Oxidative damage and delayed replication allow viable Mycobacterium tuberculosis to go undetected.

"Viable but nonculturable" states of bacteria pose challenges for environmental and clinical microbiology, but their biological mechanisms remain obscure. Mycobacterium tuberculosis (Mtb), the leading cause of death from infection until the coronavirus disease 2019 pandemic, affords a notable example of this phenotype. Mtb can enter into a "differentially detectable" (DD) state associated with phenotypic antimicrobial resistance. In this state, Mtb cells are viable but undetectable as colony-forming units. We found that Mtb cells enter the DD state when they undergo sublethal oxidative stress that damages their DNA, proteins, and lipids. In addition, their replication process is delayed, allowing time for repair. Mycobacterium bovis and its derivative, BCG, fail to enter the DD state under similar conditions. These findings have implications for tuberculosis latency, detection, relapse, treatment monitoring, and development of regimens that overcome phenotypic antimicrobial resistance.

Feasibility, Outcomes, and Safety of Telehepatology Services During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) has hampered health care delivery globally. We evaluated the feasibility, outcomes, and safety of telehepatology in delivering quality care amid the pandemic. A telemedicine setup using smartphones by hepatologists was organized at our tertiary-care center after pilot testing. Consecutive patients availing telehepatology services were recruited between March and July 2020. An adapted model for assessment of telemedicine was used after validity and reliability testing, to evaluate services 7-21 days after index teleconsultation. Of the 1,419 registrations, 1,281 (90.3%) consultations were completed. From 245 randomly surveyed patients, 210 (85.7%) responded (age [years, interquartile range]: 46 [35-56]; 32.3% females). Seventy percent of patients belonged to the middle or lower socio-economic class, whereas 61% were from rural areas. Modes of teleconsultation were audio (54.3%) or hybrid video call (45.7%). Teleconsultation alone was deemed suitable in 88.6% of patients. Diagnosis and compliance rates were 94% and 82.4%, respectively. Patients' convenience rate, satisfaction rate, improvement rate, success rate, and net promoter scores were 99.0%, 85.2%, 49.5%, 46.2% and 70, respectively. Physical and mental quality of life improved in 67.1% and 82.8% of patients, respectively, following index teleconsultation. Person-hours and money spent by patients were significantly lower with teleconsultation (P < 0.001); however, person-hours spent by hospital per teleconsultation were higher than in physical outpatient services (P < 0.001). Dissatisfied patients were more likely to have lower diagnosis rate, unsuitability for teleconsultation, noncompliance, poorer understanding, and uncomfortable conversation during teleconsultation. Connectivity issues (22.9%) were the most common barrier. Three patients, all of whom were advised emergency care during teleconsultation, succumbed to their illness. Conclusion: Telehepatology is a feasible and reasonably effective tool for rendering health care services using smartphones during the COVID-19 pandemic. Systematic implementation, possible integration into routine health care delivery, and formal cost-effectiveness of telehepatology services need further exploration.

Nature rejuvenation: Long-term (1989-2016) vs short-term memory approach based appraisal of water quality of the upper part of Ganga River, India.

The deteriorating water quality (WQ) of the sacred north-flowing perennial Indian River, Ganga was a serious concern in recent decades for population adjoining to the river and policy planners. The present evaluation attempts to assess the long-term (1989-2016) physiochemical characteristics of WQ of river Ganga at five upstream locations (Uttarkashi, Tehri, Rudraprayag, Devprayag, and Rishikesh) of Uttarakhand, India using comprehensive pollution index (CPI) and environmetrics (PCA and CA). These methods were used to categorize, summarize expensive datasets, and grouping the similar polluted areas along the river stretches. The WQ of river at all the locations were within the good category and most of the physiochemical parameters were well within their acceptable limit for drinking WQ. Considerably, CPI demonstrated the river WQ was in slight pollution range (CPI: 0.40-1.00) in the year 2007 and 2015 at all the five locations. The positive correlation coefficient (R2 > 0.50) among NO2 + NO3, Ca, Na, B, and K indicates the significant contribution of organic and inorganic salts through runoffs from catchments due to weathering of rocks. PCA confirmed the input source of nutrients in the river from both natural and anthropogenic sources. Moreover, the upstream WQ assessed was found to be good as compared to the severely polluted downstream region. Due to COVID-19 and shutdown in the country, reduction of pollution load in the river was observed due to the rejuvenation capability of river Ganga. This information can assist the environmentalist, policymaker, and water resources planners & managers to prepare strategic planning in advance to maintain the aesthetic and cultural value of Ganga river in future.