COVID-19 pandemic has affected TB case detection and continuity of care globally. Kerala, the southern Indian state has experienced a reduction in TB notification during second and third quarter of ...2020. Through (1) causal analysis (2) meticulous planning and establishment of systems (3) locally customised guidelines (4) better management of resources (5) integration with other programs and (6) good partnership with private sector, Kerala was able to catch up the TB notification and ensure that TB services remain intact even during the COVID-19 pandemic. Approach to catch up TB diagnosis included (1) Field based active case finding among the vulnerable individuals, (2) bilateral screening for TB and COVID-19, (3) enhancement of biosafety in laboratories, (4) strengthening of specimen collection and transportation systems, (5) targeted advocacy and communication to find out missed cases and (6) effective partnership with the private sector. Current experiences also show that TB case finding could be improved and delay in diagnosis could be averted by integrating TB case finding into the screening and testing systems established for COVID-19. The experiences of ensuring TB services during pandemic in Kerala also affirms the importance of maintaining an integrated and strong TB control component in the public health sector and vesting ownership of the TB control programme with the primary health care team. Community-based and community-led responses that take diagnosis, care, and support to the doors of those affected have much potential in delivering TB services in the subsequent years of pandemic.
Next Generation Sequencing (NGS) is the gold standard for the detection of new variants of SARS-CoV-2 including those which have immune escape properties, high infectivity, and variable severity. ...This test is helpful in genomic surveillance, for planning appropriate and timely public health interventions. But labs with NGS facilities are not available in small or medium research settings due to the high cost of setting up such a facility. Transportation of samples from many places to few centers for NGS testing also produces delays due to transportation and sample overload leading in turn to delays in patient management and community interventions. This becomes more important for patients traveling from hotspot regions or those suspected of harboring a new variant. Another major issue is the high cost of NGS-based tests. Thus, it may not be a good option for an economically viable surveillance program requiring immediate result generation and patient follow-up. The current study used a cost-effective facility which can be set up in a common research lab and which is replicable in similar centers with expertise in Sanger nucleotide sequencing. More samples can be processed at a time and can generate the results in a maximum of 2 days (1 day for a 24 h working lab). We analyzed the nucleotide sequence of the Receptor Binding Domain (RBD) region of SARS-CoV-2 by the Sanger sequencing using in-house developed methods. The SARS-CoV-2 variant surveillance was done during the period of March 2021 to May 2022 in the Northern region of Kerala, a state in India with a population of 36.4 million, for implementing appropriate timely interventions. Our findings broadly agree with those from elsewhere in India and other countries during the period.
The Indian state of Kerala has achieved remarkable success in communicable disease prevention and in maternal and child health. Over the past 30–40 years, non-communicable diseases, such as cancer, ...have emerged as new public health challenges. The Kerala Cancer Control Strategy provides a roadmap to address the various cancer-related challenges in a timely manner. The goals and targets set in the document will complement larger efforts to meet sustainable development goals.
A State Cancer Control Board was formed, with the Minister for Health of the Government of Kerala as the chairperson and representation by administrators and oncologists from both private and public institutions. District cancer control committees are being formed in all 14 districts of Kerala under the head of district administration and with the involvement of public representatives, civil society, medical professional associations, and health-care administrators. The committees will monitor and implement the cancer control strategy. The main objective of decentralising the approach by having District Cancer Control Committees is to promote early diagnosis and ensure a treatment–care continuum. It will focus not only on current cases but also take preventive measures at the individual and societal levels, and engage the Panchayathi Raj Institutions (local self-government) to take various measures to reduce the cancer burden in the state. The Kerala Cancer Care Grid is being formed to ensure equitable access to affordable cancer detection and treatment services within 50 km of the residence of patients. This grid is envisaged as a network of different tiers of public health institutions with assistance from private health facilities. Defined responsibilities in cancer awareness, public education, early cancer detection, referral pathway, appropriate management, rehabilitation, and patient follow-up form the core of function of the Kerala Cancer Care Grid, which will ensure that standard treatment protocols are used and that costs are contained. Integrated prevention and control of cancer risk factors through citizen participation and policy support will be implemented through the District Cancer Control Committee.
The Kerala Cancer Control Strategy is in the initial implementation stage. District Cancer Control Committees act as a platform for partnership with private hospitals and civil society organisations. A District Cancer Control Programme was piloted in one district and is being extended to two more districts in 2022. The programme is expected to be extended to all districts in Kerala by the end of 2022. Decentralisation of cancer care has begun with district hospitals and sub-district hospitals to provide cancer chemotherapy services. Workshops were done to bring out uniform information, education, and communication materials and treatment protocols. To streamline cancer documentation and assess cancer burden, a state cancer registry is being implemented, which would also provide longitudinal details and survival data.
The Kerala Cancer Control Strategy envisages a state-wide uniform strategy for cancer control. Decentralisation of cancer care will reduce the workload of apex cancer centres, freeing resources for those with greater needs. The Kerala Cancer Care Grid has the potential to revolutionise the delivery of cancer care in the state. Other low-resource countries could adapt this model to provide optimum cancer care for their population.
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Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We ...described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
We report here a Nipah virus (NiV) outbreak in Kozhikode district of Kerala state, India, which had caused fatal encephalitis in a 12-year-old boy and the outbreak response, which led to the ...successful containment of the disease and the related investigations. Quantitative real-time reverse transcription (RT)-PCR, ELISA-based antibody detection, and whole genome sequencing (WGS) were performed to confirm the NiV infection. Contacts of the index case were traced and isolated based on risk categorization. Bats from the areas near the epicenter of the outbreak were sampled for throat swabs, rectal swabs, and blood samples for NiV screening by real-time RT-PCR and anti-NiV bat immunoglobulin G (IgG) ELISA. A plaque reduction neutralization test was performed for the detection of neutralizing antibodies. Nipah viral RNA could be detected from blood, bronchial wash, endotracheal (ET) secretion, and cerebrospinal fluid (CSF) and anti-NiV immunoglobulin M (IgM) antibodies from the serum sample of the index case. Rapid establishment of an onsite NiV diagnostic facility and contact tracing helped in quick containment of the outbreak. NiV sequences retrieved from the clinical specimen of the index case formed a sub-cluster with the earlier reported Nipah I genotype sequences from India with more than 95% similarity. Anti-NiV IgG positivity could be detected in 21% of
(
) and 37.73% of
(
). Neutralizing antibodies against NiV could be detected in
. Stringent surveillance and awareness campaigns need to be implemented in the area to reduce human-bat interactions and minimize spillover events, which can lead to sporadic outbreaks of NiV.
Boundary layer instabilities and shock–boundary-layer interactions (SBLIs) critically affect the performance and safe operation of mixed-compression air intakes. We present a computational study ...anchored in companion experiments, to evaluate the multimodal mechanisms driving the dynamics of the external compression ramp flow and the cowl SBLI in a Mach $3$ intake. Boundary layer transition over the external ramp is first analysed through a global linear analysis, and the linear estimates are further validated through direct numerical simulations. The separation bubble over the ramp harbours three-dimensional stationary instabilities that induce transition, under the influence of secondary instabilities driven by the shear layer modes of the bubble. The interaction of the resulting turbulized boundary layer with the cowl shock at the ramp–isolator junction and its control through geometrical modification constitutes the second part of the study. We tested a faceted (baseline) and a notched (modified) junction design to evaluate its impact on the low-, mid- and high-frequency scales generated at the cowl SBLI region. In relation to the baseline case, the notched geometry effectively locks the separation point of the bubble, thus attenuating the upstream low-frequency breathing motion. The notch also energizes the midfrequency content through vortex shedding in a well-developed shear layer, which persists into the isolator, thus assisting in an efficient compression process through cross-stream mixing of near-wall flow. The isolator boundary layer in the notched design exhibits relatively lower static pressures and higher velocity fluctuations, which are conducive to improving the flow stability, unstart margin and efficiency of high-speed propulsion systems.
Background: India is facing serious hunger situation now. Factors responsible for this hunger situation are different. This study focuses on hunger situation in 4 different states of India and ...remedial measures.Methods: Secondary data was collected from National Family Health Survey-IV (NFHS). Data entry was done in excel sheet. GHI was calculated using new formula given by IFPRI.Results: There are wide disparities in hunger situation in Indian states. Madhya Pradesh is in alarming state of hunger.Conclusions: Hunger situation in Indian states varies from states to states. Different types of interventions are required at each state level to improve the overall hunger situation.
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