Search

Redoy Ranjan,1 Gie Ken-Dror,1 Pankaj Sharma1,2 On behalf of the BEAST Collaborators1Department of Biological Sciences, Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, Greater London, UK; 2Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UKCorrespondence: Pankaj Sharma, Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, Greater London, TW20 0EX, UK, Email pankaj.sharma@rhul.ac.ukIntroduction: Risk prediction models are commonly performed with logistic regression analysis but are limited by skewed datasets. We utilised neural networks (NNs) model to identify independent predictors of poor outcomes in cerebral venous thrombosis (CVT) due to the limitations of logistic regression (LR) analysis with complex datasets.Methods: We evaluated 1309 adult CVT patients from the prospective BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. The area under the receiver operating characteristic (AUROC) curve confirmed the goodness-of-fit of prediction models. The normalised importance (NI) of the NNs determines the significance of independent predictors.Results: The stepwise logistic regression model found thrombolysis (OR 32.1; 95% CI 3.6– 287.0; P=0.002), craniotomy (OR 6.9; 95% CI 1.3– 36.8; P=0.02), and cerebral haemorrhage (OR 4.5; 95% CI 1.3– 15.4; P=0.01) as predictors of poor clinical outcome with the AUROC of 0.71. Conversely, the NNs model identified major independent predictors of long-term poor clinical outcomes as cerebral haemorrhage (NI 100%) and thrombolysis (NI 98%), as well as trivial predictors of age (NI 2.8%) and altered mental status (NI 3.5%). The accuracy of the NNs model was 95.1% and 94.1% for self-learned randomly selected training and testing samples with an AUROC of 0.82. Positive and negative predictive values for poor outcomes were 13.2% and 97.1% for the LR model, compared with the NNs model of 18.8% and 98.7%, respectively.Conclusion: Cerebral haemorrhage and thrombolysis was a strong independent predictor, whereas age merely impacts the long-term poor clinical outcome in adult CVT. Integrating unorthodox neural networks risk prediction model can improve decision-making as it outperforms conventional logistic regression with complex datasets.Keywords: cerebral venous thrombosis, neural network, stroke, predictors, outcome

Redoy Ranjan,1 Md Kamrul Hasan,2 Asit Baran Adhikary1,3 1Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 2Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh; 3Department of Cardiac Surgery, Impulse Hospital & Research Centre, Dhaka, BangladeshCorrespondence: Redoy Ranjan, International Journal of General Medicine, Department of Cardiac Surgery, Bangabandhu Sheikh Mujib medical University, Dhaka, 1000, Bangladesh, Email redoy_ranjan@bsmmu.edu.bdBackground: Genetic factors contribute significantly to the risk of ischaemic heart disease (IHD), which is the leading cause of mortality in Bangladesh. The BANGABANDHU (Bangladeshi Atherosclerosis Biobank AND Hub) study will allow a hypothesis-free genome-wide association study (GWAS) to identify genetic risk factors associated with ischaemic heart disease patients undergoing coronary artery bypass graft (CABG) surgery in Bangladesh.Methods: This is a multi-centre population-based case–control study aimed to evaluate 1500 (Fifteen Hundred) adult (≥ 18 years of age) people divided into 2 study groups: Case/Proband (750 IHD patients undergoing CABG surgery) and Control (750 healthy people). Spouses or family members are preferred as healthy control subjects due to their shared geographic location and similar environmental exposure.Results: This will be the first largest DNA repository of CABG patients in Bangladesh, and identifying novel gene loci among CABG patients might help to discover novel therapeutic targets for Bangladeshi IHD patients. Further, identifying and comparing novel gene loci among CABG patients with other ancestry might help devise national guidelines for treating coronary artery disease.Conclusion: Promising current study results will encourage Bangladeshi researchers and pharmaceutical companies to conduct further studies into the genetic basis of Bangladeshi complex coronary artery disease, which might identify novel genes for therapeutic targets for Bangladeshi patients and strengthen the healthcare standards in Bangladesh.Keywords: Bangabandhu, Bangladesh, biobank, IHD, CABG

Aziz Momin,1 Redoy Ranjan,1,2 Oswaldo Valencia,1 Adam Jacques,3 Pitt Lim,4 David Fluck,3 Tuan P Chua,5 Venkatachalam Chandrasekaran1 1Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK; 2Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 3Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK; 4Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; 5Department of Cardiology, Royal Surrey NHS Foundation Trust, London, UKCorrespondence: Aziz Momin, Consultant Cardiac Surgeon, St George’s University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom, Tel +447956336739, Email aziz.momin@stgeorges.nhs.ukObjective: This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort.Methods: A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups- Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery.Results: The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups- (95% CI 18.33– 19.94), (95% CI 18.14– 19.06), (95% CI 15.40– 16.32), and (95% CI 9.61– 12.38) in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤ 0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting.Conclusion: In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.Keywords: coronary artery bypass graft, CABG, bilateral internal mammary artery, total arterial CABG, long term outcome, multiple arterial graft, mortality, survival benefits

Byline: Richa. Kumar, Manas. Chatterjee, R. Ranjan Sir, A 42-year-old male, resident of Ajmer district, Rajasthan, and armed forces personnel by occupation presented with complaints of swelling and pain over [...]

Redoy Ranjan,1,2 Dipannita Adhikary,2 Debasish Das,3 Asit Baran Adhikary1 1Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 2Department of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK; 3Department of Thoracic Surgery, Dhaka Medical College & Hospital, Dhaka, BangladeshCorrespondence: Redoy Ranjan, Department of cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, 1000, Bangladesh, Tel +8801717556046, Email redoy_ranjan@bsmmu.edu.bdPurpose: This study aimed to evaluate the prevalence of carotid stenosis among ischaemic heart disease (IHD) patients undergoing coronary artery bypass graft (CABG) surgery and identify risk factors associated with carotid stenosis at a tertiary-level hospital in Bangladesh.Patients and Methods: This cross-sectional study examined 200 IHD patients scheduled for isolated and elective CABG surgery, and multivariate regression analysis was used to determine the impact of independent variables on carotid stenosis with coronary artery disease. A vascular surgeon and sonographer assessed carotid stenosis, and the severity of stenosis was classified according to the current Grayscale and Doppler US diagnosis models.Results: We observed that the prevalence of carotid artery stenosis was 13.5%, and the male was significantly higher (85.2%) in the carotid stenosis group. A multivariate regression analysis observed that age (OR 1.79), dyslipidaemia (OR 2.19), uncontrolled hypertension (OR 2.38), uncontrolled DM (OR 2.51), multivessel coronary artery disease (OR 3.79), and multiple comorbidities (OR 4.46) are potential predictors of having significant carotid stenosis in a patient undergoing CABG surgery.Conclusion: In Bangladesh, multivessel coronary artery disease, especially in elderly patients with multiple comorbidities, are 4 (four) times higher risk to have significant carotid artery stenosis. Preoperative carotid duplex screening should be performed to curtail the risk of postoperative adverse cerebrovascular events, particularly those who have carotid stenosis associated potential risk factors.Keywords: prevalence, carotid stenosis, coronary artery disease, ischaemic heart disease

Niroj Kumar Sahoo,1 Richa Ranjan,2 Mudit Tyagi,3 Hitesh Agrawal,3 Subhakar Reddy3 1Department of Retina and Vitreous, L V Prasad Eye Institute, Vijayawada, India; 2Bharti Eye Foundation and Hospital, New Delhi, India; 3Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, IndiaCorrespondence: Mudit TyagiSmt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, 34, IndiaTel +91-9553339042Email drmudittyagi@gmail.comAbstract: A gradual shift in trend from primary enucleation to globe salvaging radiation therapy for the management of ocular tumors has resulted in the rise of several post-treatment ocular complications including radiation retinopathy. Radiation retinopathy is a chronic, progressive, and occlusive vasculopathy that can manifest anytime between 1 month to 15 years after starting radiation therapy. The aim of treatment in most of these cases is to prevent further vision loss. Treatment options such as laser photocoagulation, anti-vascular endothelial growth factor and intraviral steroids have been described. However, despite several advances in diagnostic and therapeutic modalities, a significant proportion of eyes with radiation retinopathy eventually go blind. This review summarises some of the clinical features, investigative modalities, and recent therapeutic strategies used in the management of radiation retinopathy.Keywords: radiation retinopathy, radiation maculopathy, anti-VEGFs, laser photocoagulation, ocular tumors

Background: The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error‐prone lesion counts. This proof‐of‐concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images. Methods: 777 ambient‐light and size‐controlled images were used to build a class‐balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0–3), and to assess disease‐dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U‐NET algorithm was implemented for automated localization of diseased skin. Results: CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84–0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42. Limitations: Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I. Conclusion: CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy‐to‐use HS severity assessments using clinical images. [ABSTRACT FROM AUTHOR]

The present study addresses an exponentially fitted finite difference method to obtain the solution of singularly perturbed two-point boundary value problems (BVPs) having a boundary layer at one end (left or right) point on uniform mesh. A fitting factor is introduced in the derived scheme using the theory of singular perturbations. Thomas algorithm is employed to solve the resulting tri-diagonal system of equations. The convergence of the presented method is investigated. Several model example problems are solved using the proposed method. The results are presented with terms of maximum absolute errors, which demonstrate the accuracy and efficiency of the method. It is observed that the proposed method is capable of producing highly accurate results with minimal computational effort for a fixed value of step size h, when the perturbation parameter tends to zero. From the graphs, we also observed that a numerical solution approximates the exact solution very well in the boundary layers for smaller value of ε. [ABSTRACT FROM AUTHOR]

Manganese-doped cadmium sulphide semiconductor nanoparticles (CdS: Mn) NPs have been created utilizing a microwave-assisted solvothermal technique at different Mn concentrations (0, 1%, 3%, and 5%). The chemicals utilized for the preparation of Mndoped CdS nanoparticles were sodium sulphide (Na2S.xH2O), manganese chloride (MnCl2.4H2O), and cadmium acetate (CH3COO)2Cd., H2O). To determine the structural dimensions of the generated nanoparticles, the Debye-Scherer equation was used to calculate the average crystallite size at the full-width half maximum (FWHM) of the diffraction peaks. FTIR spectra analysis was used to look at the various functional and vibrational groups present in the Mn-doped CdS nanoparticle sample. The structure features of the produced nanoparticles have been examined using X-ray diffraction patterns. Energy dispersive X-rays were employed to ascertain the chemical composition of the synthesized nanoparticles. The optical properties and quantification of the energy band gap of the nanoparticles have been done using UV-V spectroscopy. According to XRD calculations, the cubic zinc-blend structure of the generated NPs had a crystal size of between 4 and 7 nm. By using EDX spectroscopy, the incorporation of Mn at the CdS lattice was confirmed. [ABSTRACT FROM AUTHOR]

Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee. Arthroscopic ACL reconstruction is the gold standard procedure for treating ACL tears. Good postoperative analgesia is the secret for immediate postoperative rehabilitation. Various techniques, such as Femoral Nerve Blocks (FNB), epidural blocks, adductor canal blocks, and Intra-Articular injections (IA), are used to manage postoperative pain. Aim: To compare the quality of postoperative analgesia using a combination of levobupivacaine with clonidine via IA and FNB in patients undergoing ACL reconstruction under spinal anaesthesia. Materials and Methods: This randomised, double-blinded trial was conducted at Pondicherry Institute of Medical Sciences, Puducherry, India, from August 2016 to May 2018. Forty patients with American Society of Anaesthesiologists (ASA) physical status I and II, aged between 18-60 years, undergoing arthroscopic ACL repair under spinal anaesthesia were randomly assigned to two groups, with 20 patients in each group. After the surgery, patients in group 1 received FNB with 15 mL of 0.25% levobupivacaine and 30 mcg clonidine, while patients in group 2 received IA with 15 mL of 0.25% levobupivacaine and 30 mcg clonidine. Parameters such as the total duration of sensory block, the need for rescue analgesia, and total analgesic consumption within 24 hours were recorded postoperatively. The data were analysed using Student’s unpaired t-test, Analysis of Variance (ANOVA), Chi-square test, and Fisher’s-exact test. Statistical analysis was performed using Statistical package for the Social Science (SPSS) software (version 20.0 and info version 3.5.1) for Windows, with a p-value <0.05 considered significant. Results: The quality of postoperative analgesia, including the total duration of block, the need for rescue analgesia, and total analgesic consumption within 24 hours, was similar in both groups. The total duration of block was 216±36.041 minutes for the FNB group and 224±47.395 minutes for the intra-articular group, with a p-value of 0.552. The time for rescue analgesia was 307±87.666 minutes for the FNB group and 305±82.00 minutes for the intra-articular group, with a p-value of 0.963. There were no significant differences between the groups in terms of sex, age, weight, or ASA physical status classification. Conclusion: The present study showed that the postoperative analgesia following arthroscopic ACL reconstruction was equally effective in both groups. Both combinations reduced postoperative pain, expedited the return of postoperative function, maintained vital parameters, and had no apparent side-effects. However, IA may be considered as the preferred option since it is easier to perform than a femoral block. [ABSTRACT FROM AUTHOR]

Insulin like growth factor-1 (IGF-I) has an antioxidant effect to maintain sperm motility. The present study designed to evaluate the effect of different levels IGF-1 on semen characteristic after cryopreservation of buck semen. Fifty ejaculates were collected and were extended with tris-citric acid-fructose diluent with 10% egg yolk and 6% glycerol with sperm concentrations of 4 × 108 mL-1. The effect of IGF-1 concentration showed significant differences (P<0.05) on most of studied traits (sperm motility, live sperm count, acrosomes integrity, hypo osmotic swelling positive spermatozoa, malondialdehyde (MDA)) and were significantly (P<0.05) highest in 250 ng/mL of IGF-1in post thaw semen. The post thaw progressive motility, live, hypo osmotic swelled and acrosome intact sperm increased by 25.26%, 26.77%, 30.35% and 25.52%, respectively in 250 ng/mL IGF1supplemented group in compare with control group. The 250 ng/mL IGF-1 supplemented group showed the lowest MDA content (P<0.05) in compare with other studied groups. The fortification 250 ng/mL IGF-1 reduced the MDA content by 31.16% more than the control group. The results suggested that IGF-1 protects sperm membrane lipid peroxidation by lowering MDA production by reducing the harmful effect of reactive oxygen species. Eight out of ten goats were conceived and kidded by using supplemented of 250 ng/mL IGF-1 and three goats were kidded by non-supplemented (control) frozen semen straw through artificial insemination (AI). The success of kidding was 40.00% in supplemented group (250 ng/mL IGF-1) than 30.00% in non-supplemented group (control) on actual kidding basis. [ABSTRACT FROM AUTHOR]

Photocatalytic degradation of methyl red dye using Mn(5%) doped CdS nanoparticles was studied. Mn doped CdS nanoparticles was synthesized by microwave assisted solvo thermal method where the chemicals used wereCadmium Acetate [(CH3COO)2Cd, H2O], Manganese Chloride [MnCl2.2H2O] and Sodium Sulfide [Na2S.xH2O]. X-Ray diffraction(XRD) analysis was carried out in order to analyze the structural dimensions of the synthesized nanoparticles and the average crystallite size has been calculated at the full width half maximum (FWHM) of the diffraction peaks using Debye-Scherer equation and it was found to be around2.3nm. FTIR spectra analysis was done in order to analyze different functional and vibrational groups present in the as synthesized sample of Mn doped CdSnanoparticles. The morphology of sample wasstudied by scanning electron microscope. The aqueous solution of methyl red[C15H15N3O2] has been prepared and was mixed with the as synthesized Mn doped CdSnanoparticles and was exposed for photocatalytic degradation using 100 W bulb. UV-visible spectra of the light irradiated methyl red solutions were studied at different interval of time and no red shift was observed with increase of exposure time. The intensity of the absorption peak was also found to be reduced with the increasing time interval. The photo degradation of methyl red dye was observed up to 90% at the exposure time of 90 minutes. [ABSTRACT FROM AUTHOR]