Congenital Pulmonary Vein Stenosis: Encouraging Mid-term Outcome

Congenital pulmonary vein stenosis (PVS) is a rare entity with limited outcome literature. Multiple interventional approaches have evolved including surgical and catheterization techniques. Our objective is to report our center experience and to compare short-term and mid-term outcomes among these therapeutic modalities. Retrospective study on 23 patients (n = 23) with PVS that required intervention over the last 13 years (2000–2013). Patients were divided into three groups based on type of initial intervention. Of these, 10 (43.5 %) had balloon angioplasty, 3 (13.0 %) had surgical dilation, and 10 (43.5 %) had surgical marsupialization. Mortality and number of re-interventions were our primary outcomes. Mean age at diagnosis was 10.9 ± 18.4 months. Mean age at initial intervention was 14.5 ± 18.0 months. Mean pre- and post-initial intervention PVS gradients were 9.2 ± 3.4 and 3.4 ± 2.2 mmHg, respectively. Mean survival time and re-intervention-free survival time were 4.8 ± 4.0 and 2.8 ± 3.4 years. No statistical significance was found between the interventions with respect to survival time (p = 0.52) and re-intervention free time (p = 0.78). High initial pre- and post-intervention gradients were significantly associated with re-intervention-free survival (p = 0.01 and p = 0.03, respectively). Patients with bilateral disease have increased mortality (p = 0.01) and decreased 5-year survival (p = 0.009) compared to patients with unilateral disease irrespective of type of intervention. No statistically significant difference in mortality or re-intervention rate was present among these different therapeutic modalities. This study has the longest follow-up so far reported in the current literature (58 months) with overall survival of 78 %.     

Ureaplasma urealyticum and its association with chronic lung disease in Asian neonates

OBJECTIVE: The aim of the present prospective cohort study was to evaluate the relationship between lower respiratory tract colonization with Ureaplasma urealyticum and development of chronic lung disease (CLD) in a high-risk neonatal population. METHODS: Prospective cohort study of preterm infants with a birthweight < 1,500 g needing mechanical ventilation within 24 h of birth in a tertiary care neonatal unit. Endotracheal aspirates from these infants were cultured within 24 h for U. urealyticum and the rate of colonization was determined. The primary outcome measure was the incidence of CLD at 28 days of life. RESULTS: Of the 41 infants studied, 10 (24%) infants were colonized with U. urealyticum. The colonization rate was higher in babies < 1,000 g compared with babies weighing 1,000-1,500 g (P = 0.04). There was no significant difference between the colonized and non-colonized groups with regard to the antenatal use of steroids, maternal prolonged rupture of membranes, gestational age, birthweight, sex, respiratory distress syndrome, use of surfactant, patent ductus arteriosus and gastrooesophageal reflux. Of the 37 survivors, 20 (54%) developed CLD; eight infants (88.5%) in the colonized group developed CLD compared with 12 infants (42.8%) in the non-colonized group (P = 0.01). CONCLUSIONS: Neonates colonized with U. urealyticum were twice as likely to have CLD than non-colonized babies (relative risk 2.01; 95% confidence interval 1.27-3.37). These data suggest a significant association between colonization with U. urealyticum and CLD in infants weighing < 1,500 g.     

Synthesis and Antimycobacterial Activity of a Novel Series of Isonicotinylhydrazide Derivatives

A novel series of 14 new isonicotinyl hydrazide derivatives 2a – g , 3a – g containing a 4‐thiazolidinone / 2‐azetidinone nucleus were synthesized by reacting N′‐substituted arylidene / heteroarylidene isonicotinyl hydrazide 1a – g with thioglycollic acid in the presence of dry benzene and with chloroacetyl chloride in the presence of triethylamine, respectively. Structures of all newly synthesized compounds were characterized on the basis of elemental analyses and spectral data (IR and ¹H‐NMR). All the title compounds were tested for their in‐vitro antimycobacterial activity against Mycobacterium tuberculosis H₃₇Rv using Alamar‐Blue susceptibility test, and the activity is expressed as the minimum inhibitory concentration (MIC) in μg/mL. Among the series, compounds 2b , 2g , 3b , and 3g displayed an encouraging antimycobacterial activity profile as compared to that of the reference drugs isoniazid / rifampicin.     

Tobacco use among medical professionals in Kerala, India: the need for enhanced tobacco cessation and control efforts

In developing nations where reductions in tobacco use have not been realized, it is critical that health professionals be encouraged to abstain from tobacco use. Data on tobacco use among health professionals in India are limited. We conducted cross-sectional surveys among 110 male medical school faculty (MSF), 229 physicians (67% male), 1130 medical students (46% male), and 73 female nursing students. Information on tobacco use and quit attempts was collected using structured questionnaires. Among the male respondents, current smokers were 15.1% of MSF, 13.1% of physicians, and 14.1% of medical students. Among current smokers, 42% of MSF and physicians and 51% of medical students had not attempted quitting in the last year. However, one third of MSF and physicians and 16% of medical students had attempted to quit at least 4 times. This is one of the first studies among health care professionals in India. Our findings show that a substantial proportion of physicians and medical students in Kerala continue to smoke. Smoking cessation programs are warranted in medical schools in Kerala. An initiative is presently underway by the authors to incorporate tobacco education into the medical school curriculum.     

Hospital-based evaluation of two rapid human immunodeficiency virus antibody screening tests

Two rapid human immunodeficiency virus (HIV) screening assays, HIV TRI-DOT and HIV-SPOT were compared with standard enzyme-linked immunosorbent assays according to a testing algorithm. Sensitivities and specificities in the real-time evaluation were 99.5 and 99.9% for TRI-DOT and 98.2 and 99.7% for HIV-SPOT, respectively. These two tests are suitable for use where facilities and laboratory expertise are limited.     

Upregulation of collagenase-1 and -3 in indomethacin-induced gastric ulcer in diabetic rats: role of melatonin

Collagenases are key proteases involved in inflammation and injury. We addressed whether collagenases have an association with the susceptibility of gastric injury under diabetes as well as the effect of melatonin on collagenases in ulcerated gastric tissues. Diabetes was induced in rats by a single dose of streptozotocin (STZ) followed by gastric ulceration using indomethacin, and melatonin's action was studied by its application prior to indomethacin exposure. Ulcer indices and damage were elevated significantly in gastric tissues of diabetic compared with nondiabetic rats. Melatonin reversed the effect of indomethacin during protection of gastric ulcers in diabetic rats. Matrix metalloproteinase (MMP)-13 (i.e., collagenase-3) was upregulated in diabetic gastric mucosa and enhanced further upon ulceration while melatonin ameliorated their activity. In addition, gastric tissues showed enhanced expression of both MMP-1 (i.e., collagenases-1) and -13 significantly in diabetic rats compared with nondiabetic animals and more so during ulceration while tissue inhibitors of metalloproteinase-1 (TIMP-1) showed an opposite trend. MMP-2 activities exhibited a ～50% downregulation during gastric ulceration which were rescued by melatonin. Moreover, increased expression of both MMP-1 and -13 was mediated by activator protein-1 activation via extracellular signal-regulated kinase 1/2 which were parallel to upregulation of tumor necrosis factor-α, interleukin-1β, and heat shock protein-70 during ulceration. Melatonin arrested collagenase expression by downregulation of these signaling molecules thereby halting the progression of the disease. We conclude that diabetic gastric tissues are susceptible to ulceration and associated with MMP-1 and -13 upregulation in indomethacin-induced injury. Additionally, melatonin protects the gastric damage under diabetes via regulation of both MMP-1 and -13.     

Predictors of acceptance and willingness to pay for the COVID-19 vaccine in the general public of India: A health belief model approach

Objective:To determine the predictors of acceptance and willingness to pay(WTP)for the COVID-19 vaccine among the Indian public and to provide insights for future demand forecasts and pricing considerations.Methods:A nationwide,web-based,self-administered,crosssectional survey was conducted from 5 to 20 October 2020.The health belief model(HBM)approach was used as a theoretical framework to assess the predictors of acceptance of and WTP for the COVID-19 vaccine.Results:Of 2480 respondents,2451 completed the online survey,yielding a response rate of 98.8%.Participants who participated in the survey had diverse demographics in terms of their location,educational level,occupation type,and family income.Among 2451 respondents,the majority(89.3%)intended to receive the COVID-19 vaccine.Respondents with high perceived benefits of COVID-19 vaccination,such as reduction in worry(OR 5.87;95%CI 4.39-7.96)and sickness(OR 4.31;95%CI 3.31-5.62),showed higher intention to receive the vaccine.However,respondents with a high perception of the side effects and barriers to vaccination(OR 0.36;95%CI 0.25-0.54)and vaccine shortage(OR 0.58;95%CI 0.41-0.81)showed lower intention to receive the vaccine.The majority(2162,88.21%)of respondents were willing to pay an amount of INR:500-1000 or USD:6.81-13.62 for a dose of COVID-19 vaccine,with a median(Q1,Q3)of INR:500(500,1000)or USD:6.81(6.81,13.62).The higher marginal WTP for the COVID-19 vaccine was influenced by advanced age,marital status,female sex,intermediate educational background,high family income,fair or poor perceived health status,and no affordable barriers.Conclusions:The majority of respondents intended to receive the COVID-19 vaccine.Healthcare interventions focusing on HBM constructs and demographic predictors associated with low intention to receive the vaccine can be effective in enhancing the coverage of the COVID-19 vaccine.The findings of this study provide guidance for the future price considerations of the COVID-19 vaccine.