Outcomes up to age 36 months after congenital Zika virus infection-U.S. states.

BACKGROUND: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Region-Dependent Mechanical Properties of Human Brain Tissue Under Large Deformations Using Inverse Finite Element Modeling.

This study aims to facilitate intracranial simulation of traumatic events by determining the mechanical properties of different anatomical structures of the brain. Our experimental indentation paradigm used fresh, post-operative human tissue, which is highly advantageous in determining mechanical properties without being affected by postmortem time. This study employed an inverse finite element approach coupled with experimental indentation data to characterize mechanical properties of the human hippocampus (CA1, CA3, dentate gyrus), cortex white matter, and cortex grey matter. We determined that an uncoupled viscoelastic Ogden constitutive formulation was most appropriate to represent the mechanical behavior of these different regions of brain. Anatomical regions were significantly different in their mechanical properties. The cortex white matter was stiffer than cortex grey matter, and the CA1 and dentate gyrus were both stiffer than cortex grey matter. Although no sex dependency was observed, there were trends indicating that male brain regions were generally stiffer than corresponding female regions. In addition, there were no statistically significant age dependent differences. This study provides a structure-specific description of fresh human brain tissue mechanical properties, which will be an important step toward explicitly modeling the heterogeneity of brain tissue deformation during TBI through finite element modeling.

Functionality Tuning in Hierarchically Engineered Magnetoelectric Nanocomposites for Energy-Harvesting Applications.

The ß-phase of the copolymer poly(vinylidene fluoride-trifluoroethylene) P(VDF-TrFE) possesses the highest dipole moment among all the functional polymers. It remains a key component of flexible energy-harvesting devices based on piezoelectricity and triboelectricity in the last decade. However, the quest for P(VDF-TrFE)-based magnetoelectric (ME) nanocomposites with enhanced ferroelectric, piezoelectric, and triboelectric properties remains elusive. The magnetostrictive inclusion in the copolymer matrix forms electrically conducting pathways and degrades ß-phase crystallinity significantly, deteriorating the functional properties of the nanocomposite films. To address this issue, we report the synthesis of magnetite (Fe3O4) nanoparticles on micron-scale magnesium hydroxide [Mg(OH)2] templates. These hierarchical structures were incorporated within the P(VDF-TrFE) matrix rendering composites with enhanced energy-harvesting capability. The Mg(OH)2 template prevents the formation of a continuous network of magnetic fillers, leading to lower electrical leakage in the composite. The addition of dual-phase fillers with 5 wt % only increases remanent polarization (Pr) values by ∼44%, owing to the presence of the ß-phase with significant crystallinity and increased interfacial polarization. The composite film exhibits a quasi-superparamagnetic nature and a significant magnetoelectric coupling coefficient (αME) of 30 mV/cm Oe. The film was also employed for triboelectric nanogenerator applications, exhibiting five times higher power density than the pristine film. We finally explored the integration of our ME devices with an internet of things platform to monitor the operational status of electrical appliances remotely. In light of these findings, the present work opens the path for future self-powered, multifunctional, and flexible ME devices with new application domains.

Zika-Associated Birth Defects Reported in Pregnancies with Laboratory Evidence of Confirmed or Possible Zika Virus Infection - U.S. Zika Pregnancy and Infant Registry, December 1, 2015-March 31, 2018.

Zika virus infection during pregnancy can cause serious birth defects of the brain and eyes, including intracranial calcifications, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities (1,2). The frequency of these Zika-associated brain and eye defects, based on data from the U.S. Zika Pregnancy and Infant Registry (USZPIR), has been previously reported in aggregate (3,4). This report describes the frequency of individual Zika-associated brain and eye defects among infants from pregnancies with laboratory evidence of confirmed or possible Zika virus infection. Among 6,799 live-born infants in USZPIR born during December 1, 2015-March 31, 2018, 4.6% had any Zika-associated birth defect; in a subgroup of pregnancies with a positive nucleic acid amplification test (NAAT) for Zika virus infection, the percentage was 6.1% of live-born infants. The brain and eye defects most frequently reported included microcephaly, corpus callosum abnormalities, intracranial calcification, abnormal cortical gyral patterns, ventriculomegaly, cerebral or cortical atrophy, chorioretinal abnormalities, and optic nerve abnormalities. Among infants with any Zika-associated birth defect, one third had more than one defect reported. Certain brain and eye defects in an infant might prompt suspicion of prenatal Zika virus infection. These findings can help target surveillance efforts to the most common brain and eye defects associated with Zika virus infection during pregnancy should a Zika virus outbreak reemerge, and might provide a signal to the reemergence of Zika virus, particularly in geographic regions without ongoing comprehensive Zika virus surveillance.

Region-Dependent Viscoelastic Properties of Human Brain Tissue Under Large Deformations.

This study characterizes the mechanical properties of human brain tissue resected during the course of surgery under multistep indentation loading up to 30% strain. The experimental characterization using fresh, post-operative, human brain tissue is highly advantageous since postmortem times can affect its biomechanical behavior. Although the quasilinear theory of viscoelasticity (QLV) approach has been widely used to model brain tissue mechanical properties, our analysis concluded that the linear viscoelastic approach provided a better fit to the experimental data overall. The only statistically significant regional difference in observed stiffness was between the cortex gray and dentate gyrus. There were no statistically significant age or sex dependent differences, although the data suggested that the cortex white matter in males was stiffer than that in females. Our results can help improve the accuracy of finite element models of brain tissue deformation to predict its response to traumatic brain injury.

Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes.

BACKGROUND: Measuring the appropriateness of antibiotic prescribing in nursing homes remains a challenge. The revised McGeer criteria, which are widely used to conduct infection surveillance in nursing homes, were not designed to assess antibiotic appropriateness. The Loeb criteria were explicitly designed for this purpose but are infrequently used outside investigational studies. The extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes remains insufficiently studied. METHODS: We conducted a cross-sectional chart review study in 5 Wisconsin nursing homes and applied the revised McGeer and Loeb criteria to all nursing home-initiated antibiotic treatment courses. Kappa (κ) statistics were employed to assess level of agreement overall and by treatment indications. RESULTS: Overall, 734 eligible antibiotic courses were initiated in participating nursing homes during the study period. Of 734 antibiotic courses, 372 (51%) satisfied the Loeb criteria, while only 211 (29%) of 734 satisfied the revised McGeer criteria. Only 169 (23%) of 734 antibiotic courses satisfied both criteria, and the overall level of agreement between them was fair (κ = 0.35). When stratified by infection type, levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections (κ = 0.45), fair for skin and soft-tissue infections (0.36), and slight for respiratory tract infections (0.17). CONCLUSIONS: Agreement between the revised McGeer and Loeb criteria is limited, and nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes. Studies to establish the best method for ongoing monitoring of antibiotic appropriateness in nursing homes are needed.

Knowledge, attitude, and implementation of nicotine replacement therapy by dental and medical interns in Davangere city: A cross-sectional survey.

BACKGROUND: One of the prime causes of illness and premature death is smoking. Almost 50% of smokers attempt to quit the habit; however, at most, 2%-3% achieve success. The rationale is that innumerable withdrawal attempts are unplanned, and the most effective cessation aids are unacquainted. Nicotine replacement therapy (NRT) is the most common cessation aid. Furthermore, motivation from dental and medical professionals can be effective for patients to quit smoking. The study aimed to assess the knowledge, attitude, and practice regarding the implementation of NRT among dental and medical interns in Davangere city. MATERIALS AND METHODS: A questionnaire-based survey was conducted, which included 442 dental and medical interns from two dental and two medical colleges in Davangere city, Karnataka. The questionnaire included multiple-choice questions regarding knowledge, attitude, and implementation of NRT. The response rate of interns was 93.67%. RESULTS: Among dental and medical interns, there was no statistically significant difference in knowledge about NRT with P = 0.976 (P > 0.05). However, a statistically significant difference existed regarding attitude and implementation in the interns about NRT among dental and medical interns with P = 0.001 (P < 0.05). Among dental and medical interns, dental interns had a positive attitude and implementation toward NRT than medical interns. CONCLUSION: The overview implicated that the dental interns had better vision than medical interns; however, both the groups' comprehension concerning NRT is scanty and advocates education about the fundamentals of NRT either via workshop or by continuing dental education programs.

Attenuation of Hemodynamic Responses to Endotracheal Extubation with Different Doses of Diltiazem with Lignocaine: A Placebo-Controlled Study.

INTRODUCTION: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate (HR) due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a sodium channel blocker, attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a calcium channel blocker, attenuates hemodynamic response by blocking voltage-sensitive L type channels and inhibiting calcium entry-mediated action potential in smooth and cardiac muscle. AIMS AND OBJECTIVES: The aims and objectives of this are to study and to compare the efficacy of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v. lidocaine 1.0 mg/kg, diltiazem 0.2 mg/kg and lidocaine 1.0 mg/kg, lignocaine 1.0 mg/kg with normal saline given to attenuate exaggerated hemodynamic extubation responses and airway reflexes during extubation. MATERIALS AND METHODS: This study was undertaken with 105 patients belonging to the age group 20-65 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and preservative-free lignocaine 1 mg/kg. Group B received injection diltiazem 0.2 mg/kg and lignocaine 1 mg/kg. Group C received injection lignocaine 1 mg/kg with normal saline. In this study group, the drug dosage was fixed based on the previous studies. RESULTS: At postextubation, significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were observed from 1 to 10 min between three groups. The difference in HR, SBP, DBP, and MAP were statistically significant between Group C in comparison with Group A and Group B from 1 min postextubation to 10 min. CONCLUSION: Combined diltiazem and lidocaine are more effective prophylaxis than lidocaine alone for attenuating the cardiovascular responses to tracheal extubation.

Regional mechanical properties of human brain tissue for computational models of traumatic brain injury.

To determine viscoelastic shear moduli, stress relaxation indentation tests were performed on samples of human brain tissue resected in the course of epilepsy surgery. Through the use of a 500µm diameter indenter, regional mechanical properties were measured in cortical grey and white matter and subregions of the hippocampus. All regions were highly viscoelastic. Cortical grey matter was significantly more compliant than the white matter or hippocampus which were similar in modulus. Although shear modulus was not correlated with the age of the donor, cortex from male donors was significantly stiffer than from female donors. The presented material properties will help to populate finite element models of the brain as they become more anatomically detailed. STATEMENT OF SIGNIFICANCE: We present the first mechanical characterization of fresh, post-operative human brain tissue using an indentation loading mode. Indentation generates highly localized data, allowing structure-specific mechanical properties to be determined from small tissue samples resected during surgery. It also avoids pitfalls of cadaveric tissue and allows data to be collected before degenerative processes alter mechanical properties. To correctly predict traumatic brain injury, finite element models must calculate intracranial deformation during head impact. The functional consequences of injury depend on the anatomical structures injured. Therefore, morbidity depends on the distribution of deformation across structures. Accurate prediction of structure-specific deformation requires structure-specific mechanical properties. This data will facilitate deeper understanding of the physical mechanisms that lead to traumatic brain injury.

Comparative clinical evaluation of glycosylated haemoglobin level in healthy and chronic periodontitis patients: A chairside diagnostic method.

OBJECTIVE AND BACKGROUND: Glycosylated haemoglobin (HbA1c) level can consequently be interpreted as an average of the blood glucose present over the past 3-4 months. Periodontitis is associated with glycemic control in patients with diabetes. The purpose of this study was to determine the level of HbA1c in healthy and periodontitis patients who were previously not diagnosed with diabetes mellitus. MATERIALS AND METHODS: A total of 40 patients were selected for study and divided into two groups. Group 1 included patients with a healthy periodontium, and Group 2 included patients suffering from chronic periodontitis. Finger stick blood was collected by special collection unit (A1CNOW+® Bayer Health Care, Tarrytown New York, USA), for estimating level of HbA1c. RESULT: Both groups showed similar HbA1c levels clinically with slight increase in levels in the test group, but was statistically significant (test--5.66 ± 0.35%, control--5.17 ± 0.3% P = 0.003). CONCLUSION: Indians are at a high-risk of developing periodontitis and diabetes. These data suggest a possible link between periodontitis and glycemic control in nondiabetic individuals, periodontal disease may be a potential contributor to the development of type 2 diabetes.

Prevalence of gingival biotype and its relationship to clinical parameters.

INTRODUCTION: The dimensions of gingiva and different parts of the masticatory mucosa have a profound impact in periodontics as it governs the way; the gingival tissue reacts to various physical, chemical, or bacterial insults. The purpose of the following study was to assess the gingival thickness (GT) and correlate it to gender, presence of recession, and width of keratinized gingiva (WKG) in a subset of the Indian population. METHODS: A total of 400 subjects in the age range of 20-35 years (200 males and 200 females) were included in the study. Clinical parameters such as probing depth, recession depth, WKG, and GT were recorded for all the patients. RESULTS: The prevalence of thin biotype was 43.25%, and that of thick gingival biotype was 56.75%. The mean GT of central incisor, lateral incisor, and canine in Group I was 1.11 ± 0.17, 1.01 ± 0.16, and 0.82 ± 0.17 mm, respectively. No significant association was observed between the gender and the presence of gingival recession to GT. The mean WKG of central incisor, lateral incisor, and canine in Group I was 4.38 ± 1.18, 5.18 ± 1.25, 4.16 ± 1.16 mm, respectively. A positive correlation exists between WKG and the GT (P < 0.05). CONCLUSION: It was concluded that the prevalence of thick and thin gingival biotype is 56.75% versus 43.25%, respectively, and there is no significant relationship between age, gender, and the presence of recession to gingival biotype. A positive correlation exists between WKG and the GT.

Crystal structure of 2-phenyl-ethanaminium 3-carb-oxy-prop-2-enoate.

The title mol-ecular salt, C8H12N(+)·C4H3O4 (-), crystallized with two independent cations and anions in the asymmetric unit. The ethanaminium side chains of the cations exhibit anti conformations [C-C-C-N torsion angles = 176.5 (3) and -179.4 (3)°]. In the crystal, N-H⋯O and C-H⋯O hydrogen bonds connect adjacent anions and cations, and , O-H⋯O hydrogen bonds connect adjacent anions, generating sheets parallel to (001).

Synthesis, growth, structural, thermal and optical studies of pyrrolidinium-2-carboxylate-4-nitrophenol single crystals.

Organic nonlinear optical material, pyrrolidinium-2-carboxylate-4-nitrophenol (PCN) was synthesized and single crystals were grown by slow evaporation solution growth method. Single crystal X-ray diffraction analysis confirmed the structure and lattice parameters of PCN crystals. Infrared, Raman and NMR spectral analyses were used to elucidate the functional groups present in the compound. The thermal behavior of synthesized compound was studied by thermogravimetric and differential scanning calorimetry (TG-DSC) analyses. The photoluminescence property was studied by exciting the crystal at 360 nm. The relative second harmonic generation (SHG) efficiency of grown crystal was estimated by using Nd:YAG laser with fundamental wavelength of 1,064 nm.

Occupational stress and health-related quality of life among public sector bank employees: A cross-sectional study in Mysore, Karnataka, India.

BACKGROUND: Occupational morbidities have been estimated to cause an economic loss up to 10-20% of the gross national product of a country. It is an important cause of occupational morbidity and decreased quality of life (QOL) for the workers. AIM: The aim of the present study is to assess the level of occupational stress and its association with the QOL among the public sector bank employees. MATERIALS AND METHODS: The present study was conducted among employees of public sector banks in Mysore district, Karnataka, India. A cross-sectional study design was used for the study. Job stress was measured by using occupational stress index (OSI) scale questionnaire and health-related QOL was measured using the short form 12 (SF-12) questionnaire. The sample size estimated for the study was 526 and cluster random sampling technique was used. Chi-square test was used to find the association between the study variables and level of stress. Multiple linear regression model was used to find the determinants of health-related QOL among the study subjects. RESULTS: The total number of the study subjects was 546 out of which 57% were males and 43% were females. The proportion of study subjects reporting to be current smokers was 4.2% and almost all study subjects reported occasional alcohol consumption. The mean physical component summary (PCS) score and mental component summary (MCS) using the original United States standardization were 47.90 and 48.30, respectively. The individuals with mild stress scored higher in both PCS and MCS than the individuals who had moderate to severe stress levels. There was significant association of health related quality of life with the age of the respondent,presence of at least one morbidity and level of stress with health-related QOL. CONCLUSION: This study has shown an association of occupational stress with the QOL. There is a need for interventions aimed at mitigating the occupational stress among employees of the banking sector.

Amnion membrane for coverage of gingival recession: A novel application.

INTRODUCTION: Amnion allograft has been used in the field of medicine for its exceptional wound-modulating properties. However, in the field of dentistry, only a limited number of reports have explored its potential in healing of oral wounds. MATERIALS AND METHODS: Amnion allograft in conjunction with coronally advanced flap has been used in the management of gingival recession. RESULTS: A complete coverage along with excellent esthetics and an improvement in gingival biotype was observed at 6 months postoperatively. DISCUSSION: Because of its inherent wound-modulating properties, amnion allograft may be used to enhance periodontal wound healing and enable tissue regeneration such as that in the coverage of gingival recession. CONCLUSION: Amnion allograft may provide an alternative to other conventional methods of treating gingival recession.

Crystal structure of piperidinium 4-nitro-phenolate.

In the title mol-ecular salt, C5H12N(+)·C6H4NO3 (-), the piperidine ring adopts a chair conformation and the cation is protonated at the N atom. In the anion, the nitro group is twisted at an angle of 10.30 (11)° with respect to the attached benzene ring. In the crystal, N-H⋯O hydrogen bonds link adjacent anions and cations into infinite chains propagating along [100]. The chains are linked by C-H⋯π inter-actions, forming sheets lying parallel to (001).

Crystal structure of 2-phenyl-ethyl-amin-ium 4-nitro-phenolate monohydrate.

In the title hydrated mol-ecular salt, C8H12N(+)·C6H4NO3 (-)·H2O, the conformation of the side chain in the cation is anti [C-C-C-N = 179.62 (12)°] and the dihedral angle between the aromatic ring and the nitro group in the anion is 3.34 (11)°. In the crystal, the components are linked by O-H⋯O and N-H⋯O hydrogen bonds, generating (10-1) sheets, which feature R 4 (4)(21) loops. The sheets inter-act by weak aromatic π-π stacking inter-actions [centroid-centroid distance = 3.896 (3) Å], forming a three-dimensional network.

Rapid and simple DNA extraction method for the detection of enterotoxigenic Staphylococcus aureus directly from food samples: comparison of PCR and LAMP methods.

AIMS: The study describes the development of simple and rapid DNA extraction method in combination with loop-mediated isothermal amplification (LAMP) to detect enterotoxigenic Staphylococcus aureus in food samples. METHODS AND RESULTS: In this study, isolation of genomic DNA of enterotoxigenic Staph. aureus from spiked milk, milk burfi, khoa, sugarcane juice and boiled rice was carried out by boiling the isolated sample pellets for 10 min with 1% Triton X-100. The isolated DNA was evaluated by polymerase chain reaction (PCR) and LAMP method. The LAMP was found to be 100 times more sensitive than PCR. The LAMP assay was very specific for Staph. aureus, and the presence of other contaminating bacterial DNAs and food matrix did not interfere or inhibit the LAMP assay. CONCLUSIONS: The template DNA extraction method developed in this study for food samples is simple, rapid and cost-effective. LAMP was found to be less sensitive to matrix effect of food, compared to PCR. SIGNIFICANCE AND IMPACT OF THE STUDY: The method is suitable for direct detection of Staph. aureus without any enrichment in contaminated food samples and hence finds its application in food safety analysis, in permutation with LAMP.

Non-IgE-mediated cow milk allergy is linked to early childhood clusters of commonly seen illnesses: a pilot study.

OBJECTIVE: There are few established diagnostic tools to define non-IgE-mediated food hypersensitivity reactions. Cow milk protein allergy (CMPA) is a multisystem disorder affecting the gastrointestinal, skin, and lower and upper airway systems. This link is frequently missed because of subspecialty evaluation of the multisystem effects individually. The authors hypothesize that a more global evaluation based on a simple scored questionnaire will reveal this link. METHODS: Over an 18-month period, children younger than 2 years with non-IgE-mediated CMPA were identified. A symptom questionnaire was developed and scored and also applied to a control population. The prevalence of symptoms in each group was compared and a cumulative score was determined. Symptoms evaluated included gastrointestinal, aerodigestive, lower airway, and skin symptoms. A positive response was scored 1 and a negative response scored 0. RESULTS: Significant differences in prevalence rates between CMPA and control populations were noted, particularly in aerodigestive symptoms. There were marked differences in cumulative score between populations (P < .001). The authors identified a cut-off score at which there was close to 80% sensitivity and 90% specificity for distinguishing CMPA from a control population. CONCLUSION: A global evaluation of multiple systems can be an important diagnostic tool in determining CMPA in infants.