Optimal Drug Regimen and Combined Drug Therapy and Its Efficacy in the Treatment of COVID-19: A Within-Host Modeling Study.

The COVID-19 pandemic has resulted in more than 524 million cases and 6 million deaths worldwide. Various drug interventions targeting multiple stages of COVID-19 pathogenesis can significantly reduce infection-related mortality. The current within-host mathematical modeling study addresses the optimal drug regimen and efficacy of combination therapies in the treatment of COVID-19. The drugs/interventions considered include Arbidol, Remdesivir, Interferon (INF) and Lopinavir/Ritonavir. It is concluded that these drugs, when administered singly or in combination, reduce the number of infected cells and viral load. Four scenarios dealing with the administration of a single drug, two drugs, three drugs and all four are discussed. In all these scenarios, the optimal drug regimen is proposed based on two methods. In the first method, these medical interventions are modeled as control interventions and a corresponding objective function and optimal control problem are formulated. In this framework, the optimal drug regimen is derived. Later, using the comparative effectiveness method, the optimal drug regimen is derived based on the basic reproduction number and viral load. The average number of infected cells and viral load decreased the most when all four drugs were used together. On the other hand, the average number of susceptible cells decreased the most when Arbidol was administered alone. The basic reproduction number and viral load decreased the most when all four interventions were used together, confirming the previously obtained finding of the optimal control problem. The results of this study can help physicians make decisions about the treatment of the life-threatening COVID-19 infection.

Evaluation of interobserver reliability of Nugent score for diagnosis of bacterial vaginosis.

BACKGROUND: Vaginal discharge is the commonly narrated compliant of the female attendees of sexually transmitted infection clinic, among which bacterial vaginosis (BV) is responsible for one-third of the visits. BV is often diagnosed clinically which warrants laboratory confirmation. AIMS: The study aims to detect the reliability of the Nugent scoring system between observers for the diagnosis of BV. MATERIALS AND METHODS: This is a prospective study including 177 high vaginal swabs. The gram-stained smears were examined by three independent microbiologists, and the Nugent scoring was performed. Statistical analysis was performed using IBM-SPSS version-22 statistical package for kappa value. RESULTS: Concordant results were seen in 64.03% of smears, discordant results were given in 4.51% of smears, and partial agreement was observed in 31.63% of smears. CONCLUSION: Interobserver reliability is good for the Nugent score. The Nugent score is a simple and reliable method for the diagnosis of BV that can be adapted even in the resource poor settings.

Unfolding of a Clinically Suspected Case of Pulmonary Tuberculosis.

Pulmonary nocardiosis caused by Nocardia mimics pulmonary tuberculosis in many aspects. Here, we report a case of suspected pulmonary tuberculosis turning into pulmonary nocardiosis following microbiological evaluation. Sputum sample of the patient grew Nocardia otitidiscaviarum. Identification was done by conventional methods and matrix assisted laser desorption ionization-time of flight. He was given co-trimoxazole based on susceptibility reports. Even though Nocardia is a rare entity, pulmonary nocardiosis should be ruled out before starting antitubercular treatment to avoid unnecessary burden to the patient and community.

A Study on the Prevalence of Genital Trichomoniasis among Female Outpatients Attending Sexually Transmitted Infection Clinic in a Tertiary Care Hospital.

INTRODUCTION: Women with high-risk sexual behavior accounts for more than half of the sexually transmitted infection (STI) clinic attendees. The prevalence of trichomoniasis is as low as 5% in the general population to as high as 60% in high-risk population. This infection can pave the way to the acquisition of human immunodeficiency virus and other STIs, vice versa and is even associated with cancer. OBJECTIVES: To identify, isolate and study the prevalence of Trichomonas vaginalis in genital specimens of female outpatients. MATERIALS AND METHODS: Total number of subjects involved in the study was 130, among them 85 belonged to high-risk group and 45 belonged to low-risk group. Two high vaginal swabs were collected from each patient. Saline wet mount, Giemsa stain, and culture in modified cysteine peptone liver infusion maltose medium were performed. Results were tabulated and analyzed. RESULTS: Saline wet mount was positive for trichomoniasis in seven individuals, Giemsa detected trichomoniasis in five patients, and culture was positive in eight patients. Of these eight culture positive cases, one was wet mount negative and four were Giemsa stain negative. CONCLUSION: Culture is more sensitive than wet mount and Giemsa stain.

Urinary tract infection due to Chryseobacterium gleum, an uncommon pathogen.

Chryseobacterium species are gaining importance as an emerging opportunistic nosocomial pathogen. Limited availability of clinical data necessitates reporting of such isolates. We report a case of nosocomial urinary tract infection by metallo-ß-lactamase-producing Chryseobacterium gleum in an elderly diabetic male with chronic renal disease. Identification and antibiotic sensitivity test performed by conventional methods were confirmed by Matrix-assisted Laser Desorption Ionization Time-of-Flight and VITEK-2 systems, respectively. The patient responded well to intravenous ciprofloxacin therapy.

Unforeseeable presentation of Chryseobacterium indologenes infection in a paediatric patient.

BACKGROUND: We report for the first time a case of community acquired Chryseobacterium indologenes soft tissue infection in an immunocompetent patient. CASE PRESENTATION: A 11 year female child, from South-Asia of Indian origin presented with fever, pain and swelling in right leg for 3 days with no significant past history. Incision and drainage was done and pus was sent for culture and sensitivity. Radiological investigation showed subtle irregular soft tissue density. Pus culture grew multidrug resistant C. indologenes. CONCLUSION: Though of low pathogenicity, our case emphasises its unpredictable nature and the need to determine minimum inhibitory concentration breakpoints for therapy.