Circulating serotypes and genotypes of dengue virus in North India: An observational study.

BACKGROUND OBJECTIVES: This study reports observation on circulating serotypes and genotypes of Dengue Virus in North India. METHODS: Serum samples were obtained from suspected cases of dengue referred to the virus diagnostic laboratory during 2014 to 2022. All samples were tested for anti-dengue virus IgM antibodies and NS1Ag by ELISA. NS1Ag positive samples were processed for serotyping and genotyping. RESULTS: Total 41,476 dengue suspected cases were referred to the laboratory of which 12,292 (29.6%) tested positive. Anti-Dengue Virus IgM antibodies, NS1Ag, both IgM and NS1Ag, were positive in 7007 (57.4%); 3200 (26.0%) and 2085 (16.0%) cases respectively. Total 762 strains were serotyped during 9-year period. DENV-1, DENV-2, DENV-3 and DENV-4 serotypes were found in 79 (10.37%), 506 (66.40%), 151 (19.82%) and 26 (3.41%) cases respectively. DENV-1, DENV-2 and DENV-3 were in circulation throughout. Total 105 strains were genotyped. Genotype IV of DENV-1 serotype was circulating till 2014 which was later replaced by genotype V. A distinct seasonality with increase in number of cases in post-monsoon period was seen. INTERPRETATION CONCLUSION: DENV-1, DENV-2 and DENV-3 were found to be in circulation in North India. Predominant serotype/genotype changed at times, but not at regular intervals.

Statistical optimization of cellulase production from Bacillus sp. YE16 isolated from yak dung of the Sikkim Himalayas for its application in bioethanol production using pretreated sugarcane bagasse.

Cellulolytic bacteria were isolated from yak dung samples collected from different habitats of Sikkim, India. Isolate YE16 from the Yumthang Valley sample showed highest enzyme activity of 7.68 U/mL and was identified as Bacillus sp., which has a sequence similarity of 96.15% with B. velezensis. One factor at a time (OFAT) analysis revealed that an acidic pH of 5 with 37 °C temperature was optimum for maximum enzyme production after 36 hrs of incubation (13.88 U/mL), which was further increased after statistical optimization (34.70 U/mL). Media optimization based on response surface methodology predicted that Carboxymethyl cellulose (CMC) and MgSO4 at concentrations of 30 g/L and 0.525 g/L, respectively, at pH 5.5 to show CMCase activity of 30.612 U/mL, which was consistent with the observed value of 30.25 U/mL and confirmed the model. The crude enzyme also efficiently hydrolyzed alkaline pretreated sugarcane bagasse, releasing 7.09 g/L of glucose equivalent with an ethanol production of 3.05 g.

Bioaugmentation: an approach to biological treatment of pollutants.

Industrial development and the associated generation of waste requires attention for their management, treatment, and reduction without further degrading the quality of life. Microbes and plant-based bioremediation approaches are some of the sustainable strategies for the biodegradation of harmful pollutants instead of chemical-based treatment. Bioaugmentation is one such approach where microbial strains with the ability to degrade the targeted pollutant are introduced in a polluted environment. Harnessing of microbes from various locations, especially from the site of contamination (indigenous microbes), followed by optimization of the strains, inoculum size, media, and genetic engineering of the microbes along with a combination of strategies such as bio stimulation, phytoremediation is being applied to increase the efficiency of bioaugmentation. Further, bioaugmentation is influenced by various factors such as temperature, the composition of the pollutant, and microbial inoculum which needs to be considered for maximum efficiency of the treatment process. It has numerous advantages such as low cost, sustainability, and easy handling of the contaminants however, the major limitation of bioaugmentation is to increase the survival rate of the microbes involved in remediation for a longer duration in such a highly toxic environment. The review discusses these various aspects of bioaugmentation in brief for its large-scale implementation to address the global issue of pollution and environment management.

Low prevalence of antimalarial-resistance mutations in India during 2014-15: Impact of combining first-line therapy with primaquine.

BACKGROUND: Antimalarial drug resistance surveillance and containment are crucial for countries aiming to eliminate malaria. Monitoring resistance evolution through studies before and after treatment policy changes is crucial. METHOD: A total of 939 P. falciparum-positive blood samples were collected between 2014 and 2015 across ten sites in India, categorized into four geographic clusters. PCR-amplified products were sequenced to identify point mutations at drug-resistance-conferring genes (Pfdhfr, Pfdhps, Pfmdr1, Pfk13). RESULT: Triple Pfdhfr mutants were found only in northeast India bordering Myanmar, while the wildtype was dominant in central India. Pfdhps wildtypes were prevalent in all areas, and no double mutants were found. Except in Northwest India, Pfmdr1 wildtype was dominant in all clusters. Nonsynonymous double mutations were only found in northwest India. Only synonymous mutations occurred in Pfk13. These were found in Central India at low frequency. The pattern of linkage disequilibrium and principal component analysis reflects low pressure for drug resistance and heterogeneity between the geographic clusters. CONCLUSION: Resistance levels were highest in Northeast India, close to the Myanmar border, where resistance is common. Primaquine has been widely used as a gametocidal and schizonticidal drug, has likely contributed to maintaining low drug resistance levels and preventing strong selection for resistance.

Biogas from lignocellulosic feedstock: current status and challenges.

The organic wastes and residues generated from agricultural, industrial, and domestic activities have the potential to be converted to bioenergy. One such energy is biogas, which has already been included in rural areas as an alternative cooking energy source and agricultural activities. It is produced via anaerobic digestion of a wide range of organic nutrient sources and is an essential renewable energy source. The factors influencing biogas yield, i.e., the various substrate, their characteristics, pretreatment methods involved, different microbial types, sources, and inoculum properties, are analyzed. Furthermore, the optimization of these parameters, along with fermentation media optimization, such as optimum pH, temperature, and anaerobic digestion strategies, is discussed. Novel approaches of bioaugmentation, co-digestion, phase separation, co-supplementation, nanotechnology, and biorefinery approach have also been explored for biogas production. Finally, the current challenges and prospects of the process are discussed in the review.

Biological significance of carbohydrate active enzymes and searching their inhibitors for therapeutic applications.

Glycans are the most abundant and diverse group of biomolecules with a crucial role in all the biological processes. Their structural and functional diversity is not genetically encoded, but depends on Carbohydrate Active Enzymes (CAZymes) which carry out all catalytic activities in terms of synthesis, modification, and degradation. CAZymes comprise large families of enzymes with specific functions and are widely used for various commercial applications ranging from biofuel production to textile and food industries with impact on biorefineries. To understand the structure and functional mechanism of these CAZymes for their modification for industrial use, together with knowledge of therapeutic aspects of their dysfunction associated with various diseases, CAZyme inhibitors can be used as a valuable tool. In search for new inhibitors, the screening of various secondary metabolites using high-throughput techniques and rational design techniques have been explored. The inhibitors can thus help tune CAZymes and are emerging as a potential research interest.

Optimization of Cellulase Production by Cohnella xylanilytica RU-14 Using Statistical Methods.

In this study, the cellulase activity by bacterial strain Cohnella xylanilytica RU-14 was enhanced by optimizing the medium components using statistical methods of Plackett-Burman design (PBD) and response surface methodology-central composite design (RSM-CCD). The cellulase assay was performed using NS enzyme assay method for reducing sugars. By PBD, the most significant factors (CMC, pH, and yeast extract) in an enzyme production medium that influence cellulase production by RU-14 were identified. These identified significant variables were further optimized using RSM by CCD. It was found that under optimized conditions of the medium components, the cellulase activity increased three times up to 14.5 U/mL as compared to un-optimized conditions (5.2 U/mL) of the enzyme production medium. The optimized levels of the significant factors determined by the CCD were found to be CMC, 2.3% w/v, and yeast extract, 0.75% w/v, at pH 7.5. The most adequate temperature for cellulase production by the bacterial strain was found to be 37 °C using the one-factor-at-a-time method. Thus, statistical methods to optimize medium conditions to enhance cellulase production by Cohnella xylanilytica RU-14 were found successful.

Screening of potential antiplasmodial agents targeting cysteine protease-Falcipain 2: a computational pipeline.

The spread of antimalarial drug resistance is a substantial challenge in achieving global malaria elimination. Consequently, the identification of novel therapeutic candidates is a global health priority. Malaria parasite necessitates hemoglobin degradation for its survival, which is mediated by Falcipain 2 (FP2), a promising antimalarial target. In particular, FP2 is a key enzyme in the erythrocytic stage of the parasite's life cycle. Here, we report the screening of approved drugs listed in DrugBank using a computational pipeline that includes drug-likeness, toxicity assessments, oral toxicity evaluation, oral bioavailability, docking analysis, maximum common substructure (MCS) and molecular dynamics (MD) Simulations analysis to identify capable FP2 inhibitors, which are hence potential antiplasmodial agents. A total of 45 drugs were identified, which have positive drug-likeness, no toxic features and good bioavailability. Among these, six drugs showed good binding affinity towards FP2 compared to E64, an epoxide known to inhibit FP2. Notably, two of them, Cefalotin and Cefoxitin, shared the highest MCS with E64, which suggests that they possess similar biological activity as E64. In an investigation using MD for 100 ns, Cefalotin and Cefoxitin showed adequate protein compactness as well as satisfactory complex stability. Overall, these computational approach findings can be applied for designing and developing specific inhibitors or new antimalarial agents for the treatment of malaria infections.Communicated by Ramaswamy H. Sarma.

Effect of Entamoeba histolytica infection on gut microbial diversity and composition in diarrheal patients from New Delhi.

During amoebiasis, colonization of the gut by Entamoeba histolytica can lead to alterations of the host microbiota. In this study, we have compared the gut microbiota of patients of amoebiasis with healthy controls using 16S rRNA gene variable regions, (V1-V3) and (V3-V5), of the bacterial genome. From this 16S rRNA gene amplicon data, one paired-end and two single-end datasets were selected and compared by the number of OTUs obtained, sequence count, and diversity analysis. Our results showed that the V1-V3-paired-end dataset gave the maximum number of OTUs in comparison to the two single-end datasets studied. The amoebiasis samples showed a significant drop in richness in the alpha diversity measurements and lower intra group similarity compared to the healthy controls. Bacteria of genus Prevotella, Sutterella, and Collinsella were more abundant in healthy controls whereas Escherichia, Klebsiella, and Ruminococcus were more abundant in the E. histolytica-positive patients. All the healthy controls harbored bacteria belonging to Faecalibacterium, Prevotella, Ruminococcus, Subdoligranulum, and Escherichia genera while all the E. histolytica-positive patient samples contained genus Enterobacter. The compositional changes in the gut microbiome observed in our study indicated a higher prevalence of pathogenic bacteria along with a depletion of beneficial bacteria in E. histolytica-infected individuals when compared with healthy controls. These results underline the interplay between E. histolytica and the human gut microbiome, giving important inputs for future studies and treatments.

Monitoring the distribution pattern and invasion status of Ageratina adenophora across elevational gradients in Sikkim Himalaya, India.

Understanding the spread intensity and population dynamics of invasive plant species is a prerequisite for developing management strategies in the Himalayan Forest ecosystems that are experiencing an accelerated rate of climate change. Although there are studies on the occurrence of few invasive species in the Himalayan ecosystems, systematic information on their intensity of spread and species association is still missing. Considering existing data gaps, we aimed to assess the intensity of spread and distribution pattern of A. adenophora, one of the high-concern invasive species (HiCIS) of India that is causing havoc in the Himalayas, across an elevational gradient. Field data were collected in 2018 and 2021 in the Indian federal state of Sikkim, located in the Eastern Himalayas. We analyzed the population status and species association of A. adenophora along an elevational gradient ranging from > 600 m to 2700 m above sea level, which was divided into seven gradients of 300 m width, and each gradient was further randomly sampled. Overall, 81 species were present in association with A. adenophora, including 58 herbs, 19 shrubs, and 4 climbers, belonging to 30 families and 67 genera in the region. No other species continuously co-occurred along with A. adenophora throughout the elevation ranging from > 600 m to 2700 m. The species observed increased frequency (100%), density (40.51 ind./100 m2), and basal cover (11.25 cm2/m2) in the elevational gradient 1500-1800 m in 2018. In 2021, A. adenophora dominated the highest elevational gradient (< 2400-2700 m) with increased frequency (99.96%), density (58.41 ind./100m2), and basal cover (42.54 cm2/100m2), which demonstrated rapid invasion and improved plant health and reproductive vigor in comparison to the lower elevational gradient in Sikkim Himalaya. Despite being completely absent at the highest elevation (< 2400-2700 m), in 2018, it observed gregarious spread at the highest elevation in 2021, which is of serious concern to ecologists. The presence of the targeted species in all seven studied altitudinal gradients reflects stage III of the species invasion. An enormous shift in the distribution pattern along elevational gradients within a short time span is alarming for the Himalayan ecosystem since it is becoming a thriving habitat for invasive species owing to anthropogenic activity. We mapped the potential geographical extent using the species distribution model (SDM) and predicted the suitable habitat of distribution in Sikkim Himalaya. In order to curtail the spread and counteract the negative impact of this species on native vegetation in Sikkim Himalaya and ultimately reverse the process, local and regional initiatives for its biological control and management must be taken.

Microorganisms in biological control strategies to manage microbial plant pathogens: a review.

Chemical fertilizers and pesticides are an integral part of modern agriculture and are often associated with numerous environmental problems. Biological agents such as microorganisms can largely replace chemical fertilizers and pesticides. The proper use of selected microorganisms such as bacteria, fungi and viruses have several benefits for agriculture. These include a healthy soil microbiota, biological production of important compounds that promote plant health, and to be used as biocontrol agents (BCAs) that provide protection from plant pathogenic microorganisms. Scientists have found that several bacterial genera including Bacillus and Pseudomonas have antimicrobial activity against numerous pathogenic bacterial and fungal plant pathogens. Trichoderma, Aspergillus, and Penicillium are among the most common fungal genera used as BCAs against both bacterial and fungal plant pathogens. Several bacteriophages and mycoviruses are also found effective as BCAs against selective plant pathogens. Fusarium oxysporum is a commonly found microbial plant pathogen causing wilts and rots in plants. Overall, it can be concluded that the use of microbial BCAs is an effective practice against microbial plant pathogens.

Impact of Nutritional Profile on Gut Microbiota Diversity in Patients with Celiac Disease.

The pathogenesis of celiac disease (CD) is significantly influenced by gut microbiota. Daily nutritional profile influences the diversity of gut microbiota. This study was aimed to compare the abundance of gut microbiota in CD patients compared to normal control (NC), and to investigate the impact of nutritional factors on their fecal microbiota diversity. In this study, a selected panel of intestinal bacteria was assessed in 31 confirmed CD patients adhering to gluten-free diet (GFD) for more than 6 months and in 20 NC subjects. Stool samples were collected from each participant, DNA was extracted, and absolute quantitative real-time PCR (qPCR) was carried out. The gut microbiota including Bacteroidetes, Bifidobacterium, Clostridium, Staphylococcus, Enterobacteiaceae, Firmicutes, and Lactobacillus were assessed. The quantities of fruits, vegetables, meat, liquids, sugar and gluten-free candy/bread consumption were evaluated using a questionnaire. The proportion of Bifidobacterium, Firmicutes, and Lactobacillus in CD cases was significantly lower than NC (P < 0.005). Significant correlation coefficients between Bifidobacterium and Lactobacillus (P < 0.001), and also Firmicutes and Lactobacillus (P < 0.001) were recorded. Moreover, a significant association between medium amount of meat and bean consumptions and low abundance of Lactobacillus and Firmicutes (P = 0.024 and P = 0.027, respectively), and also high amount of bean consumptions and low abundance of Lactobacillus (P = 0.027) in CD were observed. The results showed that meat and bean consumptions could reduce the beneficial bacteria including Firmicutes and Lactobacillus in CD patients. Therefore, changes in the gut microbiota abundance may contribute to dietary changes and unimproved CD symptoms.

Unreported mixed Plasmodium species infection may increase vivax malaria in India: a challenge for malaria elimination.

BACKGROUND: In India, there are several malaria-endemic regions where non-falciparum species coexist with Plasmodium falciparum. Traditionally, microscopy and rapid diagnostic tests are used for the diagnosis of malaria. Nevertheless, microscopy often misses the secondary malaria parasite in mixed-infection cases due to various constraints. Misdiagnosis/misinterpretation of Plasmodium species leads to improper treatment, as the treatment for P. falciparum and Plasmodium vivax species is different, as per the national vector-borne disease control program in India. METHODS: Blood samples were collected from malaria-endemic regions (Jharkhand, Madhya Pradesh, Chhattisgarh, Maharashtra, Odisha, Assam, Meghalaya, Mizoram and Telangana) of India covering almost the entire country. Molecular diagnosis of Plasmodium species was carried out among microscopically confirmed P. falciparum samples collected during a therapeutic efficacy study in different years. RESULTS: The polymerase chain reaction analysis revealed a high prevalence (18%) of mixed malaria parasite infections among microscopically confirmed P. falciparum samples from malaria patients that are either missed or left out by microscopy. CONCLUSIONS: Deployment of molecular tools in areas of mixed species infection may prove vital for accurate diagnosis and treatment of malaria. Further, it will help in achieving the goal of malaria elimination in India.

Evaluation of Microchip-Based Point-Of-Care Device "Gazelle" for Diagnosis of Sickle Cell Disease in India.

Sickle cell disease is a major public health problem in India. Lack of rapid and reliable diagnostic methods result in many avoidable deaths in affected population. Current diagnostic tools are laboratory based, expensive and need trained manpower. Here, we evaluated the performance of a microchip-based cellulose acetate electrophoresis test, "Gazelle" in the tribal-dominated Indian states of Chhattisgarh and Madhya Pradesh. A total of 1,050 patients were screened by sickle cell solubility, hemoglobin (cellulose acetate) electrophoresis, high-performance liquid chromatography (HPLC) and Gazelle. Of the total 1,027 test results obtained, 960 tests were "Valid" (93.5%) and included in the analysis. Gazelle identified all patients with disease (HbSS and Thalassemia Major) with 100% accuracy. Gazelle demonstrated 100% sensitivity when comparing sickle cell disease (SCD) vs. sickle cell trait and SCD vs. normal. Specificity was 98.9% and 99.5% when comparing SCD vs. trait and trait vs. normal, respectively. Specificity was 99.8% when comparing SCD vs. normal and sensitivity was 99.3% when comparing trait vs. normal. Overall, Gazelle yielded a high accuracy (99.0%) compared to reference standard tests (hemoglobin electrophoresis and HPLC). Gazelle is a low-cost, rapid diagnostic test with high accuracy for detecting SCD both quantitatively and qualitatively. Gazelle can be a potential screening tool for the rapid diagnosis in resource limited settings and developing countries with high burden of hemoglobin disorders.

CASE-CF: Context Aware Smart Epidemic Control Framework.

Novel Coronavirus (COVID-19) has become one of the deadliest pandemics that has affected almost all the nations in the world. Lockdown and systematic re-opening of shopping malls, offices, etc. is still one of the major weapons against this virus. However, the government and medical agencies take long time to reopen the places due to risks involved in this deadly virus. The delay to reopen places has resulted in sharp decline in the growth of economy. In this paper a current context aware framework is proposed which uses multiple inputs for a specific region to decide whether to open it or not. The proposed framework used series of deep neural network models to generate recommendations specific to a particular region. Most of the inputs are real-time and readily available with the government. The main aim is to develop framework which can be used in any kind of pandemic even in small region to easily contain it. However, it has been tested using opensource data available for COVID-19. Data was crawled from web for 22 districts of Haryana state of India. Experimental result proved the efficiency of proposed framework.

Genetic diversity and expression profile of Plasmodium falciparum Pf34 gene supports its immunogenicity.

PURPOSE OF THE STUDY: Genetic variation is one of the major obstacles in the development of effective vaccines. A multivalent malaria vaccine is required to increase efficacy and confer long term protection. In this context, we analysed the genetic diversity, expression profile, and immune response against Pf34. METHODS: Phylogenetic analysis was carried out using Pf34 orthologues sequences of various Plasmodium species. Genetic diversity was analysed by PCR amplification and Sanger dideoxy sequencing of Pf34 gene from Plasmodium falciparum positive human blood samples. The expression level of Pf34 gene was studied during erythrocytic stage by real time qPCR at four-hour interval, and immune response against synthetic peptides of Pf34 (P1 and P2) was analysed using ELISA. RESULTS: Phylogenetic analysis revealed the conserved nature of Pf34 gene. Genetic diversity analysis showed that majority (92%) of Plasmodium falciparum isolates in available database bore wild type Pf34 gene (Hd = 0.160 ± 0.030, π = 0.00021), including the present study (89.3%). The P. falciparum specific amino acid repeats (NNDK, NNDLK, and NNNNNN) in the B cell epitope regions were conserved. Furthermore, Pf34 gene is expressed throughout the erythrocytic cycle and comparatively high expression was observed in early ring and schizont stage. High IgG response was observed against both the peptides P1 and P2 of Pf34 containing asparagine NNNNNN and NNDLK repeat respectively. CONCLUSION: The limited genetic diversity, presence of conserved amino acid repeats within B cell epitope and high IgG response suggests that Pf34 may be a potential vaccine candidate for malaria. However, further validation studies are required.

An unusual case of adamantinoma of long bone.

Adamantinoma of the long bones is an exceedingly rare and slow-growing tumor that affects the diaphysis of long bones, particularly the tibia. Based on the pattern of the epithelial cell component and the presence or absence of the osteofibrous dysplasia-like element, several histological variants have been described, such as (i) tubular (the most frequent), (ii) basaloid, (iii) squamous, (iv) spindle variant, (v) osteofibrous dysplasia -like variant, and (vi) Ewing's sarcoma - like adamantinoma (the least frequent). The diagnosis may be challenging since this tumor may be mistakenly interpreted as carcinoma, myoepithelial tumor, osteofibrous dysplasia, and vascular tumor. We report the case of a 41-year-old male who presented with swelling over the right leg associated with pain. The X-ray showed a lytic lesion of the right-sided tibia. The diagnosis of adamantinoma was made based on the clinico-radiological, histomorphology, and immunohistochemical findings. Histologically, classic adamantinoma is a biphasic tumor characterized by epithelial and osteofibrous components in varying proportions and differentiating patterns. The diagnosis can be confirmed by immunohistochemistry for demonstrating sparse epithelial cell nests when the radiological features are strongly consistent with adamantinoma. This case is highlighted because the epithelial component can lead to a misdiagnosis, particularly when the clinico-radiological features are overlooked. Adamantinoma of long bones has the potential for local recurrence and may metastasize to the lungs, lymph nodes, or other bones. The prognosis is good if early intervention is taken.

Lectins: Biological significance to biotechnological application.

Lectins are a set of non-enzymatic carbohydrate binding proteins appearing in all domains of life. They function to recognize, interact and bring about reversible binding of a specific sugar moiety present in a molecule. Since glycans are ubiquitous in nature and are an essential part of various biological process, the lectins are been investigated to understand the profile of these versatile but complex glycan molecule. The knowledge gained can be used to explore and streamline the various mechanisms involving glycans and their conjugates. Thus, lectins have gained importance in carbohydrate-protein interactions contributing to the development in the field of glycobiology. This has led to a deeper understanding of the importance of saccharide recognition in life. Since their discovery, the lectins have become a great choice of research in the field of glycobiology and their biological significances have recently received considerable attention in the biocontrol field as well as medical sectors.

Digitisation and realtime sharing of unified surveillance tool and clinicopathological data for efficient management of disease outbreaks.

Existing chronic co-morbidities in a population affect the clinical outcome of infectious diseases. In order to devise better management strategies at community level, patients related clinicopathological as well as local health care infrastructure data is required. The use of digitised, unified, multilingual surveillance tool may facilitate real-time sharing of clinicopathological data and better service delivery to the affected communities. In this article, we discuss that how digital collection, collation and sharing of health-related data may improve planning and management of disease outbreaks.

Intubating conditions and hemodynamic changes during awake fiberoptic intubation using fentanyl with ketamine versus dexmedetomidine for anticipated difficult airway: a randomized clinical trial.

BACKGROUND AND OBJECTIVES: Awake fiberoptic intubation (AFOI) is usually performed in patients with an anticipated difficult airway. Various sedation regimens are used during AFOI, however, most of them cause respiratory depression. The present study aims to compare the effectiveness of fentanyl with ketamine versus dexmedetomidine in search of a better sedation regimen which would achieve desirable intubating conditions and hemodynamic stability without causing respiratory depression. METHODS: This is a single centered randomized, double-blind clinical trial. Patients of both sexes between age 18-55 years and ASA (American Society of Anesthesiologists) physical status I-II with an anticipated difficult airway were randomly divided into two groups of thirty each. Group FK patients received intravenous fentanyl and ketamine, and group DX patients received dexmedetomidine, until Ramsay sedation scale ≥ 2. Heart rate (HR), mean blood pressure (MBP), oxygen saturation (SpO2), respiratory rate (RR), endoscopy time, intubation time, first end-tidal carbon dioxide (ETCO2) after intubation, endoscopist satisfaction score, and patient discomfort score were recorded during the study period. The level of recall was assessed on the next postoperative day. RESULTS: Endoscopist satisfaction score was better in group DX patients (p < 0.05). There was a smaller variation in HR and MBP from baseline with dexmedetomidine compared to fentanyl with ketamine. First ETCO2 after intubation was higher in group FK patients (p <  0.05). No significant difference was found in patient discomfort score, intubation time, RR, SpO2 and level of recall of the event. CONCLUSIONS: The use of dexmedetomidine in AFOI provides better intubating conditions and hemodynamic stability compared to fentanyl with ketamine.