Natural light driven plastic leaching effects on carbon chemistry in the tropical coastal waters of eastern Arabian sea: An experimental study.

This study examined the effects of solar light driven plastic degradation on carbon chemistry in the coastal waters of eastern Arabian Sea along the west coast of India. The research was conducted through experimental incubations exposed to natural sunlight at multiple locations between December 2023-February 2024. Photodegradation induced a significant pH decrease (up to 0.38 ± 0.02) between controls and plastic incubations ranging from 8.17 ± 0.01 to 7.54 ± 0.02 with the highest variation in the Mumbai coast ranging from 8.13 ± 0.01 to 7.75 ± 0.03. pH variations are primarily caused by the leaching of organic acids and CO2 release during solar irradiated incubation. Plastic leaching due to natural light irradiation and subsequent changes in the water chemistry is of prime significance with dissolved organic carbon (DOC) leaching of 0.002-0.03% of plastic weight into the coastal waters. Our estimations suggest 15-75 metric tonnes (MT) of DOC release per year by plastic pollution in the eastern Arabian Sea coastal waters. Further, the fluorescent dissolved organic matter (FDOM) fragmentation, a part of DOC, may act as an organic source of synthetic contaminants and would promote heterotrophic microbial action in the coastal waters. Photodegradation of plastic and the interaction of natural DOC and plastic-derived DOC resulted in longer wavelengths FDOM, which may affect the penetration of photosynthetically active radiation in the water column, thereby impacting primary production. Finally, future research work focussing on the role of plastic pollution in coastal ocean acidification and vice-versa is essential and will be increasingly intense in the upcoming decades.

Freshwater discharge from the large and coastal peninsular rivers of India: A reassessment for sustainable water management.

This study offers an updated mean annual water discharge of 10 large and 11 coastal basins of the Indian Peninsula and looks into environmental parameters influencing the water flux and discharge trends. The mean annual discharge of large and coastal rivers is estimated to be 221 and 294 km3. Thus, despite draining 25% of the Indian Peninsula, coastal rivers deliver more than half of the annual flux, and west-flowing coastal rivers contribute 85% of it. This study demonstrates temporal changes in the water discharge of various river basins. The presence of dams regulates discharge regimes of large rivers. The construction of large dams resulted in a significant decline in the water discharge of the Krishna, Cauvery, and Narmada. Through this study, we demonstrate the role of rainfall, catchment size, water loss through evapotranspiration and infiltration, and societal use of water in determining the runoff of each basin. We recommend tapping the water resources of the west-flowing rivers for proper planning, development, and management to reduce the water stress in the peninsular region and promoting sustainable management.

Corticosteroids induced avascular necrosis of hip, a "long COVID-19" complication: Case report.

Introduction and importance: Since it first surfaced, the new Coronavirus has multiplied and mutated into different forms, leading to a significant impact on people's lives. COVID-19's long-term impact is not completely known; It can only be hypothesized based on the prior outbreak of severe acute respiratory syndrome (SARS). Avascular necrosis (AVN) is one of these consequences, which if left untreated can lead to catastrophic events and bone collapse. It's important to remember that individuals who have recovered from COVID-19 infection are still at risk of developing AVN. The pathological findings in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are very similar to those seen in severe acute respiratory syndrome coronavirus (SARS-CoV) infection. Case presentation: We present cases of 27 and 69-year-old men with no comorbidities admitted with complaints of bilateral hip pain post covid treatment with corticosteroids and antivirals. The diagnosis was established based on history, physical examination, and magnetic resonance imaging (MRI). Clinical discussion: The use of corticosteroids in the treatment of SARS-CoV-2 infection has saved many lives, and it is still advised for moderate to severe cases on a short-term basis. The long-term use of corticosteroids is associated with numerous side effects. One of the most prevalent side effects of steroids is avascular necrosis of the femoral head, which is aggravated by the disease process. Conclusion: Early detection of Avascular necrosis is very crucial in its management due to its high progression rate. Low therapeutic doses of corticosteroids with minimal effective duration remain the key to halting its occurrence.

Quality improvement initiative to decrease extrauterine growth restriction in preterm neonates.

BACKGROUND: Prevention of extrauterine growth restriction (EUGR) in preterm neonates is one of the biggest challenges to neonatologists. Lack of uniformity and inconsistency in nutrition practices are the most common causes. We started a quality improvement (QI) initiative with an intention to decrease the proportion of EUGR. METHODS: We performed prospective nonrandomized QI from May 2018 to July 2019. Ninety-six neonates (born at <32 weeks and/or <1.2 kg) were compared with 111 historical controls. A continuous feedback loop was maintained, and changes were analyzed as plan-do-study-actcycle. RESULTS: Although EUGR was lower after the intervention (93.7% vs 87.5%), this change was not statistically significant. However, other measures of in-hospital neonatal growth showed improvement, including median discharge weight percentile from 1% to 3% (P = .003). Median difference in the z-score for weight from birth to discharge also improved significantly from -1.84 to -1.65 (P = .04). Babies in the intervention group regained birth weight earlier (P = .005) and had better growth velocity (P = .0005). The feeding was started early (P < .0001), and these babies reached full feeds (P < .0001) earlier than the control cohort. CONCLUSION: Although our QI initiative failed to achieve a significant reduction in EUGR, it did achieve a significant improvement in discharge weight percentile and difference in the z-score for weight at birth and during discharge from hospital. There was a significant improvement in growth velocity and an early regaining of birth weight. The implementation of written nutrition practice guidelines facilitated improved outcomes.

Quadricuspid aortic valve with ruptured sinus of valsalva aneurysm to the right atrium.

A 32-year-old man with a sudden onset of chest pain and progressive dyspnea was found to have a ruptured sinus of Valsalva aneurysm to the right atrium with an associated quadricuspid aortic valve. Echocardiographic and angiographic images are presented, with real time transthoracic 3D echo. The patient was successfully operated.

Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach.

BACKGROUND: Weak public health systems have been identified as major bottlenecks in providing good quality diabetic care in low- and middle-income countries. METHODOLOGY: The present study assessed diabetic care services at public health facilities across six districts in three states of India using a mixed methods approach. The study described diabetes care services available at public health facilities and identified challenges and solutions needed to tackle them. The quantitative component included assessment of availability of services and resources, whilst the qualitative component was comprised of semistructured interviews with health care providers and persons with diabetes to understand the pathway of care. RESULTS: A total of 30 health facilities were visited: five tertiary; eight secondary and 17 primary health facilities. Patient clinical records were not maintained at the facilities; the onus was on patients to keep their own clinical records. All had the facility for blood glucose measurement, but HbA1c estimation was available only at tertiary centers. None of the primary health centers in the three states provided HbA1c estimation, lipid examination, or foot care. Lifestyle modification support was available in only a few tertiary facilities. Antidiabetic drugs (biguanides and sulphonyl ureas) were available in most facilities, and given for 14 days. Insulin and statins were available only at secondary and tertiary care centers. Forty-two physicians were interviewed and poor follow-up, patient overload, and lack of specialized training were the major barriers that emerged from the interview responses. A total of 37 patients were interviewed. Patients had to visit tertiary facilities for drugs and routine follow-up, thereby congesting the facilities. There was no formal referral or follow-up mechanism to link patients to decentralized facilities. CONCLUSION: There is a wide gap between effective diabetes management practices and their implementation. There should be a greater role of secondary care facilities in follow-up investigations and screening for complications. A holistic diabetic care package with a robust recording and cohort monitoring system and adequate referral mechanism is needed.

Impact of Advocacy, Communication, Social Mobilization and Active Case Finding on TB Notification in Jharkhand, India.

Community-level benefits of screening for active tuberculosis (TB) disease remain uncertain. Project Axshya (meaning free of TB) conducted advocacy, communication, social mobilization, and active case finding among vulnerable/marginalized populations of India. Among 15 districts of Jharkhand state, the project was initiated in 36 subdistrict level administrative units - tuberculosis units (TUs) in a staggered manner between April 2013 and September 2014, and continued till the end of 2015. Seven TUs did not implement the project. We assessed the relative change in the quarterly TB case finding indicators (n = 4) after inclusion of a TU within the project. By fitting four multilevel models (mixed-effects maximum likelihood regression using random intercept), we adjusted for secular (over previous five quarters) and seasonal trends, baseline differences within Axshya and non-Axshya TUs, and population size and clustering within districts and within TUs. After inclusion of a TU within the project, we found a significant increase [95% confidence interval (CI)] in TU-level presumptive TB sputum examination rate, new sputum-positive TB Case Notification Rate (CNR), sputum-positive TB CNR, and all forms TB CNR by 12 (5.5, 18.5), 1.1 (0.5, 1.7), 1.3 (0.6, 2.0), and 1.2 (0.1, 2.2) per 100,000 population per quarter, respectively. Overall, the project resulted in an increase (95% CI) in sputum examination and detection of new sputum-positive TB, sputum-positive TB and all forms of TB patients by 22,410 (10,203, 34,077), 2066 (923, 3210), 2380 (1162, 3616), and 2122 (203, 4059), respectively. This provides evidence for implementing project Axshya over and above the existing passive case finding.