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Abstract The Indian summer monsoon rainfall (ISMR) exhibits significant variability, affecting the food and water security of the densely populated Indian subcontinent. The two dominant spatial modes of ISMR variability are associated with the El Niño Southern Oscillation (ENSO) and the strength of the semi-permanent monsoon trough along with related variability in monsoon depressions, respectively. Although the robust teleconnection between ENSO and ISMR has been well established for several decades, the major drivers leading to the time-varying relationship between ENSO and ISMR patterns across different regions of the country are not well understood. Our analysis shows a consistent increase from a moderate to substantially strong teleconnection strength between ENSO and ISMR from 1901 to 1940. This strengthened relationship remained stable and strong between 1941 and 1980. However, in the recent period from 1981 to 2018 the teleconnection decreased consistently again to a moderate strength. We find that the ENSO–ISMR relationship exhibits distinct regional variability with time-varying relationship over the north, central, and south India. Specifically, the teleconnection displays an increasing relationship for north India, a decreasing relationship for central India and a consistent relationship for south India. Warm SST anomalies over the eastern Pacific Ocean correspond to an overall decrease in the ISMR, while warm SST anomalies over the Indian Ocean corresponds to a decrease in rainfall over the north and increase over the south of India. The central Indian region experienced the most substantial variation in the ENSO–ISMR relationship. This variation corresponds to the variability of the monsoon trough and depressions, strongly influenced by the Pacific Decadal Oscillation and North Atlantic Oscillation, which regulate the relative dominance of the two spatial modes of ISMR. By applying the PCA-Biplot technique, our study highlights the significant impacts of various climate drivers on the two dominant spatial modes of ISMR which account for the evolving nature of the ENSO–ISMR relationship.

Introduction: Undiagnosed hypertension (HTN) increases the risk of severe consequences such as chronic kidney disease (CKD), hypertensive retinopathy, heart failure, and stroke. Population-based screening can be used to expose the hidden diseased mass with active disease. Thus, a screening survey was conducted to estimate the proportion of people with HTN among apparently healthy adults of age ≥30 years residing at the urban field practice area (UHTC) of AIIMS, Raipur, and also determine the predictors of undiagnosed HTN among the study participants. Methodology: This was a community-based cross-sectional study conducted over 2 months duration in the Ramnagar area, which comes under the urban field practice area of AIIMS Raipur using the STEPS tool is an acronym of study tool provided by WHO i.e. STEPwise approach to NCD risk factor surveillance consisting of three steps viz. questionnaire for behavioural risk factors, physical measurements and biochemical measurements. Results: In this study, 24.2% (95%, confidence interval [CI]: 20.1–28.2) of participants screened positive for HTN. The proportion of males who screened positive for HTN was 28.8% (95% CI: 22.6–35), whereas the proportion of females who screened positive for HTN was 19.6% (95% CI: 14.3–25). In this study, elderly (>60 years), male gender, daily tobacco use, greater waist circumference (male >90 cm and female >80 cm), and daily salt intake of more than 5 g were found to have higher odds of having HTN. Conclusion: The prevalence of undiagnosed HTN in the UHTC of AIIMS Raipur was quite high.

Abstract Species with sympatric distribution influence ecosystem dynamics and are impacted by the presence of other co-existing species. Assessing the coexistence and the role of interspecific interactions with the landscape variables is necessary to know the species co-occurrence in space. In the Indian Himalayan region, such studies are completely lacking due to limited efforts being made, mainly because of complex terrains and inaccessible landscape features. We used camera trapping and sign survey in a multi-species occupancy framework to understand the influence of environmental variables on occupancy and detection probability of species-specific and pair-wise interaction of the three ungulates in Uttarkashi. Our results concluded that individual species' occupancy probabilities were related both to the environmental variables and the presence or absence of other interacting species. Our top model showed evidence of interspecific interaction among species pairs, and the occupancy probability of species one varied in the presence or absence of another species. The overall activity patterns were similar among all the three species and were found active throughout the day. The activity overlap between sambar—barking deer (Dhat1 value = 0.85) was considerably higher than barking deer—goral (Dhat1 value = 0.78). The findings of the present study will be useful for the conservation and management of ungulates in the Indian Himalayan and adjoining regions.

Introduction: Lateral closing wedge osteotomy is an accepted correction method for cubitus varus deformity. The techniques used to fix the osteotomy mostly lead to either angulation or loss of correction during the final tightening of the Stainless Steel (SS) wire at the osteotomy site. The records for patients undergoing two modifications in a conventional modified French Osteotomy were analysed. Four wires, two proximal and two distal to the osteotomy site for precision and guided compression over the other additional Kirschner wire (K-wire) at the osteotomy site, were the two modifications in these patients. Aim: To analyse the functional outcome of cubitus varus deformity in children treated with technical modifications of modified French osteotomy. Materials and Methods: This was a retrospective cohort study done at the Department of Orthopaedics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. The study duration was three years (from April 2019 to April 2022). A total of 34 cubitus varus deformity patients were included in this study who were operated with lateral closing wedge-modified French osteotomy with technical modification by K-wires. The patients were followed-up for a minimum of six months. The results were analysed using Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Flynn’s criteria. Statistical Package for the Social Sciences (SPSS) version 21.0 was used and p-value

Introduction: Giant Cell Tumour (GCT) around the knee joint is the most common site for this locally malignant bone tumour and, in advanced stages, requires excision of the tumour mass. Current recommendations promote joint salvage procedures in allograft or mega prosthetic replacement. Patients undergoing this surgery need massive changes in their lifestyle to cope with their activities of daily living. The psychological and social impact following these procedures has not been extensively studied. Aim: To observe the long term functional results as well as the impact on quality of life in patients undergoing endoprosthetic replacements in GCT around the knee with emphasis on any difference in results among the cases operated for distal femoral and proximal tibial GCT. Materials and Methods: This retrospective study was conducted at Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow from June 2015 to June 2019 with a total sample size of 21 cases. The two groups formed were; one having GCT of distal end femur and the other group with GCT of proximal end tibia. The evaluation was done for outcome measures by Oxford Knee Score (OKS) and Musculo Skeletal Tumour Society score (MSTS) for their functional outcome and Short Form Health Survey (SF-12) for their quality of life effect at two years postoperatively. Students unpaired t-test was performed for intergroup analysis and Analysis of Variance (ANOVA) was done for within the group analysis for subsequent follow-up visits. Data was analysed using Statistical Package for Social Sciences (SPSS) version 21. Results: The mean age of study population was 33.67±8.674 years. The male-female distribution was insignificant (p=0.673), providing us with a homogenous study group. Recurrent GCT was found significantly more commonly in the proximal tibia group than in the distal femur group (p=0.031). Comparison of OKS and MSTS preoperatively, at six months, at one year, and two years showed statistically significant improvement in successive follow-ups in both the distal femur and proximal tibia groups (p

Introduction: Comforting manoeuvres like hand holding and calming conversation with the parturients may decrease anxiety among them by establishing a rapport and building confidence and trust to alleviate fear. Aim: Evaluation of role and effectiveness of comforting manoeuvres (hand holding and calming conversation) in relieving patient’s anxiety and subjective satisfaction undergoing caesarean section in regional anaesthesia. Materials and Methods: This was a single centre randomised control trial conducted in the Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from February 2022 to June 2022. There were 144 parturients, in the age group 18-40 years, American Society of Anaesthesiology (ASA) II, and admitted for Caesarean section under regional anaesthesia. Patients were randomised into four groups- control group (C)- group 1, only calming conversation (CC)- group 2, only Hand Holding (HH)- group 3 and Hand Holding and Calming Conversation (CH)- group 4. Demographic details of the patient, Visual Analogue Scale (VAS) for anxiety, Blood Pressure (BP), Heart Rate (HR), Respiratory Rate (RR) and patient satisfaction score on a 1-5 Likert scale were noted preoperatively. VAS was noted preoperatively and postoperatively for all groups. Patient Satisfication Score (PSS) was noted postoperatively. The HR, Mean Arterial Pressure (MAP), and RR were noted every 5 minutes for 20 minutes, then every 10 minutes till the end of the surgery, and 30 minutes after surgery. Any anxiolytic medication used intraoperatively was documented for all groups. Results: Total of 144 participants were analysed with 36 patients in each of four groups. Mean age (years) for group 1 was 23.36, group 2 was 23.25, group 3 was 23.17, and group 4 was 23.22. Baseline VAS was similar in all the groups. Post-operative VAS differed significantly - group 1 was 3.33±0.926, group 2 was 1.53±0.845, group 3 was1.47±0.845 and group 4 was 1.11±0.708. PSS also differed significantly - for group 1 was 2.42±0.732, group 2 was 3.50±0.697, group 3 was 3.67±0.717 and group 4 was 3.92±0.692. Stabilisation of hemodynamics in terms of BP, HR and RR was significantly better in all three interventional groups as compared to the control group. Conclusion: All three manoeuvres (hand holding, calming conversation alone and in combination) were equally effective in reducing perioperative anxiety, stabilising the hemodynamics and improving patient satisfaction in parturients undergoing caesarean section under regional anaesthesia. Comforting manoeuvres are simple, easy to practice and without any financial implication.

Introduction: Transurethral Resection of Prostate (TURP) is a common surgical procedure performed for Benign Prostatic Hypertrophy (BPH), most commonly under Spinal Anaesthesia (SA). It is generally tolerated well by the elderly but since they suffer from several co-morbidities, therefore, it is desirable to avoid hypotension following SA, in these patients. Levobupivacaine, a pure S enantiomer of racemic bupivacaine has emerged as a safe alternative to bupivacaine with similar efficacy and better pharmacokinetic profile. Aim: To compare the efficacy of intrathecal levobupivacaine with bupivacaine using fentanyl as adjuvant in TURP. Materials and Methods: This randomised controlled trial was conducted at Pandit BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between March 2022 to September 2022. Fifty patients, 50-80 years of age, American Society of Anaesthesiologists (ASA) I-III, posted for TURP under SA, were included in the study and divided into two groups: group B (n=25): Inj. bupivacaine (0.5%) hyperbaric 12.5 mg+25 μg fentanyl citrate, group L (n=25): Inj. levobupivacaine (0.5%) isobaric 12.5mg+25μg fentanyl citrate. Onset of sensory and motor block, time to onset of maximum sensory and motor block, Heart Rate (HR), Systolic Bood Pressure (SBP), Diastolic Bood Pressure (DBP) and Mean Arterial Pressures (MAP) were recorded. Data analysis was done with the help computer software using Statistical Package for the Social Sciences (SPSS), version 24.0. Means, standard deviations, Chi-square, t-values and p-values were calculated, p-value

Background: According to the Sample Registration System report, India has reduced the maternal mortality rate from 130 per 100,000 live births in 2014–2016 to 113 per 100,000 live births in 2016–2018. The main purpose of antenatal care is to identify “high-risk” cases as early as possible from a large group of antenatal mothers and provide them skilled and appropriate care. Objective: To determine the prevalence of high-risk pregnancy (HRP) in pregnant females availing services under pradhan mantri surakshit matritva abhiyan (PMSMA) and to assess awareness of pregnant mothers about services provided under PMSMA in district Etawah of Uttar Pradesh. Material and Methods: Community-based cross-sectional study was carried out among 400 female beneficiaries who were registered under the PMSMA scheme and delivered their baby at any government health facility during one year of study period. Results: It was observed that from all the antenatal women visiting the community health center for HRP day under the PMSMA scheme, 162 (40.5%) were categorized as HRPs and 238 (59.6%) of them were nonhigh-risk pregnancies. A statistically significant association was observed (P-value = 0.005 at 95% CI) between the difference in the proportion of HRPs and the educational status of the pregnant mothers. Out of 400 beneficiaries, 167 (41.75%) were aware of the PMSMA scheme. Conclusion: Regular antenatal care (ANC) check-ups, early identification of HRP, health education, and timely screening are needed to reduce maternal mortality.

A proportion of individuals affected with severe acute respiratory syndrome coronavirus 2 continue to have COVID-19 symptoms even after recovering from illness. These are termed as post-COVID condition (PCC)/long-COVID. Evidence suggests that symptoms of COVID-19 along with other generalised sequelae may persist in some patients with severe and very severe disease, as well as in patients who had mild or no symptoms. The management of PCC is a challenge as there is limited understanding about the issue even in healthcare professionals. Then, there is not enough documentation of post-COVID and long-COVID in India. From public health perspective, the health services and facilities have not been re-designed to tackle the situation. This review article aims to explore PCC and compilation of current international and national public health response along with recommendations to identify and manage the PCC at the primary. The article concludes the urgent need to document the burden of PCCs in India, develop standard case definition and equip primary healthcare facilities and providers with the requisite skills to manage the PCC. The governments, health care providers and facilities and public health bodies should also encourage and foster continuing country specific data, analysis and research into the determinants, duration and probable treatment modalities of PCC. The post and long-COVID conditions would require sustained policy and programmatic attention in all countries with special focus in low and middle income country settings.

Background: COVID-19 pandemic has given rise to a diverse set of problems related to mental health, employment, economic wellbeing, access to education, inflation, transportation, and vaccination in addition to physical health consequences. Health care workers (HCWs), being in forefront of providing care to COVID-19 patients, are a special vulnerable population suffering from COVID-19-related mental health problems. Method: A cross-sectional study to assess the prevalence of depression among HCWs working in different specialties of a tertiary care health center of Northern India was done. A self-designed performa containing sociodemographic details along with the “Zung self-rating depression scale” was used to obtain the prevalence of depression among HCWs. Result: Among 192 participants, 14.58% had signs of depression, out of which 11.96% had mild, 1.56% had moderate, and 1.04% had signs of severe depression. Conclusion: The depression among HCWs has increased after the onset of the COVID-19 pandemic.

Background: Nutritional anemia is still the primary cause of anemia despite of various nutritional programmes in developing countries. Aims and Objective: The present study was planned to asses Iron, Folate, and Vitamin B12 deficiency anaemia in developing countries. Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in Agra in collaboration with Institute of Genomics and Integrative Biology, New Delhi. Admitted children of age 6 months to 14 years having signs and symptoms of anaemia were included in the study. Sample size calculated was 157. All the cases were subjected to CBC, GBP, serum iron, ferritin, folate and vitamin B12 level estimation. Results: Out of 672 children, 157 children with clinical feature of anaemia were enrolled in the study. Among these 157 children, 52.87% were male. Percent proportion of anaemia was highest among toddlers (27.39%) and lowest in adolescent (10.83%). The maximum cases were of urban area (65.6%) and middle socioeconomic status (47.13%). Most of the children were undernourished/underweight (60.4%). Mean iron level was significantly low in female children, children of rural areas, low socioeconomic status and malnutrition/underweight. Mixed iron, folate and B12 deficiency was found in 48.41%, 30.57% and 22.93% cases respectively. In 24.20% cases no deficiencies were found and were classified as anaemia due to some unspecified causes. Conclusion: Nutritional deficiency anaemia is contributing to a large proportion of anaemic patients. More intensified programmes are needed especially for female children, children of rural areas, low socioeconomic status and malnutrition/underweight.

Abstract Cyclone Fani, in April 2019, was the strongest pre-monsoon cyclone to form in the Bay of Bengal after 1994. It underwent rapid intensification and intensified quickly to an extremely severe cyclone. It maintained a wind speed of ≥ 51 m s−1 (≥ 100 knots) for a record time period of 36 h. The total lifespan of the cyclone was double than the climatological lifespan. Also, the duration of the cyclone in its extremely severe phase and the accumulated cyclone energy were significantly larger than the climatological records for the pre-monsoon season. In the current study, we investigate the ocean-atmospheric conditions that led to its genesis, rapid intensification and long lifespan. Our analysis shows that the Madden Julian Oscillation and anomalous high sea surface temperatures provided conducive dynamic and thermodynamic conditions for the genesis of cyclone Fani, despite forming very close to the equator where cyclogenesis is generally unlikely. Further, favourable ocean subsurface conditions and the presence of a warm core eddy in the region led to its rapid intensification to an extremely severe cyclone. A large area of warm ocean surface and subsurface temperatures aided the cyclone to maintain very high wind speed for a record time period. The vital role of the ocean surface and the subsurface in the genesis and the intensification highlights the need to efficiently incorporate ocean initial conditions (surface and sub-surface) and ocean–atmosphere coupling in the operational cyclone forecasting framework.

Introduction Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care.Methods and analysis We will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial.Ethics and dissemination We will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry—India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.

Spermidine and other polyamines alleviate oxidative stress, yet excess spermidine seems toxic to Escherichia coli unless it is neutralized by SpeG, an enzyme for the spermidine N-acetyl transferase function. Thus, wild-type E. coli can tolerate applied exogenous spermidine stress, but ΔspeG strain of E. coli fails to do that. Here, using different reactive oxygen species (ROS) probes and performing electron paramagnetic resonance spectroscopy, we provide evidence that although spermidine mitigates oxidative stress by lowering overall ROS levels, excess of it simultaneously triggers the production of superoxide radicals, thereby causing toxicity in the ΔspeG strain. Furthermore, performing microarray experiment and other biochemical assays, we show that the spermidine-induced superoxide anions affected redox balance and iron homeostasis. Finally, we demonstrate that while RNA-bound spermidine inhibits iron oxidation, free spermidine interacts and oxidizes the iron to evoke superoxide radicals directly. Therefore, we propose that the spermidine-induced superoxide generation is one of the major causes of spermidine toxicity in E. coli.

In India, under the National Tuberculosis Elimination Programme, the government provides free treatment for multidrug-resistant tuberculosis; however, many patients seek care elsewhere, which is costly. To determine those out-of-pocket expenses, we interviewed 40 presumptive patients and found that they spent more than their median annual income before registering for the government program.

SARS-CoV-2 is the third major coronavirus epidemic to affect humans. There had been multiple instances of patients turning positive after recovering from SARS-2-CoV infection. Though many different theories emerge, false positive RT-PCR is logically the foremost cause and there is a general consensus that during quarantine re-infection from outside seems unlikely when strictly adhered to. As many new strains emerge worldwide during the course of on-going pandemic, the chances of re-infection cannot be ignored as it may contribute to false negative RT-PCR test results. SARS-2-CoV though a novel virus, is phylogenetically similar to SARS-like CoV with around 79% similarity. Studies on immunological response to these infections suggest that antibodies formed after infection confers immunity only for a short period of time before it starts to wane. Also studies on SARS-CoV-2 suggest that antibody formation and longevity of immunity in an individual is dependent on the strain of coronavirus, its severity and age of the person infected. All these considerations demand reviewing the treatment duration, discharge criteria, appropriate use of imaging techniques and importance of risk communication and health education to those recovered.

India with 8.6% of tribal population is finding it difficult to bridge the gap that exists between tribal and non-tribal population in regards to healthcare. Tribal population suffers triple burden of disease; in fact it is quadruple, namely, communicable diseases, non-communicable diseases, malnutrition, mental health, and addictions complicated by poor health seeking behavior. With increasing needs, an Expert committee on Tribal health has given recommendations with the goal to bridge the current gap in the health status of tribal people latest by the year 2027. An entirely parallel health system has been proposed with key focus areas, governance, and financing. To summarize and report the present scenario in terms of disease burden, health-seeking behavior, healthcare delivery system, and a roadmap for the future along the importance of primary healthcare in achieving it. Mere establishment of more health facilities cannot overcome the poor health of tribal population and so the role of trained manpower to deliver quality healthcare, in which case the role of traditional healers, local Tribal boys and girls comes in handy. It is high time and states should act swiftly to assess the needs, priorities of their own tribal population and set goals, targets to achieve the same through proven public health strategies.

The snow leopard (Panthera uncia) plays a vital role in maintaining the integrity of the high mountain ecosystem by regulating prey populations and maintaining plant community structure. Therefore, it is necessary to understand the role of the snow leopard and its interaction with prey species. Further, elucidating landscape use and co-occurrence of snow leopard and its prey species can be used to assess the differential use of habitat, allowing them to coexist. We used camera trapping and sign survey to study the interactions of snow leopard and its prey species (Siberian Ibex- Capra sibrica and Blue sheep-Pseudois nayaur) in the Spiti valley Himachal Pradesh. Using the occupancy modelling, we examined whether these prey and predator species occur together more or less frequently than would be expected by chance. To understand this, we have used ten covariates considering the ecology of the studied species. Our results suggest habitat covariates, such as LULC16 (barren area), LULC10 (grassland), ASP (aspect), SLP (slope) and DW (distance to water), are important drivers of habitat use for the snow leopard as well as its prey species. Furthermore, we found that the snow leopard detection probability was high if the site was used by its prey species, i.e., ibex and blue sheep. Whereas, in the case of the prey species, the probability of detection was low when the predator (snow leopard) was present and detected. Besides this, our results suggested that both species were less likely to detect together than expected if they were independent (Snow leopard-Ibex, Delta = 0.29, and snow leopard-blue sheep, Delta = 0.28, both the values are

BackgroundWe retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission.Methods and findingsData on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among 'survivors' and 'non-survivors'. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets. Among 746 COVID-19 patients hospitalised [487 "survivors" and 259 "non-survivors" (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40-70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO23; 3.01 (1.61-5.83), Age ≥50 years;2.52 (1.45-4.43), Pulse Rate ≥100/min: 2.02 (1.19-3.47) and coexisting Diabetes Mellitus; 1.73 (1.02-2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO23-11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as 'OUR-ARDs score' showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85.ConclusionsThe 'OUR ARDs' risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.

Objective To develop and validate a simple risk scores chart to estimate the probability of poor outcomes in patients with severe head injury (HI).Design Retrospective.Setting Level-1, government-funded trauma centre, India.Participants Patients with severe HI admitted to the neurosurgery intensive care unit during 19 May 2010–31 December 2011 (n=946) for the model development and further, data from same centre with same inclusion criteria from 1 January 2012 to 31 July 2012 (n=284) for the external validation of the model.Outcome(s) In-hospital mortality and unfavourable outcome at 6 months.Results A total of 39.5% and 70.7% had in-hospital mortality and unfavourable outcome, respectively, in the development data set. The multivariable logistic regression analysis of routinely collected admission characteristics revealed that for in-hospital mortality, age (51–60, >60 years), motor score (1, 2, 4), pupillary reactivity (none), presence of hypotension, basal cistern effaced, traumatic subarachnoid haemorrhage/intraventricular haematoma and for unfavourable outcome, age (41–50, 51–60, >60 years), motor score (1–4), pupillary reactivity (none, one), unequal limb movement, presence of hypotension were the independent predictors as its 95% confidence interval (CI) of odds ratio (OR)_did not contain one. The discriminative ability (area under the receiver operating characteristic curve (95% CI)) of the score chart for in-hospital mortality and 6 months outcome was excellent in the development data set (0.890 (0.867 to 912) and 0.894 (0.869 to 0.918), respectively), internal validation data set using bootstrap resampling method (0.889 (0.867 to 909) and 0.893 (0.867 to 0.915), respectively) and external validation data set (0.871 (0.825 to 916) and 0.887 (0.842 to 0.932), respectively). Calibration showed good agreement between observed outcome rates and predicted risks in development and external validation data set (p>0.05).Conclusion For clinical decision making, we can use of these score charts in predicting outcomes in new patients with severe HI in India and similar settings.

BackgroundRisk factors for the development of severe COVID-19 disease and death have been widely reported across several studies. Knowledge about the determinants of severe disease and mortality in the Indian context can guide early clinical management.MethodsWe conducted a hospital-based case control study across nine sites in India to identify the determinants of severe and critical COVID-19 disease.FindingsWe identified age above 60 years, duration before admission >5 days, chronic kidney disease, leucocytosis, prothrombin time > 14 sec, serum ferritin >250 ng/mL, d-dimer >0.5 ng/mL, pro-calcitonin >0.15 μg/L, fibrin degradation products >5 μg/mL, C-reactive protein >5 mg/L, lactate dehydrogenase >150 U/L, interleukin-6 >25 pg/mL, NLR ≥3, and deranged liver function, renal function and serum electrolytes as significant factors associated with severe COVID-19 disease.InterpretationWe have identified a set of parameters that can help in characterising severe COVID-19 cases in India. These parameters are part of routinely available investigations within Indian hospital settings, both public and private. Study findings have the potential to inform clinical management protocols and identify patients at high risk of severe outcomes at an early stage.

The 2019-Coronavirus (COVID-19) pandemic has had a global impact. The effect of environmental temperature on transmissibility and fatality rate of COVID-19 and protective efficacy of Bacillus Calmette-Guérin (BCG) vaccination towards COVID-19 remains ambiguous. Therefore, we explored the global impact of environmental temperature and neonatal BCG vaccination coverage on transmissibility and fatality rate of COVID-19. The COVID-19 data for reported cases, deaths and global temperature were collected from 31st December 2020 to 3rd April 2020 for 67 countries. Temperature data were split into quartiles for all three categories (minimum temperature, maximum temperature and mean temperature). The impact of three types of temperature data and policy of BCG vaccination on COVID-19 infection was determined by applying the multivariable two-level negative binomial regression analysis keeping daily new cases and daily mortality as outcome. The highest number of cases fell in the temperature categories as following: mean temperature in the second quartile (6°C to 10.5°C), median 26, interquartile range (IQR) 237; minimum temperature in the first quartile (-26°C to 1°C), median 23, IQR 173; maximum temperature in the second quartile (10°C to 16°C), median 27.5, IQR 219. For the minimum temperature category, 28% statistically significant lower incidence was noted for new cases from the countries falling in the second quartile (2°C to 6°C) compared with countries falling in the first quartile (-26°C to 1°C) (incidence rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.57 to 0.93). However, no statistically significant difference in incidence rate was observed for mean temperature categories in comparison to the first quartile. Countries with BCG vaccination policy had 58% less mortality as compared with countries without BCG coverage (IRR 0.42; 95% CI 0.18 to 0.95). Our exploratory study provides evidence that high temperature might not be associated with low transmissibility and countries having neonatal BCG vaccination policy had a low fatality rate of COVID-19.

Abstract Endophytic actinobacteria play an important role in growth promotion and development of host plant by producing enormous quantities of novel bioactive natural products. In the present investigation, 169 endophytic actinobacteria were isolated from endospheric tissues of Rhynchotoechum ellipticum. Based on their antimicrobial potential, 81 strains were identified by 16rRNA gene analysis, which were taxonomically grouped into 15 genera. All identified strains were screened for their plant growth promoting attributes and, for the presence of modular polyketide synthases (PKSI, PKSII and nonribosomal peptide synthetase (NRPS) gene clusters to correlate the biosynthetic genes with their functional properties. Expression studies and antioxidant potential for four representative strains were evaluated using qRT-PCR and DPPH assay respectively. Additionally, six antibiotics (erythromycin, ketoconazole, fluconazole, chloramphenicol, rifampicin and miconazole) and nine phenolic compounds (catechin, kaempferol, chebulagic acid, chlorogenic acid, Asiatic acid, ferulic acid, arjunic acid, gallic acid and boswellic acid) were detected and quantified using UHPLC-QqQLIT-MS/MS. Furthermore, three strains (BPSAC77, 121 and 101) showed the presence of the anticancerous compound paclitaxel which was reported for the first time from endophytic actinobacteria. This study provides a holistic picture, that endophytic actinobacteria are rich bacterial resource for bioactive natural products, which has a great prospective in agriculture and pharmaceutical industries.

Abstract Integrin beta8 (ITGB8) is involved in the endometrial receptivity. The blastocyst first interacts with the luminal endometrial epithelial cells during its implantation; therefore, we have investigated the signaling of ITGB8 via FAK and VAV-RAC1 in the endometrial epithelial cells. Integrin beta8 was found elevated in epithelial cells at late-pre-receptive (day4, 1600 h) and receptive (day5, 0500 h) stages of endometrial receptivity period in the mouse. Integrins downstream molecule FAK has demonstrated an increased expression and phosphorylation (Y397) in the endometrium as well as in the isolated endometrial epithelial cells during receptive and post-receptive stages. Integrin beta8 can functionally interact with FAK, VAV and RAC1 as the levels of phosphorylated-FAK, and VAV along with the RAC-GTP form was reduced after ITGB8 knockdown in the endometrial epithelial cells and uterus. Further, VAV and RAC1 were seen poorly active in the absence of FAK activity, suggesting a crosstalk of ITGB8 and FAK for VAV and RAC1 activation in the endometrial epithelial cells. Silencing of ITGB8 expression and inhibition of FAK activity in the Ishikawa cells rendered poor attachment of JAr spheroids. In conclusion, ITGB8 activates VAV-RAC1 signaling axis via FAK to facilitate the endometrial epithelial cell receptivity for the attachment of blastocyst.

BackgroundThere is limited information related to health behaviors and their related factors among young men in rural setting of India. This study was conducted to investigate multiple health risk behaviors and outcomes among young men aged 18-24 years in rural India.MethodsThis was a community-based cross-sectional survey conducted in the Ballabgarh block of Faridabad district, Haryana, India. Information regarding socio-demographic details, substance use, injury & violence, mental health and sexual behaviors were collected using a semi-structured interview schedule. Age adjusted prevalence estimates of behaviors and outcomes are computed along with 95% Confidence Intervals. Mediation analysis was carried out to examine relationships between socio-demographic variables, select behaviors and outcomes reported in the study.ResultsA total of 836 young men participated in the study, with mean (SD) age of 20.6 (1.9) years. The age-adjusted prevalence (with 95% Confidence Interval) for ever use of tobacco, alcohol, and other substances was 34.2% (33.9, 34.5), 23.4% (23.2, 23.6), and 4.5% (4.4, 4.5), respectively. Loneliness and suicidal thoughts were reported by 237 and 35 youth men with age adjusted prevalence as 28.6%, 95% CI: 28.4-28.8 and 4.3%, 95% CI: 4.23-4.31, respectively. A total of 330 young men met serious injury in past one year (prevalence 39.3%, 95%CI: 39.01-39.67). Almost one-third of men (prevalence 30.6%, 95%CI: 30.34-30.85) had engaged in pre-marital sexual intercourse. Current substance use was found to be significant mediator for associations with socio-demographic variables studied for dependent variables viz. pre-marital sexual intercourse and serious injury.ConclusionHigh prevalence of various risk behaviors and outcomes was found in young men aged 18-24 years in our rural setting. It is imperative that multi-component health intervention package be rolled out to address these.

[This corrects the article DOI: 10.1371/journal.pone.0220285.].

INTRODUCTION:There is lack of information on the proportion of new smear-positive pulmonary tuberculosis (PTB) patients treated with a 6-month thrice-weekly regimen under Revised National Tuberculosis Control Programme (RNTCP) who develop recurrent TB after successful treatment outcome. OBJECTIVE:To estimate TB recurrence among newly diagnosed PTB patients who have successfully completed treatment and to document endogenous reactivation or re-infection. Risk factors for unfavourable outcomes to treatment and TB recurrence were determined. METHODOLOGY:Adult (aged ≥ 18 yrs) new smear positive PTB patients initiated on treatment under RNTCP were enrolled from sites in Tamil Nadu, Karnataka, Delhi, Maharashtra, Madhya Pradesh and Kerala. Those declared "treatment success" at the end of treatment were followed up with 2 sputum examinations each at 3, 6 and 12 months after treatment completion. MIRU-VNTR genotyping was done to identify endogenous re-activation or exogenous re-infection at TB recurrence. TB recurrence was expressed as rate per 100 person-years (with 95% confidence interval [95%CI]). Regression models were used to identify the risk factors for unfavourable response to treatment and TB recurrence. RESULTS:Of the1577 new smear positive PTB patients enrolled, 1565 were analysed. The overall cure rate was 77% (1207/1565) and treatment success was 77% (1210 /1565). The cure rate varied from 65% to 86%. There were 158 of 1210 patients who had TB recurrence after treatment success. The pooled TB recurrence estimate was 10.9% [95%CI: 0.2-21.6] and TB recurrence rate per 100 person-years was 12.7 [95% CI: 0.4-25]. TB recurrence per 100 person-years varied from 5.4 to 30.5. Endogenous reactivation was observed in 56 (93%) of 60 patients for whom genotyping was done. Male gender was associated with TB recurrence. CONCLUSION:A substantial proportion of new smear positive PTB patients successfully treated with 6 -month thrice-weekly regimen have TB recurrence under program settings.

BACKGROUND:Trauma is predicted to become the third leading cause of death in India by 2020, which indicate the need for urgent action. Trauma scores such as the international classification of diseases injury severity score (ICISS) have been used with great success in trauma research and in quality programmes to improve trauma care. To this date no valid trauma score has been developed for the Indian population. STUDY DESIGN:This retrospective cohort study used a dataset of 16047 trauma-patients from four public university hospitals in urban India, which was divided into derivation and validation subsets. All injuries in the dataset were assigned an international classification of disease (ICD) code. Survival Risk Ratios (SRRs), for mortality within 24 hours and 30 days were then calculated for each ICD-code and used to calculate the corresponding ICISS. Score performance was measured using discrimination by calculating the area under the receiver operating characteristics curve (AUROCC) and calibration by calculating the calibration slope and intercept to plot a calibration curve. RESULTS:Predictions of 30-day mortality showed an AUROCC of 0.618, calibration slope of 0.269 and calibration intercept of 0.071. Estimates of 24-hour mortality consistently showed low AUROCCs and negative calibration slopes. CONCLUSIONS:We attempted to derive and validate a version of the ICISS using SRRs calculated from an Indian population. However, the developed ICISS-scores overestimate mortality and implementing these scores in clinical or policy contexts is not recommended. This study, as well as previous reports, suggest that other scoring systems might be better suited for India and other Low- and middle-income countries until more data are available.

Endophytic fungi associated with medicinal plants are reported as potent producers of diverse classes of secondary metabolites. In the present study, an endophytic fungi, Aspergillus clavatonanicus strain MJ31, exhibiting significant antimicrobial activity was isolated from roots of Mirabilis jalapa L., was identified by sequencing three nuclear genes i.e. internal transcribed spacers ribosomal RNA (ITS rRNA), 28S ribosomal RNA (28S rRNA) and translation elongation factor 1- alpha (EF 1α). Ethyl acetate extract of strain MJ31displayed significant antimicrobial potential against Bacillus subtilis, followed by Micrococccus luteus and Staphylococcus aureus with minimum inhibitory concentrations (MIC) of 0.078, 0.156 and 0.312 mg/ml respectively. In addition, the strain was evaluated for its ability to synthesize bioactive compounds by the amplification of polyketide synthase (PKS) and non ribosomal peptide synthetase (NRPS) genes. Further, seven antibiotics (miconazole, ketoconazole, fluconazole, ampicillin, streptomycin, chloramphenicol, and rifampicin) were detected and quantified using UPLC-ESI-MS/MS. Additionally, thermal desorption-gas chromatography mass spectrometry (TD-GC-MS) analysis of strain MJ31 showed the presence of 28 volatile compounds. This is the first report on A. clavatonanicus as an endophyte obtained from M. jalapa. We conclude that A. clavatonanicus strain MJ31 has prolific antimicrobial potential against both plant and human pathogens and can be exploited for the discovery of new antimicrobial compounds and could be an alternate source for the production of secondary metabolites.

Fracture supracondylar humerus is one of the most common fractures encountered in pediatric age group at all levels (both rural and urban). Thus it needs a special review in its management protocol as per the changing trend. Modified Gartland classification is the most accepted classification and has its importance in decision making regarding management and prognosis. Neurovascular complications are mostly associated with Type III A, III B and Type IV variety and they most of the time need surgical intervention for stabilization, exploration of brachial artery, sometimes median nerve exploration and reduction of fracture. Cubitus varus is the most common associated deformity associated with this fracture (especially in Type III A). The aim of the review was to develop an insight for the understanding of variations in presentation and management of supracondylar fracture of the humerus (both simplicity and complexity) and the flowing trend in addition to the recent advances to deal with this particular pediatric orthopaedic entity which often presents as an emergency.