Introduction COVID-19 was declared as a ‘Public Health Emergency of International Concern’ by WHO on 30 January 2020.1 As on 29 June 2020, the disease has affected more than 10 million individuals, ...spread to all countries of the world and has led to death of 0.5 million.2 In India the count of those affected by COVID-19 has crossed 5.4 million with a death toll of 16 487, with Maharashtra reporting the highest number of infections (0.16 million cases) followed by Delhi (83 077), Tamil Nadu (82 275) and Gujarat (31 397), as on 29 June 2020.3 In India, Kerala was the first state affected by COVID-19, and the first coronavirus case was confirmed in Thrissur district on 30 January 2020. The objective of this commentary is to narrate key strategies adopted by the state of Kerala, which could be replicated in other states and countries.Table 1 Number of infections, deaths, case fatality rate (CFR) of various countries and Kerala Country Number of cases Deaths Recovered CFR (%) CFR (revised %) Italy 240 310 34 738 188 891 14.46 15.53 Spain 295 850 28 343 150 376 9.58 15.86 France 162 936 29 778 75 649 18.28 28.25 Canada 103 250 8522 66 191 8.25 11.41 USA 2 637 077 128 437 1 093 456 4.87 10.51 Brazil 1 345 254 57 658 733 848 4.29 7.28 China 83 512 4634 78 640 5.55 5.56 Russia 634 437 9073 399 087 1.43 2.22 Kerala 4189 22 2150 0.53 1.01 India 549 197 16 487 321 774 3.00 4.87 CFR calculations based on formula deaths/number of cases, revised CRF based on formula deaths/deaths+recovered as per methods presented in https://science.thewire.in/the-sciences/covid-19-pandemic-case-fatality-rate-calculation/. Despite having a low per capita income, its indicators of social development—such as the human development index (0.84),6 infant mortality rate (12/1000 live births),7 sex ratio (1084 females to 1000 males)8 and female literacy rates (92.07%)9 are comparable to those of many developed countries. Kerala, with a population of about 35 million,9 has a high population density of about 860 people per square kilometre.8 Kerala has 3.5 to 4 million inter-state migrant workers.10 Proportion of elderly (>60 years) is 12.6% of the total population.11 Among Indian states, the prevalence of cardiovascular diseases is reported to be highest in Kerala (>5000/100 000 population) including ischaemic heart disease (>2250/100 000) and stroke (>625/100 000).12 Prevalence of high blood pressure and diabetes is also very high with approximately one in three adults having hypertension13 and one in five adults having diabetes.14 It is estimated that there are more than 2.4 million Keralites living in various countries, a vast majority in Middle Eastern Countries, and their remittances to the state net domestic product was nearly 36.5 per cent.15 Primary healthcare services has been organised systematically with a network extending to the village level.
Assessing severity of disease in patients with alcoholic hepatitis (AH) is useful for predicting mortality, guiding treatment decisions, and stratifying patients for therapeutic trials. The ...traditional disease-specific prognostic model used for this purpose is the Maddrey discriminant function (DF). The model for end-stage liver disease (MELD) is a more recently developed scoring system that has been validated as an independent predictor of patient survival in candidates for liver transplantation. The aim of the present study was to examine the ability of MELD to predict mortality in patients with AH. A retrospective cohort study of 73 patients diagnosed with AH between 1995 and 2001 was performed at the Mayo Clinic in Rochester, Minnesota. MELD was the only independent predictor of mortality in patients with AH. MELD was comparable to DF in predicting 30-day mortality (c-statistic and 95% CI: 0.83 0.71-0.96 and 0.74 0.62-0.87 for MELD and DF, respectively, not significant) and 90-day mortality (c-statistic and 95% CI: 0.86 0.77-0.96 and 0.83 0.74-0.92 for MELD and DF, respectively, not significant). A MELD score of 21 had a sensitivity of 75% and a specificity of 75% in predicting 90-day mortality in AH. In conclusion, MELD is useful for predicting 30-day and 90-day mortality in patients with AH and maintains some practical and statistical advantages over DF in predicting mortality rate in these patients. MELD is a useful clinical tool for gauging mortality and guiding treatment decisions in patients with AH, particularly those complicated by ascites and/or encephalopathy.
Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women's empowerment and nutrition ...outcomes. National Rural Livelihoods Mission's poverty alleviation and livelihoods generation initiative is an opportune platform to layer women's nutrition interventions being tapped by project Swabhimaan in three eastern Indian states-Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women's empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women's access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women's nutrition interventions as stipulated under Swabhimaan may yield better results for women's empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.
•Kesterite and stannite phases of Ag2MgSn(S/Se)4 have been studied for the first time.•Kesterite and stannite phases of Ag2MgSnS4 is more stable than Ag2MgSnSe4.•Ag2MgSnS4 (Sta) phase has bandgap of ...1.41 eV with highest value of absorption coefficient.•Optical properties of Ag2MgSnS4 (Sta) exhibit similar characteristic as Ag2MgSnSe4 (Sta).
In this work, generalized gradient approximation (GGA) and the Heyd-Scuseria-Ernzerhof (HSE) hybrid functional within the framework of density functional theory (DFT) are used to investigate the structural, electronic and optical properties of Ag2MgSn(S/Se)4 quaternary chalcogenides in kesterite and stannite phases. The kesterite and stannite phases of Ag2MgSn(S/Se)4 are optimized and the values of lattice constants are calculated. The predicted energy bandgaps are found to be direct in nature along the Γ direction, with highest bandgap energy of less than 1.64 eV for Ag2MgSnS4 in kesterite phase. The total and partial density of states are analysed in detail. The optical properties such as imaginary and real parts of dielectric function, refractive index, reflectivity and extinction coefficient are also discussed. Further, in order to understand the light trapping capacity, we examine the absorption coefficients of Ag2MgSnS4 and Ag2MgSnSe4 materials and explore their applicability as solar cell absorber layers. The predicted values of all parameters will help researchers to carry out further investigations on these materials for photovoltaic applications.
Peripheral blood-derived macrophages isolated from Alzheimer’s disease (AD) patients have earlier been reported to demonstrate ineffective phagocytosis of amyloid-beta compared to the age-matched ...control subjects. However, the mechanisms causing unsuccessful phagocytosis remain unclear. Oxidative stress and the presence of ApoEε4 allele has been reported to play a major role in the pathogenesis of AD, but the contribution of oxidative stress and ApoEε4 in macrophage dysfunction leading to ineffective Aβ phagocytosis needs to be analyzed. Aβ phagocytosis assay has been performed using FITC-labeled Aβ and analyzed using flow cytometry and confocal imaging in patient samples and in THP-1 cells. Oxidative stress in patient-derived macrophages was analyzed by assessing the DNA damage using comet assay. ApoE polymorphism was analyzed using sequence-specific PCR and Hixson & Vernier Restriction isotyping protocol. In this study, we have analyzed the patterns of phagocytic inefficiency of macrophages in Indian population with a gradual decline in the phagocytic potential from mild cognitive impairment (MCI) to AD patients. Further, we have shown that the presence of ApoEε4 allele might also have a possible effect on the phagocytosis efficiency of the macrophages. Here, we demonstrate for the first time that oxidative stress could affect the amyloid-beta phagocytic potential of macrophages and hence by alleviating oxidative stress using curcumin, an anti-oxidant could enhance the amyloid-beta phagocytic efficacy of macrophages of patients with AD and MCI, although the responsiveness to curcumin might depends on the presence or absence of APOEε4 allele. Oxidative stress contributes significantly to decreased phagocytosis of Aβ by macrophages. Moreover, the phagocytic inefficiency of macrophages was correlated to the presence of ApoEε4 allele. This study also found that the Aβ-phagocytic potential of macrophage gets significantly enhanced in curcumin-treated patient-derived macrophages.
Psoriasis is an immune-mediated, chronic inflammatory disease affecting mainly the skin. Chronic stress leads to the blunted hypothalamic-pituitary-adrenal axis (HPA) that might induce ...pro-inflammatory conditions. Hence, we assessed the blood levels of the HPA hormones and interleukin-17 (IL-17) and the effect of stress and emotional distress to understand the link between stress and psoriasis better.
This cross-sectional study included 45 patients with psoriasis and 45 age and gender-matched apparently healthy volunteers (n = 45). IL-17, cortisol, and adrenocorticotrophic hormone (ACTH) levels were assessed in both groups. Psoriasis Area Severity Index (PASI) was used to assess disease severity. Presumptive Stressful Life Events scale PSLE, Perceived Stress scale PSS and Daily Hassles and Uplifts Scale DHUS scoring were used to assess stress levels and emotional distress.
Patients with psoriasis had higher levels of IL-17 and ACTH and lower levels of cortisol, as compared to controls. Stress scores (PSS, PSLE & DHUS) were significantly elevated in cases, as compared to the controls. IL-17, ACTH and stress scores showed a significant positive correlation with one another and a significant negative correlation with cortisol levels. They also showed a significant positive correlation with PASI, while cortisol levels showed a significant negative correlation.
Psoriasis patients having high ACTH, IL-17 and stress scores had lower levels of cortisol, indicating a dysregulated HPA axis with the pro-inflammatory state. This might lead to exacerbation of psoriatic flares, which needs investigation in further prospective studies.
•Psoriasis is a chronic inflammatory disease affecting the skin.•We undertook to elucidate the cross-section association between stress and psoriasis.•Those who experienced more stress displayed an unbalanced HPA axis and a pro-inflammatory condition.•Further research is warranted to evaluate if this could cause an increase in psoriatic flare-ups.
Purpose
The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous ...semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis.
Methods
The study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study.
Results
Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with
κ
= 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found.
Conclusion
This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis.
Level of evidence
IV.
In the Gulf of Mannar, Noctiluca scintillans blooms have been observed three times in September 2019, September and October 2020, and October 2021. It was determined and measured how the bloom period ...affects ichthyo-diversity. Noctiluca cell density varied slightly from year to year, ranging from1.8433 × 103 cells/L to 1.3824 x 106cells/L. In surface and sea bottom waters, high ammonia levels and low dissolved oxygen levels were noted. During the bloom period a significant increase in chlorophyll concentration was found. The amount of chlorophyll in GOM was extremely high, according to remote sensing photos made using MODIS-Aqua 4 km data. Acute hypoxia caused the death of wild fish near coral reefs and also in fish reared in sea cages. The decay of the bloom resulted in significant ammonia production, a dramatic drop in the amount of dissolved oxygen in the water, and ultimately stress, shock, and mass mortality of fishes.
•Harmful Algal Bloom incidents were recorded frequently over the past three years•After ten years, a Noctiluca scintillans bloom has been seen in the GoM.•Fish raised in cages and wild fishes on coral reefs were both found dead from severe hypoxia.•By using near real-time ocean colour determined chlorophyll concentration model derived current patterns it will be possible to alert cage culture farmers
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