Structure-function relationships among selected human coronaviruses-Supplementary data

Identifying the key proteins among different types of human disease-causing coronaviruses is essential for the molecular mechanism and thereby designing potential drug molecules. Eight selected proteins of seven types of disease-causing coronaviruses, viz.SARS-CoV-2 (severe acute respiratory syndrome coronavirus2), SARS-CoV (severe acute respiratory syndrome coronavirus), MERS-CoV (middle east respiratory syndrome coronavirus), Human coronavirus OC43, Human coronavirus HKU1, Human coronavirus 229E and Human coronavirus NL63, were chosen for the comparison. Further, an attempt has been made to explore the most important host-pathogen interactions with a special focus on spike (RBD) protein region as this region deemed to be functionally most important. Epitope region was also identified which helps in the design of epitope-based vaccines. The structural comparison carried out among the seven types of human coronaviruses has revealed the molecular level details on the similarity among this series. This study has facilitated the identification of the important residues in the studied proteins which control the key functions such as viral replication and transmission. Thus, exploring the protein space in the family of coronaviruses, provide valuable insights into the molecular basis associated with the role of proteins and viral infections, which is expected to trigger the identification of the drug targets for coronaviruses infections, in a rational way.

Structure-function relationships among selected human coronaviruses-Supplementary data

Identifying the key proteins among different types of human disease-causing coronaviruses is essential for the molecular mechanism and thereby designing potential drug molecules. Eight selected proteins of seven types of disease-causing coronaviruses, viz.SARS-CoV-2 (severe acute respiratory syndrome coronavirus2), SARS-CoV (severe acute respiratory syndrome coronavirus), MERS-CoV (middle east respiratory syndrome coronavirus), Human coronavirus OC43, Human coronavirus HKU1, Human coronavirus 229E and Human coronavirus NL63, were chosen for the comparison. Further, an attempt has been made to explore the most important host-pathogen interactions with a special focus on spike (RBD) protein region as this region deemed to be functionally most important. Epitope region was also identified which helps in the design of epitope-based vaccines. The structural comparison carried out among the seven types of human coronaviruses has revealed the molecular level details on the similarity among this series. This study has facilitated the identification of the important residues in the studied proteins which control the key functions such as viral replication and transmission. Thus, exploring the protein space in the family of coronaviruses, provide valuable insights into the molecular basis associated with the role of proteins and viral infections, which is expected to trigger the identification of the drug targets for coronaviruses infections, in a rational way.

Structure-function relationships among selected human coronaviruses

Identifying the key proteins among different types of human disease-causing coronaviruses is essential for the molecular mechanism and thereby designing potential drug molecules. Eight selected proteins of seven types of disease-causing coronaviruses, viz.SARS-CoV-2 (severe acute respiratory syndrome coronavirus2), SARS-CoV (severe acute respiratory syndrome coronavirus), MERS-CoV (middle east respiratory syndrome coronavirus), Human coronavirus OC43, Human coronavirus HKU1, Human coronavirus 229E and Human coronavirus NL63, were chosen for the comparison. Further, an attempt has been made to explore the most important host-pathogen interactions with a special focus on spike (RBD) protein region as this region deemed to be functionally most important. Epitope region was also identified which helps in the design of epitope-based vaccines. The structural comparison carried out among the seven types of human coronaviruses has revealed the molecular level details on the similarity among this series. This study has facilitated the identification of the important residues in the studied proteins which control the key functions such as viral replication and transmission. Thus, exploring the protein space in the family of coronaviruses, provide valuable insights into the molecular basis associated with the role of proteins and viral infections, which is expected to trigger the identification of the drug targets for coronaviruses infections, in a rational way.

Knowledge, Attitudes and Practices towards Oral Health among School Teachers in Chengalpattu Taluk, Kanchipuram District Tamilnadu.

Dental professionals are often invited by different school authorities to deliver lectures on oral health and to provide preventive services. The usual target population behind most endeavors comprises the, young school children, and it is with the aim of improving their oral health knowledge, that such programmes are held. However, the fact remains that any child's knowledge and practices are by and large a reflection of what he sees or is taught in his immediate surroundings. We wanted to assess the level of knowledge, attitudes and practices towards oral health among schoolteachers in Chengalpattu taluk, Kanchipuram district.METHODSUsing simple random sampling technique, a questionnaire study was carried out among 50 government schoolteachers and 50 private schoolteachers in Chengalpattu Taluk. The questionnaire used was a closed ended, self-administered questionnaire consisting of 30 questions pertaining to Knowledge, Attitudes and Practices towards oral healthRESULTSAbout 37.9% of government teachers and 36% of private teachers had knowledge regarding dental caries, 48% of government teachers and 34.9% of private teachers had knowledge regarding gum diseases and 26% of government teachers and 22.7% of private teachers had knowledge regarding malocclusion. Moreover 41% of government teachers and 32.1% of private teachers had knowledge regarding oral cancer. 83.9% schoolteachers were getting information regarding oral health through dentists or doctors. When enquired regarding practices, 63% of schoolteachers brushed their teeth twice daily.CONCLUSIONSKnowledge was highest among the government schoolteachers compared to private schoolteachers among Chengalpattu taluk in Kanchipuram district.

Impact of Liaison Officers in a Tertiary Care Hospital (Modern Government Maternity Hospital Petlaburz Hyderbad) on Patient Care – A Project

Introduction: There is an increased concern about theservices delivered by the hospitals and more importantlythe quality of services offered. This project explored therole of liaison officer in a government teaching hospital toimprove communication and administrative function betweenhealthcare provider and patient families.Material and methods: Three liaison officers with master’sdegree in social welfare are identified. They were allocateda well-furnished room for being approachable to the patientsand their attenders round the clock. Their duties were toclarify, counsel and direct patients & their family membersabout any query regarding admission process, treatment orany socio-psychological help on one to one basis. Numberof patients/attenders approaching liaison officer, their queriesand what was done was entered in a register.Results: This project included statistics from April 2018 toMarch2019. 64% of high risk cases who are admitted in ICUapproached liaison officer for various reasons most importantwas for socio-psychological issues and 9% of attenders wereworried about patient condition in the Labor room or ward.4% wanted information about family planning methods, 6%had doubts regarding their diet to be taken after delivery.Immunization schedule was explained to 5% of the cases. 4%of the anemia patients were helped with their treatment. WrongEntries in the birth register and KCR Kits were rectified.Conclusion: With the availability of liaison officer roundthe clock in the hospital has helped both patient healthcareproviders and patients to run the hospital smoothly. There wasnot a single case of violence or argument between patient andhealth care providers. Health care providers had more time toconcentrate on management of the patient. Presence of liaisonofficer in the hospital premises round the clock has created apositive and peaceful environment in the tertiary care teachinggovernment hospital.

A comparative study on self medication practices in ACSR Government medical college in Nellore, India

Background: Self medication is rampant in medical undergraduates. There is a need to evaluate the extent and factors that govern self medication. This study was conducted in 7th semester and 5th semester undergraduates to compare the knowledge, attitude and practice regarding self medication.Methods: It is a questionnaire based study in a total of 294 medical students comprising 147 students each belonging to 7th and 5th semesters to assess determinants and practice methods of self medication in the past one year.Results: 100% of 7th semester and 90% of 5th semester students self medicated. Majority followed modern medicine. Awareness of OTC drugs, essential drugs and generic drugs was not optimum. Students self medicated based on old prescriptions and text books for perceived mild illnesses like common cold, fever and headache. Non steroidal anti-inflammatory drugs and antihistamines were most commonly used. Not all students checked package insert prior to use.Conclusions: Self medication practice is more pronounced in 7th semester than in 5th semester students. 7th semester students used diverse drugs compared to 5th semester students who used limited groups of drugs.

A comparative analysis of generic prescribing patterns among teaching and non-teaching clinicians in Nellore, India

Background: The aim was to study the prescribing patterns of clinicians working in two different settings i.e. Teaching clinicians (clinicians working in teaching hospital) and Non-teaching clinicians (clinicians involved only in private practice).Methods: A comparative cross sectional study was carried out for a period of 6 months in two settings. The study is confined to teaching clinicians comprising of qualified medical practitioners in ACSR Government Medical College (ACSR GMC) and Non-teaching clinicians of qualified medical practitioners in private health sector (PMPs). 450 prescriptions were collected from clinicians belonging to various departments of ACSR GMC and 450 prescriptions from private practitioners of Nellore city. Data was coded and entered in MS Excel. Data was analyzed on EPI INFO version 3.5.4.Results: In this study it was found that teaching clinicians prescribed 146 (12.85%) drugs by generic name, whereas non-teaching clinicians prescribed 112 (8.75%) drugs by generic name.Conclusions: The findings of the present study indicate that the drugs prescribed by the generic names were remarkably less in both teaching and non teaching clinicians. This indicates a need for improving the generic prescribing patterns in both the settings.

Incidence of fungal etiology in patients with nasal polyps

Background: Sildenafil causes vasodilatation by relaxing the smooth muscles of blood vessels. This enhances endometrial development, the health of which is indispensable for implantation and embryonic and fetal development. Aim: To assess the role of Sildenafil when used in ovulation induction cycles with Clomiphene Citrate (CC) with reference to Endometrial Thickness (ET), follicular development, Pregnancy rates and Side Effects. Materials and methods: In this prospective comparative study on 80 infertile women, we randomly divided them into two groups. In group A with 40 patients, ovulation induction with CC was given and in group B with 40 patients oral Sildenafil Citrate 25mg – BD, was added from Day 8 up to hCG trigger, in the CC induced cycle. A transvaginal ultrasound was done on Day 13 to assess follicular growth and ET. A urine β-hCG on Day 30 was done to detect pregnancy. Patients were followed up for 8 weeks to monitor miscarriages, ectopics and multi foetal gestation. Results: Mean ET at the time of hCG trigger was 9.64 in the Sildenafil group compared to 8.47 in group A without Sildenafil (p value 0.01). 65% of the patients in group B conceived with 3 cycles of ovulation induction compared to 42.5% who conceived in group A (p value 0.04). The mean of total number of follicles greater than 18 mm at hCG trigger was 1.62 and 1.91 in group A and B respectively (p – 0.09). Side Effects were significantly higher in group B with sildenafil compared to group A with CC alone (p – 0.006). L. Pranathi Reddy, Y. Madhavi, Mohammed Ismail Khan. Role of Sildenafil in ovulation induction – A comparative study of outcomes with Sildenafil in ovulation induction cycles with Clomiphene Citrate. IAIM, 2016; 3(12): 26-32. Page 27 Conclusions: As our study shows that use of Sildenafil improves ET and rates of conception, we recommend the routine use of Sildenafil in ovulation induction protocols.

Multidrug-resistant Bacteroides fragilis Isolated from a Case of Pyopneumothorax.

Aim: The aim of this case report is to present an unusual case of multidrug- resistant Bacteroides fragilis from a patient with pyopneumothorax who had a blunt injury to the thorax and got admitted in a tertiary care hospital, South India. Presentation of Case: The patient developed pyopneumothorax after a blunt injury and on admission was treated empirically with piperacillin-tazobactam and metronidazole. Following antibiotic sensitivity testing the B. fragilis strain isolated showed multidrug resistance including metronidazole. Imipenem was initiated replacing empiric therapy with a successful clinical outcome. Discussion: Bacteroides species are obligate anaerobic bacteria that are usually found in the gastrointestinal tract of the human body. Bacteroides species are the most commonly isolated anaerobic organisms from intra-abdominal lesions and rarely from intrathoracic disease conditions like pyopneumothorax. Pyopneumothorax caused by Bacteroides species is associated with high treatment failure and mortality rates in antibiotic-resistant cases. Though metronidazole is the mainstay of treating anaerobic infections, attention has to be given to the possibility of multidrug resistance when treating critical diseases. Conclusion: This case report summarizes the multidrug- resistance in Bacteroides fragilis strain isolated from a case of pyopneumothorax. The situation calls attention to the possibility of multidrug-resistance being underestimated when given as empirical therapy and institution of appropriate and timely antibiotic policy measures to prevent mortality.

Diabetic ketoacidosis with Ebstein's anomaly in an adult

Ebstein's anomaly is a rare form of congenital malformation of the heart, characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialisation of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet. It may not be detected until late in adolescence or adulthood. The clinical manifestations of Ebstein's anomaly vary greatly. We are reporting a case of 35-year male who presented with generalized fatigue, palpitation and effort intolerance. Laboratory investigations confirmed the diagnosis of diabetes ketosis. Transthoracic echocardiography showed severe Ebstein's anomaly with severe tricuspid regurgitation, no residual atrial septal defect, but with severe right ventricular dysfunction. Though only few studies showed the high prevalence of abnormal glucose metabolism in young adult patients with complex congenital heart disease, but Epstein's anomaly with diabetes ketosis was nowhere mentioned

Formulation, in vitro Characterization and Stability Studies of Fast Dispersing Tablets of Diclofenac Sodium.

The present study was aimed to formulate, develop and evaluate the fast dissolving tablets of diclofenac sodium, used for the treatment of arthritis, inflammation, pain. Fast dissolving tablets of diclofenac sodium were prepared by direct compression method using crospovidone and sodium starch glycolate as superdisintegrants in concentrations of 5.3%, 6.6% and 8% w/w and in combination. In this work microcrystalline cellulose and mannitol are investigated as diluents. Prepared powder mixtures were evaluated for drug excipient compatibility with FTIR spectroscopy and DSC analysis. Prepared formulations are evaluated for In vitro dissolution, disintegration dispersion and wetting time. Formulation FCS6 prepared with combination of crospovidone and sodium starch glycolate at weight ratio of 6.6 and 2.3% showed better results compare with control. Post compression parameters like hardness (3.4 kg/cm2) and friability (0.31%) are at good acceptable levels in accordance with official compendia. FCS6 showed improved dissolution (99.8 %) and dispersion (75 seconds) profiles compared to control. The FTIR and DSC showed no interaction between the drug and excipients. The optimized formula FCS6 showed good drug release characteristics with acceptable mouth feel and fast dissolving properties.

Pattern of cervical lesions, with emphasis on precancer and cancer in a tertiary care hospital of Southern India.

Background: Carcinoma cervix is the most common form of cancer in India. Screening is cost-effective but compliance is an issue. Most women present to hospitals at first visit. We studied the pattern of women with carcinoma cervix who presented to the gynecology outpatient department of a large hospital in southern India. Methods: Women attending the gynecology outpatient department of King George hospital were evaluated for the presence of cervical lesions. A complete history was obtained. Biopsies from the cervix were obtained from the aceto-white areas, fixed in 10% buffered neutral formalin. Results: 860 cervical biopsy specimens were received. By routine hematoxylin eosin stains, 180 had precancerous lesions and cancerous lesions with more than two risk factors; in the study period, a total of 253 cervical neoplasms were recorded: 103 were in the pre-cancerous stage (CINU1: 74; 71.84%, CIN II 20/103; 19.41%, CIN III 9/103; 8.73%). Of the 150 cancerous lesions, maximum were SCC non-keratinising (130; 92%). A subset (viz 45/180; 25%) were tested for HPV DNA using Polymerase Cycle Reaction (PCR). The commonest presenting symptom was leucorrhea (40%). Most women reported age of first intercourse below 30 years. On visual examination of cervix, most (25; 55.55%) had exophytic growth and erosion (14; 31.11%). More than 80% (n: 24) presented in stage II and III cancer (n:27). Conclusion: In this hospital based study from a large institution from Southern India, out of 860 cervical biopsy specimens studied, 180 (32.14%) had precancerous lesions and cancerous lesions with more than two risk factors.

Deeply infiltrating endometriosis in an young woman - A case report.

Endometriosis is one of the most important causes of chronic pelvic pain in both adolescent and adult woman. Deeply infiltrated endometriosis is tough case with poor response to medical treatment and associated with complication of visceral damage after surgical treatment. Retroperitoneal fibrosis subsequent to deeply infiltrating endometriosis lesion may encase the ureter and can present as obstructive uropathy. In such cases it is necessary and the only option to free the ureter or else the function of the affected kidney compromises. Such expensive surgeries require skill and competence with a team work in the urological surgeries. Such rare case of gross pelvic endometriosis with left obstructive uropathy was successfully managed and treated by our team.

Endometrial stromal tumor in a young woman – A rare presentation.

Endometrial stromal tumors (EST) arise from stromal component of endometrium and are rare and common in peri or postmenopausal age group. EST are partially estrogen dependent tumors and their histopathology resemble the stromal cells of normal proliferative endometrium. They present in varied forms pathologically ranging from most begin to most mligrant variants. Diagnosis essentially is by histopathology and prognosis is based on the mitotic activity of the tumor. We have presented here a case of EST presenting in a young nulliparous woman.

study of cephalic index and facial index in Visakhapatnam, Andhra Pradesh, India.

Background: The description of the human body has been a major concern since ancient times. The use of medical terminology enhances reliability of comparison made between studies from different areas thereby contributing higher level of scientific evidence. Cephalic index is an important parameter in forensic medicine, anthropology and genetics to know the sex and racial differences between individuals. Facial index is useful index for forensic scientists, plastic surgeons and anatomist. The parameters are useful for plastic surgeons during treatment of congenital and traumatic deformities, identification of individuals in medicolegal cases by forensic scientists and identifying craniofacial deformities of genetic syndromes by geneticist. Methods: 170 males and 110 female adults from Visakhapatnam, Andhra Pradesh, India region are included in this study. Anthropometric points for cephalic index were measured by using spreading calipers. Facial index measurements were taken by measuring tape. All measurements were taken in subjects sitting in relaxed condition and subjects head is in anatomical position. Cranial index and facial index were calculated as per the formula. Results: Maximum number of males with mean cephalic index values of 80.21 were observed as mesocephalic and female with mean value of 79.25 observed as brachycephalic. Regarding facial index males were leptoprosopic and females were mesoprosopic. Conclusion: Cephalic index and facial index were terms used by anthropologists, anatomists, plastic surgeons and forensic scientists to identify individual’s race and sex for treatment of craniofacial deformities.

ACE DD genotype associated with the female Chronic Kidney Disease patients of Tamilnadu population

The Renin-Angiotensin System [RAS] is an important regulator for blood pressure and kidney disease. The level of vaso active peptide Angiotensin-II is mainly determined by the RAS enzyme angiotensin converting enzyme-1 [ACE-1]. To investigate the association of ACE I/D polymorphism and Chronic Kidney Disease [CKD] in south India. In the present study, we have collected CKD patients [n = 147] and control subjects [n = 211] from Tamilnadu. Genotyping was carried out by polymerase chain reaction [PCR] on the basis of allele specific primers. The DD genotype is associated with the female population [OR-CI = 2.40 [1.05-5.51], p = 0.04] as compared to the male population [OR-CI = 0.75 [0.37-1.51], p = 0.42]. Further, we found the over representation of [I] - allele [homozygous II and heterozygous ID] in unaffected males [OR [CI] - 0.58 [0.32-1.04], p = 0.07] which suggests its protective role in male population. The DD genotype of ACE is associated with CKD in south India

Evaluation of a rapid dipstick test for identifying cholera cases during the outbreak.

Background & objectives: Intermittent cholera outbreaks are major problem in many of the states of India. It is essential to identify cholera at the earliest for timely mobilization of public health responses and to abort the outbreaks. The present study was a part of a diarrhoeal outbreak investigation in Secunderabad, India, during May 2009 where the usefulness of Crystal VC rapid dipstick kit was assessed for detecting the aetiologic agent of the outbreak. Methods: Stool specimens were collected from 15 hospitalized patients with acute watery diarrhoea and analyzed for detection of cholera vibrios using Crystal VC rapid dipstick kit and the usefulness of the kit was determined by comparative analysis of the same set of specimens using both microbiological and real-time PCR (RT-PCR) based assays. Results: Detection of Vibrio cholerae O1 from 10 of 15 specimens was recorded using dipstick assay. Microbiological methods detected V. cholerae O1 positivity among 11 specimens. However, RT-PCR based assay showed all 15 specimens positive for the presence of V. cholerae O1. In addition, the same assay showed that the pathogen load in the dipstick as well as RT-PCR positive specimens ranged from 106 colony forming units (cfu)/ml or more. Interpretation & conclusions: Crystal VC kit had the potential to identify cholera cases in 10 min in field conditions without having good laboratory support. Therefore, dipstick kit may be considered as cholera detecting tool in diarrhoeal outbreak investigations. Specimens from clinically typical cholera cases, if negative by dipstick, should be reanalyzed by culture based methods.

Ameloblastic fibro-odontoma of the anterior mandible in a 22-month-old boy.

We report an ameloblastic fibro-odontoma (AFO) presenting in the anterior mandible as a "bump on his gums" in a 22-month-old boy. An occlusal radiograph revealed a well-circumscribed radiolucency with scattered radiopaque foci. The tumor was enucleated under general anesthesia. The histologic findings were characteristic of an AFO, a mixed odontogenic tumor most common in the posterior jaws, primarily affecting individuals with an average age of 10 years. The clinical presentation, microscopic findings, differential diagnoses, and treatment are discussed.

Unresolving pericarditis: Suspect filariasis in the tropics.

Filariasis, a mosquito-borne disease, is wide spread in India. While laboratory diagnosis has been conventionally done by demonstrating microfilaria in peripheral blood smears, occasionally they are reported in various body fluids including pericardial fluid. We report the case of 33-year-old man with severe dyspnoea and chest pain, referred from a private nursing home with a provisional diagnosis of unresolving pericarditis. Pericardial tap revealed massive pericardial effusion with actively motile microfilariae. No microfilariae (Mf) were seen in the peripheral blood. Haemorrhagic effusion resolved completely with DEC. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of pericardial effusion.

Role of quantitative endotracheal aspirate and cultures as a surveillance and diagnostic tool for ventilator associated pneumonia: A pilot study.

Background: Accurate diagnosis and appropriate treatment of ventilator associated pneumonia (VAP) is crucial for good outcomes. Endotracheal suctioning is performed in ventilated patients as part of routine care and for tracheal toileting. Aim: We evaluated if quantitative endotracheal aspirate (ETA) was a suitable alternative to bronchoalveolar lavage (BAL) for suspected VAP. In addition we assessed if surveillance ETA guided antibiotic selection for subsequent VAP. Setting and Design: Prospective study in the surgical intensive care unit (ICU) of a tertiary hospital in India. Materials and Methods: Two hundred consecutive patients with mean (standard deviation) APACHE II score of 12.3+/-5 and requiring mechanical ventilation beyond 48 hours underwent surveillance ETA cultures. A second ETA and BAL were performed if the patient developed features of VAP. The threshold for microbiological diagnosis of VAP was taken as 10 5 colony forming units/ml (cfu/ml) for ETA and 10 4 cfu/ml for BAL. Statistical Analysis: The sensitivity and specificity of surveillance and concurrent ETA aspirate cultures were compared with BAL cultures. RESULTS: VAP was suspected clinically and corroborated radiologically in 27/177 patients (15.3%). Although microbiological support for VAP was obtained by ETA in 19 patients, bronchoscopy was possible only in 13 patients, 8 of whom had isolates at significant threshold. Of the 16 organisms isolated from BAL, 11 were of significant threshold with 9/11 (82%) BAL isolates having a similar antibiogram to a concurrent ETA. Only one BAL isolate (9%), at significant threshold, was not isolated on a concurrent ETA. On the other hand just 6/11 BAL isolates (55%) had an identical antibiogram to surveillance ETA. BAL had 3 additional isolates (27%) at significant threshold not isolated on surveillance ETA. Conclusions: Concurrent quantitative ETA could substitute BAL cultures for VAP. Surveillance ETA at 48 hours of ventilation does not appear to assist with antibiotic selection for a subsequent VAP.