Unusual clinical presentations of scrub typhus, a neglected tropical disease: A case series from north India

Background & objectives: Scrub typhus is a neglected tropical disease common in Asia and Africa. It usually presents with non-specific symptoms like fever, rashes, and lymphadenopathy. It has a varying range of clinical picture that often leads to misdiagnosis and initiation of non-specific treatment. This disease is thus associated with high morbidity and mortality. We aim to highlight the uncommon presentations of this common disease to create awareness regarding the unusual presentations of scrub typhus. Methods: This prospective study was performed over a period of two months enrolling eleven adult patients with serological evidence of anti-scrub typhus IgM antibodies. Results: All enrolled 11 cases [5 males (45.5%) and 6 females (54.5%)] were positive for anti-ST IgM antibodies and negative for other tested microbial agents. 7/11 (63.6%) patients were admitted with a clinical diagnosis of acute encephalitis syndrome (AES as per standard WHO definition), 3/11 (27.3%) patients presented with jaundice and 1/11 (9.1%) patients presented with rashes. Two out of 7 (28.6%) AES cases had developed peripheral gangrene of extremities. Interpretation & conclusion: Scrub typhus is a common tropical disease that can have various unusual clinical presentations like meningoencephalitis, vasculitis, acute kidney injury, jaundice, MODS. It closely mimics other infective etiologies making its diagnosis difficult. A high index of suspicion and clinical awareness is required in clinical practice to identify the different presentations of this disease so that early treatment can be initiated to reduce morbidity and mortality associated with this disease.

A case series of scar endometriosis after cesarean section

Endometriosis is referred to the presence of functioning, ectopic endometrial tissue outside the pelvic cavity. Their occurrences after abdominal or pelvic surgeries especially cesarean section, at the site of scar incision, are documented. The patient experiences cyclical pain at the incision site related to the menstrual cycle. Imaging can be used to detect the lesion and medical management can be provided. However, in severe cases, total excision is recommended to avoid chances of recurrence. Here, we present a case series of two cases of scar endometriosis after cesarean section, and both presented with cyclical pain in the abdomen. Medical management was provided for both cases.

Is Menstruation a Valid Reason to Postpone Cardiac Surgery?

Background:Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective,matched case?control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who weremenstruating (group?M;n = 25) and their matched controls, i.e., women who were not menstruating (group?NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup?P) and perioperative period (subgroup?PO) was compared to determine the effect of OHS onmenstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr?M = 245.6 ± 120.1 ml vs gr?NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr?P = 36.8 ± 4.8 ml vs gr?PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr?P = 4.2 ± 0.6 days vs gr?PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Seropositivity of Anti-SARS CoV2 IgG antibodies in health care workers of an Indian tertiary care hospital during COVID-19

Purpose: Health care workers [HCW] are at a higher risk of infection SARS CoV2 infection due to frequent and close contact to patients with COVID-19. Methods: Serum samples from 500 HCW's were tested for SARS CoV2 IgG antibodies in October 2020. A questionnaire was used to collect demographic and clinical data. All these HCWs were tested for COVID-19, in 2nd week of September 2020, as a hospital policy. Results: Anti SARS CoV2 antibodies were detected in 128/ 500 [25.6%] HCWs. A total of 195/ 500 [39%] enrolled cases had already tested positive for Covid-19 at least once in last six months by RT-PCR. Sixty eight percent of HCWs with previous COVID-19 positivity by RT- PCR tested positive for Anti SARS CoV2 antibodies, whereas only 2.76% of asymptomatic HCWs tested positive. Of 121 anti SARS-CoV-2 IgG positive persons, 70 [57.85%] had CT value < 25. Low CT value and asymptomatic cases had a strong reverse statistically significant association with SARS CoV2 IgG antibody positivity. Conclusions: We report that sero-conversion rate in HCWs is similar to that in general population suggesting that preventive practices used in hospitals are satisfactory. Cases with low viral counts in respiratory sample and asymptomatic cases have lower rate of seroconversion.

Seroprevalence of immunoglobulin G antibodies against SARS-CoV-2 in children and adolescents in Delhi, India, from January to October 2021: a repeated cross-sectional analysis

Objectives@#The aim of this study was to assess changes in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence among children and adolescents in Delhi, India from January 2021 to October 2021 @*Methods@#This was a repeated cross-sectional analysis of participants aged 5 to 17 years from 2 SARS-CoV-2 seroprevalence surveys conducted in Delhi, India during January 2021 and September to October 2021. Anti-SARS-CoV-2 IgG antibodies were detected by using the VITROS assay (90% sensitivity, 100% specificity). @*Results@#The seroprevalence among 5- to 17-year-old school-age children and adolescents increased from 52.8% (95% confidence interval [CI], 51.3%−54.3%) in January 2021 to 81.8% (95% CI, 80.9%−82.6%) in September to October 2021. The assay-adjusted seroprevalence was 90.8% (95% CI, 89.8%−91.7%). Seropositivity positively correlated with participants’ age (p<0.001), but not sex (p=0.388). A signal to cut-off ratio ≥4.00, correlating with the presence of neutralization antibodies, was observed in 4,814 (57.9%) participants. @*Conclusion@#The high percentage of seroconversion among children and adolescents indicates the presence of natural infection-induced immunity from past exposure to the SARS-CoV-2 virus. However, the lack of hybrid immunity and the concomitant likelihood of lower levels of neutralization antibodies than in adults due to the absence of vaccination warrants careful monitoring and surveillance of infection risk and disease severity from newer and emergent variants.

Predictors of discogenic pain in magnetic resonance imaging:a retrospective study of provocative discography performed by posterolateral approach

Background@#Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. @*Methods@#Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. @*Results@#A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. @*Conclusions@#In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

Predictors of discogenic pain in magnetic resonance imaging:a retrospective study of provocative discography performed by posterolateral approach

Background@#Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. @*Methods@#Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. @*Results@#A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. @*Conclusions@#In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

Genetic analysis of some morphological traits in synthetic x naturally polyploid cotton derivatives

Cotton has received attention of geneticists since more than a century. Gossypium hirsutum, the predominantly cultivated cotton species worldwide, has a narrow genetic base. It is important to broaden its genetic base through introgression of novel alleles from related species. Here, we report the development and characterization of a backcross population derived from the hybridization of a ‘synthetic’ (derived by crossing and chromosomal doubling of nonprogenitor Gossypium species) and natural tetraploid upland cotton. ‘Synthetic’ was observed to be male-sterile and thus, was used as the female parent. A total of 7434 flowers were pollinated to obtain 1868 BC1F1 seeds by direct and reciprocal crosses. Characterization of the experimental plant material was conducted in the field for several morphological traits such as pubescence on the stem, leaf, petiole and bract, presence/absence of petal spot, petal margin colouration and stamen filament colouration. Genetic analysis revealed that petal margin colouration phenotype was governed by a single dominant gene, whereas the petal spot and filament colouration phenotypes manifested segregation distortion. None of the BC1F1 plants was devoid of trichomes thus demonstrating that presence of trichomes is dominant over their absence. Modern upland cotton cultivars are usually devoid of petal spot, petal margin colouration and stamen filament colouration. These floral anthocyanin pigmentation characteristics, if fixed in the cotton germplasm, may serve as diagnostic features for the identification of cultivars during DUS testing as well as in the maintenance breeding programmes

Effect of Smoking and Alcohol Consumption on Reproductive Hormones and Semen Parameters in Male Partners of Infertile Couples

Introduction: Nearly 15% couples trying to conceive areaffected by infertility, and male infertility affects nearly50% of these. Majority of the men have no apparent reasonfor infertility. Tobacco smoking and alcohol intake areavoidable factors which may affect male fertility. This studyaimed to evaluate the impact of tobacco smoking and alcoholconsumption on serum follicle stimulating hormone (FSH)and testosterone levels and on semen microscopy parametersin male partners of infertile couples.Material and Methods: This cross sectional descriptivestudy, included male partners of couples presenting withinfertility at a rural tertiary teaching hospital. Exposure torisk factors was recorded. Serum FSH and testosterone levelsand semen microscopy for sperm concentration, progressivemotility and morphology were evaluated.Results: In the 98 subjects, mean FSH levels, testosteronelevels, sperm concentration and sperm progressive motilitywere significantly lower in smokers (P=0.001, 0.002, 0.005,0.003 respectively). Same parameters were significantly lowerin alcoholics (P<0.001). Smokers had significantly higherodds of abnormal testosterone levels. Alcohol consumershad significantly higher odds of low FSH levels, abnormaltestosterone levels, oligozoospermia and asthenozoospermia.Conclusions: Smoking and alcoholism may be significantcontributors to male infertility. More efforts to inform theyouth about effects of smoking and alcoholism on fertility arerequired.

A comparative evaluation of diclofenac and tramadol as post-operative analgesics along with causality and severity assessment of ADRs

Background: Diclofenac and Tramadol are well established analgesics for post-operative pain management, yet some adverse effects are associated with their use which govern their tolerability. The objective of the study was to evaluate the comparative efficacy of the two drugs and to assess the causality and severity of documented Adverse Drug Reactions (ADRs).Methods: An open labelled, prospective, interventional, simple randomized clinical study to compare efficacy and safety of diclofenac and tramadol was conducted by the Department of Pharmacology in collaboration with the Department of Surgery. Post-operative pain intensity was measured on Visual Analogue Scale (VAS). Causality and severity assessment of the recorded ADRs was done using WHO-UMC scale and modified Hartwig and Seigel Scale respectively.Results: A total of 211 patients underwent different surgeries. The most common surgery performed was mesh hernioplasty 78 (36.96%). VAS score was used as data to determine the analgesic efficacy of two drugs. Wilcoxon Signed Rank test showed significant reduction in pain on all days for each group individually while Mann Whitney U test compared both the groups and revealed that both the drugs i.e. diclofenac and tramadol were equally efficacious in reducing post-operative pain. Causality assessment showed that all the documented ADRs fall in POSSIBLE category while severity assessment revealed that all the ADRs were MILD in nature.Conclusions: Diclofenac and tramadol proved to be equi-effective in reducing post-operative pain . The study also emphasized that active surveillance of ADRs can lead to timely intervention and provide maximum benefit to the patient.

Comparison of grading of aortic stenosis between transthoracic and transesophageal echocardiography in adult patients undergoing elective aortic valve replacement surgeries: A prospective observational study

Introduction: Intraoperative trans-esophageal echocardiography (TEE) has been found to underestimate severity of aortic stenosis (AS) compared to trans-thoracic echo (TTE). We conducted a prospective study comparing pre induction TTE and intra operative TEE grading of AS in patients posted for aortic valve replacement surgeries. Methods: Sixty patients with isolated AS who were undergoing aortic valve replacement were enrolled in our study. Baseline TTE was done and after induction of anesthesia, TEE was done. Mean gradient across aortic valve, peak jet velocity, aortic valve area (AVA) by continuity equation and dimensionless index (DI) were assessed in both. Results: Mean gradient decreased from 56.4 in TTE to 39.8 mm Hg in TEE leading to underestimation of AS in 74.5% of patients (P < 0.0). Mean of peak jet velocity also decreased from 500 in TTE to 386cm/s in TEE (P < 0.01). In 76 % of patients this led to reduction of AS grade from severe to moderate. Mean AVA was 0.67 cm2 in TTE and 0.69 cm2 in TEE. Though there was 0.02 cm2 increase, it was not statistically significant (P = 0.07). All the patients remained as severe AS in TEE. DI mean was 0.19 in both TTE and TEE (P = 0.14).It led to underestimation of severity in 6% of patients in TEE. Conclusion: Our study shows that AVA measurement by continuity equation and DI are reliable in grading aortic stenosis while performing intraoperative TEE. Mean gradient and jet velocity can be significantly reduced.

Role of serum ferritin in differential diagnosis of anaemia along with various indices of anaemia and their haematological profile in geriatric population

Anaemia is one of the commonest hematological disorders prevalent in elderly population of either sex. WHO suggested any condition with decline of haemoglobin is considered as anaemia. Ferritin an iron storage compound is considered as a well known marker of iron storage. Therefore the present study was designed to evaluate the role of serum ferritin in differential diagnosis of anaemia along with various indices of anaemia and their haematological profile in geriatric population. Methods: Complete blood count included the following: Hb level; and white cell indices such as total leucocyte count (TLC) and differential leucocyte count, as well as corrected TLC. All investigations were carried out on an automated cell counter. Serum ferritin was estimated by automated analyser. Results: The nutrition deficiency anaemia (47.5%) was most common type of anaemia among elderly population. Further, anaemia due to chronic disease (20.2%), Marrow infiltration (8.3%) and multiple myeloma (7.1%) were recorded in the elderly population. serum ferritin level was significantly low in iron deficiency anaemia (151±88 ng/ml) compare to other types of anaemia dual defficency anaemia (157±98 ng/ml). However, ferritin was significantly high in megaloblastic anaemia (210±101 ng/ml) and anaemia of chronic diseases (204±102 ng/ml). Conclusion: Findings of the current study revealed that ferritin can be an important marker for the differential diagnosis of anaemia in elderly population. Moreover, the diagnostic accuracy may be enhanced when PBF and bone marrow findings are combined with clinical examination and other relevant investigations. Biochemical investigation of serum ferritin along with other findings might be helpful in early diagnosis along with accurate aetiology of anaemia in elderly population.

Micronuclei in exfoliated cells : a biomarker of genotoxicity in tobacco users

Aims: The aim of this study was to analyze the tobacco-related genotoxic effects in individual with habit of smoking and chewing tobacco. Materials and Methods: The present study sample consisted of 120 individuals attending the outpatient department of D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh (UP). The sample was divided into four groups as follows: Group I (individuals with habit of smoking tobacco), Group II (individuals with habit of chewing tobacco), Group III (individuals with habit of smoking and chewing tobacco), and Group IV control group (nontobacco-exposed individuals). Patients were asked to rinse their mouth gently with water. The exfoliated cells were obtained by scraping the buccal mucosa of individuals with a wooden spatula. The scraped cells were placed on the precleaned slides. The smears were then stained with RAPID-PAP™ and analyzed under the microscope. Data were analyzed using SPSS statistical software. Results: In the present study, an arbitrary unit was obtained using frequency/day multiplied by the duration of years (risk multiplication factor [RMF], a positive and significant correlation were observed between the RMF and the mean percentage of micronucleated cell count in smokers, chewers, and in individuals with both smoking and chewing habit, respectively. A weak positive and nonsignificant correlation were observed between age and mean percentage of micronucleated cells in smokers and smokers + chewers, respectively, while it was weak negative and nonsignificant in chewers. In control group, correlation between age and percentage of micronucleated cells was weak positive and nonsignificant at 5% level of significance. Conclusion: The micronuclei in exfoliated mucosal cells from buccal mucosa can be used as a biomarker of genotoxicity in predicting the effects of carcinogens

Modification in spinach response to UV-B radiation by nutrient management: Pigments, antioxidants and metabolites

Fertilizers are extensively used essentially to meet the food demand of increasing population. Further, they help the plants in alleviating the deleterious effects of UV-B radiation. In this study, we explored this in spinach (Spinacia oleracea L.). S. oleracea plants were grown under ambient and elevated UV-B at different combinations and concentrations of NPK: (i) recommended level of NPK (RNPK); (ii) 1.5 times recommended level of NPK (1.5 × NPK); (iii) 1.25 times recommended level of N plus recommended PK (1.25N+PK); and (iv) 1.25 times recommended level of NPK (1.25 × NPK) to assess the amelioration potential of nutrient combination. Higher availability of NPK provided more protection to plants against oxidative stress as is obvious from reduction in MDA content under elevated UV-B which can be attributed to low oxidative stress due to higher induction of antioxidants. Protection provided to chlorophyll by nitrogen was enhanced by phosphorus and potassium in 1.5 × NPK and 1.25 × NPK compared to RNPK and 1.25 × N+ PK. Maximum increase in PAL activity in plants at 1.5 × NPK did not translate into flavonoid accumulation in same at initial age of observation. Maximum alleviation against UV-B radiation was observed at 1.5 × NPK which can be attributed to better ROS scavenging capacity, more metabolite production and maintaining photochemical efficiency.

Proposed global drooping and wrinkles classification and scoring system for aging face with validation and experience on 54 Indian subjects

Background: Aging is an inevitable biological change, but understanding the process of aging of face is important to customize the treatment options for facial rejuvenation. Evidence-based estimation of global facial aging is necessary for the validation of various treatment modalities. Aims: Classification and implementation of a scoring system for aging face based upon volume loss and surface changes as evident by drooping of different areas of the face and appearance of fine and deep wrinkles, respectively, and to apply this drooping–wrinkles classification on 54 participants to evaluate and understand the validity of scoring. Methods: An observational study was conducted, and scores were calculated based on 13 parameters (7 areas of drooping and 6 areas of wrinkles on the face) at Aura Skin Institute, Chandigarh, India. Accordingly, age was divided in different age groups followed by clinical estimation of facial age and calculation of scores. Results: According to our classification and scoring system, 61% (33 out of 54) of the participants were correlated with their chronological age group. Out of the remaining 21 (39%) participants who were aging faster, 13 (24%) were in the age group of 25–35 years. Approximately one-fourth of the patients in the age groups 36–45 and 46–55 years were aging faster. Only 1 patient had scores showing younger age in comparison to chronological age. Overall, there was a good correlation between the calculated score and the chronological age of patients. Moreover, a gradual increase in scores was noticed with increasing age groups. Conclusions: This is a new clinical classification and scoring system for facial age which is much easier to apply in daily clinical practice for easy calculation of baseline scores and customizing their antiaging treatment options. Moreover, it will also make it easier to compare the efficacy of treatment in their future follow-ups. The limitation of this study is that it has been proposed for all skin types but validation has been done only for Indian participants.

Diversity and Bioactive Potential of Culturable Fungal Endophytes of Medicinal Shrub Berberis aristata DC.: A First Report

Bioactive natural compounds, isolated from fungal endophytes, play a promising role in the search for novel drugs. They are an inspiring source for researchers due to their enormous structural diversity and complexity. During the present study fungal endophytes were isolated from a well-known medicinal shrub, Berberis aristata DC. and were explored for their antagonistic and antioxidant potential. B. aristata, an important medicinal shrub with remarkable pharmacological properties, is native to Northern Himalayan region. A total of 131 endophytic fungal isolates belonging to eighteen species and nine genera were obtained from three hundred and thirty surface sterilized segments of different tissues of B. aristata. The isolated fungi were classified on the basis of morphological and molecular analysis. Diversity and species richness was found to be higher in leaf tissues as compared to root and stem. Antibacterial activity demonstrated that the crude ethyl acetate extract of 80% isolates exhibited significant results against one or more bacterial pathogens. Ethyl acetate extract of Alternaria macrospora was found to have potential antibacterial activity. Significant antioxidant activity was also found in crude ethyl acetate extracts of Alternaria alternata and Aspergillus flavus. Similarly, antagonistic activity of the fungal endophytes revealed that all antagonists possessed inhibition potential against more than one fungal pathogen. This study is an important step towards tapping endophytic fungal diversity for bioactive metabolites which could be a step forward towards development of novel therapeutic agents.

Cementoblastoma a Rare Odontogenic Tumor - A Case Report and Differential Diagnosis.

Cementoblastoma is a rare odontogenic tumor derived from the odontogenic mesenchymal tissues. It has distinct clinical, radiographical, and histological features that aid in correct diagnosis. This article presented a case of 35-year-old female patient with pain and swelling in the right cheek region. Radiographic examination was suggestive of benign cementoblastoma in relation to unerupted right maxillary third molar. The tumor was surgically removed along with tooth, and the diagnosis of cementoblastoma was confirmed by histopathology examination.

Developmental Disorders- Genetic View.

Objective: To review genetic cause of developmental disorders. Methodology: A survey consisting of 70 children with developmental disorder was done for genetic evaluation of these disorders through case history and interview of the parents. Results: The cause was found to be combination of genetic variation with environmental risks due to which epigenetic changes might have taken place in prenatal stages in 81% of the cases in the survey. Only 16% of cases showed mendelian inheritance. Conclusion: The results indicate that developmental disorders are of epigenetical nature rather than mendelian inheritance.

Simulation in cardiac catheterization laboratory: Need of the hour to improve the clinical skills.

Simulation is an effective teaching tool to decrease the learning curve for novices without compromising patient safety. Simulation helps interventionalist in mentally translating a two dimentional, black and white image into a usable three dimentional model. It also bridges the gap in training diverse team members on new procedures and products. All simulators have collision detection, i.e., virtual contact forces generated from collision which updates haptic output with new calculations.