Convalescent Plasma Therapy: A Novel Approach To A Novel Coronavirus

Objective: The Corona virus-induced disease-19 (COVID-19) turning to its aggressive phase of spreading, the treatment options where less and several options are trialing and seeking. Convalescent plasma therapy is one of the newest trailing therapy for COVID patients today without other definite treatment. The convalescent plasma (CP) therapy is used previously and identified its benefits in other conditions. But in the case of COVID 19 the effects and safety should be ensured for its implementation. Methods: Systematically searched in Pub Med and other authentic sources for articles of interest. Results: This review includes 5 studies, over all 26 patients who treated CP and following progressions and events. All became clinically better and the antibody titer increased in the patients. Not only that the viral load decreased with a reduction in inflammatory markers Conclusion: These small studies and case series suggest that CP is effective and safety is high for clinical recover and reduction in viral load.

Melioidosis in Odisha: A clinico-microbiological and epidemiological description of culture-confirmed cases over a 2-year period

Melioidosis is an emerging infectious disease in India mostly reported from South-western coastal Karnataka and North-eastern Tamil Nadu. We speculate the existence of another major hidden focus in Odisha, one of the eastern coastal states. The clinico-epidemiological features of 47 culture-confirmed melioidosis at a tertiary care teaching hospital over a period of 2 years are reported. Septicaemia was the most common clinical presentation. Diabetes mellitus (DM) was present in 72.3% of our cases. The geo-climatic conditions of Odisha and other coastal states of India and the rise in the incidence of DM demand a nationwide surveillance of melioidosis and creation of melioidosis registry.

Clinico-epidemiological analysis of scrub typhus in hospitalised patients presenting with acute undifferentiated febrile illness: A hospital-based study from Eastern India

Acute undifferentiated febrile illness (AUFI) constitutes the predominant cause of healthcare seeking in Odisha. This prospective study was conducted to analyse the clinical, epidemiological and laboratory profile of scrub typhus patients presenting with AUFI from January to December 2017. Four hundred and thirty-two samples were tested for dengue, malaria, scrub typhus and enteric fever. Scrub typhus was overall the most common cause of AUFI (26.3%, 114/432) followed by dengue (19.2%, 83/432). Eschar was seen in 6.1% of cases. Aetiologies of 38.6% of AUFI remained unidentified. In the present study, there was no mortality attributed to scrub typhus.

Cognitive impairment in OCD patients – an exploratory study

Background and Objectives: OCD is one of the most debilitating psychiatric conditions with complex etiopathological profile causing interference with a wide range of social and cognitive demands. NeuroPsychological and neuro-imaging studies on OCD patients have implicated that the frontal cortex andsubcortical structures are involved in this disorder and testing has revealed evidence of impairment in visuospatial abilities, non-verbal memory and executive function. To evaluate cognitive impairment in ObsessiveCompulsive Disorder patients.Methods: Thirty patients who presented to Psychiatry Department of Dayanand Medical College andHospital, Ludhiana with diagnosis of OCD as per ICD-10 were taken up for the study. Cognitive impairmentwas assessed using PGI brain dysfunction battery designed for Indian population by Dwarka Pershad andSantosh K. Verma (3rd edition 2015). PGI brain dysfunction battery is a measure of cognitive impairmentconsisting of: Verbal Adult intelligence scale, Revised Bhatia short battery of performance tests ofintelligence, PGI memory scale, Nahor Benson test, Bender Visuo-Motor Gestalt test. Those patients whohad any major medical disorder or any other Psychiatry disorder on AXIS-I were excluded from the study.Results: In the present study, dysfunction was noticed in areas of immediate recall ,abstract thinking,arithmetical ability in verbal intelligence subscale and in visuo-motor coordination. These all areas areexecutive functions of frontal lobe. This shows that OCD patients are having difficulty in calculations dueto interference of the obsessive symptoms, though their attention and concentration were found intact.Visuo-motor coordination problem may be due to compulsive tendency due to which overlap, perseverationand partial rotation were found dysfunctional.Conclusion: Since OCD is highly distressing to the patient, the superadded cognitive dysfunctions such asmemory impairment, abstract thinking, impairment in visuo-motor coordination further worsens theoutcome of the illness. So, early identification of these dysfunctions would provide considerable benefit tothe patients.

Impact Of Training On Knowledge And Practices Of Nurses Regarding Hospital Infection Control In A Tertiary Care Centre.

Background and objective:Nurses provide the first-hand bedside care to the patients in a hospital thus have a direct role in hospital infection control. Thus to improve hygiene behaviour of staff, training sessions on hospital infection control is necessary. The objective of this study was to assess the impact of training on knowledge and practices regarding hospital infection control amongst nursing staff working in tertiary care centre. Method: The study included 89 nurses from different wards and I.C.U. A pre-test and a post-test was conducted with a set of 20 self designed multiple choice questions in three days session of training covering important aspects of hospital infection control. Improvement in pre-test and post test for individual candidate was assessed and statistical data analysis was done. Results: Response rate of the questionnare was 100%.The mean pre-test score was 9(S.D 3.06) while mean post-test score was 14(S.D 6.34). The difference in pre-test and post-test was statistically significant(P< 0.00001) taking 95% confidence interval. Interpretation and conclusion: Training sessions and workshops for healthcare workers conducted regularly will help curbing nosocomial infections and providing a better patient care.

Reduced susceptibility of carbapenem‑resistant Klebsiella pneumoniae to biocides: An emerging threat.

Dealing with carbapenem‑resistant Klebsiella pneumoniae (CR‑Kp) strains, which are generally pan‑drug resistant, is an uphill task for health care professionals. Owing to limited therapeutic options and the possibility of development of resistance to commonly used biocides in hospital settings, CR‑Kp infections pose a serious threat of emergence of a dreaded pandemic. The aim of the study was to highlight the possibility of emergence of biocide resistance among CR‑Kp strains. A case study was conducted in a Super‑specialty Hospital in September 2015. A 65‑year‑old female patient post‑laparotomy was admitted to the General Intensive Care Unit of a Super‑specialty Hospital. CR‑Kp was isolated from the blood and mucus trap samples of this patient. Susceptibility testing of three commonly used biocides in our hospital, namely sodium hypochlorite (4% available chlorine), 5% w/v povidone iodine (0.5% w/v of available iodine) and absolute ethanol (99.9%), respectively, was carried out using K. pneumoniae ATCC 700603 as control. The test isolate showed reduced susceptibility to sodium hypochlorite in comparison to K. pneumoniae ATCC 700603. The possibility of emergence of biocide resistance among CR‑Kp strains poses a threat of disrupting our ongoing efforts for implementation of effective infection control measures.

An Observational Study Showing Incidence of Heart Disease in the Male Population from North India.

Background: Structural Heart Disease (SHD) is a preventable cause of mortality. As age advances the morbidity rates due to SHD increases. SHD is more common in rural areas and lower socio-economic status because of poor hygiene and poor nutrition. The aim of this study was to find the incidence of heart disease in a male north Indian population. Method: A team consisting of three doctors examined all the candidates presenting over a period of one and a half years for enrollment at a particular Centre. The age group of this population was between 18 years to 22 years. All candidates underwent medical examination. Candidates having suspicion of SHD were referred to the physician/cardiologist. All those persons whose disability was within permissible limits were taken as fit and the others were taken as unfit. Results: Total 4223 candidates reported in the above period. 334 candidates who had disabilities were lost to follow-up and excluded, leaving a total of 3889 candidates. After specialist review, 1471 candidates were found unfit for various causes, out of which 283 were for cardiac murmurs. Many candidates were found to be suffering from multiples disabilities. Conclusion: Our study found an incidence rate of 72.7 per thousand which is much higher than that of other studies. The possible reasons for this could be that the persons are primarily from rural background and low socioeconomic strata which have a comparatively incidence of SHDs. Also contributing to the higher incidence may be the fact of stricter application of physical standards for enrollment in the army.

8-Hydroxydeoxyguanosine (8-OHdG) levels in urinary samples of pesticide sprayers on exposure to organophosphorus pesticides.

Background: Free radicals and other reactive species are constantly generated in vivo and cause oxidative damage to biomolecules. DNA is probably the most biologically significant target of oxidative attack. Among numerous types of oxidative DNA damage the formation of 8-hydroxyguanosine (8-OHdG) is a sensitive biomarker of oxidative stress, an adduct formed as a result of biochemical reaction between ROS and DNA. Chronic exposure to Organophosphorus (OP) pesticides is implicated in many health conditions that result from the induction of oxidative stress, including cytogenetic damage. The main objective of the study was to evaluate the biochemical levels of 8-OHdG in spot urinary samples under the exposed OP pesticide sprayers and farm workers. Methods: In this study, 51 male pesticide sprayers and 39 farm workers in the age group of 18-47 years having exposure ranged from 3 to 15 years in duration were selected. The referents (n=31) were selected on the same criteria as well as they were never exposed to pesticides at any time. This study was conducted during the growing season (January, 2009 – September, 2010). The most commonly used OP pesticides like chlorpyriphos, Diazinon, Dimethioate, Monocrotofos etc., were used in this study. Urine samples from each participant were taken in sterile tubes and were stored at -200C till analysed. The concentration of 8-OHdG in samples were analyzed using ELISA. Results: The urinary levels of 8-OHdG were found to be significantly higher in the farm workers and pesticide sprayers in contrast to the level observed in the control group (p<0.05). When the data was analyzed in the exposed groups in relation to duration of exposure it was found that both the farm workers and sprayers who were exposed to OP pesticides for less than 5 years showed the maximum mean values of 8-OHdG in comparison to those exposed to for more than 10 years. Conclusions: In view of this regular bio monitoring studies in target human populations are imperative necessary due to frequent changes in pesticide formulations and introduction of newer pesticides. Despite that several life style factors may influence the urinary concentrations of 8-OHdG but still this non-invasive bio-marker 8-OHdG is preferred over other invasive techniques to evaluate the environmental and occupational exposure effect of OP pesticides on the genotoxicity of the exposed workers.

An Anatomical Study of Glenoid Cavity: Its Importance in Shoulder Prosthesis.

Introduction: Glenoid cavity of scapula has variable morphology and therefore its anatomy is of enormous importance for orthopaedic surgeon and prosthetic designers. Presence of notch in the antero-superior part of glenoid rim affects the morphology of glenoid labrum. Anatomical variations of glenoid cavity are also important for understanding the various pathologies involving the shoulder joint. Present study aims to determine various anthropometric measurements of scapula and glenoid cavity including the variations of its shape. Materials and Methods: A total of 126 adult dry scapulae available in the Dept. of Anatomy, ACMS Delhi Cantt., India, and also procured from medical colleges in the vicinity were taken for the study. Results: The mean length and breadth of scapula observed were 141.94±12.76 mm 103.65±6.82mm respectively. The mean length of the glenoid observed in the present study was 38.78±3.03 mm. The mean AP glenoid diameter 1 and 2 were 24.93±2.55mm and18.66±2.13 mm respectively. The mean Glenoid cavity Index (GCI) found in the present study was 64.29 ± 9.79 mm. Conclusion: The dimensions of the glenoid observed in the present study were similar to those recorded in the studies done on other populations except for the shape. Higher percentage of glenoid cavities without a definitive notch was recorded in the present study compared to earlier studies. This fact may be taken into consideration while designing glenoid prostheses for the North Indian population.

Tumour necrosis factor-alpha promoter polymorphism and its association with viral dilated cardiomyopathy in Indian population: A pilot study.

Purpose: Tumour necrosis factor-α (TNF-α), a pro-infl ammatory cytokine has been implicated in the pathophysiology of several viral infections. TNF-α promoter gene polymorphism is thus believed to play the modulating role in this disease pathogenesis. Several studies have shown the increased level of TNF-α in dilated cardiomyopathy (DCM). However, the role of the TNF-α promoter polymorphism is yet to be delineated in this regard. The present study for the fi rst time tried to explore the association of TNF-α gene polymorphism with DCM of viral aetiology. Materials and Methods: Eighteen histopathologically proven DCM cases with viral genome positivity and 17 healthy controls were genotyped using polymerase chain reaction of TNF-α promoter gene followed by restriction fragment length polymorphism to determine the SNPs of -238G/A, -308G/A, -857C/T and -863C/A. Results: Of the 18 DCM cases 4 (22.2%) were positive for adenovirus (AdV), 2 (11.1%) for enterovirus (EV) and 12 (66.7%) had co-infection. Six of the 18 DCM cases (35.3%) had -238G/A polymorphism, and 10 (55.5%) had -863 homozygous AA genotype. The association of these polymorphisms was statistically signifi cant as compared to controls (P < 0.05). Conclusions: The present pilot study suggests the possible association of TNFα -238G/A and -863C/A polymorphism with DCM of viral aetiology.

An anatomic variant caudate lobe in a cadaver.

The liver can present a number of congenital anomalies. Most common among them are the irregularities in shape and the number of lobules. Less common variations include presence of accessory lobes or accessory fissures. The accessory lobe may be attached to the liver through a mesentery or a bridge of hepatic tissue and they are usually asymptomatic. An accessory liver lobe though a very rare occurrence but when it exists it becomes clinically important because of its rarity. We are reporting one such case of accessory caudate lobe of liver found during routine dissection of embalmed cadaver of a 60 year old male. It was separated from the caudate lobe by a well-defined fissure. The quadrate lobe and fissure for ligamentum teres were totally absent. Ligamentum teres was found embedded in the substance of the liver on its inferior surface. The presence of additional lobes and fissures or the absence of normal lobes and fissures might lead to confusion during surgery or clinical misdiagnosis. Knowledge and awareness of these anomalies is useful to the clinician to rule out diseases, surgeons during segmental resection of liver and radiologist when interpreting liver radiologic findings.

High division of sciatic nerve.

Background: The Sciatic nerve is the largest and thickest nerve in the human body with a long course in the inferior extremity. It divides into tibial and common peroneal nerves which can occur at any level from the sacral plexus to the inferior part of the popliteal space. Sciatic nerve variations are relatively common. These variations may contribute to clinical conditions ex sciatica, coccygodynia and piriformis syndrome and have important clinical implications in anaesthesiology, neurology, sports medicine and surgery. Methods: 10 cadavers were dissected with no previous history of trauma/surgery to study the anatomical variations of sciatic nerve. Results: In all except two cadavers, the nerve divided at the apex of the popliteal fossa. In two cadavers the sciatic nerve divided bilaterally in the upper part of thigh. Conclusion: The high division presented in this study can make popliteal nerve blocks partially ineffective. The high division of sciatic nerve must always be borne in mind as they have important clinical implications.

Cryptococcus laurentii Fungemia.

In the last few years there has been an increasing incidence of infection due to non-neoformans Cryptococcus spp. especially in immunocompromised host. Cryptococcus laurentii is a non-neoformans Cryptococcus which has rarely been known to cause bacteremia and pulmonary infection in humans. Here we report a case of fungemia due to Cryptococcus laurentii.

Use of antimicrobial agents and granulocyte colony stimulating factors for febrile neutropenia in cancer patients in a tertiary care hospital in India.

Background: Use of antimicrobials (AM) and granulocyte colony stimulating factors (G-CSF) affect the outcome and cost of treatment of febrile neutropenia (FN). There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. Materials and Methods: A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. Results: A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1%) were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE) was Rs 4694.45 ± 296.35 (113.95 ± 7.19$). G-CSF accounted for 76.14 - 97.58% of the total costs. Conclusion: Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.

Learning, education and satisfaction after compulsory rotating internship in Kathmandu University Medical School: a qualitative study of interns' response.

BACKGROUND: Internship is an integral part of MBBS training programme and mandatory to all students. Kathmandu University Medical School has adopted a programme of compulsory one year rotating internship including 6 weeks community exposure in out reach clinics for the first batch of students. The purpose of the study is to evaluate interns' feedback concerning learning, education and satisfaction. MATERIALS AND METHODS: A questionnaire with 47 items was administered to 30 interns who had finished one year rotating internship in Kathmandu University Medical School. Fourty-two responses were graded according in Likert scale and 5 open ended questions were analyzed for common themes. RESULTS: The mean age of the interns was 24.77+/-0.67 yrs with female: male ratio of 1.5:1. Confidence level of communication of interns with faculties was lesser than with junior doctors and patients. Junior doctors and colleagues contributed more in interns' learning than faculties. Community exposure for 6 weeks was considered lengthy and lacking of clear objectives. However, 53.3% interns agreed that achievement of objectives of community posting was high or very high. Of the interns, 50% perceived certain degree of physical or mental or sexual harassment during internship. Interns raised the issue of not involving them as a part of team during clinical posting. Clinical competencies for most of the skills were high or very high. CONCLUSION: Interns have learned clinical skills and patient care in one year internship programme but contribution of junior doctors and colleague are more than teachers. Clear objectives are needed before clinical and community postings. Process of providing regular feedback from interns and vice versa should be implemented to improve interns' learning, education and satisfaction.

Gastrointestinal histoplasmosis presenting as colonic pseudotumour.

We report a case of gastrointestinal histoplasmosis in a 45-year-old HIV positive man who was misdiagnosed as a case of colonic cancer. The patient presented with low-grade fever, pain in lower abdomen, anorexia and weight loss of six months duration. On examination a lump in the left iliac fossa was detected. Colonoscopy revealed stricture and ulcerated growth in the sigmoid colon. Radiological investigations suggested malignant/inflammatory mass in the sigmoid colon with luminal compromise. Patient was operated and ulcerated tissue was sent for histopathological examination, which revealed numerous intracellular, 2-4 microm, oval, narrow-based budding yeast cells suggestive of Histoplasma capsulatum. Subsequently, the patient developed fluffy opacities on X-ray chest. Examination of sputum revealed presence of acid-fast bacilli and yeast forms of H. capsulatum. Patient was started on amphotericin B but died on the seventeenth postoperative day. The diagnosis of histoplasmosis was made retrospectively. Atypical presentation and rarity of the disease led to this diagnostic pitfall. To the best of our knowledge this is the first report of gastrointestinal histoplasmosis presenting as colonic pseudotumour from India.

Hydatid cyst of mediastinum.

We report a case of hydatid cyst of the mediastinum in a 32-year-old female patient who was admitted with chest pain. CT scan reported posterior mediastinal mass towards the right side. Surgical exploration revealed a loculated cyst in posterior mediastinum on the right side, adherent to the overlying lung and underlying bone. Posterolateral thoracotomy was performed for cyst aspiration and excision. The patient was discharged on albendazole.

A rare case of mucormycosis of median sternotomy wound caused by Rhizopus arrhizus.

We describe a case of mucormycosis of median sternotomy wound caused by Rhizopus arrhizus . The patient, a known diabetic and a case of coronary artery disease underwent coronary artery bypass surgery. In the postoperative period, patient developed infection of the median sternotomy wound, from which R. arrhizus was isolated on culture. Patient succumbed in spite of being treated with surgical debridement and amphotericin B. To the best of our knowledge, this is the first reported case of mucormycosis of median sternotomy wound from India.

Affinity purification and partial characterization of IgM-like immunoglobulins of African catfish, Clarias gariepinus (Burchell, 1822).

IgM like macroglobulin from bovine serum albumin (BSA)-immunized African catfish C. gariepinus was purified by affinity chromatography and partially characterized. The molecular weight of this macroglobulin was 840 kDa, as estimated by gel filtration chromatography. Purified macroglobulin was analyzed using SDS-PAGE under reducing and non-reducing conditions. The molecular weight (MW) of heavy and light chain was 74.8 kDa and 27.2 kDa respectively, in presence of a reducing agent. In non-reducing SDS-PAGE, a single high MW band was observed representing tetrameric form.