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Severe scrub typhus infection: Clinical features, diagnostic challenges and management

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World Journal of Critical Care medicine 2015年第3期4卷 244-250页

作者： John Victor Peter Thomas I Sudarsan John Anthony J Prakash george m varghese medical Intensive Care Unit Christian Medical College Department of microbiology Christian Medical College Department of Infectious Diseases Christian Medical College

Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay(IFA) for the detection of Ig m antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.

关键词： Rickettsia Diagnosis management Outcome multi-organ failure

Spectrum of cardiac manifestations and its relationship to outcomes in patients admitted with scrub typhus infection

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World Journal of Critical Care medicine 2018年第1期7卷 16-23页

作者： Gunasekaran Karthik Thomas Isaiah Sudarsan John Victor Peter Thambu Sudarsanam george m varghese Paul Kundavaram Sowmya Sathyendra Ramya Iyyadurai Kishore Pichamuthu Department of medicine Christian Medical College medical Intensive Care Unit Christian Medical College Department of Infectious Diseases Christian Medical College

AIm To study the spectrum of cardiac manifestations in scrub typhus infection and assess its relationship to *** Demographic data, electrocardiographic(ECG) changes, left ventricular (LV) systolic and diastolic function, myocardial injury (defined as troponin T > 14 pg/mL), and pericardial effusion were documented. myocarditis was diagnosed when myocardial injury was associated with global LV systolic dysfunction. The relationship between myocarditis and outcomes was assessed using logistic regression analysis and expressed as odds ratio(OR) with 95%*** The cohort(n = 81; 35 males) aged 49.4 ± 16.1 years(mean, SD) presented 8.1 ± 3.1 d after symptom onset. The APACHE-Ⅱ score was 15.7 ± 7.0. Fortyeight (59%) patients were ventilated, and 46 (56%) required vasoactive agents. mortality was 9.9%. ECG changes were non-specific; sinus tachycardia was the most common finding. myocardial injury was evident in 61.7% of patients and LV systolic dysfunction in 30.9%. A diagnosis of myocarditis was made in 12.3%. In addition, seven patients with regional wall motion abnormalities had LV systolic dysfunction and elevated cardiac enzymes. mild diastolic dysfunction was observed in 18 (22%) patients. mild to moderate pericardial effusion was seen in 51%. On multivariate logistic regression analysis, patients with myocarditis tended to be older (OR = 1.04, 95%CI: 0.99-1.09), had shorter symptom duration (OR = 0.69, 95%CI: 0.49-0.98), and tended to stay longer in hospital(OR = 1.17, 95%CI: 0.98-1.40). myocarditis was not associated with increased *** In scrub typhus infection, cardiac manifestations are frequent and associated with increased morbidity but not mortality.

关键词： Scrub typhus myocarditis Outcome

Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?

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World Journal of Critical Care medicine 2023年第4期12卷 226-235页

作者： Prithviraj Bose Binila Chacko Ashwin Oliver Arul Leena Robinson Vimala Balamugesh Thangakunam george m varghese mohan Jambugulam Audrin Lenin John Victor Peter Department of medical Intensive Care Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Radiodiagnosis Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Pulmonary medicine Christian Medical CollegeVellore 632004Tamil NaduIndia Department of Infectious Disease Christian Medical CollegeVellore 632004Tamil NaduIndia Department of medicine Christian Medical CollegeVellore 632004Tamil NaduIndia

BACKGROUND During the second wave of the coronavirus disease 2019(COVID-19)pandemic,a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extra-pulmonary organ *** To describe the clinical and laboratory characteristics,outcomes,and management of these patients,and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory *** This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital,between may and August 2021,who fulfilled clearly defined inclusion and exclusion *** was assessed by a change in PaO_(2)/FiO_(2) ratio and levels of inflammatory markers before and after immunomodulation,duration of mechanical ventilation after starting treatment,and survival to *** Five patients developed delayed respiratory deterioration in the absence of new infection,fluid overload or extrapulmonary organ dysfunction at a median interquartile range(IQR)duration of 32(23-35)d after the onset of *** patients had elevated inflammatory markers,required mechanical ventilation for 13(IQR 10-23)d,and responded to glucocorticoids and/or intravenous *** patient died(20%).CONCLUSION This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described multisystem Inflammatory Syndrome–Adults by the paucity of extrapulmonary organ *** diagnosis can be considered in patients presenting with delayed respiratory worsening,that is not attributable to cardiac dysfunction,fluid overload or ongoing infections,and associated with an increase in systemic inflammatory markers like C-reactive protein,inteleukin-6 and ferritin.A good response to immunomodulation can be *** delayed inflammatory pulmonary syndrome may re

关键词： COVID-19 ARDS multisystem Inflammatory Syndrome in Adults Long COVID Organizing pneumonia

Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus

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四川生理科学杂志 2023年第3期45卷 536-536页

作者： george m varghese 不详

Background:The appropriate antibiotic treatment for severe scrub typhus,a neglected but widespread reemerging zoonotic infection,is ***:In this multicenter,double-blind,randomized,controlled trial,we compared the efficacy of intravenous doxycycline,azithromycin,or a combination of both in treating severe scrub *** who were 15 years of age or older with severe scrub typhus with at least one organ involvement were *** patients were assigned to receive a 7-day course of intravenous doxycycline,azithromycin,or both(combination therapy).The primary outcome was a composite of death from any cause at day 28,persistent complications at day 7,and persistent fever at day 5.

关键词： involvement intravenous Intravenous

Effect of post-thermal annealing on the structural and optical properties of ZnO thin films prepared from a polymer precursor

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Chinese Physics B 2012年第7期21卷 551-558页

作者： Jijoy.P.mathew george varghese Jacob mathew Thin Film Research Laboratory Department of PhysicsSt.Berchmans CollegeChanganasseryKerala 686101India Department of Physics Calicut UniversityThenjippalamKeralaIndia

ZnO thin films were synthesised by a new method which uses polyvinyl alcohol （PVA） as the polymer precursor. The films are annealed at different temperatures and for different annealing times. The structural parameters, like grain size, lattice constants, optical band gap, and Urbach energy, depend on the annealing temperature and time. All the films possess tensile strain, which relaxes as the annealing temperature and time increase. The photoluminescence （PL） spectra contain only ultraviolet （UV） peaks at low temperature, but as the annealing temperature and time increase, we observe peaks at the blue and green regions with a variation in the intensities of these peaks with annealing temperature and time.

关键词： stress, band gap, Urbach energy photoluminescence

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Antioxidant,anti-alpha-glucosidase and pancreatic beta-cell protective effects of methanolic extract of Ensete superbum Cheesm seeds

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Asian Pacific Journal of Tropical Biomedicine 2017年第2期7卷 121-125页

作者： Solomon Habtemariam george Kabakasseril varghese Pharmacognosy Research Laboratories&Herbal Analysis Services Medway School of ScienceUniversity of GreenwichChatham-MaritimeKent ME4 4TBUK Department of Botany St.Berchmans'CollegeChanganasseryKottayam 686101KeralaIndia

Objective: To investigate the antioxidant, anti-a-glucosidase and pancreatic b-cell protective potential of Ensete superbum(E. superbum) ***: A variety of in vitro assays including radical scavenging, reducing power potential, phenolic content determination, a-glucosidase assay and pancreatic b-cell(1.4E7 cells) viability were employed for assessing the effect of methanolic extract of E. superbum ***: The radical scavenging and reducing power effects comparable with the standard rutin were obtained while the enzyme inhibitory activity of the extract was 68-fold better than the standard antidiabetic drug, acarbose. The seed extract of E. superbum was packed-full of polyphenols with mean percentage gallic acid equivalent value of(38.2 ± 1.8)(n = 3). The protection of pancreatic cells from massive onslaught of hydrogen peroxide was far superior to that obtained for ***: The reputed antidiabetic therapeutic uses of the seeds extract of E. superbum may be justified on the basis of inhibition of carbohydrate enzymes, antioxidant effects and pancreatic b-cell protection.

关键词： Ensete superbum musaceae Seeds Antioxidant Pancreatic beta-cell protection Alpha-glucosidase inhibition

Twisted analytic torsion

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Science China mathematics 2010年第3期53卷 555-563页

作者： mATHAI varghese Department of mathematics University of Adelaide

We review the Reidemeister, Ray-Singer’s analytic torsion and the Cheeger-mller theorem. We describe the analytic torsion of the de Rham complex twisted by a flux form introduced by the current authors and recall its properties. We define a new twisted analytic torsion for the complex of invariant differential forms on the total space of a principal circle bundle twisted by an invariant flux form. We show that when the dimension is even, such a torsion is invariant under certain deformation of the metric and the flux form. Under T-duality which exchanges the topology of the bundle and the flux form and the radius of the circular fiber with its inverse, the twisted torsion of invariant forms are inverse to each other for any dimension.

关键词： analytic torsion circle bundles T-duality

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Options for converting a clone trial of Eucalyptus camaldulensis into a clonal seed orchard considering gain,fertility and effective clone number

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Journal of Forestry Research 2016年第1期27卷 51-57页

作者： R.Kamalakannan m.varghese P.G.Suraj T.Arutselvan ITC Life Sciences and Technology Centre (LSTC) Peenya Industrial Area Phase I

We evaluated a clone trial comprised of 20 ramets each of 40 Eucalyptus camaldulensis clones for growth and fertility at 4 years of age. The clones differed significantly in growth with 65-100 % survival in 38 clones while two clones had low survival （40 and 10 %）. Fecundity was high and fertility variation low, as indicated by the sibling coefficient value （ψ = 1.4） with 55 % of clones contributing 80 % of the fruits. Thinning strategies were considered to convert the clone trial to a clonal seed orchard and enhance both gain and diversity in seed crop. When clones were selected based on growth without con- sidering fertility, truncation selection （to retain clones with higher DBH than the trial mean value） would give 8 % gain, but 59 % reduction in effective population size （Ne）. Gain and predicted diversity （Ne） was highest when ramets were selected in linear proportion to the breeding value of each clone. mass selection with the same intercept （for DBH） as truncation selection would give a moderate 3 % gain, but over two times higher predicted Ne than trunca- tion selection. When fertility of retained trees was con- sidered after thinning, mass selection would yield 52 % effective contribution from the orchard trees compared to only 30 % contribution from truncation selection and linear thinning. Higher representation of superior clones in linear thinning and mass selection would lead to greater fertilityvariation and over 30 % reduction in effective clone number （Nc） from that predicted （Ne, assuming equal fer- tility among ramets） before thinning.

关键词： Seed orchard Fertility variation Geneticgain Diversity Thinning Eucalyptus

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Delaying clozapine: how long is too long?

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General Psychiatry 2020年第2期33卷 88-93页

作者： Tom varghese m KS Jyothi KS Shaji Lekshmi Rita Venugopal Department of Psychiatry Government Medical College ThrissurThrissurKeralaIndia Department of Psychiatry General Hospital KozhikodeKozhikodeKeralaIndia School of public health University of CaliforniaBerkeleyCaliforniaUSA

Background Although clozapine is the most effective drug for treatment-resistant schizophrenia,its use remains restricted in clinical practice in *** delay in initiating treatment with clozapine and its impact on disease outcome needs *** To identify the implications of delaying clozapine initiation in clinical outcomes among people with treatment-resistant *** Subjects with treatment-resistant schizophrenia,stabilised on clozapine monotherapy,were recruited from the outpatient clinic of a general hospital psychiatry unit offering tertiary care services in Thrissur district,Kerala,India.A retrospective cohort design was employed,and information on duration of illness,total duration of treatment and duration of treatment with clozapine was *** symptom status was measured using the Positive and Negative Syndrome *** associated with higher symptom scores were analysed using an independent sample f test,Spearman correlation and multiple linear *** Forty subjects stabilised on long-term clozapine therapy formed the study *** mean dose of clozapine used in the study population was 200 *** mean duration of antipsychotic treatment before starting clozapine was 89.3 months(7.4 years).The duration of treatment before starting clozapine was found to have a significant positive association with the total Positive and Negative Syndrome Scale score(correlation coefficient 0.40;p=0.01)and negative symptom score(correlation coefficient 0.33;p=0.04).The multiple regression analysis adjusting for covariates showed that the duration of treatment before starting clozapine was an independent factor associated with a higher negative symptom score in the Positive and Negative Syndrome Scale(slope p=0.05;p=0.02;R2=0.27).Conclusion Poor treatment outcomes in treatmentresistant schizophrenia could be secondary to a delay in initiating clozapine therapy.

关键词： clozapine starting treatment