Preterm General Movements in Prediction of Neurodevelopmental Disability and Cerebral Palsy at Two Years: A Prospective Cohort Study.

Background: A neurological assessment before discharge from the NICU would enable early targeted intervention to mitigate the risk and severity of cerebral palsy (CP) and neurodevelop-mental disability. OBJECTIVE: To assess the accuracy of general movements (GM) in the preterm and fidgety movement periods in predicting neurodevelopmental disability and cerebral palsy in very preterm infants (≤32 weeks gestational age) at 18-24 months corrected gestational age. STUDY DESIGN: Prospective cohort study. PARTICIPANTS: One hundred and seventy very preterm infants, mean (SD) gestation 29.8 (1.32) weeks, and birthweight 1215 (226) g. OUTCOMES: Infants underwent GM assessments in the preterm period (31-36 weeks post-conception age) and fidgety movement period (8-18 weeks post term age). Neurodevelop-mental outcomes were assessed in 127 children using the Griffiths Mental Developmental Scales-2. RESULTS: Nine children had neurodevelopmental disability (two infants with cerebral palsy and seven with global developmental delay. The relative risk (95% CI) for neurodevelopmental disability was 1.46 (0.31-6.89) with preterm movements and 6.07 (0.97 - 38.05) with fidgety movements. Sensitivity and specificity values for the prediction of neurodevelopmental disability were 33% and 64% in the preterm period and 25% and 92% in the fidgety movement period, respectively. The sensitivity and specificity values for prediction of CP were 50% and 63% in the preterm period and 100% and 93% in the fidgety movement period, respectively. CONCLUSION: Preterm movements showed lower sensitivity and specificity than fidgety movements in predicting later CP and neurodevelopmental disability in preterm infants.

Enhanced biogas production and substrate degradation through the intermittent operation of modified upflow anaerobic sludge blanket-static granular bed reactor series.

In the present study, the performance of a modified upflow anaerobic sludge blanket (MUASB) reactor-static granular bed reactor (SGBR) series in intermittent operation was analyzed for the treatment of synthetic wastewater. The reactor series was operated with a hydraulic retention time (HRT) of 24 h. The maximum chemical oxygen demand (COD) removal and biogas production of the reactor series obtained during the intermittent operation were 99 ± 0.29% and 0.529 ± 0.03 m3 /kg CODdigested , respectively. One-way analysis of variance (ANOVA) indicated a significant difference in biogas production during continuous and intermittent operations, whereas the COD removal was similar. Intermittent operation of the reactor series yielded a 56.05% increase in biogas production when compared with the continuous operation. The reactor series was maintained stable throughout the operational period. The maximum total suspended solids (TSS) removal and total nitrogen (TN) removal of the reactor series during the intermittent operation were 91.67% and 72.37%, respectively. Intermittent operation of the reactor series can be considered advantageous because of the reduced operational cost and enhanced biogas production in addition to COD removal. PRACTITIONER POINTS: Intermittent operation of MUASB-SGBR series in terms of COD removal is evaluated. COD removal of reactor series was similar in intermittent and continuous operation. Biogas production in intermittent operation was superior to continuous operation. Reactor series performance is also compared with continuous operation using one-way ANOVA.

A review on upflow anaerobic sludge blanket reactor: Factors affecting performance, modification of configuration and its derivatives.

The upflow anaerobic sludge blanket (UASB) reactor can be considered as one of the promising anaerobic wastewater treatment technologies suitable for the treatment of high-strength wastewater. In the recent period, researchers have focused on the treatment of low-strength wastewater using this technology. This review focuses on the key factors affecting the reactor performance such as hydraulic retention time (HRT), temperature, organic loading rate (OLR), pH and alkalinity, granulation, wastewater characteristics, mixing, and modification to conventional configuration. Start-up and granulation played a major role in the determination of reactor performance, and various theories have been proposed to understand the mechanism of granulation. Correlation between start-up time and OLR was found to be low, as other operating parameters might have been influencing the start-up time. Flowchart depicting the development of UASB reactor over time is included. In the present work, further development and derivatives of the UASB reactor such as static granular bed reactor (SGBR) and expanded granular sludge bed (EGSB) reactor are analyzed. The optimal conditions for UASB for treating various types of substrates was found to be HRT of 3-24 h, OLR of 1-15 kg COD/m3 /d, and operational temperature in mesophilic range (30-40°C). Analysis of various modifications that pave the way for identification of future areas of research to improve reactor performance is also presented.

Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18-24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study.

OBJECTIVE: To determine the prevalence and risk factors for poor neurodevelopmental outcome in a cohort of very low birth weight (VLBW) infants. SUBJECTS AND METHODS: Four hundred and twenty-two infants of a total of 643 VLBW survivors from a teaching hospital in South India were followed up to assess their neurodevelopmental outcomes. RESULTS: Among the 422 children who completed the assessment, results of 359 children whose assessments were done between 18 and 24 months were analysed. Thirty-seven children (10.31%) had poor neurodevelopmental outcome, six children [1.67%] had cerebral palsy, one child had visual impairment and another had hearing impairment. Poor post-natal growth was independently associated with poor neurodevelopmental outcomes in the multivariate analysis (p = 0.045). Neonatal complications were not associated with the developmental outcome. CONCLUSION: Despite lower rates of neonatal complications compared with Western cohorts, significant proportion of VLBW infants had poor neurodevelopmental outcomes. Poor post-natal growth was an important determinant of the developmental outcome.

Malignant Syphilis in an Immunocompetent Adult Male.

The occurrence of malignant syphilis in an immunocompetent individual is rare. We present malignant syphilis in a 35-year-old immunocompetent male who presented with a 1-month history of noduloulcerative lesions on the torso. Examination revealed multiple pustules, nodules, and deep-seated ulcers distributed on the trunk, face, and upper and lower limbs. Characteristic morphology of lesions, positive serological tests for syphilis, characteristic histopathology, and resolution of lesions following institution of penicillin therapy confirmed the clinical diagnosis of malignant syphilis.

Desmoid Tumor of Rectus Abdominis Presenting with Grey-Turner's and Cullen's Sign: A Report of a Rare Case.

Desmoid tumor of rectus abdominis presenting with Grey-Turner's and Cullen's sign is rare. Herein, we report desmoid tumor of rectus abdominis in a 64-year-old multiparous female who presented with ecchymosis involving left flank and around the umbilicus. Histopathological examination of biopsy from the tumor confirmed the diagnosis of the desmoid tumor. She was referred to a surgeon for radical resection.

Growth Hormone Induces Transforming Growth Factor-Beta-Induced Protein in Podocytes: Implications for Podocyte Depletion and Proteinuria.

The glomerular podocytes form a major size selective barrier for the filtration of serum proteins and reduced podocyte number is a critical event in the pathogenesis of proteinuria during diabetic nephropathy (DN). An elevated level of growth hormone (GH) is implicated as a causative factor in the development of nephropathy in patients with type 1 diabetes mellitus. We have previously shown that podocytes express GH receptor and are a target for GH action. To elucidate the molecular basis for the effects of GH on podocyte depletion, we conducted PCR-array analyses for extracellular matrix and adhesion molecules in podocytes. Our studies reveal that GH increases expression of a gene that encodes transforming growth factor-beta-induced protein (TGFBIp) expression. Similarly, microarray data retrieved from the Nephromine database revealed elevation of TGFBIp in patients with DN. Treatment with GH results in increased secretion of extracellular TGFBIp by podocytes. Both GH and TGFBIp induced apoptosis and epithelial mesenchymal transition (EMT) of podocytes. Exposure of podocytes to GH and TGFBIp resulted in increased migration of cells and altered podocyte permeability to albumin across podocyte monolayer. Administration of GH to rats induced EMT and apoptosis in the glomerular fraction of the kidney. Therefore, we conclude that the GH-dependent increase in TGFBIp in the podocyte is one of the mechanisms responsible for podocyte depletion in DN.

Metastasis of lung adenocarcinoma to the jaw bone.

Oral cavity is an uncommon site for metastasis and is usually an evidence of widespread disease. The clinical presentation of the metastatic lesions differs between the various sites in the oral region. Metastatic tumors account for 1-3% of all oral malignancies. The jawbones, particularly the mandibular molar area is more frequently affected than the oral soft tissues (2:1). Here, we report a case of a 60-year-old male patient with metastasis from lung to the mandible, where the metastasis was detected before primary tumor.