Descriptive Study of Obstetric Brachial Plexus Palsy (OBPP) at a Tertiary Care Hospital.

Objective: To study the incidence and risk factors for obstetric brachial plexus palsy and assess the functional outcome. Material and Methods: Five-year data of infants with OBPP were reviewed. Case-control study was performed using matched controls to identify the risk factors. Infants with OBPP were followed up to assess functional outcome. Results: Of the 14,184 live births over a period of 5 years from 2013 to 2017, 23 (11 males, 12 females) had OBPP. Incidence of OBPP was 1.6 per 1000 live births. Higher birth weight (p-value 0.002) and instrumental delivery (p-value 0.02) were independent risk factors for obstetric brachial plexus palsy by multivariate logistic regression analysis. No cases of obstetric brachial plexus palsy were seen in babies born by cesarean section. 95% of the infants with obstetric brachial plexus palsy had complete recovery by 4 months of age. Conclusion: Higher birth weight and instrumental vaginal delivery are independent risk factors for obstetric brachial plexus palsy. Cesarean section may have a protective effect against OBPP. Most infants with obstetric brachial plexus palsy have complete recovery.

Multisystem inflammatory syndrome with persistent neutropenia in neonate exposed to SARS-CoV-2 virus: A case report and review of literature.

BACKGROUND: Multisystem inflammatory syndrome in Children (MIS-C) is a postinfectious immune mediated hyperinflammatory state seen in children and adolescent below 21 year of age and develop after 4-6 weeks of severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) infection, however, it is rare in neonates. We report an extremely rare and first of its kind case of MIS-C in a neonate with persistent neutropenia. CASE DESCRIPTION: A 19-day old boy presented with complaints of fever and loose stools for 1 day and developed rash after admission. Baby was investigated for sepsis and commenced on IV antibiotics empirically. In view of persistent fever, diarrhoea, rash and absence of obvious microbial etiology of inflammation, with elevated inflammatory marker and an epidemiologic link to SARS-CoV-2 infection, the diagnosis of MIS-C-was made. Intravenous immunoglobulin (IVIg) was administered and defervescence occurred within 24 hours. He also developed neutropenia during course of illness which persisted on follow up. CONCLUSION: MIS-C in neonates is uncommon and fever with elevated inflammatory markers during COVID-19 pandemic should alert the pediatrician to the possibility of MIS-C. Neutropenia may be associated with MIS-C in neonates and warrants prolonged follow up.

Cytokine Signature Associated with Disease Severity in Dengue.

Dengue is the most rapidly spreading viral disease transmitted by the bite of infected Aedes mosquitos. The pathogenesis of dengue is still unclear; although host immune responses and virus serotypes have been proposed to contribute to disease severity. In this study, we examined the circulating dengue virus (DENV) and measured plasma levels of inflammatory mediators. Ninety-eight patients during a dengue outbreak in eastern India in 2016 were included in the study. The presence of DENV was demonstrated by detecting NS1 antigen; IgM capture ELISA and serotypes were discriminated by type-specific RT-PCR and/or sequencing. Plasma samples were assayed for 41-plex cytokine/chemokines using multiplex Luminex assay. Eighty-five (87%) samples were positive by NS1/IgM capture ELISA/RT-PCR. All four serotypes of DENV were detected in this outbreak, with DENV-2 as the predominant type, seen in 55% of cases. Mixed infections were seen in 39% of subjects. Among the host inflammatory biomarkers, GM-CSF, IFN-γ, IL-10, IL-15, IL-8, MCP-1, IL-6, MIP-1ß, and TNF-α levels were significantly increased in dengue with and without warning signs, in severe dengue patients in comparison to healthy controls. Four cytokines IFN-γ, GM-CSF, IL-10, and MIP-1ß correlated significantly with disease severity and could serve as potential predictor for disease severity. Information on the host biomarkers and the dengue serotype may help guide in optimizing effective intervention strategies.

Structural and Morphological Studies on Li2Fe0.5Mn0.5SiO4/C Composite Synthesized Using Polyvinyl Alcohol for Energy Storage Devices.

In this study, we first focus on effects of PVA surfactant on Li2Fe0.5Mn0.5SiO4/C by using X-ray diffraction, Fourier transform infrared spectroscopy, micro Raman analysis, scanning electron microscope, transmission electron microscope and magnetization measurements. XRD result reveals the formation of new phase (Li2Fe0.5Mn0.5SiO4/C), as a result of embedded carbon, intensity of the peaks was also suppressed. Intensity domination of G-band in micro Raman analysis affirmed that the establishment of graphene formation which was yielded from decomposition of organic materials of both PVA and acetate. Confirmation of Si-O and Si-C bond in the as-prepared material was made by FTIR analyses. A well uniform spherical shaped morphology was observed in both SEM and TEM images. In addition, the TEM picture further demonstrates Li2Fe0.5Mn0.5SiO4/C with average particle size of about 20 nm by PVA introducing.

Long-Term Neurodevelopmental and Growth Outcomes of Premature Infants Born at <29 week Gestational Age with Post-Hemorrhagic Hydrocephalus Treated with Ventriculo-Peritoneal Shunt.

OBJECTIVE: To compare long-term neurodevelopmental and growth (NDG) outcomes at 3 y corrected gestational age (GA) in premature infants with grade ≥ III intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus who were treated with ventriculo-peritoneal shunt with those who were not treated with shunt. METHODS: In a retrospective cohort study, NDG outcomes were compared between preterm infants of <29 wk GA with IVH treated with shunt (IVHS) and IVH with no shunt (IVHNS). This was a single centre study. The primary outcome was moderate to severe cerebral palsy (CP). RESULTS: Of 1762 preterm infants who survived to discharge, 90 had grade ≥ III IVH. Infants in IVHS group had more grade IV IVH than IVHNS (p < 0.05). Seventy percent of the patients in IVHNS groups had no hydrocephalus. IVHS group had increased CP (76% vs. 30%; p 0.003), and higher odds of CP after controlling for GA and IVH grade [odds ratio (OR); 4.23 (1.38 to 13.00)]. Growth delay was not different between groups. CONCLUSIONS: Infants with IVHS are at increased risk of CP but not growth delay.

Comparison of Umbilical Cord Cleansing Using Sterile Water and Povidine Iodine-Spirit During Early Neonatal Period: A Double Blind Randomized Control Trial.

AIM: To compare the effect of umbilical cord care with Povidine Iodine- Spirit on umbilical infection in early neonatal period. MATERIALS AND METHODS: Prospective double blinded randomized controlled study was undertaken to evaluate the effect of daily cleansing of the umbilical cord of term infants with Spirit (Alcohol) -Povidine Iodine combination). This was also compared to the retrospective data obtained for the prevailing practice of keeping the umbilical cord dry. RESULTS: 1518 infants were included in the study. (462 in the "cord care group", 496 in the "water" placebo group, & 560 in "Dry" retrospective group). There was an overall reduction in the clinically screened and evaluated "umbilical infection" in the Povidine -Iodine group. This was attributable to a greater reduction in the mixed bacterial (Colonizer/ commensals) isolates. The Relative Risk for Staph. aureus was lesser when the cord was kept dry (RR 0.6, p<0.01) and sterile water (Placebo) group (RR 0.7, p<0.01). CONCLUSION: Avoiding the antiseptic cleansing increased the RR for commensal / mixed bacterial over growth that would probably facilitate umbilical cord separation.

RD-1 encoded EspJ protein gets phosphorylated prior to affect the growth and intracellular survival of mycobacteria.

Mycobacterium tuberculosis (MTB) synchronizes a number of processes and controls a series of events to subvert host defense mechanisms for the sake of residing inside macrophages. Besides these, MTB also possesses a wide range of signal enzyme systems, including eleven serine threonine protein kinases (STPKs). The present study describes STPK modulated modification in one of the hypothetical proteins of the RD1 region; EspJ (ESX-1 secretion associated protein), which is predicted to be involved in virulence of MTB. We have employed knock-out MTB, and M. bovis BCG as a surrogate strain to elaborate the consequence of the phosphorylation of EspJ. The molecular and mass spectrometric analyses in this study, confirmed EspJ as one of the substrates of STPKs. The ectopic expression of phosphoablative mutants of espJ in M. bovis BCG also articulated the effect of phosphorylation on the growth and in survival of mycobacteria. Importantly, the level of phosphorylation of EspJ also differed between pathogenic H37 Rv (Rv) and non pathogenic H37 Ra (Ra) strains of MTB. This further suggested that to a certain extent, the STPKs mediated phosphorylation may be accountable, in determining the growth and in intra-cellular survival of mycobacteria.

Phosphorylation of pyruvate kinase A by protein kinase J leads to the altered growth and differential rate of intracellular survival of mycobacteria.

PknJ (Rv2088) is a serine/threonine protein kinase of mycobacteria which is present in Mycobacterium tuberculosis (MTB), but its gene is absent in Mycobacterium smegmatis (MS); a fast grower and nonpathogenic species of mycobacteria. The heterologous expression of MTB-specific PknJ in MS altered the growth of recombinant mycobacteria highlighting one of the characteristics of this protein. This nature of the protein was further confirmed when Mycobacterium bovis BCG (BCG) containing antisense copy of pknJ resulted in the increased growth of BCG. The real-time RNA quantification analysis pointed out toward increased expression of this protein during infection of THP-1 macrophage cells which further emphasized that the protein is essential for the intracellular survival of mycobacteria. The differential in gel electrophoresis (DIGE) data followed by mass spectroscopy suggested that PknJ is involved in regulation of pyruvate kinase A (Rv1617). Since pyruvate kinase (PK) A is one of the key enzymes which controls glycolytic cycle in mycobacteria, we looked for its interaction with PknJ during extracellular and intracellular growth of mycobacteria. In order to identify the specific residue(s) involved in post-translational modification, the phospho-null mutants of PK were generated, and their substrate specificities in response to PknJ were assessed through kinase assay. The findings thus underlined that the PK activity is predominantly dependent on the threonine residue at the 94(th) position and further suggested that this site may be plausible in intracellular survival of mycobacteria upon phosphorylation with PknJ.

Putative roles of a proline-glutamic acid-rich protein (PE3) in intracellular survival and as a candidate for subunit vaccine against Mycobacterium tuberculosis.

The proline-glutamic acid (PE) protein family of Mycobacterium tuberculosis (Mtb) plays diverse roles in the pathogenesis and modulation of host immune responses. The uniqueness of conserved regions of PE proteins may be useful to test and validate their corresponding functions. Hence, the present study has been undertaken to demonstrate the role of PE3 (Rv0159c) for persistence, host immune response and immunoprophylaxis. We have expressed Mtb-specific PE3 gene in M. smegmatis (MS) and used the strain to infect J774A.1 macrophage cells and BALB/c mice. It was observed that during the infection, the MS expressing PE3 showed higher bacterial load when compared to infection with wild-type MS. In hypoxic condition, the expression level of PE3 gene was induced in Mtb, which further showed its relevance in the cell survival during hypoxia-induced persistence. The expression level of PE3 in Mtb was markedly induced during chronic stage of murine infection, which reiterated its importance in mycobacterial persistence in the host. The immunization of mice with recombinant PE3 protein stimulated the secretion of TNF, IL-6 and IL-2 cytokines and generated strong protective immunity against challenge with live mycobacteria, which was evidenced by decreased viable bacilli in the lungs, histopathological changes and increased survival of PE3 immunized mice. Conclusively, the results indicated that PE3 plays significant roles in mycobacterial persistence during infection, modulate host immune response and hence could be a prospective candidate for the development of subunit vaccine against tuberculosis.

Synthesis and evaluation of small libraries of triazolylmethoxy chalcones, flavanones and 2-aminopyrimidines as inhibitors of mycobacterial FAS-II and PknG.

A synthetic strategy to access small libraries of triazolylmethoxy chalcones 4{1-20}, triazolylmethoxy flavanones 5{1-10} and triazolylmethoxy aminopyrimidines 6{1-17} from a common substrate 4-propargyloxy-2-hydroxy acetophenone using a set of different reactions has been developed. The chalcones and flavanones were screened against mycobacterial FAS-II pathway using a recombinant mycobacterial strain, against which the most potent compound showed ∼88% inhibition in bacterial growth and substantially induction of reporter gene activity at 100 µM concentration. The triazolylmethoxy aminopyrimdines were screened against PknG of Mycobaceterium tuberculosis displaying moderate to good activity (23-53% inhibition at 100 µM), comparable to the action of a standard inhibitor.

Functional characterization delineates that a Mycobacterium tuberculosis specific protein kinase (Rv3080c) is responsible for the growth, phagocytosis and intracellular survival of avirulent mycobacteria.

Serine/threonine protein kinases (STPKs) are predominantly involved in growth, development, division, differentiation, and in regulating immune responses in mycobacteria. A wide variety of functions of mycobacterial STPKs persuade mycobacterial growth and further its survival in the hosts. The polymorphic studies have shown that a full length gene of Rv3080c (pknK) is present in the slow growing mycobacteria. The wild type Mycobacterium smegmatis containing only vector (M. smegmatis) and M. smegmatis containing Rv3080c (pknK) cloned in pMV261 vector (M. smegmatis::K) were cultured in different growth media. The studies have shown that M. smegmatis did not differ in the growth and in survival while a substantial reduction in the growth (four-ten-folds) and a significant delay in the colony formation were observed in M. smegmatis::K. In order to look for the stage specific and modulated expression of PknK, the study was comprehended to quantitate pknK transcripts at different phases of cultures. The mycobacterium, containing high copy number of pknK specific RNA was unable to multiply. The study thus highlights that Rv3080c is largely accountable for changing the fate of avirulent mycobacteria and hence the protein can be utilized as an important molecule to target pathogenesis.

Plasma glucose levels in term infants who are appropriate size for gestation and exclusively breast fed.

AIM: To evaluate the plasma glucose levels in normal, term infants who were appropriate size for gestational age (AGA) and exclusively breast fed, and to assess the influence of parity of the mother, mode of delivery, and time of feed on the glucose levels. METHOD: A total of 200 healthy, term, AGA infants were longitudinally evaluated at 3, 6, 24, and 72 hours of life. Plasma glucose was estimated from heel prick capillary samples. The influence of mode of delivery, parity, and interval between feeds on plasma glucose was analysed. RESULTS: There was no significant difference between the plasma glucose levels of the cohorts at any of the sampling time points. Parity, mode of delivery, and time since the last feed did not affect plasma glucose. Satisfactory glucose levels were maintained even when infants remained unfed up to 6 hours of age. Infants with plasma glucose concentrations less than 2.2 mmol/l at 3 hours of age were more likely to have low sugar concentration (< 2.5 mmol/l) at 72 hours (RR = 6.55, 95% confidence interval 3.93 to 10.92). CONCLUSIONS: A term, breast fed infant may have its own distinct plasma glucose levels, showing no significant variation between 3 and 72 hours of age. Plasma glucose levels are satisfactorily maintained in normal term infants without resort to prelacteal feeds. Mode of delivery, parity of the mother, and interval between feeds did not influence plasma glucose. Biochemical thresholds for hypoglycaemia do not seem to be of practical importance in asymptomatic, normal, term, breast fed infants.

Mid-thigh circumference--role in assessing the nutritional status of children between 6 years and 12 years of age.

Children between 6 and 12 years form a group at risk for nutritional lag. It has been seen that their growth and nutritional status can be satisfactorily assessed by measuring the mid-thigh circumference, using a fibreglass measuring tape.

Neonatal tuberculosis: a case report.

A 3-week-old baby with neonatally acquired tuberculous bronchopneumonia is presented. The diagnosis was considered because the neonate did not respond to conventional management of bronchopneumonia. The importance of including tuberculosis as a differential diagnosis in respiratory disorders, especially in developing countries, is emphasized.