Neonatal sepsis: Aetiology, pathophysiology, diagnostic advances and management strategies

Neonatal sepsis, a bloodstream infection in the first 28 days of life, is a leading cause of morbidity and mortality among infants in both developing and developed countries. Additionally, sepsis is distinguished in neonates by unique pathophysiological and presentational factors relating to its development in immature neonatal immune systems. This review focuses on the current understanding of the mechanics and implications of neonatal sepsis, providing a comprehensive overview of the epidemiology, aetiology, pathophysiology, major risk factors, signs and symptoms and recent consensus on the diagnosis and management of both early-onset and late-onset neonatal sepsis. It also includes a discussion on novel biomarkers and upcoming treatment strategies for the condition as well as the potential of COVID-19 infection to progress to sepsis in infants

Band Sequence - Past, Present and Future

Amniotic band sequence (ABS) is a constellation of congenital malformations involving mostly distal extremities, less often craniofacial and visceral defects. It is often characterized by the asymmetry of the organ involvement and can manifest with varying severity. Amniotic band sequence lacks a precise definition and pathogenic mechanism, with the extrinsic theory of “Early amnion rupture sequence†being the most widely accepted hypothesis. Using 3-dimension (3D) or 4-dimension (4D) ultrasound scans, ABS related fetal diagnoses can be made early in pregnancy facilitating fetal interventions. Today with minimally invasive fetal surgery, the amniotic bands can be released to save a limb or to avoid a fetal death due to amniotic band constriction of the umbilical cord. To date, no definite genetic basis has been known for the defects seen in ABS. Published articles; monographs and personal experience in fetal and neonatal diagnosis of ABS have contributed extensively to this review article

Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia

IntroductionGiven that reports on severe diazoxide (DZX) toxicity are increasing, we aimed to understand if the short-term clinical outcomes of small-for-gestational-age (SGA) infants with hyperinsulinemic hypoglycemia (HH) managed primarily by supportive care, termed watchful waiting (WW), are different from those treated with DZX.MethodA real-life observational cohort study was conducted from 1 September 2014 to 30 September 2020. The WW or DZX management decision was based on clinical and biochemical criteria. We compared central line duration (CLD), postnatal length of stay (LOS), and total intervention days (TIDs) among SGA-HH infants treated with DZX versus those on a WW approach. Fasting studies determined the resolution of HH.ResultAmong 71,836 live births, 11,493 were SGA, and 51 SGA infants had HH. There were 26 and 25 SGA-HH infants in the DZX and WW groups, respectively. Clinical and biochemical parameters were similar between groups. The median day of DZX initiation was day 10 of life (range 4–32), at a median dose of 4 mg/kg/day (range 3–10). All infants underwent fasting studies. Median CLD [DZX, 15 days (6–27) vs. WW, 14 days (5–31), P = 0.582] and postnatal LOS [DZX, 23 days (11–49) vs. WW, 22 days (8–61), P = 0.915] were comparable. Median TID was >3-fold longer in the DZX than the WW group [62.5 days (9–198) vs. 16 days (6–27), P < 0.001].ConclusionCLD and LOS are comparable between WW and DZX groups. Since fasting studies determine the resolution of HH, physicians should be aware that clinical intervention of DZX-treated SGA-HH patients extends beyond the initial LOS

PrivMail: A Privacy-Preserving Framework for Secure Emails

Emails have improved our workplace efficiency and communication. However, they are often processed unencrypted by mail servers, leaving them open to data breaches on a single service provider. Public-key based solutions for end-to-end secured email, such as Pretty Good Privacy (PGP) and Secure/Multipurpose Internet Mail Extensions (S/MIME), are available but are not widely adopted due to usability obstacles and also hinder processing of encrypted emails. We propose PrivMail, a novel approach to secure emails using secret sharing methods. Our framework utilizes Secure Multi-Party Computation techniques to relay emails through multiple service providers, thereby preventing any of them from accessing the content in plaintext. Additionally, PrivMail supports private server-side email processing similar to IMAP SEARCH, and eliminates the need for cryptographic certificates, resulting in better usability than public-key based solutions. An important aspect of our framework is its capability to enable third-party searches on user emails while maintaining the privacy of both the email and the query used to conduct the search. We integrate PrivMail into the current email infrastructure and provide a Thunderbird plugin to enhance user-friendliness. To evaluate our solution, we benchmarked transfer and search operations using the Enron Email Dataset and demonstrate that PrivMail is an effective solution for enhancing email security

Hospital admission with non-alcoholic fatty liver disease is associated with increased all-cause mortality independent of cardiovascular risk factors

Non-alcoholic fatty liver disease (NAFLD) is common and strongly associated with the metabolic syndrome. Though NAFLD may progress to end-stage liver disease, the top cause of mortality in NAFLD is cardiovascular disease (CVD). Most of the data on liver-related mortality in NAFLD derives from specialist liver centres. It is not clear if the higher reported mortality rates in individuals with non-cirrhotic NAFLD are entirely accounted for by complications of atherosclerosis and diabetes. Therefore, we aimed to describe the CVD burden and mortality in NAFLD when adjusting for metabolic risk factors using a ‘real world’ cohort. We performed a retrospective study of patients followed-up after an admission to non-specialist hospitals with a NAFLD-spectrum diagnosis. Non-cirrhotic NAFLD and NAFLD-cirrhosis patients were defined by ICD-10 codes. Cases were age-/sex-matched with non-NAFLD hospitalised patients. All-cause mortality over 14-years follow-up after discharge was compared between groups using Cox proportional hazard models adjusted for demographics, CVD, and metabolic syndrome components. We identified 1,802 patients with NAFLD-diagnoses: 1,091 with non-cirrhotic NAFLD and 711 with NAFLD-cirrhosis, matched to 24,737 controls. There was an increasing burden of CVD with progression of NAFLD: for congestive heart failure 3.5% control, 4.2% non-cirrhotic NAFLD, 6.6% NAFLD-cirrhosis; and for atrial fibrillation 4.7% control, 5.9% non-cirrhotic NAFLD, 12.1% NAFLD-cirrhosis. Over 14-years follow-up, crude mortality rates were 14.7% control, 13.7% non-cirrhotic NAFLD, and 40.5% NAFLD-cirrhosis. However, after adjusting for demographics, non-cirrhotic NAFLD (HR 1.3 (95% CI 1.1–1.5)) as well as NAFLD-cirrhosis (HR 3.7 (95% CI 3.0–4.5)) patients had higher mortality compared to controls. These differences remained after adjusting for CVD and metabolic syndrome components: non-cirrhotic NAFLD (HR 1.2 (95% CI 1.0–1.4)) and NAFLD-cirrhosis (HR 3.4 (95% CI 2.8–4.2)). In conclusion, from a large non-specialist registry of hospitalised patients, those with non-cirrhotic NAFLD had increased overall mortality compared to controls even after adjusting for CVD

Bumper landings of skipjack tuna (Katsuwonus pelamis) by hooks and lines at Visakhapatnam Fishing Harbour

Bumper landings of skipjack tuna, Katsuwonus pelamis was observed at Visakhapatnam Fishing Harbour on 28th October 2011, wherein about 42 t were landed by hooks and line

Proteomics of Trypanosoma evansi Infection in Rodents

infection using mass spectrometry (MS). in mice infected with camel isolate. Homology driven searches for protein identification from MS/MS data led to most of the matches arising from related Trypanosoma species. Proteins identified belonged to various functional categories including metabolic enzymes; DNA metabolism; transcription; translation as well as cell-cell communication and signal transduction. TCA cycle enzymes were strikingly missing, possibly suggesting their low abundances. The clinical proteome revealed the presence of known and potential drug targets such as oligopeptidases, kinases, cysteine proteases and more. infections

Understanding the unusual fluidity characteristics of high ash Indian bituminous coals

High-temperature rheometry and 1H nuclear magnetic resonance (NMR) are two complementary techniques that have been used to investigate fluidity development quantitatively in the 105 Pa.s), the maximum concentration of fluid H was quite similar to that of the good coking coal (40%). This Indian non-coking coal developed fluid H with the greatest mobility (T2L > 150 μs) in the coal series, regardless of the particle size fraction studied. The probable explanation for this abnormal behavior is that the mineral matter prevents bulk movement in the sample but the local mobility of the fluid phase is still high on the nanometer scale. Blending the two Indian non-coking coals with the highly fluid medium coking coal gave higher viscosities (i.e. lower fluidity) than predicted by the polymer blend rule, probably again due to the high mineral matter restricting bulk flow. This negative effect was less pronounced with the higher ash coal suggesting that the high mobility of the fluid entities in this coal might prevent the destruction of fluid entities evolving from the medium coking coal. Partial demineralization of the high ash Indian non-coking coal to 17 wt% through a sink-float method did not decrease the complex viscosity of this coal but reduced the maximum mobility of the fluid H to levels observed with the lower ash content (20 wt%) Indian coal. Therefore, this reduction in mobility could be directly related to the mineral matter in the Indian non-coking coal