Unravelling the complex mechanisms of multidrug resistance in bovine mastitis pathogens: Insights into antimicrobial resistance genes, biofilm dynamics, and efflux systems.

Mastitis remains a paramount economic threat to dairy livestock, with antibiotic resistance severely compromising treatment efficacy. This study provides an in-depth investigation into the multidrug resistance (MDR) mechanisms in bacterial isolates from bovine mastitis, emphasizing the roles of antimicrobial resistance genes (ARGs), biofilm formation, and active efflux systems. A total of 162 Staphylococci, eight Escherichia coli, and seven Klebsiella spp. isolates were obtained from 215 milk samples of clinical and subclinical mastitis cases. Antibiotic susceptibility testing identified Twenty Staphylococci (12.35 %), six E. coli (75 %) and seven Klebsiella (100 %) identified as MDR displaying significant resistance to ß-lactams and tetracyclines The Multiple Antibiotic Resistance (MAR) index of these isolates ranged from 0.375 to 1.0, highlighting extensive resistance. Notably, 29 of the 33 MDR isolates produced biofilms on Congo red agar, while all exhibited biofilm formation in the Microtitre Plate assay. Critical ARGs (blaZ, blaTEM, blaCTX-M, tetM, tetA, tetB, tetC, strA/B, aadA) and efflux pump genes (acrB, acrE, acrF, emrB, norB) regulating active efflux were identified. This pioneering study elucidates the synergistic contribution of ARGs, biofilm production, and efflux pump activity to MDR in bovine mastitis pathogens. To our knowledge, this comprehensive study is the first of its kind, offering novel insights into the complex resistance mechanisms. The findings underscore the imperative need for advanced antibiotic stewardship and strategic interventions in dairy farming to curb the rise of antibiotic-resistant infections, thereby protecting both animal and public health.

Green synthesized silver nanoparticles from Ocimum sanctum: A potent inhibitor of biofilm forming ability and efflux pumps in bacteria causing bovine mastitis.

Therapeutic management of mastitis faces significant challenges due to multidrug resistance. In the present study, multi-drug-resistant (MDR) Staphylococcus spp, Klebsiella pneumoniae, and Escherichia coli were isolated from bovine clinical mastitis cases and the phenotypic and genotypic multidrug resistance profiling was carried out. Silver nanoparticles (AgNPs) were biosynthesized using Ocimum sanctum leaf extracts and characterized via UV Vis absorption, Fourier Transform Infrared Spectroscopy, X-ray diffraction studies, Energy dispersive spectroscopy and Electron Microscopy. The determined minimum inhibitory concentration and minimum bactericidal concentration of the AgNPs against the recovered MDR isolates were 62.5 µg/ml and 125 µg/ml respectively. At a concentration of 50 µg/ml, the AgNPs demonstrated biofilm inhibitory activities of 80.35 % for MDR E. coli, 71.29 % for S. aureus and 60.18 % for MDR K. pneumoniae. Post-treatment observations revealed notable differences in biofilm formation across bacterial isolates. Furthermore, AgNP treatment led to significant downregulation of expression of the efflux pump genes acrB, acrE, acrF, and emrB in Gram-negative isolates and norB in Staphylococci isolates. This research underscores the potential for the development of an eco-friendly antimicrobial alternative in the form of green synthesized silver nanoparticles to combat drug resistance offering potential antibiofilm and efflux pump inhibitory activities.

Long term outcome in non-multiple sclerosis paediatric acquired demyelinating syndromes.

OBJECTIVES: We aimed to study the risks of relapse and long term disability in children with non-MS acquired demyelinating syndromes (ADS). METHODS: In this prospective, multi-centre study, from the 14 UK pediatric neurology centres, children (<16 years) experiencing a first episode of ADS were recruited from 2010 to 2014. Case report forms were collected prospectively. RESULTS: A total of 269 children were recruited and followed up for a median of 7.2 years. Median age at onset was 9y (IQR 9.5-14.5, 126 females). At last follow-up, 46 (18 %) had MS, 4 AQP4-Ab NMOSD and 206 (80 %) had other ADS, of which 27 (13 %) relapsed. Relapsing MOGAD was the diagnosis in 12/27, 6 were seronegative and 9 did not have antibodies tested. Frequency of relapse differed according to first presentation in non-MS ADS, being least likely in transverse myelitis (p = 0.025). In the non-MS group, MOG-Ab was predictive of relapse (HR = 8.42; p < 0.001) occurring 8 times as often decreasing over time. Long-term difficulties did not differ between children with monophasic vs relapsing diseases. CONCLUSION: The risk of relapse in non-MS ADS depends on initial diagnosis, and MOG-Ab positivity. Long-term difficulties are observed regardless of relapses and are determined by presenting phenotype.

A novel loop-mediated isothermal amplification (LAMP) assay to diagnose feline panleukopenia.

Protoparvovirus carnivoran1, known commonly as feline panleukopenia virus (FPV) is a highly contagious and environmentally stable parvovirus of domestic as well as wild felids. A rapid and robust diagnostic tool will aid in implementing prompt treatment and control measures. A loop-mediated isothermal amplification (LAMP) as a point-of-care diagnostic tool for diagnosing feline panleukopenia was standardised using faecal samples of cats. The assay will reduce the cost and time required to diagnose feline panleukopenia. A set of two outer primers (F3 and B3) and two inner primers (FIP and BIP) were designed to target the viral polypeptide (VP2) gene of FPV. Optimisation of the LAMP reaction was done at 60 °C for one hour after an initial denaturation at 95 °C for five minutes. Visualisation of the result based on the addition of SYBR Green 1 dye offered an easy and reliable diagnosis. The detection limit of the standardised LAMP assay was as low as 1.25 ng/µl of the target DNA. Species specificity of the LAMP primers revealed no amplification of the non-target DNA of any other species except that of the canine parvovirus DNA template. DNA extracted from 100 PCR-positive and 20 PCR-negative faecal samples were subjected to the standardised assay and compared with PCR. Analysis of the results revealed that the LAMP assay was 100% sensitive and 90% specific compared to PCR. The LAMP assay could be a reliable tool for the point-of-care diagnosis of feline panleukopenia in limited resource settings.

Three-year black carbon aerosol synthesis over a pristine location surrounded by hillocks in Haryana state, India.

The three-year Black Carbon (BC) aerosol measurements made during 2020, 2021, and 2022 over a rural location, namely, Panchgaon, surrounded by Aravali hillocks (elevation of about 400-600 m) have been analyzed with an aim to determine their optical and radiative characteristics, seasonal and long-term variations in mass concentration. The affinity between these parameters and associated pollutants and planetary boundary layer height (PBLH), affected by the orography, to delineate their role in mass concentration changes with time have been investigated. The coincident OPAC (Optical Properties of Aerosols and Clouds) Model-derived aerosol optical depth (AOD), and single scattering albedo (SSA) have been compared with the observed BC mass concentration, and also with synchronous satellite measurements. The year-to-year variability analysis of the data reveals that the rate of increase of BC concentration is high. The variability was low due to the reasons explained. It implies that the year-to-year variability in BC concentration at the study site depends on the source strength modulated by the valley-driven meteorology. Added, the percentage departures of BC concentration show positive values (higher concentration) during morning and evening hours, which could be due to more anthropogenic activities while it shows negative values during afternoon hours and lower boundary layer heights. The force exerted by the radiation due to BC aerosols at the bottom of the atmosphere (BOA), and in the atmosphere (ATM) are almost equal in magnitude and negative, while that at the top-of-the-atmosphere (TOA) is smaller and positive, indicating that BC aerosols in the study region cools the atmosphere at the BOA and warms the ATM and TOA, which indirectly reveals the dominant role of long-range transport phenomenon at higher levels as compared to the surface level.

R-CNN and YOLOV4 based Deep Learning Model for intelligent detection of weaponries in real time video.

The security of civilians and high-profile officials is of the utmost importance and is often challenging during continuous surveillance carried out by security professionals. Humans have limitations like attention span, distraction, and memory of events which are vulnerabilities of any security system. An automated model that can perform intelligent real-time weapon detection is essential to ensure that such vulnerabilities are prevented from creeping into the system. This will continuously monitor the specified area and alert the security personnel in case of security breaches like the presence of unauthorized armed people. The objective of the proposed system is to detect the presence of a weapon, identify the type of weapon, and capture the image of the attackers which will be useful for further investigation. A custom weapons dataset has been constructed, consisting of five different weapons, such as an axe, knife, pistol, rifle, and sword. Using this dataset, the proposed system is employed and compared with the faster Region Based Convolution Neural Network (R-CNN) and YOLOv4. The YOLOv4 model provided a 96.04% mAP score and frames per second (FPS) of 19 on GPU (GEFORCE MX250) with an average accuracy of 73%. The R-CNN model provided an average accuracy of 71%. The result of the proposed system shows that the YOLOv4 model achieves a higher mAP score on GPU (GEFORCE MX250) for weapon detection in surveillance video cameras.

Hematological characteristics of autochthonous hypermicrofilaremic dirofilariosis in dogs in Kannur District of Kerala.

This study aimed to determine whether autochthonous high-intensity D. repens microfilaremia leads to haematological changes in companion dogs. Dogs with hypermicrofilaremia presented to the District Veterinary Centre, Kannur were selected for the study. A total of 100 dogs were positive for hypermicrofilariaemia with D. repens based on peripheral blood smear examination and Knott's test. Of these, 3 dogs were concurrently positive for sheathed microfilaria (MF) of Brugia spp. Interestingly, an adult live worm of D. repens approximately eight cm in length was detected on a subcutaneous mass on the hind limb of a hypermicrofilaremic dog in the study. We compared the hematological parameters of 100 autochthonous hypermicrofilaremic dogs and 15 uninfected dogs. The hematological findings in the study are mild to moderate anemia, moderate to severe thrombocytopenia, leucocytosis with granulocytosis, lymphocytosis and monocytosis as compared to the uninfected group of dogs. The pathogenicity of naturally occurring hypermicrofilaremia is poorly studied, and knowledge of its epidemiology, host-parasite relationship and impact on various organs is warranted for better prevention and control, especially in hot-spot areas. Supplementary Information: The online version contains supplementary material available at 10.1007/s12639-023-01622-6.

Diet, cardiovascular disease, and mortality in 80 countries.

AIMS: To develop a healthy diet score that is associated with health outcomes and is globally applicable using data from the Prospective Urban Rural Epidemiology (PURE) study and replicate it in five independent studies on a total of 245 000 people from 80 countries. METHODS AND RESULTS: A healthy diet score was developed in 147 642 people from the general population, from 21 countries in the PURE study, and the consistency of the associations of the score with events was examined in five large independent studies from 70 countries. The healthy diet score was developed based on six foods each of which has been associated with a significantly lower risk of mortality [i.e. fruit, vegetables, nuts, legumes, fish, and dairy (mainly whole-fat); range of scores, 0-6]. The main outcome measures were all-cause mortality and major cardiovascular events [cardiovascular disease (CVD)]. During a median follow-up of 9.3 years in PURE, compared with a diet score of ≤1 points, a diet score of ≥5 points was associated with a lower risk of mortality [hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.63-0.77)], CVD (HR 0.82; 0.75-0.91), myocardial infarction (HR 0.86; 0.75-0.99), and stroke (HR 0.81; 0.71-0.93). In three independent studies in vascular patients, similar results were found, with a higher diet score being associated with lower mortality (HR 0.73; 0.66-0.81), CVD (HR 0.79; 0.72-0.87), myocardial infarction (HR 0.85; 0.71-0.99), and a non-statistically significant lower risk of stroke (HR 0.87; 0.73-1.03). Additionally, in two case-control studies, a higher diet score was associated with lower first myocardial infarction [odds ratio (OR) 0.72; 0.65-0.80] and stroke (OR 0.57; 0.50-0.65). A higher diet score was associated with a significantly lower risk of death or CVD in regions with lower than with higher gross national incomes (P for heterogeneity <0.0001). The PURE score showed slightly stronger associations with death or CVD than several other common diet scores (P < 0.001 for each comparison). CONCLUSION: A diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.

Decentralisation, health and Sustainable Development Goal 3.

SETTING: Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation. OBJECTIVE: To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems. DESIGN: This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study. RESULTS: Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation. CONCLUSION: The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals.

CONTEXTE: L'État du Kerala, en Inde, a mis en œuvre des réformes de décentralisation des établissements de santé il y a 25 ans, en transférant le contrôle administratif et une part importante de l'allocation financière. OBJECTIF: Décrire les principaux impacts de la décentralisation au Kerala sur la formulation de politiques locales, la mise en œuvre de programmes et la prestation de services pour des systèmes de santé durables. MÉTHODE: Cette étude faisait partie d'une étude qualitative plus vaste sur la décentralisation et la santé au Kerala. Nous avons mené 25 entretiens approfondis et examiné 31 décrets ou documents de politique du gouvernement, cinq transcriptions connexes et cinq rapports thématiques de l'étude principale. RÉSULTATS: La liaison entre le système de santé et les gouvernements locaux s'est améliorée au fil du temps. Une réorientation des projets centrés sur le bien-être vers les infrastructures, les ressources humaines et les services était évidente. Une hétérogénéité considérable existe en raison des différents degrés d'implication, de capacité, de ressources et de besoins de la communauté. Le discours au niveau de l'État et les récents efforts d'augmentation en vue d'atteindre les objectifs de développement durable (SDG) de l'ONU soutiennent fortement le rôle des gouvernements locaux dans la planification, le financement et la mise en œuvre. CONCLUSION: Les 25 ans d'histoire de l'administration décentralisée des soins de santé au Kerala révèlent à la fois des réussites et des échecs. Un soutien central sans déresponsabiliser les gouvernements locaux peut être une option viable pour permettre une prise de décision flexible et cohérente avec les objectifs plus larges du système.

Re-engineering primary healthcare in Kerala.

INTRODUCTION: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based ('Aardram') initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care. METHODS: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema. RESULTS: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of 'Aardram' primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed. CONCLUSION: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.

INTRODUCTION: Dans le contexte des Objectifs de développement durable (SDG), l'État du Kérala, Inde, a transformé ses centres de soins primaires (PHC) existants en centres de santé familiale (FHC) conviviaux afin de fournir des soins primaires complets dans le cadre d'une initiative mandatée en mission ('Aardram'). Il était prévu que la mise en œuvre et le fonctionnement de cette mission fassent appel à la gouvernance décentralisée. Cette étude a examiné l'influence de la gouvernance décentralisée sur la réorganisation des soins primaires. MÉTHODES: L'étude a eu recours à une approche exploratoire, en utilisant des méthodes qualitatives : entretiens avec des informateurs clés (n=8), entretiens approfondis (n=20) et analyses documentaires. Une analyse thématique a été réalisée selon un codage déductif et les thèmes identifiés ont été structurés sous forme de schéma. RÉSULTATS: Les résultats peuvent être résumés en cinq thèmes principaux. Un engagement politique fort, associé à des compétences bureaucratiques, ont facilité la mise en œuvre et le fonctionnement des soins primaires de la mission 'Aardram'. Les connaissances acquises grâce à la formation multisectorielle ont aidé les gouvernements locaux (LG) à s'impliquer et à s'engager dans le système de santé en tant qu'équipe afin de planifier et de mettre en place des interventions. Les structures de gouvernance décentralisées ont permis de réorganiser les PHC en mobilisant des ressources financières, en fournissant des ressources humaines, en modifiant les infrastructures et en renforçant la participation communautaire à différents niveaux. Parmi les lacunes observées figurent le manque d'uniformité de l'engagement, l'engagement sous-optimal des LG urbains et les questions de durabilité et de suivi. CONCLUSION: La gouvernance décentralisée a joué un rôle positif dans la réorganisation des PHC, qui a été utilisée comme une plateforme pour illustrer les bonnes pratiques en matière de gouvernance sanitaire par le biais d'une approche participative. Cette étude met en évidence l'importance de l'autonomisation des LG au travers du renforcement des capacités afin de relever les défis liés à la réalisation des SDG en matière de soins primaires.

Anti-diabetic and hypolipidemic effects of Cinnamon cassia bark extracts: an in vitro, in vivo, and in silico approach.

The present investigation was aimed to study the anti-diabetic and hypolipidemic potential of Cinnamon cassia (Lauraceae family) bark in streptozotocin (STZ)-induced diabetic rats. The preliminary phytochemical analysis (hexane, petroleum ether, chloroform, ethanol, methanol, and aqueous extracts), GC-MS analysis (ethanol), in vitro (aqueous, ethanol and methanol), in vivo (ethanol) and in silico anti-diabetic activity with hypolipidemic effect of C. cassia bark was analysed. The ethanolic extract of the C. cassia bark has a fine inhibitory activity than the aqueous and methanolic extract. Out of 20 different compounds identified, seven compounds were biologically active, and 9-octadecenoic acid has highly interacted with PPARα/γ in docking studies. The levels of diabetic markers, enzymes, and lipid profiles were altered in STZ-induced rats, but after the treatment of C. cassia, the levels were returned to the normal. The study may prove the ethanolic extract of C. cassia has a powerful anti-diabetic and anti-hyperlipidemic activity.

Glycemic control and its determinants among people with type 2 diabetes mellitus in Ernakulam district, Kerala.

Background: Diabetes is a public health problem of colossal proportions. The National Family Health Survey 5 (2019-2020) has found high blood sugar levels among 13.5% of women and 15.6% of men in India. The high morbidity and mortality in diabetes mellitus are due to uncontrolled hyperglycemia resulting in micro- and macrovascular changes affecting multiple organs in the body. The objectives of this study were to estimate glycemic control and its determinants among type 2 diabetics in the Ernakulam district. Methods: A community-based cross-sectional study was conducted among 364 type 2 diabetics who had the disease for at least 5 years duration in the Ernakulam district of Kerala. Probability proportional to size cluster sampling technique was adopted. A semi-structured questionnaire was used to collect sociodemographic and behavioral profiles. Participants' HbA1c levels were assessed to determine glycemic control. Results: The proportion of people with good glycemic control was 21.4%. Determinants such as female gender adjusted odds ratio (aOR = 2.36, P = 0.005), body mass index >23 kg/m2 (aOR = 2.71, P = 0.002), combined drug treatment with Oral Hypoglycaemic agents (OHA) and insulin (aOR = 3.76, P = 0.004), and poor compliance with medications (aOR = 1.93, P = 0.030) were found to be significantly associated with poor glycemic control. Conclusions: Poor compliance with medications and unhealthy lifestyle choices has resulted in a high proportion of diabetics with poor glycemic control in the district. Women are particularly more vulnerable to uncontrolled hyperglycemia than males. Type 2 diabetes mellitus people should be encouraged to maintain strict glycemic control, which is an important measure for secondary prevention of complications.

Automatic detection of breast cancer in ultrasound images using Mayfly algorithm optimized handcrafted features.

BACKGROUND: The incidence rates of breast cancer in women community is progressively raising and the premature diagnosis is necessary to detect and cure the disease. OBJECTIVE: To develop a novel automated disuse detection framework to examine the Breast-Ultrasound-Images (BUI). METHODS: This scheme includes the following stages; (i) Image acquisition and resizing, (ii) Gaussian filter-based pre-processing, (iii) Handcrafted features extraction, (iv) Optimal feature selection with Mayfly Algorithm (MA), (v) Binary classification and validation. The dataset includes BUI extracted from 133 normal, 445 benign and 210 malignant cases. Each BUI is resized to 256×256×1 pixels and the resized BUIs are used to develop and test the new scheme. Handcrafted feature-based cancer detection is employed and the parameters, such as Entropies, Local-Binary-Pattern (LBP) and Hu moments are considered. To avoid the over-fitting problem, a feature reduction procedure is also implemented with MA and the reduced feature sub-set is used to train and validate the classifiers developed in this research. RESULTS: The experiments were performed to classify BUIs between (i) normal and benign, (ii) normal and malignant, and (iii) benign and malignant cases. The results show that classification accuracy of > 94%, precision of > 92%, sensitivity of > 92% and specificity of > 90% are achieved applying the developed new schemes or framework. CONCLUSION: In this work, a machine-learning scheme is employed to detect/classify the disease using BUI and achieves promising results. In future, we will test the feasibility of implementing deep-learning method to this framework to further improve detection accuracy.

Acute toxicity studies and protective effects of Cinnamon cassia bark extract in streptozotocin-induced diabetic rats.

The medicinal properties of Cinnamon cassia (C. cassia) bark have been reported for their clinical importance for many diseases including diabetes. However, there is no clear evidence so far regarding dose selection for its hepato- and nephroprotective effect in diabetic condition. Hence, the present study aims at evaluating in vitro antioxidant activity, the acute toxicity, and dose fixation of C. cassia bark for their effective medicinal values in streptozotocin (STZ)-induced rats. All the extracts exhibited potential in vitro antioxidant activity and showed a dose-dependent (1000, 2000, 3000, 4000, and 5000 mg/kg BW) acute toxicity by in vivo model. The levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), urea, and creatinine showed a significant elevation in animals treated with the highest dose. In further studies along with histopathological studies, animals treated with STZ (60 mg/kg BW) followed by a different dose (300, 400, and 500 mg/kg BW) of ethanolic extract of the C. cassia bark and glibenclamide (3 mg/kg BW) revealed that the altered level of mitochondrial enzymes, hepatic, and renal marker in STZ-induced animals were restored in C. cassia bark extract-treated group as of control. These results could be of scientific support for the use of the ethanolic extract of the C. cassia bark in folk medicine for the management of diabetes and its associated complications.

Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries.

Importance: Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids, and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown. Objective: To examine whether the associations of fish consumption with risk of CVD or of mortality differ between individuals with and individuals without vascular disease. Design, Setting, and Participants: This pooled analysis of individual participant data involved 191 558 individuals from 4 cohort studies-147 645 individuals (139 827 without CVD and 7818 with CVD) from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study and 43 413 patients with vascular disease in 3 prospective studies from 40 countries. Adjusted hazard ratios (HRs) were calculated by multilevel Cox regression separately within each study and then pooled using random-effects meta-analysis. This analysis was conducted from January to June 2020. Exposures: Fish consumption was recorded using validated food frequency questionnaires. In 1 of the cohorts with vascular disease, a separate qualitative food frequency questionnaire was used to assess intake of individual types of fish. Main Outcomes and Measures: Mortality and major CVD events (including myocardial infarction, stroke, congestive heart failure, or sudden death). Results: Overall, 191 558 participants with a mean (SD) age of 54.1 (8.0) years (91 666 [47.9%] male) were included in the present analysis. During 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major CVD (HR, 0.95; 95% CI, 0.86-1.04) or total mortality (HR, 0.96; 0.88-1.05). By contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major CVD (HR, 0.84; 95% CI, 0.73-0.96) and total mortality (HR, 0.82; 95% CI, 0.74-0.91) was lowest with intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. Fish with higher amounts of ω-3 fatty acids were strongly associated with a lower risk of CVD (HR, 0.94; 95% CI, 0.92-0.97 per 5-g increment of intake), whereas other fish were neutral (collected in 1 cohort of patients with vascular disease). The association between fish intake and each outcome varied by CVD status, with a lower risk found among patients with vascular disease but not in general populations (for major CVD, I2 = 82.6 [P = .02]; for death, I2 = 90.8 [P = .001]). Conclusions and Relevance: Findings of this pooled analysis of 4 cohort studies indicated that a minimal fish intake of 175 g (approximately 2 servings) weekly is associated with lower risk of major CVD and mortality among patients with prior CVD but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.

TB patient support systems in Kerala: A qualitative analysis.

INTRODUCTION: Tuberculosis (TB) is one of the leading causes of death due to infectious diseases in the world. Kerala a southern state in India aims to eliminate TB in the near future. In order to achieve its goal Kerala is providing various social support services to TB patients to ensure their smooth transition as they pass through the treatment cascade. Therefore, the objective of the current study was to qualitatively analyse the support systems provided for TB patients in Kerala and to assess the enablers and challenges faced during the provision of these services. METHODOLOGY: A qualitative study using grounded theory approach was carried out among TB survivors, current TB patients and healthcare workers from all 14 districts of Kerala along with district health officials. A total of 14 in depth interviews were conducted among healthcare workers from all the districts of Kerala. Three FGDs were conducted, out of which two were among TB survivors and another one among current TB patients. The data was collected till data saturation was reached. The audio recorded data was transcribed, translated, manually coded and emerging themes and sub themes were identified. Using data triangulation, conclusions were made. RESULTS: It was observed that different TB support services were being provided across all the 14 districts of Kerala. Each of these initiatives were found to be unique in their own way for bridging the gaps in the in the continuum of care provided for TB patients. The main domains identified were grouped as support services provided for getting diagnosis, services provided after diagnosis of TB, prevention of TB and support provided to the patients reaching private sector. Under each of these domains a wide range of TB support initiatives that facilitated early diagnosis, good adherence to treatment, minimising patient inconveniences, stigma reduction, prevention out of pocket expenditure and emotional support were identified. Majority of these supportive measures were found not to be uniform throughout. Those are locally customised initiatives, evolved at different time periods with common objective of patient support. Community ownership, proactive health care system and political commitment contributed to these patient support systems. CONCLUSION: These support services offered to TB patients were found to be very effective in paving the way towards the goal of TB elimination in Kerala.

The first state-level public health program for obstructive airway disease in India: An early field-level evaluation.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India; however, there are no programs for COPD in India at primary care level. Kerala became the first state in India to implement a program at primary care for COPD, called the Step Wise Approach to Airway Syndrome program. OBJECTIVE: The objective of the study was to evaluate and document the implementation status of a program for obstructive airway disease (OAD) in Trivandrum district of Kerala state in India and compare the treatment characteristics of patients with OAD seeking care from the centers implementing and not implementing this program for OADs. METHODS: A cross-sectional study was done as early evaluation of a program for OAD implemented in Kerala state, India, from October 2018 to February 2019. RESULTS: A reflection of the health-seeking behavior due to better facilities at the FHCs. There was no difference in the hospital visits or emergency department visits between the two groups. However, there was a statistically significant difference in the average number of visits per patient to health center for taking injectable drugs and visits for nebulization. Forty-nine (94%) of the COPD and 36 (100%) of the asthma patients underwent spirometry from implementing center itself. A higher proportion of patients receiving care from implementing centers (30.9%) never had to buy inhalers from outside. CONCLUSION: This is the first time that a public health programme for chronic respiratory disease management at primary care level was evaluated in India. The study has provided valuable insights on the need for strengthening the training for health care providers as well as patient education in bringing about a change in patient attitudes.

Social stigma associated with TB and HIV/AIDS among Kudumbashree members: A crosssectional study.

INTRODUCTION: TB and HIV/AIDS are the two major public health problems. Stigma and discrimination has an enormous impact on the sufferers. The impact is felt at home, in workplace, and at the institutions. The objective of the current study was to measure the stigma and discrimination associated with TB and HIV/AIDS and to determine the underlying factors related to it among women self-help group members in Kochi city Kerala. METHODS: A cross-sectional study was carried out among the women self-help group members in Kochi city. A total of 135 participants were included in the study. The study tool was a pretested self-administered questionnaire which captured information regarding the sociodemographic profile and stigma towards TB and HIV/AIDS. RESULT: All the respondents were women with mean age group 47.1(SD- 10.7). Majority (60%) belonged to APL category and were Hindus (52.1%). All the members have heard about HIV/AIDS and TB. The respondents reported that they would not send their children for playing with infected people (TB-49.3%; HIV-37.1%), would stay away from infected people (TB-84.3%; HIV-67.1%), and had discomfort while approaching those are infected (TB-62.1%; HIV-59.3%). Stigma toward TB and HIV was found not to have any association with any of the socio demographic factors. Correlation was observed between stigma scores of TB and HIV/AIDS (r = 0.853; P = <0.001). CONCLUSION: Stigma toward TB and HIV still exists as a major issue even among women self-help group members in Kochi. It was observed that those who had stigma toward TB also had stigma toward HIV/AIDS. Therefore is need to create holistic awareness about these diseases among women self-help groups.

Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study.

BACKGROUND: To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. METHODS: The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years. FINDINGS: This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5-10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. INTERPRETATION: Among adults aged 35-70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

Effect of co-sensitization of InSb quantum dots on enhancing the photoconversion efficiency of CdS based quantum dot sensitized solar cells.

The effect of co-sensitization of CdS and InSb Quantum Dots (QDs) on the enhancement of efficiency of Quantum Dots Sensitized Solar Cells (QDSSCs) has been investigated. InSb is synthesized by a facile solvothermal method using indium metal particles and antimony trichloride as precursors. From TEM images the average particle size of InSb was found to be less than 25 nm. The I-V data showed photoconversion efficiency (PCE) of 0.8% using InSb QDs as a sensitizer layer for QDSSC. However, co-sensitization of InSb QDs and CdS QDs on the TiO2 photoanode in QDSSCs showed an enhanced PCE of 4.94% compared to that of CdS sensitized solar cells (3.52%). The InSb QD layer broadens the light absorption range with reduced spectral overlap causing an improvement in light harvesting along with suppression of surface defects which reduced the recombination losses. As a result, co-sensitized TiO2/CdS/InSb QDSSC exhibits a greatly improved PCE of 4.94%, which is 40% higher than that of TiO2/CdS (3.52%) based QDSSCs due to improved light absorption with low recombination losses.