Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit.

Background: This study examines the trends of procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and sequential organ failure assessment (SOFA) scores in intensive care unit (ICU) sepsis patients from different infection sources. Elevations in PCT and NLR reflect infection severity and predict sepsis prognosis. Combining them may enhance diagnostic accuracy and prognostic capabilities, despite variations in cut-off values. The study emphasizes the significance of these biomarkers in improving sepsis management and patient outcomes. Materials and methods: This was a prospective observation study of ICU sepsis patients from different infection sources. Procalcitonin and NLR levels were measured on days 0, 2, and 4 of admission. Sequential organ failure assessment scores on these days were also analyzed. The cut-off values were obtained for predicting the prognosis of sepsis ICU patients. Results: The study included 100 sepsis patients with an equal distribution of males and females and a mean age of 72 years. Procalcitonin showed a significant decrease over time, while NLR initially increased before decreasing on day 4, and SOFA scores showed no significant changes. Deceased patients had significantly higher PCT and SOFA scores on days 2 and 4. Receiver operating characteristic curve analysis showed promising predictive results for PCT on day 4 and SOFA scores on days 2 and 4. Conclusion: Understanding the trends of PCT and NLR concerning the infection source can provide deeper insights into their diagnostic and prognostic capabilities. This comparative analysis of PCT, NLR, and SOFA score trends contributes to the improvement of patient outcomes through accurate assessment of sepsis severity and progression, early diagnosis, and timely intervention. How to cite this article: Jayara A, Mascarenhas J, Gandhi B, Nimbolkar J. Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit. Indian J Crit Care Med 2024;28(10):942-951.

Genomics of postvaccination SARS-CoV-2 infections during the Delta dominated second wave of COVID-19 pandemic, from Mumbai Metropolitan Region (MMR), India.

The present study was initiated to understand the proportion of predominant variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in postvaccination infections during the Delta dominated second wave of coronavirus disease 2019 (COVID-19) in the Mumbai Metropolitan Region (MMR) in India and to understand any mutations selected in the postvaccination infections or showing association with any patient demographics. Samples were collected (n = 166) from severe/moderate/mild COVID-19 patients who were either vaccinated (COVISHIELD/COVAXIN-partial/fully vaccinated) or unvaccinated, from a city hospital and from home isolation patients in MMR. A total of 150 viral genomes were sequenced by Oxford Nanopore sequencing and the data of 136 viral genomes were analyzed for clade/lineage and for identifying mutations. The sequences belonged to three clades (21A, 21I, and 21J) and their lineage was identified as either Delta (B.1.617.2) or Delta+ (B.1.617.2 + K417N) or sub-lineages of Delta variant (AY.120/AY.38/AY.99). A total of 620 mutations were identified of which 10 mutations showed an increase in trend with time (May-October 2021). Associations of six mutations (two in spike, three in orf1a, and one in nucleocapsid) were shown with milder forms of the disease and one mutation (in orf1a) with partial vaccination status. The results indicate a trend toward reduction in disease severity as the wave progressed.

Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: A multicentre study from Mumbai, India.

BACKGROUND: There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. METHODS: A retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded. RESULTS: 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001). CONCLUSIONS: Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.

Photophysical characteristics and reactivity of bis(2,9-di-tert-butyl-1,10-phenanthroline)copper(I).

The recently synthesized sterically constrained copper(I) complex [Cu(dtbp)(2)](+) (1), where dtbp is 2,9-di-tert-butyl-1,10-phenanthroline, exhibits unique photophysical and reactivity properties. Complex 1 (lambda(abs), 425 nm; epsilon, 3100 L M(-1) cm(-1); lambda(emission), 599 nm) has the longest metal-to-ligand charge-transfer (MLCT) emission lifetime (tau, 3260 ns) and largest quantum yield (varphi, 5.6%) of all [Cu(R(2)phen)(2)](+) complexes. Complex 1 also exhibits a large positive reduction potential for the [Cu(2+)(dtbp)(2)]|[Cu(+)(dtbp)(2)] couple (E(1/2) = 0.70 V vs Fc(+/0)) and a large negative excited-state reduction potential for the [Cu(2+)(dtbp)(dtbp(-*))]|[Cu(2+)(dtbp)(2)] couple (E(1/2) = -1.66 V vs Fc(+/0)), indicating that this complex is a potent photoreductant in the excited state. The steric constraint imposed by the t-butyl substituents in 1 enables unusual ligand replacement reactivity. Either CH(3)CN or CO replaces one of the dtbp ligands, a reaction that is readily followed by loss of the unique emission signature of 1. Monodentate CH(3)CN binds to the copper(I) center with an affinity 2 orders of magnitude greater than that of the displaced dtbp, despite the fact that the displaced ligand is bidentate. CO-induced displacement of dtbp from 1 is reversible, but only in the presence of 1 equiv of unbound dtbp. The exceptionally strong donor ligand CH(3)NC displaces both dtbp ligands from 1. In contrast to the facile ligand displacement reactivity with good donor ligands, 1 does not react readily with O(2), by either a ligand displacement or an oxidative pathway. Rather, O(2) induces partial quenching of emission via an outer-sphere interaction with 1.

Facile oxidation-based synthesis of sterically encumbered four-coordinate bis(2,9-di-tert-butyl-1,10-phenanthroline)copper(I) and related three-coordinate copper(I) complexes.

A new oxidation-based synthetic route was developed for synthesis of Cu(I) complexes with weakly coordinating ligands, leading to the synthesis of the elusive [Cu(dtbp)2]+ (dtbp, 2,9-di-tert-butyl-1,10-phenanthroline) complex that may be useful as a sensor or as a dye for dye-sensitized solar cells. An acetone solution of either 1 or 2 equiv of dtbp was added to excess Cu(0) and 1 equiv of AgY (Y is O3SCF3-, BF4-, SbF6-, or B(C6F5)4-) in a nitrogen-filled glove box. Following filtration and evaporation under vacuum, crystallization from CH2Cl2 and hexanes results in X-ray quality crystals of Cu(dtbp)(O3SCF3) (1), Cu(dtbp)(BF4) (2), [Cu(dtbp)(acetone)][SbF6] (3), [Cu(dtbp)2][B(C6F5)4].CH2Cl2 (4.CH2Cl2), [Cu(dtbp)2][BF4].CH2Cl2 (5.CH2Cl2), and [Cu(dtbp)2][SbF6].CH2Cl2 (6.CH2Cl2). Complexes 1-6 were characterized by X-ray crystallography and NMR. The Cu atom in complexes 1-3 exhibited distorted trigonal coordination geometries, reflecting the steric effect of the bulky tert-butyl substituents. The structures of the pseudotetrahedral complexes 4, 4.CH2Cl2, 5.CH2Cl2, and 6.CH2Cl2 revealed the longest average Cu-N distances (2.11 A, 2.11 A, 2.10 A, and 2.11 A, respectively) in this class of compounds-longer by more than three standard deviations from the average.

A new class of oxo-bridged high-valent hexamanganese clusters supported by sterically hindered carboxylate ligands.

A new class of oxo-bridged high-valent hexamanganese (Mn6) clusters containing a novel (Mn6O8)6+ core, [MnIV(4)MnIII2(mu-O)4(mu3-O)4(dmb)6(O2CR)2]4+ (where dmb=4,4'-dimethyl-2,2'-bipyridine, and RCO2=2,6-di(p-tolyl)benzoate (Ar(Tol)CO2-) (3) or 2,6-di(4-tert-butylphenyl)benzoate (Ar(4-tBuPh)CO2-) (4)), was synthesized using sterically hindered m-terphenyl-derived carboxylate ligands. These complexes can be synthesized by oxidizing the MnII mononuclear complexes, [Mn(dmb)2(OH2)(O2CR)]+ (where RCO2=Ar(Tol)CO2- (1) or Ar(4-tBuPh)CO2- (2)) with (n-Bu4N)MnO4, by direct Mn(II) + Mn(VII) in situ comproportionation reactions, or by ligand substitution on the dinuclear manganese (III,IV) or (IV,IV) complexes, [(Mn2(mu-O)2(dmb)4)](3+/4+). The compound [MnIV4MnIII2(mu-O)4(mu3-O)4(dmb)6(Ar(Tol)CO2)2](OTf)4 [3(OTf)4] crystallizes in the monoclinic space group P2(1)/n, with the cell parameters a=15.447(1) A, b=15.077(2) A, c=27.703(2) A, beta=91.68(2) degrees, V=6449.3(6) A3, and Z=2. The X-ray structure reveals that there are three different bridging modes for the oxo groups: mu, "pyramidal" mu3, and "T-shaped" mu3. Solid-state variable temperature magnetic susceptibility studies suggest that the Mn centers are net antiferromagnetically coupled to yield a diamagnetic ST=0 ground spin state with a large number of low-lying, thermally accessible states with ST>0. 1H NMR spectra were recorded for both Mn6 clusters and selected resonances assigned. The electronic and redox properties of these complexes along with the effect of the presence of the bulky carboxylate ligands are also described here.