Prevalence and distribution of various human papillomavirus genotypes in women with high risk for cervical carcinoma

Background: In India, cervical cancer is second most common cancer in women and is the second most common cause of death due to cancers in women. Human papillomavirus (HPV), mainly genotype 16 and 18, are responsible for most of the precancerous lesions of cervix and for cervical cancer. Therefore, it is necessary to prevent the spread of HPV infection and its early treatment to decrease cervical cancer associated morbidity and mortality. Aims of this study was to find out the prevalence and distribution of various HPV genotypes in women high risk for cervical carcinoma. To find correlation between HPV DNA test and cytology report.Methods: An observational study was done on a total of 384 women who were at a high risk for cervical cancer.  Ectocervix and endocervix samples for conventional cytology along with cervical swab collection for HPV DNA isolation were obtained from women aged 21-65 years. Multiplex real time PCR used for HPV DNA isolation and genotyping and Bethseda classification 2014 was used for reporting cytology. Statistical analysis was done using SPSS version 22 and Microsoft excel 2010 software. Data assessment was done using independent t-test, Chi-square test or Fisher’s exact test.Results: Prevalence of HPV in women high risk for cervical cancer in our study was 14.58%. Most common high-risk genotypes were HPV 18 (7.03%) followed by HPV 16 (6.51%). All genotypes except genotype 31, were more frequently seen as a single infection rather than a multiple infection. In 323 subjects which were negative for Pap smear, 31 were positive for HPV DNA showing a statistically significant result with a p value of <0.0001.Conclusions: It was analysed that infection with HPV is very common (9.60%) even in women who had a negative Pap smear test showing a positive correlation between the two tests. HPV DNA testing can improve the detection rate of cervical intraepithelial lesions

Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion.Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated.Results: The  sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didn’t improve the sensitivity or specificity compared to IFN alone.Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesn’t give additional benefit over IFN alone

Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion.Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated.Results: The  sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didn’t improve the sensitivity or specificity compared to IFN alone.Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesn’t give additional benefit over IFN alone

Epidemiological and mycological characteristics of candidemia in patients with hematological malignancies attending a tertiary-care center in India

Background and objectives: We undertook the present study to ascertain the contributing risk factors and explore the epidemiological and mycological characteristics of opportunistic candidemia among patients with hematological malignancies. Design and settings: Observational cross-sectional study in a tertiary care center. Patients and methods: Consecutive patients with hematological malignancies reporting to the collaborating medical and pediatric units with a febrile episode were recruited and screened for candidemia by blood culture. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI) guidelines M44-A. Further analysis was done for potential risk factors and compared between culture positive and negative patients. Results: Of 150 patients recruited, the majority (n = 27) were between 51 and 60 years and the male to female ratio was 1.63:1. Fifteen patients (10%) were culture positive. The culture positivity was significantly higher in acute lymphocytic leukemia (ALL) than in non-ALL patients (p = 0.03). There was significant association of candidaemia with leucopenia, chemotherapeutic drugs, corticosteroids and presence of indwelling devices. Duration of disease (p = 0.032) and duration of hospitalization (p = 0.003) were significantly prolonged in culture positive patients. C. tropicalis was the commonest isolate (46.67%), with non- Candida albicans outnumbering C. albicans in all categories of hematological malignancies (2.75:1). All isolates of C. albicans were uniformly sensitive to all the azoles, but only 50% were sensitive to amphotericin B and none to nystatin and flucytosine. Conclusions: This observational study identifies ALL and chronic lymphocytic leukemia (CLL) as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics. Keywords: Hematological malignancies, Candida infections, Antifungal resistance, Candida tropicalis, Non-Candida albican

Strengthening comprehensive primary health care through Ayushman Bharat: Role of demand and supply-side interventions

Background: Comprehensive primary health care (CPHC) is an effective way to respond to the challenges of changing epidemiology, growing population expectations, and universal health coverage. A set of demand and supply improvement strategies was developed to support primary health center provision and pilot tested in three model health and wellness centers (HWCs) in Punjab. Objective: The study aimed to assess the early effects of interventions on the inputs, processes, and outputs for optimal implementation of the Ayushman Bharat-HWC (AB-HWC) program. Materials and Methods: Cross-sectional facility assessments were conducted using a standardized methodology at three time points to identify the changes in inputs and processes at subcenter-HWCs from 2019 to 2021. In addition, daily and month-wise service utilization data of model HWCs and nonmodel HWCs in the intervention block and control block in a district of Punjab from the AB-HWC portal were analyzed from May 2020 to April 2021. Results: The difference-in-difference analysis indicated that the CPHC strengthening interventions in the model HWCs improved the mean number of people screened for noncommunicable diseases, mean newly diagnosed patients with hypertension and diabetes, mean hypertensive and diabetic patients on treatment, mean outpatient attendance, and mean number of wellness sessions by 265.71, 21.31, 29.48, 102.17, and 4.88 units per month, compared to control HWCs. Conclusion: The success of the initiatives can be attributed to an integrated approach encompassing multistakeholder planning of interventions, community involvement, empowerment of service providers, and consistent supportive supervision. The long-term success will be contingent on the quality of training, team dynamics, community participation, social accountability, and supervision support

Carbon composite beads for immobilization of carbonic anhydrase

Fixation of anthropogenic CO2 into calcium carbonate using carbonic anhydrase (CA) as a bio-catalyst appears to be a promising option of CO2 sequestration. In the present study, carbonic anhydrase (CA) has been immobilized on chitosan based activated alumina–carbon composite beads. Synthesized adsorbent was thoroughly characterized using XRD, FTIR, SEM and BET-SA. Maximum adsorption capacities were determined using Langmuir model and it was observed to be 172.41 mg/g. Mechanistic and kinetic aspects have been addressed for immobilized as well as free enzyme. The Km and Vmax for immobilized enzyme was 10.35mM and 0.99�mol/ml/min, whereas for free enzyme it was 1.89mM and 0.99�mol/ml/min respectively. Proof of concept has been established for carbonation reaction. The carbonate has been characterized using various tools such as XRD and SEM which confirms the calcite nature of calcium carbonate. The CO2 sequestration capacity in terms of conversion of CO2 to carbonate was quantified by gas chromatography (GC). The CO2 sequestration capacity of immobilized beads was found to be 19.22mg of CaCO3/mg of enzyme as compared to 33.06mg of CaCO3/mg of enzyme for free enzyme

Clinical profile and in-hospital outcomes of COVID-19 patients: Findings from secondary data analysis

Background: Uttarakhand, a hilly state in north India, reported the first coronavirus disease (COVID) case on 15 March 2020. Since then, the case numbers rose multiple folds. As Uttarakhand has been on a 'war-footing' amidst the recent second wave and is gearing up to fight against the third wave, the present study aims to uncover baseline clinical profile and in-hospital outcomes of COVID patients in Dehradun district (Uttarakhand) during the first wave. Methods: A record-based descriptive analysis was carried out for 671 COVID patients admitted to a private dedicated COVID hospital in Dehradun district between August 2020 and February 2021. Data was collected from medical records on a standardized abstraction form. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: The present study showed most admitted COVID patients were males, aged 40 years and above, moderately ill, had co-morbidities with about one-fourth lately succumbed to death. The proportions of deaths, moderate-to-severe and severe category of illness were invariably high for those with co-morbidities irrespective of the gender. Females, age <60 years, and absence of co-morbidities had overall high mean survival estimates from COVID. Conclusion: Females, younger age group, and absence of co-morbidities are more likely to survive from COVID than males, older age groups, and those with co-morbidities