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Background: COVID-19 pandemic has affected mankind globally. After the three waves since March 2020, the threat continues instilling fear in the minds. Vital parameter monitoring through remote health monitoring system (RHMS) becomes critical for effective disease management and manpower safety and confidence. In a low resource setting like India, a comprehensive, wearable, and remotely operable device that is economical was required to be introduced for COVID-19 care. Present study validated the remote health monitoring device named COVIDBEEP with gold standard equipment. Materials and Methods: Six parameters, namely heart rate, SpO2, respiratory rate, temperature, blood pressure, and ECG were acquired in the supine position using the devices. Result: Analysis was performed using Graph Pad Prism. Intraclass correlation coefficients were used to measure concurrent validity. Bland–Altman graphs were plotted to know the agreement for each vital parameter. Confidence limits were set at 95%. All the parameters recorded from the devices showed a significant correlation with an “r” value between 0.5 and 0.9 with P value between 0.001 and 0.0002. Bland–Altman plots showed a minimum bias of 0.033 for heart rate and maximum of 3.5 for systolic blood pressure and respiratory rate. Conclusion: The association between the parameters recorded by the devices strengthened as the time of collection of data increased. Agreement between the two methods in 95% confidence interval was also proven to be significant for the parameters. Therefore, the indigenously developed COVIDBEEP has shown good validity in comparison to standard monitoring device.

Introduction: Pre-surgical screening of patients for COVID-19 by Reverse transcription-Polymerase Chain Reaction (RT-PCR) is essential before surgeries as a precautionary measure in view of preventing COVID-19 to the health care workers. The inception of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) posed major hurdles and challenges in conducting elective surgeries. Considering that COVID-19 is expected to continue to be a problem for the public health system in the near future, institutions will need to create risk mitigation strategies with meticulous resource management especially in high burden centers. Aim: To assess the role and need of repeat RT-PCR testing after an initial negative at a tertiary care center in view of the ever changing dynamics of COVID-19. Materials and Methods: A retrospective observational study was conducted at the Mobile Virology Research & Diagnostic Laboratory in the Department of Microbiology, ESIC Medical College & Hospital, Hyderabad between September 2020 to May 2021. Pre- surgical cases admitted at the facility during the study period with ≥72 h duration of stay who have been tested for SARS-COV-2 RT-PCR more than once within a period of one week were included. RT-PCR testing was performed according to standard protocols. Clinical and demographic data were collected, including reasons for re-testing. Results: A total of 2398 patients were admitted for surgeries during the study period, out of which 697 cases had a prolonged stay ≥72 h. In all of the cases, the initial test was negative, but 11 (1.58%) of them converted to positive. During the zenith of the second wave, the conversion rate was 4%, whereas it was only 0.2% during non peak periods. Conclusion: Hence, it was concluded that to optimise the usefulness of pre-surgical screening test for SARS-COV-2, repeat testing may be avoided in a low burden setting with timely reassessment based on local positivity rate. Each facility should continuously reassess their needs based on sudden local surges to optimise utilisation, especially when faced with resource constraints and changing paradigm of the pandemic.

The pandemic caused by SARS-CoV-2 (SCoV-2) has impacted the world in many ways and the virus continues to evolve and produce novel variants with the ability to cause frequent global outbreaks. Although the advent of the vaccines abated the global burden, they were not effective against all the variants of SCoV-2. This trend warrants shifting the focus on the development of small molecules targeting the crucial proteins of the viral replication machinery as effective therapeutic solutions. The PLpro is a crucial enzyme having multiple roles during the viral life cycle and is a well-established drug target. In this study, we identified 12 potential inhibitors of PLpro through virtual screening of the FDA-approved drug library. Docking and molecular dynamics simulation studies suggested that these molecules bind to the PLpro through multiple interactions. Further, IC50 values obtained from enzyme-inhibition assays affirm the stronger affinities of the identified molecules for the PLpro. Also, we demonstrated high structural conservation in the catalytic site of PLpro between SCoV-2 and Human Coronavirus 229E (HCoV-229E) through molecular modelling studies. Based on these similarities in PLpro structures and the resemblance in various signalling pathways for the two viruses, we propose that HCoV-229E is a suitable surrogate for SCoV-2 in drug-discovery studies. Validating our hypothesis, Mefloquine, which was effective against HCoV-229E, was found to be effective against SCoV-2 as well in cell-based assays. Overall, the present study demonstrated Mefloquine as a potential inhibitor of SCoV-2 PLpro and its antiviral activity against SCoV-2. Corroborating our findings, based on the in vitro virus inhibition assays, a recent study reported a prophylactic role for Mefloquine against SCoV-2. Accordingly, Mefloquine may further be investigated for its potential as a drug candidate for the treatment of COVID.

In an interesting investigation by Khoury-Hanold et al. (1), genital infection of mice with herpes simplex virus 1 (HSV1) were reported to cause multiple pelvic organ involvement and obstruction. A small subset of mice succumbed after the first week of HSV1 infection. The authors inferred that the mice died due to toxic megacolon. In a severe form of mechanical and/or functional obstruction involving gross dilation of the colon and profound toxemia, the presentation is called “toxic megacolon.” The representative observations by Khoury-Hanold likely do not resemble toxic megacolon. The colon was only slightly dilated and benign appearing. Importantly, HSV1 infection affected the postjunctional mechanisms of smooth muscle relaxation like the sildenafil-response proteins, which may have been responsible for defective nitrergic neurotransmission and the delayed transit. Orally administered polyethylene glycol reversed the gastrointestinal “obstruction,” suggesting a mild functional type of slowed luminal transit, resembling constipation, rather than toxic megacolon, which cannot be reversed by an osmotic laxative without perforating the gut. The authors suggest that the mice did not develop HSV1 encephalitis, the commonly known cause of mortality. The premature death of some of the mice could be related to the bladder outlet obstruction, whose backflow effects may alter renal function, electrolyte abnormalities and death. Muscle strip recordings of mechanical relaxation after electrical field stimulation of gastrointestinal, urinary bladder or cavernosal tissues shall help obtain objective quantitative evidence of whether HSV infection indeed cause pelvic multi-organ dysfunction and impairment of autonomic neurotransmission and postjunctional electromechanical relaxation mechanisms of these organs.

Introduction:  Esophageal atresia with or without tracheoesophageal fistula (EA with or without TEF) is one of the neonatal surgical emergencies requiring surgical intervention in the early neonatal period, influencing the developmental outcome in the operated children. This study was aimed to assess the developmental status of children operated for EA with or without TEF along with maternal stress, their quality of life (QOL), and coping abilities.Materials and Methods:  A descriptive cross-sectional survey was conducted on 51 children aged up to 5 years after EA with or without TEF repair and their mothers' in a tertiary care facility. The tools used were, namely, demographic datasheet of child and mother, anthropometry assessment, Developmental Assessment Scale for Indian Infants, and modified Vineland Social Maturity Scale for the developmental evaluation, Child Behavior Checklist (1.5-5 years) caregiver report form, Parental Stress Scale, WHOQOL BREF, and Coping Strategies Checklist.Results:  The majority of children had low weight (47.1%) and height (31.4%), for reference age. The overall and social developmental delay was observed in 40.7 and 37.5% of children, respectively, and few children (7.4%) had behavioral problems in the borderline range. Among the mothers, 47% had moderate stress and relatively poor QOL in environmental (60.1 ± 18.9) and psychological (60.8 ± 18.8) domains. The most commonly used coping strategy by the mothers was an emotional outlet (29.4%).Conclusion:  Developmental delay was present in children operated for EA with or without TEF caused significant stress among mothers, affecting their QOL for which the emotional outlet was the most commonly used coping strategy. [ABSTRACT FROM AUTHOR]

Aim: This study investigates the fall in total serum bilirubin levels within 1 week after surgery, as a marker to predict early outcome in biliary atresia (BA) patients post-Kasai portoenterostomy (KP). Methods: The ratio of total serum bilirubin levels at the 7th postoperative day to the preoperative level (TB7/TB0) in patients undergoing KP was calculated (January 2011-July 2015). Patients were stratified after 3-months follow-up into outcome groups depending on the clinical clearance of jaundice and TB7/TB0 ratio was correlated to outcome and liver histopathological changes in these groups. Results: Sixty-one patients (M:F = 44:17), median age 75 days were included. At the end of 3 months, 27 (44.39%) were anicteric while 26 (42.6%) were still clinically jaundiced. Patients with a higher median value of TB7/TB0, that is, 0.856 were more likely to have jaundice at the end of 3 months as compared to patients with a lower median value of 0.615 (P < 0.0001). A cutoff TB7/TB0 ratio >0.723 predicted the KP outcome with 84.6% sensitivity and 81.5% specificity. The difference in TB7/TB0 ratio between patients with varying severity of liver histopathological changes was also significant, namely, cholestasis (P = 0.01), hepatocellular damage (P = 0.03), portal inflammation (P = 0.04), and portal fibrosis (P = 0.02). Conclusions: The rapidity of fall in the total serum bilirubin levels within 1 week post-KP was able to predict the likely outcome in BA patients. [ABSTRACT FROM AUTHOR]

A day-old neonate presented with bowel obstruction and an abdominal mass. exploratory laparotomy revealed complete tubular midgut duplication from duodeno--jejunal junction up to terminal ileum which was communicating with the ileum distally. at the proximal end, another 5x5 cm duplication cyst was identified and excised. postoperatively, complaints were relieved. During follow-up, 99m-Tc-pertechnetate-SPECT scan showed ectopic gastric mucosa in lower abdomen and in the right hemithorax. CECT-chest showed a 3x3 cm foregut duplication cyst, but there were no respiratory symptoms. While being planned for an elective surgery, he presented at 6 months of age in emergency with massive bleed per-rectum and shock. He underwent Wrenn procedure without any injury to the normal bowel the thoracic foregut duplication cyst was excised later. total midgut duplication, though benign, may present with life-threatening haemorrhage if left untreated. presence of one such lesion warrants a search for others. Mucosal stripping is a simple and safe alternate to resection. [ABSTRACT FROM AUTHOR]

Study Objective: This study was undertaken to compare the analgesic efficacy of ultrasound-guided single-shot caudal block with ultrasound-guided single-shot paravertebral block in children undergoing renal surgeries.Design: Randomised, interventional, blinded clinical trial.Setting: Operating rooms of All India Institute of Medical Sciences, New Delhi, India.Patients: 50 children aged 2-10 years, of ASA status I/II, posted for elective renal surgeries.Interventions: The children were randomised into two groups (Group C-caudal block, Group P-paravertebral block). After induction of general anesthesia, single-shot caudal or paravertebral block was performed under ultrasound guidance, with 0.2% ropivacaine with 1:200000 adrenaline.Measurements: Time to first rescue analgesia, time to perform blocks, intraoperative and post-operative hemodynamics, post-operative FLACC scores, incidence of complications, parental satisfaction scores were recorded.Main Results: Children in Group P had significantly longer duration of analgesia (p < 0.0004) than Group C. Post-operative FLACC scores (p < 0.005) and analgesic requirements (p < 0.0004) were lower in Group P. The mean fentanyl requirement over 24 h in group P was 0.56 ± 0.82 μg/kg, compared to 1.8 ± 1.2 μg/kg in group C. Parents in Group P reported greater satisfaction (p < 0.02). No complications were seen in either of the groups.Conclusion: This study showed superior analgesia and parental satisfaction with single-shot paravertebral block in comparison to single-shot caudal block for renal surgeries in children. However, the block performance in children requires adequate expertise and practice. [ABSTRACT FROM AUTHOR]

Several B cell defects are reported in HIV-1 infected individuals including variation in B cell subsets, polyclonal B cell activation and exhaustion, with broadly neutralizing antibodies elicited in less than 10-20% of the infected population. HIV-1 disease progression is faster in children than adults. B Lymphocyte Stimulator (BLyS), expressed on dendritic cells (DCs), is a key regulator of B cell homeostasis. Understanding how DCs influence B cell phenotype and functionality (viral neutralization), thereby HIV-1 disease outcome in infected children, is important to develop interventional strategies for restoration of B cell function. In this study, a total of 38 vertically transmitted HIV-1 infected antiretroviral therapy (ART) naïve children and 25 seronegative controls were recruited. Based on the CD4 counts and years post-infection, infected children were categorized as long-term non-progressors (LTNPs) ( n  = 20) and progressors ( n  = 18). Eight of these progressors were followed up at 6-12 months post-ART. Percentages (%) of DCs, B cell subsets, and expression of BLyS on DCs were analyzed by flow-cytometry. Plasma levels of B cell growth factors were measured by ELISA and viral neutralization activity was determined using TZM-bl assay. Lower (%) of myeloid DCs (mDCs), plasmacytoid DCs, and high expression of BLyS on mDCs were observed in HIV-1 infected progressors than seronegative controls. Progressors showed lower % of naive B cells, resting memory B cells and higher % of mature activated, tissue-like memory B cells as compared to seronegative controls. Higher plasma levels of IL-4, IL-6, IL-10, and IgA were observed in progressors vs. seronegative controls. Plasma levels of IgG were high in progressors and in LTNPs than seronegative controls, suggesting persistence of hypergammaglobulinemia at all stages of disease. High plasma levels of BLyS in progressors positively correlated with poor viral neutralizing activity. Interestingly on follow up, treatment naïve progressors, post-ART showed increase in resting memory B cells along with reduction in plasma BLyS levels that correlated with improvement in viral neutralization. This is the first study to demonstrate that reduction in plasma BLyS levels correlates with restoration of B cell function, in terms of viral neutralization in HIV-1-infected children.