Aseptic Precautions Research Articles

Finding Pathogenic Fungi in Immunocompromised Individuals in Al-Najaf City

This research aimed to explore the identification of the Phenotype and genotype of Debaryomyces species isolated from patients with diabetic foot in Al-Najaf City. Samples were collected from the depths of wounds in diabetic foot patients, ensuring aseptic precautions were taken, and then cultured on Sabouraud’s dextrose agar, followed by incubation at 30-35 °C for a duration of 5-7 days to promote growth. The identification of colonies was based on their microscopic characteristics. Subsequently, these yeasts were grown in chrome agar to isolate and identify Debaryomyces spp. A PCR technique was conducted to magnify the ITS1 and ITS4 sequences for the diagnosis of Debaryomyces spp., and the PCR products were exposed to sequencing using the Sanger method. All samples isolated were grown on SDA, and when utilizing CHROMagar differential agar. The findings indicated various molecular sizes of the ITS region for Debaryomyces spp., with the primer pair (ITS1-ITS4) targeting these ITS regions for the same sample. The products of PCR were dispatched to Macrogen Lab in the USA, where one sample of replicated products of PCR (both reverse and forward strands) was analyzed. The sequences in the current study were then matched with reference global sequences. It can be concluded that Debaryomyces species emerge as the most prevalent fungal pathogens associated with life-threatening invasive infections in highly immunocompromised individuals or those who have had major trauma and prolonged stay in the intensive care units. They occupy the fourth place as the most common agents of nosocomial-acquired bloodstream infections in hospitals.

Value of Serum MACC-1 as a New Diagnostic Biomarker in Breast Cancer Patients

Breast cancer (BC) is the leading cause of cancer-related death among females. The current study is one of the initial studies to evaluate the diagnostic value of novel serum metastasis-associated in colon cancer-1 (MACC-1) markers in BC patients. Various other serum biomarkers have been used for the diagnosis of BC but this marker proved a good sensitivity and/or specificity. This cross-sectional study included 48 BC patients (Group-I) and 48 normal healthy controls (Group-II). Study subjects demographic, pathologic, and clinical information were recorded. Random blood samples were collected from the antecubital vein after aseptic precaution with 0.5% chlorhexidine gluconate. About 4.0 mL of venous blood was collected into a red screw-capped tube. Serum MACC-1 was assessed by a double-antibody sandwich ELISA method by using the commercially available kit in the Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. In this study, serum MACC-1 levels were significantly elevated (P<0.0001) in BC patients compared to the control group. The mean serum MACC- 1 was elevated in BC patients (55.21±14.75 pg/mL) compared with healthy controls (38.19±11.42 pg/mL) (P<0.0001). Also, the receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.98, signifying a good discriminatory ability of serum MACC-1 marker for BC patients. At the cut-off value of optimal cut-off value (38.35 pg/mL), the sensitivity and the specificity of serum MACC-1 were 96.7% and 92.5%, respectively. The median age was 46.3 years in BC patients and 40.2±8.4 years in the control group (P<0.0001). Therefore, this study showed that serum MACC-1 can be a potential biomarker for the diagnosis of BC. J. of Sci. and Tech. Res. 6(1): 169-174, 2024

Challenging PPIUCD Removal: A Case of Hysteroscopic Extraction from the Uterine Fundus

Intrauterine contraceptive devices offer reliable and reversible contraception. However, there are still challenges that persist in their management, particularly regarding deeply embedded PPIUCDs (Post-Partum Intrauterine Contraceptive Devices). We present a case study of a 30-year-old woman who had two caesarean deliveries and sought PPIUCD removal to plan a future pregnancy. On speculum evaluation, the threads of the device were undetectable with no abnormal health symptoms. Subsequent ultrasound analysis confirmed the presence of PPIUCD, positioned obliquely within the uterine cavity. The first removal attempt under aseptic precautions with an IUCD hook was unsuccessful. The second attempt was guided by ultrasound and hysteroscopy, which successfully eliminated the IUCD. The case highlights the intricate challenges in managing PPIUCDs and emphasizes the importance of proactive management strategies. By integrating advanced techniques like hysteroscopy, healthcare providers can navigate these challenges effectively, enhancing patient care and satisfaction. Intrauterine contraceptive devices have become a reliable and convenient method of birth control due to their high effectiveness and reversibility. Long-acting contraceptives provide reliable and lasting protection against unintended pregnancy, making them a popular choice for individuals looking for a hassle-free contraception method. The PPIUCD technique involves implanting an IUCD within 48 hours following either vaginal delivery or caesarean surgery to block sperm survival and prevent endometrial foreign body reactions.[1] The acceptability rate for PPIUCD implantation is 36.25%.[2] The placement of the PPIUCD is preferable since it does not interfere with breastfeeding.[3] The prevalence of modern contraceptives among married women who have reached reproductive age has gradually increased globally, rising from 55.0% in 2000 to 57.1% in 2019.[4] According to the recent India National Family Health Survey, the contraception prevalence rate among currently married women under 15 to 49 increased from 54% in 2015-16 to 67% in 2019-21. Intrauterine devices comprise only 2.1% of all contraceptive techniques used in family planning. However, all government facilities offer free IUCD services.[5] Complications like bleeding, pain, infection, perforation, and expulsion contribute to 20–40% discontinuation rates.[6] Younger women using IUDs are more likely to experience adverse effects than older women.[7] The limited progress was attributed to factors such as the low quality of services offered, restricted access, and misconceptions about techniques held by providers and users. Despite their effectiveness, IUDs can lead to potential complications. One such issue is the occurrence of lost or embedded IUDs, which are rarely observed, with approximately 1-2 cases per 1000 insertions.[8] This case report illustrates the difficulties encountered in removing embedded IUDs and underscores the significance of exploring alternative techniques to manage challenging cases safely and effectively.

Management of Charmakeela by Viddha Karma followed by Arka Ksheeradi Lepa externally and Vidanga Churna orally

Introduction: Charmakeela is one of the most common skin disorders affecting the children and teenage group by and large. It can be correlated to warts according to modern science owing to signs and symptoms. The incidence rate of EGW (extra genital warts) =10% Approx. Globally, 2-25% approx. India. The Incubation period of warts is around 90 days and the high recurrence rate in various modern treatment modalities. Aim: To evaluate the efficacy of Viddha Karma followed by Teekshna, Lekhana, Ropana, Krimighna properties of Arka Ksheera and Haridra Churna externally and Vidanga Churna Orally. Objectives: To arrive at a cost effective result oriented medication with least recurrence. Materials and Methods: A lean built Female patient, presenting with multiple warts on both the palms was selected from T.M.A.E’S AMC Hospital, Hospet. The patient was treated with Vidanga Churna (0-0-5mg) with hot water bed time and with aseptic precautions a 2ml syringe needle was taken and random pricks were made on the surface and surrounding the warts. This was followed by application of Arka Ksheera mixed with Haridra Lepa and was bandaged. The procedure was repeated once a week for 5 weeks. Results: A significant reduction in the size and other symptoms of warts was seen by 2 weeks and by the end of 5weeks the palms were completely clear and appeared normal. After a regular follow upto 8 weeks with oral medication alone no recurrence was noticed. Conclusion: The treatment was successful in warding off recurrence and effectively curing all warts with economical, noninvasive technique.

Bilateral Anti-VEGF on Same-Day-Investigation on Safety in Retinopathy of Prematurity: A Multicenter Retrospective Study

PurposeTo report incidence of procedure related complications in preterm infants with ROP treated with intravitreal anti vascular endothelial growth factors (anti VEGF) injection in both eyes on same day DesignRetrospective, multicenter case series SubjectsPreterm infants with ROP treated with anti VEGF bilaterally on same day MethodsIntervention: All included infants underwent intravitreal anti VEGF injection in both eyes under aseptic precautions in ophthalmic operation theatre (OT) or neonatal intensive care unit (NICU). Postoperative examination was performed to look for procedure related complications Main Outcome MeasuresIncidence of procedure related complication (Presumed endophthalmitis, intraocular inflammation, lens injury, vitreous hemorrhage, retinal tear) in the study cohort. To study association of indication, type of anti VEGF, type of needle used, setting of procedure, site of injection (distance from limbus) and experience of the treating ophthalmologist with the complications. Results9984 eyes of 4992 infants were analysed. The procedure was most commonly performed in ophthalmic OT (8258, 82.7%) using 29G (4514, 45.2%) needle between 1-1.5 mm (9984, 100%) from limbus. Aggressive retinopathy of prematurity was the most common indication for anti VEGF use (4866, 48.7%) while Bevacizumab was the most commonly used anti VEGF agent (8642, 86.6%). Overall, 26 eyes (0.3%) had procedure related complications. Lens injury (15, 0.15%) and presumed endophthalmitis (7, 0.07%) were most common complications. One eye had culture proven endophthalmitis with Pseudomonas aeruginosa. No case of bilateral endophthalmitis was noted. Endophthalmitis was not associated with setting of procedure or type of anti VEGF used, while risk of lens injury was seven times higher when performed in NICU and 30 times higher when performed by an ophthalmologist with < 1year of experience in injecting anti VEGF in preterm infants. ConclusionsThe incidence of presumed endophthalmitis after bilateral same day anti VEGF in infants with ROP is 0.07%. These infants can be treated in both eyes on same day with the anti VEGFs and needles (29-32G) evaluated in this study, with emphasis on the direction of needle parallel to visual axis. Extra precaution is advocated if the procedure is planned in NICU or by an ophthalmologist with limited experience.

A longitudinal observational study on activated partial thromboplastin time in hypothyroidism and effect of thyroxine supplementation

Background: Hypothyroidism is a common condition characterized by thyroid hormone deficiency, which, if untreated, can lead to severe health consequences and even death. Due to the wide range of clinical presentations and non-specific symptoms, hypothyroidism is primarily diagnosed biochemically. It can result from congenital thyroid abnormalities or iodine deficiency. Aims and objectives: Aim: To evaluate the correlation between hypothyroidism and Activated Partial Thromboplastin Time (aPTT) and assess the effect of thyroxine supplementation. Objective: To study the impact of levothyroxine supplementation on aPTT in hypothyroid patients. Materials and methods: This observational study was conducted at the General Medicine outpatient clinic and inpatient wards at Al-Ameen Medical College and Hospital, Vijayapura, from September 2022 to March 2024. A total of 80 hypothyroid patients of both sexes were included. TSH, Free T4, and aPTT levels were measured with appropriate aseptic precautions. Results: The majority of subjects were females (90%), with the highest proportion (31.3%) aged 26-35 years. The mean ± SD of pre-thyroxine TSH was 25.453 ± 19.9073, which significantly decreased to 4.299 ± 0.6738 post-thyroxine. aPTT values also decreased significantly post-treatment. A positive correlation was found between TSH and aPTT, while aPTT had a negative correlation with T3 and T4 levels. Conclusion: aPTT is significantly elevated in hypothyroid patients and shows a positive correlation with TSH levels. Regular monitoring of aPTT should be included in the follow-up of hypothyroid patients.

Performing minor glaucoma interventions on the slit lamp

Background: Complications are frequently encountered after glaucoma surgeries, for which timely intervention is necessary. Many of these interventions, like bleb needling, tube repositioning, anterior chamber (AC) reformation, paracentesis, and hyphema drainage, are fairly simple, but can often be vision saving. However, waiting for operation theater availability for these minor procedures can be a risky decision. Hence, techniques for performing these procedures on a slit lamp should be part of every glaucoma surgeon’s armamentarium. Purpose: This video is meant to introduce the viewers to simple techniques for performing minor procedures, enabling management on a slit lamp. The need to know a simple yet effective way to perform these procedures cannot be overemphasized. Synopsis: This video demonstrates, in the specified order, techniques for AC paracentesis, AC reformation, Ahmed glaucoma valve tube repositioning, iris repositioning, bleb needling and hyphema drainage. Utmost aseptic precautions must be taken before performing these procedures on the slit lamp, especially in cases where the 26G needle enters AC. This includes the use of a sterile air filter, donning sterilized gloves, and using its sterile wrapper to place the 2 ml syringe being used. Use of betadine eye drops before the procedure and a week-long course of topical antibiotics after these procedures is recommended. Highlights: This video demonstrates simple techniques for performing useful procedures on the slit lamp, an effective tool for managing postoperative complications. Video link: https://youtu.be/35sOVm7rxEc

Perioperative outcomes of 105 cases of ABO-incompatible live donor kidney transplantation: a retrospective single-center observational study.

ABO-incompatible (ABOi) kidney transplantation poses significant challenges in achieving successful outcomes. This study aimed to investigate the impact of various interventions and techniques on improving the success rates of ABOi kidney transplantation. We conducted a retrospective observational analysis of patients who underwent ABOi kidney transplantation from November 2012 to March 2023. The study included a total of 105 patients. We collected and analyzed data on patient demographics, preoperative assessments, surgical details, and postoperative outcomes. The mean ages of the donors and recipients were 50.52±10.32 and 36.63±11.61 years, respectively. The majority of recipients were male (81.9%), while most donors were female (89.5%). The most common blood group among recipients was O (69.5%), and among donors, it was B (46.7%). The median durations of chronic kidney disease and dialysis were 12 months (interquartile range [IQR], 7-28 months) and 6 months (IQR, 2-12 months), respectively. Baseline antibody titers (anti-A and anti-B) ranged from 64.0 to 256.0, while on the day of surgery, they were ≤8. Perioperative complications included hypotension (10.5%), acute tubular necrosis (5.7%), delayed graft function (3.8%), and reexploration (3.8%) due to hematoma. ABOi kidney transplantation is a viable option for recipients lacking available donors with an ABO-compatible match. Perioperative concerns, including hypoalbuminemia, heightened risk of infections, coagulopathies, aseptic precautions, and immunological surveillance, must be carefully addressed.

Wrong site but intact sight

Orbital foreign bodies are common. A large metallic foreign body involving ipsilateral orbit into the maxillary sinus is potentially vision-threatening. This case report describes a potentially serious incident involving a 49-year-old man who presented with an injury to his right eye with an iron nail while working in a factory. An iron nail penetrating the infraorbital margin of the right eye extended into the maxillary sinus associated with periorbital edema. X-ray showed a metallic foreign body extending from the right eye infraorbital margin into the maxillary sinus. Under local anesthesia, under all aseptic precautions, a linear iron nail measuring 4.5 cm in length was removed from the right orbit without any evidence of damage to vital structures. This case represents one of the largest reported infraorbital metallic (iron nail) foreign bodies, highlighting its rarity and potential danger to vision and overall health.

HIV Sero-Prevalence among Tuberculosis Patients in Bangladesh: a nationwide cross-sectional study

Introduction Bangladesh is committed to achieving the SDG target of ending the tuberculosis epidemic and achieving UHC by 2030. To inform policy and program decision-making, this nationwide sero-survey of HIV among tuberculosis patients was conducted. Methods The cross-sectional survey utilized a two-stage probability proportional to size (PPS) systematic random sampling technique for selected TB reporting centers (TRCs) from June 2020 to December 2021. The estimated 12,065 diagnosed tuberculosis patients, according to the NTP diagnostic algorithm, irrespective of age and sex, were included. The required information was collected through face-to-face interviews and record reviews using a pre-tested electronic TAB-based semi-structured questionnaire. With all aseptic precautions for all respondents who gave consent, 5 ml. venous blood was collected for the standard confirmatory test by 4th generation ELISA method for detection of antibody of HIV1/2/P24 antigen. Results Out of 12,065 TB patients surveyed, most of them were from the Dhaka division (25%), urban (76%), 55 years and above (28%), male (56%), married (82%), illiterate (36%) and living in a nuclear family (70%). A total of 12 (0.1%) HIV-positive cases were found among TB patients across the country, and the majority (33%) of them belonged to the age group of 35 to 44 years, male (58%), lower educational group (67%), urban resident (67%), and from nuclear family (77%). The HIV-positive patients found more among pulmonary TB patients (83%) who were detected bacteriologically positive (58%) but smear and gene expert negative (75%). Among them, none was found to have progressed to drug-resistant TB. Conclusion HIV affects the immune system, and TB is one of the leading causes of death in HIV-infected people. Although the rate is low, there is a need for continued efforts to prevent and treat TB in Bangladesh, particularly among older age groups, urban residents, and those with co-morbidities such as diabetes.

Study of C-reactive Protein Levels in Hypertensive Disorders of Pregnancy.

Introduction Globally, one of the main causes of maternal and perinatal deaths is hypertensive disorders of pregnancy (HDP). Preeclampsia is a pregnancy-specific syndrome characterized by high blood pressure and proteinuria after 20-week gestation. Women who develop preeclampsia are at increased risk for the development of many systemic complications. Materialsandmethods A cross-sectional study was conducted in the Department of Biochemistry, SHKM, Nuh, Haryana in collaboration with the Department of Obstetrics & Gynecology. 200 study subjects; Group 1: cases - 100 HDP, Group 2: controls - 100 age-matched normotensive pregnant women. The specimen of 3 mL venous blood was collected under aseptic precautions. The data was evaluated using statistical evaluation tools. Result Out of 200 subjects, mean C-reactive protein (CRP) levels were normal in three cases and 35 controls. Minor elevation of CRP was observed in 11 cases and 29 controls (very significant). Moderate elevation of CRP was observed in 61 cases and 36 controls (highly significant). Marked elevation of CRP was observed in 25 cases. Mean CRP levels increased from preeclampsia without severe features (3.9 mg/dL), preeclampsia with severe features (5.2 mg/dL), and eclampsia (12.7 mg/dL) when compared with the respective control group (1.1 mg/dL, 1.16 mg/dL, and 1.2 mg/dL). Conclusion There is a highly significant association between CRP levels and HDP. Additionally, one useful indicator of the severity of preeclampsia is CRP, a measure ofsystemic inflammation. Elevated CRP levels in mild PE can be used as an indicator of the progress of the disease and early prevention can be done.

Acute febrile illness in pregnancy: Spectrum of disease and impact on maternal and foetal outcome.

Acute febrile illness (AFI) in pregnancy is a neglected cause of maternal and foetal mortality and morbidity in low-and middle-income countries. This prospective cohort studied antenatal and postpartum women admitted with acute fever to a tertiary care university teaching hospital from July 2014 to March 2015 for aetiology, maternal and foetal complications, and the impact on maternal mortality ratio (MMR) and perinatal mortality rate. Among the 180 women admitted with AFI, urinary tract infection 54(30%) was the commonest cause, followed by airborne infections (67; 37.2%), peripartum or wound infections (25; 13.8%) and vector-borne diseases (21; 11.6%). Maternal deaths were 4 (2%) and foetal deaths 9 (5%). Post-operative gram-negative sepsis was the most common cause of maternal mortality. The MMR was ten times higher with AFI 2778 against 197 (p < 0.0001) among the other hospital deliveries during the same period. Screening for asymptomatic bacteriuria , maintaining aseptic precautions, and vaccination may impact maternal and foetal morbidity significantly.

Bacteriological profile of bloodstream infections in pediatric age group in a tertiary care centre, Solapur

Bloodstream infections (BSI) due to multidrug-resistant organisms from paediatric setup have become increasingly common. BSI can be transient and be rapidly cleared out by the host defence mechanism or be associated with high morbidity and mortality if it becomes persistent.Blood samples were collected from 1112 children within a 1-year study period (July 2022 to June 2023) which included all children admitted with complaint of fever and suspected of having sepsis in Paediatric department of Shri Chhatrapati Shivaji Maharaj Sarvopchar Rugnalaya (SCSMSR), Solapur. Blood volume was collected depending upon age and body weight of the patient with aseptic precautions and inoculated in Brain Heart Infusion broth (BHI) which was incubated at 37°C for 7 days. Subcultures were made on blood agar and MacConkey agar plates. Organisms were identified by biochemical reactions and antibiotic susceptibility test of the isolates were performed by disk diffusion. Out of 1112 suspected cases, 175 (15.74%) were culture positive. (27.43%) was the most common isolate followed by (16.57%) Most common Gram positive isolate was (11.43%) followed by (6.86%). Total Multidrug resistant (MDR) isolates in Gram negative and Gram positive were 50.35% and 31.25% respectively.High rates of antibiotic resistance are observed in both gram positive and gram negative organisms. Thus, there is an urgent need for proper implementation of antibiotic stewardship programme and infection prevention and control measures.

Intraoperative thoracic interfascial plane block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia after modified radical mastectomy: A randomised controlled double-blinded trial.

Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain. After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18-60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U-test. Qualitative data were analysed using Chi-square/Fisher's exact test. Statistical significance was kept at P < 0.05. The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6-8] h in Group L and 18 (IQR: 16-20) h in Group DL (W = 17.000, P < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL. Adding 0.5 μg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.

Beyond the Needle: Unmasking Atypical Mycobacteria in Postvaccination Abscesses in Children.

Atypical or nontuberculous mycobacteria (NTM) are an environmental organism responsible for opportunistic infection. Rapid-growing NTM are more commonly associated with hospital-acquired infections. Many of the organisms responsible for diseases in immunocompromised patients and hospital-acquired infections originate from tap water, such as Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium gordonae, Mycobacterium simiae, Mycobacterium mucogenicum, Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus. NTM is a rare organism responsible for the injection abscess. Considering low incidents, not much clinical data are available for this condition. Here, we discuss such cases which can be helpful to spread awareness and provide data for future policy makers. This was a retrospective study. Data on patients with injection abscess were collected from the last 6 years. Detailed history and clinical examination findings were analyzed. Children with injection abscess were operated and their further management and outcome were studied. A total of 13 cases with confirmed culture of NTM were treated over 6 years. The age ranged from 2½ months to 5¾ years with male:female ratio of 7:6. All patients hailed from the same geographical area. All children were healthy with no history of any long-term or chronic illness, without additional symptoms and had received Bacillus Calmette-Guérin vaccination at birth. The total duration of illness varied from 1 to 5 months, with a mean of 3 months. All patients had a history of intramuscular age-appropriate vaccination as per the national immunization schedule. All patients were followed up to 6 months after intervention and none of our patients developed relapse. Patient who does not respond with optimum treatment should have a high suspicion of such opportunistic infection, which is crucial to their management. Hospital-acquired NTM infections often result from contaminated instruments or fluids. Adherence to strict aseptic precautions, hand hygiene and environmental precautions are the key to preventing these infections. In case of skin and soft tissue infections / abscesses, surgical intervention plays a significant role for managing the patient.

Assessment of interleukin-18 gene polymorphism and serum levels in cutaneous lichen planus

BackgroundLichen planus (LP) is a chronic inflammatory disease with uncertain etiology. Interleukin-18 (IL-18) is an interferon gamma (INFγ) inducing agent. It is a pro-inflammatory cytokine that was found to play a role in the pathogenesis of some autoimmune disorders.Material and methodsThis study included 50 patients with classic cutaneous lichen planus (CLP) and 50 healthy volunteers serving as controls. Venous blood samples were withdrawn from the study subjects under complete aseptic precautions. Blood samples were examined for single nucleotide polymorphisms (SNPs) of IL-18 gene at promoter -137(G/C) and -656 (G/T) using polymerase chain reaction (PCR) and IL-18 level was assessed using enzyme linked immunosorbent assay (ELISA).ResultsThe mean level of IL-18 was significantly higher in CLP patients (31.63 ± 4.90) compared to control subjects (13.95 ± 6.82). Significantly high levels of IL-18 were found among patients with diabetes, hypertension (p < 0.01 in both). HCV positive patients and patients with both OLP and CLP also expressed higher levels of IL-18. Genotypic and allelic distribution at position -137(G/C) showed that the genotype GG was present at significantly higher frequency in cases (58%) compared to controls (28.0%). On the other hand the CC genotype at position -137 was significantly higher in the controls (28%) as compared to CLP cases (6%). Polymorphism of IL-18 at position -656(G/T) showed no significant difference between cases and controls. No significant difference could be detected in IL-18 level between different genotypic variants at position -137(G/C) and -656(G/T).ConclusionIL-18 may play important role in pathogenesis of LP. Elevated IL-18 levels could be part of the pro-inflammatory autoimmune process in LP. The presence of OLP, HCV, diabetes and hypertension is associated with higher production of IL-18. IL-18 promotor region -137(G/C) polymorphism might be a factor that increase the risk of development of lichen planus in Egyptian patients.

#2491 Survival outcome of tunneled and non-tunneled hemodialysis catheters in incident hemodialysis requiring patients: a short term study

Abstract Background and Aims For long term hemodialysis, tunnel catheters are preferred over non –tunneled as vascular access. High cost and expertise in its catheterization are major limitations. It is unclear about the advantage of low cost non- tunneled catheter preference over costly tunnel catheters as short term access while awaiting AVF maturation. Method All consented incident End Stage Kidney Disease (ESKD) patients requiring hemodialysis from March’ 2021 to October’ 2023 were included. Less than 18 years of age, opting for peritoneal dialysis and patients initiating hemodialysis with AVF or AV Graft were excluded from the study. Subjects were randomized in two catheter groups (Tunneled and Non-tunneled). Under aseptic precautions, all catheters were inserted by ultrasound and C-arm guided following standard protocol. Mechanical, infective and catheter survival outcomes were recorded during dialysis initiation, at 2nd, 6th and 12th weeks. Blood culture samples were sent for those patients who were having fever with chills during dialysis. If the blood culture comes out to be positive for organism, all were treated for one week intravenous antibiotic depending upon the sensitivity or as per standard protocol. Catheter salvage in both the groups was tried till 6 weeks or till AVF maturation. If in any case, AVF is not matured, we continued dialysis with the same catheter. New catheter was inserted if patient do not respond antibiotics after one week of therapy, mechanical complications or due to inadequate flow. Adequacy of the dialysis and overall outcome of patients were monitored in both the groups of catheter. All demography data and survival analysis were analyzed. Results A total 133 patients were randomized into Tunneled-65 (48.87%) and non-tunneled-68 (51.12%). Average patient's age of tunneled and non-tunneled was 45.15 ± 15.89 and 40.39 ± 12.21 respectively. A total of 50 (37.3%) were males in tunneled and 54 (40.3%) males in non tunneled groups. A total 65 (54.2%) patients were complained fever with chills during dialysis, of them 31 (25.8%) in tunneled and 34 (28.3%) in non-tunneled group. Among the CRBSI group a total 3 catheters were removed in non-tunneled group whereas all patients in tunneled group were responded to antibiotic. There were total of 24 (18.2%) infections were reported and labelled as CRBSI. Of them 9 (6.7%) in tunneled and 15 (11.2%) in non-tunneled. Most common organism was Klebsiella and Coagulase negative Staphylococcus (Cons) in both the groups. There was only one mechanical complication in case of non- tunneled catheter. The estimated days for catheter survival is 66 for tunneled and 57 for non tunneled (p-0.001). However, in case of non tunneled catheter, 15 cases were reported in which two times catheter were inserted. A total of 14 (10.5%) patients were lost to follow up 8 (6%) in tunneled and 6 (4.5%) in non- tunneled. A total of 9 (5.8%) patients died, 5 (3.8%) in tunneled and 4 (3%) in non- tunneled within 12 weeks. Conclusion Although tunneled catheter showed longer catheter survival period, low cost and easy cannulation procedure in non-tunneled hemodialysis catheter is a better viable option for all incident ESKD patients while waiting for AVF maturation.

The Pattern of Bacterial Infections Among Chronic Suppurative Otitis Media Cases at a Tertiary Care Centre in North-East India.

Chronic suppurative otitis media (CSOM) is a chronic inflammation of the mucoperiosteal lining of the middle ear cleft, presenting with recurrent ear discharge through a tympanic membrane perforation. The present study aims to assess the spectrum of bacterial infection among CSOM cases and detect the isolated organism's antibiotic sensitivity pattern. The prospective hospital-based observational study was conducted from June 2021 to June 2022 and included 94 CSOM cases. An aural swab of the ear discharge was collected from each patient under aseptic precautions. The swab was utilized for Gram's staining and the aerobic bacterial pathogen culture. The organisms isolated were tested for antibiotic sensitivity using the Kirby-Bauer disc diffusion method. The most affected age group was the second decade of life (27.7%, n=26), with a male-to-female ratio of 1.35:1. The mean duration of ear discharge was 24.0±14.7 months, mostly mucoid ear discharge (39.4%, n=37). Among gram-positive bacteria, methicillin-resistant Staphylococcus aureus was isolated in 16 (17.0%) cases. Pseudomonas aeruginosa was the most isolated gram-negative bacteria strain in 26 (27.7%) cases. Cotrimoxazole (67.7%, n=21) had the highest sensitivity towards gram-positive bacteria isolates. Amongst gram-negative bacteria, amikacin and ciprofloxacin were the most sensitive, with 78.0% (n=39) susceptibility. Evaluating the spectrum of infecting organisms of CSOM and their antibiotic sensitivity may help initiate prompt treatment with the appropriate antibiotic regimen, thereby preventing future complications.

THORACIC SEGMENTAL SPINAL ANAESTHESIA IN UPPER ABDOMINAL SURGERIES AND SIMPLE MASTECTOMY-A CASE SERIES

Objective: To observe safety and efficacy of Segmental thoracic spinal anesthesia (STSA) in upper abdominal and breast surgeries. Methods: 14 cases were selected, out of which 6 laparoscopic cholecystectomy (LC), 4 open cholecystectomy (OC), 3 emergency exploratory laparotomy and 1 simple mastectomy. Under full aseptic precaution, segmental thoracic spinal anesthesia was administered through midline approach in T8-9 space for upper abdominal surgeries and T5-6 space in a simple mastectomy. Using 25G Quincke spinal needle 1.5 ml [7.5 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl was given in abdominal surgeries and 1.2 ml [6 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl in simple mastectomy. Results: Age group of patients ranged from 25 to 65 y, Male: Female ratio of 4:10, Body Mass Index (BMI) range of 22 to 24.9 with physiological status of ASA I to ASA III. Hemodynamically, hypotension was observed in every patient after 5-10 min of STSA well managed with fluid and vasopressors with no bradycardia. Average width of sensory block was T3 to L1-2 in upper abdominal surgeries and T1 to T8 in a simple mastectomy. Motor block was Modified Bromage Scale (MBS) of 0 to 1 during and postoperatively. Regarding analgesia, Visual Analogue Scale (VAS) score was 0 intraoperatively and 0-1 postoperatively. Sedation score was 2 both intraoperatively and postoperatively with no significant complications and good patient and surgeon satisfaction. Conclusion: Segmental thoracic spinal anaesthesia is a safe and effective procedure with good patient and surgeon satisfaction.

Immunogenicity of Covishield vaccine in patients with autoimmune rheumatic diseases.

The Coronavirus disease 2019 (COVID-19) pandemic has been the biggest threat to humankind during the last 3 years. It has caused the loss of more than 6.9 million precious lives across the world. The only method by which the massacre could be stopped was by mass vaccination or mass immunization. The patients suffering from autoimmune rheumatic disorders (AIRDs) and treated with immunosuppressants were the high-priority candidates for vaccination. However, the data regarding the efficacy of COVID-19 vaccines in this group of patients are very less. Hence, this study was planned to study the immunogenicity of Covishield in patients with AIRDs attending the rheumatology OPD at DMCH, Ludhiana. It was a prospective cohort study and was planned by the Department of Biochemistry and Department of Clinical Immunology and Rheumatology at Dayanand Medical College and Hospital, Ludhiana. Fifty patients with AIRDs attending the DMCH rheumatology OPD and 52 age and sex-matched healthy controls who had received two doses of Covishield vaccine were included in this study. Patients having any other immunosuppressive conditions like uncontrolled diabetes, hepatitis, malignancy or HIV were excluded. Patients who had suffered from previous laboratory-confirmed COVID-19 infection (by RT-PCR) were also excluded. Blood samples were collected following all aseptic precautions from patients and controls on the 28th day after administration of a second dose of Covishield vaccine and total antibodies to the severe acute respiratory syndrome coronavirus 2 spike (S) protein receptor binding domain was measured using Elecsys Anti-SARS-CoV-2 S kit from Roche. It was observed that no significant difference was there in antibody titre between cases and controls (6213 ± 4418 vs. 8331 ± 7979, P = 0.1022). It was also observed that no statistically significant difference in antibody titre in cases without prednisolone and those taking treatment with prednisolone was found (P = 0.7058). A similar observation was found in terms of methotrexate also (P = 0.457). No significant difference in antibody titres was there when compared with controls (for prednisolone, P = 0.169, for methotrexate, P = 0.078). We found that only the patients receiving mycophenolate mofetil showed a statistically significant decrease in antibody titre in comparison to healthy controls (P = 0.03). Our study showed no statistically significant difference in antibody titres between patients suffering from different AIRDs. Our study supplements the fact that patients with AIRDs in India can receive Covishield as the primary vaccine against COVID-19 without concerns regarding decreased immunogenicity or increased adverse effects.