Seroprevalence of Hepatitis C Virus Infection among Blood Donors at Madhya Pradesh, India: A Retrospective Study

Background: Viral hepatitis is a global health problem with 170 million Hepatitis C Virus (HCV) carriers worldwide, and 12-13 million HCV carriers in India. Unscreened blood and components play a significant role in transmission of HCV apart from reuse of injection needles, unsterilized surgical equipments and vertical transmission from mother to child. Unsafe blood transfusion not only poses risk to patients, causing significant morbidity and mortality, but also adds to the economical burden on healthcare system. Aims and Objectives: Aim of this study is to estimate the seroprevalence of HCV infection among the voluntary and relative donors over a period of 7 years at blood banks of Madhya Pradesh with collaboration of Madhya Pradesh State AIDS control Society (MPSACS) Bhopal, India from 2011 to 2017. Materials and Methods: This is a retrospective study of blood donation at blood banks, of Madhya Pradesh, India. Blood units were screened for TTIs from January 2011 To December 2017. HIV, HCV and HBV tests were done by ELISA. Data of HCV was collected and compared statistically by frequency distribution and percentage proportion. Chi Square (? 2) test was used to determine the significant difference statistically. Results: The mean age of donors was 32.4 2 ± 8.63 years. Major contribution was from male donors (93.8%). Majority of donation was done voluntarily (87.3 %). Out of the total 1,876,219 donors tested for TTIs over 7 years, 1980 (0.11%) were positive to anti HCV (p=.000001). Conclusion: The prevalence of HCV infection was 0.11% among blood donors of Madhya Pradesh, with geographic variation among districts. Aiming to provide safe blood to the patients, prevention of transmission of HCV by proper donor counseling and screening of the unit is required.

Evaluation of Lipid Profile Among Prehypertensive and Normotensive Patients: A Teaching Hospital based Study

Background: This study was designed to compare the lipid profile among prehypertensive and normotensive and its correlation between blood pressure and lipid profile in prehypertensive patients. Methods: This case-control study on forty prehypertensives and forty normotensive subjects. Blood pressures were recorded and serum lipid profiles were measured and compared using student t test. Correlation between blood pressure and serum lipid profile was done. Results: The mean SBPs of prehypertensives group and normotensives group were 132.43±6.25 mmHg versus 110.02±2.60 mmHg, respectively, and mean DBPs were 88.42±4.05 mmHg versus 74.21±3.72 mmHg, respectively. The mean SBP and DBP of prehypertensives group were higher than those of normotensives group. the serum lipid profile of recently, diagnosed prehypertensive patients was significantly altered as compared to normotensive subjects. Conclusion: The serum lipid profile of recently, diagnosed prehypertensive patients was significantly altered as compared to normotensive subjects.

High-Sensitive C–Reactive Protein with Lipid Profile Parameters in Dyslipidemic Patients: A Teaching Hospital Based Study

Background: Cardiovascular diseases, the leading causes of death in the world are rising rapidly in low- and middle-income countries. Our aim was to fine out the correlation between High-Sensitive C–reactive Protein with Lipid Profile Parameter. Methods: The strong and statistically significant positive correlation in between High-Sensitive C–reactive Protein (hsCRP) and Total Cholesterol with (p<0.016). Results: Statistically significant positive correlation between High-Sensitive C–reactive Protein and Triglycerides (p<0.001). LDL-C also showed a statistically significant positive correlation with High-Sensitive C–reactive Protein (p<0.03). HDL-C also showed a statistically not significant negative correlation with High-Sensitive C–reactive Protein (p<0.32). Conclusion: The patients with dyslipidemia for elevated blood hsCRP levels may be done to identify those patients with an increased risk stratification of atherosclerosis. Also this suggests that there may be a role for anti -inflammatory agents along with statins in treatment of dyslipidemia.

To Evaluate Efficacy of Sonographic Cervical Length to Predict Preterm Labour.

Background: Preterm birth is a major challenges faced by obstetricians worldwide during their practice. Preterm birth is one of a leading direct cause of neonatal death (27%) and more than one million preterm newborns die annually due to various complications. This study done to look for diagnostic efficacy of sonographic cervical length to predict preterm labour. Methods: A prospective study comprised of a total of 132 pregnant women with a singleton foetus with symptoms of preterm labour. Sonographic trans-cervical length measurement taken in all patients. Results: Out of which 17 patients were lost during follow up, 3 patients develop premature rupture of membrane. Hence, a study was conducted over 112 patients. Among these 62 patients went in preterm labour and 50 patients delivered at term. For predicting preterm delivery, sensitivity, specificity, positive and negative predictive value of cervical length was 82.2%, 74%, 79.6% and 77%. Conclusion: Sonographic cervical length is a good predictor. Patients with reduced cervical length are more likely to deliver preterm.

An Interesting Case of Meckel-Gruber Syndrome.

Meckel-Gruber syndrome, also known as ‘Dysencephalia splanchnocystica’, is a rare lethal autosomal recessive disorder consisting of central nervous system malformation- mainly posterior encephalocele (80%), multicystic kidneys (95%) and polydactyly (75%). Besides the classic triad of neural tube defects, polydactyly and cystic dysplasia of the kidneys, other abnormalities can occur in association with the syndrome, which may be detected sonographically include micrognathia, cardiac abnormalities, syndactyly, clinodactyly and clubbed foot. We report a case of a 26-year-old woman with previous LSCS referred from a private practitioner with abnormal ultrasonographic findings. She was diagnosed to have Meckel-Gruber syndrome. Woman and her husband were counseled regarding this lethal condition incompatible with life and after proper consent and information, pregnancy was terminated.

Double-headed Monster Delivered Vaginally.

Double-headed monster is a rare and interesting variety of twin pregnancy. In this report, we describe a case of 26-year-old gravida 3 para 2 + 0 who was referred to our center with delivered head since one hour and failure to deliver rest of the body. Here, rest of the body with second head was delivered vaginally using McRobert’s maneuver with only few vaginal lacerations to mother.

Relapse of kala-azar after use of multiple drugs: A case report and brief review of literature.

We present a case of kala-azar infection that recurred in a patient after completion of the standard treatment course of miltefosine, amphotericin B-deoxycholate (short course), and amphotericin B lipid formulations. The patient was cured after continuous amphotericin B-deoxycholate administration for 4 weeks. This is a unique case of relapse following the use of three important drugs. Although amphotericin B-deoxycholate is a second line drug in Nepal, it has shown a satisfactory clinical response with continuous treatment for 4 weeks. Therefore, an extended course of amphotericin B-deoxycholate may be beneficial in patients with resistance to the standard short course and other anti-leishmania drugs.

Totally implantable venous access ports: Retrospective review of long-term complications in 81 patients.

Aim of The Study: A totally implantable venous access port (TIVAP) has become an essential prerequisite for many chemotherapy protocols. It is serving its purpose very well, but its use is not without complications. We are presenting our experience with these devices (TIVAPs). Subjects and Methods: We retrospectively reviewed the totally implantable venous access ports in 81 patients at our hospital between January 2009 and March 2011 for long-term problems which include postoperative and follow-up problems, excluding the immediate complications which occur at the time of insertion. Results: Catheter malfunction was the most common complication (9.87%, 0.40/1000 device-days of use/observation). Catheter-related bloodstream infections were present in 5 (6.17%) patients (0.25/1000 device-days of use/observation). The mean life of the catheter was 246 days. Only 11.1% ports required removal during the treatment period. Overall, patients either completed treatment (82.8%) or died (6.1%) while receiving treatment. Conclusion: TIVAPs provide safe and reliable vascular access for patients on chemotherapy but require utmost care by a dedicated team of trained medical professionals and paramedics experienced with the use of such ports, in order to minimize the complications and their continued use while administering treatment.

Post-kala-azar dermal leishmaniasis (PKDL), HIV and pulmonary tuberculosis.

Post-kala-azar dermal leishmaniasis is usually a sequel to visceral leishmaniasis. A 25-year-old woman presented with hypopigmented maculopapular lesions all over the body for the past 4 years without any previous history of visceral leishmaniasis. She was on treatment for leprosy and pulmonary tuberculosis for the past 2 months, but did not show any improvement. Investigations confirmed that she had post-kala-azar dermal leishmaniasis associated with pulmonary tuberculosis and HIV-1 infection. She was started on treatment for the triad of diseases, and showed improvement.

Bacillus thuringiensis (Bt) transgenic crop: an environment friendly insect-pest management strategy.

Introduction of DDT (dichloro-diphenyl-trichloroethane) and following move towards indiscriminate use of synthetic chemical insecticides led to the contamination of water and food sources, poisoning of non-target beneficial insects and development of insect-pests resistant to the chemical insecticides. Increased public concems about the adverse environmental effects of indiscriminate use of chemical insecticides prompted search of altemative methods for insect-pest control. One of the promising alternatives has been the use of biological control agents. There is well-documented history of safe application of Bt (B. thuringiensis, a gram positive soil bacterium) as effective biopesticides and a number of reports of expression of delta-endotoxin gene(s) in crop plants are available. Only a few insecticidal sprays are required on Bt transgenic crops, which not only save cost and time, but also reduce health risks. Insects exhibit remarkable ability to develop resistance to different insecticidal compounds, which raises concern about the unsystematic use of Bt transgenic technology also. Though resistance to Bt products among insect species under field conditions has been rare, laboratory studies show that insects are capable of developing high levels of resistance to one ormore Cry proteins. Now it is generally agreed that 'high-dose/refuge strategy' is the most promising and practical approach to prolong the effectiveness of Bt toxins. Although manybiosafety concerns, ethical and moral issues exist, area under Bt transgenic crops is rapidly increasing and they are cultivated on more than 32 million hectares world over Even after reservation of European Union (EU) for acceptance of geneticaly modified (GM) crops, 6 out of 25 countries have already adopted Bt crops and many otherindustrial countries will adopt Bt transgenic crops in near future. While the modem biotechnology has been recognized to have a great potential for the promotion of human well-being, adoption of biosafety protocol is necessary to protect human health and environment from the possible adverse effects of the products of genetic engineering. The debate between proponents and opponents of GM technology has created major obstacles in hamessing benefits of the technology It has now become clear that transgenics willbe accepted by the public only when doubts related with general risks and environmental safety are adequately dispelled. Thus, there is need to organize public awareness and present the benefits of Bt transgenic crops to improve social attitude for their rational deployment. In this review, an attempt has been made to discuss social and environmental safety issues of Bt transgenic crops.

Biomarkers of monocrotophos in a freshwater fish Channa punctatus (Bloch).

Activity of a few biomarkers have been investigated on freshwater fish Channa punctatus treated with monocrotophos for acute exposure to 18.56 ppm at 96 hr and subacute exposure viz. 0.46 ppm, 0.96 ppm and 1.86 ppm for 30 days. Biomarkers such as total protein, lipid peroxidation and acetylcholinesterase have been measured in different tissues of fish viz. gills, liver, brain and muscles. The protein levels were found to be depleted in all the tissues after pesticide exposure to lethal and sublethal concentration over the control, where as the lipid levels showed an increase under the stress of pesticide monocrotophos. The increased lipid level may be due to inhibition of lipase activity and other biomarkers of lipid metabolism. A significant inhibition of brain acetylcholinesterase (AChE) indicating its effects on nervous system have also been observed. These parameters can be used as biomarkers to predict the early toxicity of monocrotophos added to aquatic ecosystem.

Visceral leishmaniasis and tuberculosis in patients with HIV co-infection.

We describe here two cases, one male and one female, both age 40 years, with visceral leishmaniasis and HIV-1 co-infection. The female patient had features of Koch's abdomen. The male patient had features of tuberculous lymphadenitis and bilateral pleural effusion more marked on the right side. Both were treated with highly active antiretroviral therapy, antituberculous drugs, antibiotics, antifungal medicine (fluconazole) and miltefosine. Both patients showed marked improvement with therapy.

Magnitude of unresponsiveness to sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar.

BACKGROUND: The Indian government proposes to eliminate kala-azar, which has been a serious public health problem in Bihar. This study aimed to assess the magnitude of unresponsiveness to sodium stibogluconate in the treatment of new cases of visceral leishmaniasis and to identify the associated factors. METHODS: Patients with clinically and parasitologically confirmed visceral leishmaniasis (n = 182) who had received no prior treatment, were enrolled for the study. The patients were treated with sodium stibogluconate (20 mg/kg body weight; upper limit 850 mg), intramuscularly for 30 days. The vital parameters and side-effects, if any, were monitored. Patients who developed toxicity during treatment were excluded from the study but were given rescue treatment with liposomal amphotericin B. All patients who completed the treatment were followed up for 6 months. RESULTS: Unresponsiveness to sodium stibogluconate at the end of treatment was 43%. It was higher in women (48%) compared to men (40%). A significant association was observed between unresponsiveness and level of endemicity (p = 0.0002), large spleen size (p = 0.04) and immune response (migration inhibition factor) (p = 0.00002). At the end of 6 months' follow up, 27% of patients relapsed, giving a total unresponsiveness rate of 58%. CONCLUSION: Unresponsiveness to sodium stibogluconate is a serious problem in the management of patients with visceral leishmaniasis. In patients with factors associated with nonresponse to sodium stibogluconate, alternative drugs such as miltefosine or amphotericin B should be considered as first-line drugs.

Diagnosis & management of leishmania/HIV co-infection.

Leishmaniasis, a globally prevalent parasitic disease occurs in three forms viz., visceral, cutaneous and mucocutaneous, transmitted by the bite of infected female Phlebotomus sandflies. Visceral leishmaniasis (VL) has 100 per cent fatality rate, if left untreated. India has the largest burden of this disease. HIV infection is also increasing worldwide and several reports indicate rising trend of VL/ HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. Both VL and HIV tend to lower the cell mediated immunity (CMI) resulting in poor drug response and opportunistic infections involving gastrointestinal, cutaneous, respiratory tract and central nervous system (CNS) may occur. Diagnosis of such co-infected cases is quite difficult. However, newer tests like nested PCR, rk39 immunochromatographic test etc., can be of help. Response to different antileishmanial drugs like sodium antimony gluconate (SAG), amphotericin B is far from satisfactory. However, a new oral drug miltefosine has been found to be promising. Highly active antiretroviral therapy (HAART) need to be given for management of HIV infection along with treatment of other opportunistic infections.

Pesticidal and insecticidal effect of campsis grandiflora (thumb.)

Campsis grandiflora (Thunb.); the Indian trumpet creeper; is commonly grown for ornament. In the present study; the aqueous extract of the leaves of the climber was evaluated for its pesticidal and insecticidal activities. A direct relationship was observed between the dose and the percentage larval mortality. Dosage values as expressed in log terms were; 1.398; 1.301; 1.230; 1.176 and 1.079 for 0.25; 0.20; 0.17; 0.15 and 0.12 ppm dose concentrations; respectively. For the insecticidal study; the percentage insect mortality was found to increase with the corresponding increase in dosage; indicating a direct relationship between the two. Highest insect mortality of 80

Postoperative wound infection in patients undergoing coronary artery bypass graft surgery: A prospective study with evaluation of risk factors.

PURPOSE: Wound infection is an important cause of morbidity and occasional mortality after coronary artery bypass graft surgery (CABG). The aim of this study was to report postoperative wound infection in CABG surgery patients. METHODS: Consecutive patients undergoing CABG surgery between January 1998 and October 1999 have been studied. The exclusion criteria included, age less than 30 years, penicillin / cephalosporin allergy and associated other cardiac pathologies. The parameters studied were age, sex, obesity, hypertension, diabetes, myocardial infarction, chronic renal failure, previous surgeries, alcohol consumption, smoking, length of pre and postoperative hospital stay, antibiotic prophylaxis, MRSA screening, and duration of surgery. Wounds were classified as per modified CDC's NNIS criteria. Suspected sites of infection were cultured and antibiotic susceptibility of cultured organisms was tested. Postoperative follow up was for two months. RESULTS: Six hundred and fifteen patients were studied. Of these 116 (18.86%) developed SSI, involving sternum 75%, leg 21.3%, and forearm sites 3.44%. Organisms isolated at sternum site were MSSE, MRSA, and MRSE, at leg site E. coli and MSSE, and at forearm site MSSE and MSSA. Sternal site, obesity, diabetes mellitus and female sex were associated with significantly higher infection rates (p= 0.001). No antibiotic protocol proved more effective. SSI increased the postoperative hospital stay and the total treatment cost. CONCLUSIONS: Post CABG surgery SSI rate is high. Sternum and leg are the common infection sites. Obesity, uncontrolled diabetes mellitus and female sex are associated with higher infection rates. "Higher" antibiotics do not lower postoperative infection rates.

High Thoracic Epidural Anaesthesia and Post Operative Analgesia for Fast Tracking Patients undergoing CABG: Our Initial Experience.

This prospective study was carried out is 250 patients undergoing CABG. The aim of this study was to assess the effects of high thoracic epidural anaesthesia during CABG, along with modified general anaesthsia; facilitate early extubation and fast tracking post operatively; evaluate effect on post-operative analgesia and discuss difficulties in patient selection for high thoracic epidural catheterization. 250 patients undergoing CABG over a period of nine months were included in this study. Patients with age >64 yrs, weight < 50 kg, EF < 50%, redo surgery, recent MI, receiving aspirin or ticlopidine or heparin were excluded from the study. A thoracic epidural catheter was inserted evening before surgery at T1-2 or T2-3 interspace. A total of 75 patients (30%) were found suitable to be included in this study. On table extubation or early extubation (within 3 hours) was achieved in 85% of cases. Post operative infusion of 0.1% Bupivacaine and 2 microg/ml Fentanyl was given epidurally through a PCA system for analgesia for 48-72 yrs. High thoracic epidural anaesthesia and modified GA regimen were helpful in fast tracking and early extubation of patients. Over 90% patients were discharged on day 5, from the hospital. All these patients experienced significantly less pain and discomfort following CABG. The procedural difficulties for inserting high thoracic epidural catheter were overcome with increasing experience.