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Abstract  Population ( × 107 c.f.u./g dr. soil) of the aerobic (30.5–154.1) and anaerobic (5.9–91.4) heterotrophic, aerobic (24.0–56.0) and anaerobic (2.4–4.2) spore forming, Gram (-)ve (1.6–2.9), phosphate solubilizing (10–20), asymbiotic N2-fixing (0.5–0.9), sulfur oxidizing (1.1–2.0), nitrifying (1.0–5.8) and denitrifying (12.1–18.7) bacteria; as well as, the actinomycetes (about 104 c.f.u./g dr. soil) and fungi (about 105 c.f.u./g dr. soil) were variable in the partially anaerobic, saline and drain out flooded rice soils during the post harvest period of the Himalayan, brackish water flooded, island and coastal habitats of India. The aerobic heterotrophic and spore forming bacteria were more than the anaerobic counterparts in the soils. Population (0.51–3.51 × 106 c.f.u./g dr. soil) and crystal morphotype (spherical, bipyramidal and polymorphic) of the Bacillus thuringiensis (Bt) isolates of different soils were variable. Bt index was 0.002 at Mahe but 0.006 in other soils. The Bt isolates tolerated 5–12% NaCl. The osmolytes (mg/g dr. wt.) like the amino acids (0.38–99.45) and proline (0.38–0.80); and the antioxidative enzymes (units (U)/mg protein/min) viz. the catalase (0.17–5.59) and superoxide dismutase (0.35–74.46) were related with intrinsic osmotic stress tolerance of the Bt but they formed spores to overcome anoxic stress. Two Bt isolates were potent tolerant to both osmotic and anoxic stresses. [ABSTRACT FROM AUTHOR]

Background: In Low and Middle Income Countries (LMICs), reduction of multidimensional poverty and the increase in longevity are concomitant. Although a number of studies have estimated multidimensional poverty, studies on estimates of life expectancy and pre-mature mortality by multidimensional poverty are limited. We estimated life expectancy and premature mortality among multidimensionally poor and multidimensionally non-poor in India., Methods: We have used the micro data of 636,699 households and 2,843,917 individuals from the National Family and Health Survey-5, 2019-21. We estimated multidimensional poverty in three dimensions-education, health, and standard of living using 11 indicators. Data on birth-history of women (15-49 years of age) and household-reported deaths was utilised to estimate deaths and person years and used to construct the life tables. The life tables were used to estimate life expectancy, premature mortality (the probability of dying before age 70), and adult mortality (the probability of dying between age 15-59) among multidimensionally poor and non-poor across socio-demographic characteristics.., Results: We estimated multidimensional poverty in India at 26%, with large variation across states and union territories. Multidimensionally poor individuals had a life expectancy at birth (LEB) 4 years lower compared to multidimensionally non-poor individuals (poor: 65.2 years vs non-poor 69.0 years). The lower life expectancy of the multidimensionally poor compared to multidimensionally non-poor was found across all the sub-categories. The difference in life expectancy at birth between multidimensionally poor and non-poor was higher among urban dwellers (4.6 years) than rural individuals (1.8 years). The premature mortality was estimated at 0.33 among the multidimensionally poor and at 0.25 among the multidimensionally non-poor. Adult mortality was estimated to be 0.17 among the multidimensionally poor compared to 0.12 among the non-poor individuals. Our findings on the differences in adult mortality and premature mortality between multidimensional poor and non-poor across socio-demographic characteristics were large., Conclusion: Multidimensionally poor individuals had lower longevity and higher premature mortality than their multidimensionally non-poor counterparts in India. Such differences were higher by residence (rural-urban) than by caste and religion., Competing Interests: Declarations. Ethics approval and consent to participate: All methods were carried out in relevant guidelines and regulations. Consent for publication: The study used a dataset that is available online in the public domain; hence, there was no need to seek Consent to publish this study. For more details, please visit:  https://www.iipsindia.ac.in/content/nfhs-project Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Dravet syndrome is an infantile-onset developmental and epileptic encephalopathy with limited data on the frequency of SCN1A in Indian children. The study aimed to identify and characterize the burden of SCN1A pathogenic variants associated with the Dravet syndrome phenotype through genetic testing in the North Indian population., Method: In this prospective, cross-sectional study from March 2015 to February 2019, we enrolled 52 children with Dravet syndrome phenotype who underwent genetic testing for SCN1A gene pathogenicity. We assessed variant effect using multiple algorithms, and genetic test results were reported based on recommendations from the American College of Medical Genetics and Genomics guidelines. Additionally, we performed multiplex-ligation dependent probe amplification (MLPA) to detect copy number variations of the SCN1A gene in children without identified genetic pathogenicity (n = 22) and analysed the results using Coffalyser.net., Results: Of the 52 probands studied, pathogenic variants in the SCN1A gene were identified in 30 children. Among these variants, 11 truncating variants (3 frame-shift variants, 3 intronic variants in splice site regions, and 5 nonsense variants) in 12 unrelated probands, and 17 missense variants in 18 unrelated probands were found. The genetic yield of SCN1A pathogenicity in our cohort (n = 52) was 58 %. Additionally, two of the identified variants were novel. Furthermore, MLPA analysis of the SCN1A gene in 22 children without pathogenic variants yielded no results., Conclusion: This work represents a genetic analysis of a Dravet syndrome cohort, revealing a 58 % burden of SCN1A variants in children with the Dravet syndrome phenotype from the North Indian population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Lifestyle diseases significantly contribute to the global health burden, with lifestyle factors playing a crucial role in the development of depression. The COVID-19 pandemic has intensified many determinants of depression. This study aimed to identify lifestyle and demographic factors associated with depression symptoms among Indians during the pandemic, focusing on a sample from Kolkata, India. An online public survey was conducted, gathering data from 1,834 participants (with 1,767 retained post-cleaning) over three months via social media and email. The survey consisted of 44 questions and was distributed anonymously to ensure privacy. Data were analyzed using statistical methods and machine learning, with principal component analysis (PCA) and analysis of variance (ANOVA) employed for feature selection. K-means clustering divided the pre-processed dataset into five clusters, and a support vector machine (SVM) with a linear kernel achieved 96% accuracy in a multi-class classification problem. The Local Interpretable Model-agnostic Explanations (LIME) algorithm provided local explanations for the SVM model predictions. Additionally, an OWL (web ontology language) ontology facilitated the semantic representation and reasoning of the survey data. The study highlighted a pipeline for collecting, analyzing, and representing data from online public surveys during the pandemic. The identified factors were correlated with depressive symptoms, illustrating the significant influence of lifestyle and demographic variables on mental health. The online survey method proved advantageous for data collection, visualization, and cost-effectiveness while maintaining anonymity and reducing bias. Challenges included reaching the target population, addressing language barriers, ensuring digital literacy, and mitigating dishonest responses and sampling errors. In conclusion, lifestyle and demographic factors significantly impact depression during the COVID-19 pandemic. The study's methodology offers valuable insights into addressing mental health challenges through scalable online surveys, aiding in the understanding and mitigation of depression risk factors., (© 2024. The Author(s).)

In general, the impact of two different connected extreme events is noticed on the same duration and spatial area. However, the connected extreme events can have footprint over different temporal and spatial scales. Thus, this article analyses the connected extreme events over India using the spatio-temporal compounding technique to understand the impact at different temporal and spatial scales. This approach is applied to analyse the historical and future connected extreme events. In the present study, coincident heat waves and droughts (Event C1), coincident heat waves and extreme precipitation (Event C2) are considered as connected extreme events. The future events are investigated using the suitable global climate models (GCMs) projections under three climate change scenarios (Shared Socioeconomic Pathways (SSP) 2-4.5, SSP3-7.0, and SSP5-8.5). The suitable GCMs are identified with the help of compromise programming. Subsequently, the hotspot regions are identified applying the Regional Climate Change Index (RCCI) method. The outcomes from the study suggest that with increasing temporal compounding, the mean duration of extreme events also increases. Highest increase in mean duration is observed for Event C1 over PI (Peninsular India), WCI (West Central India), and some parts of CNI (Central Northeast India) regions. The regions with high magnitude of duration have low magnitude of occurrence. The duration of Event C1 is likely to increase with respect to climate change scenarios and temporal compounding, especially in the PI region and some parts of WCI. However, there is insignificant change in the duration of Event C2. The PI region identified as the most vulnerable region followed by WCI and HR regions. The highest percentage of area under the emerging hotspot category is noticed under SSP5-8.5 climate change scenario., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors-with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients' web of kinship. Providers would take patients' kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as 'kin testing' to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. 'Kin testing' allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers' actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well.

Fluoride (F - ) enrichment in groundwater of the lower Gangetic plain in West Bengal, India is a major concern. Fluoride contamination and its toxicity were reported earlier in this region; however, limited evidence was available on the precise site of contamination, hydro-geochemical attributions of F - mobilization and probabilistic health risk caused by fluoridated groundwater. The present study addresses the research gap by exploring the spatial distribution and physico-chemical parameters of fluoridated groundwater along with the depth-wise sedimental distribution of F - . Approximately, 10 % of the groundwater samples (n = 824) exhibited high F -  ≥ 1.5 mg/l from 5, out of 19 gram-panchayats and Baruipur municipality area and the maximum F - was observed in Dhapdhapi-II gram-panchayat with 43.7 % of samples showed ≥1.5 mg/l (n = 167). The distribution patterns of cations and anions in fluoridated groundwater were Na +  > Ca 2+  > Mg 2+  > Fe > K + and Cl -  > HCO 3 -  > SO 4 2-  > CO 3 2-  > NO 3 -  > F - . Different statistical models like Piper and Gibbs diagram, Chloro Alkaline plot, Saturation index were applied to better understand the hydro-geochemical characteristics for F - leaching in groundwater. Fluoridated groundwater is of Na-Cl type which implies strong saline character. The intermediate zone between evaporation and rock dominance area controls F - mobilization along with ion-exchange process occurring between groundwater and host silicate mineral. Furthermore, saturation index proves geogenic activities related to groundwater F - mobilization. All cations present in sediment samples are closely interlinked with F - in the depth range of 0-18.3 m. Mineralogical analyses revealed that muscovite is the most responsible mineral for F - mobilization. The probabilistic health risk assessment disclosed severe health hazard in the order of infants > adults > children > teenagers through F - tainted groundwater. At P95 percentile dose, all the studied age groups showed THQ >1 from Dhapdhapi-II gram-panchayat. Supply of F - safe drinking water is required through reliable water supply strategies in the studied area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research., Methods: We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist., Results: From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types- 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more., Conclusion: Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mazumder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Due to changes in demographic and epidemiological scenarios, and the gradual increase in the older population, India is yet to prepare for rising nutrition and health-related issues among older adults in the coming decades. While the process of ageing and its associated aspect has been found to have an urban-rural divide. Thus, this study examines rural/urban differences in unmet needs for food and healthcare among Indian older adults., Methods: A sample of 31,464 older adults aged 60 years and above were considered in the study from the Longitudinal and Ageing Survey of India (LASI). The bivariate analysis was done using the sampling weights. Logistic regression and decomposition analysis was used to explain the rural-urban gap in the unmet needs for food and healthcare among Indian older adults., Results: Rural older adults were more vulnerable to meeting the need for health and food than their urban counterparts. While factors that contributed majorly to the difference in unmet need for food between urban and rural were education (34.98%), social group (6.58%), living arrangements (3.34%) and monthly per capita expenditure (MPCE) (2.84%). Similarly, for the unmet need for health, the factors that contributed the most to the rural-urban gap are education (28.2%), household size (2.32%), and MPCE (1.27%)., Conclusion: The study indicates more vulnerability among rural older adults than compared to urban older individuals. The targeted policy-level efforts should be initiated considering the economic and residential vulnerability identified in the study. There is a need for primary care services that can provide targeted help to older adults in rural communities., (© 2023. The Author(s).)

The suffering from arsenic toxicity is a long-standing concern in Asian countries. The role of the key factors (arsenic intake, age and sex) regulating arsenic toxicity is aimed to evaluate for a severely exposed population from Murshidabad district, West Bengal. Mean arsenic concentrations in drinking water supplied through tube well, Sajaldhara treatment plant and pipeline were observed as 208, 27 and 54 µg/l, respectively. Urinary arsenic concentration had been observed as < 3-42.1, < 3-56.2 and < 3-80 µg/l in children, teenagers and adults, respectively. Mean concentrations of hair and nail arsenic were found to be 0.84 and 2.38 mg/kg; 3.07 and 6.18 mg/kg; and 4.41 and 9.07 mg/kg, respectively, for the studied age-groups. Water arsenic was found to be associated with hair and nail (r = 0.57 and 0.60), higher than urine (r = 0.37). Arsenic deposition in biomarkers appeared to be dependent on age; however, it is independent of sex. Principal component analysis showed a direct relationship between dietary intake of arsenic and chronic biomarkers. Nail was proved as the most fitted biomarker of arsenic toxicity by Dunn's post hoc test. Monte Carlo sensitivity analysis and cluster analysis showed that the most significant factor regulating health risk is 'concentration of arsenic' than 'exposure duration', 'body weight' and 'intake rate'. The contribution of arsenic concentration towards calculated health risk was highest in teenagers (45.5-61.2%), followed by adults (47.8-49%) and children (21-27.6%). Regular and sufficient access to arsenic-safe drinking water is an immediate need for the affected population., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Rice arsenic (As) contamination and its consumption poses a significant health threat to humans. The present study focuses on the contribution of arsenic, micronutrients, and associated benefit-risk assessment through cooked rice from rural (exposed and control) and urban (apparently control) populations. The mean decreased percentages of As from uncooked to cooked rice for exposed (Gaighata), apparently control (Kolkata), and control (Pingla) areas are 73.8, 78.5, and 61.3%, respectively. The margin of exposure through cooked rice (MoE cooked rice ) < 1 signifies the existence of health risk for all the studied exposed and control age groups. The respective contributions of iAs (inorganic arsenic) in uncooked and cooked rice are nearly 96.6, 94.7, and 100% and 92.2, 90.2, and 94.2% from exposed, apparently control, and control areas. LCR analysis for the exposed, apparently control, and control populations (adult male: 2.1 × 10 -3 , 2.8 × 10 -4 , 4.7 × 10 -4 ; adult female: 1.9 × 10 -3 , 2.1 × 10 -4 , 4.4 × 10 -4 ; and children: 5.8 × 10 -4 , 4.9 × 10 -5 , 1.1 × 10 -4 ) through cooked rice is higher than the recommended value, i.e., 1 × 10 -6 , respectively, whereas HQ > 1 has been observed for all age groups from the exposed area and adult male group from the control area. Adults and children from rural area showed that ingestion rate (IR) and concentration are the respective influencing factors towards cooked rice As, whereas IR is solely responsible for all age groups from urban area. A vital suggestion is to reduce the IR of cooked rice for control population to avoid the As-induced health risks. The average intake (μg/day) of micronutrients is in the order of Zn > Se for all the studied populations and Se intake is lower for the exposed population (53.9) compared to the apparently control (140) and control (208) populations. Benefit-risk assessment supported that the Se-rich values in cooked rice are effective in avoiding the toxic effect and potential risk from the associated metal (As)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

As a widespread natural hazard, droughts impact several aspects of human society adversely. Thus, the present study aims to answer the following research questions; (i) What are the expected variabilities in different drought conditions over India in the future? (ii) How the population exposure to drought varies under different climate change and population scenarios? (iii) How is the total exposure attributed to the individual exposure (climate, population, and interaction) in future climate change scenarios? In this sense, the study is performed under four Shared Socioeconomic Pathways scenarios (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5) using thirteen Global Climate Models from Coupled Model Intercomparison Project Phase 6 and Standardized Precipitation Evapotranspiration Index as a drought indicator. The future period is divided into two parts i.e., 2023-2061 (T1) and 2062-2100 (T2), and compared with the historical period during 1967-2005. The results show that the severe (56 % to 72 % of the area) and extreme (99 % of the area) droughts are likely to increase under all the scenarios for 3-month scale conditions, respectively. The drought intensity is projected to increase under 3-and 12-month scale drought conditions. The population exposure to the extreme drought severity is anticipated to increase for both the drought conditions and the highest exposure is noticed under the SSP3-7.0 scenario. The significant contribution from climate or interaction effects is observed in the case of 3- and 9-month scale extreme drought conditions. The present study necessitates a call for effective measures to alleviate the risk, especially in the high-risk areas of India., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

In the Sub-Himalayan foothills region of eastern India, floods are considered the most powerful annually occurring natural disaster, which cause severe losses to the socio-economic life of the inhabitants. Therefore, the present study integrated geographic information system (GIS) and three comprehensive and systematic multicriteria decision-making (MCDM) techniques such as Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), Vise Kriterijumska Optimizacijaik Ompromisno Resenje (VIKOR), and Evaluation Based on Distance from Average Solution (EDAS) in Koch Bihar district for comparative assessment of the flood-susceptible zones. The multi-dimensional 21 indicators were considered, and multicollinearity statistics were employed to erase the issues regarding highly correlated parameters (i.e., MFI and long-term annual rainfall). Results of MCDM models depicted that the riparian areas and riverine "chars" (islands) are the most susceptible sectors, accounting for around 40% of the total area. The microlevel assessment revealed that flooding was most susceptible in the Tufanganj-I, Tufanganj-II, and Mathabhanga-I blocks, while Haldibari, Sitalkuchi, and Sitai blocks were less susceptible. Spearman's rank (r s ) tests among the three MCDM models revealed that TOPSIS-EDAS persisted in a high correlation (r s = 0.714) in contrast to the relationships between VIKOR-EDAS (r s = 0.651) and TOPSIS-VIKOR (r s = 0.639). The model's efficiency was statistically judged by applying the receiver operating characteristic-area under the curve (ROC-AUC), mean absolute error (MAE), mean square error (MSE), and root mean square error (RMSE) techniques to recognize the better-suited models for mapping the flood susceptibility. The performance of all techniques is found good enough (ROC-AUC =  > 0.700 and MAE, MSE and RMSE =  < 0.300). However, TOPSIS and VIKOR have manifested an excellent outcome and are highly recommended for identifying flood susceptibility in such active flood-prone areas. Thus, this kind of study addresses the role of GIS in the construction of the flood susceptibility of the region and the performance of the respective models in a very lucid manner., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors., Methods: We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai., Results: SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3)., Conclusions: While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Social exclusion has far-reaching consequences that extend beyond regular activities and access to resources and knowledge; social exclusion is a major social determinant of health. However, there is a lack of evidence on social exclusion and health outcomes among India's older adults. Thus, the current study investigates the association of social exclusion with depressive symptoms among Indian older adults., Methods: This study used information on 30,366 older adults from Longitudinal Ageing Study in India (LASI) wave-1, 2017-2018. Social exclusion scores were calculated, and two broad domains of social exclusion, i.e., exclusion from civic activity & social relations and exclusion from services, were considered in the study. The depressive symptom was calculated using the CES-D score. Using logistic regression models, the average marginal effects of selected covariates and domains of social exclusion on depressive symptoms were estimated to assess the links between social exclusion and depressive symptoms., Results: With the increase in the social exclusion score in the selected domains, the prevalence of depressive symptoms among older also increased. Elderly persons who do not vote or live alone in the domain of being excluded from civic & social activities and older adults excluded from services were observed to have a higher prevalence of depressive symptoms. Adjusting for sociodemographic factors, the average marginal effects suggested that older with four scores of civic activity & social relation exclusion, two scores of service exclusion and four scores of overall social exclusion were estimated to have a higher prevalence of depressive symptoms, respectively., Conclusions: This study's findings shed light on social exclusion and its relationship to depressive symptoms among older Indians. Older health care services should be expanded in breadth while also addressing social exclusion, resulting in considerable improvements in older individuals' mental health., (© 2022. The Author(s).)

We visited 1519 villages across 19 Indian states in 2009 to (a) count all health care providers and (b) elicit their quality as measured through tests of medical knowledge. We document three main findings. First, 75% of villages have at least one health care provider and 64% of care is sought in villages with 3 or more providers. Most providers are in the private sector (86%) and, within the private sector, the majority are 'informal providers' without any formal medical training. Our estimates suggest that such informal providers account for 68% of the total provider population in rural India. Second, there is considerable variation in quality across states and formal qualifications are a poor predictor of quality. For instance, the medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socioeconomic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply. Third, India is divided into two nations not just by quality of health care providers, but also by costs: Better performing states provide higher quality at lower per-visit costs, suggesting that they are on a different production possibility frontier. These patterns are consistent with significant variation across states in the availability and quality of medical education. Our results highlight the complex structure of health care markets, the large share of private informal providers, and the substantial variation in the quality and cost of care across and within markets in rural India. Measuring and accounting for this complexity is essential for health care policy in India., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

It is well understood that India is largely exposed to different climate extremes including floods, droughts, heat waves, among others. However, the exposure of co-occurrence of these events is still unknown. The present analysis, first study of its kind, provides the projected changeability of five different compound extremes under three different emission scenarios (SSP2-4.5, SSP3-7.0, and SSP5-8.5). These changes are combined with population projection under SSP2, SSP3, and SSP5 scenarios to examine the total exposure in terms of number of persons exposed during 2021-2060 (T1) and 2061-2100 (T2). Here, the outputs from thirteen GCMs are used under CMIP6 experiment. The findings from the study show that all the compound extremes are expected to increase in future under all the emission scenarios being greater in case of SSP5-8.5. The population exposure is highest (2.51- to 4.96-fold as compared to historical) under SSP3-7.0 scenario (2021-2100 i.e., T1 and T2) in case of coincident heat waves and droughts compound extreme. The total exposure in Central Northeast India is projected to be the highest while Hilly Regions are likely to have the lowest exposure in future. The increase in the exposure is mainly contributed from climate change, population growth and their interaction depending on different kinds of compound extremes. The findings would help in devising sustainable policy strategies to climate mitigation and adaptation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The novel SARS-CoV-2 virus, as it manifested in India in April 2020, showed marked heterogeneity in its transmission. Here, we used data collected from contact tracing during the lockdown in response to the first wave of COVID-19 in Punjab, a major state in India, to quantify this heterogeneity, and to examine implications for transmission dynamics. We found evidence of heterogeneity acting at multiple levels: in the number of potentially infectious contacts per index case, and in the per-contact risk of infection. Incorporating these findings in simple mathematical models of disease transmission reveals that these heterogeneities act in combination to strongly influence transmission dynamics. Standard approaches, such as representing heterogeneity through secondary case distributions, could be biased by neglecting these underlying interactions between heterogeneities. We discuss implications for policy, and for more efficient contact tracing in resource-constrained settings such as India. Our results highlight how contact tracing, an important public health measure, can also provide important insights into epidemic spread and control., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Mendelian Susceptibility to Mycobacterial diseases (MSMD) are a group of innate immune defects with more than 17 genes and 32 clinical phenotypes identified. Defects in the IFN-γ mediated immunity lead to an increased susceptibility to intracellular pathogens like mycobacteria including attenuated Mycobacterium bovis -Bacillus Calmette-Guérin (BCG) vaccine strains and non-tuberculous environmental mycobacteria (NTM), Salmonella , fungi, parasites like Leishmania and some viruses, in otherwise healthy individuals. Mutations in the IL12RB1 gene are the commonest genetic defects identified. This retrospective study reports the clinical, immunological, and molecular characteristics of a cohort of 55 MSMD patients from 10 centers across India. Mycobacterial infection was confirmed by GeneXpert, Histopathology, and acid fast bacilli staining. Immunological workup included lymphocyte subset analysis, Nitro blue tetrazolium (NBT) test, immunoglobulin levels, and flow-cytometric evaluation of the IFN-γ mediated immunity. Genetic analysis was done by next generation sequencing (NGS). Disseminated BCG-osis was the commonest presenting manifestation (82%) with a median age of presentation of 6 months due to the practice of BCG vaccination at birth. This was followed by infection with Salmonella and non-typhi Salmonella (13%), Cytomegalovirus (CMV) (11%), Candida (7%), NTM (4%), and Histoplasma (2%). Thirty-six percent of patients in cohort were infected by more than one organism. This study is the largest cohort of MSMD patients reported from India to the best of our knowledge and we highlight the importance of work up for IL-12/IL-23/ISG15/IFN-γ circuit in all patients with BCG-osis and suspected MSMD irrespective of age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Taur, Gowri, Pandrowala, Iyengar, Chougule, Golwala, Chandak, Agarwal, Keni, Dighe, Bodhanwala, Prabhu, George, Fouzia, Edison, Arunachalam, Madkaikar, Dalvi, Yadav, Bargir, Kambli, Rawat, Das, Joshi, Pilania, Jindal, Bhat, Bhattad, Unni, Radhakrishnan, Raj, Uppuluri, Patel, Lashkari, Aggarwal, Kalra, Udwadia, Bafna, Kanade, Puel, Bustamante, Casanova and Desai.)

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2., Competing Interests: The authors have declared that no competing interests exist.

Leptospirosis is a re-emerging bacterial zoonosis caused by pathogenic Leptospira, with a worldwide distribution and becoming a major public health concern. Prophylaxis of this disease is difficult due to several factors such as non-specific variable clinical manifestation, presence of a large number of serovar, species and asymptomatic reservoir hosts, lack of proper diagnostics and vaccines. Despite its global importance and severity of the disease, knowledge about the molecular mechanism of pathogenesis and evolution of pathogenic species of Leptospira remains limited. In this study, we sequenced and analyzed three highly pathogenic species of Indian isolates of Leptospira (interrogans, santarosai, and kirschneri). Additionally, we identified some virulence-related and CRISPR-Cas genes. The virulent analysis showed 232 potential virulence factors encoding proteins in L. interrogans strain Salinem and L. santarosai strain M-4 genome. While the genome of L. kirschneri strain Wumalasena was predicted to encode 198 virulence factor proteins. The variant calling analysis revealed 1151, 19,786, and 22,996 single nucleotide polymorphisms (SNPs) for L. interrogans strain Salinem, L. kirschneri strain Wumalasena and L. santarosai strain M-4, respectively, with a maximum of 5315 missense and 12,221 synonymous mutations for L. santarosai strain M-4. The structural analyses of genomes indicated potential evidence of inversions and structural rearrangment in all three genomes. The availability of these genome sequences and in silico analysis of Leptospira will provide a basis for a deeper understanding of their molecular diversity and pathogenesis mechanism, and further pave a way towards proper management of the disease., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients' underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions., Methods: Secondary analyses of data from nine SP studies were performed to estimate the proportion of SP-provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overprescribing by healthcare sector, location, provider qualification and case. The WHO Access-Watch-Reserve framework was used to categorise antibiotics based on their potential for selecting resistance. As richer data were available from India, we examined factors associated with antibiotic overuse in that country through hierarchical Poisson models., Results: Across health facilities, antibiotics were given inappropriately in 2392/4798 (49.9%, 95% CI 40.8% to 54.5%) interactions in India, 83/166 (50.0%, 95% CI 42.2% to 57.8%) in Kenya and 259/899 (28.8%, 95% CI 17.8% to 50.8%) in China. Prevalence ratios of antibiotic overuse in India were significantly lower in urban versus rural areas (adjusted prevalence ratio (aPR) 0.70, 95% CI 0.52 to 0.96) and higher for qualified versus non-qualified providers (aPR 1.55, 95% CI 1.42 to 1.70), and for presumptive TB cases versus other conditions (aPR 1.19, 95% CI 1.07 to 1.33). Access antibiotics were predominantly used in Kenya (85%), but Watch antibiotics (mainly quinolones and cephalosporins) were highly prescribed in India (47.6%) and China (32.9%)., Conclusion: Good-quality SP data indicate alarmingly high levels of antibiotic overprescription for key conditions across primary care settings in India, China and Kenya, with broad-spectrum agents being excessively used in India and China., Competing Interests: Competing interests: MP is on the editorial boards of BMJ Global Health. All other authors declare that they have no conflicts of interest., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

In this Minireview, the importance and implementation of green chemistry practices in the pharmaceutical industry are illustrated. With notable examples, some of the most important industrial organic transformations are discussed along with their applications in the synthesis of drug molecules. A brief comparison between traditional unsustainable methods and modern green methods is made to shed light on the economic and environmental benefits of greener methods. Finally, green chemistry practices in the pharmaceutical industries of India and China are also discussed., (© 2020 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Gymnema sylvestre is a highly valuable medicinal plant in traditional Indian system of medicine and used in many polyherbal formulations especially in treating diabetes. However, the lack of genomic resources has impeded its research at molecular level. The present study investigated functional gene profile of G. sylvestre via RNA sequencing technology. The de novo assembly of 88.9 million high quality reads yielded 23,126 unigenes, of which 18116 were annotated against databases such as NCBI nr database, gene ontology (GO), KEGG, Pfam, CDD, PlantTFcat, UniProt & GreeNC. Total 808 unigenes mapped to 78 different Transcription Factor families, whereas 39 unigenes assigned to CYP450 and 111 unigenes coding for enzymes involved in the biosynthesis of terpenoids including transcripts for synthesis of important compounds like Vitamin E, beta-amyrin and squalene. Among them, presence of six important enzyme coding transcripts were validated using qRT-PCR, which showed high expression of enzymes involved in methyl-erythritol phosphate (MEP) pathway. This study also revealed 1428 simple sequence repeats (SSRs), which may aid in molecular breeding studies. Besides this, 8 putative long non-coding RNAs (lncRNAs) were predicted from un-annotated sequences, which may hold key role in regulation of essential biological processes in G. sylvestre. The study provides an opportunity for future functional genomic studies and to uncover functions of the lncRNAs in G. sylvestre.

Flow cytometry has emerged as a useful technology that has facilitated our understanding of the human immune system. Primary immune deficiency disorders (PIDDs) are a heterogeneous group of inherited disorders affecting the immune system. More than 350 genes causing various PIDDs have been identified. While the initial suspicion and recognition of PIDDs is clinical, laboratory tools such as flow cytometry and genetic sequencing are essential for confirmation and categorization. Genetic sequencing, however, are prohibitively expensive and not readily available in resource constrained settings. Flow cytometry remains a simple, yet powerful, tool for multi-parametric analysis of cells. While it is confirmatory of diagnosis in certain conditions, in others it helps in narrowing the list of putative genes to be analyzed. The utility of flow cytometry in diagnosis of PIDDs can be divided into four major categories: (a) Enumeration of lymphocyte subsets in peripheral blood. (b) Detection of intracellular signaling molecules, transcription factors, and cytokines. (c) Functional assessment of adaptive and innate immune cells (e.g., T cell function in severe combined immune deficiency and natural killer cell function in familial hemophagocytic lymphohistiocytosis). (d) Evaluation of normal biological processes (e.g., class switching in B cells by B cell immunophenotyping). This review focuses on use of flow cytometry in disease-specific diagnosis of PIDDs in the context of a developing country., (Copyright © 2019 Rawat, Arora, Shandilya, Vignesh, Suri, Kaur, Rikhi, Joshi, Das, Mathew and Singh.)

C-C chemokine receptor type 5 (CCR5) serves as a co-receptor for Human immunodeficiency virus (HIV), enabling the virus to enter human CD4 T cells and macrophages. In the absence of CCR5, HIV strains that require CCR5 (R5 or M-tropic HIV) fail to successfully initiate infection. Various natural mutations of the CCR5 gene have been reported to interfere with the HIV-CCR5 interaction, which influences the rate of AIDS progression. Genetic characterization of the CCR5 gene in individuals from the National Capital Regions (NCRs) of India revealed several natural point mutations in HIV seropositive/negative individuals. Furthermore, we identified novel frame-shifts mutations in the CCR5 gene in HIV seronegative individuals, as well as the well reported CCR5Δ32 mutation. Additionally, we observed a number of mutations present only in HIV seropositive individuals. This is the first report to describe the genetic variations of CCR5 in individuals from the NCRs of India and demonstrates the utility of investigating understudied populations to identify novel CCR5 polymorphisms.

Background: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice., Methods: We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender., Findings: Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76-1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification., Interpretation: Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India., Funding: Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: India has the highest burden of tuberculosis (TB). Although most patients with TB in India seek care from the private sector, there is limited evidence on quality of TB care or its correlates. Following our validation study on the standardized patient (SP) method for TB, we utilized SPs to examine quality of adult TB care among health providers with different qualifications in 2 Indian cities., Methods and Findings: During 2014-2017, pilot programs engaged the private health sector to improve TB management in Mumbai and Patna. Nested within these projects, to obtain representative, baseline measures of quality of TB care at the city level, we recruited 24 adults to be SPs. They were trained to portray 4 TB "case scenarios" representing various stages of disease and diagnostic progression. Between November 2014 and August 2015, the SPs visited representatively sampled private providers stratified by qualification: (1) allopathic providers with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees or higher and (2) non-MBBS providers with alternative medicine, minimal, or no qualifications. Our main outcome was case-specific correct management benchmarked against the Standards for TB Care in India (STCI). Using ANOVA, we assessed variation in correct management and quality outcomes across (a) cities, (b) qualifications, and (c) case scenarios. Additionally, 2 micro-experiments identified sources of variation: first, quality in the presence of diagnostic test results certainty and second, provider consistency for different patients presenting the same case. A total of 2,652 SP-provider interactions across 1,203 health facilities were analyzed. Based on our sampling strategy and after removing 50 micro-experiment interactions, 2,602 interactions were weighted for city-representative interpretation. After weighting, the 473 Patna providers receiving SPs represent 3,179 eligible providers in Patna; in Mumbai, the 730 providers represent 7,115 eligible providers. Correct management was observed in 959 out of 2,602 interactions (37%; 35% weighted; 95% CI 32%-37%), primarily from referrals and ordering chest X-rays (CXRs). Unnecessary medicines were given to nearly all SPs, and antibiotic use was common. Anti-TB drugs were prescribed in 118 interactions (4.5%; 5% weighted), of which 45 were given in the case in which such treatment is considered correct management. MBBS and more qualified providers had higher odds of correctly managing cases than non-MBBS providers (odds ratio [OR] 2.80; 95% CI 2.05-3.82; p < 0.0001). Mumbai non-MBBS providers had higher odds of correct management than non-MBBS in Patna (OR 1.79; 95% CI 1.06-3.03), and MBBS providers' quality of care did not vary between cities (OR 1.15; 95% CI 0.79-1.68; p = 0.4642). In the micro-experiments, improving diagnostic certainty had a positive effect on correct management but not across all quality dimensions. Also, providers delivered idiosyncratically consistent care, repeating all observed actions, including mistakes, approximately 75% of the time. The SP method has limitations: it cannot account for patient mix or care-management practices reflecting more than one patient-provider interaction., Conclusions: Quality of TB care is suboptimal and variable in urban India's private health sector. Addressing this is critical for India's plans to end TB by 2025. For the first time, we have rich measures on representative levels of care quality from 2 cities, which can inform private-sector TB interventions and quality-improvement efforts., Competing Interests: We have read the journal’s policy, and the authors of this manuscript have the following competing interests: MP is a member of the Editorial Boards of PLOS Medicine and PLOS ONE and is also an editor of the PLOS Tuberculosis Channel. MP previously served as a consultant to the Bill & Melinda Gates Foundation. The other authors have no competing interests to declare.

Health care providers without formal medical qualifications provide more than 70% of all primary care in rural India. Training these informal providers may be one way to improve the quality of care where few alternatives exist. We report on a randomized controlled trial assessing a program that provided 72 sessions of training over 9 months to 152 informal providers (out of 304). Using standardized patients ("mystery clients"), we assessed clinical practice for three different conditions to which both providers and trainers were blinded during the intervention, representative of the range of conditions that these providers normally diagnose and treat. Training increased correct case management by 7.9 percentage points (14.2%) but did not affect the use of unnecessary medicines and antibiotics. At a program cost of $175 per trainee, our results suggest that multitopic medical training offers an effective short-run strategy to improve health care., (Copyright © 2016, American Association for the Advancement of Science.)

Background: Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients., Methods: We did a pilot, cross-sectional validation study of a convenience sample of consenting private health-care providers in low-income and middle-income areas of Delhi, India. We recruited standardised patients in apparently good health from the local community to present four cases (two of presumed tuberculosis and one each of confirmed tuberculosis and suspected multidrug-resistant tuberculosis) to a randomly allocated health-care provider. The key objective was to validate the standardised-patient method using three criteria: negligible risk and ability to avoid adverse events for providers and standardised patients, low detection rates of standardised patients by providers, and data accuracy across standardised patients and audio verification of standardised-patient recall. We also used medical vignettes to assess providers' knowledge of presumed tuberculosis. Correct case management was benchmarked using Standards for Tuberculosis Care in India (STCI)., Findings: Between Feb 2, and March 28, 2014, we recruited and trained 17 standardised patients who had 250 interactions with 100 health-care providers, 29 of whom were qualified in allopathic medicine (ie, they had a Bachelor of Medicine & Surgery [MBBS] degree), 40 of whom practised alternative medicine, and 31 of whom were informal health-care providers with few or no qualifications. The interactions took place between April 1, and April 23, 2014. The proportion of detected standardised patients was low (11 [5%] detected out of 232 interactions among providers who completed the follow-up survey), and standardised patients' recall correlated highly with audio recordings (r=0·63 [95% CI 0·53-0·79]), with no safety concerns reported. The mean consultation length was 6 min (95% CI 5·5-6·6) with a mean of 6·18 (5·72-6·64) questions or examinations completed, representing 35% (33-38) of essential checklist items. Across all cases, only 52 (21% [16-26]) of 250 were correctly managed. Correct management was higher among MBBS-qualified doctors than other types of health-care provider (adjusted odds ratio 2·41 [95% CI 1·17-4·93]; p=0·0166). Of the 69 providers who completed the vignette, knowledge in the vignettes was more consistent with STCI than their actual clinical practice-eg, 50 (73%) ordered a chest radiograph or sputum test during the vignette compared with seven (10%) during the standardised-patient interaction; OR 0·04 (95% CI 0·02-0·11); p<0·0001., Interpretation: Standardised patients can be successfully implemented to assess tuberculosis care. Our data suggest a big gap between private provider knowledge and practice. Additional work is needed to substantiate our pilot data, understand the know-do gap in provider behaviour, and to identify the best approach to measure and improve the quality of tuberculosis care in India., Funding: Grand Challenges Canada, the Bill & Melinda Gates Foundation, Knowledge for Change Program, and the World Bank Development Research Group., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Minimally invasive approaches to kidney transplantation (KT) have been described recently. However, information concerning perioperative management in these patients is lacking. Accordingly, in the current study, we describe our perioperative management strategy in patients undergoing robotic KT with regional hypothermia and report its safety and efficacy. Further, we describe key 6-month outcomes in these patients., Methods: Sixty-seven consecutive end-stage renal disease patients underwent live-donor robotic KT at a single tertiary care institution between January 2013 and June 2014. Outcomes including patient/graft survival, graft function, operative parameters, and perioperative complications are reported in patients with a minimum of 6-month follow-up (n=54)., Results: All patients successfully underwent robotic KT with regional hypothermia using a modified intraoperative management protocol. None of the cases required conversion to open surgery (0%). Mean console, warm ischemia, and rewarming times were 130.8 minutes, 2.3 minutes and 42.9 minutes, respectively. Mean graft-surface temperature was 19.2°C with zero incidence of systemic hypothermia. Routine extraperitonealization of the graft insured against graft-torsion (0%) despite a transperitoneal approach to graft placement. There were no instances of graft vascular thromboses/stenoses/leaks (0%). Three patients (5.6%) developed clinical head-neck edema but were successfully extubated on table. There was no delayed graft function (0%). Mean 6-month serum creatinine was 1.2 mg/dL. Patient survival was 96.3% (n=52), and death-censored graft survival was 100% at a median follow-up of 13.4 months., Conclusions: Significant differences exist in intraoperative management of patients undergoing robotic KT and open KT. By tweaking fluid infusion rates and pneumatic pressures and maintaining core body temperature, optimal patient outcomes can be achieved. Pretransplant and posttransplant management is essentially the same.

This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What's more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.

Women report significantly higher levels of mental distress than men in community studies around the world. We provide further evidence on the origins of this mental health gender-gap using data from 789 adults, primarily spousal pairs, from 300 families in Delhi, India. These data were collected between 2001 and 2003. We first confirm that, like in other studies, women report higher levels of mental distress and that gender differences in education, household expenditures and age do not explain the mental health gender-gap. In contrast, women report significantly higher levels of distress than men in families with adverse reproductive outcomes, particularly the death of a child. Controlling for adverse reproductive outcomes sharply reduces the mental health gender-gap. Finally, mental health is strongly correlated with physical health for both men and women, but there is little evidence of a differential response by sex. We complement this empirical description with anthropological analysis based on ethnographic interviews with 100 men and 100 women. With the help of these ethnographic interviews we show how adverse life events for women are experienced as the inability to maintain the domestic, which seems to be at stake within their life worlds. We raise issues for further research on the apparent finding that the mental health of women and men are differentially affected by adverse reproductive events in the family in this sample., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Density, distribution, and nutritional quality of plants are the causal basis of host plant selection in aphids. Nutritional qualities of a plant vary according to its growth stage and also in response to seasonal variation. How host plant growth stages shape aphid performance was studied in Aphis spiraecola Patch (Homoptera: Aphididae) on the perennial Siam weed, Chromolaena odorata (L.) King and Robinson (Asterales: Asteraceae). This plant species is the preferred host in the hot and humid tropical parts of northeast and southern India. Variations in developmental and reproductive performances in apterous viviparous female aphids were recorded in relation to differences in leaf chemicals in different growth stages of C. odorata. Aphids reproduced at higher rates in the vegetative stage of C. odorata when developmental time was shortest, and fecundity was higher in a longer reproductive time. Intrinsic rate of increase and net reproductive rate were also recorded to be higher in the vegetative stage of the weed host. In the vegetative stage, leaves contained higher quantity of proteins and nitrogen, which are vital for insect reproduction. Results of this study have demonstrated that A spiraecola showed synchronization of its developmental and reproductive performances to growth stages of C. odorata, which occur in high abundance in the study area.

Two Gram (+) bacterial strains, BSB6 and BSB12, showing resistance and potential for Se(IV) reduction among 26 moderately halotolerant isolates from the Bhitarkanika mangrove soil were characterized by biochemical and 16S rDNA sequence analyses. Both of them were strictly aerobic and able to grow in a wide range of pH (4-11), temperature (4-40°C) and salt concentration (4-12%) having an optimum growth at 37°C, pH ∼7.5 and 7% salt (NaCl). The biochemical characteristics and 16S rDNA sequence analysis of BSB6 and BSB12 showed the closest phylogenetic similarity with the species Bacillus megaterium. Both the strains effectively reduced Se(IV) and complete reduction of selenite (up to 0.25 mM) was achieved within 40 h. SEM with energy dispersive X-ray and TEM analyses revealed the formation of nano size spherical selenium particles in and around the bacterial cells which were also supported by the confocal micrograph study. The UV-Vis diffuse reflectance spectra and XRD of selenium precipitates revealed that the selenium particles are in the nanometric range and crystalline in nature. These bacterial strains may be exploited further for bioremediation process of Se(IV) at relatively high salt concentrations and green synthesis of selenium nanoparticles., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The purpose of this study was to determine the taxonomic status of an unidentified enigmatic macaque seen by scientists since the late 1990s in Arunachal Pradesh, India. We surveyed 49 troops of enigmatic macaques in four districts of Arunachal Pradesh. The population studied is from the macaque sinica-group as defined by the reproductive organs. The main species-separating trait in the sinica-group is tail length to head and body length ratio that decreases with latitude and elevation. We gathered data on morphology, pelage descriptions, tail to head and body ratios and tail to hind foot ratios from photos and live animals (43 individuals from 36 areas) within the range of and between the two subspecies of the Assamese macaque (Macaca assamensis). We compared the data to six western Assamese macaques and studies of Assamese macaques and related species. We found great variability in tail length, pelage color, facial skin color, and facial and hair patterns. The tail/head-body and tail/foot ratios, although varied, supported the hypothesis that these enigmatic forms were part of a population of Assamese macaques found in the gap between the two subspecies ranges and were not a new species as described earlier. Instead, we found evidence that darker pelage, larger body size, and shorter tails occur at higher elevations and latitudes similar to the general trend in the sinica-group's adaptations to colder climates. Thus, the population may be important for its variation, throwing light on the speciation process and how the northern species of Tibetan macaques evolved from an ancestor similar to the Assamese macaques as adaptations to a colder climate., (© 2011 Wiley-Liss, Inc.)

The volatile constituents of Valeriana jatamansi Jones and V. hardwickii Wall. (Valerianaceae) collected from the Khasi Hills of north-east India were analyzed by GC and GC/MS. Twenty-seven and twenty-one compounds were characterized and identified from V. jatamansi and V. hardwickii samples, representing 90.6% and 82.7% of the total oil, respectively. Sesquiterpenes were shown to be the main constituents in both the oil samples. Maaliol (26.1%), patchouli alcohol (9.3%) and a-gurjunene (8.7%) were the major components of V. jatamansi oil, whereas valeracetate (21.3%), methyl linoleate (14.1%), bornyl acetate (13.8%) and cuparene (7.1%) were the main constituents of V. hardwickii oil. Both Indian valerian essential oils were studied for their antioxidant activities using the free radical-scavanging activity (DPPH) and ferric reducing antioxidant power (FRAP) assays. V. hardwickii oil exhibited a higher antioxidant capacity than V. jatamansi in both assays. For both the valerian oil samples, there was a concentration-dependent increase in free radical scavenging activity and ferric reducing capacity. Both valerian oils and their ingredients are potential sources of natural antioxidants.

There are seventy medical care providers within walking distance of every household in Delhi. However, inequalities in health outcomes persist among the rich and poor, which might reflect differences in the quality of available care. This paper shows that providers visited by the poor were indeed less knowledgeable than those visited by the rich. There is strong evidence of inequalities in access, with lower competence among private- and public-sector providers in poor neighborhoods, but no evidence of inequalities in choices. Practical policy options include targeted information to patients on provider competence and improving the allocation of public doctors across poor and rich neighborhoods.

Country studies from Indonesia, Tanzania, India, Paraguay, and Mexico document the quality of medical advice and variation in practice quality across a number of dimensions. This overview paper serves three purposes. First, the studies use several different measures; we contextualize these measures and discuss how they relate to each other. Second, we propose a three-way decomposition to analyze variations in the quality of care. These variations can arise from inequalities in access, inequalities in choices, or inequalities arising from discrimination. We discuss common elements across the studies and draw policy implications for future research and advocacy.

The distribution of golden langurs (Trachypithecus geei) is limited to a small area of western Assam in northeast India and Bhutan between the rivers Manas in the east, Sankosh in the west, and Brahmaputra in the south. It is one of the most seriously endangered primate species of India. A comparative analysis based on satellite images taken in 1988 and 1998 showed a 50% loss of original golden langur habitat. Data on population dynamics collected using line transect and total count methods are presented here. An average group size of 8.2 (range 4.0-22.0) individuals was recorded. A total of 1,064 individuals were counted living in 130 groups. The sex ratio was 1.9-2.5 adult females for each adult male. A low percentage of juveniles and infants suggests that the population is unstable. Most of the groups had only one adult male. Small group sizes, isolated distribution, proportionately few infants and juveniles, and degrading habitat are all causes of concern. Demographic trends indicate a decline in the golden langur population., (Copyright 2001 Wiley-Liss, Inc.)

Purpose: To study the clinical profile and distribution of various subtypes of glaucoma in a referral practice in North India., Method: A retrospective analysis was done of 2425 patients who attended the glaucoma clinic in a tertiary eye-care centre for five years from January 1995 to December 1999. A detailed history was obtained and a thorough examination was performed, including gonioscopy, disc assessment, applanation tonometry and automated perimetry. Diurnal variation of IOP and provocative tests for glaucoma were done where applicable., Result: Primary angle closure glaucoma (PACG) was the most common glaucoma subtype. The primary open angle glaucoma (POAG) to the PACG ratio was 37:63. Chronic angle closure glaucoma (CACG) was the most common PACG subtype. The majority of CACG cases were relatively asymptomatic. Male dominance was seen for POAG, juvenile open angle glaucoma (JOAG), CACG, normal tension glaucoma (NTG) and secondary glaucomas. Female dominance was seen for ocular hypertension (OHT), acute or intermittent ACG and developmental glaucomas. The mean age in years at presentation was POAG:60.54 years (males 61.54 years, females 59.01 years) and PACG: 55.13 years (males 57.25 years, females 53.60). The three common secondary glaucomas were: glaucoma secondary to adherent leucoma, aphakic and pseudophakic glaucomas and traumatic glaucomas. Advanced glaucoma was detected in 42 to 53% of patients and bilateral blindness in 8 to 14% of patients in various subtypes., Conclusion: Compared to Caucasians, glaucoma patients in North India seem to present nearly a decade earlier and the disease is more advanced at presentation. While PACG is the most commonly encountered glaucoma, NTG and exfoliative glaucoma are relatively rare.

The antidiarrhoeal potential of a methanol extract of the aerial parts of Jussiaea suffruticosa Linn. (MEJS) was studied with several experimental models of diarrhoea in rats. MEJS treated rats showed significant inhibitory activity against castor oil induced diarrhoea and PGE(2) induced enteropooling. It also showed a significant reduction in gastrointestinal motility following a charcoal meal in rats. The extract exhibited significant antidiarrhoeal potential at doses of 100,200 and 300 mg/kg in all the animal models and thus established the efficacy of MEJS as a potent antidiarrhoeal agent., (Copyright 2000 John Wiley & Sons, Ltd.)

Methanol extract of Punica granatum seed was evaluated for antidiarrhoeal activity against different experimental models of diarrhoea in rats. P. granatum seed extract treated animals showed significant inhibitory activity against castrol-oil induced diarrhoea and PGE2 induced enteropooling in rats. The extract also showed a significant reduction in gastro-intestinal motility in charcoal meal test in rats. The results obtained established the efficacy of P. granatum seed extract as an antidiarrhoeal agent.

Objective: The hepatotoxic action of arsenic, when used as a therapeutic agent, has long been recognized. Data on liver involvement following chronic exposure to arsenic-contaminated water are scanty. We report the nature and degree of liver involvement on the basis of hospital-based and cohort follow-up studies in patients who consumed arsenic-contaminated drinking water for 1 to 15 years., Methods: 248 patients with evidence of chronic arsenic toxicity underwent clinical and laboratory examinations including liver function tests and HBsAg status. Liver biopsy was done in 69 cases; in 29 patients, liver arsenic content was estimated by neutron activation analysis. A cohort follow up of 23 patients who took arsenic-free water for 2-12 years was also carried out., Results: Hepatomegaly was present in 190 of 248 patients (76.6%). Noncirrhotic portal fibrosis (91.3%) was the predominant lesion in liver histology. The maximum arsenic content in liver was 6 mg/Kg (mean 1.46 [0.42], control value 0.16 [0.04]; p < 0.001); it was undetected in 6 of 29 samples studied. Cohort follow-up studies showed elevation of globulin in four cases and development of esophageal varices in one case., Conclusion: We report the largest number of patients with liver disease due to chronic arsenicosis from drinking arsenic-contaminated water. Noncirrhotic portal fibrosis is the predominant lesion in this population.

Since 1983 large number of people are being encountered with arsenic toxicity due to drinking of arsenic contaminated water (0.05-3.2 mg/l) in 6 districts of West Bengal. Clinical and various laboratory investigations were carried out on 156 patients to ascertain the nature and degree of morbidity and mortality that occurred due to chronic arsenic toxicity. All the patients studied had typical rain drop like skin pigmentation (being inclusion criteria) while thickening of palm and sole were found in 65.5% patients. Other features included weakness (70%), gastro-intestinal symptoms (58.6%), involvement of respiratory system (57.08%) and nervous system (50.6%). Lung function tests showed restrictive lung disease in 53% (9/17) and combined obstructive and restrictive lung disease in 41% (7/17) of patients. Abnormal electromyography was found in 34.8% (10/29) and altered nerve conduction velocity in 34.8% (10/29) of cases. Enlargement of liver was found in 120 cases (76.9%) while splenomegaly in 31.4% cases. Liver function test showed elevated globulin level in 15.8% and alkaline phosphatase in 51.3%, alanine amino transferase (ALT) in 11.8% and aspartate amino transferase (AST) in 27.6% of cases. Evidence of portal hypertension was found in 33.3% patients. Liver biopsy reports of 45 patients showed non-cirrhotic portal fibrosis in 41, cirrhosis in 2 and normal histology in 2 cases. There was no correlation between the quantity of arsenic taken through water and the level of arsenic in hair, nail, liver tissues and the degree of fibrosis. There were 5 deaths of which one had skin cancer. The various non-cancer manifestations which were observed in these patients were much severe than those reported in similar cases in other parts of the world.

Leucas lavandulaefolia Rees (Labiatae), commonly known as Halkusha, is a well-known plant in Indian traditional medicine. On the basis of its traditional use and literature references, this plant was selected for evaluation of its wound healing potential. A methanol extract of L. lavandulaefolia was examined for its wound healing activity both in the form of an ointment as well as an injection in two types of wound model in rats: (i) the excision wound model and (ii) the incision wound model. Both the injection and the ointment of the methanol extract of the plant material produced a significant response in both of the wound types tested. The results were also comparable to those of a standard drug, nitrofurazone, in terms of wound contracting ability, wound closure time, tensile strength and regeneration of tissues at the wound site.