Complete Blood-count-based Inflammatory Score (CBCS) of COVID-19 Patients at Tertiary Care Center.

CONTEXT: Inflammation is a significant factor driving the rise of multiple cases of viral pneumonia, including COVID-19 infection. Peripheral white blood cells (WBCs), the neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), the platelet-to-lymphocyte (PLR) ratio, and hemoglobin (Hb) are markers of systematic inflammatory reaction and often predict disease severity. OBJECTIVE: The current study intended to examine the prognostic importance of hemoglobin (Hb), total leukocyte count (TLC), absolute neutrophile count (ANC), absolute lymphocyte count (ALC), NLR, d-NLR [derived NLR = ANC/(WBC-ANC)], absolute platelet count (APC), and PLR, based on complete blood counts (CBCs) for COVID-19 patients. DESIGN: The research team designed a retrospective that was conducted between March 27 and June 5, 2020, after the first COVID-19 case was reported in Ajmer, Rajasthan, India on March 27. SETTING: The study took place at Jawaharlal Nehru (JLN) Medical College in Ajmer, Rajasthan, India. PARTICIPANTS: The study included 364 participants who were all COVID-positive patients who came to the hospital during the study's period, including patients from various age groups and of both genders. OUTCOME MEASURES: Using the results of the CBC, the research team measured: (1) Hb in g/dl, (2) ANC, (3) ALC, and (4) APC. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) were calculated from measurements of the levels of the circulating biomarkers, as cells × 103/µl. RESULT: For participants who were severely symptomatic, the mean age was 57.86 ± 8.92. Males were more likely to experience severe symptoms. Participants' Hb values were significantly different between groups, and TLC, ANC, NLR, d-NLR, and PLR were highest in the severely symptomatic group and lowest in the asymptomatic group. NLR was positively associated with a risk of COVID-19 pneumonia, while Hb was negatively associated with development of pneumonia. CONCLUSIONS: Disease severity and age are independent predictors of poor outcomes. The NLR should be used as a routine blood test that can help in the diagnosis of disease severity in COVID-19. NLR is very simple tool that can be used as a fast and low-cost test that is easily available, even in small centers where the facilities for other tests, such as tests of LDH, CRP, and IL-6, and high resolution CT scans aren't available. Thus, NLR can be used as single independent predictor of COVID-19 disease severity.

COVID-19 multisystem inflammatory syndrome in three teenagers with confirmed SARS-CoV-2 infection.

Coronavirus disease 2019 (COVID-19) is generally a relatively mild illness in children. An emerging disease entity coined as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has been reported recently, but is very rare and only affects a very small minority of children. Here we describe the clinical presentations and outcomes of three teenagers with serologically-confirmed SARS-CoV-2 infection admitted to a pediatric intensive care unit for PIMS-TS. Although their initial presentations were very similar, their COVID-19-related disease varied in severity.

A Rare Case of Brucellosis with Multivalvular Endocarditis and Complete Heart Block.

BACKGROUND: Brucellosis is a public health concern that affects multiple organs. However, cardiovascular problems arise infrequently, affecting fewer than 2% of cases, typically presenting as endocarditis. CASE PRESENTATION: A 50-year male was admitted with low-grade fever, night sweats, weight loss (13 kg), malaise, and generalized weakness for the past 6 months. On clinical examination, he was febrile with 39.0°C, an average heart rate of 54 bpm, and 100/40 mmHg blood pressure. On cardiovascular examination, S1 and S2 were soft with pan systolic murmur present in the mitral area, and the early diastolic murmur was present in the left third intercostal space. Electrocardiography was suggestive of third-degree heart block with AV dissociation. Transthoracic echocardiography showed mobile vegetations attached to multiple valves- an aortic valve (18.2x11.9mm) and a mitral valve (2.9x7.5mm) with perivalvular abscess. He was given oral doxycycline (100mg B.D.) and rifampicin (600mg/day); the patient responded, but the AV block did not resolve. CONCLUSION: This report has drawn attention to multivalvular involvement and cardiac rhythm abnormalities in Brucellosis (in this case, A.V. dissociation was present) because early diagnosis and treatment can cause a significant decrease in morbidity as well as mortality by appropriate treatment.

A review on degradation of organic dyes by using metal oxide semiconductors.

The discharge of organic dye pollutants in natural water bodies has put forward a big challenge of providing clean water to a large part of the population. As the population is increasing with time, only underground water is not sufficient to complete the water requirements of everyone everywhere. Purification of wastewater and its reuse is the only way to fulfill the water needs. Nanotechnology has been used very efficiently for wastewater treatment via photocatalytic degradation of dye molecules. In the past few years, a lot of investigations have been done to enhance the photocatalytic activity of metal oxide semiconductors for water purification. In this review, we have discussed the different methods of synthesis of various metal oxide semiconductor nanoparticles, energy band gap, their role as efficient photocatalysts, radiations used for photocatalytic reactions, and their degradation efficiency to degrade the dye pollutants. We have also discussed the nanocomposites of metal oxide with graphene. These nanocomposites have been utilized as the efficient photocatalyst due to unique characteristics of graphene such as extended range of light absorption, separation of charges, and high capacity of adsorption of the dye pollutants.

Enigma of Rabies: Prolonged Survival in a Boy with Rabies Brachial Plexitis and Encephalomyelitis.

Rabies encephalitis is a universally fatal disease. Prolonged survival in children with rabies encephalitis has only been anecdotally reported. Case report: An 11-year-old boy presented with right-handed paraesthesia followed by flaccid weakness, progressive quadriparesis and encephalopathy following an unprovoked, class III dog bite over the right wrist 1 month previously. He received five doses of the rabies vaccine as post exposure prophylaxis. Diagnosis of rabies encephalitis was supported by typical MRI brain and spine findings in addition to marked elevation of anti-rabies neutralizing antibody titers in serum and CSF. He was treated with supportive care, methylprednisolone, dexamethasone and simvastatin and was discharged after 6 weeks of hospital stay in a minimally conscious state, with tracheostomy and naso-gastric feeding tubes. At 9 months follow-up, his neurological status showed minimal improvement. Paralytic rabies with brachial plexitis and encephalomyelitis is an atypical presentation of rabies. Very few surviving cases have been reported from India. Survival from rabies is possible with effective clearing of virus with post exposure prophylaxis, but with severe neurological sequelae.

Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis. DESIGN: Randomized controlled trial. SETTING: Tertiary-care hospital in New Delhi, India. Participants: 72 infants (age <1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP. PARTICIPANTS: 72 infants (age <1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP. INTERVENTION: The outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis. MAIN OUTCOME MEASURES: Change in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score. RESULTS: 14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate [8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively. CONCLUSIONS: nCPAP helped reduce respiratory distress significantly compared to standard care.

Correlation of Infant Gender with Postpartum Maternal and Paternal Depression and Exclusive Breastfeeding Rates.

INTRODUCTION: Male bias in India has resulted in an altered sex ratio. It also results in maternal postpartum depression (PPD) and lower breastfeeding rates. We studied depression among fathers in this context. METHODS: Edinburgh postnatal depression scale (EPDS) questionnaire was administered to 479 parents separately. Breastfeeding on day 7 was determined. RESULTS: Depression was significantly higher in fathers of girls. Mean EPDS score was 5.86 ± 4.98 versus 2.5 ± 2.64 (p < 0.001). Concordance between parents was significant (r = 0.95, p < 0.001). Boys were more likely to be exclusively breastfed (64.46% versus 35.54%, p < 0.001). In second-order births, if the first born was a girl and second baby was again a girl, 23% were exclusively breastfed compared with 86% if it was boy after a girl (p < 0.001). Among parents who had EPDS scores ≥11, no babies were exclusively breastfed. Among the 25 babies who received no breast milk, 21 were girls and 4 were boys (p < 0.042). The multiple logistic regression analysis indicated that birth of girls (OR 0.269, 95% CI 0.076-0.953), high EPDS score in mothers (OR = 0.080, 95% CI 0.026-0.249), and high EPDS score in fathers (OR = 0.096, 95% CI 0.031-0.299) were associated with lower breastfeeding rates. CONCLUSION: Paternal depression correlates closely with maternal PPD and low exclusive breastfeeding of girls. Breastfeeding has implications for survival of girls. Efforts are needed to support the parents of girl children with PPD and such support must extend to fathers to improve survival.