Epileptic spasms in a child with infantile tremor syndrome: A rare case report and review of literature

Infantile tremor syndrome (ITS) is usually present in purely breastfed babies of vegetarian mothers with acute regression of developmental milestones, pallor with megaloblastic anemia, bleating goat like cry, knuckle, and other body site hyperpigmentation, apathy, listlessness, and brown scanty hair. This is usually due to Vitamin B12 deficiency and symptoms can be reversed with Vitamin B12 supplementation. There are only a few anecdotal case reports of seizure in children with ITS. Hereby, we are presenting a case of a child having epileptic spasms associated with ITS along with megaloblastic anemia with hypersegmented neutrophils in peripheral smear and high mean corpuscular volume. The child was successfully treated with Vitamin B12 supplementation and oral corticosteroids. This case report underscores the importance of considering the possibility of Vitamin B12 deficiency in any child presenting with megaloblastic anemia with either generalized tremulousness with or without seizures

Intermediate uveitis as an initial presentation of HLA B27 associated spondyloarthropathy in an adolescent boy: A rare case report and review of literature

Juvenile ankylosing spondylitis is less prevalent in children, and usually, children are presented to the hospital with chronic inflammatory back pain, enthesitis, and often hip and shoulder joint involvement. A significant proportion of these children develop ocular complications such as anterior and intermediate uveitis. Most of these children have HLA B27 positivity. On the other hand, in cases with anterior and intermediate uveitis, a considerable proportion has positivity for HLA B27 antigen. Few of these patients, later on, develop other clinical features suggestive of ankylosing spondylitis. However, there are only a few anecdotal case reports of similar HLA B27 associated intermediate uveitis, who later on developed juvenile ankylosing spondylitis. The current case is a 12-year old boy, who initially had bilateral intermediate uveitis with HLA B27 positivity without any other systemic or musculoskeletal features. However, on follow-up he developed enthesis and sacroiliitis suggestive of ankylosing spondylitis. Both rheumatological and visual complains had an excellent clinical response to corticosteroids in this child. The current case report demonstrates the importance of evaluation for HLA B27 positivity in all children with isolated intermediate uveitis, even if systemic and musculoskeletal examinations are normal

Differentially Private Image Classification by Learning Priors from Random Processes

In privacy-preserving machine learning, differentially private stochastic gradient descent (DP-SGD) performs worse than SGD due to per-sample gradient clipping and noise addition. A recent focus in private learning research is improving the performance of DP-SGD on private data by incorporating priors that are learned on real-world public data. In this work, we explore how we can improve the privacy-utility tradeoff of DP-SGD by learning priors from images generated by random processes and transferring these priors to private data. We propose DP-RandP, a three-phase approach. We attain new state-of-the-art accuracy when training from scratch on CIFAR10, CIFAR100, and MedMNIST for a range of privacy budgets $\varepsilon \in [1, 8]$. In particular, we improve the previous best reported accuracy on CIFAR10 from $60.6 \%$ to $72.3 \%$ for $\varepsilon=1$. Our code is available at https://github.com/inspire-group/DP-RandP

Visual Adversarial Examples Jailbreak Large Language Models

Recently, there has been a surge of interest in introducing vision into Large Language Models (LLMs). The proliferation of large Visual Language Models (VLMs), such as Flamingo, BLIP-2, and GPT-4, signifies an exciting convergence of advancements in both visual and language foundation models. Yet, the risks associated with this integrative approach are largely unexamined. In this paper, we shed light on the security and safety implications of this trend. First, we underscore that the continuous and high-dimensional nature of the additional visual input space intrinsically makes it a fertile ground for adversarial attacks. This unavoidably expands the attack surfaces of LLMs. Second, we highlight that the broad functionality of LLMs also presents visual attackers with a wider array of achievable adversarial objectives, extending the implications of security failures beyond mere misclassification. To elucidate these risks, we study adversarial examples in the visual input space of a VLM. Specifically, against MiniGPT-4, which incorporates safety mechanisms that can refuse harmful instructions, we present visual adversarial examples that can circumvent the safety mechanisms and provoke harmful behaviors of the model. Remarkably, we discover that adversarial examples, even if optimized on a narrow, manually curated derogatory corpus against specific social groups, can universally jailbreak the model's safety mechanisms. A single such adversarial example can generally undermine MiniGPT-4's safety, enabling it to heed a wide range of harmful instructions and produce harmful content far beyond simply imitating the derogatory corpus used in optimization. Unveiling these risks, we accentuate the urgent need for comprehensive risk assessments, robust defense strategies, and the implementation of responsible practices for the secure and safe utilization of VLMs

Fibreoptic intubation under conscious sevoflurane sedation in anticipated difficult intubation cases with unfavorable conventional airway preparation

Airway management in maxillofacial and head and neck cancer patients has remained a challenge even after significant development towards difficult airway management. When such patients have multiple difficult intubation predictors, management becomes more thought-provoking. Mucosal preparation and sedation play a vital role in producing co-operative patient and successful procedure but is not always feasible. On the other hand, intravenous sedation lacks titratability and reversibility. We describe awake fiberoptic intubation in three adult patients having multiple difficult intubation predictors whose airway preparation was not feasible due to obscured surface anatomy and nil mouth opening. The cases were done under titrated conscious sevoflurane sedation of MACage 0.4-0.6 using nasopharyngeal airway and closed circuit. This report highlights that Sevoflurane based conscious sedation is a feasible alternative for awake fiberoptic intubation in patients whose airway anesthesia and blocks are not possible

Assessment of phototherapy-induced hypocalcemia and its correlation with urinary calcium excretion in term and preterm newborns with neonatal hyperbilirubinemia: A cross-sectional study with controls

Introduction: Although hypocalcemia is often proposed to be associated with phototherapy in both term and preterm newborns, its exact incidence, clinical significance, and underlying mechanism still remain to be elucidated. Objective: The objective of this study was to determine the prevalence of hypocalcemia and its etiopathogenesis in terms of urinary calcium excretion. Methods: This study was carried out in a tertiary care center in North India with 50 neonates (29 term and 21 preterm) in the test group receiving single surface phototherapy. The other 50 age, sex, and gestational age-matched neonates were taken as controls who did not receive phototherapy. Serum calcium levels at 0 and 48 h and urinary calcium/creatinine ratio (mg/mg) at0 and 24 h of starting phototherapy were determined in both the groups and compared. Results: Total 12 preterm (57.1%) and 9 term newborns (31%) developed hypocalcemia after 48 h of phototherapy. The mean difference of serum ionized calcium between two groups was statistically significant at 48 h (4.58 mg/dl in the test group vs. 4.94 mg/dl in the control group, p<0.001). Percentage change in mean of urinary calcium/creatinine ratio at 24 h from baseline was 1.39% in the control group while it was 60.7% in the test group with statistically significant difference (p<0.001) between two groups. Only a weak negative correlation between serum ionized calcium and urinary calcium/creatinine ratio with correlation coefficient r=−0.316 could be established in the study among both term and preterm neonates. Conclusion: Both preterm and termneonates undergoing phototherapy are at increased risk for hypocalcemia and increased urinary calcium excretion. A universal recommendation regarding calcium supplementation in neonates undergoing phototherapy is yet to be established but seems like a reasonable intervention.&nbsp

An attempt at optimizing the flow characteristics of blast furnace slag by investigation of synthetic slags prepared in the laboratory using pure oxides

In the cohesive zone the ore layer becomes compacted due to softening-melting and the gas passes predominantly through the sandwiched coke layer (coke slits). Minimizing the size and lowering the position of the cohesive zone will improve productivity and decrease coke rate. This work is designed at arriving at a slag composition through actual experimentations which will ensure the lowering of the cohesive zone of the blast furnace with simultaneous decrease in the difference between the softening temperature (ST) and flow temperature (FT) of the slag. Slag samples from SAIL, Rourkela were brought and their flow characteristics were measured under the heating microscope. With the same composition as obtained from the plant, a synthetic slag was prepared in the laboratory. It was melted to 1600 °C and then water quenched to form the glassy state. Flow characteristics for the same were also determined. In addition, all slag samples were sent to DISIR, Rajgangpur for slag analysis as well as to determine the mineralogical phases present in them. For this, they heated the slag samples to 1500 °C followed by slow cooling to convert them to crystalline form. Then, XRD analysis was done to determine the mineralogical phases. Finally, with relevant phase diagram study, we arrived at a composition which will ensure the lowering of cohesive zone. Moreover, flow characteristics data of synthetic slag was compared with that obtained from Blast Furnace slag

KCNT1- related epilepsy: An international multicenter cohort of 27 pediatric cases

ObjectiveThrough international collaboration, we evaluated the phenotypic aspects of a multiethnic cohort of KCNT1- related epilepsy and explored genotype- phenotype correlations associated with frequently encountered variants.MethodsA cross- sectional analysis of children harboring pathogenic or likely pathogenic KCNT1 variants was completed. Children with one of the two more common recurrent KCNT1 variants were compared with the rest of the cohort for the presence of particular characteristics.ResultsTwenty- seven children (15 males, mean age = 40.8 months) were included. Seizure onset ranged from 1 day to 6 months, and half (48.1%) exhibited developmental plateauing upon onset. Two- thirds had epilepsy of infancy with migrating focal seizures (EIMFS), and focal tonic seizures were common (48.1%). The most frequent recurrent KCNT1 variants were c.2800G>A; p.Ala934Thr (n = 5) and c.862G>A; p.Gly288Ser (n = 4). De novo variants were found in 96% of tested parents (23/24). Sixty percent had abnormal magnetic resonance imaging (MRI) findings. Delayed myelination, thin corpus callosum, and brain atrophy were the most common. One child had gray- white matter interface indistinctness, suggesting a malformation of cortical development. Several antiepileptic drugs (mean = 7.4/patient) were tried, with no consistent response to any one agent. Eleven tried quinidine; 45% had marked (>50% seizure reduction) or some improvement (25%- 50% seizure reduction). Seven used cannabidiol; 71% experienced marked or some improvement. Fourteen tried diet therapies; 57% had marked or some improvement. When comparing the recurrent variants to the rest of the cohort with respect to developmental trajectory, presence of EIMFS, >500 seizures/mo, abnormal MRI, and treatment response, there were no statistically significant differences. Four patients died (15%), none of sudden unexpected death in epilepsy.SignificanceOur cohort reinforces common aspects of this highly pleiotropic entity. EIMFS manifesting with refractory tonic seizures was the most common. Cannabidiol, diet therapy, and quinidine seem to offer the best chances of seizure reduction, although evidence- based practice is still unavailable.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154940/1/epi16480_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154940/2/epi16480.pd

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe