Two Case Reports of Ochrobactrum anthropi Bacteremia in a Tertiary Care Hospital in Northeast India.

Ochrobactrum anthropi is a non-fermenting, Gram-negative bacillus and an emerging opportunistic pathogen. We have isolated this organism from the blood cultures of two patients, a 53-year-old immunocompetent male presenting with an episode of mild fever post craniotomy and an 85-year-old male with chronic obstructive pulmonary disease (COPD) and urinary retention on an indwelling catheter. The organism was identified using VITEK 2 (bioMérieux, France). Both the isolates were resistant to most of the ß-lactams, including cephalosporins, and sensitive to quinolones, aminoglycosides, and carbapenems.

Insulin:Glucagon Bipolar Axis in Obesity With a Glimpse Into Its Association With Insulin Resistance in Different Glucose Tolerance States.

BACKGROUND: Dysregulation of insulin and glucagon secretion alters the normal insulin:glucagon ratio (IGR) in type 2 diabetes mellitus, obesity, and metabolic syndrome. This study explores the scope of construing the role of these two diametrically opposing hormones on the glucose level not just in obesity but in different glucose tolerance states by looking at the hormone levels and at the insulin glucagon bipolar axis itself. MATERIALS AND METHODS: This is an analytical cross-sectional study of 60 healthy adults consisting of an equal number of adults who are lean and adults who are obese. It was conducted at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), located in Shillong City, Meghalaya, India. Fasting glucose, insulin, glucagon, and lipids were estimated. Postprandial estimation of glucose was done two hours after oral administration of 75 grams of glucose solution. RESULT: The study demonstrated a state of hyperinsulinemia and hyperglucagonemia prevailing in obesity and all sub-categories of the group of persons who are obese. The study showed a higher fasting IGR in the group consisting of adults who were obese (with a mean of 4.11) when compared with the group of adults who are lean (with a mean of 2.24). Fasting IGR was seen to increase with increasing levels of insulin resistance and increasing impairment in glucose tolerance. IGR showed a positive correlation with the homeostatic model assessment for insulin resistance (HOMA-IR) in the impaired fasting glucose (IFG) category and strongly in the impaired glucose tolerance (IGT) category. CONCLUSION: Hyperglucagonemia in the group of adult persons who are obese indicates a decreased sensitivity of alpha cells to insulin failing insulin to adequately suppress the secretion of glucagon. The study also demonstrated a positive correlation between IGR and HOMA-IR in obesity and all glucose tolerance states of the group of adults who are obese. It is telltale that the sturdier the insulin resistance, the higher the IGR.

COVID-19 Vaccination Status Among Healthcare Workers and Its Effect on Disease Manifestations: A Study From Northeast India.

Background and objective Since being declared a global pandemic, coronavirus disease 2019 (COVID-19) has led to millions of cases and deaths worldwide. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to wreak havoc on individuals, healthcare systems, and economies, the intensive vaccination strategies adopted by several countries have significantly slowed the progress and the severity of the disease. In this study, we aimed to determine the COVID-19 vaccination status among healthcare workers (HCWs) and examine the effects of vaccination on disease manifestations. Materials and methods This cross-sectional study was conducted at a teaching hospital in Northeast India from April 2021 to September 2021, during the second phase of the COVID-19 pandemic. HCWs employed in the hospital who were laboratory-confirmed cases of COVID-19 based on semiquantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) or cartridge-based nucleic acid amplification test (CBNAAT) on oropharyngeal samples were included in the study. Data analysis was performed using Microsoft Excel (Microsoft Office Professional Plus 2019, Microsoft Corp., Redmond, WA) Results A total of 178 HCWs reported positive for COVID-19 infection during the study period. Of these, 42 (23.59%) were males and 136 were females (76.40%). Among them, 86 (48.32%) HCWs were fully vaccinated, 58 (32.58%) were partially vaccinated, and 34 (19.10%) were not vaccinated. Most of the HCWs experienced mild disease (145, 81.46%), and only four (2.24%) reported moderate to severe disease. Compared with unvaccinated HCWs, individuals who have had either one or two doses of vaccines were less likely to have moderate to severe disease or seek treatment at the hospital. On symptoms analysis, shortness of breath was found to be more common in unvaccinated individuals than in vaccinated patients, and anosmia and loss of taste were more common in vaccinated than in unvaccinated individuals. No deaths were reported among the participants included in this study. Conclusions Following the first and second waves of the COVID-19 pandemic, a substantial proportion of HCWs were infected with SARS-CoV-2, likely as a result of the acquisition of the virus in the community during the early phase of local spread. Fully vaccinated individuals with COVID-19 were more likely to be completely asymptomatic or only mildly symptomatic compared to unvaccinated HCWs.

Inflammation and Its Determinants in Patients With Chronic Kidney Disease: A Study From North Eastern Region of India.

Background and objective Chronic kidney disease (CKD) comprises a spectrum of pathophysiologic processes with increased cardiovascular disease (CVD) risk mediated mostly by endothelial dysfunction other than traditional risk factors. The present study is carried out to see the cardiovascular risk in CKD patients with special reference to the determinants of endothelial dysfunction. Materials and methods We enrolled 60 CKD patients along with 120 healthy controls in the age group 18-50 years belonging to the same ethnicity and localities. Demographic and clinico-laboratory information including markers of endothelial dysfunction were recorded followed by univariate and multivariate analyses to assess the relationship between CKD and CVD risk. Results Cases comprised of 60 CKD patients (mean age = 38.47±8.56 years) including 35 (58%) females and 25 (42%) males. Etiology in 43% of cases was idiopathically followed by diabetes and hypertension (42%) and obstructive uropathy (13%). On comparing the means of inflammatory markers between cases and controls, calcium phosphate product, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil: lymphocyte (N:L) ratio was found to be significantly higher (p < 0.05) in cases as compared to controls but carotid intima-media thickness (CIMT) and low-density cholesterol (LDL) did not show a significant difference (p < 0.05). Conclusion Our study showed uniformly higher levels of inflammatory markers in cases irrespective of age and gender except for LDL and CIMT which uniquely showed a positive correlation with age. CKD patients require appropriate treatment and preventive measures for CVD with a high index of suspicion as endothelial dysfunction cannot be adequately gauged by traditional risk scoring methods.

Study of Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Genotype Polymorphism of G6PD B and G6PD (A+/A-) in Patients Treated for Plasmodium vivax Malaria in a Tertiary Care Hospital in North East India.

Introduction Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency is the most common enzymopathy in humans, and its distribution has been historically described to be closely associated with that of malaria. North East India provides optimal conditions for transmission of malaria and bears a considerable burden of Plasmodium vivax (P. vivax) malaria. Primaquine, a mainstay in the treatment of vivax malaria, may trigger episodes of acute hemolysis in patients with G6PD deficiency. The present study sought to delineate the frequency and genotypes of G6PD deficiency among patients suffering from vivax malaria infections.  Methods Blood specimens from 80 individuals diagnosed with vivax malaria underwent enzyme assay for G6PD deficiency. Samples with deficient phenotype underwent isolation of DNA using a genomic DNA isolation kit (Qiagen India Pvt. Ltd., New Delhi, India). The genomic DNA underwent amplification, serial denaturation, annealing, extension, final extension followed by digestion with restriction endonucleases Nla III and Fok I. The digested products were subjected to horizontal agarose electrophoresis for the separation of digested fragments. Samples without nucleotide 376 adenine→guanine (A→G) mutation were classified as G6PD B. Those with the mutation were further classified into G6PD A(+) and G6PD A(-) based on the presence of Nla III site. Results Twenty-seven out of 80 individuals (33.75%) with P. vivax malaria were found to have G6PD deficiency, of which a majority (n=24) had G6PD B genotype. Three individuals had Asparagine→Aspartic Acid mutation at position 376 (A→G), of which G6PD A(+) and G6PD A(-) were present in two and one cases, respectively. Conclusion G6PD deficiency was noted in about a third of patients with vivax malaria. Since primaquine therapy is contraindicated in this group of patients, there is a rationale for looking into screening patients with vivax malaria from the region prior to primaquine therapy. Further large scale studies may substantiate this and help in better genotypic and geographic characterization of G6PD deficiency in the region.

Amanita Nephrotoxic Syndrome: Presumptive First Case Report on the Indian Subcontinent.

Mushroom poisoning is a rare cause of acute kidney injury. Here, we present a case with presumed Amanita nephrotoxic syndrome, a first of its kind from the Indian subcontinent.

Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital.

BACKGROUND: Sputum microscopy is still used for diagnosis of drug-sensitive pulmonary tuberculosis (TB). Revised National Tuberculosis Control Program (TB programs) aims to rapidly diagnose and treat all cases of TB. The aim of this study is to find the proportion of loss to follow up during diagnosis of pulmonary TB after the patient reached hospital (was handed over sputum cups for sputum collection) from DOTS center after referral from respective outpatient department (OPD) at a tertiary care hospital. METHODOLOGY: Record-based data from designated microscopic center at a tertiary care hospital were collected regarding the number of patients who had been given sputum cup container for sputum collection for diagnosis of pulmonary TB referred from different OPDs from January to December 2015. RESULTS: A total of 1518 presumptive patient for pulmonary TB had visited DOTS center after referral from different OPDs in the hospital for sputum examination during the above period. The loss to follow-up during diagnosis among presumptive pulmonary TB patient was 461 (30.04%), which was higher among those below 15 years of age. At this rate of loss to follow up of presumptive TB patient to submit sputum for diagnosis, it was estimated to be about 46 smear-positive pulmonary TB cases per year which will be missed out for diagnosis during the above period (considering sputum positivity rate is 10% in the hospital). The mean gap between sputum referral to submission of two sputum samples was 2.73 days (95% confidence interval 2.52-2.84) among those of submitted sputum for diagnosis. CONCLUSION: Approximately one-third of presumptive patient for pulmonary TB had loss to follow-up for diagnosis of TB even after consulting a doctor at a tertiary care hospital. There is a need to address this gap in diagnosis of pulmonary TB in this region.

Purple Urine Bag Syndrome.

The purple urine bag syndrome (PUBS) i.e. purple discolouration of urine, is an uncommon and alarming condition in patients with long term urinary catheterisation. Though the condition is benign, it should draw immediate attention to the possibility of an underlying urinary tract infection. The postulated hypothesis for this unusual event is probably a chemical reaction involving tryptophan from food in the gut. We report a case with this unusual and interesting phenomenon in a 65 year old female.

Tsutsugamushi Disease (Scrub Typhus) Meningoencephalitis in North Eastern India: A Prospective Study.

BACKGROUND: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult. AIM: The aim of this study was to characterize neurological complications in scrub typhus from northeastern region of India. SUBJECTS AND METHODS: We did a prospective study of scrub meningoencephalitis at North Eastern Indira Gandhi Regional Institute of Medical Sciences among patients admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil-Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed. RESULTS: Twenty-three patients of scrub typhus meningitis that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever ≥1 week was the most common manifestation (39.1%). Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 17 cells/µL, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All patients were treated with doxycycline. There was no mortality in our study. CONCLUSIONS: Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.

Subcutaneous dirofilariasis.

Subcutaneous Human Dirofilariasis is an uncommon zoonotic infection caused by Dirofilariarepens. The reports of this infection in humans in India are limited, although increasingly being reported worldwide. We report a case of Dirofilariasis with subcutaneous presentation from the state of Meghalaya and to emphasize the importance of considering this entity in the differential diagnosis of patients presenting with subcutaneous nodules.

A clinico-serological study of neurocysticercosis in patients with ring enhancing lesions in CT scan of brain.

AIMS OF THE STUDY: To study the clinical profile of neurocysticercosis and the utility of serological test using enzyme linked immunosorbent assay (ELISA) in patients with ring enhancing lesions in CT scan of brain. METHODS: A total of 51 patients presenting between April 2003 to March 2004 to the Assam Medical College and Hospital, Dibrugarh, with ring enhancing lesions in CT scan of brain suggestive of neurocysticercosis were included in the study. Serum samples for ELISA test were taken from all patients and controlled sera were taken from 20 patients admitted in the ward, who did not have clinical evidence of cysticercosis and whose CT scan of brain were either normal or revealed lesion other than cerebral cysticercosis. RESULTS: The maximum incidence of neurocysticercosis was found in the age group between 21 and 30 years (43.41%). Seizures were the commonest clinical presentation (100%). Eleven patients (21.56%) had ring enhancing lesions with central scolex. Fourty patients (78.44%) showed only ring enhancing lesions. ELISA test for definitive neurocysticercosis showed a sensitivity of 82.60% and specificity of 100%, while patients with CT scan features of neurocysticercosis had a sensitivity of 78.43% with ELISA. CONCLUSION: ELISA for cysticercosis showed a sensitivity of 82.60% and specificity of 100%. The study also shows that therapeutic effectiveness with albendazole is quite satisfactory. As the study population is small in number which was conducted in a span of one year, an evaluation with a larger number of patients will definitely throw more light on the subject.