A study on Breakthrough Infections of COVID-19 from an Urban Healthcare Centre in Kerala

Background and Aim : While India’s vaccination drive against COVID-19 continues to progress, the number of Breakthrough Infections are also revealing an uptick due to Community spread of COVID-19. There is a dearth of data quantifying the extent of breakthrough infections, defined as infections following two doses of vaccine. We aimed to understand the occurrence of Breakthrough Infections among the public in the City of Thrissur, Kerala, India, during the recent surge of COVID-19 in Kerala. Methods : Patients visiting the Internal Medicine Outpatient Department (OPD) in a private hospital in the City of Thrissur in Kerala, India were selected for the study. Subjects above the age of 18 years presenting to the OPD between August 01, 2021 and September 30, 2021 were surveyed through a short interview on the COVID-19 infection history, symptoms, severity and vaccination status.Results : Of the 56 participants who tested positive for COVID-19, 38 had received both doses of vaccine and all had received their first dose of vaccine. 4 patients had no symptoms, 37 patients reported mild symptoms and nine patients reported moderate to severe symptoms. Conclusion : Our study demonstrates the occurrence and describes the epidemiology of COVID-19 breakthrough infections in a City from the Indian State of Kerala in a real-world setting. We conclude the occurrence of Symptomatic Breakthrough Infections of COVID-19 in patients who had received two doses of the vaccine were mild in the majority of the patients (87%). Further research is required to understand the mechanisms behind these Breakthrough infections.

Imaging spectrum and prevalence of variant branching pattern of aortic arch

Background: Variant branching patterns of the aortic arch are not infrequent but are commonly under reported. This study was conducted to determine the spectrum of Variant branching pattern of aortic arch and their prevalence using contrast enhanced computed tomography (CECT) images of the cases from a tertiary care centre.Methods:  Contrast enhanced computed tomography (CECT) images of aortic arch region from 1116(629 male and 487 female) cases from 18 to 85 years of age were examined retrospectively. The images were reviewed for normal and variant anatomy of aortic arch and the results were analyzed statistically.Results: Of 1116 patients, 878 (78.6%) cases showed normal and 238 (21.3%) cases had variant branching pattern of the aortic arch. The most common variation was the common origin of brachiocephalic trunk (BCT) and the left common carotid artery (LCCA) which was observed in 160 (14.3%) cases. In 8 (0.7%) cases, BCT and LCCA took origin from a single common trunk arising from the aortic arch. In 60(5.4%) cases, the left vertebral artery (LVA) originated directly from the aortic arch between the origin of the LCCA and left subclavian artery (SCA). 8 (0.7%) cases had aberrant right subclavian artery. Two (0.2%) cases showed right aortic arch.Conclusions: Interventional radiologists and surgeons should be well aware of variant anatomy of aortic arch. Contrast CT is a highly reliable imaging method for demonstrating anatomical features and variations of the arch.

On the path of continual improvement: An evaluation of biomedical waste management training.

Microbiologists play a pivotal role in the prevention of infection both at hospital and community level. Biomedical waste management (BMWM) is one of the aspects of infection control. For the effective implementation of this, various training programmes have been conducted at our regional training centre. This study evaluates the impact of the BMWM training programme. Knowledge on all parameters was signifi cantly better at post-course evaluation for all the participants (P value 0.001). Evaluation of training is recommended to improve the effectiveness of training method.

Fungal rhinosinusitis: A clinicomycological perspective.

Purpose: Chronic rhinosinusitis (CRS) is a widely prevalent condition globally as well as in India. The spectrum of fungal involvement in CRS runs from benign colonisation to potentially life-threatening invasive disease. Successful treatment of such mycotic infections largely depends on the accurate identification of the pathogen, early and appropriate intervention by surgical clearance, supported with antifungal medication as per standard regimen. Thus, this study was undertaken to determine the prevalence of fungal rhinosinusitis (FRS), and to analyse its clinicomycological profile. Materials and Methods: Fifty-two patients with clinical suspicion of CRS attending a tertiary care hospital during a one-year period were included in this retrospective analysis. The sinonasal specimens were subjected to microscopy by KOH mount and fungal culture as per standard mycological technique. Tissue specimens were also subjected to histopathological examination. Results: Male to female ratio was 1.25:1; age varied from 14 years to 62 years with majority of patients (37%) belonging to age group 21-40 years. The prevalence of FRS was 44%, and 74% of it was caused by Aspergillus sp. Aspergillus flavus (A. flavus) (52%) was the most prevalent fungus isolated. Allergic fungal rhinosinusitis (AFRS) was the most common presentation (79%). Conclusion: FRS is a continuous spectrum of disease varying in presentation, treatment and long-term sequelae. Correct identification of the fungus remains essential for appropriate treatment.

An analysis of multimodal occupational exposure leading to blood borne infections among health care workers.

Occupational exposure poses a signifi cant risk of transmission of blood-borne pathogens to healthcare workers (HCWs). Adherence to standard precautions, awareness about post exposure prophylaxis is poor in developing countries. This retrospective study analyzes the self-reported cases of occupational exposure in a tertiary care hospital. During the study period, 105 HCWs sustained occupational exposure to blood and body fl uids. Majority of the victims 36 (34.2%) were interns and the clinical practice that led to the occupational exposure was withdrawal of blood (45.7%). Good infection control practices and emphasis on appropriate disposal are needed to increase the occupational safety for HCWs.

Trichosporon inkin, an unusual agent of fungal sinusitis: A report from south India.

The aetiology of fungal sinusitis is diverse and changing. Aspergillus species has been the most common cause for fungal sinusitis, especially in dry and hot regions like India. Trichosporon species as a cause for fungal sinusitis has been very rarely reported the world over. Here, we report a rare case of allergic fungal sinusitis caused by Trichosporon inkin in a 28-year-old immunocompetent woman. Bilateral nasal obstruction, nasal discharge and loss of smell were her presenting complaints. Diagnostic nasal endoscopy showed bilateral multiple polyps. Functional endoscopic sinus surgery was performed and many polyps were removed. Based on mycological and histopathological studies, the pathogen was identified as T. inkin.

Buerger's disease: clinical and histomorphological study.

There is an extremely high prevalence of Thromboangiitis Obliterans (TAO) or Buerger's disease (BD) in India among people of low socioeconomic class who smoke beedies (homemade cigarettes with raw tobacco). The aim of this study was to study the clinical and histo-morphological aspects of Buerger's disease with relevance to age at presentation in the local population. The study comprised of 25 cases (all were men and were smokers) of clinically diagnosed BD based on Shionoya's criteria. The mean age was 47 years. The specimens consisted of 21 biopsies, 2 end-arterectomies and 2 amputations. Formalin fixed, routinely processed, paraffin embedded tissue sections were stained with Haematoxylin and Eosin (H and E) and Verhoeff's elastic stain. They had claudication pain either in the ankle (5) or in the calf (2) or both (13). 24 had infrapopliteal disease and 9 showed upper limb involvement. 21 showed migratory thrombophlebitis also. Histomorphological presentation included the following features: Luminal thrombosis (14), fresh thrombosis (4), chronic inflammation in the vessel wall (10), within the thrombus (1) and around perivascular channels and nerve bundles (4). Internal elastic lamina showed reduplication in 13, undulation in 9 and fragmentation in 9 cases. Media of the vessel showed the following features: fibrosis (9), hypertrophy (9) and calcification (5) Adventitial haemorrhage, cholesterol clefts and atherosclerotic plaque formation were the other changes seen. In our study the following histopathological features were consistently seen. Thrombus (with or without recanalisation), inflammatory cell infiltrate (within the thrombus wall or periadventitial tissue), subintimal and medial fibrosis and changes in internal elastic lamina. These features were also highlighted in other studies. However in our study, medial hypertrophy and calcification were observed as additional features.

Some novel approaches for radioprotection and the beneficial effect of natural products.

Due to the increased use of ionizing radiation in various aspects of human life especially in areas pertaining to radiotherapy of cancer, food preservation, agriculture, industry and power generation, there is a need to develop an effective and non-toxic radioprotector. The currently available ones have many drawbacks including high cost, side effects and toxicity. Several novel approaches are on to locate a potent radioprotector. These include mimics of antioxidant enzymes, nitroxides, melatonin, growth factors, gene therapy, hyperthermia apart from natural products. The latter has several advantages since they are non-toxic with proven therapeutic benefits. These can be classified as natural compounds and plant extracts; polyherbal formulations; besides natural and semi-natural compounds of plant origin. A review of the above agents, their efficacy in radioprotection and possible mechanisms responsible has been carried out. As India and many Eastern countries have an enormous heritage of vast natural dietary and time tested medicinal resources it is worth exploring the possibility of developing efficient, economically viable and clinically acceptable radioprotectors for human application from these resources.

Megalencephalic leukoencephalopathy with subcortical cysts.

Megalencephalic leukoencephalopathy with subcortical cysts is a rare disease first described in 1995. It is characterized by macrocephaly and early onset white matter degeneration. We report two siblings who were diagnosed to have this disease. This disease must be included in differential diagnosis of macrocephaly with early onset leukoencephalopathy.

Tumour angiogenesis and C-myc expression in breast carcinomas.

Angiogenesis in tumors has been widely studied and has been considered to be a prognostic factor particularly in breast carcinomas. The myc family of proto oncogenes has shown an amplification in breast carcinomas. The aim of this study was to assess MVD (micro vessel density) and the expression of c-myc in invasive breast carcinomas. Formalin fixed, routinely processed, paraffin embedded tissue was stained with H&E for classification and grading according to the Nottingham modification of Bloom and Richardson criteria. Immunohistochemical staining using primary antibody against F VIII antigen and anti C-myc were carried out. LSAB method was employed with AEC as chromogen and Gill's Haematoxylin as counter stain. Micro vessels were counted and positivity indicated by a cherry red staining in the cytoplasm of the tumour cells. Grades I, II and III showed 12.22 %, 20.9% and 24.5 % positivity of micro vessel density (MVD). Fifty percent of Grade 1, 69.2 % of Grade II and 24.5 % of Grade III tumours expressed c-myc proteins. In our study we found a positive association between tumour grade and micro vessel density, signifying a poor prognosis for tumours with high MVD. C-myc expression also showed a positive association with increasing grade.

Water soluble vitamin E (TMG) as a radioprotector.

Tocopherol monoglucoside (TMG), a water soluble derivative of vitamin E offers protection against deleterious effects of ionizing radiation, both under in vivo and in vitro conditions, to biological systems. TMG was found to be a potent antioxidant and an effective free radical scavenger. It forms a phenoxyl radical similar to trolox upon reaction with various one-electron oxidants. TMG protected DNA from radiation-induced strand breaks. It also protected thymine glycol formation induced by gamma-radiation. Gamma-radiation-induced loss of viability of EL-tumor cells and peroxidation of lipids in microsomal and mitochondrial membranes were prevented by TMG. TMG was nontoxic to mice when administered orally up to 7.0 g/kg body weight. The LD50 dose of TMG for ip administration in mice was 1.15 g/kg body wt. In rats, following oral and ip administration of TMG, the absorption (distribution) half lives were 5.8 and 3.0 min respectively and elimination half lives were 6.7 and 3.1 min respectively. Embryonic mortality resulting from exposure of pregnant mice to ionizing radiation (2 Gy) was reduced by 75% by ip administration of TMG (0.6 g/kg, body wt) prior to irradiation. TMG offered protection to mice against whole body gamma-radiation-induced lethality and weight loss. The LD50(30) of mice increased from 6 to 6.72 Gy upon post irradiation administration of a single dose of TMG (0.6 g/kg, body wt) by ip.

The Epstein Barr virus and gastric carcinoma.

The Epstein Barr Virus (EBV) is one of the viruses implicated in the pathogenesis of malignant tumors. Its association with Burkitt's Lymphoma, nasopharyngeal carcinoma and certain cases of Hodgkin's lymphoma is well known. More recently this virus has been found to be associated with gastric carcinoma. Studies on this association, in our country are lacking. We have studied 37 cases of carcinoma using immunohistochemistry for LMP1 protein. Most workers have found an expression of latency type I antigens in gastric adenocarcinomas, with only a few cases being LMP1 positive. In the 37 cases studied by us, 24.14% of cases were positive for LMP1. LMP1 is known to have oncogenic properties. In addition, it has been demonstrated earlier that the EBV particles in gastric carcinoma are monoclonal. These two factors support a pathogenetic role for EBV in gastric carcinoma.

Multidrug resistance 1 gene expression in Indian patients with gastric carcinoma.

BACKGROUND: Gastric carcinoma is frequently refractory to chemotherapy. The multidrug resistance 1 gene (MDR1) encodes for a protein (p-glycoprotein) that functions as a drug efflux pump and thus contributes to resistance to chemotherapeutic agents. METHODS: We studied gastric tissues from 28 patients with gastric cancer for MDR1 expression, using immunohistochemistry. RESULTS: Sixteen (57%) of 28 cases showed MDR1 expression. Sections of normal mucosa away from the tumor showed perinuclear staining for MDR1 in surface epithelial cells, whereas tumor cells showed diffuse cytoplasmic positivity. CONCLUSIONS: Over one half of gastric carcinoma specimens at our center show MDR1 gene expression.

P 53 and PCNA in Non Hodgkin's lymphoma--an immunohistochemical evaluation.

P 53 positivity and PCNA labelling index were studied in 50 cases of node based Non Hodgkin's lymphomas, P 53 positivity was observed in a spectrum of these disorders, suggesting that P 53 mutations play a role in the genesis of these tumours. P 53 positivity incresed from low through intermediate to high grade tumours and thus may be of prognostic value in these lesions. PCNA labelling index (LI) was higher in high grade tumours. P 53 and PCNA immunoreactivity showed a relationship in that PCNA LI was seen to be more than 30% in P 53 positive tumours. P 53 positivity appears to be related to the subtype and proliferation rate of NHL.

Protein C levels in ischaemic heart disease.

Protein C is a circulating glycoprotein with anticoagulant properties. Functional and immunological levels of protein C were determined in 34 cases of ischaemic heart disease and 12 healthy age-matched controls. The sensitive colorimetric assay was used to determine the functional levels and ELISA for antigenic levels. Mean protein C activity and antigenic levels were found to be elevated in these patients as compared to controls. Protein C levels in the three individual subgroups-acute myocardial infarction, previous myocardial infarction and chronic stable angina pectoris-were also raised as compared to controls. The elevation was significant in the case of the acute myocardial infarction group. These results further support the hypothesis that the body synthesises increased amounts of protein C in ischaemic heart disease to compensate for the hypercoagulable state that exists in this disorder, thus playing a protective role.

Cell marker studies in undifferentiated soft tissue sarcoma.

100 cases of undifferentiated soft tissue sarcomas were studied using cell markers by immunoperoxidase technique with DAB as substrate. Vimentin, Desmin, Myoglobin, Actin, Keratin, Epithelial Membrane Antigen, S-100 protein, F VIII R Ag, A1 Antitrypsin, A1 Antichymotrypsin, Collagen-IV and UEA-1 lectin were used as markers. Fibrosarcoma was consistently positive for Vimentin and Collagen-IV. The undifferentiated Rhabdomyosarcoma showed strong and consistent positivity for Vimentin Actin and Myoglobin. Desmin positivity was the hallmark of leiomyosarcoma, whereas the malignant schwannomas were identified by their S-100 positivity. This marker along with A1AT and A1ACT reactivity was of great use in the identification of malignant fibrous histiocytoma. Angiosarcoma/malignant haemangioendothelioma could be identified with great accuracy by their strong positivity for F VIII RAg and UEA-1 lectin. Other miscellaneous sarcomas also could be identified by their specific reactivity to the markers used. We consider immunohistochemistry to be an important and essential adjunct to routine stains in the diagnosis of undifferentiated soft tissue sarcomas.

High affinity uptake of L-glutamate and γ-aminobutyric acid in Drosophila melanogaster.

Preparations having properties resembling those of synaptosomes have been isolated from whole fly homogenates of Drosophila melanogaster using ficoll gradient floatation technique. These have been characterized by marker enzymes and electron microscopy and binding of muscarinic antagenist 3H Quinuclidinyl benzilate. An uptake system for neurotransmitter, ã-Aminobutyric acid has been demonstrated in these preparations. A high affinity uptake system for L-glutamate has also been studied in these subcellular fractions. This uptake of glutamate is transport into an osmotically sensitive compartment and not due to binding of glutamate to membrane components. The transport of glutamate has an obligatory requirements for either sodium or potassium ions. Kinetic experiments show that two transport systems, with Km values 0·33×10–6Μ and 2·0×10–6Μ, respectively, function in the accumulation of glutamate. ATP stimulates lower affinity transport of glutamate. Inhibition of glutamate uptake by L-aspartate but not by phenylalanine and tyrosine indicates that a common carrier mediates the transport of both glutamate and aspartate. β-N-oxalyl-L-β β-diamino propionic acid and kainic acid, both inhibitors of glutamate transport in mammalian brain preparations, strongly inhibited transport of glutamate in Drosophila preparations Comparison with uptake of ã-aminobutyric acid and glutamate in isolated larval brain is presented to show that the synaptosome-like preparations we have isolated are rich in central nervous system derived structures, and presynaptic endings from neuromuscular junctions.