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To study serum interleukin-6(IL-6), interleukin-8(IL-8) and interleukin-10(IL-10) levels in Epilpetic encephalopathy with spike-wave activation in sleep(EE-SWAS), drug refractory epilepsy(DRE) and well controlled epilepsy(WCE). Children(2–12 years) with immunotherapy naïve EE-SWAS, DRE and WCE were enrolled. Valid psychometric tools were used to assess cognition and behavior. Children with EE-SWAS were longitudinally followed. They received a three-month steroid course alongwith the ongoing antiseizure drugs. Electroclinical responders were defined as change in social quotient by 5-points with improvement in atleast one behavioral domain by 5-points and 50 % reduction in mean seizure frequency if active seizures were present alongwith a 25 % reduction in Spike-wave-index(SWI) at three months. Change in serum Interleukin levels at one month follow up was compared between participants who eventually became responders or non-responders at three months. Twenty children with EE-SWAS, 18 with DRE and WCE each were enrolled. Serum IL-6(pg/ml){(EE-SWAS: 3.775(IQR 2.205, 11.28); DRE: 3.01(IQR 2.04, 4.56); WCE: 1.655(IQR 1.27, 2.29), p = 0.0065} and IL-8(pg/ml){(EE-SWAS: 103.2(IQR 34.01, 200.82); DRE: 19.595(IQR 16.54, 39.7); WCE: 18.97(IQR 16.54, 21.91) p = 0.0002} was significantly different between the three groups. In EE-SWAS group 12/20(60 %) showed electroclinical response to steroids. Responders had significant reduction in IL6 levels (pg/ml){4.045(IQR 2.605, 18.96) to 1.13(IQR 054, 1.74)} at one month follow up compared to non responders {3.12(IQR 1.655, 5.27) to 4.37(IQR 2.83, 9.855)} (p = 0.0069). Proinflammatory cytokines (IL-6 and IL-8) are significantly elevated in EE-SWAS compared to DRE and WCE. Reduction in IL-6 levels at one month post-therapy predicted electroclinical responders at 3months follow up. • The neuroinflammatory nexus of EE-SWAS is distinct from DRE and WCE with elevated serum IL-6 and Il-8. • Serum IL-6 is elevated in both DRE and EE-SWAS suggesting a role in epileptogenesis in both these conditions. • A decline in serum IL-6 levels at 4-weeks post steroid therapy in EE-SWAS may predict response to steroids at 3 months. [ABSTRACT FROM AUTHOR]

• The motor cortex stays remotely inhibited/hypoexcitable in EE-SWAS in comparison to age matched neurotypical controls. • Steroids disinhibit or reverse the epilepsy induced motor cortex suppression and improve electroclinical outcome in EE-SWAS. • TMS measured cortical excitability strongly correlates with SWI in sleep EEG. The study compared real-time motor cortex excitability using transcranial magnetic stimulation (TMS)-derived parameters between children with epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) and age-matched neurotypical controls. The EE-SWAS group received steroids as standard of care and were longitudinally followed for three months. Children aged 5–12 years with immunotherapy-naive EE-SWAS (spike-wave-index≥50 %) and neurotypical controls were enrolled. Cognitive and behavioral assessments were performed using valid psychometric tools. Real-time motor cortex excitability was assessed by measuring resting motor threshold (RMT), short intra-cortical inhibition (SICI) and long intra-cortical inhibition (LICI) in both groups. In EE-SWAS group, a follow up evaluation with TMS at 4- and 12-week intervals, EEG, and neurobehavioral assessments at 12-weeks were performed to assess the effect of steroids on cortical excitability and to determine electroclinical outcome. Forty-eight children with suspected EE-SWAS and 26 neurotypical controls were screened; 20 were enrolled in each group. Children with EE-SWAS (mean age: 8.05 ± 1.76 years) had cognitive and behavioral problems (20/20), and ongoing seizures (12/20). At baseline, the dominant motor cortex was significantly inhibited in the EE-SWAS group compared to neurotypical children{RMT(%)[86.3 ± 6.96 vs 58.05 ± 4.71(p < 0.0001)]; LICI(%)[55.05 ± 4.39 vs 73.9 ± 3.75(p < 0.0001)]; SICI(%)[39.2 ± 4.36 vs 55.45 ± 4.78(p < 0.0001)]}. Reversal of motor cortex inhibition was sequentially observed in EE-SWAS group at 4- and 12-week follow-ups{(RMT[4, 12 weeks]: 71.45 ± 9.83, 63.45 ± 8.48); (LICI[4, 12 weeks]: 66.00 ± 6.26, 74.50 ± 5.36); (SICI[4, 12 weeks]: 49.35 ± 6.24, 56.05 ± 5.57)}[repeated-measures ANOVA: p < 0.0001]. Motor cortex is remotely inhibited in EE-SWAS, which may contribute to neurobehavioral impairment. Steroids can disinhibit/reverse the epilepsy-induced motor cortex inhibition leading to improvement in neurobehavior. [ABSTRACT FROM AUTHOR]

• Beyond 20 minutes, 38.9 % of abnormal awake EEGs achieve a final diagnosis. • Beyond 20 minutes, 20.4 % of abnormal sleep EEGs achieve a final diagnosis. • Sleep and awake records of 30 and 40 minutes correctly diagnose 90 % abnormal EEGs. • Inclusion of sleep records in awake EEGs increases diagnostic yield. • More focal seizures are diagnosed after 20 minutes in awake and sleep EEGs. This study aimed to determine the proportion of EEG recordings yielding diagnostic findings leading to a change in diagnosis beyond a 20-minute recording window, striking a balance between diagnostic yield and clinical practicability. At a tertiary care teaching hospital in North India, 225 subjects aged 1 month to 18 years undergoing outpatient EEG were enrolled. Patients with epileptic encephalopathies, nonepileptic phenomena, and breakthrough seizures in the last 24 hours were excluded. Two recording protocols were employed: Category A (n=163, awake recording with activation procedures for 15 minutes followed by an attempt at sleep for 60 minutes) and Category B (n=62, sleep recording for 55 minutes followed by 5 minutes of awake recording for younger children and those with impaired cognition). EEGs were prospectively reported at 20, 30, 40, 50, and 60-minute time points, with no retrospective changes allowed. Among abnormal EEGs, the final diagnosis was changed beyond 20 minutes in 38.9% and 20.4% in categories A and B, respectively. A significant change in the final diagnosis among abnormal EEGs beyond 20 minutes was seen in - those who achieved sleep compared to those who didn't (45% versus 19%, p=0.03) in category A, and - focal compared to generalised seizures (Category A: 26.1% versus 8.3%, p=0.01; Category B: 23.8% versus 0%, p=0.02). Forty minutes of awake EEGs with/without sleep and 30 minutes of sleep EEGs achieve a final diagnosis in nearly 90%. Prolonging awake records beyond 20 minutes, incorporating sleep, is particularly beneficial in focal epilepsies. [ABSTRACT FROM AUTHOR]

Post-surgery acute pain, especially after orthognathic surgery, is a debilitating experience for patients as it significantly affects their mastication function. Evaluating facial pain is crucial to provide adequate pain treatment for post-orthognathic patients. This systematic review aims to assess acute facial pain in post-orthognathic surgery patients. We screened research articles published in the last decade that evaluated pain experienced by post-orthognathic surgery patients using three search engines. After initial screening, we conducted duplication, title and abstract checking and applied inclusion and exclusion criteria to select relevant articles. We then extracted and analysed data from the final included articles. The review included seven articles that evaluated pain in post-orthognathic surgery patients. Data analysis revealed that the visual analogue scale was the most frequently used pain scale to assess facial pain after surgery (four articles), followed by the numeric rating scale (two articles), and one article used both pain scales. The pain intensity ranged from 1 to 7.8 on a 10-point scale. Factors affecting facial pain intensity included the type and duration of surgery and pre-and postoperative analgesic medication. The study concludes that post-orthognathic surgery patients experience varying degrees of facial pain, ranging from mild to severe, and this intensity is likely affected by several surgeryrelated variables. [ABSTRACT FROM AUTHOR]

This study introduced a preliminary investigation of the development of a Digital Twin (DT) model for the milling machining process for the chatter detection phenomenon. Subsequently, chatter has a dynamic interaction in which there is an unstable condition in the material removal process between the cutting tool and work-piece, leading to a decline in surface roughness and tool life, ultimately reducing the quality of machining output. Therefore, this study aimed to develop a chatter detection model using a deep learning application that can identify stable or unstable chatter. The model was built based on the data-driven method where vibration signal data from the milling process is used to train and test various supervised deep learning methods. The result showed that a model with a good level of accuracy was built, and with the help of a chatter detection application, regular operator staff can monitor the machining conditions when no specialist is available. [ABSTRACT FROM AUTHOR]

Little is known about the factors contributing to become transgender women in a Muslim country. Thus, this study aims to explore the past experience and factors contributed to become transgender among transgender women. Transgender women in Kuantan, Pahang were invited to participate in an audiotaped in-depth interviews in 2021, conducted in Malay using a topic guide. The qualitative data were recorded, transcribed and analysed using framework analysis. Majority of the respondents (n=8) admitted they have the tendency of becoming females since childhood. Some were being treated as females and they grew up with strong perceptions that they should be female. They found their circles of transgender women later in their life when they were not supported by family members. Most of the respondents agreed that they work as sex workers because of their own desire and had history of being discriminated at work. [ABSTRACT FROM AUTHOR]

This study aims to determine the level of nutritional status of athletes with disabilities in Indonesia. Good nutritional intake will also help repair or replace damaged body cells. The right food choices will help optimize energy and help athletes recover after competing. The subjects in this study were Indonesian athletes with disabilities who are members of the DKI Jakarta Provincial Government Team of 90 people in several sports, including track and field swimming, table tennis, badminton, shooting, chess, archery, wheelchair tennis, table tennis, judo blind, and boccia. The research method used is descriptive quantitative with a purposive sampling technique. The data collection technique was through a Google Form questionnaire distributed directly to athletes. In contrast, blind athletes who needed to fill in were assisted when filling out the questionnaire. An overview of nutritional status was obtained by calculating BMI (Body Mass Index) by measuring height and weight. In contrast, nutritional intake was determined by a nutritional intake questionnaire for the last 30 days, questions about energy intake, protein intake, fat, carbohydrate and fluid intake. Through this research, data was obtained, which showed that the majority of athletes with disabilities in DKI Jakarta who had a thin nutritional status were 13. Fifty-one people have normal nutritional status. While the healthy rate of obesity (13 people) and obesity (11 people). Most athletes have a level of adequacy of energy intake deficits. The level of Carbohydrate intake is mostly deficits, The level of fat intake is mostly excessive, and The level of protein intake is primarily excessive. And fluid intake in athletes is a minimum of 1000 ml/day and a maximum of 8000 ml/day. [ABSTRACT FROM AUTHOR]