COVID-19 Pandemic and the Role of Control Room in the Tertiary Care Hospital

COVID-19 has been labeled a serious public health emergency globally. Due to its high infectivity it has led to an increased burden to the Medical Fraternity as well as the Government. Therefore, the need for preparedness as well as conventional intervention strategies became integral during such health emergencies. To monitor the implementation of proper activities and to manage the patient load with adequate safety of the staff, COVID control rooms were established in the hospital premises. The main objective of the Control Room is risk mitigation, planning strategies, alleviating concerns and addressing issues associated with the health emergency across the hospital and further delegating the information to the higher authorities and the Ministry. Hereby in this review we have tried to summarize the administrative structure, functions and limitations of the 24x7 Control Room established in Tertiary Care Hospital, New Delhi.

Farmers Extent of Adoption of Climate Resilient Agro-technologies

Climate change is possibly the most significant environmental challenge and possess serious threats to sustainable development in the world and more so in developing countries. Impact of climate change affects ecosystems, water resources, food and health. To adapt to the change and overcome the threats of climate change several climate-resilient agro-technologies have been introduced under the National Innovations on Climate Resilient Agriculture (NICRA) Project. The present study was conducted in Lakhimpur District of Assam to measure the extent of adoption of the climate-resilient agro-technologies introduced under the NICRA Project by the participant and non-participant farmers. A total of 160 farmers, 80 NICRA participant farmers and 80 non-participant farmers were interviewed. Findings revealed that the majority of the participant farmers (68.75 per cent) had a medium extent of adoption followed by 17.50 per cent with a low extent of adoption of climate-resilient agro-technologies. Only 13.75 per cent of the participant farmers were found to have a high level of adoption of climate-resilient agro-technologies. Among the non-participant farmers, majority of them (75.00 per cent) had a low extent of adoption followed by 17.50 per cent with a medium extent of adoption of climate-resilient agro-technologies. Only a very small proportion of them (7.50 per cent) had a high extent of adoption of climate-resilient agro-technologies.

The Anaesthetic Potency of Intrathecally Administered Levobupivacaine and Racemic Bupivacaine: A Hospital-Based Study

Background: Lower limb surgeries are often performed under spinal anesthesia. The conventional anesthetic method for lower limb surgeries is caudal epidural block. The currently available local anesthetic for this purpose is Bupivacaine which has long duration of action of around 6-12 hour. Methods: 60 adult cases ranging in age from 20 to 60 years with ASA Grade I and II requiring elective lower limb surgery under epidural anesthesia were selected for this prospective, randomized, double-blind study. Results: 60 adult cases ranging in age from 20 to 60 years with ASA Grade I and II, requiring elective gynecological surgery under epidural anesthesia were selected for this study. Cases were randomly allocated into two groups containing 20 cases each. Cases in Group B received Bupivacaine 0.25% and those in Group T received Tramadol 100mg. Conclusion: Current study concluded that both intrathecally administered levobupivacaine and racemic bupivacaine are safe and effective local anaesthetics for lower limb surgeries. Overall parameters observed in this study showed no significant difference between the two forms of the same drug. However, intrathecal levobupivacaine produces less toxicity.

Correlation between HER2 gene amplification and protein overexpression through fluorescence in situ hybridization and immunohistochemistry in breast carcinoma patients.

Background : In India, the incidence of breast cancer has increased in the urban population, with 1 in every 22 women diagnosed with breast cancer. It is important to know the HER2/neu gene status for a better prognostication of these patients. Aim : The aim of this study was to compare the efficacy of fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) for determining HER2/neu alteration in breast carcinoma. Materials and Methods : A total of 188 histologically proven breast carcinoma cases between the years 2007 and 2011 were retrospectively analyzed on the paraffin tissue sections by both IHC and FISH techniques. FISH for HER2/neu gene amplification was performed on cases where the IHC status was already known and the results were compared. Results : A total of 64 (30%) patients were found to be amplified and the remaining 124 (65.9%) cases were found to be unamplified through FISH. Patients observed with 3+ reading on IHC were later confirmed as unamplified in 29.5% cases through FISH. Conclusion : It has been confirmed with the present study that IHC is a prudent first-step technique to screen tissue samples for HER2/neu gene status, but should be supplemented with the FISH technique especially in equivocal cases.

The inflammatory stimulus of a natural latex biomembrane improves healing in mice

The aim of the present study was to compare healing obtained with biomembranes with the natural healing process (sham) using biochemical and immunohistological assays. C57BL/6 mice were divided into 4 groups of 15 mice each and received different subcutaneous implants: natural latex biomembrane (NLB), denatured latex (DL), expanded polytetrafluorethylene (ePTFE), or sham. On the 2nd, 7th, and 14th days post-treatment, 5 mice per group were sacrificed and biopsied for the following measurements: oxidative stress based on malondialdehyde (MDA), myeloperoxidase (MPO) and hydrogen peroxide by the method of ferrous oxidation-xylenol orange (FOX), as well as glutathione and total proteins; histological evaluation to enumerate inflammatory cells, fibroblasts, blood vessels, and collagen, and immunohistochemical staining for inducible nitric oxide synthase, interleukin-1β, vascular endothelial growth factor (VEGF), and transforming growth factor-β1 (TGF-β1). On day 2 post-treatment, NLB stimulated a dense inflammatory infiltrate mainly consisting of polymorphonuclear cells, as indicated by increased MPO (P < 0.05), but oxidative stress due to MDA was not observed until the 7th day (P < 0.05). The number of blood vessels was greater in NLB (P < 0.05) and DL (P < 0.05) mice compared to sham animals on day 14. NLB induced fibroplasia by day 14 (P < 0.05) with low expression of TGF-β1 and collagenesis. Thus, NLB significantly induced the inflammatory phase of healing mediated by oxidative stress, which appeared to influence the subsequent phases such as angiogenesis (with low expression of VEGF) and fibroplasia (independent of TGF-β1) without influencing collagenesis.

Management of primary and metastatic triple negative breast cancer: Perceptions of oncologists from India.

Background: In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists. Materials and Methods: A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice. Results: A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program. Discussion: This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

Brain tumor and Gliadel wafer treatment.

Glioblastoma is a rapidly progressive and extremely fatal form of brain tumor with poor prognosis. It is the most common type of primary brain tumor. Even with the most aggressive conventional treatment that comprises surgery followed by radiotherapy and chemotherapy, most patients die within a year of diagnosis. Developments in molecular and cell biology have led to better understanding of tumor development, leading to novel treatment strategies including biological therapy and immunotherapy to combat the deadly disease. Targeted drug delivery strategies to circumvent the blood-brain barrier have shown efficiency in clinical trials. Gliadel wafer is a new approach to the treatment of glioblastoma, which involves controlled release delivery of carmustine from biodegradable polymer wafers. It has shown promising results and provides a silver lining for glioblastoma patients.

Profile of Young Acute Myocardial Infarction in Chittagong Medical College Hospital, Chittagong.

Background: Coronary artery disease (CAD) is now an emerging epidemic in developing countries including Bangladesh. Younger people are being affected here more and more. Young individuals with acute myocardial infarction (AMI) may have unique presentation, risk factor, angiographic profile and outcome which may have an influence on the preventive strategies. This study is an attempt to investigate the same. Methods: Young patients (aged d” 40 yrs) with AMI admitted to the coronary care unit of Chittagong Medical College Hospital over a period of one year were included in the study. Assessments of the patients were done with clinical history, physical examination and systemic evaluation. Location and types (STEMI, NSTEMI) of myocardial infarction were determined by ECG and serum troponin- 1 assay. Blood for glucose and lipid profile was drawn within 24 hours of admission. High sensitivity testing for C-reactive protein (hs CRP) was done in all patients. Coronary angiography was done within 6 weeks of hospital discharge. Results: A total of 83 Patients with age d” 40 years were included .Age range were 21-40 years (34.21 ± 5.07 yrs). There were 71 male (85.5%). Male: female ratio was 5.9:1. Most of the young AMI patients presented lately to the hospital. Majority of these patients were thinly built, came from urban or semiurban areas, engaged in heavy physical activities and belonged to lower socioeconomic group. A positive family history of CAD was present in 18 patients (28.68 %). Smoking was the most prevalent risk factor followed by a raised serum triglyceride or low high density lipoprotein (HDL). A raised hs CRP was present in 47 patients (49.39%). The overall in hospital mortality was only 3.61 %. Coronary angiography done in 38 patients revealed single vessel disease in the majority. Conclusion: The study focuses our attention to the rising incidence of AMI in young individuals who are less prone to CAD. Early detection of AMI and timely intervention needs high index of suspicion in this age group. These young patients have got low BMI High TG, Low HDG High hs CRP & habit of smoking. Avoidance of smoking, controlling high TG and/or low HDL may reduce incidence of AMI among young patients. Use of high dose of statin at an early age in young persons with raised CRP may be considered.

Effect of a single dose of diethylcarbamazine, albendazole or both on the clearance of Wuchereria bancrofti microfilariae and antigenaemia among microfilaria carriers: A randomized trial.

Background. Lymphatic filariasis is a major vector-borne parasitic disease. The global programme to eliminate lymphatic filariasis was launched in 1997 and currently over 570 million people are covered under it in 48 countries. Mass annual single-dose drug administration of diethylcarbamazine (DEC), co-administrated with albendazole for 5–6 years and mass distribution of diethylcarbamazine-fortified salt are the two strategies for elimination of filariasis. Methods. Asymptomatic volunteers residing in Puducherry, India were screened for microfilaria (mf) by examining nocturnal thick blood smears. Those testing positive were randomly assigned to receive a single dose of DEC (6 mg/kg body weight) or albendazole 400 mg or both. Participants were hospitalized for 5 days. Membrane filtration count was used to assess microfilaraemia and ELISA (Og4C3) assay to measure circulating filarial antigens (CFA). Measurements were done before treatment and at 1, 2 and 3 years post-treatment. Viability of the adult worms was assessed by looking for the filarial dance sign (FDS) using ultrasound examination of the scrotum in men with hydrocele. Results. Fifty-four microfilaraemic individuals were studied. The mf prevalence started decreasing only by day 180 posttreatment in the DEC group but much earlier in the other two groups (day 30 in the albendazole and day 90 in the DEC with albendazole group). The decrease in mf was marginal (17.6%, 26.3% and 27.8%, respectively) by the end of year 1 posttreatment, but significant (96.7%, 78.6% and 93.3%, respectively) by the end of year 2 post-treatment (p<0.05). By the end of year 3, the level decreased to 80% in the DEC, 90% in the albendazole and to 100% in the DEC and albendazole groups. However, the mf intensity decreased © The National Medical Journal of India 2010 Vector Control Research Centre, Department of Health Research (ICMR), Indira Nagar, Puducherry 605006, India S. L. HOTI, S. P. PANI, P. VANAMAIL, K. ATHISAYA MARY, L. K. DAS, P. K. DAS Correspondence to S. L. HOTI; slhoti@yahoo.com significantly (by 39%; p<0.05) by day 7 post-treatment in both the DEC and DEC with albendazole groups, but only by day 30 in the albendazole group. In all the drug groups, the prevalence as well as intensity of CFA returned to pretreatment levels by the end of year 3 post-treatment. Conclusion. Annual single-dose administration of all the 3 drug regimens significantly reduced antigenaemia levels. There were no significant differences in the efficacy and overall pattern of CFA clearance between the 3 drug regimens.

An allele specific PCR assay for screening for drug resistance among Wuchereria bancrofti populations in India.

Background & objectives: Albendazole, a commonly used anthelminthic drug that targets the polymerization of α- and β-tubulin dimer is currently co-administered with the antifilarial drug, diethylcarbamazine citrate (DEC) in the ongoing Global Programme for Elimination of Lymphatic Filariasis (GPELF). The experience in veterinary field has shown that there can be a rapid development of resistance to this drug, which therefore, needs to be monitored regularly in GPELF. Hence, we investigated the nucleotide polymorphism in the albendazole-binding domain of the isotype 1 β-tubulin gene from several populations of Wuchereria bancrofti and developed an AS-PCR assay useful in screening for sensitive/resistance alleles among parasite populations and also evaluated its utility. Methods: For studying the polymorphism of isotype 1 β-tubulin gene, a 475 bp fragment spanning exon 5 and 6 of the gene was amplified and sequenced from the genomic DNA of W. bancrofti collected from six geographic regions of India. An allele specific (AS) PCR for screening albendazole sensitivity/resistance was developed and a total of 55 mf samples from blood smears on slides collected from Thiruvannamalai, Thanjavur and Puducherry were screened. Selective therapy with DEC was in place in three areas, mass drug administration (MDA) with DEC alone was implemented in four areas, while DEC plus albendazole was administered in one district. Results: The analysis of the nucleotide sequence of the fragment from 20 W. bancrofti populations showed the domain to be highly conserved. An allele-specific PCR assay developed was used to detect sensitive/ resistance alleles among 55 isolates of W. bancrofti and no albendazole resistance alleles were detected among the populations tested. Interpretation & conclusion: The drug-binding domain of isotype 1 β-tubulin gene of W. bancrofti from different geographical locations was highly conserved. The AS-PCR developed showed potential application as a tool for monitoring albendazole sensitivity/resistance alleles among W. bancrofti populations, in areas where combination therapy of DEC-albendazole is being mass administered in the LF elimination programme.

Reactive haemophagocytic lymphohistiocytosis.

We present a series of five cases diagnosed and treated as reactive haemophagocytic lymphohistiocytosis (HLH) in three tertiary referral centers of Kolkata, within a time frame of 3 months. The initial presentations were very variable, the most prominent clinical feature being - acute renal failure in the first patient, convulsions in the second, encephalopathy the third, marked cervical lymphadenopathy in the fourth and polyserositis in the fifth. All had a history of prolonged fever preceding admission and hepatosplenomegaly on examination. Investigations revealed multi-organ involvement with pancytopenia;- haemophagocytosis was eventually diagnosed by bone marrow examination. These cases highlight the diagnostic challenge posed by infection associated haemophagocytosis and the need for maintaining a high index of suspicion to promptly diagnose and treat this potentially life threatening condition.

Primary lymphoma of the breast: a clinicopathological study.

3 cases of primary non Hodgkins lymphoma of the breast are described, seen over a period of 2 years among 199 cases of breast malignancies. All were diffuse large B cell type. Application of immunohistochemistry greatly aids in differentiating lymphoma from anaplastic carcinoma, with which it can easily be confused. Preoperative diagnosis on a trucut biopsy is an ideal diagnostic method since diagnosis on fine needle aspiration cytology or frozen section may not be possible. Primary breast lymphoma is a rare disease with reported incidence of 0.04-0.53% of all breast malignancies in most series. Accurate diagnosis is essential, so that appropriate treatment may be applied. Two cases were treated with CHOP chemotherapy and radiotherapy along with surgical excision. One case was treated with CHOP chemotherapy.

A clinico epidemiological study on acute viral infection of brain among children admitted in North Bengal Medical College, West Bengal.

A clinico epidemiological prospective study was carried out on acute viral infection of brain among children admitted in a rural based medical college from September '99 to Oct '01. Out of 80 cases, 8 cases (10%) of aseptic meningitis, 35 cases (43.75%) of encephalitis and 37 cases (6.25%) of meningo-encephalitis were found. Overall case fatality was 47.5% and found higher (77%) among normally nourished children in comparison to malnourished children (47.5%). Virological investigation did not isolate any known Flavivirus, Herpes Simplex virus (HSV) and Measles virus; nor any serological evidence against these viruses.

Presence of Wolbachia endosymbionts in microfilariae of Wuchereria bancrofti (Spirurida: Onchocercidae) from different geographical regions in India

In view of the recent discovery of rickettsial endosymbionts, Wolbachia in lymphatic filarial parasites, Wuchereria bancrofti and Brugia malayi and subsequently of their vital role in the survival and development of the latter, antibiotics such as tetracycline are being suggested for the treatment of lymphatic filariasis, by way of eliminating the endosymbiont. But, it is essential to assess their presence in parasites from areas endemic for lymphatic filariasis before such a new control tool is employed. In the present communication, we report the detection of Wolbachia endosymbionts in microfilariae of W. bancrofti parasites collected from geographically distant locations of India, such as Pondicherry (Union Territory), Calicut (Kerala), Jagadalpur (Madhya Pradesh), Thirukoilur (TamilNadu), Chinnanergunam (TamilNadu), Rajahmundry (Andhra Pradesh), and Varanasi (Uttar Pradesh), using Wolbachia specific 16S rDNA polymerase chain reaction.

Dental fluorosis in bovine of Nayagarh district of Orissa.

Chronic fluoride toxicity in the form of dental fluorosis was observed in cattle from nine (9) villages under two (2) blocks of Nayagarh district of Orissa. Out of 1117 cattle, 221 (18.09%) showed the signs of dental fluorosis. In all affected villages, the prevalence of dental fluorosis in calves (< 1 year age) was greater than adults. There was significant difference in prevalence in respect to age. The commonly observed signs of dental fluorosis were brown discoloration, mottling, attrition or uneven wearing of teeth with or without pitting. None of the affected animals showed characteristic signs of osteofluorosis. The mean serum and urine fluoride concentration of affected animals were significantly (P < 0.05) higher than those of control animals. Fluoride levels (mean) of ground water and surface water in two blocks were 1.30 +/- 0.16 ppm, 0. 66 +/- 0.08 ppm and 1.12 +/- 0.19 ppm, 0. 48 +/- 0.05 ppm respectively. The fluoride content of grass samples of affected and control (non-endemic) area was comparable. There was a highly positive correlation (r = + 0.664) between prevalence of dental fluorosis and fluoride content of ground water. It was concluded that fluoride intake through the water especially ground water contributed to the development of fluorosis in cattle.

Some clinico-epidemiological aspect of bronchiolitis among infants and young children--a hospital based study.

A hospital based prospective study was carried out from 1st October 1998 to 30th September 1999 on children with clinical diagnosis of bronchiolitis in OPD and indoor patients of the Department of Paediatric Medicine, Medical College Kolkata. The objective of the study was to find out the proportional case rate and clinico epidemiological features of the disease. The effectiveness of nebulized salbutamol among bronchiolitis children was also looked into. The proportional case rate was found to be 4.65%. Low birth weight (LBW)/premature babies (51.11%) malnutrition (40%), nonimmunization (55.55%) & non breastfeeding practices (48.88%) were significant risk factors for severe bronchiolitis. Response to nebulized salbutamol was remarkably higher (70%) in 6m to 12m age group.

Efficacy of two organophosphorus insecticides, Reldan & Dursban against the larvae of Culex quinquefasciatus.

BACKGROUND & OBJECTIVES: The resistance in vectors to conventional insecticides warrants development of newer insecticides for mosquito control besides use of other counter-measures. The present study was undertaken to test the efficacy of a new and toxicologically safe organophosphorus compound, Reldan (chlorpyrifos-methyl) and compare its efficacy with Dursban (chlorphyrifos-ethyl) against larvae of different mosquito vectors under laboratory conditions and against Culex quinquefasciatus in three larval habitats. METHODS: The susceptibility of larvae of mosquito vector species to Reldan and Dursban was determined by following the standard procedure and the LC50 in mg/l values were calculated by probit analysis. The insecticides were evaluated in the larval habitats of C. quinquefasciatus in and around Pondicherry. The percentage reduction in larval density was calculated using Mulla's formula and duration showing more than 80 per cent reduction was calculated by annotating the graph obtained by plotting percentage reduction in larval density against days of post-treatment. RESULTS: Dursban and Reldan were effective against Anopheles fluviatilis larvae at lower LC50 of 5.90 x 10(-7) and 1.07 x 10(-9) mg/l respectively compared to other species of mosquitoes. Dursban and Reldan were equally effective against Aedes aegypti, An. stephensi and An. culicifacies. Reldan was about nine times more effective than Dursban against C. quinquefasciatus with respective LC50 of 1.17 x 10(-4) and 1.34 x 10(-3) mg/l. Field evaluation of these insecticides against C. quinquefasciatus showed that Reldan and Dursban at the application rate of 500 g (ai)/ha reduced immature density by more than 80 per cent for a mean duration of 4.0 and 4.5 days and 4.6 and 3.7 days in cesspits and cement tanks respectively. In U-drains, at 500 g (ai)/ha, Reldan was effective for a period of 3.6 days whereas, Dursban was not effective. It was effective for 4.0 days only at 1000 g(ai)/ha. There was no significant increase in the residual activity of both Dursban and Reldan with increase in application rates. INTERPRETATION & CONCLUSION: In view of the lack of sustained control with the applications, it is inferred that these insecticides will be of limited use as larvicides against C. quinquefasciatus breeding in polluted habitats.

Oviposition attractancy of an infusion from a wood inhabiting fungus for vector mosquitoes.

BACKGROUND & OBJECTIVES: Review of literature indicates that none of the chemicals so far studied for oviposition attractancy was found to be promising for operational use. Efforts are being made to find an effective substance to corner a large number of ovipositing females to selective breeding sites for ease of control operation. This will reduce insecticidal consumption and will be cost-effective. This study is aimed to evaluate the oviposition attractancy of aqueous infusion from a wood inhabiting fungus (Polyporus spp.) for vector mosquitoes both in the laboratory and under field conditions. METHODS: An aqueous infusion (10%) was prepared by soaking 10 g of fungal powder in 100 ml of chlorine-free tap water. The mixture was shaken thoroughly and filtered through Whatman No. 1 filter paper. The filtered infusion was tested for oviposition attractancy against vector mosquitoes both in the laboratory and under field conditions. RESULTS: The laboratory study on the dose-effect relationship indicated that at an optimum concentration of 4 ppm, maximum attractancy was observed. Water treated with aqueous fungal infusion (AFI) at 4 ppm received significantly more egg rafts/eggs of vector mosquitoes than other substrates like rearing water, natural breeding water and tap water. Trials conducted in the field showed that mud pots treated with AFI placed in both indoor and outdoor locations received significantly more Aedes aegypti eggs than the control. Similarly, treated pots placed in paddy fields attracted significantly more gravid Anopheles subpictus for oviposition than untreated pots. In contrast, the number of egg rafts of Culex quinquefasciatus laid in AFI treated pots was significantly less than in the control ones owing to strong natural olfactory factors associated with the breeding habitat. INTERPRETATION & CONCLUSION: The results indicated that there is scope for developing a trap incorporating this oviposition attractant along with insect growth regulator(s) (IGR) for surveillance and/or control of Ae. aegypti and other vector mosquitoes breeding in paddy fields.

Integrated programme for control of geohelminths: a perspective.

Infestation by geohelminths is an important public health problem in developing countries like India. It is a major cause of morbidity in school-age children who have the highest burden of worm infestation. Some of the morbid conditions attributed to intestinal helminthiasis are malnutrition, growth retardation, anaemia, vitamin A deficiency and impaired intellectual performance. Chemotherapy targeted at school-age children has been recommended as a cost-effective and feasible control programme for the control of geohelminths. To optimize resources a geohelminth control programme can be integrated with other existing national health programmes. The availability of drugs such as diethyl carbamazine (DEC) and albendazole, which have anthelminthic and antifilarial properties, opens the possibility of integrating a geohelminth control programme with a filaria control programme. However, co-administration of DEC and albendazole raises several issues of frequency of administration, efficacy, compliance and cost-effectiveness. Thus, integrating a geohelminth control programme with the existing mid-day meal or anaemia prophylaxis programme would be a more appropriate and cost-effective strategy to control geohelminths, alleviate the morbidity caused by them and improve the overall health of the community.