Is ChatGPT's Knowledge and Interpretative Ability Comparable to First Professional MBBS (Bachelor of Medicine, Bachelor of Surgery) Students of India in Taking a Medical Biochemistry Examination?

Introduction ChatGPT is a large language model (LLM)-based chatbot that uses natural language processing to create humanlike conversational dialogue. It has created a significant impact on the entire global landscape, especially in sectors like finance and banking, e-commerce, education, legal, human resources (HR), and recruitment since its inception. There have been multiple ongoing controversies regarding the seamless integration of ChatGPT with the healthcare system because of its factual accuracy, lack of experience, lack of clarity, expertise, and above all, lack of empathy. Our study seeks to compare ChatGPT's knowledge and interpretative abilities with those of first-year medical students in India in the subject of medical biochemistry. Materials and methods A total of 79 questions (40 multiple choice questions and 39 subjective questions) of medical biochemistry were set for Phase 1, block II term examination. Chat GPT was enrolled as the 101st student in the class. The questions were entered into ChatGPT's interface and responses were noted. The response time for the multiple-choice questions (MCQs) asked was also noted. The answers given by ChatGPT and 100 students of the class were checked by two subject experts, and marks were given according to the quality of answers. Marks obtained by the AI chatbot were compared with the marks obtained by the students. Results ChatGPT scored 140 marks out of 200 and outperformed almost all the students and ranked fifth in the class. It scored very well in information-based MCQs (92%) and descriptive logical reasoning (80%), whereas performed poorly in descriptive clinical scenario-based questions (52%). In terms of time taken to respond to the MCQs, it took significantly more time to answer logical reasoning MCQs than simple information-based MCQs (3.10±0.882 sec vs. 2.02±0.477 sec, p<0.005). Conclusions ChatGPT was able to outperform almost all the students in the subject of medical biochemistry. If the ethical issues are dealt with efficiently, these LLMs have a huge potential to be used in teaching and learning methods of modern medicine by students successfully.

A comparative evaluation of dexmedetomidine and magnesium sulfate during awake fiber optic orotracheal intubation in patients scheduled for cervical spine surgeries: A prospective study

Background: Fiber optic intubation has become an integral part in management of anticipated difficult airways. Various anesthetic drugs have been used to assist awake fiber optic intubation (AFOI) for producing conscious sedation to provide a calm, cooperative, and responsive patient without respiratory depression for successful awake fibre optic intubation. Aims and Objectives: The aim of the present study was to compare the efficacy of dexmedetomidine and magnesium sulfate during awake fiber optic orotracheal intubation in patients scheduled for cervical spine surgeries. Materials and Methods: A randomized, prospective, and comparative study design was conducted in 60 patients in JAH group of hospitals. All patients were randomly divided into two groups: Group A (n=30) patients received dexmedetomidine (1 μg/kg) and Group B (n=30) patients received magnesium sulfate (40 mg/kg) in 100 ml normal saline over 10 min. The fiber optic orotracheal intubation was performed and primary outcome was level of sedation assessed using Ramsay sedation score. Other parameters of study included cough score and intubation score to compare intubating conditions. The secondary outcomes of study included variations in hemodynamic parameters heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and SPO2 during drug infusion at 2-min interval, immediately after intubation and every 10 min after intubation till 30 min. Results: Group A (Dexmedetomidine) had better sedation score, cough score, and intubation score with stable hemodynamic variables than Group B (Magnesium Sulphate) with statistically significant results. Conclusion: Patients receiving dexmedetomidine had better sedation providing more optimum conditions for AFOI with stable hemodynamic parameters and lesser adverse effects during the procedure than magnesium sulfate.

Dalbavancin as sequential therapy for infective endocarditis due to Gram-positive organisms: a review

Dalbavancin is a parenteral lipoglycopeptide antibiotic derived from teicoplanin, an analogue of vancomycin. It is mainly used for skin and soft tissue infections. The sustained half-life of approximately 14 days makes dalbavancin a novel option for potential use as sequential treatment in infections such as infective endocarditis, which require prolonged antibiotic courses. However, only a few studies have been reported in the literature, and the use of dalbavancin remains limited. This article is a review of the currently available literature using dalbavancin for the treatment of infective endocarditis due to Gram-positive organisms. Almost all patients received dalbavancin as sequential therapy following standard-of-care antibiotics. The overall clinical efficacy of dalbavancin was approximately 90%, and it appeared to be well tolerated.

Evaluation of sample rejection rate in clinical biochemistry laboratory before and after implementation of six-sigma methodology

Background: In pre-analytical phase of Clinical Biochemistry Laboratory, sample rejection is a very frequent and important source of error. It affects the overall quality of laboratory services and patient care by increasing cost and turnaround time. It leads to test abandonment and causes inconvenience to patients and staff. Aims and Objectives: The aim of the study was to implement the define, measure, analyze, improve, and control (DMAIC) method of six-sigma to decrease the rate of sample rejection in Clinical Biochemistry Laboratory. Materials and Methods: In this prospective study, sample rejection rates were analyzed in a clinical Biochemistry Laboratory before and after implementation of DMAIC method of six-sigma. Baseline rejection rates were calculated for a year and classified based on cause of rejection and patient location. Current defects per million opportunities and six sigma values were calculated. This was followed by root cause analysis and implementation of corrective and preventive measures. Reanalysis of the baseline measures was done to observe the impact of these measures. Results: After implementation of DMAIC, the overall rejection rate fell from 1.07% to 0.49% with an increase in sigma value from 3.8 to 4.1. Conclusion: Six-sigma tool like DMAIC can be successfully implemented to improve sample rejection rates ultimately improving the quality of laboratory services in resource limited setting with minimal financial implications.

Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial

BACKGROUND

Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection.

OBJECTIVE

To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone.

DESIGN

Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978).

SETTING

Multinational, multicenter trial.

PARTICIPANTS

Adults hospitalized with COVID-19.

INTERVENTION

Intravenous ensovibep, 600 mg, or placebo.

MEASUREMENTS

Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90.

RESULTS

An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep).

LIMITATION

The trial was prematurely stopped because of futility, limiting power for the primary outcome.

CONCLUSION

Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified.

PRIMARY FUNDING SOURCE

National Institutes of Health.

The Effect of Diabetes Mellitus on Outcomes of Patients Admitted with COVID-19: A Single - Center Experience from a Tertiary Hospital in India

BACKGROUND AND OBJECTIVES

Diabetes mellitus is associated with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics of patients with type 2 diabetes with COVID-19, and to determine the impact of type 2 diabetes on clinical outcome of patients with COVID-19.

MATERIAL AND METHODS

This single-center, retrospective, observational study enrolled patients admitted from March 2020 to June 2021 with COVID-19. The clinical and biochemical characteristics of patients with known type 2 diabetes, newly diagnosed diabetes, type 2 diabetes with comorbidities and those who succumbed to illness were analyzed.

RESULTS

Of 4,559 patients with COVID-19, 2,090 (45.8%) had type 2 diabetes. Patients with COVID-19 with diabetes were older, more likely to receive mechanical ventilation, had higher odds of mortality from COVID-19 as compared with patients without diabetes. In addition, patients with diabetes had significantly higher levels of serum creatinine, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Compared with previously diagnosed patients with diabetes, newly diagnosed patients had higher mortality (33% vs. 27%, P = 0.049). Among patients with COVID-19 and diabetes, nonsurvivors had significantly higher levels of inflammatory markers and had severe impairment of cardiac, renal, and coagulation parameters as opposed to survivors.

CONCLUSION

Patients with COVID-19 with diabetes were more likely to have severe disease and had higher mortality. Presence of chronic kidney disease and coronary artery disease in patients with diabetes with COVID-19 was associated with adverse outcome. Patients with newly diagnosed diabetes had higher odds of severe disease at presentation and had higher mortality.

1009. Biofilm Formation in Acinetobacter Baumannii Clinical Isolates

Background

Multidrug resistant Acinetobacter baumannii (MDR-Ab) is a Gram-negative bacterium known for causing severe nosocomial infections, attributed in part to its formation of biofilm. Siderophore is a virulence factor known to support biofilm formation by regulating iron availability. In this study, we screened 44 isolates of MDR-Ab from our Gram-negative repository to determine the strains that phenotypically form biofilm and produce siderophore. The results were compared to Pseudomonas aeruginosa PAO1, which produces both biofilm and siderophore.

Methods

Isolates were grown overnight in minimal M9 medium supplemented with casamino acids and hydroxyquinones at 37°C. Bacterial cells were normalized (to OD 600=0.01) and a standard diluted 10-3 tube was used in the study. A 96-well plate was inoculated with 100 microliters of each isolate in quadruplicates. This process was repeated in Tygon tubes with 50 microliters of each isolate in triplicates. The plate and Tygon tubes were incubated statically for 48 hours at 30°C and then stained with crystal violet. The contents were dissolved in 33% glacial acetic acid and analyzed by spectrophotometry to measure biofilm formation. Siderophore secretion was measured in supernatants with Chrome Azurol S (CAS) reagent and production was observed on CAS agar plates.

Results

High levels of biofilm formation were observed in 8 strains of MDR-Ab in the 96-well plate (3, 4, 9, 22, 61, 1010, 1012, 1022) and 6 strains in Tygon tubes (3, 4, 16, 66, 1002, 1010) (Fig. 1). There was minimal siderophore production in MDR-Ab isolates compared to PAO1 in both the 96-well plate and Tygon tubes (Fig. 2). Only 4 strains lacked siderophore production on CAS agar and were inversely negative for the secretion in medium.

Figure 1 Biofilm formation in a 96-well plate and Tygon tubes

Conclusion

Many strains of MDR-Ab readily form biofilm. Overall siderophore production is lower in MDR-Ab compared to consistent production by PAO1, but this does not appear to affect MDR-Ab’s ability to form biofilm. Unlike in PAO1, biofilm formation in MDR-Ab may occur independently of siderophore production. This research serves as a basis for understanding future MDR-Ab biofilm elimination in patient catheters and indwelling devices.

Disclosures

All Authors: No reported disclosures

687. Use of Dalbavancin in Gram-positive Infective Endocarditis: Review of Current Literature

Background

Dalbavancin is a long acting, semisynthetic derivative of teicoplanin that is currently approved for treatment of acute bacterial skin and skin structure infections. Its efficacy and role of in the treatment of invasive infections, in particular infective endocarditis, is not well known.

Methods

We reviewed the English-language literature for the use of Dalbavancin in the treatment of endocarditis due to Gram-positive organisms, using Pubmed.

Results

15 publications were reviewed. All the publications were retrospective in nature, with relatively small numbers of patients, including a few case reports.

A total of 159 patients received Dalbavancin for endocarditis. The mean age was 47 years. The main reasons for using Dalbavancin were non-feasibility of a standard outpatient regimen (mainly due to drug use) or the need for a simpler regimen. 75 patients had infection of a native valve, 44 of a prosthetic valve and 19 of a cardiac device. The type of infection for the rest of the patients was not specified. The tricuspid valve was the most frequently reported. The etiologic organisms causing endocarditis were Staphylococcus species, followed by Streptococcus species and Enterococcus species, with Staphylococcus aureus being the most common. All, but one, patients received Dalbavancin as sequential therapy, after receiving other intravenous antibiotics initially. The duration of antibiotics received prior to initiation of Dalbavancin was variable, with the median being 3 weeks. The median duration of Dalbavancin use was 2.7 weeks. The dosage regimens varied, with the more common ones using a loading dose of either 1500 mg or 1000 mg, followed by one or more weekly doses of 500 mg. The overall clinical efficacy was around 89%. Adverse events were mild, including nausea, vomiting, rash, headache and reversible acute kidney injury. None of the patients had to discontinue the drug because of adverse events. Two publications evaluated the cost effectiveness of Dalbavancin and found it to save about &9000 per patient, the saving being mainly due to reduced length of hospital stay.

Conclusion

Dalbavancin appears to be an efficacious, safe and cost-effective option for sequential treatment of endocarditis caused by Staph aureus and other Gram-positive organisms.

Disclosures

All Authors: No reported disclosures

Two rare cases of fungal bursitis due to Phialemoniopsis pluriloculosa

Fungal infections due to Phialemoniopsis spp. are rarely reported in the medical literature. We report the first two cases of fungal bursitis of the knee by Phialemoniopsis pluriloculosa, which has not been previously reported. Both patients were successfully treated with a six-month course of posaconazole.

323. First case of Prosthetic joint infection due to Nocardia veterana-elegans

Background

Nocardia are Gram-positive filamentous bacteria that cause Nocardiosis, a rare opportunistic infection. The most common site of infection is the lungs, with metastatic spread usually to the central nervous system. Prosthetic joint infection due to Nocardia is very rare.

Methods

We report the first case of prosthetic joint infection due to Nocardia veteran-elegans, and review the literature regarding Nocardia septic arthritis, with particular attention to prosthetic joint infection.

Results

The patient was a 35 year old male with history of Hodgkin’s Lymphoma for which he received chemotherapy previously, poorly controlled diabetes, motor vehicle accident in 2003 with right open tibial plateau fracture requiring hardware placement, who was admitted with a two week history of right knee pain and swelling. Knee aspiration revealed purulent fluid and synovial culture grew Nocardia species. He underwent right knee arthrotomy and debridement with removal of hardware. The Nocardia species was speciated as N. veterana-elegans, sensitive to trimethoprim/sulfamethoxazole, linezolid, clarithromycin, imipenem and amikacin. He was placed on oral linezolid for four weeks, which was then switched to oral trimethoprim/sulfamethoxazole, with a plan for a six month course of therapy. He has completed two months of therapy thus far and is doing well clinically.

Nocardia is an uncommon cause of septic arthritis. We found only 37 cases reported in the English literature thus far. Amongst these, only six involved prosthetic joints, including our case, which is the first one to be caused by N. veterana-elegans.Three cases were caused by N. nova and one each by N. farcinica and asteroides. Septic arthritis due to Nocardia has a favorable outcome with a combination of surgical debridement and prolonged antimicrobial therapy of three to six months. For prosthetic joint infections, removal of hardware seems to carry a better prognosis. Trimethoprim/sulfamethoxazole is the preferred antimicrobial, including for bone and joint infection, although susceptibilities can vary amongst the different species.

Conclusion

Nocardia is an uncommon cause of septic arthritis. Prosthetic joint infection is very rare. Prognosis is fair with a combination of hardware removal and prolonged antibiotic therapy.

Disclosures

All Authors: No reported disclosures

Family life stress, maternal depression and child behavioral health in industrialized Italian cities

Although family life stress adversely impacts child health, few tools measure its relationship to child outcomes in the setting of maternal variables. This study validates the Italian version of Crisis in Family Systems-Revised (CRISYS-R) and characterizes relationships between family life stress, maternal depression and child behavior in two Italian cities.

This cross-sectional study was nested in current research on health impacts of neurotoxic environmental exposures in children. 101 mother-child pairs (child age=9.91±2.17yrs; 53% female) and children's teachers were enrolled in Taranto (south Italy) and Brescia (north Italy). Mothers performed the Italian CRISYS-R and PHQ9; teachers completed Child Behavior Checklist (CBCL/6-18). Spearman's rank correlation coefficients showed associations of family CRISYS-R, maternal PHQ9 and child CBCL/6-18. Wilcoxon Rank-Sum test compared groups of continuous variables.

Mothers with depressive symptoms (PHQ9≥5) reported higher ongoing stress and proportion of negative stressors on CRISYS-R than non-depressed mothers (p &lt; 0.05). Children of depressed mothers performed worse in all CBCL/6-18 domains: Internalizing Problems, Externalizing Problems and Total Problems (p &lt; 0.01). Specifically, children of depressed mothers scored higher on subscales of Anxious-Depressed (p &lt; 0.05), Withdrawn-Depressed (p &lt; 0.01), Rule-Breaking (p &lt; 0.01) and Aggressive Behavior (p &lt; 0.05). Maternal depressive symptoms correlated with ongoing stress (rs = 0.27; p &lt; 0.01), child Internalizing Problems (rs = 0.34; p &lt; 0.001), Externalizing Problems (rs = 0.28; p &lt; 0.01) and Total Problems (rs = 0.35; p &lt; 0.001).

This study describes links among maternal depression, family life stress, and child behavioral health. It is first to validate Italian CRISYS-R and to explore these factors conjointly in Italian contexts with known neurotoxic exposures. Findings support considering maternal depression and family life stress in child behavioral and environmental health research and policy.

Key messages

Family life stress, maternal depressive symptoms, and preadolescent behavioral health were highly interrelated in two industrialized Italian cities. The Italian version of CRISYS-R is a useful instrument for assessing and understanding family life stress, a crucial yet under-explored contributor to child behavioral health outcomes.

An open-label randomised pilot trial on safety of wheat variety C273 in patients with adult celiac disease

BACKGROUND

The only effective treatment for celiac disease (CeD) is gluten free diet (GFD). However, GFD is restrictive and efforts are being made to explore alternative therapies including safer wheat varieties. Wheat variety C273 has been previously identified to have reduced load of intact T-cell stimulatory epitopes via in silico and in vitro analysis.

METHODS

Adult patients diagnosed with CeD and recovered on GFD were included in the study. Patients were randomised into two groups in a 2:1 ratio. Patients in group I had graded introduction of C273 wheat in diet, maintained for 24 weeks; in Group II, wheat was restricted with continuation of GFD. Clinical symptoms, serology [anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA)], circulating inflammatory biomarkers [intestinal fatty-acid binding protein (I-FABP), plasma citrulline, interferon-γ (IFN-γ)] and histology were evaluated periodically. Final evaluation was performed at week 28.

RESULTS

A total of 15 patients were enrolled (Group I: n = 10, Group II: n = 5). All patients except two in Group I remained compliant. None of the remaining eight patients in group I developed symptoms. No significant changes in serology (anti-tTG, anti-EMA) and histology were observed between the two groups at 28 weeks (p > 0.05). Significant changes in plasma citrulline(29.87 ± 8.98 versus 36.58 ± 3.09, p = 0.049) and IFN-γ (44.56 ± 9.74 versus 33.50 ± 3.68; p = 0.031) were observed in Group I.

CONCLUSION

Consumption of C273 wheat did not result in development of symptoms or evident changes in serology and histology at 28 weeks. However, variations in circulating inflammatory markers were noted. Larger randomised trials are needed to corroborate these findings.

CLINICAL TRIALS REGISTRY-INDIA

CTRI/2018/06/014521.

Variable Immunogenic Potential of Wheat: Prospective for Selection of Innocuous Varieties for Celiac Disease Patients via in vitro Approach

Celiac Disease (CD) is a multifactorial, autoimmune enteropathy activated by cereal proteins in genetically predisposed individuals carrying HLA DQ2/8 genes. A heterogenous gene combination of the cereal prolamins is documented in different wheat genotypes, which is suggestive of their variable immunogenic potential. In the current study, four wheat varieties (C591, C273, 9D, and K78) identified via in silico analysis were analyzed for immunogenicity by measuring T-cell proliferation rate and levels of inflammatory cytokines (Interferon-γ and Tumor Necrosis Factor-α). Peripheral Blood Mononuclear Cells and biopsy derived T-cell lines isolated from four CD patients in complete remission and two controls were stimulated and cultured in the presence of tissue transglutaminase activated pepsin-trypsin (PT) digest of total gliadin extract from test varieties. The immunogenicity was compared with PBW 621, one of the widely cultivated wheat varieties. Phytohaemagglutinin-p was taken as positive control, along with unstimulated cells as negative control. Rate of cell proliferation (0.318, 0.482; 0.369, 0.337), concentration of IFN- γ (107.4, 99.2; 117.9, 99.7 pg/ml), and TNF- α (453.8, 514.2; 463.8, 514.2 pg/ml) was minimum in cultures supplemented with wheat antigen from C273, when compared with other test varieties and unstimulated cells. Significant difference in toxicity levels among different wheat genotypes to stimulate celiac mucosal T-cells and PBMC's was observed; where C273 manifested least immunogenic response amongst the test varieties analyzed.

Can cystatin C become an easy and reliable tool for anesthesiologists to calculate glomerular filtration rate?

Background and Aims:

The aim was to evaluate the role of cystatin C as a noninvasive and easy marker of glomerular filtration rate (GFR) estimation in voluntary kidney donors.

Materials and Methods:

We retrospectively evaluated 40 voluntary kidney donors. They underwent complete biochemical and nuclear tests as a part of transplant workup. Serum cystatin C, serum creatinine, and Tc-99m diethylene-triamine-penta-acetic acid (DTPA) were used in our study. We calculated GFR using the chronic kidney disease epidemiology collaboration (CKD-EPI) formula based on creatinine only (GFR-CKD-EPI-creat), CKD-EPI formula using creatinine and cystatin C (GFR-CKD-EPI-cyst-creat), and modification of diet in renal disease (MDRD) and CKD-EPI cystatin C equation (2012) (GFR-cyst).

Data was evaluated using the SPSS software (version 11.5). The correlation analysis and analysis of variance was used for statistical computation. Agreement was determined using analyze-it version 2.30 for MS-Excel 12+.

Results:

The mean age of the donors in our study was 49.83 ± 13.06. The mean cystatin C in females was 0.72 ± 0.12, the mean cystain C in males was 0.87 ± 0.23. On correlating GFR-cyst with GFR-DTPA the Pearson correlation coefficient (ρ) was found to be 0.388 this correlation was significant with P < 0.05. While comparing with DTPA the correlation coefficient of GFR-CKD-EPI-creat group was 0.587 which was significant with P < 0.01. The correlation coefficient of GFR-CKD-EPI-cyst-creat group compared with GFR-DTPA group was 0.543 which was also significant at P < 0.001. GFR-CKD-EPI-creat gave the highest correlation with DTPA in our study. The correlation coefficient of GFR-MDRD group with DTPA group was 0.576 this correlation was also significant with P < 0.01. The results obtained were further statistically analyzed by Bland-Altman analysis the percentage error for GFR-DTPA versus GFR-cyst-creat is 29.72%; for GFR-DTPA versus GFR-EPI-creat is 30.73%; or GFR-DTPA versus MDRD is 31.63% and for GFR-DTPA versus GFR-cyst is 34.37%.

Conclusion:

Cystatin C is a good endogenous marker for calculating GFR as it correlates very well with DTPA and CKD-EPI equation based GFR.

To study the levels of C - reactive protein and total leucocyte count in patients operated of open and laparoscopic cholecystectomy

BACKGROUND

The recovery from laparoscopic cholecystectomy (LC) is rapid and most of the patients are discharged on the 1st post-operative day. There is an increased concentration of certain serum proteins, known as acute-phase reactive proteins (APRP) during the post-operative period depends on the degree of tissue damage and the inflammatory reaction. There is a direct positive correlation between the concentrations of APRP, especially C-reactive protein (CRP), and the severity of inflammation. This study was done to study the levels of C - reactive protein and Total Leucocyte Count in patients operated either by Open Cholecystectomy (OC) and Laparoscopic Cholecystectomy (LC).

MATERIALS AND METHODS

This prospective study was conducted on 50 patients after approval from the Institutional Ethics Committee. Twenty five patients underwent open cholecystectomy and the other 25 had laparoscopic cholecystectomy. The pre and post operative concentrations of serum C-reactive protein (CRP) and total leukocyte count (TLC) were compared in both the groups.

RESULTS

There were no differences in the preoperative serum CRP and TLC concentrations - in both the groups. Serum CRP rose significantly following OC compared to that of patients who underwent LC (10.52 ± 1.96 mg% vs. 8.88 ± 1.23 mg %). There were also significant differences in the post-operative TLC ( 9.49 ± 1.05 m/mm3 for the OC group vs. 8.57 ± 1.31 m/mm3 for the LC group), and the post-operative hospital stay (5.5 ±1.5 days vs. 1.9 ± 0.9 days). There was no correlation between serum CRP concentrations and the other post-operative parameters.

CONCLUSION

The study provided the biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.

Does friedewald formula underestimate the risk of ischemic heart disease?

Traditionally Friedewald formula has been used to calculate low density lipoprotein cholesterol (LDL-C) concentration though now direct homogenous methods for its measurement are also available. Clinical guidelines recommend the use of calculated LDL-C to guide therapy because the evidence base for cholesterol management is derived almost exclusively from trials that use calculated LDL, with direct measurement of LDL-C being reserved for those patients who are non fasting or with significant hypertriglyceridemia. In this study our aim was to compare calculated and direct LDL and their variation at different cholesterol and triglyceride levels. Fasting lipid profile estimation was done on 503 outpatients in a tertiary hospital. Both direct and calculated LDL were then compared. Mean fasting direct LDL was found to be higher than calculated LDL in 87.1 % of subjects by 8.64 ± 8.35 mg/dl. This difference was seen a all levels of cholesterol and triglyceride. Using 130 mg/dl LDL cholesterol as cut off fewer subjects were classified as high risk by calculated LDL than direct LDL. In conclusion, direct LDL is higher than calculated LDL. Compared with direct measurement, the Friedewald calculation underestimates the risk for ischemic heart disease.

Early clinical observations in prospectively followed patients with fungal meningitis related to contaminated epidural steroid injections

Chinese translation

BACKGROUND

Administration of epidural steroid injections (ESIs) with contaminated methylprednisolone resulted in an outbreak of fungal meningitis in many locations in the United States.

OBJECTIVE

To characterize early clinical findings and initial response to treatment.

DESIGN

Case series with standardized observation studied from 4 October to 31 October 2012.

SETTING

An 800-bed hospital in Virginia.

PATIENTS

172 patients who presented to the hospital with exposure to contaminated ESI.

INTERVENTION

Standardized approach to screening, case definition, treatment, and data collection.

MEASUREMENTS

Clinical findings, cerebrospinal fluid (CSF) values, magnetic resonance imaging (MRI), serum and CSF voriconazole concentrations, and clinician assessment of response to therapy.

RESULTS

Of 172 patients presenting to the hospital who had had ESI, 131 had lumbar puncture because of symptoms or signs consistent with central nervous system disease. Twenty-five (19%) had neutrophilic meningitis. All were started on voriconazole therapy alone. Three patients developed stroke during treatment. Ten patients had arachnoiditis, another had an epidural abscess, and 9 had urine retention. Fifteen continued to receive voriconazole, and 10 were switched to amphotericin B. Cerebrospinal fluid leukocyte counts began to decrease by day 13 of treatment. Findings on MRI included ventriculitis, leptomeningeal enhancement, infarction, hemorrhage, and arachnoiditis. Serum voriconazole levels varied, and CSF concentrations of voriconazole were approximately 50% those of serum. Exserohilum rostratum and Cladosporium species have been cultured.

LIMITATIONS

This is an observational study of an evolving outbreak. Not all exposed patients presented for evaluation. Follow-up is too short to determine final outcomes.

CONCLUSION

Meningitis after receipt of contaminated ESI has been diagnosed in many exposed patients presenting to 1 hospital. Most patients have improved on receipt of empirical voriconazole therapy. The full natural history and long-term sequelae of this infection are currently unknown.

PRIMARY FUNDING SOURCE

None.

Patterns of alcohol consumption in medical students

A prospective study was carried out among undergraduate medical students of three different medical colleges in North India. The aim of this study was to assess the consumption pattern of alcohol among medical students and correlate psychiatric disturbance and parental alcohol consumption with the patterns of alcohol use in them. Using an anonymous, self-administered questionnaire, we surveyed 168 subjects who were at various stages of their undergraduate medical career. Alcohol was the frequently used substance by all groups; 56.57% ever used alcohol and 41.46% showed patterns of problem drinking. Alcohol dependence was found in 6.09% of the students; 71.95% students started consuming alcohol after admission in the medical college. Almost one-third of respondents (37.50%) were found to be clinically depressed, anxious, or experiencing psychiatric disturbances. Such students had a greater frequency of alcohol consumption (p = 0.05). Also, a strong association between positive family history of alcohol use/abuse and use of alcohol among medical students was found (p = 0.001). Alcohol abuse amongst medical students should be taken more seriously because their own attitudes towards substances may influence their professional behaviour.

Spectrum of microbial flora in diabetic foot ulcers

A prospective study was carried out on patients with diabetic foot lesions to determine their clinical characteristics, the spectrum of aerobic microbial flora and to assess their comparative in vitro susceptibility to the commonly used antibiotics. A total of 157 organisms (143 bacteria and 14 fungi) were isolated and an average of 1.52 isolates per case was reported. Polymicrobial infection was found in 35% of the patients. In this study, Pseudomonas aeruginosa among the gram-negative (22%) and Staphylococcus aureus among the gram-positive (19%) were the predominantly isolated organisms, while Candida was the most predominantly isolated fungus. Antimicrobial sensitivity pattern of the isolates is discussed in detail. There was a linear increase in the prevalence of organisms with increase in Wagner's grade. Neuropathy (76%) and peripheral vascular disease (57.28%) was a common feature among the patients. Poor glycemic control was found in 67% of the patients. Awareness about lower limb complications of diabetes was very low (23%) among the patients.

Synthesis and anti-inflammatory activity of 1-acetyl-5-substituted aryl-3-(beta-aminonaphthyl)-2-pyrazolines and beta-(substituted aminoethyl) amidonaphthalenes

The title compounds were prepared by reaction of beta-acetylamino-naphthalene with different aromatic aldehydes followed by cyclisation with hydrazine hydrate and with different primary or secondary amines (Mannich's reaction), respectively. The structures of new compounds were confirmed by 1H-NMR and IR spectral data. Anti-inflammatory and ulcerogenic activities in vivo were evaluated and compared with the standard drugs, phenylbutazone and indomethacin. Some compounds of the series exhibited promising anti-inflammatory activity with a lower ulcerogenic liability than the standard drugs.

Newer substituted beta-aminonaphthalenes as potent anti-inflammatory agents

beta-[2-(3'-Chloro-2'-oxo-4'-substituted aryl-1'-azetidinyl)-thiazol-4- yl]aminonaphthalenes 13-17 and beta-[2-(1',3'-disubstitutedphenyl-formazan-4'-yl)-thiazol-4-yl] aminonaphthalenes 8-12 were synthesized from beta-(2-arylideneamino-thiazol-4-yl)aminonaphthalenes 3-7 by diazotisation and by cycloaddition with monochloroacetyl chloride, respectively, on the azomethine group of the compounds 3-7. The newly synthesized compounds showed potent anti-inflammatory and analgesic activities and were less ulcerogenic than phenylbutazone.

Synthesis and anti-inflammatory activity of some potential cyclic phenothiazines

Some new schiff's bases (IVa-IVe), thiazolidinones (Va-Ve), delta 2-triazolines (VIa-VIe) and formazans (VIIa-VIIe) of 2-chlorophenothiazine have been synthesized and screened against Carrageenin induced oedema in albino rats. Some compounds of the series have shown promising activity. The most active compound is 2-chloro-10[5-(2-fluorophenyl-2-oxo-4 thiazolidin-1-yl)-amino acetyl] phenothiazine was found to be most potent. This compound (Vb) was further evaluated in detail and compared with phenylbutazone for its relative anti inflammatory potency (ED50), ulcerogenic liabilities (UD50) and acute toxicity (ALD50). It was found to be almost comparable to phenylbutazone as regards anti-inflammatory activity was concerned but and minimum ulcerogenic liability and cardiovascular effects. Hence, it seems promising as an anti-inflammatory agent in our preliminary studies.