Biochemical, biophysical, and functional characterization of bacterially expressed and refolded receptor binding domain of Plasmodium vivax duffy-binding

Invasion of erythrocytes by malaria parasites is mediated by specific molecular interactions. Plasmodium vivax is completely dependent on interaction with the Duffy blood group antigen to invade human erythrocytes. The P. vivax Duffy-binding protein, which binds the Duffy antigen during invasion, belongs to a family of erythrocyte-binding proteins that also includesPlasmodium falciparum sialic acid binding protein andPlasmodium knowlesi Duffy binding protein. The receptor binding domains of these proteins lie in a conserved, N-terminal, cysteine-rich region, region II, found in each of these proteins. Here, we have expressed P. vivax region II (PvRII), the P. vivax Duffy binding domain, in Escherichia coli. Recombinant PvRII is incorrectly folded and accumulates in inclusion bodies. We have developed methods to refold and purify recombinant PvRII in its functional conformation. Biochemical, biophysical, and functional characterization confirms that recombinant PvRII is pure, homogeneous, and functionally active in that it binds Duffy-positive human erythrocytes with specificity. Refolded PvRII is highly immunogenic and elicits high titer antibodies that can inhibit binding of P. vivax Duffy-binding protein to erythrocytes, providing support for its development as a vaccine candidate forP. vivax malaria. Development of methods to produce functionally active recombinant PvRII is an important step for structural studies as well as vaccine development

Some interesting observations regarding TB patient management from a rural area of Madhya Pradesh: TB case series

Despite many serious efforts, tuberculosis (TB) is still a recognized public health problem. The Government of India has adopted the Directly Observed Treatment, Short-Course (DOTS) strategy for the entire country through the Revised National Tuberculosis Control Programme (RNTCP) for the treatment of TB. In this report, we have presented the trajectories for care seeking of two TB cases who suffered from either "patient level delays" or "health system-related delays" in seeking DOTS for the treatment of TB

Faulty feeding practices in children less than 2 years of age and their association with nutritional status: A study from a rural medical college in Central India

Background: Undernutrition has a direct correlation with the prevailing feeding practices. Early years are crucial in determining the rate and extent of growth and mainly depend on the level of nutrition and care provided. The first episode of growth faltering occurs mostly in children <2 years of age that often goes unnoticed. Objective: The objective of this study was to explore the faulty feeding practices, their determinants, and association with nutritional status in children <2 years of age. Materials and Methods: This cross-sectional study using mixed (qualitative and quantitative) methods was conducted in a sample of 187 mothers and their children at the mother and child health (MCH) clinic of a rural medical college. Results: Only 144 (77%) of the study children had received colostrum. 47 (25.1%) of the mothers had used prelacteal feeds. Although breastfeeding (BF) was universal, only 133 (71.1%) of the mothers were exclusively breastfeeding (EBF) their children. The duration of each feed was an issue; in 49 (32.4%) of the children, the duration of each feed was <10 min with almost all the mothers swapping the baby to other breast during one episode of feeding. Not giving colostrum, not giving EBF, duration of feeds <10 min, swapping the breasts during each feed, and decreased frequency of feeding during illness were found to be significantly associated with poor nutritional status. Conclusion: In our study, we found out that although practice of BF was universal, there is definite scope for further improving the practices. A definite gap between knowledge and practice was observed, which was associated with adverse nutritional outcomes

Empty stomach together with menstrual bleeding as predictors of committed suicides among women of reproductive age: What a primary physician must know

Background: Women of reproductive age group (WoRAG) are among the most vulnerable groups to suicide in India. The present study intended to develop a mathematical model to differentiate suicides from homicides among WoRAG. Methods: It was a cross-sectional study based on a record review of autopsy at Patna, India, from 2016 to 2021. The cause of deaths was ascertained by autopsies and other records independently by two investigators to reduce the interobserver bias. Independent variables were tested with confirmed suicides to calculate statistically significant association. These variables were further used for developing prediction models for the suicides by multivariate logistic regression analysis. Results: Out of total of 520 autopsies of WoRAG performed by investigators, the cause of death has been confirmed for 62. Of them, 30 were confirmed as suicides. In univariate analysis, suicides were associated with the menstrual bleed (OR 35 CI 6.9,179), gastric emptying (OR 3.9 CI 1.2,12.8), hanging, poisoning, and drowning as mode of death (OR 435 CI 37.4,5061.9). By logistic regression, three prediction models were built to predict suicide; Model I: gastric emptying, Model II: menstrual bleed, and Model III: including both. The area under the curve (AUC) for Models I, II, and III was 0.67 (95%CI 0.34,0.99), 0.92 (95%CI 0.75,1.00), and 0.94 (95%CI 0.82,1.00), respectively. The AUC of Model III differs significantly from that of Model I (P value 0.03) but not with Model II (P value 0.11). Conclusion: Menstrual bleed, gastric emptying, and mode of death may be used as a supplement tool in ascertaining the cause of death among WoRAG in medical and legal proceedings

Poor adherence to TB diagnosis guidelines among under-five children with severe acute malnutrition in central India: A missed window of opportunity?

BackgroundIn India, under-five children with Severe Acute Malnutrition (SAM) are referred to Nutritional Rehabilitation Centers (NRCs). NRCs screen the causes of SAM including tuberculosis (TB). The national TB programme recommends upfront testing with a rapid molecular test if TB is suspected in children.ObjectiveWe estimated the yield of and adherence to the TB diagnostic guidelines (clinical assessment and assessment for microbiological confirmation) among under-five children with SAM admitted at NRCs (six in district Sagar and four in district Sheopur) of Madhya Pradesh, India in 2017. We also explored the challenges in screening from the health care providers' perspective.MethodsIt was an explanatory mixed method study. The NRC records were reviewed This was followed by three key informant interviews and three focus group discussions among staff of NRC and TB programme. Manual descriptive thematic analysis was performed.ResultsOf 3230, a total of 2665(83%) children underwent Mantoux test, 2438(75%) underwent physical examination, 2277(70%) were asked about the symptoms suggestive of TB, 1220(38%) underwent chest radiograph and 485(15%) were asked for recent contact with TB. A total of 547(17%) underwent assessment for microbiological confirmation. Of 547, a total of 229 gastric aspirate specimens underwent rapid molecular test (24% positive) and 318 underwent sputum microscopy (44% positive). A total of 223 were diagnosed as TB (195 microbiologically and 28 clinically confirmed) and 209 were initiated on anti-TB treatment. The treatment outcome was favourable (cure or treatment completed) for 70(31%) and not recorded for 121(54%). The main perceived challenges in screening for TB were poor team skills, lack of diagnostic facilities and poor understanding of the guidelines due to inadequate training.ConclusionThough NRCs provided a unique window of opportunity for the screening and management of TB among under-five children with SAM, the utilization of this opportunity remained suboptimal

LU/LC Change Detection and Forest Degradation Analysis in Dalma Wildlife Sanctuary Using 3S Technology: A Case Study in Jamshedpur-India

Geo-informatics technology has dynamic role in mapping, monitoring and management of forest resources. The transformation of forest cover and its analysis on the earth’s surface are essential for understanding the associations and interactions between natural phenomena and living organism, especially human. Also deforestation is a major reason for global warming and one of the origin keys for the enhancement of greenhouse effect and climate change. The present study is grounded on the 3S technology in assessment of LU/LC changes within the forest cover area in Dalma Wildlife Sanctuary (DWLS) Jamshedpur-Jharkhand, India. The movement of forest-cover variation over the years 2009, 2011, 2013, 2015 and 2016 is precisely studied using high resolution Satellite Data (SD). It is noted that, due to shifting cultivation, forest fire, and conversion of forest cover into crop land/bare land and settlement encroachments in forest region by villagers are rapidly increasing; as a result deforestation is taking place. It is predicted that the study would demonstrate the effectiveness of 3S technology in forest renovation, planning and management

A study on prevalence of diabetes and associated risk factors among diagnosed tuberculosis patients registered under Revised National Tuberculosis Control Programme in Bhopal District

Context: Tuberculosis (TB) and diabetes mellitus (DM) remains a worldwide global public health problem. About 95% of patients with TB live in the low and middle-income countries and more than 70% of patients with DM also live in the same countries, especially in South East Asia. Screening for diabetes in patients with TB will not only ensure early case detection but also better management of diabetes and will lead to better TB treatment outcome. Aims: This study aims to determine the prevalence and its associated factors of diabetes and prediabetes among diagnosed cases of TB patients registered under Revised National Tuberculosis Control Programme (RNTCP) in Bhopal city. Settings and Design: The current study was a longitudinal follow-up study conducted among registered TB patients under RNTCP in all 5 TB units of Bhopal District. Subjects and Methods: Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested Performa during October 2013–September 2014. Statistical Analysis Used: Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. Results: Out of the total 662 TB patients, 352 were male and 310 were female. Out of the total, 82 (12.39%) patients were diagnosed as diabetic and 108 (16.3%) were prediabetic. significant association found with six variables which are age, sex, body mass index, type of TB, Category of TB, and smoking. Conclusion: This study shows feasibility and importance of screening of TB patients

Outcomes and implementation challenges of using daily treatment regimens with an innovative adherence support tool among HIV-infected tuberculosis patients in Karnataka, India: a mixed-methods study

Background: In India, a new care package consisting of (i) daily regimen with fixed-dose combination drugs, collected once-a-month and self-administered by the patient, (ii) ‘one stop service’ at antiretroviral treatment (ART) centre for both HIV and tuberculosis (TB) treatment and (iii) technology-enabled adherence support (99DOTS, which required patients to give a missed phone call after consuming drugs) was piloted for treatment of TB among HIV-infected TB patients. Conventional care included intermittent regimen (drugs consumed thrice-weekly) delivered under direct observation of treatment supporter and the patients needing to visit TB and HIV care facilities, separately for treatment. Objective: To assess the effect of new care package on TB treatment outcomes among HIV-TB patients registered during January–December 2016, as compared to conventional care and explore the implementation challenges. Methods: A mixed-methods study was conducted in four districts of Karnataka, India where new care package was piloted in few ART centres while the rest provided conventional care. Quantitative component involved a secondary cohort analysis of routine programme data. Adjusted relative risk(aRR) was calculated using Poisson regression to measure association between new care package and unsuccessful treatment outcome. We conducted in-depth interviews with healthcare providers and patients to understand the challenges. Results: Unsuccessful TB treatment outcomes (death, loss to follow-up and failure) were higher in new care package (n = 871) compared to conventional care (n = 961) (30.5% vs 23.4%; P value<0.001) and aRR was 1.3(95% CI: 1.1–1.7). Key challenges included patients’ inability to give missed call, increased work load for ART staff, reduced patient–provider interaction, deficiencies in training and lack of role clarity among providers and reduced involvement of TB program staff. Conclusion: With new care package, TB treatment outcomes did not improve as expected and conversely declined compared to conventional care. TB and HIV programs need to address the operational challenges to improve the outcomes