Search

Down's syndrome (trisomy 21) is well recognized to be associated with several autoimmune conditions such as hypothyroidism, celiac disease, and diabetes mellitus. Antiphospholipid syndrome (APS), an immune disorder, can cause a stroke due to the prothrombotic state. APS is associated with several autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, and systemic vasculitis, as well as Down's syndrome. Down's syndrome is linked to several other risk factors for stroke including congenital heart disease, moyamoya disease, and arterial dissection. We present the case of a 3-year-old girl child patient with Down's syndrome, who presented with an acute arterial ischemic stroke secondary to carotid artery dissection and subsequently was also confirmed to have APS. We review the literature on Down's syndrome and APS, the proposed pathophysiology, and management strategies. We present a case of a 3-year-old girl with Down's syndrome and who presented with stroke, review previously published cases, and discuss the conditions and their management. Autoimmune conditions, such as antiphospholipid syndrome, are more common in individuals with Down's syndrome, and as such should be investigated when these children present with symptoms suggestive of stroke.

In this work, we characterize the early stages of transition in a flat-plate boundary layer caused by two types of surface roughness: distributed roughness (a strip of 24-grit emery) and isolated roughness (a cylindrical element). Towards this, we carry out extensive particle image velocimetry (PIV) measurements. The distributed roughness consists of a range of grit heights and introduces a broad range of disturbances downstream of it. In the pre-transitional region, both isolated and distributed roughness cause steady streaks, which for the latter case show a lack of spanwise symmetry. This is in contrast to the freestream turbulence (FST), which introduces unsteady streaks in the pre-transitional boundary layer. We propose tilting of spanwise vortices downstream of the distributed roughness to be the mechanism for generation of streamwise vortices, which are likely precursors to the onset of transition. For both the roughness configurations, the steady streaks develop instability resulting in localized streak breakdowns. The wall-normal PIV visualizations show streak instability features qualitatively similar to those for the FST-induced transition. For the distributed roughness, both the outer instability of lifted-up streaks and the inner instability due to streak interaction are present, whereas for the isolated roughness, the inner instability is dominant while the outer instability is much weaker. Conditional sampling of fluctuating velocity shows an asymmetry in the positive and negative fluctuations after the onset of transition, in a manner similar to that observed for the FST-induced transition. These observations suggest that the wall-normal distribution of unsteady velocity fluctuations in the early stages of transition is qualitatively similar irrespective of the source of disturbance (roughness/FST) causing transition. We expect that this commonality of features among different types of transition will be helpful in modelling flow over aerodynamic surfaces such as turbine blades and aircraft wings.

Online learning uses technology for delivering the courses. Education with technology is considered as the most promising development in education. With technology globalization, the concept of learning and teaching has undergone a tremendous change. Technological usage in education provides a global learning environment, which allows accessing the course material anytime, anywhere, connect other learners, and get access to the content without considering any geographical boundaries. The significant changes in the use of technology in online education have seen the emergence of the concept of Massive Open Online Course (MOOC). Massive Open Online Course (MOOC). SWAYAM platform is indigenously developed by Ministry of Human Resource Development (MHRD) and All India Council for Technical Education (AICTE) with the help of Microsoft and would be ultimately capable of hosting 2000 courses and 80000 hours of learning: covering school, under- graduate, post- graduate, engineering, law and other professional courses. University Grants Commission (UGC) has vided Gazette Notification dated 19 th July 2016, notified Regulation, 2016 regarding „Credit Framework for Online Learning Courses through SWAYAM'. SWAYAM has been developed under four- quadrant approaches: (1) video lecture, (2) specially prepared reading material that can be downloaded/printed (3) self-assessment tests through tests and quizzes and (4) an online discussion forum for clearing the doubts. SWAYAM is an indigenous IT Platform for hosting the Massive Open Online Courses. The study is conducted among the Postgraduate students of Belthangady taluk to know the experience of users and to know the various challenges faced by the students while accessing the various courses.

AIMS The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS). METHOD Lesions were contoured first by clinical oncologist then reviewed/edited by MDT. Iinitial contour was compared with final using Jaccard conformity and geographical miss indices. Dosimetric impact of contouring change was assessed using plan metrics to both original and final contour. The impact of contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up. RESULTS 113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32-1.00) and 38% needed significant editing (JCI0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p CONCLUSION MDT contour review adds significant value to SRS resulting in reduced local recurrence rates. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist - particularly for resection cavities.

BACKGROUND The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS). MATERIAL AND METHODS A sequential audit was conducted of all patients receiving intracranial SRS at our local institution for the first 22 months of a new SRS service. Lesions were contoured first by clinical oncologist then reviewed/edited by the MDT. The initial contour was compared with final contour using Jaccard conformity and geographical miss indices. The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contour. The impact of the contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up (24–46 months). RESULTS 113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32–1.00) and 38% needed significant editing (JCI0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p CONCLUSION This work highlights that a MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at our local institution compared with previously published data. Radio-necrosis rates are below 10%. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist. MDT input is recommended in particular in contouring of resection cavities.

Background: The most performed surgical procedure in obstetrics is cesarean section. Purpose of this study is to establish the maternal and neonatal outcome after emergency and elective cesarean section, and identifying preventable risk factors wherever possible.Methods This is n observational comparative study done at Al Azhar medical college Thodupuzha, Kerala, India on 185 pregnant women who underwent cesarean section and who fulfilled the inclusion criteria in the department of obstetrics and gynecology. After taking consent patients were identified into two groups based on type of cesarean section that is elective or emergency. In elective cesarean section group 79 women were studied whereas emergency cesarean section group 106 women were studied. Maternal parameters like indication of cesarean section, intra operative and post-operative complications were analyzed. Neonatal parameters like respiratory distress syndrome, NICU admissions, APGAR score were analyzed.Results: Most number of cases in elective cesarean section group underwent cesarean section for prior cesarean section for maternal request (89%) and for emergency cesarean section for fetal distress (32%). Intraoperative, post-operative complications and adverse neonatal outcome were more with emergency CS group.Conclusions: Adverse maternal and neonatal outcome was found to be more in emergency cesarean section compared to elective cesarean section. Inducing labor with proper indication, assessment of cephalopelvic disproportion and intrapartum monitoring using partogram are some of the preventable factors identified to reduce adverse outcome.

Summary Background The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in paediatric patients. We aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the paediatric population. Methods An international call for cases of children with encephalopathy related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and abnormal neuroimaging findings was made. Clinical history and associated plasma and cerebrospinal fluid data were requested. These data were reviewed by a central neuroradiology panel, a child neurologist, and a paediatric infectious diseases expert. The children were categorised on the basis of their time of probable exposure to SARS-CoV-2. In addition, cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesised. The accepted referral centre imaging data, from ten countries, were remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings. Findings 38 children with neurological disease related to SARS-CoV-2 infection were identified from France (n=13), the UK (n=8), the USA (n=5), Brazil (n=4), Argentina (n=4), India (n=2), Peru (n=1), and Saudi Arabia (n=1). Recurring patterns of disease were identified, with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns were postinfectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), myelitis (eight patients), and neural enhancement (13 patients). Cranial nerve enhancement could occur in the absence of corresponding neurological symptoms. Splenial lesions (seven patients) and myositis (four patients) were predominantly observed in children with multisystem inflammatory syndrome. Cerebrovascular complications in children were less common than in adults. Significant pre-existing conditions were absent and most children had favourable outcomes. However, fatal atypical CNS co-infections developed in four previously healthy children infected with SARS-CoV-2. Interpretation Acute-phase and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognised being as potentially due to SARS-CoV-2 infection as an underlying aetiological factor. Studies of paediatric specific cohorts are needed to better understand the effects of SARS-CoV-2 infection on the CNS at presentation and on long-term follow-up in children. Funding American Society of Pediatric Neuroradiology, University of Manchester (Manchester, UK). Video Abstract Neuroimaging manifestations in children with SARS-CoV-2 infection

The growth of disturbances in the pre-transitional region of a boundary layer in presence of surface roughness is of relevance to many engineering situations and has been a topic of research for several studies in the past. In this work, we present velocity measurements in a boundary layer developing on a flat plate (mounted in a wind tunnel) downstream of a 2-D strip of distributed surface roughness of limited streamwise extent. Two different grades of sandpaper roughness are used toward this purpose. The power spectra of the streamwise velocity fluctuations show that the roughness introduces distinct frequencies as well as a broad range of disturbances into the boundary layer, with the latter being primarily responsible for the onset of transition. The disturbances in the pre-transitional region exhibit amplification which can be attributed to the transient growth mechanism. For the finer grade of roughness, the disturbance kinetic energy grows approximately linearly with streamwise distance from the mean roughness position, which is broadly consistent with the linearized disturbance theories. The wall-normal location of the peak disturbance energy shifts away from the wall with increasing streamwise distance, and the fluctuating velocity profiles exhibit a non-similar distribution in the streamwise direction. These results are qualitatively similar to the theoretical predictions of Fransson et al. (Phys Fluids 16:3627–3638, 2004) but in contrast to the optimal-disturbance theory of Luchini (J Fluid Mech 404:289–309, 2000), both of which deal with steady disturbances. The results for the coarser roughness, however, depart considerably from these theoretical trends.