Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting

Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (? or ?60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants – ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post- omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months

Stroke � Next Wave of Complications from COVID-19

Since the declaration of COVID-19 infection as Pandemic in March, 2020, There has been rise in Multisystem Complications apart from regular Acute Respiratory Syndrome which is hallmark of COVID-19 infection. As the second wave surge of COVID-19 has occurred, most of the patients already suffered from dyspnoea but also rare complications like CVA (Infarct and Haemorrhage) , Seizure and altered sensorium related to Hypoxic Brain Injury. COVID-19 frequently presents with a state of altered coagulability which increases the risk of pulmonary embolism and other Thrombotic events such as Cerebrovascular events. This case report is limited to Neurological complications seen in COVID-19 Infected patients

In vitro ?-amylase and ?-glucosidase inhibitory potential of Pleurotus ostreatus cv. Florida extract

Pleurotus ostreatus cv. Florida is one of the widely used edible mushroom. The polysaccharides from this mushrooms have been studied for antidiabetic potential; however, no efforts have been made to explore the potential of this mushroom to influence carbohydrate metabolizing enzymes viz. ?-amylase and ?-glucosidase. The present work was undertaken to investigate the inhibitory potential of Pleurotus ostreatus cv. Florida on enzymes ?-amylase and ?-glucosidase. Several concentrations of extracts were used to study inhibition of enzymatic activity of ?-amylase and ?-glucosidase. A dose dependent inhibitory effect on enzymes was observed. The current study, for the first time, uncovered ?-amylase and ?-glucosidase inhibitory potential of Pleurotus ostreatus cv. Florida. The study could be helpful to isolate and characterize compounds responsible for it.

COVID-19 Associated Mucormycosis with Newly Diagnosed Diabetes Mellitus in Young Males - A Tertiary Care Experience

Abstract Introduction Patients with a history of or active COVID-19 infection are predisposed to the development of opportunist bacterial and fungal infections. A rising incidence of a rare occurring fungal infection earlier, called mucormycosis, has been reported in abundance across the globe since March 2021, especially in India just as the second wave of COVID-19 began, caused by the trifecta of hyperglycemia (new-onset or exacerbation of pre-existing diabetes), oxygen therapy (invasive or noninvasive ventilation), and prolonged intake of steroids. Objective The present study aimed at assessing the prevalence of post-COVID mucormycosis in males of younger age group and spread of rhino-orbital-cerebral mucormycosis (ROCM). Methods A case-control study was performed over a period of 3 months among 60 male patients with confirmed diagnosis of mucormycosis. Individuals < 40 years old were included in the case group (n = 30), while those > 40 years old were included as controls (n = 30). Disease spread was assessed in three types of ROCM, that is, rhinomaxillary, rhino-orbital, and rhino-orbito-cerebral mucormycosis. Results In the control group, the mean age was 48.47 years old, the mean HbA1c was 10.62 ± 1.88%, with most of them suffering from rhino-orbital mucormycosis. In the case group, the mean age was 31.57 years old, with a mean HbA1c of 10.11 ± 2.46%, and most patients had rhinomaxillary mucormycosis. The duration of steroid intake and mode of oxygen therapy were found to be significant in the severity of ROCM. Conclusion Rising cases of post-COVID mucormycosis have brought to light the fatal consequences of prolonged use of steroids and oxygen therapy towards the development and spread of ROCM among young and middle-aged males.

Psychosocial problems in epilepsy patients in sub-urban Hyderabad

Background: Epilepsy is a common disorder with co-morbidities. It affects physical, emotional, psychological, social, financial and cognitive functioning of the patients. Identification and management of psychosocial problems are important in holistic treatment of epilepsy. There is paucity of literature in psychosocial functioning in epilepsy. Aim: To find out the occurrence of psychosocial problems in patients with epilepsy. Materials and methods: One hundred consecutive patients attending the OPD of Internal Medicine were evaluated with a questionnaire subserving seven domains of psychosocial functioning with inclusion and exclusion criteria. Results: The occurrence of depression, emotional instability, inter personal relationship and vocational difficulties were higher in patients with epilepsy. Conclusion: Psychosocial co-morbidities are higher in patients with epilepsy and are likely to be missed unless carefully evaluated.

Psychosocial assessment among ophthalmic patients attending tertiary eye care centre during the lockdown in times of COVID-19 pandemic

Purpose: The coronavirus disease (COVID?19) pandemic continues to play havoc in our lives. During the first “ lockdown” in 2020, we were keen on assessing the anxiety levels of patients who sought ophthalmic care despite the lockdown. Public health actions, such as social distancing, were necessary to reduce the spread of COVID?19. As a result, most people felt isolated and lonely, thereby causing increased levels of stress and anxiety in them. We aimed to assess the anxiety levels using the Hamilton Anxiety Scale and personality assessment using the 57?point Eysenck’s Personality Inventory (EPI) questionnaire among patients visiting a tertiary eye care hospital during the lockdown period. Methods: Consecutive patients attending an ophthalmic tertiary care hospital during the COVID?19 pandemic and lockdown were approached to be a part of this prospective cross?sectional survey. Results: In total, 1,088 responses were analyzed during the 2?month study period with the mean age being 45.7 + 16.9 years. The majority had completed graduation (78%) with 15 years or more of formal education. The purpose of the visit was an emergency consultation in 42% (n = 455), a review appointment in 42% (n = 457), and the remaining (16%, n = 176) came for a routine consultation. The majority of the patients (>90%) did not report experiencing any of the 14 sets of symptoms. A mild level of anxiety was noted in 1,086 (>99%) respondents, whereas only 2 (<1%) respondents showed mild–moderate levels of anxiety. Financial concerns such as affordability of medications (6% vs. 3%, P = 0.05) and fear of losing their job (16% vs. 11%, P = 0.02) were significantly more in those experiencing any anxiety compared to those with no anxiety. Conclusion: Our study revealed that patients visiting a tertiary ophthalmic center during lockdown were graduates, sought eye consultation primarily for emergency or a review, and had no major anxiety symptoms. In those with anxiety, the affordability of medicines and loss of jobs were the main concerns.

Harada-like syndrome post-Covishield vaccination: A rare adverse effect

Covishield is in wide use in India with about 80% efficacy. Serious side effects are still under study. A 30-year-old female presented to us 7 days post-vaccination with a 5-day history of sudden diminution of vision in both eyes. The clinical findings were suggestive of the Vogt-Koyanagi-Harada (VKH) syndrome. She was treated with high-dose oral steroids. At this juncture, the association was unclear. However, it was justified by an acute flare-up of uveitis on day 2 post the second dose of vaccination despite ongoing steroids. A direct correlation of Harada-like syndrome with the Covishield vaccine is observed here

Secondary Bacterial Infection in Patients with COVID 19 Infections Attending a Tertiary Care Hospital in Ahmedabad

Introduction: The COVID-19 disease caused by SARS COV -2 is highly contagious. Many bacterial infections were found among patients with COVID 19 infection. Aim: To estimate the prevalence of secondary bacterial infections in patients infected with COVID 19 infection attending a tertiary care hospital. Methods: Various samples were collected from COVID 19 positive patients showing signs and symptoms of bacterial infection and were subjected to culture examination. Results: In the present study, 47 (6.48%) out of total 725 COVID positive patients were positive for secondary bacterial infections. Klebseilla species followed by Escherichia coli were the most commonly isolated organisms. Pneumonia followed by Urinary tract infection were the most commonly encountered infections in our study. Conclusion: Prevalence of secondary bacterial infections in patients with COVID-19 infection attending our hospital is low. Majority of secondary bacterial infections were seen among admitted patients attributable to longer hospital stays, use of steroid and invasive procedures in such patients.

A study on Perceived Threat, Behavior Change, Lockdown Compliance and Coping Strategies among Indian Adults amid COVID-19 outbreak

Introduction: During the current pandemic, threat perception of people during lockdown, any subsequent change in their behaviour , coping mechanisms along with lockdown compliance used to deal with the crisis in the Indian subcontinent have been important. The study aims to explore prevalence of perceived threat, behaviour change, lockdown compliance, and coping strategies amid COVID-19 outbreak in India. Methodology: This cross-sectional study used a semi-structured online questionnaire. Study applied non- probability snowball sampling technique for data collection. The survey questionnaire included four sections on (a) socio-demographic variables (b) perceived threat (c) lockdown compliance and behaviour change (d) coping strategies. Descriptive statistical analysis was done for the evaluation of data. Results: The responses of 1068 participants with a mean age of 32.92±12.88 years were included for analysis. Nearly half (51%) of the participants reported feeling 'very high' anxiety and about 34% reported to have 'high' anxiety about the spread of coronavirus, on the other hand many (41.6%) of them believed that they had very less chances of getting infected with coronavirus. A large population (89.3%) reported complying to the nationwide lockdown. The major coping mechanism being used by the people is distractions, socializing as well as adaptive coping mechanisms. Conclusion: In the current scenario, there is a concern for India, as due to surge in persons infected with COVID 19 and an indication towards 'optimism bias ' prevalent in people there are chances of poor compliance with government guidelines on behaviour change. The findings of the study will be helpful in designing programs and government measures for the people aimed at ensuring compliance with the guidelines related to social distancing and sanitization and using adaptive coping strategies

Etiological factors of abnormal uterine bleeding according to PALM- COEIN classification in perimenopausal women in a tertiary care centre

Background: Perimenopause is described as years prior to menopause that encompasses the change from normal ovulatory cycle to cessation of menses, ending 12 months after the last menses. International federation of gynaecology and obstetrics (FIGO) developed a new classification PALM-COEIN in order to standardize the factors associated with AUB. It classifies AUB as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia (PALM) - structural abnormalities Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN) - unrelated to structural abnormalities. Objectives of this study were to categorise the causes of AUB in perimenopausal women in context to PALM COEIN classification system. Correlation of co-morbities (diabetes, hypertension and thyroid disorders) with AUB in perimenopausal age group.Methods: This is a retrospective study from the month of May 2019 to October 2019, considering 100 patients of perimenopausal age group (40 to 55 years of age group) in J. K. Hospital Bhopal, Madhya Pradesh with complaints of abnormal uterine bleeding, admitted in gynae ward.Results: Most of the patients in the current study were between 45-50 years of age i.e. 44%. Menorrhagia was the commonest menstrual disorder encountered in 52% of patients. As per FIGO; AUB-L constituted 42% AUB-O constituted 12%, AUB-P constituted 11%, AUB-A 10%, AUB-M constituted 8% AUB-E constituted 8%, not yet classified constituted 4% of total cases.Conclusions: AUB (PALM-COEIN) for causes of abnormal uterine bleeding classification was very useful in categorizing cases of AUB. It suggests that etiology of AUB and also gives place for presence of multiple factors as a cause of AUB in a particular case.

Myroides: An Emerging Pathogen Causing Urinary Tract Infections in Hospitalized Patients

Introduction: The genus Myroides comprises of Gramnegative, non-motile, and non- fermenting bacteria. It is arare opportunistic pathogen but many recent case reports,however, underscore the pathogenic potential that Myroidesspp. possesses for humans. Immunocompromised patients areat higher risk for Myroides infection. Diabetes, catheterizationand ICU stay may increase the chances of acquiring Myroidesinfection.Material and Methods: Urine specimens collected frominpatients were cultured as per standards. Myroides spp.were identified and sensitivity was performed on VITEK® 2Compact™.Results: A total of 16 Myroides spp. isolates were obtainedin the study period. All the isolates were from catheterizedpatients residing in intensive care units. Eleven (69%) patientswere suffering from diabetes mellitus. Extensive resistancewas seen in antibiotic sensitivity results. Minocycline was100% sensitive.Conclusion: Myroides spp. should be considered amongpathogens in hospitalized, catheterized patients. They couldbe extremely drug resistant. Minocycline is a useful antibioticwhile treating UTI caused by Myroides spp.

Prevalence and risk determinants of metabolic syndrome in obese worksite workers in hill city of Himachal Pradesh, India

Objective We report prevalence and risk factors of metabolic syndrome (MS) in the obese workforce of organized sector in hill city of Himachal Pradesh (HP), India. Methods The cross-sectional survey study of employees of organized sectors in Shimla city of HP, India, was conducted to collect data of demographics, health behavior, psychosocial factors, anthropometry, blood pressure, and blood chemistry to measure blood glucose and lipid profile in fasting state in 3004 employees using validated tools. Out of 3004 subjects screened, data of 418 subjects with body mass index of ≥30 are analyzed to estimate the prevalence of MS and its risk determinants. The association of demographics, health behavior, and psychosocial factors as the risk determinants were analyzed using multivariable logistic regression modeling. Results MS was prevalent in 57.6% [95% confidence interval (CI): 52.8%–62.3%]. The central obesity (odds ratio: 10.6, 95% CI: 2.32–48.4) and consumption of frequent or daily alcohol (odds ratio: 1.94, 95% CI: 1.05–3.59),and extra salt (odds ratio: 3.34, 95% CI: 1.09–10.2) were independent risk factors for MS. The consumption of tobacco, vegetables, sugar-sweetened drinks, physical inactivity, and psychosocial factors had no significant association with MS in obese population. Conclusions MS is highly prevalent among obese employees of organized sector. The consumption of alcohol and extra salt were major behavioral risk factors for MS and therefore have important implications in behavioral modifications for prevention of MS among obese employees in organized sectors.

Effect of El Niño Southern Oscillations on the incidence of enteric fever in Ahmedabad, India from 1985 to 2017

To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Niño Southern Oscillations and Indian Ocean Dipole over enteric fever incidence. Method: A total of 29 808 Widal positive enteric fever cases reported by the Ahmedabad Municipal Corporation and local climate data in 1985-2017 from Ahmedabad Meteorology Department were analysed. El Niño, La Niña, neutral and Indian Ocean Dipole years as reported by the National Oceanic and Atmospheric Administration for the same period were compared for the incidence of enteric fever. Results: Population-normalized average monthly enteric fever case rates were the highest for El Niño years (25.5), lower for La Niña years (20.5) and lowest for neutral years (17.6). A repeated measures ANOVA analysis showed no significant difference in case rates during the three yearly El Niño Southern Oscillations categories. However, visual profile plot of estimated marginal monthly means showed two distinct characteristics: an early rise and peaking of cases in the El Niño and La Niña years, and a much more restrained rise without conspicuous peaks in neutral years. Further analysis based on monthly El Niño Southern Oscillations categories was conducted to detect differences in median monthly case rates. Median case rates in strong and moderate El Niño months and strong La Niña months were significantly dissimilar from that during neutral months (P<0.001). Conclusions: El Niño Southern Oscillations events influence the incidence of enteric fever cases in Ahmedabad, and further investigation from more cities and towns is required.

Continuous B scan ultrasound guided post-traumatic sub-periosteal orbital hematoma drainage: An advantage over routine needle drainage procedure / 世界急诊医学杂志（英文）

@#Traumatic orbital haemorrhage is an unfortunate complication with potential vision-threatening consequences.[1-3] The collection of blood can occur anywhere along the potential free orbital spaces,[4] but the subperiosteal collection of the blood is an important clinical variant where careful and timely intervention can give commendable rewards to the surgeon as well as to the patient.[1,2] Subperiosteal hematoma could be traumatic or non-traumatic, in turns, the non-traumatic cases may be due to bleeding tendency as in cases of leukaemia, blood dyscrasia and haemophilia or could be due to vascular malformation, venous congestion, infection, inflammation and neoplastic and non- neoplastic causes.[4] Here in this report, we elaborate the advantage of continuous ultrasound-guided needle drainage of the post-traumatic subperiosteal hematoma to enhance the clinical accuracy and to avoid the untoward complications.

Use of Nicotine Gums, Tablets and Lozenges: A Review.

Difficulty quitting is best predicted by how much one smoke on a daily basis and smoking within 30 min of waking up each day, both of which are measures of nicotine dependence. It has now been established that tobacco smoking often involves dependence to nicotine. This is usually seen as a problem, but often as an opportunity. The cigarette is the most contaminated drug-delivery device. If nicotine is largely what the smoker needs, the use of nicotine from alternative sources to sustain smoking reduction could be exploited for long-term harm reduction to the smoker unable to quit.

Mathematical model-based optimization of physico-enzymatic hydrolysis of Pinus roxburghii needles for the production of reducing sugars.

The objective of this study was to optimize the physico-enzymatic pretreatment of P.roxburghii fallen foliage (needles) to produce reducing sugars through response surface methodology (RSM) with central composite face centered design (CCD). Under this, five parameters, i.e., concentration of laccase, cellulose and xylanase, steam explosion pressure and incubation period, at three levels with twenty six runs were taken into account. Cellulase, xylanase and laccase enzymes with activity 4.563, 38.32 and 0.05 IU/mL, respectively, were produced from locally isolated microbial strains. The analysis of variance (ANOVA) was applied for the validation of the predicted model at 95% of confidence level. This model predicted 334 mg/g release of reducing sugars on treating P.roxburghii fallen foliage with 1.18 mL of cellulose, 0.31 mL of xylanase and 0.01 mL of laccase, 14.39 psi steam explosion pressure and 24 h of incubation time. The experimental results obtained were in good agreement to predicted values, making it a reliable optimized model for five factors in combination to predict reducing sugar yield for ethanol production for bio-fuel industry.

Extraskeletal mesenchymal chondrosarcoma of the pleura: Report of a rare case.

Mesenchymal chondrosarcoma is a rare aggressive variant of chondrosarcoma that frequently occurs in extraskeletal location. A 28-year-old female presented with a history of dyspnea and fever and succumbed to her illness before a conclusive diagnosis was established. An autopsy performed revealed the presence of an extraskeletal mesenchymal chondrosarcoma (ESMC) involving the pleura. Only one case of ESMC of the pleura has been reported previously. Herein, we report the second case of ESMC of the pleura.

Mixed schwannoma with meningioma of the trigeminal nerve.

Mixed tumors composed of schwannoma and meningiomas are extremely rare and are usually associated with neurofibromatosis-2 (NF-2). So far, all the cases reported have involved the cerebello-pontine angle. Only two cases did not have a clear association with NF-2. We report a mixed tumor comprising of meningioma admixed with schwannoma in a 33-year-old male with bilateral trigeminal nerve schwannomas. The patient did not fit the existing diagnostic criteria of NF-2. The relevant literature, along with diagnostic criteria for NF-2 is discussed.