Demographic Risk Factors for Mortality of Covid 19 Patients Admitted in A Tertiary Care Hospital: A Cross-Sectional Study

Context/Background: During the COVID-19 pandemic, government worldwide imposed severe re-strictions on public life to limit its spread. For informed decision making it is important to quantitatively assess how the age, gender, and length of stay affects mortality of COVID 19 patients. It is important to find out more useful prognostic factor for mortality. This study revealed prevalence of mortality across age, gender, and length of stay and assessed determinants of mortality using independent variable age, gender, and length of stay. Methodology: A Cross-sectional observational study was conducted on 3084 Covid 19 positive patients admitted during April 2020 to June 2021 at Bundelkhand Medical College Sagar. Results: In this study mortality occurred in 510 patients. Age group analysis presented that majority of patients died in 60–74-year age group whereas maximum patients who died are having length of stay for 0-7 days, whereas gender has no significant role. There was significant influence of age group and length of stay on the mortality of Covid-19 positive patients (χ2(9) =495.30, P<.001). Conclusions: Mortality of covid positive patients being impacted by demographic risk factors like age group, length of stay.

Thigh Pain and Peri-Implant Fractures with the Use of Short Cephalo-medullary Nails: A Retrospective Study of 122 Patients

@#Introduction: To assess the incidence and causes of persistent thigh pain and peri-implant fractures after union in patients of intertrochanteric fractures treated with short cephalo-medullary nails. Materials and methods: A retrospective observational study conducted at a Level 1 Trauma centre. A total of 122 patients of intertrochanteric fractures who were operated using short cephalo-medullary nails (170mm and 200mm lengths) between January 2018 to June 2019 were included in the study. Main outcomes measured were the incidence of thigh pain and peri-implant fractures. Results: Out of the 122 patients with a mean follow-up of 14.1 month, 12 patients had persistent thigh pain. Six patients had the helical blade protruding from the lateral cortex, two of them had distal tip of nail abutting on the anterior cortex and four cases had prominent proximal segment of nail which may explain the cause of their pain. Five of these patients had a combination of these findings. Two patients had pain for which no other obvious cause was found. There were no cases of peri-implant fractures in our study. Conclusion: Thigh pain associated with the use of short cephalon-medullary nails is often unrelated to nail length and can be prevented by using proper surgical technique. There seems to be no association between the use of short nails and peri-implant fractures.

Intraocular amyloidosis with multifocal iris and anterior chamber translucent spherules

Ocular amylodosis, although a rare entity, is known to affect the conjunctiva, extraocular muscles, orbit, lacrimal gland, and skin around the eyes. Intraocular deposition of amyloid mainly confines to the vitreous and cornea. In this report, we describe two cases of intraocular amyloidosis presenting as multiple iris and anterior chamber cysts. Histopathological examination with special stain like Congo Red and Transmission Electron Microscopy confirmed the diagnosis of amyloidosis. Systemic investigations ruled out systemic association confirming the diagnosis of primary ocular amyloidosis.

Nasal carriage of methicillin-resistant Staphylococcus aureus among health-care workers at a tertiary care hospital in Northern India

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to all beta-lactam antibiotics, including penicillins, cephalosporins, carbapenems, and betalactamase inhibitors. MRSA remains a public health problem globally. MRSA infection increases morbidity, risk of mortality, increased financial burden, and loss of productivity. A major source of MRSA in the hospital environment can be asymptomatically colonized health-care workers (HCWs). Objectives: The aim of the study is to screen nasal swabs collected from HCWs of our hospital for colonization with S. aureus and detect methicillin resistance among them. Materials and Methods: In this cross-sectional study, consenting HCWs were consecutively enrolled. Nasal swabs were collected aseptically from study participants and processed using standard microbiological protocols for the recovery of S. aureus and MRSA. Methicillin resistance was detected by cefoxitin disc diffusion method according to the CLSI guidelines. Results: Out of a total of 184 HCWs studied, the prevalence of S. aureus carriage in anterior nares was 14.6%. The overall MRSA prevalence was 3.8%. Highest carriage rates for MRSA were found in laboratory technicians (7.1%) followed by nursing staff (4.4%). The ophthalmology department had the highest MRSA carriage rate of 22%. Conclusions: Our findings demonstrate that nasal carriage of MRSA among HCWs is relatively low in this study compared to other Indian studies done in tertiary care centres. Further studies are needed to evaluate the incidence of infections due to MRSA in this population.

Quality assurance in ophthalmic imaging

Quality assurance (QA) is the maintenance of a desired level of quality in a service, by means of attention to every stage of process of delivery. Correct image acquisition along with accurate and reproducible quantification of ophthalmic imaging is crucial for evaluating disease progression/stabilization, response to therapy, and planning proper management of these cases. QA includes development of standard operating procedures for the collection of data for ophthalmic imaging, proper functioning of the ophthalmic imaging equipment, and intensive training of technicians/doctors for the same. QA can be obtained during ophthalmic imaging by not only calibration and setting up of the instrument as per the manufacturer's specifications but also giving proper instructions to the patients in a language which they understand and by acquisition of good quality images. This review article will highlight on how to achieve QA in imaging which is commonly being used in ophthalmic practice.

Development of species-specific primers for detection of Xanthomonas campestris pv. campestris causing black rot of crucifers

Aim: Black rot of crucifers caused by Xanthomonas campestris pv. campestris (Pammel) Dowson (Xcc) is a major seed-borne disease. The present study aimed to develop a rapid diagnostic protocol for the specific and sensitive detection of this pathogen. Methodology: A specific primer set was designed based on rpf gene and optimization of PCR condition was done for specific detection of Xcc. Sensitivity of PCR for primer set was then determined by diluting the Xcc DNA and cells. Results: Specific primer set was able to amplify a specific band of 304 bp in all 11 isolates of Xcc but failed to amplify other Xanthomonas species and one each of Ralstonia solanacearum, Erwinia caratovora subsp. caratovora, Bacillus subtilis, Pseudomonas fluorescens and P. aeruginosa. The primer set was highly sensitive as it was able to detect 10 pg μl-1 bacterial DNA and up to 3x103 CFU ml-1 corresponding to 12 viable cells of Xcc which were used as template for PCR reaction Interpretation: The results suggest that developed PCR primers are highly specific and sensitive and it can be used to detect the pathogen at an early stage of infection for disease management.

Soul and Mind as Functional Control in the Management of Human Body: A Scientific Approach

Soul is an eternal, noble and everlasting presence of energy in human body, represents bestcreation of nature. The combination of five dhatus (Air, Water, Earth, Agni, Akasha) with Soul is called‘Shad Dhatu’ purusha. When the Soul leaves the body, all biological and physiological activities are notfunctional and body declared as dead body. The sharira (body), indriya (sense organs), Mann (mind),and Soul (atma) are connected together in the living human body, this is called as Ayu (life). Mann,Soul, and Sharira are just like the tri-unity. The world is self-sustained by their combination and theyconstitute the sol stratum for physical, mental, psychological activities along with spiritual knowledgegrowth in human life. The soul is non-physical and non-materials. Science does all experiments forconfirming and understanding the events and action. This initiate an effort to provide and develop aconcept to hypothesize this relationship among Soul, Mann and body. They all are connected togetherand cannot be separated till death. The separation mechanism is not clearly understood for theirinternal survival in the human body and even after death also. We never find any kind of method,techniques and technology to identify soul and mann individually in the living body even after death.The whole body functions and their operational mechanism have been witnessed by the soul. It is akind of a divine battery that never exhausts its power or capacity during individual life and re-birth ascompared to manmade battery which loses its strength with time in working of instruments/devices.The battery has to be replaced in order to make the device in working condition. We hope that presentstudy will provide the scientific basis in understanding the embedded relationship of soul, mann in thefunctioning of human and body.

Discriminating ability of Cirrus and RTVue optical coherence tomography in different stages of glaucoma

Purpose: The aim of this study is to determine which parameter of Cirrus and RTVue optical coherence tomography (OCT) has the highest ability to discriminate between early, moderate, and advanced glaucoma. Simultaneously, to compare the performance of the two OCT devices in terms of their ability to differentiate the three stages of glaucoma. Further, to analyze the macular parameters of both devices and compare them with the conventional retinal nerve fiber layer (RNFL) parameters. Methods: One hundred and twenty eyes (30 healthy and 90 glaucomatous [30 mild, 30 moderate, and 30 advanced glaucoma]) of 65 participants (15 healthy, 50 glaucomatous [15 mild, 15 moderate, and 20 advanced glaucoma]) underwent Cirrus and RTVue OCT scanning on a single visit. Results: Average RNFL thickness and superior RNFL thickness of both the devices and inferior (ganglion cell complex [GCC] of RTVue device best differentiated normals from all stage glaucomatous eyes (P > 0.05). Cirrus average RNFL thickness and superior RNFL thickness performed better than other parameters (P < 0.05) in differentiating early glaucoma from moderate and advanced. In differentiating advanced from early and moderate glaucoma, RTVue average, superior, and inferior RNFL thickness and inferior GCC parameters had the highest discriminating ability (P < 0.05). Conclusion: Overall, average RNFL thickness had the highest ability to distinguish different stages of the disease. No significant difference was found between RTVue and Cirrus OCT device in different severity levels. No significant difference was observed between RNFL and macular parameters in different stages of glaucoma.

Quality indicators for eye bank

Purpose: The aim of this study is to identify quality indicators of the eye bank and validate their effectivity. Methods: Adverse reaction rate, discard rate, protocol deviation rate, and compliance rate were defined as Quality Indicators of the eye bank. These were identified based on definition of quality that captures two dimensions – “result quality” and “process quality.” The indicators were measured and tracked as part of quality assurance (QA) program of the eye bank. Regular audits were performed to validate alignment of standard operating procedures (SOP) with regulatory and surgeon acceptance standards and alignment of activities performed in the eye bank with the SOP. Prospective study of the indicators was performed by comparing their observed values over the period 2011–2016. Results: Adverse reaction rate decreased more than 8-fold (from 0.61% to 0.07%), discard rate decreased and stabilized at 30%, protocol deviation rate decreased from 1.05% to 0.08%, and compliance rate reported by annual quality audits improved from 59% to 96% at the same time. In effect, adverse reaction rate, discard rate, and protocol deviation rate were leading indicators, and compliance rate was the trailing indicator. Conclusion: These indicators fulfill an important gap in available literature on QA in eye banking. There are two ways in which these findings can be meaningful. First, eye banks which are new to quality measurement can adopt these indicators. Second, eye banks which are already deeply engaged in quality improvement can test these indicators in their eye bank, thereby incorporating them widely and improving them over time.

Lymphatic Filariasis Presenting as a Swelling over the Upper Arm: A Case Report

@#Filariasis continues to be one of the endemic problemsworldwide with 40% of the cases in India. We report a caseof lymphatic filariasis in a 32-year old female who presentedwith a non-tender swelling over left upper arm. Bloodsample showed no eosinophilia while the FNAC wasdiagnostic of W. bancrofti. Patient responded well with oraldiethylcarbamazine. High index of suspicion of filariasis isindicated when dealing with a swelling of unknown causeespecially in filariasis endemic areas.

Pathology of a H5N1, highly pathogenic avian influenza virus, in two Indian native chicken breeds and a synthetic broiler line.

In this study, susceptibility to H5N1 virus infection was studied in two Indian native chicken breeds viz. Kadaknath and Aseel (Peela) and an Indian synthetic broiler strain (Synthetic dam line (SDL-IC). Fifty birds from each genetic group were infected intra-nasally with 1000 EID50 of a highly pathogenic avian influenza virus (HPAIV) strain A/chicken/Navapur/India/7972/ 06 (H5N1) and observed for a period of 10 days. Significant differences in severity of clinical signs, gross lesions and time for onset of symptoms were observed. The overall severity of clinical signs and gross lesions was less in SDL-IC broilers as compared to the other two genetic groups. The mortality percentages were 100, 98 and 92% with Mean Death Time (MDT) of 3.12, 5.92 and 6.96 days, respectively for the two native breeds Kadaknath and Aseel (Peela), the and SDL-IC broiler strain. Comparison of histological lesions revealed differences in disease progression among the genetic groups. Vascular lesions such as disseminated intravascular coagulopathy (DIC) were predominant on 3 days post infection (dpi) in Kadaknath, and on 5 and 6 dpi in Aseel (Peela) and SDL-IC broiler. The mean log2 HA titres of the re-isolated virus from various organs of H5N1 AIV infected birds of the three genetic groups ranged from 2.32 (lung, trachea and bursa) to 5.04 (spleen) in Kadaknath; 2.32 (lung) to 6.68 (brain) in Aseel (Peela); and 2.06 (liver) to 7.01 (lungs and kidney) in SDL-IC broiler. These results suggest that the susceptibility to H5N1 highly pathogenic avian influenza virus infection differed among the three breeds; Kadaknath being highest followed by Aseel (Peela) and synthetic SDL-IC broiler.This is possibly the first report on the differences in the susceptibility of the India native breeds to H5N1 virus infection and its severity.

Antiviral activity of crude extracts of Eugenia jambolana Lam. against highly pathogenic avian influenza (H5N1) virus.

Crude extracts of leaves and bark of E. jambolana were tested for antiviral activity against highly pathogenic avian influenza virus (H5N1) by CPE reduction assay in three different layouts to elucidate virucidal, post-exposure and pre-exposure antiviral activity of the extracts. The cold and hot aqueous extracts of bark and hot aqueous extract of leaves of E. jambolana showed significant virucidal activity (100% inhibition) which was further confirmed in virus yield reduction assay (~98 to 99% reduction) and by egg based in ovo assay. The selective index (CC50/EC50) of hot aqueous extract (248) and cold aqueous extract (43.5) of bark of E. jambolana showed their antiviral potential against H5N1 virus. The significant virucidal activity of leaves and bark of E. jambolana merits further investigation as it may provide alternative antiviral agent for managing avian influenza infections in poultry farms and potential avian-human transmission.

A comparative study of low dose weekly paclitaxel versus cisplatin with concurrent radiation in the treatment of locally advanced head and neck cancers.

PURPOSE: The purpose of this study was to compare low dose weekly paclitaxel versus cisplatin with concurrent radiation in locally advanced head and neck cancers. MATERIALS AND METHODS: From August 2005 to July 2006, a total of 100 biopsy proven, locally advanced head and neck cancers were enrolled for the study. All the patients were stratified in two groups, study group A and control group B. Study group patients received injection Paclitaxel 20 mg/m 2 , I/V 1 hr infusion weekly for 6 weeks and control group patients received injection Cisplatin 30 mg/m 2 , I/V 2 hrs infusion weekly for 6 weeks. All patients received 66-70 Gy concurrent radiation at the rate of 2 Gy/day, 5 #/week, in 6-7 weeks by cobalt theratron phoenix - 80 teletherapy units. RESULT: Complete response achieved in 73% of patients in study group and 64% of patients in control group. There was no statistically significant difference observed between the study group and the control group (chi2 = 1.167, df = 1, level of significance 0.05). On 3-10 months of follow-up 59% of patients in the study group and 42% of patients in the control group are alive and disease free. Local toxicities including mucositis, dysphasia and skin reactions were more in the study group but tolerable. CONCLUSION: Efficacy of paclitaxel in low dose weekly schedule is comparable to cisplatin in locally advanced head and neck squamous cell carcinoma. Further analysis and follow-up are needed to evaluate if this benefit will translate into prolonged survival.

Pattern of skin diseases among migrant construction workers in Mangalore.

BACKGROUND: With increasing industrialization, the construction industry provides employment to a large number of skilled and nonskilled workers, many of them migrant workers. AIM: This study was undertaken to provide epidemiological data regarding various dermatoses among migrant construction workers in India as currently there is a paucity of the same. METHODS: One thousand construction workers, including 467 migrant laborers, were examined for various dermatoses. RESULTS: Most (88%) workers were males and 51.17% were in their third decade. Infective and noninfective dermatoses were seen in 89.72% and 53.74% of laborers respectively. Among infective dermatoses, fungal infections were the most common (46.25%) ones, followed by bacterial infections (24.83%), scabies (8.56%) and viral infections (6.42%). Contact dermatitis to cement was seen in 12.48% of the laborers. Masons had a significantly higher incidence of contact dermatitis to cement, viral infections and scabies than helpers. CONCLUSIONS: The pattern of dermatoses is an expression of poverty, overcrowding and the occupational hazards of the construction industry.

Cytogenetic causes for recurrent spontaneous abortions - An experience of 742 couples (1484 cases).

BACKGROUND: First trimester pregnancy loss is a very common complication and a matter of concern for couples planning pregnancy. Balanced chromosomal rearrangements in either parent is an important cause of recurrent pregnancy loss particularly in the first trimester. AIMS: In this study an evaluation of the contribution of chromosomal anomalies in causing repeated spontaneous abortions was made. METHODS AND MATERIALS: A review of the cytogenetic data in 742 couples (1484 individuals) with recurrent spontaneous abortions who were examined for chromosomal aberrations in the period 1990-2003 is presented. Women who had at least two abortions, or spontaneous abortions preceded or followed by fetal deaths or birth of a malformed child, and patients who had recurrent spontaneous abortions (> 3) with normal live issue/s were studied. RESULTS: Chromosomal rearrangements were found in 31 individuals (2%). These abnormalities included 22 (2.9%) structural aberrations, 9 (1.2%) numerical anomalies. In addition to these abnormalities, 21 (3.2%) chromosomal variants were also found. CONCLUSION: Chromosomal analysis is an important etiological investigation in couples with repeated spontaneous abortions as it helps in genetic counseling and deciding about further reproductive options.

Tuberculoma en plaque: a case report.

A 14 year old girl presented with a 6-month history of headaches and visual blurring. CT showed a right tentorial enhancing lesion. Angiogram showed no enhancement. Histopathological examination of the excised material was consistent with tuberculoma. The presentation of such unusual intracranial tuberculoma is reported and the literature reviewed on the subject.

Endoluminal treatment of infrarenal abdominal aortic aneurysm with bifurcated stent-graft system.

Atherosclerotic infrarenal aortic aneurysm has been traditionally treated by open surgical repair. We report a high risk case where the aneurysm was successfully treated by the new technique of endoluminal stent graft placement.

Brief information about Siddhasāra Nighantu of Ravigupta.

Siddhasāra nighanti, is authored by 'Bauddhācārya Ravigupta'. On the basis of various evidences, its period is considered as 7th century A.D. Actually Ravigupta has written 'Siddhasāra Samhita', the last part of which is known as "Siddhasāra Nighantu'. The second chapter of Siddhasāra Samhita is 'Dravyasamgrahaniya', where 33 Ganas out of 37 Ganas of Suśruta Samhita of 'Dravyasamgrahaniya", chapter have been mentioned. The Dravyas have been described in Paryāya śaily and with 96 Slokas.