Continuous Kidney Replacement Therapy and Survival in Children and Young Adults: Findings From the Multinational WE-ROCK Collaborative.

RATIONALE & OBJECTIVE: There are limited studies describing the epidemiology and outcomes in children and young adults receiving continuous kidney replacement therapy (CKRT). We aimed to describe associations between patient characteristics, CKRT prescription, and survival. STUDY DESIGN: Retrospective multicenter cohort study. SETTING & PARTICIPANTS: 980 patients aged from birth to 25 years who received CKRT between 2015 and 2021 at 1 of 32 centers in 7 countries participating in WE-ROCK (Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Diseases). EXPOSURE: CKRT for acute kidney injury or volume overload. OUTCOMES: Death before intensive care unit (ICU) discharge. ANALYTICAL APPROACH: Descriptive statistics. RESULTS: Median age was 8.8 years (IQR, 1.6-15.0), and median weight was 26.8 (IQR, 11.6-55.0) kg. CKRT was initiated a median of 2 (IQR, 1-6) days after ICU admission and lasted a median of 6 (IQR, 3-14) days. The most common CKRT modality was continuous venovenous hemodiafiltration. Citrate anticoagulation was used in 62%, and the internal jugular vein was the most common catheter placement location (66%). 629 participants (64.1%) survived at least until ICU discharge. CKRT dose, filter type, and anticoagulation were similar in those who did and did not survive to ICU discharge. There were apparent practice variations by institutional ICU size. LIMITATIONS: Retrospective design; limited representation from centers outside the United States. CONCLUSIONS: In this study of children and young adults receiving CKRT, approximately two thirds survived at least until ICU discharge. Although variations in dialysis mode and dose, catheter size and location, and anticoagulation were observed, survival was not detected to be associated with these parameters. PLAIN-LANGUAGE SUMMARY: In this large contemporary epidemiological study of children and young adults receiving continuous kidney replacement therapy in the intensive care unit, we observed that two thirds of patients survived at least until ICU discharge. However, patients with comorbidities appeared to have worse outcomes. Compared with previously published reports on continuous kidney replacement therapy practice, we observed greater use of continuous venovenous hemodiafiltration with regional citrate anticoagulation.

Puberty Today, Gone Tomorrow: Transient Refractory Central Precocious Puberty in a Toddler with End-Stage Kidney Disease.

Novel Insights: - There are only three reported cases of precocious puberty in boys with CKD - Hypothalamic dysfunction due to uremia, and disordered renal clearance of LH, may lead to central precocious puberty, which resolves after uremia is corrected, e.g., after kidney transplant. - Increased drug clearance via peritoneal dialysis and/or an effect of uremia may lead to a sub-optimal response to leuprolide therapy. - Further studies are needed to characterize the relationship of CKD and peritoneal dialysis on puberty. INTRODUCTION: The onset of puberty is typically delayed in children with chronic kidney disease (CKD), with only three reported cases of precocious puberty in boys with CKD. CASE PRESENTATION: We report the case of a boy with end-stage kidney disease secondary to posterior urethral valves who, while undergoing peritoneal dialysis, presented at 17 months with central precocious puberty characterized by clinical signs of testicular and penile enlargement, pubic hair, and acne; rapid linear growth with advanced bone age; and pubertal luteinizing hormone (LH) and testosterone levels. Monthly leuprolide injections were commenced at 24 months with no pubertal or biochemical suppression thereafter, along with continued rapid bone-age advancement through 32 months. He then received a deceased-donor kidney transplant at 33 months of age, with good graft function. Within 2 months, he was noted to have prepubertal GnRH-stimulated LH and testosterone levels. Leuprolide injections were discontinued at that time with no further progression of puberty. The patient is now 48 months with minimal further bone-age advancement, and consistently prepubertal LH and testosterone levels. CONCLUSION: Our case demonstrates the development of precocious puberty due to premature activation of the hypothalamic-pituitary-testicular axis, presumably secondary to uremia and/or disordered renal clearance of gonadotropins, which was refractory to standard management with a gonadotropin-releasing hormone agonist, perhaps due to excessively rapid removal by peritoneal dialysis and/or the uremic state itself. Kidney transplantation led to a correction of uremia and a return to the prepubertal state.

Sporadic Case of Heterozygous X-Linked Alport Syndrome.

Alport syndrome is a genetically and phenotypically heterogeneous disorder that can be transmitted in an X-linked, autosomal recessive, or autosomal dominant fashion and can affect glomerular, cochlear, and ocular basement membranes. The disorder results from mutations in the collagen IV genes COL4A5 (X chromosome), COL4A3, and COL4A4. Alport patients are at lifetime risk for kidney failure, sensorineural deafness, and ocular abnormalities. Males with Alport syndrome typically present with severe phenotype with progression to end-stage kidney disease and/or sensorineural deafness and eye changes. Females generally having less severe presentation and diagnosis of X-linked Alport syndrome are generally not considered. Here, we report a case of a 3-year-old girl with gross hematuria, proteinuria, and chronic kidney disease who was found to have features of Alport syndrome on kidney biopsy and a sporadic heterozygous pathogenic COL4A5 deletion on molecular testing. This case report emphasizes the importance of kidney biopsy and molecular testing in the work up of pediatric patients with hematuria, proteinuria, and/or chronic kidney disease. It is also a poignant illustration that females with heterozygous X-linked COL4A5 mutations are often affected patients. It further illustrates the phenomenon of sporadic occurrence of genetic kidney disease in the absence of family history of kidney disease.

Interaction between micronutrients and lipid profile in prediabetes and diabetes among school-aged children (5-9 y) in India.

OBJECTIVES: Lipids and micronutrients play a major role in the pathophysiology of diabetes, and several studies have established the association between lipids and diabetes. The aim of this study was to determine the interaction between lipid profile and micronutrient status with different prediabetes and diabetes diagnosis criteria among school-aged children in India. METHODS: The data used in this study was from Comprehensive National Nutritional Survey conducted in India from 2016 to 2018. Glycosylated hemoglobin values and fasting blood glucose were used to classify normal, prediabetes, and diabetes. The interaction analysis between the lipid profile and eight micronutrients was conducted using multiple logistic regression analyses, and the predicted probabilities were determined. RESULTS: Among micronutrients, the highest deficiency was observed for hemoglobin (27%), and in the lipid profile, triacylglycerol was high in 34% of children. The interaction between high total cholesterol and vitamin B12 deficiency showed the highest average probability for prediabetes (66%). The highest average probability for diabetes was observed from the interaction between normal high-density lipoprotein and vitamin A deficiency (3%). CONCLUSION: The interaction between micronutrients and lipids suggests complex multidimensional pathways involving folate, vitamin B12, ferritin, zinc, hemoglobin, and iodine deficiencies. These interactions should be considered when planning diabetes management strategies.

Prevalence of pre-diabetes and diabetes among school-age children and adolescents of India: A brief report.

The prevalence study of pre-diabetes and diabetes among children and adolescents is crucial for early detection and intervention, public health resource allocation and monitoring the trend. The national prevalence of pre-diabetes and diabetes among school-age children was 15.35% and 0.94%, whereas, among adolescents, the prevalence was 16.18% and 0.56%, respectively.

Impact of Community Based Nutrition Intervention in the Prevention and Control of Anaemia Among Reproductive Aged Women of India.

INTRODUCTION: Maternal and child under-nutrition is particularly widespread in low and middle-income nations, increasing the overall disease burden due to poor nutritional status. The aim of this study was to develop nutrition intervention for the prevention and control of anaemia among women of reproductive age. METHODS: Community-based intervention study was conducted among 443 women of reproductive age group (15-49 years) to determine the effectiveness of a 6-month nutrition intervention package. The nutrition intervention was developed by using Precede-Proceed model and the trans-theoretical model of behavior change. Multi-channel communication approach was adopted and nutrition intervention package was provided. Assessment of haemoglobin, red blood cells, platelet, ferritin, folate, vitamin B12, haematocrit test, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width and total leucocyte count was compared at the baseline and endline after the intervention among the participants. The chi-square test of independence and t-test were performed. RESULTS: The only mean ferritin level shows significant improvement (p < 0.001). A significant decrease (~ 15%, p = 0.027) in anaemia was observed after the intervention. CONCLUSIONS: Improvement in anaemic status of women was observed. National schemes and programs require a more robust strategical implementation like food fortification/bio fortification and behaviour change communication at village level to enhance the availability and accessibility of fortified food.

Envarsus XR® pharmacokinetics in adolescents post-kidney transplantation - A pilot study.

INTRODUCTION: Envarsus XR® (LCPT), a once daily dosage formulation of tacrolimus, is an FDA-approved medication in adult renal transplant recipients (RTRs). There are limited data on its pharmacokinetics (PK) in adolescent RTRs. We report here the PK profile of LCPT in adolescent RTRs. METHODS: The dose of LCPT was determined using a dose conversion ratio targeting 0.7 relative to the total daily immediate-release tacrolimus (IR-Tac) dose. On day 7 after converting to LCPT, patients had an abbreviated PK assessment with sampling at: 0 h (pre-dose), 8-, and 12-h post-dose. The PK data analysis was performed using Bayesian estimators. Our results were compared to those of published adult PK data for LCPT and pediatric PK data for IR-Tac and extended release tacrolimus (ER-Tac) formulation (Advagraf). RESULTS: PK data from three adolescent patients on LCPT were evaluated. The mean (±SD) area under the time-concentration curve (AUC) was 240 (±20.22) h*ng/mL. The mean Tmax was 9.01 ± 2.12 h, and the % fluctuation was 77.71 ± 3.96%. The AUC, Tmax , and % fluctuation were similar to reported results in adult patients taking LCPT. The AUC was higher and the Tmax was longer than what has been reported in pediatric patients taking IR-Tac and ER-Tac. In addition, the LCPT group showed a lower % fluctuation than patients receiving ER-Tac. CONCLUSION: The PK evaluation of LCPT in adolescent RTRs showed similar results to adults. Adolescents taking LCPT had a higher AUC, a more attenuated Tmax , and a lower fluctuation than that seen with ER-Tac in pediatrics.

Deceased donor organ allocation in pediatric transplantation: A historical narrative.

BACKGROUND: Since the earliest clinical successes in solid organ transplantation, the proper method of organ allocation for children has been a contentious subject. Over the past 30-35 years, the medical and social establishments of various countries have favored some degree of preference for children on the respective waiting lists. However, the specific policies to accomplish this have varied widely and changed frequently between organ type and country. METHODS: Organ allocation policies over time were examined. This review traces the reasons behind and the measures/principles put in place to promote early deceased donor transplantation in children. RESULTS: Preferred allocation in children has been approached in a variety of ways and with varying degrees of commitment in different solid organ transplant disciplines and national medical systems. CONCLUSION: The success of policies to advantage children has varied significantly by both organ and medical system. Further work is needed to optimize allocation strategies for pediatric candidates.

Harnessing machine learning models for non-invasive pre-diabetes screening in children and adolescents.

BACKGROUND AND OBJECTIVES: Pre-diabetes has been identified as an intermediate diagnosis and a sign of a relatively high chance of developing diabetes in the future. Diabetes has become one of the most frequent chronic disorders in children and adolescents around the world; therefore, predicting the onset of pre-diabetes allows a person at risk to make efforts to avoid or restrict disease progression. This research aims to create and implement a cross-validated machine learning model that can predict pre-diabetes using non-invasive methods. METHODS: We have analysed the national representative dataset of children and adolescents (5-19 years) to develop a machine learning model for non-invasive pre-diabetes screening. Based on HbA1c levels the data (n = 26,567) was segregated into normal (n = 23,777) and pre-diabetes (n = 2790). We have considered eight features, six hyper-tuned machine learning models and different metrics for model evaluation. The final model was selected based on the area under the receiver operator curve (AUC), Cohen's kappa and cross-validation score. The selected model was integrated into the screening tool for automated pre-diabetes prediction. RESULTS: The XG boost classifier was the best model, including all eight features. The 10-fold cross-validation score was highest for the XG boost model (90.13%) and least for the support vector machine (61.17%). The AUC was highest for RF (0.970), followed by GB (0.968), XGB (0.959), ETC (0.918), DT (0.908), and SVM (0.574) models. The XGB model was used to develop the screening tool. CONCLUSION: We have developed and deployed a machine learning model for automated real-time pre-diabetes screening. The screening tool can be used over computers and can be transformed into software for easy usage. The detection of pre-diabetes in the pediatric age may help avoid its enhancement. Machine learning can also show great competence in determining important features in pre-diabetes.

Comprehensive overview of smartphone applications delivering child nutrition information.

Numerous smartphone-based applications that guide parenting, child nutrition, and child health-related knowledge are available. Here, we reviewed the applications available in the Google Play Store for child nutrition, primarily focused on children aged <5 y. The keywords used in the search were "child nutrition," "child nutrition status assessment," and "parenting." We identified 370 apps from the play store and 33 qualified for the review. Among 33 apps, 3 were not updated in the last 3 mo, and 19 did not mention their source of information. Four apps did not require the child's name, date of birth, and sex for logging in. Twenty-three apps were available in English only. The output features of the selected apps were food, growth, development and vaccine trackers, data export, reminders, meal planner, feeding tips, list of food, recipes details, information about nutrients, and question/answer session with the expert. Only eight apps provided access to consultation with experts and three suggested nutrient requirements of the child. Three apps scored similarly based on features, although the feature types differed. Findings from this review suggest that the apps do not follow any uniform guidelines for delivering the child nutrition information to the caregivers. About 50% of apps did not mention the consulted source for its development, indicating the unavailability of uniform guidelines or policy documents for child nutrition app development. App-based intervention studies are recommended to assess the effectiveness of child nutrition/health smartphone applications.

Determining the nutritional immunity information-seeking behaviour during the COVID-19 pandemic in India: a Google Trends data analysis.

OBJECTIVE: During COVID-19, the Internet was a prime source for getting relevant updates on guidelines and desirable information. The objective of the present study was to determine the nutritional immunity information-seeking behaviour during COVID-19 in India. DESIGN: Google Trends (GTs) data on relevant COVID-19 and nutritional topics were systematically selected and retrieved. Data on newly reported COVID-19 cases were also examined on a daily basis. The cross-correlation method was used to determine the correlation coefficient between the selected terms and daily new COVID-19 cases, and the joinpoint regression models were utilised to measure monthly percent change (MPC) in relative search volumes (RSV). SETTING: Online. PARTICIPANTS: People using Google search during the period 1 January 2020-31 August 2020 in India. RESULTS: The date of peak searches can be attributed to the COVID-19 guidelines announcement dates. All the nutritional terms showed a significant increase in average monthly percentage change. The higher than the average daily rise in COVID-19 cases leads to a higher than average increase in RSV of nutritional terms with the greatest association after 14-27 d. The highest mean relative search volume for nutritional terms was from Southern India (49·34 ± 7·43), and the lowest was from Western India (31·10 ± 6·30). CONCLUSION: There was a significant rise in the Google searches of nutritional immunity topics during COVID-19 in India. The local/regional terms can be considered for better outreach of public health guidelines or recommendations. Further automation of Google Trends using programming languages can help in real-time monitoring and planning various health/nutritional events.

Nutrition Status of School Children in Punjab, India: Findings from School Health Surveys.

BACKGROUND: School-going children and adolescents are rarely targeted in nutrition surveys, despite the significant impact of nutritional status on their health, cognition, educational achievements and future economic productivity. The present secondary data analysis evaluated the nutritional status of children and adolescents in the 5-18 years age group. MATERIALS AND METHODS: The anthropometric measurements of children and adolescents studying in the government and government-aided schools were collected under the 'Rashtriya Bal Swasthya Karyakram' in the District Fatehgarh Sahib of Punjab, India between March and August 2018. It was analyzed using SPSS version 21. Mean and standard deviation for weight-for-age, height-for-age, body mass index (BMI) for age z-scores were calculated using World Health Organization's Anthro-plus software. RESULTS: A total of 897 children's data were included in the study. Out of 352 children in 5-9 years age group, mean weight, height and BMI were 15.7 ± 3.8 kg, 110.7 ± 10.6 cm and 12.7 ± 2.1 kg/m2. About 58.8%, 37.4% and 31.8% of the children were categorized as severely underweight, stunted and thin, respectively. In the 10-18 years age group, mean weight, height and BMI were 30.5 ± 9.5 kg, 140 ± 13.4 cm and 15.2 ± 2.6 kg/m2. Severe stunting was present in 19.4% of adolescents, while 26.9% were severely thin. CONCLUSION: Our study depicts a high level of undernutrition in school-going children and adolescents. There is a need to strengthen the nutrition interventions for middle childhood and adolescence period that can help in a healthy transition from childhood to adulthood and break the intergenerational cycle of malnutrition. Lay summaryNational and state-level health-priorities focus mainly on improving the nutrition status of under-5-year children, while the school-going children and adolescents are usually neglected. The present secondary data analysis estimates the burden of malnutrition in school-going children and adolescents. These data were collected under one of India's national health programs that intend to tackle childhood illnesses. Our study depicts a high level of undernutrition in school-going children and adolescents. We found that girls were affected more by malnutrition in middle childhood, i.e. during 5-9 years (both by stunting and thinness) compared to boys. But in middle and late adolescence, males were more stunted and thin compared to females. Programs to support adolescents' nutrition interventions could provide an opportunity for a healthy transition from childhood to adulthood and could be an essential step in breaking the intergenerational cycle of malnutrition.

Estimates of malnutrition and risk of malnutrition among the elderly (≥60 years) in India: A systematic review and meta-analysis.

BACKGROUND: Death is inevitable, but healthy ageing is possible with proper nutrition and health care. This systematic review and meta-analysis conducted to estimate the nation-wide prevalence and malnutrition and risk of malnutrition among the elderly in India. METHODS: PubMed, EMBASE, Web of Science, Cochrane`s library, Google Scholar were searched for the articles reporting the prevalence of malnutrition among the elderly using MNA or MNA-SF tools. The study published between the year 2010-2019 were included. Sensitivity analysis, quality assessment was done using standard methods. The publication biasness was also determined using Doi plot and LFK index. The pooled prevalence was reported with effect size and considering the random effect model and quality effect model. The subgroup analysis was also conducted for gender, study setting, study area and study regions. RESULTS: The prevalence of malnutrition and risk of malnutrition among the elderly was 18.29% and 48.17% respectively. The prevalence of malnutrition was higher among female (16.67%), clinic setting (28.87%), urban areas (19.29%) and northern region (27.37%) of India. This trend differs with the prevalence of risk of malnutrition. Meta-regression analysis shows a region-based prediction of malnutrition and setting based prediction of risk of malnutrition. CONCLUSION: The prevalence of malnutrition was not considerably higher among the elderly population but about half of the elderly population were at risk of malnutrition. This trend differs with the gender, study setting, study area and study region. Additional study using other nutritional assessment tools were needed. Intervention studies among the elderly were recommended.

The multi-spectroscopic approach on the interaction between rabbit serum albumin and cationic surfactant: Investigation on the formation and solubilization of the protein aggregation.

The protein-surfactant interaction studies have great importance in the range of the application like cosmetics, food, pharmaceutical, detergent industries, and many more. In this study, we have studies protein (rabbit serum albumin, RSA) and a cationic surfactant (cetyltrimethylammonium bromide, CTAB) interaction at different physiological conditions (viz., pH, ionic strength, surfactants concentrations, protein concentration, and many more). They form the protein surfactant complexes. The interchange of electrostatic and hydrophobic force monitors the change in complexes. The three different pHs (below (4.0), above (7.0) and at (4.7) the isoelectric point of RSA) of the medium indicate the three different charges on the protein while surfactant is positive in charge. Critical micelle concentration (CMC) plays a significant role in protein-surfactant interaction. CTAB unfolds the protein at its specific concentration range afterward again; it starts refolded. RSA interacted, with the addition of the CTAB is characterized by many spectroscopic methods like UV-visible, fluorescence, fluorescence time-resolved, circular dichroism, and topographical changes monitored by the AFM. In fluorescence spectra, the blue shift shows the unfolding of RSA. The molecular docking indicates the binding energy of 5.8 kcal mol-1. The changes below and above the CMC is significant.

Spectroscopic studies of the aggregation behavior of Human Serum Albumin and cetyltrimethylammonium bromide.

To check the role of micelle in the interaction studies of human serum albumin (HSA) and cetyltrimethylammonium bromide (CTAB), many spectroscopic techniques, like UV-visible, fluorescence, circular dichroism, fluorescence lifetime measurement, and atomic force microscopy (AFM), are employed. The binding affinity of all compound groups depended on the hydrocarbon chain, indicating the predominant role of hydrophobic forces, electrostatic forces and supported by polar interactions on protein surfaces. The protein has a different effect on the polarity of a microenvironment in fluorescence spectra above and below the critical micelle concentration (CMC) of the suractant. The far-UV-CD spectra show unfolding below the CMC and refolding above the CMC. The binding of the surfactant induces changes in the microenvironment at different pHs around the residues of the aromatic amino acid and the disulfide bond of protein. The AFM images show significant changes in the protein's structure. AFM images show dense aggregation below the CMC and above the CMC, some net-like structure formed in the HSA-CTAB complex. To test the experimental results, we used Auto dock Vina to conduct molecular docking. Above and below the CMC, structural changes can be seen.

Influence of micelles on protein's denaturation.

To evaluate the role of micelles for protein-surfactant interaction, we have studied the binding modes of serum albumin proteins (human (HSA) and rabbit (RSA)) with anionic-surfactant, sodium dodecyl sulfate (SDS) by using UV-visible, fluorescence, circular dichroism, fluorescence lifetime, atomic force microscopy (AFM) techniques. The study performed with three different pHs (below (4.0), at (4.7), and above (7.0) isoelectric point). Hydrocarbon chain of the surfactant, dominant role of hydrophobic forces and electrostatic interactions helped in polar interaction on protein on binding surfaces. The change above and below the critical micelle concentration (CMC) in fluorescence spectra was due to polarity of the microenvironment. The CD spectra different binding aspects as below CMC and above CMC, explain about folding and unfolding in secondary structure. Surfactant's binding induces fluctuations in the microenvironment of aromatic amino acid's residues of both proteins at different pHs. AFM images clarify the structural changes in both proteins (HSA & RSA). AFM images also indicate some different interesting conformational and structural changes in both proteins below/above the CMC of the surfactant. The molecular docking studies indicate the binding energy -4.8 kcal mol-1 and -4.7 kcal mol-1 for HSA-SDS and RSA-SDS, respectively. Structural changes can be seen above and below the CMC.

Influence of pH on interaction of silver nanoparticles - protein: Analyses by spectroscopic and thermodynamic ideology.

To investigate the interaction between bovine serum albumin (BSA) and silver nanoparticles (AgNPs) at five different pHs (below (3.0 and 4.0), above (7.4 and 9.2) and at the isoelectric point (4.7) of BSA) by spectroscopic (viz., UV-vis, fluorescence, circular dichroism (CD)), microscopic (viz., atomic force microscopy (AFM), transmission electron microscopy (TEM), field emission scanning electron microscope (FESEM)) and thermodynamic (viz., isothermal titration calorimetry (ITC)) methods. The fluorescence quenching spectra provided binding constants via Stern-Volmer plot, quenching constant (Ksv) and rate constant (Kq) were calculated. From the CD spectra, it is clear that the α-helix decreases by increasing the AgNP's concentration. However, at isoelectric point (pH = 4.7), BSA shows more helicity in the presence of AgNPs, which indicates that the structures of BSA become more ordered and stable, and aggregation occurs at strong acidic (3.0), and basic medium (9.2) Fluorescence spectra also indicate the aggregation of the protein at strong acidic (pH = 3.0) and basic medium (pH = 9.2). Furthermore, the morphological and topographical evolute ion upon the interaction was examined using TEM, FESEM, and AFM. The studies conclude the effect of the pH in the medium and behavior of AgNPs with BSA by using different spectroscopic and microscopic techniques.

Hyperammonemic Encephalopathy due to Ureaplasma parvum Infection in an Immunocompromised Child.

Idiopathic hyperammonemia is a rare complication with a high mortality rate that occurs in persons with hematologic malignancies or hematopoietic stem cell or solid organ transplant. Patients present with encephalopathy and hyperammonemia in the absence of liver disease or inborn errors of metabolism. Several etiologies have been proposed, including chemotherapeutic agents, medications, and a catabolic state with an elevated nitrogen load in the setting of acute illness. Recently, cases of hyperammonemia in adult lung transplant recipients have been attributed to infection from Ureaplasma parvum or U urealyticum Herein, we report a 12-year-old girl with acute myeloid leukemia and neutropenic fever who developed acute encephalopathy. Laboratory testing revealed severe hyperammonemia (blood ammonia level >1609 µmol/L) with normal liver function studies. U parvum was detected in blood, urine, and respiratory specimens by polymerase chain reaction testing. After antibiotic therapy directed against U parvum, blood ammonia levels normalized, the infection was eradicated, and the patient recovered. We propose that clinicians should test for invasive infection from Ureaplasma species in immunocompromised children with unexplained hyperammonemia.

Role of (single/double chain surfactant) micelles on the protein aggregation.

To investigate the interaction between the bovine serum albumin (BSA) and cationic surfactants (monomeric, cetyltrimethylammonium bromide, CTAB) and dimeric/gemini, 1, 6 bis (N, N-hexadecyl dimethyl ammonium bromide, 16-6-16) and to find out the role of micelles in the aggregation of the protein using spectroscopic (UV-visible, fluorescence, fluorescence lifetime measurements, circular dichroism (CD), etc.) and microscopic (atomic force microscope (AFM)) techniques. The different surfactant has an effect on the polarity of the microenvironment of the protein shows in all the spectroscopic technique at below and above the critical micelle concentration (CMC). The far-UV CD spectra show that BSA is more disrupted by the dimeric surfactant compared to the monomeric CTAB above the CMC. The binding of the surfactant induce changes in the microenvironment around the aromatic amino acids residues and disulfide bond of the BSA at different pHs. The binding constant values were found to be 20.278×103M and 8.443M for the BSA-CTAB complex and BSA-16-6-16 complex, respectively. Atomic force microscope indicates the aggregation is more in case of dimeric (16-6-16) surfactant compared to the monomeric (CTAB) surfactant at the higher concentration (above their CMCs). Below and above the CMC, all changes are noticeable.