Performance of CBNAAT on Pleural Biopsies Obtained by Semirigid Thoracoscopy for Diagnosis of Unexplained Pleural Effusion: A Prospective Study from North India.

BACKGROUND: Exudative pleural effusions are commonly encountered in clinical practice, but in about one-fourth of cases, etiology remains elusive after initial evaluation. Medical thoracoscopy with semirigid thoracoscope is a minimally invasive procedure with high diagnostic yield for diagnosing pleural diseases, especially these undiagnosed exudative pleural effusions. In tubercular endemic areas, often, these effusions turn out to be tubercular, but the diagnosis of tubercular pleural effusion is quite challenging due to the paucibacillary nature of the disease. Although culture is the gold standard, it is time-consuming. Cartridge-based nucleic acid amplification test (CBNAAT) is a novel rapid diagnostic test for tuberculosis (TB) and has been recommended as the initial diagnostic test in patients suspected of having extrapulmonary TB (EPTB). MATERIALS AND METHODS: We conducted a prospective observational study of 50 patients with undiagnosed pleural effusion admitted to our tertiary care hospital. The primary aim of the study is to evaluate the diagnostic performance of CBNAAT on thoracoscopic guided pleural biopsy and compare it with conventional diagnostic techniques like histopathology and conventional culture. RESULTS: Of 50 undiagnosed pleural effusions, TB (50%) was the most common etiology. The overall diagnostic yield of semirigid thoracoscopy in this study was 74%. Our study showed that CBNAAT of pleural biopsies had a sensitivity of 36% only but a specificity of 100%. The sensitivity of CBNAAT was not far superior to the conventional culture. CONCLUSION: Tuberculosis (TB) is a common cause of undiagnosed pleural effusion in our set-up. CBNAAT testing of pleural biopsy, though, is a poor rule-out test for pleural TB, but it may aid in the early diagnosis of such patients.

Effect of Exercise Versus Metformin among Nigerians with Prediabetes: A Randomised Controlled Trial.

BACKGROUND: Prediabetes is an important risk factor for the development of type 2 diabetes and is common in Nigeria. Prediabetes often progresses to type 2 diabetes but effective intervention can reverse the carbohydrate intolerance associated with the condition. No studies have been reported among Nigerians on the natural outcome or effect of intervention in prediabetes. OBJECTIVE: To determine and compare the effect of moderate exercise and metformin on glucose tolerance among the participants with prediabetes. METHODOLOGY: Using a randomized placebo-controlled design, 54 Nigerians with prediabetes were selected using simple random sampling. They were offered treatment with metformin, moderate exercise, or placebo and followed up for 12 weeks. Plasma glucose levels were assessed before and after the interventions and the outcome was compared. RESULTS: Forty-nine participants with prediabetes completed the study. Compared to placebo the exercise group had a significant decrease in glycaemic level from the baseline, FPG=5.1mmol/L (6.4% reduction) and 2HPGL=7.6mm/L (20.5% reduction) p-value<0.05. The metformin group also had a significant decrease in glycaemic level from the baseline, FPG=5.1mmol/L (13.3% reduction) and 2HPGL=7.9mmol/L (12.4% reduction) p-value<0.05. Diabetes risk reduction for exercise and metformin interventions were 50% and 40%respectively. CONCLUSION: Among Nigerians with prediabetes, moderate exercise, and metformin interventions have significantly higher efficacy than placebo in improving glucose tolerance. However, moderate exercise and metformin have comparable efficacy in improving glucose tolerance and diabetes risk reduction. Participants in this study need to be followed up for a longer period to assess the long-term effects of these interventions.

CONTEXTE: Le prédiabète est un facteur de risque important du développement du diabète de type 2 et est fréquent au Nigeria. Le prédiabète évolue souvent vers le diabète de type 2, mais une intervention efficace peut inverser l'intolérance aux glucides associée à cette affection. Aucune étude n'a été rapportée chez les Nigérians sur l'évolution naturelle ou l'effet de l'intervention dans le prédiabète. OBJECTIF: Déterminer et comparer l'effet de l'exercice modéré et de la metformine sur la tolérance au glucose chez les participants atteints de prédiabète. MÉTHODOLOGIE: Selon un plan randomisé contrôlé par placebo, 54 Nigérians atteints de prédiabète ont été sélectionnés par échantillonnage aléatoire simple. Ils ont reçu un traitement par metformine, de l'exercice modéré ou un placebo et ont été suivis pendant 12 semaines. Les niveaux de glucose plasmatique ont été évalués avant et après les interventions et les résultats ont été comparés. RÉSULTATS: Quarante-neuf participants atteints de prédiabète ont terminé l'étude. Par rapport au placebo, le groupe exercice a présenté une diminution significative du taux de glycémie par rapport à la valeur de base, FPG = 5,1 mmol/L (réduction de 6,4 %) et 2HPGL = 7,6 mmol/L (réduction de 20,5 %), p-value < 0,05. Le groupe metformine a également présenté une diminution significative du taux de glycémie par rapport à la valeur de base, FPG = 5,1 mmol/L (réduction de 13,3 %) et 2HPGL = 7,9 mmol/L (réduction de 12,4 %), p-value < 0,05. La réduction du risque de diabète pour les interventions exercice et metformine était respectivement de 50 % et 40 %. CONCLUSION: Chez les Nigérians atteints de prédiabète, les interventions d'exercice modéré et de metformine ont une efficacité significativement supérieure au placebo pour améliorer la tolérance au glucose. Cependant, l'exercice modéré et la metformine ont une efficacité comparable pour améliorer la tolérance au glucose et réduire le risque de diabète. Les participants à cette étude doivent être suivis sur une plus longue période pour évaluer les effets à long terme de ces interventions. MOTS-CLÉS: Diabète de type 2, Prédiabète, Exercice, Metformine, Nigérians.

Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A multicenter analysis.

INTRODUCTION: Fluid administration is an important aspect of the management of children undergoing liver transplantation and may impact postoperative outcomes. Our aim was to evaluate the association between volume of intraoperative fluid administration and our primary outcome, the duration of postoperative mechanical ventilation following pediatric liver transplantation. Secondary outcomes included intensive care unit length of stay and hospital length of stay. METHODS: We conducted a multicenter, retrospective cohort study using electronic data from three major pediatric liver transplant centers. Intraoperative fluid administration was indexed to weight and duration of anesthesia. Univariate and stepwise linear regression analyses were conducted. RESULTS: Among 286 successful pediatric liver transplants, the median duration of postoperative mechanical ventilation was 10.8 h (IQR 0.0, 35.4), the median intensive care unit length of stay was 4.3 days (IQR 2.7, 6.8), and the median hospital length of stay was 13.6 days (9.8, 21.1). Univariate linear regression showed a weak correlation between intraoperative fluids and duration of ventilation (r2 = .037, p = .001). Following stepwise linear regression, intraoperative fluid administration remained weakly correlated (r2 = .161, p = .04) with duration of postoperative ventilation. The following variables were also independently correlated with duration of ventilation: center (Riley Children's Health versus Children's Health Dallas, p = .001), and open abdominal incision after transplant (p = .001). DISCUSSION: The amount of intraoperative fluid administration is correlated with duration of postoperative mechanical ventilation in children undergoing liver transplantation, however, it does not seem to be a strong factor. CONCLUSIONS: Other modifiable factors should be sought which may lead to improved postoperative outcomes in this highly vulnerable patient population.

Impact of Parity on Cardiac Structure and Function in Apparently Healthy Pregnant Nigerian Women.

BACKGROUND: There are few and conflicting reports in the literature about the relationship between parity and maternal cardiac function. The study aimed to assess the impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria. METHODS: This was a cross-sectional study carried out in 3 tertiary centers in Kano, and 1 in Ile-Ife, Nigeria. 112 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation, and their cardiac structure and function assessed using echocardiography. Left ventricular (LV) systolic dysfunction was defined as LV ejection fraction of below 50%, and diastolic dysfunction was graded using mitral filling and tissue Doppler velocities. RESULTS: LV systolic dysfunction and diastolic dysfunction were found in 6 (5.4%) subjects and 20 (17.9%) subjects, respectively. Age (p= <0.0001), left atrial (LA) size (P<0.0001), interventricular septal thickness at end diastole (IVSD) (p= 0.005), posterior wall thickness at end diastole (PWTD) (p=0.004) and QRS duration (p= <0.0001) all increased progressively with higher parity, while tricuspid annular systolic excursion (p=0.320) decreased with higher parity. There was significant positive correlation between parity and age (r= 0.475, p= <0.0001), LA size (r=0.332, p= <0.0001), IVSD (r=0.264, p= 0.005) and PWTD (r= 0.343, p= <0.0001). LV systolic function was not significantly associated with parity. CONCLUSION: Our findings suggested that parity was significantly associated with myocardial remodeling in apparently healthy pregnant women.

CONTEXTE: Il existe peu de données contradictoires dans la littérature sur la relation entre la parité et la fonction cardiaque maternelle. L'étude visait à évaluer l'impact de la parité sur la structure et la fonction cardiaques chez des femmes enceintes apparemment en bonne santé au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans 3 centres tertiaires à Kano et 1 à Ile-Ife, au Nigeria. 112 femmes enceintes apparemment en bonne santé ont été recrutées consécutivement entre la 28* et la 38* semaine de gestation, et leur structure et fonction cardiaques ont été évaluées par échocardiographie. La dysfonction systolique du ventricule gauche (VG) a été définie comme une fraction d'éjection du VG inférieure à 50 %, et la dysfonction diastolique a été graduée en utilisant le remplissage mitral et les vitesses Doppler tissulaires. RESULTATS: Un dysfonctionnement systolique VG et un dysfonctionnement diastolique ont été trouvés chez 6 (5,4 %) sujets et 20 (17,9 %) sujets respectivement. Âge (p=<0,0001), taille de l'oreillette gauche (LA) (P<0,0001), épaisseur du septum interventriculaire en fin de diastole (IVSD) (p=0,005), épaisseur de la paroi postérieure en fin de diastole (PWTD)(p=0,004) et La durée du QRS (p = <0,0001) a augmenté progressivement avec une parité plus élevée, tandis que l'excursion systolique annulaire tricuspide (p = 0,320) a diminué avec une parité plus élevée. Il y avait une corrélation positive significative entre la parité et l'âge (r = 0,475, p = <0,0001), la taille LA (r = 0,332, p = <0,0001), IVSD (r = 0,264, p = 0,005) et PWTD (r = 0,343, p=<0,0001). La fonction systolique VG était associée à la parité. CONCLUSION: Nos résultats suggèrent que la parité est significativement associée au remodelage du myocarde chez les femmes enceintes apparemment en bonne santé. n'était pas significatif. Mots clés: Grossesse, Parité, Structure Cardiaque, Registre peace.

Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Relationship between CD4 Cell Count, Viral Load and Left Ventricular Function among HIV-1 Infected Patients Asymptomatic for Cardiac Disease on HAART.

INTRODUCTION: Human immunodeficiency virus (HIV) infected patients are at increased risk for myocardial infarction and cardiomyopathy. Low CD4 cell count and high viral load were identified as independent risk factors for cardiac disease. Asymptomatic cardiac dysfunction has also been reported in HIV-infected individuals. METHODS: This was a cross-sectional study conducted among consecutive HIV patients who are asymptomatic for cardiac disease receiving highly active antiretroviral therapy (HAART) at the ART clinic of Federal Medical Centre Nguru, Yobe State Northeastern Nigeria. DATA ANALYSIS: Statistical analysis was done using SPSS version 21.0 (SPSS IBM) Chicago Illinois. Data were presented as mean ± standard deviation (SD) for continuous variables, while categorical variables were expressed as frequencies and proportions. Correlation and regression analyses were done to determine the relationship between CD4 cell count, viral load and left ventricular function. A p-value of d"0.05 was considered significant. RESULTS: Patients with high CD4 cells count (>500 cells/µL) were found to have preserved left ventricular systolic function while those with low CD4 cells count (500 cells/µL while those with low CD4 cell count (1500 copies/mL) were associated with reduced left ventricular systolic function and severe diastolic dysfunction. We therefore suggest that there is need for early evaluation of left ventricular function in HIV patients before developing symptoms of cardiac decompensation.

RÉSUMÉ: Les patients infectés par le virus de l'immunodéficience humaine (VIH) présentent un risque accru d'infarctus du myocarde et de cardiomyopathie. Un faible nombre de cellules CD4 et une charge virale élevée ont été identifiés comme des facteurs de risque indépendants de maladie cardiaque. Un dysfonctionnement cardiaque asymptomatique a également été rapporté chez des personnes infectées par le VIH. MÉTHODES: Il s'agissait d'une étude transversale menée auprès de patients VIH consécutifs asymptomatiques de maladie cardiaque recevant un traitement antirétroviral hautement actif (HAART) à la clinique ART du Federal Medical Center Nguru, dans l'État de Yobe, au nord-est du Nigéria. ANALYSE DES DONNÉES: L'analyse statistique a été effectuée à l'aide de SPSS version 21.0 (SPSS IBM) Chicago Illinois. Les données ont été présentées sous forme de moyenne ± écart-type (SD) pour les variables continues, tandis que les variables catégorielles ont été exprimées sous forme de fréquences et de proportions. Des analyses de corrélation et de régression ont été effectuées pour déterminer la relation entre le nombre de cellules CD4, la charge virale et la fonction ventriculaire gauche. Une valeur p de d"0,05 a été considérée comme significative. RÉSULTATS: Les patients avec un nombre élevé de cellules CD4 (> 500 cellules/µL) ont conservé la fonction systolique ventriculaire gauche tandis que ceux ayant un faible nombre de cellules CD4 (500 cellules/µL tandis que ceux ayant un faible nombre de cellules CD4 (1500 copies/mL) étaient associée à une fonction systolique ventriculaire gauche réduite et à un dysfonctionnement diastolique sévère. Nous suggérons donc qu'il est nécessaire d'évaluer précocement la fonction ventriculaire gauche chez les patients VIH avant de développer des symptômes de décompensation cardiaque. MOTS CLÉS: VIH, fonction ventriculaire gauche, numération des CD4 et charge virale.

The Use of Antimicrobial and Antiviral Drugs in Alzheimer's Disease.

The aggregation and accumulation of amyloid-ß plaques and tau proteins in the brain have been central characteristics in the pathophysiology of Alzheimer's disease (AD), making them the focus of most of the research exploring potential therapeutics for this neurodegenerative disease. With success in interventions aimed at depleting amyloid-ß peptides being limited at best, a greater understanding of the physiological role of amyloid-ß peptides is needed. The development of amyloid-ß plaques has been determined to occur 10-20 years prior to AD symptom manifestation, hence earlier interventions might be necessary to address presymptomatic AD. Furthermore, recent studies have suggested that amyloid-ß peptides may play a role in innate immunity as an antimicrobial peptide. These findings, coupled with the evidence of pathogens such as viruses and bacteria in AD brains, suggests that the buildup of amyloid-ß plaques could be a response to the presence of viruses and bacteria. This has led to the foundation of the antimicrobial hypothesis for AD. The present review will highlight the current understanding of amyloid-ß, and the role of bacteria and viruses in AD, and will also explore the therapeutic potential of antimicrobial and antiviral drugs in Alzheimer's disease.

Gender Disparity in Survival amongst End-Stage Renal Disease Patients on Haemodialysis.

BACKGROUND: Gender inequality in access and outcome of health care utilisation has been a major concern worldwide. We evaluated some demographic and clinical characteristics as well as compared the mortality rate between men and women with end-stage renal disease on haemodialysis (HD), to find out if gender has any influence on mortality. METHODS: This was a single centre retrospective study. All adult incident and prevalent haemodialysis patients with end-stage renal disease (ESRD) seen between July 2007 and June 2019 were enrolled in the study. Data collected included age, sex, hepatitis B and C viral status, vascular access at the commencement of haemodialysis, duration on haemodialysis, number of dialysis sessions ever conducted and outcome of haemodialysis. The outcome was stratified as alive, dead, or lost to follow up. The primary outcome measure was all-cause mortality. The IBM SPSS Statistical software version 23 was used to analyse the data. Kaplan Meier survival curve was used to compare all-cause mortality between men and women. RESULTS: This study included 995 HD patients of whom 704 (70.8%) were males. Mean age was 44.7 + 16.3 years. At the end of the study period, 878 (88.2%) patients died. The mortality rates for men and women did not significantly differ with a cumulative median survival of 17 and 16 days respectively (Log-rank = 0.85, p = 0.358). Hepatitis B seropositivity was significantly associated with increased mortality (Hazard Ratio (HR) = 1.2; 95% CI 1.025 - 1.526). CONCLUSIONS: Despite the perceived poor access to modern healthcare services by women in Northern Nigeria, there is no gender disparity in crude mortality in patients with end-stage renal disease on haemodialysis.

Fibrin tissue adhesive versus nasal packing in endoscopic nasal surgery: a systematic review and meta-analysis.

BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

Knowledge, attitude, and practice of diabetic retinopathy among physicians in Northwestern Nigeria.

BACKGROUND: Diabetic retinopathy (DR) is the leading cause of preventable blindness in the productive population that poses a considerable global public health burden. OBJECTIVE: The objective of this study is to assess the knowledge, attitude, and practice of DR screening among physicians in Northwestern Nigeria. Materials and Methods: Survey responses were obtained from 105 physicians in 4 tertiary hospitals using a Likert scale questionnaire. The internal consistency of the questionnaire was calculated using Cronbach's alpha coefficient. Principal component analysis was used for data reduction and grouping with the varimax rotation method, and the factors were extracted based on an Eigenvalue> 1. RESULTS: Most of the respondents (78.8%) were aware of the most effective method of delaying the onset of DR and frequency of eye examination (94.1%). Lack of ophthalmoscopes (70.6%) and dilating eye drops (50.6%) form important barriers to performing a good eye examination. CONCLUSION: DR screening among physicians practicing in Northwestern Nigeria was suboptimal, which prompts the need for improved training of physicians managing persons with diabetes on eye examination in a bid to strengthen DR screening and reduce the burden of visual impairment in our environment.

Population dynamics of Staphylococcus aureus from Northeastern Nigeria in 2007 and 2012.

The population structure of Staphylococcus aureus is changing globally but the situation regarding dominant clones in sub-Saharan Africa is not clear. We therefore assessed changes in the population structure of clinical S. aureus isolates obtained in 2007 (n = 75) and 2012 (n = 75) from Northeastern Nigeria. A reduction in resistance to penicillin, gentamicin, erythromycin and clindamycin was observed in 2012. A decrease of methicillin resistance rates (13·3% to 8·0%) was associated with the decline of the ST241 MRSA clone. The proportion of Panton-Valentine leukocidin (PVL)-positive isolates also decreased from 65·3% to 44%, and was linked with the emergence of PVL-negative ST601 clone in 2012. The significant decline in antibiotic resistance in the study area is in contrast to the worldwide trend of increasing resistance rates.

Capital structure, business model innovation, and firm performance: Evidence from Chinese listed corporate based on system GMM model.

This paper aims to verify the impact of capital structure on business model innovation and firm performance and the mediating effect of business model innovation. We use the data of the Chinese growth enterprises market (GME) listed high-tech firms from 2016 to 2022 as a dynamic panel data model with the system-generalized method of moments (sys-GMM), adopting return on asset and earning per share as firm performance. Our results show that capital structure has a lag effect on firm performance. The total debt ratio in the last period has a significant non-linear impact on the performance and business model innovation level of nowadays, presenting a U-shaped relationship. The first-order lag short-term debt ratio positively improves firm performance. Business model innovation significantly promotes better firm performance, and business model innovation does exist in the mediating effect between enterprise capital structure and its performance. These results remain robust to different sample sizes or proxy variables. This paper proposes some suggestions for firm operations and government policies based on the findings.

Utility of Serum Procalcitonin and Its Clearance in Predicting Outcomes in COVID-19 Patients.

Introduction Identification of coronavirus disease 2019 (COVID-19) patients at risk of worse clinical outcomes is crucial to improving patient care. Various biochemical markers have been used to predict outcomes in such patients. We aimed to evaluate the role of serum PCT (procalcitonin) and the utility of PCT clearance (PCTc) in predicting the outcome of patients with COVID-19 illness. Methods We prospectively included 39 patients with severe or critical COVID-19 illness with an age equal to more than 18 years. In addition to routine baseline investigations, serum PCT was measured at admission (PCT1) and day 5 of hospitalization (PCT2). PCTc was calculated using the formula [Formula: see text]. Results We observed that serum PCT at admission was significantly higher in non-survivors (median: 1.9 ng/ml IQR: 0.51-4.23) compared to survivors (median 0.35 (IQR: 0.1-1.2), p 0.002). On serial serum-PCT estimation, non-survivors had persistently elevated serum-PCT (median PCT1:1.9 ng/ml (IQR: 0.51-4.23) to median PCT2: 1.9ng/ml (IQR: 0.83-2.72), p 0.51) than survivors (median PCT1:0.35ng/ml (IQR: 0.1-1.19) to median PCT2: 0.15ng/ml (IQR: 0.05-0.29), p 0.01). However, no difference in serum PCTc was observed between the two groups (median: 35.3% (IQR: 12.5-84.9) in survivors vs. 71.7% (33.3-91.7) in non-survivors, p = 0.165). Conclusion Serum PCT is a potential biochemical marker that could predict outcomes in COVID-19 patients. Measurement of serial serum PCT and estimation of PCT clearance may serve as better predictors than a single value; however, well-designed studies are required to identify the definite role of serum PCT in COVID-19 patients of varying severity.

An outbreak of influenza B in an isolated nomadic community in Jammu & Kashmir, India.

BACKGROUND & OBJECTIVES: Community outbreaks of disease amongst nomadic populations generally remain undocumented. Following a reported increase in acute respiratory tract infections (ARI) in May 2011 in a nomadic population of Sangerwini in Jammu & Kashmir, India, we examined the patients with ARI symptoms and their nasal swabs were tested for influenza virus. METHODS: Patients with ARI (n=526) were screened from May 14 to 23, 2011 and nasopharyngeal swabs collected from 84 with Influenza like illness (ILI) for bacterial cultures and influenza virus testing. Samples were tested for influenza A and influenza B by real time (RT)-PCR. RESULTS: Twelve (14.3%) of the 84 patients tested positive for influenza B, compared to only one (0.9%) of 108 patients with ILI in a parallel survey performed in Srinagar during the same period, suggesting a localized outbreak in the isolated nomadic community. All presented with respiratory symptoms of less than seven days. Familial clustering was seen in 40 per cent (25% of influenza B positives). Average daytime temperatures ranged from 15-16 ° C compared to 22 ° C in Srinagar. Four patients developed pneumonia whereas others ran a mild course with a total recovery with oseltamivir and symptomatic therapy. INTERPRETATION & CONCLUSION: Our report of confirmed influenza B in this underprivileged nomadic population argues for routine surveillance with efforts to improve vaccination and infection control practices.

Correlation Between Serum Tumor Necrosis Factor-Alpha (TNF-α) and Clinical Severity of Tuberculosis: A Hospital-Based Study.

AIM: The main aim of this study was to assess the correlation between serum tumor necrosis factor-alpha (TNF-α) levels the and clinical severity of tuberculosis. METHODS: This was a hospital-based case-control prospective study and was conducted at the Sher-i-Kashmir Institute of Medical Sciences, a tertiary care hospital in the northern part of India, from May 2016 to May 2018. The subjects were recruited in the study considering inclusion and exclusion criteria. All patients with pulmonary tuberculosis as well as patients with extrapulmonary tuberculosis were included as subjects and a clinical severity score based on anemia, weight loss, presence of hypoxia, and radiological features was calculated and compared with TNF-α levels. Age- and sex-matched healthy individuals were recruited as controls. RESULTS: A total of 75 subjects comprising 50 cases and 25 controls were taken for the study. There were 34 (68.0%) patients with elevated TNF-α levels while only 16 (32.0%) patients had normal TNF-α levels. And, TNF-α levels were normal in 21 (84%) control subjects as compared to tuberculosis (TB) patients. Such difference in serum TNF-α levels between cases and controls was statistically significant (p<0.05). The mean serum TNF-α level in TB cases was 1265.63 pg/mL, while the mean serum TNF-α level in controls was 312.06 pg/mL. The difference in serum TNF-α levels between the two groups was statistically significant (p<0.01). We observed a significant increase in serum TNF-α levels with the increase in clinical severity score. CONCLUSION: Serum TNF-α levels were significantly associated with increased severity of TB.

Clinicopathological Features and Status of Programmed Death Ligand-1 (PD-L1) Expression in Lung Cancer: A Single Centre Study From North India.

Introduction Programmed death ligand-1 (PD-L1) is an immunological checkpoint that supports the inhibition of the anti-tumor immune system. A higher level of PD-L1 expression was also discovered on the cell surfaces of several cancer cells, including non-small cell lung carcinoma (NSCLC). Identifying individuals who would benefit from PD-1/PD-L1 antibody immunotherapy is crucial in the era of precision medicine. The study's objective was to assess the distribution and degree of PD-L1 ligand expression in various forms of lung cancer and examine its link to clinicopathological variables. Methods This prospective, observational, cross-sectional study was done in a tertiary care hospital in North India over 2 years from 2019 to 2021. A total of 100 patients diagnosed with lung cancer through either endobronchial or image-guided biopsies were enrolled. The biopsy specimens of lung cancer patients have been subjected to immunohistochemistry (IHC) staining. PD-L1 expression was positive when at least 1% of tumor cells were stained. In our study, we used the rabbit monoclonal Anti-PD-L1 antibody (CAL10) (ab237726) (Abcam Plc, UK).  Results  Of the 100 patients, Squamous cell carcinoma (SQCC) was the predominant histological pattern. The mean age of the study group was 57.26 ± 10.53 years. High PDL-1 positivity (>50% ) is seen in a total of 10 patients, while low PD-L1 positivity (1-50%) is seen in 24 patients. Of all patients with high PD-L1 positivity (n=10), 80% had stage IV at the time of diagnosis. However, on similar lines, 71 % of patients with low PD-L1 positivity presented with stage IV at the time of diagnosis. (p value=0.09). Among 10 patients with epidermal growth factor receptor (EGFR) positive status, high PD-L1 positivity is seen in 20%. Among 3 patients with anaplastic lymphoma kinase (ALK) positive status, only one patient showed high PD-L1 positivity, whereas negative PDL-1 was seen in 2 patients, which was not statistically significant. Conclusion  The management of lung cancer is driven by precision medicine, including PDL-1 expression, which correlates with immune checkpoint inhibitor response. In our cohort, PD-L1 expression appears to be mostly linked to the squamous cell subtype of lung cancer, with elevated tumor stage and mediastinal lymphadenopathy in Kashmiri people. Other oncogenic driver mutations are not connected to PD-L1 expression. The function of PD-L1 expression in lung tumors requires more study.

Melt-Processed Halide Perovskite Thin Films from a Two-Dimensional Ruddlesden-Popper Phase Precursor.

While halide perovskite thin films have enormous potential for photovoltaics and other optoelectronics, the use of environmentally hazardous solvents during their deposition and processing poses a barrier to their commercialization. In this work, we demonstrated the deposition of melt-processable precursors and subsequent transformation into halide perovskite thin films without using environmentally hazardous solvents. We melted the wide-bandgap layered perovskites [(C6H5CH(CH3)CH2NH3)2PbI4:ß-Me-PEA2PbI4] at ∼210 °C and blade coated them into films. The ß-Me-PEA2PbI4 films were subsequently transformed to perovskite-phase methylammonium or formamidinium lead iodide films using a cation-exchange process in an alcohol-based solvent. Lastly, we demonstrate the potential and limitations of a completely solvent-free approach that uses solid-state transformation of a ß-Me-PEA2PbI4 film. This work represents a substantial step toward eliminating environmentally hazardous solvents and enables inexpensive industrial-scale liquid-phase deposition processes that do not require expensive systems for handling and disposing of environmentally hazardous solvents.

A Rare Case of Brucellosis With Spontaneous Splenic Rupture Presenting as an Acute Abdomen.

Brucellosis is a common zoonotic infection worldwide caused by the bacterial species Brucella. It has a wide range of presentations from asymptomatic infection to multisystem involvement. Splenomegaly is seen in around 30-60% of cases, however, atraumatic spontaneous splenic rupture is extremely rare. We present a case of a 45-year-old man who presented with acute left upper quadrant pain and fever of five days duration without a history of antecedent trauma. He was hemodynamically stable with examination revealing left upper quadrant tender palpable mass. Ultrasonography followed by computed tomography revealed subcapsular hematoma with perisplenic and perihepatic free fluid. Viral markers (hepatitis B and C, cytomegalovirus {CMV}, Epstein-Barr virus {EBV}, HIV, and dengue) were negative. The autoimmune profile was negative. Brucella serum agglutination test was positive (1: 640) and blood cultures grew Brucella melitensis. He was managed conservatively for splenic hematoma and received one unit blood transfusion and treatment with combination of antibiotics (rifampicin and doxycycline) for brucella for six weeks. On follow-up, the patient reported no further complications. Spontaneous splenic rupture is a clinical rarity and should be considered in patients presenting with acute abdomen and suspected infective, neoplastic, and inflammatory pathology. Spontaneous splenic rupture in acute brucellosis requires prompt clinical recognition and immediate anti-Brucella therapy to prevent the catastrophic progression.

Tuberculosis of Finger Presenting As Non-healing Ulcer of Digit: A Case Report.

Tuberculosis (TB) is a chronic granulomatous infection which most often localises to the respiratory system. Extra-pulmonary tuberculosis is prevalent in immunocompromised individuals, of which cutaneous tuberculosis is exceedingly rare (0.5-2%). Cutaneous TB presents with varied clinical morphologies, either acquired exogenously via direct inoculation on the skin or endogenously due to systemic dissemination. Diagnosis is particularly challenging due to the multitude of differential diagnoses of skin lesions. Microbiological evidence from biopsy and histopathological findings suggestive of granulomatous inflammation are needed to make a definitive diagnosis. Herein we present a rare case of tuberculosis of the finger in a middle-aged man who presented with an ulcerating and erythematous lesion. As cutaneous TB is usually misdiagnosed at the earlier stages, dermatologists and primary care physicians should keep high suspicion for cutaneous TB in any non-healing ulcers which are otherwise unexplained.

Vitamin D Toxicity Presenting as Altered Mental Status in Elderly Patients.

Background and objective  Around 25-30% of elderly patients present to emergency departments (ED) with altered mental status (AMS), with hypercalcemia being one of the metabolic causes. Elderly patients, due to their multiple vulnerability factors and relative homeostenosis, are susceptible to alterations in mental state at even milder grades of hypercalcemia. There is a trend of overzealous prescription of higher doses of vitamin D in elderly patients for various ailments, which often exceeds the requirements of the patients. In this study, we aimed to establish vitamin D toxicity (VDT) as an underlying cause of AMS in elderly patients presenting to the hospital. Methods This was a descriptive case study conducted at a tertiary care university hospital in North India, from January 2015 to March 2020 for a total duration of five years. Elderly patients (aged ≥60 years) who were admitted with VDT as a cause for underlying hypercalcemia were included. The evaluation included patient history regarding the dosage of vitamin D received, route of administration, and biochemical parameters, such as serum calcium, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D [25(OH)D], and albumin. All other potential causes for hypercalcemia and AMS were ruled out concurrently. Results A total of 19 patients were enrolled in the study, with a mean age of 72.3 years (range: 62-86 years). All patients had received injectable vitamin D formulation. The mean serum calcium among the patients was 12.52 ± 1.12 mg/dL (range: 11.2-15.7 mg/dL), whereas the mean 25(OH)D was 196.34 ± 70.44 ng/mL (range: 107-356 ng/mL). The mean cumulative vitamin D supplement intake was 2.594 ± 0.841 million IU (range: 1.2 million-4.2 million IU). While six patients had mild hypercalcemia, 12 had moderate, and one person had severe hypercalcemia, with altered sensorium (85%) being the most common complaint for presenting to ED, followed by generalized weakness (15%). Conclusion VDT can manifest with AMS as an initial presenting complaint. The geriatric population, due to various underlying vulnerability factors, is more susceptible than their younger counterparts. We strongly recommend that in elderly patients, higher doses of vitamin D should be prescribed only after checking their serum levels, and frequent monitoring of vitamin D should be performed.