Role of Itolizumab in the Treatment of COVID-19 Patients, Admitted to ICU at a Tertiary Care Hospital

Background: Clinical studies have correlated severe deterioration of COVID-19 patients due to excessive and uncontrolled production of cytokines. There is a pressing need to explore therapies, which could prevent the cytokine storm rather than terminating it. Aims and objectives: The aim of the study is to evaluate the effect of itolizumab on clinical outcomes of patients with moderate-severe COVID-19 disease admitted to ICU. The primary aim of the current study is to find out any mortality benefit in 14 days. The secondary aim is to assess the morbidity outcomes in terms of reduction in inflammatory markers and also the duration of hospital stays to assess the prognostication. Materials and methods: It is a retrospective case-control study in which laboratory-confirmed COVID-19 patients admitted to ICU were taken. A total of 62 patients were recruited, 31 patients received itolizumab (cases/treatment group) and 31 patients didn’t receive itolizumab (designated as controls). Results: Among the total patients recruited, 68% of the study population was male and 32% were female. A total of 12 patients expired among cases and 13 expired among controls. Overall mortality in both groups was noted to be almost similar. The control group showed mortality at lower computed tomography (CT) scores compared to the cases. There is a significant reduction in inflammatory markers, like interleukins-6 (IL-6) and D-dimer in cases compared to the control group. Conclusion: In conclusion, treating patients with cytokine storms before they require intubation/mechanical ventilation is crucial to preventing deaths. Itolizumab has shown no clinical benefit in critically ill COVID-19 patients, however, timely initiation of itolizumab therapy may serve as a key therapeutic option in preventing the mortality and morbidity outcomes in moderate-severe COVID-19 patients.

Disparity in Relation to Covid-19 Preventive Behaviour and Associated Myths among Rural and Urban Residents of Lucknow: A Community Based Study

Introduction: For curbing Covid-19 disease, adequate knowledge, attitude, and practices of both rural and urban population for Covid-19 disease prevention is required along with busting of the associated myths. Objectives: To assess the Knowledge, Attitude and Practices of urban and rural residents of Lucknow district regarding covid-19 preventive behaviour and associated myths. Methodology: A community-based study was conducted among 420 rural and 421 urban residents of Lucknow. Multistage random sampling was done to select the study subjects. A pre-designed pretested semi-structured questionnaire was used to collect the information regarding the Knowledge, Attitude and Practices of the residents for covid19 disease causes, prevention, and treatment. Further, KAP scoring was done to compare the two groups. Results: The mean age of the rural and urban residents was 31.48 ± 12.05 and 30.93 ± 11.96 years respectively. Only 40.4 % urban and 25.5 % rural people had correct knowledge about social distancing (p<0.0001). Knowledge regarding quarantine for covid-19 disease prevention was less among the urban residents (64.6%) as compared to rural (70.5%) (p=0.035). More than one-third (37.6%) of the rural resident believed in the myth that alcohol can prevent the covid-19 disease (p=0.003). 68.8 and 70.5 percent rural and urban residents had positive attitude towards the Indian government’ efforts in curbing the disease. Majority of the urban (90%) and rural (87.6%) residents wore mask when they went out. Only one-fourth of the urban (24.7%) and rural (22.9%) had correct practices for the duration of hand washing. Conclusion: The knowledge was more among the urban people, attitude and practices were almost similar among both the rural and urban residents while myths were more observed among the rural residents.

A Five Year Retrospective Study of Profile of Leprosy Patients in a Teaching Tertiary Care Centre in Uttarakhand

Despite India reaching elimination levelsas a public health problem, leprosy still remains a major health care problem. The aim of our study is to determine the morphological pattern and the trend of acid-fast bacilli (AFB) positivity of the disease in the post eradication phase. A retrospective study was conducted of skin biopsies clinically diagnosed as leprosy from January 2015 to December 2019. Relevant clinical history was obtained from records. Majority were in the age group of 31-40 years (20%), with male predominance (61.25%). 10.62% cases were of children below the age of 15 years. Histologically, 38.75% of cases were diagnosed as indeterminate leprosy followed by 20% cases of lepromatous leprosy. Hypopigmentation (35.62) was the most common clinical feature. Clinical-histological concordance was highest for histioid leprosy cases (100%) followed by lepromatous leprosy (90.62%). Majority of our cases were multibacillary (71.25%). BI 1+ was seen in 51.75%, whereas BI 6+ was 11.4%. Predominance of multibacillary forms specially with high bacterial load indicates late reporting and need to diagnose and treat early for stopping its transmission. Histopathological examination of skin biopsy is important for early and proper treatment of the patients with early inderminate/atypical clinical manifestations. The health care policies need to be reconsidered and revised both at the national and global levels

Congenital rubella syndrome: A brief review of public health perspectives

Congenital rubella syndrome (CRS) is one of the most devastating congenital infections and yet the only one which is vaccine preventable and is a public health challenge for clinicians and policymakers across the developing world including India. The clinical manifestations of CRS include growth retardation, cardiac defects, cataracts, and hearing impairment. The World Health Organization (WHO) estimates that worldwide over 100,000 babies are born with CRS every year despite the availability of safe and inexpensive vaccines, thus highlighting the need for broader vaccination coverage programs. This article briefly reviews the importance of CRS, the proposed strategies for prevention by the WHO, and the 揜ubella initiative� that Government of India is launching in view of the recognition of CRS as a significant problem in India.

Association of mycobacterium tuberculosis in the causation of Eales' disease: An institutional experience.

Background: Eales’ disease is an idiopathic retinal vasculitis characterized by retinal infl ammation, ischemia, and neo-vascularisation. It frequently causes massive vitreous haemorrhage and retinal detachment leading to blindness. Although the exact etiology is unknown, this condition is considered to be a consequence of hypersensitivity reaction to tubercular protein due to previous Mycobacterium tuberculosis (M. tuberculosis) infection. This study is aimed at the detection of association of M. tuberculosis in patients with Eales’ disease. Materials and Methods: A prospective case-control study was undertaken in 65 clinically diagnosed cases of Eales’ disease. Patients with proliferative diabetic retinopathy, neo-vascular proliferation, macular oedema, premacular fi brosis and tractional retinal detachment were taken as controls. M. tuberculosis DNA was detected (MPT64 gene by polymerase chain reaction, PCR) in patients with Eales’ disease. Clinical symptoms along with tuberculin skin test (TST) and erythrocyte sedimentation rate (ESR) were used as gold standard for comparing results of PCR. Result: PCR positivity was found in 12 (38.7%) patients with Eales’ disease. The PCR positivity was signifi cantly associated with the patients with high TST reading and high ESR values. Conclusion: Patients with a high TST reading and ESR value and a positive PCR in vitreous samples have a high likelihood of having M. tuberculosis as an etiology.

Effect of cyanobacterial exopolysaccharides on salt stress alleviation and seed germination.

Effect of exopolysaccharides (EPS) produced by a consortium of cyanobacteria on germination of three crops wheat, maize and rice was studied at different salt concentrations. Production of EPS was found to be stimulated by salts, which in turn had a significant Na+ removal capability from aqueous solution. Seed germination, vigor index and mobilization efficiency in all the three crops remarkably improved when cyanobacterial EPS was applied. While germination improved significantly by 13 to 30%, mobilization efficiency increased marginally by 1.03 to 1.1 times and vigor index increased by 1.15 to 2.4 times in these crops in response to EPS under non-saline conditions. Salinity had an inhibitory effect on seed germination of all the species showing 18 to 54% reduction. However, in the presence of EPS, the salt induced inhibition diminished to 13 to 18%. Inhibitory effect of salt on chlorophyll concentration, vigor index and mobilization efficiency of the seedlings was much less in these crops in the presence of EPS, indicating the latter’s role in salt stress alleviation.

Cardiovascular risk factors in tobacco-chewers: a controlled study.

BACKGROUND : Influence of habitual tobacco chewing on cardiovascular risk has not been well studied. To determine prevalence of major cardiovascular risk factors in subjects who habitually chew tobacco we performed a controlled study. METHODS : A population based case-control study was performed in Bikaner in North-western India where the prevalence of tobacco-chewing is high. Successive 200 subjects who agreed to participate in the evaluation and had a history of isolated tobacco-chewing (range 10-60 years) were enrolled (Group III). The prevalence of major coronary risk factors- obesity, truncal obesity, hypertension, fasting hyperglycemia, and lipid levels were estimated using current guidelines. Electrocardiogram was also performed in all subjects. Chest radiography and treadmill stress test was done in subjects when indicated by symptoms. 200 age- and gender-matched controls who did not use tobacco in any form (Group I) and 200 subjects who had history of smoking bidis or cigarettes for more than 10 years (range 10-55 years) (Group II) were also evaluated. RESULTS: The body-mass index and obesity were lowest in smoker group. Tobacco chewers had a significantly higher (p<0.001) systolic blood pressure (BP), diastolic BP, resting heart rate, total cholesterol, LDL cholesterol and triglycerides as compared to controls and was similar to smoker group. There was a significantly greater (p<0.01) prevalence of hypertension, hypercholesterolemia, hypertriglyceridemia, radiographic cardiomegaly and positive stress test in Group III as compared to controls. Prevalence of these risk factors was similar among Group II and Group III subjects. HDL cholesterol levels were the lowest in tobacco-chewing group (44.3+/-8.1 mg/dl) as compared to the Group I (48.4+/-7.8) and Group II (47.4+/-7.5) (p<0.001). CONCLUSIONS : There is a significantly greater prevalence of multiple cardiovascular risk factors obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking, as compared-to tobacco non-users. Chewing tobacco is associated with similar cardiovascular risk as smoking.

Groundwater quality assessment in different land-use areas of Faridabad and Rohtak cities of Haryana using deviation index.

Physico-chemical parameters were analysed to evaluate the groundwater quality of the two important cities of Haryana, Faridabad and Rohtak, and the pollution status of groundwater was compared using deviation index (DI). Groundwater of both the cities had high alkalinity, hardness, total dissolved solids (TDS) and electrical conductivity. The groundwater of Faridabad showed low fluoride concentration whereas in 74% of groundwater samples of Rohtak the fluoride levels were high. Land use and waste disposal practices were found to have an important effect on groundwater pollution.

Heavy metal pollution in various canals originating from river Yamuna in Haryana.

Heavy metal pollution due to Fe, Ni, Pb, Cd, Co and Zn in the water of major canals originating from the river Yamuna in Haryana was studied. All these metals except Zn were found to be present in the Western Yamuna Canal (WYC) exceeding the maximum permissible limits. In the Sunder branch (SB), the heavy metal concentration was relatively more. Concentrations of the metals were, however, relatively less in the highly eutrophicated waters of Agra canal and Gurgaon canal as compared to that in WYC but Fe concentration were much higher. Except Zn and Ni the metal concentrations exceeded the standard permissible limits in these canals also.

Water quality index and suitability assessment of urban ground water of Hisar and Panipat in Haryana.

Ground water quality in two well-developed cities of Haryana, viz. Hisar and Panipat was assessed for drinking purpose based on water quality parameters like pH, EC, turbidity, TDS, alkalinity, total hardness, calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), chloride (Cl), nitrate (NO3), phosphate (PO4), sulphate (SO4) and fluoride (F) with respect to different land-use areas viz. residential, industrial, commercial and agricultural. Water quality index based on 9 parameters showed that at Panipat, underground water in all the land-use zones was fit for consumption (WQI < 50), whereas at Hisar, water in agricultural areas was good in quality, but that in other areas varied in magnitude of pollution (WQI > 50 to 100).

Association of cerebral palsy with epilepsy.

Fifty patients of various types of cerebral palsy were studied to find out an association between cerebral palsy, EEG abnormalities and development quotient. Seventy-six per cent patients had spastic cerebral palsy. Hypotonic cerebral palsy was the next common type (14%). Athetosis and ataxic forms were found to be rare (2% each). Epilepsy was associated with 56% patients. Clinical types of seizures observed were: Generalised tonic-clonic (43%), myoclonic (17.9%), generalised tonic (10.7%), partial simple (10.7%) and partial complex (17.9%). The incidence of seizures was highest in hypotonic type in which 85.7% had epilepsy. Mean developmental quotient of cerebral palsy patients was 34.9% with maximum retardation in hypotonic cerebral palsy (25.14%). Sixty per cent of patients had abnormal EEG, out of these hypotonic patients had maximum (70%) chances of EEG abnormality followed by spastic patients (55%). Developmental retardation was more severe statistically in the patients with abnormal EEG than normal EEG.

Malarial placental infection and low birth weight babies.

Two-hundred fifty-six mothers and their newborns were subjected to clinical and haematological tests for the evidence of malaria. Placentae of these were examined histopathologically for malarial parasites and malarial pigment. Forty six placentae showed scanty malarial pigment ingested by monocytes. These appearances were associated with focal syncytial necrosis and proliferation of cytotrophoblastic cells. Plasmodium falciparum was found in cord blood of six cases. The mean weight of newborns born to mothers having no evidence of malarial placental infection was 2.763 kg, while mean weight of newborns belonging to infected placentae was 2.143 kg. The difference was highly significant.

T and B cell status in bronchiolitis and bronchial asthma.

Immunologic status of 43 children, 13 with bronchiolitis and 30 with bronchial asthma was studied, and compared with 10 infants and 16 healthy children of respective control groups. Humoral immunity was assessed by absolute eosinophil count and B cell count (EAC rosette method) and cellular immunity by T cell count (E rosette method) and DNCB skin test. B cell subset of lymphocytes were raised in both the study groups but associated significant eosinophilia was seen only in bronchial asthma. The study demonstrated significantly lower mean T cell count and depressed DNCB reactivity in children of bronchial asthma. Children with bronchiolitis too had significantly lower mean T cell count. Thus both humoral and cellular immunity were altered in children with bronchial asthma and bronchiolitis.