Reliability of Early Magnetic Resonance Imaging (MRI) and Necessity of Repeating MRI in Noncooled and Cooled Infants with Neonatal Encephalopathy

In cooled newborns with encephalopathy, although late magnetic resonance imaging (MRI) scan (10-14 days of age) is reliable in predicting long-term outcome, it is unknown whether early scan (3-6 days of life) is. We compared the predominant pattern and extent of lesion between early and late MRI in 89 term neonates with neonatal encephalopathy. Forty-three neonates (48%) were cooled. The predominant pattern of lesions and the extent of lesion in the watershed region agreed near perfectly in noncooled (kappa = 0.94; k = 0.88) and cooled (k = 0.89; k = 0.87) infants respectively. There was perfect agreement in the extent of lesion in the basal nuclei in noncooled infants (k = 0.83) and excellent agreement in cooled infants (k = 0.67). Changes in extent of lesions on late MRI occurred in 19 of 89 infants, with higher risk in infants with hypoglycemia and moderate-severe lesions in basal nuclei. In most term neonates with neonatal encephalopathy, early MRI (relative to late scan) robustly predicts the predominant pattern and extent of injury.</p

Memecylon edule leaf extract mediated green synthesis of silver and gold nanoparticles

We used an aqueous leaf extract of Memecylon edule (Melastomataceae) to synthesize silver and gold nanoparticles. To our knowledge, this is the first report where M. edule leaf broth was found to be a suitable plant source for the green synthesis of silver and gold nanoparticles. On treatment of aqueous solutions of silver nitrate and chloroauric acid with M. edule leaf extract, stable silver and gold nanoparticles were rapidly formed. The gold nanoparticles were characterized by UV-visible spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy dispersive X-ray analysis (EDAX) and Fourier transform infra-red spectroscopy (FTIR). The kinetics of reduction of aqueous silver and gold ions during reaction with the M. edule leaf broth were easily analyzed by UV-visible spectroscopy. SEM analysis showed that aqueous gold ions, when exposed to M. edule leaf broth, were reduced and resulted in the biosynthesis of gold nanoparticles in the size range 20–50 nm. TEM analysis of gold nanoparticles showed formation of triangular, circular, and hexagonal shapes in the size range 10–45 nm. The resulting silver nanoparticles were predominantly square with uniform size range 50–90 nm. EDAX results confirmed the presence of triangular nanoparticles in the adsorption peak of 2.30 keV. Further FTIR analysis was also done to identify the functional groups in silver and gold nanoparticles. The characterized nanoparticles of M. edule have potential for various medical and industrial applications. Saponin presence in aqueous extract of M. edule is responsible for the mass production of silver and gold nanoparticles

Association of prenatal diagnosis of critical congenital heart disease with postnatal brain development and the risk of brain injury

IMPORTANCE: The relationship of prenatal diagnosis of critical congenital heart disease (CHD) with brain injury and brain development is unknown. Given limited improvement of CHD outcomes with prenatal diagnosis, the effect of prenatal diagnosis on brain health may reveal additional benefits. OBJECTIVE: To compare the prevalence of preoperative and postoperative brain injury and the trajectory of brain development in neonates with prenatal vs postnatal diagnosis of CHD. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of term newborns with critical CHD recruited consecutively from 2001 to 2013 at the University of California, San Francisco and the University of British Columbia. Term newborns with critical CHD were studied with brain magnetic resonance imaging preoperatively and postoperatively to determine brain injury severity and microstructural brain development with diffusion tensor imaging by measuring fractional anisotropy and the apparent diffusion coefficient. Comparisons of magnetic resonance imaging findings and clinical variables were made between prenatal and postnatal diagnosis of critical CHD. A total of 153 patients with transposition of the great arteries and single ventricle physiology were included in this analysis. MAIN OUTCOMES AND MEASURES: The presence of brain injury on the preoperative brain magnetic resonance imaging and the trajectory of postnatal brain microstructural development. RESULTS: Among 153 patients (67% male), 96 had transposition of the great arteries and 57 had single ventricle physiology. The presence of brain injury was significantly higher in patients with postnatal diagnosis of critical CHD (41 of 86 [48%]) than in those with prenatal diagnosis (16 of 67 [24%]) (P = .003). Patients with prenatal diagnosis demonstrated faster brain development in white matter fractional anisotropy (rate of increase, 2.2%; 95% CI, 0.1%-4.2%; P = .04) and gray matter apparent diffusion coefficient (rate of decrease, 0.6%; 95%CI, 0.1%-1.2%; P = .02). Patients with prenatal diagnosis had lower birth weight (mean, 3184.5 g; 95%CI, 3050.3–3318.6) than those with postnatal diagnosis (mean, 3397.6 g; 95%CI, 3277.6–3517.6) (P = .02). Those with prenatal diagnosis had an earlier estimated gestational age at delivery (mean, 38.6 weeks; 95%CI, 38.2–38.9) than those with postnatal diagnosis (mean, 39.1 weeks; 95%CI, 38.8–39.5) (P = .03). CONCLUSIONS AND RELEVANCE: Newborns with prenatal diagnosis of single ventricle physiology and transposition of the great arteries demonstrate less preoperative brain injury and more robust microstructural brain development than those with postnatal diagnosis. These results are likely secondary to improved cardiovascular stability. The impact of these findings on neurodevelopmental outcomes warrants further study

‘Opportunity to bond and a sense of normality’:Parent and staff views of cuddling babies undergoing therapeutic hypothermia in neonatal intensive care: ‘CoolCuddle’

Abstract Background Currently, parents whose sick babies are undergoing three days of cooling therapy for hypoxic–ischaemic encephalopathy in neonatal intensive care units (NICUs) are not permitted to cuddle their cooled babies, due to concerns of warming the baby or dislodging breathing tubes or vascular catheters. Parents want to stay and care for their cooled babies and have reported that bonding is adversely affected when they are not permitted to hold them. Design and Participants Qualitative interviews with 21 parents of cooled babies in NICU (11 mothers and 10 fathers) and 10 neonatal staff (4 consultants and 6 nurses) explored their views and experiences of an intervention to enable parents to cuddle their cooled babies (CoolCuddle). Thematic analysis methods were used to develop the themes and compare them between parents and staff. Results Five themes were produced. Three themes were comparable between parents and staff: Closeness, a sense of normality and reassurance and support. An additional parent theme reflected their mixed feelings about initial participation as they were apprehensive, but felt that it was an amazing opportunity. Parents and staff described the closeness between parents and babies as important for bonding and breastfeeding. Fathers particularly appreciated the opportunity to hold and bond with their infants. Parents valued the reassurance and support received from staff, and the cuddles helped them feel more normal and more like a family at a very stressful time. In a final staff theme, they discussed the skills, number of staff and training needed to undertake CoolCuddle in NICU. Conclusions Parents cuddling their babies during cooling therapy enhanced parent–infant bonding and family‐centred care in NICU and was positively received. Adverse perinatal mental health, impaired mother–infant bonding and their effects on the establishment of breastfeeding may be ameliorated by introducing CoolCuddle. Patient Contribution Our parent advisors contributed to the interview topic guides and endorsed the themes from the analysis

A Study on Acute Kidney Injury in Intensive Care Setting

INTRODUCTION: Acute kidney injury is not a single disease but a terminology for a group of conditions that have similar diagnostic features, importantly, an elevation in the blood urea nitrogen (BUN) level and / or an elevation in the plasma or serum creatinine (S.Cr) concentration, often associated with a decrease in urine volume. AKI can vary in severity from asymptomatic and transient changes in laboratory measures of glomerular filtration rate (GFR), to exaggerated and rapidly fatal derangements in effective circulating blood volume, electrolyte and acid-base composition of the plasma. AKI is the cause for 5–7% of acute care hospital admissions and 30% of intensive care admissions. The epidemiology of AKI varies enormously between developed and developing regions, because of differences in demographics, social and cultural factors. But recent change in cultural habits, life style changes and social values in developing regions produce the near similar picture as developed countries. The incidence of AKI has increased by more than fourfold in the United States from 1988 and is calculated to have a yearly incidence of 500 per 100,000 persons, more than the yearly incidence of cerebrovascular accidents. AKI causes a markedly increased risk of death in hospitalized persons, especially in those admitted to the ICU where in patient death rates may be more than 50%. The term acute renal failure was changed to "acute kidney injury." The term failure denotes only portion of the spectrum of damage to the kidney that occurs clinically. Also the term renal is not well understood in the general population and this makes understanding with patients and their caretakers more difficult; so the term renal failure has been changed to acute kidney injury. Western literature has lot of data regarding the occurrence and nature of acute kidney injury both in the community and inpatient setting. Sadly we are lagging behind in this regard as there are not many records or reports on this topic .This prompted me to take up this study which would throw light on the present scenario of acute kidney injury in intensive care unit. I sincerely believe in the relevance of this topic in our set up and hence chose this topic as my dissertation. AIMS AND OBJECTIVES: 1. To identify the incidence of acute kidney injury, their etiological factors, associated comorbid factors, interventions, and outcome in intensive care setting. 2. To address the factors which predict the mortality in acute kidney injury. MATERIALS AND METHODS: Study Design: Prospective observational study. Study Place: Intensive medical care ward (IMCW) in Stanley Medical College and Hospital, Chennai. Study Duration: May 2012 to October 2012 (6 months). Study Population: Those who were admitted in IMCU in that period, and also having acute kidney injury. Inclusion Criteria: According to RIFLE criteria 1. Patients who developed acute kidney injury during the hospital stay. 2. Patients who developed acute kidney injury in the community. 3. Patients who developed newer insult to a pre existing disease. Exclusion Criteria: 1. CKD patients who are in maintenance hemodialysis. 2. Patients who got admitted and expired within 24 hours. 3. Those who are not willing for the study. After getting approval from institutional ethical committee, the study was started in IMCW. Patients were given the consent form, and explanation was given. Those who were willing to participate were included in the study. STATISTICAL ANALYSIS: Statistical analysis was performed using IBM SPSS version 20. All categorical data were expressed as percentage of the whole. The continuous variables were expressed as Mean ± Standard Deviation. Univariate analysis was performed using Chi Square test for categorical data and Mann Whitney U test was used for the continuous variables. The significance level was fixed at p<0.05. Adjusted Odds ratio with 95% Confidence interval was calculated as an estimate of the risk in those variables with statistically significant differences between the groups. Those variables which had p values less than 0.15 in the univariate model entered the multivariate logistic regression in backward conditional method. The odds ratio (Exp[B]) and level of significance (p) were obtained in the regression analysis. Variables with p<0.05 were taken as significant. RESULTS: The study was conducted in our IMCW for 6 months. The study results were as follows: During the six month period total number of IMCU admissions were 700. The total no patients who developed AKI were 83. The incidence of acute kidney injury was 118 per 1000 admissions. About 11.9% of the admissions had AKI in our IMCW. Among the 83 cases, 43 cases were expired and 40 were discharged from ICU. The mortality rate was 51.8%. SUMMARY: Acute kidney injury, a common problem in ICU, has a strong impact in the mortality and morbidity. Although there are rampant studies available in the west, there are less than a handful of study in south India. We had few similarities and dissimilarities in comparison to the western literature. Results comparable to study done elsewhere: • Incidence of AKI is11.7%. • Mortality rate is 51.8%. • Most common causes of AKI are sepsis, shock, and hepatorenal syndrome. • Predictors of mortality are persistent oliguria requiring renal replacement therapy, hypotension, ventilator support. • Incidence of AKI is more than acute on chronic kidney disease. Results dissimilar to study done elsewhere: • Severity of AKI as per RIFLE did not correlate with mortality. • Patients in RIFLE(R) were less in number. • Age had no say in the mortality. • Coexistent diabetes and hypertension did not influence the mortality. There is one parameter, which is not taken into consideration in other studies (to the best of my knowledge), which is a independent predictor of mortality, is spot urine sodium (> 40). Further studies on large scale are required to prove its significance. In short, infections and hypotension are the most common cause of mortality. Diligent care should be taken to find the etiology and to maintain fluid homeostasis. Patients who are oliguric and/or on ventilator should be managed with special precautions, as they are significant predictors of mortality

Amendments food waste compost on soil enzymatic activities in groundnut cultivated soil, India

Soil enzymes are play an important role in organic soil. Soil microbes enhances the enzymatic activities .Which is very beneficial to solubilizing the nutrients in the soil. In the present investigation was to find out the activity of soil enzymes such as acid phosphatase, alkaline phosphatase, dehydrogenase and to find the fresh weight of groundnut pods in the addition of food waste compost

Enhanced antibacterial activity of streptomycin against some human pathogens using green synthesized silver nanoparticles

AbstractThe development of eco-friendly technologies in nanoparticle synthesis is of utmost importance in order to expand their biological horizons. In the present study, bioreduction of AgNO3 into AgNPs using various leaf extracts of Ficus virens is explained. The resulting AgNPs were characterized by UV–vis spectroscopy, dynamic light scattering (DLS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and transmission electron microscopy (TEM). Synthesis of AgNPs was confirmed by color change from transparent to brown with maximum absorption at 420 nm due to surface plasmon resonance of AgNPs. X-ray diffraction studies showed that the biosynthesized AgNPs were crystalline in nature, and TEM analysis showed spherical shape of the nanoparticles with size ranging from 4.98 to 29 nm. FTIR study indicates that mainly –C = O, -OH and N-H groups in leaf extracts are involved in the reduction of Ag+ ions to Ag atoms, and proteins are responsible for stabilizing the silver nanoparticles. The synthesized AgNPs showed significant antibacterial activity against Gram positive and gram negative human bacterial pathogens. The results showed that AgNPs also synergistically enhance (2.02–57.98%) the antibacterial activity of streptomycin, a common antibiotic. With this approach, AgNPs can be used as a new generation of antimicrobial agents for successful development of drug delivery

TACOS: Topology-Aware Collective Algorithm Synthesizer for Distributed Training

Collective communications are an indispensable part of distributed training. Running a topology-aware collective algorithm is crucial for optimizing communication performance by minimizing congestion. Today such algorithms only exist for a small set of simple topologies, limiting the topologies employed in training clusters and handling irregular topologies due to network failures. In this paper, we propose TACOS, an automated topology-aware collective synthesizer for arbitrary input network topologies. TACOS synthesized 3.73x faster All-Reduce algorithm over baselines, and synthesized collective algorithms for 512-NPU system in just 6.1 minutes