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Band-pass limiting filter based on microstrip comb line structure
Yuanxin Li
Mingtuan Lin

Yuanxin Li

and 3 more

August 16, 2022
A band-pass limiting filter (BPLF) based on a microstrip comb line loaded with PIN diodes is proposed in this letter. In contrast to conventional comb line filter designs, the BPLF utilizes PIN diodes to replace capacitor components. When the power of the input signal is below a certain level, the proposed BPLF acts as a filter. While for an input signal whose power is above a certain level, it behaves like a limiter. According to measurement data, the proposed BPLF has a broad passband with an insertion loss of about 3.5 dB from 8.2GHz to 9.0GHz, and a low limiting level of less than 17dBm with a high power input of 50W (47dBm). In general, the proposed BPLF enables dual selectivity of frequency and power, and can be applied to the front end of RF channels.
A 1.2V High-speed Low-power Preamplifier Latch based Comparator
Yue feng He
Guo shun Yuan

Yue feng He

and 1 more

August 16, 2022
The power consumption of chips has emerged as a major concern with the increased integration of analog circuitry. This work focuses on a two-stage comparator based on a preamplifier with latch for successive approximation analog-to-digital converter. In order to minimize power loss and delay time, the charge steering approach was used in the design of latch as well as preamplifier. The suggested comparator is simulated in SMIC 0.18um process in comparison to the comparator without charge steering mode. The results reveal that the average power consumption is only around 22uW for varied input voltage at a supply voltage of 1.2V, which is relatively lowered by approximately 30%. Meanwhile, delay time is also reduced by about 25%.
Investigation of bioactive nanofiber-based scaffolds for cultivated meat.
Ana Elisa Antunes dos Santos
Tiago Cotta

Ana Elisa Antunes dos Santos

and 12 more

August 16, 2022
Synthetic polymers scaffolds often need to be coated with extracellular matrix (ECM) proteins to improve cell adhesion. For cultivated meat applications, coating should be avoided since it is necessary to eliminate expensive and animal-derived components. As cellulose acetate nanofibers is a low-cost cellulose-derived material, that induces cell adhesion and proliferation, we investigated its use associated with a bioactive annatto extract, a food-dye and potential meat preservative, as scaffolds for cultivated meat. Here, the bioactive electrospun nanofibers were evaluated through morphological, mechanical and biological characterizations. The results revealed that the scaffolds were porous with no specific alignment and average fiber diameter of 420±212 nm. Molecular analyzes revealed that in contrast to cellulose acetate scaffold, annatto-loaded cellulose acetate scaffold favor a proliferative state of C2C12 mouse skeletal myoblasts. SEM microscopy images suggests that the nanofiber substrates can sustain long-term culture of the cells, up to 28 days. These results suggest that the combination of cellulose acetate fibers loaded with annatto extract may be an interesting economical alternative for support long-term muscle cells culture with potential application as a scaffold for cultivated meat and muscle tissue engineering.
Tunable Negative Group Delay of Rectangular Waveguide Based on Corrugated Tantalum Ni...
Zheng Liu
Jian Zhang

Zheng Liu

and 5 more

August 16, 2022
In this letter, a rectangular waveguide with tunable negative group delay (NGD) is proposed. Corrugated tantalum nitride (TaN) slow wave structure is used to generate the NGD response. The NGD value and NGD center frequency can be adjusted continuously by the corrugation width and height. The simulation results show that the NGD values of up to -0.7 ns are potentially available. A prototype of the proposed structure is fabricated and measured. The measured results show the fabricated structure is capable of generating up to -0.115 ns group delay at 19.4 to 19.8 GHz which is consistent with simulation predictions. To our best knowledge, this is the first time that the negative time delay has been realized at Ka-band in rectangular waveguide.
Rheology of microalgae concentrates and its influence on the power consumption of enz...
Solaima Belachqer-El Attar
Ainoa Morillas España

Solaima Belachqer-El Attar

and 4 more

August 16, 2022
The optimization of downstream processing is a critical step in any microalgae-related process. The microalgal biomass is separated from the initial diluted cultures to form a concentrated slurry, the properties of which greatly influence the design and performance of further processing steps, such as enzymatic hydrolysis. In this work, the rheological behaviour of two microalgae concentrates produced both in freshwater (Scenedesmus almeriensis) and seawater (Nannochloropsis gaditana) were studied. Measurements were performed on the entire range of biomass concentrations, from 0.5 g/L to 264 g/L. Non-Newtonian behaviour was observed whatever the water type and biomass concentration used, especially at high biomass concentrations above 10 g/L. The rheological data were adjusted to the Power Law model, and the consistency and flow behaviour indexes were correlated with the biomass concentration. The results show that the freshwater and seawater biomass exhibited different behaviour, with freshwater slurries being more viscous than seawater ones. The high viscosity of freshwater slurries requires increased energy consumption for mixing, with an estimated cost increase of 60% when using them under the non-Newtonian conditions considered. These findings highlight the considerable effect of algae biomass rheology on the mixing power required during microalgae biomass processing.
“Ruptured Uterus in a Primigravida due to Thoraco-Omphalopagus Conjoined Twins: A Cas...
Yasmeen Haseeb

Yasmeen Haseeb

August 16, 2022
A document by Yasmeen Haseeb. Click on the document to view its contents.
Community structure and diversity of endophytic bacteria in different niches of camel...
shunxing Yang
zhannan Yang

shunxing Yang

and 3 more

August 16, 2022
Endophytic bacteria are important for plant growth, stress tolerance and metabolite synthesis. Camellia oleifera is a unique woody oil crop in China, and the bacterial communities at different niches have not been fully reported. To investigate the structural characteristics and diversity of bacterial communities in different niches of C. oleifera, we applied high-throughput sequencing technology on the Illumina MiSeq platform to explore the diversity of bacteria species in roots, stems, leaves, inter-rhizosphere soils and non-rhizosphere soils of C. oleifera. We obtained 3,127 OTUs (operational taxonomic units) from five samples, belonging to 16 phyla, 58 orders, 91 families, 162 families and 249 genera; the abundance and diversity of bacterial communities in different niches of C. oleifera decreased from bottom to top; the absolute dominant species in different tissues of C. oleifera were the same at different levels except for soil, and there were specific bacterial communities in roots and stems of C. oleifera. The KEGG functional predictions revealed that endophytic bacteria were involved in a variety of metabolic pathways, including functional information related to human diseases. The structure and diversity of endophytic bacterial communities in different niches of C. oleifera showed a bottom-up filtering selection mechanism, and the bacterial communities in different niches differed significantly in structure and functional information, providing favourable information for the functional use of endophytic bacteria and the exploitation of new beneficial microbial resources, which is worth further research and exploitation.
The vaginal outlet wall anatomy: A prospective case series study
Adam Ostrzenski

Adam Ostrzenski

August 16, 2022
The vaginal outlet wall anatomy: A prospective case series study Abstract Objectives To describe and document the anatomical and histological architecture of the vaginal outlet wall. Design A prospective observational case series study. Setting International centers. Population Twelve fresh human female cadavers. Methods Female corpses were subjected to stratum-by-stratum, macro-, and micro-anatomical dissections in sagittal, transverse, and coronal planes. The multiple excisional biopsies were obtained from the vaginal outlet wall at 12, 3, 6, and 9 o’clock locations for histological examination. Digital photograms documented the anatomical and histological features. Primary Outcome measures Gross, topographic anatomy, and characteristic histologic features of the vaginal outlet wall. Results The vaginal outlet wall (VOW) was positioned in the vertical orientation and fused with horizontally located the vaginal wall at the hymeneal plate level. The hymeneal membrane and ring were not attached directly to the vaginal wall. VOW had three identifiable anatomical-histological layers a) the hymeneal membrane, b) the hymeneal ring (cartilage) with different anatomy and histology than the vaginal wall, and c) the hymeneal plate (the deep level of VOW), which connects to the vaginal wall. Conclusions The vaginal outlet wall is an anatomical structure consisting of the hymeneal membrane, hymeneal ring (cartilage), and hymeneal plate. This structure is in vertical topographic orientation. Anatomically and histologically, it differs from the vaginal wall, which fuses with the deep layer of the hymeneal plate.
Multi Attribute Monitoring Method for Process Development of Engineered Antibody for...
Alistair R. Hines
Matthew J. Edgeworth

Alistair R. Hines

and 8 more

August 16, 2022
Antibody drug conjugates are a class of biotherapeutic proteins which have been extensively developed in recent years resulting in new approvals and improved standard of care for cancer patients. Among the numerous strategies of conjugating cytotoxic payloads to monoclonal antibodies, insertion of a cysteine residue at position 239 (C239i) achieves a tightly controlled, site specific drug to antibody ratio. Tailored analytical tools are required to direct the development of processes capable of manufacturing novel antibody scaffolds with the desired product quality. Here, we describe the development of a high throughput, 12-minute, mass spectrometry based method capable of monitoring four distinct quality attributes simultaneously: variations in the thiol state of the inserted cysteines, N-linked glycosylation, reduction of inter-chain disulphide bonds, and polypeptide fragmentation. When deployed, the method provided new insight into the properties of C239i antibody intermediate and its manufacturing processes. First, C239i forms exclusively oxidised thiol states within the bioreactor, of which a variant containing an additional disulphide bond was invariably produced and remained relatively constant throughout the fed-batch process; reduced thiol variants were introduced upon harvest. Second, close to twenty percent of N-linked glycans contained sialic acid, substantially higher than anticipated for wildtype IgG1. Lastly, previously unreported polypeptide fragmentation sites were identified in the C239i constant (C H2) domain and the relationship between fragmentation and glycoform explored. This work illustrates the utility of applying a high-throughput liquid chromatography mass spectrometry (LC-MS) multi-attribute monitoring method to support the development of engineered antibody scaffolds.
Varicella Zoster Viral Infection Complicating into Necrotizing Fasciitis: A Case Repo...
Nissar  Shaikh
Umm-e Amara

Nissar Shaikh

and 6 more

August 16, 2022
A 35 years old female presented to the ED with severe pain and right thigh discharge for 2 days. She gave a history of chickenpox 2 weeks ago and received ibuprofen for excruciating pain. She was immediately diagnosed with necrotizing fasciitis and shock.
Comparison of prenatal ultrasonography and fetal MRI in diagnosing neural tube defect...
Mengchun Sun
Gan Gao

Mengchun Sun

and 4 more

August 16, 2022
Objective: To compare the diagnostic accordance rate between prenatal ultrasonography and fetal magnetic resonance imaging (MRI) for varied neural tube defects (NTDs), and introduce detailed prenatal imaging characteristics of multiple NTDs. Design: A prospective observational study Setting: Chinese PLA General Hospital Population: The fetuses developing possible NTDs. Method: We prospectively followed up the fetuses and collected their data of prenatal ultrasonography, fetal MRI, and postnatal MRI examinations. Fisher’s exact test was used to perform the statistical analysis. A P value of < 0.05 was considered statistically significant. Main Outcome Measures: The diagnostic accordance rate of prenatal ultrasonography and fetal MRI for each involved NTD, prenatal imaging characteristics of each involved NTD. Results: We included 119 fetuses with 11 NTDs. Ultrasonography revealed a significant advantage in diagnosing spina bifida (P < 0.05) and a relative advantage in diagnosing intraspinal cyst, dermal sinus, and skin mass. MRI demonstrated intraspinal lipoma better (P < 0.05), and was appropriate for identifying complex malformations. Both could accurately diagnose tethered cord syndrome (without intraspinal lesions), meningocele/myelomeningocele, and sacrococcygeal teratoma. Conclusions: Prenatal ultrasonography and fetal MRI have different advantages in diagnosing NTDs. To ensure a prompt and accurate diagnosis, it is crucial for clinicians to raise awareness of the prenatal imaging characteristics of various NTDs, which will lay a solid foundation for better fetal prognosis. Funding: This study was supported by the Capital’s Funds for Health Improvement and Research (CFH2022-2-5022). Keywords: prenatal ultrasonography, fetal magnetic resonance imaging, neural tube defects, pregnancy, diagnosis, fetus
Effectiveness, safety, and acceptability of post-placental insertion of GyneFix postp...
Yan Che
Gui-Fang Hou

Yan Che

and 15 more

August 16, 2022
Objective To assess the effectiveness, safety, and acceptability of post-placental insertion of GyneFix postpartum intrauterine device (PPIUD) in women undergoing cesarean section (C-section). Design Prospective cohort study. Setting Fourteen hospitals in four provinces of China. Population and sample Women who underwent C-section and consented to the post-placental insertion of GyneFix PPIUD. We enrolled 470 participants, and 400 completed the 12-month follow-up. Methods Participants were interviewed in the wards after delivery and followed up at 42 days, and months 3, 6, and 12 after delivery. Main outcome measures Pregnancy, PPIUD expulsion, serious adverse events, and continuation of PPIUD. Results Nine pregnancies were detected during the first year after GytneFix PPIUD insertion, 7 were due to device expulsion and 2 occurred with PPIUD in situ. The Pearl Indices (PI; pregnancy per 100 women-years) for overall 1-year pregnancy rate and pregnancies with IUD in situ were 2.32 (95% CI: 1.06–4.40) and 0.51 (95% CI: 0.06–1.86), respectively. The 1-year expulsion PI was 8.25 (95% CI: 5.63–11.63). The expulsion PI was significantly higher in the first 6 months (12.78, 95% CI: 8.42–18.60) than the second 6 months (2.82, 95% CI: 0.92–6.58). The cumulative 1-year continuation rate was 86.56% (95% CI: 83.32–89.79). We did not identify any patient with insertion failure, uterine perforation, pelvic infection, or excess bleeding due to GyneFix PPIUD insertion. Conclusions Post-placental insertion of GyneFix PPIUD is effective, safe, and acceptable for women undergoing C-section. An ultrasound scan during the first 6 months after PPIUD insertion is recommended to identify any unrecognized expulsions.
The path to condensates- 19th Wiley Prize in Biomedical Sciences Laureates share thei...
Clifford Brangwynne
Anthony Hyman

Clifford Brangwynne

and 2 more

August 16, 2022
Preface by Prof. Titia de Lange, Laboratory for Cell Biology and Genetics, The Rockefeller University, New York, NY 10065, USA The 19th Annual Wiley Prize in Biomedical Sciences celebrated a breakthrough in cell biology: how membrane-less cellular compartments are formed. The existence of membrane-less organelles, often called bodies or puncta, have been known for a long time, but what exactly they represented and how they were formed was not known. This problem was solved by a physicist, Clifford Brangwynne, a cell biologist, Anthony Hyman and a chemist, Michael Rosen. Each, synergistically, made groundbreaking contributions to the discovery that membrane-less organelles are liquid-liquid phase-separated entities. The two independent discoveries leading to the principle that multivalent low-affinity interactions between selected sets of macromolecules, some containing intrinsically disordered regions, formed a molecular condensate with unique dynamic properties, gave birth to the large, blossoming field of biomolecular condensates. The implications of those findings have influenced almost all further research of intracellular processes, including RAS signaling, immune synapses, DNA repair, transcriptional activation, and the functions of nuclear pores, the nucleolus and centrosomes. In this Perspective article, the laureates of the award take us on their personal and professional trip that led to their scientific discoveries. Their stories are a celebration of the interdisciplinary essence of Natural Sciences and the potential unlocked when scientists from different fields work together to solve mysteries.
Reliable and robust f(T,P,I)-QSPR models for ionic liquids enabled by balancing data...
Xiao Liu
Mengxian Yu

Xiao Liu

and 5 more

August 16, 2022
The thermodynamic properties at variable temperature and pressure, such as density (ρ) and viscosity (η) are necessary in chemical process design. The quantitative structure-property relationship (QSPR) is a quick and accurate method to obtain the properties from a large number of potential ionic liquids (ILs). The QSPR models for ρ and η may have “pseudo-high” robustness validated by leave-one-out cross-validation (LOO-CV) and weakened stability with the unbalanced data point distribution. A rigorous model evaluation method named the leave-one-ion-out cross-validation (LOIO-CV) was proposed to evaluate robustness of ILs QSPR models. Balancing the distribution of data points in ILs, two f(T,P,I)-QSPR models were developed with norm index (I) to predict ρ and η of ILs at variable temperature and pressure. LOIO-CV method can enhance the stability QSPR model in predicting the properties of ILs with new cations and anions, which is essential for data driven design of ILs.
Solubility prediction of CO2 in ionic liquids under subcritical and supercritical car...
Samira Heidari
Ali Aleosfoor

Samira Heidari

and 2 more

August 15, 2022
In this study, an adaptive neuro-fuzzy inference system (ANFIS) was employed to check the solubility of carbon dioxide in 26 different ionic liquids with different ionic structures under subcritical and supercritical carbon dioxide conditions during a wide range of pressure (0.34-14596 kPa) and temperature (278.1-368.4 K). Two models were introduced: Model#1 with a critical temperature (Tc), melting temperature (Tm) and molecular weight (Mw) of ionic liquids as input variables, and Model#2 with a critical temperature (Tc), critical pressure (Pc), and acentric factor (ω) of ionic liquids as input variables. The results showed that the proposed models could predict the behavior of laboratory data for both training and test data, mainly in critical conditions. The statistical factor, R2, for Model#1 was 0.95, which was a little less than that of Model#2, 0.9950. It confirmed that although both mathematical models have high accuracy, Model#2 predicts the solubility of carbon dioxide in ionic liquids better than Model#1. The R2 value for the test data in Model#2 was equal to 0.9895, indicating that the obtained model can be generalized to all ionic liquids-carbon dioxide systems. The sensitivity analysis illustrated that the pressure of the systems had the greatest effect on the solubility prediction of carbon dioxide in ionic liquids under subcritical and supercritical carbon dioxide conditions, causing the solubility to increase. Against the molecular weight, increasing the acentric factor reduced the solubility of carbon dioxide in ionic liquids. The effect of temperature on the carbon dioxide solubility compared to the other variables was negligible.
Diagnosis and Treatment Spectrum for Diamond-Blackfan Anemia: A Single Center Experie...
Erin Goode
Paulo Pena

Erin Goode

and 3 more

August 15, 2022
Diamond-Blackfan Anemia (DBA) is a rare congenital bone marrow failure syndrome typically diagnosed during infancy and is characterized by macrocytic anemia, congenital malformations, and predisposition to cancer. There were 32 patients treated for DBA at a single tertiary care referral center from 2000-2022. A retrospective chart review characterized patient presentation at diagnosis, the clinical course of each patient, and the various treatment strategies with correlation to patient outcome. Our study emphasizes the importance of screening for DBA in patients who present with macrocytic anemia regardless of age at presentation as a substantial proportion of patients presented after infancy.
The complete mtDNA genome of Huaibei Grey donkey: genome characterization and phyloge...
Jingjing Xia
Liang Chang

Jingjing Xia

and 7 more

August 15, 2022
To investigate the conservation and phylogenetic relationship with other breeds of the local Anhui Province Huaibei Grey donkey (HGD), the complete mitochondrial DNA (mtDNA) was sequenced and de novo assembled using deep sequencing data from total genomic DNA. The final size of mtDNA was 16 670 bp (NCBI submission number: MZ911746), including 22 tRNA genes, two rRNA genes, 13 protein-coding genes (PCGs), and one non-coding control region. The PCGs region consisted of 5 559 codons. Most of the PCGs had ATG and TAA as the start and stop codons, respectively. Then we analyzed the proximal part of the D-loop region (418 bp, between 15 419 bp to 15 836 bp) from HGDs, using DNAsp v6 software. We identified 23 polymorphic nucleotide sites and found that the A, C, G, and T bases comprised 30.4%, 34.9%, 13.1%, 21.6%, respectively, of the mtDNA D-loop sequence. The haplotype and nucleotide diversity were 0.87000 and 0.02115, correspondingly. Altogether, the 60 sequences displayed 11 different haplotypes, the most frequent haplotype was H9 (23.33%), followed by H4 (21.67%). MJ network analysis indicated that all haplotypes were clearly divided into Clade Ⅰ and Ⅱ lineages, which indicates that HGD may have two maternal lineages. Phylogeographic analysis indicates that the Somali lineage could be the most probable domestication center for HGD. Our study provides an empirical basis for the characterization, conservation, and management of HGD genetic resources.
What caused Abomey-Calavi and Guangzhou Sprawl? A Panel Data Analysis
BOUKARI WADJIDOU
Long Fenjie

BOUKARI WADJIDOU

and 1 more

August 15, 2022
The urban sprawl index is typically regarded as the most precise indicator of a city's potential to measure the level of sustainable urban growth. Using panel data, we examine the causes of urban sprawl over a twenty-year period in Abomey-Calavi, Benin, and Guangzhou, China. A panel data set might contain group effects, time effects, or both. This study analyzes the typical least squares approach with fixed effects and random effects for panel data analysis. Multiple specification tests, such as the Breusch--Pagan Lagrange Multiplier and Hausman specification tests, are employed to identify the optimal strategy for least square, fixed effect, or random effect models. Using a random effect model to address this scenario appears to be the most successful method for producing statistically significant results. These results could help city planners find ways to make up for the bad effects of urban sprawl on land use.
Diagnosis and Management of Food Allergy Induced Gastroesophageal Reflux Disease in y...
Rosan Meyer
Yvan Vandenplas

Rosan Meyer

and 11 more

August 15, 2022
Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect daily functioning of the infant and family, it is referred to GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and the medical and dietary management. The Task Force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using a predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD.
Double Trouble: A Case of Fraternal Twins with Iron-Refractory Iron-Deficiency Anaemi...
Jacques Malherbe
Catherine Cole

Jacques Malherbe

and 1 more

August 15, 2022
Iron-refractory iron-deficiency anaemia (IRIDA) is a rare autosomal recessive disease that presents in childhood. We report the case of fraternal twins presenting with severe hypochromic microcytic anaemia and hypoferritinemia. Two missense mutations affecting the TRMPSS6 gene were identified, consistent with IRIDA. Subsequent parenteral iron therapy improved clinical and blood parameters.
Extensive keloid scarring in a patient with pemphigus vulgaris
Elinkichari Dorsaf
Anissa Zaouak

Dorsaf Elinkichari

and 4 more

August 15, 2022
Since pemphigus blisters are intraepidermal, scarring should induce at most a post-inflammatory hyperpigmentation. We describe a very atypical and unusual course of pemphigus vulgaris with extensive keloid formation despite high systemic steroids. This could be promoted by the severe flare of the disease, the delay of scarring and the superinfection.
Brucellosis Unusually Presented as Septic Knee Arthritis: A Case Report
Bassem  Alhariri
Mohanned  Zuhair

Bassem Alhariri

and 2 more

August 15, 2022
Brucellosis is one of the world's most prevalent zoonotic illnesses. The most often afflicted joints are the sacroiliac joints, although spondylitis and peripheral arthritis are becoming increasingly prevalent. We described a case of a 40-year-old male with Brucellosis presented as septic knee arthritis.
Takotsubo Cardiomyopathy in the Setting of Severe Hyponatremia and Beer Potomania: A...
Sheriff Dodoo
Alicia  Agyemang-Sarpong

Sheriff Dodoo

and 4 more

August 15, 2022
Takotsubo Cardiomyopathy (TC), an acute cardiac event accounting for about 1-2% of all acute coronary syndromes is often associated with acute emotional stress usually in the setting of the other cardiovascular risk factors.This case report reviews a trigger of TC (severe hyponatremia) and the link between them.
Bilateral Cleft Lip and Unilateral Cleft Palate with Unilateral Renal Agenesis: A Cas...
Abhishek Kumar
Siddhartha  Shah

Abhishek Kumar

and 5 more

August 16, 2022
Cleft lip and palate (CLP) are one of the most frequently occurring craniofacial congenital anomalies. A syndromic association is frequently seen in such cases. A feeding obturator is a prosthetic aid that assists a patient in obturating a cleft until surgery is performed. Cleft lip surgery or cheiloplasty is often performed three months after birth, while palate surgery or palatoplasty is typically performed between the ages of six and fourteen months. A 2-day-old newborn presented to the Pediatric Emergency with a complaint of difficulty in feeding. On examination, bilateral cleft of the lip and unilateral cleft of the palate was present. The ultrasonography of the fetus before the birth had revealed non-visualized left kidney, so an ultrasonography (USG) of the abdomen and pelvis was advised which confirmed the finding i.e., left renal agenesis. Electrocardiography (ECG) revealed an arterial septal defect (ASD) of 4.5 mm. Such presentation is commonly seen in cases of isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD). A custom-made feeding obturator was fabricated and delivered to help the baby overcome feeding difficulties. Parents were instructed and well-taught to feed the child with the appliance in place. Apart from giving appropriate instructions regarding feeding and maintenance of the appliance, parents were also informed about the surgical procedures that would be followed at a later date. Also, considering the exceptional psychological situation of the family and the need for a long-standing relationship between the cleft team for a successful outcome, appropriate counseling with reassurance was rendered to the family members.
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