Advances in the Acute and Preventive Treatment of Pediatric Migraine.

PURPOSE OF REVIEW: Headaches are common in children and adolescents. Treatments for debilitating migraine are often not FDA approved or lack evidence of efficacy for children. This narrative review looks at the evidence for acute and preventative pharmacologic and non-pharmacologic treatment of pediatric migraine, as well as reviewing any recent or ongoing clinical trials. RECENT FINDINGS: Studies have been published on pharmacological treatments for headache, as well as non-pharmacological treatments. Recent findings in pediatric migraine using onabotulinumtoxinA, calcitonin gene related peptide antagonists, interventional procedures, and devices are reviewed. Pharmacologic as well as non-pharmacologic approaches for the prevention and treatment of migraine show safety and efficacy data that is promising. These treatments should be incorporated in a multi-modal approach to the management of pediatric migraine. Continued studies, prospective and randomized, are needed to further assess these newer treatments for migraine in the pediatric setting.

Histopathological Study of Mucormycosis in Post COVID-19 Patients and Factors Affecting it in a Tertiary Care Hospital.

Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) which may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is an opportunistic fungal infection occurring in post COVID-19 patients. Objectives. To study the role of histopathology in mucormycosis and the predisposing factors associated in development of mucormycosis in post COVID-19 patients. Materials and methods. A prospective observational study was conducted in our hospital in the pathology department over a period of 3 months on 200 patients with mucormycosis who were infected with SARS-CoV-2 virus. Results. Out of the 200 patients with mucormycosis studied in post COVID-19 patients, age ranged from 21-80 years, of which 132 were men and 68 were women. Sites involved by mucormycosis were sinuses, orbit, cranium, and cutaneous. Ethmoid sinus was most involved, followed by maxillary sinus. Diabetes was present in 162 patients and hypertension in 92 patients. On histopathological examination, fungal load was severe in 49 patients, angioinvasion was present in 48 patients, perineural invasion was present in 32 patients, and necrosis was present in 121 patients. The number of patients discharged after surgery was 169, whereas 31 died. Conclusion. Histopathological features of mucormycosis like angioinvasion, perineural invasion, severe fungal load, and large areas of necrosis were directly proportional to the mortality rate. Thus, histopathologists can help in assessing prognosis at the time of tissue diagnosis, so that clinicians can optimize treatment accordingly. Diabetes and history of corticosteroid intake for treatment of COVID-19 were the two commonest predisposing factors for development of mucormycosis.

Integrated yoga and naturopathy on cardiovascular functions and mental health in a patient with COVID-19: A case report.

A 43-year-old-married male diagnosed with coronavirus disease 2019 (COVID-19) in July 2020. His symptoms as described by him began with cough and sore throat, breathlessness, generalized body weakness, irritability, stress, and mood swing for a period of one week. He was admitted in our District COVID Care Center (DCCC) located in Tamil Nadu, India. He underwent Integrated Yoga and Naturopathy (IYN) [i.e., Conventional medicine + yoga and naturopathy] for two weeks. The results showed negative Reverse Transcription Polymerase Chain Reaction (RT-PCR) test for COVID-19, improvement in cardiovascular functions (i.e., a reduction in systolic and diastolic blood pressures, pulse rate, mean arterial pressure, rate pressure product, and double product) and mental health (i.e., a reduction in depression, anxiety, and stress levels). The results suggest that IYN might improve cardiovascular and mental health of patients with COVID-19 in addition to positive to negative conversion of RT-PCR. However, further studies are required to warrant these results.

Improved Artificial Neural Network with State Order Dataset Estimation for Brain Cancer Cell Diagnosis.

Brain cancer is one of the cell synthesis diseases. Brain cancer cells are analyzed for patient diagnosis. Due to this composite cell, the conceptual classifications differ from each and every brain cancer investigation. In the gene test, patient prognosis is identified based on individual biocell appearance. Classification of advanced artificial neural network subtypes attains improved performance compared to previous enhanced artificial neural network (EANN) biocell subtype investigation. In this research, the proposed features are selected based on improved gene expression programming (IGEP) with modified brute force algorithm. Then, the maximum and minimum term survivals are classified by using PCA with enhanced artificial neural network (EANN). In this, the improved gene expression programming (IGEP) effectual features are selected by using remainder performance to improve the prognosis efficiency. This system is estimated by using the Cancer Genome Atlas (CGA) dataset. Simulation outputs present improved gene expression programming (IGEP) with modified brute force algorithm which achieves accurate efficiency of 96.37%, specificity of 96.37%, sensitivity of 98.37%, precision of 78.78%, F-measure of 80.22%, and recall of 64.29% when compared to generalized regression neural network (GRNN), improved extreme learning machine (IELM) with minimum redundancy maximum relevance (MRMR) method, and support vector machine (SVM).

Clinicolaboratory Profile, Treatment, Intensive Care Needs, and Outcome of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: A Systematic Review and Meta-analysis.

This study was aimed to summarize the current data on clinicolaboratory features, treatment, intensive care needs, and outcome of pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2; PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C). Articles published in PubMed, Web of Science, Scopus, Google Scholar, and novel coronavirus disease 2019 (COVID-19) research database of World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) database, and Cochrane COVID-19 study register between December 1, 2019 and July 10, 2020. Observational studies involving patients <21 years with PIMS-TS or MIS-C were reported the clinicolaboratory features, treatment, intensive care needs, and outcome. The search identified 422 citations and finally 18 studies with 833 participants that were included in this study, and pooled estimate was calculated for parameters of interest utilizing random effect model. The median age was 9 (range: 8-11) years. Fever, gastrointestinal symptoms, rash, conjunctival injection, and respiratory symptoms were common clinical features. Majority (84%) had positive SARS-CoV-2 antibody test and only one-third had positive reverse transcript polymerase chain reaction (RT-PCR). The most common laboratory abnormalities noted were elevated C-reactive protein (CRP), D-dimer, procalcitonin, brain natriuretic peptide (BNP), fibrinogen, ferritin, troponin, interleukin 6 (IL-6), lymphopenia, hypoalbuminemia, and thrombocytopenia. Cardiovascular complications included shock (65%), myocardial dysfunction (61%), myocarditis (65%), and coronary artery abnormalities (39%). Three-fourths of children required admission to pediatric intensive care unit (PICU) where they received vasoactive medications (61%) and mechanical ventilation (25%). Treatment strategies used included intravenous immunoglobulin (IVIg; 82%), steroids (54%), antiplatelet drugs (64%), and anticoagulation (51%). Mortality for patients with PIMS-TS or MIS-C was low ( n = 13). In this systematic review, we highlight key clinical features, laboratory findings, therapeutic strategies, intensive care needs, and observed outcomes for patients with PIMS-TS or MIS-C. Commonly observed clinical manifestations include fever, gastrointestinal symptoms, mucocutaneous findings, cardiac dysfunction, shock, and evidence of hyperinflammation. The majority of children required PICU admission, received immunomodulatory treatment, and had good outcome with low mortality.

Deep Learning Based Capsule Neural Network Model for Breast Cancer Diagnosis Using Mammogram Images.

Breast cancer is a commonly occurring disease in women all over the world. Mammogram is an efficient technique used for screening and identification of abnormalities over the breast region. Earlier identification of breast cancer enhances the prognosis of patients and is mainly based on the experience of the radiologist in interpretation of mammogram with quality of image. The advent of Deep Learning (DL) and Computer Vision techniques is widely used to perform breast cancer diagnosis. This paper presents a new Optimal Multi-Level Thresholding-based Segmentation with DL enabled Capsule Network (OMLTS-DLCN) breast cancer diagnosis model utilizing digital mammograms. The OMLTS-DLCN model involves an Adaptive Fuzzy based median filtering (AFF) technique as a pre-processing step to eradicate the noise that exists in the mammogram images. Besides, Optimal Kapur's based Multilevel Thresholding with Shell Game Optimization (SGO) algorithm (OKMT-SGO) is applied for breast cancer segmentation. In addition, the proposed model involves a CapsNet based feature extractor and Back-Propagation Neural Network (BPNN) classification model is employed to detect the existence of breast cancer. The diagnostic outcomes of the presented OMLTS-DLCN technique is examined by means of benchmark Mini-MIAS dataset and DDSM dataset. The experimental values obtained highlights the superior performance of the OMLTS-DLCN model with a higher accuracy of 98.50 and 97.55% on the Mini-MIAS dataset and DDSM dataset, respectively.

Non-pharmacologic and Mindful-Based Approaches for Pediatric Headache Disorders: a Review.

PURPOSE OF REVIEW: Headache disorders in children and adolescents are common. Among the different headache disorders, migraine and tension headache are highly prevalent and often debilitating. Pharmacological treatments for pediatric patients are often not approved or effective. Practice guidelines for prevention of pediatric headache and migraine are now incorporating information and recommendations regarding non-pharmacologic therapeutic options. Understanding the mechanism of action, safety, and efficacy of the non-pharmacologic as well as mindful-based therapeutic alternatives currently available for the management and treatment of headache and migraine may allow additional treatment alternatives for children with these conditions. RECENT FINDINGS: Studies have been published looking at non-pharmacologic treatments, and mindful-based approaches, namely relaxation, mindfulness meditation, yoga, and hypnosis as options for the treatment of headache and migraine, although there are few that examine these in children and adolescents. Several recent studies that have relevance to the care of children with headache and migraine are reviewed. Non-pharmacologic and mindful-based approaches for the prevention and treatment of headache and migraine in children show safety and efficacy data that is promising. Consider incorporating these multi-modal approaches into the therapeutic management strategies for the child or adolescent with headache and migraine. Additional prospective studies and/or randomized-controlled trials are necessary to further assess the efficacy and cost-effectiveness of these methods.

Clinical Profile of Critical Pertussis in Children at a Pediatric Intensive Care Unit in Northern India.

OBJECTIVE: To delineate the clinical profile, complications, intensive care needs, and predictors of mortality in children with critical pertussis. METHODS: Retrospective analysis of case records of children in the pediatric intensive care unit of a tertiary-care hospital, with a diagnosis of critical pertussis over 3 years. Diagnostic criteria included CDC case definition and confirmation by polymerase chain reaction (PCR), when available. Survivors and non-survivors were compared to identify predictors of mortality. RESULTS: 36 records were analysed, most cases were infants (31, 86.1%). 10 (27.7%) were (below 6 weeks of age). In the rest, 16 (61.5%) were partially immunized or unimmunized against pertussis. Rapid breathing (88.9%), paroxysmal cough (86.1%) and apnea (41.7%) were common presenting complaints. Hypoxemia (97.2%), hyperleukocytosis (61.1%) and encephalopathy (52.8%) were common complications. Intensive care needs were mechanical ventilation in 11 (30.6%), vasoactive support in 7 (19.4%) and exchange transfusion in 3 (8.3%). Female gender, apnea, hyperleukocytosis, encephalopathy, need for vasoactive support, and mechanical ventilation predicted mortality. CONCLUSIONS: Pertussis demands attention due to its varied presentation, increased complications and higher mortality.

India: Intruder Node Detection and Isolation Action in Mobile Ad Hoc Networks Using Feature Optimization and Classification Approach.

Due to lack of a central bureaucrat in mobile ad hoc networks, the security of the network becomes serious issue. During malicious attacks, according to the motivation of intruder the severity of the threat varies. It may lead to loss of data, energy or throughput. This paper proposes a lightweight Intruder Node Detection and Isolation Action mechanism (INDIA) using feature extraction, feature optimization and classification techniques. The indirect and direct trust features are extracted from each node and the total trust feature is computed by combining them. The trust features are extracted from each node of MANET and these features are optimized using Particle Swarm Optimization (PSO) algorithm as feature optimization technique. These optimized feature sets are then classified using Neural Networks (NN) classifier which identifies the intruder node. The performance of the proposed methodology is studied in terms of various parameters such as success rate in packet delivery, delay in communication and the amount of energy consumption for identifying and isolating the intruder.

Correction to: India: Intruder Node Detection and Isolation Action in Mobile Ad Hoc Networks Using Feature Optimization and Classification Approach.

The article India: Intruder Node Detection and Isolation Action in Mobile Ad Hoc Networks Using Feature Optimization and Classification Approach, written by T. Kavitha, K. Geetha and R. Muthaiah, was originally published electronically on the publisher's internet portal (currently SpringerLink) on May 11, 2019 with open access.

Kerosene, Camphor, and Naphthalene Poisoning in Children.

Kerosene poisoning is one of the most common accidental poisoning in children in developing countries due common use of kerosene in house-hold and unsafe storage practices. Aspiration pneumonitis is the most common manifestation of kerosene ingestion due to its low viscosity, high volatility, and low surface tension. The treatment of aspiration pneumonitis due to kerosene poisoning is symptomatic including oxygen support, respiratory monitoring, and careful monitoring of fluid balance. Children with severe respiratory distress and hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require early intubation and mechanical ventilation. Transfer to the pediatric intensive care unit (PICU) is required at this stage. Emesis, gastric lavage, and administration of activated charcoal are contraindicated due to risk of aspiration. There is no clear benefit of using corticosteroids or prophylactic antibiotics. Asymptomatic children should be kept under observation for atleast 6 hours after exposure. The mortality rate is low and death occurs due to pneumonitis. Camphor is used in house-hold items including vaporized or topical cold preparations, liniments, moth repellents, for performing rituals in religious ceremonies, and in antimicrobial preparations. Camphor poisoning is not very common in childhood. Even small doses of camphor can cause serious toxicity and is potentially fatal. The onset of action is very rapid (5-15 minutes). The common manifestations are confusion, restlessness, delirium, and hallucinations, muscle twitching, myoclonus, ataxia, hyperreflexia, fasciculations, and seizures. Seizures are common and serious complication in camphor toxicity. The treatment is supportive including decontamination, gastric lavage, activated charcoal, and seizure control. Naphthalene is a major constituent of mothballs which are commonly used in household to protect clothes from moths. Though the poisoning with naphthalene is uncommon in children, most of the cases with naphthalene poisoning occur in developing countries where mothballs are still commonly used. The manifestations of naphthalene toxicity are predominantly due to acute intravascular hemolysis leading to anemia, hemoglobinuria, methemoglobinemia, and acute kidney injury (AKI). The treatment of naphthalene toxicity is supportive in form of transfusion of the packed red blood cells, monitoring of fluid and electrolyte balance, administration of alkalis in presence of hemoglobinuria, and renal replacement therapy. Prevention is better than cure. The strategies should be adopted to prevent children being exposed to these toxic compounds in the house-hold. Safe storage of toxic compounds away from the reach of children, avoiding storing kerosene in cold drink and beverage bottles, community education, provision of electricity in rural areas, safe cooking practices, and parental supervision are important interventions to prevent accidental poisoning among children. HOW TO CITE THIS ARTICLE: Kumar S, Kavitha TK, Angurana SK. Kerosene, Camphor, and Naphthalene Poisoning in Children. Indian J Crit Care Med 2019;23(Suppl 4):S278-S281.

Three-dimensional magnetic resonance-based morphometry of pituitary stalk.

PURPOSE: The pituitary or infundibular stalk is an anatomically important structure identified routinely in radiologic imaging for the evaluation of pituitary and suprasellar lesions. The morphometry of the pituitary stalk with 1.5 T MR images was useful in diagnosing the infundibular lesion and to assess the efficacy of treatment given by chemotherapy for many pathological conditions. The normative data for the length, the thickness of the stalk, and the infundibular recess are inadequate in the literature. There are no data regarding the morphometry of the pituitary stalk in the adult population. METHODS: One hundred and fifty normal brain MR images (75 males and 75 females) were analyzed for the evaluation of stalk and other parameters. Mean and the standard deviation were calculated. The unpaired t test was used to assess any significant difference between age-groups and gender. The intraclass coefficient correlation was used to analyze the inter-observer variability. RESULTS: The mean length of the stalk was 0.55 ± 0.16 mm. There was a significant difference (p < 0.05) in the length between the genders. The mean diameter of the stalk at the level of optic chiasma was 0.24 ± 0.06 mm, and the infundibular depth was 0.52 ± 0.12 mm. There was no significant difference between the genders in the thickness of the stalk and the depth of the recess. CONCLUSION: The normative data from the present study can be used as a screening tool for diagnosis as well as to assess the effect of treatment in pituitary infundibular lesions. These normative data shall be of help in the evaluation of stalk in various neurosurgical and endocrinological pathologies and lead the radiologist and endocrinologist in the early diagnosis and management of hypothalamo-pituitary axis diseases.

Turning date palm fronds into biocompatible mesoporous fluorescent carbon dots.

Here, we demonstrate the synthesis of mesoporous carbon dots (Cdot) from date palm fronds and their excellent excitation wavelength-independent photoluminescence (PL), with high photo- and storage-stability, superior biocompatibility and thermal and electrical conductivity for the first-time by a simple, green, one-step carbonization method. Interestingly, the as-obtained Cdot manifest the spherical shape of about 50 nm average diameter having surface mesopores of size less than 10 nm with sp2 hybridized carbon. The as-synthesised mesoporous Cdot, first of its kind, evince yellow-green PL (preferred over blue PL for biological applications) around 450 nm under excitation wavelength range of 320-420 nm with absolute quantum yield of 33.7% exhibiting high photo- and storage-stability. The thermal and electrical conductivity of Cdot/water nanofluids without any surfactants is illustrated. Application of Cdot as interfacial material in organic photovoltaic cell is manifested. The Cdot exhib visible sunlight driven photocatalytic and antibacterial activity. Mesoporous Cdot further reveal excellent biocompatibility with fibroblast cell (greater than 95% viability). The novelty of this study in the formation of multifunctional mesoporous Cdot from date palm fronds could inspire both research and industrial interests in the synthesis of biomass-derived Cdot and their application in a wide array of fields.

Association of Serum Vitamin D Levels with Level of Control of Childhood Asthma.

OBJECTIVE: To study the association between serum vitamin D levels and levels of asthma control in children aged 5-15 years. METHODS: Children with physician-diagnosed asthma who were under follow-up for at least 6 months were enrolled. Participants were categorized into three asthma control groups as per standard guidelines, and their serum 25-hydroxy vitamin D levels and pulmonary function tests were compared. RESULTS: Out of 105 children with asthma enrolled in the study, 50 (47.6%) were controlled, 32 (30.5%) were partly controlled and 23 (21.9%) were uncontrolled. Median (IQR) serum vitamin D levels in these three groups were 9.0 (6.75, 15) ng/mL, 10 (6.25, 14.75) ng/mL and 8 (5, 10) ng/mL (P=0.24), respectively. CONCLUSION: We did not observe any association of serum 25-hydroxy vitamin D levels with the level of control of childhood asthma.

Let-7 family of microRNA is required for maturation and adult-like metabolism in stem cell-derived cardiomyocytes.

In metazoans, transition from fetal to adult heart is accompanied by a switch in energy metabolism-glycolysis to fatty acid oxidation. The molecular factors regulating this metabolic switch remain largely unexplored. We first demonstrate that the molecular signatures in 1-year (y) matured human embryonic stem cell-derived cardiomyocytes (hESC-CMs) are similar to those seen in in vivo-derived mature cardiac tissues, thus making them an excellent model to study human cardiac maturation. We further show that let-7 is the most highly up-regulated microRNA (miRNA) family during in vitro human cardiac maturation. Gain- and loss-of-function analyses of let-7g in hESC-CMs demonstrate it is both required and sufficient for maturation, but not for early differentiation of CMs. Overexpression of let-7 family members in hESC-CMs enhances cell size, sarcomere length, force of contraction, and respiratory capacity. Interestingly, large-scale expression data, target analysis, and metabolic flux assays suggest this let-7-driven CM maturation could be a result of down-regulation of the phosphoinositide 3 kinase (PI3K)/AKT protein kinase/insulin pathway and an up-regulation of fatty acid metabolism. These results indicate let-7 is an important mediator in augmenting metabolic energetics in maturing CMs. Promoting maturation of hESC-CMs with let-7 overexpression will be highly significant for basic and applied research.

Hypoxia-inducible factors have distinct and stage-specific roles during reprogramming of human cells to pluripotency.

Pluripotent stem cells have distinct metabolic requirements, and reprogramming cells to pluripotency requires a shift from oxidative to glycolytic metabolism. Here, we show that this shift occurs early during reprogramming of human cells and requires hypoxia-inducible factors (HIFs) in a stage-specific manner. HIF1α and HIF2α are both necessary to initiate this metabolic switch and for the acquisition of pluripotency, and the stabilization of either protein during early phases of reprogramming is sufficient to induce the switch to glycolytic metabolism. In contrast, stabilization of HIF2α during later stages represses reprogramming, partly because of the upregulation of TNF-related apoptosis-inducing ligand (TRAIL). TRAIL inhibits induced pluripotent stem cell (iPSC) generation by repressing apoptotic caspase 3 activity specifically in cells undergoing reprogramming but not human embryonic stem cells (hESCs), and inhibiting TRAIL activity enhances human iPSC generation. These results shed light on the mechanisms underlying the metabolic shifts associated with the acquisition of a pluripotent identity during reprogramming.

Influence of alkyl chain length and temperature on thermophysical properties of ammonium-based ionic liquids with molecular solvent.

Mixing of ionic liquids (ILs) with molecular solvent can expand the range of structural properties and the scope of molecular interactions between the molecules of the solvents. Exploiting of these phenomena essentially require a basic fundamental understanding of mixing behavior of ILs with molecular solvents. In this context, a series of protic ILs possessing tetra-alkyl ammonium cation [R(4)N](+) with commonly used anion hydroxide [OH](-) were synthesized and characterized by temperature dependent thermophysical properties. The ILs [R(4)N](+)[OH](-) are varying only in the length of alkyl chain (R is methyl, ethyl, propyl, or butyl) of tetra-alkyl ammonium on the cationic part. The ILs used for the present study included tetramethyl ammonium hydroxide [(CH(3))(4)N](+)[OH](-) (TMAH), tetraethyl ammonium hydroxide [(C(2)H(5))(4)N](+)[OH](-) (TEAH), tetrapropyl ammonium hydroxide [(C(3)H(7))(4)N](+)[OH](-) (TPAH) and tetrabutyl ammonium hydroxide [(C(4)H(9))(4)N](+)[OH](-) (TBAH). The alkyl chain length effect has been analyzed by precise measurements such as densities (ρ), ultrasonic sound velocity (u), and viscosity (η) of these ILs with polar solvent, N-methyl-2-pyrrolidone (NMP), over the full composition range as a function of temperature. The excess molar volume (V(E)), the deviation in isentropic compressibility (Δκ(s)) and deviation in viscosity (Δη) were predicted using these properties as a function of the concentration of ILs. Redlich-Kister polynomial was used to correlate the results. A qualitative analysis of the results is discussed in terms of the ion-dipole, ion-pair interactions, and hydrogen bonding between ILs and NMP molecules. Later, the hydrogen bonding features between ILs and NMP were also analyzed using a molecular modeling program with the help of HyperChem 7.

Ethyl 3-[2-(3,4-dimeth-oxy-benz-yl)-1-phenyl-sulfonyl-1H-indol-3-yl]acrylate chloro-form hemisolvate.

In the title compound, C(28)H(27)NO(6)S·0.5CHCl(3), the ethyl acrylate substituent adopts an extented conformation with all torsion angles close to 180°. The chloro-form solvent mol-ecule is disordered across an inversion centre and is therefore half occupied. The mol-ecular packing is controlled by inter-molecular C-H⋯O inter-actions.