Clinical profile of patients with COVID-19 and tuberculosis co-infection in a tertiary care hospital

Background: Historical evidences suggest that Tuberculosis (TB) with concurrent respiratory viral infections, such as, Influenza has been associated with higher mortality. TB and COVID-19 co-infection has implications beyond mortality at the individual level. Hence there is a need to study the clinical characteristics and outcomes in COVID-19 and TB co-infection.Methods: In this retrospective observational study, COVID-19 cases admitted to Victoria Hospital, a tertiary care hospital in Bengaluru, twenty-six patients with COVID 19 and TB co-infection were observed and their clinical characteristics, radiological and laboratory parameters were recorded and analyzed for the impact of COVID-19 on TB.Results: Raised inflammatory markers, high neutrophil to lymphocyte ratio (NLR), lymphocytopenia were observed in majority of the cases. There was worsening of Tubercular lesions on Chest radiography in eighteen patients (69%). Out of the twenty six, sixteen patients (61%) needed supplemental oxygen therapy at admission, Five (19%) of them needed Assisted ventilation and intensive care. Out of the five patients who needed intensive care, two (7.6%) patients succumbed to death owing to Severe COVID-19 pneumonia, respiratory failure and other co-morbid conditions.Conclusions: Co-infection with COVID-19 and TB alters the severity, the course and management of the disease and can be associated with adverse outcomes and is associated with high mortality; a high index of suspicion is required for the detection of this co-infection and bi-directional screening of COVID-19 and TB must be carried out for the early detection and management of this co-infection.

Modulation by S-nitrosoglutathione (a natural nitric oxide donor) of photosystem in Pisum sativum leaves, as revealed by chlorophyll fluorescence: Light-dependent aggravation of nitric oxide effects

The reported effects of nitric oxide (NO), a signaling molecule, on the photochemical components of leaves are ambiguous. We examined the changes by a natural NO donor, S-nitrosoglutathione (GSNO). The effect of GSNO on Pisum sativum leaves was studied after a 3-hour exposure in dark, moderate (ML), or high light (HL). The NO levels in GSNO-treated samples were at their maximum under HL, compared to those under ML or dark. Most of the elevated NO was decreased by 2-4-carboxyphenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (cPTIO), a NO scavenger, confirming the NO increase. Treatment with GSNO caused inhibition of photosynthesis/respiration and restricted electron transport mediated by both photosystem (PS)II and PSI. However, the inhibition by NO-donor of PSII components was stronger than those of PSI. A marked increase in the PSI acceptor side limitation [Y(NA)] and a decrease in PSI donor side limitation [Y(ND)] indicated an upregulation of cyclic electron transport, possibly to balance the damage to PSII by GSNO. We suggest that NO aggravated the HL-induced inhibition of photosynthesis and dark respiration

On the Superiority of a Variable Sampling Interval Control Chart

The paper establishes the analytical grounds of the uniform superiority of a variable sampling interval (VSI) Shewhart control chart over the conventional fixed sampling interval (FSI) control chart, with respect to the zero-time performance, for a wide class of process distributions. We provide a sufficient condition on the distribution of a control chart statistic, and propose a criterion to determine the control limits and the regions in the in-control area of the VSI chart, corresponding to the different sampling intervals used by it. The condition and the criterion together ensure the uniform zero-time superiority of the VSI chart over the matched FSI chart, in detecting a process shift of any magnitude. It is shown that normal, Student's t and Laplace distributions satisfy the sufficient condition. In addition, chi-square, F and beta distributions satisfy it, provided that these are not extremely skewed. Further, it is illustrated that the superiority of the VSI feature is not trivial and cannot be assured if the sufficient condition is not satisfied or the control limits and the regions are not determined according to the proposed criterion. An application of the result to confirm the superiority of the VSI feature is demonstrated for the control chart for individual observations used to monitor a milk-pouch filling process.Adaptive control chart, average time to signal, average number of samples to signal, zero-time performance, statistical process control,

Correlation between chest CT severity score and C-reactive protein in COVID-19 positive patients admitted in a tertiary care hospital: a retrospective study

Background: COVID-19 has developed into a worldwide pandemic. The early identification of patients who will become severely ill could facilitate the allocation of the limited medical resources to patients in need of aggressive treatment. Aim of the current study was to determine the correlation between COVID-19 severity with inflammatory marker CRP and CT severity score on HRCT thoraxMethods: A retrospective observational study was done in 502 hospitalized COVID‑19 patients in a tertiary care hospital BMCRI, Bangalore from August 2021 to September 2021. Clinical and laboratory data of patients were collected. The correlation between clinical severity with chest CT score and CRP were determined by ANOVA test and independent sample t-test was applied among survivors and non survivors. Correlation between CTSS and CRP was analyzed by Pearson correlation analysis.Results: In our present study we found that, out of 502 patients who fulfilled the inclusion criteria 158 patients (31.5%) were triaged as mild cases, 228 patients (45.4%) were moderate case, and 116 patients (23.1%) severe cases. There was statistical significance between CRP values and CTSS among the mild, moderate, severe cases (p<0.001). Both CTSS and CRP values had explicit association with clinical condition of patients. By using independent sample t-test we could derive that CRP and CTSS had strong and significant correlation with the disease severity and mortality. Pearson correlation analysis revealed strong positive correlation between CRP and CTSS in COVID-19 patients. Hence an increase in CRP caused an increase in CTSS with significant p values.Conclusions: In our study we conclude that there is a strong positive clinical correlation between CRP and CTSS in COVID-19 patients reflecting disease severity and mortality

Hydrogen peroxide in exhaled breath condensate: A clinical study

Objectives: To study the ongoing inflammatory process of lung in healthy individuals with risk factors and comparing with that of a known diseased condition. To study the inflammatory response to treatment. Background: Morbidity and mortality of respiratory diseases are raising in trend due to increased smokers, urbanization and air pollution, the diagnosis of these conditions during early stage and management can improve patient′s lifestyle and morbidity. Materials and Methods: One hundred subjects were studied from July 2010 to September 2010; the level of hydrogen peroxide concentration in exhaled breath condensate was measured using Ecocheck. Results: Of the 100 subjects studied, 23 were healthy individuals with risk factors (smoking, exposure to air pollution, and urbanization); the values of hydrogen peroxide in smokers were 200-2220 nmol/l and in non-smokers 340-760 nmol/l. In people residing in rural areas values were 20-140 nmol/l in non-smokers and 180 nmol/l in smokers. In chronic obstructive pulmonary disease cases, during acute exacerbations values were 540-3040 nmol/l and 240-480 nmol/l following treatment. In acute exacerbations of bronchial asthma, values were 400-1140 nmol/l and 100-320 nmol/l following treatment. In cases of bronchiectasis, values were 300-340 nmol/l and 200-280 nmol/l following treatment. In diagnosed pneumonia cases values were 1060-11800 nmol/l and 540-700 nmol/l following treatment. In interstitial lung diseases, values ranged from 220-720 nmol/l and 210-510 nmol/l following treatment. Conclusion: Exhaled breath condensate provides a non-invasive means of sampling the lower respiratory tract. Collection of exhaled breath condensate might be useful to detect the oxidative destruction of the lung as well as early inflammation of the airways in a healthy individual with risk factors and comparing the inflammatory response to treatment

Effect of casein phosphopeptide - amorphous calcium phosphate containing chewing gum on salivary concentration of calcium and phosphorus: An in-vivo study

Aim: Caries clinical trials of sugar-free chewing gum have shown that the gum is noncariogenic and in fact has anticariogenic effect through the stimulation of saliva. Sugar-free gums, therefore, may be an excellent delivery vehicle for safe and effective additive, capable of promoting enamel remineralization. Casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have shown to remineralize enamel subsurface lesions in situ. So this study was conducted to evaluate the effect of CPP-ACP containing sugar-free chewing gum on salivary concentration of calcium and phosphorous. Materials and Methods : Unstimulated saliva from each 24 selected subjects was collected. Then each subject was given two pellets of chewing gum containing CPP-ACP and asked to chew for a period of 20 min, after which saliva samples were collected from each individual. Once all the samples were collected they were assessed for calcium and phosphorous concentration using affiliated reagent kits and photometer. Statistical Analysis Used: Data obtained were analyzed using student′s paired t test. Results: Significant difference was found in the calcium and phosphorus concentration of saliva before and after chewing CPP-ACP containing chewing gum. Conclusions: Chewing of CPP-ACP containing chewing gum showed a significant increase in the salivary concentration of calcium for a prolonged period of time hence it may help in the remineralization of tooth surfaces

Resistance pattern in drug-resistant pulmonary tuberculosis

Background: Drug-resistant tuberculosis is an important issue for public health. There is a rise in the trend of drug-resistant tuberculosis, especially multi drug resistance (MDR), in different parts of world, India being one of the high burden countries. This study is undertaken to assess the various patterns of resistance among confirmed drug resistant pulmonary tubercular patients and to initiate second line anti tubercular treatment. Aims and Objectives: To assess various resistance patterns among confirmed drug resistant pulmonary tubercular patients and for the initiation of appropriate drug regimens in our setup. Study Design: An observational prospective study. Materials and Methods: This study was conducted at Rajiv Gandhi Institute of Chest Diseases, Bangalore between January 2005 and November 2010. A total of 309 drug resistant tuberculosis cases were studied. Sputum culture and drug sensitivity were carried out at National Tuberculosis Institute. Drug sensitivity testing done for all first line drugs, except pyrazinamide, by using LJ media. Results: In this study, out of 309 patients, MDR pattern was observed in 224 (72%), of which 20 (6.47%) had resistance only to isoniazid (INH) and rifampicin (RMP), 58 (18.7%) had resistance to INH, RMP, and either of the other first line drugs streptomycinor ethambutol and 146 (47.25%) had resistance to all first line drugs. Poly drug resistance pattern was observed in 72 (23.3%) and Mono drug resistance in 13 (4.2%). Conclusion: In the present study the most common pattern observed is MDR with predominant resistance to INH. There is a rise in the number of drug resistant tuberculosis cases, especially MDR. Hence close monitoring of drug resistant pattern is required to formulate designs of different regimens in the treatment of drug resistant tuberculosis; especially MDR-TB based on accredited laboratory reports, in a specialized center which is very much essential for the betterment of the patients and the community

Identification and genetic diversity analysis of Memecylon species using ISSR, RAPD and Gene-based DNA barcoding tools

Background Memecylon species are commonly used in Indian ethnomedical practices. The accurate identification is vital to enhance the drug's efficacy and biosafety. In the present study, PCR based techniques like RAPD, ISSR and DNA barcoding regions, such as 5s, psbA-trnH, rpoC1, ndh and atpF-atpH, were used to authenticate and analyze the diversity of five Memecylon species collected from Western Ghats of India. Results Phylogenetic analysis clearly distinguished Memecylon malabaricum from Memecylon wightii and Memecylon umbellatum from Memecylon edule and clades formed are in accordance with morphological keys. In the RAPD and ISSR analyses, 27 accessions representing five Memecylon species were distinctly separated into three different clades. M. malabaricum and M. wightii grouped together and M. umbellatum, M. edule and Memecylon talbotianum grouped in the same clade with high Jaccard dissimilarity coefficient and bootstrap support between each node, indicating that these grouped species are phylogenetically similar. Conclusion Data from the present study reveals that chloroplast psbA-trnH region could be used as a potential candidate region for identifying Memecylon species, and ISSR marker system could be used for estimating genetic diversity since it has high percent polymorphism compared to RAPD marker