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Purpose: To compare the surgical outcomes of twin-site phacotrabeculectomy with Mitomycin C (MMC) in primary open-angle glaucoma (POAG) versus primary angle-closure glaucoma (PACG)., Methods: Prospective, comparative, observational study. Patients with visually significant cataract and primary glaucoma were divided into two groups: POAG and PACG. They underwent twin-site phacotrabeculectomy with MMC and followed up on days 1, 15, 1 month, 6 months, and 12 months. Baseline and follow-up visits were compared to find the differences in intraocular pressure (IOP), antiglaucoma medications (AGM), success rates, anterior chamber depth (ACD), and axial length (AXL)., Results: There were 50 eyes each in POAG and PACG groups. Mean IOP reduction from baseline to 12 months (21.22 ± 6.0 to 11.40 ± 2.8-POAG group vs 24.16 ± 7.6 to 12.42 ± 3.2-PACG group) was statistically significant in both groups (P < 0.001), but no significant difference between groups (P = 0.095). There was a statistically significant decline in the number of AGM in POAG [1.66 (0.7) to 0.38 (0.7), P < 0.001] and PACG [2.10 (0.7) to 0.70 (0.8), P < 0.001]; the decline was more in POAG (P = 0.012) at last visit. Probability of overall (complete and qualified) success at 12 months postop was 72.0% [95% confidence interval (CI): 57.4-82.4] in PACG and 84.0% (95% CI: 70.5-91.7) in POAG group. There was a significant increase in ACD and a decrease in AXL in both groups (P < 0.001). More interventions were required in the PACG group (38, P = 0.012)., Conclusion: Phacotrabeculectomy with MMC causes a significant reduction in IOP and improvement in biometric parameters in both POAG and PACG. Patients with PACG required more postoperative interventions, while a lesser number of antiglaucoma medications were needed in POAG patients., Competing Interests: None

We used remote sensing data, field observations and numerical groundwater modelling to investigate long-term groundwater storage losses in the regional aquifer of the Ganga Basin in India. This comprised trend analysis for groundwater level observations from 2851 monitoring bores, groundwater storage anomaly estimation using GRACE and Global Land Data Assimilation System (GLDAS) data sets and numerical modelling of long-term groundwater storage changes underpinned by over 50,000 groundwater level observations and uncertainty analysis. Three analyses based on different methods consistently informed that groundwater storage in the aquifer is declining at a significant rate. Groundwater level trend indicated storage loss in the range - 1.1 to - 3.3 cm year -1 (median - 2.6 cm year -1 ) while the modelling and GRACE storage anomaly methods indicated the storage loss in the range of - 2.1 to - 4.5 cm year -1 (median - 3.2 cm year -1 ) and - 1.0 to - 4.2 cm year -1 (median - 1.7 cm year -1 ) respectively. Probabilistic modelling analysis also indicated that the average groundwater storage is declining in all the major basin states, the highest declining trend being in the western states of Rajasthan, Haryana and Delhi. While smaller compared to the western states, average groundwater storage in states further towards east-Uttar Pradesh, Bihar and West Bengal within the basin are also declining. Time series of storage anomalies obtained from the three methods showed similar trends. Probabilistic storage analysis using the numerical model vetted by observed trend analysis and GRACE data provides the opportunity for predictive analysis of storage changes for future climate and other scenarios., (© 2023. The Author(s).)

Background: Vaccine and sufficient food availability are key factors for reducing pneumonia outbreaks in sub-Saharan Africa., Methods: In this study, the 10-valent pneumococcal conjugate vaccine (Synflorix® or PCV10) was administered to a child cohort (5-7 years old, n = 237) in Msambweni, Kenya, to determine relationships between dietary intake, nutritional/socioeconomic status of mothers/caregivers, and vaccine response. 7-day food frequency questionnaire (FFQ), dietary diversity score (DDS) and single 24-h dietary recall were used to address participants' dietary assessment and nutritional status. Individual food varieties were recorded and divided into 9 food groups as recommended by Food and Agriculture Organization. Anthropometric measurements, nasopharyngeal swabs and vaccine administration were performed at the initial visit. Participants were followed 4-8 weeks with a blood draw for pneumococcal IgG titers assessed by Luminex assay., Findings: Chronic malnutrition was prevalent in the cohort (15% stunting, 16% underweight). Unbalanced dietary intake was observed, with mean energy intake 14% below Recommended Dietary Allowances (1,822 Kcal) for 5-7 years age range. 72% of the daily energy was derived from carbohydrates, 18% from fats and only 10% from proteins. Poor anthropometric status (stunting/underweight) was associated with low socioeconomic/educational status and younger mother/caregiver age ( p < 0.002). Limited intake of essential micronutrients (vitamins A, E, K) and minerals (calcium, potassium) associated with low consumption of fresh fruits, vegetables, and animal source foods (dairy, meat) was observed and correlated with poor vaccine response ( p < 0.001). In contrast, children who consumed higher amounts of dietary fiber, vitamin B1, zinc, iron, and magnesium had adequate vaccine response ( p < 0.05). Correlation between higher dietary diversity score (DDS), higher Vitamin E, K, Zinc intake and adequate vaccine response was also observed ( p < 0.03)., Interpretation: Overall, this study highlights ongoing food scarcity and malnutrition in Kenya and demonstrates the links between adequate socioeconomic conditions, adequate nutrient intake, and vaccine efficacy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Migliore, Amaitsa, Mutuku, Malhotra, Mukoko, Sharma, Kalva, Kang, King and LaBeaud.)

National Capital Region (NCR, Delhi) in India is one of the fastest-growing metropolitan cities which is facing a severe water crisis due to increasing water demand. The over-extraction of groundwater, particularly from its unconsolidated alluvial deposits makes the region prone to subsidence. In this study, we investigated the effects of plummeting groundwater levels on land surface elevations in Delhi NCR using Sentinel-1 datasets acquired during the years 2014-2020. Our analysis reveals two distinct subsidence features in the study area with rates exceeding 11 cm/year in Kapashera-an urban village near IGI airport Delhi, and 3 cm/year in Faridabad throughout the study period. The subsidence in these two areas are accelerating and follows the depleting groundwater trend. The third region, Dwarka shows a shift from subsidence to uplift during the years which can be attributed to the strict government policies to regulate groundwater use and incentivizing rainwater harvesting. Further analysis using a classified risk map based on hazard risk and vulnerability approach highlights an approximate area of 100 square kilometers to be subjected to the highest risk level of ground movement, demanding urgent attention. The findings of this study are highly relevant for government agencies to formulate new policies against the over-exploitation of groundwater and to facilitate a sustainable and resilient groundwater management system in Delhi NCR., (© 2022. The Author(s).)

This paper presents two new designs of MIMO dual band coplanar waveguide (CPW)-fed-slot antennas operating in the 5G frequency band (28 and 38 GHz). The first antenna is an XX MIMO antenna and the second antenna is an XY MIMO antenna. Simulated results for the S-parameters are presented for the two antennas using HFSS. Measured results are also presented for the return loss and gain with both results showing good agreement. The current distribution, group delay, envelope correlation coefficients (ECC), and diversity gain, are also presented for both antennas. The two antennas are fabricated on a substrate having dielectric constant ε r = 10.7 and substrate thickness 0.635 mm. The size of the antenna is 4.4 mm x 4.1 mm x 0.635 mm., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: Iron deficiency may impair adaptive immunity and is common among African infants at time of vaccination. Whether iron deficiency impairs vaccine response and whether iron supplementation improves humoral vaccine response is uncertain. Methods: We performed two studies in southern coastal Kenya. In a birth cohort study, we followed infants to age 18 mo and assessed whether anemia or iron deficiency at time of vaccination predicted vaccine response to three-valent oral polio, diphtheria-tetanus-whole cell pertussis- Haemophilus influenzae type b vaccine, ten-valent pneumococcal-conjugate vaccine and measles vaccine. Primary outcomes were anti-vaccine-IgG and seroconversion at age 24 wk and 18 mo. In a randomized trial cohort follow-up, children received a micronutrient powder (MNP) with 5 mg iron daily or a MNP without iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were anti-measles IgG, seroconversion and avidity at age 11.5 mo and 4.5 y. Findings: In the birth cohort study, 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometric indices and maternal antibodies, hemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis-IgG at 24 wk ( p = 0.0071, p = 0.0339) and 18 mo ( p = 0.0182, p = 0.0360); (B) anti-pertussis filamentous hemagglutinin-IgG at 24 wk ( p = 0.0423); and (C) anti-pneumococcus 19 IgG at 18 mo ( p = 0.0129). Anemia and serum transferrin receptor at time of vaccination were the strongest predictors of seroconversion against diphtheria ( p = 0.0484, p = 0.0439) and pneumococcus 19 at 18 mo ( p = 0.0199, p = 0.0327). In the randomized trial, 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5 y. Compared to infants that did not receive iron, those who received iron at time of vaccination had higher anti-measles-IgG ( p = 0.0415), seroconversion ( p = 0.0531) and IgG avidity ( p = 0.0425) at 11.5 mo. Interpretation: In Kenyan infants, anemia and iron deficiency at time of vaccination predict decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine may be increased by iron supplementation at time of vaccination. These findings argue that correction of iron deficiency during early infancy may improve vaccine response., (Copyright © 2020 Stoffel, Uyoga, Mutuku, Frost, Mwasi, Paganini, van der Klis, Malhotra, LaBeaud, Ricci, Karanja, Drakesmith, King and Zimmermann.)

Background: Globally, vaccine-preventable diseases remain a significant cause of early childhood mortality despite concerted efforts to improve vaccine coverage. One reason for impaired protection may be the influence of prenatal exposure to parasitic antigens on the developing immune system. Prior research had shown a decrease in infant vaccine response after in utero parasite exposure among a maternal cohort without aggressive preventive treatment. This study investigated the effect of maternal parasitic infections on infant vaccination in a more recent setting of active anti-parasitic therapy., Methodology/principal Findings: From 2013-2015, 576 Kenyan women were tested in pregnancy for malaria, soil-transmitted helminths, filaria, and S. haematobium, with both acute and prophylactic antiparasitic therapies given. After birth, 567 infants received 10-valent S. pneumoniae conjugate vaccine and pentavalent vaccine for hepatitis B, pertussis, tetanus, H. influenzae type B (Hib) and C. diphtheriae toxoid (Dp-t) at 6, 10, and 14 weeks. Infant serum samples from birth, 10 and 14 weeks, and every six months until age three years, were analyzed using a multiplex bead assay to quantify IgG for Hib, Dp-t, and the ten pneumococcal serotypes. Antenatal parasitic prevalence was high; 461 women (80%) had at least one and 252 (43.6%) had two or more infections during their pregnancy, with the most common being malaria (44.6%), S. haematobium (43.9%), and hookworm (29.2%). Mixed models comparing influence of infection on antibody concentration revealed no effect of prenatal infection status for most vaccine outcomes. Prevalences of protective antibody concentrations after vaccination were similar among the prenatal exposure groups., Conclusions/significance: These findings are in contrast with results from our prior cohort study performed when preventive anti-parasite treatment was less frequently given. The results suggest that the treatment of maternal infections in pregnancy may be able to moderate the previously observed effect of antenatal maternal infections on infant vaccine responses., Competing Interests: The authors have declared that no competing interests exist.

Background and Objective: Streptococcus pneumoniae is a leading cause of mortality before age 5, but few studies examine details of childhood response to pneumococcal vaccine in less-developed settings. Although malnutrition, HIV, and concurrent infections can impair response, evidence suggests that chronic parasitic infections can also contribute to poor vaccination results. The objective of this study was to determine whether response to pneumococcal vaccine varied among children either exposed to parasitic infections in utero, previously infected in infancy, or infected at the time of immunization., Methods: Children from a 2006 to 2010 maternal-infant cohort were eligible for the current study. Children were screened for malaria, schistosomiasis, filariasis, intestinal helminths, and protozoa. Data on in utero exposure and early life infections were linked, and baseline antipneumococcal immunoglobulin G levels and nasopharyngeal carrier status were determined. Participants received decavalent pneumococcal vaccine, and 4 weeks later, serology was repeated to assess vaccine response., Results: A total of 281 children were included. Preimmunity was associated with greater postvaccination increments in anti-pneumococcal polysaccharide immunoglobulin G, especially serotypes 4, 7, 9, 18C, and 19. Present-day growth stunting was independently associated with weaker responses to 1, 4, 6B, 7, 9V, and 19. Previous exposure to Trichuris was associated with stronger responses to 1, 5, 6B, 7, 18C, and 23, but other parasite exposures were not consistently associated with response., Conclusions: In our cohort, hyporesponsiveness to pneumococcal conjugate vaccine was associated with growth stunting but not parasite exposure. Parasite-related vaccine response deficits identified before age 3 do not persist into later childhood., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Of the 1200 non-diabetic offspring of non-insulin-dependent diabetic patients registered under the prevention programme, 262 (M:F 189:73) were available for analysis with greater than or equal to 4 years of follow-up. All of them had been prescribed a calorie restricted diet to suit their body weight, occupation and age, and were advised to restrict the use of refined carbohydrates and fats. Regular exercise was also advised. Compliance with these prescriptions was assessed at each follow up. At the time of analysis, it was noted that only 14.5% had developed diabetes in a period of 8 +/- 4.2 years even though many of them had impaired glucose tolerance at entry in the programme. Multiple regression analysis showed that initial 2 h plasma glucose, initial glucose tolerance and gain in body weight were strong predictors of diabetes. Weight loss occurred in persons who adhered to diet and exercise programmes and conversion to diabetes was lower in them compared to those who gained weight (P < 0.002). Although the rate and degree of obesity is less among Indians, it has been observed in several earlier studies that even a minor increase in body mass index increased the risk of diabetes. This study highlights the fact that measures to control weight helps to delay the onset of diabetes even in the non-obese despite a strong family history of the disorder.