Prevalence and Predictors of Celiac Disease in Children With Constipation.

OBJECTIVE: To determine the prevalence of celiac disease and its predictors in children with constipation. METHODS: A hospital-based cross-sectional comparative study was conducted between November, 2018 to April, 2020. Children aged 1-12 years were screened for the presence of constipation as per ROME IV criteria and designated as cases. Age and sex matched healthy children with normal bowel habits were enrolled as comparison group. Participants underwent a detailed history and examination, and were screened for celiac disease by estimating serum anti-tissue transglutaminase IgA antibody levels (tTG-IgA). Upper gastrointestinal endoscopy and duodenal biopsy were performed in all participants who tested positive on screening (serum tTG-IgA ≥ 20 U/mL). The prevalence of celiac disease and associated factors were compared between the two groups. RESULTS: A total of 460 children (230 in each group) with mean (SD) age 64.08 (37.12) months were enrolled. Twenty-one (4.6%) children screened positive for anti tTG antibodies, among these 15 (75%) children had biopsy features suggestive of celiac disease (Marsh grade III). Children with constipation had significantly higher prevalence of celiac disease (5.65% vs 0.87%, P = 0.004) compared to children without constipation. Wasting and stunting were significantly associated with celiac disease in constipated children (P < 0.001). CONCLUSION: Children with constipation and associated growth failure have a high prevalence of celiac disease.

Prevalence and Predictors of Vitamin B12 Deficiency in Children with Severe Acute Malnutrition, and its Association with Development.

OBJECTIVES: To determine the proportion of children with severe acute malnutrition (SAM) having vitamin B12 deficiency, its clinical predictors, and its association with development. METHODS: In this cross-sectional study, 100 children between 1 mo to 59 mo [mean (SD) age 17 (12.75) mo; 55 males], with diagnosis of SAM as per WHO criteria, were included. Serum vitamin B12, serum folate, and serum ferritin levels were measured by chemiluminescence immunometric assay method, while serum Homocysteine (Hcy) level was measured by enzymatic cycling method. Development assessment was done by Denver Development Screening Tool (DDST-II). RESULTS: The mean (SD) serum vitamin B12 (cobalamin) levels were 296.52 (246.95) pg/mL; 45% children were vitamin B12 deficient (<203 pg/mL). Hyperhomocysteinemia (>14 µmol/L) was present in 39 (39%), and among these 69% (27/39) children had concomitant low serum vitamin B12 levels. Severe anemia and hypoproteinemia were significantly and independently associated with vitamin B12 deficiency [aOR (95% CI) 3.22 (1.13, 10) and 10 (1.66, 58.82), respectively]. Out of 45 children who were vitamin B12 deficient, 93%, 87%, 62% and 80% had gross motor, fine-motor, language and adaptive-cognitive delay, respectively. Vitamin B12 level was significantly associated (P <0.001) with developmental delay. CONCLUSIONS: There is a high prevalence of vitamin B12 deficiency in children with SAM, which is also associated with development delay across all domains (except language) in these children.

Municipal solid waste compost: a comprehensive bibliometric data-driven review of 50 years of research and identification of future research themes.

This paper offers a thorough bibliometric review of the literature on municipal solid waste compost (MSWC), focusing on the past two decades. Using an extensive dataset of 827 documents, the research patterns are analyzed via the R-based Bibliometrix package, merging metadata from Web of Science and Scopus. The analysis reveals substantial global growth in MSWC research, with a particular surge in the last 20 years. Discipline-specific journals are the main publishers, while multidisciplinary environmental outlets gained more citations. The study identifies five major collaborative author clusters that dominate productivity and citation frequency. The thematic evolution over the past five decades shows a transition from waste disposal towards topics such as heavy metals, soil properties, and plant nutrition, with emerging themes like carbon sequestration, biochar, and microplastics signaling future research directions. Specifically, the field has experienced a 7.86% annual growth rate, with an average citation rate of 26.88 per article. The 827 publications emerged from 317 sources and 1910 authors, with an international co-authorship rate of 14.75%, reflecting the field's interdisciplinary character. Thirteen primary sources and twenty-two key authors were identified as major contributors. On the geographical front, Spain and Italy led with the most contributions and highest citation count, respectively. In terms of keywords, "heavy metals" and "sewage sludge" were the most recurrent, indicating the prevailing topics in MSWC research. This analysis hence provides key insights into the evolution and future trajectory of MSWC studies.

Children with severe acute malnutrition have high rates of bone resorption: A cross-sectional comparative study.

Malnutrition in under-5 children (i.e., children younger than age 5 years) remains a major public health problem. Because of the reductive adaptation in children with severe acute malnutrition (SAM), changes in bone health are often subtle. We hypothesized that children with SAM have higher rates of bone resorption than bone formation, which can be assessed using bone turnover markers. In this cross-sectional comparative study, we evaluated the status of bone turnover markers, serum osteocalcin and serum tartrate-resistant acid phosphatase-5b (TRAP-5b) in under-5 children with SAM. Thirty children (6-59 months) with SAM (defined as per World Health Organization criteria) were enrolled as cases and another 30 children (age and sex matched) with normal nutritional status (weight for height -1 standard deviation [SD] to +1 SD) were enrolled for comparison of bone turnover markers. Serum TRAP-5b concentrations were significantly higher in children with SAM compared with children with normal nutritional status (mean [SD] 22.6 [15.3] vs. 11.3 [9.6], P = .009), whereas serum osteocalcin concentrations were comparable between the 2 groups (mean [SD] 40.6 [17.9] vs. 36.0 [12.5], P = .344). Frequency of hypocalcemia and vitamin D deficiency were also significantly high in children with SAM (P < .05). An inverse correlation was found between serum calcium and serum osteocalcin (r = -0.383, P < .05). Our results indicate that children with SAM have a higher bone resorption rate than children with normal nutrition status indicating compromised bone health.

An innovative technique for nasotracheal fiberoptic intubation using SNPA and its comparison with conventional technique: RCT.

Background: Awake nasotracheal fiberoptic intubation by conventional technique is time consuming and requires expertise. Complications encountered in the conventional technique sometime leads to procedure failure. Objective: The primary aim of this study was to compare the innovative technique using split nasopharyngeal airway (SNPA) with the conventional technique for nasotracheal fiberoptic intubation in terms of time taken for intubation. Method: This was a prospective, randomized, and single blind study conducted with 80 patients who were scheduled for maxillofacial surgery. Patients were randomized into two groups, group CFBI (conventional fiberoptic intubation) and group SNPA (split nasopharyngeal airway). In both the groups patients were prepared for awake fiberoptic naso-tracheal intubation. In Group CFBI (N = 41) awake naso-tracheal intubation was achieved by conventional technique of bronchoscope first approach. In Group SNPA (N = 39) spirally split nasopharyngeal airway was used first as a conduit for the passage of fiberoptic bronchoscope. The primary objective was to assess the time taken for intubation. The secondary objectives were to assess the rate of complications in the form of bleeding, cough, desaturation during the procedure, laryngospasm, and nasal bleeding. Result: The time taken for intubation was 6.15 ± 3.0 minutes in CFBI group and 3.10 ± 1.35 minutes in SNPA group and this this difference was statically significant with P value <0.001. Desaturation during the procedure was more in CFBI (99.46 ± 0.75) compared to SNPA (99 ± 0) group with significant difference P value <0.001. Conclusion: Split nasopharyngeal airway was used as conduit for the passage for the flexible fibreoptic bronchoscope and it considerably reduced the time required for fiberoptic nasotracheal intubation compared to the conventional technique of endotracheal tube first approach. Split nasopharyngeal airway provided better intubating conditions with lesser complications and superior patient comfort.

Ectopic expression of DnaJ type-I protein homolog of Vigna aconitifolia (VaDJI) confers ABA insensitivity and multiple stress tolerance in transgenic tobacco plants.

Reduced crop productivity results from altered plant physiological processes caused by dysfunctional proteins due to environmental stressors. In this study, a novel DnaJ Type-I encoding gene, VaDJI having a zinc finger motif in its C-terminal domain was found to be induced early upon treatment with heat stress (within 5 min) in a heat tolerant genotype of Vigna aconitifolia RMO-40. VaDJI is induced by multiple stresses. In tobacco, ectopic expression of VaDJI reduced ABA sensitivity during seed germination and the early stages of seedling growth of transgenic tobacco plants. Concomitantly, it also improved the ability of transgenic tobacco plants to withstand drought stress by modulating the photosynthetic efficiency, with the transgenic plants having higher Fv/Fm ratios and reduced growth inhibition. Additionally, transgenic plants showed a reduced build-up of H2O2 and lower MDA levels and higher chlorophyll content during drought stress, which attenuated cell damage and reduced oxidative damage. An analysis using the qRT-PCR study demonstrated that VaDJI overexpression is associated with the expression of some ROS-detoxification-related genes and stress-marker genes that are often induced during drought stress responses. These findings suggest a hypothesis whereby VaDJI positively influences drought stress tolerance and ABA signalling in transgenic tobacco, and suggests that it is a potential gene for genetic improvement of drought and heat stress tolerance in crop plants.

Dyslipidemia and atherogenic indexes in children with transfusion-dependent thalassemia.

OBJECTIVE: This study endeavored to assess the lipid profile and atherogenic lipid indexes in children with transfusion-dependent thalassemia (TDT) and to compare them with matched healthy children. METHOD: The study group consisted of a total of 72 TDT patients aged 3 to14 years, while the control group had 83 age- and sex-matched healthy children. The fasting lipid profile and lipid indexes were estimated and the atherogenic index of plasma (AIP), Castelli's risk indexes I and II, atherogenic coefficient were calculated and compared between the two groups. RESULT: Compared to the control group, the mean LDL, HDL and cholesterol levels were significantly lower among the case group (p-value < 0.001). The mean VLDL and triglycerides were significantly higher in the case group (p-value < 0.001). Lipid indexes, including the atherogenic index of plasma (AIP), Castelli's risk indexes I and II and atherogenic coefficients were significantly higher in TDT children. CONCLUSION: Dyslipidemia and increased risk of atherosclerosis were found in TDT children, as they had elevated atherogenic lipid indexes. Our study underlines the importance of the routine use of these indexes in TDT children. Future studies should focus on lipid indexes in this high-lipid group of children so that preventive strategies can be planned accordingly.

Shigella as a Cause of Diarrhea Hospitalization in Children Under Five: Evaluation by Conventional and Molecular Methods.

BACKGROUND AND OBJECTIVES: Shigella is an important cause of diarrhea in children under five, often missed by conventional laboratory methods. Blood in stools has always been a syndromic indicator for Shigella diarrhea, but most cases present with watery diarrhea without blood. This study aimed to determine the frequency of Shigella detected by molecular and conventional methods in children under five. Additionally, we aimed to study the clinical profile and outcome of children with Shigella diarrhea managed as per current diarrhea treatment guidelines. METHODS: In this hospital-based prospective observational study, stool samples from 150 children (age range: one month to five years) with acute diarrhea (duration < seven days) were subjected to routine microscopic examination, stool culture, and DNA extraction. The extracted DNA from stored stool samples was subjected to polymerase chain reaction (PCR) amplification using a specific primer for the invasion plasmid antigen H gene sequence (ipaH) gene at 424 bp. Results were interpreted in the context of the percentage of isolation of Shigella by molecular (PCR) and conventional methods (stool microscopy and culture) and the follow-up outcome in terms of recurrence of diarrhea or dysentery and growth faltering over three months after discharge. RESULTS: Shigella infection was diagnosed in stool samples by PCR from 13 (8.7%) children, whereas it was isolated by conventional stool culture in only one (0.7%) child. The sensitivity of culture was only 7.7% against PCR for the diagnosis of Shigella infection, whereas blood in stools had a sensitivity of 15.4%. The majority of Shigella PCR-positive cases (11 out of 13) presented with non-bloody diarrhea. None of the evaluated clinical predictors had a significant association with the Shigella infection. No statistically significant difference was found between PCR-positive and PCR-negative children at the end of follow-up (P>0.05). CONCLUSION: The majority of children with Shigella infection present with watery diarrhea rather than bloody diarrhea, and a history of blood in stools is a poor marker for the diagnosis of shigellosis. The diagnostic performance of stool culture is also very low compared to stool PCR for the diagnosis of Shigella diarrhea.

A Rare Triad of Lateral Rectus Palsy, Sylvain Fissure Bleed, and Bilateral SDH Shrouding a Benign Pathology.

Background: Arachnoid cysts are benign extra-cerebral congenital lesions that are thought to arise from the splitting of the arachnoid membrane. Although most arachnoid cysts remain static with advancing age, occasionally they can become symptomatic due to cyst enlargement or hemorrhage. Hemorrhage into the arachnoid cysts (intra-cystic hemorrhage) with or without associated subdural hematoma is of rare occurrence. Case Discussion: A 23-year-old male presented with a history of sudden onset severe headache while sleeping. The patient also noticed double vision, especially when looking towards the left side. Non-contrast computed tomography (NCCT) scan of the head showed left temporal pole hematoma with left Sylvian fissure bleed and bilateral fronto-temporoparietal (FTP) subacute SDH. Conclusion: Every patient with incidentally detected AC, especially in the middle cranial fossa, should be counseled regarding the risk of possible complications including hemorrhage and regular follow-up.

Atypical intradiploic meningioma: A case report and review of the literature.

BACKGROUND: Intradiploic meningiomas with osteolytic bony changes are rarely reported in the literature. Intradiploic meningiomas are usually slow-growing benign lesions but atypical histopathology predicts aggressive behavior. Atypical intradiploic meningiomas (WHO Grade II) have some controversies in the management which are highlighted in this article. CASE DESCRIPTION: A 40-year-old male, with a history of trauma to the head 12 years back, presented with a hard, slow-growing painless swelling exactly at the site of trauma. On imaging, lesion was intradiploic one with osteolytic margins and homogeneously enhancing on contrast magnetic resonance imaging. Biopsy was that of atypical meningioma (WHO Grade II). CONCLUSION: Atypical meningiomas with osteolytic changes are rarely reported in the literature. Because of potential aggressive behavior, they need a regular follow-up with radiological imaging.

An embedded interface regulates the underwater actuation of solvent-responsive soft grippers.

In this work, we report the role of an embedded interface between two polymer thin films in determining the overall folding and actuation characteristics of a bilayer system applied for gripping submerged objects. Along with the material properties and geometry of the individual films involved, the strength of the embedded interface governs the folding behaviour of the bilayer when exposed to a solvent. The concentration gradient developed across the film thickness when exposed to the solvent results in the deformation of the film. The evolution of concentration through the film thickness as a function of time is closely related to the interface strength. It affects various aspects of the deformation, such as the direction of folding, curvature attained, and actuation rate. In this work, we have varied the strength of the interface between solvent responsive chitosan and hydrophobic Poly(methyl-methacrylate) (PMMA) by treating the substrate (chitosan) with varying concentrations of silane before coating. Experimentally, the folding characteristics of the solvent responsive bilayer films have been investigated for four different interfacial strengths. A coupled diffusion-deformation model for the film and a cohesive zone model for the interface is developed to provide insights into the underlying mechanism behind the observations made. Finally, the application of the bilayer as a gripper for submerged objects for two different types of interfaces is demonstrated. Interestingly, in this approach, the medium where the object is immersed acts as a trigger for folding the grippers.

100 days outcome of severe wasting in hospitalised infants <6 months of age.

OBJECTIVE: To assess the outcome of severe wasting in infants below 6 months of age. DESIGN: A prospective observational study conducted between January 2017 and October 2018. SETTING: A medical college-affiliated hospital in Eastern Delhi, catering mainly to the urban poor population. PARTICIPANTS: All children with severe wasting (weight-for-length Z-score (WLZ) < -3 sd) between 1 and 6 months of age, requiring hospitalisation. RESULTS: Out of fifty children enrolled, during hospitalisation, forty-two (84 %) recovered (WLZ > -3 sd) and discharged; the median (interquartile range (IQR)) duration of stay was 9·5 (6·5, 13·0) d. After 100 d of enrolment, sustained cure (WLZ > -2 SD) could be achieved in only fifteen (30 %) infants, while another fourteen (28 %) recovered from severe wasting, but remained in moderately wasted state (WLZ between -2 and -3 sd). Overall, there were three (6 %) deaths (all during first week of hospitalisation); three (6 %) relapses and fifteen (30 %) defaulters (5, 5, 2, 1 and 2 defaulted during hospitalisation at day 15, day 60, day 75 and day 90, respectively). CONCLUSIONS: The overall recovery rate from severe wasting in infants below 6 months of age was below the acceptable levels. In order to achieve better long-term outcome, community linkage services after discharge from hospital are required for supervised feeding, close monitoring and supportive care.

Microscissor DREZotomy for post brachial plexus avulsion neuralgia: A single center experience.

INTRODUCTION: Brachial neuralgia is a dreaded sequelae which substantially impairs the quality of life in patients with brachial plexus avulsion (BPA) injuries. Dorsal Root Entry Zone (DREZ) lesioning of the cervical spinal cord is the most utilized procedure for alleviating this painful condition. In this study, we share a single center experience of surgically managing post BPA neuropathic pain. The efficacy, results and complications of the modified technique of DREZ, called the Microscissor DREZotomy (MDZ) are discussed along with the review of relevant literature. METHODS: This retrospective analysis included all the patients undergoing MDZ for post BPA brachialgia over 5 years period (2012-2018) at our institution. The pain was quantified using the Numeric rating Scale (NRS) between 0 and 10 scale and was graded as 'Excellent' in patients with more than 75% pain relief, 'Good' with 50-75% relief, 'Fair' between 25% and 50% and 'Poor' if less than 25%. RESULTS: A total of 56 patients underwent MDZ and a mean follow up of 32 months (range 18-69 months) available for 47 patients. Thirty three patients (70.4%) judged pain relief as Excellent, Five (10.6%) as Good, 3 (7%) as Fair and 6 (12%) having poor pain relief. Overall, in 38 (81%) patients long term analgesic effect (> 50%) was noted and 3 (7%) patients had more than 25% pain relief, making up an overall 41 (87%) of patients with some relief from pain. CONCLUSION: MDZ is a safe, efficacious technique with good long term pain relief and quality of life. This technique entails utilization of routine surgical instruments and can be performed with ease even in resource limited settings.

Improved photosynthetic characteristics correlated with enhanced biomass in a heterotic F1 hybrid of maize (Zea mays L.).

Heterosis is a phenomenon wherein F1 hybrid often displays phenotypic superiority and surpasses its parents in terms of growth and agronomic traits. Investigations on the physiological and biochemical properties of the heterotic F1 hybrid are important to uncover the mechanisms underlying heterosis in plants. In the present study, the photosynthetic capacity of a heterotic F1 hybrid of Zea mays L. (DHM 117) that exhibited a higher growth rate and increased biomass was compared with its parental inbreds at vegetative and reproductive stages in the field during 2017 and 2018. The net photosynthetic rate (Pn), stomatal conductance (gs), transpiration rate (E) as well as foliar carbohydrates were higher in F1 hybrid than parental inbreds at vegetative and reproductive stages. An increase in total chlorophyll content along with better chlorophyll a fluorescence characteristics including effective quantum yield of photosystem II (ΔF/Fm'), maximum quantum yield of PSII (Fv/Fm), photochemical quenching (qp) and decreased non-photochemical quenching (NPQ) was observed in F1 hybrid than the parental inbreds. Further, the expression of potential genes related to C4 photosynthesis was considerably upregulated in F1 hybrid than the parental inbreds during vegetative and reproductive stages. Moreover, the F1 hybrid exhibited distinct heterosis in yield with 63% and 62% increase relative to parental inbreds during 2017 and 2018. We conclude that improved photosynthetic efficiency associated with increased foliar carbohydrates could have contributed to higher growth rate, biomass and yield in the F1 hybrid.

Comparative Study Between Ultrasound-guided Lumbar Paravertebral Block and Lumbar Epidural Block with Ropivacaine for Postoperative Pain Relief in Patient Undergoing Total Hip Replacement Surgery: A Prospective Randomised, Double-blind Study.

Background: Total hip replacement (THR) is mostly performed in patients above 65 years of age. Patients of this age group typically have comorbidities, therefore safe techniques for anaesthesia and analgesia with minimal side effects should be chosen and should allow early mobilisation. Lumbar paravertebral block is less explored in this domain. The primary objective of this study is to compare the efficacy of ultrasound-guided lumbar paravertebral and epidural block using ropivacaine (0.25%) with fentanyl as adjuvant for postoperative pain in patients undergoing unilateral THR. Settings and Design: Randomised, controlled, double-blind, prospective study carried out in the Department of Anaesthesiology at Banaras Hindu University. Methods and Material: After receiving institutional ethical committee clearance and written informed consent from patients, this study was carried out from February 2019 to February 2020. Sixty adult patients who required THR and fulfilled the inclusion criteria were randomised into two groups. The thirty patients in Group A received a continuous infusion of 5 ml/hr (0.25%) ropivacaine + 2 mcg/ml fentanyl via lumbar epidural catheter. The thirty patients in Group B received a continuous infusion of 5 ml/hr (0.25%) ropivacaine + 2 mcg/ml fentanyl via lumbar paravertebral catheter. Visual analogue scale (VAS) was used to evaluate pain scores. Rescue analgesia use and duration of hospital stay was calculated and compared in postoperative period. The statistical analysis of data was done by using software Statistical Package for Social Sciences SPSS for Windows (Version 23.0), and chi-square test was used for categorical variables. To compare the two groups of mean Student's t-test and for more than two groups one-way analysis of variance, the ANOVA test was used. Results: In Group A, 16.7% patients required rescue analgesic, and in Group B, 26.7% required rescue analgesia which is comparable and non-significant. The mean duration of hospital stay in Group A is 7.50 days. Compared to 6.47 days in Group B, this difference is statistically significant (p-0.000). Conclusions: Analgesia provided by paravertebral block is not superior to epidural block, but paravertebral block did reduce the duration of hospital stay and provided better haemodynamic stability.

Feasibility of Double Anterior Odontoid Screw: A CT-Based Morphometric Analysis of the Axis in Adult Indian Population.

BACKGROUND: The fractures of the odontoid process constitute 10% of all cervical spine injuries. Odontoid screw placement, although technically challenging, in indicated cases is the ideal treatment. Hence, a thorough knowledge of the odontoid dimensions is necessary prior to the surgical endeavor, more so for planning double odontoid screws. MATERIALS AND METHODS: A prospective morphometric analysis of retrospective data of 250 patients was acquired at our institute using Somatom Definition edge 128 slice 64-row detector Siemens CT scanner. The dimensions of the odontoid process were measured at the waist (narrowest portion), widest diameter both in anteroposterior and transverse diameters. The dimensions of the C2 vertebra were measured at the level of the superior and inferior endplate in both the planes. RESULTS: A total of 250 patients were evaluated with age ranging from 1 to 80 years. Males constituted 174 (69.6%) and 76 (30.4%) were females. The mean transverse diameter (TD) at the odontoid waist (narrowest diameter) was 8.66 mm. The mean TD at the widest point of odontoid was 9.68 mm. Mean anteroposterior (AP) diameter 2.5 mm away from the midline on the left side at the level of the waist was 9.51 mm and 2.5 mm on the right of midline was 9.01 mm. The mean AP diameter at the C2 base was 15.824 mm in males and 14.833 mm in females (P < 0.001). CONCLUSION: Double odontoid screw insertion is feasible in only 36% of Indians in the transverse plane, whereas 98.4% of the odontoids can accommodate double screws in the sagittal plane.