A thoracophagus conjoined twins with myelomeningocele: an unusual case

Conjoined twins represent one of the rarest forms of twin gestation. Conjoined twinning is rare, occurring in about 1% of monochorionic twins with an estimated incidence ranging from 1:30,000 to 1:2,00,000 live births and 1 in 650 to 900 twin deliveries. A 21 year old gravida 2, with an abortion, a resident of Ginjakheda, Deoli Wardha came to our hospital, AVBRH Sawangi and presented with history of amenorrhoea of six months. She had her first ultrasonography done which demonstrated thoracophagus conjoined twins. Patient was admitted in view of management of conjoined twins. She was posted for elective caesarean section on 5/11/11. A conjoined twin of combined weight around 2 kgs was extracted out. Both the foetuses were female with multiple congenital anomalies. In conclusion, conjoined twins are associated with a high perinatal mortality; therefore making an early diagnosis by means of ultrasonography, gives parents a chance to elect pregnancy termination

Convulsions in early post-partum period, a diagnostic dilemma

Neurocysticercosis is the most common helminthic (tapeworm) infection of the brain worldwide. It presents as hydrocephalus and acute onset seizures. A 28-year-old para 3 live 3 [P3L3], post-partum [day 7], resident of Arvi, presented in casualty during emergency hours with headache and fever since 7 days. She presented with h/o convulsions 2 episodes, one on day 5 and one on day 7 of her full term vaginal home delivery. She presented to the Emergency Department on day 7 with generalised tonic-clonic seizures preceded by nausea and headache. All her blood investigations were within normal limits except an extremely surprising finding on CT scan. 40% of patients having postpartum convulsions do not experience preeclampsia, clinical awareness is essential for early treatment and care

Magnetic phase diagram of Fe1.1Te1-xSex: A comparative study with the stoichiometric superconducting FeTe1-xSex system

We report a comparative study of the series Fe1.1Te1-xSex and the stoichiometric FeTe1-xSex to bring out the difference in their magnetic, superconducting and electronic properties. The Fe1.1Te1-xSex series is found to be magnetic and its microscopic properties are elucidated through Moessbauer spectroscopy. The magnetic phase diagram of Fe1.1Te1-xSex is traced out and it shows the emergence of spin-glass state when the antiferromagnetic state is destabilized by the Se substitution. The isomer shift and quadrupolar splitting obtained from the Moessbauer spectroscopy clearly brings out the electronic differences in these two series.Comment: 6 pages, 9 figure

Successful maternal and fetal outcome of Guillain-Barre syndrome complicating pregnancy: a case report

Guillain-Barré syndrome rarely complicates pregnancy, incidence being 2/100000 population. We report a case of 23-year-old 2nd gravida who developed a progressive ascending paralysis during the second trimester of pregnancy. The worsening of the respiratory insufficiency required transfer to an intensive care unit but did not require artificial ventilation. Cerebrospinal fluid examination revealed albumin-cytological dissociation and repeated electrophysiological studies showed typical features of demyelinating neuropathy with conduction blocks. Biological investigations, especially CMV and campylobacter jejuni serologies, were all negative. Intravenous immunoglobulin infusions resulted in rapid improvement in the patient. This case raises the question of the relationship between the Guillain-Barré syndrome and pregnancy. The occurrence of the disease, as well as the rapid recovery in antenatal period could be consecutive to a partial failure of the maternal immunological tolerance toward the fetus

Magnetic excitations of Fe_{1+y}Se_xTe_{1-x} in magnetic and superconductive phases

We have used inelastic neutron scattering and muon-spin rotation to compare the low energy magnetic excitations in single crystals of superconducting Fe1.01Se0.50Te0.50 and non-superconducting Fe1.10Se0.25Te0.75. We confirm the existence of a spin resonance in the superconducting phase of Fe1.01Se0.50Te0.50, at an energy of 7 meV and a wavevector of (1/2,1/2,0). The non-superconducting sample exhibits two incommensurate magnetic excitations at (1/2,1/2,0)\pm(0.18,-0.18,0) which rise steeply in energy, but no resonance is observed at low energies. A strongly dispersive low-energy magnetic excitation is also observed in Fe1.10Se0.25Te0.75 close to the commensurate antiferromagnetic ordering wavevector (1/2-\delta,0,1/2) where \delta \approx 0.03. The magnetic correlations in both samples are found to be quasi-two dimensional in character and persist well above the magnetic (Fe1.10Se0.25Te0.75) and superconducting (Fe1.01Se0.50Te0.50) transition temperatures.Comment: 10 pages, 4 figure

Mechanical, electrical and thermal properties of graphene oxide-carbon nanotube/ ABS hybrid polymer nanocomposites

Multiwalled carbon nanotubes (MWCNTs), functionalized carbon nanotubes (FCNTs) and graphene oxide-carbon nanotube (GCNTs) hybrid Bucky paper (BP) reinforced acrylonitrile-butadiene-styrene (ABS) composites are prepared via vacuum filtration followed by hot compression molding. The nanomechanical, electrical and thermal properties of these BP reinforced ABS composites are studied. The nanoindentation hardness and elastic modulus of GCNTs-ABS hybrid composites reached to 389.98 +/- 91.79 MPa and 7669.6 +/- 1179.12 MPa respectively. Other nanomechanical parameters such as plastic index parameter, elastic recovery, the ratio of residual displacement after load removal and displacement at maximum load are also investigated. The improved nanomechanical properties are correlated with Raman spectroscopy and scanning electron microscopy (SEM). It is found that GCNTs and their composites showed the higher value of defect density. The maximum value of defect density range for GCNTs and GCNTs-ABS is (297.4 to 159.6) and (16.0 to11.6), respectively. The higher defect density of GCNTs indicates that the interfacial interaction between the ABS, which was further correlated with electrical and thermal properties. Additionally, the through-plane electrical conductivities of MWCNTs, FCNTs and GCNTs based ABS composites were 6.5 +/- 0.6, 4.5 +/- 0.7 and 6.97 +/- 1.2 S/cm respectively and thermal conductivities of MWCNTs, FCNTs and GCNTs reinforced ABS composites; 1.80, 1.70 and 1.98 W/mK respectively. These GCNTs-ABS composites with this value of thermal conductivity can be used in various applications of efficient heat dissipative materials for electronic devices

Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally

Abstract Background One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown. Methods A survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May–June 2019. Results No providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance). Conclusions No providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers

One-pot synthesis of multifunctional ZnO nanomaterials: study of superhydrophobicity and UV photosensing property

ZnO nanomaterials are synthesized using one-pot synthesis method. Equimolar solution of Zinc Nitrate hexahydrate (Zn(NO3)(2).6H(2)O) and Hexamethylenetetramine (C6H12N4) is used as a precursor for ZnO formation. Different nanostructures of ZnO are achieved by controlling the pH of the growth solution in the range 2-12 (acidic to alkali). ZnO nanostructures are evaluated for hydrophobic property using static contact angle measurement setup and UV photosensing activity. Surface morphology, structural properties and compositional analysis of ZnO nanostructures are examined by field emission scanning electron microscope (FE-SEM), energy dispersive X-ray analysis (EDX), high-resolution transmission electron microscope (FEG-TEM) and X-ray diffraction (XRD) measurements. Existence of ZnO wurtzite structure is confirmed from XRD study and is analyzed by Rietveld refinement method. Nanomaterials are characterized using Raman spectroscopy which confirms highest oxygen deficiency in ZnO nanorods. The material shows remarkable superhydrophobic and UV photosensing property and hence the name multifunctional. Among all morphologies grown at different pH values, ZnO nanorods show superhydrophobic nature with contact angle more than 170 degrees. Total surface energy value of ZnO nanostructures is calculated using Wendt two-component theory. Different ZnO nanostructures (with variation of pH value) are used to study UV photosensing property. Responsivity and photocurrent show a strong dependence on the morphology of ZnO

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)