Comparative evaluation of remaining dentin thickness, canal centering ability and apical deformity between ProFit S3 and Protaper gold - A nano CT study.

Purpose: For the root canal treatment to be successful, the root canal system must be cleaned and shaped, and must be gradually widened from the apical to the coronal region in order to preserve dentin thickness. ProFit S3 (Profit Dental, India) patented rotary file with variable taper design preserves dentin. The study employs ultra-high-resolution nano-computed tomography to assess the volumetric changes of two new rotary files in permanent mandibular premolars. Materials and methods: Based on inclusion and exclusion criteria, this in-vitro investigation used extracted premolars. Before the pre-operative scan, samples were made and the working length was determined using a high-precision nano-CT (SkyScan 2214, Bruker, Kontich, Belgium). A single skilled pediatric dentist used ProFit S3 (Profit Dental, India) and Protaper Gold (PTG; Dentsply, Tulsa Dental Specialties, Tulsa, OK, USA) to prepare the canals. Post-op scans were similar to pre-ops. For 3D root canal visualization and analysis, NRecon software was used to rebuild images. Results: Profit S3 has a mean value of 0.65500 and Protaper gold 1.38800, indicating a significant range. Protaper gold followed Profit S3 in canal volume differential. The two rotating file systems differed significantly (p 0.05). ProFit S3 maintained mesiodistal and buccolingual dentin thickness at 4 mm, 8 mm, and 12 mm, followed by Protaper Gold. Conclusions: ProFit S3 exhibited the lowest mean canal volume difference compared to Protaper gold. Unlike Protaper Gold, ProFit S3 offers a variable taper design that preserves root canal anatomy, peri cervical dentin, and dentin thickness.

Evaluation of Flow Rate, pH, and Buffering Capacity of Saliva in Children with Caries, Fluorosis, and Caries with Fluorosis.

Background: Saliva is one of the most important aids in the diagnosis of various oral diseases. Few physicochemical properties of saliva such as flow rate, pH, and buffering capacity often vary with the occurrence of dental caries, fluorosis, and other systemic conditions. Purpose: The aim of the study was to evaluate the relationship between the salivary flow rate, pH, and buffering capacity in healthy children, children with caries, children with fluorosis, and children with both caries + fluorosis. Materials and methods: The study population consisted of 144 children aged 7-14 years and were divided into four groups of 36 children each. Group I, 36 healthy children with no caries and fluorosis; group II, 36 children with caries (dmfs ≤ 10); group III, 36 children with fluorosis (moderate to severe); and group IV, 36 children with caries + fluorosis. Unstimulated saliva is collected from all the selected subjects and evaluated for the salivary flow rate, pH, and buffering capacity. The recorded data were tabulated and statistically analyzed using a paired t-test. Results: The mean salivary flow rate and buffering capacity were found to be highest in group III when compared with all the other groups. The mean pH was greater in group I when compared with groups I, II, and III. Conclusion: The physicochemical properties of saliva like pH, buffering capacity, and salivary flow rate alter with caries and fluorosis conditions. Hence, more clinical and laboratory studies are needed to determine the exact relationship between these physicochemical properties of saliva in dental caries and fluorosis. How to cite this article: E RR, S S, M K, et al. Evaluation of Flow Rate, pH, and Buffering Capacity of Saliva in Children with Caries, Fluorosis, and Caries with Fluorosis. Int J Clin Pediatr Dent 2023;16(4):587-590.

Rice-Magnaporthe transcriptomics reveals host defense activation induced by red seaweed-biostimulant in rice plants.

Red seaweed extracts have been shown to trigger the biotic stress tolerance in several crops. However, reports on transcriptional modifications in plants treated with seaweed biostimulant are limited. To understand the specific response of rice to blast disease in seaweed-biostimulant-primed and non-primed plants, transcriptomics of a susceptible rice cultivar IR-64 was carried out at zero and 48 h post inoculation with Magnaporthe oryzae (strain MG-01). A total of 3498 differentially expressed genes (DEGs) were identified; 1116 DEGs were explicitly regulated in pathogen-inoculated treatments. Functional analysis showed that most DEGs were involved in metabolism, transport, signaling, and defense. In a glass house, artificial inoculation of MG-01 on seaweed-primed plants resulted in the restricted spread of the pathogen leading to the confined blast disease lesions, primarily attributed to reactive oxygen species (ROS) accumulation. The DEGs in the primed plants were defense-related transcription factors, kinases, pathogenesis-related genes, peroxidases, and growth-related genes. The beta-D-xylosidase, a putative gene that helps in secondary cell wall reinforcement, was downregulated in non-primed plants, whereas it upregulated in the primed plants indicating its role in the host defense. Additionally, Phenylalanine ammonia-lyase, pathogenesis-related Bet-v-I family protein, chalcone synthase, chitinases, WRKY, AP2/ERF, and MYB families were upregulated in seaweed and challenge inoculated rice plants. Thus, our study shows that priming rice plants with seaweed bio-stimulants resulted in the induction of the defense in rice against blast disease. This phenomenon is contributed to early protection through ROS, protein kinase, accumulation of secondary metabolites, and cell wall strengthening.

Venous malformation of the conjunctiva and orbit.

A 28-year-old male presented with a large conjunctival lobulated, nonpulsatile, red vascular lesion involving a large part of the temporal quadrant of the left globe. There was no proptosis or globe displacement, but the left eye abduction was limited. T2-weighted magnetic resonance imaging scan of the brain and orbit revealed an extensive contrast-enhancing lobulated lesion in the left half of the face involving the upper lip, cheek, oral cavity, extraconal space of left orbit, and nasal cavity. He underwent surgical excision of the conjunctival lesion with amniotic membrane reconstruction.

Atypical corneal clouding in mucopolysaccharidoses.

The etiology for corneal clouding from the birth is varied and includes conditions such as sclerocornea, birth trauma, corneal ulcer, Peters anomaly, and rare causes like mucopolysaccharidoses (MPS). The lysosomal storage disorders are associated with a varied ocular manifestation including bilateral corneal clouding which is often mild and stippled except in few cases like Hunter syndrome where cornea is often clear. We report a case of MPS Type I S (MPS 1) with near-normal visual acuity and bilateral dense corneal clouding with sparing of central 3 mm of cornea. The patient also had typical facial and skeletal abnormalities of lysosomal storage disorder. To our best knowledge, MPS 1 with marked corneal clouding with sparing of central cornea is very rare and has not been reported. This case report emphasizes on the atypical ocular presentation of MPS and the need for ophthalmological screening in the storage disorders.

Dry eye among medical students before and during COVID-19.

Purpose: Dry eye is a multifactorial disease of the ocular surface. It showed an increased incidence during the pandemic situation, which may be due to long hours of exposure to electronic gadgets. We aimed to find the prevalence of dry eye disease among medical students during the coronavirus disease 2019 (COVID-19) pandemic and pre-pandemic periods. Methods: This was a cross-sectional study conducted in a tertiary care teaching institute. This was an institution-based, cross-sectional study conducted among medical students. A modified Ocular Surface Disease Index (OSDI) questionnaire was used to find the severity and prevalence of dry eye disease. Considering 95% confidence interval (CI) and prevalence as 50%, the calculated sample size was 271. Online responses were collected and entered in an Excel sheet. The Chi-square test, univariate and multivariate logistic regression were used for statistical analysis. Results: Data were collected from 271 medical students; the prevalence of dry eye disease was 41.5 and 55.19 during the pre-pandemic and pandemic periods, respectively. There was a significant rise in dry eye disease cases during the pandemic when compared to pre-pandemic period (P < 0.05). The odds of getting dry eye disease were 1.7 times more during the pandemic than pre-pandemic. Conclusion: The lockdown situation during the pandemic forced people to use electronic gadgets for work, recreation, and academics. Prolonged screen time predisposes to the development of dry eye disease.

Fast Quantum State Tomography in the Nitrogen Vacancy Center of Diamond.

Quantum state tomography is the procedure for reconstructing unknown quantum states from a series of measurements of different observables. Depending on the physical system, different sets of observables have been used for this procedure. In the case of spin qubits, the most common procedure is to measure the transverse magnetization of the system as a function of time. Here, we present a different scheme that relies on time-independent observables and therefore does not require measurements at different evolution times, thereby greatly reducing the overall measurement time. To recover the full density matrix, we use a set of unitary operations that transform the density operator elements into the directly measurable observable. We demonstrate the performance of this scheme in the electron-nuclear spin system of the nitrogen vacancy center in diamond.

Application of Artificial Intelligence Techniques for Monkeypox: A Systematic Review.

Monkeypox or Mpox is an infectious virus predominantly found in Africa. It has spread to many countries since its latest outbreak. Symptoms such as headaches, chills, and fever are observed in humans. Lumps and rashes also appear on the skin (similar to smallpox, measles, and chickenpox). Many artificial intelligence (AI) models have been developed for accurate and early diagnosis. In this work, we systematically reviewed recent studies that used AI for mpox-related research. After a literature search, 34 studies fulfilling prespecified criteria were selected with the following subject categories: diagnostic testing of mpox, epidemiological modeling of mpox infection spread, drug and vaccine discovery, and media risk management. In the beginning, mpox detection using AI and various modalities was described. Other applications of ML and DL in mitigating mpox were categorized later. The various machine and deep learning algorithms used in the studies and their performance were discussed. We believe that a state-of-the-art review will be a valuable resource for researchers and data scientists in developing measures to counter the mpox virus and its spread.

Customized Deep Learning Classifier for Detection of Acute Lymphoblastic Leukemia Using Blood Smear Images.

Acute lymphoblastic leukemia (ALL) is a rare type of blood cancer caused due to the overproduction of lymphocytes by the bone marrow in the human body. It is one of the common types of cancer in children, which has a fair chance of being cured. However, this may even occur in adults, and the chances of a cure are slim if diagnosed at a later stage. To aid in the early detection of this deadly disease, an intelligent method to screen the white blood cells is proposed in this study. The proposed intelligent deep learning algorithm uses the microscopic images of blood smears as the input data. This algorithm is implemented with a convolutional neural network (CNN) to predict the leukemic cells from the healthy blood cells. The custom ALLNET model was trained and tested using the microscopic images available as open-source data. The model training was carried out on Google Collaboratory using the Nvidia Tesla P-100 GPU method. Maximum accuracy of 95.54%, specificity of 95.81%, sensitivity of 95.91%, F1-score of 95.43%, and precision of 96% were obtained by this accurate classifier. The proposed technique may be used during the pre-screening to detect the leukemia cells during complete blood count (CBC) and peripheral blood tests.

Rare earth metal (Sm)-doped NiMnO3 nanostructures for highly competent alkaline oxygen evolution reaction.

In the present work, samarium-doped nickel manganese oxide was produced by employing a straightforward co-precipitation method. A peak with a 2θ of 36° corresponded to the (110) plane confirming the formation of the rhombohedral crystal structure of NiMnO3. The existence of Mn-O and Ni-O stretching vibration modes was confirmed by Raman spectroscopy. FTIR spectra confirmed the existence of the metal-oxygen bond of NiMnO3. The synthesized ternary Ni-based material was found to be spherical nanoparticles with an average diameter of 0.81 µm. The electrochemical oxygen evolution reaction (OER) performance was explored on 0.02 M samarium (Sm)-doped NiMnO3 demonstrating outstanding OER action with low 321 mV, a low Tafel slope value (109 mV dec-1), and low charge-transfer resistance (0.19 Ω). Moreover, the BET results suggest that the 0.02 M Sm-doped NiMnO3 exhibited elevated surface area (78.78 m2 g-1) with a mesoporous character. Therefore, NiMnO3 doped with high concentrations of a rare earth metal, Sm, is proposed as a suitable material for next-generation water splitting applications.

Transcriptomic responses under combined bacterial blight and drought stress in rice reveal potential genes to improve multi-stress tolerance.

BACKGROUND: The unprecedented drought and frequent occurrence of pathogen infection in rice is becoming more due to climate change. Simultaneous occurrence of stresses lead to more crop loss. To cope up multiple stresses, the durable resistant cultivars needs to be developed, by identifying relevant genes from combined biotic and abiotic stress exposed plants. RESULTS: We studied the effect of drought stress, bacterial leaf blight disease causing Xanthomonas oryzae pv. oryzae (Xoo) pathogen infection and combined stress in contrasting BPT5204 and TN1 rice genotypes. Mild drought stress increased Xoo infection irrespective of the genotype. To identify relevant genes that could be used to develop multi-stress tolerant rice, RNA sequencing from individual drought, pathogen and combined stresses in contrasting genotypes has been developed. Many important genes are identified from resistant genotype and diverse group of genes are differentially expressed in contrasting genotypes under combined stress. Further, a meta-analysis from individual drought and Xoo pathogen stress from public domain data sets narrowed- down candidate differentially expressed genes. Many translation associated genes are differentially expressed suggesting their extra-ribosomal function in multi-stress adaptation. Overexpression of many of these genes showed their relevance in improving stress tolerance in rice by different scientific groups. In combined stress, many downregulated genes also showed their relevance in stress adaptation when they were over-expressed. CONCLUSIONS: Our study identifies many important genes, which can be used as molecular markers and targets for genetic manipulation to develop durable resistant rice cultivars. Strategies should be developed to activate downregulated genes, to improve multi-stress tolerance in plants.

Toward the Speed Limit of High-Fidelity Two-Qubit Gates.

Most implementations of quantum gate operations rely on external control fields to drive the evolution of the quantum system. Generating these control fields requires significant efforts to design the suitable control Hamiltonians. Furthermore, any error in the control fields reduces the fidelity of the implemented control operation with respect to the ideal target operation. Achieving sufficiently fast gate operations at low error rates remains therefore a huge challenge. In this Letter, we present a novel approach to overcome this challenge by eliminating, for specific gate operations, the time-dependent control fields entirely. This approach appears useful for maximizing the speed of the gate operation while simultaneously eliminating relevant sources of errors. We present an experimental demonstration of the concept in a single nitrogen-vacancy center in diamond at room temperature.

Outcomes of Adenotonsillectomy for Obstructive Sleep Apnea in Children Under 3 Years of Age.

Objectives: To identify predictors of obstructive sleep apnea (OSA) after adenotonsillectomy (T&A) in children under 3 years of age and to describe the characteristics of children with OSA under 3 years of age undergoing T&A in an ethnically diverse population. Methods: We examined 87 children under 3 years with T&A and pre- and post-operative polysomnography (PSG) between 8/2012 and 3/2020 at a large tertiary care hospital. Differences were compared for covariates including demographics, comorbidities, and respiratory parameters. Regression was used to identify predictors of persistent severe OSA. Significance was set at P < .05. Results: Of the 87 children in the study, 64 (74%) were male, 26 (30%) were obese, 34 (39%) were Hispanic, and 35 (40%) were Black. Most children (94%) had improvements in OSA severity as measured by the apnea-hypopnea index (AHI) after T&A, but 78% had persistent OSA (AHI ≥1) after surgery. Children with persistent mild, compared to moderate-severe OSA, were more likely to have gastroesophageal reflux disease (GERD) (50% versus 24%, P = .025), a craniofacial disorder (30% versus 10%, P = .025), Down syndrome (20% versus 5%, P = .031), or pre-operative severe OSA. Conclusions: This study of an ethnically diverse population found that T&A is an effective procedure at improving, but not resolving, OSA in children under 3 years. Children with Down syndrome, craniofacial abnormalities, GERD, or pre-operative severe OSA who are under 3 years old are at high risk for persistent OSA and may benefit from post-operative PSG. Future study should examine complications and long-term outcomes of T&A in this age group.

Immune profile and responses of a novel dengue DNA vaccine encoding an EDIII-NS1 consensus design based on Indo-African sequences.

The ongoing COVID-19 pandemic highlights the need to tackle viral variants, expand the number of antigens, and assess diverse delivery systems for vaccines against emerging viruses. In the present study, a DNA vaccine candidate was generated by combining in tandem envelope protein domain III (EDIII) of dengue virus serotypes 1-4 and a dengue virus (DENV)-2 non-structural protein 1 (NS1) protein-coding region. Each domain was designed as a serotype-specific consensus coding sequence derived from different genotypes based on the whole genome sequencing of clinical isolates in India and complemented with data from Africa. This sequence was further optimized for protein expression. In silico structural analysis of the EDIII consensus sequence revealed that epitopes are structurally conserved and immunogenic. The vaccination of mice with this construct induced pan-serotype neutralizing antibodies and antigen-specific T cell responses. Assaying intracellular interferon (IFN)-γ staining, immunoglobulin IgG2(a/c)/IgG1 ratios, and immune gene profiling suggests a strong Th1-dominant immune response. Finally, the passive transfer of immune sera protected AG129 mice challenged with a virulent, non-mouse-adapted DENV-2 strain. Our findings collectively suggest an alternative strategy for dengue vaccine design by offering a novel vaccine candidate with a possible broad-spectrum protection and a successful clinical translation either as a stand alone or in a mix and match strategy.

Investigation of electrochemical performance of an efficient Ti2O3-CeO2 nanocomposite for enhanced pollution-free energy conversion applications.

The development of an economical, abundant, stable, and greatly active electrocatalyst for water oxidation is extremely important for future energy conversion system. Electrochemical water splitting is a new move toward H2 and O2 gas production. It can be used in sustainable and pollution-free energy conversion applications. In this work, Ti2O3-CeO2 nanocomposites were successfully synthesized with different molar ratios by facile hydrothermal method for electrochemical water oxidation. Mixed phase structure of Ti2O3-CeO2 nanocomposites was confirmed by X-ray diffraction spectra and well identified by highest peak of Ti2O3 in 2θ values of 33.0 and CeO2 in 2θ values of 28.5. The characteristic peaks from Raman and photoluminescence spectroscopy further confirmed Ti2O3-CeO2 nanocomposite formation. Existence of multidimensional nanostructures such as nanoparticles and small nanocubes of Ti2O3-CeO2 nanocomposites were investigated by scanning electron microscope images. Mesoporous nature of Ti2O3-CeO2 nanocomposites was further analyzed by Brunauer-Emmett-Teller analysis. The high surface area could benefit the Ti2O3-CeO2 nanocomposites with greatly improved oxygen evolution reaction (OER) performance. In three molar ratios, 1:3 M ratios of Ti2O3-CeO2 nanocomposites showed high catalytic action at overpotential of 244 mV. The best OER electrocatalyst was obtained by 1:3 M ratios of Ti2O3-CeO2 nanocomposites, which exhibited high current density and high specific capacitance values of 238 mA/g and 517 F/g, respectively. Therefore, Ti/Ce molar ratio played a crucial role in enhancing the OER performance.

Annealing temperature effect on cobalt ferrite nanoparticles for photocatalytic degradation.

In this work, cobalt ferrite nanomaterials was prepared employing simple co-precipitation technique and annealed at 300, 400 and 600 °C. XRD study revealed the formation of cubic structure of CoFe2O4 nanoparticles and confirmed by high intense peak at 2θ value of 35.3°. The creation of ferrite phase was further confirmed by the studies such as FTIR, Raman and PL spectra. FTIR spectra confirmed the occurrence of Fe-O and Co-O metal oxygen vibrations and the lattice defects and oxygen vacancies of the CoFe2O4 nanoparticles were explored by PL spectra. No other signals were detected in Raman spectra, which explored pure spinal ferrites. The energy band gap values are obtained by using Tauc plot and the obtained band gap values for all the cobalt ferrite nanoparticles were 2.84, 2.75 and 2.89 eV respectively. The morphology of synthesized cobalt ferrite nanomaterials were observed from the SEM and TEM images. The product annealed at 400 °C showed the better morphology with least amount of agglomeration in comparison to other SEM images. In addition, SAED pattern of magnetic nanoparticles confirmed the existence of polycrystalline nature of the CoFe2O4 nanoparticles. The obtained surface area of CF2 sample was 5.082 m2 g-1 and pore volume and diameter of CF2 sample was found to be 0.013 cc/g and 3.937 nm respectively. Then, the product annealed at 400 °C exhibited most excellent activity and degraded 74% of cationic dye in 80 min, and it also exhibited excellent stability even maintain in three cycles.

Antimicrobial resistance (AMR) at the community level: An urban and rural case study from Karnataka.

CONTEXT: The emergence of antimicrobial resistance (AMR) is a major public health crisis in India and globally. While national guidelines exist, the sources of data which form the basis of these guidelines are limited to a few well-established tertiary care centres. There is inadequate literature on AMR and antibiotic mismatch from India at community level and even less literature on AMR patterns from rural India. AIMS: The aims of this study were as follows: 1) to describe the patterns of AMR at an urban tertiary care hospital and a rural 100 bedded hospital; 2) to compare and contrast the AMR patterns noted with published ICMR guidelines; 3) to examine the issue of AMR and antibiotic mismatch; and 4) to identify local factors influencing drug-bug mismatch at the local level. SETTINGS AND DESIGN: The data were obtained from two independently conceived projects (Site 1: Urban tertiary care hospital, Site 2: Rural 100-bedded hospital). METHODS AND MATERIALS: Local antibiograms were made, and the antibiotic resistance patterns were compared between the urban and rural sites and with data published in the 2017 ICMR national guideline for AMR. STATISTICAL ANALYSIS USED: Descriptive statistics including means and medians were used. RESULTS: Our data reveal: a) a significant mismatch between sensitivity patterns and antibiotics prescribed; b) The national guidelines fail to capture the local picture of AMR, highlighting the need for local data; and c) challenges with data collection/retrieval, access and accuracy of diagnostic tools, administrative issues, and lack of local expertise limit antimicrobial stewardship efforts. CONCLUSIONS: Our study finds the burden of AMR high in both rural and urban sites, reinforcing that AMR burden cannot be ignored in rural settings. It also highlights that national data obtained from tertiary care settings fail to capture the local picture, highlighting the need for local data. Mechanisms of linking rural practices, primary health centres, and small hospitals with a common microbiology laboratory and shared data platforms will facilitate antibiotic stewardship at the community level.

Comparative Transcriptome Analysis of Rice Resistant and Susceptible Genotypes to Xanthomonas oryzae pv. oryzae Identifies Novel Genes to Control Bacterial Leaf Blight.

The bacterial leaf blight in rice caused by Xanthomonas oryzae pv. oryzae (Xoo) affects crop losses worldwide. In spite of developing resistant varieties by introgressing different Xa genes, the occurrence of diseases is evident. Here we report identification of several genes that are associated with improved plant immunity against Xoo in a resistant genotype BPT-5204 in comparison with susceptible genotype TN-1. The RNA sequencing information was developed to identify the genes that could provide durable resistance in rice. Xoo-resistant rice genotype BPT-5204 with Xa 5, 13 and 21 genes is compared with sensitive Taichung Native 1 (TN-1) to identify the genetic pathways and gene networks involved in resistance mechanisms. The higher levels of salicylic acid resulted in upregulation of many pathogenesis-related (PR) and redox protein encoding transcripts which resulted in higher hypersensitive response in BPT-5204. Many Serine/threonine protein kinase, leucine-rich repeat (LRR) transmembrane protein kinase, protein kinase family genes, Wall-associated kinase (WAK) were upregulated that resulted in activation of bZIP, WRKY, MYB, DOF and HSFs transcription factors that are associated with improved plant immunity. The study provided roles of many genes and their associated plant immunity pathways that can be used for developing resistant rice cultivars.

Electrocardiometry for Hemodynamic Categorization and Assessment of Fluid Responsiveness in Pediatric Septic Shock: A Pilot Observational Study.

AIM: To evaluate the utility of noninvasive electrocardiometry (ICON®) for hemodynamic categorization and assessment of fluid responsiveness in pediatric septic shock. MATERIALS AND METHODS: Pilot prospective observational study in a 12-bedded tertiary pediatric intensive care unit (PICU) in children aged between 2 months and 16 years with unresolved septic shock after a 20 mL/kg fluid bolus. Those with cardiac index (CI) <3.3 L/min/m2 and systemic vascular resistance index (SVRI) >1600 dyn sec/cm5/m2 were classified as vasoconstrictive shock-electrocardiometry (VCEC) and those with CI >5.5 L/min/m2 and SVRI <1000 dyn sec/cm5/m2 as vasodilated shock-electrocardiometry (VDEC). Fluid responsiveness was defined as a 10% increase in CI with a 20 mL/kg fluid bolus. Sepsis-induced myocardial dysfunction (SMD) was diagnosed on echocardiography. Outcomes studied included clinical shock resolution, length of PICU stay, and mortality. RESULTS: Thirty children were enrolled over 6 months with a median (interquartile range) age and pediatric risk of mortality (PRISM) III score of 87(21,108) months and 6.75(1.5,8.25), respectively; 14(46.6%) were boys and 4(13.3%) died. Clinically, 19(63.3%) children had cold shock and 11(36.7%) had warm shock; however, 16(53.3%) children had VDEC (including five with clinical cold shock) and 14(46.7%) had VCEC using electrocardiometry. Fluid responsiveness was seen in 16(53.3%) children, 10 in the VCEC group and 6 in the VDEC group. In the VCEC group, the responders had a significant rise in CI and a fall in SVRI, while the responders in the VDEC group had a significant rise in CI and SVRI. Fluid responders, compared to nonresponders, had a significantly higher stroke volume variation (SVV) before fluid bolus (24.1 ± 5.2% vs. 18.2 ± 3.5%, p < 0.001) and a higher reduction in SVV after fluid bolus (10.0 ± 2.8% vs. 6.0 ± 4.5%, p = 0.006), higher lactate clearance (p = 0.03) and lower vasoactive-inotropic score (p = 0.04) at 6 hours, higher percentage of clinical shock resolution at 6 (p = 0.01) and 12 hours (p = 0.01), and lesser mortality (p = 0.002). Five (16.6%) children with VCEC had SMD and were less fluid responsive (p = 0.04) with higher mortality (p = 0.01) compared to those without SMD. CONCLUSIONS AND CLINICAL SIGNIFICANCE: Continuous, noninvasive hemodynamic monitoring using electrocardiometry permits hemodynamic categorization and assessment of fluid responsiveness in pediatric septic shock. This may provide real-time guidance for optimal interventions, and thus, improve the outcomes. HOW TO CITE THIS ARTICLE: Rao SS, Reddy M, Lalitha AV, Ghosh S. Electrocardiometry for Hemodynamic Categorization and Assessment of Fluid Responsiveness in Pediatric Septic Shock: A Pilot Observational Study. Indian J Crit Care Med 2021;25(2):185-192.

Diffuse Alveolar Hemorrhage in Primary Versus Secondary Antiphospholipid Syndrome.

BACKGROUND: Diffuse alveolar hemorrhage (DAH) occurs in patients with both primary and secondary antiphospholipid antibody syndrome (APS). We sought to determine the differences in clinical presentation, management, and outcomes of DAH in these patients. METHODS: We performed a medical records review study and reviewed 30 patients with DAH in the setting of primary and secondary antiphospholipid syndrome seen at our institution between January 1, 1997, and December 31, 2018. We analyzed their demographics, clinical presentation, laboratory values, imaging studies, lung pathology results, management, and outcomes. RESULTS: The patients in the secondary APS cohort were younger (median age, 48.5 vs 58 years) and comprised more females (75% vs 17%) compared with those with primary APS (p < 0.05). Two thirds of patients in the secondary APS group were anemic compared with less than one fourth in the primary APS group (p = 0.005). At the time of the first episode of DAH, the patients in the secondary APS required invasive and noninvasive ventilation, antibiotics, and combination immunosuppressive therapy (includes a combination of glucocorticoids with immunosuppressants or intravenous immunoglobulins or plasma exchange) more often compared with those with primary APS. There was only one in-hospital death (3% in-hospital mortality). One-year and 5-year mortality rates were 20% and 27%, respectively, with no significant difference between the primary and secondary APS groups. CONCLUSIONS: Diffuse alveolar hemorrhage in the setting of APS, especially secondary APS, can be severe. However, in-hospital mortality is uncommon with current management strategies.