Search

Introduction: Candida auris is associated with nosocomial outbreaks in intensive care settings, and transmission despite the implementation of enhanced infection prevention and control (IPC) measures is a particular concern. Objective: Isolation and identification of C. auris from suspected cases of fungal septicemia and its surveillance. Materials and Methods: Blood culture samples of all suspected cases of fungal septicemia were taken from the trauma intensive care unit (TICU) of a tertiary care hospital in New Delhi between September 2019 and November 2019 as part of surveillance of device-associated infections. All the samples were obtained by central venous catheter line. Samples were processed in BacT/Alert automated blood culture system. Positive flagged bottles were further subcultured unto blood agar, MacConkey agar, and Sabouraud Dextrose Agar with and without cycloheximide and incubated at 37°C. All suspected Candida isolates were identified by conventional methods and the suspected C. auris isolates were further confirmed by matrix-assisted laser desorption time of flight. Results: Out of 24 suspected fungal septicemia cases from TICU, three patients had C. auris septicemia and all three isolates were resistant to fluconazole and voriconazole. Action Taken: IPC practices were reinforced as per the Centers for Disease Control and Prevention guidelines by the infection control team. Conclusion: This article depicts the emergence of multidrug-resistant C. auris and controlling its spread by appropriate infection control measures.

This study investigated the potential of decolourised Moringa oleifera leaf powder (D-MOLP) in cookies to meet consumer demand for healthier food options, addressing the issue of low acceptability due to its green colour. D-MOLP and its non-decolourised counterpart (ND-MOLP) were incorporated into wheat flour to produce cookies. The results showed that neither decolourisation nor addition level (2.5 or 7.5%) significantly affected water activity or flour functionality, though slight differences in cookie colour were observed. The Moringa-enriched cookies exhibited an improved spread ratio as well as higher protein, phenolic content, antioxidant activity, and in vitro protein digestibility compared to control cookies. The detected phenolic acids included chlorogenic, ferulic, and fumaric acids, with the D-MOLP cookies showing superior nutritional properties, likely due to nutrient concentration and reduced antinutrients. Notably, glutamic acid was the major amino acid in all the cookies, but only lysine significantly increased across the cookie types. This suggests D-MOLP could be a promising alternative for food enrichment. Future research should address the consumer acceptability, volatile components, and shelf-life of D-MOLP-enriched cookies.

Background: Lycium ruthenicum is one of the high values yet lesser explored medicinal plant of trans-Himalayan region of India. The local traditional medicine system (Amchi system) has immense interest in powerful biological activity of its fruits (black Goji berries). Lycium ruthenicum used for treatment of many health problems like abnormal menstruation, vision problem, heart disease, enhance liver and kidney function, as well as nutraceutical supplements. Purpose: In this study, we aim to have investigated, the comparative analysis of phenolics content, flavonoid, tannin, anthocyanin content, antioxidant activity and chromatographic profiling (GC–MS,LC-MS) of different parts (leaf, stem and berry) extracts of Lycium ruthenicum. Methods: Total Phenolic Content, flavonoids, tannins and Anthocyanin content were spectrophotometrically measured and the antioxidant activity was investigate using DPPH (2,2-diphenyl-1-picrylhydrazyl, ABTS (2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) and reducing power assay method. Lycium potential extracts were characterized by GC–MS and LC-MS. Result: The total phenolic content, flavonoid content and tannin content of leaf and stem soxhlet extract have shown highest values (91.5 ± 3.06 mg of (GAE)/ g DFE, 484.4 ± 4.1 mg of (QR)/ g DFE, 339.0 ± 1.61(CT)/g of DFE: 167.8 ± 2.7 mg of (GAE)/ g DFE, 310.9 ± 3.93 mg of (QR)/ g DFE, 237.0 ± 4.6(CT)/g of DFE) followed by antioxidant assays, DPPH (IC50: 0.182 mg/ml and IC50: 1.152 mg/ml) and ABTS (IC50: 0.046 mg/ml and IC50: 0.015 mg/ml) and FRAP potential (147.7 ± 4.27 mg of TE/ g DFE and100.8 ± 2.9 mg of TE/ g DFE), which significantly correlates to its high content of polyphenolics and flavonoids via a GC–MS analysis. Whereas in case of fruit, ultrasonic and maceration both extracts showed the similar results. GC–MS results of leaf and stem extracts shown the presence of 69 compounds comprising steroids, terpenes, fatty acids, esters, phenolic, aldehyde, furan, and pyridines compounds. Conclusion: Quantitative analysis showed that soxhlet extracts of leaf and stem have higher contents of total phenolics and flavonoids as well as antioxidant activity as compared to other extraction methods. The present results support the Lycium ruthenicum leaf and stem extracts might be good source in healthy food supplements, pharmaceutical, and cosmetic industries.

Background: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that selectively affects the optic nerves and spinal cord and generally follows a relapsing course. Therapeutic plasma exchange (TPE) appears to be effective in patients with central nervous system inflammatory demyelinating disease who do not respond to first-line corticosteroid treatment. Objective: We represent a retrospective review of the use of TPE in the treatment of an acute attack of NMO in five patients who failed to respond to initial immunomodulatory treatment. Materials and Methods: We evaluated the effect of TPE on the degree of recovery from NMO. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics Mobile Collection System plus) by femoral or central line access and scheduled preferably on alternate-day intervals from 8 to 10 days. Both subjective and objective clinical response to TPE was estimated, and final assessment of response was made at the time of the last TPE in the series. Results: All patients were severely disabled before the initiation of TPE and they were female; with the mean age of these patients was 52.5 years (range = 36-69 years), the median age of NMO diagnosis was 49.4 years (range = 35–65 years), and the median duration of disease was 2.6 years (range = 0–5 years). Out of five patients, three had a history of bilateral optic neuritis, and all patients were anti-against protein aquaporin-4antibody positive. Totally 24 TPE procedures were performed on five patients, the mean time of start of TPE in the acute attack was 18.6 days. Patients were severely disabled at the initiation of TPE (range = expanded disability status scale 6.5–9), and improvement was observed early in the course of TPE treatment in most patients. Conclusion: The present study provides clinical support for the importance of TPE in refractory acute attack in NMO. However, with new diagnostic technologies and increasing clinical awareness, we may see a more improved ways of TPE in these patients in the future; hence, TPE is more effective modality of treatment as it also removed the antibodies.

Introduction: Multidrug resistance Staphylococcus aureus (S.aureus) is a very notorious pathogen to develop drug resistance. After methicillin, resistance to vancomycin and linezolid were being reported from various areas of the world including India which is a serious issue. Aim: To determine prevalence of Methicillin Resistant S. aureus (MRSA), Vancomycin Intermediate S. aureus (VISA) and Vancomycin Resistant S. aureus (VRSA) in a tertiary care hospital of Punjab, India. Materials and Methods: The study was conducted in a tertiary care hospital from June 2016 to May 2017. S. aureus isolated from various clinical samples were identified as per standard protocol. Antimicrobial susceptibility was done by Kirby bauer disc diffusion method. MRSA detection was done using 30 μg cefoxitin disc on Mueller Hinton Agar (MHA). Vancomycin resistance was determined by agar dilution method. Vancomycin MIC 16 μg/mL reported as VRSA. Results: Out of 162 S. aureus isolates, 85 (52.4%) were female and 77 (47.5%) were male patients. Maximum 96 (59.2%) S. aureus were isolated from pus and pus swab. An 83 (51.2%) were MRSA, 19 (11.7%) were VISA and 4 (2.46%) were VRSA. Ampicillin 130 (80.0%), ciprofloxacin 102 (62.9%), co-trimoxazole 100 (61.7%) and erythromycim 96 (59%) were most resistant whereas tigecycline 162 (100%) was most sensitive followed by linezolid 154 (95%) and tecoplanin 153 (94%). Conclusion: There is high prevalence of MRSA and an increasing MIC of vancomycin is reported in S. aureus which is big challenge for antimicrobial therapy. Performing culture and sensitivity in infectious cases in the hospital will help in reserving these drugs for those cases where all other drugs are resistant.

Background: Transfusion-transmitted infections (TTIs) are one of the biggest threats to blood transfusion safety. Nucleic acid testing (NAT) in blood donor screening has been implemented in many countries to reduce the risk of TTIs. NAT shortens this window period, thereby offering blood centers a much higher sensitivity for detecting viral infections. Aims: The objective was to assess the role of individual donor-NAT (ID-NAT) for human immunodeficiency virus-1 (HIV-1), hepatitis C virus (HCV) and hepatitis B virus (HBV) and its role in blood safety. Materials and Methods: A total of 32978 donations were tested for all three viruses using enzyme-linked immuno-sorbent assay (Vironostika ® HIV Ag-Ab, Hepanostika ® HCV ultra and hepatitis B surface antigen ultra by Biomerieux) and ID-NAT using Procleix Ultrio plus ® Assay (Novartis Diagnostic, USA). All initial NAT reactive samples and serology nonreactive were retested in triplicate and NAT discriminatory assay for HIV-1, HCV and HBV were performed. Results: Of the 32978 samples, 43 (0.13%) were found to be ID-NAT reactive but seronegative. Out of 43, one for HIV-1, 13 for HCV and 27 for HBV were reactive by discriminatory assays. There were two samples that were reactive for both HCV-HBV and counted as HCV-HBV co-infection NAT yield. The prevalence of these viruses in our sample, tested by ID-NAT is 0.06%, 0.71%, and 0.63% for HIV-1, HCV and HBV respectively. The combined NAT yield among blood donors was 1 in 753. Conclusion: ID-NAT testing for HIV-1, HCV and HBV can tremendously improve the efficacy of screening for protecting blood recipient from TTIs. It enables detection of these viruses that were undetected by serological test and thus helped in providing safe blood to the patients.

Introduction: IOTA stands for International Ovarian Tumour Analysis group. Ovarian cancer is one of the common cancers in women and is diagnosed at later stage in majority. The limiting factor for early diagnosis is lack of standardized terms and procedures in gynaecological sonography. Introduction of IOTA rules has provided some consistency in defining morphological features of ovarian masses through a standardized examination technique. Aim: To evaluate the efficacy of IOTA simple ultrasound rules in distinguishing benign and malignant ovarian tumours and establishing their use as a tool in early diagnosis of ovarian malignancy. Materials and Methods: A hospital based case control prospective study was conducted. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analysed using chi-square test and kappa statistical method. Results: Out of initial 55 patients, 50 patients were included in the final analysis who underwent surgery. IOTA simple rules were applicable in 45 out of these 50 patients (90%). The sensitivity for the detection of malignancy in cases where IOTA simple rules were applicable was 91.66% and the specificity was 84.84%. Accuracy was 86.66%. Classifying inconclusive cases as malignant, the sensitivity and specificity was 93% and 80% respectively. High level of agreement was found between USG and histopathological diagnosis with Kappa value as 0.323. Conclusion: IOTA simple ultrasound rules were highly sensitive and specific in predicting ovarian malignancy preoperatively yet being reproducible, easy to train and use.

Historically, psychotic disorder has been associated with viral infection. Herpes simplex infections and Epstein-Barr virus (EBV) among other viral infections have been implicated in psychotic disorder. Of note in this case report is psychotic disorder that occurred following reactivation of herpes simplex infection in a background of mannose-binding lecithin (MBL) deficiency, childhood EBV infection, and severe psychosocial stress. Herpes simplex encephalitis (HSE) remains a significant cause of morbidity and mortality despite advancement in its treatment with intravenous acyclovir. Many studies have reported psychiatric and neurological manifestation of herpes simplex infection following primary or reactivated infection, while others suggest milder clinical course of herpes simplex encephalitis in a background of immunosuppression. Another contributory factor to psychotic disorder in this case is childhood EBV exposure which has been reported to increase the risk of psychosis in adolescence and adulthood. This case report describes a 15-year-old female with MBL deficiency who presented with psychosis caused by reactivated herpes simplex infection and had good clinical recovery. Based on childhood Epstein-Barr virus exposure and psychosis in adolescence (current case), she is at increased risk of psychotic disorder in adulthood, which underscores the importance of long-term monitoring.

Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.

Objectives : Examination of pregnant women in the first trimester with transvaginal ultrasonography with the aim to study various fetal development markers, e.g., gestation sac, yolk sac, fetal heart motion, CRL length, and fetal anatomy in both normal and abnormal pregnancies. Comparative evaluation of transvaginal ultrasonography vis-ΰ-vis transabdominal scanning in the study of first trimester of pregnancy and its complications. To assess the relative merits and demerits of transvaginal ultrasonography in comparison with the transabdominal technique. Materials and Methods : The study will be conducted on 50 females patients during the first trimester of pregnancy. The study population will consist of both normal and abnormal pregnancies. These patients will be included on the basis of suspicion of or proven pregnancy of duration up to 12 weeks from LMP. The evaluation of the patients will include the following: Record of patients obstetrical history and clinical examination, record of pregnancy test and relevant investigations, ultrasonic examination of pregnancy. (a) Transabdominal ultrasound scanning will be done with moderately distended bladder by using real time scanners with low frequency probe (3/3.5 MHz); (b) transvaginal sonography will be done with the real-time sector scanner using high-frequency endovaginal probe (5/7.5 MHz), after the patient voids urine. Relevant images will be taken by using the multiformat automatic camera. Results and Conclusions : In the study of 46 normal intrauterine pregnancies, TVS showed additional information in 36 patients (78.3%) as compared to TAS, in detection of gestation sac, yolk sac, double bleb sign, or better visualization of embryonic anatomy. In the abnormal pregnancy (n=17), TVS provided more information in 11 cases (64.9%), which included detection of embryonic demise, yolk sac, double bleb sign, or subchorionic hemorrhage. Regarding ectopic gestations (n=7), TVS gave additional information in 5 cases (71.4%) which included detection of ectopic fetal pole, yolk sac, decidual cast, adnexal mass, and fluid in cul de sac. In two cases, both TAS and TVS gave equal information. However, in 2 cases TAS demonstrated the extent of intraabdominal fluid better than TVS. The other advantages of TVS over TAS are that there is no need for the patient to have uncomfortably full bladder and time is saved from having to wait for bladder to fill. Thus, the potential preoperative patient can be kept fasting. TVS is also superior in obese patients, in patients with retroverted uterus and it also bypasses obstacles such as bone, gas filled bowel, and extensive pelvic adhesions. The limitations encountered with TVS were limited manoveuribility of probe and because of the unorthodox position and angle of the transducer, correct orientation was difficult initially.

Background: Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. Aim: To analyze the incidence and spectrum of ATRs occuring in critically ill patients. Materials and Methods: This was a retrospective review conducted from 1st April 2011 till 31st March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. Results: During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. Conclusions: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.

A study was conducted on 100 cases of Acute abdomen admitted in surgery department of Govt Medical college and Rajendra Hospital, Patiala, India. Study group included patients with different abdominal emergencies, e.g., gastrointestinal perforation, intestinal obstruction, acute appendicitis, acute cholecystitis, pancreatitis etc. Out of these, three cases were positive for HBsAg alone, one for anti Hepatitis C-Virus (HCV) alone and one was positive for both HBsAg and anti HCV.

Pemphigus vulgaris is an autoimmune disorder that involves intraepithelial blistering and sores of skin and mucous membrane. It generally correlates with the levels of circulating autoantibodies; their removal seems a reasonable therapeutic approach. Therapeutic plasma exchange is hypothesized to remove pathogenic autoantibodies and has been used in refractory or severe cases. It may be considered for rapid control of severe or recalcitrant pemphigus vulgaris and should be combined with use of concomitant immuno-suppressive.

Thee current research focuses on two key concepts: fuzzy quasi projectivity as a generalization of fuzzy projectivity and projective dimension estimation. We also touch on the concept of μA projective modules and utilize them to characterize fuzzy quasi projective modules while examining the fuzzy characteristics of quasi projective modules. In addition, we introduce and construct a methodology and algorithm for determining the projective dimension of a fuzzy module specified in terms of possible projective resolution lengths in this paper, which is supported by suitable examples. The projective dimension of a module indicates how far it is from being a projective module. [ABSTRACT FROM AUTHOR]