BACKGROUND The interaction between the kidney and the thyroid is important for normal function of both organs.In nephrotic syndrome,proteinuria leads to loss of several proteins,which in turn causes hypothyroidism.AIM...BACKGROUND The interaction between the kidney and the thyroid is important for normal function of both organs.In nephrotic syndrome,proteinuria leads to loss of several proteins,which in turn causes hypothyroidism.AIM To assess the thyroid function in children with nephrotic syndrome.METHODS This cross-sectional study was conducted in a tertiary center,Bhopal,from February 2020 to January 2021.Consecutive children aged 1-15 years admitted with nephrotic syndrome(first-time diagnosed and all relapse cases)were included in the study.A thyroid profile was sent along with routine investigations,and thyroid hormone status was assessed in nephrotic syndrome children.RESULTS Of the 70 patients,39(55.7%)showed abnormal thyroid profiles;19(27.1%)had overt hypothyroidism,and 20(28.6%)had subclinical hypothyroidism.Overt hypothyroidism was seen in 16.1%of newly diagnosed cases,40%of second relapses,and 2.7%of frequently relapsed cases(P<0.001).The mean serum free T3 and free T4 levels in frequent relapses were 2.50±0.39 ng/dL and 0.78±0.12 ng/dL,respectively,which were significantly lower than in newly diagnosed cases(2.77±0.37 ng/dL and 0.91±0.19 ng/dL,respectively).The mean thyroidstimulating hormone(TSH)level was significantly higher in frequent relapses (5.86±1.56μIU/mL)and second relapse(5.81±1.78μIU/mL)than in newly diagnosed cases(4.83±0.76μIU/mL)and first relapse cases(4.74±1.17μIU/mL),(P<0.01).CONCLUSION An abnormal thyroid profile was commonly observed in children with nephrotic syndrome,and overt hypothyroidism was more common in frequent relapse cases.Therefore,thyroid screening should be a part of the management of nephrotic syndrome so that hypothyroidism can be detected and managed at an early stage.展开更多
This editorial discusses a case-control study by Ibrahim et al,published in the recent issue of the World Journal of Clinical Pediatrics.Childhood bronchial asthma is a chronic inflammatory respiratory disease.It was ...This editorial discusses a case-control study by Ibrahim et al,published in the recent issue of the World Journal of Clinical Pediatrics.Childhood bronchial asthma is a chronic inflammatory respiratory disease.It was found that an increase in oxidative stress leads to a decrease in antioxidants causing oxidative damage to mitochondrial respiratory chain complexes resulting in the inflammation of the airway,hypersecretion of mucus causing a cascade of clinical manifestations ranging from recurrent episodes of coughing,wheezing,and breathlessness to shortness of breath.Since oxidative stress mediates the inflammatory response in asthma,the supplementation of anti-oxidants can be one strategy to manage this disease.Zinc is one such antioxidant that has attracted much attention about asthma and airway inflammation.Zinc is a crucial trace element for human metabolism that helps to regulate gene expression,enzyme activity,and protein structure.Apart from zinc,free serum ferritin levels are also elevated in case of inflammation.Several previous studies found that ferritin levels may also help determine the pathology of disease and predict prognosis in addition to tracking disease activity.However,this study's results were different from the findings of the previous studies and the zinc levels did not show a significant difference between asthmatic children and non-asthmatic children but ferritin levels were significantly high in asthmatic children as compared to the controls.Hence,the possible role of the biochemical nutritional assessment including zinc and ferritin as biomarkers for asthma severity should be assessed in the future.展开更多
BACKGROUND Children with thalassemia need care from the first years of life owing to the physical and psychological effects of their disorder.Thalassemia is a concern not only for the children’s physical health but a...BACKGROUND Children with thalassemia need care from the first years of life owing to the physical and psychological effects of their disorder.Thalassemia is a concern not only for the children’s physical health but also the mental health of themselves and their caregivers.AIM To screen the psychosocial problems and assessment of psychiatric morbidities among thalassaemic children and their caretakers,along with an assessment of caregiver burden in them.METHODS In this observational cross-sectional study,children with transfusion-dependent thalassemia,were included and were assessed for psychiatric morbidity and global functioning.Their parents were assessed for psychiatric morbidity and the caregiver burden they faced.All the parents completed two different questionnaires to assess their knowledge about the psycho-social functioning[using Pediatric Symptom Checklist-35(PSC-35)]of their children and the level of the burden faced by them by Caregiver Burden Scale(CBS).RESULTS A total of 46 children(28 boys and 18 girls)with transfusion-dependent thalassemia with a mean age of 8.83±2.70 years and 46 parents(12 fathers and 34 mothers)were included in this study.More than 32 children had some psychosocial problems on screening by PSC-35.On assessment by CBS moderate caregiver burden was perceived in domains of general strain,isolation,disappointment,emotional involvement,and environment.A total of 65.3%of children and 62.7%of parents were diagnosed with psychiatric problems.CONCLUSION Thalassemia affects not only the persons with the disorder but also their caregivers in several aspects,including their psychosocial well-being.This study emphasizes the role of a supportive group in the psychological well-being of caregivers,which could be used to prevent the pathological effects of caregiver burden and enhance their psychological well-being through counselling.展开更多
Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also ...Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia;it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has brought fundamental changes to our problems and priorities,especially those related to the healthcare sector.India was one of the countries severely affect...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has brought fundamental changes to our problems and priorities,especially those related to the healthcare sector.India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.AIM To understand the challenges faced by the healthcare system during a pandemic.METHODS The literature search for this review was conducted using PubMed,EMBASE,Scopus,Web of Science,and Google Scholar.We also used Reference Citation Analysis(RCA)to search and improve the results.We focused on the published scientific articles concerned with two major vital areas:(1)The Indian healthcare system;and(2)COVID-19 pandemic effects on the Indian healthcare system.RESULTS The Indian healthcare system was suffering even before the pandemic.The pandemic has further stretched the healthcare services in India.The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases.Besides the pandemic measures,there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations.The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.CONCLUSION Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic.Re-establishment of primary healthcare services,maternal and child health services,noncommunicable diseases programs,National Tuberculosis Elimination Program,etc.are important to prevent serious long-term consequences of this pandemic.展开更多
We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the le...We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the lesion was suspected as low grade glioma.She was started on isoniazid,rifampicin,pyrazinamide,ethambutol and pyridoxine.She is asymptomatic and had no neurological deficits at follow up.展开更多
Spontaneous,non-surgical haematogenous Staphylococcus aureus meningitis is rare and associated with high mortality.Mixed infection causing meningitis(pyogenic and tubercular) is further rarer,poses a difficult diagnos...Spontaneous,non-surgical haematogenous Staphylococcus aureus meningitis is rare and associated with high mortality.Mixed infection causing meningitis(pyogenic and tubercular) is further rarer,poses a difficult diagnostic and management challenge,which warrants early diagnosis and aggressive therapy.We present a case of concurrent pyogenic and tubercular meningitis in a child managed successfully.It seems that in present case initial pyogenic infection resulted in the immunocompromised state for the child that would had lead to the activation of tubercular foci resulting in tubercular meningitis.展开更多
Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spect...Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spectrum of variations of clinical and radiological features of cerebral tuberculoma and highlight the controversies in the approach to diagnosis and management.展开更多
Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,adva...Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,advanced age,use of oral anticoagulants prior to the administration of fibrinolytic therapy,diastolic blood pressure (greater than 110 mm Hg),among others.Optimal medical management involves multidisciplinary roles of hematology,neurosurgery and critical medicine.In this illustrative case,a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.展开更多
Patients with primary or secondary tumors in the central nervous system may have seizures resulting from direct tissue damage,metabolic abnormalities,infection,or toxic side effects of medications.In pediatric patient...Patients with primary or secondary tumors in the central nervous system may have seizures resulting from direct tissue damage,metabolic abnormalities,infection,or toxic side effects of medications.In pediatric patients,it is more frequent to use drugs to control secondary epilepsy.In this article,we discuss the main nuances of antiepileptic drugs for the proper management of children with central nervous system tumors.展开更多
Traumatic brain injury (TBI) is the leading cause of death and neurological disability in young adults worldwide. This work aims to review the role of progesterone in traumatic brain injury and the usefulness as a pos...Traumatic brain injury (TBI) is the leading cause of death and neurological disability in young adults worldwide. This work aims to review the role of progesterone in traumatic brain injury and the usefulness as a possible treatment. We searched pubmed database (2000-2017) for articles containing 'progesterone and brain traumatic injury'. Basic science studies have advanced knowledge of the mechanisms of secondary brain injury, creating prospects for the medical and pharmacological management of TBI. Although several comparative studies evaluated both the efficacy and safety of several groups of drugs, in which, corticosteroids, tranexamic acid, βreceptor antagonists, erythropoiesis-stimulating agents, reductase inhibitorsinclude hydroxymethyl glutaryl-CoA inhibitors (statins), among others. Several studies even evaluated the role of progesterone in the treatment of TBI, which is providing growing evidence about its potential neuroprotective mechanisms during the acute phase of trauma. Despite recent advances in the field of management of TBI care in the emergency units, intensive care and the multiple trials for more than 20 years to find useful pharmacological treatments, most of these efforts failed in pre-clinical stages (II and III).展开更多
Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal co...Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal cord injury, spinal cord injury is still associated with a high morbidity and mortality. The involvement of the autonomic nervous system has implications in acute and chronic stages of the injured spinal cord patients. The most frequent cardiovascular complications in the acute phase of the traumatic spinal lesions are bradyarrhythmia, hypotension, increased vasovagal reflexes, ventricular and supraventricular ectopic beats, venous stasis, and vasodilation. In the chronic phase, we find orthostatic hypotension, alteration of the arterial pressure and the regulation of the body temperature as well as alteration of the blood volume. The knowledge of the cardiovascular alterations is of vital importance for the management and rehabilitation of the patients with spinal cord injury. In this article, we present a critical review of medical literature.展开更多
Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma ...Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.展开更多
INTRODUCTION In the absence of other intracranial tuberculomas or systemic manifestation of tuberculosis isolated brainstem tuberculoma is a rare entity,that accounts for 6%of all brain stem masses in endemic areas. T...INTRODUCTION In the absence of other intracranial tuberculomas or systemic manifestation of tuberculosis isolated brainstem tuberculoma is a rare entity,that accounts for 6%of all brain stem masses in endemic areas. The occurrence of these lesions is further rarer in the immunocompetent adults.We discuss the findings of ring enhancing lesion of the brain stem where based on imaging findings we treated empirically with anti-tuberculous therapy with excellent outcome.展开更多
Dielectric metasurfaces,composed of planar arrays of subwavelength dielectric structures that collectively mimic the operation of conventional bulk optical elements,have revolutionized the field of optics by their pot...Dielectric metasurfaces,composed of planar arrays of subwavelength dielectric structures that collectively mimic the operation of conventional bulk optical elements,have revolutionized the field of optics by their potential in constructing high-efficiency and multi-functional optoelectronic systems on chip.The performance of a dielectric metasurface is largely determined by its constituent material,which is highly desired to have a high refractive index,low optical loss and wide bandgap,and at the same time,be fabrication friendly.Here,we present a new material platform based on tantalum pentoxide(Ta2O5)for implementing high-performance dielectric metasurface optics over the ultraviolet and visible spectral region.This wide-bandgap dielectric,exhibiting a high refractive index exceeding 2.1 and negligible extinction coefficient across a broad spectrum,can be easily deposited over large areas with good quality using straightforward physical vapor deposition,and patterned into high-aspect-ratio subwavelength nanostructures through commonly-available fluorine-gas-based reactive ion etching.We implement a series of highefficiency ultraviolet and visible metasurfaces with representative light-field modulation functionalities including polarization-independent high-numerical-aperture lensing,spin-selective hologram projection,and vivid structural color generation,and the devices exhibit operational efficiencies up to 80%.Our work overcomes limitations faced by scalability of commonly-employed metasurface dielectrics and their operation into the visible and ultraviolet spectral range,and provides a novel route towards realization of high-performance,robust and foundry-manufacturable metasurface optics.展开更多
The commercialization of atomic technologies requires replacing laboratory-scale laser setups with compact and manufacturable optical platforms.Complex arrangements of free-space beams can be generated on chip through...The commercialization of atomic technologies requires replacing laboratory-scale laser setups with compact and manufacturable optical platforms.Complex arrangements of free-space beams can be generated on chip through a combination of integrated photonics and metasurface optics.In this work,we combine these two technologies using flip-chip bonding and demonstrate an integrated optical architecture for realizing a compact strontium atomic clock.Our planar design includes twelve beams in two co-aligned magneto-optical traps.These beams are directed above the chip to intersect at a central location with diameters as large as 1 cm.Our design also includes two co-propagating beams at lattice and clock wavelengths.These beams emit collinearly and vertically to probe the center of the magneto-optical trap,where they will have diameters of≈100μm.With these devices we demonstrate that our integrated photonic platform is scalable to an arbitrary number of beams,each with different wavelengths,geometries,and polarizations.展开更多
Shrinking conventional optical systems to chip-scale dimensions will benefit custom applications in imaging,displaying,sensing,spectroscopy,and metrology.Towards this goal,metasurfaces-planar arrays of subwavelength e...Shrinking conventional optical systems to chip-scale dimensions will benefit custom applications in imaging,displaying,sensing,spectroscopy,and metrology.Towards this goal,metasurfaces-planar arrays of subwavelength electromagnetic structures that collectively mimic the functionality of thicker conventional optical elements-have been exploited at frequencies ranging from the microwave range up to the visible range.Here,we demonstrate highperformance metasurface optical components that operate at ultraviolet wavelengths,including wavelengths down to the record-short deep ultraviolet range,and perform representative wavefront shaping functions,namely,highnumerical-aperture lensing,accelerating beam generation,and hologram projection.The constituent nanostructured elements of the metasurfaces are formed of hafnium oxide-a loss-less,high-refractive-index dielectric material deposited using low-temperature atomic layer deposition and patterned using high-aspect-ratio Damascene lithography.This study opens the way towards low-form factor,multifunctional ultraviolet nanophotonic platforms based on flat optical components,enabling diverse applications including lithography,imaging,spectroscopy,and quantum information processing.展开更多
Monochromatic light can be characterized by its three fun dame ntal properties:amplitude,phase,and polarization.In this work,we propose a versatile,transmission-mode all-dielectric metasurface platform that can indepe...Monochromatic light can be characterized by its three fun dame ntal properties:amplitude,phase,and polarization.In this work,we propose a versatile,transmission-mode all-dielectric metasurface platform that can independently manipulate the phase and amplitude for two orthogonal states of polarization in the visible frequency range.For proof-o仁concept experimental demonstration,various single-layer metasurfaces composed of subwavelength-spaced titanium-dioxide nanopillars are designed,fabricated,and characterized to exhibit the ability of polarization-switchable multidimensional light-field manipulation,including polarization-switchable grayscale nanoprinting,nonuniform cylindrical lensing,and complex-amplitude holography.We envision the metasurface platform dem on strated here to open new possibilities toward creating compact multifunctional optical devices for applications in polarization optics,information encoding,optical data storage,and security.展开更多
Sentinel lymph node biopsy has become a well-established and commonplace prac-tice in many oncologic disease sites as a means to stage the regional lymphatics, avoid unnec-essary surgery and decrease patient morbidity...Sentinel lymph node biopsy has become a well-established and commonplace prac-tice in many oncologic disease sites as a means to stage the regional lymphatics, avoid unnec-essary surgery and decrease patient morbidity. In the head and neck, its role is well established for cutaneous melanoma with proven fidelity and survival benefit. Its role in use for other sites such as oral cavity carcinoma continues to develop with promising results from several recent trials. Although not widely adopted, the potential benefits of sentinel lymph node biopsy in the management of oral cavity carcinoma are apparent. Refinements in tech-nology and protocols including development of novel radiopharmaceutical tracers, routine incorporation of detailed anatomic imaging, increasing surgeon experience and development of new intraoperative identification aids will likely lead to improvements in the use and accu-racy of this technique. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
Background:Giant colloid cysts (size>3 cm) are very rare with only few reported cases in the literature. Case presentation:We report a case of 44 year female who presented with features of raised intracranial pres...Background:Giant colloid cysts (size>3 cm) are very rare with only few reported cases in the literature. Case presentation:We report a case of 44 year female who presented with features of raised intracranial pressure, memory and gait disturbances. CT and MR imaging showed a large colloid cyst at foramen of Monro leading to obstructive hydrocephalus. The patient underwent right interhemispheric transcallosal-transforaminal approach and complete excision of the cyst. Conclusions:For a large size of colloid cyst complete surgical excision is recommended. However deep midline location, proximity to the vital structures and giant size of the lesions make surrounding vital structures vulnerable for injury.展开更多
文摘BACKGROUND The interaction between the kidney and the thyroid is important for normal function of both organs.In nephrotic syndrome,proteinuria leads to loss of several proteins,which in turn causes hypothyroidism.AIM To assess the thyroid function in children with nephrotic syndrome.METHODS This cross-sectional study was conducted in a tertiary center,Bhopal,from February 2020 to January 2021.Consecutive children aged 1-15 years admitted with nephrotic syndrome(first-time diagnosed and all relapse cases)were included in the study.A thyroid profile was sent along with routine investigations,and thyroid hormone status was assessed in nephrotic syndrome children.RESULTS Of the 70 patients,39(55.7%)showed abnormal thyroid profiles;19(27.1%)had overt hypothyroidism,and 20(28.6%)had subclinical hypothyroidism.Overt hypothyroidism was seen in 16.1%of newly diagnosed cases,40%of second relapses,and 2.7%of frequently relapsed cases(P<0.001).The mean serum free T3 and free T4 levels in frequent relapses were 2.50±0.39 ng/dL and 0.78±0.12 ng/dL,respectively,which were significantly lower than in newly diagnosed cases(2.77±0.37 ng/dL and 0.91±0.19 ng/dL,respectively).The mean thyroidstimulating hormone(TSH)level was significantly higher in frequent relapses (5.86±1.56μIU/mL)and second relapse(5.81±1.78μIU/mL)than in newly diagnosed cases(4.83±0.76μIU/mL)and first relapse cases(4.74±1.17μIU/mL),(P<0.01).CONCLUSION An abnormal thyroid profile was commonly observed in children with nephrotic syndrome,and overt hypothyroidism was more common in frequent relapse cases.Therefore,thyroid screening should be a part of the management of nephrotic syndrome so that hypothyroidism can be detected and managed at an early stage.
文摘This editorial discusses a case-control study by Ibrahim et al,published in the recent issue of the World Journal of Clinical Pediatrics.Childhood bronchial asthma is a chronic inflammatory respiratory disease.It was found that an increase in oxidative stress leads to a decrease in antioxidants causing oxidative damage to mitochondrial respiratory chain complexes resulting in the inflammation of the airway,hypersecretion of mucus causing a cascade of clinical manifestations ranging from recurrent episodes of coughing,wheezing,and breathlessness to shortness of breath.Since oxidative stress mediates the inflammatory response in asthma,the supplementation of anti-oxidants can be one strategy to manage this disease.Zinc is one such antioxidant that has attracted much attention about asthma and airway inflammation.Zinc is a crucial trace element for human metabolism that helps to regulate gene expression,enzyme activity,and protein structure.Apart from zinc,free serum ferritin levels are also elevated in case of inflammation.Several previous studies found that ferritin levels may also help determine the pathology of disease and predict prognosis in addition to tracking disease activity.However,this study's results were different from the findings of the previous studies and the zinc levels did not show a significant difference between asthmatic children and non-asthmatic children but ferritin levels were significantly high in asthmatic children as compared to the controls.Hence,the possible role of the biochemical nutritional assessment including zinc and ferritin as biomarkers for asthma severity should be assessed in the future.
文摘BACKGROUND Children with thalassemia need care from the first years of life owing to the physical and psychological effects of their disorder.Thalassemia is a concern not only for the children’s physical health but also the mental health of themselves and their caregivers.AIM To screen the psychosocial problems and assessment of psychiatric morbidities among thalassaemic children and their caretakers,along with an assessment of caregiver burden in them.METHODS In this observational cross-sectional study,children with transfusion-dependent thalassemia,were included and were assessed for psychiatric morbidity and global functioning.Their parents were assessed for psychiatric morbidity and the caregiver burden they faced.All the parents completed two different questionnaires to assess their knowledge about the psycho-social functioning[using Pediatric Symptom Checklist-35(PSC-35)]of their children and the level of the burden faced by them by Caregiver Burden Scale(CBS).RESULTS A total of 46 children(28 boys and 18 girls)with transfusion-dependent thalassemia with a mean age of 8.83±2.70 years and 46 parents(12 fathers and 34 mothers)were included in this study.More than 32 children had some psychosocial problems on screening by PSC-35.On assessment by CBS moderate caregiver burden was perceived in domains of general strain,isolation,disappointment,emotional involvement,and environment.A total of 65.3%of children and 62.7%of parents were diagnosed with psychiatric problems.CONCLUSION Thalassemia affects not only the persons with the disorder but also their caregivers in several aspects,including their psychosocial well-being.This study emphasizes the role of a supportive group in the psychological well-being of caregivers,which could be used to prevent the pathological effects of caregiver burden and enhance their psychological well-being through counselling.
文摘Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia;it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has brought fundamental changes to our problems and priorities,especially those related to the healthcare sector.India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.AIM To understand the challenges faced by the healthcare system during a pandemic.METHODS The literature search for this review was conducted using PubMed,EMBASE,Scopus,Web of Science,and Google Scholar.We also used Reference Citation Analysis(RCA)to search and improve the results.We focused on the published scientific articles concerned with two major vital areas:(1)The Indian healthcare system;and(2)COVID-19 pandemic effects on the Indian healthcare system.RESULTS The Indian healthcare system was suffering even before the pandemic.The pandemic has further stretched the healthcare services in India.The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases.Besides the pandemic measures,there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations.The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.CONCLUSION Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic.Re-establishment of primary healthcare services,maternal and child health services,noncommunicable diseases programs,National Tuberculosis Elimination Program,etc.are important to prevent serious long-term consequences of this pandemic.
文摘We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the lesion was suspected as low grade glioma.She was started on isoniazid,rifampicin,pyrazinamide,ethambutol and pyridoxine.She is asymptomatic and had no neurological deficits at follow up.
文摘Spontaneous,non-surgical haematogenous Staphylococcus aureus meningitis is rare and associated with high mortality.Mixed infection causing meningitis(pyogenic and tubercular) is further rarer,poses a difficult diagnostic and management challenge,which warrants early diagnosis and aggressive therapy.We present a case of concurrent pyogenic and tubercular meningitis in a child managed successfully.It seems that in present case initial pyogenic infection resulted in the immunocompromised state for the child that would had lead to the activation of tubercular foci resulting in tubercular meningitis.
文摘Central nervous system tuberculosis can have protean manifestations.We review the clinical and radiological findings in two cases of cerebral tuberculoma in immuoncompetent patients.These two cases represent the spectrum of variations of clinical and radiological features of cerebral tuberculoma and highlight the controversies in the approach to diagnosis and management.
文摘Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,advanced age,use of oral anticoagulants prior to the administration of fibrinolytic therapy,diastolic blood pressure (greater than 110 mm Hg),among others.Optimal medical management involves multidisciplinary roles of hematology,neurosurgery and critical medicine.In this illustrative case,a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.
文摘Patients with primary or secondary tumors in the central nervous system may have seizures resulting from direct tissue damage,metabolic abnormalities,infection,or toxic side effects of medications.In pediatric patients,it is more frequent to use drugs to control secondary epilepsy.In this article,we discuss the main nuances of antiepileptic drugs for the proper management of children with central nervous system tumors.
文摘Traumatic brain injury (TBI) is the leading cause of death and neurological disability in young adults worldwide. This work aims to review the role of progesterone in traumatic brain injury and the usefulness as a possible treatment. We searched pubmed database (2000-2017) for articles containing 'progesterone and brain traumatic injury'. Basic science studies have advanced knowledge of the mechanisms of secondary brain injury, creating prospects for the medical and pharmacological management of TBI. Although several comparative studies evaluated both the efficacy and safety of several groups of drugs, in which, corticosteroids, tranexamic acid, βreceptor antagonists, erythropoiesis-stimulating agents, reductase inhibitorsinclude hydroxymethyl glutaryl-CoA inhibitors (statins), among others. Several studies even evaluated the role of progesterone in the treatment of TBI, which is providing growing evidence about its potential neuroprotective mechanisms during the acute phase of trauma. Despite recent advances in the field of management of TBI care in the emergency units, intensive care and the multiple trials for more than 20 years to find useful pharmacological treatments, most of these efforts failed in pre-clinical stages (II and III).
文摘Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal cord injury, spinal cord injury is still associated with a high morbidity and mortality. The involvement of the autonomic nervous system has implications in acute and chronic stages of the injured spinal cord patients. The most frequent cardiovascular complications in the acute phase of the traumatic spinal lesions are bradyarrhythmia, hypotension, increased vasovagal reflexes, ventricular and supraventricular ectopic beats, venous stasis, and vasodilation. In the chronic phase, we find orthostatic hypotension, alteration of the arterial pressure and the regulation of the body temperature as well as alteration of the blood volume. The knowledge of the cardiovascular alterations is of vital importance for the management and rehabilitation of the patients with spinal cord injury. In this article, we present a critical review of medical literature.
文摘Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.
文摘INTRODUCTION In the absence of other intracranial tuberculomas or systemic manifestation of tuberculosis isolated brainstem tuberculoma is a rare entity,that accounts for 6%of all brain stem masses in endemic areas. The occurrence of these lesions is further rarer in the immunocompetent adults.We discuss the findings of ring enhancing lesion of the brain stem where based on imaging findings we treated empirically with anti-tuberculous therapy with excellent outcome.
基金the National Institute of Standards and Technology(NIST)Physical Measurement Laboratory,Award No.70NANB14H209,through the University of Maryland.O.K.was supported by an appointment to the Intelligence Community Postdoctoral Research Fellowship Program at NIST administered by Oak Ridge Institute for Science and Education(ORISE)through an interagency agreement between the U.S.Department of Energy and the Office of the Director of National Intelligence(ODNI).
文摘Dielectric metasurfaces,composed of planar arrays of subwavelength dielectric structures that collectively mimic the operation of conventional bulk optical elements,have revolutionized the field of optics by their potential in constructing high-efficiency and multi-functional optoelectronic systems on chip.The performance of a dielectric metasurface is largely determined by its constituent material,which is highly desired to have a high refractive index,low optical loss and wide bandgap,and at the same time,be fabrication friendly.Here,we present a new material platform based on tantalum pentoxide(Ta2O5)for implementing high-performance dielectric metasurface optics over the ultraviolet and visible spectral region.This wide-bandgap dielectric,exhibiting a high refractive index exceeding 2.1 and negligible extinction coefficient across a broad spectrum,can be easily deposited over large areas with good quality using straightforward physical vapor deposition,and patterned into high-aspect-ratio subwavelength nanostructures through commonly-available fluorine-gas-based reactive ion etching.We implement a series of highefficiency ultraviolet and visible metasurfaces with representative light-field modulation functionalities including polarization-independent high-numerical-aperture lensing,spin-selective hologram projection,and vivid structural color generation,and the devices exhibit operational efficiencies up to 80%.Our work overcomes limitations faced by scalability of commonly-employed metasurface dielectrics and their operation into the visible and ultraviolet spectral range,and provides a novel route towards realization of high-performance,robust and foundry-manufacturable metasurface optics.
文摘The commercialization of atomic technologies requires replacing laboratory-scale laser setups with compact and manufacturable optical platforms.Complex arrangements of free-space beams can be generated on chip through a combination of integrated photonics and metasurface optics.In this work,we combine these two technologies using flip-chip bonding and demonstrate an integrated optical architecture for realizing a compact strontium atomic clock.Our planar design includes twelve beams in two co-aligned magneto-optical traps.These beams are directed above the chip to intersect at a central location with diameters as large as 1 cm.Our design also includes two co-propagating beams at lattice and clock wavelengths.These beams emit collinearly and vertically to probe the center of the magneto-optical trap,where they will have diameters of≈100μm.With these devices we demonstrate that our integrated photonic platform is scalable to an arbitrary number of beams,each with different wavelengths,geometries,and polarizations.
基金support from The National Key R&D Program of China(Grant Nos.2017YFA0303700 and 2016YFA0202100)the National Science Foundation of China(Grant No.11774163)+1 种基金support under the Cooperative Research Agreement between the University of Maryland and the National Institute of Standards and Technology(NIST)Physical Measurement Laboratory,Award No.70NANB14H209funding from Huazhong University of Science and Technology.
文摘Shrinking conventional optical systems to chip-scale dimensions will benefit custom applications in imaging,displaying,sensing,spectroscopy,and metrology.Towards this goal,metasurfaces-planar arrays of subwavelength electromagnetic structures that collectively mimic the functionality of thicker conventional optical elements-have been exploited at frequencies ranging from the microwave range up to the visible range.Here,we demonstrate highperformance metasurface optical components that operate at ultraviolet wavelengths,including wavelengths down to the record-short deep ultraviolet range,and perform representative wavefront shaping functions,namely,highnumerical-aperture lensing,accelerating beam generation,and hologram projection.The constituent nanostructured elements of the metasurfaces are formed of hafnium oxide-a loss-less,high-refractive-index dielectric material deposited using low-temperature atomic layer deposition and patterned using high-aspect-ratio Damascene lithography.This study opens the way towards low-form factor,multifunctional ultraviolet nanophotonic platforms based on flat optical components,enabling diverse applications including lithography,imaging,spectroscopy,and quantum information processing.
基金the Key Research and Development Program from Ministry of Science and Technology of China(2017YFA0303700 and 2016YFA0202100)National Natural Science Foundation of China(11774163)+1 种基金Fundamental Research Funds for the Central Universities(0213-14380194).M.L.and T.Xu ack no wledge tech nical support from micro-fabricati on and in teg rati on technology center from Nanji ng Un iversity.W.Z.L.C.and A.A.acknowledge support under the Cooperative Research Agreement between the University of Maryland and the National Institute of Standards and Technology,Award#70-NANB14H209,through the University of Maryland.M.L.,W.Z.and P.H.contributed equally to this work.
文摘Monochromatic light can be characterized by its three fun dame ntal properties:amplitude,phase,and polarization.In this work,we propose a versatile,transmission-mode all-dielectric metasurface platform that can independently manipulate the phase and amplitude for two orthogonal states of polarization in the visible frequency range.For proof-o仁concept experimental demonstration,various single-layer metasurfaces composed of subwavelength-spaced titanium-dioxide nanopillars are designed,fabricated,and characterized to exhibit the ability of polarization-switchable multidimensional light-field manipulation,including polarization-switchable grayscale nanoprinting,nonuniform cylindrical lensing,and complex-amplitude holography.We envision the metasurface platform dem on strated here to open new possibilities toward creating compact multifunctional optical devices for applications in polarization optics,information encoding,optical data storage,and security.
文摘Sentinel lymph node biopsy has become a well-established and commonplace prac-tice in many oncologic disease sites as a means to stage the regional lymphatics, avoid unnec-essary surgery and decrease patient morbidity. In the head and neck, its role is well established for cutaneous melanoma with proven fidelity and survival benefit. Its role in use for other sites such as oral cavity carcinoma continues to develop with promising results from several recent trials. Although not widely adopted, the potential benefits of sentinel lymph node biopsy in the management of oral cavity carcinoma are apparent. Refinements in tech-nology and protocols including development of novel radiopharmaceutical tracers, routine incorporation of detailed anatomic imaging, increasing surgeon experience and development of new intraoperative identification aids will likely lead to improvements in the use and accu-racy of this technique. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
文摘Background:Giant colloid cysts (size>3 cm) are very rare with only few reported cases in the literature. Case presentation:We report a case of 44 year female who presented with features of raised intracranial pressure, memory and gait disturbances. CT and MR imaging showed a large colloid cyst at foramen of Monro leading to obstructive hydrocephalus. The patient underwent right interhemispheric transcallosal-transforaminal approach and complete excision of the cyst. Conclusions:For a large size of colloid cyst complete surgical excision is recommended. However deep midline location, proximity to the vital structures and giant size of the lesions make surrounding vital structures vulnerable for injury.
