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Multiple genetic variants of H1 and H3 influenza A viruses (IAVs) circulate concurrently in US swine farms. Understanding the spatial transmission patterns of IAVs among these farms is crucial for developing effective control strategies and mitigating the emergence of novel IAVs. In this study, we analysed 1909 IAV genomic sequences from 785 US swine farms, representing 33 farming systems across 12 states, primarily in the Midwest from 2004 to 2023. Bayesian phylogeographic analyses were performed to identify the dispersal patterns of both H1 and H3 virus genetic lineages and to elucidate their spatial migration patterns within and between different systems. Our results showed that both intra-system and inter-system migrations occurred between the swine farms, with intra-system migrations being more frequent. However, migration rates for H1 and H3 IAVs were similar between intra-system and inter-system migration events. Spatial migration patterns aligned with expected pig movement across different compartments of swine farming systems. Sow-Farms were identified as key sources of viruses, with bi-directional migration observed between these farms and other parts of the system, including Wean-to-Finish and Gilt-Development-Units. High intra-system migration was detected across farms in the same region, while spread to geographically distant intra- and inter-system farms was less frequent. These findings suggest that prioritizing resources towards systems frequently confronting influenza problems and targeting pivotal source farms, such as sow farms, could be an effective strategy for controlling influenza in US commercial swine operations.

Background: The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania and continued local transmission. Methods: To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo district on the coastal mainland from 2016 to 2018. Results: Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to the rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low-level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes. Conclusions: Our data support importation as a main source of genetic diversity and contribution to the parasite population in Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive to malaria reemergence due to susceptible hosts and competent vectors. Funding: This research was funded by the National Institutes of Health, grants R01AI121558, R01AI137395, R01AI155730, F30AI143172, and K24AI134990. Funding was also contributed from the Swedish Research Council, Erling-Persson Family Foundation, and the Yang Fund. RV acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 program supported by the European Union. RV also acknowledges funding by Community Jameel.

Abstract Background RTS,S/AS01 has been recommended by WHO for widespread implementation in medium to high malaria transmission settings. Previous analyses have noted lower vaccine efficacies in higher transmission settings, possibly due to the more rapid development of naturally acquired immunity in the control group. Methods To investigate a reduced immune response to vaccination as a potential mechanism behind lower efficacy in high transmission areas, we examine initial vaccine antibody (anti-CSP IgG) response and vaccine efficacy against the first case of malaria (to exclude the effect of naturally acquired immunity) using data from three study areas (Kintampo, Ghana; Lilongwe, Malawi; Lambaréné, Gabon) from the 2009–2014 phase III trial (NCT00866619). Our key exposures are parasitemia during the vaccination series and background malaria incidence. We calculate vaccine efficacy (one minus hazard ratio) using a cox-proportional hazards model and allowing for the time-varying effect of RTS,S/AS01. Results We find that antibody responses to the primary three-dose vaccination series were higher in Ghana than in Malawi and Gabon, but that neither antibody levels nor vaccine efficacy against the first case of malaria varied by background incidence or parasitemia during the primary vaccination series. Conclusions We find that vaccine efficacy is unrelated to infections during vaccination. Contributing to a conflicting literature, our results suggest that vaccine efficacy is also unrelated to infections before vaccination, meaning that control-group immunity is likely a major reason for lower efficacy in high transmission settings, not reduced immune responses to RTS,S/AS01. This may be reassuring for implementation in high transmission settings, though further studies are needed.

Abstract Reports suggest non-falciparum species are an underappreciated cause of malaria in sub-Saharan Africa but their epidemiology is ill-defined, particularly in highly malaria-endemic regions. We estimated incidence and prevalence of PCR-confirmed non-falciparum and Plasmodium falciparum malaria infections within a longitudinal study conducted in Kinshasa, Democratic Republic of Congo (DRC) between 2015-2017. Children and adults were sampled at biannual household surveys and routine clinic visits. Among 9,089 samples from 1,565 participants, incidences of P. malariae, P. ovale spp., and P. falciparum infections by 1-year were 7.8% (95% CI: 6.4%-9.1%), 4.8% (95% CI: 3.7%-5.9%) and 57.5% (95% CI: 54.4%-60.5%), respectively. Non-falciparum prevalences were higher in school-age children, rural and peri-urban sites, and P. falciparum co-infections. P. falciparum remains the primary driver of malaria in the DRC, though non-falciparum species also pose an infection risk. As P. falciparum interventions gain traction in high-burden settings, continued surveillance and improved understanding of non-falciparum infections are warranted.

Background Human microsporidiosis presents as an important and rapidly emerging opportunistic infection. However, the exact burden of this infection especially in the pediatric population of Northern India remains unknown. In this study, we investigated the prevalence of microsporidia among human immunodeficiency virus (HIV)-positive and HIV-negative pediatric patients who presented with diarrhea.

Purpose: Clinical trials comparing the efficacy of adjuvant chemotherapy (CT) and chemo radiation therapy (CTRT) for stomach adenocarcinoma have reported equivocal results. Hence, the current retrospective cohort study assessed the long-term survival and recurrence outcomes of these therapies, to generate evidence in a real-world scenario. Methods and Materials: Pathologically confirmed patients with stomach adenocarcinoma aged ≥18 years who underwent gastrectomy and D2 lymph nodal dissection at a tertiary cancer hospital from January 2010 to October 2017 were enrolled. Hospital-based follow-up was performed until December 2021. Data were gathered from electronic medical records, supplemented by telephonic interviews for patients who could not come for physical follow-up. CT-alone and CTRT cohorts were compared in terms of survival and recurrence outcomes. Results: The analysis included 158 patients (mean age, 56.42 years; 63.9% male; CT-alone cohort, 69; CTRT cohort, 89). Patients in the CTRT cohort had significantly worse tumor characteristics at baseline (29.2% had the diffuse type of tumor, 94.4% had stage II or III, 68.5% had lympho-vascular space invasion, and 85.4% had lymph node involvement). Recurrence was observed in 13 (19.7%) of the 76 followed-up patients. Although locoregional recurrence was higher in the CT-alone cohort (7 vs 2), distant metastasis was higher in the CTRT cohort (3 vs 1). The overall 5-year survival was 67.0% (SE, 5.0%) and 5-year recurrence-free survival (RFS) was 75.0% (SE, 5.0%). On multivariate Cox regression, no variable was significantly associated with the overall survival, whereas age, positive lymph nodes without extracapsular extension, and lymph node-negative were significantly associated with RFS. The CTRT cohort had significantly (84.0%) higher RFS (hazard ratio, 0.161; 95% CI, 0.056-0.464; P < .001). Conclusions: Patients who received adjuvant CTRT after D2 dissection showed similar overall survival but significantly higher RFS than the CT-alone cohort, despite having worse baseline tumor characteristics.

Introduction Gastric cancer poses an enormous burden across the globe and India in terms of cancer-related mortality. There is paucity of epidemiological and survival data among young gastric cancer patients in India. In this study, we retrospectively analyzed the general characteristics, clinical profile, and survival data of gastric cancer in young patients 0.6. Minimum follow-up of 1 year was required for inclusion in the study. Twelve patients were lost to follow-up and were not included for survival analysis. Results Younger patients (≤30 years) with gastric cancer were 2.5% of total gastric cancer patients. Mean age was 24.9 years with males being involved twice as commonly as females (2.15:1). Positive family history was present in 14.2% patients and smoking was present in 57.1% patients. Metastatic disease at presentation was present in 69.8% patients, while only 6.4% patients presented with stage I/II disease. Fourteen patients underwent surgery, out of which six patients underwent partial gastrectomy and remaining eight underwent total gastrectomy with D2 nodal dissection. Median overall survival was 10.8 months (8.8–12.8) and 2-year overall survival was 15.1%. Conclusion Incidence of stomach cancer in young patients is more than expected and more than global average in India. Most of these young patients are presenting in advanced stage and survival is poor compared with typical aged patients

Background: The purpose was to determine whether tumor response to CPI varies by organ and to characterize response patterns in a group of surgically treated metastatic RCC patients treated with Nivolumab. Methods: A retrospective analysis was undertaken between January 2016 and March 2020 on patients receiving Nivolumab for metastatic RCC, following first-line therapy and having at least one baseline and two follow-up scans. A Fisher’s exact test was used to compare categorical variables, and a Kruskal–Wallis test was used to compare continuous variables. Results: Twenty-one out of thirty patients evaluated were eligible, and they were divided into two groups: responders (n = 11) and non-responders (n = 10). According to all iRECIST standards, 18 (85.7 percent) of the 21 patients had PD (10 patients), PR (3 patients), or SD (8 patients). At baseline, 7, 15, 4, 13, 7, and 7 patients, respectively, had detectable hepatic metastasis and lung, brain, lymph node, soft tissue, and other intra-abdominal metastases; these patients were evaluated for organ-specific response. The ORRs for hepatic metastasis and lung, brain, lymph node, soft tissue, adrenals, and other intraperitoneal metastases were correspondingly 10%, 20%, 35%, 0%, and 25%. In total, 13 (61.9%) of them demonstrated varied responses to CPI therapy, with 6 (28.5%) demonstrating intra-organ differential responses. The lymph nodes (35%) had the best objective response (BOR), followed by the adrenals and peritoneum (both 25%), the brain (20%), and the lung (20%). The response rate was highest in adrenal gland lesions (2/4; 50%), followed by lymph nodes (13/19; 68.4 percent) and liver (5/10; 50%), whereas rates were lowest for lesions in the lung (9/25; 36%), intraperitoneal metastases (1/4; 25%), and brain (1/5; 20%). Conclusions: In renal cell carcinoma, checkpoint inhibitors have a variable response at different metastatic sites, with the best response occurring in lymph nodes and the least occurring in soft tissue.

Background: The contamination of patients’ surroundings by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains understudied. Discordant findings of SARS-CoV-2 RNA in environmental samples were noted in many reports. Aims and Objectives: The study assessed the extent and persistence of environmental surface contamination in real-world surfaces around COVID-19 patients. Materials and Methods: We sampled the surroundings of two intensive care unit (ICU) and one ward that were occupied by laboratory-confirmed coronavirus disease 2019 (COVID-19) patients. Frequently touched environmental surfaces near patients were swabbed before and after daily environmental disinfection. Results: Of 355 environmental samples, 6 (1.69%) were positive by real-time reverse-transcription polymerase chain reaction assay. Among those, 5 of 75 ICU samples (6.67%) and 1 of 75 ward environmental samples (1.33%) in the pre-fumigation areas occupied by COVID-19 positive patients were positive. No samples obtained within the first 2 h of fumigation and surface disinfection was found to be positive. Conclusion: Surrounding environment of symptomatic COVID-19 patients can get contaminated and in cases of asymptomatic COVID-19 patients, contamination of their surroundings was an uncommon phenomenon. Strict contact barrier precaution, routine cleaning with disinfectants are mandatory hospital infection control practices in the management of patients infected with SARS-CoV-2.

Background: Increased body mass index (BMI) is a known risk factor for respiratory infection and is being recognized as a predisposing factor in the COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus‐2. Aims and Objectives: This study aimed to assess the association between different body mass index categories with severe COVID-19 patients leading to death. Materials and Methods: This retrospective study of six months included the laboratory-confirmed COVID-19 patients admitted to an ICU of a tertiary care academic health care organization. The medical records were reviewed at least 14 days after admission. Results: 484 patients were included, and BMI data were available for 306 patients. 40.19% had a normal weight, 26.79% were overweight, 17.97% had BMI 30-34.9 Kg/m2 and 15.03% had BMI ≥ 35 Kg/m2. Overall, 58 patients (18.95%) died within 14 days of ICU admission, 50.98% were discharged alive or referred from the hospital within 14 days, and 30.06% remained hospitalized at 14 days. After controlling for all covariates, there was a significantly increased risk of mortality in the patients with obesity class I (RR 2.03, 95% CI 1.07-3.85, P = 0.030) and patients with obesity class II & III (RR 2.83, 95% CI 1.54–5.22, P

Abstract Varun Goel Background The purpose of this study was to study the effectiveness of gemcitabine and nab-paclitaxel combination as first-line chemotherapy regimen for the treatment of metastatic pancreatic cancer. There is scarcity of data regarding efficacy and toxicity profile of this combination in Indian population. Aims and Objectives The primary aim of this study was to assess efficacy of this regimen, for which evaluation done in terms of the objective response rate, progression-free survival (PFS), and overall survival. Safety data were also evaluated. Materials and Methods In this prospective study, gemcitabine plus nab-paclitaxel combination chemotherapy was given as first line in metastatic pancreatic carcinoma patients till progression or appearance of grade 3/4 toxicities with treatment. Results The study was performed in 30 patients comprising 18 (60%) males and 12 (40%) females. The median age was 60 years. Median number of cycles administered were six cycles per patient. Seventeen patients (56.67%) had a partial response and 0% had complete response. A total of seven (23.3%) patients progressed on chemotherapy and six (20%) had stable disease (SD). The disease control rate (responses and SD) was 76.7%. The median PFS was 5.75 months. There was no statistically significant difference in terms of response rates and baseline CA 19-9 levels. Most common toxicities were hematological toxicities with rates of grade 3/4 anemia and neutropenia of 20%. Among nonhematological toxicities, nausea (46.67%) and fatigue (30%) were the commonest. Conclusion Combination of gemcitabine and nab-paclitaxel is active and well tolerated in advanced pancreatic carcinoma. To the best of our knowledge, this is the first such study conducted in India.

Abstract Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns. Methods A cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest. Results Overall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p

Objective The aim of this study is to investigate the effects of gemcitabine maintenance on progression-free survival (PFS) in patients with metastatic gallbladder cancer (GBC). Materials and Methods Sixty patients with unresectable or metastatic GBC having ongoing response to treatment with initial six cycles of gemcitabine and a platinum-based doublet chemotherapy were prospectively randomized on day 21 of the 6th cycle in 1:1 fashion to receive either maintenance gemcitabine 1 g/m2 intravenously on day 1 and day 8 of three weekly cycle or observation. Survival analysis was performed using the Kaplan–Meier method and comparisons by the log-rank test. A p-value < 0.05 was considered as statistically significant. Results Of 60 patients, a total of 56 were available for final analysis. The median PFS was 4.7 months (3.1–6.3) in gemcitabine arm and 2.6 months (2.4–2.8) in observation arm, hazard ratio (HR) 0.196 (95% confidence interval [CI]: 0.1–0.39), p < 0.001. Median overall survival in gemcitabine arm was 12.4 months (9.15–15.6) as opposed to 9.9 months (8.29–11.5) in observation arm, HR 0.76 (95% CI: 0.43–1.35), p = 0.354. The grade 3 or 4 side effects in maintenance arm were transaminitis (17.9%), thrombocytopenia (17.8%), neutropenia (14.2%), and febrile neutropenia (7.1%). Conclusions Maintenance gemcitabine therapy in unresectable/metastatic GBC patients responding to first-line gemcitabine and platinum treatment contributes to increase PFS with minimal and manageable side effects.

Household access to clean energy is a priority for public health and the environment in low- and middle-income countries. However, past illustrative studies have explored benefits of replacing all polluting energy sources, a transition that is only theoretically possible. Factors that limit achievement of the entire theoretical reduction potential should be explored to inform programmatic decision making. We propose a hierarchy of reduction potentials for emissions from household energy, representing different implementation barriers. Following similar work in renewable energy, we propose four categories of reduction potentials beyond the theoretical maximum: distributional, technical, economic, and market. We apply this framework to household energy emissions using a high-resolution spatiotemporal emission inventory of India, a country chosen for its data availability and level of interest in mitigation. We explore distributional potential using distance from urban areas, technical potential by attributing emissions to energy services, and economic potential with a village- level proxy for likelihood of program success. For distributional potential (spatial accessibility), we find that applying reduction programs within 5 km of urban centers would achieve 36%–78% of the theoretical potential across seven regions in India; extension to 10 km yields reductions of 63%–90%. Technical and economic reduction potentials differ most greatly from theoretical potential in regions that contribute the most to national emissions. Even if some of the relationships underlying emission causes are not completely known, reflecting the factors that affect transitions can inform practitioners and programs seeking to scale and deliver clean energy solutions. We assert that including these important influences should be a goal of emission inventory development, beyond the simple quantification of baseline emissions.

Introduction: Staphylococcus aureus (S.aureus) is associated with increased risk for acquiring invasive disease. There exists an increasing prevalence of resistant community acquired S.aureus infections due to the nasal colonisation of S.aureus and Methicillin-Resistant S.aureus (MRSA) worldwide. Aim: To evaluate the prevalence rate of S.aureus and MRSA nasal colonisation among healthy school children and to determine its antibiotic susceptibility rate of the S.aureus isolates. Materials and Methods: The community based cross-sectional study was conducted among 344 school going children of 5-16 years of age. Samples were obtained from the anterior nares from each child and cultured on Blood Agar (BA) and Mannitol Salt Agar (MSA). Antibiotic susceptibility pattern of S.aureus was done by Kirby-Bauer disc diffusion method. MRSA detection was done through Cefoxitin 30 µg discs along with MIC for Oxacillin and Vancomycin simultaneously according to Clinical Laboratory Standard Institute (CLSI). Results: Of the 344 children, 26 (7.55%) were found to be with nasal carriage for S.aureus of which MRSA was found to be in 12 (3.48%) isolates. S.aureus isolates exhibited resistance to multiple classes of antibiotics including Penicillin (100%), Co-trimoxazole (50%), Ciprofloxacin (15.4%), Vancomycin (7.7%), Clindamycin (7.7%), Gentamycin (7.7%). No resistance to Linezolid was observed. Conclusion: A relatively high rate of nasal carriage of S.aureus in children of age group 5-10 years was observed when compared to children of age group 11-15 years. With the risk involved transmission of infection and resistance to many classes of antibiotics among S.aureus strains exists and hence, emphasis needs to be laid to design control measures, continued surveillance and its eradication.

Poly (ADP-ribose) polymerase (PARP) inhibitors are a unique class of therapeutic agents that focus on tumors with deficiencies in the homologous recombination DNA repair mechanism. Genomic instability outlines high-grade serous ovarian cancer, with 50% of all tumors displaying defects in the important DNA repair mechanism of homologous recombination. Earlier research studies have demonstrated considerable efficiency for PARP inhibitors in patients with germ line breast-related cancer antigens 1 and 2 (BRCA-1/BRCA-2) mutations. It has also been observed that BRCA wild-type patients with other defects in the homologous recombination repair mechanism get benefited from this therapy. Companion homologous recombination deficiency (HRD) scores are being developed to guide the selection of patients that are most likely to benefit from PARP inhibition. The selection of PARP inhibitor is mainly dependent upon the number of prior therapies and the presence of a BRCA mutation or HRD. The identification of cases which are most likely to get benefited from PARP inhibitor therapy in view of HRD and other biomarker assessments is still challenging. The purpose of this review is to focus and describe the current evidences for PARP inhibitors in ovarian malignancy, their mechanism of action, and the outstanding issues, including the rate of long-term toxicities and the evolving resistance.

Introduction Malawi’s malaria burden is primarily assessed via cross-sectional national household surveys. However, malaria is spatially and temporally heterogenous and no analyses have been performed at a subdistrict level throughout the course of a year. The WHO recommends mass distribution of long-lasting insecticide-treated bed nets (LLINs) every 3 years, but a national longitudinal evaluation has never been conducted in Malawi to determine LLIN effectiveness lifespans.Methods Using District Health Information Software 2 (DHIS2) health facility data, available from January 2018 to June 2020, we assessed malaria risk before and after a mass distribution campaign, stratifying by age group and comparing risk differences (RDs) by LLIN type or annual application of indoor residual spraying (IRS).Results 711 health facilities contributed 20 962 facility reports over 30 months. After national distribution of 10.7 million LLINs and IRS in limited settings, malaria risk decreased from 25.6 to 16.7 cases per 100 people from 2018 to 2019 high transmission seasons, and rebounded to 23.2 in 2020, resulting in significant RDs of −8.9 in 2019 and −2.4 in 2020 as compared with 2018. Piperonyl butoxide (PBO)-treated LLINs were more effective than pyrethroid-treated LLINs, with adjusted RDs of −2.3 (95% CI −2.7 to −1.9) and −1.5 (95% CI −2.0 to −1.0) comparing 2019 and 2020 high transmission seasons to 2018. Use of IRS sustained protection with adjusted RDs of −1.4 (95% CI −2.0 to −0.9) and −2.8% (95% CI −3.5 to −2.2) relative to pyrethroid-treated LLINs. Overall, 12 of 28 districts (42.9%) experienced increases in malaria risk in from 2018 to 2020.Conclusion LLINs in Malawi have a limited effectiveness lifespan and IRS and PBO-treated LLINs perform better than pyrethroid-treated LLINs, perhaps due to net repurposing and insecticide-resistance. DHIS2 provides a compelling framework in which to examine localised malaria trends and evaluate ongoing interventions.

Orthopedic surgeries contribute to the overall surgical site infection (SSI) events worldwide. In India, SSI rates vary considerably (1.6–38%); however, there is a lack of a national SSI surveillance system. This study aims to identify the SSI incidence, risk factors, antibiotic prescription and susceptibility patterns among operated orthopedic patients in a teaching hospital in India. Data for 1205 patients were collected from 2013 to 2016. SSIs were identified based on the European Centre for Disease Prevention and Control guidelines. The American Society for Anesthesiologists classification system was used to predict patients’ operative risk. Univariable and multivariable backward stepwise logistic regressions were performed. Overall, 7.6% of patients developed SSIs over three years. The most common SSIs causative microorganism was Staphylococcus aureus (7%), whose strains were resistant to penicillin (100%), erythromycin (80%), cotrimoxazole (80%), amikacin (60%) and cefoxitin (60%). Amikacin was the most prescribed antibiotic (36%). Male sex (OR 2.64; 95%CI 1.32–5.30), previous hospitalization (OR 2.15; 95%CI 1.25–3.69), antibiotic prescription during hospitalization before perioperative antibiotic prophylaxis (OR 4.19; 95%CI 2.51–7.00) and postoperative length of stay > 15 days (OR 3.30; 95%CI 1.83–5.95) were identified as significant risk factors. Additionally, preoperative shower significantly increased the SSI risk (OR 4.73; 95%CI 2.72–8.22), which is unconfirmed in the literature so far.

We aimed to use quantitative values derived from perfusion and diffusion-weighted MR imaging (PWI and DWI) to differentiate radiation-induced necrosis (RIN) from tumor recurrence in Glioblastoma (GBM) and investigate the best parameters for improved diagnostic accuracy and clinical decision-making. Methods: A retrospective analysis of follow-up MRI with new enhancing observations was performed in histopathologically confirmed subjects of post-treated GBM, who underwent re-surgical exploration. Quantitative estimation of rCBV (relative cerebral blood volume) from PWI and three methods of apparent diffusion coefficient (ADC) estimation were performed, namely ADC R1 (whole cross-sectional area of tumor), ADC R2 (only solid enhancing lesion), and ADC R3 (central necrosis). ROC curve and logistic regression analysis was completed. A confusion matrix table created using Excel provided the best combination parameters to ameliorate false-positive and false-negative results. Results: Forty-four subjects with a mean age of 46 years (range, 19–70 years) underwent re-surgical exploration with RIN in 28 (67%) and recurrent tumor in 16 (33%) on histopathology. rCBV threshold of >3.4 had the best diagnostic accuracy (AUC = 0.93, 81% sensitivity and 89% specificity). A multiple logistic regression model showed significant contributions from rCBV (p < 0.001) and ADC R3 (p = 0.001). After analysis of confusion matrix ADC R3 > 2032 × 10−6 mm2 achieved 100% specificity with gain in sensitivity (94% vs. 56%). Conclusions: A combination of parameters had better diagnostic performance, and a stepwise combination of rCBV and ADC R3 obviated unnecessary biopsies in 10% (3/28), leading to improved clinical decision-making.

Abstract Background The Democratic Republic of the Congo (DRC) bears a large share of global malaria burden despite efforts to control and eliminate the disease. More detailed understanding of individual and household level characteristics associated with malaria are needed, as is an understanding of how these characteristics vary spatiotemporally and across different community-level malaria endemicities. An ongoing study in Kinshasa Province is designed to address gaps in prior malaria surveillance in the DRC by monitoring malaria across seasons, age groups and in high and low malaria sites. Across seven sites, 242 households and 1591 individuals are participating in the study. Results of the enrollment questionnaire, rapid diagnostic tests and PCR testing of dried blood spots are presented. Results Overall malaria prevalence in the study cohort is high, 27% by rapid diagnostic test and 31% by polymerase chain reaction, and malaria prevalence is highly varied across very small geographic distances. Malaria prevalence is highest in children aged 6–15. While the majority of households own bed nets, bed net usage is less than 50%. Conclusions The study cohort will provide an understanding of how malaria persists in populations that have varying environmental exposures, varying community-level malaria, and varying access to malaria control efforts.

INTRODUCTION: Timely treatment of urinary tract infection (UTI) with appropriate antibiotic administration is of immense importance in children to reduce the consequences. AIMS AND OBJECTIVES: The aim and objective of this study was to assess the temporal changes in the microbiological profiles and antimicrobial resistance patterns of uropathogens in pediatric community-acquired UTI. MATERIAL AND METHODS: This is a retrospective analysis of data collected over a Scattered period of 5 years. The baseline data collected were from January to December 2009, and the second period considered for comparison was from January to December 2014. Urine specimens from children (

Introduction: Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs). Aims and Objectives: To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents. Methods: An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3–4 weeks for seroconversion up to 6 months. Results: A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers ≥10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months. Conclusions: The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.

Overview: Nonunion scaphoid is a common complication of fracture scaphoid which always remains a difficult surgical problem. Most of the cases present late with persistent pain and disability, not responding to conservative treatment. Simple bone grafts are generally not enough in cases with evidence of decreased vascularity of proximal fragment, so pronator quadratus osteomuscular transposition flap to revascularize the nonunion scaphoid gained popularity. A series of 11 cases treated using vascularized osteomuscular graft. Materials and Methods: This study was done on eleven cases of nonunion scaphoid with pronator quadratus vascularized bone graft. Herbert and Alnot classification was used and postoperative evaluation done by scaphoid outcome score. Results: Postoperative scaphoid outcome score was excellent in 4 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. One case developed scaphoid nonunion advanced collapse and wrist arthritis and revision surgery with proximal row carpectomy was done in it. The mean follow-up period was 22 months. Conclusion: Bone grafting is the mainstay treatment for non-union scaphoid. Vascularized bone grafts using pronator quadratus osteomuscular flaps have proved to be more biological and more successful treatment option.

Background: Urinary tract infections (UTIs) remain a major problem both in hospitalized and outdoor patients. Multidrug-resistant enterococci are emerging as a major nosocomial pathogen with increasing frequency. However, the incidence of community-acquired enterococcal infections and species prevalent in India is not thoroughly investigated. Objectives: This study aims to estimate the burden of community-acquired UTIs seen at a tertiary care hospital and to identify the Enterococcus species isolated from these patients. The study also aims to determine the antibiotic susceptibility pattern with reference to high-level aminoglycosides and vancomycin. Materials and Methods: Semi-quantitative cultures from a total of 22,810 urine samples obtained from patients seen at various Outpatient Departments were analyzed. From them 115 nonduplicate isolates of enterococci were obtained as significant pure growth (>105 cfu/ml) and speciated. Antibiotic susceptibility was performed by Kirby–Bauer disc diffusion method. Vancomycin resistance screening was performed by the vancomycin screen agar method recommended by Clinical and Laboratory Standards Institute and confirmed by determination of minimum inhibitory concentration by agar dilution method. Results: Of 115 enterococcal isolates, 61 were identified as Enterococcus faecalis, 42 as Enterococcus faecium, 3 each as Enterococcus dispar, and Enterococcus pseudoavium. High-level gentamicin resistance (HLGR) was higher in E. faecium (47.6%) than E. faecalis (32.7%) and HLSR also showed the same pattern with 47.6% and 27.9% resistance, respectively. Vancomycin resistant enterococci accounted for 11.3% of the isolates, and out of them 53.8% were E. faecium by agar dilution method. Conclusion: High rate of resistance to antibiotics of penicillin group and aminoglycosides was observed in our tertiary care hospital even in community acquired UTIs. Hence, there is an urgent need for more rational and restricted use of antimicrobials.

Introduction: The metastasis to the regional cervical lymph nodes is associated with an increase in nuclear to cytoplasmic ratio leading to reduction in water diffusivity and micro circulation of the node. Aim: To analyze the potential role of diffusion-weighted imaging to differentiate benign and malignant lymph nodes in oral squamous cell carcinoma. Materials and Methods: The diffusion-weighted imaging, T1 and T2-weighted MR sequences were performed on biopsy proven squamous cell carcinomas(47 cases) involving oral tongue and/or gingivo-buccal region with cervical lymphadenopathy. The apparent diffusion coefficient [ADC] was measured by using two b factors (500 and 1000 s/mm2). Results: On diffusion images, 26/47 patients with malignant lymph nodes showed restricted diffusion on DWI with low signal intensity on ADC maps. Whereas all patients with benign nodes showed no restricted diffusion.The ADC was significantly greater in metastatic lymph nodes [0.82×10−3mm2/s, p< 0.01] than in benign lymphadenopathy [1.21×10−3mm2/s] Conclusion: Diffusion-weighted imaging helps in discriminating malignant from benign lymph nodes resulting from oral cavity squamous cell carcinomas. A minimum threshold value of ADC should be kept in mind to identify malignant lymph nodes after taking an appropriate region of interest.

The 2014–2015 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. In late July 2014, the World Health Organization (WHO) declared the outbreak a Grade 3 emergency, its highest level of any emergency response. In early August, they declared it a public health emergency of international concern, meaning it is a serious public health event that endangers international public health. Indeed, by the end of September 2014, the United Nations stated the outbreak is “a threat to international peace and security.” Guinea located on the Atlantic coast of West Africa, is the first country in this geographical region in which an outbreak of Ebola virus disease has occurred. Cases having been confirmed in other countries include Guinea, Liberia, and Sierra Leone. There were a small number of cases reported in Nigeria and Mali and a single case reported in Senegal; however, these cases were contained with no further spread in these countries. Confirmed imported cases have occurred in the United States, Italy, Spain, and the United Kingdom. The WHO declared the end of the Ebola outbreak in Liberia on May 9, 2015 but on June 29, routine surveillance again detected a new confirmed case of Ebola in Liberia. On November 18, 2014, India has quarantined a man who was cured of Ebola in Liberia. As of August 21, 2015, the cumulative number of probable, suspected, and laboratory-confirmed cases attributed to Ebola virus (EBOV) is 28,036, including 11,301 deaths. Zaire EBOV strain has been identified as causative agent for 2014 Ebola epidemic.

Ductal adenocarcinoma of pancreas is the most common pancreatic neoplasm and is the third leading cause of death due to cancer, with a 5-year survival of 8% only. Although pancreatic neoplasms are broadly classified into endocrine and exocrine variety based on cell of origin, on imaging they are classified into solid and cystic types. Pancreatic giant cell tumor (PGCT) is a very uncommon and aggressive pancreatic neoplasm. We report a case of PGCT presenting as a pancreatic tail mass and liver lesions with a morphological overlap with other cystic benign and malignant lesions of pancreas on imaging.

Background: Resistance to broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamases (ESBL), AmpC beta-lactamase, and metallo-beta-lactamase (MBL) enzymes, is an increasing problem worldwide. Aim of the study: This study was undertaken to detect ESBL, AmpC beta-lactamase and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter species from the endotracheal aspirates. Materials and Methods: A prospective study was performed over a period of 15 month in a tertiary care hospital. A total of 26 clinical isolates of P.aeruginosa and 40 of Acinetobacter species were tested for the presence of ESBL, AmpC beta-lactamase, and metallo-beta-lactamase enzyme. Detection of ESBL was done by the combined disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, and MBL was detected by imipenem-Ethylenediaminetetraacetic acid (EDTA) combined disk method. Isolates showing reduced susceptibility to cefoxitin (30 μg) disk were considered ′screen positive′ for AmpC beta-lactamases and selected for detection of plasmid-mediated AmpC by the AmpC disk test. Results : 42.30% isolates of P.aeruginosa were positive for ESBL while 53.85% were MBL producers. Among 39 isolates of Acinetobacter baumannii, 43.59% were AmpC producers while 48.72% were MBL-producing strains. Conclusion: The study emphasizes the high prevalence of multidrug-resistant P.aeruginosa and A.baumannii producing beta-lactamase enzymes of diverse mechanisms. Thus, proper antibiotic policy and measures to restrict the indiscriminative use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta-lactamase-producing pathogens.

Introduction: Squamous cell carcinoma of lower gingivobuccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration. Aim: This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence. Materials and Methods: T1- and T2-weighted MR, diffusionweighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm2 ). MRI findings were compared clinically and histopathologically. Results: Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm2 /s in the present study. Conclusion: Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.

Background: Ventilator-associated pneumonia (VAP) is a common complication of ventilatory support for patients with acute respiratory failure and is associated with increased morbidity and mortality. Aim of the Study: The present study was undertaken to do quantitative cultures of aerobic bacteria, perform the antibiotic susceptibility testing from the endotracheal aspirates and clinical outcome of the clinically suspected patients of VAP. Methods: A prospective study was performed over a period of one year in a tertiary care hospital, enrolling patients on mechanical ventilation (MV) for ≥48 hr. Endotracheal aspirates (ETA) were collected from patients with suspected VAP, and direct gram′s stain criteria was used to accept the sample. Quantitative cultures of ETA were performed with the threshold for microbiological diagnosis of VAP was taken as ≥10 5 colony forming units (cfu)/ml. Results: Out of 53 cases, 2 (3.77%) were polymicrobial. Multidrug resistant bacteria, mainly Acinetobacter baumannii 49.09% (27/55) and Pseudomonas aeruginosa 30.91% (17/55) were the most common pathogens isolated. Metallo-beta lactamases (MBLs) was produced by 47.06% (8/17) of Pseudomonas aeruginosa and 62.96% (17/27) of Acinetobacter baumannii. Conclusion: The bacteriological approach for the management of VAP helps the clinicians in choosing the appropriate antibiotics. This study showed that quantitative cultures of endotracheal aspirate at a cutoff point of 10 5 cfu/ml is one of the alternative to bronchoscopy in the diagnosis of clinically suspected ventilator associated pneumonia.

Unfortunately after publication of the original article [1], it came to the author’s attention that there is an error in the caption of Fig. 2.

Endoplasmic reticulum stress elicits unfolded protein response to counteract the accumulating unfolded protein load inside a cell. The chemical chaperone, 4-Phenylbutyric acid (4-PBA) is a FDA approved drug that alleviates endoplasmic reticulum stress by assisting protein folding. It is found efficacious to augment pathological conditions like type 2 diabetes, obesity and neurodegeneration. This study explores the binding nature of 4-PBA with human serum albumin (HSA) through spectroscopic and molecular dynamics approaches, and the results show that 4-PBA has high binding specificity to Sudlow Site II (Fatty acid binding site 3, subdomain IIIA). Ligand displacement studies, RMSD stabilization profiles and MM-PBSA binding free energy calculation confirm the same. The binding constant as calculated from fluorescence spectroscopic studies was found to be k(PBA) = 2.69 x 10(5) M(-1). Like long chain fatty acids, 4-PBA induces conformational changes on HSA as shown by circular dichroism, and it elicits stable binding at Sudlow Site II (fatty acid binding site 3) by forming strong hydrogen bonding and a salt bridge between domain II and III of HSA. This minimizes the fluctuation of HSA backbone as shown by limited conformational space occupancy in the principal component analysis. The overall hydrophobicity of W214 pocket (located at subdomain IIA), increases upon occupancy of 4-PBA at any FA site. Descriptors of this pocket formed by residues from other subdomains largely play a role in compensating the dynamic movement of W214.

Small Cell Carcinoma of the Ovary of Hypercalcemic Type (SCCOHT) is a rare entity. Very few cases have been reported to date. Most literature about SCCOHT is isolated clinico-pathological series and case reports. We report a case of SCCOHT in a 40 year old female with a pre-operative diagnosis of bilateral ovarian complex cysts. The pa- tient underwent left ovarian cystectomy with right ovarian biopsy and histopathological examination revealed fea- tures of a poorly differentiated carcinoma with intervening extensive areas of necrosis (upto 80%). Tumor cells were positive for EMA, CK, CK7 (focally) CD10, synaptophysin and vimentin hence confirming the diagnosis of SCCOHT. Post surgery patient was started on Etoposide and cisplatin based adjuvant chemotherapy. In view of highly aggressive nature of this tumor, prompt diagnosis and imparting effective chemotherapy regimen to the pa- tient is required.

Artificial roughness has been found to enhance the rate of heat transfer in solar air heater ducts. However, improvement in heat transfer enhancement is invariably accompanied by increased pumping power. Several investigators have investigated the effect of different types of roughness on solar air heaters on the basis of heat transfer and friction factor. This paper presents a comparison of effective efficiency of solar air heaters of various types of roughness geometries over the absorber plate. These geometries have been used by various investigators in order to increase the heat transfer and friction factor in solar air heaters. Based upon correlations developed by various investigators, effective efficiency is also compared for a set of roughness geometries within the investigated range of operating parameters. doi:10.14456/WJST.2014.92

A simulation model is developed for optimal sizing and analysis of a PV-diesel-battery based hybrid power generation system with the objectives to minimize life cycle cost and CO2 emission, while maintaining the desired system autonomy. A case study of a boy’s hostel in Moradabad district is taken for analysis purposes. It has 91 rooms with a capacity of 3 boys in each room. The decision variables included in the optimization methodology are total PV area, number of PV modules of 600 Wp, diesel generator power, fuel consumption per year and number of 24 V and 150 Ah batteries. The simulation result shows that the PV percentage of 86 % and diesel penetration of 14 % gives the most optimized solution with minimum LCC of $110,547 and average CO2 emission of 28 kg/day. The developed model has been validated by comparing its results with earlier research work. doi:10.14456/WJST.2014.24

In this paper, the flow field of fluid and trajectory of particle are modeled using FLUENT 12.0. In this software, continuity, momentum and particle flow equations are discretized using the Finite Volume Method (FVM) to calculate the pressure and velocity distribution in the flow domain. A Reynolds number of a value up to 1000 is used to view the flow simulation behind the cylinder, and it is found that at about the value of 100 there is a formation of eddies in the flow. Particle trajectories are calculated using the Lagrangian method. In this model, ash particles of varying diameters are used for capturing over an aluminum cylinder of 50-micron diameter. The particles of lower diameter strictly follow the fluid laminar layers, but as the particle size increases, the trajectory of the particle gets straightened, and it gets impacted on the fiber collector. Finally, the inertial deposition efficiency is calculated and is plotted against the Stoke number. Different cylinder spacing is used, and the effect on capture efficiency is monitored. These results are compared with other theoretical models, and are found to be in excellent co-ordination. doi:10.14456/WJST.2014.9

The present research work describes the development of Turgo turbine blades on the Solidworks software. Finite element simulation (Ansys V14) has been used for analysis of stress and total deformation produced inside the Turgo impulse turbine. Finite element simulation is effective when it is used to analyze the strain and stress distribution. It has been observed during analysis that the maximum stress occurs at the root of blade suction side.

A solar pond has been fabricated to analyze the thermal behavior of it, in the climatic conditions of Moradabad, Uttar Pradesh. Sodium chloride (NaCl) has been used to form a salt gradient for better performance, and a dark-colored (blackened) rigid surface bottom with 1 mm irregularities has been considered for trapping the heat in a good amount. A solar pond with a surface area of 2.56 m2 and a depth of 1 m has been filled with salty water of various densities to form three salty water zones (upper convective, nonconvective, and heat storage). A few investigations have been carried out to evaluate the thermal efficiencies of three different zones of the solar pond. An attempt is also made to improve the thermal performance of the salt gradient solar pond.