Background To compare the efficacy and safety of bioavailable turmeric extract versus paracetamol in patients with knee osteoarthritis (OA). Methods In this randomized, non-inferiority, controlled clinical study, patients of knee OA were randomized to receive bioavailable turmeric extract (BCM-95®) 500 mg capsule two times daily or paracetamol 650 mg tablet three times daily for 6 weeks. The primary outcome measure was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. The secondary outcome measures were WOMAC total, WOMAC stiffness, and WOMAC physical function scores. Responder analysis of individual patients at different levels (≥ 20%, ≥ 50%, and ≥ 70%) for WOMAC score was calculated. TNF alpha and CRP levels were evaluated and adverse events (AE) were also recorded. Results Seventy-one and seventy-three knee OA patients, respectively in bioavailable turmeric extract and paracetamol groups, completed the study. Non-inferiority (equivalence) test showed that WOMAC scores were equivalent in both the groups (p value < 0.05) in all the domains within the equivalence limit defined by effect size (Cohen’s d) of 0.5 whereas CRP and TNF-α were better reduced with turmeric extract than paracetamol. After 6 weeks of treatment, WOMAC total score, pain, stiffness, and function scores got a significant improvement of 23.59, 32.09, 28.5, and 20.25% respectively with turmeric extract. In the turmeric extract group, 18% of patients got more than 50% improvement and 3% of patients got more than 70% improvement in WOMAC pain and function/stiffness score and none of the patients in the paracetamol group met the criteria. CRP and TNF-α got significantly reduced (37.21 and 74.81% respectively) in the turmeric extract group. Adverse events reported were mild and comparatively less in the turmeric extract group (5.48%) than in the paracetamol group (12.68%). Conclusion The results of the study suggest that bioavailable turmeric extract is as effective as paracetamol in reducing pain and other symptoms of knee osteoarthritis and found to be safe and more effective in reducing CRP and TNF-α. Trial registration Clinical Trials Registry – India CTRI/2017/02/007962. Registered on 27 February 2017

A 42-year-old man, presented to the Medicine Department of our hospital with the complaint of high grade fever, vomiting, yellowish discoloration of sclera, abdominal distension and weakness since last one week. Patient also gave history of pain in abdomen which was usually located in the right hypochondrium and abdominal discomfort since last one month. There was a history of diabetes mellitus type-2 since last two years; he was on antihyperglycaemic medication irregularly. No history of tuberculosis or similar episode in the past and no relevant family history were present. On examination he was conscious, febrile (Temperature-39°C), pulse rate 98/min and blood pressure were 110/88 mmHg. He had pallor and icterus. As per abdominal examination patient had distended abdomen, tenderness in right hypochondrium and epigastrium regions, umbilicus inverted, nodulated vein were seen, itching marks present on lower abdomen and free fluid present, but, abdomen thrill were absent. There was tender hepatomegaly 4cm below the costal margin, but spleen was not palpable. Rest of systemic examination was within normal limit. Laboratory haematological investigation revealed hemoglobin 8.5gm/dl, total leukocytes count 6100/cumm, (polymorphs 74 %, lymphocytes 24%, eosinophil 2 %), Platelets count of 1.5 lacs/cumm, however liver enzymes (SGOT/SGPT-92/65), coagulation profile (PT/PTTK-12.6/27.0) and Alkaline phosphatase were elevated to 958 IU. Renal function and serum electrolytes were within references range.Serology for Hepatitis B surface antigen (HBSAg-7.38 IU/L) was also elevated from the normal reference range. While, serology from HIV and other hepatitis markers (HCV) were non-reactive. Widal test and IgM leptospira were also negative. Ultrasonography of the abdomen showed enlargement of the liver with features suggestive of abscess measuring 8cm×8cm×8.6cm and volume 700CC involving segment VI and VII along with mild ascites. Ultrasound guided liver aspiration was done. About 30ml of pus was aspirated and sent for microbiological investigations, for culture and sensitivity. The pus sample received was processed as per standard microbiological protocol. A wet mount of pus was negative for Trophozoites of Entamoeba histolytica. Ziehl-Nelsen was negative for acid fast bacilli. Direct Gram's stain showed gram negative bacilli along with the pus cells [Table/ Fig-1]. Haemolytic colonies of 2-3mm diameter grew on blood agar and non-lactose fermenting colonies on Mac-Conkey agar. The isolate was identified as A.lwoffii on the basis of biochemical reactions with cytochrome oxidase (negative), oxidative/fermentative glucose (negative), nitrate reduction (negative), and citrate (negative). It was confirmed by automated technique with Vitek-2 system. It was found to be ABSTRACTAcinetobacter lwoffii is a gram negative aerobic non-fermenter bacilli. It is considered as an important emerging pathogen after Acinetobacter baumannii in patients with impaired immune system and in nosocomial infections. Here, we present a case of community ...

S2.1 Update on Mucormycosis, September 21, 2022, 3:00 PM - 4:30 PM Introduction: Post-COVID-19 rhino orbital mucormycosis has emerged as an important life-threatening complication adding to mortality. Fungal infections are a major health challenge, especially in the immunocompromised. Mucormycosis is a severe, frequently fatal fungal infection that has a unique predisposition to infect patients with diabetes. The most probable reasons for the emergence of these cases could be the extensive use of steroids in the management of coronavirus disease 2019 (COVID-19) patients and extensive dysregulated immune response due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. A prompt diagnosis is vital for the effective management of invasive rhino-orbital fungal infections due to their propensity for angioinvasion and destructive spread with brain involvement. Materials and Methods: A total of 150 surgical pathology specimens received with a clinical suspicion of invasive fungal infection during the post-COVID-19 outbreak of mucormycosis were retrieved from the archives of the Department of histopathology. The cases were reviewed for the presence of Aspergillus fruiting bodies by senior pathologists and microbiologists on a multi-headed microscope. The morphological features of the fruiting bodies were noted and correlated with the fungal KOH and culture. The tissue reaction pattern, presence of oxalate crystals, and morphology of the fungal hyphae were also noted in each case showing Aspergillus fruiting bodies. Results A total of 8 out of 150 cases (5.3%) showed the presence of Aspergillus fruiting bodies. The histopathological diagnosis given in these 8 cases were—Aspergillus (1), combined Aspergillus and Mucorales (7). Two types of fungal hyphae were noted in all seven cases of combined infection. Granulomatous tissue reaction was noted in two out of seven cases of combined infection. Calcium oxalate crystals were noted in the single case of Aspergillosis and were absent in all cases of mixed infection. Conclusion To conclude Aspergillus fruiting bodies are found in a small but significant number of cases of post-COVID-19 Rhino-Orbital invasive mold infections so while reporting the surgical specimens with clinical suspicion of post-COVID-19 mucormycosis one should be aware of the possibility of mixed fungal infections and look for Aspergillus fruiting bodies as a tell-tale sign of mixed Mucorales and Aspergillus infection. However, their presence does not estimate the true incidence of mixed fungal infections for which immunohistochemistry and polymerase chain reaction are needed.

Objectives: The diagnosis of acute TORCH infection in pregnant women being pertinent for the management of such infections prompted the current study due to lack of published data from India describing the seroprevalence of specific IgM antibodies to TORCH agents in this part of Northern India. Material and Methods: Blood samples of a total of 240 high-risk pregnant women attending the antenatal clinic of our tertiary care hospital during a 5-year period (2005-2009) were analyzed for specific IgM antibodies to Toxoplasma gondii, rubella, Cytomegalovirus (CMV), and combined herpes simplex virus (HSV) 1 and 2 by capture enzyme-linked immunosorbent assay. Results: Overall, seropositivity to TORCH infection in the present study was 98.8%. Seropositivity to T. gondii was 24.2%, rubella 9.2%, CMV 53.8%, and 11.7% were positive for combined HSV-1 and 2 infections. The average age of the study population was 27.5 years. Overall, 15.4% of women were seropositive for coinfections. Conclusion: The high seropositivity of 98.8% and presence of multiple infections seen in the present study communicate to all health authorities to screen routinely all pregnant women for TORCH infections for appropriate intervention in the proper management of these patients.

Introduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.