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ObjectivesTo determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19.DesignRetrospective observational study.SettingMulticenter, international COVID-19 registry.SubjectsAdult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021.InterventionsNone.Measurements and main resultsData were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio [OR] = 1.28; 95% CI [1.19-1.38]; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI [1.03-1.15]; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI [0.81-0.94]; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI [1.20-1.56]; p < 0.0001).ConclusionsAmong patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.

Introduction: Type-2 Diabetes Mellitus (T2DM) is a global epidemic and a serious risk for the younger generation. A sedentary lifestyle, urbanisation, and poor dietary choices are cornerstones of diabetes. Early detection of risk factors and prevention of their progression can go a long way in delaying the onset of the disease and reducing the economic burden due to its secondary complications. Aim: To assess anthropometric variables of T2DM among the population in Belagavi, North Karnataka, India. Materials and Methods: A community-based cross-sectional study was conducted among a study population of 4,473 individuals in 10 wards of urban Belagavi district from September 2021 to September 2023 by house-to-house visits. The 10 wards were selected using a random allocation method by computer-generated random sequence. The study population was divided into three groups: the diabetic group, children of the diabetic group, and a healthy non diabetic group (Group-1, Group-2, and Group-3) with population sizes of 649, 855, and 2,969, respectively. Anthropometric parameters were recorded by trained nurses using measuring tapes, stadiometers, and weighing scales. Data were analysed using Statistical Package for Social Sciences (SPSS) 24.0 software. One-way Analysis of Variance (ANOVA) test was used to compare the data between the three groups. The Pearson's correlation test was used to find the association between Body Mass Index (BMI) and Waist Hip Ratio (WHR). A p-value less than 0.05 was considered significant. Results: There were no significant differences found in anthropometric parameters among the three groups (p>0.05). However, when comparing anthropometric parameters between different generations, a statistically significant difference was observed in Neck Circumference (NC) and WHR. Further, association between BMI and WHR among the three groups revealed that WHR is a better indicator of obesity compared to BMI, with a statistically significant p-value of 0.03. WHR detected 424 (90.4%), 463 (91.32%), and 1,220 (87%) obese cases in Group-1, Group-2, and Group-3, respectively, compared to BMI, which detected 371 (58.51%), 440 (52.25%), and 1,202 (41.91%) obese cases in Group-1, Group-2, and Group-3, respectively. Conclusion: The NC and WHR are better indicators of anthropometric measurements. Anthropometry could be a non invasive, cost-effective predictive tool for the future risk of developing DM. The present study determined there is an impending need to conduct regular screening programs for early identification of anthropometrics other than BMI, WHR, and NC. [ABSTRACT FROM AUTHOR]

Background: The association between risk factors and severe acute respiratory syndrome coronavirus-2 disease (COVID-19) related mortality among people with diabetes mellitus (DM) is uncertain. Methods: Consecutive patients with COVID-19 with type 2 DM admitted to our tertiary care centre from July 2020 to January 2021 were included in this cross-sectional study. Data including clinical, laboratory, respiratory, inflammatory biomarkers and radiological parameters were collected and compared between non-survivors and survivors. Cox-proportional hazards regression analyses were performed to analyse the risk factors associated with the mortality in COVID-19 patients with diabetes. Results: Two hundred and sixty three patients with COVID-19 were included. Of these, 173 (65.8%) had survived. Demographic, laboratory, inflammatory and pulmonary parameters were significantly different between the survivors and non-survivors (P < 0.05 for all). Time to hospitalisation from symptom onset (days) was longer in non-survivors compared to survivors (7 Vs 4 days; P = 0.0001). Computed tomography severity scores were higher in non-survivors than survivors (P = 0.0001). The hospital stay was prolonged in non-survivors (P < 0.0001). Adjusted cox-proportional hazard model showed increased neutrophil count and intensive care unit (ICU) admission were independent factors associated with COVID-19-related mortality in diabetic patients. Conclusions: We found that the non survivors as compared to the survivors showed multiple negative outcomes in terms of laboratory, inflammatory and pulmonary findings. ICU admission and elevated neutrophil count were independently associated with death in COVID-19 patients with DM. [ABSTRACT FROM AUTHOR]

Introduction: Centhaquine (Lyfaquin®) showed significant efficacy as a resuscitative agent in animal models of haemorrhagic shock. Its safety and tolerability were confirmed in healthy human volunteers. In this study, our primary objective was to determine the safety, and the secondary objective was to assess the efficacy of centhaquine in patients with hypovolemic shock.Methods: A prospective, multicentre, randomized phase II study was conducted in male and female patients aged 18-70 years with hypovolemic shock having systolic BP ≤ 90 mmHg. Patients were randomized in a 1:1 ratio to either the control or centhaquine group. The control group received 100 ml of normal saline infusion over 1 h, while the centhaquine group received 0.01 mg/kg of centhaquine in 100 ml normal saline infusion over 1 h. Every patient received standard of care (SOC) and was followed for 28 days.Results: Fifty patients were included, and 45 completed the trial: 22 in the control group and 23 in the centhaquine group. The demographics of patients in both groups were comparable. No adverse event related to centhaquine was recorded in the 28-day observation period. The baseline, Injury Scoring System score, haemoglobin, and haematocrit were similar in both groups. However, 91% of the patients in the centhaquine group needed major surgery, whereas only 68% in the control group (p = 0.0526). Twenty-eight-day all-cause mortality was 0/23 in the centhaquine group and 2/22 in the control group. The percent time in ICU and ventilator support was less in the centhaquine group than in the control group. The total amount of vasopressors needed in the first 48 h of resuscitation was lower in the centhaquine group than in the control group (3.12 ± 2.18 vs. 9.39 ± 4.28 mg). An increase in systolic and diastolic BP from baseline through 48 h was more marked in the centhaquine group than in the control group. Compared with the control group, blood lactate level was lower by 1.75 ± 1.07 mmol/l in the centhaquine group on day 3 of resuscitation. Improvements in base deficit, multiple organ dysfunction syndrome (MODS) score and adult respiratory distress syndrome (ARDS) were greater in the centhaquine group than in the control group.Conclusion: When added to SOC, centhaquine is a well-tolerated and effective resuscitative agent. It improves the clinical outcome of patients with hypovolemic shock.Trial Registration: ClinicalTrials.gov identifier number: NCT04056065. [ABSTRACT FROM AUTHOR]

Background: Fruits and vegetables are important components of the human diet since they provide essential nutrients that are required for most of the reactions occurring in the body. However, indiscriminate and overuse of pesticides damage agriculture and environment, but the pesticide residues on food products affect the health. Aim and Objective: The present study aimed to assess the Knowledge, Attitude and Practices (KAP) among the farmers of Belagavi taluka, regarding the pesticide use and to determine pesticide residues in commonly used vegetables. Materials and Methods: The present cross-sectional study included a total of 200 farmers selected randomly from 4 divisions of Belagavi taluka. Questionnaire was developed to assess the KAP. Fresh tomatoes and chilies were used as samples, fine homogenized sample (200 g) was extracted with ethyl acetate and analyzed using gas chromatography-mass spectrometry. Results: Most of them were aware of the precautions to be taken during pesticide use. However, not all farmers followed the measures. Maximum of them used pesticides (n=150), followed recommended method (n=130) and concentration (n=152). Pesticide residues found in chili and tomato samples exceeded the maximum residue limit. Conclusion: Chlorpyrifos and ethion in tomato sample, and chlorpyrifos and cypermethrin in chillies sample were the pesticide residues. Protective measures followed by the farmers was poor. Therefore, the knowledge of the farmers should be upgraded and, camps should be conducted periodically to monitor pesticide residues and health of the farmers. [ABSTRACT FROM AUTHOR]

The author addresses some of the looming problems related to the third wave of the COVID-19 pandemic in India. They include the adverse economic impact of the pandemic, posttraumatic stress disorder and other mental health issues, and higher crime rate in both individual and organized crime. The influenza pandemic of 1918-1919 is explored.

Background: NVX-CoV2373, a Covid-19 vaccine was developed in the USA with ∼90% efficacy. The same vaccine is manufactured in India after technology transfer (called as SII-NVX-CoV2373), was evaluated in this phase 2/3 immuno-bridging study., Methods: This was an observer-blind, randomised, phase 2/3 study in 1600 adults. In phase 2, 200 participants were randomized 3:1 to SII-NVX-CoV2373 or placebo. In phase 3, 1400 participants were randomized 3:1 to SII-NVX-CoV2373 or NVX-CoV2373 (940 safety cohort and 460 immunogenicity cohort). Two doses of study products (SII-NVX-CoV2373, NVX-CoV2373 or placebo) were given 3 weeks apart. Primary objectives were to demonstrate non-inferiority of SII-NVX-CoV2373 to NVX-CoV2373 in terms of geometric mean ELISA units (GMEU) ratio of anti-S IgG antibodies 14 days after the second dose (day 36) and to determine the incidence of causally related serious adverse events (SAEs) through 180 days after the first dose. Anti-S IgG response was assessed using an Enzyme-Linked Immunosorbent Assay (ELISA) and neutralizing antibodies (nAb) were assessed by a microneutralization assay using wild type SARS CoV-2 in participants from the immunogenicity cohort at baseline, day 22, day 36 and day 180. Cell mediated immune (CMI) response was assessed in a subset of 28 participants from immunogenicity cohort by ELISpot assay at baseline, day 36 and day 180. The total follow-up was for 6 months. Trial registration: CTRI/2021/02/031554., Findings: Total 1596 participants (200 in Phase 2 and 1396 in Phase 3) received the first dose. SII-NVX-CoV2373 was found non-inferior to NVX-CoV2373 (anti-S IgG antibodies GMEU ratio 0.91; 95% CI: 0.79, 1.06). At day 36, there was more than 58-fold rise in anti-S IgG and nAb titers compared to baseline in both the groups. On day 180 visit, these antibody titers declined to levels slightly lower than those after the first dose (13-22 fold-rise above baseline). Incidence of unsolicited and solicited AEs was similar between the SII-NVX-CoV2373 and NVX-CoV2373 groups. No adverse event of special interest (AESI) was reported. No causally related SAE was reported., Interpretation: SII-NVX-CoV2373 induced a non-inferior immune response compared to NVX-CoV2373 and has acceptable safety profile., Funding: SIIPL, Indian Council of Medical Research, Novavax., Competing Interests: PSK, DK, BG, CB, AD, MG, and US are employees of SIIPL. JSP, MZ and SCC are employees of Novavax Inc. CSP is Chairman and Managing Director of SIIPL. All other authors declare no competing interests., (© 2022 The Author(s).)

Obesity is a leading preventable cause of death and a growing health problem worldwide with increasing rate in both adults and children. Obesity is an important factor causing accelerated aging and various metabolic syndromes. Leptin role as proinflammatory adipokine in obesity is well established. Telomere length acts as a biological clock and a marker for cellular senescence. This study is aimed to quantify leucocyte telomere length & its association with biochemical and anthropometric surrogates of obesity., Material: This cross-sectional study was conducted for a duration of 1yr on patients admitted in the wards or attending OPD, fulfilling the inclusion criteria. After a written informed consent and a thorough history, patient's anthropometric measurements were taken following all guidelines. Based on the values obtained the participants were divided into categories based on age and BMI. Blood samples are collected for the assessment of Leucocyte Telomere length through qPCR technique, Leptin through ELIZA method and HBA1c through HPLC method., Observation: In our present study, a total of 90 patients were included. These patients are equally divided in age groups of 25-39yrs, 40-54yrs and &gt;=55yrs of age. The mean age of the patients was 48.84±16.84yrs. The patients were further categorized equally in each age group into normal, overweight and obese. The mean BMI of the study subjects was 24.20±3.32 kg/m2. Age is found to have a negative correlation with telomere length (r=-0.205). A significant negative correlation of BMI with telomere length is observed (r=-0.20, p&lt;0.05). No significant correlation between leptin with telomere length (r=0.092, p=0.386) or other anthropometric variables is observed. Waist circumference has a positive correlation with waist/hip ratio (r=0.281) (p=0.007), BMI (r=0.640), weight (r=0.677) and neck circumference(r=0.687). Whereas Telomere length has a negative correlation with waist circumference (r= -0.171), neck circumference (r=--0.2266) (p=0.0318) and positive correlation with waist/hip ratio (r=0.043). In our study a negative correlation was observed between waist/ height ratio and telomere length. Waist hip ratio had a positive correlation with BMI (r= 0.138) and telomere length (r=0.232)., Conclusion: Telomere length showed a negative correlation with all anthropometric measures except WHR which showed a positive correlation. Leptin did not show any association with telomere length or anthropometric measures in our study. Our study shows that WHR is a better marker of central obesity than BMI. The notion of metabolically healthy obese also holds true in our study results., (© Journal of the Association of Physicians of India 2011.)