Mapping serogroup distribution and seroprevalence of leptospirosis in livestock of Assam, Northeastern State of India: Unveiling uncommon Leptospira serogroups.

Leptospirosis is a significant zoonotic disease affecting livestock, leading to reproductive issues and economic losses. Despite its endemic status in India, research has predominantly focused on coastal regions, leaving the North Eastern Region (NER) underexplored. This study aims to investigate the seroprevalence and serogroup distribution of leptospirosis in livestock across Assam, a major state in the North Eastern Region (NER) of India. Serum samples (n=811) from cattle, buffalo, sheep, goats, and pigs were collected between 2016 and 2019 and screened using the Microscopic Agglutination Test (MAT) for 24 serogroups. The overall seroprevalence was 22.9 % (186/811), with highest prevalence in cattle (26.2 %) and buffalo (25 %), followed by small ruminants (19.8 %) and pigs (18.6 %) . Notably, uncommon serovars such as Mini (28.8 %), Manhao (12.4 %), and Cynopteri (7.5 %) were identified, indicating a unique epidemiological pattern in Assam. High seroprevalence was observed in districts like Bongaigaon (66.7 %), Kamrup Metropolitan (50.0 %), and Nalbari (40.0 %), emphasizing the need for targeted intervention strategies. The presence of these uncommon serogroups, typically found in neighbouring countries and other regions, suggests potential transboundary transmission from these countries. This study provides valuable insights into the seroprevalence and serogroup distribution of leptospirosis in Assam's livestock, highlighting the need for region-specific surveillance and control measures. These findings underscore the importance of understanding the local epidemiological landscape to develop effective disease management and prevention strategies, ultimately reducing the impact of leptospirosis in the NER of India.

Pathways to leadership: what accounts for women's (in)equitable career paths in the health sectors in India and Kenya? A scoping review.

OBJECTIVES: We aimed to capture evidence on enablers and barriers to improving equal opportunity and effective organisational interventions that can advance women's leadership in India and Kenya's health sectors. METHODS: We systematically searched JSTOR, PubMed, SCOPUS and Web of Science databases, reference lists of selected articles and Google Scholar using string searches. We included studies that were published in English from 2000 to 2022 in peer-reviewed journals or grey literature, focused on paid, formal health professionals in India or Kenya, described factors relating to women's representation/leadership. RESULTS: We identified 26 studies, 15 from India and 11 from Kenya. From each country, seven studies focused on nursing. Participants included women and men health sector workers. Seven studies used mixed methods, 11 were qualitative, 5 were quantitative and 3 were commentaries. Factors influencing women's career progression at individual/interpersonal levels included family support, personal attributes (knowledge/skills) and material resources. Factors at the organisational level included capacity strengthening, networking, organisational policies, gender quotas, work culture and relationships, flexibility, and work burden. Nursing studies identified verbal/sexual harassment and professional hierarchies as barriers to career progression. Structural barriers included a lack of infrastructure (training institutes and acceptable working environments). Normative themes included occupational segregation by gender (particularly in nursing), unpaid care work burden for women and gender norms. Studies of interventions to improve women's career progression and sex-disaggregated workforce data in India or Kenya were limited, especially on leadership within career pathways. The evidence focuses on enablers and barriers at work, rather than on organisations/systems to support women's leadership or address gender norms. CONCLUSIONS: Women in India and Kenya's health sectors face multiple impediments in their careers, which impact their advancement to leadership. This calls for gender-transformative interventions to tackle discrimination/harassment, provide targeted training/mentorship, better parental leave/benefits, flexible/remote working, family/coworker support and equal-opportunity policies/legislation.

A cautionary tale of pseudo-Cryptococcus infection in neonates.

We report a tale of two cases of neonates, where India Ink preparation of cerebrospinal fluid (CSF) received in glass vials was suggestive of Cryptococcus; however, the absence of correlation and report of cases sequentially from the same unit raised alarm bells. Repeat smears using routine in-house and newly prepared stains were prepared and repeat sampling was collected in a strictly sterile specimen container, which resulted in negative microscopy for repeat samples (uncentrifuged and centrifuged). The source of contamination was found to be non-sterile glass vials used for CSF collection. This report underlines the requisite to maintain an aseptic chain from sample collection to processing, to prevent reporting of pseudo-infections that can upset diagnostic accuracy, especially when the aseptic chain has not been maintained.

Subjective social status and socio-demographic correlates of perceived discrimination among older adults in India.

BACKGROUND: Considering India's diversity, marked by differences in caste, class, ethnicity, religion, region, and language, discrimination can take on varying forms across social-structural locations. We examined the association between subjective social status (SSS) and perceived discrimination, and assessed the sociodemographic correlates of perceived discrimination among older persons in India. METHODS: Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 30,253 adults 60 years or older. SSS was examined using the Macarthur scale with a ladder technique. Perceived discrimination was evaluated with the Everyday Discrimination Scale. Multivariable logistic regression models examined the odds of reporting discrimination by its types and attributions. RESULTS: 39% of older adults reported low SSS, whereas 7.3% reported high SSS. Older adults with low SSS had significantly higher odds of experiencing some discrimination than those with high SSS. Compared to high-SSS peers, low-SSS individuals attributed age, gender, caste, financial, and health status as reasons for discrimination. Older women attributed gender as a reason for discrimination. Caste was reported as a reason for discrimination by rural but not urban dwellers. Relative to northerners, those from southern India reported age, financial, and health statuses as reasons for discrimination. CONCLUSIONS: That low-SSS older adults reported age, gender, caste, financial status, and health status as reasons for discrimination and that this association persisted after considering objective indicators of socioeconomic status (SES) is suggestive of SSS as independently consequential for perceived discrimination. These findings are useful for care providers and practitioners as they encourage older patients -- especially those with low SSS who may feel stigmatized -- to seek care, comply with care regimen, and engage in behaviors that protect and promote health.

Improving access to cancer care among rural populations in India: Development of a validated tool for health system capacity assessment.

BACKGROUND: Cancer burden in India is rapidly growing, with oral, breast, and uterine cervix being the three most commonly affected sites. It has a catastrophic epidemiological and financial impact on rural communities, the vast majority of whom are socio-economically disadvantaged. Strengthening the health system is necessary to address challenges in the access and provision of cancer services, thus improving outcomes among vulnerable populations. OBJECTIVE: To develop, test, and validate a health system capacity assessment (HSCA) tool that evaluates the capacity and readiness for cancer services provision in rural India. METHODS: A multi-method process was pursued to develop a cancer-specific HSCA tool. Firstly, item generation entailed both a nominal group technique (to identify the health system dimensions to capture) and a rapid review of published and gray literature (to generate items within each of the selected dimensions). Secondly, tool development included the pre-testing of questionnaires through healthcare facility visits, and item reduction through a series of in-depth interviews (IDIs) with key local stakeholders. Thirdly, tool validation was performed through expert consensus. RESULTS: A three-step HSCA multi-method tool was developed comprising: (a) desk review template, investigating policies and protocols at the state level, (b) facility assessment protocol and checklist, catering to the Indian public healthcare system, and (c) IDI topic guide, targeting policymakers, healthcare workforce, and other relevant stakeholders. CONCLUSIONS: The resulting HSCA tool assesses health system capacity, thus contributing to the planning and implementation of context-appropriate, sustainable, equity-focused, and integrated early detection interventions for cancer control, especially toward vulnerable populations in rural India and other low-resource settings.

The disposability and inclusion of Brown bodies.

While there has been increased awareness of the ethics of curation, research, and teaching with human skeletal remains, there has been little recognition of the millions of skeletal remains from South Asia that were harvested illegally and/or unethically for educational institutions globally for over a century. This article gives a contextualization of the unique history and nature of anatomical teaching collections, and why they are an important locus for a decolonized and antiracist biological anthropology. I present the historical background of how the exportation and commodification of Indian bodies came to dominate the global bone trade. I also discuss how historical necropolitics explicitly erased the identity and objectified South Asian people made into study skeletons, and the way our current practices continue to uphold colonial violence. Finally, I discuss what we might do with these historical collections and the ways that inclusion of Brown voices is critical to ethical practice.

Geographical distribution, disease association and diversity of Klebsiella pneumoniae K/L and O antigens in India: roadmap for vaccine development.

Klebsiella pneumoniae poses a significant healthcare challenge due to its multidrug resistance and diverse serotype landscape. This study aimed to explore the serotype diversity of 1072 K. pneumoniae and its association with geographical distribution, disease severity and antimicrobial/virulence patterns in India. Whole-genome sequencing was performed on the Illumina platform, and genomic analysis was carried out using the Kleborate tool. The analysis revealed a total of 78 different KL types, among which KL64 (n=274/1072, 26 %), KL51 (n=249/1072, 24 %), and KL2 (n=88/1072, 8 %) were the most prevalent. In contrast, only 13 distinct O types were identified, with O1/O2v1 (n=471/1072, 44 %), O1/O2v2 (n=353/1072, 33 %), and OL101 (n=66/1072, 6 %) being the predominant serotypes. The study identified 114 different sequence types (STs) with varying serotypes, with ST231 being the most predominant. O serotypes were strongly linked with STs, with O1/O2v1 predominantly associated with ST231. Simpson's diversity index and Fisher's exact test revealed higher serotype diversity in the north and east regions, along with intriguing associations between specific serotypes and resistance profiles. No significant association between KL or O types and disease severity was observed. Furthermore, we found the specific association of virulence factors yersiniabactin and aerobactin (P<0.05) with KL types but no association with O antigen types (P>0.05). Conventionally described hypervirulent clones (i.e. KL1 and KL2) in India lacked typical virulent markers (i.e. aerobactin), contrasting with other regional serotypes (KL51). The cumulative distribution of KL and O serotypes suggests that future vaccines may have to include either ~20 KL or four O types to cover >85 % of the carbapenemase-producing Indian K. pneumoniae population. The results highlight the necessity for comprehensive strategies to manage the diverse landscape of K. pneumoniae strains across different regions in India. Understanding regional serotype dynamics is pivotal for targeted surveillance, interventions, and tailored vaccine strategies to tackle the diverse landscape of K. pneumoniae infections across India. This article contains data hosted by Microreact.

Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India.

Background: Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage. Methods: All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design. Findings: A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p < 0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits. Interpretation: With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services. Funding: The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.

Exploring the preferences of traditional versus Western medicine in the Spiti Valley region of India: A qualitative approach.

Background: Traditional healing practices are prevalent in rural and mountainous areas of India where Western medicine is not accessible. WHO guidelines recommend integration of traditional and Western medicine to meet rural primary care needs. We explored three dimensions of rural patients' decision-making and satisfaction with their medical care: pregnancy-related concerns, pediatric care for children under five, and acute injuries. Methods: We conducted a qualitative study using a phenomenological approach in India's Spiti Valley between August and October 2023. Sixteen individuals, age 18 years and older, participated in one-on-one interviews. The interviews were transcribed from Hindi into English, reviewed for accuracy by a native speaker, and imported into Dedoose software. Data were analyzed using inductive coding. Findings: Multiparous women aged 35-44 were concerned about pregnancy complications, leading them to choose Western medicine despite access and cost barriers. Pediatric illness requiring urgent care at night was a concern for women with children under five. Those in the injuries group reported having to travel for care beyond basic first aid. Overall, concerns were about limited access to some services locally, as well as costs of travel, medical procedures, and medications when services were obtained beyond the local area. Interpretation: All participants considered their traditional healer their first point of contact for medical care. A number of Western medical services were not available locally. These findings suggest a need to strengthen access to and integration of Western and traditional medical care in rural settings in India.

Hepatitis B Virus in People who Inject Drugs and Men who Have Sex With Men With HIV in India: A Cross-sectional Study.

Background: People with HIV (PWH) who are coinfected with hepatitis B virus (HBV) have a higher risk of mortality compared with PWH alone. Populations such as people who inject drugs (PWID) and men who have sex with men (MSM) are particularly at high risk for HBV acquisition; yet, limited epidemiological data from these populations exist on HBV prevalence from low- and middle-income country settings (LMICs). Methods: We characterized the prevalence and correlates of HBV serological markers in a sample of PWID and MSM with HIV recruited across 15 Indian cities using hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs). Testing of stored specimens for the presence of these markers was performed on the Abbott ARCHITECT i1000 as per the manufacturer's instructions. Correlates of ever being infected with HBV (reactive for anti-HBc and/or HBsAg) and chronic HBV (reactive for HBsAg) among those ever infected were assessed using univariable and multivariable multilevel logistic regression models accounting for site-level clustering. Results: A total of 2198 (95%) of the 2314 participants recruited for the trial were screened for HBV markers. The median age among the PWID and MSM participants was 30 and 32 years, respectively. The prevalence of ever being infected with HBV was 75.6% vs 46.9% in PWID vs MSM, respectively (P < .01); prevalence of chronic infection was also higher in PWID vs MSM (14.1% vs 9.5%; P < .01). Correlates of ever being infected with HBV among PWID included unstable housing (adjusted odds ratio [aOR], 5.02) and sharing injection paraphernalia (aOR, 2.70), and among MSM, correlates included history of injection drug use (aOR, 4.87) and gender identity. The prevalence of isolated core (anti-HBc in the absence of anti-HBs) was 34.7% vs 29.4% in PWID vs MSM (P < .05). Vaccination serostatus was <10% in both populations. Conclusions: In this large sample of PWID and MSM with HIV, we observed a high prevalence of serology consistent with HBV infection and low vaccination, highlighting the need for routine screening and catch-up vaccination. The high prevalence of isolated anti-HBc reactivity highlights the need to understand the risk of reactivation with this serological pattern.

A Descriptive Cross-Sectional Study on Clinical Epidemiology of Different Types of Cancer in a Tertiary Care Centre: Insights From Eastern India.

Background and aim Cancer poses a significant burden in India, with a considerable number of people living with the disease and a substantial increase in new cases every year. Hence, considering the unique challenges faced by developing nations regarding the disease burden, this study has been designed. The aim of this work was to carry out a descriptive retrospective cross-sectional study on various types of cancer conducted in a tertiary care centre in India. Methods One thousand cancer patients who attended the outpatient department (OPD) from tertiary care cancer hospitals from July 2019 to December 2023 in Eastern India were enrolled. Patients included were of either gender, with their demographic details and the disease duration, who visited the OPD of hospitals meeting the eligibility criteria. Exclusion criteria were terminally ill cancer patients and patients who did not visit the outpatient department of the studied site. Descriptive analysis and chi-square test were carried out using the SPSS statistical software, version 20.0 (IBM Corp., Armonk, NY) for data analysis. Ethics committee approval was taken. Results Gastrointestinal tract cancer (31.3%, n=313) and breast cancer (19.8%, n=198) were found to be the most common types of cancer among all. Out of the total patients studied, 41.1% were males and 58.9% were females. Among regions, North Chotanagpur had the highest (40.5%) prevalence, followed by South Chotanagpur (26.0%). The majority of individuals belonged to 41 to 60 years (49.0%, n=490), followed by 21-40 years (28.9%, n=289). Gastrointestinal cancer was more prevalent among males (35.5%, n=146), while breast cancer was predominant among females (31.4%, n=185). Conclusion Cancer is more prevalent among rural females (58.9%), providing valuable insights into the prevalence of various cancers and highlighting differences between regions, age groups, and genders.

Detection of antibodies against structural proteins of foot-and-mouth disease virus in bovines of western Uttar Pradesh, India.

Foot-and-mouth disease (FMD) is considered as one of the most important contagious viral diseases affecting cloven-footed animals. For effective control of FMD, immunization along with herd immunity is essential in the field conditions. To assure and track the coverage and effectiveness of the vaccination program, the serological studies are very much required after the vaccination program. The present study was aimed to investigate the prevalence of antibodies against structural proteins of FMD virus (FMDV) serotypes of O, A and Asia-1 in seven districts of western Uttar Pradesh, India, and assure the efficacy of vaccination under National Animal Disease Control Program. A total of 308 sera samples were collected from apparent healthy vaccinated cattle and buffaloes from seven districts including Amroha, Baghpat, Bareilly, Bulandsahar, Gautam Budh Nagar, Meerut and Muzaffarnagar of western Uttar Pradesh, India. Determination of antibodies against structural proteins of FMDV was carried out using solid-phase blocking enzyme-linked immunosorbent assay. The protective level of the FMDV serotypes O, A and Asia-1 included in the inactivated trivalent vaccine was 66.55, 48.05 and 47.08% in bovines, respectively. To provide the higher level of protection against the circulating FMDV, the present study recommended the thorough investigation of the immunogenic interaction between the vaccine strains and the field strains. Further investigations should also be conducted with larger sample size and across diverse geographical regions to gain a more comprehensive understanding of herd immunity.

Exploring the shift in newborn care practices among mothers and grandmothers in rural Odisha, India - a qualitative study.

BACKGROUND: This study delves into newborn care and infant-feeding practices in rural Odisha, specifically focusing on the rural KBK + region of Odisha (Kalahandi-Bolangir-Koraput region), inhabited predominantly by Schedule Tribes and Schedule Castes individuals. There has been an improvement in the health indicators in these areas in recent times. In the background of improved health indicators in these areas, this research explores the current and changing newborn care practices and attempts to gain insight into people's perceptions of the factors that brought about the changes. METHODS: This qualitative study was conducted between February and July 2023 at Christian Hospital, Bissamcuttack in Odisha. The methodology involved focused group discussions with mothers and grandmothers. RESULTS: Analysis revealed healthy practices like exclusive breastfeeding till six months of age, appropriate timing of the first bath, and prompt healthcare-seeking behavior for minor illnesses among the mothers. The use of cow ghee or breast milk in a baby's eyes, the application of ash on the umbilical cord, and the use of herbal medicines for minor illnesses were practiced more by the grandmothers in the past and were not as popular among the mothers. It is noteworthy that the cultural practices to ward off the 'evil eye' were practiced by both mothers and grandmothers alike. Despite the influence of traditional cultural practices on the beliefs and norms of the community, the study identified a shift in health-seeking behavior, with increased reliance on healthcare providers and safe healthcare practices. The study identifies the pivotal role of Accredited Social Health Activists (ASHAs) as a bridge between the rural communities and the healthcare system. CONCLUSIONS: This research provides valuable insights for healthcare providers aiming to enhance community-centric safe newborn care practices in rural settings. The emphasis is on the importance of understanding the current and changing local practices. This would help the healthcare providers to encourage healthy practices while eliminating the harmful practices related to newborn care through community workers like ASHA and Anganwadi workers.

Evolution of transgender rights in India: Better late than never.

The progress of transgender rights in India has seen significant strides with milestones such as the National Legal Services Authority (NALSA) judgment and the enactment of the Transgender Persons (Protection of Rights) Act in 2019. The NALSA judgment recognized the right of transgender individuals to self-identify their gender. This decision led to the formal recognition of a 'third gender', advancing legislative and social reforms. Prior to this, transgender individuals faced substantial hurdles, including limited access to education, employment, and healthcare due to a lack of legal recognition. Within a few years, The Transgender Persons (Protection of Rights) Act established a framework that safeguards the rights of transgender individuals and prohibits discrimination based on gender. This legislation requires the government to take measures like promoting education, providing vocational training opportunities, ensuring accessible healthcare services, and offering social security support. It also addresses the healthcare needs of transgender individuals thereby contributing to their overall well being. The Support for Marginalised Individuals for Livelihood and Enterprise (SMILE) program and Garima Greh are initiatives that provide spaces and empower a marginalized transgender individuals and promoting their inclusion, justice and empowerment. This article explores the progress pertaining to transgender rights and welfare, while highlighting efforts undertaken by the Indian government.

Violence in the emergency department: a quantitative survey study of healthcare providers in India.

BACKGROUND: Workplace violence (WPV) in Emergency Departments (EDs) is an increasingly recognized challenge healthcare providers face in low-resource settings. While studies have highlighted the increased prevalence of WPV in healthcare, most of the existing research has been conducted in developed countries with established laws and repercussions for violence against healthcare providers. More data on WPV against ED providers practicing in low-resource settings is necessary to understand these providers' unique challenges. OBJECTIVE: This study aims to gain insight into the incidence and characteristics of WPV among ED healthcare providers in India. METHODS: This study was conducted at two EDs in geographically distinct regions of India. A survey was designed to assess violence in EDs among healthcare providers. Surveys were distributed to ED workplace providers, completed by hand, and returned anonymously. Data was entered and stored in the RedCAP database to facilitate analysis. RESULTS: Two hundred surveys were completed by physicians, nurses, and paramedics in Indian EDs. Most reported events involved verbal abuse (68%), followed by physical abuse (26%), outside confrontation (17%), and stalking (5%). By far, the most common perpetrators of violence against healthcare workers were bystanders including patient family members or other accompanying individuals. Notably, reporting was limited, with most cases conveyed to ED or hospital administration. CONCLUSION: These results underscore the prevalence of WPV among Indian ED healthcare providers. High rates of verbal abuse followed by physical abuse are of concern. Most perpetrators of WPV against healthcare providers in this study were patient family members or bystanders rather than the patients themselves. It is imperative to prioritize implementing prevention strategies to create safer work environments for healthcare workers.

Burden of Financial Hardship Among Breast Cancer Survivors in Maharashtra, India.

INTRODUCTION: Improved breast cancer treatments have increased survival rates, but prolonged and costly therapies strain survivors financially. This study addresses the dearth of research on financial difficulties among breast cancer survivors (BCS) in India. METHODS: A mixed-methods study was employed; we assessed financial hardship (FH) using the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT), a validated 12-item questionnaire. The minimum score represents FH (FH was categorized based on scores <27). RESULTS: Out of 80 surveyed BCS, 60% experienced FH and had a median age of 48 years (40.5-56.5 years). Factors such as occupation, education, income, expenditures, insurance coverage, and impact on savings exhibited significant associations with FH. With only one-third having health insurance and 43.8% self-funding treatment, this research sheds light on the urgent need for targeted support and policies to alleviate the financial burdens faced by BCS in the Indian context. CONCLUSION: Financial hardship harms the mental and physical health of BCS. Collaborative efforts among policymakers, healthcare professionals, and insurers are crucial to establishing a compassionate healthcare system that addresses both immediate health and long-term financial concerns.

CFTR mutations and phenotypic correlations in people with cystic fibrosis: a retrospective study from a single centre in south India.

Background: Emerging data reveal higher-than-expected prevalence of cystic fibrosis (CF) among non-European populations worldwide including in the Indian subcontinent. Systematic analyses of the CFTR mutation profile, and genotype-phenotype correlations among people with CF from south, east, or northeast India have not been reported before. We wanted to identify CFTR mutations in people with CF, and highlight novel variants, selective phenotypic correlations, and regional variances within India. Methods: A retrospective study was conducted at Christian Medical College, Vellore, India (single tertiary referral hospital) from September 2010 to August 2022, involving 120 people with CF from (i) four south Indian states (Tamil Nadu, Andhra Pradesh, Kerala, Karnataka), (ii) in and nearby regions of West Bengal, India and (iii) Bangladesh. Comprehensive CFTR mutation analyses were done by Next-Generation Sequencing, and variants were categorized per American College of Medical Genetics guidelines and compared with validated Locus-specific databases. Demographic characteristics, mutation profile, novel mutations, selective phenotype correlations, and regional variances were assessed. Findings: In 120 people with CF, 55 CFTR variants were identified, including six novel variants. F508del was the predominant mutation, yet with a lower allele frequency than reported among European populations (27% versus 70%). Phenotypic correlations suggested high mutational pathogenicity causing severe multi-organ morbidity, and death in 27%. Milder variants associated with pancreatic sufficiency were also evident in 23% of people with CF. Statistically significant regional variances were noted in genotype frequency, and clinical phenotype among people with CF from the two regions. Hotspot exons and introns that could potentially help create targeted mutation panels were identified. Interpretation: The identification of 55 different CFTR variants among 120 people with CF describes the diversity of mutations noted in India, while also revealing the challenges that providers may encounter in timely diagnosis and treatment of CF. However, these single-centre data have specific limitations and cannot be generalised to all people with CF from India or to those of non-European origin. Our data on regional CFTR mutations contribute to the emerging national registry on CF epidemiology in India, help formulate diagnostic and newborn screening algorithms, help optimise clinical care, and highlight urgency to improve access to life-changing modulator therapy. Funding: Cystic Fibrosis Foundation, USA (towards the CF-India Demonstration Project) and Christian Medical College, Vellore, India.

Assessment of prevalence of elevated blood lead levels and risk factors among children and pregnant women in Bihar, India.

BACKGROUND: While modeled estimates and studies in contaminated areas indicate high lead exposure among children in Bihar, India, local data on lead exposure in the child population is limited. OBJECTIVES: To characterize lead exposure, and assess potential sources of lead exposure among a state-representative sample of children and their pregnant mothers residing in Bihar. METHODS: Blood samples were collected from 697 children under five and 55 pregnant women from eight districts in Bihar. Blood lead levels were determined using capillary blood and a portable lead analyzer. Household demographics, home environment, behavior, and nutrition information were collected through computer-assisted personal interviews with primary caregivers. Logistic regression was used to assess associations between potential risk factors and elevated blood lead levels. RESULTS: More than 90% of children and 80% of pregnant women reported blood lead levels ≥5 µg/dL. Living near a lead-related industry and pica behavior of eating soil were significantly associated with increased odds of having elevated blood lead levels. Additional risk factors for having a blood level ≥5 µg/dL included the use of skin lightning cream (aOR = 5.11, 95%CI: 1.62, 16.16) and the use of eyeliners (aOR = 2.81, 95%CI: 1.14, 6.93). Having blood lead levels ≥10 µg/dL was also significantly associated with the household member who had an occupation or hobby involving the use of lead (aOR = 1.75, 95%CI: 1.13, 2.72). DISCUSSION: Elevated blood lead levels were prevalent among children and pregnant women in Bihar, indicating the urgent need for a comprehensive lead poisoning prevention strategy.

A comprehensive approach for detection of biotin deficiency from dried blood spot samples using liquid chromatography-mass spectrometry.

Aim: The aim of the present study is to develop a liquid chromatography-mass spectrometry method to measure two important biomarkers of biotin deficiency from dried blood spot samples for effective management of the disorder. Materials & methods: The method was developed on a liquid chromatography-mass spectrometry system using pentafluorophenyl column employing a mobile phase composition of methanol and water in the isocratic mode. A full validation of the method was performed as per relevant guidelines. Results & conclusion: Correlation between the results of dried blood spot and plasma method was evaluated to determine the interconvertibility of the method. The developed method was successfully applied for establishing the reference ranges for these biomarkers in the population of Udupi, a coastal district of South India.

Biotin deficiency can lead to many complications such as impaired growth, compromised immune function, depression, myalgia and may even lead to death. The disorder can be managed by supplementation of biotin. Early detection is crucial in managing biotin deficiency. In this paper we describe a comprehensive method for the early detection of biotin deficiency. The method employs the use of minimally invasive blood sampling such as dried blood spot that is suitable for vulnerable neonatal population.

Observational evidence of changing cloud macro-physical properties under warming climate over the Indian summer monsoon region.

The cloud responses to global warming are captured in various global climate models with distinct inferences on changes in cloud vertical structure as function of surface warming. However, long term observational evidences are scarce to validate the model outputs. Here, we have studied the changes in radiosonde derived cloud macro-physical properties and their association with other atmospheric variables during the period 2000-2019 in response to warming climate over the Indian summer monsoon region. We have observed a statistically significant increase in the frequency of cloudy days (∼13 % decade-1), high-level clouds (HLCs ∼11 % decade-1) and simultaneous decrease in low-level clouds (LLCs ∼8 % decade-1) over the Indian region during the monsoon season. The multiple linear regression, principle component analyses and further correlation analyses suggest significant associations between cloud vertical structure variations and large-scale climate indicators, such as global warming and El Niño-Southern Oscillation. The vertical extension of the tropospheric column and the upward shift of clouds, attributed to global warming, explain the changes observed in both HLCs and LLCs. These results contribute to a deeper understanding of the dynamic interplay between global climate change and regional cloud dynamics, with implications for weather and climate modeling.