Trends in maternal mortality in India over two decades in nationally representative surveys.

OBJECTIVE: To assess national and regional trends and causes-specific distribution of maternal mortality in India. DESIGN: Nationally representative cross-sectional surveys. SETTING: All of India from 1997 to 2020. SAMPLE: About 10 000 maternal deaths among 4.3 million live births over two decades. METHODS: We analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country. MAIN OUTCOME MEASURES: Maternal mortality burden and distribution of causes. RESULTS: The MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%). CONCLUSIONS: India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not. TWEETABLE ABSTRACT: We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Projecting potential impact of COVID-19 on major cereal crops in Senegal and Burkina Faso using crop simulation models.

CONTEXT: The rapid emergence of COVID-19 could have direct and indirect impacts on food production systems and livelihoods of farmers. From the farming perspective, disruption of critical input availability, supply chains and labor, influence crop management. Disruptions to food systems can affect (a) planting area; and (b) crop yields. OBJECTIVES: To quantify the impacts of COVID-19 on major cereal crop's production and their cascading impact on national economy and related policies. METHODS: We used the calibrated crop simulation model (DSSAT suite) to project the impact of potential changes in planting area and grain yield of four major cereal crops (i.e., rice, maize, sorghum, and millet) in Senegal and Burkina Faso in terms of yield, total production, crop value and contribution to agricultural gross domestic product (GDP). Appropriate data (i.e., weather, soil, crop, and management practices) for the specific agroecological zones were used as an input in the model. RESULTS AND CONCLUSIONS: The simulated yields for 2020 were then used to estimate crop production at country scale for the matrix of different scenarios of planting area and yield change (-15, -10, -5, 0, +5, +10%). Depending on the scenario, changes in total production of four cereals combined at country levels varied from 1.47 M tons to 2.47 M tons in Senegal and 4.51 M tons to 7.52 M tons in Burkina Faso. The economic value of all four cereals under different scenarios ranged from $771 Million (M) to $1292 M in Senegal and from $1251 M to $2098 M in Burkina Faso. These estimated total crop values under different scenarios were compared with total agricultural GDP of the country (in 2019 terms which was $3995 M in Senegal and $3957 M in Burkina Faso) to assess the economic impact of the pandemic on major cereal grain production. Based on the scenarios, the impact on total agricultural GDP can change -7% to +6% in Senegal and - 8% to +9% in Burkina Faso. SIGNIFICANCE: Results obtained from this modeling exercise will be valuable to policymakers and end-to-end value chain practitioners to prepare and develop appropriate policies to cope or manage the impact of COVID-19 on food systems.

Environmental management partner selection for reverse supply chain collaboration: A sustainable approach.

The Indian electronics industry is facing immense pressure to include sustainability practices in order to meet customer expectations, comply with legislation and create an edge over competitors. This growing need for inclusion of sustainability is driving original equipment manufacturers (OEMs) to collaborate with third-party reverse logistics providers (3PRLPs) to sustainably manage returns. Collaboration with 3PRLP will put OEMs in a stronger position regarding compliance with government legislation, improving upon their corporate image and customer satisfaction. It is a win-win situation for the OEM. On the other hand, from the 3PRLP's point of view, it is important to know the capabilities of the OEMs before entering into a collaborative endeavour. Hence, it is firstly necessary to identify the most appropriate attributes of the manufacturer which are essential for a sustainable collaboration. In this context, the study proposes a novel framework for investigating the performance attributes of the OEMs from the economic, environmental and social aspects of sustainability. Since the evaluation of each attribute for each dimension of sustainability differs in terms of the nature of the information needed and the time and resources required, it is necessary to conduct a pre-evaluation of the attributes using the Complex Proportional Assessment (COPRAS) method. Furthermore, the shortlisted attributes for each sustainability dimension are evaluated and prioritized using the best worst method (BWM). The novelty of the attribute selection process lies in simultaneously considering the degree of importance of the attribute as well as the degree of difficulty of the collection of data required for the assessment of the OEM. The result of this study helps decision-makers and practitioners to comprehend the most influential attributes of OEMs which are crucial for collaboration, thus enhancing the overall sustainability impact of the supply chain. The managerial implications drawn from the resulting analysis provide the 3PRLP with a sustainable evaluation framework which can be ideally used for the selection of collaborative partners. The above model is validated using the case of an Indian 3PRLP company that handles electronic products.

Synthesis and investigations into the anticancer and antibacterial activity studies of ß-carboline chalcones and their bromide salts.

A series of sixteen ß-carbolines, bearing chalcone moiety at C-1 position, were prepared from easily accessible 1-acetyl-ß-carboline and various aldehydes under basic conditions followed by N2-alkylation using different alkyl bromides. The prepared compounds were evaluated for in vitro cytotoxicity against a panel of human tumor cell lines. N2-Alkylated-ß-carboline chalcones 13a-i represented the interesting anticancer activities compared to N2-unsubstituted ß-carboline chalcones 12a-g. Off the prepared ß-carbolines, 13g exhibited broad spectrum of activity with IC50 values lower than 22.5 µM against all the tested cancer cell lines. Further, the N2-alkylated-ß-carboline chalcone 13g markedly induced cell death in MDA-MB-231 cells by AO/EB staining assay. The most cytotoxic compound 13g possessed a relatively high drug score of 0.48. Additionally, the prepared ß-carboline chalcones displayed moderate antibacterial activities against tested bacterial strains.

Efficiently functionalized oxacalix[4]arenes: Synthesis, characterization and exploration of their biological profile as novel HDAC inhibitors.

A series of novel substituted oxacalix[4]arene has been synthesized and explored for their biological profile by evaluating anticancer, antifungal and antibacterial properties. The derivatives have been characterized by various spectroscopic techniques such as IR, (1)H NMR, (13)C NMR and Mass spectrometry. Many compounds showed strong inhibition (MIC) in the range of ∼0-50 µM with interesting cytotoxic activities against Hela cells in particular. The compounds were theoretically evaluated by docking studies as potential histone deacetylase inhibitors (HDACi). The study indicates that compounds bound adequately with HDAC, and hence complemented the experimental findings.

Synthesis and docking studies of pyrazine-thiazolidinone hybrid scaffold targeting dormant tuberculosis.

The persistence of Mycobacterium tuberculosis (MTB) in dormant stage assists the pathogen to develop resistance against current antimycobactrial drugs. To address this issue, we report herein the synthesis of N-(4-oxo-2 substituted thiazolidin-3 yl) pyrazine-2-carbohydrazide derivatives designed by following the molecular hybridization approach using pyrazine and thiazolidenone scaffolds. The compounds were evaluated against MTB H37Ra and Mycobacterium bovis BCG in dormancy model. Most of the compounds had IC50 values in 0.3-1 µg/ml range. The active compounds were further tested for anti-proliferative activity against THP-1, Panc-1, A549, and MCF-7 cell lines using MTT assay and exhibited no significant cytotoxicity. We also report molecular docking studies using active analogs and MTB - Decaprenylphosphoryl-ß-d-ribose-2'-epimerase (DprE1) to rationalize the biological activity and to provide an insight into the probable mechanism of action and binding mode of hybridized structures. The results obtained validate the use of molecular hybridization approach and also suggest that reported compounds can provide a novel pharmacophore to synthesize lead compounds against dormat MTB.

The impact of cigarette smoking on life expectancy between 1980 and 2010: a global perspective.

INTRODUCTION: Tobacco smoking is among the leading causes of preventable mortality worldwide. We assessed the impact of smoking on life expectancy worldwide between 1980 and 2010. METHODS: We retrieved cause-specific mortality data from the WHO Mortality Database by sex, year and age for 63 countries with high or moderate quality data (1980-2010). Using the time of the peak of the smoking epidemic by country, relative risks from the three waves of the Cancer Prevention Study were applied to calculate the smoking impact ratio and population attributable fraction. Finally, we estimated the potential gain in life expectancy at age 40 if smoking-related deaths in middle age (40-79 years) were eliminated. RESULTS: Currently, tobacco smoking is related to approximately 20% of total adult mortality in the countries in this study (24% in men and 12% in women). If smoking-related deaths were eliminated, adult life expectancy would increase on average by 2.4 years in men (0.1 in Uzbekistan to 4.8 years in Hungary) and 1 year in women (0.1 in Kyrgyzstan to 2.9 years in the USA). The proportion of smoking-related mortality among men has declined in most countries, but has increased in the most populous country in the world, that is, China from 4.6% to 7.3%. Increases in the impact of tobacco on life expectancy were observed among women in high-income countries. CONCLUSIONS: Recent trends indicate a substantial rise in the population-level impact of tobacco smoking on life expectancy in women and in middle-income countries. High-quality local data are needed in most low-income countries.

Survey of the literature on mechanoluminescence from 1605 to 2013.

Mechanoluminescence (ML) is a type of luminescence induced by any mechanical action on solids. The light emissions induced by elastic deformation, plastic deformation and fracture of solids are called elastico ML (EML), plastico ML (PML) and fracto ML (FML), respectively. Whereas nearly 50% of all organic molecular solids and inorganic salts exhibit FML, only a few solids exhibit EML and PML. The EML and FML of certain solids are so intense that they can be seen during daylight with the naked eye. Mechanolumnescence has a great potential for use in different types of mechano-optical devices such as stress sensors, damage sensors, impact sensors, fracture sensors and safety management monitoring systems. This article reports a survey of the literature from 1605 to 2013. Mechanoluminescence is studied by physicists, chemists, material scientists, geologists, medical scientists, engineers and technologists, among others and researchers will certainly benefit from the literature survey on ML given here. In addition, the field of mechanoluminescence may attract the interest of many new researchers.

Outbreak of cholera in Tilathi VDC Saptari Nepal.

BACKGROUND: On 2011, Cluster of cholera cases was reported in the Tilathi VDC of Saptari, Nepal. OBJECTIVE: The outbreak was investigated to identify the etiological agent and possible source of infection and guiding the prevention and control measures. METHODS: Demographic and clinical details were collected from the suspected case-patients, and the outbreak was described by time, place, and person. Focus group discussion and Key informant interview were conducted to assess the practice of sanitation, source of drinking water and probable cause of diarrheal disease. Five stool samples and 10 water samples of tube well and ponds were collected and microbiological study was done in BPKIHS Dharan. RESULTS: A total of 111 persons suffered with diarrhea and 02 died of it (attack rate 3.05%, case fatality rate 1.8%). All age groups were affected with disease (median age 26 yrs) and males were affected more than females. Descriptive epidemiology suggested the clustering of cases were around the pond where they clean utensils, take bath and wash clothes. The Vibrio cholerae 01 El Tor, Ogawa serotype was isolated in 03 out of 05 suspected stool samples and in all three of the pond water samples. They reported that most of the houses do not have the toilet and people do not wash their hands regularly with soap and water after defecation. CONCLUSION: Vibrio cholerae was the causative agent behind the outbreak and probable source of infection was the problematic pond water which they used for different purpose. Immediate chlorination of the pond was recommended to halt further spread of the epidemics.

Computational investigation of binding of chloroquinone and hydroxychloroquinone against PLPro of SARS-CoV-2.

Novel coronavirus SARS-CoV-2 has infected 18 million people with 700,000+ mortalities worldwide and this deadly numeric figure is rapidly rising. With very few success stories, the therapeutic targeting of this epidemic has been mainly attributed to main protease (Mpro), whilst Papain-like proteases (PLpro) also plays a vital role in the processing of replicase polyprotein. Multifunctional roles of PLpro such as viral polypeptide cleavage, de-ISGlyation and immune suppression have made it a promising drug target for therapeutic interventions. Whilst there have been a number of studies and others are on-going on repurposing and new-small molecule screening, albeit previously FDA approved drugs viz. Chloroquine (CQ) and Hydroxychloroquine (HCQ) have only been found effective against this pandemic. Inspired by this fact, we have carried out molecular docking and dynamics simulation studies of FDA approved CQ and HCQ against SARS-CoV-2 PLpro. The end aim is to characterise the binding mode of CQ and HCQ and identify the key amino acid residues involved in the mechanism of action. Further, molecular dynamics simulations (MDS) were carried out with the docked complex to search for the conformational space and for understanding the integrity of binding mode. We showed that the CQ and HCQ can bind with better binding affinity with PLpro as compared to reference known PLpro inhibitor. Based on the presented findings, it can be anticipated that the SARS-CoV-2 PLpro may act as molecular target of CQ and HCQ, and can be projected for further exploration to design potent inhibitors of SARS-CoV-2 PLpro in the near future.

Prevalence and correlates of Herpes Simplex Virus-2 and syphilis infections in the general population in India.

OBJECTIVES: To determine the prevalence and correlates of Herpes Simplex Virus-2 (HSV-2) and syphilis infections in the general population in India. METHODS: 2456 adults were surveyed in Hyderabad, Bangalore and Chandigarh in India. Socio-demographic and lifestyle characteristics were obtained through a questionnaire, and a dried blood spot (DBS) was collected from all individuals aged 18 years and over; sexual behaviour was collected from those aged 18-49 years. DBS samples were tested for HSV-2 and syphilis serology. The association between HSV-2 and syphilis infections with socio-demographic and behavioural variables was analysed using multivariable logistic regression. RESULTS: The prevalence of HSV-2 and syphilis was 10.1% and 1.7%, respectively. Geographic differences in HSV-2 prevalence were significant, while for syphilis it was comparable. Urban-rural differences in prevalence were only seen for syphilis. For both infections, the prevalence between males and females was not significantly different. In males and females, HSV-2 prevalence increased significantly with increasing age; for syphilis, a slight trend was seen only in females. In a multivariable analysis, HSV-2 infection in males and females was associated with site, religion and testing positive for syphilis, in addition to reporting ≥ 2 lifetime partners in the previous year among males and being ever married or having had sex with a non-regular partner in the last year among females. CONCLUSIONS: The burden and geographic heterogeneity of HSV-2 and syphilis infections in India are significant. A national household and DBS-based sexually transmitted infection (STI) surveillance system would enable monitoring, especially in relation to the HIV epidemic, and planning of evidence-based prevention and treatment programmes.

HLA Desensitization Based on Results of the Luminex Technique in Kidney Transplant - A Single-center Experience.

BACKGROUND: There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results. METHOD: Between 2014 and 2018, patients with complement-dependent cytotoxicity cross-match (CDC-XM) negativity but flow cytometry crossmatch (FC-XM) positivity were further analyzed with Luminex SAB for donor-specific antibodies (DSAs). A total of 12 patients who had DSA mean fluorescent intensity (MFI) of >1000 and <10,000 were included in the study. Our protocol for desensitization consisted of plasmapheresis (PP) followed by low dose intravenous immunoglobulin (IV IG) 100 mg/kg and induction with antithymocyte globulin (ATG). Patients were taken for transplant when either MFI was <1000 and/or FC-XM was negative. RESULTS: All 12 patients were first transplant and 10 had a history of some sensitizing event; pregnancy in 4, blood transfusions in 4, and both in 2 patients. FC-XM was positive for T-cell in 4, B-cell in 6, and both in 2 patients. On evaluation by Luminex SAB, 6 patients had MFI from 1000 to 2000, and 6 had MFI of >2000. All underwent desensitization successfully. Two patients had an increase in posttransplant DSA titers requiring posttransplant PP. The mean follow-up was 26.6 ± 13.9 months. On follow-up, only one patient developed acute T cell-mediated rejection 1 year after transplant, which responded to pulse steroids. There was no graft or patient loss until the last follow-up. CONCLUSION: This study shows that HLA desensitization is feasible and successful in the Indian setting if patients are properly selected.

Antiviral activity of some plants used in Nepalese traditional medicine.

Methanolic extracts of 41 plant species belonging to 27 families used in the traditional medicine in Nepal have been investigated for in vitro antiviral activity against Herpes simplex virus type 1 (HSV-1) and influenza virus A by dye uptake assay in the systems HSV-1/Vero cells and influenza virus A/MDCK cells. The extracts of Astilbe rivularis, Bergenia ciliata, Cassiope fastigiata and Thymus linearis showed potent anti-herpes viral activity. The extracts of Allium oreoprasum, Androsace strigilosa, Asparagus filicinus, Astilbe rivularis, Bergenia ciliata and Verbascum thapsus exhibited strong anti-influenza viral activity. Only the extracts of A. rivularis and B. ciliata demonstrated remarkable activity against both viruses.

Universalizing access to primary health care in India.

Life expectancy is improving steadily but India needs rapid gains in health. Communicable diseases, maternal, perinatal and nutritional deficiencies continue to be important causes of deaths; non-communicable diseases and injuries are also taking a substantial toll of human lives. A basic health care package based on a core set of cost-effective health interventions can address existing disease burden. Its implementation requires increased investment and enhanced health care delivery capacity. Large diversity in India calls for local adaptation of the basic health care package and its delivery mechanism. To encourage accountability, access should be monitored at district level by an independent agency.

Smoking, HIV and non-fatal tuberculosis in an urban African population.

Most previous studies on smoking and tuberculosis (TB) have not considered the role of human immunodeficiency virus (HIV) infection, and very few have been conducted in sub-Saharan Africa. We conducted a case-control study on smoking and TB in Addis Ababa, Ethiopia. Men aged 18-65 years with TB (n = 72) were compared to men with no history of TB (n = 81). Forty-three per cent of cases smoked vs. 25% of controls (OR 2.3, adjusted for age, education and self-reported HIV status). Given that HIV appears to increase TB transmission in Africa, our finding that smoking also increases the risk of TB in Africa is of special concern.

De Garengeot hernia: an analysis of our experience.

AIM: The presence of a vermiform appendix in a femoral hernia sac is termed De Garengeot hernia. It may present as a tender and/or erythematous groin swelling and is often misdiagnosed as an incarcerated or strangulated femoral hernia. The purpose of this study is to review the management of De Garengeot hernia at a single institution since 1991. MATERIALS AND METHODS: A retrospective analysis of seven consecutive patients operated upon at our institution from 1991 to 2006 with De Garengeot hernia was undertaken. Patients' demographics, treatment performed and postoperative outcome were analysed. RESULTS: There were three men and four women. The median age was 55 years. None of the patients were diagnosed preoperatively. The commonest presenting symptom was painful groin swelling. All patients therefore underwent emergency surgery with a presumptive diagnosis of either incarcerated or strangulated femoral hernia. Operative findings included four normal appendices, two inflamed appendices and one perforated appendix in the femoral hernial sac. Patients with normal appendix (n = 4) had mesh hernia repair without an appendicectomy. The rest of the patients (n = 3) with abnormal appendix underwent emergency open appendicectomy followed by sutured hernia repair. We had no deaths in this series and one minor wound infection. No recurrent hernia has been detected to date. CONCLUSION: Inflammation of the appendix determines the type of hernia repair and surgical approach. Incidental appendicectomy in the case of a normal appendix is not preferred.

Renal Artery Thrombosis with Renal Infarction: A Rare Cause of Acute Abdomen.

Renal artery thrombosis with renal infarction is a rare entity. Due to the nonspecific clinical presentation, the diagnosis is usually delayed. We describe such a case in a middle-aged man with membranous nephropathy who was in remission and presented with severe abdominal pain. He was managed with selective intra-arterial thrombolysis with a good outcome.

Remission of post-transplant focal segmental glomerulosclerosis with angiotensin receptor blockers.

Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation. Plasmapheresis (PP) is considered to be the most effective treatment; however, results are variable and relapse is common after stopping plasmapheresis. Here, we report an unusual case of recurrent FSGS, who achieved complete remission with angiotensin receptor blocker therapy.

Eculizumab for atypical hemolytic-uremic syndrome in India: First report from India and the challenges faced.

Much progress has been made in understanding the pathophysiology and treatment of atypical hemolytic uremic syndrome (aHUS). Plasma therapy is the mainstay of treatment for aHUS. The availability of the first effective anti-complement therapeutic agent, eculizumab, has dramatically changed the outlook of this disease. However, its use in clinical practice raises important questions, such as who should receive the drug, when to start such therapy, and is it safe to stop treatment once the disease is controlled. We describe here for the 1st time in India, use of eculizumab in a 12-year-old boy with aHUS. We also describe in this report challenges faced in procuring the drug, and an ideal, evidence-based method of treating aHUS in children.