Assessing the Effects of Holling Type-II Treatment Rate on HIV-TB Co-infection.

In this paper, a HIV-TB co-infection model is explored which incorporates a non-linear treatment rate for TB. We begin with presenting a HIV-TB co-infection model and analyze both HIV and TB sub-models separately. The basic reproduction numbers corresponding to HIV-only, TB-only and the HIV-TB full model are computed. The disease-free equilibrium point of the HIV sub-model is shown to be locally as well as globally asymptotically stable when its corresponding reproduction number is less than unity. The HIV-only model exhibits a transcritical bifurcation. On the other hand, for the TB sub-model, the disease-free equilibrium point is locally asymptotically stable but may not be globally asymptotically stable. We have also analyzed the full HIV-TB co-infection model. Numerical simulations are performed to investigate the effect of treatment rate in the presence of resource limitation for TB infected individuals, which emphasize the fact that to reduce co-infection from the population programs to accelerate the treatment of TB should be implemented.

A fractional order HIV-TB co-infection model in the presence of exogenous reinfection and recurrent TB.

In this article, a novel fractional order model has been introduced in Caputo sense for HIV-TB co-infection in the presence of exogenous reinfection and recurrent TB along with the treatment for both HIV and TB. The main aim of considering the fractional order model is to incorporate the memory effect of both diseases. We have analyzed both sub-models separately with fractional order. The basic reproduction number, which measures the contagiousness of the disease, is determined. The HIV sub-model is shown to have a locally asymptotically stable disease-free equilibrium point when the corresponding reproduction number, R H , is less than unity, whereas, for R H > 1 , the endemic equilibrium point comes into existence. For the TB sub-model, the disease-free equilibrium point has been proved to be locally asymptotically stable for R T < 1 . The existence of TB endemic equilibrium points in the presence of reinfection and recurrent TB for R T < 1 justifies the existence of backward bifurcation under certain restrictions on the parameters. Further, we numerically simulate the fractional order model to verify the analytical results and highlight the role of fractional order in co-infection modeling. The fractional order derivative is shown to have a crucial role in determining the transmission dynamics of HIV-TB co-infection. It is concluded that the memory effect plays a significant role in reducing the infection prevalence of HIV-TB co-infection. An increment in the number of recovered individuals can also be observed when the memory effect is taken into consideration by introducing fractional order model.

Open versus Closed Suctioning Among Mechanically Ventilated Pediatric Patients: A Randomised Control Trial.

OBJECTIVES: To compare the difference in efficacy of closed tracheal suction system (CTSS) to open tracheal suction system (OTSS) in reducing incidence of ventilator associated pneumonia (VAP). Also to evaluate their efficacy in stabilizing cardio-respiratory parameters, reducing mortality and duration of intubation. METHODS: This study was a single centre, parallel group, open label, randomized controlled study with an equal allocation (1:1) in pediatric patients requiring mechanical ventilation. A specific suction system of CTSS or OTSS was assigned to the two groups based on randomization. All the demographic, clinical, laboratory parameters and treatment outcomes were noted in the preformed sheet. RESULTS: Total 116 eligible pediatric ventilated patients were studied. Total incidence of VAP was 9 (7.75%) of which 3 occurred in open and 6 in closed suction group. Rate of VAP was similar among both the groups with RR 2.11 (95% CI 0.50-8.9). However, significant number of infection-related ventilator associated condition (IVAC) were found in CTSS (17) compared to OTSS (6) group with RR 3.5 (95% CI 1.3-9.9). SpO2 was better maintained in the CTSS group post-suction (p = 0.001). Incidence of mortality and intubation days were similar between both groups. CONCLUSIONS: Incidence of VAP was similar between open and closed suction groups.

Clinical Evaluation of a Wireless Device for Monitoring Vitals in Newborn Babies.

OBJECTIVES: To evaluate the ability of the Nemocare Raksha (NR), an internet of things (IoT)-enabled device, to continuously monitor vitals for 6 h and its safety in newborns. The accuracy of the device was also compared with the readings from the standard device used in the pediatric ward. METHOD: Forty neonates (either gender) weighing ≥ 1.5 kg were included in the study. Heart rate, respiratory rate, body temperature, and oxygen saturation was measured using the NR and compared with standard care devices. Safety was assessed by monitoring for skin changes and local rise in temperature. The neonatal infant pain scale (NIPS) was used to assess pain and discomfort. RESULT: A total of 227 h of observations (5.67 h per baby) were obtained. No discomfort or device-related adverse events were noted during the study period. The mean difference between the NR and the standard monitoring was 0.66 (0.42 to 0.90) for temperature (°C); -6.57 (-8.66 to -4.47) for heart rate (bpm); 7.60 (6.52 to 8.68) for respiratory rate (breaths per minute); -0.79 (-1.10 to -0.48) for oxygen saturation (%). The level of agreement analyzed using the intraclass correlation coefficient (ICC) was good for heart rate [ICC 0.77 (0.72 to 0.82); p value < 0.001] and oxygen saturation [ICC 0.80 (0.75 to 0.84); p value < 0.001]; moderate for body temperature [ICC 0.54 (0.36 to 0.60); p value < 0.001] and poor for respiratory rate [ICC 0.30 (0.10 to 0.44); p value 0.002]. CONCLUSION: The NR was able to seamlessly monitor vital parameters in neonates without any safety concern. The device showed a good level of agreement for heart rate and oxygen saturation among the four parameters measured.

Optimal control strategies on COVID-19 infection to bolster the efficacy of vaccination in India.

The Novel Coronavirus which emerged in India on January/30/2020 has become a catastrophe to the country on the basis of health and economy. Due to rapid variations in the transmission of COVID-19, an accurate prediction to determine the long term effects is infeasible. This paper has introduced a nonlinear mathematical model to interpret the transmission dynamics of COVID-19 infection along with providing vaccination in the precedence. To minimize the level of infection and treatment burden, the optimal control strategies are carried out by using the Pontryagin's Maximum Principle. The data validation has been done by correlating the estimated number of infectives with the real data of India for the month of March/2021. Corresponding to the model, the basic reproduction number [Formula: see text] is introduced to understand the transmission dynamics of COVID-19. To justify the significance of parameters we determined the sensitivity analysis of [Formula: see text] using the parameters value. In the numerical simulations, we concluded that reducing [Formula: see text] below unity is not sufficient enough to eradicate the COVID-19 disease and thus, it is required to increase the vaccination rate and its efficacy by motivating individuals to take precautionary measures.

Analyzing the Effect of Vaccination Over COVID Cases and Deaths in Asian Countries Using Machine Learning Models.

Coronavirus Disease 2019 (COVID-19) is spreading across the world, and vaccinations are running parallel. Coronavirus has mutated into a triple-mutated virus, rendering it deadlier than before. It spreads quickly from person to person by contact and nasal or pharyngeal droplets. The COVID-19 database 'Our World in Data' was analyzed from February 24, 2020, to September 26, 2021, and predictions on the COVID positives and their mortality rate were made. Factors such as Vaccine data for the First and Second Dose vaccinated individuals and COVID positives that influence the fluctuations in the COVID-19 death ratio were investigated and linear regression analysis was performed. Based on vaccination doses (partial or complete vaccinated), models are created to estimate the number of patients who die from COVID infection. The estimation of variance in the datasets was investigated using Karl Pearson's coefficient. For COVID-19 cases and vaccination doses, a quartic polynomial regression model was also created. This predictor model helps to predict the number of deaths due to COVID-19 and determine the susceptibility to COVID-19 infection based on the number of vaccine doses received. SVM was used to analyze the efficacy of models generated.

Emerging Therapeutic Approaches to COVID-19.

Coronavirus disease (COVID-19) is caused by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), which is a positive single-stranded RNA virus having a large genome ~30 kb. SARSCoV- 2 is zoonotic and highly contagious, causing severe pneumonia-like symptoms. The efficacy of the different potential drug and drug candidates against COVID-19 has been investigated, which are under various stages of clinical trials. The drugs effective against SARS, and Middle east respiratory syndrome (MERS), have been proposed to have a high potential for the treatment of COVID-19. Here, we selected plant-based materials implicated in the prevention and therapy of COVID-19. The plant produces secondary metabolites in response to viral infection. Different classes of secondary metabolites have different mechanisms to counter virus attacks. Many nanomaterials produced by carbohydrates and lipids have been exploited for their in-vitro and in-vivo delivery of antiviral therapeutics. The vaccine has shown impressive results in producing antibodies against SARS-CoV2 and has been evaluated for safety, tolerance, and preliminary immunogenicity. Similarly, DNA/RNA-based therapy has shown high clinical significance. Various forms of vitamins, minerals, herbs, and phytonutrients help to enhance immunity and be implicated in the control of COVID-19. However, such measures should not replace social distancing, quarantine and special care.

Mechanical Thrombectomy Using Retrievable Stents in Pediatric Acute Ischemic Stroke.

OBJECTIVE: To report efficacy and outcome of mechanical thrombectomy for treatment of pediatric acute ischemic stroke with large vessel occlusion using stent retrievers. METHODS: Retrospective record review of institutional database for patients <18 years of age. RESULTS: Five boys aged between 6 to 17 years received reperfusion therapy using mechanical thrombectomy for acute ischemic stroke with large vessel occlusion (2 basilar, 2 middle cerebral and 1 internal carotid artery). Pediatric National Institute of Health Stroke Scale (PedNIHSS) at onset ranged from 12 to 21. Complete recanalization as defined by the modified Treatment In Cerebral Infarction scale (mTICI 3 or 2b) was achieved in all, using stent retreivers. Favorable outcome as per the modified Rankin scale (mRS 0-1) was achieved in all with no peri-procedural complications. CONCLUSION: Mechanical thrombectomy using retrievable stents is a safe and effective therapy for pediatric ischemic stroke due to large vessel occlusion, and may be offered in carefully selected patients.

Respiratory Morbidity Following Pediatric Orthotopic Liver Transplantation.

We evaluated the pulmonary complications following orthotopic liver transplantation in 45 children (age <18 y). 22 patients (49%) developed respiratory complications. Pediatric end-stage liver disease (PELD) score >25 and positive fluid balance were independent risk factors. Patients with respiratory complication had significantly higher mortality and intensive care unit stay.

Incidence of periventricular leucomalacia among a cohort of very low birth weight neonates(< 1500 g).

BACKGROUND: Periventricular leucomalacia (PVL) is the most important neuropathologic lesion underlying major neuro-motor deficits of pre-term very low birth weight (VLBW) infants. Published data regarding PVL is not available from our country. OBJECTIVES: A study was planned with main objectives to estimate incidence and describe natural history of PVL among a very low birth weight cohort. STUDY DESIGN: A cohort study was performed on inborn VLBW babies over one year period at a tertiary neonatal intensive care unit. Serial weekly cranial ultrasounds were performed on 97 enrolled subjects until discharge, to diagnose and describe natural history of PVL. RESULTS: 31 out of 97 enrolled subjects developed PVL. No case of PVL developed beyond 19 days of postnatal life. Serial ultrasounds for each baby were tracked until discharge or death. Majority of lesions at onset were flares. Cysts tended to develop in over one third of cases during course of hospital stay. About 50% of ultrasound had normalized at discharge and sequelae such as cerebral atrophy and ventriculomegaly had appeared in few, the rest of lesions being either flares or cysts of PVL. CONCLUSIONS: PVL is fairly common among very low birth weight neonates. Ultrasonographic lesions of PVL undergo dynamic evolution from time of first detection to either progress, regress or leave sequelae before discharge. Ultrasound remains an important bedside diagnostic tool for PVL.

Dandy-Walker malformation in Rubinstein-Taybi syndrome: a rare association.

A female infant is described with the rare association of Dandy-Walker malformation in Rubinstein-Taybi syndrome.

Losartan induced fetal toxicity.

Losartan is a specific angiotensin II receptor antagonist. Although the teratogenic effects of angiotensin converting enzyme (ACE) inhibitors are well documented there are limited reports of losartan induced fetal toxicity. The authors report a case of incomplete ossification of skull bones, transient oliguria and feed intolerance in a newborn following in-utero exposure to losartan.

Polycythemia in the newborn.

Polycythemia is defined as a venous hematocrit above 65%. The relationship between viscosity and hematocrit is almost linear till 65% and exponential thereafter. Increased viscosity of blood is associated with symptoms of hypo-perfusion. The hematocrit in a newborn peaks at 2 hours of age and decreases gradually after that. The etiology of polycythemia is related either to intra-uterine hypoxia or secondary to fetal transfusion. Clinical features related to hyperviscosity may affect all organ systems and this entity should be screened for in high-risk infants. Polycythemia maybe symptomatic or asymptomatic and guidelines for management of both types are provided in the protocol.

Retinopathy of prematurity.

With improving survival of very low birth infants in India, Retinopathy of Prematurity (ROP is likely to emerge as a significant problem. The most important risk factor in the pathogenesis of ROP is prematurity. Other factors like frequent blood transfusions; sepsis, apnea and problems with oxygenation have also been implicated in the causation of ROP. Essentially asymptomatic in the initial stages, a good screening program is essential for the early detection and treatment of this condition. Description of the various stages and threshold ROP has been included in the protocol. Guidelines regarding the procedure of dilatation, ophthalmic examination and treatment (if required) has been provided in the protocols. Close cooperation between the ophthalmologist and neonatologist is essential for a successful program.

Congenital airway abnormalities in neonates.

Airway malformations such as laryngeal atresia, tracheal agenesis and subglottic stenosis are rare and present at birth with significant respiratory distress with or without stridor. There may be an initial improvement on bag and mask ventilation. Repeated attempts at intubation are met with failure. The related embryology and clinical aspect of airway malformations have been discussed. The prognosis in tracheal agenesis is universally fatal but cases with laryngeal atresia and subglottic stenosis may be saved with prompt tracheostomy and later surgical reconstruction.

Preserved umbilical cord facilitates antenatal diagnosis of spinal muscular atrophy.

Spinal Muscular atrophy (SMA) Type I is a fatal autosomal recessive disease caused by homozygous deletion of telometric region of exon 7/8 of the SMN gene. Prenatal diagnosis is feasible and desirable by most families. We report on prenatal diagnosis of SMAI in a family where dried umbilical cord stump from the deceased affected baby was used to confirm the diagnosis. Prenatal diagnosis was provided in the subsequent pregnancy. We emphasize the need for storing DNA from individuals affected with suspected single gene disorders.

Survival and morbidity in extremely low birth weight (ELBW) infants.

We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertiary care hospital over seven years (1994-2000). Data regarding maternal and neonatal details was obtained from old records, computer database and medical files. Of the 12,807 live births during this period, 137 (1.07%) were ELBW infants. All of them were managed without surfactant. Overall, 67 infants (48.7%) survived to discharge. The most commonly encountered morbidities were hyperbilirubinemia(65%), respiratory distress(65%), sepsis(52%), intraventricular hemorrhage(29%), pneumonia (25%) and retinopathy of prematurity(24%). Need for resuscitation, pulmonary hemorrhage, seizures, acute renal failure, sclerema and air leak syndromes were significantly associated with mortality. Sepsis accounted for 41% of all deaths while immaturity was the second most important cause, accounting for 24% deaths. The average length of stay for survivors was 49 days (SD +/- 15.9 days)

Early neonatal hyperbilirubinemia using first day serum bilirubin level.

OBJECTIVE: To evaluate the predictive value of total serum bilirubin (TSB) < or =6 mg/dl at 24 +/- 6 hr postnatal age in identifying near term and term infants, who do not develop hyperbilirubinemia subsequently. DESIGN: Prospective study. SETTING: Tertiary care hospital. METHODS: All healthy neonates with gestation > or =35 weeks, in absence of significant illness or Rh hemolysis were included. TSB was estimated at 24 +/- 6 hr by micromethod using spectrophotometry. Infants were followed up clinically every 12 hr till discharge and then after 48 hr. TSB level was estimated again whenever clinical suspicion of jaundice exceeded 10 mg/dl. Primary outcome was defined as presence of hyperbilirubinemia (TSB > or= 17 mg/dl) till day five of age. RESULTS: Of the 220 infants, 213 (96.8%) were followed up. All infants were exclusively breastfed. Mean age at bilirubin estimation was 24.7 +/- 1.9 hr with mean TSB of 5.9 +/- 1.8 mg/dl. Clinically detectable jaundice was present in 164 (77%) and hyperbilirubinemia occurred in 22 (10.3%) infants. A TSB level of < or = 6 mg/dl at 24 +/- 6 hr was present in 136 (63.8%) infants and only one infant developed hyperbilirubinemia subsequently (probability < 1%). In the remaining 77 (36.1%) infants, with TSB >6 mg/dl, subsequent hyperbilirubinemia developed in 21 (27.2%) (sensitivity 95%, specificity 70.6%, positive predictive value 27.2%, negative predictive value 99.3%, likelihood ratio of positive test 3.23 and likelihood ratio of negative test 0.07). Babies with TSB levels higher than 6 mg/dl had a significant risk of developing hyperbilirubinemia (relative risk 38; 95% confidence interval 6-1675). CONCLUSION: A TSB level of < or = 6 mg/dl at 24 +/- 6 hr of life predicted neonates who would not develop hyperbilirubinemia.

Scintigraphic scoring system for grading severity of gastro-esophageal reflux on 99mTc sulfur colloid gastro-esophageal reflux scintigraphy: A prospective study of 39 cases with pre and post treatment assessment.

AIM: The study aimed at developing a scoring system for scintigraphic grading of gastro-esophageal reflux (GER), on gastro-esophageal reflux scintigraphy (GERS) and comparison of clinical and scintigraphic scores, pre- and post-treatment. MATERIALS AND METHODS: A total of 39 cases with clinically symptomatic GER underwent 99mTc sulfur colloid GERS; scores were assigned based on the clinical and scintigraphic parameters. Post domperidone GERS was performed after completion of treatment. Follow up GERS was performed and clinical and scintigraphic parameters were compared with baseline parameters. RESULTS: Paired t-test on pre and post domperidone treatment clinical scores showed that the decline in post-treatment scores was highly significant, with P value < 0.001. The scintigraphic scoring system had a sensitivity of 93.9% in assessing treatment response to domperidone, specificity of 83.3% i.e., 83.3% of children with no decline in scintigraphic scores show no clinical response to Domperidone. The scintigraphic scoring system had a positive predictive value of 96.9% and a negative predictive value of 71.4%. CONCLUSION: GERS with its quantitative parameters is a good investigation for assessing the severity of reflux and also for following children post-treatment.

Pediatric liver transplantation: A report from a pediatric surgical unit.

BACKGROUND: Liver transplantation is well established worldwide as an effective treatment for end-stage liver disease in children. Acceptance in India has been slow because of considerations of cost, infections, inability to support long-term care, and non-availability of expertise. AIM: This study was designed to report our experience with pediatric liver transplantation. MATERIALS AND METHODS: Twenty-eight children underwent liver transplantation. RESULTS: Biliary atresia was the commonest indication (n = 15) followed by metabolic liver disease. Twenty-six children had living donor transplants, mothers being the donors in a majority of these. Common surgical complications included bile leaks (n = 3) and vascular problems (n = 6). Common medical complications included infections, acute rejection, and renal failure. Overall, patient survival was 71%, while that for the last 14 cases was 92%. All survivors are doing well, have caught up with physical and developmental milestones and are engaged in age appropriate activities. CONCLUSIONS: The study demonstrates the feasibility of a successful pediatric liver transplant program in our country.