Ve Cases Research Articles

Cytological, Bacteriological and Antibiogram Studies for the Management of Uterine Infection in Repeat Breeder Bovines

Background: Repeat breeding syndrome (RBS) associated with sub-clinical uterine infection (UI) remains to be a major reproductive problem faced by Indian farmers. Present study documents its diagnosis, prevalent etiological agents, antibiogram pattern and efficacy of the treatment at field level. Methods: Seventy-eight RBS affected bovines were selected. The cervical mucous (CM) was collected for study of its characteristics, white-side test, endometrial cytology, microbial examination and antibiogram. The treatment protocol was developed and the animals’ response to the treatment was assessed. Result: The overall incidence of RBS was found to be 12.9% and the cases associated with uterine infection (RBS/UI+ve) and without uterine infection (RBS/UI-ve) were 44.87% and 55.13%, respectively. The mean scores of CM character, odour, pH and number of polymorphonuclear cells in RBS/UI +ve were 2.09±1.39, 1.14±0.12, 8.49±0.08 and 12.46±0.96, respectively, and differed significantly (P less than 0.05) from RBS/UI-ve cases. The microbial examination revealed the presence of gram negative bacilli, Trueperella spp., Pseudomonas spp., Staphylococcus spp., Escherichia coli and yeast infection. Antibiogram studies recorded the response of Tetracyclin as best (48.57%) followed by Cephalexin (22.86%), Chloramphenicol (20.0%) and Streptomycin (8.57%). The RBS/UI+ve cases were treated individually, on one-to-one basis, obeying antibiogram. The infection appeared to be considerably controlled and overall success rate was observed in the form of confirmed pregnancy in 71.43% cases. Thus, it was concluded that prompt diagnosis using endometrial cytology and antibiogram guided therapeutic approach may aid for effective management of RBS/UI +ve cases, under field conditions.

The role of CT Thorax as a screening tool in Covid-19 before elective urological surgeries: a tertiary care centre experience

Background: CT thorax has been advocated and widely applied in Covid-19 clinical management. Aims and objectives: We evaluated the diagnostic value of CT thorax as a screening tool for Covid-19 in asymptomatic patients posted for elective urological surgeries & compared it with RT-PCR findings. Material & Methods: The present retrospective, observational study was conducted among those who were planned for urological surgeries in the department of Urology from April 2019 to March 2021 in a tertiary care centre institute. For each patient, a nasopharyngeal and/or oropharyngeal swab was taken and tested for the presence of SARS‑CoV‑2. If the first RT-PCR was negative, a second RT-PCR was performed within 48 hours after the first test in patients who were still admitted to the hospital. The detection rate of COVID-19 infection based on initial CT thorax & RT-PCR (as reference standard) was compared. Results: There were 24 true positive, 243 true negative, 7 false positive and 8 false negative patients. Sensitivity was 75% (95% CI: 56.60% – 88.54%), specificity: 97.20% (95% CI: 94.32 – 98.87%, positive predictive value: 61.65% (95% CI: 61.65 – 87.97%), negative predictive value: 96.81% (95% CI: 94.34 – 98.23%) and accuracy: 94.68% (95% CI: 91.38 – 96.99%). Conclusions: High diagnostic accuracy of CT with typical & relatively atypical CT findings of COVID‑19 leads to a low rate of missed diagnosis. Normal CT can be found in RT‑PCR +ve COVID‑19 cases & typical CT manifestations can be seen in RT‑PCR -ve cases. Thus, a combination of both CT & RT‑PCR may help in improving the diagnostic accuracy of Covid-19.

Human leukocyte antigen-B alleles in spondyloarthritides: A single-center, prospective, cross-sectional study

Objective: The objective of this study is to study distribution of human leukocyte antigen (HLA)-B alleles in Spondyloarthritis (SpA) and to find its clinical relevance in the patient management.Materials and Methods: A prospective, cross-sectional, pilot study was carried out on 100 participants at the single center of Northern India (Sir Ganga Ram Hospital, New Delhi). Assessment in ankylosing spondylitis (ASAS) classification criteria for axial/peripheral spondyloarthritis (SPA) (conventionally AS-ankylosing spondylitis), classification criteria for reactive arthritis (ReA), and CASPAR (classification criteria for psoriatic arthritis) criteria for psoriatic arthritis were used to sub-classify patients. Inflammatory bowel disease (IBD) patients who classified for ASAS criteria for SPA were classified as IBD-related SPA. Demographic data, disease characteristics, and relevant investigations were noted. HLA-B genotyping was carried out by the polymerase chain reaction method. HLA-B genotyping of 100 healthy kidney transplant donors were taken as controls. Fisher's exact test was used. P < 0.05 was considered as statistically significant.Results: Out of 100 patients, 58 were male and 42 were female. SPA (AS), ReA, PSA, and IBD-related SPA were 65, 12, 16, and 07, respectively. HLA-B 27+ve participants were 57. HLA-B40 and HLA-B52 were present in 25 and 19 participants, respectively. HLA-B27 allele was associated with SPA, PSA, and IBD-related SPA (P < 0.01, 0.034, and 0.037, respectively). In HLA-B27-ve cases, the frequency of HLA-B40 was increased (P value – 0.033, odds ratio [OR] with 95% confidence interval-2.44, [1.09, 5.48]). Similarly, the frequency of HLA-B15 and HLA-B13 were increased in PSA (P value – 0.034, 0.020 with OR – 4.09, 6.33, respectively). The presence of HLA-B27 allele favored axial ± peripheral disease while its absence favored peripheral disease (P value– 0.019). HLA-B27+ve participants had more active disease compared to HLA-B27-ve and HLA-B40+ve cases (P < 0.01 and 0.013, respectively).Conclusion: The utility of HLA-B alleles other than HLA-B27 is limited in SpA patients' management. To find their use in diagnosis, prognosis and treatment need further studies.xs

Relationship between COVID-19 Infection and ABO Blood Groups Differences: A Tertiary Centre Experience in Al-Madinah, Saudi Arabia

Controversial factors affecting COVID-19 infection include age, ethnicity, blood groups and Rh factor were investigated here. This study enrolled 2012 participants: COVID-19 cases (1006 patients), and control group (1006 subjects), 50.9% were Saudis and 49.1% were non-Saudis. Mean age for all participants was 36.0±12.7 years and ranged from 8 to 80 years. Mean age was 38.6+15.3 years for COVID-19+ve cases and 33.4±8.6 years for controls. Mean age significantly differed in COVID-19+ve cases from controls (p<0.001). COVID-19 infection was significant in Saudi participants compared to non-Saudi participants (p<0.001). In COVID-19 group, the frequencies of blood groups O, A, B and AB were 44.5%, 31.3%, 19.7% and 4.5%, respectively. The percentage of COVID-19 infection was higher in subjects having blood groups O and A. Regarding Rh factor, 94.0% of all participants were Rh+ve and 6.0% were Rh-ve. Among COVID+ve cases, 93.4% were Rh positive cases and 6.6% were Rh negative cases, while in the controls, 94.5% were Rh+ve and 5.5% were Rh-ve. The number of COVID-19+ve cases exceeded the number of healthy controls in A+ve subjects but not in O+ve and B+ve subjects. In multivariate analysis, people with blood groups B and AB were less likely to be infected (p =0.049) compared to those with groups O and A. In conclusion, older adults had greater risk of COVID-19 infection. Gatherings culture increased COVID-19 infection. Individuals with blood groups B and AB are less likely to get COVID-19 infection than O and A subjects. Rh+ve in O+ve and A+ve is associated with increased COVID-19 infection.

A descriptive study of COVID-19 at a tertiary care hospital

Coronavirus disease 2019 (abbreviated “COVID-19”) is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The cases of COVID-19 infection since then were showing increasing trend in all over the world.&#x0D; The aim: to study the epidemiological distribution and determinants of COVID-19 pandemic.&#x0D; Methods: it is a descriptive study carried out at a tertiary care hospital of India. The population comprised of patients admitted in the hospital. Sample size comprised of all the subjects admitted in the hospital with established COVID 19 +ve cases. The duration of study was April 2020 to June 2020. The study was approved by the Institutional Ethical committee and Informed consent was obtained from each subject before the conduct of the study. Data collection was done by a pre-structured questionnaire. Data entry and analysis was done using SPSS version 20 software.&#x0D; Results: out of total 38 COVID-19 +ve cases, 95 % were male and 5 % female ant the maximum numbers of cases ranges between 36–40 years of age group with the median age of 32 years.53 % of cases were Muslim and 47 % Hindu by religion. The median duration of stay in hospital of all COVID-19 +ve cases was11 day that on further differentiation with co-morbidity was 15 days and 11.5 without any co-morbidity. The median duration taken between 1st sample taken and report provided was 2 days, between 2nd sample taken and report provided 1 day and between 1st and 2nd sample taken was 11 days.&#x0D; Conclusions: present study concluded that middle age persons were affected in majority which may be due to more exposure to public places. Co-morbidities are strong predictors of requirement for admission and duration of stay at hospital

The Role of Certain Congenital Infections in Aplastic Anemia and Prognostic Value of Fetal Hemoglobin as a Follow-Up Marker

Background: TORCH infection has a role in aplastic anemia (AA). Fetal hemoglobin may be high in certain acquired hematological conditions such as aplastic anemia. We conducted this study to evaluate the correlation between certain congenital infections and severity of aplastic anemia and to study fetal Hb as a follow up marker during treatment of aplastic anemia. The aim of study was to correlation between certain congenital infection and severity of aplastic anemia and to study of hemoglobin F (HbF) as a follow up marker during treatment of aplastic anemia.&#x0D; Methods: Our prospective study was conducted on 20 children aged up to 18 years diagnosed with aplastic anemia following either bone marrow aspiration or biopsy that proves bone marrow hypocellularity with absence infiltrative BM disease or inherited BM disease recruited from Pediatric Hematology-Oncology Unit of Tanta University Hospital. Patients were classified according to level of HbF in to high HbF group and normal HbF group.&#x0D; Results: TORCH infections were detected in certain numbers of patients . HbF decreased in high HbF group after treatment. There was significant increase in CBC parameters in high HbF group than normal HbF group after treatment. There was insignificant decrease in mortality in high HbF group than normal HbF group. Mild to moderate cases were significantly higher with TORCH IgM +ve cases&#x0D; Conclusions: Acquired AA is associated with TORCH infection. In treated cases of AA, improvement of hematological parameters is associated with high HbF and from these results, it can be used as a prognostic marker to monitor the successful response of these cases to the used line of treatment.

Long-Term Outcome of Philadelphia Chromosome Positive Leukemia From Eastern Indian Subcontinent: An Experience in the Era of Tyrosine Kinase Inhibitor (TKI) Therapy

IntroductionPhiladelphia chromosome (Ph) marks a group of leukemia with almost all cases of chronic myeloid leukemia (CML), a subset of acute lymphoid leukemia (ALL) and rare cases of acute myeloid leukemia (AML). In the era of precision medicine, such cases are successfully managed with tyrosine kinase inhibitor (TKI) drugs. This study examined the features and long-term outcome of Ph+ve cases from a tertiary cancer care center from Eastern Indian subcontinent. Materials and MethodsReviewing retrospective case-records registered between 2005 and 2015, cases of CML and ALL were documented under Ph+ve category; while no instance of Ph+ve AML was found. ResultsIn CML cohort, adult and juvenile incidences were 95.2% and 4.8% respectively; in ALL cohort, the same was found for 66.67% and 33.33% cases. Among the CML cases, 10-year overall survival (OS) and progression-free survival (PFS) were significantly affected upon the phase of disease at time of detection. Furthermore, both OS and PFS significantly dropped whenever non-TKI-based treatment was applied prior to TKI-commencement. Long-term (10-year) sensitivity to 1st generation TKI, imatinib, was noted 88.51% and 83.33% for adult and juvenile CML cohorts, respectively. For Ph+ ALL cohort, the OS was benefitted upon combinatorial TKI and chemotherapy. However, large fractions of affected individual from CML as well as ALL cohorts were found to discontinue follow-up. ConclusionTogether with differences in outcome on the basis of drug-use from onset, age (juvenile versus adult) and stage at diagnosis, our analyses bring forward the real-world scenario of Ph+ve leukemia managed with precision medicine.

A PROSPECTIVE, OBSERVATIONAL STUDY ON THE EFFICACY OF DRUG REGIMEN USED FOR HELICOBACTER PYLORI ERADICATION IN PEPTIC ULCER DISEASE

Aim of the study: We aimed to study the efficacy of triple drug therapy which is considered as a standard regimen. Objective of the study: To observe the role of pharmacist in preventing the recurrence of H. pylori infection. To assess whether the drug regimen prescribed eradicates the H. pylori infection. Results: In a period of 6 months a total of 358 cases were observed. Among them 142 cases are rapid urease test +ve and 216 are rapid urease test – ve cases. Of 142 patients included in the analysis, Peptic ulcer disease was more common in men when compared to women and prevalent in age group of 51-60 years. The body mass index analysis showed that 35.2% of patients were obese. From the personal history of the patients, it was concluded that 32.3% were smokers whereas 31.6% were alcoholic. The medication history analysis showed non-steroidal anti-inflammatory drugs were commonly used by the patients. The diagnostic endoscopic reports show that patients suffer from erosive pan gastritis followed by erosive gastritis. Conclusion: A 14-day triple therapy was found to be completely eradicate H. pylori infection. Out of the various demographic details that were taken into consideration age, gender, BMI, smokers, alcoholics, spicy food intake and drug abuse increased symptoms whereas co-morbid illness, sleeping pattern and food interval didn’t affect much. Structured patient counselling and follow up had a significant effect which was seen in the form of zero recurrence, 100% medication adherence and improved quality of life.

Automatic COVID-19 detection from X-ray images using ensemble learning with convolutional neural network

COVID-19 continues to have catastrophic effects on the lives of human beings throughout the world. To combat this disease it is necessary to screen the affected patients in a fast and inexpensive way. One of the most viable steps towards achieving this goal is through radiological examination, Chest X-Ray being the most easily available and least expensive option. In this paper, we have proposed a Deep Convolutional Neural Network-based solution which can detect the COVID-19 +ve patients using chest X-Ray images. Multiple state-of-the-art CNN models—DenseNet201, Resnet50V2 and Inceptionv3, have been adopted in the proposed work. They have been trained individually to make independent predictions. Then the models are combined, using a new method of weighted average ensembling technique, to predict a class value. To test the efficacy of the solution we have used publicly available chest X-ray images of COVID +ve and –ve cases. 538 images of COVID +ve patients and 468 images of COVID –ve patients have been divided into training, test and validation sets. The proposed approach gave a classification accuracy of 91.62% which is higher than the state-of-the-art CNN models as well the compared benchmark algorithm. We have developed a GUI-based application for public use. This application can be used on any computer by any medical personnel to detect COVID +ve patients using Chest X-Ray images within a few seconds.

EVALUATION OF SERUM URIC ACID AND ITS CORRELATION IN YOUNG NEWLY DIAGNOSED ESSENTIAL HYPERTENSIVES

Background: Hypertension is a major public health challenge and is the third leading killer in the World. The serum uric acid has shown some prognostic importance in essential hypertension Methodology: Acase control study was undertaken in a tertiary care hospital in Gurugram. Seventy ve cases of hypertension and equal number of controls were studied for the hypertension and serum uric acid levels. Results:This study had shown that, majority of the cases and controls were aged 31 – 40 years and females. The blood pressures were signicantly more in the cases than controls. Serum uric acid levels were also signicantly higher in cases than controls. There was no statistically signicant difference in serum uric acid levels between different stages of hypertension. Conclusion:The serum uric acid levels were signicantly higher in cases of hypertension than controls.

Validation of a COVID-19 self-assessment tool for the prediction of COVID-19 in a primary health care setting in Egypt.

As SARS-CoV-2 infection is sweeping the globe, early identification and timely management of infected patients will alleviate unmet health care demands and ultimately control of the disease. Remote COVID-19 self-assessment tools will offer a potential strategy for patient guidance on medical consultation versus home care without requiring direct attention from healthcare professionals. This study aimed to assess the validity and interrater reliability of the initial and modified versions of a COVID-19 self-assessment prediction tool introduced by the Egyptian Ministry of Health and Population (MoHP) early in the epidemic. The scoring tool was released for the public through media outlets for remote self-assessment of SARS-CoV-2 infection connecting patients with the appropriate level of care. We evaluated the initial score in the analysis of 818 consecutive cases presenting with symptoms suggesting COVID-19 in a single-primary health care clinic in Alexandria during the epidemic in Egypt (mid-February through July). Validity parameters, interrater agreement and accuracy of the score as a triage tool were calculated versus the COVID-19 polymerase chain reaction (PCR) test. A total of 818 patients reporting symptoms potentially attributable to COVID-19 were enrolled. The initial tool correctly identified 296 of 390 COVID-19 PCR +ve cases (sensitivity = 75.9%, specificity = 42.3%, positive predictive value = 54.5%, negative predictive value = 65.8%). The modified versions of the MoHP triage score yielded comparable results albeit with a better accuracy during the late epidemic phase. Recent history of travel [OR (95% CI) = 12.1 (5.0-29.4)] and being a health care worker [OR (95% CI) = 5.8 (2.8-11.9)] were major predictors of SARS-CoV-2 infection in early and late epidemic phases, respectively. On the other hand, direct contact with a respiratory infection case increased the risk of infection by three folds throughout the epidemic period. The tested score has a sufficient predictive value and potential as a triage tool in primary health care settings. Updated implementation of this home-grown tool will improve COVID-19 response at the primary health care level.

COVID-19 and its relationship to particulate matter pollution - Case study from part of greater Chennai, India.

It is well known that atmospheric contamination, especially the particulate matter (PM), causes severe human diseases. Yet, presently air pollution levels have dropped primarily attributable across the nation lockdown forced in the wake of the novel Coronavirus outbreak. In this study, we have attempted to establish a conceivable relationship between Covid 19 and PM10–2.5, obtained from eleven airquality monitoring stations in Chennai city, India for both Pre and during Covid situations and its influence over Covid positive cases. The observations of the materials (+ve cases, PM 10, PM 2.5) collected proved that during precovid regime less polluted areas are indicated with less than 5 infection cases reflecting the healthy people and they are less vulnerable to covid except the few occurrence of foreign source indicating no community spread whereus most polluted spots of precovid regimes are indicated with more than 90% cases and indicated that people in pollution zones are succumbed to get infected quickly. However, during Covid the lockdown has considerably reduced the particulate suspension and the results revealed that the +ve cases are of the nature of community spreading through primary and secondary contacts as reported from the media. If Covid is a visible, brutally virulent, incredibly contagious pandemic that kills rapidly and mercilessly, air pollution is its unseen evil twin. Under the radar, but even ruthlessly, if Covid and PM paired together lead to murder without delay. This is a non-communicable disease (NCD) slow-motion pandemic, equivalent-if not exceeding-the catastrophic wrath of SARS-CoV-2.

Screening for SARS-CoV-2 antibodies in convalescent plasma in Brazil: Preliminary lessons from a voluntary convalescent donor program.

BackgroundCoronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) collection began in two Brazilian hospitals for treatment of severe/critical patients.Methods and MaterialsMild/moderate COVID‐19 convalescents were selected as CCP donors after reverse transcription polymerase chain reaction (RT‐PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and absence of symptoms for ≥14 days plus (a) age (18‐60 years), body weight greater than 55 kg; (b) immunohematological studies; (c) no infectious markers of hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human T‐lymphotropic virus‐1/2, Chagas and syphilis infection; (d) no HLA antibodies (multiparous); (e) second RT‐PCR (nasopharyngeal swab and/or blood) negativity; (f) virus neutralization test (cytopathic effect–based virus neutralization test neutralizing antibody) and anti–nucleocapsid protein SARS‐CoV‐2 IgM, IgG, and IgA enzyme‐linked immunosorbent assays.ResultsAmong 271 donors (41 females, 230 males), 250 presented with neutralizing antibodies. Final RT‐PCR was negative on swab (77.0%) or blood (88.4%; P = .46). Final definition of RT‐PCR was only defined at more than 28 days after full recovery in 59 of 174 (33.9%) RT‐PCR –ve, and 25/69 RT‐PCR +ve (36.2%; 13 between 35 and 48 days). Neutralizing antibody titers of 160 or greater were found in 63.6%. Correlation between IgG signal/cutoff of 5.0 or greater and neutralizing antibody of 160 or greater was 82.4%. Combination of final RT‐PCR –ve with neutralizing antibody ≥160 was 41.3% (112/271). Serial plasma collection showed decline in neutralizing antibody titers and IgA levels (P < .05), probably denoting a “golden period” for CCP collection (≤28 days after joining the program); IgA might have an important role as neutralizing antibody. Donor's weight, days between disease onset and serial plasma collection, and IgG and IgM levels are important predictors for neutralizing antibody titer.ConclusionsRT‐PCR +ve cases are still detected in 36.2% within 28 to 48 days after recovery. High anti–nucleocapsid protein IgG levels may be used as a surrogate marker to neutralizing antibody.

Does Age Impact Outcomes of Oropharyngeal squamous cell carcinoma?

It is well-established that human papilloma virus (HPV) positive (+ve) oropharyngeal (OP) squamous cell carcinoma (SCC) carries a better overall prognosis than HPV negative (-ve) tumors. We sought to investigate the impact of age upon survival endpoints for HPV +ve and -ve OP SCC as well as the differences in acute radiotherapy (RT) toxicity. We included all OP SCC cases treated definitively between 2010-2017. All cases underwent either surgery ± adjuvant RT; or definitive RT ± chemotherapy according to the multidisciplinary tumor board decision. After determining p16 status we dichotomized each HPV group by age at diagnosis into old (> or = 65 years) and young (<65 years) sub-groups. Patients' demographics, clinico-pathological data and treatment modalities were compared across age groups for both HPV sub-types. Log-rank test and Kaplan-Meier curves were utilized to measure effect of age on overall (OS), local recurrence free (LRFS) and distant metastases free (DMFS) survival for HPV +ve and -ve. For patients receiving RT we compared weight loss, feeding tube insertion, treatment breaks and hospitalization during RT as parameters for acute toxicity across age groups. We identified 217 OP SCC who fit our inclusion criteria. Seventy percent were HPV+ve, males were 82%, mean age at diagnosis was 61 years, 75% were white, 67% were ever smokers and 54% were frequent/heavy alcohol drinkers. According to AJCC 7th edition, Stages III and IVA formed 87%; however, these were regrouped as stage I (51%) and stage IVA (62%) as prevalent stages for HPV+ve and -ve respectively as per AJCC 8th version. Definitive CRT was utilized in 58% and surgery ± adjuvant therapy in 31% of the study cohort. For HPV+ve sub-group, 31% were old (n=47); whereas they constituted 40% (n=27) of HPV-ve cases. Clinicopathological and treatment characteristics were generally equivalent among age groups except that HPV +ve younger patients had more adequate surgical margins (≥5mm) (78% vs 36%; p=0.03) than old; and HPV-ve old cases had a trend towards more utilization of concomitant cetuximab (30% vs 13%; p=0.09) than younger ones. All endpoints were not significantly different between old vs young HPV+ve cases with 2-year OS and LRFS of (64% vs 59%; p=0.41 and 88% vs 87%; p=0.98 for both respectively). Similar outcomes were observed between study age groups for HPV-ve cases (p>0.05 for all endpoints). Hospitalization during RT was more frequent in old patients (44% vs 28%; p=0.03). Median weight loss during RT was 9.5% (0-22%) vs 9.3% (0-17%) for old vs young (p=0.35) and RT breaks were also non-significant (39% vs 27%, p=0.8). Feeding tubes were inserted after RT initiation in 41% of old and 36% in young (p=0.5). Older patients with OP SCC have equivalent outcomes compared to younger ones irrespective of HPV status. Optimal treatments must be offered following standard of care as determined by a multi-disciplinary group of providers.

CML-004: Imatinib is Protective Against Falciparum Malaria: A Case Control Study from a Tertiary Care Centre in West Bengal

Context Rising evidence of artemisin resistant malaria in Indian subcontinent and South America has prompted researchers to search for alternative antimalarials. In the last few decades, few reports and subsequent in vitro results have emerged showing dependence of malarial parasites, particularly P falciparum, on RBC tyrosine kinases for its maturation and egress. As there were no clinical data to support the hypothesis, we conducted a case control study with patients of CML-CP on fixed dose imatinib (TKI) as cases and a representative healthy population as control. Objective To compare the prevalence of asymptomatic falciparum and vivax infections in study cases with the prevalence of matched control taken from healthy blood donors. Methods A standard questionnaire and rapid diagnostic test (RDT) for plasmodium antigens from the blood of cases attending CML clinic were used as study tools. 191 CML patients who are on imatinib 400mg/d for a minimum period of 1 year were analysed. Controls were healthy voluntary blood donors attending the hospital during the same time-frame. Study time was April-September (peak malaria season). All RDT +ve cases were internally validated with PCR using two species specific forward primers. Results Out of 54 febrile episodes among cases during the study period, one had vivax malaria. RDT testing on non-febrile participants revealed two samples positive for dual vivax-falciparum antigens and the other two for vivax antigen. PCR showed three cases positive for vivax and one positive for both vivax and falciparum. Among 205 controls, three had vivax infections, three had falciparum infections and four were found to have infections with both. The concordance for positive results among the diagnostic modalities (RDT and PCR) was found to be 93.3%. The prevalence of malarial infections in cases and controls were found to be 2.05% and 4.87% respectively while falciparum parasitemia in cases and controls were found to be 0.51% and 3.41% respectively. Conclusion Analysis showed that the difference of asymptomatic falciparum carriage among cases and control was statistically significant suggesting a protective effect of imatinib against falciparum infections. The association of vivax positivity with imatinib exposure was however not statistically significant.

Serum Leptin Versus C-Reactive Protein in The Early Diagnosis of Neonatal Sepsis

Background: Neonatal sepsis is a systemic inflammatory reaction that is triggered by an infective agent. When sepsis occurs, multiple redundant inflammatory cytokines are released into the blood stream, including, leptin, Creactive protein (CRP). Aim of the Study: was to compare the sensitivity of serum leptin and C-reactive protein in early diagnosis of neonatal sepsis. Patients and Methods: This was a prospective cohort study conducted in the Zagazig General Hospital and included (34) newborn infants. The tests used were, blood culture, C - Reactive protein Level, and serum leptin level. Results: 76.5% of the studied group had +ve culture results. The most frequent organism was staph 12 (35.3%). There was a statistically significant increase in CRP and Leptin among +ve cases compared to –ve cases. There was a positive statistically significant correlation between serum leptin levels and CRP. The sensitivity of CRP in the diagnosis of sepsis at the cut off 18 was 65.4%, specificity was 50% and the accuracy was 61.8%. While the sensitivity of Leptin in the diagnosis of sepsis at the cut off 0.07 was 84.6%, specificity was 87.5% and the accuracy was 85.3%. Conclusion: Leptin is an effective diagnostic marker for sepsis and more accurate when compared with CRP

Latency of tobacco smoking for head and neck cancer among HPV-positive and HPV-negative individuals.

Human papillomavirus (HPV) infection and tobacco smoking are well-known risk factors for head and neck cancers (HNC). Although an effect modification between oral HPV infection and tobacco smoking may exist, evidence is lacking on how they interact temporally. We investigated the latency and life course effects of tobacco smoking on risk of HNC among HPV-positive (HPV+ve ) and negative (HPV-ve ) individuals. We used data from 631 ever-smoker participants of a hospital-based case-control study conducted in four major hospitals in Montréal, Canada. Cases (n = 320), incident, histologically confirmed, primary squamous cell carcinomas, were frequency-matched to controls (n = 311) by age and sex. Sociodemographic and behavioral factors (e.g., tobacco and alcohol use and sexual history) were collected using a structured interview applying a life grid technique. Oral exfoliated cells were used for HPV DNA detection and genotyping. Latency effects were estimated flexibly using a Bayesian relevant exposure model and further extended with a life course approach. Retrospective smoking trajectories for HPV+ve cases and controls had similar shapes. Exposure to tobacco smoking even 40 years before diagnosis was associated with an increased HNC risk among both HPV+ve and HPV-ve participants. The effect of smoking before the start of sexual activity compared to afterwards was higher among HPV+ve individuals. This pattern of association was less profound among HPV-ve participants. Temporal interactions may exists between oral HPV infection and life course smoking trajectories in relation to HNC risk.

Effects of Human Papillomavirus Infection with Pre-invasive Cervical Lesions: Bangladesh Perspectives

Background: Cervical cancer remains a major public health problem worldwide – particularly in less developed countries. Around 85% of their new cases and 86% of deaths occur in less development countries (IARC, 2012). In Bangladesh, Cervical cancer is the second most common disease among female with an estimated 11,956 new cases and 6,582 deaths in 2012. Objectives: The present study was undertaken to identify the Effects of Human Papillomavirus infection with Pre-invasive cervical lesions in Bangladesh.&#x0D; Methods: This cross sectional study was carried out at the colposcopy clinic of Gynaecology and Obstetrics department of Bangabandhu Sheikh Mujib Medical University during the study period January 2015 - December 2015. A total of 65 consecutive women with VIA +ve cases of all three grades of CIN (CIN I, CIN II, CIN III) were enrolled in this study. Women having invasive cervical disease and women who not interested were excluded from this study.&#x0D; Results: More than one third (35.3%) patients were in 3rd decade. More than one third (35.4%) patients had normal colposcopic findings followed by 23(35.4%) was CIN I, 11(16.9%) was CIN II and 8(12.3%) was CIN III. Majority (42.6%) patients was found CIN I, 11(26.1%) was CIN II, 8(19.4%) was CIN III and 5(11.9%) had normal in Histopathology. CIN I histopathological finding was found 18 cases, among them 8(44.4%) in positive HC-2/Viral load/ RLU index. In multivariate analysis CIN III was significantly increased 1.34 times in HC-2/Viral load/RLU index positive (human Papillomavirus) cases (95% CI 0.22 – 8.9%, &lt;0.05). Validity test of benign HPV DNA test of the study women showed that HPV DNA had sensitivity 51.4%, specificity 92.9%, accuracy 69.2%, positive predictive values 90.5% and negative predictive values 59.1%. Benign Colposcopic finding had had sensitivity 86.5%, specificity 64.3%, accuracy 76.9%, positive predictive values 76.2% and negative predictive values 78.3%. CIN III significantly 1.34 times increased HC-2/Viral load/ RLU index positive (human Papillomavirus) in multivariate analysis.&#x0D; Conclusion: From the findings of the study it was observed that colposcopy had a high sensitivity and optimum specificity; HPV DNA test had lower sensitivity and higher specificity. Colposcopic findings were closely associated with Histopathology, where the validity test was high when compared to HPV DNA test. So it can be concluded that the Colposcopy is a useful screening test for detection of cervical lesions and Human Papillomavirus is associated with pre-invasive cervical lessons. So the HPV DNA test can be used as a co-test with Colposcopy for screening of cervical lesions.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 5-10

Prevalence of HIV +ve Cases With AIDS Defining Opportunistic Infections Among ART Naive Patients Attending ART Centre

Prevalence of HIV +ve Cases With AIDS Defining Opportunistic Infections Among ART Naive Patients Attending ART Centre

Dysfunctional eating in type 2 diabetes mellitus: A multicenter Italian study of socio-demographic and clinical associations

Background and aimsDysfunctional eating might impact on the management and metabolic control of type 2 diabetes (T2DM), modifying adherence to healthy diet and food choices. Methods and resultsIn a multicenter study, we assessed the prevalence of dysfunctional eating in 895 adult outpatients with T2DM (51% males, median age 67, median BMI 30.3 kg/m2). Socio-demographic and clinical characteristics were recorded; dysfunctional eating was tested by validated questionnaires (Eating Attitude Test-EAT-26, Binge Eating Scale-BES; Night Eating Questionnaire-NEQ); food intake and adherence to Mediterranean diet were also measured (in-house developed questionnaire and Mediterranean Diet Score–MDS). Obesity was present in 52% of cases (10% obesity class III), with higher rates in women; 22% had HbA1c ≥ 8%. The EAT-26 was positive in 19.6% of women vs. 10.2% of men; BES scores outside the normal range were recorded in 9.4% of women and 4.4% of men, with 3.0% and 1.5% suggestive of binge eating disorder, respectively. Night eating (NEQ) was only present in 3.2% of women and 0.4% of men. Critical EAT and BES values were associated with higher BMI, and all NEQ + ve cases, but one, were clustered among BES + ve individuals. Calorie intake increased with BES, NEQ, and BMI, and decreased with age and with higher adherence to Mediterranean diet. In multivariable logistic regression analysis, female sex, and younger age were associated with increase risk of dysfunctional eating. ConclusionDysfunctional eating is present across the whole spectrum of T2DM and significantly impacts on adherence to dietary restriction and food choices.