A membrane-based green and low-cost system for ensuring safe drinking water in a selenium-affected region.

Towards an efficient, low-cost solution to the problem of contamination of groundwater by selenium leached out from earth's mineral crust, a new system is developed using a novel graphene-based nanocomposite membrane. The system not only purified selenium-contaminated groundwater with high degree but also ensured safe disposal of the rejected selenium through algorithmic chemical stabilization in a mineral matrix. All experiments were conducted with live contaminated water from selenium affected area rather than using synthetic solution in a semi-pilot unit involving a largely fouling-free flat sheet cross-flow membrane module. Pure water flux of up to 190 Lm-2h-1(LMH) with 96-97% selenium rejection at an optimum operating pressure of only 14 bar could be achieved. Rejected selenium was stabilized in mineral matrix through chemical coagulation-precipitation using suitable coagulants following prior optimization of the critical operating parameters by Model-based calibration toolbox (MATLAB R2020a). A high degree of stabilization efficiency (99.8%) could be achieved as reflected in an error-index of only 1.13%. For selenium-affected region, the membrane-integrated hybrid treatment system proved to be a potential candidate technology offering safe drinking water at an approximate cost of only 1.77 $/m3 which was found to be affordable to the consumers in subsequent willingness to pay survey.

Clinical characteristics, treatment and long-term prognosis in patients with anti-NMDAR encephalitis.

OBJECTIVES: We aimed to (i) analyse the clinical characteristics, treatment outcome and long-term prognosis of anti-NMDAR encephalitis and (ii) study the differences between paediatric and adult patients. METHODS: This was a chart review of all patients with anti-NMDAR encephalitis. RESULTS: There were 28 patients with 18 patients belonging to the paediatric (<18 years) age group. There was female (94%) preponderance in the paediatric age group, while in adult patients, there was no gender predilection (p=0.006). There was no significant difference in clinical feature, outcome or number of relapses between paediatric and adult population groups. MRI brain was abnormal in 53% of patients. Among the 15 patients with MRI abnormalities at the onset, 53% had poor functional outcome at 1 year, while in 12 patients with normal initial MRI brain, only 8% had poor functional outcome at 1 year (p =0.01). Nearly 53% of patients with abnormal MRI at presentation had at least one clinical relapse within 2 years while in patients with normal MRI at presentation, 15% had a clinical relapse (p=0.037). EEG abnormalities were noticed in 71% of patients; among them, 40 and 15% had poor functional outcome at 1 and 2 years respectively. In comparison, those with normal first EEG at onset, 12% had poor functional outcome at 2 years (p=0.57). CONCLUSIONS: Both paediatric and adult patients presented with similar clinical features but the paediatric population had female preponderance. The functional outcome and number of relapse were comparable in both the paediatric and adult groups. Patients with parenchymal changes on MRI and abnormal EEG showed poorer response compared to those with normal MRI and/or EEG at the onset. Patients have lesser severity of symptoms at relapse than in the first episode. An early diagnosis and treatment are essential for better long-term functional outcome.

Three-dimensional neuromelanin-sensitive magnetic resonance imaging of the substantia nigra in Parkinson's disease.

BACKGROUND AND PURPOSE: The aim was to investigate the diagnostic utility of signal intensity measurement of the substantia nigra pars compacta (SNc) using three-dimensional (3D) neuromelanin-sensitive magnetic resonance imaging (MRI), for discrimination of patients with Parkinson's disease (PD) from healthy controls. METHODS: T1-weighted neuromelanin-sensitive images of 16 patients with PD and 15 controls were quantitatively analyzed by placing circular 10 mm2 regions of interest over the central and lateral parts of the bilateral SNc and anterior to the cerebral aqueduct at three levels of the midbrain. Signal intensities and contrast ratios (CRs) were calculated, after which significant differences, correlations, sensitivity and specificity were calculated. RESULTS: The CRs of the central and lateral SNc were significantly lower in patients with PD. Lateral CRs were lower than the central CRs in both groups and significantly correlated with duration of illness. CRs of central and lateral parts of the SNc also correlated with the Unified Parkinson's Disease Rating Scale III OFF state scores. Receiver operating characteristic analysis revealed lateral CRs to be more sensitive and central CRs to be more specific for the discrimination of patients with PD from controls. CONCLUSIONS: Contrast ratio analysis of the SNc using 3D neuromelanin-sensitive MRI may serve as a quick and accurate tool to discern between patients with PD and healthy controls.

"I swear, I can't stop it!" - A case of severe Tourette's syndrome treated with deep brain stimulation of anteromedial globus pallidus interna.

INTRODUCTION: Tourette's syndrome (TS) is a complex neuropsychiatric disorder characterized by the presence of multiple motor and vocal tics. Here, we report the case of a young man with severe TS refractory to multiple medications who underwent deep brain stimulation (DBS), which was successful in substantially ameliorating his tics. To our knowledge, this is the first such report from India and South Asia. CASE REPORT: An 18-year-old right-handed male patient was diagnosed with TS at the age of 10 years. He had facial and ocular tics. He was also hitting his fist against his chest and shouting obscenities. The manifestations would be present in every waking hour with a maximum tic free interval of 15-20 minutes. They would often result in self-injury or damage to objects. He would have frequent crying spells, anger outbursts, and death wishes. As tics became highly conspicuous and socially inappropriate, he dropped out of school and remained almost completely house-bound for the preceding year. On evaluation, he scored 96 (46 on tic-severity subscale and 50 on impairment subscale) of a maximum of 100 on the Yale Global Tic Severity Scale. (YGTSS). MANAGEMENT: After failure of multiple combinations of medicines, repetitive transcranial magnetic stimulation, and behavioural therapies, he successfully underwent DBS to bilateral anteromedial globus pallidus interna. CONCLUSION: Tic severity reduced substantially post-surgery, with the YGTSS score improving by more than 72%. These improvements were sustained on follow-up visits with the patient successfully returning to join college. To our knowledge, this is the first such report from India and South Asia.

Therapeutic plasma exchange in paediatric SLE: a case series from India.

Therapeutic plasma exchange (TPE) has been reported to be a useful adjunct in severe systemic lupus erythematosus (SLE) but paediatric literature continues to be scanty. We hereby present three cases of refractory paediatric SLE (pSLE) with thrombotic thrombocytopenic purpura (TTP), diffuse alveolar haemorrhage (DAH) and crescentic glomerulonephritis which were treated with TPE as an adjunctive therapy. TPE was carried out in haemodialysis units using the membrane filtration technique. Demonstrable benefit of TPE was seen in all three cases. In refractory pSLE, TPE may be a useful tool and should be considered. The report additionally highlights the feasibility of undertaking TPE in haemodialysis units, which is important as haemodialysis units are more readily available than dedicated apheresis units in developing countries.

Repetitive transcranial magnetic stimulation induced modulations of resting state motor connectivity in writer's cramp.

BACKGROUND AND PURPOSE: Writer's cramp (WC) is a focal task-specific dystonia of the hand which is increasingly being accepted as a network disorder. Non-invasive cortical stimulation using repetitive transcranial magnetic stimulation (rTMS) has produced therapeutic benefits in some of these patients. This study aimed to visualize the motor network abnormalities in WC and also its rTMS induced modulations using resting state functional magnetic resonance imaging (rsfMRI). METHODS: Nineteen patients with right-sided WC and 20 matched healthy controls (HCs) were prospectively evaluated. All patients underwent a single session of rTMS and rsfMRI was acquired before (R1) and after (R2) rTMS. Seed-based functional connectivity analysis of several regions in the motor network was performed for HCs, R1 and R2 using SPM8 software. Thresholded (P < 0.05, false discovery rate corrected) group level mean correlation maps were used to derive significantly connected region of interest pairs. RESULTS: Writer's cramp showed a significant reduction in resting state functional connectivity in comparison with HCs involving the left cerebellum, thalamus, globus pallidus, putamen, bilateral supplementary motor area, right medial prefrontal lobe and right post central gyrus. After rTMS there was a significant increase in the contralateral resting state functional connectivity through the left thalamus-right globus pallidus-right thalamus-right prefrontal lobe network loop. CONCLUSIONS: It is concluded that WC is a network disorder with widespread dysfunction much larger than clinically evident and changes induced by rTMS probably act through subcortical and trans-hemispheric unaffected connections. Longitudinal studies with therapeutic rTMS will be required to ascertain whether such information could be used to select patients prior to rTMS therapy.

Photoinduced reduction of surface states in Fe:ZnO.

We report on the electronic structure of nano-crystalline Fe:ZnO, which has recently been found to be an efficient photocatalyst. Using resonant photoemission spectroscopy, we determine the binding energy of Fe 3d states corresponding to different valencies and coordination of the Fe atoms. The photo-activity of ZnO reduces Fe from 3+ to 2+ in the surface region of the nano-crystalline material due to the formation of oxygen vacancies. Electronic states corresponding to low-spin Fe(2+) are observed and attributed to crystal field modification at the surface. These states are potentially important for the photocatalytic sensitivity to visible light due to their location deep in the ZnO bandgap. X-ray absorption and x-ray photoemission spectroscopy suggest that Fe is only homogeneously distributed for concentrations up to 3%. Increased concentrations does not result in a higher concentration of Fe ions in the surface region. This is limiting the photocatalytic functionality of ZnO, where the most efficient Fe doping concentration has been shown to be 1%-4%.

Clinical and imaging characteristics of 16 patients with autoimmune neuronal synaptic encephalitis.

OBJECTIVES: Autoimmune neuronal synaptic encephalitis (AIE) encompasses a heterogeneous group of disorders characterized by immune-mediated neuronal cell destruction. In this study, we aim to study the clinical features, imaging profile and treatment outcome of patients with AIE. METHODS: This is a chart review of 16 (M: F-3:13) patients with AIE from 2011 to 2015. RESULTS: Among the patients, 10 had anti-NMDA, 4 had anti-TPO, and 2 had anti-VGKC antibody positivity. Cognitive impairment and seizures were the predominant symptoms present in nearly all patients, followed by psychiatric disturbances (87.5%), mutism (62.5%), movement disorders (62.5%), myoclonic jerks (37.5%) and visual hallucinations (18.75%). Magnetic resonance imaging (MRI) of the brain was available in 15 patients; it was abnormal in 53.3% patients. Abnormalities were seen in all patients with anti-VGKC positivity; and, 60% of patients with anti-NMDA positivity. Imaging was normal in 26.7% of the patients (3: anti-NMDA; and, 1: anti-TPO positivity); and, diffuse cerebral atrophy was noted in rest of the 20% (3: anti-TPO positivity) patients. All patients improved gradually with immunomodulation. CONCLUSIONS: All patients with anti-VGKC, anti-NMDA and anti-TPO antibody positivity presented with a triad of behavioral changes, impaired cognition and seizures. Mutism was a predominant symptom in patients with an anti-NMDA antibody positivity, which may help in the early identification of this disorder. MRI brain showed changes restricted to limbic structures in anti-NMDA and anti-VGKC antibody positivity. An early diagnosis and treatment of autoimmune encephalitis is essential for a better outcome and for prevention of long-term sequel.

Association between cortical volume loss and cognitive impairments in essential tremor.

BACKGROUND AND PURPOSE: Impairment of cognitive functions occurs in essential tremor (ET) although the mechanism is largely unknown. A possible association between cognitive performance and brain atrophy in ET patients was examined using neuropsychological tests and voxel-based morphometry (VBM). METHODS: Twenty-five patients with ET and 25 matched healthy controls were evaluated. ET was diagnosed using the National Institutes of Health collaborative genetic criteria. Severity of tremor was assessed using the Fahn-Tolosa-Marin (FTM) tremor rating scale. Subjects were assessed using a structured neuropsychological battery. Brain images were acquired using a 3T magnetic resonance imaging scanner. VBM analysis was performed using Statistical Parametric Mapping 8. RESULTS: The age of the patients was 45.0 ± 10.7 years and of controls 45.4 ± 10.7 years. Tremor duration was 9.84 ± 6.63 years and total FTM score was 37.34 ± 17.67. Patients were divided into two groups: ETCI with cognitive impairment (three or more abnormal neuropsychological tests, 1.5 standard deviation criterion) and ETNCI without cognitive impairment. Compared with controls, the ETCI group had significantly impaired performance in neuropsychological tests. One-way analysis of variance was performed between the three groups (ETCI, ETNCI, controls) followed by the two-sample t test. Compared with controls, grey matter volume (GMV) loss was observed in ETCI in the cerebellum (anterior and posterior lobes) and medial frontal gyrus. GMV loss was observed in ETCI compared with ETNCI in the medial frontal gyrus, post central gyrus, anterior cingulate and insula. Impairment in neuropsychological tests significantly correlated with GMV of the medial frontal gyrus, superior parietal lobe, middle temporal gyrus, occipital lobe, lentiform nucleus, insular and cingulate cortices and cerebellum posterior lobe in ETCI. CONCLUSIONS: A correlation between neurocognitive deficits in ETCI and GMV was observed suggesting that grey matter atrophy appears to be a correlate of cognitive impairment in ET.

Temporal variation in the dispersion patterns of metazoan parasites of a coastal fish species from the Gulf of Mexico.

Global climate change (GCC) is expected to affect key environmental variables such as temperature and rainfall, which in turn influence the infection dynamics of metazoan parasites in tropical aquatic hosts. Thus, our aim was to determine how temporal patterns of temperature and rainfall influence the mean abundance and aggregation of three parasite species of the fish Cichlasoma urophthalmus from Yucatán, México. We calculated mean abundance and the aggregation parameter of the negative binomial distribution k for the larval digeneans Oligogonotylus manteri and Ascocotyle (Phagicola) nana and the ectoparasite Argulus yucatanus monthly from April 2005 to December 2010. Fourier analysis of time series and cross-correlations were used to determine potential associations between mean abundance and k for the three parasite species with water temperature and rainfall. Both O. manteri and A. (Ph.) nana exhibited their highest frequency peaks in mean abundance at 6 and 12 months, respectively, while their peak in k occurred every 24 months. For A. yucatanus the frequency peaks in mean abundance and k occurred every 12 months. We suggest that the level of aggregation at 24 months of O. manteri increases the likelihood of fish mortality. Such a scenario is less likely for A. (Ph.) nana and A. yucatanus, due to their low infection levels. Our findings suggest that under the conditions of GCC it would be reasonable to expect higher levels of parasite aggregation in tropical aquatic hosts, in turn leading to a potential increase in parasite-induced host mortality.

Subcortical structures in progressive supranuclear palsy: vertex-based analysis.

BACKGROUND AND PURPOSE: To study the abnormalities of deep grey matter (GM) structures in patients with progressive supranuclear palsy (PSP) using MR volumetry and shape analysis techniques. METHODS: Twenty-eight patients with PSP and 25 matched controls (all were right handed) were evaluated using standard clinical scales. MRI was performed on a 3 tesla MRI scanner using standard protocol which included T1-3D Turbo Field-Echo images with 1-mm slice thickness. The volumes of GM and white matter, total brain and the deep subcortical GM structures, including hippocampus, amygdala, caudate, putamen, globus pallidus and thalamus were extracted using a fully automated tool. Univariate analysis of covariance, adjusted for intracranial volume (ICV), sex and age, was used to explore group differences. Shape analysis was also performed using automated software with age, sex and total brain volume as covariates of no interest in the statistical design at P < 0.05 (FDR corrected). RESULTS: The patients with PSP had significantly lower volumes of bilateral thalami, hippocampus, pallidum and brainstem. Shape analysis of GM structures showed significant surface reduction in bilateral thalami and head of right caudate nucleus. CONCLUSIONS: MR volumetry showed abnormalities of various deep GM structures. Shape analysis also revealed focal surface contractions in multiple subcortical structures. Our study highlights the usefulness of this novel technique in detecting abnormalities of deep GM structures.

Thermodynamic trade-off relation for first passage time in resetting processes.

Resetting is a strategy for boosting the speed of a target-searching process. Since its introduction over a decade ago, most studies have been carried out under the assumption that resetting takes place instantaneously. However, due to its irreversible nature, resetting processes incur a thermodynamic cost, which becomes infinite in the case of instantaneous resetting. Here, we take into consideration both the cost and the first passage time (FPT) required for a resetting process, in which the reset or return to the initial location is implemented using a trapping potential over a finite but random time period. An iterative generating function and a counting functional method à la Feynman and Kac are employed to calculate the FPT and the average work for this process. From these results, we obtain an explicit form of the time-cost trade-off relation, which provides the lower bound of the mean FPT for a given work input when the trapping potential is linear. This trade-off relation clearly shows that instantaneous resetting is achievable only when an infinite amount of work is provided. More surprisingly, the trade-off relation derived from the linear potential seems to be valid for a wide range of trapping potentials. In addition, we have also shown that the fixed-time or sharp resetting can further enhance the trade-off relation compared to that of the stochastic resetting.

Endowing networks with desired symmetries and modular behavior.

Symmetries in a network regulate its organization into functional clustered states. Given a generic ensemble of nodes and a desirable cluster (or group of clusters), we exploit the direct connection between the elements of the eigenvector centrality and the graph symmetries to generate a network equipped with the desired cluster(s), with such a synthetical structure being furthermore perfectly reflected in the modular organization of the network's functioning. Our results solve a relevant problem of designing a desired set of clusters and are of generic application in all cases where a desired parallel functioning needs to be blueprinted.

A clinical profile of 103 patients with secondary movement disorders: correlation of etiology with phenomenology.

BACKGROUND AND PURPOSE: Studying patients with secondary movement disorders (SMD) provides a unique opportunity to determine the correlation between the etiology and phenomenology of movement disorders. METHODS: This was a prospective study of 103 patients (43 women, 60 men; age=28.7±17.3 years; range=2-70 years) with SMD, in a tertiary hospital over 4 years. RESULTS: The mean age of onset of SMD was 24.3±19.7 years, and duration of symptoms was 4.3±7.1 years (42 days to 40 years). Patients with pure tremor, pure dystonia (DYS), or a combination of tremor with dystonia had longest latency (10.9-18.5 months), whereas those with parkinsonism (PAR) and hemiballismus (HMB) had shorter latency (2.7-3.0 weeks). Pure dystonia was most prevalent (30.1%) followed by dystonia plus (13.6%), tremor (12.6%), PAR (11.7%), HMB (8.7%), mixed SMD (7.8%), tremor with dystonia (6.8%), myoclonus (5.8%), and chorea (2.9%). In approximately 60% of patients, the underlying etiologies were vascular (VAS), infections, and space-occupying lesions (SOL), and 25% had SMD following trauma or hypoxia (HYP). With reference to specific etiologies, the most frequent SMDs were tremor following SOL (46%), post-traumatic syndromes (25%), dystonia following HYP (56%), VAS lesions (50%), and infections (28%). With reference to specific SMDs, the most common etiologies were VAS for dystonia (39%), SOL for tremor (67%), and PAR (31%), and both SOL and trauma (37.5% each) for tremor with dystonia. CONCLUSIONS: Our study highlights the spectrum of SMDs and the lack of correlation between types of SMDs and underlying etiologies. Preventable causes such as infections, HYP, trauma, and kernicterus still play a major role in pathogenesis of SMD.

Non-motor features in essential tremor.

INTRODUCTION: Essential tremor (ET) is increasingly recognized to have several non-motor manifestations. The aim of this study was to determine the prevalence of non-motor manifestations in ET and its impact on the quality of life (QOL). METHODS: This was a cross-sectional case-control questionnaire-based study. The subjects were 50 patients with ET and 50 matched healthy controls. All subjects were assessed by Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Parkinson Fatigue Scale, Brief Pain Inventory, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. In addition, QOL in Essential Tremor questionnaire was administered to patients with ET. RESULTS: Patients with ET, when compared with controls, had significantly higher prevalence and higher mean scores of sleep disturbances (46% vs 8%, P < 0.001; 5.9 ± 4.6 vs 2.6 ± 2.3, P < 0.001), fatigue (30% vs 8%, P = 0.009; 5.8 ± 0.8 vs 2.5 ± 0.4, P < 0.001), anxiety (66% vs 18%, P = 0.009; 7.4 ± 9.0 vs 0.7 ± 2.6, P < 0.001), depression (44% vs 8%, P = 0.009; 7.8 ± 7.9 vs 1.7 ± 3.3, P < 0.001) as well as higher mean score of pain severity (1.9 ± 2.3 vs 0.6 ± 1.2, P = 0.001) and interference owing to pain (2.0 ± 2.9 vs 0.5 ± 1.2, P = 0.001). Following hierarchical regression analysis, depression was the only non-motor feature that affected the QOL. CONCLUSION: There was a significantly higher prevalence and greater severity of sleep disturbances, fatigue, pain, anxiety, and depression in patients with ET and depression significantly affected the QOL.

Minilaparotomy female sterilisation in a rural setup: a comparison of two antibiotic regimens.

Female sterilisation is the world's most popular contraceptive method. With present advances in contraceptive technology, surgical contraception seems to be the most popular and safest method of fertility control all over the world. The advent of laparoscopy has made the procedure easier in developed countries but not so widely in a developing country like India. Current study was carried out to compare two antibiotic regimens on patients undergoing minilaparotomy tubal ligation and also to see whether local anaesthesia and intravenous sedation/analgesia can be safely practised in a rural setup, where the infrastructure of a tertiary level institution was unavailable. Out of 729 patients, none were referred to a higher centre due to any surgical or anaesthetic problem and a lower rate of infection in the group receiving postoperative combination antibiotic supports the fact that female sterilisation can be performed safely with common antibiotic coverage available in the rural hospitals of developing countries with limited operative facilities.