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Background: Nonimmune hydrops fetalis (NIHF) due to congenital chylothorax (CC) is rare and is usually associated with high mortality. Chylothorax complicated with congenital cytomegalovirus (CMV) infection is extremely rare and the management becomes challenging. We present a case of CC in a preterm infant with associated CMV positivity, which was managed successfully. Clinical Description: A 2.25 kg, 34-week female newborn, with antenatally diagnosed hydrops, delivered by emergency cesarean section, presented with pleural effusion and poor respiratory efforts. Management: The baby was provided mechanical ventilation and all supportive treatments. Pleural fluid testing was suggestive of high proteins with high white cell counts, predominantly lymphocytes. Baby was also positive for CMV immunoglobulin M with a high number of copies in the urine polymerase chain reaction. The baby initially responded well to oral valgancyclovir but returned with severe respiratory distress on day 20 of life, at which time, was again found to have right-sided chylothorax. This was managed successfully with octreotide at a dose of 8 μg/kg/hour and 90% medium chain triglyceride diet. Conclusions: CC should be considered in the differential diagnosis of NIHF. An incidental serological test positivity for CMV may be superimposed on underlying CC. If the latter is managed optimally with close monitoring, the outcome is usually favorable.

IntroductionConventional magnetic resonance imaging (MRI) has limitations in differentiating tumor recurrence (TR) from radionecrosis (RN) in high-grade gliomas (HGG), which can present with morphologically similar appearances. Multiparametric advanced MR sequences and Positron Emission Tomography (PET) with amino acid tracers can aid in diagnosing tumor metabolism. The role of both modalities on an individual basis and combined performances were investigated in the current study.Materials and MethodsPatients with HGG with MRI and PET within three weeks were included in the retrospective analysis. The multiparametric MRI included T1-contrast, T2-weighted sequences, perfusion, diffusion, and spectroscopy. MRI was interpreted by a neuroradiologist without using information from PET imaging. 18F-Fluoroethyl-Tyrosine (FET) uptake was calculated from the areas of maximum enhancement/suspicion, which was assessed by a nuclear medicine physician (having access to MRI to determine tumor-to-white matter ratio over a specific region). A definitive diagnosis of TR or RN was made based on the combination of multidisciplinary joint clinic decisions, histopathological examination, and clinic-radiological follow-up as applicable.Results62 patients were included in the study between July 2018 and August 2021. The histology during initial diagnosis was glioblastoma, oligodendroglioma, and astrocytoma in 43, 7, and 6 patients, respectively, while in 6, no definitive histological characterization was available. The median time from radiation (RT) was 23 months. 46 and 16 patients had TR and RN recurrence, respectively. Sensitivity, specificity, and accuracy using MRI were 98, 77, and 94%, respectively. Using PET imaging with T/W cut-off of 2.65, sensitivity, specificity, and accuracy were 79, 84, and 80%, respectively. The best results were obtained using both imaging combined with sensitivity, specificity, and accuracy of 98, 100, and 98%, respectively.ConclusionCombined imaging with MRI and FET-PET offers multiparametric assessment of glioma recurrence that is correlative and complimentary, with higher accuracy and clinical value.

In the wake of the COVID-19 pandemic, where almost the entire global healthcare ecosystem struggled to handle patients, it’s evident that the healthcare segment needs a virtual real-time digital support system. The recent advancements in technology have enabled machine-to-machine communication, enhanced mobile broadband, and real-time biometric data analytics. These could potentially fulfill the requirements of an end-to-end digital healthcare system. For building such a system, there is also a need for a dedicated and specialized communication network. Such a system will not only support dynamic throughput, latency and payload but also provide guaranteed QoS (Quality of Service) at every instant. The motive of our study was to define an implementable low-level architecture for the digital healthcare system by using the 5G Network Slice that incorporates all these features. Best-in-class wearable devices will collect the biometric data and transmit it via the 5G network slice. Data analytics is then applied to the collected data to build a knowledge graph used for quick predictions and prescriptions. The architecture also keeps in mind the security and integrity aspects of healthcare data.

Though additive manufacturing methods are highly attractive for the high-throughput fabrication of 3D electronic materials and devices, printing multimaterial devices remains a serious challenge. Here, the authors report optoelectronic multimaterial filaments for 3D-printed optoelectronics.

Additive Manufacturing (AM) is a novel manufacturing method where a component is fabricated by accumulating material layer-by-layer therefore facilitating customized near-net-shape components while maximizing design freedom. A metal AM technology suited for large-scale component fabrication that has been emerging in recent years and is commonly referred to as Wire and Arc AM (WAAM) uses Gas Metal Arc Welding (GMAW) technology to deposit material and large-scale robotic serial manipulator systems (reach >1 m cubed). One of the requirements for applying GMAW welding technology to AM is to identify and optimize deposition parameters in order to achieve a desired deposition quality measured in terms of geometrical, mechanical and metallurgical consistency. In this work, deposition process parameters qualitatively and quantitatively influencing the geometrical, mechanical and metallurgical consistency are identified and statistically validated. A deposition parameter combination is found that optimizes the quality of single-track wall benchmark components made from low-carbon steel. Moreover, correlations are found between accumulated heat during fabrication and the geometrical variations of the benchmark components due to bead slumping. Additionally, correlations between microstructure variations and geometrical variations are found. Finally, based on the presented analyses, in-situ temperature monitoring methods are proposed in order to achieve optimal component quality.

Aims and Objective: The aim of this study was to identify the presence of Helicobacter pylori in saliva of patients with and without gastritis by polymerase chain reaction (PCR) method. Materials and Methods: The study comprised 20 patients in Group I presenting with various symptoms of gastritis and 10 asymptomatic subjects in Group II. The intestinal endoscopy antral biopsies were collected from 20 symptomatic patients with gastroduodenal disorders. The saliva specimens were taken from all patients before endoscopy. PCR was performed using genomic DNA, isolated from the saliva and the biopsies of the patients as the template to detect the presence of the 16S ribosomal RNA gene in H. pylori. Results: In Group I, 10 (50%) cases of clinical gastritis were positive for H. pylori by endoscopy biopsy and 10 (50%) were negative. Of the 10 endoscopy biopsy positive cases for H. pylori, eight were PCR positive in saliva and two were negative. Of the 10 endoscopy biopsy negative cases, three were PCR positive for H. pylori in saliva and seven were negative. In Groups II, four were symptomatic for gastritis and six were negative. Of the six gastritis negative cases, three were PCR positive, four were gastritis positive, and three were PCR positive. Sensitivity and specificity of PCR were found to be 80% and 70%, respectively. The positive predictive and negative predictive values of PCR in saliva were 72.7% and 77.7%, respectively. Conclusion: PCR analysis of saliva may be handy in identification of H. pylori and serves as a noninvasive technique to diagnose and monitor the prognosis.

Purpose: To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children. Methods: In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner. Results: For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45). Conclusion: eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities.