A retrospective study on clinician’s practice on testing and treating for cytomegalovirus infection in patients with acute ulcerative colitis in a tertiary care center in India

Background: Reactivation of cytomegalovirus (CMV) may occur in patients with ulcerative colitis (UC) while on immunosuppressive treatment. Whereas some workers suggested that treatment of CMV is needed in them, others contradicted this. We aimed to retrospectively evaluate, a) how frequently clinicians evaluate for CMV in patients admitted with acute severe colitis, b) prevalence of its occurrence, and c) how frequently clinicians treated CMV infection in a tertiary care center.Methods: Data on consecutive patients with UC admitted to the department of Gastroenterology during a seven-year period at a tertiary care center were retrospectively reviewed. Frequency of evaluation for CMV (IgM antibody, polymerase chain reaction or inclusion body in H and E-stained sections by the treating clinicians was evaluated. Any one test positive out of all the three tests was considered as evidence of CMV infection. Frequency of treatment directed against CMV by treating clinicians was evaluated.Results: Among 181 admitted patients with UC, 41 (22.6%) were tested for CMV infection, of whom 28 (59.6%) were male. Fourteen of 41 (34.1%) were CMV positive (one of three above mentioned tests positive). Twelve had detectable CMV DNA by PCR and 3 had IgM antibody positive (one of whom also had inclusion body on histopathology). Three of 14 patients with CMV infection received anti-viral treatment (ganciclovir in two, ganciclovir followed by valganciclovir in one).Conclusions: These data suggest that investigating and treating CMV as a cause for acute ulcerative colitis is becoming obsolete About one-fourth of patients admitted with severe UC in a tertiary centre are screened for CMV infection, about one-third of whom tested positive to at least one test. Only one-fifth of patients with positive result to the test were treated against the infection.

Appraisal of Noise Level Dissemination Surrounding Mining and Industrial Areas of Keonjhar, Odisha: a Comprehensive Approach Using Noise Mapping

Noise mapping is a well-established practice among the European nations, and it has been following for almost two decades. Recently, as per guidelines of the Directorate General of Mines Safety (DGMS), India, noise mapping has made mandatory in the mining expanses. This study is an effort made to map the noise levels in nearby areas of mines in the northern Keonjhar district. The motive of this study is to quantify the existing A-weighted time-average sound level (LAeq,T) in the study area to probe its effects on the human dwellings and noise sensitive areas with the probability of future development of the mines, roads and industrial & commercial zone. The LAeq,T was measured at 39 identified locations, includes industrial, commercial, residential and sensitive zones, 15 open cast mines, 3 major highways and 3 haulage roads. With the utilization of Predictor LimA Software and other GIS tools, the worked out data is mapped and noise contours are developed for the visualization and identification of the extent and distribution of sound levels across the study area. This investigation discloses that the present noise level at 60% of the locations in silence and residential zone are exposed to significantly high noise levels surpasses the prescribed limit of Central Pollution Control Board (CPCB), India. The observed day and night time LAeq,T level of both the zone, ranged between 43.2 - 62.2 dB (A) and 30.5 – 53.4 dB (A) respectively whereas, the average Ldn values vary between 32.7 – 51.2 dB (A). The extensive mobility of heavy vehicles adjoining the sensitive areas and a nearby plethora of open cast mines is the leading cause of exceeded noise levels. The study divulges that the delicate establishments like school and hospitals are susceptible to high noise levels throughout the day and night. A correlation between observed and software predicted values gives R2 of 0.605 for Ld; 0.217 for Ln; and 0.524 for Ldn. Finally, the mitigation measure proposed and demonstrated using contour map showing a significant reduction in the noise levels by 0 – 5.3 dB (A)

Current Status of Knowledge on Hilsa

Species of the family Clupeidae are highly preferred food fishes in the world. The Indian shad, hilsa, belonging to the family Clupeidae, contribute to commercial catches in a number of countries bordering the Bay of Bengal, Indian Ocean, Persian Gulf and Arabian Sea. The species normally inhabit rivers, estuaries and coastal waters. The highest catch comes from the deltaic region of the Gangetic system in the coastal Bay o f Bengal. The fish is anadromous; grows and matures in the sea and migrates to freshwater fo r spawning. Hilsa fisheries provides direct and indirect livelihood to millions o f fishers along the coastal and riverine stretches in its range of distribution. They are highly delicious, priced and has important sociocultural importance, especially in West Bengal and the north eastern States of India. On account of its commercial importance and migratory habit, hilsa received research attraction since 1907 and there is a wealth of disseminated literature on various aspects o f hilsa by researchers o f different countries, including India

Common variants in CLDN2 and MORC4 genes confer disease susceptibility in patients with chronic pancreatitis

A recent Genome-wide Association Study (GWAS) identified association with variants in X-linked CLDN2 and MORC4 and PRSS1-PRSS2 loci with Chronic Pancreatitis (CP) in North American patients of European ancestry. We selected 9 variants from the reported GWAS and replicated the association with CP in Indian patients by genotyping 1807 unrelated Indians of Indo-European ethnicity, including 519 patients with CP and 1288 controls. The etiology of CP was idiopathic in 83.62% and alcoholic in 16.38% of 519 patients. Our study confirmed a significant association of 2 variants in CLDN2 gene (rs4409525—OR 1.71, P = 1.38 x 10-09; rs12008279—OR 1.56, P = 1.53 x 10-04) and 2 variants in MORC4 gene (rs12688220—OR 1.72, P = 9.20 x 10-09; rs6622126—OR 1.75, P = 4.04x10-05) in Indian patients with CP. We also found significant association at PRSS1-PRSS2 locus (OR 0.60; P = 9.92 x 10-06) and SAMD12-TNFRSF11B (OR 0.49, 95% CI [0.31–0.78], P = 0.0027). A variant in the gene MORC4 (rs12688220) showed significant interaction with alcohol (OR for homozygous and heterozygous risk allele -14.62 and 1.51 respectively, P = 0.0068) suggesting gene-environment interaction. A combined analysis of the genes CLDN2 and MORC4 based on an effective risk allele score revealed a higher percentage of individuals homozygous for the risk allele in CP cases with 5.09 fold enhanced risk in individuals with 7 or more effective risk alleles compared with individuals with 3 or less risk alleles (P = 1.88 x 10-14). Genetic variants in CLDN2 and MORC4 genes were associated with CP in Indian patients

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Endoscopic Drainage of Pancreatic Pseudocysts: An Experience with 77 Patients

Background: We evaluated short‑ and long‑term results of endoscopic drainage (a minimally invasive nonsurgical treatment) of pancreatic pseudocysts (PPCs) and factors associated with its success at a multilevel teaching hospital in Northern India, as such data are scanty from India. Patients and Methods: Retrospective review of records of consecutive patients undergoing endoscopic drainage of PPC from January 2002 to June 2013 was undertaken. Results: Seventy‑seven patients (56 males), median age 36 years (range, 15–73), underwent endoscopic drainage of PPC with 98% technical success. Pseudocysts drained were symptomatic (duration 11 weeks, range, 8–68), large (volume 582 mL [range, 80–2706]), located in head (n = 32, 46%), body and tail (n = 37, 54%), and infected (n = 39, 49%). Drainage procedures included cystogastrostomy (n = 54, 78%), cystoduodenostomy (n = 9, 13%), transpapillary drainage (n = 2, 3%), and multiple route (n = 4, 6%), with additional endoscopic nasocystic drainage (ENCD) in 41 (59%). Sixty‑nine patients were followed up (median 28 months, range 2–156; other eight lost to follow‑up). Complications (n = 21, 30%) included stent occlusion and migration (13), bleeding (5), perforation (2), and death (1). Endoscopic procedure had to be repeated in 19 patients (28%; 16 for sepsis, 3 for recurrence). The reasons for additional nonendoscopic treatment (n = 8, 12%) included incomplete cyst resolution (3), recurrence (2), bleeding (1), and perforation (2). Overall success rate of endoscopic drainage was 88%. Whereas infected pseudocysts were associated with poorer outcome (odds ratio [OR] 0.016; 95% confidence interval [CI] 0.001–0.037), placement of ENCD led to better results (OR 11.85; 95% CI 1.03–135.95). Conclusion: Endoscopic drainage is safe and effective for PPC

A retrospective study on clinician's practice on testing and treating for cytomegalovirus infection in patients with acute ulcerative colitis in a tertiary care center in India

Background: Reactivation of cytomegalovirus (CMV) may occur in patients with ulcerative colitis (UC) while on immunosuppressive treatment. Whereas some workers suggested that treatment of CMV is needed in them, others contradicted this. We aimed to retrospectively evaluate, a) how frequently clinicians evaluate for CMV in patients admitted with acute severe colitis, b) prevalence of its occurrence, and c) how frequently clinicians treated CMV infection in a tertiary care center. Methods: Data on consecutive patients with UC admitted to the department of Gastroenterology during a seven-year period at a tertiary care center were retrospectively reviewed. Frequency of evaluation for CMV (IgM antibody, polymerase chain reaction or inclusion body in H and E-stained sections by the treating clinicians was evaluated. Any one test positive out of all the three tests was considered as evidence of CMV infection. Frequency of treatment directed against CMV by treating clinicians was evaluated. Results: Among 181 admitted patients with UC, 41 (22.6%) were tested for CMV infection, of whom 28 (59.6%) were male. Fourteen of 41 (34.1%) were CMV positive (one of three above mentioned tests positive). Twelve had detectable CMV DNA by PCR and 3 had IgM antibody positive (one of whom also had inclusion body on histopathology). Three of 14 patients with CMV infection received anti-viral treatment (ganciclovir in two, ganciclovir followed by valganciclovir in one). Conclusions: These data suggest that investigating and treating CMV as a cause for acute ulcerative colitis is becoming obsolete About one-fourth of patients admitted with severe UC in a tertiary centre are screened for CMV infection, about one-third of whom tested positive to at least one test. Only one-fifth of patients with positive result to the test were treated against the infection. [Int J Res Med Sci 2016; 4(8.000): 3262-3266