A Retrospective Observational Study of Neurological Manifestations in COVID-19 (SON-CoV)

Objectives: Coronavirus disease 2019 (COVID-19) has neurologic manifestations associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to retrospectively analyze SARS COVID-19 patients with neurological manifestations and identify patterns of presentation including the site of neuroaxis involvement, neuroimaging, and associated systemic involvement. Methods and subjects: This retrospective observational study was conducted at two tertiary care hospitals in western Rajasthan. Data on age, sex, presenting symptoms, and comorbidities (hypertension, diabetes, cardiac, cerebrovascular disease, and cancer) were collected from 28th February 2020 to 31st December 2020 through medical records, discharge summaries, and radiological studies. Verbal/written patient consent was obtained due to the prevailing COVID-19 norms at the time of the first wave. Major inclusion criteria were as follows: age >18 years, consent from patient/surrogate, positive RT-PCR report in case of active COVID cases, or positive COVID antibody test in case of post-COVID neurological sequelae. All neurological manifestations were reviewed by at least two neurologists and were divided into central nervous system (CNS) and peripheral nervous system (PNS) manifestations. Systemic features and their temporal relationship with neurological features were recorded. Various other specialized assessments and therapeutic interventions were conducted. Statistical analysis was performed using the SPSS software. A Chi-square test was performed to determine the association between variables. Student’s t-test and one-way analysis of variance were used to determine differences in mean values. Statistical significance was set at p < 0.05. Results: The mean age was 57.32 years for the CNS group and 40 years for the PNS group (p = 0.025). Age was significantly lower in the PNS group than in the CNS group (p = 0.025). Anemia, leucocytosis, and elevated serum creatinine were more commonly seen in the CNS group, although the difference was not statistically significant. The most common CNS manifestations were stroke (41.8%), of which ischemic stroke constituted 83% of cases, followed by seizure (22%), encephalopathy (20.9%), headache (15.1%), and vertigo (3.8%). The most common PNS manifestation was neuropathy (57%), which included Guillain–Barré syndrome (GBS), critical illness neuropathy, and autonomic neuropathy Conclusion: CNS symptoms of COVID-19 are more common than PNS symptoms. Stroke is the most frequent (46%) COVID-CNS symptom, which occurs in people of age above 35 years and is associated with high mortality.

To Study the Effect of I.V. Dexmedetomidine by Two Different Means for Prevention of Pain Due to Propofol Injection

Background: The incidence of propofol injection pain during induction of general anaesthesia varies from28% to 85%. Purpose: To Study the Effect of I.V. Dexmedetomidine by Two Different Means for Preventionof Pain Due to Propofol Injection. Material and Methods: This prospective, randomized study we evaluatedthe effect of dexmedetomidine for reducing the incidence and severity of propofol injection pain by twodifferent approaches while evaluating the hemodynamic stability. 120 Patients undergoing elective surgicalprocedures were randomly divided into four groups; in group I and II with the aim of keeping the drug withinthe vein the forearm was squeezed with a tourniquet up to 70 mmHg for 20 sec; the patients were administered0.5µg/kg dexmedetomidine in Group 1 (n 30), 0.75µg/kg dexmedetomidine in Group 2 (n 30) for 5 min,followed by 15 ml of 1% propofol in all patients over 25 seconds to induce anaesthesia. In Group 3 and 4;0.5µg/kg and 0.75µg/kg dexmedetomidine was premixed with 15ml propofol respectively and administeredfor induction. Pain is graded on a 0– 6 scale. Results: Overall median propofol injection pain score reductionwas 65.75% with the maximum reduction of 80% seen in group 4 and minimum reduction of 50% in group1. There were statistically significant differences (p Â0.05) in both SBP and DBP and heart rate with themaximum decrease in all hemodynamic parameters in group 2 and 4. Conclusion: Pre-treatment withintravenous dexmedetomidine 0.75µg/kg, 5min prior to injection of long-chain triglyceride propofol is effectiveand safe in reducing the incidence and severity of pain due to propofol injection.

Nutritional assessment among children (1–5 years of age) using various anthropometric indices in a rural area of Haryana, India

Global Nutrition Targets 2025 specified a set of six global nutrition targets, and one aim is to achieve a 40% reduction in the number of children under 5 years of age who are stunted. National data on underweight provided under National Family Health Survey-4 (NFHS-4) (2015–2016) revealed an underweight prevalence rate around 35.7% as compared to NFHS-3 where it was 42.5%, which reflects only 6.8% reduction in underweight over a decade. Methods: This cross-sectional study was conducted in the rural area of Rohtak district during October 2014 to September 2015 among children who were 1–5 years of age. The anthropometric measurement and nutritional status categorization among children were done using the WHO guidelines. Results: A total of 600 children participated in the study. Around 41.3% of the study participants had stunting as their nutritional status, while taking composite index of anthropometric failure (CIAF) for nutritional status into consideration, nearly 54.4% of the participants were undernourished. Stunting and underweight were more prevalent among girls. Conclusions: Composite anthropometric index provides the actual prevalence or proportion of undernourished children in a community, so the policies should be based on the basis of CIAF so to reduce the prevalence of undernutrition in the community more effectively.

Obstructive Sleep Apnea in Children with Nocturnal Enuresis

There is increasing evidence on the association ofmonosymptomatic nocturnal enuresis (MNE) with obstructivesleep apnea. In this communication, we share our experience offour patients with Primary monosymptomatic nocturnal enuresis(PMNE) with positive Sleep-related breathing disorder (SRBD)score who underwent detailed polysomnography, and were eitherrefractory to desmopressin treatment or relapsed ondiscontinuation of desmopressin.

Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial

Background: This randomised, double-blind study was designed to assess the analgesic efficacy of dexmedetomidine as compared with fentanyl as an adjunct to local anaesthetic in thoracic epidural for upper abdominal surgeries. Methods: Forty adult patients of American Society of Anesthesiologists grade I­II undergoing upper abdominal surgery were randomly allocated into two groups to receive 50 µg fentanyl or 50 µg dexmedetomidine as an adjunct to 10 ml 0.125% bupivacaine via thoracic epidural. Anaesthesia was induced with morphine, propofol and vecuronium and maintained by isoflurane with 60% nitrous oxide in oxygen. In the postoperative period patient-controlled analgesic pumps were used to deliver similar types of mixtures via the epidural catheter. Patients were evaluated for rescue analgesic requirements, haemodynamic stability, postoperative pain, sedation and any adverse events. Results: The groups were comparable regarding intraoperative analgesic requirements, recovery times and postoperative pain scores. The total consumption of rescue analgesia was significantly less in the dexmedetomidine group as compared with the fentanyl group (p = 0.049). Two patients in the fentanyl group had vomiting and one had pruritus. None of the patients had bradycardia, hypotension, excessive sedation or respiratory depression. Patients receiving epidural dexmedetomidine were more satisfied with the technique than those receiving fentanyl (p < 0.001). Conclusion: It was concluded that the addition of dexmedetomidine with 0.125% bupivacaine in thoracic epidural provides effective perioperative analgesia with greater patient satisfaction compared with fentanyl

Viruses: A forerunner in the periodontal diseases.

The oral cavity present itself as a home to a rich flora of bacteria; more than 500 distinct microbial species are found in dental plaque. Mycoplasma, yeast, protozoa and viruses are found in the plaque as the non-bacterial microorganism. Viruses are known to be immunosuppressive and facilitate establishment of subgingival pathogens and have been detected in the gingival crevicular fluid. Viruses infect the inflammatory cells of the periodontium; they are present more frequently in diseased sites than in healthy sites. Traditional methods such as in vitro cultivation presents difficulty in detecting viruses. The field of virology has advanced greatly over the past two decades because of the introduction of sophisticated molecular tools, such as monoclonal antibodies, polymerase chain reaction based amplification, DNA sequencing, DNA and protein micro array chip assays, rapid diagnostic tests. These technologies identify the viral bodies, proteins and nucleic acids in body fluids and tissue samples.

Hospital acquired urinary tract infection by multidrug-resistant Brevundimonas vesicularis.

Infections caused by Brevundimonas vesicularis, a nonfermenting Gram-negative bacterium, are very rare. Here, we report the first case of multidrug-resistant hospital acquired urinary tract infection by B. vesicularis. Patient was successfully treated with antimicrobial therapy with piperacillin-tazobactam and amikacin.

Variation of Heavy Metal Content of Market Variants of Ayurvedic Formulation - Lack of Good Manufacturing Practices (GMP).

Aim: The present study was conducted to estimate the heavy metal content in samples of Kutazghan Vati (a pill), from three different manufacturers to know about the quality control measures being followed by manufacturers for GMP. The study will also provide a platform for regulatory authorities to tighten the noose and upgrade the industry about high heavy metal levels in relation to international regulations. Methodology: Three variants of Kutajghan Vati coded as A, B, and C manufactured by different leading manufacturers was procured from local market. Heavy metals analysis was done according to AOAC (1995) for non volatile heavy metals. Results: Cadmium content of two variants A and C was within permissible limits where as cadmium content of variant B was 2.98 ppm about ten times higher than the permissible limits of 0.3 ppm set up by WHO and the Ayurvedic Pharmacopoeia of India. The lead content of variant A was 36.33 ppm that was about four times against the permissible value set up by WHO. Despite very low detection limits, mercury and arsenic were not detectable in all the three variants depicting that the formulation were free from these heavy metals. Conclusions: Despite same guidelines issued by same regulatory authorities fo production of ayurvedic formulations for permissible limits of heavy metal content, three different manufacturers marketed the same formulation with different heavy metal content which reflects that industry seems to be negligent for maintaining proper quality control. This study suggests that periodic estimation of heavy metals is highly essential for single drugs, raw drugs as well as finished products for quality assurance and safer use of herbal drugs.

Spectrophotometric determination of chlorpheniramine maleate and phenylpropanolamine hydrochloride in dosage forms.

A rapid and simple method for simultaneous determination of Chlorpheniramine Maleate (CPM) and Phenylpropa-nolamine Hydrochloride (PPM) by first derivative UV spectrophotometry has been developed in combined pharmaceutical dosage forms. The proposed method was successfully applied for the determination of drugs in physical mixture and commercial formulations and results showed good linearity, precision and reproducibility.

Spectrophotometric determination of chlorpheniramine maleate and phenylpropanolamine hydrochloride in dosage forms.

A rapid and simple method for simultaneous determination of Chlorpheniramine Maleate (CPM) and Phenylpropa-nolamine Hydrochloride (PPM) by first derivative UV spectrophotometry has been developed in combined pharmaceutical dosage forms. The proposed method was successfully applied for the determination of drugs in physical mixture and commercial formulations and results showed good linearity, precision and reproducibility.

Comparison of quinine and rabeprazole with quinine monotherapy in treatment of uncomplicated falciparum malaria.

Objective: This study was conducted to assess the effect of combination treatment of quinine and rabeprazole in the treatment of uncomplicated Plasmodium falciparum malaria. Methods: The study included 50 patients of uncomplicated P. falciparum malaria. Group 1 (25 patients) received quinine and placebo (Q+P) while Group 2 (25 patients) received quinine and rabeprazole (Q+R). Diagnosis was confirmed by peripheral blood film (PBF) and rapid diagnostic test (RDT). Temperature was recorded every 6 h. All patients were followed-up on Days 7, 14, 21, 28 for detailed clinical and parasitological examination. Results: A total of 20 patients in each group completed the treatment and followed-up for 28 days. While two patients in Group 1 (Q+P) and one patient in Group 2 (Q+R) were lost in follow-up; and seven (Q+P = 4, Q+R =3) patients were withdrawn from the study. Fever clearance time (FCT) of the two groups was also almost similar (Group 1 : 2 = 52.8 : 51.3 h). No statistically significant difference was observed in early treatment failure (ETF) either of the groups. None of the patients in both the groups showed late clinical failure (LCF) or late parasitological failure (LPF). However, there was a significant difference in the parasite clearance rates of the two groups (p<0.05). Conclusion: The study results suggest that addition of rabeprazole to quinine regimen resulted in an increase in the parasite elimination rate, which may be helpful in reducing the duration of treatment and increasing patient compliance.

LAP V/S Open Cholecystectomy: A Prospective Study of 800 Patients.

As the number of surgeons performing laparoscopic cholecystectomy(LC), a rigorous evaluation of the safety of LC is waranted. It is essential to determine the extent of the difference in morbidity and mortality when compared with open cholecystectomy(OC). To compare the complications occurring in the patients undergoing L.C as compared to those undergoing open cholecystectomy. In a study conducted over a period of 8 years, 400 patients who underwent LC were compared to 400 patients who had undergone OC. The two groups were compared with respect to complication (severity grade 1-4), hospital stay and time required to return to work. (using the student ‘t’ test). The overall complication rate in both the groups was 4.8%. In LC group, the rate of grade 1, grade 2a and grade 2b complications were 2.3%, 0.3% and 2.3% respectively and in OC group it was 4%, 0% and 0.8% respectively. It means that grade 1 complications were 1.89 times higher in open cholecystectomy group as compared to LC group and grade 2b complications are 3.04 times higher in LC group as compared to OC group, though the variations are insignificant statistically. There was 0% mortality in both the groups. Postoperative hospital stay and time taken to return to work were less with LC group. Laparoscopic and open cholecystectomy were found to be comparable procedures in terms of complication for the treatment of gall stone disease and LC has not been associated with any increase in untoward events.

Tumor necrosis factor - alpha and transforming growth factor - beta1 polymorphisms in bronchial asthma.

Background: Bronchial asthma is a complex genetic disorder regulated by the release of cytokines and inflammatory mediators. Tumor necrosis factor alpha (TNF-alpha) and transforming growth factor beta (TGF-beta1) cytokines play pivotal roles in the inflammatory response of the airways. Differential production of these two cytokines is associated with allelic variations in the transcriptional regulatory region of these genes. Aims: The objective of the present study was to investigate G-308A TNF-alpha and C-509T TGF- beta1 polymorphisms for their association with Bronchial Asthma. Materials and Methods: DNA isolated from 123 asthmatics and 100 normal healthy controls were screened for these polymorphisms using the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) methods, developed in our laboratory. Results: Significant allelic association was observed between G-308A TNF-alpha polymorphism and asthma (P = 0.031) while no association was observed with C-509T TGF- beta1 polymorphism (P = 0.207). Further sub-grouping based on either allergic response or family history failed to reveal any statistical significance among the groups or with controls. The interaction between these polymorphisms revealed statistically significant association between the high producer genotype alleles of TNF-alpha and TGF-beta (A/T) and asthma (P = 0.016). Conclusions: The present study reports, for the first time, the role of two polymorphisms, in concert, for their association with asthma in an Indian population. Our study supports the findings that the G-308A TNF-alpha promoter polymorphism is a risk factor for asthma and furthermore suggests that the patients with high producer alleles for TNF-alpha (-308) and TGF-beta (-509) have the highest risk of getting this disease in the Punjabi population.

Atypical teratoid/rhabdoid tumor of the central nervous system associated with congenital cataract.

Atypical teratoid /rhabdoid tumor (AT/RT) of the central nervous system is a rare but highly aggressive neoplasm that usually affects young children and infants and follows a rapidly fatal course. We report a case of AT/RT in a 3-month-old male infant who also had coincidental unilateral congenital cataract even though there was no associated congenital infectious disease.

Differential association of tumour necrosis factor-alpha single nucleotide polymorphism (-308) with tuberculosis and bronchial asthma.

BACKGROUND: Tumour necrosis factor (TNF)-alpha is a pleiotropic, pro-inflammatory cytokine of 17 kDa, whose gene is localized on the short arm of chromosome 6. It has a G-308A polymorphism in the promoter region, which is known to be associated with its differential production; the A allele being the high producer. The circulating level of TNF-alpha is under genetic control and implicated in the pathophysiology of asthma and tuberculosis. Since raised levels of TNF-alpha have been found in asthma and tuberculosis, we looked for the association of TNF-alpha G-308A polymorphism in patients with these diseases. METHODS: A total of 300 blood samples from patients (155 with asthma, 145 tuberculosis) and 211 normal healthy controls were collected. The G-308A polymorphism was studied using amplification refractory mutation system analysis. RESULTS: The distribution of G/A alleles in the two patient groups when compared with normal controls revealed a statistically significant association with asthma (p = 0.016) but not with tuberculosis (p = 0.178). CONCLUSION: The data support the common variant common disease hypothesis, which emphasizes that common genetic variations may participate as critical players in inciting common diseases.

Synovial hemangioma: a rare benign synovial lesion.

We report an unusual case of a 10-year-old female with complaints of pain and swelling of the right knee for the last 4 years along with the limitation of movement for last 1 year. Repeated fine needle aspirations yielded blood and a provisional diagnosis of hemarthrosis was suggested. Coagulation profile subsequently carried out was found to be within normal limits. Arthroscopic biopsy was performed and tissue was sent for histopathological examination. A diagnosis of synovial hemangioma was made. Subtotal synovectomy was performed and the lesion was completely excised. The patient is completely asymptomatic and shows no signs of recurrence at 1 year.

A Giant Inguinoscrotal Hernia.

We report a case of giant inguinoscrotal hernia. Such hernial formations are rare (5% cases) and largely a problem of developing countries. Problems arise in the management for both the patient and the surgeon because of the rarity of the reported cases as there is no standard surgical procedure in place for their treatment. Surgical management of such giant hernias has to be individualised.

Clinical significance of airways colonization with Ureaplasma urealyticum in premature (<34 wk) neonates.

BACKGROUND & OBJECTIVE: Ureaplasma urealyticum has been implicated in various neonatal morbidities in preterm infants. Its association with chronic lung disease (CLD) remains controversial. The aim of this prospective study was to investigate colonization of U. urealyticum in preterm infants (with gestational age <34 wk) and to evaluate the relationship between U. urealyticum colonization and neonatal morbidity including CLD. METHODS: U. urealyticum was cultured from nasopharyngeal or endotracheal aspirates collected within 24 h of birth from infant <or=34 wk gestation weighing <1800 g admitted to a Neonatal Intensive Care Unit of a tertiary care hospital in north India, and PCR was performed on the DNA extracted from these samples. RESULTS: Twenty per cent of the study infants were colonized with U. urealyticum. The mean gestational age of the infants in the colonized group was less than that of non colonized infants (P<0.05). The peripheral total leukocyte counts and mortality rate were higher in infants with U. urealyticum colonization than in non-colonized infants (P<0.05). There was no significant difference between the colonized and non colonized groups with regard to the antenatal use of steroids, sex, cause of respiratory distress, use of surfactant, duration of ventilation. INTERPRETATION & CONCLUSION: None of the 20 babies colonized with U. urealyticum developed CLD as compared with two (2.5%) of the non colonized group. Colonization of the airways with U. urealyticum had no significant role in development of CLD in Indian preterm infants.