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Background: Lumbar puncture (LP) is a low-risk procedure performed on pediatric patients for a variety of indications. There are no published studies of the nature of the concerns of parents in North America, and no studies examining a process to improve pediatric lumbar puncture consent. Methods: 72 patient-parent dyads were enrolled in a randomized control trial to receive standard consent with or without an educational video. A survey was provided to determine parent self-rated understanding of the procedure, their perception of its safety, their perception of the painfulness and their overall comfort with their child undergoing LP. In addition, demographic characteristics and qualitative information about parent concerns were collected. Results: Viewing the video significantly increased parent understanding of the procedure (p=0.015) and their perception of its safety (p=0.021) compared to controls. Parent comfort with the procedure increased after viewing the video (p = 0.002). Variability of answers was reduced in the video group (p = 0.03). Parents’ top three concerns were pain, infection, and neurologic injury. Conclusions: Pediatric lumbar puncture consent can be significantly improved with a short educational video to address the parental concerns and standardize consent.
Unilateral interruption of pulmonary artery is a rare congenital anomaly which is usually associated with other congenital heart disease. Even more rarely it may occur in isolation. Most of the cases are incidentally detected in adulthood. Some cases develop pulmonary hypertension for yet unknown reasons; such cases usually present in infancy with right heart failure. Surgical correction in such cases is associated with adverse outcomes. Heart lung transplantation should be considered in such patients. We report a 3-year-old boy with interruption of right pulmonary artery with severe pulmonary hypertension and right heart failure who was considered for heart lung transplantation.
Cognitive impairments reported across psychiatric conditions (ie, major depressive disorder, bipolar disorder, schizophrenia, and posttraumatic stress disorder) strongly impair the quality of life of patients and the recovery of those conditions. There is therefore a great need for consideration for cognitive dysfunction in the management of psychiatric disorders. The redundant pattern of cognitive impairments across such conditions suggests possible shared mechanisms potentially leading to their development. Here, we review for the first time the possible role of inflammation in cognitive dysfunctions across psychiatric disorders. Raised inflammatory processes (microglia activation and elevated cytokine levels) across diagnoses could therefore disrupt neurobiological mechanisms regulating cognition, including Hebbian and homeostatic plasticity, neurogenesis, neurotrophic factor, the HPA axis, and the kynurenine pathway. This redundant association between elevated inflammation and cognitive alterations across psychiatric disorders hence suggests that a cross-disorder approach using pharmacological and nonpharmacological (ie, physical activity and nutrition) anti-inflammatory/immunomodulatory strategies should be considered in the management of cognition in psychiatry.
Graphene oxide (GO)/MnO2 nanocomposites were synthesized by adding KMnO4 in a solution of water and ethanol (3:1), containing 10 mg of GO. Brown precipitates were obtained after a continuous stirring for 1 hr. The precipitates were then washed with deionized water (DI) water and dried to obtain the MnO2-GO nanocomposites. Pure MnO2 was also synthesized using the same method without GO for the comparison. X-ray diffraction pattern confirm δ-MnO2 type of MnO2 with birnessite type MnO2 structure. The TEM images show the average diameter of MnO2 nanorods as 15 nm. Electrochemical characterizations were carried out in an aqueous solution of 3M KOH. Charge-discharge studies were carried out between 1A/g to 20 A/g current range. The MnO2-GO nanocomposites showed improved electrochemical performances. The capacitance of MnO2 and MnO2-GO electrodes was found to be as 300 F/g, and 350 F/g, respectively at a current of 0.5 A/g.
Kα X-ray sources generated from the interaction of ultra-short laser pulses with solids are compact and low-cost source of ultra-short quasi-monochromatic X-rays compared with synchrotron radiation source. Development of collimated ultra-short Kα X-ray source by the interaction of 45 fs Ti:sapphire laser pulse with Cu wire target is presented in this paper. A study of the Kα source with laser parameters such as energy and pulse duration was carried out. The observed Kα X-ray photon flux was ~2.7 × 108 photons/shot at the laser intensity of ~2.8 × 1017 W cm−2. A model was developed to analyze the observed results. The Kα radiation was coupled to a polycapillary collimator to generate a collimated low divergence (0.8 mrad) X-ray beam. Such sources are useful for time-resolved X-ray diffraction and imaging studies.
Background: Wearable activity trackers are an innovative tool for measuring sleep and physical activity. The Resident Activity Tracker Evaluation (RATE) is a prospective observational study evaluating the impact of work-hours, sleep, and physical activity on resident well-being, burnout, and job satisfaction. Methods: Residents were recruited from: 1. general surgery and orthopedics (SURG), 2. internal medicine and neurology (MED) and 3. anesthesia and radiology (RCD). Groups 1 and 2 do not enforce on-call duration restrictions and group 3 had 12-hour restricted-call durations (RCD). Participants wore FitBit activity trackers for 14 days and completed four validated surveys assessing self-reported health, sleepiness, burnout, and job satisfaction. Results: Fifty-nine residents completed the study. 778 days of activity and 244 on-call periods were tracked. Surgical residents worked 24 more hours per week than non-surgical residents (84.3 vs 60.7). Surgical residents had 7 less hours of sleep per week and reported significantly higher Epworth Sleepiness scores. Nearly two-thirds of participants (61%) scored high burnout on the Maslach depersonalization subscore. Total steps per day and self-reported well-being, burnout, and job satisfaction were comparable between the groups. Conclusions: Despite a positive correlation between work-hours and sleepiness, burnout and well-being were similar among residents. Physical activity did not prevent burnout. These findings are relevant to work-hours policies.
Background: Tuberous sclerosis complex (TSC) is a neurocutaneous disorder with a wide spectrum of manifestations. Recent consensus recommendations stress the importance of multidisciplinary management of children with TSC. The objective of this study was to examine the manifestations of TSC at a large referral centre to determine the care needs of this population. Methods: A retrospective, systematic chart review was performed of children with TSC managed at British Columbia Children’s Hospital. Patients were identified through epilepsy and clinical neurophysiology databases. Results: The study population comprised 81 patients, born between 1987 and 2014, who were a median of 10 years (range, 0.2-23.2) at most recent follow-up. Epilepsy occurred in 91% of patients, including 32% with a history of infantile spasms. Nineteen patients underwent epilepsy surgery, nine (47%) of whom were seizure-free at most recent follow-up. Overall, 61% of epilepsy patients had been seizure-free for at least 1 year at the time of last follow-up. Neuropsychiatric disorders were diagnosed in 49% of children, with autism (25%), attention deficit hyperactivity order (19%) and anxiety (16%) being the most common. Cardiac rhabdomyomata occurred in 35% of children and renal angiomyolipomas were seen in 43%. A total of 91% had skin manifestations. Conclusion: This study outlines the multisystem manifestations of TSC, observed through a large pediatric referral center. Epilepsy and neuropsychiatric disorders are the major source of morbidity in this age group and provide many challenges to the treating clinician. Because a subset of the study population is still quite young, the prevalence of neuropsychiatric disorders is likely underestimated.
Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is currently being used for rapid and reproducible identification of bacteria, viruses and fungi in clinical microbiological laboratories. However, some studies have also reported the use of MALDI-TOF MS for identification of parasites, like Leishmania, Giardia, Cryptosporidium, Entamoeba, ticks and fleas. The present review collates all the information available on the use of this technique for parasites, in an effort to assess its applicability and the constraints for identification/diagnosis of parasites and diseases caused by them. Though MALDI-TOF MS-based identification of parasites is currently done by reference laboratories only, in future, this promising technology might surely replace/augment molecular methods in clinical parasitology laboratories.
We analyze the effect of functionalization in the surface of zinc oxide crystal structure by 3-mercaptopropionic acid. X-ray powder diffraction data and extended x-ray absorption fine structure studies confirms a wurtzite structure. However, the morphology of the surface seems to be reduced and shows a film-like surface as demonstrated by x-ray absorption near edge structure and scanning electron microscopy. As a result of surface functionalization, the energy levels of the semiconductor were shifted toward reductive potentials (by 50 mV) as determined by diffuse reflectance and cyclic voltammetry.
Non-communicable diseases (NCD) and atherosclerotic CVD in particular, are the most important health problems of the 21st century. Already in every world region except Africa, NCD account for greater mortality than communicable, maternal, perinatal and nutritional conditions combined. Although modifiable lifestyle factors in adults are the main determinants, substantial evidence now suggests that factors in early life also have a major role in the development of NCD; commonly referred to as the Developmental Origins of Health and Disease hypothesis. Factors in utero, early postnatal life and throughout childhood, have been shown to affect NCD by influencing risk factors for CVD such as obesity, diabetes, hypertension and dyslipidaemia. Infant nutrition (e.g. breastfeeding rather than bottle feeding) and a slower pattern of infant weight gain have been shown to be particularly protective against later risk of obesity and CVD in both low- and high-income countries. The mechanisms involved are poorly understood, but include epigenetic changes; effects on endocrine systems regulating body weight, food intake and fat deposition; and changes in appetite regulation. As a consequence, strategies to optimise early life nutrition could make a major contribution to stemming the current global epidemic of NCD. This review will consider the role of early life factors in the development of NCD, focusing on the impact of infant nutrition/growth on obesity and CVD. The review will highlight the experimental (randomised) evidence where available, briefly summarise the underlying mechanisms involved and consider the implications for public health.
This study aimed to develop a functional model of subglottic stenosis by inducing direct airway irritation in transplanted mouse laryngotracheal complexes.
Laryngotracheal complexes from C57BL/6 mice were harvested and divided into three groups: uninjured, mechanically injured and chemically injured. Donor laryngotracheal complexes from each group were placed in dorsal subcutaneous pockets of recipient mice. Each week, the transplanted laryngotracheal complexes were harvested, and tissues were fixed, sectioned, and stained with haematoxylin and eosin. Representative slides were reviewed by a blinded pathologist, to determine the formation of granulation tissue, and graded as to the degree of granulation formation.
Direct airway irritation induced granulation tissue formation under the disrupted epithelium of airway mucosa; this was seen as early as two weeks after chemical injury.
Results indicate that granulation tissue formation in a murine model may be an efficient tool for investigating the development and treatment of subglottic stenosis.
Trimethylamine (TMA) is a tertiary amine with a characteristic fishy odour. It is synthesised from dietary constituents, including choline, L-carnitine, betaine and lecithin by the action of microbial enzymes during both healthy and diseased conditions in humans. Trimethylaminuria (TMAU) is a disease typified by its association with the characteristic fishy odour because of decreased TMA metabolism and excessive TMA excretion. Besides TMAU, a number of other diseases are associated with abnormal levels of TMA, including renal disorders, cancer, obesity, diabetes, cardiovascular diseases and neuropsychiatric disorders. Aside from its role in pathobiology, TMA is a precursor of trimethylamine-N-oxide that has been associated with an increased risk of athero-thrombogenesis. Additionally, TMA is a major air pollutant originating from vehicular exhaust, food waste and animal husbandry industry. The adverse effects of TMA need to be monitored given its ubiquitous presence in air and easy absorption through human skin. In this review, we highlight multifaceted attributes of TMA with an emphasis on its physiological, pathological and environmental impacts. We propose a clinical surveillance of human TMA levels that can fully assess its role as a potential marker of microbial dysbiosis-based diseases.
A coplanar waveguide (CPW)-fed circular-shaped fractal antenna with third iterative orthogonal elliptical slot for ultra-wideband applications is presented. The bandwidth is enhanced by using successive iterations of radiating patch, CPW feedline, and tapered ground plane. An impedance bandwidth of 2.9–20.6 GHz is achieved. The designed antenna has omnidirectional radiation patterns along with average peak realized gain of 3.5 dB over the entire frequency range of operation. A good agreement is observed between the simulated and experimental results. This antenna structure has the advantages of miniaturized size and wide bandwidth in comparison to previously reported fractal structures.
Background: Cerebral proliferative angiopathy (CPA) is a rare vascular malformation with intervening normal brain tissue interspersed among abnormal vascular channels. There are 77 reported cases, the youngest being 9 years old, with persistent symptoms and recurring symptoms being rare. Methods: A three-year-old girl with CPA is described and compared to the literature. Results: A previously healthy girl with early left-handedness and a left forehead nevus flammeus presented with sudden onset of right arm and leg weakness, along with abrupt speech arrest and right homonymous hemianopia. Head CT Angiogram and MRI revealed an abnormal vascular network with densely packed, moderately enlarged vessels arising within the white matter with no dominant feeding vessel and both old and acute infarcts in the left hemisphere. Eye exam was unremarkable. The clinical and radiologic features were most consistent with a diagnosis of CPA. Her visual deficits and motor symptoms persisted, and she had a recurrent event shortly after. Conclusions: This is the youngest reported case of CPA, with novel features including radiologic evidence of previous infarcts, clinical recurrence of symptoms, and permanent deficits. This case demonstrates the need for further research into the surveillance and management of this rare entity, possibly unique in young children
Background: Fundoscopy is an important component of the neurological examination, but can be challenging in uncooperative children. This study explores whether playing a video during eye examination, improves the success, duration and ease of pediatric fundoscopy. Methods: We completed a prospective, multi-clinic, block-randomized trial. Patients 1-4 years were recruited in the emergency department, neurology, spinal cord and general pediatric clinic. Patients were randomized (by eye examined) to video/non-video assisted fundoscopy. Successful exams were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of exam was examined using a 10-point Likert scale. Results: 101 subjects were recruited, with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (p<0.01). Time to visualize optic disc was also improved (Δ5.3s, p<0.01). Improvement in ease of examination with video were noted by caregivers and practitioners (p<0.01). Conclusion: Playing a video improved the ease, duration and most importantly the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination.
Background: Studies in the literature suggest preoperative laboratory investigations and cross-match are performed unnecessarily and rarely lead to changes in clinical management. This study explored whether preoperative laboratory investigations in neurosurgical children alter clinical management and to determine the utilization of cross-matched blood perioperatively in elective pediatric neurosurgical cases. Methods: We reviewed patient charts for elective neurosurgery procedures (2010-2014) at our institution. Variables collected include preoperative complete blood count (CBC), electrolytes, coagulation, group and screen, and cross-match. Instances of altered clinical management as a consequence of preoperative investigation were noted. The number of cross-matched blood transfused perioperatively was also determined. Results: 477 electively scheduled pediatric neurosurgical patients were reviewed. Preoperative CBC was done on 294 and 39.8% had at least one laboratory abnormality. Electrolytes and coagulation panels were abnormal in 23.8% and 24.5% respectively. The preoperative investigations led to a change in clinical management in three patients, two of which were associated with significant past medical history. 57.9% had blood cross-matched and 3.6% of patients received perioperative blood transfusions. The cross-match to transfusion ratio was 16. Conclusion: This study suggests that the results of preoperative laboratory exams have limited value, apart from cases with oncology and complex pre-existing conditions. Additionally, cross-matching might be excessively conducted in elective pediatric neurosurgical cases.