Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis.

AIM: (i) To compare perfusion index (PI) and plethysmography variability index (PVI) between neonates with proven or probable sepsis versus no-sepsis, (ii) to examine an association of PI and PVI with in-hospital mortality. METHODS: We enrolled neonates with clinically presumed sepsis. Culture-proven or probable sepsis were categorised as 'cases' and no-sepsis as 'controls'. PI and PVI were recorded hourly for 120 h and averaged in 20-time epochs (0-6 h to 115-120 h). RESULTS: We analysed 148 neonates with sepsis (proven sepsis = 77, probable sepsis = 71) and 126 with no-sepsis. Neonates with proven/probable sepsis and no-sepsis had comparable PI and PVI values. Among 148 neonates with sepsis, 43 (29%) died. Non-survivors had significantly lower PI values than survivors (mean difference 0.21 [95% CI 0.14-0.29], p-value <0.001). PI had a significant but modest discriminative ability to identify non-survivors. However, PI did not independently predict mortality. CONCLUSION: Neonates with proven/probable sepsis and no-sepsis had comparable PI and PVI values in the first 120 h of sepsis. PI but not PVI values were significantly lower in non-survivors than survivors. PI did not independently predict in-hospital mortality. Due to modest discriminative ability, PI should be interpreted along with other vital signs to take clinical decisions.

Early Blood Pressure Changes in Neonatal Sepsis and the Risk of Mortality.

OBJECTIVES: To compare blood pressures (BP) between neonates with culture-proven sepsis and clinical sepsis in the first 120 h of sepsis onset and to examine association between BP and in-hospital mortality. METHODS: In this cohort study, consecutively enrolled neonates with 'culture-proven' sepsis [growth in blood/ cerebrospinal fluid (CSF) within 48 h] and clinical sepsis (sepsis workup negative, cultures sterile) were analyzed. Their BP was recorded every 3-hourly for initial 120 h and averaged in 20 time-epochs of 6 h each (0-6 h to 115-120 h). BP Z-scores were compared between neonates with culture-proven vs. clinical sepsis and survivors vs. non-survivors. RESULTS: Two hundred twenty eight neonates (102-culture-proven and 126-clinical sepsis) were enrolled. Both groups had comparable BP Z-scores except significantly lower diastolic BP (DBP) and mean BP (MBP) in 0-6 and 13-18 time-epochs in culture-proven sepsis group. Fifty-four neonates (24%) died during their hospital stay. BP Z-scores in the initial 54 h of sepsis were independently associated with mortality [systolic BP (SBP) Z-scores in first 54 h, DBP Z-scores in first 24 h, and MBP Z-scores in first 24 h] after adjusting for gestational age, birth weight, cesarean delivery, and 5-min Apgar score. On receiver operating characteristic curves, SBP Z-scores showed better discriminative ability than DBP and MBP to identify non-survivors. CONCLUSIONS: Neonates with culture-proven and clinical sepsis had comparable BP Z-scores except low DBP and MBP in the initial few hours in culture-proven sepsis. BP in initial 54 h of sepsis was significantly associated with in-hospital mortality. SBP discriminated non-survivors better than DBP and MBP.

Predictors of Mortality in Neonatal Shock: A Retrospective Cohort Study.

OBJECTIVES: To study the incidence, clinical profile, and predictors of mortality in neonatal shock. METHODS: We enrolled consecutive inborn neonates, who developed shock during hospital stay (between January 1, 2018 to December 31, 2019) at a tertiary-care, research center of northern India. We retrieved the clinical data from our electronic database, case record files, nursing charts, and laboratory investigations from the hospital's Health Information System. Non-survivors were compared with survivors to identify independent predictors of mortality. RESULTS: We had 3,271 neonatal admissions during the study period. We recorded 415 episodes of neonatal shock in 392 neonates [incidence 12.0% (95% confidence interval: 10.9%-13.2%)]. Of 415 episodes, 237 (57%) episodes were identified as septic shock, 67 (16%) episodes as cardiogenic shock, and six (1.4%) episodes as obstructive shock. Remaining 105 (25%) episodes were contributed by more than one etiology of shock. There were 242 non-survivors among 392 neonates with shock (case fatality rate: 62%). On univariate analysis, gestational age, birth weight, incidence of hyaline membrane disease, early-onset sepsis, Acinetobacter sepsis, and cardiogenic shock were significantly different between survivors and non-survivors. Female gender and small for gestational age (SGA) neonates showed a trend of significance. On multivariable regression analysis, we found gestational age, SGA neonates, female gender, and Acinetobacter sepsis to have an independent association with mortality. CONCLUSIONS: Septic shock was the commonest cause of neonatal shock at our center. Neonatal shock had very high case fatality rate. Gestational age, SGA, female gender, and Acinetobacter sepsis independently predicted mortality in neonatal shock.

Getting to the First 90: Incentivized Peer Mobilizers Promote HIV Testing Services to Men Who Have Sex With Men Using Social Media in Mumbai, India.

Recent studies of Indian men who have sex with men (MSM) have shown widespread use of social media for seeking sex partners. We piloted a peer mobilization approach to explore the feasibility of engaging previously unreached MSM online to link them to HIV testing services (HTS). MSM were encouraged to seek HTS through messages posted on a popular dating website. Those who visited the designated HTS site and tested for HIV were recruited as peer mobilizers and given coupons with unique identifying codes to distribute to other men in their virtual networks. If a network member presented at the site with a coupon and tested for HIV, the peer mobilizer was given a small monetary incentive. Network members presenting at the testing site were also recruited as peer mobilizers and given coupons. In a 6-month period, 247 MSM were recruited and tested for HIV and syphilis, of whom 244 (99%) were first-time testers. Two-thirds were less than 25 years old and about half reported inconsistent or no condom use during the last 10 anal sex acts. Eight individuals (3.2%) tested positive for HIV, and 22 (8.9%) had a high titer for syphilis; all were referred to tertiary hospitals for treatment. Our approach was modestly successful in reaching and providing HTS to previously unreached MSM, but challenges included lower-than-expected recruitment, individuals not returning for posttest counseling, and loss to follow-up of individuals with HIV. The next phase of peer mobilization will aim to scale up these services through government-supported targeted interventions for this subpopulation of primarily young, unreached MSM at high risk. The challenges will be addressed by targeting more dating sites, increasing access to testing using rapid HIV tests at several community-based facilities, and offering peer navigation support for people living with HIV.

Evaluation of 3 T lung magnetic resonance imaging in children with allergic bronchopulmonary aspergillosis: Pilot study.

OBJECTIVE: To evaluate the diagnostic performance of 3 T lung magnetic resonance imaging (MRI) in children with allergic bronchopulmonary aspergillosis (ABPA). MATERIALS AND METHODS: This study protocol was approved by the institutional ethics committee. From October 2015 to January 2018, we prospectively evaluated twenty-seven consecutive children with ABPA. The diagnosis of ABPA was made on the ISHAM-ABPA working group criteria. High resolution computed tomography (HRCT) and 3 T MRI of the chest was performed on the same day. Bronchiectasis, consolidation, nodules, and mucus impaction were assessed in all segments. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI were calculated using HRCT findings as the reference standard. Interobserver agreement was calculated using the kappa statistic. RESULTS: The mean age of the patients was 9.89 years (range: 5-16 years). There were 20 males and 7 females. The sensitivity, specificity, PPV, and NPV for bronchiectasis was 68%, 100%, 100% and 71.43% respectively. The sensitivity, specificity, PPV, and NPV for consolidation was 80%, 100%, 100% and 96% respectively. For detection of nodules, the sensitivity, specificity, PPV, and NPV was 75%, 100%, 100% and 88.46% respectively. There was 100% sensitivity, specificity, PPV and NPV for mucus impaction. There was a high degree of interobserver agreement for MRI findings (k = 0.9-1) as well as agreement (k = 0.7-1) between CT and MRI for all the four findings. CONCLUSION: With the currently available routine MR sequences, MRI demonstrates high specificity but less sensitivity and negative predictive value to HRCT scan in children with ABPA. Newer MR sequences need to be explored and validated to enhance the potential of lung MRI in ABPA.

The S-layer biogenesis system of Synechocystis 6803: Role of Sll1180 and Sll1181 (E. coli HlyB and HlyD analogs) as type-I secretion components for Sll1951 export.

Multiple secretion pathways are known for export of protein(s) forming the S-layer in bacteria. The unicellular model cyanobacterium Synechocystis sp. strain PCC 6803 (hereafter S. 6803) also possesses a well-defined S-layer composed of Sll1951 protein. However, the mechanism of its secretion is not completely understood. In the present study, the putative T1SS (Type I secretion system) components, Sll1180 and Sll1181 [inner membrane ABC transporter and membrane fusion protein (MFP), respectively] were characterized for their role in Sll1951 secretion. The corresponding ORFs i.e. sll1180 and sll1181 were inactivated by insertion of a spectinomycin resistance gene. The viability of the homozygous mutants of both the genes indicated dispensability of the corresponding proteins under the experimental conditions. Interestingly, the culture supernatants of the mutants i.e. Δsll1180 and Δsll1181, lacked Sll1951 as observed on SDS-PAGE and confirmed by mass spectrometry. Immunofluorescence delineated a distinct outer ring of Sll1951 in S. 6803 cells only that was further iterated by transmission and scanning electron microscopy. The loss of S-layer imparted an aggregative phenotype to both the mutants. Surprisingly, Δsll1181 cells showed increased sensitivity to different antibiotics indicating a role in multidrug efflux. This is the first report establishing Sl1180 and Sll1181 proteins as partners of the previously characterized Slr1270, for Sll1951 secretion and thus S-layer biogenesis in S. 6803. Sll1181 (in conjunction with Slr1270) also acts as MFP in multidrug efflux along with a yet uncharacterized inner membrane protein.