Peri-operative tobacco cessation interventions: a systematic review and meta-analysis.

Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20-1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29-2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.

Non-linear adaptive control inspired by neuromuscular systems.

Current paradigms for neuromorphic computing focus on internal computing mechanisms, for instance using spiking-neuron models. In this study, we propose to exploit what is known about neuro-mechanical control, exploiting the mechanisms of neural ensembles and recruitment, combined with the use of second-order overdamped impulse responses corresponding to the mechanical twitches of muscle-fiber groups. Such systems may be used for controlling any analog process, by realizing three aspects: Timing, output quantity representation and wave-shape approximation. We present an electronic based model implementing a single motor unit for twitch generation. Such units can be used to construct random ensembles, separately for an agonist and antagonist 'muscle'. Adaptivity is realized by assuming a multi-state memristive system for determining time constants in the circuit. Using SPICE-based simulations, several control tasks were implemented which involved timing, amplitude and wave shape: The inverted pendulum task, the 'whack-a-mole' task and a handwriting simulation. The proposed model can be used for both electric-to-electronic as well as electric-to-mechanical tasks. In particular, the ensemble-based approach and local adaptivity may be of use in future multi-fiber polymer or multi-actuator pneumatic artificial muscles, allowing for robust control under varying conditions and fatigue, as is the case in biological muscles.

Medium optimization for submerged fermentative production of ß-cyclodextrin glucosyltransferase by isolated novel alkalihalophilic Bacillus sp. NCIM 5799 using statistical approach.

ß-cyclodextrin glucosyltransferase (ß-CGTase) is an essential enzyme to catalyse the biotransformation of starch into ß-cyclodextrins (ß-CD). ß-CD has widespread applications in the biomedical, pharmaceutical and food industries. The present study focused on ß-CGTase production using an efficient natural microbial strain and statistical production optimization for enhanced production. The isolated organism Bacillus sp. NCIM 5799 was found to be 5 µm short bacilli under FE-SEM and alkalihalophilic in nature. The ß-CGTase production was optimized using a combination of Plackett-Burman design (PBD) and Central Composite Design-Response Surface Methodology (CCD-RSM). On PBD screening Na2 CO3 , peptone and MgSO4 .7H2 O were found to be significant for optimal ß-CGTase production, whereas the soluble starch and K2 HPO4 concentrations were found to be nonsignificant for ß-CGTase production. The significant factors obtained after PBD were further optimized using CCD-RSM design. Peptone was found to have a significant interaction effect with Na2 CO3 , and MgSO4 ·7H2 O and Na2 CO3 exhibited a significant effect on the production of CGTase. The production of ß-CGTase was enhanced in the presence of peptone (3%) and Na2 CO3 (0·8%). CGTase production obtained was 156·76 U/ml when optimized using CCD-RSM. The final optimized medium (RSM) shows 7·7- and 5·4-fold high productions as compared to un-optimized and one factor at a time production media.

Association between climate and infectious diseases among children in Varanasi city, India: A prospective cohort study.

The effects of climate on infectious diseases could influence the health impacts, particularly in children in countries with the unfair socioeconomic conditions. In a prospective cohort of 461 children under 16-years-of-age in Varanasi city, India, the association of maximum-temperature (Tmax), relative humidity (RH), absolute humidity (AH), rainfall (RF), wind-speed (WS), and solar radiation (SLR) with prevalent infectious diseases (Diarrhea, Common cold and flu, Pneumonia, Skin-disease and Malaria, and Dengue) was examined using binomial-regression, adjusting for confounders and effect modifiers (socioeconomic-status; SES and child anthropometry), from January 2017 to January 2020. Attributable-fraction (AFx) was calculated due to each climate variable for each infectious disease. The result showed that each unit (1 °C) rise in Tmax was associated with an increase in diarrhea and skin-disease cases by 3.97% (95% CI: 2.92, 5.02) and 3.94% (95% CI: 1.67, 6.22), respectively, whereas, a unit decline in Tmax was associated with an increase in cold and flu cases by 3.87% (95% CI: 2.97, 4.76). Rise in humidity (RH) was associated with increase in cases of cold and flu by 0.73% (95% CI: 0.38, 1.08) and malaria (AH) by 7.19% (95% CI: 1.51, 12.87) while each unit (1 g/m3) decrease in humidity (AH) observed increase in pneumonia cases by 3.02% (95% CI: 0.75, 5.3). WS was positively associated with diarrhea (14.16%; 95% CI: 6.52, 21.80) and negatively with dengue (17.40%; 12.32, 22.48) cases for each unit change (kmph). RF showed marginal association while SLR showed no association at all. The combined AFx due to climatic factors ranged from 9 to 18%. SES and anthropometric parameters modified the climate-morbidity association in children with a high proportion of children found suffering from stunting, wasting, and underweight conditions. Findings from this study draw the attention of government and policymakers to prioritize effective measures for child health as the present association may increase disease burden in the future under climate-change scenarios in already malnourished paediatric population through multiple pathways.

Conversion of clinically isolated syndrome to multiple sclerosis: a prospective multi-center study in Eastern India.

BACKGROUND: In White populations more than 60% of clinically isolated syndrome (CIS) convert to multiple sclerosis (MS) on a long-term follow-up; several predictors for conversion have been identified. OBJECTIVE: This study aimed to determine the conversion rate and the predictors of conversion from CIS to MS (McDonald 2010) among Indians. The other objective was to evaluate the diagnostic accuracy of the new McDonald 2017 criteria in prediction of a second clinical attack. METHODS: Clinical and demographic data of CIS cohorts were collected. Baseline investigations included cerebrospinal magnetic resonance imaging (MRI) with contrast and cerebrospinal fluid (CSF) testing for oligoclonal band (OCB). Follow-up clinical and MRI examinations were performed annually for at least 24 months. RESULTS: Of the 82 subjects (age range 15-58 years), 36 (43.9%) converted to MS; 31/82 (37.8%) converted in 24 months. The predictors for conversion were earlier age of onset, CSF-OCB, cerebral MRI T2 lesion count, and periventricular and juxtacortical location of lesions. Twenty-two (26.83%) CIS fulfilled the McDonald MS 2017 criteria at baseline. CONCLUSION: In this first prospective study of CIS in India, the risk factors for conversion are similar but the conversion rate to MS is lower than that in the western nations.

A case report of Blastocystis infection and Steven Johnson's syndrome.

Blastocystis species (spp.) is an emerging pathogen. There are several unsolved issues linked to this parasite ranging from its nomenclature, commensal status, standardization of laboratory diagnostic methods, genotypes and treatment. Recently, there has been an increase in reports of Blastocystis spp. from symptomatic cases which provide enough evidence of its pathogenic potential. A range of signs and symptoms, from gastro-intestinal to cutaneous manifestations have been attributed to Blastocystis infection. Few reports have established an association between intestinal infection with Blastocystis spp. and skin manifestations in form of urticaria, palmoplantar pruritus and allergy with complete resolution of cutaneous lesions with eradication of the parasite. In this report, we describe a case of Steven Johnson's syndrome (SJS) in a 6 years old girl along with infection with Blastocystis spp. marked by diarrhea and abdominal pain. Stool examination revealed the presence of all forms of the parasite with subsequent decrease in parasite burden and diarrhea over a period of time. Interestingly, the clearance of Blastocystis spp. from stool was followed by recovery from skin lesions and other symptoms. In this case, the course of SJS was clearly associated with Blastocystis infection. Though skin manifestation with Blastocystis infection has been previously reported, this is the first report of its association with SJS. This report indicates newer insights of the parasite that are less well studied.

A case report of Blastocystis infection and Steven Johnson’s syndrome

@#Blastocystis species (spp.) is an emerging pathogen. There are several unsolved issues linked to this parasite ranging from its nomenclature, commensal status, standardization of laboratory diagnostic methods, genotypes and treatment. Recently, there has been an increase in reports of Blastocystis spp. from symptomatic cases which provide enough evidence of its pathogenic potential. A range of signs and symptoms, from gastro-intestinal to cutaneous manifestations have been attributed to Blastocystis infection. Few reports have established an association between intestinal infection with Blastocystis spp. and skin manifestations in form of urticaria, palmoplantar pruritus and allergy with complete resolution of cutaneous lesions with eradication of the parasite. In this report, we describe a case of Steven Johnson’s syndrome (SJS) in a 6 years old girl along with infection with Blastocystis spp. marked by diarrhea and abdominal pain. Stool examination revealed the presence of all forms of the parasite with subsequent decrease in parasite burden and diarrhea over a period of time. Interestingly, the clearance of Blastocystis spp. from stool was followed by recovery from skin lesions and other symptoms. In this case, the course of SJS was clearly associated with Blastocystis infection. Though skin manifestation with Blastocystis infection has been previously reported, this is the first report of its association with SJS. This report indicates newer insights of the parasite that are less well studied.

Airing 'clean air' in Clean India Mission.

The submission explores the possibility of a policy revision for considering clean air quality in recently launched nationwide campaign, Clean India Mission (CIM). Despite of several efforts for improving availability of clean household energy and sanitation facilities, situation remain still depressing as almost half of global population lacks access to clean energy and proper sanitation. Globally, at least 2.5 billion people do not have access to basic sanitation facilities. There are also evidences of 7 million premature deaths by air pollution in year 2012. The situation is even more disastrous for India especially in rural areas. Although, India has reasonably progressed in developing sanitary facilities and disseminating clean fuel to its urban households, the situation in rural areas is still miserable and needs to be reviewed. Several policy interventions and campaigns were made to improve the scenario but outcomes were remarkably poor. Indian census revealed a mere 31% sanitation coverage (in 2011) compared to 22% in 2001 while 60% of population (700 million) still use solid biofuels and traditional cook stoves for household cooking. Further, last decade (2001-2011) witnessed the progress decelerating down with rural households without sanitation facilities increased by 8.3 million while minimum progress has been made in conversion of conventional to modern fuels. To revamp the sanitation coverage, an overambitious nationwide campaign CIM was initiated in 2014 and present submission explores the possibility of including 'clean air' considerations within it. The article draws evidence from literatures on scenarios of rural sanitation, energy practises, pollution induced mortality and climatic impacts of air pollution. This subsequently hypothesised with possible modification in available technologies, dissemination modes, financing and implementation for integration of CIM with 'clean air' so that access to both sanitation and clean household energy may be effectively addressed.

Decontamination of coal mine effluent generated at the Rajrappa coal mine using phytoremediation technology.

Toxicity of the effluent generated at the Rajrappa coal mine complex under the Central Coalfields Limited (CCL, a subsidiary of Coal India Limited) in Jharkhand, India was investigated. The concentrations (mg L-1) of all the toxic metals (Fe, Mn, Ni, Zn, Cu, Pb, Cr, and Cd) in the coal mine effluent were above the safe limit suggested by the Environmental Protection Agency (EPA 2003). Among these, Fe showed the highest concentration (18.21 ± 3.865), while Cr had the lowest effluent concentration (0.15 ± 0.014). Efforts were also made to detoxify the effluent using two species of aquatic macrophytes namely "'Salvinia molesta and Pistia stratiotes." After 10 days of phytoremediation, S. molesta removed Pb (96.96%) > Ni (97.01%) > Cu (96.77%) > Zn (96.38%) > Mn (96.22%) > Fe (94.12%) > Cr (92.85%) > Cd (80.99%), and P. stratiotes removed Pb (96.21%) > Fe (94.34%) > Ni (92.53%) > Mn (85.24%) > Zn (79.51%) > Cr (78.57%) > Cu (74.19%) > Cd (72.72%). The impact of coal mine exposure on chlorophyll content showed a significant decrease of 42.49% and 24.54% from control values in S. molesta and P. stratiotes, respectively, perhaps due to the damage inflicted by the toxic metals, leading to the decay of plant tissues.

Trend and variability of atmospheric ozone over middle Indo-Gangetic Plain: impacts of seasonality and precursor gases.

Ozone dynamics in two urban background atmospheres over middle Indo-Gangetic Plain (IGP) were studied in two contexts: total columnar and ground-level ozone. In terms of total columnar ozone (TCO), emphases were made to compare satellite-based retrieval with ground-based observation and existing trend in decadal and seasonal variation was also identified. Both satellite-retrieved (Aura Ozone Monitoring Instrument-Differential Optical Absorption Spectroscopy (OMI-DOAS)) and ground-based observations (IMD-O3) revealed satisfying agreement with OMI-DOAS observation over predicting TCO with a positive bias of 7.24 % under all-sky conditions. Minor variation between daily daytime (r = 0.54; R 2 = 29 %; n = 275) and satellite overpass time-averaged TCO (r = 0.58; R 2 = 34 %; n = 208) was also recognized. A consistent and clear seasonal trend in columnar ozone (2005-2015) was noted with summertime (March-June) maxima (Varanasi, 290.9 ± 8.8; Lucknow, 295.6 ± 9.5 DU) and wintertime (December-February) minima (Varanasi, 257.4 ± 10.1; Lucknow, 258.8 ± 8.8 DU). Seasonal trend decomposition based on locally weighted regression smoothing technique identified marginally decreasing trend (Varanasi, 0.0084; Lucknow, 0.0096 DU year-1) especially due to reduction in monsoon time minima and summertime maxima. In continuation to TCO, variation in ground-level ozone in terms of seasonality and precursor gases were also analysed from September 2014 to August 2015. Both stations registered similar pattern of variation with Lucknow representing slightly higher annual mean (44.3 ± 30.6; range, 1.5-309.1 µg/m3) over Varanasi (38.5 ± 17.7; range, 4.9-104.2 µg/m3). Variation in ground-level ozone was further explained in terms water vapour, atmospheric boundary layer height and solar radiation. Ambient water vapour content was found to associate negatively (r = -0.28, n = 284) with ground-level ozone with considerable seasonal variation in Varanasi. Implication of solar radiation on formation of ground-level ozone was overall positive (Varanasi, 0.60; Lucknow, 0.26), while season-specific association was recorded in case of atmospheric boundary layer.

Identification, antifungal resistance profile, in vitro biofilm formation and ultrastructural characteristics of Candida species isolated from diabetic foot patients in Northern India.

PURPOSE: Diabetic foot ulcers are a serious cause of diagnostic and therapeutic concern. The following study was undertaken to determine the fungal causes of diabetic foot ulcers, with their phenotypic and genotypic characterisation. MATERIALS AND METHODS: A total of 155 diabetic foot ulcers were studied for 1 year. Deep tissue specimen was collected from the wounds, and crushed samples were plated on Sabouraud dextrose agar with chloramphenicol (0.05 g). Identification was done by growth on cornmeal agar, germ tube formation and urease test. For molecular identification, conserved portion of the 18S rDNA region, the adjacent internal transcribed spacer 1 (ITS1) and a portion of the 28S rDNA region were amplified, using the ITS1 and ITS2 primers. Antifungal susceptibility against voriconazole, fluconazole and amphotericin B was determined by standard broth microdilution method. Biofilm formation was studied in three steps. First, on the surface of wells of microtiter plates followed by quantification of growth by fungal metabolism measurement. Finally, biofilms were analysed by scanning electron microscopy (SEM). RESULTS: Fungal aetiology was found in 75 patients (48.38%). All were identified as Candida species (100%). The prevalence of different species was Candida tropicalis (34.6%), Candida albicans (29.3%), Candida krusei (16.0%), Candida parapsilosis (10.6%), Candida glabrata (9.33%). All were susceptible to amphotericin B (100%). On microtiter plate, all the isolates were viable within 48 h showing biofilms. The metabolic activity of cells in the biofilm increased with cellular mass, especially in the first 24 h. On SEM, majority showed budding yeast form. CONCLUSION: Non-albicans Candida spp. with potential biofilm forming ability are emerging as a predominant cause of diabetic foot ulcers.

Evaluation of pollution of Ganga River water using fish as bioindicator.

Ganga River, life line of millions of people got heavily polluted due to uncontrolled anthropogenic activities. To monitor the effect of pollution of the river on its aquatic life, a field study was conducted by analyzing the different biomarker enzymes and biochemical parameters in the various tissues (muscles, liver, gills, kidney, brain, and skin) of the Indian major carp Labeo rohita collected from the River Ganga from different study sites of Varanasi district. Activities of antioxidant enzymes, e.g., superoxide dismutase, catalase, and level of lipid peroxidation were found to be higher in the fish collected from the river showing pollutant-induced oxidative stress in the fish. Disturbed health status of the river fish was also manifested by increased activities of aspartate amino transferase, alanine amino transferase, and alkaline phosphatase. Concentration of nutritionally important biomolecules (proteins, lipids, and moisture) and energy value were also found to be significantly lower in the tissues of the River fish indicating its decreased nutritional value due to oxidative stress caused by different pollutants.

Discriminating Intercalative Effects of Threading Intercalator Nogalamycin, from Classical Intercalator Daunomycin, Using Single Molecule Atomic Force Spectroscopy.

DNA threading intercalators are a unique class of intercalating agents, albeit little biophysical information is available on their intercalative actions. Herein, the intercalative effects of nogalamycin, which is a naturally-occurring DNA threading intercalator, have been investigated by high-resolution atomic force microscopy (AFM) and spectroscopy (AFS). The results have been compared with those of the well-known chemotherapeutic drug daunomycin, which is a non-threading classical intercalator bearing structural similarity to nogalamycin. A comparative AFM assessment revealed a greater increase in DNA contour length over the entire incubation period of 48 h for nogalamycin treatment, whereas the contour length increase manifested faster in case of daunomycin. The elastic response of single DNA molecules to an externally applied force was investigated by the single molecule AFS approach. Characteristic mechanical fingerprints in the overstretching behaviour clearly distinguished the nogalamycin/daunomycin-treated dsDNA from untreated dsDNA-the former appearing less elastic than the latter, and the nogalamycin-treated DNA distinguished from the daunomycin-treated DNA-the classically intercalated dsDNA appearing the least elastic. A single molecule AFS-based discrimination of threading intercalation from the classical type is being reported for the first time.

Sex differences in hypothalamic-mediated tonic norepinephrine release for thermal hyperalgesia in rats.

Neuropathic pain is treated using serotonin norepinephrine reuptake inhibitors with mixed results. Pain facilitation mediated by α1-adrenoceptors may be involved, but whether norepinephrine (NE) is tonically released is unclear. The aim of this study was to determine whether NE is tonically released from A7 cells following chronic constriction injury (CCI), and if the lateral hypothalamus (LH) plays a role in this release in male and female rats with nociceptive and neuropathic pain types. Neuropathic groups received left CCI while nociceptive groups remained naïve to injury. Fourteen days later, rats were given intrathecal infusion of either the α1-adrenoceptor antagonist WB4101, the α2-adrenoceptor antagonist yohimbine (74 µg), or normal saline for control. Paw withdrawal latency (PWL) from a thermal stimulus was measured. The generalized estimated equation method was used for statistical analysis. Nociceptive rats given WB4101 had a PWL significantly longer than saline control (7.89 ± 0.63 vs. 5.87 ± 0.52 s), while the PWL of neuropathic rats given WB4101 was 13.20 ± 0.52 s compared to 6.78 ± 0.52 s for the saline control rats. Yohimbine had no significant effect. Microinjection of cobalt chloride (CoCl) in the A7 catecholamine cell group to prevent synaptic transmission blocked the effect of WB4101 in all groups, supporting the notion that spinally descending A7 cells tonically release NE that contributes to α1-mediated nociceptive facilitation. Microinjection of CoCl into the left LH blocked the effect of WB4101 in nociceptive and neuropathic male rats, but had no effect in female rats of either pain type, suggesting differential innervation. These findings indicate that tonic release of NE acts at pronociceptive α1-adrenoceptors, that this effect is greater in rats with nerve damage, and that, while NE comes primarily from the A7 cell group, LH innervation of the A7 cell group is different between the sexes.

Arsenic induced hematological and biochemical responses in nutritionally important catfish Clarias batrachus (L.).

The impact of sublethal toxicity of sodium arsenite on hematological and certain biochemical parameters of the fresh water catfish Clarias batrachus has been analyzed following exposure of sublethal concentration (1 mg/L; 5% of LC50 value) of sodium arsenite for 10, 30, 45, and 60 days. Arsenic bioaccumulation in the blood tissue of the fish increased progressively with increased period of exposure. The values of total erythrocyte count (TECs), total leucocytes count (TLCs), hemoglobin concentration, and packed cell volume (PCV) 1.40 ± 0.03 × 106/mm3, 174.83 ± 2.74 × 103/mm3, 5.01 ± 0.26 g/100 ml, 25.00 ± 1.06 were observed respectively at the end of 60 days of exposure. The results of hematological indices were found to be 179.23 ± 8.81fl/cell for mean corpuscular volume (MCV), 35.92 ± 1.89 pg/cell for mean corpuscular hemoglobin (MCH) and 20.17 ± 1.12 g/dl for mean corpuscular hemoglobin concentration (MCHC). The present findings are clearly indicating severe fish anemia due to the arsenic salt exposure. The continued arsenic toxicity results in decreased serum protein concentration that might be a cause for the loss of weight as well as weakness in the fish.

Interface control of electronic transport across the magnetic phase transition in SrRuO3/SrTiO3 heterointerface.

The emerging material class of complex-oxides, where manipulation of physical properties lead to new functionalities at their heterointerfaces, is expected to open new frontiers in Spintronics. For example, SrRuO3 is a promising material where external stimuli like strain, temperature and structural distortions control the stability of electronic and magnetic states, across its magnetic phase transition, useful for Spintronics. Despite this, not much has been studied to understand such correlations in SrRuO3. Here we explore the influence of electron-lattice correlation to electron-transport, at interfaces between SrRuO3 and Nb:SrTiO3 across its ferromagnetic transition, using a nanoscale transport probe and first-principles calculations. We find that the geometrical reconstructions at the interface and hence modifications in electronic structures dominate the transmission across its ferromagnetic transition, eventually flipping the charge-transport length-scale in SrRuO3. This approach can be easily extended to other devices where competing ground states can lead to different functional properties across their heterointerfaces.

Electric Field Control of Spin Lifetimes in Nb-SrTiO_{3} by Spin-Orbit Fields.

We show electric field control of the spin accumulation at the interface of the oxide semiconductor Nb-SrTiO_{3} with Co/AlO_{x} spin injection contacts at room temperature. The in-plane spin lifetime τ_{∥}, as well as the ratio of the out-of-plane to in-plane spin lifetime τ_{⊥}/τ_{∥}, is manipulated by the built-in electric field at the semiconductor surface, without any additional gate contact. The origin of this manipulation is attributed to Rashba spin orbit fields (SOFs) at the Nb-SrTiO_{3} surface and shown to be consistent with theoretical model calculations based on SOF spin flip scattering. Additionally, the junction can be set in a high or low resistance state, leading to a nonvolatile control of τ_{⊥}/τ_{∥}, consistent with the manipulation of the Rashba SOF strength. Such room temperature electric field control over the spin state is essential for developing energy-efficient spintronic devices and shows promise for complex oxide based (spin) electronics.

Burden among Parkinson's disease care givers for a community based study from India.

Aim was to analyze predictors of burden among primary caregivers (CGs) of Indian Parkinson's disease (PD) patients. 150 PD patients were administered using Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr Scale (H&Y), Montgomery Asberg Depression Rating Score (MADRS) and Mini Mental State Examination (MMSE) in this cross-sectional evaluation study. CG burden was assessed by Caregiver's Burden Scale (CBS), Hospital Anxiety and Depression Scale (HADS), SF-36 and 20-item Burden Assessment Schedule (BAS). Linear regression methods were used to evaluate factors contributing to burden and stress. Mean age of CG was 50.38±16.04 (range: 25-83 yrs). Marital status of CGs was noted to have significant relationship with CBS score (F=9.525, P<0.0001). Siblings (brother/sister) reported the highest CBS score while the wives reported the least. Correlations were strong between CBS and HADS anxiety (r=0.228, P=0.0048) and HADS depression (r=0.2172, P=0.0076). High correlations were found in caregiving duration, patients' stage of illness and motor disability among all the scales (CBS, HADS, SF36) determined. Step-wise regression analysis showed UPDRS (beta=1.364-0.202 ranging among all scales) and H&Y stages (beta=2.786-7.257) to have the strongest influence on CGs. CGs of patients with depression (MADRS: P=0.007 (SF36 mental) and dementia (MMSE: P=0.01) experienced greater stress. Social and financial status was disrupted in ~60% to 80% of the CGs. Motor imbalances with disability of PD patients and severity of disease are the main factors contributing to burden and stress in CGs.