JN.1 variant in enduring COVID-19 pandemic: is it a variety of interest (VoI) or variety of concern (VoC)?

The emergence of the SARS-CoV-2 Omicron variant, classified as a Variant of Concern (VoC) in November 2021, marked a significant shift in the COVID-19 landscape. This study investigates the subsequent development of a novel Omicron sublineage, JN.1, which displays distinctive mutations in the spike protein. The study delves into the phylogenetic differences between these variants and their potential implications. A comprehensive analysis of the genomic profiles and mutation patterns of JN.1 and BA.2.86 was conducted, utilizing SARS-CoV-2 database. The study explores the unique mutations, such as S:L455S in JN.1, associated with increased transmissibility and immune escape. Furthermore, a comparison with prevalent strains like XBB.1.5 and HV.1 highlights the substantial genetic divergence of JN.1. JN.1, first detected in August 2023, exhibits a notable spike protein mutation profile, including the reappearance of earlier variants' mutations (E484K and P681R). The variant's increased transmissibility and immune evasion potential are attributed to specific spike protein mutations like R21T, S50L, V127F, R158G, and others. The study also explores the distribution and prevalence of JN.1 globally, with a focus on the rising cases in India. JN.1 poses a unique challenge as one of the most immune-evading variants, with potential implications for COVID-19 transmission. The study emphasizes the importance of monitoring and understanding emerging variants, especially those with distinct spike protein mutations. The observed cases in India highlight the need for vigilance and prompt public health responses. As JN.1 continues to evolve, ongoing surveillance, vaccination strategies, and adherence to preventive measures are crucial to mitigating its potential impact on global public health.

Yoganidra to Alleviate Anxiety: An Interventional Study

INTRODUCTION

Anxiety and stress are challenging conditions that result in perturbation of the body's homeostasis. It disturbs one's physical and mental state of equilibrium. There are many ways to overcome anxiety and stress, however, the best among many remedies is yoganidra, as it achieves optimum functioning of not only our body but also our mind. Hence, the present study was planned to evaluate the impact of yoganidra practice on the anxiety levels of undergraduate students.

AIMS AND OBJECTIVES

This study aimed to evaluate physiological parameters like pulse rate, blood pressure, and respiratory rate, measure anxiety levels by the general anxiety disorder-7 (GAD-7) inventory and Beck's anxiety questionnaire, conduct yoganidra sessions for all the students, and compare the effects of these training sessions on physiological parameters and anxiety scales.

MATERIALS AND METHODS

The present study was carried out in the department of physiology, R.V.M. Institute of Medical Sciences and Research Center, Siddipet, and conducted on 125 students from first to final Bachelor of Medicine, Bachelor of Surgery who participated voluntarily and actively after satisfying the inclusion and exclusion criteria. All the members were assessed for physiological cardio-respiratory parameters followed by the GAD-7 scale and Beck's anxiety questionnaire pre- and post-yoganidra sessions.

RESULTS

There was a significant difference in blood pressure before and after the session, whereas the pulse rate and respiratory rate reduction after the session were highly significant. There was a highly significant reduction in GAD-7 anxiety score, from 12±3.41 to 5.80±2.56 (p<0.0001); while for Beck's score, there was a highly significant reduction in anxiety score of 20.83±0.73 after giving yoganidra training as opposed to the earlier score of 23.75±1.86 (p<0.0001).

CONCLUSION

Yoganidra provides ways to manage stress and anxiety and enhance mental wellness. It is supported by research evidence as a safe and effective method to reduce anxiety.

Evaluation of Citrated Plasma After Thawing for Routine Coagulation Testing

OBJECTIVE

We aim to find the time in which a thawed citrate plasma sample that was preserved can be analyzed for routine coagulation testing without losing precision.

METHODS

Whole blood samples from 30 healthy volunteers were collected in 3.2% sodium citrate vacutainer and centrifuged to separate platelet-poor plasma. Each sample was then aliquoted, one aliquot was used immediately for prothrombin time (PT)-international normalized ratio (INR) and activated partial thromboplastin time (APTT), four were stored at -20°C, and four were stored at -80°C for 24 hours. After 24 hours, the aliquots were taken out and thawed at 37°C in water bath and analyzed after 15, 30, 60, and 120 minutes.

STATISTICAL ANALYSIS

Data were presented as mean with standard deviation (SD). Repeated measures ANOVA with Tukey post-hoc test was performed for multiple comparisons. All analysis was done using GraphPAD Prism 8.0 software (GraphPad Software, San Diego, California, USA).  Results: In the case of PT and INR, no statistically significant difference was found between the mean values after thawing for 120 minutes when compared with the mean baseline value. However, the APTT showed a statistically significant difference (p = 0.0232) after 30 minutes of thawing when the sample was stored at -20°C. Furthermore, a statistically significance difference (p = 0.0001) was found after 60 minutes of thawing when the samples were stored at -80°C.

CONCLUSION

Plasma samples for the PT and INR may be accepted for assessment up to 120 minutes, when stored at -20°C and -80°C for 24 hours. In the case of APTT, the plasma sample can be used for assessment up to 30 minutes after thawing when stored at -20°C and up to 60 minutes when stored at -80°C.

An overview of prognostic value of neurologic and cardiac biomarkers in patients with COVID-19 sequelae

Many studies conducted after the pandemic period revealed that, while COVID-19 primarily injured the lungs, it also affects other organs in the form of cardiovascular complications, metabolic derangements, renal damage, and so on. Although we know that inflammatory cascades, complement activation, and pro-inflammatory cytokines are all involved in vasculitic processes that cause organ damage, we do not know the exact mechanism of complications such as acute respiratory distress syndrome (ARDS), cardiovascular ischemia, deep vein thrombosis, pulmonary thromboembolism, and brain injuries (embolism) that are frequently observed in COVID 19. The currently available biomarkers do not predict the severity of the aforementioned complications. As a result, more specific biomarkers such as serum calcium binding protein (S100B), glial fibrillary acid protein (GFAP), myelin basic protein (MBP), neuron-specific enolase (NSE), hs-TNI, (highly sensitive cardiac troponin) - HBDH, (Hydroxybutyrate Dehydrogenase), CK-MB (creatine kinase myocardial band), ST2 (suppression of tumorigenicity 2) are in need for early detection & improved clinical outcome.

An overview and analogy of pedagogical approaches in online-offline teaching tactics in COVD-19 pandemic

BACKGROUND

Learning helps acquire knowledge or skills. COVID-19 outbreak severely affected the progress of education all across the globe. Pandemic-induced alternative methods of teaching promoted the progress of online education. Hence, this study is undertaken to assess an overview of teaching learning strategies in the COVID-19 pandemic so as to explore the direction of medical education and help perk up the teaching learning methods in medical education.

MATERIAL AND METHODS

The cross-sectional study involves first year medical undergraduate students of 2020-2021 batch studying at Dr.VMGMC, Solapur. It involves complete enumeration of students of 2020-2021 batch. Due to the second wave of COVID-19 pandemic hematology, classes were continued and completed by the same faculty by online live teaching using Microsoft teams. As this being an online survey, it was ethically exempted. A comparison of questionnaires between offline and online classes was done by using χ²test and a P value less than 0.05 was considered as significant. Quantitative data generated by the dichotomous question and five-point Likert scale questions were analyzed using descriptive statistics and frequency analysis. Out of 189 respondents, majority of students preferred traditional offline classes over online classes. Self-directed learning was feasible in both methods of teaching.

DISCUSSION

Traditional offline classes were more interactive and enthusiastic than online classes. Offline classes helped students to revise, recollect, and reproduce necessary information as their attention span was better in offline teaching than online teaching.

CONCLUSION

Holistic understanding and better learning were experienced through traditional offline classes. Although teachers take double efforts for online teaching, the overall learning effect and impact of traditional offline classes were much better than online classes. It definitely motivates andrgaogy and helps understand the concept on their own.

Omicron variant in COVID-19 current pandemic: a reason for apprehension

COVID-19 emerged in Wuhan, China, but was caused by the original coronavirus, severe acute respiratory syndrome associated coronavirus-2 (SARS-CoV2). In early 2020, there was a widespread breakout of cases well over world, resulting in an epidemic that rapidly escalated to become a pandemic. This abruptly shook the global healthcare system. The emergence of the alpha, beta, and delta SARS-CoV-2 were associated with new waves of infections, sometimes across the entire world but until this month i.e., between Nov-Dec, 2021, Delta variant reigned supreme until the emergence of a newer variant i.e., Omicron (B.1.1.529) of SARS-CoV-2. Delta had 13 mutations. Of these, nine are in the spike protein, the protrusion on the surface of the virus that helps it latch onto human cells. Specifically, two are in a molecular hook, called the "receptor-binding domain". Omicron, a creation caused by monstrous mutations. At least 32 mutations are in the spike protein and 10 in the receptor-binding domain. was designated a COVID-19 variant of concern (VoC) by the World Health Organization (WHO) on 26th November 2021. Structurally, the omicron variant has shown too mutated at antibody binding sites which would leverage them for escaping the possible immune response by the body. We don't yet know much about the other alterations and how they might affect the virus's behavior. Omicron COVID-19 strain after identifying individuals with symptoms that were not the same as those seen in the Delta form. People with night sweats have also been reported. The new omicron variant has more mutations than the prevailing rampant delta virus. This makes the newer variant more transmissible, better able to evade itself from various vaccines readily available in the current scenario. These overall increases in the percentage changes in a single day cases of COVID-19 reported cases can be attributed to the beginning of third wave or can be speculated as newer surge of omicron variant cases. Yet another new variant has been detected in France with 46 mutations and 37 deletions in its genetic code, many affecting the spike protein. 'B.1.640.2' is the current nomenclature for this variation.

Synopsis of symptoms of COVID-19 during second wave of the pandemic in India

COVID-19 was caused by the original coronavirus, severe acute respiratory syndrome associated coronavirus-2 (SARS CoV2), which originated in Wuhan, China. COVID-19 had a large breakout of cases in early 2020, resulting in an epidemic that turned into a pandemic. This quickly enveloped the global healthcare system. The principal testing method for COVID-19 detection, according to the WHO, is reverse transcription polymerase chain reaction (RT-PCR). Isolation of patients, quarantine, masking, social distancing, sanitizer use, and complete lockdown were all vital health-care procedures for everyone. With the 'new normal' and vaccination programmes, the number of cases and recovered patients began to rise months later. The easing of restrictions during the plateau phase resulted in a rebound of instances, which hit the people with more ferocity and vengeance towards the start of April 2021. Coronaviruses have evolved to cause respiratory, enteric, hepatic, and neurologic diseases, resulting in a wide range of diseases and symptoms such as fever, cough, myalgia or fatigue, shortness of breath, muscle ache, headache, sore throat, rhinorrhea, hemoptysis, chest pain, nausea, vomiting, diarrhoea, anosmia, and ageusia. Coronavirus infections can be mild, moderate, or severe in intensity. COVID-19 pulmonary dysfunction includes lung edoema, ground-glass opacities, surfactant depletion, and alveolar collapse. Patients who presented with gastrointestinal (GI) symptoms such as anorexia, nausea, vomiting, or diarrhoea had a higher risk of negative outcomes. COVID-19's influence on cognitive function is one of COVID-19's long-term effects. More clinical situations need to be reviewed by healthcare professionals so that an appropriate management protocol may be developed to reduce morbidity and death in future coming third/fourth wave cases.

Regression of lipoedematous scalp following cryolipolysis using an icepack, with a novel dermoscopic feature of yellow background

The novel use of cryolipolysis via icepacks, a readily available and inexpensive device, is described for lipoedematous scalp with subjective and objective relief. This is a simple solution to a troublesome, intractable condition and may readily be utilized for patient benefit. Juxtaposing pre and post clinical images.

Pharmacokinetics of mycophenolate mofetil in Omani patients on cyclosporine or tacrolimus

BACKGROUND

Mycophenolate mofetil (MMF) reduces rejection in organ transplantation and is effective in controlling autoimmune diseases. Determining the area under the receiver operating characteristic curve (AUC) of MMF is not routine despite interindividual variability. The aim of this study was to look into MMF-AUC in Omani patients on cyclosporine (CsA) or tacrolimus (Tac).

METHODS

We measured MMF-AUC in 27 stable Omani patients. We used the 4-time-points-limited sampling strategy.

RESULTS

Sixteen, 8, and 3 recipients were receiving Tac, CsA, and calcineurin inhibitor (CNI)-free regimens, respectively. The mean MMF dose was 1,685 ± 442 mg/d. All except 3 patients were within or above the target AUC. The AUC was significantly higher in patients receiving Tac versus CsA. All patients on Tac were within or above the target AUC. Seven of the 8 patients with MMF-AUC above target were receiving Tac. Two of the 3 patients with MMF-AUC below target were on CsA.

DISCUSSION

These preliminary results confirm the significant interindividual variability of MMF-AUC. None of the recipients on Tac had an AUC below target. Most patients above the target AUC were receiving Tac. Two of the 3 patients with MMF-AUC below target were on CsA and receiving 1 g/d MMF. Patients on Tac are at risk of having higher than the target AUC, exposing them to overimmunosuppression. Recipients on CsA seem to require >1 g/d MMF.

CONCLUSIONS

These preliminary results encourage measuring the AUC of MMF. The fixed MMF dose regimen seems to be unreliable to predict the AUC. Preventing under- or overimmunosuppression offsets the burden.

Selenium intoxication with selenite broth resulting in acute renal failure and severe gastritis

Selenium (Se) is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF). The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN), affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP) and platelet concentrates and hemo-dialysis. The patient was discharged five weeks after admission and her renal functions recovered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.

Retinal injury as an early manifestation of posttransplant thrombotic microangiopathy: recovery with plasma exchanges and conversion to sirolimus--case report and review of the literature

Thrombotic microangiopathy (TMA) remains a serious event. We report a case of occurrence of TMA in the immediate postoperative period after a living-related renal transplantation. A distinguished feature of the case was major, early involvement of the retina with marked by decreased visual acuity along with thrombocytopenia and renal functional impairment. The syndrome was reversible with plasma exchange and conversion from tacrolimus to sirolimus. The patient's renal function is excellent at 11 months after transplantation. Decreased visual acuity and cotton wool exudates may be the first manifestation of posttransplant TMA.

Donor Gender Balance in a Living-Related Kidney Transplantation Program in Oman

It has been observed in several Eastern and Western countries that there is a gender imbalance among kidney donors. In the international experience, approximately 65% of live kidney donors have been women. We retrospectively studied the distribution of female and male donors or recipients among living kidney transplantations performed from 1980 to 2005, namely 198 Omani recipients of living-related kidney transplantations. To examine cultural influences, transplantations performed or expatriates were excluded from the study. For the whole period, 98 out of 198 donors (49.5%) were women. The number of female recipients 75 of 198 (38%) versus males were 123 (62%) recipients. We then subdivided the period into three intervals: 1980 to 1990, 1991 to 2000, and 2001 to 2005. The numbers of female donors for these three periods were 29 of 64 (45%), 42 of 89 (47%), and 27 of 45 (60%), respectively. There was a persistent preponderance of male recipients ranging from 58% to 66% during these periods. We concluded that there was no gender imbalance for kidney donors. Nevertheless, there was a male preponderance in the recipient group.

Complete Regression of Cutaneous B-Cell Lymphoma in a Renal Transplant Patient After Conversion From Cyclosporin to Sirolimus

Posttransplant lymphoproliferative disease remains a serious morbidity. Herein we have reported a case of complete regression of a biopsy-proven B-cell lymphoma that occurred in the posttransplant period. A 48-year-old man received a living donor renal transplant for end-stage renal disease due to undetermined etiology. His initial immunosuppression consisted of corticosteroid, mycophenolate mofetil, and cyclosporin. The patient developed severe pneumonia within the first 2 months after transplantation due to Acineotobacter, fungus, and cytomegalovirus infections. He experienced a complete recovery and was discharged for regional follow-up. Four months after discharge, he was referred again because of presence of two nodules on his trunk. A biopsy of the nodules revealed B-cell lymphoma. Cyclosporin was stopped and he was converted to sirolimus. The lesions regressed progressively and completely within 7 weeks. The patient remains well without clinical relapses at 19 months after conversion. Renal functions remained stable. We postulated that the antincoplastic properties of sirolimus may have played an active part in the positive outcome.

Rhinocerebral mucormycosis associated with diabetic ketoacidosis

Rhinocerebral mucormycosis with hemiparesis occurred in a young woman who was not a known diabetic. Rhyzopus species grew from the initial nasal biopsy. The patient was treated with amphotericin B, in addition to control of diabetic ketoacidosis. Surgical intervention was not done. The patient died on the fourth day of hospitalisation.

Rhabdomyolysis and acute renal failure following a single dose of succinylcholine

A 30-year old with rhabdomyolysis and acute renal failure is presented. The attack followed a minor operation under general anaesthesia during which succinylcholine was administered as muscle relaxant. The fasciculations which occurred immediately after injection of succinylcholine may possibly have precipitated rhabdomyolysis.