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Abstract Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2–3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial. Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.

Objective In this study, we compare the diagnostic accuracy of dual-energy (DE) computed tomography pulmonary angiography (CTPA) derived contrast enhancement (DECTPA, CTPA images with iodine maps) with standard dual-energy pulmonary angiography (SCTPA) for diagnosis of subsegmental pulmonary embolism in the cases with clinical suspicion of acute pulmonary embolism (APE).

The two-port antenna is designed for THz communication where isolation is achieved with the defective ground. The radiator of the two-port antenna is inspired by the half-cutting technology which reduces the size and makes it a compact antenna. The T-shaped stub and open-ended slot are used to modify the capacitive and inductive reactance which diminish and discontinued the surface current to improve the port isolation. The T-shaped stub improves the electric length of the ground and enhances the port isolation by up to 3.4 dB and open-ended slot in the ground is used to weaken the mutual current and create the non-uniform current which intensifications the port isolation up to 7.7 dB at 2.2 THz. The dimensions of the design is 100 µm × 105 µm and the edge distance of the antennas is only 0.20λ with maximum isolation is 30 dB at 2.2 THz. The bandwidth of the two-port antenna is 1.74 THz to 2.52 THz that can be applicable in wireless communication applications.

The primary objective of this study is to evaluate the issue of noise pollution in the vicinity of the industrial zone of Haridwar city and its correlation with the health of the people in and around the SIDCUL (State Industrial Development Corporation of Uttarakhand Limited). The study revealed that noise pollution levels were above the CPCB Standard for the sound level for industrial zones and residential zones. During the period from January to December 2018, noise levels were observed and monitored in both the industrial zone (Site-I SIDCUL) and the residential zone (Site-II Siwalik Nagar). The average noise levels varied throughout the year. At Site-I (Industrial Zone), during the daytime in July, the maximum average noise level recorded was 89.5 dB, while in April; the minimum average noise level was 81.1 dB. During nighttime, in January, the maximum average noise level reached 84.1 dB, and in May, the minimum average noise level was 76.6 dB. In Site-II Siwalik Nagar (Residential Zone), the daytime noise levels were a maximum average noise level of 61.1 dB in May and a minimum average noise level of 58.8 dB in September. During nighttime, the noise level reached a maximum average of 47.2 dB in October and a minimum average of 44.5 dB in May. Overall, the study revealed that noise levels were generally higher in both zones, except for the average nighttime noise level at Site II (residential zone), which was below the prescribed standard limit for noise.

Introduction: Acute encephalitis syndrome (AES) or acute febrile encephalopathy is a clinical condition characterized by altered mental status occurring after or along with a short febrile illness. In developing countries, infections are the predominant cause of AES. Prominent infections known to cause AES include viruses (such as herpes simplex virus [HSV], Japanese Encephalitis [JE] virus, dengue, enteroviruses [EVs]), bacteria, fungus, and parasites. In the present study, we aim to analyze the etiology, clinical features, and predictors of mortality in patients presenting with acute febrile encephalopathy or acute encephalitic syndrome. The present study was a prospective observational study conducted at Post Graduate Institute of Medical Education and Research a tertiary care center in Chandigarh, India. Methods: A total of 105 patients with ≥18 years of age with fever (body temperature >101° F for duration ≤14 days) and altered sensorium (Glasgow coma scale [GCS] score ≤10) lasting for more than 24 h, either accompanying the fever or following it were enrolled. Demographic and clinical details were recorded on pro forma. Cerebrospinal fluid (CSF) analysis was performed for all the enrolled patients at admission for cytology, CSF glucose to blood glucose ratio, protein levels, gram stain and culture sensitivity, adenosine deaminase levels, polymerase chain reaction for HSV/EV/mycobacterium tuberculosis (TB) and immunoglobulin M Enzyme-linked immune assay for JE. Computed tomography of the brain was done in all patients while magnetic resonance imaging (MRI) of the brain was carried out in 75 patients. Results: Among the 105 patients, tubercular meningitis was seen in 27 (25.7%) patients followed by acute pyogenic meningitis in 18 (17.1%) patients. Probable viral encephalitis was present in 12 (11.4%) cases. Septic encephalopathy (n = 10) and scrub typhus encephalitis (n = 8), HSV encephalitis (n = 6), dengue encephalitis (n = 4), leptospirosis (n = 3) were the other infections causing acute febrile encephalitis in our study. In addition to fever and altered sensorium common symptoms observed were headache (52.4%), vomiting (35.2%), and seizures (29.5%). The factors predicting increased mortality were female gender, fever of more than 38°C at admission, GCS

Scrub typhus infection is reemerging leading cause of acute febrile illnesses in post-rainy or monsoon season in Southeast Asia. It is caused by Orientia tsutsugamushi and spread by the bite of chiggers, larval forms of trombiculid mites. The clinical picture can range from simple acute febrile illness to multiorgan dysfunction. Neurological manifestations also vary from aseptic meningitis, meningoencephalitis, cerebral infarction, acute disseminated encephalomyelitis, transverse myelitis, and psychiatric manifestations. Here, we present a case series of eight cases of scrub meningoencephalitis diagnosed based on clinical, laboratory, and radiological criteria.

Morphometry helps in understanding the behaviour of drainage characteristics with respect to various hydrological processes including infiltration, runoff, erosion and sediment transport. Morphometric analysis of river basins is an essential technique to the study the response of drainage basin in response to topological characteristics. The river basins' morphometric analysis is an important technique to prioritize the watersheds for implementation of soil and water management strategies. In this study, the morphometric characteristics of the lower Sutlej River have been determined using the geo-spatial techniques. The river basin, having area of 8577 km2, was delineated into the fourteen sub-watersheds (WS-1 to WS-14) in the GIS environment. The ALOS PALSAR DEM and ArcGIS were utilized to evaluate the morphometric parameters of the delineated watersheds. The calculated morphometric parameters were used to rank the watersheds in terms of soil erosion potential. The priority ranks to the watersheds were assigned as per compound parameter, which was calculated by averaging the ranks designated to each morphometric parameter. Watersheds with the lowest compound parameter values were given the highest priority rating, and vice versa. Based on the results WS-7 was assigned the first rank whereas WS-13 was assigned the 13th rank. The principal component analysis was performed to determine the highly correlated morphometric parameters. Out of the 18 parameters, 13 were found be highly correlated. The compound parameter obtained based on these highly correlated parameters also prioritized WS-7 as the most vulnerable watershed. Therefore, WS-7 should be selected for the implementation of soil and water conservation strategies. It can be concluded that morphometric analysis along with PCA in combination with GIS can be helpful in prioritizing the watersheds in terms of soil erosion vulnerability and water management.

Objective: Older patients are rapidly increasing in the emergency department in low-middle-income countries and have poor outcomes. The present study aimed to find the spectrum of comorbidities, medical emergencies, and prognosis in geriatric patients and compare the elderly with very elderly patients in North India. Methodology: A prospective cohort study was conducted on patients aged ≥60 years admitted at Postgraduate Institute of Medical Education and Research, Chandigarh (India). The elderly and very elderly age was defined as 60–74 years and ≥75 years, respectively. Results: Of 935 enrolled patients, 763 (81.6%) were elderly, and 172 (18.4%) were very elderly. Very elderly more frequently required admission in the red area (65.7% vs. 57.4%, P = 0.045). 85.2% (n = 796) of patients had preexisting comorbidities, hypertension (44.5%) and diabetes (34.8%) being the most common. The most comorbidities and the Charlson comorbidity index score distribution were similar to the two age groups; however, hypertension was more in the elderly (52.3% vs. 42.7%, P = 0.022). Overall, gastrointestinal (25.7%), neurological (20.7%), and cardiovascular (19.0%) emergencies were common; however, the very elderly patients more frequently had neurological illnesses (30.8% vs. 18.5%, P < 0.001). Pulmonary infections were the most prevalent infections in both age groups. The frequency of urinary tract infections was higher in the very elderly (17.5% vs. 6.1%, P = 0.023). In-hospital survival was 82.7% (n = 773) and significantly low in the very elderly (76.7% vs. 84.0%, P = 0.023). The survival was predicted by quick sequential organ failure assessment but not by the Charlson comorbidity index. Conclusion: Very elderly patients more frequently have hypertension, neurological emergencies, urinary tract infections, and poor outcomes.

Abstract The efficacy of Hydroxychloroquine (HCQ) as post-exposure prophylaxis (PEP) for the prevention of COVID-19 was contentious. In this randomized control double-blind clinical trial, asymptomatic individuals with direct contact with laboratory-confirmed COVID-19 cases were randomized into PEP/HCQ (N = 574) and control/placebo (N = 594) group. The PEP/HCQ group received tablet HCQ 400 mg q 12 hourly on day one followed by 400 mg once weekly for 3 weeks, and the control/Placebo group received matching Placebo. The incidence of COVID-19 was similar (p = 0.761) in PEP [N = 24 out of 574, (4.2%)] and control [N = 27 out of 594, (4.5%)] groups. Total absolute risk reduction for the incidence of new-onset COVID-19 was -0.3% points with an overall relative risk of 0.91 (95% confidence interval, 0.52 to 1.60) and the number needed to treat (NNT) was 333 to prevent the incident of one case of COVID-19. The study found that, PEP with HCQ was not advantageous for the prevention of COVID-19 in asymptomatic individuals with high risk for SARS-CoV-2 infection. Though HCQ is a safer drug, the practice of irrational and indiscriminate use of HCQ for COVID-19 should be restrained with better pharmacovigilance.

The increasing anthropogenic and technogenic activities to compensate the raising population and unending demands of humans ended in severe pollution and detrimental damage to the environment. This environmental pollution due to lethal pollutants, toxic heavy metals and organic wastes has been drastically affecting the ecosystem of the living organisms. These are forced to enter into the food chain as they tend to accumulate in the agricultural soils. In order to eliminate these pollutants from the soils the bioremediation will be an efficient tool and this can be achieved by plant growth promoting rhizobacteria and by green wastes. In this study the plant growth promoting rhizobacteria (PGPR) and green wastes are evaluated for their effectiveness in bioremediating the toxic contaminants. Green wastes are rich sources of naturally occurring polyphenols which are potential eliminating agents of these pollutants, they can perform metal chelation, reduction, antibiotic properties, adsorption, complexation and by supplying the nutrients. However, PGPRs are well known plant life saviors from various biotic and abiotic stresses; they are also the bioremediating agents as they perform heavy metal elimination by various methods. In this study, it is also depicted that the combined application of PGPR and green wastes result in the significant method to bioremediate the contaminated sites. The bioremediation by PGPRs and green wastes is the prominent effective way to terminate the pollutants compared to phytoremediation.

Scrub typhus (caused by Orientia tsutsugamushi) is a neglected and underdiagnosed disease due to its non-specific clinical presentation and challenging diagnostics. We document the first study of direct diagnosis of scrub typhus from the blood sample of a patient by full-length 16S ribosomal RNA gene amplicon analysis using Oxford Nanopore sequencing.

ABSTRACT Background Variceal hemorrhage (VH) is a medical emergency. Prompt endoscopic variceal ligation (EVL) is therapeutic. Terlipressin is used in VH and continued for 2—5 days even after EVL. As hemostasis is primarily achieved by EVL, the benefit of continuing trelipressin after EVL is unknown. Objective To evaluate the efficacy of continuing terlipressin after EVL to prevent re-bleed and mortality. Methods In this pilot study, after EVL 74 patients of VH were randomized into two treatment groups TG2 & TG5, received terlipressin (1 mg IV bolus q 4 hourly) for 2 days and 5 days respectively and one control group (TG0), received 0.9% normal saline (10 mL IV bolus q 4 hourly) and followed up for 8 weeks. Results A total of 9 (12.6%) patients had re-bleed with maximum 4 (5.6%) patients in TG5 group followed by 3 (4.2%) in TG2 and 2 (2.8%) in TG0 groups (P=0.670). The overall mortality was 15 (21.1%) patients, 6 (8.5%) patients in TG0 group, followed by 5 (7.0%) in TG5 and 4 (5.6%) in TG2 group (P=0.691). Adverse drug reactions were significantly higher in treatment groups with maximum 18 (24.32%) patients in TG5, followed by 8 (10.8%) in TG2 and 2 (2.7%) in TG0 groups (P=0.00). Duration of hospital stay was also significantly higher in treatment group, 6.63 (±0.65) days in TG5 followed by 3.64 (±0.57) in TG2 and 2.40 (±0.50) days in TG0 groups (P=0.00). Conclusion The rational for continuing terlipressin after EVL is doubtful as it didn’t have any benefit for the prevention of re-bleed or mortality; rather it increased the risk of adverse drug reactions and duration of hospital stay. Further randomized clinical trials are encouraged to generate more evidence in support or against continuing terlipressin after EVL.

Objective: To assess the pattern, prevalence and outcome of poisoning cases reporting to hospital in North India during COVID-19 pandemic. Material and Methods: An observational, prospective study was conducted for 100 patients reporting to medical emergency with history of poisoning intake from April 2020 to January 2021. Age range was 14-85 years. Obtained data were analysed using descriptive statistics and results were expressed as percentage and mean. Results: Out of 100 patients (77M, 33F), mean age of 32.6 years, most cases belong to age group of 20-30 years and 50% were matriculates and majority of the patients belonged to Punjab and Himachal Pradesh. The most common poisoning agents consumed were corrosives (34%) followed by Aluminium Phosphide (24%). Respiratory distress (53%), loss of consciousness (43%), acute kidney injury (36%) were the common clinical presentations. PSS (Poisoning Severity Score) was moderate in 52% of patients, severe in 14%, fatal in 16% and minor PSS in 18% of patients. 16 patients with fatal PSS and 16 patients with moderate to severe PSS got expired. High mortality of 33% was seen in our study. Conclusions: The most vulnerable group in our study was of young males in age group of 21-30 years and less educated, who had lost their jobs due to COVID-19 pandemic lockdown. Corrosives were the most commonly consumed poison during lockdown. Our study found that scoring systems PSS and GCS were good assessment tools for degree of severity of poisoning at an early stage.

Skin radiation exposure occurs during planned or unplanned radiation events, such as radiotherapy or nuclear radiation accidents, respectively, resulting into acute and chronic effects depending upon the extent of the radiation exposure or contamination. Radioactive nuclide-induced contaminations severely affect the human skin as skin is the largest organ of the body. Skin radioactive contamination may result into radiation-induced burns that may significantly cause morbidity without any medical intervention. In such scenario, it is necessary to provide priority to severe and life-threatening injuries. The current review provides a holistic picture about the mode of occurrence of radiation injuries, types of radiation burns, local skin effects and pathophysiology, prognosis, diagnosis and treatment, and challenges in the management of radiation wounds. Further, the review also includes the dressings used for irradiated wounds and comparison of amniotic and silver dressings, which possess potential bactericidal and wound-healing properties.

Objective: Several studies have demonstrated a shift in the spectrum of infective endocarditis (IE) in the developed world. We aimed to investigate whether demographic and microbiologic characteristics of IE have changed in India. Design: A retrospective analysis of patients with in north India between 2010 and 2020. Methods: The clinical and laboratory profiles of 199 IE admitted to an academic hospital patients who met the modified Duke criteria for definite IE were analysed. Results: The mean age was 34 years, and 84% were males. The main predisposing conditions were injection drug use (IDU) (n = 71, 35.7%), congenital heart disease (n = 46, 21.6%), rheumatic heart disease (n = 25, 12.5%), and prosthetic device (n = 19, 9.5%). 17.1% of patients developed IE without identified predispositions. Among 64.3% culture-positive cases, the most prevalent causative pathogens were Staphylococcus aureus (46.1%), viridans streptococci (7.0%), enterococci (6.0%), coagulase-negative staphylococci (5.5%), gram negative bacilli (5.5%), polymicrobial (5.5%), and Candida (1.0%). The tricuspid (30.3%), mitral (25.6%), and aortic (21.6%) valves were the most common sites of infection, and 60.3% had large vegetations (>10 mm). Systemic embolization occurred in 55.3% of patients at presentation. Cardiac surgery was required for 13.1%. In-hospital mortality was 17.1% and was associated with prosthetic devices (p-value, 0.001), baseline leucocytosis (p-value, 0.036) or acute kidney injury (p-value, 0.001), and a microbial etiology of gram negative bacilli or enterococci (p-value, 0.005). Conclusion: IDU is now the most important predisposition for IE in India, and S. aureus has become the leading cause of native valve endocarditis with or without IDU.

With increasing atrial septal defect (ASD) repairs, more women of childbearing age will have ASD closure devices. Current ASD closure trials have excluded women planning pregnancy, making their management challenging. We present a pregnant woman, with a repaired ASD, who presented with device-related infective endocarditis. (Level of Difficulty: Beginner.)

Introduction: Bitter tasting of drugs leads to non-compliance especially in the case of pediatric patients due to their inability to swal-low medication. Aim: In this study, we aimed to mask the bitter taste of acetaminophen (APAP) particles through coating. Materials and methods: A pH independent water insoluble ethylcellulose polymer was used to coat the APAP. The coating of water insoluble ethylcellulose on APAP can have a significant impact on the dissolution profile. Various grades of APAP were used for coating; fine grade, Compap L90% having wide particle size distribution (PSD), and a special granular (SG) APAP 1680 having narrow PSD. Coating was performed using top spray (Vector) for Compap L90% and SG APAP 1680 grade of APAP. Results: Bitter taste of SG APAP was masked after spraying dispersion equivalent to a weight gain of 10% compared to 35% used for Compap L90%. Using bottom spray (Wurster coater, GPCP 2.0), coating was performed on SG APAP 1680 grade of APAP by spraying aqueous dispersion of ethylcellulose (Surelease) equivalent to a weight gain of 10%. The scalability of the top spray process was also evaluated in GPCG 30 and bitter taste was masked by using Surelease dispersion equivalent to a weight gain of 6%. Coated APAP was examined for particle size (PS), particle size distribution (PSD), flowability, and drug release profile. Dissolution was performed using USP apparatus 2 and 4 in phosphate buffer and evaluated for mechanism of drug release. Particle size obtained for coated SG APAP 1680 via top and bottom spray process was 404 µm d(90) and 487 µm d(90) respectively. Conclusions: The results of the study demonstrated the potential of Surelease dispersion in taste masking. The use of SG APAP 1680 having narrow PSD allowed taste masking to achieve at low weight gain without greatly affecting the dissolution profile.

Traumatic wounds are the wounds that damage both the skin and the underlying tissues. Bacterial load in wounded tissue triggers elongation of the inflammation phase of wound healing. In case of excessive inflammation, the wound may undergo delayed healing that can lead to complications such as sepsis or amputation. In the present work, a hydrogel using green-synthesized silver nanoparticles (AgNPs) was synthesized and characterized in terms of homogeneity, viscosity, spreadability, excipient compatibility, etc. The hydrogels containing different percentages of AgNPs were tested for healing efficacy in full-thickness excision wound model in adult female Sprague–Dawley (SD) rats. Safety study of hydrogels was performed in SD rats as per the OECD guideline 410. The prepared hydrogels were stable for over 3 months and remain intact on parameters such as homogeneity, pH balance, good spreadability, and extrudability. Healing efficacy study showed that an increased amount of AgNPs in hydrogel enhanced wound contraction over 100% with increased tensile strength and dense aligned collagen fibers in treated wound tissues as compared to standard (silver sulfadiazine), placebo, and sham groups. Dermal toxicity studies showed that there were no signs of irritation, inflammation, and edema on the dorsum of SD rats. Besides, there was no local and systemic toxicity in hydrogel-treated groups.

Objectives: Many authors' have advocated a minimum of two implants to support a mandibular overdenture, but financial restraints specifically among the geriatric population in developing countries made this treatment plan economically difficult. Hence, this study was planned to assess the symphyseal (midline) single implant-assisted complete overdenture for patient satisfaction and masticatory performance. Materials and Methods: In this clinical study, 12 edentulous first-time denture wearers underwent placement of a single implant in the mandibular symphyseal region. After 1 week, new complete dentures were fabricated and delivered to the patients. Post 3 months, the denture was fixed with a nylon cap-ball attachment to the anchor implant. Patients were questioned about comparison in the level of satisfaction and complaint before loading the implant (control group) and after 1 week, 1 month, and 3 months. The implant-assisted overdenture was fabricated with the help of a questionnaire. Masticatory performance was calculated with the help of a bite force measuring device at the same time intervals. SPSS 17.0 statistical software was used to analyze the data. Results: It was found that single implant anchorage of the mandibular complete denture resulted in a significant increase (P < 0.05) in patient's subjective satisfaction and a decrease (P < 0.05) in complaints at the end of 3 months. There was a significant (P < 0.01) increase in bite force in implant overdenture after 3 months (5.459 kgf) as compared to that of the complete denture (3.406 kgf). Conclusion: Single implant-assisted overdenture can be an appropriate treatment modality to treat edentulousness in the geriatric population. It insinuates the remarkable improvement of prosthesis function and oral comfort with minor surgical procedures.

Background & objectives: Cardiac injury in scrub typhus is uncommonly reported. We studied the incidence and clinical significance of cardiac involvement among seventy consecutive adult patients of scrub typhus, using circulating cardiac biomarkers, including N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin T, creatine kinase-muscle/brain isoenzyme (CK-MB) and 2D-echocardiography. Methods: This was a hospital-based prospective cohort study conducted in the medical emergency of PGIMER, Chandigarh, India. Seventy consecutive patients aged 12 years and above with the diagnosis of scrub typhus were enrolled. Results: Elevations of NT pro-BNP, troponin T, and CK-MB levels were observed in 70 (100%), 51 (72.8%), and 29 (41.4%) patients, respectively. Echocardiography detected reduced ejection fraction (EF) in 30 patients (42.8%) with mild reduction (EF 45-54 %) in 20 (28.5%) and moderate reduction (EF 30-44%) in 10 (14.3%). The age showed a significant difference with EF (p-value 0.003), and the patients with moderate reduction were younger (mean age of 20.7 ± 5.6 years). Pericardial effusion was found in nine patients (12.9%). Increased circulating levels of all the three cardiac biomarkers showed statistically significant association with a systolic dysfunction on echocardiography, and elevated CK-MB level further predicted a longer duration of hospital stay (p-value 0.002). No statistically significant association was observed between cardiac biomarkers or reduced EF and mortality. Interpretation & conclusion: Cardiac injury is a common condition among patients with scrub typhus admitted in a medical emergency; however, it does not influence in-hospital mortality.

Objective: To study the spectrum and outcome of severe scrub typhus in adult patients and to predict the hospital mortality by organ failure on admission. Methods: This was a prospective observational cohort study conducted between July 2017 and October 2020 at the medical emergency centre of PGIMER, Chandigarh, India. One hundred and twenty-six patients aged ≥13 years were diagnosed with scrub typhus. Severe disease was defined as the presence of organ failure based on the Sequential Organ Failure Assessment (SOFA) score on admission. Results: About two-thirds of the patients were from geographic regions outside the endemic sub-Himalayan belt. Fever (99.21%) and dyspnea (79.36%) were the most frequent complaints. Respiratory failure (81.75%) was the most common organ failure, followed by hepatic (52.38%), coagulative (47.62%), circulatory (33.33%), renal (21.43%), and cerebral dysfunction (13.49%). The median (Q1, Q3) SOFA score was 8 (6, 9), and 48.41% of the patients had a quick-SOFA score ≥2. Organ supports with invasive ventilation (40.48%), vasopressors (36.51%), and renal replacement therapy (7.14%) were frequently required. The in-hospital mortality was 11.90% and was independently predicted by circulatory and hepatic failures on multivariate logistic regression (OR 11.12, 95% CI 1.73-71.31 and OR 8.49, 95% CI 1.18-61.41, respectively). Conclusions: Most patients had pulmonary dysfunction; circulatory or hepatic failure on admission strongly predicts death.

Background: It is essential to assess the knowledge and awareness about COVID-19 infection among people utilizing the emergency health-care services. Aim: This study aimed to evaluate the knowledge and awareness about COVID-19 infection and the practices followed by the patients and their caregivers with respect to prevention of spread of COVID-19. Methodology: A cross-sectional exploratory study was conducted in the emergency outpatient services of a tertiary care center using a brief self-designed questionnaire. Results: More than half of the participants considered that touch and coming in contact with a person with cough/cold were the most common mode of spread of the infection, but many others had several misinformations regarding the exact mode of transmission. Three-fourth of the participants thought that wearing a mask is required to protect oneself from getting infected, while handwashing and social distancing as important precautionary measures were reported by only half and one-fourth of the participants respectively. Only half of the participants used masks during traveling to the hospital and one-third reported of sanitizing hands during travel and only half of the participants reported of having knowledge about using surgical masks and sanitizers in emergency premises, and only two-fifths thought social distancing to be a precautionary measure to follow in the emergency setting. Conclusions: The study findings highlight the need to improve awareness programs so as to improve the knowledge and practices of medically ill patients and their caregivers attending the emergency services.

Transcatheter aortic valve replacement (TAVR) has become a widely adopted treatment modality for severe aortic stenosis. Transfemoral access is the approach of choice; however, approximately 25% of patients undergoing TAVR also have concomitant peripheral arterial disease. The recent advent of intravascular lithotripsy has enabled preservation of transfemoral access in some patients; although, a proportion still require alternative, non-femoral access. Alternative access sites can be broadly categorized into transthoracic and peripheral, facilitated by surgical or percutaneous techniques. In this review, the technical details and clinical outcomes of various TAVR accesses are discussed. Initially, transthoracic approaches were most common, but recently, the trend has been toward alternative peripheral access due to superior outcomes. Although there are no randomized data to support all the alternative access sites, the experiences reported provide available options for a large portion of patients to be candidates for TAVR. The intervention site should be selected by a multidisciplinary heart team based on patient anatomical factors and institutional expertise.

Basal cell carcinoma (BCC) is the most common type of nonmelanocytic tumor. Multiple BCCs are generally associated with heredo-familial conditions or syndromes, but in sporadic cases, multiple BCCs are relatively rare. They tend to occur in synchronous or metachronous manner, but in our setup, synchronicity is uncommon and metachronous BCCs are attributed mainly to reoccurrence. We present a case of dual BCC of face with synchronicity and different histopathology, treated with wide local excision using full-thickness grafting and V-Y advancement flap.

Background: Scrub typhus has emerged as a major cause of acute febrile illness in India in recent years. The causative agent, Orientia tsutsugamushi has more than 20 prototype strains due to a variable 56-kDa outer membrane protein. It is crucial to know the prevailing types in India for the success of diagnostic immunoassays and prospective vaccine candidates. In north India, the principal types circulating are largely unknown. Our tertiary care hospital caters to a large area of north India (around 7 states and one union territory). Therefore, the current study was planned to identify the genotypes of O. tsutsugamushi strains circulating in this wide area of north India. Materials and methods: Adults and children presenting with suspected scrub typhus between July 2013 and December 2013 were included in this study. DNA was extracted from whole blood and a nested PCR was used to amplify a 483-bp region of the 56-kDa antigen gene of O. tsutsugamushi. The PCR products were purified and DNA sequencing was performed and aligned using the CLUSTAL_X2 program. A phylogenetic tree was constructed using neighbour- joining algorithms and analysed using the sequences obtained in this study and those obtained from the GenBank database. Results: A total of 34 samples were positive for PCR. The amplicons were sequenced and analyzed. Karp-like strains predominated in all states studied (64.7%) followed by Gilliam-like (26.47 %) and 8.82% similar to Hualien 1 or S072. We did not find any Kato or Kawasaki-like strain. Karp like strains showed >99% similarity to TH2033, TH2191, TH2208, Xinjiang & Neimeng strains and Gilliam-like strains showed >99% similarity to Clone ISS -11. Conclusion: Orientia tsutsugamushi shows a great diversity in its strains over a large geographical area of north India. This has implications in the production of both diagnostic assays and vaccine for scrub typhus. Keywords: Scrub typhus, Orientia tsutsugamushi, Eschar, North India

The industrialization and its consequential imperialism and colonialism have impacted this world for three centuries. India has been a colony of the British Empire for two centuries. These eventful two centuries of Indian history did see the influence of not only the political and economical might of the “great” Britain, but its influence on every milieu of Indian life. India’s indigenous education system was gradually displaced and the colonial model of education pervaded under the patronage from the colonial-state. The language, pedagogy, evaluation and knowledge of the colonizer became naturalis obligato for the population of the colony. India got independence in 1947 and took to the task of decolonizing education immediately. The attempts to decolonize education from various standpoints of political activism, universalism and religious nationalism are charted in this article. What decolonizing education should entail and how India has responded to this question in the last century and how the neo-liberal order has supported a particular ideology to have a dominant say in this process are concerns of this article. We analyse how re-schooling and indoctrination are projected as the most nationalist response for methodical decolonizing of education.

Thanatophoric dysplasia is a lethal osteochondral dysplasia which occurs sporadically in 1/64,000-100,000 total live births and it is very common of the congenital lethal skeletal dysplasias. It is diagnosed on antenatal ultrasound based of findings of cloverleaf skull, macrocephaly, hydrocephalus, narrow thorax, shortened limbs, thickened subcutaneous tissue of extremities, platyspondyly and polyhydramnios. Two subtypes have been recognised on the basis of presence of bowing of shortened femur and cloverleaf skull. Type I is more frequent than Type II. Autosomal dominant mutations in the fibroblast growth factor Receptor 3 gene result in both subtypes. This condition has characteristic sonographic features that suggest the diagnosis prenatally. It is lethal condition with most neonates being dead within the first few hours or days of life. At present no specific treatment regimen is available. This condition can be diagnosed by ultrasonography in mid gestation scan. So the radiologist should carefully scan the fetus for any features of this entity and proper patient counselling should be done regarding prognosis of fetus and future implications. The present authors report three cases depicting antenatal findings of Thanatophoric dysplasia which include both subtypes. One of the cases includes twin pregnancy with one fetus being normal and another showing sonographic feature of thanatophoric dysplasia.

The industrialization and its consequential imperialism and colonialism have impacted this world for three centuries. India has been a colony of the British Empire for two centuries. These eventful two centuries of Indian history did see the influence of not only the political and economical might of the “great” Britain, but its influence on every milieu of Indian life. India’s indigenous education system was gradually displaced and the colonial model of education pervaded under the patronage from the colonial-state. The language, pedagogy, evaluation and knowledge of the colonizer became naturalis obligato for the population of the colony. India got independence in 1947 and took to the task of decolonizing education immediately. The attempts to decolonize education from various standpoints of political activism, universalism and religious nationalism are charted in this article. What decolonizing education should entail and how India has responded to this question in the last century and how the neo-liberal order has supported a particular ideology to have a dominant say in this process are concerns of this article. We analyse how re-schooling and indoctrination are projected as the most nationalist response for methodical decolonizing of education.

The purpose of this study was to evaluate the effect of process (homogenization speed and evaporation time) and formulation (aqueous/organic phase ratio, surfactant concentration, polymer type and concentration, and drug amount) variables on the preparation of paclitaxel-loaded biodegradable polymeric nanoparticles using modified solvent evaporation technique. Thereafter, a formulation was selected and subjected to evaluation of inclusion of a co-surfactant for further reduction of particle size. Particle size, encapsulation efficiency and in-vitro drug release kinetics were evaluated. It was observed that the inclusion of vitamin E TPGS (0.01%), Poloxamer 188 (0.5%) or Tween 80 (0.25%) reduced the particle size of nanoparticles to 230, 244 or 301 nm from 438 nm, respectively. Encapsulation efficiency increased for both vitamin E TPGS and Poloxamer 188 up to concentration at 0.010% and 0.25%, respectively, while this was not the case for Tween 80. Comparison of drug release kinetics demonstrated that drug release accelerated from paclitaxel-loaded biodegradable nanoparticles prepared with the inclusion of Tween 80 but was delayed for Poloxamer 188 and vitamin E TPGS. Thus, it was concluded that the particle size of the nanoparticles could be reduced further and the paclitaxel release kinetics could easily be adjusted by taking advantage by the inclusion of a co-surfactant.

The managed aquifer recharge (MAR) of excess monsoonal runoff to mitigate downstream flooding and enhance groundwater storage has received limited attention across the Indo-Gangetic Plain of the Indian subcontinent. Here, we assess the performance of a pilot MAR trial carried out in the Ramganga basin in India. The pilot consisted of a battery of 10 recharge wells, each 24 to 30 m deep, installed in a formerly unused village pond situated adjacent to an irrigation canal that provided river water during the monsoon season. Over three years of pilot testing, volumes ranging from 26,000 to 62,000 m3 were recharged each year over durations ranging from 62 to 85 days. These volumes are equivalent to 1.3–3.6% of the total recharge in the village, and would be sufficient to irrigate 8 to 18 hectares of rabi season crop. High inter-year variation in performance was observed, with yearly average recharge rates ranging from 430 to 775 m3 day−1 (164–295 mm day−1) and overall average recharge rates of 580 m3 day−1 (221 mm day−1). High intra-year variation was also observed, with recharge rates at the end of recharge period reducing by 72%, 88% and 96% in 2016, 2017 and 2018 respectively, relative to the initial recharge rates. The observed inter- and intra-year variability is due to the groundwater levels that strongly influence gravity recharge heads and lateral groundwater flows, as well as the source water quality, which leads to clogging. The increase in groundwater levels in response to MAR was found to be limited due to the high specific yield and transmissivity of the alluvial aquifer, and, in all but one year, was difficult to distinguish from the overall groundwater level rise due to a range of confounding factors. The results from this study provide the first systematic, multi-year assessment of the performance of pilot-scale MAR harnessing village ponds in the intensively groundwater irrigated, flood prone, alluvial aquifers of the Indo-Gangetic Plain.

Rickettsial diseases (RDs) are major under-diagnosed causes of arthropod borne acute febrile illness (AFI) presenting with a range of symptoms from mild self-limiting fever to fatal sepsis. The spotted fever group (SFG) and typhus group (TG) are major RDs, which are commonly caused by Rickettsia conorii and Rickettsia typhi, respectively. The limited availability and role of serological tests in the acute phase of illness warrants rapid reliable molecular methods for diagnosis and epidemiological studies. Two hundred patients with AFI in whom the routine fever diagnostics were negative, were enrolled over a period of two months (April 2019 to May 2019). DNA was extracted and in-house nested PCR using primers specific for both SPG and TG pathogens was used. The positive amplified products were sequenced for species identification and phylogenetic analysis was performed using MEGA 7.0.14 software (iGEM, Temple University, Philadelphia, PA 19122, USA). The demographic details of the RD cases were documented. The prevalence of RD among AFI cases was 7% (14/200); SFG and TG were identified as the cause in 4% and 3% of AFI cases, respectively. The median age of the RD cases was 22 years (range 2–65). The median duration of fever was 3 days (range 1–12). The RD cases presented with respiratory symptoms or signs (44.44%), jaundice (22.22%), abdominal pain (22.22%), diarrhea (22.22), vesicular rash (11.11%), vomiting (11.11%), loss of appetite (11.11%), headache (11.11%), leukocytosis (88.88% with mean count 22,750/mm3), and thrombocytopenia (33.33%). The cases were treated empirically with piperacillin-tazobactam (66.66%), clindamycin (44.44%), cefotaxime (33.33%), meropenem (33.33%), metronidazole (33.33%), doxycycline (22.22%), azithromycin (22.22%), ceftriaxone (11.11%), and amoxicillin-clavulanic acid (11.11%). The mortality among the RD cases was 11.11%. The present pilot study shows that RD is not an uncommon cause of AFI in north India. The febrile episodes are usually transient, not severe and associated with heterogenous clinical presentation without documented history of tick exposure in the hospitalized patients. The transient, non-severe, febrile illness could be due to transient rickettsemia resulting from empirical antimicrobial therapy as the rickettsial organisms are expected to be more susceptible to higher doses of β-lactam antibiotics. The study emphasizes the molecular method as a useful tool to identify rickettsial etiology in AFI.

Diabetic ketoacidosis is one of the most serious complications of diabetes mellitus. Role of bicarbonate therapy in severe diabetic ketoacidosis is controversial. There are only few case reports of management of refractory diabetic ketoacidosis with renal replacement therapy. Here, we present a case of young male with severe diabetic ketoacidosis, which was refractory to fluid resuscitation, insulin and was managed successfully managed with peritoneal dialysis.

Background: Bungarus caeruleus (common krait) bite during monsoon season is common in northwest India. Respiratory failure is responsible for high mortality in the victims. In this study we report our experience with manual ventilation using bag valve mask (BVM) in patients with neuroparalysis due to common krait bite. Methods:This prospective study was conducted between June 2009 and December 2009. All consecutive patients with diagnosis of common krait bite who were manually ventilated by BVM were studied. The duration of ventilation and complications associated with ventilation were noted. Polyvalent anti snake venom was administered as per the "national snake bite protocol" and patients were followed up until final outcome. Results: Thirty-four patients (70.6% men) were studied. All patients except two came from rural areas and they were hospitalized between June and September. Majority of patients were bitten during the night while sleeping on the floor. The mean time interval between bite and arrival to hospital was 4.4 hours. Ptosis (100%) was he most common clinical finding followed by ophtalmoplegia (80%) and limb muscle weakness (74%). Twenty-four patients (70%) developed respiratory symptoms and 20 (59%) were intubated and manually ventilated by BVM. Mean duration of assisted ventilation was 34.6 ± 12.8 hours. Hoarseness of voice and throat pain were noted in all intubated patients following extubation, which responded to conservative therapeutic measures. The mean duration of hospitalization was 6 ± 1.6 days. All patients except one survived. Conclusion: Manual ventilation with BVM in patients with neuroparalysis due to common krait bite is a safe and effective modality in resource constraint settings.

Background:Epidemic dropsy occurs due to ingestion of mustard oil contaminated with oil from Argemone mexicana, leading to edema and tenderness of the abdomen, upper and lower limbs. In this study, clinical profiles of patients presented with epidemic dropsy in north India are described. Methods: This was a prospective study of patients presented with epidemic dropsy to the emergency department of Nehru Hospital, during the period from March 2004 to December 2011. Inclusion criteria were patients presenting with tender bilateral pitting leg edema and dermal telangiectasia. Clinical and laboratory data of patients were entered into case record forms at the time of presentation until discharge from the hospital. Results: Leg edema was the principal symptom in our series, and was in concurrence with current literature. Erythema has only been reported in 35-82% of published series, though it was present in all of our patients. Similarly, features such as diarrhea, hepatomegaly and anemia were more frequent in our cases compared to the literature. Furthermore, pancytopenia which was documented on peripheral blood counts in 54% of our cases has never been reported before. Conclusion: Epidemic dropsy should be considered in patients presenting with progressive erythema, edema, and tenderness of the limbs who had a history of consumption of mustard oil and confirmation of Argemone oil contamination according to laboratory tests. How to cite this article: Sharma N, Mohan N, Bhalla A, Sharma A, Singh S. Changing Pattern of Epidemic Dropsy in North India. Asia Pac J Med Toxicol 2013;2:87-91.

Background: Nanotechnology plays a remarkable role in the field of the treatment of Lymphomas associated with tumor. Objective: The purpose of this study is to determine and to compare the tumor uptake, biodistribution and pharmacokinetics of radiolabeled etoposide and etoposide loaded nanoparticles in Dalton′s Lymphoma tumor bearing mice and healthy mice. Materials and Methods: Etoposide loaded nanoparticles were prepared by nanoprecipitation technique using the poly (lactic-co-glycolic) acid (PLGA) in the presence of Pluronic F 68 (F 68) as a stabilizer and characterized by particle size analyzer, zeta potential and transmission electron microscope. Etoposide and etoposide loaded nanoparticles were labeled with Technetium-99m (Tc-99m) by the direct method and various quality control tests were carried out. The labeling parameters like labeling efficiency, stability, etc., were optimized to get high labeling efficiency as well as stability of the labeled formulations. Tc-99m labeled formulations were administered intravenously in Balb C mice and their biodistribution and pharmacokinetics were determined. Results: Mean size of the etoposide loaded PLGA nanoparticles was found to be 105.1 nm. The concentration of both free etoposide and nanoparticles increased with time and showed higher tumor concentrations of both free etoposide and nanoparticles increased with time and showed higher retention, indicating their applicability in effective and prolonged tumor therapy. Nuclear scintigraphic images confirm the presence of labeled complexes at the site of tumor for 24 h at higher concentration than in the normal muscles. Conclusion: This study indicated higher tumor affinity and targeting properties of etoposide loaded nanoparticles than free etoposide.

Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very high case fatality ratio. We studied five patients of aluminum phosphide poisoning with polyserositis. Methods: We enrolled all patients with aluminum phosphide poisoning presenting to emergency medical department, at a tertiary care hospital in northwestern India from January to July 2006. These patients were managed according to a standard treatment protocol and their complications were recorded. Results: During the study period, total of 35 patients were admitted with 57.5% mortality in the first 12 hours. Among the rest, 5 patients were found to develop polyserositis. All these patients had severe hypotension at presentation and developed respiratory distress requiring mechanical ventilation after an average stay of 3.8 days post-ingestion. They were managed conservatively and four of them were discharged from the hospital after the average stay of 10 days. Conclusion: In this case series, features of polyserositis (pleural effusion, ascites and pericardial effusion) were found in 15% patients of severe aluminum phosphide poisoning. We postulate systemic capillary leak syndrome, secondary to mitochondrial damage in the endothelium, as a possible mechanism.

Background/Aim: Oxidative stress plays a major role in the pathogenesis of pancreatitis. Antioxidant therapy in the form of high-dose vitamin has been used for the treatment of severe acute pancreatitis with equivocal results. We wished to evaluate the efficacy and safety of antioxidant (vitamin A, vitamin C, vitamin E) therapy in patients with severe acute pancreatitis. Setting and design: This was a single-center, prospective, randomized, open-label with blinded endpoint assessment study of antioxidant therapy, conducted in the emergency department attached to our hospital. Materials and Methods: Thirty-nine patients with severe acute pancreatitis were randomly assigned to antioxidant treatment group (n=19) or a control group (n=20) within 96 hours of developing symptoms. Patients in the antioxidant group received antioxidants (vitamin A, vitamin E, vitamin C) in addition to the standard treatment provided to both the groups for a period of 14 days. The primary outcome variable was presence of organ dysfunction at day 7. The secondary outcome variables were length of hospital stay, multiorgan dysfunction (MODS) at day 7, recovery at the end of 4 weeks, complications, and mortality. The change in markers of oxidative stress from baseline was also measured. Results: We demonstrated no significant difference in organ dysfunction (P=1.0), MODS (P=0.8), and length of hospital stay (P=0.29) between the two groups. All the patients survived in the antioxidant-treated group, whereas two patients died in the control group. The change in the levels of malondialdehyde, superoxide dismutase, and reduced glutathione were not significantly different in the two groups at day 7. Univariate analysis showed marginal benefit with antioxidant treatment (P=0.034) in patients with severe acute pancreatitis. Conclusions: This randomized study demonstrates that there is no significant benefit from antioxidant therapy in patients with established severe acute pancreatitis.

Summary: Bungarus caeruleus (Indian common krait) bite during monsoons is common in Northwest India. This study was undertaken to find the effectiveness of neostigmine and polyvalent antivenom in improving neuromuscular paralysis following bite. All the consecutive patients admitted between June 2007 and December 2008 with common krait bite, identified either from brought snake or circumstantial evidence were studied. Ten vials of polyvalent antivenom and three doses of 2.5 mg neostigmine at 30 min intervals after administration of 0.6 mg of atropine were administered I.V. and patients were assessed for any improvement in neuroparalysis. Seventy-two patients were admitted during the study period. All the patients except two came from rural areas and were brought between June and September. Sixty-two patients were bitten during the day while clearing bricks, cutting grass or walking. The mean time interval between bite and arrival to hospital was 4.5 h. None of the patients showed any improvement following treatment and all patients developed respiratory paralysis, requiring assisted ventilation. Seventy survived and two died. Neostigmine is ineffective in reversing or improving neuroparalytic features in patients with B. caeruleus bite even at higher dose than normally recommended. Keywords: Snake bites, Antivenoms, Asia, Envenoming, Neostigmine, Neurotoxicity, India

BackgroundInfection-related acute kidney injury (AKI) is an important preventable cause of morbidity and mortality in the tropical region. The prevalence and outcome of kidney involvement, especially AKI, in scrub typhus is not known. We investigated all patients with undiagnosed fever and multisystem involvement for scrub typhus and present the pattern of renal involvement seen.MethodsFrom September 2011 to November 2012, blood samples of all the patients with unexplained acute febrile illness and/or varying organ involvement were evaluated for evidence of scrub typhus. A confirmed case of scrub typhus was defined as one with detectable Orientia tsutsugamushi deoxyribonucleic acid (DNA) in patient's blood sample by nested polymerase chain reaction (PCR) targeting the gene encoding 56-kDa antigen and without any alternative etiological diagnosis. Renal involvement was defined by demonstration of abnormal urinalysis and/or reduced glomerular filtration rate. AKI was defined as per Kidney Disease: Improving Global Outcomes (KDIGO) definition.ResultsOut of 201 patients tested during this period, 49 were positive by nested PCR for scrub typhus. Mean age of study population was 34.1±14.4 (range 11-65) years. Majority were males and a seasonal trend was evident with most cases following the rainy season. Overall, renal abnormalities were seen in 82% patients, 53% of patients had AKI (stage 1, 2 and 3 in 10%, 8% and 35%, respectively). The urinalysis was abnormal in 61%, with dipstick positive albuminuria (55%) and microscopic hematuria (16%) being most common. Acute respiratory distress syndrome (ARDS) and shock were seen in 57% and 16% of patients, respectively. Hyperbilirubinemia was associated with AKI (p = 0.013). A total of 8 patients (including three with dialysis dependent AKI) expired whereas rest all made uneventful recovery. Jaundice, oliguria, ARDS and AKI were associated with mortality. However, after multivariate analysis, only oliguric AKI remained a significant predictor of mortality (p = 0.002).ConclusionsScrub typhus was diagnosed in 24% of patients presenting with unexplained febrile illness according to a strict case definition not previously used in this region. Renal abnormalities were seen in almost 82% of all patients with evidence of AKI in 53%. Our finding is contrary to current perception that scrub typhus rarely causes renal dysfunction. We suggest that all patients with unexplained febrile illness be investigated for scrub typhus and AKI looked for in scrub typhus patients.

Implantation S1 family serine proteinases (ISPs) are tryptases involved in embryo hatching and uterine implantation in the mouse. The two different ISP proteins (ISP1 and ISP2) have been detected in both pre- and post-implantation embryo tissue. To date, native ISP obtained from uterus and blastocyst tissues has been isolated only as an active hetero-dimer that exhibits trypsin-like substrate specificity. We hypothesised that in isolation, ISP1 might have a unique substrate specificity that could relate to its role when expressed alone in individual tissues. Thus, we isolated recombinant ISP1 expressed in Pichia pastoris and evaluated its substrate specificity. Using several chromogenic substrates and serine proteinase inhibitors, we demonstrate that ISP1 exhibits trypsin-like substrate specificity, having a preference for lysine over arginine at the P1 position. Phage display peptide mimetics revealed an expanded but mixed substrate specificity of ISP1, including chymotryptic and elastase activity. Based upon targets observed using phage display, we hypothesised that ISP1 might signal to cells by cleaving and activating proteinase-activated receptors (PARs) and therefore assessed PARs 1, 2 and 4 as potential ISP1 targets. We observed that ISP1 silenced enzyme-triggered PAR signaling by receptor-disarming. This PAR-disarming action of ISP1 may be important for embryo development and implantation.

BACKGROUND: Leptospirosis, a zoonosis associated with potentially fatal consequences, has long been a grossly underreported disease in India. There is no accurate estimate of the problem of leptospirosis in non-endemic areas such as north India. METHODS/PRINCIPAL FINDINGS: In order to understand the clinical spectrum and risk factors associated with leptospirosis, we carried out a retrospective study in patients with acute febrile illness in north India over the last 5 years (January 2004 to December 2008). There was increased incidence of leptospirosis (11.7% in 2004 to 20.5% in 2008) as diagnosed by IgM ELISA and microscopic agglutination titer in paired acute and convalescent sera. The disease showed a peak during the rainy season (August and September). We followed up 86 cases of leptospirosis regarding their epidemiological pattern, clinical features, laboratory parameters, complications, therapy, and outcome. Mean age of patients was 32.6 years (2.5 years to 78 years) and males (57%) outnumbered females (43%). Infestation of dwellings with rats (53.7%), working in farm lands (44.2%), and contact with animals (62.1%) were commonly observed epidemiological risk factors. Outdoor workers including farmers (32.6%), labourers (11.6%), para-military personnel (2.3%), and sweepers (1.2%) were commonly affected. Modified Faine's criteria could diagnose 76 cases (88.3%). Renal failure (60.5%), respiratory failure (20.9%), the neuroleptospirosis (11.6%), and disseminated intravascular coagulation (DIC) (11.6%) were the commonest complications. Five patients died, giving a case fatality rate of 5.9%. CONCLUSIONS/SIGNIFICANCE: There has been a rapid rise in the incidence of leptospirosis in north India. Severe complications such as renal failure, respiratory failure, neuroleptospirosis, and DIC are being seen with increasing frequency. Increased awareness among physicians, and early diagnosis and treatment, may reduce mortality due to leptospirosis.

AbstractBackground:The aim of this clinical trial was to determine whether prophylactic antibiotics could prevent surgical site infection (SSI) after laparoscopic cholecystectomy and to identify any risk factors for infection.Methods:The study included 100 patients undergoing laparoscopic cholecystectomy. They were randomized to receive either a single dose of ceftriaxone (Group A; n = 50) or physiologic saline as placebo (Group B; n = 50) after the induction of anesthesia. Patient demographics and clinical and surgical outcomes were recorded.Results:The incidence of SSI was similar in the two groups: 2 patients in group A and 4 patients in group B (χ2= 0.71; p = 0.40). None of the factors studied was associated with surgical site infection statistically, as shown by binary logistic regression analysis.Conclusion:A single dose of prophylactic antibiotic failed to decrease the likelihood of SSI after laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]