Publications by authors named "Deepak Jain"

178 Publications

Leveraging long short-term memory (LSTM)-based neural networks for modeling structure-property relationships of metamaterials from electromagnetic responses.

Sci Rep 2021 Sep 20;11(1):18629. Epub 2021 Sep 20.

TCS Research, Tata Consultancy Services, Mumbai, India.

We report a neural network model for predicting the electromagnetic response of mesoscale metamaterials as well as generate design parameters for a desired spectral behavior. Our approach entails treating spectral data as time-varying sequences and the inverse problem as a single-input multiple output model, thereby compelling the network architecture to learn the geometry of the metamaterial designs from the spectral data in lieu of abstract features.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-97999-6DOI Listing
September 2021

Perinatal famine is associated with excess risk of proliferative retinopathy in patients with type 2 diabetes.

Acta Ophthalmol 2021 Jun 24. Epub 2021 Jun 24.

Department of Clinical Science, Center for Diabetes Research, University of Bergen, Bergen, Norway.

Purpose: Intrauterine undernutrition is associated with increased risk of type 2 diabetes. Children born premature or small for gestational age were reported to have abnormal retinal vascularization. However, whether intrauterine famine act as a trigger for diabetes complications, including retinopathy, is unknown. The aim of the current study was to evaluate long-term effects of perinatal famine on the risk of proliferative diabetic retinopathy (PDR).

Methods: We studied the risk for PDR among type 2 diabetes patients exposed to perinatal famine in two independent cohorts: the Ukrainian National Diabetes Registry (UNDR) and the Hong Kong Diabetes Registry (HKDR). We analysed individuals born during the Great Famine (the Holodomor, 1932-1933) and the WWII (1941-1945) famine in 101 095 (3601 had PDR) UNDR participants. Among 3021 (251 had PDR) HKDR participants, we studied type 2 diabetes patients exposed to perinatal famine during the WWII Japanese invasion in 1942-1945.

Results: During the Holodomor and WWII, perinatal famine was associated with a 1.76-fold (p = 0.019) and 3.02-fold (p = 0.001) increased risk of severe PDR in the UNDR. The risk for PDR was 1.66-fold elevated among individuals born in 1942 in the HKDR (p < 0.05). The associations between perinatal famine and PDR remained statistically significant after corrections for HbA1c in available 18 507 UNDR (p  < 0.001) and in 3021 HKDR type 2 diabetes patients (p < 0.05).

Conclusion: In conclusion, type 2 diabetes patients, exposed to perinatal famine, have increased risk of PDR compared to those without perinatal famine exposure. Further studies are needed to understand the underlying mechanisms and to extend this finding to other diabetes complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aos.14948DOI Listing
June 2021

Efficacy of late postnatal dexamethasone on weaning from invasive mechanical ventilation in extreme premature infants.

J Perinatol 2021 Aug 28;41(8):1951-1955. Epub 2021 May 28.

Department of Pediatrics, Division of Neonatology, University of Miami School of Medicine, Miami, FL, USA.

Objective: To evaluate the short-term respiratory effects of PND in a cohort of ventilator-dependent premature infants.

Study Design: Clinical data from 106 infants 23-28 weeks gestation who received PND for weaning from MV during 2011-2017 were evaluated. PND was started at a dose of 0.1 mg/kg/d tapered over 5-7 d. Treatment success was defined as extubated and free from MV on d14 after start of treatment.

Result: Treatment was successful in 83 (78%) infants. Demographics and age of treatment did not differ between groups. In the failure group, a higher proportion were on HFOV and FiO ≥ 0.50 before treatment, compared to the successful group.

Conclusion: In most infants, PND resulted in successful weaning from MV. Reduced need for oxygen in infants not extubated may be beneficial, but it is unknown if this offsets the risks. The long-term effects PND in ventilator dependent infants need to be evaluated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41372-021-01108-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161346PMC
August 2021

Changes in Patent Ductus Arteriosus Treatment Strategy and Respiratory Outcomes in Premature Infants.

J Pediatr 2021 Aug 21;235:58-62. Epub 2021 Apr 21.

Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL. Electronic address:

Objective: To evaluate whether change in patent ductus arteriosus (PDA) management strategies over time had an impact on respiratory outcomes in premature infants.

Study Design: Prospectively collected data were included from all preterm infants born at 23-30 weeks gestational age with PDA admitted to the Children's Hospital of the University of Miami/Jackson Memorial Medical Center from January 1, 2005 to December 31, 2007 (epoch 1) and January 1, 2011 to December 31, 2015 (epoch 2). The 2 epochs were compared for approach with PDA diagnosis and subsequent management strategies and respiratory outcomes.

Results: Significantly fewer infants were treated for PDA in epoch 2 (54%) compared with epoch 1 (90%). Multivariable logistic regression analysis demonstrated that infants in epoch 2, with later PDA diagnosis and less frequent PDA treatment, had greater odds of bronchopulmonary dysplasia (BPD), composite of BPD or death, and more treatment with postnatal steroids than in epoch 1.

Conclusions: The change in approach to diagnosis and management of PDA, from a more proactive and aggressive approach during the earlier epoch 1 to a more expectant approach during the subsequent epoch 2, was associated with worse respiratory outcomes, including increase in BPD and in BPD or death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2021.04.030DOI Listing
August 2021

Protocol and Baseline Data on Renal Autologous Cell Therapy Injection in Adults with Chronic Kidney Disease Secondary to Congenital Anomalies of the Kidney and Urinary Tract.

Blood Purif 2021 1;50(4-5):678-683. Epub 2021 Mar 1.

ProKidney, Grand Cayman, George Town, Cayman Islands.

Background: Advanced cell therapies with autologous, homologous cells show promise to affect reparative and restorative changes in the chronic kidney disease (CKD) nephron. We present our protocol and preliminary analysis of an IRB-approved, phase I single-group, open-label trial that tests the safety and efficacy of Renal Autologous Cell Therapy (REACT; NCT04115345) in adults with congenital anomalies of the kidney and urinary tract (CAKUT).

Methods: Adults with surgically corrected CAKUT and CKD stages 3 and 4 signed an informed consent and served as their "own" baseline control. REACT is an active biological ingredient acquired from a percutaneous tissue acquisition from the patient's kidney cortex. The specimen undergoes a GMP-compliant manufacturing process that harvests the selected renal cells composed of progenitors for renal repair, followed by image-guided locoregional reinjection into the patient's renal cortex. Participants receive 2 doses at 6-month intervals. Primary outcomes are stable renal function and stable/improved quality of life. Additional exploratory endpoints include the impact of REACT on blood pressure, vitamin D levels, hemoglobin, hematocrit and kidney volume by MRI analysis.

Results: Four men and 1 woman were enrolled and underwent 5 cell injections. Their characteristics were as follows: mean 52.8 years (SD 17.7 years), 1 Hispanic, 4 non-Hispanic, and 5 white. There were no renal tissue acquisition, cell injection, or cell product-related complications at baseline.

Conclusion: REACT is demonstrating feasibility and patient safety in preliminary analysis. Autologous cell therapy treatment has the potential to stabilize or improve renal function in CAKUT-associated CKD to delay or avert dialysis. Patient enrollment and follow-up are underway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000512586DOI Listing
March 2021

A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project.

Malar J 2021 Feb 16;20(1):91. Epub 2021 Feb 16.

Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.

Background: Health care technologies are now offering accountability, quality, robustness, and accuracy in disease surveillance and health care delivery programmes. With the advent of mobile hand-held devices, these technologies have become more accessible and adaptable for use by field staff working in remote areas. The Malaria Elimination Demonstration Project started collection of data and conduct of routine operations using paper-based reporting systems. Observing the need for a robust and quality digital mobile application, a comprehensive mobile application tool was developed that allowed the project to conduct disease surveillance, workforce management and supply chain management.

Methods: In June 2017, the project conceptualized a comprehensive mobile application tool in the local language (Hindi) for disease surveillance, human resources management, and supply chain management. The tool is also available in English. Solution for Community Health-workers (SOCH) mobile app is an android native application developed using android SDK and web-based tool using MVC.net framework. Construction of the application started in November 2017 and rolled out its pilot in April 2018, followed by pan-district roll out in July 2018. The application uses self-validation tools to ensure high level of data quality and integrity.

Results: The software is available in android based hand-held devices and web-screens with built-in data analytical capabilities. Using SOCH, the project has now successfully digitized its routine surveillance, attendance, tour plans, supply chain management components. The project has documented a reduction in 91% indigenous cases in the district, 60% improvement in stock accountability, and 99.6% accuracy in data collected through the mobile application.

Conclusion: SOCH is an excellent and user-friendly tool, which can be customized for any public health management programme. The system ensures accountability and data robustness, which is needed for malaria elimination efforts throughout the country. The mobile application can be adapted for English or any other Indian or international language for use for malaria or any other disease surveillance and control programme. Another expansion feature of this mobile application is incorporation of indicators for Indoor Residual Spraying (IRS), Long-Lasting Insecticidal Nets (LLINs), and minor engineering by the residents of community under surveillance. The authors believe that it would be highly desirable and appropriate for an international organization, such as the World Health Organization (WHO), to conduct an independent comparison of all available mobile e-surveillance tools, so that a high-performing and globally suitable system can be selected for use in malaria elimination programmes. The Foundation of Disease Elimination and Controlof India has decided to make the SOCH mobile application available to anyone who would like to use it for disease surveillance and health care programmes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12936-021-03623-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885520PMC
February 2021

Evaluation of visual evoked potentials and brain-stem auditory evoked response in patients of chronic kidney disease.

Saudi J Kidney Dis Transpl 2020 Nov-Dec;31(6):1245-1253

Department of Medicine, Division of Nephrology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India.

Chronic kidney disease (CKD) is associated with functional changes in the central nervous system (CNS) which, in the initial stages do not manifest clinically. Early involvement of the CNS can be identified by the assessment of the electrocortical activity. Visual evoked potential (VEP) and brain-stem auditory evoked response (BAER) are useful tests for the early diagnosis of CNS involvement in CKD and are more sensitive compared to electroencephalography. One hundred adult CKD patients (stage 3-5 and 5D) and 50 controls were included in the study. Clinical and biochemical parameters were assessed and all the patients and controls underwent VEP and BAER evaluation. Evaluation of the VEP showed prolonged latencies of all the three peaks (N75, P100, and N145) compared to controls. Furthermore, all the absolute and interpeak BAER latencies for the CKD patients were similarly prolonged compared to controls. CNS dysfunction is common in CKD patients. The electrophysiological tests of VEP and BAER can be used for the early diagnosis of these disorders, even in the sub-clinical stages, thus allowing for their better management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/1319-2442.308333DOI Listing
February 2021

Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Children (Basel) 2020 Dec 10;7(12). Epub 2020 Dec 10.

Division of Neonatology, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.

Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/children7120283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763238PMC
December 2020

POPX2 phosphatase enhances topographical contact guidance for cell morphology and migration.

Biomed Mater 2021 02 24;16(2):025020. Epub 2021 Feb 24.

Mechanobiology Institute, National University of Singapore, Singapore.

Topography mediated contact guidance affects multiple cell behaviors such as establishment of cellular morphology and migration. The direction of cell migration is associated with the establishment of cell polarity, which also affects the primary cilia in migrating cells. POPX2, a partner of PIX2, is involved in pathways essential to primary cilium formation, while over-expression of POPX2 has been reported to cause a loss of cell polarity during migration. This study aims to examine how topographical cues direct morphological changes, and how topography affects the process of cellular migration and primary cilium architecture, in the context of POPX2 over-expression. Thus, the effect of anisotropic topography, 2 μm grating pattern on tissue-culture polystyrene, was used as a contact guidance cue to investigate the migration and cell polarity of POPX2 overexpressing cells, in comparison to control NIH3T3 fibroblast cells. We report that POPX2 overexpressing NIH3T3 cells were more sensitive to surface topographical cues as the cells became more elongated. In addition, these cues also affected focal adhesion alignment of POPX2 overexpressing cells. Cell migration was further studied using wound closure assays, in which the 2 μm gratings were designed to be either perpendicular or parallel to wound-induced cell migration direction, which would be agonistic or antagonistic to cell migration, respectively. We observed that both POPX2 overexpressing cells' migration direction and migration rate were more significantly influenced by gratings direction compared to control NIH3T3 cells. The migration paths of POPX2 overexpressing cells become more direct in the presence of anisotropic topographical cues. Further, cilia and centrosome alignment, which is important in cell migration, was also affected by the direction of gratings during this migration process. Collectively, enhancement of NIH3T3 cell sensitivity towards surface topography through POPX2 overexpression might reflect one of the mechanisms that combine biochemical and mechanical cues for directional cell migration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/1748-605X/abd3b5DOI Listing
February 2021

Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia - A prospective randomised controlled study.

Indian J Anaesth 2020 Sep 1;64(9):750-755. Epub 2020 Sep 1.

Department of Anaesthesia, Fortis Hospital, Mohali, Punjab, India.

Background And Aims: To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies.

Methods: A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2% Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent -test and visual analogue scale (VAS) scores were compared by the Mann-Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0).

Results: Opioid consumption in both groups was comparable, for the first two post-operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group.

Conclusions: As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ija.IJA_976_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641078PMC
September 2020

Air Leak Syndrome in Two Very Preterm Infants Born to Mothers with Coronavirus Disease 2019: An Association or a Coincidence?

AJP Rep 2020 Jul 2;10(3):e266-e269. Epub 2020 Sep 2.

Division of Neonatology, Department of Pediatrics, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey.

The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly affects adults with limited information on possible vertical transmission from pregnant mothers. We present here two very preterm infants born to mothers with COVID-19, whose respiratory course was significant for initial mild respiratory distress syndrome who developed acute onset severe air leak syndrome at approximately 24 to 36 hours of age requiring thoracentesis. Their respiratory status improved gradually with resolution of air leak and respiratory failure by 2 weeks of age. Both infants tested negative for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction of multiple respiratory specimens collected beyond 24 hours after birth. As the incidence of severe air leak syndrome is relatively low in preterm infants without risk factors, this presentation in two very preterm infants born to mothers with COVID-19 is intriguing and needs to be further evaluated in larger cohorts. If confirmed, this data could potentially be the first step toward generating hypotheses for mechanisms of lung injury, intrauterine transmission, or how to detect COVID-19 in preterm infants. In addition, these data will be critical for developing evidence-based guidelines for perinatal management of these infants as we continue to battle against the COVID-19 pandemic for the foreseeable future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1715180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591363PMC
July 2020

Data based predictive models for odor perception.

Sci Rep 2020 10 13;10(1):17136. Epub 2020 Oct 13.

Tata Research Development and Design Centre, Tata Consultancy Services, 54-B, Hadapsar Industrial Estate, Pune, 411013, India.

Machine learning and data analytics are being increasingly used for quantitative structure property relation (QSPR) applications in the chemical domain where the traditional Edisonian approach towards knowledge-discovery have not been fruitful. The perception of odorant stimuli is one such application as olfaction is the least understood among all the other senses. In this study, we employ machine learning based algorithms and data analytics to address the efficacy of using a data-driven approach to predict the perceptual attributes of an odorant namely the odorant characters (OC) of "sweet" and "musky". We first analyze a psychophysical dataset containing perceptual ratings of 55 subjects to reveal patterns in the ratings given by subjects. We then use the data to train several machine learning algorithms such as random forest, gradient boosting and support vector machine for prediction of the odor characters and report the structural features correlating well with the odor characters based on the optimal model. Furthermore, we analyze the impact of the data quality on the performance of the models by comparing the semantic descriptors generally associated with a given odorant to its perception by majority of the subjects. The study presents a methodology for developing models for odor perception and provides insights on the perception of odorants by untrained human subjects and the effect of the inherent bias in the perception data on the model performance. The models and methodology developed here could be used for predicting odor characters of new odorants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-73978-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553929PMC
October 2020

Influence of pulse duration and repetition rate on mid-infrared cascaded supercontinuum.

Opt Lett 2020 Sep;45(18):5161-5164

We experimentally investigate the influence of varying pulse parameters on the spectral broadening, power spectral density, and relative intensity noise of mid-infrared (mid-IR) in-amplifier cascaded supercontinuum generation (SCG) by varying the pulse duration (35 ps, 1 ns, 3 ns) and repetition rate (100, 500, 1000 kHz). The system is characterized at the output of the erbium-ytterbium-doped in-amplifier SCG stage, the thulium/germanium power redistribution stage, and the passive ZBLAN fiber stage. In doing so, we demonstrate that the output of the later stages depends critically on the in-amplifier stage, and relate this to the onset of modulation instability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1364/OL.401274DOI Listing
September 2020

Coronavirus disease (COVID-19) detection in Chest X-Ray images using majority voting based classifier ensemble.

Expert Syst Appl 2021 Mar 26;165:113909. Epub 2020 Aug 26.

Department of Radiodiagnosis, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India.

Novel coronavirus disease (nCOVID-19) is the most challenging problem for the world. The disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2), leading to high morbidity and mortality worldwide. The study reveals that infected patients exhibit distinct radiographic visual characteristics along with fever, dry cough, fatigue, dyspnea, etc. Chest X-Ray (CXR) is one of the important, non-invasive clinical adjuncts that play an essential role in the detection of such visual responses associated with SARS-COV-2 infection. However, the limited availability of expert radiologists to interpret the CXR images and subtle appearance of disease radiographic responses remains the biggest bottlenecks in manual diagnosis. In this study, we present an automatic COVID screening (ACoS) system that uses radiomic texture descriptors extracted from CXR images to identify the normal, suspected, and nCOVID-19 infected patients. The proposed system uses two-phase classification approach (normal vs. abnormal and nCOVID-19 vs. pneumonia) using majority vote based classifier ensemble of five benchmark supervised classification algorithms. The training-testing and validation of the ACoS system are performed using 2088 (696 normal, 696 pneumonia and 696 nCOVID-19) and 258 (86 images of each category) CXR images, respectively. The obtained validation results for phase-I (accuracy (ACC) = 98.062%, area under curve (AUC) = 0.956) and phase-II (ACC = 91.329% and AUC = 0.831) show the promising performance of the proposed system. Further, the Friedman post-hoc multiple comparisons and z-test statistics reveals that the results of ACoS system are statistically significant. Finally, the obtained performance is compared with the existing state-of-the-art methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eswa.2020.113909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448820PMC
March 2021

Cognitive Dysfunction in Patients with Chronic Kidney Disease.

Saudi J Kidney Dis Transpl 2020 Jul-Aug;31(4):796-804

Department of Medicine, Division of Nephrology, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India.

Cognitive impairment is a common entity in patients with chronic kidney disease (CKD), which plays an important role in increasing the morbidity in these patients. This study was performed to evaluate cognitive dysfunction and its severity in different stages of CKD and identify the correlation with factors affecting this dysfunction. A cross-sectional design study was conducted on 100 patients with CKD Stage III to V-D fulfilling the eligibility criteria. Cognitive status was assessed using the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) tests. The patients were divided into four groups according to their estimated glomerular filtration rate (eGFR); Group A with eGFR ranging between 30 and 59 mL/min/1.73 m, Group B with eGFR between 15 and 29 mL/min/1.73 m, Group C with eGFR <15 mL/min/1.73 m not on hemodialysis (HD), and Group D with eGFR <15 mL/min/1.73 m and on HD for the past six months. Factors affecting MMSE and MoCA scores were assessed using univariate and multivariate linear regression analysis. Mean MMSE score was 28.72 ± 1.37 in Group A, 26.00 ± 3.67 in Group B, 20.76 ± 4.84 in Group C, and 17.28 ± 3.32 in Group D, which showed a statistically significant difference. The mean MoCA score also showed a statistically significant decline from Group A to Group D with values being 26.36 ± 1.91, 24.56 ± 1.94, 22.08 ± 2.12 and 20.12 ± 1.81, respectively (P < 0.05). The MMSE and MoCA scores were found to have a statistically significant positive correlation with hemoglobin; serum corrected calcium and eGFR (P < 0.01) and statistically significant negative correlation with blood urea, serum creatinine, serum uric acid, serum phosphate, serum potassium and stage of CKD (P < 0.01). By raising the clinician's awareness about cognitive dysfunction in CKD patients and its potential effects on medication, fluid and, dietary compliance improved quality of care is expected. Early intervention will improve the patient's quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/1319-2442.292313DOI Listing
July 2021

In-amplifier and cascaded mid-infrared supercontinuum sources with low noise through gain-induced soliton spectral alignment.

Sci Rep 2020 May 19;10(1):8230. Epub 2020 May 19.

DTU Fotonik, Department of Photonics Engineering, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.

The pulse-to-pulse relative intensity noise (RIN) of near-infrared (near-IR) in-amplifier supercontinuum (SC) sources and mid-IR cascaded SC sources was experimentally and numerically investigated and shown to have significantly lowered noise due to the fundamental effect of gain-induced soliton-spectral alignment. The mid-IR SC source is based on a near-IR in-amplifier SC pumping a cascade of thulium-doped and ZBLAN fibers. We demonstrate that the active thulium-doped fiber not only extend the spectrum, but also to significantly reduce the RIN by up to 22% in the long wavelength region above 2 μm. Using numerical simulations, we demonstrate that the noise reduction is the result of an interplay between absorption-emission processes and nonlinear soliton dynamics leading to the soliton-spectral alignment. In the same way we show that the RIN of the near-IR in-amplifier SC source is already significantly reduced because the spectral broadening takes place in an active fiber that also introduces soliton-spectral alignment. We further show that the low noise properties are transferred to the subsequent fluoride SC, which has a RIN lower than 10% (5%) in a broad region from 1.1-3.6 μm (1.4-3.0 μm). The demonstrated low noise significantly improves the applicability of these broadband sources for mid-IR imaging and spectroscopy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-65150-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237674PMC
May 2020

Plasma Exchange as a First Line Therapy in Acute Attacks of Neuromyelitis Optica Spectrum Disorders.

Ann Indian Acad Neurol 2019 Oct-Dec;22(4):389-394. Epub 2019 Oct 25.

Department of Neurology, SMS Medical College, Jaipur, Rajeshthan, India.

Background And Aims: Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disorder of central nervous system with deleterious effects. At present Intravenous corticosteroids are used for the relapse as the first line of treatment, but with only a class evidence III-IV. Having an underlying humoral immune mechanism in the pathogenesis of NMOSD and as it is rightly said that "Time is Cord and Eyes", delaying the time to start plasma exchange (PLEX) awaiting favorable outcome in response to corticosteroids is detrimental for the patient. Hence, PLEX may be a promising first line therapeutic approach in the management of severe attacks of NMOSD. The aim of this study is to evaluate the efficacy of PLEX as the first line of treatment for the acute attacks in patients with NMOSD that is being largely used as an add-on therapy for more than 10 years, and also to define the time opportunity window for the starting of PLEX.

Methods: The study analysed the therapeutic efficacy and safety profile of PLEX as a first line therapy in 30 patients diagnosed with NMOSD over a period of 30 months. PLEX was performed using a Hemonetics Mobile Collection System plus machine with due written consent including the risks and benefits of the treatment that is being proposed to the patient/relative in their own language.

Results: A total of 30 patients were analysed, out of which 16 were females and rest males. 85% of the patients were in the age group of 25-35 years. All the patients had severe Expanded Disability Status Scale (EDSS) scores at the baseline, and 73.33% showed significant improvement following PLEX. The only predictor of good outcome was the time to PLEX i.e shorter delay betters the outcome.

Conclusion: The study ascertained the importance of early PLEX as a therapeutic intervention in severe attacks of NMOSD irrespective of their Anti-Aquaporin 4 (AQP4) antibody status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/aian.AIAN_365_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839304PMC
October 2019

Neonatal monitoring during delivery room emergencies.

Semin Fetal Neonatal Med 2019 12 14;24(6):101040. Epub 2019 Oct 14.

University of Miami Miller School of Medicine, United States. Electronic address:

Fetal to neonatal transition after birth is a complex, well-coordinated process involving multiple organ systems. Any significant derangement in this process increases the risk of death and other adverse outcomes, underlying the importance of continuous monitoring to promptly detect and correct these derangements by effective resuscitative support. In recent years, there has been increasing efforts to move from subjective and discontinuous monitoring to more objective and continuous monitoring of different physiological parameters. Some of them like pulse oximetry for arterial oxygen saturation and electrocardiography for heart rate monitoring are now part of resuscitation guidelines whereas others like respiratory function monitoring, near infrared spectroscopy, or amplitude integrated electroencephalography are being evaluated. In this review, we describe some of the physiological parameters that can be monitored during delivery room emergencies and review the evidence for some of the monitoring technologies currently being evaluated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.siny.2019.101040DOI Listing
December 2019

Loss of ZnT8 function protects against diabetes by enhanced insulin secretion.

Nat Genet 2019 11 1;51(11):1596-1606. Epub 2019 Nov 1.

Oxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, UK.

A rare loss-of-function allele p.Arg138* in SLC30A8 encoding the zinc transporter 8 (ZnT8), which is enriched in Western Finland, protects against type 2 diabetes (T2D). We recruited relatives of the identified carriers and showed that protection was associated with better insulin secretion due to enhanced glucose responsiveness and proinsulin conversion, particularly when compared with individuals matched for the genotype of a common T2D-risk allele in SLC30A8, p.Arg325. In genome-edited human induced pluripotent stem cell (iPSC)-derived β-like cells, we establish that the p.Arg138* allele results in reduced SLC30A8 expression due to haploinsufficiency. In human β cells, loss of SLC30A8 leads to increased glucose responsiveness and reduced K channel function similar to isolated islets from carriers of the T2D-protective allele p.Trp325. These data position ZnT8 as an appealing target for treatment aimed at maintaining insulin secretion capacity in T2D.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41588-019-0513-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858874PMC
November 2019

Extracellular matrix and biomimetic engineering microenvironment for neuronal differentiation.

Neural Regen Res 2020 Apr;15(4):573-585

Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada.

Extracellular matrix (ECM) influences cell differentiation through its structural and biochemical properties. In nervous system, neuronal behavior is influenced by these ECMs structures which are present in a meshwork, fibrous, or tubular forms encompassing specific molecular compositions. In addition to contact guidance, ECM composition and structures also exert its effect on neuronal differentiation. This short report reviewed the native ECM structure and composition in central nervous system and peripheral nervous system, and their impact on neural regeneration and neuronal differentiation. Using topographies, stem cells have been differentiated to neurons. Further, focussing on engineered biomimicking topographies, we highlighted the role of anisotropic topographies in stem cell differentiation to neurons and its recent temporal application for efficient neuronal differentiation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/1673-5374.266907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6975142PMC
April 2020

DIFFERENT SCORING SYSTEMS IN ACUTE ALCOHOLIC PANCREATITIS: WHICH ONE TO FOLLOW? AN ONGOING DILEMA.

Arq Gastroenterol 2019 30;56(3):280-285. Epub 2019 Sep 30.

Pt B D Sharma University of Health Sciences Rohtak, Department of Pathology, Haryana, India.

Background: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle's tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject.

Objective: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis.

Methods: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients.

Results: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions.

Conclusion: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/S0004-2803.201900000-53DOI Listing
December 2019

Use of a Mechanical Ventilator with Respiratory Function Monitoring Provides More Consistent Ventilation during Simulated Neonatal Resuscitation.

Neonatology 2020 8;117(2):151-158. Epub 2019 Oct 8.

Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA.

Introduction: Positive pressure ventilation (PPV) with T-Piece and self-inflating bag (SIB) during neonatal resuscitation after birth is associated with variability in ventilation. The use of a ventilator with respiratory function monitoring (RFM) for PPV, however, has not been evaluated.

Objective: To determine if ventilator + RFM can reduce ventilation variability compared to T-Piece and SIB in a preterm manikin at different combinations of target tidal volume (VT) and lung compliance (CL).

Methods: Twenty clinicians provided PPV via mask and endotracheal tube (ETT) using SIB, T-Piece, T-Piece + RFM and Ventilator + RFM to a manikin with adjustable lung CL. Three combinations of CL and target VT: Low CL-Low VT, Low CL-High VT and High CL-Low VT were used in a random order.

Results: The use of ventilator + RFM for PPV via ETT during High CL-Low VT period reduced the proportion of breaths with expiratory VT above target when compared to the other 3 devices (56 ± 35%, 85 ± 20%, 90 ± 25%, 92 ± 12% for ventilator + RFM, T-Piece + RFM, T-Piece, SIB, respectively; p < 0.05). During PPV via both mask and ETT, ventilator + RFM maintained the set Ti and rate, whereas SIB and T-Piece use resulted in higher rates, and T-Piece in higher proportion of breaths with prolonged Ti. During PPV via mask, ventilator + RFM reduced gas leakage compared to other devices.

Conclusion: In this simulation study, use of a mechanical ventilator with RFM led to an overall improvement in volume targeting at different settings of CL and reduced the gas leak during mask ventilation. The efficacy and safety of using this strategy to neonatal resuscitation in the delivery room needs to be evaluated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000503257DOI Listing
August 2021

Comparative Evaluation of Continuous Veno-venous Hemodiafiltration and Continuous Arterio-Venous Hemodiafiltration in Patients of Hepatic Failure and / or Hepatorenal Syndrome.

J Assoc Physicians India 2019 Aug;67(8):39-42

Associate Professor, Department of Medicine and Division of Nephrology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana.

Objectives: Continuous renal replacement therapies (CRRT) are the most favoured form of renal replacement therapies (RRT) in patients of decompensated liver cirrhosis and hepatorenal syndrome (HRS). The role of CRRT has been limited only to acute kidney injury and HRS in prior studies. We therefore aimed to evaluate the role of two different modes of CRRT- CVVHDF and CAVHDF in patients of hepatic failure and / or hepatorenal syndrome in reducing hyperbilirubinemia, uremia and fluid overload.

Methods: 30 critically ill patients of hepatic failure and /or HRS were randomly divided into two groups of 15 cases each. Group A patients received continuous veno-venous hemodiafiltration (CVVHDF), whereas group B patients underwent continuous arterio-venous hemodiafiltration (CAVHDF). The inclusion criteria were hepatic failure and / or hepatorenal syndrome (HRS) with hyperbilirubinemia and fluid overload in hemodynamically unstable patients, who were unfit for conventional hemodialysis.

Results: Despite hemodynamic fragility of the subjects, both the procedures were effective in achieving biochemical and clinical improvements. There was a significant fall in blood urea, serum creatinine and serum bilirubin at the end of procedures. After mean 27.32 h of CVVHDF and 27.02 h of CAVHDF, blood urea decreased to 39.54 ± 28.6 mg/dl and 45.11 ± 31.9 mg/dl in respective groups. Serum bilirubin decreased to 7.01 ± 6.4 mg/dl and 3.21 ± 1.99 mg/dl in group A and B. All the patients had gradual and steady improvement in pH and bicarbonate concentration towards normal. Urea clearance was 24.98 ± 1.09 ml/min and 22.72 ± 1.58 ml/min respectively in the two groups, whereas bilirubin clearance was 27.77 ± 1.38 ml/min and 28.74 ± 0.3 ml/min in group A and B respectively. Ultrafiltration rate had mean value of 141.66 ± 22.33 ml/h in group A and 134.26 ± 38.71 ml/h in group B. Both the modes of CRRT were well tolerated without any new episodes of hypotension secondary to the procedures and requirement of inotropes didn't change significantly. Symptomatic relief and improvement in clinical and biochemical parameters were observed in all the cases. There were no significant differences between the results of two groups. Complication rate was less and survival was 30%.

Conclusion: Continuous hemodiafiltration is probably the best available modality of CRRT to treat hemodynamically unstable and critically ill patients of hepatic failure and/ or hepatorenal syndrome and it should be advocated more frequently.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2019

Bulk and surface DFT investigations of inorganic halide perovskites screened using machine learning and materials property databases.

Phys Chem Chem Phys 2019 Sep 28;21(35):19423-19436. Epub 2019 Aug 28.

TCS Research, Tata Research Development and Design Center, 54-B Hadapsar Industrial Estate, Hadapsar, Pune - 411013, Maharashtra, India.

In the recent past, there has been proliferation in high-throughput density functional theory and data-driven explorations of materials motivated by a need to reduce physical testing and costly computations for materials discovery. This has, in conjunction with the development of open-access materials property databases, encouraged accelerated and more streamlined discovery and screening of technologically relevant materials. In this work, we report our results on the screening and DFT studies of one such class of materials, i.e. ABX inorganic halide perovskites (A, B and X representing the monovalent, divalent and halide ions respectively) using a coupled machine-learning (ML) and density functional theory (DFT) approach. Utilizing the support vector machine algorithm, we predict the formability of 454 inorganic halide compounds in the perovskite phase. Compounds with a formation probability P≥ 0.8 are further checked for thermodynamic stability in at least one of these three open materials databases - Materials Project (MP), Automatic FLOW for Materials Discovery (AFLOW) and Open Quantum Materials Database (OQMD). The shortlisted candidate perovskites are then considered for DFT computations. Taking input geometries from MP's structure predictor, the optimized lattice parameters and computed band gaps (BG) for all screened compounds are compared with predictions across all databases. Subsequently, detailed studies on low index surfaces are presented for two halide perovksites - RbSnCl and RbSnBr- having band-gaps in the favourable range for photovoltaics (PV). Different possible (100), (110) and (111) surface terminations are investigated for each of these compositions and the atomic relaxations, surface energies and electronic band structures are reported for each termination. To the best of our knowledge, no surface studies have been reported in the literature for any of the halide perovskites present in our database. These studies, therefore, are an important step towards gaining a fundamental understanding of the interfacial properties of perovskites, which can help facilitate further breakthroughs in the PV technology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1039/c9cp03240aDOI Listing
September 2019

Role of Hepcidin in Heart Failure with Iron Deficiency - Deception or Disposition.

J Assoc Physicians India 2019 Apr;67(4):53-56

Associate Professor, Department of Medicine and Division of Nephrology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana.

Introduction: Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients.

Material And Methods: This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care centre in North India. Patients on intravenous iron, erythropoietin stimulating agents or other phosphate binders were excluded from the study. All the patients were given tablet ferric citrate (each tablet containing ferric citrate 1.1 gm equivalent to ferric iron 210 mg) in a dose of 3 tablets per day for three months. Patients were followed up at two weekly intervals and relevant investigations were done. They were divided into three groups according to their CKD stages for subgroup analysis.

Observations: After three months of therapy with ferric citrate there was a significant decrease in mean serum phosphate from 6.55±0.70 mg/dl at baseline to 4.36±0.50 mg/dl at the end of three months (p<0.001). Mean hemoglobin increased from 7.92±1.05 g/dl at baseline to 10.96±1.04 g/dl at the end of three months (p<0.001). Serum ferritin and serum transferrin saturation increased from 278.25±110.56 ng/dl, 25.02±4.03 % at baseline to 401.24±152.47 ng/dl and 29.62±3.77 % at the end of three months. The mean serum vitamin D and serum iPTH levels, at baseline and at the end of 3 months were 14.61±10.80 ng/ml, 509.48±210.75 pg/ml and 23.65±14.00 ng/ml, 424.14±173.18 pg/ml respectively. The change in all these parameters were significant irrespective of the CKD stages.

Conclusion: The present study has shown that ferric citrate is an effective and well tolerated phosphate binder, which also significantly improves hematologic parameters in an iron deficient CKD patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2019

Role of Ferric Citrate in Hyperphosphatemia and Iron Deficiency Anemia in Non Dialysis CKD Patients.

J Assoc Physicians India 2019 Apr;67(4):53-56

Associate Professor, Department of Medicine and Division of Nephrology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana.

Introduction: Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients.

Material And Methods: This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care centre in North India. Patients on intravenous iron, erythropoietin stimulating agents or other phosphate binders were excluded from the study. All the patients were given tablet ferric citrate (each tablet containing ferric citrate 1.1 gm equivalent to ferric iron 210 mg) in a dose of 3 tablets per day for three months. Patients were followed up at two weekly intervals and relevant investigations were done. They were divided into three groups according to their CKD stages for subgroup analysis.

Observations: After three months of therapy with ferric citrate there was a significant decrease in mean serum phosphate from 6.55±0.70 mg/dl at baseline to 4.36±0.50 mg/dl at the end of three months (p<0.001). Mean hemoglobin increased from 7.92±1.05 g/dl at baseline to 10.96±1.04 g/dl at the end of three months (p<0.001). Serum ferritin and serum transferrin saturation increased from 278.25±110.56 ng/dl, 25.02±4.03 % at baseline to 401.24±152.47 ng/dl and 29.62±3.77 % at the end of three months. The mean serum vitamin D and serum iPTH levels, at baseline and at the end of 3 months were 14.61±10.80 ng/ml, 509.48±210.75 pg/ml and 23.65±14.00 ng/ml, 424.14±173.18 pg/ml respectively. The change in all these parameters were significant irrespective of the CKD stages.

Conclusion: The present study has shown that ferric citrate is an effective and well tolerated phosphate binder, which also significantly improves hematologic parameters in an iron deficient CKD patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2019

Myelitis: A Rare Presentation of Epstein Barr Virus.

J Assoc Physicians India 2019 Mar;67(3):93-95

Assistant Professor, Department of Neurology, SMS Medical College, Jaipur, Rajasthan.

EBV associated nervous system complications includes encephalitis, meningitis, cerebellitis, polyradiculomyelitis, transverse myelitis, cranial and peripheral neuropathies, and psychiatric abnormalities are usually more commonly seen in immunocompromised patients and rarely in immunocompetent patients. Here we are reporting a 13 years old boy developed headache, malaise, sore throat and low back pain with radiation to both lower limbs. Next day he felt numbness below umbilicus followed by acute onset weakness in both lower limbs and urinary retention. Motor exam revealed proximal muscle power MRC grade 4/5 and distal power 1/5 in right lower limb and proximal power 4-/5 and distal power 0/5 in left lower limb with normal power in both upper limbs. Deep tendon reflexes were bilaterally normal except absent ankle reflexes. Both plantars were mute. All the modalities of sensation including pain, touch, temperature, joint position and vibration were impaired below umbilicus. Routine investigations were normal. The magnetic resonance imaging (MRI) of thoracic spine showed intramedullary lesion in conus, which was iso-hyperintense on T1-weighted and hyperintense on T2- weighted images extending from D12thoracic vertebral level to L1 with cord expansion (Figures 1, 2). The MRI features were suggestive of conus myelitis. Cerebrospinal fluid (CSF) analysis revealed increased protein, normal cells, glucose and Chloride. CSF Polymerase chain reaction (PCR) was positive for Epstein Barr virus . The clinical and imaging findings were consistent with the diagnosis of myelitis and responded well to steroid plus acyclovir treatment. The clinicians should be aware of such uncommon etiology of a common disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2019

New Developments in Respiratory Support for Preterm Infants.

Am J Perinatol 2019 07 25;36(S 02):S13-S17. Epub 2019 Jun 25.

Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.

The evolution of neonatal respiratory support has been one of the cornerstones for the advancements in neonatal-perinatal medicine, allowing survival of infants previously considered not viable. There is an increasing focus on developing strategies which are not only lifesaving but also minimize lung and other organ systems injury, thereby reducing long-term morbidities. Respiratory support immediately after birth is an area that had lagged behind in terms of evidence base and technological advancements until recently. Some of these advancements include use of a respiratory function monitors for measuring flow and tidal volume, new evidence for oxygen supplementation and monitoring, and the efforts to formulate an ideal strategy for establishing functional residual capacity after birth. Increasing evidence for the benefits of avoiding invasive ventilation on reduction of bronchopulmonary dysplasia has resulted in efforts to further reduce the need for endotracheal intubation by applying newer strategies such as less invasive surfactant instillation, noninvasive high-frequency oscillatory ventilation, or use of high flow nasal cannula oxygen. For infants requiring mechanical ventilation, newer strategies such as volume targeted ventilation or neurally adjusted ventilation are being evaluated to reduce ventilator induced lung injury. Despite these advances, there are significant challenges, including lack of conclusive evidence base for many of currently used respiratory strategies, no reduction in the incidence of bronchopulmonary dysplasia in the last decade, and difficulties in defining outcome measures that better reflect long-term respiratory health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1691817DOI Listing
July 2019

Functional outcome of open distal femoral fractures managed with lateral locking plates.

Int Orthop 2020 04 24;44(4):725-733. Epub 2019 May 24.

Department Of Orthopaedics, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, 141001, India.

Purpose: This prospective study evaluated the functional outcome and union rates of open distal femoral fractures managed with anatomic lateral locking plates.

Methods: Thirty-four patients with open distal femur fractures with mean age of 40.8 years (range 20-65 years) were included in the study. Patients with Gustilo-Anderson grade IIIC fractures and those managed with non-locking modalities were excluded. In total, 70.6% (n = 24) of the fractures were Type IIIA and 55.9% (n = 19) were AO/OTA Type C3 fractures. In 23.5% (n = 8) patients, knee spanning external fixator was applied initially before definitive fixation. Patients were followed up for a mean period of 11.6 months (range 8-22.5 months). Functional outcome was evaluated using Sanders Score.

Results: In the primary plating group, 69.2% (n = 18) fractures united at an average of 27 weeks (range 21-40 weeks), while eight patients had non-union and required bone grafting. All eight patients with external fixator underwent lateral locked plating with bone grafting and united at an average time of 39.6 weeks (range 31-50 weeks). There were two cases each of infection and screw failure. The final mean Sanders Score was 30.1 (range19-40) with 73.5% (n = 25) patients having good to excellent functional outcomes.

Conclusions: Lateral locking plates offer excellent stability to allow fracture union in open distal femoral fractures. A proactive approach to identify and manage potential healing difficulties is advisable to promote bone healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-019-04347-5DOI Listing
April 2020
-->