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Drug-induced movement disorders (DIMDs) form an important subgroup of secondary movement disorders, which despite conferring a significant iatrogenic burden, tend to be under-recognized and inappropriately managed.
We aimed to look into phenomenology, predictors of reversibility, and its impact on the quality of life of DIMD patients.
We conducted the study in the Department of Neurology at a tertiary-care centre in India. The institutional ethics-committee approved the study. We assessed 55-consecutive DIMD patients at presentation to our movement disorder clinic. Subsequently, they followed up to evaluate improvement in severity-scales (UPDRS, UDRS, BARS, AIMS) and quality of life (EuroQol-5D-5L). Wilcoxan-signed-rank test compared the scales at presentation and follow-up. Binary-logistic-regrerssion revealed the independent predictors of reversibility.
Fourteen patients (25.45%) had acute-subacute DIMD and 41 (74.55%) had tardive DIMD. Tardive-DIMD occurred more commonly in the elderly (age 50.73±16.92 years, p<0.001). Drug-induced-Parkinsonism (DIP) was the most common MD, followed by tardivedyskinesia. Risperidone and levosulpiride were the commonest culprit drugs. Patients in both the groups showed a statistically significant response to drug-dose reduction /withdrawal based on follow-up assessment on clinical-rating-scales and quality of life scores (EQ-5D-5L). DIMD was reversible in 71.42% of acute-subacute DIMD and 24.40% of patients with chronic DIMD (p=0.001). Binary-logistic-regression analysis showed acute-subacute DIMDs and DIP as independent predictors of reversibility.
DIP is the commonest and often reversible drug-induced movement disorder. Levosulpiride is notorious for causing DIMD in the elderly, requiring strict pharmacovigilance.
Pulmonary valve endocarditis after transcatheter pulmonary valve implantation has been an emerging concern due to the increasing prevalence of transcatheter placement of pulmonary valve in the treatment of residual right ventricular outflow tract stenosis or regurgitation. Pulmonary valve endocarditis is a dreadful complication of transcatheter pulmonary valve implantation that have been reported with Melody valve (Medtronic, Inc., Minneapolis, MN) and Edward Sapien valve (Edwards Life Sciences, Irvine, CA) till date. There are scanty available literatures for pulmonary valve endocarditis with Venus P valve (Venus Medtech, Hangzhou, China) implantation. Furthermore, cardiovascular comorbidity is common in COVID-19 infection with limited evidence of COVID-19 infection concomitant with infective endocarditis. This case happens to be the first reported case of infective endocarditis of pulmonary valve with concomitant COVID-19 infection and also delayed presentation of pulmonary valve endocarditis with Venus P valve implantation.
Congenital heart block is a rare and lethal condition in paediatric population associated with maternal connective tissue disorders and rarely with structural cardiac disease like atrioventricular canal defects with or without left isomerism and congenitally corrected transposition of great arteries. Pacing in neonate if indicated is generally accomplished by epicardial pacing systems. However, in cases of significant bradycardia and haemodynamic instability, temporary pacemaker implantation via transvenous approach remains as a suitable option. Despite the advances in percutaneous catheter interventions, use of transvenous pacing in newborn is extremely challenging due to inadvertent risk of vessel injury, thrombus formation and mortality, and most of the time technical inability to place the lead within the right ventricular cavity. We report a case of congenital complete atrioventricular block in a premature male with birth weight of 1.51 kg who was managed with temporary pacemaker implantation through umbilical vein.
Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
Tricuspid valve atresia with severe pulmonary stenosis is one of the common cyanotic diseases in neonate. Child can succumb due to profound cyanosis and arterial hypoxaemia after closure of patent ductus arteriosus. Evolving procedure of right ventricular outflow tract stenting may be considered as a palliative procedure in such vulnerable group, destined for a later definitive management. The right ventricular outflow tract stenting is described essentially for tetralogy of Fallot physiology with a catheter course across tricuspid valve. We describe a case of successful right ventricular outflow tract stenting in a 5-day-old symptomatic neonate. We discuss the possible routes and the tips to facilitate right ventricular outflow tract stenting in such a case. This happens to be the first reported case description with successful stenting of neonate with tricuspid atresia with critical pulmonic stenosis.
This study compared the efficacy and safety of oxcarbazepine and divalproex sodium in acute mania patients.
Subjects and methods
In this 12 week, randomized, double-blind pilot study, 60 patients diagnosed with acute mania (DSM-IV) and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexibly dosed oxcarbazepine (1000–2400 mg/day) or divalproex (750–2000 mg/day). The mean decrease in the YMRS score from baseline was used as the main outcome measure of response to treatment. A priori protocol-defined threshold scores were ≤12 for remission and ≥15 for relapse. Number of patients showing adequate response and the time taken to achieve improvement was compared. Adverse events were systematically recorded throughout the study.
Over 12 weeks, mean improvement in YMRS scores was comparable for both the groups including the mean total scores as well as percentage fall from baseline. There were no significant differences between treatments in the rates of symptomatic mania remission (90% in divalproex and 80% in oxcarbazepine group) and subsequent relapse. Median time taken to symptomatic remission was 56 days in divalproex group while it was 70 days in the oxcarbazepine group (p = 0.123). A significantly greater number of patients in divalproex group experienced one or more adverse drug events as compared to patients in the oxcarbazepine group (66.7% versus 30%, p < 0.01).
Oxcarbazepine demonstrated comparable efficacy to divalproex sodium in the management of acute mania. Also the overall adverse event profile was found to be superior for oxcarbazepine.
The aim of this paper is to introduce a new stochastic order based on the residual lifetimes of two nonnegative dependent random variables and the stochastic precedence order. We develop some characterizations and preservation properties of this stochastic order. In addition, we study some of its reliability properties and its relation with other existing stochastic orders. One of the possible applications in reliability theory has also been discussed.
The possible association between teat morphometric traits and subclinical mastitis (SCM) in dairy buffaloes was studied. Teat morphometric parameters, i.e. teat shape (bottle, conical, cylindrical, and others), teat-end shape (flat, round, and pointed), teat length (TL), teat diameter (TD), and teat-end to floor distance were measured before milking, but after proper milk let-down, in clinically healthy buffaloes (47 Murrah and 34 Nili-Ravi breeds). Subclinical mastitis was defined on the basis of bacteriology and somatic cell count (SCC) of quarter foremilk samples. A high proportion of cylindrical teats (40%) and pointed teat-ends (64·4%) was observed. Hind teats were longer and thicker than fore teats (P < 0·05). A significant breed effect was found with respect to teat shape, length and diameter (P < 0·05). Teats were mostly cylindrical (43·3 vs. 35·4%) and conical (34·2 vs. 30·8%) shaped, smaller (mean 8·2 vs. 9·5 cm) and thinner (mean 3·3 vs. 3·6 cm) in the Murrah breed compared with the Nili-Ravi breed. Teats that had ‘other’ shapes and were longer, wider, and placed closer to the floor were more associated with SCM (P < 0·05). Mean SCC was significantly higher (P < 0·05) in Nili-Ravi buffaloes, teat shapes classified as ‘others’, and quarters with SCM. Teat morphometric traits seem to be associated with indicators of udder health in buffaloes, thus, their inclusion in breeding programmes for selection against undesirable dairy type traits may be of value in reducing susceptibility to intramammary infections in Indian buffaloes.
Fractals have unique properties such as self-similarity and space-filling. The use of fractal geometry in antenna design provides a good method for achieving the desired miniaturization, multi-band, and wideband properties. In this communication, novel fractal geometry is proposed based on which a multiband antenna is designed. The proposed antenna has fractal patches which are shaped as different iterations of an eight-pointed star. The multiband behavior is in the frequency range from 4.50 to 17.00 GHz. The proposed antenna is designed on a dielectric substrate Roggers RO4003 lossy with a dielectric constant of εr = 3.55. The antenna has applications in commercial and military communication system.
This is the first report on novel mushroom-type electromagnetic band gap (EBG) structures, consisting of fractal periodic elements, used for enhancing the gain of microstrip patch antennas. Using CST Microwave studio the performance of rectangular patch antenna has been examined on proposed fractal EBG substrates. It is found that fractal EBGs are more effective in suppressing surface wave thus resulting in higher gain. The gain of rectangular patch has been improved from 6.88 to 10.67 dBi. The proposed fractal EBG will open new avenues for the design and development of variety of high-frequency components and devices with enhanced performance.
Root traits, such as depth and root biomass, have been identified as the most promising plant traits in chickpea for terminal drought tolerance. With this objective, five contrasting genotypes of chickpea, viz. ICCV-4958, H-208, HC-5, RSG-931 and CSJ-379, having wide adaptability to drought prone areas at national level were assessed for various root characteristics under two environments, i.e. irrigated and rain-fed. The sampling was done at full bloom stage and there were significant differences in the rooting depth among the genotypes both under irrigated and rain-fed conditions. The chickpea roots penetrated to a minimum depth of 92 cm in CSJ-379 and maximum of 122 cm in ICCV-4958 under rain-fed conditions. The rooting depth remained higher under rain-fed than irrigated environment. Under irrigated conditions, the chickpea roots were able to grow to a maximum depth of 99 and 97 cm in HC-5 and ICCV-4958, respectively. Among the genotypes, biomass per plant of the root was higher in ICCV-4958 (6.7 g) and HC-5 (5.6 g) under rain-fed conditions. Similar observations were recorded for root/shoot ratio, dry weights of stem, leaf, nodules and total dry weight per plant. The moisture stress increased the biomass partitioning towards the roots. The water potential (ψw), osmotic potential (ψs) and relative water content (RWC %) of leaf were –0.98 MPa, –1.82 MPa and 60%, respectively, in the genotype HC-5, and –1.02 MPa, –1.72 MPa and 64%, respectively, in ICCV-4958 under rain-fed conditions. The rates of photosynthesis, and transpiration, values of the stomatal conductance and photochemical efficiency/quantum yield as indicated by Fv/Fm ratio were in the range of 6.7 to 10.6 (μmol m−2 s−1), 1.27 to 2.38 (mmol m−2 s−1), 0.23 to 0.48 (mol m−2 s−1) and 0.457 to 0.584, respectively, under rain-fed conditions. Genotypes HC-5 and ICCV-4958 also maintained higher photosynthetic and transpiration rates and Fv/Fm ratio than others. The maximum Fv/Fm values in these genotypes were correlated with the higher photosynthetic rate and dry matter yield per plant. Relative stress injury (RSI %) values in HC-5 and ICCV-4958 noticed were 25.3% and 23.7%, respectively. The results of this study indicate that under rain-fed conditions, genotypes ICCV-4958 and HC-5 had higher dry weight of stem, leaves, roots, nodules and total dry weight per plant, rooting depth, root/shoot ratio, photosynthetic and transpiration rates, photochemical efficiency and better plant water status but lower stomatal conductance than other genotypes. These traits are directly associated with maximum seed yield per plant, i.e. 15.6 g and 14.7 g per plant, respectively, in these genotypes. Therefore, both the genotypes in future can be used in crop improvement programme of chickpea breeding for drought tolerance.
We consider the problem of optimally allocating one/two active spares in series systems. Lifetimes of different configurations are compared with respect to the reversed failure rate order, the failure rate order, the increasing concave order, and the stochastic precedence order.
To enhance the performance of a system, a common practice employed by reliability engineers is to use redundant components in the system. In this paper we compare lifetimes of series (parallel) systems arising out of different allocations of one or two standby redundancies. These comparisons are made with respect to the increasing concave (convex) order, the hazard rate order, and the stochastic precedence order. The main results extend some related conclusions in the literature.
25-Hydroxy vitamin D (25(OH)D) deficiency is linked with predisposition to autoimmune type 1 diabetes and multiple sclerosis. Our objective was to assess the relationship between serum 25(OH)D levels and thyroid autoimmunity. Subjects included students, teachers and staff aged 16–60 years (total 642, 244 males, 398 females). Serum free thyroxine, thyroid-stimulating hormone (TSH), and thyroid peroxidase autoantibodies (TPOAb), intact parathyroid hormone and 25(OH)D were measured by electrochemiluminescence and RIA, respectively. Thyroid dysfunction was defined if (1) serum TSH ≥ 5 μU/ml and TPOAb>34 IU/ml or (2) TSH ≥ 10 μU/ml but normal TPOAb. The mean serum 25(OH)D of the study subjects was 17·5 (sd 10·2) nmol/l with 87 % having values ≤ 25 nmol/l. TPOAb positivity was observed in 21 % of subjects. The relationship between 25(OH)D and TPOAb was assessed with and without controlling for age and showed significant inverse correlation (r − 0·08, P = 0·04) when adjusted for age. The prevalence of TPOAb and thyroid dysfunction were comparable between subjects stratified according to serum 25(OH)D into two groups either at cut-off of ≤ 25 or >25 nmol/l or first and second tertiles. Serum 25(OH)D values show only weak inverse correlation with TPOAb titres. The presence of such weak association and narrow range of serum 25(OH)D did not allow us to interpret the present results in terms of quantitative cut-off values of serum 25(OH)D. Further studies in vitamin D-sufficient populations with wider range of serum 25(OH)D levels are required to substantiate the findings of the current study.
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