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Background Recurrent myocardial infarction (re-MI) remains a significant challenge in cardiovascular care, especially in low-income countries. Despite advancements in cardiac care, many patients with coronary artery disease (CAD) fail to follow the secondary prevention guidelines consistently. This study aims to determine the independent predictors of re-MI and inadequate adherence to secondary prevention strategies among adults with CAD in a rural cohort in South India. Methods A nested case–control study with risk set sampling of controls was conducted from January 2022 to March 2022 within the ENDIRA (Epidemiology of Non-communicable Diseases In Rural Areas) Cohort in the rural part of Aluva municipality of Ernakulam district, Kerala, India. CAD patients aged 35–80 years from the ENDIRA cohort who have had one or more episodes of myocardial infarction 28 days post the index episode as confirmed by medical reports were selected as cases while those with no recurrent episodes were taken as controls. Descriptive analysis was conducted to characterise the study population and was expressed in frequencies and percentages. Regression models were used to determine the independent predictors of re-MI as well as inadequate adherence and was expressed using adjusted odds ratio along with 95% confidence intervals. Results The study included 187 cases and 436 controls. The independent predictors of recurrent myocardial infarction included poor socio-economic status (Adjusted Odds Ratio [AOR] 1.98; 95% confidence interval [CI] 1.34–2.91), > 5 years since CAD diagnosis (AOR 1.53; 95% CI 1.06–2.22), previous history of CABG (AOR 1.75;95% CI 1.17–2.61), alcohol consumption (AOR 1.65; 95% CI 1.04–2.61), follow up under complementary and alternative medicine (AOR 2.04; 95% CI 1.03–4.01), distance to follow up hospital > 20 kms (AOR 1.85; 95% CI 1.09–3.12) and uncontrolled blood pressure (AOR 1.60; 95% CI 1.07–2.39). The CAD patients preferring private facilities for follow up were 43% less likely to develop recurrent myocardial infarction. (AOR 0.57; 95% CI 0.34–0.95). Conclusion The determinants of recurrent myocardial infarction and inadequate adherence are multifactorial, encompassing socioeconomic, behavioural and health system factors. Strengthening equitable access to quality secondary prevention services, integrating social support, and improving continuity of cardiac care are essential to reduce recurrence and improve outcomes in rural India.

ObjectivesTo determine the independent predictors of full immunisation coverage (FIC) among children aged 12–23 months along with the parental awareness and attitudes (of children aged ≤23 months) regarding routine childhood vaccinations in Perambalur district of Tamil Nadu, South India.DesignA community-based cross-sectional analysis.SettingPerambalur district situated in the central region of Tamil Nadu state, South India.ParticipantsParents of children aged ≤23 months.Outcome measuresThe primary outcome measured was the FIC and FIC plus in the district along with the parental awareness and attitudes regarding routine childhood vaccinations. The independent predictors of FIC and FIC plus were determined using multivariable logistic regression models.ResultsThe study included 652 children, with a mean (±SD) age of 16.47 (±6.37) months and a male-to-female ratio of 60:40. The FIC and FIC plus of children aged 12–23 months were 91.3% (95% CI 88.64 to 93.33) and 79.7% (95% CI 76.15 to 82.80), respectively. The immunisation card retention was 97.9% among the parents of children aged 12–23 months. The independent predictors of FIC included below poverty line families (adjusted OR (AOR) 0.11; 95% CI 0.02 to 0.64), illiteracy among mothers (AOR 0.67; 95% CI 0.32 to 0.87), lack of immunisation card (AOR 0.14; 95% CI 0.03 to 0.55), lack of frequent home visits by healthcare worker (AOR 0.38; 95% CI 0.18 to 0.79) and hesitancy of parents towards vaccination (AOR 0.26; 95% CI 0.12 to 0.87).ConclusionThis study revealed a high FIC in this specific district. However, achieving full coverage is influenced by factors like socioeconomic status, maternal education and parental attitudes. Understanding these factors is essential for improving immunisation rates and ensuring all children are protected.

ObjectivesTo assess the pattern and determinants of healthcare service utilisation among adults with coronary artery disease (CAD) in a rural setting in Kerala, India.DesignA community-based cross-sectional analysis conducted within a study cohort.SettingThe study was conducted from January 2022 to March 2022 within the ENDIRA Cohort (Epidemiology of Non-communicable Diseases In Rural Areas) in the rural part of Aluva municipality of Ernakulam district, Kerala, India, which comprises five adjacent panchayats with a population of approximately 100, 000 individuals.ParticipantsPatients with CAD aged 35–80 years from the ENDIRA cohort with a history of at least one event of myocardial infarction in the past decade.Outcome measuresThe main outcome measured was the inadequacy of healthcare service utilisation among patients with CAD. The factors evaluated included age, gender, socioeconomic status, insurance, out of pocket expenses, choice of health care facility for follow up, distance from health centre as well as reported alcohol use, tobacco use and healthcare satisfactionResultsThe study encompassed 623 participants with a mean age of 65.12 (±8.55) years, of whom 71% were males. The prevalence of inadequate utilisation of health services was 58.7%. The independent predictors of underutilisation included reported alcohol consumption (adjusted OR (AOR) 2.36; 95% CI 1.41 to 3.95), living more than 20 km from healthcare facilities (AOR 1.96; 95% CI 1.14 to 3.37) as well as the preferences for specific doctors and adequate services at healthcare facilities (AOR 3.43; 95% CI 1.46 to 8.04). The patients with monthly CAD medication expenses exceeding Rs4000 had 0.26 times lesser odds to underuse healthcare services (AOR 0.26; 95% CI 0.10 to 0.65).ConclusionThe study reveals a suboptimal pattern of healthcare service utilisation among patients with CAD. Ensuring community access to standardised, high-quality follow-up care is crucial for enhancing healthcare utilisation following CAD.

Introduction India is currently experiencing a significant burden of diabetes mellitus, characterized by its high prevalence and associated complications. Diabetic retinopathy (DR) is a major microvascular complication of diabetes, leading to blindness. Awareness regarding this ocular complication of diabetes can help prevent vision loss due to early screening and diagnosis. However, awareness of DR among diabetes patients remains low, especially among developing nations, which affects the smooth functioning of health programs and interventions. This study aimed to determine the independent predictors of awareness regarding DR among patients with diabetes mellitus in the Ernakulam district of Kerala state in South India. Methods A hospital-based cross-sectional study was conducted from June 2024 to July 2024 among patients with diabetes mellitus attending a tertiary care hospital in Kerala. A pre-tested, structured questionnaire was used to collect the data. The patients' responses regarding awareness of DR were scored on a two-point scale, with correct responses receiving a score of 2 and incorrect responses receiving a score of 1. The total score ranged from 20 to 40. The data were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA, USA), numerically coded, and analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, USA). Descriptive analysis was carried out to characterize the study participants and was expressed in frequencies, percentages, and mean (±standard deviation (SD)). Independent samples t-test and one-way analysis of variance (ANOVA) were used for bivariate analyses. A multivariable linear regression model was used to determine the independent predictors of DR awareness score. A p-value <0.05 was considered statistically significant. Results The study included a total of 253 patients. The mean ± SD age of the study participants was 58.74 ± 12.51 years, and the majority (55.7%) were females. While 161 (63.6%, 95% CI: 57.71-69.56) patients were not aware that DR was due to the abnormal changes in the blood vessels of the retina, 219 (86.6%, 95% CI: 82.36-90.76) patients were aware that DR screening includes evaluation of the retina by dilating the eye. The independent predictors that had a positive impact on DR awareness scores were: (1) age (B = 1.46; 95% CI: 1.18-2.35), (2) education (B = 4.32; 95% CI: 3.57-5.06), and (3) family history of diabetes (B = 1.04; 95% CI: -1.79 to -0.29). The independent predictor that had a negative impact on DR awareness scores was the occupation of the patients: (a) semi-professional, skilled, unskilled (B = -1.24; 95% CI: -2.26 to -0.21), and (b) unemployed, retired (B = -1.32; 95% CI: -2.43 to -0.21). Conclusion It is crucial to evaluate the awareness of DR among patients with diabetes in the Ernakulam district of Kerala, South India. Age, graduate and post-graduate levels of education, as well as family history of diabetes, were the positive predictors of awareness, while lower-level occupations, including unemployment and retirement, were the negative predictors. This information is crucial for developing effective strategies for the early detection, treatment, and prevention of this ocular complication of diabetes. Future research should include longitudinal studies coupled with in-depth interviews, which would provide valuable insights into public perception and attitudes toward DR.

Kyasanur forest disease (KFD) is one of the neglected tick-borne viral zoonoses. KFD virus (KFDV) was initially considered endemic to the Western Ghats region of Karnataka state in India. Over the years, there have been reports of its spread to newer areas within and outside Karnataka. The absence of an effective treatment for KFD mandates the need for further research and development of novel vaccines. The present study was designed to develop a multi-epitope vaccine candidate against KFDV using immunoinformatics approaches. A total of 74 complete KFDV genome sequences were analysed for genetic recombination followed by phylogeny. Computational prediction of B- and T-cell epitopes belonging to envelope protein was performed and epitopes were prioritised based on IFN-Gamma, IL-4, IL-10 stimulation and checked for allergenicity and toxicity. The eight short-listed epitopes (three MHC-Class 1, three MHC-Class 2 and two B-cell) were then combined using various linkers to construct the vaccine candidate. Molecular docking followed by molecular simulations revealed stable interactions of the vaccine candidate with immune receptor complex namely Toll-like receptors (TLR2-TLR6). Codon optimization followed by in-silico cloning of the designed multi-epitope vaccine construct into the pET30b (+) expression vector was carried out. Immunoinformatics analysis of the multi-epitope vaccine candidate in the current study has potential to significantly accelerate the initial stages of vaccine development. Experimental validation of the potential multi-epitope vaccine candidate remains crucial to confirm effectiveness and safety in real-world conditions.

Normally, in human skulls, the basilar part of the occipital bone presents two occipital condyles which articulate with the superior articular facets of the atlas vertebra. A rare case of third occipital condyle (condylus tertitus) with an additional articular facet on it was observed in a dry skull from South India. The third condyle was on the basilar part of the occipital bone along the anterior margin of the foramen magnum. It showed an additional articular facet which was smooth surfaced and oval in shape measuring 1cm antero-posteriorly and 1.5cm transversely at its maximum width. Available literature on the condylus tertius and its clinical, surgical and radiological importance were discussed.

Individuals with underlying chronic inflammatory conditions are prone to increased morbidity when posed with an additional inflammatory challenge such as an injury or infection, but why this occurs remains unclear. Herein, we address this question in mouse models by demonstrating that chronic inflammation results in a pronounced expansion of circulating immature neutrophils that exhibit dysregulated effector functions as determined by single cell RNA sequencing and ex vivo functional assays. We show that these immature neutrophils are associated with and contribute to increased immunopathology in response to a new inflammatory challenge. Blocking the migration or function of these immature neutrophils through the administration of therapeutic antibodies or small molecules, profoundly lowers the immunopathology caused by the inflammatory challenge. Together, these studies establish a causal link between immature neutrophils and increased immunopathology, while also providing insights into new therapeutic strategies for treating individuals with chronic inflammatory ailments.

Kyasanur Forest Disease (KFD) is one of the neglected tick-borne viral zoonoses. KFD virus was initially considered endemic to the Western Ghats region of Karnataka. Still, over the years, there have been reports of its spread to newer areas within and outside Karnataka. The absence of an effective treatment for KFD expedites the need for further research and development of novel vaccines. The present study was designed to develop a multi-epitope vaccine candidate against KFDV using immunoinformatic tools. After analyzing 74 complete KFDV genome sequences for genetic recombination and phylogeny, different prioritized B and T cell epitopes were combined using various linkers to construct the vaccine candidate. Docking analysis of the designed vaccine construct revealed a stable interaction with the TLR2-TLR6 receptor complex. After confirming the stability of the vaccine receptor complex, codon optimization was done to ensure the efficient translation of the designed multi-epitope vaccine in the prokaryotic host system, and the subsequent in-silico cloning into the pET30b(+) expression vector was carried out. Immunoinformatics analysis of the multi-epitope vaccine in the current study is satisfactory as it can significantly accelerate the initial stages of vaccine development by narrowing down potential vaccine candidates and providing insights into their design. Experimental validation of the potential multi-epitope vaccine candidate remains crucial to confirm effectiveness and safety in real-world conditions.