Prediction score for prolonged hospital stay in meconium aspiration syndrome: A multicentric collaborative cohort of south India.

BACKGROUND AND OBJECTIVE: With improved survival in neonates with meconium aspiration syndrome (MAS), the focus is currently on mitigating the morbidities. The objective of this study was to predict factors determining prolonged hospital stay in neonates with MAS. MATERIALS AND METHODS: It was a retrospective cohort from five centers of south India between 2018 and 2020. Neonates ≥35 weeks of gestation admitted to neonatal intensive care unit with the diagnosis of MAS and requiring oxygen beyond 24 h of life were included in the study. The morbidities in the neonates with stay ≤7 days (short stay) were compared with >7 days (prolonged stay). Logistic regression by the backward stepwise method was used for predictive score creation. RESULTS: Out of 347 neonates with MAS discharged home, 103 (29%) had a short stay and 244 (71%) had prolonged stay. The primary support beyond O2 (continuous positive airway pressure/mechanical ventilation) (42% vs. 83%, p < 0.001), fractional inspired oxygen (FiO2 ) at 1 h >30% (45% vs. 87%, p < 0.001), hypoxic ischemic encephalopathy (HIE) stage 2 or 3 (1% vs. 27%, p < 0.001), moderate-severe persistent pulmonary artery hypertension (PPHN) (3% vs. 31%, p < 0.001) were independent factors associated with prolonged stay on logistic regression. A prediction model was devised using weighted scores of these four associated morbidities. The clinical score thus developed had 83% sensitivity, 68% specificity for the prediction of prolonged stay (area under curve: 82%, 95% confidence interval [78-87], p < 0.001). CONCLUSION: More than two-thirds of neonates with MAS had prolonged stay. The primary support beyond oxygen, FiO2 requirement >30%, Moderate to severe PPHN, HIE stage 2 or 3 were predictive of prolonged stay in neonates with MAS.

Curse of Fluorosis.

Fluoride was identified to have caries preventive properties and was widely used for fluoridation of water since 1940, especially in developed countries. After this there was sudden increase in the use of fluorides in food items and in oral medicinal products like toothpastes and mouth washes. Inadvertent use of above has lead to increase in fluorosis as a public health problem. In many places high fluorides are naturally present in earth crust leading to high water fluoride content increasing the risk of fluorosis. Maintaining a fine balance of fluorides in the body is mandatory for exploiting its advantages. World Health Organization (WHO) has fixed permissible limit of fluorides in water to 1.5 mg/L as a preventive step to contain fluorosis. Fluorosis has three clinical components: Dental, Skeletal and Non-Skeletal Fluorosis. It occurs with increasing level of fluorides in the body. Acute toxicity due to fluorides is also known and occurs as a result of sudden exposure to high levels of fluorides, usually by ingestion. Once fluorosis occurs it is irreversible without any cure. Only symptomatic and supportive management is possible. Hence prevention is the mainstay of management. Prevention is by using alternative sources of water or its de-fluoridation. National Program for Prevention and Control of Fluorosis (NPPCF) was launched in 2008-9 to identify areas with high fluoride content of water, manage the water bodies, screen schools and community for fluorosis and comprehensive management of cases. Improving quality of drinking water as per standards and improving nutritional status of children are also important components of prevention of fluorosis.

An Arrow Poison (Abrus Precatorius) Causing Fatal Poisoning in a Child.

Ingestion of whole seeds of Abrus precatorius often does not produce serious illness. It generally presents initially with gastrointestinal manifestations. Haemolysis, acute renal damage, hepatotoxicity and seizures are the other manifestations. Herewith we report a child with accidental ingestion of abrus precatorius seeds who presented with altered sensorium and convulsions. The case is being reported on account of its rarity in its initial neurological manifestation and has not been reported earlier in paediatric age group.

Posterior reversible encephalopathy syndrome in early postpartum women: a case report.

Posterior reversible encephalopathy syndrome (PRES) is a rare acute neurologic condition, characterized by acute neurological symptoms. The radiological findings are predominantly seen in the posterior cerebral hemispheres and are reversible with appropriate management. We are reporting a case of a 21-year-old woman (primigravida), who presented with loss of vision, head ache and vomiting on 2nd day of post-caesarean section. Caesarean section was done due to fetal distress. On examination, patient appeared drowsy but arousable, had a blood pressure of 140/114 mmHg, rest of the examination was unremarkable. CT and MRI brain was performed to rule out cerebral venous sinus thrombosis and cortical blindness; imaging and clinical findings were suggestive of posterior reversible encephalopathy syndrome (PRES). She was treated successfully with antihypertensives and showed dramatic improvement.

Tick induced facial palsy.

We report a 3-year old boy with acute onset of left sided facial palsy secondary to tick infestation in the left ear. On 7th day of follow-up, following tick removal, the facial palsy had resolved.

Scurvy in infantile tremor syndrome.

Infantile Tremor Syndrome is a distinct clinical entity most commonly seen in Indian Subcontinent. Syndrome consists of tremors, mental and developmental retardation, abnormal skin pigmentation and anemia in children between 6 months to 2 years. The etiology is still elusive. Amongst various theories, nutritional theory is the most accepted. So far there are no cases reported of vitamin C deficiency in ITS. In this article, three cases of ITS associated with vitamin C deficiency are reported.

Effects of oxygen deprivation on parapyramidal neurons of the ventrolateral medulla in the rat.

We characterized the electrophysiological properties and responses of neurons located in the parapyramidal region of the ventral aspect of the rat medulla oblongata (parapyramidal neurons, PP neurons) to oxygen deprivation, in order to understand the mechanisms involved in hypoxia induced respiratory depression. The responses of PP neurons to oxygen deprivation were compared to those of the functionally dissimilar neurons of the dentate gyrus (DG). Neurons from the PP region were found to fire spontaneously with a frequency of 3-3.5 spikes/sec in both adults and neonates and responded to an anoxic insult with a complete loss of spontaneous firing. Discrete metabolite analysis showed a small (about 17%) decrease in tissue adenosine triphosphate (ATP) levels of the PP neurons during an anoxic insult and the decrease was significantly smaller than in the DG cell region (28%). In contrast to the DG neurons, the PP neurons recovered from an anoxic insult lasting more than 30 min, indicating a greater survival capacity of the PP neurons during oxygen deprivation. The PP neurons were also capable of withstanding successive anoxic insults better than the DG cells as demonstrated by their complete recovery following reoxygenation. It is suggested that the PP neurons may depress their electrical activity as an energy conservation mechanism, and thereby survive anoxic insults longer than the dentate neurons, whereas the loss of cellular activity in the DG neurons may be a result of energy depletion.

Modulation of inhibitory synaptic potentials in the piriform cortex.

Modulation of inhibitory synaptic potentials in the piriform cortex. Intracellular recordings from pyramidal neurons in brain slice preparations of the piriform cortex were used to test results from a computational model about the effects of cholinergic agonists on inhibitory synaptic potentials induced by stimulation of afferent fibers in layer Ia and association/intrinsic fibers in layer Ib. A simple model of piriform cortex as an associative memory was used to analyze how suppression of inhibitory synaptic transmission influenced performance of the network. Levels of suppression of excitatory synaptic transmission were set at levels determined in previous experimental work. Levels of suppression of inhibitory synaptic transmission were then systematically varied within the model. This modeling work demonstrated that suppression of inhibitory synaptic transmission in layer Ib should be stronger than suppression of inhibitory synaptic transmission in layer Ia to keep activity levels high enough for effective storage. Experimental data showed that perfusion of the cholinergic agonist carbachol caused a significant suppression of inhibitory postsynaptic potentials (IPSPs) in the pyramidal neurons that were induced by stimulation of layer Ib, with a weaker effect on IPSPs induced by stimulation of layer Ia. As previously described, carbachol also selectively suppressed excitatory postsynaptic potentials (EPSPs) elicited by intrinsic but not afferent fiber stimulation. The decrease in amplitude of IPSPs induced by layer Ib stimulation did not appear to be directly related to the decrease in EPSP amplitude induced by layer Ib stimulation. The stimulation necessary to induce neuronal firing with layer Ia stimulation was reduced in the presence of carbachol, whereas that necessary to induce neuronal firing with layer Ib stimulation was increased, despite the depolarization of resting membrane potential. Thus physiological data on cholinergic modulation of inhibitory synaptic potentials in the piriform cortex is compatible with the functional requirements determined from computational models of piriform cortex associative memory function.

Cholinergic agonist carbachol enables associative long-term potentiation in piriform cortex slices.

Pyramidal cells in piriform (olfactory) cortex receive afferent input from the olfactory bulb as well as intrinsic association input from piriform cortex and other cortical areas. These two functionally distinct inputs terminate on adjacent apical dendritic segments of the pyramidal cells located in layer Ia and layer Ib of piriform cortex. Studies with bath-applied cholinergic agonists have shown suppression of the fast component of the inhibitory postsynaptic potentials (IPSPs) evoked by stimulation of the association fibers. It was previously demonstrated that an associative form of LTP can be induced by coactivation of the two fiber systems after blockade of the fast, gamma-aminobutyric acid-A-mediated IPSP. In this report, we demonstrate that an associative form of long-term potentiation can be induced by coactivation of afferent and intrinsic fibers in the presence of the cholinergic agonist carbachol.