Comparative Study Between the First and Second Wave of COVID-19 Deaths in India: A Single Center Study

Introduction  The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously evolving, and many mutant variants of the virus are circulating in the world. Recurrent waves of COVID-19 have caused enormous mortality all across the globe. Considering the novelty of the virus, it becomes crucial for healthcare experts and policymakers to understand the demographic and clinical attributes of inpatient deaths in the first and second waves of COVID-19. Methods This hospital record-based comparative study was conducted at a tertiary care hospital in Uttarakhand, India. The study included all COVID-19 RT PCR-positive patients admitted to the hospital during the first wave, from 1^st April 2020 to 31^st January 2021, and the second wave from 1^st March 2021 to 30^th June 2021. Comparisons were made with respect to demographic, clinical, laboratory parameters, and course of hospital stay. Results The study exhibited 11.34% more casualties in the second wave, with the number of deaths being 424 and 475 for the first and second waves, respectively. A male preponderance of mortality was evident in both waves with significant differences (p=0.004). There was no significant difference in age between the two waves (p=0.809). The significantly different comorbidities were hypertension (p=0.003) and coronary artery disease (p=0.014). The clinical manifestations demonstrating a significant difference were cough (p=0.000), sore throat (p=0.002), altered mental status (p=0.002), headache (p=0.025), loss of taste and smell (p=0.001), and tachypnea (p=0.000). The lab parameters with a significant difference across both waves were lymphopenia (p=0.000), elevated aspartate aminotransferase (p=0.004), leukocytosis (p=0.008), and thrombocytopenia (p=0.004). During the hospital course of the second wave, in terms of intensive care unit stay, the need for non-invasive ventilation and inotrope support was higher. The complications manifesting in the form of acute respiratory distress syndrome and sepsis were observed more in the second wave. A significant difference was discerned in the median duration of hospital stay in both waves (p=0.000). Conclusion Despite being of shorter duration, the second wave of COVID-19 culminated in more deaths. The study demonstrated that most of the baseline demographic and clinical characteristics attributed to mortality were more common during the second wave of COVID-19, including lab parameters, complications, and duration of hospital stays. The unpredictable nature of COVID-19 waves calls for instituting a well-planned surveillance mechanism in place to identify the surge in cases at the earliest possible time and prompt response, along with developing infrastructure and capacity to manage complications.

COVID-19 Vaccination status among Health care workers diagnosed with COVID-19 in a tertiary care institute of Uttarakhand: A Cross-sectional Study

Background: Vaccines are considered as the one of the main pillars in halting and ending the presently on-going coronavirus disease (COVID-19 disease) pandemic which has spread globally since it was first detected in Wuhan, China in December 2019. In the absence of specific therapy, infection prevention practices and mass vaccination remains the mainstay in controlling the disease. Objectives: Objective of the study was to assess COVID-19 vaccination status, socio-demographic and clinical profile among healthcare workers diagnosed with COVID-19. Methodology: A cross-sectional survey from 1st March 2021 to 30th June 2021 among healthcare workers who were diagnosed with COVID-19 in a tertiary care institute of Uttarakhand, India was conducted, and universal sampling was used. Institutional Ethics Committee approved this study. Results: Total 662 healthcare workers were diagnosed with COVID-19. 429 (64.8%) of these COVID-19 diagnosed healthcare workers had received either single (129,30%) or both dose (300,70%) of COVID-19 vaccine while remaining 233 (35.2%) belonged to non-vaccinated group. History of exposure to COVID-19 positive patients was higher in vaccinated (66.4%) than in non-vaccinated group (55%) (p = 0.004). Hospitalisation was found to be higher among non-vaccinated (5.6%) than vaccinated group (2.3%) (p = 0.029). Conclusions: This study concludes that being vaccinated against COVID-19 disease provides protection against severe infection and reduces the need for hospitalization.

COVID-19 Infection After Vaccination Among Healthcare Workers at a Tertiary Level Health Care Center in Northern India: A Cross-Sectional Study

Background and aims:

COVID19 vaccines are now accessible to all Indian citizens. Infection with COVID19, on the other hand, continues to spread continuously. Our study aimed to determine the number of persons who had COVID-19 infections despite receiving the recommended number of doses of the COVID 19 vaccination at AIIMS Rishikesh, a tertiary care facility in Uttarakhand, India.

Methods:

We analysed meticulously preserved data regarding COVID-19 vaccination, COVID-19 infection, Clinical symptoms, and RT-PCR testing among all HCWs in our healthcare institution during period from 16 January 2021 to 30th June 2021..

Results:

During this period, 5273 (90.3%) HCWs received two doses of COVID-19 vaccine, while 566 (9.7%) received only one dose. 628 HCWs (10.8%) were BBV152 recipients and 5211(89.2%) AZD1222 (ChAdOx1-S) recipients. 423 HCWs (7.2%,confidence interval of 95% - 13.8, 22.0) reported COVID-19 infections.274(5.19% of total vaccinated HCWs ) breakthrough infections and 149 non-breakthrough COVID-19 infections reported in HCWs who had previously received a single dose of the COVID-19 vaccination. .

Conclusion:

Viral infections sepecially breakthrough infections following adequate vaccination are a cause for concern, but there is a lack of data on these infections in the actual world. Therefore, the primary focus of research should be on the emergence of illness in India following the completion of a full vaccine course.

Postoperative continuous non-invasive cardiac output monitoring on the ward: a feasibility study

Postoperative hypotension is common (occurring in one third of patients) and is associated with worse clinical outcomes. The LiDCO CNAP (continuous non-invasive arterial pressure) device measures haemodynamics but has not been widely adopted in ward environments. Improved early detection of hypotension by CNAP might guide interventions to improve clinical outcomes. We aimed to find the proportion of patients who tolerated LiDCO CNAP for 12 h postoperatively, to unmask episodes of hypotension detected by continuous monitoring and to characterise the haemodynamic profile at the time of hypotension. In this feasibility study, patients undergoing major elective surgery were continuously postoperatively monitored using CNAP. Haemodynamic data gathered from CNAP, including nSVRI (nominal systemic vascular resistance index), nSVI (nominal stroke volume index), SVV (stroke volume variation) and blood pressure, were analysed using Microsoft Excel and GraphPad Prism 8. 104 patients (age (mean ± sd): 68 ± 14, male (56%)) had CNAP sited postoperatively. 39% tolerated the CNAP device for at least 12 h. Within the 104 patients a mean of 81.2 min of hypotension detected by CNAP was not detected by usual care. The proportion of low/normal/high nSVI was 71%, 27% and 2%, nSVRI was 43%, 17% and 40%, respectively. CNAP monitoring was not tolerated for 12 h in the majority of patients. There were many episodes of hypotension unmasked through continuous monitoring. Based on the advanced haemodynamic data provided it is possible that the underlying cause of a third of postoperative hypotensive episodes is vasodilation rather than hypovolaemia.Trial registry number: NCT04010058 (ClinicalTrials.gov) Date of registration: 08/07/2019.

HbA1C in Management of Type II Diabetes Mellitus: A Cross-sectional Survey of Indian Physicians

OBJECTIVES

Hemoglobin A1C (HbA1C) estimation is the standard and commonly used method for diagnosis and monitoring of diabetes therapy. We conducted a questionnaire based survey to understand the Indian physician's adherence to HbA1C for effectively managing Type 2 diabetes mellitus (T2DM) patients and its influence on the decision making process.

METHODS

A validated questionnaire comprising of 10 questions was administered to physicians/endocrinologists at the 44th Annual Conference of RSSDI-2016, Hyderabad. The questions of the survey were designed to understand average cutoff HbA1C level for physicians to start the mono-therapy or combination therapy with or without insulin along with preferred class of Oral anti-diabetic drugs (OAD) in Indian T2DM patients.

RESULTS

41% physicians selected HbA1C level in between 7.0-7.4% to start mono-therapy while 94.5% chose metformin as the first line OAD. In metformin uncontrolled patients, 56.8% responders chose to start a DPP4 inhibitor. To initiate dual therapy 42.9% responders chose HbA1c level of 8.0-8.4% while for triple therapy 37.1% responders selected HbA1c level of 9.0-9.4%.

CONCLUSION

This survey shows the management patterns of T2DM patients by Indian physicians are in line with western guidelines especially AACE. Though guidelines do not offer stringent recommendation on first/second add-on class of OADs, DPP4i emerged as preferred choice for mono-therapy in metforminintolerant patients and as first add-on in patients uncontrolled on metformin alone.

Characterizing the hypertolerance potential of two indigenous bacterial strains (Bacillus flexus and Acinetobacter junii) and their efficacy in arsenic bioremediation

AIMS

The aims of the study were to (i) isolate and characterize arsenic-tolerant bacterial strains, (ii) study the plant growth-promoting traits and (iii) explore their bioremediation potential.

METHODS AND RESULTS

Indigenous arsenic hypertolerant bacterial isolates NM02 and NM03 were screened as they were capable of growing at 150 mmol l^-1 As (V) and 70 mmol l^-1 As (III). They were identified on the basis of morphological, physiological and biochemical parameter and 16sDNA sequence as Bacillus flexus and Acinetobacter junii respectively. Genomic DNA analysis for the investigation of ars operon revealed the presence of metalloregulatory arsC gene, suggesting their ability to detoxify arsenic. The analysis for siderophore, phosphate solubilization, indole acetic acid (IAA) and ACC deaminase highlighted the intrinsic plant growth-promoting rhizobacteria traits of both the bacterial strains. The energy dispersive spectroscopy analysis proved the potential of cellular arsenic sequestration within the strains. Moreover, Fourier-transform infrared spectra revealed the repositioning of the spectral bands in As presence, indicating the presence of those functional groups on the bacterial surface that is involved in As adsorption.

CONCLUSIONS

Our results indicate that bacterial strains NM02 and NM03 were identified as potent applicants for arsenic bioremediation and possess the ability to facilitate plant growth.

SIGNIFICANCE AND IMPACT OF THE STUDY

The bacterial strains are proficient in As detoxification and can be employed for arsenic bioremediation; a cost-effective and in situ remediation technique for the polluted soil.

Matrix Metalloproteinase 20–Dentin Sialophosphoprotein Interaction in Oral Cancer

Matrix metalloproteinase 20 (MMP-20), widely regarded as tooth specific, participates with MMP-2 in processing dentin sialophosphoprotein (DSPP) into dentin sialoprotein, dentin phosphoprotein, and dentin glycoprotein. In biochemical system, MMP-2, MMP-3, and MMP-9 bind with high affinity to, and are activated by, specific small integrin-binding ligand N-linked glycoproteins (SIBLINGs): bone sialoprotein, osteopontin, and dentin matrix protein 1, respectively. Subsequent reports documented possible biological relevance of SIBLING-MMP interaction in vivo by showing that SIBLINGs are always coexpressed with their MMP partners. However, the cognate MMPs for 2 other SIBLINGs—DSPP and matrix extracellular phosphogylcoprotein—are yet to be identified. Our goal was to investigate MMP-20 expression and to explore preliminary evidence of its interaction with DSPP in oral squamous cell carcinomas (OSCCs). Immunohistochemistry analysis of sections from 21 cases of archived human OSCC tissues showed immunoreactivity for MMP-20 in 18 (86%) and coexpression with DSPP in all 15 cases (71%) positive for DSPP. Similarly, 28 (93%) of 30 cases of oral epithelial dysplasia were positive for MMP-20. Western blot and quantitative real-time polymerase chain reaction analysis on OSCC cell lines showed upregulation of MMP-20 protein and mRNA, respectively, while immunofluorescence showed coexpression of MMP-20 and DSPP. Colocalization and potential interaction of MMP-20 with dentin sialoprotein was confirmed by coimmunoprecipitation and mass spectrometry analysis of immunoprecipitation product from OSCC cell lysate, and in situ proximity ligation assays. Significantly, results of chromatin immunoprecipation revealed a 9-fold enrichment of DSPP at MMP-20 promoter–proximal elements. Our data provide evidence that MMP-20 has a wider tissue distribution than previously acknowledged. MMP-20–DSPP specific interaction, excluding other MMP-20–SIBLING pairings, identifies MMP-20 as DSPP cognate MMP. Furthermore, the strong DSPP enrichment at the MMP-20 promoter suggests a regulatory role in MMP-20 transcription. These novel findings provide the foundation to explore the mechanisms and significance of DSPP-MMP-20 interaction in oral carcinogenesis.

Arsenic and lead induced free radical generation and their reversibility following chelation

Health hazards caused by heavy metals have become a great concern to the population. Lead and arsenic are one of the most important current global environmental toxicants. Their toxic manifestations are being considered caused primarily due to the imbalance between pro-oxidant and antioxidant homeostasis and also due to a high affinity of these metals for thiol groups on functional proteins. They also interfere with a number of other body functions and are known to affect central nervous system (CNS), hematopoietic system, liver and kidneys and produce serious disorders. They produce both acute and chronic poisoning, of which chronic poisoning is more dangerous as its very difficult to revert back to normal condition after chronic exposure to these insidious metals present in our life. Despite many years of research, we are still far from an effective treatment of chronic plumbism and arsenicosis. Current approved treatment lies in the administration of chelating agents that forms an insoluble complex with the metal and removes it. They have been used clinically as antidotes for treating acute and chronic poisoning. The most widely used chelating agents are calcium disodium ethylenediamine tetra acetic acid (CaNa2EDTA), D-penicillamine and British anti-lewisite (BAL). Meso 2,3 dimercaptosuccinic acid (DMSA), an analogue of BAL, has been tried successfully in animals as well as in humans. But it is unable to remove the metal from intracellular sites. Effective chelation therapy for intoxication by heavy metals depends on whether the chelating agents are able to reach the intracellular site where the heavy metal is firmly bound. One of the important approaches has been the use of combination therapy. This includes use of structurally different chelators or a combination of an adjuvant/ antioxidant/ herbal extracts and a chelator to provide better clinical/ biochemical recovery. A number of other strategies have been suggested to minimize the numerous problems. This article presents the recent development made in this area with possible directions for future research.

A rare foreign body on penis leading to incarceration

Foreign body on penis is usually put himself or by his female partner by adults for sexual gratification and in children as an innocent childish play. We have managed a 10 years shepherd who put on a bark of tree with successful outcome which is not being reported in literature.

Novel natural products from soil DNA libraries in a streptomycete host

As a route to accessing the potential chemical diversity of uncultivable microbes from the soil, combinatorial biosynthetic libraries were constructed by cloning large fragments of DNA isolated from soil into a Streptomyces lividans host. Four novel compounds, terragines A (1), B (2), C (3), and D (4), were isolated from recombinant 436-s4-5b1, and another novel compound, terragine E (5), was isolated from 446-s3-102g1. The structures were determined by a combination of spectroscopic techniques, primarily 2D NMR.

An efficient in vitro procedure for micropropagation and generation of somaclones of rose scented Pelargonium

Efficient protocols have been established for both direct and indirect regeneration of plants in Pelargonium graveolens Indian cultivar Hemanti (Algerian type). Murashige and Skoog's (MS) medium [T. Murashige, F. Skoog, A revised medium for rapid growth and bioassays with tobacco tissue cultures. Physiol. Plant. 15 (1962) 473-497] supplemented with 5.0 mg/l kinetin and 1.0 mg/l NAA was optimal for direct regeneration of plants from leaf explants while 8.0 mg/l kinetin and 1.0 mg/l NAA proved optimum for nodal explants for maximum number of shoots per explant. Callus induction was observed from nodal explants on MS medium supplemented with 10 mg/l kinetin and 1.0 mg/l NAA. Callus on further transfer to MS medium with 0.5 mg/l BAP and 0.1 mg/l NAA exhibited regeneration of maximum number of shoots. In vitro grown shoots of both direct and indirect origin rooted within 7-10 days following transfer to half strength MS medium with 1.0 mg/l IBA. Plantlets were acclimatized under glass house conditions with 90% survival. Randomly selected 85 individual Calliclones were subjected to field trial with 85-95% survival for two successive years along with control in randomized block design with three replicates. Screening of these calliclones revealed two distinct morphotypes, one with parental type highly dentated leaves (HDL) and the other with less dentated, round leaves (LDL). Only HDL calliclones flowered under field conditions. The LDL clones differed in several herb related agronomic characteristics such as plant height, herb yield, canopy size and number of branches per plant from the parental type as well as from the parent, which seems advantageous for commercial exploitation of such clones. The HDL clones closely resemble the parent in having higher content of citronellol than geraniol while the LDL clones contain almost equal contents of citronellol and geraniol in their essential oils as revealed by gas chromatography analysis. It is noticeable that the variability both in terms of agronomic characters and essential oil profiles among the clones were stable over 2 years of field trials.

Antimycobacterial polyynes of Devil's Club (Oplopanax horridus), a North American native medicinal plant

Two new (3 and 5), as well as three known (1, 2, and 4), polyynes were isolated from Devil's Club (Oplopanax horridus; Araliaceae), a medicinal plant of North America. The structures were established by 1H and 13C NMR. The absolute configurations of 2 and 5 were determined by application of Mosher's method. All the polyynes exhibited significant anti-Candida, antibacterial, and antimycobacterial activity, with an ability to kill Mycobacterium tuberculosis and isoniazid-resistant Mycobacterium avium at 10 micrograms/disk in a disk diffusion assay.

Antibacterial and antifungal polyine compounds from Glehnia littoralis ssp. leiocarpa

Glehnia littoralis F. Schmidt ssp. leiocarpa (Mathias) Hult. (Apiaceae), a species of ethnopharmacological interest in British Columbia, has antibacterial and antifungal properties. Antibacterial and antifungal compounds include two hitherto unreported polyine compounds, (9Z)1,9-heptadecadiene-4,6-diyne-3,8,11-triol and (10E)1,10-heptadecadiene-4,6-diyne-3,8,9-triol.

An antibacterial thiophene from Balsamorhiza sagittata

Balsamorhiza sagittata, a species of ethnopharmacological interest in British Columbia, is reported to have antibacterial and antifungal properties. An antibacterial compound isolated from this species was identified as 7,10-epithio-7,9-tridecadiene-3,5,11-triyne-1,2-diol based on the HMQC and HMBC experiments.

Chlorochimaphilin: a new antibiotic from Moneses uniflora

A study of the antimicrobial compounds from Moneses uniflora resulted in the isolation of a novel compound, 8-chloro-2,7-dimethyl-1,4-naphthoquinone (8-chlorochimaphilin) (1), together with chimaphilin (2) and 3-hydroxychimaphilin (3) as the antimicrobial components. 2,7-Dimethyl-1,3-dihydroxynaphthyl 4-O-alpha-L-rhamnopyranoside (4) and 2,7-dimethoxy-1,4,8-trihydroxynaphthalene (6) were also isolated and identified.

Antimicrobial constituents of Rhus glabra

The antimicrobial activity of the methanol extract and isolated constituents of Rhus glabra (Anacardiaceae), a species used in folk medicine by North American native people, was evaluated against 11 microorganisms, including gram-positive and gram-negative bacteria. The extract was subsequently fractionated and monitored by bioassays leading to the isolation of three antibacterial compounds, the methyl ester of 3,4,5-trihydroxybenzoic acid (methyl gallate) (minimal inhibition concentration (MIC) 12.5 micrograms/ml), 4-methoxy-3,5-dihydroxybenzoic acid (MIC 25 micrograms/ml) and gallic acid (MIC > 1000 micrograms/ml). The first two compounds are reported here for the first time from Rhus glabra. Their structures were established using spectroscopic and chemical methods.

Immunomodulation due to coexposure to styrene and dioctyl phthalate in mice

Pathomorphological and immunological alterations caused by a mixture of styrene and dioctyl phthalate were studied in albino mice following oral administration of 0.02, 0.03, 0.05 x LD50 of the mixture. The chemicals were mixed together proportionate to their respective LD50 values and fed in ground nut oil, 5 d/wk for 4 weeks. Histological examination of spleen revealed considerable depletion of cellular population of lymphoid follicles which corresponded to the dose dependent decrease in splenic mononuclear cell population count. The thymic lobules revealed slight atrophy but accompanied by a significant increase in thymocyte population. Correspondingly few significant histological changes were observed in mesenteric and peripheral lymph nodes. The treatment caused impairment of primary humoral immune response to SRBC (IgM) but there was a significant increase in response of splenocytes to B-cell mitogen LPS. There was a suppression of cutaneous delayed type hypersensitivity and increase in splenic lymphocyte response to T-cell mitogen PHA. Simultaneously, indirect immunity represented by decreased phagocytosis and enhanced metabolic function of reducing NBT by peritoneal exudate cells was observed. The in vitro exposure of vero cells to the mixture caused dose dependent protective effect. The results of present study indicate that subchronic exposure to low doses of mixture of styrene and dioctyl phthalate under certain conditions may modulate some of the immune functions as compared to exposure to either chemicals alone.