Clozapine is the only evidence-based intervention for treatment-resistant schizophrenia. One of the drug's most well-known and potentially fatal adverse effects is agranulocytosis (severe neutropenia). Hence, regular blood tests are an essential component of clozapine treatment. This article presents a narrative review of the history, incidence, potential aetiology and management of clozapine-associated neutropenia. It gives an overview of clozapine monitoring requirements, including those for benign ethnic neutropenia. We point to the growing body of evidence that the risk of clozapine-induced agranulocytosis is mostly confined to the first year of treatment and that the risk of fatality is considerably lower than previously assumed. Given the absence of alternative evidence-based interventions for treatment-resistant schizophrenia, we suggest that rechallenging with clozapine should be considered in most patients with clozapine-associated mild to moderate neutropenia who do not respond to other treatments. A more careful risk–benefit analysis is needed in cases of severe neutropenia (agranulocytosis).

Aortopulmonary window is a rare CHD, which comprises a communication between the ascending aorta and the pulmonary artery. The standard treatment of aortopulmonary window is surgical; however, few cases are amenable to closure via percutaneous intervention. We present a case of aortopulmonary window closure using Lifetech™ Konar-MF occluder device (Lifetech Scientific Co. Ltd., Shenzhen).

This study assessed the impact of improved green fodder production activities on technical efficiency (TE) of dairy farmers in climate vulnerable landscapes of central India. We estimated stochastic production frontiers, considering potential self-selection bias stemming from both observable and unobservable factors in adoption of fodder interventions at farm level. The empirical results show that TE for treated group ranges from 0.55 to 0.59 and that for control ranges from 0.41 to 0.48, depending on how biases are controlled. Additionally, the efficiency levels of both adopters and non-adopters would be underestimated if the selectivity bias is not appropriately accounted. As the average TE is consistently higher for adopter farmers than the control group, promoting improved fodder cultivation would increase input use efficiency, especially in resource-deprived small holder dairy farmers in the semi-arid tropics.

We aimed to compare the efficacy of daily v. low dose depot oral vitamin D3 for treating nutritional rickets. We conducted a randomised controlled trial in the department of paediatrics of a tertiary care hospital catering to semi-urban and rural population in Delhi, India. We randomised sixty-six children aged 3 months to 5 years with nutritional rickets to receive either daily oral vitamin D3 drops (3–12 months: 2000 IU; > 12 months to 5 years: 4000 IU; n 33) for 12 weeks duration or a single oral depot dose of vitamin D3 granules (3–12 months: 60 000 IU; > 12 months to 5 years: 150 000 IU; n 33). Participants in both groups had comparable demographic characteristics, laboratory features and radiological severity of rickets. Thirty-three participants in each group received the assigned intervention and all were followed up till 12 weeks. At 12 weeks follow-up, children in both groups showed a significant improvement in all biochemical parameters (serum Ca, P, alkaline phosphatase (ALP), parathormone and 25(OH) vitamin D levels) as well as radiological healing. At 12 weeks, the mean serum 25(OH) vitamin D levels (nmol/l) were statistically comparable in both groups (daily: 120·2 (sd 83·2), depot: 108 (sd 74), P = 0·43) and 31 (93·9 %) children in each group had radiological healing (Thacher score < 1·5). Two children in each group persisted to have raised ALP, and one child each in the daily group continued to have hypocalcaemia and hypophosphataemia at 12 weeks. Low dose oral depot vitamin D3 is an effective alternative to daily oral vitamin D3 for nutritional rickets.

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.

Funding: None

Disclosures: None

The Murshidabad District of West Bengal, India has practised traditional mulberry sericulture since time immemorial. One of the most important aspects for sustainable development of the sericulture industry is the control and prevention of silkworm diseases. The main objective of this study was to determine silkworm disease incidence over the period 1992–2011 in Murshidabad District and how environmental factors have contributed towards their occurrence. Data were collected from a crop-wise survey of silkworm diseases from 25 farmers (five farmers from five villages), who each had a separate rearing house, were progressive and had a capacity of rearing at least 100 disease free layings (dfls) in each crop. Disease incidence was expressed in percentage and calculated taking into consideration 40,000 larvae per 100 dfls. Crop-wise silkworm disease mortality data were correlated with meteorological data. Data collected from the continuous survey conducted in the district during 1992–2011 revealed that there was no set pattern of occurrence of silkworm diseases. However, maximum mortality (up to 30%) of silkworm due to diseases in all the seasons occurred mainly due to grasserie, as relative humidity remains high for most part of the year in this area. However, other than grasserie, for most of the period, disease incidence was below 10%. This observation of the dominance of grasserie over other diseases in causing silkworm mortality calls for renewed emphasis on the preventive measures and development of disease forecasting models, for disease control. Another observation was that since 1993, pebrine, the deadliest disease of the silkworm, has not been reported from the farmers’ fields.

The present experiment was undertaken to validate a probiotic of canine origin for its potential use in dogs. A total of fifteen adult female Labrador dogs were allocated to three equal groups and fed a basal diet without probiotic (control) or with probiotic of either canine (Lactobacillus johnsonii CPN23; cPRO) or dairy (L. acidophilus NCDC 15; dPRO) origin for 9 weeks. The digestibility of most macronutrients remained similar among the groups; however, fibre digestibility was improved (P = 0·034) in dogs receiving cPRO. The faecal fermentative metabolites ammonia (P < 0·05) and lactate (P = 0·094) were altered favourably, indicating a positive influence of both probiotics. Faecal concentrations of acetate, propionate and butyrate were increased (P < 0·01) in both probiotic groups. However, improvements were higher in cPRO v. dPRO. The delayed-type hypersensitivity reaction to intradermal inoculation of phytohaemagglutinin-P was higher (P = 0·053) in cPRO as compared with control. The antibody response to sheep erythrocytes was, however, similar across the three groups. Overall, in dogs, the canine-origin probiotic was superior when compared with the dairy-origin probiotic.

Objectives: Zika virus (ZikaV) is currently one of the most important emerging viruses in the world which has caused outbreaks and epidemics and has also been associated with severe clinical manifestations and congenital malformations. Traditional approaches to combat the ZikaV outbreak are not effective for detection and control. The aim of this study is to propose a cloud-based system to prevent and control the spread of Zika virus disease using integration of mobile phones and Internet of Things (IoT).

Methods: A Naive Bayesian Network (NBN) is used to diagnose the possibly infected users, and Google Maps Web service is used to provide the geographic positioning system (GPS)-based risk assessment to prevent the outbreak. It is used to represent each ZikaV infected user, mosquito-dense sites, and breeding sites on the Google map that helps the government healthcare authorities to control such risk-prone areas effectively and efficiently.

Results: The performance and accuracy of the proposed system are evaluated using dataset for 2 million users. Our system provides high accuracy for initial diagnosis of different users according to their symptoms and appropriate GPS-based risk assessment.

Conclusions: The cloud-based proposed system contributed to the accurate NBN-based classification of infected users and accurate identification of risk-prone areas using Google Maps.

A five-point drought stress screening methodology for muskmelon based on visual observation has been standardized by modifying an earlier field screening method. The scale (1 to 5), were categorized into five groups, namely, highly drought tolerant (1), drought tolerant (2), average drought tolerant (3), drought susceptible (4) and highly drought susceptible (5). To validate and standardized the technique, 48 genotypes of muskmelon were evaluated for two successive years. Important physiological parameters, i.e.: relative water content (RWC), electrolyte leakage, photosynthetic efficiency (Fv/Fm), chlorophyll concentration index (CCI), root and shoot length were measured and correlated to make screening results more reliable. Drought tolerance efficiency of genotypes was calculated based on yield, and drought-tolerant genotypes were identified with better yield efficiency and ranking on visual scale. Whereas, yield efficiency of some drought-tolerant genotypes were less, althouth they came under drought-tolerant scale. Being a tolerant genotype, these may not be economical for commercial cultivation. Under water-deficit condition a significant positive correlation was observed between drought tolerance efficiency, and RWC, Fv/Fm, CCI and root length. Out of 48 genotypes, 14 genotypes were came under highly drought-tolerant category based on 5 point scale.

Genetic diversity of a red clover global collection was assessed using 36 simple sequence repeat (SSR) primers representing all seven linkage groups (LGs). The number of fragments amplified ranged from 1 to 6 for all the primers. Primer RCS0060 detected highest number of fragments, whereas four SSRs viz., RCS0899, RCS1594, TPSSR40 and RCS6927 amplified single fragment. Size range of amplicons generated by all the primers varied from 100 to 400 bp. Polymorphism information content values ranged from 0.301 to 0.719 with an average value of 0.605. LG wise diversity analysis showed that LG 3 was most diverse (I = 0.65, Ht = 0.44), whereas LG-1 showed minimum diversity (I = 0.48, Ht = 0.26) for the microsatellites used. Bayesian model-based clustering inferred three genetically distinct populations in the red clover germplasm holding and showed considerable admixture in individuals within clusters. Neighbour-joining analysis showed intermixing of accessions within groups. Principal component analysis plot complemented the clustering shown by Structure and distinguished three populations to greater extent. Analysis of molecular variance showed that 91% of the genetic variation was residing within populations, while 9% variation was among populations. Overall, the results showed that a high level of genetic diversity is prevailing in this worldwide collection of red clover, which can be exploited for its genetic improvement through breeding approaches.

Background: The issue of tobacco control had almost unanimous support among public health professionals. It is therefore apparent that the dental care system should be involved in tobacco prevention and tobacco cessation. Objective: To assess dental students’ and practicing dentists’ perceptions of tobacco cessation content in curriculum and attitudes concerning their professional responsibility to help users quit tobacco. Methods: The study was conducted with Bachelor of Dental Surgery (BDS) 3rd year students, Interns and practicing dentists of Moradabad city (India). A 17-item questionnaire focused on attitudes of dental fraternity, professional responsibilities, effectiveness and scope of Tobacco Use Cessation (TUC) practice in dental setting. Results: Statically significant difference is seen among responses of dental fraternities, with students having less positive attitudes than practicing dentists (p < 0.001). Conclusion: Attitudes of the participants appear to be positive and encouraging, but they feel unprepared and needed further training in TUC.

Pebrine caused by Nosema bombycis in the silkworm Bombyx mori L. causes severe economic loss to the sericulture industry. Several species of microsporidia and strains of N. bombycis have been isolated from infected silkworms. The study of the developmental stages of any parasite is important, as it leads to the identification of stages that may be susceptible to control measures. For this study, five microsporidian isolates from B. mori were collected from five different locations in West Bengal, India and a study of the developmental stages from mid-gut smears and histological techniques was undertaken. The observations of mid-gut smears and histological specimens revealed differences in the morphometry and duration of different developmental stages of the parasites.

Increasing prevalence of childhood obesity calls for comprehensive and cost-effective educative measures in developing countries such as India. School-based educative programmes greatly influence children's behaviour towards healthy living. We aimed to evaluate the impact of a school-based health and nutritional education programme on knowledge and behaviour of urban Asian Indian school children. Benchmark assessment of parents and teachers was also done. We educated 40 196 children (aged 8–18 years), 25 000 parents and 1500 teachers about health, nutrition, physical activity, non-communicable diseases and healthy cooking practices in three cities of North India. A pre-tested questionnaire was used to assess randomly selected 3128 children, 2241 parents and 841 teachers before intervention and 2329 children after intervention. Low baseline knowledge and behaviour scores were reported in 75–94 % government and 48–78 % private school children, across all age groups. A small proportion of government school children gave correct answers about protein (14–17 %), carbohydrates (25–27 %) and saturated fats (18–32 %). Private school children, parents and teachers performed significantly better than government school subjects (P < 0·05). Following the intervention, scores improved in all children irrespective of the type of school (P < 0·001). A significantly higher improvement was observed in younger children (aged 8–11 years) as compared with those aged 12–18 years, in females compared with males and in government schools compared with private schools (P < 0·05 for all). Major gaps exist in health and nutrition-related knowledge and behaviour of urban Asian Indian children, parents and teachers. This successful and comprehensive educative intervention could be incorporated in future school-based health and nutritional education programmes.

Foreign bodies of the upper aerodigestive tract are common problems dealt with by the otolaryngologist. Among all foreign bodies in the oesophagus, an open safety pin still presents a challenge for the ENT specialists because of its propensity to pierce the oesophagus and surrounding structures. We present an interesting case of a long-standing foreign body i.e. an open safety pin, which, after piercing the hypopharynx, caused fatal common carotid artery rupture.