, chest-x ray, tuberculin test positivity was analysed in a retrospective manner., Results: Among the 54 biopsy proven cases (33 women, 21 men) ranging from 6 to 76 years, 27 patients have been found to have Lupus Vulgaris followed by 15 cases of scrofuloderma. Acid fast bacilli were seen in 9 patients with majority in scrofuloderma. Histopathology revealed epithelioid cell granuloma without necrosis in 34 cases and caseation necrosis in 20 patients. 48 patients showed complete recovery with 6 months of Anti-Koch Treatment and some complications were observed in remaining. Limitation of this research was that long term follow up was not possible., Conclusion: Lack of familiarity might lead to overlooking of a standard presentation or misdiagnosis. So, an eagle eye with high degree of suspicion is crucial for control and prevention of morbidity and for improving socio-economic burden of cutaneous tuberculosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Tuberculosis (TB) is one of the main contributors to global mortality and morbidity. Prevalence of TB is more in developing countries. It is one of the airborne diseases that has always been a major health problem. It is caused by organisms of the Mycobacterium tuberculosis (MTB) complex affecting different organ systems. The proverb prevention is better than cure best applies to TB and it has been practiced from ancient periods. However, modalities of prevention have varied much depending upon the advancement in research and technology. TB preventive practice reduces the load of TB significantly and it was used as the theme for world TB Day for the year 2013. Bacille Calmette-Guérin (BCG) vaccination is one of the modalities to prevent TB and it's been practiced for decades with a lot of modifications from synthesis, schedule and method of administration. BCG mainly prevents serious TB with a less known effect on TB prevention. Other uses of BCG vaccination are being studied. In the modern era, heterologous effects of BCG vaccination have brought BCG once again into the limelight. TB prevention strategies start from basic health education and vaccination. Newer vaccines are under trial to improve the efficacy of TB vaccination and yet to be used for general practice. Prevention and immunization against TB have been modified in immunocompromised children. The concept of drug resistance has to be kept in mind before using anti tubercular drugs without any bacteriological evidence for tuberculosis. National Tuberculosis Elimination Programme (NTEP) focuses on contact tracing and treatment of latent TB infection as a resort to prevent further spread of TB in India. This review article has been authored following an exhaustive examination of the existing literature, with the aim of enhancing comprehension regarding tuberculosis prevention and immunization., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available "over the counter." OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly., Methodology: It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0-3 is considered mild poisoning, 4-7 as moderate poisoning, and 8-11 as severe poisoning., Results: Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20-30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities., Conclusion: This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Background/objectives: Addressing gaps in knowledge about T.B. is a vital component of T.B.'s elimination to achieve the End T.B. strategy by 2025 in India. The present study compares the correct knowledge regarding T.B. by analysis of the nationally-representative secondary data of NFHS-4 (2015-16) and NFHS-5 (2019-20) data in India., Methods: NFHS-4 and NFHS-5 secondary data on eleven T.B.-related questions analysis was done after seeking permission to use datasets from the Demographic and Health Surveys (DHS) program-sociodemographic details and Responses exported and analysed using M.S. Excel. Descriptive variables were represented as frequency and percentages. Z tests for proportions were used to compare and determine differences between NFHS-4 and NFHS-5 knowledge. Statistical significance was set at a p-value of <0.05., Results: The correct knowledge regarding T.B. significantly rose from 457,399 (56.3%) in NFHS-4 to 507,517 (61.4%) in NFHS-5. However, a significant increase in incorrect knowledge about the other modes of transmission of T.B. and T.B. courtesy stigma in households from 95,985 (13.4%) in 2015-16 to 113,978 (14.9%) in 2019-20 was observed., Conclusions: The correct knowledge of T.B. has significantly increased from NFHS-4 (2015-16) to NFHS-5 (2019-20). However, there is a significant increase in incorrect knowledge regarding the modes of transmission and stigmatising attitudes towards T.B. through improvement in the communication efforts in the National T.B. Elimination Programme (NTEP)., Competing Interests: Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Tuberculosis Association of India. All rights reserved.)

Background & Objective: Tuberculosis (TB) is endemic in India. TB is transmitted through droplet infection and the transmission occurs when a person inhales droplet nuclei containing of Mycobacterium tuberculosis. Infection control practices play a major role in controlling the TB infection in healthcare settings and further prevents TB infection in the HCWs. The aim of the study is to conduct the cross sectional study for infection control practices in DOTS cum Sputum Microscopy Centre's under NTEP in Ghaziabad (Uttar Pradesh) & Dehradun (Uttarakhand) districts with the objective to assess the compliance of infection control measures by HCWs in DOTS cum Sputum Microscopy Centre's and to suggest the suitable measures and/or model to reduce the transmission of infection to the HCWs and to the community at large., Materials & Methods: The cross sectional study is conducted for two years in two districts of different state having high burden of TB disease in UP and low burden of disease in UK state. All DOTS cum Sputum Microscopy centres of both selected districts i.e. 100% sample size are covered in the study., Results: Hand washing is the most efficient and cost-effective practice for prevention and control of infection. In Dehradun district 66.66% (12) centers and in Ghaziabad district 57.14% (16) centers have adequate hand washing facility available at DOTS and sputum microscopy lab. Unavailability of adequate PPE will lead to the infection. In Dehradun district, 55.56% (10) centers have adequate PPE available whereas in Ghaziabad District 21.43% (6) centers have adequate PPE available. Training on infection prevention and control for HCWs are provided in 27.78% (5) DOTS/sputum microscopy center in Dehradun whereas none of the DOTS/sputum microscopy center in Ghaziabad district are given training on infection prevention & control for HCWs in last one year. Adequate ventilation plays an important role in transmission of TB/MDR TB or any respiratory infection. HCWs working in DOTS/Sputum microscopy center are at risk to contact the TB/MDR TB infection if there is no proper ventilation in their working places. In 33.33% (6) DOTS/sputum microscopy center in Dehradun & 28.57% (8) in Ghaziabad district have adequate ventilation. Layout of DOTS room and for sputum microscopy center are suggested to reduce the risk of transmission of TB/MDR-TB and other respiratory pathogens amongst HCWs who are working in DOTS cum sputum microscopy center., Conclusion: DOTS cum Sputum Microscopy Centers of both districts in different states are having deficient infection control practices. Staff is not adequately trained in infection prevention and control practices., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

BCG vaccination is known to be safe in infants and a part of immunization schedule in high tuberculosis (TB) burden countries. In the conquest to bring down the severity of the COVID 19 pandemic, many drugs were repurposed in research mode including BCG vaccination/revaccination in various populations. We did a study among the elderly population (>60 years of age) to assess the role of BCG revaccination in preventing the severity of COVID 19 disease. Live attenuated BCG vaccine was given to the willing participants and were followed up for 6 months to estimate COVID19 incidence, understand severity and immunogenicity profile. A total of 48 serious adverse events (SAE) were reported among 1566 elders, none of them had more than one SAE. None of the SAEs were related to the BCG revaccination. Among the 372 adverse events reported, 96% were local reactions at the vaccine site and resolved on its own. BCG revaccination appeared to be safe and could be explored further if repurposing studies were planned for other diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Silico-Tuberculosis (silico-TB) is a severe combination of tuberculosis and silicosis, caused by occupational exposure to fine crystalline silica dust, which has become a global health concern. This comprehensive review compiles the updated knowledge regarding pathophysiology, clinical manifestations, important diagnostic techniques, treatment aspects, and challenges in understanding silico-TB. The review compiles the disease's history and epidemiology, highlighting a lack of data owing to poor monitoring and healthcare particularly in low- and middle-income countries like India. Further weak safety regulations, lack of preventative measures, and inadequate education increase the rates of silico-TB. The pathophysiology shows how silica particles impair the immune system and stimulate Th2 cells and M2 macrophages, which exacerbate TB, while inhibiting Th1 cells and M1 macrophages, which fight against the disease. Subsequently, it can be difficult to distinguish current TB from pre-existing silicosis. In cases where sputum and X-ray results are negative, chest CT scans may be helpful since radiographic screening identifies TB earlier than sputum assessment. Isoniazid, rifampicin, or both minimize the risk of active tuberculosis in people with silicosis. Consistent anti-tuberculosis drug therapy is recommended for 8-9 months to stop recurrence. The assessment recommends integrating silicosis and TB control initiatives to fight this combined health issue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Tubercular Pleural effusion (TBPE) is one of most common extrapulmonary tuberculosis. It can be difficult to diagnose due to low sensitivity of pleural fluid smear, culture and CBNAAT. Diagnosis of TBPE is then dependent on the level of pleural fluid Adenosine Deaminase (ADA). Thoracoscopic pleural biopsy gives definite diagnosis specially in Low Pleural fluid ADA setting., Aims and Objective: This study was planned to find out the prevalence of tubercular etiology in patients of exudative pleural effusion with low ADA (ADA <40 IU/L)., Material and Methods: A Prospective, observational study was carried out in a tertiary teaching institute in north India. Total 142 patients of pleural effusion with low ADA were enrolled. All patients underwent rigid thoracoscopy for confirmation of their diagnosis., Results: Out of 142 patients, male were 78 (55%) and female were 64 (45%). Mean age of patients were 57.4 years. Tuberculosis was diagnosed as a cause of effusion in 22 (15.5%) out of 142 patients. Majority of TBPE patients had pleural thickening as thoracoscopic finding. Mean ADA level in TBPE was 27.36 ± 11.6 as compared to 18.55 ± 9.02 in non tubercular pleural effusion patients and this difference was significant statistically (P- 0.002)., Conclusion: The diagnosis of patients having exudative, low ADA pleural effusion can be very easily confirmed by thoracoscopy guided pleural biopsy which has a very high diagnostic yield., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Competing Interests: We declare no competing interests.

Context: Adrenal incidentalomas (AIs) are relatively uncommon neoplasms in 2% of apparently healthy individuals requiring evaluation for functionality and malignancy., Aim: We aimed to study the clinical, biochemical, and radiological profiles of patients presenting with AI and histopathological outcomes of those undergoing adrenalectomy. Materials and Methods: This retrospective study enrolled 62 AI patients attending a tertiary care center in South India between January 2016 and October 2023. Demographic details, radiological features, functionality, and histopathological data were analyzed., Results: Out of 62 patients, total masses evaluated were 65 indicating bilaterality in 3 patients. The female: male ratio was 1.69, with a median age of 55 years (interquartile range: 44-64 years). 45.1% of individuals were >60 years. The most common indication for imaging was pain abdomen in 43 (69.4%). The median size was 3.2 cm. Fifty-five (88.7%) were assessed for functionality and 27 (49.1%) were functional. Among the 62 individuals, 14 (20.2%) had hypercortisolism, 11 (15.9%) had pheochromocytoma, 5 (7.24%) had primary hyperaldosteronism (PA), and 4 (5.7%) had hyperandrogenism including plurihormonal in 7. A mass size of 3.2 cm was of great value in distinguishing functional tumors with a sensitivity of 72% and specificity of 66% with an area under the curve of 0.682. A total of 34 (54.8%) patients underwent adrenalectomy. On histopathological examination, Adenoma (44.1%) was the most common followed pheochromocytoma (26.5%), adrenal cysts (8.8%), and Myelolipoma (5.9%). Two (5.9%) incidentalomas were adrenocortical carcinoma (ACC). Eight (53.3%) adenomas were functional with 6 having hypercortisolism (including 1 with hyperandrogenism) and 2 with PA., Conclusion: In our experience, the incidence of pheochromocytoma was second most common after adenoma. Since most functional tumors (60%) and all ACCs were ≥4 cm, a thorough biochemical evaluation for hormonal excess and evaluation for malignancy followed by surgery should be considered for lesions, especially ≥4 cm. Thus, we report the baseline demographic and clinical characteristics of patients with AI from a single center in South India., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome (MIM# 208250) is a rare monogenic disorder, characterized by early onset of camptodactyly, progressive coxa vara, bilateral arthropathy and constrictive pericarditis. The syndrome is caused by biallelic loss-of-function variants in PRG4 . Deficiency of PRG4 results in progressive worsening of joint deformity with age. Thirteen individuals with CACP syndrome from eight consanguineous Indian families were evaluated. We used exome sequencing to elucidate disease-causing variants in all the probands. These variants were further validated and segregated by Sanger sequencing, confirming the diagnosis of CACP syndrome in them. Seven females and six males aged 2-23 years were studied. Camptodactyly (13/13), coxa vara (11/13), short femoral neck (11/13) and arthritis in large joints (12/13) [wrists (11/13), ankle (11/13), elbow (10/13) and knee (10/13)] were observed commonly. Five novel disease-causing variants (c.3636G>T, c.1935del, c.1134dup, c.1699del and c.962T>A) and two previously reported variants (c.1910&#95;1911del and c.2816&#95;2817del) were identified in homozygous state in PRG4 . We describe the phenotype and mutations in one of the large cohorts of patients with CACP syndrome, from India., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study tried to understand the association between exposure to indoor air pollution and angina among the aging population in India. We utilized the data from the Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018), with a sample of 62,846 aging adults. We applied Chi-square and multivariate logistic regression models. The odds of angina were higher among individuals living in households that used solid fuels for cooking (aOR = 1.15, 99% CI- 1.09-1.20), had someone smoked inside the house (aOR = 1.12, 99% CI- 1.07-1.18), and households that used of incenses inside the home (aOR = 1.11, 99% CI- 1.05-1.18). In addition, it was also found that work-limiting impairment, unhealthy behaviors, and poor health status increased the odds of angina. These results indicate the need to reduce in-house air pollution by promoting clean fuel usage and changing attitudes and practices. Other implications are discussed.

Objective: Despite generating huge employment opportunities and profitable business, fishing is considered a dangerous occupation due to challenging weather conditions and exposure to unhealthy occupational factors and lifestyles, which contribute to various health issues. However, few studies have examined the health status of shrimp cultivators. Consequently, this study aims to estimate the age group-wise burden of non-communicable diseases (NCDs) among shrimp cultivators., Methods: Simple random sampling was employed for collecting data. The sample size was 357 shrimp cultivators. Disability-adjusted life years (DALY) and relative risk (RR) methods were used to measure the burden of NCDs among shrimp cultivators. This study reported the burden of NCDs per 100,000 shrimp cultivators., Results: The top five prevalence of NCDs per 100,000 shrimp cultivators were mental disorders (85,434), musculoskeletal diseases (26,325), digestive diseases (9,803), diabetes (5,882), and cardiovascular diseases (4,481). DALY per 100,000 shrimp cultivators was 33,407.59, while at the national level, it was 24,775.99 per 100,000 people across all age groups. The RR of NCDs among shrimp cultivators in terms of DALY was 1.35, indicating a 0.35 times higher burden of NCDs among shrimp cultivators than at the national level. The largest RR of NCDs was found among shrimp cultivators aged 15-49 years (1.85), followed by 50-69 years (1.09). The highest percentage changes in the burden of NCDs among shrimp cultivators, resulting from changes in the methods of estimating DALY, was observed in the age group of 70 years and above (-48.36%) followed by 15-49 years (-46.08%) and 50-69 years (-40.33%) when compared to the baseline method of estimating DALY without utilizing age weightage and discount rate., Conclusions: Focus should be given to improving the lifestyle and occupational factors of shrimp cultivators to mitigate the burden of NCDs.

Purpose: The caruncle is a unique anatomical site in the human body, comprising various structures derived from the surface ectoderm and mesoderm. Caruncular lesions can range from benign to malignant and present challenges in accurate diagnosis and timely management due to their hidden nature and proximity to the lacrimal sac. This study aims to provide a comprehensive description of caruncular lesions, presenting the first Indian case series on this topic., Methods: Ethical approval was obtained, and data collection was conducted at a tertiary care center in India. A retrospective analysis was performed on 44 patients with caruncular lesions treated between 2013 and 2020. Detailed patient histories, clinical examinations, slit lamp imaging, and excision biopsies were conducted. Histopathological examination of the specimens was carried out., Results: The study included 42 cases of caruncular lesions, with a mean age of 31.09 years. The majority of cases were male (54.54%). Benign lesions accounted for 84.09% of the cases, while premalignant and malignant lesions accounted for 11.36% and 4.54%, respectively. Papilloma and nevus were the most common lesions, with 11 cases each. All caruncular lesions were successfully and completely excised without complications. Histopathological examination confirmed the accuracy of the diagnoses, with an 84.09% concordance rate between clinical assessment and pathological diagnosis., Conclusion: This case series reveals a predominance of benign lesions among individuals in their early thirties. The successful excision of all lesions with a high concordance rate between clinical assessment and histopathological diagnosis underscores the importance of timely and accurate management., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: Leptospirosis is an endemic disease in India and uveitis is its late complication. Several Indian reports showed diversity of serovars, changing patterns and existence of new serovars. Failure to add new serovars in testing panel result in increased false-negativity in serology., Aim: To analyse seroprevalence, changing patterns and to discuss the resulting challenges in diagnosis., Methods: In this retrospective study covering the period from 1994 to 2020, we analysed data from laboratory records of patients diagnosed with leptospiral uveitis in South India. Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals., Results: Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. autumnalis , L. icterohaemorrhagiae , and L. australis . There were notable variations in the distribution of serovars over the years., Conclusions: The data suggest a declining sensitivity of MAT and ELISA, possibly due to the emergence of new serovars. Customizing the panel based on local isolates could enhance the performance of MAT. Critical need is the addition of advanced molecular techniques to improve the diagnosis.

Objective: To test the hypothesis that conductive hearing loss (CHL) is associated with dementia, and that middle ear reconstruction (MER) associates with improved outcomes for these measures in a multinational electronic health records database., Study Design: Retrospective cohort study with propensity-score matching (PSM)., Setting: TriNetX is a research database representing about 110 million patients from the United States, Taiwan, Brazil, and India., Patients: Subjects older than 50 years with no HL and any CHL (ICD-10: H90.0-2). Subjects of any age with and without any MER (CPT: 1010174)., Main Outcome Measures: Odds ratios (ORs) and hazard ratios with 95% confidence intervals (95% CIs) for incident dementia (ICD-10: F01, F03, G30)., Results: Of 103,609 patients older than 50 years experiencing any CHL, 2.74% developed dementia compared with 1.22% of 38,216,019 patients with no HL (OR, 95% CI: 2.29, 2.20-2.37). Of patients experiencing CHL, there were 39,850 who received MER. The average age was 31.3 years, with 51% female patients. A total of 343,876 control patients with CHL were identified; 39,900 patients remained in each cohort after 1:1 PSM for HL- and dementia-related risk factors. Matched risk for developing dementia among MER recipients was 0.33% compared with 0.58% in controls (OR: 0.58, 0.46-0.72)., Conclusions: CHL increases the odds for dementia, and MER improves the odds for incident dementia. This study represents the first population study on the topic of CHL, MER, and dementia., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Malignant catarrhal fever (MCF) presents a sporadic yet significant threat to livestock and wildlife. A comprehensive investigation in Karnataka, India into the prevalence and transmission patterns of sheep-associated MCF (SA-MCF) was conducted. A total of 507 sheep peripheral blood leukocyte samples from 13 districts along with 27 cows and 10 buffalo samples from various regions in Karnataka were tested for SA-MCF infection i.e. Ovine gammaherpesvirus 2 (OvHV-2) using heminested PCR. Furthermore, serum samples collected from 73 cows and 15 buffalo suspected of MCF were tested using a commercially available ELISA kit. Additionally, histopathological examinations of affected tissues and phylogenetic analysis of viral tegument protein sequences were conducted. Our findings indicated a 20.11%, 33.33% and 20% positivity for OvHV-2 in sheep, cows and buffalo respectively by PCR. Statistical analysis revealed a significant association between the age of sheep and the detection of OvHV-2. Seven cows and one buffalo serum samples tested positive for ELISA. Clinical findings in bovids were consistent with typical MCF signs, and histopathological results revealed multi-organ involvement characterised by necrotising vasculitis and lymphoid hyperplasia. The nucleotide pairwise identity matrix revealed 99.5% identity between the sequences obtained in the study with sequences from other states. The phylogenetic analysis of partial tegument protein sequences from bovid and sheep samples suggested a close genetic relationship between the local OvHV-2 strains and those from various global regions. Crucially, this study underscores the widespread presence of SA-MCF in Karnataka, with significant implications for both livestock management and wildlife conservation., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: Although previous studies have described phenomenological diagnoses, they lacked description of aetiological spectrum in patients visiting movement disorders (MD) service. Herein, we classify the MD phenomenology and describe aetiology wise distribution of each phenomenology in patients visiting a tertiary care movement disorders service., Methods: Collected information included demographic profile (age of onset, age at presentation, gender, duration of illness before presentation), predominant MD phenomenology [such as parkinsonism, dystonia, ataxia, tremor, chorea, ballism, myoclonus, tics, stereotypy, restless legs syndrome (RLS) and others], diagnostic evaluations and detected aetiology., Results: This observational study included 1140 MD patients over a span of 5 years. The median (IQR) age of onset was 49 (35-60) years and age at presentation was 54 (40-65) years, with median duration of illness being 36 (18-72) months. Nearly two-third of patients were males (M:F=731:409). Parkinsonism (n=494, 43.3 %) was the most common MD phenomenology observed, followed by dystonia (n=219, 19.2 %), ataxia (n=125, 11 %), tremor (n=118, 10.4 %), myoclonus (n=73, 6.4 %), chorea (n=40, 3.5 %), spasticity (n=22, 1.9 %), tics (n=8, 0.7 %), and RLS (n=8, 0.7 %). Thirty-three (2.9 %) patients were grouped under miscellaneous MDs. Overall, neurodegenerative disorders (57.4 %) were the most common cause of MDs. Parkinson's disease, genetic dystonia, essential tremor, genetic ataxias, hemifacial spasm, and Huntington's disease were the most common aetiologies for parkinsonism, dystonia, tremor, ataxia, myoclonus, and chorea, respectively., Conclusion: Parkinsonism was the most common phenomenology observed in MD patients, and was followed by dystonia, ataxia and tremor. Neurodegenerative disorders were the most common aetiology detected., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: To assess the prevalence of non-communicable disease risk factors among the nursing staff and educate them on prevention., Background: Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non-communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non-communicable disease risk factors among nursing staff are crucial for education on prevention., Design: A cross-sectional digital survey-based study., Method: We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community-Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening., Result: Among 682 nursing staff who attended, 70% had never undergone screening for non-communicable diseases. The prevalence of non-communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non-communicable diseases were significant risk factors among nursing staff., Conclusion: The study findings suggest that the nursing staff have suboptimal self-health concerns on non-communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion., (© 2024 John Wiley & Sons Australia, Ltd.)

Objective: ​​This study aimed to characterize the profile of myositis-specific and myositis-associated autoantibodies (MSAs/MAAs) in an Indian cohort of juvenile dermatomyositis (JDM) patients and correlate them with clinical features and outcomes., Methods: Forty-three children diagnosed with JDM were enrolled for this observational study. Clinical details (presentation, course, and outcome) were noted in a predesigned proforma. Serum samples were tested for 16 MSAs/MAAs by line immunoassay. MSAs/MAAs were correlated with clinical features and outcome (defined as a complete clinical response [≥6 months' disease inactivity on medication] or complete remission [≥6 months' inactivity off all drugs])., Results: Thirty-five subjects (81.4%) had at least 1 MSA/MAA detected. The most common antibodies were anti-NXP2 (n = 13, 30.2%), anti-TIF1γ (n = 10, 23.2%), and anti-MDA-5 (n = 8, 18.6%). No patient had anti-Ku, anti-Pm Scl-100, anti-PL-12, anti-EJ, anti-OJ, or anti-Ro52. Thirty-two patients (74.4%) attained a complete clinical response over a median follow-up duration of 14 months, among which 6 (13.9%) achieved complete remission over a median follow-up duration of 30 months. Anti-TIF1γ was associated with younger age at onset (≤3 years) (odds ratio [OR], 6.25; 95% confidence interval [CI], 1.15-34.12; p = 0.034) and disease flares after attaining complete response (OR, 10.18; 95% CI, 1.64-70.93; p = 0.013). Patients with anti-NXP2 had higher odds of severe muscular weakness (OR, 3.73; 95% CI, 0.95-14.59; p = 0.058) and truncal weakness (OR, 3.89; 95% CI, 0.97-15.64; p = 0.056). One child with anti-MDA-5 positivity had interstitial lung disease. We found no association between the MSA/MAA profile and the achievement of complete clinical response or remission., Conclusions: MSAs/MAAs were identified in 81% of children with JDM in our study, which is higher than most other studies. The most frequently observed antibodies displayed a pattern consistent with other studies. Anti-TIF1γ was associated with a younger age at onset and disease flares even after attaining a complete clinical response. Anti-NXP2 had higher odds of severe muscular weakness. These observations suggest consistency in certain phenotypic associations observed across geographic boundaries., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The most frequent head and neck cancer is oral squamous cell carcinoma (OSCC), the common histological cancer of the oral cavity and is one of the most prevalent forms of cancer globally. It has been known that there are several biomarkers and therapeutic targets that have been discovered for OSCC, but none of them were effective against the progression of OSCC. Interestingly, small non-coding RNAs termed microRNAs (miRNAs) regulate cellular activity by targeting numerous signaling pathways or genes that either promote or repress the progression of diseases. Surprisingly, among the differentially expressed miRNAs, miR-34a was identified to be highly sensitive and specific to OSCC and widely studied for its role in various cancers, including OSCC., Methods: The secondary structure of miR-34a-3p was analyzed using bioinformatic analysis and its targets were screened using the TargetScan database. Specimens of 25 OSCC cancer tissues and adjacent normal tissues were collected from the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals. The tissues were processed for H&E staining and gene expression analysis of miR-34a-3p and tumor necrosis factor alpha (TNF-α)., Results: The minimum free energy for miR-34a-3p was found to be -47.20 kCal which proved the stability of the miRNA. The histopathological examination confirmed the OSCC cases and the gene expression analysis revealed that miR-34a-3p was significantly downregulated in OSCC tissues, whereas TNF-α showed vice versa expression., Conclusions: miR-34a-3p could be postulated as a potential therapeutic target for OSCC.

The global demographic and epidemiological transition have led to a rapidly increasing burden of cancer, particularly among older adults. There are scant data on the prevalence and demographic pattern of cancer in older Indian persons. This was a multicentric observational study conducted between January 2019 and December 2020. Data were retrieved from existing electronic databases to gather information on two key variables: the total number of patients registered with oncologists and the number of patients aged 60 years and above. The primary objective was to determine the percentage of older adults among patients with cancer served by these hospitals. Secondary objectives included understanding the prevalence of different types of cancer in the older population, and the sex- and geographic distribution of cancer in older Indian patients. We included 272,488 patients with cancer from 17 institutes across India. Among them, 97,962 individuals (36 %) were aged 60 years and above. The proportion of older adults varied between 20.6 % and 53.6 % across the participating institutes. The median age of the older patients with cancer was 67 (interquartile range, 63-72) years. Of the 54,281 patients for whom the details regarding sex were available, 32,243 (59.4 %) were male. Of the 56,903 older patients, head and neck malignancies were the most prevalent, accounting for 11,158 cases (19.6 %), followed by breast cancer (6260 cases, 11 %), genitourinary cancers (6242 cases, 10.9 %), lung cancers (6082 cases, 10.7 %), hepatopancreaticobiliary (6074, 10.7 %), and hematological malignancies (5226 cases, 9.2 %). Over one-third of Indian patients with cancer are aged 60 years and above, with a male predominance. Head and neck, breast, and genitourinary cancers are the most prevalent in this age group. Characterizing the burden of cancer in older adults is crucial to enable tailored interventions and additional research to improve the care and support for this vulnerable population., Competing Interests: Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest from any authors associated with this publication. No funding was required for this project., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Human immunodeficiency virus (HIV) is a sexually transmitted infection impacting populations worldwide. While there have been major improvements in controlling HIV over recent years, the COVID-19 pandemic may have potentially resulted in major interruptions to this control of HIV. Bharat (India) is a country that has been greatly impacted by the COVID-19 pandemic, and we aimed to analyse the trends in HIV control since the start of the pandemic., Methods: In this study we evaluated changes in rates of HIV incidence and mortality across Bharat for the years both before, and after, the start of the COVID-19 pandemic. Percent and absolute changes were determined, and thereafter, both bivariate and multi linear regression was conducted to evaluate the relationship between COVID-19 burden and changes in HIV epidemiology across the nation., Results: It was shown that, despite the COVID-19 pandemic, annual incidence and deaths of HIV/AIDS have both decreased across Bharat. From 2019-2021, in Bharat, the total number of new HIV cases annually decreased by 9.03%, and the total number of HIV/AIDS deaths annually decreased by 28.82%. A similar trend was shown across most states/union territories; however, there were notable exceptions (such as Karnataka, Bihar, and Assam) where the rates have instead increased., Conclusions: Our analysis has demonstrated that government efforts to control the HIV/AIDS epidemic have not been greatly impacted across the majority of Bharat since the emergence of COVID-19. The reduction in annual HIV/AIDS deaths in the country has been better than the world average, and the improvements from the period of 2019 to 2021 were greater than those from 2017 to 2019. Regardless, there are regions in the nation where the epidemic has instead worsened during this period., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aimed to investigate the association between lifetime occupational history and risk of buccal mucosa cancer (BMC)., Methods: We utilized a multi-centric, hospital-based case-control study across five centres of Tata Memorial Centre, Mumbai, India. Cases included men aged 20-75-years with histological confirmed primary cancer of the buccal mucosa. Visitor controls were frequency matched to cases for age (10 years interval) and current residential zone. Study participants were interviewed face-to-face. Logistic regression was performed to estimate odds ratio (OR) and 95 % confidence intervals (CI)., Results: Among ever employed males, we identified 1969 BMC cases and 2145 controls. We observed an increased risk of BMC in 'Craft and Related Trades Workers' (OR 1.37; 95 % CI 1.13-1.65), 'Plant and Machine Operators and Assemblers' (OR: 1.26; 95 % CI 1.01-1.56), and 'Elementary Occupations' (OR:1.33; 95 % CI 1.12-1.58). More specifically, the increased risk was observed for 'Metal, Machinery and Related Trades Workers', 'Handicraft and Printing Workers', 'Drivers and Mobile Plant Operators', and 'Laborers in Mining, Construction, Manufacturing and Transport'., Conclusion: Our findings suggest that certain occupations may be at a higher risk of BMC. Some fraction of BMC can be prevented by reducing exposure to hazardous agents used in these occupations. Further research is needed to identify which exposures are responsible for the increased risk. Moreover, tobacco control and early detection activities can be focused towards these occupations as tobacco consumption is also high in them, which may also be the reason for increased risk observed in these groups., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Tuberculosis (TB) is a chronic infectious multisystemic disease caused by Mycobacterium tuberculosis and is one of the leading causes of mortality worldwide. Both common mental disorders (CMD) and TB are global public health problems that have a considerable impact on human health. Moreover, TB and CMDs share common risk factors including poverty, drug addiction, and homelessness and the coexistence of CMD and TB leads to difficult management of TB., Materials and Methods: This was a hospital-based longitudinal study, carried out between June 2021 and December 2022. In this study, 147 pulmonary TB patients were included as per inclusion and exclusion criteria, and psychiatric illness was evaluated by the Brief Psychiatric Rating Scale., Results: The mean age of study participants was 37.59 ± 15.37 years, there were 99 (67.3%) were male and 48 (32.7%) were female. Psychiatric illness was found in 77 (52.38%) pulmonary TB patients. Among psychiatric illness, anxiety was found in 33 (22.4%) participants and 21 (14.3%) participants had depression. Mixed anxiety and depression were found in 20 (13.6%) patients and 03 (2%) participants had severe psychosis. The association of psychiatric illness with age group and gender was not significant ( P = 0.734, 0.203, respectively). There were 105 (71.40%) patients who had <12 standard education and 42 (28.60%) had >12 standard education and their association with psychiatric illness was statistically significant ( P = 0.044). Adverse drug reactions were found among 80 (54.42%) patients and the association between adverse drug reactions and psychiatric illness was significant ( P = 0.031)., Conclusion: Psychiatric illness is one of the important domains to be evaluated in timely manner in TB patients and early intervention is needed for better management of the TB because the severity, social factors, and chronicity of the disease make them susceptible to develop psychiatric illness., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)