Intussusception after Rotavirus Vaccine Introduction in India.

BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).

Study of interface reaction in a B4C/Cr mirror at elevated temperature using soft X-ray reflectivity.

Boron carbide is a prominent material for high-brilliance synchrotron optics as it remains stable up to very high temperatures. The present study shows a significant change taking place at 550°C in the buried interface region formed between the Cr adhesive layer and the native oxide layer present on the silicon substrate. An in situ annealing study is carried out at the Indus-1 Reflectivity beamline from room temperature to 550°C (100°C steps). The studied sample is a mirror-like boron carbide thin film of 400 Šthickness deposited with an adhesive layer of 20 ŠCr on a silicon substrate. The corresponding changes in the film structure are recorded using angle-dependent soft X-ray reflectivity measurements carried out in the region of the boron K-edge after each annealing temperature. Analyses performed using the Parratt recursive formalism reveal that the top boron carbide layer remains intact but interface reactions take place in the buried Cr-SiO2 region. After 300°C the Cr layer diffuses towards the substrate. At higher temperatures of 500°C and 550°C the Cr reacts with the native oxide layer and tends to form a low-density compound of chromium oxysilicide (CrSiOx). Depth profiling of Si and Cr distributions obtained from secondary ion mass spectroscopy measurements corroborate the layer model obtained from the soft X-ray reflectivity analyses. Details of the interface reaction taking place near the substrate region of boron carbide/Cr sample are discussed.

SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results.

BACKGROUND: Superior mesentery artery syndrome (SMAS) is a rare vasculo-anatomic occlusive pathologic entity for which a period of conservative medical management is advocated with surgery reserved for nonresponsive cases. We present our management plan that entails a single admission approach and complete rendering of medical and surgical treatment to the patient on a background of the socioeconomic and cultural trends prevalent in this geographic region. METHODS: A retrospective analysis of 22 cases of SMAS admitted in our health care system who underwent a period of preoperative conditioning followed by laparoscopic duodenojejunostomy from September 2009 to June 2019 was performed. Patients were followed up at regular intervals. RESULTS: The mean follow-up of the cohort was 41.2 months (2-108 months). The median length of stay was 6 days. The mean postoperative stay was 4.13 days. A subgroup of six patients who had severe physiological depletion required a period of preoperative optimisation. Five of the 22 (22.7%) patients suffered from postoperative complications in the form of delayed return of bowel functions. None of the patients had complications more than Clavien-Dindo grade 2 with no mortality. Long-term data are available for 19 patients (86.3%) which showed no symptom recurrence. CONCLUSION: Management of SMAS that entails an antecedent medical therapy followed by surgery can be accomplished in a single admission with good to excellent results in the intermediate and long-term follow-up. Physiologically depleted patients do require a period of intensive preconditioning but on long-term follow-up, they have excellent results.

A versatile beamline for soft x-ray reflectivity, absorption, and fluorescence measurements at Indus-2 synchrotron source.

A versatile beamline for performing reflectivity, fluorescence, and absorption experiments in the soft x-ray region of 100-1500 eV is commissioned on a bending magnet port of the Indus-2 synchrotron source. A high vacuum 2-axis reflectometer with x, y, and z sample scanning stages is installed. This reflectometer is used to measure the reflectivity of large samples up to 300 mm in length and 5 kg in weight. This feature is useful for characterizing x-ray optical elements, such as mirrors, gratings, and multilayers. A flange mounted silicon drift detector is installed in the downstream of the reflectometer for soft x-ray fluorescence measurements. The soft x-ray absorption measurements are carried out in the total electron yield and partial fluorescence yield modes. Integration of three different experimental techniques in the experimental station makes the beamline versatile for materials science applications as it provides structural, chemical, and electronic state information by performing the required experiments in an identical environment. The beamline uses a varied line spacing plane grating monochromator and gives a high flux (∼109 to 1011 photon/s) with a moderate resolution (λ/Δλ ~1000-5000). A three-mirror-based higher harmonic setup is incorporated to get rid of harmonics and to get a high spectral purity monochromatic beam with less than 0.1% harmonic content. In the present article, the beamline optical scheme, mechanical configuration, and details of the experimental setups are presented, along with a few representative results of each experimental mode.

Fine structures in refractive index of sapphire at the L(II,III) absorption edge of aluminum determined by soft x-ray resonant reflectivity.

The optical constants of sapphire crystal (α-Al(2)O(3)) and amorphous Al(2)O(3) in the soft x-ray region (67-85 eV) around the aluminum LII,III absorption edge (73.1 eV) are determined by angle-dependent x-ray reflectivity. The differences between the optical constant values of both the samples are discussed. The fine structures obtained in the absorption of crystalline sapphire are explained. An absorption feature at 70.2 eV is observed for the first time for crystalline alumina. Both datasets are compared to the tabulated values of Henke et al. [At. Data Nucl. Data Tables 54, 181 (1993)], Weaver et al. [Physik Daten, Physics Data: Optical Properties of Metals (Fach-information zentrum, 1981), Vols. 18-1 and 18-2], and [Handbook of Optical Constants of Solids II (Academic, 1991)].

Efficacy of Shanvac-B recombinant DNA hepatitis B vaccine in health care workers of Northern India.

BACKGROUND: Health care workers (HCWs) constitute a high-risk population of HBV infection. There are limited data on the efficacy of vaccination in HCWs in India. This study was to evaluate the efficacy of indigenous recombinant hepatitis B vaccine, Shanvac-B, in HCWs. METHODS: In 597 HCWs screened before the vaccination, 216 (36.2%) showed the presence of at least one of the markers of HBV/HCV infection. Of the remaining 381 (63.8%) HCWs who were considered for vaccination, only 153 (age 18-45 years; 48 males and 105 females) were available for final assessment. These HCWs received 20 microg of vaccine at 0, 1 and 6 months. They were asked for the reactogenicity and monitored for the seroprotective efficacy of the vaccination. Anti-HBs titres were measured after vaccination at 1, 2 and 7 months. The presence of anti-HBs titers equal to 1 MIU/ml was considered as seroconversion and that of titres greater than 10 MIU/ml as seroprotection. RESULTS: After vaccination, 32 males (67%) and 76 females (72%) showed seroconvertion; finally 12 (25%) of the males and 47 (45%) of the females were seroprotected. Seroprotection at 2 and 7 months was more dominant in the females than in the males (96% vs. 56%, P=0.001, 100% vs. 85%, P=0.0001), respectively. Geometric mean titres of anti-HBs after vaccination were also higher in the females than in the males (257+/-19.7 vs. 29+/-1.88 MIU/ml, P=0.01, 1802+/-35.2 vs. 306+/-13.6 MIU/ml, P< or =0.05, 6465+/-72 vs. 2142+/-73.6 MIU/ml, P<0.05). Seven male HCWs showed unsatisfactory response, non-response (n=3, 6%) and hypo-response (< or =10 MIU/ml, n=4, 8%) at the end of vaccination. Smoking and alcoholism were significantly correlated with unsatisfactory response. No significant adverse effects of vaccination were observed in any HCW. CONCLUSIONS: The presence of HBsAg in HCWs indicates that a high proportion of HCWs are infected with HBV and HCV in India. Recombinant indigenous vaccine Shanvac-B is highly efficacious in HCWs, and its immunogenicity is significantly higher in females than in males. However, pre-vaccination screening of HCWs is strongly recommended in India.

Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease.

PURPOSE: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. METHODS: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. RESULTS: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75-1). CONCLUSION: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75-1). This cut-off may be used in combination with clinical judgment to diagnose CD.

Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease.

PURPOSE: To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. METHODS: It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. RESULTS: Mean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. CONCLUSION: Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.

Ultrasound biomicroscopy in the subtypes of primary angle closure glaucoma.

PURPOSE: To evaluate the anterior segment parameters in the subtypes of primary angle closure glaucoma (PACG) using ultrasound biomicroscopy. METHODS: Five groups, each comprising 30 consecutive patients, diagnosed to have subacute PACG, acute PACG, chronic PACG, primary open angle glaucoma (POAG), and healthy controls were included in the present study. All patients underwent slit-lamp biomicroscopy, direct ophthalmoscopy, 90D fundus examination, gonioscopy, applanation tonometry, visual field testing, A-scan biometry, and ultrasound biomicroscopy (UBM). The anterior segment parameters recorded included: trabecular-iris angle, angle opening distance, trabecular ciliary process distance, and the iris thickness among other parameters. RESULTS: On ultrasound biomicroscopy the trabecular iris angle of control and POAG groups was more than all the subtypes of PACG (P < 0.001). The trabecular iris angle of subacute PACG (P < 0.001) and chronic PACG (P = 0.003) was more than acute PACG. Angle opening distance of controls and POAG group was significantly more than acute PACG and chronic PACG (P < 0.001). The trabecular ciliary process distance of POAG group and controls was more than subacute PACG, acute PACG, and chronic PACG. The trabecular ciliary process distance of subacute PACG (P < 0.001) and chronic PACG (P < 0.001) was more than acute PACG. Eyes with acute PACG had the least iris thickness at the three different positions tested. There was a positive correlation between the anterior chamber angle (trabecular iris angle) and the following parameters: trabecular ciliary process distance, angle opening distance, anterior chamber depth, and the axial length (r = 0.57). CONCLUSION: Eyes with primary angle closure glaucoma have a thinner iris with a shorter trabecular iris angle, angle opening distance, and trabecular ciliary process distance. The eyes with acute primary angle closure glaucoma have the narrowest angle recess.

Predictors of Compliance to Gluten-Free Diet in Children with Celiac Disease.

Aim. To identify the predictors of compliance to gluten free diet in children with celiac disease. Methods. 134 children in the study group were assessed for dietary compliance followed by a questionnaire based interview. Psychosocial parameters were assessed by standard Pediatric Symptom Checklist (PSC). Dietary compliant and noncompliant groups were compared and assessed for factors affecting the dietary compliance. Predictability of all of these factors was assessed using binary logistic regression analysis with backward elimination to find out the best predictors of compliance. Results. In the study group, 88 (65.67%) were found to be strictly compliant. Factors that were found to be significantly associated with compliance were age at presentation, nuclear families, mother's education, and parents having better knowledge of celiac disease. Parents' and child's attitude towards his having to follow a restrictive diet and child's feelings were also shown to be significantly associated with compliance. Binary logistic regression analysis with backward elimination demonstrated that age at presentation, family type, child's attitude, and child's behaviour made a significant contribution to prediction. Conclusions. These results will contribute to the current body of research by providing health care practitioners with a framework for better dietary instruction to ensure maximum adherence to GFD.

Analysis of higher harmonic contamination with a modified approach using a grating analyser.

Soft x-ray spectra of the toroidal grating monochromator (TGM) at the reflectivity beamline of Indus-1 synchrotron source are analyzed for higher harmonic contribution. A diffraction grating of central line spacing 1200 l/mm is used to disperse the monochromatic beam received from TGM to quantify the harmonic contents in the 50-360 Å wavelength range. In order to calculate the harmonic contamination, conventionally the intensity of higher order peak is divided by first order peak intensity of the desired wavelength. This approach is found to give wrong estimate as first order peak itself is overlapped by higher order peaks. In the present study, a modified approach has been proposed to calculate harmonic contamination where the intensity contributions of overlapping orders have been removed from the first order diffraction peak of the desired wavelength. It is found that the order contamination in the TGM spectra is less than 15% in the wavelength range of 90-180 Å. The total harmonic contribution increases from 6%-60% in the wavelength range of 150-260 Å. The critical wavelength of Indus-1 is 61 Å hence the harmonic contamination below 90 Å is significantly low. The results obtained with modified approach match well with those obtained by quantitative analysis of multilayer reflectivity data. The obtained higher harmonics data are used to fit the transmission of aluminum edge filter in the 120-360 Å wavelength range.