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OBJECTIVE: To evaluate prevalence of psychiatric comorbidities in children with epilepsy (CWE) and to assess their impact on quality of life (QOL). METHODS: All CWE with normal Intelligence Quotient (IQ) were assessed using the Revised Child Anxiety and Depression Scale (RCADS) for anxiety and depression, and Strengths and Difficulties (SDQ) Questionnaire for behavioral and emotional problems. QOL in Children with Epilepsy (QOLCE-31) scale was used to assess the Quality of Life at enrolment and was repeated again after appropriate intervention for comorbidities at 3 months. RESULTS: It was found that 22 (24.4%), 18 (20.0%), 35 (38.9%), 32 (35.56), 26 (28.89), 12 (13.34) children met the clinical threshold for social phobia, major depression, generalized anxiety, separation anxiety, conduct problem and peer problem respectively. After appropriate intervention for the co-morbidities, improvement was noted in the quality of life. CONCLUSION: Psychiatric co-morbidities are common in children with epilepsy and these contribute to the poor quality of life.
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The pyrochlore lattice is a versatile venue to probe the properties of magnetically ordered states induced or perturbed by anisotropic terms like the Dzyaloshinskii-Moriya interactions or single-ion anisotropy. Several such ordered states have been investigated recently as precursors of topological magnons and the associated surface states. In parallel, there has been recent progress in growing thin films of magnetic materials with this lattice structure along high symmetry directions of the lattice. In both cases, an account of the magnetic excitations of relevant Hamiltonians for finite slabs is a necessary step in the analysis of the physics of these systems. While the analysis of bulk magnons for these systems is quite common, a direct evaluation of the magnon spectra in the slab geometry, though required, is less frequently encountered. We study here magnon bands in the slab geometry for a class of spin models on the pyrochlore lattice with Heisenberg exchange, Dzyaloshinskii-Moriya interaction and spin-ice anisotropy. For a range of model parameters, for both ferromagnetic and antiferromagnetic exchange, we compute the classical ground states for different slab orientations and determine the spin wave excitations above them. We analyze the ferromagnetic splay phase, the all-in-all-out (AIAO) phase and a coplanar phase and evaluate magnon dispersions for slabs oriented perpendicular to the [111], [100] and [110] directions. For all the phases considered, depending on the slab orientation, magnon band structures can be non-reciprocal and we highlight the differences in the three orientations from this point-of-view. Finally, we present details of the surface localized magnons for all the three slab orientations in the phases we study. For the ferromagnetic splay phase and the AIAO phase we analyze surface states associated with point degeneracies or nodal lines in the bulk spectrum by computing the magnonic Berry curvature and Weyl charges or Chern numbers associated with it.
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OBJECTIVES: To evaluate the incidence of long-term de novo acid reflux-related complications following sleeve gastrectomy (SG) to determine whether routine postoperative surveillance endoscopy is necessary. METHODS: A systematic search of Medline, Embase, CINAHL, CENTRAL, the Web of Science, and bibliographic reference lists was conducted. A proportion meta-analysis model was constructed to quantify the risk of the de novo gastro-oesophageal reflux disease (GORD), oesophagitis, and Barrett's oesophagus (BE) at least 4 years after SG. Random-effects modelling was applied to calculate pooled outcome data. RESULTS: Thirty-two observational studies were included reporting a total of 7904 patients who underwent primary SG and were followed up for at least 4 years. The median follow-up period was 60 months (48-132). Preoperative acid-reflux symptoms existed in 19.1% ± 15.1% of the patients. The risk of development of de novo GORD, oesophagitis, and BE after SG was 24.8% (95% CI 18.6-31.0%), 27.9% (95% CI 17.7-38.1%), and 6.7% (95% CI 3.7-9.7%), respectively. The between-study heterogeneity was significant in all outcome syntheses. It was suspected that several of the included studies have not reported BE and oesophagitis because such events might not have happened in their cohorts. CONCLUSIONS: Long-term risk of de novo GORD after SG seems to be comparable with those of the general population which questions the merit of surveillance endoscopy after SG in asymptomatic patients. De novo BE and oesophagitis after SG have not been reported by most of the available studies which may lead to overestimation of the rates of both outcomes in any evidence synthesis. We recommend endoscopic surveillance for symptomatic patients only.
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Esófago de Barrett , Esofagitis , Reflujo Gastroesofágico , Obesidad Mórbida , Humanos , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/cirugía , Endoscopía/efectos adversos , Esofagitis/complicaciones , Esofagitis/cirugía , Esófago de Barrett/epidemiología , Esófago de Barrett/etiología , Esófago de Barrett/cirugía , Gastrectomía/efectos adversos , Obesidad Mórbida/cirugíaRESUMEN
BACKGROUND: The goal of treatment of traumatic brain injury (TBI) is to avoid secondary brain injury. Decompressive craniectomy has been shown to reduce intracranial pressure (ICP), but it actually provides an outlet for brain tissue to expand without reducing edema. Basal cisternostomy is an emerging microsurgical technique to manage cerebral edema in TBI. Cerebrospinal fluid is released from basal cisterns, which reduces cerebral edema. We compared outcomes of cisternostomy with decompressive craniectomy in a randomized controlled trial and studied the effectiveness of cisternostomy in decreasing cerebral edema. METHODS: All enrolled patients were randomly assigned to 2 groups and assessed clinically and radiologically. TBIs were categorized as mild, moderate, and severe injuries, and Marshall computed tomography-based score was assessed. Intraoperative ICP was measured in both groups. Outcomes were assessed based on postoperative intensive care unit stay, days on ventilator support, and Glasgow Outcome Scale score. RESULTS: There were 50 patients randomly assigned to 2 groups (25 patients in each group). Mortality rate was 32% (8 deaths) in the cisternostomy group and 44% (11 deaths) in the decompressive craniectomy group. Patients in the cisternostomy group had decreased mean days of ventilator support and intensive care unit stay. Cisternostomy resulted in significant decreases in ICP after craniotomy. Age, time from trauma to surgery, and Marshall score showed prognostic importance on outcomes. CONCLUSIONS: Cisternostomy was effective in reducing ICP in patients with TBI. Good Glasgow Outcome Scale scores and low rates of complications were found in the postoperative period after cisternostomy. Age, presenting Glasgow Coma Scale score, Marshall score, other major injuries, and time from trauma to surgery had a significant prognostic impact on outcome in management of TBI.
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Edema Encefálico , Lesiones Traumáticas del Encéfalo , Craniectomía Descompresiva , Edema Encefálico/etiología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/cirugía , Craniectomía Descompresiva/métodos , Escala de Coma de Glasgow , Humanos , Presión Intracraneal , Resultado del TratamientoRESUMEN
BACKGROUND: Intervertebral disc herniation (IVDH) is one of the common causes of spinal cord injury (SCI) in dogs. It is commonly treated by performing surgical decompression that involves the removal of the extruded disc material. However, the recovery rates after surgical interventions are variable and many times unsatisfactory. This report aims to document a case of paraplegia associated with IVDH in a Beagle dog and its therapeutic management using allogenic bone marrow-derived mesenchymal stem cells (aBM-MSCs). CASE DESCRIPTION: The dog was presented with paraplegia that was initiated three weeks back. Based on the findings of computed tomography (CT), the condition was diagnosed as Hansen type I IVDH at T12-T13 intervertebral space. FINDINGS/TREATMENT AND OUTCOME: Neurological examination was performed to grade the neurological deficit. The isolation, culture, and characterization of aBM-MSCs were done as per the standard protocol. The prepared cell suspension of aBM-MSCs was percutaneously transplanted to the spinal cord parenchyma at the site of injury. A total of four doses of 1 × 106 cells were given at an interval of 15 days along with methylcobalamin and gabapentin orally. Improvement was evaluated based on the neurological examination and grading. Considerable improvement was noticed after the first dose of aBM-MSCs. The animal started complete weight bearing on its pelvic limbs after two doses. CONCLUSION: Percutaneous transplantation of aBM-MSCs might have played an important role in reversing the neurological deficits secondary to IVDH in this dog. Further studies are required preferably in a larger population to confirm the efficacy of aBM-MSCs therapy in ameliorating neural deficits associated with IVDH.
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Primary lymphomatous involvement of spinal cord, nerve roots, and cauda equina is a rare entity and comprises only 0.1% of extra-nodal lymphoma spectrum. Here, we present a case of non-Hodgkin lymphoma involving cauda equina, initially suspected as ependymoma on magnetic resonance imaging that was later confirmed on nerve root biopsy as high B cell non-Hodgkin's lymphoma of L1-S1 nerve roots. F-18 fluorodeoxyglucose positron emission tomography-computed tomography was performed for staging workup which showed abnormal metabolic activity within the spinal canal from D10-S2 with no evidence of distant organ involvement.
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OBJECTIVES: To compare lens comfort and dry eye (DE) symptoms of DE scleral lens (SL) wearers fit with polyethylene glycol (PEG)-based surface-treated and untreated SLs. Dry eye signs, comfortable SL wearing time (WT), vision quality, and lens-related ocular surface changes were also assessed. METHODS: Twenty-one SL wearers with DE and SL discomfort were enrolled in a double-masked crossover study. Participants were randomized to wear their untreated or PEG (Tangible Hydra-PEG, Tangible Science; Redwood, CA) surface-treated SL of the same parameters first for 30 days. Lens comfort, DE symptoms, and ocular surface assessments were measured at baseline, after the first test period, and after the crossover. Comfortable lens WT and frequency of foggy vision were recorded. Comparisons were assessed using paired t tests or Wilcoxon signed-rank tests. RESULTS: Polyethylene glycol-treated SL wear resulted in significantly improved: lens comfort (P=0.003), DE symptoms (P=0.004), corneal sodium fluorescein staining (P=0.01), temporal conjunctival lissamine green staining (P=0.01), lid wiper epitheliopathy (P=0.002), conjunctival papillae (P=0.003), frequency of foggy vision (P=0.002), tear break-up time (TBUT) (P=0.01), and comfortable lens WT (P=0.002) compared with untreated wear. There were no significant changes between treated and untreated lens wear for TBUT over the SL (P=0.14) and nasal conjunctival lissamine green staining (P=0.06). CONCLUSIONS: Polyethylene glycol surface-treated SLs provided improved comfort, reduced DE symptoms, and reduced ocular surface compromise compared with untreated SLs for participants with DE.
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Enfermedades de la Conjuntiva , Síndromes de Ojo Seco , Estudios Cruzados , Síndromes de Ojo Seco/etiología , Síndromes de Ojo Seco/terapia , Humanos , Esclerótica , LágrimasRESUMEN
PURPOSE: To test the Contact Lens Assessment in Youth Contact Lens Risk Survey (CLRS) scoring algorithm in soft contact lens (SCL) wearers presenting with SCL-related adverse events and healthy matched controls. METHODS: This prospective case-control study compared CLRS responses in SCL wearers presenting with symptomatic red eyes (Cases) with age-, sex- and site-matched healthy SCL wearers (Controls) at six locations across North America. Responses to individual questions from Cases and Controls were analyzed using either the Pearson, Mantel-Haenszel chi-square, or Fisher's exact test. Differences in the CLRS scores were compared using t-tests. RESULTS: A total of 171 SCL wearers were enrolled (nâ¯=â¯57 Cases, 114 Controls). Cases were adjudicated to consensus and classified as contact lens-related serious and significant (S&S) or non-serious events. S&S Cases scored significantly higher on the CLRS (56.1⯱â¯11.1) than either their matched Controls (44.3⯱â¯11.1) (Pâ¯<⯠0.001) or the non-Serious Cases (44.8± 12.8 Pâ¯=⯠0.002). Scores of non-serious Cases were not significantly different than scores of their Controls (43.4 ± 10.7, P = 0.33) CONCLUSIONS: The CLRS scoring algorithm discriminated between SCL wearers presenting with S&S CL-related adverse events from healthy SCL wearers and those with non-serious events. This survey and scoring system could help practitioners identify patients at greatest risk for CL-related adverse events and support targeted interventions aimed at reducing risk behaviors.
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Lentes de Contacto Hidrofílicos , Adolescente , Estudios de Casos y Controles , Lentes de Contacto Hidrofílicos/efectos adversos , Humanos , Factores de Riesgo , Asunción de Riesgos , Encuestas y CuestionariosRESUMEN
Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not always technically successful because of hepatic vein thrombosis and inability to catheterize the hepatic veins. In these situations, direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC has been shown to be a viable alternative that may ameliorate portal hypertension in these patients. Typically, DIPS involves the use of transabdominal ultrasound to target the portal vein. Herein a case in which a 39-year-old female underwent DIPS without the use of ultrasound guidance is presented. Instead, a hepatic venogram generated using collateral circulation was used to opacify and guide access to the portal vein.
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AIM: The present study aimed to study the seroprevalence of brucellosis in small ruminants of Gujarat state, India, using Rose Bengal Plate test (RBPT) and indirect enzyme-linked immunosorbent assay (iELISA). MATERIALS AND METHODS: A total of 2444 sera samples (675 sheep and 1769 goat) from unorganized sector and 1310 sera samples (861 sheep and 449 goat) from seven organized farms were collected for brucellosis screening. RESULTS: In unorganized sector, 23.70% sheep (160/675) and 15.99% goat (283/1769) were positive by RBPT and 24.44% sheep (165/675) and 17.24% goat (305/1769) by iELISA. The organized sector samples showed higher seroprevalence in goat (7.79 %, 35/449) than sheep (4.06 %, 35/861) by RBPT. Similarly, in iELISA, goat samples showed a higher seroprevalence (9.35%, 42/449) compared to sheep (7.50%, 65/861). The diagnostic sensitivity and specificity of RBPT with ELISA were 88.69% and 99.65%, respectively, and showed a significant difference (p≤0.0001). The Chi-square analysis revealed a significant difference in seroprevalence between sectors (p≤0.01) and species (p≤0.01). CONCLUSION: The seroprevalence of brucellosis in small ruminants of Gujarat was investigated and showed a higher prevalence of brucellosis and warrants the implementation of proper preventive measures.
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Mitochondrial neurogastrointestinal encephalomyopathy is a rare autosomal recessive disorder characterized by severe muscle wasting, gastrointestinal dysmotility, leukoencephalopathy, peripheral neuropathy, and ophthalmoplegia. The pathogenesis involves the accumulation of very high concentrations of nucleosides dThd and dUrd along with depletion of nucleotide dCTP. One of the treatment measures is the removal of nucleosides dThd and dUrd by hemodialysis and peritoneal dialysis. Only a few patient reports of dialysis as a measure to remove nucleosides had been reported.
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Trace minerals feeding had significant effects on sperm production and fertility with better absorption and proper utilization within the body for optimum reproductive function. Several studies have shown that more influenced trace elements in the diets of animals are copper (Cu) and zinc (Zn). Bucks showing deficiency of this mineral might affect the quality of semen production which in turn would affect the fertility. This experiment was thus designed to test the effects of organic Cu and Zn supplementation on antioxidants enzyme activities and sperm functional attributes in fresh semen of bucks. Forty bucks (n = 40, Aged 5 months) were assigned to ten groups of four animals in each group, supplemented (for a period of 8 months) with different levels of organic Zn: 20 mg (T2), 40 mg (T3) and 60 mg (T4), organic Cu: 12.5 mg (T5), 25 mg (T6), 37.5 mg (T7) and combined organic Zn and Cu: 20 + 12.5 mg (T8), 40 + 25 mg (T9), 60 + 37.5 mg (T10), respectively, per kg dry matter and no additional mineral diet (control; T1). One hundred and sixty semen samples were collected through electro-ejaculator and analysed for sperm quantity, quality, acrosome intactness and plasma membrane integrity and correlated with the catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase enzyme activities in seminal plasma. The results indicated organic Cu and zinc supplemented bucks produced more sperm cells, had higher sperm concentrations, maintained higher (p < .01) sperm livability, plasma membrane and acrosome integrities, more motility and velocity. The increased antioxidant enzyme activities, reduced oxidative stress and lowered lipid peroxidation were positively correlated (p < .05) with the sperm functional attributes. In conclusion, organic Cu and Zn supplement to male goats showed protective roles against oxidative damage and maintained better fresh semen characteristics.
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Cobre/farmacología , Cabras/fisiología , Espermatozoides/efectos de los fármacos , Zinc/farmacología , Acrosoma , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Antioxidantes , Membrana Celular , Cobre/administración & dosificación , Suplementos Dietéticos , Masculino , Semen/enzimología , Análisis de Semen/veterinaria , Motilidad Espermática/efectos de los fármacos , Espermatozoides/citología , Espermatozoides/fisiología , Zinc/administración & dosificaciónRESUMEN
BACKGROUND: Patients often have less than realistic expectations of the weight loss they are likely to achieve after bariatric surgery. It would be useful to have a well-validated prediction tool that could give patients a realistic estimate of their expected weight loss. OBJECTIVES: To perform a systematic review of the literature to identify existing prediction models and attempt to validate these models. SETTING: University hospital, United Kingdom. METHODS: A systematic review was performed. All English language studies were included if they used data to create a prediction model for postoperative weight loss after bariatric surgery. These models were then tested on patients undergoing bariatric surgery between January 1, 2013 and December 31, 2014 within our unit. RESULTS: An initial literature search produced 446 results, of which only 4 were included in the final review. Our study population included 317 patients. Mean preoperative body mass index was 46.1 ± 7.1. For 257 (81.1%) patients, 12-month follow-up was available, and mean body mass index and percentage excess weight loss at 12 months was 33.0 ± 6.7 and 66.1% ± 23.7%, respectively. All 4 of the prediction models significantly overestimated the amount of weight loss achieved by patients. The best performing prediction model in our series produced a correlation coefficient (R2) of .61 and an area under the curve of .71 on receiver operating curve analysis. CONCLUSIONS: All prediction models overestimated weight loss after bariatric surgery in our cohort. There is a need to develop better procedures and patient-specific models for better patient counselling.
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Cirugía Bariátrica , Índice de Masa Corporal , Obesidad Mórbida/cirugía , Pérdida de Peso/fisiología , Humanos , Estudios RetrospectivosRESUMEN
The long-term dialysis therapy for end-stage renal disease takes a heavy toll of quality of life of the patient. Several factors such as fatigue and decreased physical capability, impaired social and mental functioning, contribute to this forlorn state. To meld maintenance dialysis treatment with a regular employment can be a serious test. A cross-sectional study of employment of patients on hemodialysis and peritoneal dialysis in a state government tertiary institute in South India was performed between June 2015 and December 2015. Patients who completed 3 months of regular dialysis were only included in the study. The number of patients on hemodialysis was 157 and on peritoneal dialysis was 69. The employment status before the initiation of dialysis was 60% (93 out of 155) and 63.7% (44 out of 69) in hemodialysis and peritoneal dialysis, respectively. After initiation, the loss of employment was observed in 44% (41 out of 93) in hemodialysis and 51.2% (26 out of 44) in peritoneal dialysis (P = 0.2604). Even though there was fall of absolute number of job holders in both the blue and white collar jobs, the proportion of jobholders in the white collar job holders improved. On univariate analysis, the factors which influenced the loss of employment were males, age between 50 and 60 years, number of comorbidities >2, illiteracy and blue collar versus white collar job before the initiation of dialysis. The majority of patients had the scores above 80 on Karnofsky performance scale and the majority belonged upper and middle classes than lower classes on modified Kuppuswamy's socioeconomic status scale; however, the loss of employment was also disproportionately high. There appeared a substantial difference in the attitude of the patients toward the employment. There was no difference between hemodialysis and peritoneal dialysis in the loss of employment of our patients.
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The literature, particularly from India, is scarce on the renal effects of glyphosate poisoning. Glyphosate causes toxicity not only after its ingestion but also after dermal exposure by inhalation route and on eye exposure. We present a patient report of glyphosate consumption which resulted in toxic epidermal necrolysis - the first report after glyphosate consumption and acute kidney injury.
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The present paper reports the thermoluminescence (TL) of (ZnS)1-x (MnTe)x nanophosphors that were prepared by a wet chemical synthesis method. The structure investigated by X-ray diffraction patterns confirms the formation of a sphalerite phase whose space group was found to be F 4¯3m. From XRD, TEM and SEM analyses the average sizes of the particles were found to be 12 nm, 11 nm and 15 nm, respectively. Initially the TL intensity increased with increasing values of x because the number of luminescence centres increased; however, for higher values of x the TL intensity decreased because of the concentration quenching. Thus the TL, mechanoluminescence and photoluminescence intensities are optimum for a particular value of x, that is for x = 0.05. Thermoluminescence of the (ZnS)1-x (MnTe)x nanophosphor has not been reported previously. There were two peaks seen in the thermoluminescence glow curves in which the first peak lay at 105-100 °C and the second peak lay at 183.5-178.5 °C. The activation energies for the first and second peaks were found to be 0.45 eV and 0.75 eV, respectively.