Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India

Background & objectives: Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods: This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results: A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ? 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ? 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ? 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation & conclusions: Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay

Extended spectrum β‑lactamase producing Shigella flexneri serotype‑2 causing bacteremia in a patient with uncontrolled diabetes mellitus.

We report a case of Shigella flexneri serotype‑2 causing bacteremia in an elderly gentleman with uncontrolled diabetes mellitus, who had no other apparent risk factors. Antibiotic susceptibility testing revealed that the organism was a multidrug resistant extended spectrum beta‑lactamase producing strain, which was confirmed by molecular characterization. This rare case alerts both the clinician and microbiologist to a previously unaddressed risk factor of Shigella spp. causing bacteremia, as well as emerging resistant strains that are on the rise in immunocompromised patients.

Reliability of Kirby-Bauer disk diffusion method for detecting meropenem resistance among non-fermenting gram-negative bacilli.

Background: Meropenem is empirically used as a last resort for the treatment of infections by non-fermenting gram-negative bacilli (NFGNB). Minimum inhibitory concentration (MIC) determined using agar or broth dilution methods is widely used for testing meropenem resistance. However, it is not possible in resource-poor settings. Aim: A prospective study was performed to evaluate the reliability of Kirby-Bauer disk diffusion (KBDD) method for detecting meropenem resistance among NFGNB. Materials and Methods: A total of 146 NFGNB consisting of 56 Acinetobacter baumannii, 24 Acinetobacter lwoffii, 48 Pseudomonas aeruginosa and 18 Pseudomonas spp. were included in the study. All the isolates were tested simultaneously by both KBDD method and agar dilution method. Results: Very major errors were not observed with A. baumannii, A. lwoffii and P. aeruginosa, while other Pseudomonas spp. showed a very major error rate of about 5.6%. The major error rates observed with A. baumannii, A. lwoffii, P. aeruginosa and Pseudomonas spp. were 1.8%, 0%, 2.1% and 28.6%, respectively. All the isolates showed a good correlation between zone diameters (KBDD method) and MICs (agar dilution method). The sensitivity and specificity of KBDD method for detecting meropenem resistance was above 90% for all the NFGNB except Pseudomonas spp. Conclusions: The KBDD method can be reliably used for routine testing of meropenem resistance in A. baumannii, A. lwoffii and P. aeruginosa. However, further studies are needed before employing this technique for detecting meropenem resistance in Pseudomonas spp.

Histochemistry and functional organization of the dorsal skin of Ancistrus dolichopterus (Siluriformes: Loricariidae)

The structural organization and histo-cytochemical features of dorsal skin of Ancistrus dolichopterus (acari bodo) are the main focus of this work. The epidermis, dermis and subcutis are the principal layers of the skin. The epidermis mainly consists of epithelial and mucous cells. Interspersed between them are lymphocytes, pigment cells, eosinophilic granular cells (EGC), and the taste buds as sensory structures. The high number of EGCs is implicated in general and specific immunological defense from pathogenic bacteria and multicellular parasites. The epithelial cells and mucous cells contain glycoproteins with oxidizable vicinal diols, carboxyl groups and O-sulphate esters and their high secretory activity is correlated with the bottom dwelling habit of this species. A thick stratum laxum contains overlapping osteoderms bearing denticles, and the stratum compactum make the integument thicker to help the fish in negative buoyancy for maneuvering near the bottom and protection. The entire body surface is covered by conical, backwardly directed denticles. These are composed of a dentine cone, surrounding a pulp cavity with the top covered by mineralized cap, and are the true homologues of teeth. These structures provide effective protection from abrasion and enemies. These structural peculiarities and histochemical features indicate additional physiological role of the skin of A. dolichopterus.

A organização estrutural e aspectos histo-citiquímicos da pele dorsal de Ancistrus dolichopterus (acari-bodó) são os principais alvos do presente estudo. A epiderme, a derme e a hipoderme são as principais camadas da pele. A epiderme consiste principalmente de células epiteliais e mucosas. Intercalados entre elas estão os linfócitos, as células pigmentares, as células granulares eosinofílicas (CGE), e as papilas gustativas como estruturas sensoriais. Um grande número de CGEs está relacionado em geral com a defesa imunológica específica de bactérias patogênicas e parasitas multicelulares. As células epiteliais e as células mucosas contem glicoproteínas com grupos diol oxidáveis, grupos carboxilas e ésteres O-sulfatados sendo que sua alta atividade secretória está correlacionada com o comportamento bentônico, de fundo, dessa espécie. Um espesso stratum laxum contém osteodermos sobrepostos, parecidos com dentículos, e o stratum compactum que torna o tegumento mais espesso, contribuindo com a flutuação negativa necessária ao movimento perto do fundo e proteção. Toda a superfície do corpo é coberta por dentículos cônicos retrodirecionados. Esses dentículos são compostos por um cone de dentina, envolvendo uma cavidade pulpar e com o ápice coberto por uma capa mineralizada, verdadeiros homólogos dos dentes. Essas estruturas oferecem efetiva proteção contra abrasão e oponentes. Essas peculiaridades estruturais e aspectos histoquímicos sugerem a existência de uma função fisiológica adicional para a pele de A. dolichopterus.

Endomyocardial fibrosis.

We present a case report of a 26-year-old male from Bulandsahar, India. The patient presented with right heart failure. Evaluation revealed peripheral eosinophilia. An echocardiogram and MRI showed biventricular hypertrophy with obliteration of the ventricular apices, typical of endomyocardial fibrosis. This condition is rare in Bulandsahar, India.

Role of bone marrow trephine biopsy in the diagnosis of marrow involvement in Hodgkin's disease.

Bone marrow involvement in Hodgkin's disease alters the stage and hence the prognosis and treatment modality. Seventy-six patients of biopsy proven Hodgkin's disease in whom a bone marrow aspiration and biopsy were done simultaneously at the time of diagnosis were included in the study. Bone marrow involvement was seen in 14 (18%) cases. All 14 cases were diagnosed on biopsy. Only one aspirate was suspicious of involvement. Rest was either diluted (28%) or was normal (64%). Eleven patients were upstaged from stage I, II and III to stage IV. All patients had cytopenia of one or more cell line. Increased fibrosis, necrosis and a polymorphic cellular infiltrate were associated findings in the marrow. We wish to highlight the importance of bone marrow trephine biopsy over aspirate in staging even clinically early stage Hodgkin's disease.

DNA polymorphism of leptin gene in Bos indicus and Bos taurus cattle

Leptin plays an important role in the regulation of feed intake, energy metabolism, growth and reproduction of cattle. We used the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique to screen for DNA polymorphisms of the leptin gene in 403 cattle belonging to various breeds of Bos indicus (Hariana, Sahiwal, Gir and Nimari cattle), Bos taurus (Holstein Friesian (HF) and Jersey cattle) as well as Bos taurus x Bos indicus crossbreds (½ HF x ½ Hariana). In all the cattle we amplified two regions of the leptin gene, a 522 bp fragment comprising the partial intron 2 and exon 3 and another 94 bp fragment consisting of part of exon 2. Digestion of 522 bp PCR products with the BsaAI restriction enzyme revealed three genotypes in all the breeds of cattle studied. This is the first report of the presence of leptin gene polymorphism in purebred Bos indicus cattle of Indian origin (indicine cattle). Almost similar gene and genotype frequencies were observed in all the breed groups, while the frequency of mutant homozygotes (AA) was very low (0.03 to 0.07). On digestion of the 94 bp fragment with the Kpn2I restriction enzyme, three genotypes were observed in HF, Jersey and crossbred cattle. The CC genotype had the highest frequency (0.68) in crossbreds whereas the frequency of CT heterozygotes was highest (0.69) in HF cattle. This mutation was absent in all the breeds of indicine cattle. The results suggest that the BsaAI-RFLP mutation has occurred far back in evolution before the divergence of taurine and indicine cattle while the Kpn2I mutation has occurred recently as indicated by the fact that this mutation was only detected in taurine cattle.

Growth performance and nutrient utilization in black Bengal bucks (Capra hircus) supplemented with graded doses of chromium as chromium chloride hexahydrate

Black Bengal bucks (Capra hircus) were supplemented with 0, 0.2 or 0.4 mg elemental chromium (Cr) as chromium chloride hexahydrate per day for 70 days. Intake of dry matter (p0.05) effect on the plasma half life (k) and clearance rate of glucose (T1/2) during an intravenous glucose tolerance test. Area under the response curve from 0 to 180 minutes after glucose loading was lower (p<0.001) in the control group of bucks. The study revealed that Cr supplementation might promote growth and nutrient utilization in black Bengal bucks. However, little difference between the 0.2 and 0.4 mg Cr supplemented bucks suggested limited benefit of increasing the level of supplementation beyond 0.2 mg per day under the normal management regimes.