Clinical profile and outcome of cardiac manifestations in patients presenting with multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection

Multisystem inflammatory syndrome in children (MIS-C) can cause significant morbidity and mortality in children. This study was conducted to assess the pattern and outcome of cardiac abnormalities in MIS-C. This retrospective study was conducted in children with MIS-C between 1 month and 18 years. We enrolled 53 children with a mean age of 7.78 ± 4.62 years. Overall, 35.8% of children with MIS-C had cardiac manifestations in the form of coronary artery abnormalities (CAAs) or left ventricular (LV) dysfunction. Younger age (P 0.009) and high C-reactive protein at admission (P = 0.001) were significant predictors of cardiac involvement. CAAs were seen in 11.3% of children. On follow-up, 67% and 83% of children showed regression of CAA at 1 and 6 months, respectively. 24.5% of patients had presented with LV dysfunction. LV ejection fraction improved significantly at 1 month (P = 0.002) and 6 months (P = 0.001). Cardiac outcomes in MIS-C were favorable with timely identification and treatment.

Improving the ACS Triage-Using High Sensitivity TroponinI and Copeptin for Early 'Rule-Out' of AMI

Rule-out of acute myocardial infarction (AMI) in patients presenting with acute chest pain at the emergency department (ED) is a major challenge across the globe. Patients presenting very early with chest pain may provide a diagnostic challenge even when using a cardiac necrosis specific biomarker, high sensitivity troponin (hs-Tn) as they are elevated at 3-6 h after the symptom onset. Copeptin is a marker of acute hemodynamic stress which is released within few minutes of the occurrence of MI and is elevated immediately at the presentation of patients with AMI. This indicates a complementary pathophysiology and kinetics of these two biomarkers. Hence, we evaluated whether or not a protocol with combined testing of copeptin and hs-TnI at admission in patients presenting with chest pain within 6 h in low to intermediate risk and suspected ACS leads to an earlier diagnosis of AMI and thereby, aids to prevent a higher proportion of major adverse cardiac events than the current standard protocol followed in ED. A total of 148 patients as per the inclusion criterion were recruited for the study. The dual biomarker copeptin and hs-TnI allows a rule-out of AMI at presentation with a sensitivity of 100% and NPV of 99.8%. Hence, the use of dual biomarker in conjunction with clinical assessment may obviate the need for a prolonged stay in the ED and retesting hs-TnI after 2 h (for delta check) in more than two-thirds of the patients. The inclusion of these tests could have an impact on the economic burden of the ED without jeopardizing the outcome for the patient.

Regional Public Relations after COVID-19: A new frontier of growth in India’s Public Relations landscape

India - a land of vast cultural & linguistic diversity, where ‘word of mouth’ plays a crucial role in building brands. Public Relations have strongly emerged as an indispensable function for protecting and enhancing reputation. With 70% population of the nation living within the rural or semi-urban geographies, and nearly 34% of the same, annually migrating to urban cities in search of a better livelihood and employment, the role of regional Public Relations becomes more intrinsic to “Integrated Communications and Marketing strategies” for brands. The research paper attempts to understand the following: a) Evolution of consumer consumption and engagement through the lens of regional Public Relations in India b) Introduction of the concept of G-LO-RI: Global – Local-Regional c) Challenges faced by professionals/ agencies The research aims to emphasize the need and importance of regional Public Relations. With the help of in-depth interviews and secondary data, the research will deduce the opportunities and scope to grow in this unorganized and untapped regional territories pan India. The research paper has considered variables - demographic factors, purchasing power, access and dissemination of information and news, effects of social channels and influencers, regional content consumption patterns, and urbanization. The qualitative study of these factors aims to share an outlook and future of regional Public Relations in India. As per existing information available at the time of drafting this research paper, there was no such material or reporting evidence in the context of the role and relevance of regional Public Relations in India. This research paper aims to highlight the current ecosystem, gaps, and key findings and showcase the importance, growth, and challenges of regional Public Relations in India. Interpretations/Implications: This study found that the Regional Public Relations industry has grown multi-folds in the past two decades. There have been many contributing factors instrumental towards this growth size, scale, and reach. This study included a mix of national public relations agency professionals and regional Public Relations agency owners/ founders. They shared their journey and explained the concept, growth and evolution, agency revenue model, team size, opportunities, and challenges on the whole. The level of growth is varied region-wise, while Western, Northern, and Southern regions are hot spots of growth of regional Public Relations business, Eastern and North-East region remain a potential growth market. It was also observed that the affiliate model or the associate model of business is prevalent in the industry. The upcoming trends and practices were also discussed with the participants. The agencies have relied heavily on traditional media for a long time, but there is a gradual shift towards creating more digital content, which is data-driven. In due course of the study, it was evident that industry spending differed from one region to another. FMCG, followed by Automobile and Telecom, were the front runners in spends on regional Public Relations, Government and Education sectors have also caught up. The variation is observed due to the general demand and supply rule and socio-cultural factors, including language, customs, lifestyles & values, playing a crucial role.

Clinical Profile and Outcome of Children Requiring Noninvasive Ventilation (NIV)

OBJECTIVES

To determine the clinical profile and outcome of children requiring noninvasive ventilation (NIV) in a PICU.

METHODS

This prospective observational study was conducted in the PICU at Dayanand Medical College and Hospital, Punjab. Children (1 mo-18 y) with moderate-to-severe respiratory distress who received NIV during one-year period were included. Failure was defined as the need for endotracheal intubation. The patients received bilevel positive airway pressure (BiPAP) with inspiratory and expiratory positive airway pressure (8-18 cm H₂O and 4-8 cm), respectively and indigenous continuous positive airway pressure (CPAP) were included. Vital signs (heart rate, respiratory rate) and gasometric parameters (pH, HCO₃, pCO₂, pO₂) were recorded.

RESULTS

Out of total 115 patients, 81.7% were successfully treated by NIV whereas 18.3% constituted NIV failure group. Two types of NIV were used, 65.2% were started on BiPAP and 34.8% on indigenous bubble CPAP. Most common diagnosis was tropical fever (24.3%), bronchopneumonia (20%), and sepsis with multiple organ dysfunction syndrome (MODS) (7.8%). Commonest indication of NIV was respiratory distress (70.4%) and prevention of postextubation respiratory failure (20.8%). Seven patients (6.9%) died during the study. NIV failure is higher in children with sepsis with MODS, abnormal blood gas (acidosis), and moderate-to-severe acute respiratory distress syndrome (ARDS).

CONCLUSIONS

This study demonstrates that NIV is an effective form of respiratory support for children with acute respiratory distress/failure. Sepsis with MODS, acidosis and ARDS (moderate to severe) were predictors of NIV failure. Careful patient selection may help in judicious use of NIV in PICU.

Comparison of Non-Invasive Oscillometric and Intra-Arterial Blood Pressure Measurements in Children Admitted to the Pediatric Intensive Care Unit

Intra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t-test, Bland–Altman analysis, and Pearson's correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were −3.6 ± 12.85, −4.7 ± 9.3, and −3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively (p < 0.001), with wide limits of agreement. NIBP significantly overestimated BP (p < 0.001) in all three BP states (hypotensive, normotensive, and hypertensive), except systolic blood pressure (SBP) during hypertension where IABP was significantly higher. The difference in SBP was most pronounced during hypotension. The difference in SBP was significant in children <10 years (p < 0.001), with the maximum difference being in infants. It was insignificant in adolescents (p = 0.28) and underweight children (p = 0.55). NIBP recorded significantly higher BP in all states of BP except SBP in the hypertensive state. SBP measured by NIBP tended to be the most reliable in adolescents and underweight children. NIBP was the most unreliable in infants, obese children, and during hypotension.

Role of montelukast in multitrigger wheezers attending chest clinic in Punjab, India

BACKGROUND

Wheeze is seen in 40% of preschool children, one-third of these may develop recurrent wheeze. Montelukast is an oral, once a day, easy to give therapy but there is no definite evidence to support its use in a recent meta-analysis. Present study was done to evaluate role of daily montelukast and various factors affecting the outcome after therapy in multitrigger wheeze (MTW).

METHODS

A prospective study conducted in Pediatric chest clinic over 18 months at DMCH, Ludhiana. Children from 6 months to 5 years, diagnosed cases of MTW were started on montelukast. Diagnosis based on symptoms of recurrent wheeze triggered by various allergens/precipitants was made by pediatrician in charge of chest clinic. Children were followed up at 1 and 3 months. They were labeled as controlled, partially controlled, or uncontrolled as per global initiative for asthma guidelines. Data were used to compare the outcome related to various factors.

RESULTS

Total 139 out of 150 children came for regular follow-up. At the end of 3 months, 94 (67.7%) were controlled, 8 (5.7%) partially controlled, and 37 (26.6%) children remained uncontrolled on montelukast. Factors associated with poor control were onset of symptoms at younger age (<6 months of age), family history of allergies, prior multiple visits or hospitalizations due to MTW, use of MDI in the past. No significant side effects were reported by parents.

CONCLUSION

Symptomatically two-third of children became better after starting montelukast. There were few factors which resulted in poorer control in subset of patients.

Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID-19 (MIS-C)

Objective

To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes.

Methods

This comparative cross-sectional study was done at a tertiary care teaching institute. We enrolled all hospitalized children aged 1 month–18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma.

Results

During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. MIS-C with shock was seen in 15 cases (44%), MIS-C without shock in 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients [100.2 (85.1) vs 16.9 (29.3) mg/dL] (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Mean hospital stay (patient days) was longer in MIS- C compared to dengue fever (8.6 vs 6.5 days; P=0.014).

Conclusions

Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at 10.1007/s13312-021-2329-9.

Role of Sildenafil in Management of Pediatric Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) has high mortality and multiple therapeutic strategies have been used to improve the outcome. Inhaled nitric oxide (INO), a pulmonary vasodilator, is used to improve oxygenation. This study was conducted to determine the role of sildenafil, an oral vasodilator, to improve oxygenation and mortality in pediatric ARDS (PARDS). The prevalence of pulmonary hypertension in PARDS was studied as well. Inclusion criteria included children (1–18 years) with ARDS requiring invasive ventilation admitted to the pediatric intensive care unit of a teaching hospital in Northern India over a 1-year period of time. Thirty-five patients met the inclusion criteria. Cardiologist performed a detailed echocardiogram to determine pulmonary arterial pressure (PAP). Patients with persistent hypoxemia were started on oral sildenafil. The majority (77%) patients had a primary pulmonary etiology of PARDS. Elevated PAP (>25 mm Hg) was detected in 54.3% patients at admission. Sildenafil was given to 20 patients who had severe and persistent hypoxemia. Oxygenation improved in most patients after the first dose with statistically significant improvement in PaO2/FiO2 ratios at both 12 and 24 hours following initiation of therapeutic dosing of sildenafil. Improvement in oxygenation occurred irrespective of initial PAP. Outcomes included a total of 57.1% patients discharged, 28.6% discharged against medical advice (DAMA), and a 14.3% mortality rate. Mortality was related to the severity of PARDS and not the use of sildenafil. This is the first study to determine the effect of sildenafil in PARDS. Sildenafil led to improvement in oxygenation in nearly all the cases without affecting mortality. Due to unavailability of INO in most centers of developing countries, sildenafil may be considered as an inexpensive alternative in cases of persistent hypoxemia in PARDS. We recommend additional randomized controlled trials to confirm the effect of sildenafil in PARDS as determined in this study.

Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum

OBJECTIVE

To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease.

METHODS

A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection.

RESULTS

Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment.

CONCLUSION

New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked.

Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

One-Month Postoperative Horizontal Strabismus Surgery Outcomes Using Adjustable and Nonadjustable Sutures

INTRODUCTION

Previous series suggest adjustable sutures (AS) in adult strabismus surgery yield improved ocular alignment and better success rates compared to nonadjustable sutures (NAS). We questioned whether these differences are clinically significant and whether they justify the added time and discomfort required for AS.

METHODS

We reviewed all available records of adults undergoing horizontal strabismus surgery by the last two authors between 2000 and 2014. Independently, the two surgeons developed a preference for NAS midway through the study period, permitting comparisons between two treatment groups. Results were assessed at one to two months postoperatively. The primary outcome was alignment in primary position at one to two months postoperatively. The secondary outcome was success rate, defined as <10PD residual or consecutive deviation.

RESULTS

We included 184 patients, 68 with AS and 116 with NAS. No significant difference in primary position alignment at 1-2 months was noted between AS and NAS for esotropia (P = .26) or for exotropia (P = .10). Success rates were similar (P = .58 for esotropia and P = .34 for exotropia).

DISCUSSION

Although we acknowledge limitations in this retrospective study, our results suggest that AS overall was not associated with improved alignment or success rates, compared to NAS, at 1- to 2- months postoperatively.

CONCLUSIONS

Although adjustable sutures represent a valuable surgical option at the discretion of individual surgeons and their patients, we no longer routinely use AS in all adult cases. A prospective study to evaluate long-term outcomes would be helpful.

Evaluation of MTBDRsl for detecting resistance in Mycobacterium tuberculosis to second-line drugs

SETTING: Patients with presumed multidrug-resistant tuberculosis (MDR-TB) and undergoing MDR-TB treatment from Rajasthan, India.OBJECTIVE: To compare the GenoType^® MTBDRsl v.1.0 (MTBDRsl) assay capacity to detect resistance to ofloxacin, amikacin, capreomycin, kanamycin and ethambutol in Mycobacterium tuberculosis with phenotypic drug susceptibility testing (DST) using MGIT^™960™ in sputum samples and isolates.DESIGN: Fifty-three smear-positive sputum samples were tested directly by MTBDRsl and 205 MDR-TB isolates were processed using MTBDRsl and DST for five drugs on MGIT960. DNA sequencing was performed in isolates with discordance in the results between the two methods for the gyrA, gyrB and rrs genes.RESULT: Sensitivity and specificity of MTBDRsl was found to be respectively 93.1% and 100% for fluoroquinoline, respectively 75-78% and 100% for aminoglycosides/cyclopeptides, respectively 70% and 92% for ethambutol and respectively 92.3% and 100% for extensively drug-resistant (XDR) TB detection. On sequencing eight discordant isolates for quinolones, mutations were seen in 12.5% of the gyrB gene and among 20 discordant isolates for aminoglycosides/cyclopeptides in the rrs gene in 15% isolates. The turnaround time was 2 days for MTBDRsl vs. 10 days for MGIT960.CONCLUSIONS: MTBDRsl can be used as an initial rapid test for detecting XDR-TB, resistance to quinolones and aminogycosides/cyclopeptides in smear-positive sputum samples.

Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper

BACKGROUND

Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations.

OBJECTIVE

The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India.

METHODS

In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India.

RESULTS

Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents.

CONCLUSION

The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings.

Ginkgo Biloba Extract in Ophthalmic and Systemic Disease, With a Focus on Normal-Tension Glaucoma

Glaucoma is a neurodegenerative eye disease that results in retinal ganglion cell loss and ultimately loss of vision. Elevated intraocular pressure (IOP) is the most common known risk factor for retinal ganglion cell damage and visual field loss, and the only modifiable risk factor proven to reduce the development and progression of glaucoma. This has greatly influenced our approach and assessment in terms of diagnosis and treatment. However, as many as ≥50% of patients with progressive vision loss from primary open angle glaucoma without IOP elevation (≤22 mm Hg) have been reported in the United States and Canada; 90% in Japan and 80% in Korea. Extensive research is currently underway to identify the etiology of risk factors for glaucoma other than or in addition to elevated IOP (so-called "normal-tension" glaucoma; NTG) and use this knowledge to expand available treatment options. Currently, Food and Drug Administration-approved medications for glaucoma exclusively target elevated IOP, suggesting the need for additional approaches to treatment options beyond the current scope as the definition of glaucoma changes to encompass cellular and molecular mechanisms. This review focuses on alternative medical approaches, specifically Ginkgo Biloba extract, as a potential treatment option for normal-tension glaucoma.

Demographics and Outcomes of Spine Surgery in Octogenarians and Nonagenarians: A Comparison of the National Inpatient Sample, MarketScan and National Surgical Quality Improvement Program Databases

Introduction

Despite the increasing use of national databases to conduct spine research, questions remain regarding their study validity and consistency. This study tested for similarity and inter-database reliability in reported measures between three commonly used national databases.

Methods

International Classification of Diseases, 9th edition (ICD-9) codes were used to identify elderly (80-100 years) who underwent spine surgery patients in Truven Health Analytics MarketScan® claims database, National (Nationwide) Inpatient Sample (NIS) discharge database and National Surgical Quality Improvement Program (NSQIP) database (2006-2016). Patient baseline characteristics, comorbid status, insurance enrollment, and outcomes were queried and compared. 

Results

We analyzed 15,105 MarketScan, 40,854 NIS, and 7682 NSQIP patients between ages 80 to 100 years (median, 82 years) who underwent spine surgeries during the study period. A majority of patients in both MarketScan and NIS were insured by Medicare (97% vs. 94%). Patients in MarketScan had lower comorbidity scores (comorbidity, 0-2) compared to those in NIS and NSQIP databases. The most common diagnosis was spinal stenosis in MarketScan (54.4%), NIS (54.6%), and NSQIP databases (65.2%). Fusion was the most common procedure performed in MarketScan (48.9%) and NIS databases (46.2%), whereas decompression (laminectomy/laminotomy) was the most common procedure in the NSQIP database (51.84%). In-hospital complications (any) were 6.5% in the MarketScan cohort, 5.3% in the NIS, and 2.02% in the NSQIP cohort. In terms of 30-day complications (any), the MarketScan database reported higher complications rate (12.7%) compared to the NSQIP database (5.08%). In-hospital mortality was slightly higher in the NIS database (0.32%) compared to MarketScan (0.21%) and NSQIP database (0.2%). MarketScan and NIS databases showed an increased risk of complications with increasing age, whereas NIS and NSQIP showed increasing complications with a higher number of comorbidities. Male gender had higher complication at 30-day post-discharge using MarketScan and NSQIP database.

Conclusions

Patients in the NSQIP and NIS database have more comorbidities; patients in the MarketScan database had the highest number of perioperative and 30-day post-discharge complications with the highest number of fusion procedures performed. Patients in the NSQIP database had the lowest number of fusion procedures and complication rates. As databases gain popularity in spine surgery, clinicians and reviewers should be cautious in generalizing results to whole populations and pay close attention to the population being represented by the data from which the statistical significance was derived.

Jejunal stricture due to mucormycosis

Mucormycosis is generally considered to be an acute, rapidly progressing, opportunistic fungal infection. Chronic manifestations are extremely rare. Mucormycosis affecting the jejunum is very rare and few cases have been reported. We report a case of mucormycosis causing jejunal stricture in an infant aged six months.

Structural exploration of hydroxyethylamines as HIV-1 protease inhibitors: new features identified

The current study deals with chemometric modelling strategies (Naïve Bayes classification, hologram-based quantitative structure-activity relationship (HQSAR), comparative molecular field analysis (CoMFA) and comparative molecular similarity index analysis (CoMSIA)) to explore the important features of hydroxylamine derivatives for exerting potent human immunodeficiency virus-1 (HIV-1) protease inhibition. Depending on the statistically validated reliable and robust quantitative structure-activity relationship (QSAR) models, important and crucial structural features have been identified that may be responsible for enhancing the activity profile of these hydroxylamine compounds. Arylsulfonamide function along with methoxy or fluoro substitution is important for enhancing activity. Bulky steric substitution at the sulfonamide nitrogen disfavours activity whereas smaller hydrophobic substitution at the same position is found to be favourable. Apart from the crucial oxazolidinone moiety, pyrrolidine, cyclic urea and methyl ester functions are also responsible for increasing the HIV-1 protease inhibitory profile. Observations derived from these modelling studies may be utilized further in designing promising HIV-1 protease inhibitors of this class.

Hydroxyethylamine derivatives as HIV-1 protease inhibitors: a predictive QSAR modelling study based on Monte Carlo optimization

Application of HIV-1 protease inhibitors (as an anti-HIV regimen) may serve as an attractive strategy for anti-HIV drug development. Several investigations suggest that there is a crucial need to develop a novel protease inhibitor with higher potency and reduced toxicity. Monte Carlo optimized QSAR study was performed on 200 hydroxyethylamine derivatives with antiprotease activity. Twenty-one QSAR models with good statistical qualities were developed from three different splits with various combinations of SMILES and GRAPH based descriptors. The best models from different splits were selected on the basis of statistically validated characteristics of the test set and have the following statistical parameters: r² = 0.806, Q² = 0.788 (split 1); r² = 0.842, Q² = 0.826 (split 2); r² = 0.774, Q² = 0.755 (split 3). The structural attributes obtained from the best models were analysed to understand the structural requirements of the selected series for HIV-1 protease inhibitory activity. On the basis of obtained structural attributes, 11 new compounds were designed, out of which five compounds were found to have better activity than the best active compound in the series.

Accumulation of stem sugar and its remobilisation in response to drought stress in a sweet sorghum genotype and its near-isogenic lines carrying different stay-green loci

Near isogenic lines (NILs) of sweet sorghum genotype S35 into which individual stay green loci were introgressed, were used to understand the contribution of Stay green loci to stem sugar accumulation and its remobilization under drought stress exposure. Sugar and starch content, activities of sugar metabolism enzymes and levels of their expression were studied in the 3rd (source) leaf from panicle and the 5th (sugar storing) internode of the three lines, in irrigated plants and in plants exposed to a brief drought exposure at the panicle emergence stage. Annotation of genes in the respective Stay green loci introgressed in the NILs was carried out using bioinformatics tools. The leaves of NILs accumulated more photoassimilates and the internodes accumulated more sugar, as compared to the parent S35 line. Drought stress exposure led to a decrease in the starch and sugar levels in leaves of all three lines, while an increase in sugar levels was observed in internodes of the NILs. Sugar fluxes were accompanied by alterations in the activities of sugar metabolizing enzymes as well as the expression of genes related to sugar metabolism and transport. Remobilization of sugars from the stem internodes was apparent in the NILs when subjected to drought stress, since the peduncle, which supports the panicle, showed an increase in the sugar content, even when photoassimation in source leaves was reduced. Several genes related to carbohydrate metabolism were located in the Stay green loci, which probably contributed to variation in the parameters studied.

National trends following decompression, discectomy, and fusion in octogenarians and nonagenarians

BACKGROUND

The National Inpatient Sample (NIS) database is used to evaluate a wide variety of surgical procedures across a range of specialties. The authors of this study assess national trends of the three commonest spine procedures performed (decompression, fusion, and discectomy) in patients between the ages of 80 and 100 years (octogenarians and nonagenarians).

METHODS

The NIS database was queried to identify patients between the ages of 80 and 100 with a primary diagnosis of spinal stenosis, disk herniation without myelopathy, or protrusion due to degeneration of spine/disk disorders and who have undergone spinal decompression, fusion, or discectomy between the years 1998 and 2011. Variables of concern included length-of-stay (LOS), non-routine discharge, average total charges, in-hospital complications, and mortality rate.

RESULTS

Decompression was the most common procedure performed (n = 113,267, 50.5%). Fusion (n = 60,345, 26.9%) was associated with the longest LOS (5.1 days), highest in-hospital complication and mortality rates (n = 13,170, 21.8% and n = 449, 0.7%, respectively), most non-routine discharges (n = 42,662, 70.7%), and highest mean for average total charges ($69,295) (p < 0.001). Discectomy (n = 50,740, 22.6%), had the shortest LOS (3.7 days), lowest complication and mortality rates (n = 6823, 13.4% and n = 102, 0.2%, respectively), fewest non-routine discharges (n = 22,861, 45.1%), and lowest mean for average total charges ($22,787) (p < 0.001).

CONCLUSIONS

Decompression was most common. Fusion had the longest LOS, highest complication and mortality rates, most non-routine discharges, and was most expensive. Discectomy was least commonly performed, had the shortest LOS, lowest complication and mortality rates, fewest non-routine discharges, and was least expensive.

Combining additive manufacturing and catalysis: a review

A review on additive manufacturing (AM) applied to heterogeneous catalysis reveals enabling power of AM and challenges to overcome in chemical interfacing and material printability.

Rapid detection of rifampicin resistance in Mycobacterium tuberculosis by high-resolution melting curve analysis

SETTING

High-resolution melting curve analysis (HRMA) can be used to screen for mutations in genes without the need for specific probes, with low turnaround time and high cost-effectiveness.

OBJECTIVE

To detect the sensitivity and specificity of a line-probe assay (LPA) and HRMA in comparison with BACTEC™ MGIT™ 960 for the detection of rifampicin (RMP) resistance.

DESIGN

A total of 219 Mycobacterium tuberculosis isolates tested by MGIT 960 for RMP susceptibility were tested with HRMA and LPA. Discordant samples were processed for sequencing of the RMP resistance-determining region (RRDR) of the rpoB gene.

RESULTS

HRMA identified 93 of 103 (90.3%) isolates that were resistant and 113/116 (97.4%) that were susceptible on MGIT 960, with a sensitivity and specificity of respectively 90.3% and 97.4%. HRMA identified 117/119 (98.3%) LPA-susceptible and 94/100 (94%) resistant isolates, with 98.3% specificity and 94% sensitivity. Two isolates that were susceptible on LPA but resistant on HRMA showed silent mutations at 539 and 541 codons on sequencing, while 6 isolates that were susceptible on HRMA but resistant on LPA showed D516V (n = 4) and H526C/D (n = 2) mutations. Four isolates (3.9%) that were resistant on MGIT were susceptible on all three genotypic methods, which could be due to mutations outside the RRDR or efflux pumps.

CONCLUSION

HRMA shows good potential as a rapid screening tool for the detection of drug resistance.

Systemic jasmonic acid modulation in mycorrhizal tomato plants and its role in induced resistance against Alternaria alternata

Tomato plants colonised with the arbuscular mycorrhizal (AM) fungus Glomus fasciculatum show systemic induced resistance to the foliar pathogen Alternaria alternata, as observed in interactions of other AM-colonised plants with a range of pathogens. The role of jasmonic (JA) and salicylic (SA) acid in expression of this mycorrhiza-induced resistance (MIR) against A. alternata was studied by measuring: (i) activity of enzymes reported to be involved in their biosynthesis, namely lipoxygenase (LOX) and phenylammonia lyase (PAL); and (ii) levels of methyl jasmonate (MeJA) and SA. Transcript abundance of some defence genes associated with JA and SA response pathways were also studied. Both LOX and PAL activity increased twofold in response to pathogen application to control plants. AM-colonised plants had three-fold higher LOX activity compared to control plants, but unlike controls, this did not increase further in response to pathogen application. Higher LOX activity in AM-colonised plants correlated with four-fold higher MeJA in leaves of AM-colonised plants compared to controls. Treatment of plants with the JA biosynthesis inhibitor salicylhydroxamic acid (SHAM) led to 50% lower MeJA in both control and AM-colonised plants and correlated with increased susceptibility to A. alternata, suggesting a causal role for JA in expression of MIR against the pathogen. Genes involved in JA biosynthesis (OPR3) and response (COI1) showed six- and 42-fold higher expression, respectively, in leaves of AM-colonised plants compared to controls. AM-colonised plants also showed increased expression of the SA response gene PR1 and that of the wound-inducible polypeptide prosystemin. Our results suggest that the systemic increase in JA in response to AM colonisation plays a key role in expression of MIR against A. alternata.

A direct observation of bacterial coverage and biofilm formation by Acidithiobacillus ferrooxidans on chalcopyrite and pyrite surfaces

To obtain a fundamental understanding of the population behaviour of Acidithiobacillus ferrooxidans at chalcopyrite and pyrite surfaces, the early stage attachment behaviour and biofilm formation by this bacterium on chalcopyrite (CuFeS2) and pyrite (FeS2) were studied by optical microscopy, Raman spectroscopy, time-of-flight secondary ion mass spectrometry (ToF-SIMS) and electron backscatter diffraction (EBSD). The results indicate there was no significant difference in selectivity of bacterial attachment between chalcopyrite and pyrite. However, the result of ToF-SIMS analysis suggests that the surface of the pyrite was covered more extensively by biofilm than that of the chalcopyrite, which may indicate more extracellular polymeric substances (EPS) formation by bacterial cells growing on pyrite. EBSD and optical image analysis indicated that selectivity of bacterial attachment to chalcopyrite was not significantly affected by crystal orientation. The results also suggest that the bacterial population in defective areas of chalcopyrite was significantly higher than on the polished surfaces.

Cleidocranial dysplasia with autosomal dominant inheritance pattern

Cleidocranial dysplasia (CCD) is an autosomal dominant disease with a wide range of expression, characterized by clavicular hypoplasia, retarded cranial ossification, delayed bone and teeth development, supernumerary teeth, stomatognathic, craniofacial and skeletal abnormalities. This paper presents a case of CCD in a female with brachycephalic skull, depressed frontal bone and nasal bridge, hypoplastic middle one-third of face with mandibular prognathism and hyper mobility of both shoulders with associated radiographic features. Odontologist is often the first professional who patient of CCD approaches, since there is a delay in the eruption or absence of permanent teeth. The premature diagnosis allows a scope for proper treatment modalities, offering a better life quality for patient.