Profile of COVID-19 breakthrough cases and its comparison with unvaccinated COVID-19 cases among healthcare workers in a tertiary care centre in North Kerala.

Background: Healthcare workers (HCWs) were the most vulnerable group during COVID-19 pandemic and had faced many challenges including high rate of breakthrough infections. Aims: To study the incidence of reported breakthrough infections among HCWs in Government Medical College, Kozhikode and to compare profile of COVID-19 infection between fully vaccinated and unvaccinated COVID-19 positive HCWs. Settings and Design: The research was conducted as a prospective study for a duration of 78 weeks from 1st of March 2020 through 31st of August 2021 in Government Medical College, Kozhikode. Methods and Material: The study was conducted among HCWs in a COVID-19 tertiary care institute. Real-time data were collected from 401 breakthrough cases and 390 unvaccinated COVID-19 positive HCWs through telephonic interviews. Statistical Analysis Used: Univariate analysis was done using frequency for categorical variables and mean and standard deviation for quantitative variables. Chi-square test was used to find out statistical significance. Results: Incidence of breakthrough infection was found to be 5.62% with 43.3% being asymptomatic. Fever was the most predominant symptom (62.5%). None of the breakthrough cases developed complication requiring intensive care (ICU). There was a reduction in incidence of acute post-COVID-19 syndrome in vaccinated group (17.45%) compared to unvaccinated group (57.2%). Conclusions: COVID-19 vaccination plays a key role in preventing severity, complication, and ICU admissions in COVID-19 infection. Incidence of post-COVID-19 syndrome is also less among fully vaccinated compared to unvaccinated individuals.

Disposable-micropipette tip supported electrified liquid-organogel interface as a platform for sensing acetylcholine.

Sensing acetylcholine has been predominantly based on enzymatic strategies using acetylcholine esterase and choline oxidase because of its electrochemical inertness. Electrified liquid-liquid interfaces are not limited to oxidation/reduction processes, and can be utilized to detect non-redox molecules which cannot be detected using conventional solid electrodes. In this study, a disposable micropipette tip based liquid-organogel interface, in the presence/absence of calixarene has been developed as a platform for sensing acetylcholine. We also explored a liquid-liquid interface approach for sensing acetylcholine using a pre-pulled glass micropipette. In both approaches, the configuration, i.e., liquid-organogel and liquid-liquid interface-current linearly increases during the backward transfer of acetylcholine. The simple and facilitated ion transfer of acetylcholine across the liquid-organogel exhibited a linear range of 10-50 µM and 1-30 µM with a detection limit of 0.18 µM and 0.23 µM and a sensitivity of 9.52 nA µM-1 and 9.20 nA µM-1, respectively. Whereas, the detection limit of simple and facilitated ion transfer of liquid-liquid interface using pre-pulled glass micropipette was found to be 0.42 µM and 0.13 µM with a sensitivity of 5 × 10-3 nA µM-1 and 3.39 × 10-2 nA µM-1. The results indicate that the liquid-organogel configuration supported on a disposable micropipette tip without any pre-fabrication is highly suitable for electrified soft interface sensing applications.

Quantum chemical calculation, performance of selective antimicrobial activity using molecular docking analysis, RDG and experimental (FT-IR, FT-Raman) investigation of 4-[{2-[3-(4-chlorophenyl)-5-(4-propan-2-yl) phenyl)-4, 5-dihydro- 1H- pyrazol-1-yl]-4-oxo-1, 3- thiazol-5(4H)-ylidene} methyl] benzonitrile.

The research received a great deal of worldwide attention due to the nature of interpretation before the experimental process. Based on the systematic process the structure of thiazole -pyrazole compound 4-[{2-[3-(4-chlorophenyl)-5-(4-propan-2-yl) phenyl)-4, 5-dihydro- 1H- pyrazol-1-yl]-4-oxo-1, 3- thiazol-5(4H)-ylidene} methyl] benzonitrile [CPTBN] was investigated. In the first level, the spectral statistics on experimental FT-IR and FT- Raman was reported. At the next level, geometrical parameters was theoretically acquired from density functional theory (DFT) using B3LPY/6-31G and 6-311G basis set. The computed Wavenumber were collected and compared with the experimental data. The vibrational modes were interpreted in terms of potential energy distribution (PED) results. The FMO, MEP, and NBO analysis further validated the electrophilic and nucleophilic interaction in the molecular systems. Two grams-positive bacteria: staphylococcus aureus, Bacillus subtilis and two gram-negative bacteria: Esherichia coli, Pseudomonas aeruginosa was performed for antibacterial activity. Two fungal strain Candida albicans and Aspergillus Niger was carried out against a ligand using anti-fungal activity. The molecular docking analysis explores the antimicrobial and selective potential inhibitory nature of the binding molecule. Besides, RDG and ELF analysis were also performed to show the nature of interactions between the molecule.

Psychosocial counseling of patients planned for hematopoietic stem-cell transplantation for malignant conditions-practical challenges and solutions from India.

Hematopoietic stem-cell transplantation (HSCT) is a life-saving procedure often performed to cure relapsed and difficult-to-treat malignancies. Only a handful of centers in India were initially involved in the delivery of these services. However, in the last decade, more than 100 centers in the private and public domain have started offering transplant services in the country. Moreover, there are funding options, which has opened up this expensive treatment options for economically backward patients. Costs apart, there are multiple social, familial, and emotional challenges faced by these patients. A multidisciplinary support team involving social workers, psychologists, and transplant nurses, besides the treating hematologist/oncologist, is required for the optimum care of these patients. These challenges, in the Indian context, are often unique. Unfortunately, there is limited information and resource available to guide counseling of patients planned for HSCT in India. We conducted a workshop at our center where a panel of experts with experience in dealing with patients undergoing HSCT discussed issues faced by them. These discussions constitute a valuable resource for counseling patients planned for HSCT. They were transcribed by a postgraduate doctor and are summarised here in a case-based format.

Nipah Virus Infection in Kozhikode, Kerala, South India, in 2018: Epidemiology of an Outbreak of an Emerging Disease.

BACKGROUND: An outbreak of the rare and highly pathogenic Nipah virus infection occurred in Kozhikode, Kerala, India, during May 2018. METHODOLOGY: Outbreak control activities included laboratory case confirmation and isolation. Contact surveillance was initiated and close contacts were home quarantined for the maximum incubation period of the disease. Field visits and verbal autopsy of the deaths were done to elicit the details of exposure. RESULTS: Of the 18 confirmed cases, 16 succumbed (case fatality rate, 88.8%). The mean incubation period was 9 days. The transmission was person to person wherein the primary case served as a point source for 15 other cases including 2 health-care workers. The mean age of the affected cases was 41 years with male preponderance. More than 2600 contacts were under surveillance. The outbreak was contained within 3 weeks and declared closed by July the same year. CONCLUSION: Early detection of the outbreak and prompt isolation of cases along with strengthening of infection control practices and barrier nursing helped in containing the outbreak.

Role change as breadwinner in cancer caregiving.

INTRODUCTION: : Indian families are known for adopting the role of caregiver naturally when someone in the family falls ill to cancer. Although there were strong family structure and system existed here, now the changing family pattern and structure are challenging the role of cancer caregiving as well. OBJECTIVE: : This study analyses the life situation of caregivers of cancer survivors during the course of treatment and attempts to explore the areas of interventions for caregivers themselves. METHODS: : A descriptive research design was adopted for the study. A sample of 40 respondents was chosen for the study through purposive sampling technique. RESULTS: : Majority of the caregivers were females (75%) and fell into the age group of 35 to 45 years (65%). The education among the caregivers was varying between illiteracy to postgraduation. Majority of 95% of them adapted the dual role voluntarily and 85% of them felt that they were finding it very difficult to cope with the dual responsibility. About 60% of them felt that they would fail in their roles and were not satisfied with their performances dually. CONCLUSION: : Adaptation to a dual role involves time factor and as part of care to the caregiver, a guided interaction and orientation towards managing these roles would help them better ways to adapt. Given the scarcity of support system on Indian settings, the caregivers who do dual role have huge responsibility and challenges to deliver quality caregiving and fulfill their other roles as well. It is the duty of the complete health care system to seriously take this into consideration and to act on it.

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Kerala.

INTRODUCTION: Delay in the diagnosis of tuberculosis (TB) can lead to an increased infectivity period, delayed treatment, and increased severity of the disease. The objective of this study was to estimate the diagnostic delay and factors associated with the delay in diagnosis among the newly diagnosed smear-positive pulmonary TB patients in Kerala, India. MATERIALS AND METHODS: A cross-sectional study was conducted among TB patients who were in the intensive phase of directly observed treatment short-course treatment in four randomly selected TB units in a district in Kerala during the years 2012-2013. Diagnostic delay was defined as the delay between the onset of symptoms and diagnosis. Data collection using a modified World Health Organization questionnaire was done by interviewing 302 participants. RESULTS: Mean age of the participants was 48.6 ± 14.5 years. Males constituted 76.5% of the study population. The mean diagnostic delay was 43.5 ± 29.1 days (median: 37 days). The median patient and health system delays were 16 days and 15 days, respectively. Patient delay (55.6%) contributed more than health system delay (44.4%). Poor knowledge about TB, first consulting a private physician, and increased number of consultations were found to be significantly associated with diagnostic delay. CONCLUSION: The diagnostic delay in tuberculosis reported in this study was lower than other studies in India but it needs further reduction. Both patients and health providers play a role in a delay in diagnosis, and poor knowledge about the disease among the patients was one of the main risk factors. Interventions to improve knowledge and awareness of the disease and to increase the suspicion of chest symptomatic by health-care providers in the private sector are vital to reduce diagnostic delay.

Drug-induced hypersensitivity syndrome with human herpesvirus-6 reactivation.

A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.

Course of poly(4-aminodiphenylamine)/Ag nanocomposite formation through UV-vis spectroscopy.

Kinetics of chemical oxidative polymerization of 4-aminodiphenylamine (4ADPA) was followed in aqueous 1 M p-toluene sulfonic acid (p-TSA) using silver nitrate (AgNO3) as an oxidant by UV-vis spectroscopy. The medium was found to be clear and homogeneous during the course of polymerization. The absorbances corresponding to the intermediate and the polymer were followed for different concentrations of 4ADPA and AgNO3 and at different reaction time. The appearance of a band around 450 nm during the initial stages of polymerization corresponds to the plasmon resonance formed by the reduction of Ag+ ions. Rate of poly(4-aminodiphenylamine)/Ag nanocomposite (RP4ADPA/AgNC) was determined for various reaction conditions. R(P4ADP/AgNC) showed second order power dependence on 4ADPA and first order dependence on AgNO3. The observed order dependences of 4ADPA and AgNO3 on the formation of P4ADPA/AgNC were used to deduce a rate equation for the reaction. Rate constant for the reaction was determined through different approaches. The good agreement between the rate constants obtained through different approaches justifies the selection of rate equation.

The ASPIRE approach for TIA risk stratification.

BACKGROUND: The risk of stroke after transient ischemic attack (TIA) is elevated in the days to weeks after TIA. A variety of prediction rules to predict stroke risk have been suggested. In Alberta a triage algorithm to facilitate urgent access based on risk level was agreed upon for the province. Patients with ABCD2 score ≥ 4, or motor or speech symptoms lasting greater than five minutes, or with atrial fibrillation were considered high risk (the ASPIRE approach). We assessed the ability of the ASPIRE approach to identify patients at risk for stroke. METHODS: We retrospectively reviewed charts from 573 consecutive patients diagnosed with TIA in Foothills Hospital emergency room from 2002 through 2005. We recorded clinical and event details and identified the risk of stroke at three months. RESULTS: Among 573 patients the 90-day risk of stroke was 4.7% (95% CI 3.0%, 6.4%). 78% of the patients were identified as high risk using this approach. In patients defined as high risk on the ASPIRE approach there was a 6.3% (95% CI 4.2%, 8.9%) risk of stroke. In patients defined as low risk using the ASPIRE approach there were no recurrent strokes (100% negative predictive value). In contrast, two patients with low ABCD2 scores (ABCD2 score < 4) suffered recurrent strokes. CONCLUSION: The ASPIRE approach has a perfect negative predictive value in the population in predicting stroke. However, this high sensitivity comes at a cost of identifying most patients as high risk.

Biological control potential of the obligate parasite Pasteuria penetransagainst the root-knot nematode, Meloidogyne incognita infestation in Brinjal.

The efficacy of the obligate bacterial parasite, Pasteuria penetrans against the rootknot nematode, Meloidogyne incognita infestation was assessed in brinjal. The seedling pans with sterilized soil were inoculated with nematodes and root powder of P. penetrans were applied at different dosages viz., 0 x 10(6), 0.5 x 10(6) spores and 1 x 10(6) spores/pan. Seeds of brinjal cv Co2 were sown in the pans and seedlings were allowed to grow. The seedlings were transplanted to microplots containing sterilized soil. Observations on nematode infestation and plant growth were recorded at seedling, flowering, and fruiting stages. Nematode infestation was significantly reduced by P. penetrans treatment. There was 22, 75 and 86% reduction in nematode population of soil over control at seedling, flowering and fruiting stages, respectively, at higher spore density (1 x 10(6)). Egg mass production was decreased by 63, 78 and 89% over control at 35 (seedling), 100 (flowering) and 160 (fruiting) days after sowing respectively, at 1 x 10(6) spores treated soil. The parasitizing ability of P. penetrans increased with the age of the crop. At higher spore density the percentage of parasitization was increased from 52.0 (35 days after sowing) to 90.0 (160 days after sowing) %. At these stages of the crop, the spore load per juvenile also increased at the higher dose. The P. penetrans application enhanced the plant growth. The weight of the shoot was increased by 17.6% whereas root weight by 41.0% over the control at fruiting stage. The experimental results revealed the potential use of P. penetrans as biological control agent of M. incognita. Application of P. penetrans spores in the nursery is a good strategy since the mass multiplication is quite difficult.

Integrated management of root-knot nematode, Meloidogyne incognita infestation in tomato and grapevine.

An integrated approach with the obligate bacterial parasite, Pasteuria penetrans and nematicides was assessed for the management of the root-knot nematode, Meloidogyne incognita infestation in tomato and grapevine. Seedlings of tomato cv. Co3 were transplanted into pots filled with sterilized soil and inoculated with nematodes (5000 juveniles/pot). The root powder of P. penetrans at 10 mg/pot was applied alone and in combination with carbofuran at 6 mg/pot. Application of P. penetrans along with carbofuran recorded lowest nematode infestation (107 nematodes/200 g soil) compared to control (325 nematodes/200 g soil). The rate of parasitization was 83.1% in the carbofuran and P. penetrans combination treatment as against 61.0% in the P. penetrans treatment only. The plant growth was also higher in the combination treatment compared to all other treatments. A field trial was carried out to assess the efficacy of P. penetrans and nematicides viz., carbofuran and phorate in the management of root-knot nematode, M. incognita infestation of grapevine cv. Muscat Hamburg. A nematode and P. penetrans infested grapevine field was selected and treatments either with carbofuran or phorate at 1 g a.i/vine was given. The observations were recorded at monthly interval. The results showed that the soil nematode population was reduced in nematicide treated plots. Suppression of nematodes was higher under phorate (117 nematodes/200 g soil) than under carbofuran (126.7 nematodes/200 g soil) treatment. The number of juveniles parasitized was also influenced by nematicides and spore load carried/juvenile with phorate being superior and the increase being 17.0 and 29.0% respectively over the control. The results of these experiment confirmed the compatibility of P. penetrans with nematicides and its biological control potential against the root-knot nematode.

In situ UV-visible spectroelectrochemical evidences for conducting copolymer formation between diphenylamine and m-methoxyaniline.

Electrochemical copolymerization of diphenylamine (DPA) with m-methoxy aniline (MA) was carried out in 4 M H(2)SO(4) by cyclic voltammetry (CV). Cyclic voltammograms (CVs) of the copolymer films were recorded in monomer-free background electrolyte. In situ sepectroelectrochemical studies were carried out on an optically transparent electrode (Indium tin oxide (ITO) coated glass) in 4 M H(2)SO(4) for different feed ratios of the comonomers. Constant potential and potential sweep methods were employed for performing polymerization. UV-visible absorption spectra were collected continuously and concurrently during the copolymerization in both the cases. The results from constant potential electropolymerisation indicated the formation of an intermediate with an absorption peak at 576 nm. Derivative cyclic voltabsorptogram (DCVA) was deduced from the results of cyclic spectrovoltammetry. The DCVA derived at 576 nm confirms the intermediates formed during the electrochemical copolymerization. The compositional changes of the two monomers in the copolymers with changes in feed composition of two monomers as predicted from in situ spectro electrochemical studies are evident from elemental analysis. A plausible copolymerization mechanism is suggested.

In-situ spectroelectrochemical evidences for the copolymerization of o-toluidine with diphenylamine-4-sulphonic acid by UV-visible spectroscopy.

In-situ spectroelectrochemical studies on the copolymerization of o-toluidine (OT) with diphenylamine-4-sulfonic acid (DPASA) were carried out on ITO electrode in 0.5 M H2SO4 for different feed ratios of OT and DPASA. The early stages of copolymerization of OT with DPASA have been identified through spectroelectrochemical techniques. The results revealed the formation of a head-to-tail dimer type of intermediate at the initial stages of copolymerization. This N-phenyl-paraphenylene diamine (PPD) type of intermediate was assigned to have a peak at 550 nm in UV-visible spectra and confirmed via derivative cyclic voltabsorptogram (DCVA). Constant potential electropolymerization results also supported the formation of intermediate with an absorption maximum at 550 nm.