Calcutta National Medical College

Topical roflumilast (ROF) is a recently approved phosphodiesterase 4 inhibitor for the treatment of psoriasis. It has strong anti-inflammatory effects which are quite helpful in the management of the distressing symptoms of psoriasis, as seen in several clinical trials. It also displayed a wide range of safety and, hence, can be utilized in patients without fearing the advent of any dangerous side effects. However, more clinical data are required to find out the extended properties of this molecule and future applications in other dermatological conditions. In 2011, oral ROF (Daliresp®) received Food and Drug Administration (FDA) approval for patients with severe chronic obstructive pulmonary disease and recurrent exacerbations. More recently, in 2022, topical ROF 0.3% cream (Zorvye ™ ) obtained FDA approval for the management of plaque psoriasis in patients aged 12 years and older.

In view of insufficient data on the epidemiology and genomics of bla KPC-2 producing Klebsiella pneumoniae subsp. pneumoniae (KPC-2 Kpn ) from India, this study, first of its kind, was conducted to characterize blood-borne KPC-2 Kpn isolates according to their resistome, plasmid types, and genotypes. This study included 45 blood-borne KPC-2 Kpn isolates from ICU-admitted sepsis patients in Kolkata from 2015 to 2024. These isolates were tested for antibiotic susceptibility against ≥10 antimicrobial classes. Antimicrobial resistance gene profiles, genetic environment of bla KPC-2 , plasmid types, MLST genotypes, and virulence genes were determined by whole-genome shotgun sequencing (WGS). The transmissibility of bla KPC-2 genes was evaluated by conjugation experiment. Pulsed-field gel electrophoresis (PFGE) was conducted to confirm their clonality. SNP-based phylogenomic analysis was performed to compare the study isolates with global KPC-2 Kpn isolates. All 45 (100%) KPC-2 Kpn isolates showed resistance to 21 antimicrobials. In addition, 55.55% and 33.33% isolates were resistant to colistin and ceftazidime-avibactam, respectively. Presence of triple carbapenemase ( bla KPC-2 , bla NDM-1/5 and bla OXA-181/232 ) was observed in six isolates. bla KPC-2 transferable by IncFII/IncFII(pBK30683)/ColRNAI conjugative plasmids. WGS identified two distinct genetic environments of bla KPC-2 among the isolates based on presence or absence of Tn 4401 . PFGE identified 45 pulsotypes with a 39.3% similarity coefficient, indicating a variety of infection sources. Of the 16 MLST genotypes found in circulation, ST15 was predominant and ST7485 was novel. Hypervirulent genetic markers ( iucA , iutA , and rmpA2 ) were identified in four isolates. Hospital infection control and surveillance programs should be strengthened to detect and combat K. pneumoniae co-harboring bla KPC-2 and/or bla NDM /or bla OXA-48-like carbapenemase. IMPORTANCE Klebsiella pneumoniae ( Kpn ) is the primary etiology of ICU-related bloodstream infections in India. Multi-drug resistance, including resistance to carbapenems and colistin, along with myriad virulence factors, makes this bacterium really troublesome with respect to effective treatment. In India, bla NDM and bla OXA-48-like carbapenemases are the most prevalent types with only sporadic reports of bla KPC in Kpn . This study focuses on the emergence of bla KPC-2 in Kpn along with other carbapenemases in Kolkata, India. This study is also the first of its kind to describe the presence of triple carbapenemase ( bla KPC-2 , bla NDM-1/5 and bla OXA-181/232 ) and concurrent resistance to carbapenems, colistin, and ceftazidime-avibactam antimicrobials in Kpn. In addition, this study also highlights the diverse genotypes (sequence types) identified in KPC-2 Kpn, including the novel ST7485 identified in this study. Routine monitoring of antimicrobial resistance genes in Kpn should be encouraged to identify the emerging resistome, which will aid in determining the most effective treatment.

A BSTRACT Introduction The burden of noncommunicable diseases (NCDs) like cardiovascular diseases, diabetes, hypertension, stroke, and cancers has been increasing in India. This rise of NCDs is mainly due to an increase in prevalence of various risk factors like tobacco use, alcohol intake, overweight, and physical inactivity. Objective 1) To estimate the proportion of different NCDs among study subjects, 2) to identify association of NCDs with various risk factors if any, and 3) to assess perceptions regarding risk factors and curative aspects of NCDs. Materials and Methods A mixed method study (quantitative ◊ qualitative) was done in Hariharpara Rural Hospital from September 26, 2023 to November 6, 2023, and quantitative data were collected using predesigned pretested semistructured schedules framed on the basis of WHO STEPS framework from 224 patients who were satisfying inclusion criteria by complete enumeration in NCD clinics. Data were analyzed with SPSS version 23.0, and binary logistic regression was done to identify association of NCDs with various risk factors. Qualitative exploration was conducted by focused group discussion to know their perceptions regarding risk factors and curative aspects of NCDs. Results In this study, 60.26% were hypertensive, 30.35% were diabetic, and 16.51% had other noncommunicable diseases. The binary logistic regression model was done and found geriatric age group study subjects had 4.26 times more chances than their below counterparts and alcoholics had 3.21 times more chances than nonalcoholics of having hypertension, which were statistically significant. In the case of diabetes, geriatric study subjects had 3.19 times more chances of having diabetes than their below counterparts, which was statistically significant. Qualitative analysis revealed there was more inclination toward curative than preventive aspects of NCDs. Conclusion The rise of NCDs was more among the geriatric age group and study subjects who were alcoholic. The perceptions of study subjects were inclined more toward curative than preventive aspects of NCDs.

A BSTRACT Background and Aims Complex interaction of maternal environment has been considered to play pivotal role in fetal survival including postnatal growth and future development. Anemia during pregnancy is being studied as a major determinant of obstetric outcome and effect on anthropometric parameters of newborns. Accordingly, an attempt was made to study the effects of maternal anemia on birth weight (BW) and other parameters of newborns while keeping attention on different maternal bio-social proximates. Methods An observational study included 200 mother-newborn dyad: newborns of mothers suffering from anemia during pregnancy and another group consisting of newborns born to non-anemic mothers. Appropriate statistical analysis was done to interpret the anthropometric data of newborns to assess the relationship between maternal factors including anemia and neonatal outcome before the results of the study were compared with similar types of studies performed earlier on different population groups. Results Significant differences ( P < 0.05) in anthropometric parameters (birth weight, length, crown–rump length, maximum cranial breadth, head circumference, chest circumference, abdominal circumference) of newborns were observed between the two groups. More or less no difference ( p ≥ 0.05) was found on account of maternal parameters except anemia. Correlations of the mother’s anemic level with each newborn anthropometric parameter were computed and maximum correlation was studied with crown–rump length ( r = 0.40, P < 0.01). Conclusions Maternal anemia as an individual factor can significantly explain variations of different birth parameters of newborns which could be possibly due to its chronic effect on growth potential rather than its acute effect which is usually exerted on birth weight alone.

A BSTRACT Background Biobehavioral surveys confirm that HIV prevalence is high or ‘concentrated’ among ‘key populations’ (KPs) who have unprotected sexual contacts with multiple partners or who engage in injecting drug use. These populations include female sex workers (FSW), men who have sex with men (MSM), hijra/transgender (TG), and people who inject drugs (PWID). Antiretroviral therapy is offered under the program of National AIDS Control to Seropositive population at the designated center. Other than the stigma of being HIV positive, there is an additional factor present among these groups of people hindering their uptake of antiretroviral therapy. Aims To identify and quantify the factors causing poor uptake of ART (antiretroviral therapy) among high risk group of subjects receiving antiretroviral therapy, namely, female sex workers (FEW) and intravenous drug users (IDU). A concurrent parallel design of mixed methodology was conducted with integration of the two arms at analysis. Material and Method The quantitative arm involves a retrospective cohort analysis of group on ART having “exposure” defined as high risk behavior for a period of 1 year. High-risk behavior constituted of exposure involved in commercial sex work and those exposed to intravenous drug usage. The comparator arm was sex-matched cohort who were sero-positive and on ART but did not have an “exposure” to defined high-risk behavior practice for a period of 1 year. The qualitative arm constituted of development of a grounded theory based on thematic analysis from coded transcripts. Result Time taken to travel and expenditure incurred therein added with long waiting time compounded with loss of daily wage (reiterated in both arms) emerged to be the most prominent factor. Conclusion Monetary incentive for travel, single window service rapid service and process to access drugs from any center (via a central registration system if possible) may be useful.

Meningiomas are the most common primary tumors of the central nervous system (CNS) and often require radiation therapy (RT), which can lead to the development of complications, such as radiation-induced demyelination. The present study describes the case of a 40-year-old male patient who developed demyelinating lesions following RT for a WHO grade I meningioma, ultimately diagnosed with MS. This condition shares clinical and radiological features with multiple sclerosis, including damage to oligodendrocytes, which are the cells responsible for myelination in the CNS, cognitive impairment, motor dysfunction, and white matter abnormalities on magnetic resonance imaging (MRI). Distinguishing between radiation-induced demyelination and multiple sclerosis can be challenging, particularly in patients with a history of radiation therapy, as MRI findings often overlap. Additionally, radiation therapy may trigger or exacerbate multiple sclerosis in individuals with pre-existing risk factors or undiagnosed multiple sclerosis. A thorough clinical history, advanced neuroimaging, and careful differential diagnosis are essential for accurate management of these conditions.

Molluscum contagiosum (MC) is a common viral skin infection in children, caused by a poxvirus. Atopic dermatitis (AD) is a chronic inammatory skin condition characterized by impaired skin barrier function and immune dysregulation, which predisposes individuals to infections like MC. However, cases where MC acts as a trigger for AD ares are less frequently reported and present unique clinical challenges. We describe a 9-year-old boy with a past history of mild AD who presented with multiple umbilicated papules consistent with MC, surrounded by inamed, eczematous plaques. The temporal association of AD exacerbation with the spread of MC lesions suggested a reactive process consistent with Meyerson's phenomenon. Additionally, hypersensitivity responses such as id reactions can mimic or exacerbate eczematous eruptions, complicating diagnosis and management. This case highlights the bidirectional relationship between MC and AD. While AD increases susceptibility to MC, the viral infection itself may provoke immune-mediated ares of dermatitis. Understanding this interplay is crucial, as aggressive treatment of one condition may worsen the other. A conservative, well-balanced therapeutic approach is essential to minimize symptom escalation. This case underscores the importance of clinical awareness and further investigation into the immunologic mechanisms linking viral infections and chronic dermatoses to improve patient outcomes.

Introduction Common warts are benign skin lesions caused by human papillomavirus (HPV) infection. They are often resistant to conventional treatments and may cause cosmetic and psychological distress. Immunotherapy is a promising alternative that stimulates the host immune system to clear the virus and the infected cells. This study compared the efficacy and safety of two immunotherapeutic agents, intralesional measles, mumps, and rubella (MMR) vaccine and intralesional vitamin D, in the treatment of common warts. Methods This was a single-blind randomised controlled trial conducted at a tertiary care hospital in Kolkata, India. Patients aged 12 years or older with common warts were randomly assigned to receive either intralesional MMR vaccine or intralesional vitamin D every 3 weeks for a maximum of three doses or until complete resolution, whichever was earlier. The primary outcome was the reduction in the size of the largest wart. Secondary outcomes included patients’ and physicians’ global assessment, complete response rate, adverse effects, and recurrence rate. Results A total of 36 patients were enrolled and analysed. Both MMR and vitamin D groups showed a significant reduction in the size of the largest wart throughout the treatment period ( P < 0.0001). There was no significant difference between the two groups in terms of size reduction, patients’ and physicians’ global assessment and adverse effects. The complete response rate was higher in the MMR group (64.7%) than in the vitamin D group (36.8%); however, the difference was not statistically significant ( P = 0.14). The recurrence rate was low in both groups (5.9% in the MMR group and 10.5% in the vitamin D group). Conclusion Both intralesional MMR vaccine and intralesional vitamin D are effective and safe immunotherapeutic options for the treatment of common warts. MMR vaccine may have a slight advantage over vitamin D in terms of complete response rate; however, further studies with larger sample sizes and longer follow-ups are needed to confirm this finding.

Introduction: Diabetes mellitus, one of the widespread endocrine disorders, is characterized by hyperglycemia. Hydrogen sulfide (H2S), a signaling gas transmitter, is involved in carbohydrate metabolism. The pathophysiology of β-cell dysfunction in type 1 and 2 diabetes may be significantly affected by alterations in the H2S balance. Diabetes mellitus causes an increase in ferritin, an acute-phase reactant. Aims and objectives: This study aims to investigate the relationship between serum H2S and ferritin levels in patients with type 2 diabetes. Methodology: Spectrophotometric measurements of serum H2S were made using a lab-standardized technique. Enzyme-linked immunosorbent assay (ELISA) was used with standardized kits (BioRad Laboratories, Hercules, CA, USA) to determine serum ferritin levels. Results: Compared to the control group, type 2 diabetic patients had significantly greater serum ferritin levels and significantly lower H2S levels. H2S and ferritin levels are negatively correlated among cases and controls. Conclusion: The negative connection between ferritin and H2S levels indicates that oxidative stress plays an important part in the beginning and development of diabetes mellitus.

Renal cell carcinoma (RCC) is the one of the most fatal and frequent form of urological malignancy worldwide. The von Hippel-Lindau (VHL) tumour suppressor gene is a critical component of the VHL-Cullin2-ElonginB/C (VCB) complex that regulates the ubiquitin-mediated proteasomal degradation of proteins with mutations consistently associated with the development of clear cell renal cell carcinoma (ccRCC). Despite extensive investigations conducted worldwide, there is a notable lack of data concerning VHL mutations in sporadic ccRCC patients from India. Our study aimed to investigate the sporadic VHL mutations within the tumours of 210 ccRCC patients without a familial history of VHL disease. We extracted genomic DNA from tumour and adjacent normal tissues, PCR amplified and sequenced the VHL gene. In silico tools were used assess the damaging potential of missense variants on pVHL structure and stability. Protein-protein docking and protein flexibility molecular docking simulation study were employed to study the interaction between wild-type and mutated VHL models with Elongin C. Sequence analysis revealed seven novel missense mutations in patient tumour tissues p.(Val170Phe), p.(Arg69Cys), p.(Phe76Leu), p.(Glu173Asp), p.(Leu201Val), p.(His208Leu), p.(Arg205Pro). I-Mutant 2.0 indicated these mutations reduced pVHL stability (ΔΔG < -0.5 kcal/mol). Protein Flexibility-Molecular Dynamic (MD) Simulation study indicated that mutations weaken the interaction of VHL with Elongin C, with V170F showing the most significant reduction in binding quality and stability. In conclusion, this study introduces novel genetic data from an understudied population and highlights the impact of VHL mutations on its interaction with Elongin C. These findings contribute to our understanding of the molecular basis of VHL-related pathologies and may guide future therapeutic strategies targeting these interactions.

Introduction Retrocaval ureter (RCU) is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava, leading to upper urinary tract stasis. This condition is often misdiagnosed and can result in significant complications due to obstructed urine flow. The feasibility of laparoscopic repair is reported in this study. Materials and Methods We retrospectively analyzed 13 patients who underwent laparoscopic uretero-ureterostomy for RCU between 2020 and 2024. All patients underwent pre-operative evaluation using computed tomography (CT) urogram or magnetic resonance (MR) urogram and nuclear functional imaging. Intraoperatively, a retrograde pyelogram (RGP) was performed to confirm the diagnosis. Laparoscopic uretero-ureterostomy was performed under general anesthesia in all cases. Pre-operative, demographic, and intraoperative data were recorded. Follow-up assessments were conducted to monitor for urinary symptoms and other post-operative complications. Results All 13 surgeries were completed laparoscopically, with no conversions to open surgery. The average operative time was 118.37 min. Two patients developed Clavien–Dindo Grade 1 complications postoperatively. Five patients experienced stent-related symptoms during their first follow-up, which resolved with symptomatic treatment. At 3 months post-operatively, 69.2% of patients showed asymptomatic static hydronephrosis on serial ultrasound, while 30.8% exhibited resolution of hydronephrosis. A follow-up diethylenetriamine pentaacetate (DTPA) renal scan at 6 months confirmed that there was no obstruction at the anastomotic site in any of the operated patients. Conclusion Laparoscopic repair of RCU is an effective surgical approach and is increasingly being adopted as part of the urological treatment arsenal.

Objective: To determine the role of high-sensitive C-reactive protein (hsCRP) in predicting the severity of preeclampsia in a high-population, resource-poor country. Patients and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology of Calcutta National Medical College, India, from March 2021 to September 2022. A total of 180 participants were divided into three equal groups: patients with severe preeclampsia and non-severe preeclampsia and healthy pregnant women. Results: The levels of the biomarkers hsCRP and uric acid differed significantly between women with preeclampsia and healthy women, with cutoff levels of 3.72 mg/L and 5.15mg/dL, respectively, as determined using receiver operating characteristic (ROC) curve analysis. HsCRP was also able to differentiate severe preeclampsia from non-severe preeclampsia at a cutoff level ≥8.75 mg/L (high Youden index >0.6). However, uric acid levels failed to discriminate between pregnant women with severe and non-severe preeclampsia. Elevated hsCRP levels were strongly associated with low birth weight of newborns in pregnant women with preeclampsia and healthy control groups (P=0.001) and with disease severity (P<0.001), respectively. Conclusions: HsCRP can be used as an important diagnostic tool to exclude and evaluate the severity of preeclampsia.

Testicular torsion (TT) is the rotation of the testis to the longitudinal axis of the spermatic cord, which impedes testicular blood supply. Haemorrhagic infarction of the testis starts 2 h after the torsion; irreversible vascular injury appears 6 h later and complete infarction starts 24 h later. Clinically suspected cases often pose a diagnostic dilemma since colour Doppler ultrasound cannot yield a precise and conclusive diagnosis. In this case series, we share our experiences with various forms of TT and re-evaluate the critical presentations, clinical and radiology findings and tests to improve the diagnosis and treatment.

Objective Surgical site infection (SSI) is a common complication, especially following emergency caesarean section (CS) leading to maternal morbidity and prolonged hospital stay. Results are conflicting regarding the ideal method of skin closure after abdominal surgery in clean contaminated and contaminated wound. To compare the outcome of wound health between primary and delayed primary closure (DPC) of skin incision in emergency CS. Material and Methods A total of 70 pregnant women undergoing emergency caesarean deliveries with a history of membrane rupture were randomized into group A (n=40) and group B (n=30). In group A monofilament sutures were placed in skin incision but the wound was left open for daily dressing with normal saline. It was closed by tying the monofilament sutures on fifth day and stitches were removed on seventh day. In group B skin was apposed by a routine primary closure procedure. Results No patient in group A required secondary wound closure following SSI (p<0.001) and duration of hospital stay was also significantly reduced (p<0.05). Conclusion This trial demonstrated that DPC is effective in reduction of requirement of secondary stitches due to SSI in emergency CS.

Objective To assess comprehensive abortion care (CAC) services uptake and barriers to it in selected representative units of the three tier health care in the district of Malda in West Bengal, India. Methods We conducted community-based, concurrent, parallel mixed methods study. Quantitative assessment of knowledge of primary health care workers on CAC and appropriate infrastructure assessment was done. Qualitative methods were used to identify themes affecting uptake of quality care among stakeholders. Results A total of 48 staff nurses and 133 auxiliary nurses and midwives were included in the study. About half of nurses (of total 48) who were second tier health care provider and two thirds (of total 133) of first tier health care provider had incorrect knowledge about legality of abortion. Only 40% mothers seeking abortion were accompanied to subcentre by primary health care worker. At the third tier health care site, physicians insisted on necessity of refresher training. Suboptimal uptake of available CAC services was due to lack of enabling environment. Lack of updated training across health care workers was observed. Conclusions Health care providers at the community level were unaware of facilities available for mothers seeking abortion. Higher level health care providers were unsure of specific knowledge about legal permissibility and sterilization of apparatus for abortion. At the highest level, more training on medical methods of abortion was required. The problems identified are amenable to correction, and some administrative and service-related provision on appropriate measures may lead to immediate success.

Diabetic retinopathy (DR), a prevalent microvascular complication of diabetes, is the fifth leading cause of blindness worldwide. Given the critical nature of the disease, it is paramount that individuals with diabetes undergo annual screening for early and timely detection of DR, facilitating prompt ophthalmic assessment and intervention. However, screening for DR, which involves assessing visual acuity and retinal examination through ophthalmoscopy or retinal photography, presents a significant global challenge due to the massive volume of individuals requiring annual reviews. To counter this challenge, there has been an increasing interest in the potential of artificial intelligence (AI) tools for automated diagnosis of DR. The AI tools primarily utilize deep learning (DL) techniques and are tailored to analyse extensive medical image data and provide diagnostic outputs, essentially streamline the DR screening process. However, the development of such AI tools requires access to a comprehensive retinal image database with a plethora of high-resolution fundus images from various cameras, covering all DR lesions. Additionally, the accurate training of these AI algorithms necessitates skilled professionals, such as optometrists or ophthalmologists, to provide reliable ground truths that ensure the precision of the diagnostic outputs. To address these prerequisites, we have initiated a study involving multiple institutions to establish a large-scale online 'Retinal Image Database’ in India, aiming to contribute significantly to DR research. This paper delineates the methodology employed for this significant undertaking, detailing the steps taken to create the large retinal image database, as well as the framework for developing a cost-effective, robust AI-based DR diagnostic tool. Our work is expected to mark a significant stride in DR detection and management, promising a more efficient and scalable solution for tackling this global health challenge.

Objectives: Atopic dermatitis (AD) and contact dermatitis (CD) have a complicated and debatable correlation. A large number of studies have suggested that AD patients have a higher prevalence of contact allergy than non-AD patients. In this study, we aimed to compare the prevalence and patterns of CD in AD and non-AD patients using patch testing. We also investigated the gender distribution and the sources of contact allergens in both groups. This study aimed to examine the frequency and characteristics of contact allergy in individuals with AD and those without atopic conditions by the utilization of patch testing. In a co-primary objective, we hypothesized that individuals with AD would exhibit a higher prevalence of contact allergy compared to those without AD, aiming to validate or refute this null hypothesis. Material and Methods: We included all adult patients (age >18 years) who had undergone patch testing with a suspected diagnosis of CD. In this group, we further divided the cases into two subgroups, patients with AD and non-AD patients. Exclusion criteria included pregnancy, lactation, use of systemic corticosteroids within the past 10 days, and use of immunosuppressive agents within the past 8 weeks. The haptens were pasted on the back of the skin for 48 hours. Assessments were conducted on day 2 (D2) and day 4 (D4), and in certain cases, day 7 (D7) was performed as per the recommendations of the International CD Research Group standards. Results: We recruited 64 patients who underwent patch testing for contact allergies. Of these, 29 had AD and 35 did not have AD. In our cohort, 36 patients (56%) were positive for contact allergies and 28 were negative. Of these, 18 out of 29 AD patients (62%) and 18 out of 35 non-AD patients (51%) were positive for contact allergies. The most common contact allergens in both groups were nickel, cobalt, and potassium dichromate. Other allergens included fragrance mix I, benzocaine, wool alcohol, colophony, and neomycin. There was no significant difference in the frequency of contact allergy between AD and non-AD patients (P = 0.41). The majority of the positive patch test reactions were relevant in both groups. Conclusion: Both patients with AD and those without AD may have sensitization to different occupational or non-occupational antigens. In addition, individuals with AD are more prone to contact allergies compared to those without AD.