Permeation Flux Prediction of Vacuum Membrane Distillation Using Hybrid Machine Learning Techniques.

Vacuum membrane distillation (VMD) has attracted increasing interest for various applications besides seawater desalination. Experimental testing of membrane technologies such as VMD on a pilot or large scale can be laborious and costly. Machine learning techniques can be a valuable tool for predicting membrane performance on such scales. In this work, a novel hybrid model was developed based on incorporating a spotted hyena optimizer (SHO) with support vector machine (SVR) to predict the flux pressure in VMD. The SVR-SHO hybrid model was validated with experimental data and benchmarked against other machine learning tools such as artificial neural networks (ANNs), classical SVR, and multiple linear regression (MLR). The results show that the SVR-SHO predicted flux pressure with high accuracy with a correlation coefficient (R) of 0.94. However, other models showed a lower prediction accuracy than SVR-SHO with R-values ranging from 0.801 to 0.902. Global sensitivity analysis was applied to interpret the obtained result, revealing that feed temperature was the most influential operating parameter on flux, with a relative importance score of 52.71 compared to 17.69, 17.16, and 14.44 for feed flowrate, vacuum pressure intensity, and feed concentration, respectively.

Metronidazole Potentiation by Panax Ginseng and Symphytum officinale: A New Strategy for P. gingivalis Infection Control.

The important periodontal disease pathogen Porphyromonas gingivalis produces thick biofilms that increase its pathogenicity. Finding natural antimicrobial agents is crucial because of the rise in antibiotic resistance. The purpose of this study was to determine if plant extracts such as Symphytum officinale (S) and Panax Ginseng (G) were effective against P. gingivalis separately and in combination with a common antibiotic, metronidazole (F). Six different dilutions were produced using the plant extracts in different concentrations and antibiotics separately and in combination with F, G, and S using the two-fold serial dilution technique. To evaluate the effects of these substances, biofilm inhibition experiments were conducted. Plaque samples were collected from periodontitis patients to isolate P. gingivalis, and a standard strain of P. gingivalis (ATCC 33277) was purchased. Additionally, Acylated Homoserine Lactones (AHLs) detection was carried out to look for any activity that would interfere with quorum sensing. GraphPad Prism was used for statistical analysis with a p-value < 0.05. The combinations of Symphytum officinale and metronidazole (S+F) showed the maximum effectiveness in biofilm inhibition (98.7%), which was slightly better than G+F (98.2%), with substantial variations in biofilm inhibition levels in different treatment regimes. Notably, the patient isolate was more active than the standard strain. Additionally, the plant extracts and their combinations at particular dilutions had notable inhibitory effects on the generation of AHL (p < 0.05). The study highlights the possibility of Symphytum officinale and Panax Ginseng as effective treatments for P. gingivalis biofilm and AHLs, both on their own and in combination with metronidazole. These organic substances may open the door to cutting-edge methods of treating periodontal disorders.

Polydimethylsiloxane (PDMS) Membrane for Separation of Soluble Toluene by Pervaporation Process.

A commercial polydimethylsiloxane (PDMS) membrane was employed to separate the soluble toluene compounds (C7H8) from an aqueous solution via the pervaporation (PV) process. The performance and the efficacy of the PDMS PV membrane were evaluated through the estimation of the permeation flux and separation factor under various operating parameters. The response surface method (RSM) built in the Minitab-18 software was used for the design of the experiment in this study, and the responses of the permeation flux and the separation factor were analyzed and optimized based on the operating conditions. A nonlinear regression analysis was applied to the experimental output and input, and as a result, a quadratic equation model with parameters interactions was obtained as mathematical expressions to predict the permeation flux and separation factor. At the optimal conditions of temperature 30 °C, initial toluene concentration 500 ppm, and feed flowrate 3.5 L/min, the toluene permeation flux and separation factor were 125.855 g/m2·h and 1080, respectively. The feed concentration was the most impactful and significant in the improvement of the permeation flux and separation factor of the PDMS membrane.

Modeling and simulation of pervaporation (PV) separation for alcohol dehydration.

The separation performance of commercial crosslinked poly (vinyl alcohol) (PVA) membranes (i.e., the new commercial membrane PERVAP™ 4100 H F and standard membrane PERVAP™ 4100) used for the dehydration of two alcohol-water systems (i.e., ethanol-water and isopropanol-water mixtures, with an azeotropic point) were studied based on pervaporation process (PV) experimental data and mathematical modeling. Pervaporation process experiments proved that these two membranes have excellent applicability for the dehydration of alcohol. A semi-empirical solution-diffusion transport model was developed to describe the mass transport in the PVA membranes, which showed a good agreement with the experimental values. The universal quasi-chemical (UNIQUAC) model was utilized to predict the activity coefficient of nonideal alcohol-water systems in PVA membranes. In addition to the UNIQUAC model, the transport of alcohol-water across the commercial polymeric membrane was modeled using the conventional driving force model. The PV process experimental data with the mathematical model were used to develop the diffusivity correlations for water and alcohol (i.e., ethanol and isopropanol) through the PVA membranes. It was found that for swollen membranes (PVA), the developed correlations of water and alcohol diffusivity were strongly influenced by the feed water activity and feed temperature. Based on the mass transport model and developed diffusivity correlations, the permeation flux of water and alcohol through the PVA membranes was predicted, and the results showed a good agreement between the experimental data and the predictive model. The mean relative errors estimated for the permeate mass fluxes of water were 8.4%, and 3.8%, and for the permeate mass fluxes of ethanol were 18%, and 13.6% for the PERVAP™ 4100 and 4100 H F, respectively, as well as for the IPA-water-PVA system are as follows: 5% and 2.8% for the permeate mass fluxes of water and 14.4%, and 12.6% for the permeate mass fluxes of IPA for the PERVAP™ 4100 and 4100 H F, respectively.

HbA1c and physical performance in older adults from different aging epidemiological contexts: Longitudinal findings of the International Mobility in Aging Study (IMIAS).

OBJECTIVE: This study aimed to assess the longitudinal predictions between glycated hemoglobin A1c (HbA1c) and physical performance scores in different epidemiological contexts of aging. MATERIAL AND METHODS: Longitudinal data of 1,337 older people from three countries (Canada, Brazil and Colombia) of the International Mobility in Aging Study (IMIAS) were used to assess the relationship between HbA1c and Short Physical Performance Battery (SPPB) scores between 2012 and 2016. Linear Mixed Models grouped by sex and adjusted by Age, Study site, Chronic Conditions, Anthropometric Measures, and Inflammatory Level were used to estimate the influence of HbA1c and covariates on SPPB scores. RESULTS: At the IMIAS baseline, Latin American (LA) cities had higher HbA1c averages compared to Canadian cities, with Natal (Brazil) being the city with the highest HbA1c averages in men and women (6.32 ± 1.49; 6,56 ± 1.70 respectively). SPPB scores were significantly lower in LA cities, and older people in Natal had lower SPPB averages in men (9.67 ± 2.38; p-value < 0.05) and women (8.52 ± 2.33; p-value <0.05). In the multivariate mixed linear models of longitudinal analyses, HbA1c was significantly associated with lower SPPB scores in men (ß = -0.25, 95% CI: -0.39 to -0.12, p-value = 0.02) but not in women. CONCLUSION: High HbA1c levels at baseline were longitudinally associated in older adults from different countries, and this association was observed only in men and not in women. This study highlights a possible influence of gender on this relationship.

Separation of Soluble Benzene from an Aqueous Solution by Pervaporation Using a Commercial Polydimethylsiloxane Membrane.

A developed polydimethylsiloxane (PDMS) membrane was used to separate soluble benzene compounds (C6H6) from an aqueous solution via a pervaporation (PV) process. This membrane was characterized by scanning electron microscopy (SEM), Fourier-transform infrared (FTIR) spectroscopy, contact angle (CA), and energy-dispersive spectroscopy (EDS). To evaluate the performance of the membrane, the separation factor and permeation flux were estimated in various operating conditions, including the feed temperature, initial benzene concentration, and feed flow rate. The experiments to maximize the separation factor and permeation flux were designed using the response surface method (RSM) that is built into Minitab 18. A quadratic model (nonlinear regression equation) was suggested to obtain mathematical expressions to predict the benzene permeation flux and the separation factor according to the effect of the parameters' interaction. The optimization of the PV was performed using an RSM that was based on the analysis of variance (ANOVA). The optimal values of the benzene permeation flux and separation factor were 6.7 g/m2·h and 39.8, respectively, at the optimal conditions of temperature (30 °C), initial concentration of benzene (1000 ppm), and feed flow rate (3.5 L/min). It was found that the feed concentration was the most influential parameter, leading to a significant increase in the permeation flux and separation factor of the PDMS membrane.

Ethanol Separation from an Ethanol-Water Solution Using Vacuum Membrane Distillation.

The vacuum membrane distillation (VMD) process was applied to separate ethanol from a simulated ethanol-water solution using a commercial polytetrafluoroethylene (PTFE) membrane. The presence of ethanol in the ethanol-water solution with a 2 wt.% ethanol concentration at a temperature above 40 °C during the MD process may result in membrane failure due to an increase in the chance of the PTFE membrane wetting at high temperatures. Therefore, the operating temperature in this study was not higher than 35 °C, with an initial ethanol concentration up to 10 wt.%. This work focuses on optimizing the VMD operating parameters using the Taguchi technique based on an analysis of variance (ANOVA). It was found that the feed temperature was the most-affected parameter, leading to a significant increase in the permeation flux of the PTFE membrane. Our results also showed that the permeate flux was reported at about 24.145 kg/m2·h, with a separation factor of 8.6 of the permeate under the operating conditions of 2 wt.%, 30 °C, 60 mm Hg(abs), and 0.6 L/min feed (concentration, temperature, permeate vacuum pressure, and flow rate, respectively). The initial feed concentration, vacuum pressure, and feed flow rate have a lower impact on the permeation flux.

A Systematic Framework for Optimizing a Sweeping Gas Membrane Distillation (SGMD).

The present work has undertaken a meticulous glance on optimizing the performance of an SGMD configuration utilized a porous poly (vinylidene fluoride-co-hexafluoropropylene) (PVDF-co-HFP) membrane. This was carried out by conducting a systematic framework for investigating and optimizing the pertinent parameters such as sweeping gas flow rate, feed temperature, feed concentration and feed flow rate on the permeate flux. For this purpose, the Taguchi method and design of experiment techniques were harnessed to statistically determine optimum operational conditions. Besides that, a comprehensive surface and permeation characterization was conducted against the hand-made membranes. Results showcased that the membrane performance was ultimately controlled by the feed temperature and was nearly (~680) % higher when the temperature raised from 45 to 65 °C. Also, to a lesser extent, the system was dominated by the feed flow rate. As the adopted feed flow rate increases (from 0.2 to 0.6 L/min), around 47.5% increment was bestowed on water permeability characteristics. In contra, 34.5% flux decline was witnessed when higher saline feed concentration (100 g/L) was utilized. In the meantime, with raising the sweeping gas flow rate (from 120 to 300 L/h), the distillate was nearly 129% higher. Based on Taguchi design, the maximum permeate flux (17.3 and 17 kg/m2·h) was secured at 35 g/L, 0.4 L/min, 65 °C and 300 L/h, for both commercial and prepared membranes, respectively.

Experimental and Theoretical Analysis of Lead Pb2+ and Cd2+ Retention from a Single Salt Using a Hollow Fiber PES Membrane.

The present work reports the performance of three types of polyethersulfone (PES) membrane in the removal of highly polluting and toxic lead Pb2+ and cadmium Cd2+ ions from a single salt. This study investigated the effect of operating variables, including pH, types of PES membrane, and feed concentration, on the separation process. The transport parameters and mass transfer coefficient (k) of the membranes were estimated using the combined film theory-solution-diffusion (CFSD), combined film theory-Spiegler-Kedem (CFSK), and combined film theory-finely-porous (CFFP) membrane transport models. Various parameters were used to estimate the enrichment factors, concentration polarization modulus, and Péclet number. The pH values significantly affected the permeation flux of the Pb2+ solution but only had a slight effect on the Cd2+ solution. However, Cd2+ rejection was highly improved by increasing the pH value. The rejection of the PES membranes increased greatly as the heavy metal concentration rose, while the heavy metal concentration moderately affected the permeation flux. The maximum rejection of Pb2+ in a single-salt solution was 99%, 97.5%, and 98% for a feed solution containing 10 mg Pb/L at pH 6, 6.2, and 5.7, for PES1, PES2, and PES3, respectively. The maximum rejection of Cd2+ in single-salt solutions was 78%, 50.2%, and 44% for a feed solution containing 10 mg Cd/L at pH 6.5, 6.2, and 6.5, for PES1, PES2, and PES3, respectively. The analysis of the experimental data using the CFSD, CFSK, and CFFP models showed a good agreement between the theoretical and experimental results. The effective membrane thickness and active skin layer thickness were evaluated using the CFFP model, indicating that the Péclet number is important for determining the mechanism of separation by diffusion.

Familial Hydrocephalus and Dysgenesis of the Corpus Callosum Associated with Xp22.33 Duplication and Stenosis of the Aqueduct of Sylvius with X-Linked Recessive Inheritance Pattern.

INTRODUCTION: X-linked recessive mutations predominantly affect male fetuses with milder or no abnormalities in female siblings. Most reports show only one affected member in the family. We are reporting a family affected with hydrocephalus, stenosis of the aqueduct of Sylvius, dysgenesis of the corpus callosum, and Xp22.33 microduplication. CASE PRESENTATION: Eighteen-year-old patient was evaluated for her 2 pregnancies; the first was a male fetus with severe hydrocephalus and the second a female fetus with mild hydrocephalus. Postnatal MRI evaluation of the male neonate revealed stenosis of the aqueduct of Sylvius, dysgenesis of the corpus callosum, and severe hydrocephalus requiring ventriculoperitoneal shunt. Postnatal MRI evaluation of the female neonate revealed mild hydrocephalus, stenosis of the aqueduct of Sylvius, and mild dysgenesis of the corpus callosum. The female baby did not require surgical intervention. Genetic testing of the mother and the 2 children revealed a 439 Kb duplication of Xp22.33. DISCUSSION: This family demonstrates typical X-linked recessive heritability. X-inactivation is a compensatory mechanism that explains the mild symptoms of the female child and the severe symptoms of the male child. This familial case shows the importance of prenatal testing and genetic counseling and testing, including karyotype and chromosomal microarray.

Sleep disturbances in diabetic peripheral neuropathy patients: a clinical and polysomnographic study.

BACKGROUND: Disordered sleep breathing is a common complication of diabetic peripheral neuropathy (DPN) manifested by excessive daytime sleepiness, morning headache, morning dizziness, cognitive decline, and mood changes. METHODS: This study was performed on 30 non-obese type 2 diabetic patients; 20 with clinically evident DPN and 10 without. Ten age-, sex-, and body mass index-matched healthy control subjects were also included. Patients and control were subjected to history taking, neurological examination, glycated hemoglobin, and clinical assessment of the sensori-motor manifestations by the neuropathy symptom score and neuropathy disability score. The autonomic nervous system was evaluated clinically by the systolic blood pressure response to standing and heart rate response to each of standing, Valsalva, and deep breath. Finally, sleep was assessed by one-night polysomnogram (PSG) followed by multiple sleep latency test in the next day. RESULTS: The study showed significant increase in sleep apnea syndromes in diabetic peripheral neuropathy patients compared to diabetic neuropathy free patients and healthy control (p < 0.0001). The sleep apnea was mainly obstructive and to a little extent mixed (obstructive/central) sleep apnea. The severity of sleep PSG abnormalities was positively correlated with the severities of sensory, motor, and autonomic manifestations. CONCLUSIONS: Non-obese type 2 diabetic patients complicated by peripheral neuropathy especially those having dysautonomia are at increased risk of developing sleep disordered breathing resulting in their excessive daytime sleepiness, decreased productivity, and poor glycemic control.

Sleep and psychiatric abnormalities in Gullian Barré Syndrome.

BACKGROUND: The sensori-motor manifestations of Guillain Barré Syndrome (GBS) are usually severe enough to mask the psychiatric and sleep problems which are in need for more attention for better functional outcome. METHODS: This study was performed on 20 GBS patients and 10 healthy controls. Patients were evaluated initially before immunotherapy using the Overall Disability Sum Score (ODSS), Neuropathy Pain Scale (NPS), Hamilton Anxiety Scale (HAS), Montgomery-Åsberg Depression Rating Scale (MADRS) and one-night polysomnography (PSG) followed by the multiple sleep latency test (MSLT) to evaluate the mean sleep latencies. Reevaluation was done using the same parameters 1 month after completing immunotherapy. RESULTS: The study showed significant increase in HAS in GBS patients which were positively correlated with the degree of motor disability. The mean sleep latencies of MSLT were significantly shortened and PSG showed shortening of the total sleep time, sleep efficiency, lowest O2 saturation and pulse transit time with increased wake after sleep onset, sleep stage transition index, apnea hypopnea index, desaturation index, arousal index, snore index and periodic limb movement index. One month after immunotherapy, the anxiety symptoms and sleep abnormalities showed non-significant improvements which were not correlated with the improvements in the sensori-motor manifestations. CONCLUSIONS: GBS patients usually have sleep and psychiatric abnormalities which may take longer time to improve than the sensori-motor manifestations. So, they need more attention in the management protocol for early patients' independence and return to usual daily activities.

Association of DSM-5 Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations.

Importance: Betel-quid (BQ) is the fourth most popular psychoactive agent worldwide. An emerging trend across Asia is the addictive consumption of BQ, which is associated with oral cancer and other health consequences. Objective: To investigate the validity and pattern of DSM-5-defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations. Design, Setting, and Participants: In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016. Main Outcomes and Measures: Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD. Results: Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5-defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5-defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P < .001), whereas those with mild BUD showed a 9.6-fold (95% CI, 1.8-56.8) risk (P = .01), those with moderate BUD showed a 35.5-fold (95% CI, 4.3-292.3) risk (P = .001), and those with severe BUD showed a 27.5-fold (95% CI, 1.6-461.4) risk of OPMD (P = .02). Individuals with moderate to severe BUD who used BQ and had the symptom of tolerance had a 153.4-fold (95% CI, 33.4-703.6) higher risk of OPMD than those who did not use BQ, and those with moderate to severe BUD who used BQ and had a larger amount or longer history of BQ use had an 88.9-fold (95% CI, 16.6-476.5) higher risk of OPMD than those who did not use BQ. Conclusions and Relevance: This international study gathered data about BQ users across 6 Asian populations, and it demonstrates that DSM-5 symptoms could fulfill a BUD construct. Most current Asian users of BQ already have BUD, which is correlated with risk of OPMD. Among individuals with moderate to severe BUD who used BQ, tolerance and a larger amount or longer history of BQ use are the key symptoms that correlated with enhanced risk of OPMD. These findings play an important role in providing a new indication of an additional psychiatric management plan for users of BQ who have BUD.

Perinatal outcomes following Helping Babies Breathe training and regular peer-peer skills practice among village midwives in Sudan.

BACKGROUND: Over 80% of deliveries in Sudan occur in rural areas, attended by village midwives (VMWs). OBJECTIVE: To determine the impact of Helping Babies Breathe training and regular peer-peer skills practice (HBBT+RPPSP) on VMW resuscitation practices and outcomes. METHODS: In a prospective community-based intervention study, 71/82 VMWs, reporting to six East Nile rural medical centres, with previous experience in community health research, consented to HBBT+RPPSP. Outcomes included changes in the resuscitation practices, fresh stillbirths (FSB) and early neonatal deaths <1 week (ENND). RESULTS: There were 1350 and 3040 deliveries before and after HBBT+RPPSP, respectively, with no significant differences between the two cohorts regarding maternal age, education or area of birth. Drying of the newborn increased almost tenfold (8.4%, n=113 to 74.9%, n=1011) while suctioning of the mouth/nose decreased fivefold (80.3%, n=2442 to 14.4%, n=437) following HBBT+RPPSP. Pre-HBBT+RPPSP9/18 (50%) newborns who had mouth-to-mouth ventilation died, compared with 13/119 (11%) who received bag-mask ventilation post-HBBT+RPPSP. Excluding 11 macerated fetuses, there were 55 perinatal deaths: 14 FSB/18 ENND (6 months pre-HBBT+RPPSP) and 10 FSB/13 ENND (18 months post-HBBT+RPPSP). FSB rates decreased from 10.5 to 3.3 per 1000 births ((χ2)=8.6209, p=0.003), while ENND rates decreased from 13.5 to 4.3 per 1000 live births ((χ2)=10.9369, p=0.001) pre-HBBT+RPPSP and post-HBBT+RPPSP, respectively. CONCLUSION: In a selected group of VMWs, HBBT+RPPSP was associated with improvements in newborn resuscitation and perinatal outcomes. HBBT+RPPSP could have immense benefits if propagated nationally to all 17 000 VMWs in Sudan.

Osteitis of the radius following Bacillus Calmette-Guérin vaccination at birth: a case report.

BACKGROUND: The Bacillus Calmette-Guérin vaccine, which is used for the prevention of tuberculosis, is considered protective against the severe forms of childhood tuberculosis. However, some serious adverse reactions including osteitis of the long bones can occur. CASE PRESENTATION: We report a case of an 18-month-old Sudanese girl who presented at the age of 3 months with swelling of her left forearm following Bacillus Calmette-Guérin vaccination administered at birth. Radiological and histological investigations confirmed tuberculous osteitis of the distal radius. She responded very well to antituberculous treatment with complete healing at follow-up visits. To the best of our knowledge this is the first case report of osteitis of the radius following Bacillus Calmette-Guérin vaccination described from Sudan. CONCLUSIONS: Bacillus Calmette-Guérin osteitis, although rare, should be considered a possible complication of the Bacillus Calmette-Guérin vaccination, and early diagnosis and treatment are essential.

Dietary habits, oral impact on daily performance and type 2 diabetes: a matched case-control study from Sudan.

BACKGROUND: It is evident that social and behavioural factors influence on individuals' general health and quality of life. Nevertheless, information about the influence of dietary habits on oral health-related quality of life is limited; especially among patients with type 2 diabetes (T2D). The aim of this study was to examine the influence of dietary habits and clinical oral health indicators on oral health-related quality of life in individuals with and without T2D. METHODS: A total of 149 T2D cases and 298 controls were recruited for this age and gender matched case-control study. Questionnaire-guided interviews were conducted to collect data about socio-demographic characteristics, consumption of food items per week (milk, meat, eggs, vegetables, fruits, sweets and bread) and oral impact on daily performance (OIDP). Plaque index, bleeding on probing, probing depth, tooth mobility, decayed, missing and filled teeth index (DMFT) and root caries were recorded. RESULTS: Difficulty with eating and sleeping were more frequently reported by T2D cases (23.5% and 16.1%, respectively) than by the controls (10.7% and 5.0%, respectively) (P < 0.01). After adjusting for diabetic status, plaque index, bleeding on probing, probing depth, tooth mobility, root caries, and missing teeth, those with high consumption of milk and sweets, were more likely than those with low consumption to report any oral impact (OIDP > 0). The corresponding ORs were 1.23 (1.01-4.89) and 2.10 (1.08-4.09), respectively. Participants with low consumption of meat and vegetables were more likely than their counterparts with high consumption to report any oral impact. The corresponding ORs were 0.46 (0.25-0.83) and 0.38 (0.17-0.87), respectively. There was a significant interaction between diabetic status and meat consumption as well as between diabetic status and bread consumption. CONCLUSIONS: Oral impacts were more frequently reported in T2D cases than controls. Independent of diabetic- and oral clinical status, dietary habits discriminated between individuals with and without oral impacts. The influence of meat and bread consumption on OIDP varied significantly according to T2D status.

Brain tuberculoma, an unusual cause of stroke in a child with trisomy 21: a case report.

BACKGROUND: Tuberculosis remains a public health problem in developing countries and is associated with lethal central nervous system complications. Intracranial tuberculomas occur in 13% of children with neurotuberculosis. Patients with trisomy 21 have an increased risk for stroke, which usually stems from cardiovascular defects. CASE PRESENTATION: We report a case of a 12-year-old Sudanese boy with trisomy 21 who was presented to our hospital with focal convulsions and right-sided weakness. The results of neuroimaging and histopathological examinations were consistent with cerebral tuberculoma. The patient had a good initial response to antituberculosis drugs and steroids. To the best of our knowledge, this is the first case report of multiple brain tuberculomas described in a child with trisomy 21. CONCLUSIONS: Patients with trisomy 21 have an increased risk for stroke. Our patient had an exceptional case of stroke caused by tuberculoma. The present case emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurological symptoms living in areas of high tuberculosis incidence.

Post-malaria myasthenia gravis

We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction of medial gaze following an attack of febrile illness. The child was admitted into a rural hospital where she was misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospital when her condition was not improving and where she developed the eye signs. She was diagnosed as a case of severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examination revealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors. Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorum communis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvement after pyridostigmine therapy which continued for three months. Regular follow-up showed no recurrence of her symptoms

Randomized Trials Comparing Inactivated Vaccine After Medium- or High-titer Measles Vaccine With Standard Titer Measles Vaccine After Inactivated Vaccine: A Meta-analysis.

BACKGROUND: Observational studies have suggested that girls have higher mortality if their most recent immunization is an inactivated vaccine rather than a live vaccine. We therefore reanalyzed 5 randomized trials of early measles vaccine (MV) in which it was possible to compare an inactivated vaccines [after medium-titer MV (MTMV) or high-titer MV (HTMV)] and a live standard titer MV (after an initial inactivated vaccine). METHODS: The trials were conducted in Sudan, Senegal, The Gambia and Guinea-Bissau. The intervention group received live MTMV or HTMV from 4 to 5 months and then an inactivated vaccine from 9 to 10 months of age; the control children received inactivated vaccine/placebo from 4 to 5 months and standard titer MV from 9 to 10 months of age. We compared mortality from 9 months until end of study at 3 to 5 years of age for children who received inactivated vaccine (after MTMV or HTMV) and standard titer MV (after inactivated vaccine), respectively. The original datasets were analyzed using a Cox proportional hazards model stratified by trial. RESULTS: The mortality rate ratio (MRR) was 1.38 (95% confidence interval: 1.05-1.83) after an inactivated vaccine (after MTMV or HTMV) compared with a standard titer MV (after inactivated vaccine). Girls had a MRR of 1.89 (1.27-2.80), whereas there was no effect for boys, the sex-differential effect being significant (P = 0.02). Excluding measles cases did not alter these conclusions, the MRR after inactivated vaccines (after MTMV or HTMV) being 1.40 (1.06-1.86) higher overall and 1.92 (1.29-2.86) for girls. Control for variations in national immunization schedules for other vaccines did not modify these results. CONCLUSIONS: After 9 months of age, all children had been immunized against measles, and mortality in girls was higher when they had received inactivated vaccines (after MTMV or HTMV) rather than live standard titer MV (after an inactivated vaccine).

Burst-mode optical label processor with ultralow power consumption.

A novel label processor subsystem for 100-Gbps (25-Gbps × 4λs) burst-mode optical packets is developed, in which a highly energy-efficient method is pursued for extracting and interfacing the ultrafast packet-label to a CMOS-based processor where label recognition takes place. The method involves performing serial-to-parallel conversion for the label bits on a bit-by-bit basis by using an optoelectronic converter that is operated with a set of optical triggers generated in a burst-mode manner upon packet arrival. Here we present three key achievements that enabled a significant reduction in the total power consumption and latency of the whole subsystem; 1) based on a novel operation mechanism for providing amplification with bit-level selectivity, an optical trigger pulse generator, that consumes power for a very short duration upon packet arrival, is proposed and experimentally demonstrated, 2) the energy of optical triggers needed by the optoelectronic serial-to-parallel converter is reduced by utilizing a negative-polarity signal while employing an enhanced conversion scheme entitled the discharge-or-hold scheme, 3) the necessary optical trigger energy is further cut down by half by coupling the triggers through the chip's backside, whereas a novel lens-free packaging method is developed to enable a low-cost alignment process that works with simple visual observation.