Kalinga Institute of Medical Sciences (KIMS) (Jun – Jul 2022)

35

Research Funding

Dr Ashok K Badamali

Title: Sanjivani QCPR: Resuscitation Ecosystem Connecting Cardiac Arrest Victims with Emergency Healthcare

Principal Investigator’s Name: Dr Ashok K Badamali, Asst. professor, Cardiac Anesthesiologist, KIMS, KIIT DU

Name of Funding Agency: BIRAC, “Biotechnology Ignition Grant” BIG-20.

Sanctioned Amount of Project: 50 Lakhs, 18 months

Abstract

This project has been conceptualized with an idea of developing an ecosystem, “Sanjivani QCPR: A resuscitation ecosystem connecting cardiac arrest victims with emergency healthcare services. Sudden cardiac arrest (SCA) is sudden cessation of cardiac mechanical activity with hemodynamic collapse. Approx. 85% of SCA at home or outside hospital and the survival rate is less than 10 %. Survival can be doubled or tripled if cardiopulmonary resuscitation (CPR) is initiated early by a bystander. The poor emergency medical service (EMS) service density, traffic congestion and large population in India are the hindrance for early CPR. Victim’s brain suffers irreversible damage after 6 minutes of cardiac arrest. A successful resuscitation comprises of “3Cs” Check the response, Call For help, Chest compression. The early beginning and quality of chest compression by the first responder determines the neurological function of victim subsequently. Automated devices like LUCAS, Auto pulse, available in Western world are costing more than 20 lakh and operated by health care workers who reaches the event site within 3 min of dialling 911. For Indian geography it’s the common men and availability of Sanjivani QCPR device for chest compression of victim will be more beneficial. BIRAC Has sanctioned a grant amount of 50 lakh under BIG-20 (Biotechnology Ignition Grant) to be used for equipment, human resources, Consumables, IPR, contingency within 18 months of time to develop Sanjivani Ecosystem for connecting cardiac arrest victim with emergency healthcare system. Extended version of the ecosystem will be an essential healthcare connectivity for the 100 smart cities of India.  The alpha prototype of components is already made at KIIT TBI, Rest components and complete communication ecosystem will be developed at KIIT TBI and other collaborators. KIMS Hospital will be the first hospital of India to have the Sanjivani ecosystem within next 1year.


Journal Papers

1. Behera, D., Rao, C.M., Jagaty, S.K., Singh, N., Subhankar, S., Alone,V.D., Deep, A., Pati S. (2022).  Clinical, Laboratory and Radiological Profile of COVID-19 Patients during the Second Wave with Special Reference to Vaccination Status.  Journal of Clinical and Diagnostic Research, 16(5), 12-16.

Abstract

Introduction: Coronavirus Disease-19 (COVID-19) has been creating havoc worldwide since the first report in December, 2019. Vaccination against the disease was thought to bring respite, reducing the severity of disease, morbidity and mortality. However, considering the fact that no vaccine is fully efficient, people may get COVID-19 even after full vaccination. Aim: To determine the clinical, laboratory, radiological features of COVID-19 including the outcome and compare these between vaccinated and unvaccinated patients. Materials and Methods: The prospective observational study was conducted in a dedicated COVID-19 hospital in Odisha, India, from May 2021 to June 2021. Detailed history including symptoms and vaccination status, laboratory parameters, and radiological investigations were collected from 200 patients. The cases were classified as mild, moderate and severe as per the Ministry of Health and Family Welfare (MoHFW) guidelines. All the patients were followed till the end of hospital stay. The results were expressed as the mean±standard deviation and percentages. Chi-square test was used to compare the categorical variables, and unpaired t-test was used to compare two discrete variables. A p-value of less than 0.05 was considered significant. Results: Majority of the patients were unvaccinated (65%) and belonged to the age group of 39-59 years (58.5%). Among the non vaccinated patients, 32.3% had moderate disease, while 35.4% had severe disease. In the vaccinated group, 51.4% had moderate disease, whereas only 28.6% patients developed severe disease. Increased Neutrophil to Lymphocyte Ratio (NLR), D-dimer levels, and radiological evidence of pneumonia in chest radiology were witnessed in both groups. Inflammatory markers between the vaccinated and unvaccinated groups did not show any statistical significance (p>0.05). A total of 12 (6%) patients died, out of which five were vaccinated (p=0.6). Conclusion: Vaccination is found to be protective in terms of disease severity and mortality. Vaccination of all individuals is recommended to curb the wrath of the virus.


2. Rao, C.M., Sarbhai, K., , Subhankar, S., Mohapatra, A., Singh, N., Panda, P.S., Patro, S., Pati, S. (2022). Pathogens Isolated and Their Association With the Long-Term Outcome in Patients WithAcute Exacerbation of Chronic Obstructive Pulmonary Disease. Cureus, 14(6), e26174. https://doi.org/10.7759/cureus.26174.

Abstract

Background: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation. Materials and methods: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical ResearchCenter, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded. Results: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms suchas Acinetobacter baumanniiKlebsiella pneumoniae, and Pseudomonas  aeruginosa  were isolated. Readmission was more among patients with coinfection. Conclusion: Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.


3. Panda, A., Saxena, S., Pathak, M,, Rath, S.(2022). Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic surgeries: A systematic review and meta-analysis. Trends in Anesthesia and clinical care, 44, 20-26. https://doi.org/10.1016/j.tacc.2022.04.007

Abstract

Background: Efficient pain management modalities are the armamentarium of the Enhanced Recovery Surgery protocol. Transversus abdominis plane (TAP) block is one such measure and has mixed findings regarding its effectiveness. Hence, this systematic review and meta-analysis aimed to assess the effectiveness of laparoscopic-assisted (LAP) TAP block versus USG-TAP block on pain management and opioid consumption. Methods: We searched PubMed, Scopus, EMBASE and the Cochrane Register of controlled trials to identify eligible RCTs. Two authors screened, selected studies, and extracted data independently. Quality was assessed by two authors using the Cochrane risk of bias assessment tool. Heterogeneity and publication biases were assessed using the I2 -statistic and Egger’s test respectively. The random effect method was used to synthesize weighted/standardized mean differences. Results: A total of 8 RCTs were found eligible out of 424 unique records. Weighted mean difference between LAP and USG blocks in pain intensity measured on VAS scale are 0.23(-1.10,0.64), 0.14(- 0.69,0.41) and 0.04(-0.18,0.26) at 6, 24 and 48 h respectively. Intraoperative and postoperative standardized mean difference in opioaid consumption was 0.24(0.00,0.47) and 0.20(-0.63,0.23) respectively. Conclusion: Our results based on a few small-scale RCTs show that the pain management and opioid consumption were similar in laparoscopic or USG guided TAP blocks.


4. Kandregula, S., Behura, A.A., Behera, C.R., Pattnaik, D.,  Mishra, A., Panda, B., Mohanty, S. (2022). A Clinical Significance of Fungal Infections in Diabetic Foot Ulcers. Cureus, 14(7), e26872. https://doi.org/10.7759/cureus.26872.

Abstract

Background: Diabetic foot ulcers (DFUs) are the most common and serious complications in uncontrolled diabetes. Infections are predominantly polymicrobial, with aerobic Gram-positive, anerobic, and fungal infections. Early detection of fungal infection and initiation of appropriate treatment in DFUs may lead to better healing and avoid amputations. The primary objective was to find out the prevalence of DFUs getting infected with fungus and the secondary objective was to identify the appropriate methodology for the detection of the fungus in DFUs. Materials and methods: This was a cross-sectional observational study carried out in a tertiary care hospital with a sample size of 60 DFUs. Microbiological analysis was done by swab culture and deep tissue culture. Observational data were collected and the significance level was statistically analyzed. Results: In the present study, the prevalence of fungal infections in DFUs was 31.7%. Only fungal tissue was positive in 15%, the fungal swab was positive in 8.33%, and both tissue and swab were positive in 8.33%. All these patients were treated with antifungal treatment as per the culture report in addition to appropriate antimicrobial therapy. Conclusion: A fungal culture should be done in all patients with non-healing DFUs. Both fungal swab and tissue culture testing should be advocated in patients with DFUs for better mycological evaluation. The addition of antifungal medications may provide better outcomes in selected cases.


5. Nath, P., Kumar, R., Mallick,B., Das, S., Anand, A. C., Panigrahi, S.C., Duseja, A., Acharya S.K., Chawala. Y.K., Praharaj, D.L. (2022) Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients with Review of Literature. Cureus, 14(7), e26683. https://doi.org/10.7759/cureus.26683.

Abstract

Aminotransferase assay is often used as a screening test as well as an endpoint for resolution of disease in nonalcoholic fatty liver disease (NAFLD). Aim of the study was to evaluate the relationship of transaminase level with metabolic variables and histology in NAFLD. Single center observational study was conducted in a gastroenterology clinic at Cuttack in coastal Odisha. Subjects were consecutive patients presenting with functional bowel disease and undergoing abdominal sonography. All participants were evaluated for the presence of metabolic syndrome (MS), insulin resistance, liver function test and lipid profile. Various parameters were compared between NAFLD subjects and controls. 53.5 % of NAFLD had normal serum transaminases, whereas 20.8 % of healthy controls had transaminitis. NAFLD patients had significantly higher BMI, fasting plasma glucose, serum transaminases, serum triglycerides, serum insulin and homeostatic model assessment (HOMA) IR than controls. NAFLD patients who had transaminitis had significantly higher incidence of MS and higher mean HOMA IR than those without. There was no significant difference in histopathological features between NAFLD with and without transaminitis. To conclude, over half of NAFLD subjects do not have transaminitis while transaminitis is present in a fifth of healthy people without fatty liver. Hence serum transaminase should not be used as screening test for NAFLD. NAFLD patients with transaminitis had a higher incidence of MS and insulin resistance than those without. However, there was no significant difference in histopathological features between these two groups.


6. Kar, S., Singh, S., Parimita, P., Mishra, A., Panda, P.S. (2022). Awareness regarding prevention and management of needle stick injury among the health care providers in a tertiary care Hospital, Bhubaneswar, Odisha- A qualitative data exploration. Indian Journal of Microbiology Research, 9(2), 135-139.

Abstract

Background: Needle stick injuries are preventable causes of fearsome diseases like Hepatitis B and HIV. In spite of this knowledge, the health care providers are quite negligent, and the institutional support too is compromised due to the increased demand for services.
Objectives: The current study is a dipstick audit of the knowledge and practices on NSI (prevention and management) among exposed health care workers, with specific reference to HIV infection in a private health facility in Bhubaneswar city, using an unorthodox tool of Focus Group Discussions among the participants. Materials and Methods: The exercise was a part of the academic activity of health promotion on World AIDS Day 2021. Health care workers such as doctors, paramedical staff & utility staff voluntarily participated in the FGD session. Total 3 FGDs were conducted at 3 different places inside the hospital premises. Three moderators were selected previously and after discussing the theme of World AIDS Day, they guided the FGDs with similar probing questionnaires. The sessions were recorded with the help of a recorder and also noted down along with Sociograms. Result: The data gave a real picture of how even premier institutions are complacent regarding the problem. Only 27% knew about the SOPs, and in none of the stations, SOPs were displayed or a register was maintained regarding NSI in their work area. None of the participants were aware of Post Exposure Prophylaxis for the same. This indeed highlighted an ignored aspect of quality health care. Conclusion: The data was an eye-opener in a tertiary care center and from time to time there should be refresher training or sessions to increase the level of awareness.


7. Saha, A., Ahmed, S. (2022). The link between heat shock proteins, renin-angiotensin system, and the coagulation cascade in the pathogenesis of the coronavirus-19 disease. Advances in Experimental Medicine and Biology, https://doi.org/10.1007/5584_2022_735

Abstract

Introduction: Understanding the pathogenesis of COVID-19 is integral for its successful treatment.

Methods: Available literature on the relationship between COVID-19, heat shock proteins (HSP), and the renin-angiotensin-aldosterone (RAAS) system were searched and used to hypothesize how HSP can be targeted in COVID-19.Results: During SARS-CoV-2 cellular entry, the ACE-2 receptor is downregulated. This leads to the augmentation of angiotensin-2/AT1 receptor axis along with attenuation of the ACE-2/angiotensin1–7/Mas axis. Heat shock proteins are key stabilizing molecules in various pathways. In the heart and vessels, HSP-90 and HSP-60 can facilitate angiotensin-2-mediated myocardial injury and endothelial cell activation. HSP-60-TLR4/CD14 complex formation stabilizes IκB-kinase (IKK) potentiating NF-κB activation. HSPs in lungs and kidneys have antioxidant, vasodilatory, and anti-inflammatory actions and may be protective against the effects of RAAS. Stress-induced HSP-70 has a role in complement-mediated microvascular injury such as has been demonstrated in COVID-19. SARS-CoV-2 can induce autophagy via Beclin-1 and ER (endoplasmic reticular) stress via BIP. These two can be potential targets in the HSP environment.

Conclusion: Various HSP molecules can modulate the effects of the renin-angiotensin-aldosterone (RAAS) system and thus may have a potential role in the pathogenesis of COVID-19.

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