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Introduction Spirometry is the gold standard for COPD diagnosis and severity determination, but is technique-dependent, nonspecific, and requires administration by a trained healthcare professional. There is a need for a fast, reliable, and precise alternative diagnostic test. This study’s aim was to use interpretable machine learning to diagnose COPD and assess severity using 75-second carbon dioxide (CO2) breath records captured with TidalSense’s N-TidalTM capnometer.Method For COPD diagnosis, machine learning algorithms were trained and evaluated on 294 COPD (including GOLD stages 1–4) and 705 non-COPD participants. A logistic regression model was also trained to distinguish GOLD 1 from GOLD 4 COPD with the output probability used as an index of severity.Results The best diagnostic model achieved an AUROC of 0.890, sensitivity of 0.771, specificity of 0.850 and positive predictive value (PPV) of 0.834. Evaluating performance on all test capnograms that were confidently ruled in or out yielded PPV of 0.930 and NPV of 0.890. The severity determination model yielded an AUROC of 0.980, sensitivity of 0.958, specificity of 0.961 and PPV of 0.958 in distinguishing GOLD 1 from GOLD 4. Output probabilities from the severity determination model produced a correlation of 0.71 with percentage predicted FEV1.Conclusion The N-TidalTM device could be used alongside interpretable machine learning as an accurate, point-of-care diagnostic test for COPD, particularly in primary care as a rapid rule-in or rule-out test. N-TidalTM also could be effective in monitoring disease progression, providing a possible alternative to spirometry for disease monitoring.

A 31-year-old Type 1 diabetes mellitus presented with exudative retinal detachment due to rhino-orbital-cerebral mucormycosis secondary to a periodontal abscess developed following a tooth extraction. He received liposomal amphotericin B due to diabetic nephropathy. We report this case for the rarity in the combination of exudative retinal detachment in a case of orbital cellulitis as well for its rarest origin following a dental extraction.

This is a case report of a young male with poorly controlled type 1 diabetes mellitus who presented with the clinical features of diabetic ketoacidosis. On examination, he had severe growth retardation, elevated liver enzymes, advanced diabetic eye disease, and other diabetes-related microvascular complications. Along with the other clinical features, the patient was diagnosed as a case of Mauriac syndrome. Mauriac syndrome, initially described by Mauriac in 1930, is one of the causes of growth retardation and elevated liver enzymes in poorly controlled diabetic patients. Patients with poorly controlled type 1 diabetes must be closely observed for sexual maturation and growth. An early intervention with optimal therapy to bring glycemic control combined with a close follow-up would help avoid such late complications.

A highly pure, small particle-sized and high surface area nano silica powder was prepared from rice husk using alkali extraction, followed by an acid precipitation method. The composition, phase, morphology, size and surface area of the as-synthesised nano silica powder was investigated by energy-dispersive spectroscopy, Fourier transform infrared spectroscopy, X-ray diffraction, transmission electron microscopy, particle size analyser and BET surface area analyser. High-purity nano silica powder was obtained by sodium hydroxide (NaOH) purification treatment (0.5, 1, 1.5, 2 and 2.5 N). The high purity of silica (∼99.9%) was obtained at 2.5 N NaOH treatment. The pure nano silica powder that is obtained shows an average particle size of ∼25 nm with a high-specific surface area (SSA) of 274 m2 g−1, with an average pore diameter of 1.46 nm. [ABSTRACT FROM AUTHOR]

Senior Loken syndrome is a rare autosomal recessive genetic disorder. This syndrome mainly targets kidney and eye. Nephronophthisis, a chronic kidney disorder, is the common renal manifestation of this syndrome. End-stage renal disease eventually occurs during adulthood if not intervened. Thus, Senior Loken syndrome is a rare combination of chronic kidney disease, anemia, bronchiectasis, and retinitis pigmentosa. Retinitis pigmentosa that starts in early childhood is the typical ocular manifestation of this syndrome although Leber congenital amaurosis occurs in severe cases. Retinitis pigmentosa is a type of retinal dystrophy affecting mainly rods and cones in a later stage. Although X-linked inheritance causes severe form of retinitis pigmentosa, autosomal recessive is the most common mode of inheritance where retinitis pigmentosa forms part of many systemic syndromes. Night blindness is the presenting symptom which progresses to tubular vision in later stages, with the characteristic fundus features of bony spicule, arteriolar attenuation, and waxy pallor of the disc. Counseling of patient and caretakers about the course of disease and the need for low-vision aids in later stages is vital in retinitis pigmentosa patients. Patients should also be educated about the need for regular nephrology and ophthalmology follow-up to prevent further morbidity.

TiO2 a wide bandgap material has a great potential for use in semiconductor industry due to its better electronic properties combined with low cost, chemical stabilioty and nontoxicity. Further metal doping is found to modify the conductivity, electrical, and optical characteristics. In this research, deposition of Sn-doped TiO2 was carriedout using the spray pyrolysis technique. The electrical properties were obtained by using the Hall effect technique and structural properties of the film were analyzed by X-ray diffraction and EDAX Scanning electron microscopy. The result of X-ray diffraction showed that the thin film deposited by spray pyrolysis is polycrystalline with preferential orientation in the direction of (002) fields. SEM analysis exhibited membrane structure for the thin film deposited by spray pyrolysis. The results of electrical conductivity were obtained by using the Hall effect technique. [ABSTRACT FROM AUTHOR]

The WHO Global Vaccine Safety Multi-Country Collaboration study on safety in pregnancy aims to estimate the minimum detectable risk for selected perinatal and neonatal outcomes and assess the applicability of standardized case definitions for study outcomes and maternal immunization in low- and middle-income countries (LMICs). This paper documents the operational lessons learned from the study. A prospective observational study was conducted across 21 hospitals in seven countries. All births occurring at sites were screened to identify select perinatal and neonatal outcomes from May 2019 to August 2020. Up to 100 cases per outcome were recruited to assess the applicability of standardized case definitions. A multi-pronged study quality assurance plan was implemented. The impact of the COVID-19 pandemic on site functioning and project implementation was also assessed. Multi-layered ethics and administrative approvals, limited clinical documentation, difficulty in identifying outcomes requiring in-hospital follow-up, and poor quality internet connectivity emerged as important barriers to study implementation. Use of electronic platforms, application of a rigorous quality assurance plan with frequent interaction between the central and site teams helped improve data quality. The COVID-19 pandemic disrupted data collection for up to 6 weeks in some sites. Our study succeeded in establishing an international hospital-based surveillance network for evaluating perinatal and neonatal outcomes using common study protocol and procedures in geographically diverse sites with differing levels of infrastructure, clinical and health-utilization practices. The enhanced surveillance capacity of participating sites shall help support future pharmacovigilance efforts for pregnancy interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: Most perinatal and neonatal deaths occur in low- and middle-income countries (LMICs), yet, quality data on burden of adverse outcomes of pregnancy is limited in such countries., Methods: A network of 21 maternity units, across seven countries, undertook surveillance for low birthweight, preterm birth, small for gestational age (SGA), stillbirths, congenital microcephaly, in-hospital neonatal deaths, and neonatal infections in a cohort of over 85,000 births from May 2019 - August 2020. For each outcome, site-specific rates per 1,000 livebirths (or per 1,000 total births for stillbirth) and 95% confidence intervals (CI) were calculated. Descriptive sensitivity analysis was conducted to gain insight regarding underreporting of four outcomes at 16 sites., Findings: Estimated rates varied across countries and sites, ranging between 43·3-329·5 and 21·4-276·6/1000 livebirths for low birthweight and preterm birth respectively and 11·8-81/1,000 livebirths for SGA. No cases of congenital microcephaly were reported by three sites while the highest estimated rate was 13/1,000 livebirths. Neonatal infection and neonatal death rates varied between 1·8-73 and 0-59·9/1000 livebirths respectively while stillbirth rates ranged between 0-57·1/1000 total births across study sites. Results from the sensitivity analysis confirmed the underreporting of congenital microcephaly and SGA in our study., Interpretation: Our study establishes site-specific baseline rates for important adverse perinatal and neonatal outcomes and addresses a critical evidence gap towards improved monitoring of benefits and risks of emerging pregnancy and neonatal interventions., Funding: The study was sponsored by the World Health Organization with funding from the Bill and Melinda Gates Foundation., Competing Interests: Margarita Riera-Montes (P95) & Christine Guillard Maure (WHO) declare that their institutions received funding support for this manuscript from the WHO and the Bill & Melinda Gates Foundation respectively. All the remaining authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 World Health Organization.)

Tobacco cessation is a key component of WHO's Framework Convention on Tobacco Control. However, success rates decline significantly from intending to quit tobacco, through attempting and becoming a successful quitter. Among Indian adults, the prevalence of smoking and smokeless tobacco use was 10.7% and 21.4% respectively in 2016. Furthermore, 9% of all deaths were estimated to be attributable to tobacco. This study aims to explore associations of socio-demographic, environmental and behavioural dimensions of tobacco users with the process of successful quitting. Multivariable logistic regression analyses were conducted to study (i) attempting to quit and (ii) being a successful quitter for smoked and smokeless tobacco, using cross-sectional Global Adult Tobacco Survey (GATS) datasets for India (2009-10 and 2016-17), where data was pooled from the two surveys (n = 53,463). Advise to quit by health care provider was associated with quit attempts of smoking (1.82, 95% CI: [1.51; 2.20]), and smokeless tobacco (1.71, 95% CI: [1.45; 2.01]). Never being exposed to smoke at home was the strongest environmental factor for successful smoking cessation (4.04, 95% CI: [2.59; 6.31]). Noticing label warnings and advertisements was also associated with attempting to quit smoked and smokeless tobacco. Being a former smoker/smokeless tobacco user was positively connected with attempting to quit the current use of the other tobacco form. We recommend strategies to promote smoke-free homes, and incorporating 'tobacco cessation advocacy' into the curriculum of health care workers. Strengthening the tobacco control law and program promulgated in India since 2003 and its implementation would significantly promote tobacco cessation., (Copyright © 2022 Elsevier Inc. All rights reserved.)