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Community based tuberculosis (TB) prevalence surveys in ten sites across India during 2006-2012. To re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a pooled national level estimate of prevalence of TB. Individuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB. Of 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4-428.1, 147.9-429.8 and 170.8-528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7-377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas. TB burden continues to be high in India suggesting further strengthening of TB control activities.

Gallbladder cancer (GBC) is a significant public health concern in India, with a high disease burden and complex challenges in delivering effective care. This registry aims to shed light on the epidemiology, and barriers to early detection and treatment, to inform future research and policy initiatives. From January 2019 to December 2022, all consecutive patients with a presumed diagnosis of GBC, presenting to our institution were prospectively enrolled after informed consent. Each patient completed a standardized questionnaire, and clinical, radiologic and treatment data were recorded in a case record form. Management followed standard institutional protocols. Survival analysis was done using Kaplan–Meier curves. A total of 1950 patients were included, 1441 (73.9 %) of these hailed from the Gangetic belt region (northern and eastern states); an additional 209 (10.7 %) were migrants from these regions, representing 84.6 % of the cohort. Over 55 % belonged to lower socioeconomic classes. At presentation, 60 % had metastatic disease; only 318 (16.3 %) were eligible for curative-intent therapy, and 132 (6.8 %) did not complete planned treatment. Treatment dropout correlated significantly with male gender (p = 0.012) and unemployment (p = 0.014). After a median follow-up of 38.2 months, median overall survival was 58.2 months for early-stage patients versus 4.2 months for those with metastatic disease. This registry is an attempt to generate evidence-based awareness about the substantial disease burden of gallbladder cancers in India and highlights the un-met need for capacity building of our health system, in order to provide, timely, accessible and cost-effective management of this disease. •High incidence in Gangetic belt; environmental, genetic, and socioeconomic factors contribute.•Late presentation limits curative options (<16 % curative surgery rate).•Map hotspots and implement dedicated screening in high-risk regions.•Strengthen primary care training and referral systems.•Public awareness on dietary/lifestyle risks.

Extrarenal teratoid Wilms’ tumor is a rare variant of Wilms’ tumor. Literature shows only 17 reported cases. We present this right-sided teratoid Wilms’ tumor in a 3-year-old boy for its rarity in association with the horseshoe kidney. The tumor was found in the anterior aspect of the right kidney and consisted of triphasic Wilms’ tumor element along with the presence of heterologous components.

Paneer is an acid coagulated concentrated indigenous Indian dairy product. The texture of paneer manufactured from a developed automatic machine was studied with respect to the processing parameters such as coagulation temperature (70–90°C), pressure (0.3–0.6 MPa), types of coagulant (vinegar and citric acid), and milk (cow, buffalo, and full cream milk). The paneer samples were analysed for texture profile analysis of hardness, adhesiveness, springiness, gumminess, chewiness, and cohesiveness. An inscribed central composite design was used to optimize the desired textural characteristics of paneer such as minimum hardness and maximum springiness of paneer. The optimization result concluded that the full cream milk at the coagulation temperature of 88°C with citric acid at pneumatic pressure of 0.3 MPa would result on minimum hardness of 105.84 N and the springiness value of 0.6073, and the result was validated.

AbstractBackgroundDiabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. ObjectivesDetermine the association of frailty with allcause hospitalizations and mortality in older Veterans with diabetes. Design: Retrospective cohort. SettingOutpatient. ParticipantsVeterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. MeasurementsThe FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤.10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. ResultsWe identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31–2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16–3.64), p=.014. ConclusionsFrailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.

A study was carried out to produce chocolates from coconut variants viz, coconut oil, coconut cream and coconut milk as a substitute for cocoa butter. The chocolate prepared with 40% cocoa butter was taken as control. The preliminary trials were conducted with different composition of ingredients for the optimization of the level of substitution of coconut variants. Cocoa butter substituted at the levels of 10 %, 20 % and 30 % by coconut oil, coconut cream and coconut milk respectively were optimized based on the consumer acceptance. The raw materials used in the fabrication of chocolate were subjected to analysed for Peroxide value (PV), Acid Value (AV) and Free Fatty Acid (FFA) content and were found to have desirable oxidative stability.

Prolapsed uterus in a newborn is a rare condition. We present our purse-string suturing as a new technique to restore it to its normal position to avoid complications. Prolapse is usually associated with congenital spinal defects, and is often resistant to simple reduction.

We report a case of parasitic twin or incomplete or heteropagus twining of extra portions of a pelvis, lower and upper limbs, duplication of genitalia and herniation of intestinal tract with spleen—variant of conjoined twinning (CT) consistent with fusion of two embryos followed by resorption of the caudal half of one of them, resulting in a normal male baby with the upper half of a male parasitic twin fused to his chest.

Background Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. Methods New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. Results Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. Conclusion The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen.

Shortening tuberculosis (TB) treatment duration is a research priority. This paper presents data from a prematurely terminated randomized clinical trial, of 4-month moxifloxacin or gatifloxacin regimens, in South India. Newly diagnosed, sputum-positive HIV-negative pulmonary TB patients were randomly allocated to receive gatifloxacin or moxifloxacin, along with isoniazid and rifampicin for 4 months with pyrazinamide for first 2 months (G or M) or isoniazid and rifampicin for 6 months with ethambutol and pyrazinamide for first 2 months (C). All regimens were administered thrice-weekly. Clinical and bacteriological assessments were done monthly during treatment and for 24 months post-treatment. The Data and Safety Monitoring Board recommended termination of the trial due to high TB recurrence rates in the G and M regimens. Of 416 patients in intent-to-treat analysis, 6 (5%) of 124, 2 (2%) of 110 and 2 (2%) of 137 patients with drug-susceptible TB in the G, M and C arms respectively had unfavorable response at the end of treatment; during the next 24 months, 17 (15%) of 115, 11 (11%) of 104 and 8 (6%) of 132 patients respectively, had TB recurrence. Of 38 drug-resistant patients 1 of 8 and 3 of 26 in the G and C arms respectively had unfavourable response at the end of treatment; and TB recurrence occurred in 2 of 7 and 2 of 23 patients, respectively. The differences in TB recurrence rates between the G and C arms was statistically significant (p = 0.02). Gastro-intestinal symptoms occurred in 23%, 22% and 9% of patients in the G, M and C arms respectively, but most reactions were mild and manageable with symptomatic measures; 1% required regimen modification. 4-month thrice-weekly regimens of gatifloxacin or moxifloxacin with isoniazid, rifampicin and pyrazinamide, were inferior to standard 6-month treatment, in patients with newly diagnosed sputum positive pulmonary TB. Clinical Trials Registry of India CTRI/2012/10/003060.