A cross-sectional study to estimate the serum level of C-reactive protein among pediatric meningitis with bacterial etiology

Background: Bacterial meningitis is a global public health issue. C-reactive protein (CRP) has suitable diagnostic value in distinguishing between bacterial and aseptic meningitis especially in cases of negative bacterial culture of the blood and spinal fluid. Aim and Objective: The objective of this study was to estimate the serum level of CRP among pediatric meningitis cases with bacterial etiology. Materials and Methods: The hospital-based descriptive cross-sectional study was performed in a tertiary care pediatric hospital in Eastern India from June to August, 2021 with 150 samples. Patients fulfilling the inclusion criteria were selected for this study after obtaining informed consent. Cerebrospinal fluid sample was collected as per standard guidelines. Phenotypic identification of bacteria including antimicrobial susceptibility testing was done by automation (Vitek 2 compact, bioMerieux). Quantitative estimation of CRP was performed in a solid phase and sandwich-format immunometric assay using a gold antibody conjugate. Human rights, welfare, and autonomy were protected as per national ethical guidelines. Results: Median age (Inter Quartile Range) of 150 cases was 3(1–4.5) year. Escherichia coli (60.52%, 23/38) was the commonest isolate (P < 0.00000001 by Binomial test calculation) followed by Klebsiella pneumoniae (34.24%, i.e., 13/38). A total of 43/150 (28.66%) participants had higher serum CRP. Serum CRP was raised more in Gram-negative bacterial etiology (36 out of 38, 94.73%). Mean serum CRP was higher in Gram-negative cases (P < 0.05). Conclusion: Serum CRP was found significantly higher in meningitis caused by Gram-negative bacteria.

Three shades of black - secondary thrombotic microangiopathy

Thrombotic microangiopathy is a group of disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia and organ damage. Wide age distribution and the heterogeneity in presentation demand a deeper understanding into the pathogenesis of TMA. Primary TMA is distinct from TMA associated with secondary causes and remains clinically occult till a precipitating factor aggravates it. The extent and severity of renal damage caused by each of them is also distinct. The first alerting signal could be the presence of schistiocytes on peripheral smear and arteriolar thrombi on light microscopy. Thus in secondary TMA, identification of the underlying disorder is indispensible for targeted management.

Is there any correlation between tumor infiltrating lymphocytes and expression of EGFR in squamous cell carcinoma of head and neck? A retrospective observational study

Background: The dismal survival of one of the commonest malignancies of the world, head neck squamous cell carcinomas (HNSCC), has prompted researchers to probe into its various characteristics, especially those which reflect the outcome. Over the years, even though epidermal growth factor receptor (EGFR) and tumor-infiltrating lymphocytes (TIL) have emerged as useful biomarkers of the disease, the two parameters have rarely been considered in conjunction. Aims and Objectives: The study aimed to assess if there is any correlation between TIL levels (both stromal and intratumoral) and site, grade, stage, and EGFR score of HNSCC. Materials and Methods: A retrospective observational study was conducted in which histopathologically confirmed cases of HNSCC were included. The site of tumor, grade, stage, stromal and intratumoral TIL levels, and EGFR score were noted for each case. The data were analyzed using standard statistical tests. Results: The study population consisted of 122 patients with a mean age of 53.8 ± 9.2 years. The oral cavity was the commonest site of tumor (109 cases, 89.3%). Most cases were moderately differentiated (75, 61.5%). Pathological staging showed 66 cases (54%) to be in pT1, and 92 cases (75.4%) to be in pN0. In 68 cases (55.7%), stromal TIL level was high, and intratumoral TIL was low in 102 cases (83.6%). A statistically significant correlation was found between TIL levels and site, grade, pathological stage, and EGFR score of HNSCC. Conclusion: This pioneering study is unique in its exploration of the correlation between two significant biomarkers of HNSCC – TIL and EGFR score.

Temporal changes in behavioural responses and serum metabolites of Cirrhinus mrigala exposed to acute hypoxia

Aim: The present study was conducted to determine the tolerance to reduced oxygen level (hypoxia) and the behavioural and biochemical responses of mrigal, Cirrhinus mrigala to environmental hypoxia. Methodology: Cirrhinus mrigala were subjected to LC50 test for 96 hr and the mortality were recorded. In a second experiment, the fishes were subjected to a stressful, but safe limit of hypoxia (0.5±0.04 mg l-1) and the behavioral responses and serum metabolites (glucose, lactate, total lipids, free amino acids and ammonia) were evaluated for 96 hrs. Results: A median lethal concentration (LC50, 96 hr) value of 0.25 mg l-1dissolved oxygen) was estimated for mrigal. The upper safe limit was 0.49 mg l-1 DO and the lower lethal limit was 0.19 mg l-1 DO. Gill ventilation frequency increased under severe hypoxic conditions and decreased with exposure time. The serum level of glucose, lactate and total lipids increased significantly (P<0.05) within 24 hr of exposure to hypoxic conditions. Free amino acids and ammonia contents were not altered by a four day exposure to hypoxia. Interpretation: The present study explains the basic metabolic and behavioural mechanism behind the hypoxia tolerance of Indian Major Carp, mrigal assisted by alterations in gill ventilation and metabolic responses.

Determinants of infant mortality in rural India: An ecological study

Background: Long-term reductions in infant mortality (IM) are possible only by addressing the distal determinants. Objectives: The objective of the present study was to determine the relationship between IM and its major distal determinants in rural India. Methods: The dependent variable used in the study was state wise IM rate (IMR), the values of which were obtained from the Sample Registration System, 2015. State level literacy rate in females, unemployment rates of females, GINI index, and round-the-clock neonatal services in primary health centers in the rural areas and the per capita gross state domestic product at purchasing power parity (GSDP at PPP) of the states, were used as the predictor variables for IM. Relationship between the variables was obtained by the Pearson's correlation coefficient. Bivariate and multivariable linear regressions were used to identify the magnitude and direction of the predictors on IM. Results: Correlation statistics showed none or weak positive correlation between the Gini coefficient and 24 � 7 primary health-care services and IMR. There was a strong negative correlation between female literacy rate and IMR, while the unemployment rates and per capita gross state domestic product (GSDP) were moderately negatively correlated to IMR. Bivariate analysis revealed that, for unit increase in unemployment rates in females, proportion of literate women, and 1000$ increase in the GSDP at current prices, IMR decreased by 0.07, 0.763, and 1.702, respectively. However, after adjustment, only the female literacy rates showed significant association with IMR. Conclusions: Of the major determinants included in the study, rural female literacy is the most important distal determinant of IM in rural areas of India.

Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India

Background: Despite evidence regarding the beneficial effects of vaccines, vaccination uptake has not been up to the mark across the globe in various sociocultural and sociodemographic groups. Logistics and workforce have been issues of concern to public health managers, but the latent issue of vaccine hesitancy leading to vaccine delays and refusals has not been widely addressed particularly in the Indian context. Objectives: The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for childhood vaccinations in slums of Siliguri, India. Methods: A cross-sectional study was carried out among 194, 0–59 months' children residing in slums of Siliguri in 2016. Data were collected at the household with interviews of mothers/primary caregivers using a predesigned pretested interview schedule developed based on the validated version of vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Associations were analyzed using logistic regression. Results: Majority 161 (83%) of the families were vaccine-hesitant and only 33 (17%) were not hesitant. Nuclear families and mothers of lower educational status had significantly higher odds of vaccine hesitancy. Reluctance to vaccinate (26.1%) and to be unaware/having no reliable information (20.5%) were the major reasons cited for vaccine hesitancy. Conclusion: Most of the families of the children were vaccine-hesitant in the area. Uniformity in schedules in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mothers' education can address the issue of vaccine hesitancy.

Comparative studies between longitudinal and torsional modes in phacoemulsification, using active fluidics technology along with the intrepid balanced tip

Purpose: To compare and report the intra- and postoperative outcomes of phacoemulsification between longitudinal (LPKE) and torsional (TPKE) mode, using active fluidics along with the intrepid balanced tip. Methods: This single center prospective randomized comparative study comprised a total 108 consecutive eyes of 108 patients having senile cataract subdivided into nuclear opalescence (NO) grades II–IV according to the lens opacities classification system III (LOCS III). Cataracts of each grade were randomly assigned to two groups LPKE (n = 54) and TPKE (n = 54) mode, who were operated on by the same surgeon using same machine (Centurion® Alcon Laboratories, Inc., USA) having features of both active fluidics and intrepid balanced tip. Pre-, intra-, and postoperative evaluations were done independently by a different author, who was masked to the surgical procedures. Patients were evaluated on the postoperative days (PODs) 1, 7, 15, and 28. Intraoperative outcome measures were cumulative dissipated energy (CDE) and ultrasound time (UST). Postoperative outcome measures were endothelial cell loss (ECL), central corneal thickness (CCT), and best-corrected visual acuity (BCVA). Results: Age, gender, and NO-grade distribution among two modes were comparable (P > 0.05). Difference of CDE and UST between modes were found to be significant (P < 0.001) in favor of TPKE with all NO-grades. TPKE mode performs better than LPKE mode with regard to ECL, CCT-change, and BCVA-change, although the differences were found to be insignificant (P > 0.05). Conclusion: When using active fluidics along with the intrepid balanced tip, TPKE mode appeared to be a more efficient mode of PKE with reduced mean UST and CDE across all NO-grades, as compared to LPKE mode. However, ECL, CCT-change, and BCVA-change were seemed to be comparable between the two modes.

Accuracy of noncycloplegic refraction performed at school screening camps

Purpose: The aim of this study was to compare noncycloplegic refraction performed in school camp with that performed in eye clinic in children aged 6� years. Methods: A prospective study of children with unaided vision <0.2 LogMAR who underwent noncycloplegic retinoscopy (NCR) and subjective refraction (SR) in camp and subsequently in eye clinic between February and March 2017 was performed. A masked optometrist performed refractions in both settings. The agreement between refraction values obtained at both settings was compared using the Bland朅ltman analysis. Results: A total of 217 eyes were included in this study. Between the school camp and eye clinic, the mean absolute error � standard deviation in spherical equivalent (SE) of NCR was 0.33 � 0.4D and that of SR was 0.26 � 0.5D. The limits of agreement for NCR were +0.91D to ? 1.09D and for SR was +1.15D to -1.06D. The mean absolute error in SE was ?0.5D in 92.62% eyes (95% confidence interval 88%�%). Conclusion: A certain degree of variability exists between noncycloplegic refraction done in school camps and eye clinic. It was found to be accurate within 0.5D of SE in 92.62% eyes for refractive errors up to 4.5D of myopia, 3D of cylinder, and 1.5D of hyperopia.

Efficacy and tolerability of fixed dose combination of silymarin, alpha lipoic acid, N-acetyl cysteine and selenium in the management of some liver disorders

Globally liver disorders are major cause of illness death and death. Oxidative stress plays a critical role in the progression of alcoholic and nonalcoholic related diseases. The aim of the present study was to evaluate the efficacy and tolerability of fixed dose combination (FDC) of silymarin, alpha lipoic acid, N-acetyl cysteine and selenium in the management of liver disorders. This was an observational, non-randomized, open label, non-comparative, multi-centric post-marketing surveillance study. The above mentioned FDC was administered to 15 patients diagnosed with alcoholic or viral hepatitis for three months. Evaluation of liver function tests (LFT) were carried out at baseline and at the end of 3rd month of the treatment. Significant changes were observed in the LFT parameters at the end of three months of this study. aspartate aminotransferase (AST): (Mean ± SEM) 369.9 ± 128.0 to 97.00 ± 34.27 U/L, (p < 0.0001); alanine aminotransferase (ALT): 652.93 ± 214.57 to 194.40 ± 82.51 U/L, (p < 0.03); Alkaline phosphatase: 197.47 ± 25.57 to 151.60 ± 17.92 U/L, (p < 0.0059); Gamma glutamyl transferase: 156.67 ± 49.80 to 87.33 ± 22.94 U/L, (p < 0.0490); Total bilirubin: 3.44 ± 0.76 to 1.66 ± 0.57 mg/dL, (p < 0.0192) and bilirubin direct: 2.13 ± 0.58 to 1.00 ± 0.50 mg/dL, (p < 0.0273). Two patients reported mild gastrointestinal adverse events (nausea, bloating). This FDC was therapeutically effective under the circumstances of elevated oxidative stress and produces significant reduction in LFT parameters in alcoholic and viral hepatitis patients.

Health impact of research in emergency medicine: moving forward in the field / Impacto sobre la salud como resultado de la investigación en la medicina de emergencia: progresos en este campo

This article provides a brief description of the conceptual framework of some specific areas of research carried out either collaboratively or independently in the Emergency Department in an effort to positively impact on health issues in an era of evidence-based medicine. The paper focusses on epidemiological studies of infectious diseases, chronic non-communicable diseases, and a recent update on trauma patterns. Conduction of clinical trials is also highlighted. The role of collaboration in Emergency medicine is also discussed. Research must be developed deliberately to facilitate the primary goal of improved patient care and outcomes. Further recommendations are suggested.

Este artículo ofrece una descripción breve del marco conceptual de algunas áreas específicas de investigación llevada a cabo de forma colaborativa o independiente en el Departamento de Emergencias, en un esfuerzo por lograr un impacto positivo en los problemas de salud en una era de medicina basada en la evidencia. El trabajo se centra en los estudios epidemiológicos sobre enfermedades infecciosas, enfermedades crónicas no comunicables, y una actualización reciente de los patrones de trauma. También se subraya la conducción de ensayos clínicos, y se discute el papel de la colaboración en la medicina de la emergencia. Deben desarrollarse investigaciones con el propósito deliberado de facilitar el objetivo primario de mejorar la atención y los resultados clínicos del paciente. Se hacen algunas recomendaciones.

Occurrence and Determinants of Postpartum Maternal Morbidities and Disabilities among Women in Matlab, Bangladesh.

The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03- 4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery.

Tubo-ovarian Actinomycosis: A case report with brief review of literature.

Pelvic actinomycosis is an uncommon condition, often associated with the use of intrauterine contraceptive device (IUCD). Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. Ovarian actinomycosis is even rarer. Here, we present a 24-year-old woman using an IUCD for 3 1 / 2 years with right-sided adnexal mass, which was diagnosed postoperatively as tubo-ovarian actinomycosis. Many times, an appropriate management is overlooked or delayed due to its non-specific and variable clinical and radiological features. Sometimes, it can even mimic an advanced pelvic malignancy. Therefore, the gynecologist should consider the possibility of this infection to spare the patient from morbidity of radical surgical procedure.

Surgical Angioplasty for Left Main Coronary Artery Disease - A Case Report.

Conventional treatment of left main coronary artery (LMCA) disease includes coronary artery bypass graft (CABG) and more recently, in selective indications, percutaneous coronary intervention (PCI). Direct surgical patch angioplasty of the LMCA using fresh autologous pericardium, saphenous vein, or mammary artery patch can be proposed as an alternative treatment. We have successfully operated one patient with surgical angioplasty for isolated ostial left main coronary stenosis at National Heart Journal.

Interactions of bacterial polysaccharides with cationic dyes: Physicochemical studies.

Capsular polysaccharides (SPS) are an integral component of gram-negative bacteria, and also have potential use as vaccine. In this paper, interactions of SPS isolated from Klebsiella strains K20 and K51 with cationic dyes pinacyanol chloride (PCYN) and acridine orange (AO) were studied by absorbance and fluorescence measurements. Both the polysaccharides having glucuronic acid as the potential anionic site induced strong metachromasy (blue shift ~100 nm) in the PCYN. The spectral changes were studied at different polymer/dye molar ratios (P/D = 0-40). A complete reversal of metachromasy was observed upon addition of co-solvents, suggesting the breakaway of dye molecules from the biopolymer matrix. Binding constant, changes in free energy, enthalpy and entropy of the dye polymer complex were also computed from the spectral data at different temperatures to reveal the nature of the interaction. Quenching of fluorescence of AO by the polymers and the incorporated mechanisms were also explored.

Influence of culture media and environmental factors on mycelial growth and sporulation of Lasiodiplodia theobromae (Pat.) Griffon and Maubl.

Lasiodiplodia theobromae, a common tea (Camellia sinensis) pathogen, usually does not sporulate or sporulates poorly in common media, which makes spore production difficult. In this study the effects of culture media, carbon source, nitrogen source, temperature, pH and light on mycelial growth and sporulation were evaluated. Among several carbon sources tested, glucose and sucrose were found superior for growth. Potassium nitrate supplemented media showed maximum growth amongst the tested inorganic nitrogen sources while peptone produced maximum growth among the tested organic nitrogen sources. Tea root extract supplemented potato dextrose agar medium was found to be the most suitable for mycelial growth and sporulation of L. theobromae. The fungus grow at temperatures ranging from 40 to 36 degrees C, with optimum growth at 28 degrees C and no growth was noted at 40 degrees C. There was no significant effect of different light period on growth of L. theobromae, but light enhanced sporulation. The fungus grow at pH 3.0-8.0 and optimum growth was observed at pH 6.0. Tea root extract supplemented potato dextrose agar medium with pH 6.0 was the most suitable for production of conidia of L. theobromae at 28 degrees C. Hence this media may be recommended for inoculum production for further studies.

Present status of understanding on the genetic etiology of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with a prevalence of approximately 7-10% worldwide. PCOS reflects multiple potential aetiologies and variable clinical manifestations. This syndrome is characterized by serious health implications such as diabetes, coronary heart diseases and cancer and also leads to infertility. PCOS can be viewed as a heterogeneous androgen excess disorder with varying degrees of reproductive and metabolic abnormalities determined by the interaction of multiple genetic and environmental factors. In this paper, we have attempted a comprehensive review of primarily molecular genetic studies done so far on PCOS. We have also covered the studies focusing on the environmental factors and impact of ethnicity on the presentation of this syndrome. A large number of studies have been attempted to understand the aetiological mechanisms behind PCOS both at the clinical and molecular genetic levels. In the Indian context, majority of the PCOS studies have been confined to the clinical dimensions. However, a concrete genetic mechanism behind the manifestation of PCOS is yet to be ascertained. Understanding of this complex disorder requires comprehensive studies incorporating relatively larger homogenous samples for genetic analysis and taking into account the ethnicity and the environmental conditions of the population/cohort under study. Research focused on these aspects may provide better understanding on the genetic etiology and the interaction between genes and environment, which may help develop new treatment methods and possible prevention of the syndrome.