Evaluation of Scrub Typhus Surveillance, Alwar District, Rajasthan, India, July-August 2020.

Introduction: Scrub typhus is one of the most underreported and fatal illnesses accounting for 23% of all febrile illness. Rajasthan reported cases during 2018-2019 in state reporting system but did not report any case to central Integrated Disease Surveillance Programme (IDSP) unit. We evaluated the Scrub typhus surveillance system in Alwar district, Rajasthan, with the objective of describing and evaluating the system and providing evidence-based recommendations to identify gaps. Material and Methods: In cross-sectional study, we reviewed records and conducted key informant interviews at district- and block-level health facilities. Using US Centers for Disease Control guidelines, we evaluated the system by framing indicators for selected attributes for a defined reference period. Overall performance was ranked as outstanding (90-100%), excellent (80-89%), very good (70-79%), good (60-69%), and poor (<60%). Results: Line list of confirmed cases was sent from district to block level for additional active case search (ACS) to implement control measures. We conducted 26 key informant interviews and reviewed records and calculated simplicity as 79%, flexibility 100%, data quality 46%, acceptability 92%, representativeness 48%, timeliness 43%, and stability 79%. Conclusions: Epidemiological surveillance (active and passive) is a core intervention under scrub typhus surveillance system. Lab reports were incompletely uploaded on IDSP portal. Surveillance reports should be updated after each ACS. Reporting format under IDSP should be uploaded timely, and lab reports from state should be sent within 48 hours of diagnosis so that case investigation is not delayed.

Excess hydrogen peroxide inhibits head and foot regeneration in hydra by affecting DNA repair and expression of essential genes.

Reactive oxygen species (ROS) are necessary for various cellular processes. However, excess ROS cause damage to many biological molecules and therefore must be tightly regulated in time and space. Hydrogen peroxide (H2 O2 ) is the most commonly used ROS as second messenger in the cell. It is a relatively long-lived freely diffusible signaling molecule during early events of injury. In the Cnidarian hydra, injury-induced ROS production is essential for regeneration to proceed. In the present study, we have examined influence of varying exposure to H2 O2 on head and foot regeneration in the middlepieces of trisected hydra. We find that longer (4 hours) exposure to 1 mM H2 O2 inhibits both head and foot regeneration while shorter exposure (2 hours) does not. Longer exposure to H2 O2 resulted in extensive damage to DNA that could not be repaired, probably due to suboptimal induction of APE1, an enzyme necessary for base excision repair (BER). Concomitantly, genes involved in activation of Wnt pathway, necessary for head regeneration, were significantly downregulated. This appeared to be due to failure of both stabilization and transient nuclear localization of ß-catenin. Similarly, genes involved in foot regeneration were also downregulated on longer exposure to H2 O2 . Thus, exposure to excess ROS inhibits regenerative processes in hydra through reduced expression of genes involved in regeneration and diminished DNA repair.

Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks.

OBJECTIVES: Neck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern's validity has not been tested against the 'gold standard' of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain. DESIGN: Prospective concurrent validity study that employed a diagnostic model building approach to analysis. SETTING: Hospital-based multidisciplinary outpatient clinic in Joliet, Illinois. PARTICIPANTS: A convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis. OUTCOME MEASURES: Participants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3-C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants' responses to diagnostic blocks. RESULTS: Ten of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants' responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses. CONCLUSIONS: This study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache.

Estimation of electronic waste using optimized multivariate grey models.

Rapid and revolutionary changes in technology and rising demand for consumer electronics have led to staggering rates of accumulation of electrical and electronic equipment waste, viz., WEEE or e-waste. Consequently, e-waste has become one of the fastest growing municipal solid waste streams in the United States making its efficient management crucial in supporting the efforts to create and sustain green cities. Accurate estimations on the amount of e-waste might help in increasing the efficiency of waste collection, recycling and disposal operations that have become more complicated and unpredictable. Early work focusing on prediction of e-waste generation includes a wide range of methodologies. Among these, grey forecasting models have drawn attention due to their capability to provide meaningful results with relatively small-sized or limited data. The performance of grey models heavily rely on their parameters. The purpose of this study is to present a novel forecasting technique for e-waste predictions with multiple inputs in presence of limited historical data. The proposed nonlinear grey Bernoulli model with convolution integral NBGMC(1,n) improved by Particle Swarm Optimization (PSO) demonstrates superior accuracy over alternative forecasting models. The proposed model and its findings are delineated with the help of a case study utilizing Washington State e-waste data. The results indicate that population density has a major impact on the generated e-waste followed by household income level. The findings also show that the e-waste generation forms a saturated distribution in Washington State. These results can help decision makers plan for more effective reverse logistics infrastructures that would ensure proper collection, recycling and disposal of e-waste.

Coronary Angiography Profile at the Time of Hemodialysis Initiation in End-Stage Renal Disease Population: A Retrospective Analysis.

Cardiovascular disease is associated with increased mortality in dialysis population. However, there are very few studies that assessed the prevalence of coronary artery disease (CAD) at the time of initiation of hemodialysis (HD). The present study was aimed to assess the prevalence of CAD in end-stage renal disease (ESRD) patients at the time of initiation of HD and the risk factors for CAD in this population. This was a single-center retrospective study and included ESRD patients who underwent coronary angiography (CAG) at the time of initiation of HD. Inclusion criteria were age >18 years and those who were subjected to CAG within 2 weeks of initiation of HD. According to the findings on CAG, patients were divided into no CAD and CAD groups. CAD was diagnosed if there was >50% stenosis of vessel. Clinical and laboratory parameters between these two groups were analyzed. Ninety-seven patients were included in the study based on the inclusion criteria. Forty-four (45%) patients were diagnosed with CAD. Patients who had CAD were younger compared to no CAD group (50.7 + 10 vs. 55.8 + 9.3 years; P = 0.01). Majority of them were males. Diabetic nephropathy (DN) was associated with increased risk of CAD (60% vs. 40%, P = 0.007). History of smoking, high high-sensitivity C-reactive protein (hs-CRP), low total cholesterol, and low high-density lipoprotein (HDL) were associated with significantly increased risk of CAD. Gender, symptoms of CAD, serum low-density lipoprotein (LDL), very LDL, and triglycerides were not associated with increased risk of CAD. Neither calcium (Ca), phosphorus (PO4), nor Ca × PO4products were associated with an increased risk of CAD. Resting electrocardiogram abnormalities had no significance in predicting CAD (32% in CAD and 19% in no CAD group). Echocardiography showed regional wall motion abnormalities/global hypokinesia in 18% patients of CAD group and 3.8% patients of no CAD group (P = 0.03). Single-, double-, and triple-vessel disease was documented in 17 (38%), 13 (29.5%), and 14 (32.5%) patients, respectively, and the most common vessel involved was the left anterior descending artery. At the initiation of HD in ESRD patients, CAD was seen in almost half of the patients. DN was a significant risk factor for CAD. Other risk factors for CAD include smoking, low cholesterol, low HDL, and high hs-CRP levels.

Clinical Profile and Outcome of Posterior Reversible Encephalopathy Syndrome in Hemodialysis Patients.

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity characterized by headache, altered level of consciousness, seizures, visual disturbances, and reversible vasogenic subcortical edema. Hypertension and renal failure are well known principal risk factors for the development of PRES. However, risk factors and outcome of PRES has not been studied in patients on maintenance hemodialysis (MHD). The objective of this study is to characterize the factors predisposing to the development of PRES in patients on MHD. We performed a retrospective analysis in patients of MHD who were diagnosed with PRES between August 1, 2013, and July 31, 2015. Those with a history of cerebrovascular accidents/stroke, and epilepsy were excluded. We analyzed the clinical details, course, and laboratory data. One year follow-up data were noted in recurrence of PRES and mortality. A total of 18 patients were included for the final analysis. Of these, 13 (72%) patients were males. Majority of these patients were young and mean age was 21.1 years (6-50 years). Most of the PRES episodes developed shortly after initiation of MHD with mean duration of 2 months after initiation of MHD (1 month-3 years). All 18 patients had resistant hypertension. Eight (45%) patients had infection at the time of PRES episodes. Four patients had catheter-related bloodstream infection, 1 had pneumonia and 3 patients were recently diagnosed with pulmonary tuberculosis. Four (22%) patients developed recurrence of PRES and all these episodes developed within 2 months of index event. Seven (39%) patients underwent renal transplantation, and all received triple immune suppression and had uncontrolled hypertension in the perioperative period. However, none of these patients developed PRES after transplantation. All these patients had been maintaining stable graft function in the follow-up. All episodes of PRES were of generalized tonic-clonic seizure type and 6 of them presented as status epilepticus. None of them had any neurological sequel and no mortality at the end of 1 year. PRES is not uncommon in patients on MHD. Uncontrolled hypertension and infection are common predisposing factors. Renal transplantation is safe and not adversely affected by prior episodes of PRES in MHD.

Rare Association of Waardenburg Syndrome with Minimal Change Disease.

Waardenburg syndrome (WS) is a rare genetic disorder characterized by varying degrees of hearing loss, pigmentary anomalies, and defects of other neural crest cell-derived structures. The association of WS with renal anomalies has been described in the literature. However, nephrotic syndrome is a very rare association with WS, and only one case has been reported in the literature. We report a case of WS2 associated with biopsy-proven nephrotic syndrome (minimal change disease).

A New Prognostication System for Dental Implants.

Given the popularity of dental implants, determining their prognosis is an integral component of dental practice. An accurate prognosis is crucial to development of an appropriate treatment plan and may require alterations as overall status or the status of implants or natural teeth change. The importance of an established set of factors for determining implant prognosis would be highlighted in dentist-patient communication and in interdisciplinary collaboration. The main objective of the proposed prognostication system is short- and long-term success of dental implants. The aim of this study was to review evidence-based prognostic factors including surgical, peri-implant, prosthetic, and overall considerations in implant dentistry and to propose a new prognostication system. A blind survey was taken by 67 prosthodontists, periodontists, and oral surgeons at three dental schools to assess the importance of each consideration based on clinical experience and available evidence. The results supported incorporation of the comprehensive review of evidence-based prognostic factors into the proposed dynamic system for dental implant prognostication.

Comparative study of Anuvasana Basti with constant and escalating dose as an alternative to Snehapana in Purvakarma of Vamana and Virechana.

BACKGROUND: Snehapana is the essential step prior to Vamana and Virechana (therapeutic vomiting and purgation). But it was found that 10-15% patients are reluctant towards Snehapana hence may deprive the benefits of Shodhana. These inconveniences made us think about effective alternative to counter drawbacks of Snehapana. On the basis of literature review and pilot study, it was confirmed that, Anuvasana Basti can be administered as an alternative for Snehapana. OBJECTIVE: To evaluate samyak snigdha lakshana achieved by administration of Anuvasana Basti and to evaluate outcomes of Vamana and Virechana. MATERIALS AND METHODS: Specially designed basti pouches were used according to doses. In group A, constant dose of processed sesame oil (120 ml) and rock salt (500 mg) was used. In group B, the dose was escalating started with 120 ml and 500 mg with 25 ml and 100 mg increase in sesame oil and rock salt respectively for maximum seven days. RESULTS: Patients from group B showed better results than group A i.e. 29 patients showed symptoms of proper oleation. Mridu koshtha required minimum dose and duration for getting proper symptoms of oleation. Outcome of Vamana and Virechana were also very promising. CONCLUSIONS: Hence it can be concluded that Anuvasana Basti in escalating dose can be used as an alternative for Snehapana.

Rituximab in the treatment of refractory late acute antibody-mediated rejection: Our initial experience.

Antibody-mediated rejection (AMR) is not uncommon after renal transplantation and is harder to handle compared to cell-mediated rejection. When refractory to conventional therapies, rituximab is an attractive option. This study aims to examine the effectiveness of rituximab in refractory late acute AMR. This is a retrospective study involving nine renal transplant recipients. Four doses of rituximab were administered at weekly interval for 4 weeks, at a dose of 375 mg/m2. The mean age of patients was 35.3 ± 7.38 years. The median period between transplantation and graft dysfunction was 30 ± 20 months. Mean serum creatinine at the time of discharge after transplantation and at the time of acute AMR diagnosis was 1.14 ± 0.19 mg/dl and 2.26 ± 0.57 mg/dl, respectively. After standard therapy, it was 2.68 ± 0.62 mg/dl. One patient died of Pseudomonas sepsis and three patients progressed to end-stage renal disease (ESRD). Four biopsies showed significant plasma cell infiltrations. Mean serum creatinine among non-ESRD patients at the end of 1 year progressed from 2.3 ± 0.4 to 3.8 ± 1.2 mg/dl (P value 0.04). eGFR prior to therapy and at the end of 1 year were 34.4 ± 6.18 and 20.8 ± 7.69 ml/min (P value 0.04), respectively. Only one patient showed improvement in graft function in whom donor-specific antibody (DSA) titers showed significant improvement. Rituximab may not be effective in late acute AMR unlike in early acute AMR. Monitoring of DSA has a prognostic role in these patients and plasma cell rich rejection is associated with poor prognosis.

Novel L-lactide-depsipeptide polymeric carrier for enhanced brain uptake of rivastigmine in treatment of Alzheimer's disease.

The present study discusses possibility of targeting an anti-Alzheimer's drug rivastigmine tartarate (RT) to the brain using novel synthesized L-lactide-depsipeptide polymeric nanoparticles (NPs). Single emulsion-solvent evaporation technique was used for preparation of NPs. The mean particle size, zeta potential and entrapment efficiency of drug loaded NPs were found to be 142.2 +/- 21.3 nm, +4.85 mV and 60.72 +/- 3.72% respectively. Pharmacodynamic study showed faster regain of memory loss in amnesic rat with RT loaded NPs as compared to RT solution. In pharmacokinetic study, total concentration and mean residence time was increased up to 3.79 fold and 2 fold respectively while clearance was decreased to 1.91 fold on intravenous administration of RT loaded NPs as compared to RT solution. The biodistribution study demonstrated 5.45 fold and 2 fold increase in brain concentration of drug after administration of RT loaded NPs (i.v; 10.52 +/- 1.31 ng/ml) as compared to plain RT solution by oral (1.93 +/- 1.23 ng/ml) and intravenous (5.34 +/- 1.22 ng/ml) route, respectively. Therefore, RT loaded L-lactide-depsipeptide polymeric NPs might be a potential drug delivery system in treatment of Alzheimer's disease.

Anuvasan Basti in escalating dose is an alternative for Snehapana before Vamana and Virechana: Trends from a pilot study.

Oral administration of medicated fats (oil or ghee) is termed as Snehapana. It is an essential step before Vamana (therapeutic emesis) and Virechana (therapeutic purgation). Ayurveda physicians often experience a poor compliance in 10-15% patients for oral administration of medicated fats especially in escalating doses. Incomplete Snehapana sometimes creates a problem for a physician to prepare the patient for these processes. These inconveniences made us think about effective alternatives to counter drawbacks and improve acceptance of Snehapana. The present study was planned to assess the efficacy of Anuvasana Basti (oil enema) in escalating doses as an alternative for Snehapana. Anuvasana Basti of medicated sesame oil with rock salt was administered in 10 patients for three to seven days till they showed signs and symptoms of complete Snehana. The symptoms of Snehana like semisolid or loose stools, feeling exhausted without much exertion, lightness of body and oiliness of skin were observed. Though the Snehana symptoms varied in intensity, they were similar as they are produced after oral administration of fats. This trend suggests Anuvasana Basti in escalating dose is an alternative for Snehapana before administration of Shodhana therapy like Vamana or Virechana.

HoCrO3 and YCrO3: a comparative study.

A comparative study on structural, optical and magnetic properties of orthorhombic perovskite-like isostructural compounds HoCrO3 and YCrO3 was carried out, wherein Ho(3(+)) is a magnetic ion and Y(3+) is non-magnetic. We found almost identical structural parameters for both compounds, however a significant difference was observed in low wavenumber Raman active phonon modes. The effect of local field on optical transitions of Cr ion is studied by diffused reflectance spectroscopy. In order to understand the effect due to the Ho(3(+)) local magnetic field on the magnetic ordering of Cr(3(+)) in ACrO3 (A=Ho, Y), dc magnetization measurements were carried out in a temperature range of 5-300 K and several isotherms were analyzed. Magnetization measurements reveal that Cr(3+) magnetic ordering temperature is insensitive to local fields (due to Ho(3+)) and very sensitive to thermal cycling in the presence of an external applied magnetic field. This behavior is related to magnetic disorder near the phase transition due to weak ferromagnetism and/or structural distortions which we observed as thermal hysteresis. The importance of this work lies with the fact that both Ho(3+) (10.6 µB) and Y(3+) (0 µB) have identical ionic radii and the electron correlation effects in both the systems have been studied using different experimental techniques.

Human bone marrow-derived mesenchymal cells differentiate and mature into endocrine pancreatic lineage in vivo.

BACKGROUND AIMS: The scarcity of human islets for transplantation remains a major limitation of cell replacement therapy for diabetes. Bone marrow-derived progenitor cells are of interest because they can be isolated, expanded and offered for such therapy under autologous/allogeneic settings. METHODS: We characterized and compared human bone marrow-derived mesenchymal cells (hBMC) obtained from (second trimester), young (1-24 years) and adult (34-81 years) donors. We propose a novel protocol that involves assessment of paracrine factors from regenerating pancreas in differentiation and maturation of hBMC into endocrine pancreatic lineage in vivo. RESULTS: We observed that donor age was inversely related to growth potential of hBMC. Following in vitro expansion and exposure to specific growth factors involved in pancreatic development, hBMC migrated and formed islet-like cell aggregates (ICA). ICA show increased abundance of pancreatic transcription factors (Ngn3, Brn4, Nkx6.1, Pax6 and Isl1). Although efficient differentiation was not achieved in vitro, we observed significant maturation and secretion of human c-peptide (insulin) upon transplantation into pancreactomized and Streptozotocin (STZ)-induced diabetic mice. Transplanted ICA responded to glucose and maintained normoglycemia in diabetic mice. CONCLUSIONS: Our data demonstrate that hBMC have tremendous in vitro expansion potential and can be differentiated into multiple lineages, including the endocrine pancreatic lineage. Paracrine factors secreted from regenerating pancreas help in efficient differentiation and maturation of hBMC, possibly via recruiting chromatin modulators, to generate glucose-responsive insulin-secreting cells.

Use of a low profile ultrasound transducer for coronary sinus cannulation: a pilot study.

BACKGROUND: Cardiac resynchronization therapy with biventricular pacing has been shown to be beneficial in improving heart failure in patients with prolonged QRS duration (≥120 ms) and low ejection fraction (≤35%). Unsuccessful cannulation of the coronary sinus (CS) has been reported in up to 10% of cases. The feasibility of the transthoracic continuous cardiac imaging for coronary sinus cannulation has not been previously demonstrated. METHODS AND RESULTS: We developed a 2.5-MHz hemi-spherical continuous cardiac imaging transducer (CONTISON), mounted in an external housing, to permit steering in 360°. The transducer was attached to the chest wall using an adhesive ring. The CS was easily imaged by echocardiography by placing the transducer just medial to the apex and tilting it dorsally. The feasibility study was done in 11 patients. CS ostium and body were imaged in all patients. Cannulation was successfully achieved in nine patients with a mean cannulation time of 1 minute 16 seconds. In two patients, poor image quality precluded adequate visualization of CS. Fluoroscopy was not used for cannulation. CONCLUSION: We demonstrated the feasibility of using the CONTISON echography transducer for the guidance CS cannulation. This technique could expedite CS cannulation and reduce radiation exposure. Further studies comparing ultrasound versus fluoroscopy for CS cannulation appear warranted.

"Hands-Free" continuous echocardiography during treadmill exercise using a novel ultrasound transducer.

BACKGROUND: Echocardiographic imaging using a handheld transducer in conjunction with treadmill exercise testing is commonly used for the diagnosis of coronary artery disease. Motion of the hand and the transducer during peak exercise preclude optimal imaging. To circumvent the limitations of handheld transducers, we developed a low profile transducer (CONTISON) which can be attached to the chest wall for continuous cardiac imaging. METHODS AND RESULTS: This feasibility study was performed in 10 normal male subjects (28 to 36 years). The ultrasound transducer was placed in the third or fourth intercostal space at the left sternal border to permit imaging of the left ventricle in its short axis. The transducer was interfaced with a commercially available ultrasound machine. The left ventricle was imaged at rest and while subjects exercised according to a standard Bruce protocol. All segments of the left ventricular short axis were seen at rest and peak exercise. Increased left ventricular wall thickening and wall motion were seen at peak exercise. There were no complications from the procedure. CONCLUSION: We demonstrated the feasibility of hands-free left ventricular imaging during treadmill exercise using the CONTISON transducer. Further evaluation of the technique to detect stress-induced wall motion abnormalities, as a means of diagnosing myocardial ischemia, appears warranted. (ECHOCARDIOGRAPHY 2010;27:563-566).

Environmentally conscious manufacturing and product recovery (ECMPRO): A review of the state of the art.

Gungor and Gupta [1999, Issues in environmentally conscious manufacturing and product recovery: a survey. Computers and Industrial Engineering, 36(4), 811-853] presented an important review of the development of research in Environmentally Conscious Manufacturing and Product Recovery (ECMPRO) and provided a state of the art survey of published work. However, that survey covered most papers published through 1998. Since then, a lot of activity has taken place in EMCPRO and several areas have become richer. Many new areas also have emerged. In this paper we primarily discuss the evolution of ECMPRO that has taken place in the last decade and discuss the new areas that have come into focus during this time. After presenting some background information, the paper systematically investigates the literature by classifying over 540 published references into four major categories, viz., environmentally conscious product design, reverse and closed-loop supply chains, remanufacturing, and disassembly. Finally, we conclude by summarizing the evolution of ECMPRO over the past decade together with the avenues for future research.