To study the effect of 'Covishield' vaccination on pre-donation platelet counts of plateletpheresis donors

ABSTRACT Introduction: Approximately 55.52% of the Indian population had been fully vaccinated by Jan. 2022, since its first roll out on January 16, 2021. A few concerns were raised concerning the Covishield vaccination related to thrombotic thrombocytopenia. Apheresis-derived platelet concentrates are frequently required in a plethora of clinical situations and post-vaccination decrement of platelet counts might lead to increased deferral of the plateletpheresis donors. Objectives. The aim of the study was to discover the effect of the Covishield vaccination on deferral rates of plateletpheresis donors. Methods: Blood samples were collected from the potential platelet donors for the completion of the standard questionnaire for the complete blood count. The data collected were tabulated in the MS Excel spreadsheet and the biostatistical analysis was performed with the SPSS v23. A p-value of < 0.05 was taken as significant. We compared this data with age-and sex-matched controls. Results: The mean age of cases and controls was 29.69 ± 8.57 and 30.15 ± 7.11, respectively. There was a significant difference in platelet counts of cases (188496.35 ± 72065.66/cumm) and controls (269524.50 ± 53981.60/cumm). Furthermore, donors who received one dose had higher platelet counts of 248676.47 ± 80075.24/cumm than those who received both doses of vaccine (179970.83 ± 66773.73/cumm). The difference in deferral rates between the two groups was remarkable (34.7% vs. 0.9%, with the p-value < 0.001). Conclusion: Vaccination certainly increased the deferral rates of plateletpheresis donors due to low platelet counts. Average platelet counts were low in fully vaccinated individuals, however, the platelets returned to normal counts as the post-vaccination days progressed.

A pilot non-randomized trial of smartphone-based anaglyph system for treatment of adult amblyopia through VR (Virtual Reality)

Purpose: To evaluate the effectiveness of amblyopia treatment through a smartphone?based anaglyph system by virtual reality (VR) in adult patients. Methods: A total of 10 subjects diagnosed with anisometropic amblyopia were enrolled during the study period. Best Corrected Visual Acuity (BCVA), stereoacuity, and contrast acuity were evaluated during three visits (at presentation, 3 months and 6 months) of smartphone?based anaglyph video run in the VR mode. All the amblyogenic factors including stereopsis, color vision, and contrast acuity were compared using Friedman two?way analysis of variance. Statistical significance was considered if P < 0.05. Results: Mean BCVA in amblyopic eye improved significantly from a logMAR value of 0.73 ± 0.64 before Virtual reality vision therapy (VRVT) to a post?training VRVT value of 0.48 ± 0.44 (P < 0.01). Mean stereoacuity changed from a value of 560.00 ± 301.58 before VRVT to a value of 263.00 ± 143.58 seconds of arc after training (VRVT) (P < 0.01). Mean accommodation changes from a value of 15.00 ± 7.40 before training or VRVT to value of 12.60 ± 6.10 cm after training (P < 0.01). Mean contrast acuity changes from a value of 1.21 ± 0.72 at presentation to a value of 1.52 ± 0.49 log unit after VRVT. Conclusion: A smartphone?based anaglyph system using VR vision therapy appears to be an effective treatment option for amblyopia in adults.

A STUDY OF IMMUNOHISTOCHEMICAL EXPRESSION OF GALECTIN-3 IN NON-NEOPLASTIC AND NEOPLASTIC LESIONS OF THYROID

Introduction: Thyroid lesions are fairly common and have a wide spectrum of diseases ranging from functional, immune mediated to neoplastic lesions. Malignancy of thyroid constitutes approximately 1% of all cancers. These malignant tumors of thyroid gland exhibit a variety of histopathologies and clinical behavior. Immune markers are gaining more and more importance in diagnostic pathology, especially in the differential diagnostics and in the grading of thyroid gland tumors. In the recent times Galectin-3 has received notable recognition for its usefulness as a diagnostic marker for thyroid cancer. To evaluate the diagnostic role of galectin-3 (Gal-3) in Aims and objectives: differentiating malignant from benign thyroid neoplasm. In this observational study, we evaluated Gal-Material and method: 3 expression in a spectrum of all non-neoplastic and neoplastic lesions including benign and malignant lesions of thyroid gland. All types of thyroidectomy specimens were xed in 10% formal saline and subjected to histopathological examination. Sections were stained with H&E stain. Gal-3 immunoperoxidase reaction was carried out in histological sections from all the cases and descriptive analysis was done. In the study of 100 cases of thyroid swelling were included and evaluated by Result: histopathological and by using Gal-3 immunoperoxidase marker. Out of 100 cases, majority of thyroid lesions were seen in females with 76 cases (76%) while only 24 cases (24%) were seen in male. Among 66 non-neoplastic cases, only 6 cases (9.1%) and among 34 neoplastic lesions, 28 cases (82.4%) were positive for galectin-3 marker. Statistical signicance of galectin-3 expression between non-neoplastic and neoplastic thyroid lesions found to be statistically signicant (P value <0000.1). The sensitivity and specicity of galectin-3 detection of malignant lesions were found to be 82.4% and 91% respectively with 82.4% positive predictive value and 90.9% negative predictive value. We suggest that Galectin-3 expression is helpful in Conclusion: enabling better diagnosis and patient care by guiding appropriate therapeutic decisions.

Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India

Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).

Small Cell Type Undifferentiated Carcinoma of Gall Bladder with Pas Positive Hyaline Globule Masquerading as Liver Mass: A Case Report and Literature Review / 대한소화기학회지

An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase-resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.

Immunity Status of Health Care Workers Post-Recovery from COVID-19: Natural Adaptive Immunity Persists at Nine Months Post-Infection : An Online Longitudinal Panel Survey

Background : Various studies have pinned longevity of protective Immunoglobulin-G (IgG) titres at 2-5 months. The robustness and longevity of the IgG antibody response to COVID-19 infection has been gauged in a cohort of 214 single institutional health care workers by serial quantitative immunometric tests. Currently no separate guidelines exist for vaccination of COVID-survivors and this study provides data to fill this lacuna in knowledge. Methodology : Prospective longitudinal panel survey administered to the same cohort of Health Care Workers (HCW) till such time they got vaccinated under Indian Government’s free vaccination drive for HCW. Depending upon the date of contraction of infection the HCW could be longitudinally monitored for variable periods (2-9 months). The survey questionnaire comprising multiple-choice, dichotomous, matrix and Likert-scale questions was deployed to the respondents online via email/WhatsApp. Data was expressed as box-whisker plots, trendlines and trend areas. A p-value<0.05 was considered statistically significant. The composite index of ‘Effective Immunity’ was calculated. Results : The mean IgG antibody titre was 11.13±8.6AU at 1-2m, 9.68±8.9AU at 3-4m, 8.35±5.9 AU at 6-7m and 7.87±4.4 AU at 8-9m after first symptom, respectively. The lowest titre at all time points was 0 while the highest titres were 46.8 AU, 56.5 AU, 23.4 AU and 17.4 AU at 1-2m, 3-4m, 6-7m and 8-9m, respectively. Conclusion : Adaptive active immunity acquired through natural infection may last for at least 9 months post-initial exposure and lies in the moderate protection range in 77% HCW, which can be extrapolated to vaccination and immunity passports. Separate vaccination guidelines are required for COVID-survivors. The first shot of vaccine serves as a booster second exposure/booster dose in all COVID-survivors.HCW with low IgG-titre may suffer from a false sense of security. Periodic quantitative IgG-titre based serological tests can help guide timing of second shot of vaccination and predict likelihood of re-infection

Raktamokshana- Ancient Blood Letting Technique: A Review

Ayurveda is a science that focuses on both well-being and disease treatment. Many surgical and para-surgical procedures have been described by Acharya Sushruta for the management of various diseases; among these, Raktamokshana is popularly used for the management of various pathologies occurring due to Rakta Dushti (blood-borne disorders). It is derived from two words i.e., ‘Rakta’ which means blood & ‘Mokshana’ which means leave. Hence, Raktamokshana means to let the vitiated blood out. It is one of the five purification therapies by Acharya Sushruta. There are two ways to do Raktamokshana i.e., Shastra Visravana (using sharp instruments) and Anushastra Visravana (without using sharp instruments). Furthermore, it is said that Siravedha is ‘Chikitsaardha’ i.e., half of the treatment described in Shalya Tantra is similar to a well-performed Basti karma (Therapeutic Medicated Enema) advocated in Kaya-Chikitsa. However, there are relatively limited recommendations or use of Raktamokshana in clinical practices nowadays which may be due to fear associated with the procedure, lack of skillfulness, and unawareness about the efficacy of Raktamokshana in various diseases. This review article is specifically intended to assemble the usefulness of numerous modes of Raktamokshana based on Ayurvedic parameters with its detailed procedure

Incidência de doença inflamatória intestinal: estudo retrospectivo de um único centro / Incidence of inflammatory bowel disease: a single centre retrospective study

ABSTRACT Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract. The etiology of this alarming condition is multifactorial. A Recently increasing trend in IBD is noted in our country. Objective: The present study was designed with the main objective to assess the incidence and to identify the associated risk factors including demographic, geographical areas, and dietary patterns of IBD population of Northern of Karnataka viz. Hubli-Dharwad city. Methods: A retrospective investigation was conducted on a cohort of 226 patients with a working diagnosis of IBD and those who were admitted between 2015 to 2019 the department of gastroenterology, SDMCMS&H. The diagnosis of IBD was made based on clinical, radiological, endoscopic, and histopathologic findings. The patients were categorized into IBD and those who have symptoms suggestive of IBD but did not fit into the diagnostic criteria into, non-IBD groups. The data about of on demography, diet patterns, and laboratory parameters were recorded. Results: Among 226 patients enrolled in this study 2015-2019, IBD was confirmed in 54 Ulcerative colitis - 44 (19.46%), Crohn's disease - 10 (4.42%) patients with varying distribution of disease among different age groups and both genders, Ulcerative colitis (UC) [M: F: 28 (63.6%): 16 (36.4%)] and Crohn's disease (CD) [M: F: 07 (70.0%):03 (30.0%)]. Dietary pattern and other habitats had no significant contribution to illness and its symptoms. Urban (U) and Rural (R) divide was UC [U: R: 32 (72.7%): 12 (27.3%)], CD [U:R:07(70.0%):03(30.0%)] maintained. Conclusion Incidence of IBD was high with UC as compared to CD. The incidence of IBD among patients presenting with symptoms suggestive of IBD is 19.46% with UC being major as compared to CD (4.42%). Male predominant patterns of IBD incidences were noted. Year by year increasing trend in disease burden was observed. The Dietary pattern has no direct correlation with IBD disease prevalence and incidences.

Resumo Contexto: A Doença inflamatória intestinal (DII) é uma doença inflamatória crônica que afeta o trato gastrointestinal. A etiologia desta condição alarmante é multifatorial. Uma tendência recentemente crescente na DII é notada em nosso país. Objetivo: O presente estudo foi desenhado com o objetivo principal de avaliar a incidência e identificar os fatores de risco associados, incluindo demográficos, áreas geográficas e padrões alimentares da população com DII do Norte de Karnataka viz. Cidade de Hubli-Dharwad. Metodos: Uma investigação retrospectiva foi realizada em uma coorte de 226 pacientes com diagnóstico de DII e que foram admitidos entre 2015 e 2019 no departamento de gastroenterologia, SDMCMS&H. O diagnóstico de DII foi feito com base em achados clínicos, radiológicos, endoscópicos e histopatológicos. Os pacientes foram categorizados em DII e aqueles que apresentam sintomas sugestivos de DII, mas não se enquadraram nos critérios diagnósticos em grupos sem DII. Os dados sobre a demografia, padrões de dieta e parâmetros laboratoriais foram registrados. Resultados: Entre os 226 pacientes inscritos neste estudo entre 2015-2019, DII foi confirmada em 54 [RCUI - 44 (19,46%), DC - 10 (4,42%)] com distribuição variada da doença entre diferentes faixas etárias e ambos os sexos, colite ulcerativa (RCUI) [M: F: 28 (63,6%):16 (36,4%)] e doença de Crohn (DC) [M: F: 07 (70,0%): 03 (30,0%)]. O padrão alimentar e outros hábitos não tiveram contribuição significativa para a doença e seus sintomas. Urbanos (U) e rurais (R) dividiram-se em RCUI [U: R: 32 (72,7%):12 (27,3%)], DC [07 (70,0%): 03 (30,0%)]. Conclusão A incidência de DII foi elevada para RCUI em relação a DC. A incidência de DII entre os pacientes com sintomas sugestivos de DIB é de 19,46% com a RCUI sendo maior em relação a DC (4,42%). Foram observados padrões predominantes masculinos de incidência de DII. Ano a ano foi observada tendência crescente de carga da doença. O padrão dietético não tem correlação direta com a prevalência e incidências da DII.

A prospective, multicenter, clinical Study to evaluate the Safety, Pharmacokinetics, and Efficacy of Bleed Outcomes, with HemoRel-A® in severe Hemophilia A Patients

Background and aims: Drug-resistant epilepsy (DRE) is a common and important neurological problem to identify with scope for curative surgical treatment if underlying cause is delineated. There are very few prospective structured studies in our population. This study aimed to look at the neuroimaging profile of DRE presenting in a tertiary care center in South India. Materials and methods: All patients diagnosed clinically as DRE as per International League Against Epilepsy (ILAE) criteria and who underwent magnetic resonance imaging (MRI) over a period of 24 months were included in the study. Their clinical and MRI features were documented and analyzed. Results: A total of 150 patients diagnosed with DRE were included in the study. Clinically, 96 of them presented with generalized tonic-clonic seizures (GTCS), 36 with complex partial seizures (CPS), 14 with simple focal seizures, and two each with atonic seizures and focal seizures with secondary generalization. Magnetic resonance imaging (done in 1.5 T) was normal in 32%. In those with abnormal MRI, mesial temporal sclerosis (MTS) was the commonest pathology seen in 41.3%, followed by cortical malformations (6.7%), tumors (2.6%), vascular malformations (2.7%), and other nonspecific lesions (12%). Conclusion: The clinical and neuroimaging profile of DRE showed that DRE is more common in younger age (of less than 30 years); presents mainly with GTCS or CPS; mesial temporal sclerosis is the commonest underlying pathology which was bilateral in 8.6%; temporal lobe lesions predominate (49.3% of all DRE); and cortical malformation, low-grade tumors, and vascular lesions are other important causes.

Detecção de 'CA. Phytoplasma phoenicium' em plantas de pervinca (Cathranthus roseus) em Uttar Pradesh, Índia

Cathranthus roseus also known as periwinkle, an ornamental plant contains several medicinal values, was found with the symptoms of little leaf and witches' broom at Shahjahanpur location with the incidence of up to 8%. The phytoplasma etiology was confirmed through scanning electron microscopy examination in all the four-leaf samples. Molecular analysis through PCR with universal primer pairs P1/P6 followed by nested PCR with R16F2n/R16r2 primers yielded ~1.2kbp amplicons in all the four symptomatic leaf samples. One amplicon was eluted, purified, sequenced, and used in BLASTn searches, which showed maximum identity of periwinkle isolate with several isolates of 16SrIX group of phytoplasma. Further, phylogenic analysis and in silico RFLP confirmed the association of 16SrIX-C subgroup phytoplasma in little leaf and witches broom plants which is the first report from India.

Spontaneous Rectal Perforation with Transanal Evisceration of the Small Bowel: A Rare Case Report

Transanal evisceration of the small bowel is a rare surgical emergency. Rectal perforation in such cases is usually due to an underlying rectal prolapse. We report a case of a middle aged (45 years) male with spontaneous rectal perforation and transanal evisceration of the small bowel. Approximately 150 cm of small bowel had eviscerated transanally and the patient required emergent abdominal exploration, reposition of the small bowel, and repair of the rectal perforation. Small bowel evisceration through the anal verge is an emergent condition and the aim was to prevent life threatening complications related to sepsis.

Epidural steroid injection in herniated disc and lumbar canal stenosis: is it just a placebo? / Injeção epidural de esteroides em hérnia de disco e estenose do canal lombar: é apenas um placebo? / Inyección epidural de esteroides en hernia de disco y estenosis del canal lumbar: ¿es solo un placebo?

ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.

RESUMO Objetivo Estudar o papel da injeção epidural de esteroides (IEE) em pacientes com hérnia de disco lombar (HDL) e estenose do canal lombar (ECL). As IEEs são usadas regularmente para dar suporte ao tratamento não cirúrgico da dor lombar e nossa impressão empírica é que uma proporção considerável de pacientes relata alívio substancial da dor depois da IEE. Métodos Foram incluídos mil pacientes consecutivos (645 pacientes com HDL e 355 pacientes com ECL) que precisaram de IEE de janeiro a agosto de 2018. Todos receberam a mesmo IEE preparada com triamcinolona (80 mg), bupivacaína (0,25% 4 ml) e solução salina normal (4 ml). Os pacientes foram avaliados pela Escala de Estimativa Numérica (NRS, Numeric Rating Scale) imediatamente, 7 dias e 3 meses depois. Resultados O escore médio de dor nas costas da NRS no grupo HDL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor nas costas do NRS do grupo ECL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 3 (intervalo: 1- 7) após 3 meses (valor de p <0,001). O escore médio de dor na perna da NRS do grupo HDL foi reduzida de 5 (intervalo: 4-9) para 3 (intervalo: 3-7) imediatamente após a injeção, para 1 (intervalo: 1-6) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor na perna da NRS do grupo ECL foi reduzida de 5 (intervalo: 4-9) para 4 (intervalo: 3-7) imediatamente após a injeção, para 3 (intervalo: 1-7) após 7 dias e para 2 (intervalo 1-6) após 3 meses (valor de p < 0,001). Conclusão A IEE causa melhora estatisticamente significativa das dores nas costas e nas pernas em pacientes com HDL e ECL. No entanto, a eficácia a curto e médio prazo da IEE na ECL foi menor do que a da HDL. Nível de evidência IV; Estudo prospectivo baseado em hospital.

RESUMEN Objetivo Estudiar el papel de la inyección epidural de esteroides (IEE) en pacientes con hernia de disco lumbar (HDL) y estenosis del canal lumbar (ECL). Las IEE se utilizan regularmente para respaldar el tratamiento no quirúrgico del dolor lumbar y nuestra impresión empírica es que una proporción considerable de pacientes informa alivio sustancial del dolor después de la IEE. Métodos Se incluyeron mil pacientes consecutivos (645 pacientes con HDL y 355 pacientes con ECL) que necesitaron IEE de enero a agosto de 2018. A todos se les administró la misma IEE preparada con triamcinolona (80 mg), bupivacaina (0,25% 4 ml) y solución salina normal (4 ml). Los pacientes fueron evaluados usando una Escala de Valoración Numérica (NRS, Numeric Rating Scale) inmediatamente, 7 días y de 3 meses después. Resultados La puntuación media de dolor de espalda de la NRS del grupo HDL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de espalda de la NRS del grupo ECL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 3 (rango: 1- 7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo HDL se redujo de 5 (rango: 4-9) a 3 (rango: 3-7) inmediatamente después de la inyección, a 1 (rango: 1-6) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo ECL se redujo de 5 (rango: 4-9) a 4 (rango: 3-7) inmediatamente después de la inyección, a 3 (rango: 1-7) después de 7 días y a 2 (rango 1-6) después de 3 meses (valor p < 0,001). Conclusión IEE causa una mejoría estadísticamente significativa en el dolor de espalda y piernas en pacientes con HDL y ECL. Sin embargo, la eficacia a corto y medio plazo de la IEE en la ECL fue menor que la de HDL. Nivel de evidencia IV;Estudio prospectivo basado en hospitales.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis / 대한소화기학회지

Background/Aims@#Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. @*Methods@#Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. @*Results@#Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. @*Conclusions@#The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy

Background/Aims@#The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19). @*Methods@#This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages. @*Results@#A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period. @*Conclusions@#The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.

COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy

Background/Aims@#The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19). @*Methods@#This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages. @*Results@#A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period. @*Conclusions@#The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis / 대한소화기학회지

Background/Aims@#Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. @*Methods@#Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. @*Results@#Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. @*Conclusions@#The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

Hair tourniquet syndrome of labia minora in 14 year teen: a rare case report

Hair tourniquet syndrome (HTS) is rare clinical phenomenon in which body appendage is circumferentially entangled by string of hair leading to ischemia and necrosis or even autoamputation of the appendage. HTS commonly affects toes, finger or genitalia. Early diagnosis and prompt intervention lead to good outcome.  This article presents a case of hair tourniquet syndrome of labia minora, a rare presentation in 14 year child.

Assessment of Insulin Resistance and its Correlation with 25-OH Vitamin D in Chronic Kidney Disease

Introduction: Insulin resistance is more frequent atprogressively declining glomerular filtration rate levels and isalmost universal in end-stage kidney failure. Multiple studieshave also demonstrated that 1,25(OH)2D administrationimproves glucose metabolism in patients with chronic kidneydisease (CKD). The present study was carried out with an aimto assess insulin resistance and to find an association betweeneGFR, insulin resistance, and vitamin D levels in patients withchronic kidney disease.Material and Methods: This Cross-sectional study wasconducted in a tertiary care academic hospital. Subjects withage ≥18 years; and estimated GFR <60 mL/min/1.73m2 wererecruited. CKD was characterized as an estimated glomerularfiltration rate (eGFR) <60 mL/min/1.73m2 using a CockcroftGault equation. Insulin Resistance was assessed using theHOMA: HOMA-IR. Quantitative measurement of 25-OHvitamin D in serum and plasma samples was done usingChemiflex.Results: Among sixty-four enrolled subjects, 53.1% hadinsulin resistance. Insulin resistance showed an inverserelationship with eGFR (r= -0.50, p< 0.001), and metabolicacidosis (r= -0.39, p<0.001) while, it has no relation withvitamin D levels (r= -0.01, p<0.90). The study also showsthat BMI (OR 1.43, 95% CI 0.99-2.07, p=0.05), waistcircumference (OR 1.37, 95% CI 1.10-1.72, p=0.005), andmetabolic acidosis (OR 5.71, 95% CI 1.85-17.61, p=0.002)were independently related to insulin resistance.Conclusion:The present study shows that eGFR and metabolicacidosis has an inverse association with insulin resistancein CKD patients. The study also shows that BMI, waistcircumference, and metabolic acidosis were independentlyrelated to insulin resistance.