Diagnostic dilemma in a case of neonatal cardiac tumor - The importance of histopathology and mutation analysis in clinical practice.

Fetal or neonatal cardiac tumors are rarely encountered in neonatal practice. Moreover, these can be the earliest manifestation of underlying systemic conditions, such as tuberous sclerosis. Cardiac tumors are primarily diagnosed by characteristic findings in transthoracic echocardiography. However, these findings are not absolute, and histopathology remains the gold standard in diagnosing cardiac tumors. Sometimes, doubtful imaging findings can delay the diagnosis and initiation of definitive management. We describe a case of fetal and neonatal cardiac tumor where histopathology served as a benchmark in making a diagnosis and helped in identifying the underlying systemic disease.

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12 h (D1) and 48-72 h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography.   Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Prediction of surfactant requirement in Indian preterm infants by lung ultrasound scores: a diagnostic accuracy study from a developing country.

The purpose of this study is to validate lung ultrasound score (LUS) for prediction of surfactant replacement therapy (SRT) in Indian infants of 27-336/7 weeks gestational age (GA). This prospective diagnostic accuracy study was conducted in a level 3 neonatal care unit in India. Consecutively born preterm infants with respiratory distress syndrome (RDS) were enrolled. Surfactant was administered if oxygen requirement exceeded > 30%. Baseline characteristics, respiratory parameters, and lung ultrasound images were recorded soon after admission and compared between surfactant and non-surfactant groups. Adjusted odds ratio (OR) and diagnostic accuracy of LUS were calculated for SRT. Among 78 infants with RDS included in the final analysis, 62 received surfactant (79.48%). Median time of performing lung ultrasound was 50 min of life in both groups. Median LUS in the anterior and posterior chest areas of either side as well as total LUS was significantly higher in the surfactant group. After adjusting for other confounders, LUS was found to be a significant predictor of SRT (adjusted OR (95%CI): 1.55 (1.15-2.087)). Diagnostic accuracy of LUS was determined by receiver operating characteristic (ROC) curve analysis (AUC (95% CI): 0.751 (0.64-0.842), p < 0.001). A cutoff score of ≥ 9 for LUS was considered optimal for SRT (sensitivity (95%CI): 70.97% (57.87-81.45), specificity (95%CI): 68.75% (41.48-87.87)). CONCLUSION: Lung ultrasound is a valid diagnostic tool for SRT in Indian setting with a cutoff score ≥ 9. TRIAL REGISTRATION: CTRI/2021/11/038269. WHAT IS KNOWN: • Surfactant requirement in preterm infants with RDS has been traditionally based on FiO2 criteria. • Lung ultrasound score can predict the need for surfactant although majority of the studies originated in developed countries. WHAT IS NEW: • Lung ultrasound is a valid tool for surfactant replacement therapy even in developing countries like India.

A Three-Arm Randomized, Controlled Trial of Different Nasal Interfaces on the Safety and Efficacy of Nasal Intermittent Positive-Pressure Ventilation in Preterm Newborns.

OBJECTIVES: To compare the safety and efficacy of different nasal interfaces for delivering non invasive positive pressure ventilation (NIPPV) in preterm neonates. METHODS: In this three-arm parallel group stratified nonblinded randomized trial involving 210 preterm neonates the participants were randomly allocated to 'nasal mask', 'nasal prongs' and '4 hourly rotation of masks and prongs' groups in a 1:1:1 ratio. The groups were further stratified by gestational age (26-316/7 wk versus 32-366/7 wk) and indication of NIPPV (primary versus post extubation). Primary outcome was incidence of NIPPV failure within 72 h of initiation. Secondary outcomes were moderate/severe nasal injury, requirement of surfactant post randomization, total duration of respiratory support, duration of NICU stay, common neonatal morbidities and mortality. RESULTS: Primary analysis revealed that mask group was superior to prongs and rotation groups in terms of reduction in NIPPV failure within 72 h (8.6%, 24.3%, 22.8%, p = 0.033), decreased incidence of moderate/severe nasal injury (8.6%, 22.8%, 11.4% p = 0.038), decreased requirement of surfactant (20%, 38.6%, 42.8%, p = 0.01) and reduction in total duration of respiratory support [median (interquartile range)-6 (3, 10) d, 7.7 (4.9, 19.2) d, 7 (5.5, 18.5) d, p = 0.005]. Post hoc analysis confirmed that nasal mask was superior to prongs with respect to primary outcome (p = 0.012) and also reduced surfactant requirement compared to both prongs (p = 0.015) and rotation (p = 0.003) groups. Other pairwise comparisons were not statistically significant. CONCLUSIONS: Administering NIPPV by nasal mask significantly decreases the incidence of NIPPV failure within first 72 h compared to nasal prongs and also reduces the requirement of surfactant compared to both prongs and rotation groups.

Effect of Antenatal Dexamethasone in Late Preterm Period on Neonatal Hypoglycemia: A Prospective Cohort Study from a Developing Country.

OBJECTIVES: This study compared the risk of hypoglycemia within 72 h of life in infants with and without exposure to antenatal dexamethasone in the late preterm period (34-366/7 week's gestational age). METHODS: This prospective cohort study was conducted in a tertiary care neonatal unit of Eastern India from May 2021 to November 2021. Babies in the exposed group received at least one dose of antenatal dexamethasone in the late preterm period between 7 days before delivery and birth. 'Complete course' of antenatal steroid was defined as four doses of injection dexamethasone at 12 h intervals and <4 doses were considered as 'Partial course'. Primary outcome was incidence of hypoglycemia within 72 h of life, defined as whole blood glucose <45 mg/dl. RESULTS: Total 298 infants (98 in control, 134 in partial and 66 in complete group) were assessed for final outcome. No significant difference in outcomes were seen in the exposed group compared to unexposed group. However, incidence of hypoglycemia within 72 h (complete vs. partial p= 0.008, complete vs. control p=0.005) and 12 h of life (complete vs. partial p=0.013, complete vs. control p=0.013) was significantly less in complete steroid group. Logistic regression analysis revealed complete course of antenatal corticosteroid significantly decreased the risk of hypoglycemia [adjusted odds ratio, 95% confidence interval (CI) 0.15 (0.03-0.69), p=0.015]. Number needed to be exposed for one additional benefit was 7 (95% CI, 6.35-22.14). CONCLUSION: Complete course of dexamethasone administered to mothers at risk of late preterm delivery reduces risk of neonatal hypoglycemia within 72 h of life.

Evolution of the Local Structure within Chromophoric Mn-O5 Trigonal Bipyramids in YMn1- xIn xO3 with Composition.

We have investigated the local environment around Mn3+ and In3+ ions in YMn1- xIn xO3 chromophores to understand the origin of the intense blue color for small values of x in these solid solutions. While X-ray diffraction results provide an average description of the trigonal bipyramidal (TBP) units about Mn/In atoms with five oxygens surrounding the cation, the X-ray absorption near edge structure (XANES) as well as extended X-ray absorption fine structure (EXAFS) of these materials clearly suggest the presence of two different TBP environments, one of which is similar to MnO5 TBP in YMnO3. EXAFS in conjunction with first-principles calculations show that replacing larger In3+ ions by smaller Mn3+ ones additionally gives rise to another TBP strongly distorted along the axial direction, expanding one of the axial Mn-O bonds by ∼11%. The relative fraction of these two environments changes in close agreement with the global stoichiometry with the elongated TBP, therefore, being dominant in the regime of the low Mn content. This local structural difference is responsible for the intense, but relatively narrow, absorption feature in the red-yellow region of the absorption spectrum, and hence YMn1- xIn xO3 appears blue for small Mn dopings. This distortion is relatively less abundant in Mn-rich compositions, and therefore, such compositions appear black, controlled by the wide absorption feature of the trigonal bipyramid coordination with Mn-O bond lengths that are essentially the same as those in YMnO3, covering the entire visible range. The chromophore properties are, thus, governed by the ratio of these two MnO5 TBP environments, one with a characteristic optical absorption giving it a blue color and the other absorbing over the entire visible range.

Use of a Comic Book to Assist Pharmacy Student Learning of the Affordable Care Act (ACA).

PURPOSE: To assess the pedagogical effectiveness of a comic book in pharmacy student learning of the Affordable Care Act (ACA). METHODS: Comparative-group, matched pre-posttest survey design was used to measure pharmacy students' comprehension of ACA. PharmD students (P-1year) from two sections of a Pharmacy and US Healthcare course participated in this study. Treatment group students received a comic book on ACA. The comparison group received the textual information, without pictures, from the book in a typed document. A posttest survey was administered later in the semester, before the instructor discussed ACA in class. Fourteen questions, developed from the information in the book and document, assessed pharmacy students' comprehension of ACA. Response options included a visual analogue scale. Independent sample t-test was used to assess the differences in the mean pre-posttest scores between the two groups. RESULTS: A total of 103 (n = 49 comparison vs. n = 54 treatment group) students completed the survey. No statistically significant differences were found in the pre-test mean scores between the groups. Differences in the pre-post test mean scores of treatment group were significantly higher than the differences in the mean scores of the comparison group. Students agreed that the comic book format gave them a better understanding of ACA and increased their interest in learning more about the Act. CONCLUSION: Comic books were found to be effective in student learning of the ACA. The positive response from students highlight the point that pharmacy faculty could use comic books as supplemental reading in pharmacy courses.

Behavior of Methylammonium Dipoles in MAPbX3 (X = Br and I).

Dielectric constants of MAPbX3 (X = Br, I) in the 1 kHz-1 MHz range show strong temperature dependence near room temperature, in contrast to the nearly temperature-independent dielectric constant of CsPbBr3. This strong temperature dependence for MAPbX3 in the tetragonal phase is attributed to the MA+ dipoles rotating freely within the probing time scale. This interpretation is supported by ab initio molecular dynamics simulations on MAPbI3 that establish these dipoles as randomly oriented with a rotational relaxation time scale of ∼7 ps at 300 K. Further, we probe the intriguing possibility of transient polarization of these dipoles following a photoexcitation process with important consequences on the photovoltaic efficiency, using a photoexcitation pump and second harmonic generation efficiency as a probe with delay times spanning 100 fs-1.8 ns. The absence of a second harmonic signal at any delay time rules out the possibility of any transient ferroelectric state under photoexcitation.

Solvent-Dependent Delamination, Restacking, and Ferroelectric Behavior in a New Charge-Separated Layered Compound: [NH4 ][Ag3 (C9 H5 NO4 S)2 (C13 H14 N2 )2 ]⋠8 H2 O.

A new anionic coordination polymer, [NH4 ][Ag3 (C9 H5 NO4 S)2 (C13 H14 N2 )2 ]⋅8 H2 O, with a two-dimensional structure, has been synthesized by a reaction between silver nitrate, 8-hydroxyquinoline-5-sulfonic acid (HQS), and 4,4'-trimethylene dipyridine (TMDP). The compound stabilizes in a noncentrosymmetric space group, and the lattice water molecules and the charge-compensating [NH4 ]+ group occupy the inter-lamellar spaces. The lattice water molecules can be fully removed and reinserted, which is accompanied by a crystalline-amorphous-crystalline transformation. This transformation resembles the collapse/delamination and restacking of the layers. To the best of our knowledge, this is the first observation of delamination and restacking in an inorganic coordination polymer that contains silver. The presence of a natural dipole (the anionic framework and cationic ammonium ions) along with the noncentrosymmetric space group gives rise to the room-temperature ferroelectric behavior of the compound. The ferroelectric behavior is also water-dependent and exhibits a ferroelectric-paraelectric transformation. The temperature-dependent dielectric measurements indicate that the ferroelectric/ paraelectric transformation occurs at 320 K. This transformation has also been investigated by using in-situ IR spectroscopy and PXRD studies. The second-harmonic generation (SHG) study indicated values that are comparable to some of the known SHG solids, such as potassium dihydrogen phosphate (KDP) and urea.

Switchable Room-Temperature Ferroelectric Behavior, Selective Sorption and Solvent-Exchange Studies of [H3 O][Co2 (dat)(sdba)2 ]⋠H2 sdba⋠5 H2 O.

A newly synthesized compound, [H3 O][Co2 (dat)(sdba)2 ]⋅H2 sdba⋅5 H2 O (I, dat=3,5-diamino-1,2,4-triazole; H2 sdba=4,4'-sulfonyldibenzoic acid), has Co2 "paddlewheel" units connected by sdba ligands to form one-dimensional chains, which are connected by dat to form an anionic three-dimensional structure with cds topology. The one-dimensional channels in the structure contain water molecules, hydronium ions and H2 sdba. The water molecules could be reversibly exchanged with D2 O, CH3 OH and C2 H5 OH molecules; these exchanges were performed in a single-crystal-to-single-crystal manner. Gas sorption studies on the dehydrated compound showed the selective adsorption of CO2 over methane at 195 K. Nonlinear optical measurements indicated that I exhibits a second harmonic generation signal that is approximately one-third that of urea. Studies of polarization versus electric field demonstrated compound I as a potential room-temperature ferroelectric material with a saturation polarization of 0.23 µC cm-2 and remnant polarization of 0.14 µC cm-2 . The dehydrated compound exhibited a simple paraelectric behavior.

Electrical and Plasmonic Properties of Ligand-Free Sn(4+) -Doped In2 O3 (ITO) Nanocrystals.

Sn(4+) -doped In2 O3 (ITO) is a benchmark transparent conducting oxide material. We prepared ligand-free but colloidal ITO (8 nm, 10 % Sn(4+) ) nanocrystals (NCs) by using a post-synthesis surface-modification reaction. (CH3 )3 OBF4 removes the native oleylamine ligand from NC surfaces to give ligand-free, positively charged NCs that form a colloidal dispersion in polar solvents. Both oleylamine-capped and ligand-free ITO NCs exhibit intense absorption peaks, due to localized surface plasmon resonance (LSPR) at around λ=1950 nm. Compared with oleylamine-capped NCs, the electrical resistivity of ligand-free ITO NCs is lower by an order of magnitude (≈35 mΩ cm(-1) ). Resistivity over a wide range of temperatures can be consistently described as a composite of metallic ITO grains embedded in an insulating matrix by using a simple equivalent circuit, which provides an insight into the conduction mechanism in these systems.

Protein C deficiency.

This report describes a 4 year old female child who presented with fever, pain and swelling of left leg following a trivial trauma. She was diagnosed as a case of deep vein thrombosis and subsequently found to be due to protein C deficiency.

Motivating factors influencing college students' choice of academic major.

OBJECTIVES: To assess the factors, motivations, and nonacademic influences that affected the choice of major among pharmacy and nonpharmacy undergraduate students. METHODS: A survey was administered to 618 pharmacy and nonpharmacy majors to assess background and motivational factors that may have influenced their choice of major. The sample consisted of freshman and sophomore students enrolled in a required speech course. RESULTS: African-American and Hispanic students were less likely to choose pharmacy as a major than Caucasians, whereas Asian-Americans were more likely to choose pharmacy as a major. Pharmacy students were more likely to be interested in science and math than nonpharmacy students. CONCLUSION: Students' self-reported racial/ethnic backgrounds influence their decision of whether to choose pharmacy as their academic major. Results of this survey provide further insight into developing effective recruiting strategies and enhancing the marketing efforts of academic institutions.

Dynamics of nanoscale droplets.

Several aspects of the dynamical behavior of nanometer-sized liquid drops have been investigated using molecular dynamics computer simulations. The liquids consist of chains of lengths 2-100 with Lennard-Jones and nonlinear elastic interactions, comprising drops made of O(100,000) atoms with radius O(10 nm), placed on an atomistic substrate. We simulate the solidification of a liquid drop on a substrate as the latter is cooled, and observe a smooth contraction and smoothing process but no dimple formation. If instead we simulate heating of the substrate, the drop evaporates, and we find a decrease on contact angle in the partially wetting case, in accord with recent predictions. Last, we consider the coalescence of two such droplets, either spontaneously or when pushed together, to study shape evolution scaling laws and to document a rapid internal structural reequilibration. Aside from the intrinsic novelty associated with the small scale of these systems, the results illustrate the relation between atomic scale interactions and macroscopic continuum properties of materials.