Infectious Disease And Diabetes.

In this communication, we provide a bird's eye view of the various ways in which infectious diseases intersect with diabetes. We list the ways in which infectious diseases can influence glucose homoeostasis and diabetes management, and explores how diabetes care is associated with infections and infection management. This is especially important for health care providers in regions with a high burden of infectious disease.

Cryptococcal antigenemia in people living with HIV and AIDS.

AIM: To assess the prevalence of cryptococcal antigenemia among people living with HIV/AIDS (PLHA) with CD4 ≤100/mm3. DESIGN: This observational study was performed on PLHA with laboratory-confirmed CD4 ≤100/mm3. All PLHA were recruited irrespective of their duration of HIV diagnosis, antiretroviral therapy (ART) naïve, or ART failure. METHODS: The prevalence of cryptococcal antigen (CrAg) was assessed in 102 PLHA, with CD4 ≤100/mm3, using a latex agglutination test on serum samples. All the subjects were followed up for 3 months. RESULTS: Amongst 102 PLHA, 62 (60.8%) and 40 (39.2%) patients were ART-naïve and ART failures, respectively, with 2.9% (n = 3) having clinical features of meningitis and 6.8% (n = 7) patients being asymptomatic CrAg-positive. At the 3 month follow-up, total mortality was 10.8%, of which 33.3% and 8.8% were among CrAg-positive and negative patients (p = 0.05). Mortality in asymptomatic and meningitis symptomatic CrAg-positive patients was 1.03% (n = 1) and 2.06% (n = 2), respectively. Of note, five patients were lost to follow-up. CONCLUSION: Cryptococcal antigenemia is common among patients with CD4 ≤100/mm3 who were either ART naïve or had treatment failure. Asymptomatic patients who underwent pre-emptive therapy demonstrated good clinical outcomes.

Opportunistic infections in elderly TB patients.

Since ancient times, tuberculosis has been a lethal infectious illness. The elderly are particularly susceptible to various illnesses, including tuberculosis. Tuberculosis (TB) and people ageing weaken the immune system, thus increasing the risk of getting other co-infections. Most elderly TB cases are associated with the reactivation of dormant lesions, and these lesions have reactivated due to immunosenescence. Elderly patients have a greater mortality rate from tuberculosis and other co-infections. Active infection signs and symptoms are generally less severe in the elderly. The interaction of structural lung damage, prolonged inflammation, bacterial and fungal colonisation of the respiratory system, and mucociliary insufficiency causes recurrent infections. It is imperative to use all available tools to make a microbiological diagnosis in diagnostic challenges in atypical cases. The therapeutic management of older people presents a significant difficulty in identifying frailty to prevent loss of independence.

Development and validation of a questionnaire to evaluate the knowledge, attitude and practices regarding travel medicine amongst physicians in an apex tertiary hospital in Northern India.

OBJECTIVES: Travel medicine focuses primarily on pre-travel preventive care and the conditions and diseases acquired during or after travel. There is a paucity of validated tools to assess the knowledge, attitude and practises of physicians with regard to travel medicine. We attempted to develop a tool to assess existing expertise among Medicine and Infectious Diseases resident doctors with respect to travel medicine. METHODS: Item level content validity index (I-CVI) and scale level content validity index (S-CVI/Ave) were estimated for each of the items to establish the content validity. Refined measures of inter-rater agreement (Brennan and Prediger Agreement Coefficient and Gwet's Agreement Coefficient) were estimated for the tool. RESULTS: The final version of the questionnaire had satisfactory content validity (I-CVI > 0∙6 and S-CVI/Ave > 0∙9) and possessed high agreement among the raters (Brennan and Prediger AC > 0∙7, p < 0∙01 and Gwet's AC > 0∙8, p < 0∙01) with regard to necessity, clarity and relevance of the scale. CONCLUSIONS: This tool covers a wide range of questions and is scientifically validated. The final version of the tool can be used largely for the assessment of knowledge, attitude and practices among medical practitioners. This is instrumental to build targeted intervention programs to enhance the knowledge regarding travel medicine among health care providers.

Leucocytosis and early organ involvement as risk factors of mortality in adults with dengue fever.

The clinical profile and risk factors for mortality in dengue fever have evolved over the years. The all-cause mortality in admitted dengue patients is around 6%. We aimed to evaluate the recent change in trends of the clinical characteristics and risk factors for in-hospital mortality in adults with dengue fever. This is a retrospective study on adults with confirmed dengue fever admitted in a medical unit of a tertiary care center in North India. Medical records of confirmed dengue fever patients admitted between January 2011, and December 2016 were reviewed. Chi-squared tests with Bonferroni correction for multiple testing were used to identify risk factors for mortality. 232 records were included, of which 66.8% were males. The mean age was 31.6 ± 14 years. There were 17 deaths with an all-cause mortality rate of 7.3% with 76.5% being classified as severe dengue at admission. Among the 17 mortality cases, dyspnea (47%), tachypnea (86.7%), leucocytosis (58.8%), raised urea (80%), and elevated serum creatinine (52.9%) at presentation were significantly associated with mortality (p < 0.001). Shock at any time during the hospital stay (58.8%) was also found to be significantly associated with mortality (p < 0.001). We found that dyspnea, tachypnea, acute kidney injury, and leucocytosis at presentation was significantly associated with in-hospital mortality. Based on our results, we recommend aggressive management of patients with severe dengue and those with mild/moderate disease with the above risk factors.

The Cellular basis of loss of smell in 2019-nCoV-infected individuals.

A prominent clinical symptom of 2019-novel coronavirus (nCoV) infection is hyposmia/anosmia (decrease or loss of sense of smell), along with general symptoms such as fatigue, shortness of breath, fever and cough. The identity of the cell lineages that underpin the infection-associated loss of olfaction could be critical for the clinical management of 2019-nCoV-infected individuals. Recent research has confirmed the role of angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) as key host-specific cellular moieties responsible for the cellular entry of the virus. Accordingly, the ongoing medical examinations and the autopsy reports of the deceased individuals indicate that organs/tissues with high expression levels of ACE2, TMPRSS2 and other putative viral entry-associated genes are most vulnerable to the infection. We studied if anosmia in 2019-nCoV-infected individuals can be explained by the expression patterns associated with these host-specific moieties across the known olfactory epithelial cell types, identified from a recently published single-cell expression study. Our findings underscore selective expression of these viral entry-associated genes in a subset of sustentacular cells (SUSs), Bowman's gland cells (BGCs) and stem cells of the olfactory epithelium. Co-expression analysis of ACE2 and TMPRSS2 and protein-protein interaction among the host and viral proteins elected regulatory cytoskeleton protein-enriched SUSs as the most vulnerable cell type of the olfactory epithelium. Furthermore, expression, structural and docking analyses of ACE2 revealed the potential risk of olfactory dysfunction in four additional mammalian species, revealing an evolutionarily conserved infection susceptibility. In summary, our findings provide a plausible cellular basis for the loss of smell in 2019-nCoV-infected patients.

Severe Immune Thrombocytopenia in a Patient with HIV-HCV Co-infection: Challenges in Management.

Immune thrombocytopenia is a well-known complication of both HIV and Hepatitis C virus infections. Management becomes challenging when a patient with HCV-HIV co-infection presents with severe thrombocytopenia. Adverse drug reactions and drug interactions has to be considered while choosing treatment options for such patients. We report such a case which illustrates the difficulty in managing severe thrombocytopenia in HCV-HIV co-infected patients where evidence based clinical decision making helped in choosing the right therapy for the patient.

Mask fatigue.

Extended wearing of mask, which has become a part of routine life, has led to the emergence of 'mask fatigue'. Mask fatigue is defined as the lack of energy that accompanies, and/or follows prolonged wearing of a mask. This communication describes the various aspects of mask fatigue, and shares pragmatic tips on its reduction. This discussion is relevant to all health care professionals and to general public to some extent, in the present scenario.

Rogue waves in injected semiconductor lasers with current modulation: role of the modulation phase.

Semiconductor lasers with continuous-wave optical injection display a rich variety of behaviors, including stable locking, periodic or chaotic oscillations, excitable pulses, etc. Within the chaotic regime it has been shown that the laser intensity can display extreme pulses, which have been identified as optical rogue waves (RWs), and it has also been shown that such extreme pulses can be completely suppressed via direct modulation of the laser current, with appropriated modulation amplitude and frequency. Here we perform a numerical analysis of the RW statistics and show that, when RWs are not suppressed by current modulation, their probability of occurrence strongly depends on the phase of the modulation. If the modulation is slow (the modulation frequency, fmod, is below the relaxation oscillation frequency, fro), the RWs occur within a well-defined interval of values of the modulation phase, i.e., there is a "safe" window of phases where no RWs occur. The most extreme RWs occur for modulation phases that are at the boundary of the safe window. When the modulation is fast (fmod > fro), there is no safe phase window; however, the RWs are likely to occur at particular values of the modulation phase. Our findings are of interest for the study of RWs in other systems, where a similar response to external forcing could be observed, and we hope that they will motivate experimental investigations to further elucidate the role of the modulation phase in the likelihood of the occurrence of RWs.

Interceptive Orthodontics and Growth Modification Therapy with Fixed Functional Appliance: A Case Report.

A 12-year-old female patient presented with proclined upper anteriors on a class II skeletal base, a retrognathic mandible and high maxillary- mandibular plane angle. Lower first molars were mesially tipped and lower second premolars were impacted. Treatment plan included uprighting and distalising the lower molars followed by growth modulation with Jasper Jumper to correct the mandibular retrognathism. Final finishing and detailing of occlusion was carried out through 0.022" MBT prescription preadjusted edgewise appliance therapy.