Multisystem inflammatory syndrome with persistent neutropenia in neonate exposed to SARS-CoV-2 virus: A case report and review of literature.

BACKGROUND: Multisystem inflammatory syndrome in Children (MIS-C) is a postinfectious immune mediated hyperinflammatory state seen in children and adolescent below 21 year of age and develop after 4-6 weeks of severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) infection, however, it is rare in neonates. We report an extremely rare and first of its kind case of MIS-C in a neonate with persistent neutropenia. CASE DESCRIPTION: A 19-day old boy presented with complaints of fever and loose stools for 1 day and developed rash after admission. Baby was investigated for sepsis and commenced on IV antibiotics empirically. In view of persistent fever, diarrhoea, rash and absence of obvious microbial etiology of inflammation, with elevated inflammatory marker and an epidemiologic link to SARS-CoV-2 infection, the diagnosis of MIS-C-was made. Intravenous immunoglobulin (IVIg) was administered and defervescence occurred within 24 hours. He also developed neutropenia during course of illness which persisted on follow up. CONCLUSION: MIS-C in neonates is uncommon and fever with elevated inflammatory markers during COVID-19 pandemic should alert the pediatrician to the possibility of MIS-C. Neutropenia may be associated with MIS-C in neonates and warrants prolonged follow up.

Increased tracheostomy rates in head and neck cancer surgery during the COVID-19 pandemic.

Surgical practice during the coronavirus disease 2019 (COVID-19) pandemic has changed significantly, without supporting data. With increasing experience, a dichotomy of practice is emerging, challenging existing consensus guidelines. One such practice is elective tracheostomy. Here, we share our initial experience of head and neck cancer surgery in a COVID-19 tertiary care centre, emphasizing the evolved protocol of perioperative care when compared to pre-COVID-19 times. This was a prospective study of 21 patients with head and neck cancers undergoing surgery during the COVID-19 pandemic, compared to 193 historical controls. Changes in anaesthesia, surgery, and operating room practices were evaluated. A strict protocol was followed. One patient tested positive for COVID-19 preoperatively. There was a significant increase in pre-induction tracheostomies (28.6% vs 6.7%, P=0.005), median hospital stay (10 vs 7 days, P=0.001), and postponements of surgery (57.1% vs 27.5%, P=0.01), along with a significant decrease in flap reconstructions (33.3% vs 59.6%, P=0.03). There was no mortality and no difference in postoperative morbidity. No healthcare personnel became symptomatic for COVID-19 during this period. Tracheostomy is safe during the COVID-19 pandemic and rates have increased. Despite increased rescheduling of surgeries and longer hospital stays, definitive cancer care surgery has not been deferred and maximum patient and healthcare worker safety has been ensured.

Nanobiocomposite from Collagen Waste Using Iron Oxide Nanoparticles and Its Conversion Into Magnetic Nanocarbon.

Collagenous wastes discarded from leather industry were stabilized using superparamagnetic iron oxide nanoparticles and further converted into a magnetic nanocarbon. Stabilization of collagen using iron oxide nanoparticles treatment (25% offer) was confirmed through differential scanning calorimetric analysis and further evidenced through scanning electron microscopic analysis. A simple high temperature treatment of the collagen-iron oxide nanoparticle composite at 850 degrees C for 2 h under Ar atmosphere yielded a bi-functional, magnetic and conducting, nanocarbon. The X-ray diffraction and Raman spectroscopic analysis reveal the partial graphitation and X-ray photoelectron spectroscopic results show the presence of trace-iron containing carbon, naturally doped with nitrogen and oxygen. Transmission electron microscopic analysis show the presence of larger iron oxide nanocrystals embedded in graphitic carbon layers while superconducting quantum interference device based analysis reveals a perfect ferrimagnetic property with saturation magnetization. Thus, we have stabilized the collagen waste fibers using iron oxide nanoparticles and converted them into a bi-functional nanocarbon, which has potential for various applications including energy, leather making and environmental remediation.

Effect of concentrates restriction on feed consumption, diet digestibility, and nitrogen utilization in captive Asian elephants (Elephas maximus).

In order to study the effect of concentrates restriction on feed consumption, diet digestibility, and utilization of nitrogen in captive Asian elephants (Elephas maximus), two feeding trials were conducted on three juveniles, four sub-adults, and three adults. During trial I, the conventional zoo diets of juveniles, sub-adults, and adult contained 22, 17, and 16% of concentrates on dry matter (DM) basis, respectively. During trial II, the amount of concentrate was reduced by 50%. A digestion trial of five days collection period was conducted during each period. The animals ate more roughages when concentrates were restricted. Intake of DM (g/kg BW(0.75) /day) was highest in sub-adults, followed by juveniles and adults. Apparent digestibility of crude protein (CP), neutral detergent soluble (NDS), and supply of digestible energy (DE) was highest in juveniles, followed by sub-adults and adults. Based upon the estimated metabolic fecal nitrogen (MFN) and calculated endogenous urinary nitrogen (EUN) and dermal losses, minimum dietary CP required to meet maintenance requirement was estimated to be 6.12, 6.05, and 5.97% in juveniles, sub-adults, and adults, respectively. Restriction of concentrates resulted in decreased (P < 0.05) digestibility of DM and GE, but the diet still supplied adequate amounts of DE and CP to fulfill estimated requirements of energy and protein during the period of experimentation. Thus, the concentrates portion of the diets of captive Asian elephants should be fed in a restricted way so as to reduce the intake of excessive calories and the potential risk of obesity.

Ubiquitin-like (UBX)-domain-containing protein, UBXN2A, promotes cell death by interfering with the p53-Mortalin interactions in colon cancer cells.

Mortalin (mot-2) induces inactivation of the tumor suppressor p53's transcriptional and apoptotic functions by cytoplasmic sequestration of p53 in select cancers. The mot-2-dependent cytoprotective function enables cancer cells to support malignant transformation. Abrogating the p53-mot-2 interaction can control or slow down the growth of cancer cells. In this study, we report the discovery of a ubiquitin-like (UBX)-domain-containing protein, UBXN2A, which binds to mot-2 and consequently inhibits the binding between mot-2 and p53. Genetic analysis showed that UBXN2A binds to mot-2's substrate binding domain, and it partly overlaps p53's binding site indicating UBXN2A and p53 likely bind to mot-2 competitively. By binding to mot-2, UBXN2A releases p53 from cytosolic sequestration, rescuing the tumor suppressor functions of p53. Biochemical analysis and functional assays showed that the overexpression of UBXN2A and the functional consequences of unsequestered p53 trigger p53-dependent apoptosis. Cells expressing shRNA against UBXN2A showed the opposite effect of that seen with UBXN2A overexpression. The expression of UBXN2A and its apoptotic effects were not observed in normal colonic epithelial cells and p53-/- colon cancer cells. Finally, significant reduction in tumor volume in a xenograft mouse model in response to UBXN2A expression was verified in vivo. Our results introduce UBXN2A as a home defense response protein, which can reconstitute inactive p53-dependent apoptotic pathways. Inhibition of mot-2-p53 interaction by UBXN2A is an attractive therapeutic strategy in mot-2-elevated tumors.

Genetic divergence in natural populations of bronze featherback, Notopterus notopterus (Osteoglossiformes: Notopteridae) from five Indian rivers, analyzed through mtDNA ATPase6/8 regions.

The present study characterized 842 bp fragment of mitochondrial ATP synthase 6 and 8 (ATPase6/8) genes in Notopterus notopterus. In all, 97 samples of N. notopterus were collected from five distant rivers; viz Satluj, Gomti, Yamuna, Brahmaputra and Mahanadi representing 4 river basins in India. The analysis of variation revealed presence of 23 haplotypes in ATPase6/8 gene with haplotype diversity (Hd) of 0.899 and nucleotide diversity (π) of 0.00336. The within population variation which was 41.78% of the total variation of 58.22% was found among population. The Fst value of 0.582 (P < 0.05) of the total population was found significant. The results concluded that the polymorphism in ATPase6/8 gene is a potential marker that is important for determining genetic divergence of wild N. notopterus populations. The findings reveal common ancestry of mahanadi population with the populations in rivers of Indo-Gangetic region. However, long evolutionary isolation must be responsible for the high genetic divergence between N. notopterus in Mahanadi and other regions.

Role of cerebrospinal fluid adenosine deaminase level estimation in diagnosis of tuberculous meningitis.

Five lakh patients of tuberculosis die every year in India. Meningeal tuberculosis is an endemic disease with 7-12% incidence. Delay in diagnosis and in initiating treatment results in poor prognosis and sequelae in upto 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective and non-invasive test for diagnosing this disease. Forty patients between 6-24 months of age having symptoms and signs of meningitis were selected and divided into two groups tuberculous and non-tuberculous, depending upon the accepted criteria. Cerebrospinal fluid (CSF) was drawn and adenosine deaminase (ADA) estimated. Out of 19 tuberculous patients, 18 patients had CSF ADA at or above the cut-off value while 1 had below the cut-off value. Out of 21 non-tuberculous patients, 2 patients had at or above the cut-off value while 19 were below this value. Results of this study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of tuberculous meningitis, CSF ADA level of 10 U/L as a cut-off value exhibited 94.73% sensitivity and 90.47% specificity in differentiating tuberculous from non-tuberculous meningitis; it also has 90.00% positive predictive value and 95.00% negative predictive value. ADA estimation in CSF is simple, inexpensive, rapid and fairly specific method for making a diagnosis of tuberculous aetiology in TBM; especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous and for this reason ADA estimation in TBM may find a place as a routine investigation.

Molecular evolution of the Asian francolins (Francolinus, Galliformes): a modern reappraisal of a classic study in speciation.

We investigated the evolution of the Asian francolins, five little known species in the genus Francolinus (Phasianidae). Evolutionary affinities of two of these species, F. gularis (swamp francolin) and F. pondicerianus (grey francolin), has long remained unclear. In contrast, the other three species, F. pintadeanus (Chinese francolin), F. pictus (painted francolin) and F. francolinus (black francolin) have been cast among the "spotted francolins" on a morphological and ecological basis. Previous molecular DNA investigations including Asian francolins mostly relied upon partial gene sequencing of one specimen per species (no more than three species and with the exclusion of F. pictus). Therefore, fundamental questions do persist. What relationship exists among the spotted and the other Asian francolins? What is the geographic origin of the black francolin, the species with the largest distribution range? How did the geological history influence the diversification of francolins across Asia? We sequenced the entire Control Region of the mitochondrial DNA in 228 samples of all five Asian francolin species, which were collected in 16 countries (from East Europe to East Asia). We constructed a molecular phylogeny according to four different procedures. We showed the monophyly of each of the Asian francolins and the spotted group, while that of the entire Asian group was presumed according to a biogeographical model we proposed. The splitting of the genus Francolinus occurred ~17.4 Ma (95% HPD: 13.4-22.1) while the spotted francolins diverged ~10.5 Ma (7.0-14.9). We resolved the most recent common ancestor to painted and black francolin as being in the Indian sub-continent, thus suggesting a westwards adaptive radiation of the latter. In Pakistan, we identified F. f. asiae representatives in the Northern Areas and in the Sindh. The latter represents a relict population of Indian fauna within the Pakistani range of the Great Rann of Kachchh.

A case series of splenic infarction during acute malaria in northwest Rajasthan, India.

Malaria is a rare cause of splenic infarction. Only a few cases have been reported worldwide, mostly associated with Plasmodium falciparum infection. Here we report a series of four acute malaria patients with splenic infarction, two with P. vivax infection, one with P. falciparum and one with a mixed infection (P. vivax and P. falciparum). This small case series suggests that if a patient with malaria is complaining of left upper quadrant abdominal pain, pleuritic left lower chest pain and/or enlarging tender splenomegaly during treatment, splenic infarct should be suspected and managed accordingly to avoid further life-threatening complications.

Evaluation of antibiotic sensitivity pattern in cases of enteric fever in north west Rajasthan.

A total of 50 cases of blood culture proved enteric fever were studied for clinical response to the treatment and compared with in vivo antibiotic sensitivity pattern. Out of 50 Salmonella strains isolated, 37 were S typhi and 13 S paratyphi A. All S typhi isolates were sensitive in vitro to gentamicin and ceftriaxone while sensitivity to ciprofloxacin was 73%, ampicillin 29.7%, chloromphenicol 27%, tetracycline 27% and co-trimoxazole 13.5%. Multidrug resistance (Ampicillin, Chloramphenicol, Cotrimoxazale and Tetracycline) was observed in 62% isolates. All Sparatyphi A isolates were sensitive to all the antibiotics. Clinical response to the antibiotic therapy was as follows: Group I--Ampicillin + Gentamicin: 15 cases, clinical response (CR), 9.1% (S typhi) and 75% (S paratyphi A), mean day of defervescence 5.33 days. Group II--Ciprofloxacin: 29 cases, clinical response 47.6% (S typhi) and 75% (S paratyphi A), mean day of defervescence--5.22 days. Group--III Ceftriaxone: 30 cases, clinical response 100% in all, mean day of defervescence--4.93 days. Thus we observed highly significant discrepancy in antibiotic sensitivity pattern of the isolates and clinical response. Most importantly we observed significantly delayed clinical response to the ceftriaxone. This may be indicative of evolving resistance to ceftriaxone.

Atherosclerotic risk factors in adolescents.

METHODS: We studied 200 school going children age ranging 12-18 yr with regard to their nutritional intake, family history, anthropometric measurements, blood pressure and lipid profile. RESULTS: It was observed that adolescents received less energy from carbohydrates and more from fats in comparison to the recommended standard. Sodium intake was found to be very high whereas fibre intake was low. The prevalence of hypertension was 1.5% and hypercholesterolemia 50%. The high prevalence of hypercholesterolemia was related mainly to dietary habits of these children. Thus our study shows that for the prevention of adult atherosclerotic cardiovascular disease in Indian population measures are urgently needed towards behavioral and life style modification including change in dietary habits.

A validated UV spectrophotometric method for estimation of nebivolol hydrochloride in bulk and pharmaceutical formulation.

A simple, sensitive and accurate UV spectrophotometric method was developed for the assay of nebivolol hydrochloride in raw material and tablets. Validation of the method yielded good results concerning range, linearity, precision and accuracy. The absorbance was measured at 282 nm for nebivolol hydrochloride tablet solution. The linearity range was found to be 5-50 microg/mL for the drug. It was found that the excipients present in the commercial formulation did not interfere with the method.

Hospital-based case series of 175 cases of serologically confirmed brucellosis in Bikaner.

OBJECTIVE: To study the clinical spectrum of brucellosis in Bikaner (Northwest India). METHODS: A total of 175 cases were diagnosed as brucellosis during the period of six year (June 1997 to May 2003). They were studied for clinical profile and treated by rifampicin and doxycyclin and additionally streptomycin for initial 14 days in patients of neurobrucellosis. These patients were followed up to 3 months. RESULTS: Patients of brucellosis presented with a wide spectrum of clinical manifestations. Out of 175 cases 155 were from rural area. Age ranged between 12-60 years (124 males, 51 females). Analysis of risk factors revealed history of raw milk ingestion (86.86%), occupational contact with animals (81.14%), handling of infected material (62.28%), household contact (16%) and 2 patients were veterinarian. Joint pain (83.43%) and fever (77.71%) were the commonest presenting feature. Sacroiliac joint was most commonly involved (46.86%). 31 cases had involvement of multiple joints. Other mode of presentation were neurobrucellosis (18.86%), manifested as polyradiculoneuropathy, myeloradiculopathy, meningoencephalopathy and polyradiculomyeloencephalopathy; predominant pulmonary involvement (4.0%) presented as bronchitis, pneumonia and pleural effusion; epididymoorchitis, infective endocarditis, nephrotic syndrome and recurrent abortion. All patients responded well to the treatment. CONCLUSION: Brucellosis is an important emerging zoonotic disease but it is often under-diagnosed due to lack of suspicion and diagnostic facilities despite the fact that cattle farming (an important high risk group) is one of the main occupation in rural area. This report should infuse the awareness about this reemerging disease specifically in high-risk group.

Cardiovascular risk factors in tobacco-chewers: a controlled study.

BACKGROUND: Influence of habitual tobacco chewing on cardiovascular risk has not been well studied. To determine prevalence of major cardiovascular risk factors in subjects who habitually chew tobacco we performed a controlled study. METHODS: A population based case-control study was performed in Bikaner in North-western India where the prevalence of tobacco-chewing is high. Successive 200 subjects who agreed to participate in the evaluation and had a history of isolated tobacco-chewing (range 10-60 years) were enrolled (Group III). The prevalence of major coronary risk factors- obesity, truncal obesity, hypertension, fasting hyperglycemia, and lipid levels were estimated using current guidelines. Electrocardiogram was also performed in all subjects. Chest radiography and treadmill stress test was done in subjects when indicated by symptoms. 200 age- and gender-matched controls who did not use tobacco in any form (Group I) and 200 subjects who had history of smoking bidis or cigarettes for more than 10 years (range 10-55 years) (Group II) were also evaluated. RESULTS: The body-mass index and obesity were lowest in smoker group. Tobacco chewers had a significantly higher (p<0.001) systolic blood pressure (BP), diastolic BP, resting heart rate, total cholesterol, LDL cholesterol and triglycerides as compared to controls and was similar to smoker group. There was a significantly greater (p<0.01) prevalence of hypertension, hypercholesterolemia, hypertriglyceridemia, radiographic cardiomegaly and positive stress test in Group III as compared to controls. Prevalence of these risk factors was similar among Group II and Group III subjects. HDL cholesterol levels were the lowest in tobacco-chewing group (44.3+/-8.1 mg/dl) as compared to the Group I (48.4+/-7.8) and Group II (47.4+/-7.5) (p<0.001). CONCLUSIONS: There is a significantly greater prevalence of multiple cardiovascular risk factors obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking, as compared-to tobacco non-users. Chewing tobacco is associated with similar cardiovascular risk as smoking.

Prevalence of rheumatic heart disease in school children in Bikaner: an echocardiographic study.

OBJECTIVE: To determine prevalence of rheumatic heart disease (RHD) using clinical and echocardiographic criteria and to study influence of socioeconomic status (SES) we studied school children in a north-western Indian town. METHODS: 3292 school children, age range 5-14 years, in two private schools, ten middle SES government schools and six low SES government schools were invited to participate in the study. 3002 (1837 boys, 1165 girls) were clinically examined (response 91%) of which 1042 were in private schools, 1002 in middle SES schools and 958 in low SES schools. Prevalence of cardiac murmurs and RHD based on clinical diagnosis was determined in school by a trained team of physicians. Those with a murmur were further evaluated by Doppler-echocardiography in the hospital. Group-specific and age-specific rates (prevalence/thousand) of murmurs and cardiac lesions were determined. RESULTS: A significant cardiac murmur was observed in 55 subjects (18.3/1000) with similar prevalence in boys (20.7) and girls (14.6). The prevalence of murmur was significantly greater in children belonging to low SES schools (29.2/1000) as compared to middle SES (18.9) and higher SES schools (7.6). RHD prevalence based on clinical diagnosis was observed in 50 children (16.7/1000) and was similar in boys (19.1) and girls (12.9). Clinical RHD was more in the low SES school children (28.2/1000) as compared to middle (17.0) and high SES schools (5.8). RHD was demonstrated on echocardiography in 2 children (0.67/1000). Other prevalent cardiac lesions were congenital heart disease in 5 (1.66/1000) and mitral valve prolapse in 37 (12.3/1000). CONCLUSIONS: There is a low prevalence of RHD in school children in this region compared to previous Indian studies. Cardiac murmurs are more prevalent among low SES children.

Ankylosing spondylitis in association with mitral stenosis, mitral regurgitation, and aortic regurgitation: a case report and review of the literature.

We report on a patient with ankylosing spondylitis in association with mitral stenosis, mitral regurgitation, and aortic regurgitation. Despite extensive search of literature, we could not find association of mitral stenosis with ankylosing spondylitis. This report is the first to describe this association. Our findings are based on clinical and echocardiographic findings.

Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study.

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.