P300 Wave Alterations and Cognitive Impairment in Cerebellum Lesions.

Patients with cognitive deficits have a prolonged latency and reduced amplitude of the P300 wave. However, no study has correlated P300 wave alterations with the cognitive performance of patients with cerebellar lesions. We aimed to determine if the cognitive status of these patients was associated with P300 wave alterations. We recruited 30 patients with cerebellar lesions from the wards of the N.R.S. Medical College, Kolkata, in West Bengal (India). The Kolkata Cognitive Screening Battery tasks and the Frontal Assessment Battery (FAB) were used to assess the cognitive status and the International Cooperative Ataxia Rating Scale (ICARS) for cerebellar signs. We compared the results with the normative data of the Indian population. Patients had P300 wave alterations with a significant increase in latency and a non-significant trend in amplitude. In a multivariate model, P300 wave latency was positively associated with the ICARS kinetic subscale (p = 0.005) and age (p = 0.009), regardless of sex and years of education. In the model that included cognitive variables, P300 wave latency was negatively associated with performance in phonemic fluency (p = 0.035) and construction (p = 0.009). Furthermore, P300 wave amplitude was positively associated with the FAB total score (p < 0.001). In closing, patients with cerebellar lesions had an increase in latency and a decrease in the amplitude of the P300 wave. These P300 wave alterations were also associated with worse cognitive performance and some of the subscales of the ICARS, reinforcing that the cerebellum has motor, cognitive, and affective functions.

Caspase-11 interaction with NLRP3 potentiates the noncanonical activation of the NLRP3 inflammasome.

Caspase-11 detection of intracellular lipopolysaccharide (LPS) from invasive Gram-negative bacteria mediates noncanonical activation of the NLRP3 inflammasome. While avirulent bacteria do not invade the cytosol, their presence in tissues necessitates clearance and immune system mobilization. Despite sharing LPS, only live avirulent Gram-negative bacteria activate the NLRP3 inflammasome. Here, we found that bacterial mRNA, which signals bacterial viability, was required alongside LPS for noncanonical activation of the NLRP3 inflammasome in macrophages. Concurrent detection of bacterial RNA by NLRP3 and binding of LPS by pro-caspase-11 mediated a pro-caspase-11-NLRP3 interaction before caspase-11 activation and inflammasome assembly. LPS binding to pro-caspase-11 augmented bacterial mRNA-dependent assembly of the NLRP3 inflammasome, while bacterial viability and an assembled NLRP3 inflammasome were necessary for activation of LPS-bound pro-caspase-11. Thus, the pro-caspase-11-NLRP3 interaction nucleated a scaffold for their interdependent activation explaining their functional reciprocal exclusivity. Our findings inform new vaccine adjuvant combinations and sepsis therapy.

Predictors and Pathway of Maternal Near Miss: A Case-Control Study in a Tertiary Care Facility in Kolkata.

Background: Use of maternal near-miss (MNM) cases as an adjunct has been advocated to understand the processes of obstetric care because they share similar pathways as maternal deaths. Identifying the predictors and care pathway is crucial to improve the quality of care and end preventable maternal deaths. Materials and Methods: This case-control study was conducted at a tertiary care facility in Kolkata from May 2019 to March 2020. Women admitted with complications during pregnancy, childbirth, or within 42 days of postpartum, who met the World Health Organization (WHO) near-miss criteria, were identified as cases, and equivalent age-group matched controls were recruited. Sample size of 60 cases and 60 controls was estimated, assuming a power of 80%, level of significance 0.05, and case-control ratio of 1. After obtaining approval from the institutional ethics committee and informed written consent from the participants, data was collected through face-to-face interview and review of records. Statistical analysis including care pathway analysis (using three-delay model) was performed using Statistical Package for Social Sciences version 16. Results: Joint family type (adjusted odds ratio [AOR] [CI] = 5.06 [1.48, 7.28]), lack of antenatal checkups (AOR [CI] = 7.85 [1.47, 12.09]), previous history of cesarean section (AOR [CI] = 3.94 [1.09, 14.33]), first delay in seeking care (AOR [CI] = 13.84 [3.62, 32.83]), and preexisting medical disorders (AOR [CI] = 11.03 [4.62, 22.80]) were identified as significant predictors of MNM in the adjusted model. Significant difference in the proportion of first and second delays in the care pathway was observed between cases and controls. Conclusions: Identification of risk factors of MNM and pattern of delays in the care pathway will help improving quality of obstetric care.

Burden of malnutrition among school-going children in a slum area of Kolkata: A matter of concern.

BACKGROUND: Malnutrition is still a great barrier to the growth and development of children, especially in India. Children from the underprivileged sections of the society like slum children are more vulnerable to both undernutrition and overnutrition. This study aimed to estimate the magnitude of malnutrition among school-going children in a slum area of Kolkata and to elicit the association of nutritional status with parental education. METHODS: A cross-sectional observational study was conducted from November 2017 to May 2018 among 508 school-going children of 6 years to 19 years of age in slums of Chetla, Kolkata. Out of three coeducation high schools catering to those children, two schools were randomly selected. 254 participants from each school were selected using systematic random sampling. Students, unwilling to participate and/or whose parents denied providing informed written consent were excluded. After the interview by a predesigned, pretested schedule, their anthropometric examination was conducted. RESULTS: Prevalence of stunting and severe stunting was present in 9.4% and 1.2% of subjects whereas the prevalence of thinness was 23.6% among them. The prevalence of overnutrition was 11%. Boys are more stunted (OR = 2.13, P = 0.013) and thin (OR = 1.73, P = 0.011) than girls. Poor parental education was significantly associated with both undernourishment (stunting and thinness) as well as overweight and obesity. CONCLUSION: Substantial burden of double malnutrition was observed among school-going slum children. Parental education had an important role to prevent malnutrition of their children. Thus, periodic growth monitoring with the strengthening of the Mid-Day Meal program and awareness generation campaigns regarding malnutrition among parents of slum children are highly needed.

Factors Associated with Intention and Attempt to Quit: A Study among Current Smokers in a Rural Community of West Bengal.

CONTEXT: Tobacco smoking is one of the preventable causes of death. Global Adult Tobacco Survey 2 report showed that 19% Indian males were current smokers. It is important to find out factors which help smokers on smoking cessation, ultimately to prevent of lung and other morbidities. There are few community-based studies on intention and attempt to quit smoking in rural area. AIMS: The present study aimed to determine the factors associated with intention and attempt to quit smoking among current smokers. SETTINGS AND DESIGN: A cross-sectional study was conducted from June to September 2019 among 198 male daily smokers residing in the rural field practice area of AllH and PH, Kolkata. SUBJECTS AND METHODS: After cluster sampling, data were collected by predesigned schedule by the face-to-face interview. RESULTS: 151 (76.3%) study subjects intended to quit smoking. 63 (31.8%) study subjects attempted to quit in last 1 year. Thirty-one (47.5%) showed high-to-medium nicotine dependence. There was a significant association of intention to quit with agriculture as occupation (acquisitive crime [AOR]-2.17, confidence interval [CI]-1.01-4.63), low nicotine dependence (AOR-2.98, CI-1.43-6.21), doctor's advice (AOR = 2.84, CI-1.27-6.33), and family pressure (AOR = 2.16, CI-1.07-4.38). Attempt to quit was significantly associated with low nicotine dependence (AOR = 5.85, CI-2.85-12.00), family pressure (AOR = 2.94, CI-1.47-5.91). CONCLUSION: Along with counseling to reduce nicotine dependence, comprehensive approach both from family members as well as health care providers, is vital to escalate the quitting behaviour in smoking habit.

Hazardous practices related to blood borne viral infection transmission among male barbers: A study in a rural area of West Bengal.

BACKGROUND: Barbers are occupationally predisposed to blood borne viral infection (BBVI) such as human immunodeficiency virus, hepatitis B and C. Unhygienic workplaces, improper disinfection and inadequate wound-care can increase the susceptibility of both clients and barbers to BBVI. There is paucity of studies on practices regarding BBVI among barbers, especially in India. OBJECTIVES: To identify the pattern and predictors of practices related to BBVI transmission among male barbers in a rural area of West Bengal. METHODS: A cross-sectional study was conducted from June 2017 to August 2019 in Indas block of Bankura district among 138 male barbers, who were permanent residents and worked for >6 months. Barbers, randomly selected from 10 Gram Panchayats according to probability proportionate to size, were interviewed. Two barbering sessions were observed. Data were analyzed using SPSS version 16 software. Univariate and multiple linear regression was carried out to identify predictors of better practices. P < 0.05 was considered for statistical significance. RESULTS: Dangerous practices such as reuse of blades (8, 5.8%) and face-towel (77, 55.8%), sale/distribution of used blades (77, 55.8%), improper disinfection of sharps (79, 57.2%), reuse of alum without disinfection (129, 93.5%), and improper wound care (71, 51.4%) were observed. Predictors of better practice regarding BBVI were better attitude regarding BBVI (B = 0.172, standard error [SE] = 0.046, P = 0.000) and increased years of schooling (B = 0.054, SE = 0.021, P = 0.012). CONCLUSION: Inimical infection control practices were noticed. They are serving the general people and therefore they should be imbibed with correct BBVI knowledge and must do away with all hazardous practice during their barbering activities.

Nutritional status and eating behavior of children: A study among primary school children in a rural area of West Bengal.

BACKGROUND: Dietary preferences and childhood eating behavior has marked influence on nutritional status of children. The objective of the study was to find out eating behavior of primary school children in a rural area of West Bengal using Child Eating Behavior Questionnaire and to determine association of body mass index (BMI) with eating behavior. METHODOLOGY: It was an institution-based observational study with cross-sectional design done from May to August, 2018. The study was done among 142 children studying at four primary schools at Singur, in the rural field practice area of our institute. The four schools were selected randomly using list of primary schools in the area. Eating behavior of children was assessed using Child Eating Behavior Questionnaire (CEBQ). BMI of the children was assessed using WHO Z scores tables for children. Data analysis was done using SPSS Version 16 and binary logistic regression was done to find out association of BMI with eating behavior of study participants. RESULTS: The proportion of under-nutrition and overnutrition was 22.0% and 16.0%, respectively. Food fussiness was significantly associated with thinness [BMI below (-2SD)]. Enjoyment of food, satiety response was significantly associated with overnutrition [BMI above (+1 SD)]. Food avoidance subscale was significantly associated with thinness [OR: 2.5, CI: 1.11, 5.63] and this subscale was protective for overweight [OR: 0.22, CI: 0.07, 0.69]. CONCLUSION: This study showed association of BMI with child eating behavior. Therefore, awareness among parents should be created to change problematic eating of their children which would further help them to achieve normal BMI.

Morbidities of rice mill workers and associated factors in a block of West Bengal: A matter of concern.

CONTEXT: Rice mill workers usually belong to unorganized sector and lack in training regarding hazard prevention. Unprotected exposure to suspended particles and fumes can lead to respiratory morbidities among them. Workers, especially loaders, were susceptible to work-related musculoskeletal diseases. AIM: To find out the morbidity profile and associated factors among rice mill workers. METHODOLOGY: A cross-sectional workplace-based study was conducted during July--September 2018 among 143 workers of two rice mills in Indas block, West Bengal. Workers, employed for at least 6 months in the rice mills and who gave informed written consent was interviewed using a predesigned pretested questionnaire and were clinically examined. Nonfasting capillary blood glucose estimation and spirometry were carried out. Workers contraindicated to spirometry were excluded. RESULT: Commonest morbidities were musculoskeletal discomfort (65%), hypertension (20.9%), and chronic respiratory morbidity (16.9%). No personal protective equipment (PPE) was used by these workers. Significant association of musculoskeletal discomfort was found with tobacco abuse (Adjusted Odds Ratio (AOR) =2.90), job of loader (AOR = 3.51), and central obesity (AOR = 3.39). Hypertension was significantly associated with increasing age (AOR = 1.06), and increasing body mass index (AOR = 1.17). Whereas increasing age (AOR = 1.08), working inside mill (AOR = 7.58), working more than 48 hours a week (AOR = 7.37) were significantly associated with chronic respiratory morbidity. CONCLUSION: Optimization of working hours, effective continuous use of PPE, and use of proper ventilation technology are recommended. Proper work placement, preplacement examination, and periodic health screening with spirometry are also needed.

Tobacco exposure is a menace among women: - A cross-sectional study in a rural area of West Bengal, India.

CONTEXT: In India, despite implementation of the strategies under National Tobacco Control Programme [NTCP], women are easily exposed to tobacco consumption that is smokeless (SLT) and smoking tobacco along with second-hand smoke [SHS], making them highly susceptible to tobacco hazards. AIMS: This study aimed to assess the exposure of women to tobacco use and SHS at home and to elicit predictors of tobacco exposure in a rural community of West Bengal. METHODOLOGY: A community based, cross-sectional study was conducted among 176 women aged 18 years and above. Data was collected by cluster sampling technique (16*11) using predesigned pretested structured schedule. Tobacco exposure was measured using a composite score including tobacco consumption and SHS at home. RESULTS: Tobacco use (SLT and smoking tobacco) was significantly associated with educational attainment [AOR = 2.12], occupation [AOR = 2.13] and knowledge [AOR = 1.22]. There was significant association between SHS at home with knowledge [AOR = 1.16] and attitude of the study subjects. [AOR = 1.93]. Overall tobacco exposure (SLT, smoking tobacco, and SHS), was found to be 79.5%. Significant association was found between high tobacco exposure with age group [AOR = 3.82], educational attainment [AOR = 1.74] and knowledge regarding hazards of tobacco [AOR = 1.31]. CONCLUSION: Prevalence of SLT use as well as exposure of women to SHS at home is unexpectedly high in the study population. Women specific information and education campaigns focusing on tobacco hazards (both tobacco use and SHS) through existing primary health care infrastructure should be strategized under NTCP.

A cross-sectional study on prevalence and determinants of anemia among women of reproductive age in a rural community of West Bengal.

CONTEXT: Anemia is a serious public health concern especially in women of reproductive age (WRA) as it causes a high burden of morbidity and mortality and persists through intergenerational cycle. As most of the risk factors are preventable, a thorough understanding of its risk factors is necessary to design better interventions. AIMS: Current study aimed to estimate the burden of anemia as well as explore determinants of various grades of anemia among WRA in a rural area. SETTINGS AND DESIGN: A community-based cross-sectional study was conducted among non-pregnant, non-lactating women of reproductive age in rural field practice area of All India Institute of Hygiene and Public Health. METHODS AND MATERIALS: House to house visit was conducted for interviewing with pre-designed pre-tested questionnaire along with blood hemoglobin and anthropometric measurement. STATISTICAL ANALYSIS USED: Descriptive statistics and test of significance like multinomial logistic regression and Kruskal-Wallis test (with post-hoc) were used. RESULTS: Majority (70.8%) of participants were anemic. Proportion of mild, moderate, and severe anemia were 24.16%, 37.5%, and 9.16%, respectively. Different levels of anemia were significantly associated with higher age, lower education, poor iron-rich food intake, lack of dietary diversity, and adiposity. Significantly low hemoglobin level in both underweight and obesity was noticed suggesting U shaped relationship between BMI and anemia. CONCLUSION: Periodic screening for anemia among WRA especially in both extremes of malnutrition, i.e., undernutrition and obesity should be considered at the policy level. Year-round behaviour change communication campaigns must be carried out for the promotion of necessary food groups in diet.

Community perception and risk reduction practices toward malaria and dengue: A mixed-method study in slums of Chetla, Kolkata.

BACKGROUND: Globally, vector-borne diseases account for 17% of infectious disease burden. In India, despite accelerated efforts, both malaria and dengue are major public health concern. Understanding local community perspectives is essential to strengthen ongoing program activities. OBJECTIVES: The study aimed to assess the community perceptions and risk reduction practices toward prevention and control of malaria and dengue at slums of Chetla in South Kolkata and to explore the perspectives of relevant local stakeholders in this regard. METHODS: This cross-sectional study with mixed-method design was conducted from June to September 2018. Quantitative data were collected in 288 sampled households through face-to-face interview of respondents and environmental checklist, whereas, qualitative exploration was done with five key informant interviews. Quantitative data were analyzed using SPSS version 16 Software. Qualitative data were analyzed thematically using "cut and sort" processing technique. RESULTS: In household survey, majority had unsatisfactory knowledge (68.4%), attitude (64.2%), and practices (62.8%) regarding diseases prevention/control, which was further substantiated by qualitative findings. The use of electric fans (79.5%), mosquito repellents (53.8%) were predominant practices; however, only a few used bed nets regularly (26.0%). Reportedly, "heat" and "poor ventilation" were key reasons behind reluctance to use bed nets. Multivariable regression analysis revealed that increasing age, proximity to a nearby canal, and unsatisfactory knowledge significantly predicted unfavorable attitude, whereas, respondents' gender and unfavorable attitude significantly predicted poor practices. CONCLUSIONS: Intensified social behavior change communication with active community participation is the need of the hour to prevent malaria and dengue occurrence and future outbreaks.

How frail are our elderly? An assessment with Tilburg frailty indicator (TFI) in a rural elderly population of West Bengal.

CONTEXT: "Frailty" is a multidimensional geriatric syndrome that increases the risk for adverse health outcomes, such as falls, hospitalization, increased morbidity, and mortality, among elderly persons. AIM: The objective of this study is to find out the proportion of frailty and its associates among elderly (aged ≥60 years) in a rural area of West Bengal. SETTINGS AND DESIGN: It is a community-based cross-sectional observational study done during May-August 2018 among 165 elderly persons selected by systematic random sampling by probability proportionate to size method from three villages at the rural field practice area of our institute. MATERIALS AND METHODS: Tilburg frailty indicator is used to measure frailty. An elderly is considered as frail if s/he scores ≥6 in this scale. STATISTICAL ANALYSIS: Data analysis is done by SPSS Version 16. The logistic regression is done to find out the associates of frailty. RESULTS: Proportion of frailty is 38.8% (mean age ± SD: 67.03 ± 3.43 years) among the study subjects. Age, female gender, loss of spouse, illiteracy, economic dependency, no job/at home status, ≥2 chronic diseases are significantly associated with frailty in univariate logistic regression. In multivariable logistic regression, ≥2 chronic diseases [AOR: 8.4, CI: 4.6, 11.33] and illiteracy [AOR: 3.3, CI: 1.05, 9.8] retain their significance. CONCLUSION: Frailty should be recognized as a public health priority and awareness generation among elderly population for healthy ageing including self-motivation for proper management of their ailments should be emphasized for reduction of morbidity as well as for augmenting their quality of life.

STING Senses Microbial Viability to Orchestrate Stress-Mediated Autophagy of the Endoplasmic Reticulum.

Constitutive cell-autonomous immunity in metazoans predates interferon-inducible immunity and comprises primordial innate defense. Phagocytes mobilize interferon-inducible responses upon engagement of well-characterized signaling pathways by pathogen-associated molecular patterns (PAMPs). The signals controlling deployment of constitutive cell-autonomous responses during infection have remained elusive. Vita-PAMPs denote microbial viability, signaling the danger of cellular exploitation by intracellular pathogens. We show that cyclic-di-adenosine monophosphate in live Gram-positive bacteria is a vita-PAMP, engaging the innate sensor stimulator of interferon genes (STING) to mediate endoplasmic reticulum (ER) stress. Subsequent inactivation of the mechanistic target of rapamycin mobilizes autophagy, which sequesters stressed ER membranes, resolves ER stress, and curtails phagocyte death. This vita-PAMP-induced ER-phagy additionally orchestrates an interferon response by localizing ER-resident STING to autophagosomes. Our findings identify stress-mediated ER-phagy as a cell-autonomous response mobilized by STING-dependent sensing of a specific vita-PAMP and elucidate how innate receptors engage multilayered homeostatic mechanisms to promote immunity and survival after infection.

Vita-PAMPs: signatures of microbial viability.

Can the innate immune system detect and respond to microbial viability? Using bacteria as a model, we found that indeed the very essence of microbial infectivity, viability itself, can be detected, and notably, in the absence of the activity of virulence factors. The microbial molecule that serves as the signature of viability is bacterial messenger RNA (mRNA), common to all bacteria, and without which bacteria cannot survive. Prokaryotic mRNAs also differ from eukaryotic mRNAs in several ways, and as such, these features all fulfill the criteria, and more, for a pathogen-associated molecular pattern (PAMP) as originally proposed by Charles Janeway. Because these mRNAs are lost from dead bacteria, they belong to a special class of PAMPs, which we call vita-PAMPs. Here we discuss the possible receptors and pathways involved in the detection of bacterial mRNAs, and thus microbial viability. We also consider examples of vita-PAMPs other than bacterial mRNA.

Essential role of Drosophila black-pearl is mediated by its effects on mitochondrial respiration.

Black-pearl (Blp) is a highly conserved, essential inner-mitochondrial membrane protein. The yeast Blp homologue, Magmas/Pam16, is required for mitochondrial protein transport, growth, and survival. Our purpose was to determine the role of Drosophila Blp in mitochondrial function, cell survival, and proliferation. To this end, we performed mitotic recombination in Drosophila melanogaster, RNAi-mediated knockdown, MitoTracker staining, measurement of reactive oxygen species (ROS), flow cytometry, electron transport chain complex assays, and hemocyte isolation from Drosophila larvae. Proliferation-defective, Blp-deficient Drosophila Schneider cells exhibited mitochondrial membrane depolarization, a 60% decrease in ATP levels, increased amounts of ROS (3.5-fold), cell cycle arrest, and activation of autophagy that were associated with a selective 65% reduction of cytochrome c oxidase activity. N-acetyl cysteine (NAC) rescued Blp-RNAi-treated cells from cell cycle arrest, indicating that increased production of ROS is the primary cause of the proliferation and survival defects in Blp-depleted cells. blp hypomorph larvae had a 35% decreased number of plasmatocytes with a 45% reduced active mitochondrial staining and their viability was increased 2-fold by administration of NAC, which blocked melanotic lesions. Loss of Blp decreases cytochrome c oxidase activity and uncouples oxidative phosphorylation, causing ROS production, which selectively affects mitochondria-rich plasmatocyte survival and function, leading to melanotic lesions in Blp-deficient flies.