A study on bacteriological profile in suspected cases of neonatal sepsis and its correlation with various biomarkers in the rural population of a university hospital.

Introduction: Neonatal sepsis is an infection in newborns that may be caused by bacteria, fungi, or viruses and has a high death and morbidity rate. The clinical presentation of sepsis may be rather general, making it challenging to make a diagnosis. While blood culture is the most accurate method to diagnose sepsis, it is also time-consuming. Because of this, it is crucial to locate other biomarkers like C-reactive protein (CRP), high sensitive C-reactive protein (hs-CRP), and procalcitonin (PCT) that may aid in early identification. Aim: To learn about the bacterial composition of suspected cases of neonatal sepsis in a tertiary care hospital in western Uttar Pradesh and how that composition relates to the biomarkers CRP, hs-CRP, and PCT. Materials and Methods: Hundred people who fulfilled the study's inclusion criteria were included. All neonatal venous blood samples have been obtained after receiving written informed permission from either parent. The conventional method was used to perform the blood culture. The ELISA technique has been used to determine hs-CRP along with serum PCT levels, while the latex agglutination test was utilized for CRP detection. Result: A total of 100 cases were enrolled, 78% presented within 3 days of birth. Blood culture was positive in 33 neonates (33%). There were 17 Gram-positive, 15 Gram-negative, and in all 2 cases with poly bacterial culture. CRP positivity rate was significantly higher in culture positive (57.6%) as compared to culture-negative neonates (25.4%). It was shown that a CRP >6 mg/l level was sensitive at 57.6% and specific at 74.6%. hs-CRP has a 100% sensitivity and 47.8% specificity. The PCT's sensitivity was 69.7%, whereas its specificity was 89.6%. Conclusion: PCT is more specific for detecting sepsis, but hs-CRP is more sensitive than CRP. The combination of PCT along with hs-CRP has a negative predictive value and high sensitivity compared to other markers. Thus, the most accurate predictors of neonatal sepsis would be a combination of factors.

An epidemiological study and trend analysis of laboratory confirmed COVID-19 cases among children in North India.

Background: The role of children in transmitting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is difficult to ascertain and the consequences remain unclear. This is necessary for public health or infection control purposes. The objective of this study was to describe the epidemiological, month-wise trends and clinical characteristics of coronavirus disease 2019 (COVID-19) infection among children in a tertiary care hospital. Materials and Methods: A cross-sectional study was performed on all pediatric samples of suspected cases of SARS-CoV-2 infection. The samples were received from the adjoining districts and our Institution in the Department of Microbiology from June to November 2020. Cases were then confirmed by real-time reverse transcriptase-polymerase chain reaction. Results: Of the total 62,030 pediatric samples tested, 847 (1.3%) were SARS-CoV-2 positive. The majority of positive cases were between the ages of 11-15 years. The median age of confirmed patients was 14 years. The male to female ratio was 1.5:1. Infants represented 1.6% of the positive cases. About 62.1% of all positive cases were asymptomatic. Childhood cases increased from June 2020 and peaked in September 2020 before declining. Conclusion: Children of all ages appeared susceptible to COVID-19 and accounted for a very small proportion of confirmed cases. Mostly, children were found to be asymptomatic. Young children can be important transmitters of SARS-CoV-2 infection in the general population. This population can be important for targeting immunization efforts throughout a rapidly evolving situation. Our findings provide further evidence of the distribution of infection in children and the transmission of SARS-CoV-2.

Pregnane-Oximino-Alkyl-Amino-Ether Compound as a Novel Class of TGR5 Receptor Agonist Exhibiting Antidiabetic and Anti-Dyslipidemic Activities.

INTRODUCTION: The present study deals with the synthesis of pregnane-oximino-amino-alkyl-ethers and their evaluation for antidiabetic and anti-dyslipidemic activities in validated animal and cell culture models. METHODS: The effect on glucose tolerance was measured in sucrose-loaded rats; antidiabetic activity was evaluated in streptozotocin (STZ)-induced diabetic rats and genetically diabetic db/db mice; the anti-dyslipidemic effect was characterized in high-fructose, high-fat diet (HFD)-fed dyslipidemic hamsters. The effect on glucose production and glucose utilization was analyzed in HepG2 liver and L6 skeletal muscle cells, respectively. RESULTS: From the synthesized molecules, pregnane-oximino-amino-alkyl-ether (compound 14b) improved glucose clearance in sucrose-loaded rats and exerted antihyperglycemic activity on STZ-induced diabetic rats. Further evaluation in genetically diabetic db/db mice showed temporal decrease in blood glucose, and improvement in glucose tolerance and lipid parameters, associated with mild improvement in the serum insulin level. Moreover, compound 14b treatment displayed an anti-dyslipidemic effect characterized by significant improvement in altered lipid parameters of the high-fructose, HFD-fed dyslipidemic hamster model. In vitro analysis in the cellular system suggested that compound 14b decreased glucose production in liver cells and stimulated glucose utilization in skeletal muscle cells. These beneficial effects of compound 14b were associated with the activation of the G-protein-coupled bile acid receptor TGR5. CONCLUSION: Compound 14b exhibits antidiabetic and anti-dyslipidemic activities through activating the TGR5 receptor system and can be developed as a lead for the management of type II diabetes and related metabolic complications.

Burden of increased blood glucose due to modifiable risk factors among men in India.

BACKGROUND AND AIMS: Worldwide, many diabetes cases are occurring mainly due to lifestyle risk factors. Hence, to quantify and compare the attributable burden of key modifiable risk factors associated with increased Blood Glucose (BG) among Indian states and districts. METHODS: The study used the National Family Health Survey (2015-16) data to estimate Population Attributable Risk (PAR) for increased BG (>140 mg/dl) among men aged 15-54 years in 640 districts of 36 States/Union Territories (UTs), India. We have considered three key modifiable factors such as high Body Mass Index (BMI), use of tobacco and alcohol. Population Attributable Risk techniques were employed to address the attributable burden of increased blood glucose due to modifiable risk factors. RESULTS: Substantial variations were found in the burden of increased BG due to high BMI, alcohol and tobacco use in India. The overall burden of increased BG due to high BMI, tobacco and alcohol in India was 28.5%, 2.1% and 6.4%, respectively. Regional variations in BG were found in high BMI, tobacco and alcohol consumption groups. The high burden of increased BG related to the above key modifiable risk factors mostly seen in North-Eastern' districts due to alcohol, Southern and Northern' districts was due to high BMI. However, the higher burden due to tobacco was reported in Central, Eastern and North-Eastern' districts. CONCLUSION: Three modifiable risk factors are contributing significantly to increased BG among men. Since there are regional differences in their contributions, state/district, specific targeted interventions may be necessary to control increased BG among men in India.

Higher frequencies of functional HIV-envelope-specific memory B cells are associated with nonprogressive HIV infection in Indian population.

OBJECTIVE: The HIV-1-specific antibodies are being considered for prevention and therapy in HIV infection. For effective antibody response, presence of functionally competent memory B cells (MEBs) is important; however, HIV-infection is known to alter the B-cell functionality. Very limited data are available on the HIV-specific memory B-cell population in HIV-infected Indian population. METHODS: In this study, the frequencies of HIV-gp140-specific MEBs were measured in individuals with nonprogressive [long-term-nonprogressors (LTNPs), N = 20] and progressive (N = 19) HIV infection using multicolor flow cytometry. The activation and functional status of these MEBs were assessed as frequencies and mean fluorescence intensity (MFI) of the CD38 and CD40 expression, respectively. RESULTS: The percentages of gp140 + MEBs were higher in LTNPs than seen in progressors (P = 0.0475) and associated with higher CD4 cell count (P = 0.0312, r = 0.2833). As compared with the progressors, LTNPs also showed higher functional (CD40+) gp140 + MEBs both frequencies (P < 0.0001) and CD40 MFI (P = 0.0222), whereas the frequencies (<0.0001) and the MFI (P = 0.0047) of CD38 expression was significantly lower. Higher CD4 cell counts and lower plasma viral load values were associated with higher frequencies of CD40+ gp140 + MEBs (P < 0.0001, r = 0.4962) (P = 0.0036, r = -0.4202) and lower frequencies (P = 0.0008, r = -0.4231) and CD38 expression (MFI) (P = 0.004, r = -0.3719) (P = 0.0066, r = 0.4033). CONCLUSION: Our study suggests that LTNPs have functional HIV-specific memory B-cell compartment with reduced activation that may lead to effective HIV-specific humoral immune responses contributing to their nondisease progression status. These findings would help in better understanding of the characteristics of the HIV-specific memory B-cell population in nonprogressive HIV infection.

Gender differences in the risk factors for high and very high blood glucose levels: A study of Kerala.

BACKGROUND AND AIMS: Worldwide, lifestyle is a significant risk factor for diabetes. Lifestyle changes can lead to differences in the extent of risk of diabetes among women and men. Kerala, a state with one of the best health indicators in India, has a high prevalence of diabetes. This study aimed at comparing the variations in the risk factors for HBG and VHBG among adult women and men in Kerala. METHODS: Data from the fourth round of the National Family Health Survey (2015-16) used to examine the differences in the risk factors for HBG and VHBG in men and women aged 15-49 years. We used bivariate, multivariate and Population Attributable Risk (PAR) techniques for analysing the data. RESULTS: Bivariate results have shown the pattern of HBG and VHBG prevalence in women and men was same among all the age groups; however, men show a higher HBG and VHBG than women in all the age groups. Prevalence of HBG and VHBG was higher in women with a primary education, who were poor and not working as compared to their male counterparts. PARs results show that the prevalence of VHBG was higher among obese men and women as compared to normal men and underweight women. Prevalence of HBG was higher among men as compared to women due to alcohol use and weekly consumption of non-vegetarian food. CONCLUSIONS: The study suggests that there is an urgent need for targeted intervention programs to address the problem of HBG and VHBG in both men and women in Kerala to control blood glucose levels.

Increased hypertension following hysterectomy among reproductive women in India.

BACKGROUND: In recent years, hysterectomy has received increased attention in health policy debates in India. On the other hand, based non-communicable disease specific data for India, in 2011, WHO portray a grim picture and recommended to the government a 20% reduction in hypertension by 2020; however, the trends show that it is increasing. Yet, to date, there has not been a single nationally representative study of hypertension prevalence among women who undergo a hysterectomy. METHODS: The study has used the Indian fourth round of National Family Health Survey data, which is a cross-sectional nationally representative sample of 699,686 women in the age group 15-49 years and conducted during 2015-16. Bivariate and multivariate logistic regressions were used to examine the effect of hysterectomy on increased odds of hypertension among women of reproductive age groups. RESULTS: The age adjusted prevalence of hypertension was higher among women those who undergone hysterectomy (11.9%) compared to non-hysterectomy women (10.6%). The pattern holds true among relevant background characteristics such as age, place of residence, education, caste, religion, wealth, family size, years since hysterectomy, body mass index (BMI), anaemia and consumption of tobacco. The adjusted odds of hypertension among women who underwent hysterectomy compared to those who did not was 1.72 (95% CI: 1.14-2.58). CONCLUSIONS: The results indicated increased hypertension level among hysterectomy women. However, these results are based on a cross-sectional study, and hence, further through investigation based on a prospective study is necessary before undertaking any policy changes. Meanwhile, the government of India may like to suggest surveillance to the general practitioners as well as obstetricians and gynaecologists following a hysterectomy in order to better understand the effect of hysterectomy on hypertension.

Clinical correlation of severe acute respiratory syndrome-coronavirus-2 cases in selected districts of Uttar Pradesh: A cross-sectional hospital-based study.

BACKGROUND: The novel coronavirus (CoV) has resulted in a global pandemic despite drastic measures to avoid contagious spread. On April 3, 2020, there were around 1 million reported cases and 51,515 deaths due to CoV disease 2019. The disease presents with flu-like symptoms such as fever, dry cough, and fatigue. India being a resource-limited country, it is very important to differentiate the suspected cases clinically. AIM: The aim was to know the correlation of various clinical features of severe acute respiratory syndrome CoV 2 (SARS-CoV-2)-infected cases in selected districts of UP. SETTING AND DESIGN: This was a retrospective cross-sectional hospital-based study. MATERIALS AND METHODS: This was a retrospective cross-sectional study performed on 1243 suspected cases of SARS-CoV-2 infection from March 25, 2020 to April 17, 2020 in the department of microbiology of our institute to know the incidence of SARS-CoV-2 infection in selected districts of Uttar Pradesh. These cases were analyzed to see the association of various clinical symptoms with SARS-CoV-2 infection. For statistical analysis, Pearson's Chi-square test was performed using SPSS version 23. RESULTS: Out of total suspected cases, 4.5% were positive. Travel history was present in 80.4% of positive cases. About 83.9% had fever, 28.6% had shortness of breath, 35.7% had dry cough, 17.9% had either Type I or II diabetes mellitus, 12.5% had chronic kidney disease, and 7.1% had obstructive pulmonary diseases. CONCLUSION: Negative clinical history is very important in ruling out the suspected cases who came out to be free from the infection.

In search of an ideal test for diagnosis and prognosis of kala-azar.

The latex agglutination test (KAtex), direct agglutination test (DAT), and the rK39 immuno-chromatographic strip test (dipstick test) were evaluated for their role in the diagnosis and prognosis of visceral leishmaniasis (kala-azar) in India. Sera and urine samples from 455 subjects--150 confirmed visceral leishmaniasis cases, 160 endemic controls, 100 non-endemic controls, and 45 other febrile diseases--were included in the study. The sensitivity of the KAtex, DAT, and rK39 strip test was 87% [95% confidence interval (CI) 80-96], 93.3% (95% CI 88-100), and 98% (95% CI 93-100) respectively. The specificity of these tests was 98% (95% CI 93-100), 93% (95% CI 87-100), and 89% (95% CI 82-97) for the KAtex, DAT, and rK39 strip test respectively. Fifty cases were followed up and subjected to the KAtex, DAT, and rK39 strip test after 30 days of successful treatment. The DAT and rK39 strip test showed positive results in all the 50 cases whereas the KAtex showed no positive reaction in any case. Based on the results, it is concluded that the sensitivity and specificity of the DAT and rK39 strip test are comparable but the greater convenience of use of the strip test makes it a better tool for the diagnosis of visceral leishmaniasis in the peripheral areas of endemic regions whereas the sensitivity of the KAtex needs to be improved to promote its use as a first-line diagnostic test in the field-setting. It may be used for the prognosis of the disease as antigen becomes undetectable in urine after 30 days of the completion of the treatment. Alternatively, it can be used as an adjunct with rK39 for sero-epidemiological surveys.

Distal femoral rotational axes in Indian knees.

PURPOSE: To measure the angular relationships of distal femoral rotational axes in 100 normal Indian knees. METHODS: 42 men and 8 women aged 26 to 40 (mean, 31) years, with 100 normal non-arthritic knees were recruited. Anatomic landmarks were measured using computed tomography. They included the posterior condylar axis, the transepicondylar axis, the anteroposterior axis (Whiteside's line), the posterior condylar angle (PCA), the Whiteside-epicondylar angle (W-EP), and the Whiteside-posterior condylar angle (W-PC). RESULTS: The mean PCA, W-EP, and W-PC were 5, 90.8, and 95.8 degrees, respectively. The mean femorotibial alignment was 179.6 degrees. The differences between the left and right sides were significant only for the WEP and W-PC. Only the PCA and W-EP were weakly correlated (r=0.338, p=0.001). CONCLUSION: There are differences in distal femoral rotational axes among Indian, Caucasian, and Japanese knees. Our data can be used to evaluate changes in those axes in ageing or arthritic patients.

The rK39 strip test is non-predictor of clinical status for kala-azar.

BACKGROUND: The rK39 strip test is reported to be simple, sensitive, specific, non-invasive and economical test. Since this method is supposed to be patient friendly, it may easily be accepted for sero-epidemiological surveys. An attempt was made to evaluate the role of rK39 strip test in pre and post treatment phases of Kala azar, as a diagnostic and prognostic marker, in addition to other laboratory investigations, in order to evaluate its role in sero-epidemiological surveys. FINDINGS: A total of 210 cases were selected for the study. One hundred clinically and parasitologically confirmed cases were corroborated with other hematological profiles. The formol-gel test was included along with well matched control group comprising of normal endemic controls (50), non-endemic normals (20) and other febrile cases (40). All groups were tested by rK39 strip test. Fifty Kala azar cases were followed up after completion of successful treatment. They were subjected to rK39 strip test after 0, 90 and 180 days of completion of successful treatment.The rK39 showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 98% (95% CI 91.7-100), 100%, 100%, 90% (95% CI 66-100) and 98% (95% CI 92.6-100) respectively. All the 50 cured followed up cases showed positive result by rK39 strip test even after 180 days of completion of successful treatment. CONCLUSION: The test seems an ideal qualitative test for the diagnosis of kala-azar. But for sero-epidemiological studies the test may be used with other parameters. Alternatively a quantitative ELISA using rK39 antigen may be used.

Applicability of MELD as a short-term prognostic indicator in patients with chronic liver disease: an Indian experience.

BACKGROUND: The model for end-stage liver disease (MELD), which employs objective variables, statistical weighting and a continuous scale, has replaced the Child-Turcotte-Pugh (CTP) classification as the scoring system of choice in several liver transplant centers. However, the predictive ability of MELD has never been prospectively evaluated in India. The aim of this study was to examine the MELD score, the CTP score and the recently proposed modified CTP score in Indian patients with liver cirrhosis to determine their correlation and compare their prognostic significance for short-term survival. METHODS: A total of 76 patients with cirrhosis (mean age 46.97 years) were prospectively evaluated and followed up for 6 months. MELD score, CTP score and modified CTP score were calculated at baseline. The correlation between variables was evaluated by Pearson's correlation test. Receiver-operating characteristic (ROC) curves were used to determine the cutoff values for each score with the best sensitivity and specificity in discriminating between patients who survived and those who died. RESULTS: Alcoholic liver disease was the most common (50%) etiology of cirrhosis. MELD score and CTP score showed very good correlation (Pearson correlation r = 0.983). ROC curve showed area under curve (c-statistics) for MELD score, CTP score and modified CTP score as 0.764, 0.804 and 0.817, respectively. CONCLUSION: The MELD score was not found to be superior to CTP score and modified CTP score for short-term prognostication of patients with cirrhosis in this study.