Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India

Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription?polymerase chain reaction (RT?PCR) to screen COVID?19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital?based study. Point?of?care (PoC) RAT was performed using nasopharyngeal swab, while RT?PCR for SARS?CoV?2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS?CoV?2 by using both RAT and RT?PCR. Only one patient had tested positive for SARS?CoV?2 with both RAT and RT?PCR, while two patients had tested positive with RT?PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT?PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen’s kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT?PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen’s kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT?PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID?19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.

Study on physical properties of Ayurvedic nanocrystalline Tamra Bhasma by employing modern scientific tools

Background: Tamra Bhasma is derived from metallic copper that is recommended for different ailmentsof liver and spleen, dropsy, abdominal pain, heart disease, colitis, tumors, anemia, loss of appetite,tuberculosis, as well as eye problems.Objectives: The knowledge of crystallite size and active ingredients in Bhasma materials is limitedrestricting its use as nanomedicine in the modern era. Also, the 2015 Nobel prize in medicine hasmotivated many researchers towards traditional medicines. Therefore, the different chemical andphysical properties of prepared Tamra Bhasma has been studied by modern experimental tools (XRD,VSM, SEM, FTIR and PL spectrometer) and the preliminary testing of Tamra Bhasma nanoparticles wasexamined on bacteria.Materials and methods: Bhasma is prepared by metals and minerals using three step procedures e.g.Shodhana, Bhavana and Marana. In the present work, for the preparation of Tamra Bhasma, pulverizedcopper wire was used and prepared by the principle of Puta (incineration) in an Electrical Muffle Furnace(EMF).Results: X-ray diffraction analysis and scanning electron microscopy results revealed that the crystallitesize of Bhasma powder was less than 100 nm and nanocrystallites of aglomerated size in micrometer.Magnetometer measurement supports its medicinal value. Photoluminescence (PL) properties of nanocrystalline Bhasma powder was investigated in UV-NIR region and shows luminescence in visible region.The antimicrobial study of Tamra Bhasma shows effectiveness on bacteria and, may be useful to controlthe bacterial infection disease.Conclusion: Scientific data obtained using modern scientific tools and evidence would support in utilizing the ancient Indian wisdom of Ayurveda for the development of newer drugs as a modern nanomedicine and in other possible technological applications.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Leishmania donovani infection activates Toll-like receptor 2, 4 expressions and Transforming growth factor-beta mediated apoptosis in renal tissues

Abstract The present study was aimed to identify the underlying mechanisms of improper renal function in Leishmania donovani infection that causes VL. Mice (BALB/c) were infected with L. donovani and different parameters for proteinuria were assessed. The levels of superoxide anion (O2 -), hydrogen peroxide (H2O2), lipid peroxidation (MDA), inflammatory cytokines, and toll-like receptor (TLR) 2 and 4 expression were found significantly elevated at 60th day in these animals and declined at 90th day post infection. However, TGF-β and caspase 3 activities were higher at 90th day in comparison to 60th day post infection. These findings suggested that exacerbated inflammatory conditions correlate with abnormal renal functions in L. donovani infection, which is further augmented by activated TLRs expressions by circulating leishmanial antigens. Further, the increased levels of TGF-β and caspase 3 at 90th day suggested TGF-β mediated apoptotic cell death of renal and other cells during later stages of disease that may eventually result in release of host and parasitic factors in urine during visceral leishmaniasis.

Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation.

Background: Alpha-2 agonist are being extensively evaluated as an alternative to neuraxial opoids, as an adjuvants in regional anaesthesia The faster onset of action of local anaesthetics, rapid establishment of both sensory and motor blockade, prolonged duration of analgesia into postoperative period, dose sparing action of local anaesthetics and stable cardiovascular parameters make these agents a very effective adjuvant in regional anaesthesia. Methods: Our study had 45 patients, all patients belonged to ASA Grade-I or II, between 20 and 55 years of age with an average height of 150 and 170 cm and have ideal body weight requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups Group-I: Epidural bupivacaine 0.5% (16 ml) + clonidine 75 μgm (1 ml) Group-II: Epidural bupivacaine 0.5 % (16 ml) + Dexmedetomidine 50 μgm (1 ml) Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia, sedation and adverse effects in perioperative period. Results: The time of onset of sensory block at T10 and time to reach maximum sensory block (T6) in group-I was significantly longer as compared to group-II. The complete motor blockade (grade-3) was achieved much later and time taken for recovery to grade-0 was significantly shorter in group-I. The time for rescue analgesia in group-I was significantly shorter as compared to group-II. Hypotension was the most common side effect in both the groups. Dry mouth is a known side effect of alpha-2 agonists. Epidural dexmedetomidine produced profound sedation. Conclusions: We conclude from this study that dexmedetomidine is a better adjuvant than clonidine for providing early onset of sensory analgesia, superior sedative properties and prolonged post-operative analgesia.

Epidural ropivacaine combined with fentanyl or in combination with clonidine in infraumblical surgeries: a comparative study.

Background: The addition of an adjuvant, like clonidine and fentanyl, in epidural blockade has enhanced the effectiveness of local anaesthetics as they not only help in intensifying and prolonging the blockade effect but also help in the reduction of the dose of local anaesthetics. Methods: Our study had 45 patients, all patients belonged to ASA grade-I or II, between 20 and 55 years of age requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups. Group-I: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 μgm (1 ml) + 0.5 ml distilled water. Group-II: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 μgm (1 ml) + clonidine 50 μgm. Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia and adverse effects in perioperative period. Results: Highest level of sensory and motor blockade was found to be insignificant (p>0.05) in both the groups. Mean time for regression of sensory blockade to T10 was significantly longer (p<0.05) in group II as compared to group I. The duration of motor blockade was significantly (p<0.001) higher in patients of Group-II as compared to Group-I. The addition of clonidine to epidural Ropivacaine and fentanyl (Group-II) produces longer duration of analgesia as compared to Group-I. Haemodynamically the patients in both the groups behaved similarly. The patients, in whom epidural fentanyl was used, had slightly higher incidence of nausea, vomiting, dry mouth and pruritus. Conclusions: So this study re-established the fact, that the fentanyl and clonidine when added as adjuvant to epidural ropivacaine, significantly prolongs the analgesic duration without causing significant hemodynamic and respiratory changes.

Prediction of morbidity and mortality in middle and old aged surgical patients-comparison of standard scoring system and addition of echocardiography with hemodynamic indices.

Background: A prospective study was carried out in our hospital to predict morbidity and mortality in middle and old aged surgical patients by adding echocardiography to standard scoring system with hemodynamic studies. Methods: A total of 50 patients of either sex ranging from 40-70 years of ASA grade 1 & 2 scheduled for various types of noncardiac surgeries were enrolled for the study in our hospital. Patients were divided in two groups according to echocardiographic examinations. The patients with normal echocardiographic values were kept in control group and the patients with abnormal values were kept under study group. The patients in study group were further divided in three groups according to LVEF. Group1-LEVF≥60%, Group2-LVEF≥50-59%, Gr3≥40-49% Tab lorazepam was given to all the patients’ orally prior night of surgery. All the patients were induced with same type inducing agents according to body weight. All the patients were maintained on IPPV by anaesthesia machine with supplemental fentanyl, N2O, O2 and muscle relaxant. SPO2, electrocardiograph (ECG), Non-invasive/invasive blood pressure (BP), Spirometry, Capnography and temperature were monitored. At the end of the research project data’s were compiled systematically and were subjected to statistical analysis using odd’s ratio(OR),95% confidence interval (CI), z value and p value, two statistical software programme were used. Results: Significant difference in the results seen between the three study groups (Gr1, Gr2, Gr3) for perioperative ischemic changes, CHF and arrhythmias. Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients.

Evaluation of role of Candida in patients with chronic paronychia.

Background: Chronic paronychia, earlier considered to be an infection due to Candida, is currently being considered as a dermatitis of the nail fold. Irritant, allergic and protein contact dermatitis are the suggested major pathogenic mechanisms. Hypersensitivity to Candida is more likely to be the etiology, rather than the infection itself. Aims: To assess the clinico‑etiological profiles of patients with chronic paronychia and to determine the role of contact sensitization and hypersensitivity to Candida. Methods: All consecutive patients of chronic paronychia attending the dermatology outpatient department (OPD) were assessed for risk factors, number of nails affected, clinical presentation and presence of fungus, patch tested for contact allergy and prick tested for hypersensitivity to Candida allergen. Results: A total of 80 patients of chronic paronychia were recruited into our study. There was female preponderance (66 patients, 82.5%), with the most common group affected being housewives (47 patients, 58.8%). Frequent washing of hands (64 patients, 80%) was the most common risk factor. Fungal culture was positive in 56.1% (41 patients), the predominant species cultured was Candida albicans (15 patients, 36.5%). Patch testing with Indian standard series was positive in 27.1% patients (19 out of 70 patients tested), with nickel being the most common allergen. Prick test with Candida allergen was positive in 47.6% patients (31 out of 65 patients tested). Limitations: Prick test and patch test provide indirect evidence of hypersensitivity, with inherent limitations. Conclusion: Our study shows that chronic paronychia is probably a form of hand dermatitis associated with prolonged wet work, and that there is a higher incidence of contact sensitization and Candida hypersensitivity in these patients.

Fungal profile of funguria cases at a tertiary care hospital in southern India.

Background & objectives: Candida albicans is the most common aetiological agent in funguria cases commonly observed in hospitalized patients. But a few reports are available from India where non-albicans Candida species have accounted for >50 per cent of urinary Candida isolates. We undertook this study to know the fungal profile amongst funguria cases. Methods: A total of 123 consecutive fungal isolates obtained from clinically suspected cases of urinary tract infection from April to September, 2013, were included. Yeast species was identified by standard phenotypic methods. Antifungal susceptibility testing of yeast was performed for fluconazole (25 μg) by disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The male to female ratio was 0.92. The mean age of patients was 42.7 ± 18.9 yr. C. tropicalis (58.5%) was the most common fungal agent followed by C. albicans (30.1%). Only one isolate of C. tropicalis was resistant to fluconazole. Interpretation & conclusions: C. tropicalis and C. albicans were the predominant fungal pathogens responsible for urinary tract infection. Less resistance to fluconazole observed in the study may be due to restricted use of fluconazole in this area.

Effects of tert-butyl hydroperoxide on Ca2+ ATPase activity in isolated rat hepatocytes and its reversal by antioxidants.

Calcium ions play an important role in various physiological processes such as nerve impulse transmission, muscle contraction, hormone action, blood clotting. They ions act as an intracellular second messenger, relaying information within cells to regulate their activity. To understand the mechanism of hepatotoxicity of t-BHP, studies were carried out using freshly isolated rat hepatocytes. The effect of t-BHP on Ca2+ accumulation and Ca2+ uptake by rat hepatocytes was monitored using 45Ca2+. It caused decrease in 15% accumulation of 45Ca2+ in comparison to the control group. t-BHP also significantly decreased the Ca2+ ATPase activity in isolated hepatocytes. This decrease in Ca2+ATPase activity by t-BHP was reversed 40% by naturally occurring antioxidant glutathione (GSH) and 20% by the synthetic antioxidant butylated hydroxy toluene (BHT). These results indicate that the hepatotoxic action of t- BHP involves oxidative stress as evident by the protection accorded by various antioxidants employed in the study as well as impairment of intracellular calcium homeostasis which can lead to liver cell injury.

Synthesis, characterization and rheological properties of guaran grafted polyacrylamide (G-G-Pam) copolymer.

Guaran was transformed into grafted polymer using vinyl monomer. The vinyl monomer used for the graft was acrylamide. The grafting was initiated through the formation of free radical centers on the polymer backbone by oxidation of guaran with cerium (IV) in nitric acid medium. The degree of grafting was varied by using varying amount of acrylamide vinyl monomer. The rheological properties of the guaran grafted polyacrylamide copolymer have been studied by varying the degree of grafting, time, concentration, temperature, spindle number and shear rate. Thermal Characteristics of the guaran-grafted polyacrylamide was studied using thermo gravimetric analysis under nitrogen atmosphere. The prepared copolymer was characterized by FTIR.

Coexistence of onychomycosis in psoriatic nails: A descriptive study.

Background: Psoriatic nail changes predispose to onychomycosis because it becomes easier for fungi to penetrate an already compromised nail plate. Moreover, some of the psoriatic nail changes closely resemble onychomycosis. Aim: To investigate cases of nail psoriasis for any evidence of onychomycosis. Methods: Seventy-two patients with psoriasis were included in the study. The patients were selected from the psoriasis clinic and dermatology in-patient ward. Direct microscopic examination with 20% KOH and culture were carried out in all patients showing psoriatic nail changes. Histopathological examination with Periodic Acid-Schiff (PAS) stain was done in cases negative by KOH examination and culture. Results: Nail changes were seen in 66.66% (48/72) of psoriasis patients. The most common fingernail changes observed were pitting, onycholysis and subungual hyperkeratosis, and the most common toenail changes were onycholysis and subungual hyperkeratosis. Nail changes were significantly more common in males. The duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes. Out of 48 patients with psoriatic nail change, 23 (47.91%) had investigative evidence of onychomycosis. The fungal isolates on culture were non-dermatophytic molds in nine patients (18.75%) and yeast like fungi also in nine patients (18.75%). Conclusion: Coexistent onychomycosis in psoriatic nails does occur.

Twenty-two year follow-up of an Indian family with dysferlinopathy-clinical, immunocytochemical, western blotting and genetic features.

Long-term observations over a period of 22 years in an Indian family with primary dysferlinopathy are recorded, defining phenotypic variability. In the propositus, the dystrophy began distally in the tibialis anterior muscles, before involving the gastrocnemius. Transient painful calf hypertrophy, followed by calf wasting was observed. The proximal lower and upper limbs weakened after three to four years. The younger sibling presented with the proximo-distal phenotype. Both patients showed very high creatine kinase values early into the illness. Disease progression was slow. The younger sibling lost ambulation 14 years after onset, while the elder one remains ambulatory 22 years into the illness. Muscle biopsy showed dystrophic features and absence of dysferlin. Monocyte western blotting confirmed absence of dysferlin. Genetic analysis detected a heterozygous mutation in Exon 54 [c.6124C>T] in the DYSF gene. This is the first family with a diagnosis of dysferlinopathy supported by genetic data, reported from India.

Limb girdle muscular dystrophies in India.

The recent years have seen remarkable progress in the field of limb girdle muscular dystrophies (LGMDs) with the advances in immunocytochemistry and genetics. Based on this, many subgroups have emerged. Protein products and genes are getting defined and newer mechanisms of disease are being recognized. Limb girdle muscular dystrophies are common in India. The clinical material is plentiful, and from various centers in the country, phenotypes have been studied. With the help of immunocytochemistry, sarcoglycanopathies and dysferlinopathies have been studied. Genetic information on these subgroups is now beginning to emerge. The laboratory facilities are limited and available in select centers in large institutes. Establishment of genetic laboratories and sophisticated muscle pathology techniques will further elucidate the LGMDs in India.

Severe childhood autosomal recessive muscular dystrophy, mental subnormality and chorea.

Severe childhood autosomal recessive muscular dystrophy (SCARMD) is characterized by a severe Duchene muscular dystrophy like phenotype. Most such cases represent alpha or gamma sarcoglycanopathies. Mental subnormality is very uncommon and other central nervous system deficits have not been documented in patients with SCARMD. We report a brother and sister with the SCARMD phenotype, who additionally had static mental subnormality and choreiform movements. Work-up for sarcolgycan genes, dystrophin gene and known causes of mental retardation and chorea was normal.

Predictive accuracy of commissural morphology and its role in determining the outcome following Inoue balloon mitral valvotomy.

BACKGROUND: Commissural morphology is an important predictor of outcome following balloon mitral valvotomy. The aim of this prospective study was to assess if the site of commissural splitting could be reliably predicted by echocardiography and whether the extent of commissural split affected the result of balloon mitral valvotomy. METHODS AND RESULTS: A total of 140 patients (mean age 29.1+/-8.6 years) were studied. Prediction of splitting was done based on the presence of echolucent dark zones as seen in the parasternal short-axis view on echocardiography. Of 102 patients in whom a split of both commissures was predicted, the prediction was accurate in 86% (88/102). Of 33 patients with a predicted unilateral split, the accuracy of prediction was 82% (27/33). In the 5 patients with bilateral commissural fibrosis (in whom none of the commissures were predicted to split), all had a unilateral split. Overall, 93 patients (66%) had a bilateral commissural split, 43 (31%) had a unilateral split, and 4 had no commissural split. All the latter 4 developed moderate-to-severe mitral regurgitation. Those with bilateral commissural split following balloon mitral valvotomy had lower transmitral gradients (5.53+/-1.46 v 7.4+/-1.2 3 mmHg, p = 0.03) and greater mitral valve area (1.83+/-0.15 v. 1.64+/-0.15 cm2, p<0.02), as compared to those with unicommissural split. The incidence of an increase in mitral regurgitation by > or = grade 1 was also lower in the former group (7.5% v. 28%). An optimal result with the first dilatation (using a balloon size <2 mm of the predicted size) was achieved more frequently in those with a bilateral split (18% vs 8%). Oversizing of the balloon by 2 mm (of the predicted size) was done more frequently (19% v. 7%) in those with unicommissural split. CONCLUSIONS: We conclude that the assessment of commissural morphology is possible with excellent predictive accuracy. In this study, those with bilateral commissural split had more favorable hemodynamic results with lower transmitral gradients. greater mitral valve area and lesser frequency of mitral regurgitation in contrast to those with unicommissural split.