Impact of COVID-19 infection on maternal near miss cases in tertiary care centre

Background: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to a health crisis. Since the beginning of the severe acute respiratory syndrome (SARS-CoV-2) or COVID-19 outbreak, it has been argued whether pregnant women are at increased risk of severe infection.1 The objective of this study was to summarize the effect of COVID-19 on maternal near miss cases.Methods: This single-centre prospective observational study, included all consecutive pregnant women with COVID-19 infection admitted to Lokmanya Tilak Municipal Medical College and General Hospital (Mumbai, India), a tertiary referral hospital, from 1 April 2020, to 20 December 2020. In this study, a total of 46 patients were included in near miss cases, who required ICU admission with severe morbidity. Of these, 8 patients were COVID-19 positive and remaining 38 patients were included in control group (COVID-19 negative). The course of each of their stay in ward was noted and findings were compared in both the groups. Results: During their course in ICU it was found that 6 COVID-19 patients had maternal death representing 75% and 12 non-COVID-19 patients had maternal death representing 31.57%.  Conclusions: The mortality rate from the above results concludes that in this study mortality appeared to be higher in COVID-19 infection. Multi-centre retrospective analysis with larger population size is required in order for this to be statistically significant

Fracture of humerus in a newborn during cesarean section: A case report

Risk of birth injuries and long bone fractures are common in vaginal breech deliveries but have also occurred in the cesarean section. Here, we report the case of a term neonate who was admitted with swelling and paucity of movement of the right arm with a history of energetic traction during the emergency cesarean section. The diagnosis was confirmed by radiography and managed by plaster of paris slab. Obstetrician and pediatrician should remain vigilant regarding such rare complications so that these cases are not overlooked, as timely intervention and management are necessary to prevent disability and deformities in the future

Clinico-epidemiological profile of malaria: Analysis from a primary health centre in Karnataka, Southern India

Malaria continues to be a major public health problem in India and worldwide. The present study was based on records from a primary health centre in Karnataka. Morbidity patterns and important features of malaria transmission specific to Udupi district were investigated. The incidence of malaria and various morbidity patterns during 2010 and 2011 were compared and analyzed. Factors such as rapid urbanization, increased construction activities and influx of migratory workers were highlighted as the leading causes for the advent of malaria in the area. Recommendations have been provided for implementation in the near future

Lipid Profile Parameters and Coronary Artery Disease in Young Patients Undergoing Diagnostic Angiography

Introduction: It is vital to understand the association between lipid profile and the severity of coronary artery disease (CAD) in young patients with suspected CAD. The clinical presentation, lipid profile and severity of CAD may differ in patients who develop CAD at young age and those at older age. Friesinger (FR) index is an important tool to assess the extent and severity of coronary artery lesions.Methods: This study was a single center retrospective study involving patients below 40 years who underwent diagnostic coronary angiography. Demographic variables, lipid profile and FR index were estimated. Patients were divided into four groups based on the FR index scores of 0, 1–4, 5–10 and 11-15, respectively.Results: A total of 158 patients (Mean ± SD of age; 35.65 ± 3.81 years) were included in the study. Among demographic variables, gender (P = 0.03) and body mass index (BMI) (P < 0.001) were found to be associated with FR index. In addition, total cholesterol (P < 0.001), low density cholesterol (LDL) cholesterol (P < 0.001), non-high density cholesterol (non-HDL) (P < 0.001) and ratio of triglycerides (TG) /non-HDL cholesterol (P = 0.004) showed significant differences between the FR groups. Logistic regression analysis showed that only diabetes (P = 0.02) and BMI (P = 0.004) were significant predictors of the extent and severity of coronary artery lesions in terms of FR index.Conclusions: A strong direct relationship was observed between total cholesterol, LDL and non HDL cholesterol while a negative correlation with the TG/non HDL ratio. Diabetes and BMI also play a very significant role

Rotation of pear-shaped 100^{100}Ru nucleus

Atomic nuclei in general can have deformed shapes and nearly all these shapes are symmetric with respect to reflection. Only a few Actinide nuclei have stable reflection asymmetric pear shapes in their ground state and exhibit characteristic rotational bands. In this article, we report on the observation of two alternate parity rotational bands in 100Ru, which are connected by seven interleaved electric dipole transitions and their rates are found to be enhanced. In addition, the moments of inertia associated with these two opposite parity rotational bands have been found to be similar. These experimental observations indicate the rotation of a stable pear-shaped 100Ru nucleus, which is the first such observation outside the Actinide mass region. This shape is built on an excited configuration and originates from the rotational alignment of the angular momenta of a pair of neutrons. This unique observation establishes an alternate mechanism by which an atomic nucleus can assume a pear shape.Comment: 13 pages, 7 figures, 2 table

Identification of a Vitamin-D Receptor Antagonist, MeTC7, which Inhibits the Growth of Xenograft and Transgenic Tumors In Vivo

Vitamin-D receptor (VDR) mRNA is overexpressed in neuroblastoma and carcinomas of lung, pancreas, and ovaries and predicts poor prognoses. VDR antagonists may be able to inhibit tumors that overexpress VDR. However, the current antagonists are arduous to synthesize and are only partial antagonists, limiting their use. Here, we show that the VDR antagonist MeTC7 (5), which can be synthesized from 7-dehydrocholesterol (6) in two steps, inhibits VDR selectively, suppresses the viability of cancer cell-lines, and reduces the growth of the spontaneous transgenic TH-MYCN neuroblastoma and xenografts in vivo. The VDR selectivity of 5 against RXRα and PPAR-γ was confirmed, and docking studies using VDR-LBD indicated that 5 induces major changes in the binding motifs, which potentially result in VDR antagonistic effects. These data highlight the therapeutic benefits of targeting VDR for the treatment of malignancies and demonstrate the creation of selective VDR antagonists that are easy to synthesize

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Prevalence of High and Low -level Mupirocin, resistance against MRSA from a tertiary care hospital in eastern UP

Aim: To determine the prevalence of High and Low -level Mupirocin, resistance against MRSA from a tertiary care hospital in eastern UP was the aim of this study. Methods and Material: A total of 62 non duplicate previously confirmed MRSA isolates were included in this study. The Susceptibility testing andresult interpretation for determining the high and low level of mupirocin resistance was performed by disk diffusion method using 200 µg and 5 µg disc respectively as per Clinical and Laboratory Standards Institute (CLSI) M100-S25 recommendations. Results: A total of 60 isolates (96.8 %) were found sensitive to mupirocin, 2 isolates (3.2 %) had low-level mupirocin resistance whereas none of the isolates was found to have high-level mupirocin resistance. Conclusion: The high-level mupirocin-resistant is uncommon in our patient population. The Periodic monitoring is useful for detecting changing trends in mupirocin resistance as a risk of emergence of high level mupirocin resistant strains is there

Isolation and characterization of caffeine degrading bacteria from coffee pulp

86-91Pure culture of a Gram-positive bacterium was isolated from the coffee pulp and maintained on standard conventional nutrient agar medium. The bacterium was identified as Brevibacterium sp. (MTCC 10313) by the Institute of Microbial Technology (IMTECH), Chandigarh, India. The bacterium was characterized with conventional tests and used to study the tolerance to different concentration of caffeine in both solid and liquid media. Brevibacterium sp. was grown in a liquid minimal medium containing 1-8 g/L caffeine with glucose and sucrose separately. The bacterium was able to tolerate up to 6 g/L of caffeine in solid medium and 4 g/L in liquid medium. From the bacterium, a plasmid of about 2500 bp mol wt was isolated. The isolated plasmid was used to transform Escherichia coli DH5a and the transformed colonies were inoculated in 1 to 8 g/L of caffeine containing minimal media to see whether the plasmid was involved in biodegradation of caffeine. It was observed that the plasmid biodegraded caffeine up to 2 g/L in minimal media, whereas non-transformed colonies could tolerate only up to 1 g/L caffein. Growth curves obtained in the minimal media showed that transformed cells of E.coli DH5a  have greater ability to tolerate and degrade caffeine as compared to non-transformed cells