Introduction Effective postoperative pain control is essential for enhanced recovery and improved patient satisfaction following laparoscopic cholecystectomy. Pre-emptive administration of non-opioid analgesics, such as intravenous paracetamol and ibuprofen, has been incorporated into multimodal analgesic strategies to reduce postoperative pain and opioid consumption. This study compared the analgesic efficacy and safety of pre-emptive intravenous paracetamol and intravenous ibuprofen in patients undergoing elective laparoscopic cholecystectomy. Objective The primary objective of this study was to compare postoperative pain intensity between pre-emptive intravenous paracetamol and intravenous ibuprofen using the Visual Analogue Scale (VAS) at the end of surgery and at 2, 6, 12, 18, and 24 hours postoperatively. Secondary objectives included comparison of perioperative haemodynamic parameters (heart rate, mean arterial pressure, and peripheral oxygen saturation) and assessment of drug-related adverse effects, including postoperative nausea and vomiting. Methodology This prospective, randomized, double-blind, parallel-group comparative study was conducted in the Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India, between August 2023 and January 2025. Ninety patients aged 18-60 years with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated into two equal groups. Group P received intravenous paracetamol 2 g, while Group I received intravenous ibuprofen 800 mg, each diluted in 200 mL normal saline and infused over 30 minutes before induction of anaesthesia. Postoperative pain was assessed using the Visual Analogue Scale, and haemodynamic variables and adverse events were recorded for 24 hours. Results Baseline demographic and clinical characteristics were comparable between the two groups. Postoperative VAS scores improved over time in both groups, with a significantly greater reduction in pain scores in the ibuprofen group than in the paracetamol group (p < 0.001). Heart rate and other haemodynamic parameters remained comparable between groups throughout the study, with no significant difference in overall heart rate trends (p = 0.060). Although intravenous ibuprofen provided superior analgesia, it was associated with a higher incidence of postoperative nausea and vomiting. Conclusion Pre-emptive intravenous ibuprofen provided superior postoperative analgesia compared with intravenous paracetamol following laparoscopic cholecystectomy. However, because ibuprofen was associated with a higher incidence of adverse effects, it should be selected with attention to patient characteristics and clinical risk factors.

Background Muscle strength is a key factor determining metabolic health, physical performance, and morbidity. Although body mass index (BMI) is used widely to assess obesity, it does not assess body composition adequately. Percentage body fat (PBF) could provide a better estimate of adiposity and its association with muscle strength, particularly in Asian populations with higher body fat at lower BMI levels. We aimed to evaluate the associations of BMI and PBF with HGS and lower limb muscle strength among North Indian adults and to compare the independent associations of BMI and PBF with HGS. Methodology This cross-sectional study included 1,513 apparently healthy adults aged 18 to 60 years. Anthropometric measurements, BMI, and PBF were measured using bioelectrical impedance analysis. HGS was measured using a Jamar hydraulic dynamometer, and lower limb muscle strength was tested using a handheld dynamometer. Correlation and multiple regression analyses were performed to assess the association of BMI and PBF with muscle strength. Results The average age of the participants was 38.25 ± 9.76 years, and 54.5% were males. PBF showed a significant inverse association with HGS for both hands. For the right HGS, the regression coefficient B was -0.619 with an R² of 0.331, while for the left HGS, B was -0.594 with an R² of 0.336 (p < 0.001 for both). However, BMI showed a comparatively weaker association with HGS, explaining less than 2% of the variation. Higher BMI was significantly associated with greater lower limb muscle strength (p < 0.001), while no significant association was found between BMI categories and HGS. Multivariable regression analysis further showed that PBF remained independently associated with HGS (p-value < 0.001 for both hands). Conclusions According to our study, PBF demonstrated a stronger association with muscle strength than BMI. These findings show that relying on BMI alone is insufficient and suggest including body composition assessment to identify individuals at risk of reduced muscle strength and related health complications.

BACKGROUND:Antimicrobial resistance among Acinetobacter baumannii and Klebsiella pneumoniae has significantly increased which has reduced available treatment options. Omadacycline, a novel tetracycline, has shown in vitro activity against multidrug-resistant pathogens; however, in vitro susceptibility of Omadacycline has not been previously studied against the extensively drug-resistant (XDR) isolates in Indian setting. METHODS:This prospective observational study evaluated the in vitro activity of Omadacycline against extensively drug-resistant (XDR) A. baumannii and K. pneumoniae isolates obtained from bloodstream infections and bacterial meningitis. Minimum inhibitory concentrations (MICs) of Omadacycline were determined using broth microdilution method. MIC50 and MIC90 values were calculated, and results were also compared with Tigecycline. RESULTS:Overall, 30.58% of isolates demonstrated MIC values ≤ 2 μg/mL. Omadacycline exhibited better in vitro activity against A. baumannii than K. pneumoniae. Lower MICs were observed in bloodstream isolates than meningitis isolates. Comparative analysis with Tigecycline showed no statistically significant difference in vitro susceptibility. CONCLUSION:Omadacycline demonstrated favorable in vitro activity against XDR A. baumannii, particularly bloodstream isolates, with lower activity against K. pneumoniae. No statistically significant difference in vitro susceptibility was observed compared with Tigecycline. These findings support further evaluation of Omadacycline as a potential therapeutic option and further clinical and pharmacokinetic studies are required to define the role in management of XDR infections in Indian setting.

Purpose: Central nervous system tuberculosis (CNS TB) presenting with vasculitis or arachnoiditis causes significant morbidity and mortality. The purpose of this study was to characterise the clinical spectrum and outcomes of patients diagnosed with TB arachnoiditis and TB-associated CNS vasculitis Methods A retrospective study was conducted between October 2020 and September 2023, screening patients admitted with suspected CNS TB to a tertiary care hospital. Patients diagnosed with proliferative arachnoiditis, and TB-associated CNS vasculitis were recruited. Their clinical details, follow-up records, and outcomes were assessed. Results Among 318 patients admitted with suspected CNS TB, 87 patients had complications, with follow-up data available for 69 patients. Vasculitis, spinal arachnoiditis (SA), and optochiasmatic arachnoiditis (OCA) was diagnosed in 66 (76%), 41 (47%), and 26 (30%) patients respectively. Median duration of follow-up was 490 days. Median mRS at discharge was 4. 18 (69%) OCA patients and 14 (35%) SA patients received pulse methylprednisolone. Intrathecal hyaluronidase was administered in 14 patients and thalidomide was given to 9 patients. 30 (46%) patients with vasculitis were treated with aspirin. 69 patients completed follow-up, 49% died. Among the remaining, 88.6% had improvement with treatment with a median mRS of 2 (1-3). Among patients with OCA, 3(23.1%) showed complete improvement with a median improvement of 3 points on Likert scale. In the SA patients, 19 (55.9%, 34) patients were alive on follow-up, with a median mRS of 1. Aspirin use was not associated with better mRS or survival in patients with vasculitis. A multivariable Cox proportional model showed age at diagnosis to be the only predictor of mortality (HR 1.04, 95% CI (1.01- 1.08), p =0.012). Conclusions TB arachnoiditis and CNS vasculitis are severe complications of CNS TB, and management remains a challenge. The poor therapeutic response to intrathecal hyaluronidase, thalidomide, and aspirin highlights need for further larger prospective trials and search for alternative agents.

Background:Invasive pulmonary aspergillosis (IPA) is a serious infection in critically ill patients. Galactomannan detection in endotracheal aspirates (ETA) has emerged as a promising non-invasive diagnostic method. This study evaluates the supportive diagnostic value of ETA galactomannan in ICU patients suspected to have IPA. Methods:We conducted a prospective observational cohort study over two years, enrolling 120 patients in the medicine ICU at a tertiary care centre in India (January 2022 to October 2023). Patients aged over 14 years on mechanical ventilation for >48 hours meeting the entry criteria of the BM-AspICU algorithm were included. ETA galactomannan was measured and correlated with IPA classification. Results:Of 120 patients, 37% (n=44) had probable IPA and 63% (n=76) were classified as colonisers or possible IPA. The optimal ETA galactomannan cut-off was 1.097, yielding sensitivity 72.73% (95% CI 57.2-85.0%), specificity 84.2% (95% CI 74.4-90.7%), PLR 4.86, NLR 0.35, and 0.844. Conclusions:ETA galactomannan supports IPA diagnosis with favourable sensitivity and specificity. However, given the limitations of clinical scoring-based reference standards and the potential plateau in coloniser reduction at higher cut-offs, it should be integrated into a comprehensive diagnostic approach incorporating clinical, radiological, and microbiological criteria.

OBJECTIVE:This study determines the prevalence and genomic characterisation of uropathogens causing community-acquired urinary tract infections. MATERIALS AND METHODS:This is a first multicentric cross-sectional community study conducted across different regions of India, in patients aged >1.5 y suspected with urinary tract infection. Uropathogens causing significant bacteriuria were identified, and susceptibility testing was performed. Whole-genome sequencing was done to characterise antimicrobial resistance genes, virulence genes, and sequence types (ST). The effect of age and gender on significant bacteriuria was assessed by Multivariable random-effects logistic regression. RESULTS:Significant bacteriuria was seen in 11.8% (711/6009) of the specimens, out of which 63% (448/711) were Escherichia coli, and 15.7% (112/711) were Klebsiella pneumoniae. The prevalence of extended-spectrum beta-lactamase positive, multidrug-resistant and carbapenem resistant E. coli was 65.4% (293/448), 64.5% (289/448) and 9.8% (44/448); among K. pneumoniae isolates, similar resistance was seen in 56.2% (63/112), 39.2% (44/112), and 9.8% (11/112), respectively. Genomic analysis showed high-risk clones of E. coli (ST131, ST1193) and K. pneumoniae (ST15, ST16, and ST231) carrying multiple plasmids with blaCTX-M-15, blaOXA-232, blaNDM-5, and blaNDM-7 genes. CONCLUSIONS:This study revealed a wider presence of drug-resistant high-risk clones of uropathogens in community settings of India. A multifaceted approach through routine antimicrobial resistance surveillance, judicious choice of empiric antibiotics in a community setting, is deemed necessary. Whole-genome sequencing analysis of extended-spectrum beta-lactamase-producing E. coli isolates revealed a predominance of ST131 lineage (25%), while ST1193 strains carried IncFIA and ColKP3 plasmids associated with blaCTX-M-15 and blaTEM-1B. ST231 K. pneumoniae isolates harboured blaOXA-32 gene along with ColKP3 plasmid.

Background Tuberculous meningitis (TBM) is difficult to diagnose because of its variable clinical presentation, the absence of specific imaging or cerebrospinal fluid (CSF) biomarkers, and the lack of a single diagnostic test. Focal sulcal nodular enhancing lesion (FSNEL), the imaging correlate of the Rich focus, has been suggested to aid in diagnosis, but systematic data on its diagnostic accuracy are lacking. We aimed to determine the sensitivity, specificity, and predictive value of FSNEL for diagnosing TBM in patients with chronic meningitis. Methods In this diagnostic accuracy study conducted at a tertiary care center in Northern India, consecutive patients aged ≥ 14 years with clinically suspected chronic meningitis (headache for more than five days, with or without fever, nuchal stiffness, and constitutional symptoms) were screened on clinical grounds alone before neuroimaging or CSF results. Chronic meningitis and TBM were diagnosed using composite clinical, CSF, and imaging criteria. A radiologist, blinded to the final diagnosis, assessed FSNEL on post-contrast MRI. Diagnostic accuracy measures were calculated with 95% confidence intervals, including subgroup analyses restricted to patients without characteristic imaging findings. Results Of 146 patients screened, 113 had index test and reference standard available for analysis (91 with TBM, 22 with other chronic meningitides), yielding a TBM prevalence of 80.5%. FSNEL had a sensitivity of 39.6% (95% CI 29.5–50.4%), specificity of 86.4% (95% CI 65.1–97.1%), positive likelihood ratio of 2.90 (95% CI 0.98–8.56), negative likelihood ratio of 0.70 (95% CI 0.55–0.89), positive predictive value of 92.3% (95% CI 79.1–98.4%), and negative predictive value of 25.7% (95% CI 16.2–37.2%). In patients without parenchymal lesions (n = 75), the findings remained highly specific (89.5%) with lower sensitivity (32.1%). In a stricter subgroup without tuberculomas, hydrocephalus, or basal exudates (n = 41), specificity remained similar (88.2%) with lower sensitivity (12.5%). Conclusion FSNEL is a specific, noninvasive imaging marker for TBM with a modest rule-in value and remains useful even in the absence of parenchymal lesions. Given its limited sensitivity, this finding should be interpreted alongside clinical, CSF, and microbiological assessments rather than used alone. Larger multicentre studies are warranted to validate these findings.

More than one billion individuals throughout the globe suffer from iron-deficiency anemia (IDA). It is mostly caused by dietary deficits. In the Indian context, studies linking psychological stress to anemia and iron deficiency are limited. To investigate the association between iron deficiency anemia and psychological stress. This cross-sectional investigation was carried out on 385 IDA patients. Blood samples were obtained for the analysis of complete blood count, vitamin D, iron markers, folate, TSH, and vitamin B12. Psychological stress was assessed by evaluating perceived stress and life events stress using standardized approved score tests. 385 IDA patients and 102 controls were included. Age and BMI were comparable in both groups. IDA patients had significantly higher perceived stress (p = 0.005), but life event stress was not different between groups (p = 0.16). Hemoglobin, hematocrit, RBC count, red cell indices, ferritin, and hepcidin were significantly lower, but transferrin and TIBC were significantly higher in IDA patients (all p < 0.0001). In multivariable analyses, higher perceived and combined stress scores were independently associated with lower hemoglobin, hematocrit, RBC count, MCH, and MCHC and higher RDW-CV (all Bonferroni-adjusted p < 0.05). Stratified analyses showed a stepwise deterioration of hematological parameters with higher perceived stress (p < 0.001), while life event stress was only weakly associated except for higher platelet counts and lower vitamin B12 and folate levels in higher stress groups. Psychosocial stress showed a significant association with a worse hematological profile in patients with iron deficiency anemia. Incorporating stress management and lifestyle change-related strategies in clinical evaluation may complement standard IDA treatment and improve patient outcome. Future randomized trials must be conducted to confirm stress as a risk factor.

Iron deficiency anemia (IDA) is a significant micronutrient deficiency that affects million worldwide. A crucial trace element, cobalt (Co), is involved in erythropoiesis and is a component of vitamin B12 (cobalamin). The levels of Co in anaemic patients are not well documented. This study was designed to evaluate the Co status in IDA patients by correlating with various biochemical markers. At a tertiary care facility in North India, 166 subjects with IDA participated in this cross-sectional study. Parameters such as TSH, Co, vitamin B12 (VB12), Hepcidin, vitamin D (VD3), folate, iron markers and complete blood count (CBC) were measured. Data analysis showed that median Co was 0.6 (0.2–2.7) µg/L, and patients exhibited significantly low hemoglobin (Hb, 8.89 ± 1.73 g/dL), ferritin FER, 8.2 (5-14.6) ng/mL, and VD3 13.5 (8.9–22) ng/mL. Noteworthy significant associations of Co with VD3 (r = 0.154,p = 0.0482), VB12 (r = 0.153,p = 0.0496), and total iron-binding capacity (TIBC; r = 0.182,p = 0.0188) was observed. However, parameters such as FER (p = 0.1260), Hb (p = 0.0952), didn’t showed any significant correlation with Co levels. Co’s correlation with VB12, VD3, and TIBC implies that it is involved in iron and micronutrient metabolism, even if it had shown no significance with HB and FER. The possible role of Co in the pathophysiology of anaemia requires future investigation in retrospective trials.

Cardiac fibrosis is one of the main causes of mortality from cardiovascular disorders and may result in heart failure, irregular heartbeats, and sudden cardiac death. Multiple complex mechanisms involved in cardiac fibrosis are beyond the scope of current treatments. Inflammasomes are significant inflammatory modulators. Inflammasome impairment may exacerbate heart failure. The most specific inflammasome associated with inflammatory and cardiovascular disorders is Nucleotide-binding oligomerisation domain leucine-rich repeat and pyrin domain-containing protein 3 (NLRP3). Pathogen-associated molecular patterns and damage-associated patterns are recognised by the intracellular sensor NLRP3, which causes the NLRP3 inflammasome to assemble and become active. Thus, a greater awareness of the pathological function of the inflammasome in heart fibrosis may lead to new approaches to the disease's early detection and management. Understanding the inflammasome's regulatory functions in fibrosis of the heart in its entire form has been made possible by recent research on the subject. The most recent studies on the roles of the NLRP3 inflammasome in different cardiac conditions are included in this review. According to recent research, the NLRP3 inflammasome promotes a number of inflammatory reactions and is linked to myofibroblast development, mitochondrial modulation, and pyroptosis in cardiac fibrosis. These discoveries provide light on the critical function of the NLRP3 inflammasome in the aetiology of heart fibrosis, which may help establish novel paths for therapy and prevention.

During counselling, pharmacists or health care personnels should assess patients' grasp of their condition and treatment, and offer personalized guidance to ensure safe and effective use of the medication. To provide accurate guidance and knowledge to patients, health care personnel must grasp the disease's genesis and remedies. Good interpersonal abilities are essential for establishing patient trust and persuading them to adhere to the treatment plan. This section emphasizes the significance of communications such as empathy, rapport-building, and effective communication (verbal and nonverbal). Health care personnels may be providing therapeutic services such as medication evaluation, counselling, and monitoring of adverse drug reactions (ADRs) as well as other Service and conversational Interaction are vital for effective practice. A logical structure is necessary for written communications. The goal of this chapter is to clearly figure out the things which is patients require like good communication, fully understand about the illness, providing aureate information related to the treatment. Patient counselling involves offering information, advice, and assistance to ensure proper medication usage. The pharmacist provides information and advice to patients or their representatives, which may include details about the patient's ailment or advised lifestyle modifications. Typically, information is conveyed verbally, but may also include written materials. During counselling, pharmacists should assess patients' grasp of their condition and treatment, and offer personalized guidance to ensure safe and effective medication use. Family support is essential throughout the overall health journey. In a nation like India, where family dynamics and interdependence are strongly established, family has a significant impact on mental health results. Family members have become more widely accepted as important allies in the care of chronically ill patients, as there is an increasing gap between the need for self-care support and available resources. Self-management programs that include family members have grown rapidly in the last decade. New family therapies based on behavioural theory are currently being evaluated, influenced by recent quantitative and qualitative research.

Background & objectives Gallbladder cancer (GBC) has a low overall survival rate due to late detection and poor prognosis. Chronic inflammation contributes to malignant conversion and metastasis in GBC. Expression of inflammatory proteins, such as signal transducer and activator of transcription factor (STAT) and nuclear factor kappa B (NFĸB) proteins, for diagnosis through immunohistochemistry (IHC) is a promising area of research; however, diagnosis of GBC through IHC-based methods is still in its infancy. So, the present pilot study explores the use of STAT proteins (STAT 3 and 6) and NFĸB as diagnostic biomarkers for GBC. Methods Histologically confirmed cases of GBC (n=13) and cholelithiasis (n=23) as controls, were recruited. IHC was performed for protein expression of STAT3, STAT6, and NFĸB. Subgrouping into high and low expression was performed based on the receiver operating curve (ROC) analysis. Diagnostic utility and its association with the aggressiveness of cancer were assessed. Results The mean age of GBC and cholelithiasis patients was 50.84±14.5 and 44.0±11.9 years, respectively. Liver infiltration and metastasis were observed in 61 per cent and 69 per cent of the patients, respectively. STAT3, STAT6, and NFĸB expressions were significantly higher in GBC as compared to cholelithiasis. Sensitivity and specificity for STAT3 and STAT6 were 91, 47 and 75, 39 per cent, respectively. STAT6 expression was associated with lymph node involvement. Whereas, both STAT3 and STAT6 expressions were associated with Liver infiltration. Interpretation & conclusions This pilot study demonstrated STAT3 and STAT6 as sensitive and specific molecular biomarkers for diagnosing and assessing the aggressiveness of GBC. These may be used as an adjunct to the diagnosis of GBC after validation on a larger sample size.

Travel medicine emerged from the growing demand of travelers. The COVID-19 pandemic taught humans the need of following health standards while traveling to minimize illness transmission. A doctor must provide pre- and post-travel advise in a densely populated country like India with a lot of passengers. Despite many surveys in other countries, no such comprehensive studies have been conducted in India to assess the travel medicine knowledge of health care providers. We conducted a cross-sectional survey on the residents undergoing post-graduate training in Medicine and Infectious Diseases course in All India Institute of Medical Sciences (Ref. No.: IECPG-326/22.07.2020, RT-34/26.08.2020), New Delhi, using a self-administered validated tool/questionnaire. The residents underwent a training program and were again administered the questionnaire to see the effect of intervention. Eighty-five percent of the respondents were aware about the mortality and morbidity associated with travel, whereas 64

Background Patients with underlying intracranial pathology often develop elevated intracranial pressure (ICP). We assessed the utility of optic nerve sheath diameter (ONSD) measurement using point-of-care ultrasonography (POCUS) in patients with non-traumatic elevated ICP. Methods A prospective observational study was conducted amongst 80 patients, 18 years and above, recruited from AIIMS, New Delhi, over 2 years. Patients were divided into 5 etiopathological groups for analysis and interpretation which were infectious meningoencephalitis, metabolic encephalopathy, cerebrovascular accident, intracranial space-occupying lesions and other diagnosis. Based on their need for osmotherapy, patients with elevated ICP were divided into 4 groups: group 1 with hypertonic saline, group 2 with hypertonic saline and glycerol, group 3 with mannitol and group 4 with mannitol and glycerol. Statistical analysis was performed using STATA 16.0 version. Results In our study of 80 patients (aged > 18 years, mean age 38.58 ± 14 years), headache was the most common symptom (84%). Sequential ONSD measurements showed significant decrease after osmotherapy, with marked differences between groups. A statistically and clinically significant decrease in mean ONSD (overall) from 6.15 mm at baseline to 5.79 mm at 120 mins after osmotherapy (difference of 0.36 mm) was noted. Decrease in ONSD was statistically significant at 30 mins (difference of 0.14, p value < 0.05) and was clinically significant (difference of > 0.3 mm, p value < 0.05) from 60 mins onwards with further sustained decrease by 120 mins after osmotherapy. Patients with a Cushing response had varying ONSD decreases, with responders showing greater reductions, difference of 0.51 as compared to 0.24 in non-responders, (p value < 0.05). Conclusion The serial measurement of ONSD by POCUS is a rapid, non-invasive and feasible technique that can be performed by a clinician to assess response to osmotic therapy in a dynamic manner and thereby guide treatment.

Leprosy, one of the great imitators, can present with diverse clinical manifestations, often making it challenging to diagnose. We report an unusual case of steroid-modified leprosy in a 50-year-old man who presented with an erythematous, atrophic plaque with telangiectasia over the left periorbital area and mild sensory loss. The lesion had intensified in redness after prolonged application of topical corticosteroids prescribed for presumed contact dermatitis. Histopathology revealed granulomatous inflammation with perineural involvement. Slit-skin smear confirmed Mycobacterium leprae (BI-2+, MI-10%). A diagnosis of TT Hansen's was made, and WHO-recommended multidrug therapy was initiated. The absence of acute inflammation ruled out a type 1 lepra reaction. The clinical appearance mimicked topical steroid-damaged facies, highlighting the need to consider leprosy as a differential of atypical steroid-modified dermatoses. To our knowledge, this is the first report of "leprosy incognito," an entity analogous to tinea incognito, underscoring the importance of awareness to avoid diagnostic delays.

Background Transmission of the delta variant resulted in a surge of SARS-CoV-2 cases in New Delhi, India, during the early half of the year 2021. Healthcare workers (HCWs) received vaccines on priority for the prevention of infection. We estimated the effectiveness of the BBV152 vaccine among HCWs against SARS-CoV-2 infection, hospitalization, or death. Methods This retrospective cohort study was done at a multi-speciality tertiary care public-funded hospital in New Delhi, India. 12 237 HCWs participated in the study. The intervention was the BBV152 whole virion inactivated vaccine (Covaxin, Bharat Biotech Limited, Hyderabad, administered two doses four weeks apart). The outcome measures were vaccine effectiveness against any SARS-CoV-2 infection, symptomatic infection, or hospitalization or death. Results The mean (SD) age of HCWs was 36 (11) years, 66% were men, and 16% had comorbid conditions. After adjusting for potential covariates—age, sex, health worker type category, body mass index, and comorbid conditions, the vaccine effectiveness (95% confidence interval) in fully vaccinated HCWs and >14 days after receipt of the second dose was 44% (37 to 51, p<0.001) against sympto-matic infection, hospitalization or death due to SARS-CoV-2, and 61% (37 to 76, p<0.001) against hospitalization or death, respectively. The partial dose was not effective. Conclusion The BBV152 vaccine, with complete two doses, offered a modest response to SARS-CoV-2 infection in real-life situations against a backdrop of high delta variant community transmission.

Necrotising enterocolitis (NEC) is a life-threatening condition predominantly affecting preterm neonates. In contrast to well-characterised neonatal forms, adult NEC (ANEC) is a rare entity. Early diagnosis is crucial, as NEC carries a high mortality rate if left untreated. This report describes a man in his 80s presenting with acute abdomen subsequently diagnosed as ANEC. This case emphasises diagnostic challenges and highlights the key differences between the neonatal and adult forms of the disease. This case contributes to the limited literature on ANEC, supporting the need for early diagnosis and management of this rare condition in adults.

INTRODUCTION:Cefiderocol is a parenteral catechol-type siderophore cephalosporin, which has been approved for the treatment of Gram-negative bacterial infections. Its activity among the carbapenem-resistant Gram-negative bacilli (CR-GNBs) in India is largely unknown. METHODOLOGY:We tested in-vitro susceptibility of cefiderocol in 84 CR-GNB [ carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP)] by broth microdilution (BMD) and disc diffusion (DD) using Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints and concordance of DD was compared with BMD. Cefiderocol susceptibility was evaluated based on the presence of blaNDM and blaOXA-48 genes. RESULTS:Following CLSI and EUCAST breakpoints, 76.2% [CRKP: 95.65% (22/23); CRPA: 80% (16/20); CREC: 65% (13/20); CRAB: 61.9% (13/21)] and 52.3% [ CRKP: 82.6% (19/23); CRPA: 50% (10/20); CREC: 20% (4/20)] of CR-GNBs were observed susceptible to cefiderocol, respectively. The susceptibility to cefiderocol was seen higher with lower MIC50 and MIC90 values for CRKP [1 μg/ml; 4 μg/ml ] and CRPA [2 μg/ml; 8 μg/ml ] in comparison to the other two groups of organisms. The categorical agreement between BMD and DD was found between 90% and 100% for all organisms. Cefiderocol susceptibility among the isolates harbouring blaNDM, blaOXA-48, and both blaNDM and blaOXA-48 genes was observed 75% (24/32); 100% (3/3); and 66.6% (4/6), respectively. CONCLUSION:Cefiderocol demonstrated high in-vitro activity against CRKP and CRPA isolates from India with lower MIC50 and MIC90 irrespective of the presence of blaNDM and blaOXA-48 genes.