Unusual Involvement of Basal Ganglia and Dentate Nucleus in Children with Acute Encephalopathy with COVID-19

Children account for 1% to 5% of diagnosed COVID-19 infection with relatively mild presentation compared to adults. The frequency of neurological involvement in acute COVID-19 infection in children is unclear. COVID-19 is also considered to be a neurotropic virus, but so far, in the pediatric age group, very few cases with involvement of basal ganglia and no case of dentate nucleus involvement have been reported in the literature. The present paper reports two cases of acute encephalopathy with COVID-19, the frst case with basal ganglia involvement and the second with dentate nucleus involvement. Both cases required aggressive management and had complete neurological recovery on follow-up. Hence, these cases are reported to make everyone aware of the neurological presentation with atypical neuroimaging fnding of acute COVID-19 infection in the pediatric age group; timely management improves the outcome.

Efficacy of Herbmed Plus in urolithic rats: An experimental study

Background: In Ayurveda, several herbs and formulations are available for the treatment of Urolithiasis.However, they are not systematically evaluated for their safety, efficacy, indication and limitations.Herbmed Plus is one such herbal formulation that has been known for the management of urinary tractdisorders. An attempt has been made to evaluate its efficacy on Urolithiasis.Objective: To evaluate the efficacy and safety of Herbmed Plus in urolithic rats.Materials and methods: A total of 60 Wistar albino rats were used for this study. The male and female ratswere divided into five groups: disease control, test (dose 90 mg/kg), standard I (Cystone), standard II(Alkaston insta) and normal control (six in each group). Urolithiasis was induced using ethylene glycol0.75% in drinking water for 28 days. The rats with urinary oxalate crystals were dosed with oral test orstandard treatments for 28 days.Results: All the animals appeared normal and showed no clinical signs of toxicity. None of the groups reported mortality or adverse effect on body weight and food consumption. The treatment with test drugshowed improvement in the SGPT level and urine output (5.4 vs 3.47 mL/24 h). A drastic reduction in numberof crystals were observed in male 0.5 vs 22 and female rats 0 vs 22.7 in test and disease group. The kidneylactate dehydrogenase, alkaline phosphatase, urinary phosphorus and calcium oxalate level decreased in thetest and standard drug groups as compared to disease groups. Microscopy of the urine samples showedreduction in the number of crystals after treatment compared to the urolithic group. Increase in citrate levelsin urine in all the treatment groups indicated anti-urolithiatic activity. The test group showed a 69.70% recovery in males and 47.57% recovery in female rats compared to the disease control group.Conclusion: Herbmed Plus showed a significant reduction in oxalate synthesizing enzymes suggestinganti-urolithiatic activity and anti-inflammatory and regenerative property in cellular injury caused bycrystal deposits

Analysis of prescription pattern of anemia in pregnancy: an observational, cross-sectional study

Background: Anemia is a major health problem that affects 25% to 50% of the population of the world and approximately 50% of pregnant women. This research on the use of prescription medicines in anemia during pregnancy remains critically important. Prescribing patterns of the drug in the pregnant women include age, trimester, gravid condition, US-FDA risk category, WHO core indicators.Methods: A prospective, cross sectional observational multicentric study was conducted in outpatient and inpatient departments of Indira Gandhi Hospital and Civil Hospital in Nasik, for period of 6 months. Ethical approval was taken prior to study from Independent ethics committee. A total of 197 patients were enrolled in the study. Inform consent form was obtained from the patients. After studying them; statistical analysis were done and result and conclusion were drawn.Results: Out of 197 women抯 prescriptions, the average number of drug per prescription was 2.14. 27.28% drugs were prescribed there brand name and 72.72% by generic name. Iron, folic acid and calcium were prescribed to all pregnant women. The majority of the patients were prescribed category A and category C drugs. No patients were given category X drug.Conclusions: Nearly all prescription showed a prescribing practice for writing prophylactic iron and folic acid therapy in all pregnant women. No women was prescribed category X drug. Most of the drug prescribed in generics and thus, prescription pattern of our study set a fine example of prescribing behaviour.

Protocol for developing a surveillance system for surgical site infections

Purpose: Healthcare-associated infections (HCAIs/ HAIs) are the most common adverse occurrences during health care delivery. Across the globe, millions of patients are affected by HAIs annually, with a higher burden and impact in developing nations. a major lacuna in planning preventing protocols is the absence of National Surveillance Systems in most low-middle income countries, which also prevents allocation of resources to the high-priority areas. Among all the HAIs, there is a huge global burden of SSIs, in terms of morbidity, prolonged hospital stays, increased antimicrobial treatment as well as attributable mortality. Method: This manuscript details the process of establishment of an SSI surveillance protocol at a level-1 trauma centre in North India. Result and Conclusion: Surveillance is an essential tool to reduce this burden. It is also an important primary step in recognizing problems and priorities, and it plays a crucial role in identifying risk factors for SSI and to be able to target modifiable risk factors. Therefore, it is imperative to establish reliable systems for surveillance of HAIs, to regularly estimate the actual burden of HAIs, and to use these data for developing indigenous preventive measures, tailored to the country's priorities.

A prevalence study of ocular manifestations in HIV positive patients on highly active anti-retroviral therapy

Background: Among 40 million cases worldwide, 50-75% of patients have at least one ocular manifestation in their lifetime. Many of ocular infections are treatable with therapeutic agents. Ocular manifestations invariably reflect systemic disease and can be the initial manifestations of HIV in many cases. Understanding of ocular sequel of HIV infection can lead to the early diagnosis and effective treatment. This study emphasizes on the need of developing a specific ophthalmic examination for the management of ocular manifestations in HIV infected patients.Methods: Cross sectional and observational study of 100 HIV positive participants on HAART were done irrespective of presence or absence of ocular symptoms. Participants were examined for complete ocular examination. Prevalence find out using chi-square test, find p values and ensuring statistical significance.Results: In our study, prevalence of ocular manifestation in HIV positive patients receiving HAART was 39%. Out of them, 20% adnexal involvement, 28% anterior segment involvement, 33% posterior segment involvement, 11% neuro-ophthalmic abnormality, 4% orbital involvement were present. 76% patients belonged to WHO clinical stage 2 and 3. 51% had CD4+ T cell counts <200 cells/µl.Conclusions: Posterior segment followed by anterior segment are the most commonly encountered ocular manifestations of HIV infection. Low CD4 count is good predictor for ocular manifestations in HIV positive patients. Higher WHO stage is also directly related with the severity of the ocular symptoms. Routine baseline ophthalmic screening to all HIV positive patients are necessary to prevent ocular morbidity.

Study Of Clinical Profile And Electrocardiographic Changes In Chronic Obstructive Pulmonary Disease

Aims: To analyse the ECG changes in COPD patients and to correlate them with the severity of the disease. Material and methods: COPD patients were clinically examined and underwent chest radiograph, ECG, 2D Echo and spirometry Results: 82% were males and 18% were females. The mean duration of symptoms was 9.88±6.123 years. The mean FEV1 was 42.14±11.63 percentage of predicted. The most common at presentation was tachypnoea (88%) followed by loud P2 (46%).36% of patients had features suggestive of right heart failure. 24% of the patients had cyanosis and 10% of the patients had clubbing. The most common ECG abnormality is right axis deviation of P wave (64%) followed by right axis deviation of QRS complex (60%).Conclusions: ECG is better than clinical methods in detecting right ventricular dysfunction in COPD.

Does the presence of Klebsiella pneumoniae carbapenemase and New Delhi metallo‑β‑lactamase‑1 genes in pathogens lead to fatal outcome.

Introduction: Infections due to multidrug‑resistant (MDR) pathogens are a medical challenge. There is considerable apprehension among clinicians regarding pathogens reported as carrying New Delhi metallo‑β‑lactamase‑1 (NDM) and Klebsiella pneumoniae carbapenemase (KPC) genes from their patients. In the face of extremely high rates of antimicrobial resistance, it is essential to gauge the clinical significance of isolation of pathogens carrying these genes from clinical samples. This study compares the outcome of patients infected with pathogens carrying NDM/KPC genes versus those without these genes. Methods: The study was conducted over a 1‑year period at a Level‑1 trauma centre. Hospital‑acquired infections were diagnosed on the basis of CDC’s criteria. The correlation of isolation of a multi‑resistant pathogen carrying KPC or NDM genes with the clinical outcome was ascertained. Results: A total of 276 consecutive patients admitted to the Intensive Care Units/wards of the JPNA Trauma Centre were included in this study. Of the 371 isolates recovered from these patients, 116 were from patients who had a fatal outcome. The difference in prevalence of blaNDM and blaKPC was not significant in any genera of Gram‑negative pathogens isolated from patients who survived versus those who had a fatal outcome. Conclusion: Isolation of MDR pathogens carrying NDM/KPC genes from clinical samples is not always a harbinger of a fatal outcome. Efforts should be made to prevent cross‑transmission of these pathogens.

Clinical effects of photodynamic and low‑level laser therapies as an adjunct to scaling and root planing of chronic periodontitis: A split‑mouth randomized controlled clinical trial.

Background: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) and low‑level laser therapy (LLLT) as an adjunct to conventional scaling and root planing (SRP) alone. Aim: The aim of this clinical trial was to evaluate the clinical effects of adjunctive use of PDT, combination of PDT with LLLT as adjunct to conventional SRP alone in the treatment of chronic periodontitis. Materials and Methods: In a single‑centered randomized and controlled clinical trial, 24 patients (15 males and 9 females) with untreated chronic periodontitis were randomly assigned in a split‑mouth design into three treatment groups which included Group I: SRP only, Group II: SRP and PDT (1% methylene blue [MB] solution), and Group III: SRP, PDT, and LLLT. Clinical parameters such as plaque index, gingival index, modified sulcular bleeding index, probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 1, 3, and 6 months after therapy. Results: Within each group, significant improvements (P < 0.001) were found for all variables in 6‑month follow‑up compared with baseline. The improvement in clinical parameters was significantly greater in Group III compared to Group I and Group II. The mean PD (mm) reduction from baseline to 6 months in Group I was 2.50 ± 0.54, Group II was 2.57 ± 0.53, and Group III was 3.14 ± 0.50. The mean CAL (mm) gain from baseline to 6 months in Group I was 2.63 ± 0.47, Group II was 2.55 ± 0.44, and Group III was 3.07 ± 0.55. Conclusion: In patients with chronic periodontitis, a combination of a single application of PDT (using a 980 nm laser and MB) and LLLT provide additional benefit to SRP in terms of clinical parameters 6 months following the intervention.

Systematic review of drug utilization studies & the use of the drug classification system in the WHO-SEARO Region.

Background & objectives: Information available on drug consumption is inadequate in most low and middle income countries. This systematic review was conducted to analyse published work on drug utilization research/studies (DUR) in the SEARO region of WHO for study objectives, methodology, results and recommendations and to identify the need for improving DUR and the use of the ATC/DDD system. Methods: A literature search for DUR was carried out in biomedical databases (PubMed, Scirus, Scopus and Google Scholar) up to May 2012. Publications were selected if those were in the English language, describing DUR or prescription practices, and study conducted in the WHO-SEARO countries. Results: A total of 318 publications were included in the review. Of these, 67 per cent were from India and 13 per cent were from Thailand. Majority of the publications were hospital based; only 16 per cent were community based. The ATC/DDD system was used in only 20 per cent of the publications, of which 73 per cent publications used DDD indicators. Several publications focused on antibiotics (31%). Publications that recommended the need for a policy or intervention to improve prescription practices/rational drug use amounted to 35 per cent. Interpretation & conclusions: Drug utilization studies using ATC/DDD system need to be promoted and carried out on an ongoing basis. DUR is important for rational use of drugs. Its relevance to policy making and resource allocation needs to be emphasized.

Safe transportation of biomedical waste in a health care institution.

Introduction: The chances of health care waste (Biomedical waste) coming in contact with the health care workers, patients, visitors, sanitary workers, waste handlers, public, rag pickers and animals during transportation are high. Materials and Methods: The study was conducted over a period of seven months (April 2013–October 2013) in a 500‑bedded hospital where the average quantum of biomedical waste is 0.8 kg/bed/day. The issues related to transportation of health care waste from 39 generation sites to the health care waste storage site inside the hospital (intramural transfer) were addressed and analysed in a predesigned proforma. Results: The biomedical waste management team inspected the generation sites in the hospital on a daily basis and conformance to the procedures was checked. It was found that waste was collected at scheduled timings in 99.6% occasions; however, compliance to wearing personal protective equipment (PPE) was poor and ranged from 1.22−1.84%. Conclusion: Transportation of health care waste is a crucial step in its management. Regular training program for all the sections of health care workers with special emphasis on waste handlers is needed.

Cost analysis of antiretroviral agents available in India.

Background: AIDS is one of the most prevalent causes of death due to infectious origin which requires a lifelong therapy. There is variation in prices of antiretroviral drugs available in Indian market. Thus, a study was planned to find out variation in prices of antiretroviral drugs either as a single drug or in combination and to evaluate the difference in cost of various brands of the same antiretroviral drugs by calculating percentage variation in cost in Indian rupees. Methods: Cost of antiretroviral drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October 2014 and “Indian Drug Review” Vol. XXI, Issue No. 4, 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost was calculated. Results: Percentage variation in cost for antiretroviral drugs marketed in India was found to be zidovudine (100 mg) - 436%, lamivudine (100 mg) - 268%, tenofovir (300 mg) - 149.5%, didanosine (250 mg) - 73.75%, indinavir (400 mg) - 35.26%. Among the combination therapy, price variation was lamivudine + zidovudine (150 + 300 mg) - 314%, lamivudine + stavudine (150 + 40 mg) - 105%, lopinavir + ritonavir (133.3 + 33 mg) - 25%. Conclusion: There is wide variation in the prices of antiretroviral agents available in the market. Regulatory authorities, pharma companies, physicians should maximize their efforts to reduce the cost of drugs.

ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC).

Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance.

Spontaneous Rupture of Spleen: A Case Report

Spontaneous or idiopathic splenic rupture is a rare cause of acute abdominal pain and hemoperitoneum and its incidence is 1% of all cases of splenic rupture. The etiology of spontaneous splenic rupture can be idiopathic or it may occur as a complication of an infectious, neoplastic or hematologic disease. Splenic rupture presents with pain in the left upper quadrant with shock and features of peritoneal irritation, like Kehr’s sign (left shoulder pain due to diaphragmatic irritation) and Balance sign (palpable tender mass in left upper abdomen). The diagnosis of spontaneous splenic rupture presents a diagnostic challenge due to the absence of a history of trauma. Focused Abdominal Sonography for Trauma FAST may be suggestive but due to its limitations, Computerized Tomography Scan CT scan of abdomen is the best imaging modality both for detection and grading of splenic injury. Management can be non-operative or surgical depending on grade and hemodynamic status of the patient. We report a rare case of spontaneous rupture of the spleen, which was idiopathic and fulfills the criteria of Orloff and Peskin, due to absence of any history of trauma, absence of perisplenic adhesions or scarring, and it without any evidence of disease affecting the spleen with macro and microscopically normal spleen. This case also adheres to fifth criteria described by Crate and Payne, as there was no immunological evidence suggestive of any viral infections affecting the spleen.

A case of dual infection in a paediatric trauma victim of primary cutaneous aspergillosis caused by Aspergillus flavus and Aspergillus terreus.

Aspergillus spp. are widely distributed throughout the environment. They are opportunistic pathogens causing infection at various sites in the body such as lungs, sinuses, eyes, skin, central nervous system etc., Primary cutaneous aspergillosis is an uncommon disease entity. Primary infections usually occur at sites having disruption of the skin and usually occur in burn patients, trauma and surgical patients. A 4-year-old girl who was run over by a truck and suffered extensive de-gloving injury to bilateral lower limbs developed greenish discharge and scaly lesions around the wound margins after 50 days of hospital stay. The skin biopsy demonstrated the presence of thin septate hyphae branching at acute angles and culture demonstrated growth of Aspergillus flavus and Aspergillus terreus. The child was started on voriconazole therapy for 3 weeks and the lesion healed satisfactorily. Subsequent skin biopsy culture was negative for fungi. Prompt diagnosis and management of such cases can salvage the limbs in severe trauma cases.

PCR-based evaluation of tuberculous endometritis in infertile women in north India

Tuberculous endometritis is often a diagnostic dilemma for gynecologists in the evaluation of infertility. This study evaluated and compared different diagnostic methods in tuberculous endometritis. 100 infertile women were investigated for tuberculous endometritis. The endometrial samples obtained by curettage were evaluated by Ziehl-Neelsen [ZN] staining of the smears for acid-fast bacilli [AFB], the samples were also cultured on Lowenstein-Jensen medium, and histopathological examination and nested PCR targeting 'hupB' gene [Rv 2986c in M. tuberculosis and Mb 3010c in M. bovis] which can differentiate between M. tuberculosis and M. bovis were performed. Antibodies against 38-kDa and 16-kDa mycobacterial antigens were detected in serum using ELISA. Statistical analysis was done by online GraphPad Prism software, version 5.0. McNemar's test was applied and Kappa agreement coefficient was calculated for agreement between various methods. A p-value < 0.05 was considered significant. among the 100 evaluated endometrial samples, one was AFB smear positive, none was positive by culture, four were positive by histopathology and 13 were positive by PCR. Of the PRC-positive cases, 38.4% were positive for M. tuberculosis, 23.07% for M. bovis, and 38.4% showed co-infection with both species. 40% of the patients had raised IgG against M. tuberculosis 38-kDa antigen. McNemar's test was applied to PCR and the conventional methods of TB diagnosis [AFB, Culture and histopathology] and the p-value was <0.001 [highly significant] for PCR. Detection by PCR showed a fair agreement with detection by Mantoux test and ELISA. In paucibacillary endometrial tuberculosis, the positive detection rate was found to be significantly higher for PCR compared to other methods. The 'in-house' nested PCR assay targeting the hupB gene and used in this study, can serve as a rapid diagnostic aid for tubercular endometritis. It can also differentiate between members of the mycobacterium tuberculosis complex, namely M. tuberculosis and M. bovis

Effect of Cold Hexane Extract of Karanja (Pongamia Glabra Vent) Seed Kernel on the Development of Mosquito Larvae.

Cold Hexane extract of karanja, Pongamia glabra Vent (Fabaceae) seed kernel (HKSK) ranging at the concentrations of 4 ppm to 28 ppm was evaluated against the freshly emerged larvae of Aedes aegypti and Culex quinquefasciatus. Treatment of HKSK imparted the mortality that was correlated with the level of dosage. Before pupation,100% fatality occurred in Ae. aegypti at a concentration of 20 ppm whereas in Cx. quinquefasciatus the same degree of mortality occurred at the extract concentration of 12 ppm in the first instar larvae only. At low doses, the emerging adults of Cx. quinquefasciatus had deformed legs, wings and truncated abdomen but the adults of Ae. aegypti showed no deformities. The developmental period was prolonged significantly in a dose-dependent manner for both the species treated. In Cx. quinquefasciatus this effect was more pronounced because of increased intermoult period showing an IGR effect of the extract. The calculated growth index also decreased in dose-dependent manner significantly more in Cx. quinquefasciatus. Indeed, Ae. aegypti appeared more susceptible to HKSK than Cx. quinquefasciatus.

Use of mycelial suspension and metabolites of Paecilomyces lilacinus (Fungi: Hyphomycetes) in control of Aedes aegypti larvae.

Mycelial suspension of possible was assessed to examine its Paecilomyces lilanicus, a fungus, detrimental effects on fourth instar larvae of Aedes aegypti. The immature stages suffered 64-68% mortality with 0.5-1% mycelial suspension. There was 12-16% adult emergence which was statistically significant (P < 001). Czapeckdox and PYG media metabolites were used against the third instar larvae in various concentrations. The effects were evaluated on several parameters like mortality, mean survival time and time taken for adult emergence. The results indicate that the fungus does not producae any toxic metabolites.

Bioactivity of ethanol extract of Karanja (Pongamia glabra vent) seed coat against mosquitoes.

Laboratory evaluation revealed that the treatment of larvae of Aedes aegypti and Culex quinquefasciatus with ethanol extract of karanja seed coat (ALKSC) significantly increased the larval mortality and developmental period proportianately with increase in the extract concentrations. Aedes proved more sensitive to the effect of extract in terms of mortality than Culex. At a high concentration (8 ppm), 100% Aedes larvae died in the first instar within two days whereas, 16 pmm was required for achieving the same level of mortality in Culex. Culex was also found more sensitive than Aedes regarding IGR effect. In emerging Culex pupae several abnormalities were observed while Aedes pupae did not exhibit any abnormalities. However larvae which pupated successfully resulted in adults with several structural abnormalities in both the species.

Effects of aqueous extract of deoiled neem (Azadirachta Indica A. juss) seed kernel and karanja (Pongamia Glabra vent) seed kernel against Culex quinquefasciatus.

Aqueous extract obtained from deoiled neem and karanja seed kernels (ADNSD and ADKSK) were assessed for their toxic and growth regulating activities against Cx quinquefaciatus treated as first instar larvae. ADNSK at various concentrations was effective on the growth regulating mechanism, inducing prolonged larval stages. However, 100% larval mortality was observed, especially during the first and the second instars at all the tested concentrations. ADKSK caused 100% mortality in the fourth instar larvae and prepupae at the concentration of 100 ppm with no significant effect on the developmental period. The adults emerging from treated (50 ppm) larvae were smaller in size and malformed. We found ADNSK to be more effective than ADKSK.

Is a hypertensive always a hypertensive?

Forty two patients of uncomplicated essential hypertension with well controlled and stable blood pressure for the last six months have been followed up for 2 years after withdrawal of therapy. Drug therapy was reinstituted if they became hypertensive again. Thirty four (89.9%) and 33 patients remained normotensive at 4 and 8 weeks respectively. At the end of 6 months, 26 (61.9%) patients were drug free, 9 (21.4%) were back on therapy and 7 (16.5%) were lost to follow up. At the end of one year, 18 (42.8%) were drug free, 14 (33.3%) were on drugs and 10 (23.8%) had dropped out. At the end of 2 years, the figures were 14 (drug free), 15 (on drugs) and 13 (drop-outs). No cardiovascular or any other complication was recorded during the period. These observations suggest that there may be a subgroup of mild or moderate hypertensives in whom it may be possible to withdraw therapy under observation. However, there is a risk of substantial drop out rate possibly under a false sense of security. Considering the large number of hypertensives in our country and the world over, its economic and therapeutic implications are obvious.