Prevalence of Coronary Artery Disease in Asymptomatic type 2 Diabetes Mellitus Patients with Invasive Correlation in North India.

Introduction: Type 2 diabetes mellitus (T2DM) is the risk factor for coronary artery disease (CAD). Material and Methods: In this study, we assessed the prevalence of CAD in asymptomatic T2DM patients and its correlation with invasive testing in treadmill testing (TMT)-positive cases. A total of 90 patients with asymptomatic T2DM were recruited and subjected to TMT TMT-positive patients were subjected to coronary angiography (CAG). Results: At baseline, the mean duration of T2DM (years) was 4.87 ± 4.04 with mean levels of HbA1c (%) of 7.96 ± 1.02. TMT was positive in 28 patients (31.1%) for reversible myocardial ischaemia (RMI), and among them, 16 patients consented to CAG, of which 14 required coronary angioplasty and the remaining two (7.1%) had to undergo coronary artery bypass grafting (CABG). The remaining 12 TMT positives (42.9%) were managed medically. Conclusion: To conclude, there is a high prevalence of silent CAD in T2DM. They need regular screening to detect the same and prevent the morbidity and mortality associated with overt CAD. Hence, it is important to screen people with type 2 diabetes, to prevent the morbidity and mortality associated with overt CAD.

Genotyping-by-Sequencing Based Investigation of Population Structure and Genome Wide Association Studies for Seven Agronomically Important Traits in a Set of 346 Oryza rufipogon Accessions.

Being one of the most important staple dietary constituents globally, genetic enhancement of cultivated rice for yield, agronomically important traits is of substantial importance. Even though the climatic factors and crop management practices impact complex traits like yield immensely, the contribution of variation by underlying genetic factors surpasses them all. Previous studies have highlighted the importance of utilizing exotic germplasm, landraces in enhancing the diversity of gene pool, leading to better selections and thus superior cultivars. Thus, to fully exploit the potential of progenitor of Asian cultivated rice for productivity related traits, genome wide association study (GWAS) for seven agronomically important traits was conducted on a panel of 346 O. rufipogon accessions using a set of 15,083 high-quality single nucleotide polymorphic markers. The phenotypic data analysis indicated large continuous variation for all the traits under study, with a significant negative correlation observed between grain parameters and agronomic parameters like plant height, culm thickness. The presence of 74.28% admixtures in the panel as revealed by investigating population structure indicated the panel to be very poorly genetically differentiated, with rapid LD decay. The genome-wide association analyses revealed a total of 47 strong MTAs with 19 SNPs located in/close to previously reported QTL/genic regions providing a positive analytic proof for our studies. The allelic differences of significant MTAs were found to be statistically significant at 34 genomic regions. A total of 51 O. rufipogon accessions harboured combination of superior alleles and thus serve as potential candidates for accelerating rice breeding programs. The present study identified 27 novel SNPs to be significantly associated with different traits. Allelic differences between cultivated and wild rice at significant MTAs determined superior alleles to be absent at 12 positions implying substantial scope of improvement by their targeted introgression into cultivars. Introgression of novel significant genomic regions into breeder's pool would broaden the genetic base of cultivated rice, thus making the crop more resilient.

First report of Uromyces rumicis on Rumex crispus in Canada.

Rumex crispus L. (curled dock) is a noxious weed in both grasslands (mainly pastures) and arable lands, but is also an early colonizer of many disturbed areas in lowland and upland regions. Rumex crispus is of agricultural significance because it competes with sown or native pasture and crops species and occupies areas that could be utilized by more palatable crop species. Rumex crispus can grow on almost all soil types but less often on peat and acidic soils. The range of altitude to which the species has become adapted varies from sea level to 3,500 m (Zaller 2004). This plant species has Eurasian origin and is widely distributed through temperate regions of North America as an introduced species. There is no previous rust report on R. crispus in Canada. On other Rumex species two Puccinia species viz. Puccinia acetosae (Schumach.) Körn., and P. ornata Arthur & Holw., have been previously reported from Canada (Farr & Rossman 2022). During the recent field survey from southern British Columbia, Langley, heavily rust infected leaves of R. crispus were observed. Uredinia and telia were present on both sides of the leaf mainly on the lower side. Uredinia early exposed, brown, and pulverulent. Urediniospores were obovoid, ellipsoid or oblong, measuring 20-28 × 17-23 µm. Urediniospore walls are yellowish brown to brown, 1.5-2 µm thick; covered in evenly distributed echinulae, spaced 2 to 3 µm apart, with smooth (non-echinulate) patches at the equator of the urediniospores. Urediniospores with 2- (mostly 3 and less often 2) germ pores, usually supraequatorial (at the upper part of the spore), or distributed irregularly (scattered), or 2 germ pores supraequatorial, one equatorial or all germ pores equatorial, germ pores covered with flat papilla. Telia similar to the uredinia, dark brown. Teliospores more or less globoid, ellipsoid, broadly ellipsoid, obovoid or oblong, 25--36 × 15-23 µm, brownish yellow to brown, smooth, 2-3 um thick, with apical or sup-apical germ pore, covered with a hemispherical, yellowish papilla, pedicels colorless, short. The above-mentioned characters fit Majewski's (1977) description for Uromyces rumicis (Schumach.) G. Winter. To confirm identity, the first 903 bp of the 5' end of the 28S rDNA of the above specimen was amplified following protocols of Aime (2006) and Aime et al. (2018) (GenBank accession no. ON166844). BLAST queries of the sequence shared 99.56% identity (900/903) with U. rumicis (GenBank accession no. KY764197). To our knowledge this is the first report of U. rumicis from Canada (Farr and Rossma 2022). There is only one previous published report of this rust species in North America made by French (1989) who reported U. rumicis on R. crispus from California. Uromyces rumicis is quite common on Rumex species including R. crispus in Eurasia and has also been reported on this host from Africa (Farr and Rossman 2022). It appears that the above rust fungus species may have been introduced to the North America by accompanying its host plant. A voucher specimen of infected R. crispus with U. rumicis was deposited at Arthur Fungarium (PUR) under the accession number PUR N24014. Uromyces rumicis is a heteromacrocyclic rust with aecial state on Ranunculaceae members especially Ranunculus ficaria L. This species is another introduced plant in North America. However, there is no report of the aecial state of this rust in North America to date. Existence of only two reports of U. rumicis in California and British Columbia, making it likely that U. rumicis became established in the West Coast of North America probably no earlier than the second half of the 20th century.

Knowledge, Awareness, and Practices (KAP) towards COVID-19 among the marine fishers of Maharashtra State of India: An online cross-sectional Analysis.

The knowledge, awareness, and practices (KAP) about COVID-19 among the marine fishers who are engaged in the high-risk occupations and depend on the vulnerable sources of income in the Maharashtra state of India, were investigated to understand the behavioral changes and vulnerability among the respondents because of COVID-19. Data were collected through an online survey from 1st July to 30th July 2020 during the first peak of COVID-19 in the study area by using the questionnaire. Authors based on the latest recommendations by the World Health Organization (WHO) developed the questionnaire and covered the KAP aspects under study. The questionnaire was administered through Google form link and the link was disseminated through social media such as Facebook and What's App. The completed responses (n = 533) received from the eligible sample, excluding those outsides of the fisher community and duplicate entries were considered for analysis. Appropriate statistical tools were used to analyze the data. Among the respondents, 447 men (83.86%) and 86 women (16.14%), with a mean age of 45.4 years (M = 45.4, SD = 1.18). The results revealed that 70.92% of respondents perceived a low risk of infection because of COVID-19 with M = 1.77 and SD = 0.583, but authors found the perceived severity score high (M = 3.95, SD = 1.21) among the 60.97% of respondents. Around 95% of respondents were aware of the COVID-19, while almost all respondents knew the medium of infection and symptoms of COVID-19. The behavior of respondents towards COVID-19 infection was positive and was following sufficient precautionary measures suggested by WHO to protect themselves from COVID-19 infection. The results of multiple regression analysis revealed that the demographic features of respondents like age, education were significantly contributing to the KAP of the fisher community. The results confirmed the importance of KAP which is reflected in the behavioral responses of the fishers while tackling the COVID-19 pandemic situation. The results regarding the risk perception, severity, KAP about COVID-19 provide a collective understanding of the emerging infectious disease among the marine fishers of Maharashtra state of India.

Lessons from SARS-CoV-2 Pandemic: Evolution, Disease Dynamics and Future.

The COVID-19 pandemic is rising at an unprecedented rate. The surging number of deaths every day, global lockdown and travel restrictions have resulted in huge losses to society. The impact is massive and will leave a historical footprint. The Spanish Flu of 1918, which was the last pandemic that had a similar impact, was shadowed under the consequences of World War I. All the brilliance, strength and economies of countries worldwide are aimed at fighting the COVID-19 pandemic. The knowledge about coronavirus dynamics, its nature and epidemiology are expanding every day. The present review aims to summarize the structure, epidemiology, symptoms, statistical status of the disease status, intervention strategies and deliberates the lessons learnt during the pandemic. The intervention approaches, antiviral drug repurposing and vaccine trials are intensified now. Statistical interpretations of disease dynamics and their projections may help the decision-makers.

Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey.

INTRODUCTION: Coronavirus disease pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19. METHODS: Online questionnaire was prepared in accordance with the Center for Disease Control recommendations to assess preparedness of hospitals for COVID-19. The questionnaire was circulated to the over 800 doctors across the nation, who are the life members of six medical societies. RESULTS: We obtained 131 completed responses from all seven provinces. Majority of respondents had anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that their hospital had policy to receive suspected or proven cases with COVID-19. Presence of isolation ward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presence of airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124 (94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of 42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6 (4.6%) respondents. CONCLUSIONS: It is apparent that most of the hospitals are not well prepared for management of patients with COVID-19. Resource allocation and policy making should be aimed to enhance national preparedness for the pandemic.

Comparative analysis of chromosome 2A molecular organization in diploid and hexaploid wheat.

Diploid A genome wheat species harbor immense genetic variability which has been targeted and proven useful in wheat improvement. Development and deployment of sequence-based markers has opened avenues for comparative analysis, gene transfer and marker assisted selection (MAS) using high throughput cost effective genotyping techniques. Chromosome 2A of wheat is known to harbor several economically important genes. The present study aimed at identification of genic sequences corresponding to full length cDNAs and mining of SSRs and ISBPs from 2A draft sequence assembly of hexaploid wheat cv. Chinese Spring for marker development. In total, 1029 primer pairs including 478 gene derived, 501 SSRs and 50 ISBPs were amplified in diploid A genome species Triticum monococcum and T. boeoticum identifying 221 polymorphic loci. Out of these, 119 markers were mapped onto a pre-existing chromosome 2A genetic map consisting of 42 mapped markers. The enriched genetic map constituted 161 mapped markers with final map length of 549.6 cM. Further, 2A genetic map of T. monococcum was anchored to the physical map of 2A of cv. Chinese Spring which revealed several rearrangements between the two species. The present study generated a highly saturated genetic map of 2A and physical anchoring of genetically mapped markers revealed a complex genetic architecture of chromosome 2A that needs to be investigated further.

Revealing the Role of Structural Features in Bulk Mechanical Performance of Ternary Molecular Solids of Isoniazid.

Mechanical performance in ternary (3n) molecular solids has been rarely studied, and hence it is an interesting topic of investigation in the direct compression method of tableting. The structural features of 3n-eutectic (3n-Eu: INZ-ADP-NIC) and 3n-cocrystal (3n-Co: INZ:SUC:NIC) were explored to understand the bonding area-bonding strength (BA-BS) interplay. Higher compressibility and lower values of the Heckel parameter of 3n-Co as compared to 3n-Eu suggested its better deformation behavior, with BA being the predominant factor. The higher tensile strength and Walker analysis indicated a higher compressibility coefficient ( W) and lower pressing modulus ( L) for 3n-Eu, which was consistent with its better tabletability over 3n-Co. The higher compressibility and plastic energy, and higher value of L of 3n-Co, were attributed to the facile propagation (⟨-1' 0' 5'⟩) of the shearing molecular slip (-1 0 5) when subjected to the external mechanical stress. Thus, the overall higher tableting performance of 3n-Eu over 3n-Co was found due to the predominant BS and limited contribution of BA. The latter was the dominant factor in 3n-Co. Cohesive interactions, like the 3D mechanically interlocked structure of conglomerates of 3n-Eu, contributed toward the higher BS. Moreover, the prediction of better tabletability solely based on crystallographic feature slip planes (0D/1D/2D H-bonded layer (h k l) ⊥ vdW interactions) is warranted in pharmaceutical molecular solids. Eutectics with varying microstructural variants ( nLα + nLß + nLγ) may open up the opportunity to manipulate the physicomechanical performance.

Mapping of stripe rust resistance gene in an Aegilops caudate introgression line in wheat and its genetic association with leaf rust resistance.

A pair of stripe rust and leaf rust resistance genes was introgressed from Aegilops caudata, a nonprogenitor diploid species with the CC genome, to cultivated wheat. Inheritance and genetic mapping of stripe rust resistance gene in backcrossrecombinant inbred line (BC-RIL) population derived from the cross of a wheat-Ae. caudata introgression line (IL) T291- 2(pau16060) with wheat cv. PBW343 is reported here. Segregation of BC-RILs for stripe rust resistance depicted a single major gene conditioning adult plant resistance (APR) with stripe rust reaction varying from TR-20MS in resistant RILs signifying the presence of some minor genes as well. Genetic association with leaf rust resistance revealed that two genes are located at a recombination distance of 13%. IL T291-2 had earlier been reported to carry introgressions on wheat chromosomes 2D, 3D, 4D, 5D, 6D and 7D. Genetic mapping indicated the introgression of stripe rust resistance gene on wheat chromosome 5DS in the region carrying leaf rust resistance gene LrAc, but as an independent introgression. Simple sequence repeat (SSR) and sequence-tagged site (STS) markers designed from the survey sequence data of 5DS enriched the target region harbouring stripe and leaf rust resistance genes. Stripe rust resistance locus, temporarily designated as YrAc, mapped at the distal most end of 5DS linked with a group of four colocated SSRs and two resistance gene analogue (RGA)-STS markers at a distance of 5.3 cM. LrAc mapped at a distance of 9.0 cM from the YrAc and at 2.8 cM from RGA-STS marker Ta5DS_2737450, YrAc and LrAc appear to be the candidate genes for marker-assisted enrichment of the wheat gene pool for rust resistance.

Use of WONCA global standards to evaluate family medicine postgraduate education for curriculum development and review in Nepal and Myanmar.

Family medicine is an integral part of primary care within health systems. Globally, training programmes exhibit a great degree of variability in content and skill acquisition. While this may in part reflect the needs of a given setting, there exists standard criteria that all family medicine programmes should consider core activities. WONCA has provided an open-access list of standards that their expert community considers essential for family medicine (GP) post-graduate training. Evaluation of developing or existing training programmes using these standards can provide insight into the degree of variability, gaps within programmes and equally as important, gaps within recommendations. In collaboration with the host institution, two family medicine programmes in Nepal and Myanmar were evaluated based on WONCA global standards. The results of the evaluation demonstrated that such a process can allow for critical review of curriculum in various stages of development and evaluation. The implications of reviewing training programmes according to WONCA standards can lead to enhanced training world-wide and standardisation of training for post-graduate family medicine.

Gatifloxacin versus ceftriaxone for uncomplicated enteric fever in Nepal: an open-label, two-centre, randomised controlled trial.

BACKGROUND: Because treatment with third-generation cephalosporins is associated with slow clinical improvement and high relapse burden for enteric fever, whereas the fluoroquinolone gatifloxacin is associated with rapid fever clearance and low relapse burden, we postulated that gatifloxacin would be superior to the cephalosporin ceftriaxone in treating enteric fever. METHODS: We did an open-label, randomised, controlled, superiority trial at two hospitals in the Kathmandu valley, Nepal. Eligible participants were children (aged 2-13 years) and adult (aged 14-45 years) with criteria for suspected enteric fever (body temperature ≥38·0°C for ≥4 days without a focus of infection). We randomly assigned eligible patients (1:1) without stratification to 7 days of either oral gatifloxacin (10 mg/kg per day) or intravenous ceftriaxone (60 mg/kg up to 2 g per day for patients aged 2-13 years, or 2 g per day for patients aged ≥14 years). The randomisation list was computer-generated using blocks of four and six. The primary outcome was a composite of treatment failure, defined as the occurrence of at least one of the following: fever clearance time of more than 7 days after treatment initiation; the need for rescue treatment on day 8; microbiological failure (ie, blood cultures positive for Salmonella enterica serotype Typhi, or Paratyphi A, B, or C) on day 8; or relapse or disease-related complications within 28 days of treatment initiation. We did the analyses in the modified intention-to-treat population, and subpopulations with either confirmed blood-culture positivity, or blood-culture negativity. The trial was powered to detect an increase of 20% in the risk of failure. This trial was registered at ClinicalTrials.gov, number NCT01421693, and is now closed. FINDINGS: Between Sept 18, 2011, and July 14, 2014, we screened 725 patients for eligibility. On July 14, 2014, the trial was stopped early by the data safety and monitoring board because S Typhi strains with high-level resistance to ciprofloxacin and gatifloxacin had emerged. At this point, 239 were in the modified intention-to-treat population (120 assigned to gatifloxacin, 119 to ceftriaxone). 18 (15%) patients who received gatifloxacin had treatment failure, compared with 19 (16%) who received ceftriaxone (hazard ratio [HR] 1·04 [95% CI 0·55-1·98]; p=0·91). In the culture-confirmed population, 16 (26%) of 62 patients who received gatifloxacin failed treatment, compared with four (7%) of 54 who received ceftriaxone (HR 0·24 [95% CI 0·08-0·73]; p=0·01). Treatment failure was associated with the emergence of S Typhi exhibiting resistance against fluoroquinolones, requiring the trial to be stopped. By contrast, in patients with a negative blood culture, only two (3%) of 58 who received gatifloxacin failed treatment versus 15 (23%) of 65 who received ceftriaxone (HR 7·50 [95% CI 1·71-32·80]; p=0·01). A similar number of non-serious adverse events occurred in each treatment group, and no serious events were reported. INTERPRETATION: Our results suggest that fluoroquinolones should no longer be used for treatment of enteric fever in Nepal. Additionally, under our study conditions, ceftriaxone was suboptimum in a high proportion of patients with culture-negative enteric fever. Since antimicrobials, specifically fluoroquinolones, are one of the only routinely used control measures for enteric fever, the assessment of novel diagnostics, new treatment options, and use of existing vaccines and development of next-generation vaccines are now a high priority. FUNDING: Wellcome Trust and Li Ka Shing Foundation.

Fine mapping of powdery mildew resistance genes PmTb7A.1 and PmTb7A.2 in Triticum boeoticum (Boiss.) using the shotgun sequence assembly of chromosome 7AL.

KEY MESSAGE: A novel powdery mildew resistance gene and a new allele of Pm1 were identified and fine mapped. DNA markers suitable for marker-assisted selection have been identified. Powdery mildew caused by Blumeria graminis is one of the most important foliar diseases of wheat and causes significant yield losses worldwide. Diploid A genome species are an important genetic resource for disease resistance genes. Two powdery mildew resistance genes, identified in Triticum boeoticum (A(b)A(b)) accession pau5088, PmTb7A.1 and PmTb7A.2 were mapped on chromosome 7AL. In the present study, shotgun sequence assembly data for chromosome 7AL were utilised for fine mapping of these Pm resistance genes. Forty SSR, 73 resistance gene analogue-based sequence-tagged sites (RGA-STS) and 36 single nucleotide polymorphism markers were designed for fine mapping of PmTb7A.1 and PmTb7A.2. Twenty-one RGA-STS, 8 SSR and 13 SNP markers were mapped to 7AL. RGA-STS markers Ta7AL-4556232 and 7AL-4426363 were linked to the PmTb7A.1 and PmTb7A.2, at a genetic distance of 0.6 and 6.0 cM, respectively. The present investigation established that PmTb7A.1 is a new powdery mildew resistance gene that confers resistance to a broad range of Bgt isolates, whereas PmTb7A.2 most probably is a new allele of Pm1 based on chromosomal location and screening with Bgt isolates showing differential reaction on lines with different Pm1 alleles. The markers identified to be linked to the two Pm resistance genes are robust and can be used for marker-assisted introgression of these genes to hexaploid wheat.

Experimental observation of the effect of generic singularities in polychromatic dark hollow beams.

This Letter presents the essence of our recent experimental study on generic singularities carrying spatially partially coherent, polychromatic dark hollow beams (PDHBs). To the best of our knowledge, this is the first experimental demonstration of generic singularities-induced wavefront tearing in focused polychromatic beams.

Bloodstream infection among children presenting to a general hospital outpatient clinic in urban Nepal.

BACKGROUND: There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital. METHODS: We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter). Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi. RESULTS: Putative etiological agents for fever were identified in 164 (15%) patients. Salmonella enterica serovar Typhi (S. Typhi) was identified in 107 (10%), S. enterica serovar Paratyphi A (S. Paratyphi) in 30 (3%), Streptococcus pneumoniae in 6 (0.6%), S. enterica serovar Typhimurium in 2 (0.2%), Haemophilus influenzae type b in 1 (0.1%), and Escherichia coli in 1 (0.1%) patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2%) patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus. CONCLUSIONS: Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.

The burden of vaccine-preventable invasive bacterial infections and pneumonia in children admitted to hospital in urban Nepal.

BACKGROUND: Protein-polysaccharide vaccines have made a significant impact on the burden of disease caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and have the potential to do so for Salmonella Typhi. Nepal is one of many resource-poor nations with limited information on the epidemiology of childhood infections caused by these pathogens. METHODS: Over a 21-month period, we studied children aged ≤12 years admitted to an urban hospital in Nepal with suspected bacteremia, meningitis, or pneumonia. Patan Hospital is a non-profit hospital with the second largest pediatric unit in the Kathmandu Valley. RESULTS: Of 2039 children enrolled in the study, 142 (7.5%) included in the analysis had positive blood cultures. The agents of enteric fever, Salmonella Typhi and Salmonella Paratyphi, accounted for 59/142 (42%) of all bacteremias and were the most frequently cultured pathogens in children ≥1 year of age. S. pneumoniae was isolated in 16% of positive blood cultures and was the most common cause of bacteremia in children <1 year of age. Pneumonia accounted for 51% of admissions in children ≥2 months, with 44% of these children having radiographically defined primary endpoint pneumonia. S. pneumoniae was the most commonly identified pathogen in cases of pneumonia and meningitis. The S. pneumoniae serotype distribution indicated that the 10-valent and 13-valent pneumococcal conjugate vaccines would cover 44% and 47%, respectively, of all S. pneumoniae cultured from blood or cerebrospinal fluid (CSF) isolates and 62% and 67%, respectively, of isolates associated with pneumonia. H. influenzae type b was isolated infrequently from blood or CSF cultures, but is likely to be more important as a cause of pneumonia. CONCLUSIONS: The data on the burden of invasive bacterial infections and pneumonia from this study suggest that vaccines in development against Salmonella Typhi and the pneumococcus have the potential to significantly improve the health of children in Nepal.

Hospital-based surveillance of invasive pneumococcal disease among young children in urban Nepal.

BACKGROUND: Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in young children. Before implementation of the pneumococcal conjugate vaccine in developing countries, there is an urgent need to provide regional epidemiological data on pneumococcal disease. The aims of this study were to determine the prevalence and serotype distribution of invasive pneumococcal disease among young children hospitalized in urban Nepal. METHODS: Children aged 2 months to 5 years who were admitted to Patan Hospital, Kathmandu, with fever and/or suspected pneumonia, meningitis, or bacteremia were recruited. Blood culture specimens were collected from all participants. In cases of suspected meningitis, cerebrospinal fluid specimens were cultured and were tested for S. pneumoniae antigen. RESULTS: A total of 885 children were recruited during the 21-month study period. Of these, 76 (9%) had meningitis and 498 (56%) had pneumonia, on the basis of clinical criteria. Radiographically confirmed pneumonia occurred in 354 (40%), and probable or definite meningitis occurred in 47 (5%). S. pneumoniae was isolated in specimens from 17 (2%) of the children. Serotypes 1 and 12A were isolated most frequently, and only 1 of 17 isolates had a serotype contained in the currently available 7-valent pneumococcal conjugate vaccine. CONCLUSIONS: More than 60% of children aged <5 years who were admitted with fever and/or suspected invasive bacterial disease in urban Nepal had the clinical syndromes of meningitis and/or pneumonia. A new generation of pneumococcal vaccines that prevent infection with a broader range of serotypes may be necessary to most effectively control pneumococcal disease in young children in Kathmandu.

Information exchange in free space using spectral switching of diffracted polychromatic light: possibilities and limitations.

Spectral switching is now a well-known phenomenon. Several research groups have studied it theoretically and experimentally for different optical systems. Recently, its potential applications have been demonstrated for information encoding and transmission in free space. In this paper we report experimental observations in the far field for spectral switching of polychromatic light passing through an astigmatic aperture lens. An information encoding scheme, a free-space optical link, and related boundary conditions are studied in detail. In addition, on the basis of experimental and theoretical studies carried out so far for spectral switching, we explore possibilities of information transmission in free space and analyze experimental limitations of spectral-switching-based free-space optical communication.

An open randomized comparison of gatifloxacin versus cefixime for the treatment of uncomplicated enteric fever.

OBJECTIVE: To assess the efficacy of gatifloxacin versus cefixime in the treatment of uncomplicated culture positive enteric fever. DESIGN: A randomized, open-label, active control trial with two parallel arms. SETTING: Emergency Room and Outpatient Clinics in Patan Hospital, Lagankhel, Lalitpur, Nepal. PARTICIPANTS: Patients with clinically diagnosed uncomplicated enteric fever meeting the inclusion criteria. INTERVENTIONS: Patients were allocated to receive one of two drugs, Gatifloxacin or Cefixime. The dosages used were Gatifloxacin 10 mg/kg, given once daily for 7 days, or Cefixime 20 mg/kg/day given in two divided doses for 7 days. OUTCOME MEASURES: The primary outcome measure was fever clearance time. The secondary outcome measure was overall treatment failure (acute treatment failure and relapse). RESULTS: Randomization was carried out in 390 patients before enrollment was suspended on the advice of the independent data safety monitoring board due to significant differences in both primary and secondary outcome measures in the two arms and the attainment of a priori defined endpoints. Median (95% confidence interval) fever clearance times were 92 hours (84-114 hours) for gatifloxacin recipients and 138 hours (105-164 hours) for cefixime-treated patients (Hazard Ratio[95%CI] = 2.171 [1.545-3.051], p<0.0001). 19 out of 70 (27%) patients who completed the 7 day trial had acute clinical failure in the cefixime group as compared to 1 out of 88 patients (1%) in gatifloxacin group(Odds Ratio [95%CI] = 0.031 [0.004 - 0.237], p<0.001). Overall treatment failure patients (relapsed patients plus acute treatment failure patients plus death) numbered 29. They were determined to be (95% confidence interval) 37.6 % (27.14%-50.2%) in the cefixime group and 3.5% (2.2%-11.5%) in the gatifloxacin group (HR[95%CI] = 0.084 [0.025-0.280], p<0.0001). There was one death in the cefixime group. CONCLUSIONS: Based on this study, gatifloxacin is a better treatment for uncomplicated enteric fever as compared to cefixime. TRIAL REGISTRATION: Current Controlled Trials ISRCTN75784880.