Background: Hyperphenylalaninemia (HPA) is the most common inborn error in amino acid metabolism. It can be primarily classified into phenylalanine hydroxylase (PAH) deficiency and tetrahydrobiopterin (BH4) deficiency. BH4 deficiency (BH4D) is caused by genetic defects in enzymes involved in the biosynthesis and regeneration of BH4. 6-pyruvoyl-tetrahydropterin synthase (PTPS/PTS), which is encoded by the PTS gene, participates in the biosynthesis of BH4. PTPS deficiency (PTPSD) is the major cause of BH4D. In this study, we investigated that the prevalence of BH4D in Jiangxi province was approximately 12.5 per 1,000,000 live births . Furthermore, the frequency of BH4D was estimated to be 28.8% (69/240) in the HPA population of Jiangxi. In this study, we aimed to characterize the mutational spectrum of the PTS gene in patients with PTPSD from Jiangxi province.Method: Newborn screening data of Jiangxi province from 1997 to 2021 were analyzed and 53 families with PTPSD were enrolled for the analysis of the PTS gene variants by Sanger sequencing.Results: 106 variants were identified in 106 alleles of 53 patients with PTPSD, including 13 types of variants reported previously, and two novel variants (c.164-36A>G and c.146_147insTG). The predominant variant was c.259C>T (47.2%), followed by c.84-291A>G (19.8%), c.155A>G (8.5%), c.286G>A (6.6%) and c.379C>T (4.7%).Conclusion: The results of this study can not only provide guidance for the molecular diagnosis and genetic counseling in cases of PTPS deficiency but also enrich the PTS mutation database. It is ceductase . In addi pathway . PTPS dePR) gene .PTS mutation spectrum at the provincial level, which will lay the foundation for accurate diagnosis and individualized genetic counseling.As a cofactor of the phenylalanine hydroxylase (PAH) enzyme that catalyzes the transfer of L-tyrosine (Tyr) from L-phenylalanine (Phe), BH4D causes a build-up of Phe in the blood, which leads to hyperphenylalaninemia (HPA) . ApproxiPTS gene using Sanger sequencing. Based on the results, we summarized the PTS mutation spectrum in Jiangxi province for the first time.In this study, we analyzed the newborn screening data of Jiangxi province from 1997 to 2021. 69 newborns were diagnosed with BH4D in all. Following this, we recruited 53 patients with PTPSD and extracted DNA samples from the patients and their parents to identify mutations in the PTPSD patients came from the positive cases encountered in newborn screening form October 1997 to December 2021. The study recruited 53 patients with PTPSD, 29 males and 24 females. All participants originated from Jiangxi province. Patients were diagnosed with HPA when the ratio of blood Phe/Tyr concentration exceeded two and the blood Phe concentration exceeded 120 µmol/L. The analysis of urinary pterins profile and BH4 loading test results and the measurement of DHPR activity in red blood cells were used to diagnose BH4D . Patients with BH4D were diagnosed with PTPSD with the increase in neopterin levels and decrease in biopterin levels, according to the consensus about the diagnosis and treatment of hyperphenylalaninemia in China . ShanghaPTS gene was identified in each family using PCR and Sanger sequencing. To amplify all the coding exons and primary splice sites, six pairs of primers were designed by Primer-BLAST (https://www.ncbi.nlm.nih.gov/tools/primer-blast/) (Supplementary Table S1) and synthesized by a company . According to the manufacturer’s protocol, the PCR amplification reaction system was configured with a 2x Taq PCR Master MixII . The PCR program was 95°C for 5 min for initial denaturing, then 30 cycles at 95°C for 40 s, at 57°C for 30 s, and at 72°C for 35 s, followed by a final extension of 8 min at 72°C in a T100 Thermal Cycler for the Classroom (biorad). Six of the PCR products were sent to a sequencing provider  for Sanger sequencing. Mutation analysis was performed by sequence alignment with the PTS transcript (NM_000317). Information on the Mutation naming scheme can be found at the HGVS site (https://www.HGVS.org/varnomen). The definite causative variants were elected by going through the Human Gene Mutation Database  and International Database of Patients and Mutations causing BH4-responsive HPA/PKU  from among variants detecting by sequencing.Taking advantage of a QIAamp DNA Mini Kit (Qiagen), genomic DNA was extracted only from the whole blood in patients diagnosed with PTPSD and their parents. The causative variant of Graph- Pad Prism version 8.0.1 software was adopted to study and analyze statistically. Measurement data were compared with analysis of variance. Calculators’ information was displayed as a percentage.A total of 5,541,627 newborns were screened for neonatal diseases at our center between 1997 and 2021, and HPA was detected in 240 patients. In the past 25 years, 69 HPA cases have been diagnosed as BH4D patients in total. These included 68 cases with PTPSD and 1 case with DHPRD. The frequency of BH4D was estimated to be 28.8% (69/240) in the HPA population of Jiangxi province, which was considerably higher than the 3.9% observed in the Chinese population on average . TherefoPTS gene  and primary splice sites (blue line) of On the basis of mutation types, the detected variants were divided into three groups. The missense variants accounted for 74.5%, followed by splicing variants (23.6%) . As a reDNA sequence assays showed that a proband had two splicing variants located in intron1 and intron2 (c.164-36A>G and c.84-291A>G) respectively. Further, the sources of two variants were examined in her parents respectively. In addition, the sequencing result of another proband revealed c.146_147insTG was in compound heterozygosity with c.379C>T. Previous research had found c.84-291A>G and c.379C>T were the common variants in the Chinese PTPSD patients . HoweverIn BH4D, the activity of PAH, tyrosine hydroxylase and tryptophan hydroxylase are reduced, which hampers the synthesis of neurotransmitters in the brain . Most chOnly a few studies have been conducted on BH4D prevalence in live births. . The gloPTS gene in this region is generally consistent with that reported in previous studies  . c.1222C studies , but alsPTS mutation spectrum in Jiangxi province. This mutation spectrum is meaningful and can help guide molecular diagnosis and effective genetic counseling in PTPSD.In summary, we analyzed the newborn screening data from 1997 to 2021 in Jiangxi province. The prevalence of BH4D in Jiangxi province was approximately 12.5 per 1,000,000 live births , and the proportion of BH4D among HPA cases was 28.8% (69/240). For the first time, we successfully constructed the


There is consensus that caesarean delivery (CD) is a lifesaving procedure for both mother and child in emergency situations and that CD without medical indication should be avoided. However, the rate that optimally balances the risks and benefits of CD is unresolved. In 1985, the World Health Organization concluded that the CD rate should be no more than 10-15%; subsequent reviews relating CD rates to infant mortality show no benefits at the country-level for rates higher than 15-19%. However, stillbirth has not been investigated because comparable international stillbirth data are not readily available.We conducted an ecological study in 25 European countries from 2015 to 2019 utilizing data from routine birth data sources aggregated using the Euro-Peristat PHIRI federated data analysis protocol. We assessed country-level associations between CD rates and perinatal outcomes  for all years using Pearson correlations, adjusted for clustering of years within country. Correlations were also estimated between linear trends over time in the indicators.The median [range] of CD rates was 23.1% [16.2 to 56.9] in 21 participating countries, while these were 6.9% [5.3 to 11.9] for preterm birth, 3.3 per 1000 total births [1.8 to 7.6] for stillbirth and 1.9 per 1000 live births [0.7 to 6.1] for neonatal mortality. The CD rate was not associated with the stillbirth rate  or with the neonatal mortality rate . However, there was a strong positive correlation with the preterm birth rate . Results were similar in time trend analyses.Higher CD rates were not associated with lower stillbirth or neonatal mortality rates, but were strongly correlated with higher preterm birth rates. This study suggests no benefits and indicates potential harms for higher CD rates in Europe.


The aim of this study is to determine whether the use of tranexamic acid (TXA) in patients with hip fracture reduces intraoperative and postoperative blood loss, and on the other hand, whether it increases thromboembolic risk. The study was performed on patients with hip fracture for a period of one year. Patients were divided into two groups (1:1): the first group receiving TXA and the second group receiving placebo. The amount of blood aspiration during the surgery was measured as well as drainage in the postoperative period of 24 h. The occurrence of deep vein thrombosis (DVT) was monitored before and after the surgery by ultrasound of the lower extremities. The amount of total blood loss was two times lower in patients who received TXA (291.8 ± 65.5 mL of blood vs 634.7 ± 150.5 mL of blood). Among the patients who developed DVT, one patient was from the group that did not receive TXA, and two patients were from the group that received TXA. The use of TXA in patients with hip fracture significantly reduces intraoperative and postoperative blood loss, without a significant thromboembolic risk. According to some authors, mortality in these patients in the first year is 25% ,2,3. OneThe aim of our study is to determine whether the use of TXA in patients with hip fracture affects the reduction of intraoperative and postoperative blood loss, hemoglobin and hematocrit values in patients after surgery, reduction of the need for blood transfusion, and whether it increases thromboembolic risk.2A prospective randomized clinical study lasting one year was conducted. The study included patients with hip fractures who were surgically treated at the Clinic for Orthopedics and Traumatology of the University Clinical Center Kragujevac. The study was approved by the ethics committee of our hospital. Written informed consent was obtained from each patient.We divided the patients into two groups: the first group receiving TXA and the second group receiving placebo. TXA was administered in two equal doses. The first dose of 15 mg/kg body weight was given immediately before the surgery, and the second, in the same dose 3 h afterward. Randomization was carried out by the method of closed envelopes with the group number, which were opened immediately before the surgery.2.1The study included patients of both genders, over 18 years of age, with a confirmed diagnosis of hip fracture acquired in the last 24 h . Excluding factors are patients with polytrauma, impaired coagulation status, suspected hypersensitivity to TXA, patients with open fractures, long-term uninterrupted anticoagulant therapy, patients with a history of arterial or venous thrombosis or thromboembolic risk, patients with pathological fractures, patients who have suffered from deep vein thrombosis (DVT), pulmonary embolism (PE), cerebrovascular stroke or myocardial infarction in the last year, patients with disseminated intravascular coagulation, patients who have experienced subarachnoid hemorrhage, renal failure, severe liver diseases, pregnant, breastfeeding, or women taking oral contraceptives.2.2The following variables were recorded and analyzed for each patient: gender, age, type of fracture , preoperative values of hemoglobin, hematocrit, D-dimer, blood pressure, the amount of blood aspiration during surgery, postoperative values of hemoglobin and hematocrit, number of blood units required for transfusion in the postoperative period of 14 days, total blood loss (measured by Gross equation ), presenThe indication for postoperative transfusion was a hemoglobin value below 80 g/L. In the preoperative and postoperative period, an ultrasound examination of blood vessels of the lower extremities was performed in all patients to possibly detect asymptomatic DVT. Surgical treatment involved performing surgeries by the same surgical team that represents standard procedures for a certain type of fracture . Patients follow-up was three months after the surgery.2.3χ²) or the Fisher test with a low frequency of certain categories was used. The significance of the difference in the values of the continuous variables between cases and controls was tested by the student’s T test for the independent samples  or the Mann–Whitney U test .Statistical data processing was performed using SPSS 20 statistical software. In the data analysis, the chi-square test  male and 46 (57.5%) female, and the average age of 75.4 ± 82 years. A fracture of the femur neck was detected in 41 patients (51.3%), while the extracapsular fracture of the upper part of the femur was found in 39 patients (48.7%). The most commonly used surgical technique for hip fracture treatment was osteosynthesis of the proximal part of the femur with the proximal femoral nail antirotation (PFNA) technique, in every third patient, and then partial hip arthroplasty with the implantation of a biarticular endoprosthesis, in every fourth patient. Hip arthroplasty with the implantation of a unipolar endoprosthesis (Austin Moore) was the least commonly used, in every tenth patient.χ² = 1.25, df = 1, p > 0.05). Among the operated patients who received TXA, 55% (n = 22) had a trochanteric femur fracture, and 45% had a femoral neck fracture (n = 18). In patients not receiving TXA, 57.5% (n = 23) had a femoral neck fracture, and 42.5% (n = 17) had a fracture of the proximal part of the femur.Forty patients, 23 (57.5%) male and 17 (42.5%) female, the average age of 74.2 ± 86 years, received TXA. The use of TXA is similar in both types of the femur fractures  .The mean amount of blood aspiration in patients receiving TXA was 133 ± 32.1 mL vs 305.8 ± 60.3 mL in patients receiving placebo  Table 2Table 2.t = −11.2, df = 58.6, p < 0.01). The mean amount of drainage in patients who received TXA was 147.2 ± 51.5 mL compared with 346.8 ± 100.1 mL in patients who did not receive TXA  , which is a statistically significant difference ( < 0.01) .t = 5.84, df = 78, p < 0.01), platelets from 287.3 ± 79.75 to 227.78 ± 64.1 , hemoglobin from 108.45 ± 15.32 to 87.48 ± 11.21 , hematocrit from 0.327 ± 0.04 to 0.233 ± 0.07  and consequently systolic blood pressure from 116.8 ± 8.1 to 107.5 ± 8.2 , and diastolic blood pressure from 72 ± 6.3 to 65.1 ± 5.1   .n = 11), two male and nine female, and the average age was 78.1 ± 7.9 years. Two patients from the first group (18.2%), who received TXA, needed a blood transfusion, while nine patients from the second group (81.8%), who did not received TXA, needed a blood transfusion.The need for blood transfusion was in 13.8% of patients (Deep vein thrombosis (DVT) occurred in three patients (two men/one woman). One patient developed DVT after femoral neck surgery and two patients after trochanteric femoral region surgery. Of these three patients with DVT, two were treated with TXA and one was not.4Many studies describe the use of TXA in orthopedic surgery, primarily in arthroplasty and spinal surgery. Some authors  have faIt is important to note that hip fractures are not all the same in terms of the pattern of injury or surgical treatment. Extracapsular hip fractures are associated with higher total blood loss than intracapsular hip fractures . TherefoStudies in patients who suffered a hip fracture exist, but the results obtained are much less convincing than in studies with patients who underwent total arthroplasty of the hip or knee, especially in relation to the occurrence of thromboembolic risk ,13. PatiIn our study, in addition to the effect of TXA on hip fractures in total, the effect of intracapsular and extracapsular fractures was examined separately. Intraoperative blood loss in intracapsular fractures was slightly higher (138.3 mL on average in patients who received and 318.9 mL on average in patients who did not receive TXA) than in extracapsular fractures (128.6 and 287.9 mL). It can be explained by various surgical techniques, because hip arthroplasty, which is mainly performed in intracapsular fractures, is certainly more invasive than the PFNA and DHS techniques. There are concerns about a hypothetical increase in the thromboembolic risk, DVT, and PE following the systemic administration of TXA in major orthopedic surgeries. There is a statistically significant difference in intraoperative blood loss depending on whether the patient has been treated with TXA, regardless of the type of fracture (Table 2). Massimo Francini et al. evaluated intravenous use of TXA in major orthopedic surgeries. They observed that the overall incidence of venous thromboembolism is 86 in 4,174 (2.1%) patients with intravenous infusion of TXA infusion and 55 in 2,779 (2.0%) patients in the control group [p < 0,001). This corresponds to a significant relative risk reduction of 70% (odds ratio (OR) 0.299, 95% confidence interval (CI) 0.184–0.485). TXA was associated with a 17.15% reduction in total blood loss and a 64.05% reduction in erythrocyte transfusion rate in this study [p = 0.10) [p = 0.07) [Jinwei Xie and co-workers performed ultrasonography only if DVT was suspected, while computed tomography was performed for clinically suspected cases of PE. The overall erythrocyte transfusion rate was 16.75% (102 patients), with transfusion of at least 1 erythrocyte unit given to 25 patients in the TXA group (8.65%) and 77 in the control group   and high = 0.07) . In our  = 0.07) . The res5The use of TXA in patients with hip fracture (extracapsular and intracapsular) significantly reduces the amount of blood aspiration during surgery and after surgery. The total blood loss was 2.5 times lower in patients who received TXA compared with the control group. A decrease in the value of erythrocytes, hemoglobin, and hematocrit after hip fracture surgery, in both groups and with all surgical methods, was also detected. Patients who received TXA had a reduced need for blood transfusions. These patients also had a smaller postoperative decrease in the values of basic laboratory parameters compared with patients who did not receive TXA. Finally, the use of TXA is not associated with an increased risk of thromboembolism (thromboembolic events) in this type of patients.TXAtranexamic acidMSCTmulti-slice computed tomographyPFNA antirotation intramedullary nail for the proximal part of the femurDHSdynamic hip screwBHP(biarticular hip prosthesis) partial biarticular hip prosthesisAM(Austin Moore) Austin Moore partial hip prosthesisVTEvenous thromboembolismDVTdeep vein thrombosisCVIcerebrovascular insult


The Obstructive Sleep Apnea/Hipopnea Syndrome (OSAHS) is closely related to obesity; a linear relation, however, has not been established, particularly in morbid obesity patients.To evaluate clinical and polysomnographic findings in a group of class III obese patients, and to relate these findings with the presence or absence of OSAHS.Forty five patients with body mass indexex (BMI) over 40Kg/m2 were selected consecutively. A clinical history, the anthropometric examination and polysomnography were undertaken in all patients. The results of a study group and a control group (with no OSAHS) were compared.The sample consisted of 68.9% female and 31.1% male patients. The average age was 46.5 years (SD - 10.8 years); the average BMI was 49 (SD - 7 Kg/m2) and the average neck circumference was 43.4 cm (SD - 5.1 cm). All subjects were habitual snorers and 48.9% had daytime drowsiness. Polysomnography showed that 77.8% had an apnea/hipopnea index over 5. The findings associated with OSAHS were: younger age  and an increased neck circumference (p=0.004).The prevalence of OSAHS was very high, which emphasizes the importance of investigating this syndrome in patients sent for bariatric surgery. The neck circumference was the best OSAHS marked in this group of patients. The obstructive sleep apnea hypopnea syndrome (OSAHS) is currently defined according to the American Academy of Sleep Medicine (AASM) classification published in 2005.This study included 45 consecutive patients from the obesity clinic of the Gastric Surgery Discipline, seen between June 2005 and January 2006, chosen according to inclusion and exclusion criteria, who had been referred to bariatric surgery. Inclusion criteria were: adults of both sexes aged between 18 and 75 years, with a BMI equal to or over 40 Kg/m². Exclusion criteria were: having undergone surgery or medical therapy for snoring or OSAHS, more than 10% variation of body weight (gain or loss) between the dates of polysomnography and the physical examination, and using sedative or stimulant drugs. A guided clinical history was taken, and anthropometric measurements were done as follows: height, weight and neck circumference. Baseline polysomnography was done in a specialized clinic. A descriptive analysis of this population was made, as well as a comparative analysis between patients with and with no OSAHS (Student's t test and the X²). The Research Ethics Committee of the institution approved this paper (protocol number 1223/05).There were 45 patients, 14 male (31.1%) and 31 females (68.9%). Age ranged from 22 to 74 years (mean 46.5 ±10.8 years). The BMI ranged from 40 to 71 kg/m² (mean 49 ±7 kg/m²). The AHI throughout the group ranged from zero to 109.6 events per hour (mean 30.8 ±31.9 events per sleeping hour). The neck circumference ranged from 33 to 58 cm (mean 43.4 ±5.1cm). All patients were habitual snorers and 48.9% complained of excessive daytime drowsiness.Ten subjects had an AHI below five events per hour (22.2%) and 35 subjects had an AHI above five events per hour (77.8%). The former group (non-apneic) consisted only of female subjects, and the latter group (apneic) contained 14 male subjects (40%) and 21 female subjects (60%). Age ranged from 44 to 74 years (mean 53.1 ±9.1 years) in the non-apneic group. The BMI ranged from 41.9 to 57.7 Kg/m² (mean 47.8 ±6 Kg/m²). The AHI ranged from zero to five events per hour . The neck circumference ranged from 37 to 42cm (mean 39.5 ±2cm). In the group of apneic subjects, age ranged from 22 to 61 years (mean 44.6±10.6 years). The BMI ranged from 40 to 71 Kg/m² . The AHI ranged from 6.5 to 109.6 events per hour . Of these patients, 34.3% had mild apnea (AHI between five and 15), 25.7% had moderate apnea (AHI between 15 and 30), and 40% had severe apnea (AHI over 30 events per sleeping hour). The neck circumference ranged from 33 to 58 cm (mean 44.6±5.2cm). A comparison of the clinical features in both groups may be found in In the apneic and non-apneic groups the features related with the presence of OSAHS were: younger age (p=0.02) and a higher neck circumference (p=0.004). There was no statistically significant proportion between a higher BMI and increased severity of OSAHS.OSAHS was found in 77.8% of 45 subjects, showing that OSAHS is highly prevalent in class III obese patients. Its prevalence in the general population is between 2 to 4%.The mean age in the non-apneic group was 53.1±9.1 years; the mean age in the apneic group was 44.6±10.2. There was a statistically significant age difference. Curiously, the apneic group was younger than the non-apneic group. We had expected that the non-apneic group would have been younger, because of the possibility that pharyngeal tissue and muscle flaccidity - which occurs naturally with age - would be related to the pathophysiology of OSAHS. We found, however, that both groups were in the age group with maximum prevalence of OSAHS,4 leading us to believe that the age difference in these groups of middle-aged adults was less relevant than other features found in the class III obese patients. Although there is no doubt about the relation between obesity and OSAHS, we found no direct correlation between the higher BMIs and AHIs. This suggests that above a certain value, additional BMI scores do not have the same impact on OSAHS as happens with eutrophic or class I obese subjects.Snoring was found in all patients of this sample, showing that its presence should not be used as indicative of OSAHS in this group. Excessive daytime drowsiness was reported by 48.9% of subjects. As OSAHS was detected in 77.8% of cases, this complaint isolatedly is not a good indicator of this condition; the risk in doing so is to underestimate the diagnosis.The analysis of polysomnography showed that a high AHI in OSAHS patients affects mostly oxyhemoglobin saturation; the minimum oxyhemoglobin saturation was significantly lower in apneic patients. This effect was not seen in the sleep architecture of these patients; there was no statistically significant difference in sleep efficiency or in the distribution of sleep stages.The mean neck circumference in the non-apneic group was 39.5±2cm; in the apneic group it was 44.6±5.2cm. This difference was statistically significant (p=0.004). Our analysis revealed that the neck circumference was related both with the presence and the severity of OSAHS. In the literature, the neck circumference has been described as one of the best independent predictive variables of OSAHS.16The prevalence of OSAHS in this sample with class III obesity was high, confirming its existing correlation with obesity. This condition should be investigated in patients that are referred to bariatric surgery units. The neck circumference was the main marker for the presence of OSAHS in this sample.


Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort. Although current guidelines consider surgery to be the best option in cases of prosthetic valve endocarditis (PVE), the current literature reports a general reluctance toward the surgical treatment of IE following transcatheter aortic valve implantation (TIE), with some patients entering palliative care upon diagnosis ,2,3,4,5.We reviewed the IE case load at our center between January 2013 and December 2020 and retrospectively identified patients who underwent surgery for IE following SAVR and TAVR. Postoperative treatment and data acquisition were performed as part of routine patient care. This study was approved by the ethics board of the Ludwig Maximilian University (Nos. 19-730 and 20-821), and the requirement to obtain patient consent was waived for this retrospective study. Sampling and microbiological analysis are described elsewhere . Data acTo predict the postoperative mortality, the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), as proposed by Nashef et al. , and theData were analyzed by using IBM SPSS version 25  . Categorical variables were evaluated by using the Chi-Squared and Fisher’s exact method, and continuous variables were evaluated by using the Mann–Whitney U test. Survival analysis was performed with a Kaplan–Meier curve and log-rank test. Data are presented as medians (25th–75th quartiles) or absolute values (percentages), unless otherwise specified. Illustrations were prepared by using GraphPad Prism  and BioRender .Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE . Among tp = 0.010). The median Charlson Comorbidity Index was 5 (4–7) in the SAVR–PVE group and 7 (6–8) in the TIE group (p = 0.005).TIE accounted for 13.7% of the aortic PVE between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020 . The demp < 0.001). In the SAVR–PVE group, 84 (85.7%) patients had biological prostheses, 13 (13.3%) had mechanical prostheses, and 1 (1.0%) patient had a homograft. A stentless pericardial prosthesis was implanted in one patient. In the TAVR group, 3 (13.6%) patients had received self-expanding prostheses , and 19 patients (86.4%) had received balloon expanding prostheses . A significantly higher proportion of patients in the TIE group had pacemakers (9 (40.9%) v/s 12 (12.2%); p = 0.003) and were on chronic steroid therapy (3 (13.6%) v/s 1 (1.0%), p= 0.019) as compared to the SAVR–PVE group. The time to IE was significantly longer in patients who underwent SAVR as compared to those who underwent TAVR (3.7 years (0.8–9.5 years) v/s 1.2 years (0.4–2.8 years); p = 0.001). The classical risk scores and the endocarditis-specific risk scores, as described above, are detailed in p = 0.013).In the TIE group, nine patients (40.9%) had undergone previous cardiac surgery (p = 0.024). The causative organisms in our cohort were predominantly Gram-positive, with Gram-negative organisms accounting for 2.5% of the cases. The details of the individual pathogens are outlined in BCNIE accounted for 27 cases (27.8%) in the SAVR–PVE group and 1 case (4.5%) in the TIE group (p = 0.005). The duration of aortic cross-clamping was 134 min (106–169 min) in the SAVR–PVE group and 95 min (58–168 min) in the TIE group (p = 0.003). Biological prostheses were used in 91 patients (92.9%) in the SAVR–PVE group and in 20 patients (90.9%) in the TIE group, whereas mechanical prostheses were used in 7 patients (7.1%) in the SAVR–PVE group and in 2 patients (9.1%) in the TIE group. Bentall procedures were carried out in 34 patients (34.7%) in the SAVR–PVE group and in 1 patient (4.5%) in the TIE-group (p = 0.004). Stentless xenopericardial prostheses were used in 30 patients (30.6%) in the SAVR–PVE group and in 1 patient (4.5%) in the TIE group. One patient in the SAVR–PVE group received a Homograft. Repair of aortomitral curtain was required in two patients (2.0%) in the SAVR–PVE group, whereas it was required in only one patient (4.5%) in the TIE group (p = 0.458). A total of 19 patients (19.4%) required patch repair in the SAVR–PVE group, whereas 3 patients (13.6%) underwent the same in the TIE group (p = 0.762). Concomitant procedures were performed in 35 patients (29.2%) and are detailed in The details of surgery are presented in p = 0.234) and median intensive care unit stay (5 days (2–9 days) v/s 4 days (3–14 days); p = 0.953) were comparable between the groups. The in-hospital mortality was 26.5% (n = 26) in the SAVR–PVE group and 9.1% (n = 2) in the TIE group (p = 0.098). Following discharge, the survival at 30 days was 100% in both groups, whereas the survival at 6 months was found to be 98% in the SAVR–PVE group and 89% in the TIE group (p = 0.081) (The postoperative morbidities and outcomes are listed in = 0.081) .The devastating nature of TIE has long since been recognized, not just due to the myriad of co-morbidities, but also due to surgical challenge associated with explantation of TAVR prostheses and lack of surgical experience ,17. The The number of PVE cases in general and TIE cases in particular has been on the rise ,18. BetwHowever, previous studies have shown that TAVR prostheses can be explanted with reasonable results and no damage to adjacent structures ,17. The The endocarditis-team approach has been reported to result in early diagnosis, better management strategies and compliance in antimicrobial therapy, and fewer cases of renal failure and deaths by embolic events and multiple organ failure ,24. At oIn our cohort, we observed a few differences in the preoperative-risk profile of the patients that may influence the decision-making process and partly explain the reluctance toward surgery ,7. Age iThis is a retrospective single-center study with the inherent limitation of such an analysis. The small number of patients is associated with a low power of statistical analyses. Owing to the small sample size, a multivariable analysis could not be performed. Furthermore, our study is a descriptive retrospective registry of patients with IE after SAVR and TAVR considered operable by the endocarditis team, and, therefore, it does not reflect the status of treatment of IE after TAVR. Patients who remained undiagnosed or were treated conservatively are out of the scope of this study. Further studies with longer follow-up are required.To date, the current literature advises surgeons to err on the side of caution in cases of TIE; our results, however, indicate that patients suffering from SAVR–PVE and TIE present with comparable risk profiles and can be surgically treated with comparable results. The high rates of postoperative complications may be attributed to the disease and its severity. Endocarditis-specific risk scores should be included more frequently in the decision-making process, as they may predict the operative risk with more precision as compared to the classical scores. Surgery as a curative option should not be blatantly rejected, even in this high-risk cohort. However, the endocarditis-team approach and a patient-centered approach should always be considered.


Refractive errors are relatively common all around the world. In particular, early onset myopia is associated with a significant burden in later life. Little is known about refractive errors in preschool children. The aim of this study was to assess the prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children.We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6934 6-year-olds from the Generation R study, and 2974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction.N = 583) and 7 years (N = 350) 29.8 and 34.6% had myopia respectively, of which 21.1 and 21.6% combined with astigmatism; 19.6 and 6.8% had hyperopia, 37.2 and 11.1% hyperopia and astigmatism, and 12.5 and 32.7% astigmatism only.The prevalence of spectacle wear ranged from 1.5 to 11.8% between 3 to 7 years with no significant gender differences. Among children with spectacle wear at 6 years (Spectacle wear in European children starts early in preschool and increases to a relatively frequent visual aid at school age. Advocating early detection and monitoring of refraction errors is warranted in order to prevent visual morbidities later in life.The online version contains supplementary material available at 10.1186/s12887-022-03467-z. Refractive errors  are relatively common all around the world. They can be easily corrected using spectacles, making their early detection an important component of well-child care . The preBabies are born with an average hyperopic refraction of + 2.00 diopters (D) following a Gaussian distribution. Their refractive development decreases towards emmetropia following a narrower leptokurtic distribution in infancy and childhood. This process is called emmetropisation and is largely completed by the age of 6 years . An infaPediatric vision screening programs emphasize early detection and provision of appropriate visual rehabilitation to prevent or minimize visual disability. Many high income countries have services for the early detection of vision problems in children . EffectiN = 14,018), 4 years  and/or 5 years  between 2013 and 2018. Most of the children (90.8%) participated in only one vision screening , some (9.0%) participated in two vision screenings , and only few children (0.2%) participated in all three vision screenings . The PCHR database is unique and has never been analyzed before.We analyzed three population-based studies from the Netherlands: the Preventive Child Healthcare Registry (PCHR), Generation R study, and the Rotterdam Amblyopia Screening Effectiveness Study (RAMSES). PCHR is a cross-sectional study in which population vision screening was performed as part of preventive child health care by Dutch organizations. These organizations provide community-based preventive services free of charge, reaching about 95% of all children . PermissSince the PCHR database did not contain information on the results of referral after screening, we also performed a secondary analysis of the relevant data from Generation R and RAMSES. Both studies are prospective multi-ethnic population-based cohorts from Rotterdam. Regarding Generation R, 9778 pregnant women were included in this study and children were born between 2002 and 2006. At 6 years of age, these children were invited for examination at the research center. Of the initial cohort, 6690 children participated in the physical examination . The complete methodology has been described elsewhere . RegardiAge, gender, presenting spectacle wear and visual acuity were assessed. Spectacle wear was defined as those who already had spectacles (presenting spectacle wear). Uncorrected visual acuity was measured with Landolt C charts at a distance of five meters. Children with reduced visual acuity were referred to an ophthalmologist or orthoptist for further assessment. Visual acuity data of children who were not screened with the Landolt C charts  were excluded. In accordance with the Dutch vision screening guidelines, visual acuity was not assessed at the screening center in children with spectacles, this is performed at the hospital.Age, gender, spectacle wear, visual acuity and refractive errors were registered. Presenting visual acuity was measured with LEA charts at a distance of three meters . ChildreIn this study, age, gender and visual acuity with Landolt C chart were registered. Children with visual acuity of > 0.1 LogMAR  were referred to the study orthoptists for visual acuity measurement with a Snellen chart and retinoscopy under cycloplegia if deemed necessary. Children with spectacle wear and visual acuity of ≤0.1 LogMAR  during the screening were not further investigated. Spectacle wear (needed) was based on the judgement of the orthoptist who performed the visual acuity and cycloplegic refractive error measurements after referral.The main outcome measure was spectacle wear at age 3, 4, 5, 6 and 7 years. The second outcome measure was reduced visual acuity, which is assessed at 4, 5, 6 and 7 years and classified according to three criteria: > 0.1 LogMAR  in OD (right eye) and in OS (left eye) separately, > 0.3 LogMAR  in OD and OS separately, and ≥ 2 LogMAR lines difference between OD and OS. At the age of 4 and 5 years > 0.3 LogMAR  is considered abnormal. At ages 6 and 7 years, > 0.1 LogMAR  is considered abnormal. Amblyopia is defined as an interocular acuity difference of ≥2 LogMAR lines, indicated on the chart. Refractive errors among children with spectacle wear were measured at 6 and 7 years. Spherical equivalent of refraction of the most severely affected eye was calculated in diopters (D) as sphere + ½ cylinder. The most severely affected eye was chosen, instead of the random or right eye, to investigate the main reason for spectacle wear. Myopia was defined as spherical equivalent of ≤ − 0.5 D and hyperopia as spherical equivalent ≥ + 1.0 D and astigmatism was defined as cylindrical power of ≤ − 0.75 D. Sensitivity analysis were performed with astigmatism defined as cylindrical power of ≤ − 2.00 D in order to better compare with other studies.. All analyses were performed using SPSS Statistics program  version 25.The proportion of spectacle wear and reduced visual acuity were calculated by dividing the number of children with spectacle wear or reduced visual acuity by the total sample size times 100% for the ages 3, 4, 5, 6 and 7 years specifically. Differences between males and females in spectacle wear were tested using chi-square tests. The proportion of refractive error categories was calculated among 6 and 7-year-old children with spectacle wear, and for the whole study sample (% spectacle wear * % refractive error category). The distribution of spherical equivalent was plotted for both cohortsWithin the PCHR database , Generation R (at 6 years) and RAMSES (at 7 years), gender was equally represented; proportions of females were 49.4, 48.9, 48.9, 49.9, and 48.8%, respectively.p = 0.38), 4 years (p = 0.75), 5 years (p = 0.64), 6 years (p = 0.45) and 7 years (p = 0.92). The proportion of children with visual acuity > 0.1 LogMAR  ranged between 76% at 4 years and 6% at 5-7 years. The proportion of children with visual acuity > 0.3 LogMAR  ranged between 11% at 4 years, and 0.4% at 6 years. The proportion of children with ≥2 LogMAR lines difference between OD and OS ranged between 3.8% at 4 years and 4.6% at 7 years.The spectacle wear and visual acuity across the age groups are presented in Table N = 583) and 7 years (N = 350), information on refractive errors was available for 582 and 162 children, respectively. Of them, 29.8 and 34.6% had myopia respectively, of which 21.1 and 21.6% combined with astigmatism; 19.6 and 6.8% respectively had hyperopia, 37.2 and 11.1% hyperopia and astigmatism, and 12.5 and 32.7% astigmatism only in the most severely affected eye. When we apply these percentages to the whole study sample including those without spectacles, 2.4% of the 6-year-olds and 4.0% of the 7-year-olds had myopia with or without astigmatism. When astigmatism is defined as cylindrical power of ≤ − 2.00 D, only 0.3% of the 6-year-olds and 1.5% of the 7-year-olds had astigmatism only  school children. Our study among > 100,000 3- to 7-year-old children from the Netherlands showed that the prevalence of spectacle wear ranged between 1.5% at 36 months and 11.8% at 7 years. Among all children with spectacles around the age of 6 and 7 years, most children had hyperopia or astigmatism and 2.4-4.0% of the children aged 6 and 7 years had myopia.presenting spectacle wear was provided and in the Generation R and RAMSES databases we calculated the prevalence of spectacles needed. We performed a literature search on spectacle wear within the age range 0-7-year-olds published the past 10 years and found a wide range in the prevalence of presenting and needed spectacle wear between countries. The highest prevalence of presenting spectacle wear was 12.8% among 6- to 7-year-old children from Ireland, while the lowest prevalence was 3.4% in 4.5- to 7-year-old children from Denmark and 5- to 6-year-old children from Pakistan [needed was 21.0% among 3- to 6-year-old children from Medina in western Saudi Arabia; the lowest 4.5% among 4- to 8-year-old children from Riyadh in Saudi Arabia  was only 1% at this age. The proportion of spectacles needed at age 3 and 4 years, however, may have been higher because diminished visual acuity (> 0.3 LogMAR) occurred up to 10% at 4 years. Slightly reduced visual acuity > 0.1 LogMAR at 4 years was relatively frequent, which probably is due to errors because of the difficulty of testing visual acuity in children at this age .Most of the 6- and 7-year-old children with spectacles in our study had astigmatism (71 and 65%), 57 and 18% had hyperopia, and 30 and 34% had myopia respectively. Studies have reported a large variance in astigmatism prevalence, e.g., 69% of the 3- to 5-year-old children from the United States wear spectacles for astigmatism compared to 40% of the 4–5-year-old children from the United Kingdom , 24. WheA large study on European populations showed a general shift towards myopia over generations, an increase in myopia prevalence and a decrease in hyperopia prevalence . The resOur study had several strengths and limitations. Strengths are the large number of children screened over a substantial region of the Netherlands resulting in a unique database, and the uniform guideline-based vision screening for different age-groups in the PCHR study.A limitation is the number of missing data on refractive error of the children with spectacles in the RAMSES study. This may have led to an overestimation of myopia, because hyperopia remains relatively stable whereas myopia usually increases in childhood. In our analysis we assume the missing refractive error is non-differential. Another limitation is the relatively large number of missing data for visual acuity at 4 years, because we only included visual acuity measurements with the validated Landolt C chart. Whether or not Landolt C charts were used mainly depended on organizational choices, this is therefore unlikely to have resulted in a systematic under- or overrepresentation of visual acuity. Third, when children are referred to services, recommended spectacles are not always bought or if bought not used. We therefore collected refractive error data from the prescriptions of the orthoptist or ophthalmologist to ensure we had complete measurements, thus preventing potential bias.Spectacles have become a relatively frequent visual aid in young children which already increases in preschool years. A gradual increase of visual aid with age indicates a need to monitor these changes including behavioral changes like the early use of mobile devices. Advocating early detection of refraction errors is warranted. Effective vision screening and follow-up after referral for services are points of concern. As early-onset myopia has major consequences for visual acuity later in life, awareness and advice for preventive behavior by professionals in well-child care will improve the visual prognosis, and thus highly improve child health.Additional file 1: Figure S1. Spectacle wear among 3-10-year-old children in the world.Additional file 2: Table S1. Distribution of refractive errors in children with spectacle wear and share of the full study samples.Additional file 3: Table S2. Spectacle wear and refractive errors in other childhood population-based studies.


Self‑harm is an ‘act of self‑poisoning or self‑injury carried out by a person, irrespective of their motivation’. A history of self-harm is linked with suicide risk. A study in Pakistan found self-harm to be more common in young people with unemployment and interpersonal difficulties as common triggers. Expanding liaison psychiatry services leads to an earlier assessment of patients with self-harm.To study the demographic and clinical variables of patients along with methods and precipitating factors of self-harm.A retrospective chart review of patients presenting with self-harm seen as a part of liaison psychiatry from October 2018 to June 2021.A total of 168 cases were seen of which 10 were excluded due to incomplete data. Of 158 cases gender split was roughly in the middle, with 49.4% males (n=78) and 50.6% females (n=80). The mean age of patients was 27.59 with a range of 12-70, 40.5% belonged to the age group of 20-29 (n=64) .77.8% (n=123) had a past psychiatric history. The most common being depressive disorder 31.6% (n=50) and borderline personality disorder 30.4% (n=48). 35.4% of patients reportedly had previous attempts of self-harm. The most common methods being the use of sharp objects, rat-pill poisoning, and corrosive intake .Conflicts with family and relationship difficulties were reported to be the most common precipitating factors.Self-harm is a challenging and frequent presentation. Patients may present with diverse characteristics and varying needs. Hence physicians must be prepared for timely liaison and prompt management.No significant relationships.


The cases of dengue fever have been reported more frequently in Nepal these days. The aim of this study was to find the prevalence of seropositivity among blood samples drawn from suspected dengue cases at a tertiary care centre of Nepal.st June 2017 to 31st October 2018 after getting approval from the Institutional Review Committee (Reference number: 23/2016). A total of 537 suspected dengue patients were selected for the study using convenience sampling. These dengue positive sera were assayed for their reactivity with Immunoglobulin M and Immunoglobulin G present in sera and synthetic peptides of dengue virus by enzyme linked immunosorbent assay. Data was entered and analysed in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation.A descriptive cross-sectional study was conducted at a tertiary care hospital from 1Among 537 suspected dengue cases, the seropositivity for dengue was found in 124 (23.09%)  of the serum.The present study revealed that dengue was more prevalent in our setting compared to similar studies. All the synthetic peptides showed reactivity with dengue-positive sera with maximum reactivity shown by RR2 peptide. In dengue-positive sera, RR2 peptide of dengue virus identified more Immunoglobulin M than Immunoglobulin G. These epitopes were synthesised as linear peptides with the help of DNA star approach.7The envelope (E) protein and non-structural protein (NS1) encoded by dengue virus are very important in the pathogenicity of dengue virus infection and are highly conserved in all strains.The aim of this study was to find the prevalence of seropositivity among blood samples drawn from suspected dengue cases.st June 2017 to 31st October 2018 after getting approval from the Institutional Review Committee (Reference number: 23/2016) of Nobel Medical College and Teaching Hospital (NMCTH). All the patients, who presented to the emergency and medicine departments of NMCTH, suspected with dengue were the study population. Convenience sampling was done. The sample size was calculated by using the formula:This was a descriptive cross-sectional study carried out at a tertiary care hospital from 12 × p × q / e2n = Z2 × 0.5 × (1-0.5) / 0.052  = (1.96)  = 385Where,n = minimum required sample sizeZ = 1.96 at 95% Confidence Interval (CI)p = prevalence taken as 50% for maximum sample sizeq = 1-pe = margin of error, 5%The sample size calculated was 385. However, we have included 537 patient's samples from Clinical laboratory services, NMCTH. Dengue-positive serum was diagnosed based on the NS1 antigen in an immunochromatographic card test kit. These denguepositive sera were assayed for their reactivity with IgM and IgG present in the sera and synthetic peptides  of dengue virus by ELISA technique.At PH 9.6, 400ng of peptide was dissolved in 100ml of 0.05M carbonate bicarbonate buffer. At 37°C for 4 hours, the dissolved peptide was coated in the wells of microtiter plates. The wells were rinsed three times with PBS/0.05% Tween 20 (PBS-T) before being blocked overnight at 4°C with 200ml blocking solution (five percent skimmed milk powder in PBS-T). After washing the plates, Chikungunya (CHIKV), DENV, and negative sera (1:100 dilutions) were added to duplicate wells and incubated at 37°C for two hours. Antigen-antibody complexes were identified using HRP-conjugated goat anti human IgM/IgG antibodies (1:2000). The plates were cleaned as before, and colour was developed with a TMB-containing substrate solution. Adding 100 micro litre of 1N sulphuric acid and optically stopping the reaction and optical density (OD) was measured at 492nm. The synthetic peptide RR2 was tested for nondengue viral reactivity using CHIKV sera. The sera that were neither IgM nor IgG DNEV positive were used as a negative control.To test the diagnostic efficiency of peptide with patient sera, a cutoff value for optical density (OD) was calculated. The cutoff values for peptide were in the range of 0.31-0.34 based on the seroreactivity of 18 healthy human sera tested for IgM. We looked at the seroreactivity of all dengue positive and 20 chikungunya positive patient sera based on the cutoff value for this peptide. The computed cutoff value for IgG was in the range of 0.33-0.38. There was no seroreactivity with any of the peptides in any of the 20 chikungunya positive and healthy sera. When the OD Value of a human blood sample was found to be greater than the cut-off value when tested for IgM and IgG in an ELISA, it was declared reactive with synthetic peptides.7 The readymade form of these synthetic peptides were gifted to us by AIIMS to carry out the study in Nepal.All the peptides were synthesised, purified and authenticated in the All India Institute of Medical Sciences (AIIMS), New Delhi. The Peptide was selected on hydrophilicity, secondary structures, antigenicity index, amphipathicity, using Bcepred/DNA star software for B cell and T cell prediction. These peptides were synthesised by Fluorenylmethoxycarbonyl Chemistry.The data was entered and analysed in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation.Among 537 suspected dengue cases, the seropositivity for dengue was found in 124 (23.09%)  of the serum. Out of 124 dengue positive patients, 71 (57.3%) were male and 53 (42.7%) were female. The mean age of dengue positive patients was 41±19.6 year with a range from 5 to 83 years. The maximum number of dengue positive patients was 47 (37.9%) in the 21-40 years age group. Thirty-six (29.03%) of patients were dengue positive in the 41-60 years age group .All peptides responded with dengue sera, according to an analysis of 124 dengue positive sera verified for NS1 using a determined cutoff value. RR2 detected IgM in 100 (80.6%) sera, RR3 in 93 (75%) sera, RR4 in 96 (77.41%) sera, RR5 in 64 (51.6%) sera, RR6 in 86 (69.35%) sera, and RR8 in 90 (72.58%) sera. IgG antibodies against synthetic peptides were found in several of the dengue positive samples. IgG was identified by RR2 in 60 (48.38%), RR3 in 64 (51.6%), RR4 in 57 (45.96%), RR5 in 53 (42.74%), RR6 in 50 (40.32%), and RR8 in 51 (41.12%) sera .The samples having OD more than the cut-off values were considered reactive. With RR2 peptide the dengue positive sera, the maximum OD obtained was 3.3 and the minimum OD value was 0.5 . Similar8 A similar finding was reported in a study carried out in Western Uttar Pradesh, India, which revealed that 23% patients were found seropositive either by NS1 Ag or IgM Ab ELISA.9 In the present study, among dengue positive patients, 71 (57.3%) were male and 53 (42.7%) were female with mean age of 41 year ranging from five to 83 years. Kumar M, et al. reported that among all dengue seropositive cases in Uttar Pradesh, India , the proportion of male was higher over female with the ratio of (M:F) being 1.54:1 with mean age±standard deviation of all patients was 27.16±14.82 years.9 A study conducted in Pakistan had reported that among all dengue positive patients, (72.9%) were males and (27.1%) were females. The patients ranged in age from 6 to 90 years old, with a median age of 30.10 We have observed in this study that the maximum number of dengue positive patients was 47 (37.9%) in 21-40 years age group, whereas the study conducted by Raza FA , et al. reported that among dengue positive cases, the maximum 48.5% of dengue positive patients were of 17-30 years old.10Dengue viral infection is a serious health concern. Dengue infection is difficult to control because it necessitates effective vector control as well as early, precise, and strain-specific diagnosis. Dengue fever diagnosis has remained a challenge for disease treatment, particularly in developing countries like Nepal. Therefore, we have made an attempt to study the sero-reactivity of synthetic antigenic peptide of dengue virus with dengue positive sera for the first time in Nepal. This peptide can be used as a tool for the diagnosis of dengue in future. The seropositivity was found in 23.09% of the serum in the present study. Rijal KR, et al. had reported the prevalence of dengue in Nepal in a study, which showed that in 2018, case incidence was about five times higher than in 2016 (incidence rate ratio (IRR): 4.8; 95 % Confidence Interval (CI) 1.5-15.3) and more than 140 times higher in 2019 .11 In another similar study carried in All India Institute of Medical Sciences, New Delhi demonstrated that synthetic antigenic peptides detected IgM and IgG in Dengue positive sera. Many synthetic peptides were used in combination to form multiple antigenic peptides . Multiple antigenic peptide one detected IgM in 96.81% of sera and IgG in 68.15% of sera. Multiple antigenic peptide two discovered IgM positive sera in 94.90% of cases and IgG positive sera in 59.23% of cases. Multiple antigenic peptide three also found IgM and IgG positive sera in 96.17% and 59.87% of cases, respectively.7 Mazumdar R, et al. detected dengue specific IgG with some synthetic continuous peptides, spanning over amino acids at positions 51-65, 71-90, 131-170, 196-210, and 246-260 from E protein of Dengue virus-3.12 Honda ER, et al. had reported in his study that NS1 specific IgG, IgM and IgA antibodies are found in the sera of patients with dengue fever and dengue hemorrhagic fever.13 In many of the studies, these chemically synthesised peptides have been studied as a alternate source of antigen for diagnosis.14 RR2 synthetic peptide of dengue virus was reactive with dengue positive sera in the present study, which makes it suitable for the easy and accurate diagnosis of dengue infection in developing country like Nepal, where dengue is endemic. The study also demonstrates that such synthetic peptide can be used easily for dengue diagnosis in the set up of hospitals in countries like Nepal.In the present study, RR2 peptide detected IgM in 80.6% sera and IgG in 48.38% sera. RR3 detected IgM in 93 (75%) sera, RR4 in 96 (77.41%) sera, RR5 in 64 (51.6%) sera, RR6 in 86 (69.35%) sera, and RR8 in 90 (72.58%) sera. IgG was identified by RR2 in 60 (48.38%), RR3 in 64 (51.6%), RR4 in 57 (45.96%), RR5 in 53 (42.74%), RR6 in 50 (40.32%), and RR8 in 51 (41.12%) sera. In one study, it has been reported that the synthetic peptides detected antibodies in Dengue virus positive serum samples using the predicted epitopes in an indirect ELISA.There are some limitations of the present study. Dengue-positive patients had been included from one study centre. The results would have been interpreted more reasonably if the more dengue-positive samples would have been enrolled from different epidemic regions of Nepal.The prevalence of dengue was higher in our setting as compared to other similar studies. Among all patients, dengue positivity was found to be more in male than females. The maximum number of patients were reported from the middle younger age group. All the synthetic peptides of dengue virus had shown their reactivity with immunoglobulin M and immunoglobulin G present in the dengue-positive sera. The synthetic peptides detected more IgM than IgG in all dengue-positive sera. Among all the synthetic peptides of dengue virus, RR2 peptide detected more IgM and IgG than other peptides.


CD200 expression shows a significant correlation with total leucocytic count and hemoglobin level . Conclusions: This study showed that CD200 expression was expressed in 100% of the patients. Correlations between CD200 expression and different laboratory data of patients revealed that there was an impact of CD200 on different diagnostic findings. After the follow-up of the patients, we found that the use of PRISM function of the software could add value to the detection of minimal residual disease.Background: Overexpression of CD200 in ALL patients indicates that it may be useful in the characterization of leukemia initiating cells (LIC). We aim at investigating the expression pattern of CD200 on leukemic B cells and the correlation of CD200 expression with various clinical and laboratory findings in 62 newly diagnosed acute lymphoblastic leukemia patients. Methods: All patients were subjected to full history taking, a thorough clinical examination, and laboratory investigations, which included complete blood count (CBC), BM aspiration, immunophenotyping of blast cells, and CD200 expression. Results: There is a higher statistically significant mean value of CD200 expression among the cases (66.15 ± 23.08) than the control group (0.37 ± 0.2) ( Acute lymphoblastic leukemia (ALL) comprises about 30% of all malignancies in children. ALL is most common in preschool children. Another incidence peak is seen in adults aged over 50 years. The identification of new prognostic factors has provided a means of stratifying patients into different risk groups and “tailoring” treatment accordingly . The curMinimal residual disease (MRD) is an important predictor of relapse in acute lymphoblastic leukemia (ALL). It is used as a criterion for risk stratification in many current studies, but its relationship to other prognostic variables has not been fully researched . Two welCD200 (cluster of differentiation 200) (OX-2 antigen) is a type I immunoglobulin superfamily membrane glycoprotein. It is expressed in multiple cell types, including B cells, a subset of T cells, dendritic cells, endothelial cells, and in the peripheral and central nervous systems. CD200 interacts with CD200R, an immunoglobulin superfamily inhibitory receptor expressed primarily on myeloid/monocyte lineage cells and a subset of T cells. CD200R suppresses monocyte and T cell-mediated immune responses . In ALL,This study aims to investigate the expression pattern of CD200 on leukemic B cells and to determine whether CD200 could emerge as a new tool for the detection of B-ALL cases and the incorporation of CD200 into routine MRD panels. We will correlate CD200 expression with various clinical and laboratory findings in newly diagnosed acute lymphoblastic leukemia patients.The present study was conducted on 62 newly diagnosed acute lymphoblastic leukemia patients who attended the adult and pediatric hematology/oncology clinic of the National Cancer Institute. Patients were followed up throughout the period of the study (one year). Thirty age- and sex-matched healthy subjects were taken as a control group; they were 21 males and 9 females, aged between 5 and 50 years.The pediatric protocol was based on total XV St. Jude protocol, while adults received the Dana Farber Cancer Institute (DFCI) ALL/LBL protocol .The samples used were either peripheral blood or bone marrow samples for both cases and controls. BM samples were used in the follow-up of the cases to assess MRD.All patients were subjected to full history taking, a thorough clinical examination, and laboratory investigations, which included complete blood count (CBC), BM aspiration, immunophenotyping of blast cells, and CD200 expression.It was performed by using Navious EPICS XL  flow cytometry and cytogenetic analysis. CD200 was assessed using flow cytometry on either PB or BM samples of the B-ALL cases as well as PB or BM samples of the control group according to the method described by Cox et al. .DNA index (DI) analysis and karyotyping were performed on the patients to detect hypoploidy. On days 15 and 42 following therapy initiation, remission achievement was assessed. The minimal residual disease is the accumulation of at least 10 clustered events out of 100,000 events that exhibit lymphoid-scattering qualities and leukemia-associated immunophenotypic traits .3 and Hemoglobin < 10 gm% [Morphological remission was considered when blasts in the bone marrow <5% . However< 10 gm% .The Navios Cytometer software PRISM is used to analyze multicolor immunofluorescence samples. PRISM allows you to display percentages for all phenotypic populations in a single plot. It is software-derived and can be acquired in either run-time or list mode .p-value below 0.05 was considered significant.For data analysis, the SPSS software (version 17.0) was utilized. The mean and standard deviation were quantitative data estimations. The Mann-Whitney test compared the means of two independent groups, and the Kruskal-Wallis test compared the means of more than two groups. Chi-square and Fischer exact were percentage independence tests. The Kaplan-Meier technique was used to get the total log-rank of survival curves. Correlation analysis was used to determine the degree of correlation between various numerical variables, including research markers. The cut-off level for distinguishing leukemic patients from normal ones was determined using receiver operator characteristic curve (ROC) analysis. A The present study was conducted on 62 newly diagnosed B-ALL patients attending the adult and pediatric hematology/oncology clinic of the National Cancer Institute. They were 40/62 males (64.5%) and 22/62 females (35.5%). The children were 48/62 (77.5%) and their ages ranged from 1 to 18 years, with a mean value of 6.729 ± 5.188 years, and the adults were 14/62 (22.5%) and their ages ranged from 20 to 79 years, with a mean value of 43.571 ± 17.99 years. Out of these 35 cases analyzed, 21 were pediatric (60%) and 14 were adults (40%).All patients were followed up throughout the study period (one year). Thirty age- and sex-matched healthy subjects were taken as a control group. They were 21 males (70%) and 9 females (30%). The children were 17/30 and the adults were 13/30. Their age ranged from 5 to 50 years, with a mean value of 20.33 ± 12.35.Platelets, hemoglobin level, and total leucocytic count are shown in Out of 62 B-ALL patients, 22 (35.5%) were of the common ALL (c-ALL or CD10 positive) phenotype. Pre-B phenotype  heavy chain) represented 62.9% of patients (39 patients). One patient was of the Pro-B phenotype (CD10 negative), which represents 1.6%. One case (1.6%) showed aberrant expression of myeloid antigens, CD33, and it was of the c-ALL phenotype.DNA index (DI) and karyotypingDNA index (DI) showed that 10 (16.9%) had a high DNA index (>1.16), which indicates a hyper-diploid karyotype. No patients had a low DNA index (<0.95), which is considered hypodiploidy. The rest of the patients  had a diploid DNA index between 0.95 and 1.16.p-value = 0.389). When comparing the different karyotyping categories as regards CD200 expression, results showed a statistically non-significant difference in CD200 expression within abnormal karyotypes: hyper-diploid cases 13/23 (56.7 ± 33) and other different abnormal cases (10/23 (66.8 ± 21.8); p-value = 0.389), of which five patients were positive for t  and two patients were positive for t . Karyotyping was performed on thirty-five patients with a mean value of normal cases 12/35 (28.53 ± 5) and abnormal cases 23/35 (12.26 ± 3.5). Out of these 35 cases analyzed, 21 were pediatric (60%) and 14 were adults (40%). Results showed a statistically non-significant difference in CD200 expression between normal cases (28.53 ± 5) and abnormal cases (12.26 ± 3.5)   and abnormal cases (12.26 ± 3.5) (= 0.005) .p-value = 0.389)  and other abnormal cases 10/23 (66.8 ± 21.8) (= 0.389) .p < 0.001).Analysis of CD200 expression was performed for 62 patients and 30 control cases. In the B-ALL group, CD200 expression ranged from 2.4–98 (%), with a mean value of 66.15 ± 23.08. In the control group, CD200 expression ranged from 0–0.585 (%), with a mean value of 0.37 ± 0.2. There was a high statistically significant difference between the B-ALL group and the control group, with a high expression in the B-ALL group (p = 0.91) and age (p = 0.49), hepatomegaly, splenomegaly, and lymphadenopathy in CD200 expression compared to those without organomegaly or lymphadenopathy . Considering the laboratory data, there was a statistically significant difference between CD200 expression, total leucocytic count, and hemoglobin level . There was no statistically significant difference between CD200 expression, platelet count, and bone marrow blasts .There was no statistically significant difference regarding sex . . The comparison was not performed on Pro B and C-ALL with aberrant CD33, as there was only one patient in each of them. There was no significant correlation between CD200 initial expression and the DNA index, with a p-value of 0.496.Correlation studies between CD200 expression and other B-cell markers such as CD10, CD19, CD22, and Cyto µ showed no statistically significant correlation except for CD10 and CD19, which were statistically significant (tively). . There wThe receiver operating characteristic curve (ROC curve) for the determination of the cutoff of CD200 was performed with 100% sensitivity and 100% specificity. The area under the ROC curve = 1.0. CD200 > 1% was considered positive for B-ALL cases as compared to the control group. The best cutoff value was 60%. The smallest cutoff value is the minimum observed test value minus one, and the largest is the maximum value minus one. All the other cutoff values are the averages of two consecutively ordered observed test values. Therefore, we have chosen 60% as our cutoff value.p-value of 0.393 and 0.317, respectively.Thirty-nine patients were followed up for detection of minimal residual disease (MRD) on day 15 of induction therapy and 28 patients on day 42. Results showed that at day 15, 26/39 patients (66.7%) achieved immunological remission (negative MRD ≤ 0.01%), and all of them  were in morphological remission (blast < 5%), while 13/39 patients (33.3%) did not achieve immunological remission (positive MRD > 0.01%). In the meantime, 7/13 (53.8%) were in morphological remission . At day p-value = 0.72)  . Results showed that there was no statistically significant difference between the two groups at day 15, where 72.7% of patients who had initial CD200 expression ≤60% achieved immunologic remission, while 64.3% of those who had initial CD200 expression >60% achieved immunologic remission ( = 0.72) . At day  = 0.55) .MRD D15 was compared in twenty of the cases using the combination of CD38 or CD58/CD200/CD19/CD10/CD34 (PRISM), where 100% of the cases who were negative by PRISM achieved immunological remission, while 22.2% of the cases who were positive by PRISM achieved immunological remission . Eleven Two of the cases were positive by PRISM and negative by MRD , and seven of the cases were positive by PRISM and positive by MRD.p = 1.0; p-value of 0.86. . The one-year probability of overall survival for the B-ALL patient group with CD200 expression ≤60% was 78.9%, compared to 67.4% for those with CD200 expression >60%  probability was evaluated by log-rank analysis of Kaplan-Meier plots comparing the B-ALL patient group with initial CD200 expression ≤60% to those with initial CD200 expression of >60%. Results revealed that there was no significant influence of CD200 expression on the overall survival probability . Correlation studies showed no significant associations between CD200 expression and different clinical findings; when compared to different laboratory data, there was no significant correlation except for total leucocytic count and hemoglobin level . In the current study, a white blood cell (WBC) count at diagnosis >50.0 × 109 cells/L was registered in 21% of cases, matching Brazilian and Canadian studies that reported WBC counts >50.0 × 109 cells/L in 21% and 20% of cases, respectively [Acute lymphoblastic leukemia (ALL) is the most common type, accounting for about 80% of leukemia incidence among children below the age of 14 years . Regardiectively .For the diagnosis of B-ALL, a broad leukemia marker panel was applied, including common progenitor markers , panleucocytic marker (CD45), B-cell markers , T-cell markers , and myeloid markers .9 cells/L [In this study, DNA index analysis showed that 10 16.9%) had a high DNA index (>1.16), which indicates a hyperdiploid karyotype. No patients had a low DNA index (<0.95), which is considered hypodiploidy. The rest of the patients  had a diploid DNA index of 0.95–1.16. The correlation was conducted between CD200 initial expression and DNA index, which reveals no significant correlation. These results are in concordance with Lustaza et al.  DI >1.16 cells/L ,16..9% had ap = 0.0002) [p = 0.01 for both). When comparing patients with CD200+ and CD56+ expression to those with CD200 and CD56 expression, the OS and DFS were considerably lower in the CD200+ and CD56+ cases. Positive expression of CD200 and/or CD56 upon diagnosis in B-ALL is related to a poor prognosis and may be indicative of biological aggressiveness [In the present work, CD200 expression was statistically significantly higher in B-ALL cases compared to healthy subjects. CD200 expression in B-ALL cases ranged from 2.4–98 (%), with a mean value of 66.15 ± 23.08, which is higher than the control group, where CD200 expression ranged from 0–0.585 (%), with a mean value of 0.37 ± 0.2. Similar results were obtained by Cox et al., who reported that CD200 was overexpressed in B-ALL cases compared to cord blood (CB) samples  ,18. In asiveness . This coIn this study, correlation of CD200 expression with total leucocytic count and hemoglobin level was used to calculate the best cutoff value for CD200 expression for the prediction of poor prognosis in B-ALL, and the best cutoff value was 60%. This was done to determine whether the initial percent of CD200 expression could predict the prognosis of ALL patients.One-year overall survival (OS) probability was evaluated by log S–rank analysis of Kaplan-Meier plots comparing the B-ALL patient group with initial CD200 expression ≤60% to those with initial CD200 expression of >60%. The one-year probability of overall survival for the B-ALL patient group with CD200 expression ≤60% was 78.9% compared to 67.4% for those with CD200 expression >60%. Our results revealed that there was no significant influence of CD200 expression on the overall survival probability. The PRISM function of the software was used to estimate the percentage of cell populations expressing different antigen combinations. The PRISM processor represents data from 2, 3, 4, or 5 antibody combinations as 4, 8, 16, or 25 evenly spaced peaks in a single-parameter graph. Each peak represents an antibody combination, or phenotype. For example, one peak represents the cells that are negative for all parameters, the second peak represents the cells that are positive for the first parameter and negative for all other parameters, and the last peak represents the cells that are positive for all parameters. The height of the peak is proportional to the number of events belonging to the phenotype represented by the peak.MRD D15 was compared in twenty of the cases using PRISM software with the combination of CD38 or CD58/CD200/CD19/CD10/CD34, where 100% of the cases that were negative by PRISM achieved immunological remission, while 22.2% of the cases that were positive by PRISM achieved immunological remission. Awad et al., used the PRISM function of the software in 84 newly diagnosed AML patients to characterize leukemia stem cells (LSCs) and to discriminate them from normal hematopoietic stem cells (HSCs) . Coustanp = 0.002 and 0.009, respectively). Moreover, when comparing the different B-ALL subtypes as regards CD200 expression, the results showed no statistically significant difference in CD200 expression between the different subtypes . The best cutoff value for CD200 (%) expression in the detection of B-ALL was found to be 1% with a sensitivity of 100% and specificity of 100%. On the other hand, the best cutoff value for CD200 (%) expression in predicting the prognosis was found to be 60%, which showed no significant correlation with MRD at days 15 and 42. MRD D15 was compared in twenty of the cases using the combination of CD38 or CD58/CD200/CD19/CD10/CD34/CD45 (PRISM), where 100% of the cases who were negative by PRISM achieved immunological remission, while 22.2% of the cases who were positive by PRISM achieved immunological remission with a significant p-value (p < 0.001).Correlation studies between CD200 expression and other B-cell markers such as CD10, CD19, CD22, and Cyto µ showed a statistically significant correlation for CD10 and CD19 only (More extensive studies should be conducted on this finding to confirm whether PRISM software could add value to MRD. Further studies on the prognostic value of CD200 expression should be performed on a wider scale of patients.This study showed that CD200 expression was expressed in all the patients, while it was not expressed in the normal control group. CD200 was found to be stably expressed during MRD monitoring, and it increases MRD sensitivity by incorporating it in the MRD panel, indicating its potential role in MRD monitoring in ALL patients. These findings recommend the use of CD200 as a powerful tool for MRD detection in B-ALL cases. Correlations between CD200 expression and different laboratory data from patients revealed that there was an impact of that antigen on different diagnostic findings. With a follow-up of patients, we found that the use of the PRISM function of the software could add value to the detection of minimal residual disease. However, this finding was found in a small number of patients, so more studies should be performed on a larger scale of patients.


To evaluate the results obtained with direct-from-blood culture antimicrobial susceptibility tests (ASTs) for the study of bacterial susceptibility to antibiotics during bacteraemia.This was a prospective study in which 124 direct ASTs were performed directly from positive blood cultures according to the CLSI technique using Mueller–Hinton CHROMagar Orientation medium. Twenty-one antibiotics were tested. The resulting diameters were read after 8 h and 18 h of incubation and interpreted according to the CLSI breakpoints. Thus, a standard AST was performed and interpreted for all isolated strains according to CLSI recommendations. The results were analysed by calculating the rates of categorical agreements (CA) and disagreements represented by minor errors (mE), major errors (ME) and very major errors (VME).Escherichia coli , Klebsiella pneumoniae  and SCN . More than half of the isolates  were MDR bacteria. It was found that the overall percentage CA (%CA) obtained at 18 h (94.43%) was higher than the one obtained at 8 h (87.32%). Disagreement rates obtained at 8 h and 18 h remain acceptable. The best %CA was obtained with non-fermenting GNB (98.74%) and the lowest with Staphylococcus species (90.70%). For Enterobacteriaceae, an excellent overall %CA (94.32%) was found at 18 h with 96.3% for CTX, 95.38% for ETP, 95.31% for CRO and 92.19% for MEM. Lower rates were noted with IPM (88.71%), CAZ (87.5%) and CIP (85.71%); due to mE for CAZ (12.5%) and mE and ME for IPM  and CIP . Particular attention should be given to clindamycin and teicoplanin tested with Staphylococcus species as they record low categorical agreements at 8 h and 18 h.One hundred and twenty-four strains were isolated, including The encouraging results obtained at 18 h suggest a possible future implementation of the direct-from-blood culture AST as a routine technique for studying susceptibility to antibiotics during bacteraemia. However, the standard AST remains the reference technique.


Medical studies have always been considered as very stressful. Although these students are generally among the most academically successful students, they are not spared from developing both substance and behavioral addictions, particularly pornography cyberaddiction.To evaluate the pornography cyberaddiction in a group of tunisian students, to study their impulsivity and determinate the link between these two entities.A descriptive and analytical cross-sectional study including 155 medical students. We used the S-IAT sex : to evaluate pornography cyberaddiction and Barrat bis 10 : to evaluate impulsivity.The average age of students was 25.8 ±3.5 years old. The sex ratio (M/W) was 0,72. This medical students were single in 76.8%, had a high socio-economic status in 99.4% of case. They had a personal psychiatric history in 15.0%. They are smokers in 20%, consume alcohol in 30.3% and cannabis in 9% of case. The mean score of : the BIS 10 was 63.3 and the S-IAT was 15.6. The viewing of pornographic movies started around the age of 15 years old. Pornographic sites are the most frequently used tool (58.2%). The factors correlated with this addiction are: male sex (p=0.014), tobacco consumption (p=0.012), alcohol consumption (p=0.02) and impulsivity (p=0.03).It resort from our study that medical students may suffer from pornography cyberaddiction. This increased use may be associated with impulsivity and substance use. Psychological support aimed specifically should be used to protect medical students.


This study describes regional differences and determinants on key noncommunicable disease (NCD) risk factors in adults from the National NCD Monitoring Survey (NNMS) across six geographic regions of India.p-value < 0.05 was considered for statistical significance.The NNMS was a cross-sectional multistage cluster survey conducted in 2017–18, on a representative sample of 300 urban and 300 rural primary sampling units (PSU) covering 20 households per PSU. One adult aged 18–69 years per household was selected using the KISH grid. Globally standard survey tools were adapted for data collection. To arrive at regional estimates, the country was divided into six regions  based on the distribution of a national sample. The results are presented as proportion with 95% confidence intervals (CI). Univariable and multivariable logistic regression analyses were performed to identify NCD risk factor determinants significant in the regions. A The overall survey response rate was 96.3%. The prevalence of current tobacco (45.7%) and alcohol use (22.3%) was significantly high in the northeast region. The highest proportion of adults from northern India showed low levels of physical activity (49.6%). The prevalence of metabolic risk factors — obesity (12.5%), raised fasting blood glucose (21.2%) and raised blood pressure (35.6%) was highest in south India. The prevalence of raised blood pressure was high in north India (35.2%) similar in proportion to south India. Clustering of ≥3 risk factors (50.1%) and ten-year CVD risk of ≥30% or with existing CVD (18.1%) was highest in south India when compared to other regions. Older age, urban residents, alcohol consumption and overweight/obesity were significantly associated with higher odds of raised blood pressure and raised fasting blood glucose.The NNMS presents variations in NCD risk factors within the regions of India. It contributes to robust evidence for strengthening interventions and monitoring the progress in reducing NCDs and their associated risk factors.The online version contains supplementary material available at 10.1186/s12889-022-13466-5. The disease epidemiology in India has transitioned within the past 2 decades from infectious diseases, undernutrition, maternal and childhood diseases to the increasing burden of noncommunicable diseases (NCDs) . NCDs coIn 2013, the Government of India adopted the Global NCD Monitoring Targets and formulated the national specific NCD targets (10) and indicators (21) to be achieved by 2025 . Though India is the world’s second-most populous country with 28 states and 8 union territories (UTs). All Indian states and UTs are categorized into six administrative zones/regions namely north, west, central, south, east and northeast , 18. EveThe NNMS was the first comprehensive and NCD specific national community-based, cross-sectional survey conducted from October 2017 to April 2018 to estimate key NCD indicators among adults (18–69 years), adolescents (15–17 years) and national health system preparedness to NCDs in India as identified in the National NCD Monitoring Framework and Action Plan , 14–16. The NNMS survey adopted a multistage cluster sampling design in both urban and rural areas. A nationally representative sample of 12,000 adults from 600 primary sampling units (PSUs) equally distributed as 300 wards (an administrative unit of the city) in urban areas and 300 villages in rural areas were selected through probability proportional to size sampling method –17. , raised blood pressure and raised fasting blood glucose including those on medication , daily use of smoked tobacco [15.5% 95% CI: 12.1–19.4)] as well as smokeless forms [33.6% (95% CI: 29.0–38.4)] than other regions of the country. The lowest prevalence of current tobacco use was in southern region [18.4% (95% CI: 17.0–19.9)] ] among women in the northern region and highest [61.8% (95% CI: 54.9–68.3)] among men in the northeast. Adults aged 30–69 years showed the highest consumption of tobacco, with predominance in the adults between 30 and 49 years from the northeast [50.5% (95% CI: 43.4–57.7)]. Young adults aged 18–29 years from southern India [12.6% (95% CI: 10.2–15.4)] showed the lowest consumption of tobacco. The western region presented a low prevalence of daily use of smoked tobacco [4.1% (95% CI: 3.2–5.1)], while daily smokeless tobacco use was lower in the south [9.1% (95% CI: 8.0–10.2)] ]  and lowest in the western (10.1%) and eastern (10.0%) parts of India  at a 5% level of significance.The highest proportion of men aged between 18 and 69 years from the northeast region reported alcohol consumption [35.2% (95% CI: 28.8–42.0)] in the last 12 months before the survey. The prevalence of heavy episodic drinking was higher among men in the south [13.8% (95% CI:12.0–15.9)] followed by northeast [13.6% (95% CI: 9.3 - 18.8)]. Across the age groups, the highest prevalence (28.3%) of current alcohol use was among the middle-aged adults (30–49 years) from northeast India, while the lowest was among the younger adults (18–29 years) from western India (5.7%) (Table (p < 0.001). Across all the six regions, women and urban adults were insufficiently physically active compared to men and rural adults. The highest prevalence of insufficient physical activity was among the older adults (50–69 years) from north India (60.1%). The younger (49.2%) and middle (46.1%) aged adults from eastern India also showed significant insufficient levels of physical activity ], east [48.8% (95% CI: 46.7–50.8)] and central [47.2% (95% CI: 45.1–49.3)] regions were doing insufficient levels of physical activity in a week. These findings were statistically significant Southern India showed significantly highest prevalence of overweight [41.1% 95% CI: 39.3–42.9)], obesity [12.5% (95% CI: 11.3–13.7)], central obesity [49.5% (95% CI: 47.7–51.4)], raised blood pressure [35.6% (95% CI: 33.9–37.4)] and raised fasting blood glucose [21.2% (95% CI: 19.7–22.8)]. The prevalence of raised blood pressure in the north [35.2 (95% CI: 32.7–37.8)] was similar to the prevalence in the south. Northeast India showed the lowest prevalence of overweight (22.4%), obesity (3.7%) and central obesity (29.0%), while raised blood pressure and raised fasting blood glucose was lowest in the central (26.3%) and eastern India (7.0%), respectively , obesity (16.5%) and central obesity (66.0%) in the north; and raised blood pressure 58.3%) and raised fasting blood glucose (37.8%) being highest in the south ] and north [46.4% 95% CI: 43.5–49.2)]. A lower proportion of risk factor clustering was seen amongst the rural adults from central India [32.9% (95% CI: 30.4–35.5)]. Similarly, ≥30% (or with existing CVD) of ten-year CVD risk among adults aged 40–69 years was highest in south [18.1% (95% CI: 15.8–20.5)] and north [16.1% (95% CI: 12.7–20.0)]. While 8.7% (95% CI: 6.8–11.0) adults from east and 9.9% (95% CI: 7.7–12.5) from the central region were at lowest risk for the development of CVDs  from the northeast (aOR: 9.99) and southern India (aOR: 9.90); adults with overweight including obesity from central India aOR: 2.74), current alcohol users from the northeast (aOR: 2.31), and men from northern India (aOR: 1.40) had higher odds of risk for raised blood pressure  and south parts of India (aOR 15.06) had the highest odds of risk for raised fasting blood glucose with least in the northeast (aOR: 2.97). Urban residents from the northeast (aOR: 2.26) and overweight/obese adults from the west (aOR: 2.89) were at increased risk for raised fasting blood glucose  in the northeast region and metabolic risk factors  in the south. This predominance was similar in both sexes. These regional differences could be due to the rapid and different rates in urbanization, access and quality of health care, nutritious food and spaces for physical activity, economic stability, health sector preparedness, other behavioural, occupational, and environmental risks, etc. The current study findings show a high prevalence of smoking and smokeless tobacco use in the northeast. A study done by Lahoti et al. in 2021 showed a relative decrease in smoking by 5.7% but an increase in smokeless tobacco use 31.1%) between GATS-1 (2009–10) and GATS-2 (2016–17) in the northeast . Shaikh .1% betweOur results revealed a high prevalence of obesity and raised fasting blood glucose in the south and a similar prevalence of raised blood pressure in the south and north. Chandrupatla et al. in 2020 analysis using the NFHS data showed a high prevalence of diabetes among the young and middle-aged adults from the southern region (9.39%) . Mote BNOverall, a major proportion of adults from the south were exposed to all NCD risk factors when compared to other regions. Adults from the west showed low exposure to risk factors when compared to other regions except for the high prevalence of raised fasting blood glucose. In addition, both men and women from south India showed a high prevalence of clustering of ≥3 risk factors and 10-year CVD risk of ≥30% or with existing CVD. Contrasting to our study were the results from the cross-sectional analysis results from 2005 to 2016 NFHS data by Shaikh et al. in 2021 . This stRegional analyses from the national sample have been periodically undertaken in various sectors to score economic development, communicable diseases, etc., at the national and international level to inform and facilitate actions –38. SimiThere is paucity of literature related to comprehensive NCD risk factor for different regions in India. This study provides an opportunity to fill the literature gaps and mark the discrepancies in the NCD risk factor profile across the six regions at a given point of time. It helps to set regional baseline for monitoring NCD indicators to be achieved by 2025. For subnational governments to implement all the actions needed to control and manage NCDs and their risk factors, they need comprehensive evidence on NCD risk factors. With the established methods, well-structured study tools, protocols, wide network of collaborators and regional evidence, they can set-up NCD surveillance systems.The main strengths of the current study include the representativeness of sample, use of primary national survey data to arrive at the region-wise key behavioural (self-reported) and metabolic (both self–reported and measured) NCD risk factor estimates. The narrow confidence intervals among the risk factors indicates greater precision of the estimates. The robustness of these estimates can be attributed to the multistage sampling design, adequate sample power, standardised questionnaires  and show cards, rigorous training and quality control mechanisms, and high survey response rates. The study findings offer academicians and researchers to study these regional disparities and plan further research studies. Furthermore, regional estimates guide to frame culturally appropriate behaviour change communication strategies like encouraging self-care, and technological tools like mobile applications and health trackers, etc.The current study has inadequate power to generate gender stratified estimates for rural versus urban subgroups, state and district specific NCD indicators. Future studies could be designed to arrive at both regional and national estimates. Since the study involves self-reported responses, there is a possibility of recall bias and under/over reporting of behavioural risk factors . However, adequate time was spent on each question ensuring participant privacy and confidentiality of responses.There are observed regional differences in the NCD risk factors among adults and the rapidly increasing burden of NCDs in India. These differences among risk factor prevalence have not been studied systematically and there is a need for sustainable monitoring mechanisms on risk factors most prevalent within the regions. This needs to be backed up by developing regional NCD action plans, standard methods and periodicity. These regional estimates from the present study provide the much-needed evidence to plan and target effective NCD control programs and facilitate the allocation of financial resources.Additional file 1: Supplementary Table 1. List of indicators, definitions and instruments used in the National NCD monitoring Survey (NNMS) 2017-18. Supplementary Table 2. Prevalence of behavioural risk factors associated with NCDs among adults aged 18-69 years in India by place of residence, sex, age group and region. Supplementary Table 3. Prevalence of metabolic risk factors associated with NCDs among adults aged 18-69 years in India by place of residence, sex, age group and region. Supplementary Table 4. Prevalence of clustering of ≥3 risk factors associated with NCDs among adults aged 18-69 years in India by place of residence, sex, age group and region. Supplementary Table 5. Prevalence of 30% or more 10 Year CVD risk or with existing CVD among adults aged 40-69 Years in India by place of residence, sex, age group and region. Supplementary Table 6. Comparison of prevalence of risk factors among adults in India with Human Development Index and its Components. Supplementary Table 7. Distribution of survey respondents for various risk factors by place of residence, sex, age group and region.