Zika virus outbreak in Rajasthan,India in 2018 was caused by a virus endemic to Asia

Zika virus (ZIKV) infection in human has been reported from Gujarat and Tamil Nadu states during the year 2016 and 2017 respectively. In paucity of complete genome data of ZIKV, the analysis and prediction were not possible. Zika cases were reported in Jaipur city, Rajasthan, India during the period of 21^st September 2018 to 29^th October 2018. In order to understand the circulating ZIKV strain in Rajasthan state about ten human serum samples from the positive cases of Jaipur city, Rajasthan state considering the locality and clustering variations were sequenced using next-generation sequencing (NGS) platform. Complete genome phylogenetic analysis of Jaipur city sequences with known GenBank ZIKV sequences revealed that the outbreak in Jaipur city was being caused by ZIKV belonging to Asian lineage. Partial genome sequencing revealed the presence of a pre-outbreak strain of ZIKV in Gujarat and current outbreak strain of Asian lineage in Tamil Nadu. Further sequence analysis of the five ZIKV positive samples of Jaipur revealed that the S139N and A188V mutations, linked to enhanced neurovirulence and transmission in animal models, were not found in the current outbreak strain. Whether this strain can cause birth defects and cause large outbreaks is not currently known, but they should be treated as such until more is known. With the identification of ZIKV in Gujarat, Tamil Nadu, and recent outbreaks of ZIKV in Rajasthan and Madhya Pradesh states alarm for India to enhance surveillance in other states and monitor the mutation and evolutionary changes in circulating Zika strains.     

Potential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review

ObjectiveTo investigate the prevalence, outcomes, and factors associated with potential glycemic overtreatment and undertreatment of type 2 diabetes mellitus (T2DM) in long-term care facilities (LTCFs).DesignSystematic review.Setting and ParticipantsResidents with T2DM and aged ≥60 years living in LTCFs.MeasuresArticles published between January 2000 and September 2020 were retrieved following a systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL plus, and gray literature. Inclusion criteria were the reporting of (1) potential overtreatment and undertreatment quantitatively defined (implicitly or explicitly) based on hemoglobin A1c (HbA1c) and/or blood glucose; (2) prevalence, outcomes, and associated factors of potential glycemic overtreatment and undertreatment; and (3) the study involved residents of LTCFs.ResultsFifteen studies were included. Prevalence of potential overtreatment (5%–86%, n = 15 studies) and undertreatment (1.4%–35%, n = 8 studies) varied widely among facilities and geographical locations, and according to definitions used. Prevalence of potential overtreatment was 16%–74% when defined as treatment with a glucose-lowering medication in a resident with ≥1 hypoglycemia risk factor or serious comorbidity, together with a HbA1c <7% (n = 10 studies). Potential undertreatment was commonly defined as residents on glucose-lowering medication having HbA1c >8.5% and the prevalence 1.4%–14.8% (n = 6 studies). No studies prospectively measured resident health outcomes from overtreatment and undertreatment. Potential overtreatment was positively associated with use of oral glucose-lowering medications, dementia diagnosis or dementia severity, and/or need for assistance with activities of daily living (n = 2 studies). Negative association was found between potential overtreatment and use of insulin/combined insulin and oral glucose-lowering medication. No studies reported factors associated with potential undertreatment.Conclusions and ImplicationsThe prevalence of potential glycemic overtreatment and undertreatment varied widely among residents with T2DM depending on the definition(s) used in each study. Longitudinal studies examining associations between glycemic management and health outcomes, and the use of consensus definitions of overtreatment and undertreatment are required to establish findings about actual glycemic overtreatment and undertreatment in LTCFs.