A Comprehensive Analysis of Clinical, Biochemical, and Polysomnographic Characteristics in Patients With Type 2 Diabetes Mellitus With and Without Obstructive Sleep Apnea.

BACKGROUND: Obstructive sleep apnea (OSA) has been a significant contributor to mortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on, but the indicators of its early detection are still elusive. OBJECTIVE: The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. DESIGN AND METHODS: This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. RESULTS:  Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. A total of 110 patients underwent a sleep study, of which 68 (61.8%) had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09 vs 0.930, p = 0.001). HbA1c >7% was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. CONCLUSIONS: OSA frequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalence of OSA in persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.

The U- advancement Burrow's Flap in Persistent Tracheocutaneous Fistula. ~ Case Report.

Persistent tracheo-cutaneous fistulae necessitate a closure with pedicled or free flaps. The modality adopted is to reconstitute the anterior tracheal wall without compromising the tracheal lumen. We have developed the lateral U advancement Burrow's flap over the strap muscles and tracheal lateral fibrous flaps, to repair a large trachea-cutaneous fistula.

Role of Fine Needle Aspiration Cytology in the Rapid Diagnosis of Pulmonary Infections in Renal Allograft Recipients with Respiratory Failure.

Background: Renal transplantation is the treatment of choice in patients with end-stage renal disease. However, allograft recipients are at a higher risk of infection due to immunosuppressive therapies. This study aimed to analyze the utility of fine needle aspiration cytology (FNAC) lung in the etiological diagnosis of pulmonary infections in renal allograft recipients with respiratory failure. Materials and Methods: This is a retrospective study done in post-renal transplant patients presenting with pulmonary infections and respiratory failure in the past 7 years, in whom image-guided lung FNAC was done for diagnosis. Results: A total of 35 renal allograft recipients presenting with respiratory failure and having focal or diffuse pulmonary opacities (lesions) on radiological imaging were subjected to lung FNAC. The mean age of the patients was 41.1 ± 11.8 years (range 19-72), with the majority being males (n = 28, 80%); six (17.1%) of them were on invasive ventilation. The diagnostic yield of FNAC in our cohort was 77.1% (27 out of 35). Microorganisms were isolated in 21 cases (60%), with Nocardia being the most common (nine cases, 25.7%), Mycobacterial tuberculosis identified in six patients (17.1%), Aspergillus in three (8.6%), and one (2.9%) each had atypical Mycobacterium, zygomycetes, and Cryptococcus. FNAC suggested viral cytopathic effect in five patients, and cytomegalovirus (CMV) quantitative polymerase chain reaction test was found positive in four of these. One case was diagnosed as adenocarcinoma lung. Conclusion: Lung FNAC is a useful for establishing the etiological diagnosis of pulmonary lesions in renal transplant patients with respiratory failure.

Preparation and Characterization of Clopidogrel Bisulfate-hydroxypropyl-ß-Cyclodextrin Mixed Inclusion Complex for Improved Intestinal Solubility and Anti-Thrombotic Efficacy.

The study aimed to increase the intestinal solubility and absorption of orally bioavailable clopidogrel-bisulfate (CPB) by complexing with hydroxypropyl-ß-cyclodextrin (HCD) to form a binary inclusion complex that was stabilized by Tween 80 (T80) resulting into mixed inclusion complex. The results of phase solubility studies and molecular docking of CPB with ß-cyclodextrin (ß-CD) and HCD suggested higher solubility and binding energy of the stable CPB: HCD complex in the presence of T80 as compared to the CPB: ß-CD complex. The D-Optimal mixture design was used to optimize the formulation containing the CPB: HCD: T80 mixed inclusion complex. The results suggest the enhanced stability of the CPB: HCD inclusion complex in the presence of T80. The spectral attributes confirmed the inclusion complexation and pointed out the central position of CPB in a hydrophilic cavity of HCD. Further, the prepared soft gelatin capsule successfully confirmed the importance of obliterating the intestinal precipitation associated problem of CPB through an in-vitro release study. The anticoagulant activity in rabbits confirmed that soft gelatin capsules showed 1.2 folds and 1.3 folds increase in clotting time, 1.2 fold and 1.5 folds increase in bleeding time when compared to marketed formulation and pure drug, respectively. Conclusively, soft gelatin capsules exhibit the potential to enhance the oral bioavailability of CPB, leading to reduction of the dose and dose-related side effects.

Diagnostic Efficacy of New Xpert Ultra for Extrapulmonary Tuberculosis Using Culture and Composite Reference Standard.

Introduction: Xpert Ultra (Cepheid, USA) is recently introduced with an extra category of trace-positive results and higher sensitivity for tuberculosis (TB) diagnosis. Objective: The objective of the study was to assess the diagnostic accuracy of Xpert Ultra for extrapulmonary samples using culture and composite reference standard (CRS) as the gold standard. Materials and Methods: In a 1-year (March 2021-22) prospective observational study, samples of suspected extrapulmonary TB (EPTB) patients were subjected to Ziehl-Neelsen staining, culture, and Xpert Ultra (Cepheid, Sunnyvale, CA) tests. Relevant clinical and treatment information was noted. The diagnostic accuracy of Xpert Ultra compared with culture and CRS was calculated. Results: Out of 1720 suspected patients of EPTB, 223 (13%), predominantly males 135 (60%), with a mean age of 41.46 ± 19.81 years, were diagnosed as TB positive following CRS criteria. The maximum cases were of pleural TB (35.4%), followed by central nervous system TB (17.9%), gastrointestinal TB (17.5%), and lymph node TB (12.1%). Of all samples, 150 (8.7%) were microbiologically confirmed, including 141 detected by Xpert ultra, 67 culture positive, and only 16 smear positive. Among the Xpert Ultra-positive samples, 35 showed trace results, including six false-positive results. Considering culture and CRS as the gold standard, the sensitivity (86.57%, 59.64%) and specificity (94.98%, 99.47%) of Xpert Ultra were calculated, respectively. Rifampicin resistance was detected in 1 (0.70%) sample. Conclusion: Diagnosis of EPTB is a challenge and Xpert Ultra may detect TB at a very early stage. However, it is essential to rule out false-positive results. Additional studies are needed on Xpert Ultra to interpret trace results better.

QEEG Predictors of Treatment Response in Major Depressive Disorder- A Replication Study from Northwest India.

Background: Predicting treatment response with antidepressant is a challenging task for clinicians and researchers. An important limitation of an antidepressant trial is the increased time spent before an adequacy of trial can be decided. Quantitative Electroencephalography has shown some evidence in identifying early changes seen with antidepressants. No data has been reported from Indian population on its predictive capabilities. Aim: To examine whether early changes in frontal and prefrontal theta value in QEEG could predict antidepressant treatment response. Methods: Structured clinical assessments were conducted at baseline and after one week in a sample of treatment-seeking adults with major depressive disorder (n = 50). Patients were started on SSRI (Escitalopram, fluoxetine, paroxetine or sertraline) and followed for 8 weeks. QEEG recordings were carried out at baseline and week 1 and its parameters (relative theta power and cordance) were assessed to identify its predictive value for treatment response. Treatment response was assessed using Hamilton depression rating scale with 50% reduction after 8 weeks being considered as response. Results: Mean age of the sample was 39 ± 10 years and majority of them were females (64%). A significant reduction was found in relative frontal theta value (p = 0.021) from baseline to one week in responders. However, linear regression revealed that this change could not predict the treatment response (p = 0.37). Conclusions: QEEG changes are observed in initial phase of antidepressant treatment but these changes can't predict the treatment response.

Endocrine and Metabolic Manifestations of COVID-19 Patients Admitted to an Intensive Care Unit.

CONTEXT: The effects of coronavirus disease 2019 (COVID-19) on the endocrine system remain uncertain. OBJECTIVE: Our study aimed to explore the possible effects of COVID-19 on endocrine organs and to determine the impact of glycemic status, 25-hydroxyvitamin D levels, calcium levels, and thyroid dysfunction on the final outcome of patients with COVID-19. DESIGN AND METHODS: This single-center, retrospective study evaluated endocrine function abnormalities in 102 patients hospitalized with COVID-19 in the intensive care unit (ICU). RESULTS:  Of 102 patients admitted to ICU, 42 (41.2%) succumbed to illness. The most frequently observed abnormality in thyroid function tests was low free triiodothyronine (FT3) levels (56%). A thyroid profile indicating thyrotoxicosis was detected in five (4.9%) patients, and overt hypothyroidism was identified in two (1.9%) patients. New-onset diabetes was detected in five (4.9%) patients whereas diabetic ketoacidosis at presentation was found in six (5.9%) cases. Rhino-orbital mucormycosis was detected in one patient with diabetes during treatment of COVID-19 while three (2.9%) patients were diagnosed with pulmonary mucormycosis after recovery from COVID-19. Hypocalcemia was observed in 52 (51 %) patients. Out of 42 patients who died, 32 patients had low FT3, 26 patients had high glycated haemoglobin (HbA1c), and 33 patients had low 25-hydroxyvitamin D. Multivariate analysis demonstrated that low concentration of 25-hydroxyvitamin D, low FT3 and higher HbA1c levels were significantly associated with increased mortality. CONCLUSION:  New-onset thyrotoxicosis in COVID-19 patients is mostly due to subacute thyroiditis. Hypocalcemia is also frequently encountered in patients with moderate disease and those with critical COVID-19. A high index of suspicion is required to timely diagnose mucormycosis in COVID-19 patients with diabetes.

Comparison of Tocilizumab and High-dose Methylprednisolone Pulse on Outcomes in Severe Corona Virus Disease-2019: TAME-COVID, a Retrospective Multicentric Study.

BACKGROUND: India recently encountered fierce second wave of coronavirus disease (COVID-19), and scarcity of novel medications added to the management challenges. Various studies have highlighted the effectiveness of tocilizumab and high-dose steroids in severe COVIDs, but none has compared their efficacy. MATERIALS AND METHODS: This retrospective multi-centric analysis compares intravenous tocilizumab (8 mg/kg/day, maximum dose-800 mg), and intravenous Methylprednisolone Pulse (MPS-1 g/day for 3 days) in severe COVID-19. Both the groups had additionally received the standard of care COVID treatment as per protocol. Outcomes were assessed at 30 days. RESULTS: A total of 336 patients, with 249 receiving MPS and 87 receiving tocilizumab were compared. Majority of these were males (72.9%) with a mean age of 57.4 ± 13.6 years. Diabetes was the most common comorbidity. Patients in both groups had comparable age distribution, comorbidities, presenting mean-arterial pressures, d-Dimer levels, serum ferritin, serum leukocyte-dehydrogenase, and procalcitonin. However, the tocilizumab group had more number of males, higher incidence of coronary artery disease, more tachypnea and leukocytosis, more number of patients with severe acute respiratory disease syndrome (PaO2/FiO2 ratio <100), and higher C-reactive protein levels at presentation. Both groups had comparable adverse events' profile. Tocilizumab group had lesser requirement of invasive ventilation than MPS group (17% vs. 29%, P = 0.038), however mortality at the end of 30 days follow-up was similar (36% vs. 34% respectively; P = 0.678). CONCLUSIONS: Tocilizumab decreased the need for invasive ventilation in severe COVID-19; however, it did not translate to improved survival. A planned prospective randomized study is recommended in this respect to compare their efficacy.

Study of Changes in Optic Nerve Sheath Diameter Following Tracheal Intubation Using Macintosh Laryngoscope or Fibreoptic-Guided Intubation Through Ambu Aura-I: A Randomised Controlled Study.

BACKGROUND: Neuroanaesthesiologists are faced with managing and optimising the intracranial pressure in the perioperative period. Laryngoscopy and tracheal intubation are known to increase sympathetic activity that is well tolerated by healthy patients but may be detrimental to many comorbid patients. We, therefore, hypothesised that airway management and tracheal intubation through Ambu Aura-I (Ambu, Baltorpbakken 13, Denmark) may be associated with lesser changes in optic nerve sheath diameter (ONSD) compared to conventional tracheal intubation and designed a study to ultrasonographically measure the changes in optic nerve sheath diameter following tracheal intubation using Macintosh laryngoscope or fibreoptic-guided intubation through Ambu Aura-I in patients receiving endotracheal anaesthesia. MATERIAL AND METHODS: This randomised controlled hospital-based clinical study was conducted on 60 patients divided into two groups: group 1 (n=30, tracheal intubation facilitated by direct laryngoscopy with Macintosh laryngoscope) or group 2 (n=30, fibreoptic-guided tracheal intubation through Ambu Aura-I), undergoing elective surgery under general anaesthesia requiring tracheal intubation. RESULTS: Baseline parameters before induction of anaesthesia were recorded for further comparison. Baseline ONSD at 3 mm behind the globe in both eyes (before induction of anaesthesia), both in transverse and the coronal plane, was measured by transorbital sonography with the patient lying in the supine position using a portable Sonosite Turbo-M ultrasonography (Fujifilm Sonosite, Bothell, USA) machine. End-tidal carbon dioxide concentration (EtCO2) was also recorded at this time. Observations of HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), oxygen saturation (SpO2), EtCO2, and ONSD measurements were recorded immediately and at three and five minutes after intubation, and complications were recorded. Data collected were tabulated, and statistical analysis was done using SPSS 22.00 for windows (SPSS Inc, Chicago, USA). The ONSD increase peaked at 4.19±0.35 and 4.16±0.31 mm in right and left eyes. Like in group 1, the ONSD decreased slightly to 4.06±0,29 and 4.05±0.29 mm in right and left eyes in group 2 at 10 minutes after intubation. The changes in ONSD when compared to baseline values (before intubation) were statistically not significant (p>0.05). Between-group comparison in ONSD in both the eyes at different time intervals was statistically not significant (p>0.05). CONCLUSION: We conclude that fibreoptic-guided tracheal intubation through Ambu Aura-I is not superior to tracheal intubation using direct laryngoscopy with Macintosh laryngoscope in terms of its effect on intracranial pressure, as measured ultrasonographically by optic nerve sheath diameter.

Comparative Study of the Management of Intertrochanteric Fracture Femur With Proximal Femoral Nail vs. the Dynamic Hipscrew With Derotation Screw in Elderly Population.

BACKGROUND: Intertrochanteric fractures can be treated, both by conservative and operative methods depending upon the status of the patient. The purpose of this study was to assess the functional outcome of intertrochanteric fracture of femur treated with dynamic hip screw (DHS) with de-rotation screw comparing and proximal femoral nail (PFN). METHODOLOGY: We compared 30 (male: 23, female: seven) cases of intertrochanteric fractures with a mean age of the population was 65 years and male to female ratio in was 2.75:1. Patients were recruited in this study having inclusion criteria of adults above 50 years of age, isolated intertrochanteric fractures of the AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1 and A2, fracture less than two weeks, and intertrochanteric fracture with or without distal extension. RESULTS: Post-operatively, patients treated by either of these two methods were statistically analyzed in terms of comparing advantages and disadvantages in terms of the time of fracture union and outcome of both above-mentioned procedures using Harris hip score. CONCLUSION: PFN gives better results than DHS with De-Rotation Screw-in intertrochanteric fractures in terms of the amount of blood loss during surgery, duration of surgery, early toe-touch weight-bearing, and Harris hip scores. There is no difference between the two modalities in terms of duration of hospitalization, fracture union, mortality and morbidity, and postoperative complications.

Telemedicine Versus In-Person Visits in Postoperative Care in Orthopedic Patients: Follow-Up Study From North India.

BACKGROUND: Telemedicine is improving healthcare delivery in orthopedic patients but the data regarding this are scarce from India, especially North India. METHODOLOGY: During this one-year prospective observational study, all patients with fractures of the upper end of tibia requiring surgical intervention and who consented to avail teleconsultation services were included. All these patients were assessed by patient satisfaction score pre-operatively. Patients were randomly assigned for post-operative care schedules of 5 and 14 days in telemedicine and inpatient visits during their follow-up period. RESULTS: A total of 50 patients were included and the satisfaction rating among the two groups was identical. The average patient satisfaction score (on a 10-point scale) was found to be 9.77 in the inpatient visits based on the one-on-one follow-up group and 9.79 in the telemedicine consultation group. CONCLUSION:  In orthopedics, the implementation of telemedicine can minimize the need for the patient to physically visit the outpatient department. The rates of response and overall patient satisfaction were high in the telemedicine group. However, more efforts should be made to address the limitations and problems of using telemedicine.

Next-generation sequencing in childhood-onset epilepsies: Diagnostic yield and impact on neuronal ceroid lipofuscinosis type 2 (CLN2) disease diagnosis.

Epilepsy is one of the most common childhood-onset neurological conditions with a genetic etiology. Genetic diagnosis provides potential for etiologically-based management and treatment. Existing research has focused on early-onset (<24 months) epilepsies; data regarding later-onset epilepsies is limited. The goal of this study was to determine the diagnostic yield of a clinically available epilepsy panel in a selected pediatric epilepsy cohort with epilepsy onset between 24-60 months of life and evaluate whether this approach decreases the age of diagnosis of neuronal ceroid lipofuscinosis type 2 (CLN2). Next-generation sequencing (NGS)-based epilepsy panels, including genes associated with epileptic encephalopathies and inborn errors of metabolism (IEMs) that present with epilepsy, were used. Copy-number variant (CNV) detection from NGS data was included. Variant interpretation was performed per American College of Medical Genetics and Genomics (ACMG) guidelines. Results are reported from 211 consecutive patients with the following inclusion criteria: 24-60 months of age at the time of enrollment, first unprovoked seizure at/after 24 months, and at least one additional finding such as EEG/MRI abnormalities, speech delay, or motor symptoms. Median age was 42 months at testing and 30 months at first seizure onset; the mean delay from first seizure to comprehensive genetic testing was 10.3 months. A genetic diagnosis was established in 43 patients (20.4%). CNVs were reported in 25.6% diagnosed patients; 27.3% of CNVs identified were intragenic. Within the diagnosed cohort, 11 (25.6%) patients were diagnosed with an IEM. The predominant molecular diagnosis was CLN2 (14% of diagnosed patients). For these patients, diagnosis was achieved 12-24 months earlier than reported by natural history of the disease. This study supports comprehensive genetic testing for patients whose first seizure occurs ≥ 24 months of age. It also supports early application of testing in this age group, as the identified diagnoses can have significant impact on patient management and outcome.

Molecular basis of mucopolysaccharidosis IVA (Morquio A syndrome): A review and classification of GALNS gene variants and reporting of 68 novel variants.

Mucopolysaccharidosis IVA (MPS IVA, Morquio A syndrome) is a rare autosomal recessive lysosomal storage disorder caused by mutations in the N-acetylgalactosamine-6-sulfatase (GALNS) gene. We collected, analyzed, and uniformly summarized all published GALNS gene variants, thus updating the previous mutation review (published in 2014). In addition, new variants were communicated by seven reference laboratories in Europe, the Middle East, Latin America, Asia, and the United States. All data were analyzed to determine common alleles, geographic distribution, level of homozygosity, and genotype-phenotype correlation. Moreover, variants were classified according to their pathogenicity as suggested by ACMG. Including those previously published, we assembled 446 unique variants, among which 68 were novel, from 1190 subjects (including newborn screening positive subjects). Variants' distribution was missense (65.0%), followed by nonsense (8.1%), splicing (7.2%), small frameshift deletions(del)/insertions(ins) (7.0%), intronic (4.0%), and large del/ins and complex rearrangements (3.8%). Half (50.4%) of the subjects were homozygous, 37.1% were compound heterozygous, and 10.7% had only one variant detected. The novel variants underwent in silico analysis to evaluate their pathogenicity. All variants were submitted to ClinVar (https://www.ncbi.nlm.nih.gov/clinvar/) to make them publicly available. Mutation updates are essential for the correct molecular diagnoses, genetic counseling, prenatal and preimplantation diagnosis, and disease management.

Bilateral Asymmetric Hip Dislocations with Vascular Compromise: A Case Report.

Bilateral asymmetric hip dislocations are rare injuries and associated vascular compromise is even rarer. We report a unique case of bilateral asymmetric hip dislocations with vascular compromise, due to mechanical arterial compression by the anteriorly dislocated femoral head on one side. Prompt closed reduction re-established the blood flow. Operative intervention was done subsequently to remove intra-articular loose bodies in the hip on the same side. At 6-month follow-up, patient had good functional outcome and no radiographic evidence of complications.

Neuropsychiatric manifestations of methyl iodide toxicity.

Methyl iodide is an industrial chemical used in methylation for pharmaceutical intermediates. Its toxicity is a rare industrial hazard. Its toxicity is reported with both acute sudden exposure and gradual exposure. The authors report a case of methyl iodide toxicity occurring in a 47 year-old male with sudden exposure to this chemical. He presented with neuropsychiatric symptoms primarily slurring of speech, ataxia followed by delusion and hallucinations which resolved within 2 weeks with parenteral thiamine and an antipsychotic. Symptoms reappeared after a re-exposure, this time with more prominent psychiatric symptoms which were late to resolve (4 weeks) with similar treatment. Neuroimaging revealed hyperintensities in posterior regions of the brain which resolved after 4 weeks. The patient had prominent neurocognitive deficits which were persistent. The case highlights the rare chemical toxicity with neuropsychiatric manifestations with persistent neurocognitive symptoms.

Role of FNA and Special Stains in Rapid Cytopathological Diagnosis of Pulmonary Nocardiosis.

BACKGROUND: Nocardia, a gram-positive aerobic bacillus of the Actinomycetales family, is a significant opportunistic pathogen in immunocompromised individuals. Clinical and radiological features of pulmonary nocardiosis are nonspecific and can be misdiagnosed as tuberculosis, pneumocystis, staphylococcal or fungal infections, or as malignancy. Aspiration cytology with special stains is a quick and effective approach for accurate diagnosis. MATERIALS AND METHODS: We present 7 cases of pulmonary nocardiosis, admitted to the pathology department in a tertiary-care hospital in Punjab. Clinical findings, immune status, laboratory tests, chest radiographs, and computed tomography scans were reviewed. Cytologically, special stains like 1% Ziehl-Neelsen (ZN), 20% ZN, periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), and reticulin stains were studied along with May-Grünwald Giemsa, Papanicolaou, and hematoxylin and eosin. RESULTS: All the patients were immunocompromised. The radiological changes were nonspecific. Cytomorphology showed acute and chronic inflammatory infiltrates with necrosis. None of the cases showed well-defined granulomas. GMS, modified 1% ZN and, Gordon and Sweet reticulin stains highlighted the delicate filamentous bacteria in all cases. PAS and 20% ZN stain for tuberculous bacilli were uniformly negative. CONCLUSION: FNAC can provide a quick and accurate diagnosis of nocardiosis and thereby facilitate timely medical management.

Severe Varicella Pneumonia in Adults: Seven Years' Single-center Experience from India.

CONTEXT: Varicella pneumonia is a rare but a serious complication of chickenpox in adults. There is paucity of data on varicella pneumonia from India. AIMS: The aim of this study is to describe the clinical manifestations, hospital course, treatment, and outcome of adult patients with severe varicella pneumonia. SETTINGS AND DESIGN: This was a retrospective, observational study of patients with severe varicella pneumonia attending a tertiary care teaching hospital. SUBJECTS AND METHODS: The cases of varicella were identified by a computerized search of the medical record for the period between January 2010 and December 2016. During this period, 137 patients got admitted with varicella of which 22 had severe varicella pneumonia. STATISTICAL ANALYSIS: Mean and standard deviation were computed. Fisher's Z-test of proportions and analysis of variance were applied. RESULTS: There were 17 (77.3%) men and 5 (22.7%) women. The mean age of the patients was 33.4 ± 10.8 years. History of contact with an infected person followed by high-grade fever and typical rash was present in all patients. Forty-five percent (10/22) of patients were immunosuppressed. All the patients received intravenous acyclovir. Forty-five percent (10/22) of patients received invasive mechanical ventilation. The various factors associated with the need for mechanical ventilation were partial pressure of oxygen:fraction of inspired oxygen ratio <150, quick sequential (sepsis-related) organ failure assessment (qSOFA) >2, and early bacterial coinfection. The mean Intensive Care Unit and hospital stay were 7 days (range; 1-16) and 9 days (range; 4-21), respectively. The overall mortality was 22.7% and reached 50% in those requiring invasive ventilation. The mortality was higher among patients with qSOFA >3, mean arterial blood pressure <60 mmHg, and severe acute respiratory distress syndrome at presentation. CONCLUSIONS: Patients with severe varicella pneumonia are at an increased risk of respiratory failure and death.

Identificación de las especies de Candida en las infecciones sanguíneas / Characterization of Candida species in blood stream infections

Introducción: La candidemia se convirtió en una infección importante del torrente sanguíneo que se asocia frecuentemente con índices elevados de mortalidad y morbilidad. Las especies de Candida generan del 70% al 80% de las infecciones micóticas invasivas del torrente sanguíneo y son la cuarta causa más frecuente de infecciones hospitalarias del torrente sanguíneo. La identificación de las especies de Candida es importante, ya que las especies no albicans son cada vez más numerosas y resistentes a las drogas antimicóticas. El objetivo del estudio fue aislar e identificar diferentes especies de Candida asociadas con candidemia y analizar su patrón de susceptibilidad a los antimicóticos. Materiales y métodos: Los pacientes con sospecha de infecciones del torrente sanguíneo (ITS) fueron reclutados durante un período de un año para el estudio prospectivo. Se analizaron las características demográficas, la duración de la internación y los factores de riesgo asociados y la evolución clínica. El análisis de las muestras de sangre tuvo lugar mediante el sistema automatizado BacTAlert. La identificación y la susceptibilidad antimicótica de las levaduras fueron realizadas mediante el uso de dispositivo VITEK-2. Resultados: Las especies de Candida fueron aisladas en 30 de los 3146 cultivos recibidos (0.9%). La mayoría de los casos de candidemia tuvieron lugar en hombres (66%). Los factores de riesgo más frecuentes fueron el uso de antibióticos de amplio espectro, la vía central y la ventilación mecánica. Entre las levaduras aisladas, las especies de Candida no albicans fueron predominantes (60%), en comparación con la especie C. albicans (40%). La especie albicans presentó una susceptibilidad del 100% a los azoles y la anfotericina, en tanto que las especies no albicans fueron resistentes. De los 30 pacientes mencionados, 5 fallecieron. Conclusión: La prevalencia de Candida no albicans fue mayor en comparación con la prevalencia de Candida albicans. Las especies no albicans fueron más resistentes a los antimicóticos. En consecuencia, los pacientes internados deberían ser evaluados para identificar la candidemia.

Introduction: Candidemia has become an important bloodstream infection that is frequently associated with high rates of mortality and morbidity. Candida species account for 70-80% of invasive bloodstream fungal infections and represent the fourth most common nosocomial bloodstream infections. The identification of Candida species is important as the number of non albicans Candida species is increasing and they are becoming more resistant to antifungal drugs. The aim of the study was to isolate and identify various Candida species associated with candidemia and to study their antifungal susceptibility pattern. Materials and methods: Patients suspected of having BSI were enrolled on a one-year prospective study. Patient's demographic details, duration of hospital stay, associated risk factors and outcome were studied. Blood samples were analyzed by BacTAlert automated system. Identification and antifungal susceptibility testing of yeasts was done using VITEK-2 compact system. Results: Of 3146 blood cultures received, Candida species were isolated in 30 samples (0.9%). The majority of candidemia cases were in males (66%). The most common risk factors were use of broad spectrum antibiotics, central line and mechanical ventilation. Among the yeast isolates, non albicans Candida species were predominant (60%) compared to C. albicans (40%). Candida albicans showed 100% susceptibility to azoles and amphotericin whereas non albicans Candida species showed resistance. Of these 30 patients, 5 patients died. Conclusion: Prevalence of non albicans Candida was greater than C. albicans and cases were more resistant to antifungal drugs. Therefore surveillance for candidemia should be carried out in hospitalized patients.

Investigating the potential of Tamarindus indica pectin-chitosan conjugate for reducing recovery period in TNBS induced colitis.

The present study was aimed at exploiting the wound healing applications and tablet coating potential of Tamarindus indica pectin-chitosan (PCH) conjugate for reducing recovery period from TNBS induced colitis. The PCH (60:40, 3% w/v) solution when spray coated followed by drying at 50°C created hydrophobic surface, that may be due to interaction of pectin with chitosan as evident from temperature ramping rheological investigations. Further, the 15% w/v coating was sufficient to prevent Mesalamine (Ma) release in pH 1.2. The AUC and AUMC of PCH coated tablets were 1.98 and 17.69 fold increased as compared to uncoated tablets. A synergistic therapeutic effect of PCH conjugate with Ma was evident from the colon/body weight ratio, clinical activity and damage score. Overall, the findings suggested PCH and Ma (20mg) reduces the recovery period from 5 to 4days with reduction in dose.