COVID-19 Pandemic and the Role of Control Room in the Tertiary Care Hospital

COVID-19 has been labeled a serious public health emergency globally. Due to its high infectivity it has led to an increased burden to the Medical Fraternity as well as the Government. Therefore, the need for preparedness as well as conventional intervention strategies became integral during such health emergencies. To monitor the implementation of proper activities and to manage the patient load with adequate safety of the staff, COVID control rooms were established in the hospital premises. The main objective of the Control Room is risk mitigation, planning strategies, alleviating concerns and addressing issues associated with the health emergency across the hospital and further delegating the information to the higher authorities and the Ministry. Hereby in this review we have tried to summarize the administrative structure, functions and limitations of the 24x7 Control Room established in Tertiary Care Hospital, New Delhi.

Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study

Purpose@#Uncertainty exists about whether early laparoscopic cholecystectomy (LC) is an appropriate surgical treatment for acute calculous cholecystitis. This study aimed to compare early vs. late LC for acute calculous cholecystitis regarding intraoperative difficulty and postoperative outcomes. @*Methods@#This was a prospective randomized study carried out between December 2015 and June 2017; 60 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 30 patients. Thirty patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other 30 patients were placed in the delayed group, first treated conservatively, and followed by LC 3 to 6 weeks later. @*Results@#The conversion rates in both groups were 6.7% and 0%, respectively (p = 0.143). The operating time was 56.67 ± 11.70 minutes in the early group and 75.67 ± 20.52 minutes in the delayed group (p = 0.001), and both groups observed equal levels of postoperative complications. Early LC patients, on the other hand, required much fewer postoperative hospital stay (3.40 ± 1.99 vs. 6.27 ± 2.90 days, p = 0.006). @*Conclusion@#Considering shorter operative time and hospital stay without significant increase of open conversion rates, early LC might have benefits over late LC.

Transient hypothyroxinemia of prematurity and its risk factors in an extramural neonatal intensive care unit

ABSTRACT Objective: Thyroid functions in preterm newborns may be altered in the first week of life. Hypothyroxinemia has been commonly reported in these babies, which could be due to the immaturity of the hypothalamic pituitary thyroid axis or acute illness. It could have a long-term impact on the developing brain of these babies. We conducted this study to estimate the incidence of transient hypothyroxinemia of prematurity (THOP) and to determine its risk factors. Materials and methods: We analyzed thyroid stimulating hormone (TSH) and free T4 levels of 64 preterm neonates admitted in the neonatal intensive care unit. TSH and free T4 levels were measured in the first week and then at 14-21 days of life to estimate the incidence of THOP and determine its risk factors. We also estimated the incidence of congenital hypothyroidism (CH) and delayed TSH elevation in CH. Risk analysis was conducted using simple and multiple logistic regression, and numerical data was compared using the Mann Whitney U test and t test. Results: THOP was seen in 25% of the preterm babies. Caesarean delivery, presence of one or more morbidities, mechanical ventilation, birth weight ≥ 1,500 g, and gestational age ≥ 32 weeks were identified as risk factors for THOP based on simple logistic regression. In multiple regression, mechanical ventilation and gestational age ≥ 32 weeks were significantly associated with THOP. CH was seen in 2 (3.1%) babies, and 1 of these cases had delayed TSH elevation. Conclusion: Thyroid abnormalities are common in preterm admitted neonates. Mechanical ventilation is an independent risk factor for development of THOP.

Identification of T-Cell Epitopes in Proteins of Novel Human Coronavirus, SARS-Cov-2 for Vaccine Development

Recently, a novel human coronavirus, SARS-CoV-2 led to a worldwide serious health concern, causing severe respiratory tract infections in humans. It is the third highly pathogenic and transmissible coronavirus after severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in humans. The source of origin, transmission to humans and mechanisms associated with the pathogenicity of SARS-CoV-2 are not clear yet, however, its resemblance with SARS-CoV and several other bat coronaviruses was recently confirmed through genome sequencing related studies. It has been an emergent need to develop a potent and adequate number of drugs and vaccines to control the spread of coronavirus. We have screened the specific proteins such as ORF1ab polyprotein, surface glycoprotein, membrane glycoprotein and nucleocapsid phosphoprotein of SARS-CoV-2 for identification of T-cell epitopes using immunoinformatics tools. In this study we used different bioinformatics tools for analysis of genome and proteome. We retrieved gene sequence from NCBI. The expected molecular weight and isoelectric point (pI) values were also verified using Generunner and ExPaSy. These epitopes have showed the highest binding affinity with major histocompatibility complex (MHC) class I and II molecules. These findings may be useful as an immunodiagnostic tool for the development of peptide based novel vaccines.

Prospective study of laparoscopic surgery in paediatric patients

Background: Laparoscopic cholecystectomy and laparoscopic appendectomy is gold standard treatment modality for symptomatic cholelithiasis and appendicitis. Laparoscopy in paediatric patient have many limitations and  factors restricting its use in paediatric patient are smaller surface area for access, compliant abdominal wall,  the liver margin  below the rib cage, the bladder being  an intra-abdominal structure, the viscera close to  anterior abdominal wall and small sized abdominal cavity and conventional instruments too long for paediatrics use.  The so-called obliterated structures like umbilical vein, umbilical artery and urachus remain relatively large and partially patent in infants further restricting use of therapeutic laparoscopy.Methods: The present study was carried out in Department of General Surgery, MDM Hospital, Dr. S. N. Medical College, Jodhpur, Rajasthan. Total 50 patients were included in the present study of laparoscopic surgery in paediatric patients below 14 years of age and were studied in terms of, duration of surgery, postoperative pain, analgesic requirement, postoperative hospital stay, intraoperative and postoperative complication and factors necessitating conversion of laparoscopic procedure to open method.Results: As per the present study inguinal hernia was most common diagnosis (48%) followed by hydrocele (22%) and acute appendicitis (22%).Conclusions: It is concluded from the present study that laparoscopic surgery in paediatric patients is safe, complication free, had less analgesic requirement, shorter duration of surgery, short postoperative hospital and total hospital stay and better cosmetic results.

A study of contaminated sharp injury and associated morbidity among health care workers

Background: Needles are one of the biomedical waste materials generated during the treatment or procedure in the hospital. Improper handling, capping or disposal technique causes a major health hazard among the health care workers (HCWs). Needle stick injuries (NSIs) can occur accidentally at any time when people use, disassemble, or dispose needle. The aim of the present study were to find out the burden of chronic morbid condition due to NSIs to HCWs, to find out various risk factors responsible for causing chronic disease to HCWs and to suggest the prevention and control of needle stick injury among the HCWs.Methods: A cross-sectional study, conducted among HCWs. Sample size was estimated by using standard formula and 312 HCWs were taken in study. Equal number of respondent was taken from each group. The information has been collected and data entry has been done using specific software SPSS version 20.0.Results: Most of the HCWs were infected with hepatitis B (24.0%) followed by hepatitis C virus (8.7%) and HIV (1.9%) after the percutaneous injuries with needle of infectious patients during any intervention procedures of the patients.Conclusions: Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health-care workers because of the poor practice as well as not opting personal protective equipment’s during intervention process regarding preventive and control measures. These infections are highly preventable and should be eliminated.

A Comparative Study Of Onset Time And Intubating Condition For Different Dose Of Rocuronium In Burn And Non-Burn Patients

An aberrant pharmacodynamics responses to neuromuscular blocking drugs(NMBD)in burn patients increases the potential for lethal hyperkalemia with the administration of depolarizing muscle relaxant eg:succinylcholine and 2.5–5 folds increase in the dose of plasma concentration requirement for non–depolarizing muscle relaxants like :D–tubocurarine,metacurine,pancuronium,atracurium,vecuronium.Therefore Rocuronium may be the drug of choice in burn patients.This study was planned to assess the onset time and intubating conditions with two different doses of rocuronium in patients with thermal injury.It was concluded that in non–burn patient onset time(loss of response to TOF) was 85.5�4.8 sec with a dose of 0.9 mg/kg as compared to 1.2 mg/kg it was 60.55�70.4,while in burn patients (more than 30% burn area) these values were 120.83�6.81 sec and 86.16�5.2 respectively.

Profile of organo phosphorous poisoning at a tertiary medical centre in Jharkhand, India

Background: Poisoning is the most common method, employed for the act of deliberate self-harm. The wide availability, lack of rules and regulations for the sale of pesticides resulted in wide spread use of Organophosphate as one of the most common poison used for deliberate self-harm.Methods: In this study, authors aim to find out clinical profile with respect to different O.P. compounds, prognosis and outcome of each patient in relation to the delay in getting medical attention. Present study objective is to find out if there is any specific clinical finding which can predict bad outcome.Results: Out of 344 cases, 189 cases had type 1 respiratory failure, while in 34 cases type II respiratory failure present. 61 cases expired and out of these 61 cases 47 cases died within 24 hours and 11 cases died in next 48 hours.Conclusions: Maximum number of cases were in the age group of 21 - 30years. The maximum number of deaths were in the first 72 hours. Number of cases were more in males as compared to females. Chances of survival was better in persons who reached early to the hospital.

Importance of Neem Leaf: An insight into its role in combating diseases.

The neem (Azadirachta indica A. Juss) is a tropical evergreen tree (Fam. Meliacae; Subfam. Melioideae) traditionally well known for its medicinal value. Beneficialt effects of different parts of neem are attributed to its biologically active principle ‘Azadirachtin’. Apart from Indian subcontinent, neem is widely used in African countries as therapeutics, preservatives and insecticides. Neem leaves, natural source of flavonoids, polyphenols, isoprenoids, sulphurous and polysaccharides, play important role in scavenging the free radical and subsequently arresting disease pathogenesis. Considerable research has gone into neem for developing cost effective and non-toxic products. The present review has compiled different phytochemicals isolated from neem leaves, methods of extraction and their therapeutic use in preventing several diseases. Here, we highlighted the mechanism of anti-inflammatory and antioxidant activity of neem leaf that underscores the disease through regulation of physiological responses. Also, multiple roles of neem leaf and commercial use of neem formulation as an alternative in paving a frontier in the field of drug discovery are discussed.

Laparoscopic appendectomy versus open appendectomy: A randomized prospective comparative study.

Introduction: Laparoscopic Appendectomy confers advantages to the patient in terms of fewer wound infections, less pain, faster recovery and earlier return to work. The aim of this study was to evaluate and compare advantages and disadvantages between laparoscopic Appendectomy and open Appendectomy in general surgical practices. Materials and methods: A two year randomized, prospective comparative study of Laparoscopic Appendectomy versus Open Appendectomy was done in the Department of Surgery, M.G.M medical college & L.S.K. hospital, Kishanganj, Bihar. SPSS software was used for data analysis. Chisquare test was applied. Results: Wound infections in LA group was 9% and OA group was 20%. Intra- abdominal abscess in LA group was 9% and OA group 1.8%. Adhesive ileus in LA group was 4.5% and OA group was 1.7%. Caecal leak was seen only in LA group. Pneumonia was not reported in both the groups. Operation time in LA group was 60 mins and OA group was 30mins. Duration of Hospital stay in LA group was 3 days and OA group was 5 days. Mean duration of return to normal activity in LA group was 5.4 days and OA group was 7.1 days. Mean duration of return to heavy work was 12.2 days in LA group and OA group was 16.8 days. Conclusion: Laparoscopic Appendectomy was found to be both feasible and safe in comparison with open Appendectomy.

Comparative Structural and Functional Analysis of E6 Oncogene of Human Papillomavirus Type 16.

Human papillomavirus (HPV) is an etiologic agent of the uterine cervix cancer and several other neoplasias in women globally. E6 protein of HPV type 16 is highly conserved and plays the key role in an inducing cancer via suppressing activity of P53. We have used different bioinformatics tools for generation of phylogenetic tree, modeling of RNA secondary structure, gene designing and codon optimization of HPV E6 gene. The size of E6 gene sequences of nine strains HPV type 16 was estimated to be 456 to 477 bp and G+C content was ranged between 37.06 to 37.94%. We used E6 gene sequences for construction of phylogenetic relationship and these divided into five groups. RNA secondary structures of E6 gene were modeled and analyzed that folding free energy of wild genes was -093.96, -106.21,-040.48, -090.76, - 072.68, -092.86, -039.32, -044.78, -047.88 kcal/mol and after codon optimization free energy was -122.70, -107.40, - 104.80, -121.40, -127.40, -110.80, -105.20, -122.30, -110.40 kcal/mol respectively. Moreover, gene designing and codon optimization have used to improve the heterologous expression in living organisms by increasing translational efficiency. All strains of HPV16 were used for codon optimization in E. coli. Codon adaptation index (CAI) and G+C contents of E6 gene in optimized DNA were enhanced by 3.6 (72.7%) and 1.3 (25.2%) fold, respectively. The present study provides useful insights into phylogenetic and evolution in the cervical cancer causing Human papillomavirus type 16. The optimized DNA can be chemically synthesized and over expressed in E. coli as compare to its wild type counterparts. Alternatively, the secondary structure and free energy of E6 were investigated that will be helpful to predict the evolution of primitive and genetically stable HPV type 16 strains. This finding provides new insight in better understanding of cervical cancer.

Identification of T-Cell epitopes in structural proteins of tick borne encephalitis virus for vaccine development.

Tickborne encephalitis (TBE) is a human viral infectious disease caused by tickborne encephalitis virus (TBEV). It is transmitted by the bite of an infected tick and also initiated the swelling of brain (encephalitis) and spinal cord. There is a pressing need to develop potent and sufficient amount of drugs and vaccines for control of TBE. We have selected the structural proteins such as anchored core protein C, core protein C, premembrane, matrix and envelope proteins of TBEV for identification of T-cell epitopes using immunoinformatics tools. These epitopes were showed the highest binding affinity with major histocompatibility complex (MHC) class I and II molecules. These finding may be used as an immunodiagnostic agent and also development of peptide based novel vaccines.

Molecular characterization and modeling of secondary structure of 16S rRNA from aeromonas veronii.

Aeromonas veronii is a human pathogen that causes diarrhea, wound infections and hemorrhagic septicemia. A. veronii isolated from Gomti river water and identified on basis of 16S rRNA sequences, which showed the high degree of homology with existing sequences. Moreover, the 16S rRNA sequences were also being used for modeling of RNA secondary structures and resembles with Gibbs free energy of other available strains. The result indicates the accurate molecular identification of A. veronii and its phylogeny shows the high degree of homology with diverse source of other strains.

Evaluation of antimicrobial activity and bronchodialator effect of a polyherbal drug-Shrishadi

<p><b>OBJECTIVE</b>To investigate antimicrobial and bronchodialator effect of hydroalcholic extract of polyherbal drug Shirishadi containing Shirisha (Albezzia lebbeck), Nagarmotha (Cyprus rotandus) & Kantakari (Solanum xanthocarpum).</p><p><b>METHODS</b>Antimicrobial activity was evaluated by disc diffusion method and MIC, MBC, MFC were calculated by micro dilution method. Hydroalcholic extract of this preparation was investigated for its phytochemical analysis, phenol and flavonoid were determined by spectrophotometric method and in vivo bronchodilator effect was analysed by convulsion time.</p><p><b>RESULTS</b>The phytochemical tests revealed presence of alkaloids, anthraquinones, carbohydrates, flavonoids, saponins and tannins. The antimicrobial result showed the MIC of 6.25 mg/mL against Staphylococcus aureus and 12.5 mg/mL for Escherichia coli and 12.5 mg/mL against remaining bacteria tested, with strong antifungal activity. The maximum inhibition zone is found against Pseudomonas aeruginosa with MIC 16 mg/mL. Drug showed significant bronchodilator effect with 27.86% & 36.13% increase in preconvulsion time of guinea pigs pretreated with 100 & 200 mg/kg body weight of extract.</p><p><b>CONCLUSIONS</b>The study reveals that the extracts possess antibacterial activity and antifungal activity in a dose dependent manner. This antimicrobial property may be due to presence of several saponins, further studies are highly needed for the drug development.</p>

Immunochemical characterization of antigens of Brucella canis and their use in seroprevalence study of canine brucellosis

OBJECTIVE@#To explore immunochemical characterization of antigens of Brucella canis (B. canis), and the use in seroprevalence study of canine brucellosis.@*METHODS@#External hot phosphate buffer saline extract (HPBSE) and internal sonicated (SA) antigens were prepared from B. canis strain MEX 51 and immunochemically characterized. These antigens were used to test 527 serum samples of dogs by 2-mercaptoethanol-tube agglutination test (2 ME-TAT), agar gel immunodiffusion test (AGID), dot-ELISA and indirect enzyme-linked immunosorbent assay (I-ELISA) to assess the seroprevalence of canine brucellosis.@*RESULTS@#The protein content of HPBSE and SA antigens was 0.387 mg/mL and 0.195 mg/mL, respectively, whereas carbohydrate content was 0.174 mg/mL and 0.150 mg/mL, respectively. The sodium dodecyl sulfate-polyacrylamide gel electrophoresis (12.5%) of HPBSE and SA, revealed 6 and 8 visible peptide bands ranging from 18-80 kDa and 12-45 kDa, respectively. Western blot analysis showed immunodominant bands of MW 12, 28, 39 and 45 kDa for HPBSE and 20-24 kDa for SA. The AGID revealed HPBSE as more specific antigen than SA but both I-ELISA and dot-ELISA indicated SA antigen to be more specific and reliable than HPBSE. The seroprevalence of canine brucellosis was 2.27% by 2ME-TAT, 1.5% by AGID, 3.03% by dot-ELISA and 16.12% by I-ELISA.@*CONCLUSIONS@#On the basis of the results of present study, we concluded that HPBSE is suitable antigen for AGID, which is more specific; whereas SA antigen is suitable for I-ELISA, which is highly sensitive. Therefore, initial screening of serum samples should be carried out by I-ELISA followed by confirmation with AGID.

Codon optimization of the potential antigens encoding genes from mycobacterium tuberculosis.

Current approach for controlling of tuberculosis is going on by recommended doses of vaccines. Codon optimization and simulation techniques are used to improve the protein expression in living organism by increasing their translational efficiency of gene of interest. We have designed; optimized the codon and simulated in nineteen indigenous genes of Mycobacterium tuberculosis H37Rv in the Escherichia coli. We minimized the G+C content in optimized genes from 64.75% to 59.67% of the studied genes as the richness of G+C content is reflected in a strong bias. CAI and AT of optimized DNA were enhanced by 1.9 (47.8%) and 1.1 (12.5%) fold more with respect to its native type. Our finding indicates the optimized genes can be useful for over expression in host and the study provides a new insight for the emerging research in synthetic biology.

A New Technique for Single Spore Isolation of Two Predacious Fungi Forming Constricting Ring

A new technique for single spore isolation was developed for predacious fungi forming constricting rings directly on the spores using Dactylaria brochopaga and Arthrobotrys dactyloides. Constricting rings were induced directly on the spores by transferring the spores in 25 ppm solution of DL-Valine in sterile distilled water. Freshly hatched and thoroughly washed second stage juveniles of Meloidogyne incognita were transferred into cavity blocks containing induced rings for trapping and killing of nematodes. The killed nematodes were surface sterilized with streptomycin and inoculated into petri dishes containing maize meal agar media with 100 ppm streptomycin. The petri dishes were incubated at 29+/-1degrees C for few days which yielded axenic culture of these fungi.