Verbal autopsy to assess causes of mortality among the economically productive age group in the tribal region of Melghat, central India.

Background & Objectives: Verbal autopsy (VA) is the systematic and retrospective inquiry (from relatives) about the symptoms of an illness prior to death. In tribal India, 67-75 per cent of deaths occur at home with an unknown cause of death (CoD). Hence, the aim of this study was to determine the CoD in the 16-60 yr age group utilizing VA. Methods: A prospective, community based longitudinal study was conducted in 32 tribal villages in the Melghat region of Maharashtra, between 2004 and 2020. Number of deaths and VAs in 16-60 yr age group were collected by village health workers (VHWs) and supervisors, verified by five different persons (internal-external) and cross-checked by three VA interpretation trained physicians. A modified version of WHO VA was used. Cause-specific mortality fractions were calculated. Results: Of the 1011 deaths recorded, mortality in males was significantly higher than females (P<0.001). A total of 763 VAs were conducted which revealed that tuberculosis was the leading CoD, followed by jaundice, heart diseases, diarrhoea, central nervous system infections and suicide. Suicides were significantly more common among males than in females (P=0.046). Significantly, more deaths occurred during the monsoon (P=0.002), especially diarrhoeal deaths (P=0.024). Interpretation & conclusions: The findings of this study suggest that, in Indian tribal areas, infectious diseases are the leading causes of morbidity and one of the major causes of deaths in economically productive age group. Intensified VHW-mediated interventions are required to reduce the premature deaths.

Enlargement of the Pancreas in Children Diagnosed with Acute Pancreatitis: An Approach Based on P/V Ratio.

Background Acute pancreatitis is a reversible inflammation of the pancreatic parenchyma. Enlargement of the pancreas is often envisaged in such conditions. This study evaluates P/V ratio, as a marker to decide pancreatic enlargement in disease condition. Purpose The aim of this study was to develop imaging-based diagnostic criterion for acute pancreatitis in children based on P/V ratio. Material and Methods This study included 37 children with acute pancreatitis and 283 children asymptomatic for pancreatic disorders, from a single hospital center. The age of children ranged between 2 and 18 years. P/V ratio, which is the ratio of greatest anteroposterior dimension of the head, body, and tail of the pancreas relative to the transverse lumbar vertebral body, was obtained for each child through ultrasonographic examination. Age-adjusted receiver operating characteristics (AROC) analysis was performed on P/V ratio at presentation for each pancreatic region, and the sensitivity at 90% specificity, the threshold errors, and the corresponding cutoffs were obtained. The enlargement assessment was also done after clinical recovery by referring to the cutoffs of respective regions. Results AROC analysis for males and females resulted into a maximum sensitivity of 83.33 and 81.67%, respectively, at 90% specificity for head. The error thresholds for both the groups were same, i.e., 0.098, indicating that 90% of the observations had errors less than the threshold. The corresponding P/V ratio cutoff for males and females was 0.43 and 0.42, respectively. Conclusion Radiologists and clinicians can refer a cutoff value of 0.4 for each region, along with hypoechogenicity, to decide about enlargement of the pancreas in acute pancreatitis condition.

Refractive prediction by various intraocular lens formulas using optical biometry and effect of ocular parameters on their accuracy.

PURPOSE: To assess the prediction accuracy of intraocular lens (IOL) formulas and study the effect of axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), and lens thickness (LT) on the accuracy of formulas using optic biometry. METHODS: This study was performed on 164 eyes of 164 patients who underwent uneventful cataract surgery. Ocular biometry values were measured using Lenstar-900, and intraocular lens (IOL) power was calculated using the SRK/T, SRK II, Hoffer Q, Holladay 2, and Barrett Universal II formulas. We evaluated the extent of bias within each formula for different ocular biometric measurements and explored the relationship between the prediction error and the ocular parameters by using various IOL formulas. RESULTS: The summarization of refractive prediction error and absolute prediction error for each IOL formulation was performed after adjusting the mean refractive error to zero. The deviation in the error values was minimum for SRK/T (0.265) followed by Holladay 2 (0.327) and Barret (0.382). Further, SRK/T had the lowest median (0.15) and mean (0.198) absolute error as compared to other formulations. For the above formulations, 100% of the eyes were in the diopter range of ±1.0. It was observed that the overall distribution of error was closer to zero for SRK/T, followed by Holladay 2 and then Barrett. CONCLUSION: In summary, we found that accuracy was better in SRK/T formula. We achieved a better understanding of how each variable in the formulas is relatively weighed and the influencing factors in the refraction prediction.

Expression of serum proteins in noise induced hearing loss workers of mining based industry.

Noise Induced Hearing Loss (NIHL) is caused by excessive noise exposure due to occupational activities thus affects communication and quality of life. Prolonged occupational and environmental exposure to loud noise damages key molecules present in the micro-machinery of the ear which are required for the mechano-electrical transduction of sound waves in cochlea. Specific proteins are known to be associated with hearing loss and related structural and functional disabilities in the human inner, outer hair cells and cochlea. Rationale of this study was to identify the cochlear proteins associated with the pathophysiology of NIHL using proteomic approaches in mining based industrial workers. Total (n = 210) samples were collected from mining based industrial workers of central India. Subjects were categorized based on audiometric analysis. Proteome changes of the host serum were investigated using one and two-dimensional electrophoresis in combination with LC-MS/MS and MALDI-TOF-MS. Up-regulated 46 cochlear proteins among confirmed NIHL cases were identified by MASCOT. Shrinkage discriminant analysis provided top 25 discriminating feature proteins namely myosin, transthyretin, SERPIN, CCDC50, enkurin, transferin etc. The identified potential proteins may be used as biomarkers for early detection and to understand the pathogenic mechanism of NIHL. Evaluation of these biomarkers in follow-up cases may further aid in improving NIHL diagnosis. SIGNIFICANCE: Human proteome study in Noise Induced Hearing Loss (NIHL) cases has not been published till date. This study represents most comprehensive proteomic analysis in NIHL cases taken from Indian mine workers. The identified key twenty-five discriminating feature proteins which are upregulated when an individual develops (or is in stage of development of) NIHL, provides insights into the potential roles of these varied proteins in disease progression. The proteins thus identified by proteomic approach may be used as early diagnostic biomarker to predict the occurrence of disease at very early stage.

Can We Predict Severity of Osteoarthritis of Knees and Compartmental Involvement Based on a Set of Predefined Clinical Questions in Patients of Knee Pain?

BACKGROUND: We investigated whether the severity of Osteoarthritis (OA) knees can be predicted based on a set of predefined clinical questions (PCQs) about activities of daily living (ADL). We studied the association of demographic factors and advanced radiographic OA (KL 3 and 4) and the relationship between various physical activities and radiographic involvement of knee joint compartments based on PCQs. MATERIALS AND METHODS: Demographic data, radiographic grading of knee OA and PCQs score, were obtained prospectively. Patients' responses to PCQs were marked as scores-that were predefined and graded according to the severity of knee pain. Radiographic knee OA grades were dichotomized and patients were classified as either negative (KL grade 1, 2) or positive (KL grade 3, 4). Multivariate logistic regression was performed to obtain the adjusted odds for total PCQs score in relation with positive radiographic OA considering confounders like age, gender and BMI in the model. Log odds score (LOS) were obtained and ROC analysis was performed on scores to obtain the cut-off value for the screening of knee OA in patients of knee pain. RESULTS: Age and BMI were significantly negatively correlated with PCQs score (r = - 0.473; P < 0.0001 and r = - 0.136; P = 0.046). PCQs scores were significantly lower in females (P = 0.031). Total PCQs score had corresponding OR of 0.901 (P = 0.002) towards knee OA after adjusting for age, gender and BMI. Multivariate model-based LOS resulted in a cut-off of 1.315, which had a sensitivity of 85.5%, specificity of 66.7% and PPV of 92.7%. CONCLUSION: Severity of knee OA can be predicted based on PCQs. PCQs can predict severity of knee OA and patellofemoral or medial tibiofemoral compartment without radiographs. LOS based on demographics and total PCQs score can be developed as a screening tool for advanced knee OA.

Internal limiting membrane peel: Does it change the success rate of primary vitrectomy without belt buckle in rhegmatogenous retinal detachments?

Purpose: To compare the anatomic success of pars plana vitrectomy (PPV) after internal limiting membrane (ILM) peeling at macular area and macular plus peripapillary area versus no peeling in rhegmatogenous retinal detachments (RRD). Methods: A prospective observational study between July 2014 and March 2017 conducted on 289 eyes of 287 patients with RRD were randomly assigned to three treatment procedures, viz., PPV with no ILM peeling, PPV with macular peeling, and PPV with macular plus peripapillary peeling. Recurrent RD (ReRD) was treated as an event and accordingly the overall primary (PS) and final success (FS) rates were obtained. The risk of ReRD associated with peeling procedures after adjusting for risk factors were obtained using Cox-proportional hazard analysis. Results: The PS percentage for no peel, macular, and macular plus peripapillary procedures were 77.78% (70/90), 82.18% (83/101), and 94.89% (93/98; maximum), respectively, which was statistically significant with a P value of 0.003. The FS percentage for no peel, macular, and macular plus peripapillary were 93.33%, 95.04%, and 100%, respectively, which was significantly different with a P value of 0.048. With reference to no peeling, the adjusted hazard ratio for macular peeling was 0.841 [95% CI: 0.44-1.60] while 0.235 [95% CI: 0.088-0.626] for macular plus peripapillary peeling. Conclusion: The anatomic success rate of PPV with macular plus peripapillary ILM peeling was significantly higher as compared to no peel category. The hazard of ReRD in patients undergoing macular plus peripapillary peel was significantly reduced as compared to no peel procedure.

Linear discriminant score for differentiating early primary open angle glaucoma from glaucoma suspects.

PURPOSE: To determine the diagnostic accuracy of a linear discriminant function (LDF) based on macular ganglion cell complex (GCC), optic nerve head (ONH) and retinal nerve fibre layer (RNFL) for differentiating early primary open-angle glaucoma (POAG) from glaucoma suspects. METHODS: In this cross-sectional study, data from consecutive 127 glaucoma suspects and 74 early POAG eyes were analysed. Each patient underwent detailed ocular examination, standard automated perimetry, GCC and ONH and RNFL analysis. After adjusting for age, gender and signal strength using the analysis of covariance; Benjamin-Hochberg multiple testing correction was performed to detect truly significant parameters to calculate the LDF. Subsequently, diagnostic accuracy of GCC and ONH and RNFL were determined. The obtained LDF score was evaluated for diagnostic accuracy in another test set of 32 suspect and 19 glaucomatous eyes. Data were analysed with the R-3.2.1 (R Core Team 2015), analysis of variance, t-test, Chi-square test and receiver operating curve. RESULTS: Among all GCC parameters, infero temporal had the best discriminating power and average RNFL thickness and vertical CDR among ONH and RNFL parameters. LDF scores for GCC had AUROC of 0.809 for a cut-off value 0.07, while scores for ONH and RNFL had AUROC of 0.903 for a cut-off value - 0.24. Analysis on combined parametric space resulted in avg RNFL thickness, vertical CDR, min GCC + IPL and superior GCC + IPL as key parameters. LDF scores obtained had AUROC of 0.924 for a cut-off value 0.1. The LDF was applied to a test set with an accuracy of 84.31%. CONCLUSION: The LDF had a better accuracy than individual GCC and ONH and RNFL parameters and can be used for diagnosis of glaucoma.

Percentile reference curves for normal pancreatic dimensions in Indian children.

OBJECTIVES: This study aims at determining the normal pancreatic dimensions in pediatric age groups considering demographic parameters and thus developing percentile reference curves for normal pancreatic dimensions in Indian children. SETTING AND DESIGN: It is a cross-sectional study. MATERIALS AND METHODS: A hospital-based cross-sectional study was planned at a children hospital during July 2016-December 2017, in which the pancreatic dimensions of 1078 normal children in the age range of 1 month to 19 years were obtained through abdominal ultrasonography (USG). The demographic details like age and gender were obtained for each child. STATISTICAL ANALYSIS USED: Percentile reference curves were obtained with reference to age for each gender type independently. Generalized additive models for location, scale, and shape were used to obtain percentile plots for each pancreatic part. RESULTS: The mean age of children was 6.65 ± 4.43 years and the male-to-female ratio was 1.63:1. The head, body, and tail dimensions increased with the age. For head, up to 25th percentile, the curves were similar for both genders, while subsequent curves were higher in males as compared to females. Similar was the observation for body of pancreas. For tail, up to 75th percentile, the curves were similar for both genders. CONCLUSION: The normal ranges can be supportive in diagnosis of illness related to pancreas. The dimensions within 5-95th percentile along with iso-echogenicity can be regarded as normal, while the dimensions beyond these limits along with change of echogenicity can be suspected for pancreatic disorders.

Incidence and Clinical Outcome of Patients with Hypertensive Acute Ischemic Stroke: An Update from Tertiary Care Center of Central India.

INTRODUCTION: We evaluated the incidence and clinical outcome of patients with hypertensive acute ischemic stroke (AIS) admitted to a tertiary care center in Central India. In addition, we examined the status of stroke biomarkers namely neuron-specific enolase (NSE), glial specific protein (S-100ßß), and inter-α-trypsin inhibitor heavy chain 4(ITIH4) in the serum of patients suffering from AIS with hypertension (HTN) and without HTN. METHODS: A total of 104 patients with AIS were enrolled for the study. Clinical outcome and stroke biomarker levels were evaluated in them at the time of hospital discharge and then followed at 12 months and 18 months after hospital discharge. RESULTS: HTN is a major risk factor associated with 67%(70.104) of patients with AIS. Multivariate analysis suggests higher odds of 4.088(95%Cl, 0.721-23.179) and 2.437(95%Cl, 0.721-23.179) for 12 and 18 months outcome in patients with AIS and HTN, respectively. Serum NSE and S-100ßß decreased at the time of discharge as compared to admission level in improved patients suffering from AIS with or without HTN, whereas levels of ITIH4 peptides 2 and 7 increased at the time of discharge (compared to its admission level) only in improved patients with AIS regardless of HTN or non-HTN condition. CONCLUSION: HTN is one of the major risk factors associated with higher risk of AIS as well as long-term unfavourable outcome after AIS in Central India region. NSE, S-100ßß, and ITIH4 were found to be independent predictors of outcome in patients with AIS irrespective of HTN and non-HTN condition.

Prediction of Outcome in Diabetic Acute Ischemic Stroke Patients: A Hospital-Based Pilot Study Report.

BACKGROUND: Demographic and clinical characteristics are known to influence the outcome in acute ischemic stroke (AIS) patients. PURPOSE: This study is aimed at evaluating short- and long-term outcomes in diabetic AIS patients. In addition, the study also evaluates the impact of diabetes on the performance of indigenously reported biomarker, inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and known biomarkers, neuron-specific enolase (NSE) and glial-derived S-100 beta beta protein (S-100ßß). METHODS: This study was performed on 29 diabetes and 75 non-diabetes AIS patients. Outcome of AIS patients was analyzed by using modified Rankin scale at discharge, then at 12 and 18 months after discharge. Based on the obtained scores, patients were classified as improved group (scales 1-3) and dependent/expired group (scales 3-6). Blood samples were collected during admission and at discharge/expired time. Levels of NSE, S100ßß, and ITIH4 were analyzed in all samples. RESULTS: On discharge, frequencies of dependent/expired outcome were 4/29 (14%) and 19/75 (17%) in diabetic and non-diabetic AIS patients. However, follow-up outcome at 12 and 18 months showed higher dependent/expired cases of 43 and 41% among diabetic AIS patients compared to 27 and 21% in non-diabetic patients. Multivariate analysis revealed that diabetes is an independent risk factor for dependent/expired outcome in AIS patients (OR 0.484 (at discharge); 1.307 (at 12 months) and 1.675 (at 18 months)). NSE, S100ßß, and ITIH4 showed a differential expression in both the outcome groups of AIS patients, irrespective of diabetes. CONCLUSION: Diabetes increases the risk of dependent/expired outcome in AIS patients. Also, serum NSE, S100ßß, and ITIH4 are independent biomarkers for prognosis of outcome in AIS patients, irrespective of diabetes.

Impact of socioeconomic status and living condition on latent tuberculosis diagnosis among the tribal population of Melghat: A cohort study.

AIMS: To study socioeconomic status (SES) and living conditions (LC) as risk factors for latent tuberculosis infection (LTBI) and their impact on QuantiFERON-TB gold (QFT-G) and tuberculin skin test (TST) outcome for determining a better diagnostic test for LTBI in the malnourished tribal population of Melghat. SETTINGS AND DESIGN: Six hundred sixty nine participants matching the inclusion criteria were recruited from 10 tribal villages of Melghat region, India. SUBJECTS AND METHODS: Complete information related to various risk factors and test outcome was obtained on 398 participants, which was analyzed as per predefined conceptual framework. Factors were classified based on their relevance either at individual or household level, and subsequently based on the possibility of intervention. Data were partitioned into concordant and discordant sets depending on test agreement. RESULTS: In concordant set, the two tests revealed that LTBI was significantly associated with smoking (adjusted odds ratio [aOR]: 2.64 [95% confidence interval [CI]: 1.03-6.79]), tobacco usage (aOR: 2.74 [95% CI: 1.50-4.99]), and malnourishment (aOR: 1.97 [95% CI: 1.12-3.48]) after basic adjustment. Inclusion of latent variable SES and LC in the model has mediating effect on the association of above factors with LTBI. Further, the association of SES and LC with LTBI in concordant set was unaltered in presence of other cofactors. From discordant set, results of QFT-G corroborated with that of concordant set. CONCLUSIONS: Poor SES and LC can be considered as strong risk factors linked with LTBI as compared to malnourishment, which is often targeted in such communities. Further, our study showed QFT-G test as a reliable tool in screening of LTBI in the tribal population of Melghat, India.

The effect of a high-roughage diet on the metabolism of aromatic compounds by rumen microbes: a metagenomic study using Mehsani buffalo (Bubalus bubalis).

In developing countries, livestock are often fed a high-lignin, low-nutrient diet that is rich in aromatic compounds. It is therefore important to understand the structure of the microbial community responsible for the metabolism of these substances. A metagenomic analysis was therefore carried out to assess the microbial communities associated with the liquid and solid fractions of rumen biomaterial from domestic Mehsani buffalo (Bubalus bubalis) fed with varying proportions of roughage. The experimental design consisted of three feeding regimes (50, 75 and 100 % roughage) and two roughage types (green and dry). Genes associated with aromatic compound degradation were assessed via high-throughput DNA sequencing. A total of 3914.94 Mb data were generated from all treatment groups. Genes coding for functional responses associated with aromatic compound metabolism were more prevalent in the liquid fraction of rumen samples than solid fractions. Statistically significant differences (p < 0.05) were also observed between treatment groups. These differences were dependent on the proportion of roughage fed to the animal, with the type of roughage having little effect. The genes present in the highest abundance in all treatment groups were those related to aromatic compound catabolism. At the phylum level, Bacteroidetes were dominant in all treatments closely followed by the Firmicutes. This study demonstrates the use of feed type to selectively enrich microbial communities capable of metabolizing aromatic compounds in the rumen of domestic buffalo. The results may help to improve nutrient utilization efficiency in livestock and are thus of interest to farming industries, particularly in developing countries, worldwide.

Comparative evaluation of risk factors, outcome and biomarker levels in young and old acute ischemic stroke patients.

BACKGROUND: Stroke is the third leading cause of death and disability worldwide accounting for 400-800 strokes per 100,000 individuals each year. PURPOSE: In the present study, we compared risk factors, clinical outcome, and prognostic biomarkers NSE, S-100 ßß and ITIH4 levels in young and old acute ischemic stroke (AIS) patients. METHODS: We compared the risk factors and clinical outcomes in young (n = 38) and old (n = 66) AIS patients admitted to tertiary health care centre in Central India. In addition, we also evaluated NSE, S100ßß & ITIH4 levels in admission and discharge samples of young and old AIS patients with different clinical outcome. RESULTS: Hypertension was a major risk factor in 45% of young and 80% of old AIS patients. Hospital outcome was less favorable in young AIS patients with higher dependent rates of 24% as compared to 12% in old AIS patients. Whereas long term outcome at 12 and 18 months after discharge was more favorable in young AIS patients with low dependency rates of 16% and 11% as compared to 41% and 24% in older AIS patients respectively. Similarly, serum NSE, S100ßß and ITIH4 levels showed a distinct pattern of expression at discharge time in AIS patients with improved and dependent outcome in both the age groups. CONCLUSION: Young males with hypertension and smoking habits are at a high risk of AIS while old AIS patients are at a greater risk of worse long term outcome. Serum levels of NSE and S100ßß are independent predictors of outcome in AIS patients. Similarly, it also suggests that serum ITIH4 levels could be used as a potential biomarker for predicting the outcome in AIS patients.

Latent TB infection diagnosis in population exposed to TB subjects in close and poor ventilated high TB endemic zone in India.

BACKGROUND: The present study was designed to investigate the utility of Quantiferon TB gold (QFT-G) and Tuberculin skin test (TST) for diagnosis of latent TB infection (LTBI) in high crowding TB endemic zone of Nagpur, India and their comparison with associated risk factors. METHODS: Out of 342 eligible participants, QFT-G and TST were performed in 162 participants. RESULTS: The prevalence of LTBI observed according to QFT-G and TST was 48% and 42% respectively, with an agreement of 52.47%. QFT-G positivity was associated with age while TST positivity was associated with body mass index (BMI). Duration of exposure emerged as a key risk factor significantly associated with both the tests. CONCLUSION: The prevalence of LTBI was quite high in the studied zone as detected by both the evaluated tests and thus, the combination of both the tests will be best predictive for LTBI in such high TB endemic regions.

Demonstration of sequential adaptation strategy for developing salt tolerance in bacteria for wastewater treatment: a study using Escherichia coli as model.

A wastewater isolate identified as Escherichia coli HPC781 was adapted for high salt concentration through sequential transfers in Luria Broth (LB). The cells were grown in LB with 5% sodium chloride (NaCl) and were analyzed for the acquired salt resistance network through gene expression profiles. Microarray studies revealed TCA, glyoxylate shunt and acetyl Co-A metabolism as key nodes for stress combat to arrive at compromised physiology. It also proposed that the cells were receiving signals from salt environment via OmpR-EnvZ two component systems and stress dependent general regulatory protein rpoH and rpoE. The salt adapted culture, when challenged with wastewater having additional 5% salt showed growth. The work represents a tactic to adjust biochemical network towards stress and reveals its applicability via real-time PCR measurement of genes in wastewater. The study proposes that the recycled biomass with an adaptation strategy could be applied for treatment of wastewater with high salt levels.

SATB1-binding sequences and Alu-like motifs define a unique chromatin context in the vicinity of human immunodeficiency virus type 1 integration sites.

Retroviral integration has recently been shown to be nonrandom, favoring transcriptionally active regions of chromatin. However, the mechanism for integration site selection by retroviruses is not clear. We show here the occurrence of Alu-like motifs in the sequences flanking the reported viral integration sites that are significantly different from those obtained from the randomly picked sequences from the human genome, suggesting that unique primary sequence features exist in the genomic regions targeted by human immunodeficiency virus type 1 (HIV-1). Additionally, these sequences were preferentially bound by SATB1, the T lineage-restricted chromatin organizer, in vitro and in vivo. Alu repeats make up nearly 10% of the human genome and have been implicated in the regulation of transcription. To specifically isolate sequences flanking the viral integration sites and also harboring both Alu-like repeats and SATB1-binding sites, we combined chromatin immunoprecipitation with sequential PCRs. The cloned sequences flanking HIV-1 integration sites were specifically immunoprecipitated and amplified from the pool of anti-SATB1-immunoprecipitated genomic DNA fragments isolated from HIV-1 NL4.3-infected Jurkat T-cell chromatin. Moreover, many of these sequences were preferentially partitioned in the DNA associated tightly with the nuclear matrix and not in the chromatin loops. Strikingly, many of these regions were disfavored for integration when SATB1 was silenced, providing unequivocal evidence for its role in HIV-1 integration site selection. We propose that definitive sequence features such as the Alu-like motifs and SATB1-binding sites provide a unique chromatin context in vivo which is preferentially targeted by the HIV-1 integration machinery.