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Background: There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes., Methods: A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded., Results: 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001)., Conclusions: Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients., (© Royal College of Physicians 2021. All rights reserved.)

Introduction: A sensitive and rapid method for quantitation of Sofosbuvir in human plasma has been established using ultra performance liquid chromatography-electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS)., Materials and Methods: Sofosbuvir d3 was used as an internal standard. Sofosbuvir and internal standard in plasma sample were extracted using ethyl acetate (liquid liquid extraction). A centrifuged upper layer was then evaporated and reconstituted with the mobile phase of 0.5% formic acid: methanol (30:70, v/v). The reconstituted samples were injected into a Gemini C18 (50×4.6mm, 5μm) column., Results: Using MS/MS in the multiple reaction monitoring mode, Sofosbuvir and Sofosbuvir d3 were detected without severe interferences from human plasma matrix. Sofosbuvir produced a protonated precursor ion ([M+H] + ) at m/z 428.35 and a corresponding product ion at m/z 279.26. The internal standard produced a protonated precursor ion ([M+H] + ) at m/z 431.38 and a corresponding product ion at m/z 282.37. The calibration curves for the analyte was linear (R 2 ≥0.9956, n=4) over the concentration range of 4.063-8000.010ng/mL. Stability studies revealed that Sofosbuvir was stable in plasma during bench top (7h at room temperature), in injector (20h), at the end of five successive freeze and thaw cycles and long term at -70°C±15°C for 15 days., Conclusion: The developed method was validated as per the guidelines of USFDA and the obtained results were found to be within the limits and could be successfully employed for the determination of Sofosbuvir in human plasma for regular and pharmacokinetic studies., (Copyright © 2017 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

One hundred and thirty five patients with gallstones along with eighty nine matched controls were studied ultrasonographically to look for any association with hyperlipidemias. Plasma cholesterol and triglycerides were estimated by colorimetric methods and lipoproteins were classified according to Beaumont's classification. Male to female ratio in gallstone patients was 1:3. Mean plasma cholesterol and triglyceride values were higher in male gallstones patients as compared to controls (166.40 +/- 54.21 vs 40.26 +/- 32.80 mg/dl, p <0.01 and 182.65 +/- 84.49 vs 133.18 +/- 52.37 mg/dl, p <0.01 respectively). In female gallstone patients, on the other hand, only plasma triglyceride levels were raised as compared to control (182.65 +/- 84.49 vs 133.18 +/- 52.32 mg/dl, p <0.01). Prevalence of type IIb and type IV was 24.32% and 29.72% in male gallstone patients and 13.2 and 39.70% respectively in female gallstone patients. Thus, more than half of our gallstone patients had hyperlipidemia, the commonest types amongst them being type IIb and type IV.

Anti-pre-S antibody was tested in 38 sera from patients with fulminant hepatitis (positive for HBsAg and/or IgM anti-HBc) using a specific solid phase enzyme linked immunosorbent assay (ELISA). Anti-pre-S activity was detected in 50 percent sera samples positive for HBsAg but negative for IgM anti-HBc. There were 12.5% sera positive for both HBsAg as well as IgM anti-HBc and 75% sera negative for HBsAg but positive for IgM anti-HBc. The prevalence of HBV-specific DNA-polymerase activity was high in all the three groups whereas anti-HBs positivity was low. Anti-pre-S activity was observed both in the presence as well as in the absence of DNA-polymerase activity. High-anti-pre-S level in fulminant hepatitis B patients was assumed to be implicated in the fast clearance of HBsAg from circulation.

A rapid, cheap, simple and specific serological test of adequate sensitivity for detecting IgG antibodies against Entamoeba histolytica antigen is described. Axenically cultured amoebic antigen was used to precoat the nitrocellulose membrane. The strips were incubated with test samples and later with horseradish peroxidase (HRPO) labelled protein-A conjugate. A dark blue spot was obtained by treatment with peroxidase substrate, 4-chloro-1-naphthol, in positive samples. Serum samples from 32 healthy controls, 45 patients with acute amoebic liver abscess and 10 asymptomatic E. histolytica cyst passers were tested. This test was positive in 93% of cases of amoebic liver abscess, 3% of healthy controls and none of the cyst passers; its sensitivity (97%) and specificity (93%) were as good as that of the ELISA test and, because it is simple, quick and cheap it is recommended as a serological test of choice for the diagnosis of invasive amoebiasis.

The anti-pre-S antibody in the samples of sera from normal healthy persons and patients with different clinical types of liver diseases due to hepatitis B virus (HBV) infection was detected by a newly established enzyme-linked immunosorbent assay technique. This test is a blocking assay where anti-pre-S antibody in the patient's serum blocks subsequent addition of horse radish peroxidase-labelled polymerized human serum albumin (pHSA) to the pHSA-receptor site of HBsAg molecules fixed on a solid surface. Anti-pre-S activity was not detected in any from 95 healthy persons who were negative for all HBV-markers or from 105 healthy HBV carriers. In 12 sera from HBV vaccine recipients, anti-pre-S activity was noted in higher proportions compared with anti-HBs, after both the second and third doses of vaccine. Anti-pre-S activity was detected in small proportions of HBsAg positive sera from acute viral hepatitis (4.2%) and chronic active hepatitis (10%). In subacute viral hepatitis patients, the anti-pre-S antibody was totally absent. However, anti-pre-S activity was recorded in high proportions of HBsAg-positive sera from patients with cirrhosis of liver (57.2%) and fulminant hepatitis (41.6%). The anti-pre-S antibodies were assumed to be implicated in the clearance of HBV particles from circulation without causing tissue damage.

Peripheral blood polymorphonuclear leucocytes (PMN) from patients with invasive amoebiasis, i.e. amoebic liver abscess (ALA) and acute amoebic dysentery, showed marked elevation of nitroblue tetrazolium dye (NBT) reduction. This dramatic change was not observed in PMN from patients with non-invasive amoebiasis, i.e. non-suppurative hepatic amoebiasis, or in asymptomatic Entamoeba histolytica cyst passers. A small number (12%) of patients with viral hepatitis displayed increased NBT reduction. 10 to 12 days after recovery following treatment, the majority (75%) of ALA patients failed to show increased NBT reduction. Our results suggest that the PMN-NBT reduction test could be useful as an aid to the diagnosis of ALA.

The mean plasma fibronectin (FN) concentrations in 30 patients with fulminant hepatic failure (FHF) and in 10 patients with subacute hepatic failure (SAHF) were 111.2 +/- 70 and 123.5 +/- 46.5 micrograms/ml, respectively, significantly lower than that of normal controls (362.0 +/- 69.2 micrograms/ml) and patients with uncomplicated viral hepatitis (320 +/- 58.5 micrograms/ml) (p less than 0.001). Plasma FN levels showed significant negative correlation with serum glutamic pyruvate transaminase values in the FHF group (p less than 0.02) and with prothrombin time in the SAHF group (p less than 0.02). Serial estimation of plasma FN showed that failure of FN levels to rise despite fresh plasma infusions indicates poor prognosis in these patients. The reduced availability of FN may be responsible for the impaired Kupffer cell function and consequent increased susceptibility to endotoxemia and the bacterial infections seen in these patients.

Fifty four blood recipients were administered prophylactic immune serum globulin (31) or hepatitis B immune globulin (23) and followed up for six months. None of the patients developed either acute hepatitis B or HBsAg carrier state. However, 7 (14%) had anicteric self limiting non-B post-transfusion hepatitis. Twenty (40%) of the blood recipients developed anti-HBs during the follow up period suggesting either HBV exposure by subdetectable levels of HBsAg present either in blood or immunoglobulin preparation or due to passive transfer by administration of immunoglobulins.

Although mental stress as well as hypercholesterolaemia have been individually linked with atherosclerosis, the relationship between mental stress and hypercholesterolaemia is poorly understood. Serum lipid profile was studied in eight male medical student volunteers before, near and after examinations. Identical observations were also made on seven well-matched control volunteers. As compared to pre-exam levels, total serum cholesterol (T-C) increased significantly (P less than 0.05) near exams, and so did low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). The HDL-C/T-C and HDL-C/LDL-C ratios remained essentially constant throughout the study. Control subjects did not show any significant change in serum lipid profile. Further serial measurement in five of the subjects revealed that examination-related changes were transient. Moreover, a second examination after about 40 days did not evoke any change in the lipid profile. The response to examination stress may be related to the enhanced utilisation of cholesterol in the adrenal cortex for steroidogenesis.

Cell-mediated immunity studies were carried out in 26 cases of amoebic liver abscess by the leucocyte migration inhibition test and in 23 cases by T-cell counting. The tests were repeated after treatment and clinical recovery in 20 and 18 cases respectively. In addition, the leucocyte migration inhibition test was performed on 20 normal healthy controls and 11 Entamoeba histolytica cyst passers, and T-cell counting was carried out on 18 normal healthy controls and nine E. histolytica passers. The results of the present study show a transient state of immunodepression which may help E. histolytica to evade the defence mechanism of the host, and thereby invade target cells and produce liver abscess. This immune response is reversed after treatment and clinical recovery.

Serological studies of hepatitis viruses A and B were carried out on 362 patients with acute viral hepatitis, 130 with fulminant hepatitis, and 56 with subacute hepatitis, and on samples of serum from 230 subjects during epidemics of viral hepatitis. A diagnosis of non-A, non-B viral hepatitis was made when serological tests showed that anti-HAV IgM and anti-HBc IgM were absent. Hepatitis virus non-A, non-B was the causative agent responsible for 58% of cases with acute viral hepatitis, 58% with fulminant hepatitis, 87% with subacute hepatitis, and 66% with epidemic hepatitis. A considerable proportion of patients (6-32%) were infected with both hepatitis virus non-A, non-B and hepatitis virus B. Viral hepatitis non-A, non-B is probably transmitted by infection of drinking-water and is the principal cause of hepatitis in India.

Buckwheat (Fagopyrum esculentum) was picked up for a study of its effects on lipid profile and glucose tolerance in view of its relatively high fibre content. In earlier studies, we demonstrated that supplementing the daily diet with 100 g whole buckwheat flour raised the high density lipoprotein cholesterol (HDL-C)/cholesterol ratio and improved glucose tolerance. In the present study, 12 human volunteers replaced part of their cereal intake at lunch by a preparation made from 100 g sieved buckwheat flour for a period of 4 weeks. At the end of 4 wk, there was a significant rise in HDL-C from 42.8 +/- 11.4 mg/100 ml to 55.2 +/- 15.3 mg/100 ml (P less than 0.05), and in HDL-C/cholesterol ratio from 26.7 +/- 7.0% to 33.8 +/- 10.2% (P less than 0.02): The other changes in lipid profile were not significant. There was also no significant change in fasting blood glucose or oral glucose tolerance in the 5 subjects on whom the test was done. Comparing the results with the observations made earlier on whole buckwheat, it is still not possible to say to what extent the effects of buckwheat on lipids may be attributed to its fibre content. The effects on glucose tolerance, on the other hand, seem to be more directly related to the fibre content.

Sera of 134 lepromatous (LL/BL) and 57 tuberculoid (TT/BT) leprosy patients were analysed for four HBV markers. HBsAg was detected in 6.71% of lepromatous and 3.5% of tuberculoid sera. The per cent positivity of lepromatous and tuberculoid sera for anti-HBs antibodies was 30.59% and 35.08%, respectively. The positivity of normal sera for HBsAg and anti-HBs was 3.60% and 21.69%, respectively. The difference in the positivity of three groups of sera (lepromatous, tuberculoid and normal) for HBsAg or anti-HBs was not statistically significant. Anti-HBc (IgM) antibodies were detected in 6% of lepromatous sera. HBV-specific DNA-polymerase activity was found in 22.22% of HBsAg positive (but anti-HBc negative) sera, and 66.66% of anti-HBc positive (but HBsAg negative) sera. The pattern of acute HBV infection in leprosy patients followed the typical pattern prevalent in the normal population.

The etiological spectrum of viral hepatitis and the prevalence of serological markers of hepatitis A and B virus infection in healthy persons in north India were studied. Hepatitis A virus was found to be the most common cause of acute hepatitis in children (67%). It was a less frequent cause of this disease in adults (14%). Hepatitis A virus was only rarely the cause of acute (12%) and subacute (4%) liver failure. It was recorded as the etiological agent in an epidemic among schoolchildren. Exposure to hepatitis A virus occurs in early childhood, and by the age of 10 years, 90% of healthy persons have serological evidence of hepatitis A virus infection.Hepatitis non-A non-B virus was the cause of acute hepatitis in 44% of adults and 24% of children with this disease. This virus was also the most important etiological agent in acute liver failure (55%) and subacute hepatic failure (51%). It was the cause of all the hepatitis epidemics in the general population.Only 9% of hepatitis cases in children were due to hepatitis B virus whereas 42% of cases in adults were attributable to this virus. Hepatitis B virus was the causative agent in 33% of cases of acute hepatic failure and 45% of cases of subacute hepatic failure. The carrier rate for hepatitis B virus was 5% and antibody to hepatitis B surface antigen was found in up to 38% of specific population groups.

Enzyme linked protein-A has been used to develop an enzyme-linked immunosorbent assay (ELISA) to detect circulating IgG antibodies to Mycobacterium tuberculosis. The specific binding of protein-A to IgG fractions through Fc receptors, makes the test more specific for detection of total IgG antibodies. The ELISA system has been used for detection of circulating antibodies to M. tuberculosis H37Ra in 22 patients with histologically proven intestinal tuberculosis and 88 healthy controls, in addition to 7 diseased controls. The ELISA has been found to be a sensitive test as it was positive in all 22 patients with intestinal tuberculosis. Its specificity was 85% in Indian controls and 97% in Norwegian controls. The test is easy to perform and may be recommended for the serological diagnosis of intestinal tuberculosis.

Fasting plasma samples from 29 patients of cirrhosis were analysed for cholesterol and triglycerides and their lipo-protein fractions. The patients included 11 alcoholic cirrhotics consuming over 130 g/day of absolute ethanol and 18 non-alcoholic cirrhotics. The difference in lipid values between the two patient groups was not significant except that VLDL cholesterol was raised in alcoholic cirrhotics (P less than 0.05). However, in comparison to normal healthy controls, the values were significantly altered. The dietary intake, in the two groups showed no difference, except that non-alcoholic cirrhotics consumed more animal proteins. Low intake of exogenous fat and reduced synthesis of endogenous cholesterol in cirrhotic patients seemed to influence the total lipid values.

Bridging necrosis was recorded in 14% of 361 patients with acute viral hepatitis on examination of the liver biopsy. The clinical and biochemical features of acute viral hepatitis with bridging necrosis were compared with acute viral hepatitis with no bridging necrosis (NBN). It was noted that fever of more than 8 days' duration in the preicteric phase, the presence of mild ascites and pedal edema during the icteric phase, increasing or persistently high levels of serum bilirubin even 4 weeks after the onset of the icteric phase and positive hepatitis-B surface antigen were significantly more common in acute viral hepatitis with bridging necrosis. Hepatitis-B surface antigen clearance was slow in this group. The long-term complication of chronic hepatitis was more frequent in patients with acute viral hepatitis with bridging necrosis.

Enzyme linked protein-A was used to develop an enzyme linked immunosorbent assay (ELISA) system for the detection of circulating antibodies to amoebic antigen. The specificity of protein-A to bind IgG only through Fc receptors, makes the test more specific for the detection of IgG antibodies to amoebic antigen. The ELISA system was used to detect amoebic antibody in control subjects (56), patients with amoebic liver abscess (79) and Entamoeba histolytica cyst-passers (10) and the results compared with those of indirect haemagglutination assay (IHA). The ELISA was more sensitive and detected 74.7% of cases with amoebic antibody in amoebic liver abscess compared with 66.7% detected by IHA. The test was more specific, sensitive and easy to perform and is recommended as a test of choice for the serological diagnosis of amoebic liver abscess.