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Background: A phase 3 study to assess the efficacy and safety of the desidustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, against the epoetin alfa for the treatment of anemia in patients with chronic kidney disease (CKD) with dialysis dependency. Methods: DREAM-D was a phase 3, multicenter, open-label, randomized, active-controlled clinical study conducted across 38 centers in India. A total of 392 patients with clinical diagnosis of anemia due to CKD with dialysis need (Erythrocyte Stimulating Agent [ESA] naïve or prior ESA users) and with baseline hemoglobin levels of 8.0–11.0 g/dL (inclusive) were randomized in a 1:1 ratio to receive either desidustat oral tablets (thrice a week) or epoetin alfa subcutaneous injection for 24 weeks to maintain a hemoglobin level of 10–12 g/dL. The primary endpoint was to assess the change in the hemoglobin level between the desidustat and the epoetin alfa groups from the baseline to evaluation period week 16–24. The key secondary efficacy endpoint was the number of patients with hemoglobin response. Results: The least square mean (standard error) change in hemoglobin from the baseline to week 16–24 was 0.95 (0.09) g/dL in the desidustat group and 0.80 (0.09) g/dL in the epoetin alfa group (difference: 0.14 [0.14] g/dL; 95% confidence interval: −0.1304, 0.4202), which met the prespecified noninferiority margin. The number of hemoglobin responders was significantly higher in the desidustat group (106 [59.22%]) when compared to the epoetin alfa group (89 [48.37%]) (p = 0.0382). The safety profile of the desidustat oral tablet was comparable with the epoetin alfa injection. There were no new risks or no increased risks seen with the use of desidustat compared to epoetin alfa. Conclusion: In this study, desidustat was found to be noninferior to epoetin in the treatment of anemia in CKD patients on dialysis and it was well-tolerated. Clinical Trial Registry Identifier: CTRI/2019/12/022312 (India). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify the needs and concerns of older people in Jaipur, Rajasthan, India during the lockdown phase of the Covid-19 crisis. The study also aims to present a viable model for extending needed support through a telephone helpline run by a team of young student volunteers. Design/methodology/approach: The study uses a thematic analysis of the interaction between callers (service users) and volunteers. Findings: The study shows that the main reasons that motivate the use of the helpline are to seek medical advice and to request medical services and medical supplies free of charge. However, the study also shows that other reasons for calling the helpline are feelings of loneliness and the need for psychological support, especially due to insufficient assistance from families. Practical implications: The study shows the benefits of providing this type of service for older people during a time of national health crisis. The service is cost-effective and offers a one-stop assistance point. Social implications: The service also constitutes an avenue for building intergenerational solidarity and empathy between younger and older people. This is especially important for citizens who feel socially isolated and disconnected from the rest of society. Originality/value: The study offers a model for an easily created resource that could usefully be exported to other geographic settings. [ABSTRACT FROM AUTHOR]

Educational institutions across the world are passing through a transformation period. To meet out the social and commercial expectation of stakeholder's government took several initiatives to strengthen and fulfill the demand of technology based, futuristic and carrier-oriented education and have invested many dollars to adopt ICT within the education system during the last 20 years. Information and communication technology (ICT) has become a crucial source of innovation and improvement of efficiency for several sectors across the world. In the education sector, particularly, the appliance of ICT has become a critical a part of the training process for university students both outside and inside the classroom setting. This paper addresses the role and benefits of ICTs in various aspects of higher education in the present scenario ad defining the role of ICT as a catalyst in the growth of higher education. Further this paper critically analyzes some previous researches related to ICT in the Indian Education System. This paper has also discussed the initiatives taken by the government to implement ICT in higher education and providing them quality education. We further came up with recommendations to address the different issues of ICT. [ABSTRACT FROM AUTHOR]

Diabetes is one of the most prevalent non-communicable diseases and is the 6th leading cause of death worldwide. It's a chronic metabolic disorder which has no cure, however, it is a highly treatable condition, if diagnosed and managed on time to avoid its complications. This paper explores and compares various machine learning (ML) approaches that can help in determining the risk of diabetes at an early stage and aid in improving the medical diagnosis of diabetes. The paper considers two real-world datasets one is a diabetic clinical dataset (DCA) collected from a medical practitioner in the state of Assam, India during the year 2017–2018 and other is public PIMA Indian diabetic dataset. To analyze the various machine learning techniques on DCA and PIMA Indian diabetic datasets for the classification of diabetic and non-diabetic patients, different classifiers like perceptron, Gaussian process, linear discriminant analysis, quadratic discriminant analysis, statistical gradient descent, ridge regression classifier, support vector machines, k-nearest neighbors, decision tree, naïve Bayes, logistic regression, random forest and ELM for multiquadric, RBF, sigmoid activation functions are used. The results of numerical experiments suggested that logistic regression yields better performance in comparison to the other techniques. [ABSTRACT FROM AUTHOR]

Introduction: Omphalomesenteric Duct (OMD) anomalies are rare congenital disorders of primitive yolk sac. The spectrum of OMD anomalies has varied clinical presentations. Aim: To study the spectrum and management of symptomatic OMD anomalies in children at a rural tertiary care centre. Materials and Methods: This was a retrospective study done at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, a tertiary care centre located in rural part of Northern India. Medical records of all children less than 15 years of age who were diagnosed with symptomatic OMD anomalies and manged surgically between January 2016 to December 2019 (four years) were carefully analysed and data recorded. The recorded parameters were age, sex, symptomatology, clinical presentation, intraoperative findings, surgical procedure performed, complications that developed during the early postoperative period, length of hospital stay and Histopathology Examination (HPE) of the specimens excised. The collected data were statistically analysed. A p-value <0.05 was considered statistically significant. Results: Records revealed that 40 children underwent surgeries for symptomatic OMD anomalies which constituted 6.21% of all surgeries (644) performed by the Department of Paediatric Surgery during January 2016 to December 2019 (four years). There were 29 males (72.5%) and 11 females (27.5%) (M:F=2.6:1). Out of 40 patients, 17 (42.5%) were infants and 23 (57.5%) were of post-infancy age. Mean age of cohort was 41.77 months. The three predominant clinical presentation in children were intestinal obstruction, acute abdomen and umbilical abnormalities. The commonest clinical presentation of the symptomatic OMD anomalies was umbilical abnormalities (50%). Clinical presentation of umbilical abnormality was significantly higher in infancy (p=0.0039*). The incidence of Meckel's diverticulum was 50%. Wedge resection was the commonest surgical procedure performed (67.5%). On HPE, ectopic gastric mucosa was identified in 12 out of 40 patients (30%). Conclusion: Symptomatic OMD remnants have varied clinical presentation. Patients presenting with umbilical abnormalities are common in infancy. Presence of ectopic tissue is commoner in patients with symptomatic OMD remnants. Surgery is the treatment of choice. [ABSTRACT FROM AUTHOR]

Background: Leprosy is a slow, chronic disorder caused by Mycobacterium leprae. India has achieved elimination of leprosy in December 2005 but new cases are being detected and continue to occur in some endemic pockets. The possible ways of transmission of leprosy is not fully understood and is believed that leprosy is transmitted from person to person in long term contact. Studying the transmission dynamics is further complicated by inability to grow M. leprae in culture medium and lack of animal models. More than one family members were found to be affected by leprosy in some highly endemic pockets. This study reported the transmission pattern of leprosy in a family having 4 patients. Methodology/Principal findings: We investigated the transmission of leprosy in a single family having 4 patients using microsatellite typing. DNA was isolated from slit skin smear samples taken from the patients and the isolated DNA were amplified using microsatellite loci TA11CA3. The amplified products were sequenced using Sanger’s sequencing methods and the copy number variation in the microsatellite loci between strains were elucidated by multiple sequence alignment. The result showed that all the 4 members of the family acquired infection from 3 different strains of M. leprae from 3 different sources. The elder and middle daughters were infected by same types of strains having the repeat unit TA13CA3 and could have acquired the infection from social contacts of leprosy cases while the father and younger daughter were infected by strains with the repeat unit TA12CA3 and TA11CA3 and could have acquired infection from social contacts. Conclusions/Significance: The study suggested that three family members viz, elder daughter, father and younger daughter could be infected by M. leprae from 3 different sources and the history of the disease and genetic analysis showed that the middle daughter acquired infection from her elder sister in due course of contact. This study implies that the transmission of leprosy not only occurred amongst the house hold members but also has been transmitted from social and neighborhood contacts in long term association with the them. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the performance of the 'TB Detect ' kit-based bio-safe fluorescent microscopy filter (BioFM-Filter) microscopy in comparison with direct smear microscopy and culture for the detection of pulmonary tuberculosis (TB) in a multi-centric setting in India. The TB Detect kit enables sputum concentration through filtration using the BioFM-Filter for improved and bio-safe smear microscopy. We evaluated the performance of the TB Detect kit in a six-site multi-centric validation study on sputum collected from 2086 presumptive TB patients. The combined positivity of TB Detect microscopy performed on these sputum samples was 20% (n = 417/2086) vs 16.1% of light-emitting diode fluorescence microscopy (LED-FM, n = 337/2086) and 16% of Ziehl Neelsen (ZN) smear microscopy (n = 333/2086). The increment in positivity of TB Detect over both LED-FM and ZN smears was significant (p < 0.001). The overall sensitivity of TB Detect for six sites was ~55% (202/367, 95% confidence interval (CI): 50, 60%) vs 52% (191/367, 95% CI: 47, 57%) for LED-FM (p 0.14) and 50.9% (187/367, 95% CI: 46, 56%) for ZN smear (p < 0.05), using Mycobacterium Growth Indicator Tube culture (MGIT, n = 1949, culture positive, n = 367) as the reference standard. A bio-safety evaluation at six sites confirmed efficient sputum disinfection by TB Detect ; 99.95% samples (1873/1874) were sterile after 42 days of incubation. Scientists and technicians at the study sites indicated the ease of use and convenience of TB Detect microscopy during feedback. TB Detect added value to the smear microscopy test due to its improved performance, convenience and user safety. These findings indicate that equipment-free TB Detect technology has the potential to improve TB diagnosis in basic laboratory settings by leveraging on the existing nationwide network of designated microscopy centres and primary healthcare centres. [ABSTRACT FROM AUTHOR]

Background: The current strategy for leprosy control depends mainly on early case detection and providing the recommended multidrug therapy (MDT) dosage. Understanding the molecular mechanisms of drug resistance to each of these drugs is essential in providing effective treatment and preventing the spread of resistant strains in the community. The progress of molecular biology research provides a very efficient opportunity for the diagnosis of drug resistance by in vitro method., Aim: We aimed to investigate the point mutations within the rpoB gene region of the Mycobacterium leprae genome, which are responsible for resistance to rifampicin, in order to determine the emergence of drug resistance in leprosy in the Kolkata region of West Bengal., Methods: A total of 50 patients with a relapse of leprosy were enrolled in the study. Skin smears were obtained for estimation of bacillary index and biopsies were obtained in 70% alcohol for extraction of DNA. The extracted DNA was amplified by M. leprae-polymerase chain reaction (PCR) targeting rpoB gene region. Every single nucleotide base in the sequence is aligned to reference sequence and identity gaps were determined by NCBI - BLAST. Later in-silico analysis was done to identify the changes in the translated protein sequences., Results: A mutation at the base pair position 2275405 where G is replaced by C in the M. leprae genome, which corresponds to the coding region of rpoB gene (279 bp - 2275228 to2275506), was observed in two patients. This missense mutation in CAC codon brings about a glutamic acid to histidine change in the amino acid sequence of RNA polymerase beta subunit at the position 442 (Glu442His), a region specific for rifampicin interaction, which might be responsible for unresponsiveness to rifampicin by manifesting a stable bacteriological index in these 2 patients even after completion of 24 months of multibacillary multi-drug therapy (MB-MDT)., Limitations: The major limitations of multiple-primer PCR amplification refractory mutation system (MARS) assay is that it capable of detecting mutation at codon 425 and cannot distinguish any silent amino acid changes., Conclusion: The study indicates the existence of rifampicin drug resistance in Eastern India.