Consensus Statement of the IAP - Neurodevelopmental Chapter On Neurodevelopmental Disorders Habilitation Process: Strategic Plan for Prevention, Early Detection and Early Intervention.

JUSTIFICATION: Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders. PROCESS: Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors. OBJECTIVES: These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor. STATEMENT: There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/ NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs) / district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations.

Red Herring in Orthopedics: A Case Report on Painful Os Vesalianum Pedis Masquerading as an Avulsion Fracture of 5th Metatarsal and Review of Literature.

Introduction: Os vesalianum pedis (OVP) is a rare accessory ossicle of the foot located proximal to the base of 5th metatarsal. It is usually asymptomatic but can mimic an avulsion fracture of proximal 5th metatarsal and is an infrequent cause of lateral foot pain. There have only been 11 cases of symptomatic OVP reported in the current literature. Case Report: Our patient, a 62-year-old male presented with lateral foot pain following an inversion injury of his right foot, with no history of any previous trauma. What was initially mistaken as an avulsion fracture of the 5th metacarpal base was later revealed to be an OVP on contralateral X-ray. Conclusion: Treatment is mostly conservative, but surgical excision can be done in cases following failed non-operative treatment. In the context of trauma, OVP must be differentiated from other causes of lateral foot pain such as Iselin's disease and avulsion fractures of base of 5th metatarsal. Understanding the various etiologies of the condition and what those etiologies are usually related to can help prevent unnecessary treatment.

Effect of supplementation of lysine producing microbes vis-a-vis source and level of dietary protein on performance and egg quality characteristics of post-peak layers.

AIM: The aim was to study the effect of supplementation of lysine producing microbes (LPM) as an in vivo source of lysine on performance and egg quality characters of post-peak layers. MATERIALS AND METHODS: BIS (1992) specified diets (except crude protein [CP] and lysine) were prepared using either soybean meal (SBM) or groundnut extractions (GNE) or sunflower extractions (SFE) with 16 and 15% CP resulting in six control diets. Further, each control diet was fortified with either synthetic lysine or LPM to meet BIS (1992) specified lysine requirement resulting in the set of 12 test diets. Each of the eighteen diets was offered to quadruplets groups of 4 post-peak (52 weeks) commercial laying hens in each. The trial lasted for 119 days. RESULT: The results revealed that the feed consumption and body weight changes and Roche yolk color and yolk index were significantly (p ≤ 0.05) different among different treatments. However, egg production, feed efficiency, egg weight, egg shape index, Haugh unit score, albumen index and shell thickness, and net returns remained non-significant (p ≤ 0.05) among different treatments. Among main factors, protein level (16% and 15% CP) made a significant (p ≤ 0.05) difference in egg production (79.6 and 75.1%) and feed efficiency (2.64 and 2.81 kg feed/kg egg mass, respectively). Among protein source GNE- and SFE-based diet fed groups showed significantly (p < 0.0%) higher feed consumption and body weight gain than SBM based diets fed birds. Yolk color (7.0, 7.3 and 7.3, respectively) and yolk index (0.40, 0.38 and 0.43, respectively) were significantly (p ≤ 0.05) different from the protein sources. CP level and Protein source interaction effects showed significant differences in albumen index and Haugh unit score. CONCLUSION: Optimum level of protein (16% CP) and GNE as a source of protein tended to be superior in increasing the performance and egg characteristics of post-peak layers and supplementation of lysine in either synthetic or LPM form found to be beneficial in optimizing their performance.

Characterization of a Reuterin-Producing Lactobacillus reuteri BPL-36 Strain Isolated from Human Infant Fecal Sample.

A reuterin (3-hydroxypropinaldehyde, 3-HPA)-producing isolate from a human infant fecal sample was identified as Lactobacillus reuteri BPL-36 strain. The organism displayed a broad-spectrum antimicrobial activity. The gene (gdh) encoding a glycerol dehydratase subunit was detected by PCR, thus confirming its reuterin-producing ability. Reuterin concentration of 89.63 mM/mL was obtained in the MRS-glycerol medium after 16 h of incubation at 37 °C. The reuterin concentration required to inhibit the growth of Pseudomonas aeruginosa, Escherichia coli O157: H7, Salmonella typhi, Staphylococcus aureus, and Listeria monocytogenes was found to be 1.0, 2.0, 2.0, 4.0, and 10.0 AU/mL, respectively. Antimicrobial efficiency test using BPL-36 cell-free supernatant co-incubated along with different test pathogens was done. Viability of all the tested pathogens decreased with increasing contact time with the cell-free supernatant. S. typhi was observed to be the most susceptible among the tested organisms, and the number of viable cells hugely declined as the contact with cell-free supernatant continued, resulting in a reduction of 6 log cycles (100 % inhibition) of the cells after 4 h of treatment. Production of biogenic amines and degradation of mucin by the reuterin-producing BPL-36 strain were not detected.

An investigation into the sorption of heavy metals from wastewaters by polyacrylamide-grafted iron(III) oxide.

An adsorbent for heavy metals was synthesized by introducing carboxylate functional group into polyacrylamide-grafted hydrous iron(III) oxide. The product exhibits a very high adsorption potential for Pb(II), Hg(II) and Cd(II). The removal of metal ions by adsorption on adsorbent has been found to be contact time, concentration, pH and temperature dependent. The process follows first-order reversible kinetics. The intraparticle diffusion of metal ions through pores in the adsorbent was shown to be the main rate-limiting step. The optimum pH range for the removal of metal ions was found to be 5.0-6.0. The thermodynamic parameters such as free energy change, enthalpy change and entropy change have been calculated to predict the nature of adsorption. The adsorption data were fitted using the Langmuir equation and maximum adsorption for each metal was estimated using their respective Langmuir equation constants. The method was applied for synthetic wastewaters. NaCl regeneration has been tried for several cycles with a view to recover the adsorbed metal ions and also to restore the sorbent to its original state.