Comparison between Phenobarbitone and Levetiracetam as the initial anticonvulsant in preterm neonatal seizures - a pilot randomized control trial in developing country setup.

This study aimed to compare the efficacy and safety of intravenous Levetiracetam and Phenobarbitone in the treatment of seizures in preterm neonates. It was an open-labeled, parallel randomized controlled trial conducted in a tertiary Neonatal Intensive Care Unit, India. Total 48 preterm neonates (28-36+6 weeks) with clinical seizures were randomized to receive either Levetiracetam (LEV; 40 mg/kg, then 20 mg/kg) or Phenobarbitone (PB; 15 mg/kg, then 10 mg/kg) intravenously as first loading dose in ratio 1:1; second loading was given for persistent seizure. Efficacy was denoted by cessation of clinical seizures with first or second doses of the allotted antiepileptic, and remaining seizure-free for the next 24 h. The demographic characteristics of preterm neonates and seizure types were comparable between both groups. Clinical seizure was controlled in 19 (79%) neonates in LEV group and 17 (70%) neonates in PB group, RR 1.12 (95% CI: 0.80 to 1.55), p = 0.504. There was increased respiratory support in PB group 9 (38%) vs. 3 (13%) in LEV group, RR 3.0 (95% CI: 0.92 to 9.74), p = 0.06.  Conclusion: Levetiracetam and Phenobarbitone were equally efficacious for clinical neonatal seizure control, but increased respiratory support was found with Phenobarbitone use. What is Known: • Preterm neonates are at higher risk of neonatal seizure and Phenobarbitone is commonly used as the first line antiepileptic drugs in treating them. What is New: • Levetiracetam found equally efficacious as Phenobarbitone for cessation of clinical seizures in preterm neonates, with less adverse effect.

Accuracy to detect neonatal hyperglycaemia using real-time continuous glucose monitoring during postoperative period.

Identifying hyperglycaemia during postoperative period is essential for neonates. The objective of the study was to analyse the accuracy and reliability of continuous glucose monitoring (CGM) device for detecting hyperglycaemia during postoperative period in neonates. In this prospective study, hourly glucose recordings by CGM device and six hourly by glucometer glucose (GG-reference test for patient management) were collected in ten surgical neonates during first three postoperative days. Mean absolute relative difference (MARD) and proportion of CGM values within ± 15%/15 mg/dL, ± 20%/20 mg/dL, and ± 30%/30 mg/dL of GG, were analysed from matched pair CGM and GG recordings. The diagnostic performance of CGM for neonatal hyperglycaemia (> 150 mg/dL) was expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV); and the clinical reliability was assessed in Clarke Error Grid Analysis. A total of 720 CGM glucose readings, 120 matched -paired glucose readings by CGM --GG, and 37 episodes were hyperglycaemia by GG. The MARD was 10.76 %; the percentages of glucose readings within 15%/15 mg/dL, 20%/20 mg/dL, and 30%/30 mg/dL were 94.6%, 97.3% and 100% during the hyperglycaemia period. The sensitivity, specificity, PPV and NPV to detect hyperglycaaemia by CGM device were 100%, 93.9%, 88% and 100 % respectively. In Clarke Error Grid Analysis, 97.3 % points were in zone A and B during the hyperglycaemia period. CONCLUSION: CGM device can be a clinically reliable tool for hyperglycaemia management during postoperative period in neonates. WHAT IS KNOWN: • Neonates are vulnerable for hyperglycaemia during post-operative period and bed side glucometers are used for frequent glucose monitoring in them. • Continuous glucose monitor(CGM) devices are used for the glucose monitoring in adult and paediatric diabetes care. WHAT IS NEW: • For the first time, this study analysed the accuracy and clinical reliability of FreeStyle Libre (CGM device) for identifying hyperglycaemia during post-operative period in neonates. • CGM device has very good accuracy for detecting hyperglycaemia in neonates, it may help the clinician for better glucose stability during post-operative period.

Utilization of plant-derived recombinant human ß-defensins (hBD-1 and hBD-2) for averting salmonellosis.

We describe the use of plant-made ß-defensins as effective antimicrobial substances for controlling salmonellosis, a deadly infection caused by Salmonella typhimurium (referred to further as S. typhi). Human ß-defensin-1 (hBD-1) and -2 (hBD-2) were expressed under the control of strong constitutive promoters in tobacco plants, and bio-active ß-defensins were successfully extracted. In the in vitro studies, enriched recombinant plant-derived human ß-defensin-1 (phBD-1) and -2 (phBD-2) obtained from both T1 and T2 transgenic plants showed significant antimicrobial activity against Escherichia coli and S. typhi when used individually and in various combinations. The 2:1 peptide combination of phBD-1:phBD-2 with peptides isolated from T1-and T2-generation plants reduced the growth of S. typhi by 96 and 85 %, respectively. In vivo studies employing the mouse model (Balb/c) of Salmonella infection clearly demonstrated that the administration of plant-derived defensins individually and in different combinations enhanced the mean survival time of Salmonella-infected animals. When treatment consisted of the 2:1 phBD-1:phBD-2 combination, approximately 50 % of the infected mice were still alive at 206 h post-inoculation; the lowest number of viable S. typhi was observed in the liver and spleen of infected animals. We conclude that plant-made recombinant ß-defensins (phBD-1 and phBD-2) are promising antimicrobial substances and have the potential to become additional tools against salmonellosis, particularly when used in combination.

Filarial antigens mediate apoptosis of human monocytes through Toll-like receptor 4.

BACKGROUND: Apoptosis of several host cells induced by parasites/parasite products has been investigated in human filariasis to understand immune hyporesponsiveness. However, apoptosis of monocytes-one of the major antigen presenting cells in peripheral circulation, which are chronically exposed to filarial antigens in infected subjects-is yet to be understood. METHODS: Apoptosis of human monocytes with Brugia pahangi antigen (BpA) was demonstrated by scoring several apoptotic markers using flow cytometry. Ability of BpA and plasma of infected subjects to suppress lymphocyte proliferation was demonstrated by (3)H thymidine incorporation assay and carboxyfluorescein succinimidyl ester dilution assay. RESULTS: BpA induced significant apoptosis of normal human monocytes, primarily through Toll-like receptor 4 (TLR4), and suppressed phytohemagglutinin (PHA)-mediated proliferation of normal human T lymphocytes. However, monocytes of Wuchereria bancrofti-infected subjects were resistant to BpA-induced apoptosis. Plasma of infected subjects also mediated apoptosis of normal monocytes, presumably due to circulating filarial antigens, and resulted in inhibition of PHA-induced proliferation. CONCLUSION: Normal human monocytes were found to be qualitatively different from those of filariasis-infected subjects; whereas filarial antigens mediate apoptosis of normal human monocytes through TLR4, those of infected subjects were found to be resistant.

The diagnostic performance of mean neutrophil volume in neonatal sepsis: A systematic review and meta-analysis.

BACKGROUND: There is a need for reliable diagnostic tests for early identification of sepsis to prevent neonatal mortality and antibiotic misuse. During sepsis, many immature neutrophils came into the bloodstream, altering the mean neutrophil volume (MNV) shown in the previous studies. OBJECTIVES: To summarize the diagnostic performance of mean neutrophil volume (MNV) in neonatal sepsis from the published literature. METHOD: Databases such as PubMed, Scopus, and Web of Science were searched from January 1990 to April 2023 for studies reporting MNV as a diagnostic test in neonatal sepsis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve of MNV were estimated with reference blood culture-positive sepsis and clinical sepsis for meta-analysis. RESULT: The diagnostic performance of MNV was analyzed in 1685 neonates, including 829 septic and 856 non-septic neonates, from six prospective studies. The pooled sensitivity and specificity of MNV were 0.87 and 0.75, respectively, for neonatal sepsis; the DOR was 20.01 (95% CI: 5.90-67.82); and the AUC of the SROC for MNV was 0.81 (95% CI: 0.69-0.88). Higgins I2 was 92.1% (95% CI: 85.5%-95.7%). The diagnostic performance of MNV was better during sub-group analysis of studies reporting culture-positive sepsis (DOR 85.61). CONCLUSION: The diagnostic performance of MNV is moderate for neonatal sepsis. As the evidence originated from a small number of studies with marked heterogeneity, further large-scale diagnostic accuracy studies are recommended to resolve heterogeneity in the future.

Elucidating the role of chemokines in inflammaging associated atherosclerotic cardiovascular diseases.

Age-related inflammation or inflammaging is a critical deciding factor of physiological homeostasis during aging. Cardiovascular diseases (CVDs) are exquisitely associated with aging and inflammation and are one of the leading causes of high mortality in the elderly population. Inflammaging comprises dysregulation of crosstalk between the vascular and cardiac tissues that deteriorates the vasculature network leading to development of atherosclerosis and atherosclerotic-associated CVDs in elderly populations. Leukocyte differentiation, migration and recruitment holds a crucial position in both inflammaging and atherosclerotic CVDs through relaying the activity of an intricate network of inflammation-associated protein-protein interactions. Among these interactions, small immunoproteins such as chemokines play a major role in the progression of inflammaging and atherosclerosis. Chemokines are actively involved in lymphocyte migration and severe inflammatory response at the site of injury. They relay their functions via chemokine-G protein-coupled receptors-glycosaminoglycan signaling axis and is a principal part for the detection of age-related atherosclerosis and related CVDs. This review focuses on highlighting the detailed intricacies of the effects of chemokine-receptor interaction and chemokine oligomerization on lymphocyte recruitment and its evident role in clinical manifestations of atherosclerosis and related CVDs. Further, the role of chemokine mediated signaling for formulating next-generation therapeutics against atherosclerosis has also been discussed.

Assessment, analysis and appraisal of road traffic noise pollution in Rourkela city, India.

The problem of road traffic noise pollution has become a concern for both the public and the policy makers. Noise level was assessed in 12 different squares of Rourkela city during different specified times (7-10 a.m., 11 a.m.-2 p.m., 3-6 p.m., 7-10 p.m., 10 p.m.-12 midnight and 4-6 a.m.). Noise descriptors such as L,eq, traffic noise index, noise pollution level, noise climate, Lday, Levening, Lnight and Lden were assessed to reveal the extent of noise pollution due to heavy traffic in this city. The equivalent noise levels of all the 12 squares were found to be much beyond the permissible limit (70dB during day time and 55dB during night time). Appallingly, even the minimum L eq and NPL values were more than 82 dB and 96 dB during day time and 69 dB and 91 dB during night time respectively. Lden values of investigated squares ranged from 83.4 to 86.1 dB and were even more than the day time permissible limit of traffic noise. The prediction model was used in the present study to predict noise pollution level instead of Leq. Comparison of predicted with that of the actual measured data demonstrated that the model used for the prediction has the ability to calibrate the multicomponent traffic noise and yield reliable results close to that by direct measurement. Lastly, it is inferred that the dimension of the traffic generated noise pollution in Rourkela is critical.

Agreement between Noninvasive Hemoglobin and Laboratory Hemoglobin Measurements in Neonates: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVE: The noninvasive hemoglobin (NHb) devices are recently evaluated as an alternative to laboratory hemoglobin (LHb) in neonates. This systematic review explores the diagnostic accuracy of NHb devices for neonatal hemoglobin measurement. METHODS: Literature related to the comparison of NHb device with LHb in neonates was searched from Medline, PubMed Central, PubMed, Web of Science, Google Scholar, and Scopus databases after PROSPERO registration. The quality of included publications was assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). The pooled correlation coefficient and bias (precision) in Bland-Altman difference plots were used for summary statistics using MetaXL 5.0 software. RESULTS: A total of 1,477 paired NHb-LHb observations were analyzed from 1,047 neonates in 10 studies. Massimo radical-pulse co-oximetry (8 studies) and Mediscan-2000 (2 studies) were used for NHb estimation. The pooled correlation coefficient between NHb and LHb was r = 0.94 (95% CI: 0.83-0.98, p < 0.001), and the pooled bias (precision) was -0.013 (1.4) gm/dL between NHb and LHb measurements in Bland-Altman analysis. NHb device had better precision in stable neonates (0.91gm/dL) over sick neonates (1.66 gm/dL). CONCLUSIONS: Hemoglobin measurement by NHb is excellently correlated with LHb measurement with a minimal average difference. It may be used as a screening tool for hemoglobin measurement in neonates to avoid frequent phlebotomy.

Screening and Management of Congenital Hypothyroidism - Guidelines by American Academy of Pediatrics, 2023.

Guidelines for screening and management of congenital hypothyroidism in neonates have been recently updated by the American Academy of Pediatrics (AAP). This article compares new AAP guideline with the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) Guidelines, 2018 and lists the changes in screening, diagnosis, and management of congenital hypothyroidism suggested in the new guidelines, along with clinical utilization in the Indian scenario.

Anti-Vascular Endothelial Growth Factor (Anti-VEGF) for the Treatment of Type I ROP.

This retrospective study evaluated the trends in the use of anti-vascular endothelial growth factor (anti-VEGF) for the treatment of type-1 retinopathy of prematurity (ROP) during two periods - 2016-2019 (epoch A) and 2020-2022 (epoch B) in a neonatal unit of India. The study also compared the efficacy of anti-VEGF and laser therapies. Anti-VEGF was used in 8 (12.2%) out of 66 eyes treated during epoch A and 54 (75%) out of 72 eyes during epoch B (P = 0.001). The proportion of eyes in which ROP regressed with a single attempt of laser and anti-VEGF therapies was 8/20 (40%) and 7/15 (46.6%) respectively for the disease in zone 1 and aggressive-posterior ROP (P = 0.70) and 46/66 (69.6%) and 17/37 (45.9%) respectively for the disease in zone 2 (P = 0.018). There was a trend towards an increase in the use of anti-VEGF for ROP management over time. Anti-VEGF showed equal efficacy as laser for zone 1 ROP and AP-ROP, but laser therapy was better for zone 2 ROP.

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care.

Introduction: The number of neonatal cerebrospinal fluid (CSF) samples sent from the neonatal intensive care unit (NICU) for cytologic examination is rising, warranting accurate analysis and interpretation of the same. This study was taken up to assess the usefulness of CSF cell count and cytology in NICU settings, as it can be used even in a resource-limited setting. Aim and Objective: 1) To study the prevalence of cell count and cytologic changes in CSF from NICU and assess their usefulness in correlation to C-reactive protein, CSF neutrophil percentage, blood, CSF culture, and other biochemical parameters. 2) To correlate cell counts and cytology with age, period of gestation, presence, and absence of sepsis, seizures, intracranial hemorrhage, and their clinical follow-up. Materials and Methods: A retrospective study was done on neonatal CSF samples submitted for cytology over one year (January-December 2016) in the Department of Pathology. CSF cell counts were retrieved, and cytosmears were reviewed for cellularity, cell type, proportion, and background and correlated with the biochemical, microbiological, and clinicoradiological findings. Results: A total of 213 samples were included with 140 males and 73 females with an age range of 0-28 (mean: 7.3) days. The mean CSF cell count was 5.48/cu.mm (0-90 cells/cu.mm). The most frequent cytologic finding was occasional lymphocytes or acellular CSF (63.9%). The CSF leucocyte count and protein levels showed a significant correlation with s C-reactive protein. The CSF cytology showed a significant correlation between the age of the neonate and blood neutrophil percentage (P = 0.0158). History of intracranial hemorrhage showed a significantly higher frequency of the presence of red blood cells (P = 0.0147). Conclusion: Accurate cell counts, cytology of neonatal CSF, and biochemical and microbiological workup can help diagnose and manage neonates in intensive care.

Alternations of Fertility Parameters by Graded Dose of Inorganic Arsenic in Adult Male White Pekin Ducks.

A significant health issue, reproductive toxicity is mostly linked to exposure to various environmental heavy metals. A pervasive toxin that occurs naturally in the environment is arsenic (As). This research was done to determine the effects of various doses of inorganic As supplements on the reproductive organs of adult male white Pekin ducks. A total of 240 numbers of 14-days-old male white Pekin ducks were weighed and randomly assigned into 4 experimental groups with six replicates (10 ducklings in each replicate). The experimental groups were as follows: (T-1) basal diet along with normal drinking water (control group); (T-2 to T-4) basal diet along with As in the form of sodium-meta-arsenite at 7, 14, and 28 ppm of drinking water respectively. The results showed reduction in body weight and testicular weight, disruption of spermatogenesis, reduction in follicular-stimulating hormone (FSH), leutinizing hormone (LH), and testosterone levels and histopathological alterations as compared to control. Additionally, there was not only a significant decrease in various antioxidant parameters in testis tissue, like catalase (CAT), reduced glutathione (GSH), super oxide dismutase (SOD), and ferric-reducing antioxidant power (FRAP), but also a significant increase in oxidative parameters of testis like lipid peroxidation (LPO), myloperoxidase (MPO), nitric oxide (NO), and super oxide anion radical (O2-) in As-treated groups, in comparison with T-1. A significantly higher level of As content in testis was observed in all the 3 As-treated groups, with highest level recorded in T-4 birds. Besides that, there was upregulation of nuclear factor kappa B (NF-κB), heat shock proteins (Hsps) and pro-inflammatory cytokines like interlukin (IL) series, i.e., IL-2, IL-6, IL-18, IL-1ß and tumor necrosis factor- α (TNF-α) levels, whereas anti-inflammatory parameters like IL-4 and IL-10 levels showed downregulation in testis of As-treated groups. Together, these findings provide deeper understandings of the roles played by oxidative stress, NF-κB and Hsps in the progression of testicular injury, which may help to explain how the As induced male sterility, in ducks, due to exposure.

Hepatorenal Toxicity of Inorganic Arsenic in White Pekin Ducks and Its Amelioration by Using Ginger.

The toxic metalloid arsenic is known to cause liver and kidney injury in many humans and animals. The goal of this paper was to exemplify the antagonism of ginger against arsenic (As)-induced hepato-renal toxicity. In addition, the pathways Nrf2/Keap1 and NF/κB were studied to reveal the molecular mechanism of the stress. One hundred twenty 7-day-old White Pekin ducks were randomly allocated into five groups, having 24 birds in each. Each group contained three replicates having 8 birds in each replicate and maintained for 90 days. The groups were as follows: T-1 [control-basal diet with normal water], T-2 [T1 + As at 28 ppm/L of water], T-3 [T2 + ginger powder at 100 mg/kg feed], T-4 [T2 + ginger powder at 300 mg/kg feed], and T-5 [T2 + ginger powder at 1 g/kg feed]. It was observed that there was a significant increase in oxidative parameters whereas a significant decrease in antioxidant parameters in hepato-renal tissues in T-2. The exposure to As not only decreased the mRNA expression of antioxidant parameters like Nrf2, SOD-1, CAT, GPX, and HO-1and anti-inflammatory markers like IL-4 and IL-10 but also increased the m-RNA expression of NF-κB, Keap-1 and pro-inflammatory markers like IL-2, Il-6, IL-18, IL-1ß, and TNF-α. There was also an accumulation of As in hepatic and renal tissue, confirmed by residual analysis of these tissues. By correlating the above parameters, As at 28 ppm showed significant toxic effects, and ginger powder at 1 g/kg feed effectively counteracted the toxic effects of As in ducks.

Dynamics of road traffic noise in Bhadrak city, India.

Road traffic noise assessed in 13 different squares of major intersection points in Bhadrak city during four different specified times i.e. 7-10 a.m., 11 a.m.-2 p.m., 3-6 p.m. and 7-10 p.m.. Road traffic was found to be the most important source of community noise at the studied sites. The noise levels of all the 13 squares were found to be beyond the permissible limit [70 dB (A)] during day time. Leq (equivalent noise level) values ranged from 93.4 to 100.5; 91.5 to 100.6; 95.1 to 107.3 and 97.3 to 106.3 dB during 7-10 a.m., 11 a.m.-2 p.m., 3-6 p.m. and 7-10 p.m. respectively. LNP values range from 115.7 to 127.7; 114.2 to 129.8; 118.2 to 138.2 and 120.7 to 135 dB, while TNI values range from 134.3 to 154.7; 130.7 to 157.9; 136.7 to 168.2 and 137.2 to 165 dB during 7-10 a.m., 11 a.m.-2 p.m., 3-6 p.m. and 7-10 p.m. respectively. Reprehensibly, even minimum LNP and TNI values are more than 114 and 130 dB respectively. Analysis of variance also computed for investigated squares at the peak hour i.e. 7-10 p.m. to infer the level of significance. The observed value of F (0.47) was less than the tabulated values and was not significant at both 5 and 1% levels of significance. Thus, the noise levels of different squares did not differ significantly at their peak hours. A preliminary public health survey carried out based on questionnaire method amongst 202 local inhabitants reveal the degree of annoyance due to road traffic noise.

Manual Method vs Breast Pump for Breast Milk Expression in Mothers of Preterm Babies During First Postnatal Week: A Randomized Controlled Trial.

OBJECTIVES: To compare breast milk volume between manual method and breast pump expression in mothers of preterm infants at different time point of first week. DESIGN: Randomized controlled trial. SETTING: Postpartum ward of Obstetrics department and tertiary level neonatal intensive care unit (NICU) in a single institution in Orissa between October, 2020 and May, 2021. PARTICIPANTS: Mothers who delivered before 34 completed weeks of gestation. INTERVENTIONS: Manual breastmilk expression (ME) group using Marmet technique and breast pump milk expression (PE) group using pigeon manual breast pump, initiated milk expression within one hour of delivery. OUTCOME MEASURES: Expressed breast milk (EBM) volume in mothers of preterm infants at different time point of first week, and cumulative milk volume. RESULTS: Out of 170 mothers (83 PE and 87 ME group), 7-days milk volume data was available for 137 (71 ME and 66 PE) mothers. In per protocol analysis for 126 mothers (63 in each group), the median (IQR) EBM volume on day 2 and day 7 of ME and PE groups were similar [10 (5,20) vs 12 (5,28), P=0.10] and [280 (220-356) vs 280 (220-360), P=0.66]. The median (IQR) cumulative EBM volume over first 7 days in ME group was not significantly different from PE group [733 (593-995) vs 848.5 (571-1009)] P=0.55). A similar number of mothers in the PE and ME group [56 (88.9%) vs 58 (92%); P=0.14] provided exclusive breast milk for their neonates during the first week. Similar results were found on intention to treat analysis. CONCLUSION: EBM volume expressed was comparable between mothers expressing manually or with breast pump.

Comparison of Continuous Real Time Blood Glucose Measurement With Venous Laboratory Blood Glucose Level in Neonates During Perioperative Period.

OBJECTIVES: To compare the continuous real time blood glucose (CG) measurement with venous laboratory blood glucose (LG) level in neonates during perioperative period. METHODS: Glucose levels were measured simultaneously by CG, glucometer glucose (GG) and LG at 40 time points in ten neonates during perioperative period. Intraclass correlation coefficient (ICC) and Bland Altman analysis were used for comparison. RESULT: Correlation between CG and LG was excellent (ICC= 0.953; P<0.001), and average difference was 23.8 (95%CI 52.9 to -5.3) mg/dL, showed better reliability than at hyperglycemic state (ICC=0.653; P=0.006). The GG-LG showed excellent reliability with ICC = 0.985; P<0.001 and average difference of 15.4 (95% CI 30.7 to 0.1) mg/dL. CG at euglycemic state (ICC= 0.880; P<0.001). CONCLUSION: CG measurement is reliable for blood sugar estimation in neonates; but has lower reliability for hyperglycemia. The continuous trend of glucose measurement by CG is helpful for timely diagnosis of hyperglycemia during perioperative period in neonates.

Comparison between oral melatonin and 24% sucrose for pain management during retinopathy of prematurity screening: a randomized controlled trial.

BACKGROUND: Preterm neonates perceive multiple painful procedures during Neonatal Intensive Care Unit (NICU) stay, having long term neurobehavioral effects. This study aims to compare the analgesic efficacy of oral melatonin with 24% sucrose in neonates during retinopathy of prematurity (ROP) screening. METHODS: A prospective, non-blinded, randomized controlled trial was conducted in a tertiary care NICU. All preterm neonates with gestational age (GA) < 34 weeks or birth weight (BW) < 2000 grams eligible for ROP screening were randomized into oral melatonin (4 mg/kg) and oral 24% sucrose (0.5 ml) groups. Both groups received standard non-pharmacological measures and topical proparacaine. The intensity of pain was measured by Premature Infant Pain Profile (PIPP) score during the procedure, at 1st and 5th minutes following the procedure and compared between the two groups by Mann-Whitney U test with p value < 0.05 considered as significant. RESULTS: A total of 60 preterm neonates were randomized with 30 neonates in the melatonin (median [interquartile range] GA: 30.86 [3.78] weeks, BW: 1160 [430] grams) and 30 neonates in the 24% sucrose (median [IQR] GA: 29.29 [4.68] weeks, BW: 1070 [315] grams) group. The median PIPP score during the procedure in the melatonin and sucrose groups were 17 and 16, respectively (p=0.64). The median (Q1-Q3) PIPP score at the 1st minute was significantly lower among the melatonin group (7 [5.25-10]) vs 24% sucrose group (9.5 [7.25-11]) (p=0.02); and at the 5th minute, the median (Q1-Q3) PIPP scores in the melatonin group (5 [4-6]) was comparable to the 24% sucrose group (5.5 [3.25-7]) (p= 0.52). CONCLUSIONS: Oral melatonin is not inferior to oral 24% sucrose for pain management during ROP screening.

Platelet parameters as a diagnostic marker in early diagnosis of neonatal sepsis- Seeking newer answers for older problems.

Background: Early identification and intervention of neonatal sepsis can improve the clinical outcome. Blood cultures remain the gold standard for diagnosis but are not easily available and require time. There is a need to identify and validate newer easily available cost-effective investigations, which would help in the diagnosis of neonatal sepsis. Aim: To test the hypothesis that whether platelet parameters, i.e., total platelet count (TPC), mean platelet volume (MPV), and the ratio of MPV/TPC can serve as diagnostic markers in neonatal sepsis. Methods: It is was a prospective study conducted in a tertiary care neonatal intensive care unit (NICU). The platelet parameters, i.e., TPC, MPV, and MPV/TPC of blood culture-positive septic neonates were compared with those of non-septic neonates admitted to the NICU. The diagnostic accuracy of the platelet indices was assessed by receiver operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Result: During the study period, 43 blood culture-positive sepsis neonates were compared with 54 cases of non-septic neonates. There was a significant difference in the mean of TPC, MPV, and MPV/TPC ratio between septic groups and non-septic groups. The sensitivity, specificity, PPV, NPV values of MPV (cut-off >9 fL) were 63.40%, 53.8%, 52.0%, and 65.11% respectively. The sensitivity, specificity, PPV, NPV of MPV/TPC ratio (>7.2) were 48.8%, 96.22%, 90.9%, and 70.42% respectively. The area under the curve (AUC) values for TPC, MPV, and MPV/TPC in the ROC analysis were 0.797, 0.641, and 0.809, respectively. Conclusion: Platelet indices MPV and MPV/TPC ratio can be useful in the early diagnosis of neonatal sepsis.

Antidiabetic and antihyperlipidemic effects of Premna spinosa bark in experimental animal models.

The purpose of the study is to evaluate the antidiabetic and hyperlipidemic potential of stem bark extract of Premna spinosa (Lamiaceae), by using streptozotocin (STZ)-nicotinamide (NA)-induced diabetic and triton-induced hyperlipidemic models in albino rats. The blood glucose, total cholesterol, and triglyceride levels were determined in STZ-NA-induced diabetic and triton-induced hyperlipidemic rats, as per the respective protocols. It was found that there is the dose dependent and significant reduction in foregoing parameters on the administration of extract from Premna spinosa stem bark at the doses of 200, 400, and 800 mg/kg body weight to diabetic and hyperlipidemic rats. From these observed results it may be inferred that the stem bark of Premna spinosa possesses remarkable antidiabetic and antihyperlipidemic properties.

Immunoinformatic approach employing modeling and simulation to design a novel vaccine construct targeting MDR efflux pumps to confer wide protection against typhoidal Salmonella serovars.

Overcoming multi drug resistance is one of the crucial challenges to control enteric typhoid fever caused by Salmonella typhi and Salmonella paratyphi. Overexpression of efflux pumps predominantly causes drug resistance in microorganisms. Therefore, immunotherapy targeting the various efflux pumps antigens could be a promising strategy to increase the success of vaccines. An immunoinformatic approach was employed to design a Salmonellosis multi-epitope subunit vaccine peptide consisting of linear B-cell and T-cell epitopes of multidrug resistance protein families including ATP Binding Cassette (ABC), major facilitator superfamily (MFS), resistance nodulation cell division (RND), small multidrug resistance (SMR), and multidrug and toxin extrusion (MATE). The selected epitopes exhibited conservation in both S. typhi and S. paratyphi and thus could be helpful for cross-protection. Further, the final vaccine construct encompassing the peptides, adjuvants and specific linker sequences showed high immunogenicity, solubility, non-allergenic, nontoxic, and wide population coverage due to strong binding affinity to maximum HLA alleles. The three-dimensional structure was predicted, and validated using various structure validation tools. Additionally, protein-protein docking of the chimeric vaccine construct with the TLR-2 protein and molecular dynamics demonstrated stable and efficient binding. Conclusively, the immunoinformatic study showed that the novel multi epitopic vaccine construct can simulate the both T-cell and B-cell immune responses in typhoidal Salmonella serovars and could potentially be used for prophylactic or therapeutic applications.Communicated by Ramaswamy H. Sarma.