Role of polymerase chain reaction–based viral detection in pterygia

Purpose: Pterygium is a fibrovascular disease that originates in the conjunctiva and commonly spreads to the corneal surface, thereby posing a threat to eyesight. Despite intensive research, the pathophysiology of this disease remains unclear. Recent research suggests that oncogenic viruses, such as human papillomavirus (HPV), cytomegalovirus, and Epstein–Barr virus (EBV), may play a role in pterygia development. Although there are questions concerning the function of oncogenic viruses in pterygium pathogenesis, existing research shows a lack of consensus on the subject, demonstrating the heterogeneity of pterygium pathophysiology. Therefore, we aimed to simultaneously detect the three common viral pathogens that have been reported in pterygium tissue obtained after excision. Methods: Thirty?five tissue specimens of pterygium from patients undergoing pterygium surgery (as cases) were analyzed for evidence of viral infection with multiplex polymerase chain reaction (PCR), and virus?specific real?time quantitative PCR was used for the samples that were detected positive by multiplex PCR. Results: Of the 35 patients, one sample was positive for EBV and two samples were positive for HPV. Further PCR?based DNA sequencing of the HPV PCR?positive product showed identity with HPV?16. Real?time quantitative PCR on samples that showed EBV or HPV positivity did not yield any detectable copy number. Conclusion: Our study results confirmed that PCR positivity could be due to transient flora, but it was not quantitatively significant to conclude as the causative factor of pterygium pathogenesis. However, additional studies with larger sample populations are warranted to fully determine the role of the virus in pterygium.

Transtorno de trabalho em turnos entre enfermeiros durante a pandemia da COVID-19 na Arábia Saudita / Shift work disorder among nurses during the COVID-19 pandemic in Saudi Arabia

RESUMO Objetivo avaliar a prevalência de sintomas de transtorno de trabalho em turnos entre enfermeiros em vários turnos por longas horas durante a pandemia da COVID-19. Métodos estudo descritivo de corte transversal com 120 enfermeiros em hospitais governamentais na Arábia Saudita. Utilizaram-se questionários estruturados: Escala Hospitalar de Ansiedade e Depressão, para medir ansiedade e depressão, Escala de Sonolência de Epworth, para sonolência e insônia, e Escala de Gravidade da Fadiga, para fadiga. Resultados Mostrou-se alta prevalência de sintomas de transtorno de trabalho em turnos, como sonolência diurna (59,2%), fadiga e ansiedade (42,5%) em todos os departamentos durante a pandemia da COVID-19. Também, registrou-se depressão limítrofe de 30,5%. Evidenciou-se diferença significativa entre nível de escolaridade, horas de trabalho e departamentos de trabalho com ansiedade, e entre nível de escolaridade e horas de trabalho com depressão. Conclusão enfermeiros apresentaram sintomas de transtorno de jornada de trabalho em turnos durante a pandemia da COVID-19. Contribuições para a prática: trabalho em turnos altera estilo de vida e saúde dos enfermeiros. Poucas pesquisas foram realizadas sobre transtorno do trabalho em turnos entre enfermeiros sobre a prevalência e seus efeitos. Os resultados são úteis para identificar problemas, superar dificuldades e manter os fundamentos da qualidade do atendimento

ABSTRACT Objective to assess the prevalence of shift work disorder symptoms among nurses who work multiple shifts for long hours during COVID-19 pandemic. Methods descriptive cross-sectional study was utilized in this study of 120 nurses working in governmental hospitals in Saudi Arabia. The study used structured questionnaires: Hospital Anxiety and Depression Scale, to measure anxiety and depression, Epworth Sleepiness Scale to measure sleepiness and insomnia, and Fatigue Severity Scale to measure fatigue. Results this study showed high prevalence shift work disorder symptoms such as daytime sleepiness (59.2%), fatigue and anxiety (42.5%) across all departments during the COVID-19 pandemic. Also, it showed a 30.5% borderline depression. Significant difference between the educational attainment, hours of working and working departments with Anxiety was identified. Significant difference was found between educational attainment and hours of working with depression. Conclusion the nurses suffered shift work disorder symptoms during the COVID-19 pandemic. Contributions to practice: shift work alters the nurses' lifestyle and their health. Little research has conducted on shift work disorder among the nurses on the prevalence and its effects. The results are useful to identify the issues and to overcome the difficulties, which will help to keep the essentials of quality of care.

Sepsis-induced autoimmune hemolytic anemia in the elderly

Autoimmune hemolytic anemia (AIHA) secondary to hematological malignancy is well-known and common in the elderly. AIHA associated with infection is less commonly reported in the elderly. We are reporting a case of AIHA in an elderly female with comorbidities, probably secondary to Gram-negative infection. The case was admitted and treated during the peak of the second wave of the COVID pandemic. The treatment of AIHA also had an impact on the progress and outcome of the underlying disease, leading to readmission in a short span of time. The patient also developed a thrombotic complication known to be associated with AIHA.

Pregnancy outcome among gestational diabetes mellitus patients in a tertiary care centre

Background: Gestational diabetes mellitus poses numerous health problems for both mother and the fetus. Even though there are improved outcomes, complications of gestational diabetes still persists. Objectives of this study was to find out the maternal and perinatal outcomes in gestational diabetes mellitus.Methods: This study was done among pregnant women attending antenatal outpatient department at Sree Mookambika Institute of Medical Sciences, Kulasekharam. oral glucose tolerance test was done at between 24 to 28 weeks and the values more than their cutoff was labelled as gestational diabetes and their outcome was measured as complications during antenatal period, mode of delivery and perinatal outcome in view of neonatal intensive care unit admissions due to hyperbilirubinemia and respiratory distress syndrome.Results: Out of 500 antenatal mothers 65 were found to have gestational diabetes which is approximately 13%. Obstetric outcomes were 10% of them developed pregnancy induced hypertension, 12% of them ended in preterm labour and polyhydramnios in 2%. Delivery by caesarean section and vaginal route is almost similar. Maximum number of neonatal intensive care admissions are due to hyperbilirubinemia followed by respiratory distress.Conclusions: Screening for gestational diabetes and adequate glycemic control is necessary in preventing short term and long-term complications.

Lesson learned: Retrospective analysis of 'missed out' dengue NS1 positives among IgM negative population

To determine the proportion of dengue non-structural protein 1 (NS1) positives among laboratory confirmed dengue IgM negative patients. Methods: Data for 1 732 samples received from January to October 2017 at the Virus Research and Diagnostic Laboratory (VRDL) for dengue diagnosis were downloaded from the National Institute of Epidemiology server. Samples that were previously reported as IgM negative for dengue diagnosis were identified and their NS1 status was determined using ELISA. Thus, 'missed out' NS1 positives were correlated with the duration of illness. Furthermore, an epidemic curve for the study period was constructed. The increase in positivity rate within and between the months was compared by McNemar's and Pearson's chi-square test, respectively. Results: The reported IgM-negatives were 813, of which, 22.5% (183) were retrospectively positive for NS1 antigen. The addition of NS1 positives revealed by this study has raised the reported positivity across the months that ranged from 8.1% to 29.6%. By analyzing the dengue positives per month and the epidemic curve, the period between January and September, 2017 was identified as non-epidemic while the epidemic started from the month of October, 2017. Conclusions: Acute dengue infection is widely confirmed by detecting NS1 antigen in serum. Missing out of NS1 positives happen due to shortened window period and such cases act as reservoir for further viral transmission. Hence, this study highly emphasizes performing all three tests for dengue diagnosis that warrants the accurate dengue proportion in India.

Placental thickness and its correlation with estimated foetal weight: a cross-sectional study in a tertiary care centre in South India

Background: The placenta is a multifaceted organ which modulates and modifies the maternal environment resulting in foetal development. It could be assumed that a healthy placenta culminates in a healthy foetus. Hence the morphometric analysis of a placenta during sonogram is inevitable. The aim of the study was to estimate the relationship between placental thickness and estimated foetal weight.Methods: The study was a cross-sectional study and included 450 antenatal women attending the department of Obstetrics and Gynaecology, Tirunelveli Medical College from May 2013 to May 2014. These women had regular cycles with a known Last menstrual period and a singleton foetus. After ethics committee approval, meticulous history including age, parity, demographic factors and past history were recorded. After obtaining consent, these women underwent placental thickness measurement between 14-40 weeks of pregnancy.Results: In the study mean placental thickness between the ranges of 11-49mm was 28.7mm and mean estimated foetal weight was 1.421kilogram. The correlation between the two was 0.943. Hence the positive correlation between the placental thickness and foetal weight is confirmed (p value <0.001).Conclusions: Determining the estimated foetal weight is an important reason for doing a sonogram, especially in third trimester. Placental thickness measured at the level of umbilical cord insertion can serve as an additional parameter in estimating foetal weight in addition to the foetal parameters, since there is a linear correlation between placental thickness and foetal weight.

Influenza Virus Among Children with Acute Respiratory Infections in Chennai, India

nfluenza is a major public health concern. Information on theprevalence of influenza virus in respiratory tract infections inIndian children is very sparse. In the present study, 267 nasalswabs were collected from children with acute respiratoryinfections in Chennai, India, out of which 22 (8.2%) and 6 (2.3%)samples were positive for influenza A and B virus respectively.

Outcomes of severe sepsis and septic shock patients after stratification by initial lactate value / 世界急诊医学杂志（英文）

BACKGROUND: In the setting of severe sepsis and septic shock, mortality increases when lactate levels are ≥ 4 mmol/L. However, the consequences of lower lactate levels in this population are not wel understood. The study aimed to determine the in-hospital mortality associated with severe sepsis and septic shock when initial lactate levels are < 4 mmol/L. METHODS: This is a retrospective cohort study of septic patients admitted over a 40-month period. Totally 338 patients were divided into three groups based on initial lactate values. Group 1 had lactate levels < 2 mmol/L; group 2: 2–4 mmol/L; and group 3: ≥ 4 mmol/L. The primary outcome was in-hospital mortality. RESULTS: There were 111 patients in group 1, 96 patients in group 2, and 131 in group 3. The mortality rates were 21.6％, 35.4％, and 51.9％ respectively. Univariate analysis revealed the mortality differences to be statistically significant. Multivariate logistic regression demonstrated higher odds of death with higher lactate tier group, however the findings did not reach statistical significance. CONCLUSION: This study found that only assignment to group 3, initial lactic acid level of ≥ 4 mmol/L, was independently associated with increased mortality after correcting for underlying severity of illness and organ dysfunction. However, rising lactate levels in the other two groups were associated with increased severity of illness and were inversely proportional to prognosis.

Exploring novel drug targets in fatty acid pathway of Plasmodium falciparum.

The malarial parasite Plasmodium falciparum infects humans and proliferates rapidly inside the host before its detection. The proliferation step requires a large amount of lipids for membrane synthesis. Thus fatty acid biosynthesis occurring in the apicoplast plays an important role in causing cerebral malaria. In this study, we explored and analyzed these pathways using stoichiometric matrix, elementary flux modes and robustness analysis. Based on the above analysis, the robustness of this pathway diminished as the result of virtual enzyme knock out indicating four key enzymes, 3-oxoacyl-ACP synthase, 3-oxoacyl-ACP synthase, 3-oxoacyl-ACP synthase and Glycerol-3-phosphate o-acyl transferase. Among the four, the first three are existing drug targets. Subsequently, we also found that a combinatorial double knock out of these enzymes predicts further reduction in overall pathway enzyme activity. Thus, we propose multi drug targeting as a better way to treat brain malaria.

Profile of pharmacological effects of combination of buspirone with selected antidepressants: a behavioral study in mice.

Background: Antidepressants are commonly prescribed drugs. Co-existing disorders like anxiety require therapy with other drugs. The profiles of pharmacological effects of these drugs on central nervous system are influenced by the administration of these drugs either as single or combination. This study is designed to observe the behavioral effects of antidepressants along with the antianxiety agent buspirone in mice. Methods: Four antidepressant drugs belonging to different groups are selected for the study. Amitriptyline, citalopram, venlafaxine and mirtazapine are given orally for 2 weeks. Subsequently, buspirone is added to each antidepressant drug for a period of 3 weeks. The behavioral effects in mice are observed at weekly intervals using photoactometer, rotarod, forced swim test and elevated plus maze. Results: The antidepressant drugs amitriptyline and citalopram showed any change in spontaneous motor activity recorded by photoactometer. In rotarod test venlafaxine showed an increase in values, which showed further increase when buspirone was added. In the forced swim test also, venlafaxine showed a different pattern of effects when compared to other antidepressants. In the elevated plus maze test, the four antidepressants did not show any increase in the time spent in open arm excepting citalopram. Venlafaxine showed an increase in time spent in closed arm. Conclusions: The test drugs do not show any significant depression of central nervous system at the dose used. Venlafaxine showed a different pattern of activity in the rotarod test and swim test. The variation in response is attributed to their effects on central neurotransmitter.

Introduction to concept of personal drugs, essential drug list and awareness of cost of drugs.

Background: Undergraduate medical students acquire knowledge about use of drugs during teaching sessions related to prescription of drugs. Appropriate selection of drugs from the available list of numerous formulations requires skill. This can be imparted using the concept of personal drugs (P-drugs). Knowledge of the price of drugs is important consideration in selection of drug. This paper describes method of introducing medical student to the concept of P-drugs, essential drug list (ED list) and economic aspects of drug utilization. Methods: Students are divided into groups, guided by faculty member. Each group is allotted a clinical case scenario with specific questions; students have to select suitable drugs which can be prescribed. They also have to search for the suitable drug included in the ED list and price of different brands of the same drug. The work done by the group is presented as a report to the whole class. Results: Each group presented the list of P-drugs and ED list and price of the drugs for the selected cases viz.: pharyngitis, urinary tract infection, hypertension, diabetes mellitus. After collecting the information on these aspects each group selected the most appropriate drug for the clinical condition allotted to them. Comparison of prices of various brands provided opportunity to learn about economic aspects of drug use. Conclusion: This method of study using patient oriented problems is a useful method to impart knowledge to medical students about concept of P-drugs, ED list and economic aspects of using drugs.

Low vaccine efficacy of mumps component among MMR vaccine recipients in Chennai, India.

introduction of MMR vaccine was believed to have resulted in a decline in the incidence of measles, mumps and rubella infections. However, recent reports suggest the re-emergence of mumps infection worldwide in the vaccinated populations. Iit was proposed that the reason for this re-emergence was poor efficacy of MMR vaccine. The present study was aimed to investigate mumps infection in MMR vaccinated and non-vaccinated populations in Chennai, Iindia. Blood samples were collected from acute mumps cases (n=74, 42<12 yr age, 54% males) and investigated for IgM antibody against mumps, IgG antibody against measles, mumps and rubella viruses by ELISA. Sixty seven (91%) patients had received MMR vaccine. All the 67 vaccinated cases were positive for parotitis, and mumps IgM. However, only 10 (15%) were positive for IgG. All samples (100%) were positive for rubella and measles IgG. These findings showed the occurrence of mumps infection among MMR vaccinated individuals in Chennai, India. The MMR vaccine failed to generate anti-mumps IgG. The reason may be low vaccine efficacy of the mumps component of the MMR vaccine used.

Protective role of vitamin E on drug-induced neuropathy.

Background: The objective of this study was to look into the protective role of vitamin E (Vit.E) on drug induced neuropathy. Methods: The study involved 18 albino rats; rats were divided into 3 Groups; Group 1 control (n = 6), Group 2 - anti leukemic drugs treated rats (n = 6), Group 3 - anti leukemic drugs and Vit.E treated rats (n = 6). Anti leukemic drugs which included vincristine (VCR), L asparaginase (L Asp), doxorubicin (ADR), prednisolone (PDN), were administered to Group 2 and Group 3 rats according to acute lymphoblastic leukemia treatment regimen (MCP841). Group 3 rats were given in addition to the anti leukemic drugs, Vit.E (100 mg/kg bodyweight/orally) daily. Tests for neuropathy were done using tail clip method, tail flick method, hot plate method on the 2nd week and tail clip method on 4th week of therapy. Results: At the end of 2nd week by tail clip method and tail flick method the mean reaction time of the anti leukemic drugs alone treated group (Group 2) was increased showing the development of neuropathy. The mean reaction time of the anti leukemic drugs + Vit.E treated group (Group 3) showed a reduction in the reaction time, showing the protective role of Vitamin E. Hot plate method done at the end of 2nd week showed a decrease in mean reaction time in Group 2 rats compared with Group 3. This could be due to the hyperthermalgesia by VCR. Group 3 was protected by Vit.E. Conclusion: Observations showed a protective role of Vit.E on drug induced neuropathy.

Characterisation of mumps virus genotype C among patients with mumps in India.

Measles, mumps and rubella (MMR) vaccine failure had been reported globally and here, we report that it occurs in India now. MMR vaccinated people have developed acute mumps accompanied by anti-mumps immunoglobulin M. Genotypic characterisation revealed that the circulating mumps strain was genotype C, which is distinct from the vaccine strain of genotype N (L-Zagreb). This is the first report in India to suggest that genotype C is responsible for the present mumps infection. Thus, the present MMR vaccine must be revamped and optimised for its efficacy to prevent any future mumps epidemics.

Genotyping of erythromycin resistant group C & G streptococci isolated in Chennai, south India.

Background & objectives: Increasing resistance to erythromycin has been observed worldwide in group C and group G streptococci (GCS/GGS). The information available from India is scanty. The aim of the study was to identify erythromycin resistant GCS/GGS isolates in Chennai, south India, and to compare erythromycin resistant genotypes with emm types. Methods: One hundred and thirty one GCS/GGS isolates were tested for erythromycin resistance by disc diffusion and agar dilution methods. Erythromycin resistance genotypes [erm(A), erm(B) and mef(A)] were determined by a multiplex PCR. emm types of erythromycin resistant GCS/GGS isolates was also assessed using emm gene sequencing method. Results: Sixteen of the 131 isolates (12.21%) were resistant to erythromycin. Majority of the isolates were GGS (15/16). Eight of the 16 (50%) were S. dysgalactiae subsps. equisimilis. Twelve isolates (75%) were MLSB phenotype and four (25%) were M phenotype. Of the 12 isolates which exhibited MLSB resistance, seven showed cMLSB phenotype and were positive for erm(B) gene. The remaining five were iMLSB phenotype of which three were positive for erm(A) gene and two for erm(B) gene. erm(A) was common among carriers whereas erm(B) was common among clinical isolates. Interpretation & conclusions: MLSB was the predominant phenotype and erm(B) was the common genotype in the present study. The emm type stC1400.0 was frequently associated with erythromycin resistant GCS/GGS in our study.

Antifungal susceptibility testing of Candida tropicalis biofilms against fluconazole using calorimetric indicator resazurin.

Background: C.tropicalis is an important cause of nosocomial infections particularly in immunocompromised patients. Infections caused by Candida spp. are often associated with biofilm formation on implanted medical devices or on epithelial cell surfaces. Phenotypic characteristics of sessile cells in biofilms are known to be different from those of their free-living, planktonic counterparts. Biofilm forming strains often show increased resistance to antimicrobial agents. Materials and Methods : We measured susceptibility to fluconazole of fifty C.tropicalis isolates from immunocompromised (29) and immunocompetent (21) patients by minimum inhibitory concentration (MIC) and minimum biofilm inhibitory concentration (MBIC) assays. MBIC was done using the calorimetric indicator resazurin, to measure the metabolically active cells. Results : Biofilm forming cells showed increased resistance to fluconazole. Conclusion : The resazurin dye test was found to be a good method for determining MBIC.

In Vitro Antioxidant and Anticancer potential of Bark of Costus pictus D.DON

Objective: To evaluate the antioxidant and anticancer potential of different fractions of bark of Costus pictus using various in vitro antioxidant assay systems. Methods: In this study, assay like DPPH radical, superoxide anion radical scavenging activity, nitric oxide scavenging activity, hydrogen peroxide scavenging activity, metal chelating activity and reducing power were used. The concentrations of total phenolic and flavonoids were also calculated for the extracts.Result:pictus. This study suggested that, among the three fractions, the chloroform fraction possesses high antioxidant activity which might be helpful in preventing or slowing the progress of various oxidative stress related disorders. Moreover, all fractions possess potent anticancer properties against colon cancer cells of HT29 and lung carcinoma cells of A549. Conclusions: It can be concluded that the extract of the bark of C. pictus has potential natural antioxidant and this can be used in food industries. There are few reports on the antioxidant capacity of bark of C. pictus and the mechanism of different fractions of bark of C. pictus as antioxidative agents is still not fully understood. Hence further research is underway to analyse and isolate the active compounds responsible for the antioxidant and anticancer activity of different fractions of the bark of C.pictus. The present study elucidated for the first time the antioxidant property of bark of C.

Mechanism of oil-pulling therapy - In vitro study.

Background: Oil pulling has been used extensively as a traditional Indian folk remedy without scientific proof for many years for strengthening teeth, gums and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat and cracked lips. Aim: The aim of this study was to evaluate the antibacterial activity of sesame oil and lignans isolated from sesame oil on oral microorganisms and to check whether saponification or emulsification occurs during oil-pulling therapy. Materials and Methods: The in vitro study was carried out in three different phases: (1) Antibacterial activity of the lignans and sesame oil were tested by minimum inhibitory concentration assay by agar dilution method and agar well diffusion method, respectively. (2) Increase in free fatty acid level of oil and the quantity of sodium hydroxide (NaOH) used up in the titration are good indicators of saponification process. This was assessed using analytical tests for vegetable oils. (3) Swished oil was observed under light microscope to assess the status of the oil, presence of microorganisms, oral debris and foreign bodies. Results: Sesamin and sesamolin isolated from sesame oil did not have any antibacterial effect against oral microorganisms like Streptococcus mutans, Streptococcus mitis and Streptococcus viridans. Emulsification of sesame oil occurs during oil-pulling therapy. Increased consumption of NaOH in titration is a definite indication of a possible saponification process. Conclusion: The myth that the effect of oil-pulling therapy on oral health was just a placebo effect has been broken and there are clear indications of possible saponification and emulsification process, which enhances its mechanical cleaning action.