Salivary lactate dehydrogenase levels can provide early diagnosis of hypoxic-ischaemic encephalopathy in neonates with birth asphyxia.

AIM: Timely detection of hypoxic-ischaemic encephalopathy (HIE) is crucial for selecting neonates who are likely to benefit from neuroprotective therapy. This study evaluated the efficacy of salivary lactate dehydrogenase (LDH) in the early diagnosis of HIE among neonates with perinatal asphyxia. METHODS: We prospectively enrolled 30 neonates who needed resuscitation at birth or had a history of delayed cry into the HIE group if they developed HIE within 12 h of birth. The control group comprised 30 neonates who had no evidence of HIE, but had intrapartum foetal distress or needed resuscitation at birth. LDH was measured using saliva samples collected within 12 h of birth. RESULTS: Salivary LDH was significantly higher in the HIE group, with a median of 2578 and an interquartile range (IQR) of 1379-3408 international units per litre (IU/L), than in the control group (median 558.5, IQR: 348-924 IU/L, p < 0.001). The test demonstrated excellent discriminating ability: the area under the curve was 0.92 and the levels of 893 IU/L showed a sensitivity of 90% and a specificity of 73.3%. CONCLUSION: Measuring salivary LDH among neonates with birth asphyxia provided an early and accurate diagnosis of HIE and could be used as a triage tool.

Evaluation of phthalic acid tri-ethylene diamine (TED) and folic acid-based carbon quantum dots for the detection of heavy metals in water resources using fibre-optic instrumentation.

Heavy metal pollution and toxicity from water resources have remained a great concern for the entire population. This research demonstrates the capability of carbon quantum dots (CQDs) for fluorescence-based heavy metal detection in different water resources using a fibre-optic spectrometer device. Two different types of CQDs phthalic acid and triethylenediamine (PT CQDs) and Folic acid (FCQDs) were synthesized using microwave irradiation and hydrothermal method, respectively. CQDs were characterized using several techniques such as TEM, EDX, XPS and FTIR. PTCQD and FCQDs both were tested for sensing capability in water reservoirs like household and river water. The results indicate that both CQDs were able to detect all six heavy metal ions (Pb2+, Co2+, Mn3+, Hg2+, Ni2+, Cr3+) tested in the study in the range of 0-100 µM. It was found that FCQDs show a three-fold higher sensitivity and greater resolution than PTCQDs for all the heavy metals samples. The CQDs' sensing capability shows that they can achieve a limit of detection in the range of 0.15-3 µM along with 100% accuracy in terms of recovery with minimal error, these results indicate that both CQDs have a tremendous potential to be used as a sensor for the detection of heavy metals even in complex water matrices. FCQDs show more sensitivity for all metals compared to PTCQDs and used in future as a sensing tool for heavy metal detection with better sensitivity and accuracy with less response time.

Efficacy of Short Course of Preksha Dhyana for Functional Abdominal Pain Disorder in a Busy Pediatric Clinic.

Introduction: Mind body techniques such as meditation improve symptoms in children and adults with IBS. Typical courses, however, are lengthy and difficult to administer. We report our experience with a short course of Preksha Dhyana (PD), a child-friendly focused meditation with yoga. Method: Physicians deliver focused meditation while medical assistants taught yoga. Three sessions were administered biweekly with recommendations for daily practice. Pain severity Likert scores were compared with a treatment as usual (TAU) historical control. Anxiety scores were compared from baseline in the PD group. Results: Thirty PD patients aged 9-17 (20 female) and 52 consecutive TAU group aged 5-17 (33 female) were reviewed. The biweekly sessions had high (71%) completion rates. Utilization rates of PD were similar to TAU despite added sessions. The PD group had an average time of follow-up of 8.9 ± 9.4 vs. 6.0 ± 3.9 months in the TAU group (p = 0.522). Changes in pain scores from baseline showed improvement in the PD group, 0.67 ± 0.13 vs. TAU 1.39 ± 0.11 (p = 0.0003). In the PD group, anxiety scores improved significantly from baseline (0.5 vs. 1, P < 0.001). Pain improved in 93% (28/30) and resolved in 47% (14/30). Conclusion: A short course of PD was successfully embedded in a busy pediatric office without additional staffing. The approach proved cost-effective without increasing overall healthcare utilization and showed significant benefits over TAU. Pending RCT confirmation, this offers a cost-effective method to incorporate mind-body techniques into a pediatric office practice.

Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population.

OBJECTIVE: To compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS). DESIGN: Multicentre prospective observational projection study. SETTING: Eight maternity hospitals in Wales, UK. PATIENTS: All live births ≥34 weeks gestation over a 3-month period (February-April 2018). METHODS: Demographics, maternal and infant risk factors, infant's clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC. MAIN OUTCOME MEASURE: Proportion of infants recommended for antibiotics on either tool. RESULTS: Of 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction of 74%. Of the 426 infants avoiding antibiotics, SRC assigned 314 (54.6%) to normal care only. There were seven positive blood cultures-three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant. No EONS-related readmission was reported. CONCLUSION: The judicious adoption of SRC in UK clinical practice for screening and management of EONS could potentially reduce interventions and antibiotic usage in three out of four term or near-term infants and promote earlier discharge from hospital in >50%. We did not identify any EONS case missed by SRC when compared with NICE. These results have significant implications for healthcare resources.

What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope?

Paroxysmal atrioventricular (AV) block is characterized by sudden appearance of complete heart block with no escape rhythm. Three types have been described having different mechanisms namely, vagally mediated, intrinsic, and idiopathic. A rare case scenario is being described with the occurrence of paroxysmal AV block of all three types in the same patient.

Effects of Anteromedial Portal versus Transtibial ACL Tunnel Preparation on Contact Characteristics of the Graft and the Tibial Tunnel Aperture.

BACKGROUND: The purpose of this study was to compare the tibial tunnel aperture contact characteristics simulating an anteromedial and transtibial anterior cruciate ligament (ACL) tunnel preparation. METHODS: Seven matched pairs of cadaveric knees were tested. From each knee, a 10-mm quadriceps ACL graft was prepared. The native ACL was arthroscopically removed and tibial tunnels were drilled. In one knee, a transtibial technique was performed with femoral tunnel drilling approached through the tibial tunnel. For the anteromedial technique on the contralateral knee, the posterior tibial tunnel was chamfered with a rasp. The knees were then disarticulated and tibial tunnel aperture geometry was measured. A pressure sensor was placed between the graft and the posterior aspect of the tibial tunnel and the graft was secured with an interference screw. Contact force, contact area, contact pressure, peak contact pressure, hysteresis and stiffness were measured at cyclic loads of 50 N, 100 N, 150 N, and 200 N. RESULTS: Tibial tunnel aperture area, diameter and deviation from a circle were significantly larger with the transtibial technique (p < 0.05). There was no significant difference in hysteresis, stiffness, contact area, contact force and mean contact pressure. The peak contact pressure between the ACL graft and the tibial tunnel was significantly higher with the anteromedial technique for 100 N (p = 0.04), 150 N (p = 0.01), and 200 N (p = 0.002) cyclic loading. CONCLUSIONS: Increased peak contact pressure on the graft at the tibial aperture with the anteromedial technique may increase the stress on the graft and possibly lead to failure following ACL reconstruction.

Fluid supplementation in management of neonatal hyperbilirubinemia: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of oral or intravenous fluid supplementation in accelerating the decline of serum bilirubin with intensive phototherapy among healthy term and late preterm neonates with hyperbilirubinemia. STUDY DESIGN: This open-label randomized controlled trial randomized neonates with severe hyperbilirubinemia (serum total bilirubin ≥18 mg/dL or within 2 mg/dL of threshold for exchange transfusion) to receive 50 mL/kg of intravenous fluid over 8 h (IVF group, n = 51), 50 mL of oral rehydration solution over 8 h (oral rehydration solution (ORS) group, n = 50) or only standard therapy (control group, n = 49). Intensive phototherapy was administered in all the three study groups. RESULT: Over 8 h of intervention, serum bilirubin declined by 15.5% (95% CI: 11.7-19.4%) in IVF group, by 9.1% (95% CI: 7.3-10.9%) in ORS group and by 8.0% (95% CI: 6.2-9.7%) in control group (p < .001). Percent decline in serum bilirubin serum total bilirubin (STB) was significantly greater in IVF group as compared to ORS (mean difference: -6.4% 95% CI: -1.9 to -11.0) and control (mean difference: -7.6% 95% CI: -3.0 to -12.1) groups. Duration of phototherapy and proportion of neonates needing exchange transfusion were comparable in the three study groups. CONCLUSIONS: Intravenous fluid supplementation may result in a faster decline of STB in first few hours of treatment. However, with the use of intensive phototherapy, there was no effect on overall duration of phototherapy or need of exchange transfusion. CLINICAL TRIAL REGISTRATION: Clinical trial registry of India: REF/2015/09/009775.