A Study to Assess Symptom Profile and Break Through Infections Among Health Care Workers Post Covid Vaccination at Tertiary Care Health Facility.

Introduction: Breakthrough infections in fully vaccinated persons pose a major challenge to the ongoing vaccine campaign against SARS-CoV-2 globally. Objectives: To investigate the occurrence of breakthrough infections and the association of Covid symptoms with the vaccination status of health care workers (HCWs). Material and Methods: Done in Government Medical College, Patiala among Covid-positive HCWs who have received one or both doses of Covid vaccine, using pretested semi-structured validated Proforma and telephonic interview from April 1, 2021 to June 15, 2021. Results: Among 3388 HCWs, 115 vaccinated HCWs (1st or 2nd dose) became Covid positive. Among vaccinated Covid positive HCWs, 54 received the first dose and 61 both doses. Breakthrough infections (≥14 days post 2nd dose) occurred in 4.6% (47 of 1021) HCWs. The vaccine is significantly protective as shown by an odds ratio of 0.27; thus, vaccinated HCWs are 73% less likely to get Covid infection as compared to non-vaccinated HCWs. There was no statistically significant difference between symptom profiles of cases whether they took one or both doses of vaccine, except headache. Only tiredness and headache were reported significantly higher in the unvaccinated group in comparison to vaccinated HCWs. Conclusion: Research is needed on tracking the immune response and viral genomic sequence of samples of vaccinated Covid-positive HCWs to have constant vigilance on remerging new strains of the SARS-CoV-2.

Morphological and Morphometric Analysis of the Orbital Aperture and Their Correlation With Age and Gender: A Retrospective Digital Radiographic Study.

Purpose Precise knowledge about clinically observed bony orbital aging is needed for surgical planning for acceptable cosmetic results. The effect of age and gender on the facial skeleton and orbital aperture has been appreciated earlier, but its quantification remains ignored. The purpose of this study was to evaluate age- and sex-related changes in the shape of the orbital aperture and construct a reference data set for the aging phenomenon in Indians. Methods Two hundred digital radiographs (Water's/frontal view) of the skull, obtained for various reasons, were evaluated. The radiographs comprised 107 males and 93 females aged between 10 and 60 years (10-59 years). Orbital shape, height/width, and interorbital/biorbital distances were noted, and orbital indices (OIs) were calculated. Orbital parameters thus obtained were compared between right and left sides and males and females. The relation of the parameters with age and gender was analyzed. Results Four types of orbits, round (33.5%), elliptical (30.5%), rectangular (27.5%), and square (9.5%), were noted in the study population. The average value of height and width of the right orbit was found to be higher than that of the left (p > 0.05). Male patients had higher (p > 0.05) and wider (p > 0.05) orbits than females. The right OI (81.55 ± 5.30) was higher than the left (80.75 ± 4.80) (p > 0.05). When comparatively evaluated between gender, both orbits were found to be of the microseme type with a mere difference (p > 0.05). The average interorbital/biorbital distance was 1.27 ± 2.11 and 9.78 ± 4.40 cm, respectively, without any gender difference. No significant relation was found between the age change and the parameters defined (p > 0.05), except in one age group (10-19 years). Conclusions Orbital dimensions showed no association with age and gender except in one age group (10-19 years); a pubertal growth spurt in females might be causing this phenomenon. The morphometric data may be useful in forensic anthropology and better planning for reconstructive surgeries in the orbito-maxillary region.

Treatment Outcomes of Patients Receiving Combination Antiretroviral Therapy under the National Acquired Immunodeficiency Syndrome Control Programme.

INTRODUCTION: The free antiretroviral therapy (ART) initiative of the Government of India was launched on April 1, 2004, since then it is being scaled up in a phased manner. The aim of this study was to analyze the treatment outcome of patients receiving first-line ART through the National Acquired Immunodeficiency Syndrome Control Programme of India. MATERIALS AND METHODS: This was an record-based retrospective analysis of data of patients who were put on ART from January 2009 to December 2009. RESULTS: Of the 548 patients (63.87% males; median age of 37 years), 55% of patients were employed and majority of them have low monthly income. Patients showed a significant improvement in clinical and functional status after staring ART therapy, as percentage of patients in clinical Stage 1 increased significantly (from 35.5% to 90.3%) and that of Stage 3 and 4 decreased drastically. Ninety percent of patients were working, and none was bedridden after 2 years of ART. Patients with >95% adherence to ART showed more improvement than those with <95% adherence (40% patients). The median increase in cluster of differentiation 4 (CD4) count was 134 cells/mm3 at 6 months, 185 cells/mm3 at 12 months, and 255 cells/mm3 at 24 months. Majority of patients died in clinical staging 4 with CD4 cell count <50 cells/mm3. Over 2 year's period, 20% patients died and 9.31% were lost to follow-ups (LFUs). CONCLUSION: Early detection, timely treatment, and long-term adherence are the keys for the success of ART programme in India; it is of utmost importance to do intense Information Education Communication/Behavioral Change Communication, regular monitoring, up-to-date record keeping, tracking of LFUs, and triangulation and data analysis for timely action and for consolidation of success made so far.

Morphometric Analysis of the Corpus Callosum Using Cadaveric Brain: An Anatomical Study.

PURPOSE: The present study was conducted to measure the longitudinal and vertical lengths of the brain hemisphere, longitudinal length of the corpus callosum (CC), and distances of CC from the frontal and occipital poles, in order to define its topographic location within the brain hemispheres. MATERIALS AND METHODS: Fifty formalin-fixed human brains were dissected in the midsagittal plane. The parameters measured were as follows: (i) straight distance between frontal and occipital pole (AB); (ii) vertical distance (height) between the upper and lower surface of the brain hemisphere (CD); (iii) frontal pole to anterior-most point of CC (EG); (iv) occipital pole to posterior-most point of CC (ZO); (v) anterior-most point to posterior-most point of CC (EZ); and (v) anterior edge of genu to the upper end of lamina terminalis (EF). RESULTS: The mean value of AB, CD, EG, ZO, EZ, and EF was 15.47 ± 0.94 cm, 9.48 ± 0.83 cm, 3.31 ± 0.29 cm, 5.65 ± 0.54 cm, 6.96 ± 0.55 cm, and 2.1 ± 0.39 cm, respectively. AB had the strongest positive correlation with ZO (0.79), whereas CD (height) had it with EZ (0.59). Both AB and CD had a strong positive correlation with EZ. The ratios EZ/AB = 0.45 (P = 0.001) and EZ/CD = 0.73 (P = 0.003) illustrated a steady and significant proportions, present in all the brains studied. Although the mean values of all the parameters were greater in males than in females, only two parameters (ZO and EZ) showed statistically significant (P < 0.05) gender differences. CONCLUSION: The precise anatomical knowledge regarding the morphometry of CC will provide baseline data for the diagnosis and progression of disease affecting it.

Identification of most consistent and reliable anatomical landmark to locate and protect radial nerve during posterior approach to humerus: a cadaveric study.

The location of the radial nerve (RN) is described with various bony landmarks, but such may be disturbed in the setting of fracture and dislocation of bone. Alternative soft tissue landmarks would be helpful to locate the nerve in such setting. To recognize certain anatomic landmarks to identify, locate and protect RN from any iatrogenic injury during surgical intervention such as open reduction and internal fixation. Forty arms belonging to 20 adult cadavers were used for this study. We measured the distance of RN from the point of confluence of triceps aponeurosis (TA), tip of the acromion and tip of the lateral epicondyle along the long axis of the humerus. These distances were correlated with the upper arm length (UAL). The average UAL was 32.64±0.64 cm. The distance of the RN from the point of confluence of TA (tricepso-radial distance, TRD), tip of acromion (acromion-radial distance) and tip of lateral epicondyle of humerus (condylo-radial distance, CRD) was 3.59±0.16 cm, 14.27±0.59 cm, and 17.14±1.29 cm respectively. No correlation was found with UAL. Statistically, TRD showed the least variability and CRD showed maximum variability. The minimum TRD was found to be 3.00 cm. So this should be considered as the maximum permissible length of the triceps split. The point of confluence of the TA appears to be the most stable and reliable anatomic landmark for localization of the RN during the posterior approach to the humerus.

Analysis of multiple variations in azygos venous system anatomy with its classification: A cadaveric study

The azygos venous system varies greatly in mode of its origin, course, number of vertical channels, number of horizontal anastomoses and nature of termination. Anatomical knowledge of such variations is of immense importance in radiological investigations and surgical intervention of posterior mediastinum pathologies. The present study was undertaken on 30 adult embalmed cadavers aging between 40-65 years, to determine the anatomical variations of the azygos system and to classify accordingly. The vertebral level and diameter of the azygos, hemiazygos, accessory hemiazygos veins at their origin and terminations were also observed. The azygos system was classified into 3 types as per the Anson & McVay system: primitive (type I), transient (type II) and unicolumnar (type III). Type II was further subdivided into 5 subgroups (A to E) according to the number of retroaortic communications. Type I was observed in 1 case (3.33%), type II in 27 (90%) and type III in remaining 2 cases (6.67%). The vertebral level of termination of the azygos, hemiazygos, accessory hemiazygos veins were between T2 and T3, T6 and T10, T6 and T9 respectively. Variations in the formation of azygos system is not an uncommon phenomenon and these variations may easily mislead the radiologists while performing CT/MRI of posterior mediastinum or cardiothoracic surgeons while performing vascular surgeries in this region

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Re-definition of position and calculation of safe area for axillary nerve in deltoid muscle with its clinical relevance: a cadaveric study.

Several authors have made efforts to define the position of the axillary nerve within deltoid muscle and to calculate the so called safe area for this nerve but it still remains a matter of debate. The primary aim of the study was to investigate the acromio-axillary (AA) distance and its correlation with upper arm length. The secondary aim was to re-define the safe area for axillary nerve within deltoid muscle. Sixty shoulders of thirty adult human cadavers were dissected using standard methods. The distance from the anterior and posterior edge of acromion to the upper border of the course of the axillary nerve was measured and recorded as anterior and posterior AA distance respectively. Correlation analysis was done between the upper arm length and AA distance for each limb. The ratios between anterior and posterior AA distance and upper arm length were calculated and mentioned as anterior index and posterior index, respectively. The mean of anterior and posterior AA distance was 5.22 cm and 4.17 cm, respectively. The mean of upper arm length was 29.30 cm. The means of anterior index and posterior indices were 0.18 and 0.14, respectively. There was a significant correlation between upper arm length and both the anterior and posterior AA distance. The axillary nerve was found to lie at variable distance from the acromion. The minimum AA distance was found to be 3.50 cm. So this should be considered as the maximum permissible length of the deltoid split. Upper arm length has strong correlation with both anterior and posterior AA distances. The ideal safe area for the axillary nerve was found to be a quadrangular area above it and the size of which depends on the length of the upper arm.

Chemical rescue of ΔF508-CFTR in C127 epithelial cells reverses aberrant extracellular pH acidification to wild-type alkalization as monitored by microphysiometry.

Cystic fibrosis (CF) is caused by mutations in the gene for CFTR, a cAMP-activated anion channel expressed in apical membranes of wet epithelia. Since CFTR is permeable to HCO3(-), and may regulate bicarbonate exchangers, it is not surprising evidence of changes in extracellular pH (pHo) have been found in CF. Previously we have shown that tracking pHo can be used to differentiate cells expressing wild-type CFTR from controls in mouse mammary epithelial (C127) and fibroblast (NIH/3T3) cell lines. In this study we characterized forskolin-stimulated extracellular acidification rates in epithelia where chemical correction of mutant ΔF508-CFTR converted an aberrant response in acidification (10%+ increase) to wild-type (25%+ decrease). Thus treatment with corrector (10% glycerol) and the resulting increased expression of ΔF508-CFTR at the surface was detected by microphysiometry as a significant reversal from acidification to alkalization of pHo. These results suggest that CFTR activation as well as correction can be detected by carefully monitoring pHo and support findings in the field that extracellular pH acidification may impact the function of airway surface liquid in CF.

Pantothenate kinase associated neurodegeneration (Hallervorden-Spatz syndrome).

Hallervorden-Spatz syndrome is a rare autosomal recessive hereditary condition characterized by early onset of progressive movement alteration that include dystonia, rigidity and choreoathetosis usually associated with pyramidal signs and mental deterioration. We report two sisters where diagnosis was missed till MRI showed classic imaging findings. Mutation analysis in one, revealed homozygous mutations in the PANK 2 gene. The need for clinical recognition of this entity and differentiation of this form from other static and progressive neurological illnesses is emphasized.

Pantothenate kinase associated neurodegeneration (Hallervorden - Spatz syndrome).

Hallervorden-Spatz syndrome is a rare autosomal recessive hereditary condition characterized by early onset of progressive movement alteration that include dystonia, rigidity and choreoathetosis usually associated with pyramidal signs and mental deterioration. We report two sisters where diagnosis was missed till MRI showed classic imaging findings. Mutation analysis in one, revealed homozygous mutations in the PANK 2 gene. The need for clinical recognition of this entity and differentiation of this form from other static and progressive neurological illnesses is emphasized.