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Background and Objective: The COVID-19 disease caused by SARS-CoV-2 was declared as pandemic by WHO soon after its emergence in 2019. This virus was known to cause serious clinical symptoms and severe illness. By using RT-PCR, which reports the cycle threshold value, the disease is diagnosed, whereas for the severity of the disease, biomarker levels, like IL-6, CRP, D-dimer, serum ferritin and serum procalcitonin, can be measured. We, thus, aimed to explore any potential correlation of the cycle threshold value and biomarker level with the outcome of COVID-19-positive hospitalized patients. Method: Patients with the cycle threshold (Ct) value 30.0, Group 2 20.0–30.0 and Group 3

Background: Dengue fever is an arthropod-borne disease transmitted to humans by Aedes aegypti mosquitoes and one of the leading causes of arthropod-borne viral disease in the world. Aims and Objectives: The present study aims to analyze any association between platelet count and immunochromatography -based dengue serology tests. Materials and Methods: This was a cross-sectional study conducted in Government Doon Medical College and Hospital. A total of 19,208 clinically suspected cases of dengue who reported in various outpatient departments, emergency services, and inpatient departments of our hospital between June 2023 and November 2023 were included in this study. Samples were tested by rapid immunochromatographic test for dengue non-structural protein 1 (NS1) antigen, immunoglobulin M (IgM), IgG, and platelet count was also obtained and a comparison was made. Results: Out of total 19,208 samples tested, 4876 (25.38%) samples were positive for NS1, 589 (3.06%) samples were positive for IgM. Majority of the patients were in the age group of 21–40 years 9274 (48.28%). 11,753 (61.19%) were males and 7455 (38.80%) were females. A strong correlation was seen between NS1 and thrombocytopenia where a total of 2737/4876 (n=56.13%) patients showed positivity in NS1 with low platelet counts. Conclusion: Detection of NS1 antigen helps in early diagnosis of dengue to avoid complications significantly. In confirmed dengue cases with fever, thrombocytopenia is more consistently found and can be used as a predictor to reduce the morbidity and mortality of dengue disease.

Introduction: Following the surge of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in late 2019, there was an 11-month period of relative evolutionary stability. However, since late 2020, SARS-CoV-2 evolution has been characterised by the emergence of mutation sets impacting virus characteristics like transmissibility and antigenicity, termed “variants of concern.” This shift likely responds to changing immune profiles within the human population. There is mounting evidence suggesting that post-vaccination serum is less effective in neutralising certain SARS-CoV-2 genotypes. XBB is a recombinant variant comprising sublineages BA.2.10.1 and BA.2.75 of the Omicron variant. Aim: To investigate the genomic characterisation and epidemiology of the XBB recombinant variant of SARS-CoV-2 in Uttarakhand, India. Materials and Methods: A retrospective cross-sectional study was conducted at the Viral Research Diagnostic Laboratory (VRDL Lab), Government Doon Medical College (GDMC), Dehradun, Uttarakhand, India. A total of 1,162 nasopharyngeal swabs received between September 2022 and February 2023 from various healthcare facilities were included for Next Generation Sequencing (NGS) of coronavirus. NGS was performed and all results were forwarded to the Indian SARS-CoV-2 Genomics Consortium (INSACOG) and the Indian Biological Data Centre (IBDC) for variant determination. Data collection occurred from March to April 2023, with data analysis following from May to June 2023. Statistical analysis was conducted using Microsoft Excel and Omnicalculator. Results: Among the 1,162 processed samples, 41 (3.53%) were identified as the XBB variant of Omicron. Within the XBB variants, XBB.2 was predominant 22 (53.7%). Maximum XBB samples (38, 92.7%) originated from District Dehradun, Uttarakhand, India. Conclusion: SARS-CoV-2 has been evolving and advancing with each new variant coming across. As XBB is impacting both previously infected individuals and those vaccinated, there is an imperative to develop new and efficacious vaccines against circulating variants to reduce associated risks of morbidity and mortality.

The etiological agent of coronavirus disease (COVID-19) that emerged at the end of year 2019 was first reported in Wuhan, China and was found to be SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). The massive COVID-19 waves were due to various variants. As per the reports of other study it was also found that Omicron variant spread faster than various other variant such as delta variant. Omicron has been reported from various countries and now from many states of India too. Therefore, keeping this in mind, this study was undertaken to study all the lineages of SARS-CoV-2 Omicron variant of disease COVID-19 that are circulating in the population of Uttarakhand with objective to study next generation sequencing of all the RT-PCR positive of SARS-CoV-2 and to find out all the lineages of the Omicron variant of SARS-CoV-2. This was a retrospective study conducted from 1st January 2022 to 30th September 2022. Next generation sequencing was performed on all the samples that were tested for COVID-19 by using Ion AmpliSeq kit on Ion Chef instrument. A total of 2149 samples were tested in which majority of samples belong to age group of 21-40 years. Males were affected more than females. BA.2 was found to be the predominant lineage of total of 46 lineages that were identified. Their mutations were also studied. We conclude that different variants of clade 21L, 22B, 22D and Omicron subvariant BA.2, BA.2.38 and BA.2.75 were the ones that were circulating amongst the population of Uttarakhand. The characteristic mutation that was found were T19I and V213G in NTD, S373P, S375F, T376A, and D405N in RBD.

Background: Adequate knowledge among nursing professionals toward hospital infection control measures related to hemodialysis (HD) services is essential to decrease infection among patients. Objective: This study assessed nursing professionals' knowledge about hospital infection control measures related to HD services and the effect of training interventions. Settings and Designs: It was a single group, a pre–post-interventional study conducted on nursing professionals of a single apex medical college of Haryana. Materials and Methods: A pretested questionnaire consisting of two parts was used as a study tool. Statistical Analysis: Various statistical tests such as paired t-test and Pearson's correlation were used. Results: The pre-intervention group had a lower mean knowledge score (mean knowledge = 90.2786, strongly disagree [SD] = 15.52682, standard error [SE] = 1.09518) and then the post-intervention mean knowledge score (mean knowledge = 137.5622, SD = 9.72252, SE = 0.68577). Conclusions: The training program or educational intervention proved very useful for enhancing nursing professional's knowledge about hospital infection control measures related to HD services.

The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in.

PURPOSEImmune checkpoint inhibitors (ICIs) is the initial line of management in advanced hepatocellular carcinoma (HCC), but survivals in the real world are not known.MATERIALS AND METHODSA retrospective study of patients with advanced HCC receiving ICIs (as first-line therapy or as later lines of therapy) across 11 Indian institutions was conducted. Patients were divided into either cohort 1 (trial-like receiving ICI as first-line therapy), with a Child Pugh score (CTP) of ≤6, an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0/1, and no VP4 (main portal vein thrombosis [MPVT]) or cohort 2 (trial unlike) who did not satisfy at least one of the above criteria. The primary end point was 12-month overall survival (OS).RESULTSBetween January 2017 and January 2022, 133 patient data were analyzed. The presence of MPVT was seen in 33 patients (25%). The ICIs used were atezolizumab-bevacizumab, nivolumab, and pembrolizumab in 89 (66%), 44 (33%), and one (1%) patients, respectively. With a median follow-up of 13.8 months, the 12-month OS for the entire cohort was 33.4% (95% CI, 23.6 to 43.2). Patients in cohort 1 (n = 31) had a significantly improved OS compared with patients in cohort 2 (n = 102; 12-month OS, 57.9% [95% CI, 38.5 to 77.3] v 24% [95% CI, 13.4 to 34.6]; P = .005). Patients with CTP A as compared with CTP B (9.7 v 4.3 months; P < .001) and an ECOG PS of 0/1 as compared with a PS of ≥2 (8.7 v 7.2 months; P = .04) and without MPVT (9.4 v 4.0; P < .001) had superior survivals.CONCLUSIONPatients with advanced HCC in the real world, trial-like have survivals in consonance with trial data, whereas patients with features excluding them from trials, such as main portal vein thrombosis, poor ECOG PS, and child Pugh B status, have markedly inferior survivals, despite good tolerance to immunotherapy.

Breast cancer is a public health challenge globally as well as in India. Improving outcome and cure requires appropriate biomarker testing to assign risk and plan treatment. Because it is documented that significant ethnic and geographical variations in biological and genetic features exist worldwide, such biomarkers need to be validated and approved by authorities in the region where these are intended to be used. The use of western guidelines, appropriate for the Caucasian population, can lead to inappropriate overtreatment or undertreatment in Asia and India. A virtual meeting of domain experts discussed the published literature, real-world practical experience, and results of opinion poll involving 185 oncologists treating breast cancer across 58 cities of India. They arrived at a practical consensus recommendation statement to guide community oncologists in the management of hormone positive (HR-positive) Her2-negative early breast cancer (EBC). India has a majority (about 50%) of breast cancer patients who are diagnosed in the premenopausal stage (less than 50 years of age). The only currently available predictive test for HR-positive Her2-negative EBC that has been validated in Indian patients is CanAssist Breast. If this test gives a score indicative of low risk (< 15.5), adjuvant chemotherapy will not increase the chance of metastasis-free survival and should not be given. This is applicable even during the ongoing COVID-19 pandemic.

PURPOSEThere are deficient data on prevalence of germline mutations in breast cancer susceptibility genes 1 and 2 (BRCA1/BRCA2) in Indian patients with ovarian cancer who are not selected by clinical features.METHODSThis prospective, cross-sectional, noninterventional study in nine Indian centers included patients with newly diagnosed or relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer. The primary objective was to assess the prevalence of BRCA1/BRCA2 mutations, and the secondary objective was to correlate BRCA1/BRCA2 status with clinicopathologic characteristics. Mutation testing was performed by a standard next-generation sequencing assay.RESULTSBetween March 2018 and December 2018, 239 patients with a median age of 53.0 (range, 23.0-86.0 years) years were included, of whom 203 (84.9%) had newly diagnosed disease, 36 (15.1%) had family history of ovarian or breast cancer, and 159 (66.5%) had serous subtype of epithelial ovarian cancer. Germline pathogenic or likely pathogenic mutations in BRCA1 and BRCA2 were detected in 37 (15.5%; 95% CI, 11.1 to 20.7) and 14 (5.9%; 95% CI, 3.2 to 9.6) patients, respectively, whereas variants of uncertain significance in these genes were seen in four (1.7%; 95% CI, 0.5 to 4.2) and six (2.5%; 95% CI, 0.9 to 5.4) patients, respectively. The prevalence of pathogenic or likely pathogenic BRCA mutations in patients with serous versus nonserous tumors, with versus without relevant family history, and ≤ 50 years versus > 50 years, were 40 of 159 (25.2%; 95% CI, 18.6 to 32.6) versus 11 of 80 (13.8%; 95% CI, 7.1 to 23.3; P = .0636), 20 of 36 (55.6%; 95% CI, 38.1 to 72.1) versus 41 of 203 (20.2%; 95% CI, 14.9 to 26.4; P < .0001), and 20 of 90 (22.2%; 95% CI, 14.1 to 32.2) versus 31 of 149 (20.8%; 95% CI, 14.6 to 28.2; P = .7956), respectively.CONCLUSIONThere is a high prevalence of pathogenic or likely pathogenic germline BRCA mutations in Indian patients with ovarian cancer.

India, as a member of the World Health Organization South-East Asia Region, had committed to measles elimination by 2020. Efforts to increase immunization coverage, special immunization activities, and case-based surveillance have been implemented rigorously over the last 7 years, but India has not been able to eliminate measles. Multiple factors led to this namely inadequate vaccination coverage and COVID pandemic and others. The pandemic added its contribution in disruption of vaccine delivery services under Intensified Mission Indradhanush preventing the achievement of the elimination target, in stipulated time. India may need to think beyond strengthening the routine immunization activities and increasing the geographical coverage under Intensified Mission Indradhanush. Promising the future in the measles vaccine delivery system in the form of Measles-Micro-Array-Patches is seen on the horizon may prove to be a game-changer for targeting measles elimination, in the current decade.

Purpose This article presents our experience regarding survival benefits in inoperable intermediate stage hepatocellular carcinoma (HCC) and advanced stage HCC treated with 131I-lipiodol. Materials and Methods This is a retrospective study of intermediate stage HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) not responding to prior treatment and/or advanced stage HCC (BCLC stage C) treated with 131I-lipiodol. 131I-lipiodol was injected into the hepatic artery through transfemoral route. Postprocedure, the patient was isolated for 5 to 7 days. All patients underwent tumor response evaluation after 4 weeks. Survival of patients was calculated up to either death or conclusion of the study. Results A total of 55 patients (52 males [94.5%], 3 females [5.4%]) were given intra-arterial 131I-lipiodol therapy. The median overall survival after transarterial radioembolization (TARE) was 172 ± 47 days (95% confidence limit, 79–264 days). The overall survival at 3, 6, 9, and 12 months was 69, 47, 32, and 29%, respectively. A multivariate Cox regression analysis showed the presence of treatment prior to TARE to most significantly influence survival (B = 2.161, p ≤ 0.001). This was followed by size of the lesion which was second in line (B = 0.536, p = 0.034). Among 45 patients, 14 patients (31.1%) showed a partial response, 11 patients (24.4%) showed stable disease, and 20 patients (44.4%) showed progressive diseases. Conclusion TARE with 131I-lipiodol can be a safe and effective palliative treatment in advanced stage HCC and in patients with poor response to prior treatments like transarterial chemoembolization.

Globally Small and Medium Enterprises (SMEs) are the biggest contributors to the economy by providing two-thirds of global employment opportunities and more than half the GDP of the developed economies. Regardless of many existing cybersecurity standards or frameworks, SMEs are most vulnerable to cyber threats. SMEs face serious impacts on their existence if undergo successful cyber-attacks by cybercriminals. There is a need to understand the challenges SMEs are facing especially in the implementation of cybersecurity controls. Through a research survey conducted by authors where one hundred and fifteen SMEs voluntarily participated, this research paper will throw light on the current cybersecurity controls implementation posture for different SMEs, along with the challenges they are facing which are stopping them to decide, plan and implement cybersecurity controls. Further, using an analysis of the inputs and the core concepts of cybersecurity, the authors are also going to propose a recommended solution for SMEs.

The ongoing COVID-19 vaccine drives across the world, including India, may have caused people to adopt risky behavior such as decreased or non-adherence to COVID-appropriate social behavior. Such phenomenon in which people are more likely to engage in risky behavior when security measures have been mandated is termed as the “Peltzman Effect” and apart from the emergence of various variants, it may have contributed to the recent upsurge in the number of new COVID-19 cases across the world, including in India. To make the worldwide COVID-19 vaccine drive successful, it is important to acknowledge, understand and minimize the potential harms from Peltzman Effect.

Introduction: Staphylococcus aureus is one of the most common human pathogen causing a wide range of infections. It is estimated that S.aureus colonizes the anterior nares in approximately 31% of the general population at any given time. The incidence of community acquired & hospital acquired S. aureus has been increasing over the past few decades, predominantly due to continuous upsurge in the drug resistant isolates. Moreover, globally the incidence of methicillin resistant S.aureus (MRSA) is progressively increasing. Hence, it would be imperative to screen all healthcare workers, interns and admitted patients for MRSA carriage and to treat all those who are found positive for the same. With the above background, the current study was undertaken to investigate the carrier rate of S. aureus (including MRSA) among hospital unexposed & exposed medical students. Methods: A total of 181 medical students of Veer Chandra Singh Garhwali Government Institute of Medical Sciences & Research, Srinagar Garhwal, Uttarakhand. Study participants were broadly divided into two groups: hospital exposed group (n=107) and hospital unexposed group (n=74). Nasal swabs were obtained & cultured for the detection of S. aureus. Congo red agar and 0.1% Crystal Violet Assay were performed to observe the ability to form in vitro biofilm by S. aureus. Results: Out of total 181 medical students 29.28% were found to be healthy carrier of S. aureus. Among the hospital exposed group 37.38% and among hospital unexposed group 17.57% were found to be healthy carrier of S. aureus. Only one student (hospital exposed group) was found to be positive for MRSA. Beta-lactamase production was noted in 90.57% strains of S. aureus while the significant rate of slime layer production was observed in 73.58% of strains. Conclusion: Prevalence of S. aureus nasal carriage increases with the duration of exposure to the hospital environment. The nasal carriage of S. aureus in medical students indicate the potential danger of dissemination of S. aureus including MRSA from them to the hospitalized patients which in turn complicates the treatment of same.

Rationale: India and the USA, the worst affected countries by COVID-19, experienced very different pandemic courses. By 2020, COVID-19 cases had steadily declined in India, whereas the fight continued in the US. The people of India and the USA perhaps perceived threats very differently, influenced by their knowledge, available healthcare facilities, and social security. We conducted an online survey study to compare COVID-related perceptions between Indian participants (IND-P) and US-based participants (US-P).Methods: COVID-related perceptions such as stress, knowledge, and preventive behaviors were measured with specific questionnaires, and normalized scores were computed. T-tests were used to compare the perception scores, while the Kruskal-Wallis-H (KWH) tests were used to compare socioeconomic distributions between participants from two countries. Generalized linear model (GLM) adjusted for sociodemographic confounders estimated the association between the country of residence and COVID-perception.Results: The IND-P (N = 242) were younger and male-dominated compared with the US-P (N = 531) (age: KWH = 97.37, p < 0.0001, gender: KWH = 140.38, p < 0.0001). Positive attitudes toward preventive guidelines were associated with higher perceived risk and stress (r = 0.35, p < 0.001, and r = 0.21, p < 0.001, respectively) but not with the knowledge (r = −0.05, p = 0.14). Compared with the US-P, the IND-P had lower knowledge (5.19 ± 1.95 vs. 7.82 ± 1.35; t-test: p < 0.0001), higher stress (7.01 ± 1.51 vs. 6.07 ± 1.61; t-test: p < 0.0001), and better adherence to preventive guidelines (8.84 ± 1.30 vs. 8.34 ± 2.09; t-test: p = 0.0006). GLM demonstrated a significant association between the country and COVID-perception scores.Conclusion: The IND-P experienced higher stress and perceived threat during COVID-19 than the US-P, perhaps due to a lack of faith in the healthcare system and insecurity. Despite lower knowledge, the IND-P had better acceptance of preventive guidelines than the US-P.

Currently, there is an increased dependency on the impact factor in scientific research publications. Sometimes the overzealousness in implementing the impact factor value to a publication is detrimental to the growth of the scientific authors, especially the junior lot, for no fault of theirs. The inept and myopic application of the impact factor defeats the purpose of making the value judgment and hence has been criticized by many learned authors. The scientist Eugene Garfield, who formulated the impact factor, feels wrong that it is being not judiciously used. A corollary is the invention dynamite by Alfred Nobel which instead of helping, aiding, and reducing human effort and endeavor it was more misused for human annihilation and pained the scientist who gave it to the world. The authors reexamine the application of impact factor to scientific manuscripts for rightful application of the value judgment.

Introduction: Surgical site infections (SSIs) represent the second most common type of healthcare-associated infections and remain a relatively common postoperative complication and the most common reason for readmission after surgery. SSIs have dire implications for the surgeon, patient, and institution which often require prolonged treatment, impose an economic burden and double the risk of patient mortality. Staphylococcus aureus is currently the most common cause of SSIs causing as many as 37% of cases of SSIs in community hospitals with methicillin-resistant S. aureus (MRSA) of particular concern. Materials and Methods: This cross-sectional study was conducted from January 2014 to December 2014 in a rural tertiary care hospital of Pauri Garhwal district of Uttarakhand state, India. Samples were collected using sterile cotton swabs from 269 patients clinically diagnosed with SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using a modified Kirby-Bauer disc diffusion method. Results: Out of 1294 patients, 269 (20.8%) were found to have SSIs and samples were collected from them. Out of a total of 269 samples, 258 (95.9%) yielded bacterial growth and 267 bacterial isolates were obtained. S. aureus (45.3%) was the commonest organism followed by Escherichia coli (13.9%), Pseudomonas aeruginosa (6.7%), and Proteus species (4.9%). Antimicrobial profile of S. aureus revealed maximum sensitivity to rifampicin, linezolid, teicoplanin, vancomycin, and amikacin whereas ampicillin, cefazolin, and gentamicin were found to be least sensitive. Conclusion: S. aureus played a predominant role in the etiology of SSIs in this hospital with MRSA being a major concern as the treatment options for such resistant strains are limited. Reduction in SSI rates can lead to both better clinical outcomes for patients and cost savings for hospitals. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative, and postoperative patient care can surely reduce the incidence of SSIs. A multifaceted approach involving the surgical team, microbiologist, and the infection control team is required to provide quality surgical services.

Death certificate data is used to monitor local, regional and national mortality trend and is helpful in improving public health as well as public safety. Accurate and reliable information about the cause of death in a population is useful for understanding disease burden estimation and trends in the health of populations; moreover, the information provided by such data is vital in terms of public health planning as well. With the continuous upsurge in mortality due to coronavirus disease 19 (COVID-19), mortality analysis could be valuable in addressing the current pandemic and implementing the epidemic control strategies effectively and efficiently. Given that COVID-19 death certification substantially affects the local and national responses towards disease prevention and transmission, the importance of the accuracy and quality of information in these certificates cannot be understated. Hence, accurate death certification related to COVID-19 is vital to understand the extent and progression of the current pandemic.

The fungus Purpureocillium lilacinum previously known as Paceliomyces lilacinus is an emerging pathogen that can cause severe human infections including devastating oculomycosis. Treatment with traditional antifungals often fails, and the organism shows variable susceptibility to novel triazoles. We hereby report a case of keratomycosis caused by Pur. lilacinum in an immunocompetent male patient following trauma. The patient was successfully treated with voriconazole. The drug shows good activity against Pur. lilacinum and could be a promising therapeutic alternative to treat infections caused by this fungus, which generally shows resistance to conventional antifungal agents including novel triazoles.

Background/aimPatients with primary extra-thoracic malignancy (ETM) often have hyper-metabolic mediastinal lymph nodes (HM-MLN) in the PET-scan done for initial staging or post treatment follow-up. There is scant data on the etiology of HM-MLN in such patients, which can also be due to non-malignant causes. We used endobronchial ultrasound (EBUS) guided sampling to determine the etiology of HM-MLN in patients with ETM and study the relationship between PET-SUV values and a diagnosis of malignancy in this population.Materials and methods65 consecutive patients, from March 2013 to March 2017 with either known ETM for primary staging or post-treatment follow-up, with PET CT showing HM-MLN (SUV > 2.5) were included in the study.Results65 patients with ETM had EBUS-TBNA for HM-MLN. 20/65 (30.7%) were malignant, 45/65 (69.23%) were benign MLN. In patients with benign etiology of HM-MLN, 6/45 (13.3%) had necrotising granulomatous, 24/45 (53.3%) had non- necrotising granulomatous MLN and 15/45 (33.3%) had reactive MLN. We found discordance (i.e. primary ETM responded to treatment and a new HM-MLN was detected) in 21/65 (32.3%) patients with PET-CT done for initial ETM staging, and 44/65 (67.7%) with a post-treatment PET-CT. showed. Correlating SUV with diagnoses, the SUV values in EBUS-proven malignant MLN were 8.9 ± 4.1, while they were 10.2 ± 5.57 in benign MLN. There was no statistically significant difference between the SUV of benign and malignant MLNs.ConclusionThis study shows a significant incidence of EBUS-TBNA proven benign diagnoses 45/65 (69.2%) in 'SUV-deemed-malignant MLN' and a poor relationship between high SUV and malignant MLN, in patients with known ETM. The ETM related HM-MLN have a significant chance of being benign, and a tissue diagnosis is imperative as it impacts on the treatment plan and prognosis.

Aims: Socioeconomic and environmental factors influence childhood asthma prevalence across the world. In-depth epidemiological research is necessary to determine the association between asthma prevalence and socio-environmental conditions, and to develop public health strategies to protect the asthmatic children against the environmental precipitators. Our research was based on aggregative data and sought to compare the asthma prevalence between children of two different age-groups across the world and to identify the association among the key socio-environmental conditions with increased childhood asthma prevalence.Method: We included forty countries with available data on various socio-environmental conditions (2014–2015). Childhood asthma prevalence of two different age groups (6–7 and 13–14 years) were obtained from global asthma report 2014. Because of significant diversities, the selected countries were divided into two groups based on human developmental index (HDI), a well-recognized parameter to estimate the overall socioeconomic status of a country. Robust linear regression was conducted using childhood asthma prevalence as the dependent variable and female smoking prevalence, tertiary school enrollment (TSE), PM10 (particulate matter ≤10 μm in diameter) and gross domestic product (GDP) as predictors.Results: Asthma prevalence was not different between two age groups. Among all predictors, only female smoking prevalence (reflecting maternal smoking) was associated with asthma prevalence in the countries with lower socio-economic conditions (HDI), but not in the higher HDI group. The results were unchanged even after randomization.Conclusions: Childhood asthma prevalence did not change significantly with age. Female smoking may have a positive correlation with childhood asthma prevalence in lower HDI countries.

Otoacariasis or parasitic otitis, is the infestation of the ear with ticks/mites and is a common condition in the livestock and domestic animals. Although, less common, cases of human otoacariasis caused by mites can be occupational in origin and ear being in permanent contact with biotic elements of the biosphere is one of the commonest organs predisposed for various microorganisms to settle in. The local lesions observed in otitis such as skin congestion, increased vascular permeability and raised temperature creates favourable conditions for their development. We here describe a unique case of human otoacariasis caused by mixed aetiology–mites, fungi and bacteria in a 45-year-old female, a grain dealer by profession. To the best of our knowledge this is the first report of human otoacariasis by Cosmoglyphus (Acari: Acaridae) species.

Tay–Sachs disease is an autosomal recessive neurodegenerative disorder occurring due to impaired activity of β-hexosaminidase-A (EC 3.2.1.52), resulting from the mutation in HEXA gene. Very little is known about the molecular pathology of TSD in Indian children except for a few mutations identified by us. The present study is aimed to determine additional mutations leading to Tay–Sachs disease in nine patients confirmed by the deficiency of β-hexosaminidase-A (C (D175A) and c.805G>C (p.G269R) in one case; and one small 1 bp deletion c.426delT (p.F142LfsX57) and one splice site mutation c.459+4A>C in the other two cases respectively. None of these mutations were detected in 100 chromosomes from healthy individuals of the same ethnic group. Three previously reported missense mutations, (i) c.532C>T (p.R178C), (ii) c.964G>T (p.D322Y), and (iii) c.1385A>T (p.E462V); two nonsense mutations (i) c.709C>T (p.Q237X) and (ii) c.1528C>T (p.R510X), one 4 bp insertion c.1277_1278insTATC (p.Y427IfsX5) and one splice site mutation c.459+5G>A were also identified in six cases. We observe from this study that novel mutations are more frequently observed in Indian patients with Tay–Sachs disease with clustering of ~73% of disease causing mutations in exons 5 to 12. This database can be used for a carrier rate screening in the larger population of the country.

Background: Internship is the best period foracquiring practical knowledge and skills in com-munity medicine to become a successful pri-mary health care physician. Effectiveness ofinternship has been questioned in many researchpapers. Internship in India is clinically orientedwith inadequate community experience. Objec-tives: This study was conducted among medi-cal interns with the objective of assessing thebase line knowledge about application of prin-ciples of primary health care and the change inknowledge about the same at the end of theCommunity Medicine posting. Methods: All theinterns attending the community medicineposting were included in the study. A structuredquestionnaire related to principles and elementsof primary health care was self administeredbefore and after the Community Medicine post-ing. Marking system was devised and WilcoxonSinged rank test, Paired t test and Pearsonscorrelation coefficient were applied whereverappropriate. Results: Among 9 questions re-lated to the theory aspect only two showed sta-tistically significant improvement. All the sixquestions related to practical aspect did notshow any significant change. Conclusion: In-ternship training of two months in CommunityMedicine has failed to create a positive impacton the post test scores, indicating no gain inknowledge during this period. Framework ofinternship training, especially in CommunityMedicine needs to be restructured. Further re-search needs to be directed to understand thefelt needs of the medical interns and reasonsfor their poor performance.

Despite an overall good prognosis, a significant proportion of patients with hormone receptor positive human epidermal growth factor receptor 2 negative breast cancers develop distant metastases. The metastatic potential of epithelial cells is known to be regulated by tumor–stromal interaction and mediated by epithelial-to-mesenchymal transition. Hormone receptor positive human epidermal growth factor receptor 2 negative tumors were used to estimate markers of epithelial-to-mesenchymal transition, and the luminal breast cancer cell line MCF-7 was used to examine the interactions between integrins and growth factor receptors in causation of epithelial-to-mesenchymal transition. A total of 140 primary tumors were sub-divided into groups enriched for the markers of epithelial-to-mesenchymal transition (snail family transcriptional repressor 2 and integrin β6) versus those with low levels. Within the epithelial-to-mesenchymal transition+ tumors, there was a positive correlation between the transcripts of integrin β6 and growth factor receptors—human epidermal growth factor receptor 2 and epidermal growth factor receptor. In tumors enriched for epithelial-to-mesenchymal transition markers, patients with tumors with the highest quartile of growth factor receptor transcripts had a shorter disease-free survival compared to patients with low growth factor receptor expression by Kaplan–Meier analysis (log rank, p = 0.03). Epithelial-to-mesenchymal transition was induced in MCF-7 cells by treatment with transforming growth factor beta 1 and confirmed by upregulation of SNAI1 and SNAI2 transcripts, increase of vimentin and integrin β6 protein, and repression of E-cadherin. Treatment of these cells with the dual-specificity tyrosine-kinase inhibitor lapatinib led to downregulation of epithelial-to-mesenchymal transition as indicated by lower levels of SNAI1 and SNAI2 transcripts, integrin αvβ6, and matrix metalloproteinase 9 protein. The results suggest that synergistic interactions between growth factor receptors and integrin β6 could mediate epithelial-to-mesenchymal transition and migration in a subset of luminal breast cancers and lapatinib might be effective in disrupting this interaction.

ABSTRACT Introduction: Typhoid fever is endemic in all parts of India and the Widal test is widely used for its diagnosis. In the endemic areas, the healthy people may contain antibodies which are capable of reacting upto a variable titre in the Widal test, due to a past exposure, TAB vaccination and cross reacting antigens. Therefore it varies widely from place to place and is referred to as the baseline titre of that area. The aim of this study was to determine the average baseline titre of the apparently healthy population in the Garhwal region of Uttarakhand, India. Material and Methods: Blood samples were collected from healthy volunteers over the period from February 2011 to January 2012 and they were analyzed for the presence of the Salmonella antibodies by carrying out the Widal tube agglutination test. Results: Among the 2164 serum specimens which were tested, 922 (42.6%) sera were found to be positive for the Widal test and 1242 were negative. The most frequently recorded titre of the reactive sera was 1:40 for the anti-O antibodies and it was 1:80 for the anti-H antibodies and this was the baseline titre for this region. Conclusion: Based on the above results of our study, it has been recommended that the cut-off titre of 1:80 for the anti-O antibodies and of 1:160 for the anti-H antibodies may be considered as diagnostic for enteric fever in the Garhwal region of Uttarakhand, India.

ABSTRACT Objective: This study was undertaken to assess the frequency of the phenotypic expression of the inducible resistance to clindamycin which was due to the expression of the erm genes in various clinical isolates of the Staphylococcus species. Materials and Methods: This was a cross sectional study conducted in the Dept. of Microbiology and Immunology, Veer Chandra Singh Garhwali Govt. Medical Sciences and Research Institute, Srikot, Uttarakhand, from July 2010 to December 2011. A total of 373 consecutive, non duplicate strains of Staphylococci isolated from various clinical samples like pus, wound swab, blood, urine and other body fluids, were tested. The isolates which had a discordant resistance pattern (clindamycin-sensitive and erythromycin-resistant) by Kirby Bauer Disk Diffusion method were selected and subjected to the D-test for inducible clindamycin resistance, as per the Clinical and Laboratory Standards Institutes (CLSI) guidelines. Results: Among the 373 clinical isolates of Staphylococci which were studied, 134 isolates showed a discordant resistance pattern. Among these discordant strains, 45 (33.6%) isolates were D-test positive, which had inducible clindamycin resistance and belonged to the inducible macrolide lincosamide streptogramin-B phenotype (MLSBi). 89 (66.4%) isolates were D-test negative and they belonged to the macrolide streptogramin phenotype (MS). Among the MLSBi phenotypes, 6 (13.3%) isolates were methicillin-resistant Staphylococcus aureus (MRSA), 13 (28.9%) were Methicillin-sensitive S.aureus (MSSA) and 26 (57.8%) were coagulase negative staphylococci (CONS). Conclusion: The D-test is a simple, effective and an important method for the phenotypic detection of inducible clindamycin resistance and it should be used routinely, as it will help in guiding the empirical therapy. The possible clinical failures can thus be avoided.

Introduction: Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality. Aim: To determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram. Materials and Methods: Samples were collected using sterile cotton swabs from 137 patients clinically diagnosed of having SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. This cross sectional study was conducted for a period of six months (January 2013 to June 2013) in the Department of Microbiology at a rural tertiary care hospital of Uttarakhand state, India. Results: Out of 768 patients, 137 (17.8%) were found to have SSIs and samples were collected from them. Out of total 137 samples, 132 (96.4%) yielded bacterial growth and 139 bacterial isolates were obtained. Staphylococcus aureus (50.4%) was the commonest organism followed by Escherichia coli (23.02%), Pseudomonas aeruginosa (7.9%) and Citrobacter species (7.9%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to vancomycin, teicoplanin and linezolid, whereas among gram negative isolates meropenem, piperacillintazobactam, and amikacin were found to be most sensitive. Conclusion: The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs.

Aim: To determine the efficacy and outcome of pyeloplasty in poorly functioning kidneys in the pediatric population and whether pyeloplasty could be offered as an upfront procedure in such patient population, instead of nephrectomy., Materials and Methods: A retrospective data analysis of 83 patients who underwent pyeloplasty in poorly functioning kidneys from 2010 to 2015 was performed. Success was defined based on improvement in symptoms, stable or improved function, and better drainage on post-operative Tc-99m Diethylene Triamine Pentaacetic acid scan instead of DTPA scan renography done after 3 months and yearly thereafter., Results: Eighty-three patients with a mean age of 6.8 ± 2.88 years with poor function on isotope renogram (<30%) were included in the study. Three patients were excluded in view of postoperative outflow obstruction. Out of the remaining 80 patients, 56 were male and 24 were female. They were divided into two groups based on preoperative differential renal function (DRF), Group I ( n = 26) having preoperative DRF of <10% and Group II ( n = 54) having preoperative DRF of 10%-30%. All patients underwent laparoscopic dismembered pyeloplasty with ureteral stenting. The mean DRF improved from 7.58 ± 2.39 to 29.71 ± 5.16 postoperatively in Group I. However, in Group II, DRF improved from 20.81 ± 5.68 to 37.25 ± 7.11 postoperatively. At a follow-up of 24 months, the overall success rate was 98%., Conclusion: Pyeloplasty gives good intermediate-term results even in extremely poorly functioning kidneys and an upfront pyeloplasty instead of nephrectomy should be offered to all pediatric patients irrespective of preoperative function., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Indian Association of Pediatric Surgeons.)