Trends in fetal and neonatal outcomes during the COVID-19 pandemic in Alabama.

BACKGROUND: The current study evaluated the hypothesis that the COVID-19 pandemic is associated with higher stillbirth but lower neonatal mortality rates. METHODS: We compared three epochs: baseline (2016-2019, January-December, weeks 1-52, and 2020, January-February, weeks 1-8), initial pandemic (2020, March-December, weeks 9-52, and 2021, January-June, weeks 1-26), and delta pandemic (2021, July-September, weeks 27-39) periods, using Alabama Department of Public Health database including deliveries with stillbirths ≥20 weeks or live births ≥22 weeks gestation. The primary outcomes were stillbirth and neonatal mortality rates. RESULTS: A total of 325,036 deliveries were included (236,481 from baseline, 74,076 from initial pandemic, and 14,479 from delta pandemic period). The neonatal mortality rate was lower in the pandemic periods (4.4 to 3.5 and 3.6/1000 live births, in the baseline, initial, and delta pandemic periods, respectively, p < 0.01), but the stillbirth rate did not differ (9 to 8.5 and 8.6/1000 births, p = 0.41). On interrupted time-series analyses, there were no significant changes in either stillbirth (p = 0.11 for baseline vs. initial pandemic period, and p = 0.67 for baseline vs. delta pandemic period) or neonatal mortality rates (p = 0.28 and 0.89, respectively). CONCLUSIONS: The COVID-19 pandemic periods were not associated with a significant change in stillbirth and neonatal mortality rates compared to the baseline period. IMPACT: The COVID-19 pandemic could have resulted in changes in fetal and neonatal outcomes. However, only a few population-based studies have compared the risk of fetal and neonatal mortality in the pandemic period to the baseline period. This population-based study identifies the changes in fetal and neonatal outcomes during the initial and delta COVID-19 pandemic period as compared to the baseline period. The current study shows that stillbirth and neonatal mortality rates were not significantly different in the initial and delta COVID-19 pandemic periods as compared to the baseline period.

Neodymium-decorated graphene oxide as a corrosion barrier layer on Ti6Al4V alloy in acidic medium.

Ti6Al4V alloy is light weight and is used in construction, oil industries and airbus, automobile, and bio implant materials. The native oxide layers of the alloy are not stable at high temperatures and strong mineral acid environments. The conventional epoxy-based layers are porous and the alloy finally fails in the harsh environment in the long term. Therefore, the carbon-based functional materials are being proposed as coating materials to overcome the alloy degradation. In the present contribution, we have used the neodymium-decorated graphene oxide as the corrosion inhibiting barrier for the Ti6Al4V alloy. As a novelty, we found that the few-layer graphene decorated with neodymium acts as a self-cleaning coating. The Nd-decorated graphene oxide were studied by XRD, TEM, FESEM, FTIR, UV, and Raman spectroscopy. The corrosion inhibition efficiency was studied by electrochemical methods.

Magnitude of unreported kala-azar cases in a highly endemic district of Bihar, India: A positive impact of Indian elimination programme.

BACKGROUND & OBJECTIVES: In India, kala-azar surveillance is weak and no public-private partnership exists for disease containment. Estimate of disease burden is not reliably available and still cases are going to private providers for the treatment. The present study aimed to assess the magnitude of kala-azar cases actually detected and managed at private set-up and unreported to existing health management information system. METHODS: Institution based cross-sectional prospective pilot study was conducted. List of facilities was created with the help of key informants. The information about incidence of kala-azar cases were captured on monthly basis from July 2010 to June 2011. Rapid diagnostic strip test (rk-39) or bone marrow/splenic puncture were applied as laboratory methods for the diagnosis of kala-azar. Descriptive statistics as well as chi-square test for comparison between proportions was conducted. RESULTS: Overall availability of private practitioners (PPs) was 4.59/1,00,000 population and maximum PPs (46; 93.9%) were from qualified category. The median years of medical practice was 25 yr (inter quartile-range [18, 28]). Interestingly, only a small proportion (240; 19%) of cases was managed by PPs. Amongst the PPs, only low proportion (32; 18.2%) managed >2 cases per month. The mean number of kala-azar suspects and cases identified varied significantly between different PPs' professions with p <0.048 and p <0.032, respectively. A highly significant difference (p <0.0001) was observed for kala-azar case load between qualified and unqualified practitioners. A small proportion (38; 15.8%) of kala-azar cases was not present in the public health system record. INTERPRETATION & CONCLUSION: Still sizeable proportions of cases are going to PPs and unrecorded into government surveillance system. A mechanism need to be devised to involve at least qualified PPs in order to reduce treatment delay and increase case detection in the region.

Transfusion-associated necrotizing enterocolitis in preterm infants: an updated meta-analysis of observational data.

BACKGROUND: The number of observational studies that report an association between packed red blood cell (PRBC) transfusions and necrotizing enterocolitis (NEC) has increased. The primary objective of this study was to evaluate the association between PRBC transfusions and NEC in observational studies. METHODS: Medline, Embase and Cochrane Library databases as well as the Pediatrics Academic Societies abstract archives were systematically searched to identify observational studies that investigated the association between PRBC transfusions and NEC. Key search terms included premature infant, blood transfusion and necrotizing enterocolitis. The generic inverse variance method with a random-effects model was used to meta-analyze selected studies. Odds ratios (ORs) and confidence intervals (CIs) were calculated. RESULTS: A meta-analysis of 17 observational studies that reported the association between PRBC transfusions and NEC was performed. The meta-analysis revealed no evidence of an association between PRBC transfusions and a higher risk of NEC (OR: 0.96; 95% CI: 0.53-1.71; P=0.88). The effect estimates that suggested an association between PRBC transfusion and NEC in matched case-control studies (OR: 1.20; 95% CI: 0.58-2.47; P=0.63) differed from those reported in cohort studies (OR: 0.51; 95% CI: 0.34-0.75; P=<0.01). CONCLUSIONS: This updated meta-analysis of predominantly low-to-moderate quality observational studies suggests that there is no significant association between PRBC transfusions and NEC. A higher quality of evidence on this topic is needed.

Praseodymium-decorated graphene oxide as a corrosion inhibitor in acidic media for the magnesium AZ31 alloy.

In the present work, Pr-decorated graphene oxide was synthesized and tested as a corrosion barrier layer in acidic media for the magnesium AZ31 alloy. The morphology, composition and structure of Pr-decorated graphene oxide sheets were characterized via HRTEM, FESEM, Raman, XRD, DLS, UV and FTIR studies. The corrosion inhibition efficiency on the alloy surface was monitored via microstructural and electrochemical methods. The results indicate that Pr-decorated graphene oxide provides improved protection for the Mg AZ31 alloy compared to conventional epoxy coatings. The proposed mechanism arises from a combination of the barrier activities of the composite, GO + Pr, and the epoxy coating on the Mg alloy in acidic media.

Reduced Baroreflex Sensitivity, Decreased Heart Rate Variability with Increased Arterial Stiffness in Predialysis.

High cardiovascular morbidity and mortality is observed in predialytic chronic kidney disease (CKD) patients. The underlying mechanism of cardiovascular dysfunction often remains unclear. The present study was designed to perform multiparametric assessment of baroreflex sensitivity (BRS), arterial stiffness indices, and cardiovascular variabilities (heart rate variability [HRV] and blood pressure variability [BPV]) together in predialytic CKD patients; compare it with normal healthy controls; and determine their relationships in predialytic nondiabetic CKD patients. Thirty CKD Stage 4 and 5 predialytic non-diabetic patients and 30 healthy controls were enrolled in the study. BRS was determined by spontaneous sequence method. Short-term HRV and BPV were assessed using 5 min beat-to-beat data of RR intervals and blood pressure by time domain and frequency domain analysis. Arterial stiffness indices - carotid-femoral pulse wave velocity (PWV) and augmentation index - were measured using SphygmoCor Vx device (AtCor Medical, Australia). Predialytic CKD patients had significantly low BRS, high PWV, and low HRV as compared to healthy controls. Independent predictors of reduced systolic BRS in predialytic CKD patient group on multiple regression analysis emerged to be increase in calcium-phosphate product, increase in BPV, and decrease in HRV. Predialytic nondiabetic CKD Stage 4 and 5 patients have poor hemodynamic profile (higher PWV, lower HRV, and reduced BRS) than healthy controls. Reduced HRV and altered calcium-phosphate homeostasis emerged to be significant independent predictors of reduced BRS.

Hypertriglyceridemia: a possible diagnostic marker of disease severity in visceral leishmaniasis.

PURPOSE: Visceral leishmaniasis (VL), a protozoan disease, is 100% fatal if left untreated. Anemia is common in VL which plays a role in expression of clinically overt VL disease. Laboratory clues are scarce for strengthening clinical suspicion for severity in VL. Hypertriglyceridemia has emerged as a new concept for the diagnosis and prognosis in VL. The present study is aimed at correlating the magnitude of hypertriglyceridemia with the severity in VL. MATERIALS AND METHODS: A retrospective case-control study was conducted between January 2012 to December 2013 among 124 patients coming for treatment from VL endemic areas, who had fever of more than 15 days and did not respond to antimalarials and antibiotics. The parasitologically confirmed VL cases (n = 87) were categorized as mild/moderate (n = 60) and severe (n = 27) groups according to WHO classification for anemia and parasite burden. Serum triglycerides were assayed in VL groups along with controls (n = 37). RESULTS: Serum triglyceride level was significantly higher in VL than controls [mean values were 173.50 ± 47.67 versus 127.1 ± 53.79 mg/dl, respectively (p < 0.0001)]. Triglyceride level was significantly higher in severe than in mild/moderate group of VL [211.3 ± 50.2 mg/dl versus 134 ± 45.09 mg/dl, respectively (p < 0.0001)]. Hypertriglyceridemia (>161.7 mg/dl) was noted in all severe VL patients, compared to 31.66% of mild or moderate group (p < 0.0001). There was no significant difference between mild/moderate VL and controls. CONCLUSIONS: It is hypothesized that hypertriglyceridemia could be of additional diagnostic benefit to assess the probability and severity of VL in endemic areas.

Human exposure risks for metals in soil near a coal-fired power-generating plant.

Coal-fired thermal power stations (TPSs) may contaminate the surrounding soil and could lead to pollution levels that can affect human health. Soil samples collected from the immediate vicinity of a TPS were analysed for heavy metals. TPS soils were enriched with arsenic (As), strontium (Sr), copper (Cu), mercury (Hg), barium (Ba), vanadium (V), beryllium (Be), cadmium (Cd), cobalt (Co), chromium (Cr), and nickel (Ni). Enrichment factor, principal component, and cluster analyses suggest that As, Cd, Co, Cr, and Hg in TPS soils originated from the TPS, whereas Pb and Zn were from vehicular/traffic-related emissions. The human exposure risk assessment based on different exposure pathways showed that the hazard index (HI) was <1.0 for all of the elements. The relative exposure risk was greater for toddlers. Although the overall risk was within the acceptable limit of 1.00, the HIs of Co (0.15) and Cr (0.082) were close to the threshold limits, which over the long-term may pose a health risk.

Hypomagnesemia secondary to cerebrospinal fluid losses in a patient with congenital hydrocephalus.

We describe a newborn infant with massive congenital hydrocephalus, presenting with hypomagnesemia secondary to magnesium losses through cerebrospinal fluid (CSF) aspirations. Hypomagnesemia due to CSF losses has not been described in pediatric literature.

Fatal acute pancreatitis in a patient with visceral leishmaniasis during miltefosine treatment.

Pancreatitis is a known side effect of the once commonly used drug, sodium stibogluconate, for treatment of visceral leishmaniasis (VL). In India, miltefosine has recently been introduced as the first-line drug. Its side effects include loose motions, vomiting, and teratogenicity. We report here a case of a 41-year-old parasitologically confirmed male case of VL, who developed acute pancreatitis during treatment with miltefosine. On the 13 th day of treatment, he presented with abdominal pain and vomiting. The biochemical, hematological, and radiological features were suggestive of acute pancreatitis. The patient was put on conservative treatment for pancreatitis at the specialized center but succumbed to renal failure and septicaemia.

Development of post-kala-azar dermal leishmaniasis in AmBisome treated visceral leishmaniasis: a possible challenge to elimination program in India.

We report two cases, one male (33 years) and a female (14 years), that developed Post-Kala-azar Dermal Leishmaniasis (PKDL) after successful treatment for visceral leishmaniasis (VL) or Kala-azar with AmBisome, the lipid complex of Amphotericin B. Both cases presented with hypo-pigmented macular lesions all over the body. The patients responded well to AmBisome after treatment with three courses. This first ever case report from India indicates that possibly there is no effective drug for VL until date, which can prevent post-treatment development of PKDL.

Evaluation of the co-application of fly ash and sewage sludge on soil biological and biochemical quality.

Disposal of sewage sludge (SS) and fly ash (FA) is a multifaceted problem, which can affect environmental quality. FA has the potential to stabilize SS by reducing metal availability and making the SS suitable for application in the agricultural sector. An experiment was performed to evaluate soil biological quality changes with the combined amendment of SS and FA (fluidized bed combustion ash (FBCA) and lignite fly ash (LFA)). SS was amended with 0, 10, 30, 50 and 100%, (w/w) of FA, and then the FA-SS mixtures were incubated with red soil at 1:1 (v/v). Soil quality parameters such as pH, electrical conductivity, N, soil enzyme activities such as dehydrogenase (DHA), urease (URE), and catalase (CAT), and microbial biomass carbon (MBC) were evaluated at 20, 30, and 60 days of incubation, pH and EC increased with FA-SS dose; however, N decreased. DHA and URE were found to be increased with 10% LFA amendment; thereafter it decreased. However, URE increased up to 30% of FBCA. CAT and MBC increased with both FA amendments, even up to addition of 50% FA. Bioavailable Zn, Cu, and Co contents were decreased by the addition of FA. Principal component analysis showed that pH is the most influential factor. MBC appears to be a sensitive soil indicator for the effects that result from the addition of FA-SS. Phytotoxicity studies with Zea mays showed optimum performance at 30% FA. Addition of 10-30% FBCA or LFA to SS has a positive advantage on soil biological quality.

Post-kala-azar dermal leishmaniasis in a patient treated with injectable paromomycin for visceral leishmaniasis in India.

Post kala-azar dermal leishmaniasis (PKDL) is a skin manifestation that usually develops after treatment of visceral leishmaniasis (VL), a major public health problem in India. The diagnosis and management of PKDL is complex. This is the first case report from India in which PKDL occurred after paromomycin treatment for VL in an Indian patient.

Cerebellar hemorrhage: a major morbidity in extremely preterm infants.

OBJECTIVE: To determine the impact of cerebellar hemorrhage (CH) on mortality and adverse neurodevelopmental (ND) outcome rates in extremely preterm infants admitted to a tertiary neonatal unit. STUDY DESIGN: A total of 1120 eligible infants (<28 weeks gestation) were born from 1998 to 2008 and had at least one cranial ultrasound. ND outcome was determined at 12 to 18 months corrected age. RESULTS: Most CH (75%) occurred in infants <25 weeks gestation. CH did not affect mortality rates, however, it was associated with both mental and motor impairments, with incidence rate ratios of 3.08 (1.71 to 4.84) and 2.12 (1.12 to 3.45), respectively. Moreover, the risk of cerebral palsy (CP) was increased in infants with CH involving the medial part of the cerebellum. CONCLUSION: Our findings substantiate recent reports about the cerebellum, highlighting its role in cognitive and executive functions, and associating early cerebellar injury not only with CP but also with learning, affective and behavioral disorders.

Approach to STEMI and NSTEMI.

Acute coronary syndrome (ACS) refers to any constellation of clinical symptoms that are compatible with acute myocardial ischemia. ACS is divided into ST- elevated myocardial infarction (STEMI), non-ST elevated myocardial infarction (NSTEMI), and unstable angina (UA). STEMI results from complete and prolonged occlusion of an epicardial coronary blood vessel and is defined based on ECG criteria..NSTEMI usually results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material. NSTEMI is defined by an elevation of cardiac biomarkers in the absence of ST elevation. The syndrome is termed UA in the absence of elevated cardiac enzymes. History, physical examination, ECG, biochemical markers, ECHO all remain important tools to make an appropriate diagnosis The management of ACS should focus on rapid diagnosis, risk stratification, and institution of therapies that restore coronary blood flow and reduce myocardial ischemia.

Post-kala-azar dermal leishmaniasis (PKDL), HIV and pulmonary tuberculosis.

Post-kala-azar dermal leishmaniasis is usually a sequel to visceral leishmaniasis. A 25-year-old woman presented with hypopigmented maculopapular lesions all over the body for the past 4 years without any previous history of visceral leishmaniasis. She was on treatment for leprosy and pulmonary tuberculosis for the past 2 months, but did not show any improvement. Investigations confirmed that she had post-kala-azar dermal leishmaniasis associated with pulmonary tuberculosis and HIV-1 infection. She was started on treatment for the triad of diseases, and showed improvement.

Change in conformation of polymer PFO on addition of multiwall carbon nanotubes.

Multiwall carbon nanotubes (MWNTs) have been added to the polymer poly (9,9-dioctylfluorenyl-2, 7-diyl) end capped with dimethylphenyl (PFO) in various weight percentages and the blends thus prepared, using a solution processing approach, have been characterized using SEM, UV-VIS spectroscopy, PL spectroscopy and I-V characterization. The SEM micrographs show a change in the structure of the polymer from partially crystalline to a glassy state in the blend form. The morphology observations are supported by absorption spectra which show a very high diminution of the polymers' beta peak in the spectra obtained from the polymer-nanotube blend. Thus, multiwall carbon nanotubes modify the local nanoscopic structure of PFO leading to a more glassy structure instead of a partially crystalline form and provide a method to tailor the conformation of polymer PFO, depending on intended application. I-V characteristics reveal an increase in current on formation of the polymer-nanotube blend as compared to the polymer-only structure. On the basis of percolation theory, as applied to these polymer-nanotube blends, a percolation threshold value of 0.45 wt% and critical exponent value of 1.84 has been obtained, indicating the formation of a three dimensional polymer-nanotube network.