Approach to fever in children.

Background: Fever in children is one of the most common reasons for outpatient visits as well as in-patient evaluation, often causing anxiety among parents and caregivers. Fever can be a standalone feature or be associated with other localising symptoms and signs like rash, lymphadenopathy, or any other organ system involvement with or without a focus of infection. The etiologies of fever vary depending on the clinical setting and epidemiology.

Comparative analysis of pink and white esthetics of anterior full veneer crown: Indian scenario.

A goal of modern dentistry is to make an esthetic outcome as one of the major modalities in dental treatment. In recent years, more emphasis has been given to esthetic parameters, especially in the anterior regions. The aim of this study was to evaluate the presence of change in pink and white esthetics scores after giving crowns in a single tooth.

Litchi consumption and missed meals continue to be associated with acute encephalopathy syndrome among children: an investigation of the 2019 outbreak in Muzaffarpur district, Bihar, India.

Background: Muzaffarpur district in Bihar State of India recorded a resurgence of acute encephalopathy syndrome (AES) cases in the summer of 2019 after no reported outbreak in 3 y. Earlier studies generated evidence that litchi consumption and missing the previous evening's meal were associated with AES. We investigated the recent outbreak to understand the risk factors associated with AES.

Computational and Experimental Evaluation of the Stability of a GLP-1-like Peptide in Ethanol-Water Mixtures.

Aggregation resulting from the self-association of peptide molecules remains a major challenge during preformulation. Whereas certain organic solvents are known to promote aggregation, ethanol (EtOH) is capable of disrupting interactions between peptide molecules. It is unclear whether it is beneficial or counterproductive to include EtOH in formulations of short peptides.

Discovering Novel Small Molecule Compound for Prevention of Monoclonal Antibody Self-Association.

Designing an antibody with the desired affinity to the antigen is challenging, often achieved by lengthening the hydrophobic CDRs, which can lead to aggregation and cause major hindrance to the development of successful biopharmaceutical products. Aggregation can cause immunogenicity, viscosity and stability issues affecting both the safety and quality of the product. As the hydrophobic residues on the CDR are required for direct binding to antigens, it is not always possible to substitute these residues for aggregation-reduction purposes.

An outbreak of bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network.

Objective: The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network.

Setting: A 780-bed, tertiary-level, public teaching hospital in northern India.

An algorithmic approach to identifying the aetiology of acute encephalitis syndrome in India: results of a 4-year enhanced surveillance study.

Background: Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. Although Japanese encephalitis virus (JEV) accounts for around 15% of reported cases, the aetiology of most cases remains unknown. We aimed to establish an enhanced surveillance network and to use a standardised diagnostic algorithm to conduct a systematic evaluation of acute encephalitis syndrome in India.

Demographic and clinical characteristics of patients who recommence clozapine following therapy interruptions.

Objective: The proportion of patients who recommence clozapine after cessation, the time taken to resume clozapine post-cessation, and distinguishing demographic and clinical characteristics of this group have been poorly researched. We evaluated these in the current study.

Method: We retrospectively extracted selected demographic and clinical variables and clozapine treatment interruption and recommencement data up to December 2018 of a cohort of 458 patients who first commenced clozapine between 2006 and 2016.

Outbreak investigation of foodborne illness among political rally attendees, Cuddalore, Tamil Nadu, India.

In July 2015, we investigated a foodborne illness outbreak in Sithalikuppam and Verupachi villages, Cuddalore district, Tamil Nadu, among the political rally attendees to determine the risk factors for illness. We conducted a retrospective cohort study, calculated risk ratio for the food exposures, and cultured stool specimens. Of 55 rally attendees, we identified 36 (65%) case patients; 32 (89%) had diarrhea and 20 (56%) had vomiting.

Shellfish poisoning outbreaks in Cuddalore District, Tamil Nadu, India.

Background: Two suspected shellfish poisoning events were reported in Cuddalore District in Tamil Nadu, India, between January and April 2015.

Objectives: The study was conducted to confirm the outbreaks and to identify the source and risk factors.

Methods: For both outbreaks, a case was defined as a person with nausea, vomiting, or dizziness.

A Retrospective Study on Implant Prosthesis in Missing Maxillary Anteriors among Middle-Aged Adults.

The ultimate goal of modern dentistry is to restore the normal comfort, contour, function, aesthetics, health, and speech of a patient's dentition while restoring or replacing teeth. When it comes to the anterior region, particularly the maxillary anteriors, aesthetics is of prime importance as it shapes the smile and builds confidence. The most ideal treatment option for replacement of a single missing tooth in the anterior region is placement of an implant.

Evaluation of a hospital-based surveillance system for birth defects in Chennai, India.

The Birth Defects Registry of India-Chennai (BDRI-C) was created in 2001 to monitor birth defects and provide timely referrals. Using established guidelines to evaluate surveillance systems, we examined the following attributes of BDRI-C to help strengthen the registry: simplicity, flexibility, data quality, representativeness, acceptability, timeliness, and stability. We reviewed BDRI-C documents, including reporting forms; interviewed key informants; and calculated data completeness, coverage, and reporting time.

Effect of novel cycloaliphatic comonomer on the flexural and impact strength of heat-cure denture base resin.

This study aims to evaluate the impact of adding a novel tricyclodecane dimethanol diacrylate comonomer on the flexural strength (FS) and impact strength (IS) of heat-cure denture base resin at 10% and 20% (v/v) concentrations. To test the FS and IS, a sum total of 150 bar-shaped specimens were prepared according to standard specifications. For the FS, the specimens were subjected to the three-point bend test with a span length of 50 mm.

Mental health recovery and physical health outcomes in psychotic illness: Longitudinal data from the Western Australian survey of high impact psychosis catchments.

Objective: There is a dearth of longitudinal data on outcomes in prevalent cases of psychotic illness across a range of ages and levels of chronicity. Our aim was to describe changes over time in mental and physical health outcomes, as well as patterns of service utilisation that may have influenced outcomes, in a representative prevalence sample of 641 Western Australians with a psychotic illness who, at Wave 1, were part of the National Survey of High Impact Psychosis.

Methods: In Wave 1 (2010, 2012), a two-phase design was employed to ensure representativeness: Phase 1 psychosis screening took place in public mental health and non-government organisation services, while, in Phase 2, a randomised sample was interviewed.

The Wellness Clinic: A retrospective Quasi-experimental, longitudinal study of physical health support in an Australian mental health service setting.

The poor physical health of patients with severe/chronic mental illness is now well-known, yet little has been done to address the issue. Adverse medication effects, lifestyle, and social factors can all contribute to high morbidity and mortality rates when compared to the general population. To arrest poor physical health, a Wellness Clinic within a mental health hospital was developed to provide continuity of care when patients were discharged from the hospital.

The physical health Wellness Clinic model of care for patients with mental health issues who are 'hard to engage'.

Objective: People with chronic and severe mental health issues die 15-25 years earlier than people in the general population - the main reason for this is poor physical health. An innovative treatment model for the management of primary care within a mental health service setting for 'hard to engage' patients is presented.

Conclusion: The Wellness Clinic model provides the final level of care, where individuals who are at risk will receive a thorough physical health check and be referred for any additional tests and scans that are needed ensuring that any health issues are addressed.

Multiple importations and transmission of colistin-resistant in a hospital in northern India.

Objective: Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.

Design: Retrospective observational study.

Hybrid optimization of preparative chromatography for a ternary monoclonal antibody mixture.

In the purification of monoclonal antibodies, ion-exchange chromatography is typically used among the polishing steps to reduce the amount of product-related impurities such as aggregates and fragments, whilst simultaneously reducing HCP, residual Protein A and potential toxins and viruses. When the product-related impurities are difficult to separate from the products, the optimization of these chromatographic steps can be complex and laborious. In this paper, we optimize the polishing chromatography of a monoclonal antibody from a challenging ternary feed mixture by introducing a hybrid approach of the simplex method and a form of local optimization.

Stability of two competing populations in chemostat where one of the population changes its average mass of division in response to changes of its population.

This paper considers a novel dynamical behaviour of two microbial populations, competing in a chemostat over a single substrate, that is only possible through the use of population balance equations (PBEs). PBEs are partial integrodifferential equations that represent a distribution of cells according to some internal state, mass in our case. Using these equations, realistic parameter values and the assumption that one population can deploy an emergency mechanism, where it can change the mean mass of division and hence divide faster, we arrive at two different steady states, one oscillatory and one non-oscillatory both of which seem to be stable.

Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): Results from a four year AES surveillance study of Japanese encephalitis in selected states of India.

Background: Acute encephalitis syndrome (AES) surveillance in India has indicated that Japanese encephalitis virus (JEV) accounts for 5-35% of AES cases annually; the etiology remains unknown in the remaining cases. We implemented comprehensive AES surveillance to identify other etiological agents of AES, with emphasis on dengue virus.

Methods: Serum and cerebrospinal fluid (CSF) specimens were collected from patients enrolled prospectively in AES surveillance from 2014-2017 at selected sites of three high burden states of India.

Risk Factors for Acquiring Scrub Typhus among Children in Deoria and Gorakhpur Districts, Uttar Pradesh, India, 2017.

Scrub typhus is associated with outbreaks of acute encephalitis syndrome in Uttar Pradesh, India. A case-control study indicated that children residing, playing, or visiting fields; living with firewood stored indoors; handling cattle fodder; and practicing open defecation were at increased risk for scrub typhus. Communication messages should focus on changing these behaviors.

Data-driven multi-objective optimization via grid compatible simplex technique and desirability approach for challenging high throughput chromatography applications.

Recently, a grid compatible Simplex variant has been demonstrated to identify optima consistently and rapidly in challenging high throughput (HT) applications in early bioprocess development. Here, this method is extended by deploying it to multi-objective optimization problems. Three HT chromatography case studies are presented, each posing challenging early development situations and including three responses which were amalgamated by the adoption of the desirability approach.

Modulator Dynamics Shape the Design Space for Stepwise-Elution Simulated Moving Bed Chromatographic Separations.

For proteins and other biological macromolecules, SMB chromatography is best operated non-isocratically. However, traditional modes of non-isocratic SMB operation generate significant mobile-phase modulator dynamics. The mechanisms by which these modulator dynamics affect a separation's success, and thus frame the design space, have yet to be explained quantitatively.