Comparative Analysis of Enzyme-Linked Immunosorbent Assay and Immunochromatography for Rotavirus and Adenovirus Detection in Children below Five Years with Acute Gastroenteritis

Introduction The most frequent etiologies of viral gastroenteritis among young children are rotavirus and enteric adenovirus. The clinical signs and symptoms of viral gastroenteritis are not distinct enough to allow for diagnosis. For the diagnosis and treatment of acute gastroenteritis, it is preferable to use quick, simple, and low-cost procedures. This study was undertaken to determine efficacy of immune-chromatography test (ICT) in comparison with enzyme-linked immunosorbent assay (ELISA) to detect rotavirus and adenovirus antigen in fecal specimen among children less than 5 years of age with acute gastroenteritis.

Materials and Methods In a cross-sectional observational study, 314 fecal samples were collected from children aged less than 5 years with acute gastroenteritis attending or admitted to a tertiary care hospital during the 1 year study period. Samples were tested for rotavirus and adenovirus antigen using ICT and ELISA.

Results Among the 314 children evaluated, 112 (35.66%) had rotavirus infection, nine (2.86%) had adenovirus infection, and three (0.95%) had both rotavirus and adenovirus infection. This study found that ICT is 98.20% sensitive and 100% specific for the diagnosis of rotaviral diarrhea and 100% sensitive and 99.7% specific for adenovirus diarrhea, compared to ELISA.

Conclusion Immunochromatography tests used for the detection of rotavirus and adenovirus in the fecal sample showed a high degree of sensitivity and specificity. The ICT is easy to perform and rapid, and it does not require any special equipment. Hence, the ICT could be used as an alternative method for detecting viral pathogens in clinical practice.

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.

Association of Cord Blood Glucose, Sodium, Potassium, and Calcium Levels With Neonatal Birth Asphyxia: A Hospital-Based Study

Context

Neonatal birth/perinatal asphyxia is a serious condition with the potential to cause damage to various tissues of the body especially the brain. Hypoxia can cause metabolic disturbances, which in turn can lead to imbalances in the levels of glucose, electrolytes, and calcium, which can further worsen the condition. Early detection of these biochemical derangements and immediate correction can prevent the complications and lifelong disabilities of birth asphyxia due to injury to vital organs particularly the brain. The aim is to assess any correlation between the cord blood glucose, electrolytes, and calcium levels and the severity of birth asphyxia.

Methods and material

In this study, 50 birth asphyxia neonates with birth weight >2.5 kg, and a 5-minute Apgar score ≤ 6 at birth with clinical evidence of asphyxia were compared with healthy neonates with birth weight > 2.5 kg, and a 5-minute Apgar score > 7. In all the cases and controls, cord blood glucose was estimated by glucose oxidase and peroxidase (GOD-POD) method, total calcium by Arsenazo method, and sodium and potassium were estimated by ion-selective Electrode (ISE) method using fully automated biochemistry analyzers.

Results

The mean cord blood concentrations of glucose, sodium, potassium, and calcium were significantly lower among birth asphyxia neonates in comparison with that of controls (p < 0.05). The correlation coefficient (r) for the study variables among cases indicates that there is a low to moderate positive correlation between the 5-minute Apgar score which is a measure of severity of birth asphyxia and cord blood concentrations of glucose, sodium, and calcium.

Conclusion

In our study, birth asphyxiated neonates were found to have statistically significant low levels of cord blood glucose and electrolytes like sodium and calcium except for potassium. There was a low to moderate positive correlation between cord blood glucose and electrolyte concentrations with the severity of birth asphyxia. Analysis of cord blood for these simple biochemical tests can help pediatricians in the active management of birth asphyxia cases.

Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

BACKGROUND

The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain.

METHODS

We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale.

RESULTS

A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events.

CONCLUSIONS

Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).

Continuous vs Intermittent Phototherapy in the Management of Non-Haemolytic Neonatal Hyperbilirubinemia - A Randomised Non - Inferiority Study

Introduction: Phototherapy is used to manage neonatal hyperbilirubinemia in early life. We aimed to compare between intermittent and continuous phototherapy in reducing TSB, rate of fall of bilirubin, duration of phototherapy and duration of hospitalisation in neonates with non-haemolytic hyperbilirubinemia. Methods: Total 190 neonates who were > 34 weeks and birth weight ≥ 2000 gm were included. They were randomised into group A (continuous phototherapy) and group B (intermittent phototherapy). Group A received phototherapy for three hours and 45 minutes off and group B received phototherapy for three hours and then three hours off. TSB levels estimation were done in both groups and compared after each 12 hours, 24 hours, and 48 hours of commencing phototherapy. Results: The mean TSB at presentation was 15.64 ± 2.19 mg/dl for continuous and 15.03 ± 1.07 mg/dl for intermittent group. Mean TSB at 12, 24, 48 hours were 13.26 ± 2.4 mg/dl, 10.8 ± 1.72 mg/dl, 10.16 ± 0.95 mg/dl respectively for continuous and 12.6 ± 1.65 mg/dl, 10.04 ±1.8 mg/dl, 9.1 ± 0.66 mg/dl respectively for intermittent group (p < 0.05). The mean rate of fall in serum bilirubin was 0.22 ± 0.12 mg/dl/hr for group A and 0.21 ± 0.08 mg/dl/hr for group B (p = 0.45). There was not much difference in mean duration of hospitalisation in both groups (p = 0.547). Conclusions: Intermittent phototherapy is a non-inferior option to continuous phototherapy, in the management of non-haemolytic hyperbilirubinemia with additional advantages of less interrupted mother infant bonding and decreased irradiance.

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.

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.

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.

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.

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.