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Abstract This research presents a predictive model aimed at estimating the progression of Amyotrophic Lateral Sclerosis (ALS) based on clinical features collected from a dataset of 50 patients. Important features included evaluations of speech, mobility, and respiratory function. We utilized an XGBoost regression model to forecast scores on the ALS Functional Rating Scale (ALSFRS-R), achieving a training mean squared error (MSE) of 0.1651 and a testing MSE of 0.0073, with R² values of 0.9800 for training and 0.9993 for testing. The model demonstrates high accuracy, providing a useful tool for clinicians to track disease progression and enhance patient management and treatment strategies.

Cystic fibrosis (CF) is a life-limiting genetic condition with multisystemic manifestations. However, there are vast phenotypic as well as genotypic variations. This contributes to delay in diagnosis, especially in pancreatic-sufficient patients who may not manifest typical symptomatology. The last decade has witnessed significant breakthroughs in CF therapeutics. This in combination with early diagnosis through newborn screening, and aggressive supportive care can offer near-normal life expectancy for a majority of patients with CF (pwCF) worldwide. Even while addressing disparities in CF care around the world, it is crucial to train medical professionals to suspect and diagnose CF in children as well as in adults. Here, we share our experience of pwCF diagnosed beyond 16 years of age with an aim to highlight the clinical presentations in young adults, the need for screening family members of a newly diagnosed pwCF, and the negative effects of late diagnosis of CF.

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.

Hepatitis C virus positive (HCV+) organ donors offer a viable strategy for expansion of the heart donor pool without an increased risk of recipient mortality. Cardiac magnetic resonance imaging (CMR) is an effective tool for graft surveillance in heart transplant (HT) recipients. However, there are no data comparing CMR findings in HT recipients based on donor HCV status. The aim of this propensity score matched case-control study was to evaluate baseline CMR characteristics of HCV+ HT recipients and HCV- HT recipients, as well as compare cardiac allograft structure, function, performance, and tissue characterization between groups. CMR normative values did not differ between groups in matched analysis. There were no significant differences in CMR-derived biventricular function, strain, late gadolinium enhancement, or myocardial tissue characteristics by parametric mapping. This study suggests CMR can be a valuable tool for surveillance in HCV+ HT patients, and abnormalities on imaging should not be attributed to HCV infection.

Background: Rapid detection of tuberculosis (TB) and its resistance are essential for the prompt initiation of correct drug therapy and for stopping the spread of drug-resistant TB. There is an urgent need for increased use of rapid diagnostic tests to control the threat of increased TB and multidrug-resistant TB (MDR-TB). Methods: EMPE Diagnostics has developed a multiplex molecular diagnostic platform called mfloDx™ by combining nucleotide-specific padlock probe-dependent rolling circle amplification with sensitive lateral flow biosensors, providing visual signals, similar to a COVID-19 test. The first test kit of this platform, mfloDx™ MDR-TB can identify Mycobacterium tuberculosis (MTB) complex and its clinically significant mutations in the rpoB and katG genes and in the inhA promotor contributing resistance to rifampicin (RIF) and isoniazid (INH), causing MDR-TB. Results: We have evaluated the performance of the mfloDx™ MDR-TB test on 210 sputum samples (110 from suspected TB cases and 100 from TB-negative controls) received from a tertiary care center in India. The clinical sensitivity for detecting MTB compared to acid-fast microscopy and mycobacteria growth indicator tube (MGIT) cultures was 86.4% and 84.9%, respectively. All the 100 control samples were negative indicating excellent specificity. In smear-positive sputum samples, the mfloDx™ MDR-TB test showed a sensitivity of 92.5% and 86.4% against MGIT culture and Xpert MTB/RIF, respectively. The clinical sensitivity for the detection of RIF and INH resistance in comparison with MGIT drug susceptibility testing was 100% and 84.6%, respectively, while the clinical specificity was 100%. Conclusion: From the above evaluation, we find mfloDx™ MDR-TB to be a rapid and efficient test to detect TB and its multidrug resistance in 3 h at a low cost making it suitable for resource-limited laboratories.

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 Prospective and sequential evaluation of homeostatic changes leading to thrombosis across COVID 19 disease severity spectrum are limited. In this prospective observational study, haemostasis was evaluated in patients with mild, moderate-severe, and critical COVID-19 infection. Markers of endothelial activation [Soluble thrombomodulin (sTM), von Willebrand Factor (VWF)], platelet activation [Soluble P-selectin, beta-thromboglobulin (BTG)] and global haemostasis [Rotational thromboelastometry (ROTEM)] were evaluated on days 1 and 5 after admission. The study cohort comprised of 100 adult patients (mild = 20, moderate-severe = 22, critical = 58). Sixty-five patients received anticoagulation for 10 (7–14) days. Thrombotic events were seen in 9 patients. In-hospital mortality was 21%. Endothelial activation markers were elevated at baseline in all subgroups, with levels in moderate-severe (sTM = 4.92 ng/ml, VWF = 295 U/dl) [reference-ranges: sTM = 2.26–4.55 ng/ml; Soluble P-selectin = 13.5–31.5 ng/ml; BTG = 0.034–1.99 ng/ml] and critical patients (sTM = 6.07 ng/ml, VWF = 294 U/dl) being significantly higher than in the mild group (sTM = 4.18 ng/ml, VWF = 206 U/dl). In contrast, platelet activation markers were elevated only in critically ill patients at baseline (Soluble P-selectin = 37.3 ng/ml, BTG = 2.51 ng/ml). The critical group had significantly lower fibrinolysis on days 1 and 5 when compared with the moderate-severe arm. COVID-19 infection was associated with graded endothelial activation and lower fibrinolysis that correlated with illness severity.

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.

Introduction: Baseline expression of p16INK4a characterises cellular senescence. Similarly, the measurement of γ-GammaH2AX (γ-H2AX) foci levels in cells provides a reliable method for quantification of Deoxyribonucleic Acid (DNA) damage. Aim: To explore the role of p16INK4a and γ-H2AX as biomarkers of senescence in skin tissue. Materials and Methods: This was a cross-sectional study conducted in the Department of Anatomy, PGIMER, Chandigarh, Punjab, India from June 2022 to January 2023. Skin tissue was obtained from 30 cadavers, aged 20-90 years, from the anterior abdominal wall. The time duration of sample collection after death varied from six hours to 12 hours. Samples were divided into two groups: Group-I 70 years, with n=15 in each group. The relative change in the expression pattern of p16INK4a and γH2AX markers, as well as the microstructure of the skin (thickness of epidermis and dermis, distribution of collagen I/II/III fibres, architecture of sebaceous glands), were statistically analysed using an unpaired t-test. Results: Intense staining was observed with p16INK4a in Group-II, showing positivity in 60.75% of the cells, while Group-I depicted a weak staining pattern (15%). On immunostaining with γ-H2AX, only Group-II cells showed intense positivity (45%). Significant differences were observed in the epidermal and dermal thickness: Group-I (165.5267±37.73 μm; 2394.6±874.13 μm); Group-II (54.6±22.79 μm; 566.67±242.23 μm), and collagen Type-II/III fibres were found predominantly in aging skin tissue. Conclusion: The present study provides comprehensive data regarding age-associated changes between p16INK4a, γ-H2AX, and skin microstructure, which result in decreased repair and regenerative capacity of skin tissue and various age-related skin diseases.

Objectives To describe injury frequency and characteristics in roundnet athletes and compare injury characteristics between elite and non-elite athletes.Methods This cross-sectional study was performed by convenience sampling recreational and competitive roundnet athletes via a REDCap survey distributed through social media platforms. The custom survey evaluated athlete demographics, past sport participation, training workload and roundnet-related injuries throughout their whole playing career. Injury characteristics were reported for the full study cohort and compared between elite and non-elite athletes.Results 166 athletes participated in the study, with 33.7% playing at the elite level. 279 injuries were reported, with 86.1% (n=143) of athletes reporting at least one injury throughout their playing career. Injuries most frequently involved the shoulder (20%), ankle (18%), knee (14%) and elbow (14%). 47% of reported injuries occurred due to overuse, and 67% resulted in missed competition time averaging 2.0 months. There were 10 injuries (3.6%) that required surgery. No differences were found in regards to injury frequency (1.9±1.5 vs 1.6±1.1 injuries per athlete, p=0.159) or any injury characteristics between elite and non-elite athletes.Conclusion Roundnet athletes experienced a mean of 1.7±1.2 injuries while playing roundnet. Injuries most frequently involved the shoulder and ankle and often resulted in missed competition time. The level of competition does not significantly impact injury frequency or characteristics. Roundnet athletes may benefit from injury prevention programmes that include shoulder strengthening, maintaining shoulder range of motion and ankle stability.

After recovery from COVID-19, there is data to suggest potential long-term pulmonary sequelae and associated impairment of functional capacity. This cross-sectional study was designed to assess the impact on respiratory function in a cohort of Indian subjects. Subjects who had recovered from COVID-19 were recruited. Clinical symptoms, pulmonary function test results, 6-minute walk test (6MWT) results, St George's Respiratory questionnaire (SGRQ) and chest radiographs were obtained. Information on the COVID-19 illness during hospitalization, baseline laboratory biomarkers and the disease severity categories as outlined by WHO (asymptomatic, mild, moderate, severe and critical), were retrieved from the hospital records. The 'COVID pneumonia'(WHO category moderate, severe & critical) group was compared with the 'Mild COVID' (WHO category mild) group and likewise, the WHO category moderate and the WHO category severe/critical groups were compared. In 207 subjects, whose mean age was 48.7 years were assessed after an average of 63 days from onset of symptom, 35% had TLC< 80% (restrictive defect), 8.3% had FEV1/FVC

Abstract A method of desymmetrization of geminal difluoroalkanes using frustrated Lewis pair (FLP) mediated monoselective C–F activation where a chiral sulfide is the Lewis base component is reported. The stereoselective reaction provides generally high yields of diastereomeric sulfonium salts with dr of up to 95:5. The distribution of diastereomers is found to be thermodynamically controlled via facile sulfide exchange. The use of enantiopure chiral sulfides allows for high stereospecificity in nucleophilic substitution reactions and the formation of stereoenriched products.

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.

A novel wearable consumer electronics device for detecting Major Depressive Disorder (MDD) has been developed using deep learning techniques for smart healthcare. Accurate identification of MDD through individual interviews or perceiving Electroencephalogram (EEG) signals is challenging. This study presents the concept of a novel wearable smart cap named DepCap for real-time detection of depression using EEG signals. First, spectrogram images are generated from the EEG signals of depressed and healthy patients using Short-Time Fourier Transform (STFT) to extract valuable features. Then, these spectrogram images obtained from STFT are used as input to the classification model. A deep analysis is done using various neural networks consisting of Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs). RNNs are used to extract temporal data from the EEG, while CNNs are used to retrieve spatial information. Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) are the two different kinds of RNNs evaluated in this work. The implemented combination models are (STFT+CNN), (STFT+CNN-LSTM) and (STFT+CNN-GRU). Four pre-trained models, Inception, AlexNet, VGG16, and ResNet50 are also implemented along with the combination models. The dataset for this work is a publicly accessible dataset with 33 major depressive disorders and 30 healthy subjects. The evaluation results show that the STFT+CNN-LSTM has much better performance in terms of accuracy, sensitivity, specificity, and precision of 99.9%, 100%, 99.8%, and 99.4%, respectively, than other implemented models. The proposed wearable device DepCap is based on the STFT+CNN+LSTM model and is also integrated with the Internet of Medical Things (IoMT) framework for real-time depression detection.

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.

Abstract Background Thoracic air leak syndrome (TALS) is a rare complication associated with chronic lung graft-versus-host disease (GVHD) and bronchiolitis obliterans syndrome (BOS). In the present case, TALS was the sole pulmonary manifestation of GVHD. Case presentation A 30-year-old woman presented with dyspnea on exertion and swelling of the neck and face after allogeneic stem cell transplantation for acute myeloid leukemia. She was found to have subcutaneous emphysema, and chest imaging suggested pneumomediastinum, with normal lung parenchyma. Her clinical and radiological findings indicated TALS. There were no other features suggestive of lung GVHD. Her condition improved with conservative management and increased immunosuppression. However, she subsequently had two relapses, developed severe infection and pneumothorax, and died. Conclusions The present case report illustrates a unique presentation of TALS, a rare complication of GVHD, in a post-stem cell transplant patient. It highlights the challenges in the diagnosis and management of this condition.

Abstract Background Head injury most commonly occur following road traffic accidents. Often hearing loss and other otological injuries are missed in view of serious head injury or other visible bodily injuries, leading to delayed recognition of problems. There is a need for early clinical and radiological indicators which can predict adverse outcome. Early diagnosis of otological injury during initial evaluation of the head injury has given some clues regarding the severity of hearing outcomes and such correlation has been attempted in this study. Two-year cross-sectional study involving head injury patients with radiological evidence of temporal bone fracture were assessed for hearing impairment. Results Thirty-seven patients who satisfied the inclusion criteria were assessed. Fifty-one percent patients had conductive hearing loss. 35.14% of the patients had involvement of mastoid, external auditory canal, and middle ear involvement. A weakly positive correlation was noted between otic capsule sparing fracture and hearing loss. (R value + 0.2064). Conclusion Weak correlation was observed between temporal bone sub-site classification and severity of hearing loss in otic capsule sparing temporal bone fractures.

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at

Translesion synthesis by translesion polymerases is a conserved mechanism of DNA damage tolerance. In bacteria, DinB enzymes are the widely distributed promutagenic translesion polymerases. The role of DinBs in mycobacterial mutagenesis was unclear until recent studies revealed a role for mycobacterial DinB1 in substitution and frameshift mutagenesis, overlapping with that of translesion polymerase DnaE2. Mycobacterium smegmatis encodes two additional DinBs (DinB2 and DinB3) and Mycobacterium tuberculosis encodes DinB2, but the roles of these polymerases in mycobacterial damage tolerance and mutagenesis is unknown. The biochemical properties of DinB2, including facile utilization of ribonucleotides and 8-oxo-guanine, suggest that DinB2 could be a promutagenic polymerase. Here, we examine the effects of DinB2 and DinB3 overexpression in mycobacterial cells. We demonstrate that DinB2 can drive diverse substitution mutations conferring antibiotic resistance. DinB2 induces frameshift mutations in homopolymeric sequences, both in vitro and in vivo. DinB2 switches from less to more mutagenic in the presence of manganese in vitro. This study indicates that DinB2 may contribute to mycobacterial mutagenesis and antibiotic resistance acquisition in combination with DinB1 and DnaE2.

Patients who have features of both Asthma & COPD are now known as Asthma COPD overlap (ACO). Prevalence of ACO based on the Global Initiative for Asthma (GINA) and Global initiative for obstructive lung disease (GOLD) Syndromic Approach is scarce. In this cross-sectional observational study, we recruited physician-diagnosed–pAsthma, pCOPD & pACO by simple random sampling. Clinical features, spirometry, 6-min walk test, Serum Immunoglobulin E, % blood eosinophils and chest x-rays were reviewed. Syndromic approach was applied, and the diagnosis was reclassified accordingly.In all, 877 patients were included (Male = 445, Female = 432). Physician diagnosis for these were: pAsthma–713, pCOPD–157 and pACO–7. They were reclassified using the Syndromic approach as: sAsthma, sCOPD and sACO. The 713 pAsthmatics were reclassified as follows: sAsthma–684 (95.94%), sCOPD–12 (1.68%) and sACO–17 (2.38%). Of the 157 pCOPD patients, 91 (57.96%) were reclassified as sCOPD, 23 (14.6%) as sACO, and 17 (927.38%) as sAsthma. Of the 7 previously diagnosed pACO patients, only 1 (14.28%) was reclassified as sACO, 5 (71.42%) as sAsthma and 1 (14.28%) as sCOPD. sCOPD patients had more exacerbations (52.88% vs 46.34%, p = 0.479), critical care admissions (16.35% vs 7.32%, p = 0.157) and intubations (17.31% vs 9.76%, p = 0.255) compared to sACO patients, the latter had more events than sAsthma patients: exacerbations 46.34% vs 10.11% (p

Objective: To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India. Patients and Methods: We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of H2O, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death. Results: In total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode. Conclusion: Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.

Abstract Background The role and performance of various serological tests for the diagnosis of COVID-19 are unclear. This study aimed to evaluate the performance of seven commercially available serological assays for SARS-CoV-2 antibodies by testing COVID-19 cases and controls. Methods Adult patients with fever for > 5 days, admitted to a tertiary-care teaching hospital in South India, were enrolled prospectively between June and December 2020. SARS-CoV-2 RT-PCR confirmed patients were classified as cases, and patients with febrile illness with laboratory-confirmed alternative diagnosis and healthy participants were controls. All participants were tested with SCoV-2 Detect™ IgM ELISA kit and SCoV-2 Detect™ IgG ELISA kit (InBios International, Seattle, USA) (Inbios), SARS-CoV-2 Total and SARS-CoV-2 IgG (Siemens Healthcare Diagnostics Inc., Tarrytown, USA) (Siemens), Roche Elecsys® Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) (Roche), Abbott SARS-CoV-2 IgG (Abbott Diagnostics, IL, USA) (Abbott), and Liaison® SARS-CoV-2 S1/S2 IgG (DiaSorinS.p.A., Saluggia, Italy) (Liaison). The sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV), and accuracies were compared. Results There were 303 participants: 153 cases and 150 controls. ELISA detecting anti-S protein antibody was more sensitive (88.9% for IgG and 86.3% for IgM) than the CLIAs (82.4% for total antibodies and 76.5–85.6% for IgG). Among CLIAs, Roche IgG was most sensitive (85.6%) followed by Abbott (83%) and Liaison (83%). Abbot had the best PPV (88.8%) and was more specific (89.3%) than Liaison (82%) and Roche (82%). Siemens IgG was less sensitive (76.5%) than Siemens Total (82.4%). The specificity of all the serological assays was modest (75–90%). Antibody test positivity increased with the duration of illness reaching 90% after 10 days of illness. When cases were compared against pre-pandemic controls, the IgG gave excellent specificity (98–100%). For seroprevalence studies, InBios IgG had the best accuracy (90.8%) with 88.9% sensitivity and 97.6% specificity. Conclusion The serological assays are important adjuncts for the diagnosis of COVID-19 in patients with persistent symptoms, especially in the second week of illness. The value of serological diagnostic tests is limited in the first week of illness and they provide additional value in seroprevalence studies. The diagnostic accuracy of the ELISA and CLIA platforms were comparable.

The foot and ankle serve vital roles in weight bearing, balance, and flexibility but are susceptible to many diverse ailments, making treatment difficult. More commonly, Total Ankle Arthroplasty (TAA) and Total Talus Replacement (TTR) are used for patients with ankle degeneration and avascular necrosis of the talus, respectively. Ankle prosthesis and orthosis are also indicated for use with lower limb extremity amputations or locomotor disability, leading to the development of powered exoskeletons. However, patient outcomes remain suboptimal, commonly due to the misfitting of implants to the patient-specific anatomy. Additive manufacturing (AM) is being used to create customized, patient-specific implants and porous implant cages that provide structural support while allowing for increased bony ingrowth and to develop customized, lightweight exoskeletons with multifunctional actuators. AM implants and devices have shown success in preserving stability and mobility of the joint and achieving fast recovery, as well as significant improvements in gait rehabilitation, gait assistance, and strength for patients. This review of the literature highlights various devices and technologies currently used for foot and ankle prosthesis and orthosis with deep insight into improvements from historical technologies, manufacturing methods, and future developments in the biomedical space.

Background: In India, on 30th January 2020, the first case of COVID-19 was reported, thereafter country has faced two waves with disastrous second wave. A total of about 34 million cases and 4.68 lakh deaths have been reported so far from India. Few studies have reported death rate as 5.7% among COVID-19 patients with at least one co-existing medical condition, as compared to 0.7% in patients without any comorbidity. Aims and Objectives: We aim to analyze the death audit data of 467 COVID-19 death cases considering factors of age, gender, area of residence, cause of death, related comorbidities, and relation with duration of hospital stay and presence or absence of comorbidity in COVID-19 death cases. Materials and Methods: This is an observational study from April 2020 to July 2021which is based on records obtained from death audit reports of a dedicated COVID-19 facility at a tertiary hospital, Agra, Uttar Pradesh. The state authorities introduced a standard “COVID-19 Death Audit Proforma” on a death audit portal to audit all deaths related from COVID-19 (SARS-CoV-2) infection. Statistical analysis used: The data were recorded in Microsoft Excel and analyzed using statistical software, Microsoft Excel (Version 16.49). The results are presented accordingly in form of descriptive statistics. Results: We have reported findings from 467 COVID-19 deaths from our dedicated COVID-19 facility in the present study. Median age of deceased was found to be 57 years with (71.9%) deaths in males, with predominantly 77.1% of patients residing in urban area. 74% of COVID-19 deaths were reported along with one or more comorbid illness at the time of admission with hypertension to be the most common comorbid disease (42.9%) followed by diabetes (34.5%). Median length of hospital stay is reported as 4 days. Conclusion: Our analysis from Uttar Pradesh dedicated COVID-19 facility found that comorbidities were present invariably in 74% of deaths from SAR-CoV-2 infection. Early diagnosis and timely aggressive management is pillar for reducing morbidity and mortality from COVID-19 disease.

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.

Purpose: To report the intraocular pressure (IOP) and visual outcomes in patients operated for phacomorphic glaucoma in a developing country Methods: Patients undergone surgery for phacomorphic glaucoma between January 2015 and February 2018 with a minimum follow-up of 6 months were reviewed. Multinomial logistic regression was used to predict final visual acuity with different preoperative variables. A Kaplan-Meier analysis was done to calculate survival probabilities at different time points. Results: Presenting IOP of study eye was 38.3±13.4 mmHg with 97.91% (n=94/96) patients on AGMs (mean: 2.7±1.08). Mean duration of complaints was 7.7±6.3 days. The most common postoperative complication was severe anterior chamber inflammation with or without fibrin membrane (in 29.16% eyes). The mean follow-up period was 14.5±9.2 months. At the last visit, the CDVA was 20/30 or better in 54/96 (56.25%) eyes, the mean IOP was 13.6±2.6 mmHg and 30 (31.25%) eyes required additional AGM with the mean number being 1.5±0.6. Two eyes required trabeculectomies for IOP control. The mean survival time of complete and qualified success was 28.5±1.9 and 41.2±0.05 months respectively. The probability of complete and qualified success at month 42 was 11% and 98%. Duration of complains and VCDR were found to be associated with final visual acuity. Conclusions: There was a positive correlation between shorter duration of symptoms with post-operative visual gain, but the glaucomatous damage showed a plateau effect at the IOP of around 35 mmHg. It is not the level of IOP, rather its duration which determines the degree of visual loss.

Introduction: Obesity is considered to be a risk factor for a variety of cardiovascular conditions. Various markers for obesity are used to evaluate effect of obesity on cardiovascular autonomic activity. In light of conflicting reports on effect of obesity on heart rate variability (HRV), use of obesity indices, and the effect of physical activity on HRV, we evaluated autonomic activity in young Indian obese adults using revised Indian and World Health Organization (WHO) body mass index (BMI) guidelines for obesity, waist circumference (WC), and waist–hip ratio (WHR) taking into consideration the level of physical activity. Methods: The study was conducted on 91 young healthy adults. Height, weight, waist, and hip circumference were recorded to determine BMI and WHR. Five-minute electrocardiogram (ECG) was recorded for assessment of HRV. Physical activity was assessed by the WHO Global Physical Activity Questionnaire (GPAQ). Results: Waist circumference showed a negative correlation with the time domain parameters of HRV and high frequency normalized units (HFnu) while a positive correlation with low frequency normalized units (LFnu). In multiple linear regression analysis, time domain indices, HFnu and total power decreased while LFnu increased with an increase in WC. The result was supported by the similar effect of waist–hip ratio categories on HRV in analysis of covariance (ANCOVA). Physical activity had no effect on HRV. Conclusion: Central obesity parameters are better predictors of effect of obesity on HRV independent of the effect of physical activity.

Objectives: The value of the “trace” result in Xpert Ultra for diagnosing active tuberculosis (TB) remains unclear. Our study evaluated the diagnostic accuracy of Xpert MTB/RIF Ultra (Xpert Ultra) (Cepheid, Sunnyvale, USA) over Xpert MTB/RIF (Xpert) (Cepheid, Sunnyvale, USA) and mycobacterial culture when compared with a composite reference standard (CRS).Methods: A retrospective single-center observational study was conducted in a tertiary care hospital in South India. Over three months, patients (aged ≥15 years) data on Xpert Ultra tests and mycobacterial culture of pulmonary and extrapulmonary samples were extracted from their electronic medical records. Patients were defined as TB cases based on the CRS criteria. Sensitivity, specificity, positive and negative predictive values of diagnostic tests were calculated by comparing them to the CRS.Results: Xpert Ultra was more sensitive (87.8%) than Xpert (72.1%) and culture (44.1%). The specificity of Xpert Ultra was lower (98.1%) than those of Xpert (100%) and culture (100%). The sensitivity (92%) and specificity (100%) of Xpert Ultra were highest when performed on pus samples.Conclusions: Xpert Ultra with the trace category is superior to the conventional Xpert, and mycobacterial culture in identifying TB.

Abstract Lung epithelial lining fluid (ELF) harbors a variety of proteins that influence homeostatic and stress responses in the airspaces. Exosomes, nano-sized extracellular vesicles, contain many proteins that vary in abundance and composition based on the prevailing conditions. Ozone causes inflammatory responses in the airspaces of experimental animals and humans. However, the exosomal protein signatures contained within the ELF from ozone-exposed lung airspaces remain poorly characterized. To explore this, we hypothesized that ozone triggers the release of exosome-bound inflammatory proteins from various cells that reflect mucoobstructive lung disease. Accordingly, we repetitively exposed adult male and female C57BL/6 mice to HEPA-filtered air (air) or 0.8 ppm ozone (4 h per day) for 14 days (five consecutive days of exposure, 2 days of rest, five consecutive days of exposure, 2 days of rest, four consecutive days of exposure). Exosome-bound proteomic signatures, as well as the levels of soluble inflammatory mediators in the bronchoalveolar lavage fluid (BALF), were determined 12–16 h after the last exposure. Principal component analyses of the exosome-bound proteome revealed a clear distinction between air-exposed and ozone-exposed mice, as well as between ozone-exposed males and ozone-exposed females. In addition to 575 proteins that were enriched in both sexes upon ozone exposure, 243 and 326 proteins were enriched uniquely in ozone-exposed males and females, respectively. Ingenuity pathway analyses on enriched proteins between ozone- and air-exposed mice revealed enrichment of pro-inflammatory pathways. More specifically, macrophage activation-related proteins were enriched in exosomes from ozone-exposed mice. Cytokine analyses on the BALF revealed elevated levels of G-CSF, KC, IP-10, IL-6, and IL-5 in ozone-exposed mice. Finally, the histopathological assessment revealed significantly enhanced intracellular localization of mucoinflammatory proteins including MUC5B and FIZZ1 in ozone-exposed mice in a cell-specific manner indicating the cellular sources of the proteins that are ferried in the exosomes upon ozone-induced lung injury. Collectively, this study identified exosomal, secretory, and cell-specific proteins and biological pathways following repetitive exposure of mice to ozone.

Script recognition is the first necessary preliminary step for text recognition. In the deep learning era, for this task two essential requirements are the availability of a large labeled dataset for training and computational resources to train models. But if we have limitations on these requirements then we need to think of alternative methods. This provides an impetus to explore the field of transfer learning, in which the previously trained model knowledge established in the benchmark dataset can be reused in another smaller dataset for another task, thus saving computational power as it requires to train only less number of parameters from the total parameters in the model. Here we study two pre-trained models and fine-tune them for script classification tasks. Firstly, the VGG-16 pre-trained model is fine-tuned for publically available CVSI-15 and MLe2e datasets for script recognition. Secondly, a well-performed model on Devanagari handwritten characters dataset has been adopted and fine-tuned for the Kaggle Devanagari numeral dataset for numeral recognition. The performance of proposed fine-tune models is related to the nature of the target dataset as similar or dissimilar from the original dataset and it has been analyzed with widely used optimizers.

BackgroundThe use of telemedicine has increased dramatically through the COVID-19 pandemic. Although data are available about patient satisfaction with telemedicine, little is known about immigrant patients’ experience. ObjectiveWe sought to investigate patients’ experiences with telehealth compared to in- person visits between immigrants and nonimmigrants. We wanted to identify and describe next visit preferences within the Farmington University of Connecticut Internal Medicine practice to ultimately guide suggestions for more equitable use and accessibility of visit options. MethodsA total of 270 patients including 122 immigrants and 148 nonimmigrants were seen by 4 Internal Medicine providers in an in-person (n=132) or telemedicine (n=138) university practice setting. Patients were queried between February and April 2021, using an adaptation of a previously validated patient satisfaction survey that contained standard questions developed by the Consumer Assessment of Healthcare Providers and Systems Program. Patients seen via in-person visits completed a paper copy of the survey. The same survey was administered by a follow-up phone call for telemedicine visits. Patients surveyed spoke English, Spanish, or Arabic and were surveyed in their preferred language. For televisits, the same survey was read to the patient by a certified translator. The survey consisted of 10 questions on a Likert scale of 1-5. Of them, 9 questions assessed patient satisfaction under the categories of access to care, interpersonal interaction, and quality of care. An additional question asked patients to describe and explain the reasons behind next visit preferences. Survey question responses were compared by paired t tests. ResultsAcross both immigrant and nonimmigrant patient populations, satisfaction with perceived quality of care was high, regardless of visit type (P=.80, P=.60 for televisits and P=.76, P=.37 for in-person visits). During televisits, immigrants were more likely to feel providers spent sufficient time with them (P

Osteoporosis is a bone disease characterized by structural deterioration and low bone mass, leading to fractures and significant health complications. In this review, we summarize the mechanisms by which B-lymphocytes and neutrophils contribute to the development of osteoporosis and potential therapeutics targeting these immune mediators to reduce the proinflammatory milieu. B-lymphocytes—typically appreciated for their canonical role in adaptive, humoral immunity—have emerged as critical regulators of bone remodeling. B-lymphocytes communicate with osteoclasts and osteoblasts through various cytokines, including IL-7, RANK, and OPG. In inflammatory conditions, B-lymphocytes promote osteoclast activation and differentiation. However, B-lymphocytes also possess immunomodulatory properties, with regulatory B-lymphocytes (Bregs) secreting TGF-β1 to restrain pathogenic osteoclastogenesis. Neutrophils, the body’s most prevalent leukocyte, also contribute to the proinflammatory environment that leads to osteoporotic bone remodeling. In aged individuals, neutrophils display reduced chemotaxis, phagocytosis, and apoptosis. Understanding the delicate interplay between B-lymphocytes and neutrophils in the context of impaired bone metabolism is crucial for targeted therapies for osteoporosis.

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.

Purpose: The aim of this study was to evaluate the diagnostic ability of optic nerve head (ONH), RNFL, and GC-IPL parameters in differentiating eyes with PPG from normals. Methods: This was a retrospective, cross-sectional, observational study. We studied 73 eyes of 41 patients and compared them to 65 eyes of 34 normal persons. Each patient underwent detailed ocular examination, standard automated perimetry, GC-IPL, ONH, and RNFL analysis. PPG was defined as eyes with normal visual field results and one or more localized RNFL defects that were associated with a glaucomatous disc appearance (e.g., notching or thinning of neuroretinal rim) and IOP more than 21 mm Hg. Diagnostic abilities of GC-IPL, ONH, and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity and specificity, and likelihood ratios (LRs). Results: All GC-IPL parameters differed significantly from normal. The ONH, RNFL, and GC-IPL parameters with best area under curves (AUCs) to differentiate PPG were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.79), and inferotemporal quadrant GC-IPL thickness (0.73), respectively. Similarly, best LRs were found for clock hour 5, 6, and 12 thicknesses among RNFL; inferior sector and inferotemporal sector thicknesses among GC-IPL parameters. Conclusion: Diagnostic abilities of GC-IPL parameters were comparable to RNFL parameters in differentiating PPG patients from normals. The likelihood of ruling in a disease was greater with GC-IPL parameters.

Purpose: The aim of this study was to evaluate the application and safety of three-dimensional (3D) visualization system in varied anterior segment procedures and Scleral Buckle. Methods: This was a prospective observational study of 313 eyes. Patients undergoing phacoemulsification (PE) with intraocular lens (IOL), trabeculectomies, glaucoma triple procedure (GTP), scleral fixated (SF) IOL, and scleral buckle (SB) were included in the study. Cases were randomly distributed in 3D visualization system (learning and post-learning phase) and conventional microscope group. Parameters studied were complications (intraoperative and early postoperative), surgical outcomes, and surgeon's perspective on various parameters (through a validated questionnaire) like surgical time, time lag, learning curve, ease of doing various steps and its value as an educational tool, for both groups [Questionnaires 1 and 2]. Results: Complications rates were not different in two groups. Surgical outcomes (anatomical and physiological) were similar in both the groups. Mean duration of surgery in PE+IOL, Trabeculectomy, GTP in learning stage by 3D was significantly higher than Microscope, which became insignificant in postlearning stage. For, SB and SFIOL, duration between two groups were insignificantly different. There was significant learning struggle in PE+IOL, SB, and Trabeculectomy. Image resolution, depth perception, illumination and postural comfort was graded higher for 3D surgery across the stages. Time lag, poor color contrast, and field of view were appreciated during the learning stage. Educational relevance of 3D was higher, as appreciated by resident and nurses. Conclusion: 3D surgery is as safe, faster, and predictable after initial learning struggle. Even in anterior segment procedure, no apparent lag was appreciated after learning curve.

BACKGROUND: Mixed phenotype acute leukemias (MPALs) are a heterogeneous group of rare leukemias, with an incidence of 2%–5% of all acute leukemias and varied clinical, cytogenetic, immunophenotypic, and molecular genetic features. They have been reported to have a poor prognosis, early relapse, and increased incidence of extramedullary infiltration. MATERIALS AND METHODS: Retrospective analysis of all the acute leukemias (ALs) diagnosed in the department of pathology over the period of August 2017 to December 2019 was done. MPAL cases were identified in accordance with the World Health Organization (WHO) 2016 guidelines and European Group for the Immunological Classification of Leukemias Criterion. Beckman and Coulter FC500 flow cytometer was used using AL panel with CD3, cyCD3, CD5, CD1a, CD2, CD4, CD8, and CD7 as the markers for T-cell lymphoid lineage, along with CD19, CD 79a, CD22, and CD20 for B-cell lineage and CD13, CD33, CD 14, CD64, and myeloperoxidase for myeloid lineage/monocytic lineage. Molecular analysis was also done. RESULTS: Of the 153 cases newly diagnosed cases of AL during this period, 6 fulfilled the European group for immunological characterization of acute leukemia/WHO criteria for MPAL (3.9%). The age ranged from 3 to 13 years with male-to-female ratio of 1:1. Four out of the six cases (66.6%) were assigned B-lymphoid/myeloid type and two (33.3%) were assigned B/T lymphoid. Cytogenetics was available in four out of six cases, among which three had a normal karyotype and one had Breakpoint Cluster Region- Abelson Murine Leukemia 1 (Philadelphia chromosome) (BCR-ABL) translocation (t [9;22] [q34; q11]). CONCLUSION: Distinction at the outset is of paramount importance and the role of morphology, flow cytometry compounded with cytogenetic/molecular studies cannot be denied.

Background: Foreign bodies in ENT are common occurrence. The present research was conducted to study clinicoepidemiological pattern of 117 cases of foreign bodies in ear, nose & throat presented to the S.S. Medical college & G.M. Hospital, Rewa. Materials & methods: The present study was a case series of 117 patients of foreign bodies in ear, nose & throat who presented to the S.S. Medical college & G.M. Hospital, Rewa from January 2014 to August 2014. Results: Among 117 patients 58.12 % were males with age ranging from 14 months to 75 years. Most patients 82 (70.09 %) belong to

A patient with a history of heart block and longstanding chloroquine use presented in cardiogenic shock refractory to medical therapy and mechanical circulatory support. Autopsy supported antimalarial-induced cardiomyopathy (AMIC). Progression of AMIC may be halted with early recognition and cessation of antimalarial therapy, highlighting importance of screening and timely diagnosis. (Level of Difficulty: Beginner.)

The handwriting style of every writer consists of variations, skewness and slanting nature and therefore, it is a stimulating task to recognise these handwritten documents. This article presents a study on various methods available in literature for Devanagari handwritten character recognition and performs its implementation using Convolutional neural network (CNN). Available methods are studied on different parameters and a tabular comparison is also presented which concludes superiority of CNN model in character recognition task. The proposed CNN model results in well acceptable accuracy using dropout and stochastic gradient descent (SGD) optimizer.

Introduction: Beta Thalassemia Trait (BTT) is the most common haemoglobinopathy worldwide. High Performance Liquid Chromatography (HPLC) is the technique of choice for diagnosis. However, it is expensive and there is a need to triage patients for HPLC in resource limited nations. Various discriminator indices are used for the same purpose. Aim: To compare the utility of 11 different discriminator indices for differentiating between Iron Deficiency Anaemia (IDA) and BTT. Materials and Methods: The present study was a retrospective observational study done at Maulana Azad Medical College, Delhi, India over a period of one year (January 2017-January 2018). A total of 510 cases with clinically suspected haemoglobinopathy or with microcytic hypochromic anaemia along with relative erythrocytosis were analysed. After noting clinical details, data regarding haemogram findings, iron parameters and serum vitamin B12 and folate levels were collected. An Haemoglobin A2 (HbA2) value of 3.8-8% was used for confirming diagnosis of BTT. Eleven discriminator indices prediciting BTT were calculated and their utility was assessed by calculating the sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Youden’s index. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 16 software. Results: Out of total 510 cases, 149 (29.2%) were confirmed as BTT. Green and King index had the maximum sensitivity (67.1%) and Shine-Lal index had maximum specificity (91.1%) for diagnosing BTT. Green and King index also had the best Youden’s index (43.9%). Conclusion: Cell counter based formulas are cheaper, easy to calculate and reliable tools for screening BTT suspected cases which can be further confirmed by more specific tests like HPLC and electrophoresis. The authors found Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC) and Red Blood Cell (RBC) count as the most useful for selecting patients for more specific tests. The Green and King index was found to be most reliable for predicting BTT in the present study

Afebrile Plasmodium vivax disease is believed to be extremely rare; and so is the association of a secondary immune thrombocytopenia due to Plasmodiun vivax malaria. This is a case of malaria presenting in an atypical manner. A middle aged male (31 years) came with occasional bleeding around gums, small petechial haemorrhages over chest and abdomen, and blood in stools for a few months, but no fever. In addition, the cervical lymph nodes were slightly enlarged. Spleen was 3 cm below costal margin. Platelets were found to have markedly decreased with clusters of megakaryocytes in the bone marrow. A possibility of Immune thrombocytopenic purpura was considered and immunoglobulin started intravenously, however platelet counts remained low. Later, in a follow up smear, trophozoites of P. vivax were discovered. Antimalarial drugs (Artesunate) were administrated for the patient along with IV immunoglobulins, to which he responded. It was revealed by flow cytometry that the ratio of helper to cytotoxic cells was reversed (0.9). This highlighted a rare case of afebrile malaria in association with immune dysregulation. Accordingly, malaria, though uncommon, could trigger immune thrombocytopenia.

Health research plays an integral part in scientific and academic innovation in health care. India, a rapidly developing country, showed a tremendous increase in the number of health research projects and publications in recent years. Given the broad spectrum of health research areas and a vast number of funding agencies that fund specific areas, it is difficult to gain knowledge about them from a single source. Hence, we scanned the various funding opportunities which exist in India for healthcare research. Various agencies fund health-care research on their thrust areas of national importance. Choosing the funding agency depending on the area of interest and following the guidelines given by them ensures a successful proposal for funding. This article enlists various funding agencies and gives overall information about the nature of support and fund provided for health research in India.

The principal causative agent of acute bacterial meningitis (ABM) in children and the elderly is Streptococcus pneumoniae, with a widespread increase in penicillin resistance. Resistance is due to non-synonymous single-nucleotide polymorphisms (nsSNPs) that alter the penicillin-binding proteins (PBPs), the targets for all β-lactam drugs. Hence, resistance against one β-lactam antibiotic may positively select another. Since meropenem is an alternative to cefotaxime in meningeal infections, we aim to identify whether nsSNPs in the PBPs causing penicillin and cefotaxime resistance can decrease the pneumococcal susceptibility to meropenem. Comparison of the nsSNPs in the PBPs between the cefotaxime-resistant Indian (n = 33) and global isolates (n = 28) revealed that nsSNPs in PBP1A alone elevated meropenem minimal inhibitory concentrations (MICs) to 0.12 μg/ml, and nsSNPs in both PBP2X and 2B combined with PBP1A increases MIC to ≥ 0.25 μg/ml. Molecular docking confirmed the decrease in the PBP drug binding affinity due to the nsSNPs, thereby increasing the inhibition potential and the MIC values, leading to resistance. Structural dynamics and thermodynamic stability pattern in PBPs as a result of mutations further depicted that the accumulation of certain nsSNPs in the functional domains reduced the drug affinity without majorly affecting the overall stability of the proteins. Restricting meropenem usage and promoting combination therapy with antibiotics having non-PBPs as targets to treat cefotaxime non-susceptible S. pneumoniae meningitis can prevent the selection of β-lactam resistance.

Objective To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.Design Retrospective analysis using data extracted from the National Neonatal Research Database.Setting All National Health Service neonatal units in England.Patients Infants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measures Proportion of infants who received iNO; age at initiation and duration of iNO use.Results 4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born 34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: 34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation:

We describe a case of 63-year-old woman, with primary open-angle glaucoma (POAG) who presented to us in the COVID era with uncontrolled intraocular pressure (IOP) on maximum medical therapy (MMT) in the right eye (OD), previously operated twice for trabeculectomy in (OD), and once in left eye (OS). A modified graft-free surgical technique of inserting the Ahmed Glaucoma valve (AGV) tube through a scleral sleeve was employed. Visual acuity and IOP remained stable during 6-month follow-up period.

Background: Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis which can cause multifocal aneurysms of visceral arteries, which may rupture causing haemorrhage, thrombosis, organ ischemia and infarction While the treatment of vasculitis requires long term use of immunosuppressive drugs, these patients are more prone for diseases like tuberculosis due to decreased cell mediated immunity. Case presentation: Hepatic involvement in PAN is not common and many of the findings are occult. A 40 year old lady, a known case of polyarteritis nodosa on treatment with steroid and immuno-suppressants for the last 18 years, with history of multiple episodes of relapse of the vasculitis, and cyclophosphamide induced ovarian failure on hormone replacement therapy was diagnosed to be having sputum positive tuberculosis. She was initiated on anti-tuberculosis treatment. Vasculitis was on remission for the last 12 months. So Mycophenolate Mofetil was stopped as per the advice of the Rheumatologist. 14 days later she developed abdominal pain with dropping hemoglobin. CT angiography showed ruptured liver hematoma with hemoperitoneum and she succumbed to her illness. Conclusion: Spontaneous hepatic hemorrhage, probably due to a ruptured hepatic artery aneurysm is a rare complication which is reported, only a very few times in the literature so far. This case report throws light on the possible detrimental outcomes in stopping immunosuppressive drugs, especially in a patient with multiple episodes of relapse in the past, in the background of an ongoing infection like tuberculosis. Continuation of the immunosuppressive drugs need to be considered against it’s stoppage in high risk patients.