The Role of Sirtuin-1 Isoforms in Regulating Mitochondrial Function.

The sirtuin-1 (SIRT1) gene contains multiple exons that usually undergo alternative splicing. The exclusion of one or more exons causes domain loss in the alternatively spliced isoforms and may change their functions. However, it is not completely established to what extent the loss of a non-catalytic domain could affect its regulatory function. Using muscle cells and SIRT1-knockout cells, we examined the function of the constitutively spliced isoform (SIRT1-v1) versus the alternatively spliced isoforms SIRT1-v2 and SIRT1-v3 that had lost part of the N-terminal region. Our data indicate that partial loss of the N-terminal domains in SIRT1-v2 and SIRT1-v3 attenuated their function. The full-length SIRT1-v1 significantly increased the oxidative phosphorylation and ATP production rate. Furthermore, SIRT1-v1 specifically upregulated the mitochondrial respiratory complex I without affecting the activity of complexes II, III, and IV. Additionally, domain loss affected the regulation of site-specific lysine acetylation in the histone H4 protein, the gene expression of respiratory complex I subunits, and the metabolic balance of oxidative phosphorylation versus glycolysis. Since alternatively spliced isoforms tend to increase with advancing age, the impact of SIRT1 isoforms on mitochondrial respiratory complexes warrants further investigation.

Physiological responses of European sea bass (Dicentrarchus labrax) exposed to increased carbon dioxide and reduced seawater salinities.

BACKGROUND: The iono- and osmoregulatory capacities of marine teleosts, such as European sea bass (Dicentrarchus labrax) are expected to be challenged by high carbon dioxide exposure, and the adverse effects of elevated CO2 could be amplified when such fish migrate into less buffered hypo-osmotic estuarine environments. Therefore, the effects of increased CO2 on the physiological responses of European sea bass (Dicentrarchus labrax) acclimated to 32 ppt, 10 ppt and 2.5 ppt were investigated. METHODS: Following acclimation to different salinities for two weeks, fish were exposed to present-day (400 µatm) and future (1000 µatm) atmospheric CO2 for 1, 3, 7 and 21 days. Blood pH, plasma ions (Na+, K+, Cl-), branchial mRNA expression of ion transporters such as Na+/K+-ATPase (NKA), Na+/K+/2Cl- co-transporters (NKCC) and ammonia transporters (e.g. Rhesus glycoproteins Rhbg, Rhcg1 and Rhcg2) were examined to understand the iono- and osmoregulatory consequences of elevated CO2. RESULTS: A transient but significant increase in the blood pH of exposed fish acclimated at 10 ppt (day 1) and 2.5 ppt (day 21) was observed possibly due to an overshoot of the blood HCO3- accumulation while a significant reduction of blood pH was observed after 21 days at 2.5ppt. However, no change was seen at 32 ppt. Generally, Na + concentration of control fish was relatively higher at 10 ppt and lower at 2.5 ppt compared to 32 ppt control group at all sampling periods. Additionally, NKA was upregulated in gill of juvenile sea bass when acclimated to lower salinities compared to 32 ppt control group. CO2 exposure generally downregulated NKA mRNA expression at 32ppt (day 1), 10 ppt (days 3, 7 and 21) and 2.5ppt (days 1 and 7) and also a significant reduction of NKCC mRNA level of the exposed fish acclimated at 32 ppt (1-3 days) and 10 ppt (7-21 days) was observed. Furthermore, Rhesus glycoproteins were generally upregulated in the fish acclimated at lower salinities indicating a higher dependance on gill ammonia excretion. Increased CO2 led to a reduced expression of Rhbg and may therefore reduce ammonia excretion rate. CONCLUSION: Juvenile sea bass were relatively successful in keeping acid base balance under an ocean acidification scenario. However, this came at a cost for ionoregulation with reduced NKA, NKCC and Rhbg expression rates as a consequence.

Stress Levels in Mothers of Admitted Newborns in NICU and Effect of Counseling.

OBJECTIVES: To examine the effect of counseling on stress levels in mothers of neonates admitted to the Neonatal Intensive Care Unit (NICU). METHODS: This prospective research was carried out from January 2020 to December 2020 in a central India teaching hospital providing tertiary care. Parental Stressor Scale (PSS):NICU questionnaire was used to measure maternal stress among mothers of 540 admitted infants between 3 and 7 d of admission. Counseling was done at the time of recruitment and its effect was measured after 72 h and re-counseling was done. This cycle of stress assessment and counseling was repeated every 72 h till the baby was admitted in the NICU. Overall stress levels for each subscale were determined, and pre- and post-counseling stress was compared. RESULTS: For the subscales of sight and sound, appearance and behavior, change in the parental role, and staff behavior and communication, the median scores were 1.5 (IQR-1.2-1.88), 2.5 (2.3-2.9), 3.3 (3.0-3.6) and 1.3 (1.1-1.62), respectively indicating high stress in the parental role alteration. Counseling was effective in reducing stress levels among all mothers irrespective of various maternal factors (p <0.01). Stress reduces more with increasing number of counseling, as suggested by higher change in the stress score with increased number of counseling. CONCLUSIONS: This study shows that NICU mothers are under remarkable stress and repeated counseling sessions targeted at particular concerns might assist.

Role of fetal hemoglobin in the development and progression of retinopathy of prematurity in preterm infants.

Purpose: The objective of this study was to find the association between fetal hemoglobin (HbF) concentration and retinopathy of prematurity (ROP) in preterm infants. Methods: In this observational, prospective, longitudinal study, a total of 410 preterm infants with <36 gestational weeks and <2.5 kg birth weight, who were attending ROP clinic in a tertiary care hospital of central India for 1 year duration were included. Dilated fundus examination was done as per ROP screening guidelines, and ROP was staged as per international classification for retinopathy of prematurity (ICROP) classification, 2021. HbF (%) was measured with high-performance liquid chromatography, and data was analyzed statistically. The relationship between HbF (%) and ROP was evaluated. Those infants who had ROP were further divided into treatment-requiring and non-treatment-requiring groups and HbF was compared in these groups at the first visit and after 1-month follow-up period. The outcome of ROP was studied with HbF levels. Results: A total of 410 preterm infants were included, out of which 110 infants had ROP (26.8%). Infants with ROP had significantly lower percentage of HbF with gestational age groups and birth weight groups, compared to infants without ROP. Higher percentage of HbF was associated with a lower prevalence of ROP. Higher concentration of HbF was found in the ROP infants who regressed spontaneously without treatment and less concentration was found in those who progressed to a severe disease and those who required treatment. The predictive ability of HbF (%) was 0.976 for ROP. Conclusion: Low fraction of HbF was found to be significantly associated with the development and progression of ROP.

Psychiatric disorders and caregiver burden in children with transfusion dependent ß-thalassaemia and their caregivers.

BACKGROUND: Children with thalassemia need care from the first years of life owing to the physical and psychological effects of their disorder. Thalassemia is a concern not only for the children's physical health but also the mental health of themselves and their caregivers. AIM: To screen the psychosocial problems and assessment of psychiatric morbidities among thalassaemic children and their caretakers, along with an assessment of caregiver burden in them. METHODS: In this observational cross-sectional study, children with transfusion-dependent thalassemia, were included and were assessed for psychiatric morbidity and global functioning. Their parents were assessed for psychiatric morbidity and the caregiver burden they faced. All the parents completed two different questionnaires to assess their knowledge about the psycho-social functioning [using Pediatric Symptom Checklist-35 (PSC-35)] of their children and the level of the burden faced by them by Caregiver Burden Scale (CBS). RESULTS: A total of 46 children (28 boys and 18 girls) with transfusion-dependent thalassemia with a mean age of 8.83 ± 2.70 years and 46 parents (12 fathers and 34 mothers) were included in this study. More than 32 children had some psychosocial problems on screening by PSC-35. On assessment by CBS moderate caregiver burden was perceived in domains of general strain, isolation, disappointment, emotional involvement, and environment. A total of 65.3% of children and 62.7% of parents were diagnosed with psychiatric problems. CONCLUSION: Thalassemia affects not only the persons with the disorder but also their caregivers in several aspects, including their psychosocial well-being. This study emphasizes the role of a supportive group in the psychological well-being of caregivers, which could be used to prevent the pathological effects of caregiver burden and enhance their psychological well-being through counselling.

Risk Factors of Delirium in Children in Pediatric Intensive Care Unit.

OBJECTIVES: To determine the prevalence of delirium and its risk factors among children admitted to a Pediatric intensive care unit (PICU). METHOD: A descriptive study in which consecutive patients admitted to the PICU over a period of 12 months were screened daily for delirium using the Cornell Assessment of Pediatric Delirium (CAPD) score. Treatment-related and demographic variables were collected and analyzed. The statistically significant risk factors for delirium were analyzed by multivariable logistic regression for independent associations. RESULTS: Among the 476 screened patients, 96 (20.2%) developed delirium. The independent risk factors associated with the development of delirium were respiratory failure (P<0.001), administration of benzodiazepines during PICU stay (P<0.001), and presence of multiple (≥2) risk factors for delirium (P<0.001). The mean length of PICU stay was significantly higher among delirious subjects with P<0.001. CONCLUSION: Delirium is a frequent complication in critically ill children, and recognition of associated factors may assist in early diagnosis and focussed management.

Coping strategies in response to different levels of elevated water hardness in channel catfish (Ictalurus punctatus): Insight into ion-regulatory and histopathological modulations.

Water hardness above the optimal level can incite toxic effects in fish, which are often species specific. Hence, we aimed at obtaining insights on the potential effects of elevated water hardness as well as coping strategies in channel catfish (Ictalurus punctatus). First, a toxicity assay was performed where the 96 h-LC50 was calculated as 4939 mg/L CaCO3. Thereafter, to gain knowledge on the underlying adaptive strategies to high water hardness, fish were exposed to seven hardness levels (150, 600, 1000, 1500, 2000, 3000 and 4000 mg/L CaCO3 at pH 8.15) for 15 days. Results showed that branchial activities of Ca2+-ATPase and Na+/K+-ATPase, which facilitate Ca2+ uptake, reduced starting respectively from 1000 mg/L and 1500 mg/L CaCO3. Nevertheless, Ca2+ burden in plasma and tissue (gills, liver and intestine) remained elevated. Hardness exposure also disturbed cations (Na+, K+, Mg2+) and minerals (iron and phosphorus) homeostasis in a tissue-specific and dose-dependent manner. Both hemoglobin content and hematocrit dropped significantly at 3000-4000 mg/L CaCO3, with a parallel decline in iron content in plasma and gills. Muscle water content rose dramatically at 4000 mg/L CaCO3, indicating an osmo-regulation disruption. Higher hardness of 3000-4000 mg/L CaCO3 also incited a series of histopathological modifications in gills, liver and intestine; most likely due to excess Ca2+ accumulation. Overall, these data suggest that channel catfish can adapt to a wide range of elevated hardness by modulating Ca2+ regulatory pathways and histomorphological alterations, however, 1500 mg/L CaCO3 and above can impair the performance of this species.

Paediatric COVID-19: Milder Presentation-A Silver Lining in Dark Cloud.

OBJECTIVE: To assess the clinico-epidemiological profile of paediatric patients with Corona virus disease 2019 (COVID-19) infection during the pandemic. METHODS: Clinico-epidemiological and laboratory profile of children between 1 month and 14 years were studied between 15 May and 31 July 2020, who had positive nasopharyngeal and oropharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: A total of 30 children with median age of 10.5 years (8 months to 14 years) were included in the present study. Sixty percent were boys. Twenty-seven (90%) belonged to an urban area and all 30 children were from a containment area. All were belonging to Kuppuswamy upper lower and lower socioeconomic class. Twenty-one (70%) were asymptomatic. All children had a positive household contact. Symptomatic children had only mild symptoms of fever, dry cough and rhinitis. All were fully vaccinated as per age. Nine (30%) had anaemia. The mean leucocyte count was 7470 ± 2427 (4300-14 100). Leucocytosis was seen in 3 (9%) children. C-reactive protein was found to be raised in only 4 (13%) children. We did not find alteration in sense of smell and taste. No mortality was reported. CONCLUSION: COVID-19 in paediatric patients is usually mild. Severe acute respiratory infection is not a major manifestation of COVID 19 infection in children. All children infected by the novel Corona virus-2 in this study, have a documented household contact.

Differential modulation of oxidative stress, antioxidant defense, histomorphology, ion-regulation and growth marker gene expression in goldfish (Carassius auratus) following exposure to different dose of virgin microplastics.

Goldfish (Carassius auratus) juveniles were exposed to virgin polyvinyl chloride microplastics (PVC-MPs) in triplicate at 0, 0.1 or 0.5 mg/L for four days. Afterwards, the histopathology of the gills, liver and intestines were examined, along with various antioxidant enzymes and indicators of oxidative damage (malondialdehyde (MDA) and hydrogen peroxide (H2O2)), in the brain, liver and gills. In addition, we also studied the expression of hepatic insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein 1 (IGFBP-1) and growth hormone (GH) receptor, while cortisol receptor (CR) and cytochrome P450 1A (CYP1A) gene expression were assayed in both the liver and gills. Histological analysis revealed PVC-MPs in the intestines at 0.1 and 0.5 mg/L, along with substantially shorter villi. The gills appeared undamaged by PVC-MPs exposure and had limited or no effect to antioxidant activity, Na+/K+-ATPase and H+-ATPase activity or plasma ion levels, but there was a prominent upsurge of the detoxification enzymes glutatione S-transferase (GST) activity and CYP1A expression. Livers showed inflammation and some occurrences of hemorrhaging and necrosis at 0.5 mg/L. While the brain showed some evidence of oxidative damage, the liver was the most susceptible to oxidative damage, based on increased MDA, H2O2 and various antioxidant enzymes. Hepatic expression of IGFBP-1 and GH receptor were significantly downregulated at 0.5 mg/L while CR was upregulated. Results indicate that exposure to environmentally relevant PVC-MP can cause oxidative damage in the brain and liver, adverse histomorphological changes to the intestine and liver and alter the gene expression in goldfish.

Oxidative stress, histopathological alterations and anti-oxidant capacity in different tissues of largemouth bass (Micropterus salmoides) exposed to a newly developed sodium carbonate peroxyhydrate granular algaecide formulated with hydrogen peroxide.

Various strategies exist to control noxious cyanobacterial populations, although the application of a newly developed granular compound (sodium carbonate peroxyhydrate 'SCP', trade name 'PAK® 27' algaecide) containing hydrogen peroxide (H2O2) as the active ingredient, has been recently proven as an effective and ecofriendly treatment. However, in aquaculture settings the application of SCP to treat cynobacterial blooms may affect non-targeted biota, such as fish due to H2O2 being known to elicit toxic oxidative stress. Consequently, a better understanding of the side effects as a function of dosing concentrations would help to improve treatment efficacy and fish welfare. Thus, the aim of the current study is to assess the potential risks of SCP to largemouth bass (Micropterus salmoides), a high priced fish in the U.S. To this end, fish were exposed to two recommended doses of SCP corresponding to either 2.5 or 4.0 mg/L H2O2 for 6 days, with a control group in parallel. After 6 days, the effect of SCP exposure on oxidative stress, histopathological changes and anti-oxidant potential in the brain, liver, gills and muscle were investigated. Results show that exposure to 4.0 mg/L H2O2 -SCP incited oxidative damage, evidenced by an over-accumulation of H2O2 and malondialdehyde (MDA) in the brain and liver, which were accompanied by an increment in xanthine oxidase activity. Unlike 4.0 mg/L H2O2, these oxidative stress biomarkers in the brain and liver tissue of 2.5 mg/L H2O2-SCP exposed fish were restrained within control levels and concomitant with an increase in superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), glutathione reductase (GR) and glutathione-s-transferase (GST) activity. In contrast, many of these anti-oxidants sentinels in the 4.0 mg/L H2O2 exposed fish were either unaffected or significantly inhibited, which resulted in over-accumulation of H2O2 and MDA. In addition, a series of histopathological alterations were observed, and the most severe brain injuries and liver inflammation were recorded in 4.0 mg/L H2O2-SCP exposed fish. Based on oxidative parameters, both SCP doses resulted in a relatively mild oxidative stress in gills but no effect in muscle, probably explaining the modest anti-oxidative responses in the former and almost complete lack of anti-oxidative responses in the latter. Overall, our findings suggests that the application of SCP at 4.0 mg/L H2O2 to control cyanobacterial blooms in aquaculture settings can possess potential risks to the farmed fish.

Physiological trade-offs, acid-base balance and ion-osmoregulatory plasticity in European sea bass (Dicentrarchus labrax) juveniles under complex scenarios of salinity variation, ocean acidification and high ammonia challenge.

In this era of global climate change, ocean acidification is becoming a serious threat to the marine ecosystem. Despite this, it remains almost unknown how fish will respond to the co-occurrence of ocean acidification with other conventional environmental perturbations typically salinity fluctuation and high ammonia threat. Therefore, the present work evaluated the interactive effects of elevated pCO2, salinity reduction and high environmental ammonia (HEA) on the ecophysiological performance of European sea bass (Dicentrarchus labrax). Fish were progressively acclimated to seawater (32 ppt), to brackish water (10 ppt) and to hyposaline water (2.5 ppt). Following acclimation to different salinities for at least two weeks, fish were exposed to CO2-induced water acidification representing present-day (control pCO2, 400 µatm, LoCO2) and future (high pCO2, 1000 µatm, HiCO2) sea-surface CO2 level for 3, 7 and 21 days. At the end of each exposure period, fish were challenged with HEA for 6 h (1.18 mM representing 50% of 96 h LC50). Results show that, in response to the individual HiCO2 exposure, fish within each salinity compensated for blood acidosis. Fish subjected to HiCO2 were able to maintain ammonia excretion rate (Jamm) within control levels, suggesting that HiCO2 exposure alone had no impact on Jamm at any of the salinities. For 32 and 10 ppt fish, up-regulated expression of Na+/K+-ATPase was evident in all exposure groups (HEA, HiCO2 and HEA/HiCO2 co-exposed), whereas Na+/K+/2Cl- co-transporter was up-regulated mainly in HiCO2 group. Plasma glucose and lactate content were augmented in all exposure conditions for all salinity regimes. During HEA and HEA/HiCO2, Jamm was inhibited at different time points for all salinities, which resulted in a significant build-up of ammonia in plasma and muscle. Branchial expressions of Rhesus glycoproteins (Rhcg isoforms and Rhbg) were upregulated in response to HiCO2 as well as HEA at 10 ppt, with a more moderate response in 32 ppt groups. Overall, our findings denote that the adverse effect of single exposures of ocean acidification or HEA is exacerbated when present together, and suggests that fish are more vulnerable to these environmental threats at low salinities.

Role of Vitamin-D Deficiency in Term Neonates with Late-Onset Sepsis: A Case-Control Study.

OBJECTIVE: To find the relationship between vitamin-D levels and late-onset sepsis (LOS) in term neonates. METHODS: This case-control study was conducted in neonatal intensive care unit of a tertiary care teaching institution in central India. Full-term neonates with culture-proven LOS were taken as cases. Maternal and neonatal demography, clinical examination and investigations were recorded. Correlation of vitamin-D deficiency (<20 ng/ml) with LOS was assessed. RESULTS: Total 225 term neonates including 175 cases and 50 controls were included. Maternal and neonatal demographic profile was comparable. The mean vitamin-D level in cases (12.28 ± 6.11 ng/ml) was significantly lower than that in controls (14.88 ± 7.2 ng/ml) (p = 0.002). Total 151 (86.29%) neonates out of 175 cases and 37 (74%) out of 50 controls had the vitamin-D deficiency (p = 0.00003). On multiple regression analysis, neonatal sepsis (p = 0.00003) was found to be significantly associated with vitamin-D deficiency. CONCLUSION: This study shows that vitamin-D deficiency in term neonates may predispose them to LOS.

Exercise improves growth, alters physiological performance and gene expression in common carp (Cyprinus carpio).

It has been suggested that induced swimming has the potential to improve the growth performance of fish. We tested this hypothesis by measuring growth, metabolic efficiency and physiological capacity of common carp (Cyprinus carpio). Fish were swum at different exercise regimes: 0.0 (control), 1.5 and 2.5 body lengths per second (BL/s) in 1600 L recirculating raceways for 4 weeks. The results showed a significant increase in weight gain, specific growth rate, improved feed conversion efficiency, and a higher hepatosomatic index for 2.5 BL/s exercised fish compared to control. Glycogen, protein and lipid energy stores in hepatic and muscular tissue showed limited differences among experimental groups. Likewise, plasma [Na+], [K+] and [Cl-] remained stable at all swimming regimes. Expression of genes controlling energy metabolism and growth (IGF-I axis, cytochrome oxidase) and stress response (cortisol receptor, heat shock protein 70) revealed clear regulatory roles as the mRNA transcript levels of IGF-I and growth hormone receptors in hepatic tissue were up-regulated in fish exercised for 3-4 weeks at 2.5 BL/s. Oxygen consumption rate and swimming performance (Ucrit) for each experimental group were evaluated in parallel in Blazka-type swim-tunnels (3.9 L) and showed no training effect while prolonged swimming at 1.5 and 2.5 BL/s facilitated ammonia excretion and prevented build-up of plasma ammonia. Overall, these data suggest that sustained exercise at 2.5 BL/s enhanced growth and physiological fitness without compromising energy metabolism or ion-regulation. Our study provides a prospective of implementing exercise as a tool to increase fish production efficiency in commercial aquaculture systems.

Pre-acclimation to low ammonia improves ammonia handling in common carp (Cyprinus carpio) when exposed subsequently to high environmental ammonia.

We tested whether exposing fish to low ammonia concentrations induced acclimation processes and helped fish to tolerate subsequent (sub)lethal ammonia exposure by activating ammonia excretory pathways. Common carp (Cyprinus carpio) were pre-exposed to 0.27mM ammonia (∼10% 96h LC50) for 3, 7 and 14days. Thereafter, each of these pre-exposed and parallel naïve groups were exposed to 1.35mM high environmental ammonia (HEA, ∼50% 96h LC50) for 12h and 48h to assess the occurrence of ammonia acclimation based on sub-lethal end-points, and to lethal ammonia concentrations (2.7mM, 96h LC50) in order to assess improved survival time. Results show that fish pre-exposed to ammonia for 3 and 7days had a longer survival time than the ammonia naïve fish. However, this effect disappeared after prolonged (14days) pre-exposure. Ammonia excretion rate (Jamm) was strongly inhibited (or even reversed) in the unacclimated groups during HEA. On the contrary, after 3days the pre-exposure fish maintained Jamm while after 7days these pre-acclimated fish were able to increase Jamm efficiently. Again, this effect disappeared after 14days of pre-acclimation. The efficient ammonia efflux in pre-acclimated fish was associated with the up-regulation of branchial mRNA expression of ammonia transporters and exchangers. Pre-exposure with ammonia for 3-7days stimulated an increment in the transcript level of gill Rhcg-a and Rhcg-b mRNA relative to the naïve control group and the up-regulation of these two Rhcg homologs was reinforced during subsequent HEA exposure. No effect of pre-exposure was noted for Rhbg. Relative to unacclimated fish, the transcript level of Na+/H+ exchangers (NHE-3) was raised in 3-7days pre-acclimated fish and remained higher during the subsequent HEA exposure while gill H+-ATPase activities and mRNA levels were not affected by pre-acclimation episodes. Likewise, ammonia pre-acclimated fish with or without HEA exposure displayed pronounced up-regulation in Na+/K+-ATPase activity and mRNA expression relative to the corresponding ammonia naïve groups. Overall, these data suggest that ammonia acclimation was evident for both lethal and the sub-lethal endpoints through priming mechanisms in ammonia excretory transcriptional processes, but these acclimation effects were transient and disappeared after prolonged pre-exposure.

Differential modulation of ammonia excretion, Rhesus glycoproteins and ion-regulation in common carp (Cyprinus carpio) following individual and combined exposure to waterborne copper and ammonia.

The main objective of this study was to understand the mode of interaction between waterborne copper (Cu) and high environmental ammonia (HEA) exposure on freshwater fish, and how they influence the toxicity of each other when present together. For this purpose, individual and combined effects of Cu and HEA were examined on selected physiological and ion-regulatory processes and changes at transcript level in the common carp (Cyprinus carpio). Juvenile carp were exposed to 2.6µM Cu (25% of the 96h LC50value) and to 0.65mM ammonia (25% of the 96h LC50value) singly and as a mixture for 12h, 24h, 48h, 84h and 180h. Responses such as ammonia (Jamm) and urea (Jurea) excretion rate, plasma ammonia and urea, plasma ions (Na(+), Cl(-) and K(+)), muscle water content (MWC) as well as branchial Na(+)/K(+)-ATPase (NKA) and H(+)-ATPase activity, and branchial mRNA expression of NKA, H(+)-ATPase, Na(+)/H(+) exchanger (NHE-3) and Rhesus (Rh) glycoproteins were investigated under experimental conditions. Results show that Jamm was inhibited during Cu exposure, while HEA exposed fish were able to increase excretion efficiently. In the combined exposure, Jamm remained at the control levels indicating that Cu and HEA abolished each other's effect. Expression of Rhcg (Rhcg-a and Rhcg-b) mRNA was upregulated during HEA, thereby facilitated ammonia efflux out of gills. On the contrary, Rhcg-a transcript level declined following Cu exposure which might account for Cu induced Jamm inhibition. Likewise, Rhcg-a was also down-regulated in Cu-HEA co-exposed fish whilst a temporary increment was noted for Rhch-b. Fish exposed to HEA displayed pronounced up-regulation in NKA expression and activity and stable plasma ion levels. In both the Cu exposure alone and combined Cu-HEA exposure, ion-osmo homeostasis was adversely affected, exemplified by the significant reduction in plasma [Na(+)] and [Cl(-)], and elevated plasma [K(+)], along with an elevation in MWC. These changes were accompanied by a decline in NKA activity. Gill H(+)-ATPase mRNA levels and activities were not affected by either Cu or HEA or both. Likewise, NHE-3 expression remained unaltered but tended to be numerically higher during HEA exposure. Overall, these data suggest that at equitoxic concentrations (25% of 96h LC50), the individual effect of Cu is more harmful while HEA induces quicker adaptive responses. Our findings also denote a competitive mode of interaction, exemplified by the inhibition of HEA -mediated adaptive responses in the presence of Cu.

Multidrug-resistant tubercular liver abscess in ß-thalassemia.

BACKGROUND: Liver abscesses in thalassemics are predominantly pyogenic. CASE CHARACTERISTICS: 12-year-old thalassemic boy with abdominal pain and high grade fever for 15 days. OBSERVATION: CT abdomen revealed multiple liver abscesses. Pus culture and sensitivity showed multidrug-resistant mycobacteria. Patient was started on second line anti-tubercular drugs. OUTCOME: He responded well with symptomatic improvement and is doing well after 6 months of follow-up. MESSAGE: Liver abscess in patients with thalassemia rarely can be tubercular.

Intravenous Ketamine for Refractory Bronchospasm Precipitated by H1N1 Infection.

Acute severe bronchospasm is an emergency situation and sometimes these children may fail to respond to conventional treatment and deteriorate rapidly to respiratory failure requiring mechanical ventilation. We present a case of 2-year-old girl, who presented with severe bronchospasm resulting in respiratory failure not responding to conventional management including mechanical ventilation and was found to be H1N1 positive. She was treated with ketamine infusion, which led to prompt improvement in airway obstruction.

Assessment of iron status and red cell parameters in healthy full term small for gestational age neonates at birth.

BACKGROUND: Hematological values of the newborn babies vary according to the gestational age and intrauterine growth. OBJECTIVE: The objective of this study is to compare the iron status and red cell parameters in healthy term small for gestational age (SGA) and appropriate for gestational age (AGA) neonates. MATERIALS AND METHODS: A prospective hospital based study was conducted in a tertiary care teaching institution of central India. 50 AGA and 50 SGA neonates were included in the study and serum iron, serum ferritin and red cell parameters (hemoglobin (Hb), red blood cell (RBC) count and hematocrit (Hct), mean corpuscular volume (MCV), means corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW]) were estimated within 24 h of birth. RESULTS: Serum ferritin levels were significantly low in SGA neonates as compared with AGA (mean 103 vs. 158 ng/ml; P=0.001) neonates. In SGA neonates, mean values of Hb (P=0.001), RBC count (P=0.018) and Hct (P=0.005) were significantly higher than in AGA neonates. Higher values of RDW and MCV were seen in SGA group in comparison with AGA neonates. Similarly, lower values of serum iron, MCH and MCHC were seen in the same group; although, these were non-significant. CONCLUSION: Despite higher Hb content, SGA neonates are deficient in iron store at birth as indicated by lower serum ferritin levels in them and early iron supplementation should be considered in them.