An Analysis of Antibody Response to COVID-19 Vaccination Among Medicos in a Predominantly Tribal State in India: A Comparative Study.

Introduction Global health is still being impacted by the coronavirus disease 2019 (COVID-19) pandemic. Objectives We evaluated the antibody response in this study in individuals who received two doses of the COVID-19 vaccination, both with and without a history of SARS-CoV-2 infection. Methodology It was a hospital-based cross-sectional study conducted among healthcare personnel at a tertiary institution of a predominantly tribal state in India. Results A total of 187 medical students made up the vaccinee group; the majority (152; 81.3%) were between the ages of 18 and 23; 128 (68.4%) of the students were female; and 104 (55.6%) had received the Covishield (AstraZeneca plc, England, UK) vaccination. Of the subjects, 51 (27.3%) had a history of COVID-19 infection. For those who were infected, the antibody titer peaked after six months, whereas it took twice as long for those who were not. Up to a year later, the antibody titers for Covaxin (Bharat Biotech, Hyderabad, India) and Covishield remained equal; however, Covishield titers drastically decreased while Covaxin stayed constant when an infection history was present. Conclusion The study's findings show that immunization in individuals who have previously contracted COVID-19 induces a higher level of antibody response than immunization in individuals who have not previously contracted the virus.

Evaluating the efficacy of artificial intelligence tools for the automation of systematic reviews in cancer research: A systematic review.

To evaluate the performance accuracy and workload savings of artificial intelligence (AI)-based automation tools in comparison with human reviewers in medical literature screening for systematic reviews (SR) of primary studies in cancer research in order to gain insights on improving the efficiency of producing SRs. Medline, Embase, the Cochrane Library, and PROSPERO databases were searched from inception to November 30, 2022. Then, forward and backward literature searches were completed, and the experts in this field including the authors of the articles included were contacted for a thorough grey literature search. This SR was registered on PROSPERO (CRD 42023384772). Among the 3947 studies obtained from search, five studies met the preplanned study selection criteria. These five studies evaluated four AI tools: Abstrackr (four studies), RobotAnalyst (one), EPPI-Reviewer (one), and DistillerSR (one). Without missing final included citations, Abstrackr eliminated 20%-88% of titles and abstracts (time saving of 7-86 hours) and 59% of the full-texts (62 h) from human review across four different cancer-related SRs. In comparison, RobotAnalyst (1% of titles and abstracts, 1 h), EPPI Review (38% of titles and abstracts, 58 h; 59% of full-texts, 62 h), DistillerSR (42% of titles and abstracts, 22 h) also provided similar or lower work savings for single cancer-related SRs. AI-based automation tools exhibited promising but varying levels of accuracy and efficiency during the screening process of medical literature for conducting SRs in the cancer field. Until further progress is made and thorough evaluations are conducted, AI tools should be utilized as supplementary aids rather than complete substitutes for human reviewers.

Trends of Private Drugs' Sales and Costs Incurred by Patients on Anti-tuberculosis Drugs in Selected Districts of Jharkhand (2022): Results From Sub-national TB-Free Certification.

BACKGROUND: The government of India is committed to eliminating tuberculosis (TB) by 2025 under the National Tuberculosis Elimination Programme which provides free investigations and treatment as well as incentives for nutritional support during their treatment course. Many TB patients prefer to seek treatment from the private sector which sometimes leads to financial constraints for the patients. Our study aims to find the burden of TB patients in the private sector and the expenses borne by them for their treatment. METHODOLOGY: Sales data of rifampicin-containing formulation drug consumption in the private sector of six districts of Jharkhand was collected from Clearing and Forwarding agencies. Based on the drug sales data, the total incurring costs of the drugs, total number of patients, and cost per patient seeking treatment from the private sector were calculated for the year 2015-2021. ANOVA and the post hoc test (Tukey honestly significant difference (HSD)) were applied for analysis. RESULTS:  There was a marked difference amongst all the districts in relation to all the variables namely total costs, cost per patient, and total private patients seeking treatment from the private sector which was statistically significant (p < 0.001). East Singhbhum had the highest out-of-pocket expense and private patients as compared to all six districts. Lohardaga showed the sharpest decline in total private patients from 2015 to 2021. The average cost borne by private patients in 2015 was INR 1821 (95% CI 1086 - 2556) which decreased to INR 1033 (95% CI 507 - 1559) in 2021. CONCLUSION: From the study, it was concluded that the purchase of medicines for TB treatment from the private sector is one of the essential elements in out-of-pocket expenditure (OOPE) borne by TB patients. Hence, newer initiatives should be explored to foresee the future OOPE borne by the patients and decrease OOPE-induced poverty.

Medical and social implications of alcohol use among adult women in a rural area of Ranchi, Jharkhand: A cross-sectional study.

Introduction: The harmful use of alcohol is increasing at a huge pace leading to the occurrence of multiple diseases and has become a leading risk factor for global burden of diseases. Aims and Objectives: The aim of this study is to assess the health profile of adult women and to find out the medical and social effects of alcohol consumption. Methodology: A cross-sectional study was conducted in the rural field practice area, Ormanjhi of RIMS, Ranchi, for a duration of 27 months (September 2016 to November 2018) among 336 women by multistage random sampling. A pretested semi-structured questionnaire was used for data collection. Templates were generated in MS Excel sheet and analysis of data was done using SPSS software (20.0). Results: The mean BMI of the study subjects was 21.62 ± 3.33 kg/m2. Anaemia was present in 42.6% of the women, 10.4% women were hypertensive and 9.2% were suffering from diabetes. The association between alcohol consumption and occurrence of co-morbidities was found insignificant. The social effects of alcoholism varied ranging from going into debts seen in 35.42% of the women; 62.5% of the women were criticised about their drinking habit by relatives or children. About 9.5% of the women were found to consume alcohol during their last pregnancy, and among women who were on regular intake of alcohol even during pregnancy, majority (65.62%) of them delivered by normal vaginal delivery. Conclusion: Alcohol consumption among females caused several adverse social consequences without any significant effect on health.

Hip Arthroscopy Improves Outcomes With Moderate Conversion to Total Hip Arthroplasty Rates in Patients Aged 50 Years or Older: A Systematic Review.

PURPOSE: The purpose of this systematic review was to assess the indications, outcomes, and complications of hip arthroscopy in individuals 50 years of age or older over the past 5 years. METHODS: The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 3, 2022, for studies assessing the use of primary hip arthroscopy for patients aged 50 years or older from the past 5 years. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS: Overall, 17 studies were included, consisting of 6,696 patients (37.5%) with a mean age of 61.4 ± 5.0 years and a median follow-up of 24 months (range: 1.4-70.1). Indications for hip arthroscopy in patients aged 50 years or older were unspecified/undefined (93.8%), mixed pathology (i.e., combined femoroacetabular impingement [FAI], labral tear, osteoarthritis, etc.) (2.7%), and FAI (2.6%). Eleven studies demonstrated significant improvement in functional outcome scores from baseline to final follow-up. Of the 6 studies that compared outcomes across multiple age groups, 3 demonstrated significantly worse functional outcomes, and 2 demonstrated significantly higher rates of conversion to THA for older patients compared to younger patients. Lastly, the overall complication rates ranged from 0 to 38.3%. The rate of conversion to THA ranged from 0 to 34.6%, occurring between 6 and 60 months postoperatively. CONCLUSIONS: Hip arthroscopy for patients aged 50 years or older yields significant improvements in patient-reported outcomes postoperatively compared to baseline, with a moderate rate of conversion to THA (range: 0 to 34.6%). Clinicians should consider patient history (e.g., imaging, comorbidities, etc.) and values when electing for hip arthroscopy in the older population. LEVEL OF EVIDENCE: IV, systematic review of Level III and IV studies.

The Expression of the RUVBL1 Component of the R2TP Complex Correlates with Poor Prognosis in DLBCL.

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of non-Hodgkin's lymphoma (NHL) accounting for 30% of adult NHL worldwide and 50% in developing countries like India. DNA damage and Myc-induced transformation are well-known contributing factors towards development of DLBCL. A recently identified HSP90 co-chaperone complex R2TP has been shown to contribute towards DNA damage and Myc-induced transformation. This study aimed to analyse the immunohistochemical (IHC) expression of R2TP complex components RUVBL1, PIH1D1, and RPAP3 in DLBCL patients and correlate with prognosis. METHODS: DLBCL (n = 54) histological slides were retrieved from archives, and detailed histomorphological and clinical features were noted. IHC staining of R2TP complex components RUVBL1, PIH1D1, and RPAP3 was performed on 54 cases (FFPE) of DLBCL. Expression data were correlated with survival and clinical features. RESULTS: Out of the 54 DLBCL cases, 59.26% (n = 32) stained positive for RUVBL1. The RUVBL1 expression was associated with poor prognosis in both progression-free survival (PFS) (p = 0.0146) and overall survival (OS) (p = 0.0328). The expression was positively correlated with bone marrow involvement (p = 0.0525). The expression of PIH1D1 was observed in 68.51% (n = 32) of DLBCL cases, and positive correlation was observed with international prognostic index score (p = 0.0246); however, no correlation was observed with PFS or OS. Finally, RPAP3 was found immunopositive in only 1 case of DLBCL. CONCLUSIONS: Immunopositivity for RUVBL1 is associated with poor prognosis along with a higher relapse rate amongst the DLBCL patients. PIH1D1 immunopositivity correlated with a higher IPI score.

Bilateral hip arthroscopy for treating femoroacetabular impingement: a systematic review.

PURPOSE: Femoroacetabular impingement (FAI) is a hip disorder which can often present bilaterally. The purpose of this systematic review was to explore the current practices for bilateral hip arthroscopy in treating FAI as they relate to outcomes and complications. METHODS: This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 18th, 2020. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS: Overall, 19 studies were identified, comprising 957 patients (48.6% male) with a mean age of 27.9 ± 7.1 years and a mean follow-up of 31.7 ± 20.8 months. The majority of patients were treated with a staged bilateral hip arthroscopy (78.5%) with a mean duration between surgeries of 7.1 ± 4.0 months. Significant preoperative-to-postoperative improvements for clinical outcomes such as pain, hip function, and health-related daily living as well as radiographic outcomes were reported in six studies for staged procedures (p < 0.05) and three studies for simultaneous procedures (p < 0.02). Significant improvements in patient-reported outcomes (e.g., HOS-ADL, Pain, HOS-SS, mHHS, and NAHS) were found in favor of those undergoing a shorter delay between surgeries in three studies (i.e., < 3, 10 or 17 months) (p < 0.05) compared to those who had delayed surgeries (i.e., > 3, 10, or 17 months). The overall complication rate was 10.1% (97/957). CONCLUSIONS: Bilateral surgery for FAI yields improved outcomes postoperatively and complication rates similar to unilateral surgery. The overall complication rate was 10.1% with the most common complication being revision surgery. Staged bilateral surgery is more commonly performed than simultaneous surgery. Clinicians should consider preoperative imaging, clinical history, and patient values when deciding between staged and simultaneous procedures for bilateral FAI surgery. Future studies are required to determine the optimal indications for simultaneous versus staged procedures, as well as the ideal timing between surgeries for the latter. LEVEL OF EVIDENCE: Level IV.

Effect of milk supplementation on the status of micronutrients among rural school children aged 5-19 years in a tribal predominating district of India.

BACKGROUND: In the tribal state of Jharkhand, there have been very few studies on micronutrient deficiency and how it is addressed among school children. This study was conceived and undertaken to assess the effect of milk supplementation on the micronutrient status of school children. DESIGN: A comparative observational study was conducted among school children of a tribal district in India during 2017-2018. Two groups of schools/clusters were randomly selected, one with milk supplementation and the other without supplementation. A total of 318 children from the two groups of schools were recruited for biochemical analysis of certain micronutrients, such as calcium, vitamin D, vitamin B12 and iron (haemoglobin level), using cluster random sampling. Data were analysed using SPSS V.20.0 software, and multiple logistic regression analysis was done to determine the predictors of serum calcium and vitamin B12 level among school children. RESULTS: Almost all children from both groups had vitamin D deficiency. A higher risk of lower serum vitamin B12 level (OR 2.59, 95% CI 1.61 to 4.16) and calcium level (OR 3.36, 95% CI 1.74 to 6.49) was observed in children of the control group. The difference in the proportion of anaemia in the two study groups was found to be statistically insignificant. Milk consumption was found to be the only significant predictor of normal vitamin B12 and calcium level in the present study. CONCLUSIONS: In this study, it was concluded that milk consumption may help in improving the calcium and vitamin B12 status of school children of a tribal state, whereas it does not have any significant effect on vitamin D level.

Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty.

OBJECTIVE: Prospectively analyze the effect of preoperative walking status and the patient's surgical education on functional outcomes and the three dimensions of quality of life (QoL) (pain, physical function, and mental health) after elective total knee arthroplasty (TKA). METHODS: A comparative analysis on the QoL and functional outcomes in patients who underwent total knee arthroplasty between January 2014 and June 2015. To compare effects of the patient's walking status and knowledge of the surgical procedure on QoL and functional outcomes following TKA by means of SF-36 questionnaire, CES D10, VAS, KSS, KSFS, WOMAC, as well as Friedmann and Wyman scores, 10MWT, and 30-second timed chair test, assessed before the operation and one, three, and six months after the operation. RESULTS: There were 168 knees in 154 patients: 46.75% men and 53.24% women. 52.38% of knees had grade-III OA and 40.47% of knees had grade-IV OA. Preoperatively, SF-36 PCS was 33.2 and MCS was 35.4. Mean KSS and KSFS in females was 37.3 (16.2) and 31.5 (13.8); in males it was 49.2 (18.4) and 42.5 (15.7), respectively. Mean WOMAC scores were 64.2 in females and 56.5 in males. Mean VAS and CES D10 scores were 8.8 and 8.2 in females, and 6.9 and 6.4 in males, respectively. Post operatively at the first, third, and sixth month, significant improvements in QoL and mean SF-36, CES D10, VAS, KSS, KSFS, WOMAC, and Friedmann and Wyman scores were observed, as well as in the 10MWT and 30 s timed chair test scores. Patients with better preoperative functional activity and satisfactory understanding of TKA presented a better functional performance and achieved a good quality life (p < 0.01). DISCUSSION: Surgeons educate TKA candidates regarding the surgical procedure, the nature of implants, and how the procedure would affect their lifestyle and what their expectations from TKA should be. These crucial considerations should boost their confidence, enhancing their involvement and cooperation in post-surgical rehabilitation, thereby improving their QoL, functional results, and post TKA experience. CONCLUSION: TKA candidates with good preoperative walking ability and understanding of knee arthroplasty have better QoL in early and late post-surgery periods. Patient's lifestyle and understanding significantly enhances the postoperative functional ability.

OBJETIVO: Analisar prospectivamente o efeito do estado ambulatório pré-operatório e da educação cirúrgica do paciente sobre os resultados funcionais e das três dimensões da qualidade de vida (QV; dor, função física e saúde mental) após a artroplastia total do joelho (ATJ). MÉTODOS: Análise comparativa da QV e dos resultados funcionais em pacientes submetidos a artroplastia total de joelho entre janeiro de 2014 e junho de 2015. Para comparar os efeitos do estado ambulatório do paciente e o conhecimento sobre o procedimento cirúrgico na qualidade de vida e nos resultados funcionais após ATJ, os questionários SF-36, CES D10, EVA, KSS, KSFS e WOMAC foram usados, bem como os escores de Friedman e Wyman, 10MWT e o teste de cadeira de 30 segundos, no pré-operatório e um, três e seis meses após a cirurgia. RESULTADOS: O estudo incluiu 168 joelhos de 154 pacientes: 46.75% homens e 53.24% mulheres. 52,38% dos joelhos apresentaram OA de grau III e 40,47% dos joelhos, OA de grau IV. No período pré-operatório, o SF-36 PCS foi 33,2 e o MCS foi 35,4. A média do KSS e do KSFS em mulheres foi 37,3 (16,2) e 31,5 (13,8), respectivamente; nos homens, foi 49,2 (18,4) e 42,5 (15,7), respectivamente. Os escores médios do WOMAC foram 64,2 para as mulheres e 56,5 para os homens. Os escores médios da EVA e CES D10 foram 8,8 e 8,2 nas mulheres e 6,9 e 6,4 nos homens, respectivamente. No primeiro, terceiro e sexto meses pós-operatórios, foram observadas melhorias significativas na QV e na média dos escores SF-36, CES D10, EVA, KSS, KSFS, WOMAC e Friedmann e Wyman, bem como no 10MWT e no teste de cadeira de 30 segundos. Pacientes com melhor atividade funcional pré-operatória e com compreensão satisfatória sobre a ATJ obtiveram resultados funcionais melhores e alcançaram uma boa qualidade de vida (p < 0,01). DISCUSSÃO: Cirurgiões explicam aos pacientes candidatos a ATJ o procedimento cirúrgico, a natureza dos implantes, como o procedimento afetaria o estilo de vida e quais devem ser as expectativas em relação ao resultado da ATJ. Estas considerações cruciais devem aumentar a confiança do paciente, aumentando o seu envolvimento e cooperação no processo de reabilitação pós-cirúrgica, melhorando assim sua qualidade de vida, resultados funcionais e experiência após a ATJ. CONCLUSÃO: Candidatos à ATJ com boa capacidade ambulatória pré-operatória e compreensão da cirurgia apresentam melhor qualidade de vida no período pós-operatório inicial e de longo prazo. O estilo de vida e o grau de compreensão do paciente em relação à cirurgia aumentam significativamente a capacidade funcional pós-operatória.

Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty / Efeitos da habilidade ambulatória pré-operatória e da educação cirúrgica do paciente sobre a qualidade de vida e os resultados funcionais após artroplastia total do joelho

ABSTRACT OBJECTIVE: Prospectively analyze the effect of preoperative walking status and the patient's surgical education on functional outcomes and the three dimensions of quality of life (QoL) (pain, physical function, and mental health) after elective total knee arthroplasty (TKA). METHODS: A comparative analysis on the QoL and functional outcomes in patients who underwent total knee arthroplasty between January 2014 and June 2015. To compare effects of the patient's walking status and knowledge of the surgical procedure on QoL and functional outcomes following TKA by means of SF-36 questionnaire, CES D10, VAS, KSS, KSFS, WOMAC, as well as Friedmann and Wyman scores, 10MWT, and 30-second timed chair test, assessed before the operation and one, three, and six months after the operation. RESULTS: There were 168 knees in 154 patients: 46.75% men and 53.24% women. 52.38% of knees had grade-III OA and 40.47% of knees had grade-IV OA. Preoperatively, SF-36 PCS was 33.2 and MCS was 35.4. Mean KSS and KSFS in females was 37.3 (16.2) and 31.5 (13.8); in males it was 49.2 (18.4) and 42.5 (15.7), respectively. Mean WOMAC scores were 64.2 in females and 56.5 in males. Mean VAS and CES D10 scores were 8.8 and 8.2 in females, and 6.9 and 6.4 in males, respectively. Post operatively at the first, third, and sixth month, significant improvements in QoL and mean SF-36, CES D10, VAS, KSS, KSFS, WOMAC, and Friedmann and Wyman scores were observed, as well as in the 10MWT and 30 s timed chair test scores. Patients with better preoperative functional activity and satisfactory understanding of TKA presented a better functional performance and achieved a good quality life (p< 0.01). DISCUSSION: Surgeons educate TKA candidates regarding the surgical procedure, the nature of implants, and how the procedure would affect their lifestyle and what their expectations from TKA should be. These crucial considerations should boost their confidence, enhancing their involvement and cooperation in post-surgical rehabilitation, thereby improving their QoL, functional results, and post TKA experience. CONCLUSION: TKA candidates with good preoperative walking ability and understanding of knee arthroplasty have better QoL in early and late post-surgery periods. Patient's lifestyle and understanding significantly enhances the postoperative functional ability.

RESUMO OBJETIVO: Analisar prospectivamente o efeito do estado ambulatório pré-operatório e da educação cirúrgica do paciente sobre os resultados funcionais e das três dimensões da qualidade de vida (QV; dor, função física e saúde mental) após a artroplastia total do joelho (ATJ). MÉTODOS: Análise comparativa da QV e dos resultados funcionais em pacientes submetidos a artroplastia total de joelho entre janeiro de 2014 e junho de 2015. Para comparar os efeitos do estado ambulatório do paciente e o conhecimento sobre o procedimento cirúrgico na qualidade de vida e nos resultados funcionais após ATJ, os questionários SF-36, CES D10, EVA, KSS, KSFS e Womac foram usados, bem como os escores de Friedman e Wyman, 10MWT e o teste de cadeira de 30 segundos, no pré-operatório e um, três e seis meses após a cirurgia. RESULTADOS: O estudo incluiu 168 joelhos de 154 pacientes: 46,75% homens e 53,24% mulheres. 52,38% dos joelhos apresentaram OA de grau III e 40,47% dos joelhos, OA de grau IV. No período pré-operatório, o SF-36 PCS foi 33,2 e o MCS foi 35,4. A média do KSS e do KSFS em mulheres foi de 37,3 (16,2) e 31,5 (13,8), respectivamente; nos homens, foi de 49,2 (18,4) e 42,5 (15,7), respectivamente. Os escores médios do Womac foram 64,2 para as mulheres e 56,5 para os homens. Os escores médios da EVA e CES D10 foram 8,8 e 8,2 nas mulheres e 6,9 e 6,4 nos homens, respectivamente. No primeiro, terceiro e sexto meses pós-operatórios, foram observadas melhorias significativas na QV e na média dos escores SF-36, CES D10, EVA, KSS, KSFS, Womac e Friedmann e Wyman, bem como no 10MWT e no teste de cadeira de 30 segundos. Pacientes com melhor atividade funcional pré-operatória e com compreensão satisfatória sobre a ATJ obtiveram resultados funcionais melhores e alcançaram uma boa qualidade de vida (p < 0,01). DISCUSSÃO: Cirurgiões explicam aos pacientes candidatos a ATJ o procedimento cirúrgico, a natureza dos implantes, como o procedimento afetaria o estilo de vida e quais devem ser as expectativas em relação ao resultado da ATJ. Essas considerações cruciais devem aumentar a confiança do paciente, aumentar o seu envolvimento e a sua cooperação no processo de reabilitação pós-cirúrgica, melhorar assim sua qualidade de vida, seus resultados funcionais e sua experiência após a ATJ. CONCLUSÃO: Candidatos à ATJ com boa capacidade ambulatória pré-operatória e compreensão da cirurgia apresentam melhor qualidade de vida no período pós-operatório inicial e de longo prazo. O estilo de vida e o grau de compreensão do paciente em relação à cirurgia aumentam significativamente a capacidade funcional pós-operatória.

Biokinetic model-based multi-objective optimization of Dunaliella tertiolecta cultivation using elitist non-dominated sorting genetic algorithm with inheritance.

Algal model based multi-objective optimization using elitist non-dominated sorting genetic algorithm with inheritance was carried out for batch cultivation of Dunaliella tertiolecta using NPK-fertilizer. Optimization problems involving two- and three-objective functions were solved simultaneously. The objective functions are: maximization of algae-biomass and lipid productivity with minimization of cultivation time and cost. Time variant light intensity and temperature including NPK-fertilizer, NaCl and NaHCO3 loadings are the important decision variables. Algal model involving Monod/Andrews adsorption kinetics and Droop model with internal nutrient cell quota was used for optimization studies. Sets of non-dominated (equally good) Pareto optimal solutions were obtained for the problems studied. It was observed that time variant optimal light intensity and temperature trajectories, including optimum NPK fertilizer, NaCl and NaHCO3 concentration has significant influence to improve biomass and lipid productivity under minimum cultivation time and cost. Proposed optimization studies may be helpful to implement the control strategy in scale-up operation.

Effect of change in sequence of administration of DTwP and Hepatitis B vaccines on perception of pain in infants: A randomized control trial.

OBJECTIVE: This study was designed with objective to study pain response of infants to change in sequence of administration of Hepatitis B and DTwP vaccines. METHODS: This was a randomized parallel control trial. The study was carried out in the immunization clinic of the Department of Pediatrics, LLRM Medical College, Meerut. One hundred and thirty healthy term infants up to 4 months of age were injected either DTwP vaccine first or Hepatitis B vaccine first, followed one minute later by the other vaccine. RESULT: Baseline characteristics did not differ between the groups. The mean (SD) of AUC of MFCS and NIPS was significantly more in DF group as compared to HF group (for MFCS 25.5 ± 5.4 versus 22.5 ± 5.5, p<0.01; for NIPS 31.77 ± 5.5 versus 27.64 ± 6.9, p < 0.01). Similarly mean (SD) of AUC of Heart rate and saturation of oxygen showed significant variation in DF group as compared to HF group (for heart rate 591.6 ± 55 versus 559.6 ± 49, p< 0.01; for SpO2 326.4 ± 12 versus 335 ± 8, p < 0.01). CONCLUSION: These results showed that infant experienced lesser pain when Hepatitis B was administered first than when DTwP vaccine was given first.

Validity of non-invasive point-of-care hemoglobin estimation in healthy and sick children-a method comparison study.

This study was conducted at a tertiary care center in northern India to evaluate the validity of non-invasive transcutaneous hemoglobin estimation in healthy and sick children in comparison to hemoglobin estimation by traditional lab method. A method comparison study was conducted including 150 subjects. Enrolled patients included 80 neonates with average age of 3.9 ± 2.1 days, and 70 children with average age of 5.8 ± 2 years. Each population (newborn and children) comprised of almost equal numbers of healthy and critically ill patients with shock. Hemoglobin (Hb) was estimated on enrolment by transcutaneous spectrophotometry (SpHb) and traditional automated lab analyzer (Hb-Lab). Difference between Hb levels by the two methods (called bias) was measured and analyzed using Bland-Altman method. Out of 148 data pairs analyzed, bias between SpHb and Hb-Lab was -1.52 ± 1.91 g/dl (mean ± SD). SpHb showed excellent positive correlation with Hb-Lab (r = 0.94 (p < 0.001)) and good visual agreement on Bland-Altman plots. Bias was higher in sick subjects with shock as compared to healthy ones in both neonatal and pediatric population (-2.31 ± 2.21 g/dl versus -0.77 ± 1.2 g/dl, respectively). CONCLUSIONS: SpHb showed good accuracy and correlated well with lab estimated Hb levels in healthy children. However, in children with impaired peripheral perfusion, its diagnostic accuracy was inadequate to justify routine use for quantification of severity of anemia and making transfusion decisions solely on non-invasive estimation of hemoglobin. WHAT IS KNOWN: Non-invasive hemoglobin estimation is a relatively new and novel method which has given mixed results regarding its potential efficacy in adults. There is limited data regarding usefulness and accuracy of non-invasive Hb estimation by SpHb in sick neonates and children. WHAT IS NEW: Non-invasive Hb estimation by SpHb monitor is reasonably accurate in healthy neonates and children. It can be used in critically ill children and neonates, but in conjunction with lab confirmation of Hb values.

Effects of Osteoarthritis on Quality of life in Elderly Population of Bhubaneswar, India: A Prospective Multicenter Screening and Therapeutic Study of 2854 Patients.

INTRODUCTION: Osteoarthritis (OA) is the most common age-related joint disease affecting >80% people beyond 55 years of age. It is a leading cause of elderly visit to outpatient departments and accounts for almost half of all nonsteroidal anti-inflammatory drug prescriptions. The burden and impact of knee OA in Indian population and extent of public health services usage by people with OA are not known. METHODS: We performed a prospective blinded multicenter screening and therapeutic study from June 2013 to June 2014 at 3 centers to screen patients >55 years with knee OA to assess quality of life, functional disability, and limitation of functions and to compare the effectiveness of hip and leg strengthening exercise programs in these patients. Functional disability was assessed by Western Ontario and McMaster's Universities OA index (WOMAC), Friedman, and Wyman Scores; locomotor function was assessed by walking status, Visual Analog Scale (VAS), and 30-second timed chair stand tests; and quality of life was assessed by Short Form-36 (SF-36). RESULTS: Of 2854 patients screened, 2054 (72%) patients had OA (male:female-1.9:1) with mean age of 63 years and standard deviation of 8. Of 2054 patients, 226 patients were randomly selected for therapeutic study. In remaining 1828 patients, baseline 10-meter walk test (10MWT) was 0.3 m/s, mean SF-36 Physical Component Score (PCS) was 31.3, and Mental Component Score (MCS) was 34.2. At 3 months, 79% patients were comfortable with significant VAS, WOMAC, Friedman-Wyman Scores, 10MWT, and timed chair test improvements in patients who performed lifestyle modifications and exercises (P = .04). Short Form-36 improved, mean PCS was 43.6, and MCS was 54.2. At 3 months, 274 (15%) patients were unsatisfied among whom 26% and 74% were treated with arthroscopic procedures and arthroplasty, respectively. Isolated hip and leg strengthening exercise programs similarly improved knee pain, function, and quality of life. CONCLUSION: Motivation and counseling with hip and leg strengthening exercises should be incorporated with pharmacotherapy in each OA prescription. Physical fitness and weight reduction should be promoted as first-line management of OA.

Numerical study on influence of cross flow on rewetting of AHWR fuel bundle.

Numerical study on AHWR fuel bundle has been carried out to assess influence of circumferential and cross flow rewetting on the conduction heat transfer. The AHWR fuel bundle quenching under accident condition is designed primarily with radial jets at several axial locations. A 3D (r, θ, z) transient conduction fuel pin model has been developed to carry out the study with a finite difference method (FDM) technique with alternating direction implicit (ADI) scheme. The single pin has been considered to study effect of circumferential conduction and multipins have been considered to study the influence of cross flow. Both analyses are carried out with the same fluid temperature and heat transfer coefficients as boundary conditions. It has been found from the analyses that, for radial jet, the circumferential conduction is significant and due to influence of overall cross flow the reductions in fuel temperature in the same quench plane in different rings are different with same initial surface temperature. Influence of cross flow on rewetting is found to be very significant. Outer fuel pins rewetting time is higher than inner.

Genotoxicity of crotonaldehyde in the bone marrow and germ cells of laboratory mice.

Genotoxicity of crotonaldehyde was evaluated by employing bone marrow and spermatocyte chromosomal aberration and dominant lethal mutation assays in Swiss albino mice. For bone marrow chromosomal aberration assay, animals were treated with 0.2ml olive oil containing 8, 16 and 32microl kg b.w. of crotonaldehyde for 6, 12 and 24h through single intraperitoneal injection. Treatment induced dose-dependent and statistically significant decrease in mitotic index and increase in chromosome aberrations per cell (CAs/cell excluding gaps and stickiness and pulverizations) and percent aberrant metaphase (excluding gaps) in the bone marrow cells at 6, 12 and 24h after treatment. For spermatocyte chromosomal aberration assay, male mice were treated with 8, 16 and 32microl/kg b.w. of crotonaldehyde for 24h through single intraperitoneal injection. The percentage of the induced chromosome aberrations in diakinesis-metaphase-I cells showed dose-dependent increase. For dominant lethal mutation assay, adult male mice were injected intraperitoneally with 0.2ml olive oil containing crotonaldehyde at the rate of 8, 16 and 32microl/kg b.w. for 5 consecutive days. The negative control animals received 0.2ml olive oil as above. In the dominant lethal mutation assay after the last dose, the treated males were allowed to mate with untreated virgin females. The mating continued for 5 consecutive weeks. At pregnancy days 14-16, the females were killed and uterine contents were examined for live and dead implants. Treatment of mice resulted in statistically significant decrease in the fertility indices and total number of implants per female. Statistically significant decrease in the number of live implants per female and increase in the number of dead implants per female were recorded in females mated with males during 8-14 and 15-21 and 22-28 days post-treatment mating. Crotonaldehyde treatment of males induced appreciably higher frequencies of dominant lethal mutation during 8-14, 15-21 and 22-28 days post-treatment mating periods. Percent dominant lethal mutation increased concomitantly with the dose. Dominant lethality was maximum in females mated with males treated with 5x32microl/kg b.w. during the 15-21 days post-treatment mating. The overall result suggests a positive dose-response relationship between treatment and induction of chromosomal aberrations in the somatic and germ cells and dominant lethal mutation in the germ cells.

In vivo evaluation of induction of abnormal sperm morphology in mice by an unsaturated aldehyde crotonaldehyde.

Crotonaldehyde, a highly reactive unsaturated aldehyde is used for the manufacture of sorbic acid, synthesis of butyl alcohol, butylaldehyde, quinaldine, thiophenes, pyridines, dyes, pesticides, pharmaceuticals, rubber antioxidants, chemical warfare agents, etc. and also occurs naturally in meat, fish, in many fruits and vegetables, bread, cheese, milk, beer, wine and liquors. Human exposure to crotonaldehyde occurs from both man-made and natural sources. No human data was located describing carcinogenicity associated with crotonaldehyde exposure. In the present study we have evaluated whether or not exposure to crotonaldehyde results in a significant increase in the frequency of abnormal sperm heads in male Swiss albino mice. Adult male mice were treated with 8, 16 and 32 microl/kg b.w. of crotonaldehyde as a single intraperitoneal injection. The animals were killed 1, 3 and 5 weeks after treatment. Five animals were sacrificed per dose and time tested. Crotonaldehyde induced dose related increase in the percentage of abnormal sperm heads. Statistically significant increase in percentage of abnormal sperm heads was recoded at 16 and 32 microl/kg b.w. after 1 and 3 weeks of treatment and only at 32 microl/kg b.w. after 5 weeks of treatment.

Development of a hybrid delta-endotoxin and its expression in tobacco and cotton for control of a polyphagous pest Spodoptera litura.

A hybrid delta-endotoxin protein was designed against a polyphagous lepidopteran insect pest Spodoptera litura, which is tolerant to most of the known delta-endotoxins. The hybrid delta-endotoxin was created by replacing amino acid residues 530-587 in a poorly active natural Cry1Ea protein, with a highly homologous 70 amino acid region of Cry1Ca in domain III. The truncated delta-endotoxins Cry1Ea, Cry1Ca and the hybrid protein Cry1EC accumulated in Escherichia coli to form inclusion bodies. The solubilised Cry1EC made from E. coli was 4- fold more toxic to the larvae of S. litura than Cry1Ca, the best known delta-endotoxin against Spodoptera sp. None of the two truncated toxins, solubilised from E. coli caused larval mortality. However, trypsinised Cry1Ca protoxin obtained from E. coli and solubilised from inclusion bodies caused mortality of S. litura with LC50 513 ng/ml semi synthetic diet. A synthetic gene coding for the hybrid delta-endotoxin Cry1EC was designed for high level expression in plants, taking into consideration several features found in the highly expressed plant genes. Transgenic, single copy plants of tobacco as well as cotton were developed. The selected lines expressed Cry1EC at 0.1-0.7% of soluble leaf protein. Such plants were completely resistant to S. litura and caused 100% mortality in all stages of larval development. Hence, unlike in E. coli, the hybrid delta-endotoxin folded into a functionally active conformation in both tobacco and cotton leaves. The truncated Cry1EC expressed in tobacco leaves was about 8-fold more toxic (LC50 58 ng/ml diet) compared to expression in E. coli.

Genotoxicity of lomefloxacin--an antibacterial drug in somatic and germ cells of Swiss albino mice in vivo.

The in vivo genotoxicity of lomefloxacin, a diflourinated antibacterial drug, was evaluated by employing mouse in vivo chromosomal aberration test in bone marrow cells and dominant lethal mutation assay in germ cells. Statistically significant reduction in mitotic index, increase in chromosomal aberrations (CAs)/cell and percent abnormal metaphase was observed only at the highest dose (160 mg/kg b.w.) of the drug. In the dominant lethal mutation assay, a statistically significant decrease in the number of implants/female, compared to vehicle control, was noticed only in the females mated with males treated with 32 mg/kg b.w. during the third week of mating, while statistically significant reduction in live implants/female was noticed at both the doses during the second and third weeks of mating. Nevertheless, no significant change in the number of dead implants/female was observed after lomefloxacin treatment. These results seems to indicate that lomefloxacin is a weak clastogen in the bone marrow cells and non-mutagenic in the germ cells of mouse in vivo.