Adverse Drug Reactions to Antifungals Used in the Management of COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis

Objectives: To determine the incidence and frequency of adverse drug reactions (ADRs) to find out factors, if any contributing to the same, while also exploring the use of amphotericin B deoxycholate as a cheaper and safe alternative to liposomal amphotericin B. Materials and Methods: It was a cross-sectional observational study, with a study population of 50 conducted over three months after ethics approval. All adult patients admitted to a tertiary care center, in a metropolitan city of Maharashtra, diagnosed with Rhino-orbito-cerebral mucormycosis, with a history of previous COVID-19 infection and receiving antifungals for the treatment of the same were included in the study. Central Drugs Standard Control Organization (CDSCO) ADR reporting forms were used to collect data. Results: Electrolyte disturbances mainly hypokalemia were the most frequently encountered ADR with both Amphotericin formulations (39/50; 20.31%) followed by pain at the injection site (33/50; 17.19%). Nephrotoxicity occurred slightly more frequently with Amphotericin B Deoxycholate (19/29; 65%), compared to Liposomal Amphotericin B (11/19; 57%), while Posaconazole was mainly associated with gastrointestinal (GI) disturbances and hepatotoxicity. Conclusion: Amphotericin B Deoxycholate was associated most with ADRs, hypokalemia, and pain at the injection site being the most frequent. However, concerning nephrotoxicity, both Amphotericin formulations showed only a modest difference. Posaconazole was associated with the least number of ADRs and had a favorable safety profile.

Outbreaks of dengue in Central India in 2016: Clinical, laboratory & epidemiological study

Background & objectives: Dengue virus (DENV) causes outbreaks and sporadic cases in tropical and subtropical countries. Documenting intricacies of DEN outbreaks is important for future interventions. The objective of this study was to report clinical, laboratory and epidemiological features of DEN outbreaks reported in different districts of Central India in 2016. Methods: In 2016, outbreaks (n=4) suspected of DEN were investigated by rapid response team. Door-to-door fever and entomological surveys were conducted. Blood samples were collected and tested using NS1 or IgM ELISA; real-time reverse transcription-polymerase chain reaction was done to identify serotypes of DEN virus (DENV). NS1-positive samples were tested for the presence of IgG by ELISA. Clinical and demographic data were collected and analyzed. Results: Outbreaks occurred in both urban and rural areas in monsoon season and Aedes aegypti was identified as the vector. Fever, chills, headache and myalgia were the major symptoms; no fatality was recorded. Of the 268 DEN suspects, 135 (50.4%) were found serologically positive. DEN positivity was higher (n=75; 55.56%) among males and in the age group of 16-45 yr (n=78; 57.8%). DENV 3 followed by DENV 2 were detected as the major responsible serotypes. High attack rates (up to 38/1000) and low cumulative IgG prevalence (14.9%) were recorded in rural areas. Interpretation & conclusions: Our study showed that DENV 3 was the major serotype responsible for outbreaks that occurred in monsoon. High attack rates and lower number of secondary infections in rural areas indicated that DENV is emerging in rural parts of Central India. Early diagnosis at local level and timely intervention by mosquito control activities are needed to avoid such outbreaks in future.

Effect of Dietary Supplementation of Rumen Protected Methionine and Lysine on Nutrient Utilization and Growth Performance in Sahiwal Female Calves

An experiment was conducted to evaluate the effect of supplementation of rumen protected methionine (RPM) and rumen protected lysine (RPL) individually and in combination on nutrient utilization and growth performance in twenty Sahiwal female calves. Sahiwal female calves having age groups of 7 to 12 months and between 80 to 111 kg body weights were randomly allotted into four groups of five animals in each, viz., T1 (basal diet), T2 (basal diet with RPM 5 g/d), T3 (basal diet with RPL 15 g/d) and T4 (basal diet with RPM 5 g plus RPL 15 g/d) their body weight for 90 days. The results revealed that intake of DM and CP were similar amongst all four groups. Digestibility of nutrients was also similar amongst the groups while average daily gain was found to be better in supplemented groups

Field testing & evaluation of the efficacy & duration of effectiveness of a biolarvicide, Bactivec® SC (Bacillus thuringiensis var. israelensis SH-14) in Bengaluru, India

Background & objectives: Different formulations of Bacillus thuringiensis var. israelensis (Bti) have been tested against different mosquito vectors and other insects for their residual activity. In the present study, the efficacy and residual activity of a new formulation of Bti (Bactivec Suspension Concentrate) were evaluated against immature stages of Anopheles stephensi Liston (Diptera: Culicidae), Aedes aegypti Linnaeus (Diptera: Culicidae) and Culex quinquefasciatus Say (Diptera: Culicidae), in natural habitats in Phase II and Phase III in Bengaluru, India. Methods: Preferential breeding habitats of the mosquito species were selected and four dosages (0.25, 0.5, 1 and 2 ml/50 l) were tested in Phase II trial. Two most effective dosages, 0.5 and 1 ml/50 l were selected for Phase III trial. The evaluation was carried out essentially following the guidelines of the World Health Organization Pesticide Evaluation Scheme. Pre-treatment and post-treatment densities were recorded at regular intervals, and >80 per cent reduction in pupae was taken as the duration of effectiveness. Results: Bactivec SC treated at the dosage of 1 ml/50 l could produce 10-17 days efficacy (>80% reduction in pupae) in clean water habitats tested, whereas 0.5 ml/50 l dosage showed residual activity from 7 to 14 days against Ae. aegypti and An. stephensi in Phase III studies. In polluted water habitats, 4-7 days efficacy could be recorded against Cx. quinquefasciatus in Phase III. Interpretation & conclusions: The Bactivec SC formulation was operationally feasible and easy to handle. For the control of Anopheles and Aedes mosquitoes in freshwater habitats, 1 ml/50 l dosage was found effective, whereas in polluted water habitats against Cx. quinquefasciatus 5 ml/m2 was found effective.

Role of Vitamin-D in the prevention and treatment of Alzheimer’s disease.

Alzheimer’s disease is the most common form of age related cognitive impairment. Aim of the present study was to see the effect of vitamin D on cognitive function in elderly. The study was conducted in Department of Physiology, King George’s Medical University (KGMU). A total of 80 subjects were enrolled based on Mini Mental State Examination (MMSE) score < 24 and vitamin D deficiency. They were divided into two groups as Group A (case) and Group B (control), each group having 40 subjects. Intervention (Vitamin D supplementation) was given in Group A. The assessment of dementia was done by Mini Mental State Examination (MMSE) score. Every subject was clinically evaluated and estimation of vitamin D was done by direct ELISA kit. Gender, weight, height, BMI, residence and education were also similar between two groups. A significant (p=0.0001) change in MMSE score was observed in both Group A and Group B from baseline to 3 & 6 months and from 3 to 6 months, however, mean change was higher in Group A than Group B. In conclusion, vitamin D supplementation caused significant improvement in the cognitive performance in subjects with senile dementia.

A review on some common diseases in children and their treatment with traditional system of medicine.

There are so many diseases specially classified for children come under Kaumarabhria treatment as per Ayurveda. Recently many researchers’ works to explore development of treatment of diseases related with childhood. The utilization of traditional system of treatment is well known but now it has been well proved and established also on the basis of scientific study and evidences. Further more research investigation need to be required for the establishment and modernizing of traditional therapy for children disease. This review article summarizes advanced research work of this area. Article involve discussion of traditional Ayurveda text related to the childhood disorders like; Rickets, asthma, constipation, Jwara and krimi etc. Further research and new concepts are utilizing for exploring Kaumarabhria.

Effects of rotating night shift and exposure of light at night on circadian pattern of salivary cortisol and urinary melatonin levels.

Objectives: The objective of the present study was to investigate the effects of rotating night shift and light exposure at night on circadian pattern of salivary cortisol and urinary melatonin levels. Methods: 62 healthy nursing professionals of both genders performing day and night shifts (continuous 9 days night shift with alternate day shifts) were recruited. Each month scheduled to continuous 9 days night shift (12 hours in regular 9 nights, from 20:00 to 08:00); after 9 days night shift they perform remaining duties in day shift and 4 days off. Saliva and Urine samples were collected at around 8 hours interval while they were performing night duties and repeated when they were assigned day duties. Saliva and Urine samples were analyzed by the ELISA method. Results: Significant difference was found in night cortisol among night (4.34 ± 3.37) vs day shift (2.70 ± 2.32), (p<0.001). Alteration in morning cortisol was also found between night (3.73 ± 2.47) vs day shift (5.00 ± 2.73). Night melatonin level was decreased as compared to morning melatonin. Significant deference were observed when compared night melatonin between night (16.71 ± 11.98) vs day shift (22.71 ± 13.25) (p<0.001), morning melatonin between night (20.07 ± 14.13) vs day shifts (28.26 ± 14.14) (p<0.001). The circadian pattern of cortisol and melatonin was altered by rotating night shift particularly at night and in the morning time. Conclusion: The present study concluded that the desynchronization was appeared during night shift and entrainment of circadian rhythm in the day shift.

Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in northern India.

Background & objectives: The population of elderly is growing globally and so are the physical illnesses and psychiatric morbidity. This study was planned to assess the prevalence and patterns of psychiatric morbidity amongst rural older adults in Lucknow, north India. Methods: A survey was conducted in subjects aged 60 yr and above to identify the cases of psychiatric morbidity in rural population from randomly selected two revenue blocks of Lucknow district, Uttar Pradesh, India. All subjects were screened through Hindi Mental Status Examination (HMSE) and Survey Psychiatric Assessment Schedule (SPAS) to identify for the suspected cases of cognitive and the psychiatric disorders, respectively. The subjects screened positive on HMSE and SPAS were assessed in detail on Cambridge Mental Disorder of the Elderly Examination-Revised (CAMDEX-R) and Schedule for Clinical Assessment in Neuropsychiatry (SCAN), to diagnose cognitive disorders and psychiatric disorders (other than the cognitive), respectively on the basis of International Classification of Diseases-10 (ICD-10) diagnostic guidelines. Results: The overall prevalence of psychiatric morbidity in rural older adults was found to be 23.7 per cent (95% CI=21.89-25.53). Mood (affective) disorders were the commonest (7.6%, 95% CI=6.51-8.80), followed by mild cognitive impairment (4.6%, 95% CI=3.72-5.53), mental and behavioural disorders due to substance use (4.0%, 95% CI=3.17-4.87) and dementia (2.8%) [Alzheimer’s disease (2.4%, 95% CI=1.81-3.16) and vascular (0.4%, 95% CI=0.16-0.73)]. Interpretation & conclusions: Overall prevalence of psychiatric morbidity amongst rural elderly in this study was found to be less in comparison to those reported in earlier studies from India. However, prevalence pattern of different disorders was found to be similar. Therefore, it appears that a stringent methodology, refined case criteria for diagnosis and assessment by trained professionals restrict false diagnosis.

HIV associated renal disease: A pilot study from north India.

Background & objectives: HIV/AIDS patients may have renal involvement also, however, Indian data are sparse. The present study was done to find the spectrum of renal diseases in HIV/AIDS patients in north India. Methods: In this prospective pilot study, HIV positive patients aged >18 yr were screened for renal involvement [serum creatinine >1.5 mg% and/or significant proteinuria (>500 mg /day)]. Patients who were positive on screening were followed up prospectively and underwent kidney biopsy if indicated. Results: A total of 526 patients were screened, of these, 91 (17.3%) were found to have renal involvement. Group A (Treatment naïve) comprised 392 patients who were not on antiretroviral treatment (ART) and group B (patients on ART) comprised 134 patients. More patients (74/392, 18.9%) in group A had renal involvement as compared to patients in group B (17/134, 12.7%). Of the 91 patients with renal involvement, 26 were followed up and underwent kidney biopsy. Thirteen patients had only proteinuria and another 13 had renal dysfunction with or without proteinuria. Most common histological diagnosis was mesangioproliferative glomerulonephritis (mes PGN) (10/26). Two patients had collapsing FSGS (focal segmental glomerulosclerosis) and three patients had immune complex glomerulonephritis. Seven patients had acute kidney injury, whom six totally recovered from their renal function. All patients with mesPGN tolerated angiotensin converting enzyme (ACE) inhibitors well. There was mixed response of collapsing FSGS to steroids. Both patients with MPGN (membranoproliferative glomerulonephritis) did well on low dose of steroid and ART. Interpretation & conclusions: Renal involvement was found to be common in HIV positive patients (17.3%). A low occurrence of renal involvement found in patients already on ART suggests some renoprotective effect of ART. Our preliminary results showed that collapsing FSGS was not rare in Indian HIV positive population, but classical HIV associated nephropathy was not seen. Longitudinal studies with robust study design and large sample size need to be done to confirm the findings.

Factors associated with low birth weight among newborns in an urban slum community in Bhopal.

A community based cohort study on birth weight of newborns was conducted among pregnant women of an urban slum in Bhupal, India. The study was carried out to assess the magnitude of low birth weight (LBW) and factors contributing it in an urban slum community. Socio-demographic and maternal characteristics were examined applying statistical techniques to find out the variables associated with the LBW. An additional schedule was used to collect information from mothers about their socio-demographic background, dietary intake and the rest during the pregnancy. Weight of newborns of mothers registered in the study and delivering at the district hospital was recorded. Mean birth weight of newborns of 290 registered mothers was 2.57 ± 0.36 g. One hundred and five newborns (36.2%) had a birth weight lesser than 2500 g. Among different variables studied, statistically significant association was found in case of occupation, daily calorie intake and duration of day-time rest taken by pregnant women.

Rhinosporidiosis of the parotid duct presenting as a parotid duct cyst - A report of three cases.

Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi. Rhinosporidiosis has been reported from many countries but is endemic in certain parts of India and Sri Lanka. The common sites of involvement are the nose and nasopharynx followed by ocular tissue. Rhinosporidiosis is also known to involve many rare sites and may become disseminated to occur in a generalized form. Rhinosporidiosis of the parotid duct is rare and only five reported cases could be found in the literature. We report three cases of rhinosporidiosis of parotid duct presenting clinically as a parotid duct cyst. Rhinosporidiosis was diagnosed by histopathology. None of these patients had rhinosporidiosis at any other site

The analgesic and anti-inflammatory activities of the hydroalcholic extract of "Shirishadi compound" in animal model.

The main objective of the present investigation is to evaluate the anti-inflammatory & analgesic activity of ethanolic extract of Shirishadi polyherbal compound on rats. Shirishadi compound consist of three herbal drugs namely- Shirisha (Albizzia lebbeck), Nagarmotha (Cyprus rotandus) & Kantakari (Solanum xanthocarpum).In Ayurveda (ancient Indian system of medicine) all these herbs alone or in combination with other herbs are commonly used in the managmant of bronchial asthma. In the carrageenan-induced rat paw edema test for acute inflammation, the extract of Shirishadi compound in doses of 50mg, 200 mg and 500 mg/kg body weight showed 77% and 79% and 81% inhibition of edema, respectively, at the end of 4h which is comparable to that of standard ( endomethacin) i.e. 92%. In the acetic acid induced writhing test the extract of Shirishadi compound ( 200 and 500 mg/kg body weight) showed a significant (p<0.001) reduction in the number of writhes with 65.6% and 70.9% of inhibition, respectively. In radiant heat tail-flick test the crude extract produced 58.1% (p<0.001) and 61.1% (p<0.001) elongation of tail flicking time 30 minutes after oral doses of 200 and 500 mg/kg body weight respectively . After 60 minutes the extract showed 56.3% (p<0.001) and 59% (p<0.001) elongation of tail flicking time. Experimental results showed that Shirishadi compound has persuasive anti-inflammmatory property along with significant analgesic activity.

Field evaluation of lambda-cyhalothrin (ICON 10 CS) indoor residual spraying against Anopheles culicifacies in India.

Background & objectives: Field trials of lambda-cyhalothrin 10 CS (ICON 10 CS) in indoor residual spraying (IRS) with 25 mg a.i./m2 against Anopheles culicifacies was undertaken vs malathion IRS (25% WP–2 g a.i./ m2) in Tumkur district, Karnataka; vs deltamethrin IRS (2.5% WP–20 mg a.i./m2) in Dharmapuri district; and vs lambda-cyhalothrin (10 WP–25 mg a.i./m2) in Ramanathapuram district, Tamil Nadu, India. Methods: Spray operations in the experimental villages were done by the National Institute of Malaria Research (NIMR) and in the control villages by the respective State Health Department staff. Persistence of efficacy of insecticide sprayed in villages was assessed by contact bioassays against vector mosquitoes. Entomological indicators such as per structure density, parity rates of vector mosquitoes and sporozoite rates were measured in all the three study areas using standard procedures. Mass blood surveys and active fever case detections were carried out in experimental and control villages to study the impact of IRS on malaria transmission. Results: Persistence of effectiveness of ICON 10 CS was observed up to 2–3 months in all the three study areas. ICON 10 CS was found effective at par with or better than the insecticides used in the national programme in reducing the mosquito densities and in interrupting malaria transmission in the study villages. Vector density, parity rates and malaria cases considerably reduced in the ICON 10 CS-sprayed villages. Conclusion: Field trials at three sites have established that ICON 10 CS formulation was relatively more effective than malathion 25% WP, deltamethrin 2.5% WP and lambda-cyhalothrin 10% WP in some evaluation parameters like indoor resting mosquitoes, parity rates in vector mosquitoes and persistence of effectiveness. It can be used for IRS for malaria vector control with two rounds of spray at an interval of 3 months for curtailing the malaria transmission and an additional round is recommended in perennial malaria transmission areas.

Nasal spirometery.

Nasal obstruction is a common symptom which is difficult to quantify clinically. Rhinomanometry, Acoustic Rhinometry and Forced Oscillation methods are available for estimating nasal resistance but, these require sophisticated machines. Because of limited availability of these techniques, this potential physiological measure has not been tapped fully for research and clinical purposes. Here, we describe the use of pulmonary spirometer with little modification for quantification of nasal flow. Nasal inspiratory and expiratory flow rates along with oral inspiratory and expiratory flow rates are used to derive different nasal resistance indices. This way of reporting nasal resistance is not new but, the data for these variables is currently not available in published literature. The reproducibility of nasal flow rates were tested as variation after one day and the interclass coefficient for inspiratory and expiratory nasal flow rates were found to be with in acceptable limits. Thus, nasal spirometery is able to describe the nasal resistance in a reliable manner and may be used to quantify nasal obstruction in pathological condition and also to study the physiological phenomenon like nasal cycle.

A Study of Awareness of Health Problems of the Elderly with Reference to Mental Health.

Objective: To access the public awareness about elderly mental health problems method 750 subjects of above the age of 18 years of urban sector were selected through purposive sampling technique. Method: The study sample consisted, 862 subjects both male & female above the age of 18 years. Out of the total population 1724 (study universe) were identified from Lucknow Municipal corporation. Only 862 (families residing elderly persons) were selected for study and rest 750 could be contacted due to their non-availability during visit of research team on working days. Self developed Performa were used for assessment of elderly problem. Results: Awareness was found very low about the elderly mental health problems (Dementia 0.8%, Delirium 0.4%, Delusional Disorder 1.6%, Insomnia 1%, Stroke 1.71 etc). Surprisingly few educated urban residents included in the study opined that the treatment of elderly problems is not necessary. Mostly the subjects (98.8%) were found unaware about the immunization of elderly and were also unaware about the appropriate diet of elderlies. Conclusion: The study strongly suggests need for psycho-education of the community particularly of the care givers. Study was carried out to sought out the suggestions of caregivers about the public awareness programmes.

Role of azithromycin against clinical isolates of family enterobacteriaceae: A comparison of its minimum inhibitory concentration by three different methods.

PURPOSE: To determine the effect of azithromycin, a new azalide antibiotic, on clinical isolates of the family Enterobacteriaceae and to determine and compare its minimum inhibitory concentration (MIC) by disk diffusion, agar dilution and E-test methods. MATERIALS AND METHODS: One hundred fifty-nine bacterial strains belonging to the family Enterobacteriaceae, isolated from different clinical samples, were tested for their susceptibility to azithromycin by disk diffusion, agar dilution and E-test methods. The MIC values were analysed and the percentages of agreement between the different methods were mentioned. RESULTS: Of the 159 isolates of the family Enterobacteriaceae, 60.37% were E. coli followed by Klebsiella species 28.3%, Salmonella and Shigella species 3.77% and Enterobacter and Citrobacter species 1.88% each. Maximum isolates were obtained from urine 117/159 (73.58%). Azithromycin was found to be more active against Salmonella and Shigella species, showing 100% sensitivity the by E-test and 83.33% by the disk diffusion methods. In the agar dilution method, 83.33% of Salmonella and 66.66% of Shigella species were sensitive to azithromycin. The overall agreement between disk diffusion and agar dilution method was 96.8%, between agar dilution and E-test was 88% and between disk diffusion and E-test was 91.2%. CONCLUSION: Azithromycin may become an important addition to our antimicrobial strategies, especially for the treatment of bacterial diarrhoea and infections caused by Salmonella typhi.

Comparison of internal sphincterotomy with topical diltiazem for post-hemorrhoidectomy pain relief: a prospective randomized trial.

AIM: To assess the efficacy of internal sphincterotomy compared with application of topical 2% Diltiazem ointment after hemorrhoidectomy for pain relief. SETTINGS AND DESIGN: Prospective randomized study. MATERIALS AND METHODS: In an 18-month period, 108 subjects with uncomplicated Grade 3/ 4 hemorrhoids were enrolled in the study and were randomized into two equal groups: Subjects in Group A underwent internal sphincterotomy at time of primary surgery while those in Group B received 1 g of 2% Diltiazem ointment locally, thrice daily for seven days. Postoperative pain perception was measured using visual analog score (VAS) and on the basis of number of analgesic tablets (Tab tramadol 50 mg) required in each group. Time to discharge, time to return to work and incidence of complications measured and compared. STATISTICAL ANALYSIS USED: Statistical techniques applied were Student T test, Chi-square and Fisher's Exact Test. RESULTS: There were 102 analyzable subjects (Group A: 50 and Group B: 52). The mean VAS score was significantly less in the internal sphincterotomy group from the fourth postoperative day onwards compared to topical Diltiazem (2.23 vs. 3.72; P =0.031). Similarly, the mean requirement of analgesic tablets [10.54 vs. 15.40; P =0.01] was much lower in Group A. There was no significant difference in terms of time to discharge and time to return to work between the two groups. The incidence of complications was more with the internal sphincterotomy group (11.5% vs. 3 %; P =0.488). CONCLUSIONS: In patients undergoing hemorrhoidectomy, addition of surgical internal sphincterotomy results in lesser pain in the postoperative period as compared to those receiving topical application of Diltiazem.

Public health strategies to stem the tide of chronic kidney disease in India.

It is estimated that 10-15% of the population has chronic kidney disease (CKD), resulting in significant health expenditure, which is largely met by out-of-pocket by the patient in India. However, the seriousness of this public health problem has remained largely under-recognized so far. Luckily the preventive measures are simple and not difficult to implement. Public health strategies are essential to control the burgeoning problem. Lifestyle modifications can reduce the incidence of obesity, hypertension and diabetes. These diseases account for a significant proportion of CKD cases. Active involvement of the primary care physicians is vital for early detection of CKD with retardation of its progress, since nephrologists do not see the patients in the early stages. The role of community health specialists is essential to organize health education programs and screening camps, form active patient support groups; and incorporate the prevention program in the various tiers of the health-care system. Availability of optimal nephrology services in peripheral hospitals can rehabilitate most cases of end-stage renal disease, and also prevent the illegal organ trade, which keeps rearing its ugly head at regular intervals in India.