Myofibrosarcoma of Maxilla - Case Report and Review of Literature.

Myofibrosarcoma is a distinct mesenchymal malignancy which commonly occurs in head and neck region. It has a high tendency for local recurrence and distant metastasis. 39-year-old male presented with epistaxis, nasal obstruction and left sided complete loss of vision. He underwent functional endoscopic sinus surgery and guided biopsy. MRI scan showed a lesion epicentred in the left maxillary sinus, superiorly extending into the orbit. He underwent Class 4b maxillectomy with neck dissection, tracheostomy and free flap reconstruction. Histopathological examination yielded final diagnosis as myofibrosarcoma of maxilla. The patient was planned for adjuvant radiotherapy and has been disease free for 3 years.

Spontaneous Tumor Lysis Syndrome in a Case of Hepatocellular Carcinoma with Sarcomatoid Differentiation.

Sarcomatoid hepatocellular carcinoma is a rare histologic variant of primary liver cancer comprising of malignant spindle cells and typical hepatocellular carcinoma (HCC). In terms of clinical presentation, they usually exhibit extensive tumor burden due to their larger size and a metastatic disease at the time of diagnosis as compared to conventional HCC. Tumor lysis syndrome is an oncological emergency, usually seen after cytotoxic chemotherapy in haematological malignancies. Here, we highlight a case of 76-year old male with no comorbidities, presenting with an excruciating backache and a paravertebral soft tissue mass and multiple osteolytic lesions, was clinically suspected to be a plasma cell neoplasm. On further evaluation, the patient was diagnosed of a sarcomatoid variant of hepatocellular carcinoma. This report showcases multiple rare findings by the presence of non-specific symptoms, non-cirrhotic liver, normal serum alpha protein levels and the occurrence of a spontaneous tumor lysis syndrome in a solid malignancy.

Fracture risk and bone health in adrenal adenomas with mild autonomous cortisol secretion/subclinical Hypercortisolism: a systematic review, meta-analysis and meta-regression.

Adrenal adenomas/incidentalomas with mild autonomous cortisol secretion (MACS)/subclinical hypercortisolism (SH) are often associated with metabolic syndrome, glucocorticoid-induced osteoporosis and fractures. In this background, the present systematic review and meta-analysis aimed to collate the available evidence and provide a summary of effect of MACS/SH on bone health in terms of fractures, osteoporosis/osteopenia, microarchitecture, and bone turnover. PubMed/MEDLINE, Embase, and Web of Science databases were systematically searched for observational studies reporting prevalence of fractures, osteoporosis/osteopenia or data on bone microarchitecture/bone turnover markers (BTMs). Following literature search, 16 observational studies were included. Pooled prevalence of any fractures (vertebral and non-vertebral), vertebral fractures and osteoporosis/osteopenia in MACS/SH were 43% [95% confidence intervals (CI): 23%, 62%], 45% (95% CI: 22%, 68%) and 50% (95% CI: 33%, 66%), respectively. On meta-regression, age, sex, 24-hour urinary free cortisol and dehydroepiandrosterone-sulfate did not predict fracture risk. The likelihood of any fractures [odds ratio (OR) 1.61; 95% CI: 1.18, 2.20; p = 0.0026], vertebral fractures (OR 2.10; 95% CI: 1.28, 3.45; p = 0.0035) and osteoporosis/osteopenia (OR 1.46; 95% CI: 1.15, 1.85; p = 0.0018) was significantly higher in adrenal adenomas and MACS/SH than non-functional adrenal adenomas. Subjects with MACS/SH had significantly lower bone mineral density (BMD) at lumbar spine [mean difference (MD) -0.07 gm/cm2; 95% CI: -0.11, -0.03; p = 0.0004) and femoral neck (MD -0.05 gm/cm2; 95% CI: -0.08, -0.02; p = 0.0045) than their non-functional counterparts. Limited data showed no significant difference in BTMs. Publication bias was observed in the pooled prevalence of any fractures, vertebral fractures and pooled MD of femoral neck BMD. To conclude, people with adrenal adenomas/incidentalomas and MACS/SH are at 1.5 to 2-fold higher likelihood of fractures and osteoporosis/osteopenia compared to non-functional adrenal adenomas and should routinely be screened for bone disease. Nevertheless, considering the modest sample size of studies and evidence of publication bias, larger and high-quality studies are required (CRD42023471045).

Mild autonomous cortisol secretion (MACS), often also referred to as subclinical hypercortisolism (SH), is usually associated with an underlying adrenal incidentaloma (AI), an adrenal mass incidentally found during abdomen imaging. Although signs of overt cortisol excess are lacking, subjects with MACS/SH often have features of metabolic syndrome, osteoporosis and fractures. The present systematic review and meta-analysis showed that the pooled prevalence of any fractures (vertebral and non-vertebral), vertebral fractures and osteoporosis/osteopenia in MACS/SH were 43%, 45% and 50%, respectively. People with adrenal adenomas/incidentalomas and MACS/SH are at 1.5 to 2-fold higher likelihood of fractures and osteoporosis/osteopenia compared to non-functional adrenal adenomas. Besides, subjects with MACS/SH had significantly lower bone mineral density (BMD) at lumbar spine and femoral neck than their non-functional counterparts. It is thus imperative to assess bone health in all subjects with MACS/SH.

A Rare Case Report of Osteosarcoma of Maxilla with Double Free-Flap Reconstruction.

Osteosarcomas are rare and highly malignant bone tumours which are composed of malignant mesenchymal cells producing osteoid or immature bone. Maxillary osteosarcomas are rare tumours accounting for less than 1% of head and neck malignancies. Aggressive surgical resection is the main modality of treatment with good reconstruction. Due to the complex anatomy and location of maxilla as well as its proximity to the skull, resection with negative margins is always a challenge and so is the reconstruction so as to reduce the morbidity of the patient and to also give a good functional and cosmetic outcome. Clinical outcomes can be improved with administration of neoadjuvant or adjuvant chemotherapy in selected cases and radiotherapy in case of positive margins. A 41-year-old male patient presented to the outpatient department with complaints of a bulge over the hard palate for the past 1 year. CT scan showed a 6 × 5 × 4 cm osseous expansile lesion arising from the maxillary bone. Biopsy of the tumour showed features of conventional high-grade osteosarcoma. Plate-preserving maxillectomy with tracheostomy was done followed by reconstruction with a double free flap. On post-operative day 1, the flap showed signs of venous congestion and a new free anterolateral thigh flap was done. Patient was discharged on day 7 with a Ryles tube and a tracheostomy tube in situ. Final histopathological examination showed that the tumour was a high-grade chondroblastic osteosarcoma. After regular post-operative visits in the outpatient department and evaluation with flexible laryngoscopy, patient was started on oral feed by day 10 and decannulated by day 15. He has been on regular follow-up for the past 1 year and shows no signs of recurrence or residual disease on clinical examination as well as imaging. Maxillary osteosarcoma is a rare bone tumour which requires accurate imaging and biopsy for accurate surgical planning. The ideal treatment modality is radical resection with negative margins and appropriate reconstruction. With the advent of microvascular surgery, free flaps form the backbone for reconstruction of such large defects.

Naphthaldehyde-Based Schiff Base Chemosensor for the Dual Sensing of Cu2+ and Ni2+ Ions.

In this study, a simple Schiff base sensor 1-(((4-nitrophenyl)imino)methyl)naphthalen-2-ol(NNM) has been used for chemosensing of metal ions. The metal sensing properties of sensor NNM have been investigated using UV-visible and fluorescence spectroscopic approaches. The spectral investigations revealed a red shift in absorption spectra and quenching in the emission band of the ligand molecule in the presence of Cu2+ and Ni2+ ions. The binding stoichiometry of sensor NNM for the analyte (Cu2+ and Ni2+ ions) has been investigated by the Job's plot analysis and found to be 1:1 (NNM:Analyte). The data of the Benesi-Hildebrand plot demonstrated that NNM detected Cu2+ and Ni2+ ions in nanomolar quantity. The binding insights among NNM and analytes (Cu2+ and Ni2+ ions) have been confirmed by shifted IR signals. Moreover, the reusabilty of the sensor has been investigated using an EDTA solution. In addition, the sensor NNM also successfully applied to real water samples for the identification and measurement of Cu2+ and Ni2+ ions. Hence, this system could be highly applicable in environmental and biological applications.

An Isoniazid Based Schiff Base Sensor for Selective Detection of Pd2+ Ions.

Here, we developed a novel isoniazid based fluorescent probe (E)-N'-(thiophen-2-ylmethylene)isonicotinohydrazide (TINH) through simple condensation reaction and employed for selective detection of Pd2+ ions with a low detection limit of 4.102 × 10-11 M. Among the many existing cations, TINH bound Pd2+ ions with an association affinity of 9.794 × 105 M-1. Adding Pd2+ ions to ligand solution increased the absorption intensity in UV-Visible and quenched the emission intensity in fluorescence spectroscopic experiments. More importantly, this TINH complexed to Pd2+ ions in 1:1 stoichiometric ratio. To evaluate the stability of complexed system, pH experiments has been performed. The binding insights among the ligand and Pd2+ ions has been confirmed by IR spectroscopic and MASS spectrometric methods. Additionally, TINH also applied to real water samples for the identification and measurement of Pd2+ ions. Hence, this system could be highly applicable for detection of Pd2+ ions in environmental and industrial samples with in low detection range.

Trigeminal Schwannoma - Case Report of a Rare Tumour.

Schwannomas are benign nerve tumours arising from the Schwann cells. Approximately 25-45% of schwannomas occurs in the head and neck region. Majority of schwannomas in the head and neck region arise from the vagus nerve. Trigeminal schwannomas account for about 0.2% of all intracranial tumours. Trigeminal schwannomas can originate from any section of the fifth cranial nerve, from the root to the distal extracranial branches, but majority develops from the Gasserian ganglion, usually growing in the middle cranium. Most common presenting symptom is facial pain. MRI is the imaging modality of choice and CT scan usually serves as a supplementary imaging especially for skull base tumours. 47 year old male patient presented to the outpatient department with complains of swelling over the left side of palate. Contrast enhanced CT scan demonstrated a large bilobed heterogeneously enhancing soft tissue lesion in the left infratemporal fossa with widened foramen ovale and extension of lesion into the Meckel's cave, larger contiguous component extending into ramus of mandible. MRI scan showed a large lobulated mass in the left masticator space with intracranial extension. Biopsy of the lesion was suggestive of schwannoma. The patient underwent left composite resection with dural repair and free flap reconstruction. Post operatively, on day 5 he developed features of meningitis for which he was treated conservatively and later discharged in stable condition. Trigeminal schwannomas are rare tumours with very low chance of malignant transformation which commonly presents with facial pain. MRI is the imaging modality of choice. Complete surgical excision is the treatment of choice.

Ketamine Augmentation of Electroconvulsive Therapy: A Scoping Review of Dose-Dependent Effects in Major Depressive Disorder.

Intravenous ketamine infusions in subanesthetic doses have been shown to rapidly alleviate depressive symptoms. However, the efficacy of ketamine as an anesthetic during electroconvulsive therapy (ECT) for major depression has not yet been answered by a large randomized control trial (RCT). This scoping review aims to examine the available literature to determine whether the dose of ketamine used during ECT influences the response to treatment. A literature search was conducted on PubMed to identify all published RCTs within the last 10 years which compared ketamine anesthesia during ECT for major depression with another anesthetic. Studies using low (<0.8 mg/kg) versus high (≥0.8 mg/kg) doses of ketamine during ECT were evaluated for the differences in outcomes using depression rating scales. Studies that examined ketamine as a standalone treatment for depression or focused primarily on the anesthetic benefits of ketamine were excluded from our review. Fifteen studies were utilized for this literature review. Overall, the studies showed inconsistent results in terms of the speed and magnitude of response to ketamine-assisted ECT in patients with major depression. Limitations of the available literature are discussed, including the lack of head-to-head comparisons, differences in methodology, inclusion/exclusion criteria, and primary and secondary endpoints.

The COVID-19 pandemic: an opportunity to strengthen telemedicine in low and middle-income countries.

IMPACT: During the peak of the COVID-19 pandemic the healthcare systems of several countries came under strain and were even crippled, especially in LMICs, necessitating the exploration of alternate mechanisms for scaling-up healthcare services. Telemedicine can be an invaluable modality for complementing standard modes of pediatric healthcare delivery, not only during crises like the COVID-19 pandemic, but also for reducing the inequities that exist in access and delivery of pediatric healthcare in LMICs. A well-coordinated approach in health policy, development of infrastructure, and effective community participation is required for effective integration of pediatric telemedicine in LMICs healthcare systems.

Potential approaches using teneligliptin for the treatment of type 2 diabetes mellitus: current status and future prospects.

INTRODUCTION: Based on pharmacological properties and results from clinical studies, teneligliptin has a great potential to be used as an alternate-day therapy and also the daily dose can be reduced to 10 mg. Clinical data also suggest its excellent efficacy and safety among older subjects. AREAS COVERED: We have reviewed and discussed potential approaches using teneligliptin for the treatment of type 2 diabetes mellitus (T2DM) including alternate-day therapy and reduction of dose from 20 mg to 10 mg per day. We have also discussed the potential of teneligliptin to address the needs of older patients with T2DM. EXPERT OPINION: It is an excellent option for use in older patients as studies in the geriatric population have shown encouraging results. Teneligliptin has a desirable pharmacokinetic profile that makes it a potential drug for use on an alternate-day basis. Teneligliptin has shown anti-diabetic efficacy even at a dose of 10 mg. These approaches may improve treatment satisfaction and patient compliance and can lower the cost; however, it is crucial to identify the subset of T2DM patients who can obtain maximum benefits. To verify these effects, large clinical investigations need to be planned and robust clinical evidence should be generated.

Elucidation of Structural, Morphological, Electrical Parameters, and Anti-Bacterial Activity of Polyaniline-Nanocomposite: New Paradigm of Controlling Bacterial Activity.

In this communication, we purpose an alternative electrical method to determine the anti-bacterial activity of compounds. Polyaniline/magnetite (Fe3O4/PANI) and polyaniline/hydrochloric acid (HCl/PANI) nanocomposites have been prepared. We have tested the anti-bacterial activity of Fe3O4/PANI and HCl/PANI nanocomposites by Agarwell Diffusion Assay and Bacterial Inhibition Assay method. The electrical characteristics of the prepared composites have been measured. The doping of 12% of Fe3O4 in PANI caused a substantial increase in anti-bacterial activity. The observed bacterial inhibition is in agreement with optimized values of resistivity, loss factor, quality factor, and spontaneous magnetization. Sample 2 associated with 12% Fe3O4-PANI composites has a high resistivity of 1.70×106Ω .m among all prepared composites. The magnetic character and insulating nature of Fe3O4 influenced the investigated parameters. The morphological variation of prepared composites is also consistent with electrical parameters. The alleviated energy zone formed by the magnetic behavior of Fe3O4 and interfacial polarization of PANI mitigates the polarization/field of charge carriers of bacteria. These effects altogether diminish the energy of bacterial zone revealed in the experiment. The tuning of electrical parameters provides an alternative to control bacterial growth in various compounds. The proposed method of electrical characterization for the detection of the anti-bacterial activity of the compounds can be very useful in terms of time and cost in contrast to the lab tests performed in biological labs. After implementing an electrical parameter standard equivalent to anti-bacterial activity, real-time detection can be performed by electrical parameters in the fields outside without any hassle, which otherwise is not possible for biological labs.

Simultaneous axial and radial swelling studies from 2D stereozoom images of tablet compacts composed of superdisintegrants.

Swelling-based disintegration is considered important for drug release from tablets and can be modified with excipients called tablet disintegrants. Swelling of tablets occurs axially and radially, and most researchers have observed both these events separately using 2D images. In the current work, we have studied these events simultaneously instead of separately under a stereozoom microscope for tablet compacts composed of high proportions of disintegrants (sodium starch glycolate, SSG and croscarmellose sodium, CCS), using water as the disintegrating medium. A hypothesis is proposed for the measurements of radial and axial swellings from a single 2D image, as horizontal lengths based on trigonometric functions for a right-angle triangle. All predicted axial and radial lengths (as per proposed hypothesis) are found validated with respect to vernier calliper measurements for dry-tablet compacts with a minute error of 3.809%. The axial swelling is approximately fivefolds more than that of radial swelling on the basis of normalised lengths. No particular trend can be spotted exclusively in favour of a superdisintegrant; however, the CCS-based tablets have shown higher swelling as compared to SSG-based tablets. From the current studies, it is evident that both axial and radial dimensions are obtainable from single 2D stereozoom images and can be successfully implemented for swelling studies of tablets.

Correlation of Vitamin D Deficiency with Predictors of Mortality in Critically Ill Children at a Tertiary Care Centre in North India-A Prospective, Observational Study.

This study was conducted to assess the relationship of vitamin D deficiency (VDD) with various demographic characteristics, laboratory parameters, and predictors of mortality. This prospective observational study was performed at pediatric intensive care unit (PICU) of a tertiary care hospital situated in north India. A total of 125 children admitted in PICU with age from 2 months to 14 years were analyzed. The subjects were classified as Vitamin D deficient (≤20 ng/mL) and nondeficient (>20 ng/mL). The relationship between VDD and predictors of mortality were analyzed using correlation and multivariate analysis. Respiratory system (40%) was most commonly involved. VDD was seen in 72% of the patients. There was statistically significant correlation of VDD with age ( p = 0.019), season ( p = 0.018), height ( p = 0.005), and weight ( p = 0.003). On multivariate analysis factors associated with VDD were age (odds ratio [OR] = 1.01, 95% confidence interval [CI] 1.00-1.03, p = 0.006), season (OR = 3.98, 95% CI 1.09-14.50, p = 0.036). VDD was also correlated to bacteriuria ( p = 0.033), cardiovascular sequential sepsis-related organ failure assessment score (CV-SOFA score) ( p = 0.001), and mechanical ventilation ( p = 0.043). On multivariate analysis, factors associated with VDD were bacteriuria (OR = 4.88, 95% CI 1.04-22.89, p = 0.04), mechanical ventilation requirement (OR = 2.95, 95% CI 1.12-7.85, p = 0.029), and CV-SOFA score (OR = 2.33, 95% CI 1.14-4.76, p = 0.021). Median (interquartile range) duration of PICU stay in VDD patients was (3-7) days while in nondeficient patients it was (2-6) days ( p = 0.107). VDD was a significant risk factor for the need of mechanical ventilation, bacteriuria, and mortality among patients in our cohort.

Transneuronal tracing to map connectivity in injured and transplanted spinal networks.

It has become widely appreciated that the spinal cord has significant neuroplastic potential, is not hard-wired, and that with traumatic injury and anatomical plasticity, the networks that we once understood now comprise a new anatomy. Harnessing advances in neuroanatomical tracing to map the neuronal networks of the intact and injured spinal cord has been crucial to elucidating this new spinal cord anatomy. Many new techniques have been developed to identify these networks using a variety of retrograde and anterograde tracers. One method of tracing that has become more widely used to map anatomical changes is transneuronal tracing. Viral tracers are being increasingly used to map spinal networks, leading to an advanced understanding of spinal circuitry and host-donor-host interactions between the injured spinal cord and neural transplants. This review will highlight advances in neuronal tracing, specifically using pseudorabies virus (PRV), and its use in the intact, injured, and transplanted spinal cord.

New insights into the disintegration mechanism and disintegration profiling of rapidly disintegrating tablets (RDTs) by thermal imaging.

In current studies, the disintegration process of tablets has been studied by thermal imaging. The study covers two major aspects; first, new revelations in the mechanism of tablet disintegration, and second, the development of disintegration test as a multi-point test by new thermometric and non-thermometric methods. The study has been carried out on fexofenadine rapidly disintegrating tablets (FEX RDTs) in a dark room cabinet fitted with a Fluke thermal imager and using water as the disintegration medium. The studies exhibit the existence of endothermic peaks during the early penetration of water in FEX RDTs. These endotherms are prominent at the starting point when the disintegration has just started, or the tablet has been just exposed to the water. Such endotherms have not been reported earlier for tablets and can be considered as a part of the wicking mechanism during disintegration. In later stages, when the water has completely wet the tablet, the endotherms are superimposed by exotherms. The endotherms or exotherms have also been used as a measurement of disintegration in the form of a new thermometric parameter, "area under temperature curve" (AUTC). Non-thermometric disintegration profiling by residual and subtraction methods is also performed. Among these, disintegration by the residual method, i.e., disintegration (residual) is newly introduced. In the end, the principal component analysis (PCA) describes the relationship between various disintegration methods, particle size distribution, and dissolution. PCA reveals that AUTC is the best method for studying the disintegration behavior of FEX RDTs.

In silico molecular docking of SARS-CoV-2 surface proteins with microbial non-ribosomal peptides: identification of potential drugs.

Outbreak of COVID-19 by SARS-CoV-2 infection caused severe acute respiratory syndrome that has been declared a public health emergency of international concern. To control infections, there is urgent need to develop an effective therapeutic strategy. COVID-19 viral spike glycoprotein and proteases play major role in viral entry and mediating virus replication and spread and thus can serve as potential antiviral drug target. Being highly specific, efficacious and safe, peptides hold their place in therapeutics. In present study, molecular docking of 21 pharmacologically active non ribosomal peptides (NRPs) from marine microbes with SARS-CoV-2 spike glycoprotein and papain such as protease was done. Dactinomycin, Tyrocidine A and Gramicidin S showed highest binding interaction with target proteins. The binding affinity of Dactinomycin and Gramicidin S docked with SARS-CoV-2 spike glycoprotein was - 12.4 kcal/mol and - 11.4 kcal/mol, respectively. This suggested their potential to destabilize SARS spike protein binding with human host ACE2 receptor and thus hindering viral entry to the cells. Binding affinity of Tyrocidine A and Gramicidin S with SARS-CoV-2 papain-like protease was - 13.1 kcal/mol and - 11.4 kcal/mol, respectively which might be inhibited COVID-19 by acting on the protease. Gramicidin S showed same binding affinity for both target proteins and thus expected to be most potent. Based on the binding energy score, it was suggested that these pharmacologically active NRPs are potential molecules to be tested against SARS-CoV-2 and used to develop effective antiviral drugs.

Transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India: a prospective observational study.

OBJECTIVE: The paucity of specialised care in the peripheral areas of developing countries necessitates the referral of sick neonates to higher centres. Organised interhospital transport services provided by a skilled and well-equipped team can significantly improve the outcome. The present study evaluated the transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India. DESIGN: Prospective observational study. SETTINGS: Tertiary care teaching hospital in North India. PATIENTS: 1013 neonates referred from peripheral health units. MAIN OUTCOME MEASURES: Mortality among referred neonates on admission to our centre. RESULTS: Of the 1013 enrolled neonates, 83% were transferred through national ambulance services, 13.7% through private hospital ambulances and 3.3% through personal vehicles. Major transfer indications were prematurity (35%), requirement for ventilation (32%), birth asphyxia (28%) and hyperbilirubinaemia (19%). Hypothermia (32.5%, 330 of 1013), shock (19%, 192 of 1013) and requirement for immediate cardiorespiratory support (ICRS) (10.4%, 106 of 1013) on arrival were the major complications observed during transfer. A total of 305 (30.1%, N=1013) deaths occurred. Of these, 52% (n=160) died within 24 hours of arrival. On multivariate logistic analysis, unsupervised pregnancy (<4 antenatal visits; p=0.037), antenatal complications (p<0.001), prematurity ≤30 weeks (p=0.005), shock (p=0.001), hypothermia (p<0.001), requirement for ICRS on arrival (p<0.001), birth asphyxia (p=0.004), travel time >2 hours (p=0.005) and absence of trained staff during transfer (p<0.001) were found to be significant predictors of mortality. CONCLUSION: The present study depicts high mortality among infants referred to our centre. Adequate training of peripheral health personnel and availability of pre-referral stabilisation and dedicated interhospital transport teams for sick neonate transfers may prove valuable interventions for improved outcomes.

Catatonia-Induced Saddle Pulmonary Embolism.

In this case report, we highlight a patient with catatonia secondary to schizoaffective disorder, depressive type. This patient developed a bilateral deep venous thrombosis progressing to a saddle pulmonary embolism without any predisposing factors to hypercoagulability other than immobility and obesity. The goal of this case report is to increase monitoring and prophylactic treatment for deep venous thrombosis in patients with catatonia, retarded type.

Concomitant use of dexamethasone and tetracyclines: a potential therapeutic option for the management of severe COVID-19 infection?

Introduction: The global coronavirus disease-2019 (COVID-19) pandemic has posed a critical challenge to the research community as well as to the healthcare systems. Severe COVID-19 patients are at a higher risk of developing serious complications and mortality. There is a dire need for safe and effective pharmacotherapy for addressing unmet needs of these patients. Concomitant use of dexamethasone and tetracyclines, by virtue of their immunomodulatory and other relevant pharmacological properties, offers a potential strategy for synergy aimed at improving clinical outcomes.Areas covered: Here we review the potential benefits of combining dexamethasone and tetracyclines (minocycline or doxycycline) for the management of severe COVID-19 patients. We have critically examined the evidence obtained from in silico, experimental, and clinical research. We have also discussed the plausible mechanisms, advantages, and drawbacks of this proposed combination therapy for managing severe COVID-19.Expert opinion: The concomitant use of dexamethasone and one of the tetracyclines among severe COVID-19 patients offers several advantages in terms of additive immunomodulatory effects, cost-effectiveness, wide-availability, and well-known pharmacological properties including adverse-effect profile and contraindications. There is an urgent need to facilitate pilot studies followed by well-designed and adequately-powered multicentric clinical trials to generate conclusive evidence related to utility of this approach.

Gastroenteritis in Haryana, India Post Introduction of Rotavirus Vaccine.

OBJECTIVE: To evaluate the epidemiology of rotavirus gastroenteritis in Haryana post-introduction of rotavirus vaccine. Expanded National rotavirus surveillance network in India reported high burden of rotavirus diarrhea in India. The Government of India introduced the monovalent rotavirus vaccine made in India by Bharat Biotech in the national immunization programme from 2016 onward along with oral polio vaccine (OPV) and Pentavalent vaccines. METHODS: A multi-centric, hospital-based surveillance study in the initial vaccine introducing states was started in a phased manner over a period of 3 y. PGIMS, Rohtak is a tertiary care center and was a part of the surveillance from 2016 to 2019. Children aged 0-59 mo admitted with acute gastroenteritis were enrolled into the surveillance and their stool samples were collected. Samples were tested at Christian Medical College (CMC), Vellore to detect rotavirus and reverse transcription-polymerase chain reaction (RT-PCR) was used for G and P typing. RESULTS: A total of 904 children were enrolled in the present surveillance over a period of 3 y starting 1st July 2016 to 30th June 2019. Stool samples were collected and analyzed for 827 children and out of them 141 samples were positive for rotavirus (17.1%). Maximum rotavirus positivity was observed during the winter months. Rotavirus positivity percentage was observed maximum in 12-23 mo age group. A declining trend was observed in rotavirus positivity from 22.8% in 2016 to 14.5% in 2019. Most common strains of rotavirus isolated were G3P[8] followed by G1P[8]. CONCLUSION: This study highlights that epidemiology of acute gastroenteritis among children less than 5 y of age in Haryana postintroduction of rotavirus vaccination in the state and the decline in rotavirus positivity from 22.8% in 2016 to 14.5% in 2019.