Rajneesh Kumar Joshi

Background: Acute mountain sickness (AMS) poses a unique and formidable challenge to healthy personnel at high altitudes. Objective: This randomized controlled trial (RCT) protocol aimed to assess the effectiveness of Ayurvedic nutritional supplements in conjunction with a yoga protocol in reducing the incidence and severity of AMS among healthy personnel stationed in the challenging high-altitude landscapes of the western Himalayas. Methods: The proposed open-label, parallel-group RCT was conducted in apparently healthy individuals of any gender aged 18‐50 years. The study was conducted at two distinct high-altitude stages within the western Himalayan region: stage I, situated at an elevation ranging from 9000 to 12,000 feet and stage II, spanning 12,000 to 15,000 feet. A total of 1660 participants (n=830 per stage) underwent random assignment in a 1:1 ratio to receive either the existing acclimatization schedule (AS) for high altitude (control group) or the Ayush intervention (Ayush group) in addition to the AS. The participants in the Ayush group received Ayurvedic nutritional supplements, including the Ayur-nutri kit (Ayush poshak yoga, 25 g, and Ayush cardiac care tea, 125 mL), twice daily, along with a yoga protocol (60 min daily) for 120 days. The primary outcome was the incidence of AMS, assessed using the 2018 Lake Louise Scoring System, and the proportion of participants with a Lake Louise Scoring System score of 6 or higher during the first 7 days from baseline. The secondary outcome measures included the proportion of participants with thromboembolic events; changes in coagulation and hemostasis activation markers and proinflammatory markers; and changes in self-reported negative emotional states (depression, anxiety, and stress), sleep quality, and overall quality of life (assessed through Depression Anxiety Stress Scale-21 items, Pittsburgh Sleep Quality Index, and 12-item short-form, respectively) on day 60 and day 120 from baseline. Results: The study was funded in March 2023. The data collection was completed in December 2023. A total of 1660 participants were enrolled in the study. The analysis of the study data is in progress. The study outcomes are expected to be published by December 2026. Conclusions: This RCT was the first of its kind to explore the potential benefits of using Ayurvedic nutritional supplements and a yoga protocol in conjunction with the standard AS to reduce the occurrence and severity of AMS among healthy personnel. The outcomes of this trial can aid in better acclimatization and resilience among healthy personnel at high altitudes.

Objective: To create a nomogram based on transcutaneous bilirubin values (TCB) in first week of life for term and late preterm (>34 weeks) neonates. Methods and design: Prospective longitudinal study. Setting: Four tertiary-care teaching hospitals (one each in eastern and southern India, two in northern India) between February 2019 and March 2020. Participants: A total of 2492 term and late preterm (>34 weeks) neonates. Intervention: Bilirubin was measured by transcutaneous bilirubinometer (Drager JM-105, Germany) in all neonates in pre-specified times of the day, 12 hourly every day since birth till discharge between 48 and 72 h, and data were recorded in epochs of 6 hourly intervals. Post-discharge, all neonates were called for review in next 48 h. Outcome measures: Primary—TCB in first week of life. Secondary—factors having significant association with significant hyperbilirubinaemia requiring phototherapy. Results: Total of 2492 neonates (males 1303 and female 1189), with a total of 14 162 TCB recordings were analysed and mean hourly bilirubin (TCB) at hourly intervals till 120 h and then daily bilirubin values on Days 6 and 7 were tabulated. We have constructed hour-specific bilirubin nomogram with percentiles as per gestational age in term and near-term Indian neonates till 120 h of life. Amongst the known risk factors, delayed cord clamping, primipara and breastfeeding jaundice had significant association for hyperbilirubinaemia needing phototherapy. Conclusions: We have created gestation-specific nomogram of TCB levels in 6 hourly intervals for the first 120 postnatal hours, obtained from a large predominantly breast fed healthy, term and near-term Indian neonates.

BACKGROUND: The ChAdOx1 nCoV-19 vaccine against COVID-19 is a two-dose vaccine spread 3 to 4 weeks apart. This study aims to ascertain the antibody response to each dose with respect to age, previous infection status etc. METHODS: Baseline total COVID-19 antibody level was ascertained using Siemens SARS‑CoV‑2 Total Antibody assay in consenting health care workers before the first dose of vaccination. Adverse effects were noted in each individual and were monitored weekly for the total antibody titre following both doses. Descriptive statistical tests were used to analyse the changes in antibodies levels weekly after both doses. Association of previous COVID infection and age with antibody levels was assessed. RESULTS: Median (range) of age of the 30 study participants was 31.5 years.23% of the participants had a history of previous COVID-19 infection. Mild adverse events following immunisation were reported by 87% participants after first dose whereas only in 7% after second dose. Median baseline antibody titres were significantly higher among those with previous COVID infection as compared to previously uninfected individuals. Antibody titres increased consistently after first dose and showed a declining trend following the second dose in all participants and showed no significant association with previous COVID-19 infection or age. CONCLUSIONS: Antibody titre response was similar amongst the various age groups. Higher response in the previously infected individuals following first dose may make them ideal candidates for a single dose vaccine regimen. Individuals showing lower levels of neutralising antibodies can be ideal candidates for a booster dose.