Dynamics of sediment phosphorus in the middle and lower stretch of River Ganga, India: insight into concentration, fractionation, and environmental risk assessment of phosphorus.

Despite continuous efforts, eutrophication is still occurring in freshwater and phosphorus (P) is the most important nutrients that drive the eutrophication in rivers and streams. However, little information is available about the distribution of P fractions in river sediment. Here, the sequential extraction approach was used to evaluate the sediment P fractionation and its content in the anthropogenically damaged river Ganga, India. Different sedimentary P fractions viz. exchangeable (Ex-P), aluminum bound (Al-P), iron bound (Fe-P), calcium bound (Ca-P), and organically bound phosphorus (Org-P), were quantified. Significantly higher level of total P was recorded in pre-monsoon season (438.5 ± 95.8 mg/kg), than other [winter (345.7 ± 110.6 mg/kg), post-monsoon (319.2 ± 136.3 mg/kg), and monsoon (288.6 ± 77.3 mg/kg)] seasons. Different P fractions such as Ex-P, Al-P, Fe-P, Ca-P and Org-P varied from 2.88-12.8 mg/kg, 7.64-98.8 mg/kg, 32.2-179.2 mg/kg, 51.97-286.1 mg/kg and 9.3-143.7 mg/kg, respectively, which correspondingly represented 0.5-10.54%, 3.41-20.18%, 17.27-37.82%, 37.35-60.2%, 4.15-25.88% of the Total P with a rank order of P-fractions was Ca-P > Fe-P > Org-P > Al-P > Ex-P. Bio-available P contributes a considerable portion (37.9-46.0%) of total P which may increase the eutrophication to overlying water. Results demonstrate that inorganic P species control the P bio-availability in both time and space. However, an estimated phosphorus pollution index based on sediment total P content showed no ecological risk of phosphorus to Ganga River sediment.

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.

Outbreak of Ichthyophthirius multifiliis associated with Aeromonas hydrophila in Pangasianodon hypophthalmus: The role of turmeric oil in enhancing immunity and inducing resistance against co-infection.

Ichthyophthirius multifiliis, a ciliated parasite causing ichthyophthiriasis (white spot disease) in freshwater fishes, results in significant economic loss to the aquaculture sector. One of the important predisposing factors for ichthyophthiriasis is low water temperature (i.e., below 20°C), which affects the health and makes freshwater fishes more susceptible to parasitic infections. During ichthyophthiriasis, fishes are stressed and acute immune reactions are compromised, which enables the aquatic bacterial pathogens to simultaneously infect the host and increase the severity of disease. In the present work, we aimed to understand the parasite-bacteria co-infection mechanism in fish. Later, Curcuma longa (turmeric) essential oil was used as a promising management strategy to improve immunity and control co-infections in fish. A natural outbreak of I. multifiliis was reported (validated by 16S rRNA PCR and sequencing method) in Pangasianodon hypophthalmus from a culture facility of ICAR-CIFRI, India. The fish showed clinical signs including hemorrhage, ulcer, discoloration, and redness in the body surface. Further microbiological analysis revealed that Aeromonas hydrophila was associated (validated by 16S rRNA PCR and sequencing method) with the infection and mortality of P. hypophthalmus, confirmed by hemolysin and survival assay. This created a scenario of co-infections, where both infectious agents are active together, causing ichthyophthiriasis and motile Aeromonas septicemia (MAS) in P. hypophthalmus. Interestingly, turmeric oil supplementation induced protective immunity in P. hypophthalmus against the co-infection condition. The study showed that P. hypophthalmus fingerlings supplemented with turmeric oil, at an optimum concentration (10 ppm), exhibited significantly increased survival against co-infection. The optimum concentration induced anti-stress and antioxidative response in fingerlings, marked by a significant decrease in cortisol and elevated levels of superoxide dismutase (SOD) and catalase (CAT) in treated animals as compared with the controls. Furthermore, the study indicated that supplementation of turmeric oil increases both non-specific and specific immune response, and significantly higher values of immune genes (interleukin-1ß, transferrin, and C3), HSP70, HSP90, and IgM were observed in P. hypophthalmus treatment groups. Our findings suggest that C. longa (turmeric) oil modulates stress, antioxidant, and immunological responses, probably contributing to enhanced protection in P. hypophthalmus. Hence, the application of turmeric oil treatment in aquaculture might become a management strategy to control co-infections in fishes. However, this hypothesis needs further validation.

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.

Interplay of piezoresponse and magnetic behavior in Bi0.9A0.1FeO2.95 (A = Ba, Ca) and Bi0.9Ba0.05Ca0.05FeO2.95 co-doped ceramics.

Extensive piezoresponse force microscopy (PFM) and magnetic force microscopy (MFM) measurements in conjunction with piezoresponse spectroscopy have been carried out on pellets of Bi0.9A0.1FeO2.95 (A = Ba, Ca) and Bi0.9Ba0.05Ca0.05FeO2.95 co-doped ceramic samples in order to characterize their ferroelectric and magnetic nature and correlate the findings with our recent far-infrared spectroscopic studies on these samples. We are able to clearly discern the switching behavior of the 71° and 109° ferroelectric domains as distinct from that of the 180° domains in both pristine and Ba-doped bismuth ferrite samples. While substitution of Ba at the Bi site in bismuth ferrite does not affect the ferroelectric and magnetic properties to a great extent, Ca-doped samples show a decrease in their d 33 values with a concomitant increase in their magnetic behavior. These results are in agreement with the findings from our far-infrared studies.

Invasive pulmonary aspergillosis infection in severely ill COPD patients in pulmonary ward and ICU.

PURPOSE: This study was planned to determine the trends and susceptibility pattern of invasive pulmonary aspergillosis (IPA) in severely ill chronic obstructive pulmonary disease (COPD) patients admitted in pulmonary ward and ICU of our tertiary care centre. METHODS: Fifty COPD patients suspected of IPA from pulmonary ward and ICU from April 2017 to September 2018 were investigated. Samples were processed by standard methods, culture positive isolates were confirmed by MALDI-TOF MS and antifungal susceptibility testing was performed by microbroth dilution method. RESULTS: Twenty-two critically ill COPD patients were microbiologically positive for IA infection, of which 13 were classified as putative invasive aspergillosis. The most common comorbid illness associated was diabetes. A. flavus and A. fumigatus were the commonest species isolated. The minimum inhibitory concentration of the antifungals was low. Morbidity due to IPA in COPD patients was very high. CONCLUSIONS: Prevalence of IPA in the pulmonary ward and ICU was found to be 9.6%. MALDI-TOF seems to be a promising tool for aiding rapid identification especially for slow growing and non-sporulating fungi. Heightened awareness and suspicion for pulmonary mould infections along with early diagnosis can substantially alter the patient prognosis.

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.

Cerebrospinal fluid Gene XPERT (CBNAAT) in children with tuberculous meningitis.

OBJECTIVES: To observe the role of CSF Gene XPERT (CBNAAT) in diagnosis of tuberculous meningitis (TBM) and determine its sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). METHODS: A prospective study was done from October 2017 to March 2020. CSF samples of 55 children diagnosed as tuberculous meningitis as per defined clinical and imaging criteria, were subjected to routine CSF analysis, MGIT culture and CBNAAT. Children on prior anti-tuberculous therapy for more than one month were excluded from study. RESULTS: Of 55 children, meningeal signs were present in 54.5% children. Neurological deficits were present in 47.3%. Common CT brain findings were communicating hydrocephalus followed by infarct and basal exudates. CSF Gene XPERT (CBNAAT) were positive in 9 (16.4%), of which 6 was also culture positive and 3; negative. Two children were rifampicin resistant. Fifteen (27.3%) children had positive CSF culture. Gene XPERT showed sensitivity, specificity, PPV, NPV and diagnostic accuracy of 40%, 92.5%, 66.7%, 80.4% and 78.2% respectively as compared to culture. CONCLUSION: Although sensitivity of CSF CBNAAT is low i.e. 40% but positive result not only confirm bacteriological diagnosis of tuberculous meningitis but also reveal about rifampicin sensitivity and resistance for plan of therapy.

On valorization of solvent extracts of Terminalia arjuna (arjuna) upon DNA scission and free radical scavenging improves coupling responses and cognitive functions under in vitro conditions.

Chronic diseases have been treated using the phytochemical concepts of ethnomedicinal plant-derived herbal products. Terminalia arjuna, a significant ethnomedicinal plant, was revisited and reconnoitred for antioxidant, free radical scavenging, and DNA nicking inhibiting activity under H2O2 conditions using 21 solvent extracts. Ferric reducing antioxidant power (FRAP), 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulphonic acid, and nitrous oxide scavenging (%) were found to have a strong positive association and interaction (PCA 1 explains 84.54% variation) with ethanol bark (Etoh-AB) (Meoh-AF). TPC (144.67-1794 µg/mL GAE) and TFC (2.5-34 µM Fe(II)/g were highest in Etoh-AB. In a pattern of combined solvent extracts, Etoh-AB had the highest antioxidant capacity, accompanied by Etoh-AL ≥ Meoh-AB ≥ Dw-AF. With R2 = 0.94, the DNA nicking inhibition behaviour parameters relative front, relative quantity, band (%), and lane (%) formed a positive significant (p < 0.01) connection. For the first time, we show that Etoh-AB nicks supercoiled, circular plasmid DNA in a way that is comparable to normal antioxidants. Normal antioxidants with the ability to prevent DNA nicking include Butylated hydroxy anisole < Butylated hydroxy toluene < ascorbic acid < and Gallic acid. Gallic acid (m/z 170.0208 g/mol) and Ellagic acid (m/z 302.0063 g/mol were present in high concentrations in solvent extracts. 0.48 mg was found to be the effective concentration for inhibiting relative DNA nicking. The current study is the first of its kind to show that steroid concentrations are higher in bark fractions of acetone, ethanol, and methanol. Furthermore, T. arjuna solvent extracts provide a wealth of information on phytochemical profiling, antioxidant ability, and DNA nicking inhibition, which may be useful for exploring the natural way and further research to develop a remedy against geriatric chronic disease. Despite the fact that ethanol is very close to methanol in terms of solvent toxicity, the current study identified it as the preferred solvent. Thus, the current research revisits previous studies and explores the potentiality of non-polar and polar aprotic and polar protic solvent systems, which lend credence to bioactive compounds that may be useful in isolating and formulating safe and cost effective herbal medicament for livestocks and aquaculture, and drugs for deoxygenerative human diseases, and can also be investigated further to instil environmental frugality.

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 (Igeo), 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. Igeo, CF, mCd, 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.

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.

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.

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.

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.

A randomized pilot study to compare hair follicle cell suspensions prepared using trypsin alone versus trypsin in combination with collagenase type I for transplantation in vitiligo.

BACKGROUND: Noncultured extracted hair follicle outer root sheath cell suspension (NC-EHF-ORS-CS) is an upcoming surgical technique to treat stable vitiligo. Conventionally it employs trypsin to tap the hair follicle (HF) reservoir for autologous melanocytes and their precursors for transplantation. However, a perifollicular dermal sheath composed of type 1 collagen encases the target 'bulge' region of the HF. Adding collagenase type 1 would digest the ORS, facilitating better release of cells. AIM: To compare the repigmentation achieved using trypsin and a combination of collagenase plus trypsin, respectively, with dermabrasion alone, and to compare cell counts, viability and composition of both suspensions. METHODS: This was a randomized, double-blind, comparative, therapeutic trial, conducted as a pilot study on 22 patients with stable vitiligo. Three similar patches were randomized into three parallel treatment arms [(A) trypsin plus collagenase, (B) trypsin alone and (C) dermabrasion with vehicle alone]. Each patient's HF sample was divided and digested by the two methods, and transplanted as suspensions onto dermabraded patches, while a third dermabraded patch received the vehicle only. Suspensions were sent for laboratory analysis. Repigmentation was assessed over a follow-up of 6 months. RESULTS: There was a significant increase in cell yield and comparable viability when collagenase was added. Immunohistochemical and flow cytometry studies showed a nonsignificant increase in HMB45+ melanocytes and their precursor stem cells in group A. This trend was reflected clinically in the extent of repigmentation [group A (33.22%) > B (24.31%) > C (16.59%); P = 0.13]. Adding collagenase induced significantly higher repigmentation than dermabrasion alone (P < 0.05). CONCLUSIONS: Incorporating collagenase type I into the conventional NC-EHF-ORS-CS technique resulted in enhanced retrieval of pigment-forming cells and subsequently improved repigmentation in vitiligo.

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.

Emerging multidrug resistance isolates of hospital-acquired bacterial meningitis in a tertiary care centre in North India.

Purpose. Acute bacterial meningitis continues to be a potentially life threatening condition. Hospital-acquired meningitis is rapidly increasing and adding an immense burden to the health system due to the emergence of multidrug resistance isolates. The purpose of this study is to find the antibiotic susceptibility pattern of the bacteria detected from hospital- and community-acquired meningitis.Methodology. A total of 400 Cerebrospinal fluid (CSF) samples from the suspected meningitis cases were collected and processed for cell count, biochemical examination, Gram staining, latex agglutination and culture. Bacteria grown on blood, chocolate and Mac-conkey agar were identified by matrix-assisted laser desorption/ionization-time of flight. Antibiotic susceptibility tests were performed as per Clinical and Laboratory Standard Institute guidelines.Results. Of the isolates, most prevalent Gram negative organisms in hospital-acquired bacterial meningitis were Escherichia coli 13 (27.08 %), Acinetobacter baumannii 12 (25 %), Klebsiella pneumoniae 5 (10.42 %), Pseudomonas aeruginosa 4 (8.33 %) and Gram positive organisms were Staphylococcus aureus 4 (8.33 %), Enterococcus faecium 3 (6.25 %) and CONS 2 (4.16 %). Streptococcus pneumoniae 3 (6.25 %) was the predominant organism in community-acquired bacterial meningitis. All the Gram negative isolates were multidrug resistance. Only colistin and imipenem were effective antibiotics against them. Likewise Gram positive organisms were susceptible to most of the antibiotics tested. However, E. faecium was only susceptible to Vanco+Teicoplanin.Conclusion. In hospital-acquired bacterial meningitis, multidrug resistance Gram negative bacteria are a huge challenge for the treatment of patients. Hence, antimicrobial stewardship should be followed to counteract with the emerging multidrug resistance isolates.