It is the only referral hospital in the southern part of Assam, also referred to as the Barak Valley, and serves neighbouring states including Mizoram, North Tripura, West Manipur and South Meghalaya.
Background and objective Acute-on-chronic pancreatitis (ACP) is an increasingly recognized clinical entity associated with significant morbidity, prolonged hospitalization, and increased intensive care utilization. Early identification of high-risk patients remains challenging because conventional prognostic scoring systems are often time-consuming, complex, or insufficiently validated in ACP. Procalcitonin (PCT), a rapid inflammatory biomarker, has demonstrated prognostic utility in acute pancreatitis. However, evidence regarding its role in ACP remains limited. This study aimed to evaluate serial serum PCT levels in hospitalized patients with ACP from Northeast India. Methods This prospective observational study was conducted over one year at a tertiary care center and included 58 adult patients diagnosed with ACP based on the revised Atlanta classification criteria and imaging evidence of chronic pancreatitis (CP). Serial serum PCT levels were measured at admission and 48 hours later. Clinical outcomes, including mortality, ICU admission, organ dysfunction, local complications, and duration of hospitalization, were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess the prognostic accuracy of PCT. Results Severe clinical outcomes were common, with mortality observed in 12.1% (n = 7) of patients, ICU admission in 60.3% (n = 35), and local pancreatic complications noted among 82.8% (n = 48) of the cases. Admission PCT demonstrated poor prognostic performance for mortality prediction (area under the curve (AUC): 0.555), with a sensitivity of 46.9% at a cutoff of 3.46 ng/mL. In contrast, 48-hour PCT showed excellent predictive accuracy, yielding an AUC of 0.992. A threshold value of 4.04 ng/mL achieved 100% sensitivity and 100% negative predictive value (NPV) for mortality prediction. Elevated PCT levels were significantly associated with ICU admission (p = 0.034), organ dysfunction (p = 0.021), local complications (p = 0.041), and prolonged hospitalization (r > 0.95). Conclusions Serial serum PCT assessment, particularly at 48 hours, is a reliable prognostic biomarker in ACP and may facilitate early risk stratification, optimized critical care allocation, and individualized clinical management.
AmpC β-lactamases are less commonly reported and are one of the major contributors to third-generation cephalosporin resistance within hospital settings. Emergence of new variants of this beta-lactamase complicates laboratory detection and treatment options. In the current investigation, we report the presence of blaCMY-225, a new type of class C beta-lactamase from a teaching hospital in northeast India.
Bats, often silent carriers of lethal pathogens, serve as natural reservoirs for numerous viruses capable of crossing species barriers with devastating effects. Among them, Rousettus aegyptiacus (R. aegyptiacus) has emerged as a pivotal species in understanding viral spillovers. This fruit bat hosts the Marburg virus (MARV), supporting its replication and occasional transmission to humans, where it causes fatal hemorrhagic fever. However, a striking paradox remains while MARV infection is deadly in humans, R. aegyptiacus remains asymptomatic. Driven by this contrast, our study explores the codon usage patterns to reveal evolutionary mechanisms underlying viral adaptation and host tolerance. Far from being a passive carrier, R. aegyptiacus represents an insightful model for antiviral research. Our analysis revealed distinct codon usage patterns in MARV, indicating fine-tuned evolutionary alignment with the host's codon preferences. MARV exhibited low codon bias, suggesting broad compatibility with the host's translational machinery. Further, COA and PR2 analyses suggested that ecological factors shape codon selection in both virus and host. RNA modification analysis revealed frequent cytosine-to-thymine transitions, implying conserved mutational pressures or host-driven editing. Variations in RCDI values indicated deoptimized codon usage.
The combination of simultaneous fractures of both the proximal and distal end of radius is rare. Only a few cases had been mentioned in the literature. They are also termed as “bipolar fractures of radius”. The association of olecranon fracture with this combination is again very rare. The management protocol is also not very clear. Maintenance of the radius length is perhaps the main crux of treatment, since it takes part in both the proximal and distal radio-ulnar joint. Implant choices can be varied from rigid platting to percutaneous fixation. Radial head can be reconstructed or replaced depending on the fracture comminution. Post-operative rehabilitations also need to be tailored. Rigid fixation like platting favored early mobilization, while semi rigid fixation may need a period of immobilization. Regular follow up and guided physiotherapy optimizes good clinical outcome in such rare combinations of fracture.
Critical illness is characterized by profound inflammatory, oxidative, immune, metabolic, and microcirculatory disturbances that contribute to progressive organ dysfunction and complicate pharmacological management. Ayurvedic pharmacotherapy has attracted interest as a potential adjunctive approach because medicinal plants and complex formulations contain bioactive constituents capable of modulating multiple pathophysiological pathways. This review critically evaluates the pharmacological basis, potential therapeutic applications, safety considerations, and translational prospects of integrating Ayurvedic interventions into critical-care practice. Emphasis is placed on anti-inflammatory, antioxidant, immunomodulatory, mitochondrial, and endothelial mechanisms relevant to sepsis, acute respiratory distress syndrome, acute kidney injury, hepatic dysfunction, cardiovascular instability, and neurocritical illness. The review further examines altered pharmacokinetics and pharmacodynamics during critical illness, including herb–drug interactions involving cytochrome P450 enzymes, drug transporters, and commonly administered intensive-care medications. Major safety concerns include organ-specific toxicity, herbo-mineral exposure, contamination, adulteration, formulation variability, and inadequate pharmacovigilance. Current evidence remains limited by heterogeneous interventions, insufficient pharmacokinetic characterization, inconsistent standardization, and scarcity of rigorous intensive care trials. Future translation requires standardized formulations, mechanistic validation, dose optimization, biomarker-guided patient selection, multicenter randomized trials, and continuous safety surveillance. Ayurvedic pharmacotherapy may ultimately have adjunctive potential, but integration should remain evidence driven, pharmacologically justified, and subordinate to established critical-care standards and therapies.
