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We report fulminant hepatic failure, an extremely rare manifestation of scrub typhus, in a young male who presented with a brief history of fever, jaundice and altered sensorium

We report on high efficiency InGaN nanowire‐based micro and nanoscale light emitting diodes (LEDs). We show that record‐ high efficiency and highly directional emissions can be achieved with red and green submicron nanowire micro‐LEDs. Such LEDs are critical for augmented reality displays which require both efficiency and high optical throughput. [ABSTRACT FROM AUTHOR]

Four cladoceran species of importance as fish food organisms, viz. Daphnia similis (Claus), Simocephalus vetulus (Schodler), Moina macrocopa (Straus) and Ceriodaphnia cornuta (Sars), were raised in the laboratory on nutrient sources including manures, rice bran and Chlorella. The organisms responded better with rice bran and Chlorella. The productivity of culture organisms appeared to depend upon inoculum and residual densities, indicating a relationship between periodic harvesting and increased production. Associated study reveals the importance of space per individual in the success of laboratory cultures. The optimum space requirement of each species determined by the size of culture organism may vary from 4·5cm³ per individual for small species like Ceriodaphnia to 41·8 cm³ per individual for the larger species, Daphnia. [ABSTRACT FROM AUTHOR]

A case report of solitary lymphocytoma cutis of the nose and its treatment in a 35-year-old woman is presented. Biopsy is necessary in establishing a definitive diagnosis as lymphocytoma cutis is commonly confused with other cutaneous lesions. A possible pathogenesis is discussed. [ABSTRACT FROM AUTHOR]

An electronic search was performed of the electronic patient record (EPR) system to identify whether each of 13 key interventions recommended by the British HIV Association (BHIVA) had been performed for all eligible patients attending in 2009 and 2010 at one of our HIV clinics: 345 and 358 eligible HIV-positive patients were identified in 2009 and 2010, respectively. The success rates for having completed each intervention in 2009 and 2010, respectively, were all better for 2010 and none was <94%. These improved results in 2010 over those of 2009 could be attributed to the clinicians' improved experience in using the checklist and the facility of EPR to provide flagged reminders. [ABSTRACT FROM AUTHOR]

A case of scleredema adultorum is reported. Systemic corticosteroids administration resulted in a rapid resolution of the indurated area. [ABSTRACT FROM AUTHOR]

This review provides a comprehensive analysis of AlphaFold (AF) and its derivatives (AF2 and AF3) in protein structure prediction. These tools have revolutionized structural biology with their highly accurate predictions, driving progress in protein modeling, drug discovery, and the study of protein dynamics. Its exceptional accuracy has redefined our understanding of protein folding, which enables groundbreaking advancements in protein design, disease research and discusses future integration with experimental techniques. In addition, their achievement features, architectures, important case studies, and noteworthy effects in the field of biology and medicine were evaluated. In consideration of the fact that AF2 is a relatively recent innovation, it has already been taken into account in many studies that highlight its applications in many ways. Moreover, the limitations of AF2 that directed to the introduction of AF3 are also reported, which is a great improvement as it provides precise predictions of the structures and interactions of proteins, DNA, RNA, and ligands, thereby aiding in the understanding of the molecular level. Addressing current challenges and forecasting future developments, this work underscores the lasting significance of AF in reshaping the scientific landscape of protein research., Competing Interests: Declaration of competing interest No any authors declare conflict of interest., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Purpose: Merozoites are the only extracellular form of blood stage parasites, making it a worthwhile target. Multiple invasins that are stored in the merozoite apical organelles, are secreted just prior to invasion, and mediates its interaction with RBC. A comprehensive identification of all these secreted invasins is lacking and this study addresses that gap., Experimental Design: Pf3D7 merozoites were enriched and triggered to discharge apical organelle contents by exposure to ionic conditions mimicking that of blood plasma. The secreted proteins were separated from cellular contents and both the fractions were subjected to proteomic analysis. Also, the identified secreted proteins were subjected to GO, PPI network analysis, and AI-based in silico approach to understand their vaccine candidacy., Results: A total of 63 proteins were identified in the secretory fraction with membrane and apical organellar localization. This includes various MSPs, micronemal EBAs and rhoptry bulb proteins, which play a crucial role in initial and late merozoite attachment, and majority of them qualified as vaccine candidates., Conclusion and Clinical Relevance: We, for the first time, report the secretory repertoire of merozoite and its status for vaccine candidacy. This information can be utilized to develop better invasion blocking multisubunit vaccines, comprising of immunological epitopes from several secreted invasins., (© 2024 Wiley‐VCH GmbH.)

III-nitride-based micro-light-emitting diodes (micro-LEDs) are currently under rapid development for next-generation high-resolution and high-brightness displays and augmented/virtual reality (AR/VR) technologies. However, it remains elusive to achieve red-emitting III-nitride micro-LEDs with a microscale size, high efficiency, and high spectral stability, posing significant impediments to the development of full-color micro-LEDs. In this work, through detailed strain engineering and control of charge carrier transport, we achieved pure red emission (≥620 nm) micro-LEDs over 2 orders of magnitude of injection current variation. We show both theoretically and experimentally that the combination of a short-period InGaN/GaN superlattice and a thick n-type GaN interlayer can not only relieve the quantum-confined Stark effect in the active region but also suppress parasitic emission from the superlattice. The optimized deep red micro-LEDs with a device lateral dimension of ∼1 μm feature a maximal external quantum efficiency of over 3% emitting at ∼660 nm.

Background: Coronary artery disease (CAD), the leading cause of death worldwide, is influenced by both environmental and genetic factors. Although over 250 genetic risk loci have been identified through genome-wide association studies, the specific causal variants and their regulatory mechanisms are still largely unknown, particularly in disease-relevant cell types such as macrophages., Methods: We utilized single-cell RNA-seq and single-cell multiomics approaches in primary human monocyte-derived macrophages to explore the transcriptional regulatory network involved in a critical pathogenic event of coronary atherosclerosis-the formation of lipid-laden foam cells. The relative genetic contribution to CAD was assessed by partitioning disease heritability across different macrophage subpopulations. Meta-analysis of single-cell RNA-seq data sets from 38 human atherosclerotic samples was conducted to provide high-resolution cross-referencing to macrophage subpopulations in vivo., Results: We identified 18 782 cis-regulatory elements by jointly profiling the gene expression and chromatin accessibility of >5000 macrophages. Integration with CAD genome-wide association study data prioritized 121 CAD-related genetic variants and 56 candidate causal genes. We showed that CAD heritability was not uniformly distributed and was particularly enriched in the gene programs of a novel CD52-hi lipid-handling macrophage subpopulation. These CD52-hi macrophages displayed significantly less lipoprotein accumulation and were also found in human atherosclerotic plaques. We investigated the cis-regulatory effect of a risk variant rs10488763 on FDX1 , implicating the recruitment of AP-1 and C/EBP-β in the causal mechanisms at this locus., Conclusions: Our results provide genetic evidence of the divergent roles of macrophage subsets in atherogenesis and highlight lipid-handling macrophages as a key subpopulation through which genetic variants operate to influence disease. These findings provide an unbiased framework for functional fine-mapping of genome-wide association study results using single-cell multiomics and offer new insights into the genotype-environment interactions underlying atherosclerotic disease., Competing Interests: Disclosures None.

The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care, published in 2023, highlights key components of a Neonatal Patient Safety and Quality Improvement Program (NPSQIP). A comprehensive Neonatal Intensive Care Unit (NICU) quality and safety infrastructure (QSI) is based on four foundational domains: quality improvement, quality assurance, safety culture, and clinical guidelines. This paper serves as an operational guide for NICU clinical leaders and quality champions to navigate these domains and develop their local QSI to include the AAP NPSQIP standards., Competing Interests: Disclosure The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2024. Published by Elsevier Inc.)

Prescription opioids are the gold standard for treating moderate to severe pain despite their well-documented adverse effects. Of all prescription medications, opioids are abused most widely, and fatal overdoses have reached epidemic levels. One strategy for improving the margin of safety of opioids is combining them with non-opioid drugs to decrease the opioid dose needed for pain relief, thereby reducing adverse effects that occur with larger doses. The N-methyl-D-aspartate receptor antagonist ketamine has been used safely as an analgesic but only under a very limited range of conditions. The current studies characterized the antinociceptive, behavioral suppressant, and gastrointestinal effects of morphine and ketamine alone and in mixtures to determine their interaction in 24 adult male Sprague-Dawley rats (n = 8 per assay). Given alone, both morphine and ketamine produced antinociception, decreased responding for food, and reduced gastrointestinal transit (i.e. produced constipation). The effects of morphine:ketamine mixtures generally were additive, except for the antinociceptive effects of 1:1 mixtures for which the difference in slope (i.e. non-parallel shift) between the observed and predicted effects suggested synergy at smaller doses and additivity at larger doses. The potency of morphine to produce constipation was not enhanced by administration of morphine:ketamine mixtures with antinociceptive effects. The nature of the interaction between morphine and ketamine for adverse effects such as dependence, withdrawal, abuse, or respiratory depression remains unknown but also might be related to the ratio of each drug in mixtures. It will be important to identify conditions that produce the largest potential therapeutic window in humans., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

High efficiency micro-LEDs, with lateral dimensions as small as one micrometer, are desired for next-generation displays, virtual/augmented reality, and ultrahigh-speed optical interconnects. The efficiency of quantum well LEDs, however, is reduced to negligibly small values when scaled to such small dimensions. Here, we show such a fundamental challenge can be overcome by developing nanowire excitonic LEDs. Harnessing the large exciton oscillator strength of quantum-confined nanostructures, we demonstrate a submicron scale green-emitting LED having an external quantum efficiency and wall-plug efficiency of 25.2% and 20.7%, respectively, the highest values reported for any LEDs of this size to our knowledge. We established critical factors for achieving excitonic micro-LEDs, including the epitaxy of nanostructures to achieve strain relaxation, the utilization of semipolar planes to minimize polarization effects, and the formation of nanoscale quantum-confinement to enhance electron-hole wave function overlap. This work provides a viable path to break the efficiency bottleneck of nanoscale optoelectronics.

Micro or submicron scale light-emitting diodes (µLEDs) have been extensively studied recently as the next-generation display technology. It is desired that µLEDs exhibit high stability and efficiency, submicron pixel size, and potential monolithic integration with Si-based complementary metal-oxide-semiconductor (CMOS) electronics. Achieving such µLEDs, however, has remained a daunting challenge. The polar nature of III-nitrides causes severe wavelength/color instability with varying carrier concentrations in the active region. The etching-induced surface damages and poor material quality of high indium composition InGaN quantum wells (QWs) severely deteriorate the performance of µLEDs, particularly those emitting in the green/red wavelength. Here we report, for the first time, µLEDs grown directly on Si with submicron lateral dimensions. The µLEDs feature ultra-stable, bright green emission with negligible quantum-confined Stark effect (QCSE). Detailed elemental mapping and numerical calculations show that the QCSE is screened by introducing polarization doping in the active region, which consists of InGaN/AlGaN QWs surrounded by an AlGaN/GaN shell with a negative Al composition gradient along the c-axis. In comparison with conventional GaN barriers, AlGaN barriers are shown to effectively compensate for the tensile strain within the active region, which significantly reduces the strain distribution and results in enhanced indium incorporation without compromising the material quality. This study provides new insights and a viable path for the design, fabrication, and integration of high-performance µLEDs on Si for a broad range of applications in on-chip optical communication and emerging augmented reality/mixed reality devices, and so on., (© 2022. The Author(s).)

We report the demonstration of monolithic integration of multicolor LEDs with highly spatially uniform emission wavelength. LEDs with colors ranging from green to orange are realized in a single selective area epitaxy process, and pronounced emission peak with very narrow spectral linewidth from photonic crystal effect is also achieved simultaneously. The In contents and emission colors are tuned by precisely controlling the nanowire emitter diameter and spacing. The emission wavelengths exhibit small variations of only a few nanometers among countless individual nanowire emitters over a sub-mm 2 area region.

Objective: This study aimed to determine if laboratory inflammatory markers can predict critical disease in symptomatic COVID-19 pregnant women., Study Design: Multicenter, retrospective cohort study of all pregnant women presenting to New York City Health + Hospitals emergency departments from March 1 to May 30, 2020. We assessed all symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pregnant women with room air oxygen saturation <95% on presentation. Logistic regression modeled the relationship of inflammatory markers to outcomes. Area under receiver operating characteristic (ROC) curve and maximum Youden index determined prognostic ability and optimal predictive cut-off values., Results: A total of 498 of 5,002 pregnant women were SARS-CoV-2 RT-PCR positive of which 77 presented with hypoxemia. The absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) were highly sensitive for progression to severe illness. ROC curve analysis identified predictive cutoffs: ALC < 1.49 × 10 9 /L (96% sensitivity, 52% specificity, area under the receiver operating characteristic curve [AUC] = 0.80 (95% confidence interval [CI]: 0.70-0.90) and NLR >8.1 (100% sensitivity, 70% specificity, AUC = 0.86 (95% CI: [0.76-0.96])., Conclusion: ALC and NLR on presentation are sensitive markers of progression to critical COVID-19 disease in symptomatic pregnant women. This finding provides a practical, rapid method for assessment and can assist clinicians with decision-making regarding triage, level of care, and patient management., Key Points: · Few tools exist to gauge risk of severe COVID-19 disease in pregnancy.. · ALC and NLR are sensitive predictive markers of disease progression in symptomatic women.. · Cut-off values for ALC and NLR will help direct patient triage and management.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: In 2017, a postoperative multidrug resistant case of urinary tract infection made obstetricians at Sitaram Bhartia Institute of Science and Research introspect the antibiotic usage in labouring mothers. Random case file reviews indicated overuse and variability of practice among care providers. This prompted us to explore ways to rationalise antibiotic use., Methods: A multidisciplinary team of obstetricians, paediatricians and quality officers was formed to run this improvement initiative at a private hospital facility in India. Review of literature advocated formulating a departmental antibiotic policy. Creating this policy and implementing it using improvement methodology helped us rationalise antibiotic usage., Interventions: We aimed to reduce the use of antibiotics from 42% to less than 10% in uncomplicated vaginal deliveries. We tested a series of sequential interventions using the improvement methodology of Plan-Do-Study-Act (PDSA) cycles, an approach recommended by the Institute for Healthcare Improvement. Learning from the PDSA cycle of the previous intervention helped decide the subsequent change ideas. The interventions included creation of a departmental antibiotic policy, staff engagement, and modification in documentation, concept of dual responsibility and team huddles as feedback opportunities. Information was analysed to understand the progress and improvement with change ideas., Results: Background analysis revealed that antibiotic usage ranged from 24% to 69% and average rate of antibiotic prophylaxis was high (42.28%) in low-risk uncomplicated vaginal deliveries. The sequential changes resulted in reduction in antibiotic usage to 10% in the target population by 4 months. Sustained improvement was noted in the following months., Conclusion: We succeeded in implementing a departmental antibiotic policy aligning it with existing international guidelines and our local challenges. Antibiotic stewardship was one of the first major steps in our journey to avoid multidrug-resistant infections. Sustaining outcomes will involve continuous feedback to ensure engagement of all stakeholders in a hospital setting., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The impact of evolving guidelines and clinical practices on SARS-CoV-2-positive dyads across New York City Health and Hospitals during the early peak of COVID-19., Design: A retrospective cohort study of positive-positive (P/P), positive-negative (P/N), and positive-untested (P/U) dyads delivered from March 1 to May 9, 2020. Wilcoxon rank sum, Chi-squared, and Fisher exact tests were used to analyze demographics, clinical variables, and system-wide management practices., Result: A total of 2598 mothers delivered. 23.8% (286/1198) of mothers tested for SARS-CoV-2 were positive. 89.7% (260/290) newborns of SARS-CoV-2-positive mothers were tested and 11 were positive. Positive-positive newborns were more likely to be breastfed (81%), be admitted to NICU, and have longer length of stay (7.5 days) than P/N and P/U newborns., Conclusion: Our study shows that varied testing, feeding, and isolation practices resulted in favorable short-term outcomes for SARS-CoV-2-positive mothers and their newborns. High-risk populations can be safely and effectively treated in resource-limited environments.

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) or coronavirus disease 2019 (COVID-19) is currently in worldwide pandemic state with very limited data about the mode of transmission to the growing fetus. There are a few published cases of COVID-19 infection in the infants born to COVID-19 positive mothers where most of the reported cases were either mildly symptomatic with positive COVID-19 polymerase chain reaction (PCR) or had negative COVID-19 PCR raising the question of vertical transmission. We present a case of likely intrauterine transmission of COVID-19 infection in a critically ill premature infant born to a COVID-19 infected mother and describing her clinical course thus far. The clinical presentation in the infant is consistent with COVID-19 infection described so far in literature along with positive PCR, and positive COVID-19 serology: immunoglobulin G, immunoglobulin M, and immunoglobulin A., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Purpose: To study the prevalence of left ventricular diastolic dysfunction (LVDD) in patients with subclinical hypothyroidism (SCH) and the response of LVDD to L-thyroxine therapy., Materials and Methods: This cross-sectional case-control study with one longitudinal arm included 67 patients with SCH attending a tertiary care hospital in Uttarakhand, India, and 67 age- and sex-matched healthy controls. LVDD was assessed by 2D, pulsed-wave Doppler (PWD), continuous wave Doppler (CWD), and tissue Doppler echocardiography (TDE). Patients with LVDD received L-thyroxine therapy with reassessment for LVDD 6 months later., Results: SCH patients had a higher prevalence of LVDD than controls (13.43% versus 1.49%; p = 0.017). LVDD showed a significant association with gender (p = 0.004) and serum FT4 (p = 0.001). E velocity, E' velocity, A' velocity, iso-volumetric relaxation time (IVRT), E/A, and E'/A' ratios were significantly lower, while A velocity, deceleration time (DT), E/E' ratio, left atrial (LA) volume index, and peak tricuspid regurgitation (TR) velocity were significantly higher in cases than controls (p < 0.05 each). The E/A ratio correlated significantly with age, serum very low-density lipoprotein (VLDL), triglycerides (TG), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and high-density lipoprotein (HDL) (p < 0.05 each). E' velocity correlated significantly with age, serum total cholesterol, VLDL, and TG (p < 0.05 each), DT with serum total cholesterol (p = 0.047), and LA volume index with age (p = 0.021). Age (p = 0.016) and serum HDL (p = 0.029) were independent predictors of E/A ratio. Gender was an independent predictor for LVDD (p = 0.003). Echocardiographic indices for LVDD showed significant improvement after 6 months of L-thyroxine therapy (p < 0.05 each)., Conclusions: LVDD occurs commonly in SCH patients. It can be detected timely using echocardiography and may be reversed by L-thyroxine therapy.

Background: Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment., Objective: Purpose of this study was to evaluate and compare the effect of sedation by intranasal dexmedetomidine and oral combination drug midazolam-ketamine in a group of children with uncooperative behavior requiring dental treatment., Materials and Methods: This was a prospective, randomized, double-blind study that included patients 3-9 years old with American Society of Anesthesiologists-I status. About 36 children presenting early childhood caries were randomly assigned to one of three groups studied: Group MK received intranasal saline and oral midazolam (0.5 mg/kg) with ketamine (5 mg/kg) mixed in mango juice; Group DX received intranasal dexmedetomidine (1 μg/kg) and oral mango juice; and Group C received intranasal saline and oral mango juice. Patients' heart rate, blood pressure, and oxygen saturation were recorded before, during, and at the end of the procedure. Patients' behavior, sedation status, and wake up behavior were evaluated with modified observer assessment of alertness and sedation scale. Ease of treatment completion was evaluated according to Houpt scale., Results: Hemodynamic changes were statistically insignificant in Group MK and Group DX. About 75% patients in Group MK were successfully sedated as compared to 53.9% Group DX and none of the patients in Group C. Ease of treatment completion was better with Group MK as compared to Group DX and least with Group C. Around 50% patients in Group MK had postoperative complications., Conclusion: Oral midazolam-ketamine combination and intranasal dexmedetomidine evaluated in the present study can be used safely and effectively in uncooperative pediatric dental patients for producing conscious sedation.

Objective: This study aims to elicit physician and nursing perceptions about initiation of minimal enteral feedings (MEF) in very low-birth-weight (VLBW) infants., Study Design: A three-phase, mixed methods study including a quantitative chart review of 37 VLBW infants, followed by 26 qualitative observations of morning rounds, 26 interviews of neonatal intensive care unit (NICU) medical team members, tailored interventions based on the identified barriers to MEF, and finally a postintervention chart audit of 50 VLBW infants., Results: The main barriers to initiation of MEF were failure to appreciate the differences between the goals of MEF versus nutritive feedings, inconsistent definition of "sick" infant, indomethacin for intraventricular hemorrhage prophylaxis, awaiting mother's own milk, complicated feeding protocols/algorithms for feeding intolerance, and lack of buy-in from nurses/nurse practitioners. The compliance with early initiation of MEF per the feeding guidelines rose from 25 to 92% after our interventions., Conclusion: Understanding the complex interplay of provider, system and patient-based factors that interfere with initiation of MEF may enable NICUs to develop consensus guidelines and targeted interventions and to achieve timely initiation of nonnutritive feedings., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Kaposiform hemangioendothelioma (KHE) associated with Kasabach-Merritt phenomenon is a life-threatening vasculopathy. The current mainstay treatment for KHEs is corticosteroids and chemotherapy, but these medications do not work for all patients and carry significant side effects. We report a neonate with a large congenital KHE who responded extremely well to low-dose radiation therapy., (© 2013 Wiley Periodicals, Inc.)

Objective: To perform a randomized controlled trial comparing moxifloxacin hydrochloride with polymyxin B-trimethoprim for the treatment of acute conjunctivitis., Study Design: Patients ages 1-18 years old with acute conjunctivitis had cultures performed and were randomized to receive either moxifloxacin hydrochloride or polymyxin B-trimethoprim ophthalmic solution for 7 days. Response to treatment was determined by phone query on day 4-6 and by examination with post-treatment conjunctival culture on day 7-10., Results: One hundred and twenty-four patients were enrolled. Eighty patients (65%) had recognized pathogens (55 Haemophilus influenzae, 22 Streptococcus pneumoniae, 4 Moraxella catarrhalis) isolated from their conjunctiva. One hundred fourteen (56/62 moxifloxacin and 58/62 polymyxin B-trimethoprim) completed the 4-6 day evaluation, with 43/56 (77%) of the moxifloxacin group and 42/58 (72%) of the polymyxin B-trimethoprim group clinically cured according to parents (noninferiority test P = .04). Eighty-nine (39/56 moxifloxacin and 50/58 polymyxin B-trimethoprim) patients completed the 7-10 day evaluation. Clinical cure was observed in 37/39 (95%) of the moxifloxacin and 49/51 (96%) of the polymyxin B-trimethoprim treated groups (noninferiority test P ≤ .01). Clinical cure rates for culture positive and negative conjunctivitis were not different. There was no statistically significant difference in bacteriologic cure rates between the 2 groups., Conclusions: Polymyxin B-trimethoprim continues to be an effective treatment for acute conjunctivitis with a clinical response rate that does not differ from moxifloxacin. Use of polymyxin B-trimethoprim for the treatment of conjunctivitis would result in significant cost savings compared with fluoroquinolones., (Copyright © 2013 Mosby, Inc. All rights reserved.)

We report the first pediatric case of an extrarenal, noncentral nervous system, diffusely metastatic, gastrointestinal rhabdoid tumor in a 106-day-old, previous 25-week preterm infant. The unusual clinical presentation, the diagnosis, and biology of this tumor as well as the etiology of hemoperitoneum in neonates and infants are discussed., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Autonomic functions were studied by six standard tests in 65 patients with lepromatous leprosy and 25 healthy controls. Dysautonomia was observed in 22 patients, all having the disease for more than five years. Associated peripheral neuropathy, judged clinically, was present in all, except one patient. Of the 22 dysautonomic patients, 9 each had mild or moderate dysantonomia and 4 had severe dysautonomia as per the scoring schedule devised by us. Syncope, gustatory sweating and impotence were the symptoms suggestive of dysautonomia. But not all affected patients reported these symptoms. Involvement of the sympathetic system was more frequent than that of the parasympathetic system. Statistically significant abnormality was seen with Atropine ratio, standing 30:15 beat ratio, postural hypotension and sustained hand grip test. Sustained hand grip test was the one which consistently gave abnormal results in all the 22 dysautonomic patients.