Dyschromatopsia and contrast sensitivity changes in COVID-19 patients.

PURPOSE: To evaluate the alterations in the psycho-physical tests, contrast sensitivity (CS) and hue discrimination (total estimation score, TES) in COVID-19 patients. METHODS: A prospective case-control study was undertaken in 2021-22 to look at CS and TES among COVID-19 patients and RT-PCR negative normal subjects by a mobile app "smart optometry" and X-Rite's free online version of Farnsworth-Munsell 100 hue test. Strict visual acuity (minimum of 6/9 equivalent on Snellen) and other clinical parameters were used as exclusion criteria to filter potentially confounding pre-receptoral co-morbid conditions. The effect of mismatch in recruiting age and sex matched controls during the pandemic were analyzed by multivariate linear regression. RESULT: One-way ANOVA ruled out any influence of gender on CS and TES; however, there was significant difference in the TES on Mann Whitney U test (TES- 2.95 +/- 3.8 for cases; 0.30 +/- 1.1 for controls; p <0.001) and it persisted after accounting for age. Six controls with breakthrough infections had a significant deterioration in TES (Mean scores -3.0; 95% CI = -5.89 to -0.11; p = 0.04) on paired t test. Qualitative analysis showed that S-cone mediated deficiencies outnumber those affecting M-L cone mediated deficiencies. Among 53 subjects exhibiting three sensory features, anosmia, loss of taste and dyschromatopsia, nine (16.98%) had all features concurrently. CONCLUSION: The study demonstrates that COVID-19 infection leads to altered TES representing dyschromatopsia -an ocular counterpart of anosmia, with little difference on CS.

Blood Inventory Management During COVID-19 Pandemic Using a Simple Mathematical Tool: A Two-Year Study from a Tertiary Care Hospital in North India.

Multiple recurrent waves of the coronavirus disease 2019 (COVID-19) resulted in major fluctuations in blood supply and demand, which presented a major challenge for the blood centres to maintain adequate blood inventory. Hence, the primary aim of the present study was to determine whether safety stock as a simple mathematical tool can be used to maintain optimum blood inventory to meet all blood demands. The secondary aim of the study was to test whether daily blood stock index (DBSI), which was a novel index developed by the authors and derived from the calculated safety stock, can be used to minimize blood wastage due to the outdating of packed red blood cells (PRBC)/whole blood (WB) units. The present study was a descriptive, cross-sectional study conducted from 1st October 2019 to 31st December 2021 at a blood centre of a tertiary care hospital. For the purpose of data analysis, the time period of study was divided into 7 periods signifying different phases during the COVID-19 outbreak. Data of PRBC/WB (referred to as red cell) collection, red cell issue and the daily red cell stock were collected for these 7 time periods. Safety stock, percentage of out-dated whole blood/packed red blood cell units (OB) and DBSI were calculated based on the data extracted. Red cell collection as well as red cell utilization decreased during the 1st as well as the 2nd wave of the COVID-19 outbreak. The blood centre was able to meet the blood demand of the hospital at all times, as the daily average red cell stock remained above the calculated safety stock during all periods. OB (12.4%) and DBSI (2.3) were highest during the lockdown period of second wave of COVID-19 outbreak (period E). A strong direct relationship was seen between OB (dependent variable) and DBSI (predictor variable) [R = 0.79; p = 0.03]. Firstly, safety stock is a simple, user-friendly mathematic tool which can be used for efficient blood inventory management not only at times of a pandemic/disaster but also during routine times. Secondly, DBSI is a logical and empirical tool to reduce OB units and consequently reduce blood wastage.

Vaccine hesitancy after taking the first dose of COVID-19 vaccine: A challenge for the COVID-19 vaccination program in India.

Background: Coronavirus disease 2019 (COVID-19) vaccination campaigns are trying to curb the pandemic by vaccinating as many individuals and as quickly as possible. The speed of immunization depends upon the availability of the vaccine and vaccine uptake by the communities, which in turn is related to vaccine hesitancy, the safety/efficacy profile of the vaccines, and adverse events following immunization (AEFI). Objectives: (i) To study the AEFI experienced by vaccine recipients and (ii) to assess the subjective effect of these AEFI on the vaccine recipients, that is, perceived disability and opinion regarding taking the vaccine's second dose. Methods: This was a cross-sectional study conducted at a tertiary care hospital where a questionnaire was distributed to the medical students who had taken at least one dose of a COVID-19 vaccine. Results: Out of 208 participants, more than three-quarters (n = 169, 81.2%) experienced AEFI symptoms within 12 hours of vaccination. The commonest symptoms were pain at the injection site (n = 173, 83.2%), body aches (n = 91, 43.8%), fever (n = 88, 42.3%), weakness (n = 86, 41.3%), and headache (n = 72, 34.6%). A majority of the participants reported complete recovery within 13-24 hours. Complete recovery was seen in all the study participants, and no serious event was seen. Twenty (10%) participants reported that they were not confident in taking the second dose of the vaccine. Conclusions: The disability perceived by the vaccine recipients should be taken into consideration in a vaccine with a multi-dose schedule. Pitfalls in alleviating the immunization-related anxiety should be identified and addressed.

Seroprevalence of hepatitis A and hepatitis E in patients at a teaching hospital of northern India over a period of 8 years.

Background: Considering the diverse socio-economic and demographic factors in a vast country like India, it is important to study the long-term trends of hepatitis A (HAV) and hepatitis E (HEV) viruses. This study describes their seroprevalence and long-term trends in a tertiary care center of North India. Methods: The present retrospective observational study was conducted over a period of 8 years (January 2011-December 2018). Serological testing was done for detecting IgM antibodies against HAV and HEV using enzyme-linked immunosorbent assay. Results: A total of 5319 samples were received during the study period, of which 903 (16.9%) were reactive for anti-HAV IgM antibodies and 795 (14.9%) were reactive for anti-HEV IgM antibodies. Majority of the cases occurred from June to October while HEV cases had a constant presence during the later years. Among HAV group, 534 (59.1%) were children, 336 (37.2%) were adults, and 33 (3.7%) were pregnant females. In HEV group, 632 (79.5%) were adults, 114 (14.3%) were pregnant females, whereas only 49 (6.2%) were children. Among those who were co-infected (n = 87), 48 (55.2%) were adults, 22 (25.3%) were pregnant females, and the rest 17 (19.5%) were children. Conclusions: The shift in seroprevalence toward adults, along with an increasing trend of the number of cases reporting to the hospital, warrants active surveillance of HAV. Similarly, screening protocols for HEV should be set up as part of the antenatal management for early detection of the cases among pregnant females.

A novel scoring system for selecting the target patients of COVID-19 convalescent plasma therapy: A hypothesis.

The primary cause of mortality in patients of coronavirus disease 2019 (COVID-19) is the cytokine storm and not directly due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Therefore, it is being stressed by transfusion medicine specialists to use COVID-19 convalescent plasma (CCP) therapy early in the course of the disease, preferably within 72h of diagnosis. The authors herein, propose a scoring system for the rapid assessment of the patients who have tested positive for SARS-CoV-2. Therefore, a systematic approach may be followed where the patients are categorised into two groups, namely, the low-risk group [LRG; score<5] and the high-risk group [HRG; score ≥ 5] based on this scoring system. Those classified as an HRG should be administered CCP therapy within 72h of a confirmed diagnosis of COVID-19 to neutralise the SARS-CoV-2 virus and prevent the occurrence of the cytokine storm. This in turn could help reduce the overall mortality in the recipients.

Clinical and laboratory profile of patients with amoebic liver abscess.

Context: Amebic liver abscess (ALA) occurs in 3%-9% of the amebiasis cases, with complications seen in 20%-40% of the cases and 2%-18% mortality rate. Successful treatment thus requires the accurate identification of these cases. Aims and Objectives: We aimed to assess the seropositivity and profile of ALA patients in western Rajasthan. Materials and Methods: This retrospective study was conducted at a tertiary care center in western Rajasthan from November 2017 to May 2019. Serological diagnosis of ALA was done by detecting immunoglobulin G (IgG) antibodies in the serum of the patients by ELISA. The derangements in laboratory profile (hematological and biochemical parameters) and ultrasonography findings were assessed from the hospital records. Statistical analysis was performed using Mann-Whitney U-test. Results: Among the total cases (n = 34), 20 were diagnosed as ALA. Twenty-one (61.8%) were positive for anti-amebic IgG antibodies. Among ALA patients, 14 (70%) were >40 years old and only 6 (30%) patients were of age ≤40 years. Male: female ratio was 5.7:1, and ultrasonography records of 15 ALA patients revealed the presence of hepatomegaly (n = 7, 46.7%), pleural effusion (n = 3, 20%), lung collapse (n = 2, 13.3%), and vascular involvement (n = 1, 6.7%). The right lobe of the liver was involved in majority of the patients (n = 12, 80%). Total white blood cell count (P < 0.001), absolute neutrophil count (P = 0.001), total serum bilirubin (P = 0.019), and serum alkaline phosphatase (P = 0.018) were significantly elevated in ALA patients. Conclusions: Seroprevalence shows that ALA still remains the dominant etiology in liver abscess patients in this region. There are significant derangements in the laboratory profile that require a larger study for corroboration.

Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016).

BACKGROUND: Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases. OBJECTIVE: To study the epidemiology of Nocardia infections in a tertiary care center. MATERIALS AND METHODS: This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram's stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture. RESULTS: A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods. CONCLUSION: Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.

Diagnostic dilemma in a case of Salmonella Typhi sacroiliitis.

Sacroiliitis is a rare complication of enteric fever, seen in <1% of the cases and its concomitant presence with hepatitis has been reported only once. Incorrect or delayed diagnosis of enteric fever may lead to serious complications. Here, we present a complicated case of enteric fever in a 15 years old female who was misdiagnosed elsewhere to be a case of dengue fever owing to thrombocytopenia at presentation along with a weak positive dengue IgM immunochromatography test. The patient eventually developed a rare combination of complications (sacroiliitis, hepatitis, ascites and pleural effusion) and was transferred to our hospital where specific antimicrobial treatment was instituted after isolation of Salmonella Typhi from the clinical samples. This case demonstrates the importance of establishing the correct diagnosis by optimum utilization of the diagnostic services at the time of admission to prevent potentially life threatening complications in an otherwise treatable condition.

Thrombocytopenia in malaria patients from an arid region of Western Rajasthan (India).

CONTEXT: The arid climate of Western Rajasthan is challenging for malaria transmission, with the number of cases correlating directly with the annual rainfall pattern. Moreover, >90% of the cases in this region are caused by Plasmodium vivax, which has recently been shown to cause a similar degree of thrombocytopenia as Plasmodium falciparum. AIMS AND OBJECTIVES: The aim of the study was to determine the degree of thrombocytopenia in malaria patients and its association with different species of malaria in this region with an unstable malaria epidemiology. MATERIALS AND METHODS: This retrospective study was conducted on all microbiologically confirmed malaria patients with documented platelet counts from August 2017 to October 2018. Microbiological diagnosis was established by rapid diagnostic tests and peripheral blood film examination. Platelet counts were used to assess the degree of thrombocytopenia. RESULTS: A total of 130 cases were included in the study, of which 118 (91%) were caused by P. vivax, while the rest 12 (9%) were caused by P. falciparum. Thrombocytopenia was present in 108 (83%) cases, and the mean values of platelets in thrombocytopenic patients with P. vivax and P. falciparum infection were 72600/µL and 48500/µL, respectively. Although P. falciparum infection was significantly associated with severe thrombocytopenia (odds ratio: 4.7, [95% confidence interval 1.3-16.1]), extremely low platelet counts (n = 5) warranting platelet transfusions (n = 1) were seen only in P. vivax cases. Only one patient required platelet transfusions in these patients suggesting good tolerance to thrombocytopenia. CONCLUSIONS: Avoiding unnecessary transfusions in febrile thrombocytopenic patients with an established malaria diagnosis can help in reducing transfusion-transmitted infections.

Case of Ludwig's angina due to Corynebacterium diphtheriae from western Rajasthan, India-A case report of an uncommon presentation.

Corynebacterium diphtheriae is a toxin producing, classically noninvasive bacteria that causes diphtheria a vaccine-preventable disease mainly in children. With increasing vaccine cover, new spectrum of infections is increasingly seen involving invasive infections and nontoxigenic strains of C. diphtheriae. Here, we present a case of Ludwig's angina caused by C. diphtheriae in a 45-year-old female. Only Corynebacterium spp. have been previously reported in Ludwig's angina patients.

Seroprevalence of brucellosis in Western Rajasthan: A study from a tertiary care centre.

Brucellosis is a significant bacterial zoonotic disease with a high seroprevalence in low-to-middle-income countries where there is a significant contact of humans with animals. This prospective study was conducted to observe the seroprevalence of brucellosis in 75 symptomatic patients with pyrexia of unknown origin (PUO) and 75 high-risk individuals (10 veterinarians, 15 milkmen and 50 healthy contacts of symptomatic patients) with possible exposure to brucellosis. Serum samples collected from these patients and individuals were subjected to rose Bengal test (RBT) and ELISA for the detection of IgM and IgG antibodies. RBT was positive in 50 samples (40 PUO and 10 high risk), of which 25 (33.3%) PUO cases had detectable IgM antibodies, whereas IgG antibodies were detected in 20 patients. None of samples from high-risk individuals was reactive for IgM/IgG antibodies by ELISA. The overall seroprevalence in this study was 16.7% (33.3% in PUO patients). Being a predominantly livestock rearing area, brucellosis is a significant health-care problem in this part of India with this entity being linked to 33% of PUO cases.

Molecular identification of Fusarium species complex isolated from clinical samples and its antifungal susceptibility patterns.

BACKGROUND AND PURPOSE: More than 300 Fusarium species are grouped into approximately 23 species complexes out of which around 70 are involved in human infections. The nomenclature of these species has undergone considerable changes in recent years. These species cause localized infections in individuals while inducing systemic infections mainly in immunocompromised patients. The present study was conducted to identify Fusarium species in clinical isolates by molecular methods and determine their in vitro minimum inhibitory concentration (MIC) patterns to address the lack of data in this domain in Northern India. MATERIALS AND METHODS: For the purpose of the study, Fusarium isolates obtained from various clinical samples were sent to the Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands, for molecular identification. The MIC testing was performed using the microbroth dilution method as per the Clinical and Laboratory Standards Institute reference method (M38-A2). RESULTS: Fusarium was isolated from 33 patients (i.e., 1, 1, 2, 14, and 15 cases with endophthalmitis, sinusitis, pulmonary involvement, onychomycosis, and keratitis, respectively). These 33 isolates belonged to three species complexes, namely F. solani species complex (FSSC; n=13), F. fujikuroi species complex (FFSC; n=13), and F. incarnatum equiseti species complex (FIESC; n=7). The species identified within FSSC, FFSC, and FIESC included F. keratoplasticum (n=6)/F. falciforme (n=6)/F. solani (n=1), F. proliferatum (n=7)/F. sacchari (n=5)/F. anthophilum (n=1), and F. incarnatum SC species (n=6)/F. equiseti SC species (n=1), respectively. The MIC results showed that all isolates had a lower MIC against amphotericin B than against the other antifungal agents.

Fusarium sacchari, a cause of mycotic keratitis among sugarcane farmers - a series of four cases from North India.

The two most common filamentous fungi causing mycotic keratitis are Aspergillus and Fusarium spp. Around 70 Fusarium spp. are involved in causing human infections. In this study, four cases of keratitis in sugarcane farmers in India are being reported, caused by the sugar cane pathogen Fusarium sacchari, a species of the Fusarium fujikuroi species complex. Fusarial keratitis was established by potassium hydroxide/Calcofluor white wet mounts and fungal culture of corneal scrapings on conventional media. Final identification was done by genetic sequencing at CBS-KNAW, Utrecht, The Netherlands. The antifungal susceptibility testing was done using broth microdilution method as per CLSI document M38-A2. Four cases of F. sacchari keratitis were identified. Three of them had trauma with sugarcane leaves, whereas one sugarcane farmer reported trauma by vegetative matter. The morphological similarities among various Fusarium species warrant use of molecular methods for identification of cryptic species. A wide distribution of sugarcane farming could be the possible explanation for emergence of F. sacchari keratitis in India.