Use of central venous access devices and its complications in neonates

Background: Intravenous therapy is a major component in the health care and appropriate research-based knowledge is essential to ensure positive patient outcomes. Objective: The objective of the study was to study the use of Central Venous Access Devices (CVADs) and their complications in neonates in routine practice. Methods: A prospective observational study was conducted at a tertiary care neonatal intensive care unit (NICU) on 40 newborns. CVADs were inserted in neonates, who had been anticipated to have intravenous access for >7 days. CVADs used in the study included Peripherally Inserted Central Catheters (PICCs) and umbilical venous catheters. CVADs were inserted under strict aseptic precautions as per international guidelines, and maintenance protocols followed. Monitoring for complications was done daily. Central Line Associated Blood Stream Infection (CLABSI) was established by a combination of suggestive clinical signs and blood culture reports as per Centre for Disease Control and prevention definition. Results: Extremely low birth weight neonates contributed 40% of the patients. PICC insertions formed the 85% of the devices used. Basilic vein was the preferred site of the insertion in almost one-half of the patients. 80% of the PICCs in neonates were used to administer total parenteral nutrition. CLABSI was the most common complication occurring at a rate of 7.5/1000 catheter days. Other complications were occlusion, suspected infection, accidental displacement, and thromboembolism. Conclusion: Central venous catheterization is a safe and efficient procedure with minimal complication in neonates. This study emphasizes its use whenever prolonged intravenous access requirement is expected

Effect of Electromagnetic Field on Antimicrobial Activity and Novel Antimicrobial Compounds

The objective of this study is to determine the antimicrobial activity of the essential oils and effect of electromagnetic field on the activity. To find out antimicrobial activity of essential oils (Thyme, Clove, Lavender), against test organisms disc diffusion assay was performed. MIC of all essential oils were determined under electromagnetic field and non-electromagnetic field. Both studies confirmed the antimicrobial activity of oils and effect of electromagnetic field. However, time killing experiment was conducted to calculate rate of inhibition for essential oils, lavender oil and thyme oil showed higher rate as compared to that of clove oil. This study provides evidence to antimicrobial activity of essential oils, and also confirmed the effect of electromagnetic field on the activity. The proposed mechanism for antimicrobial activity is inhibition of metabolic enzymes which has supported with Analytical Profile Identification (API 20NE)

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

WINROP algorithm for prediction of sight threatening retinopathy of prematurity: Initial experience in Indian preterm infants

Purpose: To determine the efficacy of the online monitoring tool, WINROP (https://winrop.com/) in detecting sight-threatening type 1 retinopathy of prematurity (ROP) in Indian preterm infants. Methods: Birth weight, gestational age, and weekly weight measurements of seventy preterm infants (<32 weeks gestation) born between June 2014 and August 2016 were entered into WINROP algorithm. Based on weekly weight gain, WINROP algorithm signaled an alarm to indicate that the infant is at risk for sight-threatening Type 1 ROP. ROP screening was done according to standard guidelines. The negative and positive predictive values were calculated using the sensitivity, specificity, and prevalence of ROP type 1 for the study group. 95% confidence interval (CI) was calculated. Results: Of the seventy infants enrolled in the study, 31 (44.28%) developed Type 1 ROP. WINROP alarm was signaled in 74.28% (52/70) of all infants and 90.32% (28/31) of infants treated for Type 1 ROP. The specificity was 38.46% (15/39). The positive predictive value was 53.84% (95% CI: 39.59–67.53) and negative predictive value was 83.3% (95% CI: 57.73–95.59). Conclusion: This is the first study from India using a weight gain-based algorithm for prediction of ROP. Overall sensitivity of WINROP algorithm in detecting Type 1 ROP was 90.32%. The overall specificity was 38.46%. Population-specific tweaking of algorithm may improve the result and practical utility for ophthalmologists and neonatologists

Age-related reference intervals for immunoglobulin levels and lymphocyte subsets in Indian children

Background: In children, innate and adaptive immunity varies with age, disease status, and ethnicity, reflected by lymphocyte subsets and serum immunoglobulin (Ig) levels. The paucity of such data from the Indian subcontinent necessitated this study. Aims: This study aims to determine reference ranges of Ig and lymphocyte subsets in Indian children from birth to 5 years. Settings and Design: Neonates, infants, and children from a tertiary care hospital were selected and categorized into 5 groups from cord blood/newborn to 5 years. Materials and Methods: Samples were taken from cord blood and healthy children up to 5 years of age. Complete blood counts, serum Ig levels (by turbidimetry), and lymphocyte subsets (by flow cytometry) were studied, and reference ranges calculated. Results: Four hundred and three samples were analyzed; 53 from cord blood and 350 from children 1 month to 5 years. High IgG levels were noted at birth, which decreased in the first 6 months followed by a rise thereafter. IgM remained low in infancy and peaked at 13–36 months. IgA levels were very low at birth but increased with age. CD4 counts were high in cord blood till 3 years of age and then declined. CD8 and CD19 counts remained steady till 5 years of age. CD56 increased after the age of 2 years. Conclusions: While our data correlated well with published literature, notable differences were higher IgM levels seen in 1–3 years' age group and higher natural killer cells through all age groups in our study. Our results provide the largest database of its kind from our country