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Abstract Background Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala’s approach towards UHC and health systems strengthening through a political economy approach. Methods Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state’s progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. Results The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. Conclusions Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in ‘public provisioning’ should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.

Context: The existence of more than one antibody in systemic autoimmune rheumatic diseases (SARDs) or connective tissue disease (CTD) along with features of more than one autoimmune disease (AD) in an individual is suggestive of overlap syndrome (OS). Line immunoassay (LIA) can target many autoantibodies in a single approach, thus making the identification of OS feasible. Aims and Objectives: This study aimed to identify the pattern of distribution of antinuclear antibodies by LIA prevalent in a hospital population in eastern India and identify common forms of SARD in this belt based on laboratory findings. Material and Methods: A total of 1660 samples received for ANA profile testing by LIA were analysed. Statistical Analysis: Factor analysis was performed with factor loading scores used in the k-means algorithm to identify clustering of various autoantibodies. Results: U1-snRNP positivity was the highest at 16.69%, and the least frequent autoantibody noted was anti-Jo-1 at 0.71% positivity. Based on the outcome of factor analysis, three clusters were determined. Cluster 1 showed a predominance of anti-PM/Scl antibodies, cluster 2 showed a predominance of anti-dsDNA, anti-histone, anti-SmD1, anti-nucleosomes, anti-PCNA, anti-Po, anti-SSA/Ro52, anti-SSA-Ro60, anti-SSB/La, anti-Scl-70, anti-Mi-2, anti-Ku and anti-AMA-M2, and cluster 3 showed a predominance of anti-U1-snRNP. Conclusions: Mixed connective tissue disease (MCTD) and overlap syndrome (OS) are prevalent more than pure form of an AD in our study population. OS may be missed out by monospecific immunoassays and hence adds to diagnostic challenges. LIA may be more useful in identifying specific autoantibodies by a single approach rather than monospecific immunoassays in populations after a positive screen by indirect immunofluorescence (IIF).

Introduction Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, making them inaccessible to many. This geographic and economic inaccessibility contributes to a significant ‘detection gap’ where many children who might benefit from support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based platform administered by non-specialist workers to assess motor, social and cognitive developmental status. The goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions.Methods and analysis The STREAM project will enrol and assess 4000 children aged 0–6 years from Malawi (n=2000) and India (n=2000). It integrates three established developmental assessment tools measuring motor, social and cognitive functioning using gamified tasks, observation checklists, parent-report and audio-video recordings. Domain scores for motor, social and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves.Ethics and dissemination Ethical approval has been obtained from local review boards at each site (India: Sangath Institutional Review Board; All India Institute of Medical Science (AIIMS) Ethics Committee; Indian Council of Medical Research—Health Ministry Screening Committee; Malawi: College of Medicine Research and Ethics Committee; Malawi Ministry of Health—Blantyre District Health Office). The study adheres to Good Clinical Practice standards and the ethical guidelines of the 6th (2008) Declaration of Helsinki. Findings from STREAM will be disseminated to participating families, healthcare professionals, policymakers, educators and researchers, at local, national and international levels through meetings, academic journals and conferences.

The trend of current robotic research is to develop mobile robots that can perform highly dynamic tasks, which include jumping and running. To be employed profitably, this research necessitates a significant amount of work in the development of innovative planning and control algorithms that need experimental validation on actual robots. However, the majority of robots with highly dynamic performance capabilities are currently restricted to a few expensive platforms. This is a major obstacle that ultimately restricts the amount of contributors and the advancement of the research. Thus, a cost-effective actuator solution is needed that is also able to execute very dynamic movements. With this goal in mind, we present EM-Act, a modular series elastic actuator (SEA) for legged and multimodal dynamic robots. This work focuses on the development of the actuator solution by defining jump height as the prerequisite, identifying actuator parameters through simulations, and selecting and testing mechatronic elements of the design. The work also discusses a compact integration of desired compliance to address the impact forces. Furthermore, the work also details the implementation of the actuator solution on a 2-degree-of-freedom (DOF) robotic leg and experimentally validates its jumping performance.

OBJECTIVE: To evaluate the effect of different shapes and sizes of attachments used for rotation, tipping, and torquing tooth movement in clear aligner therapy. MATERIAL AND METHODS: Using computer-aided design/computer-aided manufacturing technology, 15 replicas of the upper right human canines were produced. Finite element analysis (FEA) was utilized to mimic tooth movement by applying a constant force of 2.942 N to these models, which contained various forms and sizes of composite attachments. Analysis was done on the stress on different dental structures and the displacement of the attachments. RESULTS: The outcomes demonstrated that tooth movement during clear aligner treatment was considerably impacted by attachment size and shape. Rectangular beveled attachments with dimensions of 3.5 mm × 1.2 mm × 3.5 mm showed the greatest rotating mobility. Triangular beveled attachments with dimensions of 5 mm by 0.8 mm by 2 mm produced the most displacement during tipping motion. For torquing motions, rectangular power ridge attachments with dimensions of 0.5 mm × 0.5 mm × 5 mm worked well. CONCLUSION: The size and geometry of composite attachments were shown to be extremely important in regulating tooth movement during clear aligner treatment, according to this FEA research. Greater displacement is produced when smaller attachments with less surface area dissipate more force. When using clear aligner therapy, orthodontists may optimize treatment plans, shorten treatment times, and provide more predictable results by having a better understanding of the biomechanics of various attachment designs.

Background: Latency reversing agents (LRAs) such as protein kinase C (PKC) modulators can reduce rebound-competent HIV reservoirs in small animal models. Furthermore, administration of natural killer (NK) cells following LRA treatment improves this reservoir reduction. It is currently unknown why the combination of a PKC modulator and NK cells is so potent and whether exposure to PKC modulators may augment NK cell function in some way. Methods: Primary human NK cells were treated with PKC modulators (bryostatin-1, prostratin, or the designed, synthetic bryostatin-1 analog SUW133), and evaluated by examining expression of activation markers by flow cytometry, analyzing transcriptomic profiles by RNA sequencing, measuring cytotoxicity by co-culturing with K562 cells, assessing cytokine production by Luminex assay, and examining the ability of cytokines and secreted factors to independently reverse HIV latency by co-culturing with Jurkat-Latency (J-Lat) cells. Results: PKC modulators increased expression of proteins involved in NK cell activation. Transcriptomic profiles from PKC-treated NK cells displayed signatures of cellular activation and enrichment of genes associated with the NFκB pathway. NK cell cytotoxicity was unaffected by prostratin but significantly decreased by bryostatin-1 and SUW133. Cytokines from PKC-stimulated NK cells did not induce latency reversal in J-Lat cell lines. Conclusions: Although PKC modulators have some significant effects on NK cells, their contribution in “kick and kill” strategies is likely due to upregulating HIV expression in CD4+ T cells, not directly enhancing the effector functions of NK cells. This suggests that PKC modulators are primarily augmenting the “kick” rather than the “kill” arm of this HIV cure approach.

Abstract The introduction of more effective and selective mRNA delivery systems is required for the advancement of many emerging biomedical technologies including the development of prophylactic and therapeutic vaccines, immunotherapies for cancer and strategies for genome editing. While polymers and oligomers have served as promising mRNA delivery systems, their efficacy in hard-to-transfect cells such as primary T lymphocytes is often limited as is their cell and organ tropism. To address these problems, considerable attention has been placed on structural screening of various lipid and cation components of mRNA delivery systems. Here, we disclose a class of charge-altering releasable transporters (CARTs) that differ from previous CARTs based on their beta-amido carbonate backbone (bAC) and side chain spacing. These bAC-CARTs exhibit enhanced mRNA transfection in primary T lymphocytes in vitro and enhanced protein expression in vivo with highly selective spleen tropism, supporting their broader therapeutic use as effective polyanionic delivery systems.

Abstract Background Universal health coverage (UHC) has emerged as one of the important health policy discourses under the current sustainable development goals in the world. UHC in individual disease conditions is a must for attaining overall UHC. This study measures progress towards UHC in terms of access to health care and financial protection among individuals with mental disorders in India. Methods Data from the 75th Round National Sample Survey (NSS), 2017-18, was used, which is the latest round on health in India. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232), from randomly selected 8077 villages and 6181 urban areas, included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses. Results Self-reporting of mental disorders was considerably lower than the actual disease burden in India. However, self-reporting of ailment was 1.73 times higher (95% CI: 1.18–2.52, p

Background: Bihar is one of the focus states under Swachh Bharat Mission (SBM) in India. A study was conducted to estimate the prevalence and to determine the factors associated with the practice of open defecation among adults having household toilets, in rural Patna, Bihar. Methods: An analytical cluster cross-sectional study was conducted for a duration of one year among 609 participants using cluster sampling in rural block of Patna. The prevalence was calculated with 95 % confidence interval and binary logistic regression analysis was done to determine factors associated with open defecation. Results: Out of 609, 391(64.2 %, 95 % CI: 60–68 %) were practising open defecation despite having a household toilet. Male gender (AOR, 1.684; 95 % CI, 1.1–2.4), scheduled caste community (AOR, 2.168; 95 % CI, 1.3–3.4), family gross monthly income Rs. 35 years (AOR,1.453; 95%CI, 1.0–2.0), absence of government supply as water source (AOR: 2.106, 95 % CI: 1.088–3.410) were the independent factors associated with practice of open defecation. Conclusions: Nearly two-third of adults were practising OD despite having a household toilet. Male gender, schedule caste community, family gross monthly income Rs. 35 years, lack of government supply as water source were the factors associated with the practice ofOD.

Abstract Background Universal Health Coverage (UHC) aims to ensure universal access to quality healthcare according to health needs. The extent to which population health needs are met should be a key measure for progress on UHC. The indicators in use for measuring access mostly relate to physical accessibility or insurance coverage. Or, utilization of services is taken as indirect measure for access but it is assessed against only the perceived healthcare needs. The unperceived needs do not get taken into account. The present study was aimed at demonstrating an approach for measuring the unmet healthcare needs using household survey data as an additional measure of UHC. Methods A household survey was conducted in Chhattisgarh state of India, covering a multi-stage sample of 3153 individuals. Healthcare need was measured in terms of perceived needs which would be self-reported and unperceived needs where clinical measurement supplemented the interview response. Estimation of unperceived healthcare needs was limited to three tracer conditions- hypertension, diabetes and depression. Multivariate analysis was conducted to find the determinants of the various measures of the perceived and unperceived needs. Results Of the surveyed individuals, 10.47% reported perceived healthcare needs for acute ailments in the last 15 days. 10.62% individuals self-reported suffering from chronic conditions. 12.75% of those with acute ailment and 18.40% with chronic ailments received no treatment, while 27.83% and 9.07% respectively received treatment from unqualified providers. On an average, patients with chronic ailments received only half the medication doses required annually. The latent need was very high for chronic ailments. 47.42% of individuals above 30 years age never had blood pressure measured. 95% of those identified with likelihood of depression had not sought any healthcare and they did not know they could be suffering from depression. Conclusion To assess progress on UHC more meaningfully, better methods are needed to measure unmet healthcare needs, taking into account both the perceived and unperceived needs, as well as incomplete care and inappropriate care. Appropriately designed household surveys offer a significant potential to allow its periodic measurement. Their limitations in measuring the ‘inappropriate care’ may necessitate supplementation with qualitative methods.

Introduction: Bihar has experienced high nutritional public health problem among children and women over the years. In this background, this study was planned to find the level of food insecurity and identify contributing factors in rural Bihar. Material and Methods: We conducted community-based cross-sectional study among 255 families residing in villages catered by RHTC, Naubatpur. A pretested semi-structured interview schedule and HFIAS were used. Result: A total of 27.8% of the 255 households were food insecure, of which 73.3% were severely food insecure. Kutcha houses, dispossession of agricultural land, and lower SES were found to be predictors. Conclusion: Around one in three families experienced food insecurity, and it was more among families residing in kutcha houses, without possession of agricultural land and belonging to lower socioeconomic status.

Introduction: To assess the association of blood biomarkers such as C-reactive protein (CRP), serum ferritin, lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio, and D-dimer at admission with in-hospital mortality in COVID-19 and to determine best predictive cut-offs for them. Materials and Methods: This cross-sectional study included 984 confirmed cases of COVID-19 admitted in months of July and August 2020. The optimal biomarker cut-off points for mortality were defined by a receiver operating characteristic curve. Survival probabilities were estimated by the Kaplan–Meier method and compared with the log-rank test. Results: The overall mortality rate among the hospitalized cases was 254 (25.81%). All the markers were found to be significantly higher (P < 0.001) in nonsurvivor group as compared to the survivors at the time of admission. Serum CRP, ferritin, D-dimer and LDH were found to be elevated, i.e., higher than the upper limit of normal range in 426 (83%), 469 (68.37%), 449 (67.9%), and 380 (93.1%) respectively overall. However, these markers were significantly more elevated in nonsurvivor compared to survivors. A significant increasing trend of elevated level of all biomarkers was observed with increase of severity level (P < 0.0001). It was found that CRP ≥82 mg/L had sensitivity of 63.58% and specificity of 68.38% for predicting the mortality. Similarly, serum ferritin ≥475.6 mg/ml had sensitivity of 68.09% and specificity of 65.26%, D-dimer ≥0.65 had sensitivity of 90.71% and specificity of 55.45%, and LDH ≥915 U/L had sensitivity of 69.34% and specificity of 73.8% to predict the mortality. Furthermore, neutrophil and lymphocyte count ratio (NLR) ≥8.86 had sensitivity of 65.61% and specificity of 79.7% to predict the mortality. Conclusion: Levels of the blood biomarker such as CRP, serum ferritin, LDH, NLR, and D-dimer at admission can predict mortality in COVID-19 infection.

Purpose: The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods: This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome. Results: There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion: Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.

Purpose: This study was designed to test the hypothesis that exposure to ivermectin in early disease prevents mortality due to COVID-19. A secondary objective was to see if the drug has any impact on the length of hospital stay among the survivors. Methods: It was a hospital-based retrospective case-control study conducted at a tertiary teaching hospital in India. All patients with a diagnosis of COVID-19 who were admitted between 1st April and 15th May 2021 and received inpatient care were included. Important variables like demographic details, dates of admission and discharge or death, symptoms at the time of admission, comorbidities, severity of illness at the time of admission, whether ivermectin was administered or not during the course of the illness and other treatments received as part of the standard of care were retrieved from the medical records. Results: Of the 965 patients who received inpatient care, 307 died during their hospital stay while 658 were successfully discharged. The proportion of cases treated with ivermectin was 17.26% among the non-survivors (53/307) and 17.93% among the survivors (118/658). The effect was statistically insignificant (crude OR = 0.954; 95% CI: 0.668–1.364, P = 0.80). Among the survivors, the median length of stay was 11 days for patients who received ivermectin (IQR: 7–15) as well as for those who did not (IQR: 7–16). Conclusion: This study did not show any effect of ivermectin on in-patient mortality in patients with COVID-19 and there was no effect of the drug on the length of hospital stay among the survivors.

Abstract Wheat, one of the most widely consumed staple food crops globally, is relatively vulnerable to high temperature-induced heat stress. It is therefore essential to gain more insight into the comprehensive mechanism of thermotolerance of wheat in order to safeguard its production. In view of this, we analysed heat stress responsive transcriptome data of wheat to determine its gene expression level under heat stress. A total of 7990 DEGs, including 4483 up-regulated and 3507 down regulated genes were identified. Gene Ontology (GO) analysis categorized 3910 DEGs into different ontology families. 146 pathways involving 814 DEGs were enriched during KEGG analysis. Metabolic pathways and biosynthesis of secondary metabolites were the major pathways enriched. MYB (myeloblastosis) transcription factors (TFs) and many other TFs as bHLH, WRKY, NAC, ERF, were determined to be quite abundant in the DEGs. Since various reports indicate that these TFs play important role in plants abiotic stress, it is an indication that our DEGs are functional in heat stress tolerance. Verification of few selected DEGs using RT-qPCR produced expression levels similar to the transcriptome data. This indicates that the transcriptome data is reliable. These results could be helpful in enhancing our understanding of the mechanism underlying thermotolerance in wheat.

Summary: KRAS mutations are prevalent in pancreatic and lung cancers, but not all mutant (mt) KRAS tumors are addicted to mt KRAS. Here, we discovered a 30-gene transcriptome signature “KDS30” that encodes a novel EGFR/ERBB2-driven signaling network and predicts mt KRAS, but not NRAS or HRAS, oncogene addiction. High KDS30 tumors from mt KRAS lung and pancreatic cancer patients are enriched in genes upregulated by EGFR, ERBB2, mt KRAS or MEK. EGFR/ERBB2 (neratinib) and MEK (cobimetinib) inhibitor combination inhibits tumor growth and prolongs mouse survival in high, but not low, KDS30 mt KRAS lung and pancreatic xenografts, and is synergistic only in high KDS30 mt KRAS patient-derived organoids. Furthermore, mt KRAS high KDS30 lung and pancreatic cancer patients live significantly shorter lives than those with low KDS30. Thus, KDS30 can identify lung and pancreatic cancer patients whose tumors are addicted to mt KRAS, and predicts EGFR/ERBB2 and MEK inhibitor combination response.

Abstract Background Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government. Methods For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients and claims raised under publicly funded health insurance (PFHI) schemes (n = 903 hospitalisation episodes) b) survey of public facilities to find supply-side government spending per hospitalisation (n = 64 facilities). Results Taking into account all relevant demand and supply side expenditures, the average total spending per day of hospitalisation was INR 2833 for public hospitals and INR 6788 for private hospitals. Adjusted model for logarithmic transformation of OOPE while controlling for variables including case-mix showed that a hospitalisation in private hospitals was significantly more expensive than public hospitals (coefficient = 2.9, p

AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month post-surgical outcome of rhino-orbito-mucormycosis (ROCM) cases. METHODS: All COVID associated mucormycosis (CAM) patients underwent comprehensive multidisciplinary examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31 (34.8%) had orbital apex syndrome. Sixty-six (74.2%) of such patients had pre-existing diabetes mellitus, 18 (58%) patients had prior documented use of steroid use, and 55 (61.8%) had no light perception (LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen (19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34 (38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.

Background: Body mass index (BMI) is the most frequently used method to determine the nutritional status in adolescents. School-going population in developing countries like India are susceptible to undernutrition due to several socioeconomic, demographic, and nutritional factors. Poor dietary habits, sedentary lifestyles and improper hygiene can have a deleterious effect on their BMI. Methods: The aim of the study was to determine any association of BMI with physical health, nutrition, and personal hygiene among the school-going adolescents near Patna, Bihar. Analytical cross-sectional study was conducted among 160 school-going adolescents, chosen by stratified random sampling. They were given Indian Adolescent Health Questionnaire which had close-ended questions about physical activity, nutritional, and hygienic practices. BMI was calculated from self-reported height and weight. Pearson's correlation, independent t test, ANOVA, and Chi-Square test of proportions were done. Significance level was set at P < 0.05. Results: Only 39.4% adolescents had normal BMI, and almost half were underweight. Pearson's correlation of BMI with age showed a weak positive correlation (r = 0.124, P = 0.118). Participants perceiving themselves overweight, did physical exercise to lose weight (P < 0.001), whereas who stated that they rarely consumed cooked vegetables, had the self-perception of being underweight (P = 0.009). This self-perception of their weight, physical activity, handwashing after using toilet/latrine and weekly frequency of brushing teeth significantly predicted the BMI in these adolescents (F = 10.895, df (4,155), P < 0.001, R2 = 21.9%, Adj. R2 = 19.9%). Conclusion: Malnutrition can lead to infection, impaired reproductive health, anaemia and other long-term morbidities into adulthood. Hence there is need of more objective nutritional assessment in adolescence for prevention of disease burden in the community.

Predicting tip positions of a spring based continuum manipulator is highly challenging due to its nonlinear deformations. External loading on the tip further deteriorates the accuracy. Model-less control strategies have shown great success in the tip positioning. However, they require a large amount of data and time for the training. Performances of these controllers also deteriorate with external loads. To address these problems, this paper presents a MAML(Model-Agnostic Meta-Learning) based closed loop controller for the continuum manipulators. This controller requires a relatively small amount of data to achieve the state-of-art positioning accuracy. It can also adapt to changes due to the external loads with less than 2.5 percent of the original data. Two algorithms for the offline adaptation of the known and unknown external loading are proposed here. These techniques are also helpful for automatic stiffness tuning of the spring based continuum manipulators. The experimental validations have been done both in the simulation environment and on the real prototype. The continuum arm used for the experimentation is a tendon based non constant curvature spring-based manipulator. The average relative positioning error for the zero loading case was found to be 3.83% on the spring based prototype. The controller was successful in bringing down the relative tip positioning error of the manipulator from 5.42% to 2.7% in the simulation environment. It also showed success in bringing down the relative tip positioning error from 7.8% to 3.96% on the real prototype. Average relative tip positioning errors below 4.27% and 4.89% have been achieved in the trajectory following tasks for the known and unknown external loading cases respectively.

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing coronavirus disease 2019 (COVID-19) has led to a global health crisis. Health workforce has been working vigorously in COVID-19 management. So, we have planned this study with an aim to assess the psychological profile of healthcare and allied workers involved in SARS-CoV2 pandemic and to look for associated factors. Methodology: A cross-sectional observational study was planned at All India Institute of Medical Sciences, Patna. Study population comprised of Health care workers and allied health care workers involved in COVID-19 management. Results: Data from 254 study participants have been included in the study. The prevalence of severe and extremely severe depression among study participants was 8.3 and 3.1 percent. Severe and extremely severe anxiety prevalence was found to be 9.4 and 13.8 percent. The prevalence of severe and extremely severe stress was 2.4 and 2.4 percent each. Education till post-graduation, unmarried, occupation of doctor, Comorbidity of headache and occurrence of influenza-like illness in last 3 months had a statistically significant association with high depression score. With high Anxiety score and high-stress score statistically significant association was seen in education till postgraduation, unmarried, occupation of doctor, duration of 1 COVID-19 duty of ≥8 hours. Conclusion: The study highlights high psychological comorbidities in the form of depression, anxiety and stress among health care workers and allied health care workers working in COVID-19 pandemic. Prevalence of psychological morbidity is higher among doctors compared to nurses and allied health workers. COVID-19 duty of ≥8 hours have been found to be hampering mental health.

Background and objectives: Laryngoscopy and tracheal intubation lead to a sympathoadrenal response. We compared the efficacy of dexmedetomidine with fentanyl bolus to attenuate this response. Methods: One hundred patients admitted for routine surgical procedures under general anesthesia were enrolled in this double blind, randomized, controlled study. Patients were randomly assigned to two groups: Group F received injection of fentanyl 2 μg.kg-1 and Group D received injection of dexmedetomidine 0.5 μg.kg-1 diluted up to 5 mL by adding normal saline intravenously over 60 seconds. Five minutes thereafter, following induction with propofol and vecuronium, tracheal intubation was performed after 3 minutes of mask ventilation. Hemodynamic parameters were observed at an interval of 2 minutes before tracheal intubation and at an interval of 1 minute for 5 minutes after tracheal tube cuff inflation. Continuous variables are presented as mean with 95% confidence interval, and t-test was applied for comparing the difference of means between two groups after checking the normality condition. Chi-square test was applied to test the independence of attributes of categorical variables. Repeated measures two-way ANOVA was performed to compare the outcome variables between the two groups. Results: The difference in heart rate and mean arterial pressure of patients in two groups after laryngoscopy and intubation was not statistically significant at any point of time. The hemodynamic changes did not require any intervention in the form of administration of rescue medication. Conclusions: Dexmedetomidine 0.5 μg.kg-1 is as effective as fentanyl 2 μg.kg-1 in attenuating the hemodynamic response accompanying laryngoscopy and tracheal intubation. Clinical trial number & registry URL: CTRI/2017/09/009857 [ctri.nic.in]

Background: The COVID-19 pandemic has become a global threat, with an inexplicable course of action and suboptimal response to the multitudes of therapies being tried. Vitamin D's pleiotropic effects (immunomodulatory, anti-inflammatory, and antiviral) have lately received considerable attention in the scientific community, and it has been shown to be helpful in the defense against viral respiratory infections. Aim: To find out the association between vitamin D and COVID-19. Methods: Overall, 360 (156 COVID-19 +ve and 204 COVID-19 −ve) subjects were investigated in this hospital-based case-control study. The study participants were taken from the COVID-19 wards and Flu clinic of a dedicated COVID hospital between August 1 and September 15, 2020. The demographics and clinical data including alcohol and smoking history along with serum vitamin D levels were recorded. Binary logistic regression analysis was performed to assess the association between age, gender, alcohol intake, smoking history, vitamin D status, and COVID-19. Results: There was no significant difference in the mean vitamin D levels between cases and controls. Bivariate analysis of predictors and COVID-19 revealed that predictors such as advanced age, BMI, alcohol intake, smoking habit, diabetes, hypertension, and vitamin D deficiency were significantly associated with COVID-19. Conclusions: This study showed that serum vitamin D status might be able to reduce the impact of COVID-19, although more studies are required to establish clear causality.

Introduction: Slums are the most vulnerable settlements for COVID-19 infection due to overcrowding and unsanitary conditions. Thus, this study was undertaken to determine the level of seroprevalence for SARS-CoV-2 infection among slum dwellers. Material and Methods: A community-based cross-sectional seroepidemiological survey was conducted at several slums of Patna over four weeks, that is, January 20–February 20, 2021. A total of 650 participants were recruited in the study by applying a two-stage random sampling technique. Results: Seroprevalence for SARS-CoV-2-specific IgG antibody was found to be 31.5% (95% Confidence Interval (CI): 27.9–35.1). The seropositivity prevalence was found to be statistically higher among participants belonging to the age group of 18–30 years (41.1%), male gender (67.9%), high-risk occupation (70%), below poverty line (BPL) economic status (62.1%), and residing in a hut (51.2%) and kutcha house (42.4%). Further, 262 participants reported having COVID-like symptoms in the preceding 1 month of the survey, which was found to be significantly associated with the seropositivity status. Conclusion: The finding of the study reflects that a moderate seroprevalence level of COVID-19 infection was acquired in the slum settings of Bihar. Unchecked spread in these informal communities will pose a serious threat to the rest of the bigger sections of urban populations. This indirectly calls for early intervention in the form of preference in the roadmap of COVID-19 vaccination.

Background Fistula-in-ano is one of the most common clinical condition encountered in a surgical outpatient department. Many treatment modalities have been described with variable outcomes but gold standard surgical treatment is yet to be agreed upon. The aim of the present study is to evaluate the treatment outcomes of ligature of intersphincteric fistula tract (LIFT) technique in the treatment of simple and complex fistula-in-ano with the primary objective of recurrence rate and broad objective of other postoperative complications during the period of study and after long-term follow-up. Methods It is a retrospective study of prospectively collected data from the patients who have been operated for fistula-in-ano using the LIFT technique at our institute from February 2018 to March 2020 and followed-up until September 2020. Results A total of 56 patients with fistula-in-ano were treated with the LIFT procedure during the study period, of which 20 patients had simple fistula and 36 had complex fistula. A success rate of 83% was obtained with completely healed fistulas in 46 patients. No patient developed postoperative incontinence. Conclusion Ligature of intersphincteric fistula tract is an effective treatment modality for fistula-in-ano with less procedure-related morbidity, but it is associated with a higher recurrence rate in simple fistula than in complex fistula.

We conduct a systematic, direct-numerical-simulation (DNS) study, in mathematical models for ventricular tissue, of the dependence of spiral- and scroll-wave dynamics on GKr, the maximal conductance of the delayed rectifier Potassium current (IKr) channel, and the parameter γCao, which determines the magnitude and shape of the current ICaL for the L-type calcium-current channel, in both square and anatomically realistic, whole-ventricle simulation domains. We study canine and human models. In the former, we use a canine-ventricular geometry, with fiber-orientation details, obtained from diffusion-tensor-magnetic-resonance-imaging (DTMRI) data; and we employ the physiologically realistic Hund-Rudy-Dynamic (HRD) model for a canine ventricular myocyte. To focus on the dependence of spiral- and scroll-wave dynamics on GKr and γCao, we restrict ourselves to an HRD-model parameter regime, which does not produce spiral- and scroll-wave instabilities because of other, well-studied causes like a very sharp action-potential-duration-restitution (APDR) curve or early after depolarizations (EADs) at the single-cell level. We find that spiral- or scroll-wave dynamics are affected predominantly by a simultaneous change in ICaL and IKr from their original values in the model, rather than by a change in any one of these currents; other currents do not have such a large effect on these wave dynamics in this parameter regime of the HRD model. In particular, we examine spiral-wave dynamics for ten different values of GKr and ten different values of γCao in our 2D DNSs. For our 3D DNSs in an anatomically realistic domain, we chose 16 parameter sets. In the parameter regime we begin with, the system displays broken spiral or scroll states with S1–S2 initial conditions (see below). We show that, by simultaneously increasing GKr and reducing γCao, we can get to a parameter regime in which the system displays single, stable rotating spirals or scroll waves. We obtain stability diagrams (or phase diagrams) in the GKr−γCao plane; and we find that these diagrams are significantly different in our 2D and 3D studies. In the 3D case, the geometry of the domain itself supports the confinement of the scroll waves and makes them more stable compared to their spiral-wave counterparts in our flat, 2D simulation domain. Thus, a combination of functional and geometrical mechanisms produce different dynamics for 3D scroll waves and their 2D spiral-wave counterparts. In particular, the former do not break easily because, in an anatomically realistic ventricular geometry, they are not easily absorbed at boundaries, nor do they break near boundaries. We have also carried out a comparison of our HRD results with their counterparts for the human-ventricular TP06 model; and we have found important differences between wave dynamics in these two models. The region in parameter space, where we obtain broken spiral or scroll waves in the HRD model is the region of stable rotating waves in the TP06 model; the default parameter values produce broken waves in the HRD model, but stable scrolls in the TP06 model. In both these models, to make a transition, (most simply, from broken-wave to stable-scroll states) we must simultaneously increase IKr and decrease ICaL; a modification of only one of these currents is not enough to effect this transition. Furthermore, the converse, i.e., an increase in ICaL along with a decrease in IKr does not yield any interesting dynamical transitions in the HRD model, for, in this range of currents, this model does not sustain spiral or scroll waves or broken waves.

Abstract Introduction Understanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India’s. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients. Methods The average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode. Results The average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others. Conclusions and recommendations The findings have implications for the desired mix of public and private providers in India’s health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.

Introduction: There is a risk of chronic hepatitis B virus (HBV) infection to the newborn through perinatal transmission from a hepatitis B surface antigen (HBsAg) positive mother that can later cause liver cirrhosis or hepatocellular carcinoma. This study was undertaken in a primary health center (PHC) in the Patna district to determine the prevalence of HBV among pregnant women and assess their knowledge across different characteristics. Methodology: A cross-sectional study was done among 275 pregnant women attending the PHC for the first time, using consecutive sampling. The study duration was 12 months. Socioeconomic, obstetric, risk history, and levels of knowledge about hepatitis B were collected followed by rapid diagnostic test (RDT) for serum HBsAg. Univariate analysis was used to compare the knowledge levels across different background characteristics. The significance was set at P < 0.05. Results: Hepatitis B-positive pregnant women were 0.4%. Out of the 275 participants, only 43 had heard about hepatitis B. The mean knowledge score was 0.65 (±1.73) with 1.45% having adequate knowledge. The knowledge score was significant across education (P 0.040), category (P 0.022), hepatitis B immunization status (P 0.003), and risk factor (P 0.039). Conclusion: Knowledge was higher in the literate women belonging to the general category and higher social class, who received hepatitis B vaccination. However, the overall level of knowledge among the pregnant women was very poor, so they should be targeted for quality health education. Additionally, identifying the afflicted pregnant women through point-of-contact diagnosis will aid in community prevention of chronic hepatitis B.

Coronary artery anomalies are found in 0.6%–1.55% of patients who undergo coronary angiography, and the increasing use of diagnostic coronary angiography is unveiling even more complex coronary anomalies. We report an interesting rare case of a single coronary artery from the left coronary sinus with anomalous origin of the right coronary artery from the mid-segment of the left anterior descending coronary artery. Such a variant case of a single coronary artery is not reported on computed tomography (CT) scan coronary angiography to the best of our knowledge.

BackgroundTreatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease.MethodsPatients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities.FindingsAt the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups.InterpretationLDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia.FundingAn intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India.Clinical Trial RegistrationClinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php

Unruptured aneurysm of sinus of Valsalva is an asymptomatic pathology and diagnosed incidentally. This extremely rare anomaly can be associated with other congenital cardiac anomalies which can make the diagnosis and prognosis even more complex. We are reporting a case of a 12-year-old boy with progressive dyspnea and episodes of syncope. Multimodality imaging confirmed the diagnosis and paved the way for appropriate surgical treatment options.

Abstract Background Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak, called coronavirus disease - 2019 (COVID-19), has affected more than 200 countries across the globe with a higher fatality rate among the elderly population. Aim of the study is to highlight the vulnerability of the aged amidst the current COVID-19 pandemic, and in the light of the recent international evidence, suggests what government could do to mitigate their vulnerability. Methods Data from the recently released (November 2019) 75th Round National Sample Survey (NSS), which was conducted from July 2017 to June 2018, across 8077 rural villages and 6181 urban wards was used for this study. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232) included 42,762 elderly individuals (60 years or above). Bivariate and multivariate analyses were used for the calculation. Results Of the total sample of elderly individuals, 27.7% reported suffering from an ailment in the last 15 days, whereas 8.5% had been hospitalized during the last 365 days. Among the elderly, hospitalization rate was higher in the urban areas (OR: 1.23), general social category (OR: 1.18), richest economic quintile (OR: 1.69), and among those living alone (OR: 2.40). Also, among the elderly, 64% of those in the scheduled tribe (social group) and 51% in the poorest economic quintile utilized public facilities for hospitalization. Cardiovascular ailments were the major cause for hospitalization (18.1%) and outpatient visit (32%) among the elderly. Ailments related to diabetes and hypertension constituted 55% of outpatient visit for the elderly. Only 18.9% of the elderly had health insurance though chances of facing catastrophic health expenditures were high among the elderly. 6.6% of elderly female and 1.6% male live alone, and 27.5% of age 80 years and above are immobile. 50% of male and 90% of female are financially dependent on others and more so in poorer economic quintiles. Conclusions The vulnerability of India’s elderly increases across economic levels, and other dimensions such as the place of residence, gender, social group (caste), marital status, living arrangements, surviving children, and economic dependence. The current COVID-19 pandemic poses a greater risk of social isolation among the elderly, which may cause detrimental health impact. Trial registration Not applicable since the study is based on secondary data.

At present aluminium-magnesium alloys are widely used in various engineering applications due to its light weight and superior properties. Joining is considered as one of the most complex phenomenon in various precision industries like aerospace, railway, automotive and marine structures because inflexible tolerances are required during different product assembly. The friction stir welding (FSW) of aluminium-magnesium of various grade has incited substantial scientific and industrial importance since it has a potency to transform the product with a good quality joint. The fabrication of such alloys is a challenging task through conventional fusion welding due to its various metallurgical concerns. Therefore, the present work is intended to summarize the recent progress in FSW of aluminium-magnesium alloys. Particular attention has been paid to microstructural evolution, phase transformation, recrystallization mechanism, material flow behaviour and how the process parameters influence the various mechanical properties and associated defects during FSW. Various experimental and numerical simulation results have been mentioned for weld property comparison. Finally, this work not only points out the prominent conclusions of the preceding research but also recommends the upcoming guidance concerning to fabrication of aluminium-magnesium alloys through FSW.

Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to understand the role of vaccination with Bacillus Calmette–Guerin (BCG) and measles administered as part of MMR vaccine on COVID 19. Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used. Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to independently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)]. Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted.

OBJECTIVE: To evaluate the changes in surface morphology of two different types of mini-implants after clinical en masse retraction using scanning electron microscopy. MATERIAL AND METHODS: Fifty mini-implants of Dentos (Korea, Absoanchor, BH-1817-08) and Orlus (Korea, Yesanchor, C-1817) were inserted in patients in a split-mouth design who required en masse anterior retraction and absolute anchorage. Surface characteristics of mini-implants such as pitch (distance between consecutive threads), flank width (distance between root and crest), and taper were studied using scanning electron microscope (FEI nanosem450) before and after clinical use. RESULTS: Statistically significant difference (p value = 0.003) was found in a mean reduction of pitch dimension among the two groups with a mean difference of 25.000 μm. Also, a statistically significant difference was noted (p value = 0.001) in a mean reduction of flank width among Dentos implants as compared to Orlus implants. A statistically significant difference (p = 0.001) was seen in the mean reduction of taper dimension among Dentos group (0.0140 ± 0.02271) as compared to the Orlus group (0.0810 ± 0.05152). CONCLUSION: A marked reduction in surface morphology such as the pitch, flank width, and taper of both mini-implants after retrieval was observed. Dentos group of mini-implants displayed better dimensional stability post-retrieval as compared to the Orlus group of mini-implants. All the mini-screws showed milling defects in form of scratches on observation under scanning electron microscopy despite a smooth appearance to the naked eye.

A B S T R A C T Introduction: Control efforts of visceral leishmaniasis (VL) are hindered due to inappropriate early case detection of Leishmania infection with varying degree of susceptibility to develop the disease. Methods: We assessed the current infection status using Leishmanin skin test (LST) and direct agglutination test (DAT) in a cohort population (206 randomly selected individuals) in a VL endemic area of Bihar, India. Results: Cellular immunity was revealed in 18.4% and antibody response in 18.9% of the population. The age-group of 20-29 years were most vulnerable. DAT titer was inversely proportional to duration of past history of VL. The houses having present or past history of kala-azar in family were observed with high Leishmanin and DAT positivity, indicating relevance of household contacts in the disease transmission. Conclusion: The reactivity of both LST and DAT tests may help in identifying the possible groups with varying degree of susceptibility and risk of infection or having prior exposure to the leishmania infection with or without development of the disease.

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are lethal rhythm disorders, which are associated with the occurrence of abnormal electrical scroll waves in the heart. Given the technical limitations of imaging and probing, the in situ visualization of these waves inside cardiac tissue remains a challenge. Therefore, we must, perforce, rely on in silico simulations of scroll waves in mathematical models for cardiac tissue to develop an understanding of the dynamics of these waves in mammalian hearts. We use direct numerical simulations of the Hund–Rudy-Dynamic (HRD) model, for canine ventricular tissue, to examine the interplay between electrical scroll-waves and conduction and ionic inhomogeneities, in anatomically realistic canine ventricular geometries with muscle-fiber architecture. We find that millimeter-sized, distributed, conduction inhomogeneities cause a substantial decrease in the scroll wavelength, thereby increasing the probability for wave breaks; by contrast, single, localized, medium-sized (≃ cm) conduction inhomogeneities, exhibit the potential to suppress wave breaks or enable the self-organization of wave fragments into stable, intact scrolls. We show that ionic inhomogeneities, both distributed or localized, suppress scroll-wave break up. The dynamics of a stable rotating wave is not affected significantly by such inhomogeneities, except at high concentrations of distributed inhomogeneities, which can cause a partial break up of scroll waves. Our results indicate that inhomogeneities in the canine ventricular tissue are less arrhythmogenic than inhomogeneities in porcine ventricular tissue, for which an earlier in silico study (Majumder et al., 2016) has shown that the inhomogeneity-induced suppression of scroll waves is a rare occurrence.

Introduction COVID-19 pandemic still poses a serious challenge to health system worldwide. This study was planned to determine exposure characteristics, in-hospital mortality, and predictors of in hospital mortality among COVID-19 patients. Material and methods We retrospectively investigated epidemiological, clinical, and laboratory profile of confirmed COVID-19 patients admitted from 25th March to 31st August 2020. COVID-19 patient profiles were collected from Medical Record Section of the hospital. Results In hospital mortality occurred in 159 (11%) cases. Increasing respiratory rate, higher temperature, higher total leukocyte count, and high blood urea levels were found to be independent risk factors for in hospital mortality whereas higher hemoglobin and higher oxygen saturation at the time of hospital admission were found to be protective against in hospital mortality. Conclusion In hospital mortality among COVID-19 patients is almost 1 in 10 in tertiary care hospital. Patients with advancing age (AOR: 1.048; 95% CI: 1.021-1.076), higher respiratory rate (AOR: 1.248; 95% CI: 1.047-1.489), higher temperature (AOR: 1.758; 95% CI: 1.025-3.016), higher leukocyte count (AOR: 1.147; 95% CI: 1.035-1.270), and higher urea levels (AOR: 1.034; 95% CI: 1.005-1.064) at the time of admission are important predictors of COVID-19 in-hospital mortality.

BackgroundVisceral leishmaniasis (VL), also known as kala-azar (KA), is a neglected vector-borne disease, targeted for elimination, but several affected blocks of Bihar are posing challenges with the high incidence of cases, and moreover, the disease is spreading in newer areas. High-quality kala-azar surveillance in India, always pose great concern. The complete and accurate patient level data is critical for the current kala-azar management information system (KMIS). On the other side, no accurate data on the burden of post kala-azar dermal leishmaniasis (PKDL) and co-infections are available under the current surveillance system, which might emerge as a serious concern. Additionally, in low case scenario, sentinel surveillance may be useful in addressing post-elimination activities and sustaining kala-azar (KA) elimination. Health facility-based sentinel site surveillance system has been proposed, first time to do a proper accounting of KA, PKDL and co-infection morbidity, mortality, diagnosis, case management, hotspot identification and monitoring the impact of elimination interventions.Methodology/principal findingsKala-azar sentinel site surveillance was established and activated in thirteen health facilities of Bihar, India, using stratified sampling technique during 2011 to 2014. Data were collected through specially designed performa from all patients attending the outpatient departments of sentinel sites. Among 20968 symptomatic cases attended sentinel sites, 2996 cases of KA and 53 cases of PKDL were registered from 889 endemic villages. Symptomatic cases meant a person with fever of more than 15 days, weight loss, fatigue, anemia, and substantial swelling of the liver and spleen (enlargement of spleen and liver).The proportion of new and old cases was 86.1% and 13.9% respectively. A statistically significant difference was observed for reduction in KA incidence from 4.13/10000 in 2011 to 1.75/10000 in 2014 (pConclusions/significanceEstablishment of a sentinel site based kala-azar surveillance system in Bihar, India effectively detected the rising trend of PKDL and co-infections and captured complete and accurate patient level data. Further, this system may provide a model for improving laboratory services, KA, PKDL and co-infection case management in other health facilities of Bihar without further referral. Program managers may use these results for evaluating program's effectiveness. It may provide an example for changing the practices of health care workers in Bihar and set a benchmark of high quality surveillance data in a resource limited setting. However, the generalizability of this sentinel surveillance finding to other context remains a major limitation of this study. The justifications for this; the sentinel sites were made in the traditionally high endemic PHC's. The other conditions were Program commitment for diagnostic (rk-39) and the first line anti kala-azar drug i.e. miltefosine throughout the study period in the sentinel sites. In addition, there were clause of fulfillment of readiness criteria at each sentinel site (already described in the line no 171 to 180 at page no-8, 181-189 at page no-9 and 192-212 at page no-10). Rigorous efforts were taken to improve all the sentinel sites to meet the readiness criteria and research activities started only after meeting readiness criteria at the site. Therefore sentinel site surveillance described under the present study cannot be integrated into other set up (medium and low endemic areas). However, it can be integrated into highly endemic areas with program commitment and fulfillment of readiness criteria.

Occupational health and safety hazards in the extreme work environment of underground mines remained a serious concern for both mine management and regulatory agency. Miners are often employed to perform different mining activities across the mine and are always exposed to health risks such as lung cancer. With the technology advancements, it is now possible to keep track of mine individuals and their health parameters. The current practice of health analysis is periodic in nature and is highly dependent on voluntary participation. Wearable health sensing system is an alternative solution to overcome these challenges and is able to provide insights on miners' health conditions. Timely analysis of physiological parameters of the miners is immensely helpful to minimize the injuries and can also provide preventive measures for potential health hazards. In this paper, we propose a wireless health monitoring system, especially for underground mines. The contributions of this paper are twofold. First, it presents and discusses our proposed system architecture and solution followed by challenges of such system in the context of underground mines. Second, as a preliminary analysis, detailed discussion on the wireless link behavior for reliable data transmission and communication are presented. We performed real-world experimental measurements in an operational underground coal mine considering several deployment settings in straight, near face and curved mine galleries. The communication metrics (e.g., received signal strength and packet reception rate) are extensively evaluated.

Background: Population mobility and migration are important processes of human life. It affects broad range of sociocultural parameters. Mobility increases personal interaction and exposure to sexual partners from high-risk group. Although traditional Indian value prohibits premarital or extramarital sexual activities, but this aspect has not been explored in migrant workers. Methods: It was a qualitative study based on indepth interview of participants. The participants were wives of migrant workers. Indepth interviews were conducted by two female field interviewers recruited for the study. A total of 24 study subjects were recruited for the study. An indepth interview guide was prepared which mainly focused on sexual behavior, including premarital, marital, and extramarital, quality of marital relationship, gender roles, peer networks, substance abuse, work-related activities, etc., The transcripts were analyzed in NVIVO and themes were generated. Results: The premarital sex was more common in boys than girls. It is more common in the same age group and has increased in the recent years. Various reasons were cited in relation to premarital sex in rural areas like love affair, delayed marriage, watching bad movies, bad company, allurement for gifts money, etc., Some women had opinion that males belonging to affluent and powerful families had tendency to enjoy sex with other women within and outside village. The major themes which emerged from the study were the sexual activity, type of sexual partners, reasons for multiple sexual partner, and risky and nonrisky sexual activity. Conclusion: The findings of the study provided insights to design and conduct a larger and more representative quantitative study among the wives of migrant workers to understand the dynamic combination of biomedical, behavioral, and sociocultural factors that may influence transmission of infection within marriage.

Introduction: Avoidable sickness, disabilities and death among under 5 children are prevented by routine immunization against some specific diseases. The percentage fully immunized children was 69.9% in Bihar, India, and was almost same in rural area. Immunization coverage is also associated with various socio-demographic factors. The aim of this study is to assess the immunization coverage among children in rural areas of Bhojpur district and identify socio-demographic factors associated with it. Methods: A cross-sectional study was conducted in rural areas of Bhojpur district during January to May 2015. 2 stage cluster sampling was done. 36 villages were selected randomly as primary selection units and within each village, 10 children of age 12-36 months were selected from the sampling frame of all eligible children in selected village. A pre-designed, pre-tested checklist was used by the trained investigators during their visits. Results: A total of 360 children of age 12-36 months were included in the study, of which 65% of children were fully immunized, 33.9% were partially immunized, and 1.1% were not immunized at all. Mother's education (AOR 2.28 (1.28-4.05), P value = 0.005), place of birth (AOR 29.04 (10.75-78.43), P value = 0.0001) and availability of immunization card (AOR 120.04 (15.82-916.47), P value = 0.001) were significantly associated with immunization status. Conclusion: Immunisation coverage in this area was lower. Socio-demographic factors like mother's literacy, place of birth and availability of immunization cards were significantly associated with full immunization of children. It is needed to focus on health related education among parents regarding immunizing services.

BACKGROUND: Asthma is a chronic inflammatory disorder of airway characterized by variable symptoms and variable airflow limitation. There are many patients developed persistent airflow limitation in due course of disease due to many factors. The present study was conducted to characterize this phenotype and to identify the factors which are implicated in causing persistent airflow limitation. MATERIALS AND METHODS: We recruited consecutive 164 patients aged 12% and >200 ml increase in FEV1) was fulfilled by only 26.7% of the study patients. The factors such as onset of disease after 18 years, history of atopy, serum IgE level, family history of asthma, and biomass fuel exposure did not differ between groups with or without airflow limitation. CONCLUSIONS: Bronchial asthma is more having a COPD such as spirometry features if it has been started since childhood, longer disease duration, and history of allergic rhinitis. Reversibility in spirometry, which is specific for asthma diagnosis, is found only in one-fourth of the patients.

Conventionally, before placing dental implants, the compromised teeth are removed, and the extraction sockets are left to heal for several months. However, in the recent past, to preserve the alveolar bone level from collapsing and to reduce treatment time and procedures, tooth extraction is followed by implant placement immediately without waiting for the site to heal. The situation becomes critical with the presence of periapical pathology as it may cause failure of implant due to the presence of remnants of infection. This case series shows the survival of immediate implants placed in postextraction-infected sites and restored with cemented crowns.

Abstract Background Soil salinity is one of the primary causes of yield decline in rice. Pokkali (Pok) is a highly salt-tolerant landrace, whereas IR29 is a salt-sensitive but widely cultivated genotype. Comparative analysis of these genotypes may offer a better understanding of the salinity tolerance mechanisms in rice. Although most stress-responsive genes are regulated at the transcriptional level, in many cases, changes at the transcriptional level are not always accompanied with the changes in protein abundance, which suggests that the transcriptome needs to be studied in conjunction with the proteome to link the phenotype of stress tolerance or sensitivity. Published reports have largely underscored the importance of transcriptional regulation during salt stress in these genotypes, but the regulation at the translational level has been rarely studied. Using RNA-Seq, we simultaneously analyzed the transcriptome and translatome from control and salt-exposed Pok and IR29 seedlings to unravel molecular insights into gene regulatory mechanisms that differ between these genotypes. Results Clear differences were evident at both transcriptional and translational levels between the two genotypes even under the control condition. In response to salt stress, 57 differentially expressed genes (DEGs) were commonly upregulated at both transcriptional and translational levels in both genotypes; the overall number of up/downregulated DEGs in IR29 was comparable at both transcriptional and translational levels, whereas in Pok, the number of upregulated DEGs was considerably higher at the translational level (544 DEGs) than at the transcriptional level (219 DEGs); in contrast, the number of downregulated DEGs (58) was significantly less at the translational level than at the transcriptional level (397 DEGs). These results imply that Pok stabilizes mRNAs and also efficiently loads mRNAs onto polysomes for translation during salt stress. Conclusion Under salt stress, Pok is more efficient in maintaining cell wall integrity, detoxifying reactive oxygen species (ROS), translocating molecules and maintaining photosynthesis. The present study confirmed the known salt stress-associated genes and also identified a number of putative new salt-responsive genes. Most importantly, the study revealed that the translational regulation under salinity plays an important role in salt-tolerant Pok, but such regulation was less evident in the salt-sensitive IR29.

Objectives Existing health and community nutrition systems have the potential to deliver many nutrition interventions. However, the coverage of nutrition interventions across the delivery platforms of these systems has not been uniform. We (1) examined the opportunity gaps between delivery platforms and corresponding nutrition interventions through the continuum of care in India between 2006 and 2016 and and (2) assessed inequalities in these opportunity gaps.Methods We used two rounds of the National Family Health Survey data from 2005 to 2006 and 2015–2016 (n=36 850 and 190 898 mother–child dyads, respectively). We examine the opportunity gaps over time for seven nutrition interventions and their associated delivery platforms at national and state levels. We assessed equality and changes in equality between 2006 and 2016 for opportunity gaps by education, residence, socioeconomic status (SES), public and private platforms.Results Coverage of nutrition interventions was consistently lower than the reach of their associated delivery platforms; opportunity gaps ranging from 9 to 32 percentage points (pp) during the pregnancy, 17 pp during delivery and 9–26 pp during childhood in 2006. Between 2006 and 2016, coverage improved for most indicators, but coverage increases for nutrition interventions was lower than for associated delivery platforms. The opportunity gaps were larger among women with higher education (22–57 pp in 2016), higher SES status and living in urban areas (23–57 pp), despite higher coverage of most interventions and the delivery platforms among these groups. Opportunity gaps vary tremendously by state with the highest gaps observed in Tripura, Andaman and Nicobar islands, and Punjab for different indicators.Conclusions India’s progress in coverage of health and nutrition interventions in the last decade is promising, but both opportunity and equality gaps remained. It is critical to close these gaps by addressing policy and programmatic delivery systems bottlenecks to achieve universal coverage for both health and nutrition within the delivery system.