Computational prediction of potential vaccine candidates from tRNA encoded peptides(tREP) using a bioinformatic workflow and molecular dynamics validations

Transfer RNAs (tRNA) are non-coding RNAs. Encouraged by biological applications discovered for peptides derived from other non-coding genomic regions, we explore the possibility of deriving epitope-based vaccines from tRNA encoded peptides (tREP) in this study. Epitope-based vaccines have been identified as an effective strategy to mitigate safety and specificity concerns observed in vaccine development. In this study, we explore the potential of tREP as a source for epitope-based vaccines for virus pathogens. We present a computational workflow that uses verified data sources and community-validated predictive tools to produce a ranked list of plausible epitope-based vaccines starting from tRNA sequences. The top epitope, bound to the predicted HLA molecule, for the virus pathogen is computationally validated through 200 ns molecular dynamics (MD) simulations followed by binding free energy calculations. The simulation results indicate that two tRNA encoded epitope-based vaccines, RRHIDIVV and IMVRFSAE for Mamastrovirus 3 and Norovirus GII, respectively, are likely candidates. Peptides originating from tRNAs provide unexplored opportunities for vaccine design. Encouraged by our previous experimental study, which established the inhibitory properties of tREPs against infectious parasites, we have proposed a computationally validated set of peptides derived from tREPs as vaccines for viral pathogens.

Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among sick and healthy children in northern India: A case-control study

BACKGROUND

Streptococcus pneumoniae is leading bacterial cause of community acquired pneumonia and according to World Health Organization, responsible for 14 % death in children. There is effective vaccine available against Streptococcus pneumoniae. Hence the primary objective was to isolate Streptococcus pneumoniae from nasopharyngeal swabs in children aged 2-59 months with and without community acquired pneumonia and to assess their serotypes.

METHODS

This case-control study was conducted in tertiary teaching institutes in northern India. Hospitalized children, aged 2-59 months, with World Health Organization-defined community acquired pneumonia were included as cases. Age matched healthy controls were recruited from immunization clinic. All enrolments were done after written informed parental consent. Nasopharyngeal swabs were taken from both cases and controls, and were cultured on 5 % sheep blood agar with gentamycin plate for growth of Streptococcus pneumoniae and incubated in a jar at 370 for 18-24 hrs. Quellung reaction test was used for serotyping.

RESULTS

From March 2017 to December 2022, 2693 children (1910 cases and 783 controls), were recruited. The median age of cases was 7 months and controls 10 months. Almost all the cases had received antibiotics prior to hospitalization. Streptococcus pneumoniae positivity in nasopharyngeal swab was 8.1 % in cases, of which 56.8 % were vaccine serotypes and 23.6 % in controls, of which 37.8 % were vaccine serotypes. Adjusted odds ratio of isolating vaccine serotypes among cases as compared to controls was 1.77 (95 % CI, 1.09-2.88).

CONCLUSION

Streptococcus pneumoniae isolation from nasopharyngeal was found to be in lower proportion in cases as compared to control, though colonization with vaccine serotypes was higher in cases as compared to control. Therefore, pneumococcal vaccine coverage must be increased to prevent community acquired pneumonia.

Survival Outcomes for Oligometastatic vs. Polymetastatic Extensive-Stage Small Cell Lung Cancer Following Consolidative Thoracic Radiotherapy

PURPOSE/OBJECTIVE(S)

For patients with limited metastatic burden, metastasis-directed radiotherapy has been shown to be associated with improved OS for certain types of cancer. However, these prior trials did not include patients with ES-SCLC. It is not yet clear if patients with oligometastatic ES-SCLC have improved outcomes over polymetastatic ES-SCLC after cTRT.

MATERIALS/METHODS

We identified patients treated with cTRT for ES-SCLC in 2013-2020 at a single institution. Oligometastatic disease was defined at the time of diagnosis as three or fewer organs with distant disease, and with each organ having three or fewer metastatic lesions. All other patients were considered polymetastatic. The Kaplan-Meier estimator, log-rank test, and multivariable Cox proportional hazards regression were used to compare OS, progression-free survival (PFS), local recurrence-free survival (LRFS), and new metastasis-free survival (NMFS) between oligometastatic and polymetastatic ES-SCLC patients undergoing cTRT.

RESULTS

Among 70 included patients, 36 were defined as oligometastatic. All patients received platinum-doublet chemotherapy and cT. Immunotherapy was given in 7 (19.4%) oligometastatic patients and 5 (14.7%) polymetastatic patients (p = 0.56). Median follow-up time was 38.2 months. Multivariable Cox regression analysis showed that oligometastatic disease (vs. polymetastatic disease) at diagnosis was associated with improved OS (hazard ratio [HR] 0.44, 95% CI 0.25-0.78, p = 0.005, 1-year OS 86.1% vs. 46.9%, 2-year OS 47.1% vs. 15.1%). PFS, LRFS, and NMFS were not significantly different between the cohorts. Among oligometastatic patients, pleural involvement (HR 2.44, 95% CI 1.02-5.83, p = 0.046) and lung involvement (HR 4.93, 95% CI 1.02-23.9, p = 0.047) were associated with inferior OS. Among the 26 of 36 (72.2%) oligometastatic patients with neither pleural nor bilateral lung involvement, 1-year OS was 88.5% and 2-year OS was 58.3%.

CONCLUSION

We observed that oligometastatic ES-SCLC patients treated with cTRT (especially those without pleural or bilateral lung involvement) have superior OS than those with polymetastatic disease. We encourage enrollment on the NRG LU007/RAPTOR randomized trial to determine the impact of complete or incomplete consolidative RT to up to 5 sites in ES-SCLC, especially in those with oligometastatic disease.

Estimation of spectroscopic parameters and TL glow curve analysis of Eu3+-activated CaY2O4 phosphor

The solid-state reaction method was utilised to create a down-conversion phosphor in an air environment in CaY2O4:Eu3+ nanocrystalline material. The calcination temperature was set at 1000 °C, and the sintering temperature was set at 1300 °C. Following annealing, confirmation of the crystallinity quality of the phosphor was accomplished by the use of X-ray diffraction analysis. The particle size was predicted to be 43.113 nm using Scherrer's formula. To produce down-conversion luminescence spectra, an excitation wavelength of 247 nm was applied with a fluorescence spectrophotometer. The PL got increasingly intense as the concentration of the dopant increased. The maximum intensity was measured at 2.0 mol% of Eu3+ ion, which gradually decreased as the concentration increased because of concentration quenching. To analyse spectrophotometric peak determinations, the approach developed by the Commission Internationale de l'Éclairage (CIE) was used. Thermoluminescence (TL) glow curve analysis of the CaY2O4:Eu3+-doped phosphor manufactured here revealed a wide TL centred at 225 °C, which comprised of so many peaks that may be extracted by the computerised glow curve deconvolution (CGCD) approach using glow-fit software. The associated kinetic parameters were then determined. The prepared phosphor may be useful for application in various display devices upon excitation by 247 nm; the prominent 613 nm peak of the Eu3+ ion (5D0 → 7F2) electric dipole transition features a red component. CaY2O4:Eu3+ phosphors show promise as materials for potential use in phosphor-converted white LEDs in the field of solid-state lighting technology. The linear connection that the TL glow curve has with UV dose provides evidence for its possible use in dosimetry.

Intense green light emission and thermoluminescence glow curve analysis of Tb3+ -activated CaY2 O4 phosphor

Here, the synthesis and luminescence analysis of the Tb3+ -activated phosphor were reported. The CaY2 O4 phosphors were synthesized using a modified solid-state reaction method with a variable doping concentration of Tb3+ ion (0.1-2.5 mol%). As synthesized, the phosphor was characterized using Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction analysis techniques for the optimized concentration of doping ions. The prepared phosphor showed a cubic structure, and FTIR analysis confirmed functional group analysis. It was discovered that the intensity of 1.5 mol% was higher than at other concentrations after the photoluminescence (PL) excitation and emission spectra were recorded for different concentrations of doping ions. The excitation was monitored at 542 nm, and the emission was monitored at 237 nm. At 237 nm excitation, the emission peaks were found at 620 nm (5 D4 →7 F3 ), 582 nm (5 D4 →7 F4 ), 542 nm (5 D4 →7 F5 ), and 484 nm (5 D4 →7 F6 ). The 1931 CIE (x, y) chromaticity coordinates showed the distribution of the spectral region calculated from the PL emission spectra. The values of (x = 0.34 and y = 0.60) were very close to dark green emission. Therefore, the produced phosphor would be very useful for light-emitting diode (green component) applications. Thermoluminescence glow curve analysis for various concentrations of doping ions and various ultraviolet (UV) exposure times was carried out, and a single broad peak was found at 252°C. The computerized glow curve deconvolution method was used to obtain the related kinetic parameters. The prepared phosphor exhibited an excellent response to UV dose and could be useful for UV ray dosimetry.

Optimizing the luminescence efficiency of an europium (Eu3+) doped SrY2O4 phosphor for flexible display and lighting applications

This research paper reports the synthesis and luminescence study of an Eu³⁺ activated SrY₂O₄ phosphor prepared by a modified solid-state reaction method with varying concentrations of Eu³⁺ ions (0.1-2.5 mol%). X-ray diffraction (XRD) revealed the orthorhombic structure and Fourier transform infrared spectroscopy (FTIR) methods were used to analyse the produced phosphors. Photoluminescence emission and excitation spectra were recorded for varying concentrations of Eu³⁺ ions, and an optimum concentration of 2.0 mol% was found to produce the highest intensity. Under 254 nm excitation the emission peaks were found to be at 580 nm, 590 nm, 611 nm and 619 nm, corresponding to transitions at ⁵D₀ → ⁷F₀, ⁵D₀ → ⁷F₁, and ⁵D₀ → ⁷F₂ respectively. Because of Eu³⁺ inherent luminosity, these emission peaks indicate radiative transitions between excited states of ions, making them useful for developing white light-emitting phosphors for optoelectronic and flexible display applications. The 1931 CIE (x, y) chromaticity coordinates were calculated from the photoluminescence emission spectra and found to be near white light emission, indicating the potential application of the prepared phosphor for light emitting diodes (white component). TL glow curve analysis was also performed for various concentrations of doping ions and UV exposure times, and a single broad peak was observed at 187 °C. Using the computerised glow curve deconvolution (CGCD) method, kinetic parameters were computed.

Effect of Multiple Doses of Sparsentan on the Single-Dose Pharmacokinetics of Dapagliflozin: An Open-Label Drug-Drug Interaction Study in Healthy Adults

Sparsentan is a single-molecule dual antagonist of the endothelin type A receptor and angiotensin II type 1 receptor under investigation for the treatment of focal segmental glomerulosclerosis and immunoglobulin A nephropathy. Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, has recently been indicated in chronic kidney disease. Sparsentan may be considered for concomitant use with dapagliflozin. The purpose of this open-label, 1-sequence crossover study was to determine whether drug-drug interactions between sparsentan and dapagliflozin affect dapagliflozin pharmacokinetics (PK). In addition, exposure to the inactive metabolite of dapagliflozin, dapagliflozin-3-O-glucuronide, was used to evaluate the effect of sparsentan on the primary metabolizing enzyme of dapagliflozin, uridine 5'-diphospho-glucuronosyltransferase 1A9. The study included 22 healthy adults treated with 10 mg of dapagliflozin on day 1, and 800 mg/day of sparsentan on days 5-14, with a 10-mg dose of dapagliflozin coadministered on day 11. PK samples were taken for dapagliflozin, dapagliflozin-3-O-glucuronide, and sparsentan before and after treatment throughout the study. Steady-state concentrations of sparsentan following daily dosing did not affect the PK of single-dose dapagliflozin in healthy adults. Dapagliflozin-3-O-glucuronide PK suggests a minimal effect of sparsentan on metabolism of dapagliflozin by uridine 5'-diphospho-glucuronosyltransferase 1A9. No deaths, serious adverse events, or unusual safety signals occurred. Results suggest dapagliflozin PK is not affected by sparsentan daily dosing.

A Mechanistic Review on Phytomedicine and Natural Products in the Treatment of Diabetes

Diabetes mellitus is a metabolic syndrome of excess glucose levels in the blood. It may be due to glucose intolerance by the tissues and inadequate insulin production from pancreatic β-cells. However, diabetic complication includes cardiovascular and kidney diseases, eye, skin, and foot complications, and neuropathy. The intention behind writing this article was to gather recent information regarding the use of ancient traditional medicinal plants having recent importance in treating diabetes. Several therapies are available for curing the condition based on severity and type of diabetes. Although pharmacological treatments are effective and economical, drugs are associated with unwanted side effects and physiological complications on long-term use. Interestingly, herbs and herbal plants have been used since ancient times against diabetes worldwide. Its importance still exists due to medicinal plants' effectiveness and safety profile in treating various diseases. In this article, we searched online databases, including PUBMED, SCOPUS, MEDLINE, and traditional resources, for collecting information regarding the use of plants against diabetes. We described the pathophysiology of the disease and incorporated plant sources and their chemical constituents responsible for antidiabetic activity with their mechanism in reducing blood glucose levels. The present article may be very helpful for researchers and professionals whose work is inclined towards diabetes and in search of lead compounds for the development of a suitable drug.

Nasopharyngeal Carriage of Streptococcus pneumoniae Serotypes Among Healthy Children in Northern India

Streptococcus pneumoniae (SP) infections cause morbidity and mortality among children worldwide. Hence India introduced 13-valent pneumococcal conjugate vaccine (PCV-13) in 2017 in a phased manner. The primary objective of this study was to assess the proportion of healthy children having nasopharyngeal colonization (NP) with SP. Secondary objective was to determine prevalent serotype of SP among the PCV13 vaccinated and non-vaccinated children. This cross-sectional study was conducted in 4 hospitals of Lucknow District, Northern India. Three hundred healthy children (2-59 months) were recruited between July and August 2019 from vaccination-clinics of hospitals. NP specimen was cultured using 5% sheep blood agar plate containing gentamicin. Pneumococcal isolates were identified by optochin sensitivity and bile-solubility tests. Serotyping was done using Quellung Method. Of the 300 healthy children, 56.7% (170/300) were males and 59.3% (181/300) had received at least one dose of PCV13 vaccine. The NP carriage rate of SP among healthy children was 37.7% (113/300). Vaccine serotypes were found in 33.3% (22/66) in PCV vaccinated children and 48.9% (23/47) in non-vaccinated children (p 0.09). Common vaccine serotypes that isolated were: 18C, 19A, 19F, 23F, 3, 4, 6A, 6B, 9 V. Thus more than one-third of healthy children had NP colonization with SP. Adjusting for age, there was a trend for significant reduction in vaccine serotypes in the NP with one doses versus two or more doses (ptrend = 0.04).

Extra credit for disruption: trend of disruption in radiology academic journals

AIM

To identify the most disruptive publications, which are those that are cited more frequently than their own references, in academic radiology journals and their characteristics, such as the number of authors and relative time to publication.

MATERIAL AND METHODS

A comprehensive literature search was undertaken to identify the 100 most disruptive publications in the field of radiology. Subsequently, statistical analysis was applied to establish the distribution of disruptive scores of the isolated publications using a non-parametric probability density function. The relation between disruptive scores and citation counts was then determined, with the aid of a correlation coefficient. Finally, data regarding any significant connection between disruption scores and time of publication, number of authors, and study design were examined.

RESULTS

Analysing the top 100 papers in increments of 10-year periods showed no significant difference in the distribution of disruption scores over time. No correlation between an article's citation count and disruption score was established. Additionally, no significant relation between the number of authors/study design and disruption scores was identified.

CONCLUSION

The disruption score highlights significant impact elements not entirely accounted for by citation count. Its potential benefit in assessing scientific impact should be contemplated.

Impact of age and gender disparity on CD4+ cell counts to control disease progression using specific HAART in HIV-1 positive patients: A case-control study

BACKGROUND

Highly Active Antiretroviral Therapy (HAART) is composed of several drugs in the antiretroviral class to better treat human immunodeficiency virus type 1 (HIV-1) patients. The estimation of CD4+ T cell counts and HIV-1 viral load in plasma is required to evaluate the treatment success of a specific HAART.

METHODOLOGY

The study included the effects of NRTIs (nucleoside reverse transcriptase inhibitors) and novel protease inhibitors (HAART) on normal control subjects and HIV-1 positive subjects from SGPGIMS, Lucknow, with different age groups and genders. Furthermore, the study was conducted by the estimation of HIV through ELISA, measurement of absolute CD4+ cell count, and the measurement of viral load through qRT-PCR. Furthermore, NRTIs (Retrovir and Epivir) were administered orally one tablet daily in the morning followed by newly FDA-approved protease inhibitors (fosamprenavir and darunavir) orally in the evening at the same dose. Furthermore, CD4+T cell counts and HIV-1 viral load were investigated and correlated in patients with different genders and age groups.

RESULT

Administration of NRTIs and novel protease inhibitors (HAART) in HIV patients had a significant effect on the CD4+ cell count in various age intervals among males and females. The mean comparison of viral load distribution based on gender in CD4 +ve patients in the case group exhibited a viral load higher in females compared to males, indicating a statistically significant difference between males and females (p<0.05). A notable association between virological and immunological parameters was observed with a reciprocal relationship between viral load and CD4 cell count in CD4 +ve patients, demonstrating multiple correlation coefficients with an R-value of 0.853.

CONCLUSION

The administration of specific HAART (NRTIs and novel protease inhibitors) in HIV patients had a notable improvement in the CD4+ cell count and viral load with significant age and gender disparity.

Estradiol inhibits HIV-1BaL infection and induces CFL1 expression in peripheral blood mononuclear cells and endocervical mucosa

An inhibitory effect of estradiol (E2) on HIV-1 infection was suggested by several reports. We previously identified increased gene expression of actin-binding protein cofilin 1 (CFL1) in endocervix in the E2-dominated proliferative phase of the menstrual cycle. Actin cytoskeleton has an integral role in establishing and spreading HIV-1 infection. Herein, we studied in vitro effects of E2 on HIV-1 infection and on CFL1 expression to gain insight into the mechanism of HIV-1 inhibition by E2. E2 dose-dependently inhibited HIV-1_BaL infection in peripheral blood mononuclear cells (PBMCs) and endocervix. In PBMCs and endocervix, E2 increased protein expression of total CFL1 and phosphorylated CFL1 (pCFL1) and pCFL1/CFL1 ratios. LIMKi3, a LIM kinase 1 and 2 inhibitor, abrogated the phenotype and restored infection in both PBMCs and endocervix; inhibited E2-induced expression of total CFL1, pCFL1; and decreased pCFL1/CFL1 ratios. Knockdown of CFL1 in PBMCs also abrogated the phenotype and partially restored infection. Additional analysis of soluble mediators revealed decreased concentrations of pro-inflammatory chemokines CXCL10 and CCL5 in infected tissues incubated with E2. Our results suggest a link between E2-mediated anti-HIV-1 activity and expression of CFL1 in PBMCs and endocervical mucosa. The data support exploration of cytoskeletal signaling pathway targets for the development of prevention strategies against HIV-1.

A stitch in time saves nine: All about pediatric facial fracture

Fractures of the pediatric craniofacial skeleton can be challenging to engage in. The initial injury and subsequent treatment can cause long-term growth disturbances yielding problematic secondary deformities. It is important that clinicians involved in the care of these patients understand the differences between children and adult fracture patterns and understand the potential long-term effects on the growth of the pediatric skeleton and how to manage these problems when they occur.

Effects of COVID-19 on maternal, child healthcare (MCH) services in slums: lessons from India

Background

The study aims to understand the effect of COVID lockdown on MCH for slum dwellers and coping mechanisms adopted in Indore and Agra, India. Slum women's perspectives on seeking, delaying, avoiding healthcare in COVID-19, barriers and facilitators were explored.

Methods

In-person qualitative interviews were conducted in slums in Sept-Oct 2020 with mothers who had deliveries; pregnant women needing ante-natal care; mothers with children <2 yrs needing immunization during COVID lockdown. 30 mothers requiring these MCH services during April -June 2020 (lockdown phase) were interviewed. We chose qualitative study over quantitative as a shorter and useful precedent to replicate in similar situations.

Results

Govt. and most private hospitals refused non-COVID services during lockdown.; Police restricted movement on roads. Being on COVID duty, frontline health functionaries were not doing outreach health sessions. Women missed ante-natal check-up, Iron Folate, Tetanus toxoid; Demand side challenges included fear of COVID infection, lack of money due to livelihood loss; Home deliveries by self, neighbors were resorted to; Maternal, neonatal deaths ensued; Children missed immunization e.g., Measles, DPT. Few peri-urban slum families visited nearby rural health facility for delivery. Some families borrowed money from community saving's groups for delivery in private hospitals. Few families visited low-cost private doctor/nurse for immunization of pregnant mother, children.

Conclusions

Demand and supply side factors led to pregnant women and children not receiving care during lockdown. Peri-urban slum families should be encouraged to link with nearby rural health facility for MCH services during COVID-19 or similar situations. Govt. partnering with private providers near slums will help access during challenging times. Promoting community savings groups as mandated under National Urban Health Mission can enable slum families borrow with ease when in need.

Key messages

Government health system should set up emergency (e.g., mobile clinic) MCH services for future epidemic, disaster, should partner with private doctors/nurses near slums.

Rural health infrastructure serving nearby peri-urban slums formally recognized by Govt. despite separate jurisdictions is an approach adaptable in LMIC cities.

Vegetable gardening in slum homes for food security especially in COVID-19 and well-being in India

Issue

With livelihood loss, uncertain earning, slum families are often food insecure, at risk of undernutrition particularly during COVID-19 in Indian and other LMIC cities. While wheat flour was provided free during lockdown, later at subsidized costs and during non-COVID times, vegetables need to be bought at market price.

Methods

UHRC provided seeds, encouraged families to grow vegetables in slums of Indore, India for five years. In 2019-20 and 20-21, data was gathered through interviews, observations in 20 slums (where &gt;15 families grew vegetables).

Results

Uptake of seeds increased from 900 families in 2019-20 to 1200 in 20-21. With sharing of surplus harvest, 70,000 persons benefited in 2020-21. Families overcame food insecurity by arranging just wheat flour and cooked a vegetable for a meal. Used paint tubs, broken buckets and small spaces were used. Creepers were made to climb on roofs, walls, trees. Green cover increased to &gt; 8 acres in 2021. The practice saves valuable family resources particularly in COVID-19 distress through provision of vegetables for family consumption.

Lessons

Perseverant efforts are key and help build a ‘fairer, healthier world'. Yield per family increased as they grow with incremental confidence. Despite small spaces slum families creatively grew vegetables. Children and youth help overcome constraints and are key actors. Early adopters serve as motivators and champions for subsequent adopters who begin growing vegetables on observing neighbours, friends grow vegetables and share with them. Nurturing plants, seeing vegetables grow fostered positivity, hope, motivation to grow every year, enhanced self-worth, and a positive feeling about their abode. People particularly children and youth learn how eating home-grown vegetables reduces carbon footprint of purchased vegetables transported to urban markets, save cost and overcome food insecurity. They reduce ambient air temperature to cool urban spaces.

Key messages

Despite small spaces, slum families grow, share vegetables, feel accomplished, enable food security, social cooperation, all crucial to well-being of slum populations. Methods used and lessons learnt of perseveringly motivating slum families have the potential of replication/adaptation in cities of India and other LMICs.

Birth Preparedness and Complication Readiness (BPACR) among brick kiln workers in Indore, India

Background

Birth preparedness and complication readiness (BPACR), promotes utilization of skilled maternal and neonatal care. Preparing for childbirth reduces delays in seeking care. Brick-kiln workers constitute a vulnerable social group who contribute to city infrastructure by laboring at low wages. 37% of the sample were Scheduled Castes, 49% Scheduled Tribes.

Methods

139 mothers of children &lt; 2 years, residing temporarily in brick kilns of Indore were asked about preparedness for birth of youngest child. Birth preparedness was assessed by enquiring about saving money, arranging transport, identifying health facility for delivery, identified family member to accompany for labor/emergency.

Findings

10% did &gt;3 BPACR practices implying good level of preparedness; 50% did 1-2 BPACR practices; 40% did no birth preparedness. Access to maternity benefit scheme was twice as likely to result in reasonable birth preparedness as compared to no access. Those with primary to class XII were twice as likely to practice birth preparedness as compared to those with no formal education. &gt;3 ANC was associated with 8 percentage points greater practice of reasonable BPACR as compared to &lt; 2 or no ANC. Mothers with knowledge of one danger sign each of pregnancy and delivery were 3 times more likely to practice BPACR than those without this knowledge. FGDs revealed challenges in access to bank account, obtaining required documents to apply for and access state maternity benefit. Lack of family support led to low BPCAR and low institutional delivery.

Conclusions

Brick-kiln women face risk of low utilization of government healthcare services. The health systems should conduct outreach antenatal care sessions in brick-kilns on knowledge of key danger signs and BPACR during health education and ANC counselling can help promote BPACR and hospital delivery. Information on requisite steps to apply for maternity benefit schemes should be shared among brick-kiln workers.

Key messages

It is crucial to promote BPACR among urban vulnerable sections, through NUHM’s outreach sessions by ANMs/ASHAs in brick-kiln, construction workers and similar groups. Access to maternity benefit cash transfer scheme should be enhanced particularly among excluded temporary urban groups such as brick-kiln workers as it is a motivation to avail hospital care.

Efficacy of Transdermal Diclofenac Patch and Ketoprofen Patch as Postoperative Analgesia after Extraction of First Premolars Bilaterally in Both Arches for Orthodontic Purpose: A Comparative Study

Aim:

The aim of the study was to compare the efficacy of transdermal diclofenac patch with ketoprofen patch as postoperative analgesia after extraction of first premolars bilaterally in both arches for orthodontic purpose.

Materials and Methods:

A split-mouth technique was used in 52 patients with the age group of 15–25 years for extracting maxillary and mandibular first premolars bilaterally for orthodontic reason. A single ketoprofen patch was used after the extraction of premolars from first and fourth quadrant, whereas for the extraction of second and third quadrant premolars, diclofenac patch was used. All the extractions were performed under local anesthesia. The data were compiled and statistically analyzed using the student's t-test.

Results:

Mean visual analog scale score for diclofenac and ketoprofen patch was 2.05 (0.75) and 1.09 (0.3), respectively. Thirteen patients required additional medication (25%) and 1 (1.9%) patient with diclofenac and ketoprofen patch, respectively. No major complication or adverse effects were observed in any of the groups.

Conclusion:

Both diclofenac and ketoprofen transdermal patches are helpful in relieving pain after orthodontic extraction. Patients with diclofenac patch required more additional analgesia within 24 h compared to that with ketoprofen patch. None of the drugs showed any significant adverse effects and were well tolerated by the patients.

Comparative Evaluation of Changes in Microflora in Delayed and Immediate Implant Placement: An In vivo Study

Aim:

This study is aimed to compare and evaluate the changes in the microflora in immediate and delayed placed implants.

Materials and Methods:

In this study, the implant site sample was taken and assessed during different phases of treatment for delayed and immediate implants. They were looked for Streptococcus, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, and Fusobacterium nucleatum.

Results:

The results showed that Streptococci were found in a higher number in all the phases of the treatment. The presence of pathogenic organisms such as P. gingivalis and Fusobacterium, in considerable amounts, was seen in both the groups.

Conclusion:

Thus, we conclude that implant mode of placement, delayed or immediate placement does not alter the flora of the oral cavity. Organisms present remains the same in all the phase of the treatment. To prevent the disease, one must continuously monitor the implant, with the increasing age changes, the microflora is continually changing in the oral cavity. The periodontal health should be assessed before the placement of the implant, followed by follow-ups after a set period for a better prognosis.

Simulated physiological oocyte maturation (SPOM) improves developmental competence of in vitro produced goat embryos

The effect of simulated physiological oocyte maturation on the developmental competence, reactive oxygen species production and apoptosis rate of in vitro produced goat embryos were studied in the present experiment. Oocytes and spermatozoa were recovered from ovaries and epididymis, respectively, procured from a local small animal abattoir. The oocytes aspirated from the ovaries were allocated into two groups, control (subjected to routine in vitro maturation, fertilization and culture) and simulated physiological oocyte maturation (SPOM) group (subjected to prematuration, followed by routine in vitro maturation, fertilization and culture). The SPOM group showed a significantly (p < 0.05) higher maturation and blastocyst rates (90.60 ± 0.46% and 29.09 ± 2.59%, respectively) as compared to the control group (85.29 ± 0.98% and 24.09 ± 1.08%). The intensity of reactive oxygen species of the embryos in the control group (14.98 ± 0.83 pixels/embryo) was significantly (p < 0.05) higher than the SPOM group (9.60 ± 0.76 pixels/embryo). The apoptosis rate was also significantly (p < 0.05) higher in the embryos of the control group (9.18 ± 1.07%) as compared to the SPOM group (5.71 ± 0.90%). In conclusion, the simulated physiological oocyte maturation system significantly increases the developmental competence of the oocytes and decreases the intensity of reactive oxygen species and embryonic apoptosis in abattoir derived goat embryos.

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Background

Scrub typhus is a neglected rickettsial disease in India. Every year, we are facing outbreaks of Scrub typhus after Monsoon season. Patients present with a wide clinical spectrum ranging from pyrexia of unknown origin to multiple organ dysfunction. Some of these clinical features overlap with presentation of other tropical infections prevalent in Indian subcontinent, which leads to diagnostic dilemma and delay in diagnosis. Hence, we planned this study to know the demographic, clinical and biochemical profile of scrub typhus patients.

Methods

This was an observational study conducted in department of Medicine, King George's Medical University Lucknow, India a leading tertiary care hospital of Northern India. All scrub typhus patients were evaluated by detailed history, examination and laboratory tests.

Results

We enrolled 52 patients in our study. The mean age of the patients was 35.17 ± 16.90 years with majority (82.7%) of patients from rural background. All the patients had fever with an average duration of 9.6 ± 2 days. Most of the patients developed hepatitis (69.2%) followed by acute encephalitis syndrome (47%), acute kidney injury (23.1%) and acute respiratory failure (19.2%). Eschar was found in 11 patients (21.2%).

Conclusion

Scrub typhus is often misdiagnosed or diagnosed late due to its wide clinical spectrum overlapping with clinical presentation of other commonly prevalent tropical diseases. One should always consider the differential diagnosis of scrub typhus while evaluating a young febrile patient of rural background, with features of single or multiple organ dysfunction and laboratory findings of leucocytosis, thrombocytopenia and elevation of transaminases.

Team based learning in pathology: Lessons learned from a pilot study

Background: Team based learning (TBL) is an approach where students are organised in groups where they learn from each other. TBL is a student centric approach, which ensures active participation of each member and also promotes teamwork and learning ability. Looking at the teacher centric approach of the conventional teaching learning methods in medical education, where the students are mere passive learners and the sessions can be monotonous, TBL seems to be extremely relevant today as a more student centric teaching learning method. Aim of this study was to compare TBL with conventional teaching learning method (CTL). Methods: This randomised crossover study was conducted in the Department of Pathology, SMS Medical College, on 224 third semester medical students, wherein they were exposed to TBL session and their learning outcome and perception was compared to CTL. The data was analysed using Primer version 6 software. Results: In this study, there was a statistically significant improvement (p < 0.001) in the score of students after exposure to TBL. Also, there was a significant difference in the learning outcome of students of TBL (mean assessment score 7.21) as compared to CTL (mean assessment score 6.09). The student perception trends revealed a positive tilt towards TBL, wherein 70.98 % students agreed that TBL was a better learning strategy as compared to lectures. Conclusion: This pilot study concluded that TBL can be used as a supplement to the conventional lectures for improving the learning as well as team work and leadership skills of students.

Increased tracheostomy rates in head and neck cancer surgery during the COVID-19 pandemic

Surgical practice during the coronavirus disease 2019 (COVID-19) pandemic has changed significantly, without supporting data. With increasing experience, a dichotomy of practice is emerging, challenging existing consensus guidelines. One such practice is elective tracheostomy. Here, we share our initial experience of head and neck cancer surgery in a COVID-19 tertiary care centre, emphasizing the evolved protocol of perioperative care when compared to pre-COVID-19 times. This was a prospective study of 21 patients with head and neck cancers undergoing surgery during the COVID-19 pandemic, compared to 193 historical controls. Changes in anaesthesia, surgery, and operating room practices were evaluated. A strict protocol was followed. One patient tested positive for COVID-19 preoperatively. There was a significant increase in pre-induction tracheostomies (28.6% vs 6.7%, P = 0.005), median hospital stay (10 vs 7 days, P = 0.001), and postponements of surgery (57.1% vs 27.5%, P = 0.01), along with a significant decrease in flap reconstructions (33.3% vs 59.6%, P = 0.03). There was no mortality and no difference in postoperative morbidity. No healthcare personnel became symptomatic for COVID-19 during this period. Tracheostomy is safe during the COVID-19 pandemic and rates have increased. Despite increased rescheduling of surgeries and longer hospital stays, definitive cancer care surgery has not been deferred and maximum patient and healthcare worker safety has been ensured.

Emergence of spatio-temporal variations in chemotherapeutic drug efficacy: in-vitro and in-Silico 3D tumour spheroid studies

Background

The mechanisms of action and efficacy of cisplatin and paclitaxel at cell population level are well studied and documented, however the localized spatio-temporal effects of the drugs are less well understood. We explore the emergence of spatially preferential drug efficacy resulting from variations in mechanisms of cell-drug interactions.

Methods

3D spheroids of HeLa-C3 cells were treated with drugs, cisplatin and paclitaxel. This was followed by sectioning and staining of the spheroids to track the spatio-temporal apoptotic effects of the drugs. A mechanistic drug-cell interaction model was developed and simulated to analyse the localized efficacy of these drugs.

Results

The outcomes of drug actions on a local cell population was dependant on the interactions between cell repair probability, intracellular drug concentration and cell’s mitosis phase. In spheroids treated with cisplatin, drug induced apoptosis is found to be scattered throughout the volume of the spheroids. In contrast, effect of paclitaxel is found to be preferentially localized along the periphery of the spheroids. Combinatorial treatments of cisplatin and paclitaxel result in varying levels of cell apoptosis based on the scheduling strategy.

Conclusions

The preferential action of paclitaxel can be attributed to the cell characteristics of the peripheral population. The model simulations and experimental data show that treatments initiated with paclitaxel are more efficacious due to the cascading of spatial effects of the drugs.

Variability of contrast enhancement of pancreas on computed tomography in patients with acute pancreatitis and isolated extrapancreatic necrosis

BACKGROUND AND STUDY AIM

To evaluate the variability in the enhancement of pancreas on computed tomography (CT) in patients with acute pancreatitis (AP) and isolated extrapancreatic necrosis (EPN) and to investigate whether it affects the extrapancreatic findings and patient outcomes.

PATIENTS AND METHODS

This retrospective study comprised of consecutive patients with isolated EPN evaluated between April 2017 and April 2019. A radiologist measured the pancreatic attenuation values (PAV) of head, body, and tail on a contrast enhanced CT. Using a cut-off PAV of 100HU, patients were divided into two groups. The extrapancreatic CT findings and outcome parameters were compared between the two groups.

RESULTS

Thirty patients (mean age, 42.13 years, 17 males) with isolated EPN were evaluated. The mean PAV in the head, body, and tail was 83.13 HU (range, 59-161), 84.17 HU (range, 60-160), and 82.23 HU (range, 53-137). The overall mean PAV was 83.12 HU (range, 58-152). There were six patients with overall mean PAV≥100 HU. The group with PAV≥100 HU had a higher number of patients with infected necrosis (66.6% vs. 14.2%, P=0.018). PAV had a significant association with length of hospitalization (P=0.045).

CONCLUSION

There is significant variability in the pancreatic enhancement on CT among patients with AP and isolated EPN. Patients with PAV≥100 HU had a significantly longer hospital stay. This, however, may be related to a greater number of patients with infected necrosis in this group.

Local solutions by slum communities to deal with summer water scarcity: Learning from Indore, India

Issue

Government of India's, NITI Aayog reports that 600 million people in India face extreme water stress. Slums and similarly vulnerable urban populations face huge challenges in accessing water for basic needs, increasing in summers. Indore is an extreme water stressed city in India.

Methods

During Urban Health Resource Centre's (UHRC) program work in slums, including women's groups UHRC forms and trains in 2018 we learnt of acute water scarcity in summers. Women in 16 slums were motivated to evolve and implement possible solutions. Most slum dwellers provide services on low wages to the city. With public bore-wells drying-up, in Feb.- May 2019 UHRC helped women's groups' submit community requests, reminders to elected ward representatives and Municipal offices for free water tankers. UHRC motivated slum families to collectively negotiate with private providers to reduce cost, systematise water supply for more families. In 4 peri-urban slums we strengthened water access relationship between farmers and slum dwellers.

Results

During Feb.-May 2019 10 of the 16 slums received free water tankers from Municipal Corporation. More population of 4 peri-urban slums accessed water from farmer's tube-well. Slum families evolved coping mechanisms of storing more general use water in underground tanks or many cans. Families with larger storage shared water with needy families demonstrating social cooperation.

Lessons

Trained and mentored slum women's groups gently negotiating with elected ward-level politicians and municipal officials helps in provision of free water tankers in summers. This strategy to get govt. water supply in slums is adaptable in fast growing Indian cities. Owing to geographical proximity, rural-urban cooperation can help slums in city's fringes obtain water from farmer tube-wells used for irrigation. Fostering community cooperation helps more needy families get water.

Key messages

Slum communities develop local mechanisms to access and store water which need to be understood by civil society organisations and Government to improve solutions for water supply in summer months. Slum women emerge as dynamic actors to improve the lives of both women and men (Sen, 2000). In this case women help negotiate for and foster community cooperation for water, store more water.

Assessing and implementing practical ways to address slum health determinants: Learning from India

Issue

There is a need for adaptable/scalable methods to understand environmental determinants of health and well-being in slums of LMIC cities. Catalysing grassroots actions to reduce health inequalities is needed with strong community leadership in slums.

Methods

Conducted in 2016-2017 in Indore (3 m population), India this practice undertakes qualitative health assessments using simple, actionable indicators with community knowledge and prioritizes solutions. Participatory neighbourhood level assessment of sewerage, toilets, garbage disposal and water supply by slum women was done using three colour scale: red for poor condition, yellow for moderate condition and green for good condition across 24 slums. Since slum women live these challenges daily, they can assess conditions. A qualitative adaptation of WHO's Urban HEART, this practice seeks to learn how slum women assess conditions, implement actions for improvement of slum environment.

Results

Context responsive actions included submitting community petitions and reminders to Municipal authorities by slum women to repair sewerage lines, construct toilets, increase regularity of garbage collection and improve public water supply in slums. Of 24 slums assessed in 2016, 6 were designated as “red”, 14 as “yellow” and 4 as “green” on condition of toilets and sewerage. On garbage disposal and water supply, 8 slums were designated as “red”, 10 as “yellow” and 6 as “green”. With coordination with Municipal authorities in 2017, slums on “red” reduced to 3 in each group, those assessed as “green” increased to 10 with improved conditions.

Lessons

This approach helps slum communities to assess problems and implement solutions. The methodology is simple, low-cost, easily understood by less educated, academics, policy makers and uses community wisdom. It is adaptable for NGOs, relevant policies/guidelines in LMIC cities. This collective community health assessment directly catalyses demand side action.

Key messages

Collective efficacy is a group’s shared belief in its ability to utilize information, pursue actions to overcome obstacles accomplishing a valued goal. This method is key to replicate this practice. People’s efforts to bring public services to the slums through collective action can reduce urban health inequality.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

A preliminary clinico-epidemiological portrayal of COVID-19 pandemic at a premier medical institution of North India

CONTEXT

The outbreak and spread of severe acute respiratory syndrome coronavirus 2 has led to a global exigency of colossal and monstrous proportions in terms of public health and economic crisis. Till date, no pharmaceutical agent is known to manage in terms of prevention and treatment of coronavirus disease 2019 (COVID-19), the disease caused by a novel virus.

AIMS

The aim of the present work was to understand the underlying disease profile and dynamics that could provide relevant inputs and insight into pathophysiology and prevent further spread and evolve management strategies of COVID-19 patients from data-driven techniques.

SETTINGS AND DESIGN

A retrospective observational descriptive study was conducted on 29 COVID-19 patients admitted at a premier medical institution of North India in the months of February and March 2020.

METHODS

The patients were diagnosed with reverse transcription-polymerase chain reaction test. Demographic, clinical, and laboratory data were collected.

RESULTS

The mean age of population was 38.8 years with male preponderance, of which two patients were residents of Italy, and others hailed from semi-arid and Western sandy arid regions of Rajasthan (urban population). The major presenting symptom complex of said COVID-19 sample population included fever (48%), cough (31%), and shortness of breath (17%). Most of the patients (83%) had no comorbidity. No clinical correlation (r) could be appreciated between the duration of test positivity and age of afflicted COVID-19 patients (r = -0.0976).

CONCLUSIONS

The present evaluation of various facets of the ongoing global pandemic of COVID-19 is an attempt to portray early clinical and epidemiological parameters of the menace of COVID-19 patients admitted at SMS Medical College and Attached Hospitals, Jaipur.

Association of miR-760 with cancer: An overview

MicroRNAs (miRNAs) are small non-coding RNA molecules of around 22 nucleotides in length. They are crucially involved in the post transcriptional regulation and thus play a significant role in the modulation of different diseases. Several studies have suggested that miRNA expression is dysregulated in various cancers through different mechanisms and the dysregulated miRNA in return affects different cancer hallmarks including cell proliferation, cell death suppression, metastasis and angiogenesis. Compilation of the available miRNA data can be a stimulator for proper understanding of the correlation between the miRNA expression and cancer progression. In this review, we have focussed on the role of miR-760 in the progression of different cancer. MicroRNA-760 (miR-760) has been found to be down regulated in various cancers, thus it can be utilized as a possible prognostic marker for cancer detection. Here, we have tried to fill a gap regarding the role of miR-760 in relation to cervical cancer also. Moreover, unravelling the role of miR-760 in different cancers will enlighten the researchers with proper understanding of biology of miR-760 in regulation of different cancers.

Direct molecular detection of amoxicillin-susceptible E. coli in urine samples from children with suspected urinary tract infection: A potential tool to improve antibiotic stewardship and patient care

BACKGROUND

Rapid detection of amoxicillin-susceptible Escherichia coli (ASEC) urinary tract infections (UTIs) could have a significant impact on patient care and improve antibiotic stewardship. This is especially true for infants and children, for whom antibiotic choices are more limited than for adults.

METHODS

A real-time polymerase chain reaction (PCR) uniplex panel for detection of ASEC using PCR assays for E. coli and five resistance genes (bla _TEM, bla _SHV, bla _OXA, bla _CTX-M, and bla _CMY) and an internal control was designed. PCR was then performed directly on pediatric urine samples using an inhibitor-resistant DNA polymerase. The main outcome measure was the performance of the PCR panel (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], accuracy) for the detection of ASEC. ASEC samples were defined as those that were E. coli PCR positive and PCR negative for all five resistance genes. PCR results were compared with the reference standard for culture and susceptibility testing.

RESULTS

Two hundred and six urine samples with pyuria (>10 white blood cells/high power field) were tested with the PCR panel. Two samples showed PCR inhibition (1%). For ASEC detection, the PCR panel showed a sensitivity of 91.53% (95% CI 81.32% to 97.19%), specificity of 98.21% (95% CI 90.45% to 99.95%), PPV of 98.18% (95% CI 88.54% to 99.74%), NPV of 91.67% (95% CI 82.61% to 96.22%), and accuracy of 94.78% (95% CI 88.99% to 98.06%).

CONCLUSIONS

This PCR method could potentially enable amoxicillin or ampicillin to be used in a greater proportion of children with E. coli UTIs, improving antibiotic stewardship.

Characterisation of cholinesterases in mucous secretions and their localisation in epidermis of Labeo rohita and Cirrhinus mrigala

Cholinesterases are multifunctional enzymes and have been associated with diverse physiological functions in addition to their classical role at synapses. In the present study, cholinesterase (ChE) isozymes have been characterised in mucous secretions and their activity has been localised in the epidermis of Labeo rohita and Cirrhinus mrigala. Zymography using specific substrates and inhibitors revealed the presence of two ChE isozymes-ChE-1 and ChE-2. The isozyme ChE-1 was characterised as an atypical butyrylcholinesterase and ChE-2 as a typical acetylcholinesterase in skin mucous secretions of both the fish species. Enzyme histochemical analysis demonstrated the presence of ChE activity in the epidermis of the fish species investigated. In both the fish species, strong ChE activity was observed in the outer-layer epithelial cells, taste buds and neuromasts. The middle and basal layer epithelial cells showed moderate to weak ChE activity. Club cells and mucous goblet cells showed the absence of ChE activity. Characterisation with specific inhibitors indicates that acetylcholinesterase (AChE) was the major cholinesterase type expressed in the epidermis of the two fish species investigated. Immunohistochemical localisation of apoptotic and cell proliferation markers, in addition, revealed high expression of active caspase 3 in the outer-layer epithelial cells, and proliferating cell nuclear antigen (PCNA) in the middle and basal layer epithelial cells. High ChE activity in caspase 3-positive cells in the outer layer of the epidermis and low in PCNA-positive cells in middle and basal layers could point towards the possible involvement of ChEs in cell death and their final extrusion from skin surface.

Inferior right hepatic vein on routine contrast-enhanced CT of the abdomen: prevalence and correlation with right hepatic vein size

AIM

To determine the prevalence of the inferior right hepatic vein (IRHV) in patients undergoing routine contrast-enhanced computed tomography (CECT) of the abdomen and to compare it with the size of the right hepatic vein (RHV).

MATERIALS AND METHODS

Two hundred and twenty-four consecutive patients who underwent routine CECT abdomen, with adequate venous opacification, were included in the study. The number and diameter of IRHVs and the diameter of the RHV was noted in each case.

RESULTS

A total of 214 IRHVs were detected in 126 cases (56.2%) with a mean diameter of 4.15±1.44 mm. The number of IRHVs ranged from one to four (more than one IRHV was present in 39.7% [50/126] of cases). In approximately one-third of cases (46/126), an IRHV ≥5 mm was found. A weak negative correlation was found between size of the RHV and IRHV (Pearson's correlation coefficient -0.222; p=0.01). The RHV was smaller in size in patients with an IRHV (7.34±1.88 mm) than in patients without an IRHV (8.47±1.99 mm) on CECT abdomen. A larger IRHV was associated with a smaller RHV (6.91±2.05 mm).

CONCLUSION

The presence of IRHV on routine CECT abdomen is frequent, and it is not uncommon to encounter more than one IRHV. The diameter of the IRHV has a weak negative correlation with the diameter of the RHV, and a smaller RHV is found in patients with an IRHV.