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The current research ethics review systems are composed of isolated institutional Research Ethics Committees (RECs) that develop their own standard operating procedures (SOPs), templates and so on, with low adoption of digital solutions to manage submission and review processes. This poses several challenges, such as delays, higher costs, and hindering multi-site research. We propose an online national research ethics platform that all RECs can use, with common review processes and documentation requirements following national policy. The system will scale up adoption of digital solutions to all RECs. It will reduce administrative burden and harmonize review procedures. It will also obviate the need for separate and isolated interventions such as national REC registries or clinical trial registries, as these can be generated as transactional outputs of the system. The harmonized procedures and possibility of single submission will facilitate multi-site research. Sharing of resources and expertise among RECs on the platform will enhance resilience. An e-EC system developed in India and a Regional Health research portal developed by the WHO South-East Asia office offer proof of concepts to demonstrate the feasibility of developing and using such systems. The proposed solution is ambitious but feasible. Developing the proposed system will be a vital cost-effective investment in national health infrastructure to strengthen the research ecosystem and accelerate delivery of improved healthcare innovations by reducing unnecessary delays in conducting research. To maximize benefits, concurrent efforts are needed to build researchers’ capacity and enhance the quality and efficiency of human reviews of the research proposals by REC.

The emergence and spread of antimicrobial resistance (AMR) in clinically important bacterial pathogens has severely compromised the effectiveness of commonly used antibiotics in healthcare. Acquisition and transmission of AMR genes (ARGs) are often facilitated by sublethal concentrations of antibiotics in microbially dense environments. In this study, we use sewage samples (n = 381) collected from six Indian states between June and December 2023 to assess the concentration of eleven antibiotics, microbial diversity, and ARG richness. We find antibiotics from seven drug classes and detect over 2000 bacterial amplicon sequence variants (ASVs). Metagenomic (n = 220) and isolated genome sequences (n = 305) of aerobic and anaerobic bacterial species identify 82 ARGs associated with 80 mobile genetic elements (MGEs). These MGEs are predominantly present in multidrug-resistant (MDR) bacterial pathogens. Comparative core genome analysis of MDR bacterial isolates (n = 7166) shows strong genetic similarity between sewage-derived strains and clinical pathogens. Our results highlight sewage as a significant reservoir for ARGs, where genetic exchanges occur and facilitate the evolution and spread of AMR pathogens in both community and healthcare settings. Additionally, the dipstick-based assay developed for ARGs detection can be used for sewage surveillance in low-resource settings for better understanding of resistance prevalence. This study used metagenomic analyses of Indian urban sewage. It revealed antibiotic contamination, resistance genes, and mobile genetic elements from multidrug-resistant pathogens, highlighting sewage as a critical antimicrobial resistance reservoir.

Annually, an estimated 2.3 million infants die within their first month of life, primarily in sub-Saharan Africa and South Asia. Infections, including sepsis are among the major contributors to these deaths. Effective interventions added to standard antimicrobial therapy can reduce sepsis mortality. A recent meta-analysis suggests that adjunct zinc treatment of young infants with sepsis could reduce case fatality risk. This study evaluated the efficacy of zinc as an adjunct to antibiotics in young infants with suspected sepsis, defined as clinical severe infection (CSI). We conducted a randomized, double-blind, placebo-controlled trial across seven hospitals in India and Nepal from February 28, 2017, to February 22, 2022. Infants aged 3-59 days hospitalized with suspected sepsis, defined as CSI, adapted from the WHO Integrated Management of Childhood Illness (IMCI) criteria, were randomly assigned to receive 10 mg of elemental zinc daily or placebo orally for 14 days, in addition to standard of care. The primary outcomes were death during hospitalization and death within 12 weeks after enrollment. Among 3,153 enrolled infants (1,203 [38%] females), the median age at enrollment was 25 days (interquartile range 13-41 days), and the mean weight was 2.9 kg (standard deviation 0.8). During the hospital stay, 64 (4.1%) of 1,576 infants died in the zinc arm compared to 77 (4.9%) of 1,577 in the placebo arm (relative risk [RR] 0.83 (95% CI [0.60, 1.15]; p = 0.267)). Among those who completed 12 weeks of follow-up, 140 of 1,554 infants (9.0%) died in the zinc arm, and 133 of 1,550 (8.6%) in the placebo arm (RR 1.05 (95% CI [0.84, 1.32]; p = 0.674)). Adverse events were similar across trial arms, except for a slight increase in vomiting in the zinc arm; no events were attributed to the intervention. The main limitation of the study is that it was underpowered due to lower-than-anticipated event rates and a shortfall in the achieved sample size. In this setting, we found little evidence for an effect of adjunct zinc therapy on young infants with CSI on the risk of dying during hospitalization or for the subsequent 3 months. Our findings contrast previous studies that used more specific case definitions. This underscores the need for further RCTs to evaluate the effect of zinc in young infant sepsis before it can be recommended in treatment guidelines. Clinical Trials Registry-India (CTRI/2017/02/007966) on February 27, 2017, and Universal Trial Number is U1111-1187-6479.

Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3–59 days old, enrolled in a clinical trial, and admitted to the Kanti Children’s Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3–28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29–59 days) were USD 111.7 (69.8–155.5) and 65.17 (43.4–98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).

Background Lactobacillus crispatus is a dominant member of the healthy female reproductive tract microbiota, contributing to mucosal homeostasis and pathogen exclusion. Numerous studies have highlighted the protective effects of L. crispatus against both intestinal and genital infections. In the present study, we build on this foundation to investigate the broader health-promoting properties of L. crispatus , focusing on its antimicrobial and metabolic functions; and its protective roles in hepatic and cardiometabolic disorders. Methods Three L. crispatus strains were selected from a panel of sixty isolates based on comprehensive genome mining analyses described in our previous publication. In the present study, we generated complete genome data for these three strains, and delineated biosynthetic pathways including their capacity for antimicrobial peptide production, lactic acid biosynthesis, short chain fatty acid synthesis and biogenic amine production. The antimicrobial activity of these isolates was assessed via agar well-diffusion assay and time-kill assay. Their ability to survive gastric pH and bile stress was evaluated through acid and bile salt tolerance assays. Further, to assess metabolic benefits, anti-steatotic and cardioprotective effects were examined in a preclinical diet-induced mouse model of cardiometabolic disorder. Results Complete genome analysis of L. crispatus strains revealed multiple antimicrobial peptide (AMP) biosynthetic gene clusters, including several novel loci associated with bacteriocins. Metabolic profiling identified pathways for bile salt metabolism, folate biosynthesis and short chain fatty acids production. Cell-free culture supernatants exhibited broad-spectrum antibacterial activity, particularly against Escherichia coli , Enterobacter hormaechei, Staphylococcus aureus and Staphylococcus haemolyticus . Further, the strains tolerated gastric pH 2 and physiological bile stress of 0.3% suggesting potential for oral administration. In vivo, oral administration of L. crispatus (10 8  CFU) daily for 2 weeks followed by twice-weekly for 12 weeks significantly reduced hepatic steatosis, improved insulin sensitivity and cardiac function in a diet-induced cardiometabolic disorder mouse model. This is the first report demonstrating the cardiometabolic protective potential of L. crispatus . Conclusions L. crispatus confers diverse health benefits through pathogen resistance functions and modulation of host metabolic pathways. These findings support its potential as a novel biotherapeutic for preventing and managing hepatic and cardiometabolic disorders, extending its therapeutic relevance beyond reproductive health.

Background The high rates of culture-positive sepsis, sepsis-related mortality, and multidrug resistance in neonates admitted to special care newborn units in district hospitals (DH) in India necessitate urgent actions to prevent infections in these settings. Immediate kangaroo mother care (iKMC), initiated before stabilization within the first few hours of life, has been shown to reduce neonatal mortality among low birth weight (LBW) neonates admitted to tertiary care hospitals. However, the effect of iKMC on sepsis and sepsis-related mortality, particularly in DH, remains unclear. This study aims to evaluate whether iKMC can lower the incidence of mortality or culture-positive sepsis in LBW neonates admitted to neonatal units in district hospitals. Methods This stepped-wedge cluster randomized trial will be conducted in ten district hospitals in Chhattisgarh, India, over 42 months. All neonates weighing between 1000 and 1799 g at birth and admitted to the participating hospitals, in whom KMC can be initiated within 12 h of life, will be eligible for inclusion. During the pre-intervention period (control), routine KMC will be practiced at the sites as is. Following a baseline period of 6 months, iKMC will be implemented sequentially in ten steps across the ten study sites at intervals of 3 months. The intervention includes initiating continuous skin-to-skin contact with the mother or relatives within 12 h of life, continuing KMC until discharge or weight 2.5 kg, and providing breastfeeding support. The primary outcome is the incidence of all-cause neonatal mortality and/or culture-positive sepsis until 28 days of life. Relative risks with 95% confidence intervals will be reported and analyzed using a generalized linear mixed model. An intention-to-treat analysis will be conducted. Discussion The PRISM (Protective Role of Immediate KMC in neonatal Sepsis and Mortality) trial will sequentially implement iKMC for LBW neonates in ten district hospitals with a relatively high burden of sepsis in India. If proven effective in reducing the risks of sepsis or neonatal mortality, the trial will provide necessary evidence for its safety and efficacy, as well as the impetus for implementing and upscaling the intervention in district hospitals across India and other low- and middle-income countries. Trial registration Clinical Trial Registry of India, CTRI/2024/09/074269. Registered on 24/09/2024, https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTE0MzY3&Enc=&userName=immediate%20kangaroo%20mother%20care .

Objectives To study clinical disease outcomes in both human and animal models to understand the pathogenicity of omicron compared to the delta variant. Methods In this cross-sectional observational study, clinical outcomes of adults who tested positive at 2 testing centres in Delhi National Capital Region between January 2022 and March 2022 (omicron-infected; N  = 2998) were compared to a similar geographical cohort (delta-infected; N  = 3292). In addition, disease course and outcomes were studied in SARS-CoV-2-infected golden Syrian hamsters and K-18 humanized ACE2 transgenic mice. Results Omicron variant infection was associated with a milder clinical course [83% (95% CI 61, 94) reduced risk of severity compared against delta] adjusting for vaccination, age, sex, prior infection and occupational risk. This correlated with lower disease index and vir comparing omicron with other variants in animal models. Conclusions Infections caused by the omicron variant were milder compared to those caused by the delta variant independent of previous immunity.

The human peripheral leukocyte subset composition depends on genotype variation and pre-natal and post-natal environmental influence diversity. We quantified this composition in adults and neonates, and compared the median values and dispersal ranges of various subsets in them. We confirmed higher frequencies of monocytes and regulatory T cells (Tregs), similar frequencies of neutrophils, and lower frequencies of CD8 T cells, NKT cells, B1 B cells and gamma-delta T cells in neonatal umbilical cord blood. Unlike previous reports, we found higher frequencies of eosinophils and B cells, higher CD4:CD8 ratios, lower frequencies of T cells and iNKT cells, and similar frequencies of CD4 T cells and NK cells in neonates. We characterized monocyte subsets and dendritic cell (DC) subsets in far greater detail than previously reported, using recently described surface markers and gating strategies and observed that neonates had lower frequencies of patrolling monocytes and lower myeloid dendritic cell (mDC):plasmacytoid DC (pDC) ratios. Our data contribute to South Asian reference values for these parameters. We found that dispersal ranges differ between different leukocyte subsets, suggesting differential determination of variation. Further, some subsets were more dispersed in adults than in neonates suggesting influences of postnatal sources of variation, while some show the opposite pattern suggesting influences of developmental process variation. Together, these data and analyses provide interesting biological possibilities for future exploration.

The trillions of microorganisms residing in the human body display varying degrees of compositional and functional diversities within and between individuals and contribute significantly to host physiology and susceptibility to disease. Microbial species present in the vaginal milieu of reproductive age women showed a large personal component and varies widely in different ethnic groups at the taxonomic, genomic, and functional levels. Lactobacillus iners, L. crispatus, L. gasseri, L. jensenii, and L. johnsonii are most frequently detected bacterial species in the vaginal milieu of reproductive age women. However, we currently lack (i) an understanding of the baseline vaginal microbiota of reproductive age Indian women, (ii) the extent of taxonomic and functional variations of vaginal microbiota between individuals and (iii) the genomic repertoires of the dominant vaginal microbiota associated with the Indian subjects. In our study, we analyzed the metagenome of high vaginal swab (HVS) samples collected from 40 pregnant Indian women enrolled in the GARBH-Ini cohort. Composition and abundance of bacterial species was characterized by pyrosequencing 16S rRNA gene. We identified 3067 OTUs with = 10 reads from four different bacterial phyla. Several species of lactobacilli were clustered into three community state types (CSTs). L. iners, L. crispatus, L. gasseri, and L. jensenii are the most frequently detected Lactobacillus species in the vaginal environment of Indian women. Other than Lactobacillus, several species of Halomonas were also identified in the vaginal environment of most of the women sampled. To gain genomic and functional insights, we isolated several Lactobacillus species from the HVS samples and explored their whole genome sequences by shotgun sequencing. We analyzed the genome of dominant Lactobacillus species, L. iners, L. crispatus, L. gasseri, and L. paragesseri to represent the CSTs and identify functions that may influence the composition of complex vaginal microbial ecology. This study reports for the first time the vaginal microbial ecology of Indian women and genomic insights into L. iners, L. crispatus, L. gasseri, and L. paragesseri commonly found in the genital tract of reproductive age women.

The presence of non-neutralizing antibodies of any dengue serotype increases the severity of subsequent infection by other dengue serotypes. During the SARS-CoV-2 pandemic, the number of symptomatic dengue cases increased in India. We found that antibodies isolated from convalescent plasma from COVID-19 patients enhances DENV2 infection in vitro . CR3022, an antibody against the SARS-CoV-2 spike protein, also elevated DENV2 infection in vitro . In silico protein–protein interactions between spike antibodies and the DENV2 E-protein revealed significant interactions. Likewise, few monoclonal/polyclonal antibodies against SARS-CoV-2 have shown increased dengue infection in vitro . Importantly, AG129 mice infected with SARS-CoV-2 three weeks prior to DENV2 infection showed elevated dengue pathogenesis. This highlights the possibility of elevated infection and symptomatic dengue disease in COVID-19 survivors.