Replication of SARS-CoV-2 in cell lines used in public health surveillance programmes with special emphasis on biosafety

Background & objectives: Polio, measles, rubella, influenza and rotavirus surveillance programmes are of great public health importance globally. Virus isolation using cell culture is an integral part of such programmes. Possibility of unintended isolation of SARS-CoV-2 from clinical specimens processed in biosafety level-2 (BSL-2) laboratories during the above-mentioned surveillance programmes, cannot be ruled out. The present study was conducted to assess the susceptibility of different cell lines to SARS- CoV-2 used in these programmes. Methods: Replication of SARS-CoV-2 was studied in RD and L20B, Vero/hSLAM, MA-104 and Madin–Darby Canine Kidney (MDCK) cell lines, used for the isolation of polio, measles, rubella, rotavirus and influenza viruses, respectively. SARS-CoV-2 at 0.01 multiplicity of infection was inoculated and the viral growth was assessed by observation of cytopathic effects followed by real-time reverse transcription–polymerase chain reaction (qRT-PCR). Vero CCL-81 cell line was used as a positive control. Results: SARS-CoV-2 replicated in Vero/hSLAM, and MA-104 cells, whereas it did not replicate in L20B, RD and MDCK cells. Vero/hSLAM, and Vero CCL-81 showed rounding, degeneration and detachment of cells; MA-104 cells also showed syncytia formation. In qRT-PCR, Vero/hSLAM and MA-104 showed 106 and Vero CCL-81 showed 107 viral RNA copies per ?l. The 50 per cent tissue culture infectious dose titres of Vero/hSLAM, MA-104 and Vero CCL-81 were 105.54, 105.29 and 106.45/ml, respectively. Interpretation & conclusions: Replication of SARS-CoV-2 in Vero/hSLAM and MA-104 underscores the possibility of its unintended isolation during surveillance procedures aiming to isolate measles, rubella and rotavirus. This could result in accidental exposure to high titres of SARS-CoV-2, which can result in laboratory acquired infections and community risk, highlighting the need for revisiting biosafety measures in public health laboratories

Hypertension prevalence and associated risk factors among bank employees working in an urban area of Marathwada region, Maharashtra, India

Background: Epidemiologic transition of diseases is occurring in recent times throughout the world. The morbidity, disability and mortality burden is now more because of non-communicable diseases. Cardiovascular diseases are number one killer throughout the world. Hypertension has been found to be an independent and consistent risk factor for cardiovascular diseases. Bank employee’s job being sedentary in nature and involving cash management related stress makes bank employees a potential occupational group to develop hypertension. So, this study was planned to assess the prevalence of hypertension in bank employees in the urban area of Latur district, Maharashtra.Methods: A cross-sectional observational study was carried out between January 2016 to December 2016 among all the bank employees working in urban area of Latur, Maharashtra. Approval from institutional ethics committee was obtained beforehand.Results: Total 577 bank employees were surveyed for this study. 32.4% of subjects were found to be hypertensive. Association of higher age group and managerial cadre of employment were found to be statistically significant.Conclusions: Bank employees have a higher prevalence of hypertension as compared to general population. Bank employees are an occupational risk group to develop hypertension.

Trends of suicidal hanging in Western Mumbai region

Background: The present study was conducted with aims to determine various epidemiological factors of death due to hanging in the western Mumbai region and variation in types of hanging deaths.Methods: Four year study conducted at H. B. T. Medical College & cooper Hospital, Mumbai for period of January 2015 to December 2018. During study period total 6338 of medico-legal autopsies were conducted, of which 228 (3.59%) autopsies were of death due to hanging.Results: T228 out of 6338 medicolegal autopsies were of death due to hanging making incidence rate 3.59 % of hanging. Age group most commonly involved in hanging was 21-30 years constitutes 41.22% cases of hanging deaths. Male victims constitute of 59.64% cases and female victims were 40.36% cases. In 96.5% cases place of hanging was closed place inside room 3.5% cases hangings takes place in open place. Most common ligature material used for hanging was dupatta/odani constitute 46.5% cases followed by rope in 20.17% cases.Conclusions: Young age group population between 21-40 years are more susceptible victims of suicides by hanging constitute 65.78% cases. Proper parental and social guidance and support could prevent suicides in this age group. Timely counselling of such vulnerable group victims could preventable. Effective prevention strategies are needed to promote awareness of prevention of suicides in young age group.

Knowledge and attitude towards basics of communication skills amongst resident doctors

Background: The pillar of doctor patient relationship is the bond of mutual trust. This pillar is strengthened by effective communication between doctor and patient/relatives. It has been widely accepted that a doctor needs to have very good communication skills in addition to clinical knowledge and skills required for effective healthcare. Every doctor duly needs to demonstrate humanity, healthy behaviour, as well as sensible communication with patients which can build the sustainable ‘trust’ in the treatment offered by that doctor. However, the current curriculum of medical courses is enormously focused on providing competent medical knowledge but lacking the focus on inculcating communication skills.Methods: A cross sectional study was carried out amongst 377 resident doctors of first to third year, from randomly selected medical colleges of Maharashtra having postgraduate courses in clinical subjects and affiliated to Maharashtra University of Health Sciences, Nashik, Maharashtra, India during the period of February 2017 to January 2019. Data was entered in MS Excel sheet and analyzed using percentages and proportions wherever appropriate.Results: Highest study respondents were from General Medicine with 13% of total and having 17.4% males and 8% females among respective genders followed by General surgery and Pediatrics residents with 12.5% each specialty.Conclusions: The study has shown that there was varied knowledge about the communication skills among the resident doctors. The residents have shown fair attitudes and behaviours towards mindfulness and basic communication skills.

Doctor-patient relationship: effectiveness of an intervention training module on knowledge and attitude of resident doctors

Background: The mutual trust between doctor and patient, an indispensable part of the healthcare, is weakening day by day. This has resulted in unwanted incidences of violence and attacks on doctors. Communication between doctors and patients is an integral part of the relationship and is one of the major determinants of mutual trust. Apart from the knowledge and skills required to treat a disease, communication skill is an indispensable part of a doctor’s professional life. The resident doctors do not get a chance to learn and implement the communication skills required for the doctor patient relationship. Methods: An interventional study was carried out amongst 377 resident doctors of first to third year, from randomly selected medical colleges of Maharashtra having postgraduate courses in clinical subjects and affiliated to Maharashtra University of Medical Sciences, Nashik, Maharashtra during the period of February 2017 to January 2019. Results: There was significant difference in the pre and post test scores for quantified knowledge in relation to training in communication skills (p<0.0001), and also significant difference in the pre and post test scores for quantified knowledge in relation to basic doctor patient relationship, suggesting that the intervention was effective in improving the communication skills. Conclusions: The study has shown that there was significant difference in the pre and post test scores for quantified knowledge in relation to being doctor, basics of communication skills, doctor patient relationship, communication in special situation, and training in communication skills.

Study of mucormycosis patients attending tertiary care hospital: a retrospective study

Background: Treatment of mucormycosis involves a combination of surgical debridement of involved tissues and antifungal therapy. Intravenous amphotericin B is the drug of choice. In this study authors assessed the outcomes of treating patients with mucormycosis with varied formulations of amphotericin.Methods: Authors performed a retrospective observational study of patients diagnosed with mucormycosis and admitted in the inpatient ward of Bharati Hospital, Sangli, Maharashtra, India from May 2015 till May 2018. Patients either received amphotericin B, lyophilized amphotericin B or lipid soluble amphotericin B. Resolution of symptoms was graded as good clinical response and persistence of symptoms as poor clinical response.Results: During the study period a total of 16 patients were included in the study. All patients underwent surgical debridement and received different forms of amphotericin. Three patients received amphotericin B 1.5 to 3 grams over 21 days and responded satisfactory and later had renal toxicity. Five patients received lyophilized amphotericin B 3 to 4 grams over 21 days, with good response and less renal toxicity as compared to amphotericin B. Lipid soluble amphotericin B was given to 8 patients 3.5 to 5 gm over 21 days with good clinical response and minimal renal toxicity. Of the 10 patients who presented with nasal discharge, 60% had a good clinical outcome, 30% had poor and one patient died.Conclusions: Amphotericin B is an effective anti-fungal. Further studies are needed to assess the utility of immunologic and metabolomic profiling of the host and prescribing targeted immunotherapy in decreasing the incidence of mucormycosis.

INTRAOSSEOUS LESION OF PHALANX: TWO SIMILAR CASES BUT NOT THE SAME

@#Intraosseous lesions at phalanges are rare. They frequently present with pain and swelling. Fortunately, the majority of the lesions are benign. However, some lesions are destructive and early interventions are required. We report two cases of similar presentations of swelling and discomfort at the little finger for six months. The lytic lesions involved the whole middle phalanx with cortical breach sparing the joints. A provisional diagnosis of osteomyelitis was made, although unlikely. Bone biopsy was performed early to plan for definitive treatment and surgery. Patient 1 was diagnosed for intraosseous gout whereas Patient 2 for epithelioid hemangioma. Both were benign destructive bone lesions. Thus, we counselled the patients for curettage of lesion, bone grafting and spanning external fixation in view of extensive lesion. Patient 1 defaulted treatment. Patient 2 had an uneventful surgery. She regained her grip strength. In two years follow up, there was no evidence of infection, recurrence or malignant transformation.

Ethosomes as Novel Drug Delivery System: A Review.

The ethosomes are vesicular carrier comprise of hydroalcoholic or hydro/alcoholic/glycolic phospholipid in which the concentration of alcohols or their combination is relatively high. To provide continuous drug infusion through an intact skin, several transdermal therapeutic systems have been developed for topical application onto the intact skin surface to control the delivery of drug and its subsequent permeation through the skin tissue. Transdermal route is promising alternative to drug delivery for systemic effect. An attempt was made to formulate the highly efficient ethosomal drug delivery system and enalapril meleate is used as model drug. The following conclusion are drown from the result and discussion described in the previous chapter. Liposomal formulation was also prepared by the thin film hydration method. The techniques used were simple and reproducible. The prepared ethosomes were spherical and discrete in shape. The size of vesicles were found to be in the range of 3.26-5.79 tim,o.716-1.3o1 tim and 5.32 tim for unsonicated ethosomes, sonicated ethosomes and liposomes respectively. However ethosomes prepared by sonication method were more uniform and smaller in size, which is essential for skin permeation. While comparing the entrapment efficiency, ethosomes containing 3o% w/w ethanol and prepared by sonication showed highest value with respect to all other formulation, so it is concluded ethosomes prepared by sonication and containing 3o% w/w ethanol as the best formulation considering all other aspects. The highest value of transdermal flux for sonicated ethosomes containing 3o% w/w ethanol is the indication of complete and rapid penetration through the skin may be because of tiny vesicular size.

The effect of different grades polymer blends on release profiles of diclofenac sodium from hydrophilic matrices.

An attempt was made to design matrix tablet of diclofenac sodium by using various grades of hydroxypropyl methyl cellulose (HPMC E50, E15 and E300LV). The effect of hydrophilic polymers was studied on release characteristics of the diclofenac matrix tablet. Dicalcium phosphate and magnesium stearate were used as an excipients. Tablets were prepared by direct compression method. The in vitro dissolution test carried out for 12 hrs using USP dissolution apparatus II at 50 rpm in 900ml phosphate buffer pH 6.8. Statistically significant difference was found among the drug release profile from different matrices. The tablet evaluation parameters of hardness, friability, thickness, content uniformity were founded within the limit. At a fixed polymer level, drug release from the higher viscosity grades E50 was slower as compared to the lower viscosity grades (E300LV and E15). Tablet prepared with HPMC E50 is more release retardant. As the drug to polymer ratio increased drug release decreased. The dissolution study revealed that maximum retardation of the drug was obtained by highest viscosity grade HPMC at higher concentrations. The release of the model drug from these HPMC matrix tablets was prolonged.

Development of Lipid Based Nanoparticulate Drug Delivery Systems and Drug Carrier Complexes for Delivery to Brain.

Many neurotherapeutics are unsuccessful in treating CNS disorders because they cannot be effectively drug delivered. Drug delivery to the brain is a challenge even though there is relatively high blood flow. There are two physiological barriers likes blood-brain barrier and blood-cerebrospinal fluid barrier which separates the brain from its blood supply controlling the transport of compounds. Many of the brain or CNS associated diseases remain untreated by effective therapies. This is not because there is a lack of candidate drugs but due to the inability of many therapeutic molecules to cross the BBB, the BCSFB or other specialized CNS barriers to reach the specific areas of brain. Hence there is a need in the modern approaches and present insights into using ligand conjugation and nanotechnology to target the BBB via different transport pathways and mechanisms. The field of novel drug delivery system has fully emerged and came into existence as an ideal approach of drug targeting and delivery to brain. The new approaches of drug delivery to brain help in successful transporting drugs across the BBB.

A overview: non-steroidal anti-inflammatory drugs and mechanisms.

The inflammatory response represents a generalized response to infection or tissue damage and is designed to remove cellular debris, to localize invading organisms and arrest the spread of infection. NSAIDS are metabolized primarily in the liver. They vary in their half-lives and bioavailability. Given the multitude of available NSAIDs, the variability of their half-lives allows for different dosing regimens. The fluid in the inflamed area is known as inflammatory exudates, commonly called as pus. These exudates contain dead cells and debris in addition to body fluids. The inflammatory response is characterized by the following symptoms: Reddening of the localized area, swelling, pain and elevated temperature. Reddening results from capillary dialation that allows more blood to flow to the damaged tissue. Elevated temperature results from capillary dialation which permits increased blood flow through these vessels, with associated high metabolic activities of neutrophils and macrophages. The release of histamine from mast cells during antigen antibody reactions is well known, as is its involvement in the inflammatory response to skin injury. The present review focused on list and precautions of NSAID with its typed and classification, Analgesic activity study, histamine.

Effectiveness of the addition of citicoline to patching in the treatment of amblyopia around visual maturity: A randomized controlled trial.

Aim: To study the effectiveness of the addition of citicoline to patching in the treatment of amblyopia in the age group of 4‑13 years. Materials and Methods: A randomized controlled trial, which included patients who were randomly divided into two groups. Both the groups received patching therapy till plateau was achieved in phase 1 of the study. Then in phase 2, group I received citicoline plus patching and group II continued to receive only patching. Outcome Measures: Outcome was measured by the visual acuity in logMAR every month in phase 1 till plateau was achieved and then for 12 months in phase 2. Results: No significant difference was found in the mean visual acuities in these two groups in phase 1 till plateau was reached. In phase 2, for the initial four months, there was no significant difference in the visual acuities in these two groups, at the respective intervals. However, five months onward, up to 12 months, there was a significant difference in the visual acuities in these groups.The result was the same in younger patients (< seven years of age) as well as in older patients (> seven years of age). In phase 2, the mean proportional improvement in group I was significantly more than that in group II, at two months and onward, at the respective intervals. Conclusion: The improvement in visual acuity with citicoline plus patching was significantly more than that with patching alone, in one year of treatment.

Expulsion by Ionic Complexation: Benchmark Therapy for Atherosclerosis A Review.

Ethylenediamine tetraacetic acid (EDTA) chelation therapy has been practiced since longtime for the treatment of cardiovascular diseases, alone or in combination with other treatments. It has been recommended as a harmless, relatively inexpensive and non-surgical method of restoring blood flow in atherosclerotic vessels. Ability of EDTA to form complex with heavy metals like calcium, lead, copper is used to remove calcium from arthrosclerosis plaques which ultimately improves the condition. It can be concluded that chelation therapy is emerging form of complementary or alternative medicine to surgery and can be used in safe manner. Still there is insufficient evidence to decide on the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of patients with atherosclerotic cardiovascular disease.

Implementation of time release technology in formulation development and evaluation of sustained release tablet of Lornoxicam.

In present study, the attempts have been made to formulate sustained release tablets of lornoxicam by direct compression method. Based on viscosity grades different proportions of hydrophilic polymers (HPMC K4M, HPMC K15M, HPMC K100M) are used for preparation of lornoxicam sustained release matrix tablet. The drug excipient mixtures were subjected to preformulation studies comprising of micromeritic properties. The tablets were subjected to various studies like as physicochemical studies, in vitro drug release, kinetic studies, etc. FTIR studies shown there was no interaction between drug and polymers. The physicochemical properties of tablets were found within the limits. Lornoxicam is a first generation analgesic, inflammatory & antipyretic agent used in relieving symptoms of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute sciatica and low back pain. From developed formulations batch F1 have shown zero order drug release behavior and prolong drug release over a period of 12 h which was deemed as suitable and optimum formulation for sustained drug delivery. Results of the present study indicated the suitability of the low viscous polymer in the proportion of (drug:polymer) 1:1 in the preparation of sustained release formulation of lornoxicam.

Coeliac autoimmunity in type I diabetes mellitus

Coeliac autoimmunity [CA] has a known association with type 1 diabetes mellitus [T1DM] for which screening is routinely recommended but less frequently followed. The impact of CA in T1DM has been variably reported. The aims of this study are as follows: [1] to study the prevalence of CA in patients with T1DM and [2] to study the impact of CA not only on nutritional parameters but also on glycaemic control, endocrine axes and bone health. Patients and Eighty-six consecutive patients with T1DM were screened for CA using immunoglobulin A [IgA] tissue transglutaminase as a marker [TTG; IgG anti-gliadin in IgA-deficient case]. CA positive [CA+] cases were compared with age-matched and sex-matched CA negative [CA-] T1DM cases for anthropometry, glycaemic control [assessed by glycated haemoglobin [HbA1c] and hypoglycaemic/ hyperglycaemic episodes], endocrine [thyroid function, cortisol, growth hormone [GH] axis, gonadal axes], haematological [haemoglobin, iron profile and vitamin B12 status] and calcium metabolism parameters and bone densitometry [by dual-energy X-ray absorptiometry [DXA]]. Consenting patients with CA also underwent upper gastrointestinal [GI] endoscopy with duodenal biopsy. Out of 86 patients, 11 [12.75%] screened positive for CA [seven patients underwent duodenal biopsies which were suggestive of Marsh grade III[2], II[3] and I[2] disease]. The CA+ T1DM patients were comparable with CA- T1DM in terms of anthropometry. CA+ patients had higher HbA1c [10.7 +/- 1.8 vs. 8.4 +/- 1.0 [93 +/- 19 vs. 68 +/- 11 mmol/mol]; p < 0.01], more hypoglycaemic episodes [five vs. two; p < 0.05], higher prevalence of iron and vitamin B12 deficiency, lower insulin-like growth factor-1 [IGF- 1] levels and lower bone mineral density [BMD] z-score at total body [-1.91 +/- 1.05 vs. -0.63 +/- 0.73; p < 0.05] and lumbar spine [-1.69 +/- 0.92 vs. 0.36 +/- 0.93; p < 0.05]. The incidence of fractures in the past 3 years was also more in CA+ patients than in CA- patients [four vs. one; p < 0.05]. CA has an important autoimmune association with T1DM. The concomitant presence of CA adversely affects stature, bone health, glycaemic control and iron and B[12] levels in T1DM. IgA sufficiency should be ensured before using an IgA-based screening test for CA

Superior Vena Cava Syndrome Associated with Right-to-Left Shunt through Systemic-to-Pulmonary Venous Collaterals

Superior vena cava (SVC) obstruction is associated with the gradual development of venous collaterals. We present a rare form of systemic-to-pulmonary subpleural collateral pathway that developed in the bridging subpleural pulmonary veins in a 54-year-old woman with complete SVC obstruction. This uncommon collateral pathway represents a rare form of acquired right-to-left shunt due to previous pleural adhesions with an increased risk of stroke due to right-to-left venous shunting, which requires lifelong anticoagulation.

Effect of smoking on neutrophil apoptosis in chronic periodontitis: An immunohistochemical study.

Context: Periodontal disease is caused by chronic infection inducing an inflammatory reaction leading to breakdown of tooth-supporting tissues. There are various risk factors for the disease, and smoking is one of them. Apoptosis plays a critical role in the regulation of inflammation and host immune response which helps in tissue homeostasis, and a disturbance in this is often associated with disease. The imbalance between the apoptosis and proliferation in the periodontal tissue results in periodontal disease. Neutrophils play an important role in the defense mechanism and are the most abundant immune cells in gingival inflammatory infiltrate in patients suffering from periodontal disease. Neutrophil disorders are associated with rapid destruction of periodontal tissues. Aim: To study the influence of smoking on apoptosis of neutrophils by quantifying them in the gingival connective tissue of smoking and nonsmoking subjects suffering from chronic periodontitis. Materials and Methods: Thirty gingival biopsies were harvested from 15 smoking and 15 nonsmoking subjects who suffered from chronic periodontitis. The apoptosis of neutrophils was assessed and quantified using p53 monoclonal mouse antihuman antibody. Statistical Analysis Used: Chi-square/Fisher'sexact test was used to find the significance of study parameters on a categorical scale between the two groups. Results: Neutrophil apoptosis was significantly more in the group of nonsmokers. There was no statistical difference between plaque and bleeding index, but there was a significant increase in clinical attachment loss among smokers. Conclusions: The study reveals that smoking plays a significant role in the inhibition of neutrophil apoptosis, thereby contributing to the destruction of periodontal tissues in periodontitis.