Journal of Clinical and Basic Research
Volume:6 Issue: 4, Autumn 2022

Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia that develops in patients who have been on mechanical ventilation for more than 48 hours. This study aimed to determine the bacteriological profile of VAP in the pediatric intensive care unit (PICU) as well as patient outcomes in a hospital in India.

The study included 190 children (99 males and 91 females) aged 1 month to 12 years who were either manually or mechanically ventilated in a PICU. Clinical characteristics, microbiological profile, intubation details, complications, and outcomes were recorded. Blood and endotracheal aspirate were collected from VAP suspects and semi-quantitatively processed using standard microbiological techniques.

Septic shock, bronchopneumonia, acute encephalopathy, acute central nervous system infection, congenital heart disease, and snake envenomation poisoning were diagnosed in 57, 41, 23, 15, 11, and 7 cases, respectively. The most common neurological causes were status epilepticus, neuromuscular diseases, and raised intracranial pressure. Nosocomial pneumonia (16%) and air leak (8.9%) were the most common complications in ventilated children. There was a 10% mortality rate among children in PICU. There were 100 VAP suspects, with 33 developing VAP. There were 11 children with early-onset VAP (<4 days) and 22 children with late-onset VAP (>4 days). Pathogenic microorganisms were isolated from 31 intubated children who were suspected of having VAP. Klebsiella pneumoniae was the predominant isolate from both early-onset and late-onset VAP cases. The majority of deaths were related to infection with Acinetobacter baumannii. Gram-negative isolates from early-onset VAP showed sensitivity to meropenem (87.5%), piperacillin-tazobactam (75%), and ciprofloxacin (62.5%). Enterobacteriaceae isolates from late-onset VAP showed susceptibility to meropenem (82%) and piperacillin-tazobactam (27%).

Infection with A. baumannii may be a risk factor for death in children with VAP. The most common pathogens isolated from children with VAP are K. pneumoniae and A. baumannii.

Coronary artery disease (CAD) is one of the most common morbidities associated with diabetes mellitus. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are precursors to diabetes and major risk factors for atherosclerosis. The study aimed to evaluate the prevalence of IFG and IGT in nondiabetic patients with CAD.

The study was performed on 100 non-diabetic patients with CAD and 50 healthy age- and sex-matched controls. Data were collected via detailed medical history taking, clinical examination, routine blood chemistry tests, fasting blood sugar test, 2-hour post-prandial blood sugar test, lipid profile, electrocardiogram, 2D-echocardiogram, and carotid Doppler.

Dyslipidemia was more prevalent among the patients. The mean carotid intima–media thickness was higher in the patients. Overall, IFG was found in 9 (15%) cases and IGT was found in 13 (22%) cases. The co-existence of IFG and IGT was detected in 3 (5%) cases. Abnormal glucose regulation was found in 42% of patients.

The findings indicate the need for early screening and management of prediabetes for the prevention of further progression to diabetes.

Thyroglossal duct cysts (TGDCs) are the most common congenital cervical anomalies that account for about 2-4% of all midline neck swellings. They may present as a cyst, abscess, or sinus in the anterior neck region. The cysts are managed by the standard or a modified Sistrunk operation with the least chance of recurrence when compared to the removal of the cyst alone.  This study aimed to present our experience in the modified Sistrunk operation over thyroglossal duct cyst anomalies with particular emphasis on the clinical diversity in presentation, surgical technique, and management of postoperative complications.

This prospective observational study was carried out on 25 newly diagnosed cases of TGDC, which were confirmed histologically and radiologically over a period of 5 years.

All patients underwent a modified Sistrunk operation under general anesthesia and followed up for 2 years. The surgery consisted of complete excision of the cyst with the removal of the central portion of hyoid bone and macroscopically evident duct tissue with intraoperative T-shaped closure of the muscular layer to restore the function of hyoid bone and reduce most postoperative complications, such as recurrence and swallowing difficulties.

The results indicate that the modified Sistrunk operation is one of the best surgical procedures for the treatment of TGDC anomalies limited up to hyoid without lingual extension, especially to prevent a recurrence. More attention should be paid to supra and infra hyoid muscular closure to restore the normal function of the hyoid

Metagenomics is a promising approach to discovering novel sequences of microorganisms in environmental samples. A recently published RNA-Seq data of Solanum tuberosum from China was used for a metavirome study.

RNA-seq data of a BioSample project of S. tuberosum containing sequence read archive (SRA) of six plant samples were imported into the Galaxy server. Transcriptome data were de novo assembled for viral sequences with rnaviralSPAdes. The contig files were further organized by VirHunter and Kraken tools. Raw SRA data were trimmed and assembled for severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) genome by coronaSPAdes. The scaffolds were arranged by pairwise alignment against the SARS-CoV-2 reference genome (NC_045512.2). Coronavirus Typing Tool, Nextstrain, and Pangolin platforms were used to further investigate the SARS-CoV-2 genotype, phylogenetic analysis, and mutation estimations.

Several environmentally related non-intact virus sequence reads from forest animals, moths, bacteria, and amoeba were detected. Further investigation resulted in non-indigenous sequences of SARS-CoV-2 genomes of lineage B with novel substitutions. Three polymorphisms, including A22D and A36V in the envelope protein, and Q498H in the spike (S) glycoprotein that were recently reported from a mice-adopted strain of SARS-CoV-2 with enhanced virulence were detected in all samples. Further novel substitutions at ORF1ab were also uncovered. These were L1457V, D4553N, W6538S, I1525T, D1585Y, D6928G, N3414K, and T3432S. Two unexpected frameshifts, ORF1a:2338-4401 and ORF1a:3681-4401, were also detected.

The findings of the presented study highlight the threats of the emerged potentially severe genotypes of SARS-CoV-2 bearing substitutions that are not yet clinically reported.

Insulin resistance plays a significant role in the pathogenesis of type 2 diabetes mellitus (T2DM). Irisin, an adipo-myokine, is found to increase insulin sensitivity by adaptive thermogenesis. Various studies have found that endocrine and exocrine functions of the pancreas are affected in T2DM. This case-control study with 180 participants aimed to find any association of serum irisin with insulin resistance and pancreatic profile in newly diagnosed T2DM.

Fasting blood sugar (FBS) and pancreatic profile were measured by Auto Analyzer, serum insulin by chemiluminescence assay, serum irisin by Enzyme-Linked Immunoassay (ELISA) kit, and insulin resistance by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).

Significantly lower irisin levels were observed in T2DM patients compared to healthy individuals (p =0.001*). A positive correlation was found between serum irisin and insulin resistance in T2DM patients, whereas a negative correlation was found in healthy controls. In some cases, serum amylase and lipase positively correlated with irisin, whereas a negative association was observed in controls.

This study concludes a protective role for irisin in combating insulin resistance and improving pancreatic function in T2DM, but more extensive studies are required to prove it.