126 research outputs found
A New Finding of a Tethered Cord in a Patient with Okamoto Syndrome
No full textWe report a boy with Okamoto syndrome who presented to us at 11 years and 3 months of age with bladder dysfunction and gait difficulties suggestive of tethered cord syndrome (TCS). To date, TCS has yet to be reported in the history of individuals with this syndrome (Table 1). The patient subsequently underwent filum terminale sectioning with neuromonitoring for release of his cord. This surgery is relatively safe (Michelson and Ashwal, 2004), and this patient showed a reversal of his TCS symptoms at follow-up clinical visits.Peer reviewed
Mycoplasmal cerebral vasculopathy in a lymphoma patient: presumptive evidence of Mycoplasma pneumoniae microvascular endothelial cell invasion in a brain biopsy
No full textA 73-year-old man had episodic encephalopathy, ataxia and neuropathy. Symptoms largely resolved but adenopathy later lead to the diagnosis of a low-grade follicular lymphoma. The neurological symptoms soon recurred with new pontine calcifications identified by computed tomography. Brain biopsy revealed microvascular endothelial cell nuclear changes. Electron microscopy identified small polymorphic bacteria without a cell wall and with terminal and attachment organelles within endothelial cells and clustered in some microvascular lumina. Immunostaining was positive for Mycoplasma pneumoniae and convalescent serum enzyme immunoassay was positive for M. pneumoniae IgG. The patient again recovered and he was neurologically stable 33 months after the initial episode. The ultrastructural findings of the bacterial cells are distinctive of some mycoplasmal species when compared to other small bacteria. Mycoplasma-like organisms are reported in four autopsied patients who had chronic encephalopathy, movement disorders, and some of the same light- and electron-microscopic findings in the brain as our patient. Direct neuroinvasion by Mycoplasma species has been suggested, while anatomic observations in our patient and in the four autopsy cases show microvascular invasion but not parenchymal invasion. Most mycoplasmal encephalitis may be immune-mediated. The frequency of neurovascular invasion is not known. It may be rare and it may persist.Peer reviewed
Management of vagal nerve stimulator infections: do they need to be removed?
No full textOBJECT: Vagal nerve stimulators (VNSs) have been used successfully to treat medically refractory epilepsy. Although their efficacy is well established, appropriate management of infections is less clearly defined. In the authors' experience, patients who have gained a benefit from VNS implantation have been reluctant to have the device removed. The authors therefore sought conservative management options to salvage infected VNS systems.Peer reviewe
Occurrence and fate of aromaticity driven recalcitrance in anaerobic treatment of wastewater and organic solid wastes
No full textAromatic compounds such as aromatic amines (AAs) or lignocellulose biomass derivatives are often recalcitrant to biological processes (i.e., anaerobic digestion). The level of recalcitrance is usually explained by the biochemical structure of the compounds, which determines their removal. AAs are present in dye wastewaters mainly originated from textile industries and are considered carcinogenic and challenging pollutants to be removed from wastewater. The hydrolysis of lignin leads to the formation of some aromatic compounds, which could be recalcitrant at certain concentrations and operation conditions. Similarly, derivatives from sugar degradation such as furfurals and 5-hydroxymethylfurfural (HMF) from pentose and hexose degradation, respectively, have also been reported to be recalcitrant to anaerobic treatment. This chapter details the different forms of recalcitrance found and/or formed during wastewater and organic solid waste treatment, particularly in the anaerobic digestion process. Moreover, the possible strategies to mitigate the recalcitrance of these compounds are comprehensively explained.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Sanitary Engineerin
Untethering an unusual cause of kidney injury in a teenager with Down syndrome
No full textAcute kidney injury (AKI) is characterized by the acute nature and the inability of kidneys to maintain fluid homeostasis as well as adequate electrolyte and acid-base balance, resulting in an accumulation of nitrogenous waste and elevation of serum blood urea nitrogen and creatinine values. Acute kidney injury may be a single isolated event, yet oftentimes, it results from an acute chronic kidney disease. It is critical to seek out the etiology of AKI and to promptly manage the underlying chronic kidney disease to prevent comorbidities and mortality that may ensue. We described a case of a 16-year-old adolescent girl with Down syndrome who presented with AKI and electrolyte aberrance.Abdominal and renal ultrasounds demonstrated a significantly dilated bladder as well as frank hydronephrosis and hydroureter bilaterally. Foley catheter was successful in relieving the obstruction and improving her renal function. However, a magnetic resonance imaging was pursued in light of her chronic constipation and back pain, and it revealed a structural defect (tethered cord) that underlies a chronic process that was highly likely contributory to her AKI. She was managed accordingly with a guarded result and required long-term and close monitoring.Peer reviewed
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy
No full textBACKGROUND: Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment.
OBJECTIVE: To answer the question: “does physical therapy provide effective treatment for positional plagiocephaly?” Treatment recommendations are created based on the available evidence.
METHODS: The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III).
RESULTS: Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included.
CONCLUSION: Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.Peer reviewe
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Management of Patients With Positional Plagiocephaly: Executive Summary
No full textBACKGROUND: Positional plagiocephaly is a common problem seen by pediatricians, pediatric neurologists, and pediatric neurosurgeons.
OBJECTIVE: To create evidence-based guidelines for the treatment of pediatric positional plagiocephaly.
METHODS: This guideline was prepared by the Plagiocephaly Guideline Task Force, a multidisciplinary team made up of physician volunteers (clinical experts), medical librarians, and clinical guidelines specialists. The task force conducted a series of systematic literature searches of PubMed and the Cochrane Library, according to standard protocols for each topic addressed in subsequent chapters of this guideline.
RESULTS: The systematic literature searches returned 396 abstracts relative to the 4 main topics addressed in this guideline. The results were analyzed and are described in detail in each subsequent chapter included in this guideline.
CONCLUSION: Evidence-based guidelines for the management of infants with positional plagiocephaly will help practitioners manage this common disorder. The full guidelines documents can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly.Peer reviewed
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning
No full textBACKGROUND: Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation.
OBJECTIVE: To answer the question: “what is the evidence for the effectiveness of repositioning for positional plagiocephaly?” Treatment recommendations are provided based on the available evidence.
METHODS: The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III).
RESULTS: There were 3 randomized trials (Class I), 1 prospective cohort study (Class II), and 6 retrospective cohort studies (Class III). Repositioning education was found to be equal to a repositioning device and inferior to a physical therapy program. Five of the 7 cohort studies comparing repositioning with a helmet reported helmets to be better and take less time.
CONCLUSION: Within the limits of this systematic review, repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly. Most studies suggest that a molding helmet corrects asymmetry more rapidly and to a greater degree than repositioning education. In a Class I study, repositioning education was as effective as repositioning education in conjunction with a repositioning wrap/device. Another Class I study demonstrated that a bedding pillow was superior to physical therapy for some infants. However, in keeping with the American Academy of Pediatrics' warning against the use of soft positioning pillows in the sleeping environment, the Task Force recommends physical therapy over any positioning device. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3.Peer reviewe
D.H. Lawrence is the Harbinger of New Psycho Dynamics in the Modern Literature: Tyagi Pallavi
No full textThe psychodynamic model is founded on the ideas of Sigmund Freud. Freud’s writings have a greater influence on the development of psychology. Central to his approach is the assumption that biological drives and inborn instincts towards self-preservation direct behavior. Thus we are dominated by sexual and aggressive urges, catching the infant or young child in a crosscurrent. Though we are the mercy of our inherited urges and early parental training experiences, we survive by imposing rational control over these basic conflicts. Behavior that does not appear to make sense, or to be based on logic, is analyzed as a symptom of unconscious motives. According to psycho dynamic model, human nature is fully determined by heredity and early life experiences. In accordance of Freud’s belief, Lawrence as an author pours in his own unconscious into the characters and situations depicted in his works more specifically in his novels. Freudian interpretation of literature applied to Lawrence’s works becomes convincing and ingenious in explaining the “return of the repressed”. His novels besides portraying the psychology of characters are also taken as the conscious or ‘Overt’ interpretation of the ‘covert’ or the unconscious of the author himself. The critical analysis of the psycho dynamics revealing itself through abstract impulses, feelings, and instincts, mythical or materialistic symbols has been attempted in the present study
A Case Study on Pharmaceutical Sector: Indian Context
No full textThe Indian pharmaceutical sector has recorded a remarkable growth with tremendous scope of service offering and employment. The sector ranks as the third-largest pharmaceutical market globally by volume and 14th by value, playing a critical role in making healthcare accessible worldwide. With over 10,000 manufacturing units and more than 3,000 pharmaceutical companies, India is a major exporter of medicines, supplying over 200 countries, including highly regulated markets like the United States and the European Union. Additionally, India’s adherence to stringent global standards, such as those set by the U.S. Food and Drug Administration (FDA) and the World Health Organization’s Good Manufacturing Practices (WHO-GMP), has cemented its reputation as a reliable supplier of safe and effective pharmaceuticals. (www.ibef.org, 2024)
The Indian pharmaceutical firms have consistently prioritized quality, resulting in the production of affordable yet reliable medicines. India’s pharmaceutical sector is also experiencing a digital transformation, integrating cutting-edge technologies to enhance efficiency and patient care. This case study explores the Indian pharmaceutical sector, focusing on its current status, associated dilemmas, and strategies to address them. It provides insights into the dynamics of the industry within the Indian context, offering a practical understanding for students, business owners, and executives in the pharmaceutical sector. The case literature also contributes Teaching Notes at the end of the case for the case Instructors referring the case
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