Clinical Profile of COVID-19 Illness in Children-Experience from a Tertiary Care Hospital.

OBJECTIVE: To detail clinical profile and outcome in children infected with SARS-CoV-2. METHODS: This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (< 18 y) with COVID-19 illness from April 2020-October 2020 were reviewed and analyzed. RESULTS: A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the flu emergency (n = 1744), severe acute respiratory infection (SARI) ward (n = 825), and non-COVID area (n = 350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. CONCLUSIONS: Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children > 10 y of age with malnutrition and comorbid illness.

Immunohistochemical Characterization of Normal Ovary and Common Epithelial Ovarian Neoplasm with a Monoclonal Antibody to Cytokeratin and Vimentin.

BACKGROUND & OBJECTIVE: The common epithelial ovarian tumors are classified into serous, mucinous, clear cell, endometrioid, the Brenner, mixed, and undifferentiated types. Cytoskeleton intermediate filament composition of ovarian tissues indicates that the cytokeratin and vimentin are observed in ovarian surface epithelium along with the common ovarian epithelial tumors. The current study aimed at investigating the cytokeratin and vimentin expression in epithelial ovarian tumors to establish a diagnostic relevance. METHODS: Sixty-six common epithelial ovarian tumors were studied using anti-cytokeratins (Monoclonal Mouse Anti-Human Cytokeratin Clones AE1/AE3; DAKO, Denmark,) and anti-vimentin (Monoclonal Mouse Anti-Vimentin, Clone V9; DAKO, Denmark,) to ascertain the intermediate filament profiles in formalin-fixed and paraffin-embedded surgical pathology materials. RESULTS: All ovarian epithelial tumors expressed cytokeratin in a uniform fashion. Vimentin was coexpressed with high intensity in 62.5% of serous carcinomas, mild intensity in 25% of mucinous adenocarcinoma, and moderate intensity in single case of endometrioid adenocarcinoma. Vimentin decoration in mucinous carcinoma had a focal involvement, whereas malignant endometrioid and serous decoration tended to involve larger areas. There was a significantly increased expression of vimentin in serous cystadenoma and serous carcinoma, compared with their mucinous counterparts. Also, vimentin expression and histologic grade of serous tumors showed a positive correlation. No association was found between vimentin expression and degree of differentiation in mucinous, endometrioid, and Brenner tumors. CONCLUSION: The current investigation emphasized the efficiency of immunohistochemistry (IHC) typing as a tool for a more precise characterization of the origin and differentiation of human neoplasms.

Early Total Enteral Feeding in Stable Very Low Birth Weight Infants: A Before and After Study.

Background: Fear of necrotizing enterocolitis (NEC) has perpetuated delayed initiation and slow advancement of enteral feeding in very low birth weight (VLBW) infants with inherent risks of parenteral alimentation. The objective of this study was to assess effect of early total enteral feeding (ETEF) on day of achievement of full enteral feeds, feed intolerance, NEC and sepsis. Methods: In total, 208 stable VLBW neonates (28-34 weeks) admitted during 6 month periods of three consecutive years were enrolled. First phase (n = 73) constituted the 'before' phase with standard practice of initial intravenous fluid therapy and slow enteral feeding. The second prospective phase (n = 51) consisted of implementation of ETEF with infants receiving full enteral feeds as per day's fluid requirement since Day 1 of life. The third phase (n = 84) was chosen to assess the sustainability of change in practice. Results: Day of achievement of full feeds was significantly earlier in Phases 2 and 3 compared with Phase 1 (8.97 and 5.47 vs. 14.44 days, respectively, p = 0.0001). Incidence of feed intolerance was comparable between Phases 1 and 2 (22 vs. 14%, p = 0.28), with marked reduction in incidence of NEC (14 vs. 4%, p = 0.028). There was a significant decrease in sepsis, duration of parenteral fluid and antibiotic therapy as well as hospital stay with comparable mortality. Conclusion: In stable preterm VLBW infants, ETEF is safe and has the benefit of optimizing nutrition with decrease in sepsis, NEC and hospital stay.

Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial.

UNLABELLED: The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to 'Antibiotic' group and 129 to 'No Antibiotic' group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between 'No Antibiotic' and 'Antibiotic' groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32-1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23-2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. CONCLUSION: Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003).

Clinical & biochemical profile of trichinellosis outbreak in north India.

BACKGROUND & OBJECTIVES: Trichinellosis is a parasitic infection caused by Trichinella nematodes, acquired from consumption of raw meat. However, data from Indian subcontinent are limited. The aim of this study was to investigate the clinical and biochemical profile of a suspected trichinellosis outbreak in a village in Tehri Garhwal district of Uttarakhand state in north India. METHODS: Three index cases presenting as acute febrile myalgia syndrome with eosinophilia, after consumption of uncooked pork in a common feast, were confirmed as trichinellosis on muscle biopsy. A detailed epidemiological survey was carried out in the affected community and all the people who participated in the feast were investigated for clinical and biochemical profile. RESULTS: A total of 54 patients were evaluated in the study. The type of pork consumed included uncooked in 24 per cent (n=13), open fire roasted in 39 per cent (n=21) and fried in 37 per cent (n=20). Clinical symptoms were found in those who consumed pork in uncooked or open fire roasted form (n=34). These included fever with chills and myalgia (100%), periorbital oedema (67%), dyspnoea (9%), and dysphagia (3%). Laboratory parameters studied in both symptomatic and asymptomatic patients showed eosinophilia in 90 per cent (n=41), raised ESR in 98 per cent (n=45), and an elevated creatinine phosphokinase (CPK) level in 85 per cent (n=39). All symptomatic patients were treated with a short course of oral steroids and albendazole therapy. CONCLUSIONS: Trichinella infection is not uncommon in India, and should be suspected in case of acute febrile myalgia especially in areas, where habits of consumption of raw meat is more prevalent.

Gastric lavage for prevention of feeding problems in neonates with meconium-stained amniotic fluid: a randomised controlled trial.

BACKGROUND: The role of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid is uncertain, and no there are no definitive guidelines. OBJECTIVE: To evaluate the effect of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid. METHODS: This was an open-label, parallel, randomized controlled trial conducted in the labour room, postnatal and neonatal wards of a tertiary-care teaching hospital. Vigorous neonates of ≧34 weeks gestation with meconium-stained amniotic fluid were randomised into two groups using block randomisation. Infants requiring oxygen, in respiratory distress or with major congenital malformations were excluded. Infants in the study group received elective gastric lavage in the labour room after initial stabilisation. No gastric lavage was done in the control group. The newborns were assessed for retching, vomiting and secondary meconium aspiration syndrome in the first 48 hrs of life or until discharge from the hospital, whichever was later. RESULTS: A total of 267 newborns were randomly assigned to the gastric lavage group and 269 to the no gastric lavage group. There were no statistical differences in overall feeding between the two groups (6·74% vs 10·78%). Feeding of two newborns in the no-lavage group had to be omitted for the initial few hours because of vomiting; this did not happen in any newborn in the lavage group. No newborn in either group developed secondary meconium aspiration syndrome. CONCLUSION: Gastric lavage in newborns with meconium-stained amniotic fluid does not prevent or reduce the occurrence of feeding problems or secondary meconium aspiration syndrome.

Use of physical and intellectual activities and socialization in the management of cognitive decline of aging and in dementia: a review.

Lifestyle nonpharmacological interventions can have a deep effect on cognitive aging. We have reviewed the available literature on the effectiveness of physical activity, intellectual stimulation, and socialization on the incidence of dementia and on the course of dementia itself. Even though physical activity appears to be beneficial in both delaying dementia onset and in the course of the disease, more research is needed before intellectual stimulation and socialization can be considered as treatments and prevention of the disease. Through our paper, we found that all three nonpharmacological treatments provide benefits to cognition and overall well-being in patients with age-related cognitive impairments. These interventions may be beneficial in the management of dementia.

Effect of placement agitation and drying time on dentin shear bond strength: an in vivo study.

The current study measured the bond strength of a self-etch system to dentin with and without agitation and with varying drying times of primer in vital dentin. The null hypotheses tested were that primer agitation and primer drying time did not affect the dentin shear bond strength. Sixty human maxillary and mandibular premolars scheduled to be extracted for orthodontic reasons were selected. The adhesive/resin combination used was Clearfil SE (Kuraray, Osaka, Japan)/TPH Spectrum (Dentsply DeTrey, Konstanz, Germany). The occlusal surfaces of the teeth were flattened using straight fissure diamond abrasive points ISO-012. Samples were divided into six groups of 10 teeth each. Primer was applied following the manufacturer's instructions with and without agitation followed by air-drying time of 0 (without air drying), five and 10 seconds. Clearfil SE Bond was applied and cured for 10 seconds. TPH Spectrum composite, shade A2 (Dentsply DeTrey), was placed over cured adhesive and was cured for 40 seconds. The teeth were restored to their original anatomy. The teeth were extracted after one week and the samples were kept in distilled water until testing at room temperature. The samples were tested in shear at a 1 mm/minute crosshead speed using an LR100 Universal Testing Machine. The data was analyzed using ANOVA and Tukey post-hoc tests (p < 0.05). Varying the drying time of the primer from zero (0) to 10 seconds did not significantly affect the bond strength values in vivo. At five seconds drying time, agitation significantly improved the shear bond strength to dentin. Agitation showed no effect when primer was not dried or it was dried for 10 seconds.