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Background and purpose: To compare the efficacy, safety, and immunogenicity of recombinant insulin aspart 100 U/mL manufactured by BioGenomics Limited (BGL-ASP) with innovator NovoRapid® in type 2 diabetes mellitus patients (T2 DM). Experimental approach: This was a multicenter, open-label, randomized, parallel-group study in T2 DM patients, on premix human insulin therapy ± oral anti-diabetics. Besides self-monitored plasma glucose, fasting and post-prandial plasma glucose (FPG and PPG) were tested at baseline, week 12, and week 24. Anti-insulin aspart antibodies measured immunogenicity at 12 and 24 weeks. Findings/Results: 160 patients out of 320 patients randomly received BGL-ASP and the remaining patients received NovoRapid®. The changes in glycated hemoglobin (HbA1c) from baseline to weeks 12 and 24 for the BGL-ASP group were -0.8 ± 0.83 and -0.8 ± 0.81, respectively, while for the NovoRapid®group was -0.8 ± 1.01 and -0.9 ± 0.89, respectively. Changes in FPG and PPG were comparable between the treatment groups after 12 weeks and 24 weeks. The incidence of detectable antibodies at baseline, weeks 12, and 24 were comparable between treatment groups. Eighteen (11.3%) patients in the BGL-ASP group and 23 (14.4%) in the NovoRapid®group reported adverse events. Conclusion and implications: BGL-ASP and NovoRapid®were comparable and equally effective in lowering HbA1c, FPG, and PPG levels, with similar immunogenicity and safety profiles.

Byline: Reshma. Shaik, M. Netravathi, L. Nitish, R. Mani, P. Shah, T. Damodar, M. Anita, P. Pal Sir, Anti- N -methyl-d-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder with a [...]

Introduction: Raised serum ferritin levels often indicate iron overload, but they are not specific as the levels are elevated in inflammatory disorders, liver diseases, alcohol excess, or malignancy. If regular transfusions are required for the patient with thalassemia, this doubles the rate of iron accumulation leading to earlier massive iron overload and iron-related damage. The aim of this study aimed to find out the prevalence of high serum ferritin levels among blood-transfused thalassemic patients admitted to the Department of Paediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at a tertiary care centre from 1 March 2022 to 31 December 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 078/79-017/HG). Children who were confirmed by haemoglobin electrophoresis on regular blood transfusion were included in the study. Those who did not gave consent were excluded from the study. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Out of 53 cases, the prevalence of high serum ferritin level was seen in 46 (88.79%) (80.30-97.28, 95% Confidence Interval). Among 46, 34 (73.91%) had serum ferritin levels of more than 1000 to 2500 ng/ml whereas 12 (26.09%) had more than 25000 ng/ml. Conclusions: The prevalence of high serum ferritin levels among blood transfused thalassemic patients admitted to the Department of Paediatrics in a tertiary care centre was found to be higher than in other studies done in similar settings.

The base fluids of eco-friendly cutting fluids should contain some vegetable oil. Due to their eco-friendly, thermal, and tribological qualities, these types of machining fluids are becoming increasingly popular among researchers throughout the world. The authors summarized published research studies on the use of eco-friendly machining fluids (including nanofluids) in various metal removal processes such as turning, milling, grinding, and drilling in this review paper. The impact of several biodegradable oil-based machining fluids on performance metrics such as surface irregularity, machining force, tool wear, power demand, and temperature-induced during the machining process is also explored in this paper. According to the previous and current literature, using an eco-friendly nano machining fluid results in better surface features, less cutting tool wear, lower cutting force, less power required, and lower machining zone temperature during the machining operation due to superior cooling and lubrication properties.

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Introduction: Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy. Methods: All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar

The article presents case study of a 10‑year old girl who was diagnosed with Japanese encephalitis‑induced anti‑N‑methyl‑d‑aspartate receptor (NMDAR) encephalitis. It mentions that herpes simplex virus (HSV) encephalitis plays a vital role in triggering the anti‑NMDAR antibodies. It states that electroencephalography (EEG) showed a slow background activity with intermittent epileptiform discharges.

The present paper deals with the brief introduction of Turtle Rescue and Conservation Centre (TRCC) and description of some rescued turtles. Nine specimens of turtles belonging to five genera were rescued and translocated to the centre till date including 9.3 kg male Indian Peacock soft-shelled turtle (Nilssonia hurum) for the first time from Jhapa district. The rescue operations were conducted for the translocation of turtles confiscated from the local market, censorial collectors, fisherman and public residence. The high resolution photographs of captured specimens, their necessary biometry and GPS coordinates of location were taken. Species identification was done with the help of and pictorial field guide and relevant literatures. Climatic data of study area were recorded from Gainde Irrigation Project, Maidhar, Jhapa. Interviews were taken during field visits with the help of structured questionnaire. Preliminary rescue data showed that the Indian flap-shelled turtle (Lissemys punctata) and Yellow bellied roofed turtle (Pangshura flaviventer) were the most overexploited species in the vicinities of the study area. The climatic condition of the rescue centre and water quality found suitable to support terrestrial and freshwater turtles and other various wetland flora and fauna. However, the rapid population growth and habitat destruction due to deforestation, unmanaged urbanization and expansion of agricultural land are found as the major threats to the survival of turtles and other wetland creatures at the study area and its vicinities. DOI: http://dx.doi.org/10.3126/bibechana.v11i0.10394 BIBECHANA 11(1) (2014) 141-148

The diversity and population of birds was studied from January, 2011 to December, 2011, once a week regularly. Altogether fifteen species of wetland birds were recorded from Tengra and Budhi rivers. Maximum species were recorded in January and minimum in July and August. Out of total bird species 40% were migratory, 46.67 % were resident, and 13.33 % were winter visitors. On the basis of abundance, there were 46.67% scarce, 33.33% fairly common and 20% common. On the basis of their population status, maximum number belonged to Ardeola grayii species and minimum in Leptoptilos javanicus species. Maximum species of the birds belonged to family Ardeidae. According to statistical analysis, the resident bird were more diversed then migrant and winter visitor respectively. Similarly, resident birds were much evenly distributed then winter visitors and migrant respectively. The study revealed decreasing trend of bird species from previous period. The conversion of wetland into agricultural land and plotting programmes were the main causes to decline the bird species. DOI: http://dx.doi.org/10.3126/bibechana.v9i0.7184 BIBECHANA 9 (2013) 113-120

Physico-chemical parameters of the Seepage stream of Kushaha area were studied for two years from July, 2002-June, 2004, once in every month at regular intervals. The monthly data were pooled in seasonal value. The maximum air temperature was recorded in rainy season during first year study period (July, 2002 to June, 2003) but in the second year study period (July, 2003 to June 2004) it was maximum in summer season. Water temperature was maximum in summer and lowest in winter season. Transparency, PH, dissolved oxygen, total alkalinity, total hardness, chloride were recorded maximum in winter season. Free carbondioxide, and biological oxygen demand was maximum in summer season. The minimum transparency, total alkalinity, total hardness and chloride were recorded in rainy season. Dissolved oxygen, and PH, were minimum in summer season. The minimum carbondioxide and BOD were recorded in winter season. Air temperature, water temperature, free carbondioxide, biological oxygen demand showed positive and significant correlation with each other. Similarly, transparency, PH, total alkalinity, total hardness, chloride, showed positive and significant correlation with each other. Dissolved oxygen showed positive and significant correlation with pH, total alkalinity, total hardness and chloride. Keywords: Physico- chemical parameters; seepage system DOI: http://dx.doi.org/10.3126/bibechana.v8i0.5697 BIBECHANA 2012; 8: 105-115

This paper deals with 15 freshwater and 1 terrestrial mollusc species collected from Betna wetland and its surroundings. Among the collected 16 species, 12 species were gastropods representing 3 orders, 6 families, 8 genera and 4 species were bivalves representing 1 order, 2 families and 2 genera. Seven species of the total species of molluscs were edible and consume by the local people and 3 species were harmful. Key words: Molluscs diversity; Betna wetland DOI: 10.3126/bibechana.v7i0.4041 BIBECHANA 7 (2011) 30-32

The paper deals with the herpetofauna of Koshi Tappu Wildlife Reserve and its surroundings. A total of 23 species of herpetofauna belonging to 19 genera and 13 families were recorded. Of these 8 species belonging to 6 genera and 3 families were amphibians, and 15 species belonging to 13 genera and 10 families were reptiles. Keywords: herpetofauna; Gavialis gangeticus; Koshi Tappu DOI: 10.3126/bibechana.v6i0.3933 BIBECHANA Vol. 6, March 2010 pp.15-17

Competing Interests: The authors declare no conflicts of interests related to this article, financial or otherwise.

Acute encephalitis syndrome (AES) in children poses a significant public health challenge in India. This study aims to explore the utility of host inflammatory mediators and neurofilament (NfL) levels in distinguishing etiologies, assessing disease severity, and predicting outcomes in AES. We assessed 12 mediators in serum (n = 58) and 11 in cerebrospinal fluid (CSF) (n = 42) from 62 children with AES due to scrub typhus, viral etiologies, and COVID-associated multisystem inflammatory syndrome (MIS-C) in Southern India. Additionally, NfL levels in serum (n = 20) and CSF (n = 18) were examined. Clinical data, including Glasgow coma scale (GCS) and Liverpool outcome scores, were recorded. Examining serum and CSF markers in the three AES etiology groups revealed notable distinctions, with scrub typhus differing significantly from viral and MIS-C causes. Viral causes had elevated serum CCL11 and CCL2 compared with scrub typhus, while MIS-C cases showed higher HGF levels than scrub typhus. However, CSF analysis showed a distinct pattern with the scrub typhus group exhibiting elevated levels of IL-1RA, IL-1β, and TNF compared with MIS-C, and lower CCL2 levels compared with the viral group. Modeling the characteristic features, we identified that age ≥3 years with serum CCL11 < 180 pg/mL effectively distinguished scrub typhus from other AES causes. Elevated serum CCL11, HGF, and IL-6:IL-10 ratio were associated with poor outcomes (p = 0.038, 0.005, 0.02). Positive CSF and serum NfL correlation, and negative GCS and serum NfL correlation were observed. Median NfL levels were higher in children with abnormal admission GCS and poor outcomes. Measuring immune mediators and brain injury markers in AES provides valuable diagnostic insights, with the potential to facilitate rapid diagnosis and prognosis. The correlation between CSF and serum NfL, along with distinctive serum cytokine profiles across various etiologies, indicates the adequacy of blood samples alone for assessment and monitoring. The association of elevated levels of CCL11, HGF, and an increased IL-6:IL-10 ratio with adverse outcomes suggests promising avenues for therapeutic exploration, warranting further investigation., (© 2024 Wiley Periodicals LLC.)

Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.

Background: Scrub typhus has become a leading cause of central nervous system (CNS) infection in endemic regions. As a treatable condition, prompt recognition is vital. However, few studies have focused on describing the symptomology and outcomes of neurological scrub typhus infection. We conducted a systematic review and meta-analysis to report the clinical features and case fatality ratio (CFR) in patients with CNS scrub typhus infection., Methods: A search and analysis plan was published in PROSPERO [ID 328732]. A systematic search of PubMed and Scopus was performed and studies describing patients with CNS manifestations of proven scrub typhus infection were included. The outcomes studied were weighted pooled prevalence (WPP) of clinical features during illness and weighted CFR., Results: Nineteen studies with 1,221 (656 adults and 565 paediatric) patients were included. The most common clinical features in CNS scrub typhus were those consistent with non-specific acute encephalitis syndromes (AES), such as fever (WPP 100.0% [99.5%-100.0%, I2 = 47.8%]), altered sensorium (67.4% [54.9-78.8%, I2 = 93.3%]), headache (65.0% [51.5-77.6%, I2 = 95.1%]) and neck stiffness 56.6% (29.4-80.4%, I2 = 96.3%). Classical features of scrub typhus were infrequently identified; an eschar was found in only 20.8% (9.8%-34.3%, I2 = 95.4%) and lymphadenopathy in 24.1% (95% CI 11.8% - 38.9%, I2 = 87.8%). The pooled CFR (95% CI) was 3.6% (1.5%- 6.4%, I2 = 67.3%). Paediatric cohorts had a CFR of 6.1% (1.9-12.1%, I2 = 77%) whilst adult cohorts reported 2.6% (0.7-5.3%, I2 = 43%)., Conclusion: Our meta-analyses illustrate that 3.6% of patients with CNS manifestations of scrub typhus die. Clinicians should have a high index of suspicion for scrub typhus in patients presenting with AES in endemic regions and consider starting empiric treatment whilst awaiting results of investigations, even in the absence of classical signs such as an eschar or lymphadenopathy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Alam 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.)

The ongoing COVID-19 pandemic highlights the need to tackle viral variants, expand the number of antigens, and assess diverse delivery systems for vaccines against emerging viruses. In the present study, a DNA vaccine candidate was generated by combining in tandem envelope protein domain III (EDIII) of dengue virus serotypes 1-4 and a dengue virus (DENV)-2 non-structural protein 1 (NS1) protein-coding region. Each domain was designed as a serotype-specific consensus coding sequence derived from different genotypes based on the whole genome sequencing of clinical isolates in India and complemented with data from Africa. This sequence was further optimized for protein expression. In silico structural analysis of the EDIII consensus sequence revealed that epitopes are structurally conserved and immunogenic. The vaccination of mice with this construct induced pan-serotype neutralizing antibodies and antigen-specific T cell responses. Assaying intracellular interferon (IFN)-γ staining, immunoglobulin IgG2(a/c)/IgG1 ratios, and immune gene profiling suggests a strong Th1-dominant immune response. Finally, the passive transfer of immune sera protected AG129 mice challenged with a virulent, non-mouse-adapted DENV-2 strain. Our findings collectively suggest an alternative strategy for dengue vaccine design by offering a novel vaccine candidate with a possible broad-spectrum protection and a successful clinical translation either as a stand alone or in a mix and match strategy., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Africa has one of the highest incidences of gonorrhea. Neisseria gonorrhoeae is gaining resistance to most of the available antibiotics, compromising treatment across the world. Whole-genome sequencing (WGS) is an efficient way of predicting AMR determinants and their spread in the population. Recent advances in next-generation sequencing technologies like Oxford Nanopore Technology (ONT) have helped in the generation of longer reads of DNA in a shorter duration with lower cost. Increasing accuracy of base-calling algorithms, high throughput, error-correction strategies, and ease of using the mobile sequencer MinION in remote areas lead to its adoption for routine microbial genome sequencing. To investigate whether MinION-only sequencing is sufficient for WGS and downstream analysis in resource-limited settings, we sequenced the genomes of 14 suspected N. gonorrhoeae isolates from Nairobi, Kenya., Methods: Using WGS, the isolates were confirmed to be cases of N. gonorrhoeae ( n = 9), and there were three co-occurrences of N. gonorrhoeae with Moraxella osloensis and N. meningitidis ( n = 2). N. meningitidis has been implicated in sexually transmitted infections in recent years. The near-complete N. gonorrhoeae genomes ( n = 10) were analyzed further for mutations/factors causing AMR using an in-house database of mutations curated from the literature., Results: We observe that ciprofloxacin resistance is associated with multiple mutations in both gyrA and parC. Mutations conferring tetracycline ( rpsJ ) and sulfonamide ( folP ) resistance and plasmids encoding beta-lactamase were seen in all the strains, and tet(M) -containing plasmids were identified in nine strains. Phylogenetic analysis clustered the 10 isolates into clades containing previously sequenced genomes from Kenya and countries across the world. Based on homology modeling of AMR targets, we see that the mutations in GyrA and ParC disrupt the hydrogen bonding with quinolone drugs and mutations in FolP may affect interaction with the antibiotic., Conclusion: Here, we demonstrate the utility of mobile DNA sequencing technology in producing a consensus genome for sequence typing and detection of genetic determinants of AMR. The workflow followed in the study, including AMR mutation dataset creation and the genome identification, assembly, and analysis, can be used for any clinical isolate. Further studies are required to determine the utility of real-time sequencing in outbreak investigations, diagnosis, and management of infections, especially in resource-limited settings., 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 Juma, Sankaradoss, Ndombi, Mwaura, Damodar, Nazir, Pandit, Khurana, Masika, Chirchir, Gachie, Krishna, Sowdhamini, Anzala and Meenakshi.)

Karnataka, a state in south India, reported its first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on March 8, 2020, more than a month after the first case was reported in India. We used a combination of contact tracing and genomic epidemiology to trace the spread of SARS-CoV-2 in the state up until May 21, 2020 (1578 cases). We obtained 91 genomes of SARS-CoV-2 which clustered into seven lineages (Pangolin lineages-A, B, B.1, B.1.80, B.1.1, B.4, and B.6). The lineages in Karnataka were known to be circulating in China, Southeast Asia, Iran, Europe and other parts of India and are likely to have been imported into the state both by international and domestic travel. Our sequences grouped into 17 contact clusters and 24 cases with no known contacts. We found 14 of the 17 contact clusters had a single lineage of the virus, consistent with multiple introductions and most (12/17) were contained within a single district, reflecting local spread. In most of the 17 clusters, the index case (12/17) and spreaders (11/17) were symptomatic. Of the 91 sequences, 47 belonged to the B.6 lineage, including eleven of 24 cases with no known contact, indicating ongoing transmission of this lineage in the state. Genomic epidemiology of SARS-CoV-2 in Karnataka suggests multiple introductions of the virus followed by local transmission in parallel with ongoing viral evolution. This is the first study from India combining genomic data with epidemiological information emphasizing the need for an integrated approach to outbreak response., Competing Interests: FH is an employee of TruFactor-InMobi group company, however, he was permitted to participate as a volunteer in this study and his employer neither had access to data, nor any say in the design of the study or the decision to publish. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors are employees of state (PD, PK) or central government. The employers had no role in the design of the study or the decision to publish. The authors declare that they do not have any other financial or non-financial relationships that could present a conflict of interest.

Background: Early ante-mortem laboratory confirmation of human rabies is essential to aid patient management and institute public health measures. Few studies have highlighted the diagnostic value of antibody detection in CSF/serum in rabies, and its utility is usually undermined owing to the late seroconversion and short survival in infected patients. This study was undertaken to examine the ante-mortem diagnostic utility and prognostic value of antibody detection by rapid fluorescent focus inhibition test (RFFIT) in cerebrospinal fluid (CSF)/serum samples received from clinically suspected human rabies cases from January 2015 to December 2017., Methodology/principal Findings: Samples collected ante-mortem and post-mortem from 130 and 6 patients with clinically suspected rabies respectively, were received in the laboratory during the study period. Ante-mortem laboratory confirmation was achieved in 55/130 (42.3%) cases. Real time PCR for detection of viral nucleic acid performed on saliva, nuchal skin, brain tissue and CSF samples could confirm the diagnosis in 15 (27.2%) of the 55 laboratory confirmed cases. Ante-mortem diagnosis could be achieved by RFFIT (in CSF and/or serum) in 45 (34.6%) of the 130 clinically suspected cases, accounting for 81.8% of the total 55 laboratory confirmed cases. The sensitivity of CSF RFFIT increased with the day of sample collection (post-onset of symptoms) and was found to be 100% after 12 days of illness. Patients who had received prior vaccination had an increased probability of a positive RFFIT and negative PCR result. Patients who were positive by RFFIT alone at initial diagnosis had longer survival (albeit with neurological sequelae) than patients who were positive by PCR alone or both RFFIT and PCR., Conclusions/significance: Detection of antibodies in the CSF/serum is a valuable ante-mortem diagnostic tool in human rabies, especially in patients who survive beyond a week. It was also found to have a limited role as a prognostic marker to predict outcomes in patients., Competing Interests: The authors have declared that no competing interests exist.

Rabies, a zoonotic viral encephalitis, continues to be a serious public health problem in India and several other countries in Asia and Africa. Survival is rarely reported in rabies, which is considered to be almost universally fatal. We report the clinical and radiological findings of eight patients with laboratory-confirmed rabies who survived the illness. With the exception of one patient who recovered with mild sequelae, all survivors had poor functional outcomes. The reported survival from rabies in recent years may reflect an increased awareness of the disease and greater access to better critical care facilities in rabies-endemic countries. Nonetheless, there is an urgent need to focus on preventive strategies to reduce the burden of this dreadful disease in rabies-endemic countries.

Background: Dengue (DEN) is being recognised as the world's major emerging tropical disease. Clinically, DEN may resemble other infections such as malaria, leptospirosis, and typhoid, and thus, laboratory investigations are required for definitive diagnosis. Secondary DEN infection, caused most often by dengue virus (DENV) serotypes 2 and 3, is known to present with severe disease manifestations. This study was undertaken to examine the clinical and laboratory profile of DEN viral infections and to determine the circulating serotypes in and around Mangalore, India., Materials and Methods: Serum samples from 285 clinically suspected cases of DEN in and around Mangalore between September 2013 and January 2014 were processed for detection of DEN IgM and IgG antibodies and nonstructural 1 (NS1) antigen using commercial ELISA kits. Detection of DEN viral RNA and serotyping was done by multiplex real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The clinical and haematological profiles of the patients were analysed., Results: Serum samples from 83 (29%) patients were positive for DEN NS1 antigen and/or IgM antibodies. 33 (45%) out of 73 serum samples processed by multiplex real-time RT-PCR were positive for DEN viral RNA. DEN-1, -2 and -3 were the serotypes identified in this study. Fever was the most common presenting symptom followed by myalgia/arthralgia. Majority of the patients had thrombocytopaenia., Conclusion: Early detection of DEN can be achieved effectively using NS1 ELISA and IgM capture ELISA. Circulating DENV serotypes should be closely monitored for prevention of fatal outcomes in secondary infections.

Undifferentiated Acute Febrile Illness (AFI) is a common clinical syndrome among patients seeking hospital care. Detection of co-infections at the time of presentation is a diagnostic challenge, especially with limited laboratory support. Even if detected, early treatment and cure of these co-infections can be difficult for the clinicians. We are presenting a rare case of Hepatitis B and leptospirosis co-infection with high titres of Salmonella paratyphi A and scrub typhus. There are a few reports of leptospirosis in Hepatitis -B infected individuals but no generalization can be made due to limited data. Prompt and accurate serological diagnosis of multiple infectious agents have becomes mandatory in a healthcare set-up.