Early diagnosis of lupus: A possibilty. A multicentric study from SLE Special Interest Group (SIG) of Indian Rheumatology Association (IRA).

INTRODUCTION: Systemic Lupus Erythematosus (SLE) warrants an early diagnosis and prompt management. Delay in diagnosis can result in repeated flares, permanent damage, and even death. There is a large variability in the time taken to diagnose SLE across the world. We undertook this study to determine the time taken for diagnosis of SLE in India and to identify the factors associated. METHODS: Patients with SLE diagnosed within the previous 1 year as per Systemic Lupus Erythematosus International Collaborating Clinics criteria (SLICC) 2012 criteria were included in a cross-sectional multicentre questionnaire-based survey. Demographic profile, self-reported socioeconomic status as per Kuppuswamy classification of socioeconomic status (version 2022) (SES), and several healthcare related parameters including referral pattern were recorded. Median time taken for diagnosis was used to demarcate early or late diagnosis and associated factors were explored. RESULTS: We included 488 patients with SLE from 10 rheumatology centres. The median time to diagnosis was 6 months Interquartile Range (IQR 3,14.7) and within 3 months in about one third [150(30.7%)]. Very early diagnosis (<1 month) was established in 78(16.0%) patients. The mean SLE Disease Activity Index (SLEDAI) at diagnosis was 10.28+7.24. In univariate analysis, an older age, lower SES, non-southern state of residence and larger family size were significantly associated with late diagnosis. In the multivariate analysis, higher SES (AOR 0.95, 95% CI: 0.92-0.98), multiple organ system involvement at initial presentation (AOR1.75 95%CI: 1.08-2.84) and place of residence in south Indian states (AOR1.92 95%CI: 1.24-2.97) had lesser odds of being associated with late diagnosis. Distance from the closest medical centre/professional did not influence the time to diagnosis. Majority of patients had first consulted a medical graduate (42.5%) or postgraduate doctor (48.2%), and referral to rheumatologist was largely done by postgraduate (65%) doctors. More than half of our patients (61%) self-finance their treatment. CONCLUSION: Median time to diagnosis of SLE was 6 months, 1/3rd being diagnosed within 3 months and 78(16.0%) with 1 month of symptom onset. Delay in diagnosis was noted in those belonging to lower socioeconomic strata and those with single organ disease. Distance to the health care facility did not influence time to diagnosis.

A Comparative Analysis of Heart Rate Variability Indices in Patients with Liver Cirrhosis.

BACKGROUND: Cardiac autonomic dysfunction (AD) in reference to chronic liver disease (CLD) has become widely accepted as a symptomatic burden. This study will be undertaken to measure heart rate variability (HRV) indices and detect the severity of cardiac autonomic dysfunction in CLD patients. MATERIALS AND METHODS: This study was conducted on 150 patients with liver cirrhosis and compared with 110 healthy controls. Information concerning medical history, radiological and laboratory findings was extracted for interpretation and association among both groups. The HRV was assessed by recording with a polygraph (RMS Polyrite D, version 1.0), which was based on the principle of electrocardiography. RESULTS: Heart rate variability indices like standard deviation of each interval normal-to-normal (SDNN), percentage of successive RR intervals that differ by >50 ms (pNN50%), high frequency (HF), low frequency (LF), and the LF/HF ratio were found to be remarkably low in cases with CLD in comparison to the healthy control group (p < 0.05). The Child-Pugh (CP) score was class C (10-15) in 52%, class B (7-9) in 30%, and class A (5-6) in 18% of patients. The CP score in CLD patients had a statistically significant negative correlation with SDNN (r = -0.5429, p < 0.001), root mean square of successive differences (RMSSD) (r = -0.375, p < 0.001), pNN50% (r = -0.6037, p < 0.001), HF (r = -0.2033, p = 0.0125), and LF (r = -0.3674, p < 0.001). SDNN, pNN50%, and LF parameters were lowest in alcohol-related CLD, highest in hepatitis C virus (HCV)-related CLD, and intermediate in hepatitis B virus (HBV)-related CLD. CONCLUSION: Our study concluded that liver cirrhosis patients have reduced HRV compared to healthy individuals. A decrease in HRV highlights people at risk of death. This is a variable that can be used to track patients over time and aid in transplant selection.

Enhancing microbial fuel cell performance for distillery wastewater treatment and bioelectricity generation: harnessing niacin as a redox mediator.

The role of redox mediators in improving electron transport from electrochemically active bacteria to the anode is crucial for enhanced bioelectricity output from microbial fuel cells (MFCs), which makes the selection of an ideal mediator very important. This study aims at exploring a new redox mediator niacin (vit B3) for enhanced bioelectricity generation in MFC while treating distillery wastewater through facile modification of anode electrode by niacin doping (MFC-NME) and simple application of niacin to the anolyte (MFC-NAA). Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), and X-ray diffraction (XRD) of NME confirmed the effective adsorption of niacin onto the carbon felt surface. Notably, MFC-NME exhibited a significantly higher power density (PD) of 6.36 W/m3 compared to MFC-NAA (4.59 W/m3) and control MFC (3.49W/m3). The charge transfer resistance (RCT) in MFC-NME (1.73 Ω) and MFC-NAA (2.06 Ω) were lowered by more than half than that in control MFC (4.33 Ω), which underscores the efficacy of niacin as a redox mediator. SEM analysis revealed improved bacterial attachment over the bioanode in the MFC-NME as compared to that of MFC-NAA and control MFC. Removal of chemical oxygen demand (COD) was higher in MFC-NAA (85%) and MFC-NME (80%) than in control MFC (73%) suggesting that niacin in the anolyte supported greater organic matter removal due to enriched microbial activity. Niacin used in anode modification shows great potential for improved electron transfer and enhanced bioelectricity production and supports greater wastewater treatment performance. The modified bioanode NME exhibits excellent stability.

An in-depth study on survival mechanism of bacterial isolates in disinfectants within the hospital environment.

Introduction: The emergence of disinfectant resistance has become a severe threat due to reduced effectiveness. This study was undertaken to determine how bacteria adapt to survive exposure to disinfectants in the busiest section of a tertiary care hospital in Varanasi, India. Methods: Four isolates (two Klebsiella pneumoniae, Kp1 and Kp2; two Pseudomonas aeruginosa, Pa1 and Pa2) were obtained from chlorhexidine (CHX)-based handwash during microbiological surveillance of "in-use disinfectants" in hospital. Six disinfectants [4% CHX, 2% glutaraldehyde, 7.5% hydrogen peroxide, 1% sodium hypochlorite and 0.1% benzalkonium chloride (BAC), and 70% ethyl alcohol] were tested against these four isolates to determine minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Antibiotic profile, change in MIC on exposure to disinfectants and biofilm formation in the presence and absence of disinfectants was studied. Whole genome sequencing (WGS) was done to identify the resistance mechanisms. Result: The isolates showed the highest MBC/MIC ratio (4) against glutaraldehyde. Exposure to supra-inhibitory concentration of BAC for 21 days resulted in doubling of MIC/MBC. The majority (75%) of the isolates were multidrug resistant. All the isolates were strong biofilm producers. The reduction rate of biofilm formation decreased with an increase in the concentration of disinfectants (p = 0.05 for BAC). WGS revealed multiple AMR genes including bla DIM-1, disinfectant-resistant gene and efflux pump genes. Conclusion: The study emphasized the various adaptation strategies of these isolates for survival in disinfectant environment, thus posing a huge challenge for their control in the hospital environment.

Assessment of obstructive airway disease in the multicenter SWORD survey India.

BACKGROUND AND OBJECTIVES: The study aimed to assess the control of asthma and the severity of chronic obstructive pulmonary disease (COPD) and evaluate the adequacy of treatment in patients presenting to the outpatient department (OPD) across India. The secondary aim was to assess the risk factors associated with poorly controlled asthma and severe COPD. MATERIALS AND METHODS: This is the analysis of Phase IV of the multicenter questionnaire-based point prevalence SWORD survey, conducted in May 2018, and designed to capture details on disease control and treatment as per the global initiative for asthma and the global initiative for chronic obstructive lung disease guidelines. RESULTS: Of the 5,311 respiratory disease patients presenting to the OPD, there were 1,419 and 412 patients with asthma and COPD, respectively, across 290 sites in India. There were 1,022 (72%) patients having well-controlled asthma, 293 (20.6%) patients with partly controlled asthma, and 104 (7.4%) patients with poorly controlled asthma. Of the 412 patients with COPD, there were 307 (74.5%) in A, 54 (13.1%) in B, and 51 (12.4%) in the E category. In spite of poor control or severe disease, 34.8% of asthmatic and 25.7% of patients in the B and E categories of COPD were not using any medicine. Risk factors for partly and poorly controlled asthma included rain wetting (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.02-2.47) and gastroesophageal reflux disease (AOR: 1.50, 95%CI: 1.08-2.10). CONCLUSION: This study identifies a gap in the treatment of both poorly controlled asthma and severe COPD. A substantial number of patients had poorly controlled asthma and severe COPD, and many were either not taking treatment or taking it inappropriately.

Porphyrins with combinations of 4-carboxyphenyl and 4-hydroxyphenyl substituents in meso-positions as anti-HIV-1 agents.

A series of 4-carboxyphenyl/4-hydroxyphenyl meso-substituted porphyrins were synthesized, purified, and characterized. The compounds exhibited anti-HIV-1 activities, in vitro, under both non-photodynamic (non-PDT) and photodynamic (PDT) conditions. Specifically, the porphyrins inhibited HIV-1 virus entry, with c-PB2(OH)2 and PB(OH)3 showing significant anti-HIV-1 activity. All of the porphyrins inhibited HIV-1 subtype B and C virus entry under PDT conditions. Our study demonstrated that the compounds bearing combinations of 4-carboxyphenyl/4-hydroxyphenyl moieties were not toxic even at higher concentrations, as compared to the reference porphyrins 5,10,15,20-tetra-(4-carboxyphenyl)porphyrin (TCPP) and 5,10,15,20-tetra-(4-hydroxyphenyl)porphyrin (THPP), under PDT conditions. This study underscores the promising potential of these compounds as HIV entry inhibitors in both non-PDT and PDT scenarios.

Evaluation of fuel properties for possible biodiesel output based on the fatty acid composition of oleaginous plants and microalgae.

In the past decade, there has been a significant rise in sustainable biomass based biofuel production to address energy needs while mitigating environmental impacts. Traditionally, bioethanol was used for biofuel production, but concerns over food security and environmental preservation have led to growing interest in alternative sources such as neutral lipids from vegetable oil and microalgae for biodiesel production. This research paper evaluates the potential of various oleaginous plants and microalgae as feedstocks for biodiesel production, with a focus on their fatty acid composition and its impact on biodiesel properties. The study examines the fatty acid profiles of 43 different plant and microalgae species and employs various equations to estimate key physical properties of biodiesel. Additionally, the communication compares these properties to International Biodiesel Standards (EN 14214 and ASTM D6751-08) to assess the suitability of the derived biodiesel for commercial use. It is impossible to describe a single composition that is optimal in terms of all essential fuel properties due to the opposing effects of some structural features of the Fatty Acid Methyl Esters (FAME). However, biodiesel should contain relatively low concentrations of both long chain saturated and polyunsaturated FAME to ensure adequate efficiency in terms of low temperature operability and oxidative stability. The results reveal significant variations in properties amongst different feedstocks, highlighting the importance of feedstock selection in biodiesel production. The study also establishes correlations between various fuel properties, providing valuable insights in to optimizing biodiesel production processes, which will be of great use to researchers, engineers, and stakeholders involved in biodiesel production.

Evaluation of Serum Amylase and Lipase in Gestational Diabetes Mellitus and Association With Gastrointestinal Symptoms.

INTRODUCTION: Gestational diabetes mellitus (GDM) is a common complication during pregnancy, with potential adverse effects on maternal and fetal health. Several studies have reported that in diabetic patients, both morphological and functional pathological mechanisms lead to exocrine pancreatic dysfunction. Pancreatic enzyme deficiency or dysfunction result in the inability to digest food properly, giving rise to a range of gastrointestinal (GI) symptoms. We hypothesized that pregnant women with GDM may also have deficiency of pancreatic enzymes, amylase and lipase, leading to persistent GI symptoms beyond the first trimester and impaired quality of life. OBJECTIVE: The objective of this study was to evaluate serum amylase and lipase levels in pregnant women with GDM and association with GI symptoms. Understanding the relationship between GDM and exocrine pancreatic function may help identify novel therapeutic targets and improve the clinical management of GDM women with GI symptoms. MATERIALS AND METHODS: This cross-sectional comparative study included a total of 125 pregnant women in their third trimester, who were either diagnosed with diabetes (n = 25) or were healthy volunteers without diabetes (n = 100). A detailed history, including the presence or absence of GI symptoms and the type of symptoms, was recorded. Serum amylase and lipase levels were measured using enzyme kinetic assay. Data were coded and analysed. RESULTS: GI symptoms were significantly more in GDM women than in normal pregnant women, and GDM women with GI symptoms had significantly lower levels of serum lipase and amylase than normal pregnant women with GI symptoms. CONCLUSION: The study suggests the importance of evaluating serum amylase and lipase in GDM women with GI symptoms, as they may be indicative of underlying pancreatic enzyme deficiency.

Factors Affecting Biochemical and Echocardiographic Indices in Type 2 Diabetes Mellitus Patients Without Overt Symptoms of Heart Failure: A Cross-Sectional Study.

Introduction Diabetes is a known risk factor for heart failure (HF), and HF often manifests as a common cardiovascular event in people with type-2 diabetes mellitus (T2DM). Once HF is present, diabetes presents an especially adverse prognosis for subsequent morbidity and mortality. Brain natriuretic peptide (BNP) and n-terminal ProBNP (NT-proBNP) are used as diagnostic biomarkers for HF that are secreted by the ventricles in response to increased myocardial wall stress. If we could unmask some clinical and routine laboratory parameters affecting BNP and ejection fraction (EF), we can predict impending HF and take measures to prevent it. The current study was conducted to investigate the factors affecting BNP and EF for detecting potential HF in T2DM patients who do not exhibit overt HF symptoms. Materials and methods The present cross-sectional study was performed after obtaining ethical clearance from the Institutional Ethics Committee. T2DM patients consulting the Medicine Outpatient Department (OPD) of BRD Medical College Gorakhpur during a two-month period (from 20 July 2023 to 19 September 2023) with age >40 years and duration of T2DM >10 years. Multistage random sampling was done to recruit study participants, and 308 patients participated in the study. Informed consent was obtained from the recruited participants. The chi-square or Fisher's exact test (whichever was applicable) was used to explore the association between categorical variables. Correlation statistics were calculated using Spearman correlation among the NT-proBNP, EF, and other relevant variables. The Statistical Package for Social Sciences (SPSS) (version 21; IBM SPSS Statistics for Windows, Armonk, NY) was used for the analysis, and a two-sided p-value of < 0.05 was considered significant. Results Three hundred and eight diabetic patients satisfying inclusion and exclusion criteria were enrolled as study participants and completed the study. The mean age of the total study subjects was 60.82 ± 9.23 years. There were 161 (52.3%) male and 147 (47.7%) female participants, and about half (153/308, 49.7%) of the participants belonged to the age group 40-60 years. There was a statistically significant association (p = 0.01) between NT-proBNP and glycated hemoglobin. Statistically highly significant (p < 0.001) associations were found between NT-proBNP with duration of T2DM and EF. There was a strong negative correlation (correlation coefficient = -0.743) between EF and NT-proBNP, and this correlation was statistically highly significant with a p-value < 0.001. Conclusion Elevated NT-proBNP levels and impaired EF were found in a significant proportion of these patients, indicating an increased risk of cardiovascular complications. This study highlights a significant association between NT-proBNP and EF in patients with T2DM in those without overt heart failure symptoms. Furthermore, longer T2DM duration and higher HbA1c levels were found to be associated with elevated NT-proBNP levels, while longer T2DM duration and elevated NT-proBNP were linked to lower EF. These findings have important clinical implications, as they suggest that monitoring NT-proBNP levels in patients with T2DM without clinical features of overt heart failure may help identify those at risk for decreased EF and potentially prevent heart failure.

Creep in nitroimidazole inhibitory concentration among the Entamoeba histolytica isolates causing amoebic liver abscess and screening of andrographolide as a repurposing drug.

Infections by Entamoeba histolytica (E. histolytica) lead to considerable morbidity and mortality worldwide and treatment is reliant on a single class of drugs, nitroimidazoles. Treatment failures and intermittent reports of relapse from different parts of world indicate towards development of clinical drug resistance. In the present study, susceptibility testing of clinical isolates of E. histolytica was carried against metronidazole and tinidazole. Additionally, anti-amoebic property of active compounds of Andrographis paniculata was also evaluated. Prevalence of metronidazole resistance gene (nim) in patients attending hospital was also done to get comprehensive insight of present situation of drug resistance in E. histolytica. Mean inhibitory concentration 50 (IC50) value of E. histolytica isolates against metronidazole and tinidazole was 20.01 and 16.1 µM respectively. Andrographolide showed minimum mean IC50 value (3.06 µM). Significant percentage inhibition of E. histolytica isolates by andrographolide was seen as compared to metronidazole (p = 0.0495). None of E. histolytica isolates showed presence of nim gene. However, in stool samples from hospital attending population, prevalence of nimE gene was found to be 76.6% (69/90) and 62.2% (56/90) in diarrheal and non-diarrheal samples respectively. Inhibitory concentration of commonly used nitroimidazoles against clinical isolates of E. histolytica are on rise. Percentage inhibition of E. histolytica isolates by andrographolide was significantly higher than control drug metronidazole.

Poor Glycemic Control Is Associated With Lower Interleukin-2 (IL-2) Levels and Low Macrophage Viability in Chronic Diabetic Foot Ulcers (DFUs).

Low macrophage viability in chronic diabetic foot ulcers (DFUs) may lead to inadequate interleukin (IL) expression and the persistence of infection. This study evaluates the association between macrophage function, IL-2 expression, and wound microflora in chronic DFUs. Diabetic patients with DFUs (group 1, n = 40) and without DFUs (group 2, n = 40) were compared for macrophage function in serum by viability testing. Immunological response was measured by serum IL-1ß, IL-2ß, and IL-10 levels. The aerobic and anaerobic microflora of the DFUs were assessed by culture and molecular methods. Demographic, clinical, and biochemical factors were statistically analyzed by χ2 test and Student t test. Multiple correspondence analysis (MCA) was used to detect the pattern of association between glycosylated hemoglobin (hemoglobin A1c), serum IL-2 levels, and macrophage viability. Of the total DFU cases, 22 (55%) showed the presence of polymicrobial microflora. Low macrophage viability with predominant Gram-negative flora was seen in 10 (25%) cases in group 1. Serum IL-2 levels were significantly lower (P = .004) in patients in group 1 along with elevated levels of hemoglobin A1c (P = .038). MCA showed an association between low viability of macrophages and lower IL-2 levels and elevated hemoglobin A1c levels with lower serum IL-2 levels. As compared to group 2, the low viability of macrophages was significantly associated (P = .007) with lower IL-2 levels in group 1. Elevated hemoglobin A1c levels are strongly associated with lower IL-2 levels and low macrophage viability. This might be a contributing factor to the persistence of infections in chronic DFUs.

Emergence of Unusual Microorganisms in Microflora of Pilonidal Sinuses: A Multiple Case Series.

PURPOSE: Recent reports have noted an emergence of unusual organisms in microflora of pilonidal sinus (PNS); this study was undertaken to identify the primary microbial flora associated with infected primary PNS over a period of 1 year. DESIGN: A prospective multiple case series. SUBJECTS AND SETTING: A case series of 20 patients with primary PNS in a tertiary care center in Varanasi, India, was studied. The study was conducted at the Department of Microbiology and General Surgery, Institute of Medical Sciences, Varanasi, over a period of 1 year (September 2016 to July 2017). METHODS: Purulent exudate (pus) samples were collected from 20 patients with primary PNS from the discharging sinuses by aseptic methods. Samples were assessed for aerobic and anaerobic flora by conventional culture and molecular methods. Antimicrobial susceptibility testing was done for bacterial isolates. Bacterial diversity was compared with the demographic and clinical profile of the sinuses by multiple correspondence analysis. RESULTS: Of the total cases, 11 (55%) had purulent discharge, among which all showed polymicrobial flora. The ratio of aerobic to anaerobic organisms was 1:2 (16/32). Escherichia coli (E. coli, 4, 36.36%) and Enterococcus faecalis (E. faecalis, 4, 36.36%) were commonly isolated. Bifidobacterium was the most frequent anaerobe. Detailed molecular analysis revealed the presence of Kocuria flava as an unusual pathogen. On statistical analysis, factors like male gender, increased body mass index, absence of hair in sinus, presence of features of hirsutism, and absence of Fusobacteria were closely associated with one another in these PNS cases. CONCLUSIONS: The case series revealed the predominance of anaerobes in primarily infected PNS cases. Bifidobacterium spp and unusual pathogens like K. flava were among the emerging pathogens in infected PNS. Use of better molecular diagnostic facilities in addition to the conventional methods might enhance the verified diversity of microorganisms in such cases.

Analysis of Hematological Indices in Patients of Systemic Lupus Erythematous and Its Correlation with SLEDAI-2K.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease which is characterized by chronic multisystem inflammation and end-organ damage. In recent times there has been a need for new hematological markers to assess disease activity in SLE patients specifically, which can be easily available like eosinophil, basophil, neutrophil, monocytes, and platelet to lymphocyte ratios (ELR, BLR, NLR, MLR, and PLR, respectively). Materials and methods: The present investigation determines the use of a different peripheral hematological marker to assess SLE activity in 106 patients attended for medical care at Sawai Mansingh (SMS) Medical College and attached hospital, Jaipur. SLE disease activity index 2000 (SLEDAI-2K) was used to assess the disease activity in all patients. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were assessed in each subject. The ratio of various hematological indices, like NLR, BLR, ELR, MLR, PLR, etc., analyzed and correlated with CRP, ESR, and SLEDAI-2K. Results: The present study revealed that the SLEDAI-2K score showed a significant positive correlation with ELR and MLR (p < 0.005). CRP showed a significant positive correlation with PLR (p < 0.005). ESR showed a significant positive correlation with ELR, MLR, PLR, and NLR (p < 0.005). Conclusion: The final results demonstrate that in SLE patients, the ratio of hematological indices like ELR, MLR, and PLR can be employed as disease activity markers. How to cite this article: Meena VP, Meena PD, Chejara RS, et al. Analysis of Hematological Indices in Patients of Systemic Lupus Erythematous and Its Correlation with SLEDAI-2K. J Assoc Physicians India 2023;71(11):40-42.

Proportionate clinical burden of respiratory diseases in Indian outdoor services and its relationship with seasonal transitions and risk factors: The results of SWORD survey.

BACKGROUND: The Global Burden of Disease data suggest that respiratory diseases contribute to high morbidity in India. However, the factors responsible for high morbidity are not quite clear. Therefore, the Seasonal Waves Of Respiratory Disorders (SWORD) study was planned to estimate the point prevalence due to respiratory diseases in Indian OPD services and its association with risk factors and change in seasons. METHODS: In this point prevalence observational multicenter study conducted during 2017-18, participating physicians recorded information of consecutive patients in response to a questionnaire. The study was conducted on four predetermined days representing transition of Indian seasons i.e., February (winter), May (summer), August (monsoon), and November (autumn). RESULTS: The eligible number of patients from across 302 sites in India was 25,177. The mean age of study population was 46.1±18.1 years, 14102(56.0%) were males and 11075(44.0%) females. The common diagnoses were: asthma(29.8%), chronic obstructive pulmonary disease (COPD),15.6%, respiratory tract infections (RTIs),11.3%, and tuberculosis(8.7%). All these conditions showed significant seasonal trends (Asthma 31.4% autumn vs. 26.5% summer, COPD 21.1% winter vs. 8.1% summer, RTIs 13.3% winter vs. 4.3% summer, and tuberculosis 12.5% autumn vs. 4.1% summer, p<0.001 for each respectively). After adjustment for risk factors, asthma was significantly associated with exposure to molds (OR:1.12,CI:1.03-1.22), pet animals (OR:1.07,CI:1.01-1.14), recent-travel (OR:1.22,CI:1.13-1.32), and rain-wetting (OR:1.27,CI:1.15-1.40); and RTIs with rain-wetting (OR:1.53,CI:1.34-1.74), and recent-travel (OR:1.17,CI:1.05-1.30). CONCLUSIONS: The SWORD study showed wide seasonal variations in outpatient attendance of patients with common respiratory conditions. Novel risk-factors associated with respiratory diseases were also identified.

A Study of Procalcitonin as an Early Predictor of Severity in Acute Pancreatitis.

Acute Pancreatitis is an acute inflammation of the pancreas.Acute pancreatitis is an acute inflammatory process ranging clinically from mild discomfort with localized inflammation to severe disease involving remote organ systems. There is a continuum from the development of systemic inflammatory response syndrom, to the onset of multiple organ dysfunction (MODS), which is seen in about 24% of patients with acute pancreatitis and carries the highest mortality rate of 36%, and imaging tests showing characteristic findings of acute pancreatitis. Several inflammatory markers are being used routinely in various hospitals in India to assess the prognosis of patients with acute pancreatitis. Among these are the total and differential leukocyte counts, erythrocyte sedimentation rate, and C-reactive protein (CRP), interleukin-6, thioredoxin-1, and polymorphonuclear elastase. serum procalcitonin is one of the components to assess the severity of pancreatitis. Procalcitonin is an acute phase reactant that has been extensively investigated as early marker in systemic bacterial infection, sepsis, and multi organ failure. Because severe acute pancreatitis is associated with sepsis, infected pancreatic necrosis, and multi organ failure. Procalcitonin can be used as a useful marker in early prediction of severity. MATERIAL: a prospective observational hospital based study conducted on patients of Department of General Medicine with collaboration from Department of Biochemistry and Radio diagnosis of SMS Medical College Jaipur. Patient who were diagnosed as case of acute pancreatitis on basis of diagnostic criteria as per Atlanta classification 2013 guidelines7 were included. Total of 56 cases were included in this study. OBSERVATION: The finding observed are as under:- 1) The mean age of the population was 38.5 ±11.83 years. CONCLUSION: In present, study serum PCT was done in patients diagnosed as acute pancreatitis on basis of Atlanta classification within 48 hours of admission and was found to be increased (value is significant if it is more than 0.5ng/ml) in 23 patients out of 60, with mean of 1.94±2.4ng /ml. These 23 patients were later on found to have severe acute pancreatitis on the basis Atlanta classification and rest 37 patients who had mild pancreatitis had mean PCT 0.38±0.66ng/ml. A study conducted on 40 patients of acute pancreatitis which was confirmed by Computed tomography was conducted in Poland, where they collected blood samples on admission and 24 hour thereafter, in which they tried to evaluate the role of procalcitonin as an early predictor of course of acute pancreatitis and they found that procalcitonin concentration was significantly higher in patients of acute pancreatitis and cut off was estimated at 0.5ng/ml.79 Similarly, in this study PCT was found to be high in patients of severe acute pancreatitis only.

Microalbuminuria: As an Indicator of Sepsis and to Predict Mortality in Patients Admitted to Intensive Care Unit.

BACKGROUND: Sepsis is an important healthcare concern in India as well as globally. This study shows how the level of microalbuminuria predict mortality of patients diagnosed with sepsis and those without sepsis. METHODS: In this study total 150 patients of which 75 patients belonging to each sepsis and non-sepsis group, with age >15 years admitted in Medical Intensive Care Unit (ICU) were enroled Microalbuminuria levels were analyzed at admission and after 24 hours after admission. RESULTS: Microalbuminuria levels were significantly high in patients with sepsis as compared to non sepsis. Microalbuminuria has highest sensitivity of 90 % and specificity of 98 % to differentiate between sepsis and non sepsis in comparison to APACHE II and SOFA scores. CONCLUSION: Serial monitoring of bedside urine albumin-creatinine measurement might help in the early identification of patients with sepsis that requires early targeted therapy. The 24-hour ACR assessment predicts ICU survival and may have the potential to monitor the efficacy of therapeutic interventions delivered, such as fluid resuscitation, appropriate antibiotics, vasopressors, and ionotropes that affect the endothelium.

Significant in-Vitro and in-Vivo Antimicrobial and Antibiofilm Activity of Colloidal Silver Nanoparticles (cAgNPs) in Chronic Diabetic Foot Ulcers.

Infection is a foremost challenge in the cases of wound care, especially in cases of chronic wounds. The present study was conducted to determine the antimicrobial and antibiofilm activity of the colloidal silver nanoparticles (cAgNPs) on Gram positive organisms and to evaluate the in-vivo response of cAgNPs on patients of chronic diabetic foot ulcers (DFUs). cAgNPs were tested against selected Gram-positive organisms like methicillin-sensitive and resistant Staphylococcus aureus (MSSA, MRSA), Enterococcus faecalis and vancomycin resistant enterococci (VRE) using microbroth dilution assay to estimate minimum inhibitory/bactericidal concentration (MIC/MBC). Biofilm inhibition capacity and time kill assay was performed. Further, the in-vivo response of topical application of cAgNPs was evaluated on patients of DFUs. The susceptibility testing demonstrated the MIC and MBC values of the cAgNPs ranging from 0.5µg/ml to 1.0 µg/ml and 1.0 µg/ml to 8 µg/ml against the tested organisms respectively. The cAgNPs showed inhibition of biofilm formation in the low, medium and high biofilm producers by 91%, 83% and 75% respectively at the highest concentration (52ppm). The time kill kinetics showed significant reduction in the number of viable cells (p < 0.0001). Significant reduction in microbial load (p = 0.0062) and in the number of moderate to strong biofilm producing organisms (p = 0.0069) after treatment with cAgNPs was seen. cAgNPs exhibited significant in-vitro bactericidal and bacteriostatic activity against MRSA, MSSA and VRE respectively along with anti-biofilm activity. Additionally, cAgNPs showed significant reduction in microbial load of the chronic DFUs.

Host-parasite interactions in infections due to Entamoeba histolytica: A tale of known and unknown.

Entamoeba histolytica (E. histolytica) is an enteric microaerophilic protozoan parasite responsible for millions of cases worldwide. Majority of the infections due to E. histolytica remain asymptomatic; however, it can cause an array of symptoms ranging from devastating dysentery, colitis, and abscesses in different vital organs. The interactions between the E. histolytica and its host are a multifaceted chain of events rather than merely destruction and invasion. There are manifold decisive steps for the establishment of infections by E. histolytica which includes degradation of mucosal layer, adherence to the host epithelium, invasion into the host tissues, and dissemination to vital organs. It is widely hypothesized that, for establishment of infections, the interactions at the intestinal mucosa decides the fate of the disease. The delicate communications between the parasite, the host factors, and the associated bacterial microflora play a significant role in the pathogenesis of E. histolytica. In this review, we summarize the interactions between the E. histolytica and it's host at the genetic and immunological interphases emphasizing the crucial role of microbiota in these interactions.

High carriage rate of intestinal parasites among asymptomatic HIV-seropositive individuals on antiretroviral therapy attending the tertiary care hospital in Varanasi, India.

INTRODUCTION: Infections by intestinal parasites (IPs) are prevalent among human immunodeficiency virus (HIV)-seropositive individuals. Although diarrhea is the usual manifestation, asymptomatic presentations are common. In such situations, the problem of parasitosis is often underestimated. This study was performed to assess the presence of IPs among asymptomatic HIV-seropositive patients. MATERIALS AND METHODS: A case-control study was designed, including stool samples from 75 asymptomatic HIV-seropositive patients and 75 seronegative patients with gastrointestinal discomfort. IPs was identified by microscopy and polymerase chain reaction (PCR) for Entamoeba spp, Cryptosporidium and Microsporidium spp. The data were statistically analyzed using the Chi-square test. RESULTS: The prevalence of IPs in HIV-seropositive cases (25.33%) was statistically significantly more (P < 0.05) than that of controls (4%). Helminths predominated in both the groups. PCR detected IPs in 5 (6.6%) additional microscopy-negative cases. The presence of IPs was associated with CD4 count <200 cells/µl. CONCLUSION: The asymptomatic carriage of IPs in HIV patients poses an important reservoir in the community. To prevent transmission, frequent screening is needed.