Conversations in the Gut: The Role of Quorum Sensing in Normobiosis.

An imbalance in gut microbiota, termed dysbiosis, has been shown to affect host health. Several factors, including dietary changes, have been reported to cause dysbiosis with its associated pathologies that include inflammatory bowel disease, cancer, obesity, depression, and autism. We recently demonstrated the inhibitory effects of artificial sweeteners on bacterial quorum sensing (QS) and proposed that QS inhibition may be one mechanism behind such dysbiosis. QS is a complex network of cell-cell communication that is mediated by small diffusible molecules known as autoinducers (AIs). Using AIs, bacteria interact with one another and coordinate their gene expression based on their population density for the benefit of the whole community or one group over another. Bacteria that cannot synthesize their own AIs secretly "listen" to the signals produced by other bacteria, a phenomenon known as "eavesdropping". AIs impact gut microbiota equilibrium by mediating intra- and interspecies interactions as well as interkingdom communication. In this review, we discuss the role of QS in normobiosis (the normal balance of bacteria in the gut) and how interference in QS causes gut microbial imbalance. First, we present a review of QS discovery and then highlight the various QS signaling molecules used by bacteria in the gut. We also explore strategies that promote gut bacterial activity via QS activation and provide prospects for the future.

Additive Manufacturing Applications in Biosensors Technologies.

Three-dimensional (3D) printing technology, also known as additive manufacturing (AM), has emerged as an attractive state-of-the-art tool for precisely fabricating functional materials with complex geometries, championing several advancements in tissue engineering, regenerative medicine, and therapeutics. However, this technology has an untapped potential for biotechnological applications, such as sensor and biosensor development. By exploring these avenues, the scope of 3D printing technology can be expanded and pave the way for groundbreaking innovations in the biotechnology field. Indeed, new printing materials and printers would offer new possibilities for seamlessly incorporating biological functionalities within the growing 3D scaffolds. Herein, we review the additive manufacturing applications in biosensor technologies with a particular emphasis on extrusion-based 3D printing modalities. We highlight the application of natural, synthetic, and composite biomaterials as 3D-printed soft hydrogels. Emphasis is placed on the approach by which the sensing molecules are introduced during the fabrication process. Finally, future perspectives are provided.

Consensus Statement of the IAP - Neurodevelopmental Chapter On Neurodevelopmental Disorders Habilitation Process: Strategic Plan for Prevention, Early Detection and Early Intervention.

JUSTIFICATION: Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders. PROCESS: Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors. OBJECTIVES: These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor. STATEMENT: There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/ NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs) / district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations.

Familial left ventricular noncompaction cardiomyopathy due to a novel mutation in the MYH 7 gene.

Left Ventricular Non Compaction (LVNC) is considered a unique cardiomyopathy according to the American Heart Association guidelines. The genetic ethology of LVNC in children is not completely understood although upto 41% of LVNC are thought to be genetic. We report a family with LVNC due to a novel mutation in the MYH 7 gene.

Diagnostic accuracy of MicroRNA 208b level with respect to different types of atrial fibrillation.

MicroRNAs (miRNA) are prerequisite for cardiovascular functions. miRNA miR-208 b is a cardio-specific miRNA with tissue (atrial) levels elevated in atrial fibrillation (AFib) and blood levels significantly elevated in myocardial infarction. We calculated serum levels of miR-208 b in paroxysmal and persistent AFib, embolic cerebrovascular accident patients with AFib as possible etiology and controls. There was a statistically significant change of miR-208 b levels in paroxysmal (p = 0.044) and persistent (p = 0.040) AFib patients, but not for embolic CVA patients. miR-208 b could serve as a new serum marker for paroxysmal AFib.

Enzymatic Protein Hydrolysates, and Ultrafiltered Peptide Fractions from Two Molluscs: Tympanotonus fuscatus var. radula (L.) and Pachymelania aurita (M.), with Angiotensin-I-Converting Enzyme Inhibitory and DPPH Radical Scavenging Activities.

CONTEXT: Multifunctional food protein-derived peptides attract a great deal of research interest due to their health-promoting benefits. Particularly, peptides that have both antihypertensive and antioxidant properties are desired, since both effects can be synergistic in prevention of cardiovascular diseases. AIM: The aim of this study was to investigate the angiotensin-I-converting enzyme (ACE) inhibitory and 2,2'-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activities of two species of the Nigerian periwinkles: Pachymelania aurita and Tympanotonus fuscatus. METHODS: The ACE inhibitory and 2,2'-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activities of simulated gastrointestinal digestion (SGID) hydrolysates and ultrafiltered (UF) fractions of T. fuscatus var. radula and P. aurita were determined. Human SGID of the protein extracts of T. fuscatus and P. aurita was carried out using pepsin, trypsin, and chymotrypsin, and the hydrolysates were fractionated into two by centrifugal ultrafiltration. The ACE inhibitory and DPPH radical scavenging activities of the crude hydrolysates and UF fractions were tested. The UF permeates were observed to have relatively higher activities and was subjected to gel filtration chromatography on Sephadex G-50. The chromatographic fractions showed absorbance at 215, 225, and 280 nm and were assayed for DPPH radical scavenging activity. RESULTS: The inhibitory effect of the fractions on ACE activity was reported as the minimum concentration of extract that caused 50% of the inhibition (IC50), where the IC50 values of P. aurita UF permeate and P. aurita UF retentate were 65.2 ± 6.4 and 301.9 ± 59.1 µg/ml, respectively, and that of T. fuscatus UF permeate (TFUFP) and T. fuscatus UF retentate were 54.93 ± 2.83 and 291.7 ± 8.6 µg/ml, respectively. CONCLUSION: This study suggests the potential health benefits of consuming T. fuscatus var. radula and P. aurita in health maintenance.

Antioxidant activity of the simulated gastro-intestinal digestion hydrolysate of two edible Nigerian marine molluscs: Tympanatonus fuscatus var radula (L.) and Pachymelania aurita (M.).

The multifunctional nature of antioxidant peptides makes them more attractive candidates as dietary ingredients in health maintenance. Therefore, food protein-derived antioxidant peptides are continuously investigated. This study investigated the in vitro antioxidant properties of hydrolysate and ultrafiltered peptide fractions of Pachymelania aurita and Tympanatonus fuscatus var radula-two commonly consumed marine molluscs known as periwinkles in southern Nigeria. Simulated gastrointestinal digestion (SGID) of soluble proteins of T. fuscatus and P. aurita was carried out using pepsin, trypsin and chymotrypsin, and the SGID hydrolysates were fractionated using a 3 kDa membrane filter. The hydrolysates and their fractions were investigated for anti-lipid peroxidation, hydroxyl radical scavenging activity (HRSA), ferric reducing antioxidant property (FRAP) and metal chelation activity, and they demonstrated clear antioxidant properties in all the assay models used. Low molecular weight fractions of the hydrolysates demonstrated more potent antioxidant activity than higher molecular weight fractions. This is profound in the metal chelation assay, where low molecular weight peptide fractions, T ≤ 3 kDa and P ≤ 3 kDa (IC50 values of 8.10 ± 0.011 and 5.56 ± 0.50 µg/ml respectively) had activity that is similar to that of EDTA (11.84 ± 0.89 µg/ml). Similar activity effects were observed in other assays where there was about 3-fold higher activity in low molecular weight fractions. These results demonstrate the presence of antioxidant peptide(s) in the protein hydrolysates of the periwinkles.

Teens and Spice: A Review of Adolescent Fatalities Associated with Synthetic Cannabinoid Use.

Synthetic cannabinoids (SCs) are commonly abused by adolescents with reported past year (2013) use in high school students between 3 and 10%. Standard adolescent postmortem toxicology does not include routine SC analysis, and thus, the true burden of fatalities related to SCs is unknown. A retrospective case review of two cases included scene investigation, interviews, autopsy, and toxicology. SCs were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Review of the eight adolescent SC-associated fatalities in the literature revealed five of eight cases had no other discernible cause of death on autopsy. Compounds detected included PB-22 (1.1 ng/mL), JWH-210 (12 ng/mL), XLR-11 (1.3 ng/mL), JWH-122, AB-CHMINACA (8.2 ng/mL), UR-144 (12.3 ng/mL), and JWH-022 (3 ng/mL). With synthetic drug use on the rise, forensic experts should have a high index of suspicion for the possibility of SC intoxication in adolescent fatalities with no other discernible cause of death.

Consensus Statement of the Indian Academy of Pediatrics on Newborn Hearing Screening.

JUSTIFICATION: Hearing impairment is one of the most critical sensory impairments with significant social and psychological consequences. Evidence-based, standardized national guidelines are needed for professionals to screen for hearing impairment during the neonatal period. PROCESS: The meeting on formulation of national consensus guidelines on developmental disorders was organized by Indian Academy of Pediatrics in Mumbai, on 18th and 19th December, 2015. The invited experts included Pediatricians, Developmental Pediatricians, Pediatric Neurologists and Clinical Psychologists. The participants framed guidelines after extensive discussions. OBJECTIVE: To provide guidelines on newborn hearing screening in India. RECOMMENDATIONS: The first screening should be conducted before the neonate's discharge from the hospital - if it 'fails', then it should be repeated after four weeks, or at first immunization visit. If it 'fails' again, then Auditory Brainstem Response (ABR) audiometry should be conducted. All babies admitted to intensive care unit should be screened via ABR. All babies with abnormal ABR should undergo detailed evaluation, hearing aid fitting and auditory rehabilitation, before six months of age. The goal is to screen newborn babies before one month of age, diagnose hearing loss before three months of age and start intervention before six months of age.

Fun During Knee Rehabilitation: Feasibility and Acceptability Testing of a New Android-Based Training Device.

PURPOSE: The initial goals of rehabilitation after knee injuries and operations are to achieve full knee extension and to activate quadriceps muscle. In addition to regular physiotherapy, an android-based knee training device is designed to help patients achieve these goals and improve compliance in the early rehabilitation period. This knee training device combines fun in a computer game with muscular training or rehabilitation. Our aim was to test the feasibility and acceptability of this new device. METHODS: 50 volunteered subjects enrolled to test out the computer game aided device. The first game was the high-striker game, which recorded maximum knee extension power. The second game involved controlling quadriceps muscular power to simulate flying an aeroplane in order to record accuracy of muscle activation. The subjects evaluated this game by completing a simple questionnaire. RESULTS: No technical problem was encountered during the usage of this device. No subjects complained of any discomfort after using this device. Measurements including maximum knee extension power, knee muscle activation and control were recorded successfully. Subjects rated their experience with the device as either excellent or very good and agreed that the device can motivate and monitor the progress of knee rehabilitation training. CONCLUSION: To the best of our knowledge, this is the first android-based tool available to fast track knee rehabilitation training. All subjects gave very positive feedback to this computer game aided knee device.

Centralized Newborn Hearing Screening in Ernakulam, Kerala , Experience Over a Decade.

A two-stage centralized newborn screening program was initiated in Cochin in January 2003. Infants are screened first with otoacoustic emission (OAE). Infants who fail OAE on two occasions are screened with auditory brainstem response (ABR). All Neonatal intensive care unit babies undergo ABR. This successful model subsequently got expanded to the whole district of Ernakulam, and some hospitals in Kottayam and Thrissur districts. Over the past 11 years, 1,01,688 babies were screened. Permanent hearing loss was confirmed in 162 infants (1.6 per 1000). This practical model of centralized newborn hearing screening may be replicated in other districts of our country or in other developing countries.

A Rare Cause of Death in a Woman: Iatrogenic Bladder Rupture in a Patient With an Indwelling Foley Catheter.

The CDC estimates that 12-25% of all hospitalized patients receive a urinary catheter during their hospital stay. Foley catheter failure is uncommon and Foley catheter failure associated with iatrogenic urinary bladder rupture (IUBR) is extremely rare. Symptoms are often nonspecific and thus misdiagnosis and delayed treatment is common. In this case report, we present a case of IUBR in a woman from Foley catheter failure, which ultimately led to her demise. This case adds to the literature the importance of suspicion for IUBR in patients with indwelling Foley catheters presenting with lower abdominal pain, hematuria, and decreased urine output.

Unnatural pregnancy deaths in Las Vegas: A descriptive study.

This study reports descriptive data assessing the prevalence of various risk factors and associations among pregnancy-related death by unnatural causes (PRUD), namely suicide, homicide and accidental causes in the city of Las Vegas. In 7215 women referred for autopsy, results showed PRUD 0.1% (n = 37) was more common in the Caucasian race 45.9% (n = 17), and ages 20-30 years 43.2% (n = 16). We also identified high prevalence of mental illness 51.3% (n = 19) and low prenatal care 37.8% (n = 14), particularly in our suicide cohort 100.0% (n = 13), and 15.3% (n = 2) respectively. Our study demonstrates the first investigation to identify the relationship between mental illness, particularly mood and substance disorders with pregnancy-related unnatural death.

Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience.

Significant hearing loss is one of the most common major abnormalities present at birth. If undetected, it will impede speech, language and cognitive development. Significant bilateral hearing loss is present in 1 to 3 per 1000 new born infants in the well-baby nursery population and in 2 to 4 per 100 infants in the intensive care unit population. It is an established fact that if hearing loss is present it should be detected and remediated before the baby is 6 months old. Neither universal screening nor a high risk screening, exists in majority of the hospitals in our country. In such a situation, a centralized facility catering to all hospitals in the city is a practical option. A two-stage screening protocol is projected, in which infants are screened first with otoacoustic emissions (OAE). Infants who fail the OAE are screened with auditory brainstem response (ABR). This two tier screening program (the second tier being ABR, which is more expensive) is required only for a selected few, making the program more practical and viable. It is the practicability of this program that makes it relevant for replication in other cities of the country, making it a model screening program for any developing country.

Evolución de los pacientes sometidos a cirugía de revascularización de miocardio con doble arteria mamaria interna en el Instituto Nacional Cardiovascular en el periodo 2012-2015 / Evolution of the patients undergoing to surgery of revascularization of myocardium with internal mammary artery double at the National Institute Cardiovascular in the period 2012-2015

Introducción: La revascularización de miocardio con utilización de una arteria mamaria interna es considerada actualmente el tratamiento quirúrgico de elección de la enfermedad isquémica coronaria multiarterial severa. Ya que la aplicación de esta técnica se ha asociado con resultados clínicos superiores en comparación con otros injertos, múltiples investigadores reportan que el empleo de doble arteria mamaria interna (AMI) podría mejorar dichos resultados. Metodología: La presente investigación es de tipo transversal en donde se revisaron historias clínicas. La población estuvo conformada por 36 pacientes con enfermedad isquémica coronaria multiarterial crónica quienes cumplieron con los criterios de selección. Resultados: La mortalidad a 30 días fue 0 por ciento. Se presentaron dos casos (5.56 por ciento) de infarto agudo de miocardio perioperatorio. No se presentó ningún caso de stroke ni de reintervención coronaria a 30 días. El 19.44 por ciento del total presentó infección de herida esternal superficial. Se presentaron 5 casos (13.88 por ciento) de sangrado postoperatorio excesivo. Conclusiones: La revascularización de miocardio con doble AMI no incrementa la mortalidad ni la incidencia de complicaciones mayores a 30 días. No existen diferencias significativas en la incidencia de infección de herida esternal tanto en el grupo de pacientes diabéticos/no diabéticos como en el grupo de pacientes con sobrepeso/IMC normal.

Introduction: Myocardial revascularization using internal mammary artery is currently considered the treatment of choice for severe multi-vessel ischemic coronary disease. Since the application of this technique has been associated with superior clinical outcomes compared with other grafts, multiple researchers report that the use of double internal mammary artery (IMA) could improve those results. Methodology: The current research is a cross-sectional study where medical records were reviewed. The population consisted of 36 patients who were diagnosed with multi-vessel chronic ischemic coronary disease who met the selection criteria. Results: The 30-day mortality was 0 per cent. Two cases (5.56 per cent) of acute perioperative myocardial infarction occurred. There were not any cases of stroke or coronary re-intervention after 30 days. 19.44 per cent of the total presented sternal wound infection. There were 5 cases (13.88 per cent) of excessive postoperative bleeding. Conclusion: Myocardial revascularization with double IMA does not increase mortality or the incidence of major complications after 30 days. There are no significant differences in the incidence of sternal wound infection both in the group of diabetic/non diabetic patients and in the group of overweight/normal BMI patients.

Hospital contact patterns and vulnerability to SARS-CoV-2 outbreaks

The transmission risk of SARS-CoV-2 within hospitals can exceed that in the general community because of more frequent close proximity interactions (CPIs). Heterogeneity of risk across wards is still poorly described. We measured CPIs in 15 clinical wards across three hospitals using wearable sensors over 36 hours in spring 2020. This data was combined with a transmission model to estimate and compare transmission risks across wards. We found a four-fold range of epidemic risk between wards, with patients frequently presenting high risk to patients and healthcare workers (HCWs). Using a simulation study, we then assessed the potential impact on global risk of targeting individuals for prevention based on their contact patterns. We found that targeting individuals with the highest cumulative contact hours was most impactful. This study reveals patterns of interactions between individuals in hospital during a pandemic and opens new routes for research into airborne nosocomial risk. One Sentence SummaryWe measured contacts between staff, patients and visitors in 15 hospital wards, and used models to predict epidemic risk and evaluate interventions.