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Background: Trauma is globally associated with significant mortality with developing countries bearing a disproportionately high burden. It represents a major epidemic of non – communicable disease. The aim of this study is to evaluate the incidence of various fracture and dislocation patterns in patients with extremity injuries and their 1- year mortality rate. Materials and Methods: An observational, prospective study was undertaken to analyse the incidence of fracture and dislocation patterns in patients coming to the Orthopaedics OPD and emergency medicine department in a tertiary hospital during a period of two years from 1st, October 2017 to 30th, September 2019. Overall, 1182 patients were enrolled for the study with a mean age of 43 yrs. Results: Age group 21 – 30 years was most common (17.1%) age to suffer injuries with a male preponderance (67.5%). The most common mode of injury was by road traffic accident (43%). 97.9% of the injuries had unilateral involvement with the lower extremity (57.2%) and the femur (21.2%) being most frequently fractured. Dislocations/fracture-dislocations constituted only 5.5% cases with shoulder dislocation being the most frequently involved joint. Plain radiographs were used in 96.9% cases for final diagnosis. Forty cases (3.4%) were found to not survive in the 1-year follow up after fracture. Conclusion: The present study shows that most of the causes of trauma are preventable. This study could assist in raising the profile of RTI as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge.

Background and Objectives: The burden of poor sanitation, particularly in India, is exacerbated by challenges in infrastructure and education. Previous studies reveal unsatisfactory sanitary conditions, the association between low standard of living and open defecation, the need for collective effort, the positive impact of improved sanitation on child height, and factors hindering latrine adoption. This study aimed to identify factors influencing open-air defecation in tribal villages of Dhamni and Dhodani in the Raigad district of Maharashtra, India. Subjects and Methods: Data were collected through a door-to-door survey using a pretested questionnaire from December 2019 to February 2020, covering sociodemographic information, personal and family history, and environmental factors. Out of 130 willing participants, 112 were included in the final analysis. Descriptive statistics, including percentages, means, and standard deviations, were used to analyze the data. The Chi-square test was used to compare categorical variables. Results: The study found that a significant majority of the subjects (75%) engaged in open field defecation (OFD), whereas a smaller proportion used household latrines (25%). Among those practicing OFD, a considerable portion (46%) defecated in agricultural fields, and a notable percentage (27%) preferred defecating near water sources. Conclusion: The study revealed unsatisfactory sanitary conditions in the research area. It was observed that rural areas with higher levels of literacy exhibited a lower prevalence of OFD and higher rates of sanitary latrine utilization.

Multidrug-resistant yeast Candida auris is a serious threat to public health with documented survival in various hospital niches. The dynamics of this survival benefit and its trade off with drug resistance are still unknown for this pathogen. In this study we investigate the oxidative stress response (OSR) in fluconazole-resistant C. auris and compare its relative fitness with fluconazole-susceptible strains. A total of 351 C. auris clinical isolates (61 fluconazole-susceptible and 290 fluconazole-resistant) were screened for stress tolerance by spot assay and 95.08 % fluconazole-susceptible isolates were hyper-resistant to oxidative stress while majority (94.5 %) fluconazole-resistant isolates had lower oxidative tolerance. Expression of Hog1 and Cta1 gene transcript levels and cellular catalase levels were significantly higher in fluconazole-susceptible isolates and a corresponding higher intracellular reactive oxygen species level (iROS) was accumulated in the fluconazole-resistant isolates. Biofilm formation and cell viability under oxidative stress revealed higher biofilm formation and better viability in fluconazole-susceptible isolates. Fluconazole-resistant isolates had higher basal cell wall chitin. On comparison of virulence, the % cytotoxicity in A549 cell line was higher in fluconazole-susceptible isolates and the median survival of the infected larvae in G. mellonella infection model was higher in fluconazole-resistant (5; IQR:4.5–5 days) vs. fluconazole-susceptible C. auris (2; IQR:1.5–2.5 days). All organisms evolve with changes in their environmental conditions, to ensure an optimal balance between proliferation and survival. Development of tolerance to a certain kind of stress example antifungal exposure in yeast can leads to a compensatory decrease in tolerance for other stresses. This study provides useful insights into the comparative fitness and antifungal susceptibility trade off in C. auris. We report a negative association between H2O2 tolerance and fluconazole susceptibility. Using in-vitro cell cytotoxicity and in-vivo survival assays we also demonstrate the higher virulence potential of fluconazole-susceptible C. auris isolates corroborating the negative correlation between susceptibility and pathogen survival or virulence. These findings could also be translated to clinical practice by investigating the possibility of using molecules targeting stress response and fitness regulating pathways for management of this serious infection.

Objective: The objective of this study was to investigate the relationship between Vitamin D levels, radiographic severity, and functional status in patients with primary knee osteoarthritis (OA). Materials and Methods: A cross-sectional study was conducted on 71 patients with primary knee OA. Clinical and radiological evaluations were performed to confirm the diagnosis of knee OA. Vitamin D levels were measured, and radiographic severity was assessed using the Kellgren–Lawrence grading system. Functional status was evaluated using Lequesne’s indices. Statistical analyses were conducted to compare variables between patients with deficient Vitamin D levels (

Summary: Background: Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition. Methods: We analysed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors. Findings: The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation: Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors. Funding: Wellcome Trust.

A novel combination of Butyric and Valeric acid glycerol esters with oregano oil in a dry powder form was evaluated for performance improvements in broilers. The dosing regimen (500 g/Ton feed in starter and grower; 250 g/Ton in finisher feed) was considered low compared to conventional practices using non-esterified Butyric and Valeric short-chain fatty acids (SCFA). Six trials were conducted at various trial facilities in Italy, United Kingdom, Spain, and Poland. Supplemented broilers weighed significantly more than the control birds at 28 days of age (+3.4%; 1459 g vs. 1412 g; p = 0.0006) and at 42 days of age (+2.5%; 2834 g vs. 2763 g; p = 0.0030). Supplementation significantly reduced mortality from 1.9% to 0.8% during the finisher phase (from 29 to 42 days of age); however, average mortality was 3.2% for the whole 42-day growth period and was not affected. Further, supplemented broilers grew more (66.4 vs. 64.5 g/day; p = 0.0005), ate more feed (104.7 vs. 103.1 g/day; p = 0.0473), converted feed significantly more efficiently (1.58 vs. 1.60; p = 0.0072), leading to better EPEF value (410 vs. 389; p = 0.0006) than the control broilers. Meta-analysed trial performance data for novel SCFA formulations such as these are not commonly available, and serve to facilitate efficacy determination from an end-user perspective. The use of short- and medium-chain fatty acid esters in optimal low-dose combinations to reliably augment gut health and performance appears promising in commercial broiler production, and may lead to further improvements in industry practices and reduced antibiotic use.

Purpose: To study the clinical presentation, mycological profile, and risk factors of fungal keratitis (FK) cases presenting at two tertiary-care centers, one each at North (Chandigarh) and Northeast (Assam) India, and to compare the spectrum of fungi recovered from the clinical and environmental samples at both locations. Methods: All patients with suspected FK were enrolled from both the centers between January 2018 and December 2019. Corneal samples were collected and processed as per standard laboratory protocols. Demographic details and clinical and mycological profiles were noted in all patients. Environmental sampling from the soil, air, and the vegetative matter was performed from both locations and neighboring districts. Results: Of the 475 suspected cases, 337 (71%) were diagnosed as FK (median age: 50 years; 77.2% males). The presence of diabetes, hypertension, blurred vision, and corneal discoloration was significantly higher in patients with FK compared to those without FK. Aspergillus sp. (52.1%) and Fusarium sp. (47.61%) were the predominant etiological agents isolated from cases in North and Northeast India, respectively. FK due to melanized fungi was associated with diabetes, trauma with animal tail, and corneal discoloration. A similar spectrum of fungi was seen in environmental and clinical samples in both the regions. Conclusion: The difference in etiological agents of FK and environmental fungal isolates in North and Northeast India highlights the need to identify the ecological niche of potential fungal pathogens. Prospective, multicenter studies, systematic environmental sampling, and the evaluation of the differences in causative agents and clinical presentation of FK from different parts of the country can substantially improve our understanding of its region-specific clinico-epidemiological profile.

BackgroundHypnotherapy is a useful treatment for a variety of gastrointestinal conditions. While there is strong evidence for delivering other treatments virtually and in groups, there is no research thus far on delivering hypnotherapy in this format. Given the growth of both psychogastroenterology and telehealth, these methods should be explored as they have great potential for increasing access and cost-effectiveness of intervention.AimsThis qualitative study was developed to help understand patients experiences in virtual, group-based, gut-directed hypnotherapy (GDH) in two different institutions.MethodsAuthors developed a qualitative interview with the assistance of two patient partners and then recruited patients from New York University and Dartmouth Health to participate. Interviews were completed one-on-one with patients who started and then completed GDH (≥5 visits) and who did not complete GDH (≤3 visits). Data were coded and then analyzed using thematic analysis.ResultsTwenty-one patients from NYU and Dartmouth participated in qualitative interviews. Broadly, patients reported coming to GDH because they believed in the importance of the mind-body connection or were desperate for treatment. Regardless of why patients came to GDH, they generally reported positive outcomes for GI symptoms and for other physical and mental health conditions. Most patients appreciated the group and virtual formats, though some concerns about inflexible schedules and lack of anonymity were voiced. Despite these concerns, there was broad support for virtual, group-based GDH and general excitement for behavioral health programming.ConclusionVirtual, group-based GDH is an acceptable treatment for patients from rural and urban settings. Given the possible improvements in access and cost-effectiveness that this treatment modality can provide, GI practices may want to consider it in lieu of or in addition to the traditional one-on-one treatment format. Barriers and facilitators and recommendations for practice are discussed.

With the rapidly growing online sales, e-commerce firms in emerging economies like India risk unsustainable practices such as the relentless consumption of goods, increased plastic and paper packaging, or inefficient delivery options that increase fuel consumption. To maintain a favorable corporate image amongst consumers, online firms possibly adopt various mechanisms to signal consumers' adoption of sustainable practices. Such practices by firms may involve implementing sustainability practices in doorstep delivery, packaging, and product selection to influence consumers' buying preferences. This research uses a structured survey approach to explore the impact of three sustainable practices implemented by an e-commerce firm on the consumer's intention to purchase from such a firm. Using a dual theory perspective of the theory of consumption value (TCV) and the theory of planned behavior (TPB), the study demonstrates the impact of the belief of environmental risks on consumers' intentions to purchase from such e-commerce firms with sustainable practices. The data findings from 301 Indian e-commerce consumers suggest that consumers with a higher belief of environmental risks display a higher degree of tolerance for the inconvenience of order delivery and sustainable product purchase intentions, further influencing their intentions to purchase from e-commerce firms with sustainable practices. However, the preference for sustainable packaging does not impact intentions to purchase from e-commerce firms with sustainable practices. The study discusses the implications for online e-commerce retailers and policymakers and informs online e-commerce consumers' choices. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 illness caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus has been declared a pandemic by the World Health Organization in March 2020. It had an overwhelming effect on health-care delivery in India. We report the 5 months, April–September 2020, experience in our radiotherapy (RT) department. Methods: Since April–September 2020, we registered 184 cancer patients with various site diseases for RT/chemoradiation treatment for curative/palliative therapy. Preregistration and weekly once during treatment period all underwent throat/nasopharynx swab testing with reverse transcription polymerase chain reaction. Dedicated infection prophylaxis was carried for patients and staff. Results: Of the 184 patients, 10.9% (20/184) swab results were positive for SARS-CoV-2. With appropriate COVID-19 care and quarantine, 18 patients completed the planned RT. Two died with COVID-19 infection illness and progressive locoregional cancer. We observed no excess acute RT/chemoradiation effects in this group due to infection. Conclusions: Our 5-month experience in this COVID-19 pandemic period reveals that RT treatment, COVID-19 care, and quarantine can be done with dedicated infection protective measures.

Aminoglycoside antibiotics interfere with the selection of cognate tRNAs during translation, resulting in the synthesis of aberrant proteins that are the ultimate cause of cell death. However, the toxic potential of aberrant proteins and how they avoid degradation by the cell's protein quality control (QC) machinery are not understood. Here we report that levels of the heat shock (HS) transcription factor σ32 increased sharply following exposure of Escherichia coli to the aminoglycoside kanamycin (Kan), suggesting that at least some of the aberrant proteins synthesized in these cells were recognized as substrates by DnaK, a molecular chaperone that regulates the HS response, the major protein QC pathway in bacteria. To further investigate aberrant protein toxic potential and interaction with cell QC factors, we studied an acutely toxic 48-residue polypeptide (ARF48) that is encoded by an alternate reading frame in a plant cDNA. As occurred in cells exposed to Kan, σ32 levels were strongly elevated following ARF48 expression, suggesting that ARF48 was recognized as a substrate by DnaK. Paradoxically, an internal 10-residue region that was tightly bound by DnaK in vitro also was required for the ARF48 toxic effect. Despite the increased levels of σ32, levels of several HS proteins were unchanged following ARF48 expression, suggesting that the HS response had been aborted. Nucleoids were condensed and cell permeability increased rapidly following ARF48 expression, together suggesting that ARF48 disrupts DNA-membrane interactions that could be required for efficient gene expression. Our results are consistent with earlier studies showing that aberrant proteins induced by aminoglycoside antibiotics disrupt cell membrane integrity. Insights into the mechanism for this effect could be gained by further study of the ARF48 model system.