Fatal neonatal varicella infection despite intravenous immunoglobulin at birth.

There is a high risk of severe varicella infection in the neonate when the mother develops a rash around the time of delivery. Current guidelines recommend separation of mother-baby dyad and passive immunization to prevent severe infection in such cases. We report a case of severe varicella in a neonate whose mother developed primary varicella infection two days prior to delivery. The neonate had a fatal outcome despite physical separation from mother and passive immunization in the immediate postnatal period.

"Efficient novel fungal-enriched biochar formulation for hexavalent chromium bioremediation".

Chromium (Cr), a key element in industrial processes such as leather tanning, poses severe environmental hazards, particularly its hexavalent form, Cr(VI), which is highly toxic and prevalent in tannery effluents/sludge. The persistence and toxicity of Cr(VI) necessitate the development of effective remediation strategies to mitigate its environmental impact. This study investigated the potential of Trichoderma yunnanense (NBRICRF_97) and its combination with 0.5% sugarcane bagasse biochar (SBC) for the reduction of Cr(VI). The results demonstrated that T. yunnanense alone achieved a 91.04% reduction of 50 mg L-1 Cr(VI) within 72 h. Combined with 0.5% SBC, the reduction efficiency increased to 99.65% within 48 h. However, the efficiency decreased at higher concentrations (200 mg L-1). The combination also improved fungal growth and increased extracellular ChrR enzyme activity (13.07 U mg-1 protein compared to the control). Total glutathione activity was boosted by 161.07% at 100 mg L-1 Cr(VI). Antioxidant enzymes (SOD, POD, CAT) and proline mitigated oxidative stress and FTIR analysis revealed changes in fungal cell wall functional groups (-OH and -NH) upon Cr(VI) exposure. SEM-EDX confirmed chromium deposition on fungal surfaces. These results underscore the Cr(VI) detoxification capabilities of T. yunnanense and the synergistic benefits of SBC, suggesting a promising bioremediation strategy for Cr(VI)-contaminated environments. The integration of T. yunnanense with SBC offers a sustainable and cost-effective approach for the bioremediation of Cr(VI)-contaminated sites, with potential for implementation in large-scale environmental cleanup efforts.

Post-discharge Outcomes of COVID-19 Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Understanding the post-discharge outcomes of COVID-19 patients is essential for informed healthcare planning and support services. This study aimed to assess the physical health status of COVID-19 patients three months after discharge from a tertiary care hospital in Kathmandu, Nepal. METHODS: A descriptive follow-up study design was used, involving 200 COVID-19 discharged patients. Data were collected from healthcare facilities and participants through structured questionnaires and telephonic interviews. The study duration was between November 2020 to April 2021. RESULTS: Persistence of COVID-19-related symptoms was reported by 49 (24.50%) of participants reported at follow-up, while 41 (20.50%) indicated previous symptoms from discharge. CONCLUSIONS: After discharge, most of patient returned to normal activities within three months.Persistence of symptoms and test positive rate was less in those patients.

Less invasive surfactant administration with specially designed semirigid catheter: Experience from a tertiary level neonatal unit of a lower middle-income country.

Clinical outcomes of 74 preterm neonates, who received surfactant replacement therapy (SRT), were collected retrospectively, to compare the following modes of administration: (1) less invasive surfactant administration (LISA) via a specially designed semirigid catheter (Surfcath), (2) INtubate-SURfactant-Extubate (INSURE) and (3) through endotracheal tube (ETT), in neonates requiring mechanical ventilation. The primary composite outcome of mortality or bronchopulmonary dysplasia (BPD) at 36 weeks' post-menstrual age was 41% in LISA, 38% in INSURE and 77% in ETT groups (p < 0.01), the difference being mainly due to the high incidence of mortality in the latter. LISA, via a specially designed semirigid catheter, was safe and feasible in preterm neonates.

Implementation Research on Cardiovascular Diseases in India: A Systematic Review.

SUMMARY: Cardiovascular diseases (CVDs) are the leading cause of death globally and the prevention and control of these diseases tend to entail longer and larger social and economic commitments on the part of governments. This systematic review (SR) aims to understand the quantum, diversity, and quality of implementation research (IR) done in the field of CVDs in India with a view to maximizing the utility of the efforts made by the government. The evidence was collated on IR on CVDs in India conducted in the past 20 years (2001-2021) using a SR approach. The SR was drafted using Preferred Reporting Items for SRs and Meta-analyses guidelines. Academic databases (PubMed, Embase, and Science Direct) and nonacademic databases (Google Scholar and ProQuest) were chosen, along with repositories of gray literature. Retrieved articles were screened for titles and abstracts and assessed by two independent reviewers. The articles also underwent a concomitant risk of bias assessment utilizing checklists (STARI, STROBE, CONSORT, etc.,) and a narrative summary was drafted using SwiM guidelines. In the final analysis, 10 articles that fitted the inclusion criteria of IR for CVD in India were included, of which seven were directed at IR on hypertension, and three were related to coronary artery disease, myocardial infarction, and stroke. Acceptability, adoption, and feasibility were the only attributes of IR that were explored in these studies.

Tailoring pH-sensitive carboxymethyl tamarind kernel gum-based hydrogel for an efficient delivery of hydrophobic drug indomethacin.

Polyacrylamide hydrogels have gained attention in the drug delivery field for their pH-dependent nature. Nevertheless, their limited degradability and lower entrapment efficiency for hydrophobic drugs hinder their utility in controlled drug release. This research aims to design a degradable pH-sensitive hydrogel for delivering the hydrophobic drug indomethacin to the colon. This work developed and optimized the hydrogels based on ß-cyclodextrin, carboxymethyl tamarind kernel gum, and polyacrylamide with varying amounts of polyethylene glycol diacrylate. The optimized hydrogel exhibits 76.52 % gel fraction, 89.21 % porosity, 1000.27 % swelling, and 90.0 % equilibrium water content. The hydrogel was characterized using Attenuated Total Reflection-Fourier Transform Infrared spectroscopy, confirming the successful crosslinking of the synthesized hydrogel. Powder X-ray Diffraction revealed their amorphous nature while Scanning Electron Microscopy showed a porous surface morphology of the hydrogel. Moreover, rheology confirmed the hydrogel's elastic nature. Notably, the hydrogel demonstrated a drug release of 60.26 % at pH 7.4. Kinetic modelling of indomethacin release data indicated a Fickian diffusion release mechanism. Cytotoxicity tests on HCT-116 cells showed 79 % viability, and the hydrogel fully degraded within 10 days. These results confirmed the potential of synthesized ß-CD/PAM/CMTKG hydrogel for controlled indomethacin delivery to the colon.

Microwave-Assisted Self-Healable Biovitrimer/rGO Framework for Anticorrosion Applications.

Microwave-stimulated smart self-healable polymeric coatings with significant protective technology against corrosion have been developed in this work. Herein, a generous approach is strategized to generate linseed oil-derived epoxy composites embedded with reduced graphene oxide (rGO) as a nanofiller in the shielding network. The composite showed excellent self-healing and shape memory properties when irradiated with microwaves due to the dynamic reversible nature of the disulfide covalent bond exchange mechanism. The network also has improved thermomechanical properties and thermal stability, with a storage modulus of 20.8 GPa and a low activation energy of 79 kJ/mol, indicating a fast disulfide dynamic exchange reaction. The amine functionality in the composite contributes to excellent corrosion protection, with 99.9% protection efficiency, as validated via a Tafel plot. The composite also showed excellent hydrophobicity, with a 131° contact angle. This study provides insights into the engineering and application of smart materials as anticorrosive coatings.

Exploring enzyme-immobilized MOFs and their application potential: biosensing, biocatalysis, targeted drug delivery and cancer therapy.

Enzymes are indispensable in several applications including biosensing and degradation of pollutants and in the drug industry. However, adverse conditions restrict enzymes' utility in biocatalysis due to their inherent limitations. Metal-organic frameworks (MOFs), with their robust structure, offer an innovative avenue for enzyme immobilization, enhancing their resilience against harsh solvents and temperatures. This advancement is pivotal for application in bio-sensing, bio-catalysis, and specifically, targeted drug delivery in cancer therapy, where enzyme-MOF composites enable precise therapeutic localization, minimizing the side effects of traditional treatment. The adaptable nature of MOFs enhances drug biocompatibility and availability, significantly improving therapeutic outcomes. Moreover, the integration of enzyme-immobilized MOFs into bio-sensing represents a leap forward in the rapid and accurate identification of biomarkers, facilitating early diagnosis and disease monitoring. In bio-catalysis, this synergy promotes efficient and environmentally safe chemical synthesis, enhancing reaction rates and yields and broadening the scope of enzyme application in pharmaceutical and bio-fuel production. This review article explores the immobilization techniques and their biomedical applications, specifically focusing on drug delivery in cancer therapy and bio-sensing. Additionally, it addresses the challenges faced in this expanding field.

Trichoderma produces methyl jasmonate-rich metabolites in the presence of Fusarium, showing biostimulant activity and wilt resistance in tomatoes.

Bioactive secondary metabolites from fungi, including Trichoderma, are an excellent source of plant biostimulants. Although production of novel biostimulants from known microbes is critical, challenging them may produce novel bioactive compounds. With this hypothesis, the study used live Fusarium chlamydosporum (FOL7) culture as the inducer during T. harzianum (IF63) growth in broth. Plate assays and gas chromatography-mass spectrometry (GC-MS) analysis were used to characterise the metabolites. Microscopy, pot experiments and, biochemical estimations of the defence-related enzymes in tomato plants established the biostimulant activity of the induced Trichoderma metabolites. Fungal crude metabolites (FCM) obtained from IF63+FOL7 extracts (TF.ex) showed increased antimicrobial activity. TF.ex at 50 µg mL-1, inhibited the FOL7 growth by 68.33% compared to the Trichoderma alone extract. Scanning electron microscopy (SEM) revealed morphological disruption of FOL7 mycelia by TF.ex. GC-MS analysis of the extracts revealed the presence of approximately 64 compounds, of which at least 13 were detected explicitly in TF.ex. Methyl (3-oxo-2-pentylcyclopentyl) acetate (Methyl dihydrojasmonate), a lipid functionally related to jasmonic acid, was the major metabolite (∼21%) present in TF.ex. Tomato seed dressing with TF.ex promoted plant growth and induced systemic resistance against FOL7 compared to alone Trichoderma and Fusarium extracts. The TF.ex treatment increased the superoxide dismutase (33%) and catalase activity by 2.5-fold in tomato plants. The study concludes that fungal secondary metabolites may be modulated by providing appropriate challenges to produce effective metabolite-based biostimulants for agricultural applications.

Efficacy of short-course antibiotics for culture-positive neonatal sepsis: A systematic review and meta-analysis.

Sepsis is a common cause of neonatal mortality and morbidity. Though antibiotics are the mainstay of treatment in culture-positive neonatal sepsis, the dilemma persists for the optimum duration of antimicrobial therapy. The present study aimed to evaluate the efficacy of short-course antibiotics for uncomplicated culture-positive neonatal sepsis. This systematic review and meta-analysis (PROSPERO: CRD42023444899) identified, appraised, and synthesised the available evidence from randomised and quasi-randomised controlled trials related to the efficacy of short-course (7-10 days) versus standard-course (14 days) antibiotics for uncomplicated culture-positive neonatal sepsis on the rate of treatment failure, mortality, duration of hospitalisation, morbidities including antibiotics-related adverse events, long-term neurodevelopmental outcomes and cost analysis. Data were pooled using RevMan 5.4 software. Certainty of evidence (COE) for predefined outcomes was analysed by GRADE. Available evidence showed no significant difference in the rate of treatment failure between 7- to 10-day versus 14-day antibiotics courses [risk ratio (95% confidence interval, CI), 2.45 (0.93-6.47), I2 = 0%, six studies, n = 573, very low COE]. No incidence of death was reported in either treatment arm in the two included studies. Duration of hospitalisation was significantly shorter with the short-course antibiotics arm compared to standard-course [mean difference (95% CI), -3.88 (-4.22 to -3.54) days, I2 = 0%, five studies, n = 507, low COE]. Morbidities reported in the three studies were similar. Other outcomes were not reported. To conclude the evidence is very uncertain about the effect of short-course antibiotic regimen, compared to a standard-course, on the treatment failure rate in uncomplicated culture-positive neonatal sepsis. Adequately powered trials with outcomes including death and long-term neurodevelopmental impairment are needed.

An unusual case of scalp ulceration.

ABSTRACT: Granulomatosis with polyangiitis, a form of necrotizing vasculitis can present as a limited variant with the involvement of a single organ system. The superficial protracted form can present as face and scalp ulceration for chronic periods of time. Diagnosis can be established histopathologically by examining the involvement of blood vessels. Here, we present a case of scalp ulceration that was diagnosed as a limited variant and started on steroids and immunosuppressants with excellent response.

Ultrafast terahertz Stark spectroscopy reveals the excited-state dipole moments of retinal in bacteriorhodopsin.

The photoinduced all-trans to 13-cis isomerization of the retinal Schiff base represents the ultrafast first step in the reaction cycle of bacteriorhodopsin (BR). Extensive experimental and theoretical work has addressed excited-state dynamics and isomerization via a conical intersection with the ground state. In conflicting molecular pictures, the excited state potential energy surface has been modeled as a pure S[Formula: see text] state that intersects with the ground state, or in a 3-state picture involving the S[Formula: see text] and S[Formula: see text] states. Here, the photoexcited system passes two crossing regions to return to the ground state. The electric dipole moment of the Schiff base in the S[Formula: see text] and S[Formula: see text] state differs strongly and, thus, its measurement allows for assessing the character of the excited-state potential. We apply the method of ultrafast terahertz (THz) Stark spectroscopy to measure electric dipole changes of wild-type BR and a BR D85T mutant upon electronic excitation. A fully reversible transient broadening and spectral shift of electronic absorption is induced by a picosecond THz field of several megavolts/cm and mapped by a 120-fs optical probe pulse. For both BR variants, we derive a moderate electric dipole change of 5 [Formula: see text] 1 Debye, which is markedly smaller than predicted for a neat S[Formula: see text]-character of the excited state. In contrast, S[Formula: see text]-admixture and temporal averaging of excited-state dynamics over the probe pulse duration gives a dipole change in line with experiment. Our results support a picture of electronic and nuclear dynamics governed by the interaction of S[Formula: see text] and S[Formula: see text] states in a 3-state model.

Lung ultrasound for prediction of surfactant requirement in Indian preterm neonates: a diagnostic accuracy study.

Surfactant replacement for respiratory distress syndrome (RDS) is currently guided by oxygen (FiO2) requirement in preterm neonates. Lung ultrasound (LUS) has emerged as an important predictive tool; however, there is a paucity of evidence from developing countries. The objective of this study was to determine the diagnostic accuracy of the LUS score in comparison to standard criteria based on FiO2 requirement for prediction of surfactant requirement. In this prospective study, preterm neonates of < 34 weeks' gestation with RDS were included within 2 h of life. Surfactant was administered if the FiO2 requirement exceeded 30%. Baseline characteristics, respiratory parameters, and LUS clips were recorded soon after birth and compared between the surfactant and non-surfactant groups. LUS scoring was later performed by masked assessors which was not used in the management of neonates. Among 82 neonates (mean gestation 30.6 weeks and weight 1375 g) included in the study, 33 (40.2%) received surfactant. The surfactant group had a higher Silverman score, required higher FiO2 and mean airway pressure, and needed invasive ventilation more frequently. The mean (± SD) LUS score was significantly higher in the surfactant (9.4 ± 3.2) compared to the non-surfactant group (5.1 ± 2.1). The diagnostic accuracy of LUS scoring was determined by ROC curve analysis (AUC (95% CI): 0.83 (0.74-0.92), p < 0.01). A cutoff score of ≥ 8 for LUS was considered optimal for the prediction of surfactant requirement (sensitivity and specificity (95% CI) of 70% (51-84) and 80% (66-90), respectively).    Conclusion: Lung ultrasound is a valid diagnostic tool for the prediction of surfactant requirements in resource-limited settings. What is Known: • Lung ultrasound has a good diagnostic accuracy in predicting the need for surfactant administration in preterm neonates in developed countries, but its role in developing countries is unclear. What is New: • Lung ultrasound proved to be a valid diagnostic tool in predicting surfactant replacement therapy in resource-limited settings. • The diagnostic performance of lung ultrasound was better in neonates on non-invasive ventilation, compared to invasive ventilation.

Plumbagin accelerates serum albumin's amyloid aggregation kinetics and generates fibril polymorphism by inducing non-native ß-sheet structures.

The ligand-induced conformational switch of proteins has great significance in understanding the biophysics and biochemistry of their self-assembly. In this work, we have investigated the ability of plumbagin (PL), a hydroxynaphthoquinone compound found in the root of the medicinal plant Plumbago zeylanica, to modulate aggregation precursor state, aggregation kinetics and generate distinct fibril of human serum albumin (HSA). PL was found to moderately bind (binding constant Ka âˆ¼ 10-4 M-1)) to domain-II of HSA in the stoichiometric ratio of 1:1. We found that PL-HSA complex aggregation was accelerated as compared to that of HSA aggregation and it may be through an independent pathway. We also detected that fibril produced in the presence of PL is wider in diameter, contains a higher amount of ß-sheet (∼18%) and disordered (∼46%) structures, and is less stable. We concluded that the acceleration of aggregation reaction and generation of fibril polymorphism was mainly because of the higher extent of unfolding and high content of non-native ß-sheet structure in the aggregation precursor state of PL-HSA complex. This study offers opportunities to explore the ability of ligand binding to modulate aggregation reactions and generate polymorphic protein fibrils.

Transitional Hemodynamics in Neonates Born Through Meconium-Stained Amniotic Fluid: A Prospective Observational Study.

Neonates born through meconium-stained amniotic fluid (MSAF) are at increased risk of altered cardiopulmonary transition at birth. There is a paucity of literature evaluating the transitional hemodynamics in these neonates. We aimed to evaluate transitional hemodynamics via echocardiography in neonates born through MSAF, compared to healthy neonates. The primary objective was to assess pulmonary vascular resistance using left pulmonary artery-velocity time integral (LPA-VTI). The secondary objectives were to assess other pulmonary vascular parameters and myocardial function. We enrolled 35 MSAF-born and 35 healthy neonates. Echocardiography was performed at 24 and 48 h of life by a pediatric cardiologist. Echocardiographic parameters were compared between MSAF-born and healthy neonates, and between MSAF-born neonates who developed meconium aspiration syndrome (MAS) and who did not (non-MAS). Among 35 MSAF-born neonates, 14 (40%) were non-vigorous, 18 (51%) required admission to neonatal intensive care unit, 8 (23%) developed MAS, 3 (9%) pulmonary hypertension and 1 (3%) air leak. On echocardiography, LPA-VTI (cm; mean ± SD) was significantly decreased at 24 and 48 h in MSAF-born neonates (14.38 ± 2.48; 15.55 ± 2.48), compared to healthy neonates (16.60 ± 2.14; 17.66 ± 2.71), respectively. Further, LPA-VTI was significantly reduced at 24 and 48 h among MAS (11.81 ± 3.0; 12.43 ± 2.5), compared to non-MAS neonates (15.15 ± 1.72; 16.48 ± 1.55), respectively. Other pulmonary vascular and myocardial function parameters were comparable between the two groups. Pulmonary adaptation was significantly delayed in neonates with MSAF, which was more pronounced in MAS neonates. Further studies should explore the utility of these parameters for early prediction of cardiorespiratory morbidities in this population.

Genistein effect in cultured ovine ovarian granulosa cells.

Genistein, an isoflavone has the potential to mimic, augment, or dysregulate the steroid hormone production pathways. We hypothesized that genistein affects the granulosa cell (GCs) functions through a series of biochemical, molecular, and genomic cascades. The present study was conducted to evaluate the impact of genistein exposure on GCs viability, apoptosis, and steroidogenesis. The present study involved 3/5 days of exposure to genistein on GCs collected from abattoir-derived ovine ovaries at doses of 0, 1, 10, 25, 50, and 100 µM. The harvested GCs were used for growth, cytotoxicity, and gene expression studies related to apoptosis, growth, and steroidogenesis. We observed that genistein had both stimulatory at 10 and 25 µM levels as well as inhibitory effects at 50 and 100 µM levels on the growth and proliferation of GCs. Genistein significantly decreased the levels of 17ß-estradiol at higher exposure (50 and 100 µM), whereas the progesterone level increased significantly as the genistein exposure increased. Additionally, genistein could also alter the mRNA expression of the steroidogenic receptor, enzymes, proteins, and growth-related genes suggesting that genistein could potentially alter the steroidogenic pathways. We conclude that genistein can interfere with cell survival and steroidogenesis by exhibiting a dose-dependent biphasic response on the viability, growth-related parameters, and the synthesis of 17ß-estradiol in the cultured GCs.

Efficacy and safety of short- vs. standard-course antibiotics for culture-negative neonatal sepsis: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis of evidence from randomized controlled trials (RCTs) comparing a short course of antibiotics (2-4 days), to a standard course (5-7 days), for the treatment of culture-negative neonatal sepsis. METHODS: Relevant databases were searched for RCTs comparing short- vs. standard-course of antibiotics for culture-negative sepsis. The primary outcomes were mortality and treatment failure, defined as the reappearance of clinical signs suggestive of sepsis within 7 days of stoppage of antibiotics. Secondary outcomes included neurological impairment, duration of hospital stay, need for oxygen, respiratory support and double-volume exchange transfusion (DVET). RESULTS: Seven RCTs were included in the review with 729 neonates >30 weeks gestational age at birth. No mortality occurred in either of the groups (2 studies; 276 neonates). Treatment failure rates were similar in the short- and standard-course antibiotic groups [7 studies; 729 neonates; risk ratio (RR) = 1.01; 95% confidence interval (CI), 0.55 to 1.86; very low certainty]. The short course of antibiotics resulted in a shorter hospital stay [3 studies; 293 neonates; mean difference (MD), -2.46 days; 95% CI, -3.16 to -1.75]. There was no difference in the need for oxygen supplementation (2 studies; 258 neonates; RR, 1.40; 95% CI, 0.40 to 4.91), any respiratory support (2 studies; 258 neonates; RR, 1.04; 95% CI, 0.92 to 1.17) or DVET (2 studies; 258 neonates; RR, 1.29; 95% CI, 0.56 to 2.95). CONCLUSION: Very-low certainty evidence suggests that a short antibiotic course, compared to a standard course, does not affect treatment failure rates in culture-negative neonatal sepsis. There is a need for well-designed RCTs powered enough to assess critical outcomes such as mortality and neurological sequelae to generate stronger evidence and inform guidelines. PROSPERO REGISTRATION NUMBER: CRD42023437199.

Prolonged antibiotic usage has been associated with increased mortality and morbidity in neonates. The standard practice in culture-negative neonatal sepsis has been to administer antibiotics for 5­7 days, based on expert consensus. In this systematic review, a short course of antibiotics (2­4 days), in comparison to a standard course (5­7 days), did not affect the treatment failure rates in culture-negative neonatal sepsis. However, the certainty of evidence was too low to make robust conclusions. There is a need for well-designed large trials to generate stronger evidence and inform guidelines.

From Gut to Hormones: Unraveling the Role of Gut Microbiota in (Phyto)Estrogen Modulation in Health and Disease.

The human gut microbiota regulates estrogen metabolism through the "estrobolome," the collection of bacterial genes that encode enzymes like ß-glucuronidases and ß-glucosidases. These enzymes deconjugate and reactivate estrogen, influencing circulating levels. The estrobolome mediates the enterohepatic circulation and bioavailability of estrogen. Alterations in gut microbiota composition and estrobolome function have been associated with estrogen-related diseases like breast cancer, enometrial cancer, and polycystic ovarian syndrome (PCOS). This is likely due to dysregulated estrogen signaling partly contributed by the microbial impacts on estrogen metabolism. Dietary phytoestrogens also undergo bacterial metabolism into active metabolites like equol, which binds estrogen receptors and exhibits higher estrogenic potency than its precursor daidzein. However, the ability to produce equol varies across populations, depending on the presence of specific gut microbes. Characterizing the estrobolome and equol-producing genes across populations can provide microbiome-based biomarkers. Further research is needed to investigate specific components of the estrobolome, phytoestrogen-microbiota interactions, and mechanisms linking dysbiosis to estrogen-related pathology. However, current evidence suggests that the gut microbiota is an integral regulator of estrogen status with clinical relevance to women's health and hormonal disorders.