Time to Attain Full Enteral Feeds Among Preterm Fetal Growth Restricted Neonates With Absent/Reversed End-Diastolic Flow

OBJECTIVES

To determine the difference in time to attainment of full enteral feeds between fetal growth restricted (FGR) preterm neonates with and without absent/reversed end-diastolic flow (AREDF). Secondary objectives were to compare the short-term outcomes including the incidence of necrotizing enterocolitis (NEC) and feed intolerance between the two groups and to determine the factors affecting the time to attainment of full enteral feeds (FEF) among preterm FGR neonates.

METHODS

A prospective cohort study was conducted among consecutive preterm FGR neonates delivered at 28-36 weeks gestation admitted in level III NICU. An umbilical artery doppler ultrasound was performed antenatally for all participants to detect AREDF. FGR neonates with AREDF were taken as the study group and those without AREDF were taken as the comparison group. Time to attain FEF was defined as time taken to establish enteral feeds of 150 ml/kg/day and tolerating it for the next 3 consecutive days. Delayed attainment of FEF was taken as ≥10 days needed to attain FEF.

RESULTS

The median (IQR) time to attainment of full feeds was longer among neonates with AREDF compared to those without AREDF [12 (8, 16.5) vs 8 (5, 10) days; P < 0.001]. Neonates with AREDF had more feed intolerance [RR, 95% CI = 1.51 (1.13 - 2.02); P = 0.004], higher mortality [RR, 95% CI = 2.5 (1.02 - 6.2); P = 0.036], prolonged time to regain birth weight [15 (11.5, 19) days, P = 0.035], longer NICU stay [10 (7, 15), P < 0.001] and longer hospital stay [33 (23, 49), P < 0.001]. Also, neonates with AREDF had more hypoglycemia [RR, 95% CI=2.15 (1.2-3.7); P = 0.004], hypoxic ischemic encephalopathy [RR, 95% CI 5.05 (1.13 - 22.4); P = 0.016], hypothyroidism [RR, 95% CI= 8.08 (1.02 - 63.4), P = 0.016], cholestasis (P = 0.007), prolonged parenteral nutrition requirement [10 (7, 15) days, P < 0.001] and oxygen requirement [4.5 (2, 8) days, P < 0.001]. Multivariable logistic regression showed, AREDF [aOR 95% CI 2.91 (1.49 - 5.68), P = 0.002], lower gestational age [aOR 95% CI 0.724 (0.604 - 0.867), P < 0.001] and thrombocytopenia at birth [aOR 95% CI 2.625 (1.342 - 5.136), P = 0.005] are significant predictors of delayed attainment of full feeds among preterm FGR neonates.

CONCLUSION

Preterm FGR neonates with AREDF are slower to attain FEF, have more feed intolerance, higher mortality, need longer time to regain birth weight, prolonged NICU stay and hospital stay. AREDF, lower gestation, sepsis and thrombocytopenia at birth are significant predictors of delayed full feed attainment among preterm FGR neonates. It is essential to devise strategies to reduce morbidity and mortality among this group of preterm neonates.

Time to Attain Full Enteral Feeds Among Preterm Fetal Growth Restricted Neonates With Absent/Reversed End-Diastolic Flow

OBJECTIVES

To determine the difference in time to attainment of full enteral feeds between fetal growth restricted (FGR) preterm neonates with and without absent/reversed end-diastolic flow (AREDF). Secondary objectives were to compare the short-term outcomes including the incidence of necrotizing enterocolitis (NEC) and feed intolerance between the two groups and to determine the factors affecting the time to attainment of full enteral feeds (FEF) among preterm FGR neonates.

METHODS

A prospective cohort study was conducted among consecutive preterm FGR neonates delivered at 28-36 weeks gestation admitted in level III NICU. An umbilical artery doppler ultrasound was performed antenatally for all participants to detect AREDF. FGR neonates with AREDF were taken as the study group and those without AREDF were taken as the comparison group. Time to attain FEF was defined as time taken to establish enteral feeds of 150 ml/kg/day and tolerating it for the next 3 consecutive days. Delayed attainment of FEF was taken as ≥10 days needed to attain FEF.

RESULTS

The median (IQR) time to attainment of full feeds was longer among neonates with AREDF compared to those without AREDF [12 (8, 16.5) vs 8 (5, 10) days; P < 0.001]. Neonates with AREDF had more feed intolerance [RR, 95% CI = 1.51 (1.13 - 2.02); P = 0.004], higher mortality [RR, 95% CI = 2.5 (1.02 - 6.2); P = 0.036], prolonged time to regain birth weight [15 (11.5, 19) days, P = 0.035], longer NICU stay [10 (7, 15), P < 0.001] and longer hospital stay [33 (23, 49), P < 0.001]. Also, neonates with AREDF had more hypoglycemia [RR, 95% CI=2.15 (1.2-3.7); P = 0.004], hypoxic ischemic encephalopathy [RR, 95% CI 5.05 (1.13 - 22.4); P = 0.016], hypothyroidism [RR, 95% CI= 8.08 (1.02 - 63.4), P = 0.016], cholestasis (P = 0.007), prolonged parenteral nutrition requirement [10 (7, 15) days, P < 0.001] and oxygen requirement [4.5 (2, 8) days, P < 0.001]. Multivariable logistic regression showed, AREDF [aOR 95% CI 2.91 (1.49 - 5.68), P = 0.002], lower gestational age [aOR 95% CI 0.724 (0.604 - 0.867), P < 0.001] and thrombocytopenia at birth [aOR 95% CI 2.625 (1.342 - 5.136), P = 0.005] are significant predictors of delayed attainment of full feeds among preterm FGR neonates.

CONCLUSION

Preterm FGR neonates with AREDF are slower to attain FEF, have more feed intolerance, higher mortality, need longer time to regain birth weight, prolonged NICU stay and hospital stay. AREDF, lower gestation, sepsis and thrombocytopenia at birth are significant predictors of delayed full feed attainment among preterm FGR neonates. It is essential to devise strategies to reduce morbidity and mortality among this group of preterm neonates.

Is green FinTech reshaping the finance sphere? Unravelling through a systematic literature review

The revolutionary and transformative potential of FinTech has led to the Green Digital Finance Alliance, noting the dawn of a new era of FinTech-"the green FinTech", yet, surprisingly, the scholarly exploration surrounding climate finance in general and green FinTech and climate FinTech remains restrained. In our attempt to decode the intricate interlinkage between green finance and FinTech, the study wrestles with the theoretical complexity of the "green FinTech" concept through a systematic review of relevant studies and conceptual mapping. We develop a comprehensive grasp of the concept, how to leverage it to combat the pressing climate crisis, and its implications for the FinTech segment-the first of its kind in the scanty green FinTech literature. Based on the PRISMA analysis, we find that green FinTech promotes a green economy through its manifold impact on all aspects of the finance sphere, thereby channelling climate finance and promoting sustainability. It has the power to heighten inclusivity, disclosure, trust, and democratisation, thus reducing information asymmetry and greenwashing. Hence, FinTech integration can be game-changing in eliminating the hurdles before conventional green finance. However, the literature remains fragmented, along with a young, growing green FinTech market. Therefore, this study proposes a framework for future researchers by providing a holistic research agenda to fully integrate "green FinTech" into practical real-world applications.

Detection of COVID-19 Cases from Chest X-Rays using Deep Learning Feature Extractor and Multilevel Voting Classifier

Purpose: During the current pandemic scientists, researchers, and health professionals across the globe are in search of new technological methods for tackling COVID-19. The magnificent performance reported by machine learning and deep learning methods in the previous epidemic has encouraged researchers to develop systems with these methods to diagnose COVID-19.

Methods: In this paper, an ensemble-based multi-level voting model is proposed to diagnose COVID-19 from chest x-rays. The multi-level voting model proposed in this paper is built using four machine learning algorithms namely Random Forest (RF), Logistic Regression (LR), Support Vector Machine (SVM) with a linear kernel, and K-Nearest Neighbor (KNN). These algorithms are trained with features extracted using the ResNet50 deep learning model before merging them to form the voting model. In this work, voting is performed at two levels, at level 1 these four algorithms are grouped into 2 sets consisting of two algorithms each (set 1 — SVM with linear kernel and LR and set 2 — RF and KNN) and intra set hard voting is performed. At level 2 these two sets are merged using hard voting to form the proposed model.

Results: The proposed multilevel voting model outperformed all the machine learning algorithms, pre-trained models, and other proposed works with an accuracy of 100% and specificity of 100%.

Conclusion: The proposed model helps for the faster diagnosis of COVID-19 across the globe.

Factors Associated with Pulse Methylprednisolone Treatment Failure in COVID-19-Related Multisystem Inflammatory Syndrome in Children (MIS-C)

Objective This article determines the occurrence and variables associated with pulse methylprednisolone treatment failure in children with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C).

Methods This prospective observational study was undertaken at a tertiary care teaching hospital in Kerala, India. Children admitted with COVID-19-related MIS-C who were treated with pulse methylprednisolone as first-line therapy were included in the study. Depending on the response to the treatment, they were divided into two groups. The clinical, laboratory parameters, and follow-up findings at 3 months were compared between the two groups

Results Seventy-six patients were admitted with MIS-C during the study period. Sixty received pulse methylprednisolone as the first-line therapy. Of the 60 patients who received pulse methylprednisolone, 50 responded to treatment, while 10 required repeat immunomodulation. Need for noninvasive or invasive ventilation (relative risk [RR]: 13.14, 95% confidence interval [CI]: 3.147–54.88), six or more organ involvement (RR: 4.667, 95% CI: 1.349–16.149), thrombocytopenia (RR: 6.43, 95% CI: 0.87–47.6, p 0.003), and abnormal chest X-ray findings at admission (RR: 4.5, 95% CI: 1.46–13.8), were found to be associated with increased risk of treatment failure with pulse methylprednisolone therapy. Note that 88% of patients with coronary artery involvement showed resolution at 3-month follow-up.

Conclusion More than 80% of children with MIS-C can be treated successfully with corticosteroids. The need for ventilator support, abnormal chest X-ray findings, and thrombocytopenia at admission were found to be factors associated with pulse methylprednisolone treatment failure.

An integrated approach for the characterization of groundwater quality using multivariate statistical techniques and spatial analysis

ABSTRACT. Ground water accessed via wells in areas of Tiruvallur district of the southern Indian state of Tamil Nadu has been a subject to increase sea-water intrusion. The present study highlights the potable water crisis in the northern district evaluated using GIS-assisted determination of water quality parameters across fifty sampling sites. The most informative parameters evaluated within this study were TDS, EC, TH, Na+, Mg2+, Ca2+, Cl- and SO42- while parameters such as pH, CO32-, etc. had limited correlated significance to water quality. The total dissolved solids (TDS) and electrical conductivity (EC) determined in the study area indicated significantly elevated levels across the sampling sites. Weighted arithmetical indexing (WAI) of the water quality parameters indicated 30 out of 50 water sources meet the tolerance limits for both drinking and irrigation. Based on BIS standards, only 13 sites met acceptable limits for safe drinking water. Principal component analysis and piper plot analysis revealed a significant involvement of Mg2+, Na+, Cl- and SO42- in the impairment of water quality, particularly in the coastal zones. Spatial hydro-chemical profiles developed in this study reveal ‘hot-spots’ of sea-water tainted water sources, and the hydro-chemical dominance of alkali earth components. Altogether, the study findings indicate a widening water crisis on top of over-exploited water resources and discuss possible factors and remedial steps in addressing the situation.   KEY WORDS: Ground water, Principal component analysis, Piper Plot, Water quality index, Irrigation suitability   Bull. Chem. Soc. Ethiop. 2022, 36(2), 241-260.                                                           DOI: https://dx.doi.org/10.4314/bcse.v36i2.1                                                        

An Efficient Steganalysis of Medical Images by Using Deep Learning Based Discrete Scalable Alex Net Convolutionary Neural Networks Classifier

Steganalysis is the technique that tries to beat steganography by detecting and removing secret information. Steganalysis involves the detection of a message embedded in a picture. Deep Learning (DL) advances have offered alternative approaches to many difficult issues, including the field of image steganalysis using deep-learning architecture based on convolutionary neural networks (CNN). In recent years, many CNN architectures have been established that have enhanced the exact identification of steganographic images. This work presents a novel architecture which involves a preprocessing stage using histogram equalization and adaptive recursive median filter banks to reduce image noise, a feature extraction stage using shearlet multilinear local embedding methods and then finally the classification can be done by using the discrete scalable Alex NET CNN classifier. Performance was evaluated on the RGB-BMP Steganalysis Dataset with different experimental setups. To prove the effectiveness of the suggested algorithm it can be compared with the other existing methodologies. This work improves classification accuracies on all other existing algorithms over test data.

Morpho-Physiological Traits and Functional Markers Based Molecular Dissection of Heat-Tolerance in Urdbean

Urdbean (Vigna mungo L. Hepper) is one of the important pulse crops. Its cultivation is not so popular during summer seasons because this crop is unable to withstand excessive heat stress beside lack of humidity in the atmosphere. Therefore, a panel of 97 urdbean diverse genotypes was assessed for yield under stress and non-stress conditions with an aim to identify heat tolerant genotypes. This study identified 8 highly heat tolerant and 35 highly heat sensitive genotypes based on heat susceptibility index. Further, physiological and biochemical traits-based characterization of a group of six highly heat sensitive and seven highly heat tolerant urdbean genotypes showed genotypic variability for leaf nitrogen balance index (NBI), chlorophyll (SPAD), epidermal flavnols, and anthocyanin contents under 42/25°C max/min temperature. Our results showed higher membrane stability index among heat tolerant genotypes compared to sensitive genotypes. Significant differences among genotypes for ETR at different levels of PAR irradiances and PAR × genotypes interactions indicated high photosynthetic ability of a few genotypes under heat stress. Further, the most highly sensitive genotype PKGU-1 showed a decrease in different fluorescence parameters indicating distortion of PS II. Consequently, reduction in the quantum yield of PS II was observed in a sensitive one as compared to a tolerant genotype. Fluorescence kinetics showed the delayed and fast quenching of Fm in highly heat sensitive (PKGU 1) and tolerant (UPU 85-86) genotypes, respectively. Moreover, tolerant genotype (UPU 85-86) had high antioxidant activities explaining their role for scavenging superoxide radicals (ROS) protecting delicate membranes from oxidative damage. Molecular characterization further pinpointed genetic differences between heat tolerant (UPU 85-86) and heat sensitive genotypes (PKGU 1). These findings will contribute to the breeding toward the development of heat tolerant cultivars in urdbean.

Kabasura Kudineer (KSK), a poly-herbal Siddha medicine, reduced SARS-CoV-2 viral load in asymptomatic COVID-19 individuals as compared to vitamin C and zinc supplementation: findings from a prospective, exploratory, open-labeled, comparative, randomized controlled trial, Tamil Nadu, India

INTRODUCTION

Despite several ongoing efforts in biomedicine and traditional medicine, there are no drugs or vaccines for coronavirus disease 2019 (COVID-19) as of May 2020; Kabasura Kudineer (KSK), a polyherbal formulation from India's Siddha system of medicine, has been traditionally used for clinical presentations similar to that of COVID-19. We explored the efficacy of KSK in reducing viral load and preventing the disease progression in asymptomatic, COVID-19 cases.

METHODS

A prospective, single-center, open-labeled, randomized, controlled trial was conducted in a COVID Care Centre in Chennai, India. We recruited reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 of 18 to 55 years of age, without clinical symptoms and co-morbidities. They were randomized (1:1 ratio) to KSK (60 mL twice daily for 7 days) or standard of care (7 days supplementation of vitamin C 60,000 IU morning daily and zinc 100 mg evening daily) groups. The primary outcomes were reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR], prevention of progression of asymptomatic to symptomatic state, and changes in the immunity markers including interleukins (IL-6, IL-10, IL-2), interferon gamma (IFNγ), and tumor necrosis factor (TNF α). Siddha clinical assessment and the occurrence of adverse effects were documented as secondary outcomes. Paired t-test was used in statistical analysis.

RESULTS

Viral load in terms of the CT value (RdRp: 95% CI = 1.89 to 5.74) declined significantly on the seventh day in the KSK group and that of the control group, more pronounced in the study group. None progressed to the symptomatic state. There was no significant difference in the biochemical parameters. We did not observe any changes in the Siddha-based clinical examination and adverse events in both groups.

CONCLUSION

KSK significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings.

TRIAL REGISTRATION

Clinical Trial Registry of India CTRI2020/05/025215 . Registered on 16 May 2020.

Burden of congenital rubella syndrome (CRS) in India based on data from cross-sectional serosurveys, 2017 and 2019-20

Background

India has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to <15 years and established a hospital-based sentinel surveillance for CRS. Reliable data about incidence of CRS is necessary to monitor progress towards the elimination goal.

Methods

We conducted serosurveys in 2019–20 among pregnant women attending antenatal clinics of 6 hospitals, which were also sentinel sites for CRS surveillance, to estimate the prevalence of IgG antibodies against rubella. We systematically sampled 1800 women attending antenatal clinics and tested their sera for IgG antibodies against rubella. We used rubella seroprevalence data from the current survey and the survey conducted in 2017 among antenatal women from another 6 CRS surveillance sites to construct a catalytic models to estimate the incidence and burden of CRS.

Result

The seroprevalence of rubella antibodies was 82.3% (95% CI: 80.4–84.0). Rubella seropositivity did not differ by age group and educational status. Based on the constant and age-dependent force of infection models, we estimated that the annual incidence of CRS in India was 225.58 per 100,000 live births (95% CI: 217.49–232.41) and 65.47 per 100,000 live births (95% CI: 41.60–104.16) respectively. This translated to an estimated 14,520 (95% CI: 9,225–23,100) and 50,028 (95% CI: 48,234–51,543) infants with CRS every year based on age-dependent and constant force of infection models respectively.

Conclusions

Our findings indicated that about one fifth of women in the reproductive age group in India were susceptible for rubella. The estimates of CRS incidence will serve as a baseline to monitor the impact of MRCV SIAs, as well progress towards the elimination goal of rubella/CRS.

Rubella infection during the first trimester of pregnancy can affect fetus, resulting in spontaneous abortion, stillbirth or birth of a baby with a combination of birth defects known as congenital rubella syndrome (CRS). Vaccination with rubella containing vaccine (RCV) is recommended as one of the strategies for eliminating rubella/CRS. The Southeast Asia region has set a target to eliminate rubella/CRS by 2023. Towards this goal, India completed nationwide immunization campaigns using measles-rubella vaccine during 2017–19, targeting children aged 9 months to <15 years. A case-based surveillance for CRS was initiated in five sentinel hospitals (Phase-1) in 2016 and later expanded to additional 6 sites (Phase-2) in 2019, to estimate burden of CRS and monitor its trend. As an adjunct to CRS surveillance, periodic serologic surveys were also planned to monitor the rubella seroprevalence among the pregnant women. A serosurvey conducted in 2017 indicated that 83.4% pregnant women attending antenatal clinics of Phase-1 sentinel hospitals had IgG antibodies against rubella. The second serosurvey conducted during 2019–20 in 6 Phase-2 sites indicated a comparable seroprevalence of 82.3%. Using seroprevalence data from these two serosurveys, we estimated that the annual incidence of CRS in India was 225.58 per 100,000 live births with constant force of infection and 65.47 per 100,000 live births with age-dependent force of infection models. This incidence rates translated to an estimated 14,520 to 50,028 infants with CRS every year. The estimates of CRS incidence will serve as a baseline to monitor the progress towards the elimination goal of rubella/CRS in India.

Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone

Objective

Method

Results

Conclusion

Dental caries prevalence among HIV adult population in India: A systematic review

Dental caries is a universal disease. Untreated dental caries adds to the existing burden of diseases. It is necessary to have national data on the same, especially in HIV cases, to understand the epidemiological aspects and formulate a treatment plan for the population. Hence, a systematic review was carried out to collectively report the dental caries prevalence among this population. A systematic search for articles was done in PubMed and Google Scholar using the keywords: Dental Caries, India, HIV, AIDS and adults from January 1990 to December 2019. All freely available full-text articles were evaluated based on the inclusion criteria. Only four articles fulfilled the criteria based on qualitative analysis. Decayed, Missing and Filled Teeth index was used to record dental caries. Risk factors related to the same were not specified by any of the authors. Studies were not from different regions of India. More epidemiological studies are needed to understand the prevalence rate and correlated to dental caries among HIV-positive population in India.

Genome-Wide DArTSeq Genotyping and Phenotypic Based Assessment of Within and Among Accessions Diversity and Effective Sample Size in the Diverse Sorghum, Pearl Millet, and Pigeonpea Landraces

Germplasm should be conserved in such a way that the genetic integrity of a given accession is maintained. In most genebanks, landraces constitute a major portion of collections, wherein the extent of genetic diversity within and among landraces of crops vary depending on the extent of outcrossing and selection intensity infused by farmers. In this study, we assessed the level of diversity within and among 108 diverse landraces and wild accessions using both phenotypic and genotypic characterization. This included 36 accessions in each of sorghum, pearl millet, and pigeonpea, conserved at ICRISAT genebank. We genotyped about 15 to 25 individuals within each accession, totaling 1,980 individuals using the DArTSeq approach. This resulted in 45,249, 19,052, and 8,211 high-quality single nucleotide polymorphisms (SNPs) in pearl millet, sorghum, and pigeonpea, respectively. Sorghum had the lowest average phenotypic (0.090) and genotypic (0.135) within accession distances, while pearl millet had the highest average phenotypic (0.227) and genotypic (0.245) distances. Pigeonpea had an average of 0.203 phenotypic and 0.168 genotypic within accession distances. Analysis of molecular variance also confirms the lowest variability within accessions of sorghum (26.3%) and the highest of 80.2% in pearl millet, while an intermediate in pigeonpea (57.0%). The effective sample size required to capture maximum variability and to retain rare alleles while regeneration ranged from 47 to 101 for sorghum, 155 to 203 for pearl millet, and 77 to 89 for pigeonpea accessions. This study will support genebank curators, in understanding the dynamics of population within and among accessions, in devising appropriate germplasm conservation strategies, and aid in their utilization for crop improvement.

The efficacy of Siddha Medicine, Kabasura Kudineer (KSK) compared to Vitamin C & Zinc (CZ) supplementation in the management of asymptomatic COVID-19 cases: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine.

TRIAL DESIGN

A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial.

PARTICIPANTS

Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded.

INTERVENTION AND COMPARATOR

Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days.

MAIN OUTCOMES

The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes.

RANDOMISATION

The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures.

BLINDING (MASKING)

This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial.

NUMBERS TO BE RANDOMISED (SAMPLE SIZE)

Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm.

TRIAL STATUS

Protocol version 2.0 dated 16^th May 2020. Recruitment is completed. The trial started recruitment on the 25^th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection TRIAL REGISTRATION: The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020.

FULL PROTOCOL

The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

WHO 2009 Warning Signs as Predictors of Time Taken for Progression to Severe Dengue in Children

OBJECTIVES

To identify WHO 2009 warning signs that can predict time taken for progression to severe dengue in a pediatric population.

DESIGN

Prospective analytical study over 1 year and 2 months.

SETTING

Tertiary care center.

PARTICIPANTS

350 children aged 1 mo-12 y with serologically confirmed dengue without co-morbidities/co-infections; conse-cutive sampling.

PROCEDURE

At admission, clinical and laboratory details were noted. Disease progression, time of onset of each warning sign, hematocrit, and platelet counts were recorded daily till discharge/ death. If progressing to severe dengue, its time of onset was noted. Time to event analysis with Log Rank test, Kaplan Meier plots and Cox Proportional Hazards Model was done.

OUTCOME MEASURES

Primary outcome was time interval from onset of first warning sign to onset of severe dengue (defined as per WHO 2009 guidelines). Predictors were WHO 2009 warning signs: abdominal pain, lethargy, persistent vomiting, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm, hematocrit ≥0.40 and platelet count <100x109/L.

RESULTS

Among 350 children followed up completely till discharge/death, 90 developed severe dengue (event) while 260 did not (censored). Median age of study population was 7.75 y. Clinical fluid accumulation [(P=0.002, Hazard Ratio (HR) 2.19, 95% CI 1.33-3.60)] and hematocrit ≥0.40 [(P=0.009, HR (95%CI) 1.715, (1.13-2.60)] were significant in univariate analysis. Final multivariate model includes clinical fluid accumulation [(P=0.02, HR (95%CI) 1.89, (1.116-3.202)], hematocrit ≥0.40 (P=0.07), mucosal bleed (P=0.56) and persistent vomiting (P=0.32).

CONCLUSION

WHO warning signs that predict time taken for progression to severe dengue in children include clinical fluid accumulation, hematocrit ≥0.40, persistent vomiting and mucosal bleed. Study results have implications in policy making and practice guidelines to triage children attending a health care facility with or without warning signs.

Guidelines on Diagnosis and Management of Cow's Milk Protein Allergy

JUSTIFICATION

Cow's milk protein allergy (CMPA) is increasingly being diagnosed in the West, while there is scant data on the subject from India. There is low awareness among pediatricians about its diagnosis and management; leading to improper diagnosis.

PROCESS

A group of experts from the pediatric gastroenterology sub-specialty chapter of Indian Academy of Pediatrics (Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition) met at Mumbai on 26 October, 2018 and discussed various issues relating to the subject. A broad consensus was reached and a writing committee was formed. They met again on 11 August, 2019 at Chennai for a detailed discussion. The statement was sent to the entire group by e-mail and their approval obtained.

OBJECTIVE

To formulate a consensus statement enable proper diagnosis and management of Cow's milk protein allergy.

RECOMMENDATIONS

Cow's milk protein allergy is most common in the first year of life. Gastrointestinal manifestations are usually non-IgE mediated and therefore skin prick test and specific IgE levels are not useful in diagnosis. Clinical response to elimination diet followed by a positive oral food challenge is diagnostic. In patients with only gastrointestinal manifestations, sigmoidoscopy and rectal biopsy may be considered as an alternative. Management involves strict avoidance of all forms of bovine milk protein. For infants who are artificially fed, an extensively hydrolyzed formula is the first choice. Soy formula is an alternative in those above six months of age. Since most infants outgrow the allergy, elimination diet is only for a limited period and re-evaluation should be done periodically.

Predicting the Spread of COVID-19 Using SIR Model Augmented to Incorporate Quarantine and Testing

India imposed a nationwide lockdown from 25th March 2020 onwards to combat the spread of COVID-19 pandemic. To model the spread of a disease and to predict its future course, epidemiologists make use of compartmental models such as the SIR model. In order to address some of the assumptions of the standard SIR model, a new modified version of SIR model is proposed in this paper that takes into account the percentage of infected individuals who are tested and quarantined. This approach helps overcome the assumption of homogenous mixing of population which is inherent to the conventional SIR model. Using the available data of the number of COVID-19 positive cases reported in the state of Kerala, and in India till 26th April, 2020 and 12th May 2020, respectively, the parameter estimation problem is converted into an optimization problem with the help of a least squared cost function. The optimization problem is then solved using differential evolution optimizer. The impact of lockdown is quantified by comparing the rising trend in infections before and during the lockdown. Using the estimated set of parameters, the model predicts that in the state of Kerala, by using certain interventions the pandemic can be successfully controlled latest by the first week of July, whereas the R 0 value for India is still greater than 1, and hence lifting of lockdown from all regions of the country is not advisable.

A new distribution record of Albunea groeningi (Crustacea: Anomura: Decapoda: Albuneidae) from the Digha Coast, West Bengal, India

Members of the genus Albunea Weber, 1795 (family Albuneidae) are commonly known as sand crabs. Albuneidae contains 59 species belonging to 13 genera (Boyko McLaughlin 2010; WoRMS 2019), of which four genera and nine species are known only as fossils. Most species are relatively uncommon and adapted to living in sandy habitats (Boyko Harvey 1999). Among the 24 species of Albunea, four are known only as fossils (WoRMS 2019). The diversity and distributions of most albuneids were reported by Boyko (2002, 2010).

Efficient high capacity technique to embed EPR information and to detect tampering in medical images

Reversible data hiding (RDH) is one of the well-known and highly recommended method to enhance medical data security or electronic patient record (EPR), privacy and truthfulness. In clinical images, while hiding the data, care must be taken to maintain the confidentiality of the information that is to be hidden within the clinical images because the hidden information should not bring down the original quality of the image. Mostly, the investigations carried out for medical diagnosis are usually constructed on the basis of investigation systems used for diagnosis and are grounded on the images usually used for medical study. Magnetic resonance image (MRI), CR and CT, digital format images which are acquired are related to the patient's data and information regarding their diagnosis study. In this presented approach, we introduce an RDH scheme that can also be combined with encryption and reversible watermarking techniques. Here, we use the data related to the patient diagnosis as the secret information to embed in medical images. Quality of the marked image after embedding the data is usually measured with metrics that are usually used in image processing such as PSNR and SSIM.

Oral health status and knowledge among 10-15years old type 1 diabetes mellitus children and adolescents in Bengaluru

Context

Type 1 diabetes mellitus (T1DM) is a chronic systemic metabolic disease. This disorder affects mainly children and adolescents. The main complications of diabetes mellitus affect the organs and tissues rich in capillary vessels such as kidney, retina, and nerves. These complications are secondary to the development of microangiopathy. Similar changes in small vessels can be found in the oral tissues. There is a significant increase in gingival inflammation and plaque seen in children with T1DM.

Aims

The aim of this study is to assess the oral health status and knowledge among T1DM children and young adolescents aged 10-15 years in Bengaluru.

Subjects and Methods

One hundred and seventy-five 10-15 year-old children with T1DM and 175 age, sex, and socioeconomic status matched nondiabetic controls were included in the study. Oral health status was assessed using community periodontal Index and decayed/decayed-missing/missing-filled/filled teeth index (DMFT/dmft). Oral health knowledge was assessed using 11 item questionnaire. Chi-square test and Student's t-test were used in the statistical analysis.

Results

With regard to periodontal status, subjects with healthy periodontal tissue were less in diabetic than control group. Patients with bleeding and calculus were more in diabetic group than control group. The difference between diabetic group and control group was statistically significant (P = 0.001).The mean number of DMFT/dmft were less in diabetics (0.07 ± 0.006)/(0.26 ± 0.05) compared to control groups (0.1 ± 0.01)/(0.84 ± 0.2), respectively. Overall, oral health knowledge was more among diabetic patients (8.3 ± 1.7) compared to controls (7.5 ± 1.8).

Conclusions

The results of the present study showed more gingival changes and higher oral health knowledge in diabetic group when compared to control group.

Genetic transformation of tropical maize (Zea mays L.) inbred line with a phytase gene from Aspergillus niger

A full-length cDNA of phyA gene of Aspergillus niger, encoding phytase enzyme, was cloned and expressed in E. coli BL21 cells and assayed for its activity. The phyA cDNA consisted of 1404 bp, which encoded 467 amino acid residues. The phytase activity of purified phytase was 826.33 U/mL. The phyA gene under the control of endosperm-specific promoters was transformed into an Indian maize inbred line, UMI29, using particle bombardment-mediated transformation method to generate transgenic maize plants over-expressing phytase in seeds. PCR and GUS analyses demonstrated the presence of transgenes in T₀ transgenic plants and their stable inheritance in the T₁ progenies. Three transgenic events expressing detectable level of A. niger phytase were characterized by western blot analysis. Phytase activity of 463.158 U/kg of seed was observed in one of the events, JB-UMI29-Z17/2. The phytase activity of transgenic maize seeds was 5.5- to 7-fold higher than the wild-type UMI29 seeds and, consequently, the seeds had 0.6- to 5-fold higher inorganic phosphorus content.

Integrating Ethics into the Physiology curriculum: a scale-up study in three medical colleges in Karnataka, South India

A published pilot study showed the feasibility of integrating ethics into physiology in a single medical college. However, questions were raised about feasibility of scale-up and acceptance across different colleges. To assess feasibility of integrating ethics into Physiology, first year MBBS students of three medical colleges (n=449, College A=149; 59M, 90F; College B=150; 78M, 72F; College C=150; 48M, 102F) were exposed to the integrated ethics programme. Triggers related to theory or practicals were included. Faculty volunteers conducted the sessions with feedback from observers and students. Students across three colleges felt that the programme was relevant (92%-98%), effectively integrated (86%-98%) [significantly greater number of College A students: (p=0.003)], seldom interfered with physiology teaching (59%-66%). Greater number of students from College C followed by College B and A opined to continue the integrated programme for future years (p=0.004). A scale-up study of integration of ethics programme across different colleges was perceived to be feasible by students and observers.

Identification of mega-environments and rice genotypes for general and specific adaptation to saline and alkaline stresses in India

In the present study, a total of 53 promising salt-tolerant genotypes were tested across 18 salt-affected diverse locations for three years. An attempt was made to identify ideal test locations and mega-environments using GGE biplot analysis. The CSSRI sodic environment was the most discriminating location in individual years as well as over the years and could be used to screen out unstable and salt-sensitive genotypes. Genotypes CSR36, CSR-2K-219, and CSR-2K-262 were found ideal across years. Overall, Genotypes CSR-2K-219, CSR-2K-262, and CSR-2K-242 were found superior and stable among all genotypes with higher mean yields. Different sets of genotypes emerged as winners in saline soils but not in sodic soils; however, Genotype CSR-2K-262 was the only genotype that was best under both saline and alkaline environments over the years. The lack of repeatable associations among locations and repeatable mega-environment groupings indicated the complexity of soil salinity. Hence, a multi-location and multi-year evaluation is indispensable for evaluating the test sites as well as identifying genotypes with consistently specific and wider adaptation to particular agro-climatic zones. The genotypes identified in the present study could be used for commercial cultivation across edaphically challenged areas for sustainable production.

Internet of things enabled real time water quality monitoring system

Smart solutions for water quality monitoring are gaining importance with advancement in communication technology. This paper presents a detailed overview of recent works carried out in the field of smart water quality monitoring. Also, a power efficient, simpler solution for in-pipe water quality monitoring based on Internet of Things technology is presented. The model developed is used for testing water samples and the data uploaded over the Internet are analyzed. The system also provides an alert to a remote user, when there is a deviation of water quality parameters from the pre-defined set of standard values.

A Comparison of Practice Pattern and Outcome of Twice-weekly and Thrice-weekly Hemodialysis Patients

Renal replacement therapy (RRT) options and practice varies in countries worldwide and is influenced by patients' choice, nephrologists' practice patterns, health system, payer practice, public policy, and socioeconomic factors. In India, hemodialysis (HD) remains the dominant RRT modality, and the practice is largely influenced by socioeconomics of the region of practice since third party payer is limited. Resource stretch to maximize outcome benefit is essential and HD session twice weekly is an improvized and cost-effective clinical practice. However, within the country, the patient characteristics, practice patterns, and outcomes of twice-weekly HD compared against patients dialyzed thrice weekly remain unclear. We did a retrospective analysis of patients who underwent twice- and thrice-weekly HD in a single center under similar settings. The patients on thrice a week dialysis were older and with a higher proportion of diabetics and were insured by private payers. Weight gain, ultrafiltration rates, blood pressures, and hemoglobin remained more favorable in the thrice-weekly patients. There was no significant difference in the hospitalization rates or mortality rates in the two groups. Patients who undergo twice-weekly HD have poorer intermediate measures of the outcome; although, morbidity and survival were not different in a small study population with short follow-up. The small sample size and the short duration of follow-up may limit the scope of findings of our study.

Clinical profile of PanIN lesions in tropical chronic pancreatitis

BACKGROUND

Chronic pancreatitis (CP) found in the tropical countries is known to have a higher risk for carcinoma of the pancreas. This study aimed to explore the clinical profile of pancreatic intraepithelial neoplasia (PanIN), one of the precursors of carcinoma of the pancreas, in tropical CP and to identify the possible clinical predictors of the same.

METHODOLOGY

A retrospective study was done enrolling patients who underwent either Frey's procedure or pancreatic resection for symptomatic CP, between January 2008 and December 2012. They were grouped into PanIN positive and PanIN negative based on histopathology. Their clinical and laboratory parameters were compared statistically to identify the predictors of the PanIN status.

RESULTS

Sixty-two tropical CP patients who had Frey's procedure or pancreatic resection were enrolled into this study; 38.7 % cases showed PanIN changes and 61.29 % had no PanIN changes. Majority of the clinical and laboratory parameters were found comparable between the two groups except obstructive jaundice and CA 19-9 value >137.5 which were there in 54.2 % of PanIN-positive cases. On histopathology, 54.83 % cases were benign CP and 45.16 % were malignant CP. Among the benign CP, 33.3 % were PanIN positive and among those with malignancy 66.7 % were PanIN positive. Low-grade PanINs were seen in 73 % cases of benign CP and in 26.1 % of malignancy whereas high-grade PanIN-3 lesions were seen exclusively in patients with malignancy.

CONCLUSION

High-grade PanIN-3 lesions showed significant association with pancreatic malignancy. Obstructive jaundice and CA 19-9 ≥ 137.5 could predict PanIN positivity.

Prevalence of classical swine fever in Karnataka, India

Aim:

The present study was conducted to know the current scenario of classical swine fever (CSF) in Bengaluru Urban, Bengaluru Rural, Chikkaballapur, Madikeri, Mandya, Bagalkot, Gadag, Yadgir, Koppal, and Bidar districts of Karnataka with the using of both antigen and antibody ELISA.

Materials and Methods:

We collected 218 sera and 121 blood samples from pigs from 10 different districts of Karnataka. Screening of sera for CSF IgG antibody and whole blood for CSF virus antigen were carried out using the CSF virus (CSFV) antibody and antigen ELISA kits, respectively.

Results:

The mean seroprevalence was 41% (89/218) and prevalence of CSFV antigen in blood samples was 32% (39/121) for the 10 districts of Karnataka. Seroprevalence of 61%, 29%, 20%, and 21%; and antigen prevalence of 40%, 50%, 13%, and 12% were recorded for Bangalore, Mysore, Belgaum, and Gulbarga divisions of Karnataka, respectively.

Conclusions:

The study revealed an alarmingly high prevalence of CSF, both for the antigen (32%) and antibody (41%) in Karnataka. Southern Karnataka has the highest seroprevalence (61% in Bangalore and 29% in Mysore divisions), which confirms the endemicity of the disease in that region. This could be attributed to the intensive pig farming practices in the region as compared to Northern Karnataka (Seroprevalence of 20% in Belgaum and 21% in Gulbarga divisions), where the commercial pig farming is still in infantile stages.

A maize α-zein promoter drives an endosperm-specific expression of transgene in rice

An alpha-zein promoter isolated from maize containing P-box, E motif sequence TGTAAAGT, opaque-2 box and TATA box was studied for its tissue-specific expression in rice. A 1,098 bp promoter region of alpha-zein gene, fused to the upstream of gusA reporter gene was used for transforming rice immature embryos (ASD 16 or IR 64) via the particle bombardment-mediated method. PCR analysis of putative transformants demonstrated the presence of transgenes (the zein promoter, gusA and hpt). Nineteen out of 37 and two out of five events generated from ASD 16 and IR 64 were found to be GUS-positive. A histological staining analysis performed on sections of mature T1 seeds revealed that the GUS expression was limited to the endosperm and not to the pericarp or the endothelial region. GUS expression was observed only in the following seed development stages : milky (14-15 DAF), soft dough (17-18 DAF), hard dough (20-23 DAF), and mature stages (28-30 DAF) of zein-gusA transformed (T0) plants. On the contrary a constitutive expression of GUS was evident in CaMV35S-gusA plants. PCR and Southern blotting analyses on T1 plants demonstrated a stable integration and inheritance of transgene in the subsequent T1 generation. GUS assay on T2 seeds revealed that the expression of gusA gene driven by alpha-zein promoter was stable and tissue-specific over two generations. Results suggest that this alpha-zein promoter could serve as an alternative promoter to drive endosperm-specific expression of transgenes in rice and other cereal transformation experiments.

Seasonal Changes of Sedimentation Rates and Sediment Characteristics Status in the Gulf of Mannar Coral Island, India

Corals are known to flourish in various turbid environments around the world. The quantitative distinction between clear and turbid water in coral habitats is not well defined nor are the amount of sediment in suspension and rates of sedimentation used to evaluate the condition of reef environments well established. This study of sedimentation rate, sediment composition and pH, OC deposition was on a fringing reef flat off Thoothukudi and Vembar group of islands, Gulf of Mannar, India. In the present study the sedimentation rate ranged from 1.97 mg/cm2/day to 12.31 mg/cm2/day. The percentage of sand in the sediment was higher than silt and clay. The organic carbon level in all the study stations ranged from 0.03 to 2.54. The sediment pH of the six studied stations was highly acidic in nature at all the study sites in the Gulf of Mannar.

Seasonal Changes of Sedimentation Rates and Sediment Characteristics Status in the Gulf of Mannar Coral Island, India

Corals are known to flourish in various turbid environments around the world. The quantitative distinction between clear and turbid water in coral habitats is not well defined nor are the amount of sediment in suspension and rates of sedimentation used to evaluate the condition of reef environments well established. This study of sedimentation rate, sediment composition and pH, OC deposition was on a fringing reef flat off Thoothukudi and Vembar group of islands, Gulf of Mannar, India. In the present study the sedimentation rate ranged from 1.97 mg/cm2/day to 12.31 mg/cm2/day. The percentage of sand in the sediment was higher than silt and clay. The organic carbon level in all the study stations ranged from 0.03 to 2.54. The sediment pH of the six studied stations was highly acidic in nature at all the study sites in the Gulf of Mannar.

Faecal fat content in healthy adults by the 'acid steatocrit method'

Malabsorption syndromes causing steatorrhoea are quite common in India. Estimation of faecal fat is an important non-invasive investigation, which provides vital information regarding the occurrence of malabsorption. The aim of this study was to estimate the fat excretion per day in stools of apparently healthy adults on an unrestricted diet in random spot stool samples using the Acid Steatocrit Method, which provides an alternate, simpler and yet reliable method of stool fat estimation. Several studies have proved the correlation of the acid steatocrit method with the conventional methods. In India, however, there has been no published data regarding the normal levels of fat in the stools, by the acid steatocrit method. We follow the normal range values, as set by the United States and the European countries, not having a range for the Indian population. Hence, we took up a preliminary study, to estimate stool fat in a section of normal and healthy Indian population. The result obtained after screening 600 healthy and normal adults, showed the mean of stool fat to be 8.72 gms/24 hours, which is much higher than that, defined by Western literature (7 gms/24 hours). This can be accounted for, by the cultural and ethnic variations in dietary and food habits. Further studies are required in the same direction, involving larger population groups, and in different malabsorptive conditions.

Detection of a secreted metalloprotease within the nuclei of liver cells

ADAMTS13 is a secreted zinc metalloprotease expressed by various cell types. Here, we investigate its cellular pathway in endogenously expressing liver cell lines and after transient transfection with ADAMTS13. Besides compartmentalizations of the cellular secretory system, we detected an appreciable level of endogenous ADAMTS13 within the nucleus. A positively charged amino acid cluster (R-Q-R-Q-R-Q-R-R) present in the ADAMTS13 propeptide may act as a nuclear localization signal (NLS). Fusing this NLS-containing region to eGFP greatly potentiated its nuclear localization. Bioinformatics analysis suggests that the ADAMTS13 CUB-2 domain has a double-stranded beta helix (DSBH) structural architecture characteristic of various protein-protein interaction modules like nucleoplasmins, class I collagenase, tumor necrosis factor ligand superfamily, supernatant protein factor (SPF) and the B1 domain of neuropilin-2. Based on this contextual evidence and that largely conserved polar residues could be mapped on to a template CUB domain homolog, we hypothesize that a region in the ADAMTS13 CUB-2 domain with conserved polar residues might be involved in protein-protein interaction within the nucleus.

A follow-up study of children with posterior urethral valve

There are not many studies on long term follow up of children following surgery for posterior urethral valve in India. This study was done to assess the growth and renal function of children who had completed five years after surgery for posterior urethral valve at our hospital. Thirty children were included in this study. They were assessed retrospectively for the age and pattern of presentation, time of surgery and outcome. Outcomes measured were stunting, renal failure (GFR, tubular functions) and bladder functions. Fifty per cent of children were symptomatic five years after surgery with enuresis, dribbling, polyuria and recurrent urinary tract infection (UTI). GFR was <60 ml/m/1.73 m² in 33%. Growth failure, according to the World Health Organization (WHO) definition, was present in one-third of children. A low GFR was associated with growth failure. Poor bladder function evidenced by history of dribbling and significant residual urine was seen in one-third of patients. Residual hydronephrosis was seen in 74%. The most common presenting symptoms of PUV were poor urinary stream followed by recurrent UTI, poor weight gain, renal failure and abdominal mass. Eighty per cent of the study population had undergone surgery in infancy. Five years after surgery, 50% children were symptomatic; 30% had stunting. 33% had a GFR <60 ml/m/1.73 m² and a significantly greater degree of stunting than those with GFR >60 ml/m/1.73 m². Sonologically normal kidneys on follow-up were associated with a GFR above 60 ml/m/1.73 m². Poor bladder function was present in 30% of the children. Univariate analysis showed that statistically significant risk factors for decline in GFR in this study are oligohydramnios and surgery beyond the neonatal period.