An Unusual Presentation of Neonatal Sepsis as Hyperleukocytosis With Firm Lymphadenopathy: A Diagnostic Challenge.

The neonatal leukemoid reaction is an acute response of the body to stress. Any inflammatory processes in the newborn period may lead to an increase in the white blood cell (WBC) count. Hyperleukocytosis refers to an extremely elevated leukocyte count beyond 100,000/cubic millimeter (cumm). Here, we report a case of a leukemoid reaction in a newborn who presented with fever, swelling over the neck, and failure to thrive. Peripheral smear showed the presence of all precursors of white blood cells, but no blast cells were seen. Fine needle aspiration cytology (FNAC) did not show any abnormal cells or any evidence of leukemia. Hence, the diagnosis of a leukemoid reaction was made. Hyperleukocytosis presenting as palpable lymphadenopathy in a neonate is a rare finding that was seen in this case secondary to septicemia.

Inflammatory Markers as Early Predictors of Disease Severity in COVID-19 Patients Admitted to Intensive Care Units: A Retrospective Observational Analysis.

Background: In pandemic situations, it is essential that the limited resources are used judiciously to achieve most benefits. Prediction of the disease severity at the earliest will help in better allocation, thus, positively affecting prognosis and treatment. Aim and objective: To investigate patient characteristics and specific biomarkers as possible early predictors of disease severity of SARS-COV-2 infection. Materials and methods: Retrospective single-centric observational study conducted at 70-bedded intensive care unit of tertiary care hospital at Haryana, India. 100 consecutive RT-PCR positive coronavirus disease-2019 (COVID-19) adult patients. Demographics, acute physiology and chronic health evaluation II (Apache-II) score, and Inflammatory markers were compared with respect to oxygenation defect (PaO2/FiO2 ratio: <300 or ≥300 mm Hg), need of invasive ventilation, ICU length of stay and 28-day mortality. Findings: Mean age was significantly more in lower PF ratio group (58.01 ± 15.33 vs 50.97 ± 13.78, p = 0.023) whereas sex ratio was comparable among patients in two groups. Significantly, higher APACHE-II score (p ≤0.001) and presence of hypertension (43.54% vs 23.68%; p = 0·045) in low PF ratio group along with higher C-reactive protein (171.78 ± 124.45 vs 101.52 ± 88.70), IL-6 (173.51 vs 53.18) and ferritin (1677.60 ± 2271.13 vs 643.54 ± 718.68) levels. Procalcitonin, lactate dehydrogenase, and creatine phosphokinase (CPK) levels were not significant. Interpretation: Age and APACHE II score and among laboratory parameters CRP, ferritin, and IL-6 levels were significantly higher in low PF ratio group, patients requiring invasive ventilation and in mortality group. Use of this triad (CRP, ferritin, and IL-6 levels) at admission may predict the disease severity early in the course. Addition of APACHE-II may further improve the accuracy of the score. How to cite this article: Gupta D, Jain A, Chauhan M, Dewan S. Inflammatory Markers as Early Predictors of Disease Severity in COVID-19 Patients Admitted to Intensive Care Units: A Retrospective Observational Analysis. Indian J Crit Care Med 2022;26(4):482-486.

Modeling dark- and light-induced crystal structures and single-crystal optical absorption spectra of ruthenium-based complexes that undergo SO2-linkage photoisomerization.

A family of coordination complexes of the type [Ru(SO2)(NH3)4X]m+Yn - (m, n = 1 or 2) exhibit optical switching capabilities in their single-crystal states. This striking effect is caused by the light-induced formation of SO2-linkage photoisomers, which are metastable if kept at suitably cool temperatures. We modeled the dark- and light-induced states of these large crystalline complexes via plane-wave (PW)- and molecular-orbital (MO)-based density functional theory (DFT) and time-dependent DFT in order to calculate their structural and optical properties; the calculated results are compared with experimental data. We show that the PW-DFT-based periodic models replicate the structural properties of these complexes more effectively than the MO-DFT-based molecular-fragment models, observing only small deviations in key bond lengths relative to the experimentally derived crystal structures. The periodic models were also found to more effectively simulate trends seen in experimental optical absorption spectra, with optical absorbance and coverage of the visible region increasing with the formation of the photoinduced geometries. The contribution of the metastable photoisomeric species more heavily focuses on the lower-energy end of the spectra. Spectra generated from the molecular-fragment models are limited by the geometry of the fragment used and the number of excited-state roots considered in those calculations. In general, periodic models outperform the molecular-fragment models owing to their ability to better appreciate the periodic phenomena that are present in these crystalline materials as opposed to MO approaches, which are finite methods. We thus demonstrate that PW-DFT-based periodic models should be considered as a more than viable method for simulating the optical and electronic properties of these single-crystal optical switches.

3-D Inorganic Crystal Structure Generation and Property Prediction via Representation Learning.

Generative models have been successfully used to synthesize completely novel images, text, music, and speech. As such, they present an exciting opportunity for the design of new materials for functional applications. So far, generative deep-learning methods applied to molecular and drug discovery have yet to produce stable and novel 3-D crystal structures across multiple material classes. To that end, we, herein, present an autoencoder-based generative deep-representation learning pipeline for geometrically optimized 3-D crystal structures that simultaneously predicts the values of eight target properties. The system is highly general, as demonstrated through creation of novel materials from three separate material classes: binary alloys, ternary perovskites, and Heusler compounds. Comparison of these generated structures to those optimized via electronic-structure calculations shows that our generated materials are valid and geometrically optimized.

Preventing inadvertent Endobronchial intubation: Upper incisor to manubriosternal joint length as a predictor of airway length in children.

BACKGROUND: Malpositioning of the endotracheal tube within the airway can lead to serious complications. The estimated insertion depth of the endotracheal tube should be accurate and reliable. AIMS AND OBJECTIVES: To study whether the upper incisor-manubriosternal joint length in the extended head position can be used as a predictor of airway length to guide the depth of insertion of endotracheal tube in children and to evaluate the correlation of upper incisor-manubriosternal joint length with the upper incisor-carina length in the neutral head position, in Indian pediatric population. MATERIALS AND METHODS: After induction of anesthesia, upper incisor-manubriosternal joint length was measured using a flexible metallic tape. Endotracheal tube was inserted and secured in the midline over the upper incisors. The degree of the maximum head extension was recorded with a goniometer, and the upper incisor-carina length was measured with the help of a fiberoptic bronchoscope. RESULTS: Analysis revealed a positive correlation between upper incisor-carina length and upper incisor-manubriosternal joint length (R = .456, R2  = .208, P = .000) and also between upper incisor-carina length and the height of the patient (R = .528, R2  = .279, P-value .000). The degree of maximum head extension did not influence the upper incisor-carina length and the upper incisor-manubriosternal joint length relationship. CONCLUSION: The upper incisor-carina length shows a positive correlation with the patient's upper incisor-manubriosternal joint length and the patient's standing height, while the degree of maximum head extension has no significant bearing on this relationship. The upper incisor-manubriosternal joint length can be used as a predictor of airway length and the depth of insertion of endotracheal tube in children.

Diffuse erythematous rash after teneligliptin therapy: A case report.

We report a yet unreported, adverse effect of teneligliptin [Dipeptidyl peptidase IV inhibitor (DPP IV)] presenting as diffuse pruritic erythematous rash, in a patient, 2 days after initiation of the drug. The rash waned off after the discontinuation of the drug without any residual lesion.