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Morbidity and mortality statistical trends of COVID-19 pandemic reveal that, “The coronavirus may be with us for a long time, and we have to learn to live with it rather than hope to vanquish its threat”. Considering these trends, it is imperative to make changes in our lives at home and workplace so as to prepare ourselves to face and protect the community at large from the risk of infection. Human interaction is necessary in healthcare particularly in panchakarma due to which panchakarma practitioners are in a dilemma about how to start their services in the non-covid cases and how to protect the patients and hospital personnel from the possibility of exposure to COVID-19 infection. With this background, preliminary guidelines have been formulated as an aid to resume the panchakarma procedures. This guideline highlights the specific measures needed to protect occupational safety and quality in healthcare services in the area of panchakarma practice amid the COVID-19 pandemic.

Objectives To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity.Design Hospital-based prospective cohort study.Setting Two tertiary care centres in Kerala, India.Participants Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention.Statistical analysis Pearson χ2 test or Fisher’s exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni’s correction was used for multiple comparisons.Results We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes.Conclusions Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, life-threatening multi-system adverse drug reaction characterized by febrile skin rash, hematologic abnormalities, and involvement of internal organs. We report a case of DRESS syndrome in a child presenting with primary ophthalmic manifestations. Case Report: An 11-year-old boy presented with severe pain and diminished vision in both eyes six weeks after starting carbamazepine therapy for seizure disorder. Ocular examination revealed features of bilateral acute anterior uveitis, acute onset myopia, and angle closure glaucoma secondary to uveal effusion. Additionally, the patient was febrile with a generalized maculopapular rash, and blood investigations revealed eosinophilic leukocytosis. A diagnosis of carbamazepine-induced DRESS syndrome was made, and carbamazepine therapy was discontinued. Treatment with cycloplegics, topical, and systemic steroids resulted in prompt clinical recovery. Conclusion: Ophthalmologists should be aware that hypersensitivity to anticonvulsants, such as carbamazepine, can present with bilateral uveitis and uveal effusion along with systemic symptoms. Prompt diagnosis and treatment can prevent vision loss and life-threatening complications. Patients should be counselled about potential adverse effects of anticonvulsants before therapy.

In this paper, a Novel Hybrid control approach is applied to a Single Fluid Heat Transfer System. Mathematical model of the system has been developed. The proposed control scheme can reduce the power burn rate by 21%. The Novel Hybrid controller is robust against perturbations. The control scheme has been corroborated on the numerical simulations. The transient response attributes have been used as validating strictures.

On September 25 and 26, 2021, the Alzheimer's Association hosted the first meeting focused on people with early-onset Alzheimer's disease (EOAD)-sometimes referred to as younger onset Alzheimer's disease (AD). Though a diagnosis of AD can be devastating at any age, those with a younger onset-defined as symptoms developing prior to 65 years of age-face unique challenges. EOAD occurs when people are in the prime of their lives, often with multiple responsibilities including careers, community activities, and raising children and caring for older family members. These challenges warrant special consideration and study, yet people with EOAD are often excluded from AD research because of their atypical age of onset. To help fill this gap, we designed and launched the Longitudinal Early-Onset Alzheimer's Disease Study (LEADS) to enroll and follow 500 people with EOAD from > 15 sites in the United States, which the National Institute on Aging funded in 2018. The September 2021 meeting was designed to inform people with EOAD and their family members and caregivers about the latest research on the biology of EOAD, treatments in the pipeline, practical considerations about legal and financial arrangements for families, and the support networks available to them. More than 217 registrants attended.

Purpose: To evaluate patient satisfaction and symptom control in hypogonadal men transitioning from other testosterone therapies to oral testosterone undecanoate (TU). Materials and Methods: In this open-label clinical trial, men aged 18 to 75 years with hypogonadism were switched to oral TU after a sufficient washout of previous testosterone therapies. Treatment satisfaction and symptom control were primarily measured using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) and quantitative androgen deficiency in aging males (qADAM) questionnaires, respectively. Secondary outcomes included changes in serum testosterone (T), estradiol (E2), hematocrit (HCT), and prostate-specific antigen (PSA) levels. Results: Forty-one men participated, with significant improvements in all TSQM-9 scores observed over 6 months. Symptom control as measured by qADAM remained consistent. There was a significant increase in serum T and E2 levels, but HCT and PSA levels remained stable. Conclusions: Switching to oral TU from other testosterone therapies is associated with increased patient satisfaction and stable hypogonadal symptom control.

Abstract This article introduces a novel FIR filter using a Radix-2r multiplier combined with 4:2 and 3:2 compressors for denoising Electrooculography (EOG) signals. This approach replaces traditional ripple-carry adders with compressors to add the partial products generated by the Radix-2r multiplier, resulting in reduced delay and energy consumption. The FIR filter is implemented in gate-level Verilog HDL, verified using ModelSim and Altera DSP Builder, and synthesized with the Cadence RTL compiler. Compared to conventional designs, the proposed filter achieves a 71.48% reduction in area, 73.28% reduction in power, 51.84% reduction in delay, 86.22% reduction in the area-delay product (ADP), and 92.38% reduction in energy-per-operation (EPS), significantly outperforming the SOPOT filter.

Background: Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening. Methods: Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test. Results: Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (

Introduction: Heyde syndrome is a multisystem disorder characterized by the triad of aortic stenosis, acquired coagulopathy (von Willebrand syndrome type 2A) and gastrointestinal angiodysplasia. The diagnosis of Heyde syndrome in adults is challenging because of high frequency of aortic stenosis and gastrointestinal angiodysplasia. Clinical suspicion is therefore essential for diagnosis. Case Presentation: We present the case of a male with recurrent hospital admissions and transfusions for anemia post bleeding per rectum who was diagnosed to have Heyde’s syndrome. The patient was managed with aortic valve replacement and coronary artery bypass surgery involving left anterior descending artery. He remained symptom free 1 year after appropriate therapy. Conclusions: The management of aortic stenosis in patients with Heyde syndrome results in resolution of anemia. Hence, treatment decisions are based on correct identification.

Bow Hunter's syndrome (BHS) is an uncommon condition characterized by impingement of one of the two vertebral arteries induced by cervical rotation, causing symptomatic vertebrobasilar insufficiency of the posterior cerebral circulation. We report a case of BHS in an 84-year-old male. Two months following a motor vehicle accident, the patient presented to an urgent care facility with subsequent transfer to the emergency department with complaints of lightheadedness upon right-lateral head movement. A cerebral angiogram demonstrated mild focal stenosis in the dominant left vertebral artery at the C2 level when in neutral position with significant worsening of the stenosis in the right-lateral head position with absent anterograde flow, consistent with BHS. Resultantly, the patient was referred for neurosurgery and successfully underwent placement of right-sided C2-C4 postero-lateral instrumentation and left-sided C2-C3 laminar screws projected towards the right side. This case highlights the importance of imaging in BHS diagnosis and guidance for treatment, as well as the need for a surgical standard of care for BHS patients.

Treatment of tuberculosis (TB) infection (TBI) to prevent active TB disease is a key component of the National Strategic Plan to end TB in India, without which the strategies to end TB would be futile. There is a need to rapidly scale up access to effective shorter regimens for tuberculosis preventive treatment (TPT) to a wider set of risk groups. This applies for identifying high-risk groups for TPT expansion. Thus, our aim with this review is to determine the TBI prevalence in different risk groups in India. We searched databases like Embase, Medline, Scopus, and CINAHL for studies published between 2012 and 2023 to estimate TBI in different risk groups in India. The PRISMA guidelines were followed when reviewing the publications, and a predetermined search strategy was used to find relevant sources across various databases. Using MetaXL (MS excel) software, we pooled data based on a random-effects model, along with heterogeneity testing using Cochrane’s Q and I2 statistic. A total of 68 studies were included from 10,521 records. TBI pooled prevalence was estimated using the IGRA data, while in the absence of IGRA data, TST data were utilized. The key findings revealed a total of 36% pooled TBI prevalence for all risk factors, 59% among smokers, 53% among diabetics and alcoholics, 48% among malnourished, 47% among contacts of TB patients, 44% among HIV, 36% among pregnant women, 35% among COVID-19 patients, 31% among healthcare workers, 18% among sarcoidosis patients, and 15% among rheumatoid arthritis patients in India. Our review depicted a high TBI burden among groups such as diabetes mellitus, smokers, malnourished, and alcoholics. WHO has yet to recommend for systematic screening and treatment for TBI among these groups for want of evidence which this study provides, highlighting the need to reprioritize the risk groups for tailored TPT strategies.

Abstract Background Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology characterized by a large vessel vasculitis involving the aorta and its branches. Myocardial involvement is extremely unusual in TA and is mostly in the form of myocarditis, ventricular hypertrophy, and ventricular dysfunction secondary to coronary ischemia. Submitral aneurysms have been reported in TA and has been attributed to the chronic inflammatory process in TA. Case presentation We report a novel instance of left ventricular apical aneurysm in a 37-year-old lady with TA and normal epicardial coronaries. She was diagnosed with a left ventricular apical aneurysm, moderate aortic regurgitation, and moderate pericardial effusion. The coronary arteries were normal. The patient had concomitant chronic active Epstein–Barr virus infection complicating patient outcome. Conclusions Left ventricular apical aneurysm with normal epicardial coronaries is a rare cause of heart failure in Takayasu arteritis. Concomitant chronic active Epstein–Barr virus infection can potentially accentuate the inflammatory process in Takayasu arteritis and complicate management and patient outcomes.

Introduction: Oxidative stress plays a central role in the pathogenesis of Diabetic Retinopathy (DR) and serum bilirubin has been shown to have antioxidant properties. Aim: To investigate the association between serum bilirubin concentration and DR in patients with Type 2 Diabetes Mellitus (DM). Materials and Methods: This was a hospital based, crosssectional study where in 86 patients with Type 2 DM and 30 controls were recruited. The study was conducted at a tertiary care centre in Southern India between January 2014 and December 2014. The presence and the severity of DR were determined by fundus examination and grading of colour fundus photographs using the international clinical disease severity scale for DR. Serum total, direct and indirect bilirubin levels were determined in all subjects and the association between bilirubin levels and severity of DR was studied. Results: Among the 86 diabetics, 24 had no retinopathy and 62 had DR of varying grades. The mean total bilirubin level among diabetic subjects (0.52±0.17) and controls (0.51±0.19) were found to be similar. The mean total as well as direct bilirubin levels were found to be lower in patients with retinopathy as compared to no retinopathy group (p