bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence for Detection, Control and Monitoring of Monkeypox Outbreaks Using a Mobile Application
Authors: Cabanillas-Carbonell Michael
Published: December 2024

Monkeypox is a disease of zoonotic origin that reflects the connection between human, animal, and environmental health. It is transmitted primarily through direct contact with body fluids, skin lesions, or contaminated surfaces. Being of interest after the global outbreak of 2022, which recorded nearly 70,000 cases in more than 100 countries. This study presents a prototype mobile application that incorporates tools such as artificial intelligence (AI) for early detection and monitoring of the disease. The mobile-D methodology was used. The results were validated by experts and users, reaching an average of 85% in user satisfaction and 81% in expert evaluation, indicating a high level of acceptance. This application facilitates real-time data collection, improving communication between health authorities and the population, which is crucial for disease control. With the use of AI and data analysis, the application seeks to optimize case management and support health systems in at-risk areas, representing a significant advance in the response to monkeypox.
Usages et limites de la violence de guerre à la haute époque hellénistique
Authors: Pimouguet-Pédarros Isabelle
Published: December 2024

La violence de guerre, que l’on s’accorde à considérer comme une catégorie intrinsèquement liée au fait militaire, voire comme une de ses composantes, présente-t-elle à l’époque hellénistique des spécificités propres ? Les représentations historiques et culturelles attachées à la violence de guerre ont-elles évolué par rapport aux périodes antérieures ? Les luttes et rivalités permanentes entre les différentes puissances grecques pour le commandement des territoires conquis ont-elles entraîné un déplacement des seuils de tolérance ? Considérant que la violence de guerre diffère d’un espace-temps à un autre, cette étude se propose de caractériser et d’identifier les actes qui en relèvent, mais aussi de mettre en évidence la façon dont ces actes sont rapportés par les auteurs anciens et intégrés dans le récit des événements. Mais par-delà les formes et représentations de la violence de guerre, cette étude vise aussi à rendre compte des actes qui entrent dans le champ de la transgression – qu’il s’agisse de la violation des normes fondamentales ou du non-respect des usages. Il s’agit par conséquent de considérer les situations dans lesquelles ces actes se produisent, mais aussi de mettre en évidence le vocabulaire qui leur est associé, susceptible de rendre compte du franchissement d’une frontière morale, voire d’une infraction aux règles régissant la relation des hommes au divin. Les écrits de Polybe sont, de ce point de vue, particulièrement intéressants en ce qu’ils posent la question d’une possible redéfinition des usages et des limites de la violence de guerre à l’époque hellénistique.
La symbolique égyptienne de la rencontre ludique entre Rhampsinite et Déméter-Isis (Hérodote, II, 122)
Authors: Haziza Typhaine
Published: December 2024

Cet article poursuit la réflexion entamée dans le cadre du colloque du CIERGA, qui s’est tenu à Fribourg les 6 et 7 septembre 2021, concernant l’anecdote hérodotéenne de Rhampsinite aux Enfers (II, 122), en s’interrogeant sur la finalité du jeu pratiqué entre le Pharaon et Déméter et, plus largement, sur son symbolisme égyptien, ainsi que sur celui du don par la déesse d’une « serviette lamée d’or ». Différentes pistes sont explorées qui montrent qu’en dépit d’une vraisemblable interpretatio Graeca du récit initial et d’une interprétation qui peut être différente selon les milieux de réception de l’anecdote, celle-ci est encore très marquée par ses origines égyptiennes.
Le uersus aureus comme structure annulaire
Authors: Foucher Antoine
Published: December 2024

Par bien des aspects (construction verbale et syntaxique, organisation phonique), le uersus aureus apparaît comme une structure annulaire. Il est sans doute plus proche encore du uersus teres que le grammairien Diomède choisit d’illustrer par un uersus aureus de Perse. De fait, l’esthétique de la rondeur ou de la circularité est au cœur du projet poétique de certains poètes de l’époque néronienne, Calpurnius Siculus notamment, et semble correspondre à certains traits dominants de l’architecture de cette époque. Cependant, le choix d’un vers de Perse pour illustrer ce type de vers révèle peut-être aussi les défauts d’une rondeur trop parfaite, comme le montre également un passage du Satyricon.
L’espace vécu à l’échelle micro
Authors: Dreyer Pascal , Vernay Florence
Published: December 2024

Dans le cadre d’une recherche exploratoire sur l’expérience corporelle de l’habiter conduite entre 2019 et 2021, cet article investigue la manière dont quatre personnes âgées de 66 à 96 ans ont exploité les ressources spatiales de leur logement pour maintenir leur santé dans le cadre d’un confinement. Quatre monographies ont été menées, attentives au rapport des habitants à différents types de micro-espaces : ceux assurant le bien-être à travers la réassurance et le maintien de la continuité de soi, la maîtrise du temps et de l’espace ; ceux créés de manière ad hoc pour entretenir et maintenir la santé physique, enjeu majeur au regard du spectre de la dépendance. Le rapport aux différents micro-espaces est appréhendé par la notion d’« arrangement ».
Supporting the Writing of Adult Literacy Learners
Authors: Traga Philippakos Zoi A. , Puranik Cynthia , Greenberg Daphne , MacArthur Charles A. , Miller Christine Dunagin , Martinez Jennifer
Published: December 2024

The chapter addresses writing instruction with adult learners and their instructors, challenges, and lessons learned through two case studies. The goal in the development of a writing program for adults was to examine whether repetition of lessons by the same instructor and the same students supported their learning and confidence, and in what ways. Further, the goal was to examine what challenges the instructors faced with specific instructional components. Participants in this work were two instructors, an experienced adult instructor and a graduate research assistant, working with small groups of students across two semesters. The results (quantitative and qualitative) indicate that it was beneficial to repeat the lessons and the instructional process. Further, insights by the adult instructor offered guidance about how to work with instructors and with adult literacy learners.
A neurophysiological and genetic assessment of a case of rapidly progressive scoliosis
Authors: Maccarone Maria Chiara , Paramento Matilde , Passarotto Edoardo , Contessa Paola , Rubega Maria , Formaggio Emanuela , Masiero Stefano
Published: December 2024

Scoliosis is a three-dimensional spinal deformity characterized by a lateral deviation of at least 10° Cobb, categorized into idiopathic and non-idiopathic forms, caused by identifiable factors like congenital abnormalities, neuromuscular conditions, or genetic syndromes.
This case report discusses a 15-year-old girl with growth delay and growth hormone (GH) deficiency who experienced rapid scoliosis progression. Initial evaluations were normal, and electroencephalography (EEG) showed nonspecific alterations, but further assessment revealed a MYH3 gene variant associated with scoliosis, short stature, and distinct facial features. Treatment with a Lyon ARTbrace and tailored exercises stopped curve progression. This case highlights the need for thorough evaluations in atypical AIS cases to uncover potential causes.
The syntactic features and emotional impact of Xitsonga interjections
Authors: Mlambo Respect , Hlungwani Madala C.
Published: December 2024

The syntactic features and emotional impacts of interjections in Xitsonga have been largely overlooked in existing literature. This article aims to close this gap by exploring these aspects. Employing a qualitative approach, the data were collected through corpus-based methods by extracting relevant words, phrases and sentences featuring interjections from published Xitsonga drama texts. The data were purposefully sampled and subsequently subjected to content analysis. The article was written following the principles of prototype theory. The findings revealed that Xitsonga interjections can occur at the beginning, middle and end of a sentence or occupy various positions within a sentence, and they are used to convey the speaker’s emotional state, such as surprise, distress, fear, remembrance, frustration or anger. The article also notes that interjections can function as standalone utterances (holophrases) or adjuncts, enhancing emotional expression while maintaining grammatical integrity. Their placement significantly influences the emotions conveyed. The article further illustrates how juxtaposing interjections can heighten emotional intensity, showcasing their versatility in expressing complex emotional states. This applies to both primary and secondary interjections in Xitsonga. These findings suggest that interjections are an integral part of the Xitsonga, serving important syntactic features and expressing a range of emotional states.Contribution: This article enhances our understanding of Xitsonga by exploring the diverse syntactic features and emotional effects of interjections, an area that has received little attention. Drawing on data from published Xitsonga drama texts, the article reveals that interjections can appear at the beginning, middle or end of a sentence or occupy various positions, each carrying different emotional impacts. Using prototype theory as a framework, the article demonstrates that interjections function as standalone utterances (holophrases) or adjuncts, encompassing both primary and secondary forms. These insights deepen our understanding of Xitsonga’s interjections, closing a research gap and contributing valuable knowledge to the fields of syntax and semantics.
Retrospective analysis of CD4 count trends in South Africa
Authors: Cassim Naseem , Coetzee Lindi-Marie , Da Silva Manuel P. , Glencross Deborah K. , Stevens Wendy S.
Published: December 2024

Background: South Africa has the largest HIV epidemic globally. Despite the scale-up of antiretroviral therapy, people living with HIV are still presenting with low CD4 counts.Objectives: This study assessed CD4 trends.Method: A retrospective analysis of laboratory data from 2013 to 2023 was conducted. Annual test volumes, the median CD4, and the percentage of specimens with a count ≤ 200 cells/μL and 500 cells/μL were reported at the national and provincial levels, and by age and gender. The percentage change in both CD4 categories between 2013 and 2023 was assessed, and the CD4 counts per 100 000 population reported.Results: Data are reported for 32 154 644 specimens. The overall median CD4 increased from 396 cells/μL to 473 cells/μL. The percentage of specimens with CD4 counts 500 cells/μL increased over time but the percentage with CD4 counts ≤ 200 cells/μL remained stable. Men had lower CD4 median and higher percentage of specimens with counts ≤ 200 cells/μL than women. However, the rate of, CD4 ≤ 200 cells/μL decreased from 1411 to 700 per 100 000 population; this decrease occurred in all provinces except the Western Cape.Conclusion: This study found high percentage of specimens with CD4 counts ≤ 200 cells/μL despite an increase in median CD4 count. Men had lower CD4 counts than women.
Poetry is a subject as precise as geometry: A poetic deconstruction of Psalms 23, 51 and 137
Authors: Diko Mlamli , Celliers Adelheid Bechtold
Published: December 2024

This scholarly discourse concentrates on the poetic deconstruction of Psalms 23, 51 and 137, elucidating the affluent literary devices and profound themes within these biblical poems. Psalms, a collection of poetic expressions, provide unique perspectives on the human experiences concerning the spiritual world. In Psalm 23, the pastoral imagery and metaphorical expressions of the shepherd and green pastures are unravelled, unmasking the symbolic affluence that captures the essence of spiritual abundance and sacred companionship. Psalm 51 marks a plot twist as the psalmist implores for an immaculate heart and a right spirit, shifting from external rituals to a profound internal struggle for spiritual regeneration. In Psalm 137, a dramatic turn occurs as the captives are requested to sing the songs of Zion in a foreign land, unmasking tensions between preserving identity and the grievous reality of displacement. The hideous imagery of dashing infants against rocks mirrors the profundity of their suffering and the complex interplay between memory, loss and the pursuit of justice. This scholarly discourse navigates the intricate tapestry of these Psalms, uncovering the profound themes, sensibilities and transformative power that are profoundly entrenched within the poetic expressions of these ancient voices.Contribution: The scholarly contribution herein lies in its application of poetic deconstruction, unmasking covert layers of meanings and symbolisms within the selected biblical poems and offering new perspectives into their theological and literary significance.
Transmission dynamics & epidemiology of malaria in two tribal districts in Madhya Pradesh, India
Authors: Chand Gyan , Chaudhary N.K. , Soan V. , Kaushal L.S. , Sharma R.K. , Singh Neeru
Published: December 2024

Background and objectives:

Epidemiology and transmission of malaria vary within the tribal areas with the variation in topography, forest cover and type of forest. For the control of disease, understanding of the dynamics of transmission in the varied ecological situation is essential. This study was carried out in the two distinct tribal areas- Baiga Chak (thick forested area) of Dindori district and Bichhia block (forest fringe area) of Mandla district, Madhya Prasdesh, India, to understand the epidemiology and transmission dynamics of malaria.

Methods:

Mosquitoes were collected using hand catch and whole night collections to determine the proportion of vectors, their density and seasonality. Vector incrimination was done by sporozoite ELISA and feeding preferences of vector by gel diffusion method. Active fever surveys were carried out fortnightly to determine the age specific malaria parasite rates among the inhabitants of two areas.

Results:

Density of Anopheles culicifacies was significantly higher in Bichhia while the density of An. fluviatilis was higher in Baiga Chak. An. culicifacies was incriminated from both the areas while An. fluviatilis was incriminated from Baiga Chak only. Malaria slide positivity rate (SPR) was significantly higher (OR=3.7 95%CI, 3.1-4.4) in Baiga Chak (28.2%) than Bichhia (9.6%).

Interpretation & conclusions:

The features of malaria transmission in tribal areas differed from those reported in rural or semirural population. Site-specific and region-specific studies are required to develop appropriate intervention measures to control malaria.
Diurnally subperiodic filariasis among the Nicobarese of Nicobar district - epidemiology, vector dynamics & prospects of elimination
Authors: Shriram A.N. , Krishnamoorthy K. , Vijayachari P.
Published: December 2024

In India diurnally subperiodic filariasis (DspWB) is prevalent only in the Nicobar district of Andaman and Nicobar Islands. Studies undertaken at different points of time indicate that this form of filariasis is restricted to a small region in Nancowry group of islands where it is transmitted by mosquito Downsiomyia nivea, a day biting mosquito. Studies on prevalence, distribution, and assessment of endemicity status, vector incrimination, bioecology, host seeking behaviour, population dynamics of the vector, transmission dynamics and clinical epidemiology indicate the prevalence and persistence of this infection in the Nancowry group of islands with perennial transmission. There was no control programme in these islands, until the National programme to eliminate filariasis was launched in 2004. Eight rounds of annual mass drug administration (MDA) with diethyl carbamazine (DEC) + albendazole have been completed. Despite this, microfilaria prevalence remains at above one per cent, the level identified for initiating transmission assessment survey to decide on continuation of MDA further. This necessitates adjunct measures to the ongoing MDA programme in these islands. The vector control options could be an adjunct measure, but the vector is a forest dweller with a unique bio-ecology, therefore, not a technically feasible option. Use of DEC fortified salt for six months to one year could hasten the process of elimination. Although administration of DEC-fortified salt is simple, rapid, safe, and cost-effective, challenges are to be tackled for evolving operationally realistic strategy. Such a strategy requires commitment of all sections of the society, a distribution mechanism that ensures the use of DEC-fortified salt in the Nancowry islands. Here we discuss the plan of action to serve the indigenous communities and operationalizing DEC fortified salt strategy through an inter-sectoral approach involving multiple stakeholders.
Epidemiological investigation of an outbreak of typhoid fever in Jorhat town of Assam, India
Authors: Roy Jashbeer Singh , Saikia Lahari , Medhi Mithu , Tassa Dipak
Published: December 2024

Background & objectives:

Typhoid fever is a global health problem and is also endemic in India. An outbreak of fever occurred in January 2014 in Jorhat Town in Assam, India. Here we report the results of an investigation done to find out the aetiology and source of the outbreak.

Methods:

The affected areas were visited on January 23, 2014 by a team of Jorhat district Integrated Disease Surveillance Project personnel. A total of 13 blood samples from patients with fever as first symptom and six water samples were collected from the affected areas. The blood samples were cultured and isolates were identified using standard biochemical tests. Isolates were also tested for antimicrobial sensitivity. Widal test was performed on 10 of the 13 blood samples collected. Sanitary survey was carried out to find any leakage in the water supply and also the sewage system of the Jorhat town.

Results:

Blood culture yielded Salmonella enterica serovar Typhi in six (46.15%) patients whereas Widal test was positive in 10 (76.9%) of 13 patients. Water culture showed presumptive coliform count of >180/100 ml in two out of the six samples tested. Salmonella Typhi was also isolated from water culture of these two samples. Sanitary survey carried out in the affected places showed that the water supply pipes of urban water supply were in close proximity to the sewage drainage system and there were few leakages.

Interpretation & conclusions:

The outbreak occurred due to S. Typhi contaminating the water supply. Sanitation and immunization are the two most important components to be stressed to prevent such outbreaks.
Morphological spectrum of mediastinal lesions with special emphasis on evaluation of needle biopsy
Authors: Aggarwal Riti , Rao Seema , Chopra Prem , Bhalla Sunita , Vijay C. L. , Asaf Belal Bin , Kumar Arvind
Published: December 2024

Background & objectives:

Mediastinal lesions are uncommon and are infrequently encountered in routine clinical practice. Hence, there is a need for more elaborate studies of mediastinal lesions to make the pathologists and clinicians aware of the large spectrum of these lesions. The present study describes the histomorphological spectrum of various mediastinal lesions in a tertiary care hospital in India, along with the discussion of some unusual and interesting cases. Considering the limited diagnostic material obtained in guided biopsies, the adequacy of such tissue for providing a definite opinion was also evaluated.

Methods:

This was a retrospective study performed on 125 mediastinal masses diagnosed on surgically resected specimens as well as needle biopsies over a period of two years (January 2012-December 2013). A few cases had inadequate diagnostic material, making a total of 116 cases which were further evaluated.

Results:

A total of 116 patients of mediastinal lesions were included in the study. Most of the lesions were in 21-30 yr age group, with male:female ratio of 1.7:1. Anterior mediastinal compartment was most commonly involved. Majority of the cases (62.1%) were of neoplastic nature, with benign tumours (34.5%) being more common than malignant ones (27.6%). Thymoma followed by lymphoma constituted the most common mediastinal tumours. One-third of the total cases were diagnosed on needle biopsy samples. All cases where needle biopsy was followed by resection specimen showed concordant diagnosis. The percentage adequacy of biopsy was 91.7 per cent and the diagnostic accuracy was 100 per cent.

Interpretation & conclusions:

This study provides the histomorphological spectrum and biological diversity of the mediastinal lesions. It also emphasizes that biopsy is sufficiently adequate, with the help of a comprehensive immunohistochemistry panel, for providing a definite diagnosis in majority of cases.
Study of adverse drug reactions in patients with diabetes attending a tertiary care hospital in New Delhi, India
Authors: Singh Abhishank , Dwivedi Shridhar
Published: December 2024

The present prospective observational study was carried out in a tertiary care hospital in New Delhi, India from May 2014 to June 2015 to report adverse drug reactions (ADRs) in patients with type 2 diabetes mellitus (T2DM) using antidiabetic drugs. A total of 220 patients (121 males, 99 females) were enrolled. ADRs were recorded on the prescribed form. Causality and severity assessment was done using Naranjo's probability scale and modified Hartwig and Siegel's severity scale, respectively. Commonly prescribed drugs were biguanides, peptide hormone and sulphonylurea. A total of 26 ADRs were recorded (16 in males and 10 in females). Most commonly observed ADRs were related to endocrine and gastrointestinal system. Severity assessment of ADRs showed seven (26.9%) ADRs as moderate, and 19 (73.1%) as mild. No severe reactions were observed. ADRs were mostly related to endocrine and gastrointestinal system. More information on prescribed drugs and their side effects is required for ensuring patient safety.
Glucose tolerance & insulin secretion & sensitivity characteristics in Indian children with cystic fibrosis
Authors: Jain Vandana , Kumar Santosh , Vikram Naval K. , Kalaivani Mani , Bhatt Surya Prakash , Sharma Rajni , Kabra Sushil Kumar
Published: December 2024

Background & objectives:

Cystic fibrosis (CF) is a life-limiting genetic condition resulting in chronic respiratory infections, pancreatic enzyme insufficiency and associated complications. This pilot study was undertaken to assess the glucose tolerance and insulin secretion and sensitivity among Indian children with CF.

Methods:

Children with CF under regular follow up at the Paediatric Pulmonology Clinic of a tertiary care hospital in New Delhi, India, were enrolled. Children who had a history of acute exacerbation or intake of systemic steroids within the last two weeks were excluded. Anthropometry, pulmonary function and disease severity (Shwachman) score were assessed. Fasting venous sample was drawn to assess glucose, insulin, haemoglobin and calcium. Oral glucose tolerance test was performed, and blood glucose and insulin were assessed at 30, 60, 90 and 120 min. Insulin secretion and sensitivity indices were calculated.

Results:

Twenty nine patients with a mean age of 11.2±4.1 yr were enrolled. Stunting, thinness, anaemia and hypocalcaemia were present in 31.0, 13.8, 37.0 and 48.3 per cent of the patients, respectively. Abnormal glucose tolerance (AGT) was present in 21.4 per cent. Insulin secretion was similar in individuals with AGT and normal glucose tolerance (NGT), but insulin sensitivity index was lower (0.12±0.02 vs 0.15±0.01, P<0.001) and homeostatic model assessment of insulin resistance higher [1.63 (0.53-1.76) vs 0.83 (0.28-4.43), P<0.05] in individuals with AGT compared to NGT.

Interpretation & conclusions:

AGT was observed in 21.4 per cent of children with CF. The CF patients with AGT had significantly lower insulin sensitivity compared to patients with NGT. Future multicentric studies with a large sample should be conducted to assess insulin secretion and sensitivity indices in CF patients compared to healthy controls.
Staphylococcus hominis subsp. novobiosepticus, an emerging multidrug-resistant bacterium, as a causative agent of septicaemia in cancer patients
Authors: Ahmed Nishat Hussain , Baruah Frincy K. , Grover Rajesh K.
Published: December 2024

Staphylococcus hominis subsp. novobiosepticus is a new sub-species of S. hominis, thus dividing S. hominis into subsp. hominis and novobiosepticus. This study was designed to identify subsp. novobiosepticus isolates amongst the S. hominis isolated from blood samples of patients with malignancy and septicaemia and to study their resistance profile. The identification was performed by using three simple tests which differentiated between the two sub-species. It was found that 22.8 per cent of S. hominis isolates belonged to subsp. novobiosepticus.
Molecular characterization of human Dirofilaria isolates from Kerala
Authors: Nazar Najuma , Lakshmanan Bindu , Jayavardhanan K.K.
Published: December 2024

Background & objectives:

Human dirofilariosis is a well-recognized zoonosis caused by several species of the genus Dirofilaria. The disease is prevalent among canines and human beings in Kerala. The objective of the present study was to confirm the human Dirofilaria isolates by molecular characterization.

Methods:

The worms or segments obtained from human sources were subjected to diagnostic polymerase chain reaction (PCR) targeting the cytochrome oxidase subunit 1 (COI) and 5S ribosomal RNA (rRNA) genes of Dirofilaria repens. The amplicons were sequenced and analyzed.

Results:

The filariid nematodes recovered from ocular as well as subcutaneous tissue of human origin were identified as D. repens based on PCR targeting COI as well as 5S rRNA genes. The phylogenetic analysis of the COI gene nucleotide sequence obtained in the present study showed that D. repens shared the closest evolutionary relationship with D. honkongensis.

Interpretation & conclusions:

Molecular identification of D. repens isolated from human source assumes significance from the point of zoonotic threat of this mosquito-borne nematode. Phylogenetic analysis revealed a close evolutionary relationship with Asian isolate of D. honkongensis. Timely detection and treatment of infection in dogs, together with mosquito control, should be an integral part of the control strategy of this disease.
Use of real-time ultrasound for locating tip position in neonates undergoing peripherally inserted central catheter insertion
Authors: Telang Nagsen , Sharma Deepak , Pratap Oleti Tejo , Kandraju Hemasree , Murki Srinivas
Published: December 2024

Background & objectives:

Securing long-term venous access is an essential part of sick newborn care. The malposition of central line tip leads to several complications. There is a need for an easily available bedside investigating tool to diagnose these malpositions. This study was done to compare the effectiveness of real-time ultrasound (RTUS) with X-ray in identifying the peripherally inserted central catheter (PICC) line tip.

Methods:

This pilot observational study was conducted in a level III Neonatal Intensive Care Unit of a tertiary care hospital in India, from June 2012 to June 2013. A total of 33 PICC lines in 31 infants were included in the study. After insertion of PICC line, X-ray and RTUS were done to locate the tip of the PICC line.

Results:

In this study, PICC line tip could be identified by bedside RTUS in 94 per cent of line insertions. Standard X-ray identified the tip in all cases. RTUS has been shown to have good diagnostic utility in comparison with X-ray with sensitivity and specificity being 96.55 and 100 per cent, respectively. In our study, majority of malpositions were identified and manipulated by RTUS, thus second X-rays were avoided.

Interpretation & conclusions:

The result of this pilot study shows that RTUS may be a reliable and safe bedside tool for determining the tip of PICC lines. However, studies with large sample size need to be done to confirm these findings.
A mini-review of Bunyaviruses recorded in India
Authors: Yadav Pragya D. , Chaubal Gouri Y. , Shete Anita M. , Mourya Devendra T.
Published: December 2024

Newly emerging and re-emerging viral infections are of major public health concern. Bunyaviridae family of viruses comprises a large group of animal viruses. Clinical symptoms exhibited by persons infected by viruses belonging to this family vary from mild-to-severe diseases i.e., febrile illness, encephalitis, haemorrhagic fever and acute respiratory illness. Several arthropods-borne viruses have been discovered and classified at serological level in India in the past. Some of these are highly pathogenic as the recent emergence and spread of Crimean-Congo haemorrhagic fever virus and presence of antibodies against Hantavirus in humans in India have provided evidences that it may become one of the emerging diseases in this country. For many of the discovered viruses, we still need to study their relevance to human and animal health. Chittoor virus, a variant of Batai virus; Ganjam virus, an Asian variant of Nairobi sheep disease virus; tick-borne viruses such as Bhanja, Palma and mosquito-borne viruses such as Sathuperi, Thimiri, Umbre and Ingwavuma viruses have been identified as the members of this family. As Bunyaviruses are three segmented RNA viruses, they can reassort the segments into genetically distinct viruses in target cells. This ability is believed to play a major role in evolution, pathogenesis and epidemiology of the viruses. Here, we provide a comprehensive overview of discovery, emergence and distribution of Bunyaviruses in India.
Index-TB Guidelines
Authors: Sharma Surendra K. , Ryan H. , Khaparde Sunil , Sachdeva K. S. , Singh Achintya D. , Mohan Alladi , Sarin Rohit , Paramasivan C N , Kumar Prahlad , Nischal Neeraj , Khatiwada Saurav , Garner Paul , Tharyan Prathap
Published: December 2024

Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.
Value of CD16/CD66b/CD45 in comparison to CD55/CD59/CD45 in diagnosis of paroxysmal nocturnal haemoglobinuria
Authors: Kotru Mrinalini , Sharma Rahul , Pramanik Suman Kumar , Purohit Abhishek , Singh Gurmeet , Singh Avinash Kumar , Muterja Deepti , Mishra Pravas , Seth Tulika , Tyagi Seema , Mahapatra Manoranjan , Pati Hara Prasad , Saxena Renu
Published: December 2024

Background & objectives:

Diagnosis of paroxysmal nocturnal haemoglobinuria (PNH), a rare haematopoietic stem cell disorder, is challenging in patients with bone marrow failure (BMF) syndrome like aplastic anaemia (AA). This study was conducted with the aim to test the efficacy of the newly recommended markers viz. anti-CD16 and CD66b antibody over the existing anti-CD55 and CD59 antibody for PNH diagnosis in India.

Methods:

This study was conducted on 193 suspected cases of PNH by flow cytometry using lyse wash technique to stain the granulocytes with CD16/CD66b and CD55/CD59.

Results:

Of the 193 suspected cases, 62 patients showed the presence of PNH clone. Forty six patients were detected by CD55/CD59/CD45, whereas 61 were detected by CD16/CD66b/CD45. CD16/CD66b detected 16 (25.8%) additional patients over CD55/CD59 (P<0.05) and was more sensitive in detecting the PNH clone with higher negative predictive value. Most of the patients (11/16) who were picked up by CD16/CD66b were of AA who had small clone sizes. Further, the PNH clones were more discreetly identified in CD16/CD66b plots than by CD55/CD59. Clone size assessed by CD16/CD66b which reflects the clinical severity of classical PNH (thrombosis/haemolysis), was more representative of the underlying clinical condition than CD55/59.

Interpretation & conclusions:

In our experience of 62 patients of PNH, CD16/CD66b proved to be more efficacious in detecting PNH. The new panel was especially useful in monitoring PNH associated with BMF which had small clone sizes.
Typical & atypical enteropathogenic Escherichia coli in diarrhoea & their role as carrier in children under five
Authors: Singh Taru , Das Shukla , Ramachandran V.G. , Shah Dheeraj , Saha Rumpa , Dar Sajad Ahmad , Rai Arvind
Published: December 2024

Background & objectives:

Multidrug-resistant enteropathogenic Escherichia coli (EPEC) is responsible for a large number of cases of infantile diarrhoea in developing countries, causing failure in treatment with consequent health burden and resulting in a large number of deaths every year. This study was undertaken to determine the proportion of typical and atypical EPEC in under five children with diarrhoea and controls, their function as a carriage and to identify virulent genes associated with them.

Methods:

During the study period, 120 stool samples including 80 from controls children were collected and analyzed for the presence of EPEC using standard bacteriological methods. Isolates were subjected to antimicrobial testing by disc diffusion method. Isolates confirmed as E. coli by phenotypic method were further tested for the presence of attaching and effacing (eae) and bundle-forming pilus (bfpA) genes by real-time SYBR Green-based polymerase chain reaction.

Results:

All isolates were tested for the presence of EPEC. The frequency of typical EPEC was 20 and 16.25 per cent whereas the frequency of atypical EPEC strains was 5 and 23.75 per cent in patients and controls, respectively (P< 0.05) and bfpA was seen in 45 and 18.75 per cent isolates of diarrhoeal patients and controls, respectively.

Interpretation & conclusions:

Our results showed that typical EPEC was a common cause of diarrhoea, but at the same time, atypical EPEC was emerging as colonizers in the intestine of children with and without diarrhoea in and around Delhi. Children can be considered asymptomatic carriers of these pathogens and can transmit them to other susceptible children. Adequate steps need to be taken to stop these strains from developing and spreading further.
Protective effect of antigen excess immune complex in guinea pigs infected with Mycobacterium tuberculosis
Authors: Ebenezer Rajadas Sam , Gupta Umesh D. , Gupta Pushpa , Shakila Harshavardhan
Published: December 2024

Background & objectives:

Immune complexes (ICs) play a crucial role which can either be beneficial or pathological to the host. Involvement of circulating immune complexes (CICs) has been shown in tuberculosis (TB) cases (adults and neonates form), but its immunomodulatory effect has not been studied in vivo. Hence, this study was carried out to understand and explore the prognostic therapeutic potential of CICs on the host immune system in guinea pigs animal TB model.

Methods:

In this study, the guinea pigs (group I) were immunized with in vitro synthesized antigen excess IC (AgX-IC), group II with antibody excess IC (AbX-IC) and group III with phosphate-buffered saline. All these animals were sensitized with Mycobacterium tuberculosis H37Rv before immunization and subsequently infected with M. tuberculosis H37Rv strain post-immunization with IC.

Results:

Mortality was observed in animals belonging of groups II and III, while all animals in group I survived. A steady increase in the body weight of animals immunized with AgX-IC was observed when compared to the other groups. The infection load in the spleen and lungs was less in animals from group I when compared to the other groups. The CICs were found to be in higher concentration in serum of IC-immunized guinea pigs when compared to ICs non-immunized animals.

Interpretation & conclusions:

Based on our findings, it can be speculated that the ICs may have a protective immunomodulatory role pertaining to disease progression and development of pathology. As a new perspective, with further insight into the underlying mechanism of action and correlation with clinical data, ICs may also be used as a potential tool for assessing the immune status of the infected individuals, especially the close contacts of TB patients.
Pefloxacin as a surrogate marker for quinolone susceptibility in Salmonella enterica serovars Typhi & Paratyphi A in India
Authors: Sharma Priyanka , Dahiya Sushila , Kumari Bhavana , Balaji Veeraraghavan , Sood Seema , Das Bimal Kumar , Kapil Arti
Published: December 2024

Background & objectives:

The emergence of resistance to fluoroquinolones in enteric fever despite the pathogen being susceptible by in vitro laboratory results, led to repeated changes in Clinical and Laboratory Standard Institute (CLSI) guidelines for this class of antibiotics to have specific and sensitive interpretative criteria. In 2015, CLSI added pefloxacin disk diffusion criteria as a surrogate marker for fluoroquinolone susceptibility. This study was carried out to evaluate the use of pefloxacin as a surrogate marker for ciprofloxacin, ofloxacin and levofloxacin susceptibility in clinical isolates of Salmonella Typhi and S. Paratyphi A.

Methods:

A total of 412 strains of S. Typhi and S. Paratyphi A were studied for pefloxacin disk diffusion test as a surrogate marker for susceptibility to ciprofloxacin, ofloxacin and levofloxacin as per CLSI and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Molecular mechanisms of resistance to fluoroquinolones were also determined and correlated with pefloxacin susceptibility breakpoints.

Results:

Of the total 412 strains, 34 were susceptible to ciprofloxacin and 33 each to levofloxacin and ofloxacin using CLSI minimum inhibitory concentration (MIC) breakpoints. There was a positive correlation between MICs with correlation coefficients 0.917, 0.896 and 0.958 for the association between ciprofloxacin and ofloxacin, ciprofloxacin and levofloxacin and ofloxacin and levofloxacin, respectively (P <0.001). The sensitivity, specificity and positive predictive value of pefloxacin as a surrogate marker using ciprofloxacin MIC as a gold standard were 100, 99.5 and 94.4 per cent, while 100, 99.2 and 91.7 per cent taking ofloxacin and levofloxacin MIC as gold standard. Mutations in target genes correlated with the pefloxacin susceptibility results.

Interpretation & conclusions:

Our results showed that pefloxacin served as a good surrogate marker for the detection of susceptibility to ciprofloxacin, ofloxacin and levofloxacin in S. Typhi and S. Paratyphi A. Further studies are required to confirm these findings.
S100 proteins
Authors: Verma Rachna , Verma Priyanka , Budhwar Snehil , Singh Kiran
Published: December 2024

S100 proteins are calcium (Ca2+)-binding proteins and these have an important function in progression, manifestation and therapeutic aspects of various inflammatory, metabolic and neurodegenerative disorders. Based on their involvement in intracellular or extracellular regulatory effects, S100 proteins are classified into three subgroups: one subgroup is specialized in exerting only intracellular effects, other performs both intracellular and extracellular functions and the third subgroup members only display extracellular regulatory effects. S100 proteins are expressed particularly in vertebrates and have cell-specific expression. Functionally, S100 proteins act through their surface receptors and regulate cell functions in autocrine or paracrine mode. Receptor for advanced glycation end products (RAGEs) and toll-like receptor 4 are the main surface receptors. S100 proteins participate in the regulation of cellular differentiation, proliferation, apoptosis and inflammation along with Ca2+ homeostasis, energy metabolism and cellular migration, and perform the respective functions through their interaction with transcription factors, nucleic acids, enzymes, receptors, cytoskeleton system, etc. Currently, their role in adverse pregnancy outcomes and compromised reproductive health is being explored. These proteins are present in amniotic fluid, endometrium tissue and foetal brain; therefore, it is quite likely that alterations in the expression levels of S100 family members will be affecting the particular function they are involved in and ultimately affecting the pregnancy in adverse manner. The current review discusses about an association of S100 proteins in pregnancy disorders such as endometriosis, intrauterine growth retardation and miscarriage.
Mid-life fertility
Authors: Jindal Umesh N.
Published: December 2024

This review highlights the challenges, priority areas of research and planning, strategies for regulation of services and the need to develop guidelines and laws for fertility treatments during mid-life. The success rate of all treatments is poor in advanced age women because of declining ovarian reserve and natural fertility. There is often a need of third-party involvement which has its own ethical, legal and medical issues. Welfare of children born to older women and early death of parents are important concerns. Most of the new techniques such as the pre-implantation genetic diagnosis, oocyte augmentation, use of stem cells or artificial gametes, ovarian tissue preservation and ovarian transplantation are directed to improve, preserve or replace the declining ovarian reserve. These techniques are costly and have limited availability, safety and efficacy data. Continued research and policies are required to keep pace with these techniques. The other important issues include the patients’ personal autonomy and right of self-determination, welfare of offspring, public vs. private funding for research and development of new technologies vs. indiscriminate use of unproven technology. It is important that mid-life fertility is recognized as a distinct area of human reproduction requiring special considerations.
Evaluation of platelet surface glycoproteins in patients with Glanzmann thrombasthenia
Authors: Mutreja Deepti , Sharma Rahul Kumar , Purohit Abhishek , Aggarwal Mukul , Saxena Renu
Published: December 2024

Background & objectives:

Glanzmann thrombasthenia (GT) is a rare, inherited autosomal recessive disorder characterized by qualitative or quantitative deficiency of integrin αIIbβ3 [glycoprotein IIb (GPIIb)/IIIa, CD41/CD61] diagnosed by absent or reduced platelet aggregation to physiological agonists, namely, collagen, adenosine-di-phosphate, epinephrine and arachidonic acid. The objective of this study was to quantitate platelet surface GPs, classify GT patients and relate the results with the severity of bleeding and platelet aggregation studies.

Methods:

Fifty one patients of GT diagnosed by platelet aggregation studies were evaluated for the expression of CD41, CD61, CD42a and CD42b on platelet surface by flow cytometry. The association between the clinical phenotype based on bleeding score and GT subtype on flow cytometric evaluation was assessed.

Results:

Twenty four (47%) patients of GT were classified as type I (as CD41/CD61 were virtually absent, <5%), six (11.8%) patients as type II (5-20% CD41/CD61) and 21 (41.2%) as type III or GT variants as they had near normal levels of CD41 and CD61. Type III GT patients had significantly lower numbers of severe bleeders (P=0.034), but the severity of bleeding did not vary significantly in type I and II GT patients. In all GT patients, mean CD41 expression was found to be lower than mean CD61 expression (P=0.002).

Interpretation & conclusions:

Type I GT was found most common in our patients and with lowered mean CD41 expression in comparison with CD61. Type III GT patients had significantly lower numbers of severe bleeders, but the severity of bleeding did not vary significantly in type I and II GT patients.
Evaluation of evidence for pharmacokinetics-pharmacodynamics-based dose optimization of antimicrobials for treating Gram-negative infections in neonates
Authors: Shafiq Nusrat , Malhotra Samir , Gautam Vikas , Kaur Harpreet , Kumar Pravin , Dutta Sourabh , Ray Pallab , Kshirsagar Nilima A.
Published: December 2024

Background & objectives:

Neonates present a special subgroup of population in whom optimization of antimicrobial dosing can be particularly challenging. Gram-negative infections are common in neonates, and inpatient treatment along with critical care is needed for the management of these infections. Dosing recommendations are often extrapolated from evidence generated in older patient populations. This systematic review was done to identify the knowledge gaps in the pharmacokinetics-pharmacodynamics (PK-PD)-based optimized dosing schedule for parenteral antimicrobials for Gram-negative neonatal infections.

Methods:

Relevant research questions were identified. An extensive electronic and manual search methodology was used. Potentially eligible articles were screened for eligibility. The relevant data were extracted independently in a pre-specified data extraction form. Pooling of data was planned.

Results:

Of the 340 records screened, 24 studies were included for data extraction and incorporation in the review [carbapenems - imipenem and meropenem (n=7); aminoglycosides - amikacin and gentamicin (n=9); piperacillin-tazobactam (n=2); quinolones (n=2); third- and fourth-generation cephalosporins (n=4) and colistin nil]. For each of the drug categories, the information for all the questions that the review sought to answer was incomplete. There was a wide variability in the covariates assessed, and pooling of results could not be undertaken.

Interpretation & conclusions:

There is a wide knowledge gap for determining the doses of antimicrobials used for Gram-negative infections in neonates. A different profile of newborns in the developing countries could affect the disposition of antimicrobials for Gram negative infections, necessitating the generation of PK-PD data of antimicrobials in neonates from developing countries. Further, guidelines for treatment of neonatal conditions may incorporate the evidence-based PK-PD-guided dosing regimens.