Containment of a cluster of COVID-19 to prevent impending community transmission: experience from a rural area in South India

Background: On 23 July 2020, COVID-19 contact tracing cell was informed of a laboratory confirmed case of COVID-19 with substantial number of contacts. The current scenario under investigation is an example for a large outbreaks amenable to containment. If not contained immediately and effectively it may pass on to large community transmission.Methods: Epidemiological investigation and contact tracing was carried out to identify the source and contacts of a confirmed case of COVID-19 reported on 22 July 2020. A semi-structured questionnaire prepared by COVID-19 contact tracing cell, Government Medical College (GMC), Palakkad was used to collect data on clinical characteristics, likely source of exposure and contacts made by the index case. High risk and low risk contacts were contacted over telephone to ensure quarantine, testing on 8th day (both for high risk contacts) and symptom monitoring.Results: Total of 55 high risk contacts were identified, 15 of which were of high risk exposure. All 15 high risk contacts were kept in quarantine with testing on day 8 after last exposure. 7 new cases occurred among 15 the high risk contacts of which one turned out to be suspected primary, 5 secondary cases of index case and one secondary case of the suspected primary case. All secondary and low risk contacts were kept under symptom surveillance, and did not develop COVID-19.Conclusions: Timely case notification coupled with complete and effective contact tracing and quarantining has contained the cluster and prevented it from emerging as large community transmission

Marital satisfaction : A predictor of post-partum depression

Abstract Post-Partum Depression (PPD) is the most common mental health disorder that has raised major public health concerns. Post-partum depression is related to various adverse health outcomes for mothers and children. Studies from lower and middle-income countries suggest up to 25% of pregnant women experience symptoms of common mental health disorders, including depression. Post-partum depression adversely affects a mother’s mental health, quality of life, and interactions with their partner, infant, and relatives and can predispose her to subsequent depression. Factors such as prenatal depression and stressful life events like marital dysfunction or conflict are gaining researchers’ attention, with additional focus on effects on the infant. It is crucial to comprehend how social support and marital satisfaction affect the prevention and treatment of post-partum depression

Analysis of railway track deaths-an autopsy based study

Background: Railway related deaths account for approximately one percentage of all fatalities submitted to medicolegal autopsies. The study is undertaken with the aim of better understanding of railway track deaths by analyzing the demographic details of victims and other contributing factors which favours the occurrence of railway track deaths.Methods: A cross sectional descriptive study of all railway track deaths brought for medicolegal autopsy at Thiruvananthapuram Medical College, Kerala, India from 1st March 2010 to 28th February 2011 was done. A total of 104 cases of railway track deaths were studied excluding cases with advanced decomposition. Clinical case records were studied in treated cases. details regarding nature dimensions and location of injury was entered in a proforma. The data were entered in MS Excel and statistical analysis was done.Results: Out of 104 cases studied 83 (79.8%) victims were male and 21 (20.2%) victims were female. The lowest and highest age of the victim involved in the study was 15 years and 90 years respectively. Elderly people with impairment of vision and hearing are most vulnerable to such accidents 12.5%. The highest frequency of incidence of railway deaths occurred while crossing the Railway track (32.7%), followed by jumping in front of the train (19.2%) and walking along the side or through track (16.3%). In 17.3% of the cases there was no exact history regarding the incident. The most common types of external injuries were lacerated wound and abrasion. In all the cases head showed lacerated wounds and the upper limbs showed abrasion.Conclusions: Present study concludes that majority of victims were males showing a female ratio 4:1, The peak incidence was noted in the 6th decade. Most of the victims were manual labourers. Travelling, moving and crossing near railway tracks in intoxicated condition is very usual practice. Survival period was found to be very less

Injuries to the great vessels: an autopsy-based study

Background: Injuries of the chest causing disruption of the thoracic cage, damaging the great vessels are increasing daily. Aorta is most vulnerable to injury in deceleration trauma from road and air accidents, fall from height and penetrating injuries. Incidence of traumatic rupture of the aorta is rising with higher travel speed.  Methods: In this study we analysed the pattern of injury to great vessels and the socio-demographic pattern of the victims in trauma. 250 cases brought to a tertiary care institution for autopsy were studied from 1st January 2005 to 30th November 2005 (1st July 2005 - 30th November prospectively, and 1st January - 30th June 2005, retrospectively). A cross sectional study design including all cases of trauma to the chest was done with consecutive sampling. Data was collected in pro forma and analysed.Results: 206 victims were males. Commonest cause of chest injury was trauma. 130 (52%) were victims of road traffic accidents and the vehicle implicated the most was bus (41 cases, 16.4%). Pedestrians constituted the majority (26.4%). 15 cases (6%) involved major blood vessels of the thorax. Descending part of the thoracic aorta was vulnerable, with transection of the great vessels in 5 cases (2%). Haemothorax was observed in 102 cases on right side and 94 cases on the left side. 9 cases (4%) of bronchial or tracheal ruptures with 6 cases of severance and 3 incidences of tear were recorded.Conclusions: The wound of aorta or pulmonary artery are immediately fatal and commonly seen in case of vehicular accident or fall from height due to the intense compression to the chest with or without any sign of external injury. Most ruptures are due to automobile accidents and the mechanism of injury is sudden motion of the heart and great vessels

Neurodevelopmental assessment of neonates with congenital hypothyroidism in a tertiary care center

Background: Thyroid hormones play a crucial role in early neurodevelopment so that untreated severe congenital hypothyroidism (CH) results in neurological and psychiatric deficits, including intellectual disability, spasticity, and disturbances of gait and coordination. Objective: The aim of this study is to assess the neuromotor and neurocognitive development of babies at 12 months of age who are diagnosed to have CH and initiated on thyroxine treatment at birth. Furthermore, to estimate the occurrence of CH among babies delivered in our hospital through thyroid screening. Study Design: This was a descriptive study. Setting: The study was conducted in Sree Gokulam Medical College Hospital and Research Foundation, a tertiary care center, located in Trivandrum, Kerala. Participants: All babies delivered in the hospital during the study period and neonatal screening was done for CH. Methods: Cord blood was collected as the direct flow of blood from cord, labeled and sent to laboratory from delivery room for analysis (by chemiluminescent assay) of thyroid-stimulating hormone (TSH). Babies with cord blood TSH level ≥20 uIU/ml were repeated at 72 h of age for venous TSH and FT4 level. Venous TSH level ≥20 uIU/ml with low FT4 (below normal range for age) was considered as abnormal and initiated on treatment before discharge from the hospital. These babies were followed till 12 months of age for neurodevelopmental assessment. Results: The occurrence of CH among babies delivered in our hospital was 0.6 in 100 live births. Neurodevelopmental assessment of babies with CH on follow-up has shown normal neuromotor and neurocognition at 12 months of age with early detection and prompt initiation of L-thyroxine at a higher dose range within 5 days of age. Conclusion: In our study, early detection and initiation of treatment in infants with CH have shown normal neuromotor and neurocognitive development at 12 months of age

Oxytocin and neonatal hyperbilirubinemia: A prospective cohort study

Objective: To study the incidence of neonatal jaundice requiring phototherapy in babies exposed to maternal oxytocin for inductionof labor and to compare the increase in neonatal jaundice in oxytocin group with the jaundice in babies born of spontaneous labor.Materials and Methods: This prospective cohort study was conducted in the neonatal unit of a tertiary care center in Trivandrum,Kerala over a period of 6 months. After exclusion, 308 babies were divided in two groups, Group A (babies exposed to maternaloxytocin for induction of labor) or Group B (babies born of spontaneous labor with oxytocin use for augmentation of labor). Babies wereobserved daily for clinical jaundice till discharge. Results: Incidence of neonatal jaundice in Group A was 52% and in Group B was 12%with relative risk 4.3 (95% confidence interval: 2.69-6.73). Conclusion: Our study shows that maternal oxytocin used for inductionof labor increase the incidence of neonatal jaundice, and it is logical to prevent hyperbilirubinemia by reducing the dose of oxytocin

LL37 and Cationic Peptides Enhance TLR3 Signaling by Viral Double-stranded RNAs

BACKGROUND:Toll-like Receptor 3 (TLR3) detects viral dsRNA during viral infection. However, most natural viral dsRNAs are poor activators of TLR3 in cell-based systems, leading us to hypothesize that TLR3 needs additional factors to be activated by viral dsRNAs. The anti-microbial peptide LL37 is the only known human member of the cathelicidin family of anti-microbial peptides. LL37 complexes with bacterial lipopolysaccharide (LPS) to prevent activation of TLR4, binds to ssDNA to modulate TLR9 and ssRNA to modulate TLR7 and 8. It synergizes with TLR2/1, TLR3 and TLR5 agonists to increase IL8 and IL6 production. This work seeks to determine whether LL37 enhances viral dsRNA recognition by TLR3. METHODOLOGY/PRINCIPAL FINDINGS:Using a human bronchial epithelial cell line (BEAS2B) and human embryonic kidney cells (HEK 293T) transiently transfected with TLR3, we found that LL37 enhanced poly(I:C)-induced TLR3 signaling and enabled the recognition of viral dsRNAs by TLR3. The presence of LL37 also increased the cytokine response to rhinovirus infection in BEAS2B cells and in activated human peripheral blood mononuclear cells. Confocal microscopy determined that LL37 could co-localize with TLR3. Electron microscopy showed that LL37 and poly(I:C) individually formed globular structures, but a complex of the two formed filamentous structures. To separate the effects of LL37 on TLR3 and TLR4, other peptides that bind RNA and transport the complex into cells were tested and found to activate TLR3 signaling in response to dsRNAs, but had no effect on TLR4 signaling. This is the first demonstration that LL37 and other RNA-binding peptides with cell penetrating motifs can activate TLR3 signaling and facilitate the recognition of viral ligands. CONCLUSIONS/SIGNIFICANCE:LL37 and several cell-penetrating peptides can enhance signaling by TLR3 and enable TLR3 to respond to viral dsRNA

6-Formyl-2-meth­oxy-3-nitro­phenyl 4-toluene­sulfonate

In the title compound, C15H13NO7S, the inter­planar angle between the two aromatic rings is 26.04 (3)°. The crystal structure is stabilized by C—H⋯O interactions

Neural development features: Spatio-temporal development of the Caenorhabditis elegans neuronal network

The nematode Caenorhabditis elegans, with information on neural connectivity, three-dimensional position and cell linage provides a unique system for understanding the development of neural networks. Although C. elegans has been widely studied in the past, we present the first statistical study from a developmental perspective, with findings that raise interesting suggestions on the establishment of long-distance connections and network hubs. Here, we analyze the neuro-development for temporal and spatial features, using birth times of neurons and their three-dimensional positions. Comparisons of growth in C. elegans with random spatial network growth highlight two findings relevant to neural network development. First, most neurons which are linked by long-distance connections are born around the same time and early on, suggesting the possibility of early contact or interaction between connected neurons during development. Second, early-born neurons are more highly connected (tendency to form hubs) than later born neurons. This indicates that the longer time frame available to them might underlie high connectivity. Both outcomes are not observed for random connection formation. The study finds that around one-third of electrically coupled long-range connections are late forming, raising the question of what mechanisms are involved in ensuring their accuracy, particularly in light of the extremely invariant connectivity observed in C. elegans. In conclusion, the sequence of neural network development highlights the possibility of early contact or interaction in securing long-distance and high-degree connectivity