Essential Service Products as Channels for COVID-19 Awareness and Behavior Change: A Narrative Review

Coronavirus disease 2019 (COVID-19) is here to stay. Nonpharmacological interventions such as hand hygiene, social distancing, and respiratory hygiene have remained the mainstay to curb the spread of the virus, and these are sustainable. To understand the information, education, and communication (IEC) efforts undertaken during previous pandemics and successful behavior change strategies that may be applicable to ongoing COVID-19 pandemic, we conducted a narrative review of articles using PubMed search on September 11, 2022. The results highlighted that reinforced IEC is the need of the hour in efforts against COVID-19 pandemic. The communication strategy during a pandemic should be of three stages aligned to the objectives of building a basic understanding and knowledge in the target population: building an awareness of the threat; personal actions to minimize the impact; and reinforcing the need for appropriate actions to minimize disease transmission, in that order. An innovative strategy of displaying IEC on the daily essential products can result in a sustainable solution that might result in a “felt need” in the community to follow COVID-19 appropriate behavior. A broad base of stakeholders' engagement with civil bodies, nongovernmental organizations, private sectors with well-defined responsibilities and accountability would offer an enabling environment for these efforts in ultimately curbing the COVID-19 pandemic.

Synergistic protective effect of picrorhiza with honey in acetaminophen induced hepatic injury.

Rhizome of picrorhiza along with honey prevents hepatic damage and cure the acetaminophen (paracetamol) induced hepatotoxicity by modulating the activity of hepatic enzymes. Here, we studied the in vivo effects of Picrorhiza kurroa and honey on acetaminophen induced hepatotoxicity Balb/c mice model. Hepatic histopathological observations of acetaminophen fed (day-6) group showed more congestion, hemorrhage, necrosis, distorted hepatic architecture and nuclear inclusion. Such damages were recompensed to normal by picrorhiza or honey alone or both in combinations. We observed increased activity of SGPT and SGOT in injured liver tissues, and that too was compensated to normal with picrorhiza or honey alone or both in combinations. We observed 1.27 and 1.23-fold enhanced activity of SGPT in serum and liver lysate, respectively while SGOT showed 1.66 and 1.11 fold enhanced activity. These two enzymes are signature enzymes of liver damage. Thus, our results support that honey may be used with drug picrorhiza due to its synergistic role to enhance hepatoprotective and hepatoregenerative ability along with allopathic drugs to mitigate the hepatotoxic effects.

Level of PAX5 in differential diagnosis of non-Hodgkin’s lymphoma.

Background & objectives: The PAX5, a paired box transcription factor and B-cell activator protein (BSAP), activates B-cell commitment genes and represses non-B-cell lineage genes. About 14 transcript variants of PAX5 have been observed in human. Any alteration in its expression pattern leads to lymphogenesis or associated diseases and carcinogenesis in non-lymphoid tissues. Its mechanisms of function in pathophysiology of non-Hodgkin’s lymphoma (NHL) are unclear. This study was intended to explore influence of PAX5 in cascade of NHL pathogenesis and diagnosis. Methods: Samples of 65 patients were evaluated by immunohistochemical staining for cellular localization of PAX5, CD19, CD3, cABL, p53, Ras and Raf and by TUNEL assay, RNA-isolation and reverse transcriptase (RT)-PCR, Western blot analysis, and lactate dehydrogenase (LDH) specific staining. Results: B-cell type NHL patients were positive for PAX5, p53, Ras, CD19, Raf and CD3. All of them showed TUNEL-positive cells. The differential expression pattern of PAX5, CD19, p53, CD3, ZAP70, HIF1α, Ras, Raf and MAPK (mitogen-activated protein kinase) at the levels of transcripts and proteins was observed. The LDH assay showed modulation of LDH4 and LDH5 isoforms in the lymph nodes of NHL patients. Interpretation & conclusions: The histological observations suggested that the patients represent diverse cases of NHL like mature B-cell type, mature T-cell type and high grade diffuse B-cell type NHL. The findings indicate that patients with NHL may also be analyzed for status of PAX5, CD19 and ZAP70, and their transcriptional and post-translational variants for the differential diagnosis of NHL and therapy.

Clinico‑histopathological study of varicose vein and role of matrix metalloproteinases‑1, matrix metalloproteinases‑9 and tissue inhibitor of matrix metalloproteinase‑1 in varicose vein formation.

Background and Aims: Varicose vein (VV) is an important cause of morbidity in the young and elderly population. Many studies of the Western country suggest that matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs have a crucial role in the pathogenesis of VV, but limited work has been done in Indian population. The aim of this study is to study detailed histology of VV and to see the expression of MMP‑1, MMP‑9 and tissue inhibitor of matrix metalloproteinase‑1 (TIMP‑1). Materials and Methods: A total of 63 cases of VV and 10 control leg veins were included in this prospective study. Paraffin sections of VV were prepared. Hematoxylin and eosin (H and E), Masson trichrome and Verhoeff’s staining were performed. Immunohistochemistry of VV was done with MMP‑1, MMP‑9, and TIMP‑1 antibodies. Cytoplasmic expression of MMP‑1, MMP‑9 and TIMP‑1 were graded as intense positive (++), weak/slight positive (+), and absent (−). Results: Focal intimal thickening (47.6%), increased medial thickening (73%) and fragmentation of elastin fibers (84.1%) were the major histological changes noted in H and E and special stained sections. MMP‑1 expression increased in all layers of VV in 58 cases (92.1%) as compared to control veins. As compared to the control veins, intimal and adventitial expression of MMP‑9 were increased in 31 (49.2%) and 40 (63.5%) cases, respectively. Expression of TIMP‑1 was absent in both the varicose and the control veins. Conclusion: Increased expression of MMP‑1 and MMP‑9 suggests they have an important role in the pathogenesis of VV.

Phage therapy of staphylococcal chronic osteomyelitis in experimental animal model.

Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) are the commonest cause of osteomyelitis. The aim of this study was to evaluate the role of an alternative therapy i.e. application of S. aureus specific bacteriophages in cases of osteomyelitis caused by MRSA in animal model. Methods: Twenty two rabbits were included in this study. The first two rabbits were used to test the safety of phage cocktail while the remaining 20 rabbits were divided into three groups; group A (n=4) to assess the establishment of osteomyelitis; group B (n=4) osteomyelitis developed but therapy started only after six weeks; and group C (n=12) osteomyelitis developed and therapy started after three weeks. Groups B and C rabbits were treated with four doses of cocktail of seven virulent bacteriophages at the interval of 48 h. Comparison between three groups was made on the basis of observation of clinical, radiological, microbiological, and histopathological examinations. Results: Experimental group rabbits recovered from the illness in the subsequent two weeks of the therapy. Appetite and activity of the rabbits improved, local oedema, erythema and induration subsided. There were minimal changes associated with osteomyelitis in X-ray and histopathology also showed no signs of infection with new bone formation. Control B group rabbits also recovered well from the infection. Interpretation & conclusions: The present study shows a potential of phage therapy to treat difficult infections caused by multidrug resistant bacteria.

Gastrointestinal Stromal Tumors: Experience from a Single Surgical Unit.

Background: Gastrointestinal stromal tumors (GISTs) are rare tumors, but comprise the most common mesenchymal neoplasms of the gastrointestinal (GI) tract. We report a clinical series of abdominal GIST and discuss the diagnosis and management in Indian patients. Case Series: The data on demographic profile, clinical presentation and management of 12 cases of GIST from a single surgical unit in the last seven years were studied retrospectively. Preoperatively, ultrasonographic and computerized tomographic scans of the abdomen were the main investigations used for evaluation; the others being upper gastrointestinal endoscopy and X-ray of the chest. Histopathological examination and immunohistochemical evaluation were used to confirm the diagnosis. Results: The mean age at presentation was 47.9 years (range 35 – 70 years). Mean duration of symptoms was of 5 months (range 10 days–2 years). While all 12 patients presented with abdominal pain, 10 complained of abdominal lump. Two patients complained of vomiting and 1 of upper GI bleed. All patients were operated. In 7 cases, the GIST was arising from the ileum, 3 from the stomach and 2 from the mesentery. Nine cases had low grade benign tumors and 3 had malignancy. Conclusion: Abdominal pain and lump are the most common clinical symptoms of abdominal GIST. Vomiting, upper GI bleeding and weight loss are among the other important symptoms. Most of the tumors are benign and surgical resection remains the mainstay of treatment.

Rectifying calibration error of Goldmann applanation tonometer is easy.

Purpose: Goldmann applanation tonometer (GAT) is the current Gold standard tonometer. However, its calibration error is common and can go unnoticed in clinics. Its company repair has limitations. The purpose of this report is to describe a self‑taught technique of rectifying calibration error of GAT. Materials and Methods: Twenty‑nine slit‑lamp‑mounted Haag‑Streit Goldmann tonometers (Model AT 900 C/M; Haag‑Streit, Switzerland) were included in this cross‑sectional interventional pilot study. The technique of rectification of calibration error of the tonometer involved cleaning and lubrication of the instrument followed by alignment of weights when lubrication alone didn’t suffice. We followed the South East Asia Glaucoma Interest Group’s definition of calibration error tolerance (acceptable GAT calibration error within ±2, ±3 and ±4 mm Hg at the 0, 20 and 60‑mm Hg testing levels, respectively). Results: Twelve out of 29 (41.3%) GATs were out of calibration. The range of positive and negative calibration error at the clinically most important 20‑mm Hg testing level was 0.5 to 20 mm Hg and ‑0.5 to ‑18 mm Hg, respectively. Cleaning and lubrication alone sufficed to rectify calibration error of 11 (91.6%) faulty instruments. Only one (8.3%) faulty GAT required alignment of the counter‑weight. Conclusions: Rectification of calibration error of GAT is possible in‑house. Cleaning and lubrication of GAT can be carried out even by eye care professionals and may suffice to rectify calibration error in the majority of faulty instruments. Such an exercise may drastically reduce the downtime of the Gold standard tonometer.

Primary subcutaneous mixed-type liposarcoma of the thigh showing three simultaneous dedifferentiations: Report of an unusual case.

Liposarcoma most commonly occurs in deep soft tissues of the limb and the retroperitoneum; however, its occurrence in the subcutaneous tissue is rare. Mixed-type liposarcoma (MTL) is the rarest subtype. We herein describe a unique case of MTL with three simultaneous dedifferentiations occurring in subcutaneous tissue of left thigh in a 45-year-old male. We briefl y review the pertinent literature and report this case because of extreme rarity.

Healing effect of terminalia chebula fruit extract on trinitrobenzene sulfonic acid induced colitis in rat.

The present study aims to evaluate healing effect of 50% ethanolic extract of Terminalia chebula fruit pulp (TCE) on trinitrobenzene sulfonic acid (TNBS, intra-colonic route) induced colitis in rats. TCE (600 mg/kg, oral) was studied in TNBS-induced colitis for its effects on fecal output, food and water intake and body weight changes, histology, antibacterial activity and levels of free radicals (nitric oxide and lipid peroxidation), antioxidants (superoxide dismutase; catalase and reduced glutathione) and acute inflammatory marker (myeloperoxidase) in colonic tissue. TNBS administration increased colonic mucosal damage and inflammation (macroscopic and microscopic) and stool output but decreased body weight which was reversed by TCE treatment. TCE showed significant antibacterial activity and enhanced the antioxidants but decreased free radicals and myeloperoxidase activities affected in TNBS colitis. Thus, Terminalia chebula dried fruit pulp extract healed colitis by promoting antioxidant status and decreasing intestinal bacterial load, free radicals and myeloperoxidase responsible for tissue damage and delayed healing.

Healing effects of Aegle marmelos (L.) Correa fruit extract on experimental colitis.

Graded doses of 50% ethanolic extract of dried fruit pulp of Aegle marmelos (AME) (100, 200 and 400 mg/kg) daily for 14 days in acetic acid (AA)-induced colitis in rats showed 200 mg/kg of AME as an optimal effective dose against AA-induced colonic damage score and weight. This dose (200 mg/kg; po) was further studied in AA-induced colitis for its effects on various physical (mucous/blood in stool, food and water intake and body weight changes), histology, antibacterial activity and biochemical parameters like free radicals (nitric oxide and lipid peroxidation), antioxidants (superoxide dismutase, catalase and reduced glutathione) and myeloperoxidase (acute-inflammatory marker) activities in rat colonic tissue. AME decreased colonic mucosal damage and inflammation (macroscopic and microscopic), mucous/bloody diarrhea, fecal frequency and increased body weight affected in AA-induced colitis. AME showed significant antibacterial activity and enhanced the antioxidants but decreased free radicals and myeloperoxidase activities thereby decreasing tissue damage and inflammation and thus, affording ulcer healing. The above effects of A. marmelos authenticated its use in indigenous system of Medicine.

Efficacy of diltiazem as an adjunct to lignocaine in intravenous regional anesthesia

Various adjuncts have been used with lignocaine to decrease tourniquet pain and prolong post-operative analgesia during intravenous regional anesthesia [IVRA]. Calcium-channel blockers potentiate the analgesic effect of local anesthetics. This study was designed to evaluate the efficacy of diltiazem as an adjunct to lignocaine in IVRA with respect to tourniquet tolerance, perioperative analgesia, and quality of anesthesia. In this prospective, randomized, and double-blind study, 40 patients [American Society for Anesthesiologists grade I/II] undergoing elective hand surgery under IVRA were assigned into two groups of 20 each and administered IVRA either with lignocaine 3 mg/kg [group Lignocaine [L]] or lignocaine 3 mg/kg plus diltiazem 0.2 mg/kg [group Lignocaine-Diltiazem [LD]] with normal saline [total volume-40 ml]. Hemodynamic parameters, onset of the complete sensory blockade, motor blockade, and intraoperative [tourniquet pain] and post-operative Visual Analogue Scale scores, total intraoperative and consumption of post-operative fentanyl intraoperative were recorded. Sensory block was established in 2.5 +/- 0.688 min in group LD verses 5.60 +/- 0.851 min in group L. Motor blockade was established in 8.65 +/- 0.933 min in group LD and 13.46 +/- 0.604 min in group L. The mean VAS scores >3 were attained early at 30 min [3.1 +/- 0.912] in group L. Patients in group L requested early rescue analgesic at 30 +/- 8.633 min compared with 49.64 +/- 7.958 min in group LD. Diltiazem as an adjunct to lignocaine provided enhanced intraoperative and post-operative analgesia without any significant side effects

Primary high-grade testicular leiomyosarcoma.

We herein present an extremely rare occurrence of primary intratesticular leiomyosarcoma. A 65-year-old patient presented with painless enlargement of the right testis. A high inguinal orchiectomy was done. Histopathological examination of the excised mass was consistent with high-grade leiomyosarcoma. Pertinent literature is reviewed and the importance of excluding the germ cell tumor and the paratesticular neoplasm is emphasized.

Metabolic syndrome – prevalence and significance of its detection in selected population in pondicherry.

Obesity by itself is not an immediate lethal disease, however, it is a significant risk factor associated with a range of serious noncommunicable diseases. Our aim is to find out the prevalence of metabolic syndrome in interns coming from higher socioeconomic class. Sixty one interns participated in the study. BMI, WHR and blood chemistry were performed. EGIR criteria were considered to identify the metabolic syndrome. According to EGIR criteria, insulin resistance was found in 24.5% cases and metabolic syndrome exists in 14.7% of overweight/obese interns. Insulin resistance as per HOMA-IR was found in 6% of those having metabolic syndrome. High diastolic blood pressure, low HDLc are prone to develop metabolic syndrome by six times where as an increase in WHR (central obesity) particularly in male are eleven times more prone to develop metabolic syndrome. Abbreviations :–EGIR – European Group for Insulin Resistance, HOMAIR – Homeostasis model assessment for insulin resistance (HOMA-IR), WHR – waist hip ratio. HDLc–HDL cholesterol.

Spinal cord hamartoma with pseudopancreatic cyst.

A 2-year-old boy presented with weakness of both lower limbs with bladder and bowel involvement and history of frequent falls. Magnetic resonance imaging of the spine revealed a T2 altered signal intensity enhancing mass lesion seen in the spinal epidural space extending from sixth cervical to fourth thoracic vertebrae, which was compressing the adjacent spinal cord. Histopathology of the lesion was suggestive of hamartoma. A brief review of the literature including its embryogenesis is discussed here. The child subsequently developed pseudopancreatic cysts possibly because of repeated falls leading to blunt trauma abdomen.

Effect of ethanolic extract of Eugenia jambolana seeds on gastric ulceration and secretion in rats.

Eugenia jambolana (Jamun) fruit has been reported to give soothing effect on human digestive system. Present study includes the effect of ethanolic extract of seeds of E. jambolana (EJE) against gastric ulcers induced by 2 h cold restraint stress (CRS), aspirin (ASP, 200 mg/kg, 4 h), 95% ethanol (EtOH, 1 ml/200 g, 1 h) and 4 h pylorus ligation (PL) in rats. To ascertain the mechanism of action of EJE, its effect was studied on mucosal offensive acid-pepsin secretion, lipid peroxidation (LPO, free radical) and defensive mucin secretion, cell proliferation, glycoprotein and glutathione (GSH, an antioxidant). Acute and subacute toxicity studies were also conducted for the safety profile of Eugenia jambolana. EJE 200 mg/kg, when administered orally for 10 days in rats was found to reduce the ulcer index in all gastric ulcer models. It tended to decrease acid-pepsin secretion, enhanced mucin and mucosal glycoprotein and decreased cell shedding but had no effect on cell proliferation. It showed antioxidant properties indicated by decrease in LPO and increase in GSH levels in the gastric mucosa of rats. Acute toxicity study indicated LD50 to be more than 10 times (>2000 mg/kg) of the effective ulcer protective dose while subactue toxicity study (>1000 mg/kg) indicated no significant change in the general physiological and haematological parameters, liver and renal function tests. The result of the present study indicates that E. jambolana seed has gastro-protective properties mainly through promotion of mucosal defensive factors and antioxidant status and decreasing lipid peroxidation.

Adenoid cystic carcinoma of ceruminous gland: a case report.

Adenoid cystic carcinoma of the external auditory canal (EAC) is a very rare malignant tumor and its diagnosis is frequently missed because of the superficial nature of biopsies. A 30 year old male presented with 6 months history of recurrent painful right ear discharge. On examination there was a nodule of 2 cms in diameter. The microscopic examination of the punch biopsy specimen of tumor revealed typical features of an adenoid cystic carcinoma. While reporting the biopsies of external auditory canal one should keep the adenoid cystic carcinoma as one of the possible differentials, especially if the biopsy is superficial, problem is recurrent and histopathological features suggest the granulation tissue.

Two-port and single port laparoscopic appendicectomy.

Minimally invasive surgery for appendicectomy generally involves use of 3 or 4 ports. But if the procedure can be safely performed using two or even a single port, it would be beneficial to the patient, since it is less invasive than standard procedure. The present article describes an experience of laparoscopic appendicectomy using only two ports and occasionally a single port and highlights its efficacy and safety.

Residual breast tissue in the skin flaps after Patey mastectomy.

BACKGROUND & OBJECTIVES: Patey mastectomy implies complete removal of breast tissue. Likely area where residual breast tissue may be left is under the skin flaps. There is no study examining left over breast tissue under the Patey mastectomy skin flap. The present study was undertaken to study the presence of residual breast tissue in skin flaps after Patey mastectomy in patients with breast cancer. METHODS: In 37 patients of breast cancer undergoing Patey mastectomy, biopsy from under the skin flap at central point of 4 quadrants (upper outer, upper inner, lower inner and lower outer), 3 cm from cut margin of skin was taken to examine for residual breast tissue. RESULTS: In 8 of 37 (21.6%) cases residual breast tissue and in 3 of these (37.5%) tumour tissue was found under the skin flap. INTERPRETATION & CONCLUSION: Overall in 21.6 per cent biopsies from under the skin flap revealed information of probable therapeutic importance. This information may in future serve as an additional prognostic factor to consider irradiation to reduce the incidence of local recurrence in flap positive patients.