Scrub typhus in pregnancy - A threat to maternal and fetal outcome.

Background and Objectives: Scrub typhus is an acute febrile illness transmitted by the bite of trombiculid mite in the larval stage. Scrub typhus is rare in pregnancy and there is paucity of data on the clinical outcome of scrub typhus during pregnancy. Material and Methods: We present five cases of scrub typhus complicating pregnancy who were admitted in the obstetric ward at AIIMS Rishikesh, India during the antenatal period for management. Results: The first patient presented at term pregnancy in semiconscious state while the rest were preterm between 31 and 34 weeks period of gestation. The age at presentation was 21-31 years. All five had febrile illness of >5 days' duration along with cough. Fever investigations like blood culture, peripheral smear for malarial parasite, dengue serology, widal test, and urine culture were negative. Serology for scrub typhus was positive in all. Once diagnosis was confirmed for scrub typhus, patients were given the drug of choice azithromycin 500 mg twice daily for five days. Scrub typhus complicating pregnancy led to maternal mortality in one patient. It resulted in one preterm delivery, one intrauterine fetal death, and rest three were delivered at term with good perinatal outcome. Conclusion: Scrub typhus is common in endemic areas like Uttarakhand, India. It has a poor fetal outcome. If diagnosed early and treatment started, maternal and fetal prognosis can be favorable. As large case series are unavailable in literature, it is difficult to predict the course of disease which at times may be fulminant.

Analysis and remediation of phthalates in aquatic matrices: current perspectives.

Phthalic acid esters (PAEs) are high production volume chemicals used extensively as plasticizers, to increase the flexibility of the main polymer. They are reported to leach into their surroundings from plastic products and are now a ubiquitous environmental contaminant. Phthalate levels have been determined in several environmental matrices, especially in water. These levels serve as an indicator of plasticizer abuse and plastic pollution, and also serve as a route of exposure to different species including humans. Reports published on effects of different PAEs on experimental models demonstrate their carcinogenic, teratogenic, reproductive, and endocrine disruptive effects. Therefore, regular monitoring and remediation of environmental water samples is essential to ascertain their hazard quotient and daily exposure levels. This review summarises the extraction and detection techniques available for phthalate analysis in water samples such as chromatography, biosensors, immunoassays, and spectroscopy. Current remediation strategies for phthalate removal such as adsorption, advanced oxidation, and microbial degradation have also been highlighted.

Long-term community integration study of an affordable manual standing wheelchair.

PURPOSE: The manual, user-operated Arise Standing Wheelchair (SWC) is the end result of multiple design iterations based on findings and feedback from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customisability. This paper describes a long-term community integration study of the Arise SWC. METHODS: All participants (N = 8; 7 Male, 1 Female) were persons with spinal cord injuries. During the study period (six months), the participants integrated the Arise SWC into their daily routines. To assess the impact of the Arise SWC on various outcome measures, participants' responses were captured using a Likert-scale questionnaire at the beginning of the study, after 30 days, and after 180 days of Arise SWC usage. RESULTS: The long-term usage of the Arise SWC positively impacted the users' standing performance (ability to stand regularly, stand at different locations, and stand in community settings), productive ability (accessibility to environmental controls and ability to perform overhead reaches), and pathophysiology (spasticity and ability to get proper sleep). Furthermore, all the users were able to independently move using the Arise SWC over even and uneven terrain (some needed minimal assistance over uneven terrain). CONCLUSIONS: Overall, we believe that Arise SWC will benefit eligible users and improve their ability and performance in daily activities.

Arise Standing Wheelchair (SWC) positively impacted users' standing performance, mobility over uneven terrain, ability to transfer between surfaces, and overhead reaches.Arise SWC positively impacted users' overall physical well-being.The study shows that Arise SWC improved the users' overall daily living activities.Arise SWC, an affordable solution, is anticipated to have a global impact, especially on low-income nations.

May-Thurner Syndrome in a Case of Left Iliofemoral Vein Thrombosis With Contralateral Tubo-Ovarian Abscess in the Post-postpartum Period.

May-Thurner syndrome (MTS) is a rare, yet important, differential diagnosis in reproductive-age women with deep vein thrombosis (DVT). It is characterized by the compression of the left common iliac vein by the right common artery against the lumbar vertebra. The condition is complicated by recurrent DVT with pulmonary thromboembolism (PTE). Here is a case of multiparous women in early puerperium with right tubo-ovarian abscess and left lower limb DVT likely due to MTS. The diagnosis was further complicated by the presence of persistent thrombocytosis but a myeloproliferative neoplasm was ruled out by genetic mutation testing. She was given anticoagulants, and laparotomy was done for the excision of the tubo-ovarian mass in view of the persistent fever not responding to injectable antibiotics. PTE in the postoperative period was managed by anticoagulants followed by an inferior vena cava (IVC) filter for the risk of recurrent DVT and/or PTE in an MTS case.

Ureteric Leiomyosarcoma.

Ureteric leiomyosarcoma is a rare but aggressive tumor among other sarcomas. There is no established epidemiological data due to the scarcity of literature on this uncommon disorder. The present literature comprises about 20 case reports mostly of women above 40 years of age. The presenting complaint is mostly pain in the abdomen with only a few reporting urological symptoms like hematuria. Understandably, this tumor is diagnosed by histopathological examination with immunohistochemistry. We report one such case of a 32-year-old female who underwent an exploratory laparotomy with preoperative suspicion of adnexal neoplastic mass only to find normal ovaries and left ureteric tumor intraoperatively. She was managed with excision of the tumor with partial resection of the involved ureter and end-to-end anastomosis of the ureter followed by chemotherapy and radiation.

Predictors of Posterior Reversible Encephalopathy Syndrome (PRES) in Women With Pre-eclampsia/Eclampsia: A Retrospective Analysis.

CONTEXT:  Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by acute neurological symptoms with reversible subcortical vasogenic brain edema. One of the most common risk factors is pre-eclampsia/eclampsia. AIMS:  This study aimed to compare the clinical and radiological characteristics of PRES with those without PRES in patients with pre-eclampsia/eclampsia and attempts to find independent predictors of PRES. METHODS AND MATERIALS:  This was a single-center, retrospective study. Fifty-three female patients admitted to the Department of Obstetrics & Gynaecology, AIIMS Rishikesh between 2018 and 2021 with severe pre-eclampsia/eclampsia were included. Brain imaging was done to confirm the diagnosis of PRES. Baseline characteristics between patients whose imaging was suggestive and not suggestive of PRES were compared. RESULTS:  Fifty-three patients with pre-eclampsia/eclampsia were included in the analysis. The median age and period of gestation of the study population were 28 (range 19-37) years and 36.6 (range 24.2-41.5) weeks respectively. Twelve patients (22.6%) had eclampsia, and 41 (87.4%) had pre-eclampsia of which 28 (52.8%) had severe pre-eclampsia. Twelve patients were diagnosed with PRES. Patients with PRES were significantly younger with a median age of 23 [range 20-30 vs 29 (range 19-37; p = 0.005) years], and more likely to be primiparous (91.7% vs 36.6%; p < 0.001) compared to those without PRES. PRES was significantly more common in patients with eclampsia. Of 12 patients with eclampsia, nine (75%) had evidence of PRES. The maternal and fetal outcome, however, was similar in both groups. Patients with PRES were more likely to have poor sensorium compared to those without PRES (83.3% vs 5.3%; p < 0.01). Eclampsia was found in the independent predictor of PRES (odds ratio, OR 20.9; 95% confidence interval, CI 3.0-147.0, p = 0.02). CONCLUSIONS:  In this study, patients with PRES were younger and significantly more likely to be primiparous and have eclampsia compared to those without PRES. Headache followed by seizures and altered sensorium were the most common clinical manifestations and subcortical white matter hyperintensities involving fronto-parieto-occipital lobes were the most common radiological finding. Eclampsia emerged as an independent risk factor for PRES.

A comparative analysis of molecular genotypes of Mycobacterium tuberculosis isolates from HIV-positive and HIV-negative patients.

Setting: Tuberculosis Research Laboratory, Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, and the National Institute of Tuberculosis and Respiratory Diseases (NITRD), both situated in New Delhi. Objectives: We aimed to identify the distribution of various genotypes of M. tuberculosis among HIV-positive and HIV-negative patients suspected of having Tuberculosis, seen at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi, which is a tertiary care dedicated TB hospital. Patients and methods: Genotyping by Spoligotyping and 24 loci MIRU-VNTR was performed and analyzed using SITVITWEB and MIRU-VNTRplus. Drug susceptibility patterns were also analyzed. Results: A total of 503 subjects who were PTB/EPTB suspected were recruited and 287 were culture positive. Among them, 276 had growth of Mycobacterium tuberculosis (MTB) and in 11 patients non-tuberculous mycobacteria (NTM) were grown. The isolation rate of NTM was predominantly from HIV positive [10 of 130 (7.6%)] patients. Of the total isolates of MTB, 156 (56.5%) were from HIV negative patients and 120 (43.5%) were from HIV positive patients. All 276 M. tuberculosis isolates were genotyped and tested for drug susceptibility patterns. The CAS genotype was most predominant [153 (55.4%)], followed by Beijing lineage [44 (15.9%)], East African India [25 (9.1%)] and others [54 (19.6%)]. Beijing genotype was significantly more common in HIV positive patients (22.5%) than in HIV negative patients (10.9%). In MIRU-VNTR analysis, clustering was found to be more frequent in CAS strains irrespective of HIV status. In the HIV positive group, spoligotyping could differentiate various genotypes in 90% of isolates and MIRU-VNTR analysis in 84.2% of isolates. The clustering of various MTB strains was more associated with drug resistance. Conclusion: The Beijing lineage was predominant in HIV-TB coinfected cases, even though the Central Asian Strain (CAS) was overall more predominant in the region.

Potential of agro-industrial produced laccase to remove ciprofloxacin.

Ciprofloxacin (CIP), a widely used antibiotic, is frequently detected in the environment due to insufficient wastewater and water treatment. Hence, novel, green and cost-effective technologies are required to enhance the removal of these pollutants. The potency of crude enzymes, especially laccases, produced by white-rot fungi was tested to assess their effectiveness to degrade CIP from water. Crude laccase alone could not oxidize CIP. The addition of syringaldehyde, a redox mediator, resulted in a decrease in antibiotic concentration up to 68.09±0.12% in 24 h, which was the highest removal efficiency achieved with 0.15 mg/mL syringaldehyde and 2 mg/mL of crude laccase (0.1 U/ml). Crude laccase oxidation of CIP was inhibited after 6 h of treatment. To compare, a pure enzyme with the same activity as the crude one removed 86% of CIP in 24 h. No inhibitory effect during the treatment was observed. The estimation of antimicrobial efficiency revealed that after 6 h of treatment, the toxicity towards Escherichia coli decreased by 30%. The wastewater treatment by the crude laccase-mediated system was estimated to significantly reduce the cost of enzymatic treatment.

Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study.

OBJECTIVE: The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. METHODS: We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. RESULTS: We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. CONCLUSION: In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Feasibility of the use of different types of enzymatically treated cellulosic fibres for polylactic acid (PLA) recycling.

In the present study, the potential use of cellulosic microfibers (CMFs) extracted from hemp fiber (HF) and pulp and paper solid waste (mixed sludge (MS), deinked sludge (DS)) as a reinforcing agent in novel bio composite materials produced from recycled Polylactic acid (rPLA) was investigated. CMFs were extracted and treated using physicochemical method followed by enzymatic treatment with laccase and cellulase. The effects of CMFs concentrations (1.5, 3 and 6% w/w) and fiber size (75 µm-1.7 mm) on the mechanical properties (impact and tensile) and biodegradability of the biocomposite samples were investigated. A modified interfacial adhesion between rPLA matrix and the three fibers used, was clearly observed through mechanical tests due to alkali and enzymatic treatments. The use of different types of enzymatically treated cellulosic fibers for polylactic acid (PLA) recycling was assessed by Scaning electron microscopy (SEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The combined physicochemical and enzymatic treatments led to a considerable size reduction of the cellulosic fibers (HF, MS and DS) resulting in the enhanced interfacial adhesion between rPLA matrix and fibers. The biocomposite obtained with rPLA with HF gave the most favorable values for Young's modulus (324.53 ± 3.10 MPa, p-value 0.03), impact strength (27.61 ± 2.94 kJ/m2, p-value 0.01) and biodegradation rate (1.97%).

Biodegradation of aflatoxin B1 with cell-free extracts of Trametes versicolor and Bacillus subtilis.

Aflatoxin B1 (AFB1) is one of the most common contaminants of poultry feed and has been linked to adverse effects on animal health and productivity. In this study, the degradation of AFB1 was studied with cell-free extracts (CFE) of Trametes versicolor and Bacillus subtilis using High-Performance Liquid chromatography (HPLC). CFE from B. subtilis and T. versicolor gave 60% and 34% of AFB1 degradation respectively, while heat-inactivated extracts showed no degradation. By-products obtained at the end of AFB1 degradation were analyzed by Liquid Chromatography with tandem mass spectrometry (LC-MS/MS). After 96 h of incubation, by-products with lower m/z values were obtained with CFE from B. subtilis as compared to that from T. versicolor, indicating a higher degradation efficiency of the former. Additionally, the detection of a by-product which could correspond to AFB1-8,9 dihydrodiol - a less toxic derivative of AFB1 - after 72 and 96 h of incubation with CFE from B. subtilis, could indicate the simultaneous detoxification along with degradation of AFB1 by B. subtilis CFE.

Evaluation of pyroligneous acid as a therapeutic agent against Salmonella in a simulated gastrointestinal tract of poultry.

Pyroligneous acid (PA) was evaluated as a potential alternative to therapeutic antibiotics in poultry. Antimicrobial activity of PA was studied at acidic pH (2.0) and neutral pH (7.0) of the liquid against Salmonella enterica and Lactobacillus acidophilus. Acidic PA gave a MIC value of 0.8% (v/v) and 1.6% (v/v), and neutralized PA gave a MIC value of 1.6% (v/v) and 3.2% (v/v) against S. enterica and L. acidophilus respectively. Acidic PA was evaluated at different concentrations in a simulated poultry digestive tract and cecal fermentation to study its effect on the cecal microflora and fermentation profile. PA at a concentration of 1.6% (v/v) completely inhibited S. enterica and was also found to have a similar effect on lactobacilli count as compared with the control (p = 0.17). Additionally, PA at this concentration was found not to have a significant effect on acetic acid production after 24 h of cecal fermentation (p = 0.20). Graphical abstract.

Ciprofloxacin removal via sequential electro-oxidation and enzymatic oxidation.

The combination of electro-oxidation and enzymatic oxidation was tested to evaluate the potency of this system to remove ciprofloxacin (CIP), a fluoroquinolone antibiotic, from water. For the electro-oxidation boron-doped diamond (BDD) and mixed metal oxides anodes were tested, at three current densities (4.42, 17.7 and 35.4 A/cm2). BDD anode at 35.4 A/cm2 exhibited the highest removal efficiency in the shortest time (>90 % removal in 6 min). For the enzymatic oxidation, laccase from Trametes versicolor was chosen. Laccase alone was not able to remove CIP; hence the influence of redox mediators was investigated. The addition of syringaldehyde (SA) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) resulted in enhanced CIP transformation. About 48.9±4.0 % of CIP remained after 4 h of treatment when SA-mediated laccase was applied and 87.8±6.6 % in the case of ABTS-mediated laccase. The coupling of enzymatic oxidation followed by electro-oxidation led to 73 % removal of the antibiotic. Additionally, the antimicrobial activity increased up to its original efficiency after the treatment. The combination of electro-oxidation followed by enzymatic oxidation led to 97-99 % removal of CIP. There was no antimicrobial activity of the solution after the treatment. The tests with wastewater confirmed the efficacy of the system to remove CIP from the complex matrix.

Use of antibiotics in broiler production: Global impacts and alternatives.

Antibiotics are used to fight bacterial infections. However, a selective pressure gave rise to bacteria resistant to antibiotics. This leaves scientists worried about the danger to human and animal health. Some strategies can be borrowed to reduce the use of antibiotics in chicken farms. Much research has been carried out to look for natural agents with similar beneficial effects of growth promoters. The aim of these alternatives is to maintain a low mortality rate, a good level of animal yield while preserving environment and consumer health. Among these, the most popular are probiotics, prebiotics, enzymes, organic acids, immunostimulants, bacteriocins, bacteriophages, phytogenic feed additives, phytoncides, nanoparticles and essential oils.

Microwave-assisted one-pot conversion of agro-industrial wastes into levulinic acid: An alternate approach.

Brewery liquid waste (BLW), brewery spent grain (BSG), apple pomace solid wastes (APS), apple pomace ultrafiltration sludge (APUS) and starch industry waste (SIW) were evaluated as alternative feedstocks for levulinic acid (LA) production via microwave-assisted acid-catalyzed thermal hydrolysis. LA production of 204, 160, 66, 49 and 12 g/kg was observed for BLW, BSG, APS, APUS, and SIW, respectively, at 140 °C, 40 g/L substrate concentration (SC), 60 min and 2 N HCl (acid concentration). Based on the screening studies, BLW and BSG were selected for optimization studies using response surface methodology. Maximum LA production of 409 and 341 g/kg for BLW and BSG, respectively were obtained at 160 °C, 4.5 M HCl, 85 g/L SC and 27.5 min. Results demonstrated the possibility of using brewery wastes as promising substrates for economical and higher yield production of LA, a renewable platform chemical and versatile precursor for fuels and chemicals.

Alternatives to antibiotics in poultry feed: molecular perspectives.

The discovery of the growth promoting property of antibiotics led to their use as antibiotic feed additives (AFAs) in animal feed at sub-therapeutic doses. Although this has been beneficial for animal health and productivity, it has been, essentially, a double-edged sword. The continued and non-judicious use of AFAs has led to the selection and dissemination of antibiotic-resistant strains of poultry pathogens such as Salmonella, Campylobacter and Escherichia coli. The rapid spread of drug-resistant pathogens as well as emergence of antibiotic-related environmental pollutants is of global concern. Hence, the identification and development of new and effective alternatives to antibiotics that do not hinder productivity is imperative. For this, it is essential to understand not only the molecular basis of development of resistance to AFAs but also the mechanisms of action of AFA alternatives and how they differ from AFAs. This review provides a molecular perspective on the alternatives to antibiotics that have been proposed till date and their current trends, as well as novel approaches such as development of improved delivery systems.

Hydrolytic pre-treatment methods for enhanced biobutanol production from agro-industrial wastes.

Brewery industry liquid waste (BLW), brewery spent grain (BSG), apple pomace solid wastes (APS), apple pomace ultrafiltration sludge (APUS) and starch industry wastewater (SIW) have been considered as substrates to produce biobutanol. Efficiency of hydrolysis techniques tested to produce fermentable sugars depended on nature of agro-industrial wastes and process conditions. Acid-catalysed hydrolysis of BLW and BSG gave a total reducing sugar yield of 0.433 g/g and 0.468 g/g respectively. Reducing sugar yield from microwave assisted hydrothermal method was 0.404 g/g from APS and 0.631 g/g from APUS, and, 0.359 g/g from microwave assisted acid-catalysed SIW dry mass. Parameter optimization (time, pH and substrate concentration) for acid-catalysed BLW hydrolysate utilization using central composite model technique produced 307.9 g/kg glucose with generation of inhibitors (5-hydroxymethyl furfural (20 g/kg), furfural (1.6 g/kg), levulinic acid (9.3 g/kg) and total phenolic compound (0.567 g/kg)). 10.62 g/L of acetone-butanol-ethanol was produced by subsequent clostridial fermentation of the substrate.

Supplement comprising of laccase and citric acid as an alternative for antibiotics: In vitro triggers of melanin production.

An indiscriminate use of antibiotics in humans and animals has led to the widespread selection of antibiotic-resistance, thus constricting the use of antibiotics. A possible solution to counter this problem could be to develop alternatives that can boost the host immunity, thus reducing the quantity and frequency of antibiotic use. In this work, for the first time, citric acid and laccase were used as extracellular inducers of melanin production in yeast cells and human cell lines. It is proposed that the formulation of laccase and citric acid together could further promote melatonin-stimulated, melanocyte-derived melanin production. Melanization as a probe of immunity described in this study, is an easy and a rapid test compared to other immunity tests and it allows performing statistical analyses. The results showed the synergistic effect of citric acid and laccase on melanin production by yeast cells, with significant statistical differences compared to all other tested conditions (p: 0.0005-0.005). Laccase and citric acid together boosted melanin production after 8 days of incubation. An increase in melanin production by two human colon cells lines (Cacao-2/15 and HT-29) was observed on supplementation with both laccase and citric acid in the cell growth medium. Produced melanin showed antimicrobial properties similar to antibiotics. Therefore, a formulation with citric acid and laccase may prove to be an excellent alternative to reduce the antibiotic use in human and animal subjects.