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Background: Acute Viral Hepatitis (AVH) is a major health problem worldwide, with a higher incidence in developing countries, like India. The most common cause of viral hepatitis is a specific group of hepatic viruses A, B, C and E (HAV, HBV, HCV and HEV). Their clinical manifestations range from asymptomatic to acute and fulminant hepatitis or chronic hepatitis. Exploring the etiological spectrum and clinic-epidemiological profile of AVH becomes essential for formulating the preventive measures to control the disease. The aim of the present study was to determine the prevalence of Hepatitis A virus (HAV), Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Hepatitis E virus (HEV) as causes of AVH in a tertiary care hospital of North India. Materials and Methods: A retrospective study was conducted on 122 patients with clinical signs and symptoms of acute viral hepatitis during May 2021 to April 2022. Serum was separated and tested for IgM anti-HAV antibodies, IgM anti-HEV antibodies, Hepatitis B surface antigen (HbsAg) and IgM anti-HCV antibodies by Enzyme Linked Immunosorbent Assay (ELISA). Results: Out of 122 AVH patients, HAV (41.80%) was identified as the most common cause of acute hepatitis followed by HEV (36.88%), HBV (17.21%) and HCV (13.11%). Co-infections with more than one virus were present in 28 cases; HAV-HEV co-infection being the most common. Amongst the positive AVH cases, the seropositivity was higher in males (60.65%) than females (39.34%). The most common symptom was Icterus (64.87%), followed by fever (52.51%), pain abdomen (50.91%), anorexia (46.22%), vomiting (26.24%), malaise (21.24%) and diarrhea (12.23%). Conclusion: In our present study we have found that HAV is the most common cause of acute viral hepatitis followed by HEV, HBV and HCV with icterus being the most common symptom followed by fever, pain abdomen, anorexia, vomiting, malaise and diarrhea. Regular diagnosis of AVH and monitoring of cases will help in patient management and thus reduce morbidity and mortality.

Background: Studies have consistently demonstrated low rates of adoption of Advance Care Planning in the community. Methods: We studied Medicare enrollees age 65 and over and non-Medicare patients using a cross-sectional survey undertaken in February and March 2019 using questionnaires completed by out-patients attending a teaching hospital clinic in East Tennessee USA. We evaluated patient knowledge, attitudes, satisfaction and aspirations towards Advance Care Planning. Results: 141 properly completed questionnaires were used. All Medicare enrollees were aware of Advanced Care Planning compared to 43% in the non-Medicare group. 70% of the Medicare enrollees and 94% of non-Medicare group were not ready to complete a written Advanced Care Plan. Of the respondents, 46% had appointed spouses, 24% adult children, 11% siblings, 10% parents, 3.6% friends and 1.2% aunts as their surrogate medical decision makers. 41% agreed that they were satisfied with their current advance care planning arrangements. This research identified that individual’s knowledge, attitudes and aspirations influenced the adoption of Advance Care. Conclusions: Patients have adopted the Advance Care Plan concept but have modified it to reduce their concerns by using family and loved ones to convey their wishes instead of filling the required legal documents. Clinicians could improve this informal system and increase the observability of the treatment choices including the use of video and web-based tools.

Introduction: Leptospirosis is an anthropozoonotic disease; it occurs worldwide but is most common in tropical and subtropical countries. It is usually underreported due to a lack of awareness, atypical presentations and lack of diagnostic facilities, especially in a resource-limited setting like India. Knowing the local prevalence of such infections is of utmost importance for appropriate control and management. Aim: To estimate the seroprevalence of leptospirosis among suspected Acute Febrile Illness (AFI) cases and to assess the clinicoepidemiological profile of leptospirosis cases presented at Government Medical College, Amritsar, Punjab, India. Materials and Methods: This hospital-based cross-sectional study was conducted at Government Medical College, Amritsar, Punjab, India. A total of 360 clinically suspected AFI cases were enrolled in the study. The demographic and clinical profile of the cases was taken on a semistructured predesigned proforma. Blood sample was collected from the patients, and an Immunoglobulin M (IgM) Enzyme-linked Immunosorbent Assay (ELISA) was done for diagnosis. Data analysis was done using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistical package for windows. Results: Out of 360 AFI cases suspected of leptospirosis, 62 (17.2%) were positive for leptospirosis IgM ELISA. The majority of AFI cases and leptospirosis cases belonged to the 21-40 years age group followed by the 41-60 years age group. Seroprevalence was found to be higher in males (20.8%) as compared to females (12.7%). Maximum seroprevalence (20.1%) was seen during the monsoon season followed by the autumn, summer and winter season. The association between risk exposure to risk factors and leptospirosis seroprevalence was found to be statistically significant (p=0.034). Fever, myalgia, headache, nausea/vomiting, icterus and hepatomegaly were common clinical features observed in leptospirosis cases. Conclusion: Leptospirosis has rapidly emerged to become the major cause of AFI in many parts of India. High seroprevalence of leptospirosis was reported among undifferentiated AFI cases in the present study. A programmatic approach towards the prevention, control and management of these emerging diseases in Punjab is highly recommended.

Introduction: There are many types of coronaviruses that causes respiratory and intestinal infection in humans. Among these coronaviruses, is a group of Severe Acute Respiratory Syndrome (SARS)-like bat coronavirus, including both SARS-CoV and SARS-Cov-2 that comprise a unique clade under the subgenus Sarbecovirus. The SARS-CoV-2 strains in India are more closely related to bat-CoVRaTG13 (93% homology) than pangolin CoV (83.5% homology). India reported its first case of Coronavirus Disease 19 (COVID-19) on January 30, 2020. Punjab, a state in northwestern India comprises of 22 districts which are classified into three major distinct regions viz. Majha, Malwa and Doaba. Four districts of Majha region of Indian state of Punjab are Amritsar, Tarn Taran, Gurdaspur and Pathankot. Aim: The present study describes the SARS-CoV-2 epidemiology based on samples tested for this virus; received at Viral Research and Diagnostic Laboratory (VRDL), Government Medical College, Amritsar-Punjab, India. Materials and Methods: This epidemiological study was designed taking into consideration three main factors i.e. the gender, the age groups and the factor whether the individual has any symptoms or not. To study their context of applicability and its interpretation, a total of 3,47,418 samples from period of 01st April 2020 to 31st October 2020 were included in this study. Ribonucleic Acid amplification by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of SARS-CoV-2 from nasopharyngeal/oropharyngeal swabs of all individuals revealed confirmation of 17,920 positive samples. Total 2,29,310 males and 1,18,108 females were tested for the COVID-19 infection. Social science statistics online tool (https://www.socscistatistics.com/tests/) was used for χ2 test to analyse different parameters. Results: Maximum number of COVID-19 positive patients was detected in 21 to 30 years age group (p

BACKGROUND Systemic biochemical disarray has been implicated in the pathogenesis and progression of diabetes and its complications. However, the modifications in the metabolic state of the retina and its microenvironment in response to the systemic metabolic malfunction has not been documented. OBJECTIVE The objective of the present study was to document the various biomarkers that may be involved in the pathogenesis and progression of Proliferative Diabetic Retinopathy (PDR). METHOD The vitreous humour and plasma samples from 38 PDR, 7 Proliferative Vitreo Retinopathy (PVR) and 17 control patients undergoing pars plana vitrectomy were analysed for sixteen different biomarkers. Whole genome Single Nucleotide Polymorphism (SNP) microarray was performed on ten PDR patients' peripheral blood samples. RESULTS The vitreous humour glucose, creatinine, micro protein, phosphorus and lactate dehydrogenase were found significantly increased in the PDR patients compared to controls. The plasma urea, creatinine and micro protein were also significantly increased. The plasma phosphorus of PDR patients on oral hypoglycemic therapy was found significantly decreased compared with PDR patients on insulin therapy and controls. SNPs previously associated with glucose (5), lactate dehydrogenase (2) and creatinine (2) levels were identified to be polymorphic homozygous (minor allele) in ≥ 60% patients in this study, suggesting enhanced susceptibility. CONCLUSION The metabolic overactivity of the retinal microenvironment appears to play a vital role in the pathogenesis of PDR. The significantly elevated biomarkers may have diagnostic, prognostic and therapeutic significance. These findings shed light on the biochemical disarray in the vitreous humour of PDR patients that could have significant management implications.

Particularly PIN1, PIN protein-mediated rate-limiting auxin distribution plays a critical role in plant differentiation. Although well-characterized in Arabidopsis, little is known about the structural and functional relationship of the PIN1 gene among other plants. Here, we report that the gene structure remained conserved among bryophytes and angiosperms while the gene size varied by ~ 17%. Although the positions were conserved, highly variable intron phase suggests preference for specific regions in the gene sequence for independent events of intron insertion. Significant variation was observed across gene length for insertions and deletions that were mainly localized to the exonic regions flanking intron 1, possibly demarcating the sequences prone to deletions/duplications. The N and C-terminals showed a higher protein sequence similarity (~ 80%) compared to the central hydrophilic loop (~ 26%). In addition to the signature domains and motifs, we identified four novel uncharacterized motifs in the central divergent loop of PIN1 protein. Three different homo-loci, one each on chromosome groups 4, 6, and 7, were identified in wheat each showing dramatically different expression patterns during different plant developmental stages. Virus-induced gene silencing of the TaPIN1 gene resulted up to 26% reduction in plant height. Because of its direct role in controlling plant height along with a higher expression during stem elongation, the TaPIN1 gene can be manipulated to regulate plant height.

Amebiasis is a common cause of dysentery in India and can have an atypical fulminant course with negative serological tests in immunosuppressed individuals such as chronic kidney disease (CKD). We present a patient of CKD on dialysis who presented with features of dysentery with negative blood and serology workup. The diagnosis of amebic colitis was made after colonoscopy and histopathology which revealed amebic trophozoites and her symptoms abated after appropriate therapy. This case report illustrates the need for colonoscopy and histopathology for definite diagnosis of fulminant presentation of amebic colitis in an immunosuppressed individual such as CKD.

In the United Stated population70years is likely to double by the year 2050. Elderly population (70years) are most vulnerable to burns and outcomes following such injuries in this special group is poorly studied. This study aimed to look at outcomes following burns in patients70years over a period of 17 years.Data on 6512 patients admitted to a Level I Burn Center between 1995 and 2011 was analyzed. Age, gender, ethnicity, TBSA, burn etiology, hospital and burn intensive care unit (ICU) length of stay (LOS) and status at discharge were abstracted. Three broad categories were created based on presence or absence of smoke inhalation, No smoke inhalation (Group A), smoke inhalation only (Group B) and smoke inhalation with burn injury (Group C). Differences were analyzed using the student's t-test for continuous variables and Chi-Square test for categorical variables.The study group was comprised of 564 patients, 72.3% in group A, 4.8% in group B and 22.9% in group C formed the study population. The mean age of the patients studied was 80.4±6.7, with female patients being more common (58%). The number of Caucasians (72.9%) was highest in group C compared to other racial groups (p=0.047). Majority of patients in the group B (59.3%) were admitted directly compared to other two groups (group A=24.0%, group B=34.9%, p0.001). Overall percent total body surface area (% TBSA) and % TBSA third degree burns were higher in group C, whereas % TBSA second degree burns were common in group B (p0.05). The number ICU admissions, the mean length of ICU stay, mean duration of ventilator support and mean length of hospitalization were all highest in group C patients (p0.001). The number of discharges to home without home health aide were higher in group A, whereas the number of discharges to nursing home/rehabilitation/extended care facility were higher in group B (p0.001). The in-hospital mortality (58.1%, p0.001) and overall burn related mortality (62.8%, p0.001) were highest in group C. There was no significant difference between the groups for the number of patients converted to hospice care (p=0.21). On multivariate analysis ICU admission (Odds Ratio [OR]=3.7, 95% Confidence Interval [95% CI]=2.1-6.5), ventilator support (OR=7.1, 95% CI=4.1-12.0), and %TBSA10% (OR=3.1, 95% CI=1.9-5.0) significantly increased mortality. In terms of complications, group C had a significantly higher incidence of pneumonia (18.6%, p0.001), respiratory failure (17.1%, p=0.001), and sepsis (7.8%, p=0.003).Patients70 years constitute small (8.6%) but significant number among burn patients. The overall ICU admissions, number of days on ventilator, ICU stay, in-hospital mortality and overall mortality is higher in this group of population even for low % TBSA burns. Presence of smoke inhalation increases mortality.

It is extremely rare to find mullerian choristomas in association with spinal dysraphism, with

Introduction There is a paucity of published data on epidemiology of the viral infections in Punjab, India. The Viral Research and Diagnostic Laboratory (VRDL) located at Government Medical College (GMC), Amritsar conducts the initial diagnosis of common viruses circulating in the region. Aim To report the seroprevalence of various viral diseases in Amritsar and neighboring districts of Punjab along with the demographic and geographical data of the patients. Materials and methods Whole blood sera samples from a total of 5781 patients suspected of various viral diseases (chikungunya, dengue, hepatitis A, hepatitis B, hepatitis C, hepatitis E, herpes simplex-1 or herpes simplex-2) were received at VRDL, GMC, Amritsar from January 2015 to April 2016 and a cross sectional study was conducted. The diagnosis was based on serological assays. Results Out of total 5781 suspected cases, 1790 were diagnosed with antibodies for atleast one of the tested viral diseases. Dengue virus was the highest occurring viral disease (56.77%). Male patients infected with viruses outnumbered female cases, except for hepatitis E and herpes simplex-1. The 21-40 years age group appeared to be the most susceptible age group for nearly all studied viral infections. Among the total nine reported outbreak investigations, largest encompassed 1335 dengue cases from Amritsar district. Conclusion VRDL established in GMC, Amritsar has become instrumental in detection of emerging and re-emerging viral diseases including outbreak investigation of communicable diseases. Timely action with the help of adequate information and capacity to diagnose the viruses might help in saving numerous lives.