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Venous thromboembolism (VTE) risk is increased in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A key question was whether increased intensity of anticoagulation would help prevent VTE and improve patient outcomes, including transfer to the intensive care unit (ICU) and mortality. At the start of the coronavirus disease-19 (COVID-19) pandemic, our institution, Boston Medical Center, instituted a VTE risk stratification protocol based on patients’ initial D-dimer levels, medical history, and presence of thrombosis to determine whether they should receive standard-dose prophylaxis, high-dose prophylaxis, or therapeutic anticoagulation. We performed a retrospective observational cohort study examining the association of degree of anticoagulation with outcomes in 915 hospitalized COVID-19 patients hospitalized initially on the general inpatient wards between March 1,, 2020, and June 1, 2020. Patients directly hospitalized in the ICU were excluded. Most, 813 patients (89%), in our cohort were on standard-dose prophylaxis; 32 patients (3.5%) received high-dose prophylaxis; 70 patients (7.7%), were treated with therapeutic anticoagulation. VTE occurred in 45 patients (4.9%), and the overall in-hospital mortality rate was 5.4% (49 deaths). On multivariable analysis of clinical outcomes in relation to type of anticoagulation, in the high-dose prophylaxis group, there was a trend towards increased in-hospital mortality (odds ratio 2.4 (0.8–7.5, 95% CI)) and increased ICU transfer (odds ratio 2.2 (0.9-5.7, 95% CI)). Our results suggest that patients receiving high-dose prophylaxis had more severe disease that was not mitigated by intermediate-dose anticoagulation.

IntroductionHealth interventions often target pregnant women and their unborn children. Interventions in rural India targeting pregnant women, however, often do not cover the critical early windows of susceptibility during the first trimester and parts of the second trimester. This pilot seeks to determine if targeting newlyweds could protect entire pregnancies with a clean stove and fuel intervention.MethodsWe recruited 50 newlywed couples who use biomass as a cooking fuel into a clean cooking intervention that included a liquefied petroleum gas (LPG) stove, two gas cylinders, a table to place the stove on and health education. We first evaluated whether community health workers in this region could identify and recruit couples at marriage. We quantified how many additional days of pregnancy could be covered by an intervention if we recruited at marriage versus recruiting after detection of pregnancy.ResultsOn average, we identified and visited newlywed couples within 40 (SD 21) days of marriage. Of the 50 couples recruited, 25 pregnancies and 18 deliveries were identified during this 1-year study. Due to challenges securing fuel from the LPG supply system, not all couples received their intervention prior to pregnancy. Regardless, couples recruited in the marriage arm had substantially more days with the intervention than couples recruited into a similar arm recruited at pregnancy (211 SD 46 vs 120 SD 45). At scale, a stove intervention targeting new marriages would cover about twice as many weeks of first pregnancies as an intervention recruiting after detection of pregnancy.ConclusionsWe were able to recruit in early marriage using existing community health workers. Households recruited early in marriage had more days with clean fuel coverage than those recruited at pregnancy. Our findings indicate that recruitment at marriage is feasible and warrants further exploration for stove and other interventions targeting pregnancy-related outcomes.

ABSTRACTThe WHO pre-qualified rotavirus vaccine, ROTAVAC®, is derived naturally from the neonatal 116E rotavirus strain, and stored at −20°C. As refrigerator storage is preferable, immunogenicity and safety of liquid formulations kept at 2–8°C, having excipients to stabilize the rotavirus, with or without buffers, were compared with ROTAVAC® in different clinical studies. Study-1, the pivotal trial for this entire product development work, was a randomized, single-blind trial with two operationally seamless phases: (i) an exploratory phase involving 675 infants in which two formulations, ROTAVAC 5C (LnHRV-1.5 mL and LnHRV-2.0 mL) containing buffer and excipients to stabilize the virus against gastric acidity and temperature, were compared with ROTAVAC®. As the immune response of ROTAVAC 5C (LnHRV-2.0 mL) was non-inferior to ROTAVAC®, it was selected for (ii) confirmatory phase, involving 1,302 infants randomized 1:1:1:1 to receive three lots of LnHRV-2.0 mL, or ROTAVAC®. Primary objectives were the evaluation of non-inferiority and lot-to-lot consistency. The secondary objectives were to assess the safety and interference with the concomitant pentavalent vaccine. As it was separately established that buffers are not required for ROTAVAC®, in Study-2, the safety and immunogenicity of ROTAVAC 5D® (with excipients) were compared with ROTAVAC® and lot-to-lot consistency was assessed in another study. All lots elicited consistent immune responses, did not interfere with UIP vaccines, and had reactogenicity similar to ROTAVAC®. ROTAVAC 5C and ROTAVAC 5D® were immunogenic and well tolerated as ROTAVAC®. ROTAVAC 5D® had comparable immunogenicity and safety profiles with ROTAVAC® and can be stored at 2–8°C, leading to WHO pre-qualification.Clinical Trials Registration: Clinical Trials Registry of India (CTRI): CTRI/2015/02/005577CTRI/2016/11/007481 and CTRI/2019/03/017934.

Household air pollution from the combustion of biomass and coal is estimated to cause approximately 780,000 premature deaths a year in India. The government has responded by promoting uptake of liquefied petroleum gas (LPG) by tens of millions of poor rural families. Many poor households with new LPG stoves, however, continue to partially use traditional smoky chulhas. Our primary objective was to evaluate three strategies to transition pregnant women in rural Maharashtra to exclusive use of LPG for cooking. We also measured reductions in kitchen concentrations of PM2.5 before and after our interventions. Our core intervention was a free stove, 2 free LPG cylinders (one on loan until delivery), and repeated health messaging. We measured stove usage of both the traditional and intervention stoves until delivery. In households that received the core intervention, an average of 66% days had no indoor cooking on a chulha. In an adjacent area, we evaluated a conditional cash transfer (CCT) based on usage of LPG in addition to the core intervention. Results were less successful, due to challenges implementing the CCT. Pregnant women in a third nearby area received the core intervention plus a maximum of one 14.2 kg cylinder per month of free fuel. In their homes, 90% of days had no indoor cooking on a chulha. On average, exclusive LPG use decreased kitchen concentrations of PM2.5 by approximately 85% (from 520 to 72 μg/m3). 85% of participating households agreed to pay the deposit on the 2nd cylinder. This high purchase rate suggests they valued how the second cylinder permitted continuous LPG supply. A program to increase access to second cylinders may, thus, be a straightforward way to encourage use of clean fuels in rural areas.

Abstract Recent proposals towards non-local thermoelectric voltage-based thermometry, in the conventional dual quantum dot set-up, demand an asymmetric step-like system-to-reservoir coupling around the ground states for optimal operation (Physica E, 114, 113635, 2019). In addition to such demand for unrealistic coupling, the sensitivity in such a strategy also depends on the average measurement terminal temperature, which may result in erroneous temperature assessment. In this paper, we propose non-local current based thermometry in the dual dot set-up as a practical alternative and demonstrate that in the regime of high bias, the sensitivity remains robust against fluctuations of the measurement terminal temperature. Proceeding further, we propose a non-local triple quantum dot thermometer, that provides an enhanced sensitivity while bypassing the demand for unrealistic step-like system-to-reservoir coupling and being robust against fabrication induced variability in Coulomb coupling. In addition, we show that the heat extracted from (to) the target reservoir, in the triple dot design, can also be suppressed drastically by appropriate fabrication strategy, to prevent thermometry induced drift in reservoir temperature. The proposed triple dot setup thus offers a multitude of benefits and could potentially pave the path towards the practical realization and deployment of high-performance non-local “sub-Kelvin range” thermometers.

Objective: Probiotics have been researched extensively over the past few years for the prevention and treatment of diarrhea in pediatric populations. In the present study, the efficacy and safety of probiotic Bacillus subtilis HU58 and probiotic Bacillus coagulans SC208 in combination were evaluated in children for the treatment of acute diarrhea. Materials and Methods: In this randomized, double-blind, parallel, placebo-controlled trial, 64 children with average age of 4.18 ± 3.0 years (mean ± standard deviation), out of which 32 children with antibiotic-associated diarrhea (AAD) and 32 children with acute infective diarrhea randomly received either syrup containing B. subtilis HU58 and B. coagulans SC208 probiotics or placebo syrup daily for a period of 7 days. Stool consistency, duration of diarrhea in days, and abdominal pain intensity during the treatment period, were assessed daily in all subjects for the improvement in clinical signs and symptoms. Also, an assessment of adverse events was done from the screening visit to the end of study visit. Result: A total of 32 subjects were screened and randomized in both cohort 1 and cohort 2. At the end of the study, that is, on day 7, B. subtilis HU58 + B. coagulans SC208 syrup-treated subjects in both cohorts showed significant improvement in stool consistency and duration of diarrhea over placebo syrup. No adverse events were observed in the study of both cohorts. Conclusion: This study's results conclude that B. subtilis HU58 and B. coagulans SC208 syrup improved the recovery and reduced the course of acute infectious diarrhea and AAD in children, with no reported adverse effects.

Introduction: Protein-Energy Malnutrition (PEM) and prevalence of under-weight children in India, is an important health concern. Aim: To evaluate the effect of Oral Nutritional Supplement (ONS) on growth, overall nutrient intake and frequency of illness in nutritionally at-risk Indian children. Materials and Methods: In this prospective, randomised, gender-stratified, controlled, parallel group, open label study, 216 children (aged 4-6 years with weight-for-age z-score between -2 and -1) were randomised (1:1) to receive either 45 g of ONS {Test product+Dietary advice (T+D)} or control group {Dietary advice only (D-only)} for three months. Primary endpoints included weight-for-age z-score and weight gain in terms of g/kg/day from baseline to three months. Secondary endpoints included change in height-for-age z-scores; frequency of illness, change in dietary nutrient intake and Protein/Energy (P/E) ratio from baseline through three months. Safety endpoint included Adverse Events (AEs). PROC MIXED was used to perform Repeated Measures Analysis Of Variance (RMANOVA) based on the changes in z-scores. The z-scores changes within the group from baseline to the end of three months End-ofStudy (EOS) were compared using paired t-test. Results: At baseline, the mean (SD) weight-for-age z-scores were similar in both the groups {1.50 (0.309) and -1.49 (0.312) in T+D and D-only groups, respectively}. At the EOS, only T+D group showed significant mean (SD) change from baseline in weight-for-age z-score compared to the D-only group {0.59 (0.296), p

Background: Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection can lead to multisystem inflammatory syndrome in children (MIS-C). This study was conducted to study epidemiology, clinical profile, treatment strategies associated in children MIS-C in two cities in Western India. Subjects and Methods: This is a retrospective, observational study of children who fulfilled the criteria for MIS-C, admitted to eleven pediatric intensive care units (PICUs) in Western India during the first wave SARS-CoV-2 infection in India, between February 2020 and December 2020. Demographic and clinical data including laboratory parameters, treatment regimens, and outcomes were collected and analyzed. Results: Of the 234 children presenting with MIS-C, they were categorized into 3 clinical phenotypes: fever and hyperinflammation, Kawasaki disease (KD)-like, and shock with multisystem organ dysfunction syndrome (MODS). C-reactive protein, procalcitonin (PCT), D-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. Intravenous immunoglobulin (IVIG) was used in 128 (54.7%), corticosteroids in 214 (91.45%), tocilizumab in 1 (0.4%), and remdesivir in 4 (1.7%). 95 (40.5%) children required vasopressors and invasive mechanical ventilation was necessary in 26 (11.1%). Two hundred and twenty-nine patients were discharged home with median duration of PICU stay of 4 days and hospital stay of 7 days, and 5 (2.1%) patients died during treatment. Significant reduction in the duration of hospital stay was observed in those who received both steroid and IVIG (P < 0.05) and also in the shock ± MODS group (P < 0.05). Conclusions: Combination of steroid and IVIG for the treatment of MISC, especially with Shock and MODS reduce the duration of PICU stay than treated with steroid alone.

Background: Attention in the medical literature has been primarily focused on the effects of alcohol on the nervous system and liver, In the past few years, isolated reports have appeared in the medical literature concerning the effects of alcohol on the bony skeleton.1 Chronic alcohol consumption has major harmful effects on bone development and maintenance at all ages.2 The purpose of this paper is to classify these lesions, discuss their pathophysiology, and briefly review their clinical course. Methods: The cross-sectional survey that was conducted in Karad City served as the basis for this article. The purpose of this survey is to determine how common early arthritic changes are in long-term alcohol users. Prior to conducting the survey, the ethical committee's approval was obtained. Patients were chosen based on inclusion and exclusion standards. With their permission, 233 chronic drinkers participated in this study, and result was obtained by the statistician. Result: In this study we found the prevalence of 81.97% of early arthritic changes in chronic alcoholers which includes elevation in the ESR and CRP levels, changes in the X-rays and symptoms like morning stiffness, joint pain, swelling. Conclusion: This study shows overall prevalence of early arthritic changes in chronic alcoholers is very high (81.97%). Lack of awareness and habit of excessive habit of alcohol consumption can cause these problems. [ABSTRACT FROM AUTHOR]

Introduction Health interventions often target pregnant women and their unborn children. Interventions in rural India targeting pregnant women, however, often do not cover the critical early windows of susceptibility during the first trimester and parts of the second trimester. This pilot seeks to determine if targeting newlyweds could protect entire pregnancies with a clean stove and fuel intervention.Methods We recruited 50 newlywed couples who use biomass as a cooking fuel into a clean cooking intervention that included a liquefied petroleum gas (LPG) stove, two gas cylinders, a table to place the stove on and health education. We first evaluated whether community health workers in this region could identify and recruit couples at marriage. We quantified how many additional days of pregnancy could be covered by an intervention if we recruited at marriage versus recruiting after detection of pregnancy.Results On average, we identified and visited newlywed couples within 40 (SD 21) days of marriage. Of the 50 couples recruited, 25 pregnancies and 18 deliveries were identified during this 1-year study. Due to challenges securing fuel from the LPG supply system, not all couples received their intervention prior to pregnancy. Regardless, couples recruited in the marriage arm had substantially more days with the intervention than couples recruited into a similar arm recruited at pregnancy (211 SD 46 vs 120 SD 45). At scale, a stove intervention targeting new marriages would cover about twice as many weeks of first pregnancies as an intervention recruiting after detection of pregnancy.Conclusions We were able to recruit in early marriage using existing community health workers. Households recruited early in marriage had more days with clean fuel coverage than those recruited at pregnancy. Our findings indicate that recruitment at marriage is feasible and warrants further exploration for stove and other interventions targeting pregnancy-related outcomes.

Objective:Orthosiphon pallidus (O. pallidus), which belongs to the Lamiaceae family, is a popular garden plant that is widely used for the treatment of various diseases, such as urinary lithiasis, fever, hepatitis, cancer and jaundice. The objective of the present work was to investigate the antioxidant free-radical scavenging and the anticancer activities of O. pallidus against human breast-cancer cell lines.Methods:The antioxidant activity of Orthosiphon pallidus aqueous extract (OPAE) was investigated using different models, such as the 1,1-diphenyl-2-picrylhydrazyl (DPPH) and the 2, 2’-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) models, as were the Fe + chelation, the hydroxyl radical and superoxide radical scavenging, and total reducing power activities. The anticancer activities of the extract were determined by using the 3-(4, 5- dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) and the sulforhodamine (SRB) assays on the MCF-7 and the MDA-MB-231 cancer cell lines.Results:The aqueous Orthosiphon pallidus extract showed potent activity in in-vitro models. It significantly inhibited the scavenging of hydroxyl and superoxide radicals, but induced a remarkable Fe + chelation activity. For both cell lines, the percent cytotoxicity was found to increase steadily with increasing OPAE concentration up to 240 μg/mL.Conclusion:These results suggest that Orthosiphon pallidus has excellent antioxidant, antimicrobial, and anticancer activities against human breast-cancer cell lines.

Moringa oleifera Lam. or munga is one of the most important plant widely cultivated in India. It belongs to family Moringaceae. This plant is widely used as nutritional herb and contains valuable pharmacological action like anti-asthmatic, anti-diabetic, hepatoprotective, anti-inflammatory, anti- fertility, anti-cancer, antimicrobial, anti-oxidant, cardiovascular, anti-ulcer, CNS activity, anti-allergic, wound healing, analgesic, and antipyretic activity, Moringa oleifera Lam. The plant is also known as Horse - radish tree, Drumstick tree. Every part of this plant contains a valuable medicinal feature. It contain rich source of the vitamin A, vitamin C and milk protein. Different types of active phytoconstituents like alkaloids, protein, quinine, saponins, flavonoids, tannin, steroids, glycosides, fixed oil and fats are present. This plant is also found in the tropical regions. Some other constituents are niazinin A, niazinin B and niazimicin A, niaziminin B. The present review discusses the phytochemical composition, medicinal uses & pharmacological activity of this plant.