Government Rajaji Hospital

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. An expanding body of evidence supports the role of human microbiome in the establishment of CVDs and, this has gained much attention recently. This work was aimed to study the circulating human microbiome in CVD patients and healthy subjects. The levels of circulating cell free DNA (circDNA) was higher in CVD patients (n = 80) than in healthy controls (n = 40). More specifically, the relative levels of circulating bacterial DNA and the ratio of 16S rRNA/β-globin gene copy numbers were higher in the circulation of CVD patients than healthy individuals. In addition, we found a higher circulating microbial diversity in CVD patients (n = 3) in comparison to healthy individuals (n = 3) by deep shotgun sequencing. At the phylum level, we observed a dominance of Actinobacteria in CVD patients, followed by Proteobacteria, in contrast to that in healthy controls, where Proteobacteria was predominantly enriched, followed by Actinobacteria. The circulating virome in CVD patients was enriched with bacteriophages with a preponderance of Propionibacterium phages, followed by Pseudomonas phages and Rhizobium phages in contrast to that in healthy individuals, where a relatively greater abundance of eukaryotic viruses dominated by Lymphocystis virus (LCV) and Torque Teno viruses (TTV) was observed. Thus, the release of bacterial and viral DNA elements in the circulation could play a major role leading to elevated circDNA levels in CVD patients. The increased circDNA levels could be either the cause or consequence of CVD incidence, which needs to be explored further.

BACKGROUND: The World Health Organization has recommended that individual governments identify vaccine hesitancy areas. It is proposed that the governments, with the aid of local organizations, educate and implement social insights on the vaccination so that high population levels are covered with this safe immune program. METHODS: A longitudinal online survey covered 3000 adults from India. We examined the demography, behavioral (socio-economic) attitude, vaccine hesitancy, vaccine resistance for the COVID-19 vaccine. The specific reasons for the COVID-19 vaccine decline were also evaluated. RESULTS: Our survey revealed 59% definite response, 29% low-level response, and 7% high-level response for vaccine hesitancy, while 6% had resistant views on the COVID-19 vaccine. Individuals who had higher income levels, lived in a society, maintained social distancing, had downloaded the COVID-19 update app, showed a positive attitude towards their government, and more confidence in their healthcare system were more inclined towards the vaccination. On the contrary, individuals who had overstated the risks of COVID-19 and had a religious and populistic attitude towards vaccination were more hesitant/resistant to vaccination. The respondents who declined vaccine administration were further evaluated for their specific reason for their response. The most common reasons for declining the COVID-19 vaccine were post-vaccine scare of adverse health effects and accepting the information spread by social media. CONCLUSIONS: The results in our study show that by identifying population "hot spots" that have negative or unclear information on the COVID-19 vaccination, these "hot spots" can be addressed by involving friendly organizations that can clear their strong disbeliefs and increase the percentage of vaccine-definite people within the population. The role of government-induced COVID-19 vaccine policy measures can always be beneficial to cause this shift from disbelief to confidence within the population.

BACKGROUND: Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS: The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS: Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS: The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.

BACKGROUND: Shortening tuberculosis (TB) treatment duration is a research priority. This paper presents data from a prematurely terminated randomized clinical trial, of 4-month moxifloxacin or gatifloxacin regimens, in South India. METHODS: Newly diagnosed, sputum-positive HIV-negative pulmonary TB patients were randomly allocated to receive gatifloxacin or moxifloxacin, along with isoniazid and rifampicin for 4 months with pyrazinamide for first 2 months (G or M) or isoniazid and rifampicin for 6 months with ethambutol and pyrazinamide for first 2 months (C). All regimens were administered thrice-weekly. Clinical and bacteriological assessments were done monthly during treatment and for 24 months post-treatment. The Data and Safety Monitoring Board recommended termination of the trial due to high TB recurrence rates in the G and M regimens. RESULTS: Of 416 patients in intent-to-treat analysis, 6 (5%) of 124, 2 (2%) of 110 and 2 (2%) of 137 patients with drug-susceptible TB in the G, M and C arms respectively had unfavorable response at the end of treatment; during the next 24 months, 17 (15%) of 115, 11 (11%) of 104 and 8 (6%) of 132 patients respectively, had TB recurrence. Of 38 drug-resistant patients 1 of 8 and 3 of 26 in the G and C arms respectively had unfavourable response at the end of treatment; and TB recurrence occurred in 2 of 7 and 2 of 23 patients, respectively. The differences in TB recurrence rates between the G and C arms was statistically significant (p = 0.02). Gastro-intestinal symptoms occurred in 23%, 22% and 9% of patients in the G, M and C arms respectively, but most reactions were mild and manageable with symptomatic measures; 1% required regimen modification. CONCLUSIONS: 4-month thrice-weekly regimens of gatifloxacin or moxifloxacin with isoniazid, rifampicin and pyrazinamide, were inferior to standard 6-month treatment, in patients with newly diagnosed sputum positive pulmonary TB. TRIAL REGISTRATION: Clinical Trials Registry of India CTRI/2012/10/003060.

Uveitis is considered a rare complication of leptospirosis. This report describes an epidemic of uveitis among patients with leptospirosis and provides data, using polymerase chain reaction (PCR) amplification of Leptospira DNA, that the pathogenesis is associated with anterior chamber spirochetes. Forty-six uveitis patients, 49 uveitis controls, and 54 cataract controls were enrolled at Aravind Eye Hospital (Madurai, India). Leptospiral DNA was detected by PCR of aqueous humor; serum antibody titers were determined by ELISA and microagglutination (MAT). Thirty-seven uveitis patients (80%) demonstrated leptospiral DNA compared with 5 controls (8%; P < .001). Thirty-three uveitis patients (72%) had positive serology compared with 10 uveitis controls (20%) and 13 cataract controls (24%; P < .001). This report describes the largest cluster of patients with leptospiral uveitis and identifies six clinical characteristics that provide a diagnostic profile for leptospiral uveitis. This profile will be important for determining treatment regimens in countries where PCR and MAT are not available.

SETTING: The currently recommended dosages of rifampicin (RMP), isoniazid (INH), pyrazinamide (PZA) and ethambutol in children are extrapolated from adult pharmacokinetic studies, and have not been adequately evaluated in children. OBJECTIVE: To describe the pharmacokinetics of RMP, INH and PZA given thrice weekly in children with tuberculosis (TB), and to relate pharmacokinetics to treatment outcomes. METHODS: Eighty-four human immunodeficiency virus negative children with TB aged 1-12 years in Chennai and Madurai, India, were recruited. Phenotypic INH acetylator status was determined. Nutritional status was assessed using Z scores. During the intensive phase of anti-tuberculosis treatment, a complete pharmacokinetic study was performed after directly observed administration of drugs. At 2 and 6 months, drug levels were measured 2 h post-dose. Drug concentrations were measured using high performance liquid chromatography and pharmacokinetic variables were calculated. Multivariable regression analysis was performed to explore factors impacting drug levels and treatment outcomes. RESULTS AND CONCLUSIONS: Children aged <3 years had significantly lower RMP, INH and PZA concentrations than older children, and 90% of all children had sub-therapeutic RMP Cmax (<8 μg/ml). Age, nutritional status and INH acetylator status influenced drug levels. Peak RMP and INH concentrations were important determinants of treatment outcome. Recommendations for anti-tuberculosis treatment in children should take these factors into consideration.

A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.

P-glycoprotein, encoded by ATP-binding cassette transporters B1 gene (ABCB1), renders multidrug resistance (MDR) during cancer chemotherapy. Several synthetic small molecule inhibitors affect P-glycoprotein (P-gp) transport function in MDR tumor cells. However, inhibition of P-gp transport function adversely accumulates chemotherapeutic drugs in non-target normal tissues. Moreover, most small-molecule P-gp inhibitors failed in the clinical trials due to the low therapeutic window at the maximum tolerated dose. Therefore, downregulation of ABCB1-gene expression (P-gp) in tumor tissues seems to be a novel approach rather than inhibiting its transport function for the reversal of multidrug resistance (MDR). Several plant-derived phytochemicals modulate various signal transduction pathways and inhibit translocation of transcription factors, thereby reverses P-gp mediated MDR in tumor cells. Therefore, phytochemicals may be considered an alternative to synthetic small molecule P-gp inhibitors for the reversal of MDR in cancer cells. This review discussed the role of natural phytochemicals that modulate ABCB1 expression through various signal transduction pathways in MDR cancer cells. Therefore, modulating the cell signaling pathways by phytochemicals might play crucial roles in modulating ABCB1 gene expression and the reversal of MDR.

Purpose The purpose of this study is to test the thesis that the family firm’s success hinges on effective strategic knowledge management (SKM) capability coupled with an entrepreneurial orientation (EO). Contingency theory holds that entrepreneurial success is contingent on strategic capabilities and resource orchestration theory explains how well family firms nurture capabilities to structure, bundle and leverage resources that define competitive advantage (CA). This study combines these two theoretical viewpoints to propose the effects of EO and SKM capability on CA to achieve successful performance in family firms. Design/methodology/approach This study uses a hybrid approach applying structural equation modelling (SEM) and deep-learning artificial intelligence (DL-AI) analysis to survey data on 268 Malaysian family firms. Findings SEM results confirm that CA mediates the relationship between innovativeness, proactiveness and risk-taking dimensions of EO and firm performance. Autonomy and competitive aggressiveness have no bearing, however. The relationships among innovativeness, proactiveness and risk-taking with CA and performance are positively moderated by SKM capability, becoming more potent at higher levels. Moreover, four additional DL-AI models reveal the necessity of specific EO dimensions and the interacting effects of EO–SKM capability to influence CA and to attain performance success subsequently. Originality/value This study theorizes and presents two new boundary conditions to a knowledge-based theory of the family firm and its firm performance. First, CA mediates the relationship between EO and performance; and second, SKM capability moderates the relationships between EO and CA and between EO and family firm performance. Methodologically, this study uses DL-AI to embrace non-linearity and prioritize predictor variables based on normalized importance to produce greater accuracy over regression analysis. Hence, DL-AI adds methodological novelty to the knowledge management and family firm literature.

Running waters contribute substantially to global carbon fluxes through decomposition of terrestrial plant litter by aquatic microorganisms and detritivores. Diversity of this litter may influence instream decomposition globally in ways that are not yet understood. We investigated latitudinal differences in decomposition of litter mixtures of low and high functional diversity in 40 streams on 6 continents and spanning 113° of latitude. Despite important variability in our dataset, we found latitudinal differences in the effect of litter functional diversity on decomposition, which we explained as evolutionary adaptations of litter-consuming detritivores to resource availability. Specifically, a balanced diet effect appears to operate at lower latitudes versus a resource concentration effect at higher latitudes. The latitudinal pattern indicates that loss of plant functional diversity will have different consequences on carbon fluxes across the globe, with greater repercussions likely at low latitudes.

Abstract E‐waste generation is rising apace, and it is estimated that e‐waste production could reach 74.7 Mt by 2030. Hence, it is essential to develop tactics and methodologies for the formal management and treatment of e‐waste. The implementation of the concepts of a circular economy (CE) has been perceived as an efficient methodology for the efficacious management of such waste; however, the transition process from the linear economy to CE still involves several barriers. There are only a few studies that have integrated the concept of CE with e‐waste management for sustainability. This study will focus on the UK's household e‐waste management sector to identify and analyze the key barriers that impede the transition of the UK's e‐waste management sector to the CE model. For this purpose, a team of experts was formulated and their expertise was captured using the Decision‐making trial and evaluation laboratory (DEMATEL) methodology. The DEMATEL technique employs critical evaluation principles, measures the weights of the evaluation criteria, and helps in finding the most critical barriers through a visual structural model. The DEMATEL method also categorizes the factors into cause‐and‐effect groups and utilizes a visualization model to simplify the interdependence and intensity of the impacts of the various factors. The results revealed that the “Lack of processing technologies,” “Lack of returns and profits,” “Lack of expert knowledge,” “Lack of effective guidance and standards for the proper collection methods,” and “Lack of proper knowledge” are the most significant barriers obstructing the adoption of CE in the management of e‐waste in the United Kingdom. Thus, the government needs to take strong actions to give financial support in terms of incentives to the stakeholders for effective e‐waste handling.

Early diagnosis of breast cancer is essential to save lives of patients. Usually, medical datasets include a large variety of data that can lead to confusion during diagnosis. The Knowledge Discovery on Database (KDD) process helps to improve efficiency. It requires elimination of inappropriate and repeated data from the dataset before final diagnosis. This can be done using any of the feature selection algorithms available in data mining. Feature selection is considered as a vital step to increase the classification accuracy. This paper proposes a Modified Bat Algorithm (MBA) for feature selection to eliminate irrelevant features from an original dataset. The Bat algorithm was modified using simple random sampling to select the random instances from the dataset. Ranking was with the global best features to recognize the predominant features available in the dataset. The selected features are used to train a Random Forest (RF) classification algorithm. The MBA feature selection algorithm enhanced the classification accuracy of RF in identifying the occurrence of breast cancer. The Wisconsin Diagnosis Breast Cancer Dataset (WDBC) was used for estimating the performance analysis of the proposed MBA feature selection algorithm. The proposed algorithm achieved better performance in terms of Kappa statistic, Mathew’s Correlation Coefficient, Precision, F-measure, Recall, Mean Absolute Error (MAE), Root Mean Square Error (RMSE), Relative Absolute Error (RAE) and Root Relative Squared Error (RRSE).

In this study, we analyzed 53 oral squamous-cell carcinomas among Indians for the presence of alterations in the tumor-suppressor gene p53 by PCR-SSCP and sequencing methods. Our results showed that 21% (11/53) of oral carcinomas analyzed carried mutations within the exons 5-8 of the p53 gene. We have identified 11 single-base pair substitutions consisting of 10 mis-sense mutations and one at the splice acceptor site, and one deletion mutation involving 4 consecutive bases. The majority of the base substitutions were transitions (5 TA to CG and 5 GC to AT), while only one transversion (TA to GC) was observed. Probable hot-spots for the mutation induction were identified at codons 149 and 274, which have not been observed before in head-and-neck cancers. The mutational spectrum might have originated from base alkylations at guanine and thymine residues, caused by some alkylating agents. The present results are thus consistent with the involvement of tobacco-related nitrosoamines in the etiology of oral squamous-cell carcinoma.

BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).

Abstract Despite increasing concern for corporate environmental responsibility in numerous industries, the relationship between green innovation strategy (GIS) and idiosyncratic risk is a rarely scrutinised topic, particularly in the automotive domain. In this study, we empirically explore the association between GIS and idiosyncratic risk and analyse the moderating role played by the firm's competitive action. We rely on the secondary information sourced for 132 top automotive firms, in the period ranging from 2011 to 2017 by applying the system generalised methods of moments estimator to the dynamic panel data model. Our findings indicate that GIS significantly reduces the idiosyncratic risk of all firms, and this relationship strengthens with the increase in the competitive action of the firms. Our evidence supports “it pays to be green” firm heterogeneity argument. This study highlights the academic and managerial implications and focuses on the environmental issues published in environmental management literature.

BACKGROUND: Validity of Friedewald formula (FF) in patients with serum triglycerides (TGs) <400 mg/dl is unclear. MATERIALS AND METHODS: We compared low-density lipoprotein (LDL)-cholesterol calculated by FF to directly measured LDL in a laboratory database of 14,620 lipid profile samples from south India. RESULTS: LDL by FF correlated with directly measured LDL with correlation coefficient of 0.89 with the best correlation seen in TG levels 100-150. Higher level of TG (>200) underestimates the LDL calculated by FF particularly at LDL values <70 mg/dl. On the other hand, LDL is overestimated by FF in more than 70% of cases at LDL levels >130 mg/dl. CONCLUSION: We suggest repeating the LDL by direct assay techniques particularly in patients with TG >200 and when LDL <70 or >130. This helps in correctly stratifying the coronary artery diseases' (CADs') risk and goals of treatment.

Abstract The business world is becoming increasingly complex, disrupted, and uncertain. As Industry 4.0 (I4.0) takes shape, to endure this change and focus on growth, industries must learn to embrace change and move quickly; this is particularly so for the automotive industry, which is a major sector of any economy. Agility is needed to embrace this change and promote sustainability across every industry. To face these contingencies, it is essential to identify and understand the strategies that can aid industries in sustaining real‐time scenarios. In this paper, we aim to assess the agility indicators that bring resilience to the inclusion of I4.0 and sustainability in the automotive sector. The unexpected changes in the environment related to sustainability and technological disruptions of I4.0 require the identification of sustainable agile mitigation strategies to manage such situations. The fuzzy Delphi methodology assesses agility indicators based on a questionnaire for prioritization. Further, the fuzzy technique for order performance by similarity to ideal solution (TOPSIS) is utilized to prioritize these agility indicators with the agility strategies that manufacturing industries can deploy to enhance the sustainability of their operations. The fuzzy extension to the methodologies helps in incorporating vagueness and ambiguity in the decision‐making process. A fuzzy approach to prioritizing agile strategies as the industries are changing is helpful. The decision makers have only a few clear ideas about how best to integrate them. Among the agile strategies, “resilience,” “technological capabilities,” and “customer‐centric innovation” are the top strategies. By executing the strategies suggested in the study and understanding the agility indicators, practitioners can ensure resilience in the work systems and minimize the impact of the disruptions caused by the industrial revolution. Thus, this research has been underpinned by the organizational change theory and discusses all mitigation strategies concerning the rapid changes organizations are facing with the fourth industrial revolution.

Purpose The purpose of this paper is to measure the influence of peers, and the Government and non-governmental organization (NGO) initiatives on an individual’s attitudinal drivers such as environmental knowledge and environmental concern, which are the reasons for their green purchasing intentions. This concept was applied among the Indian young consumers. Design/methodology/approach For the research, a structured online questionnaire was used to obtain responses from 342 Indians from various cities. The participants were 20-25 years of age. SPSS software package was used to refine the data while SmartPLS was used to test the validity of the hypotheses. Findings The findings revealed that the Government and NGO initiatives along with peer influence do have a significant effect on a consumer’s environmental knowledge and environmental concerns. Further, this study found a significant positive effect of environmental knowledge and environmental concern on perceived value. In turn, the perceived value had a direct positive impact on green attitude leading to green purchase intention. Practical implications This paper provides critical insights for marketers, as well as for governmental agencies and NGOs promoting the conservation of the environment through environmental-friendly practices. These parties aim to generate greater awareness among consumers and impart knowledge about the benefits of green practices. Originality/value The studies measuring the impact of external factors on green consumption are scarce. Even the few studies available have measured the direct impact of external factors on green purchase intention. Governmental and NGO initiatives along with peer influence are the stimuli impacting operational factors such as environmental knowledge, environmental concern, perceived value, and green attitude, which, in turn, lead to the response of green purchase intention. This study provides new insights to this relationship by using a stimulus – organism – response framework.

BACKGROUND: Thyroid disorders are common in India but scarce data exists on its prevalence in young women. MATERIALS AND METHODS: This study was conducted in female college students in seven colleges in Madurai District, Tamil Nadu. Thyroid-stimulating hormone (TSH) was used as the screening test to diagnose thyroid dysfunction. The abnormal TSH values were classified as mild TSH elevation (TSH 4.5-10 mIU/ml), significant TSH elevation (TSH > 10 mIU/ml), and low TSH (TSH < 0.4 mIU/ml). RESULTS: A total of 1292 subjects were screened of whom 161 subjects (12.5%) had abnormal TSH. The overall prevalence of elevated TSH was 11% out of which 9.7% had mild TSH elevation. A low TSH was seen in 1.3% of the study population. CONCLUSION: Thyroid dysfunction was common in young women in south India. One out of every eight young women had thyroid dysfunction, and mild TSH elevation was the most common abnormality.

Multilevel inverters have been widely used for high-voltage and high-power applications. Their performance is greatly superior to that of conventional two-level inverters due to their reduced total harmonic distortion (THD), lower switch ratings, lower electromagnetic interference, and higher dc link voltages. However, they have some disadvantages such as an increased number of components, a complex pulse width modulation control method, and a voltage-balancing problem. In this paper, a novel nine-level reduced switch cascaded multilevel inverter based on a multilevel DC link (MLDCL) inverter topology with reduced switching components is proposed to improve the multilevel inverter performance by compensating the above mentioned disadvantages. This topology requires fewer components when compared to diode clamped, flying capacitor and cascaded inverters and it requires fewer carrier signals and gate drives. Therefore, the overall cost and circuit complexity are greatly reduced. This paper presents modulation methods by a novel reference and multicarrier based PWM schemes for reduced switch cascaded multilevel inverters (RSCMLI). It also compares the performance of the proposed scheme with that of conventional cascaded multilevel inverters (CCMLI). Simulation results from MATLAB/SIMULINK are presented to verify the performance of the nine-level RSCMLI. Finally, a prototype of the nine-level RSCMLI topology is built and tested to show the performance of the inverter through experimental results.