Prevalence status and detection of benzimidazole resistance using AS-PCR in Haemonchus contortus of goats from Marathwada region, Maharashtra, India

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.

Molecular evidence of hepatozoonosis in tigers of Vidarbha region of Maharashtra State of India

BACKGROUND

Hepatozoonosis has been reported in many species around the world. Few incidences have been reported in various species of wild felids. Tigers are endangered large cats and are protected under the Wildlife Protection Act, 1972 under Schedule I. The study was carried out to estimate the positivity rate of hepatozoonosis in tigers of the Vidarbha region of Maharashtra, India.

METHODS

Blood (n = 21) or tissue samples (n = 5) were collected from 26 wild captured / zoo-born or dead tigers during the quarantine period/post-mortem examination. Blood smear examination along with Polymerase Chain Reaction (PCR) studies were conducted for the detection of hepatozoonosis. All the amplicons from the positive samples were purified and sequenced, and the sequences were subjected to nBLAST analysis to detect the species of Hepatozoon. The sequences were deposited into public domain database of National Center for Biotechnology Information (NCBI) and accession numbers were allotted. A phylogenetic study was undertaken to understand the evolutionary lineage of the pathogen. Tissue distribution studies were carried out on tissue samples received during post mortem. A clinical case in a tiger cub was managed and sub-clinical cases were monitored for relapse. Age-wise, sex-wise, region-wise and captive time-wise positivity rate was estimated. The data was analyzed using statistical tools.

RESULTS

A total of 12 tigers were found positive for H. felis during the screening. A clinical case was diagnosed and successfully treated. The age group of 0-3 years reported a positivity rate of 66.66%, and all the cases found positive were reported between the age group of 0-7 years. Males reported a positivity rate of 58.33 per cent, while females reported 35.71%. Taboba and Andhari Tiger Reserve of the state had a positivity rate of 52.94 per cent. However, the statistical analysis for blood parameters and positivity rate by 't' test and Chi-squared test were found to be non-significant.

CONCLUSIONS

An overall positivity rate of 46.15% indicates the wide distribution of hepatozoonosis among wild tigers of the Vidarbha region of Maharashtra, India, which is strategically important considering the gene flow and migration of tigers. Hepatozoonosis can progress to clinical outcomes in young animals and require veterinary intervention. Molecular tools and phylogenetic studies can supplement important data on circulating species of Hepatozoon in the field. Further studies on the clinical management and epidemiology of the infection in wild felids will comprehend the cause of wildlife conservation.

Current profile of phenotypic pyrethroid resistance in Rhipicephalus microplus (Acari: Ixodidae) populations sampled from Marathwada region of Maharashtra state, India

This study examined the pattern of resistance to widely applied synthetic pyrethroids, i.e., cypermethrin and deltamethrin, against larvae of Rhipicephalus microplus ticks sampled from Marathwada region in Maharashtra, India. The study also examined the role of α- and β-esterases and glutathione-S-transferase (GST) in resistance development. All eight R. microplus isolates tested were resistant to deltamethrin (RL IV), having RR50 values from 6.88 to 131.26. LPT analysis exhibited the resistance level II deltamethrin resistance in Beed and Hingoli, III in Dharashiv, and IV in Sambhajinagar, Parbhani, Latur, Jalna, and Nanded isolates. The LIT analysis showed that Dharashiv field isolates had the lowest LC50 value of 229.09 ppm against cypermethrin, while Sambhajinagar field isolates had the highest at 489.78 ppm. The RR50 ranged from 1145.45 to 2448.9. Seven isolates were level I resistant to cypermethrin while the Jalna isolate was level II resistant. In larvae treated with deltamethrin and cypermethrin, the activity of α- and β-esterase enzymes increased significantly compared to control groups. The enzyme ratios in treated larvae ranged from 0.7533 to 1.7023 for α-esterase and 0.7434 to 3.2054 for β-esterase. The Hingoli isolate treated with cypermethrin exhibited the highest α-esterase activity (903.261), whereas Sambhajinagar isolate had the highest GST enzyme ratio (2.8224) after deltamethrin exposure. When exposed to cypermethrin, the Hingoli isolate showed the highest GST enzyme ratio, 2.0832. The present study provides the current resistance status in tick populations from Marathwada region indicating deltamethrin and cypermethrin to be ineffective for tick control. The results also suggest that SP compounds should be regulated in this region and alternative control strategies should be introduced.

Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals

BACKGROUND

The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India.

METHODS

A State-level online survey was conducted among the registered HCPs (n = 2143) casing all five regions of the Maharashtra state using a pre-tested self-administered questionnaire. The responses were expressed as mean, and proportions with their standard deviation and 95% CI respectively. Binary logistic regression and a multivariate logistic model were used to determine factors associated with knowledge, attitude, and practice of bioethics.

RESULTS

Of the 2143 registered HCPs in Maharashtra included in this study, most of them (65.2%) had adequate knowledge of bioethics. Adequate knowledge was associated with lower age, profession (nurses and dentists), employment in the private sector, HCPS at Marathwada and Pune, and higher educational attainment. About 3 in 5 HCPs (59.4%) had a favorable attitude towards the ethical practice of bioethics, and was associated with profession, place of work, region of practice, and work experience. The distribution of unethical bioethics practices among 10 items was proportionally high, and only 34.4% reported good/fair practice. The common unethical practices in the state were allowing patients to be examined by interns, and not informing them about professional misconduct to the regulatory bodies.

CONCLUSION

Most HCPs had adequate knowledge of bioethics, which is encouraging and would favor the laying foundation for forming a good bioethics framework. Only 3/5 HCPs demonstrated a favorable attitude, and the observed unethical practice is alarmingly common. A serious consideration to evaluate the compliance level of bioethics practice periodically and measures to educate, sensitize, and train bioethics among HCPs in Maharashtra is warranted.

Mental health resources, barriers, and intervention needs among women in rural Maharashtra, India: A qualitative study

This research paper focuses on the mental health needs, the need for mental health interventions and barriers in mental healthcare of women living in rural Maharashtra, India. Using a mixed-methods approach, the study has collected data from a sample of women living in the rural areas of Maharashtra through in-depth interviews. The data collected has been analyzed to identify the barriers and obstacles in mental healthcare, how the existing community support serves as a resource as well as the desire for potential mental healthcare interventions among participants. The findings of the study are expected to contribute to the development of effective mental health interventions tailored to the specific needs of women living in the rural areas of Maharashtra. Overall, this research paper aims to improve the understanding of the mental health needs of women in rural Maharashtra and provide insights for policymakers and mental health practitioners to develop effective interventions to promote their mental well-being.

Domestic Violence and the Law: A Study of Complaints Under the Protection of Women From Domestic Violence Act, 2005 in Maharashtra, India

Violence against women is a complex phenomenon that is deeply embedded in Indian society. In this mixed methods article, court records data (2005-2010) from two sites in Maharashtra, India along with in-depth interviews with stakeholders were analyzed to examine the implementation of the Protection of Women from Domestic Violence Act, 2005 (PWDVA). Out of 77.28% married women who filed a case under the PWDVA, 60.28% of them reported dowry-related harassment. Maharashtra has the social infrastructure in place to implement the law, although optimal use needs to be ensured for speedy delivery of justice.

Awareness and attitude about mental illness in the rural population of India: A mixed method study

Context

Recent systematic review and meta-analysis of public attitudes have shown that despite improvements in mental health literacy, public attitudes and desire for social distance with mental illnesses have remained stable over time.

Aims

To assess the awareness and attitude of the rural community towards mental disorders using the CAMI scale.

Materials and Methods

This mixed method study was conducted under the ICMR-STS grant scheme after IEC approval. It included administration of a pre-tested questionnaire adapted from CAMI scale on 196 adults aged 18-60 years from an adopted village in the field practice area of medical college along with 8 in-depth interviews of key people in the same community. Thematic analysis was done for the qualitative part whereas for the quantitative part, Pearson's correlation coefficient, independent t-test, ANOVA and Kruskall-wallis test were used.

Results

Age was positively correlated with the attitude of authoritarianism, social restrictiveness, CMHI and showed a negative correlation with attitude of benevolence. Females showed higher scores for authoritarianism and social restrictiveness. There was a statistically significant difference between APL and BPL groups for authoritarianism attitude towards the mentally ill (P value = 0.02) and CMHI (P value = 0.033). It was observed that with increase in the education levels there was a rise in the mean score of the values for the attitude of benevolence but the difference wasn't statistically significant (P > 0.05). Thematic analysis of the key informant interviews suggested various perceptions of the community regarding mental illness, available options for management, current practices of the community and what can be done further to improve facilities for mental health.

Conclusions

People in the community have a varied perspective to mental illnesses which has changed for the better over time but community still approaches quacks first which warrants the need for more awareness. For this, feasibility and effectiveness of increasing involvement of females from the community in health-related decisions can be explored further. We recommend further awareness generation in the younger generation with community-based research on perceptions of the community about mental health. This will provide more practical and feasible solutions to complement the national mental health program.

COVID-19 Pandemic: Did Strict Mobility Restrictions Save Lives and Healthcare Costs in Maharashtra, India?

INTRODUCTION

Maharashtra, India, remained a hotspot during the COVID-19 pandemic. After the initial complete lockdown, the state slowly relaxed restrictions. We aim to estimate the lockdown's impact on COVID-19 cases and associated healthcare costs.

METHODS

Using daily case data for 84 days (9 March-31 May 2020), we modeled the epidemic's trajectory and predicted new cases for different phases of lockdown. We fitted log-linear models to estimate the growth rate, basic (R₀), daily reproduction number (R_e), and case doubling time. Based on pre-restriction and Phase 1 R₀, we predicted new cases for the rest of the restriction phases, and we compared them with the actual number of cases during each phase. Furthermore, using the published and gray literature, we estimated the costs and savings of implementing these restrictions for the projected period, and we performed a sensitivity analysis.

RESULTS

The estimated median R₀ during the different phases was 1.14 (95% CI: 0.85, 1.45) for pre-lockdown, 1.67 (95% CI: 1.50, 1.82) for phase 1 (strict mobility restrictions), 1.24 (95% CI: 1.12, 1.35) for phase 2 (extension of phase 1 with no restrictions on agricultural and essential services), 1.12 (95% CI: 1.01, 1.23) for phase 3 (extension of phase 2 with mobility relaxations in areas with few infections), and 1.05 (95% CI: 0.99, 1.123) for phase 4 (implementation of localized lockdowns in high-case-load areas with fewer restrictions on other areas), respectively. The corresponding doubling time rate for cases (in days) was 17.78 (95% CI: 5.61, -15.19), 3.87 (95% CI: 3.15, 5.00), 10.37 (95% CI: 7.10, 19.30), 20.31 (95% CI: 10.70, 212.50), and 45.56 (95% CI: 20.50, -204.52). For the projected period, the cases could have reached 631,819 without the lockdown, as the actual reported number of cases was 64,975. From a healthcare perspective, the estimated total value of averted cases was INR 194.73 billion (USD 2.60 billion), resulting in net cost savings of 84.05%. The Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Year (QALY) for implementing the lockdown, rather than observing the natural course of the pandemic, was INR 33,812.15 (USD 450.83).

CONCLUSION

Maharashtra's early public health response delayed the pandemic and averted new cases and deaths during the first wave of the pandemic. However, we recommend that such restrictions be carefully used while considering the local socio-economic realities in countries like India.

Landscape assessment of the cities in the state of Maharashtra: first step towards air quality management (AQM) and strategic implementation of mitigation plans

OBJECTIVE OF THE STUDY

This study aims to understand the need for landscape assessment of the 18 non-attainment cities in the state of Maharashtra, to understand and rank the cities according to the need and necessity for strategic implementation of air quality management. This air quality management is a National Clean Air Programme initiative to curb the air pollution level in all the highly polluted Indian cities by 20-30% till 2024.

METHODOLOGY

The ranking and selection of the cities consisted of a two-phase approach including (a) desk research and (b) field interventions and stakeholders' consultations. The first phase included (a_i) review of 18 non-attainment cities in Maharashtra, (a_ii) identification of suitable indicators to inform prioritisation during the ranking process, (a_iii) data collection and analysis of the indicators and (a_iv) the ranking of the 18 non-attainment cities in Maharashtra. The second phase, i.e. field interventions included (b_i) Mapping of stakeholders and field visits, (b_ii) the consultations with the stakeholders, (b_iii) information and data collection and (b_iv) ranking and selection of cities. On analysing the score obtained from both the approaches a ranking of all the cities is done accordingly.

RESULTS AND DISCUSSION

The screening of cities from the first phase gave a possible list of 8 cities-Aurangabad, Kolhapur, Mumbai, Nagpur, Nashik, Navi Mumbai, Pune, Solapur. Further, the second round of analysis involving field interventions and stakeholder consultations was done within the 8 cities to find out the most suitable list of two to 5 cities. The second research analysis gave Aurangabad, Kolhapur, Mumbai, Navi Mumbai and Pune. A more granular stakeholder consultation resulted in the selection of cities like Navi Mumbai and Pune as the cities where implementation of new strategies seemed feasible.

INTERVENTION AND ACTIVITIES

New strategic interventions like (a) strengthen the clean air ecosystem/institutions, (b) air quality monitoring and health impact assessment, and (c) skill development to ensure the long-term sustainability of initiatives planned for the cities.

Diversity of sandflies in Vidarbha region of Maharashtra, India, a region endemic to Chandipura virus encephalitis

Background & objectives

Sandflies are implicated as vectors of Chandipura virus (CHPV) (Vesiculovirus: Rhabdoviridae). The virus is prevalent in central India including Vidarbha region of Maharashtra. CHPV causes encephalitis in children below 15 yr of age with case fatality rates ranging from 56 to 78 per cent. The present study was undertaken to determine the sandfly fauna in the CHPV endemic Vidharba region.

Methods

A year round survey of sandflies was conducted at 25 sites in three districts of Vidarbha region. Sandflies were collected from their resting sites using handheld aspirators and identified using taxonomical keys.

Results

A total of 6568 sandflies were collected during the study. Approximately 99 per cent of the collection belonged to genus Sergentomyia, which was represented by Ser. babu, Ser. bailyi and Ser. punjabensis. Genus Phlebotomus was represented by Ph. argentipes and Ph. papatasi. Ser. babu was the predominant species (70.7%) collected during the study. Ph. argentipes was detected in four villages with 0.89 per cent, whereas Ph. papatasi was detected in only one village with 0.32 per cent of the total collection. CHPV could not be isolated despite processing all the sandflies for virus isolation in cell culture.

Interpretation & conclusions

The present study showed influence of higher temperature and relative humidity on sandfly population dynamics. An important observation during the study was the absence or decline in the population of Ph. papatasi and Ph. argentipes in the study area. Surge in Sergentomyia population and their breeding/resting in close vicinity to humans pose a concern as they are known to harbour CHPV and other viruses of public health importance.

Incidence & factors influencing maternal near miss events in tertiary hospitals of Maharashtra, India

Background & objectives

Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future.

Methods

This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals.

Results

The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively.

Interpretation & conclusions

The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.

Assessing the potential of self-help group women for improving reproductive health of women in a tribal block of Maharashtra, India

Background & objectives

In the current health system, cash incentives are given to accredited social health activists for referring women to public health facilities for specific maternal and child health services, however many reproductive health problems are not included in these services. The objective of this study was to assess the impact of involvement of self-help groups (SHGs) in improving reproductive health seeking behaviour and service utilization by tribal women.

Methods

An experimental study was conducted in two tribal blocks of Nasik district (Kalvan and Surgana) in Maharashtra, India, over a period of 18 months. Interventions included training of SHG women and providing incentives to them for conducting health education sessions for reproductive age group women in the community and referring those with the requisite problems, to the health facilities. Pre- and post-intervention focus group discussions and in-depth interviews among SHG women were conducted. Training of service providers on diagnosis and treatment of reproductive morbidities was done, and health service utilization was assessed.

Results

Sixty five per cent of the referred women with reproductive morbidities availed services at the public health facilities. A review of records of women seeking services for reproductive health problems showed that there was a significant improvement in the intent for seeking services in the study block as compared to the control block (χ^[2]-9.06, P<0.002).

Interpretation & conclusions

This study demonstrates the feasibility of utilizing the potential of SHGs for improving reproductive health seeking behaviour of the tribal women. The results suggest that this model could be scaled up to address the neglected reproductive health needs of women without burdening the existing human resources.

Visual impairment and blindness among children from schools for the blind in Maharashtra state, India: Changing trends over the last decade

Purpose:

To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India.

Methods:

Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recorded using the World Health Organization’s standard reporting form. Causes of blindness were compared among different regions of the state and also by different age groups.

Results:

Of the 1,969 students examined from 39 schools for the blind, 188 children (9.5%) had severe visual impairment and 1,666 children (84.6%) were blind. Whole globe anomalies (794, 42.8%) were the most common anatomical site of vision loss in children, followed by corneal (289, 15.6%) and retinal abnormalities (280, 15.2%). Corneal causes were second most common in the poorer districts of Vidarbha (15.3%) and Marathwada (14.6%), whereas retinal causes were second most common in the wealthier regions of western Maharashtra (18.3%) and Khandesh (24.1%). Nearly one-third (593, 32%) of children were blind from potentially avoidable causes. Preventable blindness consisting of corneal causes and retinopathy of prematurity was seen in 281 (15.2%) cases, whereas treatable causes comprising of lens-related causes, glaucomas, refractive errors, amblyopia, and uveitis accounted for another 311 (16.8%). Among the younger children (≤10 years), the proportion of corneal blindness was lower (83/623, 13.3% vs. 206/1232, 16.7%) and that of retinal blindness was higher (119/623, 19% vs. 163/1232, 13.2%) than the older children.

Conclusion:

Whole globe anomalies constitute a major cause of SVI and blindness in Maharashtra. There seems to be an increase in the proportion of retinal blindness, especially retinopathy of prematurity, suggesting a need for increased screening coverage.

Meager Perception of Preconception Care Among Women Desiring Pregnancy in Rural Areas: A Qualitative Study Using Focus Group Discussions

Background: India has the second-highest number of under-five deaths in any country in the world. WHO and the Government of India recommended the rollout of preconception care (PCC) to reduce maternal and child mortality. However, very few countries, including India, have started a comprehensive package of PCC services. It implies that women, mainly from rural and tribal areas, are not aware of PCC. PCC has been rolled out through the government health system in two blocks of Nashik district in Maharashtra state, India, among all women who desire to be pregnant within 1 year. This project is the first of its kind in India. To assess basic perceptions, knowledge, and behavior of women on PCC before the implementation of the project, focus group discussions (FGDs) were carried out. The authors think that the finding may help to develop strategies for behavioral change communication.

Methods: From each of the four blocks, two villages having subcenter were selected for conducting FGD. A house-to-house survey was conducted by Accredited Social Health Activist (ASHA) to enlist women who desire a baby in 1 year and invite them to subcenter for FGDs, which were conducted in June 2018.

Results: A total of 76 women having a mean age of 23.97 years participated in the FGDs. Most of them (46.05%) had completed 10 years of education. About 50% of pregnancies were planned. The decision about the timing of the first pregnancy is influenced by the mother-in-law. Women knew that they should not conceive before 20 years of age, and their suboptimal weight may have an adverse impact on the health of the newborn. There are many myths about food like “hot and cold foods” and “forbidden food” etc. Women had some knowledge about the adverse effects of tobacco and alcohol; very few consumed these. Most of them did not practice behaviors or accessed services related to PCC.

Conclusions: Women neither have the knowledge nor adopt behaviors or accessed services related to PCC. Roll out of PCC among them may help in further reduction of maternal and neonatal morbidity and mortality in India.

Severe acute respiratory syndrome-coronavirus-2 seroprevalence study in Pimpri-Chinchwad, Maharashtra, India coinciding with falling trend - Do the results suggest imminent herd immunity?

Background

COVID-19 is a public health concern currently demanding continuous efforts to understand its epidemiology. Pimpri-Chinchwad township with a population of over 25 lakhs is located in Maharashtra, one of the worst affected states in India. After the incidence peaked in the township in mid-September 2020, cases started declining even as lockdown restrictions were eased.

Objectives

A seroprevalence study was conducted to understand the transmission dynamics of the pandemic in this region.

Methods

We carried out a population-based seroprevalence study for IgG antibodies for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among 5000 residents 12 years and above selected by the cluster random sampling. We selected 50 clusters in slums, 80 clusters in tenements, and 70 clusters from housing societies. The field work for collection of samples was carried out from October 07 to October 17, 2020. We used kit from Abbott (SARS-CoV-2 IgG), which employs chemiluminescent microparticle immunoassay technology. The prevalence of IgG antibodies was expressed as point estimates with 95% confidence intervals (CIs). These were weighted for areas and cluster effect and further adjusted for test performance.

Results

The overall seropositivity for IgG was 34.04% (95% CIl 31.3%-36.8%). Slum dwellers had 40.9% positivity rate (95% CI 37.0%-44.7%), those in tenements 41.2% (95% CI 37.7%-44.8%) and people living in housing societies had 29.8% positivity (95% CI 25.8%-33.8%).

Conclusion

A considerable proportion of population had encountered the novel coronavirus approaching partial, if not complete, herd immunity, which may partly explain the declining trend in spite of easing of lockdown restrictions.

Prevalence of stress, stressors, and coping strategies among medical undergraduate students in a medical college of Mumbai

BACKGROUND

Stress is a subjective experience which creates an obstacle in a person's path of achieving his or her goals. It creates negative outcomes among the population. Medical curriculum is very vast and stressful. As doctors are the very important part of society, medical students must be allowed to learn their trade in a stress-free environment. The present study aimed to assess the perceived stress, various sources of stress among medical undergraduate students, and the coping strategies adopted.

MATERIALS AND METHODS

This was a cross-sectional study conducted among medical under-graduate students studying at a tertiary care hospital situated in Mumbai city of Maharashtra between January and June 2018. Using purposive sampling technique, a total of 450 medical students from 1^st year to final year were invited to participate in the study. A self-administered questionnaire consisting of sociodemographic details and perceived stress scale questions was used. Logistic regression analysis was carried out to assess the determinants of stress. Odds ratio, 95% confidence interval was calculated. P < 0.05 was considered statistically significant.

RESULTS

The overall response rate was 79.11%, with 356 out of 450 students returning the questionnaire. Among 356 participants, 324 participants (91%) were suffering from high levels of stress. Factors such as curriculum vastness, frequency of examination, competition with peer, performance in examinations, worry about future, loneliness, relation with opposite sex, and quality of food played a major role in creating additional stress.

CONCLUSIONS

The perceived stress was higher among female medical students. Academic factors are greater perceived cause of stress in medical students in this study. A substantial proportion of medical undergraduate students were found to be stressed which necessitates appropriate and timely interventions. Reframing the academic curriculum along with examination and evaluation patterns, incorporating extracurricular activities, and establishment of counselling cells in the institution is the need of the hour.

SARS-CoV-2 Spike Mutations, L452R, T478K, E484Q and P681R, in the Second Wave of COVID-19 in Maharashtra, India

As the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic expands, genomic epidemiology and whole genome sequencing are being used to investigate its transmission and evolution. Against the backdrop of the global emergence of "variants of concern" (VOCs) during December 2020 and an upsurge in a state in the western part of India since January 2021, whole genome sequencing and analysis of spike protein mutations using sequence and structural approaches were undertaken to identify possible new variants and gauge the fitness of the current circulating strains. Phylogenetic analysis revealed that newly identified lineages B.1.617.1 and B.1.617.2 were predominantly circulating. The signature mutations possessed by these strains were L452R, T478K, E484Q, D614G and P681R in the spike protein, including within the receptor-binding domain (RBD). Of these, the mutations at residue positions 452, 484 and 681 have been reported in other globally circulating lineages. The structural analysis of RBD mutations L452R, T478K and E484Q revealed that these may possibly result in increased ACE2 binding while P681R in the furin cleavage site could increase the rate of S1-S2 cleavage, resulting in better transmissibility. The two RBD mutations, L452R and E484Q, indicated decreased binding to select monoclonal antibodies (mAbs) and may affect their neutralization potential. Further in vitro/in vivo studies would help confirm the phenotypic changes of the mutant strains. Overall, the study revealed that the newly emerged variants were responsible for the second wave of COVID-19 in Maharashtra. Lineage B.1.617.2 has been designated as a VOC delta and B.1.617.1 as a variant of interest kappa, and they are being widely reported in the rest of the country as well as globally. Continuous monitoring of these and emerging variants in India is essential.

Severity of the COVID-19 pandemic in India

The main objective of this study is to identify the socioeconomic, meteorological, and geographical factors associated with the severity of COVID-19 pandemic in India. The severity is measured by the cumulative severity ratio (CSR)-the ratio of the cumulative COVID-related deaths to the deaths in a pre-pandemic year-its first difference and COVID infection cases. We have found significant interstate heterogeneity in the pandemic development and have contrasted the trends of the COVID-19 severities between Maharashtra, which had the largest number of COVID deaths and cases, and the other states. Drawing upon random-effects models and Tobit models for the weekly and monthly panel data sets of 32 states/union territories, we have found that the factors associated with the COVID severity include income, gender, multi-morbidity, urbanization, lockdown and unlock phases, weather including temperature and rainfall, and the retail price of wheat. Brief observations from a policy perspective are made toward the end.

Impact of COVID-19 infection on life expectancy, premature mortality, and DALY in Maharashtra, India

BACKGROUND

The COVID-19 infections and deaths have largely been uneven within and between countries. With 17% of the world's population, India has so far had 13% of global COVID-19 infections and 8.5% of deaths. Maharashtra accounting for 9% of India's population, is the worst affected state, with 19% of infections and 33% of total deaths in the country until 23rd December 2020. Though a number of studies have examined the vulnerability to and spread of COVID-19 and its effect on mortality, no attempt has been made to understand its impact on mortality in the states of India.

METHOD

Using data from multiple sources and under the assumption that COVID-19 deaths are additional deaths in the population, this paper examined the impact of the disease on premature mortality, loss of life expectancy, years of potential life lost (YPLL), and disability-adjusted life years (DALY) in Maharashtra. Descriptive statistics, a set of abridged life tables, YPLL, and DALY were used in the analysis. Estimates of mortality indices were compared pre- and during COVID-19.

RESULT

COVID-19 attributable deaths account for 5.3% of total deaths in the state and have reduced the life expectancy at birth by 0.8 years, from 73.2 years in the pre-COVID-19 period to 72.4 years by the end of 2020. If COVID-19 attributable deaths increase to 10% of total deaths, life expectancy at birth will likely reduce by 1.4 years. The probability of death in 20-64 years of age (the prime working-age group) has increased from 0.15 to 0.16 due to COVID-19. There has been 1.06 million additional loss of years (YPLL) in the state, and DALY due to COVID-19 has been estimated to be 6 per thousand.

CONCLUSION

COVID-19 has increased premature mortality, YPLL, and DALY and has reduced life expectancy at every age in Maharashtra.

A study of genomic diversity in populations of Maharashtra, India, inferred from 20 autosomal STR markers

OBJECTIVE

This study was planned to evaluate the genetic diversity in the admixed and Teli (a Hindu caste) populations of Maharashtra, India using 20 autosomal Short Tandem Repeat (STR) genetic markers. We further investigated the genetic relatedness of the studied populations with other Indian populations.

RESULTS

The studied populations showed a wide range of observed heterozygosity viz. 0.690 to 0.918 for the admixed population and 0.696 to 0.942 for the Teli population. This might be due to the multi-directional gene flow. The admixed and Teli populations also showed a high degree polymorphism which ranged from 0.652 to 0.903 and 0.644 to 0.902, respectively. Their combined value of matching probability for all the studied loci was 4.29 × 10-25 and 5.01 × 10-24, respectively. The results of Neighbor-Joining tree and Principal Component Analysis showed that the studied populations clustered with the general populations of Jharkhand, UttarPradesh, Rajasthan and Central Indian States, as well as with the specific populations of Maharashtra (Konkanastha Brahmins) and Tamil Nadu (Kurmans). Overall, the obtained data showed a high degree of forensic efficacy and would be useful for forensic applications as well as genealogical studies.

Pre-to-post lockdown impact on air quality and the role of environmental factors in spreading the COVID-19 cases - a study from a worst-hit state of India

The present study aims to examine the changes in air quality during different phases of the COVID-19 pandemic, including the lockdown (LD1-4) and unlock period (UL1-2) (post-lockdown) as compared to pre-lockdown (PL1-3) and to establish the relationships of the environmental and demographic variables with COVID-19 cases in the state of Maharashtra, the worst-hit state in India. Atmospheric pollutants such as PM2.5, PM10, NOx, and CO were substantially reduced during the lockdown and unlock phases with the greatest reduction in cities having larger traffic volumes. Compared with the immediate pre-lockdown period (PL3), the averaged PM2.5 and PM10 reduced by up to 51% and 47% respectively during the lockdown periods, which resulted in 'satisfactory' level of air quality index (AQI) as a result of reduced vehicular traffic and industrial closing. These parameters continued to reduce as much as 80% during the unlock periods due to the additive impact of weather (rainfall and temperature) combined with the lockdown conditions. Kendall's correlation matrix showed a significant negative correlation between temperature and air pollutants (r= - 0.35 to - 057). Conversely, SO2 and O3 did not improve, and in some cases, they increased during the lockdown and unlocking. COVID-19 spreading incidences were strongly and positively correlated with temperature (r < 0.62) and dew point (r < 0.73). Thus, this indicates that the increase in temperature and dew point cannot weaken the transmission of this virus. The number of COVID-19 cases relative to air pollutants was negatively correlated (r = - 0.33 to - 0.74), which may be a mere coincidence as a result of lockdown. However, based on pre-lockdown air quality data and demographic factors, it was found that particulate matter (PM2.5 and PM10) and population density are closely linked with higher morbidity and mortality although a more in-depth research is required in this direction to validate this finding. The onset of COVID-19 has allowed us to determine that 'immediate' changes in air quality within densely populated/industrialized areas can improve livelihood based on pollution mitigation. These findings could be used by policymakers to set new benchmarks for air pollution that would improve the quality of life for major sectors of the World's population. COVID-19 has shown us that we can make changes when necessary, and findings may pave the way for future research to inform policy on the tough choices we will have to make between quality of life and survival. Also, our results will enrich the ongoing discussion on the role of environmental factors on the transmission of COVID-19 and will help to take necessary steps for its control.

Value chain management under COVID-19: responses and lessons from grape production in India

The COVID-19 pandemic has affected several economic sectors in India, dragging many to the brink of survival. In particular, the already fragile horticulture industry is now facing a double burden of a weak value chain management system as well as perishability of produce (fresh fruits and vegetables), this pandemic season. Also, the strict enforcement of lockdown has altered both demand and supply factors, which in turn have shocked various linkages in the value chain of fresh fruits and vegetables. So, this paper dissects the value chain management of grapes and its processed products, namely juice, wine, and raisins in Maharashtra, the largest producer of grapes in India. For this, a value chain analysis (VCA) is carried out by computing the degree of value addition to uncover the rupture points caused by the pandemic as well as advocate policy measures to build a resilient system. The value chain analysis shows that post-COVID-19, the degree of value addition, has shot up for the intermediary agents, i.e., pre-harvest contractors, at the expense of the farmers. Using the insights from the VCA results plus the demand and supply shocks, various policy measures are elucidated to strengthen the grape value chain.

Claiming crisis: narratives of tension and insurance in rural India

This article discusses local expressions of crisis in Beed district, central Maharashtra. Both in public and academic discourse crisis has become the term of choice for the many structural deficiencies which make agriculture an increasingly precarious livelihood in India. While most voices subscribe to the explanation that the current state of distress can be attributed to the unprofitability of agriculture, a wide range of structural explanations are suggested as to why this might be the case. Consequently, in some debates agricultural crisis runs the risk of moving the experiences, agency and postionalities of those imagined to be living through its consequences to the background. This paper counterbalances such causal explanations by empirically delving into the imaginaries of agricultural crisis as they are articulated, negotiated and employed by farmers in Maharashtra. Based on twelve months of ethnographic research, the paper examines how ideas of crisis are entangled with colloquial understandings by taking experiences of 'tension', an Anglicised term used to express feelings akin to stress, as object of inquiry. I argue that by claiming crisis through invoking feelings of tension farmers mobilise a plurality of meanings, narratives and moral evaluations about what is wrong with agriculture in this part of India.

A revision of the pelomedusoid turtle Jainemys pisdurensis from the Late Cretaceous (Maastrichtian) Lameta Formation of India

BACKGROUND

Jainemys pisdurensis comb. nov. is an extinct pleurodiran turtle from the Late Cretaceous (Maastrichtian) of India, previously referred to Carteremys and Shweboemys. The holotype, an eroded skull, had been collected near the village of Pisdura, south of Nagpur, in Maharashtra State, while all referred shell material originates from coeval sediments exposed at the nearby village of Dongargaon. Initial estimates believed this turtle to either be an early representative of Podocnemididae or a basal representative of Pelomedusoides.

METHODS

We here figure and describe all specimens that had previously been referred to Jainemys pisdurensis comb. nov. We furthermore re-evaluate the validity of this fossil turtle and explore its phylogenetic relationships within Pleurodira.

RESULTS

The holotype of Jainemys pisdurensis comb. nov. displays a morphology that differs substantially from that originally reported. Most notably, the palatines only have a minor contribution to the broad triturating surfaces but have a broad midline contact with each other, the pterygoids only have a midline contact of intermediate length and do not contact the opisthotics posteriorly, the basisphenoid is broad and short, and the opisthotics do not contribute to the flooring of the cavum acustico-jugulare. The referred shell material also displays a morphology different from that reported originally, in particular in that vertebral I does not contribute to the anterior margin of the carapace while the nuchal does. Phylogenetic analysis places the cranial material within the bothremydid clade Kurmademydini, while the shell material is placed in an unresolved polytomy at the base of this clade. Jainemys pisdurensis is confirmed to be a valid species of pleurodiran turtle, but the high diversity of coeval kurmademydines in India demands removal of the postcranial remains from this taxon. The realization that all valid species of Late Cretaceous (Maastrichtian) turtles from India form a clade supports the hypothesis that India was physically separated from the rest of Gondwana at this time.

Kinetics of viral RNA, immunoglobulin-M & G antibodies in Kyasanur forest disease

Background & objectives:

Kyasanur forest disease (KFD) is an infectious disease discovered in Karnataka State of India in 1957; since then, the State has been known to be enzootic for KFD. In the last few years, its presence was observed in the adjoining five States of the Western Ghats of India. The present study was conducted to understand the kinetics of viral RNA, immunoglobulin M (IgM) and IgG antibody in KFD-infected humans for developing a diagnostic algorithm for KFD.

Methods:

A prospective follow up study was performed among KFD patients in Sindhudurg district of Maharashtra State, India. A total of 1046 suspected patients were tested, and 72 KFD patients were enrolled and followed for 17 months (January 2016 to May 2017). Serum samples of KFD patients were screened for viral RNA, and IgM and IgG antibodies.

Results:

KFD viral positivity was observed from 1^st to 18^th post-onset day (POD). Positivity of anti-KFD virus (KFDV) IgM antibodies was detected from 4^th till 122^nd POD and anti-KFDV IgG antibodies detected from 5^th till 474^th POD. A prediction probability was determined from statistical analysis using the generalized additive model in R-software to support the laboratory findings regarding viral kinetics.

Interpretation & conclusions:

This study demonstrated the presence of KFD viral RNA till 18^th POD, IgM antibodies till 122^nd POD and IgG till the last sample collected. Based on our study an algorithm was recommended for accurate laboratory diagnosis of KFDV infection. A sample collected between 1 and 3 POD can be tested using KFDV real-time reverse transcriptase polymerase chain reaction (RT-PCR); between 4 and 24 POD, the combination of real-time RT-PCR and anti-KFDV IgM enzyme-linked immunosorbent assay (ELISA) tests can be used; between POD 25 and 132, anti-KFDV IgM and IgG ELISA are recommended.