Investigation of Seroprevalence of Sars-Cov-2 IgG Antibodies Among Healthcare Workers in a Tertiary Care Centre in District Amritsar

Background: SARS-CoV-2 infection poses tremendous challenge to the healthcare system of nations across the globe.Healthcare workers (HCWs) are crucial to the ongoing response to the SARS-CoV-2 pandemic. During the course of their work, they are exposed to hazards that place them at the risk of infection. Serological testing for SARS-CoV-2 among healthcare workers, which form a high risk group helps in identifying the burden of hidden infection in an institutional setting. The present study aims to investigate the seroprevalence of IgG antibodies against SARS-CoV-2 among HCWs during 1stand 2ndwave.Material & Methods:A prospective study was conducted at Viral Research and Diagnostic Laboratory, Government Medical College, Amritsar during JuneJuly2020 (1stwave)and April May 2021(2nd wave). During this period, 184 blood samples were collected from healthcare workers from Government Medical College and Hospital, Amritsar. Serum was separated and used for detection of Anti-SARS-CoV-2 IgG antibodies by ELISA technique.Results:Out of the 184 samples, 79 (42.9 %) were found to be seropositive. Higher seropositivity was seen i.e 60.8 % during the 2ndwave (April-May 2021 ) as compared to 25% during 1st wave. The increase in seroprevalence was observed in almost all categories of HCWs, Doctors 44.4% vz 13.04%, nurses 54.8 % vz 34.7 %, lab technicians 72% vz 30.4 % and housekeeping staff 72.2 % vz 21.7%. Also the unvaccinated HCWs showed higher seroprevalence during the second wave and 87.5 % of vaccinated HCWs had demonstrable IgG antibodies.Conclusions:High seropositivity was observed among healthcare workers due to their nature of work. Rise of seropositivity among unvaccinated HCWs during 2ndwave concludes that increase in seroprevalence was attributable to natural infection.The vaccine’s immunological response was also highlighted in the study.

Correlation of C-Reactive Protein, Low Total Leucocyte Count and Platelet Count with Blood Culture in Neonates With Sepsis

Background: Neonatal sepsis is characterized by systemic signs and symptoms of generalised bacterial infection in the first four weeks of life. Early recognition and diagnosis of neonatal sepsis remains a challenge because of the variable and nonspecific clinical presentation. A combination of haematological and biochemical tests may provide a more rapid diagnosis of sepsis than blood culture which takes at least 24 to 48 hours for the results. Objectives: To study the correlation of parameters of sepsis screen with blood culture in neonates with clinical sepsis and or having significant risk factors for sepsis and To study the outcome of neonatal sepsis was our secondary aim.Material & Methods:The descriptive prospective study with cross sectional design was conducted on 100 neonates admitted with signs and symptoms of sepsis in the nursery ward and NICU of paediatric department of BebeNanki Hospital, GMC, Amritsar. Sepsis screen and blood culture (gold standard for neonatal sepsis diagnosis) and other relevant investigations were sent under strict aseptic conditions and treatment was started. S.CRP levels >1mg/dl, total leukocyte count < 5000 cells/cumm, platelets count < 1.5 lakhs/ µL were taken as positive significant (P <0.005) markers for neonatal sepsis. The data was tabulated and subjected to statistical analysis.Results:Positive CRP (>1mg/dl) were found to be highly significant (p<0.0001), Sensitivity, Specificity, PPV, NPV and Diagnostic accuracy were 93.33%,16.00%,76.92%,44.44% and 74.00% respectively. TLC <5000 were found to be significant (p<0.0001), Sensitivity, Specificity, PPV, NPV and Diagnostic accuracy were 65.33%,44.00%,77.78 %,29.73% and 60.00% respectively. Platelet count < 1.5 lakhs/ µL was found to be significant (p<0.0091), Sensitivity, Specificity, PPV, NPV and Diagnostic accuracy were 68.00%, 16.00%,70.83%,14.29% and 55.00% respectively.Conclusions:In developing countries like India, where blood culture investigations are limited, altered haematological parameters such as CRP, TLC, and Platelets counts can serve as quick, simple, economical methods to diagnose neonatal sepsis. Further studies with larger sample size are required to substantiate the results.

Prevalence and Epidemiological Profile of COVID-19 Infection Detected Through RT-PCR AmongPatients of Various Districts of Punjab, India

Background: The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge for healthcare systems worldwide. Earlier to SARS-CoV pandemic, coronaviruses were only thought to cause mild, self-limiting upper respiratory tract infections in humans. COVID 19 presents across a spectrum of symptoms. WHO recommends detection of unique sequences of virus RNA by Nucleic Acid Amplification Test (NAAT) such as real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). The aim of this cross sectional study was analysis and confirmation of Nasopharyngeal/oropharyngeal swab specimen by real-time reverse transcription polymerase chain reaction (RT-PCR).Material & Methods:This was a cross-sectional retrospective study that reviewed records of samples collected from June 2021 to March 2022. Nasopharyngeal/oropharyngeal swab specimen were collected from suspected COVID-19 subjects of various districts of Punjab and referred to Viral Research Diagnostic Laboratory [VRDL], Government Medical College [GMC], Amritsar for laboratory analysis and confirmation by real-time reverse transcription polymerase chain reaction (RT-PCR).Results:During the present study, a total of 11,27,005 samples were analyzed from June 2021 to March 2022 for SARS-CoV-2 detection by ICMR approved COVID-19 RT-PCR kits. Out of total 11,27,005 cases, 24,466 cases (2.17%) were found to be SARS-CoV-2 positive while 11,02,539 cases (97.83%) were SARS-CoV-2 negative.Conclusions:Ever since the COVID-19 global pandemic emerged, the developing countries are facing challenges regarding its diagnosis. Isolation of the infected person will eventually decrease the Reproduction number i.e Ro which will further interrupt the transmission cycle leading to decrease in community spread.

Preoperative Factors Affecting the Outcome of Single Stage Hypospadias Repair- An Observational Study

Background:Hypospadias is one of the commonest congenital anomaly in boys which requires either a single stage repair or staged repair. The success of the procedure depend upon the type, anatomy, experience of the surgeon, method of repair and preoperative hormonal stimulation. Aim: The aim of the study was to evaluate the various preoperative factors responsible for outcome of single stage repair in distal penile, mid penile and proximal penile hypospadias. Methods: There were 48 patients in this observational study which were divided into two groups. Group A comprised of 24 patients with glanular and coronal hypospadias while Group B comprised of 16 patients with distal penile, 5 mid penile and 3 proximal penile types with minimal chordae. All the 24 (50%) patients in group A underwent meatal advancement and glanuloplasty incorporated (MAGPI) repair while in group B 15 (31.25%) patients underwent Tabularized Incised Plate (TIP) repair and 9 (18.75%) patients underwent combined TIP and Mathieu抯 repair. Results: Overall operative success rate observed in the study was 41 (85.41%) patients. In 7 (14.58%) patients urethrocutaneous fistula as a major complication occurred which included 1 patient in Group A and 2 patients with Distal Penile Hypospadias (DPH), 2 patients with Mid Penile Hypospadias (MPH) and 2 patients with Proximal Penile Hypospadias (PPH) in Group B. In 2 (4.16%) patients, mild meatal stenosis was noted which settled with meatal dilatation. Urethrocutaneous fistula (UCF) disappeared in 2 (4.16%) patients on follow up with regular urethral dilatation. Conclusion: MAGPI is the ideal procedure for glanular/coronal hypospadias. For distal penile hypospadias, TIP alone or combined TIP and Mathieu抯 repair gives equally good results. Preoperative testosterone therapy reduces the incidence of complications in a single stage hypospadias repair.

Dynamics of Selected Trace Minerals during Estrus Induction in Anestrus Sahiwal Cattle

The present study evaluated the effect of circulatory trace mineral profiles on fertility response during estrus induction by progesterone based therapy in acyclic Sahiwal cattle. Sahiwal cows and post-pubertal heifers (n=25 each) with true anestrus condition (acyclicity confirmed ultrasonographically) were subjected to CIDR-based protocol (intravaginal CIDR application for 7 days, 500 IU eCG at CIDR removal, followed by estrus observation and AI). In heifers, additionally an injection of 5.0 mg estradiol valerate at CIDR insertion was given. Blood samples on days 0 (before CIDR application), 3, 5, 7 and 9 were collected. Almost similar estrus induction (68% vs. 64%) and subsequent conception rates (41.2% vs. 50%) during the first induced estrus were recorded in cows and heifers, respectively. During the course of treatment, significant (P<0.05) variation in plasma copper and zinc concentrations was recorded both in cows and heifers. Contrarily, manganese concentrations varied significantly (P<0.05) in cows only. However, iron profiles remained uniform during the course of treatment. Significantly (P<0.05) higher pre-treatment plasma concentrations of copper, zinc and manganese was recorded in those cows and heifers in which estrus was induced, compared to those in which estrus induction failed to occur. No significant difference (P>0.05) was recorded for iron concentration vis-à-vis estrus induction response. Hence, it is indicated that circulatory copper, zinc and manganese profiles influence the reproductives energy in acyclic animals and their suboptimal profiles may reduce the efficacy of estrus induction protocols in Sahiwal cattle.

Synergistic effect of metformin and fenugreek on the lipid profile of type-II diabetic patients

Background: Fenugreek is a traditional herb which has great relevance in the world since time immemorial due to its multifarious uses. Besides being a rich source of nutrition, it also finds place in the cure of certain pathological conditions. One of its highly beneficial effects is have been observed on the lipid profile of the hyperlipidemic patient. This study was thus undertaken to see the hypolipidemic effect of fenugreek seeds in patients of Type 2 Diabetes Mellitus (DM) as add-on therapy with metformin.Methods: An open-labelled comparative study of 12 weeks duration was conducted on patients (randomly divided in 2 groups of 30 each) of Type 2 DM. Group 1 was given metformin 500 mg twice a day while group 2 was given 500 mg of metformin along with fenugreek seed powder capsule, 1gm thrice a day. Evaluation for fasting lipid profile estimation was done at the beginning and at the end of the study. Student’s t-test (paired and unpaired) was applied for statistical analysis.Results: After 12 weeks of treatment, there was significant improvement in the lipid profile of both the groups. However, group 2, that received fenugreek along with metformin showed statistically greater improvement as compared to group 1 which received only metformin.Conclusions: This study shows the beneficial effects of fenugreek seeds on lipid profile in patients of Type 2 DM and can be used as an add-on therapy with metformin in controlling the lipid profile of Type 2 DM.

Electrolyte Changes in the Term Neonates Following Phototherapy in Neonatal Hyperbilirubinemia

Hyperbilirubinemia is one of the most prevalent problems in neonates. Jaundice is observed during first week of life in approximately 60% of term neonates and 80% of preterm neonates. Phototherapy is the most common therapeutic modality used in the treatment of uncomplicated neonatal hyperbilirubinemia. Objective: To study electrolyte (Ca, Na, K, Cl) changes in the term neonates following phototherapy in neonatal hyperbilirubinemia. Methods: This study was performed on 100 term neonates (65 males, 35 females) admitted to the Department of Pediatrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, Punjab with unconjugated hyperbilirubinemia and were managed with phototherapy. These neonates were completely normal on physical examination. Electrolytes were checked at 0 hr (at the time of admission) and after 48 hours of phototherapy or at discontinuation of phototherapy (second sample) whichever was earlier. The first sample was considered as control. Results: After phototherapy, among electrolytes (Ca, Na, K ,Cl) there was significant fall in serum calcium (ionized) level. 16 neonates developed hypocalcemia after 48 hr or less of phototherapy and 11 neonates developed hypocalcemia after 48 hr or up to 96 hr of phototherapy. The difference between pre and post phototherapy serum calcium (ionized) levels was found to be statistically significant (p <0.005). Of the 27 term neonates who developed hypocalcemia, 7 (26%) developed jitteriness and none of them developed irritability, seizures and aponea. No statistically significant fall/rise in levels of Na, K, Cl were observed in term neonates after phototherapy. The incidence of potassium, sodium and chloride changes following phototherapy was found to be nonsignificant irrespective of gestational age, birth weight and duration of phototherapy. Conclusion: The study concluded that among electrolytes (Ca, Na, K, Cl), phototherapy induced hypocalcemia is a significant problem. Thus calcium supplementation should be considered.

To Study the Effect of Ursodeoxycholic Acid in Lowering Neonatal Non – Hemolytic Hyperbilirubinemia: A Randomized Control Study

Hyperbilirubinemia is a common and in most cases, a benign problem in neonates. Conventional treatment for severe indirect hyperbilirubinemia consists of phototherapy and exchange transfusion. Phototherapy, which is the main treatment modality has its own side effects and it also upsets maternal and fetal interactions. So there is a need for adjuvant therapies to decrease duration of phototherapy and hospital stay. Objective: This study was planned to assess the role of UDCA in decreasing the duration of phototherapy in neonatal hyperbilirubinemia. Methods: Study setting: Pediatrics department, Bebe Nanki Mother & Child Care Centre, GMC Amritsar. Participants: 100 newborns with bilirubin levels in phototherapy range. Study design: Double blind, placebo controlled study. Participants were divided into two groups and UDCA (10mg/kg/d) and microcrystalline cellulose were given to group A and group B respectively. Outcome variables: Rate of fall of bilirubin levels in both the groups and total duration of phototherapy needed in both groups. Results: Mean duration of phototherapy was 36.26±8.41 hours in group A and 38.94±9.86 hours in group B. P value was 0.147 that is statistically not significant. Level of fall of bilirubin in both groups at 12hrly intervals were also compared and difference was not statistically significant. Conclusion: UDCA administration to the neonates receiving phototherapy does not hasten the fall in bilirubin levels and does not reduce the time of phototherapy significantly.

Study of LV functions in patients of subclinical hypothyroidism in patients coming to rural medical college of Sub-Himalayan region of India.

Background: Subclinical hypothyroidism (SCH) is a common disorder and has been implicated in increased cardiovascular morbidity and mortality. Therefore, it is important to study the effect of SCH on cardiac morphology and function. Thus, present study titled “Study of LV functions in patients of subclinical hypothyroidism in patients coming to rural medical of sub-Himalayan region of India” was conducted in the department of medicine, Rajinder Prasad government medical Tanda over a period of three years from December, 2010 to November, 2013 to study left ventricular function in subclinical hypothyroidism. Methods: The study was conducted in the department of medicine, Rajinder Prasad government medical Tanda over a period of three years from December, 2010 to November, 2013 to study left ventricular function in subclinical hypothyroidism. The data was analysed using computer software Epi-info version 6.0 and SPSS version 12.0 for Windows. Descriptive characteristics were presented as percentages for quantitative variables including measurement of thyroid hormones and ejection fraction. Mean and standard deviation were reported. Results: Diastolic parameters were markedly altered, mainly isovolumic relaxation time, which was increased and reduction of E/A wave ratio (<1). Systolic function parameters were within normal range. 155 patients had diastolic dysfunction with E/A wave <1.45 patients were not affected and they had E/A wave >1. Conclusions: Implication for echocardiography in SCH patients observed were that early recognition of silent diastolic dysfunction can be done. We can institute L-thyroxinee therapy which has been found to reverse diastolic dysfunction of heart along with improvement in lipid levels, decreased systemic vascular resistance, diastolic hypertension and coagulation profile. SCH, invariably affects heart and sooner or later and leads to diastolic dysfunction. Early recognition by echocardiography and then treatment with L-thyroxinee is indicated.

Perineal Ectopic Testis- A Rarity In Pediatric Surgical Practice.

Perineal ectopic testis (PET) is a rarity in pediatric surgical practice seen in less than 10% cases of maldescended testis. An eighteen months old boy presented with empty right scrotum and a palpable soft mass in the perineum which on preoperative ultrasonography was consistent with testicular morphology. Orchidopexy was performed by standard operative technique and testis was placed in Dartos Pouch. The case is reported to highlight the importance of examination of ectopic sites in a cryptorchid child and the need for long term follow-up of patient.

Infarction in Fibroadenoma Breast During Pregnancy with Skin Necrosis and Fungation.

A 35 year old multigravida in the 24th week of gestation presented with history of swelling left breast of 2 years duration. The swelling rapidly increased in size during the pregnancy & underwent spontaneous necrosis of skin with fungation & haemorrhage. Fine needle aspiration cytology showed a diagnosis of fibroadenoma. Lumpectomy was performed in the emergency & histopathology of specimen revealed infarction in fibroadenoma. Patient delivered a normal healthy baby and is alright at 6 month follow up.

Phytobezoar Induced Ileal Obstruction in Children - Report of Two Cases

Two cases of small bowel obstruction ( SBO) in children induced by phytobezoar impaction are reported. Both the children were between 3-4 yrs of age and had no history of any previous intra-abdominal operation. Preoperative diagnosis was not possible in either case. Both the cases were diagnosed at laparotomy and obstruction was relieved by disintegration of the phytobezoar mass. Postoperatively, after specific questioning suggestive history of Carissa Opaca (Garna) ingestion, 24 hrs before onset of symptoms was obtained from the parents.

Rare thoracic mass lesion--myofibrobastoma.

Mesenchymal soft tissue masses are uncommon tumours of the chest. Myofibroblastoma is a recently described entity consisting of cells with origin from the myoepethelial cell, mostly seen as benign well-circumscribed neoplasms of the breast tissue. Though usually classified as a benign lesion, rarely it can be multifocal and prone to recurrence. We describe below the case of a 26-year-old female who presented with exertional dyspnoea and evidence of a massive mass lesion in the left hemithorax causing mediastinal displacement to the opposite side. On histological and immunophenotypic analysis, a diagnosis of the very rare thoracic myofibroblastoma was made. The incidence, salient features, pathological differential diagnoses and treatment are reviewed.