Late-Season Influenza Vaccine Effectiveness Against Medically Attended Outpatient Illness, United States, December 2022-April 2023.

BACKGROUND: The 2022-23 US influenza season peaked early in fall 2022. METHODS: Late-season influenza vaccine effectiveness (VE) against outpatient, laboratory-confirmed influenza was calculated among participants of the US Influenza VE Network using a test-negative design. RESULTS: Of 2561 participants enrolled from December 12, 2022 to April 30, 2023, 91 laboratory-confirmed influenza cases primarily had A(H1N1)pdm09 (6B.1A.5a.2a.1) or A(H3N2) (3C.2a1b.2a.2b). Overall, VE was 30% (95% confidence interval -9%, 54%); low late-season activity precluded estimation for most subgroups. CONCLUSIONS: 2022-23 late-season outpatient influenza VE was not statistically significant. Genomic characterization may improve the identification of influenza viruses that circulate postinfluenza peak.

Capillary Haemangioma of Gingiva - A Rare Lesion.

Capillary Haemangioma is a benign vascular tumour characterized by proliferation of blood vessels with a very striking similarity to pyogenic granuloma with a predilection to occur on the gingiva. Though the head and neck are the most common region of occurrence, but is considered to be rare occurring on the gingiva, intra-orally. The lesion clinically mimicked pyogenic granuloma but was histopathologically diagnosed as capillary haemangioma. It was surgically excised and followed up for 6 months without any recurrence.

Successful restoration of archived ovine formalin fixed paraffin-embedded tissue DNA and single nucleotide polymorphism analysis.

Archived formalin fixed paraffin-embedded (FFPE) tissues are powerful tools in medicine, capable of harboring diagnostic and genetic answers to challenging clinical questions. Successful utilization of DNA derived from FFPE samples is dependent upon repairing DNA damage generated from the fixation process. Methods to repair FFPE DNA have been successful in human medicine for a variety of research and clinical applications, yet remain underutilized in veterinary medicine. Despite the available technology, our study is the first to evaluate the repair of FFPE derived DNA from veterinary species for single-nucleotide polymorphism (SNP) analysis using the Illumina OvineSNP50 BeadChip and Illumina FFPE QC and DNA Restore kit. To accomplish this, 48 ovine FFPE samples were run using the Illumina OvineSNP50 BeadChip with and without restoration. Compared to pre-restore data, we found increased sample call rates, SNP call frequency, and assay metrics for all samples post-restoration. Further, we utilized four sheep with available parallel fresh DNA and FFPE DNA to compare assay metrics and genotype calls between the two starting sample types. Although fresh samples generated increased call rates, we found 99% concordance in allele calls between restored FFPE and fresh DNA for all four samples. Our results indicate successful restoration and genotyping of ovine FFPE samples using this technology, with potential for utilization in other veterinary species.

25-hydroxyvitamin D is a predictor of COVID-19 severity of hospitalized patients.

OBJECTIVES: Studies investigating the association between vitamin D and severity of COVID-19 have mixed results perhaps due to immunoassay assessment of total 25-hydroxyvitamin D (tD) (the sum of 25-hydroxyvitamin-D2 [25-OH-D2] and 25-hydroxyvitamin-D3 [25-OH-D3]). Liquid chromatography tandem mass spectrometry (LC-MS/MS) has high analytical specificity and sensitivity for 25-OH-D2 and 25-OH-D3, and thus enables a more accurate assessment of impact on COVID-19 outcomes. METHODS: We established reference intervals for 25-OH-D3 and tD using LC-MS/MS. 25-OH-D2, 25-OH-D3 and tD were quantitated for 88 COVID-19 positive and 122 COVID-19 negative specimens. Chi-square or Fisher's exact tests were used to test associations in binary variables. T-Tests or Wilcoxon rank sum tests were used for continuous variables. Cox proportional hazards were used to test associations between 25-OH-D3 or tD levels and length of stay (LOS). For mortality and ventilation, logistic regression models were used. RESULTS: COVID-19 patients with deficient (<20 ng/mL) levels of 25-OH-D3 had significantly longer LOS by 15.3 days. COVID-19 P patients with deficient (<20 ng/mL) and insufficient (<30 ng/mL) of tD had significantly longer LOS by 12.1 and 8.2 days, respectively. Patients with insufficient levels of tD had significantly longer LOS by 13.7 days. COVID-19 patients with deficient serum 25-OH-D3 levels had significantly increased risk-adjusted odds of in-hospital mortality (OR [95% CI]: 5.29 [1.53-18.24]); those with insufficient 25-OH-D3 had significantly increased risk for requiring ventilation during hospitalization was found at LCMS insufficient cutoff (OR [95% CI]: 2.75 [1.10-6.90]). CONCLUSIONS: There is an inverse relationship of 25-hydroxyvitamin D levels and hospital LOS for COVID-19 patients. Vitamin D status is a predictor for severity of outcomes. LCMS results are useful for assessing the odds of mortality and the need for ventilation during hospitalization.

Surveillance genome sequencing reveals multiple SARS-CoV-2 variants circulating in central Texas, USA, with a predominance of delta variant and review of vaccine breakthrough cases.

As surges in the COVID-19 pandemic have continued worldwide, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has mutated, spawning several new variants, and impacting, to various degrees, transmission, disease severity, diagnostics, therapeutics, and natural and vaccine-induced immunity. Baylor Scott & White Health has implemented, along with laboratory diagnosis, SARS-CoV-2 sequencing to identify variants in its geographical service area. We analyzed virus sequencing results of specimens collected across Central Texas and found dramatic changes in variant distribution in the first half of 2021. The alpha variant (B 1.1.7) became predominant at week 13 and continued dominance until week 25. A growth rate of 1.20 (R2 = 0.92) for the first 15 weeks was noted and this growth gradually declined to -0.55 (R2 = 0.99) for the final 13 weeks. Currently, B.1.1.7 is being displaced with B.1.617.2 at a 0.58 growth rate (R2 = 0.97). We also investigated vaccine breakthrough cases (VBCs) within our healthcare system and present clinical data on 28 symptomatic patients.

Dental Negligence: Accidental Administration of Formalin Instead of Local Anesthetic.

A solution like formalin used as a fixative has to be handled with lot of care and needs to be stored with utmost care. Negligence on part of the dental professional by accidentally injecting formalin instead of the local anesthetic can lead to permanent tissue damage and also may induce a life threatening situation. The operating dentist injected formalin accidentally instead of the local anesthetic and the patient experienced severe pain and burning sensation. The general practice of formalin being stored in the local anesthetic bottles and being assisted by untrained assistant is the most common reason for mishaps to happen. The dentist operating should be careful and aware of the drugs and chemicals being available in the operatory and re-check the solution being injected in the patient as to not land up in complications because of the negligence.

COVID-2019-2020-2021: Systematic Review and Meta-Analysis.

INTRODUCTION: The world has faced the pandemic of COVID-19 in March 2020 and still it continues to affect in 2021. There is a great variation about the course of the disease and its features. Hence, in the present systemic review, we intend to determine the pooled estimations in the clinical features and prognosis along with the subgroups based on the severity of the disease in various regions of the world. MATERIALS AND METHODS: Online data were collected from the search engines of EBSCO, PubMed, Google Scholar, and Scopus. The searched terms were COVID 19, CORONA, SARS-CoV-2, clinical features, Wuhan, etc. The study articles were collected that from January 2020 to February 2021. Based on the PRISMA guidelines, a meta-analysis was performed. RESULTS: A total of 5067 articles were selected, of which 176 were finalized for the study. There were a total of 11 countries that were included, with a total of 2½ lakh participants. Mean age was 47.5 years. Around 22.5% had comorbidities. The mortality was 5.5%. We observed a strong association between the medical condition of the patient and the severity of the infection. In severe cases, the most common symptoms were respiratory and gastrointestinal. The mortality was registered in those with pneumonia and end-organ failure. CONCLUSION: It can be concluded from this meta-analysis that in a fourth of the positive patients, the disease was severe. In nearly 6% of the COVID-19 patients, mortality was seen. Patients with comorbidities and the severe form of the disease should be closely monitored.

Correlation of ELISA method with three other automated serological tests for the detection of anti-SARS-CoV-2 antibodies.

Public health emergency of SARS-CoV-2 has facilitated diagnostic testing as a related medical countermeasure against COVID-19 outbreak. Numerous serologic antibody tests have become available through an expedited federal emergency use only process. This paper highlights the analytical characteristic of an ELISA based assay by AnshLabs and three random access immunoassay (RAIA) by DiaSorin, Roche, and Abbott that have been approved for emergency use authorization (EUA), at a tertiary academic center in a low disease-prevalence area. The AnshLabs gave higher estimates of sero-prevalence, over the three RAIA methods. For positive results, AnshLabs had 93.3% and 100% agreement with DiaSorin or Abbott and Roche respectively. For negative results, AnshLabs had 74.3% and 78.3% agreement with DiaSorin and Roche or Abbott respectively. All discrepant samples that were positive by AnshLabs and negative by RAIA tested positive by all-in-one step SARS-CoV-2 Total (COV2T) assay performed on the automated Siemens Advia Centaur XPT analyzer. None of these methods, however, are useful in early diagnosis of SARS-CoV-2.

Early trends for SARS-CoV-2 infection in central and north Texas and impact on other circulating respiratory viruses.

Rapid diagnosis and isolation are key to containing the quick spread of a pandemic agent like severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which has spread globally since its initial outbreak in Wuhan province in China. SARS-CoV-2 is novel and the effect on typically prevalent seasonal viruses is just becoming apparent. We present our initial data on the prevalence of respiratory viruses in the month of March 2020. This is a retrospective cohort study post launching of SARS-CoV-2 testing at Baylor Scott and White Hospital (BSWH), Temple, Texas. Testing for SARS-CoV-2 was performed by real-time reverse transcription polymerase chain reaction assay and results were shared with State public health officials for immediate interventions. More than 3500 tests were performed during the first 2 weeks of testing for SARS-CoV-2 and identified 168 (4.7%) positive patients. Sixty-two (3.2%) of the 1912 ambulatory patients and 106 (6.3%) of the 1659 emergency department/inpatients tested were positive. The highest rate of infection (6.9%) was seen in patients aged 25 to 34 years, while the lowest rate of infection was seen among patients aged <25 years old (2%). County-specific patient demographic information was shared with respective public health departments for epidemiological interventions. Incidentally, this study showed that there was a significant decrease in the occurrence of seasonal respiratory virus infections, perhaps due to increased epidemiological awareness about SARS-CoV-2 among the general public, as well as the social distancing measures implemented in response to SARS-CoV-2. Data extracted for BSWH from the Centers for Disease Control and Prevention's National Respiratory and Enteric Virus Surveillance System site revealed that Influenza incidence was 8.7% in March 2020, compared with 25% in March 2019. This study was intended to provide an initial experience of dealing with a pandemic and the role of laboratories in crisis management. This study provided SARS-CoV-2 testing data from ambulatory and inpatient population. Epidemiological interventions depend on timely availability of accurate diagnostic tests and throughput capacity of such systems during large outbreaks like SARS-CoV-2.

Tooth -A Potential Graft Material for Periodontal Regeneration ?

Use of tooth as a promising replacement substitute has been validated by various animal as well as human studies. Though widely used in GBR and Sinus grafting techniques, its use in periodontal intrabony defect is not documented. In the present case report, the tooth graft has been placed in periodontal intrabony defect. Postoperative CBCT after 26 weeks revealed homogeneous incorporation of tooth graft. Clinical parameters show bone fill. However; results with larger sample size could further validate the use of tooth graft in periodontal regeneration.

Preparation, characterization and functional properties of Moringa oleifera seed protein isolate.

Moringa seed protein isolate (MPI) was prepared by aqueous salt extraction followed by watering-out to precipitate proteins. Extraction and precipitation steps were optimized to achieve maximum MPI yield. Besides, MPI was characterized based on its composition and functional properties. Among the multiple salts examined, Na2SO4 (69.9%), KCl (66.2%), NaCl (65.4%), and NaBr (63.5%) displayed better protein extractability as well as higher MPI yield (~ 52%) with a protein content of > 90% d.b. However, NaCl was preferred considering its wider acceptance. Based on response surface methodology analysis, solvent-to-flour ratio, 22:1 (v/w), NaCl concentration, 0.4 M and temperature, 55 °C were found optimal for maximum protein extractability of 70.3%. Subsequent watering-out resulted in a maximum MPI yield of 56% (protein basis). MPI contained all the protein subunits (6.5, 14, 29 kDa) present in its source. It also scored over commercial soy protein isolate in many of the functional properties.

Rotavirus gastroenteritis in Indian children < 5 years hospitalized for diarrhoea, 2012 to 2016.

BACKGROUND: In 2016, the Government of India introduced the oral rotavirus vaccine (ROTAVAC, Bharat Biotech, India) in 4 states of India as part of the Universal Immunization Programme, and expanded to 5 more states in 2017. We report four years of data on rotavirus gastroenteritis in hospitalized children < 5 years of age prior to vaccine introduction. METHODS: Children from 7 sites in southern and northern India hospitalized for diarrhoea were recruited between July 2012 and June 2016. Stool samples were screened for rotavirus using enzyme immunoassay (EIA). The EIA positive samples were genotyped by reverse-transcription polymerase chain reaction. RESULTS: Of the 5834 samples from the 7 sites, 2069 (35.5%) were positive for rotavirus by EIA. Genotyping was performed for 2010 (97.1%) samples. G1P[8](56.3%), G2P[4](9.1%), G9P[4](7.6%), G9P[8](4.2%), and G12P[6](3.7%) were the common genotypes in southern India and G1P[8](36%), G9P[4](11.4%), G2P[4](11.2%), G12P[6](8.4%), and G3P[8](5.9%) in northern India. CONCLUSIONS: The study highlights the high prevalence of rotavirus gastroenteritis in India and the diversity of rotavirus genotypes across different geographical regions. Pre- vaccine surveillance data is necessary to evaluate the potential change in admission rates for gastroenteritis and circulating rotavirus genotypes after vaccine introduction, thus assessing impact.

Cervical Enamel Projection - A Rare Case Report with its Management.

A developmental anomaly like cervical enamel projection is a rare finding in the maxillary anterior region. Its ectopic presence attracts attention in literature. This type of anomaly is typically found in the furcation region of molars. The case report presented here deals with the ectopic presence of combined anomalous lesion and its management. A 18 year old male presented with pronounced bilobed cingulum extending as a cervical enamel projection on the maxillary right lateral incisor associated with pain, exudation and difficulty in mastication. Enameloplasty and regenerative procedure was performed. The possible etiology, its management and healing evaluated by CBCT are presented in this report. One year follow up showed satisfactory healing with no recurrence of abscess.

Ocular manifestations of Rickettsia conorii in South India.

PURPOSE: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced-scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced-Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever-serologically proven Indian tick typhus (Rickettsia conorii)-has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients. METHODS: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes. RESULTS:: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil-Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition. CONCLUSION:: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition.

Nanocharacterization of liposomes for the encapsulation of water soluble compounds from Cordyceps sinensis CS1197 by a supercritical gas anti-solvent technique.

Nano-liposomes were designed for the sustained release of water soluble compounds from C. sinensis CS1197 using a supercritical gas anti-solvent (SC-GAS) method at various pressures, temperatures and Tween 80 concentrations. The SC-GAS method was compared to the Bangham method of liposome production in terms of mean diameter, coefficient of uniformity (C u), encapsulation efficiency, morphology, viscosity and actual energy required for liposome formation. Liposome production via the SC-GAS method under optimized formulation conditions, i.e., 180 bar; 50 °C; 0.75% Tween 80; and a depressurization rate of 25 bar min-1, yielded nano-liposomes exhibiting the lowest C u value (1.10 ± 0.012) with a mean diameter of 0.072 ± 0.002 µm and better encapsulation efficiencies of 75.48 ± 2.5, 74.9 ± 2.1 and 70.23 ± 2.9% for adenosine, cordycepin and polysaccharides, respectively. Nano-liposomes were characterized using FTIR, XRD, DSC and TGA techniques. The stability indices and viscosities of the prepared liposome suspensions indicated good stability of up to 2 months and near-Newtonian behavior. The in vitro release of CS1197 water soluble compounds exhibited biphasic and sustained release patterns.

Antioxidant and Cholesterol Esterase Inhibitory Properties of Supplementation with Coconut Water in Submerged Cultivation of the Medicinal Chinese Caterpillar Mushroom, Ophiocordyceps sinensis CS1197 (Ascomycetes).

We investigated the potential use of coconut water to supplement potato dextrose broth (PDB) in the production of Ophiocordyceps sinensis CS1197 by submerged cultivation. The basal PDB medium was modified by supplementation with tender coconut water (TCW) and mature coconut water (MCW) at 10% and 5% (v/v), respectively; these mixtures were cultured at 28°C for 14 days, with a pH of 7 and an inoculum volume of 10%. The addition of optimized levels of TCW and MCW improved the biomass yield by 2.2- and 2.5-fold, respectively, and adenosine, cordycepin, and polysaccharide content by 58% and 69%, 50% and 55%, and 19% and 27%, respectively. Antioxidant and cholesterol esterase (CE) inhibitory activities of the aqueous extract from O. sinensis CS1197 mycelia supplemented with TCW and MCW were high compared with those of the control, indicating that coconut water has a positive correlation with the enhanced antioxidant and CE inhibitory activities. These antioxidant and CE inhibitory responses were dependent on concentration, and the larger amounts of bioactives in O. sinensis CS1197 are beneficial in pharmaceutical formulations.

Acidified Hot Water Extraction of Adenosine, Cordycepin, and Polysaccharides from the Chinese Caterpillar Mushroom, Ophiocordyceps sinensis CS1197 (Ascomycetes): Application of an Artificial Neural Network and Evaluation of Antioxidant and Antibacterial Activities.

The effects of process variables (temperature, time, and pH) on the extraction of adenosine, cordycepin, and polysaccharides from Ophiocordyceps sinensis CS1197 were studied using response surface methodology (RSM) and an artificial neural network (ANN). The ANN model resulted in low root mean square errors (0.022, 0.079, 0.018) and high R2 values (0.995, 0.934, 0.997) for adenosine, cordycepin, and polysaccharide yields, respectively, which implied good agreement between the predicted and actual data. An overall desirability of 0.86 suggested optimal extraction conditions (temperature, 70°C; time, 1 hour; and pH ~4) for adenosine (0.205%) and cordycepin (0.246%) yields. For polysaccharide yield (6.34%), an overall desirability of 0.93 suggested extraction conditions: temperature, 87°C; time, 3.4 hours, and pH ~4. The water extract exhibited better antioxidant activity. The antibacterial activity of the water extract was assayed against Bacillus subtilis, Staphylococcus aureus, and Escherichia coli, and larger amounts of the extract (30 and 50 mg) exhibited antibacterial activity (<35%). The predictive ability of an ANN is superior to RSM and resulted in the best agreement between experimental and predicted values.

Glial cell activation, recruitment, and survival of B-lineage cells following MCMV brain infection.

BACKGROUND: Chemokines produced by reactive glia drive migration of immune cells and previous studies from our laboratory have demonstrated that CD19(+) B cells infiltrate the brain. In this study, in vivo and in vitro experiments investigated the role of reactive glial cells in recruitment and survival of B-lineage cells in response to (murine cytomegalovirus) MCMV infection. METHODS: Flow cytometric analysis was used to assess chemokine receptor expression on brain-infiltrating B cells. Real-time RT-PCR and ELISA were used to measure chemokine levels. Dual-immunohistochemical staining was used to co-localize chemokine production by reactive glia. Primary glial cell cultures and migration assays were used to examine chemokine-mediated recruitment. Astrocyte: B cell co-cultures were used to investigate survival and proliferation. RESULTS: The chemokine receptors CXCR3, CXCR5, CCR5, and CCR7 were detected on CD19(+) cells isolated from the brain during MCMV infection. In particular, CXCR3 was found to be elevated on an increasing number of cells over the time course of infection, and it was the primary chemokine receptor expressed at 60 days post infection Quite different expression kinetics were observed for CXCR5, CCR5, and CCR7, which were elevated on the highest number of cells early during infection and decreased by 14, 30, and 60 days post infection Correspondingly, elevated levels of CXCL9, CXCL10, and CXCL13, as well as CCL5, were found within the brains of infected animals, and only low levels of CCL3 and CCL19 were detected. Differential expression of CXCL9/CXCL10 and CXCL13 between microglia and astrocytes was apparent, and B cells moved towards supernatants from MCMV-infected microglia, but not astrocytes. Pretreatment with neutralizing Abs to CXCL9 and CXCL10 inhibited this migration. In contrast, neutralizing Abs to the ligand of CXCR5 (i.e., CXCL13) did not significantly block chemotaxis. Proliferation of brain-infiltrating B cells was detected at 7 days post infection and persisted through the latest time tested (60 days post infection). Finally, astrocytes produce BAFF (B cell activating factor of the TNF family) and promote proliferation of B cells via cell-to-cell contact. CONCLUSIONS: CXCR3 is the primary chemokine receptor on CD19(+) B cells persisting within the brain, and migration to microglial cell supernatants is mediated through this receptor. Correspondingly, microglial cells produce CXCL9 and CXCL10, but not CXCL13. Reactive astrocytes promote B cell proliferation.