Changing trend in bacterial etiology and antibiotic resistance in sepsis of intramural neonates at a tertiary care hospital.

BACKGROUND: Septicemia is an important cause of neonatal morbidity and mortality. However, organized data on causative organisms and their resistant pattern are scanty from developing countries. The changing trend in causative organisms and their antibiotic resistance is yet to be documented in India. The present study examines the trends in bacterial profile and antibiotic resistance of the organisms causing sepsis in hospitalized neonates. MATERIALS AND METHODS: A retrospective laboratory-based analysis of blood cultures obtained from Neonatal Intensive Care Unit of a tertiary care hospital in New Delhi was done for the period of 1999-2014, divided into five phases. RESULTS: A total of 4700 isolates were considered. Over time, Gram-negative organisms have replaced Gram-positives as frequent isolates. Initially, there was predominance of Klebsiella pneumoniae, then of Staphylococcus aureus which recently has been changed with coagulase negative-Staphylococcus and Acinetobacter. Growing resistance against the first and second line of drugs has been noted, including methicillin-resistant S. aureus and vancomycin-resistant Enterococcus. CONCLUSION: The etiological profile of neonatal sepsis has changed tremendously in the past 15 years. High resistance against common drugs necessitates continued surveillance and review of empirical antibiotic policy for neonatal sepsis. These steps are important to effectively curtail the surge of further antibiotic resistance.

Air pollution and Covid-19: experience from India.

Since the onset of the pandemic caused by Covid-19, air pollution has been repeatedly implicated for a possible role in determining the magnitude of the outbreak. The present paper aims to find out whether such an association exists between air pollution and Covid-19. For examining such a relationship in India, data on air quality parameters (SO2, NO2, PM2.5, and PM10) and Covid-19 from 30 states were considered. The extent of air pollution was seen to influence the pandemic only in certain locations. Future research may consider it as a potential area for quantifying the threshold. The mitigation of the pandemic should incorporate a particular focus on air pollution.

Short report - COVID-19 and weather parameters: Pune, India.

Weather parameters may have some role in determining the spread of Coronavirus disease 2019. Daily data on COVID-19 from Pune, India were collected from 17th May to 4th July 2020 and analyzed with such parameters. Relative humidity was found to have a positive relationship with the number of daily cases, even after taking a lag period of one week. Further studies may be helpful in understanding such relationships.

Cardiovascular stress reactivity and job strain as determinants of ambulatory blood pressure at work.

OBJECTIVE: To test the hypothesis that cardiovascular reactivity to laboratory mental stressors interacts with job strain in predicting blood pressure at work. DESIGN: Ambulatory monitoring of blood pressure and heart rate was carried out for an 8-h period on a work day and on an equivalent non-work day in 49 male firefighters. METHODS: Participants were recruited from a larger cohort (n = 90) on the basis of showing high or low systolic reactions to mental arithmetic 15-24 months previously, coupled with high or low ratings of perceived job strain (high demand-low control). Four groups were tested: low job strain-low systolic reactors (n = 12), low job strain-high systolic reactors (n = 12), high job strain-low systolic reactors (n = 12) and high job strain-high systolic reactors (n = 13). RESULTS: Systolic blood pressure (SBP) was higher on work than non-work days, and diastolic blood pressure and heart rate were higher at work in the morning but not in the afternoon. These effects were due partly to posture and physical activity differences between the two days. Neither job strain nor laboratory reactivity independently predicted ambulatory blood pressure. However, SBP was significantly higher during the afternoon at work in the high job strain-high systolic reactors than in the other groups. This was independent of baseline SBP, and was not due to differences in posture or activity at the time of recordings. Ambulatory SBP reactivity (difference between ambulatory values and workplace resting levels) in the afternoon at work was also elevated significantly in high job strain-high systolic reactors compared with in the other groups. CONCLUSIONS: The results support the hypothesis that individual differences in the appraisal of work stress modulate the relationship between stress reactivity and ambulatory blood pressure.

Psychological, cardiovascular, and metabolic correlates of individual differences in cortisol stress recovery in young men.

The relationship of free salivary cortisol stress recovery and basal cortisol with psychological, cardiovascular and metabolic factors was investigated in 82 healthy young men. Blood pressure, heart rate, cortisol and mood were assessed during a single laboratory session involving mental arithmetic and speech tasks, and lipid profiles were analysed from a fasting blood sample. Participants were divided into high (n=31) and low (n=51) cortisol stress recovery groups on the basis of the magnitude of changes between the peak cortisol responses to tasks and the lowest levels recorded at the end of a 30 min post-stress rest period. The high recovery group showed consistent increases in cortisol following each of the tasks, while the low recovery group showed little change across the session. Cortisol levels in the two groups did not differ at the end of the post-stress recovery period. The groups were indistinguishable in age, body mass index, smoking and alcohol consumption, and did not differ in psychological characteristics including anxiety, depression and perceived social support. However, the high stress recovery group had elevated low density lipoprotein cholesterol and total cholesterol/high density lipoprotein ratios, suggesting raised cardiovascular disease risk. The high stress recovery group also reported greater psychological activation during tasks, and greater recent minor life stress, than did the low recovery group. There was no association between rate of cortisol recovery and cardiovascular responses to tasks. But resting cortisol was related to blood pressure stress reactivity, suggesting that cortisol played a permissive role in augmenting sympathetically-driven cardiovascular responses. The results suggest that the rate of cortisol stress recovery is associated with variations in metabolic risk, and with differences in psychological state but not trait characteristics.

Life events and social support as moderators of individual differences in cardiovascular and cortisol reactivity.

Whether prior stress increases acute stress reactivity is unresolved. The impact of life events (within the past 12 months) and social support on cardiovascular responses was investigated in 90 young male firefighters. Cardiovascular and cortisol measures were collected across baseline, arithmetic, and speech tasks; intertask recovery; and three recovery trials. Reactivity differences were not independently associated with life events. High social support was associated with greater arithmetic cardiovascular reactivity and faster recovery. Combined life events and social support grouping showed that effects of support were accentuated when event frequency was high, suggesting that life events and support interacted to sensitize future stressor responses. Support may promote the alerting response mobilization but prevent chronic allostatic load by enhancing recovery.

Evaluation of low-dose estrogen and progestin therapy in postmenopausal women. A double-blind, prospective study of sequential versus continuous therapy.

In this prospective, double-blind study, we evaluated the efficacy and safety of low-dose estrogen and progestin replacement therapy in 36 postmenopausal women who were administered oral medroxyprogesterone acetate (MPA) cyclically or continuously in combination with conjugated equine estrogen (CEE) 0.625 mg daily. In the sequential group, MPA (5.0 mg) was administered daily for 12 days of each 25-day treatment cycle. In the two continuous groups, MPA was administered without interruption at a daily dose of either 2.5 mg or 5.0 mg for 12 treatment cycles. Of the 36 women in the study, 29 women completed the one-year protocol. The clinical and metabolic responses were assessed before and every three cycles during the 12 cycles of treatment. Endometrial biopsies and lumbar bone density scans were performed before and during the last week of the 12th treatment cycle. Vasomotor and urogenital symptoms improved in all women. Cyclic menstrual bleeding occurred in all patients on sequential therapy, and proliferative endometrium was noted in two of these women. All patients in both continuous treatment groups experienced amenorrhea after the fifth cycle of therapy, and all endometrial biopsies were atrophic or inactive. From the 3rd through the 12th month of cycle, favorable lipid and lipoprotein changes occurred in all treatment groups. Lumbar bone mineral density improved significantly (P < .05) by an average of 6.41% in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth, growth hormone secretion and somatomedin C after cranial irradiation for acute lymphoblastic leukemia.

In a large group of 74 patients irradiated with 2400 rad for acute lymphoblastic leukemia an unusually high frequency of complete GH deficiency was observed (40%). Only 11 out of 46 prepubertal children had growth retardation and seven children received hGH treatment. On the contrary 11 other prepubertal cases had normal growth rates in spite of lack of response to AITT. Plasma SmC values were correlated with growth rates but were discrepant with GH responses to AITT in some cases. Because of this high frequency of GH dysregulation further growth at time of puberty should be carefully documented.

Association between smoking status and cardiovascular and cortisol stress responsivity in healthy young men.

Acutely, cigarette smoking stimulates increases in blood pressure (BP), heart rate (HR), and cortisol, but little evidence is available concerning the impact of habitual smoking status on cardiovascular stress responsivity. This relation was assessed in 86 healthy male firefighters, age 19 to 31. comprising 52 nonsmokers and 34 smokers. Measures of BP, HR, salivary free cortisol, breathing pattern, and self-reported stress and alertness were obtained while subjects performed nonverbal mental arithmetic and a socially evaluative speech task. Systolic and diastolic BP were higher at rest in nonsmokers than smokers, and a consistent difference in stress responsivity was also found. BP, HR, and cortisol responses to mental arithmetic were significantly smaller in smokers than nonsmokers, with mean changes in BP (adjusted for body weight) averaging 19.3/11.0 mmHg and 28.5/15.4 mmHg in smokers and nonsmokers, respectively. There were no effects of smoking status on task performance or subjective stress responses and no differences between groups in family health history, health-related behaviors, o r psychological characteristics that might account for the reactivity difference. Possible explanations of the results are discussed, and methodological implications for cardiovascular stress reactivity studies are outlined.

[Increment in height of the upper segment and bi-iliac diameter after menarche in young girls. Longitudinal study of 40 adolescents]. / Croissance de la taille, du segment superieur et du diametre biiliaque chez la fille apres l'apparition des premieres regles. Etude longitudinale de 40 adolescentes

The growth in height, upper segment and biiliac diameter after the menarche has been studied in 40 girls followed longitudinally until the mean age of 18 years 3 months. The mean increase in height after the menarch was 7.3 +/- 2 cm., with significant individual variations. The upper segment was responsible for much of the total increase, which was greater with an early menarche. The percentage of the final height attained by the menarche was constant: 95.5 % +/- 1,2 %. After cessation in height growth, the biiliac diameter still increased for 75 % of the children. The median value for this increase after the menarche was 2 cm., with a significant scatter. The increase in these three parameters was in indirect correlation with the bone age: the less the bone age at the menarche, the greater the increase in height, upper segment and biiliac diameter.

[Treatment with hGH. Factors influencing response in children with somatotrophic insufficiency (author's transl)]. / Le traitement par l'hormone de croissance humaine. Facteurs influençant la réponse des enfants atteints d'insuffisance somatotrophique.

The present study was designated to investigate causes of hGH treatment failure in 59 prepubertal children, with idiopathic or organic GH deficiency. Children with height gain of less than 6 cm during the first year of treatment were the oldest, those with tallest stature, and had a lower growth rate prior to treatment. Increase of growth rate was negatively correlated with pre-treatment growth rate. Poor results were chiefly observed in children with tumoral organic hypopituitarism or after irradiation of the brain. Finally hGH doses appeared to be similar when two groups with respectively poor and good results were compared, indicating a major role of endogenous factors.

[Results of treatment with human growth hormone in children with pituitary insufficiency under 7 years of age. Study of 26 cases]. / Résultats du traitement par l'hormone de croissance humaine chez les enfants insuffisants hypophysaires âgés de moins de 7 ans. Etude de 26 observations.

Twenty-six children below age 7 years with idiopathic growth hormone deficiency have been treated with hGH for 2 years. Bone ages were inferior to 3 years and growth retardation averaged 3.9 +/- 0.9 standard deviation (SD) below the population mean. Results were compared to those obtained in a control group of 29 prepubertal patients, aged more than 7 years, and treated with hGH according to the same protocol. The mean height gains during the first and second year of treatment were respectively 8.4 +/- 1.8 cm and 6.6 +/- 1.5 cm. These values are significantly higher than those obtained in the group of older children. However within 2 years of treatment the initial catch-up in height of 0.9 +/- 0.6 DS was not different. In conclusion, we did not observe a better catch up growth in children before 7 years of age than in older prepubertal children, in spite of using higher doses of hGH.

[Thyroid involvement in cystinosis]. / Atteintes thyroidiennes au cours de la cystinose.

Thyroid function was assessed in 15 children with cystinosis and it was abnormal in 12. Three of these children were clearly hypothyroid and in the other 9 there were abnormalities of TSH or in the response to TRF. Compensated hypothyroidism is frequent in cystinosis and may be one factor in the severe growth retardation in this condition. The preliminary results of replacement therapy support this hypothesis.