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Background: Tuberculosis (TB) continues to be a major cause of morbidity and mortality worldwide. The main strategy to fight the pandemic is the development of rapid, accurate diagnostic tests, which helps to reduce the time for initiation of therapy. In 2010, WHO recommended the use of Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) (G4), which is a cartridge-based semi-automated nucleic acid amplification test (NAAT) as a primary test with an aim to improve the detection of MTB. Later on, to improve the diagnostic efficacy, the new and improved cartridges called Xpert Ultra were introduced in 2017. MATERIALS AND METHODS: One thousand and sixty-nine clinical samples were utilized for the study for microscopy, culture, and NAATs (Xpert MTB/RIF G4 and Ultra). The samples were randomly allocated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated while assuming trace results as positive and negative in two separate scenarios. Results: The sensitivity of Xpert MTB/RIF Ultra cartridge was higher (100%) than Xpert MTB/RIF G4 cartridge (95.23%) and the specificity of Ultra cartridge was lower (71.79%) when compared to G4 cartridge (91.63%). However, the specificity of Xpert Ultra cartridge improved by reclassifying the “trace” interpretation as negative (89.1%). The NPV was 100% and 99.09% for Xpert Ultra cartridge and the Xpert G4 cartridge, respectively, and did not change by reclassifying the “trace” interpretation as negative. In contrast, the PPV varied greatly between the two tests, 26.66% for Xpert Ultra cartridge and 66.66% for Xpert G4 cartridge. The PPV of Xpert Ultra cartridge was improved to 48.48% by including “trace” samples in the negative pool. Conclusion: Xpert Ultra and G4 shows good performance as a first line diagnostic test. Caution should be exercised when interpreting ‘trace’ results in a country like India without parallel confirmatory tests like microscopy and culture. Data is limited on this newly incorporated value assigned in the automated report. Conducting further studies on results interpreted as ‘trace’ will help in improving the guidelines and as well as utilisation of such tests.

Background: Microbial keratitis is a major preventable cause of visual impairment. In developed countries viral infections are the leading cause of corneal ulcer whereas bacteria and fungi attributes to maximum number of cases in the developing countries. There is paucity of recent data, risk factors and demographic distribution of patients for all three leading etiological agents of keratitis. Material and Methods: This study included all clinically diagnosed cases of infective keratitis from 01 Jan 2021 to 01 Jan 2022. In brief, four sets of corneal scrapings were taken from patients of infectious keratitis and processed for bacterial and fungal culture, microscopy and RTPCR of viral agents. Results: It was observed that rural elderly males were the most predisposed to occurrence of infectious keratitis and trauma being the leading cause. Out of total 151 samples processed, 49(32%) samples were found to have definitive evidence of bacterial, fungal and viral pathogens. Fungi were found to be the most common 37 (24%) etiological agent leading to keratitis followed by bacterial 7(5%) and viral agents 5(3%). Conclusion: Clinical signs alone are not sufficient to diagnose infectious keratitis, the importance of microbiology in the identification of pathogen and aiming at definitive therapy of infectious keratitis helps in rescuing the eye from this reversible cause of blindness.

Abstract Background Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. Method The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. Discussion We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. Trial registration ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php —use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

Objective: To evaluate the effect of continuous arch and piggyback mechanics in a straight wire appliance (SWA) for the alignment of buccal and variably vertically positioned maxillary canines. Methods: A three-dimensional finite element model with near-normal occlusion and buccal and vertically displaced maxillary canines was used. Two groups were created to simulate two commonly used SWAs techniques, continuous archwire (Group 1) and piggyback models (Group 2). Each group had three subgroups with varying vertical displacement of the canine from 2 to 6 mm from the occlusal plane. The displacement and stress distribution were noted in each group. Results: As the vertical displacement increased in Group 1, the concentration of von Mises stress increased progressively at the incisal third (0.36, 0.41 and 0.44 MPa) at 2, 4, and 6 mm, respectively, with decreased maximum occlusal movement in the vertical plane with respect to the canine. Group 2 exhibited a similar pattern but greater occlusal movement of the canine compared with Group 1. Conclusion: A vertical displacement of 4 mm is the optimal level at which continuous arch mechanics should be considered. For displacements beyond 4 mm, the piggyback wire technique is a suitable alternative.

IntroductionLinking olfactory epithelium to the central nervous system are cranial nerve 1, the olfactory nerve, and cranial nerve “0,” and the nervus terminalis (NT). Since there is minimal expression of angiotensin-converting enzyme-2 (ACE-2) in the olfactory nerve, it is unclear how SARS-CoV-2 causes anosmia (loss of smell) and hypogeusia (reduction of taste). In animal models, NT expresses ACE-2 receptors, suggesting a possible SARS-CoV-2 viral entry site in humans. The purpose of this study was to determine whether ultra-high-field 7 T magnetic resonance imaging (MRI) could visualize the NT, olfactory bulbs (OB), and olfactory tract (OT) in healthy controls and COVID-19 anosmia or hypogeusia and to qualitatively assess for volume loss and T2 alterations.MethodsIn this study, 7 T MRI was used to evaluate the brain and olfactory regions in 45 COVID-19 patients and 29 healthy controls. Neuroimaging was qualitatively assessed by four board-certified neuroradiologists who were blinded to outcome assignments: for the presence or absence of NT; for OB, OT, and brain volume loss; and altered T2 signal, white matter T2 hyperintensities, microhemorrhages, enlarged perivascular spaces, and brainstem involvement.ResultsNT was identifiable in all COVID-19 patients and controls. T2 hyperintensity in the NT, OB, and OT in COVID-19 patients with anosmia or hypogeusia was statistically significant compared to controls and COVID-19 patients without anosmia or hypogeusia.DiscussionOn 7 T MRI, NT was radiographically identifiable, adjacent to OB and OT. In COVID-19 anosmia and hypogeusia, T2 hyperintensity of NT, OB, and OT was statistically significant compared to COVID-19 patients without anosmia or hypogeusia and controls. The NT may be a potential entry site for SARs-CoV-2 and may play a role in the pathophysiology of COVID-19 anosmia.

Summary: Background: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary outcome was presence of myocardial injury as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Findings: Patients with C-VAM were predominantly white (67%) adolescent males (91%, 15.7 ± 2.8 years). Their initial clinical course was more likely to be mild (80% vs. 23%, p 15 years, OR 2.74 [95% CI: 1.28, 5.83, p = 0.009]) and when C-VAM occurred after the first or second dose as compared to the third dose of mRNA vaccine. Mid-term clinical outcomes of C-VAM at a median follow-up of 178 days (IQR 114–285 days) were reassuring. No cardiac deaths or heart transplantations were reported until the time of submission of this report. LGE persisted in 60% of the patients at follow up. Interpretation: Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM. Funding: The U.S. Food and Drug Administration.

Occlusion of foramen of Monro is an uncommon clinical entity that usually presents in children. Common causes are obstructing mass, infectious etiologies or vascular malformation. Rarely, it may be an idiopathic stricture or membrane. We report a case of idiopathic membranous obstruction of the foramen of Monro in a 45-year-old male with no past medical or surgical history. He presented with new intermittent dull and burning bifrontal severe headache for 2 d, which was alleviated slightly by non-steroidal anti-inflammatory medication. Imaging showed marked dilation of the lateral ventricles with normal third and fourth ventricles. The patient was discharged initially with conservative medical management and close follows up; however, the headache continued to progress and neurosurgical intervention was offered. The patient underwent endoscopic exploration, fenestration of the septum pellucidum, and right ventriculoperitoneal shunt placement. Bilateral membranous obstruction of foramina of Monro and an auto-fenestrated cavum septum pellucidum were identified intraoperatively. The patient reported resolution of headache post-operatively without recurrence on 1-month follow up. This case is unusual in that the patient presented without any known neurologic history or prior intracranial infections. It became apparent at the time of surgery that chronic obstruction of the bilateral foramina with collapse of the third ventricle had developed, and the safest durable treatment for him was septostomy and cerebrospinal fluid (CSF) shunt placement. [ABSTRACT FROM AUTHOR]

Background: Echocardiographic quantification of left ventricular (LV) volume and ejection fraction (EF) is widely used in the pediatric population. However, there is no consensus on the most accurate method of quantifying ventricular volumes and systolic function. Purpose: The purpose of this study is to compare two commonly used echocardiographic methods for the evaluation of LV volume and quantification of EF, the five-sixth area-length (5/6 AL) and the modified biplane Simpson (BS), to cardiac magnetic resonance (CMR) imaging in children. Methods: CMR studies were paired with echocardiograms and retrospectively analyzed in children 18 years of age and younger. Studies performed more than 3 months between modalities, patients with congenital heart disease, and patients who had changes in medication regimen between corresponding CMR and echocardiograms were excluded. LV volumes and EF were calculated using the 5/6 AL and BS methods and compared to volumes and EF measured on corresponding CMR studies. Subgroup analyses were conducted based on LV function, pathology, and weight. Results: We retrospectively analyzed 53 CMR and corresponding echocardiogram studies (23 studies for myocarditis and 30 studies for cardiomyopathy) in 46 patients. LVEF derived by both echocardiographic methods showed a good correlation to CMR (5/6 AL r = 0.85 and BS r = 0.82). However, both echocardiographic methods overestimated LVEF and underestimated LV volumes when compared to CMR. Conclusion: Left ventricular volumes and EF, as measured by echocardiography, correlate well with CMR measurements. Echocardiography underestimates LV systolic and diastolic volumes and overestimates LVEF. While echocardiography is a good surrogate for estimating LVEF, CMR should be considered in patients for whom accurate measurements are needed for critical clinical decision-making.

Abstract Increased left atrial volume and decreased left atrial function have long been associated with atrial fibrillation. The availability of large-scale cardiac magnetic resonance imaging data paired with genetic data provides a unique opportunity to assess the genetic contributions to left atrial structure and function, and understand their relationship with risk for atrial fibrillation. Here, we use deep learning and surface reconstruction models to measure left atrial minimum volume, maximum volume, stroke volume, and emptying fraction in 40,558 UK Biobank participants. In a genome-wide association study of 35,049 participants without pre-existing cardiovascular disease, we identify 20 common genetic loci associated with left atrial structure and function. We find that polygenic contributions to increased left atrial volume are associated with atrial fibrillation and its downstream consequences, including stroke. Through Mendelian randomization, we find evidence supporting a causal role for left atrial enlargement and dysfunction on atrial fibrillation risk.

Abstract Background Previous literature on cutaneous squamous cell carcinoma (cSCC) suggests that the incidence, rate of metastasis, and tumour severity of cSCC are higher in immunosuppressed patients than in immunocompetent patients. However, current literature lacks an extensive comparison of cSCC clinical characteristics and outcomes in immunosuppressed patients. Objectives We compared cSCC tumour characteristics and disease‐related outcomes to help guide the clinical management of immunosuppressed patients. Methods We conducted a retrospective review of histopathologic and clinical data from 935 cSCC cases (19.5% immunosuppressed) from the Mayo Clinic. Results Immunosuppression was associated with younger age (69.3 vs. 74.8 years old, p

This case report highlights a severe eczematous rash manifesting broadly across the scalp, face, and neck of a 54-year-old female following a resolved herpes zoster infection. Notably, such cutaneous reactions post-varicella zoster virus infection, which may present weeks to years after the acute phase, have been documented but remain poorly understood in their pathogenesis. This patient exhibited a blistering rash diagnosed as shingles with overlying cellulitis, initially treated with valacyclovir and cefalexin. Upon returning with a diffuse rash post-treatment, further examination and tests led to a differential diagnosis that most closely aligned with eczema exacerbation with superimposed bacterial infection, confirmed by the presence of methicillin-resistant Staphylococcus aureus . Treatment encompassed intravenous vancomycin, ciprofloxacin eye drops, topical hydrocortisone, betamethasone lotion, and gabapentin, leading to substantial improvement. This case underscores the complexity of diagnosing and managing cutaneous reactions post-varicella zoster virus infection and suggests a multimodal treatment approach may yield favorable outcomes.

The diagnosis and classification of autism spectrum disorder (ASD) presents anatomical difficulty owing to the existence of a wide range of symptoms that may be organized into many categories. The present research investigates the efficacy of machine learning methods for facilitating the recognition of individuals who have been diagnosed with ASD. The primary aim of this study has been to assess the effectiveness of multiple algorithms based on machine learning in identifying intricate patterns seen in datasets related to ASD, which includes a wide range of diagnostic categories. The results indicate that the Logistic Regression approach demonstrated great levels of accuracy, with rates of 94.3 % for children and 99 % for adolescents in the binary classification system. Similarly, it has been reported that the Support Vector Machine (SVM) had superior performance compared to all other systems in the binary classification test focused on adults exclusively, with an accuracy rate of 98.5 %. Moreover, a supplementary series of experiments conducted on the combined dataset of children, adolescents, and adults has resulted in the observation that Logistic Regression and SVM exhibited notable accuracy rates of 97.2 % for binary classification and 99.55 % for multiclass classification, encompassing individuals from diverse age groups. The results provide evidence in favor of that progress has been achieved in the diagnosis and treatment of ASD as a result of the capacity to detect and categorize the disorder at an earlier developmental phase.

Background: Infections caused by metallo-beta-lactamases (MBLs) producing Gram-negative bacteria (mainly Enterobacterales) pose a great challenge for clinicians in treating these multidrug-resistant infections. In recent times, combination antibiotic therapy with ceftazidime–avibactam (CAZ-AVI) with aztreonam (ATM) has been researched by a number of laboratories worldwide and has gained much clinical attention. This study evaluated a practical laboratory method of testing for clinically significant in vitro synergy between CAZ/AVI + ATM in New Delhi MBLs (NDM) producing Gram-negative organisms. Materials and Methods: A total of 100 isolates of carbapenem-resistant Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Enterobacter cloacae) were tested for synergy between CAZ/AVI + ATM using E-strip of CAZ/AVI and disc of ATM. The minimum inhibitory concentration value of CAZ/AVI was measured and the zone of inhibition was observed when ATM was placed parallel to the E-strip on a lawn culture of an isolate. Simultaneously, all isolates were tested for NDM and OXA-48 by Xpert Carba-R. Results: Of 100 isolates, 63/100 (63%) were harboring OXA-48 beta-lactamase, 54/100 (54%) were harboring NDM beta-lactamase and 18/100 (18%) were harboring both (OXA-48 and NDM). In vitro synergy between CAZ/AVI + ATM was noted in 99 isolates (99%). Conclusion: A significant synergy was demonstrated in vitro with CAZ/AVI + ATM combination therapy and seems to be a promising treatment strategy for infections caused by Enterobacterales harboring NDM and OXA-48 beta-lactamases.

PURPOSE This study aimed to compare the executive functional ability among participants regularly practicing and participating in four different sports, including Cricket, Volleyball, Kho-Kho, and Kabaddi, and the active control group. METHODS This pilot study included 125 university youths aged 19-25 years. Twenty-five participants were selected for each of the four different sports disciplines, including Cricket, Volleyball, Kho-Kho, and Kabaddi, to meet the purpose of the study. Twenty-five active, healthy male participants served as the control group. Moreover, participants in the control group did not regularly engage in organized sports; however, they were all recreationally active and healthy. The Executive Functions (EFs) of all sampled participants were assessed using the Tower of London (TOL) and Stroop Color and Word Test (SCWT). Mean, standard deviation, one-way analysis of variance (ANOVA), and Tukey's honest significant difference (HSD) post-hoc tests were used for data analysis and interpretation. RESULTS One-way ANOVA demonstrated significant differences among groups in both tests; thus, the post-hoc Tukey's HSD test was conducted, which gave pairwise comparisons between and within groups. Pairwise comparison of the TOL test indicated significantly higher EFs in Kabaddi players than those in the Volleyball (p

Abstract Background Primary cutaneous B‐cell lymphoma (PCBCL) is a group of B‐cell lymphomas of the skin containing primary cutaneous follicle centre lymphoma (PCFCL) and marginal zone B‐cell lymphoma/lymphoproliferative disorder (PCMZL), which are indolent, and diffuse large B‐cell lymphoma, leg type (PCDLBCL‐LT), which is aggressive. Objectives To evaluate treatment outcomes between PCBCL subtypes after treatment with rituximab and to compare the efficacy of intralesional against systemic rituximab in indolent subtypes. Methods A search for patients diagnosed with PCBCL and treated with rituximab (systemic or intralesional) across all Mayo Clinic sites was performed, yielding 39 patients. Results Eight patients had PCFCL (six treated intralesionally and two systemically), 11 had PCMZL (four intralesional, eight systemic with one dual‐treated) and 20 had PCDLBCL‐LT (all systemic). The average age at diagnosis was 62.1 years (SD = 15.1), with average follow‐up of 1852.6 days (SD = 1473.2). 69.2% of all patients treated with any form of rituximab experienced a complete response (100% PCFCL, 81.8% PCMZL and 50% PCDLBCL‐LT). When comparing all three subtypes, a significant difference was seen in overall treatment response (p = 0.022), and progressive disease rates (p = 0.015), but not in retreatment with rituximab (p = 0.440), time to retreatment (p = 0.757), recurrence (p = 0.907) or survival (p = 0.093). In the indolent subtypes, no difference in overall treatment response (p = 1.000), progressive disease rates (p = 1.000), recurrence (p = 0.650), rituximab retreatment (p = 0.650) or time to retreatment (p = 0.724) was observed. Conclusions This study suggests that rituximab, as systemic therapy and intralesional therapy, is effective in the management of PCBCL, and that intralesional therapy should be considered before more aggressive therapy in indolent disease.

Objective: To evaluate the effectiveness of a diode laser (810 nm) for circumferential supracrestal fiberotomy compared with conventional surgical circumferential supracrestal fiberotomy in preventing rotational relapse in orthodontically treated cases. Methods: Seventy-six patients (age range from 18-25 years) with mandibular crowding ranging between 5-8 mm and rotation >10˚ (from the individualized arch form) treated non-extraction with a straight wire appliance (McLaughlin, Bennet, Trevisi; 0.022 inch) prescription were selected for the study. The patients were randomly allocated into 3 groups of 22 patients each: Group 1 (Control group-No circumferential supracrestal fiberotomy), Group 2 (Conventional circumferential supracrestal fiberotomy), and Group 3 (diode laser circumferential supracrestal fiberotomy). After leveling and alignment up to “0.019x0.025” stainless steel wire, the arch wire was removed for a period of 1 month. Impressions were made and the poured casts were scanned. The 3D models (.STL files) were evaluated for changes in the irregularity index and rotational relapse. Results: One-way ANOVA and post-hoc Tukey’s test were used for data analysis. Group 1 (Control group) showed greater relapse in both irregularity index and rotation angulations in comparison with Groups 2 and 3, which was statistically significant (p

Abstract Background Chronic edema as a complication of systemic diseases or infections can mimic filarial lymphedema (also known as elephantiasis) and considered so. We describe a case of chronic lymphedema that mimicked elephantiasis in a diabetic man. Case presentation The patient was a 70-year-old black man, bed-bound at the time of admission following a diagnosis of stroke and hypertension in the previous 5 years. He had been diabetic for 20 years with poorly controlled diabetes mellitus. He suffered recurrent bilateral lower limb skin infections for 5 years prior to admission that culminated into progressive lowerlimb edema. The infections eventually complicated into skin edema, hardening, fissuring, and hyperkeratotic plaques. The physical examination revealed Tinea pedis and bilateral non-pitting edema of lowerlimbs to the level of the knees. Investigations confirmed non-filarial lymphedema-related skin changes. The absence of the classic pebbly/cobblestone skin changes ruled out elephantiasis nostra verrucosa (ENV), with a possibility of it being in the early stages of evolution. The patient’s skin fissuring and infections were successfully treated with antibiotics and antifungals while compression stockings helped to relieve the edema. Conclusions Chronic lymphedema can complicate repeated non-filarial infections of lower limbs. Its fissures are a risk factor for cellulitis, prompting early identification and management of both infections and lymphedema to halt their vicious cycle, especially in at risk populations like diabetics.

Vertebral compression fractures (VCFs) affect 1.4 million patients every year, especially among the globally aging population, leading to increased morbidity and mortality. Often characterized with symptoms of sudden onset back pain, decreased vertebral height, progressive kyphosis, and limited mobility, VCFs can significantly impact a patient’s quality of life and are a significant public health concern. Imaging modalities in radiology, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) studies and bone scans, play crucial and evolving roles in the diagnosis, assessment, and management of VCFs. An understanding of anatomy, and the extent to which each imaging modality serves to elucidate that anatomy, is crucial in understanding and providing guidance on fracture severity, classification, associated soft tissue injuries, underlying pathologies, and bone mineral density, ultimately guiding treatment decisions, monitoring treatment response, and predicting prognosis and long-term outcomes. This article thus explores the important role of radiology in illuminating the underlying anatomy and pathophysiology, classification, diagnosis, treatment, and management of patients with VCFs. Continued research and advancements in imaging technologies will further enhance our understanding of VCFs and pave the way for personalized and effective management strategies.

AIM: The present study was undertaken to evaluate and compare muscle activity after the treatment with rigid and flexible fixed functional appliance. MATERIAL AND METHOD: The study was conducted on 14 skeletal Class II malocclusion patients in the age group of 13–17 years, divided into two groups comprising 7 patients in each group. Group I was treated with a rigid fixed functional appliance (MPA IV), and Group II was treated with a flexible fixed functional appliance (Churro Jumper). Masseter and anterior temporalis muscle activities were recorded using needle electromyography (EMG) at postural rest, saliva swallowing, and clenching during five intervals (T0 to T4) during fixed functional appliance treatment. Unpaired t-test, Mann–Whitney U, and Wilcoxon sign rank test were applied for statistical analysis, and a P value of

Background: Alagille syndrome (ALGS) is a multisystem disorder involving at least three systems among the liver, heart, skeleton, face, and eyes. Common cardiac associations include pulmonary artery stenosis/atresia, atrial septal defect (ASD), ventricular septal defect (VSD) and tetralogy of fallot (ToF). Coarctation of aorta (CoA), renal and intracranial arteries are commonly involved vessels in Alagille syndrome. We present two cases with rare cardiovascular manifestations of Alagille syndrome. Case description: Case 1: A 25-year-old female with a history of Alagille syndrome presented to the cardiologist office for progressive exertional dyspnoea, orthopnoea, and palpitations. She was tachycardiac on examination and had an apical diastolic rumble. A transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 60% and parachute mitral valve (PMV) with severe mitral stenosis. A transoesophageal echocardiogram (TOE) showed insertion of chordae into the anterolateral papillary muscle, severe mitral stenosis with a valve area of 0.7 cm. She was referred to a congenital heart disease specialist and underwent robotic mitral valve replacement with improvement in her symptoms. Case 2: A 27-year-old female with known Alagille syndrome and resistant hypertension presented to the cardiologist office due to progressive exertional dyspnoea for a year. She was hypertensive and had a new 2/6 systolic ejection murmur along the left upper sternal border. TTE revealed an LVEF of 60% and pulmonary artery pressure of 19 mmHg. A CoA was suspected distal to the left subclavian artery due to a peak gradient of 38 mmHg. Cardiac magnetic resonance (CMR) imaging ruled out CoA, and diffuse narrowing of the descending thoracic aorta measuring 13–14 mm in diameter was noted. The patient was referred to a congenital heart disease specialist for further management. Conclusion: PMV presenting as mitral stenosis and mid-aortic syndrome are not commonly described anomalies in association with Alagille syndrome. TTE, TOE and CMR played a key role in diagnosis and management of these patients.

The immunopathogenesis of dengue severity is convoluted. The primary objective of the research was to examine the dynamics of cytokine storm and its correlation with disease development in individuals affected by DENV infection. Additionally, the study aimed to discover potential biomarkers that could indicate severe dengue infection and determine the most suitable timeframe for predicting the severity of these biomarkers during the acute stage of dengue infections. We conducted a temporal analysis of the daily viral load and cytokine levels in 60 hospitalized dengue patients until discharge. Our findings reveal a distinct cytokine profile (elevated IL-8, IL-10, IL-6, GM-CSF, MCP-1, IL-13, and IL-4 and decreased IL-12, MIP-1β) on the third day after symptom onset is predictive of severe dengue in secondary dengue infection. The imbalanced cytokine signature may inform clinical decision-making in treating severe dengue infections.

Abstract Traditional cancer treatments use nonspecific drugs and monoclonal antibodies to target tumor cells. Chimeric antigen receptor (CAR)-T cell therapy, however, leverages the immune system's T-cells to recognize and attack tumor cells. T-cells are isolated from patients and modified to target tumor-associated antigens. CAR-T therapy has achieved FDA approval for treating blood cancers like B-cell acute lymphoblastic leukemia, large B-cell lymphoma, and multiple myeloma by targeting CD-19 and B-cell maturation antigens. Bi-specific chimeric antigen receptors may contribute to mitigating tumor antigen escape, but their efficacy could be limited in cases where certain tumor cells do not express the targeted antigens. Despite success in blood cancers, CAR-T technology faces challenges in solid tumors, including lack of reliable tumor-associated antigens, hypoxic cores, immunosuppressive tumor environments, enhanced reactive oxygen species, and decreased T-cell infiltration. To overcome these challenges, current research aims to identify reliable tumor-associated antigens and develop cost-effective, tumor microenvironment-specific CAR-T cells. This review covers the evolution of CAR-T therapy against various tumors, including hematological and solid tumors, highlights challenges faced by CAR-T cell therapy, and suggests strategies to overcome these obstacles, such as utilizing single-cell RNA sequencing and artificial intelligence to optimize clinical-grade CAR-T cells.

It is imperative to evaluate for secondary causes of membranous glomerulonephritis, from infections such as hepatitis B and C, viruses and parasites, autoimmune diseases like systemic lupus erythematosus, and other neoplasms. Tuberculosis associated with membranous glomerulonephritis is rare. The authors report a case of microbiologically proven pulmonary tuberculosis and membranous nephropathy occurring concurrently in the same patient. Antitubercular therapy alone was sufficient to cause improvement in the patient. Tuberculosis should be recognised as a potentially treatable infectious cause of secondary membranous nephropathy.

Background The objective of our study was to derive an objective assessment scale for three-dimensional (3D) qualitative and quantitative evaluation of secondary alveolar bone grafting (SABG) using cone-bone computed tomography (CBCT) in patients with unilateral cleft lip and palate (UCLP). Methods CBCT scans for pre- and 3-month post-SABG were reviewed for bone volume, height, width, and density of the bony bridge formed in the cleft defect in 20 patients with UCLP. Basic descriptive and principal component analysis was used to extract the various sub-components of the scale. Spearman's correlation was used to check the validity of the scale, and intra-class coefficient (ICC) and Cronbach's α were calculated to establish the reliability and retest applicability of the scale. Results Each CBCT scan was assessed in five areas: cementoenamel junction (CEJ), root apex, root midpoint, 3 and 6 mm below CEJ, and tabulated in percentiles of 20, 25, 40, 50, 60, and 75 for all the parameters (bone volume, density, and width). These scores were validated when correlated to the scale given by Kamperos et al. Cronbach's α for the domains demonstrated acceptable to excellent internal consistency. The ICC showed good test–retest reliability having a range of scores from 0.89 to 0.94. Conclusion The proposed scale for the 3D assessment of SABG in patients with UCLP provides gradation for the objective assessment of the bony bridge. This gradation enables the qualitative and quantitative assessments of the bony bridge, thus allowing each clinician to judge SABG more conclusively.

Abstract A fundamental challenge in diagnostics is integrating multiple modalities to develop a joint characterization of physiological state. Using the heart as a model system, we develop a cross-modal autoencoder framework for integrating distinct data modalities and constructing a holistic representation of cardiovascular state. In particular, we use our framework to construct such cross-modal representations from cardiac magnetic resonance images (MRIs), containing structural information, and electrocardiograms (ECGs), containing myoelectric information. We leverage the learned cross-modal representation to (1) improve phenotype prediction from a single, accessible phenotype such as ECGs; (2) enable imputation of hard-to-acquire cardiac MRIs from easy-to-acquire ECGs; and (3) develop a framework for performing genome-wide association studies in an unsupervised manner. Our results systematically integrate distinct diagnostic modalities into a common representation that better characterizes physiologic state.

Objective Dashboards can support person‐centered care by helping people partner with their clinicians to coproduce care based on preferences, shared decision‐making, and evidence‐based treatments. We engaged caregivers of children with juvenile idiopathic arthritis (JIA), adults with rheumatoid arthritis (RA), and clinicians in a pilot study to assess their experiences and the utility and impact of an electronic previsit questionnaire and point‐of‐care dashboard to support coproduction of rheumatology care. Methods We employed a mixed‐methods design to assess users’ perceptions of a customized electronic health record rheumatology module at four pediatric rheumatology practices and two adult rheumatology practices. We surveyed a convenience sample of caregivers of children with JIA (n = 113), adults with RA (n = 116), and clinicians (n = 12). We conducted semistructured interviews with 13 caregivers and patients and six care teams. Experiences were evaluated using descriptive statistics and thematic analyses. Results Caregivers of children with JIA and adults with RA reported the dashboards were useful during discussions (88%) and helped them talk about what mattered most (82%), make health care decisions (83%), and create a treatment plan (77%). Clinicians provided similar feedback. Two‐thirds (67%) of caregivers and adults and 55% of clinicians would recommend the dashboard to peers. System usability scores (77.1 ± 15.6) were above average. Dashboards helped users make sense of health information, communicate more effectively, and make decisions. Improvements to the dashboards and workflows could enhance patient self‐management and clinician efficiency. Conclusion Visual point‐of‐care dashboards can support caregivers, patients, and clinicians to coproduce rheumatology care. Findings demonstrate a need to spread and scale for broader benefit and impact.

A genome-wide association study of cardiac magnetic resonance-derived left ventricular mass index including 43,000 UK Biobank participants reveals 12 associations (11 novel), implicating genes involved in cardiac contractility and cardiomyopathy.

Severe mitral stenosis for non-cardiac surgery is a challenge to anesthesiologists. General anesthesia as well as regional anesthesia have their own limitations. We present here a case of abdominal hysterectomy with ovarian cyst in a patient of severe mitral stenosis managed with graded epidural anesthesia who had heart failure in the post-operative period but was successfully managed by continuous positive airway pressure.

Introduction: Dengue virus (DENV) infection is a significant global public health problem, caused by four antigenically distinct serotypes of DENV, namely, DENV-1, DENV-2, DENV-3, and DENV-4. The disease manifestations range from asymptomatic or mild undifferentiated fever to severe diseases such as dengue hemorrhagic fever and dengue shock syndrome. Extensive research has been done on pathogenesis of DENV infection and the factors responsible for its severe manifestations. However, there is no ideal prognostic biomarker available yet. In various studies, it has been observed that DENV nonstructural-1 (NS1) protein plays a crucial role in pathogenesis. DENV NS1 protein acts by various mechanisms such as direct effect on vascular endothelium and activation of alternate complement pathway, which causes the release of inflammatory cytokines, leading to plasma leakage. It has also been observed that DENV NS1 levels correlate with disease severity. Until the present date, no commercial quantitative DENV NS1 ELISA is available for quantifying DENV NS1 levels in patients of DENV infection. Aim: Standardization of quantitative DENV NS1 ELISA. Methods: This study utilizes an already available NS1 ELISA kit and known concentrations of recombinant DENV NS1 protein to standardize quantitative DENV NS1 ELISA to estimate the NS1 concentration in human sera. Conclusion: Commercially available DENV NS1 detection kits can be standardized for quantification of DENV NS1 in human sera and use this data to find the association between NS1 concentration and disease severity.

Different location of adipose tissue may have different consequences to cardiometabolic risk. Here the authors report that deep learning enabled accurate prediction of specific adipose tissue volumes, and that after adjustment for BMI, visceral adiposity was associated with increased risk of cardiometabolic disease, while gluteofemoral adiposity was associated with reduced risk.

Abstract Gene editing has great potential in treating diseases caused by well-characterized molecular alterations. The introduction of clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9)–based gene-editing tools has substantially improved the precision and efficiency of gene editing. The CRISPR/Cas9 system offers several advantages over the existing gene-editing approaches, such as its ability to target practically any genomic sequence, enabling the rapid development and deployment of novel CRISPR-mediated knock-out/knock-in methods. CRISPR/Cas9 has been widely used to develop cancer models, validate essential genes as druggable targets, study drug-resistance mechanisms, explore gene non-coding areas, and develop biomarkers. CRISPR gene editing can create more-effective chimeric antigen receptor (CAR)-T cells that are durable, cost-effective, and more readily available. However, further research is needed to define the CRISPR/Cas9 system’s pros and cons, establish best practices, and determine social and ethical implications. This review summarizes recent CRISPR/Cas9 developments, particularly in cancer research and immunotherapy, and the potential of CRISPR/Cas9-based screening in developing cancer precision medicine and engineering models for targeted cancer therapy, highlighting the existing challenges and future directions. Lastly, we highlight the role of artificial intelligence in refining the CRISPR system's on-target and off-target effects, a critical factor for the broader application in cancer therapeutics.

Objective: To propose a theoretical formulation of engeletin-nanostructured lipid nanocarriers for improved delivery and increased bioavailability in treating Huntington’s disease (HD).Methods: We conducted a literature review of the pathophysiology of HD and the limitations of currently available medications. We also reviewed the potential therapeutic benefits of engeletin, a flavanol glycoside, in treating HD through the Keap1/nrf2 pathway. We then proposed a theoretical formulation of engeletin-nanostructured lipid nanocarriers for improved delivery across the blood-brain barrier (BBB) and increased bioavailability.Results: HD is an autosomal dominant neurological illness caused by a repetition of the cytosine-adenine-guanine trinucleotide, producing a mutant protein called Huntingtin, which degenerates the brain’s motor and cognitive functions. Excitotoxicity, mitochondrial dysfunction, oxidative stress, elevated concentration of ROS and RNS, neuroinflammation, and protein aggregation significantly impact HD development. Current therapeutic medications can postpone HD symptoms but have long-term adverse effects when used regularly. Herbal medications such as engeletin have drawn attention due to their minimal side effects. Engeletin has been shown to reduce mitochondrial dysfunction and suppress inflammation through the Keap1/NRF2 pathway. However, its limited solubility and permeability hinder it from reaching the target site. A theoretical formulation of engeletin-nanostructured lipid nanocarriers may allow for free transit over the BBB due to offering a similar composition to the natural lipids present in the body a lipid solubility and increase bioavailability, potentially leading to a cure or prevention of HD.Conclusion: The theoretical formulation of engeletin-nanostructured lipid nanocarriers has the potential to improve delivery and increase the bioavailability of engeletin in the treatment of HD, which may lead to a cure or prevention of this fatal illness.

Introduction: Chronic kidney disease (CKD) affects the pituitary-thyroid axis and peripheral metabolism of thyroid hormones, thereby causing dysfunction of thyroid hormones. This study aimed to highlight the correlation between thyroid dysfunction and the staging of chronic kidney disease. Methods: Fifty patients with CKD were studied between 2014–2017 in a tertiary care centre in Western India. These patients were split into a subgroup for Stage 4 and 5 CKD, based upon estimated glomerular filtration rate as per the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Thyroid function tests and lipid levels were compared in the different CKD subgroups by analysis of variance. Pearson’s correlation coefficient was used to evaluate the thyroid dysfunction with respect to degree of renal dysfunction in the study population. Results: Thyroid abnormalities were seen in 68% of the author’s patients. Euthyroid sick syndrome (ESS) was the most prevalent thyroid hormonal abnormality seen in 32% (n=16), followed by hypothyroidism category seen in the remaining 36% (n=18) of the study population. Of these, 18% (n=9) of the patients had subclinical hypothyroidism, while the remaining 18% (n=9) manifested overt hypothyroidism. Results showed that ESS had a positive correlation with estimated glomerular filtration rate (r=0.822; p less than 0.001). No significant differences were found between groups in thyroxine or thyroid-stimulating hormone (p>0.05). Linear regression in unadjusted analysis revealed that deranged low-density lipoprotein levels was found to be significantly associated negatively with hypothyroidism (p less than 0.001) in patients with CKD. Conclusion: Patients with Stage 4 and 5 CKD have many hormonal disturbances, of which ESS is a common occurrence, and has a significant association with dyslipidaemia, increasing morbidity in these patients. Hypothyroidism is more prevalent in patients with severe renal dysfunction, as a result of higher uremic milieu in these patients.

Abstract Colorectal cancer (CRC) is a predominant life‐threatening cancer, with liver and peritoneal metastases as the primary causes of death. Intestinal inflammation, a known CRC risk factor, nurtures a local inflammatory environment enriched with tumor cells, endothelial cells, immune cells, cancer‐associated fibroblasts, immunosuppressive cells, and secretory growth factors. The complex interactions of aberrantly expressed cytokines, chemokines, growth factors, and matrix‐remodeling enzymes promote CRC pathogenesis and evoke systemic responses that affect disease outcomes. Mounting evidence suggests that these cytokines and chemokines play a role in the progression of CRC through immunosuppression and modulation of the tumor microenvironment, which is partly achieved by the recruitment of immunosuppressive cells. These cells impart features such as cancer stem cell‐like properties, drug resistance, invasion, and formation of the premetastatic niche in distant organs, promoting metastasis and aggressive CRC growth. A deeper understanding of the cytokine‐ and chemokine‐mediated signaling networks that link tumor progression and metastasis will provide insights into the mechanistic details of disease aggressiveness and facilitate the development of novel therapeutics for CRC. Here, we summarized the current knowledge of cytokine‐ and chemokine‐mediated crosstalk in the inflammatory tumor microenvironment, which drives immunosuppression, resistance to therapeutics, and metastasis during CRC progression. We also outlined the potential of this crosstalk as a novel therapeutic target for CRC. The major cytokine/chemokine pathways involved in cancer immunotherapy are also discussed in this review.

Abstract Prediction models are commonly used to estimate risk for cardiovascular diseases, to inform diagnosis and management. However, performance may vary substantially across relevant subgroups of the population. Here we investigated heterogeneity of accuracy and fairness metrics across a variety of subgroups for risk prediction of two common diseases: atrial fibrillation (AF) and atherosclerotic cardiovascular disease (ASCVD). We calculated the Cohorts for Heart and Aging in Genomic Epidemiology Atrial Fibrillation (CHARGE-AF) score for AF and the Pooled Cohort Equations (PCE) score for ASCVD in three large datasets: Explorys Life Sciences Dataset (Explorys, n = 21,809,334), Mass General Brigham (MGB, n = 520,868), and the UK Biobank (UKBB, n = 502,521). Our results demonstrate important performance heterogeneity across subpopulations defined by age, sex, and presence of preexisting disease, with fairly consistent patterns across both scores. For example, using CHARGE-AF, discrimination declined with increasing age, with a concordance index of 0.72 [95% CI 0.72–0.73] for the youngest (45–54 years) subgroup to 0.57 [0.56–0.58] for the oldest (85–90 years) subgroup in Explorys. Even though sex is not included in CHARGE-AF, the statistical parity difference (i.e., likelihood of being classified as high risk) was considerable between males and females within the 65–74 years subgroup with a value of − 0.33 [95% CI − 0.33 to − 0.33]. We also observed weak discrimination (i.e.,

Abstract Inter-individual variation in fat distribution is increasingly recognized as clinically important but is not routinely assessed in clinical practice, in part because medical imaging has not been practical to deploy at scale for this task. Here, we report a deep learning model trained on an individual’s body shape outline—or “silhouette” —that enables accurate estimation of specific fat depots of interest, including visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) adipose tissue volumes, and VAT/ASAT ratio. Two-dimensional coronal and sagittal silhouettes are constructed from whole-body magnetic resonance images in 40,032 participants of the UK Biobank and used as inputs for a convolutional neural network to predict each of these quantities. Mean age of the study participants is 65 years and 51% are female. A cross-validated deep learning model trained on silhouettes enables accurate estimation of VAT, ASAT, and GFAT volumes (R 2: 0.88, 0.93, and 0.93, respectively), outperforming a comparator model combining anthropometric and bioimpedance measures (ΔR 2 = 0.05–0.13). Next, we study VAT/ASAT ratio, a nearly body-mass index (BMI)—and waist circumference-independent marker of metabolically unhealthy fat distribution. While the comparator model poorly predicts VAT/ASAT ratio (R 2: 0.17–0.26), a silhouette-based model enables significant improvement (R 2: 0.50–0.55). Increased silhouette-predicted VAT/ASAT ratio is associated with increased risk of prevalent and incident type 2 diabetes and coronary artery disease independent of BMI and waist circumference. These results demonstrate that body silhouette images can estimate important measures of fat distribution, laying the scientific foundation for scalable population-based assessment.

Abstract Development of a native language robust ASR framework is very challenging as well as an active area of research. Although an urge for investigation of effective front-end as well as back-end approaches are required for tackling environment differences, large training complexity and inter-speaker variability in achieving success of a recognition system. In this paper, four front-end approaches: mel-frequency cepstral coefficients (MFCC), Gammatone frequency cepstral coefficients (GFCC), relative spectral-perceptual linear prediction (RASTA-PLP) and power-normalized cepstral coefficients (PNCC) have been investigated to generate unique and robust feature vectors at different SNR values. Furthermore, to handle the large training data complexity, parameter optimization has been performed with sequence-discriminative training techniques: maximum mutual information (MMI), minimum phone error (MPE), boosted-MMI (bMMI), and state-level minimum Bayes risk (sMBR). It has been demonstrated by selection of an optimal value of parameters using lattice generation, and adjustments of learning rates. In proposed framework, four different systems have been tested by analyzing various feature extraction approaches (with or without speaker normalization through Vocal Tract Length Normalization (VTLN) approach in test set) and classification strategy on with or without artificial extension of train dataset. To compare each system performance, true matched (adult train and test—S1, child train and test—S2) and mismatched (adult train and child test—S3, adult + child train and child test—S4) systems on large adult and very small Punjabi clean speech corpus have been demonstrated. Consequently, gender-based in-domain data augmented is used to moderate acoustic and phonetic variations throughout adult and children’s speech under mismatched conditions. The experiment result shows that an effective framework developed on PNCC + VTLN front-end approach using TDNN-sMBR-based model through parameter optimization technique yields a relative improvement (RI) of 40.18%, 47.51%, and 49.87% in matched, mismatched and gender-based in-domain augmented system under typical clean and noisy conditions, respectively.

The inherited basis of body fat distribution is not fully understood. Here, the authors use genetic data and MRI-derived measures of local adiposity to highlight fat depot-specific genetic architecture with implications for cardiometabolic health.

Abstract Electronic health record (EHR) datasets are statistically powerful but are subject to ascertainment bias and missingness. Using the Mass General Brigham multi-institutional EHR, we approximated a community-based cohort by sampling patients receiving longitudinal primary care between 2001-2018 (Community Care Cohort Project [C3PO], n = 520,868). We utilized natural language processing (NLP) to recover vital signs from unstructured notes. We assessed the validity of C3PO by deploying established risk models for myocardial infarction/stroke and atrial fibrillation. We then compared C3PO to Convenience Samples including all individuals from the same EHR with complete data, but without a longitudinal primary care requirement. NLP reduced the missingness of vital signs by 31%. NLP-recovered vital signs were highly correlated with values derived from structured fields (Pearson r range 0.95–0.99). Atrial fibrillation and myocardial infarction/stroke incidence were lower and risk models were better calibrated in C3PO as opposed to the Convenience Samples (calibration error range for myocardial infarction/stroke: 0.012–0.030 in C3PO vs. 0.028–0.046 in Convenience Samples; calibration error for atrial fibrillation 0.028 in C3PO vs. 0.036 in Convenience Samples). Sampling patients receiving regular primary care and using NLP to recover missing data may reduce bias and maximize generalizability of EHR research.

Abstract Background Pantothenate kinase (PANK) is the first and rate-controlling enzymatic step in the only pathway for cellular coenzyme A (CoA) biosynthesis. PANK-associated neurodegeneration (PKAN), formerly known as Hallervorden–Spatz disease, is a rare, life-threatening neurologic disorder that affects the CNS and arises from mutations in the human PANK2 gene. Pantazines, a class of small molecules containing the pantazine moiety, yield promising therapeutic effects in an animal model of brain CoA deficiency. A reliable technique to identify the neurometabolic effects of PANK dysfunction and to monitor therapeutic responses is needed. Methods We applied 1H magnetic resonance spectroscopy as a noninvasive technique to evaluate the therapeutic effects of the newly developed Pantazine BBP-671. Results 1H MRS reliably quantified changes in cerebral metabolites, including glutamate/glutamine, lactate, and N-acetyl aspartate in a neuronal Pank1 and Pank2 double-knockout (SynCre + Pank1,2 dKO) mouse model of brain CoA deficiency. The neuronal SynCre + Pank1,2 dKO mice had distinct decreases in Glx/tCr, NAA/tCr, and lactate/tCr ratios compared to the wildtype matched control mice that increased in response to BBP-671 treatment. Conclusions BBP-671 treatment completely restored glutamate/glutamine levels in the brains of the mouse model, suggesting that these metabolites are promising clinically translatable biomarkers for future therapeutic trials.

Objective: To evaluate and compare the effect of variation in storage temperatures and duration on a tensile load at failure of elastomeric modules. Methods: In total, 140 modules were used in the study, 20 of which were tested on day 0 as received from a company using a Universal testing machine for baseline estimation of tensile load at failure. The rest 120 modules were divided into 6 groups. Groups I, II, and III modules were stored at low (T1 = 1–5°C), moderate (T2 = 20–25°C) and high (T3 = 35–40°C) temperatures, respectively, for 6 months. Groups IV, V and VI modules were stored at temperatures T1, T2 and T3 for 1 year, respectively, and were tested for tensile load at failure. Results: The tensile load at failure for the control group was 21.588 ± 1.082 N and for 6-month interval at temperatures T1, T2 and T3 was 18.818 N ± 1.121 N, 17.841 N ± 1.334 N and 17.149 N ± 1.074 N, respectively, and for 1 year, it was 17.205 N ± 1.043 N, 16.836 N ± 0.487 N and 14.788 N ± 0.781 N, respectively. The tensile load at failure decreased significantly from 6 months to 1 year among each temperature group. Conclusions: Maximum force degradation was seen in modules at high temperature followed by medium temperature and low temperature at both 6 months and 1 year intervals, and tensile load at failure decreased significantly from 6 months to 1 year storage duration. These results conclude that the temperature and duration at which the samples were exposed during storage produce a significant change in the forces exerted by the modules.

Context : Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. Aims : We sought to describe strain findings in both the groups on initial presentation and follow-up. Settings and Design : A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. Subjects and Methods : TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. Results : Forty-five patients (34 – MIS-C and 11 – COVID-19) met the inclusion criteria. There was a statistically significant decrease in LV longitudinal strain (P < 0.001), LV circumferential strain (P < 0.001), and left atrial strain (P = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain (P = 0.028) in the acute COVID-19 group. All patients with abnormal left ventricular EF (LVEF) had abnormal strain. However, 14 (41%) patients in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. There was a significant correlation with LV longitudinal strain (P = 0.005) and LVEF (P = 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. Conclusions : Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.