Development and performance evaluation of a solenoid valve assisted low-cost ventilator on gas exchange and respiratory mechanics in a porcine model.

INTRODUCTION: During the COVID-19 pandemic, ventilator shortages necessitated the development of new, low-cost ventilator designs. The fundamental requirements of a ventilator include precise gas delivery, rapid adjustments, durability, and user-friendliness, often achieved through solenoid valves. However, few solenoid-valve assisted low-cost ventilator (LCV) designs have been published, and gas exchange evaluation during LCV testing is lacking. This study describes the development and performance evaluation of a solenoid-valve assisted low-cost ventilator (SV-LCV) in vitro and in vivo, focusing on gas exchange and respiratory mechanics. METHODS: The SV-LCV, a fully open ventilator device, was developed with comprehensive hardware and design documentation, utilizing solenoid valves for gas delivery regulation. Lung simulator testing calibrated tidal volumes at specified inspiratory and expiratory times, followed by in vivo testing in a porcine model to compare SV-LCV performance with a conventional ventilator. RESULTS: The SV-LCV closely matched the control ventilator's respiratory profile and gas exchange across all test cycles. Lung simulator testing revealed direct effects of compliance and resistance changes on peak pressures and tidal volumes, with no significant changes in respiratory rate. In vivo testing demonstrated comparable gas exchange parameters between SV-LCV and conventional ventilator across all cycles. Specifically, in cycle 1, the SV-LCV showed arterial blood gas (ABG) results of pH 7.54, PCO2 34.5 mmHg, and PO2 91.7 mmHg, compared to the control ventilator's ABG of pH 7.53, PCO2 37.1 mmHg, and PO2 134 mmHg. Cycle 2 exhibited ABG results of pH 7.53, PCO2 33.6 mmHg, and PO2 84.3 mmHg for SV-LCV, and pH 7.5, PCO2 34.2 mmHg, and PO2 93.5 mmHg for the control ventilator. Similarly, cycle 3 showed ABG results of pH 7.53, PCO2 32.1 mmHg, and PO2 127 mmHg for SV-LCV, and pH 7.5, PCO2 35.5 mmHg, and PO2 91.3 mmHg for the control ventilator. CONCLUSION: The SV-LCV provides similar gas exchange and respiratory mechanic profiles compared to a conventional ventilator. With a streamlined design and performance akin to commercially available ventilators, the SV-LCV presents a viable, readily available, and reliable short-term solution for overcoming ventilator supply shortages during crises.

To Compare the Effects of a Standard Versus Hydrophilic Polymer Coated Airway Stent in a Porcine Model: A Randomized, Single-Blinded Study.

BACKGROUND: Stent encrustation with debris and mucostasis is a significant cause of airway injury and comorbidity, leading to ~25% of stent exchanges (1-3). Previous work from our group has shown that the experimental coating can reduce mucous adhesion in bench testing and demonstrated a signal for reducing airway injury and mucostasis in a feasibility study. OBJECTIVES: The aim of this study is to continue our inquiry in a randomized, single-blinded multi-animal trial to investigate the degree of airway injury and mucostasis using silicone stents with and without this specialized coating. METHODS: We modified commercially available silicone stents with a hydrophilic polymer from Toray Industries. We conducted an in vivo survival study in 6 mainstem airways (3 coated and 3 uncoated) of 3 pigs to compare the degree of airway injury and mucostasis between coated versus noncoated stented airways. Both stents were randomized to either left or right mainstem bronchus. The pathologist was blinded to the stent type. RESULTS: We implanted a total of six 14×15 mm silicone stents (1 per mainstem bronchi) into 3 pigs. All animals survived to termination at 4 weeks. All stents were intact; however, 1 uncoated stent migrated out. On average, all the coated stents demonstrated reduced pathology and tissue injury scores (75 vs. 68.3, respectively). The average total dried mucous weight was slightly higher in the coated stents (0.07 g vs. 0.05 g; respectively). CONCLUSION: Coated stents had lower airway injury compared with uncoated stents in this study. Of all the stents, 1 uncoated stent migrated out and was not included in the dried mucous weight totals. This could explain the slightly higher mucous weight in the coated stents. Nevertheless, this current study demonstrates promising results in lowering airway injury in stents incorporated with the hydrophilic coating, and future studies, including a larger number of subjects, would be needed to corroborate our findings.

The Feasibility of Using the "Artery Sign" for Pre-Procedural Planning in Navigational Bronchoscopy for Parenchymal Pulmonary Lesion Sampling.

BACKGROUND: Electromagnetic navigation bronchoscopy (ENB) and robotic-assisted bronchoscopy (RAB) systems are used for pulmonary lesion sampling, and utilize a pre-procedural CT scan where an airway, or "bronchus sign", is used to map a pathway to the target lesion. However, up to 40% of pre-procedural CT's lack a "bronchus sign" partially due to surrounding emphysema or limitation in CT resolution. Recognizing that the branches of the pulmonary artery, lymphatics, and airways are often present together as the bronchovascular bundle, we postulate that a branch of the pulmonary artery ("artery sign") could be used for pathway mapping during navigation bronchoscopy when a "bronchus sign" is absent. Herein we describe the navigation success and safety of using the "artery sign" to create a pathway for pulmonary lesion sampling. METHODS: We reviewed data on consecutive cases in which the "artery sign" was used for pre-procedural planning for conventional ENB (superDimension™, Medtronic) and RAB (Monarch™, Johnson & Johnson). Patients who underwent these procedures from July 2020 until July 2021 at the University of Minnesota Medical Center and from June 2018 until December 2019 at the University of Chicago Medical Center were included in this analysis (IRB #19-0011 for the University of Chicago and IRB #00013135 for the University of Minnesota). The primary outcome was navigation success, defined as successfully maneuvering the bronchoscope to the target lesion based on feedback from the navigation system. Secondary outcomes included navigation success based on radial EBUS imaging, pneumothorax, and bleeding rates. RESULTS: A total of 30 patients were enrolled in this analysis. The median diameter of the lesions was 17 mm. The median distance of the lesion from the pleura was 5 mm. Eleven lesions were solid, 15 were pure ground glass, and 4 were mixed. All cases were planned successfully using the "artery sign" on either the superDimension™ ENB (n = 15) or the Monarch™ RAB (n = 15). Navigation to the target was successful for 29 lesions (96.7%) based on feedback from the navigation system (virtual target). Radial EBUS image was acquired in 27 cases (90%) [eccentric view in 13 (43.33%) and concentric view in 14 patients (46.66%)], while in 3 cases (10%) no r-EBUS view was obtained. Pneumothorax occurred in one case (3%). Significant airway bleeding was reported in one case (3%). CONCLUSIONS: We describe the concept of using the "artery sign" as an alternative for planning EMN and RAB procedures when "bronchus sign" is absent. The navigation success based on virtual target or r-EBUS imaging is high and safety of sampling of such lesions compares favorably with prior reports. Prospective studies are needed to assess the impact of the "artery sign" on diagnostic yield.

Green Recycling Methods to Treat Lithium-Ion Batteries E-Waste: A Circular Approach to Sustainability.

E-waste generated from end-of-life spent lithium-ion batteries (LIBs) is increasing at a rapid rate owing to the increasing consumption of these batteries in portable electronics, electric vehicles, and renewable energy storage worldwide. On the one hand, landfilling and incinerating LIBs e-waste poses environmental and safety concerns owing to their constituent materials. On the other hand, scarcity of metal resources used in manufacturing LIBs and potential value creation through the recovery of these metal resources from spent LIBs has triggered increased interest in recycling spent LIBs from e-waste. State of the art recycling of spent LIBs involving pyrometallurgy and hydrometallurgy processes generates considerable unwanted environmental concerns. Hence, alternative innovative approaches toward the green recycling process of spent LIBs are essential to tackle large volumes of spent LIBs in an environmentally friendly way. Such evolving techniques for spent LIBs recycling based on green approaches, including bioleaching, waste for waste approach, and electrodeposition, are discussed here. Furthermore, the ways to regenerate strategic metals post leaching, efficiently reprocess extracted high-value materials, and reuse them in applications including electrode materials for new LIBs. The concept of "circular economy" is highlighted through closed-loop recycling of spent LIBs achieved through green-sustainable approaches.

To Investigate the Effect of Targeted Overdilation in Balloon-Expandable Stents.

PURPOSE: Balloon-expandable stents are commonly used for the treatment of tracheobronchial strictures. We routinely perform targeted overdilation of these stents 1-2mm on initial deployment to prevent stent migration or allow foreshortening to target airway caliber; however, specific data on the effect of targeted overdilation is unknown. PATIENTS AND METHODS: We used three iCAST stents (6×22mm, 7×22mm, and 10×38mm) to perform the study. We had two sets of each size to average our results. Targeted overdilation was accomplished with Merit Elation balloons. RESULTS: The 6 × 22 and 7 × 22 stent OD increased from 6 to 11.4mm and 7 to 11.6mm. The 10 × 38 stent demonstrated minimal OD change with overdilation (OD change of 10.4 to 12.2mm). All stents demonstrated significant foreshortening with overdilation (20.2 to 5.65mm, 19.4 to 6mm, and 30.9 to 10.2mm for 6 × 22, 7 × 22, and 10 × 38, respectively). The breakpoint was seen at near twice the stated stent OD (13.5mm, 15mm, and 15mm with 6 × 22, 7 × 22 and 10 × 38, respectively). CONCLUSION: We have demonstrated that iCAST stents can increase their OD with subsequent foreshortening during targeted overdilation. This data can help facilitate decisions when selecting a particular iCAST stent for a specific airway application. Additionally, we have highlighted that balloon inflation diameter does not correspond to the actual stent OD during deployment. We believe that this data offers practical information for end-users of this stent type and additional data will be needed to corroborate our findings.

A review on the recycling of spent lithium-ion batteries (LIBs) by the bioleaching approach.

This review discusses the latest trend in recovering valuable metals from spent lithium-ion batteries (LIBs) to meet the technological world's critical metal demands. Spent LIBs are a secondary source of valuable metals such as Li (5%-7%), Ni (5%-10%), Co (5%-25%), Mn (5-11%), and non-metal graphite. Recycling is essential for the battery industry to extract valuable critical metals from secondary sources to develop new and novel high-tech LIBs for various applications such as eco-friendly technologies, renewable energy, emission-free electric vehicles, and energy-saving lightings. LIB waste is currently undergoing high-temperature pyrometallurgical or hydrometallurgical processes to recover valuable metals, and these processes have proven to be successful and feasible. These methods, however, are not preferable due to the difficulties in controlling the process, secondary waste produced, high operational cost, and high risk of scaling up. Biotechnological approaches can be promising alternatives to pyrometallurgical and hydrometallurgical technologies in metal recovery from LIB waste. Microbiological metal dissolution or bioleaching has gained popularity for metal extraction from ores, concentrates, and recycled or residual materials in recent years. This technology is eco-friendly, safe to handle, and reduces operating costs and energy demands. The pre-treatment process (material preparation), microorganisms used in the bioleaching of LIBs, factors influencing the bioleaching process, methods of enhancing the leaching efficiency, regeneration of electrode materials, and future aspects have been discussed in detail.

Doctors and social media: knowledge gaps and unsafe practices

INTRODUCTION@#Easy access and availability of communication tools have facilitated doctors' communication, adding new challenges. Through this study, we aimed to determine the profile of the knowledge and practices of doctors in our institution, and to identify knowledge gaps in the use of social media accounts.@*METHODS@#An anonymous survey was sent by electronic mail in March-May 2018 to 931 doctors working in National University Hospital, Singapore. It included questions on demographics; use of social media; and case-based scenarios involving professionalism, patient-doctor relationship and personal practices of social media use.@*RESULTS@#The response rate was 12.8%. The majority of the respondents owned a social media account (93.3%), had not received education on social media use in medical school (84.0%), did not own a separate work phone (80.7%) and claimed to have no medical education on this as a doctor (58.8%). Unawareness of the institution's social media policy was reported by 14.3% of the respondents. Questions on knowledge of the privacy settings of their account were incorrectly answered. Only 75.6%-82.4% of the participants responded 'no' when asked if they would post pictures of patients or their results, even if there were no patient identifiers.@*CONCLUSION@#There is inadequate knowledge regarding institutional social media policy and privacy settings of social media accounts among doctors. Regarding practices in social media use, while most agree that caution should be exercised for online posts involving patients, ambiguity still exists. The emerging knowledge deficit and potentially unsafe practices that are identified can be addressed through continuing medical education and training on social media use.

Effects of Specific Language Impairment on a Contrastive Dialect Structure: The Case of Infinitival TO Across Various Nonmainstream Dialects of English.

Purpose: Using data from children who spoke various nonmainstream dialects of English and who were classified as either children with specific language impairment (SLI) or typically developing (TD) children, we examined children's marking of infinitival TO by their dialect and clinical status. Method: The data came from 180 kindergartners (91 speakers of African American English, 60 speakers of Southern White English, 29 speakers of +Cajun); 53 were children with SLI, and 127 were TD children. Data included 4,537 infinitival TO contexts extracted from language samples; each was coded as zero or overtly marked and by preceding verb context (i.e., verbs of motion vs. other). Results: Across dialects, overall rates of zero marking differed by the children's clinical status (SLI > TD), and other verb contexts accounted for this result. Across the TD and SLI groups, dialect variation was evident for verbs of motion contexts, and the effect was stronger for the TD than for the SLI groups, particularly if the TD children's dialects were classified as +Cajun. Conclusion: Children's marking of infinitival TO can be affected by both their dialect and clinical status. Results support language assessments that include context-specific rate-based measures of infinitival TO and other contrastive structures when they prove useful for understanding the linguistic profile of SLI within a dialect.

Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Philippines: Results from the Dyslipidemia international study II

Objective@#To quantify the extent of hyperlipidemia and its treatment in patients with stable coronary heart disease (CHD) or an acute coronary syndrome (ACS) in the Philippines.@*Methods@#The Dyslipidemia International Study (DYSIS) II was an observational, multinational study conducted in patients aged ≥18 years with stable CHD or being hospitalized with an ACS. A full lipid profile was evaluated at baseline, and for the ACS cohort, at 4 months after discharge from hospital. Achievement of low-density lipoprotein cholesterol (LDL-C) targets and the use of lipid-lowering therapy (LLT) were assessed.@*Results@#A total of 232 patients were enrolled from 10 centers in the Philippines, 184 with stable CHD and 48 being hospitalized with an ACS. The mean LDL-C level for the CHD patients was 88.0±40.1 mg/dL, with 33.3% achieving the target of <70 mg/dL recommended for very high-risk patients. For the ACS cohort, the mean LDL-C level was 109.0±48.5 mg/dL, with target attainment of 25.0%. The majority of the CHD cohort was being treated with LLT (97.3%), while 55.3% of the ACS patients were receiving LLT prior to hospitalization, rising to 100.0% at follow-up. There was little use of non-statins.@*Conclusions@#For these very high-risk patients from the Philippines, LDL-C target attainment was poor. Opportunities for better monitoring and treatment of these subjects are being missed.

Linguistic constraints on children's overt marking of BE by dialect and age.

PURPOSE: Overt marking of BE in nonmainstream adult dialects of English is influenced by a number of linguistic constraints, including the structure's person, number, tense, contractibility, and grammatical function. In the current study, the authors examined the effects of these constraints on overt marking of BE in children as a function of their nonmainstream English dialect and age. METHOD: The data were language samples from 62 children, ages 4-6 years; 24 children spoke African American English (AAE), and 38 spoke Southern White English (SWE). Analyses included analysis of variance and logistic regression. RESULTS: Rates of overt marking varied by the children's dialect but not their age. Although the person, number, tense, and grammatical function of BE influenced the children's rates of marking, the nature and magnitude of the influence differed by the children's dialect. For AAE-speaking children, contractibility also influenced their marking of BE. CONCLUSIONS: Consistent with the adult literature, the current study showed that AAE- and SWE-speaking children marked BE in ways that differed from each other and from what has been documented for child speakers of Mainstream American English. These findings show stability in the use of BE in AAE and SWE that spans different generations and different dialect communities.

Pleomorphomonas diazotrophica sp. nov., an endophytic N-fixing bacterium isolated from root tissue of Jatropha curcas L.

A novel aerobic, non-motile, pleomorphic, Gram-negative and nitrogen-fixing bacterial strain, designated R5-392(T), was isolated from surface-sterilized root tissue of Jatropha curcas. The organism grew optimally at 30 °C in media containing 1 % (w/v) NaCl and at pH 6.0-8.0. The predominant ubiquinone was Q-10 and the major fatty acids were C18 : 1ω7c/C18 : 1ω6c, C16 : 0 and C19 : 0 cyclo ω8c. The DNA G+C content was 63.2 mol%. Analysis of the 16S rRNA gene sequence suggested that strain R5-392(T) is affiliated with the order Rhizobiales within the class Alphaproteobacteria and is most closely related to Pleomorphomonas oryzae F-7(T) (98.8 % similarity) and Pleomorphomonas koreensis Y9(T) (98.3 % similarity). Analysis of partial nifH gene sequences also revealed a monophyletic lineage within the class Alphaproteobacteria, and strain R5-392(T) was most closely related to P. oryzae F-7(T) (98 %). Highest nitrogenase activity was detected in the presence of low-level organic nitrogen or in the presence of nitrogenase co-factors (Fe/Mo) in N-free media. Phenotypic and chemotaxonomic data suggest that strain R5-392(T) represents a novel species within the genus Pleomorphomonas, for which the name Pleomorphomonas diazotrophica sp. nov. is proposed. The type strain is R5-392(T) ( = KACC 16233(T) = DSM 25022(T)).

Hospital policy on medical futility - does it help in conflict resolution and ensuring good end-of-life care?

<p><b>INTRODUCTION</b>This paper aimed to ascertain if hospital policy on medical futility helps in conflict resolution, and in ensuring good end-of-life care.</p><p><b>MATERIALS AND METHODS</b>Literature on the subject published in the last 5 years was identified through Pubmed, and those with empirical data pertaining to the outcomes of interest were examined. A systematic analysis was not possible as papers varied greatly in aims, designs, outcomes and their measures. Instead, the outcomes of representative papers were described and discussed.</p><p><b>RESULTS</b>There is a widespread use of policies and guidelines based on the concept of medical futility. Conflicts are rare and appear to arise primarily from the manner in which policies are implemented. End-of-life care appears to be improving as evidenced by a significant number of deaths occurring following: (i) discussions involving patient, family, healthcare team members; (ii) cessation of intensive care and (iii) cessation of institution of palliative care. Deaths are increasingly taking place in the presence of family and outside the intensive care wards. Finally, post mortem audit of processes and practices indicate (i) compliance but in a limited manner with policies and recommended guidelines, (ii) family satisfaction and (iii) identify areas where improvement in end-of-life (EOL) care can be effected. Key areas are in improving education of, communication with, and documentation by all stakeholders.</p><p><b>CONCLUSION</b>Hospital policies on medical futility have helped to resolve conflicts and improve end-of-life care. Prospective, multicentre and controlled trials will be useful in determining the value of specific interventions, obtaining generalisable data and facilitating implementation of better end-of-life care models.</p>

The relationship between tumor cell differentiation and age at diagnosis in retinoblastoma.

PURPOSE: To determine the relationship between tumor cell differentiation and age at diagnosis in retinoblastoma. METHODS: Medical records of 170 patients with retinoblastoma treated by enucleation were reviewed retrospectively. Age at diagnosis and histopathological features were analyzed. RESULTS: Well-differentiated tumors presented earlier than poorly differentiated tumors. The frequency of presentation was highest in the first year of age for well-differentiated tumors and in the third year of age for poorly differentiated tumors (P < .0001). Bilateral well-differentiated tumors presented earlier than bilateral poorly differentiated tumors. Similarly, unilateral well-differentiated tumors presented earlier than unilateral poorly differentiated tumors. CONCLUSIONS: Differentiated tumors present earlier than poorly differentiated tumors, irrespective of laterality in retinoblastoma.

Neuro-developmental deficits in early-treated congenital hypothyroidism

This paper summarises the current evidence on neuro-developmental deficits in the early (< 1 month of age) treated congenital hypothyroid and the influencing factors. A literature search revealed only few citations that compared outcome with matched controls. In all but one, the median age of treatment onset was >2 weeks. Mean Global IQ scores are about 10 points lower and remain identifiable in adulthood. Verbal and performance scores are usually similar. Deficits persisting into adolescence and adulthood involve the visuomotor, memory, attention and posture domains. Lower academic performance is common in the early years. Prenatal factors associated with a worse prognosis are aetiology (dysgenesis), low birth weight, associated complications and severity of hypothyroidism. Postnatal factors are age at onset of treatment (>1 month), lower thyroxine dose at onset (<8 mcg/kg/day), late normalisation of thyroid function (>2 weeks after treatment), and a lower socio economic family status. The author proposes the evaluation of a multi centre cohort with a median age of treatment onset <1 week, TSH normalisation by <3 weeks with treatment thyroxine levels maintained in the 3rd quartile for age. The outcome of this cohort should indicate if current targets in management need to be revised.

Hyperhomocysteinemia and low methionine stress are risk factors for central retinal venous occlusion in an Indian population.

PURPOSE: The underlying cause of disturbed homocysteine metabolism is incompletely understood in young persons with central retinal vein occlusion (CRVO) with mild hyperhomocysteinemia (HHcys) and no other systemic disease in India. A 2-year prospective study was undertaken to determine whether HHcys is a risk factor for CRVO in an Indian population. METHOD: The prevalence of fasting HHcys was evaluated in a consecutive series of 29 patients with CRVO (mean age, 30 +/- 6 years) along with 57 age- and sex-matched control subjects (healthy subjects, mean age 27 +/- 5 years). Strict inclusion and exclusion criteria were used. Plasma levels of homocysteine (Hcys), methionine, cysteine, glutathione, B(12), and folate were measured. Multivariate logistic regression analysis was performed to determine the risk factors for CRVO. RESULT: Fifteen of 29 patients with CRVO (51.72%) exhibited HHcys (>15 muM). The mean Hcys level was significantly elevated in the patients with CRVO (19.1 +/- 13.1 muM) compared with that in the healthy control subjects (14.7 +/- 6.2 muM) with P = 0.04. The increased Hcys levels in CRVO cases was associated with decreased methionine (P = 0.052) and decreased B(12) (P = 0.001). A multivariate logistic regression analysis revealed an odds ratio of 1.9 (95% CI = 0.50-7.16) for Hcys and 15.9 for methionine (95%CI = 1.50-169.62; P = 0.022). CONCLUSION: Elevated Hcys and low methionine were risk factors for CRVO in an Indian population.

Anterior chamber collapse following vitreoretinal surgery with gas tamponade in aphakic eyes: incidence and risk factors.

PURPOSE: To report the risk factors associated with occurrence of anterior chamber collapse in aphakic eyes that underwent vitrectomy with gas tamponade. METHODS: A total of 314 eyes of 314 patients who underwent vitrectomy with gas tamponade and who were aphakic or were made aphakic intraoperatively were studied prospectively. Factors such as iris and pupillary integrity, depth of anterior chamber, gonioscopic grading, behavior of the anterior chamber on the operation table during fluid-air exchange, removal of crystalline lens or intraocular lens during surgery, and type of internal tamponade were noted. The anterior chamber was assessed postoperatively in supine and sitting position and with head bent forward. Statistical methods were used to identify risk factors for development of postoperative anterior chamber collapse using SPSS soft ware. RESULTS: Anterior chamber collapse occurred in 13 eyes (3.14%). Presence of preoperative shallow anterior chamber, removal of intraocular lens as a part of the procedure, occurrence of intraoperative anterior chamber collapse, and use of sulfur hexafluoride (SF6) were associated with higher risk of anterior chamber collapse postoperatively. CONCLUSIONS: The identification of potential risk factors in a given eye can alert the surgeon to the possibility of development of anterior chamber collapse postoperatively.

Early neonatal streptococcal infection.

OBJECTIVE: To determine the incidence of early onset Group B Streptococcal (GBS) infection in infants born over a two year period and to determine the outcome of sepsis evaluation in infants born to mothers with GBS colonization. METHODS: The charts of infants born to mothers with GBS colonization were reviewed for details of sepsis evaluation and management. The microbiology records were used to identify proven cases of GBS septicemia and meningitis in neonates born during the study period. RESULTS: Out of a total of 4636 live births in 2 years, there was one infant with culture-proven GBS septicemia, an incidence of 0.2 per 1000 live births. During the study period 83 infants were born to mothers who were known to have GBS carriage at the time of delivery. 73 out of these 83 infants (88%) had sepsis evaluation and received empirical parenteral penicillin for at least 5 days. There were no cases of blood culture-proven GBS sepsis among these 83 infants. However, there were 2 cases of probable sepsis giving an attack rate of 2.4%. All the three infants with definite or probable sepsis were preterm; there were no deaths among these affected infants. CONCLUSION: The overall incidence of early onset GBS sepsis was found to be low when compared to previous reported studies. The strategy of sepsis evaluation and management was found to be effective in preventing death and definite GBS septicemia in infants born to GBS colonized mothers.

Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners.

PURPOSE: To study the intraocular pressure (IOP) changes in Sirsasana (headstand posture) done by experienced yoga practitioners and correlate the ocular biometric parameters with the IOP changes, and to screen for the prevalence of ocular hypertension in this group of subjects. DESIGN: Prospective case observational series. PARTICIPANTS: Seventy-five subjects (50 Asian Indians and 25 Caucasians) from a yoga training institute volunteered for the study. METHODS: All participants underwent a detailed ophthalmic examination along with ocular biometry and corneal pachymetry. Intraocular pressure was recorded using a Tonopen before, during, and after the Sirsasana. Changes were compared using the paired t test. Age, axial length, anterior chamber depth, lens thickness, corneal curvature, corneal thickness, race, and the length of time for which the practitioner was performing yoga were correlated with the induced IOP difference in a randomly selected eye using Pearson's correlation coefficient with Bonferroni correction for multiple comparisons. MAIN OUTCOME MEASURES: Ocular biometry and induced IOP difference. RESULTS: The mean increase in IOP at baseline and immediately after assuming Sirsasana was 15.1+/-4.1 mmHg (R = 0.07; P = 0.999) and after 5 minutes was 15.8+/-4.6 mmHg (R = -0.25; P = 0.357). The induced increase in IOP during the posture was twice the baseline IOP. There was no correlation between age, ocular biometry, and ultrasound pachymetry when compared with the induced IOP difference. One subject (1.33%) was found to have baseline IOP of more than 21 mmHg. CONCLUSION: There was a uniform 2-fold increase in the IOP during Sirsasana, which was maintained during the posture in all age groups irrespective of the ocular biometry and ultrasound pachymetry. We did not demonstrate a higher prevalence of ocular hypertensives in this cohort of yoga practitioners nor did the risk factors contributing to glaucoma show any correlation with magnitude of IOP raise during the posture.

Karyotyping in retinoblastoma--a statistical approach.

PURPOSE: Karyotype analysis in hereditary retinoblastoma is considered to be of marginal value in risk prediction due to uncertainties in the assessment of 13q14 deletions. However, it is a low cost genetic test for retinoblastoma in developing countries. In the present study, the results of karyotype analysis were refined by a statistical method to overcome limitations. METHODS: Karyotype analysis was performed by trypsin-Giemsa banding and naked eye karyotyping for 33 bilateral, 25 unilateral and one regressed retinoblastoma patients. The percentage of metaphases with 13q14 deletions in each case was plotted on a scatter diagram. Normalization of the data was achieved by log transformation and the results were statistically analyzed by one-sample 't' test using SPSS version 9.0. RESULTS: Seven samples had 13q14 deletion percentages above the cutoff value. One-sample 't' test showed significance (p< 0.001). By this method, two unilateral and five bilateral patients had 13q14 deletions, constituting 11.8 % of cases. CONCLUSION: For accuracy, statistical analysis should be considered as an adjunct in karyotyping.

Comparative study of the reactogenicity of a three-component acellular pertussis vaccine and whole-cell pertussis vaccine administered to healthy Singaporean infants.

The objective of this study was to assess and compare the reactogenicity of GlaxoSmithKline (GSK) Biologicals' diphtheria-tetanus-tricomponent acellular pertussis vaccine (DTPa) and the locally used combined diphtheria-tetanus-whole-cell pertussis vaccine (DTPw) as a primary vaccination course in healthy infants at the age of 3, 4 and 5 months. A phase IV, single-blinded, randomized comparative clinical study involved one hundred and eighty healthy infants with two study groups in a 2:1 ratio to receive either DTPa or DTPw vaccine which were administered intramuscularly at the right anterior-lateral aspect of the thigh. The incidence and intensity of local solicited symptoms such as pain, redness and swelling at injection site and general solicited symptoms such as fever and fussiness were evaluated. Serious adverse events were followed for one month after each vaccination. The overall incidence of local and general symptoms was significantly higher in the group receiving locally used DTPw vaccine as compared to the group receiving GSK DTPa vaccine. Solicited local symptoms, pain (47.4% vs 15.1%), redness (95.9% vs 84.9%) and swelling (46.2% vs 18.5%), were reported more frequently in the group receiving DTPw vaccine than in the group receiving DTPa vaccine. Fever (> or = 37.5 degrees C) (52% vs 14.6%) and fussiness (60.8% vs 33.6%) were also more commonly reported in the DTPw group. There were six serious adverse events reported (4 with DTPw and 2 with DTPa). None of them related to the study vaccines, as considered by the investigators. Thus it was found that GSK Biologicals' DTPa vaccine was significantly less reactogenic as compared to the locally used DTPw vaccine manufactured by Commonwealth Serum Laboratories when administered as a 3-dose primary vaccination course to healthy infants at the age of 3, 4 and 5 months in Singapore.