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Introduction: Endoscopic strip craniectomy with helmeting (ESCH) has been shown to be a safe and efficacious alternative to fronto-orbital remodeling (FOR) for selected children with craniosynostosis. In addition to clinical factors, there may be economic benefits from the use of ESCH instead of FOR. Methods: A retrospective review of 23 patients with nonsyndromic unicoronal craniosynostosis (UCS) treated with FOR was carried out at Great Ormond Street Hospital (GOSH) for Children in London, UK. Secondary data were used for the ESCH cohort from a paper published by Jimenez and Barone (2013). Data were collected on surgical time, transfusion rates, length of hospital stay, adverse event rates, reintervention rates, and overall costs. Costs were categorized and then assigned to the appropriate data sets. Results: The mean age of patients undergoing FOR (vs. ESCH) was 17.4 mo (vs. 3.1 mo) with a mean surgical time of 234 min (vs. 55 min), mean transfusion volume of 221.6 mL (vs. 80.0 mL), mean transfusion rate of 14/23 (vs. 2/115), and a total immediate overnight stay of 3.13 days (vs. 97% next-day discharge). The FOR group had a higher adverse event rate (5/23 vs. 4/115, p=

Abstract Salinity impacts crop growth and productivity and lowers the activities of rhizosphere microbiota. The identification and utilization of habitat-specific salinity-adapted plant growth-promoting rhizobacteria (PGPR) are considered alternative strategies to improve the growth and yields of crops in salinity-affected coastal agricultural fields. In this study, we characterize strain L1I39T, the first Aquabacter species with PGPR traits isolated from a salt-tolerant pokkali rice cultivated in brackish environments. L1I39T is positive for 1-aminocyclopropane-1-carboxylate deaminase activity and nitrogen fixation and can promote pokkali rice growth by supplying fixed nitrogen under a nitrogen-deficient seawater condition. Importantly, enhanced plant growth and efficient root colonization were evident in L1I39T-inoculated plants grown under 20% seawater but not in zero-seawater conditions, identifying brackish conditions as a key local environmental factor critical for L1I39T-pokkali rice symbiosis. Detailed physiological studies revealed that L1I39T is well-adapted to brackish environments. In-depth genome analysis of L1I39T identified multiple gene systems contributing to its plant-associated lifestyle and brackish adaptations. The 16S rRNA-based metagenomic study identified L1I39T as an important rare PGPR taxon. Based on the polyphasic taxonomy analysis, we established strain L1I39T as a novel Aquabacter species and proposed Aquabacter pokkalii sp nov. Overall, this study provides a better understanding of a marine-adapted PGPR strain L1I39T that may perform a substantial role in host growth and health in nitrogen-poor brackish environments.

In a single-bandgap absorber, photons having energy less than the bandgap are not absorbed, while those having energy larger than the bandgap lose the excess energy via thermalization. We present outdoor measurements of a photovoltaic system that overcomes these losses via spectrum splitting and concentration using a planar diffractive optic. The system was comprised of the diffractive optic coupled with GaInP and CIGS solar cells. The optic provides a geometric concentration of 3X for each solar cell. It is easily fabricated by single-step grayscale lithography and it is ultra-thin with a maximum thickness of only 2.5μm. Electrical measurements under direct sunlight demonstrated an increase of ∼25% in total output power compared to the reference case without spectrum splitting and concentration. Since different bandgaps are in the same plane, the proposed photovoltaic system successfully circumvents the lattice-matching and current-matching issues in conventional tandem multi-junction solar cells. This system is also tolerant to solar spectrum variation and fill-factor degradation of constitutive solar cells.

ABSTRACTBacterial pathogens use protein secretion systems to transport virulence factors and regulate gene expression. Among pathogenic mycobacteria, including Mycobacterium tuberculosis and Mycobacterium marinum, the ESAT-6 system 1 (ESX-1) secretion is crucial for host interaction. Secretion of protein substrates by the ESX-1 secretion system disrupts phagosomes, allowing mycobacteria cytoplasmic access during macrophage infections. Deletion or mutation of the ESX-1 system attenuates mycobacterial pathogens. Pathogenic mycobacteria respond to the presence or absence of the ESX-1 system in the cytoplasmic membrane by altering transcription. Under laboratory conditions, the EspM repressor and WhiB6 activator control transcription of specific ESX-1-responsive genes, including the ESX-1 substrate genes. However, deleting the espM or whiB6 gene does not phenocopy the deletion of the ESX-1 substrate genes during macrophage infection by M. marinum. In this study, we identified EspN, a critical transcription factor whose activity is masked by the EspM repressor under laboratory conditions. In the absence of EspM, EspN activates transcription of whiB6 and ESX-1 genes during both laboratory growth and macrophage infection. EspN is also independently required for M. marinum growth within and cytolysis of macrophages, similar to the ESX-1 genes, and for disease burden in a zebrafish larval model of infection. These findings suggest that EspN and EspM coordinate to counterbalance the regulation of the ESX-1 system and support mycobacterial pathogenesis.IMPORTANCEPathogenic mycobacteria, which are responsible for tuberculosis and other long-term diseases, use the ESX-1 system to transport proteins that control the host response to infection and promote bacterial survival. In this study, we identify an undescribed transcription factor that controls the expression of ESX-1 genes and is required for both macrophage and animal infection. However, this transcription factor is not the primary regulator of ESX-1 genes under standard laboratory conditions. These findings identify a critical transcription factor that likely controls expression of a major virulence pathway during infection, but whose effect is not detectable with standard laboratory strains and growth conditions.

An inexpensive method for the purification and evaluation of user-synthesized or crude commercially prepared double-labeled fluorescent probes is presented. These probes exhibit the characteristics required for use in 5′-nuclease assays, including efficient reporter dye quenching, target specificity and susceptibility to cleavage by Taq DNA polymerase during PCR amplification. The method is suitable for research laboratories that wish to develop 5′ nuclease assays for the detection of PCR-amplified target sequences to eliminate the requirement for agarose gels and to advance throughput.

ObjectivesTo analyze outcomes in patients with normal preoperative left ventricular ejection fraction (LVEF) undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy due to postcardiotomy cardiogenic shock (PCCS) related to coronary malperfusion.MethodsRetrospective single-center analysis in patients with normal preoperative LVEF treated with VA-ECMO for coronary malperfusion-related PCCS between May 1998 and May 2018. The primary outcome was 30-day mortality, which was compared using the Kaplan-Meier method and the log-rank test. Multivariable logistic regression was performed to identify predictors of mortality.ResultsDuring the study period, a total of 62,125 patients underwent cardiac surgery at our institution. Amongst them, 59 patients (0.1%) with normal preoperative LVEF required VA-ECMO support due to coronary malperfusion-related PCCS. The mean duration of VA-ECMO support was 6 days (interquartile range 4-7 days). The 30-day mortality was 50.8%. Under VA-ECMO therapy, a complication composite outcome of bleeding, re-exploration for bleeding, acute renal failure, acute liver failure, and sepsis occurred in 51 (86.4%) patients. Independent predictors of 30-day mortality were lactate levels > 9.9 mmol/l before VA-ECMO implantation (odds ratio [OR]: 3.3; 95% confidence interval [CI] 1.5-7.0; p = 0.002), delay until revascularization > 278 minutes (OR: 2.9; 95% CI 1.3-6.4; p = 0.008) and peripheral arterial artery disease (OR: 3.3; 95% 1.6-7.5; p = 0.001).ConclusionsMortality rates are high in patients with normal preoperative LVEF who develop PCCS due to coronary malperfusion. The early implantation of VA-ECMO before the development of profound tissue hypoxia and early coronary revascularization increases the likelihood of survival. Lactate levels are useful to define optimal timing for the VA-ECMO initiation.

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Intracranial hematoma due to traumatic brain injury is a serious health concern with rates of morbidity and mortality that are increasing worldwide. Manual identification is slow, subject to observer variabilities, and the existing automated techniques for intracranial hematoma detection in non-contrast computed tomography images cannot effectively detect multiple lesions of irregular sizes and shapes. Therefore, a computer-aided system using different window settings, YOLOv5s, cascaded attention module, and spatial pyramid pooling-fast is proposed to detect hematoma types, namely acute intraparenchymal, intraventricular, subdural, epidural, subarachnoid, and chronic subdural. Firstly, the computed tomography images are pre-processed using a window-based stacking approach wherein a three-channel image is generated by stacking grayscale images obtained with the aid of multiple window settings, i.e, brain, bone, and subdural. Secondly, a cascaded attention module is constructed in the neck of the YOLOv5s model to improve its detection performance by placing the convolution block attention module in serial with the efficient channel attention module. The cascaded attention module enriches the feature representation of various hematoma types in complex backgrounds especially when they are small and inconspicuous. The spatial pyramid pooling is replaced by a spatial pyramid pooling-fast to reduce the computational parameters and accelerate the feature fusion ability. The proposed deep learning model is trained, validated, and tested with 15,921 images from the brain haemorrhage extended dataset and it achieved overall precision, recall, F1-score, and mean average precision at 0.5, and mean average precision at 0.5:0.95 of 0.935, 0.908, 0.921, 0.943 and 0.65 respectively. The experimental results show that in comparison to the original YOLOv5s model and state-of-the-art methods, the model was able to localize and classify the acute or chronic instances of five hematoma subtypes in an individual image with improved precision and recall values. Hence the proposed system can be used in hospitals for the early and accurate detection of hematoma.

Introduction Indian Council of Medical Research (ICMR), New Delhi has established a nationwide registry ‘Indian Registry for Venous Thromoembolism Disorder (i-RegVeD)’ for real-time analytics of sociodemographic profile of patients, disease patterns, management strategies, treatment choices and outcomes of patients with venous thromboemobolism (VTE). The purpose is to generate evidence on VTE in order to fill the gaps in the knowledge of the disease across various demographic regions.Methods and analysis This prospective hospital-based registry will be a continuous data collection process on the occurrence and characteristics of VTE from the 16 hospital sites pan India. This process would include obtaining clinical profiles, risk factors, diagnostic tests, treatment and outcome information of patients collected from medical records through an active method of data abstraction and data capture mechanism guided by an online web-based tool.Ethics and dissemination At centralised programme management unit, the study protocol was approved by the Institutional Ethics Committees (IEC) named ICMR-Central Ethics Committee on Human Research and similarly each of the participating site has obtained the ethical approval by their respective IECs. The results from this study will be disseminated publicly on the study website (https://iregved.icmr.org.in) as well as through scientific meetings and publications.

IntroductionExposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.MethodologyMulticentric case–control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).ResultsA total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29–4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43–3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.DiscussionThe results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Social media platforms help brands connect with their customers online, and a social media -based brand community (SMBBC) enable brand attachments to particular brands. These brand communities enhance consumer relationships, increase customer advocacy, discover customer problems, and generate unique product and marketing ideas. In the context of Social Identity Theory and SOR framework (stimulus-organism-response), the present study explored the influence of customer-centric elements (the four relationships) on an online brand community that affect and provoke members’ conscious brains to get into action. The study further examines the impact of SMMBC on brand trust and brand equity variables (brand awareness, perceived quality, brand association and brand loyalty) and, consequently, on customer response (purchase intention, response to brand extension and willingness to pay a premium). A self-administered online survey was conducted to collect data on all selected brands. The brands were selected using a stratified sampling method, and the stratum used was the number of fans following the brands. The top three brands with the highest fan following from 15 sectors were picked. The study selected 384 final responses after the data screening procedure. SPSS version 26 and AMOS graphics were used for testing hypothesised relationship. Exploratory factor analysis (EFA) was conducted to ensure that the selected scale items were appropriately loaded, followed by measurement model’s reliability and validity testing using Confirmatory factor analysis (CFA). The findings of SEM analysis conclude that customer-centric elements are significant determinants of the online brand community. The results also confirmed that strengthening SMBBC leads to higher brand trust and positively influences all brand equity dimensions. In addition, the research study found that positive brand equity results in favourable consumer responses. This study contributes theoretically to past studies on brand community and customer response, mainly in social media. The findings are helpful for managers to design and manage their online brand communities effectively and to elicit more positive responses.

BackgroundPeople with disabilities are vulnerable because of the many challenges they face attitudinal, physical, and financial. The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resources for the country and seeks to create an environment that provides equal opportunities, and protection of their rights, and full. There are limited studies on health care burden due to disabilities of various types.AimThe present study examines the socioeconomic and state-wise differences in the prevalence of disabilities and related household financial burden in India.MethodsData for this study was obtained from the National Sample Survey (NSS), 76th round Persons with Disabilities in India Survey 2018. The survey covered a sample of 1,18,152 households, 5,76,569 individuals, of which 1,06,894 of had any disability. This study performed descriptive statistics, and bivariate estimates.ResultsThe finding of the analysis showed that prevalence of disability of any kind was 22 persons per 1000. Around, one-fifth (20.32%) of the household's monthly consumption expenditure was spent on out-of-pocket expenditure for disability. More than half (57.1%) of the households were pushed to catastrophic health expenditure due to one of the members being disabled. Almost one-fifth (19.1%) of the households who were above the poverty line before one of members was treated for disability were pushed below the poverty line after the expenditure of the treatment and average percentage shortfall in income from the poverty line was 11.0 percent due to disability treatment care expenditure.ConclusionThe study provides an insight on the socioeconomic differentials in out-of-pocket expenditure, catastrophic expenditure for treatment of any kind of disability. To attain SDG goal 3 that advocates healthy life and promote well-being for all at all ages, there is a need to recognize the disadvantaged and due to disability.

Background: Transesophageal echocardiography (TEE) is a powerful diagnostic tool which has become an integral part in the management of cardiac surgery patients. We developed a one-day 3D TEE workshop specifically designed to meet the needs of perioperative cardiac anaesthesiologists. We hypothesized that participation in the workshop would increase the uptake of 3D TEE in routine perioperative practice. Aims: To examine the impact of one-day 3D TEE workshop on 3D TEE image acquisition and incorporation into routine perioperative practice. Setting: Tertiary care hospital. Design: Prospective observational monocentric study. Subjects and Methods: A convenience sample of 20 cardiac anesthesiologists (with an option to attend the one- day workshop midway through the study) from a single center consented to have their intraoperative TEE images collected during the course of the study reviewed for research purposes. Images acquired 6 months before, immediately after, and 6 months following the workshop and images were examined by a blinded, expert echocardiographer. Results: Data collected for 16 participants (8 workshop attendees, 8 non-attendees) indicate that the TEE workshop increased the number of 3D TEE images, but not x images acquired immediately following the workshop (P=0.006). No difference was observed in number of 3D images at six months' post workshop. Workshop participants obtained more 3D and multi-plane images after the workshop and more 3D images at 6 months compared to those who did not attend the workshop. Conclusion: Our study suggests that a single day hands-on 3D TEE workshop may have had an impact on the implementation of intraoperative 3D TEE in experienced echocardiographers.

An experiment was conducted under the ICAR-All India Coordinated Research Project on Fruits to study the high-density planting (HDP) and nutrient requirement of banana at six research centres across the country, including Bhubaneswar (Orissa), Gandevi (Gujarat), Jalgaon (Maharashtra), Jorhat (Assam), Kannara (Kerala) and Mohanpur (West Bengal) to enable higher productivity of banana and profit to farmers. The objective of this study was to explore the possibility of increasing productivity through the intervention of only per unit plant population (through planting system) and level of nutrition, but without any interference to the regional choices of variety (eg., choice variety Nendran for Kerala or Martaman for West Bengal), production system (mono/poly- clone, single/multi-year plantation, and POP of respective states), for which national productivity ranges are much skewed also. Results indicated that intervention of only plant density could increase the productivity of banana within the existing system of production and choice of a variety of different regions or states. The experiment was laid out in RBD with four planting densities (S1P2, S1P3, S2P2 and S2P3, where S1=2m x 3m, S2=1.8m x 3.6m, P2=2 suckers/hill, P3=3 suckers/hill), three nutrition levels (F1, F2 and F3 , which is 100%, 75% and 50% of RDF) and one with region-specific conventional planting density and nutrition (100% of RDF) practices as control. The results of this experiment showed that HDP (S1P3, 5000 plants /ha) in banana, accommodating three suckers per hill at 2m x 3m spacing increased productivity over the conventional system at the Bhubaneswar, Gandevi, Jorhat, Kannara and Mohanpur centres. The increase in productivity due to HDP (5,000/ha) over control was 28.9% (RDF 25%) to 50.6% (RDF 100%) at Bhubaneswar, 15.2% (RDF 25%) to 21.9% (RDF 100%) at Gandevi, 4.0% (RDF 25%) to 7.4% (RDF 100%) at Jorhat, 33.5% (RDF 25%) to 43.5% (RDF 100%) at Kannara and 46.5% (RDF 25%) to 79.0% (RDF 100%) at Mohanpur centre. The nutrient requirement under HDP was 100% RDF at Kannara, 75% RDF at Bhubaneswar and Mohanpur and 50% RDF at Gandevi and Jorhat centres, which indicates a saving in cost of fertilizer input by 25% -50%. It is, therefore, recommended for HDP (5000 plants/ha) in banana, accommodating three suckers per hill at 2m x 3m (6.6 ft x 3.8 ft) spacing with 50% RDF in the agro-climatic regions of Gandevi and Jorhat, with 75% RDF in the agro-climatic regions of Bhubaneswar and Mohanpur and with 100% RDF in the agro-climatic region of Kannara in order to ensure higher productivity and profit to farmers.

Background: More than 278 million cases and more than 5.4 million deaths due to coronavirus disease (COVID-19) were reported worldwide by the end of 2021. More than 34 million cases and more than 478,000 deaths have been reported in India. Epidemiologists, physicians and virologists are working on a number of conceptual, theoretical or mathematical modelling techniques in the battle against COVID-19. Protocol: This systematic review aims to provide a comprehensive review of published mathematical models on COVID-19 in India and the concepts behind the development of mathematical models on COVID-19, including assumptions, modelling techniques, and data inputs. Initially, related keywords and their synonyms will be searched in the Global Literature on Coronavirus Disease database managed by World Health Organisation (WHO). The database includes searches of bibliographic databases (MEDLINE, Scopus, Web of Science, EMBASE etc.,), preprints (MEDRXIV), manual searching, and the addition of other expert-referred scientific articles. This database is updated daily (Monday through Friday). Two independent reviewers will be involved in screening the titles and abstracts at the first stage and full-texts at the second stage, and they will select studies as per the inclusion and exclusion criteria. The studies will be selected for their quality, transparency, and ethical aspects, using the Overview, Design concepts, Details (ODD) protocol and International Society for Pharmacoeconomics and Outcomes Research-Society for Medical Decision Making (ISPOR-SMDM) guidelines. Data will be extracted using standardized data extraction tools and will be synthesized for analysis. Disagreements will be resolved through discussion, or with a third reviewer. Conclusions: This systematic review will be performed to critically examine relevant literature of existing mathematical models of COVID-19 in India. The findings will help to understand the concepts behind the development of mathematical models on COVID-19 conducted in India in terms of their assumptions, modelling techniques, and data inputs.

IntroductionCoronary artery disease (CAD), the leading cause of mortality worldwide, is characterised by an earlier onset and more severe disease in South Asians as compared to Western populations.MethodsThis is an observational study on 928 individuals who attended three tertiary care centres in Kerala, India from 2014-to 2017. The demographic, anthropometric, behavioural factors and the lipoprotein (Lp(a)) and cholesterol values were compared between the two groups and across disease severity. The Chi-square test was used to compare the categorical variables and independent sample t-test for the continuous variables. Multivariable logistic regression was performed to investigate the association of demographic, clinical and behavioural factors with the disease. Odds ratios are presented with a 95% confidence interval. In individuals below 50 years, two logistic regression models were compared to investigate the improvement in modelling the association of the independent factors and Lp(a) with the occurrence of the disease.ResultsWe included 682 patients in the diseased group and 246 patients treated for non-coronary conditions in the control group. Those in the control group were significantly younger than in the diseased group(pConclusionAge, diabetes, hypertension and tobacco use appear to be associated more with the occurrence of coronary artery disease in adults of all ages. Lipoprotein(a), cholesterol and BMI categories do not seem to be related to disease status in all ages. However, in individuals below 50 years, diabetes, tobacco use and lipoprotein (a) are significantly associated with the occurrence of the disease.

Background: In India, lack of data and underreporting of cases and deaths due to snakebite makes it difficult to estimate its socio-economic burden. Previous studies measuring economic burden of snakebite in low-and-middle-income countries (LMICs) using different approaches have been conducted, but none in India. The proposed study aims to provide evidence on disability weights, epidemiological and economic burden due to snakebites in Kerala state, India. Protocol: The study is a community based cross-sectional study recruiting victims of snakebite occurring over a 12 month period prior to start of the study , across Ernakulam district, Kerala state, India. For the community-derived disability weights,70 adult patients who were treated within a 3 month period prior to commencement of the study at Amrita Institute of Medical Sciences, Kochi or Little Flower Hospital, Angamaly would be interviewed. The study will measure annual incidence, mortality, treatment cost of snakebites along with community-derived disability weights for snakebites in Ernakulam district.. Standard methods for analysis and reporting of mortality, morbidity, Years of Lives Lost (YLL), Years lived with disability (YLD), disability weights, and costs of treatment will be calculated. The study will be started in April 2021 and is expected to be completed by July2021.. Discussion: This protocol is the first published for estimating epidemiological, economic burden and community derived disability weights for snakebites in India. Besides, the Global Burden of Disease has not attached a particular disability weight to snakebite and this would be an attempt to do so. The protocol has been developed using guidelines for cross-sectional studies, cost of illness studies and international guidelines for conducting community derived disability weights. The evidence generated by this study will contribute significantly to knowledge regarding the epidemiology, economic burden and community-derived disability weights for snakebites in India and other countries where incidence of snakebite is high.

Background: In India, geographical variation, lack of data and underreporting on cases and deaths due to snakebite makes it difficult to estimate socio-economic burden of snakebites. Previous studies measuring economic burden of snakebite in low-and-middle-income countries (LMICs) using different approaches have been conducted, but none so far in India. The proposed study aims to provide evidence on disability weights, epidemiological and economic burden due to snakebites in Kerala state, India. Protocol: A cross-sectional community based study for estimating epidemiological and economic burden of snakebite, recruiting victims of snakebite occurring over a nine month period prior to start and over the three month period of the study, across Ernakulam district, Kerala state, India. For the community derived disability weights, 60 adult patients admitted and treated at Amrita Institute of Medical Sciences, Kochi or Little Flower Hospital, Angamaly would be interviewed. The sample size to determine the mortality rate is calculated at 108,458 persons in Ernakulam.The study will measure annual incidence, mortality, treatment cost of snakebites along with community-derived disability weights for snakebites. Standard methods for analysis and reporting of mortality, morbidity, years of lives lost, years lived with disability, disability weights, and costs of treatment will be calculated and presented. The study will be started in March 2021 and is expected to be completed by June 2021. Discussion: This protocol is the first published for estimating epidemiological, economic burden and community derived disability weights for snakebites in India. Besides, the Global Burden of Disease has not attached a particular disability weight to snakebite and this would be an attempt to do so.The protocol has been developed using guidelines for both cross-sectional studies and for conducting community derived disability weights. The evidence generated will contribute to knowledge regarding epidemiology, economic burden and community-derived disability weights for snakebites in India and other LMICs.