Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study.

BACKGROUND: Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS: This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION: Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.

Optimal first-line treatment in ovarian cancer.

Treatment of ovarian cancer remains challenging despite the high complete response rate seen after maximal surgical debulking surgery and platinum-combination chemotherapy. as most patients will relapse and eventually succumb to ovarian cancer, new strategies are urgently required to improve survival. a platinum-taxane combination has been the cornerstone of treatment for >15 years. Better use of these drugs is being explored through scheduling studies, and dose-dense or intraperitoneal (IP) therapies. Further improvements in treatment will most likely come from the integration of optimal chemotherapy with one or more of the hundreds of molecular-targeted agents that could be active in ovarian cancer. The greatest experience has been with anti-angiogenic agents. Two large phase III trials in first-line ovarian cancer have demonstrated a positive effect of bevacizumab when administered concurrently with chemotherapy and then as a maintenance treatment. In this review, we discuss the existing treatments for ovarian cancer and highlight areas of recent progress.

Importance of specimen length during temporal artery biopsy.

BACKGROUND: Variations in surgical technique of temporal artery biopsy (TAB) performed for diagnosis of giant cell arteritis (GCA) may contribute to high false-negative rates. This was a retrospective analysis of a large database that explored potential associations between specimen length and diagnostic sensitivity of TAB. METHODS: Histopathological reports and medical records of patients who underwent TAB in six hospitals between 2004 and 2009 were reviewed. RESULTS: A total of 966 biopsies were analysed. The median postfixation specimen length was 1 (range 0·1-8·5) cm and 207 biopsies (21·4 per cent) were positive for GCA. Significant variation in prebiopsy erythrocyte sedimentation rate (ESR), arterial specimen length and positive results was noted amongst hospitals. Multivariable analysis revealed that patient age, ESR value and specimen length were independent predictors of GCA. Positive biopsies had significantly longer median specimen length compared with negative biopsies: 1·2 (range 0·3-8·5) versus 1·0 (0·2-8·0) cm respectively (P = 0·001). Receiver operating characteristic (ROC) analysis identified postfixation specimen length of at least 0·7 cm as the cut-off length with highest positive predictive value for a positive biopsy (area under ROC curve 0·574). Biopsies with specimen length of 0·7 cm or more had a significantly higher rate of positive results than smaller specimens (24·8 versus 12·9 per cent respectively; odds ratio 2·17, P = 0·001). CONCLUSION: Specimen length and ESR were independent prognostic factors of a positive TAB result. A uniform referral practice and standard specimen length of approximately 1 cm could help eliminate discrepancies in the results of TAB.

Neonatal abstinence syndrome.

Intrauterine exposure to drugs by mothers is not an uncommon finding ine our society. Due to the mother's suppression of a medical history, the diagnosis of neonatal abstinence syndrome is often missed. We report a case of a term, female, newborn, who presented with the following features;e restlessness, inconsolable crying, along with sweating, vigorous sucking; andadiarrhoea. No conclusion was derived from routine investigations. Eventually, with a high degree of suspicion regarding maternal drug addiction, her history was reviewed and it was discovered that the mother was a heroin addict. The baby was diagnosed as a case of Neonatal Abstinence Syndrome. The neonate was successfully managed thereafter and discharged.

Boron nitride nanotubes.

The successful synthesis of pure boron nitride (BN) nanotubes is reported here. Multi-walled tubes with inner diameters on the order of 1 to 3 nanometers and with lengths up to 200 nanometers were produced in a carbon-free plasma discharge between a BN-packed tungsten rod and a cooled copper electrode. Electron energy-loss spectroscopy on individual tubes yielded B:N ratios of approximately 1, which is consistent with theoretical predictions of stable BN tube structures.

Gun trauma and ophthalmic outcomes.

PurposeThis retrospective cohort study assesses the visual outcomes of patients who survive gunshot wounds to the head.MethodsThe Elmhurst City Hospital Trauma Registry and Mount Sinai Data Warehouse were queried for gun trauma resulting in ocular injury over a 16-year period. Thirty-one patients over 16 years of age were found who suffered a gunshot wound to the head and resultant ocular trauma: orbital fracture, ruptured globe, foreign body, or optic nerve injury. Gun types included all firearms and air guns. Nine patients were excluded due to incorrect coding or unavailable charts. Statistical analysis was performed using a simple bivariate analysis (χ2).ResultsOf the 915 victims of gun trauma to the head, 27 (3.0%) sustained ocular injuries. Of the 22 patients whose records were accessible, 18 survived. Eight of the 18 surviving patients (44%) suffered long-term visual damage, defined as permanent loss of vision in at least one eye to the level of counting fingers or worse. Neither location of injury (P=0.243), nor type of gun used (P=0.296), nor cause of gun trauma (P=0.348) predicted visual loss outcome. The Glasgow Coma Scale eye response score on arrival to the hospital also did not predict visual loss outcome (P=0.793).ConclusionThere has been a dearth of research into gun trauma and even less research on the visual outcomes following gun trauma. Our study finds that survivors of gun trauma to the head suffer long-term visual damage 44% of the time after injury.

Normethyl pentacyclic and lanostane-type triterpenes from Adiantum venustum.

Phytochemical studies on the aerial parts of Adiantum venustum resulted in the isolation of normethyl lupane-type, a normethyl oleanane-type and a lanostane-type triterpene. Structures of these triterpenes have been established as 30-normethyl lupane-20-one, 30-normethyl olean-3-one-30 beta-ol and lanost-20(22)-ene-30-ol on the basis of spectral data analyses and chemical methods.

A study of relapse in paucibacillary leprosy in a multidrug therapy project, Baroda District, India.

In order to judge the value of therapeutic regimens in paucibacillary leprosy, knowledge of incubation time of relapses is essential, as this will define the length of time patients have to be followed up after treatment has been stopped. The prospective study of relapse includes paucibacillary cases of leprosy belonging to a non-lepromatous group consisting of tuberculoid, neuritic and indeterminate. Data are presented on the incubation time of 21 relapses after multidrug therapy in Baroda district; 76.19% of relapses occur during the first 2 years. This figure is most important in the analysis of results of drug trials in paucibacillary leprosy. This figure should also be relevant to regimens including drugs that are more bacteriocidal than dapsone, since the bacteriocidal activity has a bearing on the minimal necessary duration of treatment, but not on the incubation time of relapses. With the introduction of bactericidal drugs e.g. rifampicin in multidrug therapy, the incidence of relapse are very low, hence relapse rates fall down to a very low level after multidrug therapy. Our study shows a mean relapse rate of 0.19% after multidrug therapy. Factors associated with the occurrence of relapse are discussed.

A new lanostane triterpenic ether from Adiantum venustum.

A new lanostane triterpenic ether, lanost-20(22)-en-3,19-ether, named adiantulanostene ether was isolated from Adiantum venustum. Its structure was elucidated on the basis of full spectral data analyses and chemical means.

Renal involvement in leprosy.

Renal involvement was studied in 70 patients with leprosy by urine analysis, detailed biochemical investigations and renal histopathology. Of these 70 patients, 40 had lepromatous and 30 had non-lepromatous leprosy. Creatinine clearance was reduced in 20 patients. Renal biopsies were studied in 50 cases (25 lepromatous, 25 non-lepromatous); of which in 13 cases (10 lepromatous, 3 non-lepromatous) abnormal histopathological lesions were found by light microscopy. Amyloidosis was seen in only one lepromatous patient. No acid-fast bacilli and leproma like lesion were demonstrated in any case.

Impact of multidrug therapy on leprosy in Baroda district (Gujarat).

Though much information is available on MDT organising, it poses a challenge to the field staff due to limited field trials conducted and varied field conditions. The MDT project was begun on 11th June, 1984 in Baroda by the Govt. of India, with active assistance of State Government, the World Health Organisation and the Swedish International Development Agency. The Drug combinations for MB cases were Rifampicin 600 mg, Clofazamine 300 mg and dapsone 100 mg daily for 14 days intensive supervised therapy followed by once a month (Pulse) supervised dose of Rifampicin 100 mg, Clof. 300 mg and dapsone 100 mg for minimum period of 2 years or more if indicated and Clof 50 mg daily with dapsone 100 mg daily unsupervised for minimum period of 2 years or more if indicated, for PB cases, dapsone 100 mg daily for 6 months along with Rifampicin 600 mg supervised (Pulse) once a month for minimum period of 6 months or more if indicated. Total number of active cases at commencement of MDT was 10706, out of these 10348 (96.37%) brought under MDT till Dec. 1987. Amongst 10348, old active cases 9112 (88.05%) are cured with MDT, (3110 MB + 6002 PB) 180 old MB cases BI is still positive inspite of completed 24 pulse. The rest 1056 (10.23%) stopped the treatment for various reasons. 790 (74.81%) cases have left the villages to earn their livelihood, 30 (2.86%) were being treated by skin specialist, 86 (7.19%) refuse to continue the treatment inspite of best efforts of field staff. New cases detected since June 1984 till Dec. 1987 are 7628, out of which 7549 (96.28%) brought under treatment. Now cases cured till Dec. 1987 are 4640 (1120 MB + 3520 PB) 17 cases relapsed after MDT (15 PB + 2 MB). 280 (1.56%) cases got complications, 250 developed reactions, 3 cases Jaundice, 15 cases Gastritis and rest 12 got moderate to severe anaemia. The prevalence rate came down from 5.81 to 1.01% per thousand population till Dec., 1987. The deformity rate came down amongst new cases from 6.15 to 1.50% till Dec. 1987. regularity of treatment among PB cases is 90.84% as compared to 90.48% for MB cases. The study showed that MDT can be implemented in tribal, rural and urban populations with high rate of compliance.

Danazol-induced biochemical changes in the rat ovary.

Effect of varying doses of danazol, a synthetic steroid derivative of 17 alpha-ethinyl testosterone has been observed on the biochemistry of the rat ovary. Biochemically total proteins decreased and total lipids increased with the danazol treatment. Triglycerides, the stored form of lipids formed the major components of lipids in the treated ovaries. The amount of phospholipids, glycolipids, cholesterol and free fatty acids decreased in the ovaries with increased danazol treatment. The functional significance of these changes have been discussed with ovarian physiology especially in relation to follicular growth and atresia.

Bis-Capsules: Cooperative Reversible Encapsulation of Two Molecules in Adjacent Separate Chambers.

Unprecedented communication takes place between guests G that are reversibly encapsulated in adjacent, but physically separate, chambers of a side-to-side bis-capsule (shown schematically). This was shown by neighbor-dependent NMR chemical shifts of the identical or nonidentical guest molecules. Furthermore, no 1:1 host - guest species is formed.

[Relationship between incisor position and status of facial soft tissues]. / Vliianie polozheniia reztsov na sostoianie miagkikh tkanei litsa.

Thirty patients with sagittal, vertical, and transverse abnormalities of occlusion combined with abnormal position of the frontal teeth and improper shape and size of dentition were examined. The position of maxillary canines was evaluated by the method suggested by L. Garner (1974) determining the relationship between the location of frontal teeth and position of soft facial tissues.

Advances in graphene-related technologies: synthesis, devices and outlook.

Graphene has been the subject of many scientific investigations since exfoliation methods facilitated isolation of the two-dimensional material. During this time, new synthesis methods have been developed which have opened technological opportunities previously hindered by synthetic constraints. An update on the recent advances in graphene-based technologies, including synthesis and applications into electrical, mechanical and thermal uses will be covered. A special focus on the patent space and commercial landscape will be given in an effort to identify current trends and future commercialization of graphene-related technologies.

Addition of salmeterol to existing treatment in patients with COPD: a 12 month study.

BACKGROUND: This study investigated the addition of salmeterol to existing treatment for exacerbations in patients with poorly reversible chronic obstructive pulmonary disease (COPD). METHODS: 634 patients aged >40 years with a history of COPD exacerbations (including at least two in the previous year) and poor reversibility of airflow obstruction (< or =10% predicted forced expiratory volume in 1 second) received either salmeterol 50 mug or placebo twice daily from a Diskus inhaler for 12 months. The primary outcome was the number of moderate and severe exacerbations. RESULTS: The median rate of moderate or severe exacerbations in the intent-to-treat (ITT) population was lower in the salmeterol group (0.00, range 0.0-9.8, n = 316) than in the placebo group (0.93, range 0.0-13.0, n = 318), but the difference was not statistically significant (p = 0.27). The median rate of exacerbations in the per protocol population (>90% compliance) was also found to be lower in the salmeterol group (0.00, range 0.0-5.0, n = 206) than in the placebo group (0.93, range 0.0-5.6, n = 195) and did reach statistical significance (p = 0.007). For secondary end points, patients receiving salmeterol had significant improvement in lung hyperinflation measured by inspiratory capacity which was evident at 4 weeks and maintained over 12 months (p = 0.035), and a significant improvement in health status measured by the St George's Respiratory Questionnaire at 12 months (p = 0.002). CONCLUSION: Salmeterol has a positive effect on symptoms and health status of patients with COPD when added to usual treatment. Exacerbations are only reduced in patients who comply with treatment.

Renal Involvement in Leprosy.

Renal involvement in 20 lepromatous leprosy (LL) and 5 non- lepromatous patients was assessed by (a) biochemical analysis of blood and urine, (b) renal functional tests, and (c) histopathological examination of renal biopsies. Ten age-matched healthy normals formed the control group. LL patients had a varying degree of renal involvement as indicated by the presence of pus cells, granular, hyaline and red cell casts, reversal of albumin/globulin ratio and lowered creatinine clearance rates. Renal biopsies showed significant histopathological lesions in 50% of lepromatous as compared to 20% of the non-lepromatous patients. The pathological changes were predominantly of chronic glomerulonephritis followed by chronic pyelonephritis and interstitial nephritis. Surprisingly none of the patients studied showed granulomas, acid-fast bacilli or amyloid in the kidney.