Food consumption behavior and lifestyle changes among rural older adults before and during the Covid-19 pandemic in Northern India: A cross-sectional study (preprint)

Background: Due to Covid-19, the lockdown was imposed throughout the nation on 24 march 2020 and Covid-19 is not over yet, cases are still coming. Food insecurity was already a problem but it became even more challenging during the pandemic. Especially rural older adult people have had to deal with the problem of food and health-related issues due to the pandemic. Objective: This study aimed to assess food consumption behavior and lifestyle changes among rural older adults before and during the Covid-19 pandemic. Material and Methods: A retrospective cross-sectional study has been done; a multistage random sampling technique was used to select the participants. 450 participants were taken aged 60 and above for final analysis. The survey was conducted in the rural areas of the Varanasi District, Uttar Pradesh through personal interviews. The McNemar and Wilcoxon sign rank tests were used to examine differences before and during the Covid-19 pandemic, adopting the statistical significance of p< 0·05. Results: Mean age of participants were found 66.72 years. 66.0% of people faced a shortage of food. 40.9% of people reported that they had reduced their food intake and 39.6% reported that the reduction in food intake was due to the rise in the price of edible items. 27.6% of participants reported a reduction in body weight. There was a significant percentage decrease in consumption of milk products, pulse, and green vegetables(p<0.001), a percentage decrease in initiating and maintaining sleep (p<0.001), and worse health conditions (p<0.001). Conclusions: Food consumption behavior and lifestyles have changed significantly during the Covid-19 pandemic among rural older adults. Although some lifestyles haven’t changed significantly, the quantity of food and health conditions were compromised.

Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review.

Background: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) has become a global pandemic, and medical experts are scrambling to understand the wide range of symptoms and consequences of the virus. Although acute pancreatitis (AP) and pancreatic damage have been associated with SARS-CoV-2, the mechanism behind this is still unclear. The current article explores whether COVID-19 is an additional cause of AP and diabetic ketoacidosis (DKA). The article illustrates the conditions associated with AP and DKA among COVID-19 patients and diabetes mellitus (DM). Another critical condition is acute kidney injury (AKI), often associated with DKA. Methods: A search strategy for the article was assigned and retrieved from PubMed, Web of Science, and Scopus databases from 2020 to June 2022. The articles which discussed case studies on AP, DKA, and AKI were included in the study. Results: The present review of 24 reported case studies represented conditions of AP (12), DKA (5), AP and DKA (5), AP and AKI (1), and DKA and AKI (1) among COVID-19 participants, and showed a potential relationship between the complications. Conclusion: Healthcare during the COVID-19 pandemic plays a major role among AP, DKA, and AKI-associated COVID-19 patients. A compilation of case studies suggests effective management of COVID-19 infection-related complications such as AP, DKA, and AKI.

Pancreatic Choristoma in Omentum in Advanced CA Ovary: A Clinical Puzzle.

Ectopic pancreatic tissue is called pancreatic choristoma or heterotopia of pancreas. It is a rare entity. We present a case of advanced Ca ovary with omental pancreatic choristoma.

Differences in Immune Responses in Individuals of Indian and European Origin: Relevance for the COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, large differences in susceptibility and mortality due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported between populations in Europe and South Asia. While both host and environmental factors (including Mycobacterium bovis BCG vaccination) have been proposed to explain this, the potential biological substrate of these differences is unknown. We purified peripheral blood mononuclear cells from individuals living in India and the Netherlands at baseline and 10 to 12 weeks after BCG vaccination. We compared chromatin accessibility between the two populations at baseline, as well as gene transcription profiles and cytokine production capacities upon stimulation. The chromatin accessibility of genes important for adaptive immunity was higher in the Indians than in the Europeans, while the latter had more accessible chromatin regions in genes of the innate immune system. At the transcriptional level, we observed that the Indian volunteers displayed a more tolerant immune response to stimulation, in contrast to a more exaggerated response in the Europeans. BCG vaccination strengthened the tolerance program in the Indians but not in the Europeans. These differences may partly explain the different impact of COVID-19 on the two populations. IMPORTANCE In this study, we assessed the differences in immune responses in individuals from India and Europe. This aspect is of great relevance, because of the described differences in morbidity and mortality between India and Europe during the pandemic. We found a significant difference in chromatin accessibility in immune cells from the two populations, followed by a more balanced and effective response in individuals from India. These exciting findings represent a very important piece of the puzzle for understanding the COVID-19 pandemic at a global level.

Evidence for the heterologous benefits of prior BCG vaccination on COVISHIELD™ vaccine-induced immune responses in SARS-CoV-2 seronegative young Indian adults.

This proof-of-concept study tested if prior BCG revaccination can qualitatively and quantitively enhance antibody and T-cell responses induced by Oxford/AstraZeneca ChAdOx1nCoV-19 or COVISHIELD™, an efficacious and the most widely distributed vaccine in India. We compared COVISHIELD™ induced longitudinal immune responses in 21 BCG re-vaccinees (BCG-RV) and 13 BCG-non-revaccinees (BCG-NRV), all of whom were BCG vaccinated at birth; latent tuberculosis negative and SARS-CoV-2 seronegative prior to COVISHIELD™ vaccination. Compared to BCG-NRV, BCG-RV displayed significantly higher and persistent spike-specific neutralizing (n) Ab titers and polyfunctional CD4+ and CD8+ T-cells for eight months post COVISHIELD™ booster, including distinct CD4+IFN-γ+ and CD4+IFN-γ- effector memory (EM) subsets co-expressing IL-2, TNF-α and activation induced markers (AIM) CD154/CD137 as well as CD8+IFN-γ+ EM,TEMRA (T cell EM expressing RA) subset combinations co-expressing TNF-α and AIM CD137/CD69. Additionally, elevated nAb and T-cell responses to the Delta mutant in BCG-RV highlighted greater immune response breadth. Mechanistically, these BCG adjuvant effects were associated with elevated markers of trained immunity, including higher IL-1ß and TNF-α expression in CD14+HLA-DR+monocytes and changes in chromatin accessibility highlighting BCG-induced epigenetic changes. This study provides first in-depth analysis of both antibody and memory T-cell responses induced by COVISHIELD™ in SARS-CoV-2 seronegative young adults in India with strong evidence of a BCG-induced booster effect and therefore a rational basis to validate BCG, a low-cost and globally available vaccine, as an adjuvant to enhance heterologous adaptive immune responses to current and emerging COVID-19 vaccines.

Stability Indicating RP-HPLC Method for the estimation of Favipiravir in API and Pharmaceutical Dosage Forms (Tablets)

Favipiravir is an anti-viral agent used for the treatment of a large number of RNA viruses including influenza and was considered for the treatment of COVID-19. A new stability indicating RP-HPLC has been developed for the estimation of Favipiravir and the method was validated. Hypersil BDS C18 column was used for the chromatographic study with a flow rate 1ml/min (Detection wavelength 230nm). The LOD and LOQ were found to be 0.2918mug/mL and 0.9207mug/mL respectively. Linearity was observed over the concentration 1-300mug/mL with linear regression equation, y = 28444x + 21853 (R2 = 09998) and the method is precise, accurate and robust. Stress degradation studies were performed and the method was found to be selective and specific. Copyright © RJPT All right reserved u.

Interim results from comparison of immune responses elicited by an inactivated and a vectored SARS-CoV-2 vaccine in seronegative and seropositive participants in India (preprint)

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 18 to 45-year age-group began in April 2021 when seropositivity rates in the general population were rising due to the Delta wave in April-May 2021. Methods Between 30 June 2021 and 28 January 2022, we enrolled 691 participants in the 18-45 age group across 4 clinical sites in India. In this non-randomized and laboratory blinded study, participants received either two doses of Covaxin(R) 4 weeks apart or two doses of Covishield 12 weeks apart per the national vaccination policy. The primary outcome was the seroconversion rate and the geometric mean titer (GMT) of antibodies against the SARS-CoV-2 spike and nucleocapsid proteins. 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(R) 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 BAU/ml, p<0.0001 in seronegative individuals; 2089.07 vs 585.7 BAU/ml, p<0.0001 in seropositive individuals). Not all sites recruited at the same time, therefore site-specific immunogenicity was impacted by the timing of vaccination relative to the Delta and Omicron waves. Surrogate neutralizing antibody responses against variants-of-concern were higher in Covishield recipients than in Covaxin(R) recipients and in seropositive than in seronegative individuals after both vaccination and asymptomatic Omicron infection. 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(R) 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(R) in both seronegative individuals and seropositive individuals, across cohorts representing the pre-vaccination immune history of the majority of the vaccinated Indian population.

Evidence for the heterologous benefits of prior BCG vaccination on COVISHIELD™ vaccine-induced immune responses in SARS-CoV-2 seronegative young Indian adults

This proof-of-concept study tested if prior BCG revaccination can qualitatively and quantitively enhance antibody and T-cell responses induced by Oxford/AstraZeneca ChAdOx1nCoV-19 or COVISHIELD™, an efficacious and the most widely distributed vaccine in India. We compared COVISHIELD™ induced longitudinal immune responses in 21 BCG re-vaccinees (BCG-RV) and 13 BCG-non-revaccinees (BCG-NRV), all of whom were BCG vaccinated at birth;latent tuberculosis negative and SARS-CoV-2 seronegative prior to COVISHIELD™ vaccination. Compared to BCG-NRV, BCG-RV displayed significantly higher and persistent spike-specific neutralizing (n) Ab titers and polyfunctional CD4+ and CD8+ T-cells for eight months post COVISHIELD™ booster, including distinct CD4+IFN-γ+ and CD4+IFN-γ- effector memory (EM) subsets co-expressing IL-2, TNF-α and activation induced markers (AIM) CD154/CD137 as well as CD8+IFN-γ+ EM,TEMRA (T cell EM expressing RA) subset combinations co-expressing TNF-α and AIM CD137/CD69. Additionally, elevated nAb and T-cell responses to the Delta mutant in BCG-RV highlighted greater immune response breadth. Mechanistically, these BCG adjuvant effects were associated with elevated markers of trained immunity, including higher IL-1β and TNF-α expression in CD14+HLA-DR+monocytes and changes in chromatin accessibility highlighting BCG-induced epigenetic changes. This study provides first in-depth analysis of both antibody and memory T-cell responses induced by COVISHIELD™ in SARS-CoV-2 seronegative young adults in India with strong evidence of a BCG-induced booster effect and therefore a rational basis to validate BCG, a low-cost and globally available vaccine, as an adjuvant to enhance heterologous adaptive immune responses to current and emerging COVID-19 vaccines.

Are We Feeding Our Critically Ill Covid Patients, Right?

Objective: Primary objective: To study the energy expenditure in a significant number of mechanically ventilated COVID-19 patients in ARDS. Secondary objective: 1. To compare the deviations seen with predictive equations based on actual and ideal body weight. 2. To compare the EE derived versus the VCO2 based estimation. Materials and methods: The Resting Energy expenditure (REE) of 60 patients was measured with the help of the ESCOVYX-module for indirect calorimetry using the GE CARESCAPE R860 ventilator. The steady-state was validated by ensuring a respiratory quotient of 0.7-0.8 and variation of 5% for VCO2 and VO2 for at least 30 minutes. It was ensured that for 60 minutes the patient was not disturbed by endotracheal tube suction, no ventilatory changes were performed, and no vasopressors alteration was done. The absence of a leak was ascertained on the ventilator. The calculation was done from day 2 onwards after mechanical ventilation and subsequently every 2nd day till the patient was on ventilator. The resting energy expenditure was also calculated by the simple predictive equations as per ESPEN COVID-19 guidelines, i.e., 25-30 kcal/kg of which the mean of 27 kcal/kg was chosen. Bodyweight was estimated by height equation 50 kg for 5 ft plus 2.3 kg for each inch >5 feet. The quantitative measures were studied by Bland and Altman plot to describe an agreement between the two by constructing a line of agreement. The limits were calculated by using the mean and standard deviation of the difference between the two measurements. Statistics: The EE derived from the two methods is compared by Bland and Altman plots. Reliability and adequacy between the methods are tested using ROC curves with kappa coefficient (reliability coefficient). For the coefficient of variation, ANOVA is used when applicable. IBM SPSS Statistics for Windows, version 24.0 (IBM Corporation, Chicago, USA) was used to perform analyses. MedCalc version 19 (MedCalc bv, Ostend, Belgium) was used to create BlandeAltman plots. Results: No 1: The estimated mean energy expenditure derived from weight-based calculations was 2576 ± 469 kcal/24 hours, which was significantly higher when compared with an estimation of EE from indirect calorimetry of 1507 ± 499 kcal/24 hours (15-20 kcal/kg/day). This correlation is significant but not useful for prediction (R = 0.345). No 2: The estimated mean EEVCO2 was 1388 ± 467 kcal/24 hours compared with an estimation of EE from indirect calorimetry of 1507 ± 499 kcal/24 hours. The Bias and precision, as visualized by the limits of agreement, are shown in the Bland-Altman plot where there was a significant bias of only 118 kcal/day (95% CI (-187 to 422 kcal);p < 0.001. The regression analysis reveals that for every one unit change in EEVCO2 value, there is one unit change in EE by IC. This correlation is significant (R = 0.951). Similarly, the Bland-Altman plot was tested between the estimated mean EEVCO2 and EE derived from weight-based calculations. The difference was wide with significant bias of 1187 kcal/day (95% CI (-2256 to (-118) kcal);p < 0.001). Conclusion: The ESPEN guidelines (30 kcal/kg through the disease state) for energy estimation may not be right in COVID-19 patients and the study calls for more personalisation of energy estimation by the correct use of indirect calorimetry.

Energy expenditure in COVID-19 mechanically ventilated patients: A comparison of three methods of energy estimation.

BACKGROUND: Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure. Energy expenditure (EE) estimated by ventilator-derived carbon dioxide consumption (EEVCO2 ) has also been proposed. In the absence of IC, predictive weight-based equations have been recommended to estimate daily energy requirements. This study aims to compare simple predictive weight-based equations with those estimated by EEVCO2 and IC in mechanically ventilated patients of COVID-19. METHODS: Retrospective study of a cohort of critically ill adult patients with COVID-19 requiring mechanical ventilation and artificial nutrition to compare energy estimations by three methods through the calculation of bias and precision agreement, reliability, and accuracy rates. RESULTS: In 58 mechanically ventilated patients, a total of 117 paired measurements were obtained. The mean estimated energy derived from weight-based calculations was 2576 ± 469 kcal/24 h, as compared with 1507 ± 499 kcal/24 h when EE was estimated by IC, resulting in a significant bias of 1069 kcal/day (95% CI [-2158 to 18.7 kcal]; P < 0.001). Similarly, estimated mean EEVCO2 was 1388 ± 467 kcal/24 h when compared with estimation of EE from IC. A significant bias of only 118 kcal/day (95% CI [-187 to 422 kcal]; P < 0.001), compared by the Bland-Altman plot, was noted. CONCLUSION: The energy estimated with EEVCO2 correlated better with IC values than energy derived from weight-based calculations. Our data suggest that the use of simple predictive equations may potentially lead to overfeeding in mechanically ventilated patients with COVID-19.

COVID-19 Pandemic: An Indian radiologist' perspective.

During the COVID-19 pandemic, differences in health-care system and policies among countries worldwide meant that each country had to come up with their own strategies for containment, diagnosis, and treatment of the disease - "no one size fits all." India being the second populous country in the world with modern and traditional systems of health care has its own challenges to face during the pandemic. Among the increased cacophony of information regarding the COVID-19 disease and controversies surrounding the usage of various radiological modalities for its diagnosis, we are trying to present a sane perspective from an Indian radiologist viewpoint. Knowing the strengths and shortcomings of the Indian health-care system, we have suggested plausible solutions which may be the answers to the issues raised by the Indian media.

BCG revaccination qualitatively and quantitatively enhances SARS-CoV-2 spike-specific neutralizing antibody and T cell responses induced by the COVISHIELDTM vaccine in SARS-CoV-2 seronegative young Indian adults.

This study tested if prior BCG revaccination can further boost immune responses subsequently induced by an otherwise efficacious Oxford/AstraZeneca ChAdOx1nCoV-19 vaccine, referred to as COVISHIELDTM in India. We compared COVISHIELDTM induced longitudinal immune responses in 21 BCG re-vaccinees (BCG-RV) and 13 BCG-non-revaccinees (BCG-NRV), all of whom were BCG vaccinated at birth and latent tuberculosis negative, after COVISHIELDTM prime and boost with baseline samples that were collected pre-pandemic and pre-BCG revaccination. Compared to BCG-NRV, BCG-RV displayed significantly higher magnitude of spike-specific Ab and T cell responses, including a greater proportion of high responders; better quality polyfunctional CD4 and CD8 T cells that persisted and a more robust Ab and T cell response to the Delta mutant of SARS-CoV-2 highlighting greater breadth. Mechanistically, BCG adjuvant effects on COVISHIELDTM induced adaptive responses was associated with more robust innate responses to pathogen-associated-molecular-patterns through TNF-α and IL-1ß secretion. This study highlights the potential of using a cheap and globally available vaccine as an adjuvant to enhance heterologous adaptive immune responses induced by COVIDSHIELDTM and other emerging vaccines.

BCG revaccination qualitatively and quantitatively enhances SARS-CoV-2 spike-specific neutralizing antibody and T cell responses induced by the COVISHIELDTM vaccine in SARS-CoV-2 seronegative young Indian adults (preprint)

This study tested if prior BCG revaccination can further boost immune responses subsequently induced by an otherwise efficacious Oxford/AstraZeneca ChAdOx1nCoV-19 vaccine, referred to as COVISHIELDTM in India. We compared COVISHIELDTM induced longitudinal immune responses in 21 BCG re-vaccinees (BCG-RV) and 13 BCG-non-revaccinees (BCG-NRV), all of whom were BCG vaccinated at birth and latent tuberculosis negative, after COVISHIELDTM prime and boost with baseline samples that were collected pre-pandemic and pre-BCG revaccination. Compared to BCG-NRV, BCG-RV displayed significantly higher magnitude of spike-specific Ab and T cell responses, including a greater proportion of high responders; better quality polyfunctional CD4 and CD8 T cells that persisted and a more robust Ab and T cell response to the Delta mutant of SARS-CoV-2 highlighting greater breadth. Mechanistically, BCG adjuvant effects on COVISHIELDTM induced adaptive responses was associated with more robust innate responses to pathogen-associated-molecular-patterns through TNF-α and IL-1β secretion. This study highlights the potential of using a cheap and globally available vaccine as an adjuvant to enhance heterologous adaptive immune responses induced by COVIDSHIELDTM and other emerging vaccines.

An Adverse Outcomes Approach to Study the Effects of SARS-CoV-2 in 3D Organoid Models.

The novel SARS-CoV-2 virus outbreak is the major cause of a respiratory disease known as COVID-19. It has caused a global pandemic and has resulted in mortality in millions. The primary mode of infection is respiratory ailments, however, due to multi-organ complications, COVID-19 patients displays a greater mortality numbers. Due to the 3Rs Principle (Refine, Reduce, Replacement), the scientific community has shifted its focus to 3D organoid models rather than testing animal models. 3D organoid models provide a better physiological architecture as it mimics the real tissue microenvironment and is the best platform to recapitulate organs in a dish. Hence, the organoid approach provides a more realistic drug response in comparison to the traditional 2D cellular models, which lack key physiological relevance due to the absence of proper surface topography and cellular interactions. Furthermore, an adverse outcome pathway (AOPs) provides a best fit model to identify various molecular and cellular events during the exposure of SARS-CoV-2. Hence, 3D organoid research provides information related to gene expression, cell behavior, antiviral studies and ACE2 expression in various organs. In this review, we discuss state-of-the-art lung, liver and kidney 3D organoid system utilizing the AOPs to study SARS-CoV-2 molecular pathogenesis. Furthermore, current challenges are discussed for future application of 3D organoid systems for various disease states.

Merging the public and private spheres of women's work: Narratives from women street food vendors during Covid-19 crisis.

Feminist economists have long questioned the dichotomy between the "private" versus "public" spheres of women's work and have argued for a more nuanced understanding of the marketable paid work and the unpaid work of household caregiving. This paper focuses on women street food vendors' (SFVs) experiences before and during Covid-19 pandemic to understand how street food vending as a livelihood activity interacts with social dimensions like gender and division of labor. Through multiple in-depth interviews with 23 women street vendors in Bengaluru, India, before and during the pandemic, we show that there is a blurring of the dichotomy between the work done in the private and public spaces before the pandemic, which is disrupted by Covid-19 crisis. The first half of the paper explores the household labor dynamics in the context of paid and unpaid work of women and explains how the women SFVs, capitalizing on their existing skills of "cooking," were able to gain agency and recognition for themselves within the households. The second half of the paper focuses on the narratives of the same women SFVs during the first wave of the Covid pandemic and the subsequent lockdown. We find that the Covid crisis brought back the dichotomy between private and public spheres, making it more pronounced, with women losing their control over the public sphere and their work being restricted only to the private sphere.

Biomedical Waste and Solid Waste Management in the Time of COVID-19: A Comprehensive Review of the National and International Scenario and Guidelines.

Biomedical waste generated during the diagnosis, isolation, and treatment of coronavirus disease 2019 (COVID-19) patients can also be the source of new infections; hence, it needs special consideration. Previous guidelines for the management of biomedical waste need to be revisited as the majority of COVID-19 patients remain asymptomatic and reside in community. Personal protective equipment (PPE) like masks, hazmat suits, gloves, and visors are now being used by the public also. Thus, the general household waste and disposables now make an exponential increase in the waste that can be considered an environmental hazard. In this article, the authors have tried to present the problems arising from COVID-19 waste and the recommendations put forth by competent authorities both nationally and internationally on COVID-19 waste management. Furthermore, in all the guidelines, it is crucial that the COVID-19 waste management follows environmentally sound principles and practices of biomedical waste management, with safe work and infection-control practices. Segregation of COVID-19 waste at source, awareness, and precautions at all steps of the waste-cycle are the only way ahead in this crisis.

A century of BCG: Impact on tuberculosis control and beyond.

BCG turns 100 this year and while it might not be the perfect vaccine, it has certainly contributed significantly towards eradication and prevention of spread of tuberculosis (TB). The search for newer and better vaccines for TB is an ongoing endeavor and latest results from trials of candidate TB vaccines such as M72AS01 look promising. However, recent encouraging data from BCG revaccination trials in adults combined with studies on mucosal and intravenous routes of BCG vaccination in non-human primate models have renewed interest in BCG for TB prevention. In addition, several well-demonstrated non-specific effects of BCG, for example, prevention of viral and respiratory infections, give BCG an added advantage. Also, BCG vaccination is currently being widely tested in human clinical trials to determine whether it protects against SARS-CoV-2 infection and/or death with detailed analyses and outcomes from several ongoing trials across the world awaited. Through this review, we attempt to bring together information on various aspects of the BCG-induced immune response, its efficacy in TB control, comparison with other candidate TB vaccines and strategies to improve its efficiency including revaccination and alternate routes of administration. Finally, we discuss the future relevance of BCG use especially in light of its several heterologous benefits.

Bostock v Clayton County Game Changer: US Federal Employment Law Now Covers Caste Discrimination Based on Untouchability (preprint)

The California Department of Fair Employment and Housing (DFEH) sued Cisco Systems, Inc. regarding its discriminatory treatment of its employee John Doe, a Dalit (this group was formerly known as “outcastes” or “untouchables”). Before the summer of 2020, asserting an employment discrimination claim of intentional caste discrimination based on untouchability would have been very contestable. However, the legal analysis utilized by Justice Neil Gorsuch, for the Supreme Court’s decision of June 15, 2020 in Bostock v Clayton County appears tailored to the issue of whether the alleged employment discrimination suffered by Dalits fits within the prohibitions of Title VII and 42 USC $1981. Applying a textual analysis of Title VII, the Supreme Court concluded that discrimination against gays, lesbians and transgendered individuals meets the definition of sex discrimination because a person’s status as gay, lesbian or transgendered is inextricably entwined with their sex. Thus, while being homosexual or transgendered is a “but for” cause of their discrimination, their sex is another one. Caste discrimination based on untouchability derives from the dominant version of Hinduism that stems from India’s 3,000-year-old caste system. For simplification, in orthodox Hinduism the “caste system” consists of four distinct ‘varnas’ or major occupational groupings, also known as castes, with Dalits constituting a fifth caste outside the four-fold system. Dalits, who make up about 16.5 percent of India’s population, have traditionally occupied the very bottom levels of the caste structure and thus, India’s social-economic structure. The status of Dalits is associated with occupations historically regarded as ritually impure. For thousands of years, Hindus believed that Dalits were religiously polluted and this pollution was contagious. In the modern parlance of the COVID-19 era, Caste Hindus engaged in extreme social distancing measures to avoid contact with Dalits, including staying far enough away so that a Dalit’s shadow (six feet) did not touch them. Since this religious pollution stemmed from birth, Daltis, even today, cannot escape it by deed, increase in educational credentials or rise in social or economic standing. Caste discrimination is a mostly hidden form of discrimination in the US. As Indians emigrated from South Asia to other parts of the world, including the US, they brought their beliefs with them, including those about the caste system. There are now over 4 million people of Indian descent in the US. However, experts estimate that Dalits make up less than 2 percent of those of Indian descent. Nevertheless, as the number of Indian immigrants has increased, so have the incidences of caste discrimination based on untouchability. Dalit activists and their supporters throughout the world have advocated for global recognition of the discrimination they face not just in India, but other countries where they reside. But, caste discrimination does not fit neatly into the normal categories of discrimination of race, ethnicity, national origin or religion. As a result, a number of western countries have struggled to find legal protection for the discrimination Dalits encounter. And, India does not provide legal protection against caste discrimination by private employers. This article is the first major work to address the issue of caste discrimination based on untouchability under Title VII and Section 1981 in the aftermath of Bostock. In doing so, it asserts that caste discrimination based on untouchability is now illegal under both Title VII and Section 1981. Because of the prodigious international weight of US law, from a global perspective for the 200 million plus Dalits in India alone and the Dalit diaspora, a determination that US federal employment discrimination law now bans caste discrimination based on untouchability will have incalculable global ramifications. Thus, this article will also quickly draw huge international attention.

Current perspectives of biomedical waste management in context of COVID-19".

COVID-19 pandemic and it's consequent biomedical waste is an unprecedented challenge worldwide. Biomedical waste generated during COVID-19 patient isolation, testing and care needs special consideration as it challenges the previous notion that only 15-20% of waste can be considered infectious. With establishment of new home quarantine facility, isolation/quarantine centres the chances of general waste getting contaminated with biomedical waste has increased exponentially. Through this systematic review the authors searched for all possible queries raised by different researchers on COVID19 waste management on Pubmed. A summary of all the different issues unique to COVID19 waste was prepared. Guidelines, rules and recommendation given by national and international agencies published till date were taken into account while trying to answer all the above questions raised by different studies. The key step in COVID19 waste management is segregation of biomedical waste from solid waste. Waste generated from COVID19 patients is like any other infectious waste, therefore creating public awareness about the COVID19 waste hazards and segregation at source is highlighted in all guidelines as a recommendation. These guidelines for management of waste generated during diagnostics and treatment of COVID-19 suspected or confirmed patients, are required to be followed in addition to existing practices under regulation. BMWM in COVID-19 context is a public health concern and is both a legal and social responsibility for all stakeholders.