Bilateral congenital choanal atresia in a preterm neonate - a rare neonatal emergency: A case report and review of literature.

Congenital choanal atresia results from the developmental failure of the nasal cavity to connect posteriorly with the nasopharynx. Although congenital choanal atresia is a well-recognized developmental disorder, it is an uncommon condition with an overall incidence of approximately 1 per 10,000 live births. The authors aim to highlight that in very preterm neonates, early diagnosis of bilateral congenital choanal atresia needs a high index of suspicion to avoid life-threatening events. It is considered as one of the neonatal emergencies, and repair is recommended in the first few weeks of life. The authors report an uncommon presentation of a very preterm neonate born at 31 weeks of gestation, diagnosed to have bilateral congenital choanal atresia with repeated failure of a trial of extubation. A transnasal endoscopic repair was performed in the eighth week of life to relieve the life-threatening nasal obstruction.

Vitamin-D Status and Clinical Outcomes in Critically Ill Children.

Aims and background: To study if 25-hydroxy cholecalciferol levels correlate with clinical outcomes in a cohort of critically ill children requiring pediatric intensive care unit (PICU) admission. Materials and methods: All children between the ages of 1 month and 14 years admitted to a PICU were included in this study. The vitamin-D level was measured within 24 hours of admission to the PICU for each patient. The patient's clinical details, vitamin-D levels, and biochemical parameters were collected. Results: There were 119 critically ill children (47 females and 72 males) admitted to our PICU. A total of 56 children were in the vitamin-D-deficient group, giving a prevalence of 47.05%. Sixty-three children had either insufficient or normal levels of 25(OH)D. Mean serum 25-OH cholecalciferol was 22.82 ± 16.48 nmol/L. There were no significant differences in O2 utilization, ventilation requirement, length of PICU stay, or the frequencies of use of antibiotics and steroids between the groups. The overall mortality rate in this study was 5.8% (three children died in the deficient group as compared with four in the insufficient/normal group). Conclusion: Even though vitamin-D deficiency was highly prevalent in the PICU, there were no statistically significant differences in O2 utilization, length of PICU stay, duration of mechanical ventilation, the use of antibiotics/steroids, and mortality outcome for both deficient and insufficient/normal groups. How to cite this article: Loni R, Zameer S, Hasan FA, Abbas I, Mesrati H, George J, et al. Vitamin-D Status and Clinical Outcomes in Critically Ill Children. Indian J Crit Care Med 2023;27(7):503-509.

Association between changes in urine output and successful indomethacin treatment for patent ductus arteriosus in preterm neonates.

AIM: To investigate the relationship between changes in urine output during indomethacin treatment and ductal closure in preterm neonates. METHODS: It is a retrospective study in neonates ≤32 weeks who had received two courses of indomethacin for PDA treatment over a 5-year period. Indomethacin courses with pre- and post-echocardiography confirmation of PDA status were included. Various urine output indices were collected and compared between successful versus unsuccessful indomethacin courses. Indomethacin treatment success was defined as: (i) where PDA closed or became haemodynamically insignificant (hisPDA) after treatment and (ii) only including neonates where PDA had complete closure after treatment. ROC analysis was performed to examine predictive ability of urine output during indomethacin for treatment success. RESULTS: One hundred and eight indomethacin courses (first course: 52, second course: 56) in 80 neonates were included. The mean gestational age and birthweight were 25.4 ± 1.3 weeks and 762 ± 165 g, respectively. Irrespective of the definition used, there was no significant differences seen in any of urine output parameters between groups, except for a higher urine output during indomethacin associated with complete PDA closure (3.6 ± 1.3 vs. 3.0 ± 1.0 mL/kg/h, P = 0.02). The incidence of significant oliguria, hyponatraemia and need to withhold/delay indomethacin doses were also similar across groups. CONCLUSION: Urine output was not a useful predictor of ductal response to indomethacin treatment in preterm neonates.

Microbial induced calcite precipitation can consolidate martian and lunar regolith simulants.

We demonstrate that Microbial Induced Calcite Precipitation (MICP) can be utilized for creation of consolidates of Martian Simulant Soil (MSS) and Lunar Simulant Soil (LSS) in the form of a 'brick'. A urease producer bacterium, Sporosarcina pasteurii, was used to induce the MICP process for the both simulant soils. An admixture of guar gum as an organic polymer and NiCl2, as bio- catalyst to enhance urease activity, was introduced to increase the compressive strength of the biologically grown bricks. A casting method was utilized for a slurry consisting of the appropriate simulant soil and microbe; the slurry over a few days consolidated in the form of a 'brick' of the desired shape. In case of MSS, maximum strength of 3.3 MPa was obtained with 10mM NiCl2 and 1% guar gum supplementation whereas in case of LSS maximum strength of 5.65 Mpa was obtained with 1% guar gum supplementation and 10mM NiCl2. MICP mediated consolidation of the simulant soil was confirmed with field emission scanning electron microscopy (FESEM), X-ray diffraction (XRD) and thermogravimetry (TG). Our work demonstrates a biological approach with an explicit casting method towards manufacturing of consolidated structures using extra-terrestrial regolith simulant; this is a promising route for in situ development of structural elements on the extra-terrestrial habitats.

Silk Fiber Multiwalled Carbon Nanotube-Based Micro-/Nanofiber Composite as a Conductive Fiber and a Force Sensor.

Silk cocoon fibers (SFs) are natural polymers that are made up of fibroin protein. These natural fibers have higher mechanical stability and good elasticity properties. In this work, we coated multiwalled carbon nanotubes (MWCNTs) on the surface of SFs using a simple stirring technique with vinegar as the medium. This SF-MWCNT micro-/nanofiber composite was prepared without any adhesives. The characterization results revealed that the SF-MWCNT micro-/nanofiber composite exhibited excellent electrical conductivity (995 Ω cm-1), tensile strength (up to 200% greater elongation), and durability characteristics. In addition, this micro-/nanofiber composite shows a change in resistance from 1450 to 960 Ω cm-1 for an applied mechanical force of 0.3-1 N kg-1. Based on our findings, SF-MWCNT micro-/nanofiber composite-based conductive fibers (CFs) and force sensors (FSs) were developed.

Selection of right medical students to combat rural shortage of doctors: could it be a solution? In perspective of Bangladesh.

This article was migrated. The article was marked as recommended. This comparative cross-sectional study was conducted to find the association between duration of service in rural health facilities and physicians' background factors to redress geographic imbalances in physician distribution. Among 6898 participants, information of 989 were retrieved from Directorate General of Health Services (DGHS), Minsitry of Health and Family Welfare (MOHFW), Bangladesh, through systematic sampling. Physicians who worked in rural health facilities for less than 3 years were labelled as group A, and those worked 3 years or more in rural places were put in group B. Background factors of two groups were compared and proportion of doctors living and working in rural areas was sorted. Among the participants, eighty percent were working in urban facilities and 50% worked in rural areas for less than three years. Proportion of females was about 30% and there was no significant differences between male and female in terms of duration of stay in rural areas in both groups (p=0.07). The association between place of completion of secondary school certificate (SSC) examination and duration of services in the rural areas were found statistically significant (p=0.003). Apart from this, no other background factors were found to be significantly associated.

Maternal and neonatal serum zinc level and its relationship with neural tube defects.

Neural tube defect (NTD) is a multi-factorial disorder in which nutritional, genetic and environmental factors are involved. Among the nutritional factors, low level of serum zinc has been reported from different parts of the world. This hospital-based case-control study was conducted with the objective of finding the relationship between serum zinc level in newborns and their mothers and NTDs in a Bangladeshi population. The study was conducted during August 2006-July 2007 at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka. In total, 32 mothers and their newborns with NTDs were included as cases and another 32 mothers with their normal babies were included as controls. Concentration of serum zinc was determined by pyro-coated graphite furnace atomic absorption spectrophotometer (GF-AAS). The mean age of the case and control mothers was 25.28 years and 24.34 years respectively. The mean gestational age of the case newborns was 36.59 weeks and that of the control newborns was 37.75 weeks. The mean serum zinc level of the case and control mothers was 610.2 microg/L and 883.0 microg/L respectively (p < 0.01). The mean serum zinc level of the case and control newborns was 723 microg/L and 1,046 microg/L respectively (p < 0.01). In both case and control groups, the serum zinc level of the newborns positively correlated with that of the mothers. The serum zinc levels of the mothers and newborns negatively correlated with NTDs. Mothers with serum zinc level lower than normal were 7.66 [95% confidence interval (CI) 2.5-23.28] times more likely to have NTDs compared to the normal zinc level of mothers. After adjusting for the zinc level of the newborns, parity, and age of the mothers, this risk reduced 1.61 times [confidence interval (CI) 95% 0.24-8.77]. On the other hand, the low serum zinc level of the newborns was 7.22 times more associated with NTDs compared to the newborns with the normal serum zinc level, which was statistically significant (p = 0.001). After adjusting for other factors, such as maternal age and parity, newborns with the low serum zinc level was found to be 9.186 times more likely to be associated with NTDs compared to newborns with normal serum zinc level. Based on the findings, it may be concluded that the low serum zinc levels of newborns may be associated with NTDs. To confirm these findings, a further study with a larger sample-size is recommended. Moreover, a follow-up study with zinc supplementation to pregnant women and its impact on NTDs is also recommended.

Microbially induced calcite precipitation using Bacillus velezensis with guar gum.

Mineral precipitation via microbial activity is a well-known process with applications in various fields. This relevance of microbially induced calcite precipitation (MICP) has pushed researchers to explore various naturally occurring MICP capable bacterial strains. The present study was performed to explore the efficiency of microbially induced calcite precipitation (MICP) via locally isolated bacterial strains and role of guar gum, which is a naturally occurring polymer, on the MICP process. The strains were isolated from local soil and screened for urease activity Further, the urease positive strain was subjected to urea and calcium chloride based medium to investigate the efficacy of isolated strain for microbial induced precipitation. Among screened isolates, the soil bacterium that showed urease positive behaviour and precipitated calcium carbonate was subjected to 16S rRNA gene sequencing. This strain was identified as Bacillus velezensis. Guar gum-a natural polymer, was used as a sole carbon source to enhance the MICP process. It was observed that the isolated strain was able to breakdown the guar gum into simple sugars resulting in two-fold increase in calcium carbonate precipitate. Major bio-chemical activities of isolated strain pertaining to MICP such as ammonium ion concentration, pH profiling, and total reducing sugar with time were explored under four different concentrations of guar gum (0.25%, 0.5%, 0.75% and 1% w/v). Maximum ammonium ion concentration (17.5 µg/ml) and increased pH was observed with 1% guar gum supplementation, which confirms augmented MICP activity of the bacterial strain. Microstructural analysis of microbial precipitation was performed using scanning electron microscopy (SEM) and X-ray diffraction (XRD) techniques, which confirmed the presence of calcium carbonate in different phases. Further, XRD and SEM based studies corroborated that guar gum supplemented media showed significant increase in stable calcite phase as compared to media without guar gum supplementation. Significant diverse group of nitrogenous compounds were observed in guar gum supplemented medium when subjected to Gas Chromatography-Mass spectrometry (GC-MS) profiling.

One-Pot Synthesis of Gel Glass Embedded with Luminescent Silicon Nanoparticles.

Preparation of highly luminescent glasses involves expensive and complicated processes and usually requires high temperature. In this work, we show that luminescent silicon (Si) nanoparticle (NP)- embedded silicate gel glasses can be developed under near-ambient conditions by a remarkably simple, one-pot strategy, without using any sophisticated instrumentation or technique. Simultaneous hydrolysis and reduction of (3-aminopropyl)triethoxysilane leads to the formation of colloidal Si nanocrystals that can be transformed to a glassy phase upon slow evaporation followed by freezing. Structural investigations reveal the formation of a sodium silicate gel glass framework having discernible shear bands, along with embedded Si NPs. High photoluminescence quantum yield (ca. 35-40%), low glass-transition temperature ( Tg ≈ 66-73 °C), strain-tolerant mechanical stability, and inexpensive preparation make the glass attractive for applications as display materials and photonic converters.

Reversible and repeatable phase transition at a negative temperature regime for doped and co-doped spin coated mixed valence vanadium oxide thin films.

Smooth, uniform mixed valance vanadium oxide (VO) thin films are grown on flexible, transparent Kapton and opaque Al6061 substrates by the spin coating technique at a constant rpm of 3000. Various elements e.g., F, Ti, Mo and W are utilized for doping and co-doping of VO. All the spin coated films are heat treated in a vacuum. Other than the doping elements the existence of only V4+ and V5+ species is noticed in the present films. Transmittance as a function of wavelength and the optical band gap are also investigated for doped and co-doped VO thin films grown on a Kapton substrate. The highest transparency (∼75%) is observed for the Ti, Mo and F (i.e., Ti-Mo-FVO) co-doped VO system while the lowest transparency (∼35%) is observed for the F (i.e., FVO) doped VO system. Thus, the highest optical band gap is estimated as 2.73 eV for Ti-Mo-FVO and the lowest optical band gap (i.e., 2.59 eV) is found for the FVO system. The temperature dependent phase transition characteristics of doped and co-doped VO films on both Kapton and Al6061 are studied by the differential scanning calorimetry (DSC) technique. Reversible and repeatable phase transition is noticed in the range of -24 to -26.3 °C.

ROS mediated high anti-bacterial efficacy of strain tolerant layered phase pure nano-calcium hydroxide.

The present work provides the first ever report on extraordinarily high antibacterial efficacy of phase pure micro-layered calcium hydroxide nanoparticles (LCHNPs) even under dark condition. The LCHNPs synthesized especially in aqueous medium by a simple, inexpensive method show adequate mechanical properties along with the presence of a unique strain tolerant behaviour. The LCHNPs are characterized by FTIR, Raman spectroscopy, XRD, Rietveld analysis, FE-SEM, TEM, TG-DTA, surface area, particle size distribution, zeta potential analysis and nanoindentation techniques. The LCHNPs have 98.1% phase pure hexagonal Ca(OH)2 as the major phase having micro-layered architecture made up of about ~100-200nm thick individual nano-layers. The nanomechanical properties e.g., nanohardness (H) and Young's modulus (E) of the LCHNPs are found to have a unique load independent behavior. The dielectric responses (e.g., dielectric constant and dielectric loss) and antibacterial properties are evaluated for such LCHNPs. Further, the LCHNPs show much better antibacterial potency against both gram-positive e.g., Staphylococcus aureus (S. aureus) and gram-negative e.g., Pseudomonas putida (P. putida) bacteria even in dark especially, with the lowest ever reported MIC value (e.g., 1 µg ml-1) against the P. putida bacterial strain and exhibit ROS mediated antibacterial proficiency. Finally, such LCHNPs has almost ~8-16% inhibition efficacy towards the development of biofilm of these microorganisms quantified by colorimetric detection process. So, such LCHNPs may find potential applications in the areas of healthcare industry and environmental engineering.

Nanocolumnar Crystalline Vanadium Oxide-Molybdenum Oxide Antireflective Smart Thin Films with Superior Nanomechanical Properties.

Vanadium oxide-molybdenum oxide (VO-MO) thin (21-475 nm) films were grown on quartz and silicon substrates by pulsed RF magnetron sputtering technique by altering the RF power from 100 to 600 W. Crystalline VO-MO thin films showed the mixed phases of vanadium oxides e.g., V2O5, V2O3 and VO2 along with MoO3. Reversible or smart transition was found to occur just above the room temperature i.e., at ~45-50 °C. The VO-MO films deposited on quartz showed a gradual decrease in transmittance with increase in film thickness. But, the VO-MO films on silicon exhibited reflectance that was significantly lower than that of the substrate. Further, the effect of low temperature (i.e., 100 °C) vacuum (10-5 mbar) annealing on optical properties e.g., solar absorptance, transmittance and reflectance as well as the optical constants e.g., optical band gap, refractive index and extinction coefficient were studied. Sheet resistance, oxidation state and nanomechanical properties e.g., nanohardness and elastic modulus of the VO-MO thin films were also investigated in as-deposited condition as well as after the vacuum annealing treatment. Finally, the combination of the nanoindentation technique and the finite element modeling (FEM) was employed to investigate yield stress and von Mises stress distribution of the VO-MO thin films.

Nanoindentation Study of Phase-pure Highly Crystalline Hydroxyapatite Coatings Deposited by Microplasma Spraying.

The present contribution has originated from a critical biomedical engineering issue e.g., loosening of metallic prostheses fixed with poly(methyl methylacrylate) (PMMA) bone cement especially in the case of hip joint replacement which ultimately forces the patient to undergo a revision surgery. Subsequently surgeons invented a cementless fixation technology introducing a bioactive hydroxyapatite (HAp) coating to the metallic implant surface. A wide variety of different coating methods have been developed to make the HAp coating on metallic implants more reliable; of which ultimately the plasma spraying method has been commercially accepted. However, the story was not yet finished at all, as many questions were raised regarding coating adherence, stability and bio-functionality in both in vitro and in vivo environments. Moreover, it has been now realized that the conventional high power plasma spraying (i.e. conventional atmospheric plasma spraying, CAPS) coating method creates many disadvantages in terms of phase impurity; reduced porosity limiting osseointegration and residual stresses which ultimately lead to inadequate mechanical properties and delamination of the coating. Further, poor crystallinity of HAp deposited by CAPS accelerates the rate of bioresorption, which may cause poor adhesion due to quick mass loss of HAp coatings. Therefore, in the present work a very recently developed method e.g. low power microplasma spraying method was utilized to coat HAp on SS316L substrates to minimize the aforementioned problems associated with commercial CAPS HAp coatings. Surgical grade SS316L has been chosen as the substrate material because it is more cost effective than Ti6Al4V and CoCrMo alloys.