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OBJECTIVES: To analyse the donor characteristics and understand the sociocultural and familial aspects of the decision to donate for living donor liver transplant. METHODS: This is a retrospective study done in the Department of Pediatric Gastroenterology and Hepatology of a liver transplant centre. We enrolled the consenting donors of pediatric liver transplantation between January 2020 and January 2022. The study was conducted through an anonymized questionnaire which was drafted in a multiple-choice format. The questionnaire had three domains having questions pertaining to demographic details, donor characteristics and sociofamilial aspects of the decision-making process. RESULTS: The study cohort consisted of 50 donors, 23 males (46%) and 27 females (54%), with the mean age being 31.8 ± 5.6 years. Parent-to-child was the most frequent relationship (n = 39, 78%). More than half of our donors had annual income <2.5 lakh/annum or <3500 USD (n = 27, 54%). Twenty-six (52%) responders had >4 members in their family; 62% were residing in urban areas and 52% of the donors were graduates. The main source of information regarding the feasibility of living donor liver transplantation was primary physicians in 46%. Financial management was the main hurdle in 72%. Majority (74%) denied any effect on their marital relationship and 6% of donors thought that the degree of information provided to them before the transplantation regarding donation was insufficient. CONCLUSION: Our study serves as an essential tool for health professionals to provide sufficient support to the donor. Clinical outcomes and cost must be part of the discussion between caregivers, health professionals and fund contributors.
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Transplante de Fígado , Masculino , Feminino , Humanos , Criança , Adulto , Estudos Retrospectivos , Doadores Vivos , Inquéritos e QuestionáriosRESUMO
The prevalence of both Obesity and Asthma is increasing worldwide. Various epidemiological data has linked obesity with the development and severity of asthma in children. The aim of this study was to assess if any relationship exists between obesity and asthma in children. The study population included school children aged 5 to 18 years. A total of 320 asthma cases and 300 controls were included in our study. Association analysis of obesity and asthma based on epidemiological basis was measured. Out of 320 cases, 61 children were found to have moderate persistent asthma. Out of 61 moderate persistent asthma cases, 50 children were selected randomly and divided into two groups. Group I included 25 obese moderate persistent asthmatics and Group II included 25 non-obese moderate persistent asthmatics. Forced expiratory volume in one second (FEV1), Forced vital capacity (FVC), Forced expiratory flow (FEF25-75%), Peak expiratory flow (PEF) were measured with spirometry and Peak expiratory flow meter. Statistical analysis was done by Odds ratio and p value. Out of 320 cases, 97 were obese and 223 were non-obese. Out of 300 controls, 46 were obese and 254 were non-obese. Exposure rate for cases and controls were 30.31% and 15.33% respectively. Odds ratio was 2.40. χ2 value was 19.56 with p value < 0.05.FEV1, FVC, FEF25-75%, PEF for Group-1 were 66.3 ± 9.9, 63.5 ± 4.2, 54.2 ± 5.7, 67.4 ± 8.4 respectively and FEV1, FVC, FEF25-75%, PEF for Group-2 were 74.07 ± 3.5, 77.4 ± 7.2, 60.1 ± 2.1, 71.6 ± 2.4 respectively and p values were < 0.001, < 0.001, < 0.001, < 0.05 respectively which is statistically significant. Children who are obese are more likely to develop severe asthma than those who were not obese.
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Asma , Obesidade Infantil , Adolescente , Asma/complicações , Asma/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Volume Expiratório Forçado , Humanos , Índia/epidemiologia , Obesidade Infantil/complicações , Obesidade Infantil/epidemiologia , Estudantes/estatística & dados numéricosRESUMO
The original publication of the article [1] unfortunately contain mistakes. The quotations from various sources [2-6] in the Discussion section should have been embraced by quotation marks.
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Sphaerulina musiva, the causal agent of Septoria leaf spot and stem canker, is responsible for mortality and yield loss in Populus plantations. However, little is known about the mode of infection and the mechanisms of resistance in this pathosystem. To characterize these phenomena, microscopic, biochemical, and transcriptome comparisons were performed between leaves of moderately resistant and susceptible genotypes of Populus inoculated with S. musiva conidia. Using scanning electron, cryofracture, and laser-scanning confocal microscopy, the infection and colonization of Populus leaves by S. musiva were examined across five time points (48 h, 96 h, 1 week, 2 weeks, and 3 weeks). The infection process was similar regardless of the host genotype. Differences in host colonization between susceptible and moderately resistant genotypes were apparent by 1 week postinoculation. However, the germination of conidia was greater on the susceptible than on the moderately resistant genotype (P < 0.008). Diaminobenzidine staining, a measure of hydrogen peroxide accumulation, was different (P < 0.001) between the host genotypes by 2 weeks postinoculation. Transcriptome differences between genotypes indicated that the speed and amplitude of the defense response were faster and more extensive in the moderately resistant genotype. Changes in gene expression support the microscopic and biochemical observations.
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Ascomicetos , Resistência à Doença , Populus , Ascomicetos/fisiologia , Resistência à Doença/genética , Genótipo , Doenças das Plantas/microbiologia , Folhas de Planta/microbiologia , Populus/genética , Populus/microbiologia , TranscriptomaRESUMO
Eliminating malnutrition remains an imminent priority in our efforts to achieve food security and providing adequate calories, proteins, and micronutrients to the growing world population. Malnutrition may be attributed to socio-economic factors (poverty and limited accessibility to nutritional food), dietary preferences, inherent nutrient profiles of traditional food crops, and to a combination of all such factors. Modern advancements in "omics" technology have made it possible to reliably predict, diagnose, and suggest ways to remedy the low protein content and bioavailability of key micronutrients in food crops. In this review, we briefly describe how proteomics techniques can potentially be used for improving the nutrient profile of major crops, through high throughput multiplexed assays. Food safety is another important issue where proteomics and related platforms can offer solution for absolute quantitation of food allergens and mycotoxins present in the plant-based food. The purpose of the present review is to discuss the proteomic-based strategies in food crops to meet the challenges of overcoming malnutrition throughout the world.
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Agricultura/métodos , Produtos Agrícolas/química , Produtos Agrícolas/crescimento & desenvolvimento , Inocuidade dos Alimentos/métodos , Valor Nutritivo , Proteômica/métodos , Alérgenos/análise , Proteínas de Plantas/análiseRESUMO
Down syndrome (DS) is one of the commonest disorders with huge medical and social cost. DS is associated with number of phenotypes including congenital heart defects, leukemia, Alzeihmer's disease, Hirschsprung disease etc. DS individuals are affected by these phenotypes to a variable extent thus understanding the cause of this variation is a key challenge. In the present review article, we emphasize an overview of DS, DS-associated phenotypes diagnosis and management of the disease. The genes or miRNA involved in Down syndrome associated Alzheimer's disease, congenital heart defects (AVSD), leukemia including AMKL and ALL, hypertension and Hirschprung disease are discussed in this article. Moreover, we have also reviewed various prenatal diagnostic method from karyotyping to rapid molecular methods - MLPA, FISH, QF-PCR, PSQ, NGS and noninvasive prenatal diagnosis in detail.
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Síndrome de Down/diagnóstico , Síndrome de Down/genética , Diagnóstico Pré-Natal , Doença de Alzheimer/complicações , Doença de Alzheimer/genética , Síndrome de Down/complicações , Síndrome de Down/terapia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/genética , Doença de Hirschsprung/complicações , Doença de Hirschsprung/genética , Humanos , Hipertensão/complicações , Hipertensão/genética , Cariotipagem , Leucemia/complicações , Leucemia/genética , MicroRNAs/genética , FenótipoRESUMO
AIMS: Several observational studies have investigated the association between hypertension or elevated systolic blood pressure and diastolic blood pressure and risk of heart failure, but not all the studies have been consistent. This systematic review and meta-analysis aimed to summarize the available data from cohort studies on the association between hypertension, systolic and diastolic blood pressure, and the risk of heart failure. METHODS AND RESULTS: PubMed and Embase databases were searched for relevant articles from inception to 10 June 2022. Cohort studies on hypertension or blood pressure and heart failure were included. Random effect models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between hypertension or blood pressure and heart failure. Forty-seven cohort studies were included. The summary RR was 1.71 (95% CI: 1.53-1.90, I2 = 98.4%) for hypertension vs. no hypertension (n = 43 studies, 166 798 cases, 20 359 997 participants), 1.28 (95% CI: 1.22-1.35, I2 = 90.3%) per 20â mmHg of systolic blood pressure (24 studies, 31 639 cases and 2 557 975 participants), and 1.12 (95% CI: 1.04-1.21, I2 = 92.6%) per 10â mmHg of diastolic blood pressure (16 studies, 23 127 cases and 2 419 972 participants). There was a steeper increase in heart failure risk at higher blood pressure levels and a three- to five-fold increase in RR at around 180/120â mmHg of systolic and diastolic blood pressure compared with 100/60â mmHg, respectively. There was little indication of publication bias across analyses. CONCLUSION: This meta-analysis suggests a strong positive association between hypertension and systolic and diastolic blood pressure and the risk of heart failure. These results support efforts to reduce blood pressure in the general population to reduce the risk of heart failure.
Hypertension is associated with a 71% increase in the risk of heart failure. A 20â mmHg increment in systolic blood pressure is associated with a 28% increment in heart failure risk, and a 10â mmHg increment in diastolic blood pressure is associated with a 12% increase in heart failure risk. The results support public health policies and interventions to reduce the prevalence of elevated blood pressure (e.g. through lifestyle changes and medication use).
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Insuficiência Cardíaca , Hipertensão , Humanos , Pressão Sanguínea/fisiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Estudos de Coortes , SístoleRESUMO
The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage.
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Análise Custo-Benefício , Potenciais Evocados Auditivos do Tronco Encefálico , Testes Auditivos , Triagem Neonatal , Humanos , Índia , Triagem Neonatal/economia , Recém-Nascido , Testes Auditivos/economia , Emissões Otoacústicas Espontâneas , Árvores de DecisõesAssuntos
Alocação de Recursos para a Atenção à Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Pesquisa Biomédica/economia , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/organização & administração , Humanos , Índia , Avaliação de Programas e Projetos de Saúde , Sistema de Registros/normas , Alocação de Recursos , Validade Social em Pesquisa , Avaliação da Tecnologia Biomédica/métodosRESUMO
Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare, benign, cutaneous hamartoma. Approximately 45 cases of PEODDN have been reported, with little information regarding treatment. We report a patient with PEODDN treated successfully using an ultrapulse carbon dioxide laser.
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Hamartoma/cirurgia , Lasers de Gás/uso terapêutico , Nevo Intradérmico/cirurgia , Poroceratose/cirurgia , Neoplasias Cutâneas/cirurgia , Doenças das Glândulas Sudoríparas/cirurgia , Pré-Escolar , Feminino , Humanos , Resultado do TratamentoRESUMO
Aim: To design and fabricate an innovative appliance for the purpose of diminishing treatment duration and enhancing patient compliance in non-complaint patients. Background: A patient reported to the orthodontic department for conventional orthodontic treatment but as the treatment progressed, he started loosing motivation which was followed by the deficiency in adherence to the treatment protocol and became less concerned. In few months, he stopped following proper instructions on taking care of the appliances leading to increase in the chances of frequent appliance breakage at every appointment. Case description: A patient reported with Class I molar and end-on canine relationship on both sides, retained deciduous second molar in upper and lower arches, increased overjet, mild generalized spacing in upper anteriors with severe crowding in lower arch anterior region and incompetent lips. On Cephalometric analysis, it showed Class I skeletal pattern with bimaxillary dentoalveolar protrusion. Conclusion: Orthodontic Retractor (innovative appliance) effectively helped in completing the orthodontic treatment in a non-complaint patient without delay as was seen during the retraction phase of the treatment. Clinical significance: "Orthodontic Retractor" can be used and advised for patients who are either less motivated or non-complaint. This appliance is simple and does not require any use of mini-implants, which is an invasive surgical procedure, which many patients does not consent for. How to cite this article: Jain S, Jain A, Raghav P. An Innovative Way to Retract Anteriors in Noncompliant Patient: A Case Report. Int J Clin Pediatr Dent 2023;16(1):180-185.
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Hearing loss in children affects cognitive development, so early detection is crucial. It is because of the lack of portable technology that the majority of hearing problems go undetected. The authors conducted a mixed-method study in India to examine the concurrent validity and operational feasibility of portable automated brainstem response (P-AABR) and otoacoustic emissions (OAE) in universal neonatal hearing screening. They screened 198 children's ears using ABR and OAE devices. Additionally, 60 observations were recorded during the 'portable automated ABR' screening process. The hearing screening could be performed with P-AABR by any health care staff with basic skill-based training. However, the interpretation of the graphical wave required an audiologist. If the baby was quiet, the test could be performed in 20 min, including electrode implantation, impediment setting, earphone installation, and swipe counts. The P-AABR device can be used in the universal health coverage of hearing screening among infants in outreach areas due to its portability and minimal infrastructural requirements.
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Surdez , Perda Auditiva , Recém-Nascido , Lactente , Criança , Humanos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Triagem Neonatal/métodos , Emissões Otoacústicas Espontâneas , ÍndiaRESUMO
Short tandem repeats are highly polymorphic sequences of nucleotides, which are abundant in eukaryotic genome. They form approximately 3% of the total human genome and occur on average in every 10, 000 nucleotides. Due to their small dimension, low mutation, and high level of polymorphism, these markers are intensely used as important genetic markers for mapping studies, disease diagnosis, and human identity testing. In the present study allelic distribution of four autosomal short tandem repeat markers (D21S2055, D21S11, D21S1435 and D21S1411) has been analyzed in Indian population. For determination of heterogeneity and their allelic frequency QF-PCR analysis have been done. All the loci were found highly polymorphic. Marker D21S1411 was the most informative (93.6%) and D21S1435 (70.1%) was the least informative marker in Indian population.
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Heterogeneidade Genética , Marcadores Genéticos/genética , Repetições de Microssatélites/genética , Primers do DNA/genética , Fluorescência , Frequência do Gene , Genótipo , Humanos , Índia , Reação em Cadeia da Polimerase/métodosRESUMO
Systemic primary carnitine deficiency (PCD) is an autosomal recessive disorder caused by mutations in the SLC22A5 gene that encodes carnitine transporter, OCTN2. Transporter deficiency leads to defective fatty acid oxidation. Signs and symptoms ranging from liver injury in children to cardiomyopathy and skeletal myopathy in adults, manifest during periods of stress and fasting. Though acute liver failure is infrequently described, young children presenting as acute liver failure should be screened for fatty acid oxidation defects including PCD by testing plasma for amino acids and further confirmed by genetic sequencing. Early identification and treatment using L-carnitine is lifesaving. Our patient presented as acute liver failure and diagnosis of PCD was confirmed by metabolic screening and genetic sequencing. He responded to the treatment.
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Cardiomiopatias , Falência Hepática Aguda , Doenças Musculares , Adulto , Cardiomiopatias/diagnóstico , Cardiomiopatias/genética , Carnitina/deficiência , Carnitina/uso terapêutico , Criança , Pré-Escolar , Ácidos Graxos , Humanos , Hiperamonemia , Falência Hepática Aguda/diagnóstico , Falência Hepática Aguda/etiologia , Masculino , Doenças Musculares/diagnóstico , Doenças Musculares/genética , Mutação , Proteínas de Transporte de Cátions Orgânicos/genética , Membro 5 da Família 22 de Carreadores de Soluto/genéticaRESUMO
INTRODUCTION: Micro-osteoperforation is a minimally invasive technique that has been used to accelerate orthodontic tooth movement and reduce treatment duration. However, literature presents conflicting reports about this technique. OBJECTIVE: To evaluate the effectiveness of micro-osteoperforations on the rate of canine retraction and expression of biomarkers in gingival crevicular fluid (GCF). METHODS: This was a randomized clinical trial with split-mouth study design. Thirty adult subjects with age above 18 years (20.32 ± 1.96) who required fixed orthodontic treatment and extraction of maxillary first premolars were enrolled and randomly allocated to either the experimental or control group. Randomization was performed by block randomization method, with a 1:1 allocation ratio. The experimental group received three micro-ostoperforations (MOPs) distal to maxillary canine, using the Lance pilot drill. The retraction of maxillary canine was performed with NiTi coil-spring (150g) in both experimental and control groups. The primary outcome was the evaluation of canine retraction rate, measured on study models from the baseline to 16 weeks of canine retraction. Secondary outcomes were the estimation of alkaline and acid phosphates activity in GCF at 0, 1, 2, 3, and 4 weeks. RESULTS: There was a statistically significant difference in the rate of canine retraction only after the first 4 weeks. Subsequently there was no statistically significant difference from the eighth to the sixteenth weeks between MOPs and control group. There was a statistically significant difference in alkaline and acid phosphates activity in GCF between MOPs and control groups during the initial 4 weeks of canine retraction. CONCLUSION: Micro-ostoperforation increased the rate of tooth movement only for the first 4 weeks; thereafter, no effect was observed on the rate of canine retraction during 8, 12 and 16 weeks. A marked increase in biomarker activity in the first month was observed.
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Dente Canino , Técnicas de Movimentação Dentária , Dente Pré-Molar/cirurgia , Biomarcadores , Humanos , Fosfatos , Técnicas de Movimentação Dentária/métodosRESUMO
Harnessing the phytomicrobiome offers a great opportunity to improve plant productivity and quality of food. In the recent past, several phytomicrobiome microbes have been explored for their potential involvement in increasing crop yield. This review strategically targets to harness the various dimensions of phytomicrobiome for biotic stress management of crop plants. The tripartite interaction involving plantmicrobiome-pathogen has been discussed. Positive interventions in this system so as to achieve disease tolerant plants has been forayed upon. The different signalling molecules sent out by interacting partners of phytomicrobiome have also been analysed. The novel concept of artificial microbial consortium in mitigation of pathogenic stress has also been touched upon. The aim of this review is to explore the hidden potential of phytomicrobiome diversity as a potent tool against phytopathogens, thereby improving crop health and productivity in a sustainable way.
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Interações Hospedeiro-Patógeno/fisiologia , Microbiota/fisiologia , Doenças das Plantas/microbiologia , Plantas/microbiologia , Estresse Fisiológico , Comunicação Celular , Consórcios Microbianos/fisiologia , Fenômenos Fisiológicos Vegetais , Transdução de Sinais , SimbioseRESUMO
OBJECTIVES: To assess the effects of different types of cataract surgeries and intraocular lenses on generic as well as vision related quality of life of cataract patients, using EQ-5D and IND-VFQ 33 instruments respectively. METHODS: An observational, longitudinal study of patients undergoing cataract surgery was carried out at three ophthalmology centres. Patients were prospectively admitted for surgery for age-related cataract. Generic quality of life was assessed by using Euroqol's EQ5D-5L questionnaire and vision related quality of life was assessed by the IND-VFQ-33 questionnaire. Data pertaining to vision function and quality of life were collected pre surgery and 4 weeks after the surgery. RESULTS: Out of total patients (n = 814) recruited for the study, 517 patients were interviewed for both pre-surgery and post-surgery for EQ5D and 519 patients were interviewed for both pre-surgery and post-surgery for IND VFQ 33 tool. The combined data from all three centres showed that Quality Adjusted Life Year (QALY) gains observed in patients undergoing phacoemulsification with foldable lens implantation (2.25 QALY) were significantly higher (0.57 QALY) as compared to Small Incision Cataract Surgery (SICS) with PMMA lens implantation (1.68 QALY). Highest improvement however, in all three subscales of IND-VFQ-33 tool were clearly observed for SICS with PMMA lens implantation. CONCLUSIONS: The study has elicited the Health related and vision related Quality of Life scores for cataract surgeries and subsequent lens implantation. This study also offers Health State Utility Values along with visual outcomes for different surgical procedures, lenses and for the combination of surgery with lens implantation for cataract procedures providing a useful resource for future economic evaluation studies.
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Extração de Catarata , Implante de Lente Intraocular , Qualidade de Vida , Visão Ocular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Common bean (Phaseolus vulgaris L.) production worldwide is hampered by Fusarium root rot (FRR), which is caused by Fusarium solani. Screening for FRR resistance on a large scale is notoriously difficult and often yields inconsistent results due to variability within the environment and pathogen biology. A greenhouse screening assay was developed incorporating multiple isolates of F. solani to improve assay reproducibility. The Andean (ADP; n = 270) and Middle American (MDP; n = 280) Diversity Panels were screened in the greenhouse to identify genetic factors associated with FRR resistance. Forty-seven MDP and 34 ADP lines from multiple market classes were identified as resistant to FRR. Greenhouse phenotyping repeatability was confirmed via five control lines. Genome-wide association mapping using â¼200k SNPs was performed on standard phenotyping score 1-9, as well as binary and polynomial transformation of score data. Sixteen and seven significant genomic regions were identified for ADP and MDP, respectively, using all three classes of phenotypic data. Most candidate genes were associated with plant immune/defense mechanisms. For the ADP population, ortholog of glucan synthase-like enzyme, senescence-associated genes, and NAC domain protein, associated with peak genomic region Pv08:0.04-0.18 Mbp, were the most significant candidate genes. For the MDP population, the peak SNPs Pv07:15.29 Mbp and Pv01:51 Mbp mapped within gene models associated with ethylene response factor 1 and MAC/Perforin domain-containing gene respectively. The research provides a basis for bean improvement through the use of resistant genotypes and genomic regions for more durable root rot resistance.
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INTRODUCTION: Quality-adjusted life year (QALY) has been recommended by the government as preferred outcome measure for Health Technology Assessment (HTA) in India. As country-specific health-related quality of life tariff values are essential for accurate measurement of QALYs, the government of India has commissioned the present study. The aim of this paper is to describe the methods for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study. Additionally, this study aspires to establish if the design of 10-time trade-off (TTO) blocks is enough to generate valid value sets. METHODS AND ANALYSIS: A cross-sectional survey using the EuroQol Group's Valuation Technology (EQ-VT) will be undertaken in a sample of 2700 respondents selected from six different states of India using a multistage stratified random sampling technique. The participants will be interviewed using computer-assisted personal interviewing technique. The TTO valuation will be done using 10 composite TTO (c-TTO) tasks and 7 discrete choice experiment (DCE) tasks. Hybrid modelling approach using both c-TTO and DCE data to estimate the potential value set will be applied. Values of all 3125 health states will be predicted using both the conventional EQ-VT design of 10 blocks of 10 TTO tasks, and an extended design of 18 blocks of 10 TTO tasks. The potential added value of the eight additional blocks in overall validity will be tested. The study will deliver value set for India and assess the adequacy of existing 10-blocks design to be able to correctly predict the values of all 3125 health states. ETHICS AND DISSEMINATION: The ethical approval has been obtained from Institutional Ethics Committee of PGIMER, Chandigarh, India. The anonymised EQ-5D-5L value set will be available for general use and in the HTAs commissioned by India's central HTA Agency.