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Severe digital ischemia (SDI), which presents with digital ulcers, necrosis, or gangrene, has been reported to be a rare manifestation of anti‐aminoacyl transfer RNA synthetase (ARS) antibody‐positive polymyositis/dermatomyositis or anti‐synthetase syndrome. A retrospective study was conducted between 2009 and 2020 at our department to investigate the clinical features of anti‐ARS antibody‐positive patients with SDI and identify their predictors. A total of 46 patients who were positive for anti‐ARS antibody were included, four of whom (8.7%) presented with SDI. The characteristics of the patients with SDI were as follows: the median age was 74 years, with 75% being female; anti‐Jo–1 antibody, Raynaud's phenomenon, interstitial lung disease, and myositis were observed in two (50%), four (100%), four (100%), and three patients (75%), respectively. Next, we reviewed the literature of anti‐ARS antibody‐positive patients with SDI and investigated the predictors of SDI by analyzing a total of 51 patients, including the previously reported five patients with SDI. Multivariable analyses revealed that Raynaud's phenomenon and myositis independently predicted the development of SDI in patients with anti‐ARS antibody. In conclusion, digital ulcers, necrosis, or gangrene seem to be more common presentations in our study, and Raynaud's phenomenon and myositis can predict the complications of SDI in anti‐ARS antibody‐positive patients.

Background: Sepsis is an important cause of neonatal mortality and morbidity. Nonspecific and subtle clinical features coupled with expensive, time consuming and unavailable definite laboratory tests challenges its accurate diagnosis in clinical practice. Sepsis is traditionally suspected in neonates based on clinical features, maternal and neonatal risk factors and is treated by empirical antibiotics. These risk factors and clinical features are variable depending on geographical, cultural and socio-economic background. We studied the clinical and bacteriological profile of high risk neonates for sepsis development in our Neonatal Intensive Care Unit (NICU), to make the precise clinical diagnosis and prevent inadvertent use of antibiotics.Methods: A prospective observational study was conducted on 200 neonates with suspected sepsis either by high risk factors and /or clinical features admitted to NICU for a period of nine months. After clinical examination, septic screen including blood culture was done and antibiotics were started as per the NICU protocol.Results: Of the 200 neonates studied, 20.5% had positive blood culture with Coagulase negative staphylococci (CoNS) and contaminants. 89.5% had early onset of sepsis (EOS). Neonatal profile showed 60.5% males, 55% inborn, 37.5% premature, 49.5% low birth weight babies. Maternal profile showed 49.5% Primigravida, 73% aged above 20 years at delivery and 97.5% literates. Outcome of admitted neonates showed, 72% were discharged after improvement, 10.5% died and 17.5% discharged against medical advice. Death due to respiratory distress syndrome was common in preterm and male neonates.Conclusions: EOS was common in our NICU. Blood culture showed more CoNS and contaminants necessitating the need for better blood sampling and hand wash technique.

Background: Neonatal sepsis remains one of the leading causes of morbidity and mortality both among term and preterm infants. Sepsis and meningitis are responsible for most of these deaths. According to WHO estimates, there are about 5 million neonatal deaths a year. Jaundice and hepatic dysfunction frequently accompany a variety of bacterial infections. This study was aimed to evaluate bilirubin fractions and liver function tests in septic and non septic neonates with hyperbilirubinemia. Materials & Methods:A total of 41 neonates, their age ranged from (1-28 days), mean age sepsis cases 4.29±5.34 and mean age in non sepsis 2.27±4.44. The patients admitted to neonatology unit for the management of hyperbilirubinemia were included in this study. Out of 41, 20 babies having sepsis (17 were males & 3 were females) and 21 (15 were males & 6 were females) were non sepsis. All study subjects were studied for the serum bilirubin fractions and other liver function tests by using vitros dry chemistry analyzer. Results: In the present study, delta bilirubin (0.955 ±0.546) and conjugated bilirubin (1.17±2.10) levels are significantly increased in sepsis cases when compared to non sepsis controls. Conclusion: In conclusion, conjugated bilirubin and delta bilirubin were significantly increased in neonates suffering from sepsis with hyperbilirubinemia. By studying individual fractions of bilirubin, especially unconjugated bilirubin, conjugated bilirubin and delta bilirubin (not as direct and indirect bilirubin) will help in early diagnosis of sepsis and thus may help in better management of the sepsis neonates.

We herein report the case of a 78-year-old woman who was diagnosed as having disseminated herpes zoster (DHZ) complicated with probable varicella-zoster pneumonia during maintenance therapy for microscopic polyangiitis. Because the patient had severe renal dysfunction, amenamevir administration was started to avoid any neurotoxicity of acyclovir, which is suggested to be optimal for treatment. It ameliorated her symptoms without any adverse events. This is the first report suggesting the efficacy of amenamevir in the treatment of severe herpes zoster infection with coexisting DHZ and probable varicella-zoster pneumonia. Amenamevir could thus be a treatment option for severe varicella zoster virus infections.