Role of White Blood Cell Count, Immature to Total Ratio and C-Reactive Protein in Early Detection of Clinically Suspected Neonatal Sepsis

Despite recent advances in neonatal care, early detection of neonatal sepsis still remains challenging. Positive blood culture is the gold standard for definitive diagnosis of neonatal sepsis but is time consuming and demands a well equipped laboratory setting. Therefore, it becomes imperative to evaluate usefulness of white blood cell count, Immature to total (IT) ratio and C-reactive protein as potential markers in the early diagnosis of neonatal sepsis. The objective of the study was to evaluate role of white blood cell count, IT ratio and C-reactive protein in early detection of clinically suspected neonatal sepsis. This cross-sectional descriptive study was conducted from January 2017 to December 2018 at Special Care Newborn Unit (SCANU) of Rangpur Medical College Hospital, Rangpur, Bangladesh. After parental permission and ethical clearance, a total of 70 eligible neonates were included into the study. Estimation of total white blood cell count, IT ratio and C-reactive protein as well as blood culture were done for each case. Significance for Chi-Square test and Pearson's correlation coefficient test was predetermined as p<0.05. Of the total 70 neonates studied, 19(27.14%) were blood culture positive and most common organism was Escherichia coli (7/14, 37.0%). Among individual and combination tests, CRP was highly sensitive (100%) followed by WBC count (74.94%). Highly specific tests in diagnosing sepsis were combination test of IT ratio and CRP (88.23%) followed by combination test of WBC count and CRP (82.35%). Positive predictive value (PPV) was high for combination test of WBC count and CRP (90.90%) followed by combination test of IT ratio and CRP (90.47%). Negative predictive value (NPV) was high in CRP (100.0%) followed by WBC count (89.19%). IT ratio positively correlated with CRP (p=0.002) and there was significant association between raised CRP and WBC count (p=0.005) in neonatal sepsis. Diagnostic role of both individual and combination tests were significant in early detection of clinically suspected neonatal sepsis while awaiting results of blood culture. However, none of the combination tests were able to achieve 100.0% sensitivity.

Prevalence and Risk Factors of Secondary Hyperparathyroidism among CKD Patients and Correlation with Different Laboratory Parameters

Hyperthyroidism is one of the major complications in CKD patients who results in a number of metabolic disorders and contributes to morbidity and mortality. The objective of the study was to investigate the prevalence and risk factors for secondary hyperparathyroidism among CKD patients as well as its correlation with different laboratory parameters. This was a cross-sectional study conducted among the admitted CKD patients of Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January 2019 to December 2019. Following recruitment, clinical parameters were extracted from the patients' medical records. Afterward, blood sample blood was collected to measure the biochemical parameters and serum parathyroid hormone levels. A binary logistic regression model was used to assess the factors associated with hyperparathyroidism. The mean±SD serum PTH in all CKD patients was 215.04±168.15 pg/ml. The overall prevalence of secondary hyperparathyroidism among CKD patients was 75.0% (32.0% in stage 3, 88.0% in stage 4 and 93.0% in stage 5 CKD). Serum PTH levels had a significant positive correlation with serum creatinine and serum phosphate levels and a significant negative correlation with serum albumin and serum calcium levels. However, only female sex was revealed as a significant risk factor in the adjusted regression model (aOR 0.26, 95% CI 0.07-0.98 for male sex compared to female sex). As the prevalence of secondary hyperparathyroidism increases in advanced stages of CKD, early detection and management of CKD are crucial to prevent metabolic disorders that could trigger the development of this complication.

Thrombocytopenia in Septic Shock Patients—A Prospective Observational Study of Incidence, Risk Factors and Correlation with Clinical Outcome

The objectives of the study were to study the incidence of various degrees of severity of thrombocytopenia in septic shock, the risk factors for its development and the correlation with clinical outcome. Complete blood counts, chemistry panel, arterial lactate, serum cortisol, APACHE II score, logistic organ dysfunction score and SOFA score were determined in 69 septic shock patients within 24 hours of admission or onset of septic shock. We followed the patients until they died or for six months to determine the mortality rate. The incidence of thrombocytopenia in our study group was 55%. Patients with thrombocytopenia had significantly higher serum creatinine, SOFA score, vasopressor requirement, lower PaO2/FiO2 ratio and higher mortality than those without thrombocytopenia (P <0.05). Higher SOFA score, low PaO2/FiO2 ratio and high vasopressor dose were independent risk factors for development of thrombocytopenia. The presence of thrombocytopenia had significant correlation with SOFA score (P=0.008). On receiver-operator characteristic curve analysis, platelet count was found to be predictive of increased mortality (area under curve=0.56). Thrombocytopenic patients had 1.4 times the risk of mortality and lower survival probability at six months (log rank test P=0.03). In conclusion, thrombocytopenia is common in septic shock and is associated with worse clinical outcome. Higher SOFA score, low PaO2/FiO2 ratio and high vasopressor dose are independent risk factors for development of thrombocytopenia in septic shock.

Breakdown of Magnetic Order in the Pressurized Kitaev Iridate β-Li_{2}IrO_{3}

Temperature-pressure phase diagram of the Kitaev hyperhoneycomb iridate β-Li_{2}IrO_{3} is explored using magnetization, thermal expansion, magnetostriction, and muon spin rotation measurements, as well as single-crystal x-ray diffraction under pressure and ab initio calculations. The Néel temperature of β-Li_{2}IrO_{3} increases with the slope of 0.9  K/GPa upon initial compression, but the reduction in the polarization field H_{c} reflects a growing instability of the incommensurate order. At 1.4 GPa, the ordered state breaks down upon a first-order transition, giving way to a new ground state marked by the coexistence of dynamically correlated and frozen spins. This partial freezing in the absence of any conspicuous structural defects may indicate the classical nature of the resulting pressure-induced spin liquid, an observation paralleled to the increase in the nearest-neighbor off-diagonal exchange Γ under pressure.

Serum Homocysteine and its Association with Glycemic Control in Type 2 Diabetic Patients

In developing countries like Bangladesh the prevalence of type 2 diabetes mellitus is increasing day by day. Among the long-term complications of diabetes mellitus, vascular complications represent a major cause of morbidity and mortality. Hyperglycemia is still considered the principal cause of diabetes complications. Total plasma homocysteine (tHcy) is an emerging cardiovascular risk factor. Hyperhomocysteinemia independently appears to be a stronger risk factor for mortality than other risk factors in type 2 diabetes than in non diabetes. It may partly explain the link between microalbuminurea and increased risk of cardiovascular disease. Objective of the study was to evaluate serum total homocysteine level and to correlate it with glycemic status in type 2 diabetic patients. This cross sectional study was conducted during the period of July 2011 to June 2013 on 95 patients of type 2 diabetes mellitus, attending the Endocrine OPD of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh. Study subjects were selected by purposive and convenient sampling technique. Study subjects were categorized according to the presence or absence of hyperhomocysteinemia. Among the total study population hyperhomocysteinemia was found in 21.05%. Among them number of male was greater. Overall glycemic control was poor in the patients. Mean HbA1c (%) was 8.31±2.04. Among those having hyperhomocysteinemia mean HbA1c (%) was significantly lower than those who had no hyperhomocysteinemia (7.2±1.5 vs. 8.6±2.06). Around one fifth of the type 2 diabetic patients had hyperhomocysteinemia. Those having hyperhomocysteinemia had significantly better glycemic control than those having no hyperhomocysteinemia.

Absence of low energy magnetic spin-fluctuations in isovalently and aliovalently doped LaCo2B2 superconducting compounds

Magnetization, resistivity and (11)B, (59)Co NMR measurements have been performed on the Pauli paramagnet [Formula: see text], and the superconductors [Formula: see text] ([Formula: see text] K) and [Formula: see text] ([Formula: see text] K). The site selective NMR experiment reveals the multiband nature of the Fermi surface in these systems. The temperature independent Knight shift and 1/T 1 T clearly indicate the absence of correlated low energy magnetic spin-fluctuations in the normal state, which is in contrast to other Fe-based pnictides. The density of states (DOS) of Co 3d electrons has been enhanced in superconducting [Formula: see text] and [Formula: see text] with respect to the non superconducting reference compound [Formula: see text]. The occurrence of superconductivity is related to the DOS enhancement.

Isotopic dependence of the predissociations of the E(1)Π state of CO

The predissociations of the E(1)Π state of CO are again studied. They include both the background predissociation attributed to the continuum of the A(1)Π state and the accidental predissociation due to the k(3)Π state. They are calculated using a coupled equations method. The three components of the k state are introduced. These predissociations are studied for different isotopologues and are shown to decrease with increasing reduced mass, in agreement with the experimental results of Ubachs et al. [J. Chem. Phys. 113, 547 (2000)].

Local electromagnetic properties of magnetic pnictides: a comparative study probed by NMR measurements

(75)As and (31)P NMR studies are performed in PrCoAsO and NdCoPO respectively. The Knight shift data in PrCoAsO indicate the presence of an antiferromagnetic interaction between the 4f moments along the c axis in the ferromagnetic state of Co 3d moments. We propose a possible spin structure in this system. The (75)As quadrupolar coupling constant, νQ, increases continuously with decrease of temperature and is found to vary linearly with the intrinsic spin susceptibility, K(iso). This indicates the possibility of the presence of a coupling between charge density and spin density fluctuations. Further, the (31)P NMR Knight shift and spin-lattice relaxation rate (1/T1) in the paramagnetic state of NdCoPO indicate that the differences of LaCoPO and NdCoPO from SmCoPO are due to the decrement of the interlayer separation and not due to the moments of the 4f electrons. The nuclear spin-lattice relaxation time (T1) in NdCoPO shows weak anisotropy at 300 K. Using the self-consistent renormalization (SCR) theory of itinerant ferromagnets, it is shown that in the ab plane, the spin fluctuations are three-dimensional ferromagnetic in nature. From SCR theory the important spin-fluctuation parameters (T0, TA, F¯1) are evaluated. The similarities and dissimilarities of the NMR results in As and P based systems with different rare earths are also discussed.

Graphical Tests for Power Comparison of Competing Designs

Lineups have been established as tools for visual testing similar to standard statistical inference tests, allowing us to evaluate the validity of graphical findings in an objective manner. In simulation studies lineups have been shown as being efficient: the power of visual tests is comparable to classical tests while being much less stringent in terms of distributional assumptions made. This makes lineups versatile, yet powerful, tools in situations where conditions for regular statistical tests are not or cannot be met. In this paper we introduce lineups as a tool for evaluating the power of competing graphical designs. We highlight some of the theoretical properties and then show results from two studies evaluating competing designs: both studies are designed to go to the limits of our perceptual abilities to highlight differences between designs. We use both accuracy and speed of evaluation as measures of a successful design. The first study compares the choice of coordinate system: polar versus cartesian coordinates. The results show strong support in favor of cartesian coordinates in finding fast and accurate answers to spotting patterns. The second study is aimed at finding shift differences between distributions. Both studies are motivated by data problems that we have recently encountered, and explore using simulated data to evaluate the plot designs under controlled conditions. Amazon Mechanical Turk (MTurk) is used to conduct the studies. The lineups provide an effective mechanism for objectively evaluating plot designs.

(11)B and (195)Pt NMR study of heavy-fermion compound CePt(2)B(2)C

We report (11)B and (195)Pt NMR Knight shift K and spin-lattice relaxation rate 1/T(1) in CePt(2)B(2)C in the range 4-315 K. The quadrupolar coupling constant, ν(Q) for boron nuclei is 790 ± 10 kHz. The change of hyperfine field, H(hf), is observed below 30 K in the K versus susceptibility, χ, plot. The calculated value of H(hf) at the (11)B ((195)Pt) is 0.156 (6.86) kOe/μ(B) in the range 30-300 K and ∼0 (0.22) kOe/μ(B) below 30 K. The 1/T(1) versus T curve shows some exotic behavior. The Ce 4f spin contribution to the nuclear relaxation rate (1/T(1f)) in each case is obtained by subtracting the T(1K)(-1) estimated from its La analog, i.e. LaPt(2)B(2)C. In the case of (11)B resonance, in the temperature range of 300-100 K, (1/T(1f)) is independent of T, suggesting a Curie-Weiss behavior of the imaginary part of the dynamic susceptibility. It then shows a slow but continuous increment in the range 100-70 K, indicating a signature of the development of short-range magnetic correlation among the Ce 4f spins. Below 70 K, this enhancement of 1/T(1f) is completely suppressed and it decreases sharply, indicating a suppression of the effect of magnetic correlation, due to the dominance of the Kondo effect over the RKKY interaction. 1/T(1f), follows ∼T(α), with an exponent α∼0.7 in the range 4-30 K for (195)Pt and in the range 8-30 K for (11)B resonance. This is a characteristics of a non-Fermi-liquid like behavior. However, in the case of (11)B, there is again a clear change in the slope of the 1/T(1f) versus T curve below 8 K, with the value of α = 1.0, as if the behavior of the conduction electrons approaches towards a Fermi liquid, when probed near the (11)B site.

Hepatitis C virus NS5A physically associates with p53 and regulates p21/waf1 gene expression in a p53-dependent manner

We have previously demonstrated that hepatitis C virus (HCV) NS5A protein promotes cell growth and transcriptionally regulates the p21/waf1 promoter, a downstream effector gene of p53. In this study, we investigated the molecular mechanism of NS5A-mediated transcriptional repression of p21/waf1. We observed that transcriptional repression of the p21/waf1 gene by NS5A is p53 dependent by using p53 wild-type (+/+) and null (-/-) cells. Interestingly, p53-mediated transcriptional activation from a synthetic promoter containing multiple p53 binding sites (PG13-LUC) was abrogated following expression of HCV NS5A. Additional studies using pull-down experiments, in vivo coimmunoprecipitation, and mammalian two-hybrid assays demonstrated that NS5A physically associates with p53. Confocal microscopy revealed sequestration of p53 in the perinuclear membrane and colocalization with NS5A in transfected HepG2 and Saos-2 cells. Together these results suggest that an association of NS5A and p53 allows transcriptional modulation of the p21/waf1 gene and may contribute to HCV-mediated pathogenesis.

A novel 16-kilodalton cellular protein physically interacts with and antagonizes the functional activity of c-myc promoter-binding protein 1

We initially identified c-myc promoter-binding protein 1 (MBP-1) from a human cervical carcinoma cell expression library which negatively regulates c-myc promoter activity. A recent study demonstrated that MBP-1 acts as a general transcriptional repressor (A. K. Ghosh, R. Steele, and R. B. Ray, Mol. Cell. Biol. 19:2880-2886, 1999). In order to identify the cellular protein(s) interacting with MBP-1 for transcriptional regulation, a HeLa cell cDNA expression library was screened using a yeast two-hybrid system. An MBP-1-interacting cDNA encoding a polypeptide of 140 amino acid residues with an approximate molecular mass of 16 kDa was identified and named MBP-1 interacting protein-2A (MIP-2A). MIP-2A has a sequence similarity with an unknown mRNA and SEDL. Mutations in the SEDL gene, located at human chromosome Xp22, has recently been implicated with an X-linked genetic disease, although the function of SEDL gene product was not determined (A. K. Gedeon et al., Nat. Genet. 22:400-404, 1999). However, our results suggested the localization of MIP-2A at human chromosome 19. The specificity of interaction between MBP-1 and MIP-2A was verified by an in vitro glutathione S-transferase pulldown experiment, a mammalian two-hybrid analysis, and in vivo coimmunoprecipitation assays. Further analysis revealed that the amino-terminal domain of MBP-1 (amino acids 1 to 95) interacts with MIP-2A. Immunofluorescent staining suggested colocalization of MIP-2A and MBP-1 primarily in the perinuclear membrane of cells. Functional analysis demonstrated that MIP-2A relieves MBP-1 mediated transcriptional repression on c-myc promoter. Additionally, MIP-2A antagonizes cell growth regulatory role of MBP-1. Taken together, these results suggest the functional interaction of MIP-2A and MBP-1 in cell growth regulation.

Determination of the immunodominant part in the O-antigenic polysaccharide from Escherichia coli O128 by ELISA-inhibition study

The immunodominant part in the O-antigenic polysaccharide from Escherichia coli O128 was immunologically characterized by an enzyme-linked immunosorbent assay (ELISA). The antibody specificity was determined by the inhibitory effects of the methyl glycosides of constituent mono- and oligosaccharides synthesized related to the O-antigenic polysaccharide from E. coli O128. It was found that methyl alpha-L-fucopyranoside was the most effective inhibitor amongst the monosaccharides while the highest antibody specificity was directed towards the trisaccharide with the structure: beta-D-GalpNAc-(1-->6)-[alpha-L-Fucp-(1-->2)]-beta-D-Galp-1-->OMe suggesting that the monospecific antibody has the extended combining site.

Hepatitis C virus NS5A protein protects against TNF-alpha mediated apoptotic cell death

Hepatitis C virus (HCV) often causes a prolonged and persistent infection which may lead to hepatocellular carcinoma. We have previously reported that the nonstructural 5A (NS5A) protein of HCV promotes cell growth [Ghosh, A.K., Steele, R., Meyer, K., Ray, R., Ray, R.B., 1999. Hepatitis C virus NS5A protein modulates cell cycle regulatory genes and promotes cell growth. J. Gen. Virol. 80, 1179-1183]. In this study, we investigated the role of HCV NS5A (genotype 1a, strain H) in TNF-alpha induced apoptotic cell death. HepG2 cells expressing NS5A exhibited an inhibitory role in relation to TNF-alpha mediated apoptotic cell death. The NS5A protein blocked the activation of caspase-3 and inhibited proteolytic cleavage of the death substrate poly (ADP-ribose) polymerase in TNF-alpha induced cells. Together, these results suggest that HCV NS5A protein protects against TNF-alpha mediated apoptotic cell death.

Hepatitis C virus NS5A protein modulates transcription through a novel cellular transcription factor SRCAP

Hepatitis C virus NS5A protein transcriptionally modulates cellular genes and promotes cell growth. NS5A is likely to exert its activity in concert with cellular factor(s). Using a yeast two-hybrid screen, we have demonstrated that NS5A interacts with the C-terminal end of a newly identified cellular transcription factor, SRCAP. The authenticity of this interaction was verified by a mammalian two-hybrid assay, in vitro pull-down experiment, and an in vivo coimmunoprecipitation assay in human hepatoma (HepG2) cells. An in vitro transient transfection assay demonstrated that SRCAP can efficiently activate transcription when recruited by the Gal4 DNA-binding domain to the promoter. However, down-regulation of p21 promoter activity by NS5A was enhanced following ectopic expression of SRCAP. Together these results suggest that the interaction of NS5A and SRCAP may be one of the mechanisms by which NS5A exerts its effect on cell growth regulation contributing to hepatitis C virus-mediated pathogenesis.

Saracin: A lectin from Saraca indica seed integument induces apoptosis in human T-lymphocytes

Saracin, a seed integument lectin from Saraca indica is highly specific for binding N-acetyl-neuraminyl-N-acetyllactosamine [Neu5Ac-alpha-(2-6)/(2-3)-D-Gal-beta-(1-4)-D-GlcNAc]. This lectin has been found to be mitogenic for human lymphocytes, and this mitogenic activity could be inhibited in presence of fetuin. Further, treatment with saracin could induce secretion of IL-2 in a culture of resting human peripheral blood mononuclear cells (PBMC) after 48 h. Saracin has a higher affinity for the CD8(+) than CD4(+) T cells as revealed by FACS analysis. Agarose gel electrophoresis of DNA isolated from lymphocytes cultured under different conditions has shown that this lectin could induce apoptosis in activated T-lymphocytes, as also confirmed by flow cytometric studies. Phenotypic analysis of the apoptotic cells reveals that they belong to CD8(+) T cells lineage. Four surface glycoproteins of PBMC have been found to interact with saracin in a trisaccharide [Neu5Ac-alpha-(2-6)/(2-3)-D-Gal-beta-(1-4)-D-GlcNAc]-sequence specific manner. Saracin seems to be an interesting immunomodulator for the mammalian immune system.

Inhibition of bacterial respiration by a low-molecular weight lectin, scyllin, from Scylla serrata crab hemolymph

Interaction of plant and/or invertebrate lectins with mammalian cells and different microorganisms is well known. In the present study, we have demonstrated that scyllin, a low molecular weight (MW 4000) lectin from the edible crab Scylla serrata hemolymph, purified by GalNAc-Sepharon affinity column followed by Mono-Q ion exchanger in FPLC exhibits antimicrobial activity against Bacillus cereus and Escherichia coli by inhibiting endogenous respiration as well as exogenous glucose oxidation. In both the cases oxygen consumption has been measured in an oxygraph. Scyllin has produced 50% inhibition of endogenous respiration at a concentration of 110 micrograms/ml and 125 micrograms/ml in B. cereus and E. coli respectively. It also reduced the exogenous glucose oxidation by 50% at a concentration of 12 micrograms/ml and 80 micrograms/ml respectively in B. cereus and E. coli. From the above study the mechanism of bacterial growth inhibitory property of scyllin is suggested though the other studies such as inhibition of nucleic acid biosynthesis, cell wall biosynthesis etc. to evaluate its total mode of inhibitory action are not yet obtained.

Subcellular distribution of jacalin in Artocarpus integrifolia seed

Seeds of Artocarpus integrifolia (jack fruit) contain large amounts of the anti-T lectin, jacalin. The mature seeds of jack fruit were homogenized in 0.25 M sucrose and separated by differential centrifugation into four fractions, viz wall, intermediate, and microsomal pellets and soluble supernatant. The lectin activity was associated with the wall pellet collected at low speed centrifugation. The other three fractions obtained by centrifugation at gradually higher speeds contained a similar lectin but of very low specific activity. The distribution pattern of jacalin remained unchanged in the presence of EDTA and/or Triton X-100 indicating that the lectin was not membrane bound. Immunofluorescent staining of jack fruit seeds showed that jacalin was localized in the cell wall in the intracellular space, which corroborated the results of fractionation studies. The possible relevance of these results to the function of lectin in the plant cell is discussed.

The benefit of lateral radiographs in an intensive care unit

The portable anteroposterior (AP) radiograph (CXR) is an essential component of clinical management in the intensive care unit (ICU). In view of the immobility of patients, and overlying tubes, wires, and catheters, lateral (LAT) CXRs are infrequently ordered. We constructed a portable acrylic (Plexiglas) CXR cassette holder and were able to obtain reproducible quality LAT CXRs in the ICU. Of the 72 simultaneously obtained AP and LAT CXRs, 60 were technically acceptable for interpretation. We found an 11 percent incidence of either unexpected conditions or we were able to improve on the AP CXR interpretation. Lateral CXRs should be obtained routinely in the ICU in select patients.

Studies on the partial structure of the O-antigen of Vibrio cholera Ogawa G-2102

Detailed information was obtained regarding the partial structure of the lipopolysaccharide (LPS), containing glucose, glucuronic acid, 2-amino-2-deoxy-glucose, L-glycero-D-gluco-heptose, and small proportions of L-glycero-D-manno-heptose, mannose, and galactose, isolated from Vibrio cholera Ogawa G-2102. Structures of three oligosaccharides were determined. Results of deamination experiments established the sequence of the linkages between the amino sugar and heptose residues in the O-antigenic polysaccharide.