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Introduction: Remdesivir was the only antiviral used in the treatment of COVID-19 in the first wave of the COVID-19 pandemic, following the adaptive COVID-19 treatment trial-1 interim analysis report. However, its use in moderate to critical hospitalized COVID-19 patients continues to be controversial. Methodology: In a cohort of 1,531 moderate to critical COVID-19 patients, we retrospectively performed a nested case-control study where 515 patients on Remdesivir were compared to 411 patients with no Remdesivir. Cases and controls were matched for age, sex and severity. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospital stay, need for intensive care unit (ICU), progression to oxygen therapy, progression to non-invasive ventilation, progression to mechanical ventilation, and duration of ventilation. Results: Mean age of the cohort was 57.05 + 13.5 years. 75.92% were males. Overall, in-hospital mortality was 22.46% (n = 208). There was no statistically significant difference in all-cause mortality among cases and controls (20.78% vs. 24.57%, p = 0.17). Progression to noninvasive ventilation was lower in the Remdesivir group (13.6% vs 23.7%, p < 0.001), however progression to mechanical ventilation was higher in the Remdesivir group (11.3% vs 2.7%, p value < 0.001*). In a subgroup analysis of critically ill patients, the use of Remdesivir lowered mortality (OR 0.32 95% CI: 0.13 - 0.75). Conclusions: Remdesivir did not decrease the in-hospital mortality in moderate to severe COVID-19 but decreased progression to non-invasive ventilation. Its mortality benefit in critically ill patients needs further evaluation. Remdesivir may be useful if given early in the treatment of patients with moderate COVID-19. [ABSTRACT FROM AUTHOR]

Purpura fulminans (PF) is associated with acute infections such as meningococcal, staphylococcal, streptococcal, and rickettsial infections. However, there are only a few reports of association of PF with rickettsial fever from India. In this case series of seven adults with PF, four were definitive cases of spotted fever as the ompA real-time polymerase chain reaction was positive. The other three adults were probable cases of spotted fever, as they were positive by immunoglobulin M enzyme-linked immunosorbent assay, and their fever subsided within 72 h of rickettsia-specific therapy. Three of the seven patients had peripheral gangrene. These patients, despite presenting with severe spotted fever, had a favorable outcome. This is attributed to the high index of suspicion and early treatment supported by diagnostic assays. [ABSTRACT FROM AUTHOR]

Scrub typhus and other rickettsial infections contribute to 25 - 50% of acute undifferentiated febrile illnesses in endemic regions. Delayed recognition and therapy increase the morbidity and mortality. The constellation of fever with eschar or rash and multisystem involvement should facilitate the diagnosis and initiation of appropriate therapy. The pathological hallmark of rickettsial infections is endothelial infection and inflammation causing vasculitis. Endothelial inflammation results in microvascular dysfunction and increased vascular permeability. Immune and endothelial activation may worsen microvascular dysfunction, predisposing to multi-organ failure. Serology is the mainstay of diagnosis, although false negatives occur early in the disease. Point-of-care rapid diagnostic tests and molecular techniques, such as quantitative polymerase chain reaction (qPCR), can hasten diagnostic processes. Intravenous doxycycline with a loading dose is the most widely used antibiotic in critically ill patients, with azithromycin as a suitable alternative. Early appropriate treatment and organ support can decrease the duration of illness and be life-saving. [ABSTRACT FROM AUTHOR]

Adverse drug reactions (ADRs) are a common cause of hospitalization, increased morbidity and mortality in the elderly. ADRs are difficult to diagnose in the elderly as they often present with nonspecific symptoms such as fatigue, falls, cognitive decline, and constipation. Statins are generally well-tolerated drugs used in the secondary prevention of coronary artery disease. We report a 75-year-old lady who developed jaundice and became bedbound due to statin-induced hepatitis and acute rhabdomyolysis causing proximal myopathy following initiation of atorvastatin 40 mg for the management of coronary artery disease. She had rapid clinical improvement with discontinuation of statin therapy and supportive management. ADR must be considered a part of differential diagnosis in elderly patients during the evaluation of illnesses. In the elderly initiated on statins, it is essential to differentiate benign muscle pain from severe muscle injury with biochemical abnormalities. Prompt discontinuation of statins will lead to rapid improvement and prevent further worsening [ABSTRACT FROM AUTHOR]

Calotropis is a widely prevalent plant in the Indian Subcontinent. The extract and various parts of the plant are used by traditional healers for treating miscellaneous diseases. All parts of the plants are toxic; there are many case reports of gastrointestinal, cutaneous and ocular toxicity with Calotropis. The plant contains Cardenolide glycosides which have Digoxin like effects and can cause severe cardiotoxicity. We report a patient who developed cardiovascular collapse after oral ingestion and cutaneous application of Calotropis following snake bite by a traditional healer, this case thus highlights the potential cardiotoxicity of Calotropis. [ABSTRACT FROM AUTHOR]

Background: Heat-related illness is a common medical emergency. There is failure of thermoregulatory mechanisms of the body resulting in multiple organ dysfunction syndrome which if not identified and treated urgently can result in high mortality rate and permanent neurological damage. This study provides description of clinical profile patients presenting with heat-related illness and identifies clinical and laboratory variables resulting in poor outcome. Methods: This retrospective study was done identifying adult patients admitted with a diagnosis of heat-related illness from April to August 2019 in tertiary care center. Their clinical profile, laboratory investigations and outcome were extracted from medical records and variables associated with poor outcome were analyzed for statistical significance. Results: Mean age of the patients in the study was 61 years with mean heat index of the localities being 39.6-degree C. 66% of patients had multiple organ dysfunction with central nervous system dysfunction (77%) followed by respiratory distress syndrome (61%) as the most common organ derangement. Evaporative cooling measures were incorporated in management of all patients, followed by cold saline infusion in 60%. Higher J-ERATO score at admission was found to be a predictor for underlying multiple organ dysfunction syndrome (P value < 0.029). The mortality rate associated with heat-related illness in this study was 11.1%. Conclusions: Multiple organ dysfunction is seen in majority of the patients and calculation of simple admission J-ERATO score helps in predicting the same. Declining mortality rate observed in our study as compared to the earlier studies could be attributed to increased awareness, prompt diagnosis and initiation of rapid cooling measures. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology. Methods: This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study. Results: Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was Staphylococcus aureus. At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%. Conclusion: Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial. [ABSTRACT FROM AUTHOR]

Acanthamoeba are ubiquitous free-living amoeba. Acanthamoeba infections cause necrotizing vasculitis, resulting in vessel thrombosis and cerebral infarction. Acanthamoeba CNS infections, though uncommon, are associated with high mortality. Diagnosis is difficult and often delayed. Here, we present two immunocompetent hosts with Acanthamoeba encephalitis with good outcomes. [ABSTRACT FROM AUTHOR]

A 38-year-old lady with advanced human immunodeficiency virus (HIV) infection presented to the emergency department with headache, vomiting and fluctuating alertness for 3 weeks. On examination, she had tachycardia, bilateral papilledema, restriction of upward gaze, gaze-evoked nystagmus and signs of meningeal irritation. Magnetic resonance imaging of the brain showed hydrocephalus and periventricular high T2-signal regions with restriction on diffusion-weighted imaging. Polymerase chain reaction done on the cerebrospinal fluid obtained after the insertion of an external ventricular drain was positive for cytomegalovirus (CMV). She was treated with intravenous ganciclovir followed by oral valganciclovir with which she made a dramatic recovery. CMV ventriculoencephalitis can present with hydrocephalus in HIV-infected individuals. A high index of suspicion must be maintained to diagnose this disease and start appropriate therapy on time. [ABSTRACT FROM AUTHOR]

Background: Central nervous system (CNS) involvement in scrub typhus is seen in up to a quarter of patients. However, the literature on cerebrospinal fluid (CSF) analysis and outcome in meningitis/meningo-encephalitis due to scrub typhus is scant. Materials and Methods: This retrospective study included patients who were admitted to a medical college hospital with scrub typhus meningitis/meningo-encephalitis between 2005 and 2011. The clinical and laboratory profile, details of CSF analysis and outcome were documented. Results: The study included 189 patients with meningitis/meningo-encephalitis due to scrub typhus. The mean age of the patients was 41 ± 4 years. The mean duration of fever before presentation was 9.4 ± 3 days. The common presenting complaints were headache (64.2%), nausea/vomiting (60%), altered sensorium (53.7%) and seizures (22.1%). The presence of an eschar was documented in 27.5% of the patients. The mean CSF white blood count was 80 cells/cu mm (range: 5-740). There was a clear lymphocyte predominance (mean 87.6%). The mean CSF protein level was 105 mg% (range: 13-640). The mean CSF sugar level was 63.9 mg% (range 25-350), and was less than 40 mg% in 11.1% of the cases. The case fatality rate was 5.8% (11/189). Univariate analysis showed the presence of an eschar (15.4% vs 2.2%; Odds Ratio [OR]: 8.1) and altered sensorium (9.8% vs 1.1%; OR: 9.2) to be significant predictors of mortality. Conclusions: In endemic regions, scrub typhus should be considered in the differential diagnosis of aseptic meningitis. Modest elevation of cells in the CSF with lymphocytic pleocytosis and multi-organ involvement may indicate scrub typhus meningitis/meningo-encephalitis. [ABSTRACT FROM AUTHOR]

Tubercular involvement of the thyroid gland is a rare entity. Tuberculosis of thyroid gland can present as cold abscess, multinodular goitre, acute abscess or generalized goitre. Clinically, these patients can be euthyroid, hypothyroid or hyperthyroid. Diagnosis is made by fine needle aspiration and demonstration of acid fast bacilli. Here, we report the case of a 46-year-old male who presented with disseminated extrapulmonary tuberculosis with obstructive hydrocephalus and cold abscess of the thyroid gland. He was managed with anti-tubercular therapy and ventriculoperitoneal shunt for hydrocephalus. This report emphasizes the clinical importance of the rare presentation of a common disease in an endemic region. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia is challenging to treat due to the presence of multiple intrinsic and acquired resistance mechanisms. TMP-SMZ is the standard care of therapy for treating S. maltophilia infections; levofloxavin and minocycline are the preferred potential alternatives. Recently, in 2024, CLSI has lowered the susceptibility breakpoints for minocycline against S. maltophilia. Applying the revised minocycline's susceptibility breakpoint of ≤ 1 mg/L, susceptibility to minocycline dropped significantly from 77% (previous breakpoint, ≤ 4 mg/L) to 35% (revised breakpoint of ≤ 1 mg/L). In the wake of this change, minocycline's dependency has been questioned for treating S. maltophilia infections. [ABSTRACT FROM AUTHOR]

Leptospirosis, a disease of zoonotic origin, is transmitted to humans via the Leptospira bacteria, which infected rats and domestic animals carry. This disease is prevalent in certain regions of South India and North‐East India. As per the Leptospirosis Burden Epidemiology Group (WHO), there are approximately 873,000 reported cases and 48,600 deaths annually. Interestingly, we have identified specific targets that are vital to metabolic processes, lipid synthesis, the flagellar motor protein system, and bacterial chemotaxis. By developing new drugs that target these areas, we could significantly mitigate the risks associated with severe Leptospirosis. This study aims to create a new antileptospiral drug using data from the IMPPAT database. We performed virtual screening with Schrodinger, molecular dynamic simulation, and free energy investigation using GROMACS throughout 50 ns. The primary objective was to identify eight potential therapeutic targets in Leptospira for drug development. The screening process successfully identified promising drug candidates for the treatment of Leptospirosis, specifically IMPHY015116, IMPHY004388, IMPHY004619, IMPHY014919, IMPHY007598, and IMPHY001246. These phytochemical compounds exhibit higher binding energy than conventional drug molecules and show stability in dynamic environments. However, additional studies are required to validate their effect on disease progression and pathogenicity through in vitro studies. [ABSTRACT FROM AUTHOR]

Clinical case report on treatment of Listeria monocytogenes meningoencephalitis: Intrathecal injection. Sir, Human listeriosis causes severe disease and, when invasive, leads to high fatality rates. Ampicillin or penicillin G was reported to be the best treatment options for listeriosis based on their bacteriostatic effect. [Extracted from the article]

Context: Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality. Aims: The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO. Materials and Methods: This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited. Results: A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, P = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, P = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge (P = 0.001). Conclusions: Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival. [ABSTRACT FROM AUTHOR]

Background Few treatment options exist for patients with severe central nervous system (CNS) tuberculosis (TB) worsening due to inflammatory lesions, despite optimal antitubercular therapy (ATT) and steroids. Data regarding the efficacy and safety of infliximab in these patients are sparse. Methods We performed a matched retrospective cohort study based on Medical Research Council (MRC) grading system and modified Rankin Scale (mRS) scores comparing 2 groups of adults with CNS TB. Cohort A received at least 1 dose of infliximab after optimal ATT and steroids between March 2019 and July 2022. Cohort B received only ATT and steroids. Disability-free survival (mRS score ≤2) at 6 months was the primary outcome. Results Baseline MRC grades and mRS scores were similar between the cohorts. Median duration before initiation of infliximab therapy from start of ATT and steroids was 6 (IQR: 3.7–13) months and for neurological deficits was 4 (IQR: 2–6.2) months. Indications for infliximab were symptomatic tuberculomas (20/30; 66.7%), spinal cord involvement with paraparesis (8/30; 26.7%), and optochiasmatic arachnoiditis (3/30; 10%), worsening despite adequate ATT and steroids. Severe disability (5/30 [16.7%] and 21/60 [35%]) and all-cause mortality (2/30 [6.7%] and 13/60 [21.7%]) at 6 months were lower in cohort A versus cohort B, respectively. In the combined study population, only exposure to infliximab was positively associated (aRR: 6.2; 95% CI: 2.18–17.83; P =.001) with disability-free survival at 6 months. There were no clear infliximab-related side effects noted. Conclusions Infliximab may be an effective and safe adjunctive strategy among severely disabled patients with CNS TB not improving despite optimal ATT and steroids. Adequately powered phase 3 clinical trials are required to confirm these early findings. [ABSTRACT FROM AUTHOR]

Gingival hyperplasia is a rare finding in clinical practice. Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. The present case is a 19-year-old male who was referred for further management of stage 5 chronic kidney disease. On evaluation, he was found to have gingival hyperplasia. He was evaluated for reversible causes of kidney disease, and since none were found, renal replacement therapy was advised. He had been taking amlodipine for blood pressure control. As this was presumed to be the cause of gingival hyperplasia, it was stopped and replaced by a combination of beta-blocker and prazosin. At six-month follow-up, he had complete resolution of gingival hyperplasia. Amlodipine as a cause of gingival hyperplasia is a rare occurrence. However, it is crucial to keep in mind such a possible side effect of this commonly prescribed antihypertensive drug. [ABSTRACT FROM AUTHOR]

Gingival hyperplasia is a rare finding in clinical practice. Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. The present case is a 19-year-old male who was referred for further management of stage 5 chronic kidney disease. On evaluation, he was found to have gingival hyperplasia. He was evaluated for reversible causes of kidney disease, and since none were found, renal replacement therapy was advised. He had been taking amlodipine for blood pressure control. As this was presumed to be the cause of gingival hyperplasia, it was stopped and replaced by a combination of beta-blocker and prazosin. At six-month follow-up, he had complete resolution of gingival hyperplasia. Amlodipine as a cause of gingival hyperplasia is a rare occurrence. However, it is crucial to keep in mind such a possible side effect of this commonly prescribed antihypertensive drug. [ABSTRACT FROM AUTHOR]

Fipronil is an N-phenylprazole insecticide which is commonly used pesticide in south India. In animals it has been described to cause toxic manifestations mainly in the Gastro-intestinal (GI) and Central nervous system (CNS) and less commonly in kidney and liver. The available medical literature about toxic effects of Fipronil consumption in humans has been very little and mostly limited to acute GI and neurological manifestation mostly lasting for less than three days. We report the case of a 32-year-old gentleman who had consumed Fipronil (5%) in an attempt of deliberate self-harm. The patient had neurotoxicity features in the form of seizures and decreased sensorium requiring intensive medical care with mechanical ventilation and also had hepatotoxicity. Both hepatotoxicity and neurotoxicity lasted for nearly three weeks. The patient improved with supportive therapy and gradually overcame both the toxicities. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is associated with significant morbidity and mortality. There is an increase in the proportion of non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA) but there is a sparsity of data about the long-term outcome of patients with NSTEMI managed by internists. The long-term outcome and predictors of mortality of individuals with NSTEMI, managed by internists were the subject of the present study. Methods: This is a prospective observational cohort study of patients admitted under the internal medicine units with ACS. One hundred forty participants were recruited from April 2016 to July 2017. The various clinical outcomes and all-cause mortality at discharge, 1 month and 6 months were recorded. Results: During the study, 132 patients had NTSEMI/UA while 8 had ST-elevation myocardial infarction; 53.2% were men. The mean age was 63.6 ± 11.8 years for NSTEMI/UA. The mean duration of onset of symptoms to primary care was 29.14 ± 34.6 h; 39 (27.9%) presented beyond 48 h. The most frequent comorbidities observed were diabetes mellitus 96 (68.6%), hypertension 94 (67.1%), and dyslipidemia 44 (31.4%). Fifty-two (37.1%) required respiratory support. All patients received Antiplatelet agents and statins. Mortality rates were 9.1%, 13.4%, and 16.1% at discharge, 1-month, and 6 month following admission. The median survival was 161 (147-175) days. Dyslipidemia (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.26, 1.15, P = 0.110) and smoking (HR: 2.16, 95% CI: 1.16-4.02, P = 0.015) were identified as risk factors which predicted mortality. Conclusions: Mortality rates following NSTEMI, managed by internists at our tertiary care hospital was similar to various national and international registries. Smoking and dyslipidemia were predictors of mortality. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, there was a necessary division of the emergency department (ED) into the COVID suspect zone and a green zone based on a modified "The" Christian Medical college (CMCTS). Triaging was initially done based on the epidemiological criteria and evolved into symptom-based assessment when community transmission began. Methodology: This retrospective study included all patients who were triaged in the ED from April 2020 to December 2020. Data were collected from the ED triage software and were analyzed to determine the performance of the modified triage criteria in admitting patients to the ED. Results: Forty-three thousand patients were triaged during the study. Of which 35.9% (n = 15429) were sent to the COVID suspect zone and 64.1% (n = 27571) to the green zone. Of the 8490 (55%) nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) tests done in the COVID suspect zone, 61.4% were positive for COVID-19 while only 9.2% (n = 274) of 2866 tested in the green zone were positive. COVID-19 positivity was the highest in the mid-pandemic months of July, August, and September 2020. In the COVID suspect zone, factors for predicting a negative RT-PCR result were priority 1 presentation and early and late pandemic presentations. The positive predictive value of our modified triage criteria during the pandemic was 85% with a higher accuracy during the peak of the first wave (July-September 2020). Conclusion: The modified CMCTS successfully segregated COVID-19-positive patients from the COVID-19 negative patients during the first wave of the COVID-19 in 2020. The CMCTS criteria can be easily adopted or adapted in other hospitals in India in case of future waves of COVID-19. [ABSTRACT FROM AUTHOR]

Background: During the COVID‑19 pandemic, many patients presented to the emergency department (ED) with features of Influenza‑like illnesses (ILI) and with other atypical presentations. This study was done to determine the etiology, co‑infections, and clinical profile of patients with ILI. Methods: This prospective observational study included all patients presenting to the ED with fever and/or cough, breathing difficulty, sore throat, myalgia, gastrointestinal complaints (abdominal pain/vomiting/ diarrhea), loss of taste and altered sensorium or asymptomatic patients who resided in or travelled from containment zones, or those who had contact with COVID‑19 positive patients during the first wave of the pandemic between April and August 2020. Respiratory virus screening was done on a subset of COVID‑19 patients to determine co‑infection. Results: During the study period, we recruited 1462 patients with ILI and 857 patients with the non‑ILI presentation of confirmed COVID‑19 infection. The mean age group of our patient population was 51.4 (SD: 14.9) years with a male predominance (n‑1593; 68.7%). The average duration of symptoms was 4.1 (SD: 2.9) days. A sub‑analysis to determine an alternate viral etiology was done in 293 (16.4%) ILI patients, where 54 (19.4%) patients had COVID 19 and co‑infection with other viruses, of which Adenovirus (n‑39; 14.0%) was the most common. The most common symptoms in the ILI‑COVID‑19 positive group (other than fever and/or cough and/or breathing difficulty) were loss of taste (n‑385; 26.3%) and diarrhea (n‑ 123; 8.4%). Respiratory rate (27.5 (SD: 8.1)/minute: p-value < 0.001) and oxygen saturation (92.1% (SD: 11.2) on room air; p-value < 0.001) in the ILI group were statistically significant. Age more than 60 years (adjusted odds ratio (OR): 4.826 (3.348‑6.956); p-value: <0.001), sequential organ function assessment score more than or equal to four (adjusted OR: 5.619 (3.526‑8.957); p-value: <0.001), and WHO critical severity score (Adjusted OR: 13.812 (9.656‑19.756); p-value: <0.001) were independent predictors of mortality. Conclusion: COVID‑19 patients were more likely to present with ILI than atypical features. Co‑infection with Adenovirus was most common. Age more than 60 years, SOFA score more than or equal to four and WHO critical severity score were independent predictors of mortality. [ABSTRACT FROM AUTHOR]

Background In locations where few people have received coronavirus disease 2019 (COVID-19) vaccines, health systems remain vulnerable to surges in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Tools to identify patients suitable for community-based management are urgently needed. Methods We prospectively recruited adults presenting to 2 hospitals in India with moderate symptoms of laboratory-confirmed COVID-19 to develop and validate a clinical prediction model to rule out progression to supplemental oxygen requirement. The primary outcome was defined as any of the following: SpO2 < 94%; respiratory rate > 30 BPM; SpO2/FiO2 < 400; or death. We specified a priori that each model would contain three clinical parameters (age, sex, and SpO2) and 1 of 7 shortlisted biochemical biomarkers measurable using commercially available rapid tests (C-reactive protein [CRP], D-dimer, interleukin 6 [IL-6], neutrophil-to-lymphocyte ratio [NLR], procalcitonin [PCT], soluble triggering receptor expressed on myeloid cell-1 [sTREM-1], or soluble urokinase plasminogen activator receptor [suPAR]), to ensure the models would be suitable for resource-limited settings. We evaluated discrimination, calibration, and clinical utility of the models in a held-out temporal external validation cohort. Results In total, 426 participants were recruited, of whom 89 (21.0%) met the primary outcome; 257 participants comprised the development cohort, and 166 comprised the validation cohort. The 3 models containing NLR, suPAR, or IL-6 demonstrated promising discrimination (c-statistics: 0.72–0.74) and calibration (calibration slopes: 1.01–1.05) in the validation cohort and provided greater utility than a model containing the clinical parameters alone. Conclusions We present 3 clinical prediction models that could help clinicians identify patients with moderate COVID-19 suitable for community-based management. The models are readily implementable and of particular relevance for locations with limited resources. [ABSTRACT FROM AUTHOR]

Background: The role and performance of various serological tests for the diagnosis of COVID-19 are unclear. This study aimed to evaluate the performance of seven commercially available serological assays for SARS-CoV-2 antibodies by testing COVID-19 cases and controls. Methods: Adult patients with fever for > 5 days, admitted to a tertiary-care teaching hospital in South India, were enrolled prospectively between June and December 2020. SARS-CoV-2 RT-PCR confirmed patients were classified as cases, and patients with febrile illness with laboratory-confirmed alternative diagnosis and healthy participants were controls. All participants were tested with SCoV-2 Detect™ IgM ELISA kit and SCoV-2 Detect™ IgG ELISA kit (InBios International, Seattle, USA) (Inbios), SARS-CoV-2 Total and SARS-CoV-2 IgG (Siemens Healthcare Diagnostics Inc., Tarrytown, USA) (Siemens), Roche Elecsys® Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) (Roche), Abbott SARS-CoV-2 IgG (Abbott Diagnostics, IL, USA) (Abbott), and Liaison® SARS-CoV-2 S1/S2 IgG (DiaSorinS.p.A., Saluggia, Italy) (Liaison). The sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV), and accuracies were compared. Results: There were 303 participants: 153 cases and 150 controls. ELISA detecting anti-S protein antibody was more sensitive (88.9% for IgG and 86.3% for IgM) than the CLIAs (82.4% for total antibodies and 76.5–85.6% for IgG). Among CLIAs, Roche IgG was most sensitive (85.6%) followed by Abbott (83%) and Liaison (83%). Abbot had the best PPV (88.8%) and was more specific (89.3%) than Liaison (82%) and Roche (82%). Siemens IgG was less sensitive (76.5%) than Siemens Total (82.4%). The specificity of all the serological assays was modest (75–90%). Antibody test positivity increased with the duration of illness reaching 90% after 10 days of illness. When cases were compared against pre-pandemic controls, the IgG gave excellent specificity (98–100%). For seroprevalence studies, InBios IgG had the best accuracy (90.8%) with 88.9% sensitivity and 97.6% specificity. Conclusion: The serological assays are important adjuncts for the diagnosis of COVID-19 in patients with persistent symptoms, especially in the second week of illness. The value of serological diagnostic tests is limited in the first week of illness and they provide additional value in seroprevalence studies. The diagnostic accuracy of the ELISA and CLIA platforms were comparable. [ABSTRACT FROM AUTHOR]

• Mortality rate was 0.2%, 3.5%, 6.2% and 12.9% among fully vaccinated, partially vaccinated, indeterminate and unvaccinated patients respectively. • Prior vaccination impacted severity of infection by reducing the need for oxygen, NIV and ICU admission. COVID-19 vaccines were authorised for emergency use to mitigate the impact of the pandemic. This study evaluated the effect of prior vaccination with either Oxford Astra Zeneca's Covishield™ or Bharath Biotech's Covaxin® on mortality among symptomatic COVID-19 patients during the second wave of the pandemic in India. In this cohort study comprising of RT-PCR confirmed symptomatic COVID-19 patients presenting during April and May 2021, the effect of prior vaccination on mortality (primary outcome), need for hospitalization, oxygen therapy, non-invasive ventilation (NIV) and intensive care unit (ICU) admission were assessed and expressed as risk ratio (RR) with 95% confidence intervals (CI). The mean (SD) age of the cohort (n = 4183) was 46.3 (15.5) years; 17.9% (748/4183) had received at least one dose of Covishield™ and 4.8% (201/4183) had received Covaxin®. Mortality was 0.2% (95% CI: 0.2% – 0.7%), 3.5% (1.9–5.2%), 6.2% (0.3–12%) and 12.9% (11.8–14.1%) among fully vaccinated (>2 weeks after two doses), partially vaccinated (>2 weeks after one dose or <2 weeks after two doses), indeterminate (<2 weeks after one dose) and unvaccinated patients respectively. The difference in mortality among unvaccinated vs. fully vaccinated was 12.7% (95% CI: 11.4–13.9%), unvaccinated vs. partially vaccinated was 9.4% (7.4–11.4%) and unvaccinated vs. indeterminate vaccinated was 6.8% (0.8–12.7%). On adjusted analysis, as compared to unvaccinated patients, at least one dose of vaccine reduced the need for hospitalization (RR: 0.40; 95% CI: 0.35–0.47), oxygen (0.33; 0.27–0.40), NIV (0.23; 0.17–0.32), ICU admission (0.18; 0.12–0.27) and mortality (0.18; 0.11–0.29). Among symptomatic COVID-19 patients, prior vaccination with Covishield ™ or Covaxin® impacted the severity of illness and reduced mortality during a period of widespread delta variant circulation. Full vaccination conferred greater protection than partial vaccination. [ABSTRACT FROM AUTHOR]

Background: Deliberate self-poisoning and harm (DSPH) is an unabating problem with a wide variation in the methods used across the world. Hence, this study was conducted to understand the current spectrum of methods used for DSPH by patients in our geographic locality and catchment area with special emphasis on newer compounds and drugs used. Methods: This retrospective study included patients presenting with DSPH to the emergency department (ED) between January 2017 and December 2018. Results: This study included 1802 patients, with a mean age of 32 ± 12.7 years. Of the patients, 85% were in the young to middle age group (16–45 years). Agrochemicals (n = 604, 33.5%), drugs (n = 498, 27.6%), plant toxins (n = 150, 8.3%) and rodenticides (n = 145, 8%) were the predominantly used compounds. The major emergency resuscitation procedures required in the ED were intubation (n = 321, 18%), vasopressor support (n = 73, 4%) and cardiopulmonary resuscitation (n = 27, 1.4%). A quarter (23.2%) was discharged stable from the ED, whereas a further 56.5% were discharged stable after hospital admission. The in-hospital mortality rate was 3% (n = 47). Multivariate logistic regression analysis showed rodenticides (odds ratio (OR): 22.32; 95% confidence interval (CI): 8.05–61.88; P = 0.005) and plant poisons (OR: 23.92; 95% CI: 8.95–63.94; P = 0.005) to be the independent predictors of mortality. Conclusion: DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality. [ABSTRACT FROM AUTHOR]

The article focuses on the study of High fluorescent lymphocyte cell count and scattergram patterns on the Sysmex XN series cell counters. Topics discussed include Novel parameters in early and reliable diagnosis of dengue on a background of acute febrile illness; and Dengue is a vector-borne illness caused by five antigenically distinct serotypes of the dengue virus and transmitted by the Aedes aegypti mosquito.

Background:Klebsiella pneumoniae (Kp), a common multidrug-resistant pathogen, causes a wide spectrum of nosocomial infections with high rates of morbidity and mortality. The emergence of pan drug-resistant international high-risk clones such as ST258, ST14, ST15, ST147, and ST101 is a global concern. This study was performed to investigate the carbapenemases, the plasmid profile, and the clonal relationship among Indian K. pneumoniae. Materials and Methods: A total of 290 K. pneumoniae isolates from seven centers in India were characterized to determine sequence types (STs) and carbapenemases. A subset of isolates was subjected to whole genome sequencing and hybrid genome assembly to obtain the complete genome. Plasmids carrying carbapenemases were characterized to determine the dissemination of carbapenem-resistant (CR) K. pneumoniae. Results: From this study, 75 different STs were observed with ST231 being predominant. About 79% of the analyzed isolates were CR with 59% (n = 136) producing OXA48-like carbapenemases. While ST231 was the predominant clone among the OXA48-like producers; NDM producers and NDM+OXA48-like producers were mostly associated with ST14. Interestingly, 61% (n = 138) of the total CR K. pneumoniae were colistin resistant, belonging to 22 different STs. Plasmid profiling shows that blaOXA48-like was exclusively carried by ColKP3, whereas blaNDM was associated with IncFII-like plasmids. Conclusion: The highly mosaic genome of K. pneumoniae coupled with the diverse ecological niches in India makes it a hotspot for antimicrobial resistance, leading to increased morbidity and mortality. Extensive molecular surveillance of the clonal spread of K. pneumoniae could help in understanding AMR dynamics and thus rework therapeutic management. [ABSTRACT FROM AUTHOR]

Positron emission tomography-computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations. [ABSTRACT FROM AUTHOR]

Background: Deliberate self-harm (DSH) in developing nations has a significant impact on health and economic conditions of patients and families. Materials and methods: This retrospective study aims to study the cost of hospitalization and the factors affecting the cost of medical care. Adult patients with a diagnosis of DSH were included. Results: A total of 107 patients were included with the most common type of poison consumed being pesticides (35.5%) followed by a tablet overdose (31.8%). There was a male preponderance with a mean (SD) age of 30.04 (9.03) years. The median cost of admission was ₹13,690 (USD 195.57); DSH with pesticide increased the cost of care by 67% as compared to non-pesticides. Other factors which increased the cost were need for intensive care, ventilation, use of vasopressors, and development of ventilator-associated pneumonia (VAP). Conclusions: Pesticide-based poisoning is the most frequent cause of DSH. Among different types of DSH, pesticide poisoning is associated with a higher direct cost of hospitalization. [ABSTRACT FROM AUTHOR]

Background: Plant poisoning is one of the common methods of deliberate self-poisoning (DSP). Exposure to plants and its consequence account for a considerable number of deaths in rural India. Materials and methods: This retrospective observational study was conducted in the emergency department of a large tertiary care hospital in South India over a period of 2 years and recruited patients who presented with DSP from plant poisoning. Results: During the study period, 150 cases of plant poisoning were included. The mean (standard deviation) age of presentation was 31.4 (12.2) years. The most common type of plant poison consumed was oleander (63%) followed by oduvanthalai (50%), Strychnos nux-vomica (3%), datura (3%), and others, which comprised about 5.3% included henna (1.3%), cactus (1.3%), and a case each of castor, Gloriosa superba, Adenanthera pavonina, and Abrus precatorius. Patients in age-group 16-30 years had the highest rate of ingestion. The seasonal pattern was found to peak in the month of April. Gastric lavage was done in 102/150:68%. Consumption of decoction [odds ratio (OR): 5, 95% confidence interval (CI): 2.27-14.00, p value: <0.001] and metabolic acidosis (pH <7.35) (OR: 11.48, 95% CI: 4.17-31.57, p value: <0.001) were more common in oduvanthalai poisoning as compared to oleander. The mortality among plant poisoning was 9.3% (14/150). Conclusion: Our study sheds light on the spectrum of local plants consumed for DSP. Oleander and oduvanthalai were most commonly used for DSP. Consuming a decoction of leaves leading to severe metabolic acidosis at presentation is seen associated with oduvanthalai poisoning. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a dominant cause of febrile illness in many parts of Asia. Immunity is limited by the great strain diversity of Orientia tsutsugamushi. It is unclear whether previous infection protects from severe infection or enhances the risk. Methods/principal findings: We studied IgG antibody levels against O. tsutsugamushi at presentation in 636 scrub typhus patients using enzyme-linked immunosorbent assays (ELISA). The association between ELISA optical density (OD) and risk of severe infection was modelled using Poisson regression. OD was categorised as low (<1.0), intermediate (1.0 to 2.9), and high (≥3.0). OD was also modelled as a continuous variable (cubic spline). Median age of cases was 41 years (range 0–85), with 37% having severe infection. Compared to the low category, the age-adjusted risk of severe infection was 1.5 times higher in the intermediate category (95%CI 1.2, 1.9), and 1.3 times higher in the high category (95%CI 1.0, 1.7). The effect was stronger in cases <40 years, doubling the risk in the intermediate and high categories compared to the low category. The effect was more pronounced in cases tested within 7 days of fever onset when IgG ODs are more likely to reflect pre-infection levels. Conclusions/Significance: Intermediate and high IgG antibody levels at the time of diagnosis are associated with a higher risk of severe scrub typhus infection. The findings may be explained by severe infection eliciting an accelerated IgG response or by previous scrub typhus infection enhancing the severity of subsequent episodes. Author summary: In some viral infections, repeat infection is associated with a higher risk of severe disease than the first infection. Clear clinical and epidemiological evidence for this effect only exists for dengue virus infection, but it may also play a role in non-viral infections. Scrub typhus is caused by intracellular bacteria of the Orientia genus, and is among the most common causes of febrile illness in many parts of Asia. Despite being common and potentially fatal, it remains a neglected and under-diagnosed infection. Due to the great strain diversity of Orientia species (especially O. tsutsugamushi) people can experience multiple infections during life. In this study of 636 scrub typhus cases from South India, we found elevated initial IgG antibody levels, possibly from an earlier infection, to be strongly associated with severe disease. The effect was especially pronounced in younger patients and at moderately elevated antibody levels. The findings may be explained by severe infection eliciting an accelerated IgG response or, as in dengue fever, by previous scrub typhus infection enhancing the risk of severe subsequent episodes. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal (UGI) bleeding is a common presentation to the Emergency Department (ED), and is associated with re‑bleeding and significant mortality. Although several studies have described etiology and outcome of UGI bleeding, few have been done in the EDs. Materials and Methods: This prospective observational cohort study included all patients presenting with hematemesis or melena, between June 2016 and January 2017 to the ED. Demographic data, risk factors, endoscopy findings and prognosticating scores were noted. Patients were followed up through telephonic communication after 3 months to assess re‑bleeding rate and mortality. Results: The study cohort included 210 patients with a male predominance (76.2%). The mean (SD) age was 51 (16.8) years. They presented with either hematemesis (33.8%), melena (28.6%), or both (37.6%). One third (35.7%) had variceal bleed, 21% had peptic ulcer disease (PUD), and 43.3%bled due to other etiology. UGI scopy was performed in 85.2% of patients with banding (25.1%) and sclerotherapy (14%) being the most frequently performed procedures. Endoscopic intervention was not required in 58.6%of patients. Packed red cells were transfused in 46.7% patients. The 48‑h re‑bleed rate among variceal bleeders was 5.3% and 11.4% among peptic ulcer bleeders. The 3‑month re‑bleeding rate was 42.9% and the 3‑month mortality rate was 17.5% among the variceal bleeders and the same was 5.6% and 2.8%, respectively, among the peptic ulcer bleeders. The overall mortality was 12.4%. Conclusions: Variceal bleeding and PUD were the predominant causes of UGI bleeding. Overall, a quarter of our patients had a re‑bleed within 3 months, with majority being variceal bleeds. [ABSTRACT FROM AUTHOR]

Aim and objective: Although studies have described the clinical profile of patients admitted to the intensive care unit (ICU) with tuberculosis, it is unclear if the type of tuberculosis (pulmonary, extrapulmonary, or disseminated) impacts outcome. Matrials and methods: Demographic data, microbiology, treatment, and outcomes over 5 years (2012--16) were obtained from electronic records. Patients were categorized as pulmonary, extrapulmonary, or disseminated tuberculosis. Comparisons were done using t test and Fisher's exact test as appropriate. Predictors of outcome were explored using bivariate and multivariate logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CI). Results: Of the 428 ICU admissions with suspected tuberculosis, 212 (121 male) patients with mean (standard deviation) age of 41.9 (16.7) years and APACHE-II score of 20.8 (6.6) were diagnosed as pulmonary (n = 55) and extrapulmonary (n = 52) or disseminated tuberculosis (n = 105). In 50.5%, the diagnosis of tuberculosis was established during the current ICU admission when they presented with organ dysfunction. Overall, microbiological confirmation was possible in 75.5%; 14 (10.3%) isolates were Rifampicin resistant. ICU admission was required primarily for ventilation (n = 176; 83%) and hemodynamic instability (n = 67; 32%). Hospital mortality was 50%. Outcomes were similar in the three groups except for longer duration of stay (p value = 0.04) in disseminated tuberculosis. On multivariate logistic regression analysis, pulmonary tuberculosis (OR 2.83; 95% CI 1.15--6.95) and vasoactive treatment (OR 15.8; 95% CI 6.4--39.2) were independently associated with death; need for ventilation predicted mortality perfectly. Conclusion: In this cohort of patients admitted to ICU with tuberculosis, 50% were newly diagnosed during ICU admission. Pulmonary site of involvement and need for organ support are independent risk factors for death. [ABSTRACT FROM AUTHOR]

Diagnosis of scrub typhus, caused by the bacterium Orientia tsutsugamushi, is challenging because of the overlap of its non-specific symptoms with other infections coupled with the lack of sufficient data on the performance of diagnostic tests. Early diagnosis of scrub typhus is crucial to improve outcomes and this study evaluates the diagnostic performance of various tests. The present study aims at assessing the accuracy of various rapid diagnostic tests, serologic tests, and nucleic acid amplification methods on well-characterized patient samples. Adult patients with acute febrile illness and manifestations suggestive of scrub typhus confirmed by positive PCR in the blood, eschar or tissue were characterized as cases. Patients with acute febrile illness and a confirmed alternate etiology such as culture-confirmed typhoid, smear/PCR positive for malaria, PCR/NS1 antigen positive for dengue, PCR positive for influenza, PCR/MAT positive for leptospirosis, PCR positive for spotted fever were characterized as controls with other infections. The healthy controls consisted of subjects from the same geographic region. We performed the following tests on blood samples for scrub typhus and calculated the sensitivity, specificity, positive predictive value, and negative predictive value: (1) Quantitative real time PCR using 47kDa gene (qPCR); (2) Conventional PCR using 56kDa gene (cPCR); (3) Loop-mediated isothermal amplification assay (LAMP assay); (4) Immunofluorescence assay (IFA); (5) Enzyme-linked immunosorbent assay (ELISA); (6) Weil-Felix test(WF test); and (7) Immunochromatographic Rapid Diagnostic Test (RDT).Among the 316 participants, 158 had confirmed scrub typhus (cases) and 158 were controls. ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies had excellent discriminative potential with sensitivities and specificities of 92%, 94% and 92%, 92% respectively. The sensitivity and specificity of IFA were found to be 95% and 74% respectively. IgM serology had a false positivity rate of 8% with other acute febrile illnesses such as dengue, leptospirosis and spotted fever due to the nonspecific binding of the pentavalent IgM. LAMP assay had 91.7% sensitivity and 77.2% specificity while qPCR provided excellent sensitivity (97%) and perfect specificity. In conclusion, ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies have excellent sensitivity and specificity while the accuracy of IFA is suboptimal for the diagnosis of scrub typhus. Given its perfect specificity and superior sensitivity, qPCR is preferred for diagnostic confirmation in reference laboratories particularly for diagnosis of early disease with less than 7 days duration. This study provides a comprehensive evaluation of all currently available diagnostic tests for scrub typhus. Author summary: Scrub typhus, a life-threatening vector borne rickettsial infection accounts for a million cases annually. While the disease was initially described predominantly in Asia, Northern Australia and islands in the Indian and Pacific Oceans (known as the tsutsugamushi triangle), scrub typhus has now been reported in areas considered previously free of disease like Africa and South America. International travel also accounts for the microbial trafficking of this disease and its presentation to non-endemic areas. The diagnosis of scrub typhus is challenging due to its non-specific symptoms and the lack of sufficient data on the performance of various diagnostic tests. Several tests have been developed for the diagnosis of scrub typhus over the last few decades. However, there exists ambiguity on which tests are most suitable in a given clinical scenario and the apt timing to perform these tests. This study provides further insight into the performance of various serological and molecular tests in the diagnosis of scrub typhus, assists in understanding their discriminatory potential and diagnostic accuracies enabling prompt treatment of the disease. [ABSTRACT FROM AUTHOR]

Objectives: Levonadifloxacin (WCK 771; IV) and its prodrug alalevonadifloxacin (WCK 2349; oral) are benzoquinolizine fluoroquinolones, recently approved in India for the treatment of acute bacterial skin and skin structure infections with concurrent bacteraemia and diabetic foot infections. Ahead of its market launch, the present study aimed to assess the in vitro activity of levonadifloxacin against contemporary Staphylococcus aureus isolates collected from a large tertiary care hospital in India. Additionally, levonadifloxacin activity was tested against hVISA and Bengal Bay clone MRSA isolates.Methods: Non-duplicate S. aureus (n = 793) isolates collected at Christian Medical College hospital, Vellore, India during 2013-19 were included in the study. MRSA isolates were identified using a cefoxitin disc diffusion assay. MICs of levonadifloxacin and comparator antibiotics were determined using the broth microdilution method. Mutations in QRDRs were identified for selected levofloxacin-non-susceptible isolates. MLST profiling was undertaken to detect the Bengal Bay clone.Results: Among the 793 isolates, 441 (55.6%) were MRSA and 626 (78.9%) were non-susceptible to levofloxacin. Levonadifloxacin showed MIC50 and MIC90 values of 0.25 and 0.5 mg/L, respectively, for all S. aureus, which included hVISA and Bengal Bay clone MRSA. The potency of levonadifloxacin was 16 times superior compared with levofloxacin.Conclusions: The present study demonstrated potent activity of levonadifloxacin against contemporary S. aureus isolates, which included MRSA isolates, hVISA isolates, Bengal Bay clone isolates and a high proportion of quinolone-non-susceptible isolates. The potent activity of levonadifloxacin observed in this study supports its clinical use for the treatment of S. aureus infections. [ABSTRACT FROM AUTHOR]

Background: Deliberate self-harm (DSH) is one of the leading causes of mortality and morbidity in India. Agrochemicals are the most commonly used compounds for DSH. The spectrum of Agrochemicals in use varies from region to region and time period with newer compound being regularly introduced into the market. Methodology: This retrospective cohort study included patients presenting with agrochemical poisoning to the ED during January 2017 to December 2018. Patient data was retrieved form the ED triage registry software and clinical workstation, following which their hospital outcome was determined. Results: During the study period, 1802 patients presented with DSH among which Agrochemical poisoning comprised 33.5% (604/1802). The mean age was 31 years and incidence of agrochemical poisoning was found to be higher in young adults (16–30 years–55.8%). The prevalence was more common in males (62.4%). The common agrochemical compounds consumed were insecticides (91%), herbicides (4.3%), fungicides (1.5%), fertilizer (1.5%), and plant growth regulators (1.5%). Majority (80.96%) of the patients were discharged alive from the hospital, 17% left against medical advice due to bad prognosis and 12 patients (2%) died in the hospital. Conclusion: Insecticides (mainly Organophosphates) are the most common agrochemicals used for DSH. Their management is better understood leading to better outcomes compared to other chemicals. The proportion of agrochemical use in DSH has reduced over the last decade. Imidacloprid (Insecticide) and Plant growth regulators are the new compounds for which appropriate management is not yet established and more research is needed. [ABSTRACT FROM AUTHOR]

Mixed connective tissue disease (MCTD) was initially described as a chronic immune-mediated disease with overlapping features of systemic lupus erythematosus, scleroderma, and polymyositis. We conducted a cross-sectional study to describe the clinical and immunological profile of patients with MCTD and to compare the four diagnostic criteria, namely, Sharp, Kasukawa, Alarcón-Segovia, and Khan criteria. A total of 291 patients who were admitted from June 2007 to June 2017 and fulfilled the inclusion criteria were included in the study. A clinical diagnosis of MCTD was made in 111 patients, of whom 103 (92.8%) were women. The mean age at presentation was 39.3 years (SD ± 11.6). The most common organ systems that were involved were musculoskeletal system (95.5%), skin and mucosa (78.4%), and the gastrointestinal and hepatobiliary systems (56%). The maximum sensitivity was for the Kasukawa criteria with a sensitivity of 77.5% (95% CI 68.4-84.6) and specificity of 92.2% (95% CI 87-95.5). The Kahn criteria and Alarcón-Segovia criteria had the maximum specificity; the Alarcón-Segovia criteria had a sensitivity of 69.4% (95% CI 59.8-77.6) and a specificity of 99.4% (95% CI 96.5-99.9), while the Kahn criteria had a sensitivity of 52.3% (95% CI 42.6-61.7) and a specificity of 99.4% (95% CI 96.5-99.9). The sensitivity and specificity of Sharp criteria were 57.7% (95% CI 47.9-66.87) and 90% (95% CI 84.4-93.8), respectively. [ABSTRACT FROM AUTHOR]

Background: The geriatric population is more prone for injuries with complications due to their associated comorbidities. This study was done to understand the mode, severity, and outcome of injuries among geriatric patients presenting to the emergency department (ED). Materials and Methods: This retrospective study included all patients >60 years who presented with trauma between October 2014 and March 2015. Details of the incident, injuries, and hospital outcome were noted. Results: Among 8563 geriatric patients, who presented to the ED during the study, 427 (4.9%) patients were trauma related. The mean age was 69 (standard deviation: 6.76) years with 87.6% being young-old (60–79 years) and 12.4% being old-old (>80 years). Majority (63.2%) were Priority 2 patients. The median time between the incident and ED arrival among Priority 1 patients was 3 h (interquartile range: 2–5). Common modes of injuries were slip and fall (37.4%), two-wheeler accidents (25.8%), fall from height (9.1%), and pedestrian (8.9%). The ED team alone managed 25.8% of patients. Specialty departments referred to included orthopedics (48%), neurosurgery (18.3%), plastic surgery (4.2%), HLRS (4%), and others. Injuries due to slip and fall were significantly more among the old-old (P = 0.001), and two-wheeler accidents were more among the young-old (P = 0.001), respectively. Superficial head injuries (28.8%), extremity (24.8%), facial (18.7%), and traumatic brain injuries (17.8%) were common presentations. Thoracic injuries were significantly more among the old-old (P < 0.001). Half (46.3%) of the young-old were discharged stable (P = 0.017). In-hospital mortality rate was 0.7% (3/427), while 12.9% (55/427) left against medical advice due to poor prognosis. Conclusion: Our study demonstrates the pattern of injury seen in the elderly in an urban setting in India. From this, we perceive the need for a prospective study evaluating the causes for geriatric trauma, which would help work on ways to prevent and minimize injuries in the elderly. [ABSTRACT FROM AUTHOR]