Perinatal outcome in oligohydramnios and borderline amniotic fluid index: a comparative study

Background: Oligohydramnios is associated with adverse perinatal outcome in the form of meconium staining, intrauterine growth restriction (IUGR), caesarean section for abnormal fetal heart rate tracing, low Apgar score and neonatal intensive care unit (NICU) admission.Methods: This was a prospective study of 100 singleton pregnancies beyond 28 weeks of gestation with AFI< 8 cm, delivered within seven days of admission. Patients were divided in two groups, those with AFI ≤ 5 cm and borderline AFI of 5.1 to 8 cm. Perinatal outcome was studied in the form of onset of labor, mode of delivery, fetal heart rate variations, meconium staining  and lower segment caesarean section (LSCS) for fetal distress, Apgar score, birth weight, NICU admission and neonatal mortality.Results: Patients with oligohydramnios with AFI ≤5 cm were significantly associated with IUGR and presence of abnormal umbilical artery Doppler velocimetry (p <0.05). Adverse perinatal outcome was seen in higher percentage of patients having AFI ≤5 cm than with borderline AFI. The difference was statistically significant for overall caesarean delivery rate and LSCS for fetal distress (p <0.05).Conclusions: Oligohydramnios with AFI of ≤5 cm is associated with high caesarean delivery rate and LSCS for fetal distress

ENHANCEMENT OF MODE I FRACTURE TOUGHNESS OF ADHESIVELY BONDED SECONDARY JOINTS USING LAYUP PATTERNING OF CFRP

This work aims to analyse the influence of the CFRP layup patterning on the crack path of composite bonded joints and evaluate its effect on the mode I fracture toughness. An experimental program has been performed using Double Cantilever Beam tests with three different CFRP layup patterning and two adhesives. In addition, a finite element analysis was also implemented to further identify different damage mechanisms during the tests. The outcome shows that different substrate CFRP layup patterning results in distinct crack onsets and propagation paths during the tests, also influenced by the type of adhesive used. Furthermore, an enhancement of around 25% in the joint's onset fracture toughness was observed with the layup patterning compared to a reference joint (with unidirectional layup). Thus, the substrate's patterning morphology seems to be a promising method to increase the mode I fracture toughness of the studied secondary joints

In Vivo Comparison of the Efficiency of En-Masse Retraction Using Temporary Anchorage Devices With and Without Orthodontic Appliances on the Posterior Teeth

Objective: To compare the effectiveness of en-masse retraction of maxillary anterior teeth using temporary anchorage devices with and without orthodontic appliances on the posterior teeth.Methods:In the study, 20 participants (18.25 ± 4.07 years) meeting the inclusion criteria were randomly divided into 2 groups using the sequentially numbered opaque sealed envelopes method. In group I (control group, n = 10), en-masse retraction was carried out with conventional high hooks soldered to the retraction wire and posterior teeth were included. In group II (experimental group, n = 10), the en-masse retraction was carried out without an orthodontic appliance on posterior teeth and a modified retraction wire was incorporated. In both groups, mini-implants were placed bilaterally between the maxillary second premolar and maxillary first molar, and a retraction force of 6 ounces (180 g) was applied using power chains. Lateral cephalograms and study models were taken before retraction and 4 months after retraction. All statistical analyses were performed with Statistical Package for the Social Sciences software with a statistically significant level of 5%. We used unpaired t-tests for the comparison, and the error of the method was assessed using intraclass correlation coefficients and the Bland–Altman method.Results: The maxillary incisor apex retraction, change in maxillary incisor in the vertical plane, and its inclination showed statistically significant differences (P < .05). The rate of retraction was significantly greater in the experimental group when evaluated clinically and in the study models (P < .05).Conclusion: The rate/amount of retraction evaluated clinically and in the study models was significantly faster/greater when the posterior teeth were not included during anterior retraction. Also, a greater amount of bodily retraction of anterior teeth was achieved

Balance between competing spectral states in subthalamic nucleus is linked to motor impairment in Parkinson's disease

Exaggerated bursts of activity at frequencies in the low beta band are a well-established phenomenon in the subthalamic nucleus (STN) of patients with Parkinson's disease. However, such activity is only moderately correlated with motor impairment. Here we test the hypothesis that beta bursts are just one of several dynamic states in the STN local field potential (LFP) in Parkinson's disease, and that together these different states predict motor impairment with high fidelity. LFPs were recorded in 32 patients (64 hemispheres) undergoing deep brain stimulation surgery targeting the STN. Recordings were performed following overnight withdrawal of anti-parkinsonian medication, and after administration of levodopa. LFPs were analysed using Hidden Markov Modelling to identify transient spectral states with frequencies under 40 Hz. Findings in the low beta frequency band were similar to those previously reported; levodopa reduced occurrence rate and duration of low beta states, and the greater the reductions, the greater the improvement in motor impairment. However, additional LFP states were distinguished in the theta, alpha and high beta bands, and these behaved in an opposite manner. They were increased in occurrence rate and duration by levodopa, and the greater the increases, the greater the improvement in motor impairment. In addition, levodopa favoured the transition of low beta states to other spectral states. When all LFP states and corresponding features were considered in a multivariate model it was possible to predict 50% of the variance in patients' hemibody impairment OFF medication, and in the change in hemibody impairment following levodopa. This only improved slightly if signal amplitude or gamma band features were also included in the multivariate model. In addition, it compares with a prediction of only 16% of the variance when using beta bursts alone. We conclude that multiple spectral states in the STN LFP have a bearing on motor impairment, and that levodopa-induced shifts in the balance between these states can predict clinical change with high fidelity. This is important in suggesting that some states might be upregulated to improve parkinsonism and in suggesting how LFP feedback can be made more informative in closed-loop deep brain stimulation systems

Efficacy and Tolerability of Fixed-Dose Combination of Dexketoprofen and Dicyclomine Injection in Acute Renal Colic

Objective. To evaluate the efficacy and tolerability of a fixed-dose combination of dexketoprofen and dicyclomine (DXD) injection in patients with acute renal colic. Patients and Methods. Two hundred and seventeen patients were randomized to receive either DXD (n = 109) or fixed-dose combination of diclofenac and dicyclomine injection (DLD; n = 108), intramuscularly. Pain intensity (PI) was self-evaluated by patients on visual analogue scale (VAS) at baseline and at 1, 2, 4, 6, and 8 hours. Efficacy parameters were proportion of responders, difference in PI (PID) at 8 hours, and sum of analogue of pain intensity differences (SAPID). Tolerability was assessed by patients and physicians. Results. DXD showed superior efficacy in terms of proportion of responders (98.17% versus 81.48; P < 0.0001), PID at 8 hours (P = 0.002), and SAPID0–8 hours (P = 0.004). The clinical global impression for change in pain was significantly better for DXD than DLD. The incidence of adverse events was comparable in both groups. However, global assessment of tolerability was rated significantly better for DXD. Conclusion. DXD showed superior efficacy and tolerability than DLD in patients clinically diagnosed to be suffering from acute renal colic

Clinical applications of magnetic resonance imaging based functional and structural connectivity

Advances in computational neuroimaging techniques have expanded the armamentarium of imaging tools available for clinical applications in clinical neuroscience. Non-invasive, in vivo brain MRI structural and functional network mapping has been used to identify therapeutic targets, define eloquent brain regions to preserve, and gain insight into pathological processes and treatments as well as prognostic biomarkers. These tools have the real potential to inform patient-specific treatment strategies. Nevertheless, a realistic appraisal of clinical utility is needed that balances the growing excitement and interest in the field with important limitations associated with these techniques. Quality of the raw data, minutiae of the processing methodology, and the statistical models applied can all impact on the results and their interpretation. A lack of standardization in data acquisition and processing has also resulted in issues with reproducibility. This limitation has had a direct impact on the reliability of these tools and ultimately, confidence in their clinical use. Advances in MRI technology and computational power as well as automation and standardization of processing methods, including machine learning approaches, may help address some of these issues and make these tools more reliable in clinical use. In this review, we will highlight the current clinical uses of MRI connectomics in the diagnosis and treatment of neurological disorders; balancing emerging applications and technologies with limitations of connectivity analytic approaches to present an encompassing and appropriate perspective

Detection of Echovirus-18 in Children Suspected With SARS-CoV-2 Infection With Multisystem Inflammatory Syndrome: A Case Report From India

There have been several reports across the globe regarding the presentation of a severe multi-system hyperinflammatory syndrome, resembling Kawasaki disease (KD), in the pediatric population during the SARS-CoV-2 pandemic. The exact pathophysiology is still unclear; however, children typically demonstrate multi-organ dysfunction and less respiratory system involvement compared to adults. The limited literature is available at present for the identification and management of such patients. In this study, we investigated four cases in children ages 11–15 years that fulfilled the case definition for the pediatric multi-system inflammatory syndrome. All were found negative for SARS-CoV-2 from oropharyngeal swabs and stool. As they were having symptoms of diarrhea, tests for bacterial and enteric viral infections were performed after SARS-CoV-2 testing. Molecular analysis revealed that all the children were infected with enterovirus (Echovirus-18). Early and exact diagnosis is vital for timely, effective, and potentially life-saving management of such cases

Neural signatures of hyperdirect pathway activity in Parkinson’s disease

Parkinson’s disease (PD) is characterised by the emergence of beta frequency oscillatory synchronisation across the cortico-basal-ganglia circuit. The relationship between the anatomy of this circuit and oscillatory synchronisation within it remains unclear. We address this by combining recordings from human subthalamic nucleus (STN) and internal globus pallidus (GPi) with magnetoencephalography, tractography and computational modelling. Coherence between supplementary motor area and STN within the high (21–30 Hz) but not low (13-21 Hz) beta frequency range correlated with ‘hyperdirect pathway’ fibre densities between these structures. Furthermore, supplementary motor area activity drove STN activity selectively at high beta frequencies suggesting that high beta frequencies propagate from the cortex to the basal ganglia via the hyperdirect pathway. Computational modelling revealed that exaggerated high beta hyperdirect pathway activity can provoke the generation of widespread pathological synchrony at lower beta frequencies. These findings suggest a spectral signature and a pathophysiological role for the hyperdirect pathway in PD