Effect of COVID 19 pandemic on time to care, use of ambulance, admission characteristics, demography, injury characteristics, management and outcome of Paediatric Orthopaedic trauma patients admitted to the trauma centre

Background: Lockdown imposed to limit the spread of COVID 19 may have had a significant effect on the time to care, demography, injury causation, injury characteristics, volume and nature of admission, management and outcome of paediatric orthopaedic trauma patients. Objective: To document the effect of lockdown on the time to care at KGMU, use of ambulance, volume and type of admissions, demography, injury causation, injury characteristics, management and outcome of paediatric orthopaedic trauma patients. Methods:. This record review compared age, sex, type of admission, mechanism of injury, injury characteristics, type of treatment, vehicle used for transport, and outcome among patients admitted in prelockdown, lockdown and post lockdown. Results: Lockdown was associated with decrease in the number of cases (p<0.01), increase in the time since injury to reception (p<0.040), a rise in the share of referred admission (p<0.040), time since reception at KGMU, time to definitive care (p<0.001), high energy falls (p<0.001), injuries at home (p<0.001), higher ISS (p<0.001), non operative treatment (p=0.038) and greater use of ambulance (p=0.003). Conclusion: Lockdown resulted in a significant change in the causation and management of injury, significant delays in timeliness of care, reduction in the volume of admissions, an increase in injury severity and share of referral admissions.

Analysis of bacterial diversity associated with polyketide synthase (PKS) gene in brackish metagenome of TsoKar Lake of Ladakh, India

Aim: To explore bacterial diversity associated to polyketide synthase (PKS) genes in the TsoKar brackish metagenome.Methodology: The metagenomic DNA of TsoKar water and sediment samples were isolated and amplified using pks specific degenerate primers. PCR amplified products were analysed using Ion Torrent PGM platform and revealed a total of 2,11,030 reads with 534 contigs and 55% of G+C content. The results of BLASTx was further analyzed for species diversity using MEGAN5 software. Results: Halomonas was found to be the dominant phyla followed by Cyanobium, Acinetobacter and Burkholderia, respectively, along with majority of uncultured microorganisms present in TsoKar metagenome. Since TsoKar is a brackish water lake, and brackish aquatic ecosystems are a major hub of diverse microbes was also revealed in this study. TsoKar metagenomic sequence with accession number SRR8381943 was deposited in SRA database. Interpretation: TsoKar Lake is considered as one of the most important biosphere reserves. The results of this study confirm that this unique niche harbors good bacterial diversity associated with polyketide synthase genes, which justifies the idea of bioprospecting such niches for the discovery of novel metabolites like antimicrobial compounds using next-generation sequencing approach

Thyrotoxic periodic paralysis: A retrospective, observational study from India

Background & objectives: Thyrotoxic periodic paralysis (TPP) is an endocrine emergency presenting with acute-onset flaccid paralysis in a patient having thyrotoxicosis accompanied by hypokalaemia. This study was conducted to evaluate the clinical profile of patients with TPP presenting to three centres in India. Methods: This retrospective, observational study was conducted at three tertiary care Armed Forces medical centres, located at Lucknow, Kolkata and Delhi. The history, clinical features, treatment details and outcomes were evaluated. Results: Of the 244 patients with thyrotoxicosis, 15 were diagnosed with TPP and included in the study. These 15 patients (14 male and 1 female) had 32 episodes of TPP which were analyzed. The mean age was 30.2�2 yr (range: 21-39), and overt thyrotoxicosis was seen in all patients except one who had subclinical hyperthyroidism. Graves' disease was the most common cause of thyrotoxicosis (13/15) and the remaining two patients had subacute thyroiditis and gestational thyrotoxicosis. Hypokalaemia (serum potassium <3.5 mmol/l) was seen in 12 patients, and the mean serum potassium was 3.2�9 mmol/l (range: 2.1-4.9). All patients had flaccid weakness, predominantly involving the lower limb with no bulbar, respiratory or cranial nerve involvement. The average duration of paralysis was 10.6�7 h (range: 3-28 h). Interpretation & conclusions: Our study demonstrated an early age of presentation and presence of clinical and biochemical thyrotoxicosis in majority of patients with TPP. Hypokalaemia may not always be evident in patients with TPP.

Evaluation of key survey components of bio-behavioral surveillance among HIV high-risk subpopulation in Western India

Background: High-quality data are of prime importance in any health survey because survey data are considered as a gold standard for nationally representative data. The quality of data collection largely depends on the design of the questionnaire, training, and skills of the interviewer. Objectives: In the present study, we tried to evaluate three key components, such as questionnaire design, human resource and training of the field staff for Integrated Biological and Behavioural Surveillance carried out among the HIV high-risk subpopulation. Methods: A mixed-methods approach was used. Qualitative and quantitative data collection was carried out in the year 2015 with cross-sectional survey design in western states of India. The in-depth interviews of 10 stakeholders, structured interviews of the survey respondents (n = 560), and field investigators (n = 71) were conducted. Data triangulation was used to find out the concurrence of the qualitative and quantitative data. Results: Comprehensive and standardized survey questionnaire, structured training agenda, and strategic preparation for recruiting human resources were the overall strengths of the survey. However, during the implementation of the survey, there were some difficulties reported in data collection process. Overall, the respondents and investigators felt that the questionnaire was long and exhaustive. Difficulties were faced while collecting data on sexual history. The field staffs were not adequately experienced to work with sensitive population. Conclusions: In order to have accurate, reliable data, especially on sexual behavior; emphasis should be given on simple questionnaire with the use of community-friendly language, skilled and experienced interviewers for data collection, and extensive field training.

Mental health, bullying, and violent injuries among adolescents – A cross-sectional study

Background: Adolescents (10–19 years) constitute about one-fifth (21.4%) of India’s population. It has been identified as one of the vulnerable periods of life when the various health problems may occur. The prevalence of mental health problems among adolescents in India varies from 8.7% to 31.2% as shown in different studies. Objectives: The objectives of this study were to estimate the prevalence of mental health issues, violence, bullying, and unintentional injuries among adolescents. Materials and Methods: The present study is an observational descriptive study. After obtaining ethical clearance from the institutional ethics committee, 100 students from rural and 100 from urban areas of both sexes were randomly selected. A questionnaire based on global school-based student health survey was prepared. Responses obtained from self-administered questionnaire were entered into Microsoft Excel. Data were analyzed in Microsoft Excel using simple proportions and Chi-square test to find statistical significance if any. Results: About 11% felt lonely most of times, 13.5% had difficulty in sleeping at most of nights, and 2.5% even considered of attempting suicide. Girls (15%) reported being bullied more as compared to boys who reported it to be 9%. Furthermore, reports were more for urban area (15%) than for rural one (9%). Conclusion: Adolescents are being bullied or get involved in a physical fight (17%). Mental health issues are also widely prevalent among them. About 28% felt lonely, 30.5% could not sleep at night, and 2.5% even considered attempting suicide.

Clinical outcome in cases of hypertensive intra-cerebral haemorrhage in relation to size of haemorrhage

Introduction: Stroke is amongst the leading causes of death exceeded only by heart disease and cancer. Those who survive are usually left with permanent disability. Cerebral infarction is responsible for about 80 percent of all strokes, primary intra-cerebral haemorrhage for 10 percent, subarachnoid haemorrhage for 5 percent and 5 percent cases are due to uncertain causes. Predictors of prognosis in primary intraparenchymal haemorrhage have been evaluated in numerous studies. Objective: To observed the effect of different sizes of hematoma and utilizing them, if feasible as a marker of prognostic significance. Material and methods: In this study we observed 60 patients from the time of admission till 30th day in various wards of Department of Medicine RIMS with hypertensive intra-cerebral haemorrhage, during the period of 2008-2009. A simple method of measuring the volume of haematoma (in cc) on the CT scan is by using the following formula: A*B*C A = longest diameter of the haematoma (in cm.), B = Diameter perpendicular to A (in cm.), C = Height (in cm) which is measured by No. of slices showing the haematoma x thickness of each slide. Result: Total 60 patient were taken into study out of which 33(55%) were alive and 27(45%) were dead in 30 days follow up. In our study, 38 were male and 22 were female out of 38 male 22(66.66%) were alive and 16 (59.2%) dead and in 22 female 11(33.33%) were alive and 11 (40.7%) were dead. Outcome with volume of ICH using the χ2 had shown significant correlation (p < 0.005) with GCS at the time stroke onset (P<0.01), IVH/VE (P<0.01), midline shift test (P<0.01), B.P. at the time of admission (P<0.01). Conclusion: In these study patients with hematoma volume exceeds 60 cm3, the mortality was 100%. Mean volume of hematoma in our study was 35.21 cm3.

A Rare Case of Salbutamol Induced Tetany Pooja Shukla1*, Mohd Tariq Salman1, R K Dixit2, Shiv Sagar Gupta3, V K Verma1, Ali Ahmad1

A 25-year-old female, housewife, Nonsmoker, with complains of Dysnoea and pain in chest was diagnosed with Bronchial asthma in the Out Patient Department of Pulmonary Medicine of our institute. As per the GINA guidelines she was prescribed nebulization with Salbutamol 5 mg for confirming the diagnosis of bronchial asthma. Within minutes of nebulization she started to have involuntary contraction involving all four limb and developed hand posture associated with tetany. The nebulization was stopped and symptoms were relieved after 15 minutes of the calcium administration. The causal relationship between the suspected drug and the adverse event was assessed to be probable and thus clinicians should always be aware of the possibility of tetany due to salbutamol

Fungal rhinosinusitis: A prospective study in a University hospital of Uttar Pradesh.

Background: To assess the purpose of fungal rhinosinusitis in a University hospital and to correlate histopathological findings with culture results for accurate clinical classification of the disease. Materials and Methods: One-hundred suspected patients were included in the study. Data was collected in a brief predetermined format. Samples like nasal lavages, sinus secretions, and tissue specimens were processed and examined by microbiology culture using recommended techniques. Slide culture was done to observe the microscopic morphology. Histopathological examination was done by H and E stain and PAS stain for classification. Results: Out of 100 cases of rhinosinusitis, 21 cases were culture-positive for fungal rhinosinusitis. On the basis of histopathological findings, 14 cases (66.67%) were found to be of non-invasive fungal rhinosinusitis. Aspergillus flavus was the most common fungal isolate. Conclusion: Mycological profile of rhinosinusitis in Lucknow was thus evaluated. Histopathological and microbiological findings reported 21 cases of fungal rhinosinusitis among 100 suspected cases of rhinosinusitis.

Vermicompost: Quality organic manure for zooplankton production in aquaculture.

Purpose of the present study was to evaluate the effect of vermicompost on water quality parameters of fish pond and zooplankton production. No significant effect on the physico-chemical properties of pond water were observed though the zooplankton population was better with significant difference in rotifers population (68.38%) comparing with cow dung treated pond. Application of vermicompost as an organic manure in fish pond is not only better but also safe than the raw cow dung. This is excellent manure for nursery and rearing pond as it has a potential to produce good rotifers population.

Bio-control potential of Cladosporium sp. (MCPL - 461), against a noxious weed Parthenium hysterophorus L.

The phenological survey of Parthenium hysterophorus L., in and around the campus of Banaras Hindu University (BHU) was done for about two years (2004-06). During Nov. 2004, a few Parthenium plants were found diseased, and symptoms were restricted to the flowers, buds, and inflorescences. The disease causes sterility and reduces seed viability, which was observed with seed germination test from infected and healthy plants. The fungal pathogen was isolated and identified as Cladosporium sp. (MCPL-461). The severity of pathogen to the reproductive organs led to serious damages of the Parthenium plants. Thus in vitro and in vivo experiments were conducted to determine the bio-control potential of Cladosporium sp. (MCPL 461) against Parthenium weed. A combinatorial effort of Cladosporium sp. (MCPL 461) bio-control potential was evaluated with different culture media, incubation periods and spores strength. Spore suspension of 105 to 1012 spores ml-1 were used to spray on healthy Parthenium plants, and it was found that severe infection symptoms were appeared at 1010 to 1012 spores ml-1 suspension. LD50 was found at 107spores ml-1. To enhance the myco-herbicide activity 3% sucrose was added to the spore suspension, which further resolute the bio-control efficacy of the isolates. Only 20-30 % seeds of infected plants could germinate. However the safety of non-targeted and wild plants was also tested with Lantana camera, Chromolaena odorata and found that suspension up to 1012 spores ml-1 were not sufficient for disease outbreak in them.

Molecular characterization of hepatitis A virus from a large outbreak from Kerala, India.

BACKGROUND & OBJECTIVES: Hepatitis A is highly prevalent in India and mainly presents as a sporadic disease. This study investigated an outbreak of viral hepatitis at Medical College Hospital area, Kottayam, Kerala state, India during January 2005. METHODS: Blood (133), faecal (1), sewage (4), and water samples (13) were collected. Sera were tested for IgG- and IgM-anti-HAV and IgM antibodies against hepatitis E (IgM-anti-HEV). Sewage, faeces and water samples were tested for HAV RNA in nested RT-PCR and HAV RNA positive samples were further processed for RNA quantitation using Real Time PCR. RESULTS: Of the 1180 total cases, 540 were reported from Medical college area. Two deaths were reported among doctors. Patients from the community gave a previous history of visit to medical college hospital area. The sewage treatment plant at the campus was non-functional since 1990 and the untreated sewage was constantly overflowing and getting mixed with a canal. At the time of the study, all the water sources were superchlorinated. HAV RNA was present in the faeces of hepatitis A patient (1.36 x 10(7) copies/ml), sewage tank (2.57 x 10(3) copies/ml and the canal (<100 copies/ml). None of the 13 water samples concentrated 10,000-fold and the soil sample showed presence of HAV RNA. Phylogenetic analysis based on 5'-non-coding and P2 regions showed HAV-genotype IIIA in all samples. INTERPRETATION & CONCLUSION: The aetiological agent of the present outbreak was found to be HAV. Epidemic hepatitis A (genotype-IIIA) is emerging in Indian adults, emphasizing the need for definite policy for control.

Anti-HCV seropositivity among multiple transfused patients with beta thalassaemia.

Hepatitis C virus is considered to be the main aetiological agent responsible for the occurrence of post-transfusion hepatitis. Patients with thalassaemia acquire hepatitis most often from viruses contracted through blood transfusions. The present study was undertaken to evaluate the prevalence of hepatitis C virus (HCV) in thalassaemic patients with multiple blood transfusions. The association of HCV seropositivity with number of blood transfusions and liver enzyme profile was also analysed. The study group consisted of fifty patients (40 males and 10 females) attending the thalassaemic unit of Lok Nayak Hospital, a tertiary care hospital at Delhi, within the age group of 1-25 years. Thirty patients (60%) were found to be seropositive for HCV antibodies while one patient (2%) was co-infected with HCV antibodies and hepatitis B surface antigen. Study of liver enzyme profile showed aspartate aminotransferase levels to be significantly higher, although the level of serum alanine aminotransferase, alkaline phosphatase, total protein, bilirubin and albumin were not significantly altered in these patients. It is inferred from this study that 60% of the thalassaemics were infected with HCV and this was directly related to the number of blood transfusions received by them. The regularised national blood policy followed by blood banks for providing safe blood along with better screening method of donated blood in blood banks would bring down the incidence of hepatitis C in such high risk group.

Incidence of anaerobes in throat infections and their sensitivity pattern in Ludhiana.

Of 175 throat swabs processed, anaerobes were isolated from 16 (9.14%) patients. Isolation of anaerobes from healthy controls was 2 out of 25 (8%). Peptostreptococci and Bacteroides species were the commonest isolates followed by Peptococci and Propioni-bacterium. All of these isolates were sensitive to Metronidazole. Clindamycin, Erythromycin and Tetracycline also showed good response.

Potentiation of analgesia and reversal of tolerance to morphine by calcium channel blockers.

Effect of four calcium channel blockers (CCBs) belonging to different chemical classes, alone and in combination with morphine was investigated on two models of pain sensitivity, i.e. formalin and tail flick tests in mice. All the studied CCBs, i.e. diltiazem, flunarizine, nimodipine and verapamil inhibited formalin-induced pain responses; however, with verapamil, though there was a trend towards a reduction of paw-licking response to formalin, it was not found to be statistically significant. In contrast, none of the CCBs affected the tail flick latency at any of the doses studied. Morphine, a mu-receptor agonist exerted a significant analgesic effect in formalin as well in tail flick tests. Pretreatment with all CCBs significantly enhanced the analgesic effect of morphine in both tests of nociception. Further, concomitant administration of one of the CCBs, diltiazem with morphine prevented the development of tolerance to the latter. However, combination of diltiazem with morphine, like morphine alone was found to be ineffective in morphine tolerant animals. Results, thus, show that CCBs produced an analgesic effect of their own in formalin-induced tonic pain and potentiated the analgesic activity of morphine. They also modulated opioid-induced tolerance.

A review on recent development of common cold therapeutic agents.

(1) The common cold is a frequently occurring illness caused by rhinoviruses. Inspite of its ubiquitous occurrence the disease has defied all efforts of finding a cure. The current approaches to the treatment of common cold can be divided into two important categories: the antiviral and antiinflammatory; both of these leave a lot to be desired. Most of the rhinovirus serotypes use a single cellular receptor, i.e. the intercellular Adhesion Molecule-1 (ICAM-1) for attachment to the cells. This has lead to the development of blockers of this receptor in an effort to find a cure for the common cold. (2) Recently tremacarmra, a synthetic ICAM-1 glycoprotein has been investigated in human volunteers as an antiadhesion molecule towards an approach to common cold therapy. Two dosage forms of the compound-phosphate buffered saline spray and carboxymethyl cellulose-mannitol powder spray were administered intra-nasally in two modes--pre-inoculation (7 h prior) and post-inoculation (24 h after) time periods of rhinovirus type 39 challenge to different groups of human volunteers. Both the treatment modes produced a significant decrease in the symptoms score of clinical illness and concentration of interleukin-8 in the nasal lavage. Saline spray was found to be devoid of any side effects, whereas powder spray produced some nasal irritation initially. The encouraging results of clinical trial with tremacamra show that a cure for common cold is not far off. However, it remains to be seen what would be the impact of such synthetic protein administration on the immune response of the body, should such compounds be used repeatedly. Further, since all colds are not due to rhinovirus it would be wise to restrict the use of tremacamra during autumn and spring when rhinoviruses are known to be the causative organisms of common cold.

Interaction of pentazocine with calcium channel blocking drugs during chemical and thermal pain in mice.

The present study was designed to investigate the antinociceptive interaction of a clinically used opioid, pentazocine which produces its analgesic effect mainly through kappa receptors, with some calcium channel blockers (CCBs, viz. Diltiazem, flunarizine, nimodipine and verapamil--each representing one chemical class) in formalin and tail flick tests in mice. All the CCBs, except verapamil, significantly inhibited the formalin-induced pain response in a dose-dependent manner. However, none of these drugs affected tail flick latency at any of the studied doses. Pentazocine showed a significant antinociceptive response in both pain models, although a high dose was required to increase the tail flick latency. Pretreatment with all CCBs, individually enhanced the analgesic effect of pentazocine in both formalin and tail flick tests. In the latter test of nociception, a per se ineffective dose of pentazocine, showed a significant analgesic response in presence of CCB dose which itself was not effective in the test. Chronic concomitant administration of diltiazem with pentazocine did not prevent the development of tolerance to the opioid compound. However, diltiazem when given in combination with pentazocine to pentazocine-tolerant animals, it effectively reversed the tolerance. Results of the study thus suggest that concomitant treatment with CCBs, irrespective of their chemical nature, not only potentiate the antinociceptive effect of pentazocine in opioid naive animals in both tonic and acute nociceptive tests but also reverse the pentazocine tolerance.

Teenage primigravidae: a comparative study.

A review of history sheets of obstetric cases recorded in a district hospital in 1992 was done to compare the obstetric outcome in 200 teenage first pregnancies (Study group) with that in Control group i.e. 20 years to 29 years. It revealed that incidence of complications of pregnancy like anaemia, pregnancy induced hypertension (PIH) and preterm labour were significantly higher among teenage mothers. The normal mode of delivery was commoner in teenagers (82.5%) in comparison to control group (76.5%), probably because of higher number of low birth weight babies. The fetal outcome was significantly worse in teenage mothers with high incidence of perinatal mortality (8%) and low birth weight babies (35%). There was not a single newborn with birthweight above 3500 gms, in teenage group, whereas, control group had 5 babies (2.5%) in the category.

Endoscopic stenting of minor papilla for symptomatic pancreas divisum.

Pancreatitis is one of the presentations of pancreas divisum. Endoscopic treatment by dorsal pancreatic duct stenting relieves symptoms in a majority of patients. We report a patient with pancreas divisum and calcific chronic pancreatitis in whom successful drainage of the dorsal duct with a stent through the minor papilla relieved the pain.