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Background: The objective of this retrospective study was to evaluate the effectiveness and safety of fast-acting insulin aspart with additional drug excipients (L-arginine and niacinamide) in the Indian pediatric population. Methods: Data of pediatric type 1 diabetes mellitus (T1DM) outpatients in the age group of 1 to 18 years on treatment with injection degludec as long-acting Insulin OD and faster aspart as rapid-acting mealtime insulin 5-minutes before the meal for 20-weeks, was collected from the medical records of subjects. The primary endpoint was the mean change in glycated hemoglobin (HbA1c) and the secondary endpoints were mean changes in fasting plasma glucose (FPG) and 1 and 2-hour postprandial glucose (PPG), from baseline to 20-weeks post-treatment. The safety of treatment was also evaluated. Results: Data of 30 pediatric patients (Male: Female-14:16) with a mean age of 7.98 years was considered for this retrospective data analysis. Compared to baseline, there was a significant decline (p

Background Studies on factors affecting mortality in neonatal tetanus (NNT) are mostly from other developing countries. Although NNT has been eliminated from India, cases are still occasionally reported from rural areas. Moreover, there is paucity of such studies from India. Hence, this study was aimed to identify risk factors affecting NNT mortality so that case fatality can be minimized especially in resource-limited settings. Methods The records of the 32 neonates diagnosed as NNT over a period of 8 years (2013-2020) were reviewed, and a statistical comparison of various variables between survivors and nonsurvivors was made. Results The overall case fatality rate in our study was 75%. Determinants of mortality in these cases were low birthweight, short incubation period, short period of onset, delay in seeking medical attention, presence of comorbidity, dose of tetanus immunoglobulin < 250 IU, and an unknown entry site of infection. Gender and place of delivery were not associated with increased mortality. Conclusion Improved maternal antenatal care (birthweight and gestation), recognition of the disease at onset of symptoms, and early hospital contact are important, in addition to optimum supportive care, to reduce NNT mortality.

Whenever the GDP goes down of any nation and unemployment increases and offences also increases the main of this paper is to analyze the cyber crime by teenager and youth and how they are affecting the society through cyber crime. The cyber crime bucks to extracts money from the people whether they belong do to nation or not and it affects the common people and I want to draw your attention towards the misuse of computer and laptop and internet and other social media networks so we have to use in a proper manner with security over computers and electronic gadgets and we have to aware about the crime and how it can affects people.

To compare mechanical characteristics and stability of Clareon CNA0T0 intraocular lens (IOL) with 4 currently marketed monofocal IOLs and to evaluate axial displacement and simulated dioptric power shift using a range of compression diameters.Alcon Laboratories, Inc., Fort Worth, Texas, USA.Experimental study.Clareon CNA0T0, AcrySof SN60WF, enVista MX60, Tecnis ZCB00, and Vivinex iSert XY1 IOLs (10 per group) were assessed using standardized methods for axial displacement, optic decentration, and optic tilt per the International Organization for Standardization ISO11979-3. Axial displacement was also measured over a range of compression diameters (9.0 to 11.0 mm).At 10.0 mm compression, the mean axial displacement for the CNA0T0 IOL (0.02 mm ± 0.01 [SD]) was significantly lower than for the MX60, ZCB00, and XY1 IOLs (P .005). At all compression diameters, the CNA0T0 and SN60WF IOLs had the lowest levels of axial displacement and corresponding simulated dioptric power shift at the corneal plane versus other IOL models. At 10.0 mm compression, the mean optic decentration was within ±0.06 mm for all models, and there were no significant differences between the CNA0T0 IOL and other IOLs. At 10.0 mm compression, the mean optic tilt was no greater than 1.2 degrees for all IOL models evaluated; however, the mean optic tilt for the CNA0T0 IOL was significantly lower than for the MX60 IOL (P .005).The CNA0T0 and SN60WF IOLs showed the lowest levels of axial displacement and corresponding simulated dioptric power shift over all tested compression diameters, indicating they might provide the most consistent refractive outcomes.

To identify risk factors for microbiologically confirmed intrathoracic tuberculosis in children. Children, 6 mo to 15 y of age, attending the out-patient department of a tertiary care centre in India, with probable intrathoracic tuberculosis were enrolled. Microbiological confirmation of tuberculosis was defined as positivity on smear (Ziehl-Neelsen staining) and/or Xpert MTB/RIF and/or MGIT-960 culture. Association of various factors with microbiological confirmation were assessed by univariate and multivariate analysis. Microbiologic confirmation was documented in 39 (25%) of 153 patients enrolled. On univariate analysis, microbiological positivity was associated with female gender, higher mean (SD) age [136.6 (31.8) vs. 117.3 (41.4) mo], parenchymal lesion on chest radiograph, low body mass index for age, having symptoms of cough and weight loss, lower mean (SD) hemoglobin [10.4 (1.37) g/dl vs. 11(1.52) g/dl; p = 0.04], and higher mean (SD) monocyte: lymphocyte ratio [0.38 (0.30) vs. 0.24 (0.02); p = 0.37]. Higher proportion of microbiologically negative children were BCG vaccinated (95% vs. 79%; p = 0.002). On multivariate analysis, microbiological positivity showed significant association with low body mass index for age (p = 0.033) and higher monocyte: lymphocyte ratio (p = 0.037). Low body mass index for age and higher monocyte: lymphocyte ratios were associated with microbiological confirmation in children with intrathoracic tuberculosis.

Introduction: Mother’s hand washing practices, immunization awareness and early initiation of breast feeding are important steps to reduce neonatal and infant morbidity & mortality. Still these are not routinely practiced in our country. Therefore health education of mothers regarding infection control practices is a necessary intervention. Materials & Methods: A hospital based cross-sectional study was conducted at immunisation centre in our institution from August 2016 to October 2016. A pre-designed questionnaire on infection control practices was used for interviewing mothers of under five children attending immunisation clinic. Data was analyzed using SPSS software and results were interpreted into percentages. Results: 348 participants took part in the study. Mean age of the participants was 27.61±4.45 years. Awareness regarding infection control practices was fairly good among mothers except for hands should be washed with both soap and water. Mother’s educational status and infection control practices were related to each other. Conclusion: Lack of adequate information, maternal education level, socioeconomic factors, etc. influences the infection control practices which can be improved by proper health education of mothers and implementing programmes for hygiene practices.

BACKGROUND Diagnosis of tuberculosis (TB) in children remains challenging due to the paucibacillary nature of the disease. Detection of TB using urine lipoarabinomannan (LAM) antigen was evaluated in children with presumed TB. MATERIAL and METHODS Children with presumed intrathoracic tuberculosis (ITTB) and lymph node TB (LNTB) were enrolled. Expectorated or induced sputum or gastric aspirates from ITTB patients and fine-needle cytological aspirates from LNTB patients were subjected to Ziehl-Neelsen staining, MGIT™960™ culture and Xpert® MTB/RIF testing. Urine samples were tested to detect LAM, and the sensitivity and specificity calculated. RESULTS Of 280 children with presumed ITTB and 101 with presumed LNTB, respectively 71 (25.3%) and 25 (24.7%) were categorised as 'confirmed TB', 70 (25%) and 33 (32.7%) as 'unconfirmed TB', and 139 (49.6%) and 43 (42.5%) as 'unlikely TB'. Respectively 8 (2.8%) children with ITTB and 3 (2.9%) with LNTB were positive on smear, 56 (20.0%) and 23 (22.7%) on Xpert, and 50 (17.8%) and 9 (8.9%) on culture. LAM assay sensitivity was 73.2% in confirmed ITTB cases, and 76% in confirmed LNTB cases; LAM assay specificity in children with ITTB and those with LNTB initiated on anti-tuberculosis treatment was respectively 92% and 93%. Detection of TB using the LAM assay was significantly better than detection using Xpert (P CONCLUSION Urinary LAM testing showed high specificity and sensitivity, was detected in more cases initiated on treatment than reference tests, and improved disease detection by 38.5% in ITTB patients and by 41.6% in LNTB patients. .

Purpose To evaluate the uveal and capsular biocompatibility as well as positioning stability of a new hydrophobic acrylic intraocular lens (IOL) in vivo in the rabbit model and compare it with a commercially available IOL. Setting John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Design Experimental study. Methods Fifteen New Zealand rabbits had the new test IOL (Clareon CNA0T0) implanted in one eye and a control IOL (Acrysof SN60WF) implanted in the contralateral eye. The test IOL is manufactured from a new hydrophobic acrylic material incorporating ultraviolet blocker and blue light filter. Its design is based on the control IOL's platform. The rabbits were followed up with weekly slitlamp evaluations, which assessed inflammatory reactions as well as capsular bag opacification. Anterior chamber depth was measured at 1 and 4 weeks post-implantation (high-frequency ultrasound). After 4 weeks, the rabbits were killed humanely and the eyes were enucleated. The anterior segment was evaluated from the posterior or Miyake-Apple view, and was then processed for complete histopathology. Results There were no statistically significant differences between test and control eyes in terms of postoperative inflammation and capsular biocompatibility, including posterior capsule opacification (P = .34, paired t test), and anterior capsule opacification (P = .53, paired t test), as observed during clinical and pathological evaluation. In vivo axial positioning for the test IOL was comparable to the control IOL and stable over time (P = .531 versus P = .788). Conclusions The new IOL showed biocompatibility and stability comparable to the control IOL.

Hypertension in pediatric patients,unlike adults, is mostly secondary to systemic disorders which may be renal,cardiovascular or endocrine, among others.Apparent mineralocorticoid excess (AME) is one such cause of hypertension.

Background: The amount of biomedical waste being generated in our country is increasing day by day. Biomedical waste if not handled properly can pollute the environment and can spread many harmful diseases. Health care workers in our country are still not fully aware about proper BMW handling and disposal, despite increasing global awareness on it. The objective of the study was to understand the level of awareness regarding BMW handling and disposal among health care professionals in our institution. Methods: After taking written informed consent doctors, nurses, lab technicians and class IV employees working in our institution were included. A pre designed questionnaire was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages. Results: 305 participants took part in the study. Doctors, nurses and lab technicians had good knowledge, attitude and practice regarding biomedical waste management but there was scope of improvement in certain areas. Knowledge, attitude and practices regarding biomedical waste management of class IV employees were found to be very low. Conclusions: There should be a continuous training programme for all health personnel with special focus on sanitary staff. Biomedical waste management rules should be strictly implemented at all levels.

Background: Adolescent period is characterized by physical, psychological and behavioural changes and girls can show different reactions to these changes. Proper information can help them in handling these changes without any stress. Tribal females are a vulnerable population and lack health care facilities. Limited data is available on awareness of pubertal changes and reproductive health among tribal adolescent girls. Aims of the study were to study and compare the level of awareness about pubertal changes and reproductive health between tribal and urban adolescent girls. Methods: The study population consisted of 200 adolescent girls between 10-19 years age 100 each, from urban and tribal setting. A predesigned questionnaire, which consisted of questions designed to evaluate the awareness about pubertal changes and reproductive health was used for data collection. Data was analysed using SPSS software, student t test, Chi- square test and co-relation test. Results: Mean age of the study population was 13.76±1.2 years. Mean awareness of urban adolescent girls about pubertal changes and reproductive health was significantly greater than tribal adolescent girls. Awareness was more in older age and more literate adolescent girls. Conclusions: Information, education and communication (IEC) campaigns have to be strengthened to increase awareness on menstrual hygiene practices and sexually transmitted diseases among tribal adolescent girls as these are a vulnerable group.

Background: Diagnosis of Intra-thoracic Tuberculosis (ITTB) in children is challenging. Contribution of Xpert MTB/RIF assay to diagnosis of suspected ITTB and multi-drug resistant TB (MDR-TB) was evaluated. Methods: Children with suspected ITTB (395) were subjected to gastric aspirates and induced-sputum twice.Samples were tested by Ziehl-Neelsen stain, Xpert MTB/RIF-assay and MGIT-960 culture. Subjects were grouped as Confirmed, Probable and No-TB and classified as progressive primary disease (PPD, lung parenchymal lesion/pleural effusion/ pneumothorax) and primary pulmonary complex (PPC, hilar lymphadenopathy) on Chest X-ray. Findings: Of children with confirmed TB 51(12.9%), probable TB 306(77.4%) and No-TB 38(9.6%),11(2.7%) were smear positive, 98(24.8%) Xpert MTB/RIF positive and 51(12.9%) culture positive. Xpert MTB/RIF detected 42/51 culture confirmed cases (sensitivity 82% and NPV 97%) and rifampicin resistance in additional 5 cases. Culture detected more children presenting as PPD (p

Introduction: Menstruation in our country is associated with various myths and restrictions leading to lack of awareness among adolescent girls. Insufficient menstrual hygiene practices are the cause of stress associated with menstruation and reproductive tract infections. Sexually transmitted infections and HIV/AIDS are not openly discussed in our society making adolescents vulnerable to them. Aim: To assess the knowledge of school going adolescent girls regarding menstrual hygiene and HIV/AIDS. Materials and Methods: Girls studying in class 8th-12th standard and who have attained menarche were included in the study. A predesigned questionnaire, which consisted of questions related to menstrual awareness and knowledge about HIV/AIDS was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages. Results: 282 girls took part in the study. Mean age of girls was 14.70 ± 1.5 years. Median age of girls was 15 years. Knowledge regarding menstrual hygiene and HIV/AIDS was found to be only satisfactory leaving a scope of improvement. Mother was the main source of information regarding both menstruation and HIV/AIDS. Conclusion: A comprehensive health education programme involving mothers is required to remove various misconceptions and taboos associated with menstruation and make it a pleasant experience for adolescent girls. Information, education and awareness programmes need to be strengthened to spread awareness regarding HIV/AIDS.

Background and Objectives: Sexually experienced, unmarried adolescent women, usually commence sex, with marriage in mind. Initially, they resist sex but are unsuccessful due to lack of resilience to end an oppressive relationship, or convince their partners to postpone sex or use protection. To retain partners, they accept unprotected sex and suffer its consequences such as unwanted pregnancies, sexually transmitted diseases, HIV/AIDS and cervical cancer. Considerable numbers of adolescents face this emotional stress and suffer the consequences, while some manage to endure and emerge from the ordeal. This study attempts to determine this resilience and extrapolate it to others who might not be so successful without an intervention. Methodology: The study compares sexual resilience in 100 unmarried adolescent abortion-seekers, in terms of time taken from meeting the partner, to sexual debut and correlates this with background factors such as age, education, family income, self-esteem, sexual knowledge, attitude toward pre-marital sex (PMS) and partner pressure. Results: Mean debut age was 17.32 years. Partners took more initiative to form emotional (64%) and physical relationship (78%). Adolescent girls' initiative reduced markedly from emotional (22%) to physical relation (5%). Correlation of sexual resilience with age, family income education and knowledge was not significant. It was significantly correlated with attitude toward PMS, self-esteem and partner pressure. Interpretation and Conclusion: It is desirable to improve self-esteem and attitude of young women to build negotiation skills in intimate relations. Counselors have to reorient the perspectives to improve attitude toward abstinence and increase self-esteem to resist pressure from partners.

Background-Contraception is the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures. An effective contraception allows a physical relationship without fear of an unwanted pregnancy and ensures freedom to have children when desired. The aim is to achieve contraception in maximum comfort and privacy, with minimum cost and side effects. Some methods, like male and female condoms, also provide twin advantage of protection from sexually transmitted diseases. The burden of unsafe abortion lies primarily in developing countries. Here, contraceptive prevalence is measured among currently married women of reproductive age, and levels have not yet reached those that exist in developed countries.In countries like India, there is a dire need for contraceptive methods to be more women friendly, accessible and provide adequate privacy. Providers also need to be sensitive to special needs of adolescents as they are at a critically vulnerable segment.

Purpose: To develop an age-dependent mathematical model of the isolated ex-vivo human crystalline lens shape to serve as basis for use in computational modeling. Methods: Profiles of whole isolated human lenses ( n = 27) aged 6 to 82, were measured from shadow-photogrammetric images. Two methods were used to analyze the lenses. In the two curves method (TCM) the anterior and posterior surfaces of the lens were fit to 10th-order even polynomials and in the one curve method (OCM) the contour of one half-meridional section of the lens was fit to 10th-order polynomials. The age-dependence of the polynomial coefficients was assessed. The analysis was used to produce an age-dependent polynomial model of the whole lens shape. Results: The root mean squared errors for the fits ranged from 11 to 70 μm for the OCM, 9 to 27 μm for the posterior surface of the TCM and 8 to 134 μm for the anterior surface of the TCM. The coefficients of the OCM did not display a significant trend with age. The 2nd-, 6th- and 10th-order coefficients of the anterior surface of the TCM decreased with age while the 8th-order coefficient increased. For the posterior surface of the TCM, the 8th-order coefficient significantly decreased with age and the 10th-order coefficient increased. The age-dependent equations of both the models provide a reliable model from age 20 to 60. The OCM model can be used for lenses older than 60 as well. Conclusion: The shape of the whole human crystalline lens can be accurately modeled with 10th-order polynomial functions. These models can serve to improve computational modeling, such as finite element (FE) modeling of crystalline lenses.

Purpura fulminans in the neonatal period due to severe congenital protein C deficiency (protein C activity1 IU/dl) is a rare autosomal recessive disorder. If untreated, it is fatal. Early identification of such patients may be lifesaving. Acquired deficiency of protein C caused by increased consumption as overt disseminated intravascular coagulation (DIC) and severe infection creates a diagnostic dilemma. Mutation analysis plays a critical role in confirming the diagnosis of the disease and offering prenatal diagnosis. In this report, we describe a newborn who presented with purpura fulminans and DIC, molecular analysis showed a novel c.1048AT transversion in a homozygous state at codon 350 (LysStop) of protein C (PROC) gene. Prenatal diagnosis in subsequent pregnancy was done which revealed the affected fetus had the same mutation in homozygous form.

To improve the in vivo performance of engineered implants, this study examines the independent effects of surface chemistry and topography on fibroblast morphology and density in vitro. Titanium (Ti) was sputter-coated onto smooth and microtextured polyethylene terephthalate (PET). Test specimens were evaluated in 24-h, fibroblast cultures and assessed with scanning electron microscopy (SEM) for cellular morphology and density. Fibroblast density increased, as the Ti film thickness increased. The fibroblasts exhibited contact guidance on the textured test specimens. The greatest cellular density was found on the Ti-coated, textured test specimens. In conclusion, Ti and surface texture appeared to strongly influence fibroblast density and morphology as compared to PET and smooth surfaces.

Familial Hemophagocytic Lymphohistiocytosis (FHL) is a rare autosomal recessive disorder. Diagnosis is established in presence of genetic mutation or positive family history in one of the siblings. Common genetic mutations associated with FHL are mutations in gene PRF-1 (also known as FHL 2), UNC13D (FHL 3) and STX11 (FHL 4). Recently mutation in STXBP2 encoding syntaxin binding protein 2 (Munc 18 -2) has been found to be associated with FHL type 5. Here we describe the first reported Indian patient with homozygous mutation in STX BP2 gene (c1697 G>A resulting in amino acid change p.G566D) causing FHL 5.

Purpose To determine whether changes in elastic properties of the lens capsule ex vivo with age contribute to the forces necessary for accommodation. Methods Postmortem human (n = 22; age average: 41 +/- 17 years; range: 6-7) and cynomolgus monkey (n = 19; age average: 7.7 +/- 1.8 years, range: 4.2-10) tissues including the lens, capsule, zonules, ciliary body, and sclera were mounted in an optomechanical lens-stretching system. Starting at 0 load, the sclera was symmetrically stretched to 2 mm in 0.25-mm steps at a speed of 0.1 mm x s(-1). The load and lens diameter were measured at each step. The lens contents were removed through a mini-capsulorhexis. The stretching cycles were repeated on the empty capsular bag. The forces necessary to stretch the natural lens and empty bag were quantified as a function of age and compared. Results The force needed to stretch the empty lens capsule was independent of age (human, 2.6-34.9 g/mm [25.2-342.7 mN/mm]; monkey, 8.2-21.3 g/mm [80.3-208.6 mN/mm]). The ratio of the force necessary to stretch the empty lens capsule to the force necessary to stretch the natural lens decreased with age in the human and monkey lenses (P = 0.003, P = 0.72, respectively). Conclusions The mechanical properties of the empty lens capsule assessed ex vivo in a lens stretcher remain constant with age, suggesting that the changes in elasticity of the lens capsule do not play a significant role in presbyopia. In young eyes, the lens capsule determines the force necessary to stretch the whole lens. The age-related increase in force needed to stretch the lens is due to changes in the lens contents.

Purpose To characterize the age dependence of isolated human crystalline lens power and quantify the contributions of the lens surfaces and refractive index gradient. Methods Experiments were performed on 100 eyes of 73 donors (average 2.8 +/- 1.6 days postmortem) with an age range of 6 to 94 years. Lens power was measured with a modified commercial lensmeter or with an optical system based on the Scheiner principle. The radius of curvature and asphericity of the isolated lens surfaces were measured by shadow photography. For each lens, the contributions of the surfaces and the refractive index gradient to the measured lens power were calculated by using optical ray-tracing software. The age dependency of these refractive powers was assessed. Results The total refractive power and surface refractive power both showed a biphasic age dependency. The total power decreased at a rate of -0.41 D/y between ages 6 and 58.1, and increased at a rate of 0.33D/y between ages 58.1 and 82. The surface contribution decreased at a rate of -0.13 D/y between ages 6 and 55.2 and increased at a rate of 0.04 D/y between ages 55.2 and 94. The relative contribution of the surfaces increased by 0.17% per year. The equivalent refractive index also showed a biphasic age dependency with a decrease at a rate of -3.9 x 10(-4) per year from ages 6 to 60.4 followed by a plateau. Conclusions The lens power decreases with age, due mainly to a decrease in the contribution of the gradient. The use of a constant equivalent refractive index value to calculate lens power with the lens maker formula will underestimate the power of young lenses and overestimate the power of older lenses.

Improving the biological performance of engineered implants apposing interfacing tissues is a critical issue in Biomaterials Science and Engineering. Micromotion at the soft tissue-implant interface has been shown to sustain an inflammatory response. To eliminate micromotion, it is desirable to promote cellular and extracellular matrix adhesion to the implant surface. Surfaces are modified topographically or chemically to effect cellular adhesion and to influence cellular interactions and function. Previous studies have identified the specific topographical characteristics that appear to elicit cellular attachment. This in vitro study compares the independent effects of surface chemistry and topography on fibroblast-test specimen proximity. Titanium (Ti) was sputter-coated in stepwise, increasing thickness (20-350 nm) onto a series of either smooth or microtextured polyethylene terephthalate (PET), resulting in a stepwise change from a PET surface to a Ti surface. The series was evaluated in a 3-day fibroblast culture with transmission electron microscopy (TEM) for cell-test specimen proximity. Fibroblast proximity to the coverslip surface increases, as the Ti thickness increases, on either smooth or textured test specimens. Furthermore, fibroblasts were firmly attached to the ridge tops on the coated textured test specimens. Therefore, fibroblast apposition is strongly enhanced by microtextured surfaces and Ti rather than smooth surfaces and PET.