Etiology and incidence of infection in Mechanically Ventilated Medical Intensive Care Unit Patients in a Tertiary Care Hospital

Introduction@#Intensive care unit (ICU) patients are at the greatest risk of acquiring nosocomial infections, partly because of their serious underlying disease, but also by exposure to life-saving invasive procedures. Hospital-acquired infections increase patient morbidity, increase the length of hospital stay and hospital costs, and also increases mortality rate. The basic knowledge of organisms infecting ICU patients is very important to empirically select appropriate antibiotics, so that the most likely infecting organisms are addressed.@*Objective@#The aim of the study was to find out the etiologic agents causing infection in medical intensive care unit patients.@*Results@#In our study of 289 patients, 180 (62.3%) showed a growth of organism during the stay in ICU. The most common site of infection was the respiratory tract in 138 patients (47.8%) with 60 patients (20.8%) showing Acinetobacter baumannii.

Vitamin D status among Kashmiri tribal population: A cross-sectional community-based study

Background & objectives: Vitamin D deficiency (VDD) is prevalent across all age groups in general population of India but studies among tribal populations are scanty. This study aimed to evaluate the prevalence of VDD in the indigenous tribal population of the Kashmir valley and examine associated risk factors. Methods: In this cross-sectional investigation, a total of 1732 apparently healthy tribal participants (n=786 males and n=946 females) were sampled from five districts of Kashmir valley by using probability proportional to size method. Serum 25-hydroxy vitamin D (25(OH)D) levels were classified as per the Endocrine Society (ES) recommendations: deficiency (<20 ng/ml), insufficiency (20-30 ng/ml) and sufficiency (>30 ng/ml). The serum 25(OH)D levels were assessed in relation to various demographic characteristics such as age, sex, education, smoking, sun exposure, body mass index and physical activity. Results: The mean age of the male participants was 43.79±18.47 yr with a mean body mass index (BMI) of 20.50±7.53 kg/m2, while the mean age of female participants was 35.47±14.92 yr with mean BMI of 22.24±4.73 kg/m2. As per the ES guidelines 1143 of 1732 (66%) subjects had VDD, 254 (14.71%) had insufficient and 334 (19.3%) had sufficient serum 25(OH)D levels. VDD was equally prevalent in male and female participants. Serum 25(OH)D levels correlated positively with serum calcium, phosphorous and negatively with serum alkaline phosphatase. Gender, sun exposure, altitude, physical activity and BMI did not seem to contribute significantly to VDD risk. Interpretation & conclusions: VD deficiency is highly prevalent among Kashmiri tribals, although the magnitude seems to be lower as compared to the general population. These preliminary data are likely to pave way for further studies analyzing the impact of vitamin D supplementation with analysis of functional outcomes

Obesity, A Risk Factor for Mortality in SARS CoV-2 Infection: A Narrative Systematic Review

SARS CoV-2 is a ?-coronavirus responsible for the current COVID-19 pandemic. Although there is increase severity and mortality described in the elderly population and people with co-morbidities, all age groups are susceptible to COVID-19. Recent data showed that obesity has also emerged as a significant risk factor for COVID-19 mortality. As per the WHO, most of the world's population lives in countries where obesity is highly prevalent. In this context, we aimed to review various studies that showed obesity as an independent risk factor for mortality in SARS CoV-2 infection. We followed the PRISMA guidelines to search for two databases including PubMed and Google Scholar using the key terms “COVID-19, OBES* and MORTALITY,” SARS CoV-2, OBES* and MORTALITY” “COVID-19, OBESITY, and MORTALITY,” SARS Cov-2, OBESITY and MORTALITY,” respectively, up to August 3, 2020. Twelve studies were finally included in this review after applying inclusion and exclusion criteria. All 12 studies included in the review consistently showed that obesity is a risk factor for mortality in patients with SARS CoV-2 infection. These studies have also shown evidence that obesity leads to increased hospitalization, ICU admission, increased need for mechanical ventilation, and poor prognosis among patients with SARS CoV-2 infection. Obesity is an independent risk factor for mortality in patients infected with this novel coronavirus. Appropriate triage, monitoring, and vigilance are required while dealing with individuals with obesity with SARS CoV2 infection, especially in the young obese population. More epidemiological studies need to be done taking BMI also into consideration in COVID-19 patients to find the exact cause of increased severity and mortality and develop appropriate preventive and therapeutic strategies.

Review on the In Vitro Cytotoxicity Assessment in Accordance to the International Organization for Standardization (ISO)

@#Cytotoxicity is a predominant biological evaluation applied to search for a suitable and non-toxic bioactive compound and to determine the biocompatibility of medical devices-related human body. The broad usage of cytotoxicity tests leads to a robust establishment of cytotoxicity assays with high sensitivity and prompt results. In vitro assays are always prioritized over in vivo due to the reproducible data, reduce numbers of animal used and easily accessible material. Compounds concentration that execute 50% of cell population is determined by calculating the IC50. According to ISO10993, cytotoxicity tests must be performed to determine the biocompatibility of medical devices that has contact with human body. This is crucial to ensure the safety of research and its clinical use. Under the recommendation of ISO10995-Part 5, three categories of tests have been documented; extract elution, direct contact and indirect contact test. Each category plays significant role depending on the nature of experiment and sample used.

Post-transcriptional gene silencing: Basic concepts and applications

Post-transcriptional gene silencing (PTGS)-mediated gene silencing exploits the cellular mechanism whereintranscripts having sequence similarity to the double-stranded RNA (dsRNA) molecules present in the cell will besubjected to degradation. PTGS is closely related to natural processes such as RNA-mediated virus resistance andcross-protection in plants. Gene silencing and the cellular machinery for affecting this phenomenon might haveevolved as a natural protective measure against viral infection in plants. In PTGS, small interfering RNA (siRNA)molecules of 21–23 nucleotides length act as homology guides for triggering the systemic degradation of transcriptshomologous to the siRNA molecules. PTGS phenomenon, first discovered in transgenic petunia plants harbouringchalcone synthase gene and termed co-suppression, has been subsequently exploited to target specific gene transcripts for degradation leading to manifestation of desirable traits in crop plants. Targeted gene silencing has beenachieved either through the introduction of DNA constructs encoding dsRNA or antisense RNA or by deploying cosuppression constructs producing siRNAs against the transcript of interest. Understanding the mechanism of genesilencing has led to the development of several alternative strategies for inducing gene silencing in a precise andcontrolled way. This has paved the way for using PTGS as one ofthe chief functional genomicstools in plants and hashelped in unraveling the mechanism of many cellular processes and identifying the focal points in pathways, besides,opening new vistas in genetic engineering of plants for human benefits. PTGS has shown great potential in silencingthe deleterious genes efficiently so that value-added plant products could be obtained. Thus, PTGS has ushered in anew era in the genetic manipulation of plants for both applied and basic studies. In this review, we have outlined thebasics of RNAi-mediated gene silencing and summarized the work carried out at our institute using this approach, ascase studies. In particular, adopting RNAi-mediated gene silencing (a) as a method to restore fertility in transgenicmale sterile lines developed based on orfH522 gene from sunflower PET1-CMS source, (b) as a tool to suppress theproduction of toxic proteins, ricin and RCA, in castor, and (c) as an approach to induce bud necrosis virus resistancein sunflower has been discussed. Examples from other plant systems also have been mentioned to exemplify theconcept and utility of gene silencing in crop plants.

Bilateral Pheochromocytoma Masquerading as Acute Severe Congestive Heart Failure in a Juvenile Male Subject: A Case Report and Review of Literature

Introduction: Pheochromocytomas are rare neuroendocrinetumours of the adrenal medulla that do not always presentwith classical triad of headache, palpitations and diaphoresisalong with paroxysmal or sustained hypertension. Herein wepresent a case of young boy with pheochromocytoma whopresented initially with congestive cardiac failure with noother significant manifestation.Case report: A 17 -year-old boy was admitted in ouremergency with 2 months history of unevaluated headacheand one day history of breathlessness along with syncopalattacks. His initial clinical evaluation was suggestive ofcongestive cardiac failure (CCF) with hypotension. Afterinitial stabilization he was shifted to intensive care unit (ICU)where his echocardiography revealed dilated cardiomyopathywith severe mitral regurgitation. Because of young ageof presentation and no past significant medical historyneuroendocrine cause for cardiac illness was suspected.Further investigations revealed grossly elevated levels ofnormetanephrines in 24-hour urine collection. Imaging studiesincluding ultrasonography followed by computed tomographyof abdomen and I123 MIBG confirmed presence of bilateralpheochromocytoma. An open bilateral adrenalectomywas performed successfully after initial stabilisation.Patient was discharged after one-month postoperative care.Patient is presently in our follow up on low dose steroids,mineralocorticoids along with betablocker and has shownmarked improvement in biochemical and clinical parameters.Conclusion: Pheochromocytoma though a rare catecholamineproducing tumour but if not timely intervened can lead tolife-threatening consequences. Our case report highlights theimportance of high clinical suspicion of pheochromocytomaeven in young adolescent patients who present first time withacute severe CCF with dilated cardiomyopathy

Clinical Profile and Complications of Continuous Ambulatory Peritoneal Dialysis in Kashmir

Introduction: Diabetes Mellitus is a syndrome characterizedby chronic hyperglycemia and disturbances of carbohydrate,fat and protein metabolism with absolute or relative deficiencyof insulin secretion and/or insulin action. It is one of themost common non-communicable diseases in the world.Adiponectin is a protein secreted exclusively by adipocytesthat regulates glucose and lipid metabolism. It has been foundto influence the body’s response to insulin thereby modulatinginsulin action and resistance. Several studies have found thatadiponectin levels are inversely associated with the severityof diabetes mellitus. Our study, thus, aims to compare theassociation between levels of adiponectin, fasting bloodglucose, body mass index and waist-hip ratio in patients ofdiabetes mellitus.Material and Methods: This case control study was done inpatients of type 2 diabetes mellitus attending Medicine OPDand ward from October 2016 to September 2018. A total of 88people were included in the study; 44 cases and 44 controls.Results: This study shows that serum adiponectin level issignificantly decreased in type 2 diabetes mellitus patients ascompared to controls and it also shows negative correlationwith fasting blood glucose, body mass index and waist-hipratio.Conclusion: It can be concluded that serum adiponectinestimation may be a useful biomarker for the diagnosis oftype 2 diabetes mellitus and it may be a useful adjunct in thetreatment of type 2 diabetes mellitus.

Concomitant dengue fever in Varicella zoster infection – A rare presentation

@#Varicella zoster infection is one of the self-limiting viral infections during childhood and dengue fever is an endemic infection in Malaysia, which commonly occurs in the form of nonspecific febrile illness at the initial stage. It is rare for the two viral infections to occur simultaneously. A case of dengue fever without warning sign in a five-year old girl was reported, with early symptoms of fever and vesicular rashes. She was clinically diagnosed with varicella zoster infection during the first visit. Surprisingly, she remained febrile even on day six of illness despite no new vesicular lesions on her skin. Due to suspicion of another infection, follow-up investigation was done and revealed isolated thrombocytopenia. This finding was confirmed with positive NS1Ag. A case of rare dengue fever concomitant with varicella zoster infection was reported.

Biomanagement of root knot nematode through non edible oil seed cakes infesting cicer arietinum L.

A pot experiment was conducted to evaluate the efficacy of different oil cakes against the root knot nematode. Root knot nematodes are the major agricultural pest of wide range of crops worldwide. Chickpea, Cicer arietinum L., family Fabaceae, is a high yielding proteinaceous pulse crop with India being the leading producer. Root knot nematodes are one of the major biological constraint that reduces per capita yield of this pulse crops. In the present investigation, studies were made to determine the efficacy of different oil cakes viz. Azadirachta indica (Neem), Brassica campestris (Mustard) and Gossypium hirsutum (Cotton). Two doses (50 and 100 g) of each neem, mustard and cotton oil cakes were applied to reduce nematode infestation in chickpea. Results revealed that root gall development due to Meloidogyne incognita were significantly reduced in all the treatments and enhance all the plant growth characters of C.arietinum. Higher dose of neem oil cake was found to be most effective as compared to other treatments. Hence, it may be concluded that oil cakes are better substitute against nematicide for the effective control of root-knot nematode and reduce environmental hazards for ecologically safe environment.

Nationwide reference data for height, weight and body mass index of Indian schoolchildren.

Background. The assessment of growth is crucial for child care and reference data are central to growth monitoring. We aimed to assess the height, weight and body mass index (BMI) of Indian schoolchildren in order to develop genderappropriate growth charts for children 5–18 years of age. Methods. Cross-sectional evaluation of anthropometric parameters (height, weight and BMI) was done in Indian schoolchildren (3–18 years) randomly selected from both fee-paying (upper socioeconomic strata) and non-fee paying (lower socioeconomic strata) schools from 4 regions (north, south, east and west) of India. A total of 106 843 children were evaluated, of which 42 214 children (19 303 boys, 22 911 girls) were from the lower socioeconomic strata and 64 629 children (34 411 boys, 30 218 girls) were from the upper socioeconomic strata. Normative charts, using the lambda–mu–sigma (LMS) method to smoothen the curves, were drawn from children belonging to the upper socioeconomic strata, in view of the gross discrepancy between the two socioeconomic strata. Results. Height, weight and BMI percentile (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th) data were calculated and charts generated. The height of boys and girls was consistently higher at all ages when compared with earlier India data, but the final height was 2–4 cm lower than that reported in the WHO multicentre study of 2007. Weight centiles showed a rising trend both in boys and girls compared not only to earlier Indian data published in 1992, but also to that reported by the WHO multicentre study. The median weight at all ages in both boys and girls was approximately 4 kg more than that reported in affluent Indian children two decades earlier. Conclusion. This large nationwide study indicates secular trends in height, weight and BMI in Indian children from the upper socioeconomic strata. We suggest that the height and weight percentiles reported by us may be used as reference standards for India.

Spontaneous pregnancy in a patient with a combination of ovarian and thyroid failure / Gravidez espontânea em uma paciente apresentando uma combinação de falência ovariana e disfunção tireoidiana

Premature ovarian failure has an overall prevalence of 0.3 percent to 0.9 percent in general population. If fertility is a concern, treatment usually consists of estrogen therapy as hormone replacement and oocyte donation. Spontaneous pregnancy in affected women is uncommon. We report a case of a 34-year old woman, who had premature ovarian failure and primary hypothyroidism, and conceived spontaneously eleven years after the development of premature ovarian failure and correction of hypothyroidism.

A falência ovariana prematura tem uma prevalência global variando de 0,3 por cento a 0,9 por cento na população em geral. Nos casos em que existe preocupação com a fertilidade, o tratamento geralmente consiste de terapia de reposição hormonal com estrógeno e doação de oócitos. A gravidez espontânea em mulheres afetadas não é comum. Relatamos um caso de uma mulher de 34 anos de idade que apresentou falência ovariana prematura e hipotireoidismo primário e concebeu espontaneamente onze anos após o desenvolvimento da falência ovariana prematura e da correção do hipotireoidismo.

The Effect of Smoking Habits on Different Histological Types of Lung Cancer in Kashmir.

A prospective study was conducted with the aim to determine the effect of smoking habits on different histological types of lung cancer. A total of 100 patients that included 91 males and 9 females with histological documentation of lung cancer were enrolled in the study. A detailed history was taken in each case that revealed active smokers 90%. Of which cigarette smokers were 40%, Hooka and Bidi smokers 17.7% and 5.6% of cases respectively. We also observed lung cancer was more common among farmers 34% who were active hooka smokers. Squamous cell carcinoma was the main histological type of lung cancer associated with all types of smoking habits.