Predictors of Poor Outcome in Patients with COVID-19 associated Respiratory Failure: A Retrospective Observational Study

Background: Coronavirus disease 2019 (COVID-19) is majorly known to cause mild to moderate disease, but a small fraction of patients may develop respiratory failure due to diffuse lung injury, requiring management in the intensive care unit (ICU). This study attempts to identify factors that can predict unfavorable outcomes in moderate to severe COVID-19 patients. Methods: Hospital records of 120 COVID-19 patients admitted to the ICU were retrospectively analyzed and data pertaining to demographic, clinical, and laboratory parameters were obtained. These data were then compared with outcome parameters like survival, duration of hospital stay, and various adverse events. Results: Out of 120 patients, 70% were male, with a mean age of 54.44 years [standard deviation (SD) ± 14.24 years]. Presenting symptoms included breathlessness (100%), cough (94.17%), fever (82.5%), and sore throat (10.83%). Diabetes, hypertension, and chronic obstructive pulmonary disease (COPD) were the common comorbidities associated. Increased serum D-dimer, ferritin, interleukin-6 (IL-6) levels, and unvaccinated status were associated with higher mortality. Overall, 25.83% of patients survived, 24.41% of patients developed septic shock, and 10.6% of patients were discharged on oxygen. World Health Organization (WHO) clinical progression scale score ? 6 had 57 and 82% sensitivity and 83 and 77% specificity on days 7 and 14 after admission, respectively, for predicting mortality. A baseline National Early Warning Score 2 (NEWS 2) ? 9 had 48% sensitivity and 88% specificity for predicting mortality. Conclusion: Advanced age and associated comorbidities are linked to adverse outcomes in moderate to severe COVID-19. Persistently high D-dimer levels, despite standard treatment, may also contribute to increased mortality. WHO clinical progression scale and NEWS 2 have high specificity for predicting mortality.

Immunohistochemical appraisal of epithelial mesenchymal transition type III in gall bladder cancer

Background: Epithelial-mesenchymal transition (EMT) is the heart of invasion. EMT associated with cancer progression and metastasis is known as type III EMT. Beta-catenin, E-cadherin, and MMP9 markers of EMT are routinely employed for diagnostic purposes. Aims: We employed these markers to study EMT by immunohistochemistry (IHC) in gall bladder cancer (GBC) with respect to depth of tumor invasion, clinical outcome, and disease-free survival. Settings and Design: This was a prospective case-control study. Material and Methods: Seventy gall bladders were included (50 GBC and 20 CC). After detailed histology, immunoexpression was studied in terms of percentage and strength of expression. Statistics Analysis Used: Expression was compared between CC and GBC by Student t test and analysis of variance. Kaplan–Meier was used for survival analysis, and the extent of agreement (“Kappa”) was calculated. Results and Conclusions: The age of incidence of GBC was 49.40 (+11.6) years with female predominance (F:M = 4:1). In 88% (44/50) of GBC, the fundus was involved. Moderately differentiated adenocarcinoma was most frequent [54%; 27/50]. Significant downregulation of E-cadherin (P = 0.022) and beta-catenin (P < 0.001) and upregulation in MMP9 (P < 0.001) were seen in GBC with respect to CC with significant association among them. MMP9 expression was significantly associated with higher tumor stage but with chemotherapeutic response. Our results display that epithelial-mesenchymal transition type III plays a role in GBC invasion. MMP9 overexpression and loss of membranous beta-catenin may be considered a marker for poor clinical outcomes and advanced disease.

Kocuria kristinae - An unusual opportunistic pathogen in head and neck malignancy: Case series from central India's regional cancer care centre

Introduction: Kocuria kristinae is a commensal organism, sometimes considered as a lab contaminant, but its repeated isolation from clinical samples in immunocompromised patients should raise red flags. Materials and Methods: We confirmed the infection with re-isolation of the organism from the same site before starting treatment. For the identification of Kocuria kristinae we used IDGP cards on VITEK 2 compact system. Antibiotic susceptibility test was done manually following CLSI guidelines 2018 for Coagulase-negative staphylococci. Results: A total of 510 major head neck oncosurgeries were performed during the period of two years. Out of which 120 patients had skin and soft tissue infections. Out of these infected patients, 90 were culture positive and of these Kocuria kristinae were isolated in 12 patients. Resistance to penicillin and oxacillin is seen in all isolates. Conclusion: Kocuria kristinae should not be ignored as a commensal flora or lab contaminant in immunocompromised hosts. Its Increase in resistance pattern is a matter of concern. It is an ignored opportunistic pathogen whose detailed sensitivity test should be developed to treat patients timely and effectively.

Intestinal metastasis from carcinoma cervix: An (un) common occurrence in a common cancer. A series of five cases from a single institution

Carcinoma cervix usually spreads directly to contiguous structures, such as the vagina, urinary bladder, ureter, and rectum. Intestinal metastasis from cervical cancer is very uncommon and accounts for less than 4% of cases and to date, 24 cases have been reported in Medical literature. These may be asymptomatic or present with features of intestinal obstruction, bowel wall perforation, and mimic acute abdomen. Intestinal metastasis is a late occurrence and carries a poor prognosis, hence a high index of suspicion with prompt diagnosis and management is essential. We report a series of five patients with squamous cell carcinoma (SCC) of the cervix with intestinal metastasis diagnosed in our hospital.

An exploratory study using the OMI scale to assess the opinion toward mental illness among young adults

Background: Public perception of mental illness is critical for successful treatment seeking behaviour as well as for early diagnosis and surveillance of disease. Two hundred eleven young patients were interviewed at Department of psychiatry, Sir Sunderlal Hospital, Varanasi with the help of consecutive sampling method. Objective: To assess the opinion towards mental illness among young adults by using the opinion on mental illness scale (OMI). Methods: Data was collected using the opinion about mental illness scale (OMI) which consists of 51 questions out of which, 15 questions directly related to the cause, care, and management of mental illness were randomly selected and analyzed. Analysis was done showing Percentage and chisquare tests to see the significance of scores between the respondents. Results: The finding shows that more than 70% of respondents believe that mental illness is a consequence of bad behavior, lack of willpower, or negative beliefs and gap in the treatment seeking behavior and understanding the cause of disease was found. Conclusions: Opinions on Mental health have received increasing attention as a useful strategy to promote early identification of mental illness, reduce stigma and enhance help-seeking behaviors. As part of the National Mental Health Programme, there is a need to raise awareness in order to enhance understanding of mental illness in facilitating early diagnosis and treatment of disease.

Comparative Evaluation Of The Efficacy Of Pocket Debridement With Diode Laser And Periodontal Open Flap Debridement

Background:In the last decade, the use of lasers (lightamplification by stimulated emission of radiation) has occupied part of the dialogue within periodontology and oral surgery because of several proposed advantages. Laser uses produces less postoperative swelling, reduces inflammation and is also relatively painless. In the arena of periodontology, laser use as an adjunct to non-surgical therapy was demonstrated to enhance periodontal health. The present study was done to highlight these facts and to add over the previous researches. Material And Methods:Atotal of 50 patients with generalized chronic moderate to severe periodontitis with pocket probing depth (PD) ?5 mm were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while routine OFD was done in the control quadrant. Clinical parameters including PD, plaque index, and gingival index were recorded at baseline, 3 months and 6 months following treatment. Result:All clinical parameters significantly improved after therapy without any statistically significant difference between the two groups for any of the parameters. The results of the present study indicate that diode laser used as an adjunct to in OFD did not significantly e nhance the treatment outcome. Conclusion: Sincethere was a significant clinical improvement in case of gingival inflammation, it can be safely and effectively used to achieve the same and can aid in tissue healing.

Effect Of TXA On Intraoperative Blood Loss In Mandibular Fracture Surgeries A Prospective, Double Blinded Randomized Clinical Trial

Background:The aim of this doubleblind prospective study was to determine whether administering 1 gm Tranexamic Acid (TXA) would the intraoperative blood loss during the Open Reduction and Internal Fixation (ORIF) surgery of mandibular fracture via the intraoral approach operated under local anesthesia (LA).Material And Methods:20 patients who underwent ORIF surgery ofmandibular fractures under LA were randomly allocated to two groups. Study group was administered 1 gm TXA diluted in a 500 ml Ringer Lactate solution one hour before thesurgery. Control group did not receive any such IV infusion. All the surgeries were performed by the same surgeon.Result:Mean difference in Intraoperative blood loss between the two groups was found out to be statistically insignificant. Effect of age, gender or site of fracture was also found out to be insignificant. Conclusion:There is not much effect of TXA on intraoperative blood loss during ORIF of a mandibular fracture via the intraoral approach. Even without tranexamic, if area is infiltrated with adrenaline, proper flap reflection and tissue handling technique is used, and vital structures avoided; blood loss will be minimal.

Retinopathy of prematurity care in peripheral districts in Odisha, India: Pilot for a sustainable model

The outcome of a retinopathy of prematurity (ROP) program initiated in five districts of Odisha over 3 years with partnerships between the government and non-government organizations was prospectively analyzed. The mentoring partners trained the district ophthalmologists and neonatal care providers; the program was handed over when the trainees were considered competent enough to diagnose and treat babies with ROP. During the project period (July 2016–June 2019), 3058 babies were examined; ROP was detected in 33.81% (n = 1034) and 5.06% (n = 159) babies required treatment. At the end of the project, ROP screening was possible in all five districts, and treatment was possible in three districts. ROP care nodal centers were built in one government medical college. To strengthen the initial gain, we recommend creating an Odisha Retinopathy of Prematurity (OD-ROP) steering committee with private–public partnerships to support the program and monitor its progress in other districts of Odisha.

The Newly Developed Highly Sensitive Method For The Determination Of Capecitabine By Using Uv-Spectroscopy

Capecitabine is a fluoropyrimidine carbamate, designed as 'pro-drug' to the cytotoxic agent 5-fluorouracil (5-FU) meant to be administered orally. Capecitabine is used as first line monotherapy for metastatic colorectal cancer. In the present study simple, rapid, accurate UV spectrophotometric methods were developed and validated for the estimation of capecitabine in bulk and its formulations as per ICH guidelines. Three solvent systems viz., 0.1N NaOH, 0.1N HCl and Methanol: Water (1:3) were tried. The results suggest that the developed methods shows linearity over the concentration range of 2-24μg/ml with a correlation coefficient of 0.9999. All the developed methods were statistically validated for accuracy, precision, linearity, robustness, and ruggedness as per ICH guidelines. The % RSD values for validated methods were found to be less than 1.5 and methods will find application in routine analysis of drug formulations containing capecitabine.

A study of clinical profile of Alopecia areata in a tertiary care hospital in Western Odisha

Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.

Sacral Hiatus Study in Dry Human Sacra

Background and objectives: The sacral hiatus is the site for caudal epidural anaesthesia during perineal surgery and also for a painless delivery. It is also used for three dimensional colour visualization of lumbosacral epidural space in orthopaedic practice for diagnosis and treatment. Work on the morphometrical study of the sacral hiatus is limited, especially in south indian population. So this study is carried to examine, measure and record the morphometry of sacral hiatus in order to study the anatomical variations which will be useful for caudal epidural anaesthesia. Material and Methods: The study was conducted in the Department of Anatomy, Prathima Institute of Medical Science, Naganur, Andhra Pradesh. 93 dry sacra with complete sacral hiatus were taken for the study. The shape of the sacral hiatus was noted by naked eye. Level of the apex and base of the sacral hiatus was noted with respect to the sacral vertebra. The length of sacral hiatus was measured from apex to the midpoint of base, the anteroposterior depth of sacral hiatus at the apex was measured with the help of vernier calipers. The transverse width of sacral hiatus at the base was measured between the inner aspects of inferior limit of the sacral cornu with the help of divider and then adjusted, and calculated with vernier caliper. Results: In 47 (50.53 %) sacra the shape was Inverted-U and in 25 (26.9 %) sacra Inverted-V. The irregular shaped of sacral hiatus was observed in 11 (11.8 %) cases. A “Dumbbell” shaped sacral hiatus was observed in 5 (5.4%) cases with a nodular bony growth projecting medially from both margins. The dorsal wall of sacral canal was entirely absence in 4 (4.3%) cases. Absence of sacral hiatus, a rare phenomenon, was observed in 1 (1%) specimens only. Conclusion: In the present study, elongated hiatus and narrowing of the sacral canal at apex of sacral hiatus was found in a significant percentage, which should be kept in mind while giving the caudal anaesthesia in Andhra Pradesh region.

hair an unusual foreign body in airways presenting with haemoptysis in an adult patient.

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Diagnostic yield of computed tomography-guided percutaneous fine needle aspiration cytology of radiological suspected cases of lung mass lesions.

Computed tomography (CT)-guided fine needle aspiration cytology (FNAC) provides high diagnostic yield in lung mass lesions, with acceptable rate of complications. In a retrospective review of data of 32 patients, the cytological diagnostic yield was found to be 90.7% of which 93% were malignant and remaining 7% were tubercular. Procedure-related complications were observed in three cases (9%); minimal haemoptysis in two and pneumothorax in one. The study confirms that CT-guided FNAC of lung mass lesions is a very useful procedure with minimal complications.

Assessment of water quality for Damodar River in Bokaro District, Jharkhand, India.

Water samples were collected from eight different sites for two successive years in order to analyze the various Physico-chemical parameters of river water. The assessment of water quality has been made by calculating water quality Index (WQI) for physico-chemical parameters of different sites. The values of water quality index of river water at all eight sites are found to be above standard value which is a clear indication of severely polluted water.

Gingival overgrowth and drug association: A review.

Drugs used locally or systemically induce several alterations in micro and macroscopic tissues. However, nearly 20 drugs have been reported so far in the literature associated with gingival enlargement. Many systemic diseases have limited therapeutic options and such drugs or their metabolites have an adverse influence on different systems/organs, and one of these is that they initiate or accelerate the overgrowth of gingival tissue. The increase in size may be to the extent that teeth may be partially or completely covered, and the resultant 'gummy smile' may result in aesthetic concern for the patient.In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. It is apparent that there is a subpopulation of fibroblasts which is sensitive to these drugs. The exuberant growth of gingival tissue is of great aesthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention, and/or substitution of the drug with analogs. A relatively healthy oral environment provided by the dentist will reduce local microflora that will help in eliminating the major focus of infection. Physicians, general practitioners, and dentists need to make a coordinated and concise treatment plan that will be beneficial for the patients. This article will facilitate full information to physicians to involve dentists in the multidisciplinary treatment plan.

Beneficial effects of Lagenaria siceraria (Mol.) Standley fruit epicarp in animal models.

Lagenaria siceraria (Mol.) Standley fruit (bottle gourd), a commonly used vegetable in India is described as cardiotonic and as a general tonic in Ayurveda. Keeping in view the presence of free radical scavenging activity in L. siceraria and involvement of free radicals in the development of various disorders, present studies were designed to evaluate the ethanolic extract of L. siceraria fruit against the disorders where free radicals play a major role in pathogenesis. The extract was found effective as hepatoprotective, antioxidant, antihyperglycemic, immunomodulatory, antihyperlipidemic and cardiotonic agent. The results showed that the radical scavenging capacity of L. siceraria fruit may be responsible for various biological activities studied.