Mortality and Air Pollution Effects of Air Quality Interventions in Delhi and Beijing

Ambient air pollution alone accounts for more than 3 million premature deaths worldwide. Low and Middle Income Countries (LMIC) account for most (~87%) of this disease burden. Air pollution in the megacities of these countries has risen to the levels of public health hazards forcing the cities to take emergency measures, such as issuing red alerts and vehicle-rationing interventions (VRI). Using in-situ and high-resolution satellite data, this research examines the efficacy of VRI in Delhi and Beijing, two of the most polluted cities of LMIC. This research shows that VRI reduced particulate matter (PM) ≤ 2.5 μm in aerodynamic diameter (PM2.5) in Beijing during the 2008 Summer Olympics. However, such interventions implemented in 2015 and 2016 in Beijing and in 2016 in Delhi were ineffective in improving air quality. Moreover, the effects of such interventions were short lived, for example 54% of the cleaning in Beijing disappeared within 2 weeks after the Olympics, and Delhi witnessed a 34% increase in PM2.5 during the 2 weeks after the interventions. Both cities observed excess cardiopulmonary mortality even during the interventions. Short- and long-term preventive and mitigation strategies are needed to manage the air pollution disease burden

Management of Treatment and Prevention of Acute OP Pesticide Poisoning by Medical Informatics, Telemedicine and Nanomedicine

Acute organophosphorous pesticide (OP) poisoning kills a lot of people each year. Treatment of acute OP poisoning is of very difficult task and is a time taking event. Present day informatics methods (telemedicine), bioinformatics methods (data mining, molecular modeling, docking, cheminformatics), and nanotechnology (nanomedicine) should be applied in combination or separately to combat the rise of death rate due to OP poisoning. Use of informatics method such as Java enabled camera mobiles will enable us early detection of insecticidal poisoning. Even the patients who are severely intoxicated (suicidal attempts) can be diagnosed early. Telemedicine can take care for early diagnosis and early treatment. Simultaneously efforts must be taken with regard to nanotechnology to find lesser toxic compounds (use less dose of nanoparticle mediated compounds: nano-malathion) as insecticides and find better efficacy of lesser dose of compounds for treatment (nano-atropine) of OP poisoning. Nano-apitropine (atropine oxide) may be a better choice for OP poisoning treatment as the anticholinergic agent; apitropine and hyoscyamine have exhibited higher binding affinity than atropine sulfate. Synthesis of insecticides (malathion) with an antidote (atropine, apitropine) in nanoscale range will prevent the lethal effect of insecticides

The antiretroviral efficacy of highly active antiretroviral therapy and plasma nevirapine concentrations in HIV-TB co-infected Indian patients receiving rifampicin based antituberculosis treatment

Abstract Background Rifampicin reduces the plasma concentrations of nevirapine in human immunodeficiency virus (HIV) and tuberculosis (TB) co-infected patients, who are administered these drugs concomitantly. We conducted a prospective interventional study to assess the efficacy of nevirapine-containing highly active antiretroviral treatment (HAART) when co-administered with rifampicin-containing antituberculosis treatment (ATT) and also measured plasma nevirapine concentrations in patients receiving such a nevirapine-containing HAART regimen. Methods 63 cases included antiretroviral treatment naïve HIV-TB co-infected patients with CD4 counts less than 200 cells/mm3 started on rifampicin-containing ATT followed by nevirapine-containing HAART. In control group we included 51 HIV patients without tuberculosis and on nevirapine-containing HAART. They were assessed for clinical and immunological response at the end of 24 and 48 weeks. Plasma nevirapine concentrations were measured at days 14, 28, 42 and 180 of starting HAART. Results 97 out of 114 (85.1%) patients were alive at the end of 48 weeks. The CD4 cell count showed a mean increase of 108 vs.113 cells/mm3 (p=0.83) at 24 weeks of HAART in cases and controls respectively. Overall, 58.73% patients in cases had viral loads of less than 400 copies/ml at the end of 48 weeks. The mean (± SD) Nevirapine concentrations of cases and control at 14, 28, 42 and 180 days were 2.19 ± 1.49 vs. 3.27 ± 4.95 (p = 0.10), 2.78 ± 1.60 vs. 3.67 ± 3.59 (p = 0.08), 3.06 ± 3.32 vs. 4.04 ± 2.55 (p = 0.10) respectively and 3.04 μg/ml (in cases). Conclusions Good immunological and clinical response can be obtained in HIV-TB co-infected patients receiving rifampicin and nevirapine concomitantly despite somewhat lower nevirapine trough concentrations. This suggests that rifampicin-containing ATT may be co administered in resource limited setting with nevirapine-containing HAART regimen without substantial reduction in antiretroviral effectiveness. Larger sample sized studies and longer follow-up are required to identify populations of individuals where the reduction in nevirapine concentration may result in lower ART response or shorter response duration

Optimizing Village-Level Targeting of Active Case Detection to Support Visceral Leishmaniasis Elimination in India.

Background: India has made major progress in improving control of visceral leishmaniasis (VL) in recent years, in part through shortening the time infectious patients remain untreated. Active case detection decreases the time from VL onset to diagnosis and treatment, but requires substantial human resources. Targeting approaches are therefore essential to feasibility. Methods: We analyzed data from the Kala-azar Management Information System (KAMIS), using village-level VL cases over specific time intervals to predict risk in subsequent years. We also graphed the time between cases in villages and examined how these patterns track with village-level risk of additional cases across the range of cumulative village case-loads. Finally, we assessed the trade-off between ACD effort and yield. Results: In 2013, only 9.3% of all villages reported VL cases; this proportion shrank to 3.9% in 2019. Newly affected villages as a percentage of all affected villages decreased from 54.3% in 2014 to 23.5% in 2019, as more surveillance data accumulated and overall VL incidence declined. The risk of additional cases in a village increased with increasing cumulative incidence, reaching approximately 90% in villages with 12 cases and 100% in villages with 45 cases, but the vast majority of villages had small cumulative case numbers. The time-to-next-case decreased with increasing case-load. Using a 3-year window (2016-2018), a threshold of seven VL cases at the village level selects 329 villages and yields 23% of cases reported in 2019, while a threshold of three cases selects 1,241 villages and yields 46% of cases reported in 2019. Using a 6-year window increases both effort and yield. Conclusion: Decisions on targeting must consider the trade-off between number of villages targeted and yield and will depend upon the operational efficiencies of existing programs and the feasibility of specific ACD approaches. The maintenance of a sensitive, comprehensive VL surveillance system will be crucial to preventing future VL resurgence

Development and Evaluation of Active Case Detection Methods to Support Visceral Leishmaniasis Elimination in India.

As India moves toward the elimination of visceral leishmaniasis (VL) as a public health problem, comprehensive timely case detection has become increasingly important, in order to reduce the period of infectivity and control outbreaks. During the 2000s, localized research studies suggested that a large percentage of VL cases were never reported in government data. However, assessments conducted from 2013 to 2015 indicated that 85% or more of confirmed cases were eventually captured and reported in surveillance data, albeit with significant delays before diagnosis. Based on methods developed during these assessments, the CARE India team evolved new strategies for active case detection (ACD), applicable at large scale while being sufficiently effective in reducing time to diagnosis. Active case searches are triggered by the report of a confirmed VL case, and comprise two major search mechanisms: 1) case identification based on the index case's knowledge of other known VL cases and searches in nearby houses (snowballing); and 2) sustained contact over time with a range of private providers, both formal and informal. Simultaneously, house-to-house searches were conducted in 142 villages of 47 blocks during this period. We analyzed data from 5030 VL patients reported in Bihar from January 2018 through July 2019. Of these 3033 were detected passively and 1997 via ACD (15 (0.8%) via house-to-house and 1982 (99.2%) by light touch ACD methods). We constructed multinomial logistic regression models comparing time intervals to diagnosis (30-59, 60-89 and ≥90 days with =90 days compared to the referent of <30 days for ACD vs PCD were 0.88, 0.56 and 0.42 respectively. These ACD strategies not only reduce time to diagnosis, and thus risk of transmission, but also ensure that there is a double check on the proportion of cases actually getting captured. Such a process can supplement passive case detection efforts that must go on, possibly perpetually, even after elimination as a public health problem is achieved

Development and Commercialization of CMS Pigeonpea Hybrids

The role of heterosis in enhancing productivity in food crops is well known. Legume breeders have not been able, however, to take advantage of this genetic phenomenon for a long time, due to biological restrictions, such as the requirement of high seeding rate and the inability to produce large quantities of F1 hybrid seed. Recently, in pigeonpea (Cajanus cajan (L.) Millsp.), a breakthrough has been realized with the development and marketing of the world’s first legume hybrid, ICPH 2671. The key for this achievement was breeding and using a stable cytoplasmic nuclear male sterility (CMS) system obtained from the cross between C. cajanifolius, a wild relative of pigeonpea, and the cultivated type. The inherent partial natural out‐crossing of pigeonpea was knitted with this CMS system to facilitate economically‐viable large‐scale hybrid seed production. These developments provided opportunities to overcome the historic stagnant low yield (0.6–0.8 t ha–1) through heterosis breeding. Among hundreds of hybrid combinations tested, a cross between ICPA 2043 and ICPL 87119 (=ICPR 2671), designated as ICPH 2671, was the most promising, with >40% yield superiority (reaching yields above 3 t ha–1) over the prevalent cultivar ‘Maruti’, in multi‐location, multi‐year, on‐station trials, as well as on‐farm evaluations. The outstanding performance of ICPH 2671 led to its release in 2010 as the first medium duration commercial pigeonpea hybrid in India. Subsequently, two additional pigeonpea hybrids, ICPH 3762 and ICPH 2740 were also released for commercial cultivation in India in 2014 and 2015, respectively. According to recent estimates, in 2015 the CMS‐based pigeonpea hybrids were grown over 150,000 hectares in central and southern India. In this review, we summarize the research efforts that led to the milestone of developing the first commercial hybrid in food legumes

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

A prospective study on surgical complication of peptic ulcer disease in tertiary care hospital

Introduction: Peptic ulcer disease indicates both gastric and duodenal ulcers. This ulcer is a major threat worldwide over the past two centuries with a high morbidity and mortality. Some epidemiological studies concluded that there is strongly association between H. Pylori infection and peptic ulcer. There is also some studies suggested that there is a complications that is seen after post operative peptic ulcer. Objective: To study the postoperative complication in peptic ulcer disease patients in tertiary care hospital. Material:&nbsp; A prospective study conducted on 180 post operative peptic ulcer patients. This study was conducted in Department of Surgery, ASJSATDS Medical College, Fatehpur. This study was carried out after taking approval from Institute Ethics Committee and informed consent from patient. Results: The present study was carried out on 180 post operative peptic ulcer patients, among them majority of the patients were males 116 (64.44%), age group under 41 to 50 years. As per the occupation, majority of the patients were employed 112 (62.22%) followed by studying 48 (26.66%) Total of 54 patients having ulcers in stomach as such 32 (59.25%) having multiple ulceration

T-cell receptor repertoire of circulating gamma delta t-cells in Takayasu's arteritis

We studied T-cell receptor (TCR) repertoire of circulating gamma delta ( &#947;&#948;) T-cells in 20 patients with Takayasu's arteritis (TA), 20 healthy controls (HC), 7 follow up TA patients, and 10 patients with rheumatoid arthritis (RA) and 5 Wegener's granulomatosis (WG) patients as disease controls. Patients with TA (8.1 &#177; 5.1%) compared to HC (3.7 &#177; 2.1%, P = 0.014), RA (4.8 &#177; 0.6%, P = 0.032), and WG (4.2 &#177; 0.8%, P = 0.030) as well as active TA compared to inactive TA (13.9 &#177; 4.1% vs. 4.9 &#177; 1.5%; P &lt; 0.001) had higher number of &#947;&#948; T-cells. The numbers of V&#948;1+ cells were significantly higher in patients with TA (40.0 &#177; 20.8%) than HC (13.1 &#177; 8.0%; P = 0.001), RA (19.5 &#177; 1.8%, P = 0.004), and WG (17.0 &#177; 3.9%, P = 0.007). The numbers of &#947;&#948; T-cells normalized in all the 7 patients after 180 days of follow up (13.9 &#177; 4.1% vs. 6.9 &#177; 2.5%; P = 0.001). We also observed higher number of activated and IFN-&#947; producing &#947;&#948; T-cells in active TA. Our data show that &#947;&#948; T-cells particularly those bearing Vd1 TCR may have an important role in the immunopathogenesis of TA