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Assessment of Dimensional Stability, Biodegradability, and Fracture Energy of Bio-Composites Reinforced with Novel Pine Cone

Jha K, Tyagi YK, Kumar R, Sharma S, Huzaifah MRM, Li C, et al.

Polymers (Basel), 2021 Sep 24;13(19).
PMID: 34641075 DOI: 10.3390/polym13193260

In this investigation, biodegradable composites were fabricated with polycaprolactone (PCL) matrix reinforced with pine cone powder (15%, 30%, and 45% by weight) and compatibilized with graphite powder (0%, 5%, 10%, and 15% by weight) in polycaprolactone matrix by compression molding technique. The samples were prepared as per ASTM standard and tested for dimensional stability, biodegradability, and fracture energy with scanning electron micrographs. Water-absorption and thickness-swelling were performed to examine the dimensional stability and tests were performed at 23 °C and 50% humidity. Results revealed that the composites with 15 wt % of pine cone powder (PCP) have shown higher dimensional stability as compared to other composites. Bio-composites containing 15-45 wt % of PCP with low graphite content have shown higher disintegration rate than neat PCL. Fracture energy for crack initiation in bio-composites was increased by 68% with 30% PCP. Scanning electron microscopy (SEM) of the composites have shown evenly-distributed PCP particles throughout PCL-matrix at significantly high-degrees or quantities of reinforcing.
Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand

Nooseisai M, Viwattanakulvanid P, Kumar R, Viriyautsahakul N, Muhammad Baloch G, Somrongthong R

Prim Health Care Res Dev, 2021 Sep 15;22:e46.
PMID: 34521493 DOI: 10.1017/S1463423621000505

AIM: The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand.
BACKGROUND: The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients.
METHODS: A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand.
FINDINGS: Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05).
CONCLUSIONS: The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.
A deep neural network-based approach for prediction of mutagenicity of compounds

Kumar R, Khan FU, Sharma A, Siddiqui MH, Aziz IB, Kamal MA, et al.

Environ Sci Pollut Res Int, 2021 Sep;28(34):47641-47650.
PMID: 33895950 DOI: 10.1007/s11356-021-14028-9

We are exposed to various chemical compounds present in the environment, cosmetics, and drugs almost every day. Mutagenicity is a valuable property that plays a significant role in establishing a chemical compound's safety. Exposure and handling of mutagenic chemicals in the environment pose a high health risk; therefore, identification and screening of these chemicals are essential. Considering the time constraints and the pressure to avoid laboratory animals' use, the shift to alternative methodologies that can establish a rapid and cost-effective detection without undue over-conservation seems critical. In this regard, computational detection and identification of the mutagens in environmental samples like drugs, pesticides, dyes, reagents, wastewater, cosmetics, and other substances is vital. From the last two decades, there have been numerous efforts to develop the prediction models for mutagenicity, and by far, machine learning methods have demonstrated some noteworthy performance and reliability. However, the accuracy of such prediction models has always been one of the major concerns for the researchers working in this area. The mutagenicity prediction models were developed using deep neural network (DNN), support vector machine, k-nearest neighbor, and random forest. The developed classifiers were based on 3039 compounds and validated on 1014 compounds; each of them encoded with 1597 molecular feature vectors. DNN-based prediction model yielded highest prediction accuracy of 92.95% and 83.81% with the training and test data, respectively. The area under the receiver's operating curve and precision-recall curve values were found to be 0.894 and 0.838, respectively. The DNN-based classifier not only fits the data with better performance as compared to traditional machine learning algorithms, viz., support vector machine, k-nearest neighbor, and random forest (with and without feature reduction) but also yields better performance metrics. In current work, we propose a DNN-based model to predict mutagenicity of compounds.
Investigating embodied carbon, mechanical properties, and durability of high-performance concrete using ternary and quaternary blends of metakaolin, nano-silica, and fly ash

Kumar R, Shafiq N, Kumar A, Jhatial AA

Environ Sci Pollut Res Int, 2021 Sep;28(35):49074-49088.
PMID: 33928510 DOI: 10.1007/s11356-021-13918-2

Research for alternative binders has become a necessity due to cement's embodied carbon, climate change, and depletion of natural resources. These binders could potentially reduce our reliance on cement as the sole binder for concrete while simultaneously enhancing the functional characteristics of concrete. Theoretically, the use of finer particles in the cement matrix densifies the pore structure of concrete and results in improved properties. To validate this hypothesis, current research was designed to investigate how the value-added benefits of nano-silica (NS) and metakaolin (MK) in fly ash (FA)-blended cement affect the mechanical and durability characteristics of concrete when used as ternary and quaternary blends. Additionally, the cost-benefit analysis and environmental impact assessment were conducted. It was observed that the synergy of MK and NS used in FA-blended cement had a greater impact on enhancing the functional characteristics of concrete, while 10% MK as ordinary Portland cement (OPC) replacement and 1% NS as an additive in FA-blended OPC concrete was the optimum combination which achieved 94-MPa compressive strength at the age of 91 days and showed more than 25% increment in the flexural and splitting tensile strengths compared to the control mix (MS00). The ultrasonic pulse velocity and dynamic modulus of elasticity were significantly improved, while a significant reduction in chloride migration of 50% was observed. In terms of environmental impact, MS100 (30% FA and 10% MK) exhibited the least embodied CO2 emissions of 319.89 kgCO2/m3, while the highest eco-strength efficiency of 0.268 MPa/kgCO2·m-3 with respect to 28-day compressive strength was exhibited by MS101. In terms of cost-benefit, MS00 was determined the cheapest, while the addition of MK and NS increased the cost. The lowest cost of producing 1 MPa was exhibited by MS01 with a merely 0.04-$/MPa/m3 reduction compared to MS00.
Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study

Iqbal R, Dehghan M, Mente A, Rangarajan S, Wielgosz A, Avezum A, et al.

Am J Clin Nutr, 2021 09 01;114(3):1049-1058.
PMID: 33787869 DOI: 10.1093/ajcn/nqaa448

BACKGROUND: Dietary guidelines recommend limiting red meat intake because it is a major source of medium- and long-chain SFAs and is presumed to increase the risk of cardiovascular disease (CVD). Evidence of an association between unprocessed red meat intake and CVD is inconsistent.
OBJECTIVE: The study aimed to assess the association of unprocessed red meat, poultry, and processed meat intake with mortality and major CVD.
METHODS: The Prospective Urban Rural Epidemiology (PURE) Study is a cohort of 134,297 individuals enrolled from 21 low-, middle-, and high-income countries. Food intake was recorded using country-specific validated FFQs. The primary outcomes were total mortality and major CVD. HRs were estimated using multivariable Cox frailty models with random intercepts.
RESULTS: In the PURE study, during 9.5 y of follow-up, we recorded 7789 deaths and 6976 CVD events. Higher unprocessed red meat intake (≥250 g/wk vs. <50 g/wk) was not significantly associated with total mortality (HR: 0.93; 95% CI: 0.85, 1.02; P-trend = 0.14) or major CVD (HR: 1.01; 95% CI: 0.92, 1.11; P-trend = 0.72). Similarly, no association was observed between poultry intake and health outcomes. Higher intake of processed meat (≥150 g/wk vs. 0 g/wk) was associated with higher risk of total mortality (HR: 1.51; 95% CI: 1.08, 2.10; P-trend = 0.009) and major CVD (HR: 1.46; 95% CI: 1.08, 1.98; P-trend = 0.004).
CONCLUSIONS: In a large multinational prospective study, we did not find significant associations between unprocessed red meat and poultry intake and mortality or major CVD. Conversely, a higher intake of processed meat was associated with a higher risk of mortality and major CVD.
Dynamic assessments of hepatic encephalopathy and ammonia levels predict mortality in acute-on-chronic liver failure

Verma N, Dhiman RK, Choudhury A, Taneja S, Duseja A, Singh V, et al.

Hepatol Int, 2021 Aug;15(4):970-982.
PMID: 34275111 DOI: 10.1007/s12072-021-10221-7

BACKGROUND: We evaluated the dynamics of hepatic encephalopathy (HE) and ammonia estimation in acute-on-chronic liver failure (ACLF) patients due to a paucity of evidence.
METHODS: ACLF patients recruited from the APASL-ACLF Research Consortium (AARC) were followed up till 30 days, death or transplantation, whichever earlier. Clinical details, including dynamic grades of HE and laboratory data, including ammonia levels, were serially noted.
RESULTS: Of the 3009 ACLF patients, 1315 (43.7%) had HE at presentation; grades I-II in 981 (74.6%) and grades III-IV in 334 (25.4%) patients. The independent predictors of HE at baseline were higher age, systemic inflammatory response, elevated ammonia levels, serum protein, sepsis and MELD score (p
Fulltext Assessment and valuation of health impacts of fine particulate matter during COVID-19 lockdown: a comprehensive study of tropical and sub tropical countries

Bherwani H, Kumar S, Musugu K, Nair M, Gautam S, Gupta A, et al.

Environ Sci Pollut Res Int, 2021 Aug;28(32):44522-44537.
PMID: 33852112 DOI: 10.1007/s11356-021-13813-w

A novel coronavirus disease (COVID-19) continues to challenge the whole world. The disease has claimed many fatalities as it has transcended from one country to another since it was first discovered in China in late 2019. To prevent further morbidity and mortality associated with COVID-19, most of the countries initiated a countrywide lockdown. While physical distancing and lockdowns helped in curbing the spread of this novel coronavirus, it led to massive economic losses for the nations. Positive impacts have been observed due to lockdown in terms of improved air quality of the nations. In the current research, ten tropical and subtropical countries have been analysed from multiple angles, including air pollution, assessment and valuation of health impacts and economic loss of countries during COVID-19 lockdown. Countries include Brazil, India, Iran, Kenya, Malaysia, Mexico, Pakistan, Peru, Sri Lanka, and Thailand. Validated Simplified Aerosol Retrieval Algorithm (SARA) binning model is used on data collated from moderate resolution imaging spectroradiometer (MODIS) for particulate matters with a diameter of less than 2.5 μm (PM2.5) for all the countries for the month of January to May 2019 and 2020. The concentration results of PM2.5 show that air pollution has drastically reduced in 2020 post lockdown for all countries. The highest average concentration obtained by converting aerosol optical depth (AOD) for 2020 is observed for Thailand as 121.9 μg/m3 and the lowest for Mexico as 36.27 μg/m3. As air pollution is found to decrease in the April and May months of 2020 for nearly all countries, they are compared with respective previous year values for the same duration to calculate the reduced health burden due to lockdown. The present study estimates that cumulative about 100.9 Billion US$ are saved due to reduced air pollution externalities, which are about 25% of the cumulative economic loss of 435.9 Billion US$.
Anti-ulcerogenic effect of methanolic extract of Elaeagnus conferta Roxb. seeds in Wistar rats

Gupta M, Gulati M, Kapoor B, Kumar B, Kumar R, Kumar R, et al.

J Ethnopharmacol, 2021 Jul 15;275:114115.
PMID: 33852947 DOI: 10.1016/j.jep.2021.114115

ETHNOPHARMACOLOGICAL RELEVANCE: Elaeagnus conferta Roxb. (Elaeagnaceae) is a subtropical shrub mainly native to India, Vietnam, Malaysia and South China, whose various parts are used for treatment of diabetes, gastric ulcers, pain, oxidative stress and pulmonary disorders. Though the other parts of the plant have been reported for their ethnic use i.e. fruits as astringent locally and for cancer systemically, leaves for body pain and flowers for pain in chest and the seeds are mentioned as edible, there is no report per se on the medicinal use of seeds. Based on the fact that seeds of closely resembling species i.e. Elaeagnus rhamnoides has demonstrated significant anti-gastroulcerative property, the probability of the seeds of E. conferta possessing similar activity seemed quite significant.
AIM OF THE STUDY: Phytochemical investigation and assessment of pharmacological mechanism(s) involved in anti-ulcer effect of methanolic extract of the seeds of E. conferta.
MATERIALS AND METHODS: Bioactive phytoconstituents were isolated by column chromatography. These were identified by spectroscopic techniques including infrared (IR) spectroscopy, nuclear magnetic resonance (NMR) and mass spectrometry. Methanolic extract (MEC) of the seeds was prepared by cold maceration and its anti-ulcerogenic potential was evaluated using indomethacin (50 mg/kg) and water immersion stress models in male rats. The animals were pre-treated with different doses of MEC (400 and 800 mg/kg) and the therapeutic effect was compared with standard drug i.e. ranitidine (RANT; 50 mg/kg). The ameliorative effects of MEC were investigated on gastric juice pH, total acidity, free acidity and ulcer index. The assays of malionaldehyde (MDA), catalase (CAT), superoxide dismutase (SOD), glutathione (GSH) and pro-inflammatory cytokines i.e. interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were carried out to find out the possible mechanism(s) of protection. Further, histopathological changes were also studied.
RESULTS: Chromatography studies and further confirmation by spectroscopic techniques revealed the presence of four different compounds in MEC i.e oleic acid (1), stearic acid (2), ascorbic acid (3) and quercetin (4). MEC exhibited anti-ulcerogenic effect in dose dependent manner which may be attributed to suppression of pro-inflammatory cytokines (IL-6, TNF-α) and MDA (112.7%), and up-regulation of protective factors such as CAT (90.48%), SOD (92.77%) and GSH (90.01%). Ulcer inhibition, reduction in total and free acidity and increase in gastric juice pH were observed in MEC treated rats as compared to disease control animals. Histopathological findings confirmed decreased cell infiltration, less epithelial cell damage and regeneration of gastric mucosa in dose dependent manner.
CONCLUSIONS: The anti-ulcer effect of MEC may be attributed to its ability to scavenge free radicals and anti-inflammatory property via suppression of TNF-α and IL-6, thus offers a complete and holistic approach for management of peptic ulcer.
Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

Joseph PG, Healey JS, Raina P, Connolly SJ, Ibrahim Q, Gupta R, et al.

Cardiovasc Res, 2021 05 25;117(6):1523-1531.
PMID: 32777820 DOI: 10.1093/cvr/cvaa241

AIMS: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes.
METHODS AND RESULTS: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P
Fulltext Optimization of FFF Process Parameters by Naked Mole-Rat Algorithms with Enhanced Exploration and Exploitation Capabilities

Chohan JS, Mittal N, Kumar R, Singh S, Sharma S, Dwivedi SP, et al.

Polymers (Basel), 2021 May 23;13(11).
PMID: 34070964 DOI: 10.3390/polym13111702

Fused filament fabrication (FFF) has numerous process parameters that influence the mechanical strength of parts. Hence, many optimization studies are performed using conventional tools and algorithms. Although studies have also been performed using advanced algorithms, limited research has been reported in which variants of the naked mole-rat algorithm (NMRA) are implemented for solving the optimization issues of manufacturing processes. This study was performed to scrutinize optimum parameters and their levels to attain maximum impact strength, flexural strength and tensile strength based on five different FFF process parameters. The algorithm yielded better results than other studies and successfully achieved a maximum response, which may be helpful to enhance the mechanical strength of FFF parts. The study opens a plethora of research prospects for implementing NMRA in manufacturing. Moreover, the findings may help identify critical parametric levels for the fabrication of customized products at the commercial level and help to attain the objectives of Industry 4.0.
Recent Applications of Artificial Intelligence in detection of Gastrointestinal, Hepatic and Pancreatic Diseases

Kumar R, Khan FU, Sharma A, Aziz IB, Poddar NK

Curr Med Chem, 2021 Apr 04.
PMID: 33820515 DOI: 10.2174/0929867328666210405114938

There is substantial progress in artificial intelligence (AI) algorithms and their medical sciences applications in the last two decades. AI-assisted programs have already been established for remotely health monitoring using sensors and smartphones. A variety of AI-based prediction models available for the gastrointestinal inflammatory, non-malignant diseases, and bowel bleeding using wireless capsule endoscopy, electronic medical records for hepatitis-associated fibrosis, pancreatic carcinoma using endoscopic ultrasounds. AI-based models may be of immense help for healthcare professionals in the identification, analysis, and decision support using endoscopic images to establish prognosis and risk assessment of patient's treatment using multiple factors. Although enough randomized clinical trials are warranted to establish the efficacy of AI-algorithms assisted and non-AI based treatments before approval of such techniques from medical regulatory authorities. In this article, available AI approaches and AI-based prediction models for detecting gastrointestinal, hepatic, and pancreatic diseases are reviewed. The limitation of AI techniques in such disease prognosis, risk assessment, and decision support are discussed.
Opening eyes to therapeutic perspectives of bioactive polyphenols and their nanoformulations against diabetic neuropathy and related complications

Khursheed R, Singh SK, Wadhwa S, Gulati M, Kapoor B, Awasthi A, et al.

Expert Opin Drug Deliv, 2021 04;18(4):427-448.
PMID: 33356647 DOI: 10.1080/17425247.2021.1846517

Introduction: Diabetic neuropathy (DN) is one of the major complications arising from hyperglycaemia in diabetic patients. In recent years polyphenols present in plants have gained attention to treat DN. The main advantages associated with them are their action via different molecular pathways to manage DN and their safety. However, they failed to gain clinical attention due to challenges associated with their formulation development such as lipophilicity,poor bioavailability, rapid systemic elimination, and enzymatic degradation.Area covered: This article includes different polyphenols that have shown their potential against DN in preclinical studies and the research carried out towards development of their nanoformulations in order to overcome aforementioned issues.Expert opinion: In this review various polyphenol based nanoformulations such as nanospheres, self-nanoemulsifying drug delivery systems, niosomes, electrospun nanofibers, metallic nanoparticles explored exclusively to treat DN are discussed. However, the literature available related to polyphenol based nanoformulations to treat DN is limited. Moreover, these experiments are limited to preclinical studies. Hence, more focus is required towards development of nanoformulations using simple and single step process as well as inexpensive and non-toxic excipients so that a stable, scalable, reproducible and non-toxic formulation could be achieved and clinical trials could be initiated.
Nanocarriers for treatment of dermatological diseases: Principle, perspective and practices

Ramanunny AK, Wadhwa S, Gulati M, Singh SK, Kapoor B, Dureja H, et al.

Eur J Pharmacol, 2021 Jan 05;890:173691.
PMID: 33129787 DOI: 10.1016/j.ejphar.2020.173691

Skin diseases are the fourth leading non-fatal skin conditions that act as a burden and affect the world economy globally. This condition affects the quality of a patient's life and has a pronounced impact on both their physical and mental state. Treatment of these skin conditions with conventional approaches shows a lack of efficacy, long treatment duration, recurrence of conditions, systemic side effects, etc., due to improper drug delivery. However, these pitfalls can be overcome with the applications of nanomedicine-based approaches that provide efficient site-specific drug delivery at the target site. These nanomedicine-based strategies are evolved as potential treatment opportunities in the form of nanocarriers such as polymeric and lipidic nanocarriers, nanoemulsions along with emerging others viz. carbon nanotubes for dermatological treatment. The current review focuses on challenges faced by the existing conventional treatments along with the topical therapeutic perspective of nanocarriers in treating various skin diseases. A total of 213 articles have been reviewed and the application of different nanocarriers in treating various skin diseases has been explained in detail through case studies of previously published research works. The toxicity related aspects of nanocarriers are also discussed.
Pilot phase experience of the International Quality Improvement Collaborative catheterization registry

Barry OM, Ali F, Ronderos M, Sudhaker A, Kumar RK, Mood MC, et al.

Catheter Cardiovasc Interv, 2021 01 01;97(1):127-134.
PMID: 32294315 DOI: 10.1002/ccd.28908

OBJECTIVES: To describe the development of a quality collaborative for congenital cardiac catheterization centers in low and middle-income countries (LMICs) including pilot study data and a novel procedural efficacy measure.
BACKGROUND: Absence of congenital cardiac catheterization registries in LMICs led to the development of the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR). As a foundation for this initiative, the IQIC is a collaboration of pediatric cardiac surgical programs from LMICs. Participation in IQIC has been associated with improved patient outcomes.
METHODS: A web-based registry was designed through a collaborative process. A pilot study was conducted from October through December 2017 at seven existing IQIC sites. Demographic, hemodynamic, and adverse event data were obtained and a novel tool to assess procedural efficacy was applied to five specific procedures. Procedural efficacy was categorized using ideal, adequate, and inadequate.
RESULTS: A total of 429 cases were entered. Twenty-five adverse events were reported. The five procedures for which procedural efficacy was measured represented 48% of cases (n = 208) and 71% had complete data for analysis (n = 146). Procedure efficacy was ideal most frequently in patent ductus arteriosus (95%) and atrial septal defect (90%) device closure, and inadequate most frequently in coarctation procedures (100%), and aortic and pulmonary valvuloplasties (50%).
CONCLUSIONS: The IQIC-CHDCR has designed a feasible collaborative to capture catheterization data in LMICs. The novel tool for procedural efficacy will provide valuable means to identify areas for quality improvement. This pilot study and lessons learned culminated in the full launch of the IQIC-CHDCR.
Fulltext Psychological impact of COVID-19 and lock down measures: An online cross-sectional multicounty study on Asian university students

Chinna K, Sundarasen S, Khoshaim HB, Kamaludin K, Nurunnabi M, Baloch GM, et al.

PLoS One, 2021;16(8):e0253059.
PMID: 34343187 DOI: 10.1371/journal.pone.0253059

The COVID-19 pandemic and the lockdown measures have taken a toll on every level of the society, worldwide. This study examines their psychological impact on university students in Asia. A cross-sectional online survey was conducted between April and May 2020 in Malaysia, Saudi Arabia, Pakistan, Bangladesh, China, India and Indonesia. The Zung's self-rating anxiety scale (SAS) and questions on adaptive and maladaptive coping strategies were used in this study. A total of 3,679 students from the seven countries participated in this study. Overall, 21.9% and 13.7% of the students in this study experienced mild to moderate and severe to extreme levels of anxiety. More than 20% of the students from China and Bangladesh reported severe to extreme level of anxiety compared to below 10% of the students from Indonesia, Malaysia and India. Among the female students, 15.9% experienced severe to extreme level of anxiety compared to 10.6% among the males. Females from Bangladesh, China, Malaysia, Pakistan and Saudi Arabia experienced significantly higher levels of anxiety compared to their male counterparts. Acceptance was the most used and Seeking Social Support was the least used coping strategies among the students. There were significant differences in the usage of the four strategies by countries. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects.
Fulltext Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

Chow CK, Nguyen TN, Marschner S, Diaz R, Rahman O, Avezum A, et al.

BMJ Glob Health, 2020 11;5(11).
PMID: 33148540 DOI: 10.1136/bmjgh-2020-002640

OBJECTIVES: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
METHODS: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types were available and affordable, group 2-all three drugs were available but not affordable and group 3-all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.
RESULTS: Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).
CONCLUSION: Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.
Interaction of LysM BON family protein domain with carbapenems: A putative mechanism of carbapenem resistance

Ali A, Kumar R, Khan A, Khan AU

Int J Biol Macromol, 2020 Oct 01;160:212-223.
PMID: 32464197 DOI: 10.1016/j.ijbiomac.2020.05.172

Carbapenem resistance in Gram-negative pathogens has become a global concern for health workers worldwide. In one of our earlier studies, a Klebsiella pneumoniae-carbapenemase-2 producing strain was induced with meropenem to explore differentially expressed proteins under induced and uninduced conditions. There is, LysM domain BON family protein, was found over 12-fold expressed under the induced state. A hypothesis was proposed that LysM domain protein might have an affinity towards carbapenem antibiotics making them unavailable to bind with their target. Hence, we initiated a study to understand the binding mode of carbapenem with LysM domain protein. MICs of imipenem and meropenem against LysM clone were increased by several folds as compared to NP-6 clinical strain as well as DH5 α (PET-28a KPC-2) clone. This study further revealed a strong binding of both antibiotics to LysM domain protein. Molecular simulation studies of LysM domain protein with meropenem and imipenem for 80 ns has also showed stable structure. We concluded that overexpressed LysM domain under induced condition interacted with carbapenems, leading to enhanced resistance as proved by high MIC values. Hence, the study proved the proposed hypothesis that the LysM domain plays a significant role in the putative mechanism of antibiotics resistance.
Studies of Charm Quark Diffusion inside Jets Using Pb-Pb and pp Collisions at sqrt[s_{NN}]=5.02 TeV

Sirunyan AM, Tumasyan A, Adam W, Ambrogi F, Asilar E, Bergauer T, et al.

Phys Rev Lett, 2020 Sep 04;125(10):102001.
PMID: 32955327 DOI: 10.1103/PhysRevLett.125.102001

The first study of charm quark diffusion with respect to the jet axis in heavy ion collisions is presented. The measurement is performed using jets with p_{T}^{jet}>60 GeV/c and D^{0} mesons with p_{T}^{D}>4 GeV/c in lead-lead (Pb-Pb) and proton-proton (pp) collisions at a nucleon-nucleon center-of-mass energy of sqrt[s_{NN}]=5.02 TeV, recorded by the CMS detector at the LHC. The radial distribution of D^{0} mesons with respect to the jet axis is sensitive to the production mechanisms of the meson, as well as to the energy loss and diffusion processes undergone by its parent parton inside the strongly interacting medium produced in Pb-Pb collisions. When compared to Monte Carlo event generators, the radial distribution in pp collisions is found to be well described by pythia, while the slope of the distribution predicted by sherpa is steeper than that of the data. In Pb-Pb collisions, compared to the pp results, the D^{0} meson distribution for 4
Fulltext Long-term exposure to outdoor and household air pollution and blood pressure in the Prospective Urban and Rural Epidemiological (PURE) study

Arku RE, Brauer M, Ahmed SH, AlHabib KF, Avezum Á, Bo J, et al.

Environ Pollut, 2020 Jul;262:114197.
PMID: 32146361 DOI: 10.1016/j.envpol.2020.114197

Exposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking with solid fuels with BP and hypertension in the Prospective Urban and Rural Epidemiology (PURE) study. Outdoor PM2.5 exposures were estimated at year of enrollment for 137,809 adults aged 35-70 years from 640 urban and rural communities in 21 countries using satellite and ground-based methods. Primary use of solid fuel for cooking was used as an indicator of HAP exposure, with analyses restricted to rural participants (n = 43,313) in 27 study centers in 10 countries. BP was measured following a standardized procedure and associations with air pollution examined with mixed-effect regression models, after adjustment for a comprehensive set of potential confounding factors. Baseline outdoor PM2.5 exposure ranged from 3 to 97 μg/m3 across study communities and was associated with an increased odds ratio (OR) of 1.04 (95% CI: 1.01, 1.07) for hypertension, per 10 μg/m3 increase in concentration. This association demonstrated non-linearity and was strongest for the fourth (PM2.5 > 62 μg/m3) compared to the first (PM2.5
Fulltext Growth Charts for Tribal, School-Going Children in Jharkhand Using Anthropometry and Lambda-Mu-Sigma Methods to Create Growth Charts

Kumar D, Rishabh Kumar R, Kujur A, Kumar C, Sunderam S, Kashyap V, et al.

Malays J Med Sci, 2020 Jul;27(4):108-118.
PMID: 32863750 DOI: 10.21315/mjms2020.27.4.10

Background: This study intends to find the growth patterns of selected school children. Globally accepted statistical methods were used to evaluate the data and prepare a growth chart.
Methods: This cross-sectional study was conducted with school-going children from 16 selected schools of a tribal district in Jharkhand using multistage cluster random sampling. In each selected school, 60 students, 30 boys and 30 girls, were chosen randomly, totaling 960 children (full data was for 935 children only). Growth charts were created using Lambda-Mu-Sigma (LMS) chart maker version 2.5 for height, weight and body mass index (BMI). In the charts, the LMS values with Z scores for each age and respective height and weight for boys and girls were recorded.
Results: The 468 boys and 467 girls were in the range of 6-14 years of age. Percentile values obtained for the measured heights in centimetres were evaluated and compared with Indian Academy of Pediatrics reference charts for boys and girls for the same age group, and our values were found to be on the lower side. We were able to plot a growth chart of the data set; as the tribal children's ethnicity is different, this growth chart might be used to assess nutritional status.
Conclusion: We concluded that growth curves for height, weight, and BMI may be used for evaluating children of age 6-14 years in the tribal population. The measures can be a good indicator of their nourishment status and overall growth patterns, which might be indigenous to their ethnicity. A larger sample size of similar tribal populations may give a clearer picture.

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