Impact of Covid-19 Disease on Health Care Services of Leprosy Patients Attending a Tertiary Care Centre, Telangana

Covid - 19 disease was declared as a pandemic by World Health Organization in March 2020. Subsequently, a nationwide lock down for variable intensity and periods was announced in India to contain the disease. Leprosy patients faced difficulties during this pandemic owing to their long-term health care requirements and lack of access to leprosy services during covid time. This resulted in deprivation of multi - drug therapy (MDT), steroids and other drugs to leprosy patients, which is detrimental to the patients as well as to the society. This study was conducted to analyze the impact of covid-19 pandemic induced lock downs and movement restrictions on leprosy patients attending a tertiary care centre. This provides data to assess their impact on leprosy healthcare services. The study observed a marked decrease in the number of leprosy patients attending the leprosy out patient care and also a reduction in the number of new cases registered during the year 2020. Quarterly analysis showed maximum reduction of cases occurring during the lockdown period and peak covid-19 infection periods. As there is a likelihood of this pandemic continuing and similar other disruptions may occur again, there is a need to assure that MDT and health care services reach leprosy patients by various other means. Some of the modifications can be a) supplying a 3 to 6 month course at a time as A-MDT, b) home delivery of drugs by health workers c) promotion of telemedicine services for leprosy patients d) optimal utilization of social media to educate and counsel leprosy patients on both covid-19 and leprosy. It is also important that leprosy clinics and drug delivery services should be continued both in Covid and Non-covid hospitals at par with Revised National TB Control Programe (RNTPC) renamed as National Tuberculosis Elimination Programme (NTEP) and Anti-Retroviral Treatment (ART) services.

Effect of newly synthesized 1,2,4-triazino5,6-bindole-3-thione derivatives on olfactory bulbectomy induced depression in rats

<p><b>OBJECTIVE</b>To study the derivatives of 1,2,4-triazino[5,6-b]indole-3-thione for antidepressant activity in olfactory bulbectomized (OBX) rats. Out of various derivatives tested for acute tail suspension test, the two derivatives showing prominent action were selected for bilateral olfactory bulbectomy model of chronic depression in rats.</p><p><b>METHODS</b>The sub acute effects of 14-day oral pretreatment of two derivatives labeled as 3a (70 mg/kg) and 3r (70 mg/kg), imipramine (20 mg/kg), fluoxetine (30 mg/kg) and moclobemide (15 mg/kg) were evaluated on bilateral bulbectomy induced rise in body weight, hyperphagia, hyperactivity, and on sexual dysfunction. The serum sodium concentration, body temperature, and heart rate were also recorded.</p><p><b>RESULTS</b>The derivatives 3a and 3r showed reversal of drop in body weight, reversed OBX induced hyperactivity, normalized body temperature, heart rate, and serum sodium concentration. In elevated maze test, moclobemide, 3a, 3r treatment significantly reduced time spent in open arm as compared to OBX rats. 3a and 3r also improved sexual behavior parameters.</p><p><b>CONCLUSIONS</b>The present study shows promising antidepressant action and provides a proof of concept for the chronic treatment of 3a, 3r to treat depression.</p>

Chronic postoperative wound infection caused by Myocobacterium fortuitum complex.

Mycobacterium fortuitum in a rapidly growing atypical mycobacteia, sometimes associated with nosocomial infections in human. These infections are often difficult to identify; and treat even after indentification. We report here a case of chronic post operative wound infection due to M. fortuitum.

Chryseobacterium meningosepticum--an uncommon pathogen causing adult bacterial meningitis.

Chryseobacterium meningosepticum is an uncommon pathogen causing meningitis. We report a case of adult meningitis caused by chryseobacterium meningosepticum in an 88 year old woman. Immunosuppression due to old age, diabetes mellitus and history of hypertension of 20 years duration were the concomitant factors. chryseobacterium meningosepticum was isolated both from the cerebrospinal fluid and blood cultures. This organism was sensitive to quinolones, rifampicin and resistant to many antibiotics commonly used for empiric therapy for meningitis.

Prosthetic valve endocarditis caused by Scedosporium apiospermum.

Scedosporium apiospermum, the asexual state of Pseudallescheria boydii, is increasingly recognized as an opportunistic pathogen. We report a case of prosthetic valve endocarditis caused by this organism that developed in a patient following cardiac surgery.

Homograft valve bank: our experience in valve banking.

BACKGROUND: A cardiac homograft valve bank with cryopreservation facility was established at the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai in July 1995. METHODS AND RESULTS: During the last 7 1/2 years of its existence, from July 1995 to March 2003, 588 hearts were processed. The valves harvested were 390 aortic, 400 pulmonary and 39 others including mitral valve, aortic conduits, pericardium etc.; 176 (29.9%) hearts were discarded for various reasons which included failure to sterilize, HBV, HIV, HCV, treponema pallidum hemagglutination test positivity, atheromatous/fatty streaks, incompetent valves, and dissection mistakes. The valves were sterilized using an antibiotic cocktail of vancomycin, amikacin, streptomycin, cefotaxime and amphotericin B in Hank's balanced salt solution. Of the 585 valves issued for clinical use, 247 were aortic, 323 pulmonary and 15 others (mitral valve, pericardium, conduits). Gram negative bacilli were the predominant contaminants from the hearts during the first half (July 1995 to February 1999) and gram positive organisms were the predominant contaminants during the later half (March 1999 to March 2003) of the study period. A variety of fungal contaminants like candida, aspergillus, penicillium and other fungi were also isolated from the homograft hearts at procurement. The valves were used most commonly for Rastelli procedure/right ventricular-pulmonary artery conduit (48.71%) followed by Ross procedure (23.41%). The other procedures were aortic valve replacement (6.15%), truncus repair (5.81%), unifocalization with conduit repair (6.49%), aortoplasty (0.512%), left ventricular-pulmonary artery conduit (0.512%), pulmonary valve replacement (0.512%), aneurysm repair (0.34%), Norwood repair (0.34%), mitral valve replacement (0.17%) and other procedures (7%). CONCLUSIONS: We have established a viable and functioning cardiac homograft valve bank to suit Indian conditions and till date, have issued 585 homograft valves for clinical use.

Nocardia asteroides mediastinitis complicating coronary artery bypass surgery.

A 63 years diabetic male was admitted with mediatinitis and sternal dehiscence. Nocardia asteroides sensu stricto Type VI was isolated from the mediastinal tissue and fluid during debridement. Prompt surgical intervention and treatment with ofloxacin both intravenously and later orally led to the cure.

Prevalence, species distribution and antifungal sensitivity of vaginal yeasts in infertile women.

A total of 326 high vaginal swabs from infertile women attending the Institute of Reproductive Medicine were cultured from June 1999 to May 2000. Candida species was isolated from 42(12.88%) patients. Candida albicans (40.47%) followed by Candida glabrata (38.09%) were the most common isolates. Other species included Candida tropicalis (14.28%) and Candida krusei (7.14%). All isolates were tested for sensitivity by disc diffusion method on Yeast Nitrogen Agar base towards four antifungals. Seven (16.7%) candida strains showed resistance to Fluconazole and 19(45.23%) of the strains showed resistance to Itraconazole, and 4(9.5%) strains showed resistance to Nystatin. There was no resistance to Amphotericin B. Of the 7 strains resistant to Fluconazole, 3 were Candida krusei, 3 were Candida glabrata and 1 was Candida tropicalis.

Rapid identification of fluconazole resistance using Chrom agar Candida.

All though extremely rare 10 years ago, antifungal drug resistance is becoming a major problem in certain populations, especially in those infected with HIV. This study was undertaken to study the resistance of Candida species isolated in our hospital to Fluconazole using Chrom agar Candida. The Candida strains which were routinely isolated from clinical specimens like blood, urine, sputum, pus, fluid and homograft isolates were included in the study. 142 Candida isolates were tested by using Chrom agar Candida incorporated with Fluconazole. 16 strains were found to be resistant to Fluconazole and 126 strains sensitive to Fluconazole. Nine were C. tropicalis, 3 C. krusei, 2 C. guillermondii, 1 Geotrichum candidum and one was an unidentified strain of Candida. The MIC of the 16 strains were done using RPMI 1640 medium by macro broth dilution method. MIC of 9 strains was 64 & > 64 ug/ml of 6 strains 32 ug/ml and 1 strain 16 ug/ml.

Sclerosing mediastinitis caused by Aspergillus terreus.

A case of Aspergillus terreus causing sclerosing mediastinitis which presented with symptoms of cardiorespiratory compromise and compressive myelopathy is described. The diagnosis was established by culturing and isolating the fungus in pure culture from the tissue and was also confirmed by demonstration of sepcific precipitating antibodies against Aspergillus terreus in patient's serum.

Vaginal carriage of group B Streptococcus in infertile women.

From May, 1999 to April, 2000, 256 high vaginal swabs were culture from asymptomatic infertile women attending the out-patient department of the Institute of Reproductive Medicine. 41 strains of Streptococcus agalactiae were isolated from 33 patients (12.89%). Five patients had repeated isolations even after adequate therapy.

Rapid identification of fluconazole resistance using Chromagar Candida.

Although extremely rare 10 years ago, antifungal drug resistance is becoming a major problem in certain populations, especially in those infected with HIV. This study was undertaken to study the resistance of Candida species isolated in our hospital to Fluconazole using Chrom agar Candida. The Candida strains which were routinely isolated from clinical specimens like blood, urine, sputum, pus, fluid and homograft isolates were included in the study. 142 Candida isolates were tested by using Chrom agar Candida incorporated with fluconazole. 16 strains were found to be resistant to Fluconazole and 126 strains sensitive to Fluconazole. Nine were C tropicalis, 3 C krusei, 2 C guillermondii, 1 Geotrichum candidum and one was an unidentified strain of Candida. The MIC of the 16 strains were done using RPMI 1640 medium by macro broth dilution method. MIC of 9 strains was 64 & > 64 micrograms/ml of 6 strains 32 micrograms/ml and 1 strain 16 micrograms/ml.

Nasal carriage of methicillin resistant Staphylococcus aureus in a cardiovascular tertiary care centre and its detection by Lipovitellin Salt Mannitol Agar.

Ecological niches of Staphylococcus aureus are the anterior nares. Carriage of Staphylococcus aureus in the nose appears to play a key role in the epidemiology and pathogenesis of infection. Numerous studier have shown that elimination of nasal carriage using Mupirocin also eliminated hand carriage and the spread of infections in hospitals. Lipovitellin-Salt-Mannitol Agar was used for screening, isolation and presumptive identification of Staphylococcus aureus from nasal carriers. From November; 97 to August'98, 724 nasal swabs were cultured and 18.23% of health care workers were found to be nasal carriers of Staphylococcus aureus. Of these 12.15% were carriers of MRSA. The carrier rate was highest in December' 97 (32.07%). All MRSA carriers were treated with local application of Mupirocin for three days. A study of the antibiogram of the clinical isolates during the corresponding period showed 100% susceptibility of MRSA to Vancomycin. Susceptibility of MRSA to Clindamycin, Netilmycin, Rifampicin & Ofloxacin was 86.6%, 69.5%, 66% & 64.7% respectively.

Cryopreservation of cardiac homografts.

A homograft valve bank for cryopreservation of cardiac homografts was established at the Institute of Cardiovascular Diseases in July 1995. From July 1995 to February 1999, 169 donor hearts were processed. All except four hearts were procured post mortem. Aortic valves (149) and pulmonary valves (139) were the common homografts dissected out for use. The valves were immersed in a cocktail of five broad spectrum antibiotics and antifungals for an average of 48 to 72 hours before cryopreservation. Fifty-three (35.57%) aortic and 42 (30.21%) pulmonary valves had to be discarded for various reasons like fungal contamination, failure to sterilise, HBsAg positivity etc.; 153 homografts have been released for use so far. Analysing the usual methods of procurement, sterilisation protocol, culture and cryopreservation used for cardiac homografts at this centre, this paper recommends observance of timeliness, use of appropriate media for preservation of heart parts, administration of specific drugs and safeguards necessary for cryopreservation procedure.