Trends in carbapenem resistance in Pre-COVID and COVID times in a tertiary care hospital in North India.

BACKGROUND: Carbapenem resistance is endemic in the Indian sub-continent. In this study, carbapenem resistance rates and the prevalence of different carbapenemases were determined in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa during two periods; Pre-COVID (August to October 2019) and COVID (January to February 2021) in a north-Indian tertiary care hospital. METHODS: Details of patient demographics and clinical condition was collated from the Hospital Information System and detection of carbapenemases NDM, OXA-48, VIM, IMP and KPC was done by Polymerase chain reaction (PCR) in 152 and 138 non-consecutive carbapenem resistant isolates during the two study periods respectively. Conjugation assay and sequencing of NDM and OXA-48 gene was done on a few selected isolates. RESULTS: As compared to Pre-COVID period, co-morbidities and the mortality rates were higher in patients harbouring carbapenem resistant organisms during the COVID period. The overall carbapenem resistance rate for all the four organisms increased from 23 to 41% between the two periods of study; with Pseudomonas aeruginosa and Klebsiella pneumoniae showing significant increase (p < 0.05). OXA-48, NDM and co-expression of NDM and OXA-48 were the most common genotypes detected. NDM-5 and OXA-232 were most common variants of NDM and OXA-48 family respectively during both the study periods. CONCLUSION: Higher rate of carbapenem resistance in COVID times could be attributed to increase in number of patients with co-morbidities. However, genetic elements of carbapenem resistance largely remained the same in the two time periods.

Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health problems such as depression and anxiety. This study aims to investigate the prescribing pattern of psychotropic drugs in patients with common mental disorders which might be altered during the pandemic and also whether the pandemic could alter their quality of life (QOL) and medication adherence. MATERIALS AND METHODS: After prior ethical approval, a descriptive cross-sectional drug utilization study (DUS) of 200 prescriptions was undertaken to evaluate the pattern of psychotropic drug usage as per WHO (World Health Organization)/International Network of Rational Use of Drugs (INRUD) guidelines. The correlation of the average number of drugs per prescription with QOL was observed. The correlation of adverse drug reactions (ADRs) with medication adherence was also analyzed. RESULTS: The average number of drugs per prescription during the pre-COVID-19 and COVID-19 period was estimated to be 2.48 and 2.96. The percentage of drugs prescribed by generic name in the two different periods (pre-COVID-19 and COVID-19) was 97.40 and 95.77%. The percentage of drugs prescribed from the list of essential medicines was 89.40 and 85.12%, respectively. The percentage of prescriptions with injections was 0.45% and 0.53%, respectively for the two periods. The QOL during the COVID-19 pandemic was found to be negatively correlated to the average number of drugs per prescription (correlation coefficient = -0.61) and medication adherence was found to be poor in patients who developed ADRs with the drugs prescribed (p-value of 0.001). CONCLUSION: In the tertiary care hospital described, rational drug prescribing was followed. Increase in the number of drugs per prescription was found to be associated with poor QOL and the development of ADRs led to medication nonadherence in the patients. Further studies with larger sample sizes are needed to confirm these results. How to cite this article: Kumar A, Halder S, Srivastava S, et al. Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic. J Assoc Physicians India 2023;71(9):14-18.

Association of serotonin transporter gene polymorphism with efficacy of the antidepressant drugs sertraline and mirtazapine in newly diagnosed patients with major depressive disorders.

OBJECTIVE: We examined the association of serotonin receptor transporter gene polymorphism in patients with MDD with the clinical efficacy of mirtazapine (MZ) and sertraline (ST). METHOD: Newly diagnosed, treatment naïve, 80 MDD patients (aged 18-45) diagnosed using DSM-5 criteria and with Beck's depression inventory score (BDI) score ≥21 were included and randomly divided into two groups of 40 participants and were administered MZ 15-45 mg/day or ST 25-200 mg/day respectively. Patients were followed up for 6 weeks for evaluation of BDI scores. Genotypic evaluation was done and three allele variants were identified based on the polymerase chain reaction fragment sizes: short (S; 486 bp), long (L; 529 bp), or extralong (XL; 612 or 654 bp) and classified into five genotypes: S/S,S/L, L/L, S/XL, and L/XL. RESULT: We found that 32.5% patients belonged to the S/S genotype, suggesting that individuals with the SS genotype are at higher risk of developing MDD. No statistically significant association was seen with ST or MZ groups on the basis of genotypes. Clinically significant improvement was observed with a more than 50% reduction in BDI scores at 6 weeks of treatment with both drugs. CONCLUSION: Identification of risk population can be carried out by genotype testing. Prior genotyping in MDD patients might help to predict a better clinical outcome with antidepressants.

Correlation between telomere length and efficacy of oral and long-acting injectable antipsychotics on severity and cognitive impairment of schizophrenia.

OBJECTIVE: To study the correlation between telomere length (TL) and long-acting injectable (LAI) and oral atypical antipsychotic (OAA) efficacy on schizophrenia (SCZ) severity and cognitive impairment. METHODS: Sixty Schizophrenia patients of 18-50 years and of either sex were included in a 12-week study. Thirty patients were recruited in each group, LAI and OAA. Positive and Negative Syndrome Scale (PANSS) and National Institute of Mental Health and Neuro-Sciences (NIMHANS) neuropsychological battery tests were evaluated at baseline and 12 weeks. TL was estimated at baseline. RESULTS: Both groups showed a significant improvement in PANSS and NIMHANS battery test scores after treatment (p < 0.001) within the group, though not between the groups. Mean TL at baseline was 407.58 ± 143.93 and 443.40 ± 178.46 in LAI and OAA groups respectively. A significant negative correlation (r = -0.28, p = 0.03) of TL was seen with the mean change in negative PANSS score after treatment. CONCLUSIONS: LAI antipsychotics are similar to OAA in decreasing the disorder severity and improving the cognitive impairment in schizophrenia. Also, patients who have shorter TL show greater improvement in the negative PANSS score. Hence, TL holds the potential of predicting antipsychotic drug response in schizophrenia patients.KEY POINTSLong-acting injectable antipsychotic was comparable to oral atypical antipsychotics in bringing out improvement in disorder severity, cognitive functions over 12 weeks.Shorter telomere length has been found to be associated with a greater response in negative symptoms of schizophrenia.

Early wound-responsive cues regulate the expression of WRKY family genes in chickpea differently under wounded and unwounded conditions.

Insect wounding activates a large number of signals that function coordinately to modulate gene expression and elicit defense responses. How each signal influences gene expression in absence of wounding is also important since it can shed light on changes occurring during the shift to wound response. Using simulated Helicoverpa armigera herbivory on chickpea, we had identified at least 14 WRKY genes that showed 5-50 fold increase in expression within 5-20 min of wounding. Our studies show that contrary to their collective effects upon wounding, individual chemical cues show distinct and often opposite effects in absence of wounding. In particular, jasmonic acid, a key early defense hormone, reduced transcripts of most WRKY genes by > 50% upon treatment of unwounded chickpea leaves as did salicylic acid. Neomycin (a JA biosynthesis inhibitor) delayed and also reduced early wound expression. H2O2 transiently activated several genes within 5-20 min by 5-8 fold while ethylene activated only a few WRKY genes by 2-5 fold. The summation of the individual effects of these chemical cues does not explain the strong increase in transcript levels upon wounding. Detailed studies of a 931 nt region of the CaWRKY41 promoter, show strong wound-responsive GUS expression in Arabidopsis even in presence of neomycin. Surprisingly its expression was lost in the coi1, ein2 and myc2myc3myc4 mutant backgrounds suggesting the requirement of intact ethylene and JA signaling pathways (dependent on MYCs) for wound-responsive expression. The studies highlight the complexity of gene regulation by different chemical cues in the presence and absence of wounding. Supplementary Information: The online version contains Supplementary material available at 10.1007/s12298-022-01170-y.

Mycobacterium tuberculosis protein PPE2 binds to DNA region containing promoter activity.

ppe2 gene is predicted to be present in operon with non pe/ppe genes, cobq1 and cobu as ppe2-cobq1-cobu. Thus, we were interested to investigate the role of ppe2 in operonic organization. We performed microscale thermophoresis (MST) experiment which revealed that PPE2 protein could bind to upstream DNA segments of ppe2-cobq1-cobu operon. Upstream region of ppe2 had shown promoter activity in ß-gal assay. In this study, for the first time, a physical interaction between PPE2 protein and DNA fragment was reported, suggesting that PPE2 protein plays a role in the regulation of the putative ppe2-cobq1-cobu operon, via unknown mechanism.

Mycobacterium tuberculosis PPE2 Protein Interacts with p67phox and Inhibits Reactive Oxygen Species Production.

Mycobacterium tuberculosis employs defense mechanisms to protect itself from reactive oxygen species (ROS)-mediated cytotoxicity inside macrophages. In the current study, we found that a secretory protein of M. tuberculosis PPE2 disrupted the assembly of NADPH oxidase complex. PPE2 inhibited NADPH oxidase-mediated ROS generation in RAW 264.7 macrophages and peritoneal macrophages from BALB/c mice. PPE2 interacted with the cytosolic subunit of NADPH oxidase, p67phox, and prevented translocation of p67phox and p47phox to the membrane, resulting in decreased NADPH oxidase activity. Trp236 residue present in the SH3-like domain of PPE2 was found to be critical for its interaction with p67phox Trp236Ala mutant of PPE2 did not interact with p67phox and thereby did not affect ROS generation. M. tuberculosis expressing PPE2 and PPE2-null mutants complemented with PPE2 survived better than PPE2-null mutants in infected RAW 264.7 macrophages. Altogether, this study suggests that PPE2 inhibits NADPH oxidase-mediated ROS production to favor M. tuberculosis survival in macrophages. The findings that M. tuberculosis PPE2 protein is involved in the modulation of oxidative response in macrophages will help us in improving our knowledge of host-pathogen interactions and the application of better therapeutics against tuberculosis.

Cardiac autonomic tone, plasma BDNF levels and paroxetine response in newly diagnosed patients of generalised anxiety disorder.

Objective: The study examined the effect on cardiac autonomic tone via heart rate variability (HRV), brain derived neurotrophic factor (BDNF) in newly diagnosed generalised anxiety disorder (GAD) cases with paroxetine-controlled release (PX) CR intervention.Methods: Fifty GAD cases using DSM-5 criteria, matched with healthy controls (HC) were assessed with clinical measures (Hamilton Anxiety Scale (HAM-A), Clinical Global Impression- Severity Scale (CGI-Severity), General Health Questionnaire -12 (GHQ-12), HRV, plasma BDNF levels initially and 6 weeks postintervention with paroxetine CR.Results: HRV parameters were significantly lower in GAD vs HC at baseline for standard deviation of normal to normal intervals (SDNN) and proportion of differences in consecutive NN intervals that are longer than 50 ms (pNN50). Significantly higher plasma BDNF levels were noted between HC versus GAD at baseline. Postintervention HAM-A, CGI scores, GHQ-12 item scores showed significant reduction. Significant differences also noted in square root of mean squared difference of successive NN intervals (RMSSD), (SDNN), pNN50 and in plasma BDNF levels after intervention within GAD group. Significant negative correlation observed between HAM-A scores and SDNN parameter after taking PX CR in GAD.Conclusion: GAD showed cardiac autonomic dysfunction, lowered plasma BDNF levels and their improvement with paroxetine CR.Key messageGAD is associated with significantly lower HRV, suggestive of cardiac autonomic dysfunction and lowered plasma BDNF levels, an indicator of stress.Therapeutic intervention with Paroxetine in GAD patients showed clinically significant improvement reflecting restoration of the cardiac autonomic tone and BDNF levels, thus implying their role as potential biomarkers.

A strong early acting wound-inducible promoter, RbPCD1pro, activates cryIAc expression within minutes of wounding to impart efficient protection against insects.

The expression of insecticidal proteins under constitutive promoters in transgenic plants is fraught with problems like developmental abnormalities, yield drag, expression in unwanted tissues, and seasonal changes in expression. RbPCD1pro, a rapid, early acting wound-inducible promoter from rose that is activated within 5 min of wounding, was isolated and characterized. Wounding increased transcript levels up to 150 and 500 folds within 5 and 20 min coupled with high translation as seen by histochemical GUS enzyme activity within 5-20 min. RbPCD1pro was activated by both sucking and chewing insects and showed wound-inducible expression in various aerial tissues of plants representing commercially important dicot and monocot families. The promoter showed no expression in any vegetative tissue except upon wounding. Functionality of RbPCD1pro was tested by its ability to drive expression of the insecticidal protein gene cryIAc in transgenic Arabidopsis and tomato. Strong wound-inducible CryIAc expression was observed in both plants that increased 100-350 fold (Arabidopsis) and 280-600 fold (tomato) over the unwounded background within 5 min and over 1000-1600 fold within 20 min. The unwounded background level was just 3-6% of the CaMV35S promoter while wound-induced expression was 5-27 folds higher than the best CaMV35S line in just 5 min and 80-fold higher in 20 min. Transgenic plants showed strong resistance even to larger fourth instar larvae of H. armigera and no abnormalities in development and general plant growth. This is one of the earliest acting promoters with wide biotechnological application across monocot and dicot plants.

Cervical cancer screening in rural India: Status & current concepts.

Cervical carcinoma is one of the most common and dreaded diseases of women, and in India, it accounts for 16 per cent of total cervical cancer cases occurring globally. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer. Different screening strategies such as rural cancer registries and camp approach for cancer detection have been found useful in minimizing the problem of cervical cancer in the villages. Various screening techniques such as visual inspection with acetic acid, visual inspection with Lugol's iodine, visual inspection with magnification devices-magnavisualizer, Pap smear and HPV-DNA testing have been suggested and tried under low-resource settings of our country, and cervical cytology screening has been found effective in reducing incidence of the disease. In the present review, feasibility of different screening methods has been assessed to find out the most suitable mode applicable at the rural level. Single lifetime screening particularly of high-risk women along with analysis of cost-effective tumour markers such as Argyrophilic nucleolar organizer regions (AgNOR) counts to discriminate high-risk dysplasia cases appears to be an appropriate approach in fighting against cervical cancer.

A Diffusion Tensor Imaging Study Using a Voxel-Based Analysis, Region-of-Interest Method to Analyze White Matter Abnormalities in First-Episode, Treatment-Naïve Major Depressive Disorder.

This study used fractional anisotropy (FA), a measure of diffusion tensor imaging, to analyze white matter abnormalities in 15 first-episode treatment-naïve patients with major depressive disorder (MDD) and 15 controls matched for age. An automated voxel-based analysis and a region-of-interest (ROI) method with 3T magnetic resonance imaging were used. Compared with controls, FA values were lower in the left superior longitudinal fasciculus, the left prefrontal cortex, and the left parietal region in patients with MDD. In addition, the ROI method revealed significantly lower FA values in the right hippocampus. Voxel-based analysis, a faster technique, complements the ROI method, which highlights FA values as potential biomarkers in early MDD.

Development of Immunochromatographic Assay for Identification of Organophosphate Pesticides in Environmental Samples.

Microtiter plate enzyme linked immunoassay (ELISA) experiments in competitive format were performed utilizing polyclonal antibody for establishing a detection system for organophosphate pesticides. IC50 value of and limit of detection (LOD) value was determined by standard inhibition curve and value obtained were 0.05 µgmL(-1) and 0.001 µgmL(-1), respectively. Specificity of antibody was investigated with different organophosphate pesticides. Immunochromatographic assay (ICA) experiments were also designed in competitive format by making use of immunochromatographic strip which was assembly of three main components: conjugate pad, membrane and adsorbent pad. Membrane was coated with hapten-OVA conjugate (test line) and antirabbit IgG (control line). ICA experiments were performed by employing gold-labeled antibody as a detector reagent which was applied over conjugate pad. Visual detection limit obtained from ICA was 0.5 µgmL(-1). Major advantage of strip assay was rapid result, i.e., less than 10 min. which makes it suitable for onsite applications.

Development, optimization, and characterization of a novel tea tree oil nanogel using response surface methodology.

PURPOSE: To develop and optimize nanoemulsion (NE)-based emulgel (EG) formulation as a potential vehicle for topical delivery of tea tree oil (TTO). METHODOLOGY: Central composite design was adopted for optimizing the processing conditions for NE preparation by high energy emulsification method viz. surfactant concentration, co-surfactant concentration, and stirring speed. The optimized NE was developed into emulgel (EG) using pH sensitive polymer Carbopol 940 and triethanolamine as alkalizer. The prepared EG was evaluated for its pH, viscosity, and texture parameters, ex vivo permeation at 37 °C and stability. Antimicrobial evaluation of EG in comparison to conventional gel and pure TTO was also carried out against selected microbial strains. RESULTS AND DISCUSSION: Optimized NE had particle size and zeta potential of 16.23 ± 0.411 nm and 36.11 ± 1.234 mV, respectively. TEM analysis revealed the spherical shape of droplets. The pH of EG (5.57 ± 0.05 ) was found to be in accordance with the range of human skin pH. EG also illustrated efficient permeation (79.58 µL/cm(2)) and flux value (JSS) of 7.96 µL cm(2)/h through skin in 10 h. Viscosity and texture parameters, firmness (9.3 ± 0.08 g), spreadability (2.26 ± 0.06 mJ), extrudability (61.6 ± 0.05 mJ), and adhesiveness (8.66 ± 0.08 g) depict its suitability for topical application. Antimicrobial evaluation of EG with same amount of TTO as conventional gel revealed broader zones of growth inhibitions against all the selected microbial strains. Moreover, EG was also found to be nonirritant (PII 0.0833). These parameters were consistent over 90 d. CONCLUSION: TTO EG turned out to be a promising vehicle for the topical delivery of TTO with enhanced therapeutic efficacy.

Competitive immunochromatographic assay for the detection of thiodiglycol sulfoxide, a degradation product of sulfur mustard.

An immunochromatographic assay (ICA) based on the competitive antigen-coated format using colloidal gold as the label was developed for the detection of thiodiglycol sulfoxide (TDGO), an important metabolite and degradation compound of sulphur mustard (SM). The ICA test strip consisted of a membrane with a detection zone, a sample pad and an absorbent pad. The membrane was separately coated with hapten-OVA conjugate (test line) and anti-rabbit mouse IgG (control line). The visual detection limit for TDGO by ICA detection was found to be 10 µg mL(-1). For validation, the ICA results obtained for spiked water samples were in good agreement with those obtained by indirect competitive inhibition enzyme-linked immunosorbent assay (ELISA) for TDGO. The assay time for detection was less than 10 min. The developed ICA has the potential to be a useful on-site screening tool for the retrospective detection of SM in environmental samples.

Stability-Indicating Densitometric Analysis of Evogliptin Tartrate in Bulk and Tablet Dosage Form.

BACKGROUND: Evogliptin tartrate is a novel dipeptidyl peptidase (DPP-4) inhibitor very recently introduced into the market as an oral hypoglycemic drug. OBJECTIVE: The literature review has revealed no reports of stability-indicating analytical methods so far for evogliptin tartrate. Thus, the goal of this study was to develop and validate a stability-indicating high-performance thin-layer chromatography (HPTLC) method for evogliptin tartrate in bulk and tablet dosage form. METHOD: For the study, precoated plates of silica gel 60F254 were used as stationary phase and acetonitrile-water-formic acid (30:8:2, v/v/v) was used as a developing system. The densitometric scanning was performed at 270 nm, and the method was validated as per International Council for Harmonisation (ICH) guidelines for accuracy, precision, limit of detection (LOD), and limit of quantitation (LOQ). Evogliptin was subjected to forced degradation studies and was exposed to various stress conditions such as acid/base hydrolysis, oxidation, thermal stress, and UV light. RESULTS: The developed method furnished compact spots of evogliptin (Rf 0.62 ± 0.05) and was linear in the concentration range of 1-5 µg/spot. The lowest detection and quantitation values were found to be 0.331 and 1.003 µg/spot, respectively, and % recovery was found to be 101.09. The low RSD values (below 2%) for intra-day (% RSD 1.86) and inter-day (% RSD 1.43) precision studies demonstrated the preciseness of the developed method. CONCLUSIONS: All the validation parameters were found to be within the acceptable range prescribed by ICH guidelines, indicating that the developed method was accurate, precise, selective, and reproducible. A total of five degradation products were resolved under various stress conditions. HIGHLIGHTS: The proposed method has a promising application commercially for identification, routine quantitative determination, and monitoring of stability of the evogliptin tartrate in bulk and tablet dosage forms to guarantee its safety, efficacy, and quality. Moreover, the developed method will also help in formulation development and in determining the appropriate storage conditions.

Vaccines against Tuberculosis: Where Are We Now?

Tuberculosis (TB) is among the top 10 leading causes of death in low-income countries. Statistically, TB kills more than 30,000 people each week and leads to more deaths than any other infectious disease, such as acquired immunodeficiency syndrome (AIDS) and malaria. TB treatment is largely dependent on BCG vaccination and impacted by the inefficacy of drugs, absence of advanced vaccines, misdiagnosis improper treatment, and social stigma. The BCG vaccine provides partial effectiveness in demographically distinct populations and the prevalence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB incidences demands the design of novel TB vaccines. Various strategies have been employed to design vaccines against TB, such as: (a) The protein subunit vaccine; (b) The viral vector vaccine; (c) The inactivation of whole-cell vaccine, using related mycobacteria, (d) Recombinant BCG (rBCG) expressing Mycobacterium tuberculosis (M.tb) protein or some non-essential gene deleted BCG. There are, approximately, 19 vaccine candidates in different phases of clinical trials. In this article, we review the development of TB vaccines, their status and potential in the treatment of TB. Heterologous immune responses generated by advanced vaccines will contribute to long-lasting immunity and might protect us from both drug-sensitive and drug-resistant TB. Therefore, advanced vaccine candidates need to be identified and developed to boost the human immune system against TB.

Phytosynthesis of Silver Nanoparticles Using Oscimum sanctum Leaf Extract and Studies on Its Antidiabetic, Antioxidant, and Antibacterial Properties.

The green synthesis of plasmonic metal nanoparticles (NPs) has gained considerable attention among researchers as it is cost-effective, environmentally friendly, energy-saving, and nontoxic. We have synthesized silver NPs (Ag NPs) with Oscimum sanctum (holy Tulsi) medicinal plant leaf extract by green synthesis methods. Further, we investigate the antibacterial, antioxidant, and antidiabetic activities of the synthesized Ag NPs. Oscimum sanctum leaf extract has secondary metabolites such as phenolic and flavonoid compounds, which play a significant role in the synthesis of Ag NPs. Subsequently, these bioactive molecules get adsorbed on the large surfaces of the synthesized NPs. Spectroscopic techniques such as X-ray diffraction (XRD), UV-visible absorption, Fourier-transform infrared, and scanning electron microscopy have been used to study and characterize the phytosynthesized Ag NPs. The XRD pattern confirms the formation of crystalline Ag NPs with a high degree of intensity. UV-visible absorption spectra confirm the surface plasmon resonance peak in the range of 440-450 nm. A scanning electron microscopy picture reveals homogeneous growth of Ag NPs with particle sizes of 200-400 nm; however, crystallite size along different planes has been estimated in the range of 18-23 nm. We have found that these Ag NPs synthesized with Oscimum sanctum leaf extract show inhibitory activity against α-amylase and α-glucosidase enzymes in vitro. Our findings further reveal that these Ag NPs are more effective in inhibiting the growth of Salmonella typhi bacteria as compared to other bacterial strains.

The Association of Psychosocial Manifestations and Quality of Life With Inflammatory Markers in SARS-CoV-2 Patients: A Study From a Dedicated COVID-19 Tertiary Care Hospital.

AIM: The second wave of the coronavirus disease 2019 (COVID-19) pandemic adversely affected an individual's physical and psychological well-being. Events such as nationwide lockdown, isolation, social distancing, loss of jobs, and mortality among close contacts and the neighborhood had a dreadful impact on the psychological well-being of the population. At the time of conducting the present study, limited literature was available on the psychosocial manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the Indian population. Hence, the present study was conducted to find out the association between depression, anxiety, stress, and quality of life with inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), D-dimer, serum ferritin, procalcitonin (PCT) in SARS-CoV-2 patients during admission and follow-up in a tertiary care hospital. METHODS: This was an observational analytical study conducted during the second wave of the SARS-CoV-2 pandemic at a designated COVID-19 tertiary care hospital in New Delhi, India. Guidelines provided by the Ministry of Health and Family Welfare; the Government of India, were used for deciding hospital admissions. Sixty patients, confirmed positive by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, aged 18-60 years, were recruited for this study. All study subjects were screened by a rating scale for which the Hindi version of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was employed, and the Hindi version of the 26-item World Health Organization Quality of Life Brief Version (WHOQOL-BREF) was used to assess the quality of life. Special investigations like CRP, IL-6, D-dimer, serum ferritin, and PCT were sent on day one of admission. RESULTS: The prevalence of depression, anxiety, and stress was 63.3%, 85%, and 26.7%, respectively. The mean D-dimer level was found to be 957.32 ± 650.91 ng/ml, mean pro-calcitonin level was 1.04 ± 1.47 ng/ml, mean serum ferritin level was 722.24 ± 486.75 µg/L, mean CRP level was 65.36 ± 35.12 mg/L, and mean IL-6 level was 62.79 ± 49.05 pg/ml. The average score for the physical domain of the WHOQOL-BREF on days 7, 14, and 28 were 66.23, 77.43, and 82.18, respectively. The average score for the psychological domain on days 7, 14, and 28 were 73.93, 78.33, and 86.21, respectively. The average score for social domain on days 7, 14, and 28 were 82.63, 86.38, and 89.73, respectively. The average score for the environmental domain on days 7, 14, and 28 were 78.33, 88.78, and 90.98, respectively. The prevalence and severity of depression were significantly associated with D-dimer, CRP, ferritin, PCT, and Interleukin-6 (p<0.05). The prevalence and severity of anxiety were significantly associated with PCT, IL-6, and CRP (p<0.05). CONCLUSION: SARS-CoV-2 infection adversely affected our study population's mental well-being. An increased prevalence of psychosocial manifestations like depression, anxiety, and stress was noted in participants. We also concluded that increased levels of inflammatory markers (CRP, IL-6, PCT, D-dimer, and serum ferritin) were associated with increased prevalence of psychiatric manifestations like depression.

Identification of potential molecular mimicry in pathogen-host interactions.

Pathogens have evolved sophisticated strategies to manipulate host signaling pathways, including the phenomenon of molecular mimicry, where pathogen-derived biomolecules imitate host biomolecules. In this study, we resurrected, updated, and optimized a sequence-based bioinformatics pipeline to identify potential molecular mimicry candidates between humans and 32 pathogenic species whose proteomes' 3D structure predictions were available at the start of this study. We observed considerable variation in the number of mimicry candidates across pathogenic species, with pathogenic bacteria exhibiting fewer candidates compared to fungi and protozoans. Further analysis revealed that the candidate mimicry regions were enriched in solvent-accessible regions, highlighting their potential functional relevance. We identified a total of 1,878 mimicked regions in 1,439 human proteins, and clustering analysis indicated diverse target proteins across pathogen species. The human proteins containing mimicked regions revealed significant associations between these proteins and various biological processes, with an emphasis on host extracellular matrix organization and cytoskeletal processes. However, immune-related proteins were underrepresented as targets of mimicry. Our findings provide insights into the broad range of host-pathogen interactions mediated by molecular mimicry and highlight potential targets for further investigation. This comprehensive analysis contributes to our understanding of the complex mechanisms employed by pathogens to subvert host defenses and we provide a resource to assist researchers in the development of novel therapeutic strategies.

The Psychological Impact of Rhino-Orbital Mucormycosis During the Second Wave of COVID-19 Pandemic From South East Asian Country.

AIM: The present study addressed overcoming the lacunae in the literature of psychiatric manifestations associated with rhino-orbital mucormycosis. The current study aimed to assess the symptoms of depression, anxiety, stress, coping measures, suicidal intent, and visual disability in patients of rhino-orbital mucormycosis (ROM) during the epidemic of the disease at the nodal tertiary care center in North India. METHODS: Fifty-four inpatients of laboratory-proven rhino-orbital mucor-mycosis (ROM) were included for an observational, cross-sectional study at nodal, designated COVID-19, and mucormycosis treating tertiary care hospital. Patients with Hindi Mini-Mental State Examination score <24, prior psychiatric illness, and severely ill requiring ventilator support were excluded. The psychological variables were assessed using Depression, Anxiety, and Stress Scale 21 (DASS 21), Beck's Suicide intent Scale, Coping Scale Questionnaire, and Visual disability scale (IND-VFQ33). Their socioeconomic status was assessed using the Modified Kuppuswamy Scale. RESULTS: Ninety percent of patients with ROM had diabetes mellitus. The majority (44%) of patients belonged to lower socioeconomic strata. Higher frequencies of severe depression (28%), extremely severe anxiety (26%), and mild stress (17%) were noted in the study participants. On the Tukey test, depression score was higher in patients of ROM compared to COVID (with ROM) (p-value= 0.016). On Tukey analysis, anxiety score was significantly higher in ROM patients compared to COVID (with ROM) patients (p-value = 0.018). Coping scores were significantly higher in COVID (with ROM) patients compared to ROM patients (p value = 0.035). Mild to moderate visual disability was noted in the study participants.  Conclusion: The current study reflects the association of higher depression and anxiety scores in cases with ROM that indicated higher mental health needs. Early assessment, early detection, and early intervention for psychological help, along with the multidisciplinary team, helped to improve the overall psychological outcome of the affected patients.