Search

Background: Scrub typhus is an emerging public health threat in South-Asian countries; with the growing number of cases in India, an understanding of local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures. Objective: To analyze the epidemiological features- annual number of cases, age distribution, sex distribution, and seasonal distribution over the four years. To find out the clinical profile, laboratory features and outcomes of cases of scrub typhus, and to identify the predictors of disease severity. Methodology: A comprehensive retrospective review of scrub typhus cases reported over a 4-year period (2019-2023) was done, with a monthly trend of patients admitted. Data was collected from the case records of patients for demographic characteristics, clinical features, treatment, and outcomes, length of stay (LOS), complications, and mortality. Data was presented in frequencies and proportions, odds ratio (OR) was calculated and a p-value of Results: A total of 886 cases were reported over the four-years. There was a declining epidemiological trend in 2020-21 and then an increasing one. Scrub typhus cases exhibited seasonality, with a peak incidence during winter season. Males were more commonly affected (58.01%), and the age group most susceptible was 19-64 years (52.22%), followed by one-month to 18years (32.22%). Clinical presentations typically included fever (96%), eschar formation (8%) and rash (8%). Complications like pneumonia (13.88%) and AKI (11.73%), were observed in a significant proportion of cases. Mortality was reported in 4.40% of cases. Altered sensorium, deranged LFT, hypotension requiring ionotropic support, requirement of ventilatory support predicted poor outcome. Conclusion: Scrub typhus was seen to cause a multi-system infection among the studied population, causing significant morbidity and mortality. The conditions found associated with poor outcome and mortality can be used as risk factor predictors and help patient management.

Breast cancer is a diverse illness that originates from genetically modified cells in the mammary epithelium. It is characterized by complex interactions between the tumor cells and the surrounding tumor microenvironment (TME). This study examines the signaling pathways of integrins in mammary epithelial cells and mammary neoplasia by doing a thorough analysis of the current literature. Integrins are transmembrane receptors that facilitate cellular interactions with extracellular matrix (ECM) proteins, including laminin, fibronectin, and collagen. They are composed of a and ß subunits that combine to create heterodimers. These interactions play a vital role in the process of cell adhesion, migration, survival, and the maintenance of tissue integrity. The signaling pathways of Integrin-ECM, which involve focal adhesion complexes and kinases such as FAK and Src, govern cellular processes such as proliferation, differentiation, and survival. Integrins play a crucial role in the creation and upkeep of the ductal tree and alveoli during mammary gland development, which are necessary for lactation. Altered expression and signaling of integrins in breast neoplasia contribute to the advancement, invasion, and spread of tumors. Integrins participate in two-way communication, influencing the behavior of cancer cells and their interactions with the tumor microenvironment (TME), which consists of stromal and immune cells. Integrins such as avß3 and a6ß4 have important functions in cell migration, the formation of new blood vessels, and the survival of cancer cells." Comprehending the dual function of integrin signaling in both promoting and inhibiting tumors is essential for the development of precise cancer treatments. Integrin-based therapies show potential for altering these pathways, thereby enhancing cancer outcomes by suppressing tumor growth and spread. Subsequent investigations should prioritize the comprehensive examination of the regulatory mechanisms governing integrins and their potential as targets for therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives: The epidemiology of scrub typhus caused by Orientia tsutsugamushi has been growing in Odisha, India. The most common symptoms include fever, cough, lymphadenopathy, eschar, and rash. In India, enzyme-linked immunosorbent assays (ELISA) and DNA real-time polymerase chain reaction (DNA RT-PCR) are the most commonly used methods to diagnose scrub typhus. We conducted this study to determine the pattern of symptoms and association between the findings of ELISA and DNA RT-PCR., Methods: This retrospective study was accomplished at the Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, OR, IND. We analyzed the data of adult patients admitted with scrub typhus between March 2022 and February 2024, and their blood samples were evaluated with both IgM ELISA and DNA RT-PCR. The IgM antibody levels against Orientia tsutsugamushi were detected by ELISA and expressed as optical density (OD) values. The bacterial load was assessed by RT-PCR and presented as cycle threshold (CT) values. The OD values > 0.5 and CT values < 40 were deemed positive diagnoses for scrub typhus. The symptoms were weighed for their incidence and co-occurrence. We correlated the OD and CT values of the study population. The R software version 4.4.1 (R Foundation for Statistical Computing, Vienna, AUT) was utilized for data analysis., Results: Of the 231 patients scrutinized, 170 were deemed eligible. Sixty-five (38.2%) participants were female. The median age of the study subjects was 44.5 (24.0-61.8) years. All of them had fever. Other symptoms (in decreasing order of incidence) were as follows: cough (139, 81.8%), lymphadenopathy (29, 17.1%), rash (26, 15.3%), abdomen pain (18, 10.6%), eschar (6, 3.5%), and seizure (2, 1.2%). Maximum co-occurrence was observed between cough, lymphadenopathy, rash, and pain in the abdomen with fever. It held good for both females and males. The study population's median OD and CT values were 2.8 (0.8-3.7) and 41.0 (36.0-42.0), respectively. The OD and CT values were positively correlated (r = 0.78, 95% CI = 0.71-0.83, p < 0.001)., Conclusion: The study participants had symptoms like fever, cough, lymphadenopathy, rash, pain in the abdomen, and eschar. Our findings suggest that ELISA and DNA RT-PCR could be used for scrub typhus diagnosis among patients with febrile illness for > 5 and ≤ 5 days, respectively. Both diagnostic methods were found to possess a positive correlation. The findings of ELISA and DNA RT-PCR must be probed further., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Kalinga Institute of Medical Sciences (KIMS) issued approval KIIT/KIMS/IEC/1755/2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Panigrahi et al.)