Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as markers of early sepsis and mortality in pediatric burns: a prospective evaluation

Background: Delay in the diagnosis of sepsis in pediatric burns results in advertently high mortality and morbidity. Our study aimed at evaluating the role of two upcoming biomarkers- neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR)- as predictors of early sepsis and mortality in this group of patients. Methods: This was a prospective study conducted at a tertiary care burn centre of northern India over 18 months. 90 pediatric burn cases, aged 1-16 years, presenting within 24 hours of burns, with >10% body surface area of thermal burns/scalds were included in the study. Cell counts were measured on day 1, 3, 5 and 7 of burns. Patients were followed up till discharge, 30th post burn day or death, whichever was earlier. Results: Sepsis was clinically present in 49 cases out of 90 (54.44%) with 30% median total body surface area (TBSA) of burns. Mortality was seen in 31cases out of 90 (34.44%) with 35% median TBSA burns. Higher PLR levels were seen in the sepsis group. NLR and PLR were also elevated in the survival group. Both parameters were found to be reliable markers of sepsis as well as mortality, particularly on days 5 and 7, in this cohort of patients. Conclusions: Indices like NLR and PLR, which can easily be derived from complete blood count, have potential utility as determinants of both sepsis and mortality in children afflicted with thermal injuries

Spectrum of Enteric Parasitic Infections in Immunocompromised and Immunocompetent Patients in a Tertiary Care Hospital, New Delhi- A Retrospective Study

Introduction: Parasitic intestinal diseases caused by protozoans and helminths are important causes of gastrointestinal disturbances which are responsible for a high burden of morbidity and mortality as they are detrimental not only to paediatric and immunocompromised patients but also to adults and immunocompetent patients. Hence, it is important to know their burden in a geographical area to develop adequate control measures. Aim: To estimate the prevalence of various intestinal parasitic infections in symptomatic patients based on age, gender and immune status in a tertiary care hospital, New Delhi, India. Materials and Methods: A retrospective analysis of 1431 stool samples which were received in the Department of Microbiology VMMC and Safdarjung Hospital, New Delhi, from April 2019 to March 2020 was done. All samples were subjected to macroscopic and microscopic examinations and underwent, wet mount (saline and iodine) examination and Modified Ziehl-Neelson staining. Data was analysed using Statistical Package for Social Sciences (SPSS) software version 21.0 with two-tailed Chi-square test wherever applicable. Results: Males (61.36%) outnumbered females. Prevalence of parasites was more in adults (7.76%) than in children. Higher positivity (7.6%) was observed in immunocompetent individuals as compared to immunocompromised. Overall predominance of protozoans (98.26%) over helminths was noted. Entamoeba histolytica/dispar group (43.60%) was found to be the most prevalent parasite. Entamoeba histolytica/dispar group (5.64%) and Cryptosporidium spp. (5.94%) were most common amongst immunocompetent and immunocompromised patients respectively. Conclusion: A higher prevalence of intestinal parasitic infections in immunocompetent symptomatic patients was observed, requiring attention of clinicians as they are no longer limited majorly to immunocompromised patients. As no effective vaccine is available for these infections, so appropriate laboratory methods, microbiological expertise, proper sanitation measures, availability of potable water supply and properly cooked food are essential to control parasitic intestinal diseases

A case-control study of serum and tissue catalase among morphological variants of vitiligo

Background: Role of oxidative stress in the pathogenesis of vitiligo. Aim: Estimation of serum and tissue catalase levels in morphological variants of vitiligo. Settings and Design: A prospective case-control study was conducted in the outpatient department of Dermatology in Safdarjung hospital. Materials and Methods: We estimated levels of serum and tissue catalase in 30 vitiligo patients and 30 matched healthy controls. Statistical Analysis: The data analysis was done in Statistical Package for Social Sciences (SPSS) version 21.0. Normality of data was tested by Kolmogorov–Smirnov test. Results: Serum and tissue catalase was lower in vitiligo patients than controls. Serum catalase was lowest in vulgaris type, whereas in the acrofacial type had lowest tissue catalase levels. Conclusion: Vitiligo patients have a generalized oxidative stress functioning at a higher pace as seen with decreased serum and tissue CAT which can well be taken as a marker of active disease and they can be helped with topical pseudoCAT preparations

Molecular characterization of the severe falciparum malaria with typhoid co-infection: A case report

Malaria and typhoid co-infections can be a serious public health issue in tropical countries leading to incorrect diagnosis due to overlapping clinical presentations of malaria and typhoid and hence, causing a delay in implementing the appropriate treatment regimen for these concurrent infections. This study reports a case of six-year-old female child co-infected with severe malaria (Plasmodium falciparum) and typhoid (Salmonella typhi) diagnosed by rapid malaria antigen test (RMAT) and blood culture respectively. Further, analysis of the chloroquine resistance gene Pfcrt for the falciparum demonstrated the presence of K76T mutant allele in pfcrt gene with high IC50 (150nM) for chloroquine (CQ) drug. The present case highlights the significance of timely identification and treatment of co-infections and also provides information about the circulating P. falciparum clinical strains

Development of Two-Tube Loop-Mediated Isothermal Amplification Assay for Differential Diagnosis of Plasmodium falciparum and Plasmodium vivax and Its Comparison with Loopamp™ Malaria

To strengthen malaria surveillance, field-appropriate diagnostics requiring limited technical resources are of critical significance. Loop-mediated isothermal amplification (LAMP) based malaria diagnostic assays are potential point-of-care tests with high sensitivity and specificity and have been used in low-resource settings. Plasmodium vivax–specific consensus repeat sequence (CRS)-based and Plasmodium falciparum–specific 18S rRNA primers were designed, and a two-tube LAMP assay was developed. The diagnostic performance of a closed-tube LAMP assay and Loopamp™ Malaria Detection (Pan/Pf, Pv) kit was investigated using nested PCR confirmed mono- and co-infections of P. vivax and P. falciparum positive (n = 149) and negative (n = 67) samples. The closed-tube Pv LAMP assay showed positive amplification in 40 min (limit of detection, LOD 0.7 parasites/µL) and Pf LAMP assay in 30 min (LOD 2 parasites/µL). Pv LAMP and Pf LAMP demonstrated a sensitivity and specificity of 100% (95% CI, 95.96–100% and 89.85–100%, respectively). The LoopampTM Pan/Pf Malaria Detection kit demonstrated a sensitivity and specificity of 100%, whereas LoopampTM Pv showed a sensitivity of 98.36% (95% CI, 91.28–99.71%) and specificity of 100% (95% CI, 87.54–100%). The developed two-tube LAMP assay is highly sensitive (LOD ≤ 2 parasite/µL), demonstrating comparable results with the commercial Loopamp™ Malaria Detection (Pf/pan) kit, and was superior in detecting the P. vivax co-infection that remained undetected by the Loopamp™ Pv kit. The developed indigenous two-tube Pf/Pv malaria detection can reliably be used for mass screening in resource-limited areas endemic for both P. falciparum and P. vivax malaria