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For the first time in the Indian subcontinent, a series of royal burials with chariots have been recovered from the Chalcolithic period at the archaeological site Sinauli (29°8′28″N; 77°13′1″E), Baghpat district, western Uttar Pradesh, India. Eight burials were excavated from the site; among them a royal burial with copper decorated legged coffin (lid with a series of anthropomorphic figures) and headgear has also been recovered. Among these remarkable discoveries, three full-sized chariots made of wood and copper, and a sword with a wooden hilt, made this site unique at historical ground. These cultural findings signify that the ancients from this place were involved in warfare. All these recovered exclusive antiquities also proved the sophistication and the high degree of craftsmanship of the artisans. According to the 14C radiocarbon dating and recovered material culture, the site date back to 4000 yr BP (∼2000 BCE) and is thought to belong to Ochre-Coloured Pottery (OCP)/Copper Hoard culture. This culture was believed to develop in the Ganga-Yamuna Doab and was contemporary to the late phase of the Indus civilization. Altogether, the findings indicate that the time period of this culture is plausibly contemporary to Late Indus, Mesopotamian and Greece civilizations.
Twelve lacustrine sediment samples from a relict lake in the Kalla Glacier valley were co-dated using AMS radiocarbon (14C) and infrared stimulated luminescence (IRSL) dating methods. In general, the radiocarbon ages of bulk organic matter were older by a minimum of 1500 years compared to (age depth) modeled luminescence ages after fading corrections. This is observed for the first time in the lake sediments of High Himalayan Crystalline zone. A combination of lipid n-alkane data, Raman spectra and geochemical proxies suggested that this was due to ancient organic carbon (OCancient) that is a mixture of pre-aged (OCpre-aged) and petrogenic (OCpetro) organic carbon within older glacial moraine debris that served as sediment source to the lake. Raman spectra suggest the presence of moderate to highly graphitized OCpetro in all the profile samples. The OCpetro contributed 0.064 ± 0.032% to the sediment and the lake stored 2.5 ± 0.7 Gg OCpetro at variable rates during the last 16 kyr, with the mean burial flux 160 kg OCpetro yr−1. This study implies (1) employing another independent dating method in addition to radiocarbon method using bulk sediment organic matter, if the carbon content is low, to observe any discrepancy, and (2) a need to investigate on the fate of OCpetro as many such small lakes become relict in this region.
Yushania anceps is a temperate woody bamboo taxon of high socio-economic importance occurring in the sub-alpine zone of the western Himalayas. This study was carried out to delineate the potential distribution of Y. anceps in the western Himalayas through species distribution modelling (SDM), and genetic characterization using sequence-tagged microsatellite (STMS) markers. The present study revealed an endemic distribution of this species in the Uttarakhand Himalayas, with an estimated area of 211.59 km2. The maximum probability of occurrence was recorded in the moderately dense forests between the altitudinal ranges of 2500 and 2700 m. The model output was well supported with high values of different statistical measures, such as the AUC (0.911) and Kappa coefficient (K = 0.513). Environmental variables related to precipitation, temperature and topography were identified as the most contributory in current SDM. In addition, diversity measures, namely allelic richness (Ar), expected heterozygosity (He), and fixation index (FST), were calculated in five sampled populations with eight STMS markers, which indicated high genetic diversity (Ar = 4.24; He = 0.689) and little differentiation (FST = 0.062). The diversity maps displayed that the populations located in the Kumaon region captured relatively more genetic diversity than the Garhwal region. Further, genetic clustering and STRUCTURE analysis revealed a substantial level of genetic admixing across the analysed populations, and as a result, no sub-structuring was detected. Due to the rare and endemic distribution of Y. anceps, it requires immediate conservation measures, and the knowledge base generated here will be of paramount importance to forest managers, researchers and policymakers.
Despite advances in medical care, we still come across pregnancy in Eisenmenger syndrome. Eisenmenger syndrome represents the severe end of the spectrum for disease in pulmonary artery hypertension associated with CHD. Due to very high maternal and perinatal morbidity and mortality, pregnancy is contraindicated among these women. Current guidelines also recommend that the women who become pregnant should opt for early termination of pregnancy. Here, we present a case series of 11 women of Eisenmenger syndrome and their pregnancy outcome.
Methods:
It was a retrospective analysis of 12 pregnancies among 11 women with Eisenmenger syndrome who were managed in a tertiary care referral centre of Northern India.
Results:
The mean age of these women was 28 ± 4 years (range 22 to 36 years). Almost 80% of them (9/11) were diagnosed with Eisenmenger syndrome during pregnancy. The commonest cardiac lesion was Ventricular Septal defect (54.5%) followed by Atrial Septal defect (27.3%) and Patent Ductus arteriosus (9.1%). Only three women opted for medical termination of pregnancy, rest eight continued the pregnancy or presented late. Pregnancy complications found include pre-eclampsia (50%), abruption (22%), and fetal growth retardation (62.5%). There were three maternal deaths (mortality rate 27%) in postpartum period.
Conclusion:
This case series highlights the delay in diagnosis and treatment of CHD despite improvement in medical care. Women with Eisenmenger syndrome require effective contraception, preconceptional counselling, early termination of pregnancy, and multidisciplinary care.
Drug-induced movement disorders (DIMDs) form an important subgroup of secondary movement disorders, which despite conferring a significant iatrogenic burden, tend to be under-recognized and inappropriately managed.
Objective
We aimed to look into phenomenology, predictors of reversibility, and its impact on the quality of life of DIMD patients.
Methods
We conducted the study in the Department of Neurology at a tertiary-care centre in India. The institutional ethics-committee approved the study. We assessed 55-consecutive DIMD patients at presentation to our movement disorder clinic. Subsequently, they followed up to evaluate improvement in severity-scales (UPDRS, UDRS, BARS, AIMS) and quality of life (EuroQol-5D-5L). Wilcoxan-signed-rank test compared the scales at presentation and follow-up. Binary-logistic-regrerssion revealed the independent predictors of reversibility.
Results
Fourteen patients (25.45%) had acute-subacute DIMD and 41 (74.55%) had tardive DIMD. Tardive-DIMD occurred more commonly in the elderly (age 50.73±16.92 years, p<0.001). Drug-induced-Parkinsonism (DIP) was the most common MD, followed by tardivedyskinesia. Risperidone and levosulpiride were the commonest culprit drugs. Patients in both the groups showed a statistically significant response to drug-dose reduction /withdrawal based on follow-up assessment on clinical-rating-scales and quality of life scores (EQ-5D-5L). DIMD was reversible in 71.42% of acute-subacute DIMD and 24.40% of patients with chronic DIMD (p=0.001). Binary-logistic-regression analysis showed acute-subacute DIMDs and DIP as independent predictors of reversibility.
Conclusion
DIP is the commonest and often reversible drug-induced movement disorder. Levosulpiride is notorious for causing DIMD in the elderly, requiring strict pharmacovigilance.
Tremor is defined as an involuntary rhythmic oscillation of a body part around a joint/axis. It is one of the most common movement disorders, and among the various tremor disorders, essential tremor (ET) is the most common. The estimated worldwide prevalence of ET is 0.9% among the general population, and it increases to 4.6% in individuals over 65 years of age.
Health-care personnel (HCPs) are predisposed to infection during direct or indirect patient care as well as due to the community spread of the disease.
Methods:
We observed the clinical presentation and course of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection in HCPs working in a dedicated coronavirus disease 2019 (COVID-19) care hospital during the first and the second wave.
Results:
A total of 100 and 223 HCPs were enrolled for the first wave and the second wave, respectively. Cough, shortness of breath, sore throat, runny nose, and headache was seen in 40 (40%) and 152 (68%) (P < 0.01), 15 (15%) and 64 (29%) (P = 0.006), 40 (40%) and 119 (53.3%) (P = 0.03), 9 (9%) and 66 (30%) (P < 0.01), 20 (20%) and 125 (56%) (P < 0.01), respectively. Persistent symptoms at the time of joining back to work were seen in 31 (31%) HCPs and 152 (68%) HCPs, respectively (P ≤ 0.01). Reinfection was reported in 10 HCPs.
Conclusions:
Most of the HCPs had mild to moderate infections. Symptoms persist after joining back to work. Upgradation of home-based care and teleconsultation facilities for active disease and redressal of residual symptoms will be helpful.
Coronavirus disease 2019 (COVID-19) emerged from a city in China and has now spread as a global pandemic affecting millions of individuals. The causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is being extensively studied in terms of its genetic epidemiology using genomic approaches. Andhra Pradesh is one of the major states of India with the third-largest number of COVID-19 cases with a limited understanding of its genetic epidemiology. In this study, we have sequenced 293 SARS-CoV-2 genome isolates from Andhra Pradesh with a mean coverage of 13324X. We identified 564 high-quality SARS-CoV-2 variants. A total of 18 variants mapped to reverse transcription polymerase chain reaction primer/probe sites, and four variants are known to be associated with an increase in infectivity. Phylogenetic analysis of the genomes revealed the circulating SARS-CoV-2 in Andhra Pradesh majorly clustered under the clade A2a (20A, 20B and 20C) (94%), whereas 6% fall under the I/A3i clade, a clade previously defined to be present in large numbers in India. To the best of our knowledge, this is the most comprehensive genetic epidemiological analysis performed for the state of Andhra Pradesh.
The Second Belt and Road Forum for International Cooperation announced the establishment of the International Commercial Dispute Prevention and Settlement Organization (ICDPASO) in 2019. The ICDPASO was coordinated by the China Council for the Promotion of International Trade and the China Chamber of International Commerce, together with industrial and commercial organizations and legal service agencies from over thirty countries and regions including the European Union, Italy, Singapore, Russia, Belgium, Mexico, Malaysia, Poland, Bulgaria, and Myanmar. It was launched on 15 October 2020. As its title indicates, ICDPASO's mandate to provide dispute resolution services is not confined to the Belt and Road Initiative (BRI) countries but includes resolving any disputes that the parties entrust to its jurisdiction. The ICDPASO aims to serve as a “legal hub” to resolve commercial and investment disputes effectively, efficiently, and practically. Unlike other multilateral dispute resolution forums, it is intended to provide an Asian-centric multilateral dispute resolution forum. This essay, the first on the subject of the ICDPASO, discusses how the ICDPASO can serve as a global laboratory for experimenting and innovating in dispute resolution with the potential to impact the landscape of international law, in particular its innovative use of mediation, good offices, and appeal processes to prevent and resolve disputes arising from the BRI. As BRI projects aim to establish infrastructure and digital connectivity within BRI countries and regions for trade and development, this essay argues that the dispute resolution process under the ICDPASO should take into account the overall development of a country or region. The essay concludes that the ICDPASO will be a game changer by introducing an Asian way of resolving disputes.
Sudden unexpected death in epilepsy (SUDEP) remains an important cause of epilepsy-related mortality, especially in patients with refractory epilepsy. The exact cause is not known, but postictal cardiac, respiratory, and brainstem dysfunctions are implicated. SUDEP prevention remains a big challenge. Except for low-quality evidence of preventive effect of nocturnal supervision for SUDEP, no other evidence-based preventive modality is available. Other potential preventive strategies for SUDEP include reducing the occurrence of generalized tonic–clonic seizures using seizure detection devices, detecting cardiorespiratory distress through respiratory and heart rate monitoring devices, preventing airway obstruction (safety pillows), and reducing central hypoventilation using selective serotonin reuptake inhibitors and adenosine and opiate antagonists. However, none of the above-mentioned modalities has been proven to prevent SUDEP. The present review intends to provide insight into the available SUDEP prevention modalities.
Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.
Design:
Retrospective observational study.
Methods:
Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.
Results:
Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).
Conclusions:
Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.
Sintered nanoparticle structures are macroscopically brittle but quite robust if deposited on a flexible substrate. The effects of a polymer substrate on the stretchability of both brittle and ductile coatings and traces are well established. Systematic effects of substrate properties on the fatigue resistance of aerosol printed nano-Ag are slightly more complex. The present work is focused on the early stages of fatigue, where the resistance increases significantly but cracks are not yet visible. Overall, the fatigue behavior is seen to vary with the combination of substrate modulus and viscoelastic deformation properties. Comparing two common polyimides, the rate of damage was seen to increase faster with increasing amplitude on the less compliant one. Consistently with this increasing the minimum strain in the cycle led to a significantly stronger reduction in damage rates. However, the damage rate remained lower on the less compliant substrate at all amplitudes and strain ranges of practical concern.
Little is known about the Himalayan glaciers, although they are of particular interest in terms of future water supply, regional climate change and sea-level rise. In 2002, a long-term monitoring programme was started on Chhota Shigri Glacier (32.2° N, 77.5° E; 15.7 km2, 6263–4050 ma.s.l., 9 km long) located in Lahaul and Spiti Valley, Himachal Pradesh, India. This glacier lies in the monsoon–arid transition zone (western Himalaya) which is alternately influenced by Asian monsoon in summer and the mid-latitude westerlies in winter. Here we present the results of a 4 year study of mass balance and surface velocity. Overall specific mass balances are mostly negative during the study period and vary from a minimum value of –1.4 m w.e. in 2002/03 and 2005/06 (equilibrium-line altitude (ELA) ∼5180 m a.s.l.) to a maximum value of +0.1 m w.e. in 2004/05 (ELA 4855 m a.s.l.). Chhota Shigri Glacier seems similar to mid-latitude glaciers, with an ablation season limited to the summer months and a mean vertical gradient of mass balance in the ablation zone (debris-free part) of 0.7mw.e.(100 m)–1, similar to those reported in the Alps. Mass balance is strongly dependent on debris cover, exposure and the shading effect of surrounding steep slopes.
Surface electroencephalogram (EEG) recording remains the gold standard for noninvasive assessment of electrical brain activity. It is the most efficient way to diagnose and classify epilepsy syndromes as well as define the localization of the epileptogenic zone. The EEG is useful for management decisions and for establishing prognosis in some types of epilepsy. Electroencephalography is an evolving field in which new methods are being introduced. The Canadian Society of Clinical Neurophysiologists convened an expert panel to develop new national minimal guidelines. A comprehensive evidence review was conducted. This document is organized into 10 sections, including indications, recommendations for trained personnel, EEG yield, paediatric and neonatal EEGs, laboratory minimal standards, requisitions, reports, storage, safety measures, and quality assurance.
To assess General Dental Practitioners’ (GDPs) in India willingness to participate in disaster management and their previous training pertaining to disaster management, and to assess GDP objective knowledge, attitude, and behavior regarding disaster management.
Materials and Methods
This study was a cross-sectional survey conducted on all GDPs of Jodhpur, Rajasthan, India. Willingness to participate, perceived knowledge, perceived effectiveness, objective knowledge, attitude, and behavior regarding disaster management were assessed through questionnaire method. Information also was collected regarding age, gender, religion, and residence.
Results
A total of 142 out of 180 GDPs participated in the study, representing a response rate of 79%. A majority (85%) of respondents were willing to participate in disaster management. Mean score for knowledge was 12.21%, for attitude was 33.56%, for behavior was 14.50%, and for perceived effectiveness was 9.08%. Significant correlations were observed between qualification and perceived effectiveness (P=.003), and between attitude and years of practice (P=.04). Willingness to participate in disaster management and age showed significant association (P=.000).
Conclusions
High willingness and attitude to participate in disaster management was observed among respondents. Low knowledge and behavior scores were observed among GDPs.
ChhabraKG, RajeshG, ChhabraC, BinnalA, SharmaA, PachoriY. Disaster Management and General Dental Practitioners in India: An Overlooked Resource. Prehosp Disaster Med. 2015;30(6):569–573.
This study was designed to determine the prevalence of rhythmic coma patterns in comatose children and to ascertain the prognostic significance of reactive rhythmic coma patterns.
Methods:
We retrospectively analyzed and classified electroencephalogram (EEGs) in comatose children between two months and 18 years of age during the period 1996 - 2003 according to modified Young's classification. Outcome at one-year was scored according to the Paediatric Cerebral and Overall Performance Category Scale. Outcomes were compared using Fisher's exact test and Mann-Whitney test.
Results:
Analysis of 63 electroencephalogram (EEG) records in 38 patients showed rhythmic patterns in 19 records (30.2%; 9 alpha, 4 spindle, 4 theta and 2 beta coma patterns, total number of children = 14). Aetiology and outcome of alpha coma patterns and other rhythmic coma patterns were similar. In five children, one type of rhythmic pattern changed to another. Records with reactive rhythmic coma 66.7% (6/9), were associated with favourable outcome. Sixty percent of the records (6/10 records in seven children) with non-reactive pattern were associated with unfavourable outcome. This clinically significant difference did not reach statistical significance (lower Paediatric Cerebral and Overall Performance Category Scale score p= 0.14; favourable outcome p=0.19).
Conclusion:
Rhythmic coma patterns in comatose children are not uncommon. Aetiology, reactivity and outcome of individual patterns are similar and thus make the rhythmic coma patterns distinct EEG signatures in comatose children. There was a clinically significant better outcome with reactive rhythmic coma patterns.
Bevacizumab, a humanized recombinant anti-vascular endothelial growth factor antibody, was approved in Canada in 2010 for the treatment of high-grade glioma. We report the effectiveness and safety of bevacizumab in the treatment of patients with recurrent high-grade gliomas at a single institution.
Methods:
Twenty-seven consecutive patients with high-grade glioma (anaplastic glioma and glioblastoma) at first or subsequent relapse were treated with bevacizumab alone or in combination with chemotherapy. The primary endpoint was progression-free survival (PFS) and secondary endpoints were objective response rate, six month PFS, overall survival (OS), and safety profile.
Results:
The clinical benefit rate (complete and partial responses plus stable disease) was 59%. Median PFS was 4.3 (95% CI, 3.0-10.9) months, with a six month PFS rate of 43%. Median OS after current relapse was 8.9 (95% CI, 5.8-not reached) months. Ten episodes of grade 3/4 adverse events were observed in nine patients, including fatigue (n = 3), thrombocytopenia (n = 4), and myelotoxicity, febrile neutropenia, and pulmonary embolism (each n = 1).
Conclusions:
We consider the efficacy and safety profile of bevacizumab is comparable to other cohorts of patients treated for recurrent high-grade glioma at other international institutions.
Caseinophosphopeptides (CPPs) are multifunctional bioactive peptides containing phosphorylated seryl residues in their sequence. In the present study, method for the production of CPPs from buffalo milk casein was optimised and characterised for their sequence, calcium solubilising and calcium binding activities. Response surface methodology was used to optimise the conditions for hydrolysis of buffalo casein by trypsin to obtain maximum yield of CPPs. The optimum hydrolysis conditions were as follows: hydrolysis pH 7·5, temperature 37 °C, hydrolysis time 7·0 h. Under these conditions, the experimental yield obtained was 10·04±0·24%, which is slightly lower than value predicted by the model. These CPPs were able to solubilise 1·03±0·08 mg la/mg CPPs in presence of excess phosphate and bind 0·935 mg of Ca/mg of CPPs. Eight phosphopeptides i.e. αs1-CN f (37-58) 2P; αs1-CN f (37-58) 3P; αs1-CN f (35-58) 2P; αs1-CN f (35-58) 3P; αs2-CN f (2-21) 4P; αs2-CN f (138-149) 1P; β-CN f (2-28) 4P and β-CN f (33-48) 1P were identified by LC-MS/MS which contained motif for binding of divalent minerals. The sequences of these CPPs differed from that of derived from bovine casein.
Nonvolatile unipolar resistive switching has been observed in Sm doped BFO thin films in Pt/Sm: BFO/SRO stack geometry. The initial forming voltage was found to be ∼ 11 V. After the forming process repeatable switching of the resistance of Sm:BFO film was obtained between low and high resistance states with nearly constant resistance ratio ∼ 105 and non overlapping switching voltages in the range of 0.7-1 V and 4-6 V respectively. The temperature dependent measurements of the resistance of the device indicated metallic and semiconducting conduction behavior in low and high resistance states respectively. The current conduction mechanism of the Pt/Sm:BFO/SRO device in low resistance states was found to be dominated by the Ohmic behavior while in case of high resistance state and at high voltages it deviated significantly from normal Ohmic behavior and was found to correspond the Pool-Frankel (PF) emission. The Pt/Sm:BFO/SRO structure also showed efficient photo-response in high and low resistance states with increase in photocurrent which was significantly higher in low resistance state when illuminated with white light.