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Objective The main aim of this study was to assess quality of life in children with epilepsy. Materials and Methods A prospective observational study was conducted in Regional Early Intervention Centre of the Department of Pediatrics Tertiary Care Hospital in central India. This study included 120 children with epilepsy aged between 2 and 18 years. In this study, we assessed the quality of life in children with epilepsy with the help of Pediatric Quality of Life Inventory (PedsQL). We further analyzed the quality of life in various dimensions. For the statistical analyses for SPSS version, 20 was used, chi-squared and Fisher's exact test was used for categorical variables, and Student's t-test was used for quantitative variables. Linear regression analysis was done for multivariate analysis. Result Mean total PedsQL score for total cohort was 70.96. The cognitive dimension of epileptic children was more affected than physical, social, and emotional dimensions. Factors associated with lower PedsQL scores in epilepsy patients were associated with long duration of epilepsy, polytherapy, male gender, low head circumference, presence of intellectual disability, and refractory epilepsy. Conclusion Epilepsy affects the quality of life in children across all age groups. Among epilepsy indicators, polytherapy, refractory epilepsy, and duration of epilepsy were the most important factors associated with poor quality of life. We can conclude that every effort should be made to decrease the duration of treatment and minimize the number of drugs for improving the quality of life in this patient cohort.

Pediatric unanticipated difficult airway in cases of subglottic stenosis (SGS) is always a challenge. We present two cases of SGS which were managed according to the pediatric difficult intubation protocols where supraglottic device was used as secondary intubation plan successfully. Airway management in these cases depends on the urgency of the surgery; if the surgery is nonemergent, the case can be postponed and both surgical and nonsurgical modalities of treatment can be offered; however, in wake of emergency surgery, surgical airway is indicated. Strategies of the pediatric airway management have evolved over the years, but the risk and morbidity associated with the adverse airway events loom larger.

Anaesthetic management of an extremely low birth weight (ELBW) neonate is always a challenge. Challenges are substantial beginning from pre-operative preparation till the neonate has been shifted to the neonatal intensive care unit. We report a case of an ELBW neonate who was operated twice for necrotising enterocolitis on day thirteen and day nineteen of life, weighing 815 grams and 746 grams respectively. Perioperative management and repair of the perforation due to necrotising enterocolitis was done on two occasions owing to the recurrence in a neonate with multiple co-morbidities. A planned approach and appropriate preparation led to a smooth peri-operative course both the times. This report discusses the multiple anaesthetic challenges and emphasises the role of a closed loop functioning among paediatric anaesthesiologists, neonatologists and the paediatric surgeons. Keywords: Co-morbidities, Extremely low birth weight, Infant, Neonate, Necrotising enterocolitis, Perioperative management.

Kafirin, the hydrophobic prolamin storage protein in sorghum grain is enriched when the grain is used for bioethanol production to give dried distillers grain with solubles (DGGS) as a by-product. There is great interest in DDGS kafirin as a new source for biomaterials. There is however a lack of fundamental understanding of how the physicochemical properties of DDGS kafirin having been exposed to the high temperature conditions during ethanol production, compare to kafirin made directly form the grain. An understanding of these properties is required to catalyse the utilisation of DDGS kafirin for biomaterial applications. The aim of this study was to extract kafirin directly from sorghum grain and from DDGS derived from the same grain and, then perform a comparative investigation of the physicochemical properties of these kafirins in terms of: polypeptide profile by sodium-dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE); secondary structure by Fourier transform infra-red (FTIR) spectroscopy and x-ray diffraction (XRD), self-assembly behaviour by small-angle x-ray scattering (SAXS), surface morphology by scanning electron microscopy (SEM) and surface chemical properties by energy dispersive x-ray spectroscopy (EDS). DDGS kafirin was found to have very similar polypeptide profile as grain kafirin but contained altered secondary structure with increased levels of β-sheets. The structure morphology showed surface fractals and surface elemental composition suggests enhanced reactivity with possibility to endow interfacial wettability. These properties of DDGS kafirin may provide it with unique functionality and thus open up opportunities for it to be used as a novel food grade biomaterial.

The anesthetic management of a patient with dilated cardiomyopathy (DCM) for noncardiac surgery is challenging due to associated congestive heart failure, malignant dysrhythmias, sudden cardiac arrest, implanted rhythm devices, and thromboembolism. We report successful conduct of a case of DCM on cardiac resynchronization device with Cauda equina syndrome (CES) under general anesthesia in prone position. The anesthetic concerns specific to the pathophysiology of DCM are also discussed.

Pregnancy with H1N1 infection presenting with early acute respiratory distress syndrome (ARDS) is a challenging situation, where the life of both mother and fetus are jeopardized. Morbidity and mortality in such a clinical situation are not uncommon; it may result in hypoxemic acute respiratory failure in a pregnant patient, leading to mechanical ventilation and poorer outcomes in neonates due to prematurity. An interdisciplinary approach involving obstetricians, respiratory physicians, neonatologist, and anesthesiologist is mandatory for a good outcome. This case report highlights the management strategy of the parturient infected with H1N1 in early ARDS with the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange therapy, which completely obviated the requirement of the invasive ventilation.

Many neonates with hypoxic ischemic encephalopathy and seizures do not respond to the first line antiepileptic drug, phenobarbital. Little is known about what factors are associated with its failure.To examine factors associated with failure of phenobarbital therapy in neonates with hypoxic ischemic encephalopathy and seizures.A single-center retrospective review of 50 term (35 weeks) neonates with hypoxic ischemic encephalopathy and seizures treated with phenobarbital as the first-line antiepileptic. Neonates were classified into either responders (n = 30) or nonresponders (n = 20). Nonresponse was defined as continued seizures after maximum dosing of phenobarbital or an additional antiepileptic. Subjects with acceptable magnetic resonance imaging (MRI) scans obtained within 2 weeks of birth were included in the study and rated using an MRI injury scoring system. Charts were reviewed for demographic, clinical, and laboratory variables. Resuscitation and seizure scores were also calculated. Electroencephalographic (EEG) background activity was reviewed in 2 different time epochs (12-24 hours and 24-36 hours of life) and graded as per ACNS guidelines.There were no significant group differences in demographic, clinical, and laboratory variables except nonresponders, who had higher mean seizure score (In the presence of above factors, one can anticipate that additional antiepileptic medication may be needed. These data also support that larger studies should be done to look prospectively at using alternative agents first line in patients with severe injury.

Purpose: To describe the prevalence, characteristics including risk factors, and pattern of severe ROP from eastern Madhya Pradesh region of India. Methods: In this 5-year retrospective study, Baseline characteristics, systemic risk factors, and findings of ROP screening were noted. Factors associated with severe ROP including aggressive posterior ROP (APROP), stage IV and V ROP were analyzed. Statistical analysis was done using SPSS version 20. Results: Of 763 babies screened, 30% were diagnosed to have ROP. Prevalence of severe ROP was 14.2% (109) of which 60 (55.5%) were classic and 30 (27.7%) were APROP. Eighteen (16.6%) were diagnosed as advanced ROP (stage IV and V). Mean gestational age (GA) and birth weight (BW) for severe ROP were 31.05 weeks and 1.34 kg, respectively which were inversely associated with severe ROP. But a significant 10% of severe ROP were seen in late preterm babies, >34 weeks. Low GA and respiratory distress syndrome (RDS) were significant risk factors for APROP. Most important factor for stage IV and V ROP was late presentation for screening. Conclusion: The study found a high prevalence of severe ROP including APROP. Almost 7% severe ROP cases were outside screening guidelines of NNF. Late presentation for screening is the most important factor associated with ROP related blindness.

Urothelial carcinoma has become the ninth most common malignancy in the world. Since the 1980s, diverse studies and treatment methods came out with their possible effects along with certain limitations. Initially, platinum chemotherapy was considered as first-line treatment of the disease. Although it was proved to be effective initially, the most number of cases reported the reoccurrence of the disease. Furthermore, aberrant ligand- dependent and constitutive ligand-independent fibroblast growth factor receptor (FGFR) signaling has been reported in a large number of solid tumors, including urothelial carcinoma that became the basis for FGFR inhibition for the treatment of the disease. Erdafitinib is a pan-FGFR inhibitor that was recently approved in the USA for the treatment of locally advanced or metastatic FGFR3 or FGFR2 urothelial carcinoma. The drug is also being investigated as a treatment for other cancers, including cholangiocarcinoma, liver cancer, non-small cell lung cancer, prostate cancer, lymphoma cancer and oesophageal cancer. This article summarizes the various treatments that evolved for bladder cancer till now, a brief description of the biology of FGFR inhibition, clinical pharmacology, and various clinical trials of erdafitinib.

A neonate born at our centre was diagnosed as Fryns Syndrome ie congenital diaphragmatic hernia with facial dysmorphism and distal limb anomalies, which is a rare disorder with only a few hundred cases reported till date.With high clinical index of suspicion and further evaluation, the diagnosis was confirmed. The baby was initially stabilized and later underwent repair of the diaphragmatic hernia. Despite best measures, the baby could not be salvaged. When severe, this can be lethal and diagnosis can only be made after autopsy. However, with early suspicion, better modalities of investigations available and improved NICU care, these babies can be salvaged. We report a case of Fryns Syndrome who was incidentally found to have Edward Syndrome as well. Such an extremely rare combination is yet to be reported in medical literature.Also with updated genetic studies, better diagnostics and treatment options coming up in future, there are chances to improve the survivability of these babies. It is prudent to document all such cases to aid in better understanding of the disease process.

Background and Aims: This study was planned to compare intubating conditions with aerosol box, while attempting intubation with either direct laryngoscope (DL) using Macintosh blade or McGrath MAC™, videolaryngoscope (VL). Methodology: Sixty adult patients coming for the emergency surgeries during COVID-19 pandemic were divided equally by consecutive sampling into either Group 1 (DL) or Group 2 (VL). General anesthesia was administered with aerosol box covering the head and trunk of the patient. The laryngoscopy was attempted based on the group allocation with either VL or DL through aerosol box. Following observations were noted, total intubation time, number of attempts, Cormack–Lehane (CL) view, intubation difficulty scale (IDS), use of airway adjuncts, and external laryngeal maneuver. Results: Mean (standard deviation) time taken to intubate was 25.36 (6.22) sec in DL group and 21.9 (5.56) sec in VL group. Median IDS scoring was 1 in DL group and 0 in VL group indicating toward ease of intubation with the videolaryngoscope. Improved glottic view (CL Grade 1) was attained commonly with VL group and higher CL grades (2b) were common with DL group (23.3%). No intubation aids were required in VL group although 30% in DL required bougie for the intubation. External laryngeal maneuver was applied in 40% subjects undergoing DL with no maneuvers needed in VL group. First pass success of intubation was comparable in both the groups. Conclusion: Intubating conditions are favorable with VL when aerosol box is included which requires acquisition of the skills depending on its availability. However, the intubation should be attempted with the technique the clinician has the expertise during this pandemic.

Introduction: Severe anaemia is a leading cause of paediatric morbidity, hospitalization, and mortality and it is very important co morbidity in children with severe acute malnutrition. Severe Acute Malnutrition (SAM) with anaemia has been shown to have 2.62 times higher mortality as compared to SAM with no anaemia. So this study was done to evaluate this co-morbidity further. The aim of present study was to determine the prevalence and type of anaemia and to evaluate the possible aetiologies of anaemia in severe acute malnourished (SAM) children.Material and Methods: In tertiary care hospital a cross sectional study was conducted over a period of 8 month with 100 cases of SAM children and 101 cases of normal children. In both cases disorders of primary haematological problem were excluded. Auto analysers were used to measure blood counts. Blood smear was analysed by pathology consultant of institute and recorded for all patients with anaemia. Grade of anaemia and morphologic type of anaemia was analysed. Data were entered in Excel spreadsheets and analysed using SPSS 20.0.Results: Patient with SAM 42% had moderate anaemia and 19% had severe anaemia in contrast 41.6% and 16.8% in NON SAM child respectively. Predominant morphologic type in SAM patient was macrocytic anaemia (33%), while in controls microcytic anaemia (40.6%) was more prevalent.Conclusion: There was a high prevalence of anaemia in SAM children. Major morphologic type in SAM children was macrocytic anaemia which may indirectly show vitamin B12 or folic acid deficiency in these children.

In this work, a simple, inexpensive room temperature chemical bath deposition is proposed to synthesize high-quality Zn(O)S nanoparticles of varied composition. The band gap of these nanoparticles is found to alter by varying their chemical composition. Through this study, the formation of quantum confined ZnS and ZnOS nanoparticles as a function of pH is confirmed. A possible mechanism for the formation of these nanoparticles with respect to pH is discussed here., by Deepak Dwivedi, Tvarit A. Patel and Emila Panda

Background: The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American Heart Association (AHA) guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. Aims: This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. Methods: We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. Results: No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR), CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ. Conclusion: A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Spinal anesthesia (SA) is utilized as an effective means of anesthesia and has an impressive safety record but it is not devoid of complications, and sometimes, the complications are as fatal as cardiac arrest. Although many factors are involved in etiology of cardiac arrest under SA, the vagal responses to the decreased preload are the most common culprits. We report two cases of cardiac arrest under SA; which happened despite our patient being adequately preloaded utilizing the ultrasonography-guided targeted volume therapy. The patients were successfully resuscitated with no neurological deficit.

Increased prevalence of obesity poses a challenge due to the altered physiologic and pharmacokinetic state which renders the patient under general anesthesia susceptible to delayed recovery, increased incidence of hypoxemia, and delayed healing. Smooth conduct of anaesthesia in a differently abled child with morbid obesity demands meticulous preoperative preparation to ward off separation anxiety from the parents as well as the anxiousness related to the unfamiliar environment.

Mining sites are source of iron ore fines which can be reduced by coal and coal dust and crystalline phases of iron ore plays important role in this regards. In this experiment, Author validated experimental data with the chemical kinetic model. No significant difference has been observed in the degree of reduction on the type of coal used as the reducing agent. The activation energy was higher (124.71 KJ) while choosing coal as a reducing agent than the coal + coal dust as a reducing agent (59.75 KJ). The highest reaction rate constant was observed at 1000°C. Abnormal swelling was noted at 850 and 900°C, whereas shrinkage was noted at 950 and 1000°C.

Objective To investigate wound healing, antimicrobial and antioxidant activity of leaf extract of Pongamia Pinnata . Materials and methods Methanolic extracts of P. pinnata leaf were studied for wound healing efficiency, and was assessed by the rate of wound contraction, tensile strength, breaking strength, hydroxyproline and hexosamine content, along with its effect on pro-inflammatory and anti-inflammatory cytokines was assessed using excision and incision model of wound repair in Wistar rats. Antimicrobial activity against ten microorganisms was also assessed. In vivo antioxidant activity was performed to understand the mechanism of wound healing potency. Results The results indicated that P. pinnata extract has potent wound healing capacity as evident from the wound contraction and increased tensile strength. Hydroxyproline and hexosamine expression were also well correlated with the healing pattern observed. extract exhibited significant antimicrobial activity, Staphylococcus aureus, Staphylococcus pyogenes, Staphylococcus epidermidis, Escherichia coli, Micrococcus luteus, Enterobacter aerogenes, Salmonella typhi, Pseudomonas aeruginosa, Candida albicans, Aspergillus niger also indicate that P. pinnata posses potent antioxidant activity by inhibition lipid peroxidation, reduce glutathione, superoxide dismutase level and increases catalase activity. During early wound healing phase TNF-α and IL-6 level were found to be up-regulated by P. pinnata treatment. Conclusion Increased wound contraction and tensile strength, augmented hydroxyproline and hexosamine content, antioxidative activity and moderate antimicrobial activity support the early wound healing exhibited by P. pinnata . Induction in cytokine production may be one of the mechanisms in accelerating the wound healing. Results suggest that P. pinnata may be useful in tropical management of wound healing.

Corrosion is a subject of interest to interdisciplinary research communities, combining fields of materials science, chemistry, physics, metallurgy and chemical engineering. In order to understand mechanisms of corrosion and the function of corrosion inhibitors, the reactions at the interfaces between the corrosive electrolyte and a steel surface, particularly at the initial stages of the corrosion process, need to be described. Naturally, these reactions are strongly affected by the nature and properties of the steel surfaces. It is however seen that the majority of recent corrosion and corrosion-inhibition investigations are limited to electrochemical testing, with ex situ analysis of the treated steels (post-exposure analysis). The characterization of materials and their surface properties, such as texture and morphology, are not being considered in most studies. Similarly, in situ investigations of the initial stages of the corrosion reactions using advanced surface characterization techniques are scarce. In this review, attention is brought to the importance of surface features of carbon steels, such as texture and surface energy, along with defects dislocation related to mechanical processing of carbon steels. This work is extended to a critical review of surface analytical techniques used for characterization of carbon steels in corrosive media with particular focus on examining steel surfaces treated with corrosion inhibitors. Further, emerging surface analysis techniques and their applicability to analyse carbon steels in corrosive media are discussed. The importance of surface properties is commonly addressed by surface scientists as well as researchers in other chemistry fields such as nanotechnology, fuel cells, and catalysis. This article is expected to appeal to a broad scientific community, including but not limited to corrosion scientists, material chemists, analytical chemists, metal physicists, corrosion and materials engineers.

Hysteroscopic gynecological surgeries are now commonly employed in the clinical practice. It has the potential to increase morbidity due to the complication resulting from perforation of the uterus, air/gas embolism, and fluid with electrolyte imbalance. Glycine 1.5%, as an irrigating fluid, is being commonly used and on increased systemic absorption can lead to a wide array of complications. We present a case of transient visual loss after increased absorption of the irrigating fluid, thereby highlighting the factors governing in its genesis and prevention.