Correlation of SARS-CoV-2 Serology and Clinical Phenotype Amongst Hospitalised Children in a Tertiary Children's Hospital in India.

INTRODUCTION: Children usually present with minimal or no symptoms of COVID-19 infection. Antibody responses to SARS-CoV-2 in children from low- and middle-income countries (LMIC) have not been well described. We describe the prevalence of anti-SARS-CoV-2 antibodies and clinical phenotype of seropositive children admitted to a tertiary children's hospital in South India. METHODS: To determine the seropositivity and describe the clinical characteristics of COVID-19 infection amongst hospitalised children, we performed a prospective clinical data collection and blood sampling of children admitted to Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India over 4 months of the COVID-19 pandemic. In seropositive children, we compared antibody titres between children with and without PIMS-TS. RESULTS: Of 463 children, 91 (19.6%) were seropositive. The median (range) age of seropositive children was 5 years (1 month-17 years). Clinical presentation was consistent with Paediatric inflammatory multisystem syndrome associated or related with SARS-CoV-2 infection (PIMS-TS) in 48% (44/91) of seropositive children. The median (range) antibody titre was 54.8 (11.1-170.9) AU/ml among all seropositive children. The median antibody titre among the children with PIMS-TS (60.3 AU/mL) was significantly (p = 0.01) higher when compared to the children without PIMS-TS (54.8 AU/mL). CONCLUSION: We describe the antibody responses to SARS-CoV-2 amongst hospitalised children in a LMIC tertiary children's hospital. Almost half of the seropositive children had PIMS-TS. Antibody levels may be helpful in the diagnosis and disease stratification of PIMS-TS. LAY SUMMARY: Children usually present with minimal or no symptoms of COVID-19 infection. However, Multisystem Inflammatory Syndrome in Children (MIS-C) or Paediatric inflammatory multisystem syndrome associated or related with SARS-CoV-2 infection (PIMS-TS) has emerged as a distinctive paediatric illness related to SARS-CoV-2. Recently, antibody testing for SARS-CoV-2 is being used increasingly as a diagnostic test for PIMS-TS. However, data on the antibody responses to SARS-CoV-2 in children are sparse. We, therefore, attempted to identify the seropositivity and describe the clinical spectrum of COVID-19 infection amongst infants and children getting hospitalised in a children's hospital in south India. Nearly one-fifth of the hospitalised children tested serology positive over 4 months. Antibody levels in children with PIMS-TS were significantly higher in comparison to the other two groups (acute COVID-19 infection and children without PIMS-TS). Results from our study suggest that all children are at risk of COVID-19 infection though they may present with mild illness or no symptoms. We also observed that antibody testing may have a possible role in diagnosis of PIMS-TS.

In vitro antibacterial activity of plumbagin isolated from Plumbago zeylanica L. against methicillin-resistant Staphylococcus aureus.

Plumbagin (5-hydroxy-2-methyl-1,4-napthoquinone) is a bicyclic naphthoquinone, found in three major plant families viz. Plumbaginaceae, Ebenceae and Droseraceae. The phytochemical is reported to exhibit various pharmacological properties. In this study, plumbagin isolated from Plumbago zeylanica L. was investigated for its in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA). Against 100 MRSA isolates that included multi-drug-resistant phenotypes, plumbagin showed consistent activity with a narrow minimum inhibitory concentration (MIC) range of 4-8 µg ml-1 . The time-kill study revealed 99% kill of a reference MRSA strain, 8 h after exposure to plumbagin. In the combination MIC study using the reference MRSA strain, plumbagin showed synergistic effect with ciprofloxacin and piperacillin while additive or indifference effect with other commonly used antibiotics. The transmission electron micrograph of the reference MRSA strain treated with plumbagin confirmed cell wall and cytoplasmic changes. Our results demonstrated potent anti-MRSA activity of plumbagin which was not impacted by multi-drug resistance. This is a first ever study that evaluated in vitro anti-MRSA activity of plumbagin employing large number of MRSA isolates. The findings of this study support the need for the further investigation on this phytochemical agent for therapeutic application. SIGNIFICANCE AND IMPACT OF THE STUDY: This study revealed phytochemical plumbagin's potent and consistent in vitro antibacterial activity against clinically problematic methicillin-resistant Staphylococcus aureus (MRSA) including multi-drug-resistant (MDR) phenotypes. The study results support further research to assess the clinical scope of plumbagin.

Rapid antigen diagnostic testing for the diagnosis of group A beta-haemolytic streptococci pharyngitis.

Background: It is difficult to make a diagnosis of group A beta-haemolytic streptococci (GABHS) pharyngitis solely on clinical findings. The McIssac scoring system has been recommended as a reliable clinical tool for diagnosis. The rapid antigen detection test (RADT) has been shown to considerably increase the number of patients who are appropriately treated for streptococcal pharyngitis, compared with the use of traditional throat cultures. It also reduces the time to start treatment. We evaluated the diagnostic utility of RADT in comparison with throat swab culture. Methods: Using the McIssac scoring system, RADT and throat swab cultures in those with a McIssac score of 3 or more, we evaluated 165 children (aged 2-15 years) with a clinical diagnosis of pharyngitis. Results: GABHS pharyngitis was confirmed in 41 (24.8%) by throat swab culture and RADT was positive in 39(23.6%). Only in 2 (4.9%) children, RADT was negative but throat swab was positive. The sensitivity of RADT was 89.7% and specificity was 98.4% with a positive predictive value of 94.6%, negative predictive value of 96.9% and diagnostic accuracy of 96.4%. Conclusion: RADT performed was observed to have high sensitivity and sensitivity for the diagnosis of GABHS pharyngitis in contrast to an earlier report from India. Our observations suggest that using RADT as a point-of-care test is reliable and cost-effective and needs to be propagated in Indian settings where facilities for throat swab culture are not routinely available and also because clinical diagnosis based on scoring systems are comparatively less reliable.

Community-based early detection of oral precancerous lesion, accessibility and utilization of oral healthcare services among Irular tribes residing at union territory of Pondicherry.

Background: The present study was conducted to estimate the prevalence of oral carcinoma and precancerous lesion, oral healthcare seeking behaviour and identify accessible areas of tobacco cessation centres and oral healthcare facilities among Irular adult tribes residing in Pondicherry. Objectives: 1. To estimate the prevalence of oral carcinomas and precancerous lesion by using toluidine blue solution. 2. To determine their oral healthcare seeking behaviour in terms of utilizing oral healthcare facilities. 3. To identify accessible tobacco cessation centres and oral healthcare centres for prevention of oral cancer. Materials and Methods: A cross-sectional study is designed to identify oral carcinomas, oral health-care seeking behaviour among Irular tribes of Pondicherry. 1% toluidine blue solution prepared for detection of oral precancerous lesion. Data was collected using a questionnaire and clinical examination. The collected data was subjected to statistical analysis. Results: Out of 587 study population, oral mucosal lesion among the study population was 46 (7.8%) leukoplakia and 18 (3.1%) candidiasis. Positive health seeking behaviour 24 (41.7%) was observed. Conclusion: The study concluded that low prevalence of oral precancerous lesion and oral healthcare seeking behaviour is poor.

The role of beat-by-beat cardiac features in machine learning classification of ischemic heart disease (IHD) in magnetocardiogram (MCG).

Cardiac electrical changes associated with ischemic heart disease (IHD) are subtle and could be detected even in rest condition in magnetocardiography (MCG) which measures weak cardiac magnetic fields. Cardiac features that are derived from MCG recorded from multiple locations on the chest of subjects and some conventional time domain indices are widely used in Machine learning (ML) classifiers to objectively distinguish IHD and control subjects. Most of the earlier studies have employed features that are derived from signal-averaged cardiac beats and have ignored inter-beat information. The present study demonstrates the utility of beat-by-beat features to be useful in classifying IHD subjects (n = 23) and healthy controls (n = 75) in 37-channel MCG data taken under rest condition of subjects. The study reveals the importance of three features (out of eight measured features) namely, the field map angle (FMA) computed from magnetic field map, beat-by-beat variations of alpha angle in the ST-T region and T wave magnitude variations in yielding a better classification accuracy (92.7 %) against that achieved by conventional features (81 %). Further, beat-by-beat features are also found to augment the accuracy in classifying myocardial infarction (MI) Versus control subjects in two public ECG databases (92 % from 88 % and 94 % from 77 %). These demonstrations summarily suggest the importance of beat-by-beat features in clinical diagnosis of ischemia.

Rapunzel Syndrome: A Rare Case of Phyto-Trichobezoar in an Indian Girl.

Phyto-trichobezoar is a rare disorder characterized by the formation of mass in the gastrointestinal tract (GIT) by the ingested inedible material, mostly hair and thread. The ingestion of hair is a rare psychiatric disorder called trichotillomania, which is more common in girls. An 11-year-old girl presented with clinical features of GIT obstruction, which were diagnosed to be Rapunzel syndrome by computed tomography. The phyto-trichobezoar was removed en masse by the anterior gastrotomy, which extended beyond the duodenum. The girl, after recovery, was counseled and treated for subclinical depression.

A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization.

Chemoembolization and other ablative therapies are routinely utilized in downstaging from United Network for Organ Sharing (UNOS) T3 to T2, thus potentially making patients transplant candidates under the UNOS model for end-stage liver disease (MELD) upgrade for hepatocellular carcinoma (HCC). This study was undertaken to compare the downstaging efficacy of transarterial chemoembolization (TACE) versus transarterial radioembolization. Eighty-six patients were treated with either TACE (n = 43) or transarterial radioembolization with Yttrium-90 microspheres (TARE-Y90; n = 43). Median tumor size was similar (TACE: 5.7 cm, TARE-Y90: 5.6 cm). Partial response rates favored TARE-Y90 versus TACE (61% vs. 37%). Downstaging to UNOS T2 was achieved in 31% of TACE and 58% of TARE-Y90 patients. Time to progression according to UNOS criteria was similar for both groups (18.2 months for TACE vs. 33.3 months for TARE-Y90, p = 0.098). Event-free survival was significantly greater for TARE-Y90 than TACE (17.7 vs. 7.1 months, p = 0.0017). Overall survival favored TARE-Y90 compared to TACE (censored 35.7/18.7 months; p = 0.18; uncensored 41.6/19.2 months; p = 0.008). In conclusion, TARE-Y90 appears to outperform TACE for downstaging HCC from UNOS T3 to T2.

Unilateral condylar hyperplasia: A case report and review of literature.

Condylar hyperplasia is (CH) an uncommon malformation of the mandible involving change in size and morphology of the condylar neck and head. CH is an anomaly that usually occurs unilaterally and equally affects in both men and women. Hyperplasia of the condyle 'differentiated into hemimandibular hyperplasia, hemimandibular elongation and CH. Here, we are presenting a case of 17-year-old male patient with unilateral CH and its review of the literature.

Two doses of pamidronate in infants with osteogenesis imperfecta.

INTRODUCTION: Current regimens of intravenous pamidronate for infants and children with osteogenesis imperfecta (OI) typically deliver 3-12 mg/kg/year of drug. We wished to ascertain the effect of pamidronate at 6 or 12 mg/kg/year on skeletal health in infants with OI. METHODS: We recruited 12 infants over a period of 4 years. Infants received either 6 or 12 mg/kg/year of pamidronate. Bone outcomes were assessed by skeletal surveys and DXA bone density measurements at baseline and at 12 months. RESULTS: Bone mass increased in both groups. Infants receiving 12 as opposed to 6 mg/kg/year pamidronate had increased spine bone density after adjusting for covariates at study entry (p = 0.04). Crush fractures improved or remained unchanged in all but one infant. Biochemical markers of bone turnover fell but remained within or above the normal range for age. Metaphyseal remodelling was not impaired. CONCLUSIONS: Pamidronate dose in infants may influence lumbar spine bone acquisition. Pamidronate improved vertebral size after prior crush fracturing and did not over-suppress bone turnover.

Concerns, coping and quality of life in head and neck cancer patients.

This study was conducted to explore the concerns and coping mechanisms used by patients with head and neck cancer and assess their quality of life. A group of 50 consecutive patients with oral and laryngeal cancers were interviewed using a coping and concerns checklist and a semistructured interview proforma to elicit the common concerns in relation to head and neck cancers and their surgical treatment. The Hospital Anxiety and Depression Scale was used to detect anxiety and depression. Concerns were compared between oral and laryngeal cancers and between preoperative and postoperative patients. Commonest concerns were about the future (64%), subjective physical evaluation (60%), finances (56%), being upset (54%), communication (54%), current illness (52%) and inability to do things (50%). The commonest coping mechanisms used were helplessness and fatalism. Resolution was noted in less than 40% of the frequent concerns. As compared to laryngeal cancer patients, those with oral cancer significantly more often had concerns about current illness, subjective evaluation of health, eating and chewing, social interactions, pain and disfigurement (P < 0.05). Most subjects had numerous unresolved concerns. Mainly ineffective coping mechanisms such as helplessness and fatalism were employed leading to incomplete resolution. Interventions to minimise these concerns and to handle associated anxiety and depression would improve their quality of life.

Adenocarcinoma of the colon as a second malignancy in a child.

Solid tumors as second malignancies are not common in children who have been managed for lymphoproliferative disorders. We report a case of adenocarcinoma (AC) of the colon as a second malignancy in a patient who was on maintenance chemotherapy for acute lymphoblastic leukemia (ALL). In children, primary AC of the colon is very rare; colonic AC occurring as a second malignancy in a child is rarer still. A case of AC of the colon following chemotherapy for ALL has not yet been published.