287 research outputs found

    Post Herpes NMDAR Encephalitis in A 8 Month Old Girl

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    Patients with Herpes Simplex virus Encephalitis are seen to have a relapse of symptoms namely seizures and choreoathetoid movements along with impairment of consciousness1. Though infective relapse is a possibility requiring extended antiviral therapy2, immune mediated mechanism is most probable.3 Although there is a similarity of symptoms between relapsing HSVE and N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis, the most likely culprit is the latter

    Subacute sclerosing panencephalitis – Current perspectives

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    Subacute sclerosing panencephalitis is a progressive neurodegenerative disease. It usually occurs 7–10 years after measles infection. The clinical course is characterized by progressive cognitive decline and behavior changes followed by focal or generalized seizures as well as myoclonus, ataxia, visual disturbance, and later vegetative state, eventually leading to death. It is diagnosed on the basis of Dyken’s criteria. There is no known cure for subacute sclerosing panencephalitis to date, but it is preventable by ensuring that an effective vaccine program for measles is made compulsory for all children younger than 5 years in endemic countries

    Laparoscopic repair of iatrogenic long ureteral injury

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    Introduction: Transection of the ureter in laparoscopic retroperitoneal lymph node dissection (RPLND) is a rare iatrogenic complication. Its repair is possible by end-to-end anastomosis when the defect is short, but if there is a long defect, laparoscopic repair is a challenge. Methods: A 30-year-old man underwent modified RPLND of a clinically stage-A mixed germ cell of the left testis. While cutting the gonadal vein, 1.5 cm of the ureter was transected 2 cm below the renal pelvis and clipped by one of our residents. The injury was diagnosed immediately. After the completion of the modified RPLND, the clips were removed and a 20-mm defect of the ureter was seen precluding anastomosis. The kidney was dissected and pulled down 35 mm. The lower pole of the kidney was then fixed to the psoas muscle by a 2-0 vicryl, making anastomosis possible after an 8-mm spatulation of both sides. Anastomosis was done over a stent by interrupted sutures using 4-0 vicryl. Results: Leakage was 400 mL at the first postoperative day and ceased at the 4th day. On the control excretion urography, the kidney function was normal and a fullness of the caliceal system was seen. Conclusion: Long defect of the ureter that may occur in laparoscopic urological surgeries could be manageable laparoscopically using methods for shortening of the interval such as relocation of the kidney. Thus, a same approach as open surgeries can yield acceptable results in laparoscopic surgeries

    Spectrum of electroencephalogram finding in Children with newly diagnosed epilepsy –an Experience at a tertiary care hospital.

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    Epilepsy is the most common neurological disorders that affect all age groups. It is characterized by at least two unprovoked seizures more than 24 hours apart. The most common investigation used for both diagnosis and management is an Electroencephalogram (EEG), which is relatively cheap and easy to perform. However, EEG requires technical expertise and is prone to misinterpretation. Objective: To determine the frequency of abnormal EEG findings in children with newly diagnosed epilepsy at tertiary care hospital

    Toxic effect of naphta exposure on respiratory system among workers in the tyre industry

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    A cross-sectional study was carried out on workers in a tyre manufacturing industry in Malaysia to determine the effects of naphtha exposure on lung functions and respiratory symptoms. Sixty male workers exposed to naphtha and 42 unexposed workers were selected for this study. Personal air monitoring carried out using solid sorbent tubes and low flow pumps (Model: PAS-500 Personal Air Sampler). Personal air monitoring showed that the mean air naphtha concentration was 28.50 mg/m3, the median was 28.47 mg/m3 and the inter quartile range of 1.27 mg/m3. The range was from 0.19 to 200.51 mg/m3 (PEL is 400 mg/m3). The lung function tests showed in 2 groups for all the 3 parameters (FVC%, FEV1% and FEV1/FVC) were in exposed group 96.16, 85.23 and 0.791 respectively and in Unexposed group was 113.23, 116.28 and 0.903 respectively. The lung function tests showed that there were significant difference in the 2 groups for FVC% (p < 0.001), FEV1% (p < 0.001) and FEV1/FVC% (p =0.002). Multiple linear regression test showed that monthly household income significantly influence the FVC% predicted (b = 0.003, p < 0.001) and FEV1% predicted (b = 0.006, p < 0.001). In conclusion there was an inverse relationship between air naphtha concentrations and lung functions ability. Early impairment of the respiratory system is detected on the workers who are exposed to naphtha which made up of several chemicals

    Concentrations of lead, mercury, arsenic, cadmium, manganese, and aluminum in the blood of Pakistani children with and without autism spectrum disorder and their associated factors

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    Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with early onset in utero or childhood. Environmental exposure to six metals (Pb, Hg, As, Cd, Mn, Al) is believed to be associated with ASD directly or interactively with genes. Objective: To assess the association of ASD among Pakistani children with the six metals and genotype frequencies of three GST genes (GSTP1, GSTM1, GSTT1).Methods: We enrolled 30 ASD cases, age 2-12 years old, and 30 age- and sex-matched typically developing (TD) controls in Karachi, Pakistan. We assessed associations of ASD status with various factors using Conditional Logistic Regression models. We also used General Linear Models to assess possible interaction of blood Mn and Pb concentrations with the three GST genes in relation to ASD status.Results: The unadjusted difference between ASD and TD groups in terms of geometric mean blood Pb concentrations was marginally significant (p = 0.05), but for Al concentrations, the adjusted difference was marginally significant (p = 0.06).Conclusions: This is the first study reporting six blood metal concentrations of Pakistani children with ASD. Estimates provided for possible interactions of GST genes with Mn and Pb in relation to ASD status are valuable for designing future similar studies

    From Ideas to Practice, Pilots to Strategy: Practical Solutions and Actionable Insights on How to Do Impact Investing

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    This report is the second publication in the World Economic Forum's Mainstreaming Impact Investing Initiative. The report takes a deeper look at why and how asset owners began to include impact investing in their portfolios and continue to do so today, and how they overcame operational and cultural constraints affecting capital flow. Given that impact investing expertise is spread among dozens if not hundreds of practitioners and academics, the report is a curation of some -- but certainly not all -- of those leading voices. The 15 articles are meant to provide investors, intermediaries and policy-makers with actionable insights on how to incorporate impact investing into their work.The report's goals are to show how mainstream investors and intermediaries have overcome the challenges in the impact investment sector, and to democratize the insights and expertise for anyone and everyone interested in the field. Divided into four main sections, the report contains lessons learned from practitioner's experience, and showcases best practices, organizational structures and innovative instruments that asset owners, asset managers, financial institutions and impact investors have successfully implemented

    AMPA receptor GluA2 subunit defects are a cause of neurodevelopmental disorders

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    AMPA receptors (AMPARs) are tetrameric ligand-gated channels made up of combinations of GluA1-4 subunits encoded by GRIA1-4 genes. GluA2 has an especially important role because, following post-transcriptional editing at the Q607 site, it renders heteromultimeric AMPARs Ca2+-impermeable, with a linear relationship between current and trans-membrane voltage. Here, we report heterozygous de novo GRIA2 mutations in 28 unrelated patients with intellectual disability (ID) and neurodevelopmental abnormalities including autism spectrum disorder (ASD), Rett syndrome-like features, and seizures or developmental epileptic encephalopathy (DEE). In functional expression studies, mutations lead to a decrease in agonist-evoked current mediated by mutant subunits compared to wild-type channels. When GluA2 subunits are co-expressed with GluA1, most GRIA2 mutations cause a decreased current amplitude and some also affect voltage rectification. Our results show that de-novo variants in GRIA2 can cause neurodevelopmental disorders, complementing evidence that other genetic causes of ID, ASD and DEE also disrupt glutamatergic synaptic transmission

    Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease

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    Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease.BackgroundAngiotensin-converting enzyme (ACE) inhibitors reduce urine protein excretion and slow the progression of renal disease. The beneficial effect in slowing the progression of renal disease is greater in patients with higher urine protein excretion at the onset of treatment. We hypothesized that the greater beneficial effect of ACE inhibitors on the progression of renal disease in patients with higher baseline levels of proteinuria is due to their greater antiproteinuric effect in these patients.MethodsData were analyzed from 1860 patients enrolled in 11 randomized controlled trials comparing the effect of antihypertensive regimens, including ACE inhibitors to regimens not including ACE inhibitors on the progression of non-diabetic renal disease. Multivariable linear regression analysis was used to assess the relationship between the level of proteinuria at baseline and changes in urine protein excretion during follow-up. The Cox proportional hazards analysis was used to assess the relationship between changes in urine protein excretion during follow-up and the effect of ACE inhibitors on the time to doubling of baseline serum creatinine values or onset of end-stage renal disease.ResultsMean (median) baseline urine protein excretion was 1.8 (0.94) g/day. Patients with higher baseline urine protein excretion values had a greater reduction in proteinuria during the follow-up in association with treatment with ACE inhibitors and in association with lowering systolic and diastolic blood pressures (interaction P < 0.001 for all). A higher level of urine protein excretion during follow-up (baseline minus change) was associated with a greater risk of progression [relative risk 5.56 (3.87 to 7.98) for each 1.0 g/day higher protein excretion]. After controlling for the current level of urine protein excretion, the beneficial effect of ACE inhibitors remained significant [relative risk for ACE inhibitors vs. control was 0.66 (0.52 to 0.83)], but there was no significant interaction between the beneficial effect of ACE inhibitors and the baseline level of urine protein excretion.ConclusionsThe antiproteinuric effects of ACE inhibitors and lowering blood pressure are greater in patients with a higher baseline urine protein excretion. The greater beneficial effect of ACE inhibitors on renal disease progression in patients with higher baseline proteinuria can be explained by their greater antiproteinuric effects in these patients. The current level of urine protein excretion is a modifiable risk factor for the progression of non-diabetic renal disease. ACE inhibitors provide greater beneficial effect at all levels of current urine protein excretion

    A theory-based intervention to promote medication adherence in patients with rheumatoid arthritis: A randomized controlled trial

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    Introduction/objectives Adherence to prescribed medication regimens is fundamental to the improvement and maintenance of the health of patients with rheumatoid arthritis. It is therefore important that interventions are developed to address this important health behavior issue. The aim of the present study was to design and evaluate a theory-based intervention to improve the medication adherence (primary outcome) among rheumatoid arthritis patients. Methods The study adopted a pre-registered randomized controlled trial design. Rheumatoid arthritis patients were recruited from two University teaching hospitals in Qazvin, Iran from June 2018 to May 2019 and randomly assigned to either an intervention group (n = 100) or a treatment-as-usual group (n = 100). The intervention group received a theory-based intervention designed based on the theoretical underpinnings of the health action process approach (HAPA). More specifically, action planning (making detailed plans to follow medication regimen), coping planning (constructing plans to overcome potential obstacles that may arise in medication adherence), and self-monitoring (using a calendar to record medication adherence) of the HAPA has been used for the treatment. The treatment-as-usual group received standard care. Results Data analysis was conducted based on the principle of intention to treat. Using a linear mixed-effects model (adjusted for age, sex, medication prescribed, and body mass index), the results showed improved medication adherence scores in the intervention group (loss to follow-up = 16) compared to the treatment-as-usual group (loss to follow-up = 12) at the 3-month (coefficient = 3.9; SE = 0.8) and 6-month (coefficient = 4.5; SE = 0.8) follow-up. Intervention effects on medication adherenc
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