Background: Sputum staining for acid-fast bacilli and microscopic examination methods are more sensitive and specific, less time consuming, low cost than other methods for the diagnosis of pulmonary tuberculosis (TB). Methods: In this cross-sectional study conducted over 1-year (n = 109), the sensitivity, specificity and cost-effectiveness of Gabbet's staining, Ziehl–Neelsen (Z-N) staining for the diagnosis of pulmonary TB were studied considering with fluorescence staining method as the gold standard. Results: Majority of the patients belonged to the age group between 21 and 40 years (45.5%). With fluorescence staining, it was found that 25 of the 44 positive smears were of good quality, 12 were of average quality and 7 had poor quality. With Z-N staining, 9/29 of the positive smears were of good quality, 10 were of average quality and poor quality each. With Gabbet's staining, 12 of the 33 positive smears were of good quality, 14 were of average quality and 7 were of poor quality. The sensitivity of the Gabbet's staining (75%) was found to be greater than the Z-N staining (65.9%) considering fluorescence staining as the gold standard. Conclusions: Gabbet's staining can be used as an effective alternative to Z-N staining in low resource settings.

Background: Stress response to surgery induces hyperglycaemia to limited extent. An additive hyperglycaemic response, secondary to the metabolism of intravenous fluids, can thus prove detrimental to the well-being of the patient, if ignored. Methods: We compared the effects of 4% gelatin and dextran-40 on blood glucose levels during surgery under subarachnoid block and their potential to induce hyperglycaemia. Sixty American Society of Anesthesiologists grade I and II patients were randomised into two groups, 30 patients in each. Group 1 patients were preloaded with 4% Gelatin (10 mL/kg) and Group 2 patients were preloaded with dextran-40 in normal saline (10 mL/kg), over a period of 30 min. Just prior to preloading, base line capillary blood glucose (CBG) level was noted this is followed by subsequent readings at 20 min interval until 100 min from base line reading. All patients received normal saline (0.9%) as a maintenance fluid. Under strict aseptic precautions, subarachnoid block using 15 mg of hyperbaric bupivacaine at L3-L4 or L4-L5 level was given after preloading. Results: The CBG levels in both the groups at 20, 40, 60, 80 and 100 min from base line were within physiological limits. In group 2, the maximum CBG level was found at 60 min from onset of preloading (P = 0.017), when compared with corresponding CBG level in Group 1. Preloading the patients prior to subarachnoid block with 4% gelatin or dextran 40 do not raise CBG levels significantly above the physiological limits.

Background: One of the key factors influencing the results of sputum smear microscopy is the quality of sputum being submitted. Methods: This is a prospective study of quality of sputum specimens being submitted for smear examination under Revised National Tuberculosis Control Programme and its impact on diagnostic yield of sputum smear microscopy. Based on sputum Gram's staining results, the submitted specimen was classified as 'sputum' and 'saliva'. Results: During the period 21 April to 20 June 2012, 238 sputum specimens submitted for evaluation were studied. Of these, 196 (82%) specimens were submitted for diagnosis and 42 (18%) specimens were obtained during follow-up evaluation. Overall, 42/238 (17.6%) specimens were in fact 'saliva' and not sputum. Among specimens submitted for diagnosis (n = 196), 28/167 (16.8%) specimens reported as 'sputum acid-fast bacilli (AFB) negative' were in fact saliva. Among the specimens submitted on follow-up examination (n = 42), 14 of the 38 (36.8%) specimens reported as 'sputum AFB negative' were actually saliva. A significantly higher proportion of sputum smears submitted on follow-up examination were actually 'saliva' as compared to specimens submitted for diagnosis (14/42 [33.3%] vs. 28/196 [14.3%], χ² = 6.738; P = 0.014). None of the saliva samples were reported to be 'sputum positive'. Conclusions: The fact that a significant proportion of specimens that are reported smear negative are in fact saliva and not sputum highlights the importance of sputum quality in smear microscopy results. Follow-up specimens are more likely to be saliva possibly because directly observed therapy (DOTS) treatment would have resulted in clinical improvements and patients may not be producing significant sputum anymore.

Introduction: Being at the forefront, health-care workers (HCWs) have been at an increased risk of developing COVID-19. Objectives: To understand the pattern of the clinical symptoms, transmission dynamics, intake of hydroxychloroquine (HCQ) prophylaxis and outcome in COVID-19 positive HCWs. Methods: One hundred and fifty-one COVID-19 infected HCWs were telephonically followed up to study the exposure details, clinical presentation, comorbidities, HCQ prophylaxis, outcome and further transmission to their families. Results: The most commonly infected were doctors 60 (39.74%), followed by nursing staff (22.52%) and office staff (13.25%). Only 40 (26.49%) of infected staff was posted in COVID area. The most common source of exposure were patients (33.11%), followed by fellow staff members (28.48%) and 13 (8.61%) had contracted the disease from their family. Fever (74.17%) was the most common symptom followed by myalgia (43.71%), anosmia (37.75), sore throat (33.77%), ageusia (31.13%) and dry cough (28.48%). Three (1.99%) HCWs expired due to COVID-19 and 23 (16.31%) transmitted infection to their family members. Conclusions: This study concludes that HCWs are at greater risk of acquiring infection, particularly while working in non COVID areas, contracting the virus mainly from patients and co-workers. They are also a potential source of onward transmission to their colleagues and family.

Introduction: The COVID-19 pandemic has resulted in an increased need for molecular diagnostics. Ribonucleic acid (RNA) extraction is a crucial step in the detection of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). The resulting outcome depends on the performance of the RNA extraction kit used. Methods: This study evaluated the efficiency of four different commercial RNA extraction kits for the detection of SARS-COV 2. The reproducibility and performance efficiency of each kit were assessed and compared. The performance, processing time and storage conditions were also considered in the evaluation. Results: A slightly lesser cycle threshold (Ct) values were observed in RNA extracted using HiPurA Viral RNA Purification Kit. Invitrogen PureLink RNA Mini Kit was found to be time-saving and user-friendly. Conclusions: All the RNA isolation kit yielded the best results; however, if time is the important considerations, Invitrogen PureLink RNA Mini Kit has the shortest processing time.

Background: Various adjuvants were combined with local anaesthetic agents, either intrathecally or epidurally, to prolong the duration of a denser neuraxial block and achieve adequate intraoperative conditions. Methods: In this prospective randomised double-blind placebo-controlled study, 90 patients were randomly allocated into three groups of 30 each depending upon the intrathecal adjuvant used. Standardised anaesthetic technique and monitoring for subarachnoid block (and epidural catheter placement) with 3 mL of 0.5% hyperbaric bupivacaine was followed. In addition, Group K (n = 30) received 0.3 mg/kg of preservative-free ketamine, Group F (n = 30) received 25 μg (0.5 mL) of fentanyl and Group C (control group, placebo, n = 30) received 0.5 mL normal saline. Time of onset and duration of sensory and motor block and duration of analgesia, haemodynamic parameters, sedation scores intra-operatively and post-operatively and side effects were recorded and analysed. Results: The mean time (sec) to onset of sensory (P = 0.04) and motor (P = 0.02) blockade was prolonged, and the duration (min) of sensory (P = 0.003) and motor (P = 0.009) block and the duration of analgesia (min) (P = 0.022) were shorter in the Group K compared to other two groups. Fentanyl showed shorter onset time, longer duration of sensory and motor block and duration of analgesia in contrast to ketamine and placebo. Conclusions: Fentanyl (25 μg) was superior to 0.3 mg/kg of ketamine and placebo as an intrathecal adjuvant with minimal side effects.

Reviews provide a condensed representation of existing literature on a particular topic. Both systematic reviews and narrative reviews have their individual merits and limitations in terms of goals, applicability, process and scope. This work aims to provide an overview of the relevance of narrative reviews in today's era of sophisticated research methodologies and to describe in detail the process involved in writing a narrative review. Narrative reviews provide a concise review of literature with the liberty to raise questions and stimulate further research. The process of writing a good narrative review involves framing a research question, deciding the most suitable methodology, going through literature, representation of evidence and preparing a draft. Some key considerations and potential pitfalls while writing narrative reviews have also been discussed.

We studied study the utility of hyperbaric oxygen (HBO) therapy in necrotising soft-tissue infection and to evolve a protocol for management with multidisciplinary surgical management. During the period November 2011 to December 2019, 29 patients with necrotising soft-tissue infection subjected to HBO therapy during the management were enrolled in the study. All had diabetes mellitus as a comorbidity; 5 had Fournier's gangrene, 20 had necrotising soft-tissue infection involving the lower extremity and 4 patients had involvement of upper extremity. Three patients did not require any surgical intervention, while 26 patients required multiple surgical wound debridement, HBO and soft-tissue reconstruction. Our observations suggest that HBO therapy is a useful adjunct for surgery in the management of necrotising soft-tissue infections.

Aplasia cutis congenita (ACC) refers to congenital absence of skin occurring alone or in association with other anomalies. Congenital epidermal naevi are benign naevi of epidermal component present at birth or appearing in the first few years of life in characteristic developmental pattern. We are reporting the case of a 9-month-old female baby born of a non-consanguineous marriage reported to the department of dermatology for loss of skin over the right side of the scalp and lesions over the right upper limb since birth. Systemic examination did not reveal any abnormalities. The mother's antenatal history was uneventful. On examination erythematous, thin parchment-like hairless scar with crusting is present over the right frontoparietal region of the scalp. Hyperpigmented verrucous papules with surrounding erythematous skin present over right axilla, dorsum of right ring finger and hypopigmented macules present over extensor aspect of right forearm in blaschkoid distribution. According to modified Frieden's classification, aplasia cutis has been categorised into nine types. Around 86% of cases are seen over the vertex of the scalp. In the third type, ACC is associated with epidermal naevi. This is an unusual association, hence being reported here.

Torsion of the greater omentum is a rare acute abdominal condition that is seldom diagnosed preoperatively. We present the unusual case of a 32-year-old male with secondary omental torsion due to a long-standing inguinoscrotal hernia. A contrast-enhanced computed tomography scan of the abdomen showed a heterogeneous fat-density mass, with a characteristic whirling pattern of concentric streaks within the greater omentum has been rarely described. An index of suspicion of omental torsion due to inguinoscrotal hernia as a differential diagnosis in the acute abdomen setting is necessary in the diagnosis and management of this rare combination.

A 48-year-old male, farmer by occupation with no prior comorbidities came with chief complaints of fever since 5 months, associated with loss of weight and loss of appetite. On general examination, pallor and clubbing were present. Blood pressures were 120/20 mmHg in both upper limbs and 200/60 mmHg in both lower limbs. Cardiovascular examination, on auscultation there was pansystolic murmur in mitral area radiating to axilla, holodiastolic murmur in aortic area. All routine blood investigations were done. Echocardiogram was suggestive of infective endocarditis of aortic valve with multiple thickened vegetations over aortic valve. Blood cultures grew Enterococcus faecium in two sets. The patient was treated with antibiotics according to culture sensitivity report. Patient improved clinically and was discharged.