A study of serum magnesium levels in postoperative ICU patients undergoing major GI surgeries.

Background: Magnesium (Mg++) deficiency can result in life-threatening complications. The incidence of hypomagnesemia, as well as any coexisting hypokalemia and Electrocardiography (ECG) abnormalities, was studied in patients undergoing major gastrointestinal (GI) surgeries. Methods: This observational study on 51 consecutive adult Intensive Care Unit (ICU) patients recorded serum Mg++ and serum potassium (K+) levels, and 12 lead ECGs, preoperatively and postoperatively, at 48 h and 72 h. Paired "t" test, Pearson Correlation Coefficient and chi-square test were used to statistically assess the difference, correlation, and association between serum Mg++, serum K+, and abnormal ECGs, respectively. Results: Mean values for serum Mg++ were 1.72 mg/dl and 1.71 mg/dl on day 2 and 3 postops, respectively, while for serum K+ it was 4.14 meq/l and 4.02 meq/l. The incidence of postop hypomagnesemia was 52.9% with a 95% confidence interval (39.2-66.2) on Day 2 and 47.1%, with a 95% confidence interval (33.7-60.7) on Day 3. The incidence of coexisting hypokalemia was 33.3% on Day 2 and 29.2% on Day 3. There was no significant difference between pre and postop serum Mg++ and serum K+ values. The incidence of abnormal ECG was 33.3% on Day 2 postop and 28.6% on Day 3 and had a significant association with incidence of hypomagnesemia on Day 2 (P = 0.02). Conclusion: Incidence of hypomagnesemia showed no significant difference pre and postoperatively. A significant association was present between the incidence of hypomagnesemia with abnormal ECG on the second postop day, but this was not found significant when compared with cases of hypomagnesemia with coexisting hypokalemia.

Genetic diversity and population genetic structure analysis of an extensive collection of wild and cultivated Vigna accessions.

Vigna is a large, pan-tropic and highly variable group of the legumes family which is known for its > 10 cultivated species having significant commercial value for their nutritious grains and multifarious uses. The wild vignas are considered a reservoir of numerous useful traits which can be deployed for introgression of resistance to biotic and abiotic stresses, seed quality and enhanced survival capability in extreme environments. Nonetheless, for their effective utilization through introgression breeding information on their genetic diversity, population structure and crossability is imperative. Keeping this in view, the present experiment was undertaken with 119 accessions including 99 wild Vigna accessions belonging to 19 species and 18 cultivated genotypes of Vigna and 2 of Phaseolus. Total 102 polymorphic SSRs were deployed to characterize the material at molecular level which produced 1758 alleles. The genotypes were grouped into four major clusters which were further sub-divided in nine sub-clusters. Interestingly, all cultivated species shared a single cluster while no such similarities were observed for the wild accessions as these were distributed in different groups of sub-clusters. The co-dominant allelic data of 114 accessions were then utilized for obtaining status of the accessions and their hybrid forms. The model-based population structure analysis categorized 114 accessions of Vigna into 6 genetically distinct sub-populations (K = 6) following admixture-model based simulation with varying levels of admixture. 91 (79.82%) accessions resembled their hierarchy and 23 (20.18%) accessions were observed as the admixture forms. Maximum number of accessions (25) were grouped in sub-population (SP) 6 and the least accessions were grouped in SP3 and SP5 (11 each). The population genetic structure, therefore, supported genetic diversity analysis and provided an insight into the genetic lineage of these species which will help in effective use of germplasm for development of cultivars following selective prebreeding activities.

Characteristics, therapeutic modalities and outcomes of COVID-19 ventilated patients in a tertiary care hospital in counter-insurgency zone: Our experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can result in severe life-threatening course requiring ventilatory support. This study highlights data pertaining to ventilated patients to enhance our understanding of COVID-19 as it evolves. METHODS: A descriptive, retrospective analysis was carried out on 50 COVID-19 RT-PCR positive patients who received mechanical ventilation at a tertiary care hospital in counter-insurgency (CI) zone, from June to December 2020. Data pertaining to patient characteristics, treatment, ventilator support and outcomes was analysed. RESULTS: Out of 50 patients, 74% were aged 50 years and above with 60% patients having comorbidities. 39 patients received non-invasive ventilation (NIV) and 04 patients received invasive mechanical ventilation (IMV) while 07 patients were converted from NIV to IMV during the hospital stay. Out of the 50 patients who received ventilator support 25 (50%) survived to discharge. The overall survival was 47.3% amongst the males while it was 58.3% for the females. The majority of survivors were in the NIV category (61.5%) while only 9.0% survived amongst those who received IMV. Average length of stay on NIV for patients was 5.3 days and for IMV was 7.5 days. All 50 patients received therapy in the form of steroids, anticoagulants, broad spectrum antibiotics and antivirals. Remdesivir was given to 40 of these patients out of which 20 survived (50%). Interleukin-6 therapy (Tocilizumab) was given to five patients of which four survived (80%). CONCLUSION: This study helps us to gain insights into the outcomes of COVID-19 patients managed in a tertiary care hospital in CI zone.

Prevalence and molecular characterization of canine parvovirus.

BACKGROUND AND AIM: Canine parvovirus (CPV) belonging to family Parvoviridae causes hemorrhagic gastroenteritis in dogs and heavy mortality in young dogs. The virus has three structural (VP1, VP2 and VP3) and two non-structural proteins (NS1 and NS2), VP2 being highly immunogenic. This study aims to study molecular epidemiology of CPV by sequence analysis of VP2 gene to determine the prevailing antigenic type(s) in the northern regions of India. MATERIALS AND METHODS: A total of 118 rectal swabs collected from dogs exhibiting clinical signs of CPV infection were processed for the isolation of DNA and subjected to polymerase chain reaction (PCR) and nested PCR (NPCR). A total of 13 NPCR products selected randomly were subjected to sequence analysis of VP2 gene. RESULTS: The percent positivity of CPV was found 28% and 70% by PCR and NPCR, respectively. Dogs with vaccination history against CPV too were found positive with a percent positivity of 24.10%. Gene sequencing and phylogenetic analysis of VP2 gene from these isolates revealed that most samples formed a clade with CPV-2a isolates. CONCLUSION: Sequence analysis and phylogenetic analysis of VP2 gene in the studied regions of northern India revealed that CPV-2a was the most prevalent antigenic type.

Averting transmission: A pivotal target to manage amoebiasis.

Amoebiasis is a parasitic infectious disease caused by the enteric protozoan Entamoeba histolytica, a leading basis of deaths accounted to parasites, succeeding malaria and schistosomiasis. Conventional treatment methodologies used to deal with amoebiasis mainly rely on the administration of anti-amoebic compounds and vaccines but are often linked with substantial side-effects on the patient. Besides, cases of development of drug resistance in protozoans have been recorded, contributing further to the reduction in the efficiency of the treatment. Loopholes in the efficacious management of the disease call for the development of novel methodologies to manage amoebiasis. A way to achieve this is by targeting the essential metabolic processes of 'encystation' and 'excystation', and the associated biomolecules, thus interrupting the biphasic life cycle of the parasite. Technologies like the CRISPR-Cas9 system can efficiently be exploited to discover novel and essential molecules that regulate the protozoan's metabolism, while efficiently manipulating and managing the known drug targets, leading to an effective halt and forestall to the enteric infection. This review presents a perspective on these essential metabolic processes and the associated molecules that can be targeted efficaciously to prevent the transmission of amoebiasis, thus managing the disease and proving to be a fruitful endeavour.

A Comparison of Acute Physiology and Chronic Health Evaluation III and Simplified Acute Physiology Score II in Predicting Sepsis Outcome in Intensive Care Unit.

CONTEXT: Acute Physiology and Chronic Health Evaluation (APACHE) III and Simplified Acute Physiology Score (SAPS) II are frequently used to predict the outcome of Intensive Care Unit (ICU) patients of sepsis. AIM: The aim of the study was to compare the predictability of outcome with APACHE III and SAPS II score in ICU patients of sepsis, severe sepsis, and septic shock and the 28-day mortality. SETTINGS AND DESIGN: This study was an observational, prospective cohort study. MATERIALS AND METHODS: A total of 100 consecutive patients of sepsis were studied over 20 months. The worst physiological and biochemical parameters during the first 24 h were recorded for the scores and the patient's 28-day outcome followed up. STATISTICAL ANALYSIS USED: Continuous data were expressed as mean ± standard deviation or median. Receivers operating characteristic (ROC) curve was used to find the cutoff value, area under the curve, sensitivity and specificity of APACHE III score, and SAPS II score. Binary logistic regression with response variable as the outcome was utilized. P < 0.05 was considered statistically significant. RESULTS: The mean APACHE III score in the survivor group was 66.49 ± 18.56 as opposed to 80.67 ± 19.03 for nonsurvivors. The mean SAPS II score for the survivor group was 43.32 ± 13.02 as against the nonsurvivor group at 51.92 ± 12.34. The area under the ROC curve for APACHE III was 0.711 with 95% confidence interval as against 0.686 for SAPS II. The best cutoff value obtained for mortality prediction using the ROC curve was 69 for APACHE III while that for SAPS II was 49. CONCLUSIONS: APACHE III was found to be a better predictor of mortality as compared to SAPS II though the margin of difference in mortality prediction was not high.

Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital.

BACKGROUND: A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit (ICU). Patients admitted to ICUs by virtue of being critically ill have a higher mortality than other hospitalized patients. This study was designed to see if any improvement could be brought about in filling death certificates. MATERIALS AND METHODS: Educating sessions, interactive workshops, and monthly audits for the department resident doctors were conducted. One hundred and fifty death certificates were audited for major and minor errors (75 before and 75 after the educational intervention) over a period of 18 months. Fisher's exact test was applied to statistically analyze the data. RESULTS: There was a significant decrease in major errors like mechanism without underlying cause of death (60.0 vs. 14.6%, P < 0.001), competing causes (88.0 vs. 13.3%, P < 0.001), and improper sequencing (89.3 vs. 36.0%, P < 0.001). There was also a significant decrease in minor errors such as use of abbreviations (89.3 vs. 29.3%, P < 0.001) and no time intervals (100.0 vs. 22.6%, P < 0.001). CONCLUSION: Authors conclude that death certification errors can be significantly reduced by educational interventional programs.

Low triiodothyronine predicts mortality in critically ill patients.

OBJECTIVE: Alteration in thyroid hormones are seen in critically ill patients admitted to intensive care units. Our objective was to study the thyroid hormone profile, prolactin and, glycosylated hemoglobin (HbA1c) at admission and analyze their correlation with mortality. MATERIALS AND METHODS: In this single centre, prospective, observational study, 100 consecutive patients (52M; 48F) admitted to medical ICU irrespective of diagnosis were included. Patients with previous thyroid disorders and drugs affecting thyroid function were excluded. All participants underwent complete physical examination and a single fasting blood sample obtained at admission was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid stimulating hormone (TSH), HbA1c, and prolactin. The patients were divided into two groups: Group 1 - survivors (discharged from the hospital) and Group 2 - nonsurvivors (patients succumbed to their illness inside the hospital). The data were analyzed by appropriate statistical methods and a P-value of <0.05 was considered significant. RESULTS: The mean age of the participants was 58.7 ± 16.9 years and the mean duration of ICU stay was 3.3 ± 3.1 days. A total of 64 patients survived, whereas remaining 36 succumbed to their illness. The baseline demographic profile was comparable between survivors and nonsurvivors. Nonsurvivors had low T3 when compared with survivors (49.1 ± 32.7 vs. 66.2 ± 30.1, P = 0.0044). There was no significant difference observed between survivors and nonsurvivors with respect to T4, TSH, HbA1c, and prolactin. CONCLUSION: Our study showed that low T3 is an important marker of mortality in critically ill patients. Admission HbA1c, prolactin, T4, and TSH did not vary between survivors and nonsurvivors.

Management of a massive pediatric cerebral infarct with mass effect.

A preschool child presented with a large middle cerebral artery (MCA) infarct with midline shift, overt signs of raised intracranial pressure and hemodynamic instability. Aggressive management including ventilatory support was instrumental in the successful outcome. Raising awareness of pediatric stroke is crucial to improving overall care of these children.