Pointer States in the Born-Markov Approximation.

Quantum states least affected by interactions with environment play a pivotal role in both foundations and applications of quantum mechanics. Known as pointer states, they surprisingly lacked a systematic description. Working within the Born-Markov approximation, we combine methods of group theory and open quantum systems and derive general conditions describing pointer states. Contrary to common expectations, they are in general different from coherent states. Thus the two notions of being "closest to the classical"-one defined by the uncertainty relations and the other by the interaction with the environment-are in general different. As an example, we study spin-spin and spin-boson models with an arbitrary central spin J.

Use of appropriate statistical tools in biomedical research: Current trend & status.

Background & objectives: Due to lack of appropriate statistical knowledge, published research articles contain various errors related to the design, analysis and interpretation of results in the area of biomedical research. If research contains statistical error, however, costly, it may be of no use and the purpose of the investigation gets defeated. Many biomedical research articles published in different peer reviewed journals may retain several statistical errors and flaws in them. This study aimed to examine the trend and status of application of statistics in biomedical research articles. Study design, sample size estimation and statistical measures are crucial components of a study. These points were evaluated in published original research articles to understand the use or misuse of statistical tools. Methods: Three hundred original research articles from the latest issues of selected 37 journals were reviewed. These journals were from the five internationally recognized publication groups (CLINICAL KEY, BMJ Group, WILEY, CAMBRIDGE and OXFORD) accessible through the online library of SGPGI, Lucknow, India. Results: Among articles assessed under present investigation, 85.3 per cent (n=256) were observational, and 14.7 per cent (n=44) were interventional studies. In 93 per cent (n=279) of research articles, sample size estimation was not reproducible. The simple random sampling was encountered rarely in biomedical studies even though none of the articles was adjusted by design effect and, only five articles had used randomized test. The testing of assumption of normality was mentioned in only four studies before applying parametric tests. Interpretation & conclusions: In order to present biomedical research results with reliable and precise estimates based on data, the role of engaging statistical experts need to be appreciated. Journals must have standard rules for reporting study design, sample size and data analysis tools. Careful attention is needed while applying any statistical procedure as, it will not only help readers to trust in the published articles, but also rely on the inferences the published articles draw.

Assessment of iodine nutrition of schoolchildren in Gonda, India, indicates improvement and effectivity of salt iodisation.

OBJECTIVE: To study the total goitre rate (TGR), urinary iodine concentration (UIC) and salt iodine content among schoolchildren in a previously endemic area for severe iodine deficiency disorder (IDD). DESIGN: Cross-sectional epidemiological study. SETTING: The study was carried out in the Gonda district (sub-Himalayan region) of North India. PARTICIPANTS: Nine hundred and seventy-seven schoolchildren (6-12 years) were studied for parameters such as height, weight, UIC and salt iodine content. Thyroid volume (TV) was measured by ultrasonography to estimate TGR. RESULTS: The overall TGR in the study population was 2·8 % (95 % CI 1·8, 3·8). No significant difference in TGR was observed between boys and girls (3·5 % v. 1·9 %, P = 0·2). There was a non-significant trend of increasing TGR with age (P = 0·05). Median UIC was 157·1 µg/l (interquartile range: 94·5-244·9). At the time of the study, 97 % of salt sample were iodised and nearly 86 % of salt samples had iodine content higher than or equal to 15 part per million. Overall, TGR was significantly lower (2·8 % v. 31·0 %, P < 0·001), and median UIC was significantly higher (157·1 v. 100·0 µg/l, P < 0·05) than that reported in the same area in 2009. CONCLUSIONS: A marked improvement was seen in overall iodine nutrition in the Gonda district after three and a half decades of Universal Salt Iodisation (USI). To sustainably control IDD, USI and other programmes, such as health education, must be continuously implemented along with putting mechanisms to monitor the programme at regular intervals in place.

Forecasting spread of COVID-19 using google trends: A hybrid GWO-deep learning approach.

The recent outbreak of COVID-19 has brought the entire world to a standstill. The rapid pace at which the virus has spread across the world is unprecedented. The sheer number of infected cases and fatalities in such a short period of time has overwhelmed medical facilities across the globe. The rapid pace of the spread of the novel coronavirus makes it imperative that its' spread be forecasted well in advance in order to plan for eventualities. An accurate early forecasting of the number of cases would certainly assist governments and various other organizations to strategize and prepare for the newly infected cases, well in advance. In this work, a novel method of forecasting the future cases of infection, based on the study of data mined from the internet search terms of people in the affected region, is proposed. The study utilizes relevant Google Trends of specific search terms related to COVID-19 pandemic along with European Centre for Disease prevention and Control (ECDC) data on COVID-19 spread, to forecast the future trends of daily new cases, cumulative cases and deaths for India, USA and UK. For this purpose, a hybrid GWO-LSTM model is developed, where the network parameters of Long Short Term Memory (LSTM) network are optimized using Grey Wolf Optimizer (GWO). The results of the proposed model are compared with the baseline models including Auto Regressive Integrated Moving Average (ARIMA), and it is observed that the proposed model achieves much better results in forecasting the future trends of the spread of infection. Using the proposed hybrid GWO-LSTM model incorporating online big data from Google Trends, a reduction in Mean Absolute Percentage Error (MAPE) values for forecasting results to the extent of about 98% have been observed. Further, reduction in MAPE by 74% for models incorporating Google Trends was observed, thus, confirming the efficacy of utilizing public sentiments in terms of search frequencies of relevant terms online, in forecasting pandemic numbers.

High Prevalence of Osteoporosis and Morphometric Vertebral Fractures in Indian Males Aged 60 Years and Above: Should Age for Screening Be Lowered?

Current guidelines recommend bone mineral density (BMD) measurement in asymptomatic men above age 70 years and vertebral fracture (VF) assessment above 80 years with T-score <-1.0 with risk factors. We studied the prevalence of osteoporosis and morphometric VF in asymptomatic males aged 60 years and above in North India. Free-living community-dwelling men (n = 241, age: mean ± standard deviation 68.0 ± 6.2 years) underwent a detailed history, physical examination, biochemical evaluation, and BMD measurements at 3 sites: lumbar spine, total hip (TH), and femoral neck (FN). Morphometric VF were assessed by instant vertebral assessment using Genant et al's semiquantitative method. We observed osteoporosis, osteopenia, and normal BMD in 19%, 56%, and 25% of subjects, respectively. The decade wise prevalence of osteoporosis in the age groups 60-70 years, 71-80 years, and >80 years was 16.9%, 17%, and 50%, respectively. Mean serum 25OHD levels were 17.2 ± 10.3 ng/mL. Vitamin D deficiency (<20 ng/mL) and secondary hyperparathyroidism (plasma intact parathyroid hormone >65 ng/mL) were present in 68.8% and 45.4%, respectively. VF were present in 29.6% subjects (grade I: 58%, grade II: 32.4%, and grade III: 8.8%). Age and iPTH had significant negative correlation with BMD at FN and TH. Serum 25OHD had no correlation with BMD at any site. The prevalence of VF was positively associated with age (p = 0.018) and negatively associated with BMD at FN (p = 0.002) and TH (p = 0.013). Osteoporosis and VF are common in asymptomatic Indian males aged 60 years and above. Screening for osteoporosis and instant vertebral assessment may be recommended earlier than currently existing guidelines.

Maximum Relative Entropy of Coherence: An Operational Coherence Measure.

The operational characterization of quantum coherence is the cornerstone in the development of the resource theory of coherence. We introduce a new coherence quantifier based on maximum relative entropy. We prove that the maximum relative entropy of coherence is directly related to the maximum overlap with maximally coherent states under a particular class of operations, which provides an operational interpretation of the maximum relative entropy of coherence. Moreover, we show that, for any coherent state, there are examples of subchannel discrimination problems such that this coherent state allows for a higher probability of successfully discriminating subchannels than that of all incoherent states. This advantage of coherent states in subchannel discrimination can be exactly characterized by the maximum relative entropy of coherence. By introducing a suitable smooth maximum relative entropy of coherence, we prove that the smooth maximum relative entropy of coherence provides a lower bound of one-shot coherence cost, and the maximum relative entropy of coherence is equivalent to the relative entropy of coherence in the asymptotic limit. Similar to the maximum relative entropy of coherence, the minimum relative entropy of coherence has also been investigated. We show that the minimum relative entropy of coherence provides an upper bound of one-shot coherence distillation, and in the asymptotic limit the minimum relative entropy of coherence is equivalent to the relative entropy of coherence.

Measuring Quantum Coherence with Entanglement.

Quantum coherence is an essential ingredient in quantum information processing and plays a central role in emergent fields such as nanoscale thermodynamics and quantum biology. However, our understanding and quantitative characterization of coherence as an operational resource are still very limited. Here we show that any degree of coherence with respect to some reference basis can be converted to entanglement via incoherent operations. This finding allows us to define a novel general class of measures of coherence for a quantum system of arbitrary dimension, in terms of the maximum bipartite entanglement that can be generated via incoherent operations applied to the system and an incoherent ancilla. The resulting measures are proven to be valid coherence monotones satisfying all the requirements dictated by the resource theory of quantum coherence. We demonstrate the usefulness of our approach by proving that the fidelity-based geometric measure of coherence is a full convex coherence monotone, and deriving a closed formula for it on arbitrary single-qubit states. Our work provides a clear quantitative and operational connection between coherence and entanglement, two landmark manifestations of quantum theory and both key enablers for quantum technologies.

A comparative evaluation of local application of the combination of eutectic mixture of local anesthetics and capsaicin for attenuation of venipuncture pain.

BACKGROUND: Topical capsaicin and eutectic mixture of local anesthetics (EMLA) have been found to be equally effective in minimizing the pain of venipuncture. After the injection of capsaicin, both tertiary amine local anesthetics and their quaternary ammonium derivatives can elicit a prolonged and predominantly sensory/nociceptor selective block. We hypothesized that the combined application of capsaicin and ELMA will be more effective than their individual effect, and lower concentrations of individual drugs in this mixture may also be associated with reduced side effects. METHODS: One hundred twenty patients were randomized into 4 equal groups. The control group received plain lubricant cream; the EMLA group received EMLA cream; the capsaicin group received Myolaxin ointment (containing oleoresin capsaicin equivalent to capsaicin 0.075% w/w, methylsalicylate IP 20% w/w, menthol IP 10% w/w, camphor USP 5% w/w, and eucalyptus oil IP 5% w/w); and the EMLA + capsaicin group received EMLA cream and Myolaxin ointment mixed in equal amounts. An anesthesiologist applied the cream to a 10-cm(2) area (site of venous cannulation) on the dorsum of the nondominant hand of the patient 1 hour before venipuncture and covered the area with an occlusive transparent dressing. Venipuncture was performed with an 18-gauge cannula after removing the dressing. Venipuncture pain was graded by the patient on a 0 to 10 visual analog scale, where 0 means no pain and 10 means worst imaginable pain. P values (after correction for multiple comparisons) of <0.05 were considered significant. RESULTS: The incidence of no pain on venous cannulation (primary end point) was 0% in the control group (0/30). The incidence of no pain were significantly higher in the EMLA group (32%, 9/28, 95% corrected confidence interval for the difference 12%-57%, P = 0.0025), capsaicin group (30%, 9/30, 10%-53%, P = 0.0031), and EMLA + capsaicin groups (47%, 14/30, 25%-69%, P < 0.0001). Severity of venipuncture pain as assessed by visual analog scale median (interquartile range) was lower in the EMLA + capsaicin group 1 (2) compared with other groups 3 (1), 1.5 (3), and 1.5 (3) for control, EMLA, and capsaicin, respectively (P < 0.001, P = 0.04, and P = 0.04, respectively). CONCLUSION: We observed that the combination of capsaicin and EMLA in a low concentration is as effective in managing venous cannulation as when applied as an individual drug alone. Larger studies with varying concentration of capsaicin and EMLA are recommended to more fully evaluate the potential advantages.

Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrhachia influence visual status?

BACKGROUND: Hyperproteinorrhachia associated with vestibular schwannomas (VSs) may influence visual status independent of the effect caused by raised intracranial pressure. The role of cisterna magna CSF protein levels (CMCP) in determining visual outcome in patients with large to giant vestibular schwannomas (VSs) was prospectively investigated. METHODS: The mean CMCP levels in VSs and control group; and, levels in VSs with or without visual deterioration were compared. Spearman's rank correlation coefficient tested for relationships between CMCP level with symptom duration and tumour volume (Kawamoto's method). Vision was regarded as normal when visual acuity was >6/18; and, deteriorated when it was between 6/18 and PL negative in the worse eye. Papilloedema (n = 26)/secondary optic atrophy (n = 6) and hydrocephalus (based on Evan's ratio, mild to moderate: n = 22; none: n = 18) were also recorded. The analysis of factors predicting diminished vision was done using logistic regression analysis (p < 0.05 significant). FINDINGS: There was a significant difference (p < 0.001) in mean CMCP levels between VS (456.3 SD 213.6 mg/dl) and control groups (96.3 SD 74.3 mg/dl). The mean CMCP levels in the VS group were also markedly higher than the ventricular mean protein levels. The CMCP levels in patients with visual diminution (<6/18 to PL negative; n = 23) was 561.4 SD 186.9 mg/dl and those without visual loss (n = 17) was 314.2 SD 160.8 mg/dl (p < 0.001). Their grade of visual diminution had a positive correlation with mean CMCP levels (p < 0.001). There was a negative correlation between total duration of symptoms and CMCP levels (p < 0.015). Logistic regression analysis using five independent factors (symptom duration, papilloedema/secondary optic atrophy, tumour volume, hydrocephalus and mean CMCP level) revealed that only CMCP level had a significant association with visual diminution. CONCLUSION: Elevated cisternal CSF proteins may play an important role in determining visual outcome in large to giant VSs. Ventricular CSF analysis is often unable confirm the presence of VS-associated cisternal hyperproteinorrhachia. High CMCP levels may influence decision-making while instituting a permanent CSF diversion for postoperative hydrocephalus or recalcitrant pseudomeningocoele.

Syndromic versus nonsyndromic atlantoaxial dislocation: do clinico-radiological differences have a bearing on management?

BACKGROUND: This prospective study attempts to study the clinico-radiological differences between patients with syndromic AAD (SAAD), non-syndromic AAD (NSAAD), and AAD with Klippel-Feil anomaly (AADKFA) that may impact management. METHODS: In 46 patients with AAD [SAAD (including Morquio, Down, Larson and Marshall syndrome and achondroplasia; n = 6); NSAAD(n = 20); and, AADKFS (n = 20)], myelopathy was graded as mild (n = 17, 37 %), moderate (15, 32.5 %) or severe (14, 30.5 %) based on Japanese Orthopaedic Association Score modified for Indian patients (mJOAS). Basilar invagination (BI), basal angle, odontoid hypoplasia, facet-joint angle, effective canal diameter, Ishihara curvature index, and angle of retroversion of odontoid and vertebral artery (VA) variations were also studied. STATISTICS: Clinico-radiological differences were assessed by Fisher's exact test, and mean craniometric values by Kruskal-Wallis test (p value ≤ 0.05 significant) RESULTS: Incidence of irreducible AAD in SAAD (n = 0), NSA AD (11.55 %) and AADKFS (n = 18.90 %) showed significant difference (p = 0.01). High incidence of kyphoscoliosis (83 %) and odontoid hypoplasia (83 %) in SAAD, and assimilated atlas and BI in NSAAD and AADKFA groups were found. In AADKFA, effective canal diameter was significantly reduced(p = 0.017) with increased Ishihara index and increased angle of odontoid retroversion; 61 % patients had VA variations. Thirty-five patients underwent single-stage transoral decompression with posterior fusion (for irreducible AAD) or direct posterior stabilization (for reducible AAD). Postoperative mJOAS evaluation often revealed persistent residual myelopathy despite clinical improvement. CONCLUSIONS: Myelopathy is induced by recurrent cord trauma due to reducible AAD in SAAD, and compromised cervicomedullary canal diameter in NSAAD and AADKFA. SAAD in children may be missed due to incomplete odontoid ossification or coexisting angular deformities. In AADKFA, decisions regarding vertebral levels to be included in posterior stabilization should take into consideration intact intervening motion segments and compensatory cervical hyperlordosis. Following VA injury, endovascular primary vessel occlusion/stenting across pseudoaneurysm preempts delayed rehemorrhage.

Quality of care as a determinant of health-related quality of life in ill-hospitalized adolescents at a tertiary care hospital in North India.

OBJECTIVE: To evaluate if quality of care (QoC) provided by hospital is a determinant of ill-hospitalized adolescent's health-related quality of life (HRQoL) from parent's perspective. DESIGN: Prospective cross-sectional study conducted at a tertiary care hospital of Northern India after institutional ethical approval. SETTING: Hospital in pediatric department of a tertiary care, teaching medical University in Lucknow, northern India. PARTICIPANTS: Sick adolescents aged between 10 and 19 years and hospitalized for four categories of illnesses, namely, acute infective; chronic infective, non-hemopoetic; hemopoetic disorders and miscellaneous. INTERVENTION: QOC assessment was done using 'Pyramid instrument' and HRQoL by culturally modified WHOQOL-BREF (World Health Organization Quality of Life-BREF). The Pyramid instrument comprises 43 questions to collect information about awareness of eight indices: namely illness, routines, accessibility, medical treatment, care processes, staff attitude, participation and staff work environment and scored on 1-4 Likert scale. WHOQOL-BREF has four domains: physical, psychological, social relations and environment and scored on 1-5 Likert scale. RESULTS: From January 2008 to December 2008, 300 adolescents with a mean age of 12.5 ± 2.6 years and 61.3% males were included. The pyramid instrument showed a substantial internal consistency (α = 0.88, P-value < 0.0001). The mean QoC was highest for medical treatment (0.76 ± 0.13) and lowest for participation (0.54 ± 0.16). The mean parent's report of child's HRQoL was highest for physical (42.8 ± 7.4) and lowest for environment domain (37.2 ± 7.1). Four QoC indices namely, medical treatment, care processes, staff attitude and participation had significant associations with the mean HRQoL. In a hierarchical linear regression, staff attitude was the only significant determinant of HRQoL (ß coefficient: 23.16, 95% confidence interval: 15.8-30.5, P-value < 0.0001). CONCLUSION: The Pyramid instrument is a reliable instrument for assessing parent's perception of QoC provided to hospitalized adolescents in Indian context. QoC was positively associated with HRQoL, thus, an increased focus on QoC especially staff attitude is likely to enhance adolescent's overall HRQoL.

Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India.

AIMS: The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients. METHODS: This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory. RESULTS: Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG. CONCLUSION: We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.

Correlates of Cigarette Smoking Among Adolescents in India.

BACKGROUND: The use of cigarettes/tobacco among adolescents is quite high in India. Worldwide, nearly, all (88%) initiation of smoking occurs before the age of 18 years. Smoking caused about 1 million deaths or 10% of all deaths in India, with about 70% of these deaths occurring at the ages of 30-69 years. AIMS AND OBJECTIVES: Different correlates of cigarette smoking among adolescents were investigated, which may help to improve public health interventions in India. MATERIALS AND METHODS: Global Youth Tobacco Survey data collected in India during 2009 were taken. Bivariate analysis, logistic regression, receiver operating characteristic, and nomogram were used to examine association between exposure and outcome variables. Cigarette smoking within the past 30 days preceding the survey was the outcome variable while independent variables were age, education, gender, parental smoking, people smoking at home/smoking in the presence of adolescents, felt boys/girls who smoke have more friends, accepting cigarette offered by one of the best friends, perception of attractiveness of boys/girls who smoke, perception smoking makes one loss or gain weight, and perception cigarettes smoking harmful. RESULTS: 11768 adolescents participated, of which 9951 (48% males and 52% female) responded on cigarette smoking. Current cigarette smoking was associated with female gender (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.52-0.90), parental smoking (OR: 1.00; 95% CI: 0.62-1.60), smoking cigarette at home (OR: 3.66; 95% CI: 2.64-5.09), and smoking cigarette in presence of adolescent (OR: 4.14; 95% CI: 2.92-5.87). Observed associations between the outcome and exposure variables reported in this study should be considered in the design of public health interventions. CONCLUSION: To eliminate smoking habits, efforts should also be made in the exploration of new ideas and their implementation by the public health experts in collaboration with international agencies, various nongovernmental organizations, and academic and research institutions. Let's plan for active action to make smoke-free environment based on evidence.

Efficacy of tadalafil in secondary Raynaud's phenomenon resistant to vasodilator therapy: a double-blind randomized cross-over trial.

OBJECTIVE: To evaluate the efficacy of tadalafil as add-on therapy in secondary RP resistant to vasodilators. METHODS: Patients with scleroderma and MCTD having four or more RP attacks per week despite being on vasodilators were randomized to receive either placebo or tadalafil (20 mg) on alternate days as add-on therapy to their current vasodilators for 6 weeks. After a 7-day washout, patients were crossed over to the other arm. Primary endpoints were improvement in the daily frequency and duration of RP episodes and RP condition score (RCS). Secondary outcome measures were healing of existing and appearance of new digital ulcers (DUs) and improvement in scleroderma-specific HAQ (SHAQ), quality of life (QoL), flow-mediated dilatation (FMD), patient and physician global assessment. RESULTS: Twenty-four of 25 recruited patients completed the study. All the patients were receiving calcium channel blockers and in addition 18 were receiving other vasodilators. During tadalafil therapy significant improvement in mean daily frequency, mean daily duration of RP and mean daily RCS were observed as compared with baseline and placebo. All the 24 digital lesions healed during tadalafil therapy as compared with 3/13 during the placebo treatment (P<0.0001). One new DU was reported during tadalafil therapy vs 13 during placebo therapy (P=0.0005). QoL, SHAQ, FMD, patient and physician global assessment significantly improved while on tadalafil. No serious adverse event was observed. CONCLUSION: Tadalafil as add-on therapy improves symptoms of RP, heals and prevents new DUs and improves QoL in patients with resistant secondary RP. TRIAL REGISTRATION: Clinicaltrials.gov, http://clinicaltrials.gov/, identifier: NCT00626665.

Bone marrow angiogenesis in multiple myeloma and its correlation with clinicopathological factors.

Increased angiogenesis has been found to be an adverse prognostic factor in solid tumors but evidences show that angiogenesis also plays an important role in hematological malignancies including multiple myeloma (MM). In this report we studied the various angiogenesis parameters like microvessel density (MVD) and total vascular area (TVA), on bone marrow biopsies in 50 newly diagnosed cases of MM. The aim was to study bone marrow angiogenesis in MM using light microscopy (MVD-A) and computerized image analyzer (MVD-B and TVA) and correlate it with clinical features, laboratory findings, histological features, and response to treatment on follow-up. Bone marrow biopsies of test cases (n = 50) were immunohistochemically stained with CD34 for visualization of microvessels. MVD-A (range 8-80; mean 50.4; SD 17.5), MVD-B (5.2-33.2; mean 16.3; SD 5.1), and TVA in percentage (range 0.42-7.20; mean 2.8; SD 1.5) were measured. Ten age- and sex-matched controls were studied and their parameters were taken as grade I. There was a significant correlation between these angiogenesis parameters (MVD-A vs MVD-B, Pearson's correlation coefficient (pcc) = 0.724; MVD-A vs TVA, pcc = 0.370; MVD-B vs TVA, pcc = 0.406). The angiogenesis was significantly higher in cases as compared to controls. Patients with residual disease had a higher MVD as compared to the complete responders. High tumor burden and diffuse pattern of infiltration were also associated with grade III MVD and TVA. Hence, it can be concluded that angiogenesis correlates with other histological features associated with prognosis and is also a good predictor for complete response in patients with multiple myeloma.

Ascitic form of sporadic acute viral hepatitis in children: a distinct entity for recognition.

BACKGROUND AND OBJECTIVES: This study looked at the frequency and differences in presentation, laboratory parameters, and outcome between ascitic acute viral hepatitis (AAVH) and nonascitic acute viral hepatitis (NAVH) in children. METHODS: Diagnosis of AVH was based on clinical features, >3-fold elevation of alanine aminotransferase, viral marker positivity (IgM antihepatitis A virus, IgM antihepatitis E virus, hepatitis B surface antigen, and IgM antihepatitis B core antigen) at presentation, absence of history of liver disease, and subsequent normalization within 6 months of clinical features and liver functions including sustained resolution of ascites in AAVH on follow-up. RESULTS: A total of 139 children (121 children with NAVH and 18 with AAVH, 12.9%) were studied. Children with AAVH in comparison with those with NAVH were younger (median age 4 vs 8 years), had lower frequency of prodrome (22% vs 51%), lower serum albumin (median 2.8 vs 3.7 g/dL), low total serum protein (median 6.5 vs 7.4 g/dL), and prolongation of prothrombin time (median 4.8 vs 1.05 seconds); all P < 0.03. No significant differences were found in sex, height standard deviation scores, duration of symptoms, liver span or consistency, transaminases, alkaline phosphatase, and etiology of NAVH versus AAVH. Among the AAVH group clinically detectable ascites was present in 38.9% (7/18), spontaneous bacterial peritonitis in 11%, and diuretics had to be used in 44% of cases. Ascites resolved in all of the cases in 8 weeks (94.4% cases in <4 weeks) and liver functions normalized in 17%, 50%, and 33% cases in <4, 4 to 8, and >8 weeks duration, respectively. CONCLUSIONS: We report AAVH as a distinct entity that affects younger children. This subgroup has compromised biosynthetic liver functions irrespective of viral etiology with total recovery.

Size of the tumor and pheochromocytoma of the adrenal gland scaled score (PASS): can they predict malignancy?

BACKGROUND: Size can predict malignancy in adrenocortical tumors, but the same extrapolation for pheochromocytomas (PCC) is controversial. The goal of this study was to find a correlation between the tumor size and malignant potential of PCC and determine whether the "Pheochromocytoma of the adrenal gland scaled score" (PASS) proposed by Thompson can be applied to predict malignancy. METHODS: A retrospective analysis of patients with PCC operated on from 1991 to 2007 revealed 98 PCC removed from 93 patients. Tumor size was available for 90 tumors. Six (6.4%) patients had proven malignancy. Five familial cases were excluded from the PASS analysis. RESULTS: Of the benign cases, none developed recurrence or metastasis. There were 54 (60%) tumors > 6 cm and 36 (40%) tumors ≤ 6 cm. All 12 PASS parameters were individually present in higher frequency in the >6-cm group; but the difference was not statistically significant except cellular monotony (p = 0.02). Overall, a PASS ≤ 4 was found in 57 patients. Mean PASS was statistically significantly higher in the >6-cm group (4.4 vs. 3.3, p = 0.04). Of the sporadic benign cases, 21 (41%) patients with tumor size > 6 cm had a PASS of >4, and none of them developed metastasis. PASS ≤ 4 was found in 25 (81%) PCC in the ≤6-cm group, and none developed metastases. PASS ≥ 4 was found in six (19%) patients in the ≤6-cm group, and none developed metastases. 68 patients completed 5-year follow-up, and the remaining had a mean follow-up of 28.7 months. No correlation was found between tumor size and PASS > 4 and PASS ≤ 4 (7.8 cm vs. 7.1 cm; p = 0.23). CONCLUSIONS: Presently there is not enough evidence to indict a large (>6 cm) PCC as malignant. Furthermore, PASS cannot be reliably applied to PCC for predicting malignancy.

Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India.

OBJECTIVE: The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India. DESIGN: In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content. RESULTS: A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27.7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5-15 ppm) of iodine from salt. CONCLUSIONS: Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

An evaluation of the efficacy of licorice gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study.

BACKGROUND: Postoperative sore throat (POST) contributes to postoperative morbidity. Licorice has been used as an expectorant in cough and cold preparations. In this study, we evaluated the efficacy of licorice gargle for attenuating POST. METHODS: Forty adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective lumber laminectomy were randomized into two groups of 20 each. Group C: received water; Group L: received 0.5 g licorice in water. Both groups received a 30 mL mixture for 30 s, 5 min before anesthesia which was standardized. The incidence and severity of POST at rest and on swallowing and side effects were assessed at 0, 2, 4, and 24 h, postoperatively. Severity of POST was assessed by visual analog scale (between 0 and 100 mm; where 0 means no sore throat and 100 means worst imaginable sore throat). Postextubation cough was assessed immediately after tracheal extubation. Data were analyzed by Z test and Fisher's exact test. P < 0.05 was considered as significant. RESULTS: POST (incidence and severity) was reduced in the Group L compared with Group C at rest and on swallowing for all time points (P < 0.05), except that the severity of POST at rest, at 24 h, was similar in both groups (P > 0.05). Postextubation cough was reduced in Group L compared with Group C (P < 0.05). There was no difference in side effects between groups (P > 0.05). CONCLUSION: Licorice gargle performed 5 min before anesthesia is effective in attenuating the incidence and severity of POST.