Prevalence & Risk Factors for Perinatal Stroke: A Population-Based Study.

Objectives: The study objective was to calculate the birth prevalence of perinatal stroke and examine risk factors in term infants. Some risk factors are present in healthy infants, making it difficult to determine at-risk infants. Study Design: Prospective population-based perinatal stroke data were compared to the Australian general population data using chi-squared and Fisher's exact tests and multivariable logistic regression analysis. Results: Sixty perinatal stroke cases were reported between 2017 and 2019. Estimated stroke prevalence was 9.6/100,000 live births/year including 5.8 for neonatal arterial ischemic stroke and 2.9 for neonatal hemorrhagic stroke. Eighty seven percent had multiple risk factors. Significant risk factors were cesarean section (p = 0.04), 5-min Apgar score <7 (p < 0.01), neonatal resuscitation (p < 0.01) and nulliparity (p < 0.01). Conclusions: Statistically significant independent risk factors do not fully explain the cause of perinatal stroke, because they are not a direct causal pathway to stroke. These data now require validation in a case-control study.

Risk factors for perinatal stroke in term infants: A case-control study in Australia.

AIM: The aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables. METHODS: A prospective case-control study was conducted in Australia. Univariate odds ratios (ORs), associated 95% confidence intervals (CIs) and multivariable logistic regression models fitted with backwards stepwise variable selection were used. RESULTS: Sixty perinatal stroke cases reported between 2017 and 2019 included 95% (57/60) with multiple risk factors. Univariate analysis identified emergency caesarean section rather than NVD (P < 0.01), low Apgar score (<7) at 1, 5 and 10 min of age (P < 0.01), resuscitation at birth (P < 0.01), abnormal cord blood gas (P < 0.01), neonatal infection/sepsis (P < 0.01), congenital heart disease (P < 0.01) and hypoglycaemia (P < 0.01) as significant risk factors. Multivariate analysis found smoking during pregnancy (OR: 1.48; 95% CI: 1.09-1.99), 1-min Apgar score < 7 (OR: 1.54; 95% CI: 1.15-2.08), 10-min Apgar score < 7 (OR: 1.26; 95% CI: 1.02-1.54) and hypoglycaemia (OR: 1.49; 95% CI: 1.07-2.06). CONCLUSIONS: Perinatal stroke is associated with multiple risk factors. Exposure to smoking, 10-min Apgar score < 7, neonatal infection and hypoglycaemia were independent risk factors. Emergency caesarean section, resuscitation at birth and abnormal cord blood gas were additional risk factors.

Detection of herpes simplex virus 2: a SYBR-Green-based real-time PCR assay.

The prevalence of Herpes simplex virus 2 (HSV2) is increasing at an alarming rate in the world. Most of the HSV2 cases are not diagnosed properly, although a range of molecular and serological diagnoses exist. Herein, we have reported a very rapid detection method specific for HSV2 using real-time PCR. The primers specific for HSV2 were designed using the Primer-BLAST tool and 120 base pairs of the polymerase gene were amplified using real-time PCR with SYBR Green dye. The designed primer pair was found highly efficient in detecting only HSV2 DNA, but not HSV1. The threshold cycle (Ct) value for HSV2 reactions by designed primers was found to be an average of 22.55 for a standard copy number of viral DNA that may denote the efficiency of the primers. The melting temperature (Tm) of the amplicon using designed primers (82.6 0C) was also higher than that using reference primers (about 78 0C), indicating the high GC content of the amplified template. The designed primer pair will help clinicians to detect the HSV2 DNA specifically and diagnose the associated disease rapidly.

Clinical Manifestations of Hospitalized COVID-19 Patients in Bangladesh: A 14-day Observational Study.

OBJECTIVES: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is currently a significant public health concern and causing a pandemic in the world. Despite immense attention to the coronavirus disease 2019 (COVID-19), very little attention has been given to the kinetics of disease progression in infected patients. Therefore, in this study, we present a 14-day clinical observation of hospital-admitted COVID-19 patients. METHODS: After recording the demography of 42 COVID-19 patients on day 1, we observed the clinical progression for 14 days by investigating the hematological and biochemical responses of patients' blood and serum, respectively. RESULTS: Approximately, 62% of the hospital-admitted COVID-19 patients presented cough, followed by fever (∼52%). The top comorbidities of these patients were hypertension (30%) and diabetes mellitus (19%). The average blood hemoglobin (Hb) level was slightly low among the patients in the early days of infection and went up to the normal level on the later days. A substantial increase in the level of ALT or SGPT [up to 106 IU/L; standard error of the mean (SEM): 12.64] and AST or SGOT (up to 64.35 IU/L; SEM: 5.013) in COVID-19 patients was observed, which may suggest that infection with coronavirus is associated with the functionality of other organs of COVID-19 patients. CONCLUSION: This 14-day observational study may help clinicians to decide the choice of treatment for COVID-19 patients. HOW TO CITE THIS ARTICLE: Shaha M, Islam MA, Huq F, et al. Clinical Manifestations of Hospitalized COVID-19 Patients in Bangladesh: A 14-day Observational Study. Euroasian J Hepato-Gastroenterol 2021;11(1):14-20.

The Role of the Placenta in Perinatal Stroke: A Systematic Review.

CONTEXT: Placental pathology may be an important missing link in the causal pathway of perinatal stroke. The study aim was to systematically review the literature regarding the role of the placenta in perinatal stroke. MEDLINE, Embase, Scopus, and Web of Science electronic databases were searched from 2000 to 2019. Studies were selected based on predefined criteria. To enable comparisons, placental abnormalities were coded using Redline's classification. RESULTS: Ten studies met the inclusion criteria. Less than a quarter of stroke cases had placental pathology reported. Placental abnormalities were more common among children with perinatal stroke than in the control group. The most frequent placental abnormality was Redline's category 2 (thrombo-inflammatory process). CONCLUSIONS: Placental abnormalities appear to be associated with perinatal stroke, supporting additional indirect evidence and biological plausibility of a causative role. However, the results should be interpreted cautiously considering the low frequency of placental examination and lack of uniformity in placental pathology reporting. CLINICAL TRIAL REGISTRATION: PROSPERO Registration no: CRD42017081256.

Diagnosing cerebral palsy in full-term infants.

More than 50% of infants with cerebral palsy (CP) are born at or near term, with the vast majority having pre- or perinatally acquired CP. While some have a clinical history predictive of CP, such as neonatal encephalopathy or neonatal stroke, others have no readily identifiable risk factors. Paediatricians are often required to discriminate generalised motor delay from a variety of other diagnoses, including CP. This paper outlines known causal pathways to CP in term-born infants with a focus on differential diagnosis. Early and accurate diagnosis is important as it allows prompt access to early intervention during the critical periods of brain development. A combination of clinical history taking, standard clinical examination, neuroimaging and genetic testing should be started at the time of referral. Attention to the investigation of common comorbidities of CP, including feeding and sleep difficulties, and referral to early intervention are recommended.

Detection of T- and B-cell Target Antigens of Fowlpox Virus Isolated from Backyard Chickens in India.

With the aim of assessing the antigenic characteristics of a circulating pool of fowlpox virus (FPV) that exists in the backyard poultry system in India, one of the field isolates generated was characterized by in vitro immunologic techniques. FPV was isolated from clinically positive fowlpox cases (n  =  10) from the Jhargram (West Midnapur district) and Kakdwip (South 24 Pargana district) areas of West Bengal State, India. Initially, FPV-specific PCR was performed for confirmation of the samples. Isolation of FPV was done using embryonated chicken eggs and the choreoallantoic membrane route. Subsequently, FPV antigen was prepared from chicken embryo fibroblast cell culture-adapted field isolate. Biologic transmission of FPV was performed in Rhode Island red chickens experimentally to assess humoral and cell-mediated immune (CMI) responses. High level of anti-FPV antibodies were observed in test birds as assessed by indirect ELISA. Seroreactive polypeptides (B-cell antigens) of FPV antigen with molecular weights of 44.5, 66.5, 75, 90.5, and 99 kDa were detected by western blot analysis. Significant increases in CMI responses were observed in inoculated chickens as assessed by lymphocyte proliferation assay, cytotoxicity assay, and T-cell immunoblotting. The predominant T-cell antigen of FPV detected had a molecular weight of 66.5 kDa. The present study revealed the antigenic characteristics of FPV that exists in backyard poultry system in West Bengal for the first time, thus exploring the rationality of designing future T- and B-cell vaccines against fowlpox.

Nitrogen oxides, sulfur trioxide, and mercury emissions during oxy-fuel fluidized bed combustion of Victorian brown coal.

This study investigates, for the first time, the NOx, N2O, SO3, and Hg emissions from combustion of a Victorian brown coal in a 10 kWth fluidized bed unit under oxy-fuel combustion conditions. Compared to air combustion, lower NOx emissions and higher N2O formation were observed in the oxy-fuel atmosphere. These NOx reduction and N2O formations were further enhanced with steam in the combustion environment. The NOx concentration level in the flue gas was within the permissible limit in coal-fired power plants in Victoria. Therefore, an additional NOx removal system will not be required using this coal. In contrast, both SO3 and gaseous mercury concentrations were considerably higher under oxy-fuel combustion compared to that in the air combustion. Around 83% of total gaseous mercury released was Hg(0), with the rest emitted as Hg(2+). Therefore, to control harmful Hg(0), a mercury removal system may need to be considered to avoid corrosion in the boiler and CO2 separation units during the oxy-fuel fluidized-bed combustion using this coal.