Search

Eastern countries are a major source of medicinal plants, which set up a rich source of ethnopharmacologically known medicines used in the treatment of various diseases. These traditional medicines have been known as complementary, alternative, or nonconventional therapy across globe for ages. Tuberculosis (TB) poses a huge global burden and leads to maximum number of deaths due to an infectious agent. Treatment of TB using Directly Observed Treatment Short‐course (DOTS) therapy comprises multiple antibiotics is quite lengthy and causes serious side‐effects in different organs. The length of the TB treatment leads to withdrawal from the patients, which paves the way for the emergence of drug resistance in the bacterial population. These concerns related to therapy need serious and immediate interventions. Traditional medicines using phytochemicals has shown to provide tremendous potential in TB treatment, mainly in the eradication of Mycobacterium tuberculosis (M.tb), increasing natural immunity, and managing the side effects of anti‐TB drugs. This review describes the antituberculosis potential of selected ethnopharmacologically important phytochemicals as potential immune‐modulator and as an adjunct‐therapy in TB. This review will be a useful reference for researchers working on ethnopharmacology and will open the door for the discovery of novel agents as an adjunct‐therapy to tuberculosis., The different modes of action of phytochemicals in adjunct therapy for the treatment of TB.

Candida auris is identified as an emerging pathogen worldwide. It is multidrug resistant and causes invasive healthcare-associated infections. Our retrospective study was conducted to determine the prevalence and epidemiology of C. auris infections in a tertiary care hospital in Jaipur. 24 clinical C. auris strains were included, most being from urine. The majority patients needed intensive care and had at least one underlying co-morbid condition. A history of broad-spectrum antibiotic or antifungal usage was present in 85%. Fluconazole, voriconazole, amphotericin B and 5-fluorocytosine resistance was seen in 96, 42, 33 and 8% isolates respectively. No echinocandin resistance was noted.

Objective: The aim of this study was to assess the clinical profile of patients with diabetic foot ulcer treated conservatively or surgically and effect of risk factors on ulcer healing. Methods: This was a retrospective observational study conducted in tertiary medical teaching hospital where medical records of diabetic patients who were admitted with foot problem were evaluated. All diabetic patients who were aged >18 years and admitted with DFU were included in this study. A structured proforma was used to collect data from the medical record. SPSS version 20.0 was used to perform the statistical analysis. Result: 280 subjects with diabetic foot ulcer (DFU) were evaluated in this study. 71% ulcers were healed where as 11% were persisted unhealed. Patients who were undergone for amputation 12% were minor (Foot only) and 4% were major (above the ankle). A statistically significant association between age, duration of diabetes, glycemic control peripheral neuropathy, and ulcer size were found with diabetic foot ulcer healing. Conclusion: Modifiable factors like good glycemic control, early management of ulcers and early treatment of peripheral neuropathy can influence Diabetic foot ulcer outcomes. Special care should be provided to diabetic subjects who are aged and have longer duration of diabetes. Keywords: Diabetic foot ulcers, ulcer severity, clinical profile, Wagner’s Classification, outcome.

Objectives Intraparenchymal epidermoid cysts (IECs) are rare lesions. They represent less than 1% of the intracranial epidermoid cysts. The supratentorial IEC is a clinically and prognostically distinct subset. Given the rarity, most of the articles are case reports. We present a series of five cases of supratentorial IEC to characterize their clinical presentation and outcome, with emphasis on the surgical features. Materials and Methods We searched our database for all cases of intracranial epidermoid cysts operated between January 2005 and January 2020. Five patients were identified having IEC from the hospital information system and the neurosurgical operation record book. Standard craniotomy and decompression of the lesion were performed in all these patients. Standard postoperative care includes computed tomography scan of head on the day of surgery and magnetic resonance imaging of brain after 6 weeks to look for the residual lesion, if any. Subsequent follow-up visits in outpatient department to look for resolution of the presurgical symptoms. Results The mean age of the patients in our series was 28.8 years (range: 28–40 years.). All the five patients were male. Four patients had IEC involving frontal lobe and one in parietal lobe with a small occipital lobe extension. Seizure was the most common presenting complaint followed by headache. Complete excision was achieved in all the cases. All the three patients with seizure attained seizure freedom postlesionectomy. Focal neurological deficits resolved gradually in postoperative period. There was no recurrence of lesion during follow-up. Conclusion Supratentorial IEC most commonly affects young males, involve frontal lobe and present clinically with seizure. Complete surgical excision offers best outcome in the form of remission of seizure disorder.

The diagnosis of unexplained syncope and sustained palpitations remains a challenging task for cardiology community. Continuous monitoring of cardiac activity is essential to know the pumping pattern of the heart for patients with mild and severe symptoms. Although attempts have been made towards developing wearable monitoring system, the demand for new system is still open due to affordability and accessibility to resource constrained settings. This research work proposes a wearable smart jacket with a single lead (Ag-NyW) textile sensor for continuous monitoring of electrocardiogram (ECG) signals. The wearable lead-I textile electrodes are evaluated in terms of visual inspection by the clinician, skin-electrode contact impedance characteristics; fidelity measures such as crest factor, signal band to noise band ratio, mean magnitude squared coherence; and ECG interval characteristics. Experimental study was carried with 212 healthy volunteers after due ethical clearance (age group 18–45 years), and RR variability and heart rate variability were assessed for different age groups and BMI levels. The study revealed that the proposed textile electrodes are comparable to disposable (conventional Ag/AgCl gel) electrodes in terms of fidelity measures, skin-contact impedance, and ECG interval measures. The HRV for different age groups and BMI levels were found to be within the limits as reported in the literature. From the current pilot study with Indian population, this cost-effective wearable ECG monitoring system will be helpful for long-term monitoring in resource constrained settings.

Chronic obstructive pulmonary disease (COPD), a heterogeneous lung disorder that is characterized by airflow obstruction and the third leading cause of death, globally. COPD is influenced by environmental and genetic factors. Here, we measured the serum level of matrix metalloproteinase-9 (MMP-9), cyclooxygenase-2 (COX-2) and prostaglandin E-2 (PGE-2) and reveal the correlation between their levels in COPD subjects. In this study, we included a total of 79 COPD and 79 healthy controls. We assessed demographic profile, risk factors, respiratory symptoms, clinical history, COPD Assessment Test (CAT) score and spirometry. Further, we determined the serum levels of MMP-9, COX-2 and PGE-2 by enzyme-linked immunosorbent assay (ELISA). The correlation between their serum levels was also determined. Among the studied population age, gender, body mass index and socioeconomic status were comparable. Serum levels of MMP-9, COX-2 and PGE-2 were significantly increased in the COPD group than in healthy controls (P 10). Serum levels of MMP-9, COX-2 and PGE-2 was enhanced in patients with larger clinical history (> 20 years) than those with lower clinical history (

Objectives The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience. Materials and Methods We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders. Results A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (n = 30) which was 10 times more common than in the sacral region (n = 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up. Conclusions The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.

Background Among the patients of drug-resistant epilepsy, a subset which has focal impaired seizures localizes to the temporal lobe region (TLE). A majority of these cases are surgically amenable with anterior-medial temporal lobe resection or “lesionectomy.” Objective In India, there is scarcity of “specialized centers” providing “comprehensive epilepsy care” and this dearth is further worse in populous states. In this article, we share our single center, observational, and retrospective experience of TLE in background of limited resources and utmost requirement. Methodology Our study is a retrospective analysis medically refractory epilepsy patients (2016–2019). Patients with medically refractory epilepsy were selected based upon our noninvasive protocol (clinical semiology, interictal scalp electroencephalography (EEG), long-term video EEG monitoring data, and magnetic resonance injury [MRI]). The follow-up was noted from the last out-patient visit record or through telephonic conversation (International League Against Epilepsy score). Results Of 23 cases of TLE (n = 7, mesial temporal sclerosis; n = 16 temporal lobe like cavernomas, tumors, or arterio-venous malformations). Single photon emission computed tomography/positron emission tomography (SPECT/PET) was performed in five cases (three cases of ictal/interictal SPECT and two cases of PET scan) where there was discordance between EEG/clinical and MRI. The median follow-up was of 19 months with 18 cases being seizure free. Five cases were fully off the antiepileptic drug (AEDs) while in 15 cases, the AEDs dosages or the number were reduced. Average number of AEDs reduced from 2.9 in preoperative period to 1.2 postoperatively. Two cases had quadrantanopia and one case of cerebrospinal fluid leak. Conclusion A multidisciplinary and holistic approach is required for best patient care. The results of our initial surgical experience are encouraging.

Bloodstream infection remains one of the most important causes of morbidity and mortality globally, specifically among intensive care unit patients. This prospective observational study included 887 blood culture samples collected cases admitted to intensive care unit suspected of having sepsis. Samples were cultured and evaluated for antimicrobial susceptibility patterns: 202 (22.78%) blood cultures were positive and yielded microbial growth with 132 (14.88%) having mono-microbial growth. Gram-negative bacteria accounted for 45.2% cases, with Escherichia coli being the most common; Gram positives accounted for 43.9% with Staphylococci haemolyticus being most common and 10.9% were fungal isolates. Gram-negative isolates were sensitive to colistin and tigecycline and 77.3% of isolates were extended spectrum beta-lactamase (ESBL) producers. Gram-positive isolates were sensitive to tigecycline, linezolid, vancomycin and teicoplanin with 97.5% being methicillin-resistant Staphylococci (MRSA). Most of the blood culture isolates from critically ill patients in intensive care unit were multidrug-resistant, ESBL producers and MRSA which raises a serious concern about the development of serious antibiotic resistance.

This study endeavours to comprehensively the study the spectrum of ENT manifestations in mild and asymptomatic COVID-19 and observe the natural course of anosmia and dysgeusia consequent to SARS-Cov-2 infection. A prospective cohort study was undertaken at a tertiary care centre in India on admitted patients with RT-PCR proven COVID-19. Patients were included provided the baseline National Early Warning Score (NEWS) was less than 4. Patients were screened for ENT manifestations using a questionnaire at baseline, 7 days, 14 days and 28 days. 225 patients were included in the study. Of these complete data at 4 weeks was available for 210. Out of 145 patients with mild COVID-19 (asymptomatic = 80), ENT manifestations accounted for 66.2% of all symptoms. Smell and taste disturbance had an overall incidence of 20% and 45% of ENT manifestations. Temporal trends of the recovery rate of anosmia and dysgeusia were 53.6% and 66.7% at 2 weeks, respectively. Corresponding rates at 3 weeks were 89.29% and 86.7%, respectively. By the end of 4 weeks 96% of the patients had recovered completely. The incidence of anosmia and dysgeusia in this study parallels the rates reported from other Asian countries, albeit, lower than the rates quoted from the Western Hemisphere. We recommend structured reporting of all ENT manifestations especially smell and taste disturbances to accurately identify individuals infected with SARS-Cov-2.

Epidermoids account for1.5% of all intracranial tumors. Overall, the cerebellopontine angle has been the most commonly reported location. In the supratentorial compartment, epidermoids will usually be found in the suprasellar area, sylvian fissure, and intraventricular area. The interhemispheric fissure represents an extremely rare location for supratentorial epidermoids, with limited cases reported previously. Surgery of an interhemispheric epidermoid can be challenging because of its adherence to the anterior cerebral artery branches or the brain parenchyma itself. In the present study, we have reported the largest Series of interhemispheric epidermoid tumors to better understand the clinical behavior, radiological features, and surgical outcomes.In the present study, we retrospectively evaluated the data from 22 consecutive patients with interhemispheric epidermoids treated surgically during the past 10 years (2009-2019) at our center. During the same study period, we had treated 2355 patients with brain tumors (both primary and secondary), including 262 patients with intracranial epidermoids. Therefore, interhemispheric epidermoids comprised 0.009% of all brain tumors and 8.4% of all intracranial epidermoids in our experience. These patients all had newly diagnosed tumors and had undergone surgery for the first time at our center. All surgical specimens had been confirmed histopathologically.The mean age of the patients was 31 years (range, 17-61 years), with a male predilection. Seizures and headache were the most common mode of presentation. The average tumor size was 5.2 cm (range, 3.5-10 cm). Of the 22 tumors, 21 were in the anterior two thirds of the fissure. Anatomical distortion of the corpus callosum was seen in 13 patients (59%). The extent of excision was total in 17 (77.3%), near total in 3 (13.6%), and subtotal in 2 (9%) patients. The near or subtotal excisions had been necessary because of either tumor adherence to the pericallosal artery (n = 3) or a missed tumor lobule (n = 2). The mean follow-up time was 32 months, with no tumor recurrence.Interhemispheric epidermoids can often reach a large size with substantial lateral extension found at diagnosis. The position of the anterior cerebral Artery branches can help to differentiate interhemispheric epidermoids from radiologically similar corpus callosum, velum interpositum, and cavum septum pellucidum epidermoids. Complete surgical excision with minimal complications is feasible, with good long-term outcomes.

Purpose: To analyze the demographic, clinical, and microbiological profile of patients presenting to our unit with chronic wounds of various etiologies with an intent to give a current overview of chronic wounds. Patients and Methods: We performed a prospective observational study of patients presenting with chronic wounds from October 2018 to September 2019. The study was conducted at the Department of Burns and Plastic Surgery of a tertiary care institute in a non-metropolitan city in Central India. A total of 103 patients were included in the study. Data collected from the patients included demographic details, history, clinical features, and relevant laboratory reports. Wound swabs obtained by Levine’s technique were sent for culture and sensitivity studies. Treatment was instituted according to the clinical picture and modified if necessary. Progress was monitored until the wound healed, either by conservative management or by surgical intervention. Patients were followed up for six months thereafter. Results: Most of the patients presented with lower limb wounds (n=81, 78.64%). Swab specimens from 103 wounds were cultured. Among the isolates, gram-negative organisms were more common than gram-positive organisms. Staphylococcus aureus was the most common species isolated, followed by Pseudomonas aeruginosa. The frequency of infections caused by other gram-negative organisms like Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis was on the rise. There were significant differences in the patterns of antimicrobial resistance in our patients. Sharp debridements were required in almost all cases for wound preparation. Most of the patients (n=74, 71.84%) underwent surgical intervention for achieving wound closure. Split-thickness skin grafting (STSG) was the most common surgical intervention performed (n=45, 43.68% patients), followed by local and distant flaps. Conclusion: Our study gives a current overview of the causes, clinical presentation, prevalent microbial flora, and their antibiotic susceptibilities prevalent in chronic wounds presenting to our unit. Treatments administered are discussed with emphasis on the different reconstructions performed.

Mucormycosis isolated to the mandible is a rare presentation occurring generally after dental procedures. The case we report presented with discharging sinuses over facial region with radiological appearance of isolated osteomyelitis of the mandible. The patient used to apply an addictive dental powder over his teeth leading to caries. Following this, he pulled out all his teeth, which probably led to his condition. Invasive sampling revealed mucormycosis. An extensive search for an underlying immunodeficiency revealed that the patient had chronic granulomatous disease (CGD). Despite a prolonged course of L-Amphotericin B, the patient continued to have intermittent pus discharge and surgical debridement and curettage was eventually required. The patient had a chronic course with minimal soft tissue involvement which initially did not raise the suspicion of mucormycosis. The main learning point is that an unusual invasive fungal infection in an otherwise healthy host can be the first symptom of an underlying primary immunodeficiency, like CGD. Invasive fungal infections in patients with CGD often have an indolent course., Highlights • Mucormycosis isolated to the mandible is a rare presentation, occurring generally after dental procedures. • Self-extraction of teeth as in our patient can result in isolated mucormycosis of the mandible. • Isolated mucormycosis of the mandible can be a presenting symptom of chronic granulomatous disease. • Combination of medical and surgical treatment is usually needed in mandibular mucormycosis.

Dear Editor, Rising and remerging pathogens are worldwide difficulties for open health.1 Coronaviruses are wrapped RNA infections that are dispersed extensively among people, different warm-blooded creatures, and flying creatures and that cause respiratory, enteric, hepatic, and neurologic diseases.2, 3 Six coronavirus species are known to cause human illness like 229E, OC43, NL63, and HKU1, SARS – CoV and MERS – CoV.4 Given the high predominance and wide circulation of coronaviruses, the huge hereditary decent variety and successive recombination of their genomes, and expanding human–creature interface exercises, novel coronaviruses are probably going to develop intermittently in people attributable to visit cross-species contaminations and incidental overflow events.5, 6 On January 30, World Health Organization (WHO) pronounced the ebb and flow flare-up that began in Wuhan, China as a Public Health Emergency of International Concern, while prescribing against movement or exchange interruptions to and from China.7 The progressing pandemic of coronavirus ailment 2019 (COVID-19) is brought about by extreme intense respiratory disorder coronavirus 2 (SARS-CoV-2).8 As of 12 April 2020, in excess of 1,777,515 instances of COVID-19 have been accounted for in more than 200 nations and regions, bringing about in excess of 108,862 passings.

Introduction: Type 2 Diabetes Mellitus (T2DM) a serious, common chronic disease constituting a major public health issue worldwide. Yet no cure is available, education of populace is still the key to control this emerging epidemic. Novel drugs are being developed, some used as monotherapy or in-combination for effective glycaemic control. Objective: Comparing the efficacy of Sitagliptin+Metformin versus Glimepiride+ Metformin on patients of T2DM. Material and method: 30 weeks open labeled Randomized controlled study enrolling 80 patients of T2DM, divided into two groups with 40 patients in each. Group A given Metformin(500mg) with Sitagliptin(100mg) and group B given Metformin(500mg) with Glimepiride(1mg). HbA1c, FBG, PPBG were done at baseline, 15 and 30 weeks. Results: Group A and Group B both leads to significant (0.05) for FBG, PPBG at 15 and 30 weeks and HbA1c at 15weeks but was the difference was statistically significant ( Conclusion: Sitagliptin with Metformin and Glimepiride with Metformin both causes efficient glycaemic control with no significant adverse reaction but the gylcaemic control of patients taking Sitagliptin with Metformin was slightly better as compared to patients taking Glimepiride with Metformin. Thus concluding Sitagliptin to be more efficacious than Glimepiride. Keywords: Diabetes mellitus type II, Sitagliptin, Glimepiride, Metformin, HbA1c (glycosylated haemoglobin), Fasting blood glucose, Post-prandial blood glucose.

BackgroundHypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterized by the presence of hypoxia without dyspnea.. Silent hypoxia has been shown to affect the outcomes in previous studies.Research QuestionAre the outcomes in patients presenting with silent hypoxia different from those presenting with dyspneic hypoxia?Study design and MethodsThis was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory, and treatment parameters in patients with silent hypoxia and dyspneic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality.ResultsAmong 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851).InterpretationSilent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively. Since home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry at the home setting to identify these patients.

Aims & Objectives: Onychomycosis is a chronic fungal infection of nails. For identification of the specific pathogen and effective selection of antifungal treatment, the clinical diagnosis of onychomycosis must be validated by direct microscopy and culture. The goal of the study was to determine the prevalence of onychomycosis and its cultural positive in relation to several etiological factors. Introduction: Dermatophytes are the most common pathogens of onychomycosis, yeasts and non-dermatophyte moulds can also be found as causative agents of onychomycosis. Materials & Methods: Nail clippings from 90 clinically suspected instances of onchomycosis were collected from O.P.D at S.M.S and E.S.I.C. hospital in Jaipur. Trauma, infection, occupation, diabetes, and personal habits (smoking, etc.) were all thoroughly investigated. Direct microscopy using a 20% KOH examination method and fungal culture on SDA and Dermatophyte Test Media were used to make the diagnosis. Results: Out of 90 onychomycosis patients, 80 (88.9%) tested positive for KOH, whereas 33 (36.7%) tested positive in culture. Dermatophytes, non-dermatophytes, and yeasts were identified as etiological agents of onychomycosis in this investigation. Patients with distal subungual onchomycosis were shown to have a common type of onychomycosis. Trichophyton rubrum was found to be the most common species among the culture positive cases, followed by Trichophyton mentagrophyte and Trichophyton tonsurans. Non dermatophyte molds were also isolated from white superficial onychomycosis and Candida species was isolated from Candida onychomycosis. In our study, the majority of patients were in the age groups of 41-50 and 51-60 years, and males were the most usually affected. According to the study, the majority of patients infected with onychomycosis infection were service class and sportsmen, followed by labours, housewives, unemployed, students, and farmers. Conclusion: Based on the findings of this study, it is possible to conclude that onychomycosis is a significant public health issue, and that accurate diagnosis of onychomycosis by direct microscopy and fungal culture is required for appropriate management of such cases.

Moyamoya disease (MMD) is caused by stenosis or occlusion of internal carotid artery in brain, thereby reducing its blood supply. To augment blood flow, brain develops abnormal anastomotic vessels with deranged carbon dioxide reactivity and tendency to bleed. Moyamoya syndrome (MMS) is the name given to MMD when the latter results from secondary to some associated disease. Occurrence of MMS secondary to sickle cell anemia (SCA) presents unique challenges to neuroanesthesiologists. Management of various physiological parameters for cerebral revascularization surgery for MMD under general anesthesia necessitates vigilant and balanced control of various physiological variables, as the manipulation of a particular physiological variable for one pathology may adversely impact the same physiological variable for the associated disease, which will result in poor outcome of the patient. Therefore, optimum outcome of MMS is determined by a watchful balancing of various physiological parameters under anesthesia.

BackgroundLung impairment is a frequently recognised outcome in patients treated for pulmonary tuberculosis (TB). The impact of post-TB sequelae is not only restricted to clinical outcomes but also includes the quality of life and psycho-social well-being. However the magnitude of involvement of quality of life and the likely factors determining it are not clear. In this study, we assess the degree of compromise of quality of life and its determinants in patients of post-TB sequelae.MethodsPatients >18 years of age with a history of pulmonary tuberculosis were included in the study. Clinical history, pulmonary function test (PFT) and chest radiographs were recorded. The severity of dyspnea was evaluated using mMRC; quality of life assessment (QoL) was done using two standardized questionnaires- St. George’s Respiratory Questionnaire (SGRQ) and Seattle Obstructive Lung Disease Questionnaire (SOLQ).ResultsA total of 90 participants (mean age 40.4±11.6 years; 60 [66.7%] males) were recruited in the study. Overall, 93.3% (95% CI: 86.1%-97.5%) were currently symptomatic. A total of 96.8% (61/63) patients had abnormal pulmonary function test results, out of which 61.9% (39/63) had a mixed type. Out of 65 patients with chest radiographs available, 60 (92.3%,95% CI:84.6-96.8) patients had abnormalities with 45 (69.2%,95% CI: 58.3-78.2) having bilateral chest radiographic abnormalities. On assessment of QoL by SGRQ, the average score obtained was 42.3±24.0 (95% CI:37.3-47.3), with ‘Symptoms’ being the most affected domain. On using SOLQ, ‘Treatment satisfaction’ (mean score 38.5±21.7, 95% CI:34-43) and ‘Physical function’ (mean score 66.6±23.7, 95% CI:61.6-71.6) were the most affected. Neither spirometry results nor chest radiograph severity score could significantly account for the reduction of QoL. There was also a significant correlation between most of the parameters of SGRQ and SOLQ questionnaires in these patients.ConclusionPersistent respiratory symptoms, radiographic and spirometric abnormalities, were present in most of the patients with post-tubercular sequelae. Quality of life, as measured by SGRQ and SOLQ, was found to be significantly impaired in the majority of patients.

Laryngeal paraganglioma is a rare tumor with diagnostic challenge. Many a times it can be confused with laryngeal cancers. CECT and MRI has an important role in its diagnosis. Surgical excision is the treatment of choice. Our case presented with stridor. Emergency tracheostomy was done followed by workup for surgery. Excision of the tumor was done by laryngeal fissure.

Introduction: Due to substantial increase of coronary heart disease, a need for identifying and correcting the conventional risk factors like hypertension, diabetes mellitus, smoking and hyperlipidemia has been emerged, as controlling them not only prevents the formation of atheromatous plaque but also slows down its progression and even promotes regression. AIM: Comparing the effects of Terminalia arjuna with Rosuvastatin on triglycerides and high density lipoprotein cholesterol in dyslipidemic patients of either sex. Materials and Methods: A 12 weeks open prospective randomized controlled study, enrolling 60 patients of dyslipidemia was conducted. Patients were distributed in two groups of 30 each. Group A was given Rosuvastatin (10mg) once daily and group B was given Terminalia arjuna (500mg) twice daily. Triglyceride and HDL-C levels were done at baseline and after 4, 8 and 12 weeks of starting the treatment and data was statistically analyzed. Results: Greater reduction in mean Triglyceride level was demonstrared with Terminali arjuna as compared to Rosuvastatin (-35.23±37.59 vs -13.30±6.64), (-51.66±48.67 vs -25.23±11.29) and (-60.63±49.93 vs-35.16±14.76) at 4, 8 and 12 weeks respectively and the difference between both the groups was statistically significant (p2.37±2.20vs 1.97±1.40) at 4 weeks but was slightly less (3.43±2.88 vs 3.53±2.31) and (4.37±2.76 vs 4.77±2.40) at 8 and 12 weeks. On comparing difference was found to be statistically non-significant. Conclusion: Rosuvastatin and Terminalia arjuna both are effective hypolipidemic agents causing significant decrease in triglyceride and increase in high density lipoprotein cholesterol. Terminalia arjuna had showed greater reduction triglyceride and was found to be safe. Keywords: Rosuvastatin, Terminalia arjuna, High density lipoprotein cholesterol, Triglyceride.

Background: Vitamin D (VD) deficiency is linked to insulin activity and its release. It is associated with uncontrolled diabetes and more complications in diabetic patients. So, this study will prove importance of investigating serum VD level in Type 2 DM (T2DM) patients and its relation to complication of diabetic nephropathy. Materials and Methods: Total 1025 patients with Type 2 diabetes were enrolled in this study. Age limit was from 40 to 76 year. Investigations for serum VD, haemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP) and urinary Albumin: Creatinine Ratio (ACR) were done in each patient. Result: It was found that most of the patient (77.89%) were having VD

Scrub typhus is a zoonotic disease caused by the bite of a mite Orientia tsutsugamushi, a bacterium from the Rickettsiaceae family, which is transmitted to humans by bite of trombiculid mite. Scrub typhus is widely spread all across India, and despite its vast occurrence, it remains underdiagnosed. The probable reasons could be the lack of specific symptoms, poor access to the diagnostic facilities, and low index of suspicion by the clinicians. It is a common trend to rule out the common causes of infection such as malaria, typhoid, and leptospirosis, and then, a good number of cases are ultimately diagnosed as scrub typhus. The common presentation is high-grade fever (98%), tender regional/generalized lymphadenopathy (40%–97%), hepatosplenomegaly, cough, and a characteristic eschar that is found in nearly 50% of cases, which represents the site of bite by the mite. Here, we present with a series of cases from Indore of scrub typhus with pulmonary complications which too were underdiagnosed. Immunoglobulin M typhus (enzyme-linked immunosorbent assay) confirmed the diagnosis, and all three were efficiently managed with doxycycline.

Aims and objective: To study the profile of Candida infection and antifungal susceptibility (AFS) pattern in neonatal sepsis.Materials and methods: In this prospective observational study, 850 bloo...

Objectives: Thyroid transcription factor-1 (TTF-1) expression is frequently associated with adenocarcinoma lung. This study was undertaken with the objectives to assess the expression of TTF-1 in non-small cell lung carcinoma (NSCLC) with adenocarcinoma phenotype and to evaluate the TTF-1 expression with clinicopathological and histomorphological features. Materials and Methods: This was a tertiary care hospital-based case series that included 250 cases of NSCLC. TTF-1 immunostaining along with a basic panel of immunohistochemistry markers was performed. The histomorphological analysis was done to compare the morphological features of TTF-1-positive versus TTF-1-negative cases. Results: TTF-1 was positive in 144 cases (57.6%), while 106 cases were negative for TTF-1. The M: F ratio in the TTF-1-positive group was 1:2, and the mean age of the cases that expressed TTF-1 was 48.5 years. The most common pattern in the TTF-1-positive group was loose clusters or singly dispersed cells (77.78%), followed by the acinar (54.86%) and solid pattern (42.36%). In the TTF-1-negative group, 86.79% of cases had singly dispersed cells or loose cohesive clusters, followed by a solid pattern in 50.94% cases. Conclusion: TTF-1 is a useful and reliable marker for pulmonary adenocarcinoma. TTF-1 expression does not have any association with the patterns and degree of differentiation evident in the tumor.

In hospitals, seizures and encephalopathy are one of the common complications observed in critically ill patients. Drug intoxication, metabolic derangements, and anatomical abnormalities can cause altered mental status. We encountered an uncommon case with a diagnostic dilemma due to persistent encephalopathy, where metronidazole toxicity was an etiological factor. A 45-year-old male, who was admitted with the diagnosis of ruptured amoebic liver abscess. During the course of his management, he developed seizures and altered sensorium. After excluding other etiologies for in-hospital de novo seizure, a suspicion of metronidazole toxicity was considered. MRI brain was done which suggested the same. Metronidazole induced encephalopathy (MIE) is an uncommon adverse effect of treatment with metronidazole. Diagnosis is made by identifying specific radiological findings. It characteristically affects the cerebellum and subcortical structures. While the clinical and neuroimaging changes are usually reversible, persistent encephalopathy with poor outcomes may occur as seen in our case.

Purpose: To describe for the first time, a new approach of subconjunctival Mitomycin-C (MMC) injection at the end trabeculectomy for secondary glaucoma. Materials and Methods: This pilot study consisted of 4 eyes of 4 patients of uncontrolled secondary glaucoma. After preoperative glaucoma workup, all patients underwent standard trabeculectomy with subconjunctival MMC injection, 0.1ml (0.02mg) in superonasal quadrant at the end of surgery. Postoperative follow-up included assessment of visual acuity, intraocular pressure (IOP), bleb, anterior chamber depth and for any complications. The success criterion was IOP of ?21 mmHg. Results: The mean pre and postoperative IOP were 43 mmHg± 16.2 and 12.00mmHg ± 1.6 respectively with a success rate of 100% during a mean follow up of 15.5 months. Blebs were mildly elevated, diffuse and less avascular. No intraoperative complications were seen. Postoperative wound leak, flat anterior chamber, hypotony, choroidal detachment or endophthalmitis were not encountered. Conclusion: This novel approach of subconjunctival MMC injection at the end of trabeculectomy was found to be safe and highly effective in secondary glaucoma without any MMC related complications. Keywords: Mitomycin C, Subconjunctival injection, Secondary glaucoma, Trabeculectomy.

This Study entitled “the study of the aetiological factors of failures of myringoplasty” was planned to find the various aetiological factors causing failure of myringoplasty and suggests remedial steps to improve the results in future. This observational study was carried in the Department of E.N.T, on patients who had undergone myringoplasty from Jan 2013 to June 2016. Total 905 patients operated in the above mentioned duration. 685 patients were operated during Jan 2013 to June 2015, who were studied retrospectively (only 540 came for follow up), and 220 patients were operated during June 2015 to June 2016 were studied prospectively. The patients who came to the OPD for follow up, were thoroughly reviewed and the re-perforation was seen in 53 patients. Total nine factors causing myringoplasty failure were studied, 4 factors i.e. size of perforation, site of perforation, eustachian tube function, and surgeons experience significantly affects the surgical outcome of myringoplasty while age, tympanosclerotic patch, type of anaesthesia, wet or dry graft placement, and deviated nasal septum does not affects the myringoplasty failure. For improvement of result in future, Eustachian tube dysfunction, symptomatic deviated nasal septum should be corrected before the surgery. Anterior and larger perforation should be operated by experienced surgeon.

BackgroundDue to the unprecedented speed of SARS-CoV-2 vaccine development, their efficacy trials and issuance of emergency use approvals and marketing authorizations, additional scientific questions remain that need to be answered regarding vaccine effectiveness, vaccination regimens and the need for booster doses. While long-term studies on the correlates of protection, vaccine effectiveness, and enhanced surveillance are awaited, studies on breakthrough infections help us understand the nature and course of this illness among vaccinated individuals and guide in public health preparedness.MethodsThis observational cohort study aimed at comparing the differences in clinical, biochemical parameters and the hospitalization outcomes of 53 fully vaccinated individuals with those of unvaccinated (1,464) and partially vaccinated (231) individuals, among a cohort of 2,080 individuals hospitalized with SARS-CoV-2 infection.ResultsCompleting the course of vaccination protected individuals from developing severe COVID-19 as evidence by lower proportions of those with hypoxia, abnormal levels of inflammatory markers, requiring ventilatory support and death compared to unvaccinated and partially vaccinated individuals. There were no differences in these outcomes among patients who received either vaccine type approved in India.ConclusionWith a current rate of only 9.5% of the Indian population being fully vaccinated, efforts should be made to improve the vaccination rates as a timely measure to prepare for the upcoming waves of this highly transmissible pandemic. Vaccination rates of the communities may also guide in the planning of the health needs and appropriate use of medical resources.Research in contextEvidence before this studyThe Government of India started vaccinating its citizens from the 16thof January 2021, after emergency use authorization had been received for the use of two vaccines, BBV152, a COVID-19 vaccine based on the whole-virion SARS-CoV-2 vaccine strain NIV-2020-770, (Covaxin) and the recombinant replication-deficient chimpanzee adenovirus vector encoding the spike protein ChAdOx1 nCoV-19 Corona Virus Vaccine (Covishield). These have been approved by the Indian regulatory authority based on randomized controlled studies. In these studies, was found that the vaccines led to more than 90% reduction in symptomatic COVID-19 disease. However, there is scarce evidence of the efficacy of these vaccines in real-world scenarios. A few studies have looked at vaccinated cohorts such as health care workers in whom the vaccines had an efficacy similar to the RCTs. In a study of patients with SARS-CoV-2 infection admitted to a tertiary care hospital in New Delhi, it was found that mortality in fully vaccinated patients was 12.5% as compared to 31.5% in the unvaccinated cohort.Added-value of this studyThis cohort of hospitalized patients with SARS-CoV-2 infection was studied during the peak of the second wave of COVID-19 in India during which the delta variant of concern was the predominant infecting strain and had 26% patients who were partially vaccinated and 71.4% who were unvaccinated. Only 3% of the patients were fully vaccinated and developed a breakthrough infection. At the time of presentation, 13% of the individuals with breakthrough infection and 48·5% in the non-vaccinated group were hypoxic. Inflammatory markers were significantly lower in the completely vaccinated patients with breakthrough infection. The need for use of steroids and anti-viral agents such as remdesivir was also significantly low in the breakthrough infection group. A significantly less proportion of the individuals with breakthrough infection required oxygen supplementation or ventilatory support. Very few deteriorated or progressed to critical illness during their hospital stay. Only 3 individuals (5.7%) out of the 53 who developed breakthrough infection succumbed to illness while case fatality rates were significantly higher in the unvaccinated (22.8%) and partially vaccinated (19.5%) groups. Propensity score weighted multivariate logistic regression analysis revealed lower odds of developing hypoxia, critical illness or death in those who were completely vaccinated.Implications of all the available evidenceThe real-world effectiveness of the vaccines against SARS-CoV-2 seems to be similar to the randomized controlled trials. The vaccines are very effective in reducing the incidence of severe COVID-19, hypoxia, critical illness and death. The reduced need for oxygen supplementation, mechanical ventilation and the requirement of corticosteroids or other expensive medications such as anti-viral drugs could go a long way in redistributing scarce health care resources. All nations must move forward and vaccinate the citizens, as the current evidence suggests that ‘prevention is better than cure’.

Introduction Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load. Hence, Ivermectin is under investigation as a repurposed agent for treating COVID-19. Methods In this pilot, double blind, randomized controlled trial, hospitalized patients with mild-to-moderate COVID-19 were assigned to a single oral administration of an elixir formulation of Ivermectin at either 24 mg or 12 mg dose, or placebo in a 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment. Safety outcomes included total and serious adverse events. The primary outcomes were assessed in patients who had positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes were assessed in all patients who received the intervention (intention-to-treat population). Results Among the 157 patients randomized, 125 were included in modified intention-to-treat analysis. 40 patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%; 12 mg arm, 35.0%; and placebo arm, 31.1%; p-value = 0.30). The decline of viral load at day 5 was similar in each arm. No serious adverse events occurred. Conclusions In patients with mild and moderate COVID-19, a single oral administration of Ivermectin did not significantly increase either the negativity of RT-PCR or decline in viral load at day 5 of enrolment compared with placebo.

Introduction: Insulin therapy is preferred as safest for glycaemic control in patients with elevated serum urea/creatinine level. Management of diabetes in grade 3-5 Chronic Kidney Disease (CKD) with oral hypoglycaemic is very challenging because most of them cause renal impairment and thus dose adjustment is needed in renal disease. Linagliptin, a DPP-4 (dipeptidyl peptidase-4) inhibitor has only 5% renal excretion; hence its dose adjustment is not needed in patients with CKD. Aim: To compare the efficacy and safety of linagliptin with insulin in patients of Type 2 Diabetes Mellitus (T2DM) with CKD. Materials and Methods: The present study was a longitudinal study, in which a total of 101 patients of grade 3-5 CKD with T2DM were divided into two groups, insulin group (n=54) and linagliptin group (n=47), based on their drug therapy. All the cases were tested for HbA1c (Glycated Haemoglobin), Random Blood Sugar (RBS), Creatinine clearance, Urine Protein-Creatinine Ratio (UPCR) and different adverse drug events at their first visit (baseline) and then during follow-up at 1st, 3rd, 6th and 12th month. Statistical analysis was done through GraphPad Instat by unpaired t-test for group comparison and Analysis of Variance (ANOVA) for intragroup comparison. Results: At the end of study, mean difference of RBS, Creatinine clearance and UPCR in both the groups were not significant. But mean HbA1c level was less in linagliptin group (6.62±0.10) as compared to insulin group (6.82±0.23) on long term therapy and the difference was statistically significant. Hypoglycaemia (33 vs 24), urinary tract infection (6 vs 5) and respiratory tract infection (5 vs 4) were more frequent in insulin group versus linagliptin group. Conclusion: Linagliptin for glycaemic control provides clinically meaningful improvements in long term glycaemic control without unacceptable side effects in CKD like vulnerable group of patients.

BackgroundThe epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies.MethodsWe performed a case-control study comparing cases diagnosed with CAM and those who had recovered from COVID-19 without developing mucormycosis (controls). Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded.Results352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases carried conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95%CI 1.1-11), use of systemic steroids (aOR 7.7,95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6,95% CI 1.2-2.2). Zinc therapy, probably due to its utility in immune function, was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM.ConclusionJudicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.

Solitary cysticercus localized to the head and neck musculature is an unusual form of presentation of cysticercosis. Since it is rare and has non-specific manifestations, it can present a diagnostic challenge to the clinician. Our patient was a 16-year-old female who presented with a gradually increasing, painful swelling over right temple region of 6-month duration. Ultrasound and computed tomography scan revealed the presence of a solitary cysticercus in the right temporalis muscle. Surgical excision of the lesion was combined with a 4-week course of the anti-helminthic drug, Albendazole. Patient had a satisfactory resolution of symptoms and there was no recurrence in a follow-up period of 3 years. We suggest that cysticercosis should be considered as one of the possibilities in the differential diagnosis of swellings in the maxillofacial region, especially in the endemic areas. Imaging studies play an important role in confirmation of the diagnosis.

Background Pulmonary aspergilloma (PA) is a common complication seen in patients with pulmonary tuberculosis sequelae. Antifungal therapy, including oral azoles, is commonly used though only surgical resection offers curative benefit. Local administration of amphotericin B like intracavitary instillation, has been effective in aspergilloma patients though nebulized amphotericin B (nAB) has never been formally assessed. Objective The aim of this prospective, non-inferior, open label, randomized controlled trial is to evaluate the efficacy and safety of nebulized amphotericin B compared to oral itraconazole therapy in the treatment of PA. Patients/methods Diagnosed cases of PA(n=32) were randomized into the control group receiving oral itraconazole (n=17) and intervention group receiving nebulized amphotericin B (n=15) . Response to treatment was assessed both clinically and radiologically at the end 6 months. Results and conclusion The number of patients showing overall improvement at the end of 6 months in the control arm(oral itraconazole) vs intervention arm(nebulized amphotericin B) was 65% (95% CI 38.3-85.8) , and 67%(95% CI 38.4% - 88.2%) respectively in the intention-to-treat and 79% (95% CI 49.2-95.3%), and 65% (95% CI 38.4% - 88.2%) respectively in the per-protocol analysis. While, there was no statistically significant difference between the intervention and control arm in both the analyses, non-inferiority was shown in the per-protocol but not in the intention-to-treat analysis. No major adverse events were noted in either group, however a significant proportion of patients receiving nAB reported minor cough (40%), which however did not lead to discontinuation of therapy in any patients. Nebulized amphotericin B can be an effective therapeutic option for pulmonary aspergilloma patients.

Graphical abstract, While the vaccination is now available to many countries and will slowly dissipate to others, effective therapeutics for COVID-19 is still illusive. The SARS-CoV-2 pandemic has posed an unprecedented challenge to researchers, scientists, and clinicians and affected the wellbeing of millions of people worldwide. Since the beginning of the pandemic, a multitude of existing anti-viral, antibiotic, antimalarial, and anticancer drugs have been tested, and some have shown potency in the treatment and management of COVID-19, albeit others failed to leave any positive impact and a few also became controversial as they showed mixed clinical outcomes. In the present article, we have brought together some of the candidate therapeutic drugs being repurposed or used in the clinical trials and discussed their safety and efficacy for the treatment of COVID-19.

Tuberculosis (TB) is an infectious disease caused by an obligate intracellular pathogen, Mycobacterium tuberculosis (M.tb) and is responsible for the maximum number of deaths due to a single infectious agent. Current therapy for TB, Directly Observed Treatment Short-course (DOTS) comprises multiple antibiotics administered in combination for 6 months, which eliminates the bacteria and prevents the emergence of drug-resistance in patients if followed as prescribed. However, due to various limitations viz., severe toxicity, low efficacy and long duration; patients struggle to comply with the prescribed therapy, which leads to the development of drug resistance (DR). The emergence of resistance to various front-line anti-TB drugs urgently require the introduction of new TB drugs, to cure DR patients and to shorten the treatment course for both drug-susceptible and resistant populations of bacteria. However, the development of a novel drug regimen involving 2-3 new and effective drugs will require approximately 20-30 years and huge expenditure, as seen during the discovery of bedaquiline and delamanid. These limitations make the field of drug-repurposing indispensable and repurposing of pre-existing drugs licensed for other diseases has tremendous scope in anti-DR-TB therapy. These repurposed drugs target multiple pathways, thus reducing the risk of development of drug resistance. In this review, we have discussed some of the repurposed drugs that have shown very promising results against TB. The list includes sulfonamides, sulfanilamide, sulfadiazine, clofazimine, linezolid, amoxicillin/clavulanic acid, carbapenems, metformin, verapamil, fluoroquinolones, statins and NSAIDs and their mechanism of action with special emphasis on their immunomodulatory effects on the host to attain both host-directed and pathogen-targeted therapy. We have also focused on the studies involving the synergistic effect of these drugs with existing TB drugs in order to translate their potential as adjunct therapies against TB.

Introduction: Till date, no drug has shown definite benefit in non-severe COVID-19. Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing coronavirus-2 (SARS-CoV-2) load in severe disease. Objectives: To determine if a single oral administration of Ivermectin to patients with mild and moderate COVID-19 is effective in converting SARS-CoV-2 RT-PCR to negative result and in reducing viral load.Methods: In this double-blind trial, patients were randomized to elixir formulation of Ivermectin in 24 mg, 12 mg or placebo in 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment and were assessed in patients with positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes included total and serious adverse events and were assessed in all patients who received the trial drug (intention-to-treat population). Results: Among 157 patients randomized, 125 patients were included in mITT analysis. Forty patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%; 12 mg, 35.0%; and placebo, 31.1%; p= 0.30). The decline of viral load at day 5 was similar in the three arms. No serious adverse events were encountered.Conclusion: In patients with mild and moderate COVID-19, a single administration of Ivermectin elixir (either 24 mg or 12 mg) demonstrated a trend towards higher proportion of RT-PCR negativity at day 5 of enrolment. The protocol was registered in the Clinical Trial Registry – India (CTRI) vide ref No CTRI/2020/06/026001.

Highlights • The basic reproduction number R0 for India was 2.08. • The Rt for India reduced to 1.16 on 22 April, about a month into the nation-wide lockdown. • A gradual lockdown relaxation farther after the first peak has passed is beneficial. • Testing and isolation prevents more secondary infections when social restrictions are relaxed. • Ramping up testing has many benefits and is much more economically feasible than extending lockdowns., India imposed one of the world’s strictest population-wide lockdown on 25 March 2020 for COVID-19. We estimated epidemiological parameters, evaluated the effect of control measures on the epidemic in India and explored strategies to exit lockdown. We obtained patient-level data to estimate the delay from onset to confirmation and the asymptomatic proportion. We estimated the basic and time-varying reproduction number (R0 and Rt)after adjusting for imported cases and delay to confirmation, using incidence data from 4 March to 25 April 2020. Using a SEIR-QDPA model, we simulated lockdown relaxation scenarios and increased testing to evaluate lockdown exit strategies. R0 for India was estimated to be 2·08 while the Rt decreased from 1·67 on 30 March to 1·16 on 22 April. We observed that the delay from date of lockdown relaxation to start of second wave increases as lockdown is extended farther after the first wave peak— this delay is longer if lockdown is relaxed gradually. Aggressive measures like lockdowns may be inherently enough to suppress an outbreak, however other measures need to be scaled up as lockdowns are relaxed. Lower levels of social distancing when coupled with a testing ramp-up, could achieve similar outbreak control as an aggressive social distancing regime where testing was not increased.

Aim: to evaluate the role of serial CRP evaluation in the diagnosis of neonatal sepsis. Materials and Methods: The present prospective observational study was conducted in the Department of Pediatrics, Darbhanga Medical College and Hospital, Bihar for the period of 1 year. A total of 97 neonates suspected of sepsis having birth-weight >1,500 g constituted the study population. CRP was measured from the serum by quantitative turbidimetric immunoassay. The CRP 1 level was measured at the time of clinical presentation; CRP 2 and CRP 3 were measured at 24 and 48 hours respectively. Results: In the present study out of total 97 subjects, there were 59 (60.8%) males and 38 (39.2%) females. CRP was found positive in 60 cases. In the present study, lethargy (100%), decreased activity (100%), poor feeding (94.7%), poor cry (94.7%), tachypnea (89.5%), hypotonia (47.4%), hypothermia (31.6%), convulsion (26.5%), prolonged CFT (21.1%) and fever (10.5%) were the various symptoms observed. Conclusion: Serial CRP measurements are useful in the diagnosis of neonatal sepsis. CRP 3 level may virtually rule out or rule in the diagnosis of neonatal sepsis, and has very good correlation with blood culture. Keywords: CRP, Sepsis, Neonates

Background: Premature infants have avascular or incompletely vascularized retina at birth and ROP evolves over 4-5 weeks after birth. The aim of this study is to know the prevalence of retinopathy of prematurity in preterm infants, with birth weight ? 1500 grams and/or gestational age ?32 weeks in a tertiary care center. Material and methods: The study was conducted in a tertiary care center of Bihar region India The sample size is 145 babies. All preterm infants admitted with a birth weight of ?1500 grams and/or ? 32 weeks of gestation and baby those at risk of ROP. Results: 145 babies have enrolled during the study period of which 124 babies fulfilled the inclusion criteria and completed this prospective study.15 babies could not complete the follow-up protocol and 6 babies died before full vascularization of the retina. 124 babies who fulfilled the inclusion criteria were screened and 33 babies were found to have ROP. The prevalence of ROP in this study is 26.6%. Conclusions: Among the preventable causes of blindness in children, ROP figures very high on the agenda. Low birth weight and gestational age were found to be the most important risk factors for the development of ROP. Keywords: Low birth weight, Prematurity in preterm infant, Retinopathy, Oxygen therapy

Background During flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton tip swab. No studies in existing literature have compared the two techniques in terms of efficacy. Methods 137 consecutive patients undergoing bronchoalveolar lavage (BAL) were recruited over a 2-year period. The patients underwent BAL after nasal anaesthesia—either by slip-tip syringe or by cotton tip swab smeared with 2% lignocaine gel. Patients were monitored for intraprocedural epistaxis, discomfort and improvement in operator visibility of nasal passage. Results 67 patients were randomised to cotton swab and 70 patients to the gel instillation group. There were no significant differences in terms of epistaxis, 29.9% in the cotton tip swab (95% CI 19.3% to 42.3%) versus 24.3% in the gel instillation group (95% CI 14.8% to 36%) or detection of nasal blocks, 7.5% in the cotton tip swab (95% CI 2.5% to 16.6%) versus 10% in the gel instillation group (95% CI 4.1% to 19.5%) in the two groups, although a significant difference was there in terms of visibility, 73.1% in the cotton tip swab (95% CI 60.9% to 83.2%) versus 42.9% in the gel instillation group (95% CI 31.1% to 55.3%). There was no difference in the mean pain score across the two groups either during the procedure or 1 hour after it. A short systematic review of existing literature on the topic has been provided for comparison. Conclusion Application of 2% lignocaine gel by slip-tip syringe and cotton tip swab are equivalent in terms of observed and narrated pain experienced by patients, frequency of epistaxis and nasal blocks. Vision was better preserved in the cotton tip swab group.

Background: Mesial temporal lobe epilepsy attributed to low-grade glioma is known for intractable seizures and choice of surgery range from lesionectomy (Lo) to lesionectomy with anteromesial temporal resection (L0 + AMTR) is still debatable. We intend to analyze the seizure outcome after lesionectomy alone or with AMTR. Subjects and Methods: Retrospective analyses of patients operated for medial low-grade temporal lobe tumors with seizures were included in the study. Preoperative records include video-electroencephalographic, magnetic resonance imaging (epilepsy protocol), and neuropsychological evaluation for language, memory, and dominance were assessed. Two groups (Lo [Group I] and Lo + AMTR [Group II]) were assessed after surgery by the international league against epilepsy (ILAE) seizure outcome scale. Results: A total of 39 patients underwent Lo (n = 20) and Lo + AMTR (n = 19) with a mean age of 26.92 ± 12.96 months, and mean duration of seizures was 36.87 46.76 months. A total of 23 patients had long-term intractable seizures for >1 year despite >2 drugs(Group I [n = 10], Group II [n = 13]); remaining 16 had frequent seizures of

Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020. One hundred procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-19-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien-Dindo grading for postoperative complications was as follows: 1-4, 2-12, 3a-2, 3b-1. Eleven patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID-19 designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID-19 ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. A matched-pair analysis was performed with similarly staged historical cohort operated during January to December 2016 to compare peri-operative complication rates (Clavien-Dindo Score). Incidence of complication with higher Clavien Dindo Score (>/=3a) was found to be lower in those patients operated during the pandemic (p=0.007). By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without jeopardising the risk of transmission of COVID-19 to the patients or health-care workers.

Background & objectives: In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and rapidly spread globally including India. The characteristic clinical observations and outcomes of this disease (COVID-19) have been reported from different countries. The present study was aimed to describe the clinico-demographic characteristics and in-hospital outcomes of a group of COVID-19 patients in north India. Methods: This was a prospective, single-centre collection of data regarding epidemiological, demographic, clinical and laboratory parameters, management and outcome of COVID-19 patients admitted in a tertiary care facility in north India. Patient outcomes were recorded as death, discharge and still admitted. Results: Data of 144 patients with COVID-19 were recorded and analyzed. The mean age of the patients was 40.1±13.1 yr, with 93.1 per cent males, and included 10 (6.9%) foreign nationals. Domestic travel to or from affected States (77.1%) and close contact with COVID-19 patients in congregations (82.6%) constituted the most commonly documented exposure. Nine (6.3%) patients were smokers, with a median smoking index of 200. Comorbidities were present in 23 (15.9%) patients, of which diabetes mellitus (n=16; 11.1%) was the most common. A significant proportion of patients had no symptoms (n=64; 44.4%); among the symptomatic, cough (34.7%) was the most common symptom followed by fever (17.4%) and nasal symptoms (2.15%). Majority of the patients were managed with supportive treatment with hydroxychloroquine and azithromycin given on a case-to-case basis. Only five (3.5%) patients required oxygen supplementation, four (2.8%) patients had severe disease requiring intensive care, one required mechanical ventilation and mortality occurred in two (1.4%) patients. The time to reverse transcription-polymerase chain reaction (RT-PCR) negativity was 16-18 days. Interpretation & conclusions: In this single-centre study of 144 hospitalized patients with confirmed COVID-19 in north India, the characteristic findings included younger age, high proportion of asymptomatic patients, long time to PCR negativity and low need for intensive care unit care.

Dengue is a mosquito-borne viral infection with many clinically diverse spectrums of presentations. Although most of the cases are diagnosed clinically, even a simple full blood count (FBC) can assist to confirming this often deceiving infection, which allows the initiation of potentially lifesaving treatment. In this article, two cases of dengue are mentioned, one of which has a high hematocrit and hemoglobin value, which can lead to multiple organ failure and disseminated intravascular coagulation (DIC) and another one added with several atypical clinical manifestation. Thrombocytopenia and leukopenia with positive dengue-NS1 antigen were seen in both cases. Both cases were treated with supportive care and intravenous fluid to improve symptoms. With such complications, there is a need to further examine these cases further in detail.