Endoscopic Repair of Spontaneous CSF Rhinorrhoea: Results from 21 Cases

Introduction Surgery to close the skull base defect is the treatment of choice in persistent spontaneous cerebrospinal fluid rhinorrhoea with endoscopic endonasal repair being the method of choice.  This study analysed the demographics of presentation, optimal diagnostic and localisation strategies and the effectiveness of transnasal endoscopic treatment strategies  with post-operative follow-up of CSF rhinorrhoea patients in a tertiary care institution   . Materials and Methods  A prospective longitudinal study was conducted on 21 CSF rhinorrhoea patients operated on between August 2014 and August 2018 and results documented. Results CSF rhinorrhoea was found most commonly in middle aged female patients in our study. HRCT PNS was capable of identifying a leak site in 66% of the cases. All patients were operated endoscopically with no major intra-operative or post-operative complications. Resolution of CSF leak occurred in 85% of cases. Conclusion CSF rhinorrhoea can be diagnosed and endoscopic repair can be effectively performed in our existing tertiary care set-ups with good results

Optimizing Village-Level Targeting of Active Case Detection to Support Visceral Leishmaniasis Elimination in India.

Background: India has made major progress in improving control of visceral leishmaniasis (VL) in recent years, in part through shortening the time infectious patients remain untreated. Active case detection decreases the time from VL onset to diagnosis and treatment, but requires substantial human resources. Targeting approaches are therefore essential to feasibility. Methods: We analyzed data from the Kala-azar Management Information System (KAMIS), using village-level VL cases over specific time intervals to predict risk in subsequent years. We also graphed the time between cases in villages and examined how these patterns track with village-level risk of additional cases across the range of cumulative village case-loads. Finally, we assessed the trade-off between ACD effort and yield. Results: In 2013, only 9.3% of all villages reported VL cases; this proportion shrank to 3.9% in 2019. Newly affected villages as a percentage of all affected villages decreased from 54.3% in 2014 to 23.5% in 2019, as more surveillance data accumulated and overall VL incidence declined. The risk of additional cases in a village increased with increasing cumulative incidence, reaching approximately 90% in villages with 12 cases and 100% in villages with 45 cases, but the vast majority of villages had small cumulative case numbers. The time-to-next-case decreased with increasing case-load. Using a 3-year window (2016-2018), a threshold of seven VL cases at the village level selects 329 villages and yields 23% of cases reported in 2019, while a threshold of three cases selects 1,241 villages and yields 46% of cases reported in 2019. Using a 6-year window increases both effort and yield. Conclusion: Decisions on targeting must consider the trade-off between number of villages targeted and yield and will depend upon the operational efficiencies of existing programs and the feasibility of specific ACD approaches. The maintenance of a sensitive, comprehensive VL surveillance system will be crucial to preventing future VL resurgence

Development and Evaluation of Active Case Detection Methods to Support Visceral Leishmaniasis Elimination in India.

As India moves toward the elimination of visceral leishmaniasis (VL) as a public health problem, comprehensive timely case detection has become increasingly important, in order to reduce the period of infectivity and control outbreaks. During the 2000s, localized research studies suggested that a large percentage of VL cases were never reported in government data. However, assessments conducted from 2013 to 2015 indicated that 85% or more of confirmed cases were eventually captured and reported in surveillance data, albeit with significant delays before diagnosis. Based on methods developed during these assessments, the CARE India team evolved new strategies for active case detection (ACD), applicable at large scale while being sufficiently effective in reducing time to diagnosis. Active case searches are triggered by the report of a confirmed VL case, and comprise two major search mechanisms: 1) case identification based on the index case's knowledge of other known VL cases and searches in nearby houses (snowballing); and 2) sustained contact over time with a range of private providers, both formal and informal. Simultaneously, house-to-house searches were conducted in 142 villages of 47 blocks during this period. We analyzed data from 5030 VL patients reported in Bihar from January 2018 through July 2019. Of these 3033 were detected passively and 1997 via ACD (15 (0.8%) via house-to-house and 1982 (99.2%) by light touch ACD methods). We constructed multinomial logistic regression models comparing time intervals to diagnosis (30-59, 60-89 and ≥90 days with =90 days compared to the referent of <30 days for ACD vs PCD were 0.88, 0.56 and 0.42 respectively. These ACD strategies not only reduce time to diagnosis, and thus risk of transmission, but also ensure that there is a double check on the proportion of cases actually getting captured. Such a process can supplement passive case detection efforts that must go on, possibly perpetually, even after elimination as a public health problem is achieved

Ion Exchange Transformation of Magic-Sized Clusters

Ultrasmall semiconductor clusters are exciting materials because of their molecularly precise structures and their unique optical spectra. “Magic-sized” CdSe clusters are transformed into their Cu₂Se counterparts by means of ion exchange. We leverage the molecularly precise structure and high sensitivity of these clusters to investigate the mechanism of cation exchange. We optically identify a metastable intermediate in the solid-state transformation. Isolation and characterization of this intermediate provide insight into the dynamic structural rearrangement of the cationic sublattice in the course of cation exchange and the role of ligand passivation. Such understanding of the dynamics of ion exchange at the solid–liquid interface could help engineer improved materials for solid-state electrolytes and energy storage devices

IL-10/IL-6 ratio from nasal &amp; oral swab samples, acts as an inflammatory indicator for COVID-19 patients infected with the delta variant

Background: Hyper-inflammatory immune response of SARS-CoV-2 is often characterized by the release of multiple pro-inflammatory cytokines with an impact on the expression of numerous other interleukins (ILs). However, from oral and nasal swab samples the specific quantitative association of the different IL-markers with the disease progression and its relationship with the status of vaccination remains unclear. Materials and methods: Patients’ combined oral and nasal swab samples were collected from both non-vaccinated and double-vaccinated individuals with high (Ct value  30) viral loads, along with uninfected donors. None of the patients were critically ill, or needed ICU support. The expression of different cytokines (IL6, IL10, IL1B, IFNG) and mucin (MUC5AC, MUC1) markers were assessed between different groups by qRT-PCR. The important cytokine markers differentiating between vaccinated and non-vaccinated patients were identified by PCA. Conclusion: IL6 expression was higher in non-vaccinated COVID-19 patients infected with delta-variant irrespective of their viral-load compared to uninfected individuals. However, in double-vaccinated patients, only in high viral-load patients (Ct value  30. IL1B, and IFNG expression remained unaltered in uninfected and infected individuals. However, MUC5AC expression was lower in non-vaccinated patients with Ct value < 25 compared to control group. Our study unveiled that IL10/IL6 ratio can be used as a biomarker for COVID-19 patients upon proper establishment of it in a clinical setting

Epidemiologic Correlates of Mortality among Symptomatic Visceral Leishmaniasis Cases: Findings from Situation Assessment in High Endemic Foci in India - Fig 1

<p>Estimates of the cumulative survival probabilities (Kaplan-Meier estimates) of VL patients, from the time of diagnosis, stratified by the categories of: (A) age of the patient; (B) gender of the patient; (C) caste of the patient; (D) place from which VL treatment was received; (E) facility where VL was diagnosed; (F) interval between symptom onset and diagnosis; (G) type of drug used for VL treatment; and (H) completion of the course of VL treatment. Bihar, 2012–13. (N = 4925).</p

Hazard ratios (and 95% confidence intervals) of death among VL cases, since the time of diagnosis, from crude and adjusted Cox proportional hazards models.

<p>Bihar, 2012–13. (N = 4925).^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005150#t002fn001" target="_blank">*</a>}</p

Comparison of socio-demographic and disease-related characteristics between the dead and surviving (till date of interview) VL cases in 8 districts of Bihar. 2012–13 (N = 4925)

<p>Comparison of socio-demographic and disease-related characteristics between the dead and surviving (till date of interview) VL cases in 8 districts of Bihar. 2012–13 (N = 4925)</p

Additional file 2: Table S2. of Variations in visceral leishmaniasis burden, mortality and the pathway to care within Bihar, India

Distribution of continuous variables (age, waiting times and house size) for the eight study districts. (DOCX 15 kb

Additional file 4: Figure S2. of Variations in visceral leishmaniasis burden, mortality and the pathway to care within Bihar, India

Maps of Bihar showing burdens of identified cases in study districts for January 2012 - June 2013 at (a) district level and (b) block level. (DOCX 996 kb