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BackgroundDuring 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. ObjectiveIn this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs. MethodsA two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. ResultsOut of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. ConclusionsOverall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial RegistrationClinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27

In vitro propagated banana plants are steadily becoming the planting material of choice because of disease free, uniformity and the possibility of rapid multiplication. The present investigation was carried out at the tissue culture laboratory, Department of Horticulture, School of Agricultural Sciences, Nagaland University, Medziphema campus during the year 2019-2022. Data recorded for different parameters viz. days to greening, days required for multiple buds' initiation, number of multiple buds produced per explant and length of multiple buds after 30 days were subjected to completely randomized design (CRD). The present study revealed the importance of various carbon sources and their role in micropropagation of banana through shoot tip culture. The minimum days required for root initiation were observed in root induction media (RIM) supplemented with 30g glucose. Rooting percentage (%), number of roots per shoot and length of longest roots (cm) after 30 days was seen in RIM supplemented with table sugar at 40g, 30g and 20g respectively. Meanwhile maximum average length of shoot (cm) after 30 days was observed in RIM supplemented with 40g glucose and highest number of leaves per plantlets was recorded in RIM supplemented with 30g sucrose. The results indicate the significance of carbon sources in micropropagation of banana. They improved plant regeneration and facilitated rapid multiplication of disease and virus free banana plantlets. [ABSTRACT FROM AUTHOR]

This article explores the genetic variability, heritability, correlation, and path coefficient of different genotypes of ash gourd. The study found high variability in traits such as seediness, fruit diameter, average fruit weight, and number of lobes. Positive correlations were observed between fruit yield and traits like average fruit weight, vine length, and fruit diameter. The study emphasizes the need for varietal improvement and the development of varieties suitable for specific agro-ecological conditions. The table provided in the article shows correlation coefficients between various traits in ash gourd, indicating strong relationships among them. The findings suggest that selecting genotypes with higher average fruit weight and number of fruits per plant may lead to higher yields. The study highlights the potential for selecting suitable genotypes for different production systems and suggests focusing on intercultural management and evaluating genotypes in different environments. [Extracted from the article]

Introduction: There is a wide discrepancy between demand for and availability of donor organs for organ transplantation. There is no study on awareness about organ donation in chronic kidney disease (CKD) patients in India. Objectives: To study the awareness and beliefs towards organ donation in CKD patients on hemodialysis in western India. Patients and Methods: Authors conducted a cross sectional study among 85 CKD patients to evaluate knowledge about and attitude towards organ donation at a tertiary hospital. Results: Age of respondents ranged from 15 to 75 years. All were aware of term organ donation and cadaver donation. About 47% of people heard about organ donation through hospital or from doctor. Strikingly, radio was not the source of information to any of the respondents, despite radio being one of the most common medium of mass communication. Almost one third of patients were unaware about any legislation regarding organ donation. All respondents felt that organs should go to the needy irrespective of their religion. About 70% feel that medical colleges should make decisions about organ donation in case of unclaimed dead bodies. About 31.76% believe that there is a danger that donated organs could be misused, abused or misappropriated. Conclusion: Our study shows about 31.76% of our participants believe that there is a danger that donated organs could be misused, abused or misappropriated. There seems to be paucity of information and awareness regarding organ donation among CKD patients. Mass media, religious and political leaders may be involved to maximize awareness about organ donation.

Epstein syndrome constitutes macrothrombocytopenia without neutrophil inclusion bodies along with deafness and renal failure. A diagnosis of Epstein syndrome was made in a 17 year-old-male patient with macrothrombopathic thrombocytopenia, renal failure and sensorineural hearing loss. Our patient is unique as he presented with rapidly progressive renal failure and developed chronic kidney disease in second decade of life with no symptomatic hearing loss or bleeding tendency. Epstein syndrome needs to be differentiated from Alport syndrome which is more common disease with similar clinical presentation.

Context: Metformin is the first-line drug for treating diabetes but has a high failure rate. Objective: To identify demographic and clinical factors available in the electronic health record (EHR) that predict metformin failure. Methods: A cohort of patients with at least 1 abnormal diabetes screening test that initiated metformin was identified at 3 sites (Arizona, Mississippi, and Minnesota). We identified 22 047 metformin initiators (48% female, mean age of 57± 14 years) including 2141 African Americans, 440 Asians, 962 Other/Multiracial, 1539 Hispanics, and 16 764 non-Hispanic White people. We defined metformin failure as either the lack of a target glycated hemoglobin (HbA1c) (<7%) within 18 months of index or the start of dual therapy. We used tree-based extreme gradient boosting (XGBoost) models to assess overall risk prediction performance and relative contribution of individual factors when using EHR data for risk of metformin failure. Results: In this large diverse population, we observed a high rate of metformin failure (43%). The XGBoost model that included baseline HbA1c, age, sex, and race/ethnicity corresponded to high discrimination performance (C-index of 0.731; 95% CI 0.722, 0.740) for risk of metformin failure. Baseline HbA1c corresponded to the largest feature performance with higher levels associated with metformin failure. The addition of other clinical factors improved model performance (0.745; 95% CI 0.737, 0.754, P<.0001). Conclusion: Baseline HbA1c was the strongest predictor of metformin failure and additional factors substantially improved performance suggesting that routinely available clinical data could be used to identify patients at high risk of metformin failure who might benefit from closer monitoring and earlier treatment intensification. [ABSTRACT FROM AUTHOR]

Common variable immunodeficiency (CVID) usually manifests in the second or third decade of life with recurrent bacterial infections and hypoglobulinemia. Secondary renal amyloidosis with history of pulmonary tuberculosis is rare in CVID, although T cell dysfunction has been reported in few CVID patients. A 40-year-old male was admitted to our hospital with a 3-month history of recurrent respiratory infections and persistent pitting pedal edema. His past history revealed 3 to 5 episodes of recurrent respiratory tract infections and diarrhoea each year since last 20 years. He had been successfully treated for sputum positive pulmonary tuberculosis 8 years back. Laboratory studies disclosed high erythrocyte sedimentation rate (ESR), hypoalbuminemia and nephrotic range proteinuria. Serum immunoglobulin levels were low. CD4/CD8 ratio and CD3 level was normal. C3 and C4 complement levels were normal. Biopsy revealed amyloid A (AA) positive secondary renal amyloidosis. Glomeruli showed variable widening of mesangial regions with deposition of periodic schiff stain (PAS) pale positive of pink matrix showing apple green birefringence on Congo-red staining. Immunohistochemistry was AA stain positive. Immunofluorescence microscopy revealed no staining with anti-human IgG, IgM, IgA, C3, C1q, kappa and lambda light chains antisera. Patient was treated symptomatically for respiratory tract infection and was discharged with low dose angiotensin receptor blocker. An old treated tuberculosis and chronic inflammation due to recurrent respiratory tract infections were thought to be responsible for AA amyloidosis. Thus pulmonary tuberculosis should be considered in differential diagnosis of secondary causes of AA renal amyloidosis in patients of CVID especially in endemic settings.

Background The coverage of community-based maternal, neonatal, and child health (MNCH) services remains low, especially in hard-to-reach areas. We evaluated the effectiveness of a mobile-phone-and web-based application, Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO), as a job aid to the government's Accredited Social Health Activists (ASHAs) and Primary Health Center (PHC) staff to improve coverage of MNCH services in rural tribal communities of Gujarat, India. Methods and findings This open cluster-randomized trial was conducted in 22 PHCs in six tribal blocks of Bharuch and Narmada districts in India. The ImTeCHO mobile-phone-and web-based application included various technology-based job aids to facilitate scheduling of home visits, screening for complications, counseling during home visits, and supportive supervision by PHC staff. Primary outcome indicators were a composite index calculated based on coverage of important MNCH services and coverage of at least two home visitations by ASHA within the first week of birth. Primary analysis was intention to treat (ITT). Generalized Estimating Equation (GEE) was used to account for clustering. Eleven PHCs each were randomly allocated to the intervention (280 ASHAs, population: 234,134) and control (281 ASHAs, population: 242,809) arms. The intervention was implemented from February, 2016 to January, 2017. At the end of the implementation, 6,493 mothers were surveyed. Most of the surveyed women were tribal (5,571, 85.8%), and reported having a government-issued certificate for living below poverty line (4,916, 75.7%). The coverage of at least two home visits within first week of birth was 32.4% in the intervention clusters compared to 22.9% in the control clusters (adjusted effect size 10.2 [95% CI: 6.4, 14.0], p < 0.001). Mean number of home visits within first week of birth was 1.11 and 0.80 for intervention and control clusters, respectively (adjusted effect size 0.34 [95% CI: 0.23, 0.45], p < 0.001). The composite coverage index was 43.0% in the intervention clusters compared to 38.5% (adjusted effect size 4.9 [95% CI: 0.2, 9.5], p = 0.03) in the control clusters. There were substantial improvements in coverage home visits by ASHAs during antenatal period (adjusted effect size 15.7 [95% CI: 11.0, 20.4], p < 0.001), postnatal period (adjusted effect size 6.4, [95% CI: 3.2, 9.6], p Conclusions In this study, we found that use of ImTeCHO mobile- and web-based application as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. Supportive supervision, change management, and timely resolution of technology-related issues were critical implementation considerations to ensure adherence to the intervention. Trial registration Study was registered at the Clinical Trial Registry of India (www.ctri.nic.in). Trial number: CTRI/2015/06/005847. The trial was registered (prospective) on 3 June, 2015. First enrollment was done on 26 August, 2015., Author(s): Dhiren Modi 1, Nishith Dholakia 2, Ravi Gopalan 3, Sethuraman Venkatraman 3, Kapilkumar Dave 1, Shobha Shah 1, Gayatri Desai 1, Shamim A. Qazi 4, Anju Sinha 5, Ravindra [...]

Background: Tobacco chewing is attributed to oral cancer. Prediction of cancer development by genotoxicity analysis is a major challenge to identify tobacco users at greater risk. Therefore, present study aimed to analyze tobacco related genotoxic effects in chewers monitoring micronuclei (MN) and chromosome aberrations (CA). The biomarkers were compared with non chewer to (i) predict risk for genotoxicity, (ii) estimate synergistic effect of tobacco exposure with level of biomarkers, and (iii) identify best cellular site of measurements for genotoxicity assessment. Methods: Healthy tobacco chewers (n=47); and controls (n=48) were enrolled in the study. The peripheral blood lymphocyte and exfoliated buccal mucosa cells were studied for CA and micro nucleated cell count (MNC) respectively. An arbitrary unit was obtained for Lifetime Tobacco Exposure (LTE) using frequency/day multiplied by duration of years of tobacco use. Data were analyzed using SPSS statistical software. Results: MNC was significantly higher (p=0.001) in chewers than controls. CA was higher in chewers than controls. MNC can differentiate higher tobacco exposure in chewers than CA. Controls having MNC above cutoff level have greater risk of genotoxic exposition (95% C.I.; 1.462-23.26, p=0.012). Conclusion: The present study concludes that MNC is a better surrogate biomarker to predict genotoxicity than CA for tobacco exposure and DNA damage index in tobacco chewers.

Background: To evaluate prognostic effect of submicroscopic deletions involving breakage and fusion points of the derivative chromosome 9 and 22 in chronic myeloid leukemia in untreated patients and their follow up samples to correlate with disease outcome. Methods: The study included 78 pretreatment (PT) samples from CML patients and 90 follow-up samples, classified as complete responders (CR, n=33), nonresponders (NR, n =54), and partial responder (PR, n=3) depending on the treatment status of the follow-up samples. Karyotype analysis was performed on metaphases obtained through short term cultures of bone marrow and blood. Detection of BCR-ABL fusion gene was performed using dual color dual fusion (D-FISH) translocation probes. Results: BCR-ABL fusion gene detection by D-FISH showed ABL-BCR deletion on derivative 9 in 47.8% of nonresponders which was higher as compared to pretreatment (11%). Mix D-FISH signal pattern was found in around 20% of pretreatment and non-responder samples. Average interval from chronic phase to blast crisis and accelerated phase was respectively 3.5 and 18 months and accelerated to blast crisis was 16.5 months from the time of diagnosis. The follow-up duration of 31 patients responded to therapy was significantly higher (p=0.0001) as compared to 45 patients who did not respond to therapy. Variant D-FISH signal pattern was seen at the time of diagnosis in patient who responded to therapy as well as those patients who did not respond to therapy. Conclusion: This is the first study from India reporting deletion in ABL, BCR, or ABL-BCR on derivative 9 did not correlate with response to therapy.

Context: Diabetic ketoacidosis (DKA) in pregnancy is an obstetric emergency with risk of maternofetal death. Objective: This work aimed to evaluate DKA events in pregnant women admitted to our inpatient obstetric service, and to examine associated clinical risk factors, presentation, and pregnancy outcomes. Methods: A retrospective cohort study was conducted at the Mayo Clinic, Rochester, Minnesota, USA, and included women aged 17 to 45 years who were treated for DKA during pregnancy between January 1, 2004 and December 31, 2021. Main outcome measures included maternal and fetal death along with a broad spectrum of maternal and fetal pregnancy outcomes. Results: A total of 71 DKA events were identified in 58 pregnancies among 51 women, 48 (82.8%) of whom had type 1 diabetes. There were no maternal deaths, but fetal demise occurred in 10 (17.2%) pregnancies (6 miscarriages and 4 stillbirths). Maternal social stressors were frequently present (n = 30, 51.0%), and glycemic control was suboptimal (median first trimester glycated hemoglobin A1c = 9.0%). Preeclampsia was diagnosed in 17 (29.3%) pregnancies. Infants born to women with DKA were large for gestational age (n = 16, 33.3%), suffered from neonatal hypoglycemia (n = 29, 60.4%) and required intensive care unit admission (n = 25, 52.1%). Conclusion: DKA is associated with a high rate of maternofetal morbidity and fetal loss. Prenatal education strategies for women with diabetes mellitus should include a strong focus on DKA prevention, and clinicians and patients should have a high index of suspicion for DKA in all pregnant women who present with symptoms that could be attributed to this condition. [ABSTRACT FROM AUTHOR]

Wide and ultrawide-bandgap semiconductors lie at the heart of next-generation high-power, high-frequency electronics. Here, we report the growth of ultrawide-bandgap boron nitride (BN) thin films on wide-bandgap gallium nitride (GaN) by pulsed laser deposition. Comprehensive spectroscopic (core level and valence band x-ray photoelectron spectroscopy, Fourier-transform infrared spectroscopy, and Raman) and microscopic (atomic force microscopy and scanning transmission electron microscopy) characterizations confirm the growth of BN thin films on GaN. Optically, we observed that the BN/GaN heterostructure is second-harmonic generation active. Moreover, we fabricated the BN/GaN heterostructure-based Schottky diode that demonstrates rectifying characteristics, lower turn-on voltage, and an improved breakdown capability (∼234 V) as compared to GaN (∼168 V), owing to the higher breakdown electrical field of BN. Our approach is an early step toward bridging the gap between wide and ultrawide-bandgap materials for potential optoelectronics as well as next-generation high-power electronics. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus in kidney transplant recipients is a risk factor for cardiovascular events and premature death. Sodium‐glucose cotransporter 2 inhibitors (SGLT2i) are increasingly used in nontransplant populations to improve diabetes control and cardiovascular and renal benefits. Limited literature exists regarding the safety and efficacy of these agents in renal transplant recipients. Methods: We retrospectively reviewed all kidney transplant recipients within our health system who were prescribed a SGLT2i after transplantation for diabetes. The safety, tolerability, and effectiveness of SGLT2i were analyzed. Results: Thirty‐nine kidney transplant recipients were initiated on SGLT2i therapy, twenty‐seven of which remained on therapy for at least 1 year. Ten (25%) patients experienced an adverse event while on a SGLT2i, with urinary tract infections (UTI) being the most common. Seventeen patients (43%) discontinued the SGLT2i at the time of chart review, most commonly due to cost and kidney function decline. The median [IQR] hemoglobin A1c (HbA1c) at SGLT2i initiation of 8.4% [7.8–9.2] decreased to 7.5% [6.8–8.0%] after 3 months and 7.5% [6.5–7.9] after 12 months. No meaningful change in kidney function or tacrolimus exposure was observed. Conclusion: SGLT2i may be a safe and effective treatment for diabetes in kidney transplant recipients. Cost is a barrier to SGLT2i therapy, and UTIs were the most frequently encountered adverse events in this cohort. More studies are needed to understand the safety profile and determine the effect of SGLT2i on diabetes‐related comorbidities among kidney transplant recipients. [ABSTRACT FROM AUTHOR]

India is a major contributor to the worldwide distribution off Plasmodium vivax malaria (1). Severe and complicated malaria is usually caused by the P. falciparum parasite, but P. vivax, usually [...]