Development of quaternary ammonium based acrylic copolymer antimicrobial coatings for polyurethane tracheoesophageal voice prostheses.

Tracheoesophageal voice prostheses (TEPs) are soft polymeric devices used to restore the voices of patients who have undergone total laryngectomy (TL). TEPs are implanted on the tracheoesophageal wall and come in direct contact with food, fluid and air. The environment of an implant is a budding ground for growth of microbes, leading to biofilm formation on the TEP surfaces. Biofilm formation is the leading cause of TEP failure because the biofilm affects its functioning by clogging the air passage over several weeks to a few months. Short useful lifespan of TEPs is a concern for patients undergoing total laryngectomy. To increase the useful lifespan of TEPs, it is imperative to prevent biofilm formation. This problem is addressed in the present study by developing a cationic crosslinked antimicrobial coating that prevents biofilm formation through contact killing. An acrylate-based tetracopolymer poly(methyl methacrylate [MMA]-co-nbutyl acrylate [BA]-co-dimethylaminoethyl methacrylate [DMAEMA]-co-2 hydroxyethyl methacrylate [HEMA]) was synthesized by free radical polymerization and was crosslinked by hexamethylene diisocyanate (THDI) trimer through urethane linkages. The crosslinked tetracopolymer coatings were subjected to quaternary ammonium formation through N-alkylation with iodooctane. Different variants of coatings were synthesized and the tetracopolymer with 22.5% MMA, 22.5% BA, 20% HEMA and 35% DMAEMA showed desirable results. The developed coatings were characterized and tested for safety as well as mechanical and antimicrobial efficacy. The final results showed that the developed coatings exhibited good cytocompatibility, haemocompatibility, mechanical properties and antimicrobial properties for 180 days against E. coli, S. aureus and C. albicans.

3-1-3 Weight averaging technique-based performance evaluation of deep neural networks for Alzheimer's disease detection using structural MRI.

Alzheimer's disease (AD) is a progressive neurological disorder. It is identified by the gradual shrinkage of the brain and the loss of brain cells. This leads to cognitive decline and impaired social functioning, making it a major contributor to dementia. While there are no treatments to reverse AD's progression, spotting the disease's onset can have a significant impact in the medical field. Deep learning (DL) has revolutionized medical image classification by automating feature engineering, removing the requirement for human experts in feature extraction. DL-based solutions are highly accurate but demand a lot of training data, which poses a common challenge. Transfer learning (TL) has gained attention for its knack for handling limited data and expediting model training. This study uses TL to classify AD using T1-weighted 3D Magnetic Resonance Imaging (MRI) from the Alzheimer's Disease Neuroimaging (ADNI) database. Four modified pre-trained deep neural networks (DNN), VGG16, MobileNet, DenseNet121, and NASNetMobile, are trained and evaluated on the ADNI dataset. The 3-1-3 weight averaging technique and fine-tuning improve the performance of the classification models. The evaluated accuracies for AD classification are VGG16: 98.75%; MobileNet: 97.5%; DenseNet: 97.5%; and NASNetMobile: 96.25%. The receiver operating characteristic (ROC), precision-recall (PR), and Kolmogorov-Smirnov (KS) statistic plots validate the effectiveness of the modified pre-trained model. Modified VGG16 excels with area under the curve (AUC) values of 0.99 for ROC and 0.998 for PR curves. The proposed approach shows effective AD classification by achieving high accuracy using the 3-1-3 weight averaging technique and fine-tuning.

The Management of Intracardiac Thrombus in a COVID-19 Patient Using IV Thrombolytics: A Case Report.

The coronavirus disease 2019 (COVID-19) pandemic has unveiled numerous clinical challenges, particularly its association with thrombotic events, which significantly contribute to morbidity and mortality. While thrombotic complications such as arterial and venous thromboembolism (VTE) are well-documented, instances of intracardiac thrombus are notably rare. This case report discusses a 60-year-old male with COVID-19 who came to the hospital due to respiratory distress. Despite treatment with remdesivir, the patient's condition worsened prompting further workup. His nuclear medicine (NM) ventilation-perfusion scan was inconclusive, but a 2D echocardiogram showed an intracardiac thrombus in the right atrium (RA) and right ventricle (RV). As the patient's condition worsened, necessitating a transition from nasal cannula to high-flow nasal cannula, a decision was made to treat him with intravenous (IV) thrombolytic therapy. The patient received 100 mg IV alteplase and IV heparin, resulting in significant respiratory improvement and symptomatic relief. A repeat echocardiogram after 48 hours showed normal ejection fraction and complete thrombus resolution. In conclusion, this case highlights the complex link between COVID-19 infection and prothrombotic states, leading to severe complications such as intracardiac thrombus in transit. The successful treatment of this patient through a multidisciplinary approach and thrombolytic therapy underscores the importance of prompt recognition and intervention in high-risk cases.

Giant Retinal Astrocytoma: A Case Report of an Uncommon Presentation of Tuberous Sclerosis in a Young Female.

Tuberous sclerosis (TS) is a rare multisystem autosomal dominant genetic disorder with characteristic pathognomonic genetic mutations involving the TSC (tuberous sclerosis complex) group of genes. Ocular signs are fairly common and include an achromic patch and retinal astrocytic hamartomas, which usually have a maximum size of between 0.5 and 5 mm. The incidence of tuberous sclerosis is estimated to be 1 in 5000-10,000 individuals, with both familial and sporadic cases reported. The diagnostic criteria for tuberous sclerosis include the presence of major and/or minor clinical features as well as genetic mutations. We present the case of a 15-year-old girl, presented with a history of seizures and blurred vision. Physical examination revealed angiofibroma on the face. Further evaluation, including contrast-enhanced MRI of the brain and ophthalmological consultation, led to the diagnosis of tuberous sclerosis. Additional imaging studies confirmed the presence of subependymal giant cell astrocytoma, retinal astrocytoma, lymphangioleiomyomatosis in the lungs, and renal angiomyolipoma. This case highlights the importance of considering tuberous sclerosis in patients presenting with seizures and ocular symptoms. This case sheds light on early diagnosis and appropriate management which are crucial in preventing complications and improving patient outcomes.

Development of iodine based sustained release antimicrobial coatings for polyurethane voice prostheses.

Voice prostheses are known to fail in few weeks to several months of implantation due to the clogging mainly caused by microbial biofilm formation, which is a cause of concern. Iodine is a known broad-spectrum biocide and is reported to easily form complexes with various polymers. For long term device disinfection, strong iodine complexation that offers sustained iodine release for a prolonged period is essential. The present research work deals with the synthesis of a poly(methyl methacrylate-n-butyl acrylate-N-vinyl-2-pyrrolidone) (poly[MMA-BA-NVP]) tercopolymer through free radical polymerization for surface coating thermoplastic polyurethane (TPU) based voice prostheses. The NVP content in the tercopolymer was varied from 20% to 50% to optimise iodine loading and subsequent release. Base TPU coated with the tercopolymer was treated with 4% aqueous iodine solution at room temperature (28 ± 3 °C) for two hours. It was observed that the tercopolymer containing 35% N-vinyl-2-pyrrolidone (NVP), 32.5% methyl methacrylate (MMA) and 32.5% butyl acrylate (nBA) gave a stable coating on TPUs together with sustained iodine release for a prolonged period. Furthermore, the tercopolymer coated and iodine loaded TPUs exhibited excellent antimicrobial activity against Candida albicans, Staphylococcus aureus and Escherichia coli.

The Management of a Urinary Bladder Leak in a Patient with Radiation Cystitis.

Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.

A rare case of Balo's disease in a young adult: A clinical presentation and management.

Key Clinical Message: Accurate diagnosis of rare neurological conditions like Balo's concentric sclerosis (BCS) is challenging but crucial for tailored treatment. Interdisciplinary collaboration and further research are essential to advance our understanding. Abstract: This case report presents a 32-year-old female patient with a puzzling neurological condition characterized by feverish feelings, joint pain, unclear speech, and an unsteady gait. Initial management did not lead to improvement, and further examination revealed neurological involvement and joint tenderness without signs of inflammatory arthritis. Laboratory investigations ruled out infectious and autoimmune causes. Magnetic resonance imaging (MRI) showed well-defined lesions with concentric rings, leading to a diagnosis of Balo' concentric sclerosis. Treatment with intravenous methylprednisolone resulted in limited improvement. This case highlights the importance of thorough evaluation and collaboration in diagnosing rare neurological conditions. Further research is needed to enhance the understanding and treatment of rare neurological disorders.

Stem Rot of Pearl Millet Prevalence, Symptomatology, Disease Cycle, Disease Rating Scale and Pathogen Characterization in Pearl Millet-Klebsiella Pathosystem.

The oldest and most extensively cultivated form of millet, known as pearl millet (Pennisetum glaucum (L.) R. Br. Syn. Pennisetum americanum (L.) Leeke), is raised over 312.00 lakh hectares in Asian and African countries. India is regarded as the significant hotspot for pearl millet diversity. In the Indian state of Haryana, where pearl millet is grown, a new and catastrophic bacterial disease known as stem rot of pearl millet spurred by the bacterium Klebsiella aerogenes (formerly Enterobacter) was first observed during fall 2018. The disease appears in form of small to long streaks on leaves, lesions on stem, and slimy rot appearance of stem. The associated bacterium showed close resemblance to Klebsiella aerogenes that was confirmed by a molecular evaluation based on 16S rDNA and gyrA gene nucleotide sequences. The isolates were also identified to be Klebsiella aerogenes based on biochemical assays, where Klebsiella isolates differed in D-trehalose and succinate alkalisation tests. During fall 2021-2023, the disease has spread all the pearl millet-growing districts of the state, extending up to 70% disease incidence in the affected fields. The disease is causing considering grain as well as fodder losses. The proposed scale, consisting of six levels (0-5), is developed where scores 0, 1, 2, 3, 4, and 5 have been categorized as highly resistant, resistant, moderately resistant, moderately susceptible, susceptible, and highly susceptible disease reaction, respectively. The disease cycle, survival of pathogen, and possible losses have also been studied to understand other features of the disease.

Achieving High-Temperature Phosphorescence by Organic Cocrystal Engineering.

Organic phosphors offer a promising alternative in optoelectronics, but their temperature-sensitive feature has restricted their applications in high-temperature scenarios, and the attainment of high-temperature phosphorescence (HTP) is still challenging. Herein, a series of organic cocrystal phosphors are constructed by supramolecular assembly with an ultralong emission lifetime of up to 2.16 s. Intriguingly, remarkable stabilization of triplet excitons can also be realized at elevated temperature, and green phosphorescence is still exhibited in solid state even up to 150 °C. From special molecular packing within the crystal lattice, it has been observed that the orientation of isolated water cluster and well-controlled molecular organization via multiple interactions can favor the structural rigidity of cocrystals more effectively to suppress the nonradiative transition, thus resulting in efficient room-temperature phosphorescence and unprecedented survival of HTP.

Lived experiences of caregivers and survivors of paediatric spinal cord injury: A scoping review of qualitative studies.

CONTEXT: Paediatric Spinal Cord Injury (SCI) has an impact on a child's dynamic development, disrupting their participation in school, community, and social relationships while simultaneously causing repercussions on their caregiver's life. The rare nature of paediatric SCI calls for a detailed inspection of the literature from the perspective of children and their caregivers. OBJECTIVE: This scoping review of qualitative research determines the extent of literature from perspective of caregivers and individuals with paediatric SCI. METHODS: 9351 full-text published articles were identified from CINAHL, Ovid, PubMed, and Scopus between 2001 and 2021. After duplicate deletion, 8354 articles were left, and 103 full-text articles were assessed for their eligibility. Finally, eight articles were assessed for their relevance. Key themes that emerged from the data were summarized, compared, and synthesized. RESULTS: Six studies were from the perspectives of individuals with SCI and two from caregiver's perspective. Three major themes were identified from caregivers' opinion studies: "Obstacles to community participation"; "Unmet needs related to a child with SCI"; and "Radiating effect on caregivers' lives"; whereas five were obtained from individuals with paediatric SCI opinion studies: "Adjusting to life with SCI"; "Hardships & hardiness"; "Peers & family/emotional support"; "Perception of self & body-image post injury"; and "Transitioning into post-traumatic life". CONCLUSION: There is a need for more specialized rehabilitation centers and an accessible environment in public spaces. Also, the review sheds some light on the discriminatory attitude of society as a whole, which can be improved by providing proper knowledge and awareness of SCI.

Parent's Perspective of Problems Faced during the COVID-19 Pandemic Lockdown on the Care of Children with Epilepsy: A Qualitative Study.

Background: COVID-19 has significantly impacted the care of children with chronic illness. There is a paucity of data on issues faced by parents of children with epilepsy (CWE) in an Indian setup. Objectives: The objective was to describe the parental perspective of the problems faced by them on the care of their CWE during the first wave of the COVID-19 pandemic. Materials and Methods: Parents of CWE who physically visited the clinic for their follow-up visit were asked to narrate their experiences about the problems they faced during the first lockdown due to COVID-19. The narratives were audio recorded, and transcripts were analyzed using thematic analysis to arrive at broad themes. Results: Four broad themes were identified: transport-related issues, medication-related issues, issues related to doctor consultation, and diagnostic delay. Limited transportation facilities, lack of appropriate social distancing norms in public transport and outpatient units, rigorous frisking by personnel during travel, fear of viral transmission during outpatient visits, nonavailability of antiseizure medications (ASMs) in local markets, lack of discounts by pharmacy, change of brands of ASM, and inability to undergo scheduled diagnostic investigations were some of the major issues raised by parents of CWE. Conclusion: Parents of CWE had trouble in transport to the hospital, inadequate access to ASMs, difficulties in doctor consultation, and delays in diagnostic investigations during the first COVID-19 pandemic lockdown.

Analysis of Risk Factors for Cholelithiasis: A Single-Center Retrospective Study.

Objectives Cholelithiasis poses a considerable medical burden worldwide. While its pathogenesis is multifactorial, identifying the key risk factors is essential for understanding the disease and improving patient care. This study aims to investigate the potential associations between demographic, clinical, and laboratory variables and the development of cholelithiasis. Methods This single-center retrospective study was conducted at Malla Reddy Institute of Medical Sciences, Hyderabad, India, over one month. A total of 200 patients diagnosed with cholelithiasis were included. Data were extracted from electronic health records and the patients using a questionnaire, including demographic information (age, gender), clinical data including body mass index (BMI), and comorbidities. Statistical analyses were conducted to determine the associations between risk factors and cholelithiasis. Results The frequency of cholelithiasis is found to be higher in the female gender and patients with obesity, sedentary lifestyle and hypertension as compared to male patients, and the risk of cholelithiasis also increases with age. Females demonstrated a higher prevalence of cholelithiasis, with an odds ratio (OR) and confidence interval (CI) of 1.4, 95% CI [1.1, 1.7], p < 0.05). Obese individuals (BMI ≥ 30) had 2.2 times higher odds of cholelithiasis compared to those with normal BMI (< 24.9) (OR = 2.2, 95% CI [1.7, 2.9], p < 0.001). The presence of diabetes significantly increased the odds of cholelithiasis by 1.6 times (OR = 1.6, 95% CI [1.2, 2.1], p < 0.01). Overweight individuals (BMI: 25-29.9) were associated with 1.4 times higher odds of cholelithiasis (OR = 1.4, 95% CI [1.1, 1.9], p < 0.05). Conclusion Our study identified age, gender, BMI, diabetes, and obesity as significant risk factors for cholelithiasis. These findings underscore the importance of targeted interventions and lifestyle modifications to mitigate cholelithiasis risk and improve patient outcomes. Further research, including prospective multicentric studies, must validate these findings and explore potential underlying mechanisms.

A Review of Electrochemical Techniques for Corrosion Monitoring - Fundamentals and Research Updates.

Interculturally, corrosion has been counted as one of the most expensive factors toward the retrogression of concrete and metallic structures resulting in huge monetary losses and unanticipated loss of life. To a large extent, corrosion-related catastrophes can be avoided by having the ability to monitor corrosion before structural integrity is jeopardized. This paper critically reviews the various accustomed electrochemical techniques utilized for corrosion monitoring in terms of their definition, timeline, experimental set-up, advantages, and shortcomings. Additionally, literature exploiting these techniques as their corrosion detection technique has been focused on here. Furthermore, a comparison between recently reported methods has been made to provide better insights into the research progress in this arena.

Proteolytically Stable ααγ-Hybrid Peptides Inhibit the Aggregation and Cytotoxicity of Aß42.

The recent approval of antibody-based therapy for targeting the clearance of amyloid plaques fuels the research in designing small molecules and peptide inhibitors to target the aggregation of Aß-peptides. Here, we report that the 15-residue ααγ-hybrid peptide not only inhibits the aggregation of soluble Aß42 into fibrils but also disintegrates the aggregated Aß42 fibrils into smaller assemblies. Further, the hybrid peptide completely rescues neuronal cells from the toxicity of Aß42 at equimolar concentrations. The shorter 10- and 12-mer peptides showed weak aggregation inhibition activity, while the fully hydrophobic 15-mer ααγ-hybrid peptide analogue showed no aggregation inhibition activity. Further, the 15-mer ααγ-hybrid peptide showed resistance against trypsin digestion and also nontoxic to the neuronal cells. The CD revealed that the peptide upon interaction induces a helix-type conformation in the Aß42. This is in sharp contrast to the ß-sheet conformation of Aß42 upon incubation. The two-dimensional-NMR (2D-NMR) analysis revealed a large perturbation in the chemical shifts of residues at the N-terminus. The presence of 15-mer peptide at an equimolar concentration of Aß42 showed less tendency for aggregation and also exhibited nontoxicity to the neuronal cells. The results reported here may be useful in designing new therapeutics for Alzheimer's disease.

Bilateral sixth nerve palsy with subdural hematoma: a unique presentation of B12 deficiency.

Vitamin B12 is inextricably associated with the development and maintenance of neuronal functions. It is classically associated with subacute combined degeneration and peripheral neuropathy; however, cranial neuropathy is uncommon. We observed the rarest neurological manifestation of B12 deficiency. A 12 months infant had history of lethargy, irritability, anorexia, paleness, vomiting, and neurodevelopmental delay for 2 months. He also developed inattention and altered sleep pattern. His mother noticed bilateral inward rotation of both eyes. On examination, the infant had bilateral lateral rectus palsy. The infant was found to have anemia (7.7g/dL) and severe B12 deficiency (74pg/mL). On MRI, there was cerebral atrophy, subdural hematoma (SDH) and wide cisternal spaces and sulci. On supplementation with cobalamin, he improved clinically though mild restriction of lateral gaze on the left side persists. Follow up MRI showed significant improvement in cerebral atrophy with resolution of SDH. To date, such clinical presentation of B12 deficiency has never been reported. The authors suggest B12 supplementation for at risk population esp at antenatal stage and lactating mothers in national programs. The treatment of this condition should be initiated early to prevent long term sequelae.

Cyclization of N-Boc-(E)-α,ß-unsaturated γ-amino acid active esters into N-Boc-(Z)-α,ß-unsaturated γ-lactams through E → Z isomerization.

Here, we are reporting the spontaneous transformation of the active esters of N-Boc protected E-α,ß-unsaturated γ-amino acids into the corresponding Z-α,ß-unsaturated γ-lactams with concomitant E → Z isomerization in the presence of a weak base. No cyclization was observed in the absence of the base. Analysis revealed that amide γ-NH is crucial for both lactamization and E → Z isomerization. This mild transformation provides easy access to the synthetically challenging α,ß-unsaturated γ-lactams and also gives new insights into the E → Z isomerization of double bonds.

Stereoselective synthesis of backbone extended π-conjugated amino esters.

Utilization of the Wittig reaction to synthesize conjugative multiple double bonds is rare. We examined the utility of the Wittig reaction to construct conjugative two and three carbon-carbon double bonds on the N-protected amino acid backbone. The ethyl esters of N-Boc amino acids with multiple carbon-carbon double bonds in the backbone were isolated in excellent yields with exceptional E-selectivity of the double bonds. The allylic alcohols of α,ß-unsaturated γ-amino esters were selectively synthesized from the DIBAL-H and BF3·OEt2. The allylic alcohols were transformed into aldehydes using IBX oxidation. Using this protocol, we synthesized ethyl esters of N-Boc-(E,E)-α,ß,γ,δ-unsaturated ε-amino acids with various side-chain functionalities and ethyl esters of N-Boc-(E,E,E)-α,ß,γ,δ,ε,ζ-unsaturated η-amino acids with excellent yields. We speculated the exceptional E-selectivity is probably due to the stabilization of the planar transition state of the Wittig reaction with the double bond p-orbitals. No racemization was observed in the synthesis of amino acids. The reported process may serve as an excellent route to synthesize multiple conjugative carbon-carbon double bonds.

The Reliability of Kaplan's Cardinal Line as a Potential Surface Marker for the Superficial Palmar Arch During Carpal Tunnel Release: An Anatomical Study With Surgical Perspective.

Purpose Kaplan's cardinal line (KCL) provides a more accurate reference point to the superficial palmar arch (SPA). The aim was to determine the KCL-SPA distances and their relationship with the other defined superficial landmarks, such as distal wrist crease (DWC) or distal portion of the transverse carpal ligament (TCL) or DWC-TCL distance. The objective was to determine the distal limit of the incision made during carpal tunnel release (CTR). Methods Sixty hands were dissected after KCL was drawn on each hand using standard methods. The distance from KCL to the SPA was measured along the radial and ulnar borders of the ring finger and recorded as radial and ulnar KCL-SPA distance, respectively. The distance between the DWC and the distal portion of the TCL was also measured (DWC-TCL). Correlation analysis was done between the DWC-TCL and KCL-SPA distance. The ratios between the radial and ulnar KCL-SPA distance and DWC-TCL distance were calculated and mentioned as radial and ulnar Kaplan cardinal index, respectively. Results KCL-SPA distance was 6.8±3.7 mm along the radial border and 6.6±3.6 mm along the ulnar border of the ring finger. The DWC-TCL distance was 29.4±1.2 mm. The means of radial and ulnar Kaplan cardinal indices were 0.23 and 0.22, respectively. A significant correlation was found between the DWC-TCL distance and the KCL-SPA distances. Conclusion Clinically, KCL can be appraised as a predictable surface landmark in limiting the distal-most extent of the incision during CTR and protecting SPA from transection. The SPA was found to lie at a variable distance from the KCL, and the minimum distance was found to be 3.3 mm. This should be considered as the maximum permissible extension of CTR incision beyond KCL.