Antimicrobial efficacy of eravacycline against emerging extensively drug-resistant (XDR) Acinetobacter baumannii isolates

PURPOSE

Drug-resistant Acinetobacter baumannii is an emerging threat. This study has been conducted to observe the efficacy of eravacycline along with the RND-efflux pump system.

METHODS

A cross-sectional study was done collecting 48 clinical isolates of Acinetobacter baumannii. MICs of 15 antibiotics were detected along with BMD of tigecycline and eravacycline. PCR products of drug-resistant regulatory genes were sequenced and analyzed.

RESULTS

Of the total 48 Isolates, 35 (72.91%) were XDR and 13 (27.08%) were MDR. Out of all, 60.41% of isolates were found to be susceptible to eravacycline by BMD according to both FDA and EUCAST guidelines. A 2-fold decline of MIC50/90 was observed with the use of eravacycline compared to tigecycline. RND-efflux genes like AdeC in 30 (62.5%) isolates and Regulatory gene AdeS in 29 (60.41%) isolates were detected, explaining the existing resistance mechanism.

CONCLUSIONS

XDR Acinetobacter poses an escalating threat due to its resistance to multiple antibiotics, raising serious concerns in healthcare settings. Eravacycline is an encouraging new drug for empirical use in severe infection caused due to the same. Molecular investigation and strict antimicrobial stewardship should be followed to control the emergence, and a better understanding of mechanisms of resistance to prevent the spread of drug-resistant isolates.

Assessment of water quality of Netravathi-Gurupur estuary, India through chemometric approach for fisheries sustainability

The present study aimed to assess the water quality dynamics (physicochemical properties, nutrient and chlorophyll-a) in the Netravathi-Gurupur estuary, India across the space and seasons and to simplify the complex water quality dataset through a chemometric approach. The results indicated that pH, EC, temperature, alkalinity, salinity, TDS, hardness, chloride and intense mixing of suspended solids, driven by the semidiurnal tides, are the major factors affecting water quality. Spatial heterogeneity and monsoon have profound impact on nutrient distribution revealing the following values (mg l-1): phosphate-P (0.015-0.105), nitrate-N (0.016-0.094), nitrite-N (0.001-0.012), and silicate (1.83-14.50). The estuary was evaluated for suitability for brackish water fisheries. The results indicated fair water quality during pre- and post-monsoon but marginal quality in monsoon, primarily due to dilution associated with reduced salinity. The outcome of this study can be suitably utilized for the sustainable development of estuaries and their feasibility for brackish water fisheries.

Trace metals and pesticides in water-sediment and associated pollution load indicators of Netravathi-Gurupur estuary, India: Implications on coastal pollution

Various environmental indicators were used to evaluate the water and sediment quality of the Netravathi-Gurupur estuary, India, for trace metals and pesticide pollution. The descended order of studied metal concentrations (μg/L) in the water was Fe (592.71) > Mn (98.35) > Zn (54.69) > Cu (6.64) > Cd (3.24) > Pb (2.38) > Cr (0.82) and in sediment (mg/kg) was Fe (11,396.53) > Mn (100.61) > Cr (75.41) > Zn (20.04) > Cu (12.77) > Pb (3.46) > Cd (0.02). However, pesticide residues were not detected in this estuarine environment. The various metal indexes categorised the water as uncontaminated, whereas contamination factor, enrichment factor, geo-accumulation index, degree of contamination and pollution load index indicated low to moderate sediment contamination. Multivariate statistics showed that the dominance of natural sources of trace metals with little anthropogenic impact. Improvement in water/sediment quality during the study period might be due to COVID-19 imposed lockdown.

Geochemical distribution and forms of phosphorus in the surface sediment of Netravathi-Gurupur estuary, southwestern coast of India

Estuaries are the most productive transition ecosystem and phosphorus (P) plays an important role in these ecosystems. Therefore, in the present study, sequential extraction method was used to determine the abundance of five sediment P fractions (calcium (Ca-P), Iron (FeP), aluminum (AlP), exchangeable (Ex-P) and organic (OrgP) bound P) in Netravathi-Gurupur estuary, India. Total phosphorus (TP) content varied from 435-810 mg/kg (non-monsoon) and 258-699 mg/kg (monsoon). Inorganic P was dominant part. Different P fractions followed similar order (Fe-P > Ca-P > Al-P > Org-P > Ex-P) with respect to seasons. FeP was dominant fraction, indicating probable anthropogenic stress. Sediment may act as source of P as bioavailable P constituted 40-69.2 % of TP. Molar ratio of OC to Org-P in sediment indicated terrestrial sources of organic matter. However, the estimated phosphorus pollution index were lower than one except a few cases indicating less ecological risk with respect to sedimentary TP load.

Survival of persons living with HIV/AIDS: A multicentric study from India

BACKGROUND

It has been more than 17 years since the introduction of free ART in India. At this point, it would be prudent to look at the factors associated with the survival of persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLHA) who are already enrolled in the ART program.

METHODS

PLHAs enrolled from antiretroviral therapy (ART) centers located in three different cities in India - Delhi, Pune and Kolkata, and were followed up at six monthly intervals monitoring the WHO stage, CD4 counts, complete blood counts, and liver and kidney function tests, for a duration of three years.

RESULTS AND DISCUSSION

The incidence of mortality among HIV/AIDS patients on ART was 5·0 per 1000 patient-years (21/1410, 1.4%). Age at initiation of ART, being above 35 years, was the only significant predictor of mortality (log-rank p = 0·018). Multivariable analysis showed a significant association of an unfavourable outcome (defined as mortality or development of opportunistic infection during follow-up) with male gender (adjusted odds ratio (AOR) = 5.26, p = <0.01) and being unmarried at ART initiation (AOR = 1.39, p = 0.005).

CONCLUSION

The survival of PLHA with good adherence to ART is independent of the WHO stage or CD4 counts at the initiation of ART. Initiation of ART after 35 years of age was a significant predictor of mortality.

Use of geographical information systems (GIS) in assessing ecological profile, fish community structure and production of a large reservoir of Himachal Pradesh

The present study demonstrates the spatial analysis and mapping of fish and different measures of environmental parameters and fish diversity of Pong reservoir, Himachal Pradesh, using Kriging spatial interpolation methods for geographical information system mapping. Seasonal data on environmental parameters, potential fish habitat and fish diversity was collected from lentic (dam), lentic (reservoir), transitional and lotic zone of the reservoir.. Important environmental parameters like water temperature, dissolved oxygen, electrical conductivity, water depth and transparency showed variations across the different zones of the reservoir. The sediment of the reservoir was sandy clay loam in nature as per texture analysis. Fish species richness, Shannon index and evenness index showed a similarity of the lotic and lentic (reservoir) zones of the reservoir. Six potential fish breeding grounds were identified in the reservoir indicating high conservation significance. The analysis of data showed a declining trend in fish production from 456.9 tonnes during the decade 1976-1987 to 347.91 tonnes during 2009-2020. The factors like anthropogenic climate change, predation of a stocked fish juvenile by water birds, undersized fish stocking and unscientific management are the probable reasons for the decreasing fish production. The spatial variation pattern of the water spread area, environmental parameters, fish catch and potential fish breeding grounds depicted in the GIS platform can be used as an important information base by the policy makers for fisheries management. The stocking of large size fish as a stocking material and adequate protection of the potential fish breeding grounds are the key advisories for the sustainable enhancement of fisheries as well as conservation.

Frozen Section Versus Permanent Section in Cancer Diagnosis: A Single Centre Study

Introduction: Frozen section is an intraoperative pathological technique which has very important role to play in diagnostics and also it plays important role in futher surgical management as specially in oncology setup. Most common indications for frozen section were confirmation of neoplasms, evaluation of margins status, evaluation of metastasis etc. Materials and Methods: This is a prospective study of 200 frozen section cases, where frozen sections were compared with permanent Haematoxylin and Eosin stained slides. Accuracy of frozen sections were analysed with various parameters like true positive, false positive, sensitivity, specificity, concordance rate etc. Results: Highest number cases were from gall bladder/ biliary tract (45) followed by breast tissue (43), lymph node (32) etc. Diagnostic accuracy of frozen section was 95.5% (191/200 cases) when compared with permanent section. Concordance rate was 191 (95.5%), sensitivity 89.5% with positive predictive value 96.7% and negative predictive value 94.9% respectively. Conclusion: Adequate and accurate sampling is recommended and also interpretation error should be minimized to help reducing the rate of discordant cases.

Phosphorus fractions in the sediment of a tropical reservoir, India: Implications for pollution source identification and eutrophication

Eutrophication level in lakes and reservoirs depends on both internal and external phosphorus (P) load. Characterization of sediment P fractionation and identifying the P pollution sources are important for assessing the bio-availability of P and the dominant P source, for effectively controlling the water pollution. For determining the availability and sources of sediment P and eutrophication status, spatio-temporal variation in different P fractionation of sediment of hyper-eutrophic Krishnagiri reservoir, Tamil Nadu, India, was investigated. Sediment average total P (TP) content ranged from 4.62 to 5.64 g/kg. Main phosphorus form was the inorganic P (IP), and it makes up to 73.4-87.7% of TP. Among the different P fraction, viz. calcium bound (Ca-P), iron bound (Fe-P), aluminium bound (Al-P), exchangeable (Ex-P) and Organic-P (Org-P), Ca-P was the dominating fraction in both IP and TP. Trend of IP fraction was as follows: Ca-P > Fe-P > Al-P > Ex-P in pre-monsoon season, Fe-P > Ca-P > Al-P > Ex-P in monsoon and Ca-P > Al-P > Fe-P > Ex-P in post-monsoon. Overall the trend was as follows Ca-P > Fe-P > Al-P > Org-P > Ex-P. Bio-available-P (BAP) fractions ranged from 35.2 to 64.0% of TP, indicating its comparative higher value. Pearson's correlation matrix revealed that there was strong correlation among the different P fractions. Factor analysis indicates that different fractions of P were the dominating factor than the other sediment parameters. The observed variation in sediment P fractionation indicate the differences in source and characterization of P which is very helpful for implementation of effective management practices in controlling pollution that arises due to phosphorus in this hyper-eutrophic reservoir.

Impact of barge movement on phytoplankton diversity in a river: A Bayesian risk estimation framework

The adverse effect of barge movement on the river's aquatic ecosystem is of global concern. The phytoplankton community, a bioindicator, is possibly the foremost victim of the barge movement. This study hypothesized phytoplankton diversity loss induced by barge movement in a large river. This article presents a novel risk assessment framework to evaluate the hypothesis-with a goal to uncoupling phytoplankton diversity loss due to barge movement over a spatiotemporal scale. For this purpose, a study was conducted in the Bhagirathi-Hooghly stretch of Inland National Waterway 1 of India. This study has proposed a new index of diversity loss and its inferential framework based on full Bayesian Generalized Linear Mixed Model. The results have diagnosed significant barge-induced impact on the phytoplankton diversity and identified ten most impacted species. The proposed framework has successfully disentangled barge-induced phytoplankton diversity loss from the biological process and predicted a substantive overall risk of phytoplankton loss of 31.44%. Besides, it has uncoupled spatiotemporal differential estimates, suggesting a risk of diversity loss in order of 'During vs After' (38.0%) > 'Before vs After' (30.7%) > 'Before vs During' (24%) barge movement in temporal scale and increasing diversity loss along downstream. Finally, the instant study has highlighted the utility of these results to facilitate better water framework directive for inland waterways.

Utility of diffusion weighted imaging in diagnosing subdiaphragmatic endometriosis presenting as shoulder pain

Extrapelvic endometriosis (EPE) is a rare entity which may potentially occur at any site. Symptomatic EPE is now increasingly being managed laparoscopically. Imaging is imperative in diagnosis as well as extent delineation prior to surgery. In addition to increasing the success rate of diagnostic laparoscopy, prior knowledge of EPE at certain sites may modify the standard surgical technique. We present here an unusual case of chronic pain in the right shoulder in a 26-year-old female caused by subdiaphragmatic endometriosis (SDE). It was noticed on conventional magnetic resonance imaging (MRI) sequences; however, due to the lack of the characteristic signal intensity, imaging findings were noncontributory. Diffusion-weighted imaging (DWI) facilitated its characterization and precisely mapped the extent of involvement. SDE should be suspected in young females presenting with cyclical shoulder pain. Due to nonspecific clinical features, it may remain undiagnosed. MRI is the imaging modality of choice in evaluation of EPE. Including DWI sequence in the MR protocol increases the diagnostic precision besides delineating the extent of involvement noninvasively.

Metal contaminations in sediment and associated ecological risk assessment of river Mahanadi, India

Mahanadi is one of the major rivers of peninsular India. Like other Indian rivers, it is contaminated with sewages, industrial discharges, and agricultural runoff. Thus, necessity was felt to monitor its pollution status. Present work was part of that program and aimed to assess the sediment contamination due to the trace metals Cd, Cr, Cu, Mn, Pb, and Zn during 2012-2015. Sediment pollution status and ecological risks were evaluated calculating contamination factor (CF), geo-accumulation (I_geo), pollution load index (PLI), potential ecological risk (EⁱR), etc. The recorded metal concentrations were Cd BDL of flame mode of AAS; Cr BDL - 73.9; Cu BDL - 44.4; Mn 37.2 - 1887.0; Pb BDL - 29.5; and Zn BDL - 92.5 mg kg^-1. As per US EPA guidelines, Cr concentrations at many locations were in the moderately polluted range. I_geo, CF, mC_d, PLI, and EⁱR indicated low pollution levels and low ecological risks due to the trace metals assessed. The sediment quality guidelines (SQGs) indicated that Cr and Cu concentrations exceeded (16% sample) the threshold effect concentrations and may occasionally exhibit adverse biological effects. The association of sediment organic matter, conductivity and content of Cu, and their grouping in component 1 of PCA revealed that the anthropogenic input was dominant and so also the component 2 where Cr exhibited moderately good correlation with organic matter. Cluster analysis of the sampling sites based on pollution status yielded 3 groups: relatively uncontaminated (S3, S4), low to moderately contaminated (S2), and moderately contaminated (S1, S5, S6) stretches.

Genome-wide association mapping revealed numerous novel genomic loci for grain nutritional and yield-related traits in rice (Oryza sativa L.) landraces

A core set of 190 rice landraces were used to decipher the genetic structure and to discover the chromosomal regions containing QTLs, affecting the grain micro-nutrients, fatty acids, and yield-related traits by using 148 molecular markers in this study. Landraces were categorized into three sub-groups based on population stratification study and followed by neighbor-joining tree and principal component analysis. Analysis of variance revealed abundant variations among the landraces for studied traits with less influence of environmental factors. Genome Wide Association Studies (GWAS) revealed 22 significant and consistent QTLs through marker trait association (MTAs) for 12 traits based on 2 years and pooled analysis. Out of 22 QTLs, three have been reported earlier while 19 QTLs are novel. Interestingly, 13 QTLs out of 22 were explained more than 10% phenotypic variance. Association of RM1148 and RM205 with Days to 50% flowering was comparable with flowering control genes Ghd8/qDTH8 and qDTH9, respectively. Similarly, Zn content was associated with RM44, which is situated within the QTL qZn8-1. Moreover, significant association of RM25 with oleic acid content was closely positioned with QTL qOle8. Association of RM7434 with grain yield/plant; RM184 with spikelet fertility %; R3M10, R9M42 with hundred seed weight; RM536, RM17467, RM484, RM26063 with Fe content; RM44, RM6839 with Zn content are the major outcomes of this study. In addition, association of R11M23 with days to 50% flowering, panicle length and total spikelets per panicle are explained the possible occurrence of pleiotropism among these traits. Prominent rice landraces viz., Anjani (early maturity); Sihar (extra dwarf); Gangabaru (highest grain yield/plant); Karhani (highest iron content); Byalo-2 (highest zinc content) and Kadamphool (highest oleic acid) were identified through this study. The present study will open many avenues towards utilization of these QTLs and superior landraces in rice breeding for developing nutrition-rich high yielding varieties.

Echocardiography versus cardiac biomarkers for myocardial dysfunction in children with scorpion envenomation: An observational study from tertiary care center in northern India

OBJECTIVE

This study was done to evaluate myocardial function by 2D Echocardiography and Cardiac biomarkers (cTnI, CK-MB, BNP) changes in patients of scorpion envenomation of grade II-IV and correlate mortality of envenomed children with myocardial dysfunction.

METHODS

A total of 40 patients admitted consecutively with grade II and more scorpion envenomation from October 2015 to July2018 were enrolled in the study. The data included demographics, the time of presentation, clinical features, echocardiographic findings, electrocardiographic findings, cardiac biomarker levels at admission and discharge, use of inotropic medication, oral prazosin, time of discharge, and their outcome.

RESULTS

The most common ECG abnormality was sinus tachycardia 28 (70%) followed by low voltage complex 13 (32.5%) which got normalized at the time of discharge in majority. Cardiac troponin I (cTnI) levels were more than 0.1 ng/mL, suggesting myocarditis was present in 25 (62.5%) and got normalized at discharge. CK-MB levels were increased in 26 (65%) patients suggesting myocardial involvement. BNP levels were also increased in 24 (60%) patients suggesting heart failure and its value got normalized at discharge. Abnormal 2D Echo findings as reduced left ventricular ejection fraction (LVEF) was present in 18 (45%) cases suggesting myocardial dysfunction and became normal at discharge. The sensitivity, specificity, positive predictive value and negative predictive value of Cardiac troponin I (cTnI) considering ECHO cardiograph as gold standard were 100, 68.1, 72 and 100% respectively. One patient had died whose Ejection fraction was less than 30%.

CONCLUSION

Echocardiography and cTnI can identify subgroup of patients, who require early aggressive therapy. Echocardiography, if not available, cardiac troponin I level can guide early therapy and indicates the prognosis.

Scrub typhus in patients with acute febrile illness: a 5-year study from India

BACKGROUND

Scrub typhus was once thought to be a disease of rural origin and was confined to specific pockets in South Asia. Early diagnosis and treatment is extremely important as it is associated with high mortality if left untreated.

AIM

To delineate the clinical and molecular epidemiology of scrub typhus in patients presenting with acute febrile illness from various parts of India.

METHODS

During the study period of 5 years (October 2013 to October 2018), a total of 1742 patients with acute febrile illness <15 days were enrolled after taking informed consent. Patients were diagnosed using IgM Enzyme-linked immunosorbent assay (ELISA) based on the pre-determined region specific cut offs. Patients with positive IgM ELISA were also subjected to IgM Immunofluorescence assay and nested polymerase chain reaction (PCR) assay. The demographic and relevant clinical details of the patients were documented and analyzed.

RESULTS

A total of 210 (12.1%) patients were diagnosed with scrub typhus. Of these, nested PCR was positive in only 85 patients. Sequencing and phylogenetic analysis showed that the predominant circulating genotypes were Gilliam and Karp. On multivariate analysis, acute respiratory distress syndrome, myocarditis, encephalitis/encephalopathy, jaundice and splenomegaly were significantly more common in those patients who were diagnosed with scrub typhus. A total of 14 patients diagnosed with scrub typhus succumbed to the illness.

CONCLUSION

Patients with fever, headache, pulmonary manifestations, CNS manifestations, myocarditis, transaminitis or thrombocytopenia presenting in the monsoon and post-monsoon season should be evaluated for scrub typhus irrespective of the geographical location in India.

Single-ion anisotropy driven splitting of spin wave resonances in BiFeO3 at low temperature

The spin wave resonances of BiFeO3 ceramics have been followed at low temperature through far-infrared reflectance measurements. Following the scheme of Fishman et al (2015 Phys. Rev. B 92 094422) we have been able to assign all the spin wave modes observed. A complete lifting of the degeneracies of all these modes is seen at 250 K concomitant with the increase in single-ion anisotropy. For the first time, all the spin wave modes have been observed in the infrared spectra of BiFeO3. Correlated changes in the strength and frequencies of spin wave excitations with the reported magnetic transitions at low temperature are observed. A simultaneous increase in anharmonicity of the magnetic cycloid and single-ion anisotropy with decreasing temperature results in a partial suppression of the spin wave excitations. An increase in the magnetoelectric coupling is also observed below 150 K.

Decoding intrathecal immunoglobulins and B cells in the CNS: their synthesis, function, and regulation

The discovery of an active lymphatic system in the meninges (dura mater) has opened up a wide range of possibilities for the role of CNS immunoglobulins in brain development in early fetal life or during infancy. The antibody-dependent and -independent functions of B cells in the immunopathogenesis of multiple sclerosis are not new to immunologists, yet their role in other neurodegenerative disorders such as Alzheimer's and Parkinson's disease is incompletely understood. Deep cervical lymph nodes have emerged as a candidate site for autosensitization against CNS antigens and have been shown to provide the right kind of milieu for the dynamic interaction of antigen-presenting cells, B cells, and T cells. The presence of different B cells in the lymph nodes and the production of natural autoantibodies by B-1 cells have definitely unlocked another piece of the puzzle. At a time when CD19 and CD20 monoclonal antibodies have shown remarkable results in ameliorating the relapse and progression of multiple sclerosis, it is imperative to dissect out the diversity in B cell populations inside the CNS to identify new targets to improve current treatment regimens for neurodegenerative diseases. This review highlights the origin, migration, function, and regulation of B cells and the production of intrathecal immunoglobulins considering the previous and current findings and taking into account the differences between a healthy state and the changes that occur during an inflammatory or autoimmune response.

Molecular characterization & epidemiology of carbapenem-resistant Acinetobacter baumannii collected across India

Background & objectives

Acinetobacter baumannii is an opportunistic pathogen responsible for causing nosocomial infections. A. baumannii develops resistance to various antimicrobial agents including carbapenems, thereby complicating the treatment. This study was performed to characterize the isolates for the presence of various β-lactamases encoding genes and to type the isolates to compare our clones with the existing international clones across five centres in India.

Methods

A total 75 non-repetitive clinical isolates of A. baumannii from five different centres were included in this study. All the isolates were confirmed as A. baumannii by bl a_OXA-51-likePCR. Multiplex PCR was performed to identify the presence of extended spectrum β-lactamases (ESBL) and carbapenemases. Multilocus sequence typing was performed to find the sequence type (ST) of the isolates. e-BURST analysis was done to assign each ST into respective clonal complex.

Results

bla_OXA-51-likewas present in all the 75 isolates. The predominant Class D carbapenemase was bla_OXA-23-likefollowed by Class B carbapenemase, bla_NDM-like. Class A carbapenemase was not observed. bla_PER-likewas the predominant extended spectrum β-lactamase. ST-848, ST-451 and ST-195 were the most common STs. Eight-novel STs were identified. e-BURST analysis showed that the 75 A. baumannii isolates were clustered into seven clonal complexes and four singletons, of which, clonal complex 208 was the largest.

Interpretation & conclusions

Most of the isolates were grouped under clonal complex 208 which belongs to the international clonal lineage 2. High occurrence of ST-848 carrying bla_OXA-23-likegene suggested that ST-848 could be an emerging lineage spreading carbapenem resistance in India.

P4448Profile of cardiovascular involvement and its relationship with disease activity in systemic lupus erythematosus

Introduction

The cardiovascular system is affected in systemic lupus erythematosus (SLE) by the disease itself, the state of chronic inflammation and also by the side effects of the treatment given.

Purpose

To find the burden of cardiovascular involvement in SLE, to correlate cardiovascular manifestation with SLE disease activity (SLEDAI-2K) and damage [SLICC/ACR Damage Index (SDI)].

Methods

Seventy-five consecutive SLE patients fulfilling SLICC criteria, aged between 15–55 years, with disease duration of <5 years, admitted to rheumatology ward, were included. Overlap syndromes, past history of cardiac disease, end stage renal disease, chronic liver disease and type 2 diabetes mellitus were excluded. Clinical examination, fasting serum lipid profile, electrocardiogram, 2D-Echocardiography, carotid intima media thickness (CIMT) and serum Troponin-I were used to assess the cardiovascular status of patients.

Results

In this cross-sectional study exploring cardiovascular disease burden in a cohort of SLE patients within 5 years of disease, we found the mean age of patients was 28.5±7.9 years with a male: female ratio of 1:14. Cardiovascular involvement was detected in 52% of patients. Raised systolic BP was detected in 42% and raised diastolic BP in 28% patients. ECG revealed sinus tachycardia in 32%. 2D-echocardiography revealed pericardial effusion in 14.66%, mitral valve involvement in 10.66% (7 had mitral regurgitation and one had mitral sclerosis). PAH and TR were observed in 5.33% and 6.66% of cases respectively. One case showed evidence of aortic sclerosis. Dilated cardiomyopathy was present in 2.66% of cases. In 2.66% of cases systolic dysfunction and diastolic dysfunction each was evident. No patient showed evidence of vegetations. Anti SS-A and anti nucleosome (30.7% each) were the most common antibodies found in SLE patients with cardiovascular involvement. Increased serum LDL, hypertriglyceridemia and low serum HDL was found in 29%, 47% and 51% of patients respectively. Sub clinical myocardial injury was absent in all our patients as evidenced by negative serum Troponin-I. The CIMT was within normal limits and comparable between patients with and without cardiovascular involvement. The mean SLEDAI-2K was 7.3±4.9 and mean SDI was 0.8±1.2. SLEDAI-2K and SDI were significantly higher in patients with cardiovascular involvement versus patients without cardiovascular involvement (p=0.002 and p=0.01 respectively).

SLEDAI-2K and SDI vs cardiac involvement

Conclusion

Cardiovascular involvement is associated with high SLEDAI-2K and SDI. Presence of anti-SSA and anti-nucleosome antibodies may predispose to cardiovascular involvement. Pericardial effusion was the most common echocardiographic abnormality. Low HDL was the most common dyslipidemia. However,atherosclerosis is not evident in patients with SLE with disease duration less than 5 years.

Plasmodium vivax Malaria Presenting with Acute Systemic Capillary Leak Syndrome

Systemic capillary leak syndrome (SCLS) is a very rare disorder characterized by hypotension with heamoconcentration, hypoalbuminemia without albuminuria and generalized edema, the etiology of which are snake bites, viral heamorrhagic fever, drugs, sepsis, upper respiratory tract infection, Hanta virus and West Nile virus infection and serum paraproteinemia. Typically, the syndrome manifests in two phases: initial capillary leak phase characterized by edema, serous effusion, hypotension which is followed by phase of volume overload or recruitment phase. Treatment is in the form of fluid replacement, inotropic support and vasopressor therapy during leak phase and diuretics during volume overload phase. Prognosis of this disease is very poor. Here we are presenting a rare case of plasmodium vivax with SCLS.

Genetic diversity and multiple antibiotic resistance index study of bacterial pathogen, Klebsiella pneumoniae strains isolated from diseased Indian major carps

Intensive fish farming systems have led to increase in disease incidence, due to higher stocking density, high organic matter levels, and poor quality of the aquatic environment. Diseased fish samples showing hemorrhages and reddish lesions were collected from different freshwater fish farms located at three different districts of West Bengal, India (Burdwan, North 24 Parganas, and Nadia). The present study was conducted to evaluate the genetic diversity of ten different Klebsiella pneumoniae strains isolated from different infected freshwater fish samples based on 16S rRNA gene sequence analysis. Primarily, Klebsiella-specific media was used for the isolation and characterization of Klebsiella pneumoniae. Further, through a biochemical test, all the strains were confirmed as K. pneumoniae. PCR analysis of 16S-23S internal transcribed spacer (PCR ribotyping) was carried out to study the species variation within different Klebsiella pneumoniae isolates. For all the isolates, a conserved PCR ribotype pattern was observed while differing from other bacterial species. Phylogenetic study showed the high degree of homology with diverse source of other strains. The multiple antibiotic resistance (MAR) values of the present study for the isolates were found to be 0.468. MAR value above 0.2 indicates that the source of isolation was highly contaminated with antibiotics. Based on the 16S rRNA gene sequence analysis, the present study revealed the genetic diversity of Klebsiella pneumoniae isolated from the different diseased fish farms of West Bengal. All the strains were found to be hypermucoviscous and multidrug-resistant, thus making it pathogenic towards the host organisms. Further, the study revealed a high prevalence of K. pneumoniae in aquaculture farms, representing a risk towards successful aquaculture.

Serum and Bronchoalveolar Lavage Fluid 25(OH)Vitamin D3 Levels in HIV-1 and Tuberculosis: A Cross-Sectional Study from a Tertiary Care Center in North India

BACKGROUND

Vitamin D is an immunomodulator, and its deficiency is associated with Tuberculosis (TB) infection. Bronchoalveolar lavage fluid (BALF) is a rich milieu of macrophages that form the first line of defense against invading TB bacilli. As there is an increased prevalence of vitamin D deficiency in TB and human immunodeficiency virus-1 (HIV-1) subjects, we intend exploring the possibility of a localized deficiency of vitamin D metabolites in BALF of these patients.

OBJECTIVE

The primary objective was to assess the level of 25D3 in serum and BALF of subjects and look for a significant difference among patients and controls. The secondary objective was to find a correlation between serum and BALF 25D3 levels.

METHODS

We performed a cross-sectional study with subjects divided into four groups: Controls (group 1), HIV positive without active TB (group 2), active TB without HIV (group 3), and HIV-TB coinfection (group 4). BALF and serum 25D3 levels were compared between the groups.

RESULTS

Among the 149 (an immunomodulator) successive subjects enrolled, there were 40 subjects in group 1 (HIV-TB-), 48 in group 2 (HIV+TB-), 37 in group 3 (HIV-TB+), and 24 in group 4 (HIV+TB+). Females constituted 31.6% of the study subjects. In groups 3 and 4, there were significantly lower serum 25D3 levels compared to group 1 (p-value group 3: 0.002; group 4: 0.012). In groups 2, 3, and 4, there were significantly lower BALF 25D3 levels compared to group 1 (p-value group 2: 0.000; group 3: 0.000; group 4: 0.001). There was a significant correlation between serum and BALF 25D3 levels (Spearman's rank correlation coefficient 0.318, p-value = 0.0001).

CONCLUSION

Lower levels of serum and BALF 25D3 were observed in HIV, TB, and HIV-TB coinfected patients. Localized deficiency of vitamin D metabolites might be associated with increased vulnerability to TB infection.

Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals

Background:

The rising incidence of obesity is one of the most serious public health issues in the developed as well as in developing countries like India. Obesity and overweight are most important risk factors for many chronic diseases, including cardiovascular diseases, diabetes and cancer. In this study the body mass index (BMI) cut off was taken as 18.5-22.9 kg/m² for normal, 23.0-24.9 kg/m² for Overweight and >25 kg/m² for obese as per WHO recommendation for Asian Indians, which is different for developed and developing countries. Role of gut microbiota mediated immune response in the development of obesity has been studied but the literature on Indian population are lacking. Therefore, a study was conducted to determine Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals using viable colonocytes in a Non invasive technique and Flowcytometry.

Methods:

A total of 20 healthy volunteer (10 obese and 10 lean) were enrolled in the study as per inclusion and exclusion criteria. Viable colonocytes were isolated from fecal samples using a Non invasive technique (SCSR Method). Toll like receptors (TLRs) and immunoglobulin (IgA &IgG) receptor concentration were measured by standard Flowcytometry methods using specific fluorochrome conjugated antibodies.

Results:

Average TLR2 receptor concentration was significantly higher in obese (6.35 %) as compared to lean (2.9 %) (P = 0.01). TLR4 receptor concentration was 1.4 % in obese and 1.65 % in lean although the difference was not statistically significant (P = 0.59). IgA & IgG receptor concentration was 49.6 % & 11.2 % in the obese and 67.15 % & 8.05 % in the lean respectively but the differences among both the group were not statistically significant.

Conclusion:

The results of the present study will be helpful for physicians and researchers to find some biomarkers which can determine predisposition of the obesity in Indian population and helps to use alternative therapeutics such as probiotics to maintain gut homeostasis and immune modulation to prevent obesity.

Rectal Carriage of Carbapenem-Resistant Enterobacteriaceae: A Menace to Highly Vulnerable Patients

Background:

Bloodstream infection (BSI) due to carbapenem-resistant enterobacteriaceae (CRE) is the leading cause of morbidity and mortality in patients with hematological malignancy. These patients receive chemotherapy during treatment, which lead to severe mucositis of gastrointestinal tract and myelosuppression. It was hypothesized that the gut colonizer translocate into the blood circulation causing BSI. Colonization rate with CRE among these patients in India is unknown.

Aim:

This study aims to determine the carriage rate of CRE in cancer patients.

Setting and Design:

A prospective study was conducted in a tertiary care hospital of India.

Materials and Methods:

Rectal swab of 93 patients were collected and processed as per the Center for Disease Control and Prevention protocol for detection of CRE. The isolate CREs were identified by standard phenotypic tests and confirmed for carbapenem resistance by disk diffusion test using carbapenem disk (imipenem, meropenem, doripenem, and ertapenem), Carba-NP test and modified Hodge test. Resistant to any of the carbapenem disc is considered as CRE.

Results:

A total of 86 isolates were detected from 93 patients. Seventy-six isolates were identified as CRE, and 10 isolates were Gram-positive cocci and other Gram-negative bacilli. Acute myeloid leukemia was the most common clinical presentation followed by acute lymphoid leukemia. Thirty-nine out of 93 patients were on chemotherapy. Sixty-seven out of 76 isolates of CRE were observed positive for carbapenemase production by Carba-NP test.

Conclusion:

This study highlights very high rate of CRE carriage among the hematological malignancy patients; who are highly vulnerable to infection. This confirms the need of infection control prevention activities among the hematological malignancy patients.

Evaluation of cardiac biomarkers in children with acute severe bronchial Asthma-A prospective study from tertiary care center in northern India

OBJECTIVES

During the attacks of acute severe bronchial asthma there are marked cardiopulmonary changes leading to hypoxia. The study aims to find the incidence of myocardial dysfunction in patients of acute severe bronchial asthma based on cardiac enzyme levels at admission and see whether the myocardial damage is transient or persistent even after stabilization of the patient based on enzyme levels at discharge.

MATERIALS AND METHODS

This prospective, case control study was done at Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University between October 2016 to May 2018. Sixty pediatric patients of acute severe bronchial asthma were taken as cases and 15 age and sex matched children served as controls. Blood samples were collected in Ethylene diamine tetra acetic acid vials before the start of treatment, for measurement of cardiac biomarkers Troponin I (TnI), Brain natriuretic peptide (BNP) and Creatine Kinase-muscle/brain (CK-MB) and repeat samples were taken before discharge.

RESULTS

Fifty percent of the cases had abnormal TnI levels, 15% had abnormal CK-MB levels and 8.3% had abnormal BNP levels at admission. At discharge, only 1 (1.7%) case had abnormal levels of CK-MB, whereas the levels of TnI and BNP normalized in all. The level of cardiac biomarkers were significantly raised at admission when compared to discharge values (p value < 0.001).

CONCLUSIONS

The raised cardiac biomarkers suggest myocardial stress during acute exacerbation of bronchial asthma. Though, the present study showed that the changes are of transient nature, larger follow up studies are required to document any permanent damage to myocardium.

Higher Frequency of HIV-1 Drug Resistance and Increased Nucleoside Reverse Transcriptase Inhibitor Mutations among the HIV-1 Positive Antiretroviral Therapy-Naïve patients Coinfected With Mycobacterium tuberculosis Compared With Only HIV Infection in India

Background:

Emergence of human immunodeficiency virus (HIV) drug resistance mutations prior to highly active antiretroviral therapy is a serious problem in clinical management of HIV/AIDS. Risk factors for appearance of drug resistance mutations are not known. We hypothesize that Mycobacterium tuberculosis infection may contribute to rapid emergence of such mutations in antiretroviral therapy–naïve patients.

Methods:

A total of 115 patients were recruited in this study of which 75 were HIV+TB+ coinfected (group 1) and 40 were HIV+TB− (group 2). Blood samples from all the patients were collected and CD4+ cell counts; HIV-1 plasma viral load and sequencing of protease and two-third region of reverse transcriptase of HIV-1 was performed and analyzed for drug resistance pattern.

Results:

For patients with HIV+TB+, 10.6% (8/75) had mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs), 4% (3/75) to nucleoside reverse transcriptase inhibitors, and only 2.6% (2/75) patients had mutations to protease inhibitors. Interestingly, for group 2 (HIV+TB−), there were only NNRTI mutations found among these patients, and only 3 patients (7.5%) had these drug-resistant mutations. Clade typing and phylogenetic tree analysis showed HIV-1 subtype C predominance in these patients.

Conclusions:

Our study showed that higher percentage of HIV drug resistance mutations was found among HIV+TB+ individuals compared with tuberculosis-uninfected patients. Tuberculosis coinfection may be a risk factor for emergence of high frequency of drug resistance mutations. Studies with a larger sample size will help to confirm these findings from the Indian population.

Hemostatic Parameters in Newborn - II. Sequential Study During the First Four Weeks of Life

A sequential study of kaolin cephalin clotting time (KCCT), prothrombin time (PT), thrombin time (TT), plasma fibrinogen and serum FDP was conducted during the first four weeks of life on term and preterm babies. A “physiological dip” of PT and TT was noted inappropriate for gestational age (AGA) babies both term and preterm; in case of KCCT, the dip was significant in term AGA babies only. At the end of four weeks, PT and TT had moderately improved in term babies but showed little improvement in preterm ones; KCCT reached almost an adult value in all babies except in preterm AGA and term LGA (large for gestational age) ones. Plasma fibrinogen showed no “physiological dip” and reached adult level in two to four weeks. Serum FDP levels were appreciably raised in preterm AGA babies only at birth and there too normalised by 72 h.

Hemostatic Parameters in Newborn - I. Effect of Gestation and Rate of Intrauterine Growth

The present study comprises of 208 term, 159 preterm and 18 post-term neonates born to mothers with no history of drug intake or any disease likely to effect coagulation of the newborn. PT, TT and KCCT were relatively prolonged and plasma fibrinogen reduced to varying degree in newborns (as compared to adults). There was further prolongation of TT and reduction in plasma fibrinogen levels amongst preterm newborns as compared to term babies; TT was more prolonged amongst post-term babies also. PT was significantly more prolonged till 30 weeks of gestation, after which a near plateau was formed. KCCT showed significant improvement after 33 weeks and a further trend to normalisation after 38 weeks of gestation. Serum FDP values showed too much of variation for any meaningful statistical analysis but generally FDPs were higher in preterm babies. Intrauterine growth rate had no significant effect on these parameters amongst preterms -similar values for SGA (small for gestational age), AGA (appropriate for gestational age) and LGA (large for gestational age). On the other hand, amongst term babies SGA neonates had significantly prolonged PT and low plasma fibrinogen as compared to AGA; LGA babies also showed more prolongation of TT as compared to AGA.

Impact of HIV infection and highly active antiretroviral therapy (HAART) on B cell subpopulations in children

B-cells play an important role in defending children against various infections. In view of scare data, we undertook this prospective cohort study to describe B cell compartment in HIV infected children (<5 years of age) and the effect of HAART on B cell subpopulations. HIV infected children (<5 years) from Pediatric HIV services of the Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, were recruited (April 2012-December 2015). The enrolled HIV-1 infected children (n = 59) were followed up regularly for 12 months; healthy controls (n = 51) included HIV uninfected children with no major illness. Flow cytometry was performed on fresh EDTA-treated blood samples to characterize B cell subpopulations. In HIV-infected children, marked depletion of naive (P = 0.003), non-switched memory (P = 0.02), mature (P = 0.0005), resting memory (P < 0.0001) B cells, and expansion of double negative memory (P < 0.0001), activated memory (P < 0.0001) and tissue like memory (P < 0.0001) B cells were observed as compared to healthy controls. In children started on HAART, at the end of 12 months of therapy, frequencies of non-switched memory (P = 0.04), switched memory (P = 0.01), and resting memory (P = 0.003) B cells were lower; activated memory (P = 0.04), and tissue-like memory (P = 0.0001) B cells were still higher than healthy controls. HIV infection resulted in reduced memory B cells in HIV infected children. Following HAART, there was normalization of some B cell subpopulations. The study emphasizes the need of re-vaccination in HIV infected children to maintain the memory B cell pool and adequate humoral immune response against infections.

Vibrational spectroscopic and computational studies on diisopropylammonium bromide

Diisopropylammonium bromide (DIPAB) can be crystallized either in an orthorhombic (P2₁2₁2₁) or in a monoclinic (P2₁) structure at room temperature depending on synthesis conditions. The non-polar orthorhombic structure exhibits a subtle, irreversible transformation into the ferroelectric monoclinic-II (m-II) phase above ~421K. At a slightly higher temperature of 426K this m-II (P2₁) phase reversibly transforms into a disordered, paraelectric monoclinic-I (P2₁/m) structure. We synthesized DIPAB in the orthorhombic structure, heated it to obtain the m-II phase and carried out a systematic study of their Raman and IR spectra. We obtained the phonon irreducible representations from factor group analysis of the orthorhombic and m-II structures based on the reported structural information. DIPAB is an organic molecular crystal, and the vibrational spectra in the intramolecular region (200-3500cm^-1) of the two different phases are identical to each other, indicating weak inter-molecular interactions in both crystalline structures. In the low wavenumber region (10-150cm^-1) the Raman spectra of the two phases are different due to their sensitivity to molecular environment. We also carried out first principles calculations using Gaussian 09 and CASTEP codes to analyze the vibrational frequencies. Mode assignments were facilitated by isolated molecule calculations that are also in good agreement with intramolecular vibrations, whereas CASTEP (solid state) results could explain the external modes.

Evolution of cross-neutralizing antibodies and mapping epitope specificity in plasma of chronic HIV-1-infected antiretroviral therapy-naïve children from India

Delineating the factors leading to the development of broadly neutralizing antibodies (bnAbs) during natural HIV-1 infection and dissecting their epitope specificities generates useful information for vaccine design. This is the first longitudinal study to assess the plasma-neutralizing antibody response and neutralizing determinants in HIV-1-infected children from India. We enrolled 26 and followed up 20 antiretroviral therapy (ART)-naïve, asymptomatic, chronic HIV-1-infected children. Five (19.2 %) baseline and 10 (50 %) follow-up plasma samples neutralized ≥50 % of subtypes A, B and C tier 2 viruses at an ID50 titre ≥150. A modest improvement in neutralization breadth and potency was observed with time. At baseline, subtype C-specific neutralization predominated (P=0.026); interestingly, follow-up samples exhibited cross-neutralizing activity. Epitope mapping revealed V3C reactive antibodies with significantly increased Max50 binding titres in follow-up samples from five infected children; patient #4's plasma antibodies exhibited V3-directed neutralization. A salient observation was the presence of CD4 binding site (CD4bs)-specific NAbs in patient #18 that improved with time (1.76-fold). The RSC3 wild-type (RSC3WT) protein-depleted plasma eluate of patient #18 demonstrated a more than 50% ID50 decrease in neutralization capacity against five HIV-1 pseudoviruses. Further, the presence of CD4bs-neutralizing determinants in patient #18's plasma was confirmed by the neutralizing activity demonstrated by the CD4bs-directed IgG fraction purified from this plasma, and competition with sCD4 against JRFLgp120, identifying this paediatric donor as a potential candidate for the isolation of CD4bs-directed bnAbs. Overall, we observed a relative increase in plasma-neutralizing activity with time in HIV-1-infected children, which suggests that the bnAbs evolve.

Coagulase-negative staphylococci causing blood stream infection at an Indian tertiary care hospital: Prevalence, antimicrobial resistance and molecular characterisation

INTRODUCTION

Recent years have seen a rise of coagulase-negative staphylococci (CoNS) from common contaminants to agents of nosocomial blood stream infections (BSI's). Molecular typing and establishing a correlation with antibiotic resistance is essential particularly in countries like India where genotyping studies for drug-resistant CoNS are sparse.

METHODS

A prospective study was done over 18 months, wherein 42,693 blood samples were received, and 59 patients with BSI due to CoNS were evaluated. The isolates recovered were identified by a biochemical test panel and matrix-assisted laser desorption ionization - time of flight mass spectrometry followed by antimicrobial susceptibility testing by Kirby-Baur disc diffusion method and E-test strips. Staphylococcal chromosomal cassette mec (SCCmec) element was characterised by multiplex polymerase chain reaction for all methicillin-resistant (MR) isolates.

RESULTS

The majority of CoNS isolated were constituted by Staphylococcus haemolyticus (47.5%) followed by Staphylococcus epidermidis (33.9%), Staphylococcus hominis (11.86%), Staphylococcus cohnii (5.08%) and Staphylococcus warneri (1.69%). Among all isolates 57.6% were MR with statistically significant higher resistance versus methicillin sensitive-CoNS. This difference was significant for erythromycin (76% vs. 44%, P = 0.011), rifampicin (50% vs. 12%,P= 0.002) and amikacin (26.5% vs. 4%, P = 0.023), ciprofloxacin (64.7% vs. 20%, P = 0.001) and cotrimoxazole (55.9% vs. 20%, P = 0.006). SCCmec type I was predominant (61.8%, P = 0.028) and exhibited multidrug resistance (76.2%). Coexistence of SCCmec type I and III was seen in 8.82% MR isolates.

CONCLUSION

CoNS exhibit high antimicrobial resistance thereby limiting treatment options. The presence of new variants of SCCmec type in hospital-acquired CoNS may predict the antibiotic resistance pattern. This is the first evaluation of the molecular epidemiology of CoNS causing BSI from India and can serve as a guide in the formulation of hospital infection control and treatment guidelines.

Molecular characterisation of antimicrobial resistance in Pseudomonas aeruginosa and Acinetobacter baumannii during 2014 and 2015 collected across India

BACKGROUND

Surveillance of antimicrobial resistance (AMR) is of great importance. Pseudomonas aeruginosa and Acinetobacter baumannii are important pathogens and emergence of resistance in these have increased the morbidity and mortality rates. This surveillance study was initiated by the Government of India - Indian Council of Medical Research. The aim of this study is to determine the antimicrobial susceptibility profile and to characterise the enzyme mediated antimicrobial resistance such as extended spectrum beta-lactamases (ESBLs) and carbapenemases among multidrug-resistant (MDR) P. aeruginosa and A. baumannii.

MATERIALS AND METHODS

A multi-centric study was conducted from January 2014 to December 2015 with a total number of 240 MDR P. aeruginosa and 312 MDR A. baumannii isolated from blood, cerebrospinal fluid, respiratory, pus, urine and intra-abdominal infections. Kirby-Bauer disc diffusion was done to determine the antimicrobial susceptibility profile. Further, MDR isolates were characterised by multiplex polymerase chain reaction to determine the resistance genes for ESBLs and carbapenemases.

RESULTS

Among the ESBLs, blaVEB (23%), blaTEM (5%) and blaSHV (0.4%) in P. aeruginosa and blaPER (54%), blaTEM (16%) and blaSHV (1%) in A. baumannii were the most prevalent. Likewise, blaVIM (37%), blaNDM (14%), blaGES (8%) and blaIMP (2%) in P. aeruginosa and blaOXA-23like (98%), blaOXA-58like (2%), blaNDM (22%) and blaVIM (3%) in A. baumannii were found to be the most prevalent carbapenemases. blaOXA-51like gene, intrinsic to A. baumannii was present in all the isolates tested.

CONCLUSION

The data shown highlight the wide difference in the molecular mechanisms of AMR profile between P. aeruginosa and A. baumannii. In P. aeruginosa, plasmid-mediated mechanisms are much lesser than the chromosomal mediated mechanisms. In A. baumannii, class D oxacillinases are more common than other mechanisms. Continuous surveillance to monitor the trends in AMR among MDR pathogens is important for implementation of infection control and to guide appropriate empirical antimicrobial therapy.

What puts them at risk? A cross-sectional case-control survey of demographic profile and sexual behavior of patients with sexually transmitted infections at a tertiary care center in North India

BACKGROUND

Sexually transmitted infections (STIs) are a major public health problem in developing nations. Identification of risk factors can help in formulating effective strategies against them. The present study was conducted in a tertiary care hospital in North India over 1 year to identify the risk factors associated with STIs.

MATERIALS AND METHODS

A questionnaire-based cross-sectional case-control survey was conducted where participants answered questions on demographic details, sexual behavior, and awareness of STIs. Cases were patients with STIs whereas controls were randomly selected from healthy individuals accompanying patients with nonvenereal complaints attending our hospital.

RESULTS

There were 106 cases and 64 controls. STI patients had sexual debut 2 years before controls. A higher proportion of STI cases had lower education, multiple sexual partners, lived separately from their partner, had nonregular partners, had protected sex in the last month, had sex under influence of alcohol/illicit drugs, sex in unstructured settings, and engaged in transactional sex, in comparison to controls (P < 0.05). More cases were aware of the symptoms/preventive measures of STIs (P < 0.001). On multivariate analysis, multiple sexual partners, sex under influence of alcohol/illicit drugs with nonregular partner, protected sex in the last month, and knowledge of preventive measures were found to be statistically associated with STIs (P < 0.05).

CONCLUSIONS

Our study identifies risk-behavior patterns in patients with STIs, which should be modified to reduce the burden of these diseases. Increasing the knowledge about STIs in these patients can translate into more common condom usage that lends support for strengthening sexual health programs at grass-root levels.

LIMITATIONS

The small size of the study population could have led to decreased power of the study to detect differences between cases and controls. The external validity of our results needs to be tested in different population groups involving larger sample sizes.

What puts them at risk? A cross-sectional case-control survey of demographic profile and sexual behavior of patients with sexually transmitted infections at a tertiary care center in North India

BACKGROUND

Sexually transmitted infections (STIs) are a major public health problem in developing nations. Identification of risk factors can help in formulating effective strategies against them. The present study was conducted in a tertiary care hospital in North India over 1 year to identify the risk factors associated with STIs.

MATERIALS AND METHODS

A questionnaire-based cross-sectional case-control survey was conducted where participants answered questions on demographic details, sexual behavior, and awareness of STIs. Cases were patients with STIs whereas controls were randomly selected from healthy individuals accompanying patients with nonvenereal complaints attending our hospital.

RESULTS

There were 106 cases and 64 controls. STI patients had sexual debut 2 years before controls. A higher proportion of STI cases had lower education, multiple sexual partners, lived separately from their partner, had nonregular partners, had protected sex in the last month, had sex under influence of alcohol/illicit drugs, sex in unstructured settings, and engaged in transactional sex, in comparison to controls (P < 0.05). More cases were aware of the symptoms/preventive measures of STIs (P < 0.001). On multivariate analysis, multiple sexual partners, sex under influence of alcohol/illicit drugs with nonregular partner, protected sex in the last month, and knowledge of preventive measures were found to be statistically associated with STIs (P < 0.05).

CONCLUSIONS

Our study identifies risk-behavior patterns in patients with STIs, which should be modified to reduce the burden of these diseases. Increasing the knowledge about STIs in these patients can translate into more common condom usage that lends support for strengthening sexual health programs at grass-root levels.

LIMITATIONS

The small size of the study population could have led to decreased power of the study to detect differences between cases and controls. The external validity of our results needs to be tested in different population groups involving larger sample sizes.

Diminished IL-17A levels may protect filarial-infected individuals from development of rheumatoid arthritis and systemic lupus erythematosus

Nematode infections have been observed to inversely correlate with autoimmune disorders. Recently, we have shown the absence of filarial infection in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who live in filarial-endemic areas. The mechanism(s) by which filarial-infected individuals are protected against the development of RA or SLE are unknown. In mice CIA, an experimental model for RA, ES-62, an execratory product of rodent filarial nematode , has been shown to improve arthritis through suppression of the IL-17 pathway. A total of 160 individuals, 40 each of endemic normal, filarial-infected cases, SLE and RA patients, from filarial-endemic areas, were enrolled in the study. Plasma levels of IL17-A, IFN-α and TNF-α were quantified by enzyme-linked immunosorbent assay (ELISA). RA and SLE patients displayed significantly higher plasma IL-17A, IFN-α and TNF-α levels compared to endemic normal and infected individuals. Furthermore, IL-17A levels were significantly low in participants with filarial infection compared to endemic controls ( p < 0.05). Interestingly, plasma IL-17A levels correlated inversely with circulating filarial antigen (CFA) ( p = 0.004, Spearman r = −0.51). Filarial infection was associated with low plasma IL-17A levels, a mechanism by which it possibly protects individuals in filarial-endemic areas from the development of autoimmune disorders like RA and SLE.

Seasonality and Antimicrobial Resistance Pattern of Vibrio Cholerae in a Tertiary Care Hospital of North India

We retrospectively analysed the seasonal distribution of cholera and the antimicrobial resistance pattern of Vibrio cholerae isolates over a 5-year period from January 1998 to December 2002. Of 3213 stool specimens processed from 3213 patients with acute watery diarrhoea during this period, 431 samples (13.4%) were found positive for V. cholerae. There were 423 V. cholerae Ol biotype E1Tor, 2 V. cholerae 0139 and six isolates of non-01 non-0139. The highest number of cholera cases occurred in May-June followed by July-August. Cases started appearing in April for all years except in the year 2002 when three cases occurred in the first week of March. A large number (90.25% strains) were resistant to at least one antibiotic.

Declining trends of Syphilis seroprevalance among antenatal clinic cases and STD clinic cases in a tertiary care centre: from January 2002 to December 2012

Syphilis affects nearly 1.36 million pregnant women, majority of these cases being concentrated in the developing countries. We aimed at analysing the 11 years' trends in syphilis seroprevalence in antenatal clinics (ANC) and STD clinic cases. Laboratory data of syphilis cases from 2002-2012 were retrospectively analysed. Out of the total 73,642 cases, 393 (0.53%) tested positive for Syphilis. A statistically significant decline in syphilis prevalence was found in both ANC and STD clinic cases. The efforts of various interventional programs should continue to make the screening and treatment facilities readily accessible to continue the decline in syphilis seropositivity.

Urine Nested Polymerase Chain Reaction in Neonatal Septicemia

This cross-sectional study was done to evaluate diagnostic efficacy of urine nested polymerase chain reaction (PCR) using broad-range 16SrDNA PCR-based amplification, followed by restriction analysis and sequencing in neonatal septicemia. The study included 50 babies; 48% had vaginal delivery, 46% were preterm, 20% had a history of prolonged rupture of membranes and 56% were low birth weight (≤2500 g). Clinical presentations were lethargy (96%), respiratory distress (80%) and bleeding diathesis (16%). Absolute neutrophil count <1800/mm(3) was observed in 60%, and positive C-reactive protein in 46%. Thirty neonates had positive blood culture, and Klebsiella pneumoniae (22%) was the predominant organism. Nested urine PCR was positive in 38 (76%) and detected bacterial DNA in 8 neonates with negative blood cultures. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of nested PCR were 100, 60, 78.9, 100 and 84%, respectively, compared with blood culture. Nested PCR can detect most bacteria in single assay and identify unusual and unexpected causal agents.

Study of the role of efflux pump in ciprofloxacin resistance in Salmonella enterica serotype Typhi

PURPOSE

There are increasing reports on failure of clinical response to ciprofloxacin in typhoid fever despite the strain being sensitive to drug in in-vitro using standard guidelines and showing mutations in DNA gyrase. But this increased MIC and clinical failures with ciprofloxacin are not always co-related with mutations presently identified in gyrA and parC genes. This shows that there may be other mechanisms such as an active drug efflux pump responsible as has been shown in other Enterobacteriaceae. This study was carried out to determine the role of efflux pump in Salmonella Typhi isolates.

MATERIALS AND METHODS

Total 25 already characterized nalidixic acid sensitive and nalidixic acid resistant S. Typhi strains with different range of ciprofloxacin MIC were included to study the role of efflux pump in the presence of CCCP (efflux pump inhibitor). For genotypic characterization, the entire acrR gene was sequenced to confirm the presence of any mutation in the gene.

RESULTS

The MIC of ciprofloxacin remained same in the presence and absence of CCCP in the studied strains and no significant mutations were found in the acrR gene in any of the isolates studied.

CONCLUSIONS

No role of efflux pump in ciprofloxacin resistance was found in strains studied. There is a need to explore further mechanism of ciprofloxacin resistance in Salmonella Typhi.

Antibiotics in third molar extraction; are they really necessary: A non-inferiority randomized controlled trial

INTRODUCTION

Antibiotic resistance is now a serious problem, although it was not so only a few years ago. The need of the hour is to give clear evidence of the efficacy of antibiotic use, or lack thereof, to the surgeon for a procedure as common as mandibular third molar surgery.

AIM

This study aimed to evaluate whether postoperative combined amoxicillin and clavulanic acid in mandibular third molar extraction is effective in preventing inflammatory complications.

STUDY AND DESIGN

The study was structured as a prospective randomized double-blind placebo-controlled clinical trial.

MATERIALS AND METHODS

A study was designed wherein the 96 units (two bilaterally similar impacted mandibular third molars per head in 48 patients) were randomly assigned to two treatment groups (Group I and Group II). Each patient served as his/her own control. Each patient received 625 mg of combined amoxicillin and clavulanic acid 1 h before surgery. In the case of third molars belonging to Group I, 625 mg of combined amoxicillin and clavulanic acid TDS was continued for 3 days; in Group II, placebo in similar-looking packs was continued for 3 days. The patients were evaluated on the third and seventh postoperative days for signs of clinical infection and for microbial load evaluation.

STATISTICAL ANALYSIS

The data between the two groups were statistically analyzed by the two-tailed Fisher's exact test, with a 95% confidence interval.

RESULTS

The difference was not statistically significant between the test group and the control group with regard to erythema, dehiscence, swelling, pain, trismus, and infection based on microbial load. The data were statistically significant for alveolar osteitis, with the occurrence of alveolar osteitis (14.58%) in the placebo group.

CONCLUSION

Postoperative antibiotics are recommended only for patients undergoing contaminated, long-duration surgery.

Semi-analytical model of arrayed waveguide grating in SOI using Gaussian beam approximation

The arrayed waveguide grating structure can be used as an important component in high-speed CMOS optical interconnects in silicon-on-insulator (SOI) platform. However, the performance of such device is found to be extremely sensitive to the fabrication-related errors in defining the critical features. In the absence of an appropriate analytical model, one needs to rely on numerical computation to analyze the device characteristics and fabrication tolerances. Because compact design of such a device structure has foot-print ∼mm² and the smallest features can be as small as ∼500  nm×220  nm (waveguide cross section), it demands a huge computational budget to optimize the design parameters. A semi-analytical model using Gaussian beam approximation of guided mode profiles has been developed to analyze the output spectrum of arrayed waveguide grating and to estimate the phase errors due to waveguide inhomogeneities. This model has been validated with existing numerical methods and published experimental results. It has been observed that a probabilistic waveguide width variations of ΔW∼5  nm can cause a cross-talk degradation of about 40 dB (25 dB) for a device (operating at λ∼1550  nm) fabricated on SOI substrate with 220 nm (2 μm) device layer thickness.

Serum ferritin level correlates with SLEDAI scores and renal involvement in SLE

Introduction

Ferritin is an acute-phase reactant that is elevated in various autoimmune disorders. Serum ferritin levels have been positively correlated with disease activity scores of rheumatoid arthritis and systemic lupus erythematosus (SLE). Further, enhanced levels of ferritin have also been reported in lupus nephritis. However, there are no reports from the Indian subcontinent.

Methods

Seventy-six female SLE patients, diagnosed on the basis of revised ACR criteria, and 50 healthy females, age matched from similar geographical areas, were enrolled in the present study. Serum levels of ferritin, IFN-α and IL-6 were quantified by enzyme-linked immunosorbent assay (ELISA). Clinical, biochemical, serological and other markers of disease activity (C3, C4 and anti-dsDNA) were measured by standard laboratory procedure.

Results

Serum ferritin levels were significantly higher in SLE patients compared to healthy controls ( p < 0.0001). Ferritin levels positively correlated with SLE Disease Activity Index (SLEDAI) ( p = 0.001, r = 0.35), anti-dsDNA ( p = 0.001, r = 0.35), IFN-α ( p < 0.0001, r = 0.51) and IL-6 (p < 0.0001, r = 0.65) and negatively correlated with C3 ( p = 0.0006, r = −0.38) and C4 ( p = 0.01, r = −0.28). Interestingly, serum levels of ferritin were positively associated with proteinuria ( p = 0.001, r = 0.36), serum urea ( p = 0.0004, r = 0.39) and serum creatinine ( p = 0.0006, r = 0.38).

Conclusion

Serum ferritin is an excellent marker of disease activity and renal dysfunction in SLE.