First report on the detection of Japanese encephalitis virus in fruit bats from India

Japanese encephalitis (JE) is a mosquito borne viral zoonotic disease and JE virus (JEV) is responsible for causing several children deaths every year in India. Since 1978, cases of JE have been reported from Gorakhpur district of Uttar Pradesh state annually. The knowledge on the role played by wildlife reservoirs in the sylvatic transmission and maintenance of JE virus remains limited. Bats are reservoir hosts for several emerging and re-emerging viral pathogens but their role in zoonotic cycle of JEV has not been elucidated yet. In Gorakhpur district of Uttar Pradesh, 52 fruit bats were found dead on 26 May 2020. The post-mortem report of the bat samples conducted at the Indian Veterinary Research Institute stated that the bats died due to brain hemorrhage, caused by excessive heat. The brain tissue samples of the bats were subjected to investigation using molecular techniques to determine the presence of JEV. The present work reports for the first time the detection of JEV in brain samples of bats from India. The viral load ranging from 8 to 18 copies/reaction was detected in brain samples by TaqMan real Time RT-PCR. The low viral load might be the reason for the absence of apparent clinical signs in bats and suggests the probable role of fruit bats in maintaining the JEV in nature.

A study of neurological disorders in pregnancy and puerperium

Background: Neurological diseases contribute to 20% of maternal deaths. The objective of this study was to find the prevalence of primary and secondary neurological disorders in pregnant and postpartum patients, to study their clinical features, feto-maternal outcome and diagnosis using radiological imaging.Methods: This is a prospective cross-sectional study done over a period of 1 year. Pregnant and postpartum women with neurological disorders except eclampsia were enrolled. A total of 100 cases were analysed out of which 92 underwent radiological imaging to confirm diagnosis. Primary outcome in the form of prevalence of neurological disorders and secondary outcome in the form of maternal and foetal outcome was assessed.Results: The prevalence of neurological disorders in pregnancy is 1150/100000 deliveries. 75 cases were classified as primary neurological disorders (prevalence of 862/100000) which included epilepsy, cerebrovascular accidents, CNS infections, neoplasm, neuropathies and miscellaneous. 25 cases were secondary neurological disorders (prevalence of 287/100000) which included hepatic and septic encephalopathy. Among primary disorders the prevalence of cerebrovascular accidents was found to be highest (33.3%) followed by epilepsy (32%) while that among secondary neurological disorder was of Hepatic encephalopathy (92%). Majority (68%) had recovery while 15%of women had residual deficit. There were 17 (17%) cases of maternal mortality.Conclusions: Neurological disorders were significantly associated with poor feto- maternal outcome. Radiological imaging in the form of MRI is an excellent diagnostic tool for confirming diagnosis of neurological disorders.

Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

Assessment of stability of orthodontic mini‑implants under orthodontic loading: A computed tomography study.

Objectives: Miniscrews have been used in recent years for anchorage in orthodontic treatment. However, it is not clear whether the miniscrews are absolutely stationary or move when force is applied. This prospective clinical study was undertaken to evaluate the mobility of orthodontic miniscrews under orthodontic loading using computed tomography. Materials and Methods: Ten adult patients (7 females and 3 males with mean age of 19 years, 7 mm overjet) who required en masse retraction of upper and lower anterior teeth in first premolar extraction spaces were included in this study. After initial alignment of anterior teeth, the 0.019” ×0.025” stainless steel archwire were placed in preadjusted edgewise appliance. The miniscrews (diameter - 1.3 mm, length - 7 mm) were inserted in between second premolar and the first molar in the maxilla (zygomatic buttress) and in mandible on the buccal side as direct anchorage. Immediately after placement of miniscrews without waiting period, NiTi coil springs (force of 150 g in the maxilla and 100 g in the mandible) were placed for the retraction. Denta Scans were taken immediately before force application (T1) and 6 months later (T2). The mean changes obtained at T1 and T2 in Denta Scans (axial plane, coronal plane, paraxial plane) were evaluated to determine any movement of different parts of miniscrews using one-way ANOVA test and Student’s unpaired t-test. Results: On average, miniscrews were extruded and tipped forward significantly, by 1 mm at the screw head in the axial plane (Group III) and 0.728 mm in the coronal plane (Group IV). Tail of miniscrews showed average tipping of 0.567 mm in the axial plane (Group I) and 0.486 mm in the paraxial plane (Group V). Least average mobility was shown by screw body of 0.349 mm in the axial plane (Group II). Clinically, no significant mobility was observed. Conclusion: Miniscrews are a stable anchorage for orthodontic tooth movement but do not remain absolutely stationary like an endosseous implant throughout orthodontic loading although miniscrews might move according to placement site, orthodontic loading, and inflammation of peri-implant tissue. Waiting period between miniscrews placement and orthodontic loading does not significantly affect the miniscrew mobility so immediate loading can be recommended. To prevent hitting any vital organs because of miniscrew mobility, it is recommended that they can be placed in a nontooth-bearing area that has no foramen, major nerves, or blood vessel pathway, or in a tooth-bearing area allowing a 1.5 mm safety clearance between the miniscrew and dental root.