A study to correlate serum pseudocholinesterase and serum creatine phosphokinase levels in acute organophosphorus poisoning with respect to Peradeniyaorganophosphorus poisoning scale

Background: Organophosphorus insecticides are one of the most common causes of poisoning in India. It has a high mortality rate and accounts for a third of suicidal deaths in south-east Asia.Methods: The objectives were to estimate serum pseudocholinesterase and creatine phosphokinase (CPK) levels in organophosphorus poisoning and correlate them with theseverity and prognosis described by the Peradeniya organophosphorus poisoning (POP) scale at initial presentation.This was a cross-sectional study conducted over 18 months. A total of 180 organophosphorus-poisoning subjects were divided into mild, moderate and severe grades based on POP scale at admission. Serum pseudocholinesterase and CPK levels were estimated at admission. The outcome was noted, and the results were statistically analysed.Results:It was found that 112 (62.2%), 51 (28.3%) and 17 (9.4%) patients had mild, moderate and severe poisoning, respectively, according to POP scale. Mean pseudocholinesterase level (units/litre) was 2393.29, 1104.37 and 638.18 and mean serum CPK level (units/litre) was 153.41,344.94 and 280.53 in mild, moderate and severe poisoning, respectively. ICU and ventilator were required for 84 (46.75%) and 72 (40%) patients, respectively. Mortality was 17.8%. Negative, weak and significant correlation was seen between POP score and pseudocholinesterase (r=-0.265, p=0.00). Positive, moderate and significant correlation was seen between POP score and CPK levels (r=0.449, p=0.00).Conclusions: POP scale applied at admission along with serum pseudocholinesterase and CPK levels serve as a simple and effective system to determine early need for ventilation and mortality in rural, peripheral centres in developing nations.

Community voices around COVID-19 vaccine in Chennai, India: A qualitative exploration during early phase of vaccine rollout

Background & objectives: Globally, vaccination is considered as an important public health strategy to mitigate the impact of the COVID-19 pandemic. The purpose of the current study was to conduct an in-depth inquiry to explore perceptions of community members around COVID-19 vaccines in the southern city of Chennai, Tamil Nadu. This was conducted during the early phase of the vaccine rollout programme in India. Methods: A qualitative investigation was conducted between January-February 2021 through in-depth interviews. Healthcare workers, religious leaders, community influencers, local administrators and representatives of marginalized communities were included. The key informant interview guides and probes explored five domains; (i) vaccine availability, (ii) trust in COVID-19 vaccines, (iii) vaccine-related concerns, (iv) health/risk balance and (v) vaccine prioritization. Transcripted interviews were coded using a thematic approach and analyzed manually as well as with the help of ATLAS.ti 9 software. Results: Eagerness to receive COVID-19 vaccines amongst some of the respondents was linked with freedom from fear, possible restoration of normalcy, protection of family and ability to travel and work abroad. Concerns around threat of emergence of new variants, damage caused by such viral mutants and trust in policymakers were other facilitatory influencers for vaccine uptake. On the other hand, doubts surrounding safety and fear of side effects of COVID-19 vaccine were the feeders to vaccine hesitancy. Lack of accurate information, sensational media reports and rumours exacerbated this fear and provoked anxiety among people. Apprehensions around COVID-19 vaccine in the wake of its rapid development and approval for use and reluctance to take it during the declining phase of the epidemic were identified as other inhibitory factors. Participants underlined the importance of having responsive communication strategies in place focussing on vaccine safety. Making vaccines available to people free of cost and ensuring wider access were other programmatic suggestions. Interpretation & conclusions: In conclusion, our study findings suggest that it is essential to remain engaged with communities and execute evidence-based information dissemination strategy about the safety and efficacy of the vaccines. We identified that it is also imperative to sensitize and train media professionals on how to report side effects related to vaccines. Responsive communication strategies will thus have the potential to serve as a key public health approach pertaining to future pandemic preparedness as well as to manage the demands of clinical and public health issues in an ongoing pandemic situation.

Study of microalbuminuria and its correlation with severity of disease in patients with chronic obstructive pulmonary disease

Background: Microalbuminuria is a marker of endothelial dysfunction and an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). The objectives were to study the presence of microalbuminuria in patients with chronic obstructive pulmonary disease and to determine the relationship of microalbuminuria with severity of COPD using GOLD staging.Methods: The study was done on 68 patients of COPD. Urine spot albumin measurement, pulmonary function tests, spirometry and GOLD staging were done. Severity of COPD was assessed by GOLD staging. Pearson Co-relation test and ANOVA test were used for statistical analysis.Results: Statistical analysis showed that strong and statistically significant positive correlation of Microalbuminuria with GOLD staging(r =0.749, p = 0.001).Conclusions: Microalbuminuria(MAB) was found to increase in patients with increasing severity of COPD. Hence its potential role as a marker of severity of disease and in predicting risk of cardiovascular disease can be explored.

Study of impact of clinical and biochemical parameters in aluminium phosphide poisoning

Background: The aim of the study was to assess the relationship between clinical and biochemical parameters with outcome of aluminium phosphide toxicity.Methods: Total 46 patients with aluminium phosphide poisoning admitted to the Hospitals attached to BMCRI between November 2018 and April 2019 were prospectively studied. After adequate history was obtained and immediate first aid measures given, clinical and biochemical parameters such as liver enzymes, serum creatinine, serum potassium and magnesium levels were studied. The patients were then followed up until outcome. Data was analysed using Descriptive statistics like mean, Standard deviation and percentages were calculated. Inferential statistics like Mann-Whitney test was used to compare the parameters between the two outcome groups (discharged and death) using SPSS software.Results: Among the study population, between the two outcome groups males were 80.6% and females were 19.4%. the outcome was death in 10 patients and 36 patients were discharged. Tachycardia and hypoxia at presentation, Low Serum Magnesium and higher levels of serum creatinine at admission were found to be associated with higher mortality in patients with aluminum phosphide toxicity and were statistically significant.Conclusions: These clinical and laboratory parameters can be considered as manifestation of hemodynamic compromise and are hence associated with poorer prognosis. Serum magnesium levels, can be used in prognostication of aluminium phosphide toxicity, owing probably to their effects of cardiotoxicity. Increased serum creatinine levels as a result of acute kidney injury, could also indirectly point to circulatory compromise. Hence these clinical and laboratory parameters at presentation have important implications.

Islets of hypoglycaemia: a rare case of adult onset nesidioblastosis

A case of diffuse nesidioblastosis in an adult patient is reported in this study. A 24-year-old female with no known comorbidities presented with multiple episodes of documented recurrent hypoglycaemia and Hypoglycaemia induced seizures both in fasting and postprandial state. Her blood investigations revealed low plasma glucose levels, high insulin and C-peptide levels with positive 72-hour fast test. Her transabdominal USG and CECT abdomen did not reveal any abnormality, 68Ga DOTANOC PET CT done showed ill-defined diffuse somatostatin receptor expression in the pancreatic head and tail suggestive of nesidioblastosis. As patient was not willing for surgical treatment, hence started on medical treatment with oral nifedipine. Nesidioblastosis is very rare in adults. It is an important differential diagnosis in adults with hyperinsulinemic hypoglycemia although the incidence is very rare in adults. PET SCAN was used to non-invasively diagnose nesidioblastosis in this case. Surgery being the preferred choice of treatment in nesidioblastosis, there is limited data on medical line of management in nesidioblastosis.

Study of neutrophil lymphocyte ratio in patients with type 2 diabetes mellitus and its correlation with glycemic control

Background: Neutrophil lymphocyte ratio (NLR) is an indicator of subclinical inflammation. Subclinical inflammation may be associated with increased cardiovascular risk. Raised NLR is associated with metabolic syndrome and is found to be a predictor of cardiovascular disorders. There are only few studies assessing the correlation between NLR and glycemic control. The aim of the present study is to investigate the relationship between NLR and glycemic control in type 2 diabetes patients.Methods: This observational study was conducted in Department of Medicine, Bangalore medical college. 100 patients diagnosed to have type 2 diabetes mellitus were assessed. They were divided into three groups based upon HbA1c levels: Group 1, HbA1c ≤7%; group 2, HbA1c 7-9%, and group 3, HbA1c>9%. Complete blood count and other relevant investigations were performed. SPSS software was used for statistical analysis. T test was used for continuous variables and chi square test for categorical variables. ANOVA test was used to compare three groups. A p value of <0.05 was considered statistically significant.Results: Out of 100 patients, the white blood cell count (WBC count) was higher in group 3 as compared to group 1 and group 2(p 0.008). Similarly, the absolute neutrophil count was higher in group 3 as compared to group 1 and group 2(p.017). The neutrophil lymphocyte ratio (NLR) was significantly higher in group 3 as compared with group 1 and group 2(p.009). NLR had a positive correlation with HbA1c and was found to be an independent predictor of poor glycemic control in patients with type 2 diabetes mellitusConclusions: Our study found a significant positive correlation between NLR and glycemic control. Increased NLR is associated with elevated HbA1c and poor glycemic control. Type 2 diabetes mellitus patients with raised NLR should be evaluated for cardiovascular, renal and ocular complications of diabetes.

A Comparative Study of AIMS 65 Score with other Scoring Systems to Predict Outcomes in Patients with Upper GI Bleed in Chronic Liver Disease

Introduction: The AIMS 65 score is a new bedside scoreproposed for the assessment of liver function which issimple and more independent. Different scores have beenrecommended to predict outcomes in the setting of uppergastrointestinal bleeding (UGIB), limited comparative studieshave been published between simplified versions of olderscores and recent scores. In this present study, we aimed toretrospectively compare the performance of AIMS 65 scorewith Child-Pugh score, MELD score and ALBI score forpredicting the outcome in patients with upper GI bleed inchronic liver disease.Material and Methods: Data of patients with chronic Liverdisease secondary to ethanol were retrospectively reviewed.Child Pugh score, MELD score, ALBI score and AIMS 65score were calculated for the patients and results . ROC curvesderived from comparison with outcome and were analysed.Results: In our study conducted on 112 patients, the agedistribution was between 20-85 years with mean age ofpatients being 46.47 ± 10.9 years, sex ratio Male: Female:105:7 with mortality rate of 33.92%. The Area under curves ofROC of AIMS65, Child Pugh score, MELD score, ALBI scorewas 0.779, 0.864, 0.763 and 0.777 respectively.Conclusion: AIMS 65 is a simple and non-endoscopic scorefor the prediction of in hospital mortality. No statisticaldifference was observed between AIMS-65 and other scoressuch as Child Pugh score, ALBI and MELD score.

Establishing Antimicrobial Resistance Surveillance & Research Network in India: Journey so far

The Indian Council of Medical Research, in 2013, initiated the Antimicrobial Resistance Surveillance & Research Network (AMRSN) to enable compilation of data on six pathogenic groups on antimicrobial resistance from the country. The overarching aim of this network was to understand the extent and pattern of antimicrobial resistance (AMR) and use this evidence to guide strategies to control the spread of AMR. This article describes the conception and implementation of this AMR surveillance network for India. Also described are the challenges, limitations and benefits of this approach. Data from the Network have shown increasing resistance in Gram-negative bacteria in the hospitals that are part of this network. Combined resistance to third-generation cephalosporins and fluoroquinolones and increasing carbapenem resistance are worrisome, as it has an important bearing on the patients' outcome and thus needs to be addressed urgently. Data generated through this Network have been used to develop treatment guidelines, which will be supportive in harmonizing treatment practices across the tertiary level healthcare institutions in the country. While, the major benefit of having a surveillance system is the collection of real-time accurate data on AMR including the mechanisms of resistance, representativeness to community, sustaining the current effort and expanding the current activities to next levels of healthcare settings are the major challenges. The data emanating from the network besides providing evidence, expose several gaps and lacunae in the ecosystem and highlight opportunities for action by multiple stakeholders.

Policy document on antimicrobial stewardship practices in India

Antimicrobial resistance (AMR) in India has become a great threat because of high rate of infectious diseases. One of the key contributing factors is high antibiotic use due to poor prescription practices, self-medication, over-the-counter sale of drugs and lack of awareness. Antimicrobial stewardship programme (AMSP) have been proved to be successful in restraining sale and use of antibiotics to a large extent in many countries. An AMSP programme for a hospital is imperative for rational and evidence-based antimicrobial therapy. The ultimate aim is to improve patient outcomes, reduce emergence of bacterial resistance and ensure longevity of the existing antimicrobials. The primary goal of AMSP is to encourage cautious use of available antibiotics by training the healthcare workers and creating awareness. This article describes the strategies and recommendations for formulation of AMSP policy for India.

Study of Diagnosis and Management of Ectopic Pregnancy

The term ‘Ectopic pregnancy’ refers to the pregnancy that implants outside the uterine cavity). This work is aimed at the clinical study of diagnosis and management of 35 cases of ectopic pregnancy over a period of two and a half years. The main aims of the study are (1) to evaluate the efficacy of the various modalities of diagnosis, and (2) to determine the best treatment option depending on the severity of presentation. A combination of accurate history, meticulous physical examination, serum β-HCG levels, culdocentesis and ultrasound will aid in early diagnosis. Management of the cases depends on the severity of the presentation. Conservative approach includes medical management with methotrexate or laparoscopic salpingostomy. Laparotomy involving salpingectomy was done in ruptured ectopic pregnancy.

Screening and Evaluation of the Effect of Exogenous Application of ABA and Propiconazole on the Antioxidant potential of Mucuna pruriens seed Extracts.

The aim of our present study was the effect of soil drenching of propiconazole (PCZ) and Abscisic Acid (ABA) on vegetative growth, biochemical changes and antioxidant activities in seed methanolic extracts of Mucuna pruriens (MEMP). In this research we evaluated the morphological parameters like fresh and dry weight of plant, number of pods and antioxidant assay such as Total phenol, Total flavanoid, 1-diphenyl 2-picryl hydrazyl (DPPH), Superoxide radical scavenging activity, Metal chelating and Ferric ion Reducing antioxidant activity(FRAP). The report shows Number of pods, Number of seeds were increased while the plant treated with PCZ than the ABA as well as control. The increased content of total phenol and flavanoids observed in treated plants than control. On the other hand the highest Superoxide radical scavenging activity, Metal Chelating activity, Ferric ion reducing antioxidant was found in PCZ treated extracts followed by ABA treated extracts and control. Based on our results it seems that PCZ considerably increased the antioxidants content than the ABA and control.

rare cytogenetic presentation of acute myeloid leukemia [AML-M2]

Acute myeloid leukemia [AML] with t[8;21][q22;q22] generating the AML1/ETO fusion gene on 8q22 is a distinct type of AML t[8;21] category [WHO]/AML-M2 [FAB], generally associated with a favourable prognosis. Variant additional chromosomal abnormalities are frequently reported. We report three adult cases of this category with unusual karyotype. Bone marrow cytogenetics of case no. 1: 45,X,-Y, t[8;21][q13;q22] with a novel breakpoint of chromosome 8 at [q13]. Case no. 2: 46,X,t[X;2][q22;q37],t[3;7][q21;q36],t[5;14][p15;q11],del[8][q22] a complex rearrangement without the involvement of chromosome 21. Case no. 3: 49,XX,+5, t[8;21][q22;q22], +16, +der[21]t[8;21][q22;q22] with additional der[21]. Endometrial in this case which was positive for myeloperoxidase [MPO] and CD117 conforming the AML infiltration. All are morphologically AML with t[8;21]. Relevant literature in cytogenetic of AML-M2 is reviewed. The molecular mechanism involved in unusual rearrangements and clinical significance of them are subjected for further studies

Acute promyelocytic leukemia with unusual karyotype.

Acute myeloid leukemia (AML-M3) is associated with the translocation t(15;17)(q22;q12-21) which disrupts the retinoic acid receptor alpha (RARA) gene on chromosome 17 and the PML gene on chromosome 15. We report a two-year-old patient with AML-M3 without the usual translocation t(15;17). Cytogenetic studies demonstrated normal appearance of chromosome 15 while the abnormal 17 homologue was apparently a derivative 17, der(17)(17qter-cen-q21:), the rearrangement distinctly shows deletion at 17q21 band and the morphology corresponding to an iso chromosome i(17q-). This case report is a rare cytogenetic presentation of acute promyelocytic leukemia (APML).

Antimicrobial activity of leaf extract of passiflora incarnata L.

Ethanolic extract of leaves of leaves of Passiflora incarnate included in Passifloraceae family were screened for phytochemical constituents and antimicrobial activities towards nine bacteria eight fungi. Among all extracts, ethanolic leaf extract of P. incarnate showed the highest antimicrobial activity when compared with other extracts. Phytochemical analysis of all the extracts revealed that the antimicrobial activity of the plant material is due to the presence of phenolic compounds.

Anti inflammatory activity of passiflora incarnate L in rats.

The Ethonolic extract of Passiflora incarnate L was tested to study the anti- inflammatory activity using the technique of carrageenan induced paw edema in albino rats. The extract showed significant anti-inflammatory activity comparable to the reference Standard Ibruofen.

Sedative and hypnotic activity of Passiflora Incarnata L.

Ethanolic extract of leaves of Passiflora incarnata.L (Passifloraceae) (200 mg/kg, p.o) exhibited significant Hypnotic activity (3.5 mg/kg i.p) being comparable to that of lorazepam (0.5 mg/kg) respectively.

Cloning and expression of S-Adenosyl Methionine Synthetase gene in recombinant E. coli strain for large scale production of SAMe

S-Adenosyl Methionine (SAMe) Synthetase is an enzyme which catalyses the synthesis of S-Adenosyl Methionine using methionine and ATP. It is also known as AdoMet which is well known methyl donor, which modifies DNA, RNA, histones and other proteins, dictating replicational, transcriptional and translational fidelity, mismatch repair, chromatin modeling, epigenetic modifications and imprinting. The objective of the present work is to clone the SAMe Synthetase gene in recombinant E. coli strain in order to express, characterize and purify it for further synthesis of SAMe in a large scale fermentation. Expression was induced by 1 mM IPTG and expressed protein was characterized by SDS-PAGE. The recombinant E. coli cells were used for the production of SAMe through batch and fed batch fermentation operations. The produced SAMe was purified through paper chromatography in order to use it in our future studies.

Tear ascorbic acid levels and the total antioxidant status in contact lens wearers: A pilot study.

Aims: The tear ascorbate owing to its high concentration, functions as an effective antioxidant against the oxidative damage of cornea. Contact lens wearers (CLW) are prone to oxidative stress due to the lens-induced hypoxic conditions. A pilot study was done to compare the tear ascorbic acid level and the total antioxidant capacity give as in normal and CLW. Materials and Methods: In this study 21 CLW (Mean age 23 ± 3 years; M-2, F-19), who were daily wear users, with duration of wear not more than four years, along with age-matched 28 controls (Mean age 28 ± 3; M-15, F-13) were recruited in the study for collection of reflex tears using Schirmer's strip. Ascorbic acid in tears was determined using high-performance liquid chromatography (HPLC), total antioxidant capacity (TAC) and total protein assay by spectrophotometric analysis. Results: CLW showed no significant change in the tear ascorbic acid levels (0.4 ± 0.26 mM) compared to the control subjects (0.61 ± 0.59 mM). The amount of ascorbic acid in tears did not correlate with the TAC or the total protein of the tears. The mean TAC in CLW was 0.69 ± 0.16 mM, with a total protein of 1.35 ± 0.46 mg/ml while in controls it was 0.7 ± 0.18 mM and 1.21 ± 0.47 mg/ml respectively. Conclusions: Soft contact lens wear did not show any significant change in tear ascorbic acid, TAC and total protein levels compared to controls.

Bone marrow involvement at presentation in pediatric non-haematological small round cell tumours.

Pediatric small round cell tumors (SRCT) are a group of neoplasms occurring in children, which have in common a cytomorphology of groups of small round cells with scanty cytoplasm. The common SRCT encountered are neuroblastoma, retinoblastoma, Ewing's sarcoma/peripheral neuroectodermal tumor (PNET), rhabdomyosarcoma and lymphoma which show varying degrees of bone marrow involvement and bone marrow evaluation forms a part of the initial staging procedure. This study was undertaken to evaluate marrow involvement at presentation in pediatric non hematological SRCT. 7833 bone marrow aspirates done over a period of three years in different malignancies were analysed and of these 180 aspirates were performed in patients of pediatric non hematological SRCT at presentation. These cases were evaluated in detail for incidence of marrow involvement. Thirty two (17.7%) cases showed marrow involvement and these cases have been analysed with respect to the primary tumor. The SRCT showing involvement of bone marrow included neuroblastoma (48.8%), retinoblastoma (11.1%), Ewing's sarcoma/PNET (8.6%) and rhabdomyosarcoma (3.2%).These findings are discussed in the light of available world literature.