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Drought is one of the major water-related natural hazards. Understanding the spatial and temporal variation of rainfall is of great importance in water resources planning and management as it is related with food security and management of scarce water resource, which becomes critical in case of drought events. The advent of GIS to produce spatially interpolated drought map helps the water managers to undertake appropriate measures in drought relief and prioritization of drought mitigation works. Limitation of literature on Tripura suggests that study of drought over Tripura could help in strengthening of mitigation planes and rationalization of disaster management policies. Hence, the present study is focused to investigate the drought persistence and severity in the Tripura state of India during the period 1980-2013, using Standardized Precipitation Evapotranspiration Index (SPEI). Three time scale i.e., 3, 6 and 12 month time scales were opted for the study. Gridded monthly precipitation data distributed over the four districts of Tripura was used for drought analysis. Significant drought events were detected over the study area during the selected period. Annual analysis of SPI time series showed that the study area received the intense drought during the year 1985. Geospatial technique was used to generate the SPEI drought map for the year 1985.

Endoscopy is the gold standard for the detection and staging of varices. Baveno, expanded Baveno, and Rete Sicilia Selezione Terapia–hepatitis C virus (RESIST-HCV) criteria predict varices non-invasively in patients with cirrhosis. We assessed the performance of these criteria for predicting varices needing treatment (VNT). Consecutive patients with compensated cirrhosis due to viral etiologies evaluated between January 2014 and May 2017 were included in this retrospective analysis of a prospectively maintained database. VNTs were defined as either large varies or small varices with red color signs on endoscopy. Performance characteristics to predict VNTs were estimated for the three criteria and spared endoscopy rate (SER) and missed VNT rates were determined. Two hundred and ninety-five treatment-naive cirrhosis patients, etiology hepatitis B (n = 154) or hepatitis C (n = 141), mean age 43.1 ± 13.2 years, 127 (43.1%) males were included. The median liver stiffness measurement (LSM) and platelet counts were 19.7 (interquartile range [IQR]: 14.8–28.8) kPa and 119 (IQR: 80–160) × 103/mm3, respectively. The SER and missed VNT rates were as follows—for Baveno criteria: 18.3% and 6.2%; expanded Baveno: 35.3% and 29.2%; and for RESIST-HCV criteria: 37.3% and 22.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 93.7%, 21.9%, 18.9%, and 94.7% for Baveno criteria; 70.8%, 42.3%, 19.3%, and 88.1% for expanded Baveno; and 77.1%, 44.5%, 21.3%, and 90.9% for RESIST-HCV criteria, respectively. Baveno criteria are useful to avoid screening endoscopies in patients with cirrhosis of viral etiologies. In contrast, although expanded Baveno criteria and RESIST-HCV criteria spare more endoscopies, a high missed VNT rate limits their applicability.

Perianal fistula is one of the most challenging complications of Crohn’s disease (CD). We aimed to describe treatment response with surgical and medical therapies, and long-term complications. We retrospectively analyzed records of patients with perianal fistulizing CD who were prospectively followed from January 2005 to December 2018. Among 807 patients, 81 (10%) had perianal fistula and 65 were included in the final analysis. The mean age of presentation was 27.4 ± 10.3 years, and 78.5% were males with a median duration of follow-up of 45 (IQR, 24–66) months. 75.4% (n = 49) had complex fistulae. 55.4% (n = 36) of patients received multiple courses (> 5 courses) of antibiotics. Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively. The relapse rate was highest after fistula surgery (52.6%). 44.6% of patients received medical (immunomodulators—21 and biologicals—8) whereas 46.1% received surgery as the first-line therapy. The absence of perianal abscess was associated with complete fistula closure. One patient developed malignancy and 4 (6.1%) died at the end of follow-up. Among the patients (n = 28) who received biologicals, TB reactivation occurred in one patient (3.5%). Medical therapy should be offered as first-line therapy, and immunomodulators can be considered when patients cannot afford biologicals. Surgery offers temporary improvement and is associated with high relapse rates. Absence of perianal abscess predicts long-term complete fistula closure.

Objectives The pathophysiology of SARS-Cov-2 is characterized by inflammation, immune dysregulation, coagulopathy, and endothelial dysfunction. No single therapeutic agent can target all these pathophysiologic substrates. Moreover, the current therapies are not fully effective in reducing mortality in moderate and severe disease. Hence, we aim to evaluate the combination of drugs (aspirin, atorvastatin, and nicorandil) with anti-inflammatory, antithrombotic, immunomodulatory, and vasodilator properties as adjuvant therapy in covid- 19. Trial design Single-centre, prospective, two-arm parallel design, open-label randomized control superiority trial. Participants The study will be conducted at the covid centre of Dr. Rajendra Prasad Government Medical College Tanda Kangra, Himachal Pradesh, India. All SARS-CoV-2 infected patients requiring admission to the study centre will be screened for the trial. All patients >18years who are RT-PCR/RAT positive for SARS-CoV-2 infection with pneumonia but without ARDS at presentation (presence of clinical features of dyspnoea hypoxia, fever, cough, spo2 24/minute) requiring hospital admission and consenting to participate in the trial will be included. Patients with documented significant liver disease/dysfunction (AST/ALT > 240), myopathy and rhabdomyolysis (CPK > 5x normal), allergy or intolerance to statins, allergy or intolerance to aspirin, patients taking medications with significant interaction with statins, prior statin use (within 30 days), prior aspirin use (within 30 days), history of active GI bleeding in past three months, coagulopathy, thrombocytopenia (platelet count < 100000/ dl), pregnancy, active breastfeeding, patient unable to take oral or nasogastric medications, patients in altered mental status, shock, acute renal failure, acute coronary syndrome, sepsis and ARDS at presentation will be excluded. Intervention and comparator After randomization, participants in the intervention group will receive aspirin, atorvastatin, and nicorandil (Fig. 1). Atorvastatin will be prescribed as 40 mg starting dose followed by 40 mg oral tablets once daily for ten days or till hospital discharge whichever is later. Aspirin dose will be 325 starting dose followed by 75 mg once daily for ten days or till hospital discharge whichever is later. Nicorandil will be given as 10 mg starting dose followed by 5mg twice daily ten days or till hospital discharge whichever is later. All patients in the intervention and control group will receive a standard of care for covid management as per national guidelines. All patients will receive symptomatic treatment with antipyretics, adequate hydration, anticoagulation with low molecular weight heparin, intravenous remdesivir, corticosteroids (intravenous dexamethasone for 5 days or more duration if oxygen requirement increasing or inflammatory markers are raised), and oxygen support. Patients will receive treatment for comorbid conditions as per guidelines. Main outcomes The patients will be followed up for outcomes during the hospital stay or for ten days whichever is longer. The primary outcome will be in-hospital mortality. Any progression to ARDS, shock, acute kidney injury, impaired consciousness, length of hospital stay, length of mechanical ventilation (invasive plus non-invasive) will be secondary outcomes. Changes in serum markers (CRP, D –dimer, S ferritin) will be other secondary outcomes. The safety endpoints will be hepatotoxicity (ALT/AST > 3x ULN; hyperbilirubinemia), myalgia—muscle ache, or weakness without creatine kinase (CK) elevation, myositis—muscle symptoms with increased CK levels (3-10) ULN, rhabdomyolysis—muscle symptoms with marked CK elevation (typically substantially greater than 10 times the upper limit of normal [ULN]) and with creatinine elevation (usually with brown urine and urinary myoglobin) observed during the hospital stay. Randomization Computer-generated block randomization will be used to randomize the participants in a 1:1 ratio to the active intervention group A (Aspirin, Atorvastatin, Nicorandil) plus conventional therapy and control group B conventional therapy only. Blinding (masking) The study will be an open-label trial. Numbers to be randomized (sample size) A total of 396 patients will participate in this study, which is randomly divided with 198 participants in each group. Trial status The first version of the protocol was approved by the institutional ethical committee on 1st February 2021, IEC /006/2021. The recruitment started on 8/4/2021 and will continue until 08/07/2021. A total of 281 patients have been enrolled till 21/5/2021. Trial registration The trial has been prospectively registered in Clinical Trial Registry – India (ICMR- NIMS): CTRI/2021/04/032648 [Registered on: 8 April 2021]. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol. The study protocol has been reported under the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

infection remains a worldwide spread disease with a definitemorbidity and mortality.Indeed, this infection is the main cause of non-ulcer dyspepsia, peptic ulcers and gastric tumors, including bothlow-grade MALT-lymphoma and adenocarcinoma. A 65-year-old female patient visited outpatient department of Gastroenterology clinic for a routine follow-up after completion of 14-day triple drug therapy for . After a few days of empirical treatment for raised liver enzymes, her liver enzymes normalized. Clinicians should be aware about the rare adverse event during eradication treatment.

Background: The ideal analgesic is not known for patients with acute pancreatitis (AP). Concerns have been raised about serious adverse effects of opioid analgesics increasing the severity of AP. We hypothesized that non-steroidal anti-inflammatory drugs (NSAIDs) might be better analgesics due to their anti-inflammatory effect. Our objective was to compare pentazocine, an opioid, and diclofenac, an NSAID for adequate analgesia in patients with AP. Methods: In a double-blind randomised controlled trial, patients with AP were randomised to either intravenous Diclofenac 75 mg or Pentazocine 30 mg. Fentanyl was given as a rescue analgesic through a patient controlled analgesia pump. Primary outcome was pain relief measured objectively by the dose of fentanyl required as rescue analgesic, pain-free period, and numbers of good and bad demands of fentanyl. Secondary outcome was adverse events. Findings: Fifty patients were randomised: 24 to pentazocine group and 26 to diclofenac group. Baseline characteristics were comparable between the groups. Pentazocine was found to be better than diclofenac in terms of significantly lower dose of rescue analgesic (fentanyl) required [126 μg (range 0-960 μg) vs. 225·5 μg (range 0-810 μg); p = 0·028], and longer pain-free period (31·1±8·2 hours vs. 27·9±6·6 hours, p=0·047). The number of good and bad demands was lower in the pentazocine compared with diclofenac group [11·5 (range 0-92) vs. 16 (range 0-85), p=0·098] although not statistically significant. Adverse events were similar between the groups. Interpretation: Pentazocine, a kappa opioid receptor agonist, was significantly better than Diclofenac for pain relief in AP. Clinical Trial Number: (Trial registration number: CTRI/2016/09/007326) Funding Statement: The authors state: "None," and "It was an investigator initiated study." Declaration of Interests: None of the authors have any conflict of interest. Ethics Approval Statement: The study was approved by the institutional ethics committee (IECPG 69/27·11·2015). An informed written consent was taken from the participants.

Background Bacterial vaginosis (BV), a common condition among reproductive age women is associated with an imbalance of vaginal microbiota composition. It has been implicated in numerous adverse reproductive outcomes and increased risk of sexually transmitted infections. The vaginal ecology varies widely among women from various geographic and ethnic backgrounds. Our study aimed to explore the spectrum of bacterial communities in Indian women with and without BV and the association of individual species with Amsel’s clinical diagnostic criteria. Methods 16S rRNA gene PCR and V3-V4 sequencing were performed on vaginal swabs from 38 women with BV (mean age= 30.84 years, Nugent score ≥7) and 16 healthy controls (mean age= 28.25 years, Nugent score≤3). BV was assessed by Amsel’s clinical criteria and confirmed by Nugent scoring of Gram stained vaginal smears. Taxonomic classification was performed using SILVA reference database. Results The vaginal community composition of women with BV was highly heterogeneous and characterized by species diversity and richness. Women with BV harbored high concentrations of Gardnerella vaginalis (>99% women), Atopobium spp (81.6%), Prevotella timonensis (73.7%), Sneathia amnii (73.7%) and Sneathia sanguinegens (63.2%). On the contrary, in healthy women with no evident symptoms of vaginitis, Lactobacillus species dominated the vaginal flora wherein L iners and L gasseri were the two most frequently detected species. Interestingly, L iners was noted in all women, irrespective of their BV status. The presence of Atopobium spp., Sneathia spp., P timonensis and Eggerthella spp., were strongly associated with all four clinical signs defined by Amsel’s criteria. Conclusion Lactobacillus species including L iners and L gasseri are the predominant vaginal species found in the vaginal tract of Indian women of reproductive age. A heterogeneous vaginal community marked by the presence of G vaginalis, Sneathia spp., Atopobium spp., Prevotella spp., Eggerthella spp., is associated with BV and its clinical symptoms.

The clinical spectrum of COVID-19 infection patients extends from being asymptomatic to mild, moderate and severe disease. This classification is largely based on oxygen saturation and respiratory rate. Asymptomatic/mild disease patients are managed in home isolation or COVID care centers. A subgroup of these patients will deteriorate and develop moderate to severe disease. Six-minute walk test is useful in identifying this group of patients by inducing hypoxia in normoxemia patients. This stage of the disease is labelled as 'pre-hypoxemia' phase in asymptomatic/mild disease. Identifying this stage in the course of illness of patients will help in intercepting further deterioration at the earliest by timely intervention.

Background Predicting severe acute pancreatitis (AP) is important for triage, prognosis, and designing therapeutic trials. Persistent systemic inflammatory response syndrome (SIRS) predicts severe AP but its diagnostic accuracy is suboptimal. Our objective was to study if cytokine levels could improve the predictive value of clinical variables for the development of severe AP. Methods Consecutive patients with AP were included in a prospective cohort study at a tertiary care center. Serum levels of IL-6, TNF-α, IL-10, MCP-1, GM-CSF and IL-1β were measured at day 3 of onset of AP. Variables such as age, co-morbidity, etiology, SIRS, and cytokines were modeled to predict severe AP by multivariable regression analysis. Genotyping was done to correlate IL-6, TNF-α and MCP-1 gene polymorphisms with cytokine levels. Results Of 236 patients with AP, 115 patients admitted within 7 days of onset formed the study group. 37 of the 115 (32%) patients developed organ failure. Independent predictors of organ failure were persistent SIRS (OR 34; 95% CI: 7.2–159) and day 3 serum IL-6 of >160 pg/ml (OR 16.1; 95% CI:1.8–142). IL-6 gene (−174 G/C) GG genotype was associated with significantly higher levels of IL-6 compared to CC/CG genotype. Serum IL-6 >160 pg/ml increased the positive predictive value of persistent SIRS from 56% to 85% and specificity from 64% to 95% for predicting OF without compromising its sensitivity and negative predictive value. Conclusion Serum IL-6 of >160 ng/ml added significantly to the predictive value of SIRS for severe AP.

To correlate expression of Glypican-3 in Wilms tumor with histopathology, stage, and outcome. Glypican-3 mRNA expression by real-time PCR on tumor and normal germline samples from 75 fresh nephrectomies for Wilms tumor with fold change after normalization against GAPDH was compared. Survival analysis for event-free and overall survival (EFS, OS) with 2-year follow-up for Glypican-3 overexpression (>1.5 times) and clinicopathological parameters was performed. Glypican-3 was overexpressed in 37/75 (49.3%). It was overexpressed in 77% (10/13) cases with blastema predominance or anaplastic histology, as compared to 44% of other histologies (27/62) (p = 0.03). OS was 73 and 93%, respectively (p = 0.016), for those with and without GPC-3 overexpression. EFS was not significantly different with Glypican-3 overexpression (p = 0.11). All 5 deaths among blastema predominant tumors and 4/5 deaths among triphasic tumors had overexpressed Glypican-3. Most deaths in Stage IV, Stage III, and Stage I + II (5/7, 3/3, 1/1) had GPC-3 overexpression. On multivariate analysis, only histology and stage were found to have independent prognostic value. Glypican-3 overexpression in Wilms tumor correlates with poor OS on univariate analysis. However, only histology and stage have independent prognostic value. Glypican-3 levels may help to stratify intermediate outcome histology (triphasic) and Stage III Wilms tumors.

Background: Abnormal glucose metabolic status at admission is an important marker of future cardiovascular events and long-term mortality after acute coronary syndrome (ACS), whether or not they are known diabetics. Objective: The aims were to study the prevalence of abnormal glucose metabolism in ACS patients and to compare the different methods of diagnosing diabetes in ACS patients. Methods: We did a prospective study. About 250 consecutive nondiabetic patients (200 men and 50 women) with ACS admitted to a tertiary care institute of Himachal Pradesh in 1 year were enrolled. Admission plasma glucose, next morning fasting plasma glucose (FPG), A1C, and a standardized 75-g oral glucose tolerance test (OGTT) 72 h after admission were done. Glucose metabolism was categorized as normal glucose metabolism, impaired glucose metabolism (impaired fasting glucose or impaired glucose tolerance [IGT]), and diabetes. Diabetes was arbitrarily classified further as undiagnosed (HBA1c ≥6.5%) or possibly stress diabetes (HBA1c

BACKGROUND/AIMS: The gold standard method for measurement of hepatic steatosis is liver histology. Controlled Attenuation Parameter (CAP) can measure hepatic steatosis non-invasively. We aimed to assess the accuracy of CAP for detection of hepatic steatosis. METHODS: A total of 462 patients (May 2012–January 2017)—89 non-alcoholic fatty liver disease, 182 chronic hepatitis B, 88 chronic hepatitis C and 103 patients with other etiologies who underwent simultaneous liver biopsy and CAP estimation using Transient Elastography (TE) were included. Steatosis was graded as S0: steatosis in 0–5% of hepatocytes, S1: 6–33%, S2: 34–66% and S3: 67–100%. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the accuracy of CAP in detecting hepatic steatosis. Predictors of CAP were assessed by multivariate linear regression model. RESULTS: The mean age ± SD was 33.8 ± 11.6 years; 296 (64.1%) were males. On liver histology, steatosis grades S0, S1, S2 and S3 were seen in 331 (71.6%), 74 (16.0%), 39 (8.4%) and 18 (3.9%), respectively. The median CAP (IQR) values for S0, S1, S2, and S3 steatosis were 206 (176–252) dB/m, 295 (257–331) dB/m, 320 (296–356) dB/m, and 349 (306–363) dB/m, respectively. For estimation of ≥S1, ≥S2, and ≥S3 using CAP, AUROC were 0.879, 0.893, and 0.883, respectively. In multivariate analysis, only BMI (OR 1.18; CI, 1.11–1.26, P

Summary Background Vitiligo is an autoimmune depigmentation disease, and defects in regulatory T cells (Tregs) have been proposed in the pathogenesis of generalized vitiligo (GV). However, the role of programmed cell death (PD)1+ Tregs has not been studied. Objectives To investigate the status of Tregs, PD1+ Tregs and associated parameters in active GV (aGV) during the first episode of disease attack and to establish the clinical correlation. Methods The percentages of circulating Tregs, PD1+ Tregs and CD3+CD4+PD1+ T cells were evaluated in 50 patients with aGV and 51 controls. Expression levels of FOXP3, TGFB1, CTLA4 and genes for chemokine receptors (CCR4, CCR7) and their ligands (CCL21, CCL22) were quantified in peripheral blood and in lesional, perilesional, nonlesional and normal skin sections. The corresponding proteins were immunolocalized in tissue of aGV. Results The percentage of Tregs was decreased (P = 0·001) and that of PD1+ Tregs increased (P = 0·001) in peripheral blood of patients with aGV compared with controls. The abundance of TGFB1 and CCL21 mRNA was significantly decreased in the peripheral blood of patients with aGV. Significant differences in forkhead box P3, transforming growth factor-β and CCL21 protein expression were found in skin sections. Conclusions Deficiency in Treg frequency and decreased expression of Treg-associated parameters (TGFB and CCL21) suggested a possible defect in Tregs that may alter their suppression function and skin homing in aGV. The increased PD1+ Tregs suggests that the PD1/PD ligand pathway may be involved in aGV and may have a role in Treg exhaustion. Further study is required to delineate the effect of PD1 in regulating Treg function in aGV.

Introduction Recurrent genital herpes is conventionally treated with acyclovir 200 mg 5 times a day orally which is inconvenient to take by the patients. We studied the effectiveness and safety of acyclovir 1 gm single oral dose once a day for 5 days in treatment of recurrent genital herpes. Methods Patients presenting with recurrent genital herpes were included in the study. After a complete clinical and laboratory evaluation, the patients were treated with acyclovir 1 gm single oral dose once a day for 5 days and followed up on days 5, 7 and 10 to determine the response to treatment and adverse effects. Results There were 19 patients (18 males and 1 female, between 18–47 years of age; mean age: 33.52±8.09 years), of which 18 patients completed the study. Seven (39%) of them had complete healing of the ulcer on day 5, 13 (72%) on day 7 and 16 (89%) by day 10. Mean percentage healing of ulcer was 72.53±22.24, 87.73±15.22 and 95.00±7.07 on day 5, 7 and 10 respectively. Visual analogue score (VAS) showed complete improvement in VAS in 9 (50%) patients on day 5, 13 (72.22%) on day 7 and 17 (94.5%) on day 10. The mean time of complete improvement in VAS was 6.38±2.97 days. Mean of percentage improvement in VAS was 81.92±20.87 on day 5, 90.00±15.18 on day 7 and 92.00±17.88 on day 10. Mean healing time of the lesions was 6.86±2.67 days (range 3–12 days). There were no significant adverse effects of the therapy. Conclusion The study demonstrated that oral acyclovir 1 gm once a day as single daily dose is effective and safe for the treatment of recurrent genital herpes. There was significant healing of lesions, which reduces morbidity, psychological distress and risk of transmission of infections to sexual partner. Further studies are however needed to confirm our results.

Clinicians have been facing an enormous challenge of treating infections caused by multiple drug resistant (MDR) pathogens since long. The latest and most alarming of such challenge is the emergence of New Delhi Metallo-β-Lactamase-type 1 (NDM-1) producing clinical isolates. NDM-1 is a metallo β-lactamase that confers resistance to all β-lactam antibiotics including carbapenems generally regarded as last resort to treat infections. NDM-1 is part of a huge conjugative plasmid blaNDM capable of rapid dissemination via horizontal gene transfer, transposition and recombination. Therefore, it has become a matter of global concern now as these pathogens have surpassed all geographical barriers and are threatening the public health all over the world. In addition to this, NDM-1 gene coexists with other resistance determinants such as other MBLs or porin mutations. Plasmid also carries genes conferring resistance to other antibiotic classes such as 16S RMTases, qcr, or mcr-1 gene imparting resistance to aminoglycosides, fluroquinolones and colistin respectively making current therapeutic recourse ineffective. If not addressed immediately, this resistance and its dissemination will bring us to a therapeutic dead end. In the present review, we have discussed the global spread of NDM-1 and its variants, its structural challenges that currently limit inhibitor drug designing, along with focusing some light on immediate measures that can be adapted at healthcare facilities with review of recent pharmacologic agents under research effective against NDM-1.

The aim of the study was to assess the impact of protocol biopsies in a live-related renal transplant program using tacrolimus-based immunosuppression in the short term. Eighty-three live-related transplant recipients were randomly allocated to protocol biopsy group (Group I, n = 40) and a control group (Group II, n = 43). Other immunosuppressants in these groups consisted of either mycophenolate mofetil or azathioprine and steroids. Protocol biopsies were conducted in biopsy group at 1, 6, and 12 months post-transplant. The non-biopsy group was followed by serial serum creatinine and biopsies in them were conducted as and when clinically indicated. Both groups were analyzed at 12 months with respect to graft function and survival. The two groups were similar with respect to age, number of dialysis pre-operatively, tacrolimus levels, induction therapy, donor age, and donor glomerular filtration rate. Forty protocol biopsies were conducted at 1 month, 31 at 6 months, and 26 at 12 months. The prevalence of sub-clinical rejection at 1, 6, and 12 months in these biopsies was 17.5%, 11.2%, and 10.3%, respectively. The prevalence of calcineurin inhibitor toxicity during same period was 15%, 15.5%, and 14.4%, respectively. The cumulative rejection rate in Group I and Group II at 12-month follow-up was 10.3% and 11.3% ( P = 0.78), respectively, and cumulative calcineurin inhibitor toxicity at 12 months was 14.4% and 9.3% ( P = 0.59), respectively, were not statistically significant. There was no difference in graft survival and function at 1 year. Protocol biopsies have a limited role in a well-matched renal transplant program with tacrolimus-based immunosuppression in the short term. However, the long-term impact of protocol biopsies needs further evaluation.

Summary Background Stability is considered the most important parameter before performing any melanocyte transplantation procedure in vitiligo; however, current criteria rely on the history given by the patients. Objective This study was undertaken to determine the clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo to facilitate better patient selection for melanocyte transplantation and to understand immunological mechanisms for disease activity. Methods Thirty-three patients with generalized vitiligo with 3 months but

Background Organ failure determines outcome in acute pancreatitis (AP). It is controversial if infected pancreatic necrosis (IPN) is also an independent determinant of mortality. We hypothesized that the predictors of mortality in AP might have changed with advances in management and consequent decline in mortality over the past decades. Our objective was to study the predictors of mortality in patients with AP. Methods Consecutive patients with a first episode of AP hospitalized from January 2015 to December 2016 were included in an observational study. Patients with IPN were treated with a conservative first approach followed by intervention. Necrosectomy, if required, was delayed beyond 4 weeks and done primarily employing minimally invasive techniques. The primary outcome measure was independent predictors of in-hospital mortality. Results Of 209 patients with AP, 81 (39%) had persistent organ failure (OF) and 108 (52%) developed IPN. Overall, 46/209 (22%) patients died. Independent predictors of mortality were OF (odds ratio [OR]19; 95% CI: 6.1–58.8), and IPN due to infection with multidrug resistant (MDR) organisms (OR: 8.4; 95% CI:3.1–22.5). Infected pancreatic necrosis by itself was not found to be a significant predictor of mortality (OR 2; 95% CI: 0.4–9.5). Conclusion Persistent OF and complicated IPN due to MDR infection were independent predictors of mortality in patients with AP. Renewed efforts to prevent MDR infection with antibiotic stewardship and strategies for early control of sepsis are urgently required.

Panniculitis may result due to various etiologies. In post-transplant immunosuppressed patients infection is the foremost cause of panniculitis. We present 2 cases of fungal panniculitis in renal transplant recipients. The first patient presented with non-tender firm erythematous plaques on the left thigh. Biopsy showed panniculitis with cryptococci. Subsequent investigations revealed the presence of cryptococcal antigens in the blood, urine, and bronchoalveolar lavage fluid. There was no evidence of cryptococcal meningitis. The second patient complained of subcutaneous nodules on the trunk and right thigh. Biopsy of one of the nodules showed panniculitis with histoplasma. This patient had been treated earlier (inadequately) for disseminated histoplasmosis. Both the cases responded well to conventional amphotericin B therapy. Their renal functions remained stable.

This paper focuses on the design and development of measurement technique and processing of signal for the detection of various explosive simulants like RDX(cyclo-trimethylene-tri-nitramine), TNT(Trinitro toluene), Sarin, TATP(Tri acetone triperoxide), their simulants like nitrobenzene, DNT(Dinitro toluene), DMMP(DiMethyl Methyl Phosphonate), acetone, propanol, etc. (in different states of matter) adsorbed on a metallic surface from a standoff distance ranging from few meters up to a distance of 25 meters in the wavelength range of 7-9 μm. The focus also lies on the measurement methodologies and the instrumentation employed in these systems. A dedicated single screen, single user, user friendly Graphical User Interface(GUI) for controlling the entire system, acquisition and processing of the incoming signal and demonstration of results has been developed with the help of Laboratory Virtual Instrument Engineering Workbench (LABVIEW). The dual phase sensitive detection technique has been employed. The “Data Acquisition for Explosive Detection System” (DAEDS) also carries out precise operation sequencing, parameter control, parameter measurement and storage of data. The incoming signal profile has been normalized with respect to the reference laser profile to obtain the resultant graph. Various experiments have been conducted and the resultant graphs have been plotted with intensity on the y-axis and wave-number on the x-axis as shown in the results section of this paper. Furthermore, online determination of the explosive or the simulant has been carried out. An engineering proto-type system has been developed which indicates the detected explosive/ simulant using the developed software.

This paper proposes a novel approach for obtaining a closed loop control scheme based on Fuzzy Logic Controller to regulate the output voltage waveform of multilevel inverter. Fuzzy Logic Controller is used to guide and control the inverter to synthesize a stepped output voltage waveform with reduced harmonics. In this paper, three different intelligent soft-computing methods are used to design a fuzzy system to be used as a closed loop control system for regulating the inverter output. Gravitational Search Algorithm and Genetic Algorithm are used as optimization methods to evaluate switching angles for different combination of input voltages applied to MLI. Wavelet Transform is used as synthesizing technique to shape stepped output waveform of inverter using orthogonal wavelet sets. The proposed FLC controlled method is carried out for a wider range of input dc voltages by considering ±10% variations in nominal voltage value. A 7-level inverter is used to validate the results of proposed control methods. The three proposed methods are then compared in terms of various parameters like computational time, switching angles and THD to justify the performance and system flexibility. Finally, hardware based results are also obtained to verify the viability of the proposed method. Full Text: PDF DOI: http://dx.doi.org/10.11591/ijpeds.v7.i4.pp1200-1211

Scrub Typhus, or tsutsugamushi disease is a febrile illness caused by bacteria of the family Rickettsiaceae and named Orientia tsutsugamushi. Recently it has been found to endemic in Subhimalayan region of India. Scrub typhus affects skeletal muscles, skin, lungs, kidneys, brain and cardiac muscles.We report a rare case of scrub typhus presenting as acute myocardial infarction.

Background Success of modern transplantation is in large part due to the successful development of effective immunosuppressive agents. The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus (Pan Graf, Panacea Biotec Ltd, India) has only been available in India for the last 2 years. This study was conducted to assess the safety and efficacy of tacrolimus in live related kidney transplantation. We report an initial experience of tacrolimus as de novo therapy in a live related renal transplantation program. Materials and Methods One hundred one consecutive recipients of a live renal allograft were commenced on triple immunosuppression consisting of tacrolimus, mycophenolate mofetil or azathioprine, and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10–12 ng/mL in the first 3 months, 8–10 ng/mL in the next 3 months, and 5–8 ng/mL thereafter. All patients were followed up for a period ranging from 4 weeks to 24 months. The effect of this regimen on the incidence of graft rejection, graft survival, patient survival, and new-onset diabetes mellitus was evaluated. Any evidence of graft dysfunction was evaluated using a graft biopsy. Results There were 89 male and 12 female patients with mean age of 32.08 years. The incidence of acute rejection was 3.96%; 21.05% developed new-onset diabetes mellitus. Six patients were diabetic prior to transplantation and 9 patients were hepatitis C virus (HCV)–positive; 77.7% of HCV-positive patients and 15.1% of HCV-negative patients developed posttransplantation diabetes mellitus. The patient survival rate at the current follow-up was 92.07%. No graft was lost due to rejection. Conclusion Tacrolimus is a safe and effective immunosuppressant in live related renal transplantation.

Background Recurrent genital herpes is conventionally treated with acyclovir 200 mg 5 times a day orally which is inconvenient to take. We studied the effectiveness and safety of acyclovir 1 gm twice daily orally for 3 days in treatment of genital herpes. Methods Patients presenting with recurrent genital herpes were included in the study. After a complete clinical and laboratory evaluation, the patients were treated with acyclovir 1 gm twice daily orally for 3 days and followed up on days 3, 5 and 7 to determine the response to treatment and adverse effects. Results There were 23 patients (21 males and 2 females, between 18–55 years of age), of which 22 complete the study. Nine (41%) of them had complete healing of the ulcer on day 3, whereas 17 (77%) and 20 (91%) had it by day 5 and 7 respectively. Mean percentage healing of ulcer was 77.95 ± 26.03, 90.00 ± 16.20 and 95 ± 7.07 on day 3, 5, and 7 respectively. Visual analogue score (VAS) showed complete improvement in VAS in 9 (41%) patients on day 3, 21 (95.5%) on day 5 and 22 (100%) on day 7. The mean time of complete improvement in VAS was 4.27 ± 1.16 days. Mean of percentage improvement in VAS was 80.45 ± 25.30 on day 3 and 100 ± 0.00 on day 7. Mean healing time of the lesions was 4.67 ± 1.87 days (range 3–10 days). There were no significant adverse effects of the therapy. Conclusions The study demonstrated that oral acyclovir 1 gm twice daily is effective and safe for the treatment of recurrent genital herpes. There was rapid healing of lesions, which reduces morbidity, psychological distress and risk of transmission of infections to sexual partner. Further studies are however needed to confirm our results.

Introduction. Subclinical rejection (SCR) in a normally functioning renal allograft may have an impact on long-term graft outcome. SCR detection is best done by protocol biopsies in clinically normal grafts. Methods. We evaluated 20 stable living related renal allografts with protocol biopsies on days 7 and 90 posttransplant. SCR when detected was treated with a 3-day pulse of methylprednisolone therapy. The outcomes of these grafts were compared with 63 other clinically stable renal allografts that did not undergo protocol biopsies. Results. SCR was observed in 60% of cases. The patients who received antirejection therapy for SCR based on protocol biopsies showed better graft survival and mean serum creatinine values at the end of the follow-up period.

Introduction External Anogenital warts (EGW) are associated with poor response to treatment and high recurrence rates. There is a need for development of immunotherapeutic agents for treatment of AGW. Objectives To compare efficiency and safety of IL injection of killed Mycobacterium w (Mw) Vaccine and Imiquimod cream in complete resolution of EGWs, recurrence rates, and reduction in HPV viral load. Method 89 patients (71 male and 18 female) with EGW were recruited over a period of 3 years. Patients were randomised in to two Group: Group A Patients (Male 34, Female 10) received Imiquimod cream and IL placebo injection; Group B patients (Male 37 and female 8) received Placebo cream and IL Mw injections. HPV Genotyping was done by reverse line blot hybridization by the Linear Array (Roche) and viral load was done by Real Time quantitative PCR. Results Mean percentage reduction in Imiquimod and Mw groups were 84.7% and 83.2%, respectively (P > 0.05). Overall, 59% and 66.7% of patients in Imiquimod and Mw groups respectively showed complete clearance. There was no significant difference in adverse events and recurrence rates. HPV DNA was detected in anogenital warts samples in 84 (94.38%) of 89 patients. The predominant types were HPV-6(55%), 11(41.5%) followed by HPV 16(5.6%), 18(4.4%), and others(27.5%). 22(24.7%) showed infection by multiple HPV types. Baseline HPV 6 and 11 DNA load ranges were 1.4 × 102–2.1 × 108 and 2.6 × 102–2.1 × 108 copies/mg, respectively (P value Conclusions There was no significant difference in efficacy and adverse events in both the treatments. HPV viral load declined significantly and correlated with clinical resolution. Further studies are needed to explore whether injection Mw works for patients who do not respond to topical imiquimod.

A 13-day-old neonate with a single functioning, hydronephrotic kidney developed complete pelviureteric junction (PUJ) obstruction and anuria following a diuretic radionuclide renal scan. Urgent pyeloplasty resulted in a favourable outcome. Possible dynamics of the obstruction are discussed. Monitoring urine output after diuretic renal scans, especially in infants with a single functioning kidney and PUJ obstruction, is of paramount importance.