A Rare Case of Postpartum Paraplegia: A Case Report.

In this case report, a 27-year-old woman who had pre-eclampsia in the past and had a cesarean section as a result of the condition presents with an uncommon and difficult form of postpartum paraplegia. She experienced bilateral lower limb paralysis and urine incontinence soon after the surgery, which quickly led to unconsciousness and required mechanical ventilator support and intensive care treatment. Comprehensive diagnostic testing, which included magnetic resonance imaging scans of the brain and spinal cord, identified signs typical of "Posterior Reversible Encephalopathy Syndrome (PRES)" and spinal cord infarction affecting segments C3 to D2. "Antiphospholipid Antibody Syndrome (APLA)" was identified by laboratory testing, highlighting the significance of taking a thorough approach to comprehending this uncommon clinical condition. Treatment included anticoagulant therapy, high-dose steroid therapy, and antihypertensive drugs, emphasizing the crucial importance of inter-disciplinary care in handling such complex situations. Even if the patient's symptoms have partially improved, their condition is still being closely monitored in the intensive care unit. In the context of postpartum neurological problems and the complex interplay between pre-eclampsia, spinal cord infarction, and related clinical symptoms, this case emphasizes the need for increased awareness and prompt management.

Predictors and patterns of empirical antibiotic therapy and associated outcomes in COVID-19 patients: a retrospective study in a tertiary care facility in South India.

BACKGROUND: The coronavirus disease (COVID-19) led to a global health crisis. Inappropriate use of antibiotics in COVID-19 patients has been a concern, leading to antimicrobial resistance. This study evaluated the patterns and predictors of empirical antibiotic therapy in COVID-19 patients and associated outcomes. METHODS: A hospital-based retrospective study was conducted with 525 patients admitted to Kasturba Hospital, Manipal, India, with moderate and severe COVID-19 from 1 March to 1 August 2021. They were divided based on empirical therapy, and predictors of antibiotic usage were assessed by logistic regression. RESULTS: Four hundred and eighty (91.4%) COVID-19 patients received at least one course of antibiotics, with 440 (83.8%) initiating empirical therapy. Patients with severe COVID-19 manifestations were more likely to be prescribed empirical antibiotics. Multivariable analysis showed that patients initiated on empirical antibiotics had significantly elevated levels of procalcitonin [OR: 3.91 (95% CI: 1.66-9.16) (p = 0.001)], invasive ventilation [OR: 3.93 (95% CI: 1.70-9.09) (p = 0.001)], shortness of breath [OR: 2.25 (95% CI: 1.30-3.89) (p = 0.003)] and higher CRP levels [OR: 1.01 (95% CI: 1.00-1.01) (p = 0.005)]. Most antibiotics (65.9%) were prescribed from the 'Watch' group, the highest being ceftriaxone. Only 23.8% of the patients had microbiologically confirmed infections. CONCLUSION: The study identified predictors for initiating empirical antibacterial therapy in our setting.

Clinical phenotype and complications of large vessel giant cell arteritis: A systematic review and meta-analysis.

BACKGROUND: Giant Cell Arteritis (GCA) is a heterogenous systemic granulomatous vasculitis involving the aorta and any of its major tributaries. Despite increased awareness of large vessel (LV) involvement, studies reporting incidence, clinical characteristics and complications of large-vessel GCA (LV-GCA) show conflicting results due to inconsistent disease definitions, differences in study methodologies and the broad spectrum of clinical presentations. The aim of this systematic literature review was to better define LV-GCA based on the available literature and identify distinguishing characteristics that may differentiate LV-GCA patients from those with limited cranial disease. METHODS: Published studies indexed in MEDLINE and EMBASE were searched from database inception to 7th May 2021. Studies were included if they presented cohort or cross-sectional data on a minimum of 25 patients with LV-GCA. Control groups were included if data was available on patients with limited cranial GCA (C-GCA). Data was quantitatively synthesised with application of a random effects meta-regression model, using Stata. RESULTS: The search yielded 3488 studies, of which 46 were included. Diagnostic criteria for LV-GCA differed between papers, but was typically dependent on imaging or histopathology. Patients with LV-GCA were generally younger at diagnosis compared to C-GCA patients (mean age difference -4.53 years), had longer delay to diagnosis (mean difference 3.03 months) and lower rates of positive temporal artery biopsy (OR: 0.52 [95% CI: 0.3, 0.91]). Fewer LV-GCA patients presented with cranial manifestations and only 53% met the 1990 ACR Classification Criteria for GCA. Vasculitis was detected most commonly in the thoracic aorta, followed by the subclavian, brachiocephalic trunk and axillary arteries. The mean cumulative prednisolone dose at 12-months was 6056.5mg for LV-GCA patients, relapse rates were similar between LV- and C-GCA patients, and 12% of deaths in LV-GCA patients could be directly attributed to an LV complication. CONCLUSION: Patients with LV-GCA have distinct disease features when compared to C-GCA, and this has implications on diagnosis, treatment strategies and surveillance of long-term sequalae.

Trait Anxiety Influences Negative Affect-modulated Distribution of Visuospatial Attention.

Visuospatial attention allows humans to selectively gate and prioritize visual (including salient, emotional) information for efficiently navigating natural visual environments. As emotions have been known to influence attentional performance, we asked if emotions also modulate the spatial distribution of visual attention and whether any such effect was further associated with individual differences in anxiety. Participants (n = 28) discriminated the orientation of target Gabor patches co-presented with distractors, speedily and accurately. The key manipulation was randomly presenting a task-irrelevant face emotion prime briefly (50 ms), conveying Neutral/Disgust/Scrambled (Null) emotion signal 150 ms preceding the target patches. We calculated attention gradient (change in negative inverse attentional efficiency with unit change in distance from the source of emotion signal) as a metric to answer our questions. Specifically, the Disgust signal modulated the direction of attention gradients differentially in individuals with varying degrees of trait - anxiety, such that the gradients correlated negatively with individual trait-anxiety scores. This implies spatial shifts in Disgust-signalled visual attention with varying trait - anxiety levels. Neutral yielded attention gradients comparable to Scrambled, implying no specific effect of this signal and there was no association with anxiety levels in both. No correlation was observed between state - anxiety and the emotion-cued attention gradients. In sum, the results suggest that individual trait - anxiety levels influence the effect of negative and physiologically arousing emotion signals (e.g., Disgust) on the spatial distribution of visual attention. The findings could be of relevance for understanding biases in visual behaviour underlying affective states and disorders.

Detection of IEMs by Mass Spectrometry Techniques in High-Risk Children: A Pilot Study.

OBJECTIVES: To determine the incidence and types of inborn errors of metabolism (IEMs) in high-risk children using mass spectrometry techniques. METHODS: Children considered high-risk for IEM were screened for metabolic diseases during a 3-y period. Dried blood spots and urine samples were analyzed by tandem mass spectrometry (LC-MS/MS) and gas chromatograph-mass spectrometry (GCMS). Samples with abnormal amino acids were confirmed by high-performance liquid chromatography (HPLC). RESULTS: Eight hundred and twenty-two suspected cases were evaluated; of which, 87 possible cases of IEMs were identified. Homocystinuria (n = 51) was the most common IEM detected followed by biotinidase deficiency (n = 7), glutaric aciduria type 1 (n = 7), and carnitine uptake defect (n = 6). Overall, there were 45 (51.7%) cases of organic acidemia, 31 cases (35.6%) of amino acid defect, 9 (10.3%) cases of fatty-acid oxidation disorders, and 2 (2.3%) cases of probable mitochondrial disorder. CONCLUSION: IEMs are common in India, with a hospital-based incidence of 1 in approximately 6642 among high-risk children. Screening of high-risk children by mass spectrometry techniques is a valuable strategy for early diagnosis of IEMs where universal newborn screening is not yet available.

Protein phosphatase 1 regulates atypical mitotic and meiotic division in Plasmodium sexual stages.

PP1 is a conserved eukaryotic serine/threonine phosphatase that regulates many aspects of mitosis and meiosis, often working in concert with other phosphatases, such as CDC14 and CDC25. The proliferative stages of the malaria parasite life cycle include sexual development within the mosquito vector, with male gamete formation characterized by an atypical rapid mitosis, consisting of three rounds of DNA synthesis, successive spindle formation with clustered kinetochores, and a meiotic stage during zygote to ookinete development following fertilization. It is unclear how PP1 is involved in these unusual processes. Using real-time live-cell and ultrastructural imaging, conditional gene knockdown, RNA-seq and proteomic approaches, we show that Plasmodium PP1 is implicated in both mitotic exit and, potentially, establishing cell polarity during zygote development in the mosquito midgut, suggesting that small molecule inhibitors of PP1 should be explored for blocking parasite transmission.

Characterization of Bacteriological Isolates from Patients and Environment Samples of Burn Ward: A Study from a Tertiary Care Hospital of India.

OBJECTIVE: Source of infection in a burn patient is from the patient's flora, contaminated environmental surfaces and transmitted from health care workers. Insufficiently disinfected hospital environmental surface provides a niche for multidrug resistant bacteria. This study was carried out to assess the bacteriological profile of the pathogens from burn wounds and the surrounding environmental areas. METHODS: During 6 months, wound swabs from burn patients were collected on admission (after 48 hours of admission), on day 5 and then weekly. Environmental samples were also collected from burn ward and studied for the bacteriological and anti-microgram profiles. RESULTS: Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii were the major bacterial isolates from the wound swabs and the environmental samples. ESBL was detected in 56.6% of our Enterobacteriaceae isolates. The environmental sites from which these bacterial isolates were found were nursing counter, sink, dressing trolley, medicine locker and patient's bed. The percentage of MRSA decreased from 50 to 5% and there was an increased role of Enterococci species causing infections (13.63%). CONCLUSION: In this study, there appears that the colonizers of the environment may play a role in the causation of infection in burn patients. In burns ward, rigorous implementation of infection control program should be warranted, which includes and hygiene and use of personal protective equipment, environmental disinfection, cohort nursing care and antibiotics stewardship programme.

Using Phosphatidylinositol Phosphorylation as Markers for Hyperglycemic Related Breast Cancer.

Studies have suggested that type 2 diabetes (T2D) is associated with a higher incidence of breast cancer and related mortality rates. T2D postmenopausal women have an ~20% increased chance of developing breast cancer, and women with T2D and breast cancer have a 50% increase in mortality compared to breast cancer patients without diabetes. This correlation has been attributed to the general activation of insulin receptor signaling, glucose metabolism, phosphatidylinositol (PI) kinases, and growth pathways. Furthermore, the presence of breast cancer specific PI kinase and/or phosphatase mutations enhance metastatic breast cancer phenotypes. We hypothesized that each of the breast cancer subtypes may have characteristic PI phosphorylation profiles that are changed in T2D conditions. Therefore, we sought to characterize the PI phosphorylation when equilibrated in normal glycemic versus hyperglycemic serum conditions. Our results suggest that hyperglycemia leads to: 1) A reduction in PI3P and PIP3, with increased PI4P that is later converted to PI(3,4)P2 at the cell surface in hormone receptor positive breast cancer; 2) a reduction in PI3P and PI4P with increased PIP3 surface expression in human epidermal growth factor receptor 2-positive (HER2+) breast cancer; and 3) an increase in di- and tri-phosphorylated PIs due to turnover of PI3P in triple negative breast cancer. This study begins to describe some of the crucial changes in PIs that play a role in T2D related breast cancer incidence and metastasis.

Resolution of "salt and pepper" appearance of the skull with vitamin D therapy.

Chronic hypovitaminosis D leads to state of decreased mineralization and generalized osteomalacia. It also results in secondary hyperparathyroidism causing increased bone turn over and decreased bone mass, manifested radiologically as a "salt and pepper" appearance in skull, subperiosteal resorption, bone cysts and lytic lesions. In this case, a young male patient with hypovitaminosis D and secondary hyperparathyroidism, radiological features show resolution of "salt and pepper" appearance of the skull with vitamin D in 11 months and regression of other lytic lesions.