Carcinoembryonic antigen (CEA) and other surrogate inflammatory biomarkers in COVID-19

It has been two years since the global outbreak of the highly contagious and deadly corona virus disease (COVID-19) caused by SARS-CoV-2 first emerged in China. Since then, various diagnostic, prognostic and treatment strategies undertaken to address the pandemic have been dynamically evolving. Predictive and prognostic role of various biomarkers in COVID-19 has been a subject of intense exploration. We aimed to determine the association of Carcinoembryonic antigen (CEA) and various surrogate inflammatory biomarkers with the severity of COVID-19 disease. This retrospective cohort study was carried out on 98 patients admitted in Jaypee Hospital, Noida with COVID-19 disease. Information regarding demographics, laboratory parameters and clinical history was collected from Hospital Information System. Serum levels of CEA and other biomarkers such as Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), Ferritin, and Procalcitonin (PCT) were assessed. Correlation analyses were performed between the parameters and acute respiratory distress syndrome (ARDS) stages. Logistic regression and ROC curve analysis were performed to assess the various parameters for distinguishing COVID-19 patients requiring ICU admission. Mean hospital stay, NLR, CEA, IL-6, CRP, Ferritin (P< 0.0001) and PCT (P =0.01) were significantly higher in ICU patients when compared to general ward patients. NLR, median serum CEA, IL-6, and CRP levels were significantly higher in non-survivor compared to the survivors (P< 0.0001, 0.0341 and 0.0092). CEA correlated well with disease severity based upon ARDS classification and was a better marker to differentiate patient according to ARDS stages (ARDS 0 vs 2 P= 0.0006; 0 vs 3 P< 0.0001; ARDS 1 vs 2 P= 0.0183; 1 vs 3 P=0.0006). The area under the Receiver operating characteristic (ROC) curve for CEA was 0.7467 (95% CI- 0.64885- 0.84459) which revealed the potential of CEA as a biomarker to distinguish COVID-19 patients requiring ICU admission. CEA can be used to predict the severity of COVID-19 associated ARDS as well as patients requiring ICU admission. Along with routine inflammatory biomarkers (NLR, CRP, IL-6, PCT, and ferritin), CEA should be used for early identification of critical COVID-19 positive patients and for assessing prognosis.

Assessment of Incidence and Risk Factors of Dry Socket

Background: Alveolar osteitis (AO) is one of the extractions wound healing disorder. Most authors agree that surgical trauma and difficulty of surgery play a significant role in the development of AO. Hence, under the light of above - mentioned data, the present study was undertaken for assessing the incidence and risk factors of dry socket. Methods: A total of 200 subjects scheduled to undergo dental extraction procedures under local anesthesia were included in the p resent study. Complete demographic and clinical details of all the patients were obtained. All the procedures were carried out under the hands of experienced surgeons. Follow - up was done and incidence of dry socket was recorded. Results: Overall, incidenc e of dry socket in the present study was 17.5 percent. Positive tobacco smoking/chewing habit, Oral contraceptives, Female gender, Existing tooth/gum infection, Past history of dry socket, Traumatic extraction and Mandibular molar extraction were the risk factors in 62.85 %, 34.28 %, 71.42 %, 14.28 %, 25.71 %, 42.85 % and 54.28 % of the patients. Conclusion: Dry socket is a commonly encountered phenomenon and can occur the under the hands of skilled and experienced oral surgeons also. Hence, early recogniti on is necessary.

Level of C-reactive Protein in Obese and Overweight Individuals at Indira Gandhi Institute of Medical Sciences: A Tertiary Care Center of Bihar

Introduction: Human adipose tissue releases interleukin-6 which is a pro-inflammatory cytokine that causes low-grade systemicinflammation. Acute-phase C-reactive protein (CRP) is a sensitive marker for systemic inflammation. Low-grade systemicinflammation in overweight and obese can be measured by serum CRP level.Objective: The objective of this study was to find out the prevalence of raised serum CRP level among the obese and overweightperson.Materials and Methods: Overweight and obese persons were screened for raised CRP (≥3.0 mg/L) after excluding comorbidity.Results: The prevalence of raised CRP among obese and overweight is 23%, the female has higher prevalence of 25.45% ascompared to male 20%. The prevalence among overweight and obese participants is 18.88% and 60%, respectively.Conclusions: The finding suggest a higher prevalence of low-grade systemic inflammation in obese as compared to anoverweight person.

Role of propranolol in the management of infantile hemangioma

Background: Infantile hemangiomas are the most common benign soft tissue tumor of infancy and childhood occurring 4-10% of all infants. It is more frequent in premature children (23% of infants <1200g) and females (3:1 to 5:1). For many hemangiomas treatment is not required, however hemangioma in some locations need treatment to prevent complication. The Present study was done with an Aim to assess the efficacy and safety of oral Propranolol in management of infantile heamangioma in our set-up.Methods: This study was conducted from May 2016 to Nov 2017 at Department of Surgery and Pediatrics, M.L.B. Medical College, Jhansi after obtaining Ethical permission. Patients having confirmed were recruited & admitted for initiation of Oral Propranolol therapy for 5 days under the observation of Paediatrician. Oral Propranolol treatment was continued till the age of 11/2 years. A clinical assessment was made at each visit to the Outpatients Clinic every four weeks.Results: The incidences of infantile hemangioma were more in age group (0-7 months) i.e 55% (22 patients) followed by age group of (8-15 days) i.e. 30% (12 patients). As age advances presentation gradually decreases as after 30 days incidence is only 5%. Infantile hemangioma were more common in females’ patients (55% patients) & mostly 90% (36 patients) present as single lesion and only 10% (4 patients) present as multiple lesions. Most of hemangiomas presented as reddish in color 80% (32 patients) which reflected lesions are mostly superficial & only 10% were brownish red and 10% skin color indicated incidence of deeper penetration.Conclusion: Authors found that drug (Propranolol) to be effective even at low dose of 1mg/kg/day. In our study group it was effective and safe in almost all patients.

Evaluation of oral health of 6 to 10-year-old asthmatic children receiving bronchodilator through inhaler

Aim: The aim of this study was to evaluate the oral health status in 6 to 10-year-old asthmatic children receiving bronchodilator (salbutamol, salmeterol, etc.) through inhaler and compare them with nonasthmatic healthy children. Settings and Design: The present study was carried out at pediatric and pedodontic department and neighboring government school. It was an observational and case–control study. Statistical Analysis: All data were analyzed using SPSS 20.0 software program and presented as mean ± standard error of mean. Chi-square test was used for the categorical data between groups. Numerical data were analyzed by Mann–Whitney U-test and t-test. Kruskal–Wallis test was performed for comparisons of median value of decayed, missing, filled surface and Decayed, Missing, Filled Surface (dmfs and DMFS) for different variables within asthmatic group. Mann–Whitney U-test for multiple comparisons and P value was adjusted according to Bonferroni correction. Negative binomial analysis was used to calculate adjusted dmfs and DMFS, and univariate analysis of variance was used for adjusted mean plaque and gingival index. Materials and Methods: The study group composed of 70 asthmatic and 70 nonasthmatic children with the same age and social background aged between 6 and 10 years old. Oral health status was assessed using caries, plaque, and gingival index. Dental caries examination was done using the WHO criteria (1997), plaque index by Silness and Loe in 1964 and gingival health by Loe and Silness in 1963. Results: The children in the asthmatic group had significantly higher caries prevalence, severity of dental plaque, and gingivitis compared with the nonasthmatic group. Plaque accumulation and gingivitis increased significantly as severity and duration of asthma increased. Conclusions: Bronchial asthma had an overall deleterious effect on caries prevalence and severity, plaque, and gingivitis on primary and permanent teeth.

Vaginal Bacterial Profile in Buffaloes Following Treatment with Progesterone Insert

The objective of this study was to characterize the vaginal bacterial flora and subsequent conception rates after AI in buffaloes subjected to 3 different estrous induction regimes-the use of CIDR and use of two intravaginal sponges (Polyurethane sponges with micronized progesterone and Polyurethane sponges with micronized progesterone with Carboxy methyl cellulose). The estrus induction was 100% in Group I and II followed by 91.67 % in group III. The pregnancy rates were Group I, II and III were 50.00, 66.67 and 54.55% respectively. All the vaginal swabs in all three groups yielded growth of bacteria and the predominance of mixed isolates over single isolates 81.94% vs 18.06% was indicative of dominance of mixed culture over single isolates. E. coli, Staphylococcus, Proteus and Klebsiela spp. were the commonest isolates obtained prior to insertion and after removal of implants in postpartum anestrus buffaloes. The gram positive bacteria were Staphylococcus, Streptococcus and Bacillus spp. while, gram negative bacteria were E. coli, Proteus and Klebsiella spp. These organisms could be considered as a part of the normal bacterial flora of the buffalo

Acceptance And Impact Of Integrated Teaching In Undergraduate Medical Student: An Observational Cross- Sectional Study.

Background & Objective: Among various method of medical education integrated teaching help in integration of basic, clinical and psychosocial sciences. Integrated teaching involves bringing together traditionally separate subjects so that students can grasp subject with more authentic understanding. We conducted the study to compare this scientific method of teaching with traditional learning and also obtained student’s and teacher’s feedback. Methodology: After approval from ethic committee faculty members from various departments we arranged integrated teaching program on important topic. Basic science faculty were made toparticipate actively in both case based learning and hospital visits along with clinical experts. The completed program was evaluated based on structured questionnaire and student and teacher feedback. Results: Among 58 students of 8th semester students, Pre test (TL) and post test (IL) mean of incorrect answers out of 10 structured questionnaires were 4.5517 and 2.9310. There was 35.5% improvement in result after integrated method of learning. 63% of faculty members felt that integrated teaching could be very useful. 85% students were enthusiastic about the new teaching methodology& felt that they had a better clinico pathological correlation. Conclusion: The new method of integrated teaching was found to be more effective than the traditional one. This method was well accepted by faculty as well as students. So it is need of today’s medical curriculum.

Isolation, serotype diversity and antibiogram of Salmonella enterica isolated from different species of poultry in India

Objective:To study the occurrence and serotype diversity of Salmonella isolates in different species of poultry (chicken, emu and duck) and determine their resistance pattern against various antibiotics of different classes. Methods:About 507 samples comprising 202 caecal contents and 305 fecal samples from chicken, emu and duck were processed for isolation of Salmonella enterica. Salmonellae were isolated and detected by standard protocol of ISO 6579 Amendment 1:Annex D. Genetic confirmation was also made by using 16S rRNA genus specific PCR. Serotype specific PCR was also done to detect the most common serovars viz. Salmonella Enteritidis, Salmonella Typhimurium and Salmonella Gallinarum. All obtained isolates were subjected to a set of 25 antibiotics to study their antibiogram by using Baeur-Kirby disk diffusion method. Results:Out of 507 samples processed, 32 isolates of Salmonella enterica (18 from caecal contents and 14 from faecal samples) were obtained, of which 24 belonged to 6 different serovars, 6 were untypeable and 2 were rough strains. Salmonella Enteritidis was the most predominant serotype (9), followed by Salmonella Typhimurium (5), Salmonella Virchow (4), Salmonella Gallinarum (3), Salmonella Reading (2) and Salmonella Altona (1). Antibiotic resistance pattern was maximum (100%) to oxacillin, penicillin and clindamycin, followed by ampicillin (68.75%), tetracycline (65.62%), nalidixic acid (56.25%) and colistin (46.87%). High sensitivity of isolates was recorded for chloramphenicol (96.87%) followed by meropenem (84.37%). Conclusions:Occurrence of high proportion of serovars in our study which can cause serious gastroenteritis in humans is a matter of concern. Salmonella Altona has been detected for the first time in India from poultry. This serotype is known to cause serious outbreaks of gastroenteritis in humans. Multidrug resistant isolates were recovered at high percentage which can be attributed to non-judicious use of antibiotics both in prophylaxis and treatment regimen. This observation draws serious attention as poultry serves as an important source of transmission of these multidrug resistant Salmonella serovars to humans.

Cancer stem cell: A rogue responsible for tumor development and metastasis.

Cancer stem cells are a small population of cells in a tumor. They have the ability to self-renew and maintain the tumor. The most apt and accepted hypothesis for tumor development is Cancer Stem Cells. This review focuses on this concept of cancer stem cells, serving their purpose and leading to the development of tumor. There are many cell biomarkers which have been described for the identification and characterization of cancer stem cells. The most prominent of the cellular markers for the detection of cancer stem cells; CD133, CD44, ALDH-1 along with some others have been discussed in detail in this review.

A survey of prescribing pattern for osteoarticular tuberculosis: Orthopaedic surgeons’ and infectious disease experts’ perspective.

Introduction: This study examines the perspective of senior orthopaedic faculty and infectious disease experts from the Indian subcontinent and other countries on the appropriate duration of multi drug antitubercular chemotherapy in osteoarticular tuberculosis. Material and methods: A questionnaire regarding what antitubercular drugs, their dosage and for how long was asked to attending faculty in an International Conference on musculoskeletal infections. Results: Thirty different prescriptions were obtained from a total of 52 respondents. Forty-two respondents voted against short course (6 months) regimen. The mode value for duration of treatment with isoniazid and rifampicin treatment in the study was 12 months; for pyrazinamide, it was three months. There was almost no consensus over the duration of treatment with ethambutol. Conclusion: There is a strong need to assess long term impact of DOTS in osteoarticular tuberculosis to facilitate the National Tuberculosis Programme planning, uniform training, wider acceptance, drug ordering and distribution. An effective communication between those planning national tuberculosis programmes and experts in osteoarticular tuberculosis is essential for universal acceptance of the management protocols.

International Health Regulations A Major Paradigm Shift from 1969 to 2005.

The International Health Regulations (IHR 1969), replaced by IHR 2005 had been adopted by the World Health Assembly on 23 May 2005 and came into force on 15 June 2007. IHR 2005 are a legally binding agreement among World Health Organisation (WHO) member states and other states that have agreed to be bound by them. New revision was necessitated by concerns about increasing global health threats and the need to respond with more effective surveillance and control practices. The limitations of IHR 1969, which led to their revision, related to their narrow scope, their dependence on official country notifications, and their lack of a formal internationally coordinated mechanism to contain international disease spread. The IHR 2005, which is firmly based on practical experiences, has broaden the scope of IHR 1969 to cover existing, new and re-emerging diseases, including emergencies caused by non-infectious disease agents.

Platelet glycoprotein IIb/IIIa inhibitors in acute ischemic stroke.

Acute ischemic stroke (AIS) is a common cause of morbidity and mortality worldwide. Thrombolytic therapy with tissue plasminogen activator, the only approved treatment for AIS, is received by less than 2% of patients. Moreover, there is a slight increase in hemorrhagic complications with thrombolysis. Therefore, there is a need for newer therapeutic modalities in AIS, which could be used in window periods beyond 3-6 h after stroke onset with fewer hemorrhagic complications. Glycoprotein IIb/IIIa inhibitors (GPI), after their initial success in patients with acute coronary syndromes, promised much in patients with AIS over the past decade or so. However, their exact role in patients with AIS, including the window periods and type of strokes, and the risk of symptomatic or asymptomatic hemorrhage are unclear at the moment. The current review focuses on the literature concerning the use of GPI in AIS and looks at the available evidence regarding their use. Abciximab thought to be safe and effective in initial case series and early trials, has not been shown to improve outcomes in AIS, and is associated with higher rates of hemorrhage. Tirofiban appears to be safe and effective in initial trials and there is a need to conduct further trials to establish its role in AIS.

Reversible electrophysiological abnormalities in hypokalemic periodic paralysis.

Compound muscle action potential (CMAP) amplitude declines during a paralytic attack in patients with hypokalemic periodic paralysis (HPP). However, serial motor nerve conduction studies in HPP have not been commonly reported. We report a 9 year old girl with HPP, who had severely reduced CMAPs in all motor nerves at presentation during the episode of quadriparesis. However, the amplitude of CMAPs increased and reached normal levels as the serum potassium concentration and motor power returned to normal state.

Cranial nerve involvement in patients with leprous neuropathy.

BACKGROUND: Leprosy is one of the most common causes of peripheral neuropathy, perhaps closely matched by diabetic neuropathy. Patterns of peripheral neuropathy in leprosy can be varied, which may include mononeuropathy, mononeuritis multiplex and symmetric polyneuropathy. Cranial nerves, especially facial and trigeminal nerves, are also commonly involved in leprosy. AIMS: To find out the pattern and spectrum of cranial nerve involvement in a consecutive series of patients with leprous neuropathy. SETTINGS AND DESIGN: A retrospective review of patients admitted with leprosy to the Neurology Department of a tertiary care center. MATERIALS AND METHODS: All consecutive patients admitted during an 8-year period (1995-2003) and diagnosed to have leprosy were included. They were clinically evaluated to determine the frequency and pattern of cranial nerve involvement. RESULTS: About 18% (9/51) of the leprosy patients seen during that period had clinical evidence of cranial nerve involvement. Facial and trigeminal nerves were the most commonly affected (five and four patients respectively). CONCLUSIONS: Cranial nerve involvement is common in leprosy, which emphasizes the need to carefully examine them. Also, one should exclude leprosy in patients presenting with isolated cranial neuropathies.

Clozapine-responsive cluster headache.

Headaches are commonly associated with various psychiatric disorders. The comorbidity of migraine and psychiatric disorders has been well documented. Here we present a case of schizophrenia with comorbid headache treated with clozapine. The patient's headache fulfilled the diagnostic criteria for cluster headache (CH). To our knowledge this is the first report of CH responding to clozapine therapy. The relationship of headache and psychiatric disorders is a matter of debate and there has been very little research on the aspect of causality or direction of causation. The response of both the conditions to a serotonin-dopamine antagonist such as clozapine might be important in giving newer insights into the pathogenesis of these disorders. It also has the clinical implication of being useful in patients with dual diagnosis.

Hypomania as an aura in migraine.

We report a 19-year-old man presenting to the department of Psychiatry for the evaluation of prominent behavioral symptoms associated with episodic headaches, with normal inter-episodic periods. A diagnosis of classic migraine with hypomanic aura was made. Other possible co-morbid or causative illnesses were excluded and preventive therapy with valproate was started due to the prominent affective symptoms as a part of the migranous aura. With this the frequency of headaches gradually decreased over the next four months. He was followed up for 2 years when he was found to be symptom-free. Recent research into the mechanisms of migraine has identified that the cortical hyperexcitability and an imbalance between neuronal inhibition and excitement mediated by gamma-aminobutyric acid and excitatory amino acids respectively may be the underlying mechanism. The high rate of affective disorders in patients with migraine, association of migraine with an aura comprising of mood symptoms and good response to treatment with mood-stabilisers might give newer insights into the pathophysiology of mood disorder as well.