Prevalence of ixodid ticks on goats and risk factors for tick-borne diseases in humans in the Kyasanur forest disease endemic area of Kerala, India.

In India, tick-borne diseases are prevalent in many states due to the presence of tick vectors. However, information on disease-causing ticks from domestic animals and the associated risk factors for residents living in the disease-endemic area is lacking. Therefore, we conducted this study to identify ixodid ticks in goats and human risk factors in three villages of the Wayanad district of Kerala. We examined 202 goats and collected 741 ticks, of which 69.8% were ticks belonging to the genus Haemaphysalis. The maximum number of ticks was collected from Thirunelli (81.3%), followed by Noolpuzha (76.27%) and Pulpally (45.6%). Overall, H. bispinosa Neumann, 1897 (54.6%), was the most common species, followed by H. turturis Nuttall and Warburton, 1915 (38.0%), H. spinigera Neumann, 1897 (5.4%), and H. intermedia Warburton and Nuttall, 1909 (1.8%). We included 428 participants (men and women) in this study. The average age of the respondents was 43 years. We found significant associations between accessing the forest for cattle grazing and other activities and tick-borne diseases (χ2 = 9.5, p = 0.002), between workers who were bitten by ticks and tick-borne diseases (χ2 = 3.8, p = 0.05), and between number of tick bites per day > 6 and tick-borne diseases (χ2 = 12.1, p = 0.001). The high frequency of Haemaphysalis spp. found in goats highlighted the risk of tick exposure and tick-borne diseases, such as Kyasanur forest disease in humans, and the need for the development and implementation of effective measures to control ticks.

Preliminary survey on the distribution of Ixodid ticks in domestic ruminants and vegetation of Pathanamthitta district, Kerala, South India.

BACKGROUND OBJECTIVES: Tick borne diseases (TBD) are becoming a major public and animal health problem in the Kerala. Recently, during 2021 - 2022, a new focus of tick nuisance and associated fever has been reported in some villages of Pathanamthitta district. METHODS: The study on the diversity of tick fauna in Southern Kerala is limited. Therefore, a preliminary survey was carried out for the first time in this focus for implementation of future tick borne pathogen detection and control measures. This research may provide a proper understanding of tick density and acarological risk by tick ecology through surveillance and identification. A cross sectional study was conducted during the summer season of 2021 and 2022 in the tick bite infected area - Naduvathumoozhy, Vayakkara, Malayalappuzha and Pallikuzhi. RESULTS: Ticks were manually collected from ruminants and by dragging method from vegetation. A total of 727 ticks of 8 different species were collected from the genus Amblyomma, Haemaphysalis, Hyalomma, and Rhipicephalus. The most prevalent species were H. bispinosa and H.turturis, at 38.7% and 29.1%, respectively. Ticks were sampled from 197 animals with the proportion of infestation being 73.60%. It was highest in goats (85.9%), followed by buffalo (73.6%) and cow (65.4%). INTERPRETATION CONCLUSION: The study concludes that, despite the absence of any TBD outbreaks, the Pathanamthitta district has a high diversity of tick fauna and a high rate of tick infestation in domestic ruminants, especially in goats. Hence active tick surveillance is necessary in order to prevent TBD outbreaks in future; the study also emphasizes the importance of performing tick surveillance in both KFD endemic and non-endemic regions.

Influence of environmental factors on tick diversity and abundance in different animal resting habitats in forest areas of the south Western Ghats.

Most tick-borne disease causing pathogens originate in wildlife and are zoonotic in nature. A key to protecting human and animal health is to understand the biology and ecology of tick establishment. The tick distribution in wild animal habitats has been attributed to multiple environmental factors, and the studies on this topic are limited. Therefore, the objective of the study is to understand the influence of environmental factors on tick diversity and abundance in wild animal resting habitats. The study was carried out in 21 different animal resting habitats in the forest areas of Wayanad district, and they were divided into three groups based on the presence or absence of selected environmental parameters. A total of 10,849 ticks with 12 species belonging to five genera were collected. Regardless of the type of habitats, Haemaphysalis spinigera (59.52%) and Haemaphysalis turturis (33.20%) were the dominant species. Tick abundance showed greater variability between types of habitats ranging from 1.23 to 28.5. The greatest diversity and abundance were found in the group one. The group 3 had greater diversity and less abundance than the group 2. Both Simpson's diversity index and Shannon's diversity index were high for groups 2. Substantial variation in diversity and abundance of ticks occurred in different groups based on different environmental factors. The dominance of ticks of the genus Haemaphysalis a primary vector of Kyasanur Forest Disease highlights the need to carry out various control strategies to reduce the tick population.

Detection of Nipah virus in Pteropus medius in 2019 outbreak from Ernakulam district, Kerala, India.

BACKGROUND: In June 2019, Nipah virus (NiV) infection was detected in a 21-year-old male (index case) of Ernakulum, Kerala, India. This study was undertaken to determine if NiV was in circulation in Pteropus species (spp) in those areas where the index case had visit history in 1 month. METHODS: Specialized techniques were used to trap the Pteropus medius bats (random sampling) in the vicinity of the index case area. Throat and rectal swabs samples of 141 bats along with visceral organs of 92 bats were collected to detect the presence of NiV by real-time reverse transcriptase-polymerase chain reaction (qRTPCR). Serum samples of 52 bats were tested for anti-NiV Immunoglobulin (Ig) G antibodies by Enzyme-Linked Immunosorbent Assay (ELISA). The complete genome of NiV was sequenced by next-generation sequencing (NGS) from the tissues and swab samples of bats. RESULTS: One rectal swab sample and three bats visceral organs were found positive for the NiV. Interestingly, 20.68% (12/58) of Pteropus were positive for anti-NiV IgG antibodies. NiV sequences of 18,172; 17,200 and 15,100 nucleotide bps could be retrieved from three Pteropus bats. CONCLUSION: A distinct cluster of NiV sequences, with significant net-evolutionary nucleotide divergence, was obtained, suggesting the circulation of new genotype (I-India) in South India. NiV Positivity in Pteropus spp. of bats revealed that NiV is circulating in many districts of Kerala state, and active surveillance of NiV should be immediately set up to know the hotspot area for NiV infection.

The species distribution of ticks & the prevalence of Kyasanur forest disease virus in questing nymphal ticks from Western Ghats of Kerala, South India.

Background & objectives: Kyasanur forest disease (KFD) is a zoonotic tick-borne disease across the Western Ghats of India. With the discovery of a cluster of human KFD cases in the Wayanad district of Kerala, the present study was focused on detecting KFD virus (KFDV) in tick populations. To manage this disease, it is necessary to understand the diversity of the tick species and factors influencing the distribution, abundance and prevalence of infected ticks in Wayanad district. Methods: Surveys were conducted from November 2016 to May 2018 in four forest ranges of Wayanad district. Ticks were collected by the dragging method and were identified to species level and assayed for virus detection using real-time polymerase chain reaction. Results: A total of 25,169 ticks were collected from 64 sites. Of the identified species, Haemaphysalis spinigera was the most abundant (56.64%), followed by H. turturis 9047 (35.94%), H. bispinosa 999 (3.96%), Amblyomma integrum 691 (2.74%), H. kyasanurensis (0.55%), Rhipicephalus sanguineus (0.08%), Hyalomma marginatum (0.02%), H. cuspidata (0.01%), R.microplus (0.01%) and Dermacentor auratus (0.003%). The nymphal stage was predominant from December to February having peak activity in January. A total of 572 pools were screened for the presence of KFDV, of which 21 pools were positive. The infection rates in H. spinigera and H. turturis tick were 2.62 and 1.04 per cent, respectively. Interpretation & conclusions: The circulation of KFDV was detected and its correlation with the prevalence in ticks near the fragmented forest and teak plantation areas of Wayanad district. Residents and visitors of these regions may become vulnerable to tick bites and to an increased risk of KFD as the distribution of established, infected tick populations continues to expand.

Ecology of breeding habitats of mosquito population and screening for virus of Japanese encephalitis and West Nile in the coastal area of Kerala, India.

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE) and West Nile virus (WNV) are two mosquito-borne diseases of medical and veterinary importance. Climate impacts in certain ecosystems are better understood; however, coastal brackish water ecosystems and their role in vector borne viral diseases have not been well studied. Hence, the aim of this study is to evaluate the distribution, spatial pattern as well as the screening of these mosquitoes for JE and WN virus in coastal area of Alappuzha district, Kerala, India. METHODS: Immature mosquitoes were collected using dipper methods along the coastal wetlands areas. Adult mosquitoes were collected in four sampling sites with light trap filled with dry ice, operating overnight. The collected mosquitoes were identified by species, using the taxonomic keys. Mosquitoes were pooled for virus detection. Water samples were collected using standard methods. RESULTS: The total quantity of rainfall and salinity varied from zero to 365.2 mm and from 1.5 to 28 ppt respectively. A total of 10,695 adult mosquitoes and 38,083 immatures revealed the presence of five genus and 23 species. The most predominant species was Culex tritaeniorhynchus. Immature collections Cx. sitiens was the only one species collected during the summer season and in the monsoon season the pond was replaced by fresh water mosquitoes such as Cx. tritaeniorhynchus and Cx. gelidus. A total of 186 pools were screened for JEV and WNV. However, none of the pools were found as positive for the virus. INTERPRETATION & CONCLUSION: The major vector of JEV Cx. tritaeniorhynchus and Cx. gelidus have adapted to immature development in coastal brackish water habitats. The public health authorities need to recognize thepotential impact on human health of brackish water-adapted mosquito vectors that weretraditionally considered to be freshwater species, and take appropriate surveillance and control measures.

Detection of coronaviruses in Pteropus & Rousettus species of bats from different States of India.

Background & objectives: Bats are considered to be the natural reservoir for many viruses, of which some are potential human pathogens. In India, an association of Pteropus medius bats with the Nipah virus was reported in the past. It is suspected that the recently emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also has its association with bats. To assess the presence of CoVs in bats, we performed identification and characterization of bat CoV (BtCoV) in P. medius and Rousettus species from representative States in India, collected during 2018 and 2019. Methods: Representative rectal swab (RS) and throat swab specimens of Pteropus and Rousettus spp. bats were screened for CoVs using a pan-CoV reverse transcription-polymerase chain reaction (RT-PCR) targeting the RNA-dependent RNA polymerase (RdRp) gene. A single-step RT-PCR was performed on the RNA extracted from the bat specimens. Next-generation sequencing (NGS) was performed on a few representative bat specimens that were tested positive. Phylogenetic analysis was carried out on the partial sequences of RdRp gene sequences retrieved from both the bat species and complete viral genomes recovered from Rousettus spp. Results: Bat samples from the seven States were screened, and the RS specimens of eight Rousettus spp. and 21 Pteropus spp. were found positive for CoV RdRp gene. Among these, by Sanger sequencing, partial RdRp sequences could be retrieved from three Rousettus and eight Pteropus bat specimens. Phylogenetic analysis of the partial RdRp region demonstrated distinct subclustering of the BtCoV sequences retrieved from these Rousettus and Pteropus spp. bats. NGS led to the recovery of four sequences covering approximately 94.3 per cent of the whole genome of the BtCoVs from Rousettus bats. Three BtCoV sequences had 93.69 per cent identity to CoV BtRt-BetaCoV/GX2018. The fourth BtCoV sequence was 96.8 per cent identical to BtCoV HKU9-1. Interpretation & conclusions: This study was a step towards understanding the CoV circulation in Indian bats. Detection of potentially pathogenic CoVs in Indian bats stresses the need for enhanced screening for novel viruses in them. One Health approach with collaborative activities by the animal health and human health sectors in these surveillance activities shall be of use to public health. This would help in the development of diagnostic assays for novel viruses with outbreak potential and be useful in disease interventions. Proactive surveillance remains crucial for identifying the emerging novel viruses with epidemic potential and measures for risk mitigation.

Bioinformatics characterization of envelope glycoprotein from Kyasanur Forest disease virus.

BACKGROUND & OBJECTIVES: Kyasanur Forest disease (KFD) is a febrile illness characterized by haemorrhages and caused by KFD virus (KFDV), which belongs to the Flaviviridae family. It is reported to be an endemic disease in Shimoga district of Karnataka State, India, especially in forested and adjoining areas. Several outbreaks have been reported in newer areas, which raised queries regarding the changing nature of structural proteins if any. The objective of the study was to investigate amino acid composition and antigenic variability if any, among the envelope glycoprotein (E-proteins) from old and new strains of KFDV. METHODS: Bioinformatic tools and techniques were used to predict B-cell epitopes and three-dimensional structures and to compare envelope glycoprotein (E-proteins) between the old strains of KFDV and those from emerging outbreaks till 2015. RESULTS: The strain from recent outbreak in Thirthahalli, Karnataka State (2014), was similar to the older strain of KFDV (99.2%). Although mutations existed in strains from 2015 in Kerala KFD sequences, these did not alter the epitopes. INTERPRETATION & CONCLUSIONS: The study revealed that though mutations existed, there were no drastic changes in the structure or antigenicity of the E-proteins from recent outbreaks. Hence, no correlation could be established between the mutations and detection in new geographical areas. It seems that KFDV must be present earlier also in many States and due to availability of testing system and alertness coming into notice now.

Medical Image Security Using Dual Encryption with Oppositional Based Optimization Algorithm.

Security is the most critical issue amid transmission of medical images because it contains sensitive information of patients. Medical image security is an essential method for secure the sensitive data when computerized images and their relevant patient data are transmitted across public networks. In this paper, the dual encryption procedure is utilized to encrypt the medical images. Initially Blowfish Encryption is considered and then signcryption algorithm is utilized to confirm the encryption model. After that, the Opposition based Flower Pollination (OFP) is utilized to upgrade the private and public keys. The performance of the proposed strategy is evaluated using performance measures such as Peak Signal to Noise Ratio (PSNR), entropy, Mean Square Error (MSE), and Correlation Coefficient (CC).

Biosynthesis of gold nanoparticles and related cytotoxicity evaluation using A549 cells.

Biosynthesis of gold nanoparticles (AuNPs) has become an attractive area of research as it is environmentally benign. The toxicity of AuNPs synthesized by chemical routes has been widely studied. However, little is known about the toxicity associated with the biological synthesis of AuNPs. The present study was carried out to synthesize AuNPs using star anise (Illicium verum; a commercially available spice in abundance)and evaluate its toxicity using human epithelial lung cells (A549) in comparison with AuNPs synthesized by the traditional chemical methods (using sodium citrate and sodium borohydride). Apart from cell viability, markers of oxidative stress (reduced glutathione) and cell death (caspases) were also evaluated to understand the mechanisms of toxicity. Cell viability was observed to be 65.7 percent and 72.3 percent in cells exposed to chemically synthesized AuNPs at the highest dose (200nM) as compared to 80.2 percent for biologically synthesized AuNPs. Protective coating/capping of AuNPs by various polyphenolic compounds present in star anise extract appears to be a major contributor to lower toxicity observed in biologically synthesized AuNPs.

Is biosorption suitable for decontamination of metal-bearing wastewaters? A critical review on the state-of-the-art of biosorption processes and future directions.

For the past few decades, biosorption has been widely investigated for the removal of different contaminants in aqueous media. A number of biomasses of different genre have been identified to possess good biosorption capacity. Insights into biosorption mechanisms have been provided by various researchers in order to develop a fundamental scientific understanding of the biosorption process. However, biosorption has not been employed widely for its large-scale commercial applications. The key factors that affect the growth and evolution of biosorption as a practical technology for decontamination of wastewaters include, (1) lack of investigations on multi-component solutions and wastewaters with complex matrix effects, (2) incomplete understanding of physico-chemical characteristics of biomasses of different types, (3) lack of studies to improve the performance of biosorbents through surface functionalization, and (4) non-integration of biosorption in wastewater/water treatment plants. This critical review aims to identify and discuss the practical limitations of biosorption and provide future research directions to make biosorption a technologically viable process with emphasis on selection and modification of biomasses to suit desired treatment applications, identify appropriate operation modes for large-scale applications of biosorption, and perform techno-economic evaluation of overall biosorption processes.

Effects of rainfall and salinity increase on prevalence of vector mosquitoes in coastal areas of Alappuzha district, Kerala.

Seasonal abundance patterns for Japanese encephalitis vectors along climatic variations were studied in the coastal areas of Alappuzha district from June 2012 to May 2013. A total of 10563 female mosquitoes belonging to eleven species were collected. Culex gelidusTheobald (50.04%), Cx. tritaeniorhynchus Giles (26.50%), and Cx. sitiens Wiedemann (7.55%) were found to be most common in these areas. Cx. sitiens females were collected from each sampling occasion from early monsoon season June to late summer May with a distinct peak in April at 7.18 electrical conductivity (EC). Cx. sitiens abundance increased rapidly when monthly salinity level consistently exceeded 7.76, occurring in March at 7.76 and April at 7.18 electrical conductivity (EC). While analyzing correlation of Cx. sitiens density with salinity and rainfall was significant. High density of Cx. gelidus was greatly influenced by total rainfall and it was found to be significantly correlated with Per Man Hour (PMH) (P < 0.05), whereas salinity was inversely correlated with mosquito density (P < 0.001). The abundance of Cx. tritaeniorhynchus was lowest in June (rainy season) and increased in October, with densities increasing sharply during summer season in April (83 PMH). During summer, due to increased salinity Cx. sitiens density increased. These areas may develop in to brackish and saline water populated by Cx. sitiens, which can be new vectors for Japanese encephalitis or West Nile virus in these areas.

The clinical spectrum of de novo donor-specific antibodies in pediatric renal transplant recipients.

The development of donor-specific HLA antibodies (DSA) is associated with worse renal allograft survival in adult patients. This study assessed the natural history of de novo DSA, and its impact on renal function in pediatric renal transplant recipients (RTR). HLA antibodies were measured prospectively using single-antigen-bead assays at 1, 3, 6 and 12 months posttransplant followed by 12-monthly intervals and during episodes of allograft dysfunction. Of 215 patients with HLA antibody monitoring, 75 (35%) developed DSA at median of 0.25 years posttransplant with a high prevalence of Class II (70%) and HLA-DQ (45%) DSA. DSA resolved in 35 (47%) patients and was associated with earlier detection (median, inter-quartile range 0.14, 0.09-0.33 vs. 0.84, 0.15-2.37 years) and lower mean fluorescence intensity (MFI) (2658, 1573-3819 vs. 7820, 5166-11 990). Overall, DSA positive patients had more rapid GFR decline with a 50% reduction in GFR at mean 5.3 (CI: 4.7-5.8) years versus 6.1 (5.7-6.4) years in DSA negative patients (p = 0.02). GFR decreased by a magnitude of 1 mL/min/1.73 m(2) per log10 increase in Class II DSA MFI (p < 0.01). Using Cox regression, independent factors predicting poorer renal allograft outcome were older age at transplant (hazard ratio 1.1, CI: 1.0-1.2 per year), tubulitis (1.5, 1.3-1.8) and microvasculature injury (2.9, 1.4-5.7). In conclusion, pediatric RTR with de novo DSA and microvasculature injury were at risk of allograft failure.

Evaluation of shear bond strength of zirconia bonded to dentin after various surface treatments of zirconia.

UNLABELLED: Establishing a reliable bond of resin cement to zirconia based materials has been a major limitation against zirconia restoration. PURPOSE OF STUDY: This study evaluated the shear bond strength of zirconia bonded to dentin specimens using a self etch dual cure resin cement after various surface treatments of zirconia. Twenty zirconia rods (3 × 2.5 mm) were prepared from zirconia blocks and assigned into 5 groups for the following surface treatments. (1) Group I: Control (C) no treatment (2) Group II: airborne-particle abrasion (APA), (3) Group III: hydrofluoric acid etching (HF), (4) Group IV: hydrofluoric acid etching followed by silanation (HF/S), and (5) Group V: application of zirconia primer (Z). Dentin Specimens were prepared from extracted molars stored in 0.5% chloramine-T. Zirconia rods were bonded to dentin using resin cement (Multilink Speed), then light polymerized. The specimens tested for failure were tested using the notched shear bond test method in a universal loading apparatus. One way ANOVA followed by Tukey HSD for cell means were used to analyze the data (=0.05). The highest values were obtained with group V (Z) (8.66 MPa) followed by group II (APA) (6.71 MPa), and group IV (HF/S) (4.41 MPa). The least values were obtained for group III (HF) (3.88 MPa) with no significant difference (P value 0.53) between group III (HF) (3.88 MPa) and group I (C) (3.70 MPa). Among the surface treatments employed in this study zirconia primer application is a practical procedure to improved bond strength of zirconia to resin cement followed by Airborne Particle Abrasion with 50 µm Al2O3 particles.

Surveillance of Nipah virus in Pteropus medius of Kerala state, India, 2023.

Introduction: Since 2018, the Indian state of Kerala has reported four Nipah virus (NiV) disease outbreaks, raising concerns about NiV spillover from bats to the human population. Considering this, a cross-sectional study was undertaken in the Pteropus medius bat population around the Nipah virus-affected regions of Kozhikode, Kerala, India, during February, July, and September 2023. Methods: Throat swabs, rectal swabs, and organ samples were collected from bats to test for NiV using the real-time reverse transcriptase polymerase chain reaction (RT-PCR), while serum samples were screened for anti-Nipah IgG antibodies through ELISA. Results: An overall seroprevalence of 20.9% was observed in 272 P. medius bats tested. The throat and rectal swab samples of 321 bats were negative for NiV RNA. However, 4 of 44 P. medius bats tested positive for NiV in their liver/spleen samples. The partial N gene retrieved showed more than 99% similarity with the earlier reported NiV genome from Kerala state, India. Discussion: The findings of the study caution that there is a spillover risk in the region and necessary precautions should be taken.

Evaluation of dimensional stability and accuracy of autoclavable polyvinyl siloxane impression material.

Dimensionally stable autoclavable impressions will be effective in controlling the cross-infection and contamination caused by patient's saliva and other oral secretions. The accuracy of newly introduced autoclavable polyvinyl siloxane impression material was assessed for its dimensional stability and accuracy. A standard metal model (Dentoform, U-501, Columbia) was customised for impression making. The impressions were made using the newly introduced polyvinyl siloxane impression materials (AFFINIS, Coltene/Whaledent AG, 9450 Alstalten, Switzerland). Fifty impressions were made and were divided into two groups A and B of 25 each. Group A was the control sample (non-autoclaved impressions) and group B was the test sample (autoclaved impressions), which was subjected to the steam autoclave procedure at 134 °C for 18 min, casts were poured in type IV gypsum products. The customised metal model, casts obtained from control and test group were subjected to laboratory evaluation with help of a travelling microscope (×10 magnification), and digital vernier calliper (0.01 mm/10 µm accuracy). Data analysis was done using one-way ANOVA and One-Sample t test to evaluate the overall accuracy (P < 0.005). As a result, there was an average reduction of 0.016 µm in overall dimension between the test and the control group when compared with the master model, which is not statistically or clinically significant. The newly introduced polyvinyl siloxane impression material is accurate and dimensional stable for clinical use when steam autoclaved at 134 °C for 18 min.

Pressure produced on the residual maxillary alveolar ridge by different impression materials and tray design: an in vivo study.

Increased ridge resorption may occur due to inappropriate pressure applied during final impression making phase of complete denture fabrication. This study was done to evaluate the pressure applied on the residual ridge while making impressions with two tray designs (with and without spacer) using, zinc oxide eugenol and light body polyvinyl siloxane impression material. Five edentulous subjects were randomly selected. For each of the five subjects four maxillary final impressions were made and were labelled as, Group A-Impression made with tray without spacer using zinc oxide eugenol impression, Group B-Impression made with tray with spacer using zinc oxide eugenol impression material, Group C-Impression made with tray without spacer using light body polyvinyl siloxane impression material, Group D-Impression made with tray with spacer using light body polyvinyl siloxane impression material. During the impression procedure a closed hydraulic system was used to remotely measure the pressures produced in three areas. The pressure produced were calibrated according to the micro strain record. Statistical comparisons of readings were done using t test and ANOVA. The acquired data revealed that ZOE produced an average pressures value of 26.534 and 72.05 microstrain, while light body PVS produced 11.430 and 37.584 microstrain value with and without spacer respectively. Significantly high values were recorded on the vault of the palate when using trays without spacer. The use of light body polyvinyl siloxane and zinc oxide eugenol impression material showed insignificant difference. Within the limitations of this study, tray design has a significantly effected on the pressures produced, while the impression materials does not have any significant difference.

Role and relevance of risk stratification models in the modern-day management of non-ST elevation acute coronary syndromes.

We summarise the international guidelines surrounding risk stratification as well as discuss new emerging data for future development of a new risk model in the management of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS accounts for the bulk of acute coronary syndrome presentations in the UK, but management strategies in this group of patients have remained a subject of debate for decades. Patients with NSTE-ACS represent a heterogeneous population with a wide variation in short-term and long-term clinical outcomes, which makes a uniform, standardised treatment approach ineffective and inappropriate. Studies in the modern era have provided some guidance in treating this subset of patients: the provision of early, more potent therapies has been shown to improve outcomes in patients at a particularly elevated risk of adverse outcomes. International guidelines recommend adopting an individualised treatment approach through the use of validated risk prediction models to identify such patients at high risk of adverse outcomes. The present available evidence, however, is based on dated demographics, different diagnostic thresholds and outdated therapies. In particular, the evidence has limited applicability to female patients and older people with frailty. Moreover, the current risk models do not capture key prognostic variables, leading to an inaccurate estimation of patients' baseline risk and subsequent mistreatment. Therefore, the current risk models are no longer fit for purpose and there is a need for risk prediction scores that account for different population demographics, higher sensitivity troponin assays and contemporary treatment options.

A cross-sectional study on determinants of indoor air pollution and its perceived impact among the residents of urban field practice area of AMCH, Salem, Tamil Nadu.

Background: Over the past 20 years, indoor air pollution (IAP) has received much attention as the quality of the indoor air is affected a lot. IAP means the presence of substances which are redundant in the indoor air at concentrations toxic to health. Very few studies have addressed the determinants of indoor air pollutants in places like urban slum areas in Tamil Nadu. To reduce this research gap, this study has been undertaken. Aim: To study the determinants of IAP and its perceived impact on health. Settings and Design: This was a community-based cross-sectional study. Complete information from 440 households consisting of 1606 individuals was collected through a semi-structured questionnaire. Materials and Methods: Residents of an urban field practice area of Annapoorana Medical College and Hospitals (AMCH) were the study participants. The study period was from April 19 to March 2020. The study area was an urban field practice area around Department of Community Medicine, Karungalpatty, AMCH. Frequency, proportions, and Spearman test were used to find out the significance between various household environmental conditions and the respiratory diseases using Epi Info software. Results: Results showed that 52.3% of the participants were using incense sticks at home in the evening during pooja and 17.7% of the houses were using mosquito coil in the evening and at night. Also, 29.5% houses reported overcrowding and 66.4% of the houses were not having chimney or exhaust. Results also showed that 71.4% households were practicing opening their windows while cooking. One hundred and fifty-two (34.5%) female respondents had perceived the symptoms like dizziness (12.3%), eye irritation (10.2%), difficulty in breathing (4.5%), dry cough (3.06%), running nose (1.4%), and nasal congestion (1.1%) due to IAP. Among under-five respondents, 1.6% reported having acute respiratory infections in the last 15 days and 10.5% reported the same in the last 1 year 10.5%.

Serosurvey for Nipah virus in bat population of southern part of India.

Nipah virus (NiV) is one of the priority pathogens with pandemic potential. Though the spread is far slower than SARS-CoV-2, case fatality is the biggest concern. Fruit bats belonging to genus Pteropus are identified to be the main reservoir of the virus causing sporadic cases and outbreaks in Malaysia, Bangladesh and India. The sudden emergence of Nipah in Kerala, India during 2018-2019 has been astonishing with respect to its introduction in the unaffected areas. With this, active Nipah virus surveillance was conducted among bat populations in Southern part of India viz., Karnataka, Kerala, Tamil Nadu, Telangana, Puducherry and Odisha during January-November 2019. Throat swabs/rectal swabs (n = 573) collected from Pteropus medius and Rousettus leschenaultii bat species and sera of Pteropus medius bats (n = 255) were screened to detect the presence of Nipah viral RNA and anti-Nipah IgG antibodies respectively. Of 255 P. medius bats sera samples, 51 bats (20%) captured from Karnataka, Kerala, Tamil Nadu and Puducherry demonstrated presence of anti-Nipah IgG antibodies. However, the presence of virus couldn't be detected in any of the bat specimens. The recent emergence of Nipah virus in Kerala in September 2021 warrants further surveillance of Nipah virus among bat populations from the affected and remaining states of India.