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Melioidosis, caused by Burkholderia pseudomallei, is a challenging infectious disease with global implications, primarily affecting Southeast Asia. We present the case of a 24-year-old male with a curious history of tobacco use, presenting with fevers, weight loss, and genitourinary symptoms. Diagnostic challenges arose as symptoms mimicked other diseases. Disseminated melioidosis was confirmed via Gram staining and positron emission tomography scan findings, emphasizing the disease’s diverse clinical manifestations. Treatment with ceftazidime and cotrimoxazole led to prompt recovery. Notably, the patient’s tobacco use linked to contaminated water highlights a unique transmission route. This case underscores the need for heightened awareness and preventive measures in endemic regions.

BACKGROUND: Tuberculosis is an important public healthcare problem in our country. Drug-resistant Tuberculosis is like a smoldering fire that if not controlled will flare up to an uncontrolled inferno. The conventional therapy for multidrug-resistant TB is associated with multiple issues like prolonged duration and various side effects. Newer anti-tubercular drugs are available but there is a lack of real-world evidence of their use. Bedaquiline is a novel drug belonging to the dairlyquinolone group. It has a bactericidal action and works by inhibiting the mycobacterial ATP synthase enzyme limiting the provision of ATP to mycobacterium. METHODS: This was an observational study done at a tertiary respiratory care center on MDR TB patients to study the efficacy and adverse event profile of Bedaquiline in a clinical setting by examining the culture and smear conversion time. RESULTS: 30 patients with MDR TB were included in the study. 28 patients had Kat G mutation of Isoniazid while 2 patients had InH A resistance. The second line probe assay showed additional resistance to fluoroquinolones in 27 patients and 2 patients had resistance to aminoglycosides. Twenty-one patients were on the first line while 9 patients were on second-line ATT drugs at the time of presentation to our center. The median smear conversion time was 4 weeks while the median culture conversion time was 10 weeks. The average weight gain was 9 kilograms. All patients recovered with a 100 % success rate. There were no life-threatening adverse effects noted, while two patients developed prolonged QTc on ECG. However, the QTc interval was less than 500 ms, and thus bedaquiline was not discontinued. CONCLUSION: Our study aims to highlight the use of Bedaquiline-based anti-tubercular therapy in drug-resistant tuberculosis.

The tribes of the Tons Valley in Uttarakhand, India, prepare Pakhoi, a traditional drink, as the subject of the current study. This drink is known to have therapeutic properties and has potential applications in anti-cancer research. The present study investigates the antiproliferative activity of key compounds found in this drink. Numerous computational tools have assessed the physicochemical properties, pharmacokinetics, drug likeness, and medicinal chemistry of these compounds. SwissADME and Molsoft were utilized to determine properties such as drug likeness scores, especially for Tomentin, which showed the highest score of 1.09. To evaluate anticancer potential, PASS Online software was employed to obtain bioactivity scores; the program reports activity as probable activity (Pa) with values ranging from 0.000 to 1.000 and has a 95% accuracy rate. Pa values greater than 0.7 suggest greater pharmacological action, whereas values less than 0.7 indicate less activity. A variety of drugs regulate ion channel modulators, crucial therapeutic targets that facilitate the passage of charged particles across cell membranes. The next server predicted Haplopine, molecule 4, to be the most bioactive ion channel modulator, with a score of 0.35. Molinspiration: Kinase inhibitors are drugs that selectively inhibit or alter disease-related signaling. Atherospermidine, one of the components in the drink, displayed a bioactivity score of 0.32 as a kinase inhibitor. CLC-Pred was employed to determine the cytotoxicity of major compounds found in the drink for specific cancer cell lines, which shows the value of Pa 0.907 and Pi 0.004. Furthermore, we used PaccMann, a compound that indicates efficacy against cancer cell lines, to determine the IC50 value. It predicted that Narciclasine and Tomentin would be efficient in reducing the proliferation of certain cell lines. Molecular docking was conducted to gain insights into the molecular interaction between the compounds and their specific targets, and the ligand shows the best binding affinity with the protein target CDK4 with -9.7 binding affinity. Swiss Target Prediction helped identify the targets associated with the compounds. The study provided significant insights into the potential of the tribal drink as an anticancer therapeutic agent.

Background: Some section of the Indian population resides in high-altitude areas of the mighty Himalayas. In addition to the residents who inhabit mountainous areas, there is also a group of lowlanders who occasionally visit these regions temporarily for work-related purposes or vacations. These individuals are prone to high-altitude illnesses, including acute mountain sickness and high-altitude pulmonary edema (HAPE). This cohort study was undertaken, among acclimatized and nonacclimatized lowlanders based on 3 years of data at a tertiary care hospital, to study the recurrence rate of HAPE in lowlanders. Materials and Methods: The inception cohort consisted of consecutive cases of HAPE among lowlanders, temporarily posted to these high-altitude regions, over 3 years. This cohort was followed up for at least 1 year. The recurrence rate of HAPE in terms of incidence density in person-months and cumulative incidence was calculated, and variables, including clinical features, altitudes at which the symptoms occurred, mode of induction to the high-altitude area, and time of onset of HAPE episodes postinduction altitudes, were studied. Results: The study revealed the recurrence of HAPE as an incidence density of 88.7 per 1000 person-months (95% confidence limit 66.1–115.9 per 1000 person-months). The cumulative incidence was 125 per 1000, over an average follow-up of 22.54 months (95% confidence limit 26–323 per 1000). The study revealed that the recurrence was found to occur at similar altitudes as the previous episode even after following strict acclimatization protocols and slow induction to the high-altitude area by road route with the onset of symptoms within 72 h of entry into the high-altitude area. Conclusion: This study brought out that there is a risk of recurrence of HAPE in lowlanders temporarily inducted to high-altitude areas, with previous episodes of HAPE at similar altitudes as previous episodes, even when acclimatization protocols are followed.

In an increasingly digital world, the significance of creating a Comprehensive Image Dataset of Contemporary Indian Coins (CIDCIC) cannot be overstated. This research presents a dataset comprising 6,672 images of 53 different classes of Indian coins, including denominations of 25 Paisa, 50 Paisa, 1 Rupee, 2 Rupee, 5 Rupee, 10 Rupee, and 20 Rupee. The images of coins with various shapes and sizes are taken from obverse and reverse sides in various environments and different backgrounds. The core significance of this dataset unfolds in its potential to offer invaluable assistance to visually impaired individuals as they navigate their daily financial transactions. The dataset is a significant contribution to the domains of computer vision, artificial intelligence, and machine learning, specifically addressing the challenges related to coin detection, recognition, and monetary system integrity. These technologies can empower visually impaired individuals to independently and accurately recognize and distinguish between various coin denominations, thereby enhancing their participation in the financial realm. The dataset addresses limitations in existing dataset of having limited size, and scope. It addresses the limitations associated to the limited number of coins and the lack of diversity in images, encompassing various angles, environments, backgrounds, and directions of coins. The dataset provides a broader and more up-to-date representation of contemporary Indian coins.

Objective: The objective of this study was to assess the Framingham Risk Score as well as the prevalence of coronary artery disease (CAD) in people living with HIV/AIDS (PLHA) male patients, in an Indian setting. Design: This descriptive pilot study was conducted in a multispecialty hospital which is a reference center for HIV/AIDS. Materials and Methods: The study included 50 HIV-positive male patients who underwent basic biochemical analysis, namely lipid profile, blood sugar (fasting), electrocardiogram, CD4 count along with basic personal history (including smoking habits and lifestyle), course of disease progression, and drug history. All were subjected to a two-dimensional echocardiogram and treadmill test (TMT). Subjects with a positive TMT underwent a confirmatory stress thallium/coronary angiography. Framingham Risk Scores were calculated, using standard scoring charts. Standard protocol forms were made for each patient. Results: The median diagnosed duration of HIV disease was 2.8 years (range: 0.5–7 years). The median 10-year risk of CAD (as calculated from the Framingham scores) was 1%. Major contributing risk factors were dyslipidemia, diabetes, and hypertension and were found to be greater as compared to published literature. Four patients had positive TMT, but all four had a negative, coronary angiogram. Conclusions: Biological plausibility suggests that CAD may be more common in PLHA due to the chronic inflammatory nature of the disease and the effects of the dyslipidemia effect of ART; however, our pilot study with the limitations could not substantiate this.

Pulse oximetry is often regarded as the fifth vital sign. Based on the absorption of near-infrared light, any changes in the concentration of oxyhemoglobin influence the reading on the pulse oximeter. We present one such case of a 30-year-old lady with leprosy on multiple drug therapy that showed low SpO2 readings not associated with respiratory distress and did not improve with oxygenation. She was found to have dapsone-induced methemoglobinemia, which was reversed after 48 h of stopping the drug intake.

Background: Pulmonary tuberculosis (PTB) is an established cause of arterial and venous thrombosis. With the rising incidence of multidrug-resistant tuberculosis (MDR TB), which has a prolonged treatment course, pulmonary thromboembolism in such cases further complicates the treatment outcome in terms of mortality and morbidity. TB causes systemic hypercoagulability, which may lead to both arterial and venous thrombosis. Therefore, it is important for treating physicians to be aware of the entity and have a sharp watch for the development of Pulmonary thromboembolism in cases of MDR TB. The Case: We present the association of pulmonary thromboembolism (PTE) with MDR TB in three young males who developed pulmonary thromboembolism during the treatment of MDR TB, along with their management using anticoagulant agents. Conclusion: PTE in cases of TB is rare but fatal. High suspicion of PTE in patients with MDR TB will help in diagnosing the dreaded condition early and aid in reducing preventable mortality with PTE. Early recognition, prompt diagnosis, and management is the key to saving the lives of those with this fatal complication.

Background and Objectives: Habitability onboard a warship is multifactorial and constitutes the environment in which the crew operates and accommodates while at sea or at harbor. Maritime work environment is a complex man-machine interaction, with human being the dynamic component as the machine is mostly run by set protocols and algorithms. Efficiency of the dynamic aspect of the man machine interaction is driven by multiple correlated and interrelated factors which can be linked to the ambient and external environment in nature. This study was therefore conducted to survey upon the crew serving onboard Indian Naval Ships as to assess crew perception toward various habitability factors onboard. Materials and Methods: The descriptive study was carried on board various naval warships. A questionnaire-based analysis was conducted on 384 personnel on active duty. Results: Majority of participants agreed that habitability factors have a direct impact on their efficiency while working. Food, ventilation, and adequate living spaces are most crucial with the maximum positive impact on the crew as determined by the survey. Interpretation and Conclusion: Subsequent increase in the quality and variety of equipment with an ergonomical approach is the way forward for an efficient and happy crew. A happy and satisfied seafarer on board a ship is the pivot point to determine the efforts in place and the mission in hand.

Sarcoidosis is a chronic granulomatous disorder often misdiagnosed as tuberculosis. Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal complication linked to extensive hemophagocytosis and hyperinflammatory response. Cases of sarcoidosis developing HLH are rarely documented and difficult to diagnose. We present the case of a 63-year-old female with sarcoidosis complicated with HLH, successfully managed at our center.

Exogenous lipoid pneumonia including diesel aspiration pneumonia is a challenging scenario for the physician view varied clinical presentation and no existing treatment guidelines. Clinico-radiological profiling remains the key toward early diagnosis of the condition. We present a case of a 32-year-old car mechanic presenting post accidental aspiration of diesel vehicle while siphoning air from the fuel pipe, a common practice in Indian subcontinent; highlighting the clinical and radiological presentation and therapeutic outcomes of corticosteroids in this case. The case reemphasizes the role of good clinical history, efficient physical examination, early management, and specific radiological evaluation toward management of this entity.

Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure and is associated with several intraoperative and postoperative complications, although less-common but intraoperative iatrogenic popliteal artery injuries have been reported. At our center, we developed a simple and effective technique using a Foley balloon catheter that ensures a safe surgery to avoid possible neurovascular complications. Through a lower posteromedial portal, this inflated balloon acts as protective mechanism between the PCL and posterior capsule. Betadine or methylene blue dye is used to inflate this bulb, which provides easy identification if balloon ruptures, as evidenced by leakage of this solution in posterior compartment. This balloon increases significant distance, equivalent to the diameter of the balloon, between the PCL and popliteal artery by pushing the capsule more posteriorly. This balloon catheter protection technique combined with other methods will ensure a greater level of safety when performing an anatomical PCL reconstruction.

Abstract Bioactive fractions obtained from medicinal plants which have been used for the treatment of multiple diseases could exert their effects by targeting common pathways. Prior knowledge of their usage could allow us to identify novel molecular links. In this study, we explored the molecular basis of action of one such herbal formulation Cissampelos pareira L. (Cipa), used for the treatment of female hormone disorders and fever. Transcriptomic studies on MCF7 cell lines treated with Cipa extract carried out using Affymetrix arrays revealed a downregulation of signatures of estrogen response potentially modulated through estrogen receptor α (ERα). Molecular docking analysis identified 38 Cipa constituents that potentially bind (ΔG

Background and Objectives: Aedes mosquito has been recognized as a global emerging threat with its potential to transmit fatal diseases of international public health importance such as dengue, chikungunya, and yellow fever. Prior attempts to manage the vector with various synthetic larvicides have resulted in emergence of resistance, thus necessitating search for a safer and effective alternative. The study was an experimental laboratory-based study to screen the recent World Health Organization (WHO)-approved insecticide spinosad for larvicidal activity and compare the efficacy of the same with other currently used larvicides, namely temephos and Bacillus thuringiensis var. israelensis (Bti). Methodology: An experimental setup was done as per the WHO Pesticide Evaluation Scheme to assess the larvicidal activity of the spinosad at varying concentrations along with a positive and negative control. A preliminary screening to assess the larvicidal property of the spinosad was undertaken with 0.5 ppm concentration as recommended by the WHO. The mortality was checked after 24 h and results were statistically analyzed and LC50 and LC90 values were calculated. Results: Spinosad brought about 100% larval mortality at the recommended dosage (0.5 ppm) as well as at a lower dosage of 0.1 ppm. The comparison with the other two commonly used larvicides, namely temephos and Bti, reveals 100% and 90% mortality, respectively, in wild Aedes larvae. Conclusion: The study concludes that spinosad is a promising larvicide that can be used in rotation with temephos against Aedes aegypti in potable water and may be used at a lower dosage of 0.1 ppm. However, large-scale field trials are required to ascertain the effectiveness of the larvicide in field conditions.

Rat-borne diseases including leptospirosis have been of historical importance in the military. With the risk of human–rat encounters onboard ships and vessels, encountering such an illness at sea is not rare for a primary care physician. Thus, it becomes important for those at the front, to be aware of its presentation and management. Leptospirosis must always be considered as a differential diagnosis of febrile patients, in an environment with positive risk factors. We present the case of a 30-year-old sailor managed and evacuated at sea, who presented with fever and abdominal pain. Our patient was found to have hypotension with oliguria and was administered fluid resuscitation along with broad-spectrum antibiotics while at sea, with a provisional diagnosis of acute pyelonephritis and differential diagnosis of leptospirosis. He was evacuated to a tertiary care center where he was evaluated and managed as anicteric leptospirosis. Our patient had an uneventful recovery. It is essential for primary health-care workers to have a high level of suspicion, to ensure the successful management of such atypical infections. Earliest initiation of empirical antibiotic therapy and symptomatic management along with fastest means of evacuation is suggested to ensure best outcome. The availability of rapid diagnostic tests at primary care centers is a must, to ensure early diagnosis and treatment. Although curable, prevention by rodent control and hygiene maintenance continues to be the most effective and economical methods to minimize the loss of workforce, morbidity, and mortality due to leptospirosis.

Background: Influenza is a global disease with frequent outbreaks which vary in extent and severity. Although Influenza Like Illness (ILI) has a low fatality, it can cause a spurt in hospitalizations and sick absenteeism. Understanding the risk factors and using the knowledge to limit complication is the need of the hour to ensure adequate resource allocation and patient outcome. Aim and Objective: The study analysed the proportion of influenza cases requiring additional supportive care and the factors associated with it in the study population. Material and Methods: A retrospective observational study was conducted on 139 patients who were admitted with ILI at a tertiary care centre in Mumbai. Patients records were evaluated in detail for clinical history, socio-demographic details, relevant co-morbidities, physical examination findings and imaging & laboratory investigations. IBM SPSS version 22 was used for statistical analysis. Results: The proportion of Influenza patients requiring additional support (IPRAS) was 18.71%(95% CI 13.1% to 26%) in the study population. The most common additional support was extra oxygen therapy in 53.85% of IPRAS patients. Conclusion: The risk factors with significant association with IPRAS were higher age of the individual, H1N1 influenza, female gender, and presence of 3 or more co-morbidities, presence of fever, cough or breathlessness at presentation, higher respiratory rate and lower SpO2 at the time of presentation.

Introduction: Outbreaks of mumps are known in places of high population density because of close contact. Studies on mumps outbreak in adults have rarely been documented in India, although globally an epidemiological shift is noticed in the disease from children to young adults because of vaccination against the disease in childhood. Materials and Methods: This outbreak investigation was conducted at a sailor training center of the Indian Navy. All cases of fever with parotitis, orchitis, or features suggestive of mumps were included in the study. The clinical, epidemiological, and demographic data of all the positive cases were analyzed using a standardized questionnaire and review of medical records. Results: A total of 58 cases reported over 3 months. Forty-two cases were from a single division and 13 cases from the same dormitory as the index case. Parotitis (89.7%) was the most common presentations, and orchitis (13.8%) was the most common complication. The attack rate (AR) within the division was 15.46%, with overall AR of 2.32%. The incidence was 23.2 per 1000 per year. Case fatality rate of the disease was nil. Recommendations: Surveillance, early diagnosis, and prompt isolation remain the key to prevent the transmission of illness during an outbreak. Other preventive measures include health education of recruits and their instructors.

Purpose. To evaluate the outcome after closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for displaced supracondylar humeral fractures. Methods. 39 boys and 11 girls aged 2 to 12 (mean, 7.27) years underwent closed reduction and pinning using a Kirschner wire inserted laterally and another inserted vertically through the olecranon for posteromedially (n=28), posterolaterally (n=7), or posteriorly (n=15) displaced extension-type supracondylar humeral fractures (Gartland types II and III). Results. Compared with the uninjured elbows, the injured elbows had a mean loss of flexion of 4.52° (p

ABSTRACT Objective: To the best of the authors' knowledge, no studies in the literature have compared the clinical outcome of the three most common implants used to treat basicervical fractures of the femoral neck in young adults, i.e. CCS, DHS, and PFN. The present study attempts to fill the void in the literature and reach a conclusion regarding the usefulness of these implants in these fractures. Methods: This was a prospective interventional study including 90 patients with basicervical fracture of the neck of femur treated randomly with cancellous cannulated lag screws or dynamic hip screw, with a derotation screw or short PFN. Results: Mean time for fracture union was 14.4, 13.9, and 13.5 weeks and union rate was 93.2%, 100%, and 100% in groups 1, 2, and 3, respectively. The mean Harris Hip Score at the final follow up was similar among all the groups, i.e. 79.4, 82.2, and 81.9 in CCS, DHS, and PFN groups, respectively. The highest proportion of good to excellent results was noted in the DHS group, i.e. 83.3%, whereas it was 73.6% and 80% in the CCS and PFN groups, respectively. Conclusion: Multiple cancellous screws do not provide a sufficiently stable construct during fracture healing. PFN, although associated with lesser implant failures than CCS, have a higher incidence of technical errors. DHS provides sufficient stability in well-reduced basicervical fractures in young adults; it is associated with highest fracture union rates and best functional outcome out of the three implants at final follow-up.

ABSTRACT Objective: To evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs. dynamic hip screw. Methods: Sixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups. Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population. The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris Hip Score. Results: In the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group. However, at the three- and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attained similar scores. Conclusion: Proximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications. However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-operations.

Abstract Background Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. Objective To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. Methods This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. Results Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. Study limitations Lack of long term follow-up and no large studies in literature to compare results. Conclusion Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.