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The main goal of this study is to investigate the strength and compaction characteristics of soil stabilized by fly ash with multiwalled carbon nanotube (MWCNT) as an additive. The materials used in the study were characterized using microscopic techniques like scanning electron microscopy-energy dispersive spectroscopy (SEM–EDS), and X-ray diffraction (XRD). The soil in the current study was replaced up to 50% by fly ash in the presence of MWCNT and sodium hexametaphosphate (SHMP) in different concentrations. The findings demonstrate that the Atterberg limits and specific gravity decrease with the increase in fly ash, MWCNT, and, SHMP. The maximum (46%) and minimum (24.2%) values of the liquid limit were recorded at 0% and 50% fly ash content, respectively. The maximum (34%) and minimum (20.2%) values of the plastic limit were observed at 0% and 50% fly ash content respectively. The specific gravity of natural soil decreases from the maximum value of 2.68 to the minimum value of 2.53 at 0% and 50% fly ash content, respectively. The optimum moisture content also decreases with the increase in fly ash, MWCNT, SHMP, and vice versa for maximum dry density. 0.01% w/w MWCNT + 80% Soil + 20% Fly Ash + 2% SHMP is the optimal mix. It gives maximum unconfined compressive strength (UCS) value in all the durations of curing, i.e. 0.50, 0.725, and 0.984 MPa at 1, 7, and 28 days of curing, respectively. The UCS value of this combination is 147% more than the UCS value of normal soil cured for 28 days. An economic analysis is also conducted to understand the feasibility of the application of MWCNTs in soil-fly ash mix. [ABSTRACT FROM AUTHOR]

Growing concern over the combustion cost and environment has made road engineers and scientists to explore the possible use of locally available materials for the construction of roads. The present study evaluated the strength and durability characteristics of five sites having locally available silty soils using lime and cement–sand stabilization technique. The test results showed that the cement–sand stabilization technique using 6% cement and 5% local sand resulted in higher strength and durability as compared to lime stabilization. There is also a significant increase in the value of the soaked California bearing ratio (CBR). As unconfined compressive strength (UCS) attained the threshold strength as prescribed by IRC SP 72 2015 for the granular sub-base (GSB) layer, by the use of sand cement stabilization, this technique of stabilization for local silty soils could be used for GSB for low volume road (LVR) construction. As observed from microstructural results which were performed by analysing SEM images, sand cement stabilisation leads to CSH gel and agglomerate formation thereby increasing strength and durability properties. The cost analysis for the replaced stabilized GSB layer showed that using sand–cement stabilization, the estimated cost can be reduced by 56% of the total cost as compared to the conventional method. [ABSTRACT FROM AUTHOR]

Warm mix asphalt mixtures became attractive paving mixes by reducing the production temperature to around 25–40 °C as compared to that of conventional hot mix asphalt (HMA). This study aims to evaluate the warm mix asphalt (WMA) using wax-based additives by incorporating two types of industrial wastes. The potential application of low calcium fly ash (FA), i.e. class F type and marble dust (MD), has been evaluated by varying different percentage. The cylindrical samples were prepared and assessed for moisture susceptibility by being subjected to Marshall stability, retained Marshall stability (RMS), indirect tensile strength (ITS) and tensile strength ratio (TSR) tests. Furthermore, the samples were also evaluated for finding the refusal density, Cantabro loss and the rutting performance. A scanning electron microscope (SEM) was also used to evaluate the size and microstructure of the filler particles. The results revealed that the inclusion of fillers into mixes had significant improvement in the mechanical properties and lowered the rutting value with FA and MD addition. The warm mix additive and fillers used were also useful in reducing the binder content of the mixes. The mixing temperature was found to be in the range of 120–130 °C using the warm mix additive. The optimum usage of FA and MD can be up to 5% based on the evaluation. The statistical results reported that there was a significant difference between FA-based and MD-based WMA. [ABSTRACT FROM AUTHOR]

Low-volume roads are anticipated to have less traffic and provide access to socio-economic activities in rural areas. The present study deals with the stabilisation of soil with locally available waste materials, i.e. low calcium fly ash (FA) and brick dust (BD). These two wastes are available abundantly and lead to an increase in pollution levels. Initially, lime was added to make the silty clayey soils plastic-free. The initial consumption of lime was found to be 5%. Then, the soil was stabilised with cement fly ash and cement brick dust techniques for strength, durability and shrinkage evaluation. The cement was varied from 2 to 8% with FA and BD by fixing the ratio to 1:3 as per AASHTO guidelines. The unconfined compressive strength (UCS), indirect tensile strength test and California bearing ratio were conducted for strength evaluation. The wetting and drying cycles were evaluated for durability analysis. The linear shrinkage cracking was evaluated after the curing period of 28 days. It was observed that there was a magnificent increase in strength and durability values. The maximum UCS attained value was so high that it could act as a replacement for the granular sub-base layer in the pavement structure. The linear shrinkage evaluated at fixed relative humidity was significantly reduced. The statistical analysis reported that there was a significant difference between the two admixtures. The utilisation of these wastes not only enhances strength, but also deficits the cost of construction along with reducing the pollutants in the environment. [ABSTRACT FROM AUTHOR]

This investigation is primarily focused on addressing the prevailing uncertainty surrounding the compressive strength of three distinct types of bricks: nanomodified; simple; and commercial. Nanomodified bricks are specifically fabricated using a minute concentration of 0.01% w/w multiwalled carbon nanotubes combined with 1% sodium hexametaphosphate. However, the utilization of both materials in a single brick is currently limited. In view of this constraint, a diligent effort was made in this study to comprehend the effects of multiwalled carbon nanotubes and sodium hexametaphosphate as additive materials for brick construction. It is important to note that the compressive strength of the bricks remains the pivotal and critical characteristic under investigation, and an exhaustive analysis was undertaken employing a probabilistic approach. The findings of the study suggest that the variability observed in the compressive strength parameters of nanomodified, simple, and commercial bricks can be explained by a normal distribution at a significance level of 5%. The calculated values for the characteristic compressive strength were determined to be 24.47, 16.47, and 14.24 N/mm2 , respectively, for the three types of bricks. Further, the regression analysis conducted to assess the relationship between brick compressive strength and the independent variables yielded a cubic fit with R2 (coefficient of determination) values of 0.984, 0.995, and 0.995 for nanomodified, simple, and commercial bricks, respectively. Consequently, the application of multiwalled carbon nanotubes in conjunction with sodium hexametaphosphate in fired clay bricks can be recommended to achieve enhanced compressive strength. [ABSTRACT FROM AUTHOR]

Warm-mix asphalt (WMA) is produced at lower temperatures—about 30°C–40°C lower—than hot-mix asphalt (HMA). Huge amounts of brick dust (BD) and fly ash (FA) are generated every year throughout the world, causing an environmental hazard, and their disposal is a serious problem. In addition, the high mixing temperature of HMA production increases environmental load. This study evaluated warm mixes made using organic wax and chemical-based technologies. Two types of filler material, i.e., FA and BD, were used as binary blended fillers (BBF). Cylindrical Marshall specimens were prepared and subjected to moisture susceptibility tests for both aged and unaged conditions. The durability of these samples was tested by evaluating the tensile strength ratio using the modified Lottman test method. The cohesion resistance of the mixtures was evaluated by Cantabro loss. Furthermore, a wheel tracker test (WTT) setup was used for rutting evaluation. Results revealed that the use of BBF in mixes led to a marked increase in mechanical properties. Microstructural behavior was studied using scanning electron microscopy (SEM) images for particle-size distribution. The statistical test indicated a significant difference in stability values and rut depths. [ABSTRACT FROM AUTHOR]

Durability of bituminous mixes is affected by presence or intrusion of moisture into it. The intrusion and amount of trapped moisture largely depend on the air voids present in the mixes. This study explores the combined influence of air voids and hydrated lime (HL, as anti-stripping agent) on moisture-induced damage of bituminous mixes prepared from two different aggregate sources. The aggregates used in the study are siliceous sandstone and basalt. Tensile Strength Ratio (TSR) test was used to determine the moisture susceptibility of bituminous mixes. A higher value of TSR depicts that the mixes are more moisture resistant. TSR was reaffirmed to be lowest at an air void range of about 5% to 13% which is termed as pessimum air void range. At this air void range, moisture gets trapped within the mix, resulting in moisture-induced damage. TSR results showed that bituminous mixes prepared with siliceous sandstone is more susceptible to moisture-induced damage as compared to mixes prepared with basalt. Boil water test reconfirmed the results. Use of HL in bituminous mixes improved its moisture-induced damage resistance only marginally. Thus, moisture-induced damage control at pessimum air void range using anti-stripping agent is not always sufficient. Observations show that air void plays a critical role in moisture-induced damage and control of air void during construction needs to be ensured. [ABSTRACT FROM AUTHOR]

Background: The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse. Methods: This randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15–60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture. Results: A total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups. Conclusions: The study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion. Trial registration: CTRI/2021/02/030977 (ICMR, Clinical trial registry-India). [ABSTRACT FROM AUTHOR]

Introduction: Universal coverage of vaccines alone cannot be relied upon to protect at-risk populations in lower- and middle-income countries against the impact of the coronavirus disease 2019 (COVID-19) pandemic and newer variants. Live vaccines, including Bacillus Calmette–Guérin (BCG), are being studied for their effectiveness in reducing the incidence and severity of COVID-19 infection. Methods: In this multi-centre quadruple-blind, parallel assignment randomised control trial, 495 high-risk group adults (aged 18–60 years) were randomised into BCG and placebo arms and followed up for 9 months from the date of vaccination. The primary outcome was the difference in the incidence of COVID-19 infection at the end of 9 months. Secondary outcomes included the difference in the incidence of severe COVID-19 infections, hospitalisation rates, intensive care unit stay, oxygen requirement and mortality at the end of 9 months. The primary analysis was done on an intention-to-treat basis, while safety analysis was done per protocol. Results: There was no significant difference in the incidence rates of cartridge-based nucleic acid amplification test (CB-NAAT) positive COVID-19 infection [odds ratio (OR) 1.08, 95% confidence interval (CI) 0.54–2.14] in the two groups, but the BCG arm showed a statistically significant decrease in clinically diagnosed (symptomatic) probable COVID-19 infections (OR 0.38, 95% CI 0.20–0.72). Compared with the BCG arm, significantly more patients developed severe COVID-19 pneumonia (CB-NAAT positive) and required hospitalisation and oxygen in the placebo arm (six versus none; p = 0.03). One patient belonging to the placebo arm required intensive care unit (ICU) stay and died. BCG had a protective efficacy of 62% (95% CI 28–80%) for likely symptomatic COVID-19 infection. Conclusions: BCG is protective in reducing the incidence of acute respiratory illness (probable symptomatic COVID-19 infection) and severity of the disease, including hospitalisation, in patients belonging to the high-risk group of COVID-19 infection, and the antibody response persists for quite a long time. A multi-centre study with a larger sample size will help to confirm the findings in this study. Clinical Trials Registry: Clinical Trials Registry India (CTRI/2020/07/026668). Plain Language Summary: The Bacillus Calmette–Guérin (BCG) vaccine has been studied previously in several settings, including reducing childhood mortalities due to viral infections and induction of trained immunity and reducing upper respiratory tract infections and pneumonia in older adults. This multi-centre trial has tried to evaluate the efficacy of BCG revaccination in reducing the incidence and severity of COVID-19 infections in adults between 18 and 60 years of age belonging to the high-risk group owing to the presence of comorbidities including diabetes, chronic kidney disease, chronic liver disease and chronic lung diseases. A single dose of BCG vaccine produced significantly high titres of BCG antibodies lasting for six months. While there was no significant reduction in the incidence of COVID-19 infection, there was an 8.4% reduction in the incidence of symptomatic COVID-19 disease at the end of 9 months of follow-up. In addition, there were significantly fewer severe COVID-19 infections requiring hospital stay and oxygen support. However, the overall numbers of severe COVID-19 infections were low. Thus, the study shows that BCG can protect against symptomatic and severe COVID-19 disease. However, it might not reduce the incidence of new infections. The study results are significant for low- and middle-income countries without adequate coverage of primary doses of COVID-19 vaccination, let alone the booster doses. Future studies should evaluate the BCG vaccine's efficacy as a booster compared with routine COVID-19 vaccine boosters. [ABSTRACT FROM AUTHOR]

In this study, the effect of multiwall carbon nanotubes (MWCNTs) on various properties of a fired clay brick was investigated and subsequently compared with other kinds of bricks. MWCNT doped bricks and traditional bricks were prepared in laboratory conditions and commercially available bricks were obtained from a nearby manufacturer. Each group of bricks were subjected to various tests such as visual examination, dimension tolerance test, efflorescence test, water absorption test, impact resistance test, soundness test, hardness test, structure test, compressive strength test, and scanning electron microscopy (SEM) imaging. An extensive characterization of soil, water, and MWCNT was carried out. X-ray diffraction (XRD), X-ray fluorescence (XRF), and scanning electron microscopy–energy dispersive spectroscopy (SEM-EDS) were done to characterize soil in addition to basic consistency limit tests. MWCNT was characterized using XRD, SEM-EDS, and Fourier transform infrared spectroscopy (FTIR). Soil passing through a 425-μm sieve was used to manufacture MWCNT doped brick (0.01% of water by weight) and traditional bricks. The compressive strength of MWCNT doped bricks was 53.9% and 45.52% more as compared to commercially available and traditional bricks. An adequate reduction in water absorption was recorded when compared with traditional and commercially available bricks. Economic analysis was also carried out, which marked an increase of $0.0134 per brick in the manufacturing of MWCNT doped bricks. [ABSTRACT FROM AUTHOR]

Background & objectives: Several studies have been conducted globally to assess the impact of usage of mobile phones on quality and duration of sleep as also on day time sleepiness. The objective of the present study was to assess the effect of mobile phone usage on the quality and composition of sleep in a sample from Indian population. Methods: The study was conducted at two tertiary care hospitals in north India from July 2014 to September 2019. A total of 566 participants were recruited in this study from both the centres. Sleep quality was assessed with the help of the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Subsequently, actigraphy was done in 96 participants and polysomnography in 95 participants. Results: Of the 566 participants, 128 (22.61%) had PSQI ≥5, reflecting poor sleep quality. A higher use of mobile phone was significantly associated with a poor sleep quality as a component of PSQI questionnaire (P=0.01) and higher overall PSQI score (P=0.01). The latency from sleep onset to N2 and N3 sleep stages was significantly shorter in participants having a higher mobile phone usage as compared to those with a lower usage [Median (range): 13.5 min (1.5-109) vs. 6.5 min (0-89); P=0.02] and [Median (range): 49 min (8.5-220.5) vs. 28.75 min (0-141); P=0.03], respectively. Interpretation & conclusions: This study focused on the maladaptive changes brought on by mobile phone usage on sleep. More studies with larger sample sizes need to be done that may serve to confirm the hypothesis generating findings of our study. [ABSTRACT FROM AUTHOR]

Background & objectives: Despite advances in diagnostics and therapeutics, tuberculosis (TB) is widely prevalent and contributes to a significant burden of illness in both developing and developed nations. The present study was aimed to assess the role of coronin in TB patients and healthy controls. Coronin is a leucocyte-specific protein that is actively recruited in mycobacterial phagolysosomes, where it inhibits lysosomal delivery of Mycobacterium by activating a calcium-dependent phosphatase-calcineurin. Methods: In the study, 100 newly diagnosed cases of TB (pulmonary and extra-pulmonary) and healthy controls were prospectively enrolled over one year and the levels of coronin-1a in these patients and controls were measured by quantitative PCR (qPCR). Results: A total of 100 TB patients and 100 healthy individuals as controls were assessed. There were 59 patients with extra-pulmonary TB (EPTB) and 41 of pulmonary TB (PTB). In 47 per cent of patients, corroborative histopathological evidence of TB was also available. Significantly higher values of coronin-1a were observed in TB patients (19.94±2.61) than in healthy controls (16.09±1.91) (P<0.001). Interpretation & conclusions: Coronin 1a appears to play an important role in the TB disease pathophysiology and agents developed against coronin may have a role in the treatment of TB. Further studies are required to assess if coronin-1a levels are elevated in non-tubercular infective a etiologies and whether these can be a potential drug target in patients with TB. [ABSTRACT FROM AUTHOR]

Correction to: Efficacy of Bacillus Calmette-Guérin (BCG) Vaccination in Reducing the Incidence and Severity of COVID-19 in High-Risk Population (BRIC): a Phase III, Multi-centre, Quadruple-Blind Randomised Control Trial The original article can be found online at https://doi.org/10.1007/s40121-022-00703-y. The supplementary material file has been corrected and the original article has been updated. [Extracted from the article]

Warm mix asphalt (WMA) has the advantage of lower production temperature as compared to conventional hot mix asphalt (HMA). It is prepared by using various types of technologies which change the properties of bitumen binder attributes to ease in workability of the mixes. In the present study, bitumen emulsion was used for preparing WMA mixes by pre-coating the aggregates. Moreover, the conventional filler used in such mixes was replaced with industrial wastes to further reap environmental benefits. Marble dust (MD) and ground granulated blast-furnace slag (GGBS) are generated abundantly and disposal is a big issue. These were used in varying contents (i.e. from 2% to 8% by the weight of mix) and WMA properties were evaluated for strength and durability. Marshall properties and indirect tensile strength test (ITS) were carried out for strength evaluation. The tensile strength ratio (TSR) was conducted as per AASHTO T 283 for durability analysis. The wheel tracker test was performed for rutting analysis. Cantabro loss was determined to assess the cohesion resistance of the asphalt mixtures. Scanning electron microscopy (SEM) images were used to assess the microscopic characteristics of WMA and its constituents. The results revealed that the inclusion of both MD and GGBS as fillers into WMA had significantly improved the stability, tensile strength, TSR, rutting and Cantabro loss results as compared to the control mix. However, the addition of GGBS filler in emulsified warm mixes showed better resistance to moisture too. Lower rut depth was observed using GGBS as compared to marble dust filler. The statistical analysis reported that there was a significant difference between stability and TSR values whereas for adhesion loss it showed insignificant difference between the GGBS and MD based mixes. [ABSTRACT FROM AUTHOR]

Background: Chronic pulmonary aspergillosis (CPA) is known to complicate patients with post‐tubercular lung disease. However, some evidence suggests that CPA might co‐exist in patients with newly‐diagnosed pulmonary tuberculosis (P.TB) at diagnosis and also develop during therapy. The objective of this study was to confirm the presence of CPA in newly diagnosed P.TB at baseline and at the end‐of‐TB‐therapy. Materials and Methods: This prospective longitudinal study included newly diagnosed P.TB patients, followed up at third month and end‐of‐TB‐therapy with symptom assessment, anti‐Aspergillus IgG antibody and imaging of chest for diagnosing CPA. Results: We recruited 255 patients at baseline out of which 158 (62%) completed their follow‐up. Anti‐Aspergillus IgG was positive in 11.1% at baseline and 27.8% at end‐of‐TB‐therapy. Overall, proven CPA was diagnosed in 7% at baseline and 14.5% at the end‐of‐TB‐therapy. Around 6% patients had evidence of aspergilloma in CT chest at the end‐of‐TB‐therapy. Conclusions: CPA can be present in newly diagnosed P.TB patients at diagnosis and also develop during anti‐tubercular treatment. Patients with persistent symptoms or developing new symptoms during treatment for P.TB should be evaluated for CPA. Whether patients with concomitant P.TB and CPA, while receiving antitubercular therapy, need additional antifungal therapy, needs to be evaluated in future studies. [ABSTRACT FROM AUTHOR]

Background: Bronchoalveolar lavage (BAL) galactomannan (GM) is commonly used to diagnose Aspergillus‐related lung diseases. However, unlike serum GM, which is measured in undiluted blood, BAL‐GM is estimated using variable aliquots and cumulative volume of instillates during bronchoscopy. Objective: Since different studies have reported varying diagnostic accuracy and cut‐offs for BAL‐GM in CPA, we hypothesized that the total volume of instillate and ‘order/label’ of aliquots significantly affects the BAL‐GM values, which was evaluated as part of this study. Patients & Methods: We obtained 250 BAL samples from 50 patients (five from each) with suspected chronic pulmonary aspergillosis. BAL fluid was collected after instilling sequential volumes of 40 mL of normal saline each for the first four labels and a fifth label was prepared by mixing 1 mL from each of the previous labels. The GM level of each label was measured by PLATELIA™ ASPERGILLUS Ag enzyme immunoassay. This study measured the discordance, level of agreement, diagnostic characteristics (sensitivity, specificity and AUROC) and best cut‐offs for BAL‐GM in the different aliquots of lavage fluid. Results: The study population, classified into CPA (28%) and non‐CPA (72%) groups, based on ERS/ESCMID criteria (excluding BAL‐GM) were not different with respect to clinico‐radiological characteristics. The discordance of BAL‐GM positivity (using a cut‐off of >1) between the serial labels for the same patient ranged between 10% and 22%, while the discordance between classification using BAL‐GM positivity (using a cut‐off of ≥1) and clinic‐radio‐microbiological classification ranged between 18% and 30%. The level of agreement for serial labels was at best fair (<0.6 for all except one ‘label’). The AUROC for the serial samples ranged between 0.595 and 0.702, with the ‘40 mL and the ‘mix’ samples performing the best. The best BAL‐GM cut‐off also showed significant variation between serial labels of varying dilutions (Range:1.01 ‐ 4.26). Interpretation: This study highlights the variation in BAL‐GM measured and the ‘positivity’ between different ‘labels’ of aliquots of BAL, with the first aliquot and the mixed sample showing the best performances for diagnosis of CPA. Future studies should attempt to ‘standardise’ the instilled volume for BAL‐GM estimation to standardise the diagnostic yield. [ABSTRACT FROM AUTHOR]

Context • Gas discharge visualization (GDV) works on the principle of the Kirlian effect. It’s a noninvasive, quick, and safe biometric tool to investigate the psychophysiological state of an individual, with the potential to identify deviations from the healthy functioning of humans at early stages. Objective • The study intended to systematically document the scientific evidence pertaining to the use of GDV devices in human health and disease conditions. Design • The research team performed a systematic search for studies on GDV on research databases such as Google Scholar, PubMed, and PsychINFO, using the following inclusion criteria: (1) experimental studies dealing with a GDV device, (2) studies dealing with human participants related to health and disease, and (3) studies published in the English language. The study excluded: (1) review articles, (2) case studies, (3) letter to editors, (4) studies with unclear methodology, and (5) studies published before the year 2000. Setting • The study took place in the Department of Integrative Medicine at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru, India. Results • After filtering, the research team obtained 108 publications that dealt with the application of a GDV device in human participants. Based on the selection criteria, 42 studies were included in the review. These 42 studies included eight randomized controlled trials (RCTs), five nonrandomized controlled studies, 17 crosssectional studies, 10 single-group pre-post studies, and two correlational studies. Conclusions • More studies with a robust methodology are needed to make definitive conclusions. The literature reveals that the GDV technique has the potential to provide early diagnosis and screening, especially in disorders of the endocrine and immune systems. It might also be used to assess wellness in healthy subjects and monitor the effects of interventions, such as yoga— including pranayama and meditation, acupuncture, qigong, music therapy, and massage on the human energy system. Future studies should focus on the validation of GDV imaging in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious concern in health-care settings, as the infections difficult to treat. In this study, we evaluated the common bacteria causing CLABSI, and various patient and pathogen factors affecting the clinical outcome. Methods: In the prospective observational study, patients diagnosed with CLABSI were recruited. Extensive clinical, microbiological, and other laboratory workup was done, and observations were recorded. Congo red agar method, tube test, and microtiter plate assay were used for eliciting the biofilm-forming attributes of the bacterial pathogens. Results: Klebsiella pneumoniae was responsible for 48% of CLABSI, followed by Coagulase-negative Staphylococci (16%) and Staphylococcus aureus and Acinetobacter baumannii (12% each). Fifty-six percent of the isolates produced biofilms. The median (interquartile range) duration of hospital stay till death or discharge was 30 (20, 43) days. The all-cause mortality was 44%. Patients having a deranged liver function on the day of diagnosis (P value for total bilirubin 0.001 and for aspartate transaminase 0.02), and those infected with multidrug-resistant organisms (P value = 0.04) had significantly poor prognosis. The difference in the demographic, clinical, laboratory profile, and outcome of patients infected with biofilm producers and nonproducers was not found to be statistically significant. Conclusion: The study throws light on various host and pathogen factors determining the cause and outcome of CLABSI patients. To the best of our knowledge, this is the first study trying to decipher the role of biofilm formation in the virulence of pathogens and the prognosis of CLABSI. [ABSTRACT FROM AUTHOR]

New variants of SARS-CoV-2 continue to evolve. The novel SARS-CoV-2 variant of concern (VOC) B.1.1.529 (Omicron) was particularly menacing due to the presence of numerous consequential mutations. In this study, we reviewed about 12 million SARS-CoV-2 genomic and associated metadata using extensive bioinformatic approaches to understand how evolutionary and mutational changes affect Omicron variant properties. Subsampled global data based analysis of molecular clock in the phylogenetic tree showed 29.56 substitutions per year as the evolutionary rate of five VOCs. We observed extensive mutational changes in the spike structural protein of the Omicron variant. A total of 20% of 7230 amino acid and structural changes exclusive to Omicron's spike protein were detected in the receptor binding domain (RBD), suggesting differential selection pressures exerted during evolution. Analyzing key drug targets revealed mutation-derived differential binding affinities between Delta and Omicron variants. Nine single-RBD substitutions were detected within the binding site of approved therapeutic monoclonal antibodies. T-cell epitope prediction revealed eight immunologically important functional hotspots in three conserved non-structural proteins. A universal vaccine based on these regions may likely protect against all these SARS-CoV-2 variants. We observed key structural changes in the spike protein, which decreased binding affinities, indicating that these changes may help the virus escape host cellular immunity. These findings emphasize the need for continuous genomic surveillance of SARS-CoV-2 to better understand how novel mutations may impact viral spread and disease outcome. [ABSTRACT FROM AUTHOR]

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis with underlying circulatory cellular and metabolic abnormalities associated with higher mortality rates. However, a detailed understanding of sepsis is still limited. The present study reports the differences in the metabolic profile of serum samples of patients with sepsis compared to healthy controls using Nuclear Magnetic Resonance (NMR) spectroscopy. The study also compares the NMR metabolomics on day zero of admission among sepsis survivors (those who survived till day seven) and sepsis non-survivors (those who succumbed on day zero). Furthermore, the different metabolites in serum were analysed by univariate and multivariate analysis, ROC analysis, principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA) methods. Metabolites with VIP score (>1·0) were considered as potential biomarker/s to discriminate sepsis survivors from non- survivors at day zero. Data showed that phenylalanine was significantly higher in sepsis patients compared to healthy controls, whereas isoleucine, valine and histidine were significantly lower in sepsis patients compared to healthy controls. Also, non-survivors had higher serum levels of creatine, phosphocreatine, choline, betaine, tyrosine, histidine and phenylalanine concentrations than survivors. These findings suggest that the metabolic alterations at day zero may predict the survival of patients with sepsis. The significant differences seen in metabolites concentration of amino acids, phospholipids and creatine may be used as early prognostic markers to discriminate non-survivors from survivors of sepsis patients at day zero. Our findings indicate that the metabolite alterations are associated with the progression of the disease. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of CPA relies on the detection of the IgG Aspergillus antibody, which is not freely available, especially in resource-poor settings. Point-of-care tests like LDBio Aspergillus ICT lateral flow assay, evaluated in only a few studies, have shown promising results for the diagnosis of CPA. However, no study has compared the diagnostic performances of LDBio LFA in setting of tuberculosis endemic countries and have compared it with that of IgG Aspergillus. Objectives: This study aimed to evaluate the diagnostic performances of LDBio LFA in CPA and compare it with existing the diagnostic algorithm utilising ImmunoCAP IgG Aspergillus. Methods: Serial patients presenting with respiratory symptoms (cough, haemoptysis, fever, etc.) for >4 weeks were screened for eligibility. Relevant investigations, including direct microscopy and culture of respiratory secretions, IgG Aspergillus, chest imaging, etc., were done according to existing algorithm. Serums of all patients were tested by LDBio LFA and IgG Aspergillus (ImmunoCAP Asp IgG) and their diagnostic performances were compared. Results: A total of 174 patients were included in the study with ~66.7% patients having past history of tuberculosis. A diagnosis of CPA was made in 74 (42.5%) of patients. The estimated sensitivity and specificity of LDBio LFA was 67.6% (95% CI: 55.7–78%) and 81% (95% CI: 71.9–88.2%), respectively, which increased to 73.3% (95% CI: 60.3–83.9%) and 83.9% (95% CI: 71.7–92.4%), respectively, in patients with a past history of tuberculosis. The sensitivity and specificity of IgG Aspergillus was 82.4% (95% CI: 71.8–90.3%) and 82% (95% CI: 73.1–89%); 86.7% (95% CI: 75.4–94.1%) and 80.4% (95% CI: 67.6–89.8%), in the whole group and those with past history of tuberculosis, respectively. Conclusions: LDBio LFA is a point-of-care test with reasonable sensitivity and specificity. However, further tests may have to be done to rule-in or rule-out the diagnosis of CPA in the appropriate setting. [ABSTRACT FROM AUTHOR]

Objective: The objective was to study the sensitivity, specificity, and diagnostic accuracy of various computed tomography (CT) chest findings in diagnosing recurrence among pulmonary tuberculosis (PTB) suspects. Materials and Methods: A prospective observational study was conducted in a tertiary care hospital in New Delhi. A total of 130 suspects with a past history of treatment for PTB, who presented with any of the symptoms suggestive of recurrence were included. Sputum-positive, HIV-positive patients, pregnant females, and patients aged <18 years were excluded. Patients underwent CT chest followed by bronchoalveolar lavage (BAL). Results: A total of 62 patients were there in the final analysis. The median age of the patients with recurrent PTB was 27.5 years. Cough was the universal symptom in all these patients (>90%). Hemoptysis was the predominant symptom among patients with chronic pulmonary aspergillosis (66.6%). Necrotic mediastinal lymph nodes had good diagnostic accuracy of 88.71% with area under the curve of 0.806, P < 0.001 in diagnosing recurrent TB. BAL GeneXpert and mycobacteria growth indicator tube had good sensitivity (83.33% and 84.62%, respectively), specificity (100% for both), and excellent diagnostic accuracy (95.16% and 96.36%, respectively) for diagnosing recurrence in sputum negative and sputum scarce patient, (P < 0.001) when compared with composite reference standard. For culture-positive cases, BAL GeneXpert MTB/RIF had 100% sensitivity and 97.73% specificity in diagnosing recurrent PTB patients. Conclusion: The presence of mediastinal necrotic lymph node is the most accurate CT finding that can differentiate recurrent TB from post-TB sequelae. No other single chest CT scan finding had reliable diagnostic accuracy in comparison to microbiological tools in diagnosing recurrence among sputum negative or scarce previously treated PTB suspects. [ABSTRACT FROM AUTHOR]

Background: Though invasive pulmonary aspergillosis is a well known complication of COVID‐19 pneumonia, indolent forms of aspergillosis have been rarely described. Methods: We prospectively collected the clinico‐radio‐microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID‐19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp. Result: The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID‐19 illness with a mean duration of 29.2 ± 12 days from COVID‐19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post‐COVID‐19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow‐up period. Conclusion: SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID‐19 in the background of steroid use with or without pre‐existing diabetes. [ABSTRACT FROM AUTHOR]

Global literature examining the association between mental health of women living with HIV (WLWH) and child development is scarce. In this study, we examined the relationship between mothers' mental health and their children's social development outcomes 6 months later. Data for these analyses come from several waves of interviews of 600 WLWH in the South Indian state of Andhra Pradesh, India. These women were enrolled in a 2 × 2 factorial clinical trial designed to assess the impact of food supplementation and nutrition education, both in addition to ASHA support, on adherence to ART and improved health outcomes for the women and one of their children. They were assessed on food security, stigma, social support, quality of life, depressive symptoms and child development outcomes. Results of longitudinal GEE regression analysis indicate that mother's depressive symptoms were significantly negatively associated with child's social quotient 6 months later. These findings have important implications for targeted health interventions, integrating mental health, both for WLWH and their children in India. [ABSTRACT FROM AUTHOR]

Background: Pulmonary aspergilloma (PA) is a common complication seen in patients with pulmonary tuberculosis sequelae. Antifungal therapy, including oral azoles, is commonly used though only surgical resection offers curative benefit. Local administration of amphotericin B, like intracavitary instillation, has been effective in aspergilloma patients though nebulised amphotericin B (nAB) has never been formally assessed. Objective: The aim of this prospective, non‐inferior, open‐label, randomised control trial is to evaluate the efficacy and safety of nebulised amphotericin B compared to oral itraconazole therapy in the treatment of PA. Patients/Methods: Diagnosed cases of PA (n=33) were randomised into the control group receiving oral itraconazole (n=18) and intervention group receiving nebulised amphotericin B (n = 15). Response to treatment was assessed both clinically and radiologically at the end 6 months. Results and Conclusion: The number of patients showing overall improvement at the end of 6 months in the control arm(oral itraconazole) vs intervention arm(nebulised amphotericin B) was 65% (95% CI 38.3–85.8) and 67%(95% CI 38.4%–88.2%), respectively, in the intention‐to‐treat and 79% (95% CI 49.2%–95.3%), and 65% (95% CI 38.4%–88.2%), respectively, in the per‐protocol analysis. While there was no statistically significant difference between the intervention and control arm in both the analyses, non‐inferiority was shown in the per‐protocol but not in the intention‐to‐treat analysis. No major adverse events were noted in either group; however, a significant proportion of patients receiving nAB reported minor cough (40%), which, however, did not lead to discontinuation of therapy in any patients. Nebulised amphotericin B can be an effective therapeutic option for pulmonary aspergilloma patients. [ABSTRACT FROM AUTHOR]

Background: Currently, there is no data on the impact of COVID-19 on patients' income and work in India. Methods: We conducted a cross-sectional study at a tertiary hospital in New Delhi. We included all the patients who were ≥18 years of age and consecutively diagnosed with COVID-19 between the 1st of May 2020 to 31st July 2020. Patients were interviewed by a physician using a semi-structure questionnaire. Data were collected on socio-economic status, occupation, income loss, leaves taken, decrease in work efficiency (self-perceived) and about-facing any stigma/discrimination at the workplace. Results: Out of 245 patients, 190 patients were employed. A total of 126 patients (66.3%) self-reported their work was affected due to COVID-19 disease. A total of 30.5% of patients (n = 58/190) reported deduction in their salary. The median amount of salary loss was INR 10,000 (IQR 9000–25000). Decrease in income and work efficiency (self-perceived) was found to be 37.3% (n = 71) and 12.1% (n = 23), respectively. A total of 47 patients (37.3%) took personal leaves (median number – 17 days (IQR 14–25), and discrimination/stigma related to the COVID-19 at the workplace was faced by 22.6% of patients. Conclusion: Income and work of a substantial number of patients was affected due to COVID-19, as there was a decrease in income and work efficiency. Patients also had to take personal leaves and face stigma in the workplace. This will inform the policymakers to formulate strategies to mitigate the impact of COVID-19. [ABSTRACT FROM AUTHOR]