Prevalence, severity, and trends in drug therapy of COVID-19 breakthrough infection at L-3 COVID Hospital, Bareilly: A cross-sectional study

Background: The COVID-19 pandemic has led to dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems, and the world of work. The availability of a safe and effective vaccine for COVID-19 is well recognized as an additional tool to contribute to the control of the pandemic. Although vaccines proved efficacious in preventing infection, yet some cases of post-vaccination breakthrough infections (BTIs) have been reported, raising concerns about the efficacy and safety of COVID vaccines. Aim and Objectives: This study was aimed to investigate the occurrence of BTIs among the vaccinated healthcare workers (HCWs), to analyze the severity of their disease and to know the trends in drug therapy. Materials and Methods: This was a retrospective cross-sectional study. Data were obtained by a predesigned questionnaire and was distributed through Google platform. Details of time, severity of BTIs and the trends in drug therapy among the vaccinated healthcare workers (HCWs) was evaluated and statistically analyzed. Results: A total of 616 HCWs participated in the study, out of which 553 were vaccinated and 63 of them were unvaccinated. About 15%, that is, 85/553 of the vaccinated HCWs developed BTI. Case rate was lesser (12.9%) in fully vaccinated HCWs as compared to partially vaccinated HCWs (19.5%). Most BTI cases (94%) suffered mild to moderate severity of symptoms and were managed in home isolation with medicines (mainly paracetamol, azithromycin, and doxycycline). Only five out of 85 BTI cases developed severe disease and needed hospitalization. Conclusion: BTIs after COVID-19 vaccination are uncommon and typically present with mild symptoms. Thus, vaccination along with hand sanitization, wearing of masks, and maintaining social distancing has provided hope in combating the pandemic.

Relationship between vitamin D and blood pressure in patients with type 2 diabetes mellitus in semi-urban North Indian population

Background: Besides being associated with cardiovascular diseases, hypertension has emerged as a risk factor for diabetes. A few studies have focused on the role of vitamin D in the control of blood pressure in hypertensive people. There is still debate about whether serum vitamin D levels play a role in causing hypertension or not. Aim and Objectives: The aim of this study was to find out the relationship between vitamin D and blood pressure in type diabetes. Materials and Methods: In this cross-sectional observational study, a total of 180 type 2 diabetes patients participated. Patients were divided into two groups on the bases of Vitamin D levels. Vitamin D levels below 20 ng/ml are considered Vitamin D deficient and more than 20ng/ml are considered as no vitamin D deficient. An independent t-test was used for comparison of glycemic parameters and blood pressure between the two groups. Person correlation was used to find out the relationship between Vitamin D and blood pressure. Results: Glycated hemoglobin and fasting plasma glucose were significantly higher in vitamin D deficient groups (P ? 0.001). Furthermore, a significant difference was found in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Moreover, a significant negative correlation was observed only with vitamin D deficient group and SBP (r = –0.22, P = 0.04); it was also true for DBP and MAP (r = –0.24, P = 0.03, r = –0.24, P = 0.01), respectively. Conclusion: A low vitamin D is negatively associated with blood pressure in type 2 diabetic patients. Vitamin D supplementation can improve blood pressure along with glycemic parameter.

Pharmacovigilance: The extent of knowledge, attitude, and practice in MBBS interns of rural tertiary health center of Maharashtra

Background: Adverse drug reactions (ADRs) are one of the leading causes of death and are responsible of 5–10% of the hospital costs. Every drug having more or less adverse effects which may leads to medical and economic burdens on patients. Some ADRs are severe enough to increase the risk of death. Pharmacovigilance aims to detect and monitor the ADR, to identify the risk factors responsible of it, and to disseminate the knowledge required for the improvement of prescription of drugs. Aim and Objective: This study aims to assess the knowledge, attitude, and practice (KAP) of pharmacovigilance in MBBS interns of rural tertiary health center of Maharashtra. Materials and Methods: This was a cross-sectional study to evaluate the KAP regarding pharmacovigilance among MBBS interns. KAP questionnaire contained 20 questions along with options and correct answer. For pre-test, 20 min were given to them for answering all questions then a seminar (an educational intervention) was taken on pharmacovigilance and its importance and last, post-test was conducted in 20 min. Results: A total of 75 MBBS interns attended the CME on pharmacovigilance and filled the pre- and post-test questionnaire. Fifty-three (70.66%) participants were not known when the Pharmacovigilance Program of India (PvPI) started and 57 (76%) participants were unaware of regulatory body which is responsible for monitoring ADR in PvPI. Forty-seven (62.66%) participants had no clue that a serious adverse event should be reported within a stipulated time period to the regulatory body. Conclusion: Interns are new budding health care workers and they do not have sufficient knowledge of pharmacovigilance. Inclusion of pharmacovigilance in undergraduate curriculum, conducting CME for doctors, nurses, and pharmacist and motivation of doctors for reporting ADRs are some measures which can improve the spontaneous reporting system, patient safety, and Indian pharmacovigilance program.

Ceftriaxone-Induced Thrombocytopenia in a Patient with Bacterial Meningoencephalitis

Drug-induced thrombocytopenia is a rare and life-threatening condition. It is mainly caused by the initiation of drug-dependent platelet reactive antibodies that leads to the accelerated platelet destruction. Ceftriaxone is a third-generation cephalosporin, which has rarely reported cases of drug-induced immune thrombocytopenia. Here, we report a case of ceftriaxone-induced thrombocytopenia after the initiation of antibiotic therapy for bacterial meningoencephalitis based on the laboratory findings with the initiation and discontinuation of ceftriaxone.

TREATMENT DIFFICULTIES WITH LIVER ABSCESS IN PREGNANCY A RARE CASE REPORTTREATMENT DIFFICULTIES WITH LIVER ABSCESS IN PREGNANCY A RARE CASE REPORT

Liver abscess in pregnancy is a rare entity and can be a life threatening condition. Here we present A case of amoebic liver abscess in 25 years old lady in of pregnancy, with highlights on treatmentthird trimester difficulties which we had faced in the management and timely intervention leads to good fetomaternal outcome

Prevalence of intimate partner violence among pregnant women attending a public sector hospital in Bengaluru, southern India

BACKGROUND Intimate partner violence (IPV) is recognized as an important public health problem globally as well as in India. It may result in adverse physical and mental health consequences for the victim or unfavourable pregnancy outcomes if it happens during pregnancy. The possible risk factors for IPV can be explained by four levels of ecological factors: individual, partner, household and community. We estimated the prevalence of IPV and its association with selected ecological risk factors among pregnant women availing of antenatal care at a public sector hospital in Bengaluru, southern India. METHODS We included 350 women above the age of 18 years with a confirmed pregnancy of less than 24 weeks and having no obstetric complication. We used the Conflict Tactics Scale to determine the presence of IPV. The risk factors measured were—individual level: respondent’s age, education, occupation, gravidity, planned or unplanned pregnancy, substance abuse, presence of depression and anxiety; partner-related: spouse’s education, occupation and marital discord; household/community-related: socioeconomic status, social support, religion and consanguinity. RESULTS The prevalence of IPV was 3.7%. Factors that were significantly associated on multivariate analysis were higher age (above 20 years) (adjusted odds ratio [AOR] 1.82 [1.12–2.97], p=0.016) and presence of depression (AOR 6.84 [1.76–26.61], p=0.005). CONCLUSION The prevalence of IPV was less in our study population compared to figures reported from other Indian study settings.

”Double-layer sign” on spectral domain optical coherence tomography in pachychoroid spectrum disease

Purpose: The “double-layer sign (DLS)” describes the shallow and irregular elevation of the retinal pigment epithelium from the underlying intact Bruch's membrane visualized on the spectral domain optical coherence tomography. In this study, we evaluated the frequency, characteristics of the space within the double layer and other features in the pachychoroid spectrum to aid the clinical diagnosis of these variants. Methods: This retrospective study evaluated the features of the DLS on multimodal imaging in consecutive patients with a clinical diagnosis of one of the four variants of pachychoroid: pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PCN), chronic central serous chorioretinopathy (CCSCR), and polypoidal choroidal vasculopathy (PCV). The features of the DLS were graded by two masked graders. Results: Overall, 102 eyes of 79 consecutive patients with pachychoroid spectrum were identified for grading. Sixteen eyes with PPE did not show any evidence of DLS. The DLS was identified in 15/16 (93.75%) eyes with PCN, 11/35 (31.43%) with CCSCR, and 32/35 (91.43%) with PCV (P < 0.001). The space within the DLS showed moderate hyperreflectivity in all eyes with PCV and PCN, while the space in the DLS in CCSCR showed uniform hyporeflectivity in 10/11 (%) eyes. Conclusion: The DLS sign was most frequent in polypoidal vasculopathy and PCN. A hyporeflective gap within the DLS favored the diagnosis of CCSCR.

In-vitro study of formulation and evaluation of nanosuspension of tamoxifen

Background: Nanosuspension technology has been developed as a promising candidate for efficient delivery of hydrophobic drugs. It could maintain the required crystalline state of the drug with reduced particle size, leading to an increased reporting on dissolution rate and therefore improved bioavailability.Methods: In this paper, we report on the preparation of Tamoxifen nanosuspension by high-pressure homogenization (HPH). The aim is to obtain a stable nanosuspension with an increased drug saturation solubility and dissolution velocity. The morphology and particle size distribution of the modified nanosuspensions were characterized by the means of several analyses that included: transmission electron microscopy (TEM), polarized light microscopy (PLM), scanning electron microscopy, differential scanning calorimetry (DSC) and powder X- ray diffractometry (XRD).Results: HPH was employed to produce aqueous drug nanosuspensions with fine solubility and dissolution properties, which render the produced particles stable up to one month. In addition, the prepared nanosuspensions possessed a high drug-loading efficiency (10%). The recoded zeta potential values (? -27 mV) indicated that the prepared nanosuspensions possess a higher degree of long-term stability. TEM data showed narrow size distribution with average size 322.7 nm. Morphologically, as indicated from results, the produced nanosuspensions have a homogenous distribution even after redispersion, indicating the stability of the product.Conclusions: It was possible to obtain Tamoxifen nanosuspensions with fine solubility and dissolution properties. Nanosuspensions possessed a high drug- loading (10%), which could reduce the dosage administration and gastrointestinal side effects. HPH can be employed to produce aqueous drug nanosuspensions that are stable up to one month. Aqueous nanosuspension can be converted to dry nanocrystals by lyophilization which offer superior physicochemical properties.

Evaluation of oral health status among drug addicts in rehabilitation centre

Background: The present study was conducted to investigate the attitude of drug addicts under withdrawal treatment towards oral health so that required interventions can be planned for the good health of those who are in rehabilitation phase of life. Materials and methods: The present study comprised of 30 drug addicts (all males) admitted in the rehabilitation centre in Punjab, India. Data so obtained was subjected to analysis using SPSS version 16. Percentage and mean ± standard deviation was calculated and Chi-square test was used for statistical analysis. Results: Most of the participants (97%) were involved in more than one type of drug abuse and most of them used more than one type of route of drug substance administration. Regarding brushing frequency, about 17% not brushed their teeth regularly and 83% once a day and regarding the use of mouthwashes, 38% never used mouthwash, 59% used occasionally, 3% reported once a day. Most of the participants 92% never used floss to clean their teeth. Significant p value (<0.05) was found on statistical analysis of periodontal status, carious and fractured teeth in relation to oral hygiene practices among drug addicts. Conclusion: The result of the present study emphasis for more attention in designing and implementing oral health programs for addicts.

Post renal transplant infections: One year follow up study

Introduction: Transplantation returns the majority of patients to an improved life-style and an improved life expectancy, as compared to patients on dialysis; however, careful prospective cohorts studies have yet to be reported. Infection is a leading cause of morbidity and mortality in transplant recipients, with more than 80% suffering at least one episode of infection in the first year. The risk for infection is strongly determined by an interaction between epidemiologic exposures and net state of immunosuppression. Aim and objectives: To study the prevalence of infections in the post renal transplant recipients, to find out the most common cause of infections in post renal transplant patients, to find out the frequency of infections in early and late phase of renal transplantation. Materials and methods: Patients who reached end stage renal disease and who underwent Renal Transplantation in our hospital was prospectively followed up for infections for a period of 1 year. Results: A total of 77 transplant recipients were included in our study. Out of which, 50 recipients (69.44%) had infections during follow up. 32 recipients (64 %) had infections involving more than one system. The infectious were common within the first 6 months of surgery and most of them occurred within the first month of surgery. Conclusions: Urinary Tract infection was the most common confection occurring in the post renal transplant recipients.

Osteosarcoma: an immunophenotypic study for characterization and behavior.

Background: Osteosarcoma is the most common primary bone tumor occurring in second and third decades of life with a second peak later. Biopsy (needle or incision) is necessary for diagnosis along with imaging modalities (X-ray, CT scan etc) and serology. Due to diagnostic dilemma in certain cases and for prognosis of patients, immunohistochemistry is increasingly used. Aims: To assess the pathologic features and determinants of osteosarcoma in patients of the Indian subcontinent that would put an insight into its appearance and behavior. Methods and Material: Forty cases of biopsy proven osteosarcoma were selected over a period of three years. Histopathology was done for tumor typing, along with serology (pre and post-operative serum alkaline phosphatase). In all cases TNM staging and immunohistochemistry for antibodies to Osteonectin (ON) (diagnosis), S100 (differentiation), Ki 67 and Her2 (prognosis) was done. Results: Serum alkaline phosphatase was high in 37 (92%) cases initially and remained high in metastatic and recurrent lesions. Osteonectin was positive in 38 (95%) cases, S100 in 31 (77%), Ki 67 showed overlapping labeling indices between 4.8-18.8% and Her2 showed more positivity in higher stage tumors. Conclusions: Biopsy (along with imaging) is mandatory to diagnose osteosarcoma. Osteonectin is a good immunohistochemical marker to differentiate osteosarcoma from its mimics. For prognostication, serum alkaline phosphatase, post chemotherapy tumor necrosis (more than 90%), lack of Her2 expression are good parameters. S100 and Ki67 were found to have limited role in diagnosis and prognosis of osteosarcoma.

Outcomes of trabeculectomy in microspherophakia.

Purpose: To report the outcomes of trabeculectomy in eyes with glaucoma in microspherophakia. Materials and Methods: In a retrospective non-comparative case series, we analyzed 29 eyes of 18 patients with glaucoma in microspherophakia, who underwent primary trabeculectomy between 1998 and 2012. Success was defi ned as complete if the intraocular pressure (IOP) was ≤21 and >5 mm Hg without any antiglaucoma medication and qualifi ed if IOP ≤21 and >5 mm Hg with or without antiglaucoma medications. Eyes not falling into qualifi ed success criteria were labeled as failure. Results: The median age at the time of trabeculectomy was 23 years (inter quartile range: 12, 28). The mean IOP reduced from 31.1 ± 8.6 mm Hg to 14.6 ± 4.4 mm Hg after trabeculectomy over a median follow up of 77 months (P < 0.001). The probability of complete success was 96% (95% CI: 77-99%) at one year, 88% (95% CI: 67-96%) at 2 years, which was maintained till 7 years and decreased to 79% (95% CI: 50-92%) at 8 years. The probability of qualifi ed success was 100% till 7 years and decreased to 90% (95% CI: 47-98%) at 8 years. The median number of postoperative medications reduced from 2 to 0 postoperatively (P < 0.001). Five eyes (21%) developed post-operative shallow anterior chamber (AC) requiring anterior chamber reformation, with 2 of these eyes needing lensectomy for resolution of this complication. Conclusion: Primary trabeculectomy had good success rate in glaucoma associated with microspherophakia. Post-operative shallow AC was a frequent complication needing additional intervention.

Contralateral intraocular pressure lowering effect of prostaglandin analogues.

Background: Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral eff ects of PGA are limited. Aims: To evaluate if PGA treatment in one eye has an eff ect on the IOP of the untreated fellow eye. Design: Retrospective study. Materials and Methods: Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had offi ce diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and offi ce diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals. Statistical Analysis: IOPs of the fellow eye during the offi ce diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests. Results: Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically signifi cant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was signifi cantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008). Conclusion: Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.

Scanning the macula for detecting glaucoma.

Background: With the advent of spectral domain optical coherence tomography (SDOCT), there has been a renewed interest in macular region for detection of glaucoma. However, most macular SDOCT parameters currently are thickness parameters which evaluate thinning of the macular layers but do not quantify the extent of area over which the thinning has occurred. We therefore calculated a new macular parameter, “ganglion cell complex surface abnormality ratio (GCC SAR)” that represented the surface area over which the macular thickness was decreased. Purpose: To evaluate the ability of SAR in detecting perimetric and preperimetric glaucoma. Design: Retrospective image analysis. Materials and Methods: 68 eyes with perimetric glaucoma, 62 eyes with preperimetric glaucoma and 165 control eyes underwent GCC imaging with SDOCT. SAR was calculated as the ratio of the abnormal to total area on the GCC signifi cance map. Statistical Analysis: Diagnostic ability of SAR in glaucoma was compared against that of the standard parameters generated by the SDOCT soft ware using area under receiver operating characteristic curves (AUC) and sensitivities at fi xed specifi cities. Results: AUC of SAR (0.91) was statistically signifi cantly bett er than that of GCC average thickness (0.86, P = 0.001) and GCC global loss volume (GLV; 0.88, P = 0.01) in diff erentiating perimetric glaucoma from control eyes. In diff erentiating preperimetric glaucoma from control eyes, AUC of SAR (0.72) was comparable to that of GCC average thickness (0.70, P > 0.05) and GLV (0.72, P > 0.05). Sensitivities at specifi cities of 80% and 95% of SAR were comparable (P > 0.05 for all comparisons) to that of GCC average thickness and GLV in diagnosing perimetric and preperimetric glaucoma. Conclusion: GCC SAR had a bett er ability to diagnose perimetric glaucoma compared to the SDOCT soft ware provided global GCC parameters. However, in diagnosing preperimetric glaucoma, the ability of SAR was similar to that of soft ware provided global GCC parameters.

Histogenesis of salivary gland neoplasms.

Salivary gland tumors are one of the most complex and relatively rare group of lesions encountered in oral pathology practice. Their complexity is attributed to heterogeneity of the cells of origin of these lesions. The problem is compounded by the ability of these cells to differentiate and modify into various morphological subtypes resulting in a myraid of histomorphological patterns. This also leads to a frequent overlap of microscopic features among various neoplasms and sometimes even between benign and malignant lesions causing significant diagnostic dilemma which sometimes may even not be resolved by immunohistochemical studies. Despite this the knowledge of histogenesis and morhogenetic concepts of salivary gland tumorigenesis greatly helps the pathologist in classifying these lesions as well as determining the prognosis. It will also help in development of newer strategies for differentiating these lesions and making an early diagnosis. The present article is aimed at reviewing and summarizing the current concepts regarding the histogenesis of salivary gland tumors and their relevance to routine diagnosis and classification of these lesions.

Evaluation of blotchy pigments in the anterior chamber angle as a sign of angle closure.

Background: Blotchy pigments in the anterior chamber (AC) angle are considered diagnostic of primary angle closure (PAC). But there are no reports either on the prevalence of blotchy pigments in AC angles or the validity of this sign. Aims: To determine the prevalence of blotchy pigments in AC angles and to evaluate their relationship with glaucomatous optic neuropathy (GON) in eyes with occludable angles. Setting and Design: Cross-sectional, comparative study. Materials and Methods: Gonioscopy was performed in 1001 eyes of 526 subjects (245 eyes of 148 consecutive, occludable angle subjects and 756 eyes of 378 non-consecutive, open angle subjects), above 35 years of age. Quadrant-wise location of blotchy pigments was documented. Statistical Analysis: Odds of blotchy pigments in occludable angles against that in open angles were evaluated. Relationship of GON with blotchy pigments in occludable angle eyes was evaluated using a multivariate model. Results: Prevalence of blotchy pigments in occludable angles was 28.6% (95% CI, 22.9-34.3) and in open angles was 4.7% (95% CI, 3.2-6.3). Blotchy pigments were more frequently seen in inferior (16%) and superior quadrants (15%) of occludable angles, and inferior quadrant of open angles (4%). Odds of superior quadrant blotchy pigments in occludable angles were 33 times that in open angles. GON was seen in 107 occludable angle eyes. Blotchy pigments were not significantly associated with GON (odds ratio = 0.5; P = 0.1). Conclusions: Blotchy pigments were seen in 28.6% of occludable angle eyes and 4.7% of open angles eyes. Presence of blotchy pigments in the superior quadrant is more common in occludable angles. Presence of GON in occludable angle eyes was not associated with blotchy pigments.

Elucidation of possible mechanism of analgesic action of Valeriana wallichii DC chemotype (patchouli alcohol) in experimental animal models.

Valeriana wallichii (Family Valerianaceae), popularly named as Indian valerian, exists as three chemotypes. Aim of the study was to evaluate the effect of V. wallichii chemotype (patchouli alcohol) extract (DCME) and essential oil (VPAEO) on experimental models of nociception and to elucidate its possible mechanism of action. Analgesic effect was evaluated using acetic acid induced writhing and tail flick model. DCME and VPAEO (40 and 80 mg/kg, p.o.) significantly inhibited the number of writhings as compared to vehicle treated group. None of the doses of DCME and VPAEO exhibited any effect in tail flick model suggesting only peripheral analgesic activity. When studied for mechanism of action in acetic acid induced writhing, subeffective dose of essential oil significantly potentiated the effect of aspirin while no potentiation was seen in case of extract. These data suggest that essential oil VPAEO exerted peripheral analgesic via inhibition of prostaglandin synthesis.