Comparison of Multisystem Inflammatory Syndrome (MIS-C) and Dengue in Hospitalized Children

Objective Multisystem infammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profle of children admitted with MIS-C and dengue were compared to understand their presentation at the outset. Methods This was a retrospective study of children?12 y admitted with MIS-C (WHO defnition) or laboratory-confrmed dengue between August 2020 and January 2021 at a tertiary center in North India. Results A total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had signifcantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140× 109 /L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable. Conclusion In hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.

Accessory right hepatic artery and its significance for a surgeon: A case report

Right hepatic artery (RHA) is a branch of the common hepatic artery; however, there are cases documented in the literature showing anatomical variations. Accessory RHA is an incidental finding during hepatobiliary and pancreatic surgery. This artery should be identified, carefully separated, and preserved during these surgeries. We encounter the variation while doing Whipple’s procedure in a 61-year-old patient diagnosed with carcinoma of the head of the pancreas. Intra-operatively, accessory RHA was present which was arising from the superior mesenteric artery. It was identified, carefully separated, and preserved. Variations in the origin of the artery may make it vulnerable to injuries during surgical procedures if due care is not taken

Speciation of coagulase negative staphylococci (CoNS) isolated from various clinical specimens in a tertiary care hospital of southern Rajasthan

Background: Coagulase negative staphylococci (CoNS) are a group of staph bacteria, which generally exist as normal flora of human skin and the oral flora found on mucous membranes. CoNS in immunocompromised pa?ents can cause variety of infec?ons like bacteraemia, central nervous system shunt infec?on, intravascular catheter-related infec?ons, endocardi?s, surgical site infec?ons, urinary tract infec?ons, foreign body infec?on, endophthalmi?s, peritoni?s and wound, bone and joint infec?ons as well as infec?ons in neonates. These infec?ons are difficult to treat because of the risk factors and the drug resistant nature of the organisms.Objec?ve:To find out species wise distribu?on of Coagulase nega?ve Staphylococci (CoNS) in various relevant clinical samples in our ins?tute. Materials and Method:A total of 500 CoNS strains were isolated from relevant clinical specimens. CoNS strains were isolated from variety of clinical specimens. Strains were iden?fied as CoNS on the basis of colony morphology, gram stain, catalase test and coagulase test. Conven?onal methods were used for species iden?fica?on a?er confirming isolates as CoNS. Results:The most common source of CoNS isola?on was blood (34%), followed by respiratory secre?ons (24.4%), urine (16.8%), pus (13.4%), swabs (5.4%), bodily fluid (1.4%), and others (4.6%). S.epidermidis was most frequently isolated (30.6%), followed by S.hemoly?cus (25.4%), S.hominis (12.6%), S.capi?s (12%), S.lugdunensis (11.4%) and S.cohnii (08%). Conclusion : As CoNS have become major cause of nosocomial infec?ons, there is a need for rapid iden?fica?on and specia?on of CoNS with their an?bio?c suscep?bility for be?er management of these cases and to prevent emergence of drug resistance.

Nosocomial infections-related antimicrobial resistance in a multidisciplinary intensive care unit

Background: Intensive care units (ICUs) have become hubs of nosocomial infections worldwide. There has been a continuous rise in the development of antimicrobial resistance among ICU-acquired infections. Particularly, the Gram-negative bacteria implicated in ICU-acquired infections have become resistant to the majority of the antibiotics leading to a critical therapeutic problem. The present study was conducted to determine the antimicrobial resistance pattern of microorganisms causing nosocomial infections (ventilator- associated pneumonia [VAP], central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) in a multidisciplinary ICU. Materials and Methods: This prospective observational cohort study included the patients with ICU stay ? 48 h and any of the ICU-acquired infections: VAP, CLABSI, or CAUTI. The appropriate specimen was collected as per the standard procedure and cultured. The antimicrobial susceptibility of all the bacterial isolates recovered from the samples was performed according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The antimicrobial resistance data were analyzed using WHONET Microbiology Laboratory Database software 5.6 (WHONET 5.6). Results: Gram-negative microorganisms were the principal pathogens causing various infections in the ICU, out of which Pseudomonas aeruginosa and Klebsiella pneumonia were the commonest. Most of the Gram- negative bacteria showed a high degree of resistance to the majority of the antibiotics. Colistin was observed to be the most effective antimicrobial for Gram-negative pathogens followed by doripenem, meropenem, and tigecycline. The majority of Staphylococcus aureus isolates (71.4%) were methicillin-resistant S. aureus; however, all were sensitive to vancomycin and linezolid. Vancomycin-resistant Enterococci constituted 43% of Enterococcus isolates and were sensitive to linezolid and tigecycline. Conclusion: Antimicrobial resistance was very high among the pathogens causing nosocomial infections in the ICU, especially Gram-negative bacteria demonstrated a substantially high degree of resistance to the majority of the antibiotics. Antibiotic stewardship will help control the emergence of multidrug-resistant microbes.

Isolation, identification and antibiotic sensitivity pattern of Escherichia coli isolated from various clinical sample in a tertiary care hospital, Jaipur, Rajasthan, India

Background: Escherichia coli is one of the most frequent causes of many bacterial infections, including Urinary Tract Infections (UTI), blood stream infections, otitis media, pneumonia, meningitis, traveler’s diarrhoea, enteric infections and systemic infections. This study was done with the aim to surveying antibiotic sensitivity pattern of isolated Escherichia coli in both sex attended in NIMS Hospital, Jaipur under the taken time period.Methods: In this cross-sectional study, 62 Escherichia coli were isolated from various clinical specimens of the patients attending both OPD and IPD. The strains were selected using the laboratory standard methods and culture-specific. The antibiotic susceptibility testing was performed using Kirby-Bauer disk diffusion method.Results: Out of total 62 isolates of Escherichia coli 26(41.93%) isolates were from male while 36(58.064%) from female patients. Maximum sensitivity were shown by Polymyxin B and Colistin i.c 100% followed by Nitrofuratonin 82.5% followed by Meropenem 79.03%, Aztreonam 72.58%, Piperacillin/ Tazobactam and Ciprofloxacin 61.30%, each Amikacin 56.45%, Imipenem 54.83%, Ofloxacin 45.16%, Cefepime 43.54%, Ceftazidime 38.71%, Gentamycin and Ceftriaxone 37.09% each, Cefotaxime 30.64%, Norfloxacin 27.5%. Maximum resistance shown against Norfloxacin 72.5%, followed by Gentamycin and Ceftriaxone 62.90%, Ceftazidime 61.30%.Conclusions: Escherichia coli infected more in urinary tract infection as compare to other sample in human, and it is common in female than male. Regular monitoring of antimicrobial susceptibility for E.coli is recommended to improve treatment. A changing trend in antibiotic sensitivity profile of the isolates need to be monitored as there is limited availability of newer drugs and the emergence of resistant bacteria far exceeds the rate of new drug development.

Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication

ustification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However,these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required whenrecommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and mayhave co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National ConsensusMeeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of MedicalSciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA.Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heartdiseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenitalheart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductusarteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heartdiseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebsteinanomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

Detection of inducible clindamycin resistance in Staphylococcus aureus from various samples in a tertiary care hospital

Background: The increasing frequency of MRSA infections and rapidly changing patterns in antimicrobial resistance, led to renewed interest in the usage of Macrolides-Lincosamide-Streptogramin B (MLSB) antibiotics to treat Staphylococcus aureus infection. Clindamycin is an important drug used in the treatment of MRSA and MSSA infection. The aim of this study was to determine inducible and constitutive clindamycin resistance among clinical isolates of Staphylococcus aureus by D-test.Methods: During a period of 6 months from July 2018 to December 2018, a total of 100 Staphylococcus aureus isolated from different clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer’s disc diffusion method. Methicillin-resistance was determined by using the cefoxitin (30 µg) disc. Incidence of MLSBc and MLSBi in Staphylococcus aureus isolates by D-test as per CLSI guidelines.Results: Out of 100 isolates of Staphylococcus aureus obtained from 350 clinical samples, 70(70%) were found to be MRSA and 30(30%) were MSSA. Among 100 Staphylococcus aureus isolates, 40% isolates showed MLSBi resistance, 28% isolates showed MLSBc resistance, 6% isolates showed MS phenotype and 26% isolates showed Sensitive phenotype. MLSBc and MLSBi were found to be higher in MRSA as compared to MSSA (21%, 27% and 7%, 10% respectively). All clinical isolates showed 100% sensitivity to Vancomycin and Linezolid in routine antibiotic susceptibility testing.Conclusions: Continuous surveillance of the MLSB resistance is important and required before the prescription of clindamycin to treat MRSA infections.

Synthesis of Some Novel Tetra Aryl Imidazoles Compounds: Evaluation of In-Vitro Cytotoxicity and Anthelmintic Activity

The imidazole derivatives have potent therapeutic activity against cytotoxicity and parasites. The present study was planned to synthesize novel tetra aryl imidazoles compounds and evaluated for in vitro cytotoxicity and anthelmintic activity. Firstly, 2-amine-4-chloro pyridine was condensed with substituted benzaldehyde to give corresponding Schiff’s base. These Schiff’s bases further on treatment with ammonium acetic acid derivation and isatin yielded comparing novel tetra aryl imidazoles. The synthesized compounds were examined for in-vitro cytotoxicity and anthelmintic activity. The discoveries showed that all the synthesized novel substituted imidazoles have moderate to great anthelmintic action. They additionally had critical in-vitro cytotoxicity against HEp2 cell lines (Human larynx malignancy cell line) against standard utilizing 5-fluorouracil. The compounds 1b, 2b, 4b, 6b, and 8b had higher anthelmintic action contrasted with standard mebendazole. The synthesized compounds 1b, 2b and 8b had noteworthy in-vitro cytotoxicity against HEp2 cell lines.

Comparison Of Intrathecal Nalbuphine With Different Doses Of Bupivacaine In Infraumbilical Surgeries

Background: Subarachnoid block (SAB) is a widely used regional anesthetic technique for infraumbilical surgeries.Aims: The study was conducted to compare intrathecal nalbuphine with different doses of bupivacaine in infraumbilical surgerieswith respect to hemodynamic changes, side effects, onset and duration of sensory as well as motor blockade, and duration ofanalgesia.Materials and Methods: After obtaining Institutional Ethics Committee approval, a prospective study was conducted on90 patients belonging to American society of Anesthesiology Grades I and II, aged 18–60 years and scheduled for infraumbilicalsurgeries using SAB. Three Groups A, B, and C each with 30 patients were given 0.8 mg nalbuphine along with 10, 12.5, and15 mg of hyperbaric bupivacaine, respectively.Statistical Analysis: Chi-square and unpaired “t” test and following results were observed.Results: Mean onset of sensory block until T10 dermatome was 2.59 ± 0.43, 2.49 ± 0.30, and 2.44–0.33 min while its totalduration was 102.23 ± 5.81, 110.10.83 ± 83, and 136.33 ± 6.15 min in Groups A, B, and C. Maximum motor blockade wasachieved in 7.55 ± 0.57, 7.41 ± 0.51, and 7.30 ± 0.62 min and mean duration of motor block was 145.27 ± 11.80, 155.00 ± 11.58,and 188.00 ± 10.27 min in Groups A, B, and C. Mean time of total duration of the analgesia in Groups A, B, and C was 240.83 ±36.34, 413.77 ± 68.60, and 719.90 ± 99.93 min. Patients in Group C had hypotension at 8th and 10th min intraoperatively whileother parameters and side effects were non-significant.Conclusion: About 0.8 mg of nalbuphine when combined with 12.5 mg of hyperbaric bupivacaine had optimum duration ofanalgesia and sensory block with lesser hemodynamic alterations and side effects.

Effect of antiplatelet therapy on mortality and acute lung injury in critically ill patients: A systematic review and meta‑analysis.

Aim: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta‑analysis. Materials and Methods: We conducted a meta‑analysis using PubMed, Central, Embase, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar. Studies were included if they investigated critically ill patients receiving antiplatelet therapy and mentioned the outcomes being studied (mortality, duration of hospitalization, ARDS, and need for mechanical ventilation). Results: We found that there was a significant reduction in all‑cause mortality in patients on APT compared to control (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.70–0.97). Both the incidence of acute lung injury/ ARDS (OR: 0.67; 95% CI: 0.57–0.78) and need for mechanical ventilation (OR: 0.74; 95% CI: 0.60–0.91) were lower in the antiplatelet group. No significant difference in duration of hospitalization was observed between the two groups (standardized mean difference: −0.02; 95% CI: −0.11–0.07). Conclusion: Our meta‑analysis suggests that critically ill patients who are on APT have an improved survival, decreased incidence of ARDS, and decreased need for mechanical ventilation.

Morphological, molecular characterization and taxonomic status of Triplophysa marmorata and Triplophysa kashmirensis (Cypriniformes: Nemacheilidae) from Kashmir valley, India

AbstractIn India the distribution of genus Triplophysa has been reported only in the upper drainage of the Indus River in Jammu and Kashmir and Lahul and Spiti area of Himachal Pradesh. There is no study on the taxonomic characterization of this genus from Kashmir Himalaya. Therefore the present study was aimed to characterize two important fish species Triplophysa marmorata and T. kashmirensis from Kashmir valley, by using morphometric and molecular tools. It is difficult to discriminate these two species due to the poor quality of original descriptions, and the lack of good reviews. Keeping this in view, a morphometric and molecular study was conducted. Morphometric data were analyzed by using univariate analysis of variance (ANOvA) and multivariate analyses (Principal component analysis) and mtDNA marker Cytochrome oxidase 1 was used for molecular support. Altogether, 22 morphometric characters were used and 15 characters were found significantly variable (P < 0.05). First two components of principal component analysis (PCA) i.e. PC1 and PC2 grouped these two species into separate clusters. The Cytochrome oxidase 1 analysis showed that the mean intraspecific nucleotide divergence (K2P) was 0.001 and interspecific nucleotide divergence was 0.007. Despite having low K2P divergence, these two species got separated into two distinct clades in both Neighbour joining (NJ) and Unweighted Pair Group Method with Arithmetic Mean (UPGMA) tree building methods. But the pattern of clade formation showed that these species were recently radiated from each other and may have the same ancestor. Furthermore, these two species were found closer to Nemacheilidae than to Balitoridae family in the phylogenetic analysis. The molecular divergence between these species was also supported by variance in morphometric data. This work may build the base for the revision of taxonomic identity of these two important fishes of genus Triplophysa. The present investigation formulated that, based on morphological and mtDNA COI sequences analysis, these two taxonomic Triplophysa species should be considered as valid. The results may further assist to enhance the knowledge of the ichthyologists in understanding the ichthyofauna of Kashmir valley and will help them in planning strategies for conservation and management of these less studied small indigenous species along their natural range of distribution. Rev. Biol. Trop. 64 (2): 473-482. Epub 2016 June 01.

ResumenEn la India, la distribución del género Triplophysa se ha reportado solo en la parte superior del río Indus en Jammu, Kashmir, Lahul y Spiti en el área de Himachal Pradesh. No existen publicaciones acerca de la caracterización taxonómica de este género en Kashmir Himalaya. Por lo tanto, en este estudio se caracterizaron dos especies del valle de Kashmir: Triplophysa marmorata y T. kashmirensi, mediante el uso de herramientas morfométricas y moleculares. Es difícil diferenciar entre estas dos species debido a las vagas descripciones originales y a la falta de buenas revisiones. Debido a esto se realizó un estudio morfométrico y molecular. Los datos morfométricos se analizaron mediante un ANOvA y un análisis de componentes principales y el marcador del gen de la citocromo oxidasa 1 se usó para apoyo molecular. En general, se usaron 22 caracteres morfométricos y 15 fueron significativos (P < 0.05). Los dos primeros componentes del análisis de components principales (PCA), PC1 y PC2, agruparon estas dos especies en clusters separados. El análisis con citocromo oxidasa 1 mostró que el promedio de divergencia del nucleótido intraespecífico (K2P) fue de 0.001 y la divergencia del nucleótido intraespecífico fue de 0.007. A pesar de la baja divergencia de K2P, estas dos species se separan en dos clados diferentes tanto por el método NJ como por el método UPGMA. Sin embargo, el patrón de formación del clado mostró que estas species radiaron recientemente una de la otra y que podrían tener un ancestro en común. Además, en el análisis filogenético estas dos especies se encontraron más cerca de la familia Nemacheilidae que de Balitoridae. La divergencia molecular entre estas dos especies también fue respaldada por la varianza en los datos morfométricos. Este estudio puede establecer la base para una revisión taxonómica de estos dos importantes peces del género Triplophysa. Esta investigación postuló que, basada en análisis morfológicos y de secuencia de ADNm COI, estas dos especies taxonómicas de Triplophysa deben considerarse válidas. Los resultados pueden contribuir a mejorar el conocimiento de los ictiólogos en la comprensión de la ictiofauna del valle de Kashmir y les ayudará a planear estrategias de conservación y manejo de estas dos pequeñas especies indígenas y poco estudiadas en su rango de distribución natural.

Papillary muscle and left ventricular trabecular calcification in rheumatic mitral stenosis.

Calcification of mitral valve apparatus in rheumatic pathology is not uncommon but isolated papillary muscle calcification and surrounding trabeculation is very rarely seen. Here valve leaflets and annulus are not calcified. This signifies the involvement of other factors in initiation of calcification other than rheumatic scarring. It may be chronic ventriculopathy that leads to trabecular calcification which involves papillary muscle and may later involve annulus. Clinical significance is that in high risk cases balloon mitral valvuotomy can be given a chance rather than replacement of valve as annulus and leaflets are pliable.