Vardhman Mahavir Medical College & Safdarjung Hospital

Malaria transmission is fuelled by the development stages called gametocytes. Prevalence, patterns, and determinants of gametocyte carriage, a silent and understudied public health issue, were evaluated in Delhi, India. Between August 2022 and September 2023, a cross-sectional study was conducted at a reference hospital. Gametocyte detection was performed by light microscopy. Of the 4259 febrile patients included, gametocytes were found at a prevalence of 1.3 %, with a predominance of P. vivax (78.6 %). Higher risks of P. falciparum gametocyte carriage were found in individuals with increased levels of platelet count -PCT (aOR = 10.66 to 12.82, p < 0.05), C-reactive protein-CRP (aOR = 4.11 to 6.16, p < 0.05), and red blood cells-RBC (aOR = 6.78, p = 0.005), whereas increased haemoglobin (Hb) was protective (aOR = 0.56, p = 0.002). Similar patterns were found for P. vivax gametocyte carriage, in addition to the effect of the malaria transmission period (aOR = 2.89, p = 0.01). This study pinpoints a low Plasmodium spp. gametocyte carriage, with a consistent influence of CRP, PCT, Hb, and malaria transmission. These findings might provide baseline information for targeting gametocyte carriers to block malaria transmission in the area.

Rheumatic heart disease (RHD), is a public health problem in low and middle-income countries. It causes high morbidity and mortality due to heart failure (HF), but there are no randomized trials of HF-treatments in these patients. Digoxin is an inexpensive drug that is widely used in RHD despite a lack of data on its effect on clinical outcomes. The Digoxin in RHD (Dig-RHD) trial will evaluate the impact of the drug on clinical outcomes in patients with RHD.

The Dig-RHD trial is an investigator-initiated multicenter, pragmatic, randomized placebo-controlled, parallel-arm, superiority trial. Symptomatic adult patients with RHD were randomized to receive oral digoxin or matching placebo on a background of usual care. The primary outcome is a composite of all-cause death, new-onset or worsening HF. Key secondary outcomes are, all-cause death, HF-related death, hospitalization for HF, sudden death, and self-reported quality of life. Patients were enrolled at 12 academic medical centers in India, beginning in February 2022. Enrolment of 1769 patients was completed in August 2024. One interim review of the data by the independent Data Safety Monitoring Board, after half the primary outcome events had accrued, indicated no safety signals. The last follow-up visits are scheduled to complete in December 2025.

Dig-RHD is the first randomized trial of digoxin in RHD powered for clinical outcomes, and the results will have major implications for the routine management of patients with RHD. (Clinical trial registration: CTRI/2021/04/032858).

This single-centre, hospital-based study from Uttarakhand, India, aimed to describe the genomic characterization data of Salmonella spp. isolated from clinical samples.

This study was performed between January 2019 and January 2023 and included eighteen clinical Gram-negative bacterial isolates which were identified as Salmonella species as per standard microbiological guidelines. The test isolates were sent to the Central Research Laboratory (CRL), Bengaluru, India, for characterization and whole-genome sequencing (WGS). At CRL, the test isolates were revived and subjected to preliminary identification and antibiotic susceptibility testing (AST) using the VITEK 2 Compact system, the results of which were interpreted according to the Clinical Laboratory Standards Institute (CLSI) guidelines 2023.

Of the 18 Salmonella spp. test isolates, twelve belonged to serovar Typhi, five to serovar Paratyphi A, and one isolate to serovar Typhimurium. The serotyping results were further confirmed by WGS in which no disparity was observed. Genotyping results were determined for twelve S. Typhi isolates, of which 41.7 % (5/12) belonged to genotype 4.3.1.2 (H58 LII) and one isolate belonged to genotype 4.3.1.1 (H58 LI), respectively. All isolates were susceptible to ampicillin, chloramphenicol, co-trimoxazole, ceftriaxone and azithromycin. Ciprofloxacin resistance and intermediate susceptibility were observed in 14 and four isolates, respectively. Genes conferring resistance to fluoroquinolones were detected in all test isolates and were mainly associated with mutations on the gyrA and parC genes. Triple mutants bearing gyrA-S83F, gyrA-D87N, and parC-S80I genes were observed in three isolates belonging to genotype 4.3.1.2.1. Genes encoding resistance to other antimicrobial drug classes were not observed in the dataset. The major Pathogenicity islands, SPI-1, SPI-2, SPI-3, SPI-5 and SPI-9, were detected in all test isolates.

This study indicates that Salmonella strains are susceptible to most antibiotics for enteric fever, except fluoroquinolones. However, gathering data from diverse Indian regions is essential to understanding regional variations in Salmonella antimicrobial resistance emergence.