Mapping the Consequences - An Exploratory Study on the Use of Body Mapping Technique to Assess Perceptions of Health-care Workers on the Effects of Uncontrolled Diabetes Mellitus and Hypertension.

Knowledge of the consequences of uncontrolled diabetes mellitus and hypertension on various body organs among health workers is necessary to educate patients. Body mapping is a tool used for exploring perceptions as a part of qualitative research. This study assesses the perceptions of health-care workers on the effects of uncontrolled diabetes mellitus and hypertension on the human body using the body mapping technique. All 19 staff members of an Urban Primary Health Center were asked to draw a human body and map the parts affected by uncontrolled diabetes mellitus and hypertension. The mean age of the participants was 35.42 ± 10.54 years, and median years of work experience were 4 (3, 7) years. Fourteen (74%) participants had mapped kidneys and 11 (58%) participants had mapped head/brain indicating stroke to indicate damage due to uncontrolled diabetes mellitus and hypertension. Only 7 (37%) and 4 (26%) participants perceived that feet and eyes could be affected.

Immunogenicity of SARS-CoV-2 vaccines BBV152 (COVAXIN®) and ChAdOx1 nCoV-19 (COVISHIELD™) in seronegative and seropositive individuals in India: a multicentre, nonrandomised observational study.

Background: There are limited global data on head-to-head comparisons of vaccine platforms assessing both humoral and cellular immune responses, stratified by pre-vaccination serostatus. The COVID-19 vaccination drive for the Indian population in the age group 18-45 years began in April 2021 when seropositivity rates in the general population were rising due to the delta wave of COVID-19 pandemic during April-May 2021. Methods: Between June 30, 2021, and Jan 28, 2022, we enrolled 691 participants in the age group 18-45 years across four clinical sites in India. In this non-randomised and laboratory blinded study, participants received either two doses of Covaxin® (4 weeks apart) or two doses of Covishield™ (12 weeks apart) as per the national vaccination policy. The primary outcome was the seroconversion rate and the geometric mean titre (GMT) of antibodies against the SARS-CoV-2 spike and nucleocapsid proteins post two doses. The secondary outcome was the frequency of cellular immune responses pre- and post-vaccination. Findings: When compared to pre-vaccination baseline, both vaccines elicited statistically significant seroconversion and binding antibody levels in both seronegative and seropositive individuals. In the per-protocol cohort, Covishield™ elicited higher antibody responses than Covaxin® as measured by seroconversion rate (98.3% vs 74.4%, p < 0.0001 in seronegative individuals; 91.7% vs 66.9%, p < 0.0001 in seropositive individuals) as well as by anti-spike antibody levels against the ancestral strain (GMT 1272.1 vs 75.4 binding antibody units/ml [BAU/ml], p < 0.0001 in seronegative individuals; 2089.07 vs 585.7 BAU/ml, p < 0.0001 in seropositive individuals). As participants at all clinical sites were not recruited at the same time, site-specific immunogenicity was impacted by the timing of vaccination relative to the delta and omicron waves. Surrogate neutralising antibody responses against variants-of-concern including delta and omicron was higher in Covishield™ recipients than in Covaxin® recipients; and in seropositive than in seronegative individuals after both vaccination and asymptomatic infection (omicron variant). T cell responses are reported from only one of the four site cohorts where the vaccination schedule preceded the omicron wave. In seronegative individuals, Covishield™ elicited both CD4+ and CD8+ spike-specific cytokine-producing T cells whereas Covaxin® elicited mainly CD4+ spike-specific T cells. Neither vaccine showed significant post-vaccination expansion of spike-specific T cells in seropositive individuals. Interpretation: Covishield™ elicited immune responses of higher magnitude and breadth than Covaxin® in both seronegative individuals and seropositive individuals, across cohorts representing the pre-vaccination immune history of most of the vaccinated Indian population. Funding: Corporate social responsibility (CSR) funding from Hindustan Unilever Limited (HUL) and Unilever India Pvt. Ltd. (UIPL).

Validation of no-biopsy pathway for the diagnosis of celiac disease in Asian adults: a multicenter retrospective study.

BACKGROUND AND AIM: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no-biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti-tissue transglutaminase antibody (anti-tTG ab) titer is ≥10-fold upper limit of normal (ULN) and have a positive IgA anti-endomysial antibody (EMA); the data for anti-tTG Ab titer-based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti-tTG Ab titer ≥10-fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD. METHODS: We recruited 937 adult patients with positive anti-tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti-tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2. RESULTS: Of 937 adult patients with positive anti-tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti- tTG Ab titers of ≥10-fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10-fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti-tTG Ab titer ≥11-fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2. CONCLUSIONS: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia.

Comparative Evaluation of Eustachian Tube Changes in Oral Submucous Fibrosis Patients.

Aim and Objective: Oral submucous fibrosis (OSMF) is a potentially premalignant disorder affecting the oral cavity and its adjacent structures. The present study was aimed at a comparative evaluation of eustachian tube (ET) changes in OSMF patients using audiometry and cone-beam computed tomography (CBCT). Materials and Methods: A total of 40 patients who were clinically diagnosed with OSMF were taken for the study and were graded into clinical and functional staging. After grading, the patients were subjected to audiometry to evaluate their hearing deficit. Subsequently, the patients were subjected to CBCT analysis for the evaluation of the length and volume of the ET. The length of ET was measured in the axial sections of the full-face CBCT images taken at the level of the root tip of the upper first molar. The radiolucency from the nasopharyngeal opening to the maximum distance was considered. The volume of ET was measured using third-party software (ITK-SNAP) in the radiolucent area. Result: The age group in which a higher number of OSMF cases were seen was between 41 and 50 years. There was mild to moderate hearing loss observed in the right and/or left ear, with little variation between right and left ear changes in audiometry. The CBCT analysis did not show a significant difference in the mean length of the eustachian tube when comparing OSMF cases with normal. However, as the disease worsened, the length on the right and left sides significantly decreased. Additionally, there was no statistically significant difference in the mean eustachian tube volume between disease cases and controls. According to the clinical subgrades, the overall volume decreased from lower grade to higher grade, but there was no discernible difference between the left and right ear. The volume on function sub-grading between the right and left ear, however, was significantly reduced. Thus, the length and volume of ET decreased as the disease severity increased, but the mild to moderate hearing loss found in different clinical and functional grades of OSMF cases was not statistically significant. Conclusion: Therefore, from the present study, it can be concluded that all OSMF cases should be evaluated for hearing deficit, and imaging of the eustachian tube should be part of the OSMF assessment for morphological changes of the ET that may cause hearing deficit.

Can adoption of climate resilient management practices achieve carbon neutrality in traditional green revolution states of Punjab and Haryana?

Decreasing greenhouse gas (GHG) emissions and enhancing soil carbon (C) sequestration in cropland are necessary to achieve carbon neutrality at national scale. The major objective of this study is to quantify the GHG mitigation potential of adopted climate resilient (CR) practices in CR villages using Ex-ACT tool developed by Food and Agriculture Organization (FAO). Intensively cultivated area of Punjab and Haryana was selected for carrying out this study. In both the states, villages were selected by considering the climate for past 30 years. In the selected villages, a set of CR practices were implemented in annuals, perennials, irrigated rice, fertilizer use, land use change and livestock and quantified the GHG mitigation potential in these villages for next twenty years. The tool predicted that the CR practices adopted were successful in enhancing the overall sink (carbon balance) in all the study villages. The villages of Punjab had recorded higher mitigation potential as compared to the villages of Haryana. The overall sink potential in these villages ranged from -354 to -38309 Mg CO2-eq. The change in sink potential varied from 3.16 to 112% with lowest in Radauri and highest in Badhauchhi kalan village. The sink potential got doubled in Badhauchhi kalan village due to stopping rice straw burning and increase in area under perennials by 25%. The source potential varied from 6.33 to -7.44% across the study villages. Even with the implementation of NICRA, there was increase in source by 5.58 and 6.33% in Killi Nihal Singh Wala and Radauri due to irrigated rice, land use change and livestock. Majorly, rice straw burning was seen in most of the study villages, yet, with proper residue management and adoption of CR practices (mainly intermittent flooding) in rice cultivation resulted in emissions reduction up to 5-26% with enhanced productivity up to 15-18%, which can be considered for scaling up. Fertilizer management reduced the emissions by average of 13% across the study villages. Farm gate emission intensity per ton of milk and rice recorded highest emission intensity compared to annuals and perennials suggesting strict implementation of CR practices in rice cultivation and livestock sector. Implementation and scaling up of CR practices could potentially reduce the emissions and make the village C negative in intensive rice-wheat production system.

Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: An initiative of the Indian Neurogastroenterology and Motility Association.

In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiopathogenesis and pathophysiology; 5 on clinical manifestations, differential diagnosis, and predictors; and 15 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservations was 80% or higher, the statement was regarded as accepted. The members of the consensus team consider that this guideline would be valuable to inform clinical practice, teaching, and research on SIBO in the Asian-Pacific region as well as in other countries.

Photon emission enhancement studies from the interaction of ultraintense laser pulses with shaped targets.

We study the photon emission by bremsstrahlung and nonlinear Compton scattering from interaction of ultra-intense laser pulses with cone target and flat foil using particle-in-cell simulations. The simulations are performed for laser pulses interacting with Al and Au targets. The strength of the two mechanisms of photon emission from bremsstrahlung and nonlinear Compton scattering are compared. When an ultra-intense (I>10^{22}W/cm^{2}) laser interacts with a cone and a foil target, photon emission by bremsstrahlung is found to be comparable to that from nonlinear Compton scattering. The obtained electron energy as well as the energy and number of photons emitted were found to be higher in case of cone shaped target compared with that of a foil target. The enhanced photon emission from cone shaped target is attributed to the guiding or collimation of hot electrons towards the cone tip from the self-generated magnetic field and electrostatic field along the cone surface which pushes the hot electrons towards the tip.

Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology.

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.

Pancreatic Adenocarcinoma With Synchronous Colonic Metastases.

Metastases from pancreatic malignancy are commonly known to occur in the regional lymph nodes, liver, lung, and peritoneum. Synchronous or metachronous metastasis from the pancreas to the colon is rare, with only 6 cases reported in the literature. We report a man who was found to have adenocarcinoma on biopsies from synchronous lesions in the colon and the pancreas. The immunohistochemistry report revealed the diagnosis of a primary pancreatic malignancy with synchronous colonic metastases.

Intimate Partner Violence among Ever-married Women Treated for Depression at a Rural Health Center in Bengaluru Urban District.

BACKGROUND: Intimate partner violence (IPV) is a risk factor for depression among women. Spousal alcoholism and marital quality are associated with both depression and spousal abuse Knowledge about the factors contributing to IPV in depression will enable us to have interventions to address IPV in tandem with treating depression. OBJECTIVES: (1) To estimate the prevalence of IPV in women treated for depression in a rural community health-care facility in Bengaluru Urban District. (2) To assess the association between IPV and various other factors in women treated for depression in a rural community health care facility. METHODOLOGY: A cross-sectional study was conducted among ever-married women above 18 years, registered under mental health program in the mental health clinic in Mugalur, Karnataka, and currently on treatment for depression. The women who consented were interviewed using structured questionnaires - WHOQOL-BREF, standard of living index, Hamilton Depression Rating Scale, Index of Spouse Abuse, family interview for genetic studies for reported alcohol use, and marital quality scale. RESULTS: The mean age of the study participants was 49.7 ± 13.2 years. The prevalence of physical IPV and non-physical IPV was found to be 18% and 7%, respectively. Marital quality was significantly lower among women who experienced IPV. Women with husbands who ever used alcohol were found to have six times more risk of experiencing physical IPV, odd ratio 6.193 (1.595, 24.047). CONCLUSION: Health education, involvement of self-help groups, and awareness programs are required to alleviate IPV.

Indian guidelines on imaging of the small intestine in Crohn's disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement.

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn's disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

Dynamics of the Electromagnetic Fields Induced by Fast Electron Propagation in Near-Solid-Density Media.

The propagation of fast electron currents in near solid-density media was investigated via proton probing. Fast currents were generated inside dielectric foams via irradiation with a short (∼0.6 ps) laser pulse focused at relativistic intensities (Iλ^{2}∼4×10^{19} W cm^{-2} µm^{2}). Proton probing provided a spatially and temporally resolved characterization of the evolution of the electromagnetic fields and of the associated net currents directly inside the target. The progressive growth of beam filamentation was temporally resolved and information on the divergence of the fast electron beam was obtained. Hybrid simulations of electron propagation in dense media indicate that resistive effects provide a major contribution to field generation and explain well the topology, magnitude, and temporal growth of the fields observed in the experiment. Estimations of the growth rates for different types of instabilities pinpoints the resistive instability as the most likely dominant mechanism of beam filamentation.

Imaging of the small intestine in Crohn's disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association.

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients with suspected or known Crohn's disease. These 29 position statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

High-intensity laser-accelerated ion beam produced from cryogenic micro-jet target.

We report on the successful operation of a newly developed cryogenic jet target at high intensity laser-irradiation. Using the frequency-doubled Titan short pulse laser system at Jupiter Laser Facility, Lawrence Livermore National Laboratory, we demonstrate the generation of a pure proton beam a with maximum energy of 2 MeV. Furthermore, we record a quasi-monoenergetic peak at 1.1 MeV in the proton spectrum emitted in the laser forward direction suggesting an alternative acceleration mechanism. Using a solid-density mixed hydrogen-deuterium target, we are also able to produce pure proton-deuteron ion beams. With its high purity, limited size, near-critical density, and high-repetition rate capability, this target is promising for future applications.

Ultrafast Time-Resolved Emission and Absorption Spectra of meso-Pyridyl Porphyrins upon Soret Band Excitation Studied by Fluorescence Up-Conversion and Transient Absorption Spectroscopy.

A comprehensive study of ultrafast molecular relaxation processes of isomeric meso-(pyridyl) porphyrins (TpyPs) has been carried out by using femtosecond time-resolved emission and absorption spectroscopic techniques upon pumping at 400 nm, Soret band (B band or S2), in 4:1 dichloromethane (DCM) and tetrahydrofuran (THF) solvent mixture. By combined studies of fluorescence up-conversion, time-correlated single photon counting, and transient absorption spectroscopic techniques, a complete model with different microscopic rate constants associated with elementary processes involved in electronic manifolds has been reported. Besides, a distinct coherent nuclear wave packet motion in Qy state is observed at low-frequency mode, ca. 26 cm(-1) region. Fluorescence up-conversion studies constitute ultrafast time-resolved emission spectra (TRES) over the whole emission range (430-710 nm) starting from S2 state to Qx state via Qy state. Careful analysis of time profiles of up-converted signals at different emission wavelengths helps to reveal detail molecular dynamics. The observed lifetimes are as indicated: A very fast decay component with 80 ± 20 fs observed at ∼435 nm is assigned to the lifetime of S2 (B) state, whereas being a rise component in the region of between 550 and 710 nm emission wavelength pertaining to Qy and Qx states, it is attributed to very fast internal conversion (IC) occurring from B → Qy and B → Qx as well. Two distinct components of Qy emission decay with ∼200-300 fs and ∼1-1.5 ps time constants are due to intramolecular vibrational redistribution (IVR) induced by solute-solvent inelastic collisions and vibrational redistribution induced by solute-solvent elastic collision, respectively. The weighted average of these two decay components is assigned as the characteristic lifetime of Qy, and it ranges between 0.3 and 0.5 ps. An additional ∼20 ± 2 ps rise component is observed in Qx emission, and it is assigned to the formation time of thermally equilibrated Qx state by vibrational cooling/relaxations of excess energy within solvent. This relaxed Qx state decays to ground as well as triplet state by 7-8 ns time scale. The femtosecond transient absorption studies of TpyPs in three different excitations at S2 (400 nm), Qy (515 nm), and Qx (590 nm) along with extensive global and target model analysis of TA data exclusively generate the true spectra of each excited species/state with their respective lifetimes along with microscopic rate constants associated with each state. The following five exponential components with lifetime values of 65-70 fs, ∼0.3-0.5 ps, ∼20 ± 2 ps, ∼7 ± 1 ns, and 1-2 µs are observed which are associated with S2, Qy, hot Qx, thermally relaxed Qx, and lowest triplet (T1) states, respectively, when excited at S2, and four (Qy, hot Qx, thermally relaxed Qx, and lowest triplet (T1) states) and three (hot Qx, thermally relaxed Qx, and lowest triplet (T1) states) states are obtained when excited at 515 nm (Qy) and 590 nm (Qx), respectively, as expected. The TA results parallel the fluorescence up-conversion studies, and both the results not only compliment each other but also unveil the ultrafast internal conversion from S2 to Qy, S2 to Qx, and Qy to Qx for all three isomers in a similar fashion with nearly equal characteristic decay times.

Prevalence of Adult Celiac Disease in India: Regional Variations and Associations.

OBJECTIVES: Although celiac disease (CeD) affects 1% of people in the northern part of India, it is believed to be uncommon in the southern and northeastern parts because of significant differences in dietary pattern and ethnicity. We estimated the prevalence of CeD in these three populations. In a subset, we also investigated differences in the prevalence of HLA-DQ 2/8 allelotype and dietary grain consumption. METHODS: A total of 23,331 healthy adults were sampled from three regions of India-northern (n=6207), northeastern (n=8149), and southern (n=8973)-and screened for CeD using IgA anti-tissue transglutaminase antibody. Positive tests were reconfirmed using a second ELISA. CeD was diagnosed if the second test was positive and these participants were further investigated. A subsample of participants was tested for HLA-DQ2/-DQ8 and underwent detailed dietary evaluation. RESULTS: Age-adjusted prevalence of celiac autoantibodies was 1.23% in northern, 0.87% in northeastern, and 0.10% in southern India (P<0.0001). Prevalence of CeD and latent CeD, respectively, was 8.53/1,000 and 3.70/1,000 in northern, 4.66/1,000 and 3.92/1,000 in northeastern, and 0.11/1,000 and 1.22/1,000 in the southern part. The population prevalence of genes determining HLA-DQ2 and/or -DQ8 expression was 38.1% in northern, 31.4% in northeastern, and 36.4% in southern India. Mean daily wheat intake was highest in northern (455 g) compared with northeastern (37 g) or southern part (25 g), whereas daily rice intake showed an inverse pattern. CONCLUSIONS: CeD and latent CeD were most prevalent in northern India and were the least in southern India. The prevalence correlated with wheat intake and did not reflect differences in the genetic background.

Micrometer-sized negative-ion accelerator based on ultrashort laser pulse interaction with transparent solids.

We report here energetic (>100 keV) negative hydrogen ions (H(-)) generated in the interaction of moderately intense (10(18) W cm(-2)) ultrashort laser pulses (45 fs) with transparent hydrogen containing solid targets. An unambiguous and consistent detection of negative hydrogen ions, with a flux of 8×10(11)H(-) ions/sr, has been observed in every single laser shot, using a Thomson parabola ion spectrograph. Simple estimates based on charge transfer cross sections match well with experimental observations. Our method offers the implementation of an intense, ultrashort laser based negative-ion source at a higher repetition rate, which can be important for various applications.