Clinical characteristics and outcome of neonates with neonatal mastitis: a hospital based study

Background: Neonatal mastitis is not an uncommon condition, mostly occurs due to Staphylococcus aureus (S. aureus), sometimes leading to breast abscess with detrimental effects.Methods: Our study was retrospective, hospital based observational study carried out at Government Medical College, Baramulla from August 2017 to August 2019, all cases with features of neonatal mastitis were included in the study and also admitted in hospital. Clinical and laboratory data along with demographic data was recorded and analysed.Results: 23 cases were included with age of presentation 8 to 28 days. Babies particularly male babies received breast massage (N=10), besides this pain (15) and redness (N=23) was most common clinical characteristics purulent discharge seen in 2 cases and 7 cases were febrile. Laboratory findings include decreased total leucocyte count (TLC) and positive C-reactive protein (CRP), pus culture from samples revealed S. aureus in 11 cases, coagulase-negative staphylococci (CONS) in 3 cases, E. coli in 2 cases and sterile in 7 cases. Most of cases were sensitive to penicillin (N=14) and in two cases were methicillin resistant S. aureus (MRSA) strains resistant to methicillin. All patients responded well to intravenous (IV) antibiotics while as 8 cases required (I and D), blood cultured showed growth in 19 cases while cerebrospinal fluid (CSF) analysis was sterile in all patients. Above all babies were discharged successfully without any complications.Conclusions: We concluded from our study that neonatal mastitis if treated early has better outcome rather than practicing misbeliefs like breast massage to express so called witch’s milk, in addition we conclude that neonatal mastitis is not an uncommon problem.

Combined Blood Indexes of Systemic Inflammation as a Mirror to Admission to Intensive Care Unit in COVID-19 Patients: A Multicentric Study

Background The Coronavirus 2019 is a pandemic that has spread worldwide, threatening human health. The main cause of death in patients with COVID-19 is a systemic pro-inflammatory mechanism that quickly progresses to acute respiratory distress syndrome. Hematological ratios as affordable indicators of inflammatory response were studied in COVID-19 patients. The study aimed to study the importance of the blood cell indexes of the systemic inflammatory response, as the Aggregate Index of Systemic Inflammation (AISI), neutrophils lymphocyte to platelet ratio (NLPR), systemic immune-inflammation index (SII) and, systemic inflammation response index (SIRI) in predicting intensive care unit (ICU) admission of COVID-19 patients. Methods 495 COVID-19 patients managed in four tertiary centers; divided into non-ICU and ICU groups. Results Total leucocyte count (TLC), AISI, NLPR, SII, and SIRI were more elevated in the ICU group (P < 0.001 for all except AMC P = 0.006), while this group had less absolute lymphocyte count (ALC) (P = 0.047). We estimated the optimal cut-off values of the hematological ratio; AISI (729), NLPR (0.0195), SII (1346), and SIRI (2.5). SII had the highest specificity (95.6%), while NLPR had the highest sensitivity (61.3%). Age, AISI, CRP, D-dimer, and oxygen aid were the independent predictors for ICU admission in COVID-19 in multivariate logistic regression. Conclusion AISI is a predictor for severity and ICU admission in COVID-19 patients, SII is a predictor of survival, while NLPR and SIRI have an additive role that needs further evaluation.

Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

Transfusion management in a pediatric patient with febrile neutropenia with red blood cell autoantibodies: a case report

Febrile neutropenia is a common complication of chemotherapy especially in hematological malignancies associated with sepsis or severe infection. We report a case where a seven-year-old girl with T – cell acute lymphoblastic leukemia (ALL) developed febrile neutropenia (absolute neutrophil count - ANC <500/µL). Patient developed transient red blood cell (RBC) autoantibodies which interfered with compatibility testing and posed a challenge in donor selection for granulocyte transfusion. Direct antiglobulin test (DAT) and compatibility testing were done by column agglutination technique (CAT) using polyspecific anti-human globulin gel cards. Antibody screen was also done by CAT using 3-cell panel. Granulocyte concentrate was collected from eligible donors after taking an informed consent using a cell separator based on continuous flow principle. The patient’s blood group was AB RhD positive, however, the auto-control was positive (2+), DAT was positive (1+) but the antibody screen was negative. Monospecific DAT revealed the characteristic of antibody to be IgG (2+). The donor for granulocyte harvesting was selected on the basis of adopting a least incompatible donor approach. During her hospital stay she was transfused with four granulocyte concentrates, and other blood components without any adverse events. The patient’s blood culture was sterile on day 33 of hospital stay and subsequently she remained afebrile and finally discharged on day 41 in a hemodynamically stable state. The hemogram was- Hb:10.7g/dL, Total leucocyte count (TLC): 5610/µL, ANC: 4375/µL, PLT: 22000 /µL. This case draws a special attention to the importance of serological testing in selection of donor for granulocyte transfusion.

Validity of Serum And Urinary Hepcidin As Biomarkers of Late-Onset Sepsis of Premature Infants

Background: Sepsis remains one of the leading causes of neonatal morbidity and mortality particularly among premature infants. Blood culture is the “gold standard” for diagnosis of neonatal sepsis but is associated with several pitfalls. Adjunctive diagnostic tests, including biological markers should be used to aid in antibiotic -starting decision in presumed septic preemies until culture results are availableAim of the work: We aim to evaluate the validity of measuring serum hepcidin concentration as diagnostic biomarker for late-onset sepsis in preemies and to quantify its cut-off value that differentiate truly septic from non-septic symptomatic premature infants. In addition, to examine the correlation between serum hepcidin (Hep-S) and urinary hepcidin (Hep-U) and to find out if measuring Hep-U can be used as an alternative safe, non-invasive biomarker for late-onset sepsis diagnosis, without exposure to frequent phlebotomy and its risks.Patients and Methods: The current case-control study included seventy-three (73) cases of clinically and laboratory confirmed late-onset sepsis as "case group" and fifty (50) non-septic premature infants of comparable age and gender as "control group". All participants were evaluated as per unit protocol to rule out sepsis by complete blood count, CRP, blood, urine, CSF and other cultures as indicated, plus different radiologic modalities as needed. Acute serum and urinary hepcidin concentration were evaluated by ELISA for all participants at enrollment "acute sample". After one week of treatment, convalescent samples for serum and urine hepcidin were collected and compared with the acute samples.Results: Statistically significant higher concentration of both serum and urinary hepcidin were recorded among cases as compared with non-septic peers (t=44.2&p=0.0001, t=23.8 &p=0.0001 for serum and urine hepcidin respectively). Similarly, Significant reduction of hepcidin at different body fluids was recoded after one week of treatment as compared with acute samples (paired t =18.1&p=0.001, paired t =14.1&p=0.001 for serum and urine hepcidin respectively). Significant direct correlations were reported between acute serum hepcidin levels and CRP, urinary hepcidin, and total leucocyte count. While significant negative correlation was recorded with platelets count. AUC of serum hepcidin ROC is 0.93, A cut off value of ≥94.8ng/ml of S. hepcidin showed sensitivity (88%), specificity (94%), PPV (95%) and NPV (84%) respectively with accurately diagnosing 90.2% of presenting cases as septic or not. While urinary hepcidin showed slightly less discriminating ability with AUC of 0.87. At cut-off value of ≥ 264 ng/mg of urinary hepcidin/urinary creatinine showed sensitivity (85%), specificity (90%), PPV (92.5%) and NPV (81%) respectively with accurately diagnosing 84.5% of presenting cases as septic or not.Conclusions: Hepcidin concentration in different body fluid can function as promising accurate and rapid surrogate test, with blood culture, that guide empiric antibiotics –starting decision or withholding it safely until the culture results is ready in symptomatic presumed septic preemies. Urinary hepcidin has advantages over serum hepcidin as; it is non-invasive, no hazards of phlebotomy, and less variable throughout the day.

A Case Report on Allergic Reaction to Pantoprazole

Pantoprazole is a proton pump inhibitor and acts by blocking the gastric pump H+, K-ATPase to inhibit gastric acid secretion. Hypersensitivity reactions due to pantoprazole can be both immediate and delayed hypersensitivity reactions but sometimes it can be a life-threatening anaphylactic reaction. A 64-year female was admitted to the private ward of Shri Mahant Indiresh hospital with chief complaints of 6-7 episodes of vomiting and abdominal pain. Various laboratory tests were performed and the diagnosis was given. After the administration of Injection pantoprazole 40 mg patient developed rashes, itching, vomiting, burning sensation in whole body, restlessness, fever, and chills immediately within few hours. Hypersensitivity reaction to pantoprazole occurred due to Type-1 hypersensitivity reaction. Proton pump inhibitors like pantoprazole decrease gastric pH which increases bacterial growth in the oral cavity and upper GIT. To check on such ADR’s health care professionals should keep an eye on the medication use and its effects and should be cautious while prescribing pantoprazole. Pharmacists should educate the patients regarding possible hypersensitivity reactions from PPIs and how to take these medications to avoid any serious adverse drug reaction. Keywords: PTCA-Percutaneous transluminal coronary angioplasty, CBC-Complete Blood Count, RFT-Renal Function tests, LFT-Liver function tests, Hb-Hemoglobin, TLC-Total Leucocyte count, PCV-Packed cell volume, RBC-Red Blood Cells, RDW-Red cell distribution width, SGOT-Serum Glutamic oxaloacetic transaminases, ALP-Alkaline phosphatase, GGT-Gamma Glutamyl transferase, PR-Pulse rate, RR-Respiratory rate, BP-Blood Pressure, Temp-Temperature, SpO2-Oxygen saturation.

To Study the Clinico-Hematological Profile of Pre-Eclampsia on Mother and Newborns

Pre-eclampsia is a significant cause of maternal, fetal, and neonatal morbidities and mortalities associated with pregnancy. We aimed at examining the impact of maternal pre-eclampsia on new-borns’ and Mother’s hematological profile. OBJECTIVE: To study the hematological profile in mothers suffering from pre-eclampsia. To study the hematological profile in neonates. MATERIAL AND METHOD: The present cross-sectional study includes 100 pregnant womens and 100 neonates were included in the study and were grouped as under. Group 1: 50 normal pregnant womens. Group II: 50 Normal Neonates of mothers having normal pregnancy Group III: 50 pregnant mothers with gestational age between 32 and 36 weeks with preeclampsia. Group IV: 50 Neonates of mothers having pre-eclampsia. RESULT: Comparatively lower platelet count in preeclamptic women as compared to normal pregnant women. Also, total leucocyte count was relatively on lower side. Neutrophils and monocytes were raised in preeclamptic women when compared with normal pregnant women. Rest of all the parameters were not significantly affected. Clearly shows that in case of new-borns of mothers who are preeclamptic, haemoglobin and red blood cell count were significantly lowered. But platelet counts and total lymphocyte count was raised when compared with new-borns of normal pregnant women. CONCLUSION: Positive correlation between preeclampsia and neonatal thrombocytopenia. Prematurity, insufficiency of the placenta and fetal development restriction and need for neonatal resuscitation in babies born to pre-eclamptic women were found to be substantially higher compared to those born to stable normotensive people.

Fish disease study of Asian seabass (Lates calcarifer) in a floating marine cage: Endoparasite and blood profile

Hidayati D, Nurindra AR, Abdulgani N, Setiawan E, Maulidina N, Syahroni N, Mulyadi Y. 2021. Fish disease study of Asian seabass (Lates calcarifer) in a floating marine cage: Endoparasite and blood profile. Biodiversitas 22: 4505-4511. The Indonesian government has multiple targets and priority programs to increase aquaculture productivity in 2021. Hence, the development of mariculture commodities such as Asian seabass (Lates calcarifer) in one of the potential coastal areas, Sendang Biru, is strategic. However, sustainable productivity needs good management, including the health monitoring of fish. This study aimed to determine the condition of seabass under mariculture in a floating cage in Sendang Biru, Malang, Indonesia. Thirty seabass (Lates calcarifer) from 0 to 60 days after stocking age (ASE) were taken from a Sendang Biru floating cage. Blood and intestine samples were taken five times from day 0 to day 60 ASE. Blood samples were carried out through the caudal vein and observed using a hemocytometer. Endoparasite analysis was performed by fish intestine examination from the anterior intestine to the posterior rectum. Pseudoterranova and Diphyllobothrium were found with 10% and 3.33% prevalence, respectively. The intensity of Pseudoterranova was one individual/fish, and that of Diphyllobothrium was 2.33 individuals/fish. The highest mean of total erythrocyte count (TEC) found in 0 day ASE was at the level of 0.82±0.55×106 cells/mm3, and the lowest was found in 60 days ASE (0.51±0.24×106 cells/mm3). The highest mean of total leucocyte count (TLC) was 9.20±3.69x104 cells/mm3, at day 0, and leukocyte levels tended to decrease until day 60 ASE (7.74±3.43×104 cells/mm3). Overall, despite the TEC and TLC tending to decrease from 0 to 60 days ASE, in statistically indicated no significant differences in TLC at different ASEs (p > 0.05). The hematological profile indicated the health statuses of the cultured Asian seabass in the current study were in a condition of anemic and infected.

Recovery of E. coli From Liver and Spleen of Broiler Birds and the Effects of Induced High Ammonia Level on Haematobiochemical Parameters and Its Amelioration by Different Modifiers

The poultry sector is one of the most vibrant segments of the agriculture industry of Pakistan. In addition to different infections, ammonia (NH3) production from litter material of broiler is the most harmful pollutant and causes serious threats for the environment. To overcome this problem, different methods are proposed assuring poultry bird’s health and production. This study was carried out to evaluate the effect of toxic levels of NH3 on the haematology and serum proteins of broiler birds and its amelioration by using different modifiers. The recovery of Escherichia coli ( E. coli) from liver and spleen of broiler birds was also carried out. A total of 100 birds were divided into 5 separate groups (groups A–D). The groups C, D and E were treated with potassium aluminium sulphate, aluminium silicate and Yucca schidigera plant extract, respectively. Blood and tissue samples were collected after slaughtering the birds at 42 days of age. This study revealed increased RBC, total leucocyte count, Hb and heterophils percentage. Serum proteins were decreased in Yucca-treated and potassium aluminium sulphate–treated groups. This study concluded that NH3 production was reduced by the application of different modifiers, and these modifiers also neutralized the changes in blood parameters induced by NH3.

Association of temperature humidity index during summer with haematological parameters in native and crossbred goats of Kerala

The study was conducted to investigate the association of temperature humidity index (THI) during summer with haematological responses in Malabari, crossbred and Attappady goats of Kerala. The research work was conducted at University Goat and Sheep Farm, KVASU, Mannuthy, Thrissur district in Kerala from March to May, 2020. In-house temperature and in-house relative humidity were measured daily at 7.00 AM, 10.00 AM, 2.00 PM and 5.00 PM. Haematological parameters such as total erythrocyte count (TEC), total leucocyte count (TLC), haemoglobin concentration (Hb), volume of packed red cells (VPRC), mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC) were analysed during 2nd, 32nd day and 60th day of the study. There was no significant change in TEC, VPRC levels in between the breeds and within the observed days. However, TLC were significantly increased for Malabari goats and MCHC were significantly increased in all the breeds at 32nd day of study period. The Hb concentration were significantly increased in crossbred and Attappady black at 32nd day of study period. There was a significant decrease in MCV values in 2nd and 32nd day for all the breeds. The study demonstrated certain altered hematological features in all the breeds under study indicating the adaptive ability of these animals during heat stress.