Free radicals have been found to play an important role in obsessive-compulsive disorder (OCD). So, we measured the oxidative/antioxidative status of OCD patients, and assessed its use as a biological marker. The study was carried out on 20 healthy and 20 OCD subjects, aged between 20 and 40 years. Biochemical parameters of all subjects were assessed and compared. A significant difference in superoxide dismutase (SOD) levels was observed between the OCD and control groups (p < 0.05); malondialdehyde (MDA) levels were also significantly higher in OCD subjects (p < 0.05). Our study found an overall oxidative imbalance in OCD, leaning towards the antioxidant side in sufferers (specifically towards SOD). SOD has a protective role in overcoming oxidative stress; therefore, oxidative stress could have a pathophysiological role in OCD. Therapy specifically targeting MDA production will have a beneficial effect in overcoming the oxidative stress, anxiety and affective disorder which may be associated with OCD.

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The folding mechanisms for β-barrel membrane proteins present unique challenges because acquisition of both secondary and tertiary structure is coupled with insertion into the bilayer. For the porins in Escherichia coli outer membrane, the assembly pathway also includes association into homotrimers. We study the folding pathway for purified LamB protein in detergent and observe extreme hysteresis in unfolding and refolding, as indicated by the shift in intrinsic fluorescence. The strong hysteresis is not seen in unfolding and refolding a mutant LamB protein lacking the disulfide bond, as it unfolds at much lower denaturant concentrations than wild type LamB protein. The disulfide bond is proposed to stabilize the structure of LamB protein by clasping together the two sides of Loop 1 as it lines the inner cavity of the barrel. In addition we find that low pH promotes dissociation of the LamB trimer to folded monomers, which run at about one third the size of the native trimer during SDS PAGE and are much more resistant to trypsin than the unfolded protein. We postulate the loss at low pH of two salt bridges between Loop 2 of the neighboring subunit and the inner wall of the monomer barrel destabilizes the quaternary structure.

A bstract Introduction World Health Organization proposes severe acute respiratory infection (SARI) case definition for coronavirus disease 2019 (COVID-19) surveillance; however, early differentiation between SARI etiologies remains challenging. We aimed to investigate the spectrum and outcome of SARI and compare COVID-19 to non-COVID-19 causes. Patients and methods A prospective cohort study was conducted between March 15, 2020, to August 15, 2020, at an adult medical emergency in North India. SARI was diagnosed using a “modified” case definition—febrile respiratory symptoms or radiographic evidence of pneumonia or acute respiratory distress syndrome of ≤14 days duration, along with a need for hospitalization and in the absence of an alternative etiology that fully explains the illness. COVID-19 was diagnosed with reverse transcription-polymerase chain reaction testing. Results In total, 95/212 (44.8%) cases had COVID-19. Community-acquired pneumonia ( n = 57), exacerbation of chronic lung disease ( n = 11), heart failure ( n = 11), tropical febrile illnesses ( n = 10), and influenza A ( n = 5) were common non-COVID-19 causes. No between-group differences were apparent in age ≥60 years, comorbidities, oxygenation, leukocytosis, lymphopenia, acute physiology and chronic health evaluation (APACHE)-II score, CURB-65 score, and ventilator requirement at 24-hour. Bilateral lung distribution and middle-lower zones involvement in radiography predicted COVID-19. The median hospital stay was longer with COVID-19 (12 versus 5 days, p = 0.000); however, mortality was similar (31.6% versus 28.2%, p = 0.593). Independent mortality predictors were higher mean APACHE II in COVID-19 and early ventilator requirement in non-COVID-19 cases. Conclusions COVID-19 has similar severity and mortality as non-COVID-19 SARI but requires an extended hospital stay. Including radiography in the SARI definition might improve COVID-19 surveillance. How to cite this article Pannu AK, Kumar M, Singh P, Shaji A, Ghosh A, Behera A, et al . Severe Acute Respiratory Infection Surveillance during the Initial Phase of the COVID-19 Outbreak in North India: A Comparison of COVID-19 to Other SARI Causes. Indian J Crit Care Med 2021;25(7):761–767.

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BackgroundSystemic lupus erythematosus (SLE) patients can present to emergency department (ED) with acute manifestations that require immediate evaluation and initiation of appropriate therapy. The reasons for ED visits could be due to disease activity or various complications arising due to therapy. However, there is paucity of data on the reasons and outcomes of SLE patients who present to ED.ObjectivesTo determine the reason, 3 month outcomes and the predictors of mortality among the SLE patients who present to ED.MethodsSingle centre prospective observational study was being performed between July 2021 and December 2022. Patients of SLE fulfilling the SLICC or the 2019 ACR/EULAR classification criteria and aged above 18 years and presenting to ED were included. Written informed consent was obtained from all the subjects. Clinical and laboratory details were noted at the time of presentation to ED. The reasons for ED visits were classified into disease activity or infection or both or non-SLE related. Outcomes of death and disease activity (by SLEDAI2K) at 3 months were noted. The study was approved by the Institute Ethics Committee.ResultsA total of 61 patients were included in the study. Median age was 28 years (IQR: 24-35) and 55 (90.2%) were females. Twenty (32.8%) patients were newly diagnosed with SLE after presentation to ED, and the median duration of illness among previously diagnosed patients was 24 months (IQR: 12-48). Disease activity alone (n=41; 67.2%) was the commonest reason for ED visit followed by disease activity co-existing with infection (n=15; 24.6%) and infections alone (n=5; 8.2%). Among the 56 patients with disease activity at presentation, active disease manifestations were noted in following organs: renal (57.1%), musculoskeletal (53.6%), skin (51.8%), haematological (42.9%), serositis (39.3%), neurological (28.6%), cardiac (26.8%), gastrointestinal (14.3%) and lung (5.4%). Among the 20 patients with infections at presentation, lower respiratory tract infections were the commonest, seen in 7 (35%) patients followed by CNS infections (15%). UTI, skin and soft tissue, ear and sino-nasal and sepsis with un-identified focus were seen in 2 (10%) patients each. Infective colitis and bacterial peritonitis were identified in 1 (5%) patient each. At 3 months of follow up, 21 (34.4%) patients died, with majority (n=18; 85.7%) dying within 1 month of presentation. Deaths were significantly more in patients who presented with both disease activity and infection compared to patients who presented with only disease activity or infection (p=0.0001). Among the remaining 40 patients, 15 (37.5%) were in remission, 13 (32.5%) were in low disease activity and 12 (30%) were in moderate to high disease activity. On multiple regression analysis, presence of hypoxia (p=0.046), serum albumin less than 2.5g/dl (p=0.006) and infection (p=0.001) at presentation predicted mortality at three months (Table 1).ConclusionThe commonest cause of ED visit by SLE patients is disease activity alone followed by disease activity and co-existing infections. Infections were present at the time of ED admission in one-third of SLE patients. Three month mortality rate was high (34.4%) and presence of hypoxia, low serum albumin and infection at presentation predicted mortality at three months.Table 1.Multiple regression analysis for prediction of mortality.Parameterp valueGender0.164New onset disease0.646Hypotension at presentation0.074Hypoxia at presentation0.046Severe anaemia0.386Low complements0.179Serum creatinine >1.5mg/dl0.451Serum albumin <2.5 g/dl0.006Renal involvement0.359Need of haemodialysis at presentation0.527Myocarditis0.112Diffuse alveolar haemorrhage0.092Haematological involvement0.557Neurological involvement0.333Enteritis0.119Serositis0.721Infections at presentation0.001REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.