Human interaction in the NICU and its association with outcomes on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

BACKGROUND: Extremely preterm infants represent one of the highest risk categories for impairments in social competence. Few studies have explored the impact of the neonatal intensive care unit (NICU) environment on social development. However, none have specifically analyzed the effects of the care structure the infant receives during hospitalization on later social competence indicators. OBJECTIVE: To identify associations between the care structures received by extremely preterm infants in the NICU and scores on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) post-discharge. PARTICIPANTS: 50 extremely preterm infants (mean gestational age: 25 weeks during hospitalization; mean chronological age during follow-up assessment: 2 years, 4 months). METHODS: A secondary analysis of BITSEA data was performed exploring its relation to care structure data we extracted from electronic medical records (i.e., how much time infants were engaged in human interaction during their first thirty days of hospitalization and what types of interaction they were exposed to). RESULTS: Extremely preterm infants spend a considerable amount of time alone during hospitalization (80%) with nursing care comprising the majority of human interaction. Infants who experienced greater human interaction scored significantly higher on the Social Competence (p = 0.01) and lower on the Dysregulation (p = 0.03) BITSEA subscales. CONCLUSION: Human interaction and isolation in the NICU is associated with social competence and dysregulation outcomes in extremely preterm infants. Further research is needed to understand how various NICU care structures including centralized nursing teams, parental skin-to-skin care, and early therapy may synergistically play a positive role in developing social competence.

Denosumab in advanced/unresectable giant-cell tumour of bone (GCTB): For how long?

BACKGROUND: Giant-cell tumours of bone (GCTB) are RANK/RANK-ligand (RANKL) positive, aggressive and progressive osteolytic tumours. Denosumab, a RANKL inhibitor, was FDA-approved for adults and skeletally mature adolescents with unresectable GCTB or when surgical resection is likely to result in severe morbidity. Data on long-term toxicity and activity of denosumab monthly 'GCTB-schedule' (120 mg per 12/year, 1440 mg total dose/year) are lacking. METHODS: Patients with GCTB receiving denosumab, 120 mg on days 1, 8, 15, 29 and every 4 weeks thereafter, from 2006 to 2015 treated in two centres were included. Long-term toxicity was evaluated. RESULTS: Ninety-seven patients were identified. 43 patients underwent resection of the tumour with a median time on denosumab treatment of 12 months (range 6-45 months). Fifty-four patients had unresectable GCTB's (male/female 23/31, median age 35 years [range: 13-76 years], 26% presented with lung metastases, 31% had primary tumor located to the spine, 63% were relapsed after previous surgery) with a median time on denosumab of 54 months (9-115 months). In the unresectable GCTB group, tumour control and clinical benefits were observed in all patients undergoing denosumab, whereas 40% of patients discontinuing denosumab had tumour progression after a median of 8 months (range 7-15 months). ADVERSE EVENTS: Overall, six (6%) patients developed osteonecrosis of jaw (ONJ): 1/43 (2%) in the resectable group, 5/54 (9%) in the unresectable group, with a 5-year ONJ-free survival of 92% (95% CI 84-100). Only patients with prolonged treatment experienced mild peripheral neuropathy (6/54, 11%), skin rash (5/54, 9%), hypophosphataemia (2/54, 4%) and atypical femoral fracture (2/54, 4%). CONCLUSIONS: Prolonged treatment with denosumab has sustained activity in GCTB, with a mild toxicity profile. The dose-dependent toxicity observed recommends a careful and strict monitoring of patients who need prolonged treatment. Decreased dose-intensity schedules should be further explored in unresectable GCTB.

Supra-aural gossypiboma: case report of a retained textile surgical sponge in an unusual location.

Gossypiboma or retained surgical sponge is an infrequently encountered surgical complication, more so in the head and neck region. A literature search did not reveal a previously reported case of retained or concealed surgical sponge after microscopic ear surgery. We present a unique and previously unreported case of a 25-year-old male who presented with a cystic swelling in the right supra-aural region 5 months post-modified radical mastoidectomy of the right ear. Surgical excision of the swelling revealed a retained surgical sponge. We emphasise the importance of counting surgical sponges after every surgical step to minimise the incidence of such retained surgical items.

Atypical Presentations of Melioidosis in North India: Report of Two Cases.

Melioidosis is an infection caused by Gram-negative bacterium, Burkholderia pseudomallei. This is a rare disease in India, more so in North India. We present two cases of melioidosis with unusual sites of infection. The first patient was a young diabetic male presenting to us with history of prolonged fever and upper abdominal discomfort, subsequently diagnosed as a case of pyogenic liver abscess. The second patient was a middle aged diabetic complaining of prolonged fever and headache and found to have right frontal lobe brain abscess.The pus cultured from the lesion in both cases showed growth of Burkholderia pseudomallei. These two cases are described to consider melioidosis as a differential diagnosis amongst pyrexia of unknown origin cases.

An in vitro comparison of detection methods for approximal carious lesions in primary molars.

BACKGROUND/AIMS: This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. METHODS: Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer's histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. RESULTS: This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. CONCLUSIONS: None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.

Bilateral fungiform papilloma with synchronous verrucous carcinoma of the nasal septum: a rare presentation and a literature review.

AIM: Fungiform papillomas are benign mucosal neoplasms presenting as a unilateral exophytic mass involving the anterior portion of the nasal septum. In this study, we present an exceptional case of a bilateral fungiform papilloma with a synchronous verrucous carcinoma of the nasal septum. MATERIAL AND METHODS: A case study with a review of the literature concerning malignant changes in fungiform papilloma. RESULTS: The general consensus in most of the literature is that malignant change in fungiform papilloma is exceptional. Our patient is probably the third reported case of verrucous carcinoma of the nasal septum, and the first report of a bilateral fungiform papilloma with a synchronous verrucous carcinoma. The tumour was subjected to complete surgical removal in the first instance. There was no recurrence at follow up seven months after surgery. CONCLUSION: Although fungiform papillomas are generally not premalignant, occasional malignant transformation may occur. Thus, they must be managed with the utmost cautiousness.

Nanomechanics of biocompatible TiO(2) nanotubes by Interfacial Force Microscopy (IFM).

Titanium dioxide (TiO(2)) coatings exhibit desirable properties as biocompatible coatings. In this paper we report on mechanical properties and deformation behavior of (TiO(2)) nanotubes grown on pure titanium substrates through anodic oxidation. Characterization of the as-processed coatings was conducted using scanning electron microscopy (SEM). Nanoindentation, using Interfacial Force Microscopy (IFM), was employed to probe the Young's modulus of the nanotubes. Using the IFM technique, the modulus of the nanotube coating may be measured with minimal contribution from the underlying Ti substrate. The modulus of the (TiO(2)) nanotube coating was estimated at 4-8 GPa. This technique was also used to study the inelastic deformation behavior of the nanotubes. (TiO(2)) nanotubes were found to inelastically deform by "tube crushing" in the immediate vicinity of indenter tip, increasing the local density. This increase in local density caused an increase in the Young's modulus from roughly 4 GPa to 30 GPa in the first 30 nm of indentation. Densification and the resulting increase in elastic modulus are related to the total work of inelastic deformation, irrespective of the loading history.

Countering imbalanced datasets to improve adverse drug event predictive models in labor and delivery.

BACKGROUND: The IOM report, Preventing Medication Errors, emphasizes the overall lack of knowledge of the incidence of adverse drug events (ADE). Operating rooms, emergency departments and intensive care units are known to have a higher incidence of ADE. Labor and delivery (L&D) is an emergency care unit that could have an increased risk of ADE, where reported rates remain low and under-reporting is suspected. Risk factor identification with electronic pattern recognition techniques could improve ADE detection rates. OBJECTIVE: The objective of the present study is to apply Synthetic Minority Over Sampling Technique (SMOTE) as an enhanced sampling method in a sparse dataset to generate prediction models to identify ADE in women admitted for labor and delivery based on patient risk factors and comorbidities. RESULTS: By creating synthetic cases with the SMOTE algorithm and using a 10-fold cross-validation technique, we demonstrated improved performance of the Naïve Bayes and the decision tree algorithms. The true positive rate (TPR) of 0.32 in the raw dataset increased to 0.67 in the 800% over-sampled dataset. CONCLUSION: Enhanced performance from classification algorithms can be attained with the use of synthetic minority class oversampling techniques in sparse clinical datasets. Predictive models created in this manner can be used to develop evidence based ADE monitoring systems.

Clinical studies on molar-incisor-hypomineralisation part 1: distribution and putative associations.

AIM: This was to describe the distributions of affected first permanent molars (FPMs) in a sample of children with molarincisor- hypomineralisation (MIH) and molar hypomineralisation (MH), and to examine their perinatal and medical histories for putative associations with molar hypomineralisation. STUDY DESIGN: A sample of 416 children aged 6-14 years with MIH or MH was identified from a specialist paediatric dental practice in Melbourne, Australia. METHODS: A questionnaire regarding perinatal and medical histories was sent to their parents/guardians; 182 (44%) useable questionnaires were returned and the dental records of these children were reviewed. RESULTS: The 182 dentitions were distributed as: MIH: 104; MH: 65; MIH* (permanent incisors unerupted): 13. These dentitions contained 720 FPMs; 429 FPMs were hypomineralised, distributed as: MIH: 282 FPMs; MH: 124 FPMs; MIH*: 23 FPMs. The 282 affected FPMs occurred in dentitions with MIH as: 1 FPM: 27%; 2 FPMs: 15%; 3 FPMs: 17%; 4 FPMs: 40% (mean 2.7 +/- 1.3 FPMs/dentition). The 124 affected FPMs occurred in dentitions with MH as: 1 FPM: 49%; 2 FPMs: 28%; 3 FPMs: 6%; 4 FPMs: 17% (mean 1.9 +/- 1.1 FPMs/dentition). The distribution of moderate to severe hypomineralisation in FPMs was: MIH: 89%; MH: 73%. Affected FPMs were similarly distributed between gender, quadrants and arches. At least one condition putatively associated with MIH/MH was seen in histories of 166 children (91%); ear infections, fevers, and perinatal conditions occurred in 53-66% of children. Frequent condition combinations were: ear infections + fevers (40% of children); antibiotics + ear infections (54%); antibiotics + other illnesses (56%). CONCLUSIONS: All four FPMs in a given dentition were more likely to be affected and to differing extents in MIH than in MH. Putative associations appear to exist between MIH/MH and combinations of antibiotic use, ear infections, fevers, perinatal conditions, and other illnesses in the child's first 3 years. It is proposed that MIH is a more severe form of the hypomineralisation condition than MH, forming an MIH spectrum.

Clinical studies on molar-incisor-hypomineralisation part 2: development of a severity index.

AIM: This was to examine the records of 182 children (aged 6-14 years) with molar-incisor-hypomineralisation (MIH) or molar hypomineralisation (MH) in order to develop and examine a Hypomineralisation Severity Index for first permanent molars (FPMs). STUDY DESIGN: Records of 429 FPMs in these children were examined and scored for eruption status, extent of hypomineralisation, sensitivity, number of restorative treatments; summed scores were converted to an index for each dentition (possible range: 1.25-7.00). Indices were examined regarding medical conditions occurring singly or in combinations in parentally-recalled children's histories to age 3 years; mean indices were compared for dentitions with these conditions/combinations. RESULTS: The proportion of FPMs receiving no/preventive treatment was higher in dentitions with MH than with MIH (56% vs. 41%); restorative treatment for FPMs was more frequent in dentitions with MIH than with MH (45% vs. 29%). Dentitions with MIH had higher severity indices than those with MH (MIH: index range: 3.25-5.25: 43%; MIH: index range: 1.25-2.00: 61%). Mean severity indices clearly had a higher trend in dentitions of children with certain condition combinations than for those without. Ten condition combinations each contained 3 to 5 medical conditions; 11/12 condition combinations included fevers; 9/12 included chicken pox; 9/12 included perinatal conditions, 6/12 included antibiotic use. CONCLUSIONS: A preliminary Hypomineralisation Severity Index developed for dentitions with hypomineralised first permanent molars in children has shown that MIH and MH form part of an MIH spectrum, where MIH is a more severe form of the condition than MH. The index has indicated associations between hypomineralisation of these molars and combinations of medical conditions, particularly implicating fevers, chicken pox, perinatal conditions and antibiotic use. Further clinical studies are indicated to validate the proposed index and confirm its prognostic value in treatment planning.

Pleural and transdiaphragmatic retroperitoneal metastasis developing two and half years after resection of invasive thymoma.

We report transdiaphragmatic pleural and retroperitoneal metastasis developing two and half years after resection of invasive thymoma (Masaoka stage III; WHO type B1, lymphocyte-rich) in a 34-year-old man. Post-surgery, he received radiotherapy and chemotherapy. Follow-up computed tomography (CT) one year post-surgery did not reveal any local recurrence or metastasis. He remained asymptomatic throughout. A follow-up CT done two and half years later revealed an enhancing retrocrural-retroperitoneal (posterior pararenal space) soft tissue mass measuring 12 cm x 10 cm x 6 cm. Another enhancing deposit was found in the left pleural space. This lesion was found infiltrating into the subjacent lung. Both these deposits were resected along with wedge resection of the affected subsegment of the lung. Histopathology confirmed these lesions to be metastases from the lymphocyte-rich thymoma.

PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals.

The present study evaluated whether Posttraumatic Stress Disorder (PTSD) symptom severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample. This study utilizes secondary data. The original study demonstrated that Vipassana meditation is associated with reductions in substance use. The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course. Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual, regardless of PTSD symptom severity levels. These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.

Microstructure and deformation behavior of biocompatible TiO2 nanotubes on titanium substrate.

Titanium oxide coatings have been shown to exhibit desirable properties as biocompatible coatings. We report on the quantitative microstructure characterization and deformation behavior of TiO(2) nanotubes on Ti substrate. Nanotubes were processed using anodic oxidation of Ti in a NaF electrolyte solution. Characterization of the as-processed coatings was conducted using scanning electron microscopy and focused ion beam milling. Increases in anodization time had no significant effect on tube diameter or tube wall thickness. Coating thickness, however, increased with time up to 2h of anodization, at which point an equilibrium thickness was established. Nanoindentation was used to probe the mechanical response in terms of Young's modulus and hardness. Progressively higher values of elastic modulus were obtained for thinner films consistent with increasing effects of the Ti substrate. A possible deformation mechanism of densification of the porous oxide and wear of the dense surface is suggested and discussed.

Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting.

OBJECTIVE: Breastfeeding initiation rates were compared at Boston Medical Center before (1995), during (1998), and after (1999) Baby-Friendly policies were in place. Boston Medical Center, an inner-city teaching hospital that provides care primarily to poor, minority, and immigrant families, achieved Baby-Friendly status in 1999. METHODS: Two hundred complete medical records, randomly selected by a computer, were reviewed from each of 3 years: 1995, 1998, and 1999. Infants were excluded for medical records missing feeding data, human immunodeficiency virus-positive parent, neonatal intensive care unit admission, maternal substance abuse, adoption, incarceration, or hepatitis C-positive mother. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: exclusive breast milk, mostly breast milk, mostly formula, and exclusive formula. RESULTS: Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rate increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Infants exclusively breastfed increased from 5.5% (1995) to 28.5% (1998) to 33.5% (1999). Initiation rates increased among US-born black mothers in this population from 34% (1995) to 64% (1998) to 74% (1999). CONCLUSIONS: Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.

Relationship between acute morphine and the course of PTSD in children with burns.

OBJECTIVE: To investigate the relationship between the dose of morphine administered during a child's hospitalization for an acute burn and the course of posttraumatic stress disorder (PTSD) symptoms over the 6-month period following discharge from the hospital. METHOD: Twenty-four children admitted to the hospital for an acute burn were assessed twice with the Child PTSD Reaction Index: while in the hospital and 6 months after discharge. The Colored Analogue Pain Scale was also administered during the hospitalization. All patients received morphine while in the hospital. The mean dose of morphine (mg/kg/day) was calculated for each subject through chart review. RESULTS: The Pearson product moment correlation revealed a significant association between the dose of morphine received while in the hospital and a 6-month reduction in PTSD symptoms. Children receiving higher doses of morphine had a greater reduction in PTSD symptoms over 6 months. CONCLUSIONS: This study suggests the possibility that acute treatment with morphine can secondarily prevent PTSD. This result is discussed in terms of the possible effect of morphine on fear conditioning and the consolidation of traumatic memory.

IMMUNOCHROMATOGRAPHIC TEST: A NEW DIMENSION IN DIAGNOSIS OF PLASMODIUM FALCIPARUM MALARIA.

75 patients with clinical features suggestive of malaria were studied to evaluate the efficacy of immunochromatographic test (ICT), which detects histidine rich protein-2 antigen secreted by Plasmodium falciparum (Pfhrp-2), as against direct microscopy. There were 40 cases of P falciparum malaria, 14 cases of P vivax malaria and 21 cases of non-malarial fevers. Direct microscopy could detect 27(67.5%) P falciparum cases but failed to detect 13 cases (32.5%) whereas ICT could detect 35(87.5%) P falciparum cases out of 40 but failed to detect 5(12.5%) cases. All the P vivax cases and non-malarial fever cases were negative for ICT. The sensitivity and specificity of ICT is 87.5% and 100% respectively where as the positive predictive value and the negative predictive value of the test is 100% and 87.5% respectively. It is concluded that ICT test is a good adjunct to blood smear studies in fever cases with neurological and multiorgan dysfunction and in antenatal ladies.