Half Years Research Articles

Quaternary Ammonium‐Free Membranes for Water Electrolysis with 1 m KOH

AbstractWhile anion exchange membrane (AEM) water electrolysis has many advantages, its commercialization is impeded by the low alkaline stability of most AEM, due to the fragility of quaternary ammonium groups. Ion solvating membranes (ISM) can be an alternative, but so far require high alkaline concentrations. Here, it is shown that sulfonation of polybenzimidazole results in ISM which swell strongly in 1 m KOH. Crosslinking with dibromoxylene controls the swelling, and after activation conductivities of >100 mS cm−1 can be reached in 1 m KOH. Stability in 1 m KOH at 80 °C is excellent: Conductivity remains unchanged and tensile strength and Young's modulus remains high over the test period of a half year. In an electrolyzer operating with 1 m KOH feed solution at 80 °C, a stable performance is achieved for over 500 h test without failure, suggesting that the high alkaline stability observed in ex situ tests is also achieved in the electrolyzer.

Risk factor and resistance profile of colistin resistant Acinetobacter baumannii and Klebsiellapneumoniae

PurposeAntimicrobial resistance is one of the major global health concerns, which is relentless despite multipronged measures. Carbapenems and colistin, drug of choice for multi drug resistant Klebsiella pneumoniae and Acinetobacter species, have also been rendered of less use. This underlines the need to decipher prevalence of colistin resistance comprehensively for formulation of hospital and country-wise antibiogram. We conducted this study to decipher the prevalence of colistin resistance in our tertiary care centre of North India. Materials and methodsThis was a prospective, case control study conducted over a period of one and half years. All carbapenem resistant Klebsiella pneumoniae and Acinetobacter isolates were included. Kirby-Bauer method of disc diffusion was used for all antibiotics, except colistin for which broth microdilution was performed and interpreted using CLSI guidelines. Demographic details, risk factors and outcome details were recorded. Genotypic characterization was performed using representative strains, for blaNDM, blaKPC and blaOXA-48. ResultsOf 103 carbapenem resistant isolates, 7 were found to be colistin resistant. Median age was 43 years, with male:female ratio of 1.1:1. 35% isolates were from pus samples, followed by endotracheal aspirate. Colistin resistance was more in ICUs than wards. Presence of indwelling devices was noted as the most common risk factor, followed by previous antibiotic exposure and use of steroids/immunosuppressants. Indwelling devices, steroids/immunosuppressants usage, length of hospital stay, COPD, prior usage of carbapenems, piperacillin-tazobactam and colistin, usage of ampicillin-sulbactam during hospital stay, were statistically significant. Mortality was noted in 4 cases, with statistical difference between control and case arm. The blaNDM and blaOXA-48 were noted in 3 and 2 isolates respectively, with absence of blaKPC. ConclusionThe present study unravels incidence, risk factors and resistance encoding genes at our centre. This is of immense help in formulation of antibiotic policies and guidance for infection control measures.

Objective Identification Method of Cold-Front Precipitation in Winter Half Years over East Asia

Cold front is an important weather system that produces precipitation in East Asia. Under the background of global warming, extreme precipitation caused by cold fronts presents a significant increasing trend. Hence, it is very important to quantify the cold-front precipitation that may cause great damages. In this study, an objective identification method is proposed for cold-front precipitation, which can objectively identify the precipitation area affected by cold fronts. Then, the climatological characteristics and trends of cold-front precipitation over East Asia in the winter half years from 1989 to 2018 are investigated by using the ERA-5 reanalysis dataset. Based on the dataset of cold fronts and frontal zones, this method automatically distinguishes the precipitation area affected by cold fronts to quantitatively estimate cold-front precipitation. The results show that this identification method can well describe cold-front activities and associated precipitation during an extreme cold wave event that occurred in southern China in January 2016. In the past 30 years, cold fronts have significantly contributed to the precipitation in East Asia in winter half years. The areas with the maximum cold-front precipitation and maximum contribution rate of cold-front precipitation to total precipitation are located in the North Pacific storm track, cold-front precipitation exceeds 700 mm, and the contribution of cold-front precipitation to total precipitation exceeds 60%. In addition, the contribution rates of cold-front precipitation are also relatively large in the midlatitudes of East Asia, especially in North China and Northeast China, where cold-front precipitation accounts for 50%–60% of total precipitation. In East Asia, the total precipitation in autumn is greater than that in winter; however, cold-front precipitation and its contribution rate in winter are significantly more and larger than those in autumn. As the cold-frontal activity is more frequent and intense in winter, the rainfall in winter depends more on cold fronts. In the past 30 years, the trends of cold-front precipitation and total precipitation are consistent in most parts of East Asia, indicating that cold-front precipitation makes a great contribution to the trend of total precipitation in winter half years.

“Really being yourself”? Racial minority entrepreneurs navigating othering and authenticity through identity work

PurposeDrawing on an intersectional perspective on racial, migrant and entrepreneurial identities, this paper investigates the identity work of racial minority entrepreneurs with native-born and migrant backgrounds, confronted to experiences of othering in a White entrepreneurial ecosystem.Design/methodology/approachThe study takes a qualitative-interpretivist approach and builds on six cases of racial minority entrepreneurs in nascent stages of venture development within the Dutch technology sector. The dataset comprises 24 in-depth interviews conducted over the course of one and a half year, extensive case descriptions and online sources. The data is thematically and inductively analysed.FindingsDespite strongly self-identifying as entrepreneurs, the research participants feel marginalised and excluded from the entrepreneurial ecosystem, which results in ongoing threats to their existential authenticity as they build a legitimate entrepreneurial identity. Minority entrepreneurs navigate these threats by either downplaying or embracing their marginalised racial and/or migrant identities.Originality/valueThe study contributes to the literature on the identity work of minority entrepreneurs. The paper reveals that, rather than “strategising away” the discrimination and exclusion resulting from othering, racial minority entrepreneurs seek to preserve their sense of existential authenticity and self-worth, irrespective of entrepreneurial outcomes. In so doing, the study challenges the dominant perspective of entrepreneurial identity work among minority entrepreneurs as overly instrumental and market-driven. Moreover, the study also contributes to the literature on authenticity in entrepreneurship by highlighting how racial minority entrepreneurs navigate authenticity threats while building legitimacy in a White ecosystem.

Israel: Political Developments and Data in 2022

AbstractThe year 2022 marked the year of yet another parliamentary election, the fifth in three years, resulting, after just one and a half years, in the return of Benjamin Netanyahu as Prime Minister and the formation of a right‐wing government. All along 2022, the centre‐left coalition government was struggling to hold its narrow majority in the Knesset, and in June, it had lost its majority completely, having only 59 members. This forced the Prime Minister, Bennet, together with Lapid, the alternate Prime Minister, to call for a new election, which was held on 1 November. The results of the election were decisive and an all‐right‐wing coalition was formed with a majority of 64 seats in the Knesset. The coalition members included the leading party, Likud, along with the orthodox religious parties and the ultra‐right‐wing religious parties. On the left wing, two of the parties, Meretz and Balad, did not pass the electoral threshold.

A Study on Prognostic Factors in Management of Breast Carcinoma in A Tertiary Care Hospital

Breast cancer is the most common malignant tumor and leading cause of death in women worldwide. It accounts for 15% of all cancer deaths According to World Health Organisation (WHO), approximately 70% of breast malignancies occur in women with unknown risk factorsThe prognostic factor can be defined as a measurable variable which correlates with natural history of the disease. The most significant factor which influences prognosis in breast cancer is axillary lymph node involvement, which is usually assessed at time of surgery using sentinel lymph node biopsy or axillary lymph node dissection. The number of lymph nodal involvement is also significant. Involvement of 1-3 lymph nodes carry better prognosis than 4-9 and more than 9 lymph nodes involvement. Size of the tumour has long been recognized as a prognostic factor and as predictor of axillary node status, with larger tumours being associated with a bad prognosis and an increased incidence of nodal metastasis. This study is conducted in Department of General Surgery, SVRRGGH, Sri Venkateswara Medical College, Tirupati for a period of more than one and half year after getting approval from Institutional Ethical Committee on March 2021. A prospective study of 50 patients who fulfilled Inclusion Criteria is taken into consideration to know how prognostic factors like tumor size & grade, axillary lymphnode involvement are influencing the prognosis and management of breast carcinoma. Patients who took part in the study were from 28-68 years of age. Majority of people were in the age group of 46-55 years (38%). Increasing age, involvement of axillary lymph nodes, tumors with larger size and higher grade, and lymphovascular invasions are all associated with worse prognosis Keywords: Estrogen Receptor, Progesterone Receptor, Locally Advanced Breast Carcinoma

Effects of Single-Course Betamethasone on the Outcomes of Late Preterm Neonates.

Background Prenatal glucocorticoids are commonly used in pregnancies before 34 weeks of gestation in women at risk of preterm delivery; however, the effects of these drugs on late preterm infants (those born after the 34th week of pregnancy) are controversial. As a result, we aimed to investigate the effect of a single course of betamethasone (two doses of betamethasone every 24 hours) on the neonatal outcome of late preterm births. Methods We retrospectively assessed all spontaneous late preterm births (34-36+6 weeks of gestation) at a tertiary hospital in Iran over a period of two and a half years. Exclusion criteria included multiple pregnancies, induced labor, and fetal malformations identified in sonograms. Neonatal outcome measures encompassed first and five-minute Apgar scores, respiratory distress syndrome, neonatal death, birth asphyxia, and the need for positive pressure ventilation, continuous positive airway pressure, tracheal intubation, and surfactant. Baseline characteristics, such as maternal age, parity, fetal gender, and high-risk pregnancy, were considered confounding variables. High-risk pregnancies were defined as any cases involving prolonged rupture of membranes or maternal comorbidities such as severe anemia, preeclampsia, diabetes, or COVID-19. Results During the study period, there were 830 spontaneous preterm births at our center. Of these, only 195 (23.5%) received complete doses of betamethasone. Low birth weight was more common in mothers who did not receive betamethasone compared to those who did (63.6% vs. 41.2%). The mean gestational age was lower in mothers who received betamethasone than in those who did not. Respiratory distress syndrome was more common in mothers who received betamethasone (P<0.001, RR 2.11, 95% CI (0.98-4.18)). However, after adjusting for confounding factors, such as gestational age and birth weight, betamethasone did not increase the risk of respiratory distress syndrome. Other adverse neonatal outcomes did not differ significantly. Conclusions There were no differences in neonatal outcomes between those who received betamethasone and those who did not.

FRI224 A Rare Case Of Recurrent Paraganglioma Presented With Liver Metastasis

Abstract Disclosure: E. Gupta: None. M. Al Mushref: None. Malignant Paragangliomas (PGLs) and Pheochromocytomas (PCC) are extremely rare. Approximately 10% of PCCs and 25% of PGLs are metastatic. Metastatic PGLs typically occur in patients with predisposing genetic mutations. We present a case of recurrent metastatic PGL in a young female with no known genetic predisposition to metastatic disease occurring after surgical resection. Our patient is a 28-year-old female with a history of PGL status post left adrenalectomy and nephrectomy two and a half years prior who presented to the ED for abdominal pain. She was first diagnosed after being admitted for hypertensive emergency. During time of diagnosis, plasma and urinary metanephrines were significantly elevated at 1.13 nmol/L and 907 ug/gCr respectively and plasma and urinary normetanephrines were elevated at 80.2 nmol/L and 52043 ug/gCr respectively. MRI showed a 16 cm left retroperitoneal mass and MIBG scan showed increased uptake in the mass however no evidence of metastatic disease was noted then. The patient had immigrated from Haiti. Her mother had passed away at age 20 of unknown cause and her father has no known history. Genetic testing was negative for hereditary gene mutations including multiple SDHDs, VHL, NF1, MEN1 and MAX. Surgical exploration showed a giant left retroperitoneal neoplasm involving the left kidney and left adrenal and both organs were resected. Pathology revealed PGL, focally extending to peripheral specimen margin and benign retroperitoneal lymph nodes and soft tissues. Post-resection meta- and normetanephrines levels were normal. Unfortunately, the patient was lost to follow up after surgery. On this admission, she endorsed right lower quadrant abdominal pain. Plasma normetanephrine was 1.72 nmol/L, metanephrine was normal, and chromogranin A level was elevated at 545 ng/mL. CT scan revealed multiple hepatic lesions and MIBG scan further showed new increased uptake suggesting metastasis. The patient was asymptomatic and blood pressure remained normal during her hospitalization. Due to concerns of recurrent PGL with metastasis, she established care with Oncology for initiation of treatment. PGL is an extremely rare neuroendocrine tumor and is closely related to PCC. Sympathetic PGLs cause catecholamine surge symptoms but low volume disease may remain asymptomatic. Genetic predisposition is common in malignant PGL particularly succinate dehydrogenase mutation subunit B. Patients should be closely followed up to screen for recurrence and genetic testing should also be done. In our patient’s case, despite surgical resection and negative genetic testing, she developed recurrence of the PGL with new metastasis emphasizing the importance of close surveillance in the case of PGL to monitor for recurrence. Presentation: Friday, June 16, 2023

SAT576 Change Is Not Always For The Best! A Transformation of Papillary Into Metastatic Anaplastic Thyroid Carcinoma

Abstract Disclosure: J. Syeda: None. R. Zafar: None. K. Rajamani: None. INTRODUCTION: Anaplastic thyroid carcinoma (ATC) can occur de-novo or from preexisting well-differentiated thyroid carcinoma (1). The presence or absence of certain driver mutations can help predict the likelihood of this transformation process. We present a case of an elderly female with an initial diagnosis of well-differentiated papillary thyroid cancer (PTC) with a transformation into metastatic anaplastic thyroid carcinoma (ATC). CASE PRESENTATION: An 81-year-old female patient was initially seen 8 years ago with a 35-year history of goiter. At the initial presentation, she felt well and did not have any symptoms. Physical examination revealed an enlarged thyroid gland with left lobe nodularity. A thyroid ultrasound showed a multinodular thyroid gland including a 2x1.7x1.2 cm solid nodule with macro calcifications in the right lobe, 2.8x2.6x2.5 cm solid nodule, and 1.6x1.3x1.6 cm heterogeneous solid nodule with calcifications and irregular margins in the left lobe. She had a fine needle aspiration of these three nodules. The right nodule was non-diagnostic and both left nodules were positive for PTC. She underwent a total thyroidectomy and central lymph node dissection. Radioactive iodine treatment with 163mCi was administered after surgery. One and a half years after surgery, her thyroglobulin levels started trending upward. This led to a further workup including a PET/CT scan, which showed a hyper metabolic 6 mm left supraclavicular lymph node. Needle biopsy of this lymph node disclosed metastatic PTC. The pathologic diagnosis following surgical resection was positive for metastatic poorly differentiated thyroid carcinoma. A subsequent PET/CT scan and a thyroid ultrasound showed an abnormal uptake of the left neck lymph node and additional metastatic nodes in the left neck respectively. A core needle biopsy of these lesions was positive for ATC. Foundation One CDx testing was positive for BRAF V600E, TP53, and TERT promoter mutations. Cellblock from the initial thyroidectomy was reevaluated by pathology and confirmed no evidence of ATC. Foundation One CDx testing of the thyroidectomy specimen was positive for BRAF V600E and TERT promoter mutations. Surveillance imaging shows mediastinal adenopathy, left pleural thickening, and bone and liver metastases. DISCUSSION: Anaplastic transformation is not uncommon (1). This case supports the evidence that TERT promoter mutations may not trigger anaplastic transformation but may predispose to the aggressive PTC phenotype prone to conversion to ATC when one of the ATC-related “second hit” genetic events occurs (2). This case suggests that the “second hit” event is a TP53 mutation. The detection of a TP53 mutation in PTC with an aggressive phenotype may help predict anaplastic transformation. REFERENCES: 1-Endocrine Pathology. 2021 Mar; 32(3):347-356. 2- Semin Cancer Biol. 2020 Apr; 61: 23-29. Presentation: Saturday, June 17, 2023

FRI209 Psychiatric Illness Masking Autoimmune Polyglandular Syndrome In A Middle-aged Woman

Abstract Disclosure: L. Esper: None. A. Ibrahim: None. S. Sen: None. Introduction: Autoimmune polyglandular syndrome type 2 (APS-2) or Schmidt's syndrome, is a rare disorder characterized by the coexistence of autoimmune adrenal and thyroid disease and/or type 1 diabetes mellitus. Clinical case: A 51-year-old woman with past medical history of depression and bipolar disorder presented to the hospital with weakness and dizziness. The patient reported increased dizziness and weakness over several months that progressed and limited her level of daily activities. She had been experiencing decreased energy, poor appetite and occasional nausea but denied vomiting or abdominal pain. She also denied any changes in her weight. She suffered from constipation but that was her baseline for many years. She was diagnosed with bipolar disorder with depression in her 20s and required multiple admissions for severe depression. She had been following up with her psychiatrist and assumed to have worsening depression. Her mood stabilizers and antidepressant medications were adjusted over several months without improvement. In the Emergency Department, her blood pressure was 98/58. Her heart rate was 57. Labs revealed Na: 115, K: 5.3 and Cr:0.87. The patient was admitted to the general medical floor for treatment of symptomatic hyponatremia. Hyponatremia was initially thought to be due to depression and decreased oral intake. She was started on fluid with slight improvement in sodium levels without significant improvement in symptoms. Further work up for the etiology of her hyponatremia and weakness elicited 2 endocrinopathies. She had a morning cortisol of 4. Cosyntropin stimulation test did not elicit a proper response. At baseline, cortisol was 4.2 and then 4.5 and 4.3 at 30 and 60 minutes, respectively. She was also found to have hypothyroidism (TSH 10, FT4: 0.4). Patient was started on hydrocortisone and fludrocortisone initially and subsequently thyroid hormone replacement was added with resolution of symptoms and hyponatremia. She reported being postmenopausal since age 41. Given that the patient had at least two endocrinopathies, 21 hydroxylase antibody testing was ordered and found to be positive. Addison's disease diagnosis is often delayed. A cross-sectional study in 2013 showed that less than 50% of patients with adrenal insufficiency were correctly diagnosed within the first half year after symptoms appeared. It however took more than 5 years until the condition was diagnosed for 20% patients. (1) The delay was primarily attributed to concomitant presence of psychiatric and gastroenterological conditions. Conclusion: Poly endocrinopathies often present with vague symptoms that need to be worked up to prevent the life-threatening effects of APS2 including adrenal crisis. We present an uncommon case of middle-aged woman with Tri-glandular syndrome with delayed diagnosis due to underlying psychiatric disease. (1) Meyer et al. Horm Metab 2013; 45:92-95 Presentation: Friday, June 16, 2023

Mode of Injury, Involvement of Bones and Post-Operative Surgical Outcomes of Patients presented with Lower Limbs Fractures attended at a Tertiary Care Hospital at Tourist City of Bangladesh

Background: Surgical management is very much crucial among the lower limb fracture patients.&#x0D; Objective: The purpose of the present study was to find out the mode of injury, involvement of bones and post-operative surgical outcomes of patients presented with lower limbs fractures patients.&#x0D; Methodology: This prospective hospital-based study was conducted in the Department of Orthopaedic and Traumatology at Cox’s Bazar Medical College Hospital, Cox’s bazar, Bangladesh from January 2019 to June 2022 for a period of three and half years. All the patients who were presented with the clinical features of fracture of lower limbs were selected as study population. The patients were managed by conservative or surgical way. The outcomes of both procedures were recorded.&#x0D; Results: A total number of 370 cases were recruited for this study. The mean age with SD of the study population was 18.2±11.56 years. Among these road traffic accident was the most common mode of injury which was 204(55.0%) cases. Open type of fracture was found in 141(38.0%) cases and the close was found in 229(62.0%) cases. The most common bones involved was the shaft of tibia and fibula which was 159(43.0%) cases. During conservative treatment mal-union was reported in 193(66.8%) cases and the rest of the 96(33.2%) patients had shown the stiffness. Among 81 operated cases majority were recovered which was 70(86.0%) cases. However, death was found in 2(2.0%) cases. Minor and major infection were reported in 6(8.0%) cases and 3(4.0%) cases respectively.&#x0D; Conclusion: In conclusion the most common mode of injury is road traffic accident with the involvement of shaft of tibia and fibula with majority improvement.&#x0D; [Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):60-64]

Utility of glutaraldehyde-fixed turkey red blood cells for influenza virus detection after 18 months of storage

Turkey red blood cells (tRBCs) are an essential reagent used in the laboratory diagnosis of influenza viruses. Fresh tRBCs when stored at 4 °C have a shelf life of less than a week. Previous studies have shown the utility of glutaraldehyde-fixed tRBCs, with an increased shelf life, for use in hemagglutination (HA) assays. In the present study, we report their functionality after storage for 18 months, at -80 °C. Three influenza A subtypes, namely, H3N2, H1N1 and H5N1, were used in the study. Hemagglutination assay was performed using freshly prepared 0.5 % tRBCs suspension and stored 1 % glutaraldehyde-fixed tRBCs. There was no significant difference in the HA titers obtained using fresh and stored tRBCs. The validation of the HA assay was carried out, to determine the specificity, linearity, precision, accuracy, and robustness of the assay. All of the titers were within the acceptable range, indicating the validity of the HA assay using stored tRBCs. Hemagglutination inhibition assay was also performed to compare the antibody titers obtained using stored and fresh tRBCs. The stored RBCs also gave equivalent antibody titers, as compared to the fresh tRBCs. Thus, the present study demonstrates the utility of glutaraldehyde-fixed tRBCs after one and a half years of storage.

The Ukrainian War

Abstract This article presents the Polish perspective together with Poland's response to the war in Ukraine. Because the situation is quite dynamic, the report documents the early period, that is, approximately the first half year of the conflict. Social consequences such as the flood of refugees from the war-torn country to Poland are examined, also with a view of how it affected resident Ukrainians at the time. In its position as a North Atlantic Treaty Organization eastern flank country, the organization's summit in Madrid at the end of June 2022 and how it was evaluated by Poles is of significance. Moreover, the acceptance of the candidacy of Ukraine as a potential member in the European Union led to a robust discussion in Poland that merged with the discussion on the results of the NATO summit. The internal situation in Ukraine and the military situation is not studied except where it arises in the discussion of Poles or EU members.

Unresolved pain in a middle-aged woman: an integrated family medicine approach

47 years old woman had applied to the outpatient clinic as she was suspicious because of COVID-19. The patient has non-specific symptoms such as fever, pain, and anosmia. The family physician has prescribed Enfluvir, vitamin D, etol-fort tb . After the medication, she has come to the clinic again because of the not finished pain. The family physician that the first one consulted has ordered Magnetic Resonance Imagining for the sacroiliac region as the patient told that the pain when she was sitting for at least two and half years and nowadays her pain was more although she was taking her painkillers. According to the non-contrast, MRI of the sacroiliac joint: “ joint surfaces exhibit irregularity and narrowing. In the posterior, more prominent articular surfaces on the right in the fat-suppressed axial and coronary sequences, there is focal bone marrow edema and sacroiliitis activation. The right adnexa within the sections showed an 8 cm cystic appearance. MRI and USG of the lower abdomen are advised.”. The lab and also with IV contrast, MRI of the pelvis, and ultrasonography were planned with the rheumatology and gynecology consultations.

The effectiveness of the early habilitation complex in premature infants according to N.A. Bernstein’s concept

BACKGROUND: Currently, the incidence of developmental disorders and the level of disability in premature infants, especially those born with a low and extremely low body weight, remain high, that determines the relevance of habilitation methods.&#x0D; AIM: to develop and evaluate the effectiveness of the early habilitation complex in premature infants with a perinatal brain damage when transferring to the stage III of rehabilitation.&#x0D; MATERIALS AND METHODS: The study included 86 patients born with a very low and extremely low body weight, who had a hypoxic-ischemic or hemorrhagic brain damage and were observed at the Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan during the first three years of life. A comparative analysis of the development and functional outcomes of the disease was carried out for children of two groups. The first group, when transferred to the stage III of rehabilitation, was assigned a complex of early sensorimotor habilitation, developed on the basis of N.A. Bernsteins concept to be carried out at home for three months after an appropriate training. The second group was not prescribed such a complex.&#x0D; RESULTS: The effect of the early sensorimotor rehabilitation complex on the functional (motor, speech and cognitive) outcomes in prematurely born patients was evaluated and described. In the first group with an assigned complex of sensorimotor exercises, despite the absence of a significant effect by the age of 6 months, it was found by the age of one and a half years, that the average indices of the development of large (p=0.022) and fine motor skills (p=0.023), expressive speech (p=0.006) and cognitive functions (p=0.040) were higher, while, by the age of three years, the differences in speech (p=0.001) and cognitive (p=0.001) outcomes retained their statistical significance compared to the development indicators in children who did not receive the same early habilitation complex.&#x0D; CONCLUSION: It was found that premature infants who received the early habilitation complex had better speech and cognitive outcomes by the age of three, compared to patients who did not receive the complex. The significance of the positive influence on the ontogenesis of motor skills persists during the second year of life.

Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients

Objectives This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. Method: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. Results: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). Conclusion: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.

Clinical characteristics and risk factors of acute lymphoblastic leukemia in children with severe infection during maintenance treatment.

Infection is the most common adverse event of acute lymphoblastic leukemia (ALL) treatment and is also one of the main causes of death. To investigate the clinical characteristics and risk factors of severe infections during the maintenance phase of ALL treatment, we conducted a retrospective study. A total of 181 children were eligible and 46 patients (25.4%) suffered from 51 events of severe infection, most of which occurred in the first half year of the maintenance phase (52.9%). The most common infection was pulmonary infection (86.3%) followed by bloodstream infection (19.6%). The main symptoms of ALL patients with pulmonary infection were fever, cough, and shortness of breath. The main manifestations of computer tomography (CT) were ground glass shadow (56.8%), consolidation shadow (27.3%), and streak shadow (25%). Multivariate binary logistic regression analysis showed that agranulocytosis, agranulocytosis ≥7 days, anemia, and low globulin level were independent risk factors for severe infection during the maintenance phase (all p < 0.05). Taken together, blood routine examinations and protein levels should be monitored regularly for ALL patients in the maintenance phase, especially in the first 6 months. For ALL patients with risk factors, preventive anti-infective or supportive therapies can be given as appropriate to reduce the occurrence of severe infections.

Anxiety and Depression and Health-Related Quality of Life in Adults with Gastroesophageal Reflux Disease: A Population-Based Study.

Adults with gastroesophageal reflux disease (GERD) are susceptible to mental disorders that might significantly affect their health-related quality of life (HRQoL). Therefore, the purpose of this study was to evaluate how HRQoL in individuals with GERD is related to coexisting anxiety and depression. A cross sectional study was conducted among 3068 adult patients 22 years of age and older with GERD diagnoses have been identified using the data from the Medical Expenditure Panel Survey from 2017 to 2020 for United States adults. Data are gathered by MEPS using an overlapping panel design over a period of two and a half years. HRQoL was established using the Physical and Mental Component Summary (PCS & MCS) values from the SF-12. Multivariate forward linear regression analysis was used to assess the relationship between anxiety, depression, and HRQoL in people with GERD after accounting for various factors. Of the 3068 people with GERD who had been identified, 56.4% were women, 59.4% were in their 50s or 60s and 64.8% were employed. Thirteen per cent of people with GERD had depression, thirteen per cent had anxiety, and ten per cent had both. Adults with concurrent anxiety and depression had the lowest mean PCS and MCS scores compared to those with GERD. After adjusting for all independent factors, GERD patients with anxiety (MCS = -10.819, p-value < 0.0001), depression (MCS = -6.395, p-value < 0.0001), and both (MCS= -42.869, p-value < 0.0001) had substantially worse HRQoL than those without these comorbidities. Notably, better HRQoL scores were positively associated with marital status, employment, perceived overall health, and physical activity. The results from this nationally representative sample shed insight into the relationships between low HRQoL and anxiety and depression among individuals with GERD. It also demonstrated the detrimental impacts of co-occurring chronic illnesses, low socioeconomic status, and the positive benefits of employment and exercise on HRQoL. This study emphasizes the clinical, policy, and public health implications for better healthcare, allocation of resources, and promotion of lifestyle modifications to improve the HRQoL in patients with GERD.

Utilization of a new restoration technique for the rehabilitation of a degraded mangrove ecosystem: a case study from Koggala Lagoon, Sri Lanka

Mangrove ecosystems, amongst the most productive and biologically complex on Earth, are being degraded worldwide, and their widespread decline during the past decades has affected vital ecosystem services. Mangroves at Koggala lagoon on the southern coast of Sri Lanka have been degraded at an alarming rate due to agricultural practices, coastal zone development, and tourism activities. Most of the banks are heavily eroded due to boat and sea plane activities, and the mangrove ecosystem has been significantly damaged. Implementation of a scientific rehabilitation project was needed to restore this degraded mangrove ecosystem, and research was carried out to enrich the mangrove community by re-establishing mangroves on the eroded banks using corrosion-resistant plastic barrels. The sustainability of replanted mangroves was monitored under phase one and the re-establishment of ecological functions in the mangrove community was monitored under phase two. The accumulated biomass carbon during the period of two and half years was calculated by an allometric equation suggested for calculating biomass carbon of mangroves using the girth and height of individuals. The highest rate of girth increment was observed by the 24th month from establishment, whilst the growth rate declined between the 18th and the 30th months. During the study period, the average above-ground and below-ground biomass per barrel showed a linear increment. Our case study showed that the new method used for restoration is successful in establishing mangroves in sites with high erosion. This restoration technique was successful in coping with the situation in Koggala lagoon where previous restoration attempts were failures. Thus, we recommend this restoration method for sites facing the threat of severe erosion.

An Individualized Homoeopathic Approach in a Case of Palmar Wart- A Case Report

Background: Palmar warts are benign skin and mucous membrane lesions, caused by human papilloma virus (HPV) infection. In this case a 32 years old woman visited our outpatient department for the complaint of outgrowths over the front and back of both hands which was clinically diagnosed to be palmar warts along with headache. Methods: After detailed case taking and repertorization, at first individualized homoeopathic medicine, Natrum-muriaticum 200c was given and thereafter other drugs as per the indication were given. Within about one and half year of homoeopathic treatment, the patient started improving and continues to be free from her complains at the time of last followup visit in OPD and leaving a clear smooth skin demonstrating a positive role of individualised homoeopathic treatment in a case of verruca vulgaris. Results: Modified Naranjo Criteria for Homoeopathy tool was used to assess the causal relationship between homoeopathic intervention and clinical outcome. The MONARCH score(+9) suggested that the clinical improvement was likely attributable to the homoeopathic treatment, which is also evident from photographic images. Conclusions: This case study shows the utility of individual homoeopathic treatment in case of palmar wart. More studies and evidenced based clinical verification is required to establish the efficacy of homoeopathy in such cases.