Clinico-Etiopathogenesis of Vitamin B12, Folic Acid and Iron Deficiency in Severe Acute Malnutrition Children: A Tertiary Care Hospital Experience from Central India.

In severe acute malnutrition, micronutrient deficiency as well as protein energy malnutrition is a major obstacle to growth & development. Iron deficiency dominates the spectrum of nutritional anemia. After taking informed consent, 211 SAM children and 211 age-and sex-matched healthy children with normal nutritional status were enrolled for the study. MUAC was used to diagnose SAM. A 5-part automated hematoanalyzer was used to measure the complete blood count and red cell indices, and the peripheral smear method to determine the red cell morphology. We measured serum ferritin, Vitamin B12, and folic acid using the ELISA method. Compared to controls, children with SAM had significantly lower red cell indices, platelet counts, and white cell counts. The most common clinical symptoms seen in SAM children were diarrhea, pneumonia, acute gastroenteritis, and acute respiratory infection. Children with SAM are more likely to suffer from iron deficiency and B12 deficiency. Severe vitamin B12 deficiency was more frequently associated with severe anemia. The severe anemia in SAM children constantly changes the body's defense mechanism, affecting the haematopoiesis. In this study, haematological indices are recommended for predicting severity of anemia, and hematopoietic changes are described, in order to improve anticipatory care and outcome in children with SAM.

An analytical and comparative study of swallowing in a tumor-infected oesophagus: a mathematical model.

This study discusses non-steady effects encountered in peristaltic flows in oesophagus. The purpose of this communication is to evolve a mechanism to diagnose tumor in an oesophagus mathematically. The tumor is modelled by generic bump function of certain height and width. The method of solution follows long wavelength and low-Reynolds number approximations for unsteady flow, while integrations have been performed numerically in order to plot graphs, which reveal various characteristics of the flow. The goal is to assess how pressure varies across the tumor's width. The spatial, as well as temporal, dependence of pressure has been studied in the laboratory frame of reference. The pressure distribution for tumor-infected oesophagus is compared with that of normal oesophagus. An intensified pressure is obtained in the presence of tumor. The interruption while swallowing through benign oesophageal tumor is confirmed by an abrupt pressure rise across the tumor's width. Tumor position also plays a significant role whether it is at contraction or relaxation of walls. Additionally, wall-shear-stress, volumetric flow rate and streamlines have also been described and compared with that without tumor growth. The expressions corresponding to all the physical quantities are computed numerically. Further, this model may also be implemented to the two-dimensional channel flow for an industrial application.

Association of Sleep Quality With Fatigue in Post-COVID-19 Patients in an Indian Population.

OBJECTIVE: The aims of the study are to assess the quality of sleep in recently recovered COVID-19 and long-COVID cases and to determine its associations with fatigue and pain. METHODS: Post-COVID-19 cases ( n = 201) and controls ( n = 206) were assessed using the Pittsburgh Sleep Quality Index questionnaire for sleep quality, Fatigue Severity Scale for fatigue, and Numeric Pain Rating Scale for pain in this observational study. RESULTS: Global Pittsburgh Sleep Quality Index score was higher ( P ≤ 0.001) among cases (5.7 ± 5.1; 95% confidence interval, 5.0-6.4) than controls (2.1 ± 2.0; 95% confidence interval, 1.8-2.4). Normal sleep latency was observed in 56 (27.9%) patients and 164 (79.6%) controls ( P < 0.001). Fatigue Severity Scale score was higher ( P ≤ 0.001) among cases (16.8 ± 10.2; 95% confidence interval, 15.4, 18.2) against controls (10.9 ± 4.1; 95% confidence interval, 10.3-11.4). The Fatigue Severity Scale scores in mild, moderate, and severe COVID-19 were 14.3 ± 8.1, 22.1 ± 10.8, and 22.8 ± 13, respectively ( P < 0.001) and higher in the older (20.7 ± 12.1) and middle-aged (19.6 ± 10.3) than in younger (13.9 ± 8.3) ( P ≤ 0.001) cases. The global Pittsburgh Sleep Quality Index score was positively correlated with the Fatigue Severity Scale ( r = 0.755, P < 0.001) and Numeric Pain Rating Scale scores ( r = 0.657, P < 0.001). Numeric Pain Rating Scale score correlated with Fatigue Severity Scale score ( r = 0.710, P < 0.001). Fatigue Severity Scale and global Pittsburgh Sleep Quality Index scores were higher in the long-COVID group ( P < 0.001). CONCLUSIONS: Significantly poor sleep quality was observed in post-COVID-19 individuals including long COVID being positively associated with fatigue and pain.

The Nicobarese tribes and their coastal fishing activities during the COVID-19 pandemic-related restrictions- preliminary findings.

We interviewed the Nicobarese tribal community (N = 95) of Car Nicobar Island situated in the Andaman and Nicobar archipelago, India to analyze the impact of COVID-19-related restrictions on their coastal fishing activities. Our surveys revealed a significant reduction (p < 0.001) in the average monthly income and fish catches during pre and post-COVID-19 scenarios. Constraints faced during the pandemic-related restrictions and the possible solutions to reinforce the fishing activities were highlighted for sustainable resource management in Car Nicobar Island.

Adhesive Capsulitis After COVID-19 Vaccination: A Case Series.

ABSTRACT: Of the many bizarre complications of administration of the COVID 19 vaccine, adhesive capsulitis is almost unheard of, although shoulder injury related to vaccine administration, which by definition has symptom onset within 48 hrs and is caused by faulty injection technique, has been rarely reported. Nine cases of adhesive capsulitis, five males and four females with a mean age of 48.7 ± 12.7 yrs, presenting within 1 mo of intramuscular Covishield vaccine on the ipsilateral deltoid and fulfilling the standard UK FROST Multicenter Study diagnostic criteria are reported. The mean time interval from vaccination until symptom onset was 12.3 ± 3.1 days, and mean symptom duration was 9.4 ± 2.4 wks. Conventional treatment with nonsteroidal anti-inflammatory drugs, followed by intra-articular steroid injection coupled with suprascapular nerve steroid block, improved the pain score and range of movement in 8 wks. The exact pathogenesis remains an enigma, although mechanisms such as local spread via deltoid muscle microvasculature, nerves, or shoulder injury related to vaccine administration causing secondary adhesive capsulitis have been hypothesized. While adhesive capsulitis is a very common diagnosis in the physiatric outpatient setting, the possible association with Covishield vaccination, the Indian version of the Oxford AstraZeneca recombinant ChAdOx1 nCoV-19 vaccine, is almost absent in existing literature and hence likely to be missed by clinicians, which necessitates this report.

Very rare incidence of ascending paralysis in a patient of traumatic spinal cord injury: a case report.

INTRODUCTION: After spinal cord injury, further neurological deterioration up to one to two neurological levels is not uncommon. Late neurological deterioration can occur after two months, mainly due to the syrinx formation. In a rare case like in sub-acute post-traumatic ascending myelopathy, the neurological level may ascend more than four levels from the initial level of injury and it usually starts within a few weeks after injury. CASE PRESENTATION: Our case was diagnosed as a case of traumatic spinal cord injury having a lower thoracic neurological level of injury initially, which rapidly progressed over a few weeks into a higher thoracic neurological level. He was operated with pedicle screw fixation of the spine before admission to rehabilitation unit. He was having progressive ascending neurological deterioration, starting a few days after surgery, which was evident by the progression of neurological level by more than four segments clinically. Cerebrospinal fluid(CSF) study showed no significant abnormality. Magnetic resonance imaging (MRI) study showed involvement of the spinal cord at the upper thoracic region. Patient was monitored to note any further worsening. Rehabilitation and supportive measures were provided according to standard protocol. DISCUSSION: Very few cases of ascending paralysis of more than four levels have been reported globally. It results in increased morbidity and mortality in spinal cord injury patients. In our case few possible reasons are ruled out but the actual underlying reason was not clear. Various hypotheses have been proposed as the cause in previous published literatures. Management is mostly supportive.

COMMENT: Covid-19: Catalyst for a comprehensive law to combat potential pandemics in India.

Despite the relative decline in communicable diseases, India witnesses hundreds of outbreaks every year. Including the current Covid-19 pandemic, India has suffered through several major pandemics and large-scale epidemics since 1900s. However, the response to most of the epidemics has been inadequate. The Epidemic Diseases Act, enacted in 1897 (EDA 1897), has been in action since and is based on the science and the socio-political environment of the country in the nineteenth century. India has several legal mechanisms to help contain and control the spread of epidemics, but on different platforms. There has been a paradigm shift in the socio-political milieu as well as scientific advancements in the prevention and control of epidemics. The century-old EDA 1897 has not been effective in containing and controlling such epidemics/pandemics, as has been witnessed during the ongoing Covid-19 pandemic. Hence, it needs to be revised to define an appropriate structural scalar chain, provide clear-cut and unambiguous terms/definitions and guidelines, delineate ethics and human rights, determine the duties and responsibilities of the affected population/community, determine the role of the private health sector, and provide for appropriate punitive measures to deter repeated violations.

Post coronavirus disease-2019 vaccination Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating disorder of the peripheral nerve. Different variants of GBS can produce a wide array of symptoms among which motor weakness, areflexia without bladder-bowel involvement are commonly encountered. ChAdOx1 nCoV-19 is a recombinant Corona Virus Vaccine and it is incorporated into India's coronavirus disease-2019 (COVID-19) vaccination program. Few rare instances of serious neurological complications have been reported following COVID-19 vaccination. Our case received 2 dose of COVID-19 vaccine. After receiving 1st dose he had rapid onset of ascending paralysis without any sensory and bladder bowel involvement. He received Intra Venous Immuno Globulin and Injection prednisolone for 5 days. Following that his lower limb weakness resolved rapidly but there was no improvement in upper limb weakness. Nerve conduction study showed demyelinating etiology and along with clinical features, it was appeared to be a case of GBS. However, more evidence is needed before establishing the causal relationship between COVID-19 vaccines and GBS.

Current Challenges for the Effective Management of the COVID-19 Pandemic.

INTRODUCTION: Within a short period, the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) spread all over the globe and became the first pandemic of the present century. Early diagnostic tools and effective drugs are urgently needed to effectively manage the COVID-19 pandemic. Based on current literature, we provide recent updates on SARS-CoV-2 biology, available diagnostic methods, and therapeutic options for the management of COVID-19 pandemic. METHODS: A literature survey was done using Google and PubMed and Web of Science to summarize the current updates on this topic. RESULTS: Current coronavirus diagnostic tests are reverse transcription polymerase chain reaction (RT-PCR), real-time RT-PCR (qRT-PCR), and reverse transcription loop-mediated isothermal amplification (RT-LAMP) which detects the presence of specific genome sequence of virus. Existing antiviral drugs or new therapeutic options such as neutralizing antibody or plasma therapy are mostly used to restrict the virus growth with a limited success. CONCLUSION: As there is no specific treatment or vaccine available to limit the infection of SARS-CoV-2, we need to rely on the existing way to limit the disease. The first priority to fight COVID-19 is development of early diagnostic tools so that infected persons can be identified and further viral transmission can be blocked. Evaluation of existing drugs or identification of new therapeutic entities becomes the major challenge to deal with the present pandemic.

Comparison of Relative Benefits of Mirror Therapy and Mental Imagery in Phantom Limb Pain in Amputee Patients at a Tertiary Care Center.

OBJECTIVE: To determine the relative benefit of mirror therapy and mental imagery in phantom limb pain. DESIGN: Prospective randomized controlled trial. SETTING: Physical Medicine and Rehabilitation Department, All India Institute of Medical Sciences, Patna. PARTICIPANTS: Amputees (N=92) with no significant difference in baseline characteristics. There was a male predominance in both groups (mirror therapy: 36 men, 10 women; mental imagery: 37 men, 9 women). INTERVENTION: Patients of both groups underwent a conventional amputee rehabilitation program and daily treatment of either mirror therapy or mental imagery on a regular basis, first in a rehabilitation care unit and later at home. MAIN OUTCOME MEASURES: Phantom limb pain (PLP) was measured by visual analog scale (VAS) score at baseline (0) and at 4, 8, and 12 months. RESULTS: This study included 92 patients ranging in age from 12 to 75 years (average, 34.79y). There was no significant difference in VAS score between the groups at baseline, but we found a significant reduction of pain in both groups at follow-up. However, upon comparing the improvement in both groups, we determined that the mirror therapy group had better improvement (from 7.07±1.74 to 2.74±0.77) compared with the mental imagery group (from 7.85±0.76 to 5.87±1.41). CONCLUSIONS: Mirror therapy and mental imagery are both good and cost-effective rehabilitation aids for amputee patients to reduce PLP, but mirror therapy appears to be more effective than mental imagery.

Role of TfR2-Y250X and TfR1- rs3817672 Single Nucleotide Polymorphism on Pathophysiology of Iron Deficiency Anemia.

BACKGROUND: Transferrin receptor (TfR) is a carrier protein for transferrin. It is regulated in response to intracellular iron concentration and plays a role for the import of iron into the cell. The transferring receptor 2 (TFR2) gene showed homology to transferrin receptor 1 (TFR1) gene and encodes a transmembrane protein with a large extracellular domain, which is able to bind transferrin. Mutations in transferrin receptors (TfR2 and TfR1) may alter the pathophysiology of iron deficiency anemia. Alteration in genes encoding transferring receptor cause change in iron homeostatsis and provides a tool for investigating the excess iron absorption and abnormal iron distribution in iron related disorders. However the clinical significance of the interaction of transferring mutations with iron deficiency anemia remains unclear. Thus, the objective of my study was to investigate the effect of TFR1 and TFR2 genotypes on pathophysiology of iron deficiency anemia. STUDY DESIGN: Study subjects were 460 iron deficiency anemia patients and 500 age and sex-matched healthy controls. Transferrin receptor, ferritin and CRP analysis was done by ELISA method while ESR analysis was done according to Wintrobes's method. CBC analysis was done by auto-analyzer. TFR1-rs3817672 SNP and TFR2 (Y250X) mutation was analyzed by using PCR RFLP method. RESULTS: Amongst the iron deficiency anemia patients, 13 were heterozygous and five were homozygous for rs3817672 SNP. TFR2 (Y250X) mutation was detected in 6 patients with heterozygous conditions. None of the patients were presenting homozygous condition while four controls were presenting heterozygous and one with homozygous condition. Controls were presenting 3% and 0.6% of TFR1 rs3817672 SNP heterozygosity respectively. CONCLUSION: TfR2 -Y250X and TfR1-rs3817672 SNP showed clinical association with iron deficiency anemia and screening for mutations of TFR2 is a new diagnostic tool that can be offered to patients who do not have HFE mutations or who have incomplete HFE genotypes. This results may have practical implications for the molecular diagnosis of hemochromatosis. Genotyping the TFR gene should be included in the disease diagnostic protocols.

Clinical variability and molecular characterization of Hbs/Gγ (Aγδß)0-thal and Hbs/HPFH in Indian sickle cell disease patients: AIIMS experience.

INTRODUCTION: In sickle cell disease (SCD) patients, among the predictors of survival, HbF levels play a significant role in lowering the morbidity and mortality. Coinheritance of 뫧 thalassemia and hereditary persistence of fetal hemoglobin (HPFH) may contribute to variable HbF levels in SCD patients, thus influencing their clinicopathological profile. Such cases are sparsely documented in the literature and thus, we screened the presence of 뫧 thalassemia and HPFH in 126 cases of SCD with high HbF. MATERIAL AND METHODS: A total 126 SCD individuals with raised HbF levels were the study subject. Capillary zone electrophoresis (CZE) was done for the quantitative assessment of hemoglobin variants. HbSC, HbSD, HbAS and HbSE cases were excluded. Asian Indian Gγ(Aγδß)0-thal, δß0-thal (Sicilian, 13.4 kb), (Chinese, 100 kb), HPFH-1 (Black, 106 kb), HPFH-2 (Ghanaian, 105 kb), HPFH-3 (Indian, 48.5 kb) were done by GAP-PCR. RESULTS: Out of 126, 78 cases (62%) were homozygous for SCD. The remaining 48 cases suspected to be heterozygous were furthered screened and 6/48 cases (12.5%) were found to be compound heterozygous. Out of these 6 cases,4(66.66%) had HbS/ δß- Gγ(Aγδß)0 and 2(33%) had HbS/HPFH compound heterozygous condition. None of the patients had δß0-thal (Sicilian, 13.4 kb), (Chinese, 100 kb), HPFH-1 (Black, 106 kb), HPFH-2 (Ghanaian, 105 kb). CONCLUSION: This study highlights the importance of understanding the complex patho-physiology of compound heterozygous cases of HbS/HPFH and HbS/뫧 thalassemia, as these infrequent conditions lead to change in phenotype and clinical severity of the disease. Insight into more such cases will open the window to better analyze the disease pathogenesis in these rare compound heterozygous conditions, as this will be beneficial to formulate proper management protocol in these patients.

Variation of pressure from cervical to distal end of oesophagus during swallowing: Study of a mathematical model.

The investigation is an attempt to explore the cause that generates high pressure in the distal oesophagus compared to that in the proximal part. We observe through computer simulation that peristaltic waves of even slightly but progressively increasing amplitude can generate high pressure near the distal end. This is illustrated through exponential growth in the wave amplitude, which represents the dependence of the rate of growth of amplitude on its current magnitude. This may be physically interpreted that the generation of high pressure in the lower oesophagus ensures complete bolus delivery to the stomach through the cardiac sphincter. This finding may prove to be a very prominent result towards creating a prosthetic oesophagus. Some more conclusions with regard to progressive exponential increase in amplitude are also drawn. The pressure falls to zero invariably in the proximal half of every bolus, whereas for constant amplitude, zero pressure is located exactly at the midpoints of the boluses for Newtonian flows. Backward flow of fluid takes place in a smaller region if amplitude increases. Circular muscles contract more in the lower oesophagus to generate higher pressure in the distal oesophagus. In a sharp contrast to the case of constant-amplitude, pressure is neither uniformly distributed in a wave, nor is of identical shape for all boluses in the case of train wave propagation. Pressure distribution along the axis of the oesophagus differs in shape and magnitude both when a single wave propagates.

Enhancing nutrient recovery and compost maturity of coconut husk by vermicomposting technology.

Vermicompost was prepared by five different treatments from relatively resistant coconut husk mixed with either pig slurry or poultry manure. The recovery of vermicompost varied from 35% to 43% and it resulted in significant increase in pH, microbial biomass carbon, macro and micro nutrients concentration. Among the treatments highest relative N (1.6) and K (1.3) recovery were observed for 20% feedstock substitution by pig slurry while poultry manure substitution recorded highest P recovery (2.4). Compost maturity parameters significantly differed and well correlated. The characteristics of different treatments established the maturity indices as C/N 15-20; Cw<1.8; Cw/Norg<0.55; Lignin<10-12; CHA/CFA>1.5 and HI>15.0. The manurial value of the coconut husk compost was improved by feedstock substitution with pig slurry (80:20). The results revealed the technical feasibility of converting coconut husk into valuable compost by feedstock substitution with pig slurry.

Phenotypic effect of α-globin gene numbers on Indian sickle ß-thalassemia patients.

BACKGROUND: Sickle cell ß-thalassemia is a compound heterozygous state of ß-thalassemia and sickle cell anemia. Patient with these conditions showed mild-to-severe clinical phenotype. OBJECTIVES: The objective of this study was to evaluate the effects of α-globin gene numbers on the phenotype of sickle cell ß-thalassemia patients. MATERIALS AND METHODS: Seventy-five sickle cell ß-thalassemia patients were characterized. Clinical, hematological, and molecular characterization was performed in all subjects. Amplified refectory mutation system-polymerase chain reaction was applied for ß-thalassemia mutation study while α-genotyping was conducted by Gap-PCR. RESULTS: Highest frequency of IVS1-5 (33 out of 75 patients) ß-thalassemia genotype was recorded. Twenty-eight patients were reported with α-globin chain deletion while four had α-triplications (Anti α-3.7kb). Sickle ß-thalassemia patients with α-chain deletions ameliorate hematological and clinical variables. CONCLUSIONS: This study indicates that the coexistence of α-globin chain deletions showed mild phenotype instead of absence of α-chain deletions while the patients with triplication of α-genes express severe phenotype.

Prevalence of factor V Leiden G1691A, MTHFR C677T, and prothrombin G20210A among Asian Indian sickle cell patients.

The prevalence of factor V (FV) Leiden G1691A, prothrombin G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations were investigated among 90 sickle trait, 61 sickle homozygous, 75 sickle beta thalassemia, and 15 HbSD Asian Indian sickle cell patients. In all, 297 healthy controls were evaluated to compare the polymorphism frequency. The prevalence of FV Leiden heterozygous G>A were significant in the group (P = .02), while PRT G20210A polymorphism was not seen among patients as well as controls. However, an increased frequency of the MTHFR 677 C>T genotype was seen among patients as well as controls, but this was not statistically significant (P = .13). This suggested a low impact of inherited hypercoagulability risk factors in the pathogenesis of sickle cell disease and/or its complications.