Genomic analysis and phylogenetic characterization of Himalayan snow trout, Schizothorax esocinus based on mitochondrial protein-coding genes.

BACKGROUND: Mitochondrial DNA (mtDNA) has become a significant tool for exploring genetic diversity and delineating evolutionary links across diverse taxa. Within the group of cold-water fish species that are native to the Indian Himalayan region, Schizothorax esocinus holds particular importance due to its ecological significance and is potentially vulnerable to environmental changes. This research aims to clarify the phylogenetic relationships within the Schizothorax genus by utilizing mitochondrial protein-coding genes. METHODS: Standard protocols were followed for the isolation of DNA from S. esocinus. For the amplification of mtDNA, overlapping primers were used, and then subsequent sequencing was performed. The genetic features were investigated by the application of bioinformatic approaches. These approaches covered the evaluation of nucleotide composition, codon usage, selective pressure using nonsynonymous substitution /synonymous substitution (Ka/Ks) ratios, and phylogenetic analysis. RESULTS: The study specifically examined the 13 protein-coding genes of Schizothorax species which belongs to the Schizothoracinae subfamily. Nucleotide composition analysis showed a bias towards A + T content, consistent with other cyprinid fish species, suggesting evolutionary conservation. Relative Synonymous Codon Usage highlighted leucine as the most frequent (5.18%) and cysteine as the least frequent (0.78%) codon. The positive AT-skew and the predominantly negative GC-skew indicated the abundance of A and C. Comparative analysis revealed significant conservation of amino acids in multiple genes. The majority of amino acids were hydrophobic rather than polar. The purifying selection was revealed by the genetic distance and Ka/Ks ratios. Phylogenetic study revealed a significant genetic divergence between S. esocinus and other Schizothorax species with interspecific K2P distances ranging from 0.00 to 8.87%, with an average of 5.76%. CONCLUSION: The present study provides significant contributions to the understanding of mitochondrial genome diversity and genetic evolution mechanisms in Schizothoracinae, hence offering vital insights for the development of conservation initiatives aimed at protecting freshwater fish species.

Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry.

BACKGROUND: Octogenarians and beyond have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS) in a multi-ethnic, middle-income country in South East Asia. METHOD: This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Consecutive patient data of those ≥80 years old admitted with ACS at 24 participating hospitals from 2008 to 2017 (n = 3162) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies over the 10-years were examined and compared across groups of interests using the Chi-square test. Multivariate logistic regression was used to calculate the adjusted odds ratio of receiving individual therapies according to patients' characteristics. RESULTS: Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (mean age = 84, SD ± 3.6) from 2008 until 2017. The largest ethnic group was Chinese (44%). Most octogenarians (95%) have multiple cardiovascular risk factors, with hypertension (82%) being the main. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p < 0.001). Within the 10-year, there were positive increments in cardiovascular intervention and pharmacotherapies. Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p < 0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less being prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blockers (43.0%). Men were more likely to receive PCI than women (adjusted Odds Ratio (aOR): 0.698; 95% CI: 0.490-0.993). NSTEMI (aOR = 0.402, 95% CI: 0.278-0.583) and unstable angina (UA) (aOR = 0.229, 95% CI: 0.143-0.366) were less likely to receive PCI but more likely given anticoagulants (NSTEMI, aOR = 1.543, 95% CI: 1.111-2.142; UA, aOR = 1.610, 95% CI: 1.120-2.314) than STEMI. The presence of cardiovascular risk factors and comorbidities influences management. CONCLUSION: Octogenarians with ACS in this country were mainly treated with cardiovascular pharmacotherapies. As the number of octogenarians with ACS will continue to increase, the country needs to embrace the increasing use of PCI in this group of patients.

Achievement of maturational milestones among very low birth weight infants.

BACKGROUND: Very low birth weight (VLBW) infants must achieve several maturational milestones to be discharged home from the NICU. OBJECTIVE: Describe the timing of maturational milestones in VLBW infants and the impact of clinical variables and milestone achievement on postmenstrual age (PMA) at discharge. METHODS: For VLBW infants without severe lung disease discharged home from a level IV NICU, we assessed PMA at the achievement of thermoregulation, cardiorespiratory stability, feeding, and discharge. RESULTS: In 400 infants (median GA 28.4 weeks), lower birth weight, white race, and having multiple comorbidities of prematurity predicted later discharge PMA. The most common milestone sequence was CPAP discontinuation, caffeine discontinuation, thermoregulation, apnea resolution, and full oral feeds. PMA at apnea resolution and full oral feeds correlated highly with discharge PMA. CONCLUSIONS: In a single-center VLBW cohort, comorbidities of prematurity impacted the timing of NICU discharge through delay in oral feeding and cardiorespiratory stability.

High throughput bar adsorptive microextraction: A simple and effective analytical approach for the determination of nicotine and cotinine in urine samples.

A simple, effective, convenient and environmentally friendly methodology using high throughput bar adsorptive microextraction (HT-BAµE) with microliquid desorption in combination with large volume injection-gas chromatography-mass spectrometry operating in the selected-ion monitoring acquisition mode (LVI-GC-MS(SIM)) was applied for the determination of nicotine and cotinine in urine samples. Under optimized experimental conditions, the developed methodology allowed for linear dynamic ranges between 20.0 and 2000.0 µg L-1 with determination coefficients of 0.9991 and 0.9992, as well as average recovery yields of 61.7-67.5% and 53.9-57.8% for nicotine and cotine, respectively. The developed methodology was applied to monitor urine samples from 86 volunteers having different smoking habits, where nicotine and cotinine were quantified in the range from 23.6 to 2612.6 µg L-1. The target compounds were extracted in a HT-BAµE apparatus, which allows for simultaneous microextraction and subsequent back-extraction of up to 100 samples. This is a major improvement over other microextraction techniques. The data from the proposed methodology were satisfactory and in line with current green analytical chemistry guidelines, and proved to be an effective sample preparation alternative with substantial potential for high throughput bioanalysis.

Bar adsorptive microextraction coated with multi-walled carbon nanotube phases - Application for trace analysis of pharmaceuticals in environmental waters.

Bar adsorptive microextraction devices were modified with multi-walled carbon nanotubes for the first time. A bar adsorptive microextraction method followed by microliquid desorption and high-performance liquid chromatography with diode array detection was developed for the determination of trace levels of ketoprofen, diclofenac, gemfibrozil and mefenamic acid in water samples. The mean parameters affecting the bar adsorptive microextraction and microliquid desorption efficiency were studied and optimized using a univariate optimization strategy. The methodology was validated in terms of linearity, limits of detection and quantification, recovery, intra- and inter-day precision, accuracy, and matrix effect. The developed method showed lower limits of quantification of 0.35 µg L-1, calibration curves from 0.35 up to 1000.0 µg L-1 and determination coefficients higher than 0.9917. Recoveries in tap, surface, sea and waste water samples at three spiking levels were between 70.2 and 117.3% for all the pharmaceuticals. The coefficients of variation values for intra- (n = 6) and inter-day precisions (n = 18) were below 9.7%. The proposed analytical methodology allowed preconcentration factors up to 250 and proved to be cost-effective, easy to operate and environmentally friendly.

High throughput bar adsorptive microextraction: A novel cost-effective tool for monitoring benzodiazepines in large number of biological samples.

In this work, we propose an innovative high throughput (HT) apparatus using the bar adsorptive microextraction (BAµE) technique, which enables the simultaneous enrichment of up to 100 samples. This novel configuration was combined with microliquid desorption and high-performance liquid chromatography-diode array detection to monitor trace levels of eight benzodiazepines (diazepam, prazepam, bromazepam, oxazepam, lorazepam, alprazolam, temazepam and loflazepate) in biological samples. The proposed methodology was fully developed, optimized and validated, resulting in suitable intraday and interday precision (RSD ≤ 15%), with recovery yields ranging from 33.0% to 104.5%. The lower limits of quantification were between 20.0 and 100.0 µg L-1, using 1.0 mL of urine and 0.5 mL of plasma or serum samples. The application of the proposed methodology to real matrices resulted in average sample preparation time of around 2 min per sample, demonstrating that it is user-friendly, cost-effective and a rapid decision-making tool, whenever large number of samples are involved.

Bifidobacterial Dominance of the Gut in Early Life and Acquisition of Antimicrobial Resistance.

Bifidobacterium species are important commensals capable of dominating the infant gut microbiome, in part by producing acids that suppress growth of other taxa. Bifidobacterium species are less prone to possessing antimicrobial resistance (AMR) genes (ARGs) than other taxa that may colonize infants. Given that AMR is a growing public health crisis and ARGs are present in the gut microbiome of humans from early life, this study examines the correlation between a Bifidobacterium-dominated infant gut microbiome and AMR levels, measured by a culture-independent metagenomic approach both in early life and as infants become toddlers. In general, Bifidobacterium dominance is associated with a significant reduction in AMR in a Bangladeshi cohort, both in the number of acquired AMR genes present and in the abundance of AMR genes. However, by year 2, Bangladeshi infants had no significant differences in AMR related to their early-life Bifidobacterium levels. A generalized linear model including all infants in a previously published Swedish cohort found a significant negative association between log-transformed total AMR and Bifidobacterium levels, thus confirming the relationship between Bifidobacterium levels and AMR. In both cohorts, there was no change between early-life and later-life AMR abundance in high-Bifidobacterium infants but a significant reduction in AMR abundance in low-Bifidobacterium infants. These results support the hypothesis that early Bifidobacterium dominance of the infant gut microbiome may help reduce colonization by taxa containing ARGs.IMPORTANCE Infants are vulnerable to an array of infectious diseases, and as the gut microbiome may serve as a reservoir of AMR for pathogens, reducing the levels of AMR in infants is important to infant health. This study demonstrates that high levels of Bifidobacterium are associated with reduced levels of AMR in early life and suggests that probiotic interventions to increase infant Bifidobacterium levels have the potential to reduce AMR in infants. However, this effect is not sustained at year 2 of age in Bangladeshi infants, underscoring the need for more detailed studies of the biogeography and timing of infant AMR acquisition.

Glucocorticoids promote apoptosis of proinflammatory monocytes by inhibiting ERK activity.

Glucocorticoids (GCs) are potent anti-inflammatory drugs whose mode of action is complex and still debatable. One likely cellular target of GCs are monocytes/macrophages. The role of GCs in monocyte survival is also debated. Although both granulocyte macrophage-colony stimulating factor (GM-CSF) and macrophage-CSF (M-CSF) are important regulators of macrophage lineage functions including their survival, the former is often associated with proinflammatory functions while the latter is important in lineage homeostasis. We report here that the GC, dexamethasone, induces apoptosis in GM-CSF-treated human monocytes while having no impact on M-CSF-induced monocyte survival. To understand how GCs, GM-CSF, and M-CSF are regulating monocyte survival and other functions during inflammation, we firstly examined the transcriptomic changes elicited by these three agents in human monocytes, either acting alone or in combination. Transcriptomic and Ingenuity pathway analyses found that dexamethasone differentially modulated dendritic cell maturation and TREM1 signaling pathways in GM-CSF-treated and M-CSF-treated monocytes, two pathways known to be regulated by ERK1/2 activity. These analyses led us to provide evidence that the GC inhibits ERK1/2 activity selectively in GM-CSF-treated monocytes to induce apoptosis. It is proposed that this inhibition of ERK1/2 activity leads to inactivation of p90 ribosomal-S6 kinase and Bad dephosphorylation leading in turn to enhanced caspase-3 activity and subsequent apoptosis. Furthermore, pharmacological inhibition of GC receptor activity restored the ERK1/2 signaling and prevented the GC-induced apoptosis in GM-CSF-treated monocytes. Increased tissue macrophage numbers, possibly from enhanced survival due to mediators such as GM-CSF, can correlate with inflammatory disease severity; also reduction in these numbers can correlate with the therapeutic benefit of a number of agents, including GCs. We propose that the ERK1/2 signaling pathway promotes survival of GM-CSF-treated proinflammatory monocytes, which can be selectively targeted by GCs as a novel mechanism to reduce local monocyte/macrophage numbers and hence inflammation.

The calreticulin (CALR) exon 9 mutations are promising targets for cancer immune therapy.

The calreticulin (CALR) exon 9 mutations are found in ∼30% of patients with essential thrombocythemia and primary myelofibrosis. Recently, we reported spontaneous immune responses against the CALR mutations. Here, we describe that CALR-mutant (CALRmut)-specific T cells are able to specifically recognize CALRmut cells. First, we established a T-cell culture specific for a CALRmut epitope. These specific T cells were able to recognize several epitopes in the CALRmut C terminus. Next, we established a CALRmut-specific CD4+ T-cell clone by limiting dilution. These CD4+ T cells recognized autologous CALRmut monocytes and hematopoietic stem cells, and T-cell recognition of target cells was dependent on the presence of CALR. Furthermore, we showed that the CALRmut response was human leukocyte antigen (HLA)-DR restricted. Finally, we demonstrated that the CALRmut-specific CD4+ T cells, despite their phenotype, were cytotoxic to autologous CALRmut cells, and that the cytotoxicity was mediated by degranulation of the T cells. In conclusion, the CALR exon 9 mutations are targets for specific T cells and thus are promising targets for cancer immune therapy such as peptide vaccination in patients harboring CALR exon 9 mutations.

Enhancement for trace analysis of sulfonamide antibiotics in water matrices using bar adsorptive microextraction (BAµE).

In this study, the enhancement for trace analysis of sulfonamide antibiotics (sulfathiazole, sulfamethoxazole and sulfadimethoxine) and trimethoprim in water matrices is proposed using bar adsorptive microextraction combined with micro-liquid desorption followed by high-performance liquid chromatography with diode array detection (BAµE-µLD/HPLC-DAD). By comparing different polymers and activated carbons as sorbent coatings for BAµE, the polystyrene-divinylbenzene polymer (PS-DVB) showed the best selectivity for the compounds under study. Assays performed through BAµE(PS-DVB)-µLD on 25mL of ultrapure water samples spiked at the 8.0µgL(-1) level showed recoveries ranging from 63.8±1.5% to 84.2±1.9%, under optimized experimental conditions. The validated method provided satisfactory limits of detection (0.08-0.16µgL(-1)) and good linear dynamic ranges (0.16-8.00µgL(-1)) with determination coefficients higher than 0.9958. The proposed analytical methodology was applied to real matrices, such as tap, estuarine and wastewater samples using the standard addition method. It showed to be easy to implement, with good reproducibility, sensitivity and requiring small amount of sample. Furthermore, negligible consumption of organic solvents was used in compliance with the green analytical chemistry principles. When compared to other well-established microextraction approaches, BAµE demonstrated better performance concerning recovery yields and sensitivity.

Bar adsorptive microextraction (BAµE) coated with mixed sorbent phases-Enhanced selectivity for the determination of non-steroidal anti-inflammatory drugs in real matrices in combination with capillary electrophoresis.

The present work proposes the application of bar adsorptive microextraction coated with mixed sorbent phases (n-vinylpyrrolidone and divinylbenzene polymers with strong and weak anion exchangers), combined with liquid desorption followed by capillary electrophoresis with diode array detection (BAµE(PMIX)-LD/CE-DAD) for the determination of trace levels of non-steroidal anti-inflammatory drugs (NSAIDs: salicylic acid, mefenamic acid, diclofenac and naproxen as model compounds) in urine and water matrices. Assays performed on 25mL of water samples spiked at the 80.0µg/L level, yielded average recoveries between 86.6 and 104.% for all the NSAIDs under study using optimized experimental conditions. The proposed analytical methodology demonstrated suitable detection limits (0.3µg/L) and good linear dynamic ranges (2.5-320.0µg/L) with determination coefficients higher than 0.9981. By using the standard addition methodology, the present analytical approach was applied on urine and water samples, where good selectivity and sensitivity were achieved. The proposed method, which operated under the floating sampling technology, proved to be a suitable sorption-based static microextraction alternative for monitoring trace levels of NSAIDs in urine and water samples. The methodology showed to be easy to implement, demonstrating good reproducibility and robustness, allowing the possibility to choose the most selective sorbent, or mixed sorbent phases, according to the compounds of interest.

Determination of mitragynine in urine matrices by bar adsorptive microextraction and HPLC analysis.

Bar adsorptive microextraction combined with liquid desorption followed by high performance liquid chromatography with diode array detection (BAµE-LD/HPLC-DAD) is proposed for the determination of the psychoactive alkaloid mitragynine (MG) in human urine matrices. By using a modified N-vinylpyrrolidone polymer (P2) sorbent phase, high selectivity and efficiency is achieved. Assays performed by BAµE(P2)-LD/HPLC-DAD on 25 mL water samples spiked at the 8.0 µg L(-1) level yielded average recoveries around 100% of MG, under optimized experimental conditions. The analytical performance showed good precision (RSD<15%), appropriated detection limits of 0.10 µg L(-1) and linear dynamic ranges (0.6-24.0 µg L(-1)) with convenient determination coefficients of 0.9924. By using the standard addition method, the application of the present methodology for the determination of MG in human urine matrices after Kratom consumer, allowed very good performances. The proposed methodology proved to be a suitable alternative to monitor MG in biological fluid matrices, showing to be easy to implement, reliable, sensitive and requiring low sample volumes, when compared with other sorbent-based methods.

Prevalence of overactive bladder syndrome (OABS) among women with gynaecological problems and its risk factors in a tertiary hospital, Negeri Sembilan, Malaysia: Implication for primary healthcare providers.

OBJECTIVE: The objective of this paper was to determine the prevalence of overactive bladder syndrome (OABS) and its risk factors among patients with other gynaecological problems. METHODS: This study was conducted on women aged more than 18 years who attended the gynaecology clinic for various diagnoses other than urinary problems at a tertiary hospital in Negeri Sembilan, Malaysia, for a period of 6 months. Data on patient's profile, symptoms and risk factors for overactive bladder (OAB) were prospectively collected using a structured questionnaire adapted from ICIQ (international consultation on incontinence questionnaire). Exclusion criteria included patients with confirmed diagnosis of stress incontinence or OAB, neurological impairment, gynaecological malignancy and those with a previous history of pelvic radiation. Chi-square test and logistic regression test were used in the statistical analysis. We presented the odds ratio (OR) and 95% confidence interval for each of the OAB symptoms with p-value of 0.05. RESULTS: The prevalence of OAB among the patients (n = 573) in this study was 19.1%. History of giving births to macrosomic babies and presence of utero-vaginal prolapse (UVP) were shown to be significantly associated with OAB in the multivariate analysis. Other factors were advanced age, high parity and menopausal for more than 5 years. More than half of the patients with the symptoms of OAB did not seek treatment, as they did not think it is necessary. CONCLUSION: It is found that the prevalence of OAB is similar with many other studies conducted elsewhere. It was found to be multifactorial, but was highly significantly related with the presence of UVP, especially cystocoele and history of giving births to macrosomic babies.

Complications of neck dissection at a tertiary level hospital: study of 30 cases.

Metastatic dissemination into lymph nodes of neck occurs frequently in head neck cancers which down grade the patient's curability and survival. Neck dissection is a curable option for its management. To evaluate the complications following different types of neck dissection. This cross sectional study was conducted among patients undergone different types of neck dissection due to cervical nodal metastasis and attended follow up during July 2010 to June 2011 in Department of ENTs and Head-Neck surgery Dhaka Medical College Hospital, Dhaka, Bangladesh. Among 30 selected patient, 23 were male (76.67%) and 7 were female (23.33%), age ranged from 31-72 years (Mean=59.1±5.44). In different modalities of neck dissection 11 were modified neck dissection (36.67%) and 10(33.33%) were radical neck dissection. Common indication was carcinoma of unknown origin (66.67%). Involved neck nodes were commonly level II-IV (69.99%). Nodal stage was N2(50%) and N3 (40%).Common immediate complications were bleeding 03(10%), facial oedema 02 (6.67%) and thoracic duct injury 02(6.67%). Intermediate complications were seroma 05(16.67%), wound infection 04(13.33%) and chylous fistula 02(6.67%), Late Complications were hypertrophic scar 07(23.33%) and shoulder syndrome 06(20%). Proper indications, skilled surgery along with early recognize and treatment in both early and late manifestations of neck dissection preventing its grave sequence.

Laryngeal histoplasmosis.

Histoplasma capsulatum is an endemic granulomatous fungus disease. Involving the larynx of an immunocompetent patient with this is a rare manifestation. A sixty years old farmer who was previously diagnosed and treated as pulmonary tuberculosis was presented as a progressive change of voice and intermittent attack of unproductive cough with no history of stridor and fever for last 7 months. Clinical and imaging investigations were suggestive of laryngeal tuberculosis or laryngeal neoplasm. Laryngoscopy revealed edema, erythema and leukoplakia of the right vocal cord. Histopathological report showed intracellular hyphae of Histoplasma capsulatum, features were consistent with histoplasmosis. Patient were treated accordingly and improved. Laryngeal histoplasmosis present as a mimicker of squamous cell carcinoma or tuberculosis, may lead to the misdiagnosis and mistreatment of tuberculosis or laryngeal cancer. A high index of suspicion and a thorough histologic workup is needed to establish the diagnosis correctly.

Application of bar adsorptive microextraction (BAµE) for anti-doping control screening of anabolic steroids in urine matrices.

This study proposes a new analytical methodology for the determination of trace levels of testosterone (T) and epitestosterone (E) in urine matrices using bar adsorptive microextraction combined with liquid desorption followed by high-performance liquid chromatography with diode array detection (BAµE-LD/HPLC-DAD). The comparison of different sorbent coatings (five activated carbons, one styrene-divinylbenzene, two modified pyrrolidone, one ciano and one n-vinylpyrrolidone polymers) through BAµE showed that the latter phase presented much higher selectivity and capacity offering multiple mechanisms of interaction. Assays using this phase were performed on 25mL of water samples spiked at the 8.0µg/L level, yielded average recoveries of 92.1 and 93.4% for T and E, respectively, under optimized experimental conditions; BAµE (n-vinylpyrrolidone): 16h (1000rpm), pH 5.5; LD: acetonitrile, 30min under sonication treatment. From the developed analytical methodology, suitable detection limits were achieved (0.4µg/L) and good linear dynamic ranges (1.4-16.0µg/L) with remarkable determination coefficients (r(2)>0.9978). By using the standard addition methodology, the application of the present analytical approach on urine samples revealed good sensitivity. The proposed method, which operated under the floating sampling technology, proved to be a suitable sorption-based static microextraction alternative for screening T, E and the T/E ratio in urine samples for doping control purposes. The methodology showed to be easy to implement, demonstrating good reproducibility, sensitivity and robustness, allowing the possibility to choose the most selective sorbent coating according to the compounds of interest.

Organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight babies with sepsis.

OBJECTIVE: To study organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight (VLBW) babies with sepsis. STUDY DESIGN: Very low birth weight babies (birth weight <1500 g) admitted to a single level-three intensive care unit from January 2000 to December 2005 were prospectively evaluated for sepsis by rapid screen test, blood counts and blood culture. In thrombocytopenic babies, organism-specific platelet response and its effect on various platelet parameters were evaluated. In addition, morbidity, mortality and factors affecting survival were studied. RESULT: Sepsis was diagnosed in 230 of 620 (37%) patients. Gram-positive sepsis occurred in 20% (46/230), Gram-negative in 71% (164/230) and fungal in 8.6% (20/230) of patients. Thrombocytopenia was observed in 67% (155/230) of babies. The frequency and duration of thrombocytopenia were more with Gram-negative and fungal infections. The incidence of persistent bacteremia, multiorgan failure and death was more in thrombocytopenic neonates (P<0.01). The incidence of multiorgan failure and death was directly related to the duration of thrombocytopenia. On multiple logistic regression analysis, poor prognostic factors include a high SNAP score at admission, a severe drop in platelet count at onset of sepsis, a low platelet nadir, a prolonged duration of thrombocytopenia, a need for platelet transfusion, less number of days off ventilation and a prolonged stay in the hospital. CONCLUSION: In thrombocytopenic VLBW babies with sepsis, organism-specific platelet response is seen. In addition, persistent bacteremia, multiorgan failure and death are more in these babies, and survival decreases with the increased severity and duration of thrombocytopenia, with prolonged ventilation and increased need for platelet transfusions.