EEG Neurofeedback Training in Children With Attention Deficit/Hyperactivity Disorder: A Cognitive and Behavioral Outcome Study

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood disorder with symptoms of inattention, impulsivity, and hyperactivity. EEG neurofeedback training (NFT) is a new intervention modality based on operant conditioning of brain activity, which helps reduce symptoms of ADHD in children.

METHODS AND PROCEDURES

To examine the efficacy of NFT in children with ADHD, an experimental longitudinal design with pre-post comparison was adopted. A total of 30 children in the age range of 6 to 12 years diagnosed as ADHD with or without comorbid conditions were assigned to treatment group (TG; n = 15) and treatment as usual group (TAU; n = 15). TG received EEG-NFT along with routine clinical management and TAU received routine clinical management alone. Forty sessions of theta/beta NFT at the C3 scalp location, 3 to 4 sessions in a week for a period of 3.5 to 5 months were given to children in TG. Children were screened using sociodemographic data and Binet-Kamat test of intelligence. Pre-and postassessment tools were neuropsychological tests and behavioral scales. Follow-up was carried out on 8 children in TG using parent-rated behavioral measures.

RESULTS

Improvement was reported in TG on cognitive functions (sustained attention, verbal working memory, and response inhibition), parent- and teacher-rated behavior problems and on academic performance rated by teachers. Follow-up of children who received NFT showed sustained improvement in ADHD symptoms when assessed 6 months after receiving NFT.

CONCLUSION

The present study suggests that NFT is an effective method to enhance cognitive deficits and helps reduce ADHD symptoms and behavior problems. Consequently, academic performance was found to be improved in children with ADHD. Improvement in ADHD symptoms induced by NFT were maintained at 6-month follow-up in children with ADHD.

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era

Vulnerable populations, including homeless persons, high-risk drug and alcohol users, prison inmates and other marginalised populations, contribute a disproportionate burden of tuberculosis (TB) cases in low-incidence settings. Drivers of this disease burden include an increased risk of both TB transmission in congregate settings, and progression from infection to active disease. Late diagnosis and poor treatment completion further propagate the epidemic and fuel the acquisition of drug resistance. These groups are therefore a major priority for TB control programmes in low-incidence settings. Targeted strategies include active case finding (ACF) initiatives and interventions to improve treatment completion, both of which should be tailored to local populations. ACF usually deploys mobile X-ray unit screening, which allows sensitive, high-throughput screening with immediate availability of results. Such initiatives have been found to be effective and cost-effective, and associated with reductions in proxy measures of transmission in hard-to-reach groups. The addition of point-of-care molecular diagnostics and automated X-ray readers may further streamline the screening pathway. There is little evidence to support interventions to improve adherence among these risk groups. Such approaches include enhanced case management and directly observed treatment, while video-observed therapy (currently under evaluation) appears to be a promising tool for the future. Integrating outreach services to include both case detection and case-management interventions that share a resource infrastructure may allow cost-effectiveness to be maximised. Integrating screening and treatment for other diseases that are prevalent among targeted risk groups into TB outreach interventions may further improve cost-effectiveness. This article reviews the existing literature, and highlights priorities for further research.

Quality protein maize based muffins: influence of non-gluten proteins on batter and muffin characteristics

Quality protein maize (QPM) is nutritionally improved maize which has twice the amount of lysine and tryptophan than normal maize. The present study evaluated the effect of different proteins namely egg white proteins (EWP), casein, whey protein isolate, soy protein isolate (SPI) on characteristics of gluten free QPM based muffins. QPM muffins without any added protein served as control and muffins prepared using wheat and EWP served as reference. Effect of addition of different proteins on pasting properties revealed that the thermal stability of QPM flour increased as indicated by decrease in breakdown viscosity. The effect of added proteins on QPM muffin-making properties was evaluated for rheology of batter and physicochemical, texture, color and sensory characteristics of muffins. Dynamic rheology showed that storage modulus (G') and loss modulus (G″) of batter with SPI was the highest while batter with EWP showed lowest value. QPM-EWP muffins were softer, chewy and springier and had more specific volume than control muffins and were comparable to reference muffins. Inclusion of all proteins increased L* values (lightness) and decreased a* (redness/greenness) and b* (yellow/blueness) values of QPM based muffins. Sensory analysis revealed that gluten free QPM muffin prepared from EWP were acceptable with a sensory score of 7.97 which was comparable to reference muffins (8.03).

Development of the R263K Mutation to Dolutegravir in an HIV-1 Subtype D Virus Harboring 3 Class-Drug Resistance

Dolutegravir (DTG), a second-generation integrase strand-transfer inhibitor (INSTI), is equivalent or superior to current non-nucleotide reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and first-generation INSTI-based antiretroviral regimens (ARVs). It has the potential to make big improvements in HIV control globally and within patients. This is perhaps the most "precious" HIV drug available. The integrase mutation R263K has been observed in tissue culture experiments and in patients treated with dolutegravir monotherapy in clinical trials. Globally, adherence and monitoring may be less than optimal and therefore DTG resistance more common. This is particularly important in low-middle-income countries, where patients may remain on failing regimens for longer periods of time and accumulate drug resistance. Data on this mutation in non-subtype B infections do not exist. We describe the first report of the R263K integrase mutation in a dolutegravir-exposed subtype D-infected individual with vertically acquired HIV. We have used deep sequencing of longitudinal samples to highlight the change in resistance over time while on a failing regimen. The case highlights that poorly adherent patients should not be offered dolutegravir even as part of a combination regimen and that protease inhibitors should be used preferentially.

DNA barcoding for specific and sensitive detection of Cuminum cyminum adulteration in Bunium persicum

BACKGROUND

Bunium persicum commonly called as Kala zeera, a very high value herbaceous spice used for medicinal purposes is often adulterated with Cuminum cyminum or Safed zeera, a closely related species. Lack of distinctive morphological features makes the identification of genuine kala zeera from its adulterant difficult, the problem is even exaggerated in case of powdered material.

METHODOLOGY

Genomic DNA was extracted from all the plant materials by using CTAB-SDS method (Möller et al., 1992) with slight modifications. On the basis of reproducibility and high amplification ability, four universal barcoding loci viz. ITS2, rbcL-a, mat K and psbA-trnH and a specific locus Cum were used in the present study. The amplified PCR products were sequenced bidirectionally and assembled to obtain contigs. The sequences thus obtained were aligned using MUSCLE algorithm (Edgar, 2004) and information pertaining to conserved/ variable/ parsimony informative sites, number of transitions, transversions and Indels was obtained after analyzing the sequences.

RESULTS AND CONCLUSION

Among the tested barcoding loci, psbA-trnH has proven to be best barcode in authentication of kala zeera as its amplification and sequencing success was high and it showed the presence of polymorphic sites to detect interspecific variation. This barcode could differentiate between safed zeera and kala zeera in a single reaction, simultaneously.

Influence of the core-hole effect on optical properties of magnesium oxide (MgO) near the Mg L-edge region

The influence of the core-hole effect on optical properties of magnesium oxide (MgO) is established through experimental determination of optical constants and first-principles density functional theory studies. Optical constants (δ and β) of MgO thin film are measured in the spectral region 40-300 eV using reflectance spectroscopy techniques at the Indus-1 synchrotron radiation source. The obtained optical constants show strong core exciton features near the Mg L-edge region, causing significant mismatch with Henke's tabulated values. On comparing the experimentally obtained optical constants with Henke's tabulated values, an edge shift of ∼3.0 eV is also observed. Distinct evidence of effects of core exciton on optical constants (δ and β) in the near Mg L-edge absorption spectra are confirmed through first-principles simulations.

A biomechanical study comparing proximal femur nail and proximal femur locking compression plate in fixation of reverse oblique proximal femur fractures

BACKGROUND

The reverse oblique trochanteric fractures are common fractures and its treatment poses a challenge. The purpose of this study was to compare the biomechanical parameters of the construct using proximal femoral nail (PFN) and proximal femoral locking compression plates (PFLCP) in these fractures using cadaveric specimens.

MATERIALS AND METHODS

Twenty freshly harvested cadaveric femoral specimens were randomly assigned to two groups after measuring bone mineral density, ten of which were implanted with PFN and the other ten with PFLCP. The constructs were made unstable to simulate reverse oblique trochanteric fracture (AO type 31A3.3) by removing a standard size posteromedial wedge. These constructs were tested in a computer controlled cyclic compressive loading with 200kg at a frequency of 1 cycle/s (1Hz) and test was observed for 50,000 cycles or until implant failure, whichever occurred earlier. Peak displacements were measured and analysis was done to determine axial stiffness and subsidence in axial loading.

RESULTS

All the specimens in PFN group completed 50,000 cycles and in PFLCP group, seven specimens completed 50,000 cycles. Average subsidence in PFN group was 1.24±0.22mm and in PFLCP group was 1.48±0.38mm. The average stiffness of PFN group (72.6±6.8N/mm) was significantly higher than of PFLCP group (62.4±4.9N/mm) (P=0.04). The average number of cycles sustained by PFLCP was 46634 and for PFN group was 50,000 (P=0.06).

CONCLUSION

The PFN is biomechanically superior to PFLCP in terms of axial stiffness, subsidence and number of specimens failed for the fixation of reverse oblique trochanteric fractures of femur.

Joint Involvement in Children with Celiac Disease

OBJECTIVE

To determine early joint involvement as detected by ultrasonography in children with newly diagnosed celiac disease, and in children with celiac disease on gluten-free diet for more than 6 months.

METHODS

Cross-sectional comparative study evaluating joint abnormalities by ultrasonography.

Results

Ultrasonography showed abnormalities in 19 out of 60 (31.7%) children with newly diagnosed celiac disease as compared to 2 (3.3%) out of 60 in those on a gluten-free diet for more than 6 months.

CONCLUSION

Subclinical synovitis as detected by ultrasound is a frequent finding in newly diagnosed children with celiac disease.

Hulless barley as a promising source to improve the nutritional quality of wheat products

In this study, efforts were made to utilize hulless barley (variety BHS352) to enhance the nutritive value of chapatti and biscuit made from wheat flour. Barley flour was added to wheat flour in different ratios (5 to 30%). Antioxidant activity, total phenolic content and β-glucan content were determined both in flour blends and their products. Changes in physical quality and taste of chapatti and biscuits after blending of hulless barley flour with wheat flour were measured. The chapatti quality score decreased by 15% and biscuit spread factor by 33% after 30% barley flour blending. Significant increase in β-glucan content and antioxidant activity of flour blends and their products was observed at 30% blending level. The phenolic content increased from 63 to 135 µg for biscuits and 237 to 287 ug GAE/g for chapatti with blending of 30% barley flour.

Structural variation in a synchrotron-induced contamination layer (a-C:H) deposited on a toroidal Au mirror surface

A carbon layer deposited on an optical component is the result of complex interactions between the optical surface, adsorbed hydrocarbons, photons and secondary electrons (photoelectrons generated on the surface of optical elements). In the present study a synchrotron-induced contamination layer on a 340 mm × 60 mm Au-coated toroidal mirror has been characterized. The contamination layer showed a strong variation in structural properties from the centre of the mirror to the edge region (along the long dimension of the mirror) due to the Gaussian distribution of the incident photon beam intensity/power on the mirror surface. Raman scattering measurements were carried out at 12 equidistant (25 mm) locations along the length of the mirror. The surface contamination layer that formed on the Au surface was observed to be hydrogenated amorphous carbon film in nature. The effects of the synchrotron beam intensity/power distribution on the structural properties of the contamination layer are discussed. The I(D)/I(G) ratio, cluster size and disordering were found to increase whereas the sp²:sp³ ratio, G peak position and H content decreased with photon dose. The structural parameters of the contamination layer in the central region were estimated (thickness ≃ 400 Å, roughness ≃ 60 Å, density ≃ 72% of bulk graphitic carbon density) by soft X-ray reflectivity measurements. The amorphous nature of the layer in the central region was observed by grazing-incidence X-ray diffraction.

Composite CuFe1-xSnxO2/p-type silicon photodiodes

CuFe_1-xSn_xO₂ composite thin film/p-type silicon diodes were prepared on substrate by sol-gel method (x=0.00, 0.01, 0.03, 0.05, 0.07). The structure of CuFe_1-xSn_xO₂ composite thin films was studied using XRD analysis and films exhibited amorphous behavior. The elemental compositions and surface morphology of the films were characterized using SEM and EDX. EDX results confirmed the presence of the compositional elements. The optical band gap of CuFe_1-xSn_xO₂ composite thin films was determined using the optic spectra. The optical band gaps of the CuFe_1-xSn_xO₂ composite thin films were calculated using optical data and were found to be 3.75, 3.78, 3.80, 3.85 and 3.83eV for x=0.00, 0.01, 0.03, 0.05 and 0.07, respectively. The photoresponse and electrical properties of the Al/CuFe_1-xSn_xO₂/p-Si/Al diode were studied. The barrier height and ideality factor were determined to be averagely 0.67eV and 2.6, respectively. The electrical and photoresponse characteristics of the diodes have been investigated under dark and solar light illuminations, respectively. The interface states were used to explain the results obtained in present study. CuFe_1-xSn_xO₂ photodiodes exhibited a high photoresponsivity to be used in optoelectronic applications.

Scrub typhus causing neonatal hepatitis with acute liver failure-A case series

Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Severity and prognosis of the disease varies widely because several different strains of Orientia tsutsugamushi exist with different virulence. Delayed diagnosis can result in complication and significant morbidity and mortality. Here, we report three cases of neonatal hepatitis with acute liver failure caused by scrub typhus to increase awareness.

Experimental observation of spatially resolved photo-luminescence intensity distribution in dual mode upconverting nanorod bundles

A novel method for demonstration of photoluminescence intensity distribution in upconverting nanorod bundles using confocal microscopy is reported. Herein, a strategy for the synthesis of highly luminescent dual mode upconverting/downshift Y_1.94O₃:Ho³⁺_0.02/Yb³⁺_0.04 nanorod bundles by a facile hydrothermal route has been introduced. These luminescent nanorod bundles exhibit strong green emission at 549 nm upon excitations at 449 nm and 980 nm with quantum efficiencies of ~6.3% and ~1.1%, respectively. The TEM/HRTEM results confirm that these bundles are composed of several individual nanorods with diameter of ~100 nm and length in the range of 1–3 μm. Furthermore, two dimensional spatially resolved photoluminescence intensity distribution study has been carried out using confocal photoluminescence microscope throughout the nanorod bundles. This study provides a new direction for the potential use of such emerging dual mode nanorod bundles as photon sources for next generation flat panel optical display devices, bio-medical applications, luminescent security ink and enhanced energy harvesting in photovoltaic applications.

Extensive subclinical sinusitis leading to Moraxella osloensis meningitis

We report a case of a 31 year old male with extensive subclinical sinusitis leading to erosion in the cribriform plate and subsequent meningitis caused by the organism Moraxella osloensis. The patient presented to the emergency department with rapid onset confusion, neck stiffness and headache. Inflammatory markers, renal and liver function, and a chest radiograph were all normal. CT Head showed extensive polyp disease in the paranasal sinuses with expansion of the left frontal sinus and CT Sinuses revealed an area of low attenuation in the cribriform plate consistent with bony erosion. MRI Head showed thick loculated sinus inflammation. Lumbar puncture yielded CSF with a high white cell count of predominantly mononuclear cells, no visible organisms and an elevated protein. CSF microscopy, culture and viral PCR were not diagnostic, and so the CSF was sent for 16S rDNA PCR screening, which identified the rDNA of Moraxella osloensis. Moraxella osloensis is a rare cause of bacterial meningitis, with only a few reported cases. This case illustrates that sinusitis, while a common condition, when severe can predispose to intracranial infection with atypical and low virulence organisms such as Moraxella species, which do not commonly cause invasive CNS disease. This case represents the first case of Moraxella osloensis meningitis reported from the United Kingdom.

Diagnostic Value of Ultrasonography in Hydatid Disease in Abdomen and Chest

A prospective diagnosis of hydatid cyst was made in 90 cases involving abdomen and chest. It was based on the various sonographic signs of hydatid disease described in the literature. Surgery was performed in 60 patients while 30 were lost to follow-up. The diagnosis was confirmed in 55 patients while it was false positive in 5. The liver was the most common organ involved, followed by chest, kidney, peritoneum, spleen and retroperitoneum. Separation of the membrane from the wall, multiple daughter cysts, and collapsed cysts, were found to be diagnostic of hydatid disease. It is stressed that certain signs are specific for hydatid disease and thus do not cause any differential diagnostic problems.

Total extraperitoneal approach in large inguino-scrotal hernias: an institutional approach

Introduction: Since 2 decades laparoscopichernia repair has gained key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia such as incarcerated, obstructed and inguino-scrotal is debatable. Cases of large inguino-scrotal raises objection to laparoscopic procedure because of anticipated problems and complications in dissecting extended hernia sac even though posterior approach is advocated as repair of choice for complicated cases. Here, we reviewed our series of patients undergoing TEP in a limited time frame.Method: Between March 2013 and June 2014, 50 consecutive patients underwent TEP repair for inguinoscrotal hernia. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative, postoperative complications and recurrence was recorded and analyzed using MS Excel.Results: 50 patients were recorded, 26 had unilateral and 24 had bilateral hernias. Mean age was 52 (22-72) years. The mean operation time was 70 (50-140) min. Bilateral repairs took 45% (18 min) longer than for unilateral repairs (52 + 12 min). Two (12.5%) patients required combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to asymptomatic seroma formation in 2 (12.5%) patients; 1 patient of combined open-TEP approach had wound infection, both treated conservatively. Mean follow up was 6.3 months; we recorded 2 recurrences (12.5%). The mean length of hospital stay was 1.8 days.Conclusion: We conclude that TEP can be safely employed for complicated inguinal hernias repair. Surgical experience in mandatory with tailored technique to reduce morbidity and achieve good clinical outcome with acceptable recurrence rates.

Laparoscopic hernioplasty of large ventral hernia with transfascial sutures: short term utility and outcome

Introduction: The laparoscopic approach to repairing ventral and incisional hernias has gained increasing popularity worldwide. The approximation of the hernia defect during laparoscopic ventral hernia repair, prior to mesh fixation, provides a more physiologic and anatomic repair. Defect closure also provides more defect overlap with mesh placement and, possibly decreases recurrence rates. We reviewed the experience of laparoscopic repair of large ventral hernia (diameter ≥5cm) at a university hospital in the Nepal with particular reference to patients with massive defects (diameter ≥15cm) and transfascial closure.Methods: A total of 32 patients underwent laparoscopic ventral (incisional or umbilical/paraumbilical) hernia repair between July 2014 and September 2015.Results: The prevalence of conversion to open surgery was 3.1%. The prevalence of postoperative complications was 15.6%. Median postoperative follow-up was 8.2 months. A total of 9.4% cases suffered late complications and 3.1% developed recurrence. Twelve patients underwent repair of defects ≥10cm in diameter with no recurrence. Three patients underwent repair of ‘massive’ incisional hernia (diameter ≥15cm) with a prevalence of recurrence of 3.1%. Ten patients with a body mass index (BMI) ≥30kg/m2 (range, 32–35kg/m2) underwent laparoscopic repair without any recurrence.Conclusions: Laparoscopic ventral hernia repair with transfascial suturing can be carried out safely with a low prevalence of recurrence. It may have advantages in obese patients in whom open repair would represent a significant undertaking. Laparoscopic ventral hernia repair may be used in cases of large and massive hernias, in which the risk of recurrence increases but is comparable with open repair and associated with low morbidity.

Laparoscopic inguinal hernia repair (total extra-peritoneal): tips and tricks

Introduction: Inguinal hernia is one of the major problems at B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiary referral center. We perform Laparoscopic hernia repair as a routine procedure for groin hernias. This technique is highly demanding and complex. In our country the development of laparoscopic technique is still in a developing phase.Aims and objective: To present technical tips and trick in LIHR, which we experienced, as lead to preventing intra/post operative complication.Results: We have performed a total of 129 groin hernia repairs in 105 patients with M: F= 26:1 and mean age 41.97±20 (16-85). The mean length of hospital stay was 1.14 ± 0.35 days. Eight patients were converted to TAPP and 1 converted to open hernia repair due to operative difficulty. The complications encountered are pain (20), seroma(8) and epididymitis(2).Conclusion: In our experience LIHR (TEP) is safe method for routine management of groin hernias.

Degradation kinetics of bioactive components, antioxidant activity, colour and textural properties of selected vegetables during blanching

Bioactive components of fruit and vegetables play an important role in scavenging free radicals and protect the body from degenerative diseases. A kinetic study was conducted to quantify the losses occurring in bioactive components, antioxidant activity and changes in colour and firmness of four commonly used vegetables (beetroot, green pea, eggplant and green pepper) during heat treatment (70-90 °C). The study revealed that logistic model can predict the variation in bioactive components and antioxidant activity with higher R² and lower root mean square error (RMSE) as compared to first order model due to logarithmic reduction in these properties in the beginning of the process itself. However zero and first order kinetic models were found suitable to predict the changes occurring in colour and firmness respectively during blanching. D, z value, activation energy (E_a), activation enthalpy and entropy were calculated for all measured parameters for selected vegetables in the temperature range of 70-90 °C. These finding would be useful in designing thermal processes and related calculations for these vegetables.