Incidence of Cardiovascular Instability in Patients With Guillain-Barré Syndrome: A Retrospective Study.

Introduction Guillain-Barré syndrome (GBS) is an autoimmune disease affecting radicles and peripheral nerves resulting in acute flaccid paralysis. Respiratory failure, autonomic dysfunction, and secondary complications such as pneumonia, and venous thromboembolism are the major causes of death and disability in GBS. Cardiovascular complications play a major role in the prognosis of GBS patients. The aim is to determine the incidence of cardiovascular instability in GBS patients and to see if there are any specific risk groups associated with the development of cardiovascular instability. Methodology This is a retrospective descriptive study conducted in a tertiary care center in South India. Data on 50 consecutive GBS patients were collected from hospital records including case sheets, death summaries, and discharge summaries. Patients with evidence of sepsis, blood loss, heavy alcohol consumption, and chronic liver disease were excluded from the study. Baseline demographic data, symptom onset to admission time, baseline Erasmus Guillain-Barré Syndrome Respiratory Insufficiency Score (EGRIS), and baseline liver function tests were documented. The presence of heart rate and blood pressure fluctuations was noted from the records. Frequency data were calculated from the categorical variables. Analysis of non-parametric variables by chi-square test was done using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). Results Cardiovascular instability was present in 15 (30%) patients in the study population. It was present in all patients (100%) who require mechanical ventilation. The incidence of cardiovascular instability was higher in patients who had lesser onset to admission times (41.9% vs 10.5%; p=0.019), EGRIS≥4 (40.6% vs 11.1%; p=0.029), and lower cranial nerve involvement (40% vs 6.7%; p=0.018). Conclusion Of patients with GBS, 30% developed cardiovascular instability during their disease course. Patients with lesser onset to admission times, EGRIS ≥4, and those with lower cranial nerve involvement had a greater incidence of cardiovascular instability.

Evaluation of Pertussis Disease in Young Infants in India: A Hospital-Based Multicentric Observational Study.

OBJECTIVES: To evaluate the incidence of laboratory-confirmed pertussis (LCP) among infants hospitalized with acute respiratory infections (ARIs) and meeting the Centers for Disease Control and Prevention (CDC)-recommended clinical case definition. METHODS: An investigator-initiated active surveillance for clinically suspected cases (CSCs) of pertussis screened infants aged ≤6 mo hospitalized with ARIs during January 2020-April 2022 at seven centers across India. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect Bordetella pertussis in nasopharyngeal swabs. Infants were classified as having 'LCP' or 'probable pertussis' (PP). RESULTS: Among 1102 screened infants, 400 participants met the CDC-2020 clinical case definition for pertussis. Of these, 34/400 (8.5%) had LCP and 46/400 (11.5%) had PP. The proportion of participants with LCP and PP was similar among infants aged 0-3 and 4-6 mo [LCP: 0-3 mo, 21/248 (~9%); 4-6 mo, 13/152 (~9%); PP: 0-3 mo, 30/248 (~12%); 4-6 mo, 16/152 (~11%)]. Cough illness lasted ≥2 wk in 3/34 (~9%) and 34/46 (~74%) participants with LCP and PP, respectively. Notably, 80% CSCs had neither LCP nor PP, and a respiratory pathogen apart from B. pertussis was detected in ~32%. Ventilation was required in 12 participants with LCP/PP. CONCLUSIONS: In this first study from India based on revised CDC guidelines, the incidence of LCP was 8.5%; cough illness was not a predominant feature. Infants below the age appropriate for vaccination are prone to pertussis-related hospital admissions, ICU care, and ventilation. Maternal immunization may be evaluated for neonatal protection, in addition to other strategies, to decrease disease burden in this highly vulnerable group. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2019/12/022449.

Chest radiograph findings in children with COVID-19-A retrospective analysis from a tertiary care paediatric hospital in South India.

OBJECTIVE: The primary aim of this study is to document the chest X-ray findings in children with COVID-19 pneumonia. The secondary aim is to correlate chest X-ray findings to patient outcome. METHODS: We performed a retrospective analysis of children (0-18 years) with SARS-CoV-2 admitted to our hospital from June 2020 to December 2021. The chest radiographs were assessed for: peribronchial cuffing, ground-glass opacities (GGOs), consolidation, pulmonary nodules and pleural effusion. The severity of the pulmonary findings was graded using a modification of the Brixia score. RESULTS: There were a total of 90 patients with SARS-CoV-2 infection; the mean age was 5.8 years (age range 7 days to 17 years). Abnormalities were seen on the CXR in 74 (82%) of the 90 patients. Bilateral peribronchial cuffing was seen in 68% (61/90), consolidation in 11% (10/90), bilateral central GGOs in 2% (2/90) and unilateral pleural effusion in 1% (1/90). Overall the average CXR score in our cohort of patients was 6. The average CXR score in patients with oxygen requirement was 10. The duration of hospital stay was significantly longer in those patients with CXR score >9. CONCLUSION: The CXR score has the potential to serve as tool to identify children at high risk and may aid planning of clinical management in such patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) created a global pandemic in early March 2020. There are very few studies describing the lung changes in affected children. We performed a retrospective study in children, aged between 0 days and 18 years, who tested positive for this virus. This study was conducted in a paediatric tertiary care hospital in South India. Chest X-ray (CXR) was done in children with moderate and severe SARS-CoV-2 infection; these X-rays were reviewed and scoring was done to assess the degree of abnormality. It was seen that the duration of hospital stay was longer in children with a high CXR score. Amongst the children with score >9, 60% needed oxygen support during their treatment. Thus, CXR score can play a role in the prediction of disease outcome in SARS-CoV-2 infection.

Hydrophilic poly (ethylene glycol) capped poly (lactic-co-glycolic) acid nanoparticles for subcutaneous delivery of insulin in diabetic rats.

The aim of the present study is to evaluate the effect of insulin loaded poly(ethylene glycol) capped poly(lactic-co-glycolic)acid nanoparticles (ISPPLG NPs) by subcutaneous administration in diabetic rats. A series of biodegradable low molecular weight PLGA [90/10 (PLG2) and 80/20 (PLG4)] copolymers were synthesized by melt polycondensation and their ISPPLG NPs were synthesized by water-oil-water (W/O/W) emulsion solvent evaporation method. The PLGA copolymers and their nanoparticles were characterized. The maximum encapsulation efficiency of ISPPLG4 NPs is 66% and the diameter of the nanoparticles is about 140nm. The in-vivo studies of ISPPLG NPs carried out in diabetic rats by subcutaneous administration show considerable reduction in serum glucose level along with partial restoration of tissue defense systems. Histopathological studies reveal that ISPPLG NPs could restore the damages caused by oxidants during hyperglycaemia. The subcutaneous administration of ISPPLG4 NPs is thus an effective method of reducing hyperglycaemia associated complications.

Synthesis, characterization and application of acryloyl chitosan anchored copolymer towards algae flocculation.

A novel water soluble flocculant AC-g-P(DMC-MACPPC) was synthesized by free radical polymerization of [2-(methacryloyloxy) ethyl] trimethylammonium chloride (DMC) and 4-methacryloyl 1-cyclopentyl piperazinium chloride (MACPPC), grafted on to acryloyl chitosan (AC). The grafting of copolymer was confirmed by DRS-UV, FTIR, NMR, Raman, XRD and XPS spectral techniques. The AC-g-P(DMC-MACPPC) exhibits higher flocculation efficiency towards harvesting of C. vulgaris micro algae, when compared to that of copolymer P(DMC-MACPPC) and homo polymer PMACPPC. The higher efficiency exhibited by the grafted copolymer can be attributed to the increase in positive charge and molecular weight after grafting on to acryloyl chitosan. The grafted copolymer AC-g-P(DMC-MACPPC) is very easy to synthesize, economical and water soluble which makes it a promising flocculant in the algae harvesting process.

Influence of in vitro oxygen concentrations on preimplantation embryo development, gene expression and production of Hanwoo calves following embryo transfer.

This study evaluated the effects of two different oxygen (O2) concentrations on in vitro embryo development, embryo quality, and gene expression and the in vivo development following embryos transfer to recipients of natural and synchronized estrus in bovines. Cumulus oocyte complexes were in vitro matured in TCM199 supplemented with FSH (10 microg/ml), LH (10 microg/ml), and 10% (v/v) FBS. Presumptive zygotes were cultured in SOF medium either under 5% (low) or 20% (high) O2 in air. Cleavage rates did not differ between groups. Blastocyst and hatched blastocyst development in 5% O2 were significantly (P < 0.05) higher than in 20% O2. Total cell number of in vivo blastocyst was significantly (P < 0.05) higher than that of in vitro blastocyst. ICM ratio and apoptosis of in vivo blastocyst were significantly (P < 0.05) lower than that of in vitro blastocyst. Using real time PCR, we have found that for the set of genes (GLUT-1, MnSOD, VEGF, Bax, and Bcl-2) analyzed, there were differences in mRNA expression between in vitro produced (IVP) and in vivo produced embryos. Interestingly, the abundance of transcript for IFN-tau in IVP embryos produced under 5% O2 concentration was similar to in vivo counterparts. The pregnancy and twin rates of natural recipients were significantly (P < 0.05) higher than those of synchronized counterparts. No significant difference in the offspring sex was observed. In conclusion, low (5%) O2 concentration during IVC was beneficial for enhancing the embryo quality and recipients of natural estrus were more suitable than synchronized estrus for stable production of Hanwoo calves.