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Background: Necrotizing fasciitis (NF) is a state of infection promptly intensifying the destruction of skin with underlying tissue leading to permanent infirmity and high mortality irrespective of good parenteral drug coverage and contentious surgical handling. NF normally begins as a confined infective focus that initially presents as cellulitis later rapidly progresses to large areas of infection which disproportionate to pain. Aims and Objectives: The primary aim of this study is to determine the incidence and management methods of NF in tertiary health-care center of western Odisha. Materials and Methods: A retrospective review of medical records of patients diagnosed with NF presenting to department of general surgery, Veer Surendra Sai Institute of Medical Sciences and Research Burla, from March, 2020 to February, 2022 was performed. Various information such as patient’s demographics, type of presentation at the time of admission, age group affected, body parts affected, mode of injury, and microbiological status were collected in a predesigned format for analysis. Data were presented in number and percentage. Results: A cumulative of 96 cases with clinical features of NF was reviewed. The median age group range was 31–40 years. Nearly 94.7% cases had significant underlying comorbidities. Extremities were most commonly affected part. About 82.2% cases had undergone surgical debridement, 13.5% cases fasciotomy, and 4.2% cases skin grafting. Most common mode of injury is trivial injury. Group A Streptococcus is most common cause of organism. Almost 78.3% cases were healed. Conclusions: NF can induce upscaled morbidity and mortality if left undetected and untreated in primordial stages. The medics, paramedics, and specialists including surgeons need to have a high degree of intuition to diagnose NF at its beginning stages and thus precisely put resuscitative efforts, plan for debridement, and need for any urgent referral.
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In the year 1989, hepatitis C virus (HCV) was specifically established as causative factor accountable for many more occurrences of hepatitis. It's a chronic disease which majorly contributes to Carcinoma and Cirrhosis. The hepatitis C virus belongs a family Flaviviridae (+) enveloped ssRNA virus. It has been described that seven major genotypes of HCV and their subtypes (a, b). Around 3 percent among global residents has been infected by HCV. HCV Transmission is frequently associated with direct percutaneous blood contact, via blood transfusions, health-related injections and substance use injections. Several new therapies have been developed to treat HCV, such as polyethylene glycol (PEG)-ylated interferon / ribavirin, antivirals acting directly and antivirals targeting the host. Despite progress in anti-HCV therapy, there is still an urgent need for new approaches of targeted drug delivery systems using nanomedicine which are affordable and reliable. Nanotechnology has the ability to play a pivotal role in lowering viral load levels and drug-resistant HCV by targeting drugs directly to the disease site. In addition to tissue targeting, a wide variety of drugs need to be administered intracellularly to achieve a therapeutic effect in the organ affected. The contribution of nanoparticles as a promising delivery mechanism for HCV immunizing, diagnostic and therapeutic agents and there latest developments of drug carriers as well as their role in anti-HCV therapy were addressed in this review.
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The latest fifth edition of the World Health Organization classification of central nervous system tumors (WHO CNS5) has been built on the prior WHO 2016 classification as well as recommendations put forward by seven updates of the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT). Various new tumor types and subtypes have been recognized which are of clinical significance. Tumor groups have been restructured and the nomenclature of some tumor types has also been revised. The use of terms 'entity' and 'variant' have been replaced by 'type' and 'subtype'. Significant changes have been introduced in the grading of tumors viz. use of Arabic numerals, grading within individual tumor types and combined histological and molecular grading. The terms 'Not otherwise specified' and 'Not elsewhere classified' can now be used for all tumor types. WHO CNS5 also for the first time endorses the use of DNA methylation profiling for the diagnosis of some tumor types/subtypes. Finally, the importance of combining histology with molecular parameters is emphasized for the “layered reporting” and “integrated diagnosis”, which will provide valuable diagnostic, prognostic, and predictive information, as well as for some entities, suggest targeted therapies.
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“Completeness (a measure of adequacy)” and the “appropriateness (a measure of the quality of care)” are two dimensions of good prescription practice. The study assessed the prescription practices at the primary health centers (PHCs); to demonstrate the effect of individual and system‑level factors, on adequacy and appropriateness of prescription practices, with special reference to e‑prescription over manual prescription given the rising acceptance of teleconsultation in health care. A total of 600 manual and 1000 e‑prescriptions were randomized using a probability‑proportional‑to‑size sampling method to distribute/allocate samples across manual and e‑prescriptions. Findings revealed that while adequacy and appropriateness of prescriptions depend on individual training and clinical practice; adequacy of prescription, especially the manual was compromised by systemic factors, such as nonavailability of space in a prescription, forcing doctors to prioritize documentation of diagnosis, advising tests, and prescribing medicines, over other details (chief complaints and examination findings).
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Background:To investigate urine uromodulin as a marker for Diabetic nephropathy (DN) and its relation with glycaemic control.Material &Methods:a cross-sectional comparative study on 180 healthy controls (Group I), 205 patients of Diabetes Mellitus were classified as Group II without microalbuminuria and those with microalbuminuria as Group III.Urineuromodulin, albumin and creatinine was estimated along with routine biochemistry.Results:The FBS, PPBS, HbA1c and serum creatinine were lowest in Group I as compared to groups II and III (p < 0.01, <0.01, <0.01, 0.008 respectively). There was no difference in urine uromodulin levels among the three groups (p= 0.609) but the Uromodulin HbA1cRatio (UHR) showed a significant difference (p <0.01). UHR showed a statistically significant negative correlation with FBS, PPBS, HbA1c and urine (p= <0.01, <0.01, <0.01 and 0.004 respectively). The Odds of having DN with UHR > 8.6 was 0.49 (95% CI is 0.308-0.78).Conclusion:The non-occurrence of a diabetic complication that is nephropathy in our studygroup is favourable to those diabetic patients with a higher UHR (>8.6). Estimation of urine uromodulin will be beneficial along with albuminuria in detecting DN.
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Aim: The present study aimed to estimate the total carbon sequestration potential of a 20-years-old teak (Tectona grandis) plantation forest spread over an area of 23 ha (in Odisha under Eastern Ghats stretch) through analysis of above ground and below ground biomass carbon of trees and soil organic carbon (SOC) stock.Methodology: The sampling was carried out during May to July 2017. Random non-destructive quadrate method was used for vegetation analysis. Based on the girth, height, basal area and bio volume of trees, the above ground carbon (AGC), below ground carbon (BGC) and total carbon storage in biomass (CSB) of teak plantation forest was calculated. Similarly, soil samples were taken by a soil core sampler at different depths and based on their organic carbon, bulk density, stone and gravel contents, soil organic carbon (SOC) stocks of soil was calculated. Results: The total SOC stock and CSB of the entire teak plantation forest was 489.21 t and 6670 t, respectively, across an area of 23 ha. Taking two carbon pools into account, the total carbon sequestration (TCS) of teak plantation forest patch was 7159.21 t, which arrived to be 311.27 t ha-1 with AGC of 230.16 t ha-1 and BGC of 59.84 t ha-1 and TOC stock of 21.27 t ha-1. The highest contribution in terms of carbon storage was established by above ground carbon (74%) followed by below ground carbon (19%) and SOC (7%). Interpretation: The current study reflects that teak plantation forest has rich potential of carbon sequestration not only in tree biomass but also in the SOC form and this plantation can act as a potent reservoir of carbon in the Eastern Ghats of India
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The incidence of carbapenem-resistant Enterobacteriaceae has been steadily rising. The morbidity, mortality and financial implications of such patients are significant. We did a retrospective analysis of the case records of 11 patients who had culture report positive for pan drug-resistant (PDR) organisms. There were total 15 isolates of PDR organisms in 11 patients. These were associated with catheter-associated urinary tract infections (7), tracheitis (4), bacteraemia (2), meningitis (1) and soft-tissue infection (1). Average APACHE II score was 23.72 (range 7-36) indicating patients with multiple co-morbidities and organ dysfunction. The average length of hospital stay was 60.72 (25-123) days. The overall mortality rate was 81.81 per cent, while PDR infection-related mortality was 18.18 per cent. Strict implementation of antibiotic stewardship programme is essential to limit use and prevent abuse of colistin.
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Background: Carcinoma of the breast is a leading cause of death in women and needs to be evaluated at an early stage. FNAC helps in rapid diagnosis of breast lesions and their management. Objective: To study the diagnostic efficacy of FNAC in breast lesions. Materials and methods: Three year retrospective study of 105 cases of breast lump was conducted which included cases, where FNAC and histopathological correlation was available. The cytological diagnosis was classified as inflammatory lesions, benign, atypical probably benign, suspicious for malignancy and malignant. Results: On cytology out of 105 cases, 57 were benign, 7 inflammatory lesions, 34 malignant and 7 were inadequate. Fibroadenoma was the most common benign lesion noted in age group of 21-30 years and infiltrating ductal carcinoma was the most common malignant lesion in 31-40 years age group. Diagnostic accuracy, sensitivity and specificity of this study were 96.93%, 91.89% and 100% respectively. Conclusion: FNAC of breast lesions is a simple, safe and effective modality in pre-operative assessment of benign and malignant lesions and shows high accuracy, sensitivity and specificity.
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Background & objectives: One of the major strategies being pursued for malaria control by the National Vector Borne Disease Control Programme is the distribution of long lasting insecticidal nets (LLINs) in endemic areas since 2009. Information on durability of insecticidal efficacy and physical integrity of LLINs and community usage at different time intervals of their use is essential to plan net replacements to maintain universal coverage for an effective and sustainable malaria control strategy. Therefore, a study was undertaken to assess these parameters in two malaria endemic districts of the Odisha State. Methods: A total of 309 households were selected in 15 villages of two community health centres (CHCs) (Borigumma and Laxmipur) from Koraput district and one (Khairput) from Malkangiri district. Data on net usage were collected during March to July 2014 using semi-structured questionnaires. PermaNet 2.0 were sampled from all households, replaced with new ones, and bioassays were carried out to determine the insecticidal efficacy of LLINs after four and half, four and two years of field use following the standard procedure of World Health Organization. Results: LLIN use rate varied from 57.9 to 90.2 per cent in the study CHCs. The annual washing rate per net in Borigumma, Khairput and Laxmipur was 6.6, 3.2 and 4.8, respectively. The LLINs used two years in the field caused 100 per cent mortality and four to four and half years caused below 80 per cent mortality, except one net. Interpretation & conclusions: Nearly 20 per cent of the people were out of net coverage and hence the Programme to ensure 100 per cent coverage. The community should adequately be educated so as to increase the net use rate and avoid incorrect washing practices.
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Background & objectives: In Odisha State, the control of malaria vectors has become dependent on synthetic pyrethroids, which are used for treatment of all approved long-lasting insecticidal nets (LLINs). The vast use of just one class of insecticide has led to the problem of resistance to insecticides in malaria vectors. One of the major malaria vectors in Odisha State is Anopheles culicifacies Giles. The aim of this study was to determine the resistance status of An. culicifacies to deltamethrin, a synthetic pyrethroid and other common insecticides used by the National Vector Borne Diseases Control Programme (NVBDCP) for indoor residual spraying in Odisha State. Methods: Mosquitoes were collected during April 2014 - June 2014 from 15 randomly selected villages in five Plasmodium falciparum endemic southern districts of Odisha State. The blood-fed wild caught females were exposed to the diagnostic dosage of DDT (4.0%), malathion (5.0%) and deltamethrin (0.05%) for one hour. Mortality was recorded at 24 h after the exposure. Results: Results indicated that An. culicifacies was resistant to all the three insecticides used in the malaria control programme in the five districts of Odisha State. Interpretation & conclusions: Resistance management strategy by appropriate rotation of different groups of insecticides including carbamates and incorporating a synergist with synthetic pyrethroids for treating mosquito nets should be considered for the control of malaria vectors in the area, especially where An. culicifacies is predominant. Periodical monitoring of susceptibility/resistance status of An. culicifacies to different insecticides is warranted.
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Background & objectives: Rapid diagnostic tests (RDTs) have become an essential surveillance tool in the malaria control programme in India. The current study aimed to assess the performance of ParaHIT-f, a rapid test in diagnosis of Plasmodium falciparum infection through detecting its specific antigen, histidine rich protein 2 (PfHRP-2), in Odisha State, India. Methods: The study was undertaken in eight falciparum malaria endemic southern districts of Odisha State. Febrile patients included through active case detection, were diagnosed by Accredited Social Health Activists (ASHAs) for P. falciparum infection using the RDT, ParaHIT-f. The performance of ParaHIT-f was evaluated using microscopy as the gold standard. Results: A total of 1030 febrile patients were screened by both microscopy and the RDT for P. falciparum infection. The sensitivity of ParaHIT-f was 63.6% (95% CI: 56.0-70.6) and specificity was 98.9% (95% CI: 97.9-99.5), with positive and negative predictive values (PPV and NPV) of 92.6% (95% CI: 86.0-96.3) and 93.0% (95% CI: 91.0-94.5), respectively. When related to parasitaemia, the RDT sensitivity was 47.8% at the low parasitaemia of 4 to 40 parasites/μl of blood. Interpretation & conclusions: The results showed that the performance of the RDT, ParaHIT-f, was not as sensitive as microscopy in detecting true falciparum infections; a high specificity presented a low frequency of false-positive RDT results. The sensitivity of ParaHIT-f was around 60 per cent. It is, therefore, essential to improve the efficiency (sensitivity) of the kit so that the true falciparum infections will not be missed especially in areas where P. falciparum has been the predominant species causing cerebral malaria.
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Pneumatic tourniquets have been used in orthopaedic surgery to get avascular fi elds. Sixteen such tourniquets were analysed for microbial colonisation. Samples were taken from two inner and two outer areas of each tourniquet and cultured on sheep blood agar. Eight of these were wiped with Savlon and the rest with Sterillium solution. Post-treatment samples from the same sites were again cultured. After incubation, colonies from each site were identifi ed and counted. It was observed that the tourniquets were colonised with coagulase-negative staphylococci, Staphylococcus aureus, Bacillus, diphtheroids, Pseudomonas, Acinetobacter, enterococci, enterobacteria, and Candida. On treating with Savlon and Sterillium, there was 92.18% and 95.70% reduction in the colony count, respectively.
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A female child of age five attended our institution in Jan 2006 with repeated upper respiratory infection. Plain skiagram and CT examinations confirmed the case to be a Scimitar syndrome.
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Background & objectives: Anopheles minimus and An. fluviatilis were incriminated as the major malaria vectors in Keonjhar district of Odisha State recently. This study was carried out to elucidate the potential role of these two vector species in transmission of malaria during different seasons, and vectorial capacity of these species was also estimated. Methods: Three hilly and forested villages of Keonjhar district were randomly selected. Vectorial capacity (C) was calculated using the Macdonald’s formula as modified by Garret-Jones. The human landing density of the vector species was obtained from all night human landing collections (bait protected by bed-net). Man feeding habit was estimated by multiplying the human blood index with feeding frequency, which was obtained on daily basis from the duration of gonotrophic cycle. The probability of survival through the extrinsic incubation cycle was calculated from the probability of survival through one day and duration of sporogonic cycle. Results: The estimated vectorial capacity of An. minimus varied between 0.014 and 1.09 for Plasmodium falciparum (Pf) and between 0.1 and 1.46 for P. vivax (Pv). The C of An. minimus for both Pf and Pv was higher during rainy season than the other two seasons. The estimated C of An. fluviatilis varied between 0.04 and 1.28 for Pf and between 0.20 and 1.54 for Pv. Interpretation & conclusions: Based on the estimated values of vectorial capacity of the two vector species, the area could be stratified and such stratification would reflect the difference in the intensity of transmission between different strata and accordingly the appropriate control strategy could be adopted for each stratum.
Subject(s)
Animals , Anopheles/pathogenicity , Humans , India/epidemiology , Insect Vectors/pathogenicity , Malaria, Falciparum/epidemiologyABSTRACT
Background & objectives: Selection of an insecticide and its appropriate formulation is a prerequisite of formulating any chemical control strategy against vectors. A hut scale field trial was carried out to study the effectiveness of house spraying with capsule suspension (CS) formulation of lambdacyhalothrin in comparison with its wettable powder (WP) formulation on mortality, density and behaviour of malaria vector in Malkangiri district, Odisha, India. Methods: The two formulations were tested at 20 and 30 mg (a.i.)/m2 for their effectiveness in terms of deterrence, excito-repellency, blood-feeding success, mortality and residual activity against Anopheles fluviatilis, the major malaria vector, in experimental huts in Malkangiri district, Odisha State, India. Results: Both CS and WP formulations prevented the entry of An. fluviatilis in to the sprayed huts by >90 per cent for >6 months, the entire peak malaria transmission season in the area. The exit rate increased (90-99%) with different treatments and the feeding rate was reduced (91-97%). There was no significant difference between WP 30, CS 20 and CS 30 mg/m2 in these respects. However, WP 20 mg/m2 caused a lesser effect than the other three groups. The formulations or the dosages differed only in causing vector mortalities. Overall, the total mortality rate of An. fluviatilis was higher in the huts sprayed with CS 30 (58%) than the huts sprayed with CS 20 (48%), WP 20 (37%) and WP 30 mg/m2 (47%). Interpretation & conclusions: Considering the duration of residual action and the effect on entry, exit, feeding and mortality of An. fluviatilis, the dosage 20 mg/m2 of CS formulation of lambdacyhalothrin could be considered for further use.
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Background & objectives: Integrated vector management (IVM) emphasizes sustainable eco-friendly methods and minimal use of chemicals. In this context, the present study highlights the environmental control of breeding of Anopheles fluviatilis, the primary malaria vector, through water management in a natural stream in Koraput district, Odisha, India. Methods: The District Rural Development Agency (DRDA), Koraput, constructed two bed-dams across streams, one in Barigaon and the other in Pipalapodar village. The bed-dam in the former village was fitted with two sluice gates whereas the bed dam constructed in the latter village was without the sluice gate. tThe sluice gates were opened once in a week on a fixed day to flush out the water from the dam. Anopheles immatures were sampled systematically in the streams using a dipper for density measurement and species composition. Results: There was a reduction of 84.9 per cent in the proportion of positive dips for aAnopheles larvae/pupae and a reduction of 98.4 per cent in immature density (number/dip) of An. fluviatilis in the experimental downstream compared to the control following opening of the sluice gates. Interpretation & conclusions: oOur findins showed that opening of sluice gates of the bed-dam regularly once in a week resulted in the control of vector breeding in the downstream due to the flushing effect of the water released with a high flow from the bed-dam that stagnated water in the upstream. The outcome of the study encourages upscaling this measure to other areas, wherever feasible.
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Aim: A new, simple, rapid, very sensitive and accurate high performance thin-layer chromatographic (HPTLC) method has been developed and validated for estimation of Gemifloxacin in rabbit plasma. Study Design: Validation study. Methodology: HPTLC was performed on silica gel 60F254 plates with ethanol: ethyl acetate: hexane, 2:7:1 (v/v), as mobile phase. Densitometry scanning was performed in absorbance mode at λ=254 nm. Result: The RF value was 0.21. The response was a linear function of concentration over the range 0.1–0.7μg mL−1 (r2=0.996). A maximum recovery of drug from plasma was obtained by using chloroform and glacial acetic acid. Mean extraction recovery was 80%. Intra-day and inter-day precision (% RSD) of the assay were in the range 1.19–2.85% and accuracy was 1.7-5.66% Conclusion: This method can be applied to pharmacokinetic studies in rabbit plasma.
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Rhizoctonia solani is a very common soil borne pathogen with a great diversity of host plants. A 52 year old lady presented with sole manifestation of subcutaneous swelling over the left leg for 3 months Pus was collected by aspiration revealed septatate fungal hyphae. After culture on SDA at 25 C showed white cottony growth initially, progressed to buff colored to black colonies on further incubation. On LPCB mount we found septate hyphae with acute and right angled branching with out any conidia and hyphal anastomosis which resembled features of Rhizoctonia solani. Patient was put on Fluconazole and responded well to the treatment.
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Rhizoctonia solani is a very common soil borne pathogen with a great diversity of host plants. A 52 year old lady presented with sole manifestation of subcutaneous swelling over the left leg for 3 months Pus was collected by aspiration revealed septatate fungal hyphae. After culture on SDA at 25 C showed white cottony growth initially, progressed to buff colored to black colonies on further incubation. On LPCB mount we found septate hyphae with acute and right angled branching with out any conidia and hyphal anastomosis which resembled features of Rhizoctonia solani. Patient was put on Fluconazole and responded well to the treatment.