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Introduction: Haemoglobinopathies are qualitative disorders of Haemoglobin (Hb) resulting from structural defects in the amino acid sequence of one of the globin chains, whereas, thalassaemia results from quantitative defects in the synthesis of one or more of the globin chain subunits of the Hb tetramer. Cation ExchangeHigh Performance Liquid Chromatography (CE-HPLC) is one of the methods for initial screening of Hb variants like HbS, HbD, HbE etc and for quantification of HbF, HbA and HbA2 levels. Aim: To find out the prevalence of haemoglobinopathies in patients of a Government paediatric tertiary care hospital in south India. Materials and Methods: In this retrospective, cross-sectional study, all laboratory requests, in the period from August 2019 to July 2021, for Hb variant analysis by HPLC were collected, irrespective of provisional diagnosis. The Hb variant analysis was carried out by CE-HPLC on the Bio-Rad D-10 analyser. This study was conducted in a Government Paediatric tertiary care hospital in Southern India for patients who had any clinical or familial suspicion of haemoglobinopathies. The Statistical analysis was performed using Microsoft Excel 2010. Results: Total data of 704 laboratory requests for Hb Variant analysis were obtained. Out of 704 laboratory request, 585 were from children younger than 12 years of age and 119 were parental screening. There were 164 abnormal chromatograms. Out of 164 patients, 91 were female patients and 73 were male patients. Out of 164 abnormal chromatograms, 97 (59.15%) were betathalassaemia trait, 18 (10.98%) were beta-thalassaemia major, 13 (7.93%) were sickle cell trait, 2 (1.22%) were sickle cell disease, 21 (12.80%) were HbE trait, 2 (1.22%) were homozygous HbE, 2 (1.22%) were HbD trait, 3 (1.83%) were Hereditary Persistence of Foetal Hb (HPFH)/delta beta-thalassaemia, 2 (1.22%) were HbJ trait, 1 (0.61%) was HbE beta-thalassaemia, 1 (0.61%) was sicklebeta-thalassaemia and 2 (1.22%) were alpha thalassaemia. Conclusion: From this study, beta-thalassaemia trait and betathalassaemia major were found to be the first and second most prevalent haemoglobinopathies in children below 12 years of age. This data suggests the importance of premarital and antenatal screening procedures that can help in reducing the possibility of such haemoglobinopathies in the future generation, suffering and burden of disease to the family and society.

Context: Intraoperative evaluation of central nervous system (CNS) lesions helps to guide the management by providing preliminary diagnosis, confirming the presence or absence of a neoplasm. Squash cytology and frozen section are reliable and sensitive techniques for rapid intraoperative diagnosis. However, both have respective limitations and the choice of the technique depends on individual preference and tissue availability. Aims: This study aims to determine the diagnostic accuracy of intraoperative squash cytology and frozen section diagnosis by correlating with the final histopathological diagnosis. Settings and Design: Prospective study over a span of 2 years in a tertiary care center. Materials and Methods: A total of 64 cases were subjected to intraoperative squash cytology and frozen section study and the intraoperative diagnosis was compared with final histopathological diagnosis. Statistical Analysis Used: Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: Out of the 64 cases, 86% cases were neoplastic and 14% cases were non-neoplastic. The overall diagnostic accuracy of squash cytology was 90.6% and frozen section was 93.7%. Conclusion: Squash cytology and frozen section are highly accurate and reliable techniques for intraoperative frozen section evaluation of CNS lesions. However, both the techniques have respective limitations. When combined together they help improve the overall diagnostic accuracy.

Abstract High-resolution reliable rainfall datasets are vital for agricultural, hydrological, and weather-related applications. The accuracy of satellite estimates has a significant effect on simulation models in particular crop simulation models, which are highly sensitive to rainfall amounts, distribution, and intensity. In this study, we evaluated five widely used operational satellite rainfall estimates: CHIRP, CHIRPS, CPC, CMORPH, and GSMaP. These products are evaluated by comparing with the latest improved Vietnam-gridded rainfall data to determine their suitability for use in impact assessment models. CHIRP/S products are significantly better than CMORPH, CPC, and GsMAP with higher skill, low bias, showing a high correlation coefficient with observed data, and low mean absolute error and root mean square error. The rainfall detection ability of these products shows that CHIRP outperforms the other products with a high probability of detection (POD) scores. The performance of the different rainfall datasets in simulating maize yields across Vietnam shows that VnGP and CHIRP/S were capable of producing good estimates of average maize yields with RMSE ranging from 536 kg/ha (VnGP), 715 kg/ha (CHIRPS), 737 kg/ha (CHIRP), 759 kg/ha (GsMAP), 878 kg/ha (CMORPH) to 949 kg/ha (CPC). We illustrated that there is a potential for use of satellite rainfall estimates to overcome the issues of data scarcity in regions with sparse rain gauges.

With the advent of the Internet of Things (IoT), smart devices have now changed their dimensions to provide applications in different domains such as medical, agriculture, and Industry 4.0. Although IoT provides more diversified applications, enhancing the security in IoT remains on the darker side of the research. Traditional IoT systems involve a third party to secure sensitive data during transmission in an IoT environment which can lead to complex and serious problems. To overcome security issues and eradicate third-party involvement, Blockchain technology is the modern-day solution in an IoT environment. In the context of a Secured IoT system, we proposed a novel chaotic encryption-based blockchain-IoT architecture to clinch the security and privacy of data. Since smart sensors and image sensors are used widely in an IoT environment, the proposed scheme was tested with different image sets to evaluate performance metrics such as Number of Pixel Change Rate (NPCR), Unified Averaged Changed Intensity (UACI), Correlation Coefficients, and entropy under different attack scenarios. We obtained an NPCR of 99.65%, a UACI of 34%, and an entropy value close to 8. These values incite that the novel chaotic encryption-based blockchain-IoT architecture will be safe from IoT attacks. Results showed that integrating chaotic encrypted blockchain architecture with IoT could be more effective in defending attacks.

An extensive fibroinflammatory stroma rich in macrophages is a hallmark of pancreatic cancer. In this disease, it is well appreciated that macrophages are immunosuppressive and contribute to the poor response to immunotherapy; however, the mechanisms of immune suppression are complex and not fully understood. Immunosuppressive macrophages are classically defined by the expression of the enzyme Arginase 1 (ARG1), which we demonstrated is potently expressed in pancreatic tumor-associated macrophages from both human patients and mouse models. While routinely used as a polarization marker, ARG1 also catabolizes arginine, an amino acid required for T cell activation and proliferation. To investigate this metabolic function, we used a genetic and a pharmacologic approach to target Arg1 in pancreatic cancer. Genetic inactivation of Arg1 in macrophages, using a dual recombinase genetically engineered mouse model of pancreatic cancer, delayed formation of invasive disease, while increasing CD8+ T cell infiltration. Additionally, Arg1 deletion induced compensatory mechanisms, including Arg1 overexpression in epithelial cells, namely Tuft cells, and Arg2 overexpression in a subset of macrophages. To overcome these compensatory mechanisms, we used a pharmacological approach to inhibit arginase. Treatment of established tumors with the arginase inhibitor CB-1158 exhibited further increased CD8+ T cell infiltration, beyond that seen with the macrophage-specific knockout, and sensitized the tumors to anti-PD1 immune checkpoint blockade. Our data demonstrate that Arg1 drives immune suppression in pancreatic cancer by depleting arginine and inhibiting T cell activation.

Background: Sleep plays an important role in our life. Adolescents undergo several changes with puberty and have a preference for later bedtimes due to internet usage. Evidence shows that many adolescents are not obtain-ing the required amounts of sleep (8-10 hours) due to inadequate sleep practices. The objectives of this research were to study sleep-pattern among adolescents in Semi urban Coimbatore and also to determine the sleep hygiene practices among the adolescents. Methodology: This study is a school based cross-sectional study. A total of 300 adolescents from class VIII to XIIth were selected using simple random sampling. Data was collected from February to May 2018. A structured questionnaire for sleep pattern and Sleep Hygiene Index was used. Results: The adolescents’ mean sleep duration was 7.49 ± 1.12 hours on weekdays and 9.32 ± 1.55 hours on weekends. Mean Sleep Pattern Index (SPI) score was 22.48±6.9 and Mean Sleep Hygiene Index (SHI) score was 17.51±6.3 in our study. Conclusions: Majority of the adolescents had moderate scores of sleep pattern and sleep hygiene practices. Inter-ventions directed towards promoting good sleep hygiene strategies are required to improve the physical and emotional health of adolescents.

BackgroundChronic kidney disease (CKD) is an important risk factor for mortality from COVID-19. Remdesivir has been shown to shorten time to recovery in patients with severe COVID-19. However, exclusion of patients with severe kidney function impairment in clinical trials has led to concerns about kidney safety of remdesivir in patients with pre-existing kidney disease.MethodsRetrospective propensity score matched cohort study of hospitalized patients with COVID-19 admitted with estimated glomerular filtration rate (eGFR) between 15 - 60 mL/min/1.73m2. Remdesivir-treated patients were 1:1 matched to historical comparators admitted during the first wave of COVID-19 (between March-April 2020) prior to emergency use authorization of remdesivir using propensity scores accounting for factors predicting treatment assignment. Dependent outcomes included in-hospital peak creatinine, incidence of doubling of creatine, rate of kidney replacement therapy initiation and eGFR among surviving patients at day 90.Results175 remdesivir-treated patients were 1:1 matched to untreated historical comparators. Mean age was 74.1 (SD 12.8), 56.9% were male, 59% patients were white, and the majority (83.1%) had at least one co-morbidity. There were no statistically significant differences in peak creatinine during hospitalization (2.3mg/dL vs. 2.5 mg/dL, P = 0.34), incidence of doubling of creatinine (10.3% vs. 13.1%, P = 0.48), and rate of kidney replacement therapy initiation (4.6% vs. 6.3%, P = 0.49) in remdesivir-treated patients versus matched untreated historical comparators, respectively. Among surviving patients, there was no difference of the average eGFR at day 90 (54.7 ± 20.0 mL/min/1.73m2 for remdesivir-treated patients vs. 51.7 ± 19.5 mL/min/1.73m2 for untreated comparators, P = 0.41).ConclusionsRemdesivir use in patients with impaired kidney function (eGFR between 15 - 60 mL/min/1.73m2) who present to the hospital with COVID-19 is not associated with increased risk of adverse kidney outcomes.

Introduction: Women perform worse after acute coronary syndrome (ACS) than men. The reason for these differences is unclear. The aim was to ascertain gender differences in the culprit plaque characteristics in ACS. Methods:Patients with ACS undergoing percutaneous coronary intervention for the culprit vessel underwent optical coherence tomography (OCT) imaging. Culprit plaque was identified as lipid rich,fibrous, and calcific plaque. Mechanisms underlying ACS are classified as plaque rupture, erosion,or calcified nodule. A lipid rich plaque along with thin-cap fibroatheroma (TCFA) was a vulnerable plaque. Plaque microstructures including cholesterol crystals, macrophages, and microvessels were noted. Results: A total of 52 patients were enrolled (men=29 and women=23). Baseline demographic features were similar in both the groups except men largely were current smokers (P

Making contributions to reducing malnutrition entails sharing evidence and approaches among the research and practice communities, including through conferences. But who is involved in these processes, including who pays, matters both in terms of actions and optics. This paper was motivated by observations – in 2022 and historically – that the International Union of Nutritional Sciences (IUNS), in putting on its flagship International Congress of Nutrition (ICN), was leaving itself – and, by extension, participating scientists – open to conflicts of interest (COI). With contemporary scholarship on the commercial determinants of health making clear the ways in which this kind of sponsorship represents both a conflict of interest for nutrition events and a negative force in broader food system drivers of nutrition, this paper aims to document the issues surrounding the 2022 IUNS-ICN conference as historical record; draw on academic literature on conflict of interest to better understand the issue; and suggest some practical options moving towards COI-free nutrition events in the future.

Cybersecurity experts estimate that cyber-attack damage cost will rise tremendously. The massive utilization of the web raises stress over how to pass on electronic information safely. Usually, intruders try different attacks for getting sensitive information. An Intrusion Detection System (IDS) plays a crucial role in identifying the data and user deviations in an organization. In this paper, stream data mining is incorporated with an IDS to do a specific task. The task is to distinguish the important, covered up information successfully in less amount of time. The experiment focuses on improving the effectiveness of an IDS using the proposed Stacked Autoencoder Hoeffding Tree approach (SAE-HT) using Darwinian Particle Swarm Optimization (DPSO) for feature selection. The experiment is performed in NSL_KDD dataset the important features are obtained using DPSO and the classification is performed using proposed SAE-HT technique. The proposed technique achieves a higher accuracy of 97.7% when compared with all the other state-of-art techniques. It is observed that the proposed technique increases the accuracy and detection rate thus reducing the false alarm rate.

Pediatric high-grade gliomas (pHGGs) are the leading cause of cancer-related deaths in children in the USA. Sixteen percent of hemispheric pediatric and young adult HGGs encode Gly34Arg/Val substitutions in the histone H3.3 (H3.3-G34R/V). The mechanisms by which H3.3-G34R/V drive malignancy and therapeutic resistance in pHGGs remain unknown. Using a syngeneic, genetically engineered mouse model (GEMM) and human pHGG cells encoding H3.3-G34R, we demonstrate that this mutation led to the downregulation of DNA repair pathways. This resulted in enhanced susceptibility to DNA damage and inhibition of the DNA damage response (DDR). We demonstrate that genetic instability resulting from improper DNA repair in G34R-mutant pHGG led to the accumulation of extrachromosomal DNA, which activated the cyclic GMP–AMP synthase/stimulator of IFN genes (cGAS/STING) pathway, inducing the release of immune-stimulatory cytokines. We treated H3.3-G34R pHGG–bearing mice with a combination of radiotherapy (RT) and DNA damage response inhibitors (DDRi) (i.e., the blood-brain barrier–permeable PARP inhibitor pamiparib and the cell-cycle checkpoint CHK1/2 inhibitor AZD7762), and these combinations resulted in long-term survival for approximately 50% of the mice. Moreover, the addition of a STING agonist (diABZl) enhanced the therapeutic efficacy of these treatments. Long-term survivors developed immunological memory, preventing pHGG growth upon rechallenge. These results demonstrate that DDRi and STING agonists in combination with RT induced immune-mediated therapeutic efficacy in G34-mutant pHGG.

Abstract A trial of three nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children's nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions' effects. We also examined how context affected implementation, mechanisms, and outcomes. We used data from intervention monitoring systems, review notes, trial surveys, 32 case studies with families (n = 91 family members), and 20 group discussions with women's group members and intervention workers (n = 181 and 32, respectively). We found that interventions were implemented with high fidelity. Groups reached around half of the mothers of children under 2 years. Videos and meetings increased women's knowledge, motivation and confidence to suggest or make changes to their diets and agricultural production. Families responded in diverse ways. Many adopted or improved rainfed homestead garden cultivation for consumption, which could explain gains in maternal and child dietary diversity seen in the impact evaluation. Cultivation for income was less common. This was often due to small landholdings, poor access to irrigation and decision‐making dominated by men. Interventions helped change norms about heavy work during pregnancy, but young women with little family support still did considerable work. Women's ability to shape cultivation, income and workload decisions was strongly influenced by support from male relatives. Future nutrition‐sensitive agriculture interventions could include additional flexibility to address families’ land, water, labour and time constraints, as well as actively engage with spouses and in‐laws.

The presence of microplastics and nanoplastics (MNPs) in soils is becoming pervasive in most agroecosystems. The recent estimates suggest that the soil burden of MNPs in the agroecosystems is more than 0.5 megatons (Mt) annually. In all the agroecosystems, the transformation, migration, and transferring of MNPs, along with other contaminants, and the trophic transfer of MNPs can threaten the food web. MPs can exhibit negative and positive effects, or none, on the physical/chemical properties of soil, soil microbiota, invertebrates, and plant systems, depending on the polymer compositions, additives, and exposure time. Difficulties in comparing the studies on the effects of MNPs, as well as the discrepancies among them, are mostly due to variations in the methods followed for sampling, detection, quantification, and the categorization of particles, abundance, and exposure time. Since agricultural soils are important environmental reservoirs for diverse chemicals and contaminants, they provide milieus for several types of interactions of MNPs with soil biota. The present review critically examines the sources and transformation of MNPs in agricultural soils, the release and fate of additives, as well as their role as vectors of other potential contaminants and influence on soil physical/chemical properties, toxicities to soil biota (i.e., microorganisms, invertebrates, and plants), current regulatory guidelines for the mitigation of MNPs, and future research directions.

Abstract Background Animal-source foods (ASFs) are high-quality nutrient-dense products key to reducing stunting and micronutrient deficiencies. However, their consumption among the poorest households in urban informal settlements is low. Several drivers beyond price, including health considerations have been reported to drive ASF choice and consumption among consumers. This current study explores consumer perceptions of food safety associated with animal source foods (ASFs) consumption in urban informal settlements with a view to unpacking the health considerations driving their choice and consumption. Methods Coupled households with children 6–59 months formed the study sample. The Food Environments Working Group (FEWG) Framework of the Agriculture and Nutrition for Health academy (ANH) was used to guide the study which utilized qualitative methods namely, 60 in-depth interviews (IDIs), 19 focus group discussions, and 19 key informant interviews (KIIs) complemented by unstructured observations. Data were transcribed and analysed according to emerging themes. Results Consumer perceptions of food safety are driven by concerns about food production, processing, handling, storage and the health risks associated with consumption of the ASFs. For all the ASFs, lack of traceability of source, unhygienic environments in which they were sold and health risks around consuming too much or improperly cooked products were key perceptions from the community. To mitigate against food safety risks, consumers used strategies such as boiling the ASFs, purchasing their products from trusted retailers, avoiding vendors in unhygienic environments and reducing the amount and frequency of consumption of ASFs or totally avoiding their consumption. These consumer perceptions are increasingly influencing the ASFs choice and consumption in low-income populations besides other drivers. Notably, given limited incomes that influence their purchasing power and the need for nutritious diets that included ASFs, the dilemma of quality vis-a-vis quantity persists and consumers still accessed and consumed these ASF products to supplement their diets. Conclusions To enhance food safety for ASFs, as well as assure consumer access to safe ASFs from informal markets, there is need to contextualize the value chain as informed by consumer perceptions on food safety as these influence their ASFs choice and consumption.

ObjectiveWe evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy (ART) and retention in care among people living with HIV in Tanzania.MethodsAt three clinics, 805 participants were randomized to three groups in a 3 : 3 : 1 ratio, stratified by site : nutrition assessment and counseling (NAC) and cash transfers (∼$11/month, n = 347), NAC and food baskets (n = 345), and NAC-only (comparison group, n = 113, clinicaltrials.gov NCT01957917). Eligible people living with HIV were at least 18 years, initiated ART 90 days or less prior, and food insecure. Cash or food was provided for 6 or less consecutive months, conditional on visit attendance. The primary outcome was medication possession ratio (MPR ≥ 95%) at 6 months. Secondary outcomes were appointment attendance and loss to follow-up (LTFU) at 6 and 12 months.ResultsThe primary intent-to-treat analysis included 800 participants. Achievement of MPR ≥ 95% at 6 months was higher in the NAC + cash group compared with NAC-only (85.0 vs. 63.4%), a 21.6 percentage point difference [95% confidence interval (CI): 9.8, 33.4, P

PurposeClinically relevant pharmacokinetic interactions exist between gastric acid-reducing agents and certain weakly basic drugs that rely on acidic environments for optimal oral absorption. In this study, we examine whether the administration of betaine hydrochloride under fed conditions can enhance the absorption of atazanavir, an HIV-1 protease inhibitor, during pharmacologically-induced hypochlorhydria.MethodsIn this randomized, single-dose, 3 period, crossover study healthy volunteers received ritonavir-boosted atazanavir (atazanavir/ritonavir 300/100 mg) alone, following pretreatment with the proton pump inhibitor rabeprazole (20 mg twice daily), and with 1500 mg of betaine HCl after rabeprazole pretreatment. Atazanavir was administered with a light meal and gastric pH was monitored using the Heidelberg Capsule.ResultsPretreatment with rabeprazole resulted in significant reductions in atazanavir Cmax (p

Abstract Women's nutritional status remains poor in South Asia, impacting maternal and infant health outcomes. Women's household status is also low, as evidenced by eating behaviours. We started with triadic qualitative interviews with newly married women, husbands and mothers‐in‐law to explore the link between women's status and eating patterns, followed by longitudinal data from a cohort of 200 newly married women in rural Nepal to measure associations over time. Quantitative data were collected every 6 months for 18 months (four rounds of data) between 2018 and 2020. Interviews suggested that household relationships, women's status, and how much and what types of food she was given were intricately linked. Using mixed effects logistic regression models, we explore the association between markers of changing women's status (becoming pregnant, giving birth and working outside the home) on two outcomes (eating last always/usually and achieving minimum dietary diversity). We also explore for interaction between women's status and household food insecurity. Pregnancy increases women's dietary diversity, but this is not sustained post‐partum. Women who work outside the home are less likely to eat last in the household. Food insecurity is associated with both the order of household eating and dietary diversity. Interactions between food insecurity and giving birth suggested that women who give birth in food insecure households are more likely to eat last in the household. Changes in women's household status are associated with some improvements in dietary diversity and order of household eating, but the associations are not long‐lasting and depend on food security status.

Lung cancer is the cellular fission of abnormal cells inside the lungs that leads to 72% of total deaths worldwide. Lung cancer are also recognized to be one of the leading causes of mortality, with a chance of survival of only 19%. Tumors can be diagnosed using a variety of procedures, including X-rays, CT scans, biopsies, and PET-CT scans. From the above techniques, Computer Tomography (CT) scan technique is considered to be one of the most powerful tools for an early diagnosis of lung cancers. Recently, machine and deep learning algorithms have picked up peak energy, and this aids in building a strong diagnosis and prediction system using CT scan images. But achieving the best performances in diagnosis still remains on the darker side of the research. To solve this problem, this paper proposes novel saliency-based capsule networks for better segmentation and employs the optimized pre-trained transfer learning for the better prediction of lung cancers from the input CT images. The integration of capsule-based saliency segmentation leads to the reduction and eventually reduces the risk of computational complexity and overfitting problem. Additionally, hyperparameters of pretrained networks are tuned by the whale optimization algorithm to improve the prediction accuracy by sacrificing the complexity. The extensive experimentation carried out using the LUNA-16 and LIDC Lung Image datasets and various performance metrics such as accuracy, precision, recall, specificity, and F1-score are evaluated and analyzed. Experimental results demonstrate that the proposed framework has achieved the peak performance of 98.5% accuracy, 99.0% precision, 98.8% recall, and 99.1% F1-score and outperformed the DenseNet, AlexNet, Resnets-50, Resnets-100, VGG-16, and Inception models.

One of the most common causes of death from cancer for both women and men is lung cancer. Lung nodules are critical for the screening of cancer and early recognition permits treatment and enhances the rate of rehabilitation in patients. Although a lot of work is being done in this area, an increase in accuracy is still required to swell patient persistence rate. However, traditional systems do not segment cancer cells of different forms accurately and no system attained greater reliability. An effective screening procedure is proposed in this work to not only identify lung cancer lesions rapidly but to increase accuracy. In this procedure, Otsu thresholding segmentation is utilized to accomplish perfect isolation of the selected area, and the cuckoo search algorithm is utilized to define the best characteristics for partitioning cancer nodules. By using a local binary pattern, the relevant features of the lesion are retrieved. The CNN classifier is designed to spot whether a lung lesion is malicious or non-malicious based on the retrieved features. The proposed framework achieves an accuracy of 96.97% percent. The recommended study reveals that accuracy is improved, and the results are compiled using Particle swarm optimization and genetic algorithms.

Abstract Background Subdermal etonogestrel implants are highly effective contraceptive methods. Despite standardization of insertion technique by the manufacturer, some implants are inadvertently placed too deeply within or below the plane of the biceps brachii fascia. Placement of these implants in a deep tissue plane results in more difficult removal, which is not always possible in the office setting. In rare cases, surgical removal by an upper extremity surgeon is warranted. Case presentation Here we present 6 cases of etonogestrel implants located in a subfascial plane requiring removal by an upper extremity surgeon. Implants were all localized with plain radiography and ultrasound prior to surgical removal. All cases had implants located in the subfascial plane and one was identified intramuscularly. The average age was 28 years (19–33) and BMI was 24.0 kg/m^2 (19.1–36.5), with the most common reason for removal being irregular bleeding. The majority of cases (5/6) were performed under monitored anesthesia care with local anesthetic and one case utilized regional anesthesia. All implants were surgically removed without complication. Conclusions Insertion of etonogestrel contraceptive implants deep to the biceps brachii fascia is a rare, but dangerous complication. Removal of these implants is not always successful in the office setting and referral to an upper extremity surgeon is necessary to avoid damage to delicate neurovascular structures for safe removal.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder with neuropsychiatric symptoms. It is most often misdiagnosed initially as a primary psychiatric disorder. Young women in the background of ovarian teratomas, viral infections are most commonly impacted. Recently, the coexistence of anti-thyroid antibodies with anti-NMDAR antibodies in nonparaneoplastic anti-NMDAR encephalitis has come to light. A 32-year-old married female presented with sudden onset of disruptive and ritualistic behavior, decreased need for sleep, preceded by spikes of high-grade fever, chills, and rigor. Later, she developed episodes of catatonia alternating with spontaneous speech associated with shouting and crying spells. Blood investigations (except for hyperthyroidism and anti-thyroid antibodies), brain imaging, electroencephalogram, and cerebrospinal fluid (CSF) analysis were normal. She was treated with lorazepam (to a maximum of 16 mg), antipsychotics, antidepressants, anticonvulsants, dopaminergic, and steroid drugs with no significant improvement. CSF analysis was repeated for the encephalitis panel and revealed anti-NMDAR encephalitis. The patient was started with intravenous immunoglobulin for 5 days which led to significant clinical improvement. Screening for encephalitis is considered necessary in patients with altered behavior, not responding to symptomatic psychotropic and neurological treatments.

Xing Tan,1 Hwan Seung Kim,1 Kimberly Baugh,2 Yanqin Huang,1 Neeraja Kadiyala,1 Marisol Wences,1 Nidhi Singh,1 Eric Wenzler,1 Zackery P Bulman1 1Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA; 2Franciscan Health Hammond/Dyer, Hammond, IN, USACorrespondence: Zackery P Bulman Department of Pharmacy PracticeCollege of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL 60612, USATel +1 312-996-1415Fax +1 312-413-1797Email bulman@uic.eduAbstract: The spread of metallo-β-lactamase (MBL)-producing Enterobacterales worldwide without the simultaneous increase in active antibiotics makes these organisms an urgent public health threat. This review summarizes recent advancements in diagnostic and treatment strategies for infections caused by MBL-producing Enterobacterales. Adequate treatment of patients infected with MBL-producing Enterobacterales relies on detection of the β-lactamase in the clinic. There are several molecular platforms that are currently available to identify clinically relevant MBLs as well as other important serine-β-lactamases. Once detected, there are several antibiotics that have historically been used for the treatment of MBL-producing Enterobacterales. Antimicrobials such as aminoglycosides, tetracyclines, fosfomycin, and polymyxins often show promising in vitro activity though clinical data are currently lacking to support their widespread use. Ceftazidime-avibactam combined with aztreonam is promising for treatment of infections caused by MBL-producing Enterobacterales and currently has the most clinical data of any available antibiotic to support its use. While cefiderocol has displayed promising activity against MBL-producing Enterobacterales in vitro and in preliminary clinical studies, further clinical studies will better shed light on its place in treatment. Lastly, there are several promising MBL inhibitors in the pipeline, which may further improve the treatment of MBL-producing Enterobacterales.Keywords: metallo-β-lactamase, Enterobacterales, carbapenemase, ceftazidime-avibactam, aztreonam, rapid diagnostics

Background: Acute pulmonary embolism remains a significant cause of morbidity and mortality. This study aimed to determine the clinical profile, management, and outcomes of patients with acute pulmonary embolism. Methods: This was a retrospective, single-center, and observational study. All consecutive patients with proven diagnosis of pulmonary embolism and treated at a tertiary care center were included in the study based on inclusion and exclusion criteria. Results: From January 2012 to May 2018, a total of 304 patients diagnosed with pulmonary embolism were included in the study. Majority of the patients (n = 195; 64.14%) were male. Among included patients, 92 (30.66%) were smokers, and 81 (26.6%) were obese. Dyspnea (98.03%) was the most commonly observed symptom. Of patients who underwent bilateral lower limb venous Doppler, deep vein thrombosis was noted in 172 (56.57%). Electrocardiography confirmed the presence of sinus tachycardia and classical S1Q3T3 pattern in 284 (93.42%) and 79 (25.99%) patients, respectively. Chest X-ray showed dilated main and right pulmonary arteries in 170 (55.92%) patients. Right ventricular dysfunction as detected by echocardiography was observed in 241 (79.28%) patients. Thrombolytic therapy was administered in 158 (51.97%) patients (n = 86 (28.29%) were treated with tenecteplase; n = 72 (23.68%) were treated with streptokinase). Conclusions: This study gives an insight into the clinical profile of patients hospitalized with a confirmed diagnosis of acute pulmonary embolism along with treatment and diagnostic approaches adopted by the physician in the Indian scenario.

The resource-constrained camera integrated Visual Sensor Networks (VSN) have conquered numerous visual aided services from visual surveillance to habitat monitoring. VSN is capable of sensing, processing and communicating visual data wirelessly. These networks are built with inexpensive low power sensor motes with a lightweight processor, limited storage, and bandwidth. The huge amount of redundancy present in the images makes the processing and communication consume more energy than expected. The number of bits must be reduced using energy-efficient compression techniques for efficient transmission. Low computational energy and communication energy are always favored for an increased lifetime of the wireless sensor network. The highly sensitive and self-descriptive nature of images makes security in VSN even more critical. In this work, we propose an energy-efficient low bitrate secured image coder for resource-constrained VSN. Light weight design protocols are highly required in secured image transmission over VSN. Through this communication, we also propose a novel chaotic map using Pascal’s triangle. The system follows a unique interleaved fashion of compression and encryption process to consume less computational resources. A series of tests were carried out to validate the secured image coder’s ruggedness and its suitability in VSN. The performance and the strength of the low bitrate secured image coder are tested with compression efficiency and cryptanalysis tests. Simulations were carried out in Atmel’s ATmega128 processor for energy consumption analysis. The energy consumed by the proposed system for compression, encryption and transmission of an image of size 512 $\times512$ is 109.364mJ (milli Joules), which is only 4.57 % of the energy consumed by raw image transmission. In addition, the system is implemented in real time image sensor platform based on Arduino Due board integrated with OV7670 camera module for real time verification and the experimental results validated the suitability of the indicated scheme in real time VSN.

Cloud computing is a continuously evolving technology that can enhance agility, availability, collaboration and scalability of data. Blockchain has a secure, immutable ledger which maintains all the transactions along with the timestamp. The blockchain framework and cloud computing technology jointly provides different ways of computational cost reduction. The existing methods help to identify the anonymous documents which are given in the form of requests from the cloud server. If the anonymized document requests are from the authorized users, then cloud provides better security and hence documents are not available for unauthorized users. But the main issue is access rights available for authorized users on sensitive data of the owner. To maintain the privacy the sensitive data are hidden using cryptographic techniques even for authorized users. The method adopted is Linear Elliptical Curve Digital Signature (LECDS) with Hyperledger blockchain, to prevent private data loss. The Linear regression method is used to classify the user information into two classes namely sensitive and non-sensitive. The non-sensitive data is encrypted using RSA and sensitive data is encrypted using LECC method. Modified Spider optimization search Algorithm (MSOA) is used to verify the integrity of outsourced data and search user query information in a cloud server. The hyper ledger blockchain verifies the user policy to create a private network through which the user communicates the cloud. In the analysis of the proposed method, the results are evaluated using various performance metrics such as security, throughput, classification accuracy and error rate.

Background: It is common among medical students to incorrectly believe that they have contracted certain diseases they have recently studied. This belief can be seen in the form of health anxiety and investigating health-related information via the Internet. Cyberchondria denotes repeated online searches for health-related information that are associated with increasing levels of health anxiety. Aims: We aimed to study the prevalence and severity of cyberchondria among medical students and its correlation with sociodemographic and clinical data. Materials and Methods: A cross-sectional study was conducted on 400 consented medical students using online Google Forms. The form included demographic and clinical details and the Cyberchondria Severity Scale-15 (CSS-15) questionnaire. Means and standard deviations were calculated for continuous variables and percentages for categorical variables. The k-means clustering was done for grouping the participants. Spearman correlation and linear regression were done for analyzing the data. Results: The mean age of the participants was 19.28 ± 1.75 years. Females constituted 54.3% of the sample. About 24.5% of the students had previously diagnosed (medical/surgical/psychiatric) illness. The mean score of the CSS was 30.86 ± 9.44. Three clusters with 28%, 66%, and 6% of the students represented the CSS cluster center scores of 19.22 (mild), 34.10 (moderate), and 49.63 (severe), respectively. There was a significant positive correlation between total CSS score and previously diagnosed illness (r = 0.233, P = 0.000) and negative correlation with age (r = −0.151, P = 0.003) and year of study (r = −0.254, P = 0.000). Conclusion: The increasing prevalence of cyberchondria is an example of how digital technology may play an important role in facilitating the development of psychopathology.

Abstract Background Not every patient achieves normal coronary flow following fibrinolysis in STEMI (ST-segment elevation myocardial infarction). The culprit lesion plaque characteristics play a prominent role in the coronary flow before and during percutaneous coronary intervention. The main purpose was to determine the culprit lesion plaque features by virtual histology-intravascular ultrasound (VH-IVUS) in patients with STEMI following fibrinolysis in relation to baseline coronary angiogram TIMI (thrombolysis in myocardial infarction) flow. Pre-intervention IVUS was undertaken in 61 patients with STEMI after successful fibrinolysis. After the coronary angiogram, they were separated into the TIMI1–2 flow group (n = 31) and TIMI 3 flow group (n = 30). Culprit lesion plaque composition was evaluated by VH-IVUS. Results On gray-scale IVUS, the lesion external elastic membrane cross-sectional area (EEM CSA) was significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group (15.71 ± 3.73 mm2 vs 13.91 ± 2.94 mm2, p = 0.041) with no significant difference in plaque burden (82.42% vs. 81.65%, p = 0.306) and plaque volume (108.3 mm3 vs. 94.3 mm3, p = 0.194). On VH-IVUS, at the minimal luminal area site (MLS), the fibrous area (5.83 mm2 vs. 4.37 mm2, p = 0.024), necrotic core (NC) area (0.95 mm2 vs. 0.59 mm2, p < 0.001), and NC percentage (11% vs. 7.1%, p = 0.024) were higher in the TIMI 1–2 groups in contrast to the TIMI 3 group. The absolute necrotic core (NC) volume (8.3 mm3 vs. 3.65 mm3, p < 0.001) and NC percentage (9.3% vs. 6.0%, p = 0.007) were significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group. Absolute dense calcium (DC) volume was higher in TIMI 1–2 groups with a trend towards significance (1.0 mm3 vs.0.75 mm3, p = 0.051). In multivariate analysis, absolute NC volume was the only independent predictor of TIMI 1–2 flow (odds ratio = 1.561; 95% CI 1.202–2.026, p = 0.001). Receiver operating characteristic curves showed absolute NC volume has best diagnostic accuracy (AUC = 0.816, p < 0.001) to predict TIMI 1–2 flow with an optimal cutoff value of 4.5 mm3 with sensitivity and specificity of 79% and 61%, respectively. Conclusions This study exemplifies that the necrotic core component of the culprit lesion plaque in STEMI is associated with the coronary flow after fibrinolysis. The absolute necrotic core volume is a key determinant of flow restoration post-fibrinolysis and aids in prognostication of less than TIMI 3 flow.

Matthew W Konigsberg, John D Mueller, Jordan A Lebovic, R Kumar Kadiyala Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USACorrespondence: Matthew W KonigsbergDepartment of Orthopedic Surgery, Columbia University Medical Center, 622 W. 168th St. 11th Floor, New York, NY 10032, USATel +1-212-305-5976Fax +1-212-305-6193Email Mk3294@cumc.columbia.eduIntroduction: The purpose of this study was to describe four cases of patients who developed concomitant upper extremity and gluteal compartment syndrome in the context of substance abuse. In somnolent patients unable to provide a reliable physical exam, the healthcare provider must be aware of patients presenting with concomitant upper extremity and gluteal compartment syndrome.Methods: Retrospective chart review identified cases of the combined upper extremity and gluteal compartment syndrome following illicit drug abuse at a single academic center during the years 2009– 2019.Results: During the 11-year period examined, a total of eight patients were diagnosed with compartment syndrome secondary to illicit drug use and prolonged immobilization. Four (50%) patients presented with combined upper extremity and gluteal compartment syndrome. All of these patients underwent prompt surgical release of the affected compartments. All eventually returned to normal activities of daily living.Discussion: Compartment syndrome is primarily a clinical diagnosis, with physical exam being extremely important. In patients presenting with somnolence secondary to illicit drug use, physical exam may not be reliable. It is critical to have a high clinical suspicion in this patient population, understanding that these patients may present with concomitant upper extremity and gluteal compartment syndrome.Level of Evidence: Level IV, case series.Keywords: compartment syndrome, fasciotomy, trauma, upper extremity, gluteal

Pancreatic ductal adenocarcinoma (PDAC) is a dismal disease with a 5-year survival rate of 10%. A hallmark feature of this disease is its abundant microenvironment which creates a highly immunosuppressive milieu. This is, in large part, mediated by an abundant infiltration of myeloid cells in the PDAC tumor microenvironment. Consequently, therapies that modulate myeloid function may augment the efficacy of standard of care for PDAC. Unfortunately, there is limited understanding about the various subsets of myeloid cells in PDAC, particularly in human studies. This review highlights the application of single-cell RNA sequencing to define the myeloid compartment in human PDAC and elucidate the crosstalk between myeloid cells and the other components of the tumor immune microenvironment.

ObjectivesTo test the external validity of a previously developed risk table, designed to predict the probability of a positive bone scan among men with non-metastatic (M0) castration-resistant prostate cancer (CRPC), in a separate cohort.Patients and methodsWe retrospectively analysed 429 bone scans of 281 patients with CRPC, with no known previous metastases, treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision-curve analysis were used to assess the performance of our previous model to predict a positive scan in the current data.ResultsA total of 113 scans (26%) were positive. On multivariable analysis, the only significant predictors of a positive scan were log-transformed prostate-specific antigen (PSA): hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.71-2.66 (P < 0.001) and log-transformed PSA doubling time (PSADT): HR 0.53; 95% CI 0.41-0.68 (P < 0.001). Among men with a PSA level

The lack of effective drug delivery strategies has impaired the therapeutic progress in the treatment of glioblastoma (GBM). Here, the authors engineer synthetic protein nanoparticle based on polymerized human serum albumin equipped with the cell-penetrating peptide iRGD to deliver siRNA against STAT3 and report improved survival in a mouse model of GBM.