Influence of COVID-19 over seasonal influenza activity in southern India.

Basic epidemiological data is urgently needed in order to ascertain the changes brought about by COVID-19 pandemic, and help researchers, clinicians, and policy makers in addressing these issues. Data on influenza positivity from 2009 to 2019 was collected from Regional Influenza laboratory, JIPMER. Being COVID testing centre we tested samples (2020-2023) from Tamilnadu and Pondicherry. All SARI samples which were negative for COVID-19 were subjected to Influenza testing as regular surveillance activity was suspended. On comparison we found significant reduction in detection rates of influenza A H1N1, H3N2 and influenza B (p value = <0.01).

The utility of inflammatory and endothelial factors in the prognosis of severe dengue.

BACKGROUND: Severe dengue is associated with a considerable risk of mortality, and there is currently a lack of appropriate prognostic biomarkers to predict its severity. Pathogenesis of severe dengue is characterized by overt inflammation, endothelial activation, and increased vascular permeability. The current study investigates the utility of endothelial, inflammatory, and vascular permeability factors as biomarkers to identify dengue severity, which could improve disease prognosis and management. METHODS: The dengue-positive subjects were classified based on seropositivity for NS1, IgM, and IgG. The samples in each group were quantified for basic clinical investigations. The levels of Interleukin-6 (IL-6), Tumor necrosis factor receptor 1 (TNFR1), EOTAXIN, Monocyte chemoattractant protein-1 (MCP-1), Monokine induced by interferon-gamma (MIG), Intercellular adhesion molecule-1 (ICAM-1), Vascular cell adhesion molecule-1 (VCAM-1), Thrombomodulin, and Angiopoietin-2 were estimated in all serum samples using the multiplex bead-based assay. RESULTS: IgG seropositive dengue patients showed abnormal laboratory characteristics and severe dengue symptoms. Among the studied markers, only IL-6, TNFR1, ICAM-1, VCAM-1, Thrombomodulin, and Angiopoietin-2 were significantly elevated in IgG seropositive patients compared to healthy controls. Increased IL-6 and TNFR1 levels were associated with decreased platelet count and elevated Hematocrit levels in IgG seropositive patients. Furthermore, ROC curve analysis indicated that IL-6, TNFR1, Thrombomodulin, and Angiopoietin-2 showed good potential for predicting dengue severity. CONCLUSION: Inflammatory markers IL-6 and TNFR1, and endothelial factors Angiopoietin-2 and Thrombomodulin, could serve as prognostic markers for severe dengue. These findings also encourage the future study of these biomarkers in the pathogenesis of severe dengue infection.

Impact of dietary counselling on the nutritional status and quality of life among pulmonary tuberculosis patients - A randomized control trial.

BACKGROUND & AIM: Undernutrition and TB have a bidirectional relationship, which is especially relevant in the Indian context. Undernutrition is an established risk factor for the progression of latent TB infection to active TB. Undernutrition at the population level contributes to an estimated 55% of annual TB incidence in India. TB leads to weight loss, wasting, and worsening of nutritional status. Hence, the present study aimed to determine the impact of dietary counselling on the nutritional status and the health-related quality of life of PTB patients. MATERIALS & METHOD: This was an interventional study (randomized controlled trial) that involved patients with PTB. 46 patients (23 patients as experimental and 23 patients as a control group) were enrolled in the study from June 2019 to February 2020 and they were divided into 2 categories based on BMI (underweight and normal weight). The special dietary counselling was given to the experimental group patients and the normal protocol was followed with the control group. The patients were followed up, till completion of treatment i.e., 6 months from enrolment. RESULTS: In our study, nearly half of the patients were underweight and DM was the predominant comorbidity. The BMI increased after dietary counselling in the experimental group than the control group (P = 0.0053) in underweight individuals. Total protein (P = 0.0025), and serum albumin (P = 0.0048) levels were found to be significantly improved in the experimental group. SGRQ symptom score (P = 0.0036) has significantly reduced in the experimental group in underweight individuals than the control group. CONCLUSION: Personalized dietary counselling was found to have a positive impact on BMI, total protein, and albumin levels in the experimental group, especially in underweight individuals. Besides, the quality of life measured using SGRQ showed that symptom score were also significantly reduced in the experimental group than the control group.

Cerebral sinus venous thrombosis: a rare complication of varicella infection in a 12-year-old girl.

Varicella infection can present with a variety of neurological manifestations, the most common of which are cerebellitis and encephalitis. A 12-year-old girl presented with headache, altered sensorium, blurring of vision and status epilepticus 2 weeks after she developed varicella lesions. Imaging demonstrated cerebral venous sinus thrombosis involving the left transverse sinus, sigmoid sinus and internal jugular vein with a haemorrhagic infarct in the left parieto-occipital region. Measures were taken to decrease the intracranial pressure, and she was commenced on anti-convulsants (phenytoin) and heparin infusion, following which she improved and was discharged after 2 weeks. Repeat imaging undertaken 3 months later demonstrated a resolving thrombus, and a pro-coagulant work-up at follow-up did not show any underlying pro-thrombotic state. Neurological complications post varicella are rare, with encephalitis and ataxia being the most common. Cerebral sinus venous thrombosis secondary to varicella is very rare with only one case reported in a child.

Fractal and inertia moment analysis of SARS CoV-2 proliferation through replication

The present work proposes a surrogate method for understanding and analyzing the replication of SARS CoV-2 through fractal and inertia moment (IM) analysis of cell culture images at different stages. The fractal analysis of images of cell culture, calculated by the box-counting and power spectral density methods, reflect the stages of virus infection, leading to the replication of the virus RNA and damaging the host cell. The linear increase of IM value reveals not only the proliferation of SARS CoV-2 by replication but also damage to the host cell with time. Thus, the work shows the possibility of fractal analysis and IM measurement for understanding the dynamics of the virus infection.

Ipsilateral brain cavernoma under scleroderma plaque: a case report.

Scleroderma is a rare disease of unknown etiology, which is characterized by thickening and hardening of skin due to an increased collagen production. A 44-year-old female patient with a scleroderma on the scalp known by our department, also presented an ipsilateral brain lesion since 2015, which was showing growth without any clinical symptomatology and the patient wanted the lesion to be removed. This atypical lesion underneath the scleroderma shows that diagnosis can be missed without brain imaging and biopsy.

Intracranial angiomatoid fibrous histiocytoma with Hodgkin lymphoma

@#Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumour of uncertain differentiation and low metastatic potential, which occurs predominantly in children and young adults. It occurs mostly within the extremities, trunk, head and neck. We report the case of a 32-year-old female that was operated in our hospital in 2016 and twice in 2017. The patient had headaches and neck pain initially in 2016. We discuss the radiographic and histologic features initially found and the findings that ultimately led to the diagnosis of AFH. The patient had a past history of Hodgkin lymphoma.

Subacute combined degeneration of the spinal cord following nitrous oxide anesthesia: A systematic review of cases.

OBJECTIVE: Vitamin B12 deficiency can lead to subacute combined degeneration (SCD). Nitrous oxide (N2O) is an anesthetic which oxidizes the cobalt ion of vitamin B12, interfering with its function as a coenzyme. In this study, we conduct a systematic review of reported cases of SCD following nitrous oxide anesthesia. PATIENTS AND METHODS: A comprehensive search of multiple databases was conducted, and information about patient characteristics, symptomatology, clinical work-up, and treatment was extracted from eligible articles. Univariate analyses were performed to identify predictors of poor neurological recovery following SCD. RESULTS: 32 studies, reporting 37 cases of nitrous oxide-induced SCD, were included through the screening process. These cases included 21 male patients and 16 female patients, with an average age of 50.4 years (SD 17.6). An etiology for subclinical B12 deficiency was determined in 30 reports; of these, 25 were due to vitamin malabsorption secondary to a gastrointestinal disorder. Duration of nitrous oxide exposure was described in 19 reports, and ranged from 30 min to 11 h. Univariate analysis failed to find an association between post-operative recovery and age (p = 0.60), sex (p = 0.46), positive MRI findings (p = 0.47), post-operative serum B12 (p = 1.00), post-operative hemoglobin (p = 0.18), type of surgery (p = 0.58), or post-operative high mean corpuscular volume (p = 0.13). CONCLUSION: In patients with postsurgical myelopathy, surgeons should evaluate B12 status and consider the possibility that nitrous oxide could cause a subclinical B12 deficiency to become overt, particularly in patients with malabsorptive GI comorbidities. Treatment with B12 in this population can result in significant improvement of neurological function.

Changing trend in the seroprevalence and risk factors of human leptospirosis in the South Andaman Island, India.

Seroprevalence of leptospirosis among a healthy population of the South Andaman Island was assessed through random sampling. Previous studies have high seroprevalences of up to 55% in general population and 65% in agricultural labourers. The study subjects (1,181 in total, 781 rural and 400 urban) were interviewed and tested for antibodies against Leptospira. Multivariate models were developed to determine the risk factors in the rural and the urban population. The overall seroprevalence was 10.9%, with rural (12.9%) being higher than the urban subjects (7.0%). The commonest infecting serogroup was Icterohaemorrhagiae (53.5%), followed by Grippotyphosa (13.2%). Compared to the earlier observation, seroprevalence was lower and an apparent shift in the infecting serogroup was found. This shift was in concordance with the changing trend in animal population. Significant difference in risk factors, both in rural and urban areas, was also observed. Similar trends in seroprevalence are being observed around the world. Therefore, time to time prevalence studies are needed for the development of effective control measure.

Can Subminimal Inhibitory Concentrations of Antibiotics Induce the Formation of Biofilm in Leptospira?

Antibiotics at subminimal inhibitory concentrations (sub-MICs) are known to induce biofilm formation in numerous bacteria in vitro. In this report, the effect of sub-MIC levels of antibiotics (doxycycline and tetracycline) on biofilm formation by leptospiral reference strains and isolates was investigated. The sub-MIC levels of both tetracycline and doxycycline were able to induce biofilm in some of the leptospiral strains. This is the first report demonstrating the effect of sub-MIC level of antibiotics in inducing biofilm formation in Leptospira. The induction of biofilm may solely be a response to the amount of threshold stress enforced by low levels of antibiotics. The mechanism of biofilm induction by subinhibitory antibiotic concentrations needs to be explored further. Studies are required to understand the clinical relevance of the phenomenon and its contribution to biofilm formation in the host, resulting in the failure of antimicrobial therapy during the treatment of chronic leptospirosis.

Overexpression of heat shock GroEL stress protein in leptospiral biofilm.

Leptospira is the causative agent of leptospirosis, which is an emerging zoonotic disease. Recent studies on Leptospira have demonstrated biofilm formation on abiotic surfaces. The protein expressed in the biofilm was investigated by using SDS-PAGE and immunoblotting in combination with MALDI-TOF mass spectrometry. The proteins expressed in Leptospira biofilm and planktonic cells was analyzed and compared. Among these proteins, one (60 kDa) was found to overexpress in biofilm as compared to the planktonic cells. MALDI-TOF analysis identified this protein as stress and heat shock chaperone GroEL. Our findings demonstrate that GroEL is associated with Leptospira biofilm. GroEL is conserved, highly immunogenic and a prominent stress response protein in pathogenic Leptospira spp., which may have clinical relevance.

Molecular detection of pathogenic leptospiral protein encoding gene (lipL32) in environmental aquatic biofilms.

UNLABELLED: Leptospirosis is a zoonotic disease often encountered during post-monsoon season due to exposure with contaminated water. Leptospires have long been regarded as solitary organisms that persist in soil and aquatic environments. Here, the presence of leptospires in the aquatic biofilm exposed in the paddy field, sewers and stagnant rain water was demonstrated. Biofilm samples from paddy field water, submerged paddy leaves, sewers and stagnant rain waters from urban and rural areas were collected. Total genomic DNA was extracted and pathogenic leptospiral specific gene amplification was carried out to determine the spatial distribution of the bacteria. The degree of pathogenic Leptospira in biofilms from paddy field surface water, submerged leaf, were 33·3% and 27·2% respectively, whereas in rural and urban area, the sampling sites such as stagnant rain water, domestic sewer and collective sewers showed 11·1%, 13% and 16·6% with leptospires respectively. Higher proportion of pathogenic Leptospira in aquatic ecosystems, such as paddy field, could be one of the main factors for the occurrence of disease, more among the agricultural workers. This study would help to identify various survival strategies of leptospires in the environment and thus disease transmission. SIGNIFICANCE AND IMPACT OF THE STUDY: Little is known regarding the mechanisms by which pathogenic leptospires persist in aqueous environment, outside the mammalian host. In this view this is the first report of the distribution of Leptospira in environmental biofilm such as sewers and paddy leaf surfaces. This ability of pathogenic Leptospira to survive in aquatic ecosystems especially in biofilms could be one of the main factors which facilitate its survival in the environment, and thus disease transmission among the risk groups, such as sewage and agriculture worker. This study will encourage researchers in the field to consider biofilm as an important factor, when detecting leptospires in environment.

GC/MS profiling, in vitro anti-leptospiral and haemolytic activities of Boesenbergia rotunda (L.) Mansf. used as a medicinal plant by Nicobarese of Andaman and Nicobar Islands.

Leaves of the plant Boesenbergia rotunda are used by the Nicobarese tribe of Andaman and Nicobar Islands, India, to prepare traditional medicine for treating fever, headache and body ache. In the present investigation, methanol fraction of these leaves were analysed by GC/MS that revealed the presence of 25 compounds. The anti-leptospiral activity of methanol crude extract was determined by both microdilution and macrodilution methods. The MICs of the extract were tested against 24 pathogenic leptospiral strains and ranged between 62.5-125 µg/mL in both microdilution and macrodilution. The range of MBCs was 250 and 500 µg/mL in macrodilution and microdilution respectively. The crude extract was subjected to cytotoxic studies and found to have negligible or no haemolytic activity, exhibiting IC50 values of greater than 4 mg/mL. Further in vivo studies are needed to investigate the pharmacological and toxicological properties of Boesenbergia rotunda, before it can be considered as a new anti-leptospiral agent.

Stabilization with the Dynamic Cervical Implant: a novel treatment approach following cervical discectomy and decompression.

OBJECT: Although cervical total disc replacement (TDR) has shown equivalence or superiority to anterior cervical discectomy and fusion (ACDF), potential problems include nonphysiological motion (hypermobility), accelerated degeneration of the facet joints, particulate wear, and compromise of the mechanical integrity of the endplate during device fixation. Dynamic cervical stabilization is a novel motion-preserving concept that facilitates controlled, limited flexion and extension, but prevents axial rotation and lateral bending, thereby reducing motion across the facet joints. Shock absorption of the Dynamic Cervical Implant (DCI) device is intended to protect adjacent levels from accelerated degeneration. METHODS: The authors conducted a prospective evaluation of 53 consecutive patients who underwent DCI stabilization for the treatment of 1-level (n = 42), 2-level (n = 9), and 3-level (n = 2) cervical disc disease with radiculopathy or myelopathy. Forty-seven patients (89%) completed all clinical and radiographic outcomes at a minimum of 24 months. Clinical outcomes consisted of Neck Disability Index (NDI) and visual analog scale (VAS) scores, neurological function at baseline and at latest follow-up, as well as patient satisfaction. Flexion-extension radiography was evaluated for device motion, implant migration, subsidence, and heterotopic ossification. Cervical sagittal alignment (Cobb angle), functional spinal unit (FSU) angle, and range of motion (ROM) at index and adjacent levels were evaluated with WEB 1000 software. RESULTS: The NDI score, VAS neck and arm pain scores, and neurological deficits were significantly reduced at each postoperative time point compared with baseline (p < 0.0001). At 24 months postoperatively, 91% of patients were very satisfied and 9% somewhat satisfied, while 89% would definitely and 11% would probably elect to have the same surgery again. In 47 patients with 58 operated levels, the radiographic assessment showed good motion (5°-12°) of the device in 57%, reduced motion (2°-5°) in 34.5%, and little motion (0-2°) in 8.5%. The Cobb and FSU angles improved, showing a clear tendency for lordosis with the DCI. Motion greater than 2° of the treated segment could be preserved in 91.5%, while 8.5% had a near segmental fusion. Mean ROM at index levels demonstrated satisfying motion preservation with DCI. Mean ROM at upper and lower adjacent levels showed maintenance of adjacent-level kinematics. Heterotopic ossification, including 20% minor and 15% major, had no direct impact on clinical results. There were 2 endplate subsidences detected with an increased segmental lordosis. One asymptomatic anterior device migration required reoperation. Three patients underwent a secondary surgery in another segment during follow-up, twice for a new disc herniation and once for an adjacent degeneration. There was no posterior migration and no device breakage. CONCLUSIONS: Preliminary results indicate that the DCI implanted using a proper surgical technique is safe and facilitates excellent clinical outcomes, maintains index-and adjacent-level ROM in the majority of cases, improves sagittal alignment, and may be suitable for patients with facet arthrosis who would otherwise not be candidates for cervical TDR. Shock absorption together with maintained motion in the DCI may protect adjacent levels from early degeneration in longer follow-up.

Holmes tremor in a patient with progressive multifocal leukoencephalopathy.

BACKGROUND: Progressive multifocal leukencephalopathy (PML) is a rare, sometimes fatal viral disease in patients with primary or secondary immunosuppression. CASE DESCRIPTION: A 57-year-old immunocompetent female with intractable Holmes tremor and elongated unique brainstem lesion reported to our hospital. The cerebrospinal fluid (CSF) screening for John Cunningham virus was negative and the diagnosis was established by brain biopsy. The course was rapidly fatal. CONCLUSION: This atypical presentation of PML in an immunocompetent patient illustrates that diagnosis can be missed without brain biopsy.

DTI of the visual pathway - white matter tracts and cerebral lesions.

DTI is a technique that identifies white matter tracts (WMT) non-invasively in healthy and non-healthy patients using diffusion measurements. Similar to visual pathways (VP), WMT are not visible with classical MRI or intra-operatively with microscope. DIT will help neurosurgeons to prevent destruction of the VP while removing lesions adjacent to this WMT. We have performed DTI on fifty patients before and after surgery between March 2012 to January 2014. To navigate we used a 3DT1-weighted sequence. Additionally, we performed a T2-weighted and DTI-sequences. The parameters used were, FOV: 200 x 200 mm, slice thickness: 2 mm, and acquisition matrix: 96 x 96 yielding nearly isotropic voxels of 2 x 2 x 2 mm. Axial MRI was carried out using a 32 gradient direction and one b0-image. We used Echo-Planar-Imaging (EPI) and ASSET parallel imaging with an acceleration factor of 2 and b-value of 800 s/mm². The scanning time was less than 9 min. The DTI-data obtained were processed using a FDA approved surgical navigation system program which uses a straightforward fiber-tracking approach known as fiber assignment by continuous tracking (FACT). This is based on the propagation of lines between regions of interest (ROI) which is defined by a physician. A maximum angle of 50, FA start value of 0.10 and ADC stop value of 0.20 mm²/s were the parameters used for tractography. There are some limitations to this technique. The limited acquisition time frame enforces trade-offs in the image quality. Another important point not to be neglected is the brain shift during surgery. As for the latter intra-operative MRI might be helpful. Furthermore the risk of false positive or false negative tracts needs to be taken into account which might compromise the final results.

Prognostic value of cardiovascular magnetic resonance in patients with suspected arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: Early recognition and accurate risk stratification are important in the management of arrhythmogenic right ventricular cardiomyopathy (ARVC). Identification of predictors of outcome by cardiovascular magnetic resonance (CMR) in patients undergoing evaluation for ARVC is limited. We investigated the predictive value of morphological abnormalities detected by CMR for major clinical events in patients with suspected ARVC. METHODS: We performed a longitudinal study on 369 consecutive patients with at least one criterion for ARVC. Abnormal CMR was defined by the presence of one of the following: increased right ventricular (RV) volumes, reduced RV ejection fraction, RV regional wall motion abnormalities, myocardial fatty infiltration, and myocardial fibrosis. The end-point was a composite of cardiac death, sustained ventricular tachycardia, ventricular fibrillation, and appropriate ICD discharge. RESULTS: Twenty patients met the composite end-point over a mean follow-up of 4.3±1.5 years. An abnormal CMR was an independent predictor of outcomes (p<0.001). The presence of multiple abnormalities heralded a particular high risk of events (HR 23.0, 95% CI 5.7-93.2, p<0.001 for 2 abnormalities; HR 35.8, 95% CI 9.7-132.6, p<0.001 for 3 or more abnormalities). The positive predictive value of an abnormal CMR study was 21.0% for an adverse event, whilst the negative predictive value of a normal CMR study was 98.8% over the follow-up period. CONCLUSIONS: CMR provides important prognostic information in patients under evaluation for ARVC. A normal study portends a good prognosis. Conversely, the presence of multiple abnormalities identifies a high risk group of patients who may benefit from ICD implantation.