Severity and Cardiac Involvement in Multisystem Inflammatory Syndrome in Children

Multisystem infammatory syndrome in children (MIS-C) occurs secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A retrospective study, involving 6 tertiary-care centers in Haryana, was conducted to evaluate the clinical features, severity, laboratory fndings, and outcomes of patients with MIS-C. Disease severity was graded (mild/ moderate/severe) and presence of cardiac abnormalities noted. Patients with and without cardiac abnormalities and with and without severe disease were compared. Forty-eight children with MIS-C were included (median age - 9.5 y). Fever (100%), gastrointestinal (83.3%) and mucocutaneous (50%) symptoms were common. Only 16.7% patients had previous history of documented SARS-CoV-2 infection/contact. Severe disease and cardiac abnormalities were seen in 47.9% and 54.2% patients, respectively. NT-proBNP>1286.5 pg/mL and thrombocytopenia (?119500/µL) were signifcant risk factors for severe MIS-C. Forty-fve patients (93.8%) recovered and 3 died. Median hospitalization duration was 7 d (5–9.5). MIS-C must be considered as a possibility in any febrile child, even if a positive epidemiological history is absent. High NT-proBNP and thrombocytopenia are signifcant risk factors for severe MIS-C.

Seroprevalence of Covid-19 infection among healthcare workers: A study from a tertiary care hospital in the National Capital Region of India

BACKGROUND Seroprevalence studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide information on the target populations for vaccination. We aimed to evaluate the seroprevalence among healthcare workers (HCWs) at our tertiary care institution and to identify parameters that may affect it. METHOD We assessed seroprevalence of SARS-CoV-2 by the chemiluminescence immunoassay test among 3258 HCW in our hospital and evaluated as per gender, age, their previous Covid-19 diagnosis, role in hospital and type/risk of exposure. RESULTS Of 3258 participants, 46.2% (95% CI 44.4%– 47.9%) were positive for SARS-CoV-2 IgG antibodies (i.e. IgG ?15 AU/ml). Higher seroprevalence was seen in non-clinical HCWs (50.2%) than in clinical HCWs (41.4%, p=0.0001). Furthermore, people with a history of Covid-19 were found to have significantly higher antibody levels (p=0.0001). Among the HCWs, doctors and nurses had lower relative risk (RR) of acquiring Covid-19 infection (RR=0.82; 95% CI 0.76–0.89) compared to non-clinical HCWs. CONCLUSION Seroprevalence in HCWs at our hospital was 46.2%. Clinical HCWs had lower seroprevalence compared to non-clinical HCWs. Previous history of Covid-19 almost doubled the seropositivity, particularly in those with current infection.

Safety, immunogenicity & effectiveness of the COVID-19 vaccine among healthcare workers in a tertiary care hospital

Background & objectives: The COVID-19 pandemic has caused significant global morbidity and mortality. As the vaccination was rolled out with prioritization on healthcare workers (HCWs), it was desirable to generate evidence on effectiveness of vaccine in prevailing real-life situation for policy planning. The objective of the study was to evaluate the safety, effectiveness and immunogenicity of COVID-19 vaccination among HCWs in a tertiary care hospital. Methods: This prospective observational study was undertaken on the safety, immunogenicity and effectiveness of the ChAdOx1 nCoV- 19 coronavirus vaccine (Recombinant) during the national vaccine roll out in January-March 2021, in a tertiary care hospital, New Delhi, India. Results: The vaccine was found to be safe, with local pain, fever and headache as the most common adverse events of milder nature which generally lasted for two days. The adverse events following vaccination were lower in the second dose as compared to the first dose. The vaccine was immunogenic, with seropositivity, which was 51 per cent before vaccination, increasing to 77 per cent after single dose and 98 per cent after two doses. Subgroup analysis indicated that those with the past history of COVID-19 attained seropositivity of 98 per cent even with single dose. The incidence of reverse transcription (RT)-PCR positive COVID-19 was significantly lower among vaccinated (11.7%) as compared to unvaccinated (22.2%). Seven cases of moderate COVID-19 needing hospitalization were seen in the unvaccinated and only one such in the vaccinated group. The difference was significant between the fully vaccinated (10.8%) and the partially vaccinated (12.7%). The hazard of COVID-19 infection was higher among male, age >50 yr and clinical role in the hospital. After adjustment for these factors, the hazard of COVID-19 infection among unvaccinated was 2.09 as compared to fully vaccinated. Vaccine effectiveness was 52.2 per cent in HCWs. Interpretation & conclusions: ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) was safe, immunogenic as well as showed effectiveness against the COVID-19 disease (CTRI/2021/01/030582).

De novo Philadelphia chromosome positive myelodysplastic syndrome: Report of two cases with brief literature review

Myelodysplastic syndromes (MDSs) are characteristically defined by the presence of specific karyotypic abnormalities, based on which they have been prognosticated. Translocation t(9;22)(q34;q11.2) (Philadelphia positive [Ph +ve]) and corresponding BCR-ABL fusion transcript is the defining parameter of chronic myeloid leukemia. It is also seen in a fair proportion of adult acute lymphoblastic leukemia. Occurrence of a Ph +ve MDS is very uncommon, and that too is seen mostly on progression to higher stage/acute leukemia. Even rarer is the de novo presence of Ph positivity in an MDS. A literature search through PubMed has shown only about forty cases of Ph +ve MDS among which less than half had shown Ph positivity at the time of initial diagnosis. Due to its rarity, this entity has not yet found its space in current WHO 2008 classification and is still under “yet to be validated phase” in current practice of hematological malignancies. The benefit of using a tyrosine kinase inhibitor in such a situation is also debatable. We report here two such cases of de novo Ph +ve MDS, diagnosed in last 1½ year at our institute along with brief literature review

Medicinal Impact of Piper- Nigrum (Piperine) Against Arsenic Induced Hepatic and Renal Toxicity in Experimental Mice

In view of the increasing risk of arsenic on human health, the present study has been carried out to investigate the hepato-protective effect of piperine on arsenic induced-hepatic and renal toxicity in mice. Various oxidative stress parameter, antioxidant level and micro nutrients were analyses in hepatic and hepatic renal organ of mice. Methods: Mice exposed arsenic (sodium arsenate 5 mg/kg body weight p.o. for 45 days) caused a significant increases oxidative stress in hepatic and renal tissue as compared to controls group. Results: Abnormal levels of arsenic in hepatic and renal tissue increased the levels of ROS, LPO, and decreased the levels of GSH with SOD, CAT, and GPx activities in the hepatic and renal tissue of mice as compared to controls. Co-treatment of arsenic with piperine (1.5 mg/kg body weight p.o. for 45 days) decreased the levels of ROS, LPO, and increased the level of GSH, also increased SOD, CAT, and GPx activity and showed improvements in hepatic and renal tissue of mice as compared to arsenic-treated groups. Conclusion: Our results proved that piperine worked as antioxidant, anti- inflammatory in nature.

Broken Sewing Needle In The Middle Finger; A Sewing Mishap: Management

Accidental penetrating injuries to the finger are common and their improper assessment can result in missed foreign bodies. These can result in a wide range of complications. Removal of retained foreign bodies is really challenging. We report the case of a male tailor who came to the department with a chief complaint of accidental injury with sewing machine needle and the broken piece of needle got stuck in his finger. This case report highlights the management of deeply embedded broken needle without the use of any expensive investigation. Even preoperative plain X-ray with a radio-opaque marker can localize the missed radio-opaque foreign body accurately. A comprehensive approach results in a successful removal of the foreign body and improved quality of life.

Painful Finger, Diagnosis And Surgical Management: Clinical Puzzle

It is really very difficult to live with a painful finger. Here, we are discussing a case who presented with a complaint of severe lancinating pain in her left index finger for about 7 years. This pain was so distressing to her that she was requesting for the amputation of her finger. Being a reconstructive surgeon, it was really very difficult to fulfill her wish. In the past 7 years, she consulted to several practitioners but did not get relief of her pain. Clinical suspicion of Glomus tumor was made and magnetic resonance imaging was done to confirm the diagnosis. Surgical excision of the swelling was done, and the patient was completely relieved of her pain

Retrospective study on prognostic importance of serum procalcitonin and amino‑terminal pro‑brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population.

Background: Timely decision making in Intensive Care Unit (ICU) is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV) are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED) in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643) and morbidity (P = 0.000, AUC = 0.763), comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045). Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study.

A Study of Central Venous Catheter Colonizations and Catheter-related Bloodstream Infections among Patients admitted in the Intensive Care Unit of a Tertiary Care Teaching Hospital.

Objectives: To describe central venous catheter (CVC) colonizations and catheter-related bloodstream infections (C-RBSIs) among patients admitted in the Intensive Care Unit (ICU) of a tertiary care teaching hospital. Materials and methods: This was a cross-sectional study conducted among critically ill patients admitted in ICU. The semi-quantitative method was used for catheter tip culture. The definitions of catheter infection and colonization were based on the Centre for Disease Control Blood Stream Infection Guidelines. Results: The study population comprised 75 ICU patients whose CVCs had been placed. The incidence of CVC-related colonizations and bloodstream infections was observed to be 42.7% (32/75) and 17.3% (13/75) respectively. Coagulase-negative staph was the most common organism found causing CVC colonization (50%) and C-RBSI (61.5%). Conclusion: Coagulase-negative staphylococci are the most frequent microorganisms which colonize the CVC. The findings of this study may help with implementation of educational and training programs on central line-associated bloodstream infections (CLABSIs) for health care personnel and enable better management of these devices with regard to the prevention, diagnosis, and treatment of CLABSIs.

Epidemiology and outcome of burn injuries in tertiary care hospital of Northern India.

Background: Burns represent a serious problem around the world especially in low and middle income countries. The aim of this study was to determine epidemiological characteristics, causes and mortality rate of burn deaths in tertiary care hospital of N India as well as to guide future education and prevention programs. Methods: A one year cross-sectional study of all burn patients admitted in Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India was conducted between January 2014-December 2014. Results: Our study revealed that type II (absence of sutural bones) was commoner than type I (presence of type I) asterion. Total of 210 burn injury patients were admitted majority were males[54.5%] and females were [45.5%] males sustained burn injuries mostly at their work place with electric burns whereas females sustained burn injuries at home with cooking appliances. Conclusions: Burn injuries can be reduced by bringing about regulations to develop safer cooking appliances, promoting less inflammable fabrics to be worn out at home and educating the community especially women.

Bilateral Supernumerary Heads of Biceps Brachii.

The Biceps brachii is a muscle of flexor compartment of the arm. The biceps brachii muscle shows variation in the number of heads, with an estimated 9–22% of all people having a supernumerary head. Themost common variation is third head, but four, five, or even seven heads have been reported. Although supernumerary heads of the biceps brachii muscle have been frequently reported, bilateral asymmetric occurrence of supernumerary heads is relatively rare. During a routine cadaveric dissection at the Department of Anatomy, National Medical College, Birgunj, Nepal, we encountered bilateral supernumerary heads of the biceps brachii muscle; Three heads on the right arm and four heads on the left arm in a 68 year old male cadaver. These additional heads were supplied by branches from the musculocutaneous nerve. No additional anomalies were found on the remainder of both upper limbs of the same cadaver. It may cause compression of surrounding neurovascular structures or itmay lead to variation of normalmechanical actions and also can cause erroneous interpretation during routine surgeries.

Etiopathogenesis of Clefts of Lip and Palate – An Invited Review

Orofacial clefts i.e., cleft lip (CL), cleft lip and palate (CLP), cleft palate (CP) alone, as well as median, lateral (transversal), oblique facial clefts) are among the most common congenital anomalies seen in humans.

Myofibroblasts in Epithelial Mesenchymal Transition and its Clinical Significance

Myofibroblasts differentiate, invade and repair injured tissues by secreting and organizing the extracellular matrix and by developing contractile forces. Under physiological conditions, the secretory and contractile activities of myofibroblasts are terminated when the repair is complete (scar formation) but the functionality of the tissue is only rarely perfectly restored. At the end of the normal repair process, myofibroblasts disappear by apoptosis but in pathological situations, myofibroblasts likely remain leading to excessive scarring. These diverse cell types probably contribute to the appearance of myofibroblast subpopulations which show specific biological properties and which are important to understand in order to develop new therapeutic strategies for treatment of fibrotic and scarring diseases.

Uncommon parathyroid mediastinal cyst compressing the trachea.

Mediastinal parathyroid cyst is a rare cause of space occupying lesion in the mediastinum. No specific symptomatology may be attributed to the non-functioning parathyroid cyst. The diagnosis is rarely made before exploration. The cysts are thin walled, smooth, of varying sizes and contained clear, opalescent or haemorrhagic fluid. Histopathological examination reveals clusters of parathyroid cells dispersed in the wall of the cyst. Surgical removal is the treatment of choice and can be performed with minimal morbidity.

Trends of prevalence and pathological spectrum of head and neck cancers in North India.

BACKGROUND: Head and neck neoplasia constitute one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc.) is on the increase in North India, especially in Uttar Pradesh, and is responsible for the large majority of these tumours. AIM: To assess the patients' characteristics, yearly prevalence and histopathological subtypes of the head and neck neoplasia (excluding oral cavity) in Allahabad and surrounding regions. SETTINGS AND DESIGN: A retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year-wise using the tumor registry data. MATERIAL AND METHODS: All biopsies submitted for histopathology to the Pathology department were reviewed and analyzed for demographic data, site and diagnosis. STATISTICAL ANALYSIS: The Kolmogorov-Smirnov Two-Sample Test was utilized to determine whether two distributions are the same. RESULTS: A total of 40559 biopsies were examined in the department, of which, lesions of the head and neck region, excluding the oral cavity, constituted 694 biopsies (409 males and 285 females). One hundred and forty-four malignant lesions were reported, 114 being males and 30 females. A comparison of the age-specific prevalence rates of cancer during the study period showed that the prevalence was highest in patients belonging to the 50-59 years age group and squamous cell carcinoma Grade II was the most prevalent type. On an average, 58 new biopsies per annum were received. CONCLUSIONS: Properly structured site-specific data like this can augment the National Cancer Registry Programme and is an essential indicator for the magnitude and the pattern of the cancer problem in India.

Lumboperitoneal shunts: review of 409 cases.

BACKGROUND AND AIMS: A prospective study was carried out to evaluate the lumboperitoneal shunt procedure. MATERIAL AND METHODS: Four hundred and nine patients having communicating hydrocephalus were selected for the procedure during a 10-year period from March 1992 to February 2002. The average follow-up was 45.34 months. RESULTS: Tubercular meningitis (TBM)-related hydrocephalus was detected in 285 patients. Forty per cent of the patients were less than 15 years of age. Glasgow Coma Scale (GCS) of less than 8 was seen in 40% patients and 14.9% patients were in GCS 13-15. At the time of discharge 56.7% patients improved in their GCS to 13 -15 and 14.9% were in GCS 8 or less. The overall mortality was 5.13% and shunt-related mortality was seen in 2% patients. Shunt malfunction requiring revision was seen in 32 patients (7.8%) and the total number of shunt revisions was 44 (11%). Shunt infection was noted in 3.4% patients. CSF leak at the lumbar end occurred in 12 patients. Four patients required conversion of LP shunt to VP shunt. CONCLUSIONS: Lumboperitoneal shunt is an effective shunting procedure in communicating hydrocephalus.