Clinical Experience of Use of High-dose Intravenous Methylprednisolone in Children With Acute Moderate to Severe Colitis.

OBJECTIVES: Treatment of acute severe colitis (ASC) has been associated with high morbidity and high colectomy rate in children. In the prebiologics era, our centre used short-term high-dose intravenous corticosteroids (IVCS) at 2 to 30 mg ·â€Škg ·â€Šday. We conducted a retrospective review to compare efficacy of different dosing regimes of IVCS. METHODS: Thirty-four children treated with IVCS for ASC were included over 8 years. Patients were studied as 2 groups with similar pretreatment patient characteristics. Group 1 (standard dose) received IVCS at 2 mg ·â€Škg ·â€Šday and group 2 (high dose) received IVCS at 10 to 30 mg ·â€Škg ·â€Šday. Safety, efficacy, and follow-up of the entire cohort for >1 year were studied. The median IVCS dose in the standard- and high-dose cohort was 1.5 mg ·â€Škg ·â€Šday (maximum 60 mg ·â€Škg ·â€Šday) and 24.8 mg ·â€Škg ·â€Šday (maximum 1000 mg ·â€Škg ·â€Šday), respectively. RESULTS: Pediatric Ulcerative Colitis Activity Index scores at day 5 were significantly lower in high-dose (15, interquartile range 8.5-20) than in standard-dose IVCS (30, interquartile range 20-30). IVCS side effects were minor and reversible. Overall, medical salvage therapy was required in 5.8% (2 children) before discharge, and in 17% (6 children) at follow-up after 1 year. The colectomy rate of the entire cohort was remarkably low with 0% during admission and 11% (4 children) after 1 year, with a trend of less colectomies in high-dose (4.8%-1 child) than in standard-dose (23%-3 children). CONCLUSIONS: Our data show that in paediatric ASC, the short-term use of high-dose IVCS is safe and effective. Prospective studies are needed to define the role of IVCS within salvage therapy protocols.

Congenital Extrahepatic Portosystemic Shunt Complicated by the Development of Hepatoblastoma: A Case Report and Review of Literature.

Congenital portosystemic shunts (CPSS) or congenital extrahepatic portosystemic shunts (CEPS) is a rare malformation. This congenital anomaly presents with a diverse array of clinical manifestations, ranging from asymptomatic to severe complications such as cardiac failure, pronounced pulmonary hypertension, and widespread pulmonary arteriovenous malformations. CPSS increases the risk of developing benign or malignant liver tumors, including nodular regenerative hyperplasia, focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma, and hepatoblastoma. We report a case of a 15-month-old boy, identified with Abernethy's malformation type Ib, who presented with an abdominal mass during a follow-up. A comprehensive assessment established a diagnosis of hepatoblastoma. The patient was transferred to a specialized liver transplant center for further treatment and management. This is a review of literature highlighting the complexity of Abernethy malformation and its associated risk of liver tumors.

Challenges in Managing Paediatric Crohn's Disease With Crohn's Disease Exclusion Diet (CDED): The First Single-Center Study in the United Arab Emirates.

BACKGROUND: Inflammatory bowel disease has been increasing significantly. For that, many modalities of treatment have shown promising results including a special diet. In our study, we looked at Crohn's disease dietary management for induction and subsequently maintenance of treatment. The research question was how feasible was applying this approach and what difficulties the patients and their parents faced. METHODOLOGY: We reviewed the electronic medical system. We had 32 paediatric patients who were diagnosed with Crohn's disease and used the special diet plan (Crohn's disease exclusion diet or exclusion enteral nutrition) to induce remission or maintenance. Then, we used a questionnaire to identify the difficulties they faced while using the special diet. RESULTS AND DISCUSSION: We have found that the cohort had used the special diet for a variable duration. The majority of patients opted to start with Crohn's disease exclusion diet. The clinical response was inconsistent due to poor compliance. Only 57 % of the patients were able to bear with the dietary plan beyond 12 weeks. Patients reported the following factors which caused non-compliance: intolerance/difficulty to follow (40%), cost (19%), poor clinical response (19%), and others. CONCLUSIONS: In managing Crohn's disease, a multidisciplinary approach, including dietary interventions, is crucial. However, adherence to specialized diets poses several challenges identified in this study based on patient feedback. Addressing barriers and prioritizing dietitians' role is essential for improved patient outcomes in inflammatory bowel disease management.

Public health impact of delaying second dose of BNT162b2 or mRNA-1273 covid-19 vaccine: simulation agent based modeling study.

OBJECTIVE: To estimate population health outcomes with delayed second dose versus standard schedule of SARS-CoV-2 mRNA vaccination. DESIGN: Simulation agent based modeling study. SETTING: Simulated population based on real world US county. PARTICIPANTS: The simulation included 100 000 agents, with a representative distribution of demographics and occupations. Networks of contacts were established to simulate potentially infectious interactions though occupation, household, and random interactions. INTERVENTIONS: Simulation of standard covid-19 vaccination versus delayed second dose vaccination prioritizing the first dose. The simulation runs were replicated 10 times. Sensitivity analyses included first dose vaccine efficacy of 50%, 60%, 70%, 80%, and 90% after day 12 post-vaccination; vaccination rate of 0.1%, 0.3%, and 1% of population per day; assuming the vaccine prevents only symptoms but not asymptomatic spread (that is, non-sterilizing vaccine); and an alternative vaccination strategy that implements delayed second dose for people under 65 years of age, but not until all those above this age have been vaccinated. MAIN OUTCOME MEASURES: Cumulative covid-19 mortality, cumulative SARS-CoV-2 infections, and cumulative hospital admissions due to covid-19 over 180 days. RESULTS: Over all simulation replications, the median cumulative mortality per 100 000 for standard dosing versus delayed second dose was 226 v 179, 233 v 207, and 235 v 236 for 90%, 80%, and 70% first dose efficacy, respectively. The delayed second dose strategy was optimal for vaccine efficacies at or above 80% and vaccination rates at or below 0.3% of the population per day, under both sterilizing and non-sterilizing vaccine assumptions, resulting in absolute cumulative mortality reductions between 26 and 47 per 100 000. The delayed second dose strategy for people under 65 performed consistently well under all vaccination rates tested. CONCLUSIONS: A delayed second dose vaccination strategy, at least for people aged under 65, could result in reduced cumulative mortality under certain conditions.

Fully Assembled Membraneless Glucose Biofuel Cell With MWCNT Modified Pencil Graphite Leads as Novel Bioelectrodes.

This paper demonstrates the performance of single compartment membraneless glucose biofuel cell (GBFC) with pencil graphite leads (PGLs) as the substrate for bioanode and biocathode. Five grades of pencils, namely, B, HB, H, 3H, and 5H were rationally selected to fabricate the electrodes separately using enzyme nanobiocomposite-laccase/carboxylic functionalized multiwalled carbon nanotube (COOH-MWCNT) for biocathode and glucose oxidase/COOH-MWCNT for bioanode. GBFCs were assembled with these bioelectrodes and tested for power density, current density, and open circuit voltage (OCV) in two sets of experiments. In set-1, biocathode was fixed as 5H-grade PGL electrode, and in set-2, bioanode was fixed as B-grade PGL electrode, respectively, and the counter electrode was varied in each assembly between the selected grades. In both sets of results, the highest OCV and maximum power output with maximum current density were observed for the anode-cathode combination of B-5H. For the first time, this paper successfully establishes the potential of cost-effective readily available PGLs as promising alternatives to the carbon-based substrates for GBFCs. Furthermore, the cost- and time-efficient fabrication procedure also supports the novelty of their use. The relatively low overall output is suitably compensated by the unique advantages offered by the PGLs, thus increasing the scope of their applicability to miniaturized bioelectronic devices.

Escherichia Coli Fed Paper-Based Microfluidic Microbial Fuel Cell With MWCNT Composed Bucky Paper Bioelectrodes.

This paper demonstrates a simple-in-struct- ure, cost-effective, and environment-friendly Microfluidic Paper-based Analytical Device for Microbial Biofuel Cell ( µ PAD-MBFC). It consists of a microchannel with biofuel cell (Escherichia.Coli) and an oxidant (aerated tap water) flowing co-parallelly over Multiwalled Carbon Nanotube (MWCNT)-based Bucky Paper (BP) electrodes using a self-capillary and co-laminar flow mechanism. The electrochemical studies, such as open circuit potential (OCP) and polarization were evaluated using a potentiostat. Various volumetric bacterial studies were also carried out to find out the best suitable optimal bacterial volume. Subsequently, the morphological and detailed element composition study of electrode surface was performed using scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) techniques. This well-designed portable µ PAD-MBFC yields a maximum power density of 4 [Formula: see text]/cm2 ( [Formula: see text]/cm2) at 0.405 V over [Formula: see text] of culture and leveraging to its long-lasting potential to operate miniaturized microelectronics sensors and portable devices.