Pollution indices of selected metals in tea (Camellia sinensis L.) growing soils of the Upper Assam region divulge a non-trifling menace of National Highway

The study investigated the influence of a National Highway (NH) traversing tea estates (TEs) on heavy metal (HM) contamination in the top soils of Upper Assam, India. The dispersion and accumulation of six HMs, viz. cadmium (Cd), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), and zinc (Zn), within tea-growing soils were assessed using diverse indices: contamination factor (CF), degree of contamination (DC), enrichment factor (EF), geo-accumulation index (Igeo), modified degree of contamination (MDC), Nemerow pollution index (PINemerow), pollution load index (PLI), potential ecological risk factor (Eri), and potential ecological risk index (RI). The order of HM prevalence was Fe > Mn > Zn > Ni > Cu > Cd. Elevated Cd levels near the NH prompted immediate attention, while Cd and Zn showed moderate pollution in CF, EF, and RI. The remaining metals posed minimal individual risk (Eri< 40), resulting in an overall contamination range of "nil to shallow," signifying slight contamination from the studied metals. From MDC values for investigated metals, it was found to be "zero to very low degree of contamination" at all locations except the vicinity of NH. Soil pollution, as determined by PLI, indicated unpolluted soils in both districts, yet PINemerow values indicated slight pollution. The statistical analysis revealed that there is a significant decrease in most of the indices of HM as the distance from NH increases. The application of multivariate statistical techniques namely Principal Component Analysis and Cluster Analysis showed the presence of three distinct homogenous groups of distances based on different indices. This investigation underscores NH-associated anthropogenic effects on TE soil quality due to HM deposition, warranting proactive mitigation measures.

Prevalence of common mental disorders and treatment gap among patients with non-communicable diseases in the rural areas of East India

BACKGROUND

Mental and physical non-communicable diseases (NCDs) coexist, because they share common environmental and behavioral risk factors. The treatment gap for common mental disorders, such as depression, anxiety, and substance use, is large compared to other NCDs.

OBJECTIVE

To determine the prevalence and treatment gap of common mental disorders among patients with non-communicable diseases.

METHODOLOGY

The community-based cross-sectional study was conducted in the rural parts of East India, in people aged 30 years and older with NCDs. A simple random sample was chosen to select the villages and participants. Eligible participants administered with screening and diagnostic questionnaire for depression, anxiety, and substance use. Those diagnosed with mental disorders were again assessed for treatment status in the last 12 months. Non-receipt of treatment was considered as treatment gap.

RESULTS

A total of 515 participants were included in the analysis. The overall prevalence of common mental disorders among the study population was 46.4% (95% CI 42.0-50.8), and excluding substance use, the prevalence was 11.7% (95% CI 9.0-14.7). The treatment gap for common mental disorders among patients with non-communicable diseases, including and excluding substance use, was 98.3% (95% CI 95.8-99.5) and 93.3% (95% CI 83.8-98.2), respectively.

CONCLUSION

The prevalence and treatment gap of common mental disorders among persons with NCDs was high. Public health interventions need to be emphasized for the integration of mental health care into NCD care.

Genetic diversity, morphological traits, quality traits and antioxidants potentiality of Coccinia grandis germplasm under rainfed semi-arid region

The present study was conducted to evaluate the genetic variability for morphological and qualitative traits of Coccinia for development of trait specific lines at ICAR-Central Horticultural Experiment Station (CIAH-RS), Panchmahals (Godhra), Gujarat during 2020-2022. In this study, we evaluated 26 gynoecious accessions to assess the genetic divergence through principal component and cluster analysis. The experiment was carried out in a randomized complete block design with three replications under rainfed semi-arid conditions. High values of PCV and GCV were observed for variables such as NFFP (25.13 and 22.20), PL (23.14 and 20.69), FD (24.01 and 21.46), AFW (22.98 and 20.13), NFPY (26.38 and 24.40), FYP (37.57 and 31.29), FY (35.55 and 33.20), AsC (28.65 and 27.73), Ac (24.32 and 21.06), TSS (37.23 and 35.94), DPPHL (20.71 and 20.38), FRAPL (21.08 and 20.92), TPF(20.81 and 20.45) respectively. High heritability coupled with high genetic advance as per cent of mean was observed for vine length (VL), internodal length (IL), number of female flowers per plant (NFFP), fruit length (FL), peduncle length (PL), fruit diameter (FD), average fruit weight (AFW), number of fruit per plant per year (NFPY), fruit yield per plant (FYP), fruit yield (FY), ascorbic acid (AsC), acidity (Ac), total soluble solids (TSS), total phenols in leaves TPL), total flavonoids in leaves TFL, CUPRAC in leaves (CUPRACL), DPPH in leaves (DPPHL), FRAP in leaves (FRAPL), Total phenols in fruits (TPF), Total flavonoids in fruits (TFF), CUPRAC in fruits (CUPRACF) and DPPH in fruits (DPPHF). The FYP exhibited a significant positive correlation with variables like VL (0.6833), IL (0.2991), NFFP (0.8107), FD (0.5245), AFW (0.6766), NFPY (0.7659), ASC (0.4611), TSS (0.5004) and TPF (0.4281). The estimates of genetic parameters revealed scope for further improvement of fruit yield by selection. Of the eight principal components, PC-I through PC-VIII had eigen values greater than 1 and it accounts 85.02% of the total variation for 26 gynoecious accessions of Ivy gourd. The eigen values of PC-I comprised 5.775% of total variation followed by PC-II (4.250%), PC-III (3.175%), PC-IV (2.588%), PC-V (1.828%), PC-VI (1.447%), PC-VII (1.179%) and PC-VIII (1.013%).The cluster VI and cluster I having highest mean values for most of traits under study. Thus, genotypes from the distinct cluster like cluster VI and I for should be used for selection of parents and varietal improvement for further breeding programme in ivy gourd.

Effectiveness of peer-led intervention in control of non-communicable diseases in rural areas of Khordha district: study protocol for a cluster randomized controlled trial

BACKGROUND

The main contributors to death and disability from chronic illnesses in developing nations are elevated blood pressure (hypertension), blood sugar (diabetes mellitus), and blood cholesterol (dyslipidaemia). Even though there are affordable treatments, the treatment gap for these conditions is still significant. Few pilot studies from industrialized nations discuss the value of peer-led interventions for achieving community-level management of blood pressure and blood sugar. This study aims to evaluate the effectiveness of peer-led intervention compared to standard care in achieving control of selected non-communicable diseases (NCDs) in Indian context at 1 year of intervention among people of 30-60 years with hypertension and/or diabetes mellitus and/or dyslipidaemia.

METHODS

A cluster-randomized controlled trial will be conducted in villages of two rural blocks of the Khordha district of Odisha from August 2023 to December 2024. A total of 720 eligible participants (360 in the intervention group and 360 in the control group) will be recruited and randomized into two study arms. The participants in the intervention arm will receive a peer-led intervention model for 6 months in addition to standard care. The sessions will be based on the six domains of NCDs - self-care, follow-up care, medication, physical activity, diet, limiting substance use, mental health and co-morbidities. The mean reduction in blood pressure, HbA1C, and blood cholesterol in the intervention arm compared to the standard care arm will be the main outcome.

DISCUSSION

The increasing burden of NCDs demands for newer strategies for management. Peer-led interventions have proven to be useful at the international level. Incorporating it in India will have remarkable results in controlling NCDs.

TRIAL REGISTRATION

Clinical Trial Registry of India (CTRI) CTRI/2023/02/050022. Registered on 23 February 2023.

Degradation and metagenomic analysis of 4-chlorophenol utilizing multiple metal tolerant bacterial consortium

Chlorophenols are persistent environmental pollutants used in synthesizing dyes, drugs, pesticides, and other industrial products. The chlorophenols released from these processes seriously threaten the environment and human health. The present study describes 4-chlorophenol (4-CP) degradation activity and metagenome structure of a bacterial consortium enriched in a 4-CP-containing medium. The consortium utilized 4-CP as a single carbon source at a wide pH range, temperature, and in the presence of heavy metals. The immobilized consortium retained its degradation capacity for an extended period. The 4-aminoantipyrine colorimetric analysis revealed complete mineralization of 4-CP up to 200 mg/L concentration and followed the zero-order kinetics. The addition of glycerol and yeast extract enhanced the degradation efficiency. The consortium showed both ortho- and meta-cleavage activity of catechol dioxygenase. Whole genome sequence (WGS) analysis revealed the microbial compositions and functional genes related to xenobiotic degradation pathways. The identified genes were mapped on the KEGG database to construct the 4-CP degradation pathway. The results exhibited the high potential of the consortium for bioremediation of 4-CP contaminated sites. To our knowledge, this is the first report on WGS analysis of a 4-CP degrading bacterial consortium.

Research Note: Effect of dietary xylo-oligosaccharide on growth performance, intestinal histomorphology, and specific cecal bacteria in broiler chickens

This study was conducted to evaluate the prebiotic effect of xylo-oligosaccharide (XOS) supplemented in a corn-soybean meal (SBM) based conventional diet on growth performance, intestinal histomorphology, and quantification of specific bacteria in the ceca of broilers. A total of 240 d of hatch Cobb 500 male broiler chicks were randomly assigned to 4 dietary treatments (corn-SBM-based control diet) containing 0, 0.05, 0.1, and 0.2% XOS. The broilers were raised for 21 d in 6 replicate cages, each containing 10 birds. Growth performance parameters were obtained weekly. Additionally, small intestinal tissues were collected to evaluate histomorphometry and whole ceca were collected to quantify bacterial populations on D21. The results showed that inclusion of XOS has similar body weight (BW), body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) as the control group during the 21-day study. The results further indicate a tendency for the jejunum villus to crypt ratio (VH:CD) to increase in birds given 0.05 and 0.2% XOS (P = 0.08). Cecal bacteria quantification showed a linear increase in Bifidobacterium with increasing XOS levels (P < 0.0001) and a decrease Clostridium perfringens levels compared to birds fed the control diet (P < 0.0001). However, there were no differences in the total counts of Lactobacillus and E. coli. Together these results showed that while there were no differences in growth parameters up to 21 d, the histomorphology findings and the increase in Bifidobacterium, along with the reduction in C. perfringens observed in the XOS groups, suggest a beneficial impact of XOS inclusion on gut health. Further research with longer feeding periods and higher XOS levels should be conducted to explore potential positive effects on both growth and gut health parameters.

Correlation of severity & clinical outcomes of COVID-19 with virus variants: A prospective, multicentre hospital network study

BACKGROUND OBJECTIVES

The clinical course of COVID-19 and its prognosis are influenced by both viral and host factors. The objectives of this study were to develop a nationwide platform to investigate the molecular epidemiology of SARS-CoV-2 (Severe acute respiratory syndrome Corona virus 2) and correlate the severity and clinical outcomes of COVID-19 with virus variants.

METHODS

A nationwide, longitudinal, prospective cohort study was conducted from September 2021 to December 2022 at 14 hospitals across the country that were linked to a viral sequencing laboratory under the Indian SARS-CoV-2 Genomics Consortium. All participants (18 yr and above) who attended the hospital with a suspicion of SARS-CoV-2 infection and tested positive by the reverse transcription-PCR method were included. The participant population consisted of both hospitalized as well as outpatients. Their clinical course and outcomes were studied prospectively. Nasopharyngeal samples collected were subjected to whole genome sequencing to detect SARS-CoV-2 variants.

RESULTS

Of the 4972 participants enrolled, 3397 provided samples for viral sequencing and 2723 samples were successfully sequenced. From this, the evolution of virus variants of concern including Omicron subvariants which emerged over time was observed and the same reported here. The mean age of the study participants was 41 yr and overall 49.3 per cent were female. The common symptoms were fever and cough and 32.5 per cent had comorbidities. Infection with the Delta variant evidently increased the risk of severe COVID-19 (adjusted odds ratio: 2.53, 95% confidence interval: 1.52, 4.2), while Omicron was milder independent of vaccination status. The independent risk factors for mortality were age >65 yr, presence of comorbidities and no vaccination.

INTERPRETATION CONCLUSIONS

The authors believe that this is a first-of-its-kind study in the country that provides real-time data of virus evolution from a pan-India network of hospitals closely linked to the genome sequencing laboratories. The severity of COVID-19 could be correlated with virus variants with Omicron being the milder variant.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India

Introduction

Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors.

Materials and methods

An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done.

Results

367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics.

Conclusion

Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

Diagnostic accuracy of flow cytometry in detecting malignant epithelial cells in serous effusions

INTRODUCTION

This study aims to evaluate diagnostic accuracy of flow cytometry (FCM) in detecting malignant epithelial cells in serous effusions.

MATERIALS AND METHODS

Flow cytometric assessment of 96 serous fluids (86 ascitic, 10 pleural) was performed by using epithelial cell adhesion molecule (EpCAM) (in all 96 fluids) and MUC-1 (in a subgroup of 40 fluids) as epithelial markers and CD45 and CD14 as leucocyte markers. The percentage of EpCAM positivity and MUC-1 positivity was calculated in the CD14 and CD45 dual negative population by selective gating. The findings were then correlated with the defined gold standard criteria.

RESULTS

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for EpCAM was found to be 92.06%, 96.96%, 98.31%, 86.48%, and 93.75%, respectively, while that for MUC-1 was 79.16%, 93.75%, 95%, 71.4%, and 85%, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for dual positivity for EpCAM and MUC-1 was found to be 83.3%, 100%, 100%, 80%, and 90% respectively. On combining FCM with cytomorphology the sensitivity, specificity, PPV, NPV, and diagnostic accuracy all increased greatly to 95.3%, 100%, 100%, 91.4%, and 96.8%, respectively.

CONCLUSIONS

This study highlights the importance of multicolored flow cytometric analysis in detecting epithelial malignancies in effusions specially in cases belonging to the atypia of undetermined significance and suspicious for malignancy categories and in cases with strong clinical suspicion of malignancy with negative fluid cytology. We recommend the combined use of FCM and cytology for this specific subgroup of patients in routine clinical practice for fast and accurate reporting.

Genetic and molecular analysis of leaf blast resistance in Tetep derived line RIL4 and its relationship to genes at Pita/Pita2 locus

The Vietnamese indica landrace 'Tetep' is known worldwide for its durable and broad spectrum-resistance to blast. We performed genetic and molecular analyses of leaf blast resistance in a Tetep derived recombinant inbred line 'RIL4' which is resistant to both leaf and neck blast. Phenotypic analysis of segregating F2 progenies suggested that leaf blast resistance in RIL4 was controlled by a dominant gene tentatively designated as Pi-l(t). The gene was mapped to a 2.4 cm region close to the centromere of chromosome 12. The search for the gene content in the equivalent genomic region of reference cv. Nipponbare revealed the presence of five NBS-LRR genes, two of which corresponded to the alleles of Pita and Pi67 genes previously identified from Tetep. The two other genes, LOC_Os12g17090, and LOC_Os12g17490 represented the homologs of stripe rust resistance gene Yr10. The allelic tests with Pita2 and Pi67 lines suggested that the leaf blast resistance gene in RIL4 is either allelic or tightly linked to these genes. The genomic position of the leaf blast resistance gene in RIL4 perfectly coincided with the genomic position of a neck blast resistance gene Pb2 previously identified from this line suggesting that the same gene confers resistance to leaf and neck blast. The present results were discussed in juxtaposition with past studies on the genes of Pita/Pita2 resistance gene complex.

Anaesthetic Management and Physiologic Effects of Pneumoperitoneum in Patients With Chronic Obstructive Pulmonary Disease Undergoing Laparoscopic Cholecystectomy

OBJECTIVE

This study aimed to assess the physiological changes and clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) undergoing laparoscopic cholecystectomy.

METHODS

This prospective cohort study included 50 patients of the American Society of Anesthesiology (ASA) physical status I and II with mild to moderate COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I-II) scheduled for laparoscopic cholecystectomy. We monitored heart rate, mean arterial pressure, end-tidal carbon dioxide (EtCO2), arterial carbon dioxide (PaCO2), and bicarbonate (HCO3) levels at baseline, 30 minutes after induction or 15 minutes post-insufflation, 15 minutes post-deflation, and 60 minutes post-operative. Perioperative complications and post-operative recovery characteristics were also observed. Descriptive statistics were used to summarise the demographic and clinical characteristics of the patients. The correlation between HCO3 and EtCO2 was plotted on a scatterplot, and Pearson's correlation 'r' was calculated. The changes in physiological parameters over time were analysed using a paired t-test. A p-value of less than 0.05 is considered statistically significant.

RESULTS

We observed a statistically significant but transient increase in heart rate, mean arterial pressure, and EtCO2 at 30 minutes after induction or 15 minutes post-insufflation, which returned to baseline levels within 15 minutes of deflation. Similarly, arterial CO2 and bicarbonate levels were also significantly increased at 15 minutes post-insufflation, yet remained within the normal physiological range. The study reported no serious perioperative complications, and all patients had an uneventful recovery.

CONCLUSION

While patients with mild to moderate COPD can experience transient physiological changes during laparoscopic cholecystectomy, these changes are generally well-tolerated and not associated with adverse clinical outcomes. Therefore, laparoscopic cholecystectomy can be considered a safe procedure in these patients. Future research should focus on the implications and safety of this procedure in patients with severe COPD.

Change in Quality of Life after Stereotactic Body Radiation Therapy (SBRT) on a Prospective Trial of Peripheral Stage I or II Non-Small Cell Lung Cancer Predicts Survival

PURPOSE/OBJECTIVE(S)

We previously reported the results of a randomized, multi-institutional phase II clinical trial evaluating one versus three fractions of SBRT for peripheral Stage I to II non-small cell lung cancer (NSCLC). A secondary objective to compare quality of life (QOL) data and its association with survival outcomes is reported.

MATERIALS/METHODS

Medically inoperable patients with biopsy-proven peripheral T1-2N0M0 NSCLC were enrolled. Patients were randomized to 30 Gy in 1 fraction (arm 1) or 60 Gy in 3 fractions (arm 2) and stratified by performance status. QOL scores from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and EORTC QLQ Lung Cancer-Specific Module (EORTC QLQ-LC13) questionnaires were required at baseline and each follow-up visit. Univariate models were generated to evaluate associations between QOL scores and survival with 95% confidence intervals (CI) calculated at each time point.

RESULTS

Among 98 patients enrolled (49 in each arm), 88 patients had data available for QOL analysis. At 6 month follow up, patients with stable or decreased (n = 49) versus those with increased global QOL scores (n = 27) had worse progression-free survival (HR [Hazards' Ratio] 2.32 [CI, 1.14-4.73], p = 0.021) and overall survival (HR 2.13 [CI, 1.01-4.51], p = 0.048). Similar results persisted at the 12 month follow up for progression-free survival (HR 3.90 [CI, 1.52-10.04], p = 0.016) and overall survival (HR 3.25 [CI, 1.25-8.43], p = 0.016). Median overall survival for patients with stable or decreased global QOL versus increased global QOL at 6 month follow up was 39.0 vs 60.3 months (p = 0.032).

CONCLUSION

Change in QOL is an early predictor of survival following SBRT for patients with peripheral early-stage NSCLC.

Sinoatrial Node Irradiation in Patients Undergoing Definitive Stereotactic Body Radiation Therapy (SBRT) for Central Lung Cancers

PURPOSE/OBJECTIVE(S)

The clinical consequences of sinoatrial node (SAN) and atrioventricular node (AVN) irradiation in patients undergoing thoracic stereotactic body radiation therapy (SBRT) remains unclear. We examined the relationship between SAN and AVN dose with survival outcomes in patients with central non-small cell lung cancer (NSCLC) tumors.

MATERIALS/METHODS

A single-institutional retrospective review of patients with primary NSCLC undergoing definitive SBRT for centrally located tumors from February 2007 to December 2021 was performed. Central tumors were defined as within 2 cm of the proximal airway, mediastinum, great vessels, or spinal cord whereas ultracentral tumors were directly abutting any of the above structures. All patients underwent five-fraction SBRT to a total dose of 50 to 60 Gy. The SAN and AVN were contoured in accordance with a published contouring atlas and the maximum dose (Dmax) and mean dose (Dmean) for each structure were calculated. Sequential log rank testing between the 50th and 90th percentiles was used to identify potential cutoff values for the corresponding dosimetric parameters and non-cancer associated survival.

RESULTS

Among 93 eligible patients, the median age was 72.5 years (Inter-Quartile Range [IQR], 66.6-78.3), median follow up was 32.4 months (IQR, 13.0-49.6), and 48 patients were female (52%). There were 49 ultracentral tumors (53%) and the median planning target volume (PTV) was 31.0 cc (IQR, 18.0-53.3). The median SAN Dmax and Dmean were 95 cGy (IQR, 37-1,072) and 58 cGy (IQR, 26-641), respectively. The median AVN Dmax and Dmean were 45 cGy (IQR, 19-506) and 34 cGy (IQR, 15-160), respectively. Candidate cutoff values for SAN Dmax and Dmean were 1,309 cGy and 814 cGy, respectively. No significant cutoff values were identified for either AVN parameter. Kaplan-Meier analysis for the proposed SAN Dmean constraint was significantly associated with overall (p = 0.016) and non-cancer associated survival (p = 0.028). The SAN Dmax constraint was significantly associated with only overall survival (p = 0.029). In a multivariate model, the SAN Dmean cutoff significantly correlated with both overall (Hazard Ratio [HR] 2.1 [1.13-3.78], p = 0.019) and non-cancer associated survival (HR 2.39 [1.12-5.10], p = 0.025) whereas the SAN Dmax cutoff was only significantly associated with overall survival (HR 1.95 [1.03-3.68], p = 0.041).

CONCLUSION

SAN Dmax and Dmean were associated with significantly worse overall survival using cut-off values of 1,309 cGy and 814 cGy, respectively. SAN dose should be considered in radiation planning and further study on the consequence of SAN irradiation during SBRT is warranted.

Corrective and preventive actions (CAPAs) in eye bank

This case series highlights the challenges in eye banking and the importance of a quality assurance program. Three cases triggered corrective and preventive actions (CAPAs) to improve the processes. Case 1 emphasized training to prevent retrieval failures. Case 2 stressed the need for blood samples and comprehensive documentation. In Case 3, mishandling led to policy revisions and staff training. CAPA involved identifying concerns, root cause analysis, action plans, implementation, checks, and closure. Errors can occur in man, machinery, process, and policies. Continuous CAPA ensures continuous quality improvement and safe corneal tissue transplantation, benefiting patients in need.

Differential expression of genes during recovery of Nicotiana tabacum from tomato leaf curl Gujarat virus infection

MAIN CONCLUSION

Nicotiana tabacum exhibits recovery response towards tomato leaf curl Gujarat virus. Transcriptome analysis revealed the differential expression of defense-related genes. Genes encoding for cysteine protease inhibitor, hormonal- and stress-related to DNA repair mechanism are found to be involved in the recovery process. Elucidating the role of host factors in response to viral infection is crucial in understanding the plant host-virus interaction. Begomovirus, a genus in the family Geminiviridae, is reported throughout the globe and is known to cause serious crop diseases. Tomato leaf curl Gujarat virus (ToLCGV) infection in Nicotiana tabacum resulted in initial symptom expression followed by a quick recovery in the systemic leaves. Transcriptome analysis using next-generation sequencing (NGS) revealed a large number of differentially expressed genes both in symptomatic as well as recovered leaves when compared to mock-inoculated plants. The virus infected N. tabacum results in alteration of various metabolic pathways, phytohormone signaling pathway, defense related protein, protease inhibitor, and DNA repair pathway. RT-qPCR results indicated that Germin-like protein subfamily T member 2 (NtGLPST), Cysteine protease inhibitor 1-like (NtCPI), Thaumatin-like protein (NtTLP), Kirola-like (NtKL), and Ethylene-responsive transcription factor ERF109-like (NtERTFL) were down-regulated in symptomatic leaves when compared to recovered leaves of ToLCGV-infected plants. In contrast, the Auxin-responsive protein SAUR71-like (NtARPSL) was found to be differentially down-regulated in recovered leaves when compared to symptomatic leaves and the mock-inoculated plants. Lastly, Histone 2X protein like (NtHH2L) gene was found to be down-regulated, whereas Uncharacterized (NtUNCD) was up-regulated in both symptomatic as well as recovered leaves compared to the mock-inoculated plants. Taken together, the present study suggests potential roles of the differentially expressed genes that might govern tobacco's susceptibility and/or recovery response towards ToLCGV infection.

Health system factors related to COVID-19 mortality in Eastern India: Hospital-based cross-sectional study

Introduction

Mortality from coronavirus disease 2019 (COVID-19) pandemic has left footprints across all ages and socio-economic strata. The deaths because of COVID-19 are usually multi-factorial. The study aimed to assess the health system factors related to COVID-19-related deaths.

Materials and Methods

A hospital-based retrospective study was conducted at a tertiary care hospital of eastern India. A total of 272 COVID-19 deaths that occurred between April and November 2020 were investigated. Data were extracted from Medical Record Department, and telephonic interviews were conducted to assess the different delays related to death. Data were analysed using Statistical Package for Social Sciences. Travel time, travel distance, delay in testing, and delay in receiving quality care were presented as median with inter-quartile range.

Results

Complete information could be collected from 243 COVID deaths of the 272 deaths (89.3%). The duration of hospital stay was 1-7 days for 42% of the deceased. The median travel time was 120 min, and the median distance travelled was 60 km. The median time to receive first attention of health care workers was 10 minutes. There was hardly any delay in reporting of test results, whereas the median time from symptoms to test and the median time from symptoms to admission were 4 days each.

Conclusion

Health system factors related to death of COVID-19 need to be addressed to avoid the avoidable deaths during the pandemic situation. The resilience of the health system can be helpful in reducing death toll in a low-resource country like India.

CoWIN: The Future of Universal Immunization Program in India

CoWIN (Covid Vaccine Intelligence Network) is a web-based platform owned and operated by the Government of India for facilitating COVID-19 vaccination of the citizens. This project is considered a tremendous success, apparent from the sheer number of hassle-free and successful COVID-19 vaccinations. We believe that the CoWIN system is an ideal platform for capturing all the vaccine-related data in the Universal Immunization program (UIP) as well as providing an all-inclusive vaccine certificate in digital format. Advantages and challenges of upscaling the CoWIN system to include UIP and a vision statement of how this can be achieved are discussed in this article. We also enlist the state-level solutions currently in use for digital immunization records, which can serve as case studies for upscaling the CoWIN system.

Performance analysis of a serrated absorber plate solar air heater with paraffin wax storage

The study aims to examine the thermal performance of solar air heaters employing two different absorber plates under two different configurations. The experiments have been conducted in the summer climatic conditions of Moradabad City, India. A total of about 04 models of solar air heaters have been developed. The experimental investigation has been done using a flat-plate absorber and a serrated geometric absorber (with and without using the tested phase change material) to estimate the thermal performance. Notably, 03 different mass flow rates (i.e., 0.01 kg/s, 0.02 kg/s, and 0.03 kg/s) have been used to investigate the heat transfer coefficient, instantaneous efficiency, and daily efficiencies. Results of the study showed that Model-4 is the best among all the tested models that provide an average exhaust temperature of about 46 °C after sunset. The optimum daily average efficiency has been obtained at about 63% at 0.03 kg/s. The efficiency of a serrated plate-type SAH without using phase change material is about 23% higher than that of a conventional system, while it is about 19% higher than that of a conventional SAH using phase change material. Overall, the modified system is suitable for moderate-temperature applications, like agricultural drying and space heating.

Jute and kenaf carrier bags: an eco-friendly alternative to plastic bags in India

Increasing demand for shopping and packaging carrier bags has given rise to various issues relating to its disposal as well as to the overall environmental footprint and sustainability of the packaging materials. This study assesses the carbon footprint and life cycle environmental impacts of the production, usage, and disposal of low density polyethylene (LDPE) and two natural fibre carrier bags (jute and kenaf). Life cycle assessment study was conducted of all inputs and outputs, aggregated in the form of resources used and environmental emissions, extending from the production of raw materials to the final disposal of the product. The carbon footprint and GHG emissions of jute and kenaf carrier bags were estimated using the CO₂, N₂O, and CH₄ emissions coefficients of inputs. Research literature from life cycle impact assessment (LCIA) results was used to determine the effects of LDPE polyethylene packaging material. It was observed that the global warming potential (GWP) for the production of 1 kg of LDPE (100 micron) carrier bag (39.4 kg CO₂eq) is more than 490 times higher than jute and kenaf carrier bags. In general, LDPE materials have the greatest impact on the carbon footprint and resource depletion. The LDPE material also has the highest impacts on indicators of terrestrial ecotoxicity, photochemical oxidation, acidification, and eutrophication as compared to jute and kenaf fibres. Since jute and kenaf are natural fibres, they sequester a substantial quantity of carbon during their agricultural stages. As a result, greenhouse gas (GHG) emission emissions of jute and kenaf were found to be negative. Popularising the use of jute and kenaf products as alternatives to plastic in industrialised countries would benefit the reduction of plastic waste and its negative environmental effects. Additional production of jute and kenaf fibre, which are already available in major bast fibre producing countries like India and Bangladesh, could meet the demand for fibre-based carrier bags.

Tinospora cordifolia modulates the seminal parameters, leakage of intracellular enzymes and seminal antioxidants in equilibrated and cryopreserved semen of Sahiwal bulls

The present study was undertaken to assess the effects of stem extract of Tinospora cordifolia (Giloy or Guduchi) in the semen extender on seminal parameters, leakage of intracellular enzymes and antioxidants in semen of Sahiwal bull. A total of 48 ejaculates from four bulls were selected for the study. Spermatozoa of 25×10⁶ were incubated in 100, 300 and 500 μg of stem extract of Guduchi as Gr II, III and IV, respectively and pre-freeze and post-thaw semen samples were analysed for seminal parameters (motility, viability, total sperm abnormality; TSA, plasma membrane integrity; PMI, and acrosomal integrity; AcI), intracellular enzymes (aspartate aminotransferase; AST and lactate dehydrogenase; LDH) and seminal antioxidants (superoxide dismutase; SOD and catalase) in comparison with an untreated control group (Gr I). The results revealed that stem extract treated semen had significantly (p<0.05) higher motility, viability, PMI, AcI, SOD and catalase and had significantly (p<0.05) lower TSA, AST and LDH compared to those in untreated control group at pre-freeze and post-thaw stages. Semen treated with 100 μg stem extract /25×10⁶ spermatozoa had significantly (p<0.05) higher motility, viability, PMI, AcI, SOD and catalase and had significantly (p<0.05) lower TSA, AST and LDH compared to those in control, 300, and 500 μg treated groups at pre-freeze and post-thaw stages. Further, these seminal parameters and antioxidants were showing decreasing trend and TSA and leakage of intra-cellular enzymes were showing increasing trend from Gr II to Gr IV at pre-freeze and post-thaw stages. Thus, 100 μg/25×10⁶ spermatozoa were optimum or suitable dose for cryopreservation of Sahiwal bull semen. The study concluded that T. cordifolia stem extract 100 μg/25×10⁶ spermatozoa in the semen extender can be effectively utilized to reduce the oxidative stress and improve the pre-freeze and post-thaw seminal parameters in Sahiwal bull. However, further studies on effects of different concentrations of stem extract on in-vitro or in-vivo fertility trials are to be conducted to assess the impact of the stem extract supplementation in the semen extender on field pregnancy outcome in bovine species.

Association between Gestational Diabetes Mellitus and Postpartum Depression among Women in Eastern India: A Cohort Study

Background

The study was planned to evaluate the association between Gestational Diabetes Mellitus (GDM) and Postpartum Depression (PPD) in a rural population of Odisha, Eastern India.

Material and Methods

Pregnant women in the first trimester were recruited and followed up till six weeks of postpartum. Gestational Diabetes Mellitus was assessed with 75 grams glucose challenge test and PPD was assessed at six weeks after delivery with Edinburgh Postnatal Depression Scale. Statistical difference between variables was assessed using Chi-square test, Fischer's exact test, and unpaired T-test. Covariates were adjusted using bivariate and multivariate logistic regression to estimate the association between GDM and PPD.

Results

Out of 436 pregnant women recruited, 347 (89.6%) remained in the study. Prevalence of GDM was 13.9% (95% CI: 10.7-17.3) and PPD was 9.8% (95% CI: 6.6-12.9). Incidence of PPD in the GDM group was 14.58% (95% CI: 4.2-24.9) and in women without GDM was 9.06% (95% CI: 5.76-12.3). However, the association was not significant on multivariate logistic regression (Risk Ratio (RR) = 1.56, 95% C.I: 0.61-6.16; P-value = 0.35).

Conclusion

This study demonstrated that women with GDM were at higher risk of developing PPD suggesting that an "at risk" approach should be implemented for screening.

Structural and functional characterization of RNA dependent RNA polymerase of Macrobrachium rosenbergii nodavirus (MnRdRp)

Macrobrachium rosenbergii is a highly valued farmed freshwater species and its production has been affected globally by white tail disease caused by M. rosenbergii nodavirus (MrNV). MrNV is a single stranded positive sense RNA virus encoding RNA-dependent RNA polymerase (RdRp) for genome replication. Due to its essentiality for pathogenesis, it is an important drug target. The domain prediction of the complete sequence revealed the presence of two enzymatic regions namely methyl transferase and RdRp separated by transmembrane region. The predicted three-dimensional (3D) structure of MnRdRp using AlphaFold 2 shows that the structure is composed of three major sub-domains common for other polymerases namely fingers, palm and thumb. Structural similarity search revealed its similarity with other flaviviridea members especially with BVDV RdRp (BvdvRdRp). The structure of fingers and palm sub-domains is more conserved than the thumb sub-domain. A small α-helix named 'priming helix' having conserve Tyr was identified at position 829-833 with a potential role in de novo initiation. Analysis of electrostatic potential revealed that nucleotide and template channels are electropositive. Metal binding residues were identified as Asp599, Asp704 and Asp705. The α and β phosphates of incoming nucleotide interact with two Mn2+, Arg455 and Arg537. For recognition of 2'-OH of incoming rNTP, Asp604, Ser661 and Asn670 were identified which can form H-bond network with 2'-OH group. Docking study revealed that Dasabuvir can potentially inhibit MnRdRp. The study concluded that the overall structure and function of MnRdRp are similar to Flaviviridae polymerases and their inhibitors can work against this enzyme.Communicated by Ramaswamy H. Sarma.

Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India

Background

Acceptance of vaccines has been on a decline in recent times, with vaccine hesitancy being listed as one of the top 10 global health threats. This study analysed vaccine hesitancy and belief towards vaccination among caregivers of children aged below 5 years.

Methods

In this cross-sectional study, 196 caregivers of children aged 6 months to below 5 years who had attended an immunization clinic at a tertiary care institute of Eastern India from March to May 2019 were surveyed. Consecutive sampling was used to recruit eligible study participants. The survey assessed the attitudes of parents towards childhood vaccination by using the Vaccine Hesitancy Scale and their beliefs towards vaccination. Univariate analysis was performed to assess the association of various sociodemographic factors with vaccine hesitancy.

Results

Among the caregivers, most (48%) mothers were aged 26-35 years, literate and homemakers. Vaccine hesitancy was observed in 9.18% of the participants. Only the age of the child was significantly associated with vaccine hesitancy. Nearly half (48.5%) of the participants were concerned about the serious adverse effects of vaccines, and a third (30.6%) agreed that newer vaccines are associated with higher risks than the older ones. Caregivers felt that vaccines are no longer required for uncommon diseases.

Conclusion

Concerns regarding vaccine hesitancy are prevalent even among caregivers attending a tertiary care institute. Thus, additional studies are required to assess hesitancy in urban, rural, remote and inaccessible areas. Policymakers ought to conduct periodic assessments and implement necessary remedial measures for the long-term sustenance of the benefits of the national immunization programme.

Differential expression of inflammatory cytokines, prostaglandin synthases and secretory leukocyte protease inhibitor in the endometrium and circulation in different graded CEH-pyometra in bitch

Cystic endometrial hyperplasia (CEH)-pyometra (CEH-P) is one of the most common reproductive disorders in bitches, posing a risk to both future fertility and life. The aims of the current study were to elucidate the differential expression patterns of inflammatory mediators at transcript and protein levels in the endometrium and to assess the concentrations of key inflammatory mediators in the peripheral circulation of bitches with different graded CEH-P. A total of 25 client-owned intact mixed breed bitches of 3-10 years presented to the outpatient department of RVP-TVCC of the institute were considered for the study. Of which, 22 cases suggestive of pyometra and 3 cases of CEH obtained during routine elective ovariohysterectomy were subjected to histopathological examination. Uteri were categorized into CEH (n = 3), moderate CEH-P (mCEH-P, n = 9), severe CEH-P (sCEH-P, n = 6) and atrophic pyometra (AT-P, n = 7). A group of age matched (n = 12) bitches without pyometra served as control. Endometrial transcripts such as IL6, IL8, PTGS2, PGFS, and SLPI were expressed differentially in the CEH and CEH-P bitch. In addition, a strong immunoreactivity (IR) of IL6, IL8, PTGS2, and mPGES1 was recorded in the sCEH-P uterus, while expression of IL10 was noticed in AT-P. In circulation, serum IL6 was the most relevant marker with high sensitivity of 96.2% and specificity of 84.6% at a cut off concentration 8.5 pg/mL followed by SLPI with 95.2% sensitivity, and 84.6% specificity at cut off concentration of 1.3 ng/mL. Serum IL10, PGFM and SLPI concentration in the peripheral circulation were 1.5-2.23 fold higher in mCEH-P, 0.87-2.5 fold higher in sCEH-P and 2.9-3.5 fold higher in AT-P than that of control. It is concluded that monitoring the serum concentration of IL6, IL10 and SLPI would be useful adjunct to the established hematobiochemical parameters in the management of pyometra in the bitch with critical illness.

Noise survey of neonatal intensive care unit at a government tertiary-care centre

BACKGROUND

With technological advancement, Neonatal Intensive Care Units (NICU) have become noisier than ever. Studies have shown the detrimental effects of increasing noise in NICU on growing pre-term and sick neonates. The present study aimed to survey the amount of noise in one of the NICU blocks of a government tertiary care centre and explore ways to control it when dealing with these sick babies.

METHODS

A detailed noise survey was carried out, for February 2023, in one of the two blocks of NICU in a government tertiary-care centre. The noise measurements were performed using two "Sound Ear 3" noise meters. The analyses were done in Leq (equivalent continuous sound levels) A-weighted decibels (dBA).

RESULTS

The extracted data analysis revealed that the NICU block was exposed to a mean Leq of 67.78 dBA noise with a maximum of 89.0 dBA. There was a significant difference between the values noted in devices at different locations and across different periods. There were certain instances (57 and 42 for two devices) when there were sudden spikes in the noise levels beyond 80 dBA. It was also seen that noise was more than 65 dBA most of the time (72% and 66% for the two devices).

CONCLUSION

The noise survey carried out over one month revealed a considerable amount of noise in the NICU of a government tertiary-care centre. The study also explored ways such as environmental modification, human behavior modification, awareness programs, and neonatal-centered modifications to reduce the noise and lower its detrimental effects on the growth of neonates.

Hypothyroidism in Pregnancy: An Alarming Concern in a Rural Community of Eastern India

Introduction

Hypothyroidism exerts a multitude of effects on pregnant women and newborns. This study aimed to estimate the prevalence of hypothyroidism and its associated factors among pregnant women.

Material and Methods

This cross-sectional study was done at a community health center in Tangi, Eastern India. A total of 436 pregnant women ≤24 weeks gestation attending the ante-natal clinic were recruited by consecutive sampling after obtaining written informed consent. Those who were a known case of any psychiatric disorder and were not able to comprehend interview questions were excluded. Estimation of serum thyroid stimulating hormone levels was done at the central laboratory of the All India Institute of Medical Sciences, Bhubaneswar. Analysis was done using STATA 17.0 and presented as means or proportions. The association of hypothyroidism with various sociodemographic factors was analyzed with bivariate logistic regression.

Results

Mean age of the study participants was 23.9 years (SD: 3.65). About 31.4% of participants were found to have hypothyroidism. On bivariate logistic regression, the presence of hypothyroidism was not associated with any variable.

Conclusions

Hypothyroidism is widely prevalent in pregnant females in rural India. Screening of high-risk pregnant females followed by appropriate management is essential.

Association of Autonomic Balance With Phone Call Duration in Healthy Individuals

Background This study aimed to estimate the association of autonomic balance with the duration of phone calls in healthy individuals. Methodology A total of 30 subjects aged between 18 and 30 years without any established systemic disease and using mobile phones for more than five years with minimum daily usage of 30 minutes were included in this analytical study. Heart rate variability (HRV) was recorded using a three-channel physiograph (AD Instruments South Asia (India) Pvt. Ltd., New Delhi, India) with the software LabChart PROV8.1.8 with HRV Module version 2.0.3 for 10 minutes. Time domain parameters were recorded in terms of the standard deviation of normal to normal interval (SDNN), root mean square of successive differences between normal heartbeats (RMSSD), R-R intervals greater than 50 ms (pRR50), and mean heart rate (MHR), and frequency domain parameters were total power, low-frequency power (LF), high-frequency power (HF), and the ratio of low-frequency to high-frequency power (LF/HF). HRV was recorded three times in each subject that included baseline HRV, HRV during the use of a mobile phone, and HRV after the use of a mobile phone. Results A total of 30 subjects (14 males and 16 females) participated in this study. The mean age of participants was 31.93 ± 8.59 years (32.07 ± 9.87 years for males, and 31.81 ± 7.64 years for females). There were no findings of significant arrhythmia in any of the participants. There was a significant difference in pRR50 on comparing all three phases (p = 0.036). However, there was no significant variation in other parameters such as very low frequency (VLF, ms²), VLF (%), LF (ms²), LF (%), HF (ms²), HF (%), LF/HF, SDNN (ms), RMSSD (ms), Poincare plot standard deviation perpendicular to the line of identity (ms), Poincare plot standard deviation along the line of identity (ms), systolic blood pressure (mmHg), and diabolic blood pressure (mmHg) during, before, and after exposure to mobile phone calls. There was no significant difference in the value of all parameters between males and females (p < 0.05). Conclusions Mobile phone calls may influence HRV and autonomic balance. This change may be affected by the electromagnetic field and by speaking as well.

Effectiveness of COVID-19 vaccine (Covaxin) against breakthrough SARS-CoV-2 infection in India

India approved COVID-19 vaccine called Covaxin, developed by the Indian Council of Medical Research and Bharat Biotech Ltd. The primary objective of the study was to estimate the effectiveness of Covaxin in preventing breakthrough SARS-CoV-2 infection in healthcare workers (HCWs). A test-negative matched case-control study was conducted among HCWs of tertiary care hospital in Eastern India. Any HCW who tested positive for COVID-19 using RT-PCR during April and May 2021 was taken as the case. The HCWs who tested negative for COVID-19 by RT-PCR were considered as controls after matching with the date of testing and profession of the cases. Vaccination data were collected from the institution's vaccine database and recall. In case of discrepancy, it was confirmed from the CoWIN portal (cowin.gov.in). The sample size was 670 participants (335 pairs). Conditional logistic regression models were used to calculate the adjusted odds ratio for breakthrough SARS-CoV-2 infection. Vaccine effectiveness was calculated using the following formula: VE = (1-aOR) × 100%. Sensitivity analysis was done for effectiveness of Covaxin, excluding Covishield vaccination. The mean age of participants was 29.1 years (SD = 7.1), and the majority were males (55.2%). Among the study participants, 60% were completely vaccinated, 18.51% were partially vaccinated, and 21.49% were unvaccinated. After adjusting for age, gender, type of household and past history of COVID-19 disease in conditional logistic models, the vaccine effectiveness was 22% (aOR 0.78, 95% CI: 0.52-1.17; p = .233). Sensitivity analysis with Covaxin showed an effectiveness of 29% (aOR 0.71, 95% CI: 0.47-1.08; p = .114) for preventing breakthrough SARS-CoV-2 infection.

Range grasses to improve soil properties, carbon sustainability, and fodder security in degraded lands of semi-arid regions

Tropical grasses are the primary source of forage for livestock and a valuable resource for improving soil health and environmental sustainability in semi-arid regions. A study was carried out in a semi-arid region of central India to determine the short-term (6-year) impact of nine range grasses on soil physio-chemical and biological properties, carbon stock, and forage security. The experiment was carried out in a randomized block design with three replications. Results show that the majority of the grass roots were distributed in the upper soil layer (0-10 cm, 63.5-76.5 %), and then in the middle (10-20 cm, 21.3-25 %) and lower (20-30 cm, 2.2-11.5 %) layers. Perennial tussock grass (Heteropogon contortus (L.) P. Beauv. ex Roem. & Schult) had a higher root volume (2219 mm³), followed by Guinea grass [Megathyrsus maximus (Jacq.) B.K. Simon & S.W.L. Jacobs] (1860 mm³). A lower soil bulk density (BD, 1.11-1.23 g cm^-3), higher gravimetric water content (GMW, 14.0-17.8 %), and soil organic carbon (0.38-0.73 %) were recorded for grass-cultivated plots compared to the barren land (1.38 g cm^-3, 13.0 %, and 0.28 %, respectively). The perennial tussock grass and Guinea grass resulted in the highest soil microbial biomass carbon (SMBC, 70.1 mg kg^-1 soil) and enzyme activities (dehydrogenase, 17.09 μg TPF g^-1 day^-1 and fluorescein diacetate activity 4.94 μg fluorescein g^-1 h^-1). The considerable improvement in soil properties with minimal inputs resulted in a higher sustainable yield index and carbon sustainability index in plots planted with Guinea grass (0.9 and 89.29) and perennial tussock grass (0.89 and 71.61). Therefore, the cultivation of either Guinea grass or perennial tussock grass as an intercrop or sole crop in the semi-arid environment can be an ecologically sound strategy to improve soil health, C sequestration, and fodder supply.

Causes of death in patients with chronic kidney disease: insights from the ASCEND-D and ASCEND-ND cardiovascular outcomes trials

Background

There are limited contemporary data available regarding adjudicated causes of death in patients with chronic kidney disease (CKD). Prior studies have indicated that cardiovascular (CV) events are one of the most common causes of death among patients with CKD, with previous reports stating approximately 30% of patients died from CV causes [1]. Here, we report the adjudicated causes of death in two recently completed large-scale randomised controlled trials (RCTs) with ∼14,200 person years of follow-up: ASCEND-D [2] (median follow-up: 2.5 years; NCT02879305) and ASCEND-ND [3] (median follow-up: 1.9 years; NCT02876835). These trials investigated the safety and efficacy of daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), in correcting anaemia in patients with CKD.

Purpose

This study assessed the causes of death in patients with CKD in the ASCEND-D and ASCEND-ND trials.

Methods

ASCEND-D and ASCEND-ND were global, randomised, open-label, CV outcome trials in adult patients with CKD-related anaemia undergoing maintenance dialysis (ASCEND-D) or with pre-dialysis CKD (ASCEND-ND) who received daily oral daprodustat or conventional erythropoiesis-stimulating agents (ESAs). Cause of death was systematically and centrally adjudicated in a blinded fashion to the study treatment assignment by an independent committee.

Results

In ASCEND-D and ASCEND-ND, respectively, 2964 and 3872 patients were randomised, of which 92% and 97% completed the study. Baseline characteristics were well-balanced across treatment groups within each trial. Adjudicated causes of death for the ASCEND-D and -ND trials are shown in the Table. All-cause mortality was similar in patients treated with daprodustat as compared with those treated with conventional ESA in both the ASCEND-D and -ND trials. Overall mortality in the ASCEND-D and -ND trials was 20.0% and 15.5%, respectively, and CV causes accounted for approximately 30–40% of all deaths and infection accounted for 25–30% of all deaths in both trials.

Conclusion

Although CV events were the most common cause of death in the ASCEND-D and ASCEND-ND trials (30–40% of cases), the risk of death due to infection was also high, accounting for approximately 25–30% of all deaths across all study arms. Sudden death accounted for most CV deaths, particularly in the ASCEND-D trial. Infection as a cause of death was more frequent than previously reported in other RCTs or disease registries. Causes of death did not differ significantly between ASCEND-D and ASCEND-ND, or between treatments. However, as this is a selected population for a CV trial, it may not be representative of a real-life CKD population. Our results provide important data to inform the design of future studies in this population.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by GlaxoSmithKline. Medical writing support was provided Natasha Tracey, PhD (Ashfield MedComms, Macclesfield, UK) and was funded by GlaxoSmithKline.

Analysis of Lung Cancer Cases Presenting in Outpatient Department of University Hospital of Nepal

Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases.

Disparity in Relation to Covid-19 Preventive Behaviour and Associated Myths among Rural and Urban Residents of Lucknow: A Community Based Study

Introduction: For curbing Covid-19 disease, adequate knowledge, attitude, and practices of both rural and urban population for Covid-19 disease prevention is required along with busting of the associated myths. Objectives: To assess the Knowledge, Attitude and Practices of urban and rural residents of Lucknow district regarding covid-19 preventive behaviour and associated myths. Methodology: A community-based study was conducted among 420 rural and 421 urban residents of Lucknow. Multistage random sampling was done to select the study subjects. A pre-designed pretested semi-structured questionnaire was used to collect the information regarding the Knowledge, Attitude and Practices of the residents for covid-19 disease causes, prevention, and treatment. Further, KAP scoring was done to compare the two groups. Results: The mean age of the rural and urban residents was 31.48 ± 12.05 and 30.93 ± 11.96 years respectively. Only 40.4 % urban and 25.5 % rural people had correct knowledge about social distancing (p<0.0001). Knowledge regarding quarantine for covid-19 disease prevention was less among the urban residents (64.6%) as compared to rural (70.5%) (p=0.035). More than one-third (37.6%) of the rural resident believed in the myth that alcohol can prevent the covid-19 disease (p=0.003). 68.8 and 70.5 percent rural and urban residents had positive attitude towards the Indian government’ efforts in curbing the disease. Majority of the urban (90%) and rural (87.6%) residents wore mask when they went out. Only one-fourth of the urban (24.7%) and rural (22.9%) had correct practices for the duration of hand washing. Conclusion: The knowledge was more among the urban people, attitude and practices were almost similar among both the rural and urban residents while myths were more observed among the rural residents.

Intra- and interspecific comparison of protein polymorphism to establish genetic differentiation in two sympatric species of Drosophila: D. bipectinata and D. malerkotliana

Drosophila bipectinata species complex includes four monophyletic closely related sympatric species with perfect reproductive isolation in natural conditions. Among these, two species, i.e., D. bipectinata and D. malerkotliana are known to be more prevalent in their occurrence all along their distribution area of Oriental-Australian regions. Genetic characteristics of these two species have been studied by earlier researchers mainly by focusing on their chromosomal polymorphism to gain knowledge pertaining to their evolutionary trend. The present work is one step farther, as we considered isozyme variants of three polymorphic enzymes to envisage genetic differentiation among the different natural populations of these two species, along with, a comparative perusal of their certain population genetic parameters. Natural populations of these two species were sampled from eight places aligned on the north-south axis of India and were subjected to isozyme analysis. The collection of both species and the geographical locations were kept same to avoid the effect of temporal or seasonal factors on the distribution of their allelic frequency. The results of this study clearly indicate that there is intraspecific genetic structuring among the populations of both the species with a distinct steady increase in the level of heterozygosity from north to south. The evolutionary tree in the form of dendrogram depicts two genetically differentiated groups of natural populations, one for north and other for South India. Most essential aspect that has been noticed through this study is the evolutionary trend of these two sympatric species being largely similar all along the north-south axis of India.

Molecular mapping of QTLs for grain dimension traits in Basmati rice

Basmati rice is known for its extra-long slender grains, exceptional kernel dimensions after cooking, high volume expansion, and strong aroma. Developing high yielding Basmati rice varieties with good cooking quality is a gigantic task. Therefore, identifying the genomic regions governing the grain and cooked kernel dimension traits is of utmost importance for its use in marker-assisted breeding. Although several QTLs governing grain dimension traits have been reported, limited attempts have been made to map QTLs for grain and cooked kernel dimension traits of Basmati rice. In the current study, a population of recombinant inbred lines (RIL) was generated from a cross of Sonasal and Pusa Basmati 1121 (PB1121). In the RIL population, there was a significant positive correlation among the length (RRL: rough rice length, MRL: milled rice length, CKL: cooked kernel length) and breadth (RRB: rough rice breadth, MRB: milled rice breadth and CKB: cooked kernel breadth) of the related traits, while there was significant negative correlation between them. QTL mapping has led to the identification of four major genomic regions governing MRL and CKL. Two QTLs co-localize with the earlier reported major gene GS3 and a QTL qGRL7.1, while the remaining two QTLs viz., qCKL3.2 (qMRL3.2) and qCKL4.1 (qMRL4.1) were novel. The QTL qCKL3.2 has been bracketed to a genomic region of 0.78 Mb between the markers RM15247 and RM15281. Annotation of this region identified 18 gene models, of which the genes predicted to encode pentatricopeptides and brassinosteroid insensitive 1-associated receptor kinase 1 precursor may be the putative candidate genes. Furthermore, we identified a novel QTL qKER2.1 governing kernel elongation ratio (KER) in Basmati rice.

Clinico-Epidemiological Characteristics of Healthcare Workers with SARS-CoV-2 Infection during the First and Second Waves in a Teaching Hospital from Eastern India: A Comparative Analysis

In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82, p < 0.001)]. Although, the prevalence of SARS CoV-2 infection and risk of being symptomatic was higher during second wave, the risk of hospitalization was less when compared with the first wave.

Effect of treatment interruptions and outcomes in cancer patients undergoing radiotherapy during the first wave of COVID-19 pandemic in a tertiary care institute

Introduction

COVID-19 patients with cancer had poorer outcomes due to immunosuppression during cancer care, poor general condition, and other comorbidities. The study was conducted to present the real-world analysis of the effect of treatment interruptions on the outcomes of patients treated with radiation therapy during the first wave of the COVID-19 pandemic in a tertiary care institute in India.

Materials and methods

The study is a retrospective observational cohort study on cancer patients undergoing radiation therapy from March 2020 to January 2021. The study’s primary outcome was to analyze the effect of treatment interruptions on the outcomes of patients treated with radiation therapy during the first wave of COVID-19 pandemic.

Results

Between March 2020 to January 2021, 218 eligible patients undergoing radiation therapy were found for the study. Among the 218 patients, 25 patients (11.47%) were found positive for COVID-19, while 193 patients (88.53%) were negative for COVID-19. Among COVID-19-positive patients, ten patients had < 3 weeks of treatment interruption, while 15 patients had > 3 weeks of treatment interruptions. After recovering from COVID-19, treatment was resumed and completed for 15 (60.00%) of the COVID-19-positive patients. In comparison, 13 patients (52.00%) were lost to follow-up. Three of the COVID-19-positive patients died. The disease was clinically controlled in 12 (48.00%) of the COVID-19-positive patients, and the patients reported locoregional disease progression in 10 (40.00%). Among the 193 COVID-19-negative patients, 32 patients (16.58%) had treatment interruption. Twelve patients (37.50%) had treatment interruptions for less than 1 week. There was a significant difference in the delay of radiation treatment delivery by 2 weeks (11 fractions) in COVID-19-positive patients compared to only two fractions delay in COVID-19-negative patients.

Conclusion

COVID-19 impacted the treatment outcomes in both COVID-19-positive and COVID-19-negative cohorts of patients. There was a longer duration of treatment interruptions in the COVID-19-positive patients, leading to fewer patients completing the radiation treatment and thereby increased locoregional disease progression. There was a significant difference in the delay in treatment between the two groups.

The Cut-off Value of Great Saphenous Vein Diameter at the Level of Femoral Condyle to Predict the Sapheno-Femoral Junction Incompetence

Background Varicose vein is one of the commonest problems that patients visit to a vascular out patient services (OPD). It causes a great deal of morbidity in today's population. Objective To see the correlation between the size of great saphenous and Saphenofemoral junction incompetence. Method From January 2019 till January 2020, 396 patients with symptomatic or clinically diagnosed varicose veins were screened for Saphenofemoral junction reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral measurements. Best saphenous vein diameter cutoff for predicting reflux was determined using receiver operating characteristics curve analysis. Result Out of 792 limbs, the Great Saphenous Venous System was involved in 452 limbs, the Short Saphenous Venous System was involved in 151 limbs and significant perforators were present in 240 limbs. Mean great Saphenous Vein diameter of diseased limb (Reflux Positive) was 5.68 mm and 4.0 mm in control group (Reflux Negative). Mean Saphenofemoral junction diameter was 8.23 mm in diseased limbs and 6.16 mm in control limbs. Receiver operating characteristics curve showed great saphenous vein diameter at femoral condyle of 4.5 mm as best cut-off value for diagnosis of sapheno femoral junction reflux. Conclusion Great Saphenous Vein diameter at femoral condyle of 4.5 mm is the best cut-off value for diagnosis Saphenofemoral junction reflux. The Sensitivity and specificity of this cut off value is 81.8% and 71% respectively.

Time management governs climate resilience and productivity in the coupled rice-wheat cropping systems of eastern India

India will need to produce 30% more wheat by 2050, and these gains must principally come from intensification in eastern India where low productivity is common. Through a dense network of on-farm surveys for the rice-wheat system in this region, we show that contemporary wheat sowing dates have a central influence on achieved and attainable yields, superseding all other crop management, soil and varietal factors. We estimate that untapped wheat production potential will increase by 69% with achievable adjustments to wheat sowing dates without incurring undesirable trade-offs with rice productivity, irrigation requirements or profitability. Our findings also indicate that transformative gains in wheat yields are only possible in eastern India if rice and wheat are managed as a coupled system. Steps taken to 'keep time' through better management of the annual cropping calendar will pay dividends for food security, profitability and climate resilience now and as a foundation for adaptation to progressive climate change.

Genome-Wide Association Mapping Reveals Novel Putative Gene Candidates Governing Reproductive Stage Heat Stress Tolerance in Rice

Temperature rise predicted for the future will severely affect rice productivity because the crop is highly sensitive to heat stress at the reproductive stage. Breeding tolerant varieties is an economically viable option to combat heat stress, for which the knowledge of target genomic regions associated with the reproductive stage heat stress tolerance (RSHT) is essential. A set of 192 rice genotypes of diverse origins were evaluated under natural field conditions through staggered sowings for RSHT using two surrogate traits, spikelet fertility and grain yield, which showed significant reduction under heat stress. These genotypes were genotyped using a 50 k SNP array, and the association analysis identified 10 quantitative trait nucleotides (QTNs) for grain yield, of which one QTN (qHTGY8.1) was consistent across the different models used. Only two out of 10 MTAs coincided with the previously reported QTLs, making the remaing eight novel. A total of 22 QTNs were observed for spikelet fertility, among which qHTSF5.1 was consistently found across three models. Of the QTNs identified, seven coincided with previous reports, while the remaining QTNs were new. The genes near the QTNs were found associated with the protein–protein interaction, protein ubiquitination, stress signal transduction, and so forth, qualifying them to be putative for RSHT. An in silico expression analysis revealed the predominant expression of genes identified for spikelet fertility in reproductive organs. Further validation of the biological relevance of QTNs in conferring heat stress tolerance will enable their utilization in improving the reproductive stage heat stress tolerance in rice.

Whey removal characteristics during conventional production of chhana

Whey removal phenomena generally studied in terms of whey removal rate, chhana weight and moisture content during chhana production process. Despite all these above factors, moisture content concerned to be the important one to maintain its soft texture and suitability for manufacturing of diversified products. The present study was undertaken to identify best model to express whey draining process so as to predict the relevant characteristics such as moisture ratio, moisture content and moisture removal rate. Whey removal rate was pursued for different cow milk quantities (5, 10, 15 and 20 kg) using delayed straining technique for gravimetric removal of whey from the chhana mass. Among the mathematical models, Logarithmic model was found best in describing the whey draining characteristics and predicting the moisture ratio of chhana. Whey removal characteristics provides important insights for the development of equipments for chhana production, downstream processing equipments for whey and online sensors for monitoring the process that regulates the moisture content and final quality of chhana and chhana based products. The novelty of the work lied on the incorporation of mathematical modeling to the chhana production process.

Understanding Community Participation in Rural Health Care: A Participatory Learning and Action Approach

Community participation is one of the founding pillars of primary health care. However, due to various reasons, we are yet to achieve complete integration of this component into the health system functioning in India. The objective of our study was to do a formative assessment of community participation in a rural healthcare setting by adopting participatory learning action (PLA). technique. The study participants included frontline health workers and members from local governing institutions of rural areas. The study design is qualitative in nature with a participatory approach. A number of three PLA techniques have been used as a part of this study to recognize available resources for community participation, address its barriers and facilitators, and finally devise a time-line-based action plan. Based on the this, a conceptual framework for community participation pertaining to the rural healthcare system has been developed. This study highlights the importance of understanding the psychosocial aspects of community participation among various stakeholders involved in rural health care. Lessons learned from this PLA study will be helpful in the integration of community-based participatory approach within grassroot level healthcare planning and service delivery.

Assessing the impact of current tropospheric ozone on yield loss and antioxidant defense of six cultivars of rice using ethylenediurea in the lower Gangetic Plains of India

Climate change influences the current tropospheric ozone (O₃) budget due to industrialization and urbanization processes. In recent years, the impact of elevated O₃ on crop development and yield loss has emerged as one of the most important environmental issues, particularly in rural and suburban areas of the lower Indo-Gangetic Plains of India. The impact of the current tropospheric ozone (O₃) on the crop yield, photosynthetic yield, and enzymatic antioxidants of six rice (Oryza sativa L.) cultivars (IR 36, MTU 1010, GB 3, Khitish, IET 4786, and Ganga Kaveri) was investigated with and without the application of ethylenediurea (EDU). The results revealed that O₃ stress significantly affected crop yield, photosynthetic yield, and antioxidant enzymes. The findings showed that O₃ toxicity induces oxidative stress biomarkers, i.e., malondialdehyde (MDA) content, and was manifested by increasing the enzymatic antioxidants, i.e., superoxidase dismutase (SOD) and catalase (CAT) in four rice cultivars (IR 36, GB 3, IET 4786, and Ganga Kaveri). At the same time, the results also illustrated that the rice cultivars MTU 1010 and Khitish are more tolerant to O₃ stress as they had less oxidative damage, greater photosynthetic SPAD value, SOD and CAT activities, and lower MDA activity. The results also elucidated that the application of EDU decreased O₃ toxicity in sensitive cultivars of rice by increasing antioxidant defense systems. The current O₃ level is likely to show an additional increase in the near future, and the use of tolerant genotypes of rice may reduce the negative impacts of O₃ on rice production.

Adverse events following immunization of COVID-19 (Covaxin) vaccine at a tertiary care center of India

The study aimed to assess the adverse events following COVID-19 vaccine (Covaxin) immunization at a tertiary care institution and also assess the predictors of the adverse events following immunization (AEFI). The prospective observational study was conducted in a tertiary care institute among the Covaxin beneficiaries between June 28 and September 6, 2021. A total of 1826 participants were assessed for any local or systemic adverse events after seven days of vaccination. A telephonic interview was conducted, and the beneficiaries were assessed according to the adverse event grading. A total of 1826 participants were assessed for AEFI, and 544 (29.8%) reported at least one of the AEFI. No severe adverse events were reported, and about 1.6% had moderate AEFI. Pain at the injection site (14.6%), fever (9.7%), and myalgia (5.9%) were the common adverse events reported by the participants. AEFI incidence was higher in the first dose (38.1%) when compared to the second dose (26.4%), and this finding was significant with a p < 0.001. The major factors associated with AEFI were female sex, history of an allergic reaction, presence of comorbidities, acute infection in the past 3 months, and intake of chronic medications. Precaution needs to be taken while vaccinating individuals having allergies, comorbidities, acute infection in the last 3 months, and individuals on chronic medication.