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Nontuberculous mycobacterial (NTM) infections are increasingly recognized, particularly in tropical regions and are often found in immunocompetent individuals. These infections are emerging as significant health concerns, especially pulmonary NTM, which is reported more frequently and is known to be associated with hospital environments. While pulmonary NTM infections are on the rise, partly due to drug resistance and possible patient-to-patient transmission, there is no current evidence indicating an increase in cutaneous NTM infections. The clinical manifestations of NTM infections, except for well-known entities like Buruli ulcer and fish tank granuloma, are diverse and nonspecific, often mimicking other chronic infections. History of minor trauma at the site of infection can be misleading and may complicate the diagnosis of cutaneous NTM. Surgical-site and port-site NTM infections typically present with erythema, edema, and abscesses and are commonly caused by rapidly growing mycobacteria like M. fortuitum and M. chelonae. These infections may not respond to standard antibiotics, suggesting the need for NTM-specific treatment. Diagnostically, histopathology may not be conclusive, and standard staining techniques often lack sensitivity. Molecular methods offer better speciation and drug resistance profiling for pulmonary NTM but are expensive and not widely available for cutaneous forms. The high cost and limited availability of diagnostic tools necessitate an empirical treatment approach, which is also recommended by the INDEX-Tb guidelines for extrapulmonary tuberculosis. Empirical treatment regimens for NTM, such as combinations of clarithromycin, doxycycline, and cotrimoxazole or fluoroquinolones, have shown promise, but there is a lack of rigorous studies to establish standardized treatments. Monitoring for adverse effects and continued evaluation of the causative organism is essential during empirical treatment, allowing for adjustment if the initial regimen fails.

The potential of artificial intelligence (AI) in diagnosing and managing sexually transmitted infections (STIs), nonvenereal genital diseases, and overall sexual health is immense. AI shows promise in STI screening and diagnosis through image recognition and patient data analysis, potentially increasing diagnostic accuracy while ensuring inclusivity. AI can fuel the transformation of e-health and direct-to-consumer services, enhancing targeted screening and personalized interventions while improving the user-friendliness of services. There is a significant role for AI in sexual education, particularly its use in interactive, empathetic chatbots. AI's integration into health care as a decision support tool for primary health-care providers can boost real-time diagnostic accuracy. Furthermore, AI's use in big data can enhance real-time epidemiology, predictive analysis, and directed interventions at population levels. However, challenges such as real-world diagnostic accuracy, liability, privacy concerns, and ethical dilemmas persist. Future directions include an emphasis on inclusivity, language accommodation, and swift research-to-practice transitions. Collaboration among policymakers, researchers, and health-care providers is needed to leverage AI's transformative potential in sexual health.

In domains where data are sensitive or private, there is great value in methods that can learn in a distributed manner without the data ever leaving the local devices. In light of this need, federated learning has emerged as a popular training paradigm. However, many federated learning approaches trade transmitting data for communicating updated weight parameters for each local device. Therefore, a successful breach that would have otherwise directly compromised the data instead grants whitebox access to the local model, which opens the door to a number of attacks, including exposing the very data federated learning seeks to protect. Additionally, in distributed scenarios, individual client devices commonly exhibit high statistical heterogeneity. Many common federated approaches learn a single global model; while this may do well on average, performance degrades when the i.i.d. assumption is violated, underfitting individuals further from the mean and raising questions of fairness. To address these issues, we propose Weight Anonymized Factorization for Federated Learning (WAFFLe), an approach that combines the Indian Buffet Process with a shared dictionary of weight factors for neural networks. Experiments on MNIST, FashionMNIST, and CIFAR-10 demonstrate WAFFLe’s significant improvement to local test performance and fairness while simultaneously providing an extra layer of security.

Mung bean or moong or green gram, an important grain legume, is cultivated mainly in Asian countries and other parts of the world as a food crop. It is a highly nutritious grain legume with a high content of easily digestible proteins (20–32%), carbohydrates (53.3–67.1%), lipids (0.71–1.85%), vitamins, minerals, and fiber. It also contains some antinutrients such as tannins, phytic acid, hemagglutinin, polyphenols, and trypsin inhibitors in low concentrations. The sprouting of seeds leads to dynamic changes in metabolites with a decrease in antinutrient content and an increase in the nutritional value. In addition to these nutrients and antinutrients, the plant also contains various other phytochemicals such as alkaloids, flavonoids, saponins, phenols, glycosides, and bioactive peptides, which exhibit an array of pharmaceutically important properties such as anti-inflammatory, antinociceptive, antimicrobial, antioxidant, antidiabetic, lipid metabolism regulation, antihypertensive, antiallergic, and antitumor. Being rich in nutritional value and other phytochemical components, the plant can be explored further for its pharmaceutical properties and used as an efficient food additive in the preparation of different types of dietary supplements or food-derived drugs.

Objectives: The aim of this study was to evaluate outcomes, survival, patterns of recurrence, and morbidity in both early and recurrent operable cervical cancer patients following radical hysterectomy, pelvic lymph node dissection, and adjuvant radiotherapy. Materials and Methods: This was a prospective analysis of 55 patients of stage IA–IIA and recurrent operable cervical cancer treated with radical hysterectomy, pelvic lymphadenectomy, and adjuvant radiotherapy from 2014 to 2017. Overall survival (OS), disease-free survival (DFS), morbidity, and mortality rates were the end points of this study. Survival analysis was performed using the Kaplan–Meir method. Results: The median age of the study group was 45 years (range 18–68 years). The most common presentation was stage IB2 disease in 34.5% of patients. Fifty (90%) patients had squamous histology, whereas 5 (9.1%) had adenocarcinoma. Upfront radical hysterectomy was performed in 90.9% of patients, whereas 9.1% underwent surgery for recurrent cervical cancer. The most common indication for adjuvant radiotherapy was lymph node involvement, followed by parametrium involvement in 20% and 13% patients, respectively. Median follow-up period was 48 months (range 6–60 months). The OS and DFS rates were 85.0% and 81.8%, respectively. The most frequent complication encountered was paralytic ileus in 4 (7.2%) patients. Conclusion: Radical hysterectomy with pelvic lymphadenectomy for early cervical cancer has a favorable survival outcome with acceptable long-term morbidity.

Automated plant diagnosis is a technology that promises large increases in cost-efficiency for agriculture. However, multiple problems reduce the effectiveness of drones, including the inverse relationship between resolution and speed and the lack of adequate labeled training data. This paper presents a two-step machine learning approach that analyzes low-fidelity and high-fidelity images in sequence, preserving efficiency as well as accuracy. Two data-generators are also used to minimize class imbalance in the high-fidelity dataset and to produce low-fidelity data that are representative of UAV images. The analysis of applications and methods is conducted on a database of high-fidelity apple tree images which are corrupted with class imbalance. The application begins by generating high-fidelity data using generative networks and then uses these novel data alongside the original high-fidelity data to produce low-fidelity images. A machine learning identifier identifies plants and labels them as potentially diseased or not. A machine learning classifier is then given the potentially diseased plant images and returns actual diagnoses for these plants. The results show an accuracy of 96.3% for the high-fidelity system and a 75.5% confidence level for our low-fidelity system. Our drone technology shows promising results in accuracy when compared to labor-based methods of diagnosis.

Blunt chest trauma (BCT) is one of the rarest causes of acute myocardial infarction (AMI). This paper reports the case of a young married man who suffered from AMI due to BCT sustained in a fight with his wife. The histopathology examination revealed a rupture of atherosclerotic plaque with superimposed thrombus in the proximal left anterior descending artery. This report also reviews previously reported BCT-induced AMI cases in the literature.

Invasive aspergillosis is an uncommon infection, which is mainly seen among immunocompromised patients. In recent years, cases of aspergillosis involving immunocompetent hosts are increasingly being reported. Herein, we report the case of a 27-year-old man with fever, productive cough, shortness of breath, and left hemiparesis. He had suffered trauma to his head 25 days prior. Imaging of the chest showed bilateral cavitary lesions in the lungs, and neuroimaging revealed a space-occupying lesion in the right frontoparietal cerebrum. He was suspected of having an abscess or metastasis. He died on day 3 of hospitalization, and an autopsy was performed. The autopsy revealed the cause of death to be invasive pulmonary aspergillosis, with brain dissemination. Invasive aspergillosis is uncommon in apparently immunocompetent individuals, and we discuss the autopsy findings in detail.

AIM: To study the demographics, staging, treatment details, and outcomes of operable endometrial cancers. METHOD: All operable endometrial cancers treated between January 2013 and February 2017 were included in the study. The details regarding demographics, staging, surgical procedure, pathological staging, adjuvant treatment, and outcomes were extracted from the case records. RESULTS: There were 25 patients with a median age of 55 years (36–78 years). The Eastern Cooperative Oncology Group performance status was 1 in 23 patients (92%) and 2 in 1 patient (4%) and 3 in 1 patient (4%). 22 patients (88%) had disease restricted to endometrium while 3 patients (12%) had cervical involvement. The surgery done was Type I hysterectomy in 24 patients (96%), Type II in 1 patient (4%). Pelvic lymph node dissection was done in 22(88%) patients while para‑aortic (infra-hilar) dissection was done in 2 patients (8%). The pathological stages were Stage IA in 13 patients, Stage IB in 3 patients, Stage II in 4 patients, Stage IIIC1 in 3 patients, and Stage IV in 2 patients. Grade 1 tumors were seen in 21 patients, Grade 2 in 2 patients, Grade 3 in 2 patients. The histology was endometrioid in 23 patients, clear cell in 1 patient, and carcinosarcoma in 1 patient. Adjuvant treatment was received by 5 patients. CONCLUSION: Endometrial cancer is 4th most common gynaecological cancer in our series, 3.5% of all cancer patients. Risk factors including menopause. Other risk factors not statistically significant. Endometrioid adenocarcinoma most common histology with early stage is most common among all surgically treated patients. Simple hysterectomy sufficient for stage 1 & 2. Adjuvant therapy needed in stage 3 & 4. DFS and OS are good in younger age groups, well-differentiated, early stage endometrial cancers but very poor in older age group, poorly differentiated, stage 3C and stage 4 patients.

Background: A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of outcomes including the costs and benefits of Hybrid and open esophagectomy approaches for esophageal cancer surgery. Methods: The data of 15 consecutive patients who underwent a McKeown's esophagectomy at Sri Aurobindo Institute of Medical Science and Post Graduate Institute (SAIMS and PGI), Indore between November 2017 and October 2019 were analysed. Open esophagectomy was performed in 10 patients, and hybrid esophagectomy in 05. There were no differences in patient characteristics among the 2 groups. Hybrid esophagectomy via a thoracoscopic-laparotomy approach and open esophagectomy by a thoracotomy-laparotomy approach. Results: Hybrid esophagectomy required a longer operative time than open esophagectomy (p value 0.02), but these patients reported less postoperative pain (p value 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 2 groups. Hybrid esophagectomy incurred higher operative and surgical material cost and inpatient care and total hospital costs than open esophagectomy (p value 0.01). Conclusion: Hybrid esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain.

Food access is a major key component in food security, as it is every individual’s right to proper access to a nutritious and affordable food supply. Low access to healthy food sources influences people’s diet and activity habits. Guilford County in North Carolina has a high ranking in low food security and a high rate of health issues such as high blood pressure, high cholesterol, and obesity. Therefore, the primary objective of this study was to investigate the geospatial correlation between health issues and food access areas. The secondary objective was to quantitatively compare food access areas and heath issues’ descriptive statistics. The tertiary objective was to compare several machine learning techniques and find the best model that fit health issues against various food access variables with the highest performance accuracy. In this study, we adopted a food-access perspective to show that communities that have residents who have equitable access to healthy food options are typically less vulnerable to health-related disasters. We propose a methodology to help policymakers lower the number of health issues in Guilford County by analyzing such issues via correlation with respect to food access. Specifically, we conducted a geographic information system mapping methodology to examine how access to healthy food options influenced health and mortality outcomes in one of the largest counties in the state of North Carolina. We created geospatial maps representing food deserts—areas with scarce access to nutritious food; food swamps—areas with more availability of unhealthy food options compared to healthy food options; and food oases—areas with a relatively higher availability of healthy food options than unhealthy options. Our results presented a positive correlation coefficient of R2 = 0.819 among obesity and the independent variables of transportation access, and population. The correlation coefficient matrix analysis helped to identify a strong negative correlation between obesity and median income. Overall, this study offers valuable insights that can help health authorities develop preemptive preparedness for healthcare disasters.

Background: Soft tissue malignancies constituted a heterogeneous group of rare solid tumors of mesenchymal cell origin with distinct clinical and pathological features. The aim of the study was to know the prevalence of soft tissue sarcoma, sex, age and site distribution, histopathology and various treatment options adopted with follow up. Methods: A total of 52 cases of soft tissue sarcoma were analyzed for a three-year period. Results: Out of 52 cases 37% of cases were between 20-40 yearsand 38% of tumors were situated in lower-extremity. The commonest histological type was Ewing’s sarcoma and Spindle cell sarcoma. Lymph node metastasis was seen in 4% of cases. Distant metastasis was present in 6-cases, 5 with lung metastasis and 1 with lung and liver metastasis. Surgery was the main modality of the treatment. Only 60% turned for follow up, 3 patients succumbed to death because of multiple pulmonary secondaries and chest infections. Conclusion: In the present study, all the cases of soft tissue sarcoma presented in late stage of the disease due to illiteracy and lack of health education. Recurrence was seen in 1% of cases. The overall survival rates and quality of life of the patients can be improved by frequent health camps at primary health centers for early detection of the disease, providing adequate health education, diagnostic and management facilities.

Background: Post-burn axillary and elbow scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction and extension that should be achieved, respectively, while treating either of the joint. The aim of this paper is to highlight the use of subcutaneous pedicle propeller flap for the management of post-burn axillary and elbow contractures. Methodology: This is a prospective case study of axillary and elbow contractures managed at a tertiary care hospital using propeller flap based on subcutaneous pedicle from 2009 to 2014. Surgical treatment comprised of subcutaneous-based pedicle propeller flap from the normal tissue within the contracture based on central axis pedicle. The flap was rotated axially to break the contracture. The technique further encompassed a modification, a Zig-Zag incision of the flap, which was seen to prevent hypertrophy along the incision line. There was a mean period of 12 months of follow-up. Results: Thirty-eight patients consisting of 22 males and 16 females were included in this study among which 23 patients had Type II axillary contractures and 15 had moderate flexion contractures at elbow joint. The post-operative abduction achieved at shoulder joint had a mean of 168° whereas extension achieved at elbow had a mean of 175°. The functional and aesthetic results were satisfactory. Conclusion: The choice of surgical procedure for reconstruction of post-burn upper extremity contractures should be made according to the pattern of scar contracture and the state of surrounding skin. The choice of subcutaneous pedicle propeller flap should be emphasised because of the superior functional results of flap as well as ease to learn it. Moreover, the modification of propeller flap described achieves better results in terms of scar healing. There is an inter-positioning of healthy skin in between the graft, so it prevents scar band formation all around the flap.

Background: Axillary post-burn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction that should be achieved. The aim of this paper was to highlight the various options used in managing axillary contractures in our hospital. Materials and Methods: This is a retrospective hospital-based study of axillary contractures managed at Safdarjung Hospital (a tertiary care hospital) from 2009 to 2013.The study consisted of 44 patients from all age group and both sex included in it. Patients with a bilateral axillary contracture were excluded. Axillary contracture was released and resurfaced using split skin graft and/or with different types of flaps including the propeller flap, parascapular flap. All the reconstructed cases were followed-up for a period of 12 months. Assessment was done on the basis of functional and aesthetic outcome. Results: Forty-four patients consisting of 25 males and 19 females presented with axillary contractures that involved 44 axillae. The mean age of the study group was 17.1 years. Injuries involved the anterior axillary fold in 8 (18.18%), posterior fold in ten (22.72%), both folds and axillary fossa in 14 (31.81%) and both folds plus part of the chest wall and arm (sparing the axillary fossa) in 12 (27.27%) axillae. Surgical treatment included split-thickness skin graft in 15 (34.1%), local skin flaps in 4 (9.1%), Z-plasties in 4 (9.1%), parascapular flaps in 3 (6.82%), while propeller flaps in 12 (27.27%) and square flap were used in 6 (13.64%) patients. The percentage of improvement in abduction had a mean of 156°. The functional and aesthetic results were satisfactory. Conclusion: The choice of surgical procedure for reconstruction of post-burn axillary contractures can be made according to the pattern of scar contracture and the state of the surrounding skin. The choice of a flap should have priority over the skin graft because of the superior functional and aesthetic results of flaps.

Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of years of productive life lost for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives.