Sepsis-induced autoimmune hemolytic anemia in the elderly

Autoimmune hemolytic anemia (AIHA) secondary to hematological malignancy is well-known and common in the elderly. AIHA associated with infection is less commonly reported in the elderly. We are reporting a case of AIHA in an elderly female with comorbidities, probably secondary to Gram-negative infection. The case was admitted and treated during the peak of the second wave of the COVID pandemic. The treatment of AIHA also had an impact on the progress and outcome of the underlying disease, leading to readmission in a short span of time. The patient also developed a thrombotic complication known to be associated with AIHA.

Survival outcomes with 12 weeks of adjuvant or neoadjuvant trastuzumab in breast cancer

Background: There is limited access to 1 year of adjuvant trastuzumab in resource-constrained settings. Most randomized studies have failed to prove non-inferiority of shorter durations of adjuvant trastuzumab compared to 1 year However, shorter durations are often used when 1 year is not financially viable. We report the outcomes with 12 weeks of trastuzumab administered as part of curative-intent treatment. Methods: This is a retrospective analysis of patients treated at Tata Memorial Centre, Mumbai, a tertiary care cancer center in India. Patients with human epidermal growth factor receptor (HER2)-positive early or locally advanced breast cancer who received 12 weeks of adjuvant or neoadjuvant trastuzumab with paclitaxel and four cycles of an anthracycline-based regimen in either sequence, through a patient assistance program between January 2011 and December 2012, were analyzed for disease-free survival (DFS), overall survival (OS), and toxicity. Results: A total of 102 patients were analyzed with a data cutoff in September 2019. The median follow-up was 72 months (range 6–90 months), the median age was 46 (24–65) years, 51 (50%) were postmenopausal, 37 (36%) were hormone receptor-positive, and 61 (60%) had stage-III disease. There were 37 DFS events and 26 had OS events. The 5-year DFS was 66% (95% Confidence Interval [CI] 56–75%) and the OS was 76% (95% CI 67–85%), respectively. Cardiac dysfunction developed in 11 (10.7%) patients. Conclusion: The use of neoadjuvant or adjuvant 12-week trastuzumab-paclitaxel in sequence with four anthracycline-based regimens resulted in acceptable long-term outcomes in a group of patients, most of whom had advanced-stage nonmetastatic breast cancer.

Neutralizing antibody response to COVID vaccination among the young and the elderly

Objective: The objective of the study was to assess the levels of neutralizing antibody after COVID vaccination in the elderly and compare it with that of the younger persons. The study also aimed at determining the association between the age, sex, and comorbidities and levels of neutralizing antibodies in the young and the old. Subjects and Methods: This was a single-center, cross-sectional, analytical study, conducted in the General Medicine Unit of ACS Medical College, Chennai, from August 2021 to October 2021. Forty?five elderly persons aged 60 years and above and 103 young adults aged 18 years and above and <60 years who were vaccinated with either COVISHIELD or COVAXIN were randomly selected to participate in this study. A detailed history regarding vaccination status, vaccination type, comorbidities, and breakthrough infection was obtained. Blood samples were collected from the participants to analyze the levels of neutralizing antibodies developed after COVID vaccination. Results: The mean age of the older participants was 66.13 ± 5.3 years and the mean age of the younger participants was 36.48 ± 10.9 years. The median level of neutralizing antibody in the younger participants was 97.4% (interquartile range [IQR]: 96.4%–98.0%) and in the older participants was 97.1% (IQR: 93.1%–97.6%). There was a significant difference in the neutralizing antibody level between the younger and the older participants (P = 0.033). There was no significant difference in the neutralizing antibody levels after two doses of either of the two vaccines among both the groups of participants. There was no significant association between the neutralizing antibody titer and sex and comorbidities in both the groups of participants. Five young and two old participants had breakthrough infections after vaccination. The antibody level was higher in persons with breakthrough infection than in those with no breakthrough infection in both the study groups. Conclusion: There was a significant difference in the neutralizing antibody level between the younger and the older participants after COVID vaccination. No significant difference existed in neutralizing antibody response with respect to the type of vaccine in both the study groups. There was no significant association between sex, comorbid status, and neutralizing antibody levels in both the groups.

Presence of integrase core domain in mutant type black pepper Piper nigrum L. ‘Thekken’ with altered inflorescence architecture

Black pepper (Piper nigrum L.), referred as the ‘King of Spices’, is native to India and has shown declined productivity over the years. It exhibits diverse quantitative and qualitative traits, particularly in spike length, floral composition, floral arrangement, fruit size and number. The novel mutant variety of black pepper (Piper nigrum L.) ‘Thekken’ shows a remarkable branching character in the spikes. In the present study, we analyzed RAMOSA3 (RA3) gene at the molecular level in this variety for yield improvement. Screening using degenerate primers designed for RA3 was carried out in ‘Thekken’ and a non-branching variety ‘Karimunda’ at the genomic level and at different stages of spike development at the transcriptome level. Sequence analysis of the amplicons generated in RT-PCR revealed the presence of an integrase core domain in the mutant type of black pepper, suggesting a possibility of mutation at this locus in the branched variety due to retrotransposon integration. The study suggests a possibility for introgression of the genes responsible for branching trait from the mutant variety of black pepper type ‘Thekken’ to other conventional cultivated varieties of black pepper that show single unbranched spike thereby increasing the productivity of black pepper which has very high economic value and export potential.

Association between Dietary Inflammatory Index and Metabolic Syndrome: A Hospital-Based Study.

Background: Elevated inflammatory biomarkers inMetabolic Syndrome (MetS) are associated withDietary Inflammatory Index (DII), which helps discernthe inflammatory impacts of diet and hence the risk ofCardiovascular Diseases (CVD) in MetS. Aim andObjectives: To assess the association between DIIscores and different components of MetS. To discernthe degree of association between the dietaryinflammatory potential and different components ofMetS using the DII score specific to this population.Material and Methods: DII scores were calculated in100 MetS participants and the diet was graded frommaximally anti-inflammatory to maximally proinflammatory. Data were represented as mean ± standarddeviation and compared using correlation coefficientand chi-square test. Results: DII scores were partiallycorrelated with triglycerides (TG; P = 0.279) in the firstquartile, with systolic blood pressure (P = 0.145) in thesecond, with High Density Cholesterol (HDL) in thethird (P = - 0.0001), and with Triglycerides (TG)(P = 0.139) and diastolic blood pressure (P = 0.203) inthe fourth quartile. Conclusion: The results reflect therole of diet in regulation of inflammation and areimperative to transform to a low inflammatory,antioxidant-rich diet to lower CVD risk.

Neonatal septicemia: bacteriological profile in a tertiary level hospital in South India

Background: Early onset bacterial sepsis remains a major cause of neonatal morbidity and death. The choice of antibiotic for an infant with sepsis depends on the predominant bacterial pathogens and the antibiotic susceptibility profiles for the microorganisms causing disease in a particular geographic region. The purpose of this study was to analyze the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in our neonatal unit.Methods: A descriptive cross sectional study carried was out at the NICU of a tertiary level hospital in South India for a period of one year.Results: Clinically suspected septicemia comprised 18.14% of total NICU admissions. Organism was isolated by blood culture in 14.9% of cases. The most common organisms causing septicemia were Coagulase negative Staphylococci, Klebsiella and Staphylococcus aureus. Gram positive isolates were most sensitive to Vancomycin (100%) while the gram negative isolates were most sensitive to Amikacin. Resistance to Crystalline Penicillin, Ampicillin  and 3rd generation cephalosporins was high.Conclusions: The most common organism isolated in septicemia was Coagulase negative staphylococcus in our NICU. Gram positive isolates were most sensitive to Vancomycin (100%) while the gram negative isolates were most sensitive to Amikacin. High resistance to commonly used antibiotics is worrisome. There should be a constant surveillance of the common microbes and their sensitivity pattern in each NICU and the antibiotic protocols should be periodically reviewed. Rational use of antibiotics and preventive measures like hand washing is the need of the hour.

Predictable factors for intervention with heparin free plasmapheresis in impending liver cell failure due to consumption of phosphorus rodenticide

Background: Yellow phosphorus containing rodenticide poisoning are common in Adult critical care. They cause coagulopathy and liver cell failure in humans. Till date, only liver transplants had been advocated as the final treatment of fulminant liver failure occurring as a complication of rodenticide poisoning. In this study, an innovative Treatment approach was given to liver cell failure cases who had consumed yellow phosphorus paste.Methods: Retrospective analysis of case records of liver cell failure cases due to the consumption of phosphorus containing Rodenticide poisonings, were analysed for a period of 1 year from January 2018 to January 2019 in a public hospital. Medical case records were obtained from records department and Postmortem registers. Symptoms, signs, investigations, treatments, complications, and outcomes were tabulated.Results: Total 11 cases were studied. 8 cases of liver cell failure and coagulopathy in whom therapeutic heparin free plasmapheresis was given, recovered completely from liver cell failure. A significant drop in Haemoglobin, platelet count, PT INR Ratio and rise in serum alkaline phosphatase, were the predictable factors used for the intervention of therapy with 5 cycles of heparin free plasmapheresis to eliminate toxic effects of phosphorus on liver cells and in the blood. A comparative analysis of untreated cases (n=3) vs treated with plasmapheresis (n=8), showed a significant statistical difference (P <0.005) in outcomes with a degree of freedom=2.Conclusions: Plasmapheresis can be a therapeutic treatment for liver cell failure caused due to the consumption of yellow phosphorus.  Predictable factors for impending liver cell failure in whom plasmapheresis will be of benefit are dependent upon prothrombin time, INR ratio, Liver enzymes and time interval between consumption and onset of liver cell failure.

Safe Blood transfusions: Still a risk in India.

Introduction: Nucleic acid testing (NAT) is the latest approved method for detection of transfusion transmitted infections. With higher prevalence of infections in window period and occult infections, blood safety can be compromised when testing is done using only serological techniques. With this background this study had been taken up to compare the results of serological test with NAT. Material and methods: Voluntary blood donations were screened for hepatitis B, hepatitis C and human immunodeficiency virus using ELISA. All samples were sent for ID-NAT and results of both methods were compared, analyzed individually. Results: A total of 11,393 blood units were collected during the study period. ELISA test results. showed 176 (1.54%) positivity for these transfusion transmitted infections (TTIs) in total. Among them, 133 (75.56%) was HBV, 22 (12.5%) was HCV and 21 (11.93%) was HIV as shown by ELISA. ID- NAT test results showed 174 (1.52%) positive in total. As analyzed by individual test results, 37 (0.32%) of total blood samples showed positivity in NAT which showed negative results in ELISA. Also 38 (0.33%) of total blood samples (HBV = 27, HCV = 08, HIV = 03) which showed positivity in ELISA were negative in NAT. Conclusion: ID-NAT is definitely a useful screening method for HBV, HCV, HIV. It clarifies infections in window period, occult infections and false seroreactive cases.

Enterococci: A journey of a successful pathogen.

Introduction: A dynamic homeostasis is maintained between the host and native bacteria of the gastrointestinal tract in humans, but migration of bacteria from the gut to other organs can lead to disease or death. Enterococci, traditionally viewed as commensal bacteria are now acknowledged to be organisms capable of causing life-threatening infections in humans, especially in the nosocomial environment. The existence of Enterococci in such a dual role is facilitated by its intrinsic and acquired resistance to virtually all antibiotics currently in use. Objective: The present pilot study was taken up to compare the multidrug resistance prevalence in commensal Enterococci and pathogenic Enterococci. Material and methods: A total of 50 commensal Enterococci isolated from stool samples and 50 clinical samples yielding Enterococci were taken for the study. Antibiotic susceptibility testing was done using Kirby Bauer’s disk diffusion method. Minimum inhibitory concentration of Vancomycin was tested by using E- strip. Results: Among 50 commensal Enterococci, majority showed resistance to Ampicillin 50 (100%), Erythromycin 38 (76%), Clindamycin 30 (60%), higher level of resistance to high level Gentamycin 14 (28%), Linezolid 6 (12%), vancomycin 3 (6%). 23 (46%) isolates showed multi drug resistance (resistance to ≥ 3 categories of antibiotics). Among 50 clinical isolates, majority showed resistance to Ampicillin 50 (100%), Erythromycin 38 (76%), Clindamycin 30 (60%), higher level of resistance to high level Gentamycin 14 (28%), Linezolid 6 (12%), vancomycin 3 (6%). 23 (46%) isolates showed multi drug resistance (resistance to ≥ 3 categories of antibiotics). Among 50 clinical isolates, majority showed resistance to Ampicillin 50 (100%), Clindamycin 46 (92%), Tetracycline 46 (92%), Erythromycin 41 (82%), Linezolid resistance was seen in 8 (16%) and Vancomycin resistance in 5(10%) clinical isolate. 48(96%) showed multi drug resistance. Conclusion: Boundary line between pathogenic and commensal Enterococci is blurred due to exchange of resistant traits. Regular screening of enterococcal isolates for resistance detection should be implemented. It is very important to consider infection control measures, screening of health care workers, surveillance cultures which can control spread of multidrug resistant Enterococci.

Obesity Affects Median Nerve Conduction - A Study in Armed Forces Individuals.

Background: Obesity, a growing public health concern, is associated with various disorders. Studies have suggested obesity as an independent risk factor that influences the prevalence of carpal tunnel syndrome (CTS) among active workers. The present study is an attempt to establish relationship between median nerve conduction velocity and obesity in people who do not have any other contributory factor for CTS other than obesity. CTS is the commonest entrapment neuropathy where the median nerve is compressed. Methods: The study was conducted in 15 obese subjects with Body Mass Index (BMI)>30 (group III) and 15 overweight subjects with BMI between 25&29.9 (group II) and 15 control subjects with BMI <25 (group I). The subjects were personnel from armed forces. Their body density was estimated using hydro-densitometry and the body fat percentage was calculated from density. The distal motor latency (DML) and the sensory conduction velocity (SCV) across the wrist on stimulation of median nerve at wrist 3cm proximal to distal crease were assessed in all subjects. Results: The mean values of DML in group I, II, and III were 3.52±0.25 ms, 3.50±0.30 ms and 3.65±0.20 ms respectively. Mean value of SCV among these groups were 48.99±3.23 m/s, 49.32±3.35 m/s and 48.69±4.00 m/s. Conclusion: No relationship could be established between BMI and DML as well as BMI and SCV. The relationship between percentage body fat and DML and SCV also found to be statistically insignificant. However, there was a correlation between BMI and body fat percentage. Carpal tunnel syndrome is uncommon even in obese armed forces personnel, which might be due to their regular body and hand exercise thereby having increased tone in hand muscles.

Activity of Ocimum sanctum (the traditional Indian medicinal plant) against the enteric pathogens.

Aqueous & alcoholic extracts of O. sanctum were prepared. Two concentrations of these extracts (30 mg & 60 mg) were tried against the enteric pathogens & candida albicans by Agar diffusion method. Wide zones of inhibition were observed at 60 mg concentration of extract. Aqeous extract showed wider zone of inhibition when compared to alcoholic extract. Aqueous extract showed wider zones of inhibition for Klebisella, E. Coil, Proteus & Staphylococcus aureus. Alcoholic extract showed wider zone for vibrio cholerae.