Endogenous fungal endophthalmitis following COVID-19 infection with microbiological and molecular biological correlation – A report of two cases

This case report describes three eyes of two patients, who were diagnosed to have endogenous fungal endophthalmitis post coronavirus disease 2019 (COVID-19) infection. Both patients underwent vitrectomy with intravitreal anti-fungal injection. Intra-ocular samples confirmed the fungal etiology by conventional microbiological investigations and polymerase chain reaction in both cases. The patients were treated with multiple intravitreal and oral anti-fungal agents; however, vision could not be salvaged.

Retinal venous occlusion in a child following Corbevax COVID-19 vaccination

A 13-year-old boy developed painless diminution of vision in left eye 15 days after taking first dose of coronavirus disease 2019 (COVID-19) vaccine (Corbevax). Fundus and fluorescein angiography revealed central retinal vein occlusion in the left eye. Blood investigations were noncontributory. He was administered three doses of pulse corticosteroids followed by a tapering dose of oral corticosteroids. Retinal vascular occlusion can occur following COVID-19 vaccination in children, and early and aggressive systemic anti-inflammatory therapy can be helpful.

Treatment of Class II division I malocclusion having severe crowding, proclination with noncomplaint fixed functional appliance therapy, and frictionless mechanics

Our Objective was to treat a patient having proclined, protruded teeth along with a Class II Skeletal malocclusion. 0.022 × 0.028 inch MBT Brackets were placed, and leveling alignment was commenced. Individual canine retraction was carried out in both arches, followed by retraction of the incisors in the upper arch with a Burrstone's T Loop. E2Z Forsus fatigue resistance appliance was given for the correction of Class II malocclusion. Proclination, protrusion, and crowding were corrected along with Class II Skeletal base. Individual canine retraction along with frictionless mechanics and noncompliant functional correction has sufficient potential to prevent anchor loss and correct a Class II skeletal base.

Open label case control prospective study to evaluate the impact of aceclofenac on antihypertensive action of amlodipine and ramipril in hypertensive patients with osteoarthritis

Objective: To study the impact of aceclofenac on antihypertensive action of amlodipine and ramiprilin hypertensive patients with osteoarthritis in an open label case control prospective study. Methods: This was an open label case control prospective study. Hypertensive patients on either amlodipine or Ramipril were included in control groups. A total of 120 patients were included in the study and divided into 4 groups: Group A- Hypertensivepatients on Ramipril; Group B – Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Ramipril; Group C– Hypertensive patients on Amlodipine and Group D- Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Amlodipine. Results: At the end of the first month (phase I), the ramipril subgroup in the control group had a mean systolic blood pressure of 136.73±3.80 which was an 8.19% decrease from the baseline and it was found significant (p<0.05). The systolic blood pressure measurements at the end of the second month (phase II) in the control groups revealed further fall in mean systolic blood pressure. The cases of osteoarthritis on aceclofenacand ramiprilshowedan increase in BP. The mean Systolic BP was 159.2 ± 5.816.An increase of 9.74%from the base line and 16.09% was noted at the end of phase-I (P<0.5). Patients on aceclofenac and amlodipine in contrast showed a fall in BP from base line in phase 0 and their mean systolic blood pressure at positive in of second month of phase-II was 142.07± 2.43 about 1.88% fall baseline and 2.94% increase in BP compared to Phase-I. Almost similar observations were recorded for diastolic blood pressure. Conclusion: The interaction of NSAIDs on the antihypertensive action of the ACE inhibitors is significantly greater than their blunting action on the calcium channel blockers.

Estimated glomerular filtration rate and proteinuria – Predictors of left ventricular mass in chronic kidney disease

Background: Chronic kidney disease is a potential threat of the 21st century, afflicting more than 50 million people all over the world. Cardiovascular diseases particularly increased left ventricular mass accounts for 40 – 50% deaths of kidney disease patients. Objective of the study: To find the factors which correlate with left ventricular hypertrophy in kidney disease patients. Materials and methods: A descriptive study was done on 75 chronic renal failure patients for a period of 6 months. Variables like proteinuria, creatinine clearance, anemia, blood pressure, serum albumin and other blood parameters were compared with left ventricular mass. Results: Of all the variables, the decline in estimated glomerular filtration rate and the increased amount of protein excretion affected the left ventricular mass index (p < 0.01). The mean GFR was 25 ml/min and the mean proteinuria > 3.5 g in females with left ventricular hypertrophy (>110 g/m2 ). With the cut-off for left ventricular hypertrophy in male > 134 g/m2 , the mean GFR was 20 ml/min and the mean proteinuria more than 7 g/L. Conclusion: Measures to decrease the amount of proteinuria and the rate of decline in glomerular filtration rate will prevent significant cardiovascular disease in chronic kidney disease patients.

Clinical profile and treatment outcome of acute kidney injury (AKI) in a tertiary care hospital

Background: Acute Kidney Injury (AKI) is one of the major cause of in-hospital mortality rates globally. The current study was conducted to study the etiological profile, severity and management of acute kidney injury.Methods: The study was a prospective observational study, conducted in the department general medicine, Dhanalakshmi Srinivasan Medical college and Hospital, Permabalur, Tamil Nadu. The study population included all the patients admitted to Intensive Care Unit (ICU) with acute Kidney injury (AKI) between January 2015 to December 2016. All the study participants were recruited to the study by convenient sampling. Descriptive analysis was carried out by frequency and proportion for categorical variables.Results: A total of 100 subjects were included. Participants were almost uniformly distributed in each of a decadal age group till above 60 years. Males (57%) were slightly higher than females (43%). Oliguria was present in 88% of the study population. The most common etiology was acute diarrhoeal disease (44%), followed by multiple infections in 12% and Sepsis in 10% of the subjects. As per RIFLE criteria 46% participants were at risk, 26.0% had injury, 28% had failure. All at risk people were treated conservatively, among injury category, 38.5% were treated by haemodialysis and 3.84% by peritoneal dialysis. In failure group, 60.71% and 3.57% were treated by haemodialysis and peritoneal dialysis respectively.Conclusions: Acute kidney Injury (AKI) can be a consequence of varied aetiologies and all the age groups and both the genders at risk of developing it. RIFLE criteria may be a useful tool in guiding the management

Family's presence associated with increased physical activity in patients with acute stroke: an observational study

ABSTRACT Background: Inherent differences in organization of stroke care and rehabilitation practices in various settings influence the activity levels of patients in the hospital. The majority of published studies have been carried out in developed countries such as the United States, United Kingdom, Australia, Switzerland and Belgium; however, data from developing countries are scarce. Objective: To measure the amount and nature of physical activity of patients admitted to medical wards of Indian hospitals and to assess the association between family presence and the patient and between the patient’s functional status and their physical activity level. Method: This is an observational behavioral mapping study. A trained physical therapist recorded the patients’ (N=47) physical activity level through direct observation in the ward using a predetermined observation scheme. Results: Participants were found inactive and alone for 19% (inter quartile range [IQR] 12-36%) and 15% (IQR 10-19%) of the time during the day, respectively. They spent 46% (IQR 31-55%) of the time in therapeutic activities and 31% (IQR 22-34%) of the time in non-therapeutic activities. The family was present with patients 50% of the time during the day. Family presence with the patient and the patient’s moderate dependence in daily activities are positively associated with their activity levels. Conclusion: Patients with stroke admitted to Indian hospitals spent less time being inactive and alone and more time with family participating in therapeutic activities. The presence of family members with the patients during hospital stay may be a significant resource for encouraging patients to be more active.

Bilateral juvenile xanthogranuloma of the buttocks - An unusual location: Case report.

Juvenile xanthogranuloma (JXG) predominantly occurs in infancy and childhood. Juvenile xanthogranulomas (JXGs) are asymptomatic; benign; self-healing; self-limiting red, yellow, or brownpapules and nodules composed of histiocytic cells. Most common site of occurrence is skin of the head and neck region and trunk but occurrence at rare sites such as nasal cavity, limbus of the eye, iris of the eye, anterior abdominal wall and tibia had been reported in literature. JXG is the most common form of non–Langerhans cell histiocytosis. Approximately 35% of cases of juvenile xanthogranuloma (JXG) occur at birth, with as many as 71% of cases occurring in the first year. The mean age at presentation is 22 months. Most JXGs resolve by age 5 years. Despite the term juvenile in the disease name, 10% of cases manifest in adulthood. Most of the lesions are solitary. Juvenile xanthogranuloma is a histiocytic inflammatory disorder capable of presenting as different histological patterns. The classic form consists of sheets of foamy histiocytes and numerous multinucleated Touton-type giant cells containing no to very few mitotic figures. We present a case of large juvenile xanthogranuloma (JXG) in a 7 year old child involving an unusual location and bilateral involvement of both the buttocks.

Molecular Modeling and Docking Studies of Cold Active Lipase from Pseudomonas fluorescens.

Molecular Modeling is essential tool in the drug design process describes the generation, manipulation or representation of 3D structures of the molecules and associated physico-chemical properties while docking predicts the preferred orientation of one molecule to a second when bound to each other to form a stable complex. A cold active lipase producing potential psychrophilic bacteria (GN) was isolated and identified by 16S rRNA molecular studies as Pseudomonas vancouverensis. Lipase gene from closely related species P. fluorescens was investigated for their functional role and in silico characterization using molecular modeling and docking studies. A 3D structure of lipase gene was generated with SWISS-MODEL and Discovery Studio 3.0. The stereochemistry of the constructed model of cold active lipase was subjected to energy minimization and the stereo-chemical quality of the predicted structure was assessed. The superimposition of the template (PDBID: 2Z8X) with predicted structure showed that weighted root mean square deviation of Cα trace between the template and the final refined model was 0.2 Å with a significant Zscore of 8.2 and sequence identity was 80.5%. Three ligands P-Nitrophenol, Acetate ion and Diethyl phosphonate were taken for docking calculation with generated structure. They were interacting on the functional motifs of predicted model. It has been observed that Leu26, Tyr29, Asn31, Asp33, Pro315 and Thr316 residues were involved in hydrogen bonding interactions with selected ligands. So these interacted residues can be used as prominent active binding sites and which was common to the predicted active site. Based on above investigations it has been found that P. vancouverensis lipase protein can play a similar role in lipid metabolic process and triglyceride lipase functional activity as reported for P. fluorescens lipase protein.

Progressive hemifacial atrophy with ciliary body atrophy and ocular hypotony.

Progressive hemifacial atrophy (PHA) is a disease of unknown etiology affecting one‑half of the face. Ocular involvement is uncommon. Atrophy of iris is rare, with only a few cases of partial atrophy being reported in the literature. We report a case of total atrophy of iris and ciliary body with associated ocular hypotony in a 16‑year‑old girl with PHA. We believe this is the Access this article online Quick Response Code: Website: www.ijo.in DOI: 10.4103/0301-4738.151474 PMID: *** first reported case of complete atrophy of iris and ciliary body in PHA. Ocular hypotony in PHA was thought to be due to intra‑ocular inflammation. However in our case it appears to be secondary to severe atrophy of the ciliary body.

Alpha thalassaemia in tribal communities of coastal Maharashtra, India.

Background & objectives: In a routine community health survey conducted in adult Adivasis of the costal Maharashtra, microcytosis and hyprochromia were observed in more than 80 per cent of both males and females having normal haemoglobin levels suggesting the possibility of α-thalassaemia in these communities. We conducted a study in Adivasi students in the same region to find out the magnitude of α-thalessaemia. methods: The participants (28 girls and 23 boys) were 14-17 yr old studying in a tribal school. Fasting venous blood samples (5 ml) were subjected to complete blood count (CBC), Hb-HPLC and DNA analysis using gap-PCR for deletion of – α3.7 and – α4.2, the two most common molecular lesions observed in α-thalassaemia in India. Results: Microcytic hypochromic anaemia was observed 50 and 35 per cent girls and boys, respectively. Iron supplementation improved Hb levels but did not correct microcytois and hypochromia. mMore than 80 per cent non-anaemic students of both sexes showed microcytois and hypochromia. DNA analysis confirmed that the haematological alterations were due to α-thalassaemia trait characterized by deletion of – α3.7. Majority (> 60%) of the affected students had two deletions (-α3.7/-α3.7) genotype α+ thalassaemia. Interpretation & conclusions: This is perhaps the first report on the occurrence of α-thalassaemia in tribal communities of coastal Maharashtra. Very high (78.4%) haplotype frequency of -α3.7 suggests that the condition is almost genetically fixed. These preliminary observations should stimulate well planned large scale epidemiological studies on α-thalassaemia in the region.

Ameliorative Effects of Alcohol on Human Diabetic Volunteers – A Prospective Study.

Aims: The purpose of this study is to assess and confirm the ameliorative effects of alcohol consumption on biochemical indices of blood i.e., blood glucose, HbA1c, NO2, NO3, lipid profiles, hs-CRP (high sensitive C–Reactive protein) and membrane lipid peroxidation of diabetics. Study Design: Pre-clinical and Biochemical experimental study. Place and Duration of Study: Department of Biochemistry, Acharya Nagarjuna University and Dept. of Biotechnology, K L University, Guntur, A.P and Dept. of Biochemistry, Katuri Medical College, Katuri Nagar, Guntur, A.P and Dept. of Biochemistry, Sri Krishna Devaraya University, Anantapur, A.P and Dept. of Basic Sciences, Madanapalle Institute of Technology and Science (MITS), Post Box No: 14, Angallu (V), Madanapalle, A. P., India, during 2008– 2013. Methodology: The study is conducted on 4 groups (n= 1200) of people of different ages ranging from 35 to 50 years at community health centers in Prakasam, Warangal, Srikakulam districts of Andhra Pradesh, India. The first group consists of type-II diabetic patients who have been consuming alcohol (arithmetic mean ranging from 14.16 to 31.61ml/day) moderately for the past 3 to 10 years. The second group consists of nondiabetic, moderately alcohol consuming healthy individuals. The third group consists of patients who are type-II diabetics (who do not drink) taking medical treatment for minimum period of 1 year. The fourth group consists of non-drinking, non-diabetic healthy individuals. Relationships of alcohol intake with lipid profile, hs-CRP and HBA1c are compared among the three groups. Results: In lipid profile analysis of moderately drinking diabetic group, the HDL levels are found to be higher while the remaining factors such as total cholesterol, LDL, VLDL (P<0.05), triglycerides (P<0.01) and membrane lipid peroxidation are significantly lower. Fasting serum glucose levels are lowered, while serum nitrites and nitrates are found to be significantly higher. These differences are not found in abstainers group and Diabetic group who do not drink. Conclusion: Moderate consumption of alcohol in diabetic individuals is found to have an inverse association with the risky factors like LDL cholesterol, Triglycerides, etc. that are the etiological factors for some of the sequelae of diabetes mellitus i.e., coronary heart diseases, Retinopathy, etc. and has a direct association with the positive factors such as HDL and nitric oxide production. Experimental results are very significant and indicate that moderate consumption of alcohol has ameliorative effects on diabetics.

UV Spectrophotometric Method for the Simultaneous Determination of Desloratidine and Pseudoephedrine HCl in Combined Dosage Form.

Aims: UV Spectrophotometric Method for the Simultaneous Determination of Desloratidine and Pseudoephedrine HCl in combined Dosage form. Study Design: A simple, rapid and specific UV spectroscopic method with good sensitivity was developed and validated for the simultaneous determination of Desloratidine and Pseudoephedrine HCl in bulk and pharmaceutical dosage form. Place and Duration of Study: Department of pharmaceutical Analysis & Quality Assurance, School of Pharmacy, Anurag Group of Institutions, Venkatapur, R.R Dist, Andhra Pradesh, India during February 2013 and April 2013. Methodology: Vierodt’s (Simultaneous equation) method was performed for Estimation of Desloratidine and Pseudoephedrine HCl in Pharmaceutical dosage form. Results: In Ethanol the max of Desloratidine and Pseudoephedrine HCl was fixed as 240 and 258 nm respectively using a Shimadzu UV-Visible spectrophotometer. In this proposed method both drugs obeyed linearity within the concentration range of 5-30 g/ml and 80-800 g/ml for Desloratidine and Pseudoephedrine HCl respectively. The low RSD values indicate good precision and high recovery values indicate accuracy of the proposed method. The proposed method has been applied to the determination of drugs in commercial formulations. Assay results were in good agreement with label claim. The method was validated as per ICH guidliness. Conclusion: The developed method was simple, accurate, precise, specific, sensitive and reproducible which can be efficiently and easily applied to pharmaceutical dosage forms.

Intensive method of assessment and classification of the bone marrow iron status: A study of 80 patients.

Background: The increasing prevalence of multiple co-morbidities among anemic patients with chronic diseases have made the use of serum ferritin (which is also an acute phase reactant) and transferrin saturation more challenging in diagnosing iron deficiency. Microscopic examination of bone marrow aspirate is the gold standard" for assessing marrow iron store. However, conventional Gale's method assesses iron in marrow fragments alone which provides little valuable information about functional iron deficiency seen in many chronic diseases. Aim: To perform an intensive bone marrow iron grading by assessing iron in fragments, in macrophages around fragments and in erythroblasts and to correlate the marrow iron store results with serum ferritin. Materials and Methods: A descriptive study of Perl's Prussian blue stained bone marrow aspirate smears of 80 adult patients with moderate to severe anemia. Bone marrow iron was assessed by both the Gale's method and the intensive method and correlated with serum ferritin. Results: The intensive grading system revealed normal iron stores in 37.5% cases, depleted iron stores in 16.25% patients while 23.75% and 22.5% patients had functional iron deficiency and combined deficiency, respectively. Mean log ferritin concentration was significantly lower in patients with depleted iron stores (0.91 μg/l) in comparison to those with normal iron stores (2.13 μg/l; P = 0.001), functional iron deficiency (2.65 μg/l; P = 0.000), or combined deficiency (2.04 μg/l; P = 0.002). Conclusion: Intense marrow iron examination provides a useful iron status classification which is of particular importance in cases of chronic diseases and inflammation.

Glomerulogenesis: Can it predict the gestational age: A study of 176 fetuses.

Background: Accurate assessment of gestational age of fetuses is essential from both clinical and medico-legal point of view. Crown-rump length, crown-heel length, foot length, and the weight of the fetus are the commonly used parameters for fetal age assessment. However, this estimate often lacks accuracy and sometimes is necessary to combine other data. An analysis of the embryological development of nephrons in the kidney can assist in this determination. Objective : To correlate the gestational age with the histological study of sequential development of nephrons in fetal kidney. Materials and Methods: This study included 176 fetuses delivered between June 2009 and June 2011 and aged from 12 to 40 weeks. The number of glomerular generations counted in hematoxylin and eosin-stained microscopic sections of the kidneys were correlated with the reported period of gestation based on obstetrical methods. Regression analysis was used to determine the statistical significance of the correlation. Results: A high degree of statistically significant correlation was observed between the period of gestation and the number of glomerular generations (P value < 0.0001). Conclusion: The histological assessment of the number of glomerular generations in kidney can be used as a reliable method of estimating fetal age.

Absolute lymphocyte count: A cost-effective method of monitoring HIV-infected individuals.

Aim: Depletion of CD4 cell count is a hallmark of disease progression in AIDS. CD4 cell count is essential for physicians to decide about the timing of initiation of antiretroviral therapy (ART) and for prophylaxis of opportunistic infections. WHO has recommended that, absolute lymphocyte count (ALC) of ≤1200/μL can substitute CD4 cell count of ≤200/μL in resource-constrained countries throughout the world. Materials and Methods: This study was undertaken to know whether there is a correlation between CD4 cell count and ALC in HIV-infected individuals. A single sample of blood was withdrawn for ALC and CD4 cell count. The samples received from December 1, 2004 to December 31, 2005 were analyzed. Results: A total of 196 samples were collected from 185 patients. After exclusion, a total of 182 samples were analyzed. Results revealed that male:female ratio was 126:56 and their age ranged from 13 to 67 years. The median ALC was 1747 cells/μL, whereas the CD4 cell count ranged from 5 to 2848. The correlation coefficient between ALC and CD4 cell count was significant (0.714). There were 49 patients with an ALC of ≤1200/μL of whom 77.6% patients had CD4 cell count ≤ 200/μL (true positive) and 22.4% had CD4 cell count > 200/μL (false positive). There were 133 patients with an ALC of >1200/μL of whom 84.2% had CD4 cell count > 200/μL (true negative) and 15.8% had CD4 cell count ≤ 200/μL (false negative). Taking ALC of ≤1200/μL as a predictor of CD4 cell count ≤ 200/μL ,the sensitivity of the test was 64.4% and specificity was 91.1%. The positive predictive value was 77.6%, negative predictive value was 84.2%, and accuracy was 82.4%. Conclusion: We found that an ALC of ≤ 1520/μL has higher sensitivity (78%) for a CD4 cell count of ≤ 200/μL. The ALC was found to be significantly cost-effective in our setup but chances of missing out patients requiring ART was 1 in 5 using the WHO guidelines.

Micronutrient supplementation and child survival in India.

India contributes to a large number and proportion of child deaths, both due to higher under five mortality rate and large child population cohort in the country. The micronutrient malnutrition is an ignored area as it is not a direct cause of child mortality but a contributory factor in many deaths. The repeated surveys and studies have noted that iron deficiency anemia, vitamin A deficiency, iodine deficiency are highly prevalent amongst the children in the country and the preventive interventions are reaching only small proportion of 10-50% of the targeted populations. The contribution of these micronutrients (Iron, Vitamin A, Iodine and Zinc) towards child survival depends upon number of factors that are responsible for child mortality, and these situations vary from region to region, time to time and depend upon number of other socio demographic characteristics of the population. This paper discusses that although there may be debate on the role of some micronutrients in reducing childhood mortality, there is no doubt that these micronutrients are needed in small amount for overall child development. These micronutrients, both directly and indirectly, contribute to the child survival and should reach to each and every child in the country and the strategy is proven cost effective.

Thermal stability of α-amylase in aqueous cosolvent systems.

The activity and thermal stability of α-amylase were studied in the presence of different concentrations of trehalose, sorbitol, sucrose and glycerol. The optimum temperature of the enzyme was found to be 50 ± 2°C. Further increase in temperature resulted in irreversible thermal inactivation of the enzyme. In the presence of cosolvents, the rate of thermal inactivation was found to be signifi cantly reduced. The apparent thermal denaturation temperature (T m ) app and activation energy (E a ) of α-amylase were found to be signifi cantly increased in the presence of cosolvents in a concentration-dependent manner. In the presence of 40% trehalose, sorbitol, sucrose and glycerol, increments in the (T m ) app were 20°C, 14°C, 13°C and 9°C, respectively. The E a of thermal denaturation of α-amylase in the presence of 20% (w/v) trehalose, sorbitol, sucrose and glycerol was found to be 126, 95, 90 and 43 kcal/mol compared with a control value of 40 kcal/mol. Intrinsic and 8-anilinonaphathalene-1-sulphonic acid (ANS) fl uorescence studies indicated that thermal denaturation of the enzyme was accompanied by exposure of the hydrophobic cluster on the protein surface. Preferential interaction parameters indicated extensive hydration of the enzyme in the presence of cosolvents.