Antibody Response to SARS-COV-2 Vaccination in Healthcare Workers of Uttarakhand: A Prospective Follow-up Study

Background: Countries around the world are now racing to vaccinate people against SARS-CoV-2, the virus that causes COVID-19. The Government of India also rolled out its vaccination drive from 16th January ‘2021. Aims: To estimate the antibody response of the COVID-19 vaccine in the form of SARS-COV-2 IgG antibodies in vaccinated healthcare workers. Methods: Prospective follow-up was study conducted on healthcare workers (HCWs) of a Medical college in Dehradun, Uttarakhand. Healthcare workers who have been vaccinated for COVID-19 were tested for SARS-CoV-2-IgG antibodies at regular intervals i.e at 4 weeks after the 1st dose and then again at 4 weeks after the 2nd dose. The third sample was taken 6 months after the 2nd dose. Results: A total of 302 HCWs were enrolled in the study who gave their samples for IgG antibody estimation after the Covishield vaccine. After 4 weeks of completion of both doses, 96% HCWs formed SARS-COV-2 IgG antibodies, whereas 4% didn’t. Then after 6 months of follow-up, 14% HCWs have become negative for antibodies and better immunity is seen in people who also got infected with COVID-19 during this time. Conclusion: This study concludes that the immunity gained after vaccination is waning off in around 6 months and there is a need for a booster dose, especially for people at high risk. The infection control practices still play a crucial role in the prevention of this deadly disease.

Bordetella trematum bacteremia in an infant: A cause to look for.

Bordetella trematum spp. nov. has been isolated from wounds, ear infections and diabetic ulcers. We report a case of a 7‑month‑old infant with fever, vomiting and abnormal body movements with bacteremia caused by this novel species. The infant responded to fluoroquinolone and macrolide combination therapy.

Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity.

Background & objectives: Early neurological deterioration (END) occurs in about 20 to 40 per cent of patients with acute ischaemic stroke and results in increased mortality and functional disability. In recent studies relative dehydration has been found to be associated with END in patients with acute ischaemic stroke. This study was conducted to identify factors useful for predicting END and to assess the role of blood urea nitrogen/creatinine ratio (BUN/creatinine) and urine specific gravity (USG) as predictors of END in patients with acute ischaemic stroke. methods: The present study was an observational prospective study. Various parameters comprising demographic, clinical, laboratory and radiological variables along with stroke severity were assessed and studied as predictors of early neurological deterioration in 114 consecutive patients presenting to the Emergency department during 2012. BUN/creatinine >15 and USG >1.010 were studied as markers of relative dehydration contributing to END. results: of the 114 patients enrolled in the study, END was observed in 25 (21.9%) patients. National Institutes Health Stroke Scale score (NIHSS) ≥ 12 at admission was found to be an independent risk factor for END. Amongst markers of relative dehydration, BUN/creatinine >15 at admission was found to be an independent risk factor for END, as also USG >1.010. Also, cerebral oedema and size of hypodensity >1/3rd of the middle cerebral artery territory on cranial CT were observed to be independent risk factors for END. Interpretation & conclusions: Our study findings highlighted a possible association of relative dehydration, as indicated by BUN/creatinine ratio >15, with END along with other parameters like stroke severity at presentation, extent of hypodensity >1/3rd of the middle cerebral artery (MCA) territory and cerebral oedema. Dehydration being a treatable condition, the use of BUN/creatinine >15 as a marker of relative dehydration, can be helpful in detecting patients with dehydration early and thus play a role in preventing END.

Central nervous system activity of an aqueous acetonic extract of Ficus carica L in mice.

Background: Ficus carica Linn. is reported to possess variety of activities, but its potential in CNS disorders is still to be explored. Objective: The present study was carried out to evaluate the CNS depressant activity of aqueous acetonic extract of Ficus carica Linn on different models in mice. Materials and Methods: The aerial parts of the plant Ficus carica L. were extracted with aqueous acetone and the solvent was removed by rotary vacuum evaporator under reduced pressure. A crude extract was given orally and its effects were tested on ketamine-induced sleeping time, muscle-coordination, anxiety (elevated-plus maze and Staircase test), convulsions [maximal electroshock (MES) and pentylenetetrazole (PTZ)-induced seizures], and nociception. In addition, we determined the levels of neurotransmitters, norepinephrine (NE) and 5-hydroxytryptamine (5-HT). Results: Results from the experimental models tested showed: (1) a delay on onset and prolongation of sleep of ketamine-induced sleeping time; (2) signifi cant muscle relaxant activity; (3) a signifi cant attenuation in the anxiety-response (4) a delay in the onset of seizures and reduction in duration of seizures and mortality induced by MES and PTZ; (5) a reduction in the licking time in nociception test and (6) increased levels of NE and 5-HT. Conclusion: This suggests that Ficus carica L. exerts its CNS depressive effect by modulating the neurotransmitters NE and 5-HT in the brain.

Fat embolism syndrome.

Fat embolism syndrome is a rare complication occurring in 0.5 to 2% of patients following a long bone fracture. It is believed to be caused by the toxic effects of free fatty acids. Diagnosis is clinical, based on respiratory, cerebral and dermal manifestations. Treatment is only supportive, directed mainly at maintaining respiratory functions.

Early diagnosis of neonatal sepsis using a hematological scoring system.

OBJECTIVE: To assess the utility of the hematologic scoring system (HSS) of Rodwell et al for the early detection of neonatal sepsis. DESIGN: Analysis of the peripheral smear findings according to the HSS by a pathologist blinded to the infection status of the neonate. SUBJECTS: One hundred and three high risk neonates having predisposing perinatal factors or clinical suspicion of sepsis. RESULTS: Analysis of the hematologic profiles in the light of the HSS found that an abnormal immature to total neutrophil (1:T) ratio followed by an abnormal immature to mature neutrophil (1:M) ratio were the most sensitive indicators in identifying infants with sepsis. These two criteria along with thrombocytopenia (< 1,50,000/cm3) had a high negative predictive value over 94%. The study also found that the higher the score the greater the certainty of sepsis being present. CONCLUSION: The HSS is simple, quick, cost effective and readily available tool in the early-diagnosis of neonatal sepsis and could provide a guideline to decisions regarding antibiotic therapy.

FNAC of papillary and solid epithelial neoplasm of pancreas--a case report.

A case of solid papillary epithelial neoplasm (PSEN) of pancreas in a young woman is reported in which the nature of tumour was recognised pre-operatively by ultrasound guided Fine needle aspiration. The pre-operative cytologic diagnosis enabled prompt and appropriate surgical treatment. FNAC revealed large cell clumps in the aspirate showing branching papillary appearance in which multiple layers of tumour cells surrounded central vascular stalks. The above was confirmed on histopathological examination of the excised tumour tissue.

Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi.

Ninety neonates were ventilated over a period of 33 months of whom 50 (55.5%) survived. Fifty seven babies received IPPV while 33 CPAP. IPPV mode was being used more frequently recently and survival rates have steadily improved over past 3 years. Survival was cent per cent in babies above 1.5 kg on CPAP mode while 16/26 (57.7%) survived on IPPV mode. Of 22 extremely VLBW (< 1 kg) babies, six survived. HMD was the commonest indication of ventilation (50%), of which 53% (24/45) survived. The other important indications of ventilation were apnea in 13 and transient tachypnea in 11 babies. All babies requiring ventilation for transient tachypnea survived. Nosocomial infections were common in association with ventilation 34/90 (37.7%), out of which in 14 was responsible for about a third of deaths. Pulmonary air leaks developed in 12 babies of which 6 died. Two babies developed BPD and one ROP. Neonatal ventilation should be ventured in centres where basic facilities for level II care already exist. It may not be cost effective to ventilate extremely low birth weight neonates.