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Metamaterial absorbers (MMAs) have tremendous potential for controlling and modulating Terahertz electromagnetic (EM) waves. It is challenging to design MMAs for optimal performance using conventional methods due to their time-consuming and computationally demanding nature. Machine learning (ML) regressor approaches have emerged as potential tools for optimizing the predictive modeling of MMAs in recent years. This article examined different regression techniques, such as Decision Tree, k-Nearest Neighbors, Random Forest, Extra Trees (ET), Extreme Gradient Boosting, Bagging, and Categorical Boosting. The primary goal is to assess the effectiveness of each regressor technique in forecasting the performance of MMAs using various performance metrics. The study focuses on a representative spectrum of MMAs, chosen for its key features that are common across a wide range of MMAs. The extra tree Regressor outperforms other models in the comparative analysis due to its capacity to integrate multiple decision trees and include randomness into the feature selection process, resulting in improved predictive skills. The ET regressor forecasts MMA performance remarkably well for a 70 % test size, with a Root Mean Squared Error of 0.0251, a Mean Absolute Error of 0.0074, a Mean Squared Error of 0.006, and an Adjusted R-squared of 0.9873. These findings can assist researchers in optimizing metamaterial absorber designs for Terahertz applications using ML regressor techniques and provide insights into how these methods can be generalized to other spectra with similar characteristics.

Polymer nanocomposites have received significant scientific and industrial attention due to the synergetic combination of features of a polymeric matrix and organic or inorganic nanofillers. While experiments have been essential for identifying and characterizing new materials, their high costs and limited trials have shifted the focus towards applying machine learning (ML) to predict nanocomposite properties. This study aims to establish a connection with the tribological performance of multi-walled carbon nanotubes (MWCNT) reinforced with polymethyl methacrylate (PMMA) nanocomposites through the comparison of ML techniques. The wear and friction characteristics of MWCNT-reinforced PMMA nanocomposites were predicted based on three input variables: material weight percentage, load weight, and track diameter. The features of nanocomposites were predicted using three different ensemble ML algorithms: random forest (RF), extra tree (ET), and gradient boosting machine (GBM). The dataset was utilized to train the proposed models in Python, followed by hyperparameter tuning to determine the best model for predicting target values. The results demonstrated that the GBM model outperformed the RF and ET models, with an R-squared of 0.99, RMSE of 0.62, and MAE of 0.18. The proposed models’ predictions of wear values were more precise than their friction values. These findings indicate that ML techniques, particularly the GBM model, can effectively predict the tribological properties of MWCNT-reinforced PMMA nanocomposites, potentially reducing the need for extensive experimental trials and contributing to advancements in nanocomposite material science.

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can’t be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.

This study presents a significant enhancement to the analytical capabilities of an existing X-ray fluorescence (XRF) spectrometer by integrating an Am-241 excitation-based system. The modification enables precise and cost-effective analysis of rare-earth elements (REEs), expanding the spectrometer’s utility. Successful identification and quantification of Scandium (8.1 ± 1.3 mg\kg), Ytterium (7.9 ± 2.0 mg\kg), Lanthanum (27.5 ± 2.1 mg\kg), Cerium (60.4 ± 2.5 mg\kg), Neodymium (29.7 ± 1.2 mg\kg), Samarium (4.6 ± 2.0 mg\kg), Europium (0.8 ± 0.4 mg\kg), Gadolinium (2.6 ± 0.6 mg\kg), and Erbium (3.5 ± 1.2 mg\kg) were achieved using their K-X-rays. The quantitative analysis employed the "Elemental Sensitivities Method" and was validated against established methods like Instrumental Neutron Activation Analysis (INAA) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The modified system demonstrated an accuracy of approximately 80% in analyzing REEs in the IAEA-Soil 7 reference material.

Abstract Bronchial Dieulafoy's disease (BDD), remains poorly understood, with only 88 cases reported globally. Herein, we present the largest case series (n = 7) from a single centre, between 2017 and 2023, retrospectively reviewed, detailing clinical presentations, diagnoses, management and up to 4‐year follow‐up outcomes. Diagnosis relied on characteristic lesions detected through white light bronchoscopy with or without endobronchial ultrasound (EBUS) or narrow band imaging (NBI), along with computed tomography (CT) scans or bronchial angiography. Identification of aberrant vessels beneath lesions and bronchoscopy details were documented. Treatment modalities and follow‐up outcomes until December 2023 were noted. All patients were non‐smokers. Review of imaging findings by an experienced radiologist was crucial in suspected cases due to risk of bleeding and often unconclusive results from biopsy. Management of BDD varied, with six patients undergoing bronchial artery embolization (BAE) and one requiring lobectomy; four patients received additional endobronchial therapy, one died due to malignancy, none experienced recurrence of haemoptysis. Identifying patients with large volume haemoptysis disproportionate to parenchymal disease in CT scans is important. A bronchoscopic surveillance is crucial to avoid biopsy; it can be confirmed using EBUS of NBI. While no established guidelines exist, BAE and endobronchial therapy emerge as valuable interventions, with surgical resection reserved for recurrent cases.

This research investigates the dielectric properties of nano epoxy composites by incorporating various concentrations of MoS2 into epoxy resin. The study explores the impact of synthesized nanoparticles on undoped epoxy composites, specifically focusing on their potential applications in dielectric materials. The experimental synthesis and characterization of nanoepoxy composites typically involve time-consuming and expensive methods. This study compares five machine learning (ML) models—random forests, decision trees, extra trees, XGBoost, and gradient boosting—in order to predict the frequency-dependent dielectric constants in these composites under different nanofiller variations in order to address this challenge. To ensure robust model performance, training is carried out on different subsets of the dataset, ranging from 60% to 30%, while the remaining portions are reserved for testing purposes (40% to 70%). The main objective of the study is to assess the performance of each regressor technique using metrics such as adjusted R2 score, MSE, RMSE, and MAE, in which the ET regressor excels. The ET method demonstrates exceptional performance, achieving an adjusted R2 value of 0.9977 and 0.9912 for target variables ε′ and ε′′, respectively when tested with a size of 0.4. The findings underscore the potential of ML models for precise and efficient prediction of frequency-dependent dielectric constants of nanoepoxy composites with various concentrations of nanofillers, offering an alternative to time-consuming and expensive laboratory work.

The increasing deployment of Internet of Things devices has introduced significant cyber security challenges, creating a need for robust intrusion detection systems. This research focuses on improving anomaly detection in industrial Internet of Things networks through feature reduction and selection. Experiments were performed to compare the effectiveness of Minimum Redundancy Maximum Relevance for feature selection with Principal Component Analysis for feature reduction. Six machine learning algorithms—Decision Trees, k-nearest neighbors, Gaussian Support Vector Machine, Neural Network, Support Vector Machines kernel, and Logistic Regression Kernel—were evaluated for both binary and multi-class classification using feature sets of 4, 12, 23, 50, and 79 features. The results reveal that Minimum Redundancy Maximum Relevance is superior to Principal Component Analysis in identifying crucial features. Notably, Minimum Redundancy Maximum Relevance achieves high accuracy with just 12 features, where the Decision Tree classifier reached an outstanding 99.9% accuracy in binary classification, and k-nearest neighbors achieved 99% accuracy in multi-class classification. The article emphasizes the critical role of feature engineering, with a specific focus on feature selection and reduction, and elaborates on applying MRMR and PCA algorithms to various feature sets. By comparing these methods, it showcases their influence on both model performance and complexity, leading to the development of more efficient and precise intrusion detection systems for Industrial IoT networks. What sets this study apart from previous ones is its novel demonstration of how these techniques significantly reduce training time and model complexity while maintaining or even improving performance, confirming the effectiveness of strategic feature utilization in strengthening Industrial IoT security by balancing accuracy, speed, and model size.

The most popular technique for converting two-class images into binary images is thresholding. However, thresholding methods tend to perform poorly when dealing with images affected by uneven lighting. To address this issue, local thresholding techniques are commonly used. While pixel-based local thresholding methods can achieve high accuracy, they are computationally complex. Window-based local thresholding presents challenges in selecting the initial window and determining the criterion function for dividing the image into smaller versions. In this study, a novel technique is proposed to improve the effectiveness of binarizing images with uneven lighting. The proposed method is based on a low-complexity functional neural network model (LC-FLANN) to estimate an image’s illumination surface. The effectiveness of the proposed technique has been evaluated using five widely used uneven lighting image binarization techniques and various uneven light image variations. The results show that the proposed approach outperforms other alternatives in both qualitative and quantitative metrics. It achieved an average F-Measure score of 0.97, a Jaccard Index (JI) score of 0.95, and a Percentage of Misclassification Error (PME) 1.42%, demonstrating superior overall performance.

The rapid growth of the Internet of Medical Things (IoMT) has introduced significant security and privacy challenges in managing and protecting medical data. This paper proposes a secure federated cloud storage system designed to address these challenges using a hybrid heuristic attribute-based encryption (ABE) scheme integrated with a permissioned Blockchain. The proposed system enhances data confidentiality and integrity by first collecting medical information and then encrypting it with ABE using an optimal key generated by the Hybrid Mexican Axolotl with Energy Valley Optimizer (HMO-EVO). The encrypted data is securely stored in a permissioned blockchain, ensuring robust access control and protection against data breaches. For effective healthcare monitoring, the system employs federated learning with a Multi-scale Bi-Long Short-Term Memory and Gated Recurrent Unit (MBiLSTM-GRU) to predict diseases accurately. This federated approach allows for decentralized training of deep learning models, preserving patient data privacy while leveraging collective learning. Experimental results show that the proposed system outperforms conventional methods in terms of security, efficiency, and predictive accuracy. This research offers a comprehensive framework for secure medical data management, combining the strengths of federated learning and blockchain technology to address the critical issues of data ownership, regulatory compliance, and privacy in IoMT networks.

Background subtraction is a crucial stage in many visual surveillance systems. The prime objective of any such system is to detect local changes, and the system could be utilized to face many real-life challenges. Most of the existing methods have addressed the problems of moderate and fast-moving object detection. However, very few literature have addressed the issues of slow moving object detection and these methods need further improvement to enhance the efficacy of detection. Hence, within this article, our significant endeavor involved identifying moving objects in challenging videos through an encoder-decoder architectural design, incorporating an enhanced VGG-19 model alongside a feature pooling framework. The proposed algorithm has various folds of novelties: a pre-trained VGG-19 architecture is modified and is used as an encoder with a transfer learning mechanism. The proposed model learns the weights of the improved VGG-19 model by a transfer-learning mechanism which enhances the model’s efficacy. The proposed encoder is designed using a smaller number of layers to extract crucial fine and coarse scale features necessary for detecting the moving objects. The feature pooling framework (FPF) employed is a hybridization of a max-pooling layer, a convolutional layer, and multiple convolutional layers with distinct sampling rates to retain the multi-scale and multi-dimensional features at different scales. The decoder network consists of stacked convolution layers projecting from feature to image space effectively. The developed technique’s efficacy is demonstrated against thirty-six state-of-the-art (SOTA) methods. The outcomes acquired by the developed technique are corroborated using subjective as well as objective analysis, which shows superior performance against other SOTA techniques. Additionally, the proposed model demonstrates enhanced accuracy when applied to unseen configurations. Further, the proposed technique (MOD-CVS) attained adequate efficiency for slow, moderate, and fast-moving objects simultaneously.

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

Abstract Spondyloepimetaphyseal dysplasia with severe short stature, RPL13-related (SEMD-RPL13), MIM#618728), is a rare autosomal dominant disorder characterized by short stature and skeletal changes such as mild spondylar and epimetaphyseal dysplasia affecting primarily the lower limbs. The genetic cause was first reported in 2019 by Le Caignec et al., and six disease-causing variants in the gene coding for a ribosomal protein, RPL13 (NM_000977.3) have been identified to date. This study presents clinical and radiographic data from 12 affected individuals aged 2–64 years from seven unrelated families, showing highly variable manifestations. The affected individuals showed a range from mild to severe short stature, retaining the same radiographic pattern of spondylar- and epi-metaphyseal dysplasia, but with varying severity of the hip and knee deformities. Two new missense variants, c.548 G>A, p.(Arg183His) and c.569 G>T, p.(Arg190Leu), and a previously known splice variant c.477+1G>A were identified, confirming mutational clustering in a highly specific RNA binding motif. Structural analysis and interpretation of the variants’ impact on the protein suggests that disruption of extra-ribosomal functions of the protein through binding of mRNA may play a role in the skeletal phenotype of SEMD-RPL13. In addition, we present gonadal and somatic mosaicism for the condition.

Macrophomina phaseolina is the most devastating and emerging threat to groundnut production in India. An increase in average temperature and inconsistent rainfalls resulting from changing climatic conditions are strongly believed to aggravate the disease and cause severe yield losses. The present study aims to conduct a holistic survey to assess the prevalence and incidence of dry root rot of groundnut in major groundnut growing regions of Southern India, viz., Andhra Pradesh, Telangana, Karnataka, and Tamil Nadu. Furthermore, the pathogenic variability was determined using different assays such as morphological, cultural, pathogenic, and molecular assays. Results indicate that disease incidence in surveyed locations ranged from 8.06 to 20.61%. Both temperature and rainfall played a major role in increasing the disease incidence. The pathogenic variability of M. phaseolina isolates differed significantly, based on the percent disease incidence induced on cultivars of JL-24 groundnut and K-6 groundnut. Morphological variations in terms of growth pattern, culture color, sclerotia number, and sclerotia size were observed. The molecular characterization of M. phaseolina isolates done by ITS rDNA region using ITS1 and ITS4 primers yielded approximately 600 bp PCR amplicons, sequenced and deposited in GenBank (NCBI). Molecular variability analysis using SSR primers indicated the genetic variation among the isolates collected from different states. The present investigation revealed significant variations in pathogenic variability among isolates of M. phaseolina and these may be considered important in disease management and the development of resistant cultivars against groundnut dry root rot disease.

Abstract Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopaedic surgery, which presents predominantly with pulmonary symptoms. The rapid worsening respiratory failure in a previously normal orthopaedic surgery or trauma patients usually get evaluated for pulmonary embolism, fat‐embolism‐related acute respiratory distress or transfusion related acute lung injury. Orthopaedic surgeons and clinicians need to be aware of related entity termed ‘Fat Embolism related Diffuse Alveolar Haemorrhage’ (FEDAH). The clinical presentation in an orthopaedic surgery of trauma patient with FEDAH are haemoptysis, worsening type 1 respiratory failure and oxygen requirement, drop in haemoglobin levels with chest x‐ray/computed tomography suggestive of Diffuse alveolar haemorrhage (DAH). Early bronchoscopy and bronchoalveolar lavage (BAL) confirmation of DAH, presence of BAL haemosiderophages and lipid‐laden macrophages are the pointers in the early diagnosis of FEDAH. It needs a high clinical suspicion and interdepartmental collaborative measures. Timely referral from orthopaedic surgeons, early bronchoscopy and treatment with steroids is key in diagnosis and management.

This work presents a metamaterial absorber (MMA) for X- and Ku-bands with a metallic resonating patch on top and a ground plane separated by substrate FR-4 with a thickness of $0.053~\lambda $ at the lowest resonance frequency. The proposed MMA demonstrates perfect absorption of 99.42, 98.48, 98.92, and 99.34 % at 9.948, 13.26, 14.92, and 15.80 GHz, respectively at normal incidence. The proposed MMA demonstrates perfect absorption for a polarization and incident angle over a wide range of angles up to 45°. To understand the fundamental EM behavior of the metamaterial structure, equivalent circuit analysis was carried out, and the circuit outputs accorded with the simulation results. This article also compares various machine learning (ML) methods for optimizing the design and predictive modeling of MMAs, such as decision trees, K-nearest neighbors, random forests, extra trees (ET), bagging, LightGBM, XGBoost, hist gradient boosting, cat boost, and gradient boosting regressors. The primary objective is to assess the usefulness of each regressor technique in estimating the performance of MMAs using multiple tests ranging from TC-40 to TC-80 and performance metrics such as adjusted R-squared score, MSE, RMSE, and MAE, in which the ET regressor excels. Simulation results suggest that ML-based techniques can save simulation resources and time while still being an efficient tool for predicting absorber behavior at intermediate and subsequent frequencies.

Abstract A hepta-band terahertz metamaterial absorber (MMA) with modified dual T-shaped resonators deposited on polyimide is presented for sensing applications. The proposed polarization sensitive MMA is ultra-thin (0.061 λ) and compact (0.21 λ) at its lowest operational frequency, with multiple absorption peaks at 1.89, 4.15, 5.32, 5.84, 7.04, 8.02, and 8.13 THz. The impedance matching theory and electric field distribution are investigated to understand the physical mechanism of hepta-band absorption. The sensing functionality is evaluated using a surrounding medium with a refractive index between 1 and 1.1, resulting in good Quality factor (Q) value of 117. The proposed sensor has the highest sensitivity of 4.72 THz/RIU for glucose detection. Extreme randomized tree (ERT) model is utilized to predict absorptivities for intermediate frequencies with unit cell dimensions, substrate thickness, angle variation, and refractive index values to reduce simulation time. The effectiveness of the ERT model in predicting absorption values is evaluated using the Adjusted R2 score, which is close to 1.0 for n min = 2, demonstrating the prediction efficiency in various test cases. The experimental results show that 60% of simulation time and resources can be saved by simulating absorber design using the ERT model. The proposed MMA sensor with an ERT model has potential applications in biomedical fields such as bacterial infections, malaria, and other diseases.

Background: Infections continue to be the leading aetiology of bronchiectasis in developing countries like India. Among non-infectious cases, the majority will have no identifiable cause despite extensive evaluation. Recently, immunodeficiency has been recognized as an important aetiology, but data on its prevalence remain rather sparse. Objectives: The objective of this study is to evaluate the prevalence of humoral immunodeficiency in a cohort of adults with bilateral bronchiectasis with no apparent aetiology. Methods: This is the single-site study from Christian Medical College (Vellore, India) of adults with HRCT-proven non-infectious bronchiectasis. Humoral immunity was assessed through quantitative analysis of immunoglobulins and IgG subclass levels. Results: Among 158 cases, immunoglobulin deficiency was found in 15%. Low IgM was the most predominate finding (7%), followed by common variable immunodeficiency (3%) and low IgA (2.5%). In addition, IgG subclass deficiency was found in 5%. In 53% of cases, no specific aetiology could be identified. Conclusion: Humoral immune deficiency is present in a significant proportion of patients with non-infectious bronchiectasis. Routine measurement of serum immunoglobulins should therefore be considered as part of the evaluation.

Abstract Background Malignancy-associated secondary spontaneous pneumothorax (MSSP) has an incidence of 1% with a risk for recurrence of 9.4% reported in association with sarcomas, histiocytoma, malignant thymoma, and cancers of the breast and thyroid. Case presentation We report a series of four patients who presented to us with MSSP associated with pulmonary metastasis of osteosarcoma, all four being young males with metastasis to the lungs. All four patients were non-smokers and had no family history of malignancy. Less than 2% of all spontaneous pneumothoraxes present with bilateral pneumothorax, and our series reports the same in three patients. The occurrence of pneumothorax in two of the patients was in the week following chemotherapy. As there was evidence of pulmonary metastasis in these patients along with the clinical presentation of pneumothorax following chemotherapy, tumor necrosis was considered the likely etiology of spontaneous pneumothorax in these patients. All four patients required intercostal chest drain insertion, and the ICD tubes had to be retained for a prolonged duration due to either persistent air leak or secondary infection. ICD tube insertion further compromised the poor mobility of patients with lower limb lesions due to increased pain and was detrimental to the emotional morale of the patient and caregivers. The 2-year survival in such patients with pneumothorax is less than 10%. Conclusions Our series highlights the need for respiratory evaluation and follow-up both clinically and radiologically in cases of osteosarcoma, especially in the immediate post-chemotherapy period.

The mountain systems of the Himalayan regions are changing rapidly due to climatic change at a local and global scale. The Indian Western Himalaya ecosystem (between the tree line and the snow line) is an underappreciated component. Yet, knowledge of vegetation distribution, rates of change, and vegetation interactions with snow-hydroclimatic elements is lacking. The purpose of this study is to investigate the linkage between the spatiotemporal variability of vegetation (i.e., greenness and forest) and related snow-hydroclimatic parameters (i.e., snow cover, land surface temperature, Tropical Rainfall Measuring Mission (TRMM), and Evapotranspiration (ET)) in Himachal Pradesh (HP) Basins (i.e., Beas, Chandra, and Bhaga). Spatiotemporal variability in forest and grassland has been estimated from MODIS land cover product (MCD12Q1) using Google Earth Engine (GEE) for the last 19 years (2001–2019). A significant inter- and intra-annual variation in the forest, grassland, and snow-hydroclimatic factors have been observed during the data period in HP basins (i.e., Beas, Chandra, and Bhaga basin). The analysis demonstrates a significant decrease in the forest cover (214 ha/yr.) at the Beas basin; however, a significant increase in grassland cover is noted at the Beas basin (459 ha/yr.), Chandra (176.9 ha/yr.), and Bhaga basin (9.1 ha/yr.) during the data period. Spatiotemporal forest cover loss and gain in the Beas basin have been observed at ~7504 ha (6.6%) and 1819 ha (1.6%), respectively, from 2001 to 2019. However, loss and gain in grassland cover were observed in 3297 ha (2.9%) and 10,688 ha (9.4%) in the Beas basin, 1453 ha (0.59%) and 3941 ha (1.6%) in the Chandra basin, and 1185 ha (0.92%) and 773 ha (0.60%) in the Bhaga basin, respectively. Further, a strong negative correlation (r = −0.65) has been observed between forest cover and evapotranspiration (ET). However, a strong positive correlation (r = 0.99) has been recorded between grassland cover and ET as compared to other factors. The main outcome of this study in terms of spatiotemporal loss and gain in forest and grassland shows that in the Bhaga basin, very little gain and loss have been observed as compared to the Chandra and Beas basins. The present study findings may provide important aid in the protection and advancement of the knowledge gap of the natural environment and the management of water resources in the HP Basin and other high-mountain regions of the Himalayas. For the first time, this study provides a thorough examination of the spatiotemporal variability of forest and grassland and their interactions with snow-hydroclimatic factors using GEE for Western Himalaya.

Background: Idiopathic pulmonary fibrosis (IPF) is a form of progressive fibrosing interstitial lung disease with a poor prognosis. Pirfenidone is an oral antifibrotic agent used in the treatment of IPF, and it reduces the rate of decline of lung function. However, the tolerable dose and adverse effect profile appear to be different in the Indian population. Methodology: This prospective observational study was conducted in the Department of Pulmonary Medicine at a tertiary care center in India between January 2015 and June 2016. All adult patients diagnosed as IPF based on multidisciplinary discussion were enrolled. Subjects with active respiratory tract infection, other end-organ failures, and drugs interacting with Pirfenidone were excluded. Data collection was done with a predesigned questionnaire at baseline. Subsequently, they were followed up telephonically every week and in-person review at 3 and 6 months. Results: The cohort has 30 patients with a mean age of 60 years ± 4.5 (standard deviation 8.9). 80% did not tolerate the recommended total dose (40 mg/kg/day or 2400 mg/kg) and the median tolerated dose was 1800 mg/day (25–30 mg/kg). 75% reported adverse events, the most common being anorexia, and gastroesophageal reflux disease in gastrointestinal (GI) reaction, followed by a rash in dermatological reactions. All these adverse effects were mild to moderate and managed with supportive care or dose reduction. None of them were severe, causing cessation of therapy. Conclusion: Pirfenidone has a lower tolerable dose and predominantly GI adverse effects in our population, and if addressed early, it can prevent cessation of treatment and better quality of life for patients.

In this article, we design a metamaterial absorber (MMA) to provide quad-band absorption characteristics in terahertz range. The proposed MMA structure comprises of a Gemini-shaped resonator, graphene, SiO2 and metallic plane demonstrating multiple peaks at 1.29, 3.32, 3.85, and 4.56 THz with absorptivities greater than 90%. The absorption mechanism can be attributed to the high-order resonances analyzed by the electric field distribution. Further, simulated results are verified using equivalent circuit model and the obtained results are in well accordance with the simulated results. The proposed absorber is further analyzed with various polarization angles suggesting that absorber is polarization sensitive due to its symmetrical shape of the resonator. The compactness and thickness of the proposed design is 0.207λ and 0.047λ, respectively, which is better than earlier reported absorbers. The Gemini shaped absorber can be utilized in various fields including sensing, detection and imaging.

During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscopy have the potential of transmission of severe acute respiratory syndrome coronavirus 2 to the healthcare workers. The decision to perform bronchoscopy during the COVID pandemic should be taken judiciously. Over the years, the indications for bronchoscopy in the clinical practice have expanded. Experts at the Indian Association for Bronchology perceived the need to develop a concise statement that would assist a bronchoscopist in performing bronchoscopy during the COVID pandemic safely. The current Indian Association for Bronchology Consensus Statement provides specific guidelines including triaging, indications, bronchoscopy area, use of personal protective equipment, patient preparation, sedation and anesthesia, patient monitoring, bronchoscopy technique, sample collection and handling, bronchoscope disinfection, and environmental disinfection concerning the coronavirus disease-2019 situation. The suggestions provided herewith should be adopted in addition to the national bronchoscopy guidelines that were published recently. This statement summarizes the essential aspects to be considered for the performance of bronchoscopy in COVID pandemic, to ensure safety for both for patients and healthcare personnel.

Background: Tumor necrosis factor-alpha (TNF-α), a ” major inflammatory cytokine,” not only plays an important role in periodontal destruction but also is extremely toxic to the host. Till date, there are not many studies comparing the levels of TNF-α in serum and its relationship to periodontal disease. Aim: Our study aimed to compare the serum TNF-α among the two study groups, namely, healthy controls and chronic periodontitis patients and establish a correlation between serum TNF-α and various clinical parameters. Hence, an attempt is made to estimate the level of TNF-α in serum, its relationship to periodontal disease and to explore the possibility of using the level of TNF-α in serum as a biochemical ” marker” of periodontal disease. Materials and Methods: Forty individuals participated in the study and were grouped into two subgroups. Group A – 20 systemically and periodontally healthy controls. Group B – twenty patients with generalized chronic periodontitis. The serum samples were assayed for TNF-α levels by enzyme-linked immunosorbent assay method. Results: The mean serum TNF-α cytokines for Group B Generalized chronic periodontitis (GCP) was 2.977 ± 1.011, and Group A (healthy) was 0.867 ± 0.865. The range of serum TNF-α was from (0.867 to 2.977). Serum TNF-α cytokines had highly significant correlation with all clinical parameters (plaque index, probing pocket depth, clinical attachment loss, and gingival index) among all study participants (P = 0.001). Conclusion: These observations suggest a positive association between periodontal disease and increased levels of TNF-α in serum. It can be concluded that there is a prospect of using the estimation of TNF-α in serum as a ” marker” of periodontal disease in future. However, it remains a possibility that the absence or low levels of TNF-α in serum might indicate a stable lesion and elevated levels might indicate an active site but only longitudinal studies taking into account, the disease ” activity” and ” inactivity” could suggest the possibility of using TNF-α in serum as an ” Indicator” of periodontal disease.

Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus. Results: The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC. Conclusion: This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.

BACKGROUND:Diabetes triples the risk of developing tuberculosis (TB). This study was designed to determine the prevalence of past and current TB disease and Latent TB infection (LTBI) in type 2 Diabetes Mellitus (NIDDM) patients. DESIGN:This was a prospective descriptive study on all NIDDM patients attending a Diabetic clinic. Detailed history, included details of previous history of TB (Past TB)and symptoms of active TB and a thorough physical exam was also done. When clinical suspicion of TB was present, appropriate investigations were carried out to diagnose 'Current TB'. Subsequently, 200 consecutive patients who were negative for Past and Current TB were screened for Latent TB infection (LTBI) by tuberculin skin test. RESULTS:Of 1000 NIDDM patients enrolled, 43(4.3%) had Past TB. Of remaining 957 patients, 50 were evaluated for New TB on the basis of suggestive symptoms and 10(1%) patients were confirmed to have Current TB. Risk factors for Past or Current TB 'DM-TB' in comparison with 'DM Only' group were; male sex (72% VS 57%; P = 0.033), manual laborer (28% VS 15%; P = 0.012), smoking (26% VS 14%; P = 0.015), alcohol consumption (23% VS 9%; P

Inflammatory mechanisms have been implicated in Alzheimer's disease (AD) and dementia. We therefore sought to study DNA sequence variation and serum levels of the potent inflammatory mediators Interleukin-6 (IL6) and C-reactive protein (CRP) in relation to AD and dementia. Tagging single nucleotide polymorphisms (tagSNPs) were chosen to capture most variation in and around CRP and IL6 in 3937 elderly Swedish men and women (1,265 AD cases). A sub-set of the population (n = 723) with serum measurements of CRP and IL6 was included in 1) a nested case-control study of incident dementia cases, and 2) a case-control study of prevalent dementia cases. None of the SNPs or haplotypes was significantly associated with AD or dementia after correcting for multiple testing nor were elevated baseline levels of hsCRP or IL6 (measured on average 4.3 years before dementia onset) significantly associated with risk of future AD or dementia. However, prevalent AD cases had higher levels of IL6 (measured on average 5.5 years after dementia onset) than age- and gender-matched controls, OR 2.24 (95% CI 1.27-3.95), p-value 0.006. In summary, this data suggests that AD patients have an altered immune profile with higher circulating levels of IL6 than age- and gender-matched controls. However, neither variation in the CRP and IL6 genes nor circulating levels of their respective protein products were associated with an increased risk of developing late-life dementias. [ABSTRACT FROM AUTHOR]

We performed a survey of sequence variation in a series of 20 genes involved in inflammation-related pathways for association with dementia risk in twin and unrelated case-control samples consisting in total of 1462 Swedish dementia casesand 1929 controls. For a total of 218 tested genetic markers, strong evidence was obtained implicating a region near AGER and NOTCH4 on chromosome 6p with replication across both samples and maximum combined significance at marker rs1800625 (OR = 1.37, 95% CI 1.19–1.56, p = 1.36×10(–6)). Imputation of the associated genomic interval provided an improved signal atrs8365, near the 3UTR of AGER (p = 7.34×10(–7)). The associated region extends 120 kb encompassing 11 candidate genes.While AGER encodes a key receptor for amyloid-β protein, an analysis of network context based upon genes now confirmed to contribute to dementia risk (AβPP, PSEN1, PSEN2, CR1, CLU, PICALM, and APOE) suggested strong functional coupling to NOTCH4, with no significant coupling to the remaining candidates. The implicated region occurs in the broad HLA locus on chromosome 6p, but associated markers were not in strong LD with known variants that regulate HLA gene function, suggesting that this may represent a signal distinct from immune-system pathways. [ABSTRACT FROM AUTHOR]

The two genetic polymorphisms, rs7412 and rs429358, that collectively form the e2, e3, and e4 alleles of apolipoprotein E (APOE) are among the most widely studied sequence variants in the genome. The predominant model for testing APOE involves the haplotype combinations of e2, e3, and e4 and has been basis of associations with dementia, atherosclerosis, and serum lipid levels. Here, we demonstrate the functional independence of these two component sites, with rs7412 contributing to the majority of variance in serum LDL (p=10-20), whereas rs429358 alone influences variance in CSF amyloid-ß42 (Aß42) (p=10(-17)). This latter relationship is also reflected in the association of APOE with dementia, where rs429358 strongly influences disease (p=10(-67)), but rs7412 does not. Models based upon e2, e3, and e4 explained less variance for both dementia risk and CSF Aß42 than did rs429358 alone. When adjusted for CSF Aß42, the association of rs429358 with dementia is greatly reduced but remains significant indicating that APOE polymorphism influences disease by additional mechanisms distinct from Aß42 metabolism. We reach four principal conclusion from this study: 1) rs429358 alone is responsible for the association of APOE with dementia; 2) The association of APOE with dementia is substantially mediated by its effect on CNS Aß42 levels; 3) The association of APOE with dementia is not mediated by its impact on peripheral lipid metabolism; and 4) The dichotomy of effects of rs429358 and rs7412 represents one of the best examples of genetic pleiotropy for complex traits known and illustrates the importance of allelic heterogeneity in APOE. [ABSTRACT FROM AUTHOR]

We have recently reported that a polymorphism in the cell division cycle (CDC2) gene, designated Ex6 + 7I/D, is associated with Alzheimer's disease (AD). The CDC2 gene is located on chromosome 10q21.1 close to the marker D10S1225 linked to AD. Active cdc2 accumulates in neurons containing neurofibrillary tangles (NFT), a process that can precede the formation of NFT. Therefore, CDC2 is a promising candidate susceptibility gene for AD. We investigated the possible effects of the CDC2 polymorphism on cerebrospinal fluid (CSF) biomarkers in AD patients. CDC2 genotypes were evaluated in relation to CSF protein levels of total tau, phospho-tau and beta-amyloid(1-42) in AD patients and control individuals, and in relation to the amount of senile plaques and NFT in the frontal cortex and in the hippocampus in patients with autopsy-proven AD and controls. The CDC2 Ex6 + 7I allele was associated with a gene dose-dependent increase of CSF total tau levels (F(2, 626) = 7.0, p = 0.001) and the homozygous CDC2 Ex6 + 7II genotype was significantly more frequent among AD patients compared to controls (p = 0.006, OR = 1.57, 95% CI 1.13-2.17). Our results provide further evidence for an involvement of cdc2 in the pathogenesis of AD. [ABSTRACT FROM AUTHOR]

Apolipoprotein E epsilon4 (APOE*4) is the only fully established susceptibility allele for Alzheimer's disease. One of the most studied candidates is the insertion (I)/deletion (D) polymorphism (indel) of the gene for angiotensin I-converting enzyme (ACE). This study aimed to clarify its association with Alzheimer's disease. The meta-analysis included 39 samples, comprising 6,037 cases of Alzheimer's disease and 12,099 controls, using mainly primary data. Potential interactions with gender, age, ethnic group, and carrier status of the apolipoprotein E epsilon4 allele were all examined. D homozygotes were at reduced risk of Alzheimer's disease (odds ratio = 0.81, 95% confidence interval: 0.72, 0.90; corrected p = 0.0004); I homozygotes showed no association with Alzheimer's disease, while heterozygotes were at increased risk. Although there were clear differences among the three ethnic groups examined (North Europeans, South Caucasians, and East Asians), in all groups D homozygotes were at reduced risk. These results confirm the association of the angiotensin I-converting enzyme indel with Alzheimer's disease across diverse populations, although this is probably due to linkage disequilibrium with the true risk factor. Further, in North Europeans, both association and Hardy-Weinberg analysis suggested partial heterosis, that is, an increased risk for heterozygotes, due to a hidden interaction with another, as yet unknown, risk factor. This interaction warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic pulmonary fibrosis (IPF), a chronic progressive interstitial lung disease (ILD), Occasionally, IPF occurs in families. Familial interstitial lung disease has been reported worldwide, limited information is available on the disease among Indian patients. Case Presentation: A 59-year-old woman presented with a 2-year history of progressive dyspnoea. Based on clinical and radiological features, our patient was diagnosed with idiopathic pulmonary fibrosis. Several family members of her first and second generations had died from respiratory failure. Her sister also diagnosed as IPF based on typical High resolution computed tomography (HRCT) finding though she was asymptomatic and came for screening. In addition, another male patient also had similar history and diagnosed as familial IPF based on HRCT and genetic testing in spite of significant occupational exposure. Genetic study revealed SFTPA1 gene was associated with susceptibility to idiopathic pulmonary fibrosis. Conclusion: Our report illustrates that asymptomatic screening of family member can uncover such a serious disease in patients with familial interstitial fibrosis. Otherwise, clinical, radiological, and histological features are indistinguishable from those of sporadic cases. Furthermore, our work highlights the importance of compiling a thorough family history in individuals presenting with cough and dyspnoea, particularly in younger patients identified with idiopathic pulmonary fibrosis.

Foreign Direct Investment (FDI) can bring in much needed capital, particularly to developing countries, help improve manufacturing and trade sectors, bring in more efficient technologies, increase local production and exports, create jobs and develop local skills, and bring about improvements in infrastructure and overall be a contributor to sustainable economic growth. With all these desirable features, it becomes relevant to ascertain the factors which attract FDI to an economy or a group of adjacent economies. This paper explores the determinants of FDI in ten sub-Saharan economies: Liberia, Sierra Leone, Ivory Coast, Ghana, Nigeria, Mali, Mauritania, Niger, Cameroun, and Senegal. After an extensive literature review of theories and empirical research, using a set of cross-sectional data over the period 1990−2017, two econometric models are estimated with FDI/GDP (the ratio of Foreign Direct Investment to Gross Domestic Product) as the dependent variable, and with inflation, exchange rate changes, openness, economy size (GDP), income levels (GNI/capita (Gross National Income) per capita), and infrastructure as the independent variables. Over the period, higher inflows of FDI in relation to GDP appear to be have been attracted to the markets with better infrastructure, smaller markets, and lower income levels, with higher openness and depreciation in the exchange rate, though the coefficients of the last two variables are not significant. These results show the type of FDI attracted to investments in this region and are evaluated from theoretical and practical viewpoints. FDI is an important source of finance for developing economies. On average, between 2013 and 2017, FDI accounted for 39 percent of external finance for developing economies. Policy guidelines are formulated for the enhancement of FDI inflows and further economic development in this region. Such a study of this region has not been made in the recent past.

BackgroundNurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort.Methodology/principal findings436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3-12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort.ConclusionsOur study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.

Among healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.Among 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). A majority (95%) were females, and almost 80% were under 22 years of age. Detailed TB exposure information was obtained using interviews and clinical log books. Prevalence of latent TB infection (LTBI) was estimated using Bayesian latent class analyses (LCA). Logistic regression analyses were done to determine the association between LTBI prevalence and TB exposure and risk factors. 219 of 436 students (50.2%, 95% CI: 45.4-55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare.Our study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions.

Purpose: The purposes were to (1) examine early to intermediate-term clinical outcomes and complications of revision anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (QT) autografts, and (2) compare quadriceps strength between patients who had hamstring versus patella tendon autografts in their previous reconstruction., Methods: One hundred patients (52 males/48 females; 22.6 ± 8.0 years) undergoing revision ACLR with all-soft tissue QT autografts were prospectively followed. All revision procedures were performed by a single surgeon, using a minimally invasive graft harvest technique and suspensory fixation. Subjective assessment of knee function was obtained before and after surgery with the International Knee Documentation Committee (IKDC) survey. Postoperative knee laxity and isokinetic quadriceps strength were collected at regular intervals. Strength was reported as limb symmetry index (LSI; surgical side divided by nonsurgical side). Complications including hematomas, postoperative loss of knee extension, and graft failures were recorded. To determine clinical significance (P ≤ .05), outcomes were compared using analysis of variance or paired samples t-tests., Results: The mean IKDC scores significantly improved (54.3 ± 13.0 vs 82.8 ± 13.8), with an average follow-up of 42.2 ± 21.2 months. There were no significant changes in knee laxity side-to-side differences: 6 weeks (1.2 ± 1.5 mm), 3 months (1.2 ± 1.8 mm), 6 months (1.4 ± 1.6 mm). Quadriceps LSIs significantly improved from 71.6% ± 19.3% at 6 months to 81.5% ± 19.3% at 12 months for 60°/s isokinetic testing and 76.6% ± 16.4% at 6 months to 83.9% ± 16.9% at 12 months for 180°/s testing. Graft harvest site hematomas developed in 2 patients, postoperative loss of knee extension in 4 patients, and graft failure in 11 patients. No significant differences in quadriceps or hamstrings LSIs were noted between patients with previous hamstring versus patella tendon autografts (P > .050)., Conclusion: Revision ACLR with all-soft tissue QT autografts has acceptable early and intermediate-term outcomes with reasonable complication rates (11/80 patients with follow-up). Secondary insult to the extensor mechanism via QT autograft harvest does not adversely affect strength after prior patellar tendon versus hamstring autograft., Level of Evidence: Level IV, cases series subgroup analysis., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objective: To compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP)., Design: Cross-Sectional., Setting: Laboratory., Participants: Sixteen individuals with PHP and sixteen matched healthy participants., Main Outcome Measures: Static foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences., Results: Individuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance., Conclusions: Individuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation., Competing Interests: Declaration of competing interest None declared., (Copyright © 2019. Published by Elsevier Ltd.)