Nasopharyngeal Carriage of Streptococcus pneumoniae Serotypes Among Healthy Children in Northern India

Streptococcus pneumoniae (SP) infections cause morbidity and mortality among children worldwide. Hence India introduced 13-valent pneumococcal conjugate vaccine (PCV-13) in 2017 in a phased manner. The primary objective of this study was to assess the proportion of healthy children having nasopharyngeal colonization (NP) with SP. Secondary objective was to determine prevalent serotype of SP among the PCV13 vaccinated and non-vaccinated children. This cross-sectional study was conducted in 4 hospitals of Lucknow District, Northern India. Three hundred healthy children (2-59 months) were recruited between July and August 2019 from vaccination-clinics of hospitals. NP specimen was cultured using 5% sheep blood agar plate containing gentamicin. Pneumococcal isolates were identified by optochin sensitivity and bile-solubility tests. Serotyping was done using Quellung Method. Of the 300 healthy children, 56.7% (170/300) were males and 59.3% (181/300) had received at least one dose of PCV13 vaccine. The NP carriage rate of SP among healthy children was 37.7% (113/300). Vaccine serotypes were found in 33.3% (22/66) in PCV vaccinated children and 48.9% (23/47) in non-vaccinated children (p 0.09). Common vaccine serotypes that isolated were: 18C, 19A, 19F, 23F, 3, 4, 6A, 6B, 9 V. Thus more than one-third of healthy children had NP colonization with SP. Adjusting for age, there was a trend for significant reduction in vaccine serotypes in the NP with one doses versus two or more doses (ptrend = 0.04).

Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction

Background

Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.

Objectives

We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).

Methods

Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.

Results

Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.

Conclusions

Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship

Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children

Meningitis literally means inflammation of the meninges. It is mostly caused by bacteria, virus, fungus and protozoa and pyogenic meningitis constitutes a serious neurological disorder associated with significant morbidity and mortality in developing countries. This study was carried out to evaluate the clinical presentation and immediate outcome of pyogenic meningitis in children. This was a prospective observational study and conducted at department of Paeditrics in Cumilla Medical College Hospital, Cumilla, Bangladesh from July 2014 to June 2015. Total 50 children were diagnosed as pyogenic meningitis fulfilling the inclusion criteria was included in this study. Cases were enrolled purposively. Immediately after admission through history and clinical examination, complete blood count, random blood sugar, Cerebrospinal fluid (CSF) examination and blood culture was done in all patients. For statistical analysis chi-square test was done and significance of analysis was made when p value <0.05. This study includes patients aged between 2 months to 12 years and male female ratio was 1.5:1. Several risk factors like male sex (60.0%), age below one year (42.0%), Protein energy malnutrition (PEM) (30.0%), not exclusively breastfed (44.0%) were identified. Common presenting complaints were fever (100.0%), convulsion (96.0%), altered consciousness (42.0%) and vomiting (38.0%). Common physical signs were neck rigidity (56.0%), Kernig's sign (26.0%) and bulged fontanelle (34.0%). CSF was hazy in 54.0%, clear in 38.0% and turbid in 08.0% cases, CSF protein was more than 100mg/dl in 90.0% of the cases and glucose was less than 40mg/dl in most of the cases (94.0%). Streptococcus Pneumoniae (49.0%) followed by Neisseria Meningitidis (38.0%) were the two most commonly isolated organism responsible for pyogenic meningitis. Mortality rate during hospital stay was 18.0% and complications developed in 18.0% of cases. To avoid maltreatment in our resource limited setting due to failure of identifying organism, this study might help to administer appropriate antibiotics against organism and to reduce morbidity and mortality in meningitis. This study revealed less mortality rate in our country than neighbors and severe malnutrition important risk factors for the burden of pyogenic meningitis. It requires large scale multicentre studies to establish the whole scenario of Bangladesh.

Genetic and molecular analysis reveals that two major loci and their interaction confer clubroot resistance in canola introgressed from rutabaga

Clubroot disease caused by Plasmodiophora brassicae is one of the serious threats to canola (Brassica napus L. subsp. napus) production. The evolution of new pathotypes rendering available resistances ineffective compel the introgression of new resistance into canola and extend our understanding of the genetic and molecular basis of the resistance. In this paper, we report the genetic and molecular basis of clubroot resistance in canola, introgressed from a rutabaga (B. napus L. subsp. rapifera Metzg. 'Polycross'), by using a doubled-haploid (DH) mapping population. Whole-genome resequencing (WGRS)-based bulked segregant analysis followed by genetic mapping and expression analysis of the genes in resistant and susceptible DH lines at 7 and 14 d after inoculation were carried out. Following this approach, two major quantitative trait loci (QTL) located at 14.41-15.44 Mb of A03 and at 9.96-11.09 Mb of A08 chromosomes and their interaction was observed to confer resistance to pathotypes 3H, 3A, and 3D. Analysis of the genes from the two QTL regions suggested that decreased expression of sugar transporter genes (BnaA03g29290D and BnaA03g29310D) may play an important role in resistance conferred by the A03 QTL, while increased expression of the toll/interleukin-1 receptor (TIR)-nucleotide binding (NB)-leucine rich repeat (LRR) (TNL) genes (BnaA08g10100D, BnaA08g09220D, and BnaA08g10540D) could be the major determinant of the resistance conferred by the A08 QTL. Single-nucleotide polymorphism (SNP) allele-specific polymerase chain reaction (PCR)-based markers, which could be detected by agarose gel electrophoresis, were also developed from the two QTL regions for use in breeding including pyramiding of multiple clubroot resistance genes.

Diversity of rumen microbiota using metagenome sequencing and methane yield in Indian sheep fed on straw and concentrate diet

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Bacteroidetes and Firmicutes were most prevalent bacteria in the sheep rumen.

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Bacteroidetes were negatively correlated with the Euryarchaeota.

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Archaea constituted ∼2.5% of the ruminal microbiota.

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Methanobrevibacter gottschalkii constituted > 50% of the ruminal archaea.

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Hydrogenotrophic methanogens distribution leads to the variability in methane yield.

An in vivo study aiming to investigate the rumen methanogens community structure was conducted in Mandya sheep fed on straw and concentrate diet. The ruminal fluid samples were collected and processed for unravelling the rumen microbiota and methanogens diversity. Further, the daily enteric methane emission and methane yield was also quantified using the SF₆ tracer technique. Results indicated that the Bacteroidetes (∼57%) and Firmicutes (25%) were two prominent affiliates of the bacterial community. Archaea represented about 2.5% of the ruminal microbiota. Methanobacteriales affiliated methanogens were the most prevalent in sheep rumen. The study inveterate that the ruminal archaea community in sheep is composed of 9 genera and 18 species. Methanobrevibacter represented the largest genus of the archaeome, while methylotrophs genera constituted only 13% of the community. Methanobrevibacter gottschalkii was the prominent methanogen, and Methaobrevibacter ruminantium distributed at a lower frequency (∼2.5%). Among Methanomassiliicoccales, Group 12 sp. ISO4-H5 constituted the most considerable fraction (∼11%). KEGG reference pathway for methane metabolism indicated the formation of methane through hydrogenotrophic and methylotrophic pathways, whereas the acetoclastic pathway was not functional in sheep. The enteric methane emission and methane yield was 19.7 g/d and 20.8 g/kg DMI, respectively. Various species of Methanobrevibacter were differently correlated, and the distribution of hydrogenotrophic methanogens mainly explained the variability in methane yield between the individual sheep. It can be inferred from the study that the hydrogenotrophic methanogens dominate the rumen archaeal community in sheep and methylotrophic/aceticlastic methanogens represent a minor fraction of the community. Further studies are warranted for establishing the metabolic association between the prevalent hydrogenotrophs and methylotrophs to identify the key reaction for reducing methane emission.

Pattern of Tubercular Uveitis in Active Pulmonary Tuberculosis

Ocular tuberculosis is an extra-pulmonary form of systemic Tuberculosis (TB). It is rarely found concomitant with active pulmonary tuberculosis (PTB). The aim of this prospective observational study was to evaluate the pattern of tubercular uveitis (TBU) in the patients with active PTB who attended in our Uvea clinic at NIO&H from July 2018 to December 2020. Active PTB patients who had uveitis consistent with TBU and TBU patients who were confirmed as active lung lesion were included in the study. Chest X-ray, TST, IGRA (QuantiFERON-TB Gold Test), RT PCR of aqueous fluid for tubercular bacillus, Gene Xpert TB test of sputum were done to confirm the diagnosis of ocular and primary TB. If the induration is 15 mm of TST was considered patient in this study. Among 33 patients of active PTB, 4 had TBU (12.12%). Among 48 patients of TBU, 5 had active PTB (10.41%). 13 eyes of 9 patients were affected. Mean age at presentation was 41.8 years. There were anterior uveitis in 23.00% eyes, posterior uveitis in 69% eyes and panuveitis in 7.00% eyes. Choroidal granuloma was the most common presentation of posterior uveitis (46.00%). There were more than 4 times chance to develop choroidal granuloma in patients with active PTB than extrapulmonary TB (Χ²=4.53, <0.05), TBU patients with choroidal granuloma should be evaluated meticulously for active PTB and active PTB patients should be evaluated routinely by ophthalmologist for the search of TBU.

Early Detection of Acute Kidney Injury by Neutrophil Gelatinase Associated Lipocalin in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

Neutrophil Gelatinase-Associated Lipocalin (NGAL) is rapidly released by renal tubules after injury, potentially allowing early identification of acute kidney injury (AKI) after cardiac surgery. However, the diagnostic performance of NGAL has varied widely in clinical studies and it remains unknown what factors modify the relationship between NGAL and AKI. The main objective of the study was to determine the efficacy of NGAL in early detection of AKI among the CABG patients undergoing cardiopulmonary bypass (CPB). This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in collaboration with the Department of Biochemistry, BSMMU among 42 patients admitted into the Department of Cardiac Surgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka Bangladesh from July 2014 to June 2015. For the measurement of NGAL, urine samples were obtained before surgery and 6 hours after commencement of CPB. Serum creatinine was measured preoperatively and 6, 24 and 48 hours postoperatively. Increase in the serum creatinine level at 6, 24 and 48 hours after surgery was used to analyze the diagnostic value of urinary NGAL. In this study 42 CABG patients with no known renal insufficiency planned to have CPB were included. Receiver-operator characteristic (ROC) was constructed by using NGAL, which gave a cut off value of ≥185.90ng/ml. Eight patients were AKI positive among them 6(75.0%) patients were NGAL positive and 2(25.0%) were NGAL negative. Diagnosis of AKI was delayed by 24-48 hours by serum creatinine measurement. This study has demonstrated that level of urinary NGAL concentration at 6 hours post CPB increased before the increase of serum creatinine level and NGAL is an early predictor of AKI in adult cardiac surgical patients. The early detection of renal injury by NGAL may allow earlier intervention in patients with high risk for AKI.

Comparison of enteric methane yield and diversity of ruminal methanogens in cattle and buffaloes fed on the same diet

An in vivo study was conducted to compare the enteric methane emissions and diversity of ruminal methanogens in cattle and buffaloes kept in the same environment and fed on the same diet. Six cattle and six buffaloes were fed on a similar diet comprising Napier (Pennisetum purpureum) green grass and concentrate in 70:30. After 90 days of feeding, the daily enteric methane emissions were quantified by using the SF6 technique and ruminal fluid samples from animals were collected for the diversity analysis. The daily enteric methane emissions were significantly greater in cattle as compared to buffaloes; however, methane yields were not different between the two species. Methanogens were ranked at different taxonomic levels against the Rumen and Intestinal Methanogen-Database. The archaeal communities in both host species were dominated by the phylum Euryarchaeota; however, Crenarchaeota represented <1% of the total archaea. Methanogens affiliated with Methanobacteriales were most prominent and their proportion did not differ between the two hosts. Methanomicrobiales and Methanomassillicoccales constituted the second largest group of methanogens in cattle and buffaloes, respectively. Methanocellales (Methanocella arvoryza) were exclusively detected in the buffaloes. At the species level, Methanobrevibacter gottschalkii had the highest abundance (55-57%) in both the host species. The relative abundance of Methanobrevibacter wolinii between the two hosts differed significantly. Methanosarcinales, the acetoclastic methanogens were significantly greater in cattle than the buffaloes. It is concluded that the ruminal methane yield in cattle and buffaloes fed on the same diet did not differ. With the diet used in this study, there was a limited influence (<3.5%) of the host on the structure of the ruminal archaea community at the species level. Therefore, the methane mitigation strategies developed in either of the hosts should be effective in the other. Further studies are warranted to reveal the conjunctive effect of diet and geographical locations with the host on ruminal archaea community composition.

P23: ENHANCED RECOVERY PROGRAMME – DOES PREOPERATIVE EDUCATION REDUCE LENGTH OF HOSPITAL STAY (LOS) IN PRIMARY HIP & KNEE ARTHROPLASTY

Introduction

Total knee and hip arthroplasty significantly improve quality of life in people suffering from end-stage hip & knee arthritides. Enhanced recovery programs have shown improved outcomes following elective arthroplasty by decreasing patients anxiety, postoperative pain and reducing the length of hospital stay (LOS). The aim of our study is to evaluate the impact of preoperative education programs on length of hospital stay in patients undergoing hip & knee arthroplasty.

Method

Retrospective data was collected from a consecutive series of 520 patients' charts and Irish National Orthopedic Register (INOR) who underwent Hip or Knee arthroplasty from January 1, 2018, to December 31, 2018, in Our Lady Hospital, Navan. The length of stay study compared two hundred and twenty-six patients in the Educational Group (EG) who attended the Hip & Knee School (Preoperative Education Class) with 294 patients in the Conventional Group (CG) who did not attend the hip and knee educational programme.

Result

We identified that Length of Hospital Stay decreased to 5.2 days in Educational Group from 5.5 days in Conventional Group (P-value equals to 0.26, statistically insignificant, t = 1.1093 df = 518), with a mean difference of only 0.3 days (95% confidence interval).

Conclusion

Preoperative education does not reduce the length of hospital stay in primary hip & knee arthroplasty.

Take-home message

Preoperative education has no role in reducing hospital stay in Arthroplasty patients.

A113 ANNUAL COLONOSCOPY VOLUME IS NOT PREDICTIVE OF COLONOSCOPY QUALITY - FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Background

Performing a minimum number of colonoscopies annually has been proposed by some jurisdictions as a requirement for maintaining privileges. However, this practice is supported by limited evidence.

Aims

The objective of this study was to determine if annual colonoscopy volume was associated with colonoscopy quality metrics.

Methods

A population-based study was performed using the Southwest Ontario Colonoscopy cohort, which consists of all adult patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 academic and community hospitals within the health region. Data were collected through a mandatory quality assurance form completed after each procedure and pathology reports were manually reviewed. Physician annualized colonoscopy volumes were compared by correlation analysis to each quality-related outcome, by means of the area under the receiver operating characteristics curve (AUROC), and logistic regression. The prognostic value of colonoscopy volume was also adjusted for case-mix and potential confounders in separate regression analyses for each outcome. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and cecal intubation.

Results

A total of 47,195 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others). There were no clear relationships between annual colonoscopy volumes and study outcomes. Colonoscopy volume was not associated with ADR (OR 1.03, 95% CI 0.96–1.10, p=0.48) and corresponded to an AUROC not significantly different from the null (AUROC 0.52, 95% CI 0.43–0.61, p=0.65). Multi-variable regression adjusting for case-mix also demonstrated no predictive value of annual colonoscopy volume for the primary outcome (OR 1.03, 95% CI 0.94–1.12, p=0.55). Similarly, analyses of secondary outcomes failed to find an association between colonoscopy volume and PDR, SSPDR, or cecal intubation (Table 1).

Conclusions

Annual colonoscopy volumes do not predict ADR, PDR, SSPDR, or cecal intubation rate.

Results of unconditional and conditional approaches for examining the predictive value of annual colonoscopy volume for quality related outcomes.

Funding Agencies

None

Development of powder based ginger drink: analysis of dehydration kinetics and moisture sorption isotherm

The perishable herb ginger (Zingiber officinale) possesses natural aroma and different biologically active components which are beneficial for our health. This can be dried for preservation in pick season for shelf-life increment. This study studied the analysis of the chemical composition, moisture sorption isotherm, dehydration kinetics of ginger for preservation. Air drying was carried out using a cabinet dryer at different temperatures and thickness. According to the sorption isotherm study, monolayer moisture content (MMC) is higher as per Guggenheim-Anderson-DeBoer (GAB) equation compared to the Brunauer-Emmett-Teller (BET) equation. Drying rate increased with the increase in temperature at constant thickness while the adverse result was found with the increase in thickness at a constant temperature. Then, powder-based drinks were prepared by using five different percentages of ginger. The preferences of consumers were measured by statistical analysis of the scores obtained from the response of organoleptic taste panel. The sample containing 1.84% ginger powder was considered the best in overall acceptability

Free Flap Reconstruction in Head and Neck Surgery: Experience in Bangabandhu Sheikh Mujib Medical University

Free flap reconstruction after surgical ablation of head & neck cancer greatly improve the surgical outcome. Microvascular anastomosis is an important part of Microsurgery and it is not widely practiced in every center. A retrospective review was conducted in the Head & Neck Division of Otolaryngology-Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from May 2016 to June 2017. Total 20 patients with head & neck cancer had been treated surgically between this period and 14 patients were reconstructed with free flap. The focus of this study is to establish the surgical outcome, which is more with free flap reconstruction in the patients previously diagnosed as head & neck cancer. We reconstructed 14 cases of oral cavity carcinoma (Stage IV) with the free flap. Majority cases were carcinoma involving the buccal mucosa with retromolar trigone (36%) followed by buccal mucosa (22%), buccal mucosa with lower alveolus (21%), carcinoma tongue with floor of the mouth (14%) and floor of the mouth (7%). Radial forearm freflap (RFFF) were commonly used in 10 cases (71.4%) and Anterolateral thigh flap (ALT) used in four cases (21.5%). Partial flap loss was seen in one case and wound infection occurred in another case but both were managed successfully with postoperative dressing and debridement. Microvascular free flap reconstruction can be a good choice after surgical removal of the head & neck cancer diseases and it should be practiced in every well-equipped tertiary medical center with the help of properly trained surgeon.

Evaluation of environmental effects of heavy metals on biochemical profile and oxidative stress among children at brick kiln sites

The present study was designed to study the health risks among children living at brick kiln industries. A survey was conducted, questionnaires were filled out, and demographic data was collected from Punjab, Pakistan. Heavy metals burden and BMI were calculated, hematological and enzyme analysis, comet assay and hormonal ELISA were performed. The results showed decreased BMI, RBC count and hematocrit in the exposed group. Nickel, cadmium, zinc and chromium concentrations in whole blood were detected among exposed children. Antioxidant enzymes and growth hormone concentration decreased, while reactive oxygen species and cortisol level increased in the exposed group. The comet assay findings showed decreased percentage DNA in the head and increased in the tail region among exposed group. It was concluded that children living at brick kiln sites experienced decreased BMI, altered antioxidant enzymes status and hormone levels and cellular DNA damage that pose a major threat on child health.

Perceptions and preparedness of veterinarians to combat brucellosis through Brucellosis Control Programme in India

Background and Aim:

Brucellosis caused by bacteria belongs to the genus Brucella is an important zoonosis and constitutes a serious public health hazard worldwide including India. The present study aimed to estimate the knowledge of veterinarians on brucellosis, its public health threat, diagnosis, and vaccination.

Materials and Methods:

This cross-sectional study was conducted during 2013-2015 and 453 veterinarians representing 11 states/Union Territories (UT) of India (Assam, Tripura, Meghalaya, Goa, Karnataka, Madhya Pradesh, Uttar Pradesh, Delhi, Jammu and Kashmir, Tamil Nadu, and Punjab) were interviewed using self-administered questionnaire.

Results:

Out of 453 veterinarians, 71.74% stated handling of the animals on day-to-day basis and 28.25% were engaged in administration activities. The veterinarians ranked foot-and-mouth disease and brucellosis at the first and fourth ranks among the list of ten economic impacted diseases in the country. A significant association was observed between laboratory confirmation with those who handled brucellosis-suspected cases (p=0.000). Similarly, significant association was noted for the availability of vials/slides (p=0.114), vacutainers (p=0.008), icebox (p=0.103), and refrigerator (p=0.106) for those who preferred laboratory diagnosis. Only 20% of the veterinarians recommended vaccination against bovine brucellosis, and 17% obtained laboratory confirmation for the brucellosis-suspected cases.

Conclusion:

The study highlighted the need for awareness programs, laboratory facilities, veterinary doctors, and protective measures for the veterinarians for combating brucellosis through the control program in the country.

Total Lip Reconstruction after Excision of Cancer with Composite Radial Forearm Palmaris Longus Tendon Free Flap

Reconstruction of total lip is a challenging task for a plastic surgeon. It becomes more complicated when there is loss of additional tissues like angle of mouth, buccal mucosa or floor of the mouth. Radial forearm flap with palmaris longus tendon provides an easier but reliable technique for three dimensional lip reconstructions with good functional and aesthetic outcome. In this short observational series we included 5 patients of total lip reconstruction and conducted at Sylhet MAG Osmani Medical College Hospital and Private Clinic of Sylhet, Bangladesh from January 2014 to December 2017. Among these one was a case of basal cell carcinoma of upper lip and rest was squamous cell carcinoma of lower lip. The mean age was 71 years. All the flaps survived and patients had normal speech and oral continence. Composite radial forearm flap with palmaris longus tendon is a good, reliable option for total lip reconstruction.

Scorecard method for assessing the severity of peste des petits ruminants in sheep and goats

A methodology to assess the clinical severity of peste des petits ruminants (PPR) in sheep and goats in the field condition was developed using a scorecard by considering five specific cardinal clinical signs (pyrexia, oculo-nasal discharge, oral lesions, respiratory signs, and diarrhoea) of disease. The scores were assigned for the signs based on the severity of the disease that ranged from 1 (low) to 4 (high). The assigned weightage for signs, morbidity, and mortality was 0.75, 0.05 and 0.2, respectively summing up to unity. The scoring and weightages and guidelines were devised by Delphi technique based on the field investigation, field veterinarian's assessment and specific inputs from PPR experts. The estimated Weighted Score Index (WSI) was considered to classify the severity into mild (WSI < 40) or moderate (WSI 41-60) or severe (WSI > 60) form. This scorecard will help preliminarily to the extent for the identification of the suspected flocks with a required case definition at the first instance, before making decisions on what merits further field investigation. This is first of its kind of methodology to assess the disease pattern in small ruminants and could be used as a disease severity assessment tool in different geographical areas in endemic settings.

Brucellosis in India: results of a collaborative workshop to define One Health priorities

Brucellosis is an important zoonosis worldwide. In livestock, it frequently causes chronic disease with reproductive failures that contribute to production losses, and in humans, it causes an often-chronic febrile illness that is frequently underdiagnosed in many low- and middle-income countries, including India. India has one of the largest ruminant populations in the world, and brucellosis is endemic in the country in both humans and animals. In November 2017, the International Livestock Research Institute invited experts from government, national research institutes, universities, and different international organizations to a one-day meeting to set priorities towards a "One Health" control strategy for brucellosis in India. Using a risk prioritization exercise followed by discussions, the meeting agreed on the following priorities: collaboration (transboundary and transdisciplinary); collection of more epidemiological evidence in humans, cattle, and in small ruminants (which have been neglected in past research); Economic impact studies, including cost effectiveness of control programmes; livestock vaccination, including national facilities for securing vaccines for the cattle population; management of infected animals (with the ban on bovine slaughter, alternatives such as sanctuaries must be explored); laboratory capacities and diagnostics (quality must be assured and better rapid tests developed); and increased awareness, making farmers, health workers, and the general public more aware of risks of brucellosis and zoonoses in general. Overall, the meeting participants agreed that brucellosis control will be challenging in India, but with collaboration to address the priority areas listed here, it could be possible.

2380Mechanisms of myocardial ischemia during exercise in microvascular angina

Background

Coronary microvascular dysfunction (MVD) is defined by impaired flow augmentation in response to a vasodilator, the pathophysiological basis of which is unclear. This study sought to address two major gaps in our understanding of MVD: firstly, whether diminished flow reserve is due to structural changes within the microvasculature or potentially reversible dysfunction and secondly to unravel the mechanism of exercise-induced ischemia in the absence of obstructive disease.

Methods

Simultaneous intracoronary pressure and flow velocity recordings were made in the left anterior descending artery of patients with angina and no obstructive epicardial disease (Fractional Flow Reserve >0.80). Measurements were made at rest, during adenosine-mediated hyperaemia and supine bicycle exercise. Wave intensity analysis was used to quantify waves that accelerate and decelerate coronary blood flow, coronary perfusion efficiency being defined as the proportion of total wave energy that accelerates blood flow. Patients were prospectively classified into MVD (coronary flow reserve <2.5) and controls with researchers blinded to the classification throughout the protocol. Myocardial perfusion and vascular function were assessed by 3T cardiac MRI and venous occlusion plethysmography with forearm blood flow (FBF) assessment during serial infusions of acetylcholine, adenosine and the nitric oxide synthase inhibitor NG-monomethyl-L-arginine (L-NMMA).

Results

78 patients were enrolled (42 patients had MVD and 36 were controls), with no differences in cardiovascular risk factors between groups. The MVD group had elevated coronary blood flow (21.3±6.4 vs. 15.1±4.5cm s–1; p<0.001) and global myocardial perfusion (1.36±0.37 vs. 1.13±0.22ml/min/g; p=0.01) at rest. Maximum coronary and myocardial blood flow during hyperaemia was similar in both groups. During exercise, MVD patients achieved similar peak flow (30.5±10.0 vs. 26.3±7.7cm s–1; p=0.07) despite a higher rate-pressure product (20777±5205 vs. 17450±4710bpm.mmHg; p=0.01). Coronary perfusion efficiency, decreased with exercise in the MVD group (61±11% vs. 44±10% p<0.001) but was unchanged in controls. On MRI, MVD had lower hyperaemic endo-epicardial perfusion ratio than controls (0.94±0.08 vs. 1.04±0.13; p=0.001). Augmentation of FBF with acetylcholine was attenuated in MVD patients compared to controls (p=0.02) but the response to adenosine was similar (p=0.13). Infusion of L-NMMA caused a significantly greater reduction in FBF in MVD patients compared to controls (p<0.001).

Exercise Physiology in MVD

Conclusion

Impaired flow reserve in MVD represents a dysfunctional state, characterised by inappropriately elevated resting flow due to increased nitric-oxide synthase mediated vasodilatation. There is abnormal flow distribution in the myocardium predisposing to subendocardial ischaemia, associated with and exacerbated by impaired cardiac-coronary coupling during exercise. These novel findings may represent distinct therapeutic targets.

Acknowledgement/Funding

British Heart Foundation

P6484Invasive and non-invasive characterisation of low gradient aortic stenosis

Background

Low gradient severe aortic stenosis (LGAS) is associated with unfavourable outcomes when compared to high gradient aortic stenosis (HGAS), yet the contributing pathophysiology is poorly understood.

Methods

Symptomatic LGAS and HGAS patients undergoing trans-catheter aortic valve implantation (TAVI) underwent 3T stress perfusion cardiac magnetic resonance imaging (CMR) pre-(within 24 hours) and post-(4–6 months) TAVI. Left ventricular (LV) contractility and coronary flow/pressure were measured during hyperaemia and rapid pacing, immediately before and after TAVI, using a conductance LV catheter and dual-pressure and Doppler sensor–tipped guidewire in the mid-left anterior descending coronary artery.

Results

24 patients were recruited resulting in 19 suitable datasets (LGAS N=9, HGAS N=10, equally matched for comorbidities and B-natriuretic peptide level). LGAS patients had a smaller LV end diastolic volume index (p=0.035) and lower LV mass index (LVMI) (p=0.037). Pre-TAVI stress global endocardium-epicardium gradient was 0.88±0.09 and global myocardial perfusion reserve (MPR) 2.0±0.48 in 14 patients (6 LGAS and 8 HGAS patients, no difference between groups). Pre-TAVI, baseline coronary data demonstrated lower augmentation pressure (AP, p=0.035) and augmentation index (AIx, p=0.02) in the LGAS group. LGAS patients also exhibited a shorter ejection time (p=0.015), larger forward compression waves during rest, hyperaemia and rapid pacing, and smaller backward expansion waves (BEW) (p=0.001). Lower baseline end systolic pressure (p=0.004), inotropy (dP/dt+, p=0.045), lusitropy (dP/dt-, p=0.069), and stroke work (p=0.019) were observed in the LGAS group. Whilst LV size was smaller the LGAS group, rapid pacing induced a more significant drop in end systolic volume (p=0.045) and ejection fraction (p=0.015) in patients with HGAS. Post-TAVI, the hyperaemic BEW fell sharply (p<0.001), along with coronary VTI (p=0.02), and average pulse velocity (p=0.028), and AP and AIx remained lower (p=0.034 and p=0.031, respectively). The forward expansion wave was reduced in LGAS during rapid pacing. The HGAS group displayed a more profound drop in dP/dt+ (p=0.011) and dP/dt- p=0.014) at rest following intervention. Repeat CMR demonstrated statistically significant reduction in LV size and LVMI (p=0.012 and p<0.001, respectively) with significant increase in 3D global peak radial, circumferential and longitudinal strain (p=0.004, p=0.001 and p=0.018, respectively). Post-TAVI stress global endocardium-epicardium gradient was 0.88±0.13 and MPR 2.46±0.59 (improved from pre-TAVI, p=0.05). There was no difference in remodelling patterns or perfusion between the two groups.

Conclusion

This is the first study detailing the combined invasive and CMR pathophysiological changes in LGAS. Despite invasive parameters indicating a disease of less severe AS, the level of perfusion abnormality is disproportionate which may in part, relate to their adverse prognosis.

Acknowledgement/Funding

This research is funded by a Clinical Research Training Fellowship grant from the British Heart Foundation (FS/16/51/32365).

Development of an antigen ELISA using monoclonal antibodies against recombinant VSG for the detection of active infections of Trypanosoma evansi in animals

Trypanosoma evansi, a haemo-flagellated protozoan parasite causes chronic wasting disease in a wide range of animals. For its diagnosis, blood smear examination is useful in clinical cases for direct identification of the parasite but in latent infection the carrier animals are difficult to screen out by conventional blood smear test. Harboring low level of parasites and showing no symptom, the carrier animals for surra can act as a source of infection. The level of parasitaemia fluctuates, especially during latent infection; moreover the antibodies which are not found early in the infection may persist even after recovery or chemotherapy. In the present study a double antibody sandwich ELISA exploring, monoclonal antibodies and hyperimmune serum, raised against recombinant variable surface glycoprotein has been developed to detect circulating trypanosome antigens. The developed antigen detection ELISA (Ag-ELISA) was evaluated using 652 blood samples collected from cattle, buffalo, equine and camel. The statistical analysis of the data showed diagnostic sensitivity and specificity at 97.4% and 96.4% respectively, with a positive-negative cut-off OD value >0.28. Furthermore, the detection limit of the assay was found to 7.15 trypanosomes per mL. The present finding revealed that the developed assay can be exploited as a potential diagnostic test in the detection of circulating trypanosome antigens and also can be used as a population screening test for multiple animal species for detection of active infection for further treatment and control of the disease.

Prevalence and Predictors of Depression among Patients with Type 2 Diabetes: A Multicenter Cross-sectional Study from Bangladesh

Depression is a common comorbidity of type 2 diabetes mellitus (T2DM) which adversely affects diabetes management and outcome. Identifying and treating comorbid depression may improve diabetes care. This cross-sectional study was conducted in several tertiary hospitals throughout Bangladesh from July 2017 to April 2018. Nine hundred (900) adult patients with T2DM aging ≥25 years having diabetes for at least 6 months and equal numbers of non-diabetic otherwise healthy controls were recruited from the outpatient departments of these centers. Depression was assessed in all consenting patients and controls by administering the Bangla (local language) version of the PRIME-MD Patient Health Questionnaire (PHQ-9); participants obtaining a score of 5 or more were labeled to have depression. Depression was present in 60.3% of T2DM patients and in 29.4% of controls. Statistically significant difference was found in age, marital status, occupation, body mass index (BMI), waist circumference, systolic blood pressure (BP), diastolic BP and PHQ-9 score between diabetic and non-diabetic subjects (<0.001). T2DM subjects had 4.71-fold higher odds of depression in comparison to the controls (95% CI: 3.76-5.90; p<0.001). Age ≥50 years, unmarried status, years of schooling ≤10 years, underweight, abdominal obesity, and hypertension appeared to be the significant predictors of depression in the study subjects. In T2DM subjects, diabetes in the family members, the presence of other comorbidities, diabetic complications, diabetes duration >5 years, insulin use, using insulin syringe for injection, albuminuria and CKD were the important predictors of depression. Our study found higher prevalence and risk of depression in T2DM patients than their non-diabetic counterparts. T2DM patients should be screened for depression in order to achieve and maintain the treatment goals.

Pathological Changes in Experimental Intramammary Infection with Different Staphylococcus Species in Mice

Introduction

Mastitis is caused by different Staphylococcus species, produce great economic loss to farmers. Present study was conducted to know pathological changes in mice inoculated with Staphylococcus epidermidis, S. chromogenes, S. haemolyticus and S. aureus isolated from bovine milk.

Materials and Methods

Mice were inoculated with 50 μl (2x104 cfu organisms) per mammary gland and euthanized at 6, 12, 24, 48, 72 and 96 h. Mammary gland weight, gross and histopathological changes of mammary gland, liver, kidney, spleen, heart, lung and inguinal lymph node were studied.

Results

Mammary gland weight and percentage of body weight increased at 6 and 96 h in S. aureus and S. haemolyticus infected mice. Gross changes were observed in mammary gland but not in other organs. Mammary gland revealed gross changes from 24 to 72 h in three Coagulase negative staphylococcal (CNS) species and persisted up to 96 h in S. aureus infected mice. Histopathological changes in mammary glands was severe in S. aureus and moderate in CNS species. S. aureus infected mice revealed severe damage to alveoli and loss of alveolar architecture at 96 h but three CNS species infection was overcome by host factors which was evident by proliferation of alveolar epithelial cells. No histological changes were observed in kidney, spleen, lung, heart and inguinal lymph nodes.

Conclusions

S. aureus caused severe mastitis in mice when compared to CNS species. Further, it is first report of mice to study CNS mastitis, and in future it can be used as model for CNS mastitis.

An inhibition enzyme immuno assay exploring recombinant invariant surface glycoprotein and monoclonal antibodies for surveillance of surra in animals

The present study is aimed at the development of inhibition ELISA (I-ELISA) exploring monoclonal antibodies (MAbs) and recombinant invariant surface glycoprotein. The extracellular domain (ED) of invariant surface glycoprotein (ISG-75) from Trypanosoma evasni has been heterologously expressed in Pichia pastoris (X-33). The recombinant ISG-75 (rISG-75ED) was characterized by immunoblot and ELISA, followed by the production of MAbs against rISG-75ED. The MAbs were characterized by immunoblot and then explored in the development of I-ELISA for the detection of surra. The diagnostic potential of the developed test has been evaluated using 1192 field sera sample including cattle, buffalo, donkey, horse and camel. The statistical analysis of the data showed optimum combination of diagnostic sensitivity and specificity at 98.8% and 99.2% respectively, with cut-off percentage inhibition (PI) value of >45. The Cohen's kappa coefficient of agreement was found to be 0.98. Hence, the diagnostic test developed in the present study can be exploited as a potential and reliable tool in the serodiagnosis and surveillance of surra in animals.

Dual Infection with Bluetongue Virus Serotypes and First-Time Isolation of Serotype 5 in India

Bluetongue is endemic in India and has been reported from most Indian states. Of late, the clinical disease is most frequently seen in the states of Andhra Pradesh, Telangana (erstwhile Andhra Pradesh state), Tamil Nadu and Karnataka. Our analysis of diagnostic samples from bluetongue outbreaks during 2010-2011 from the state of Karnataka identified bluetongue virus (BTV) serotype 5 (BTV-5) for the first time in India. One of the diagnostic samples (CH1) and subsequent virus isolate (IND2010/02) contained both BTV-2 and BTV-5. Segment 2 (seg-2) sequence data (400 bp: nucleotides 2538-2921) for IND2010/02-BTV5, showed 94.3% nucleotide identity to BTV-5 from South Africa (Accession no. AJ585126), confirming the virus serotype and also indicating that Seg-2 was derived from a Western topotype, which is in contrast to serotype 2, that belongs to an Eastern topotype. BTV-5 has been recently reported from Africa, China, French islands and the Americas. Although the exact source of the Indian BTV-5 isolate is still to be confirmed, recent identification of additional exotic serotypes in India is of real concern and might add to the severity of the disease seen in these outbreaks.

Phylogenetic analysis of glycoprotein B gene sequences of bovine herpesvirus 1 isolates from India reveals the predominance of subtype 1.1

AIM

This study was conducted for the isolation and molecular characterization of bovine herpesvirus 1 (BoHV-1) isolated from the nasal and vaginal swabs collected from naturally infected cattle showing clinical symptoms of the respiratory disease.

MATERIALS AND METHODS

Isolation of BoHV-1 virus performed on clinical samples collected from 65 cattle from five states of India. The BoHV-1 isolates were further confirmed by polymerase chain reaction (PCR) using primers specific for glycoprotein B (gB) genomic region. PCR amplification was performed using previously published gB gene-specific primer pairs. gB PCR amplicons obtained from all isolates were sequenced, and phylogenetic analysis was performed using software.

RESULTS

A total of 12 samples were found positive in cell culture isolation. 11 isolates showed the visible cytopathic effect on Madin-Darby bovine kidney after 72 h. Partial sequence analysis of gB gene of all isolates revealed 99.0-100% homology between them. All isolates showed 99.2-99.8% homology with Cooper stain.

CONCLUSION

BoHV-1.1 is the predominant circulating subtype of BoHV in India, and all isolates have homology with Cooper stain.

Cytokine gene expression and pathology in mice experimentally infected with different isolates of Trypanosoma evansi

Aim of the present study was to assess the cytokine gene expression in liver, kidney and spleen and histopathological changes in mice infected with buffalo and dog isolates of Trypanosoma evansi. Forty-four Swiss albino mice was divided into eleven groups of four mice each and injected subcutaneously with 1 × 10⁵ trypanosomes of buffalo and dog isolate to twenty mice each, four mice served as control. Mice were examined for clinical signs, blood smear for trypanosome counts. Blood for PCR, liver, kidney, spleen, heart, lung, testis and abdominal muscle for histopathology and liver, kidney, spleen for cytokine gene expression studies, were collected. Mice showed dullness, lethargy, hunched back, sluggish movements on D4 and D5 in buffalo and dog isolate, respectively. Parasite count in blood varied between the two isolates of T. evansi. By PCR, trypanosome DNA was detected on D1 and D2 for buffalo and dog isolate, respectively. Splenomegaly was observed in mice infected with buffalo isolate but not with dog isolate. Histopathological changes were observed in liver, kidney, spleen and heart of mice but no changes in testis and abdominal muscles. Blood vessels of liver, heart, lung showed presence of trypanosomes in mice infected with buffalo isolate but not for dog isolate. Cytokine gene expression of IL-2, IL-4, IL-6, IL-12, TNF-α and IFN-γ increased in liver, kidney and spleen in both these isolates. However, the buffalo isolate exhibited pronounced increase in cytokine gene expression when compare to dog isolate of T. evansi. Anti-inflammatory cytokine gene IL-10 showed 50-60 and 10-20 folds increment in buffalo and dog isolates, respectively. This is the first report of IL-4, IL-6, IL-10 and IL-12 cytokine changes in mice infected with T. evansi. A variation in pathogenicity between buffalo and dog isolates was recorded indicating buffalo isolate of T. evansi remained more pathogenic in mice.

Serum C-reactive Protein (CRP) Level in Tuberculous Patients

The present prospective case control study was carried out to assess the role of C-reactive protein (CRP) level as a diagnostic and prognostic tool of tuberculous patients. The study was conducted in the Department of Paediatrics over a period of one year. Total 60 persons were included. Case was 30 and control was 30. Out of 30 tuberculosis patients 18(60%) had pulmonary tuberculosis, 6(20%) had abdominal TB, 3(10%) had pleural effusion and 3(10%) had tubercular lymphadenopathy. CRP was positive>6 mg/L in 25(83.3%) cases. CRP level was negative after 4 weeks of treatment. There is significant difference at p<0.001 in serum CRP level in between tuberculosis and healthy children. The study concluded that CRP level is a useful indication for diagnosis and prognosis of tuberculous patients.

Prevalence of classical swine fever in Karnataka, India

Aim:

The present study was conducted to know the current scenario of classical swine fever (CSF) in Bengaluru Urban, Bengaluru Rural, Chikkaballapur, Madikeri, Mandya, Bagalkot, Gadag, Yadgir, Koppal, and Bidar districts of Karnataka with the using of both antigen and antibody ELISA.

Materials and Methods:

We collected 218 sera and 121 blood samples from pigs from 10 different districts of Karnataka. Screening of sera for CSF IgG antibody and whole blood for CSF virus antigen were carried out using the CSF virus (CSFV) antibody and antigen ELISA kits, respectively.

Results:

The mean seroprevalence was 41% (89/218) and prevalence of CSFV antigen in blood samples was 32% (39/121) for the 10 districts of Karnataka. Seroprevalence of 61%, 29%, 20%, and 21%; and antigen prevalence of 40%, 50%, 13%, and 12% were recorded for Bangalore, Mysore, Belgaum, and Gulbarga divisions of Karnataka, respectively.

Conclusions:

The study revealed an alarmingly high prevalence of CSF, both for the antigen (32%) and antibody (41%) in Karnataka. Southern Karnataka has the highest seroprevalence (61% in Bangalore and 29% in Mysore divisions), which confirms the endemicity of the disease in that region. This could be attributed to the intensive pig farming practices in the region as compared to Northern Karnataka (Seroprevalence of 20% in Belgaum and 21% in Gulbarga divisions), where the commercial pig farming is still in infantile stages.